NEW FORMS OF DISCONTENT (2)

Current Work in the NLS

This section provides a space in which echoes of original approaches to the “discontent in
civilization”, conducted in the Societies and Groups of the NLS, may reverberate.
Today: A report on a special event held by the London Society of the NLS (04/02/2023), with
the participation of François Ansermet, Eric Laurent, Alexandre Stevens and other invited
guests. Written by Peggy Papada (Chair of the London Society)

“SEXUAL IDENTITIES IN TRANSIT

A Contemporary Question”
Report of a special event held by the London Society of the NLS

On the 4th of February 2023, the London Society organised a one-day event on the theme
“Sexual Identities in Transit: A Contemporary Question”, with the starting point being
London’s Gender Identity Development Service (GIDS), the world’s largest gender clinic for
minors, which is set to close in Spring. Housed in the Tavistock, an institution internationally
renowned for its psychoanalytic approach, where Bion and Melanie Klein – among many other
pioneers of British psychoanalysis – practised and taught, GIDS was set up initially, mainly to
provide talking therapies to young people who were questioning their gender identity. But in
the last decade GIDS has referred more than 3000 children, some as young as nine years old,
for medical treatment, to block their puberty. In the same period, the number of young people
seeking GIDS's help exploded (5000 in 20-21). The profile of the patients changed too: from
largely pre-pubescent boys to mostly adolescent girls, who were often grappling with other
difficulties. Our invited British colleagues, some of whom were longstanding clinicians at the
Tavistock, and raised concerns about the clinic at different moments, responded
enthusiastically to our invitation.
More and more young people turn to the trans solution as a response to a discontent at the level
of the body, without this necessarily being accounted for by ‘gender dysphoria.’ But we know
that constructing the question, what constitutes an enigma for each one, takes time. There is no
prêt-à-porter solution yet the solution trans seems to have become one. How then to address
the complexity of lived experience of subjects who find themselves facing these offers knowing
that general ready-made answers crush the subject, is a question that concerns us.
The morning sequence of our event, ‘The Tavistock Experience and After’, started with a
presentation by Helen Joyce, journalist and author of Trans: When Ideology Meets Reality.1
She set the scene on Paediatric Gender Medicine: How we got to here, based on the research
she conducted while writing her book: How did we get to the point that we are telling children
that there are more than two sexes, or that sex is not real, or that they can choose their sex, or
that gender is more important and that it would make sense to tell a 3 or 4 year old child to
pretend that they are member of the opposite sex in front of everybody else? To put children
on medicine that were used for castrating sex offenders and thus sterilizing children before they
had their first orgasm, let alone before they had their first sexual partner?

