Content Warning: this post includes references throughout
to transphobic1 rhetoric, self-harm, and eating disorders.
The Setup
I was freshly vexed by the misbehavior of some Catholic priests last week—far from the worst I’ve seen or heard of, but a timely example of what’s the matter with catechesis in this country.
The topic of trans people came up somehow or other this past week. This predictably brought out remarks about delusion, “mutilation,” and so on. Refreshingly, a clear, no-nonsense corrective was promptly offered by an intelligent laywoman (herein “Ms. Posts”), who accurately applied the doctrine the priests in question claimed to be applying.
The opening salvo was a declaration that Catholics should not have the trans flag in their Twitter bios. Someone asked why not, and a priest charmingly replied, “Sterilizations and mutilations are bad. Hope this helps.”
This is, of course, an allusion to those surgeries which many people still call getting a sex change (now typically called sex reassignment surgery or SRS by medical professionals). Very few trans people consider SRS core to their gender identity; some, whether by choice or due to financial or medical constraints, don’t pursue surgical transition at all. But of course nuance like that wouldn’t be likely to show up in a single tweet, even if it were trying to make an argument in good faith.
Ms. Posts came into the conversation here. She pointed out that, while the Church does teach that medically superfluous amputations are sins against the integrity of the body (e.g., used as a form of torture), surgeries which contribute to the person’s total well-being are completely licit. Calling SRS “mutilation” certainly sounds bad; but why is it “mutilation,” if the same procedure in other circumstances can be permissible?
One or two priests tried to justify it on the grounds the underlying ethics of surgery, a topic that for Catholics is controlled largely by the principle of double effect. A short digression is in order.
The Best Medicine Is Not Being Sick
The aim of medicine is health, which is good, because the body and the life of the body are good. This has the odd result of making a great deal of medicine paradoxical, because many treatments involve doing some sort of harm to the body: emetics make us vomit, antibiotics kill off our gut flora, surgeries literally cut us open! However, the evils involved are morally acceptable if and when they promote the total health of the person. A hysterectomy, the surgical excision of the womb to treat certain forms of cancer, is a standard and licit treatment.
EDIT: I originally wrote “ovarian cancer” in the preceding sentence; one of my readers helpfully pointed out that this was not strictly correct: removing the womb is a distinct procedure from removing one or both ovaries (a surgery called oophorectomy [ō-off-or-EK-tə-mē]). One or two other sentences below that contained or implied the same error have been duly corrected as well. Apologies for this careless error on my part.
What isn’t acceptable is deliberately damaging a healthy body part for the sake of the damage in question. Sterilization is a good example here: its explicit purpose is to render an organ or system of the body unable to fulfill its biological function. It is breaking part of the body, not in order to achieve some greater good for the person as a whole, but in order to have the body be broken—perhaps as a chosen form of birth control (like vasectomies), or as an imposed form of torture, or as a method of eugenics.2
So wait, why are Catholics allowed to get hysterectomies3 to treat cancer? Because the principle is not “the power to have babies must be preserved at all costs.” The life of the body as a whole is a greater good than an intact reproductive system. The principle of double effect is named for situations like these. What the thing the surgeon is doing is removing the cancer, in the only or best way he knows how to, not removing the womb for its own sake. He intends the treatment of the cancer, and accepts the side effects as something beyond his control.
False Parallels
Returning to the social media discussion. One of the “anti-mutilation” group argued that SRS is mutilation because it damages a healthy reproductive system. Ms. Posts countered, quite correctly, that SRS is not just amputation “for its own sake” (which is probably not even a good description of body-modders). On the contrary, medical gender transition is the only medically-recognized method of treating certain kinds and degrees of gender dysphoria,4 and the criterion for morally acceptable surgeries is whether it benefits the person, not whether it benefits the organ. Given the distress of gender dysphoria is a well-documented contributor to depression and self-harm, there’s an excellent case for considering this morally justified!
Here, one priest stepped in with the argument that “People with anorexia should not starve themselves. People with gender dysphoria should not mutilate themselves. These are equal statements.”
