Killing off the good little boy: transition as a solution to the problems of separation from the primary object

ABSTRACT

This paper explores clinical work concerning a group of gender-questioning natal males who experienced physical difficulties in childhood. The author argues that these individuals develop a transgender (trans) identity as a defence mechanism against the psychological challenges associated with development, particularly the struggles of forming a distinct mind and identity. Anxieties related to physical health may have contributed to the formation of an anxious attachment to their primary caregiver, perceived as intrusive and demanding. Moreover, these individuals struggle to identify with their fathers, often experiencing them as distant, absent, or unsupportive of their relationship with the mother or other primary caregiver, thereby hindering separation from the primary attachment figure. These early experiences may lead to difficulties in acknowledging and owning their evolving sexuality and aggression, as well as in bearing the necessary guilt associated with separating from the primary caregiver. Consequently, the individual may fantasise about relinquishing identification with an idealised version of themselves and replacing it with a liberated version capable of living autonomously. Through a composite case, the paper illustrates how these conflicts manifest in the therapeutic setting through transference dynamics. Themes explored include gender dysphoria, confusion, adolescence, and transition.

KEYWORDS:

• Gender dysphoria
• identity
• adolescence
• transference

Acknowledgments

I would especially like to thank J Cohn for support and work in helping me write this paper. I would also like to thank Susan Evans, Bob Hinshelwood, Shlomit Gorin, Roberto D’Angelo, Heinz Weiss, and Ian Williamson.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Marcus Evans

Marcus Evans is a psychoanalyst with over 45 years of experience in mental health. He served as a consultant psychotherapist and mental health nurse, and held the position of head of the nursing discipline at the Tavistock & Portman NHS Trust from 1998 to 2018. Additionally, he played a pivotal role as one of the founding members of the Fitzjohn’s Service, aimed at treating patients with severe and enduring mental health conditions and/or personality disorders. Throughout his career, Evans has extensively contributed to both writing and teaching. He is the author of three books: ‘Making room for madness in mental health: the psychoanalytic understanding of psychotic communications’, published by Karnac in 2016; ‘Psychoanalytic thinking in mental health settings’, which introduces frontline mental health professionals to psychoanalytic thinking and was published by Routledge in 2020; and his third book, co-written with his wife Susan Evans, titled ‘Gender dysphoria: a therapeutic model for working with children, adolescents, and young adults’, published by Phoenix in 2021.