 I am Dr. Andrew Sodergren. I am a Catholic psychologist, a clinical psychologist. I work with an organization known as the Royal Woods Institute. We are a theology of the body, education, and healing apostolate in Cincinnati, Ohio. I have been director of psychological services there for 12 years. We're going to be talking today about sexual identity, about how we become man and woman, and how that process can go awry. And sadly, it does go awry for many young people today, and some thoughts about healing for those individuals. There are some handouts that go with this talk. So make sure you get a copy of those. There are two handouts, one that has a copy of all the slides and one that has an extensive list of resources. So if you don't have one, make sure that you let the helpful staff members know, and they will provide those for you. OK, but let's go ahead and dive in. This will be review likely for everyone in this room, but I still find it an important starting point. When we jump into a difficult area, such as all of this confusion going on right now about sexual identity and gender, we need to make sure we have both feet firmly planted in the truth, the truth that flows from our Catholic faith. And so let's begin just by highlighting a few key principles from Catholic anthropology that are absolutely vital for us if we're to navigate this terrain safely. First principle to keep in mind is that man is a creature. This seems so obvious, and we take it often for granted. But the idea of being a creature is pregnant with meaning and is very significant for this whole debate. Because we are a creature, this means that we come from somewhere, or more precisely, we come from someone. We receive our being. We receive our nature from our creator. We don't create ourselves. And so the kind of creature that we are, even the fact that we exist, is something that is given to us. It's something that we receive. And then something we are called to respond to and hopefully collaborate with the will of the creator. But first, we must always bear in mind this idea of being a creature, that we receive our being, our nature, our very lives from God as a gift. Next, we must keep in mind that man is always a unity of body and soul. This is so essential. It's, in a certain way, touches the heart of what it means to be human. Human beings, in a certain sense, are the only creatures in the cosmos specifically designed to unite the spiritual level of persons with the material creation, to bring and integrate these two levels of creation together in a unique way. As John Paul II said, man is an incarnate spirit, a soul which expresses itself in a body and a body informed by an immortal spirit. The Second Vatican Council taught, though made of body and soul, man is one. Through his bodily composition, he gathers to himself the elements of the material world. Thus they reach their crown through him and through him raise their voice in free praise of the creator. The body is not a shell, nor is it a mere instrument. It is integral to who I am. We're always meant to be incarnate beings. This is so fundamental. It even pertains to our end. We, as Catholics, can sometimes forget that the ultimate end of man is not to be a disembodied spirit in heaven, but to be incarnate once again in the resurrection of the body. Even the separated soul, in a certain sense, says Aquinas, is not fully me. It's an intermediate state. The separated soul awaits for the resurrection of the body so we can be whole with God for all eternity. The U.S. Bishops Committee on Doctrine has done us a great help, a great favor in addressing the confusion around gender. In their recent document, it's called The Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body. It's kind of a mouthful. But they released this document in March from the Committee on Doctrine. And on this point of body-soul unity, the Bishops wrote this, the soul does not come into existence on its own and somehow happen to be in this body as if it could just as well be in a different body. A soul can never be in another body, much less be in the wrong body. The soul only comes into existence together with this body. What it means to be a human person necessarily includes bodily-ness. What they're getting at there is the idea of the soul as the form of the body, the animating principle of the body. Okay, this body is what it is only because of the soul that animates it. The soul can't be in the wrong body because the soul is what makes this body be what it is. To be in a different body would mean somehow you would need a different soul, basically. All right, body and soul are so united. We can't really separate them. When we separate them, that's what we call death. Another key principle to keep in mind and here we can appeal to the great St. John Paul II is that man is sexually differentiated. That we exist always in the dichotomy of male and female. St. John Paul II reflected on Genesis 127. So God created man in his own image. In the image of God, he created him. Male and female, he created them. He saw the second half of this verse, male and female, he created them as disclosing something, saying something about what it means to be in the image of God. So how does that work? Well, traditionally, of course, we've thought of being in the image of God as pertaining to our intelligence and our freedom, which is true and JP2 affirmed that again and again. But what he's saying is that there's something more by being sexually differentiated persons. There's another way in which we can image God. Our male-ness and our female-ness are central to this and he developed this in his theology of the body. Essentially, what he describes there is the principle of unity and distinction. He says man, of course, is not nearly an image of a solitary person who governs the universe, but he is the image of a communion of persons, a trinity, who for all eternity exists in an exchange, an eternal exchange of love. In the trinity, we have unity, that there is one divine being, one divine nature, but you have distinction among the persons. And this unity and distinction is what allows this communion, this giving and receiving of love to take place for all eternity. The father for all eternity begets the son who for all eternity receives being from the father and loves the father in response. And their exchange is so real, so perfect, it is personified in the Holy Spirit who traditionally is identified as the love between the father and the son. What John Paul II went on to say, though, was that by way of analogy, we can think of unity and distinction on the human level reflecting this mystery of the trinity. Because at the level of human nature, we have one human nature that we all share, everyone in this room and every human being that has ever existed, participates in the one human nature. But there are two modes of being human, two ways of being human. And we call those male and female. These two ways of being human, one human nature, male and female, two ways of being human creates unity and distinction. That unity and distinction enables us in an embodied way to give ourselves to one another and to receive each other in gift in a way that is so profound that our mutual exchange can be personified in the gift of a child. And so in this way, he said, marriage and family based on this distinction of male and female in the one human nature gives us another way in which we can image God. We can form an icon of the trinity here on earth in an embodied way. He went on to talk about how this difference of male and female affects the whole person. It's not a mere and insignificant afterthought. It's not mere biology as it were, but it affects the whole person. It is true, we discover our