In Reply

Fred S. Berlin

doi:10.29158/JAAPL.230091-23

Editor:

I agree with Dr. Kaliebe that there should be a thoughtful exchange of ideas, hopefully based upon empirical evidence, regarding matters relevant to transgender persons. There is still much more that can be learned. That said, there is a great deal that is already clear.

The term “gender identity” had been introduced into the professional literature approximately 60 years ago by Dr. John Money. It is not a new concept. Dr. Kaliebe refers to that concept as “gender self–identification,” suggesting that biological sex does not change but that gender self–identification does. In most instances, however, gender self–identification does not change. The vast majority of cisgender persons (individuals whose subjective feelings of gender identity correspond with their external birth anatomy) never experience doubt about their own gender. Similarly, the vast majority of transgender persons (individuals whose subjective feelings of gender identity are in diametrically opposed conflict with their external birth anatomy) never experience doubt about their own gender.

Describing to others one's own subjective experiences is a uniquely human capacity. Ordinarily it is not, as suggested by Dr. Kaliebe, an “ephemeral” process. For example, most persons can accurately describe to others the nature of their own sexual orientation. In the vast majority of cases, if the individual disclosing is being honest, associated behaviors will correspond with self-reported mental desires and experiences. Just as some persons who characterize themselves as “bisexual” may appear to be “fluid” in their interactions with men and women, some individuals whose feelings of gender identity may not be exclusively either cisgender or transgender may also appear to be “fluid” in their self-perceptions and behaviors. Still, the vast majority of persons do not experience fluidity of gender identity.

It is well documented that transgender persons have existed for as long as history has been recorded, and that they have existed, and that they still exist, in a multitude of cultures. They can be recognized not only by self-identification, but also by the nature of their associated gender-related behaviors. The existence of transgender persons is not a “woke” invention. Just because transgender persons are different from the majority should not mean that they ought to be entitled only to diminished societal rights and protections. Historically and in many cultures that has been the case, but forensic psychiatrists can play a role in assuring that that circumstance does not continue.

In the courtroom, forensic psychiatrists can educate a judge or jury about the fact that transgender persons have been present in society for ages. Forensic psychiatrists can explain that feelings of gender identity are not chosen, but that they are discovered and experienced in the mind, and that from a psychiatric perspective transgender persons possess the same mental capacities, emotions, and human qualities as others. They can testify about the mental discomfort associated with a discrepancy between one's external genital anatomy and a person's subjective feelings of gender identity. Testimony can be provided regarding treatments that can enhance the sense of mental well-being experienced by transgender individuals.

Dr. Kaliebe suggested that gender identity has only recently been recognized within regulatory and legal frameworks. That may be true. Nevertheless, many jurisdictions allow transgender persons to change identifiers on driver's licenses, on birth certificates, and on other documents to conform to their internal sense of who they are as a person. The regulatory and legal system has already accepted the legitimacy of transgender persons as individuals who are entitled to rights and protections.

Dr. Kaliebe suggested that the rights of transgender persons need to be balanced against the rights of others; for example, the right for women to have privacy and security in bathrooms and prisons. I agree with that. At the same time, I would note that there is little reason to believe that any man would undergo breast enhancement surgery and vaginoplasty to be able to spend time in a woman's bathroom. Were a cisgender man to dress as a woman to be able to enter a woman's bathroom, existing laws already allow for criminal prosecution. It is not difficult to protect women's rights, including transgender women's rights, in bathrooms. Unisex bathrooms can be designed so as to allow for only one person at a time to enter. They can also be designed with stalls in which nudity cannot be observed by others. There need not be a conflict between anyone's rights in addressing such matters.

I agree with Dr. Kaliebe that in addressing questions related to gender, many people default to ideological or political theories. I believe that forensic psychiatrists can help to distinguish between those viewpoints, and what is known from a scientific and mental health perspective.