Volume 47 - Issue 2
Gender Dysphoria and the Body-Soul RelationshipBy Edmund Fong
After presenting the phenomenon of gender dysphoria as a state of consciousness experienced by the individual, I explore how the two major anthropological frameworks of materialism and substance dualism account for the conscious state of gender dysphoria. In particular, the article addresses the extent to which materialism and substance dualism support what I term a “created but misplaced being” scenario, where it is claimed that an individual could be created with an “inner” self gendered one way but placed in a body of a different biological sex. Three theological insights into gender dysphoria that follow from the findings of this exploration conclude the article.
Gaining prominence over the last decade or so has been transgenderism, with a particular focus on the phenomenon of gender dysphoria. Formerly defined as “gender identity disorder,” the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines gender dysphoria as “incongruence between one’s experienced/expressed gender and assigned gender” in conjunction with “clinically significant distress or impairment in social, occupational, or other important areas of functioning.”1 In other words, individuals with gender dysphoria often find themselves saying “I feel like …” and in stronger cases, “I am a woman trapped in a man’s body,” or vice versa.
Psychological, medical, biological, sociological, legal, and even political perspectives have been offered in the discussion of gender dysphoria.2 Christian perspectives, especially those coming from ministerial practice or ethics, have also been represented. The contribution that this article brings to the table lies in its attempt to answer a specific theological question: where do we locate gender dysphoria within the larger ambit of theological anthropology, particularly the body-soul relationship? This is a neither trivial nor unimportant consideration, for it remains but a breath away from the individual experiencing gender dysphoria bringing a theological slant into his or her experience: “Could God have created me a woman but placed me in the wrong body as a man (and vice versa)?” So, even as Genesis 1:27 tells us that “male and female [God] created them,” could an individual with gender dysphoria fall under the curious scenario of what I term a “created but misplaced being”?
The consideration in this article proceeds via four main sections. With reference to philosopher John Searle, I begin by arguing how the phenomenon of gender dysphoria is fundamentally a conscious experience involving a unified self—an “I,” so to speak. This forms an essential datum point that all views of the body-soul relationship must contend with in considering gender dysphoria. In the second section, I show how one of the major frameworks on the body-soul relationship, materialism or physicalism, accounts for gender dysphoria while remaining true to its commitments. The third section does the same, but with the other major framework: substance dualism. Both sections will pay particular attention to the “created but misplaced being” problem. Finally, I conclude with three implications our findings have for theological insights into the phenomenon of gender dysphoria.
1. The Conscious State of Gender Dysphoria
In arguing for how the notion of the “self” poses problems for neurobiology, philosopher John Searle presents three defining features of consciousness useful in helping us understand gender dysphoria as a state of consciousness.3 First, conscious states are qualitative in that there is a certain undeniable qualitative feel that enables us to say we are in this conscious state rather than that (the example Searle provides is the qualitative difference between listening to Beethoven’s Ninth Symphony and drinking cold beer). Contemporary literature on the topic of consciousness label this unique qualitative feel pertaining to a particular state of consciousness as “quale” (singular) or “qualia” (plural).4 Second, conscious states require a subject for their very existence; there must be an “I,” some subject that experiences the conscious state. Third, conscious states always come to us as part of a unified conscious field. Returning to Searle’s example, we do not think of the individual having the experience of listening to music and the experience of drinking separately, but the drinking and listening come as part of one total conscious experience.5 The three interrelated features lead Searle to affirm the problem of consciousness as “precisely the problem of qualitative, unified subjectivity,” and the three features as really “different aspects of the one common essential trait of consciousness.”6
The three features listed by Searle underscore the common points that all discussions on gender dysphoria relating to the body-soul relationship must attend to. Gender dysphoria is a conscious state that has its own quale, mainly identified as a sense of discordance; it is experienced by a distinct subject, and it comes as a unified field of consciousness—“I feel that I am of a gender that is different to my body’s biological sex.”
To these three points proposed by Searle we may add a fourth: the conscious state of gender dysphoria is causative in effect. It may result in an individual with this conscious state wanting to take definite actions that lead to physical events happening: “I feel that I am of a gender that is different to my body’s biological sex, so I will pursue gender reassignment surgery.” Of course, as Searle points out, in normal non-pathological cases, the causation is not “automatic.” The causes of one’s action (in our case experiencing gender dysphoria) is never causally sufficient to determine the action (pursuing gender reassignment surgery). Instead, there is always a gap between the perceived causes and the action, and Searle refers to this gap as the freedom of the will.7
Notwithstanding the above, the core phenomenological datum point in relation to gender dysphoria is clearly stated: gender dysphoria is an experienced qualitative and unified conscious state of the self with potential causative effects. I will now turn to see how the major accounts of the body-soul relationship within theological anthropology accommodate this central datum point, paying particular attention to whether the different accounts of the body-soul relationship support the notion that we could actually be “created but misplaced beings” in relation to our sexuality.
2. Materialism and Gender Dysphoria
I begin with the first of the two broad positions adopted in body-soul relationship discussions: materialism. Materialism views the human being as an entirely physical entity; that is, we comprise no additional non-physical or spiritual substance. Consequently, materialists affirm that there is nothing required for having conscious mental states and properties (such as beliefs, desires, intentions, feelings, etc.) other than the occurrence of various types of biophysical and neural states and processes in the conscious individual’s brain, body and perhaps the world around the individual. Materialism can be further broken down into “hard,” “strong,” or reductive materialism and “soft,” “weak,” or non-reductive materialism. Hard materialists either dismiss inner mental states or mental properties altogether (although this is an approach seldom taken) or, more commonly, maintain at best that mental properties are reducible to or explainable as biophysical and neural properties. Theological anthropologist Marc Cortez points out that few Christian thinkers would see themselves as hard materialists owing to the consensus that “human persons have a real mental life that is important and efficacious,”8 preferring instead some version of soft materialism.