Well … the grammar is the same, Father, I’ll give you that. However, there are problems with declaring these two statements “equal.” (I’m assuming what he meant was “equivalent” in logical, and therefore in moral, validity.) To begin with, it’s news to me that Catholics should consider physical sex something as metaphysically trivial as believing you’re too fat. Both the Bible and plain common sense suggest that meeting beauty standards is, while not actually sinful, a thing of no consequence. The Church’s adamant stances about eligibility for marriage and holy orders, on the other hand, imply that sex is important. Indeed, the latter implies that physical sex is spiritually significant (though exactly how or why may remain mysterious).
Unless, of course, he meant his statement the other way around?—i.e., that there is a specific vocation or purpose inherent to being fat or thin. Come to think of it, I’m not in a position to actually disprove this. If that’s what Father meant, I may have to allow the point.
Religionis Medicina
Ms. Posts kept a remarkably cool head through all of this. She contented herself with two other observations.
First, the claim that gender dysphoria is equivalent to anorexia nervosa flies in the face of decades of medical findings about how to treat both conditions. “Validating” the anorexic impulse, and therefore letting the patient starve themselves, does not correlate with any improvements in mental health or quality of life. On the contrary, it correlates with malnutrition and a host of illnesses that that brings in its train, such as anxiety, anemia, rickets, alopecia, scurvy, and being dead syndrome.
The opposite is true, however, about “validating” trans identities and supporting a patient through gender transition. If a patient pursues medical transition (especially but not only SRS), then yes, this does normally result in infertility. But this just makes the contrast with anorexia sharper, because infertility is about the only major drawback of medical transition. The drawbacks of dysphoria itself—depression, stress, anxiety, substance abuse, suicidality—all normally go down with transition. In other words, by “endorsing” the one we get generally worse health for the patient, while by “endorsing” the other we get generally better health. Most people consider do not consider these prognoses “equal.”
Now, the professional consensus about what effectively treats dysphoria does not prove that the treatment is morally good. Ms. Posts was careful to grant this in so many words; sometimes doing the right thing is costly. You could argue that medical transition, while normally effective in relieving gender dysphoria, is nonetheless morally inadmissible for some other reason. Or, that transition can be allowed as a palliative in the most severe cases, but it is better to avoid it if possible.
(Obviously, this sort of thought would never occur to trans people themselves. People who are different from their peers always go for the most extreme solution first, instead of trying to fit in, especially if they commonly figure out how different they are in high school. That’s why trans people go for transition when I, personally, was not expecting it, instead of spending years trying to talk or force or fake their way into just not feeling dysphoric any more. All transes know is twerk, charge they hormone, get SRS, eat hot chip and lie.)
The Disk Horse Carousel
Sarcasm aside, this brings us to the next point Ms. Posts made. If you were going to argue that transition is effective but nonetheless unacceptable for some moral reason, you would need to erect an argument (or at least an explanation) of why. The priests said stuff about the “integral health of the body” and so on, but when they were challenged to explain this, it didn’t seem to mean anything specifiable. The argument was, to all appearances, It’s mutilation when we don’t approve of it.
One interlocutor tried to argue that SRS really doesn’t treat gender dysphoria, because it doesn’t cause the recipient to be at peace with their birth sex. This is true in a sense; it’s also true in the same sense that my eyeglasses don’t treat my bad vision—take them away from me and my eyes are still bad, therefore glasses do not treat bad eyesight. Which obviously means that glasses should be forbidden.
Or rather, even the concession I’ve made in that analogy isn’t correct. Gender dysphoria is the distress caused by the mismatch between self-identity and observable sex characteristics; if something relieves that distress, it is ipso facto a treatment. (It may not be a good or lasting treatment based on this criterion alone: taking a nap counts as treating dysphoria in this sense.)
