You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Dear Editor,
It is a rare privilege to receive a response to a paper I have written from someone with lived experience of what I am writing about. Jules Schaper’s generous, courageous and moving “free association” to a term I used in my paper about transgender – “a hospitable home” – provides us with rich food for thought whilst the ongoing debates about transgender continue to divide clinicians and the transgender community alike.
I found Jules Schaper’s account deeply affecting and moving, and it resonated with the struggles articulated by some of my transgender patients. Specifically, I returned to this sentence:
After all these years, I still cannot say that gender is no longer an “issue” for me, or that I have found my home. The quest lingers on, and I believe I’ll only find some peace in trying to make sense of the source of my discomfort. Unlike people who see gender dysphoria as their end diagnosis and transitioning as the solution to their problems (a very tempting idea) I’ve always seen it as a consequence of a greater discomfort, as part of a web of intricately linked causes of suffering. (my italics)
The “web of intricately linked causes of suffering” poignantly captures the experiences my transgender patients have shared with me over the years, irrespective of whether they then chose to medically transition or not. However, in the context of gender-affirmative care, once gender issues are raised, children and young people’s wider holistic needs can be neglected, with a narrow focus on their gender-related distress. Jules Schaper invites us instead to consider the importance of psychological support that addresses a broader range of problems to reduce the risk of diagnostic overshadowing.
The debates about the merits and dangers of a gender-affirming approach continue, but what is increasingly clear is that the distress and confusion that we encounter clinically often conceals a “web of intricately linked causes of suffering” that is not clarified or resolv