Thinking postmodern and practising in the enlightenment: Managing uncertainty in the treatment of children and adolescents

Abstract

In this paper, I explore how postmodern ideas about gender may impact on clinicians working with gender variant children and adolescents. The postmodern turn has built on the feminist rejection of the idea of ‘essential’ gender, to further interrogate accepted conceptions of sex and gender and the stability of all identity categories. Some queer theorists have taken a further step, viewing all gender as fictional and artificial and celebrating the subversive potential of transgender identities. However, those working clinically with trans adolescents may experience a troubling tension between, on the one hand, a view of sex and gender categorisations as undecidable and fragmented (as postmodern theory suggests), and, on the other hand, the apparent need of many for a coherent and settled sense of self. In particular, how do we justify supporting trans youngsters to move towards treatment involving irreversible physical change, while ascribing to a highly tentative and provisional account of how we come to identify and live as gendered? I conclude that the meaning of trans rests on no demonstrable foundational truths but is constantly being shaped and re-shaped in our social world. Clinicians must be accountable in this process; far from succumbing to a paralysing relativism, the task for clinicians is to be highly attuned to our young clients’ complex narratives and to question our complex investments in the positions we adopt.