Sexual Orientation and Gender Identity Change Efforts, Part 2: The Language Problem

This blog series is drawing from the research paper: “The Problems with Correlating Sexual Orientation Change Efforts and Gender Identity Change Efforts,” available for free here. Written by Drs. Paul Eddy and Preston Sprinkle.

 

In the previous post, we looked at the widespread correlation between Sexual Orientation Change Efforts (SOCE) and Gender Identity Change Efforts (GICE). While there are some similarities between SO and GI, there are many differences between the two. These differences should encourage us to treat SOCE and GICE as two distinct phenomena. The first difference is what I call the “language problem.” In short, not only are sexual orientation and gender identity two very different things, the words used to describe gender identity constitute assumptions about human nature that are, at the very least, questionable. While the meaning and reality of sexual orientation is rather straight forward, gender identity is not. Correlating the two can only be done when the meaning of gender identity is left unexplored.

 

Let’s begin by stating some widely agreed upon definitions. According to the American Psychological Association (APA):

• “Sexual orientation refers to an enduring pattern of emotional, romantic and/or sexual attractions to men, women or both sexes.”
• “Gender identity refers to a person’s internal sense of being male, female or something else”

 

Since we’re talking about human nature, it will be helpful to state one more important definition: biological sex. While “sex” and “gender” are often conflated, correlated, and confused, in modern academic parlance, they are distinguished. When they are, biological sex is best defined as:

• Biological sex is one’s state of being male or female based on their reproductive structures

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Homo Sapiens, like most mammals, are a sexually dimorphic species. And while this is disputed in some fringe circles, I’m going to assume this view of human nature throughout this blog series, and I’ll use the terms male and female to refer biological sex (see THIS post for details on intersex).

 

So what’s the language problem with SOCE and GICE? There are actually several problems.

 

 

What Does Conversion Mean?

 

The very language of conversion, for instance, is latent with ideological assumptions. In SOCE, it’s pretty straight forward. Conversion means changing one’s sexual attractions from same sex to opposite sex. But the meaning of conversion in GICE is much more complex. Opponents of so-called GICE assume that gender identity—“one’s internal sense of self”—is who a person is, even if GI is at odds with their body. And any attempt to align one’s “internal sense of self” with their body is considered to be a harmful conversion.  But this bakes some unstated and, perhaps, unsubstantiated anthropological assumptions into the meaning of conversion. It assumes a certain perspective on human nature (which may or may not be correct), where one’s internal sense of self takes priority of one’s material self—one’s sexed body.

 

This language problem becomes more acute if we consider the alternative to so-called GICE. Those who oppose GICE often advocate for altering one’s body (through cross sex hormones and sex reassignment) as a way to address their dysphoria. If we try to match one’s sexed body with their “internal sense of self,” then this will align their body with who they really are and therefore help alleviate their gender dysphoria.

 

But, depending on one’s perspective on the body, this could be considered another form of conversion—you’re quite literally converting the body. You could almost label this BSCE—Biological Sex Conversion Efforts, if you don’t assume that one’s “internal sense of self” is a more accurate view of personhood than a person’s body. The fact that this is not considered a form of “conversion therapy” has to do with philosophical and scientific assumptions about the body more than it has to do an aversion to converting people.

 

Those who oppose Sexual Orientation Change Efforts (SOCE), however, don’t have the same tension. Not changing someone’s sexual orientation doesn’t require a different kind of change. There is no conversion, intervention, or “fixing” that needs to take place, either of the body or the mind. It just lets them be. 

 

The very label GICE needs more definitional clarity and a deeper dialogue about its underlying ideological assumptions. One person’s “gender identity change effort” is another person’s “helping someone accept the reality of their (God given) biological sex without medical intervention.” And this raises questions about the way therapeutic models are described.

 

 

The Therapeutic Problem

 

Those who oppose so-called GICE typically advocate for what’s called a Gender Affirming Model (GAM) of care for trans*-identified people. This model assumes that “one’s internal sense of self” is more indicative of personhood than biological sex (which they would describe as one’s “sex assigned at birth”), and if one’s sexed body is causing distress, then it’s their sex that should change, not their “internal sense of self” (gender identity).

