Book Review: Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture
Mark Yarhouse
IVP Academic, 2015.

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.  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 diagnostic 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’  around fourteen years ago. In particular, there has been a lack of helpful, well thought through analysis from a Christian perspective.

Understanding Gender Dysphoria by Mark Yarhouse, is a relatively slim book 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)
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.

Yarhouse  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 none of them 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. Nevertheless 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. The majority of literature at a lay-level provides brief glosses at best, while more in-depth literature tends towards ‘clinicalisation’ and diagnostic issues.

From this chapter, the book moves on to 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 excursuses 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.

Chris Porter, Vic.