Soft materialists, in turn, can be divided into two kinds. While both kinds maintain—unlike hard materialists—that mental states and properties cannot be reduced to or explained away as biophysical base properties, the first type of soft materialists would conceive of all mental states and properties as causally reducible; that is, the causal powers of the biophysical base properties are able to completely account for all mental states and properties. Such is the view of Searle who goes by the label “biological naturalism” and maintains that “consciousness does not exist in a separate realm and it does not have any causal powers in addition to those of its neuronal base any more than [the characteristic of] solidity has any extra causal powers in addition to its molecular base.”9 Searle maintains that any form of causation that takes place is solely “bottom-up,” “whereby the behavior of lower-level elements, presumably neurons and synapses, causes higher-level or system features of consciousness and intentionality.”10
Besides Searle, Nancey Murphy stands as another example of the first type of soft materialist. According to Murphy, nonreductive physicalism, especially what it has to inform us in terms of cognition and neurobiology, is able to lead us (humans) to a robust sense of moral responsibility.11 To ward off the worry of neurobiological determinism (that is, “the case that all human thought and behavior are simply determined by the laws of neurobiology”),12 Murphy allows for what she sees as “downward” or “top-down causation.” In this type of causation, new emergent complex entities (the example Murphy provides is birds) are able to use lower-level causal forces (e.g., air pressure) in new ways to do new things (e.g., to fly). The key point to note is that downward causation, according to Murphy, “does not involve overriding lower-level laws, but rather selection among lower-level causal processes.”13 The end result is that “the whole person has downward causal effects on her own parts.”14 William Hasker (a substance dualist) and Kevin Corcoran (a constitutionalist) have responded by stating that Murphy’s position is still ultimately causally reductionist.15 The flaw comes from Murphy’s insistence that all actions and interactions arising from entities in the natural world must consist entirely in the actions and interactions of the elementary parts that make up the entity, and that these actions and interactions must occur and be determined in accordance with the fundamental laws of physics. In other words, Murphy’s notions of emergence and causality still operate within what Cortez calls the “causal completeness of the physical (CCP)” principle, where “every physical event that has a cause at t has a physical cause at t.”16 Murphy’s refusal to allow for modifications in the physical laws according to which the elementary particles behave—modifications arising in turn from the emergence of a more complex organism larger than the sum of its parts—is what consigns her to a position of causal reductionism, despite her claims to the contrary.
The second type of soft materialist differs from the first in rejecting causal reductionism. Its proponents allow for mental states and properties—“wholly distinct mental phenomena,” as termed by Timothy O’Connor—to emerge when physical elements are organized in the right sorts of ways in properly-functioning neurophysiological structures. These mental phenomena “in turn do fundamental causal work, affecting the very neural processes that sustain them.”17 Here, as Hasker puts it, is a form of “top-down causation” where “consciousness, which is a higher-order, emergent property, has effects on the micro-level, and causes the microelements to behave differently than would be predicted on the basis of the physico-chemical laws alone.”18 The causal relationship between mental and physical properties in this case goes beyond the supervenience relations that mental properties have on their physical bases (Searle’s view), or even emergent relations where the causal efficacy of the mental property or state is still limited by the CCP principle (Murphy’s view), to a “stronger” emergent relation where the mental state or property exercises autonomous causal powers. Hasker terms this “the theory of emergent material persons (EMP).”19 In my view, the EMP theory serves as the strongest possible specification of the notion of the “self” afforded to any materialist, positing a “self” that is constituted by, but not identical to, their physical bodies, while not positing that “self” as another immaterial substance basic to human ontology.
With the outline of materialism in place, I proceed to explore how materialism accounts for the core datum point established of conscious states in general and gender dysphoria in particular. When it comes to conscious states in general, it could arguably be said that both varieties of hard and soft materialism are able to satisfy the requirements of the first three aspects of the conscious state posited by Searle—the “qualitative, unified subjectivity” aspects—although hard materialists will generally adopt the strategy of reducing the particular qualia associated with a conscious state to their biophysical and neural bases. Furthermore, soft materialists who do not espouse epiphenomenalism (that is, the view that mental properties are real but causally irrelevant),20 and who affirm some version of “top-down causation” would be able to affirm the fourth aspect that states of consciousness have potential causative effects.
However, I stated “arguably” because, as Hasker shows, the challenge for materialists lies in providing a robust account of “unified subjectivity”; in other words, the sense of unity associated with the “I” that is at the center of the conscious state. Hasker contends that “the self, the subject of experience, cannot be a complex physical object such as the human body or brain. Instead, it must be a simple substance, one that has no parts that are themselves substances, and which cannot be divided into parts.”21 This is an account that no materialist is able to provide, not even those who subscribe to the EMP theory, because the core tenet of materialism states that the human person is just materially composed of a multitude of parts—organs, cells, chemical compounds, and ultimately of elementary particles—and short of allowing the existence of another immaterial substance as an explanation, the “self” on materialism’s terms is complex and cannot be a simple substance. Even should the materialist pinpoint the “unified subjectivity” down to the brain that “operates in a way that is functionally simple in undergoing the conscious experiences,” Hasker questions the spatial location of this holistic and functionally simple aspect of the brain.22 To this question, Hasker postulates that the best answer a materialist can give is to grant to the tiniest particle in a person’s brain—the quark—the entirety of the person’s conscious state. Yet, this answer stretches one’s credulity to its very limits as there clearly cannot be any physical processes happening at the level of the quark itself that would correspond to the complexity of the conscious experience experienced by the self.23 O’Connor has countered Hasker by stating that it is quite possible for the materialist subscribing to the EMP theory to assert that the conscious state is instantiated by the “self” as a whole, while not being instantiated by the self’s basic parts. This is possible because O’Conner’s sort of constituent ontology—“I am a unified, albeit composed individual”— allows for a “distinctive particularizing element, or substratum, to the human person that is wholly distinct from the substrata of the person’s basic parts.”24 The debate continues, but enough has been said of the main challenge that materialists face in accounting for conscious states in general; that is, where did the unified individual “self” come from, and given their fundamental commitment that all human persons are materially composed, where is this unified individual “self” to be located? But turning aside from the finer intricacies of the debate, I believe that the materialist has sufficient explanatory power to account for the phenomenon of conscious states in general.
I turn now to explore how materialists might account for gender dysphoria. At the center of gender dysphoria is the unique quale of a discordant “gender identity,” where the latter is defined as “someone’s internal sense of being a man or a woman” to be differentiated from biological sex and gendered socializations.25 While the distinction and differentiation is clear, the definition of gender identity is amorphous and subjective, depending largely on how one defines “internal.” One thing is clear, however: gender identity presupposes the notion of an “inner” or “real” self who, in the case of gender dysphoria, is of a gender or sex different from what the body indicates. I suggest that it is precisely in addressing this “inner” self and its associated gender identity that the different and distinct ways in which materialism and substance dualism account for gender dysphoria can be clearly seen, and whether they are sufficient to face the theological challenge that comes from the charge of God having “created but misplaced my being” in the wrong body.
Based on the above discussion on materialism, I foresee two strategies open to the hard materialist (whom as we recall either dismisses mental properties altogether or reduces them explanation-wise to their biophysical properties).26 The first strategy is for the hard materialist to appeal to Philosophical (or Logical) Behaviorism, a somewhat outdated theory that seeks to translate ordinary claims about mental states and properties into statements about behavioral dispositions. So in the case of gender dysphoria (and at the risk of gross over-simplification), “I feel that I am of a gender that is different to my biological sex,” would be equivalent to “growing up, I preferred playing with doll houses and dress-ups rather than with toy guns and cowboy toy figurines,” or “if offered, I would choose to undergo puberty blockers (for pre-pubescent individuals), hormonal therapy and eventually gender reassignment surgery.” Behaviorism theories, in other words, tend to explain the “inner” self crucial to the notion of gender identity solely in terms of behavioral patterns. As detractors have highlighted, behaviorism’s chief weakness is that it is virtually impossible to specify a subject’s particular conscious state purely as behavioral dispositions, either because one could have a certain conscious state without the relevant behavioral dispositions (and vice versa) or the disposition to behave in a certain manner already presupposes the presence of other more basic underlying mental conscious states.