1
Joyce, H. (2021), Trans: When Ideology Meets Reality, London, Oneworld

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Joyce attributed the influence of the trans movement to its conflation with the gay rights
movement. The trans narrative fitted into the gay narrative, summarized as ‘born this way’,
when gay rights were won. Partly because the lobby groups needed a new cause after gay
marriage was won, but there was also a strong feeling of progress: we are on ‘the right side of
history’, let’s bring new groups to those present over 200 years (women, black people, gay
people, women’s suffrage, ending of slavery, black civil rights movement, gay rights); we now
need a new one. These factors came together and we have a movement which says that there
are trans children (i.e., born this way/ born in the wrong body).
Joyce drew attention to girls, who constitute the biggest proportion of teenagers who present
to gender clinics and made particular reference to the role of social media where the ‘culture
bound syndromes’ are shaped. The media heavily used by teenage girls are not the ones used
by adults. Teenagers are creating and changing very fast the way they are thinking about
themselves. Lastly, she spoke about the shift from the communitarian to the individual, the
identitarian, accompanied by the downfall of traditional roles of men and women, roles which
would link to others. Instead “all your identity is now put on you, it is internal and you shape
it.”
With his presentation on The Tavistock’s GIDS: A Dismal Record, Michael Biggs, Associate
Professor of Sociology at the University of Oxford and a Fellow of St Cross College, whose
research on puberty blockers formed the basis of the judicial review brought by Keira Bell
against the Tavistock, and for which he acted as an expert witness, took us through the history
of GIDS since its foundation when the referrals were only 14 a year. He talked about the
scientific failures at the clinic: the cover up of negative results from experiment on puberty
blockers and the failure of follow ups of patients after the age of 18. GIDS was saying that they
can’t track people because of changes in identity, while a former GIDS director recently
referred to “huge ethical issues in the follow up, because if people as adults have a gender
recognition certificate, they are living in that role legally now, and it is illegal to follow them
up.” In 33 years GIDS never followed its patients beyond age 18. Colin Wright (LS) chaired
the conversation with the audience, with the participation of Joyce and Biggs and questions
around puberty blockers pointing to the irreversibility of the effects and significant ethical
concerns (giving drugs to a healthy body; 98% of children who start on puberty blockers go on
to opposite sex hormones therefore the child is started on a pathway of medical transition; there
is no such thing as a ‘pause button’ in adolescence.)
Marcus Evans and Susan Evans shared elements of their work experience about which they
have written a book.2 Marcus Evans is a psychoanalyst who resigned from the board of
governors of the Tavistock in 2019 due to safeguarding concerns and Susan Evans is a
psychotherapist who worked at GIDS and first raised concerns in 2005, then started the judicial
review with ‘mother A’. Gabriela van den Hoven (LS & NLS) underlined that their work
grapples with some of the questions that concern the Lacanian school when working with these
patients. She noted the distance they take from diagnosis as well as the dynamic position they
take in the transference, insofar as the work has a conversational style.
Some of the key points of their presentation were: an attempt to gain a more holistic view of
what the struggle is, which is not always easy due to the monosyllabic responses and the
inability to think symbolically, in other words, the lack of elaboration. Instead, children usually
come with a ‘script’. Everything gets narrowed down to trans while parents are missing more
important aspects of where the child is struggling. At the same time they are “terrorised” that
their children will commit suicide anytime, if they don’t go along with what they are saying.

2
Susan & Marcus Evans, (2021), Gender Dysphoria: A Therapeutic Model for Working with Children,
Adolescents and Young Adults, Phoenix House.

2
There is a problem of identity in the broadest terms and how to get out of this rigid structure,
this narrow preoccupation called gender is a real challenge. They also referred to the tendency
to “kill off” an aspect of themselves, the so called “deadnaming”, and the question then is how
to explore, if possible, what is it from the past that they try to get rid of, how to get out of the
concreteness to thinking and exploration.
The last sequence of the morning, First Do No Harm: Lessons from the Tavistock took its title
from David Bell’s published paper, on which he based his presentation.3 He was joined by Eric
Laurent for an exchange about the matters raised. David Bell, psychoanalyst and past
President of the British Psychoanalytic Society, retired Consultant Psychiatrist at the Tavistock
and former Staff Representative on the Council of Governors of the Tavistock, is also the
author of the 2018 report that was part of the process that led to the Cass review
and subsequent decision to close GIDS. He started his presentation with a couple of
observations. a) One of the strangest things about the GIDS, is the complete absence of interest
in sexuality, which was not discussed. It had been overtaken by gender. b) There was a deep
distrust, at times amounting to hatred, for psychoanalysis.
Bell did his investigation in 2017-18 when ten GIDS staff, a third of the London service,
approached him. They all raised similar concerns and left the service soon after:
• the geometric increase in referrals and the rapid changeover from boys to girls being
about 74-75%, in combination with the lack of interrogation about these patterns.
• huge caseloads. Some staff described caseloads of 140. And these were inexperienced
staff. Staff couldn’t differentiate between the children because they all come with the same
script, they all say the same thing, and there is no clinical model; it is a procedural model and
the service functions as a conduit to puberty blockers. The kids know that, so they come saying
the things they need to say. There were serious concerns about lack of clinical engagement.
• There were huge worries about consent – Do you understand what it means to be
anorgasmic, do you understand what it means that you won’t be able to have children? ‘I’m not
interested in children, get me out of here, yuk, I don’t want to speak about that’ – and that was
accepted as a form of consent.
• The inappropriate involvement of highly ideological oriented organisations –
particularly Mermaids4 – in the formation of the service. There was a constant ideological
pressure leading to an abandonment of the clinical neutrality which is essential for any
psychotherapeutic work. Instead, there was affirmation.
• Managers would say that some of the cases are just straightforward, very easy, this is a
trans child. Bell’s position is that there is no such thing as a trans child. To say that, is to
foreclose that there is a child who is in conflict with their sexual body.
• A most disturbing concern for the staff Bell talked to, was that a lot of these children,
if left alone, would become gay or lesbian adults. And they felt that this was a kind of
conversion therapy for gay and lesbian children.
Bell wrote his report, which was then leaked to the press. He acknowledged it is now possible
to talk about these things in a way that it wasn’t before. He also referred to the huge
comorbidities in these children: depression, autism, major traumas in their own childhood,
traumas in their family etc. and made special reference to internalised homophobia, that is the
child picking up hatred in the family or in the community of being gay or lesbian, making the
point that our society is not as liberal as we would like to think. He stressed that there is

