The Body as a Site of Gender-Related Distress: Ethical Considerations for Gender Variant Youth in Clinical Settings

ABSTRACT

The present article maps out understandings about embodied distress among gender-nonconforming youth. Feminist bioethics and queer-inflected clinical perspectives are used to inform thinking about ethical, nonpathologizing health care in the case of gender-related distress. Specific attention is directed at self-harming among gender variant and trans youth. This is contextualized in relation to the role that self-harm plays for some LGBT youth, where it may be seen as a rite of passage or as reasonable and inevitable way of coping. The particular complexities of self-harm among trans youth seeking clinical intervention are examined. Queer bioethics is proposed as potentially facilitating productive uncertainty with regard to the diverse imagined futures of gender variant and trans youth.

KEYWORDS:

• Bioethics
• childhood
• clinical intervention
• gender identity
• gender nonconforming
• gender variant
• self-harm
• therapy
• transgender
• transsexual

Acknowledgments

I would like to thank Elizabeth McDermott for many discussions about queer youth and self-harm that have fed into my work on this article. I would also like to thank Anna Piela and Moritz Hagedorn for our shared research on different online forums where (LGB and) trans youth write about their self-harming. While the current article is not empirical, it does build on understandings that have emerged through our collaboration on empirical projects.

Notes

1. Cisgenderist assumptions are gender-normative assumptions, i.e., assumptions that fail to take transgendering or gender-nonconforming possibilities into account.

2. These are not direct quotations but have been altered to protect anonymity. The study through which some of these data from youth discussion forums was generated has been reported elsewhere (McDermott, Roen, & Piela, 2013a, 2013b).

3. Since the present article was written, more studies have emerged and these are documented in McDermott & Roen (2016).

4. Source: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=443#.This proposed diagnosis will also target girls and young women, who typically present with a higher rate of self-harm than do boys and young men.

5. For critical analysis, see Roen (2011).