Transgender issues have loomed large these past months. In May a series of editorials in The New York Times, titled “The Quest for Transgender Equality,” presented stories of transgender Americans as narratives of personal struggle and liberation, ringingly evoking the civil-rights struggles that are centerpieces of contemporary liberalism. Then came the rollout of Bruce Jenner’s new identity as Caitlyn, with all the attendant hoopla.

I move in liberal-progressive circles where these breakthroughs for trans people are hailed with unanimous approval. Yes, there may be a dissenting note here and there (e.g., Eleanor Burkitt’s dyspeptic op-ed, “What Makes a Woman?”), but only over peripheral issues, like whether the particular image Jenner chose for her Vanity Fair cover, evoking a Playboy bunny from the 1960s, insulted feminists. The underlying notion – that changing one’s gender identification is a liberation to be celebrated – is never challenged. Indeed, if you do challenge it, you risk being labeled a hater.

I doubt there’s a single issue that makes me feel a wearier sense of confusion, and in some ways ideological exclusion, than that of transgender life. Being so far apart from other liberal/progressives makes me wince. In late April, listening to a segment of NPR’s On Point about Jenner, I found myself uncomfortably bristling at the self-congratulatory tone of the commentary. Host Tom Ashbrook and his guests (one of them a psychiatrist and co-author of “a resource guide written for and by transgendered people”) treated it as self-evident that all Americans should greet Jenner’s revelations as a triumphant cultural and political moment. Their enthusiasm exuded the implicit sense that there simply isn’t any ground to stand on for anyone who might have qualms about transgenderism.

Yet I do.

I find stories of parents who encourage gender reassignment in their kids distressing; and when I read about what adults undergo in order to reassign themselves, the amputations and prosthetics, the powerful regimens of drugs that wreak havoc with the body’s hormones, it strikes me, at a deep level, as unnatural and even gruesome; a tragedy, not a triumph.

When and how did psychology decide that the persistent desire to be a different gender, and to dress and act and even modify one's body accordingly, is not a disorder, but rather a matter of individual freedom vis-à-vis an oppressive set of normative values? How does psychiatry distinguish between persistent desires and perceptions that it would deem disordered, and those that are normal, healthy and need to be honored?  

A psychologist friend of mine, who writes about psychiatric diagnosis, calls this question “very complex.” He notes that the most recent psychiatric diagnostic manual, the DSM-5, recast what had previously been called Gender Identity Disorder as Gender Dysphoria -- a tactical move, he says, intended to “to make it clear that the diagnosis was only to be used when the condition was causing the person distress” while maintaining access to treatment and insurance benefits. The movement is toward acceptance.  Rather than seeking to define disorder, “psychologists have been more concerned with de-pathologizing the condition, and seeing the social dimensions of the suffering it causes.”

After Jenner’s splashy Vanity Fair debut, I was on a CT Public Radio show discussing the week’s news, and while my fellow panelists celebrated Caitlyn, I resorted to evasive generalities. When one of the other guests on the radio show said that gender “is a spectrum,” and exhorted us all to “please, get rid of this binary stuff!”, I wanted to say, well, wait, there are men and there are women. That’s real! And it’s binary!  A proposal by Canadian trans activists to stop putting gender on birth certificates because the genitalia evident at birth may present “false information” doesn't make me think, Yeah, absolutely! -- but pretty much the opposite. I didn’t say so, though. I lacked the courage of my hesitations.

American progressivism’s aversion to the word “natural” is almost as strong as its aversion to “religious.” Everything is a social construction. Burkitt notes that in January 2014, when actress Martha Plimpton, an abortion-rights advocate, sent out a tweet about an abortion-funding benefit called “A Night of a Thousand Vaginas,” she was battered by trans critics for boosting an event “focused on a policed, binary genital,” as one put it. The term “vagina,” another blogger insisted, “is exclusionary and harmful.” Burkitt notes acidly that Ms. Plimpton became, to use the new trans insult, a terf, which stands for “trans exclusionary radical feminist.”

Trans exclusionary radical feminist!  The categorical complexities of the various stages of sex reassignment are themselves formidable. Upper, lower, neither; drugs only; drugs plus surgery: add to that the complication of sexual orientation, and it is a full menu indeed.  And that seems like the appropriate metaphor, too: a roster of choices, an endless smorgasbord of identities, where choosing – and changing – represent something between an individual liberty and a consumer right.

Beneath all of this is the question of identity and what – and who – determines it. (“People who haven’t lived their whole lives as women,” Burkitt asserts, referring acidly to transwomen like Jenner, “shouldn’t get to define us.”) The question encompasses the bitterly contested transracialism claimed by Rachel Dolezal. On the Today show, Dolezal, defending her decision to disguise herself as African-American, recalled being five years old and “drawing self-portraits with the brown crayon instead of the peach crayon.” But society would not indulge her self-image. “I was socially conditioned to not own that, and to be limited to whatever biological identity was thrust upon me and narrated to me.” To Matt Lauer’s blunt question, “Are you African-American,” she answered: “Well, I definitely am not white. Nothing about being white describes who I am.” What she means is, being white doesn’t describe what she feels, how she chooses to define herself.

Do we really have limitless freedom to define ourselves? Is that what we are seeking? Take away God and nature, take away any kind of transcendental framework, and what remains – especially in our kind of society – is the menu.  As one responder on the Times website commented, concerning Dolezal, “Gender, race and sexual preference should be a choice.” Order up!

Of course the ugly edifice of legal discrimination that confronts trans people needs to be torn down. But gender dysphoria still seems like a disorder to me, and gender reassignment a nightmare. Maybe knowing someone well who went through it would help get me over the hump. Lord knows that at sixteen, I would have found gay marriage bizarre. Real connections to real people have a salutary way of humbling us and correcting our ideas.

To those who share my doubts, I’d ask, How to balance skepticism with respect for real people in their life predicaments? And to those who are celebrating Trans America, I’d ask: Is there room in the public square, in the public conversation, for those of us who harbor doubts?