This leads to the second strategy available for the hard materialist: Type-Identity Theory, which at its core contends that “for each type of mental state or process M, there is a type of brain state or process B, such that M is identical with B,” or “being a state of Type M is just being a state of Type B.”27 The example provided is typically that of the mental property of pain being identical with the neural process of C-fiber stimulation happening in the brain. As some may have already intuitively noted, the success of type-identity theories depends largely on the ability to ascertain universal correlations between instances of different mental types (determined via introspective reporting of individuals in such mental states) and their relevant physical counterparts (determined via instruments such as brain scans). These universal correlations—otherwise termed Neuronal Correlate of Consciousness (NCC)28—will enable us to find out what is happening in the brain at the neurological level at a time when the subject is undergoing particular states of consciousness. From the NCCs established, the grand aim is to derive general theories or statements of the laws and principles concerning how a particular state of consciousness could operate causally in the life of the subject. Needless to say, difficulties arising from the manifold complexities and the overall ambitious nature of the project continue to plague type-identity explanations of gender dysphoria.29 Furthermore, NCC approaches suffer from a basic methodological shortcoming. The process of establishing NCCs applied to particular states of consciousness (in this case, gender dysphoria) will only reveal the NCC for a particular mode of consciousness within an already pre-existing conscious field and fails to reveal how the brain as a whole produces consciousness in the first place.30
Because soft materialists are happy to affirm the distinct presence of mental thoughts and properties without explaining them away based on their biophysical bases, they are better primed than hard materialists to attest to the “inner self” and the quale of discordance the “inner self” experiences in a conscious state of gender dysphoria. But because of their basic commitment to the material composition of human persons, soft materialists can only appeal to biophysical approaches, especially those involving neurology, in explaining the causal links between certain biophysical states and the conscious state of gender dysphoria.
I have an important qualifier to state at this juncture. That is, what follows pertains not to gender identity problems that arise from intersex conditions or what is otherwise termed disorders of sex development (DSDs). These disorders, usually involving some form of hormonal or genetic maldevelopment, can on some occasions result in affected individuals experiencing gender dysphoria, but the numbers are low and it seems more the case that people with a DSD do not identify as transgender and most who do identify as transgender do not have a DSD.31 My focus at this point is on the latter group: those who would claim that while their primary sex characteristics such as genitalia are developing normally, their secondary sex characteristics associated with the brain are developing along the lines of the opposite sex.32
This brings us to an explanation of gender dysphoria particularly appealing for the soft materialist: brain-sex theory. First mooted by Robert Sapolsky, the theory seeks a possible neurobiological explanation for cross-gender identification. Essentially, Sapolsky asserts that recent neuroimaging studies of the brains of transgender adults suggest that they have brain structures more like the gender they identify with than their biological sex. Based on this, Sapolsky concludes that there is a possibility of people being “born with bodies whose gender is different from what they actually are”; in other words, they have a female-type brain in a male body, or vice versa.33
Despite its relatively slender scientific basis, brain-sex theory has gone on to garner scientific and popular attention. Mayer and McHugh list a compilation of scientific studies that have sought to ascertain neurobiological causes such as brain structure or brain function differences between trans- and cisgender individuals as possible causes for gender dysphoria.34 Their conclusions, however, are less optimistic, writing that “it remains unclear whether and to what extent neurobiological findings say anything meaningful about gender identity.”35 To Mayer and McHugh, what is actually needed to gain maximum profitability from such neurobiological investigations are “prospective longitudinal panel studies of a fixed set of individuals across the course of sexual development if not their lifespan.” Such studies would involve the use of serial brain images at birth, in childhood, and at other developmental points. This would be the only way to ascertain fully whether certain brain features caused a trait or whether the particular brain feature noted is a consequence of the trait. If not, such studies, even if they were methodologically reliable, remain “insufficient to demonstrate that brain structure is a cause, rather than an effect, of the gender-identity behavior. They would likewise lack predictive power, the real challenge for any theory in science.”36 It should be noted that while some recent neurobiological studies conducted after Mayer and McHugh’s report provide nascent promissory findings, they similarly affirm the need for more research before any definitive conclusions can be drawn.37
To sum up, materialism as a way of conceiving the body-soul relationship varies in its ability to account for the “qualitative, unified subjectivity” dimension of conscious states in general and the conscious state of gender dysphoria in particular, depending on which species of materialism one goes with. Hard materialists have a harder time (no pun intended!) affirming the “inner self” and the distinct quale of discordance experienced that forms the central feature of gender dysphoria. In fact, if they commit themselves fully to the tenets of hard materialism, there is no “inner self” and its associated quale of discordance to begin with, but only an “inner self” governed purely by behavioral patterns or neural networks and processes! This would consequently mean that there are virtually no grounds for the “created but misplaced being” problem to feature within a hard materialism, because the notion of an “inner” and “real” misgendered self remains vague and ill-defined under its terms.
Soft materialists, on the other hand, and especially those who subscribe to an “emergent material person” theory, are much better able to affirm the “inner self” and its associated quale of discordance. But because the soft materialist is still committed to the tenet of material composition of the human person, the utmost limit that the soft materialist can go is to allow for the elementary physical particles—the quarks, atoms, molecules, neurons, neural processes etc.—to interact in such a way that the distinct mental reality of the “inner self” emerges, all this time guaranteeing that this “self” is constituted by the body and its constituent parts rather than forming a whole new distinct immaterial substance altogether. The mental phenomenon of the “inner self” for the soft materialist is still inextricably linked to the body and its constituent parts. In cases where the primary sex characteristics such as genitalia are developing normally, the gender identity of this “inner self” should by all accounts and in accordance with materialism’s own commitments be the same as that of the biological sex identity of the body. This in turn means that when it comes to the “created but misplaced being” problem, the most a soft materialist can ask is “could God have created me a woman but placed in me the brain of a man?” (or vice versa). Put differently, under a materialist framework, the “created but misplaced being” problem can at its very best and strongest form appear as an expression of brain-sex theory; even then, as we have seen, short of further research and scientific validation, it is highly unlikely and improbable that brain-sex theory serves as an explanation for gender dysphoria. In other words, there is very little basis within a consideration of materialism for one to lay claim to the charge that God created but misplaced my being in the wrong body, leading to my state of gender dysphoria.
