Psychoanalysis Needs a Sex Change

Gay & Lesbian Issues and Psychology Review, Vol. 7, No. 1, 2011

PSYCHOANALYSIS NEEDS A SEX CHANGE

PATRICIA GHEROVICI

Abstract ing through ‘castration complexes’ and ‘penis envy’, and culminating in the development of This paper discusses the crucial part played by a mature, ‘normal’ genital choice. In this psychoanalysis in the history of transsexualism reading, proper gender identification produces and assesses the controversial yet central role masculinity for males, femininity for women, of sex-change theory for psychoanalysis. In- and creates an adapted heterosexual desire deed, the pioneer sexologist and activist Mag- that is purported to result in satisfying sexual nus Hirschfeld was among the founders of the lives. Berlin Psychoanalytic Society. Hirschfeld was appreciated by Freud, although rejected by In fact, nothing could be farther from what Jung. It is time both to historicise and theorise Freud stated theoretically or observed in his the loaded connection between sexologists practice. One can even say that the previous and psychoanalysts. The author argues for the claims are all reductive distortions. Freud depathologisation of transgenderism. Lacan's never condemned homosexuality and had a theory of the sinthome offers an innovative very tolerant attitude facing it. Furthermore, framework for rethinking sexual difference. as Dean & Lane (2001) have shown, the foun- With the help of this theory, one der of psychoanalysis never considered same can challenge the pathological approach too sex desire pathological. Freud was not voicing often adopted by psychoanalysis. This calls for liberal tolerance but rather making a radical a more fruitful dialogue between Lacanian move, because for the founder of psycho- psychoanalysis and the clinic of transsexual- analysis homosexuality was a sexual orienta- ism. tion as any other, and as contingent as het- erosexuality. Freud observed “that all human Introduction beings are capable of making a homosexual object-choice and have in fact made one in Psychoanalysis has a sex problem in more their unconscious” (footnote added in 1915; than one sense. Transgender activists and Freud 1905, p. 145n). For Freud, human sexu- scholars have been wary of psychoanalysis, ality was essentially polymorphous and per- with good reasons. In both subtle and brutal verse because the erotic drive does not follow ways, psychoanalysis has a history of coercive any ‘natural’ course. Contrary to the standard hetero-normatization and pathologization of view of traditional psychoanalysis, Freud non-normative sexualities and genders. Such a ‘queered’ human sexuality (Dean & Lane, homophobic and transphobic history, how- 2001) when he proposed a sexuality that op- ever, is based on a selective reinterpretation erates in a mysterious, capricious way, contra of the Freudian texts. It is of course true that natura, veering off the reproductive aims. many normative theories about sex and gen- Freud ‘perverted’ sexuality when he separated der claim to derive from Freudian psycho- the drive from any instinctual function and analysis and classify and adjudicate individuals described its object as ‘indifferent’, that is, not according to sexual behavior. Freud’s Oedipal determined by gender. As noted by Lacan Complex, it is said, starts with the recognition (1981), Freud “posit[s] sexuality as essentially of anatomical sexual differences, before pass- polymorphous, aberrant” (p. 176.) What irri-