maleness or our femaleness in the body. We look to the body and we discover I am male or I am female. But this reveals a reality that touches the very core of my being. We are male or female all the way through not just the exterior. The catechism even affirms this in 2332. Sexuality affects all aspects of the human person in the unity of his body and soul. JP2 said that sexuality is constitutive for the person, not merely an attribute of the person. It's constitutive for the person. It's as if he's saying the person is male or female. It's not merely a quality, not merely an afterthought, not merely something as accidental as the color of my hair. It's something much deeper than that. Cardinal Ratzinger, when he was prefect of the CDF, wrote a beautiful document on the collaboration of men and women in the church in the world. If you've never read it, I highly recommend it. It's a short document and it's a wonderful synthesis of much of what John Paul II had to say about male and female. In that document, he wrote this, the importance and the meaning of the sexual difference as a reality deeply inscribed in man and woman needs to be noted. Sexuality characterizes man and woman not only on the physical level, but also on the psychological and the spiritual making its mark on each of their expressions. It cannot be reduced to a pure and insignificant biological fact, but rather is a fundamental component of personality, one of its modes of being, of expressing and of living human love. So sexuality affects the whole person. Our maleness and femaleness furthermore are fundamental to our identity and our vocation. We discover our sexuality in the body. I am male or I am female and this discloses something to me fundamental about who I am. That's identity and who I am called to be or what I am called to do with my life. Identity, I am a son or a daughter of God. Through this set of human parents, through this genealogy, ultimately I am a son or daughter of God. I am called through spousal love to become father or mother. See my sexuality, my maleness or my femaleness helps me situate myself, helps me understand my identity, where I come from and who I am and where I am going. I am a son called to become a father through a gift of spousal love. I am a daughter called to become mother through the gift of spousal love. And this call to spousal love and fruitfulness is universal. It's not only for those who get married, it's for all of us. That the culmination, the maturation, the fulfillment of our maleness is fatherhood in some form. The fulfillment of our femaleness is motherhood in some form. That's what our maleness and femaleness point us toward. There are some basic moral principles that we can already draw from this foundation that I just wanna keep in mind. The first is that we must honor and respect our bodies. Again, going back to the Second Vatican Council, man is not allowed to despise his bodily life. Rather, he is obliged to regard his body as good and honorable since God has created it and will raise it up on the last day. The body is integral to who I am. Therefore, it shares in the dignity that I have as a person made in God's image. It's not something I can despise, it's a gift to be received and cherished. Yet, we are to strive for self-mastery, especially in this regime of sin, the fallen humanity that we all inherit. The same document goes on to say, nevertheless, wounded by sin, man experiences rebellious stirrings in his body, but the very dignity of man postulates that man glorify God in his body and forbid it to serve the evil inclinations of his heart. A couple of quick points about that. The evil inclinations are not of the body per se. The body is not bad, it is not sinful per se. It is where and how I experience evil inclinations that are part of my human nature. Here, I've got an exposition that emanate from the heart, but we have these evil inclinations because of original sin. We experience them in and through our bodies. And so, our bodies and the drives and feelings we experience therein do need to be disciplined. They need to be guided, but they're not evil, they're not bad, they just need correction and guidance like a loving parent would do for any child. We receive our identity as a gift and a task. A human being is not the only one who has a nature, but is the one to whom this nature has been entrusted as a task so that it might be fulfilled through freedom, not merely instinct. One does indeed have to become what one is and so must become a woman or a man. That was Dr. Margaret McCarthy, one of my former professors at the John Paul II Institute in Washington. The idea here is that we receive our identity, we receive our maleness or our femaleness as a gift, but as persons with freedom, we are called to actively receive that and to collaborate with the Creator in developing that, to become men and women capable of fatherhood and motherhood. To put it simply, become who you are. Become who you are. Lastly, all are called to acknowledge and accept the sexual identity revealed by the body. All are called. The Catechism of the Catholic Church says this in 2333. Every one man and woman should acknowledge and accept his sexual identity. And from the context, it's quite clear the Catechism is referring to our maleness or femaleness revealed in the body. And in case there was any doubt that this principle applies to this phenomenon today of gender dysphoria and all the confusion surrounding gender ideology, the compendium of the social doctrine of the church makes it even clearer. Because if you look in the compendium of the social doctrine of the church, they quote this exact line from the Catechism, but they preface it by talking about gender ideology, saying, faced with theories that consider gender identity as merely the cultural and social product of the interaction between the community and the individual independent of personal sexual identity without any reference to the true meaning of sexuality the church does not tire of repeating her teaching. Every one man and woman should acknowledge and accept his sexual identity. So there is confusion in some Catholic circles about whether our faith has anything to say about this whole issue of gender dysphoria and gender ideology. And I hope I've made it pretty clear at this point that our faith has a lot to say about it and has been saying these things for some time. So we have tremendous resources in our faith, we have tremendous resources in our Catholic anthropology to speak to these difficulties and disorders that we're faced with today. So there's no need to feel somehow ill-equipped, we only need to plumb the depths of what the Holy Spirit has already given us through Holy Mother Church, especially thanks be to God through the teaching of St. John Paul II. So let's talk a little bit about sexual identity. What is sexual identity? I'm gonna be shifting now a bit more into psychology, my field. So a popular view today goes something like this, that sexual identity pertains only to the body. It's only biology. Sexual identity is reduced to biological sex. And sometimes you even see this language of assigned at birth. The doctor looked at your body and made a guess that you were male and so you are assigned that at birth. And this is somehow external to the person. It doesn't touch the core of me. In fact, it's viewed as something that is discardable, changeable if needed. It's something that I may or may not identify with and if I don't then I have the opportunity, perhaps even the duty to change it. Whereas gender identity is looked at as a separate reality that has to do with this internal perception of myself, this internal sense of where I am in regard to these categories of male and female or