Initially, it may seem that the answer to the question that forms the title of this brief reflection would depend on the way one chose to define the first term. Thus, if we accept the definition offered by the Trump administration’s executive order, namely, that transitioning is the “chemical or surgical mutilation of the body,” the answer would be fairly clearly “no.” But if one defined the term as “bringing one’s biology into alignment with one’s gender,” or perhaps apparently more neutrally as “changing one’s bodily expression of sex with the means provided by medicine,” the answer may seem more ambiguous. In this respect, one might believe that the matter is essentially decided by who gets to define terms, which is to say that it is defined by power.
But I would like to propose that the key term is not the first, but the second, “healthcare,” and that reflecting on the proper meaning of this term brings us beyond the realm of power and into the more fundamental realm of ontology. From this realm, I suggest, a response to the question becomes much more straightforwardly evident.
What is healthcare? It is the care—which is to say the activities, treatments, procedures, and so forth, ordered to the cultivation or restoration—of health. But how do we know whether the care we take in one instance or another actually promotes health? In his engagement with the novel science of “economics” in the late 19th century, the English writer John Ruskin insisted that we needed a word to contrast with the word “wealth” which would indicate an accumulation of possessions that did not conduce to well-being but instead to corruption. He proposed the word “illth.” We might say that the word suits even better the cultivation, through artificial means, of a physical condition that does not promote, but rather thwarts, human flourishing. So the basic question we need to ask is, how do we distinguish “healthcare” from “illthcare”?
We can receive some light from etymology. The word “health” comes from the Old English haelp, the root of hale, related most directly to “whole” (in the sense of “sound,” “intact,” or “well”), but also to the words “holy” and “hallowed.” To be healthy is to be “whole,” integral, not just to feel
good about oneself in spite of whatever state one actually happened to find oneself, but to be in a good condition. We all recognize, for example, that the use of drugs to produce a feeling of well-being can often be especially destructive of one’s health.
If we consider the question in the title from the perspective of health understood according to its roots, the answer is clear: insofar as “transitioning” means changing a body’s “phenotype” to express the contrary of its “genotype,” then, however much it may bring a body at least on the surface closer to alignment with one’s feelings or desires, it quite obviously undermines the integrity of the body, and so the person. Quite objectively, it cannot be said to bring about “wholeness,” which is to say, “health.” The issue in pharmaceutical or surgical “transitioning” is not the apparently violent medical intervention itself, because, as we know from the need to amputate under certain circumstances, a compromise of bodily integrity in a certain respect may be required to sustain integrity in a more basic sense. Amputation allows the body to survive, which is to say to maintain a kind of wholeness even if it is a compromised or wounded sort of integrity; transitioning, by reversing one feature or another, or more specifically the outward expression of sexuality in indifference to its actual reality, straightforwardly contradicts wholeness.
In addition to (and indeed by virtue of) its enabling the continuance of the human race, sexual difference is even more basically a symbol of our relation to reality.
Let us explore this last point in more depth. Although sexual difference comes to its most direct expression in the genital organs (which is why these are the principal “target” of surgical intervention in transitioning), that difference pervades the entire body. We all know that the difference is inscribed in every cell of the body insofar as it lies in the chromosomes that are present in each cell. But we are learning, increasingly, that this presence does more than simply signal the construction of those discrete organs in the embryo’s development. Instead, they bear on every part of the body and the body as a whole. There are the evident differences in typical body structures, bone shape, weight distribution, and so forth, that are formed in a basic way by one’s sex. A knowledgeable person can determine the sex of an ancient murder victim by looking at the skeleton. But there are also more subtle differences in the way all of the body’s systems operate, in the size, structure, and placement of the organs, the “wiring” of the brain, and so forth, to such an extent that doctors are now coming to realize that the medical standards and practices assumed for centuries have been “sexist,” mostly unconsciously, to be sure, extrapolating from male models diagnoses and treatments ill-suited to women. (For my part, I would venture to guess that, if we had precise enough equipment and properly designed experiments, we would discover that the very cells communicate differently with each other in men and women.) Any procedure that changed only discrete organs or systems would in this respect set the body in opposition to itself, and of course it is impossible for a procedure to do anything but treat discrete systems. Transitioning is therefore not an instance of healthcare, but of “illthcare.”