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tated people most in Freud’s early sexual of transsexualism, which are as revealing as theories was not the scandalous claim that they are exemplary. This brief history of the children were sexual beings, but rather his evolution of the nomenclature will be helpful non-essentialism in the definition of sexuality. to see how the terminology has been linked to Freud’s later notion of the drive is also non- the domain of the pathological. It also shows gender specific; this was the real scandal that the central and complex role psychoanalysis would clash with Victorian sensibility and it has played in the history of transsexualism. was thereafter repressed by post-Freudians. Psychoanalytic Beginnings How then could psychoanalysts after Freud talk about ‘normal’ sexuality assuming it The philosopher Michel Foucault has made us means heterosexual genital function when aware that sexuality has a history, and that Freud acknowledged that the mutual interest psychoanalysis has played a very important of men and women is “a problem that needs role in it as a theory of the intersections of law elucidating and is not a self-evident fact and desire. His History of Sexuality (Foucault, [...]” (footnote added in 1915; Freud 1905, p. 1990) states that a history of the deployment 146n)? As Dean & Lane (2001) note, one of of sexuality since the classical age “can serve the greatest paradoxes of the history of psy- as an archeology of psychoanalysis” (p. 130.) choanalysis is that its institutions have devel- For Dean & Lane (2001) this characterisation, oped normalizing moralistic and discriminatory which makes it look “as if the book were really practices that are antithetical to psychoana- all about psychoanalysis” (p. 8), also high- lytic concepts. This is sad because Freudian lights the fact that today we cannot think of and Lacanian psychoanalysis could make a sexuality without using psychoanalytic catego- valuable contribution to the field. Their theories. In the case of transsexuality, then, the ries study sex, sexual identity and sexuality, interrelatedness with psychoanalysis is not articulating ideas about the complex relation- just referential, as we will see. ship of the body to the psyche, the precari- ousness of gender, the instability of the oppo- The term transvestite was coined by Magnus sition of male and female, the construction of Hirschfeld in 1910 to describe those who occa- sexual identity, the challenges of making a sionally wear clothes of the ‘other’ sex. Hirsch- sexual choice, and the uncertainties of sexual- feld, a passionate sex reformer and an activ- ity, that is, the conundrum of sexual differ- ist, struggled for the legalisation of homosexu- ence. Such contributions could have important ality. He was also an occasional cross-dresser implications for transgender theorists and ac- himself and a central political figure in Ger- tivists, transgender people, and professionals many’s incipient field of sexology. Hirschfeld in the trans field by enriching current debates developed a theory of sexual intermediaries, about gender and sexuality. Dean (2000) contending that the existence of two opposite opened the ground for a fruitful engagement sexes was an oversimplification and that one with the theoretical contribution of psycho- could observe many varieties of intermediates. analysis, a development that has been obfus- A pioneer advocate for transgender people, he cated by the psychoanalytic institutions: “the argued that transgenderism could not be re- institutional history of psychoanalysis, particu- duced either to homosexuality, fetishism, or to larly in the United States, has forestalled any any form of pathology. Hirshfeld’s classic book such alliance. As I’ve already suggested […] Die Transvestiten. Eine Untersuchung über such an alliance might require both parties to den erotischen Verkleidungstrieb mit umfan- renounce some of their most cherished shib- greichem casuistischen und historischen ma- boleths” (p. 226). terial (1910) was translated only eighty years later, in 1991, as Transvestites: The Erotic To further contextualise our discussion, let us Drive to Cross-Dress. Notably, its title contains take a rapid look at some canonical definitions a word that belongs to basic psychoanalytic

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nomenclature: drive. The choice of term re- served that some transvestites were asexual veals an engagement with psychoanalysis, (automonosexual was his term); the asexual even if the sense is different. In fact, Hirshfeld group eventually led to the 1950s classifica- played a main role in the early days of psycho- tion of transsexual . Hirshfeld broke new analysis, publishing a number of analytic pa- ground proposing that transvestism was a pers. Freud’s own article ‘Hysterical Fantasies separate sexual variation different from fetish- and Their Relation to Bisexuality’ (1908) ap- ism and homosexuality. Let us note, however, peared in the very first issue of Hirschfeld’s that as a clinician and researcher, Hirschfeld new journal exclusively devoted to sexology as never wavered in his belief in a biological a science, Zeitschfrit für Sexualwissencraft . (endocrinological) basis for sexuality and thus Subsequent issues published original work by was not opposed to Eugen Steinach’s experi- Alfred Adler, Karl Abraham, and Wilhem Stekel mental testicular transplants to ‘treat’ male (Bullough, 1994, p. 68.) homosexuality.

