The Dangers of Identity


The 58 year-old woman knows something is wrong with her body, has known since the age of 4. The Cambridge graduate believes both of her legs do not belong to her and dreams of being paralysed from the waist down. Her belief is so strong that she has searched for physicians who would be willing to severe her nerves so she can fulfill her dream of becoming her true disabled self.

There are others like her, able bodied people who feel as if they are living a lie. Psychiatrist Michael First has identified dozens of people who feel the same way. One, Michael Comer, says he has “rejected” his left leg since the age of 6. His feeling that his healthy leg should not be there is so intense that he eventually dropped a concrete block on his leg in the hope that he could damage it to the point where amputation was required. To his great disappointment doctors were able to save the leg.

While the number of healthy people who “identify” as disabled is not great, they have gotten attention to the point where there is a push to recognize the disorder as a legitimate medical condition. The term “Body Integrity Identity Disorder” has as a result entered the medical lexicon. Unsurprisingly, there is now debate in the medical community as to how to respond to these people. Should their “identity” be honored? Or should they be treated as mentally ill? How should doctors respond? If it is a valid medical condition, is it medically ethical to remove a perfectly healthy limb because a patient feels it doesn’t belong?

According to one author in the Journal of Medical Ethics, the answer is a resounding “yes.” In the abstract for his article on the issue Anahita Dua states, " a discourse on how the accepted notion of harm does not apply to apotemnophilia (BIID) is developed to justify the position that amputation is indeed medically the ethical choice”

This is the place we have reached in our society. A person’s feelings are now the most important factor in identity, and these feelings must be recognized by society, no matter how absurd, preposterous or harmful they may seem to others.

There is one question that seems to be persistently ignored. “What if someone’s feelings are wrong?”

I have always considered feelings unreliable. When my children were growing up I had conversations with them about the danger of following their feelings. I asked them, “Is it possible to feel something strongly and believe something deeply and be wrong?” In each of these conversations they both answered in the affirmative. I then asked them a follow up question. “When you feel something strongly and believe something deeply, how do you know if you are wrong or right?”

This is the heart of the matter. We have all experienced times when we were certain of something that later turned out to be wrong. Many of us have experienced adverse outcomes because we acted on mistaken beliefs. We all, if we had been able to listen, would have benefited from outside counsel pointing out the error in our thinking.

And yet here we are, living in a society where the problem is not that someone wants to cut off their leg, but that anyone else would question the desire. How did we get here? How did feelings become the ultimate determinant of morality?

It seems to me that it is the rejection of truth that is the root of our current problem. Turning away from the idea of moral constants, and of moral certainty, has led us to where we are.

There was a time in our society, and in western society at large, when there was a common understanding of right and wrong and a common agreement as to Who it was that defined right and wrong. While there was always debate on the nature of God, there was a near universal agreement that there was a God and that it was He who made the rules.

It was understood that there were good actions and bad actions, good people and bad people, and there was a way to measure and identify each. All of the realms of human existence and relationships could be assessed in the context a transcendent moral law.

These concepts and ideals are being rejected today. In their place a new morality has arisen, individual in nature and focus. Right and wrong are no longer determined by God or a universal code, but instead by each person for himself. Each man and each woman is in charge of their lives, their destiny and their morality. We each get to decide for ourselves what is right and wrong.

With the idea that each person gets to decide for themselves comes another concept, the idea that no person gets to judge the decisions of anyone else. Asserting the right or ability to judge the actions of another carries with it an undesired consequence, the right of others to judge me, and no one wants this.

Deference and “tolerance” become the order of the day. Think you are a Furry beast? Or that your left leg should be removed? Who am I to question it you? Feel like you are a woman born into a man’s body and want your perfectly normal genitalia removed? I must support your belief without question or be damned as an intolerant bigot.

Evidence that we have reached the place where mindless, unquestioning support of the feelings of others is required can be found in the response of the medical community to issues such as transgenderism. Researchers are searching for a medical explanation to the condition, for a biological explanation, for evidence that people are “born this way.”

They forget that being born with something does not make something normal. The vast number of genetic diseases and illnesses speak to this truth. Normal is not defined genetically, but socially. As an extreme example, I doubt that discovering a “Murder gene” would suddenly make homicide acceptable!

