性别认同与性别表达的社会困境:医务社工介入跨性别儿童青少年多学科联合诊疗案例研究  

The social dilemma of gender identity and gender expression:case research on medical social workers’intervention in multidisciplinary joint diagnosis and treatment for transgender children and adolescents

作　　者：董颖 刘泳志 罗飞宏 魏佳 师正楠 孔祥宁 郝宇昕 杨宁 郑章乾 傅丽丽[1] DONG Ying;LIU Yongzhi;LUO Feihong;WEI Jia;SHI Zhengnan;KONG Xiangning;HAO Yuxin;YANG Ning;ZHENG Zhangqian;FU Lili(Department of Social Work,National Children’s Medical Center/Children’s Hospital of Fudan University,Shanghai 201102,China;Department of Pediatric Endocrinology and Inherited Metabolic Diseases,National Children’s Medical Center/Children’s Hospital of Fudan University,Shanghai 201102,China;National Children’s Medical Center,Department of Psychiatry and Psychology,Children’s Hospital of Fudan University,Shanghai 201102,China;School of Sociology and Political Science,Shanghai University,Shanghai 200444,China;School of Social Development and Public Policy,Fudan University,Shanghai 200433,China;School of Social and Public Administration,East China University of Science and Technology,Shanghai 200237,China)

机构地区：[1]国家儿童医学中心/复旦大学附属儿科医院社会工作部,上海201102 [2]国家儿童医学中心/复旦大学附属儿科医院内分泌遗传代谢科,上海201102 [3]国家儿童医学中心/复旦大学附属儿科医院精神心理科,上海201102 [4]上海大学社会学院,上海200444 [5]复旦大学社会发展与公共政策学院,上海200433 [6]华东理工大学社会与公共管理学院,上海200237

出　　处：《中国医学伦理学》2024年第7期843-851,共9页Chinese Medical Ethics

基　　金：复旦大学附属儿科医院重点发展项目(疑难重症诊治中心子项目号EK2022ZX01)。

摘　　要：跨性别儿童青少年(跨儿)在性别认同和表达过程中面临严重的社会困境,阻碍该群体寻求合理及平等的生存发展权利。在平权视角及社会困境理论框架下,通过对在某院跨性别多学科(MDT)门诊寻求医务社工帮助的跨儿进行访谈,揭示出在传统“二元性别”体制下,跨儿社会包容性及基础设施不足,导致该群体在性别表达和性别认同过程中同时遭遇“社会陷阱”和“社会藩篱”两大社会困境。具体表现为,跨儿的社会性别选择常导致集体非理性反应和性别惩罚,影响其获取合法有效的诊疗服务。为此,研究团队运用批判性方法论,构建医务社工参与的跨儿多学科联合诊疗路径,并验证该路径在合理化跨儿及其家庭自身需求、缓解其在性别认同过程中的心理压力和社会适应问题、培养所在家庭多元对话环境、提升自我效能和社会参与度等方面有显著干预效果,以期为社会困境中的跨儿群体提供帮助,助力其权益纳入儿童友好指标体系,提升全社会对跨儿群体的包容和理解。The transgender children and adolescents(TCAs)face serious social dilemmas in the process of gender identity and expression,which hinders this group from seeking reasonable and equal rights to survival and development.From the perspective of equal rights and the theoretical framework of social dilemma,by interviewing TCAs who seek help from medical social workers in a hospital’s multi-disciplinary transgender clinic,this paper revealed that under the traditional system of“binary gender”,TCAs lacked social inclusiveness and infrastructure,which led to the two major social dilemmas of“social traps”and“social barriers”encountered by this group in the process of gender expression and gender identity.Specifically,the social gender selection of TCAs often leads to collective irrational reactions and gender punishment,preventing their legal and effective medical services.To this end,the research team used critical methodology to construct a joint disciplinary diagnosis and treatment path for TCAs with the participation of medical social workers,as well as verified that the path has significant intervention effects in rationalizing the needs of TCAs and their families,alleviating their psychological pressure and social adaptation problems in the process of gender identity,fostering a diverse dialogue environment in their families,as well as enhancing their self-efficacy and social participation,to provide assistahce to the TCAs groups in social difficulties,assisting their rights and interests be included in the child-friendly indicator system,and improving the whole society’s tolerance and understanding for TCAs group.

关 键 词：跨性别儿童青少年 性伦理 社会困境 多学科联合诊疗 

分 类 号：R-052[医药卫生]