The latest issue of the Journal of the American Medical Association, the mythical Jama, one of the most authoritative medical journals in the world, founded in 1883, contains two articles dedicated to the physical and psychological well-being of young transgender people. The first, written by Diana Tordoff with her research group, she analyzes depression, anxiety, self-harming and suicidal thoughts in a sample of 104 transgender and non-binary US girls and boys aged 13 to 20. The assessments were carried out at the time of the first contact with the clinical service and then one year after taking charge. The results show that psychopathological levels are very high at the first evaluation, while, after one year, the young people who had started hormonal therapies, compared with those who had not started them, had a 60% reduction in the risk of developing a depressive syndrome and 73% of twisting into suicidal thoughts.
The results of this study are part of the broad panorama of empirical research that demonstrates the effectiveness of hormonal therapies in reducing the suffering related to gender dysphoria in young trans people. However, hormonal interventions alone are not enough. In Tordoff’s study, the suicide rate, although greatly reduced, was still higher after a year than the general averages of the American population. This means that taking charge requires that other aspects are also addressed, in particular “minority stress”, which is the subject of the second study published in Jama, by Doron Amsalem and collaborators.
Stigma and depression
The authors devised research to answer the question: “Can a 110-second video of a transgender protagonist describing his history of depression reduce adolescent transphobia and depression-related stigma?” And so about 1,500 teenagers were recruited who were randomly assigned to watch one of four videos, in which 1) transgender teenage girls, 2) transgender teenage boys, 3) cisgender teenage girls, 4) cisgender teenage boys video) your way of coping with depression. The results of the research show that cisgender young people who accidentally happened to have the video of transgender young people showed a drastic reduction in transphobic and stigmatizing attitudes. Bottom Line: Giving a voice and a face (and not a label) to the experiences of transgender youth allows cisgender teens to develop an empathic position towards their peers.
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The discomfort
Those of Tordoff and Ansalem are two important studies. They frame two fundamental aspects of the discomfort experienced by trans and non-binary people, two components that must always be considered in their intertwining: dysphoria, linked to a strong dissatisfaction with one’s body, in particular to the primary and secondary sexual characteristics, on which they intervene hormonal therapies; and the “minority stress”, that is the suffering deriving from belonging to an affected and discriminated minority, which must be countered on different levels: clinical, social, cultural.
It is impossible to understand mental pain (but, it is important to underline it, there are more and more trans or non-binary experiences free from suffering of clinical relevance) if these two elements – hormones and feelings – are not taken into account, weighing each time the specific weight.
Sexuality. why so many gender fluid teenagers?
by Sabina Pignataro
Gender inconsistency
We recall that what was once called the syndrome of transsexualism, counted among the mental disorders, today, more accurately described as gender incongruity, is no longer considered a pathology in itself, but, as the definition of the Psychodynamic Diagnostic Manual (PDM -2), “a psychological experience that may require clinical attention”. Attention linked, especially in children and adolescents, to the double traumatic nature of the perception of incongruity and the lack of social and family support linked to “minority stress”, the source of many psychological and psychiatric sufferings. Professionals working in clinical services often find themselves faced with very complex frameworks, in which the theme of gender is prisoner of a network of symptoms, from which it can be difficult to help the person extricate himself to explore identity themes. Trans, non-binary, or more generically confused about gender, young men and women can show vulnerability to various forms of psychopathology. The role of psychologists and psychologists, psychotherapists and psychotherapists, is precisely that of helping to orient oneself on complex paths.
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by Pasquale Quaranta
The identity
Recent psychoanalytic literature has highlighted how important it is for these people to recognize their deepest feelings about identity in the analyst’s mind. In the therapeutic relationship one of the main needs of these young people is to be seen not as “sick”, but as “incongruent”, reflecting and welcoming their painful perception of a body that does not agree with their deepest somatopsychic experiences . A lack of recognition risks (re) traumatizing them, leading them to relive the experience of not being captured in their own identity, as often happened with their parents or in other important relationships. It is essential that clinicians know how to provide this recognition, which does not involve a renunciation of the exploration of the profound meanings linked to gender, for example the investigation of the weight of traumatic experiences in identity development. But recognition is always the central ingredient, without it clinical intervention does not promote development or favorable outcome.
The therapist
Obstacles to recognition can be subtle. Some research has investigated the countertransference reactions of cisgender therapists with transgender patients: a plethora of unprocessed conceptions, perceptions and emotions (e.g. anxiety about bodily modifications, terror of mutilation / castration) that are self-centered and not attuned to the patients’ experiences emerged. . At the same time, it is important not to ideologize, in the name of a politically correctness that has little to do with a therapeutic attitude.
For this reason, it is also essential in Italy to spread an updated and informed culture among professionals in psychology, psychotherapy, pediatrics, psychiatry, who, due to real gaps in university and professional training courses, still have little knowledge about such arguments. Our task as psychotherapists is to safeguard the creative impulses in the paths of identities, creating a space for listening and meaning that gives depth to the necessary simplifications of gender labels.
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Dialogue with the teenager
The dialogue with the adolescent who turns out to be trans or non-binary must be able to integrate all the elements, even the most secret and set aside, of the internal experience. We therefore do our job trying to nourish the body of the meanings that our young interlocutors attribute to binary differences, working, as Judith Butler would say, also on the melancholy of what is inevitably lost. Always questioning the crystals of the identity kaleidoscope both when they are too solid and when they are too liquid.