Inside the Mind of Chaz Bono

Chastity Bono, the daughter of Cher and Sonny Bono, has undergone gender reassignment surgery and now asserts she [that's right, she] is a man. She now wants to be called Chaz.

She has written a tell-all entitled Transition: The Story of How I Became a Man, and has appeared on "The David Letterman Show" and "Oprah." A documentary about her journey called Becoming Chaz premiered on Oprah's OWN network. I know my thoughts on this matter will be politically incorrect, but they are entirely biologically and psychiatrically accurate.

First, Chaz Bono is not a man. She is a woman who has undergone radical surgeries and is taking male hormones in order to look like a man. That isn't a political position, it's a biological reality. Chaz Bono wants to be thought of as male, but she is not male.

You may disagree with me on philosophical grounds, arguing that behaving like a man and feeling like a man is tantamount to being a man, but that argument does nothing to change the biological reality.

Second, while Chaz Bono may now feel that her journey toward self-acceptance has ended, I am not convinced. I say this because, absent the gender politics involved, I was taught to consider Chaz Bono's contention that she is male as a psychotic delusion-a fixed and false belief.

Psychosis is not a predictor of long-term emotional well-being or stability.

Mind you, I am not judging Ms. Bono. But there is nothing substantially different from a woman believing she is a man than there is about a woman believing she is a CIA agent being followed by the KGB (when in reality, she is, say, a salesperson at J. Crew).

Very few people, if any, would suggest that the proper treatment for such a woman would be to have the Central Intelligence Agency make her an honorary agent and hire a few former KGB agents to chase her around town. While that "treatment" might make her more comfortable for a while, bending reality to conform to a person's psychosis just wouldn't be a good idea. For one thing, it would make us all lose our sense of what is real and true. For another, it would simply perpetuate the woman's underlying psychiatric illness.

Very few people, if any, would suggest that the way to treat someone who is petrified of death and insisting he is turning 16, not 61, would be to throw him a Sweet Sixteen party. Good psychiatrists, in particular, would be burrowing to the roots of the man's discomfort with aging. If necessary, medications might be prescribed.

I once treated a woman who believed her children had been replaced by masquerading doubles and another who believed her parents could hear her thoughts through listening devices implanted in the walls. I did the hard work of getting to the bottom of those psychotic symptoms. I certainly didn't hang up "Missing" posters with the first woman or start smashing holes in the walls of my office with the second.

Delusional disorders are notoriously difficult to treat. Paranoia (as in, the CIA example) can require extensive psychotherapy and anti-psychotic medication. Sometimes, that isn't even enough. So you can imagine that believing you are a man when you are a woman could require even more vigorous and dedicated attempts to alleviate the psychotic person's symptoms.

Is surgery to remove a woman's breasts, close her vagina and create a makeshift penis for her really so very different (other than being far more permanent)? Is it really likely to yield a "cure" for a woman's delusion that she is a man, or vice-versa? Does it really reach the depths of dissatisfaction, which create gender identity disturbances, to begin with?

I don't think so.

I think Chaz Bono, who is, in fact, a woman, will not escape, through surgery or manipulation of hormones, suffering that is far more than skin deep.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached via email at info@keithablow.com and his team of Life Coaches can be reached via email at lifecoach@keithablow.com. You can also visit www.keithablow.com for more information.


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