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This article offers a critical reading of David Bell's article “First, Do No Harm,” published in the International Journal of Psychoanalysis in 2020, and of the version of this article presented under the title “Önce Zarar Verme” at the Istanbul Psychoanalytical Association's “Bir Konuk Bir Kuram” [A Guest, A Theory] event in 2023. Bell's cautions regarding hasty medical interventions, the automatization of clinical decision-making, and the possible harms involved in healthcare services for children and adolescents with gender dysphoria are important in certain respects. The article nevertheless critically examines how these cautions are constructed, to what extent they are generalized, and how they are put forward as a psychoanalytic position.
The article argues that Bell's arguments proceed from a level of general acceptance that most clinicians would largely share; yet this level is generalized in a way that substitutes for a sustained engagement with the intrinsic and specific tensions of the clinical field in question. Within this framework, the principle of “first, do no harm” is argued to function as a motto that closes off specific clinical debates; this mode of use, it is suggested, may narrow psychoanalytic capaciousness in the face of clinical multiplicity. By foregrounding the Hippocratic tradition's emphasis on “at least, do no harm” and the recognition that healing is sometimes a matter of the “opportune moment,” the article proposes that the question of harm should be addressed not only through the risk of medical intervention, but within the tense and complex relations among the biological body, the psychic body, the interval of waiting, the harm of delay, and processes of subjectivation.
The article further critiques Bell's recurrent emphasis on lobbying, his large-scale sociocultural explanations, his reductive analogies, and his language linking opposing views to “non-thinking,” insofar as these drive the discussion in a polarizing and closing-off direction rather than opening a space for multiple determination, clinical specificity, and mutual clinical reflection. The article concludes that a psychoanalytic position rests less on sharp judgments invoking general truths than on the capacity to remain in contact with clinical and social tensions that admit of no easy resolution, and with the subjects implicated in these tensions.