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This short book provides the psychoanalytic clinician with an introduction to the complex and often contentious question of transgender identity. Whilst transgender identities are not new, their increasingly vocal presence and justified demand for recognition has brought to the fore debates which are vital to psychoanalysis. With
some considerable courage Alessandra Lemma offers her serious consideration of the issues based on her extensive clinical experience and scholarship. What determines our gender identity, our sexuality, whose knowledge has precedence in deciding on what is in our best interests; these debates have come up in spirited and painful ways around questions of gender identity and especially gender questioning young people. How do we as clinicians best help our patients whilst holding in mind their individuality, awareness of our own prejudices and allegiances, and the culture in which we live? Challenging the beliefs that sex determines gender identity and that gender is simply binary is disturbing, especially when patriarchal ideology has served to embed them as given and natural.
Lemma approaches the inevitable conundrums with a refusal to rest with a comfortable certainty at any place along the spectrum of views about transgender identity. She insists on the importance of recognizing the heterogeneity of transgender identities. Once heterogeneity is accepted, there is room for multiple pathways to transgender identity, multiple ways of identifying as trans, non-binary or queer, and openness to a range of outcomes. Crucially, she is clear that for some people their best interests in terms of their well-being are served by medical intervention, which allows them to live more comfortably in their bodies. She argues strongly that an exploration of both conscious and unconscious factors is likely to allow an individual to make a more truly autonomous choice. In this book, Lemma explicitly focuses on those individuals identifying as transgender who