But we can go still deeper. In the field of philosophical anthropology, the question of where the determinative “locus” of sexual differentiation most fundamentally lies remains a matter of dispute: is it a matter of the body or is it a matter of the soul? While arguments continue to be made on both sides,[1]
there is a growing consensus that the best way to characterize sex or gender is as a modality of the person.[2] Even if there is a material cause of the differentiation, sex never remains merely a matter of matter, so to speak, but is formative of the whole person, body and soul. Aristotle notoriously proposed that sexual difference arises where body and soul meet: in males, the body is adequate to the soul, while in females the body obstructs the soul’s full expression.[3] Disregarding this particular judgment, we can nevertheless retain the essential insight that the differentiation occurs at the very point of union of body and soul in the constitution of the human being. This would account for the formative presence of gender in every part of the body, and indeed, of the psyche more generally. We now know that different patterns of behavior are manifest from the very first hours of a child’s existence—that is, long before any “training” can intervene. As study after study has demonstrated, what it means to be male or female thus comes to expression not only physically, but emotionally, intellectually, and culturally as well, which is to say, at every level of human being. Understanding the matter in this way reveals that “gender” is not a social construct but arises right at the very core of our being. The distinctive implications and tasks that follow upon being a man or a woman inevitably impress themselves on us in natural and spontaneous ways: I cannot think about what it would mean to live a complete, a meaningful and fulfilling life without implicitly or explicitly conceiving that in a “gendered” mode: I think about being a good man, a good father, a faithful friend specifically to the men and women with whom I am close, in a way appropriate to each.
In this respect, to “change” the surface appearance of sexuality through artificial means is to contradict not only the health of the body but the health of the person. This is a more radical dis-integration.
But there is even a further step to take. It is interesting to note that the rise of the “transgender” phenomenon has been so commonly experienced as a “crisis of meaning.” There are many moral questions of extraordinary gravity in the public sphere—abortion, for example, or the sexual abuse of children—but none that so immediately raise doubts on what we might call our “grip on reality”: we have begun to despair about whether we are losing our capacity to see things for what they are and to say them as we see them. However disturbing it may be, we are no longer shocked when public figures deny the evidence “right in front of their very eyes” when it comes to matters of sex and gender.
It is not at all an accident that the word “gender” is so frequently paired with the word “ideology”: ideology is a system of thinking that not only fails to subordinate itself to reality according to what the scholastics called the “adaequatio intellectus et rei” (the “joining together” of the mind and the thing); even more radically, it does not even take such an “adaequatio” to be the aim of thought, but instead reconceives thinking in purely pragmatic terms as the promotion of a particular political program. Ideology imposes
ideas instead of conceiving them. The affirmation of “gender identity” as something created ad libitum goes hand-in-hand with the promotion of an ideology, insofar as both take for granted an essential detachment of the human spirit from the real. There are many reasons one might offer to explain the connection between the transgender phenomenon and despair regarding our capacity to know, to achieve communion with what is real; I propose that one of the basic reasons is that, in addition to (and indeed by virtue of) its enabling the continuance of the human race, sexual difference is even more basically a symbol of our relation to reality.
In the Wednesday Catecheses that he delivered in the first couple decades of his pontificate,[4]
St. John Paul II famously described the body as the symbol of the person, meaning that the sexual organs bore witness to our being ordered to each other in love, an ordering inscribed in our flesh. The word “symbol” is more fitting than one might initially realize in this context: etymologically speaking, the word “symbol” literally (!) means a “joining together” (sym-ballein). From this perspective, there is a certain irony in connecting the words sex and symbol, since the word “sex” appears to come originally from the verb “secare,” to cut, divide, or bifurcate. The word “sex” came into use to describe the division of a species into male and female. But this is a division that is precisely ordered to unity: the difference is what makes possible a proper joining together of two into one, in contrast to a mere juxtaposition of beings that are alike or a repetition of the same (Greek: homos). (Incidentally, “homosexuality” is a monstrosity of a word, invented in the 19th century, not only because it is a cobbling together of Greek and Latin roots, but more profoundly because it represents a self-frustrating contradiction: etymologically, it means a division that is not actually a division.)
