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

• 렘마는 ‘트랜스’라는 꼬리표가 사람들이 밝힌 성적 선호와 성별 정체성과 관련해 복잡한 범위의 내면 경험을 아우른다고 주장합니다.
• 의학적 치료를 원하는 18세 미만과 일한 경험에서, 일찍 트랜스 정체성을 취한 것이 그 청소년에게 그것이 무엇을 의미하는지 이해하는 고통스러운 작업을 방해하는 것처럼 보인 사례를 설명합니다.
• ‘어떻게 트랜스젠더인가’가 아니라 ‘왜 트랜스젠더인가’를 묻는 것이 흔히 그것을 병으로 취급하는 것으로 느껴져, 치료사가 이를 탐색하기 어렵게 만든다고 지적합니다.
• 그녀는 ‘등거리 호기심’을 권고하는데, 트랜스 정체성이 그 사람에게 무엇을 의미하고 무엇을 해 주는지에 대한 동등한 호기심이며, 이는 조용한 의심과는 다르다고 말합니다.
• 그녀의 사례 자료에는 5년간의 심층 치료 후 전환하지 않기로 한 17세 여아가 있다고 전해집니다.
• 치료가 사람들을 압박하거나 바꾸는 데 쓰여서는 안 되고, 자신의 분야가 과거에 동성애자에게 해를 끼쳤음을 인정하며, 성전환 수술이 일부 환자에게는 올바른 길이라고 말합니다.
• 자신의 견해가 ‘전통적인 성별 관념에 흠뻑 젖어 있다’고 인정하며 서로 다른 관점 사이의 대화를 요구합니다.

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.