Furthermore, Hirschfield co-founded with Karl Moving on from Hirschfield, perhaps the most Abraham the Berlin Psychoanalytic Society in influential post Freudian psychoanalytic theory August, 1908 (Gay, 1998). In 1911, at the of transgenderism was put forward by Wilhelm third international Weimar congress of psycho- Stekel (1930). He coined the term paraphilia analysts, Freud greeted Hirschfeld as an hon- for unusual sexual behaviors. Stekel’s book ored guest and a “Berlin authority on homo- Sexual Aberrations: The Phenomenon of Fet- sexuality” (Bullough, 1994, p. 64). Yet even ishism in Relation to Sex (1930) makes explicit with this recognition, Hirshfeld left the Berlin in its title the wish to systematise the struc- Psychoanalytic Society shortly after the Wei- ture of all sexual deviations as a single entity mar meeting, despite Abraham’s “attempts at under the model of fetishism. The book, how- persuasion” to stay (Falzeder, 2002, p. 139). ever, included a chapter on transvestism writ- Hirshfeld’s departure had been precipitated by ten by Emil Gutheil. For Gutheil (1930), even “an external cause” (p. 139) also described by though transvestism was not fetishism, it was Abraham as “a question of resistances” (p. a compulsion to create a phallic female: the 140). It seemed that Jung had objected to his attraction for the genitals of the ‘other’ sex homosexuality (p. 141.) Unlike Jung, Freud was transferred onto the garments. Stekel is a did not seem to mind Hirschfeld’s political ac- good example of how a former devoted disci- tivism. Freud saw Hirshfeld’s advocacy of ho- ple modified Freudian theories and popular- mosexual rights as a positive development ised them, and in so doing erased all nuances and from the beginning he had encouraged by bringing them closer to the dominating Abraham to work with him (Gay, 1998, p. medical model. As Bullough (1994) puts it, 181.) After losing Hirshfeld, the Berlin Psycho- “Freud cannot be blamed for the excesses of analytic Society decided, at Abraham’s instiga- his disciples” (p. 90). During the first half of tion, to work collectively on Freud’s Three Es- the twentieth century, in order to solve the says on the Theory of Sexuality. The irony is problem of the mind, most post-Freudians that the Three Essays owe a lot to Hirschfeld’s inevitably relied upon the notion of the trau- research (Freud, 1905, p. 1, credits in the matic effect of childhood experiences. Castra- opening page the “well known writings” of tion anxiety accounted for a psychobiological Hirschfeld along with other eight authors etiology of transgenderism often confused ranging from Krafft-Ebing to Havelock Ellis, all with homosexuality (Bullough, 2000). Cross- published in Jahrbuch für sexuelle Zwischen- dressing continued to be understood accord- stufen, a journal under Hirschfeld’s direction). ing to Gutheil’s theories as an attempt to over- Hirschfeld’s empirical data revealed that trans- come the fear of castration, creating a phallic vestites included both men and women who woman and identifying with her (Lukianowicz, were homosexual or bisexual as well as, con- 1959). trary to popular belief, heterosexual. He ob-

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Psychoanalytic vs Biological member of the opposite sex (Cauldwell, Accounts 1955.) Cauldwell is usually mistakenly credited as the first person to use the word transsexual The word Transexualis was first used in the but rarely quoted in the academic literature popular journal Sexology in a 1949 article by (except for Meyerowitz, 1998, p. 168-170, and David Cauldwell titled, in Latin, Psychopathia Stryker & Whittle, 2006, p. 40-52, who never- Transexualis . Despite the spelling with only theless caution the reader against his exces- one ‘s’, the term echoed Krafft-Ebing’s book sive pathologizing, p. 40; see also Ekins & Psychopathia Sexualis ([1886] 1965), the King 2001b). monumental catalog of the ‘aberrations’ of sexual behavior (when it deviates from the Caudwell’s role as populist column writer of sacred aim of procreation.) Cauldwell, not so tabloid sex advice warrants a comment. As much a scientific writer but rather a hyperbolic Stryker & Whittle (2006) observe, Cauldwell’s populariser and sex educator, believed in a quasi scientific work is worthy of note because biological etiology for transsexualism, which it reflects the earlier positions of Krafft-Ebing, he considered pathological. He just added the Hirschfeld, and Havelock Ellis while it antici- biological component to the old psychoanalytic pates the contributions of future transsexual- formula of childhood trauma: when a genetic ism experts like Robert Stoller, Richard Green, predisposition was combined with a dysfunc- John Money and Leslie Lothstein (p. 40). Most tional childhood, the result was the immaturity of Cauldwell’s popular booklets were published that produced a “pathologic-morbid desire to by E. Hadelman-Julius, an American publisher be a full member of the opposite who reached a substantial readership with a sex” (Cauldwell, 2006, p. 40.) It is often noted sure formula—“sex, self improvement, and that in 1923, Hirschfield had used the German attacks on respectability and religion” (Elkins term seelischer Transsexualismus & King, 2001a). Cauldwell’s position as a (psychological transsexualism), attributing populariser serves also as a cultural barome- transgenderism to the psyche. By 1949, ter—being a medical practitioner, he devel- Cauldwell described ‘transsexuals’ as oped a substantial second career explaining “individuals who wish to be members of the transgenderism to the masses, a prurient mat- sex to which they do not properly belong” (p. ter at the time, but also a subject which ac- 275). Cauldwell also coined the term sex cording to Hadelman-Julius’ winning recipe transmutationist (1947; 1951, pp. 12–16) and was seen as transgressing but also as self im- used both the spellings trans-sexual and provement. Cauldwell’s post second world transsexual interchangeably (1950). war switch to a somewhat more liberal attitude towards sexual matters, then, perhaps Cauldwell’s ([1949] 2006) initial position was reflected a new climate of more honest public at best problematic since he described trans- discussion over sex (as exemplified by the sexualism as a hereditary condition of indi- Kinsey studies). viduals who are “mentally unhealthy” (p. 275). By 1950, Cauldwell had obviously turned a The word transsexualism then became a corner: “Are transsexuals crazy? One may as popular term in the 1950s thanks to sex- well ask whether heterosexuals are crazy. change pioneer Harry Benjamin. Benjamin Some are and some are not. Some transsexu- was a Berlin endocrinologist who relocated to als are brilliant. Now and then one may be a New York in 1915. He had worked closely with borderline genius. Transsexuals are eccentric. Eugen Steinach, the gland specialist innovator Some of them are not of sound mind, but this who performed the first sex change surgeries th is true of heterosexuals” (p. 4). But still he by gland transplants in the late 19 century strongly advised against ‘sex change surgery’ and isolated the ‘sex hormones’, and knew on account of ethical and practical reasons, Hirschfeld, the sex reformer, from before the claiming that surgery could not make a ‘real’ war. Benjamin relied on a biological concept to

