Entrevista con un invitado muy especial

Jennifer Levy estuvo conversando con Domenico Di Ceglie, uno de nuestros invitados estelares al XVI Congreso Peruano de Psicoanálisis. El Dr. Di Ceglie es psiquiatra de niños y adolescentes y consultor honorario vitalicio en el Tavistock Centre, en Londres. En 1989 fundó y dirigió por veinte años el Servicio de Desarrollo de Identidad de Género en el Hospital St. George’s de Londres, que luego fue tansferido a the Tavistock & Portman NHS Foundation Trust- London. Nuestro invitado ha desarrollado modelos de atención interdisciplinaria para niños con desarrollos atípicos de la identidad de género y sus familias, ha participado en proyectos de investigación, producido numerosas publicaciones y trabajado en la formación de terapeutas. Ha ejercido la docencia en University College, Londres, en la Scuola di Specializzazione in Psicologia Clinica, Universidad La Sapienza, Roma y es Doctor Honoris Causa de la Univerisy of East London. Actualmente se desempeña como conferencista y consultor internacional. Recomendamos la lectura de “A Stranger in My Own Body – Atypical Gender Identity Development and Mental Health” (Karnac Books, London, 1998). Tenemos mucho que aprender de su larga experiencia, de sus desarrollos técnicos y, muy especialmente, de su postura clínica. Con esta entrevista, breve pero aguda, le damos la bienvenida.

A continuación, la entrevista en inglés.

1.You do not use the term “transgender” but “gender dysphoria”. Could you explain why?

I use the term ‘gender dysphoria’ to emphasize the experience of distress which is associated with the incongruence between mind and body in many young people. The term is also used in the DSM5 Classification (‘Gender identity disorder’ is no longer used). I have also used the term ‘atypical gender identity development’ as an umbrella term for different type of presentations such as gender variance, gender non conformity and gender dysphoria etc. The term ‘transgender’ is largely used by the media and it is easily recognized by a large part of the population. All these terms highlight a particular aspect of the complex experience of disharmony between mind and body and are used to indicate this particular aspect of diversity. A particular term is also chosen in connection with a particular recipient of the communication e.g. professionals, general public etc. In my view all these terms should not be taken in a rigid and concrete way. The language in this area is in continuous evolution.

2.In one of your articles you establish a relationship between autism and gender identity disorders. How do you understand autism? I wonder if it is not a contradiction to affirm that those young people who have not developed a symbolic thought are more likely to develop a gender identity disorder if we are talking about children who are developing?

Empirical research has shown an association between gender dysphoria and autistic spectrum condition.

The findings show that there is an association, but not a link between the two presentations. One could hypothesize that the presence of autistic spectrum features could influence the particular shape of the atypical gender identity development within a spectrum which goes from solidity to fluidity or from continuity to variability. The variable capacity for symbolic thinking can also play a part in shaping gender identity, but also other faces of personal identity. This is an area that requires further research.

3.Children and adolescents who want to change their gender identity often suffer a lot. Sometimes it seems that the one who needs the most help is society. The discrimination, rejection and bullying that these children face can lead to suicide. How do you work on these issues?

Children and adolescents with gender dysphoria have an inner perception (gender identity) which is incongruent with their sexual body and the gender assigned at birth. They have a strong wish to be recognized and accepted by the family and society at large for whom they feel they are. Often they want to be affirmed in their self- perception by modifying their body. As you say, they experience distress and this can be linked to a number of factors such as discrimination, rejection and bullying. This needs to be addressed at an individual level and societal level. 1) At an individual level with a range of interventions tailor-made accordingly to the individual needs. GIDS has developed ‘a network model of care’ which involves collaboration between GIDS’s staff and other professionals working where the child and the family live. This collaboration involves working with school staff and other child and adolescent professionals to agree and implement a well- integrated plan of care. Combating discrimination, rejection and bullying are among the aims of this plan. 2) At social level, education of the public and increasing awareness of these young people’s experience of diversity through television, radio and social media as well as appropriate legislation are all important interventions.

4.You founded the Gender Identity Development Service of the Tavistock Clinic in 1996. It says that in recent years there has been an increase in cases of gender dysphoria. What do you think this increase is due to?

I started the Gender Identity Development Service in 1989 in the Department of Child Psychiatry at the St Georges Hospital in London. It transferred in 1996 to The Tavistock Centre. Since the beginning there has been a gradual increase of referrals, but in the last ten years a major increase of referrals has occurred in line with increase in many western countries. The reasons for this increase are complex and there isn’t enough empirical research to explain it. I think that this phenomenon is partially due to an increased visibility of diversity in society including the LGBT community. In particular in the UK the national funding of the Service since 2009 has created more equity of access to GIDS, across the various regions of the country. Moreover TV, radio programs and social media have played an important role in making the experience of gender diversity in young people more visible and acceptable. The availability of a nationwide service with a multidisciplinary team with a range of interventions in response to the diverse needs of individuals may also have facilitated access to care.

5.You point out that professionals working at the Gender Identity Development Service often experience a lot of social pressure and may even feel at risk, as much as the patients themselves. Could you develop this topic a little more from your personal experience?

I think that you refer here to what I described in some of my papers as ‘working at the edge’. This is the feeling of being under pressure to act or not to act and to having to deal with what is perceived as a life or death type of dilemmas in some of the interactions with service users. It is a sense of threat to something fundamental in ourselves. A psychological situation where an ‘intermediate position’ seems not possible. I have expressed the view that this state of mind in the professionals mirrors the experience, especially of adolescents and their family, within themselves and in society. The creation of favorable conditions and space for thinking is a major challenge in therapeutic work, which is aimed at improving wellbeing.

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