Gender Identity & Faith: Clinical Postures, Tools, and Case Studies for Client-Centered Care is one of those books that tells you exactly what it is with the title and subtitle. Or does it? As a non-professional, I didn’t realize exactly how focused on the subtitle the book would be. Nevertheless, I found quite a bit of interest as I read the book.
Mark A. Yarhouse and Juila A. Sadusky explore questions of gender identity in a clinical setting, offering specific, concrete advice and even exact examples for how to go about having these discussions. Thus, there are specific examples of people who came in seeking therapy for a variety of gender identity related issues, and the authors share these examples from a wide array of backgrounds. Some were supported by family, others were not. Some had favored pronouns, others hadn’t contemplated that. The variety of specific examples show just how complex these topics are, going far beyond the yes-or-no that is often offered in faith settings.
The authors also offer concrete advice for therapists and others, along with worksheets that can be used to discuss topics of gender identity. I am not trained in this field, so I can’t comment much on how useful they are, but I did find them of interest as a lay person in the setting.
Some reviews of the book have attacked it for not taking an entirely negative stance towards anyone who questions gender identity. Such attacks are short-sighted and scientifically uninformed. While Yarhouse and Sadusky don’t really dive into any of this, the fact is that strict binaries of gender identity (eg. boys wear blue/girls wear pink) are obviously constructed by humans rather than being objective aspects of reality. Additionally, the existence of intersex persons, whose numbers are far higher than most people know, is a direct challenge for such binaries. So far as this reader could tell (without any relevant degree–only an interest in the topic), the authors take a neutral stance regarding the questions, seeking instead to bring help and healing to people wherever they are on their journey.
Gender Identity and Faith is a useful book for Christians (and non-Christians who want to know more about faith and gender identity) wishing to discuss gender identity in clinical settings. That’s the book’s purpose. Readers who aren’t involved in that field–such as myself–will still find it of interest to see how these topics can be approached.
Disclaimer: I was provided with a copy of the book for review by the publisher. I was not required to give any specific kind of feedback whatsoever.
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J.W. Wartick - Reconstructing Faith 
You mentioned “intersex persons, whose numbers are far higher than most people know.”
That is quite vague. Could you provide documentation to support the claim and provide ballpark estimates, based on objective empirical data, of the actual incidence?
Posted by Ralph Dave Westfall | September 12, 2022, 5:53 PMWell, “most people know” is a generalization, I’ll admit. When I started reading about it, though, I was pretty surprised, and everyone I’ve talked to about the statistics since are surprised as well. The wikipedia article on intersex persons is a decent place to start, and shows some of the range. The debate over the meaning of “intersex” is broad and technical and I’m not an expert in it. I do know that the book “Sex Difference in Christian Theology” by Megan DeFranza explores this debate. Again depending how one defines it, it’s possible 1.7% of the population (or more) are intersex (see again, the references in the Wiki article). I know my own upbringing and learning in apologetics circles always said intersex persons were such an outlier they didn’t really come into play in discussion of gender issues. Of course, this was a gross oversimplification.
Posted by J.W. Wartick | September 13, 2022, 8:16 PMThank you for your gracious reply.
The research I’ve seen indicates that intersex morphology is rare and the 1.7% of the population statistic is overstated by a factor of four or more due to inaccurate classification criteria. See
https://en.wikipedia.org/wiki/Intersex#Prevalence and https://www.webmd.com/parenting/baby/news/20190503/study-about-1-in-1000-babies-born-intersex
Posted by Ralp Dave Westfallh | September 13, 2022, 11:32 PM1/1000 is still far higher than what I personally was taught. And also seems to be based on definitional difficulties. In either case, the fact that intersex people do exist and aren’t extraordinarily rare (or even if they were) suggests major difficulties for a strictly dichotomous core of human gender.
Posted by J.W. Wartick | September 14, 2022, 11:16 PMThank you for the kindness of a reply.
For a long time I’ve been hearing figures for the incidence of intersex births of around one in a thousand. I was at a conference and there was a session on the topic in which the speaker mentioned a figure of perhaps two in a thousand, or maybe one in two thousand–this was possibly ten years ago so I’m not sure of the precise number.
One or two in a thousand is much lower than the claim that is currently
being bandied about that intersex conformations are as common as having red hair.
