Summary

Lemma, a psychoanalyst, reflects on her work with teenagers seeking puberty blockers (drugs that pause puberty) or hormones. She argues that 'trans' has become a powerful identity and cultural category, but that some young people may take it up too early. That can shut down the painful inner work needed to understand why they feel as they do. She describes how hard it is to ask 'why transgender?' when that question is widely seen as treating it as an illness. She urges therapists to stay equally curious about all possible paths, including medical transition. She firmly rejects using therapy to change anyone's identity, and warns that policing debate harms thinking. The essay is based on a few anonymous cases from her own practice. It sheds light on dilemmas therapists face, but gives no evidence of how often these patterns happen or what follows.

Key findings

• Lemma argues that the 'trans' label covers a complex range of inner experiences, in relation to people's stated sexual preferences and gender identities.
• From her work with under-18s seeking medical treatment, she describes cases where taking on a trans identity early seemed to get in the way of the painful work of understanding what it meant for that young person.
• She notes that asking 'why transgender' (rather than 'how transgender') is often felt to treat it as an illness, which makes exploring it hard for therapists.
• She recommends 'equidistant curiosity', meaning equal curiosity about what a trans identity means and does for the person, which she says is different from quiet doubt.
• Her case material reportedly includes a 17-year-old girl who decided not to transition after five years of in-depth therapy.
• She says therapy must never be used to pressure or change people, admits her field's past harm to gay people, and says sex reassignment surgery is the right path for some patients.
• She admits her own views are 'steeped in conventional gender ideas' and calls for dialogue between different viewpoints.

Abstract

The capacity of transgender to incorporate all gender variance and sexual preferences has become a powerful tool of activism and personal identification. Rather than being an index of marginality 'trans' has become a central cultural site. In this paper, I will argue that this identity label encompasses a complex range of internal psychic positions in relation to consciously stated sexual preferences and gender identifications. My aim is to explore what can appear to be in some cases a premature embracement of the empowering potential of the transgender identification through my work with under 18-year-olds who are seeking medical intervention for gender dysphoria. This can undermine the painful psychic work required to establish what transgender means for any given young person. In an external culture where to ask 'why transgender' (as opposed to 'how transgender') is felt to be pathologising, working with these young people can prove difficult for the analyst. The challenge is to tread the fine line between a dialogue based on an equidistant curiosity about meaning and function that is core to an analytic approach, and a posture of implicit skepticism.

Conclusion

My experiential and theoretical reference points are steeped in conventional gender ideas. The grids of intelligibility that frame subjective experience inevitably limit every author, which is precisely why dialogue with others is vital so that we can ensure that we understand the different meanings of transgender identity and do justice to the heterogeneity of experience within the transgender community. Only this way can we assist more effectively those who seek our help. This will include those individuals for whom SRS is the chosen way forwards as well as those for whom this is unlikely to provide a solution. Psychoanalysis has an invidious history in relation to the prejudiced stance it took with respect to homosexuality and we must be careful not to repeat mistakes of the past when we approach transgender. Psychoanalysis should never be used as a tool of coercion or conversion – however subtle – when it comes to individual choices about how to live one's life. However, dialogue is a multi-way process and requires us all to tolerate many voices with a respect for the differences that this will expose. The policing of discourse runs the risk of atrophying thinking and consolidating prejudice rather than exposing it.