maybe somewhere in between or maybe a little of both. So it's an internal perception of where I fit in relation to those categories. And those categories are based on what I understand those categories to be. So it's entirely subjective and oftentimes based on stereotyped views of male and female, the extent to which I fit in one or the other of these boxes or somewhere in between. But in this contemporary viewpoint, this is regarded as my true self. This is who I really am, this internal sense of me that you can't see, you can't measure, only I can know it. And if you ask some people, it might change from one day to the next. But this is my true self. That's how this thinking goes. I wanna offer a different viewpoint. A viewpoint that sees sexual identity as one thing, but having two components. Let's call one component the objective component. And this pertains to the maleness or femaleness revealed in my body. But remember, even though in a sense I located in the body, I find it, I discover it in my body, it affects the whole person. This is objective because it's verifiable. Others can point to it, we can agree, this is a male, this is a female. They're objective signs. And it's not something that I choose, it's something that is given to me, something that I receive. But there is a subjective component as well. And this has to do with my growing understanding of what it means to be male or female. And my free acceptance of my maleness or my femaleness. That's the subjective component as I see it. My growing understanding and my acceptance of what is revealed by the body. And I would posit that health equals the harmonious integration of these two dimensions. The more these two dimensions live in harmony in me, I would say the healthier that person's sexual identity is. That my subjective sense, my understanding, my free acceptance is in harmony with what my body is revealing. And since that frees me up to be at peace with my body, peace with my sexuality and to collaborate with what is given to me by the creator. Let's talk about how sexual identity develops. Okay, and we're gonna talk first about the objective component. And then we'll talk about the subjective component. So the objective component of sexual identity obviously begins from conception. When sperm and egg come together, 23 chromosomes from each parent are joined. And it is genetic material on that last pair of chromosomes that determines the genetic sex of the child. To this combination, the mother always contributes an X whereas the father may contribute an X or a Y. And it's on that particular chromosome that the crucial S-R-Y gene resides. That seems to be the determining factor in the genetic sex of the child. The traditional view of how sexuality develops after conception goes like this. That what goes on at the genetic level then determines the type of gonads that are formed. Either ovaries or testes. These then begin producing certain sex hormones. So testes begin producing masculinizing hormones such as testosterone, whereas ovaries will produce feminizing hormones such as estrogen. And these hormones then circulate throughout the developing body and promote the masculinization or feminization of the body, including the genitalia, but other bodily structures as well since they touch the entire body. They circulate through everything. That's the traditional view. And that view is true, but contemporary research in the last 20 years has nuanced that view. We now understand that the sex chromosomes themselves have both direct and indirect effects on the masculinization or feminization of the child. So the traditional view saw the sex chromosomes as acting indirectly through hormones, right? Chromosomes, gonads, hormones. So the sex chromosomes act indirectly, which is true, but now what we're understanding is that they also have some direct effects. In other words, some tissues, including neural tissue in your brain will develop differently simply because the nucleus contains an XY pair instead of an XX pair, independent of whether they've been exposed to testosterone or estrogen or other hormones. So we're coming to understand at the cellular level the genetics make a difference of whether a person is genetically male or female in terms of how different cellular structures in the body develop, including in the brain. According to one brain researcher, in other words, every cell in a male brain is to some degree fundamentally different than every cell in a female brain. That's a direct quote. We see this showing up in all sorts of different research now, genetic and epigenetic factors, underlying sex differences and so forth and so on. What all this is talking about is that this basic distinction of XX and XY turns out to affect all sorts of things that we didn't know about before. And we're just beginning to understand this. This area of research is rapidly unfolding and is very, very complex. The basic idea here is that you can have two people with the same gene, let's say a gene for a particular trait or for a particular propensity to a disease, but whether that gene manifests may differ based solely on the fact of whether the person is XX or XY. So genetic sex can affect whether a gene will manifest and how it will manifest. That's what this is talking about. This particular study, again, looking at these genetic and epigenetic effects of genetic sex found that this particular study found more than 6,000 genes common to both sexes that showed differential expression in males and females. Over 6,000 genes that, depending on whether the person is genetically male or female, will affect whether and how this gene expresses itself. Okay. So this is an incredibly complex thing that's beginning to unfold that really we're only scratching the surface of even now. In the womb, as a result of what's going on genetically, what's going on hormonally, we begin to see sex differences in the body and even sex differences in behavior in the womb. From the very beginning, there are differences in rates of conception, in vulnerability, to different types of maladies or problems in the womb. By the way, males are much more frequently conceived than females, but males are also much more likely to be miscarried or to not make it all the way to full term. Males are more prone to a variety of developmental problems in the early stages of life. We see differences emerging in responsiveness to environmental stimuli. Girls' brains from the very beginning seem to develop faster and are more receptive to environmental stimulation. We see differences in the body in terms of size and morphology. Boy babies tend to be bigger and heavier. There's differences in brain development. As I mentioned, girl brains tend to develop somewhat more rapidly, but also there are differences in the ways the brain get organized. And we're at the point technologically now where we're starting to be able to do brain studies on children still in the womb. This was the first one that I've come across where they actually did functional MRI imaging of children in the womb. They studied the brains of 118 children in the latter half of pregnancy. And they found that there were differences in the brains of the boys and the girls and how they were being organized. Girls showed greater what's called functional connectivity in their brains, where their brains had more organized networks across distal portions of the brain, linking higher brain centers to lower structures. Boys showed greater functional connectivity only in one area. And that was in the cerebellum, which is at the base, the back of your head at the base of the brain. Interestingly, the cerebellum is believed to be involved in coordinating motor action, motor behavior, movement, okay? Boy babies