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 主張，「跨性別」這個標籤涵蓋了複雜的內心經驗，與人們所陳述的性偏好和性別認同有關。
• 從她與尋求醫療處置的 18 歲以下者的工作中，她描述了一些案例，早早採用跨性別認同似乎妨礙了理解其對這位年輕人意義的痛苦工作。
• 她指出，詢問「為什麼是跨性別」（而不是「如何跨性別」）常被認為是把它當成一種疾病，這使得治療師難以探索。
• 她建議「等距好奇」，也就是對跨性別認同對這個人意味著什麼、起什麼作用保持同等的好奇，她說這與暗中的懷疑不同。
• 據報導，她的個案資料包括一名 17 歲的女孩，在五年的深度治療後決定不過渡。
• 她說治療絕不能用來施壓或改變人，承認她的領域過去曾傷害同志，並表示性別重置手術對某些患者是正確的道路。
• 她承認自己的觀點「浸淫在傳統的性別觀念中」，並呼籲不同觀點之間進行對話。

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.