Mia Hughes begins her recent essay, “Trans Is a Mental Disorder,” with a deliberately provocative observation: Western society has normalized the idea that otherwise healthy people may require hormones, surgeries, and even the removal of healthy body parts in order to become psychologically whole.
For Hughes, the question is obvious: How did something once understood as evidence of psychological distress come to be regarded as a healthy expression of personal identity?
Her answer is that transgender medicine underwent a process of depsychopathologization. Rather than locating the problem in a person’s relationship to his or her sexed body, the emerging gender-affirming model increasingly located the problem in the body—or in society’s refusal to affirm the individual’s internal identity. Hughes argues that this transformation was heavily influenced by activism and eventually institutionalized in medicine, law, education, and popular culture.
Hughes then proposes a psychiatric category she believes helps explain the phenomenon: the overvalued belief.
An overvalued belief is not quite a delusion. The person may remain intelligent, competent, and perfectly rational in most areas of life. Nor is it an obsession, because obsessive thoughts are normally unwanted. Instead, an overvalued belief is deeply embraced. It becomes intertwined with identity itself and can eventually dominate how someone interprets reality.
Hughes compares the phenomenon to anorexia or body dysmorphic disorder. The sufferer may become convinced that some aspect of the healthy body must be changed. The conviction becomes so powerful that medical alteration appears not merely reasonable but necessary.
“Imagine a group of powerful, well-connected anorexics gather and formulate a plot to reject the psychiatric framing of anorexia and turn their illness into a healthy identity. They make it discrimination and bigotry to call anorexia a mental disorder and frame access to liposuction and Ozempic as medically necessary and a human right. The whole world goes along with this. In the field of anorexia-affirming care, an anorexic receives immediate affirmation of her anorexic identity and unfettered access to the weight-loss medical treatments that her disorder demands.
No psychotherapeutic attempt is made to loosen the grip of the belief.
Then, instead of measuring success by objective outcomes such as physical health and quality of life, researchers in the field opt for self-report: in other words, after giving the anorexic the very treatments that her disorder compels her to seek, the researchers ask her if she is happy. When she says yes, this confirms that Ozempic and liposuction are beneficial and appropriate treatments for anorexia. That is the medical world’s current approach to managing the trans phenomenon. Read how this madness happened in my first essay of @Genspect’s REPATH series.”
Source: Trans is a Mental Disorder
Hughes’s analogy is intentionally jarring. But that is precisely why it is useful. It forces us to ask whether compassion requires affirming a person’s interpretation of his or her body—or whether genuine compassion requires challenging that interpretation. And for Christians, this question reaches deeper than psychiatry or medicine. It takes us directly into the biblical doctrines of creation, embodiment, truth, and ultimately the nature of spiritual deception.
The Body Is Not an Accident
The biblical worldview begins somewhere very different from modern expressive individualism.1Expressive individualism is the modern conviction that our deepest identity is found within our inner psychological self, and that authentic living requires expressing that inner identity outwardly and having it recognized by others. This helps explain contemporary sexual and gender ideology because the inner self is granted greater authority than the body. If the body and the psychological self appear to conflict, expressive individualism tends to say that the body must yield to the self.
“Male and female he created them.”
Our bodies are not raw material handed over to an ‘autonomous’ self that stands above them. The body participates in who the person is.
Abigail Favale of Notre Dame puts the matter helpfully when she describes male and female as two embodied ways of being human. Sexual difference is not merely a collection of stereotypes about personality. It is rooted first in the body itself. Men and women are equally human, equally bearers of the image of God, yet their bodies are meaningfully different.
Christianity therefore cannot accept the idea that the deepest self is somehow trapped inside the wrong body. That anthropology is remarkably close to the ancient dualisms Christianity rejected from the beginning (Gnosticism).
Creation matters.
The Incarnation matters.
And bodily resurrection matters.
God does not rescue human beings from embodiment. He redeems human beings as embodied creatures.
And Then There Are the Powers
But the biblical worldview goes further still.
Scripture does not describe evil merely in terms of mistaken ideas, psychological dysfunction, social systems, or individual sin. It also speaks about unseen powers—“principalities,” “powers,” “rulers,” and “authorities”—that work against God’s purposes for creation.
That does not necessarily mean that a person experiencing gender dysphoria is demon possessed. Nor should Christians casually assign demonic explanations to individual psychological suffering.
The point is larger.
The Bible tells us that deception itself has a supernatural dimension.
Spiritual warfare is fundamentally “a conflict between what is true and what is false.” The serpent’s strategy in Genesis 3 is not to create an entirely imaginary world. It is subtler. He takes what God has made and reframes reality, mixing truth with falsehood until human beings begin distrusting what God has said and what God has made.
That pattern should sound familiar.
“You will be like God,” the serpent says.
In other words: you may determine reality for yourself.
The modern version is remarkably similar:
My identity is constituted by my inner consciousness,
and my body must conform to the identity I declare.
At that point we have moved beyond a debate about pronouns.
We are dealing with anthropology.
We are dealing with creation.
And ultimately we are dealing with authority.
Who gets to say what a human being is?
Idolatry and the Autonomous Self
One of the fundamental axioms of Biblical Theology is that human beings become like what they worship. Humanity was created to image God, but idolatry distorts that image. Instead of receiving reality from the Creator, fallen humanity turns toward created things—and ultimately toward the self.
The modern ‘autonomous’ self can therefore become an idol.
The self no longer receives identity as gift. It manufactures identity through will.
The body says one thing.
The ‘autonomous’ self says another.
And increasingly the surrounding culture is required to declare that the self is right and the body is wrong.
That is why this controversy reaches far beyond the relatively small number of people suffering profound gender distress. It asks every one of us to embrace a particular understanding of reality: that personal identity originates primarily in subjective consciousness rather than in the created body.
From a biblical perspective, that reversal should trouble us deeply.
The People Are Not the Enemy
There is one final Christian qualification that is essential.
Paul tells us explicitly that “our struggle is not against flesh and blood.”
The transgender person is not the Christian’s enemy.
The confused teenager is not the enemy.
The frightened parent is not the enemy.
Even the activist advancing ideas we believe profoundly mistaken is ultimately not the enemy.
The Christian diagnosis of reality is simultaneously more severe and more compassionate than that.
Human beings can become caught inside lies larger than themselves. Institutions can reinforce those lies. Cultures can normalize them. And behind the biblical drama stands an older rebellion in which dark powers seek to deform God’s good creation by separating humanity from truth.
Yet Christianity does not end with the powers.
It ends with Christ.
The New Testament announces that Christ has already confronted, disarmed, and defeated the principalities and powers. The answer to deception is therefore neither hatred nor surrender.
It is truth joined to love.
We should have enormous compassion for people who experience anguish about their bodies. But compassion cannot require us to say that creation itself is mistaken.
Sometimes love means accompanying suffering.
Sometimes it means refusing to participate in a falsehood.
And sometimes the most compassionate sentence we can speak is very simple:
Your body is not your enemy.
+++
Truth in Love