tend to be more physically active than girl babies from this period onward, and it may have something to do with that. The researchers themselves wrote, these observations confirm that sexual dimorphism in functional brain systems emerges during human gestation. Okay, and there are differences in birth experiences. Boy babies tend to be larger at birth, but even independent of that factor, they tend to be more prone to birth injuries and complications in birth. They're also more prone to a variety of problems post-delivery, including higher rates of neonatal death and death in the first year of life. In childhood, we see differences in sensation, thinking about our external senses, the way that we sense and perceive the world around us. Differences in sensation begin to emerge. Differences in our sense of smell, known as olfaction. I bet if I put this question to you, most of the people in this room would probably get this right. Of males or females, which one do you think has a more sensitive sense of smell? Females, all right? I heard a lot of people saying females, that's exactly right. Of course, it took psychologists a lot of time and money to come to that same conclusion, but it's true, research now with many thousands of people have shown that females tend to outperform males on a variety of tests of smell sensitivity, remembering smells, and all sorts of things of that nature. So I think it is true to say that females smell better than males and they also smell better than males. There's also differences in our sense of hearing. Men and boys tend to have a higher tolerance for loud noises compared to females, like we don't experience it as painful or uncomfortable across the sexes. Females tend to have a slightly more sensitive hearing, especially in the range corresponding to human speech. But if you do tests of involving location of sounds, like you play a sound and you have to locate where that is in space, boys and men tend to do slightly better. There are differences in our visual systems and how those get organized as well. Men have, boys and men have visual systems that are more optimized for location and motion. So locating objects in space, tracking moving objects, things of that nature. There's some evidence to suggest that girls and women have a better ability to perceive color and texture. We see differences in toy preference emerging in early childhood, whereas given an option, infant girls, oh, sorry, I'm skipping slightly ahead of myself. If you give infants different objects to look at, infant girls will prefer to look at human faces rather than mechanical objects, whereas infant boys tend to show the reverse trend. Give me the shiny mechanical object to look at and they'll stare at it longer. But if you give them toddlers, for instance, a variety of toys to play with and see who gravitates towards what and how long they pick up and play with certain toys, boys tend to gravitate more towards construction, transportation, and aggressive toys. Girls tend to gravitate more towards domestic and artistic toys. The interesting thing about this finding is that it's been replicated with non-human primates. So if you do the exact same study with rhesus monkeys or other types of primates, you'll see a very similar trend, whereas the female monkeys will prefer the dolls over the trucks. So that tells us that there's something probably on the side of nature happening here. Number of other sex differences emerge in childhood, and I don't have time to get into all of these, so I'll just throw them all up on the slide and make a few general comments. We see differences in style of play, the way social groups work. Girls tend to prefer smaller social groups. Boys tend to larger social groups that are more hierarchically structured. We see differences in various dimensions of temperament. Boys tend to have a harder time regulating their impulses, they're more rambunctious, they're engaging more rough-and-tumble play. Girls tend to score better in the early years of life in measures of self-control and all sorts of good stuff like that, which tends to then spill over to moral development. Girls are basically a couple of years ahead of boys through much of early life. So comparing a boy and a girl in kindergarten is almost like, and it's like apples and oranges, it's like comparing a five-year-old and a three-year-old in terms of the self-regulatory structures in their brains. It takes longer for boys to catch up to where girls are. And as a result of all of this, we see differential rates of various developmental disorders. So boys tend to have much higher rates of various behavioral problems and also learning disorders and other developmental problems like autism, ADHD and all that kind of stuff. Let's talk a bit now about the subject of component, okay? What I've talked about so far mostly involves the body and the sexuality that's emerging in the body or maleness and femaleness in the body. Let's talk about the subjective side of things, how the child comes to understand himself as male or female. And in the field of psychology, the term that's used now is gender identity. Now this is a very problematic term in a lot of ways, but let's just accept that term for now because that's the term that's in the research literature and we're gonna talk about what psychologists have come to understand about gender identity for what it's worth. And the reality is that this is a really complex thing that we're talking about. Oftentimes in popular culture, it's talked about as if it's like this singular thing that's kind of simple that you just sort of feel it and that's what it is. But when you break it down, it's actually a very complex phenomenon that we're talking about. And these researchers did a nice review of the literature in 2019 and they highlight no less than eight dimensions of gender identity, eight dimensions. I wanna put these all up on the slide. I won't talk about every single one of these, but I will talk about several because I do think it's important. Again, we're talking about the subjective part of this, the subjective sense of myself. The first identity or first dimension here is what we call gender self-categorization. This simply refers to a child's ability to correctly label him or herself as a boy or a girl. Historically, most kids nailed this before they got to kindergarten. And that was considered a normal developmental milestone. By the time kids get to be around round age four or five, they know that they're a boy or a girl and that this doesn't change. It doesn't change if you change the clothes that you're wearing, for instance, right? But it's a stable part of who you are. And they know that boys have penises and girls have vaginas. Most little kids figure this out or are taught this or they understand this by the time they get to grade school. Felt same gender typicality, what does that mean? That refers to the extent to which I perceive myself as similar to the other boys. All right, if I'm a boy, the extent to which I feel similar to the other boys, I see myself as like them. If I'm a girl, it means the extent to which I perceive myself as similar to the other girls. I see a similarity between us. The interesting thing about this is that felt same gender typicality correlates with a number of positive outcomes. So the more a boy sees himself as similar to the other boys, girl to the other girls, they tend to correlate with higher self-esteem, lower rates of depression, better peer relations, more pro-social behavior like helping behavior, and so forth. Felt other gender typicality. This refers to the extent to which a child sees him or herself as similar to members of the other sex. So the extent to which a boy sees himself as more similar to