Book Review: Understanding Gender Dysphoria — Mark Yarhouse

Understanding Gender Dysphoria
Mark Yarhouse; 2015. | IVP Academic | 191 pages

Gender dys­pho­ria (GD) and trans­gen­der issues are cur­rent­ly a hot top­ic in the media and every­day dis­course, thanks in no small part to the top­ic being thrust into the lime­light by celebri­ty events. However, the cur­rent media focus on the top­ic doesn’t do jus­tice to the com­plex­i­ty of the issue. Especially giv­en the super­fi­cial gloss award­ed to the psy­cho­log­i­cal and med­ical aspects. From a psy­cho­log­i­cal per­spec­tive, Gender Dysphoria [302.85]—or Gender Identity Disorder (GID) as it was known—has been described in the Diagnostics and Statistics Manual (DSM)—the psy­cho­log­i­cal dis­ag­nos­tic handbook—since ver­sion III (1980) under dif­fer­ent cat­e­gories. My own inter­est in the top­ic orig­i­nat­ed with two friends announc­ing their iden­ti­fi­ca­tion as ‘trans’ and ‘gen­der iden­ti­ty dis­so­nant’ (yeah, he was a Psych friend) around four­teen years ago. In par­tic­u­lar, there has been a lack of help­ful, well thought through analy­sis from a Christian perspective.

A few books have been released recent­ly, intent on speak­ing to this mod­ern inter­est in gen­der dys­pho­ria, and the first for review is the apt­ly titled Understanding Gender Dysphoria by Mark Yarhouse. This is a rel­a­tive­ly slim book from Yarhouse, giv­en his pre­vi­ous work on Modern Psychopathologies and books on ther­a­py. As with his pre­vi­ous work he writes from a dis­tinct­ly Christian per­spec­tive, although firm­ly embed­ded with­in the psy­cho­log­i­cal dis­ci­pline as a well-round­ed prac­ti­tion­er. As such this book walks the fine line between dis­ci­pli­nary speci­fici­ty and appeal­ing to a broad­er audi­ence. The intro­duc­tion describes this ten­sion well:

This book invites Christians to reflect on sev­er­al issues relat­ed to these find­ings [sex­u­al iden­ti­ty research], a broad­er research literature…and oth­er anec­do­tal accounts. …I note that as we wade into this par­tic­u­lar pool, we are going to quick­ly be in the deep end, as the top­ic is com­plex.’ (p11)

However it is this ten­sion that makes this book both appeal­ing and some­what unsat­is­fy­ing. From my own back­ground I will be review­ing it from both a psy­cho­log­i­cal and a the­o­log­i­cal per­spec­tive, with all the con­flict and over­lap that this presents.

Given Yarhouse’s aim of engag­ing with a broad Christian audi­ence, he starts from a point that is rel­a­tive­ly acces­si­ble to his audi­ence. However, this acces­si­ble start­ing point is not with­out its costs, as the first few pages present a steep learn­ing curve. By the sec­ond page of the first con­tent chap­ter Yarhouse is deep with­in iden­ti­ty the­o­ry, chro­mo­so­mal dif­fer­ence, and intro­duc­ing a spec­trum of gen­der iden­ti­fi­ca­tion. Although this book may be writ­ten for a lay audi­ence it expects a strong degree of edu­ca­tion, reflec­tion and analy­sis. Drawing from his psy­cho­log­i­cal back­ground Yarhouse help­ful­ly dif­fer­en­ti­ates between biological/chromosomal sex, gen­der iden­ti­ty, and gen­der role/acts. It is this degree of nuance that is use­ful in defin­ing aspects of the dis­cus­sion up front.

From the first chap­ter that seeks to appre­ci­ate the com­plex­i­ty sur­round­ing gen­der dys­pho­ria, the sec­ond chap­ter attempts to assem­ble a use­ful Christian per­spec­tive on the top­ic. The open­ing anec­dote sets the tone for the chap­ter by high­light­ing a lim­it­ed and closed-mind­ed approach. Throughout this mod­el build­ing Yarhouse draws upon a bib­li­cal the­ol­o­gy of human­i­ty. From this he pro­pos­es three pre­lim­i­nary mod­els for engag­ing with gen­der dys­pho­ria: the integri­ty frame­work, the dis­abil­i­ty frame­work and the diver­si­ty frame­work. While these three frame­works rep­re­sent usable approach­es it is worth not­ing that of them none will please every­one. Conservative Christians will like­ly fol­low after the integri­ty frame­work, while abhor­ring the diver­si­ty frame­work. Similarly staunch sup­port­ers of Gender Dysphoria (in the DSM‑5 sense) will like­ly sup­port the diver­si­ty mod­el while decry­ing the integri­ty frame­work. Nevertheless these three frame­works are a use­ful heuris­tic for approach­ing the issue. Yarhouse attempts to blend these three frame­works in pre­sent­ing an inte­grat­ed mod­el that acknowl­edges ‘integri­ty of sex dif­fer­ences,’ dri­ves for ‘com­pas­sion­ate man­age­ment of gen­der dys­pho­ria,’ and val­i­dates ‘mean­ing mak­ing, iden­ti­ty and com­mu­ni­ty.’ From a the­o­log­i­cal per­spec­tive the anthro­pol­o­gy feels quite shal­low and I wish it wres­tled fur­ther with the ima­go dei and Christian iden­ti­ty. Still this sec­tion is a good intro­duc­tion to the top­ic, and will be use­ful even to those with no faith con­vic­tions what­so­ev­er, due to the pauci­ty of help­ful lit­er­a­ture on the top­ic. 1