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account for the etiology of transsexualism, greater degree of constitutional femininity, despite the fact that he could not find any perhaps due to a chromosomal sex distur- bodily confirmation for this claim. Notably, bance, must be assumed” (pp. 228–229). Benjamin advocated against psychotherapy. Benjamin borrowed Ulrich’s formula of a fe- Following British sexologist Havelock Ellis’ con- male soul trapped in a male body, all the while tentions that travestism (which Ellis renamed looking for answers in the body, not in the eonism) was not an erotic impulse but an ex- soul: “the soma, that is to say the genetic pression of the real self, Benjamin proposed a and/or endocrine constitution ... has to pro- continuum of transgender behavior with cross- vide a ‘fertile soil’ in which the ‘basic conflict’ dressing on one end, and transsexualism on must grow in order to become the respective the other. For transsexuals, Benjamin (1954) neurosis” (Hausman, 1995, p. 122). Despite reiterated that therapy was of no use. He was the use of the term neurosis , Benjamin (1954) also not naïve, admitting that for a male-to- discouraged any psychoanalytic or psycho- female transsexual surgery “may not always therapeutic intervention, seeing these as “a solve [the transsexual’s] problem. His femini- waste of time” (p. 228). Benjamin argued that zation craving may never end” (pp. 228–229). psychoanalysis did not lessen the wish to He also warned against performing sex reas- change sex but rather forced patients to hide signment on patients with psychosis or who this desire and therefore live miserable lives. were in danger of suicide or self-mutilation. As his close collaborator Hamburger (1953) The conclusion to this paper is quite revealing put it, “it is impossible to make a genuine for its contradictions: “Transsexualism is inac- transvestite [transsexual] wish to have his cessible by any curative methods at present at mentality altered by means of psychother- our disposal. Nevertheless the condition re- apy” (pp. 392–393). quires psychiatric help, reinforced by hormone treatment and, in some cases, by surgery. In Following the significant media impact of this way a reasonably contented existence Christine Jorgensen’s 1952 successful sex may be worked out for these pa- change, Benjamin chose to share publically his tients” (Benjamin, 2006, p. 52) opposition to the psychoanalytic treatment of transsexuality at a symposium of the US Asso- According to Benjamin, then, transsexualism is ciation for the Advancement of Psychotherapy, both “inaccessible by any curative methods” a professional organisation created for the and yet requires specific treatments like psy- development of psychotherapy in the medical chiatry combined with hormone treatment and field. This was a symposium that Benjamin surgery. Did this mean that although incurable himself organised and was attended by an it was still considered a pathology? In any audience mostly composed of professionals in case, Benjamin considered that if psycho- the “psy” field (Meyerowitz, 2002/2004, analysis and psychotherapy could not cure pp.106-107). The landmark 1954 paper that transsexualism, they could not explain it ei- came from this, published in the American ther. Meyerowitz (2002/2004) observes that Journal of Psychotherapy , became one of Benjamin emphasised the biological aspect of transgender studies’ touchstones, as it spelled transsexualism, which explained for him the out the distinction Benjamin was establishing failure of psychotherapy in treating the condi- between the transvestite (psycho-somatic) tion and justified a surgical intervention. Ben- and transsexual (somato-psychic) phenomena. jamin maintained a very negative bias against Physical bisexuality was the point of depar- psychotherapy and psychoanalysis but created ture. Benjamin (1954) wrote: “Organically, sex a protocol for sex change in which psychia- is always a mixture of male and female com- trists were given the power to determine who ponents”, but he suggested that mild cases the potential candidates for surgery were; (transvestism) could be “principally psycho- psychiatrists had the final word on the treat- genic”, while for true “transsexualists” “a still ment decision but no say on the diagnosis. As