In a sense, sexuality is the very paradigm of the symbol, the “joining together.” As far as I know, the word “symbol” appears only once in Plato’s dialogues: namely, in the well-known story recounted by Aristophanes in the Symposium. According to the myth Aristophanes (or perhaps Plato) invented to explain the phenomenon of eros, human beings were originally spherical, with two heads, four arms and four legs. But because of their completeness in themselves, their inner perfection, they became self-satisfied and haughty. Zeus therefore contrived to humble them by cutting them in two (secare!). This is the origin of love: a desire of each to find its “other half,” and thus to be restored to unity. In this account, Plato states that every person is a “symbol of man” (anthropou symbolon, Symposium, 191d), alluding to the “tesserae hospitalis” in the ancient ritual of friendship wherein a bone or potsherd was broken in two in order to commemorate the founding event, and the two parties took a piece with them. These “symbols” represented the capacity to renew the friendship at any moment in the future through the reunification (sym-ballein) of the pieces. The friendship thus remained implicitly present in the symbol.
By calling the person a “symbol of man” specifically in reference to the sexual organs, Plato was implying that the sexually-differentiated body was a reality that made the unity of man present, so to speak, in the flesh.[5] The Neoplatonic tradition that followed Plato opened up a more cosmological dimension in this symbolic representation. According to Plotinus, the desire for sexual union is the manifestation in the body of a desire for the transcendent unity from which all things come and to which they are destined to return. In other words, it is a specifically bodily expression, a physical image, of the desire for God. Sexual difference in this respect is a symbol of the cosmic friendship that Plato says is the most fundamental reality of the cosmos.
The Swiss philosopher Jean-Jacques Rousseau evoked something of this vision in a more modern context in his Emile, which is a fictionalized treatise on education.[6] However we might go on to judge Rousseau’s particular notion of education, it is incontrovertible to say that this was a ground-breaking book in the sense that it explored the psychological dimensions of education more carefully than anything written before. In his account, Rousseau identified the moment of puberty as the most dramatic and decisive moment—the “moment of crisis”—in a child’s education, and he did so for a very interesting reason.[7] For Rousseau, the fundamental aim of education is, in a nutshell, to reconcile the self and the other, which is to say to bring the child into a harmonious relation to the world, to teach him to connect with the other, so to speak, without losing his own self. Puberty is the essential moment, to his mind, because it represents what he calls the “second birth”: if our first birth is our entry into the world, in puberty we are awakened to the other precisely as other.[8] We can think here of the essentially dichotomous nature of sexual difference. Rousseau believes that this dawning of awareness of the “other sex” is an effective paradigm of our awareness of otherness tout court. It represents a key moment in education because in the original experience of the other in puberty the child establishes a pattern that will accompany him for the rest of his life.
It has to be acknowledged that Rousseau’s recommendation for how best to navigate this original encounter with the other is rather perverse: he suggests that a child entering puberty should be taken repeatedly on tours of a hospital to witness suffering, so that his first and formative experience of otherness would reinforce his superiority and thus never allow otherness to threaten him with a sense of alienation.[9] In other words, it was crucial for Rousseau that a child’s primal experience of otherness should occur in the mood of pity rather than that of envy. It does not seem to occur to Rousseau that one might experience otherness in the mode of love and gratitude: “The Father is greater than I.” But in any event, setting aside his specific proposal, there is a remarkable insight here: namely, that the relation to the “other sex” is not just one relation among many but is a paradigmatic expression of relation to otherness as such. Sexual difference is, in other words, a symbol of one’s relation to the world, the whole of reality, to all others (and even to oneself), and ultimately to God. It is for just this reason that matters concerning the meaning of sex and gender provoke such strong reactions one way or the other: we all sense, rightly, that there is quite a bit at stake in what some try to trivialize as just what takes place in the privacy of the bedroom.
