*The Psychoanalytic Crisis: The Place of Ego in a Contemporary World DOI: http://dx.doi.org/10.5772/intechopen.107249*

justified in the name of health, which favors insurance programs and at the same time brings "normalization" to the diagnostic. According to the new criteria of DSM-V, the gender dysphoria can be defined as: "a strong desire to be free from one's primary and/or secondary sexual characteristics, because of a marked incongruence with one's expierience/ expressed gender," and "a strong desire to be of the other gender" and additionally "a strong conviction that one has the typical feelings and reaction of the other gender." Besides that, it also states that "is associated with clinically significant impairment in social, occupational, or other important areas of functioning" [49].

The diagnostic changes mark a medical effort in medicalizing the transssexualiy and consequently proposing a way to treat it. From that idea that the gender nature has to do with something subjective and from a symbolic order distorted, mischaracterizing the symbolic formation along the development with concepts that validate the normatization of transsexuality. Thus, in a rush to satisfy parents' wishes and their own medical service, an interruption of the physiological process is proposed in order to facilitate surgical procedure.

The case Bell versus Tavistock is an example of the new position that is rising against this diagnosis. In 2020, the British Court brings to question if children under 16 years old are able to decide by themselves if they can take hormones suppressants to facilitate in future the sex changing. This case was based on a patient from the Tavistock Clinic that decided with 16 years old to use suppressants and after the transition preferred to return to the biological gender. At last, the Britannic Justice decided that the children under 16 years old hardly have the competence to decide over the use of medication, modifying the conduct line that has been carried out by the only Britannic public health service that offers this treatment [50].

Some psychoanalysts critical to the vision that promotes hormone suppressants in children see the identity problem as requiring a symbolic work, and the body intervention is a mistake, a psychotic solution [51]. According to Bell [52], there are underexplored factors from a social point of view contributing to the current emergence regarding gender dysphoria that includes misogyny internalization, seeing patients as products, and social media influence.

From the epidemiologic point of view, the prevalence of gender dysphoria is from approximately 4.6:100.000 [53], and yet according to that reference there is no correlation with social status, intelligence, or ancestry. However, it is more common a transsexual transition from male to female (6.5%) than a female to male (2.6%), and for children, the literature states that the prevalence is from 1% to 4.7% [17].

Gender dysphoria is correlated to high taxes of affective disorders and anxiety (18–80%), personalities disorder (20–70%), suicidal tendencies, suicide, and selfharm. Consequently, gender dysphoria is a delicate diagnosis that needs extreme caution from development, once in children the gender incongruence fluctuates over time. Children that manifest gender dysphoria might feel comfortable 85% of the time with their gender after adolescence [54].

The Bell versus Tavistock case is a portrait of the crisis that psychoanalysis has been facing in relation to gender identity. Whereas a group is favoring a gender transition for subjects afflicted with the pathology, including the early interventions, another group became critical, as they understood and valued the search for a bigger understanding about symbolic processes from these subjects and how this suffering might indicate that there are other questions about Ego formation.

According to Sakteopoulou [55], the maintenance of children in a non-identity body creates a "massive gender trauma," which implies an emergence of a trauma from the gender dysphoric experience. What calls the attention is that according

to this author "some psychic conflicts cannot be resolved within the psychic realm, requiring action" [55], escaping from the analyst's place, that is in search for the subject psychic realm understanding, which implies, many times, in welcoming the anxiety lived in the analytical field.

Osserman and Wallerstein [50] assert that we are witnessing the growth of psychoanalytic literature that validates the access of teenagers and children to medical intervention, medication, and body mutilation, related to gender identity. This is an alert to the anxieties that emerge from analysts to countertransferential reactions.

Therefore, while on one side a group is *gender affirmative* and believes that the suffering by feeling in a body that is not their own is severe and so needs an early intervention, on the other side a group is *gender critical* and believes that the early intervention does not give time to explore another aspect that surrounds the identity formation of a child.

The defense of a neutral identity, in which the subject chooses what one's intend to be, for instance, it is offered to a child the "choose" of how one's want to be bodily recognized in the world, in a developmental moment that depends on environmental feedback to that end, in order to avoid the suffering that the reality principle brings also may affect the developmental process. According to Winnicott [56], a child is not born alone; therefore, it is a parent and caregiver's role to protect them, including in face of situations that require mature decisions about the child's life.

Afterward, it can be said that in order to avoid children's future suffering, these interventions could stop the development of the identity against inevitable traumas from life, that is, boundaries.