the girls or vice versa. Interestingly, the research shows this tends to correlate with less ideal outcomes. So felt same gender typicality tends to correlate with things like lower self-esteem, higher rates of depression, embodied dissatisfaction, gender contentedness. This has to do with the extent to which I feel good about being a boy, or I feel good about being a girl. It's good to be a boy, yay boys team. It's good to be a girl, yay girls team. Those boys are icky, those kinds of things. You hear kids say this kind of thing sometimes, and it's good, it's good. You wanna have a sense of the goodness of your gender. And this again, gender contentedness tends to correlate with good outcomes, like better self-esteem, better peer relations, fewer emotional problems and so forth. Felt pressure for gender differentiation. This has to do with the extent to which a child feels stress or tension around not being like the other sex. So for a boy, the extent to which they feel anxiety or tension around not being like the girls, not doing girl things, not liking girl things, not acting like the girls. And this is not so good. This is not good for kids. We don't want them to experience too much of that kind of anxiety or stress. The more they feel that, the more it tends to correlate with less ideal outcomes for them. So what sorts of factors might play into this emerging subjective sense of myself in all these different dimensions? Family influences are really important. Just starting with things like family structure and health. Is there a mother and father in the home? Is there a mother and father in the home? How is their relationship? Do they get along? Do they love each other? Is there conflict? Is there violence? Family structure and health make a huge difference. Quality of the marriage, who makes up the family constellation? How the genders are treated within the family environment? All those things play a role. Parents own expectations, whether conscious or not. Their expectations, their hopes and fears of for their child will come through in one way or another. When we're expecting a child, every parent begins to imagine what this child will be. And they have ideas of how they want this child to be and fears about what might happen to this child or how this child might turn out. All of that is going to come through in various ways, sometimes very subtle ways. But the child will pick up on it. Children are incredibly perceptive and they come into the world prepared to read their social environment, to pick up on these cues and figure out how best to secure their place in this family. They'll pick up on mom's fears that her daughter's gonna be victimized like she was. They're gonna pick up on dad's desire to have a son who's athletic who will be a sports star. They'll pick up on these things and sometimes begin to try to mold themselves to fit mom and dad's expectations and to avoid mom and dad's fears so they can better secure their place in the family. I've already touched on this in my examples just now. Parents own psychological issues, things like unresolved trauma, unresolved losses, their own biases about male and female or their own just more typical mental health issues like depression, anger problems, addiction, and so forth. Even apart from all of that, men and women, including parents, including educators, do treat boys and girls differently, even when we try not to. And my solution to that is stop trying. We've been told for a long time that we should treat all children the same. And I think that first of all, that project inevitably fails. But secondly, we actually do kids a disservice when we do that. Because the needs of boys and girls are different. Boys need us to help them become men. Girls need us to help them become women. So we need to give ourselves permission to have different ways of engaging. It's okay to treat kids differently. The key is to be thoughtful about that, to be reflective about that, to think about what it means to be a man, what it means to be a woman, and how best to help this child to get there. So instead of trying to treat everybody equal, we should think more thoughtfully and deliberately, intentionally, about how to help boys become men and girls become women. Okay. If you went to my previous talk today, I talked a lot about attachment, which refers to that key emotional bond between a child and his caregiver that forms early in life. And this picture kind of tells the story of what a secure attachment looks like. For sake of time, I can't break this down for you fully right now. You can ask somebody who went to my previous talk, and there may be a recording of it available as well. But the basic idea here is that kids come into the world primed to find a way to secure this relationship as best they can, because they have to, for their survival. They have to make sure that their parents are going to take care of them. They have to find a way to fit in this family, and to do so in a fashion that's going to help them to feel as secure as possible. And for some kids, that comes very easily, because they have parents who are responsive and who are attuned and who are mature and can take care of their emotional and physical needs. But in some cases, kids resort to all sorts of secondary strategies to try to secure their place in the family. And in some cases, that may mean acting more like big brother or big sister or associating myself more with mom's activities or dad's activities, rejecting the part of myself that makes mom or dad uncomfortable and so forth and so on. And so there's a number of ways in which, as young children navigate these relationships at home and the family environment, they can affect their growing sense of themselves in regard to male and female and where they locate themselves in their growing understanding of these. Okay, so I've already talked about, oh, sorry, I'm skipping something important. The research has already shown that at least three of these eight dimensions are in fact correlated with attachment security early in life. The kids who come into the world and experience a secure attachment bond with their parents tend to have better outcomes in these three dimensions. So the research is already starting to show us that attachment and gender identity do interrelate. In addition to the family, peer relationships become very important, especially in the grade school years. In the grade school years, kids begin to self-segregate. Boys tend to congregate with other boys, girls tend to congregate with other girls and so it becomes vitally important for their ongoing psychosocial development that they find a way to feel at home with members of the same sex. We have to find a way to feel at home with members of the same sex to feel akin to them. For some boys and some girls, this is harder than for others. If you have a boy, for instance, who his temperament is such that he just doesn't like sports or maybe isn't very good at sports, he may have a harder time feeling at home with the other boys who wanna play kickball at recess every day or who are all into Major League Baseball or whatever the case may be. Same thing with girls. If you have a girl who maybe by temperament just doesn't enjoy some of the same activities that the other girls enjoy, she may have a harder time feeling at home among her female peers. And that makes her journey in the area of sexual identity more difficult. Doesn't mean that he's not a boy, doesn't mean that she's not a girl. It just means that their journey is gonna have some different challenges associated with it. And that means that they need the adults and others in their life to help them with those challenges. All right. And culture and education obviously are also vitally