3. Substance Dualism and Gender Dysphoria
I turn next to substance dualism. As the name implies, substance dualism maintains as its core commitment that there are two distinct mental and physical realms or substances: the soul/mind and the body. Both substances are fundamental and non-reducible to anything more basic, and can be conceived as capable of existing separately and of entering into causal relationships with each other. In particular, the soul under substance dualism is seen to possess a causal relation with its body such that it is able to act directly upon the body and be acted upon by the body.38 Once the majority position held in the Christian tradition, the popularity of substance dualism as a way of explaining the ontology of the human person has waned in light of the rise of secular naturalism and its two closely related views of humanity: evolutionary humanism and secular humanism. The result is that fewer numbers continue to maintain, as Joshua Farris states, the traditional “belief in a soul created by some deity that places us in a unique relation to the rest of the world.”39
Substance dualism, however, has not been totally replaced, and in fact could be said to be regaining lost ground especially in the philosophical and theological domains.40 Philosophical arguments have been advanced that point to some form of substance dualism as the more appealing way of conceiving the ontology of human beings as compared to its rival framework, materialism. These philosophical arguments center on substance dualism being the more intuitive or “common sense” approach to how we conceive ourselves. As stated by philosopher Stewart Goetz: “One of the things that I, as an ordinary person, believe about myself is that I am a soul that is distinct from my physical (material) body.”41 In other words, philosophers like Goetz see an ordinary person’s belief that he or she is a soul as an epistemologically basic belief that cannot be inferred or derived from any other more basic beliefs that this person might have. At the same time, Goetz contends that this basic belief that I am a soul finds sufficient epistemological warrant in just one’s experience that consists of “my inner or introspective awareness of myself as a simple substance that exemplifies psychological properties.”42 Another philosophical argument arguing for the soul utilizes the notion of the unity of consciousness. As seen earlier, Hasker argues that it is only the simple immaterial substance of the soul that can vouchsafe the experience of the unity of consciousness—the “unified subjectivity”—crucial to any conscious state. The only other alternative available to the materialist would be to posit the idea that it is the smallest elementary particle—the quark—that carries the entirety of the person’s conscious state; an idea that Hasker finds far-fetched.43 The final philosophical argument is an argument from replacement that derives its strength from a thought-experiment. Alvin Plantinga argues that it is still possible to conceive oneself existing even if all our bodily parts—right down to the very cellular level consisting of every minute molecule, atom, and quark—were to be replaced at an imaginary lightning speed. The possibility of being able to still conceive my existence and more importantly the continuation of my personal identity under this situation translates to the possibility that I am not identical with the whole of my body that I presently have or with the composition of my body. Instead, my identification lies with something deeper and immaterial: my soul.44 Substance dualists contend that if any of the above three arguments work, we would have reasons to reject materialism in favor of the view that human persons are essentially a soul with a body.
We now engage with the specific issue of how substance dualism might account for conscious states in general and gender dysphoria in particular. An initial glance reveals that substance dualism has a smoother path than materialism in accounting for the “qualitative, unified subjectivity” aspect common to all conscious states and their potential causative effects. The very core tenet of substance dualism positing a separate immaterial simple substance known as the soul is what fulfils the key criteria required. Put differently, it is my soul that experiences the distinct qualia associated with the conscious state (“qualitative” aspect); my soul, being a simple immaterial substance, experiences the qualia in a unified manner and all at once (“unified” aspect); I identify myself with my soul rather than my body or any of my body parts (“subjectivity” aspect), and my soul, being a separate substance from my body, could potentially cause me or my body parts to behave in a certain manner (“potential causative effect”).
When it comes to gender dysphoria, substance dualism via the positing of the soul is able to account for the “inner” or “real self” and the experience of gender identity discordance by pinpointing that “inner self” to reside in the soul. The substance dualist is able to say that one’s “real self” is to be identified with one’s soul, rather than with any “self” that might arise from the interaction or proper functioning of my body’s constituent parts right down to the cellular level, which would still be materially composed on the final count. However, the move of locating the “inner” or “real self” to the soul sets the substance dualist to be wide open to the “created but misplaced being” problem: God created my soul as female, but I have been mistakenly placed in a male body (or vice versa). Leveled as a more serious charge: God created me to be in this state of gender dysphoria. What avenues are open to the substance dualist to counter this charge?45
Here is where it is beneficial to drill deeper into the different varieties of substance dualism. Two varieties of substance dualism—Emergent Dualism and Thomistic Dualism (or Hylomorphism)—hold the two components of soul and body in such a tight and interdependent relationship that any justification or basis for positing the idea of a soul mismatched with a wrongly sexed body is dematerialized. I begin with Emergent Dualism and turn to Hasker who could be said to be emergent dualism’s foremost advocate.46 Put simply, emergent dualism states that the soul (or mind) is an emergent entity or mental substance that emerges from a properly configured physical system, in this case the body with all the biological, chemical, and neural relationships and interactions. In this way, the emergence of mental properties and mental events, in fact, emergent novel causal powers, and—nay, can we even say more—a whole emergent “self” or person, is what emergent dualism shares with the “strongest” view of materialism, what we termed the theory of emergent material persons (EMP) earlier. The key difference between the two is that on emergent dualism’s terms, once emerged, the soul or mind or mental state of the “self” subsists as a distinct substance that is simple, immaterial, and ontologically distinct and separable from the body. The “self” that emerges under the EMP theory, however, is still constituted by the body and its physical parts, hence complex, and certainly not another substance ontologically distinct and separable from the body.47
The important point to note that rules out the “created but misplaced being” scenario for emergent dualism is that the soul is not created “externally” outside of the body and then subsequently added or “plopped” into a body (a view Hasker labels as “creationism”); rather, the soul emerges “internally” from the physical, chemical, and neural operations in the created human body. The theist who subscribes to emergent dualism therefore sees the creation of one’s human soul by the divine creator not as an act of creation ex nihilo, but a creation brought about through the natural process of the appropriate physical organization and function of the body and brain.48 In situations where there is clearly no DSD at work, the body’s biological sex would serve as the proximate cause for the “gender” of the soul and as Farris observes of such an outworking, “it is not clear what other cause would contribute to the emergence of a mismatching soul with body.”49 As with the case of our consideration of materialism, the best that a challenger could do is to point to brain-sex theory as a basis for the emergence of a wrongly gendered soul, but even then, as we have seen, the theory is still far from conclusive in serving as an explanation for gender dysphoria.
