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5 December 2022

Within the field of gender and sexuality studies, the phenomenon of gender dysphoria has recently garnered some attention. Gender dysphoria could be defined as a state of consciousness. At the core of this conscious state is the unique qualitative feel of a discordant “gender identity”. Gender identity is, in turn, defined according to the American Psychological Association as “someone’s internal sense of being a man or a woman”. It is to be differentiated from biological sex and gendered socializations. Gender identity hence presupposes the idea of an “inner” or “real self” which, in the case of gender dysphoria, is of a gender or sex different from what the body indicates. This is why we often hear individuals with gender dysphoria saying “I feel like,” and in stronger cases, “I am a woman trapped in a man’s body” or vice versa.

A theological slant could easily be slipped in at this point to parse the idea of the “inner self” as a theological challenge. That is to ask, “Could God have created my ‘inner self’ as a woman but placed me in the wrong body of a man (and vice versa)?”

Here is where the subject of theological anthropology, especially the question concerning the substance or substances that constitute us as human persons, comes in handy. Are we merely and purely bodies and physical stuff? Or are we a combination of body and an immaterial substance (traditionally known as the soul)? In what follows, I want to briefly explore how the view of the constitution of the human person that we take relates to this idea of the “inner self”, and hence to the conscious state of gender dysphoria.

I begin with the first commonly adopted position in relation to the constitution of the human person: Materialism (or physicalism). Materialism sees that human persons are constituted as entirely and purely physical entities, that is, we are comprised of no additional non-physical or immaterial substances. Consequently, materialists affirm that there is nothing required for having conscious mental states and properties such as beliefs, desires, intentions, feelings etc. other than the occurrence of various types of biophysical and neural states and processes in the individual’s brain and body.

Based on the above account, the most generous position materialism can allow for is the presence of mental states and properties—even an entire mental entity that constitutes the “inner self”—to emerge when physical elements are organized in the right sorts of ways in properly-functioning neurophysiological structures. This is an “inner self” that is strictly constituted solely by the body and its constituent parts, rather than formed as or constituted by a whole new distinct immaterial substance altogether.

So, materialism as a framework for understanding the constitution of the human person is able to account for the “inner self” crucial to the conscious state of gender dysphoria. But because of their basic commitment to the pure material composition of human persons, materialists can only appeal to biophysical approaches, especially those involving neurology, in explaining any causation between biophysical states and gender dysphoria.
This brings us to an explanation of gender dysphoria particularly appealing for the materialist: Brain-sex theory. Put simply, the theory states that the brain of transgender individuals has, as it has been colloquially described, “brain features that don’t fit the sex of their cells”. This leads to a situation where the biophysical and neural operations of the brain produce an “inner self” who experiences discordance in his or her gender identity. The scientific consensus, however, is that brain-sex theory is — just that — a theory, and it remains unclear whether and to what extent neurobiological findings say anything meaningful about gender identity. More research is needed before any definite conclusions can be drawn.

I turn to the second commonly adopted position: Substance dualism. Unlike materialism, substance dualism maintains that there are two distinct mental and physical realms or substances—the mind/soul and the body—that together form the constitution of the human person. Both soul and body are fundamental and non-reducible to anything more basic. As distinct entities, they are capable of existing separately and also of entering into causal relationships with each other. In particular, the soul under substance dualism is seen to possess a causal relation with its body such that it is able to act directly upon the body and be acted upon by the body.

When it comes to gender dysphoria, the substance dualist is able to say that one’s “inner self” is to be identified with one’s soul, rather than with any “self” that might arise from the biophysical or neural interactions of my body’s constituent parts, especially the brain. However, this move of locating the “inner self” in the soul opens the substance dualist to the charge of God having created my soul, and therefore my “inner self”, female, but mistakenly placed me in a male body or vice versa.

A deeper look at the varieties of substance dualism, however, holds the above intuition in check. There is a way of conceiving the three different varieties of substance dualism—namely, emergent dualism, Thomistic dualism, and Cartesian dualism—as holding the two components of soul and body in such a tight and interdependent relationship that the possibility of having a soul mismatched with a wrongly sexed body is close to none.