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Hausman (1995) observed, “this illustrates the Who’s To Blame? ambivalent relation between the mental health specialist and the clinical endocrinologist in By 1968, Stoller, always a believer in bisexual- the treatment of transsexualism” (p. 124). The ity, had completely moved away from a bio- fact that Benjamin’s choice of treatments af- logical model to a psychological one and em- fected and transformed the body (surgery, phasised the psychological forces that resulted hormones), foreclosed a consideration of what in transsexualism. Stoller was mainly inter- may not be fully anatomical, as if the seeming ested in male transsexualism, which he con- efficacy of the interventions on the organism sidered a “natural experiment” (Stoller, 1975, would preclude any consideration of other p. 281) to measure variables in the develop- issues involved in the transition of sex. ment of masculinity and femininity, but also a pathology of psychosexual development Another collaborator of Benjamin, the Ameri- caused in early childhood by “excess merging can psychoanalyst Robert Stoller, helped es- with the mother” (p. 296). He recommended tablish a pioneer sex change clinic in the early “‘sex-change’ surgery” for patients properly 1960s, the Gender Identity Center at UCLA, diagnosed as transsexual, requesting from his which developed an influential notion derived colleagues that “everything should be done to from John Money’s 1950s new vocabulary of assist them in passing” (p. 279) and was quite gender by introducing the idea of an humble about the goals of his treatment. Stol- ‘environmental’ psychological sex separated ler opposed any attempt at “converting” male from the biological sex, and which took pains transsexuals into masculine, heterosexual or to offer a distinct transsexual psychic struc- even less feminine people, because “the treat- ture. (Meyerowitz, 2002/2004, p. 114, Millot, ment of the adult transsexual is palliative; we 1990, pp. 49-59). Money in fact further devel- must bear this and not, in our frustration, im- oped Kinsey’s explanation of sexual behavior patience, or commitment to theoretical posi- as the result of “learning and condition- tions, fail even to provide that much comfort ing” (Kinsey et al., 1953, pp. 643-644) and to our patients” (p. 280). proposed also a behaviorist model for what he called ‘gender roles’ (Money, 1955). Stoller Yet despite his efforts at contributing to psy- further refined the notion of a separation of choanalytic theories of sexuality, and perhaps sex and gender with the idea of ‘core gender because of the fact that he believed that identity’, which corresponded to the internal- transsexualism was a petri-dish for human ised idea of the individual’s belonging to a par- sexuality - a “key test, in fact the paradigm ticular sex. Stoller initially supported the idea for Freud’s theories of sexual development in of a biological force, a drive determining gen- both males and females” (Stoller, 1975, p. der. ‘Gender identity’ stressed more the sub- 297) - Stoller developed a simplistic explana- jective experience of gender and separated tion with psychological overtones that he gender from sexuality. Based on the convic- summed up in the formula: “dominant mother, tion of a distinct identity and the importance father pushed to the side, infant cuddly and of the penis, Stoller systematised a distinction lovable, mother-son too close” (p. 193). In between the transsexual, the transvestite cases of male-to-female transsexualism, the (cross-dresser), and the effeminate homosex- key was an essential femininity passed from ual. He noted that in contrast with transsexu- mother to son: “What his mother feels is femi- als, transvestites and male homosexuals iden- ninity; what he feels is femininity” (p. 204). tify as men; transsexuals abhor the penis, The model was one of mimetic imitation: The which for transvestites and homosexuals is an son copied the mother; the mother’s excessive insignia of maleness and a source of pleasure closeness to the son was considered to be a (Stoller, 1975, pp. 142—181). negative influence. Stoller also talked about a bisexual mother, who might have had a period of extreme tomboyishness, and of a distant