 

The GAM is widely popular in the U.S., to the extent that many assume it’s the only credible model of care for gender dysphoria. But this simply not true. There are other models of care that are neither GICE nor GAM. For instance, models such as Watching Waiting, the Emerging Exploratory Paradigm, and the Biopsychosocial Approach are all endorsed and practiced by experts in the field and none of them are trying to “convert” people; they would all be opposed to SOCE. Instead of trying to “convert” people, they explore non-invasive ways to help reduce a person’s gender dysphoria.

 

It is not only inaccurate but ultimately unhelpful to people with gender dysphoria when (mostly non-trans*) professionals label all non-gender affirming approaches to treating gender dysphoria as GICE.

 

But this is exactly what happens over and over again. Take, for instance, the widely cited study by Jack Turban, et al. titled: “Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults.” This study is cited as proof that GICE is harmful and that the GAM is the only approach that’s not harmful. But, as several critics point out, Turban performed his study with the “misguided notion” that “anything other than ‘affirmative’ psychotherapy for gender dysphoria (GD) is harmful and should be banned.” The critics continue:

 

The notion that all therapy interventions for GD can be categorically classified into this simplistic [“affirmation” versus “conversion”] binary betrays a mis understanding of the complexity psychotherapy. At best, this blunt classification overlooks a wide range of ethical and essential forms of agenda-free psychotherapy that do not fit into such a binary; at worst, it effectively mis-categorizes ethical psychotherapies that do not fit the “affirmative” descriptor as conversion therapies.[i] 

 

This isn’t the place to argue for one therapeutic approach over another. I’m only wanting to point out that no one is served well when GICE is used as a misleading weapon to tarnish anything other than the GAM.

 

 

Are We Converting Gay People All Over Again?

 

Speaking of the GAM, a growing number of gay people have pointed out that this actually looks eerily like another form of SOCE covered up by a language game. Here’s why they say this.

 

It’s well established that around 80% of pre-adolescents with gender dysphoria end up desisting (i.e. their dysphoria goes away) after puberty. It’s also well known that most of these kids who do desist will be attracted to the same sex. Add to this the fact that most kids who socially transition will end up hormonally and surgically transitioning. And the GAM encourages this process.

 

The glaring problem for the GAM, then, is this: By encouraging early transitioning—first social and then medical—as the primary solution for young people who experience gender incongruence/dysphoria, this model functionally facilitates the transition of what would have been a lesbian or gay cisgender person into a heterosexual transgender person. Other therapeutic approaches are perfectly fine with allowing these kids to grow up to be gay while addressing their dysphoria. (The Watchful Waiting approach actually doesn’t do anything, just leaves them alone.) But by changing their sex, the GAM turns a same-sex attracted person into an opposite sex attracted one. This is why some clinicians describe the gender affirming approach as “conversion therapy for gay kids.”[ii] 

 

From their perspective, part of the problem here could be tied to the potential “unconscious homophobia” of parents who would rather have a trans* child than a lesbian or gay child.[iii] Gay rights activist Andrew Sullivan has gone so far as to argue that “transgenderist ideology — including postmodern conceptions of sex and gender — is indeed a threat to homosexuality, because it is a threat to biological sex as a concept . . . .”[iv] Lesbian journalist Katie Herzog raises a similar question in her article “Where Have All the Lesbians Gone?” According to Herzog, many of them have become straight transmen.

 

I'm neither aggreeing nor disagreeing with Sullivan and Herzog. I only quote them to highlight an aspect of the language problem; specifically, the meaning of conversion. Some say trans* people are being converted, while others say gay people are being converted all over again. In this latter perspective, the gender affirmative approach is a form of SOCE. Clearly, we need much more definitional clarity and dialogue before SOCE and GICE are described as two sides of the same coin. 

 

 

Summary

 

To sum it up, the correlation between SOCE and GICE suffers from several undefined terms and unsubstantiated ideological assumptions. The anthropological assumptions that underlie the meaning of “conversion,” the sweeping categorization of all non-gender affirmative approaches to treating gender dysphoria, and the possible homophobic motivation that underlies the description of GICE as such all place a wedge between SOCE and what’s been called GICE.

 

And all of these are related to the ontological problem, which we’ll wrestle with in the next post.