January 23, 2022

Does transgender medicine have a sound philosophical foundation?

There are many angles from which to study the phenomenon of the transgender movement – psychological, sociological, historical, medical, political … — but surely the most fundamental is metaphysical. This is a word which is commonly used as a synonym for abstruse and impractical. In reality (so to speak), it is the most practical of all, as metaphysical is the branch of philosophy which studies what it means to be “real”.

For instance, metaphysics asks transgenderism: is the sensation of “being trapped in the wrong body” real? It depends on which is fundamentally real – the mind or the body. From a metaphysical standpoint, questions of immense importance for our whole civilisation are at stake in the trans debate.

In the latest issue of The Journal of Medicine & Philosophy, Melissa Moschella, of Catholic University of America, runs a metaphysical rule over transgender claims. It’s difficult to summarise here, but it’s a good introduction to the topic.

She points out that trans claims are an example of the ancient philosophy of dualism:

The wrong-body account of transgender identity seems to presuppose a dualist anthropology according to which the “I” or “self” is essentially a conscious, thinking, feeling entity that inhabits but is not identical to a particular body. For only by denying that the body is an essential, intrinsic component of personal identity can one claim that there is a mismatch between the body and the self.

In other words, the trans view is that the body is not real; only what we feel, think and imagine can claim to be real. That being the case, everything falls into place for trans supporters. But for a non-dualist this flies in the face of experience: “we are bodies, and whatever body we are is thus necessarily the ‘right’ body”.

Moschella says that the biological view of human experience is the real view.

regardless of whether or not there are aspects of our identity that go beyond our biological identity, our biological identity is essential and intrinsic to our personal identity. In other words, I am my body, even if there are aspects of me that transcend the bodily dimension of my being.

She identifies a contradiction in trans claims:

There is no such thing as a universal feeling of “maleness” or “femaleness.” There are probably as many ways of “feeling” female or male—whatever that means—as there are women and men. If “feeling female” or “feeling male” is to signify anything, there must be some objective, extra-mental reality to which it refers. That objective reality cannot be biological sexual identity itself, or it would be completely nonsensical for a biological male to say, “I feel female.”

This has important consequence for bioethics and transgender medicine:

If that judgment is false…then affirming transgender identity claims, and performing medical and surgical interventions on the basis of such claims is not a truly responsible or compassionate response to those suffering from gender dysphoria, but rather is likely to result in profound harm, at least in the long run.

It is probably futile for the opposing sides to harangue each other unless they tackle the knotty questions of transgender metaphysics. Moschella’s article is a good start.

4 thoughts on “Does transgender medicine have a sound philosophical foundation?

  1. I agree with the article. Transgender philosophy is a threat to the foundations of modern medicine. The huge improvements in health and longevity have been based on biological facts not on how people feel.

  2. This is a completely ridiciolous, and harmful, article.

    The only question that matters is this: Which treatments give the best outcomes? We have decades of experience showing that trying to stop someone from being transgender by manipulating their brain is completely futile. We also have decades of experience showing that gender-affirming care is often successful.

    So the metaphysics are irrelevant. The *only* thing that matters is: Which treatments end up reducing harm?

    1. Well that is a lie, we don’t have decades of success. The longitudinal studies show very poor outcomes for people who transitioned, and it certainly does not include the current cohort of children and adolescents being swept up by this craze.

      Research shows that the overwhelming majority of children reconcile with their natal sex when they are not transitioned, how do you square that with your assertion “manipulating their brain is futile”? How about supporting people to accept the body they have? Humans cannot change sex, changing your body will not assuage emotional distress about you sexed body.

    2. Even if your claim were true., which is questionable Costa’s article shows that young people do as well in counselling as they do when treated with puberty blockers, and moreover do not become lifelong patients. 87% of young men in the research by Singh et al. this year desisted by early adulthood. Kozlowska shows that kids adopt a ‘trans’ identity due to prior trauma, abuse and homophobia. Increasingly it is a means to garner high social acceptance amongst their peers – to avoid being anything as tedious as a ‘basic’ or a ‘normie’. But metaphysics does matter. Because dualism, for a long time a curious philosophical position, is now being used as a tool to argue that everyone, not just transgender people, are minds trapped in bodies, ofter described by the ugly term ‘meatsack’ – a body not of their own choosing. It’s a philosophy of bodily disassociation. Reaching a level of self-acceptance, let alone wisdom or a sense of personal integration using such a philosophy is a fruitless task. In contrast a philosophy of personhood where mind is integrated with a body does help with this endeavour.

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