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father. These were factors contributing to the the Rhetorics of Materiality . Similarly, Shanna creation of transsexuality, especially male to Carlson (2010) has proposed a collaboration female. For female-to-male transsexuals, Stol- between discourses, observing that Lacanian ler’s speculations can be rendered as “too psychoanalysis can offer “a richly malleable much father and too little mother masculinizes framework for thinking through matters of girls” (pp. 223–244). Importantly, Stoller sex, subjectivity, desire, and sexuality” and stated explicitly that female transsexualism is that “integration of the two domains can only not the same condition as male transsexual- ever be a scene of fruitful contestation” (p. ism, stressing that female and male transsex- 69). I too have argued elsewhere (Gherovici, ualism are clinically, dynamically, and etiologi- 2010; 2011) for a productive confrontation cally different (pp. 223-244.) between psychoanalysis and transgender discourses and have shown how transgender After Stoller, many psychoanalytic theories of people are actually changing the clinical gender identity development blamed gender praxis, advancing new ideas for the clinic that trouble on identifications with the ‘wrong’ par- can be expanded to social and intellectual ent (Coates, Friedman & Wolfe, 1991; Stoller, contexts. 1975; Lothstein, 1992.) And most psychoanalysts proceeded to view transgender expres- One wishes that psychoanalysts would have sions as an indicator of underlying pathology by now abandoned the moralistic and stigma- — be it a precursor of transvestism or homo- tising attitudes of previous generations of cli- sexuality (Limentani, 1979), borderline disor- nicians who, puzzled by the transgender phe- ders (Green, 1986), narcisistic disorders nomenon, could barely disguise in their dis- (Oppenheimer, 1991, Chiland, 2003) or psy- paraging comments their fear and contempt. chosis (Socarides, 1970, 1978-1979). Under- Candidly, Leslie Lothstein (1977) wrote a pa- standably, feeling relegated to the realm of per advising analysts on how to manage the pathology and abjection, transpeople rejected negative counter-transference he anticipated psychoanalysis. Ethel Spector Person & Lionel they would experience with transsexual pa- Oversey ([1974] 1999) have discussed in their tients. This situation seems to confirm Lacan’s now classic text the reasons behind the unwill- (2006) observation that “there is no other re- ingness of transsexual patients to participate sistance to psychoanalysis than the ana- in treatment. They concluded that it was in lyst’s” (p. 497). Nonetheless, several psycho- great part created by the judgmental stance of analysts have worked with transgender pa- those conducting the treatment. Nearly all of tients raising interesting clinical questions, the patients they interviewed described their such as Collete Chiland (2000), Danielle Qui- experiences of therapy in terms ranging “from nodoz (1998), Michael Eigen (1996), and Ruth useless to catastrophic” (p. 143). In most Stein (1995). The number of people raising cases, the intense negativism resulted from such questions is quite small, which is quite the clinician’s propensity to judge the patients remarkable since t ransgender people appear as psychotic and to dismiss the transsexual increasingly visible in today’s society. Accord- wish as delusional. ing to Stephen Whittle (2006) “trans identities were one of the most written about subjects Transsexualism and Castration in the late twentieth century” (p. xi). As a result, p sychoanalysts have a lot of catching up Taking up recent theorisations in the trans- to do. gender and transsexual fields, Gayle Salamon (2010) has eloquently called for a reappraisal In 2005, Shari Thurer, a psychoanalytically of psychoanalytic discourse, putting forward a trained psychologist practicing in Boston, tried sophisticated approximation of psychoanalysis, to wake up her colleagues whom she de- phenomenology, and transgender studies in scribed as “arrested in moth-eaten bias—the her book Assuming a Body: Transgender and conviction that there are two, and only two,

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normal versions of gender…” announcing that they slip on their wives’ panties. Gender ter- “sexuality has changed—all sorts of deviations rorists are those who, like Ms. Millot, bang have been ‘outed’—but theories haven’t their heads against a gender system which is caught up” (p. xi). While she accuses psycho- real and natural; and who then use gender to terrorize the rest of us. These are the real logical theorists and practitioners of displaying terrorists: the Gender Defenders (Bornstein, archaic prejudices, Thurer (2005) praises 1994, p, 236). theorists of sexuality - especially French cultural theorists “who leapfrog 180 degrees Is Bornstein’s accusation of gender terrorism away from hierarchical thinking, who view justified? Millot’s interpretation of transsexual- sexuality as okay” – but suggests that despite ity is classic: her essay Horsexe mainly fo- all their political correctness seem to “lack cuses on the motivations behind the demand common sense and are insensitive to people for a sex change to determine which subjects in pain” (p. xi). Maybe an example of the may benefit from sex reassignment surgery cross-pollination she hopes for may come and which may not. She contends that the from the other side of the Atlantic, where Gio- demand for surgery needs to be interpreted vanna Ambrosio (2009), an Italian classically before being actualised. No predetermined trained psychoanalyst, assumes that analysts norm, she suggests, could generalise the par- already work with gender nonconformist ana- ticulars of a subjective motivation: lysands but may not write about it. She ac- knowledges that “we are behind the times The feeling of being a woman trapped inside compared with the growing amount of medi- a man’s body (or vice- versa) admits radically cal, political-sociological, cultural, and mass different interpretations, depending on the media attention paid to this theme” (p.xvi) context. In the same way the demand for and invites her colleagues to pay more atten- sex-change ... may also emanate from a tion to the links between psychoanalytic the- woman hypochondriac (this has been en- ory and clinical experience even when that countered) who claims to be a transsexual in order to have her breasts removed because implies looking at “shaded areas” of sexuality she is afraid she may be affected with can- (by which she meant transgenderism) (p.xiii). cer, or from a hysteric who sacrifices herself to the power drive of the doctor willing to Casting light into the dusty corners of our as- perform the operation (Millot 1990, p. 26). sumptions about sex, gender and identity, one would hope that psychoanalysts will increas- Millot argues that sex change discourse has ingly refuse to buy into sweeping generalisa- promised cross-gender identifications that tions and negative stereotypes. Perhaps we were motivated by something that could not can break out of pointless debate between the be seen or imagined - a place beyond sexual foundations of sex and gender, the age-old difference where gender would not be simply debate of nature versus nurture, of biological questioned or subverted but completely tran- essentialism versus social constructivism. scended. She claimed that those subjects Charles Sheperdson (2000) relies on the work identify with an ‘outside sex’, and that any of Lacanian psychoanalyst Catherine Millot to genital change due to sex reassignment sur- contend that the body cannot be reduced to gery was likely to fail since no anatomical neither “a natural fact nor a cultural construc- transformation can grant a fantasized position tion” (p. 94). Of course Sheperdson’s choice of beyond lack and desire. Yet, as Dean (2000) author to support this claim may elicit a cry of notes, if reassignment surgery involves a fan- alarm because Kate Bornstein considers Cath- tasy about escaping sexual division altogether, erine Millot a gender terrorist: “[t]here is a fundamental paradox, not to mention considerable pathos, in a male-to- Gender terrorists are not the leather daddies female transsexual’s undergoing orchidec- or back-seat Betties. Gender terrorists are tomy—surgical removal of the testes—in order not the married men, shivering in the dark as to elude castration” (p. 82). Millot contended

