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Gender dysphoria and adolescents, listening to change perspective

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Gender dysphoria and adolescents, listening to change perspective

It happens more and more often to hear adults underline that today kids are all a little more queer than once. I can’t say if, in the total calculation, people have really increased queer but they sure as hell aren’t hiding anymore.

Queer, in English, means “strange” and was a derogatory term used to insult homosexual, non-binary (androgynous) and transgender people. Over the years, the LGBTQI+ movements have reclaimed this term and have chosen it as a common element among the various souls of the community.

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The queer community

Over the past 50 years, the community Queer he has led important social battles and struggles to break down stereotypes. Above all, people have come out of a condition of isolation and have known how to build community. We must remember that having a social network and a reference group is an important factor in mental well-being. At least in the West, the quality of life of these people is better than 50 years ago and their social integration is consolidating.

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It is bitter, however, to recognize that no civil right has been granted for the good heart of the majority but has always come through a tiring struggle. For this reason, when it comes to issues related to Queer people, one cannot be oblivious to the abuses they have suffered. That is, it is important to know the history so as not to repeat the practices or theories that have contributed to the alienation of these people.

Always, in the diverse community queer there is a group that has suffered and suffers more than the others: people with gender variance. They are a minority within the minority and among them are not only transsexual people but also transgender people and non-binary people.

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The suffering

These individuals often suffer both from their own personal events and from social aspects and, especially in recent years, an ideological clash between two different visions of the world has taken place over their heads. Everything has been said: old world against new world, social sectarianism against inclusiveness, right against left, degrowth against cyber-bio-technological evolution, etc. Every occasion seems good to talk about T (transgender) people.

But, to narrow the field to the life of individuals, the conflict is between those who maintain that the “body” defines the destiny of a living being and those who maintain that it is instead “identity” that has this role.

In the 1900s this opposition gave rise to the simmering debate on the theme of “Gender”. However, we must not make the mistake of thinking that this issue concerns only people queer.

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A society without differences

Thanks to the question of what it means to be Man and be Donna it has been possible to erode many stereotypes and make society evolve in a more egalitarian direction. For example, if we compare ourselves to the Italians of 1939, we can see how women have been able to access places and destinies that were previously only for men. Even in appearance, we see that women can wear pants and men can, if they want, abandon the machista myths. In short, we are all a lot more gender-fluid than we were then.

The definition of Type however, as an element of identity that moves only between the “masculine” and “feminine” poles, it has produced many difficulties for two types of people: those who feel they do not belong to the gender of their birth sex (people trans) and those who do not feel that they belong predominantly to one of the two genders (non-binary people). Incidentally, these people have always been there in history: they are not a recent invention.

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I study

Interesting IPSOS research from 2021 says that 1 % of the world‘s population don’t recognize themselves in the gender assigned at birth. Has it always been like this? They are increasing?

In the distinction between generations we see that in those born between 1946 and 1980 the percentage is always 1% while it grows starting from the millennials and reaches 4% in those born after 1997.

At a hasty glance one might think that, since social limitations have eased, Trans people have increased exponentially. Yet, looking carefully at the data provided by IPSOS, we realize that the vast majority of the sample of young people do not declare themselves transsexual but “non-binary” (i.e. gender fluid, genderqueer, Two-Spirit, a-gender, etc.).

This is not a small detail because these people, even if they have a non-conforming gender identity in common (they say so) are oriented in a different way with respect to the transition. In fact, it is by no means certain that a non-binary person is interested in undertaking the hormonal and surgical transition.

Generation Z and gender fluidity

This is the phenomenon of gender fluidity, which collects 2/3 of that 4% of generation Z. When ordinary people say that there are more and more boys of uncertain gender, most of the time they are referring to gender-fluid people .

The problem arises when an adult, an educator or even a clinician cannot distinguish a non-binary identity from a trans identity. Sometimes the kids bring unsaturated questions or, on the contrary, too full of anguish and come out of the confrontation with the adults even more confused and exasperated. On the other hand, 99% of us over-45 have never really asked ourselves a question about gender issues.