Emergent dualism states that the soul (or mind) is an emergent entity or mental substance that emerges from a properly configured body with all the biological, chemical and neural relationships and interactions in place. Once emerged, the soul is constituted and exists as an immaterial substance that is distinct and separable from the body. Because the soul is not created “externally” and subsequently added into a body, but the soul emerges “internally” from the physical, chemical and neural operations in the human body, it is unclear what cause could contribute to the emergence of a mismatched soul with the body.

Thomistic dualism, as the name implies, finds its influence in Aristotelian and Thomistic ontologies, which sees all material objects as comprising of matter and a form that determines the essential nature of the matter. Translated to the human being, the soul is seen as the form that animates or actualizes a body to be an actually existing sexed human body. Once again, for Thomistic dualism, because the soul serves as the vivifying and animating principle for a human body which is biologically sexed one way, it is virtually impossible for the soul to be gendered another way. A “male” human soul cannot serve as the animating principle for a “female” human body such that the soul-body composite exists as a female human being.

Even for Cartesian dualism, which in its stronger forms construes body and soul to be so fundamentally different that there is little interdependence between the two substances, there is a way out of the problematic scenario. That is, the Cartesian dualist simply needs to hold the view that the soul is not “gendered” by itself in abstraction from a human body. Sex or gender is not an essential property of a human soul, but an accidental property held in conjunction with a human body biologically sexed in a particular way. Here, I am appealing in part to Gregory of Nyssa’s understanding of the human soul as asexual in nature. On this Nyssen model where souls do not instantiate one gender essentially but only derivatively as a common property it shares with the body, it is difficult to envisage a case of a soul or “inner self” gendered one way mismatched with the wrong body.

In other words, be it materialism or substance dualism, whatever mental phenomenon of the “inner self” accounted for is still inextricably linked to the body and its constituent parts. In cases where the primary sex characteristics, such as genitalia, is developing normally, the gender identity of this “inner self” should by all accounts and in accordance with materialism and substance dualism’s own commitments be the same as that of the biological sex identity of the body. Taking into account the constitution of human persons, there is very little basis for the charge that God created but misplaced my “inner self” in the wrong body, leading to my state of gender dysphoria.

I believe the above exercise carries with it two theological inputs beneficial to a theological consideration of gender dysphoria, and I conclude with them.

First, in ruling out a scenario where my “inner self” was created gendered one way but mistakenly placed in a body biologically-sexed the other way, we concurrently rule out the origin or cause of gender dysphoria as being located in creation, pinpointing it instead to the Fall. In other words, we can safely assume that gender dysphoria is not a natural state of consciousness that God created us to experience. This is not to belittle in any way the genuine sense of gender identity discordance that the gender dysphoric person struggles with, but it is to say that in the case of clear-cut biologically-sexed individuals, the conscious state of gender dysphoria is a psychological phenomenon resulting from the Fall, rather than a physiological (involving the proper functioning of the human body and brain) or ethereal (involving the human soul) phenomenon that finds its origin at creation.

Even when considered as a consequence of the Fall, I remain persuaded that gender dysphoria is a result of living in a fallen world and not a result of personal moral choice, although the course of actions that one chooses to take in one’s gender dysphoria could have ethical or moral bearings.

Second, I believe that the above exercise reinforces a central conviction in thinking theologically about gender and sexuality: We need to retain some aspect of what has been termed as “essentialism”. While factoring in the role of cultural contexts and social constructs in shaping what and how we understand gender norms, our sexuality and gender identification cannot run away from being grounded in the biological givens of life. The above exploration shows that accounts of the constitution of human persons locate the gender identity of the “inner” or “real” self as having some form of a connection to the biological sex of the body that one has been created with.

At the very least, the above consideration of “essentialism” should provide guidance in our pastoral care and restraint in our psychological assessment and treatment of gender dysphoria individuals before hastily advancing them onto gender reassignment surgeries. Not only do such surgeries do irreversible violence to one’s bodily integrity and directly harm one’s capacity for marriage and reproduction—the very purpose of human flourishing that our bodies are biologically-sexed for—it is also questionable whether such surgeries achieve the alleviation of psychological distress they purport to bring about. Even if they appear to do so, as the theological findings in this article reveal, the surgery’s success in relieving psychological distress would ultimately be premised on a falsehood.

Rev Dr Edmund Fong is a lecturer in Theology, Hermeneutics and Presbyterianism at Trinity Theological College, and an ordained minister with the Presbyterian Church in Singapore.