3
Bell, D., (2020). First Do No Harm, Int. J. Psychoanal., (101)(5):1031-1038
4
Mermaids is the organisation equivalent to Stonewall, for young people. It is currently under regulatory
investigation, following concerns about its governance and management.

3
considerable evidence that a large number of these children if looked after properly and helped
to bear the pain of puberty and to manage their confusion about their sexuality, will desist.
Figures vary but probably 80 percent of kids will desist.
Sociocultural factors impacting on the trans phenomenon

• The recognition of a new condition and the creation of a specialist unit, itself results in
the increase of incidents.
• commodification of identity. That is the transformation in healthcare. From the
patient, being a patient in relation to a healthcare worker to being like a customer: I want this
commodity called this operation – so the idea that there can be a distinction between what I as
a patient want and what the professional thinks I need evaporates.
• Identity politics. The transformation of the whole political realm into a form of identity
politics. That gets related to entitlement and exceptionalism: ‘Because I have this identity I am
entitled to be treated and I’m entitled not to be questioned’. But no identity can exist without
its social sanction. You cannot have sovereignty over your identity. Identity is a social
construct.
• The sense of the body as a machine becomes very accelerated with plastic surgery.
And you could say this whole market of trans is a kind of huge escalation of the plastic surgery
market
• Hatred of mental illness. I haven’t got an illness, I’m born in the wrong body, it is not
a mental dysfunction.
• The relativisation of all truth claims. The idea that there can be no truth, it is My
truth, there is no truth that is external to me.
• misogyny. A deep-rooted misogyny is very much part of this process.
• overburdened child mental services which cannot cope with the combination of
increasing demand and cutting of resources are stretched to breaking point
• The internet. These children are abandoned to the internet as Joyce also said. They go
online and get linked to a trans group and suddenly everything is explained.

