References American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition) Washington DC: APA. Gee, J. (1991) A linguistic approach to narrative. Journal of Narrative and Life History, 1: 15-39. Labov, W. (1972) Language in the Inner City. Philadelphia: Pennsylvania University Press. Langellier, K. (2001) ‘You’re marked’: Breast cancer, tattoo and the narrative performance of identity. In J. Brockmeier & D. Carbaugh (eds.) Narrative and Identity: Studies in Autobiography, Self, and Culture. Amsterdam and Philadelphia: John Benjamins. Prosser, J. (1999) Second Skins: The Body Narratives of Transsexuality. New York: Columbia University Press.
Multi-family support for Yang Yang Teh and Carolyn Bush
“If one day you were to wake up in the
body of another gender, what would be your fi rst thoughts and feelings?” This was a question raised by a parent at a multi-family session we facilitated. We found the question so insightful, we posed it to 70 family therapists at the 2016 Eileen Jamieson Memorial workshop on gender diversity when we began our presentation on our multi-family support for adolescents with gender variance. There were three multi-family group members, including two adolescents and a mother, as well as a grandmother (chaperone of one of the adolescents), participating and contributing actively in the presentation and discussion then. Yang’s refl ection: Having the families amongst family therapists added an additional layer of refl exivity and learning at the workshop. The families were very willing to share their views and experiences throughout the workshop, even as audience to other presenters. I felt they acted almost like the outsider witness (White, 1999) for us family therapists. It was also very moving to hear and observe how proud and touched the grandmother was to experience the outspoken side of her grandson, who was usually shy and quiet, both at home and at our multi-family group sessions. Our joint venture with this multi-family
Claire Ely is a systemic psychotherapist and has since taken up the role of clinical lead for CYP IAPT for London and the South East Collaborative at The Anna Freud Centre.
Claire identifi es as a white, Welsh, heterosexual female and is keen to challenge any limitations that others may put on her or others. She hopes we are all less defi ned in future by the constructs of binary gendered-thinking and that people are enabled to fully embrace all that they are and can be. Email:
elyclaire@icloud.com
group lasted for about a year and it all began in 2015. This is the story of how it all began and our refl ections of the experiences.
Gender – a social construct We found the Gender Unicorn a very
useful visual representation of the complexity of a person’s gender. Our view is that gender is a social construction often not explored enough in a non-binary way within systemic literatures and clinical practice. We found presenting gender visually, such as the gender unicorn, opens up more understanding and discussions beyond the binary view of gender as just being man versus woman. It acknowledges the category of other genders. It also distinguishes between gender identity, gender expression, sex assigned at birth and sexual orientation (the physical/ emotional attraction to others).
8 We believe gender variance has been
an under-rated presenting issue in the CAMHS (Child and Adolescent Mental Health Service) setting. According to PACE Health (2014), a research on the mental health of transgender people (age 16-24), 48% of transgender people had attempted suicide as compared to 6% of the general population, and 58% of transgender people self-harmed as compared to 8-9% of the general population. That was an alarming fi gure we found, given the development and struggles of these adolescents. We wondered about contributing factors to this, such as the mind and body diff erences and development, including psychological pain, systemic oppression of and discrimination against the adolescents. Gender-variant adolescents not only go through the identity-development struggles all adolescents experience during puberty, but also experience gender identity distress, such as living in a cis-gender, binary social environment which puts them into a socially-constructed dichotomy of oscillating between remaining stealth (keeping one’s transgender identity private) or coming out about their gender identity to diff erent people in diff erent social contexts at diff erent times, especially during their secondary or college transition. They also experience peer-relationship challenges alongside transphobic discrimination in school, by some health professionals and from their (extended) families. Over the years, we noticed a trend.
CAMHS received an increasing number of children and young people (the youngest we encountered was age 6) referred for severe mental health problems or distress, who also expressed questions about the gender they were assigned at birth, or had a strong sense of being the other gender and wanted to be recognised as such. There were about two or three cases referred annually in the past. However, a year before we set this group up, we noted there were over 10 such cases referred. The fi ve-fold increase was coherent with the increased referrals the Tavistock Gender Identity Development Service (GIDS) received: from 94 in 2009/10 to 463 in 2013/14. This number has doubled since, to 969 in 2015/16 (McKenzie, 2016).
Context 155, February 2018
In his own words: A narrative analysis of the stories of trans men in gender transition
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