So what do we do? How do we respond?

While it is possible that we have reached the point of no return, that society has gone so far over the feelings cliff that reason has been permanently abandoned, I do not believe that absolves me of my personal responsibility. My role remains unchanged. My job is to “speak the truth in love” and accept whatever consequences society decides to hand out.


When Schools Can't Be Trusted

The words on the page took us by surprise. The graphic description of the rape of a young boy was not something we expected to find in required reading for our 15 year-old daughter. We did not expect the faculty of a public school to go out of their way to encourage morality or protect the innocence of students but we did not expect that vulgar material would be chosen and assigned.

I arranged a meeting with the teacher and the principal to bring my concerns to their attention and see if there was a possible remedy. My concerns were summarily dismissed. While I expected my concerns to be ignored the reason given for the choice of reading material was not expected at all. One of the teachers said, “It is our job to expose children to mature content.”

I did not hide my anger well when I replied, “No, it is your job to teach them how to read and write. It is the parent’s job to decide what children should be exposed to.” The reality that teachers and administrators believed it was their responsibility to determine when and how children should be exposed to sexual content was deeply disturbing to me. The belief seemed to be that it was up to parents to simply shut up and go along, to allow the “experts” to teach morality to their children.

I had two goals in meeting with the principal and teachers. The first was to get an alternative assignment for my daughter. The second was to get them to reconsider their policy on assigned reading. While I was able to get an alternative assignment for my daughter, I eventually gave up the second  fight, convinced that there was nothing I could do to change the minds of the faculty and administrators.  For the remainder of her years in school I did my best to teach Biblical values to my daughter and to teach her how to determine right and wrong. There were a number of times when that meant correcting things her teachers said but I did not make any further formal protests. She graduated from high school a few years ago and the issue faded from my mind.

The issue returned to my mind this week. Recent developments in the state of Washington reveal that the sentiments expressed by my daughter’s teachers are not isolated. It seems that the belief that public schools are responsible for determining when and how children should be exposed to sexual concepts is widespread.

The State of Washington’s recently released K-12 learning standards include a section of “core ideas” to be a part of the sexual health portion of the health and safety education of elementary age students. It is suggested that kindergarteners “understand that there are many ways to express gender” and that by second grade children should “understand there is a range of gender roles and expression” and that by grade 4 children should be able to “define sexual orientation.” In the eyes of educators, hand washing, tooth brushing and basic nutrition are no longer enough. 5 year-olds need to be introduced to the concepts of gender identity.

The presumption that all children need to learn these concepts at such a young age is absurd. There are many families who try to protect the innocence of their children. I did not know where babies came from until I was 11 years old. My son was 10 when we had “the talk” and he was clearly overwhelmed with the concept. I did not think he was emotionally ready at that age but was compelled by the reality that his elementary school was going to have a class on the topic the following month. I had to change my parenting plans because of a school program.

Parents who wish to defer exposing their children to sexual concepts are going to find themselves increasingly at odds with their school districts. According to the state of Washington, almost all children as young as 9 are all old enough and mature enough to be able to understand sexual orientation. The fact that a significant percentage of families of faith do not believe that all sexual orientations should be expressed and acted upon seems to be irrelevant. It is the responsibility of the public system to teach morality. 

I am left wondering how it is that our society has evolved to this point. Public schools across the nation are failing in their essential responsibilities to teach children reading, writing and arithmetic, but they are deciding to take on the additional responsibility of teaching young children about sexuality. More remarkably, parents are allowing it.

It is clear that concerned parents need to be increasingly involved in the education of their children. Parental responsibility extends far beyond simply making sure students get their homework done and have good attendance. Parents need to know exactly what their children are being taught and be willing to stand up for their innocence. It is likely no one else will.


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Our Newest Dilemma- Deciding What Bathroom to Use

To pee or not to pee. That is the question.

North Carolina recently passed a law about bathrooms. The text of the law is 5 pages long, but it essentially states that when it comes to multiple occupancy bathroom and changing areas (such as locker rooms) in government controlled facilities, people will need to use facilities that correspond to their biological sex. Boys must use male facilities and girls must use girl facilities. It also prohibits law suits against private entities that institute similar policies.