I move to the second variety of substance dualism that can fend off the challenges from the “created but misplaced being” problem: Thomistic Dualism (or Hylomorphism). As the name suggests, Thomistic dualism finds its influence in Aristotelian and Thomistic ontologies, which basically sees all material objects as composites comprising of first, matter, and second, a substantial form that determines the essential nature of the object at hand such that the material composite together counts as a member of the species to which it belongs.50 As Thomist philosopher Eleonore Stump puts it, “Human beings, earthworms, daisies, rocking chairs, amethyst clumps, and bread dough share with all other material things the characteristic of having both matter and form.”51
Translated to the human being, Stump contends that the human soul is “the substantial form … in virtue of which the matter informed by it … constitutes a living human body.”52 She adds further that Aquinas takes the soul to be a particular, not a universal, such that the soul can be said to be that which animates or actualizes a human body to not just be a human being, but this human being. The soul, on Aquinas’s terms, being a kind of form and an “essentially configurational state,” is also immaterial, simple (in relation to what it is), and located spatially in its entirety in each part of the body (in relation to the wholeness of what it is).53 Finally, Aquinas posits the idea that the soul is able to exist separated from the body and engage in mental acts while in that state of separation. This is an idea that Stump admits may be perplexing for some, given the question how there can exist “an essentially configurational state with nothing that is configured” and furthermore, one that is able to engage in acts while separated from the very body it is configuring. Stump’s proposed solution is to adopt a broader view of what Aquinas has in mind with the notion of form, and here, she brings in Aquinas’s idea that it is possible for some forms to be configured rather than to be configurers of things, given that “anything that has being—whether that thing is material or immaterial—… will have configuration or form.”54 The human soul, on Aquinas’s terms as Stump posits, is just this amphibian of the metaphysical world: “Like the angels, the human soul is itself configured; but like the forms of other material things, the human soul has the ability to configure matter. The human soul, then, is a configured configurer.”55
The above understanding of the human soul in its double aspect as a “configured configurer” is not to be glossed over, for it is this central concept that enables Aquinas to accomplish three key things. First, it enables him to hold out the continued existence of the soul separated from the body. Because the soul is configured, it has being, and hence it can have an existence on its own, albeit not as a full substance but as a “subsistent thing.” Aquinas attributes any cognitive functions that the disembodied soul can have to divine help.56 Second, since the soul is itself an individual configured form (and Aquinas holds that each soul is as it were handcrafted by God), the human soul makes matter be not just human but also this human being with the full individuality of his or her personhood. This is a personal identity that carries on after death in the separated soul.57 Third, the double aspect of the human soul as a “configured configurer” is what enables Aquinas to maintain that while each human soul is created directly by God (the “configured” aspect), the soul is not created before the body and then infused into an already existing body. Rather, as Stump states, “like the form of any material object, [the soul] exists in the composite it configures and it comes into existence only with that composite, not before it.”58 The soul is therefore created in the body, being produced simultaneously with human bodies at the culmination of human generation (the “configurer” aspect).59
I am not expecting Thomistic dualism as a way of accounting for the body-soul relationship to satisfy everyone.60 But taken on its terms, Thomistic dualism is able to defend itself against the charge of the “created but misplaced being” problem that substance dualism as a general framework might be open to. The understanding of the soul as the form or configurational state of the body has led some Thomistic dualists to maintain that while the immaterial soul by itself does not have a sex, the soul could be properly characterized as gendered on account of the fact that it serves as the vivifying or actualizing principle of an actually existing sexed human being.61 And since the soul serves as the configurational state of this particular human body which is of a biological sex one way, on account of Thomistic dualism, it is virtually impossible for the soul to be gendered another way. Otherwise, how could a “male” human soul be the vivifying and animating principle for a “female” human body such that the soul-body unitive composite exists as a female human being (or vice versa)?62 The plausibility of a wrongly gendered soul is also further removed when we consider Aquinas’s contention that the soul, even though it is created by God, is not created before the body is, but at the same time that the soul configures the body that is identified with a particular biological sex.63
That leaves the last variety of substance dualism: Cartesian dualism, which is slightly more problematic. Cartesian dualism, especially in its stronger forms—what has been termed “pure-substance dualism”64— construes body and soul to be so fundamentally different that there is little interdependence between the two substances. On account of this version of Cartesian dualism, the soul is often seen as that which is real and the sole constituent of one’s personal identity, including the continuance of personal identity upon death. The human body ends up being viewed as a nonpersonal instrument of the self. As Melissa Moschella highlights, “strong” Cartesian dualism could do damage in severing the link between sex (understood as biological identity) and gender (understood as a psychological identity). Because the soul alone is what constitutes the “real me” such that my biological sexual identity as a characteristic of my body is not definitive for the gender identity of the “real me,” the door is opened to the possibility that my soul could be created gendered one way but misplaced in a body of a different biological sex.65
Not all is lost for Cartesian dualists though. There is a way out of the conundrum and that is for Cartesian dualists to maintain that the soul is not gendered on its own in abstraction from a human body. On this view, even though the soul is seen as a substance fully in its own right in the sense of being a bearer of properties, “sex” or “gender” is not held as an essential property of a human soul, but an accidental property held in conjunction with a human body of a certain biological sex. This view derives its inspiration from the patristic theologian Gregory of Nyssa’s understanding of sex and gender and its application to the human soul.66 On this Nyssa-inspired model where the soul does not instantiate one’s gender essentially but only derivatively as a common property it shares with the body, it is difficult to envisage a case of a soul gendered one way mismatched with the wrong body.67 In other words, the (strong) Cartesian dualist in this case is at best able to assert that God created this human soul “female” because femaleness is a common property shared with the female body in which the soul coexists. The (strong) Cartesian dualist is not entitled to claim femaleness as an intrinsic and essential property of the created soul on its own. In fact, this is not a high price for strong Cartesian dualists to pay and it might be to their advantage. The idea of gender being an essential property of the human soul brings problems of its own. For one, if that were so, would the fact that God the Son assumed a human male soul in the incarnation show up the inadequacy of our Lord’s redemption for human female souls? For the Lord would have at best assumed half a complete human soul—a male soul but not the female soul—since gender and sexuality is deemed an essential property of the soul under this way of thinking. The (strong) Cartesian dualist who subscribes to a Nyssa-inspired way of thinking about the human soul is free of this problem.
To summarize, while the “created but misplaced being” problem might initially seem to prove a challenge for substance dualism, a closer examination of the two varieties of emergent dualism and Thomistic dualism rule out the problem. For on account of these two types of substance dualism, the soul is inextricably linked to the body—emerging from the biophysical and neural operations of a body of a particular biological sex in emergent dualism, and acting as the form or configurational state of a body that is also of a particular biological sex in Thomistic dualism. Even with the third type of strong Cartesian dualism, the challenge can be mitigated by maintaining a Nyssa-inspired view of the human soul, where gender or sexuality is not counted as an essential property of the soul, but an accidental property held in common with the body in which the soul co-subsists.
Together with the findings that we uncovered from our exploration of materialism, one could safely assert that when it comes to gender dysphoria and the body-soul relationship, there is virtually no ontological space for the “created but misplaced being” scenario to happen, where God created the “real” me gendered one way but misplaced this “real” me in the wrong human body of a different biological sex. This is regardless of how the “real” me is conceived under the two main frameworks presented: according to brain-sex theory for materialism or the theory of a sexed soul for substance dualism.
4. Conclusion: Three Preliminary Theological Implications
Perhaps some might find the above exercise a tad too speculative in nature, but I am convinced that the exploration has its benefits for a theological consideration of gender dysphoria, and I offer three preliminary insights in closing.