important. What kids are actually taught in school. So the ideas they're exposed to through media and so forth, again, are gonna be informing their growing understanding of themselves. Let's talk about adolescence and beyond. In some ways, adolescence can be understood as making your body your own and moving in. I really love that quote. This is from a book by Susan and Marcus Evans on treating gender dysphoria through psychotherapy. So it's a wonderful secular book that was just published in 2021. So adolescence is kicked off by puberty which obviously involves the sexual maturation of the body and the mind. Sexual maturation involves the whole person. And during this stage, erotic attraction begins to emerge. And psychologists, especially Daryl Bem who was a social psychologist who wrote about this 20 years ago, posited that erotic attraction is based on a perception of difference. Perceiving myself as somehow different from this other class of human beings. So for instance, for most of us, that difference falls neatly along the difference of sex, male and female. But for some, perhaps for example, for a boy who never achieved that place of feeling at home among the other boys, always perceived himself as different from the other boys, always on the outside, always wishing he could be on the inside, wishing he could be closer to them. In adolescence, that sense of being different and that longing to be on the inside can become eroticized and become the basis for same sex attraction. I think we can summarize the psychological tasks of adolescence as these three things. Identity, community, and mission. Every adolescent and every young adult are looking for these three things. Who am I? Where do I belong? And what's my purpose? Adolescents are searching for these things. And if we don't provide them compelling options to pursue, compelling answers to these questions, then the culture will fill in the gap. Gender ideology is one prominent way in which a lot of young people try to answer these questions. Obviously, the growing influence of peers, culture, and social media at this stage is well known. And we see differential mental health outcomes emerging. This is where girls begin to show up more and more with emotional problems. Earlier it was the boys with the developmental problems, behavioral problems, learning problems. Now we begin to see girls showing up with more depression and anxiety and eating disorders and things of that nature. And boys showing up more with substance abuse and things like that. All right, in adulthood, there's a huge literature on sex differences among men and women. I can't get into all that now. I just wanna mention though that if any of this is interesting to you, pick up a copy of the sexual identity book edited by John Finley. I contributed a chapter in that book where I go into this literature in a lot more detail than I can do in a talk. It's available from the St. Paul Center. And I'll be sitting at a table if anyone wants to pick up a copy or talk with me about it later. I do just wanna highlight one thing on here very quickly, maybe two. One is that when even psychologists in the field of sex differences talk about sex differences, they overlook the body. You pick up an article from a psychological journal about sex differences, they almost never talk about the body. It's as if the body doesn't really exist. We're just disembodied minds floating around and we're gonna measure things like extroversion and introversion and agreeableness, but we're not actually gonna talk about the fact that we're physically different. But we are physically different. According to the CDC, the average man in the US stands about five foot nine inches tall and weighs about 200 pounds. The average woman in the US stands about five foot three and a half inches and weighs about 170 pounds. There's a 30 pound difference between the average man and the average woman almost entirely of bone and muscle. If you look at research on various forms of physical strength, men outperform women across the board, sometimes by many, many times. All right. Our physical differences make a huge impact on how we relate with one another, how we perceive one another, the roles and responsibilities that we have towards one another. All of this mostly gets overlooked in the field of psychology. There's interesting findings emerging in brain science as well about men and women and how our brains are organized differently. There was a recent brain scan study involving more than 5,000 adults that found greater functional connections in women's brains in what's called the default mode network. I'm sure that means a lot to everyone. The default mode, oh yes, of course, the default mode network. Okay, so what is the default mode network? I had to look it up when I read the study, so we're all in the same boat. The default mode network is a network of brain regions that is active when a person is engaged in more interior, contemplative types of thought. What is sometimes called internal mentation. So I'm thinking, I'm reflecting, I'm pondering something internally. When I'm doing that, an area or a circuit in the brain called the default mode network tends to light up in brain studies. What they're saying here is that women tend to have greater functional connectivity in the default mode network. In other words, their brains are set up for this better than men's. To be able to be thoughtful, reflective, to ponder something deeply. The only way in which, I shouldn't say the only way, but one of the main differences that emerge in which men's brains have more functional connectivity than women's has to do with external perception and motor action. So you're beginning to get a sense here of inward directedness versus outward directedness that our nature and our experiences organize us for one or two, one or the other, of these two sorts of orientations. Internal thoughtfulness or external perception and action. Okay, lots of other interesting sex differences I can't get into right now. You can read about it in the sexual identity book. If I had to boil it all down, what is the essence and purpose of femaleness? It's motherhood, it's capacity for motherhood. Physically, psychologically, spiritually. To become a mother, to love as a mother loves. What is the essence and purpose of male-ness? To become a father, to love as a father loves. Biologically, psychologically, spiritually. To take this a step further, we can talk about how men and women both image God differently in complementary fashion. And the catechism even talks about this. Deacon Bob talked about this Monday night having to do with God's immanence and his transcendence. God is both transcendent in the sense that he is beyond all of creation. He is beyond all that we can ever think or say about him. But he's also imminent. He is near to us. He holds us in being. As St. Augustine said, he is more intimate to me than I am to myself. And these have to do or we can think about how men and women image God in distinct ways. How men image God in a way that emphasizes more his transcendence. And women image God in a way that emphasizes more his immanence, his nearness. One of my former professors used to illustrate this by quoting the hymn, Joyful Joyful We Adore Thee, saying that the line, I think it's in the second verse, refers to God as the wellspring of the joy of living. The wellspring of the joy of living highlights that transcendent masculine dimension, but then immediately follows with ocean depth of happy rest, the imminent near feminine dimension. And so men and women who are able to embody forth fully what it means to be man and woman show us complimentary images of who God is. And children are enriched when they grow up with these