The response to the law has been one of vehement anger by many corporations, individuals, celebrities and politicians. Those who support the law have been labeled as hateful and bigoted. Curt Schilling, a former All-Star baseball pitcher, lost his job with ESPN for tweeting in support of the law. Is it is easy to wonder how our society came to arrive at such a place.

I grew up in an era where the girl’s bathroom was a place of mystery. No male dared enter the girl’s bathroom for fear of eternal punishment. Accidentally walking into the wrong bathroom was one of the most shameful acts imaginable. It could take years for the facial redness to fade.

Shame was not limited to opposite sex facilities. As an adolescent male there was more than enough shame for a boy in the boy’s locker room. Puberty is cruel and it arrives on an inconsistent schedule. In the 7th grade locker room some boys were already men while for others signs of manhood had not even begun to appear. While I have no firsthand knowledge of the girl’s locker room I am certain there was similar variability. Young women at opposite ends of the pubertal spectrum dealt with similar angst. The thought of changing in the presence of someone with the opposite biologic gender would have been terrifying!

Yet a new variable is being introduced into the locker room equation, a transgendered one. Individuals born male (with male genitalia) who identify as female have sued school districts for the right to use girl’s locker rooms. Their belief is that it is unfair for them to not be able to have access to the same facilities as all of the other “girls”. Many of the other girls, who do not have penises, have expressed discomfort with having to change in the presence of someone who does. Remarkably, a federal court sided with the transgender student and against the district.(1)

The battle is not limited to middle and secondary schools. Elementary schools have been met with similar law suits. While there are typically no common circumstances in which fully disrobing occurs in elementary school, there have been arguments regarding bathroom use. Parents are understandably concerned that their young children who have not yet learned about the birds and the bees may not be emotionally equipped to process transgender issues. The problem is compounded by studies that have shown the overwhelming majority of “transgender” school age children ultimately identify as their biological sex. (2)An argument can be made that given the potential harm there is no need to accommodate what is likely to be only a temporary preference.

There are different concerns when it comes to adults. For the overwhelming majority of adults who are transgendered the reality is that if they have taken steps to appear as the gender with which they identify and use a bathroom stall there is very little chance of anyone even knowing their biological identity, much less objecting to it. Even if the law “prohibits” them from a facility the risk of prosecution is miniscule. The risk most often cited by proponents of laws such as North Carolina’s is instead the possibility of sexual predators taking advantage of the opportunity the law affords and preying on innocent women. While the risk of sexual assault is minimized by those who oppose the law, it is nonetheless real. There are documented instances where such assaults have occurred. (3,4)

Lawmakers are left with a difficult decision. Apart from the extremely costly and unrealistic option of mandating that all facilities be single user and non-gendered any policy implemented will favor one side of the debate over the other.

An often overlooked part of problem is the rarity of transgenderism (estimates I have seen range from 1/3000 to 1/12,000 or less). Rarity results in it being very difficult to make any scientific assertions as to the normalcy of the condition. It also makes it less reasonable to demand governmental protections. Even if a biologic cause is ultimately discovered it will not necessarily constitute evidence of normalcy, for there are many genetic conditions that are considered abnormal (sickle cell anemia, cystic fibrosis and other such diseases). Normalcy for such things is always a matter of value judgments rather than facts.

It is obvious that there is no solution that will be universally acceptable. There is nevertheless a common sense answer available. If a policy or practice has been followed for centuries without significant or widespread negative consequences, and there is not overwhelming evidence that it should be changed, it is best to leave it alone. A law such as the one in North Carolina should not be necessary but it is. The definitions of male and female that have been the foundation of societal relationships since the dawn of humanity need to be defended, as does the innocence of our children.

-          Bart

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2.       Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 2008; 47:1413.






A Christian Physician's Thoughts on Bruce Jenner

This last week seems to have been “Transgender Week” on television. NBC News devoted lengthy segments of its nightly broadcasts to stories about parents who had determined their young children to be transgender and were raising them as such. ABC aired a 2 hour interview with Bruce Jenner in which he declared he was a woman and would be living as one for the rest of his life. In each of the stories, embracing one’s transgender reality was portrayed as brave and courageous and as the right thing to do. As a Christian Physician I was left wondering how I would respond to a patient or a parent in a similar circumstance. What would be the right thing to say?

