Identity and the Foundational Myth: Psychoanalytic Insights into Gender Distress

The concept of identity is complex and affected by personal and cultural pressures. No more so than during adolescence, a time when we endeavour to find out who we truly are as our minds and bodies go through many changes, we start to disidentify with our families, and we are exposed to group attitudes and pressures. For many adolescents, puberty can feel like an unwanted betrayal by their own bodies. Their changing physicality seems to pull them further away from the self they imagine or wish to be and they struggle to reconcile their physical form with their sense of self. This book explores gender distress through the lens of early childhood development with a focus on and elaboration of developmental interpretations and corresponding psychotherapeutic approaches. It builds on the work of Evans' previous book, co-authored with Susan Evans, Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults (2021). As with his first book, it is based on continuous learning gained through clinical work with different patient groups. The analyst's role is to remain curious and help patients explore and understand themselves in every aspect of their lives. Evans uses composite cases to chart the progression of therapy and show how psychological support can help individuals. The book includes a Preface from R. D. Hinshelwood and Foreword from Ron Britton. It is essential reading for all clinicians, practising therapists and trainees, as well as any other professionals who work with adolescents and young people. AUTHOR: Marcus Evans is a psychoanalyst and was an adult psychotherapist at the Tavistock & Portman NHS Foundation Trust with 40 years' experience in mental health, originally training as a psychiatric nurse. After qualifying as a psychotherapist at the Tavistock & Portman NHS Trust, he took up a post as head of the nursing discipline. Marcus was Associate Clinical Director of the Adult & Adolescent departments between 2011 and 2015. Marcus has designed, developed, and taught outreach courses for front line staff in various settings for the last 25 years. He was also one of the founding members of the Fitzjohn's Service for the treatment of patients with severe and enduring mental health conditions and/or personality disorder in the adult department. He has written and taught extensively and is author of Making Room for Madness in Mental Health: The Psychoanalytic Understanding of Psychotic Communications, published by Karnac in the Tavistock Clinic series.

Table of Contents:
Acknowledgements About the author Preface by R. D. Hinshelwood Foreword by Ron Britton Introduction   Part I. Overview and background Introduction Introduction to early childhood development Some observed aspects of trans-identifying individuals Aspects of psychoanalytic assessment and treatment of gender dysphoric young people   Part II: Case studies Introduction to Part II Difficulty taking ownership of the body and the adult sexual body Fragile ego prone to fragmentation and concrete thinking Exploring identity and transference: A psychoanalytic journey through early trauma and gender dysphoria Eroticised as a defence against separation Killing off the good little boy: Illness in childhood Mourning the loss of the ideal self: Short-term work with a trans patient post-transition Conclusion   References Index

About the Author :
Marcus Evans is a psychoanalyst and fellow of the British Psychoanalytical Society. He was a consultant psychotherapist and mental health nurse with forty years of experience in mental health. He was head of the nursing discipline at the Tavistock & Portman NHS Trust between 1998 and 2018. He was also the lead clinician in the adult and adolescent service and one of the founding members of Fitzjohn’s Service for the treatment of patients with severe and enduring mental health conditions and/or personality disorders.  He has written and taught extensively on applying psychoanalytic thinking in mental health settings. Karnac published the first, Making Room for Madness in Mental Health: The Psychoanalytic Understanding of Psychotic Communications, in 2016. His second book, Psychoanalytic Thinking in Mental Health Settings, introduces front-line mental health professionals to psychoanalytic thinking and was published by Routledge in 2020. The following year his third book, Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents, and Young Adults, written with his wife, Susan, was published by Phoenix.

Review :
‘This is a moving and in-depth book of a psychoanalytical pioneer in the exploration of identity problems which accompany the individual over a lifetime. It is based on the author’s sound clinical experience and empirical knowledge and gives testimony of his courageous and unprejudiced journey with his patients throughout their crisis. At the same time, it goes to the heart of psychoanalytical ethics and the painful task to acknowledge some “basic facts of life” which we all would rather like to distort or omnipotently deny.’ ‘Clear, compassionate, and comprehensive, Marcus Evans’ book is a substantial contribution to the literature on working psychodynamically with young people experiencing gender distress. A psychoanalytic approach to gender dysphoria allows the unique and complex stories of individuals to emerge, as can be seen in the extensive case material discussed in this volume.’ ‘Over the last two decades, psychoanalysts have been challenged to respond in a meaningful way to the growing presence of transgender identities in our consulting rooms and social worlds. Radical revisions of theory and new clinical formulations have been proposed, along with increasing scepticism and rejection of existing psychoanalytic theories. In this volume, Marcus Evans convincingly demonstrates the relevance of Kleinian and object relations theories for transgender identities and the power of these theories to illuminate the intrapsychic worlds of young people experiencing gender distress. His work cautions us not to discard established psychoanalytic theorising in our zeal to rid psychoanalysis of limiting, heteronormative formulations.’ ‘The psychoanalytic community has struggled in recent years to apply the rigours of our thinking to the area of gender dysphoria, leaving services and clinicians without a framework for understanding and working with young people presenting in this way. Marcus Evans has been pioneering in applying established psychoanalytic thinking to this area, helping us to consider why the incidence of this presentation may have risen so dramatically and why we, as health professionals, have struggled to adequately respond. This book takes a compassionate approach in both the formulation and treatment of gender dysphoria, and will contribute greatly to these young people receiving respectful, ethical care.’