From this chap­ter, the book moves onto an inves­ti­ga­tion of the Phenomenology and Prevalence (Ch4) and Prevention and Treatment (Ch5) of Gender Dysphoria. These chap­ters are pre­sent­ed from the per­spec­tive of the DSM‑5 with some minor com­par­isons with the pre­vi­ous DSM-IV. Here Yarhouse’s clin­i­cal prac­tice is set cen­tre stage, with reg­u­lar anec­do­tal excurs­es sup­port­ing and high­light­ing facets of the clin­i­cal def­i­n­i­tions. Personally from my back­ground in Socio-cog­ni­tive psy­chol­o­gy, I would wish for more in these chap­ters on the DSM‑5 update to the DSM-IV giv­en the change from Gender Identity Disorder to Gender Dysphoria. This change in the DSM‑5 acknowl­edges the increas­ing ‘med­ical­i­sa­tion’ of the diag­nos­tic cri­te­ria, but seem­ing­ly side­lines many of the iden­ti­ty issues in favour of focus­ing on the ‘dis­tress’ involved in the diag­no­sis. (Koh, 2012) This aspect of iden­ti­ty and gen­der is the pri­ma­ry area that my inner socio-cog­ni­tive psych wants to see addressed and engaged with fur­ther from a Christian per­spec­tive, espe­cial­ly con­cern­ing issues of cog­ni­tive dis­so­nance in this sphere.

The final sec­tion of the book envis­ages a Christian response from both indi­vid­u­als and the broad­er com­mu­ni­ty (or insti­tu­tion). These chap­ters seek to cement the the­o­ry and spe­cial­ist prax­is with­in the sphere of Christian com­mu­ni­ty. Ultimately these chap­ters are like­ly to be the most use­ful to the intend­ed audi­ence and have the most impact; my psy­cho­log­i­cal and the­o­log­i­cal wish­es aside. These chap­ters paint a pic­ture of a church that seeks to love and engage with those who have gen­der iden­ti­ty con­cerns. Furthermore, the pic­ture that Yarhouse paints is cer­tain­ly not the white­wash­ing of the issue that is com­mon­ly pre­sent­ed, nor is it the seem­ing­ly ran­dom spat­ters of paint that resem­ble a church that has not wres­tled with these issues. The prac­ti­cal appli­ca­tion here will great­ly ben­e­fit church­es and indi­vid­u­als alike.

Ultimately this book pro­vides an invalu­able for­ay into the issues sur­round­ing Gender Dysphoria/Gender Identity Disorder. It seeks to present a strong case for under­stand­ing gen­der dys­pho­ria from a bib­li­cal, the­o­log­i­cal, pas­toral and psy­cho­log­i­cal stand­point. The argu­ment pre­sent­ed will cer­tain­ly not please every­one, with many con­ser­v­a­tives see­ing it as capit­u­lat­ing and many pro­gres­sives see­ing it as not rad­i­cal enough. Personally there are times I wish that cer­tain issues were inves­ti­gat­ed fur­ther, or extri­cat­ed from the holis­tic mod­el to be exam­ined indi­vid­u­al­ly. However, despite these issues the book makes an impor­tant con­tri­bu­tion to a sore­ly neglect­ed issue with­in the church, and our soci­ety, today. All read­ers, even those who have no faith affil­i­a­tion, are like­ly to find this book use­ful in address­ing the basis of their explo­ration in under­stand­ing gen­der dysphoria.

I hope that Gill can also review this book from a med­ical per­spec­tive in the near future.

This book review was orig­i­nal­ly pub­lished on Euangelion and archived here. 

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  1. The major­i­ty of lit­er­a­ture at a lay-lev­el pro­vides brief gloss­es at best, while more in-depth lit­er­a­ture tends towards ‘clin­i­cal­i­sa­tion’ and diag­nos­tic issues.