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This book was published in the wake of the highly publicized Bell v Tavistock lawsuit, which turned on the question of whether underaged patients with gender dysphoria could consent to treatment with so-called ‘puberty blocking’ drugs. The case resulted in a decision by the United Kingdom High Court that it was highly unlikely that children under the age of 16 could be competent to consent to this form of treatment, effectively making it much more difficult for young gender dys-phoric people to get access to such medications. Susan and Marcus Evans were involved in instigating the legal proceedings against the Tavistock and Portman NHS Foundation Trust, which had, in their view, adopted an approach to gender dysphoric young people that did not sufficiently explore their wish for medical interventions such as administering puberty blocking drugs or gender-related surgery. The present book aims to provide patients and clinicians with an alternative to the so-called ‘affirmative model’ of psychotherapeutic care.
After laying out their perspective on the social and political context in which the book was written, Susan and Marcus Evans provide the reader with a developmental model that considers the vicissitudes of psychosexual development leading up to and throughout adolescence that might result in a young person's wish to retreat from entering adulthood to the psychic enclave of medical transition. From the Evans' psy-choanalytically informed perspective, then, gender dysphoria is to be counted among the ‘developmental disorders that look to control ordinary developmental processes by employing primitive psychological mechanisms’ (p. 72). They argue rather convincingly for the ubiquity of psychic pain in development resulting from the ordinary demands of separation from an idealized object, of integrating the good and the bad object to a unified vision of a whole object with ambivalently perceived attributes, and of relating to the self in its less-than-perfect versio