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that the identification ‘outsidesex’ was in fact The plot of Transamerica (Tucker, 2005) con- an imaginary identification with the phallus, an firms the supposition that transsexualism is identification that can be reflected in the pre- bound up with symbolic issues hinged around occupation of transsexuals with their genitals. paternity. Bree can only truly become a I agree with Patrick Califia’s (1997/2003) ob- woman after she has faced the impossible jection that “Millot seems obsessed with cas- task of being a father and honestly grappled tration” and that she “sees sex-reassignment with it. That she fails does not contradict this surgery in simplistic Freudian terms, as castra- idea, for being a father is to fail, but her or- tion. She focuses on the loss of the penis, deal has been experienced and not avoided. whithout taking into consideration what is The happy ending places both characters in a gained in the process” (p.109). Indeed, Mil- comfortable marginality, sharing a beer; it is lot’s contribution is centered around the trans- only a matter of years before they both will be sexual’s appeal to medical practitioners for fully accepted by society. Here, the function of hormonal and surgical modifications of the the transsexual demand is crucial. Bree needs body. She analyses the sex- reassignment de- to undergo symbolic castration before being mand in order to address the clinical chal- able to qualify for sex reassignment surgery. lenges of distinguishing which candidates may After she has gone through the symbolic hur- benefit from the surgery and which will not. dles, with all the uncertainties and limitations they entail, Bree’s demand appears not as With the problems associated with Millot’s the- addressed to an absolute Other who would sis in mind, it is worth examining Trans- complete her or reducible to hysterical avoid- america (Tucker, 2005), one of the many re- ance of her sexuality. With these qualifica- cent films devoted to transsexualism, and per- tions, she does, indeed, make an ethical haps the most successful in that it offers a choice. Of course let us keep in mind that cas- mainstream version of ‘cases’ relatively invisi- tration is, as Verhaeghe (2009) observes, “a ble before. Bree Osbourne is a preoperative, secondary and even a defensive elaboration of conservative-looking, male-to-female trans- another, primary anxiety” (p. 41) and that sexual who is about to obtain the recommen- anxiety refers to being reduced to the object dation letter for sex reassignment surgery of enjoyment of the (m)Other. Notably, Freud from her supportive therapist when she learns observed that castration threats come more that, unbeknownst to her, when she was still often from the mother than from the father Stanley, she had fathered a son, now a teen- (Freud, 1924, p.174.) In Lacan’s theory cas- age runaway addict hustling on the streets of tration is the limited structure that permits New York. The plot is full of twists and impos- subjects to cope with the anxiety caused by sible to synopsise. The road movie across the the drives and especially with the jouissance United States makes the unlikely pair of trav- stemming from their own bodies. This solution elers connect until Bree’s son, Toby, is is imperfect and it always causes symptoms. shocked to discover that the biological father This leads Lacan to affirm that there is no he idealised is none other than his traveling subject without a symptom. companion, this trans woman for whom he was developing a crush, a woman claiming to There is of course a paradoxical literalisation be hailing from a Christian religious sect ‘of of what psychoanalysis calls castration in the potential father’. Bree fails to reunite the some sex change practices. This is illustrated young man with her own past and biological in a gripping passage of Martino’s (1977) family as Toby runs away on discovering the memoir of a “painful life to live, a painful life truth. Bree has her surgery at the end, and to write” (p. xi). Martino describes a second thinks that she has failed with her son. The phalloplasty that seemed to fail; the first one film’s ending, however, reconciles them as was unsuccessful, and the neopenis had to be they accept each other’s differences: She is surgically excised. As the tip of his new penis now a woman, and he is a gay-porn actor. became black, rotted away, and necrotised, he