SRS, and transition more broadly, are treatments of gender dysphoria, because they relieve it significantly for most people. “Fixing the organ” is not always the goal of any given medical procedure. In the hysterectomy example above, the surgeon removes the womb because it contains a malignant tumor: after the surgery, the womb in question is not healed but dead. Again, the ethical rationale is that the body as a whole is now free of cancer, not that the womb is better off. Sacrificing a part for the good of the whole is not an obscure or exceedingly subtle moral principle.
It is also worth reiterating: SRS is only one aspect of gender transition, and it’s not an aspect all trans people pursue, even when they can access it. Some trans people are content with the changes effected by hormone replacement therapy, and there are even some who choose not to pursue that. So in sum, the rhetoric of “mutilation” is not just bad medical ethics: it isn’t even relevant to all the people it’s ostensibly addressing.
Turn, Turn, Turn
I said at the time and wish here to repeat a hearty brava to Ms. Posts. Her eminently correct, clear articulation of Catholic doctrine was refreshing in itself, and the restraint with which she stated it showed, in my opinion, an enviable self-command. Consistency is often sacrificed to political expediency by Catholics (and, to be fair, everybody else); and even when people are operating in good faith, sometimes theology is just hard. She done did a good job.
But what about gender transition? Hasn’t the Vatican been warning us about the perils of gender ideology for years, decades by now? What has become of my much-vaunted ultramontane orthodoxy? On what grounds is a Catholic to evaluate the whole business anyway? And how can I heartlessly disregard the epidemic of rapid-onset gender dysphoria, when it is totally a thing, not at all the sensationalist result of a flimsy and irresponsible excuse for research, and clearly more plausible than the idea a teenager might hide something from their parents, maybe even with good reason?
Sarcasm aside. Transition involves discerning answers to questions that no one should presume to answer on someone else’s behalf. These questions are inherently entangled in the responsibility, and therefore in the freedom, of the human person, as well as in a self-knowledge that only oneself, under God, can be privy to.
The overwhelming majority of Catholics have no skin in the game when it comes to trans issues; this alone would make pontificating on the subject tasteless and contemptible. But what’s worse is, the rhetoric of most Catholics on this topic, including that of the clergy, is culture-war driven—which is to say, driven by politics, and by absolutely nothing else. It’s a series of irresponsible travesties of thought and virtue, such as any adult ought to be ashamed of, let alone adults who have publicly devoted themselves to the service of a God who has promised to bring judgment upon liars.
But in order to address this adequately, this post will need To be continued …
Footnotes
1For anyone already disposed to sneer at this point, I use the word transphobia advisedly. By it, I mean irrational prejudice, superiority, fear, or hatred directed toward trans people, whether or not it is expressed through deliberate cruelty and violence. For the purposes of this piece, I am not even classifying the belief that trans identities are invalid as inherently transphobic (though it obviously can be linked with transphobia). In return, I ask and expect my readers to recognize what a colossal concession that is from the perspective of a trans person. It allows their very existence to be up for debate, in a way that the existence of most readers probably never has been or will be. Regardless of who is in the right, that kind of vulnerability ought to be treated with respect. Refusing to courteously recognize the concession and respond to it with due sensitivity is, in my opinion, childish and cowardly, and I don’t propose to treat that behavior with the least respect.
2For over a hundred years now, thanks to the eugenics movement—which is not extinct—the Catholic Church has been protesting many state-run programs of sterilization of “the unfit.” To eugenicists, “the unfit” mostly means the disabled, racial minorities, and the poor. The United States has been an especially egregious offender; public support for eugenics plummeted after the Holocaust and the civil rights movement, but more than half of US states have laws on the books that allow compulsory sterilization, and new laws to that effect have been passed as recently as 2019. Other states that have run afoul of the Church’s opposition to sterilization include Bangladesh, Canada, China, Germany, Iceland, South Africa, Sweden, and Uzbekistan.
3Or, well, presumably just one hysterectomy per person.
4Gender dysphoria is the current term used in the DSM-5 for the experience of serious distress over a conflict between one’s inner sense of gender identity and one’s observable sex and/or gender. It is one of the principal elements in trans identity for most transgender people.
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