two complimentary examples in the home, ideally living harmoniously. All right, I suppose it's probably time that we talk about gender dysphoria, seeing how I only have about 16 minutes left. This is why you all came to this talk, right? All right, I feel like there's always, you have to lay a foundation now. You have to lay a foundation in Catholic anthropology and in basic science about what is male and female before you can talk about the disorders. That's why I do it this way. So what is gender dysphoria? In our field, gender dysphoria refers to the experience of clinically significant distress or impairment associated with perceived incongruence between one's psychological gender identity and one's biological sex. Essentially, in my own words, I'm not at home with my body and my sexuality. I'm not at home with my body and my sexuality. If you think about that, that's an inherently distressing thing because after all, we're with our bodies all the time. Right, you can't ever get away from it. Formerly, this condition was referred to as gender identity disorder and the change in name is significant. The old way of understanding this was that when there's a disconnect between the subjective perception and the objective reality of the body, that that signified a disorder, that my subjectivity is disconnected from reality. But the change in name communicates a shift in the field that no longer sees that disconnect as inherently disordered. It's only considered a disorder if I'm distressed about it or it's causing me some type of impairment in my life. In fact, I think you can make a strong argument that the only reason that it's still considered a disorder at all is because you have to have a diagnostic code in order to be able to get reimbursement for the hormones and surgeries and other types of medical treatments. So you have to carve a way out to leave it in the diagnostic manual while also de-pathologizing it as much as possible. That's the way the field has progressed because of the influence of gender ideology. Okay. There are subtypes of gender dysphoria. First, we make the distinction between early versus late onset. So late onset is basically anything from puberty onward. Early onset is anything before that. The prototypical case in the clinical literature for years was the early onset boy, usually diagnosed during grade school years. This condition was heavily favored boys and they would typically be diagnosed in those early years. Ray Blanchard, who's a secular sex researcher also offers another way of subdividing the types here. So there are females to males, meaning those who are biologically female but wish to identify as male. There are those who are biologically male who wish to identify as female, but among that particular group, there are a couple different types. There are those who are sexually attracted to men, what he calls androphilic, or you might think homosexual or same-sex attracted. And then there are those whom he terms autogynophilic. An autogynophilic man is someone who experiences sexual arousal associated with the idea of himself as a woman. With the idea of himself taking the role of a woman either in socially or in a sexual encounter. And this is part of his sexual arousal template, if you will. It has a sort of a fetishistic quality to it. But for some men who are autogynophilic, this actually leads many to cross-dress, at least sometimes, but some will actually seek to transition to more completely fulfill this fantasy that they have. Gender dysphoria is associated with tremendous psychological suffering. The technical term for this in our field is comorbidity. We talk about two conditions being comorbid when they occur together. So gender dysphoria is comorbid with a lot of other disorders. In children, we see high rates of anxiety disorders, depression, behavior problems, and interestingly, autism spectrum disorder. That's been replicated many times now, including the autism piece, which is interesting and still not fully explained. In adults, we see similar types of things. Anxiety, mood disorders, eating disorders, substance abuse, and self-harm, and suicidality. Kenneth Zucker, who's one of the foremost researchers in this area for many years, ran a successful clinic where they researched and also treated gender dysphoria for over 40 years, offers three explanations for why there is all this comorbidity with gender dysphoria. He said, first, perhaps gender dysphoria has emerged as secondary to another more primary mental health diagnosis. So maybe there's something else deeper going on and this is just one other symptomatic presentation of it. I think there's a lot of truth to that idea. Secondly, he says, gender dysphoria itself is inherently distressing. So you can expect to see more anxiety, more depression, more drinking, more self-harm as a result because it's a distressing condition. And then thirdly, he says, okay, we can't rule out things like social ostracism, rejection, minority stress. But he says that doesn't adequately explain all of these comorbidities. It doesn't adequately explain all of what we see in this population. Many of you might be aware of what, in the transgender community, how they refer to the name they were given at birth. It's the dead name. That's what they refer to as the dead name, the name I was given at birth in the transgender community. And I think that says a lot because it's as if they're saying that that person needs to die so that I can live. Right, that communicates a certain amount of self-hatred, a certain amount of destructiveness towards the body inherent in the condition itself. I have to erase that person. I have to make it so that they never existed so that I can live. How persistent is gender dysphoria? Well, the majority of early onset cases historically have tended to remit before adulthood. Even according to our diagnostic and statistical manual, the vast majority of cases do not persist to adulthood, whether treated or untreated. These are the early onset cases. The World Professional Association for Transgender Health has said the same thing over the years, that the vast majority of early onset cases do not last to adulthood, whether treated or untreated. However, if the gender dysphoria is of a late onset variety or if it persists through puberty, it is more likely to continue. And if social transitioning and or puberty suppression occur, then the persistence goes way up. So essentially what's happening nowadays is treatments are being offered, young children, middle school children, that pretty much guarantee or at least increase the odds that the condition will continue. That doesn't sound like a very good treatment to me. If the research shows that one of the outcomes is the persistence of the condition as a result of the treatment. Whereas the prior clinical literature established that most kids will grow out of this if nature takes its course, so to speak. How common is gender dysphoria? In terms of a clinical diagnosis, historically it's been quite rare. Even DSM-5 put the numbers as incredibly tiny. But more contemporary research, especially if you just throw out surveys and you allow people to self-select categories rather than looking for specific clinical diagnoses, but just let people check a box, then rates are much higher. So in some research studies, we see this study of many as a large group of high schools, one to 2% identified as transgender or non-binary. Some other studies show higher percentages than these. Historically, males have been three to five times more likely to have gender dysphoria than females, but that has changed. So this graph represents referrals to a gender clinic in England over a several year period, 2009 to 2016. And during that period, first