Furthermore, I don’t see any identifiable logical connection between the existence of people with an intersex morphology and “major difficulties for a strictly dichotomous core of human gender.” They appear to be separate and distinct issues with only superficial conceptual associations.
Your thoughts?
Posted by Ralph Dave Westfall | September 15, 2022, 12:52 AMIntersex people are by definition non-binary. Many many people are pushing for a purely binary gender theology and ethic; hence that is problematic because it doesn’t align with reality.
Posted by J.W. Wartick | September 15, 2022, 6:57 AMThank you for the courteous reply.
I think you are conflating two very separate issues here. Around one or two out of a thousand births are intersex. Can that objective biological fact result in any logical conclusions about people with normal genitalia who subjectively feel there is a discrepancy between their biological sex and their gender?
To facilitate discussion of this issue, could you put the reasoning for your conclusion in the form of a syllogism, filling in statements below between the initial factual statement and the conclusion?
One or two out of a thousand births are intersex.
…
…
…
…
…
Therefore “a purely binary gender theology and ethic … is problematic because it doesn’t align with reality.”
Posted by Ralph Dave Westfall | September 15, 2022, 10:50 PMWell, I don’t especially want to follow your format, and I would dispute the 1-2/1000 but am leaving that aside for the sake of argument.
Here’s how I would put it.
1. For something to correct, it must reflect reality.
2. A purely binary gender theology and ethic are correct.
3. Therefore, a purely binary gender theology and ethic must reflect reality.
4. Intersex people exist.
5. Intersex people do not reflect a gender binary.
6. Therefore, a purely binary gender theology and ethic are not correct (5, 3, 2, 1).
Or something like that.
I might massage the argument a bit and change it more to reflect how many/most purely binary gender theology and ethical stances tend to conflate sex and gender etc. But that would be farther afield, and is somewhat implied by 5 above. So there are some hidden premises there, but not ones that I personally think are worth pursuing -because- getting from 4 to 5 is not difficult.
Posted by J.W. Wartick | September 19, 2022, 6:43 PMIt’s interesting to me, too, that you (and many others) latch upon the lowest possible estimate. As the Wikipedia article, for an easy-ish read, notes, the estimates can be as high as 1.7% depending upon what one classifies as “intersex.” And it is in the interest of the gender essentialist, of course, to minimize those % as much as possible. But at no point does that % reach 0.
Posted by J.W. Wartick | September 19, 2022, 6:44 PMOoh! Clever. Iron sharpens iron.
The syllogism has two fatal implicit assumptions.
First let me explain my rationale for using Wikipedia. Anybody can contribute, edit or delete material from Wikipedia. People delete information that conflicts with their strongly held beliefs. Others can put it back in, but it gets deleted again. Eventually it goes into a mediation process. But even if there is a strong, vocal editing majority on one side, the opposing opinion can be kept in the article if the evidence for it is extremely strong. The fact that the low estimate is still there is indicative of the strength of the evidence for it.
The 1.7% figure from the Fausto-Sterling book (not a journal article) which is often quoted “includes conditions which most clinicians do not recognize as intersex, such as Klinefelter syndrome, Turner syndrome, and late-onset adrenal hyperplasia.” You can see the abstract of this quote from a peer-reviewed study in The Journal of Sex Research at https://pubmed.ncbi.nlm.nih.gov/12476264/
Unfortunately that research publication is paywalled. However you can see an extensive discussion of the issue by the author, Leonard Sax MD PhD, at https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/
Getting into your hidden assumptions, the first is that a theology has to cover all cases, no matter how rare. In other words, it would have to cover situations that occur once in one hundred, or once in a thousand or a million or a billion.
4. Intersex people exist. [true even if there were just two in the whole world’s population]
6. Therefore, a purely binary gender theology and ethic are not correct.
That is unworkable. It’s analogous to the saying in the legal profession that “hard cases make bad law.” It’s better to deal with the rare situations on a case-by-case basis rather than trying to have a rule, or law, or theology that tries to include very improbable situations.
It is interesting that you advocate for the higher figure. If a theology has to cover all cases as you argue, no matter how rare, the incidence should make no difference.
Your second hidden assumption is that because they can both fit into a very broad category, one can generalize from the incidence of intersex biology to situations involving gender dysphoria. That is like trying to make generalizations from motorcycles to bicycles. They both fit into some of the same broad categories, but there are a lot of differences. Making broad, generalizations from motorcycles to bicycles, or vice versa, could lead to bad results eg. motorcycles can go on freeways so bicycles should too.