First, in ruling out a “created but misplaced being” scenario, one concurrently rules out the origin or cause of gender dysphoria as being located in creation and pinpoints it instead to the fall. As this article has sought to prove, regardless of the body-soul framework one subscribes to—whether materialism or substance dualism—there is virtually no basis to lay claim to the charge that God created the “real” me gendered one way but mistakenly placed me in a body of a different biological sex. In other words, we can confidently assume that gender dysphoria as a phenomenon is not meant to be associated with any states of consciousness experienced by the human being at the point of creation; it is not a natural state of consciousness that God created us to experience. This in no way belittles the genuine sense of gender identity discordance that the gender dysphoric person struggles with, but it is to say that in the case of individuals with a clear-cut biological sex, the conscious state of gender dysphoria is a psychological phenomenon resulting from the fall, rather than a physiological (involving the proper functioning of the human body and brain) or ethereal (involving the human soul) phenomenon that finds its origin in creation.68 Even when considered as a consequence of the Fall, I remain persuaded that gender dysphoria is to be “understood as a result of living in a fallen world, not a result of personal moral choice,” as stated in a recent tract. As with those who suffer from mental health issues (e.g., depression or anxiety), “we do not discuss their emotional state as a moral choice, but a condition that manifests as a result of the fall. A person may make choices in response to the symptoms or an overall treatment approach which may have ethical or moral dimensions, but they did not choose their condition and they are not morally culpable for it.”69 Such an identification allows for the quale of gender identity discordance to be conceived as a psychological misworking of the mind in terms of its thought processes and rightful identification of the states of consciousness the mind undergoes. As John Calvin highlighted, the fall has brought about a vitiation of every part of our human nature such that the supernatural gifts were withdrawn and the natural gifts corrupted in terms of soundness of mind and uprightness of heart being taken away.70 In gender dysphoria, the thought processes and identification of conscious states which lead to one affirming his or her gender identity in a way that follows naturally from one’s given biological sex have sadly been disordered, and once again, this is due to the fall rather than creation itself.
Second, I believe that the above exercise reinforces a central point in thinking after a theological-anthropological manner about gender: the need to retain some aspect of what has been termed “essentialism.” While factoring in the role of cultural contexts and social constructs in shaping how we as a society understand our gender norms, expressions and roles, our gender identification cannot run away from being grounded in the biological givens of life.71 The above exploration shows that all the body-soul relationship accounts featured locate the gender identity of the “inner” or “real” self as having some form of connection to one’s biological sex, regardless of whether the idea of the “inner” self stands in need of further clarification and definition (on account of hard materialism), or the “inner” self is to be identified with the “emergent material person” (on account of soft materialism), or the human soul (on account of substance dualism). The necessity of some form of “essentialism” in turn establishes once again that gender dysphoria—especially in cases where there is no evidence of a DSD condition—is really to be seen as a psychological rather than a physiological or ethereal problem.
Third, the recognition of gender dysphoria as essentially a psychological issue resulting from the fall should provide guidance in our pastoral care and restraint in our psychological assessment and treatment of gender dysphoric individuals. At the very least, it should give pause before gender dysphoric clients or patients are hastily—in some cases, almost automatically—recommended gender-affirming therapies that usually culminate with gender reassignment surgeries.72 Gender affirming therapies, insofar as they involve any form of medical interventions on a human body that is clearly identified as belonging to a certain biological sex, do irreversible violence to one’s bodily integrity and directly harm one’s capacity for marriage and reproduction. These actions thwart the very purpose of human flourishing that our bodies are biologically-sexed for and so should be regarded as morally wrong actions.73 It is also questionable whether such medical measures, especially gender reassignment surgeries, achieve the alleviation of psychological distress they are purported to bring about.74 Even if they do appear to do so, the findings uncovered in this article reveal that the procedures’ “success” in relieving psychological distress would ultimately be premised on a falsehood: on all accounts of the body-soul relationship outlined above, the true gender identity of the “inner” or “real” self is inextricably bound to the biological sex of the human body in which this “self” is located, and not the other way round. In the case of one whose biological sex is unambiguous, gender dysphoria involves a psychological pathology where created reality is misperceived. The feeling of being a man trapped in a woman’s body (or vice versa) might well be the genuine subjective feeling of the gender dysphoric individual, but it is not an objective fact. The question remains: in this situation, does it make more sense to change the body to match the mind (changing objective reality to match subjective misperception), or to change the mind to match the body (changing subjective misperception to fit with objective reality)?75
 American Psychiatric Association, “Gender Dysphoria,” Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Publishing, 2013), 452.
 For a resource summarizing the perspectives to its date of publication, see Ryan T. Anderson, When Harry Became Sally: Responding to the Transgender Moment (New York: Encounter, 2018).
 John R. Searle, “The Self as a Problem in Philosophy and Neurobiology,” in Philosophy in a New Century: Selected Essays (Cambridge: Cambridge University Press, 2008), 137–51.
 Rocco J. Gennaro, “Introduction,” in The Routledge Handbook of Consciousness, ed. Rocco Gennaro (New York: Routledge, 2018), 2–3.
 Searle, “Self as Problem,” 141–42.
 Searle, “Self as Problem,” 142.
 Searle, “Self as Problem,” 147.
 Marc Cortez, Theological Anthropology: A Guide for the Perplexed (London: Bloomsbury T&T Clark, 2010), 70 (emphasis original).
 Searle, “Why I Am Not a Property Dualist,” in Philosophy in a New Century: Selected Essays (Cambridge: Cambridge University Press, 2008), 152–60, specifically 158.
 Searle, “Why I Am Not a Property Dualist,” 152. Searle, in keeping to a “bottom up” causation only, has difficulty maintaining a genuine freedom in the gap between the perceived causes and the subsequent actions arising from a state of consciousness, according to William Hasker, “Do My Quarks Enjoy Beethoven?” in Neuroscience and the Soul: The Human Person in Philosophy, Science and Theology, ed. Thomas Crisp, Steven Porter, and Gregg Elshof (Grand Rapids: Eerdmans, 2016), 20.
 Nancey Murphy, “Nonreductive Physicalism,” in In Search of the Soul: Four Views of the Mind-Body Problem, eds. Joel Green and Stuart Palmer (Downers Grove, IL: InterVarsity Press, 2005), 115–38 (in particular 126).
 Murphy, “Nonreductive Physicalism,” 132.
 Murphy, “Nonreductive Physicalism,” 136 (emphasis original).
 Murphy, “Nonreductive Physicalism,” 138.
 William Hasker, “An Emergent Dualist Response,” in In Search of the Soul: Four Views of the Mind-Body Problem, eds. Joel Green and Stuart Palmer (Downers Grove, IL: InterVarsity Press, 2005), 144–45; Kevin Corcoran, “A Constitutional Response,” in In Search of the Soul: Four Views of the Mind-Body Problem, eds. Joel Green and Stuart Palmer (Downers Grove, IL: InterVarsity Press, 2005), 148–49.
 Cortez, Theological Anthropology, 77.
 Timothy O’Connor, “Materially-Composed Persons and the Unity of Consciousness: A Reply to Hasker” in Neuroscience and the Soul: The Human Person in Philosophy, Science and Theology, ed. Thomas Crisp, Steven Porter, and Gregg Elshof (Grand Rapids: Eerdmans, 2016), 41.
