Even if we were to believe that a course of medical mutilation could make someone happier, this therapy seems often not to be therapeutic. A large number of those who undergo sex reassignment, as many as one in four by some estimates, pronounce themselves unhappy with the procedure. Dr. McHugh in a 1992 essay wrote about its long-term consequences: “Age accentuates the sad caricature of the sexually reassigned and saps their bravado. Some, pathetically, ask about re-reassignment.” Dr. James Bellringer, a British physician who has performed hundreds of sex-reassignment surgeries at the Charing Cross Hospital gender-identity clinic, points out in defense of the practice that about one-fifth of those who are denied the procedure attempt suicide; but a study conducted by the British National Health Service found practically identical — 18 percent — suicide-attempt rates for those who had undergone the procedure. (Mr. Avner, whose feline transformation also took a toll on his personal life — “Being a tiger is more important to me than humanity, which is difficult for many women to cope with” — was found dead of an apparent suicide.) The Aggressive Research Intelligence Facility, which advises the NHS on the effectiveness of treatments, conducted a broad review of the research literature and “found no robust scientific evidence that gender reassignment surgery is clinically effective,” according to the Guardian, the liberal newspaper that commissioned the review. A study by the scholarly journal BJUI (formerly the British Journal of Urology) found that some 24 percent of those who undergo reassignment reported that they were unhappy with the cosmetic results, and 20 percent reported that they were in general dissatisfied with the procedure. Those numbers would be high for nose jobs or breast implants; they are sobering for a course of therapy that involves elective amputations.
On that subject, elective amputations of healthy arms and legs are quietly offered as “treatment” for something we are expected to call Body Identity Integrity Disorder, which is “characterized by a burning and incessant desire to amputate an otherwise perfectly healthy limb,” in the words of Mo Costandi, a neurobiologist who writes a science column for the Guardian and advocates the procedure. The stories of these amputees trapped in amputationless bodies will sound familiar. “To date, there have been approximately 300 documented cases of BIID,” Mr. Costandi writes. “Most of these are male, almost all of whom desire amputation of a limb on the left side of the body. More often, it is the arm that is affected rather than the leg. All of these so-called ‘wannabe amputees’ know exactly where they want the limb to be cut off, to the millimetre, and almost all of them remember seeing an amputee at a very young age and thinking that they should have been born like that themselves. ‘When I was 3 years old, I met a young man who was completely missing all four of his fingers on his right hand,’ said one 21-year-old female BIID sufferer, ‘and ever since that time I have been fascinated by all amputees, especially women amputees who were missing parts of their arms and wore hook prostheses.’” Another patient says, “My left foot is not part of me.” (But it is.) There is a sexual component in many (but not all) of these voluntary amputations, a fetish documented as far back as in Richard von Krafft-Ebing’s Psychopathia Sexualis (1906).
As with the invention of “personhood” in the abortion debate, we have created a metaphysical category — “identity” — in order to avoid talking about physical reality. In the case of sex-reassignment surgery, it is gender identity; in the case of those who want their left legs removed, it is body-integrity identity. The latter may seem shocking and exotic, but the former is no more defensible. But the question of sex reassignment is linked rhetorically and politically to the question of gay rights, though homosexuality is an entirely distinct and separate phenomenon under the emotional shadow of civil rights. It is a measure of the intellectual degradation of our times that the physical reality of these cases is considered, if it is considered at all, a distant second to the subjective impressions of people who are, not to put too fine a point on it, mentally ill and in need of treatment.
We cannot think because we cannot speak. Having lost the words for things, we lose the things themselves. The word “gender” as a replacement for the word “sex” is a new development in the English language, dating from the early 1960s, not coincidentally the period during which the normalization of sex reassignment began to gain real momentum. “Gender” is a linguistic twin of the word “genre,” the two descending in parallel from the Latin “genus” via the Old French “gendre.” This was partly the natural evolution of the language — as the word “sex” began to denote erotic acts themselves, there was an opening for a word to describe the categorical differences between the male and the female. But it is not an accident that a literary term received the promotion over a scientific one: “Gender” overtook “sex” linguistically at the same time that “gender,” which denotes male-female differences that are, in the debased language of the time, “socially constructed,” overtook “sex,” which denotes male-female differences that are biological, as a guiding consideration. Every battle in the war on reality begins with the opening of a new linguistic front.
That leaves us in the unhappy position described by Dr. McHugh: “The zeal for this sex-change surgery — perhaps, with the exception of frontal lobotomy, the most radical therapy ever encouraged by twentieth-century psychiatrists — did not derive from critical reasoning or thoughtful assessments . . . [but from] the ‘illusion of technique,’ which assumes that the body is like a suit of clothes to be hemmed and stitched to style.” And not just the body: The family and society are as much the products of evolution as the body is, and attempting to reconstruct them in the image of the Venus de Milo — arms optional — with contempt for the underlying reality will yield ghastly results.