Bell ended his intervention by describing a peculiar form of thinking, or more accurately, non-
thinking, where thoughtful engagement and doubt are treated as a kind of enemy. He made
reference to “transphobia” having, for the psychoanalytic community, a particular unfortunate
resonance – which is being made use of – namely, the homophobia that is a part of our history.
In his opinion, the fear of repeating this has interfered with our capacity to think through these
issues.
In our contemporary world, he said, we are generally tolerant and accepting of expressions of
gender fluidity. This acceptance exists alongside a toleration of the limitations that arise from
the body. But in the ideology of the militant trans lobby, there is a peculiar rigidity of gender
identity, a caricature of the body (very rigid and binary), coupled with a belief in the delusional
fluidity of the body, a most peculiar reversal. This is coupled with an essentialist mode of
thought, that is, gender identity is confused with anatomical sex and it is seen as biological and
fixed.
In response, Eric Laurent stated that he shared most of the concerns Bell developed, and some
of his conclusions, and added a slightly different point of view on the causes of the trans
phenomenon. He first highlighted the importance of the number, and the speed with which the
numbers change, making reference to the increase in referrals. He linked the speed of the
change in numbers with a new ideal of inclusion; of the “largest inclusion possible”, which
seems to form a kind of an ideal of a constant transition; like Bell said, a kind of “delusional

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fluidity” of a body in transition, opposed to the obstacles that sexuality could pose on that road
towards fluidity. Laurent commented on the new category introduced in the ICD classification
that wants to replace the gender dysphoria of the DSM by gender incongruence. With this slight
change the idea of suffering linked with the dysphoria is suppressed. You only have to have
the feeling of incongruence. With only this, you enter in the transition inclusion. He referred to
the LGBTQAI+ as a chain where this ideal of fluidity between categories is realised without
obstacles, adding that nevertheless, the first obstacle to the fluidity of the LBG was the T. More
specifically, he said it was a transexual theorist, J. Prosser, who opposed that fluidity inasmuch
as he wanted to change sides. He has a firm belief in such an entity as a man and a woman. He
opposes the queering of sexuality. Laurent also referred to feminism as opposing this
movement of fluidity. It is not sufficient to declare oneself as woman; you have to have the
oppression of generations of women. He also made reference to the current debates between
England and Scotland, and the problem raised when a sexual predator wanted to declare himself
as a woman, after having raped women, and be incarcerated in a woman’s prison. It was JK
Rowling herself who opposed the now ex-prime minister of Scotland, Nicola Sturgeon,
stressing that this auto declaration, the inclusion as such, has contradiction and women as such
have to be protected.
Contrary to Bell, Eric Laurent did not see misogyny as the root cause of this phenomenon,
stressing that women have, since the 70s, accentuated the way by which they are empowered.
Rather than a fight against women, he said what we are witnessing is the dissolution of the old
patriarchate, of the old phallic order, substituted by a fascination about the jouissance of the
body as such, of a non-localised jouissance precisely, beyond the phallic question which can
be dismissed or surgically operated. We have a pluralization of communities. Of all sorts of
communities competing for the commodification.
Laurent emphasised the problem with being fascinated by the studies and big data, which
results in moving away from the old ‘case by case’. The more this clinic is disconnected from
the case by case, the more it is fascinated by communities, by activists that speak, give an
answer, approve the constructs that science proposes.
Laurent’s last remark was the silencing of interpretation that the trans activists want to impose
– as if to interpret or to have the idea that things that are said can have a certain number of
meanings would introduce a kind of conversion. He stated emphatically, quoting Jacques-Alain
Miller, that we reclaim as psychoanalysts, the right to interpret. And the right to consider that
someone is not what he says. Something is said. And that which is said, has to be
contextualised, interpreted in a larger perspective.
A discussion ensued between the two speakers on the above points. The conversation opened
to the audience and the question of suicidality was raised and how can we ensure that the
mistakes of the past – the horrific crimes on the gay community – won’t be repeated on this
very vulnerable population. Laurent offered a recent example of a clinical presentation of a
subject who identified as trans and who had suicidal ideations but who wanted to separate his
trans identity from the latter. He wanted the hospital to deal with what he called ‘the monster’
in him that manifested itself with this suicidal preoccupation, the ‘void’, which is the name he
gave to what he was confronted with and that for him has nothing to do with the transition. So
in a case like this, Laurent concluded, we see that to confuse the idea that suicidal thoughts
were linked with the transition would have been a complete error for this subject. And we have
also to listen to what this subject can say, one by one, precisely.
Bell referred to the parents being “terrorized” by the well-known motto, fortunately no longer
in use: ‘Do you want a dead girl or a live boy’. The parents were made to think that if they
made the wrong decision they were killing their child. There is suicidality and suicidal ideation,

