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 sostiene que la etiqueta 'trans' abarca una compleja gama de experiencias internas, en relación con las preferencias sexuales y las identidades de género declaradas de las personas.
• A partir de su trabajo con menores de 18 años que buscan tratamiento médico, describe casos en los que adoptar pronto una identidad trans parecía interponerse en el doloroso trabajo de entender lo que significaba para ese joven.
• Señala que preguntar 'por qué transgénero' (en lugar de 'cómo transgénero') se siente a menudo como tratarlo como una enfermedad, lo que dificulta a los terapeutas explorarlo.
• Recomienda una 'curiosidad equidistante', es decir, la misma curiosidad por lo que significa y hace una identidad trans para la persona, lo que según ella es distinto de la duda silenciosa.
• Su material de casos incluye, según se informa, a una chica de 17 años que decidió no hacer la transición tras cinco años de terapia en profundidad.
• Dice que la terapia nunca debe usarse para presionar o cambiar a las personas, admite el daño que su campo causó en el pasado a las personas gais, y dice que la cirugía de reasignación de sexo es el camino adecuado para algunos pacientes.
• Admite que sus propias opiniones están 'empapadas de ideas convencionales de género' y pide un diálogo entre distintos puntos de vista.

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.