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 betoogt dat het etiket 'trans' een complex scala aan innerlijke ervaringen dekt, in verhouding tot de opgegeven seksuele voorkeuren en genderidentiteiten van mensen.
• Vanuit haar werk met minderjarigen die medische behandeling zoeken, beschrijft ze gevallen waarin het vroeg aannemen van een trans identiteit het pijnlijke werk van begrijpen wat het voor die jongere betekende leek te hinderen.
• Ze merkt op dat de vraag 'waarom transgender' (in plaats van 'hoe transgender') vaak wordt ervaren als het behandelen ervan als een ziekte, wat het voor therapeuten moeilijk maakt het te verkennen.
• Ze beveelt 'gelijke nieuwsgierigheid' aan, dat wil zeggen evenveel nieuwsgierigheid naar wat een trans identiteit voor de persoon betekent en doet, wat volgens haar iets anders is dan stille twijfel.
• Haar casusmateriaal bevat naar verluidt een meisje van 17 dat na vijf jaar diepgaande therapie besloot niet te transitioneren.
• Ze zegt dat therapie nooit gebruikt mag worden om mensen onder druk te zetten of te veranderen, erkent de schade die haar vakgebied vroeger aan homo's toebracht, en zegt dat geslachtsaanpassende chirurgie voor sommige patiënten de juiste weg is.
• Ze geeft toe dat haar eigen opvattingen 'doordrenkt zijn van conventionele ideeën over gender' en pleit voor dialoog tussen verschillende standpunten.

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.