5
but no more so than other young people with other psychiatric problems. But it is rebadging it
as if the problem is because the child is not allowed to transition. There is no evidence of that
at all and this has caused a lot of damage.
Joyce contributed that while she hears the sincere concern, it is also used to close down the
debate and referred to the detransitioned kids who are also at high risk of suicide. In her view,
in the future this will be seen as a serious medical scandal and these children will be told they
did it to themselves: “the most painful sort of regret, regret for a choice that you made; that you
made willingly and freely and maybe fought your parents over.” We can’t keep fearing we are
fighting the same battles that we fought before and we fought badly. This is a different situation,
different kids, different ideology. You can’t say let’s not make the same mistake as we made
with gay kids; we are making different mistake with gay kids now.

***
The afternoon started with clinical vignettes offered by Sophia Berouka (LS), Susana Huler
(LS & NLS) and Colin Wright (LS), which were commented on by Alexandre Stevens,
punctuating the variety of solutions, sometimes constructed in the course of the analytic work,
sometimes outside it. Stevens returned to them in his main presentation, emphasising the ethics
of our orientation.
In A Politics of the Singular, his main reference was Jacques-Alain Miller’s text ‘Docile to
Trans,’5 a text which has not always been well received in England, as we have learned. Stevens
underlined the positive formula with which it ends, by saying that to be ‘Docile to Trans’ is an
opening to the variety of the clinic, to the variety of modes of jouir, that our ethics of the ‘case
by case’ permits. He differentiated the clinic trans from that of hysteria insofar as here, it is not
a question of uncovering the hidden meaning but a position of jouissance right from the start.
There is less a problem of repression than a discomfort directly experienced in the body,
without a hidden signification emanating from it.
Stevens referred to the ‘trans’ as a way of life rather that a pathology, one that includes a mode
of jouir and a trait of identity, depending on how one situates oneself in it. Of course, many of
these subjects suffer enormously and it is them who we welcome and learn from, accompanying
them without any preconceived ideas about the solutions to be found – which is the opposite
of the master’s discourse. The signifier ‘Trans’ is not enough to define a subject, nor the
discomfort it feels. Yet once the signifier is posed it carries consequences, which we heard
about in our discussions around the Tavistock. Similar to Eric Laurent, as well as the finding
of the Cass review, Stevens referred to the necessity to not be satisfied with the word ‘trans’
but to hear further about the difficulties a young person has.
Stevens said that the trans question is posed on two levels: that of jouissance and of
identification thus referring to the mode of jouissance and the name one uses to name their
identity, for example with the process of identification with a community. Stevens uses an array
of clinical cases to illustrate the variety of jouissance, identification and solution, concluding
his presentation by pointing to the contradiction between the fixity of jouissance and gender
fluidity, and again, to the fact that each case is singular and far from the performative ‘I am
what I say’, favouring instead the elaboration of a question.

5
Jacques-Alain Miller, Docile to Trans. Published in Lacanian Review Online (5th May 2021),
https://www.thelacanianreviews.com/docile-to-trans/
Originally published on April 25th 2021 in Lacan Quotidien n° 928.