Intersex is a birth defect, a biological, anatomical condition like having a cleft palate. It manifests at birth. The child has no knowledge of it, and no say in how it is addressed.
Gender dysphoria is something that occurs later in life, when a person has a sense of self and ideas about what they want. It is based a person’s thinking, not their biology. Some of solutions being offered involve mutilation of normal primary and secondary sexual bodily features, as opposed to surgically correcting birth defects as with intersex children.
Posted by Ralph Dave Westfall | October 17, 2022, 1:58 AMOkay, to address a few points as I don’t have a ton of time right now. The question about the overall % of people who are intersex–I was only pressing that because you are continuing to quite authoritatively assert the number is much lower, while some results make it much higher than you say. That’s it. There’s no hidden discomfort or point I need to make beyond that. I just believe you might have the number wrong, and insisting that you’re right about it. Yes, I understand you have some links to show your position. I haven’t read enough on the topic to speak to it much, other than that what I have read on the topic suggests that many of the things you’re citing are either mistaken or overstating the case.
Regarding the argument itself. The problem with your counterargument (that tough cases don’t disprove the rule) is that this is a matter of, allegedly, objective truth, reality, and theology. So if the claim is that a binary sexual ethic and theology–however that may be composed–is necessary or necessarily true, as I am sure you have also seen many claiming, then that claim has to be falsified purely by the existence of -anyone- who doesn’t match that binary. I understand why this is controversial for you, but I also don’t think your counterargument works at all against it. If the claim is that humans are either A or B, then that’s the claim, right? So the fact that some humans exist who are neither A nor B disproves that claim. You can’t have both “Either A or B” AND “there exists some person such that neither A nor B” both be true. And that’s what a totally binary gender essentialism teaches.
Posted by J.W. Wartick | October 17, 2022, 8:52 PMThank you for continuing this dialog.
Unfortunately you haven’t adequately addressed either of the major points I raised:
1-the implications for theology of the very low incidence of people with birth defects related to ambiguous genitalia, and
2-the problem of trying to generalize from these birth defects to people with gender dysphoria.
First, the following study found 18 out of 14,177 newborns in Turkey had ambiguous genitalia. That’s 0.13%.
https://academic.oup.com/jes/article/3/6/1185/5476580
Note that the 0.13% incidence is at the time of birth. In most cases the parents and medical professionals try to determine the best solution, and then surgery and/or medications are used to correct this situation in the best interests of the child’s development. They don’t always get it right, but it would seem likely such interventions would reduce the 0.13% at birth to a substantially lower level of ambiguity as the child grows up.
You said that “some humans exist who are neither A nor B” based on newborns with ambiguous genitalia. True but that begs the question of how high the incidence rate needs to be to warrant a new theology. Your statement is true even if only two people in the world have ambiguous genitalia. That’s two out of 7.98 billion or 0.00000000025%, which wouldn’t seem enough to add a new theology to well-established existing theologies such as systematic theologies related to human beings (anthropology) and sin (hamartiology), as well as to applied theologies related to evangelization, missions, hermeneutics, homiletics, spiritual formation, pastoral activities, counseling, etc.
QUESTION: What would be a reasonable threshold incidence rate (percentage) that would require a new theology just for and specific to people whose ambiguous genitalia birth defects can’t be successfully corrected, as opposed to subsuming such rare situations under existing theologies?
As for the second point, I previously mentioned the problem of trying to generalize from birth defects to doubts people might develop some years later about their gender. Both are a deviation from a binary categorization, but in most respects they are quite dissimilar. Ambiguous genitalia are objective and usually apparent to trained professionals, and parental inputs are a major factor in treatment decisions. The treatments themselves are generally largely informed by objective data—physical conformation, genetic testing, case histories, etc. Except in situations where corrective efforts are substantially delayed, the subject person’s feelings are not a factor.
Gender dysphoria is much more subjective, originating at a later age in the minds (or perhaps spirits as some would describe it) of people with normal genitalia. Treatment decisions are often based on the feelings of adolescents and supported by some professionals (and opposed by others), even in opposition to parental wishes.
QUESTION: How would you justify generalizing from rare physical birth defects to gender dysphoria? What do they have in common other than simply being deviations from a binary categorization?
I’m looking forward to more discussion on this subject.
Posted by Ralph Dave Westfall | October 28, 2022, 3:08 PM