 Hasker, “Do My Quarks?,” 20
 Hasker, “Do My Quarks?,” 25.
 Cortez, Theological Anthropology, 91.
 Hasker, “Do My Quarks?,” 28 (emphasis original).
 Hasker, “Do My Quarks?,” 34 (emphasis original). Goetz highlights that in brain science, this is known as the binding problem, where scientists or neurologists are interested in discovering where in the brain all the effects of diverse stimuli come together to create a single, unified first-person experience of an object. The binding problem remains an ongoing exercise in search for an answer. Stewart Goetz, “A Substance Dualist Response,” in In Search of the Soul: Four Views of the Mind-Body Problem, eds. Joel Green and Stuart Palmer (Downers Grove, IL: InterVarsity Press, 2005), 140.
 Hasker, “Do My Quarks?,” 35–36.
 O’Connor, “Materially-Composed Persons,” 45.
 Lucy Griffin, Katie Clyde, Richard Byng, and Susan Bewley, “Sex, Gender and Gender Identity: a Re-Evaluation of the Evidence,” BJPsych Bulletin (2020): 1–9, https://doi.org/10.1192/bjb.2020.73. See American Psychological Association, “Answers to Your Questions About Transgender People, Gender Identity and Gender Expression,” http://www.apa.org/topics/lgbt/transgender.pdf, which similarly affirms this distinction.
 Both strategies are gleaned from Janet Levin, “Materialism,” in The Routledge Handbook of Consciousness, ed. Rocco Gennaro (New York: Routledge, 2018), 38–50.
 Janet Levin, “Materialism,” 41 (emphasis original).
 Searle, “Self as Problem,” 143.
 An example of the difficulty can be seen in Stephen V. Gliske, “A new theory of gender dysphoria incorporating the distress, social behavioral, and body-ownership networks,” ENEURO 6.6 (2019), https://doi.org/10.1523/ENEURO.0183-19.2019, where it is claimed that gender dysphoria is brought about by an alteration in how one’s sense of gender is influenced by the reflexive behavioral responses associated with three neural networks. While promising, the article had to be subsequently retracted by the journal’s editorial board in ENEURO 7.2 (2020), https://doi.org/10.1523/ENEURO.0149-20.2020, on the grounds of major flaws including a lack of supporting evidence in the literature.
 Searle, “Self as Problem,” 144–45, highlights this larger problem.
 Lawrence S. Mayer and Paul R. McHugh, “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences,” New Atlantis 50, Special Report (Fall 2016), part 3, https://www.thenewatlantis.com/publications/executive-summary-sexuality-and-gender; Anderson, When Harry Became Sally, ch. 4.
 Mayer and McHugh, “Sexuality and Gender,” part 3. DSM-5, 457, continues to maintain a distinction between sexual dysphoria and an intersex condition.
 Robert Sapolsky, “Caught Between Male and Female,” Wall Street Journal, 6 December 2013, quoted in Mayer and McHugh, “Sexuality and Gender,” part 3.
 Mayer and McHugh, “Sexuality and Gender,” part 3, under the subheading “Gender and Physiology.”
 Mayer and McHugh, “Sexuality and Gender,” part 3, under the subheading “Gender and Physiology.”
 Mayer and McHugh, “Sexuality and Gender,” part 3, under the subheading “Gender and Physiology.”
 Jiska Ristori Carlotta Cocchetti, Alessia Romani, et al., “Brain Sex Differences Related to Gender Identity Development: Genes or Hormones?” International Journal of Molecular Sciences 21 (2020), https://doi.org/10.3390/ijms21062123; Ferdinand J. O. Boucher and Tudor I. Chinnah, “Gender Dysphoria: A Review Investigating the Relationship Between Genetic Influences and Brain Development,” Adolescent Health, Medicine and Therapeutics 11 (2020), https://doi.org/10.2147/AHMT.S259168, and Alberto Frigerio, Lucia Ballerini and Maria Valdés Hernández, “Structural, Functional, and Metabolic Brain Differences as a Function of Gender Identity or Sexual Orientation: A Systematic Review of the Human Neuroimaging Literature,” Archives of Sexual Behavior 50 (2021), https://doi.org/10.1007/s10508-021-02005-9.
 Cortez, Theological Anthropology, 83.
 Joshua R. Farris, An Introduction to Theological Anthropology (Grand Rapids: Baker Academic, 2020), 25–26.
 In theology, Karl Barth could be held as one who maintained a form of substance dualism. See Marc Cortez, Embodied Souls, Ensouled Bodies: An Exercise in Christological Anthropology and Its Significance for the Mind/Body Debate (New York: T&T Clark, 2008). Another example would be Farris, An Introduction to Theological Anthropology.
 Stewart Goetz, “Substance Dualism,” 33.
 Goetz, “Substance Dualism,” 39. Goetz considers the counterargument that when the materialist carries out this similar introspection, he or she could very well reach the opposite basic belief that “one is one’s physical body” (55). Goetz’s response is to plunge deeper into the content of that introspective self-awareness and affirm that what I am aware is the fact that “I occupy that same space [that my physical body with its substantive parts occupy] in a different way by being present in my entirety at each point of the space that I occupy.” That, Goetz affirms, is only achievable with the (simple) soul that is present in its entirety at each point in space where it experiences sensations (56). Hence, a stronger justification is provided for the substance dualist’s basic belief than the materialist’s. See Farris, An Introduction to Theological Anthropology, 20, where he maintains a similar common-sense argument for the soul.
 Hasker, “Do My Quarks?,” 35–36.
 Alvin Plantinga, “Against Materialism,” Faith and Philosophy 23.1 (2006): 3–32.
 At this juncture, I refer to Robert S. Smith, “Body, Soul and Gender Identity: Thinking Theologically About Human Constitution,” Eikon 3.2 (2021): 27–37, https://cbmw.org/2021/11/21/body-soul-and-gender-identity-thinking-theologically-about-human-constitution/#_ftnref39; an article which complements this present piece. Smith similarly explores the extent to which human constitution or ontology supports what he calls “spiritual gender identity theory—i.e., the claim that a person can have the spirit or soul of one sex in the body of another” (28). This is similar to the “created but misplaced being” scenario which I am exploring. The key difference between the two articles, however, lies in the narrower focus of Smith’s exploration. He focuses only on one version of substance dualism—“soft dualism” of a kind leaning towards Thomistic dualism—while my article explores the broad spectrum of views concerning human constitution, both of a materialist and substance dualist flavor. I would like to thank Brian Tabb (General Editor of Themelios) for alerting me to this article.
 William Hasker presents his views in his monograph The Emergent Self (Ithaca, NY: Cornell University Press, 1999). For a chapter-size summary of his view, see Hasker, “On Behalf of Emergent Dualism,” in In Search of the Soul: Four Views of the Mind-Body Problem, eds. Joel Green and Stuart Palmer (Downers Grove, IL: InterVarsity Press, 2005), 75–100; and Hasker, “Why Emergence?,” in The Ashgate Research Companion to Theological Anthropology, eds. Joshua R. Farris and Charles Taliaferro (Burlington, VT: Ashgate, 2015), 151–61.
