L’expansion de la « dysphorie de genre » : un phénomène social ou psychologique ?

Abstract

ObjectivesAny clinician cannot fail to wonder about the notion of “gender dysphoria” as a disease or as a disorder. The review of the few international epidemiological studies on gender transition requests leads to an attempt to “decipher” the reasons for the exponential growth of this new clinical category. Is it a psychopathological or a social phenomenon, or both? We will examine separately the cases of children and adolescents. Children experiencing hesitations about their sexual identity tend to give up requests for transitions; as for teenagers (12 girls for every boy), they seem to be largely influenced by social networks. We will position ourselves strictly on the clinical and deontological level, to defend medical ethics, at a distance from the ideological considerations disseminated by the media. Starting from the recognition of the very strong increase in France of requests to “change sex/gender” in children and adolescents in recent years, we will note that this claim of “gender dysphoria” is presented differently by children before and after puberty. From a clinical point of view, it is necessary to understand that gender dysphoria would be the result of different identification processes for children and adolescents; it also presents as a gendered behavior like other known behavioral disorders in adolescence. The objective of this article is therefore to decipher this pandemic phenomenon and to question it as a social rather than a medical phenomenon. We must then recommend great caution in medical procedures, sometimes irreversible, on these children. MethodBased on an analysis of the international literature, we focused on international epidemiological studies and on the scarce data available to us in France. We compare these data with those from testimonies of adolescents in the process of “identity transition” or “detransition” in France and in other countries, because the complaints and claims are identical. These data were collected and studied until the end of 2021. These data and testimonies will be confronted with our knowledge in the domain of child and adolescent psychiatry and psychoanalysis, the latter being a theoretical construction of childhood sexuality. ResultsThe results drawn from the analysis of these testimonies and from existing epidemiological studies show, firstly, that a fundamental distinction must be made between the phenomenon of “gender dysphoria” in children and in adolescents. The evolution of the demands is drastically different in terms of volume and environmental causality. Secondly, in adolescence, this demand for a change of identity indisputably concerns a very large majority of girls. Finally, this demand, therefore sexualized, can be seen as a fragile identity, added to other pathologies. It should also be considered with demands regarding identity and the impact of propaganda on social networks towards youth. DiscussionThese new demands for changes in gender identity should be discussed before administering lifelong medical and surgical treatments that have not proven their effectiveness and harmlessness, as is the case in Sweden and the U.K. Our discussion here focuses on some clinical and epidemiological elements that allow us to consider these new demands for recognition of “gender dysphoria” from adolescents as a “social epidemic” phenomenon. We will discuss the notion of gender and identification in children and adolescents, along with the frequent and worrying “associated disorders.” A reflection on the particular question of the body will lead us to question the refusal of the feminine in the 21st century. we will also consider the impact of the choice of treatment and support provided, before concluding with a reflection on the requests of adolescent girls. ConclusionsWe recall the importance of providing global psychological, psychodynamic, and psychiatric care for all these children. We recommend acting with the necessary prudence and ethics at these stages of life, and we defend the necessity for all children to develop thanks to the normal evolution of their chosen identifications. The diagnosis of “gender dysphoria” should not be understood as a diagnosis that would bind the child or adolescent in a gender (whether desired or not, conversion therapy is now forbidden in France), but, on the contrary, should allow the child or adolescent to be accompanied towards an emancipation in the face of these gender stereotypes in which he or she is most often trapped, or even kidnapped. Because the body is not sick, it is necessary to protect it against any deleterious transformation. But above all, by avoiding any stigmatization of identity, we can allow the child as well as the adolescent to reappropriate the image of her/his body and thus a psychic and anatomical unity. To thus preserve the freedom of choice amongst the multiple adult sexualities with which s/he will have to deal later on. It is obviously for lack of this protective psychological accompaniment that these young people prematurely put an end to any genital sexual life (homo- or heterosexual or other).