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认为，“跨性别”这一标签涵盖了一系列复杂的内心体验，涉及人们所陈述的性偏好和性别认同。
• 基于她对寻求医学治疗的18岁以下人群的工作，她描述了一些案例，其中过早接受跨性别身份似乎妨碍了理解它对该年轻人意味着什么这一痛苦的工作。
• 她指出，问“为什么是跨性别”（而不是“如何是跨性别”）常被认为是将其视为疾病，这使治疗师难以探索。
• 她建议采取“等距好奇”，即对跨性别身份对这个人意味着什么、起什么作用保持同等的好奇，她说这不同于暗中怀疑。
• 据报道，她的案例材料包括一名17岁女孩，她在接受五年深入治疗后决定不进行过渡。
• 她说治疗绝不能被用来向人们施压或改变他们，她承认自己所在领域过去曾伤害同性恋者，并说变性手术对一些患者来说是正确的道路。
• 她承认自己的观点“浸透了传统的性别观念”，并呼吁不同观点之间进行对话。

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.