More than a century later, Sigmund Freud elaborated an insight similar to Rousseau’s but worked out at a more fundamental and comprehensive level, though again within the limits of a profoundly impoverished anthropology.[10] For him, the reckoning of self and other begins, not in adolescence with the onset of puberty, but from the very first moments of existence, specifically in relation to the mother and the father. Arguably, Freud was operating with a univocal sense of sexuality, and so did not sufficiently recognize the (properly analogical) difference between post-pubescent sexuality, which is ordered to bodily union and procreation, and sexual difference simpliciter, which is the manifestation of the twofold unity of human existence. But he was nevertheless able to recognize the comprehensive significance of this differentiation, and attain insights that can continue to illuminate and inform our sense of child development. To say it again, Freud, too, reveals that sex and gender are the real symbol of man’s relation to the world; our relation to the “other” sex is a paradigm of our relation to the whole of reality.
If we return to our opening question in the light of the foregoing reflections, we begin to see how deeply it reaches. If transitioning is the medical reversal, through artifice, of some of the bodily aspects of sexual difference, it is not only contrary to healthcare in the proper sense of the term (i.e., the restoration and preservation of the wholeness of the human being), it is the very paradigm of “illthcare”; it is arguably the most radical opposition to healthcare conceivable. One might object that euthanasia is the most extreme contradiction, since it is the deliberate medical destruction of health, but the argument here is whether it is more radical to eliminate a thing altogether or to reverse it as fundamentally as one can while keeping it in existence. In any event, however well intentioned, however much it is proposed as a way to relieve what is clearly excruciating suffering, transitioning cannot but set a person in opposition to himself in a radical way insofar as it does violence to what lies at the core of his being, of his very personhood. Indeed, we have come to see that this intervention not only sets one in opposition to oneself, but symbolically in opposition to the world more broadly; it severs communion with the real. The etymological opposite of the word “symbol” is “diabolical,” from dia (across or against) and ballein (to throw or cast). This novel approach to the profound challenge, the tragedy, of “gender confusion” can be said to be diabolical in many senses of the word: it not only sets a person at odds with reality, it does so with the deceptive promise of regaining unity, and it propagates rifts and confusion beyond the individual and into the community more broadly. It undermines the reliability of words, the very thing in which individuals join together as rational animals. In this respect, the transgender phenomenon affects everyone and calls us to recover a genuine understanding of the meaning of health, and of sexuality.
[1]See, for example, John Finley, “The Metaphysics of Gender: A Thomistic Approach,” The Thomist (October 2015): 585–614, and William Newton, “Why Aquinas’s Metaphysics of Gender is Fundamentally Correct: A Response to John Finley,” The Linacre Quarterly 87 (2) (2020): 198–205.
[2]See, for example, Antonio Malo, Transcending Gender Ideology: A Philosophy of Sexual Difference
(Washington, DC: CUA Press, 2020), and Mark Spencer, “A Trinitarian Metaphysics of Man, Woman, and Priesthood,” Proceedings of the American Catholic Philosophical Association, forthcoming. This is also the language Finley proposes in the article cited above, and for which I give a sustained argument in “Perfect Difference: Gender and the Analogy of Being,” Communio (Summer 2016): 194–31.
[3]Aristotle, On the Generation of Animals, book IV, chapters 1–2.
[4]John Paul II, Man and Woman He Created Them: A Theology of the Body (Boston: Pauline Books and Media, 2006).
[5] To be sure, Aristophanes’ story seeks to account not only for the natural pairing of man and woman but equally for the male-male and female-female pairings common in Greek culture. There is no room here to make the case that, Plato, for his part, seeks precisely to critique this Greek practice in his Symposium, but such a case can be found in my essay, “Plato and the Problem of Love: On the Nature of Eros in the Symposium,” Apeiron 40:3 (2007): 199–220. In any event, that critique is already implicit in Aristophanes’ own story: neither do male bodies “fit together” (sym-ballein) with other male bodies, nor do female bodies with other female bodies. Only man and woman properly fit together; only they are actual symbols in the original sense of the term Plato’s Aristophanes himself employs.
[6] Jean-Jacques Rousseau, Emile, or On Education (New York: Basic Books, 1979).
[7]Emile, book IV.
[8]“We are, so to speak, born twice: once to exist and once to live; once for our species and once for our sex” (Emile, 211).
[9]“If the first sight that strikes him is an object of sadness, the first return to himself is a sentiment of pleasure” (Emile, 229). On this, see 223ff.
[10]Sigmund Freud, Three Essays on the Theory of Sexuality (New York: Basic Books, 2000).