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With this I am not saying that it is easy, especially in adolescence, to help someone understand whether the best way is transition or not, but this differentiation becomes utopian if clinicians reason with rigidly binary structures. There are those who speed up transitions too much and those who would prevent them.

For the record, Trans people have never yet been censored in Italy (ISTAT should do an initial research this year) but current estimates count around 400,000 trans individuals in our country, a number that is well below 1%. of the world average.

Why then cyclically alarms about the trans-genderization of society? There are certainly many factors, starting with the greater visibility these people have and the fact that more and more they can lead normal lives and end up being our neighbor or our postwoman.

Young people less alone

Then there is the big question on gender that we are all asking ourselves as a society and which can only be absorbed and re-proposed by the youngest. Indeed, there is no doubt that the average age of people who present themselves to associations and specialized centers in order to have a discussion on this issue is decreasing. The modalities also change: if older people arrive at the interviews alone, with a great load of pain, young people are often accompanied by family, friends or their partner. Not for everyone the solution to their discomfort will be the transition but it is desirable that they always find listening to them a person prepared and willing to take their questions and difficulties seriously.

When it comes to gender incongruity, it is also good to distinguish those who suffer from body dysphoria declined on gender, from those who arrive at the transition with a sufficiently good identity solidity. Some authors have proposed, for example, to distinguish people with gender dysphoria from transgender people tout court. These clinical hypotheses, all to be explored, are an attempt to recognize both the existence of a suffering related to gender identity and, however, also a natural condition linked to transgenderism. These two dimensions can occur separately but also associated.

There is much discussion, and rightly so, of those situations in which patients may not be able to make a conscious decision about the transition, for reasons of immaturity or psychopathology. In these cases, the treating teams try to help the patient and their families to the best of current clinical, psychotherapeutic, medical and ethical resources.

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The importance of psychoanalysis

Sometimes the anguish linked to dysphoria is such that the treatments offered aim to appease the desperation to restore a space of thinkability. Other times, however, the space of thought is possible immediately and this must be recognized by the person. It is above all important that those who decide to support their transition path with a psychotherapeutic or psychoanalytic space can feel that they are being listened to in an open and neutral way.

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The great challenge that we all face today is how to offer non-binary, transgender and transsexual people a welcoming space that does not involve an unnatural acceleration of identity processes but also that does not risk denying or “correcting” these people. In fact, the social debate often oscillates between “speeding up” and “preventing”. Very little, however, is attempted to understand what the concept of transition means for T (transgender) people.

The transition

For example, we will have to reflect on the fact that transgender people do not always want to achieve sterilization. In general, laws and medical interventions have always aimed at realigning gender and genitals, without wondering if there wasn’t something prevaricating and if the cure didn’t produce further unnecessary suffering in some people.

Have we ever wondered if people T, between 1982 and 2015 really all wanted to have surgery?

Many have done so because they have recognized the right to change their documents, find a job, start a new life. How long did it take us to understand that this was imposed violence rather than the exercise of a right?

The law has now begun to take these uncomfortable questions into account while, on the contrary, the social climate is becoming more and more rigid. But is raising the confrontation really good for people? Does it really allow us to understand the very delicate nuances of this speech?

The weather

Cases of de-transition (ie people who, after surgical and hormonal treatments try to return to their pre-surgery body) should make us reflect a lot on the importance of not thinking in a rigidly binary perspective. In this sense, on the other hand, those interventions, on a cultural, psychological and possibly even medical level, which offer the person a more peaceful time to work on themselves and on a possible transition, become precious.

Personally, I found great food for thought by comparing myself, in non-clinical contexts, with Trans and non-binary people. Contrary to the preconceptions according to which T people would only aim to speed up transitions, I have often found wisdom and caution even with respect to the most controversial topics. Too bad I’ve always been asked :” Why do the doctors talk about us among themselves instead of coming to know us outside the studies?”.

Anna Cordioli is a psychologist, psychotherapist, SPI psychoanalyst, associate member of the Italian Psychoanalytical Society and International Psychoanalytical Association, membro of the Veneto Center of Psychoanalysis, member of COIRAG and ASVeGrA.

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