THE REMAINS OF THE DAY: TRANSSEXUALITY,PSYCHODYNAMICS AND THE MODERN NHS

This paper describes a psychodynamic understanding of transsexualism and some related implications for NHS services. Following a brief literature review the author describes a series of clinical vignettes that tease out psychically important transsexual dilemmas. Specifically, themes of conflict with authority, idealization of destructive solutions and learning to live with regret are explored. Finally a psychological differentiation of transsexual issues is suggested as potentially helpful for future service development.