Summary

Psychoanalyst Roberto D'Angelo argues that it has become hard to ask why a young person wants to medically transition. He says the questions are blocked in three places: by the young person's own defences, in the therapy room, and by a political climate that calls such questions conversion therapy. His example is 'Elly', a trans-identified teen whose fixed story gave way, over long therapy, to memories of abuse by her mother. She still started oestrogen at 18. He points to UK, Swedish, Finnish and German evidence reviews that found the benefits of youth gender medicine uncertain. He argues careful exploration is an ethical duty before treatment that cannot be undone. He also sharply criticises fellow analysts who call this work transphobic. It is an opinion piece built on one case, by the president of SEGM (a group that urges caution), and has drawn published critiques.

Key findings

• 엘리의 사례에서는 어머니의 학대와 방임의 이력이 18개월의 치료 후에야 드러났습니다.
• 저자는 그녀의 성별 고통이 처리되지 않은 고통과 얽혀 있었고, 짧은 클리닉 평가로는 결코 찾아내지 못했을 것이라고 주장합니다.
• 청소년의 사춘기 차단제와 반대 성 호르몬의 근거를 매우 약하다고 평가한 영국(캐스 보고서), 스웨덴, 핀란드, 독일의 근거 검토를 인용합니다.
• 심장과 혈관의 위험, 불임을 포함한 심각한 신체적 해가 충분히 확립되어 있다고 말합니다.
• 모든 수준에서 ‘알 수 없게 하는 금지’가 있다고 설명합니다. 환자들은 성별에 대한 감정을 탐색하는 것을 거부하고, 어떤 의문이든 트랜스 혐오나 전환 요법으로 취급하는 정치적 분위기가 있다는 것입니다.
• 의학적 전환을 지지하는 저명한 분석가들이 ‘왜’를 묻는 치료사들을 왜곡하고 디트랜지셔너의 고통을 간과한다고 주장합니다.
• 그의 직업이 한때 동성애를 병으로 취급한 죄책감에서 과잉 교정하고 있을 수 있으며, 치료사들이 영구적인 신체 변화를 원하는 청소년과 함께 앉아 있는 불편함을 피할 수 있다고 시사합니다.

Abstract

The weak evidence base and profound consequences of gender-affirming interventions for youth call for a particularly sensitive and complex psychoanalytic exploration. However, prohibitions on knowing at the individual and social levels significantly constrain psychoanalytic work with trans-identified youth. Barriers to exploration and thinking that patients bring to treatment are reinforced and reified by the dominant socio-political trends that saturate the contexts in which young people dwell. These trends increasingly frame any attempt to deeply explore why a young person is seeking medical or surgical gender-affirming interventions as “off-limits” and a form of conversion therapy. Furthermore, politically driven clinicians who promote medical gender-affirming interventions misrepresent and attempt to discredit clinicians who explore the meaning and function of trans identification, or who express concern that transitioning may be a drastic solution to various forms of psychic pain. In doing so, they minimise the significance of the weak evidence base for these interventions and their serious, known risks. At the same time, they obscure or deny the psychic pain that is sometimes humming beneath the experience of gender dysphoria. The author asks: If there are significant uncertainties and risks of harm associated with medical interventions for young people, do we want to know?

Conclusion

D'Angelo concludes that psychoanalysis has an ethical duty to resist these prohibitions. The analytic process—slow, uncertain, and often uncomfortable—is precisely what can help young people determine whether transition will help them thrive or whether their gender dysphoria is a carrier for other, unaddressed pain. He asks the profession directly: if there are serious uncertainties and risks of harm, do we want to know?