Changing Characters

Eric Lis

There’s a very real chance that something in the area of one in every thousand to one in every ten thousand adventurers in your campaign setting is actively hoping to have their sex changed by a magical item.

Identity is a curious thing which science has always had some difficulty wrapping its head around. Medicine and the social sciences have numerous constructs which are used to describe and explain such concepts as personality, character, and temperament, but the overarching idea of identity remains hard to describe due largely to its complexity and the huge number of factors that make it up. This matters to us because there are a number of different mental disorders wherein a person’s identity, or how they perceive and conceptualize themselves, is at odds with how the world sees them. The most well-known of these disorders is currently known to Western medicine as “gender dysphoria,” and it describes a person who experiences suffering or impairment because they have a sense that the body they were born with is a different sex from the gender they “know” themselves to actually be. Importantly, merely having a discordance between their genetic and perceived gender identities doesn’t mean a person has a mental disorder; the person merits a diagnosis only if they suffer because of the discordance. Rates of gender dysphoria seem to be fairly similar between countries, suggesting that it isn’t caused by some particular element of culture, although the proportion of men compared to women with the disorder has been found to be different in different countries. While we have fair data to tell us how many people experience gender dysphoria, we don’t really know how many people are walking about feeling an identity discordance without dysphoria, nor do we know how many people experience dysphoria but never report it to a health care professional. In any event, the percentage of people who feel a disconnect between their apparent gender and their experienced gender is certainly higher than our estimates, because people are always weirder than our numbers suggest.

In the modern world, gender dysphoria is “treatable” in a few ways. Many people just learn to live with their dysphoria without help; they may experience prolonged depression or self-image issues and a certain percentage of them will eventually suicide. Some will find a therapist who can help them to make sense of their conflicting feelings; they may never feel that they have the right body, but they’re likely to at least make peace with the body they have. Finally, a good number will undergo reassignment, through a combination of hormone therapies and surgeries. This lengthy, costly process genuinely does make huge differences in the lives of some people, but it’s by no means easy on a person physically or emotionally.

As with most health issues, of course, gender dysphoria is probably much more easily treated in a medieval fantasy setting than it is in our world… assuming that the poor individual isn’t just burned at the stake or something, as they would have been throughout much human history. Depending on a storyteller’s point of view, dysphoria might conceivably be cured by remove disease, but gender dysphoria seems to be something many people are born with and in my games, where remove disease mostly just cures infections, this spell would have no effect. Similar, restoration magic probably has no effect on gender dysphoria, since there’s no clear pathology to “restore.” While a wish or miracle can probably remove the dysphoria, I would wager that most of the people who are able to get their hands on such magic use it to change their biological sex rather than their thinking, and while this may lead to other life complications it’s almost certainly curative of their dysphoria.

In medieval Europe, it would likely be difficult for such suffering individuals to find sympathy from the Church, since Christianity’s response to matters such as cross-dressing was to light people on fire. In a fantasy campaign, however, one must imagine that some faith would be more open to people with gender dysphoria than others. While many, many fantasy faiths would undoubtedly frown upon someone who seeks to change their gods-given sex and gender role, there’s almost certainly a god of love out there – or a god of trickery or something – who’s very much in favor of seeing people be transformed to have the bodies they wish for. Given the fairly small number of people out there with this problem, I would actually imagine this might be one of the few cases where mighty clerics would be willing to cast ninth-level spells for commoners.

This also begs the question of whether, in a fantasy setting, there are other forms of identity dysphoria that people develop. Are there people out there with race dysphoria, who “know” they they’re actually orcs or elves even though they were born in human bodies? If so, what options, magical or social, are available to them? Is a different therapy required when a person believes they were meant to be a halfling as opposed to if they were meant to be a dragon? What about class dysphoria, where a man with no evident magical aptitude lives with the painful certainty that he was meant to be an inherently-magical sorcerer? In addition to the sheer variety of ways one learns to question their identity in such a chaotic and varied world, the possibility of actually changing oneself through magic undoubtedly opens up people’s imaginations. Even in our world, there are the rare few people who feel, deep down, that they are not human, but actually cats or foxes or something, and without question, given polymorph magic, some of them would find a way to make this change happen. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on February 7, 2016. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system