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 susține că eticheta „trans” acoperă o gamă complexă de experiențe interioare, în raport cu preferințele sexuale și identitățile de gen declarate ale oamenilor.
• Pornind de la munca ei cu minori care caută tratament medical, ea descrie cazuri în care asumarea timpurie a unei identități trans părea să stea în calea muncii dureroase de înțelegere a ceea ce însemna pentru acel tânăr.
• Ea notează că întrebarea „de ce transgender” (și nu „cum transgender”) este adesea percepută ca o tratare a acestuia drept boală, ceea ce face dificilă explorarea pentru terapeuți.
• Ea recomandă „curiozitate echidistantă”, adică curiozitate egală față de ceea ce înseamnă și face o identitate trans pentru persoană, ceea ce spune ea că este diferit de îndoiala tăcută.
• Materialul ei de caz include, se pare, o fată de 17 ani care a decis să nu facă tranziția după cinci ani de terapie aprofundată.
• Ea spune că terapia nu trebuie folosită niciodată pentru a presa sau a schimba oamenii, recunoaște răul făcut în trecut de domeniul ei persoanelor gay și spune că operația de reasignare a sexului este calea potrivită pentru unii pacienți.
• Ea recunoaște că propriile păreri sunt „îmbibate de idei convenționale despre gen” și cere dialog între puncte de vedere diferite.

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.