Last month these columns carried two pieces on the question of “sex change” operations. Both are unsatisfactory, but for different reasons.

The letter from an unidentified parishioner can be act aside as a caricature in its prejudiced dismissal of the tiny minority of individuals who struggle with “gender identity disorder”.

But the article by the Bishop also raises serious concerns about the rigour and validity of its ethical, biblical and scientific analysis. The medical evidence especially appears to have been poorly understood, and in this respect we believe there is a risk that members of the diocese may have been misled.

Clearly a Bishop with a request for "gender redesignation" from a vicar must grapple, with some difficult questions, besides, the fundamental issue of an individual who wishes to live and behave as a member of the opposite sex.

For example, having undergone a cosmetic operation, what would be the status of any future relationships? In the case of a male seeking an operation, what would be the nature of a relationship with a man? What if (s)he then wished to be married or to have the relationship recognised by the Church? Or indeed, what would be the status of a relationship with a woman?

These issues would require careful consideration by ethicists, theologians and the Church at large;

However, if the problem could be recast as a "medical condition", with a medical solution, a number of issues would appear to be resolved. To quote the Bishop, the problem would be that of a "medical condition with pastoral implications".

Substantive moral and ethical issues, and questions concerning the ordering of human relationships, could be subordinated to "pastoral implications" and made to depend, to a considerable extent, upon the response, loving or otherwise, of the vicar's congregation. Those with continuing concerns would run the risk of being labelled intolerant and non-inclusive.

In our view this appears to have been the process so far. The Bishop's analysis hinges on the "medical condition" argument, and it is precisely at this point that the factual – basis of his thesis goes astray. Gender identity disorder is a poorly understood area. There is no clear consensus among psychiatric specialists, as the Bishop seems to be suggesting.

Some might view it as a medical condition, but others, perhaps the majority, would view it as a psychological disorder, to be understood alongside other sexual and identity problems in which people struggle with personal dissonance and psychological conflict.

In standard psychiatric classifications, such as the DSM-IV of the American Psychiatric Association, gender identity disorder is presented alongside a range of different "disorders" such as transvestism (often confused in the lay mind with gender identity disorder); various fetishistic disorders; disorders of sexual attraction, and so on.

These classifications are revised from time to time; new "disorders" are added while others are removed, homosexuality being a case in point.

The fact that a minority of individuals with one of these disorders can be helped by a cosmetic operation and hormone treatment does not render it a "medical condition".

Such reasoning is simplistic and fraught with dangers. Based upon this mistaken premise, the Bishop's article, in our view, is unsatisfactory and liable to create further confusion.

As practising psychiatrists we are not running down the need to classify and label psychological disorders. That is how science progresses. But where our knowledge is provisional and uncertain, we need to proceed with caution and avoid attaching more significance to the concept of a "disorder" than is merited by fact.

It is possible, of course, that a psychiatric colleague might write in support of the Bishop's analysis, drawing attention to recent research findings which could point to differences in brain functioning in some individuals with this problem – but this would rather illustrate our point.

This is a difficult and grey area in the medical profession at present. It seems odd that practising psychiatrists, who struggle on a daily basis with issues concerning the boundaries of the medical model, have considerable uncertainty and caution on this issue, while the Bishop appears to have a settled mind on the matter.

We do not think it appropriate to discuss this case specifically. We recognise, too, the considerable compassion of the Bishop's approach.

As practising psychiatric specialists, we hope that the Church of England will indeed be an "inclusive" Church. The Church plays a key role in welcoming and providing emotional and social support for individuals struggling with a range of psychological and emotional disorders.

But the Church must do so without compromising its role in providing insights into the ordering of human relationships and teaching on the regulation of human sexuality.

At a time of rapid social change, the Church needs leadership that matches pastoral care with an ethical and moral analysis that is both well informed and, dare we say, unafraid to be distinctive.

Professor Glynn Harrison
Professor and Head of Division of Psychiatry, University of Bristol

Dr Montagu Barker
Consultant Psychiatrist Emeritus, Clifton Park, Bristol

Dr Jan Truscott
Consultant Psychiatrist, Southmead Hospital, Bristol