What the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-4) called gender identity disorder, the DSM-5 now calls gender dysphoria.  Gender dysphoria is not a synonym for terms such as transgender, transsexual, genderfluid, gender bending, transvestism or intersex.  Instead it refers to “experiences of gender identity in which a person’s psychological and emotional sense of themselves does not match or align with their birth sex” (p 19).  The psychological world has no concern about those with gender dysphoria unless it causes significant stress.  At that point it is considered a condition needing treatment and is capitalized as gender dysphoria (pp 19, 85-100).

The author, Mark Yarhouse, has his PsyD from Wheaton College and is now a professor of psychology at Regent University and represents the Christian psychological approach that, at best, could be described as integrationalist.   Yarhouse’s views depend primarily on research and psychological analysis rather than Scripture, which is seldom referred to and never actually engaged throughout the book.

Yarhouse does not see gender identity issues, such as transgender, as sin issues (p 25) and believes those acting out gender dysphoria, including homosexuality, can be Christians (pp 40, 54, 58, 81, 115).  This is partly because most deny we do not know what causes gender dysphoria, or any of the related conditions (pp 11, 61-83).  In addition, Yarhouse does not think people choose to be gender dysphoric (pp 61-65).  For this reason, the author believes, those with sexual identity conditions should be welcomed by Christians (pp 43-44).  Yarhouse criticizes the church for causing gender fluid people to feel rejected (pp 54, 56, 126, 153), and offering them little understanding and ministry (p 147).

Perhaps Yarhouse’s main contribution to this subject is identifying four distinct lenses from which gender dysphoria can be viewed.  The lens used will determine how one reacts to all gender identity issues (pp 46-60, 122):

  • The integrity framework upholds the sacred integrity of maleness and femaleness. This would be the view held by most conservative Christians, yet the author believes it shows no compassion and will be misunderstood by society (p 153).  It is a formula for shame (p 56) (he does not discuss guilt), rejection and legalism (p 142, 157-158) and perpetuates stereotypes (pp 133-135).
  • The disability framework sees gender dysphoria as a disorder (as the DSM-4 did), most likely a brain disorder that needs to be treated psychologically (pp 48-50).
  • The diversity framework celebrates, honors and reveres all form of gender dysphoria. This is obviously the direction western culture is headed.  The author distinguishes between a strong form of the diversity view which seeks to deconstruct society and force everyone into its way of thinking, and the weak form which simply wants gender dysphoric people to be accepted and welcomed.  He believes that most in our culture take the weak form today (pp 50-53, 155), but that could be debated.
  • The integrated framework attempts to combine the best of the other three while eliminating the less desirable features. How this is actually worked out is highly subjective, but is the lens Yarhouse prefers (pp 53-57, 160-161).

The two concluding chapters address how Christians should respond to gender dysphoric issues.  Chapter six addresses the individual who is told to work with gender dysphoric people by accepting them rather than try to change them.   In essence any attempt to do otherwise can be reduced to stereotypical legalism (pp 157-158).  Chapter seven considers the Christian response on an institutional level, which the author admits is messy (p 148).  Yarhouse believes the traditional church focuses on behavior ® belief ® belong, when it should focus on belong ® believe ® become (p 147).  In other words, gender dysphoric people, however that is expressed, are to be accepted by the church and led to correct beliefs which causes them to “become.”  But since behavior has been eliminated from the equation, what they become is left undefined.  This is especially true since gender dysphoric people are to be accepted but not changed (pp 157-158).

Yarhouse presents a position on sexual gender identity issues that, while rejected historically by most cultures, is rapidly becoming the norm in society and is creeping into the church.   He offers only three pages (pp 120-122) presenting an alternative (more traditional) view.  Here he quotes a researcher who suggests that “psychiatry has essentially catered to individual preferences and cultural pressure.” He likens sex reassignment surgery to liposuction on anorexics.  Anorexics have departed from a realistic view of their bodies, seeing themselves as overweight even as they starve themselves.  Similarly gender-confused people have a distorted view of their sexuality and “more effort should be placed on prevention and management of gender dysphoria…[and treated as] a mental disorder when we fail to prevent it (p 121).   Beyond these comments Yarhouse offers little criticism of gender dysphoric conditions.  He agrees that Scripture is a reliable guide, but so is culture (pp 29-30).  It is obvious that, in his thinking, culture, psychology and secular research trump Scripture.  Perhaps this is so because, as the Barna group points out, the traditional evangelical view on these matters is facing a rising tide of public opinion in the last ten years and is getting worse.  If the church continues to stand by the biblical teaching of sex and gender it will be seen as discriminatory and bigoted (pp 23-24). Most likely Barna is right, but God’s people have always been countercultural and we must side with God against culture, whatever the fall out.

Understanding Gender Dysphoria provides a solid understanding of gender identity issues in our society today and how they are viewed by the psychological community.  It is helpful on this level.   As a biblical guide to how God’s people should view and respond to gender dysphoria however, it is of virtually no value, unless one is looking for a way to ignore God’s Word.

Understanding Gender Dysphoria, Navigating Transgender Issues in a Changing Culture by Mark A. Yarhouse (Downers Grove, Illinois: InterVarsity Press, 2015) 183 pp., paper $16.50

Reviewed by Gary E. Gilley, Southern View Chapel