I learn from reading a column published by your newspaper on March 15 my new promotion as a “transaffirmative” psychiatrist! Bigre… How to receive this new trophy, stated in this text as a guarantee of ignorance and bewilderment, by colleagues and sometimes friends, with whom I have worked for a very large number of years? Would my interest in issues related to transidentity have transformed me, under the pressure of militant offensives, into a dangerous extremist, blind and deaf to the reality of a sudden gendered radicalization of our youth, to the point of forgetting the expertise accumulated through forty years of work with young people and their families, and a large number of publications concerning them?
Rather than launching myself into an nth symmetrical escalation which seems for some time to have enchanted the psychoanalytical landernau, and which would put back to back with the greatest stupidity transphobic shrinks and transphilic (?) shrinks, I would like in all simplicity to describe a work and explain a position.
For a very long time, I have been managing a Public Psychiatry Unit called ESPAS, now located within the Psychiatry and Neurosciences University Hospital Group in Paris. This unit, initially dedicated to the psychological distress induced by the AIDS epidemic, led us from the outset to work hand in hand with associations fighting against AIDS, homosexual liberation associations, those defending health drug users or prostitutes. The gay community, through large groups such as Aides or Act Up, mobilized very early on to offer people with the disease and their loved ones tools for self-support, psychological support and empowerment. We very quickly combined our energies, the psychiatrists and psychologists of my unit thus learning to hybridize their theoretical base, each being able to draw from the other’s knowledge and know-how. The years have passed, AIDS has become less threatening, but the support of sexual risks, sexualities, questions of identity, has remained at the center of our work. How can we not get involved, as mental health specialists, in the question of marriage for all and the recognition of homoparental filiation, in the fight for the rights of homos and trans people, after having received for years bereaved spouses excluded from all rights, second class children brought up in hiding, people shattered by internalized homophobia or transphobia, linked to social invisibility, and for whom exclusion constituted an increased risk of psychological distress and therefore, of decompensation?
Transgender, bisexual or pansexual
Today, this pivotal position between public psychiatry and the voluntary sector has placed us at the forefront of this new wave of demands which is causing such a wave of panic: more and more young people who are questioning the marked boundaries of gender and sexuality: gender-neutral or fluid, transgender, bisexual or pansexual, they refuse labels, identity fixations, to claim the right to invent themselves completely, to explode the boundaries between heterosexuality or homosexuality, between masculine or feminine, between girl or boy.
These young people we receive come from all places, from all walks of life, some have brilliant studies and embrace life with enthusiasm, others go through a complex adolescent pathology marked by suffering, crises, traumas and decompensations. Some are supported by loving families, others come from families shattered by violence and rejection. Some are seasoned activists within LGBTQI groups, others are barely aware of their existence, or do not wish to speak to them.
How to accommodate this diversity? The six psychoanalysts who work in my team would laugh out loud if they were like I have just been, called “transaffirmatives”! Our “affirmation” is very simple: to receive, to listen, to hear, to accompany, to accept a request and a suffering without judgement, by giving ourselves time. In short, what all shrinks worthy of the name offer.
To all these young people who come to us, we offer, we in no way impose, this sustained and regular time of meetings, by not situating it in any way as a condition of acceptance of their journey, a sort of examination of passage, but as an opportunity to reflect and think about oneself. And surprise, most (but not all of them need it) seize this opportunity and continue to chart their course, most of them beginning a journey of transformation that we accompany. And they recommend us to their comrades, which honors us, but tends to put pressure on our consultations! For those whose psychic fragility requires care, we are psychiatrists and psychologists, we organize appropriate care.
Dignified and respectable paths
It so happens that I also work in the child and adolescent psychiatry department of the Pitié Salpêtrière hospital, I receive families with children and adolescents with gender issues and I participate in consultation meetings. multi-professional during which the files of the young people followed in this service are meticulously studied.
If I do the math, from these different places, I have met over the past five years more than four hundred young people questioning gender. They are overwhelmingly relieved by their metamorphosis. The most fragile continue their follow-ups. Some routes are linear, others more sinuous and complex. Some engage like all of us in an existence of love and work, others advance backwards or in zigzags. However, none called themselves a “detransitioner”. If some were able to disconcert their family or those around them by the speed of their quest for identity, the new visibility of transidentity being there of course for many, they continue to have a brain and are in no way radicalized by a new sect.
I have the feeling that this multitude of meetings, follow-ups, meetings, books of articles gives me if not an expertise, at least a perception of this field that, to my knowledge, no signatory of this forum has. Does that make me a “transaffirmative psychiatrist”? I accept it if this “affirmation” bears on the following point: transidentitarian paths are dignified and respectable paths. The destinies of trans people are “habitable” destinies that are part of the rich diversity of gender and sexual orientation to which the changes in our democratic societies allow us. They are not the symptoms of a psychiatric wave or a new form of radicalism that is descending on our youth. In this regard, LGBTQI struggles are political, collective struggles to defend the rights and dignity of people discriminated against because of their sex, gender or sexuality, and not terrorist groups aiming at indoctrination and sacked from our city.
Do not reduce the other by the same
Perhaps it is worth remembering that the relationship of psychiatry and psychoanalysis to social and sexual norms has always been thorny. The many psychoanalytical societies that until recently excluded homosexual psychoanalysts are there to testify to this. Moreover, many of the signatories of this forum were up in arms against marriage for all and homoparental filiation. It seems to me that for the mental health professionals that we are today the question arises of describing or prescribing. It is in no way a question of idealizing trans, hybrid bodies, but also of emphasizing their emancipatory potential, disruptive for all, rich in questioning. How does the power to act of these bodies that exist today in our public space intervene, this fantasy that circulates freely, these effects of subjectivation in motion in the elaboration of our theories of the mind?
Our listening only happens if it does not seek to reduce the other by the same, to bring the stranger back to the familiarity of what the shrink knows and understands. To refer only to the failures of the psyche or to self-hatred with regard to gender incongruences only reduces the mystery and the enigma of sexuality, the complexity and the psychic plasticity, the meanderings of fantastical circulations, at the familiar with the difference between the sexes, the binarity of genders and sexualities, and the uniqueness of desire and legal law.