Critical Therapy Antidote

As the fever around activist-driven gender-affirmative practice is slowly starting to abate, more conscientious scholars and psychologists are getting their voices of objection heard (for example, see van Zyl’s recent paper). To many in practice over this period of rapid increase in trans-identification among troubled young people, the Cass Review came as no surprise. Gender-affirmative practice has never had the solid evidence-base necessary for such an aggressive proliferation of invasive medical interventions. We furthermore had decades of established psychological theory that adequately equipped us with the frameworks necessary to listen, conceptualise, and formulate explanations for youth gender dysphoria.

Why did the mental health field in particular fail young people so dismally during a time when due diligence was so critically needed? In an enlightening article that recently appeared in the International Journal of Psychoanalysis, Australian psychoanalyst Roberto D’Angelo elegantly demonstrated how a conspiracy of not-thinking took hold of psychoanalysis.

“There is a commonly held view that the psychoanalytic investigation of trans identities is based on the notion that these identities are pathological … Some argue that if we accept that trans identification is non-pathological, it does not require exploration, just as there is generally no need to explore the psychological formation of cisgender identities. It has been pointed out that this argument does not hold, as it is based on a misunderstanding of the literature, certainly the analytic literature … There are many examples of analytic work with normatively gendered patients that explore the historical factors and contextual influences that have shaped their gendered experience … Deep, psychoanalytic work is therefore just as important and relevant for people with trans identities as it is for normatively gendered patients, and perhaps it can be argued that it is even more so: that, after all, the profound consequences of medical and surgical intervention do necessitate a particularly sensitive and complex psychoanalytic exploration.”

“Psychoanalysis has arguably never had to grapple with social changes that are both so dizzyingly rapid and so intensely politicised. Whilst prohibitions on knowing are ubiquitous in psychic life, the zones of unconsciousness that clinicians encounter when working with trans youth are particularly challenging because they are maintained on multiple interacting levels: the intrapsychic, the socio-political and within some contemporary psychoanalytic theory. The result is that any sense of alarm about the harms of medical gender-affirming interventions is kept out of consciousness, and any curiosity about whether gender transition might be a risky and drastic solution to various forms of psychic pain is foreclosed. This reverberates with and reinforces the individual defences against knowing painful, unformulated or traumatic material that our patients present us with in analytic work. In the emotionally charged political climate surrounding trans issues, can we think about these issues without being overwhelmed by powerful affects ourselves? Are these conversations so threatening that they can only occur backchannel rather than openly in our professional listservs and journals? Do we want to know?”

The full article can be accessed here.