 Hasker, “Why Emergence?,” 158–59.
 Hasker, “Why Emergence?,” 153–55. Hasker contends that soul emergentism has the following advantages over soul creationism: 1) it provides a better account of the dependence of mind (or the soul) upon the body; 2) soul emergentism is less pressured than soul creationism to attribute divinely created souls to animals, and 3) soul emergentism coheres better with biological evolution than soul creationism.
 Farris, An Introduction to Theological Anthropology, 227.
 I am dependent on Eleanore Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” Faith and Philosophy 12 (1995): 505–31, for the description of Thomistic dualism.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 507.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 508.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 512.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 513.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 514–15.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 517–19.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 516.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 516.
 Stump, “Non-Cartesian Substance Dualism and Materialism without Reduction,” 515.
 The main difficulty for fully embracing Thomistic dualism comes from the ambiguous state of the human soul: is it a “substance” or not? Hasker, “On Behalf of Emergent Dualism,” 94, sees that in positing the soul as “the form of the body,” a pattern or structure of the body, and yet allowing the soul to continue subsisting and carrying out various mental activities in a disembodied state, “Thomistic dualism suffers from a fundamental incoherence.” Hasker, Emergent Self, 167–70, presents two further problems that Thomistic dualism is not entirely able to shake off: the problem of mind-body interaction on Thomistic dualism’s own terms and the problem of the souls of animals.
 Elliott L. Bedford and Jason T. Eberl, “Is the Soul Sexed? Anthropology, Transgenderism, and Disorders of Sex Development,” CHAUSA (2016), https://tinyurl.com/35yc5hf7.
 Farris, An Introduction to Theological Anthropology, 226, states that for Thomistic dualism, “[p]ersons are matter-form composites, and persons are not, properly speaking, identical to their souls alone apart from the matter the soul informs.”
 My conclusion regarding Thomistic dualism is similar to that of Smith, “Body, Soul and Gender Identity,” 33–35. Smith highlights that although there is still some debate within Thomist scholarship, there is ample ground to read Aquinas as supporting the view that the soul takes its sex (or gender) from the body and not the other way around (34).
 Farris, An Introduction to Theological Anthropology, 65.
 Melissa Moschella, “Sexual Identity, Gender, and Human Fulfillment: Analyzing the ‘Middle Way’ Between Liberal and Traditionalist Approaches,” Christian Bioethics 25 (2019): 192–215, https://doi.org/10.1093/cb/cbz005.
 The traditional reading of the bishop’s understanding on this matter is that sexuality and gender was added to humanity in view of the Fall, whereas the prelapsarian and eschatological state of humanity was intended to follow that of the angels in their asexuality. See, for example, Hans Boersma, “Putting on Clothes: Body, Sex, and Gender in Gregory of Nyssa,” CRUX 54.2 (2018): 27–34, for this traditional reading of Nyssen. John Behr, “The Rational Animal: A Rereading of Gregory of Nyssa’s De hominis opificio,” JECS 7 (1999): 219–47, however, has proposed an alternative interpretation, suggesting that from the outset Nyssen conceived the existence of human beings as rational animals, embracing within their own being the two extremes of creation, namely, the asexual rational (which is in the image of God) and the irrational sexual (which humans share with the animals). Nyssen sees the human soul as the rational soul, and given that he associates gender and sexuality with the irrational, leads me to postulate that Gregory of Nyssa would not have seen gender and sexuality as essential properties held by the soul, even as he recognized the soul as a bearer of properties in its own right.
 Farris, An Introduction to Theological Anthropology, 226.
 Once again, the exploration of individuals with DSD or those born with intersex conditions experiencing gender dysphoria lies beyond the scope of this article and deserves a separate treatment. Even then, it can be preliminarily argued that any gender dysphoria associated with DSDs be seen as physiological effects of the Fall not intended at creation. As the paper “A Theology of Gender and Gender Identity,” Sydney Diocesan Doctrine Commission (2017), https://www.sds.asn.au/diocesan-doctrine-commission-0, states, “The biblical account of creation thus indicates that God has created each human being as either male or female. We are given no encouragement to consider male and female as two extremes at either end of a broad continuum, or to consider those with an intersex condition as intended from the beginning as a third sex” (§3.2).
 “Transformed: A Brief Biblical and Pastoral Introduction to Understanding Transgender in a Changing Culture,” Evangelical Alliance (2018), https://www.eauk.org/resources/what-we-offer/reports/transformed-understanding-transgender-in-a-changing-culture.
 John Calvin, Institutes of the Christian Religion, ed. J. T. McNeill, trans. Ford Lewis Battles (Louisville: Westminster John Knox Press, 1960), 2.1.8 and 2.2.12.
 Cortez, Theological Anthropology, 55.
 Gender-affirming therapies typically consist of a set of stages beginning with social transitioning, puberty blockers (especially if the gender dysphoric individual is still a child), hormonal treatments, and finally, gender reassignment surgeries.
 Moschella, “Sexual Identity, Gender, and Human Fulfillment,” 200–201.
 See, for example, Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Långström, and Mikael Landén, “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLoS One 6.2 (2011), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071; Richard Bränström and John E. Pachankis, “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study,” American Journal of Psychiatry 177 (2020): 727–34, https://doi.org/10.1176/appi.ajp.2019.19010080; and “Correction to Bränström and Pachankis,” American Journal of Psychiatry 177 (2020): 765, https://doi.org/10.1176/appi.ajp.2020.1778correction.
 See Griffin, Clyde, Byng, and Bewley, “Sex, Gender and Gender Identity,” where, coming from a purely psychiatric perspective, the authors issue a stirring call in the name of good psychiatry and medicine to give pause to simply going with medical/surgical transitioning procedures as a way of treating gender dysphoria. Their conclusion is worth quoting substantially (p. 9):
Language that confuses or conflates sex and gender identity, while appearing inclusive, might have the unintended consequence of closing down the means to understand complexity and respond appropriately to patients’ emotional and material reality…. Viewing transgender as a fixed or stable entity, rather than a state of mind with multiple causative factors, closes down opportunities for doctors and patients to explore the meaning of any discomfort … [especially] when multiple medical interventions are required on an otherwise healthy body or doctors are expected to deny the concept of sex or the sexed body…. It is confusing to liken open-minded working with young patients as they figure out who they are to conversion therapy. Holding an empathic neutral middle ground, which might or might not include medical transition, should not be equated with this. Psychiatrists need to feel empowered to explore the meaning of identity with their patients, treat coexisting mental illness and employ a trauma-informed model of care when appropriate.
It is hoped that my article provides a theological/philosophical basis to these findings that have otherwise come from a psychiatric perspective.
Edmund Fong is a lecturer in systematic theology, hermeneutics, and Presbyterianism at Trinity Theological College, Singapore.
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