of all, they saw a huge increase in the number of referrals. But in that period of time, the gender ratio also flipped, whereas it used to be more predominantly males over females. Now it's more predominantly females over males. So in this particular study, the total female referrals went from 17 referrals in 2009 to over 1200 in 2016. There was a 7,000% increase, 7,000% increase in female referrals over those years. What we're seeing is a huge influx of adolescent girls showing up at these gender clinics, seeking to transition. And researchers have been baffled as to why this is happening. There's no precedent for this in our research literature, in our clinical literature. There's no previous precedent for this. This particular study was an early attempt to try to understand this phenomenon. They looked at all the referrals to a gender clinic in Finland over a couple year period. The researchers said, we have so far no explanation for this great overrepresentation of natal girls. Cultural trends may somehow influence this. You don't think. Looking into the backgrounds of these girls, they found lots of mental health difficulties. So these girls showing up at the gender clinics had histories of all sorts of mental health problems. Three fourths of them had been in therapy before for other issues not related to gender. Two thirds for depression, half for anxiety disorders, half for suicide and self-harm. A quarter of them were on the autism spectrum and so forth and so on. Also lots of social difficulties like bullying, oftentimes completely unrelated to issues of gender. So these were very troubled girls. Lisa Litman did a survey of adults, parents, I should say, a survey of parents whose adolescent or young adult child came out as transgender or non-binary and looked for commonalities in their stories and found a lot of similar things. She also identified cluster outbreaks. The idea that if one girl in a social circle identified as trans or non-binary, the likelihood that somebody else in that circle would also come out in that same way went up. So she began to posit the idea of social contagion as a possible influence here and something worthy of greater research. So what causes this? What causes gender dysphoria or gender discordant identities? Researchers, of course, want to look for biological causes, want to pin it on a gene or something like that. And they haven't found one. There's been no evidence up to this point that conclusively shows that this is in some way biologically determined. There's a lot of research, though, to suggest psychological influences. A review article from 2010 concluded that psychosocial factors have a role to play in the etiology of gender variant identities. Etiology means cause. There's evidence that poor or absent parental relationship, childhood abuse, or parental encouragement of gender variants are more common against gender variant populations. I already talked about those eight dimensions and the attachment research. There's a lot more attachment research that's come out linking attachment problems with gender dysphoria. This study from Kozlowska and colleagues compared young people with gender dysphoria compared to control group. And you can see the attachment results here. The gender dysphoria group had much higher rates of insecure and disorganized attachment. The same thing was found in a recent study. If I can skip ahead here. By Giovanni, he's Italian researchers with adults. They found basically the same thing. That attachment wounds was very common, insecure and disorganized attachment was very common among the gender dysphoria groups. Let's see. They also, in that particular study, looked at complex trauma. Complex trauma has to do with like abuse and neglect, death of a loved one, prolonged sorts of situations that are very stressful for kids. And they asked in that study who in this study has experienced four or more developmental traumas, which would be a lot. The control group, 7%, had experienced four or more developmental traumas, but the adults with gender dysphoria had grown up with four or more traumas, 56% of them. So eight times higher. So the point is that we're developing a psychological profile of individuals with attachment wounds, with a variety of mental health challenges who at some point in their life come to understand the source or associate the source of their problems with being the wrong gender. I've already talked about much of these. So let me just keep advancing onward and we'll get to a point where we can take a few questions. Other psychological factors include things like dissociation from the body, being disconnected from one's body, displacing psychic pain onto the body. So I may have some type of internal pain, something I don't like about myself, some other type of shame or difficulty that I'm struggling with and I blame my body for it. And I come under the influence of gendered ideology to believe that if I change my body, my psychic pain will go away. It also can be an expression of self-hatred in an attempt to eliminate a hated part of myself. Like if I transition, if I'm a girl, for instance, and I transition, perhaps I won't be so shy, I'll be more confident as a boy. It can also be an expression of rage towards one's parents, right? Essentially rejecting the body and the sexuality I received from them. And as I've already highlighted, there's this overlap with autism spectrum. There can be overly concrete thinking, stereotypical thinking, and kind of obsessive thinking that goes into this that sometimes we see among gender dysphoric young people. One of the things I want to mention here that is tricky for us to deal with is Catholics, but it's good to be aware of is the issue of same-sex attraction. Same-sex attraction and gender dysphoria sometimes overlap. And sometimes what can happen is a child or an adolescent who maybe is beginning to experience same-sex attraction and experiences such tremendous shame about that, that it almost seems better to be trans. Because if I transition, then I won't be attracted to the same sex anymore. I'll be attracted to the opposite sex. You see, it's a solution to this shame around same-sex attraction. So that creates a delicate issue for us to walk with someone to help them to experience some ability to accept that they have, that they're beginning to experience these feelings. But obviously as Catholics, we wouldn't want them to embrace that as an identity or as a lifestyle. But I have to be able to accept if this feeling is emerging in me, I need to be able to tolerate it and look at it and figure out how to handle that. If I can't even tolerate it, it's more likely that I may take this extreme reaction of trying to literally mutilate my body so that I don't have to deal with this. Okay. I'm gonna just hit a few resources here and then maybe we can take a couple questions. I've already mentioned the sexual identity book. This book was written as part of a extended collaboration among members of different disciplines. Myself from psychology, we had several medical doctors involved, theologians and philosophers. It's a very good resource. Another great resource is Jason Everett's recent book, Male, Female, Other. Jason did a really great job of researching his book. It's very thorough and it's very accessible. So it's a great book for parents. It's a great book for teachers. It's a very useful resource. From in the secular world, this book Irreversible Damage by Abigail Schreyer. It's a great book, very thorough, really focused on this phenomenon of adolescent girls. What's going on with adolescent girls? And then if you're a therapist or in the mental health field or know someone who is, this book by Susan and Marcus Evans is very, very helpful.