6
The last presentation of the day was by François Ansermet on Disruptions in Gender: Clinical
Practice and Contemporary Changes.
He introduced the theme by telling us that gender transition is a way of giving oneself a new
origin, a new birth, a new body, a new first name, a certainty – even if it is a strange certainty
– perhaps giving oneself a new sexuality, a belief in the sexual relation beyond the transition,
even if, quite often, the question of sexuality is not at the forefront of these projects.
Psychoanalysis has to utilise the misunderstanding that resides in the very idea of identity: how
to reconcile an identity that assimilates with an identity that distinguishes and separates?
Ansermet told us that to find the subject one must, paradoxically, go through the questions and
“sticking points” (points de butée) that are at the heart of the consultations of those who seek
transition:

1) the question of the reversibility or non-reversibility of puberty blockers

2) the question of preserving fertility that, inevitably, involves the child’s consent. A question
that, in Ansermet’s experience, is usually rejected by the youngsters themselves.
3) Question of diagnosis. On the one hand, gender dysphoria entails a depathologisation of
gender transition, on the other, it relies on an unavoidable medicalisation though medical
treatments. In addition, as also underlined by Eric Laurent, the new diagnosis of ‘gender
incongruence’ already present in ICD11, implies that the condition is under the heading of
sexual health rather than a mental health. The status of suffering is no longer there.
4) Intersex and trans associations are in opposition insofar as the former campaign against
early interventions, while the trans want to have access to them.
5) There is tension between those who advocate for gender binarism and transition from one
gender to the other, and those who advocate for fluidity, change, who think of gender as
something that evolves unpredictably according to the subject’s own solutions.

Ansermet then developed the position one should adopt as a psychoanalyst in clinical practice
when presented with these novel requests. He underlined that in order to find one’s bearings,
it is important not to remain solely within the questions of identity. There is also the question
of desire to consider, even if it is rejected. It is the responsibility of the clinician to re-introduce
the axis of desire and not to stay completely within the axis of identity.
When one does not want to put the case in a pigeonhole the answer is to orient oneself case-
by-case and to thus refer oneself first to the irreducible in what is singular, if one does not
want to put the case in a pigeonhole.
The current debates revolve around misunderstanding. We know that psychoanalysis exploits
misunderstanding which is also particular, misunderstanding with oneself rather than with
others, and with the society. Gender transition is, in effect, an important manifestation of the
body as misunderstanding, therefore, the singularity of each individual, their own
misunderstandings – far more complex than any contemporary debates around identity – must
be heard. What characterises psychoanalysis is indeed that it exploits the misunderstanding,
using it to find a way forward.
Ansermet ended his presentation by stating that to make use of the misunderstanding is to make
use of singularity. This requires making another transition, from certainty to enigma; thus
acknowledging that the other side of transition is that of a sinthomatic solution. In such a way
that, the trans reveal themselves to be not only trans.
The afternoon sessions were chaired by Oriol Cobacho (LS) and Susana Huler (LS, NLS).

7
A discussion ensued between the afternoon’s speakers and the audience with several points
raised: the importance of making a differential clinic of certainty and thus the opportunity for
research in psychoanalysis on this point, the difference between demand and desire in terms of
certainty and fixity. How to modify the demand when there is certainty, the place of death in
the condition of being born and the fact that in gender transition we see this played out: One
wants to be outside this contradiction. It is a way to escape from death. The analytic process is
about permitting someone to make their own choice, not with an acting out but by deploying
the signifiers, demand and desire.

This rich day of work came to a close, by punctuating the importance of having held it – despite
the difficulties encountered in the run-up to it. This was stressed by many speakers throughout
the day. Indeed as Ansermet put it, it becomes difficult to know how to talk about this subject
if one does not want to create tensions, already in the choice of the words one uses. But this is
a current and urgent debate particularly in the Anglo-Saxon context, a “clinical issue [that] has
emerged in the public debate and has had major societal and media implications”6 and it is thus
necessary to assert the unique contribution of the psychoanalytic discourse. Psychoanalysis
deals with the unconscious and in the ideological times of self-determination, when we cannot
imagine the subject might be saying anything other than his words, the psychanalyst has to
preserve their right to intervene and to interpret.

Peggy Papada
London, 3 March 2023

6
Miller J.-A. The Current Situation of Public Debate in France, as seen by the Editorial Staff of Lacan
Quotidien. Letter to the Schools of the WAP. 2nd April 2021