As I ponder the question I am struck by how society’s definition of the “right” thing to say has evolved over time. In the not too distant past individuals who identified as transgender were considered to have a psychiatric condition that warranted treatment. Homosexuality was similarly considered to be a disorder at one time. What changed? Many assume that it was advances in scientific understanding of sexuality and gender identity that led to the change, that with increased understanding came more widespread acceptance.

The truth is that there have not been any major scientific breakthroughs in the area, that no genes have been isolated nor hormonal alterations identified. While it is possible that such discoveries may be forthcoming the increased acceptance of the medical and scientific communities has not been a result of traditional research. The reasons for the change in perception are primarily cultural and arise from a change in how society defines normal behavior.

Our nation was founded by people who were, at least in the large majority, religious in a Christian sense. Our founding document, the Declaration of Independence, made it clear that the fundamental rights of men were a gift of God. We were “endowed by our Creator with certain inalienable rights, among them life, liberty and the pursuit of happiness.” As rights came from God so did the definition of what was right and what was wrong. Moral law was established by God, not defined by men.

Over time the emphasis drifted away from the Creator who gives rights and more to the rights that are given. Life, liberty and the pursuit of happiness continue to be sacrosanct, but their definitions have become individualized. Happiness is now defined not as a result of doing what is right in the eyes of God but in doing what is right in the eyes of the individual. Liberty is no longer defined as the freedom to do right but as the freedom to do as one pleases. Autonomy is everything.

With this evolution of thought comes the rejection of a universal moral law. Right and wrong behavior are determined, whenever feasible, as what is felt to be right or wrong by the individual actor at a particular moment in time. Behaviors that were unquestionably wrong become first tolerated, then accepted, then embraced and then ultimately defended against those who would disagree.

In the realm of sexuality this cultural evolution can be seen in our views toward premarital and extramarital sex, abortion, homosexuality and same sex marriage. Societal attitudes toward the transgendered are similarly evolving. Attitudes toward the polyamorous are in the early stages of gaining societal acceptance. In every one of these cases scientific “validation” has followed the cultural change, not preceded it.

This is how it must be in such things, for biology can never prove morality. While saying “I was born this way” requires others to give careful consideration to the feelings of another and to proceed with caution in responding, it is not proof of goodness or rightness. There are many conditions with which people are born that are considered unacceptable and in need of correction. Medical conditions such as cystic fibrosis and sickle-cell anemia, and mental conditions such as schizophrenia and alcoholism are not considered acceptable simply because the patient was “born that way.” If pedophilia is one day discovered to be genetic it will not be instantly considered acceptable and appropriate. Science can never prove morality and goodness.

The recognition that moral values, not scientific facts, determine societal responses to sexuality is crucial in determining how we respond to the Bruce Jenners of the world. As a Christian physician, if I am asked by a parent how they should respond to a child who they thought was transgendered my response would be different from other physicians, for my moral viewpoint is different. I would have to preface my response by addressing the basis for any response the parent could make.

I would say that how we respond is based on what we believe. The Christian worldview is that right and wrong are not determined by our feelings but by God. It is true that everyone has feelings and desires, many which they are born with and cannot change. It is also true that everyone has a choice as to which feelings they embrace and follow and which feelings they do not. The Christian view is that when we follow those feelings which are good in God’s eyes we will experience blessing, in the next life if not in this one. If the parent embraces this viewpoint they will need to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child determine God’s plan for their life and how they can live with the feelings and desires given them at birth.

The secular worldview is that right and wrong are not absolute and that our understanding of morality evolves over time. Many in our culture have concluded that multiple forms of sexual identity and desire are acceptable and good. From this perspective parents would be more apt to encourage the child to "follow their heart." I would also encourage parents who embrace this perspective to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child recognize which feelings are enduring and should be embraced and which are temporary and need not be followed.

As our societal evolution has progressed to the point of aggressively defending individual moral choices against those who disagree (in some cases to the point of punishing those who do not embrace majority thought), Christians need to be especially careful in how we respond to these situations. It seems to me that the best initial response is to say that while many may disagree, we are of the opinion that right and wrong are determined by God and not by men and that not all feelings need to be followed.


-          Bart

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