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had to sit in water every night to slowly cut considered either a treatment or a cure. My away dead tissue. He comments ironically: perspective follows Lacan’s later theory of the “Talk about castration complex! Psychologi- sinthome to rethink sexual difference. This cally this cutting was almost impossible for theory is a departure from the classical Freu- me, yet it has to be done” (p. 262). Mario dian theory of the Oedipus complex and even broke away from the increasing distress about from Lacan’s first formulations that insisted on the inadequate results of surgery when he the symbolic and the father. It departs as well came to the realisation that even if he wanted from a second period in Lacan’s work when he “a perfect phallus” he had to accept the im- would put the emphasis on the theory of fan- possibility of the wish. “So today I’m happy tasy and the object cause of desire. Lacan with what I have: a respectable phallus—three modified his whole position a last time in the fourths perfect” (p. 263). The phallus is a mid-1970s when he elaborated a new concep- prosthesis, even then an incomplete one, tion of sexuality, just before discussing Joyce’s three fourths perfect. This demonstrates that writings. which psychoanalysis calls “phallus” is not an object but an instance to symbolise the drives, Lacan gave a new twist to Freud’s Oedipus or fundamentally a signifier. Dealing with sex- complex when he reformulated it as evincing ual difference is a process that Lacan calls the domination of the Name-of-the-Father. sexuation and would be defined by a logic that Later, Lacan (2005) went beyond the Oedipus is condensed in Lacan’s dictum that “there’s complex and finally proposed the sinthome as no such thing as a sexual relationship” (Lacan, a way of reknotting in the psychic structure 1998, p. 57), meaning that feminine and mas- what had been left unknotted because of the culine are not mirroring opposites but two un- father’s failure. This applied above all to complimentary ways of failing to the questions Joyce’s case but could be generalised some- of sexual difference. Something has been irre- what. Since the sinthome is not a complement trievably lost. As Renata Salecl (2000) states but a supplement, it is a vehicle for creative in her introduction to Sexuation , for psycho- unbalance, capable of disrupting the symme- analysis sexual difference “is first and above try. The sinthome is what helps one tolerate all the name for a certain fundamental dead- the absence of the sexual relation/proportion lock inherent in the symbolic order” (p. 2). (Lacan, 1975, p. 45). Instead of grief and re- Furthermore, human sexuality is marked by a proaches for broken promises addressed to logic of discordance in which the phallus the Other as demands, the sinthome employs serves as “an empty signifier” (Barnard, 2002, the Name-of-the-Father as a way of naming, p. 10), a stand in for the impossibility to sig- as a path in the invention of new signifiers nify sexual difference in the unconscious. (Lacan, 1977). Lacan’s notion of the sinthome thus connected fantasy, demand, the system Beyond Castration of the symbolic, and the place of the real with the infinite possibilities that it allows for jouis- To return to Millot, then, it is in the inevitabil- sance. ity yet variety of symptoms that I mainly dis- agree with Millot’s generalised assumption With Lacan’s points in mind, I will mention two that most transsexuals are psychotic. Instead, of my analysands. At the age of 4, Lou was I argue for a depathologisation of transgen- made aware by her father that she was not a derism and thus differ from the position taken boy as she had believed so far, but a girl. by nearly all analysts. What I propose is an First, she thought that her father was mis- alternative to the usual psychoanalytic treat- taken, and that even if he was right and she ment of transgenderism. That is to say, trans- was now a girl, she would grow up and be- genderism should not be systematically de- come a boy later. Eventually, she accepted fined as pathology. If transgenderism is not that she might be a girl and remain one; thus, pathological, then a sex change should not be she acknowledged that there were anatomical

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differences between males and females. She sexuality is always defective, always errone- elaborated that she had to be a girl because ous because it is a classification system based she was missing an organ, an organ that she on an organ taken for a signifying instrument. hoped she would eventually grow. Lou took the phallus as a real object, not just as specu- The second example is from another of my lation, but as something directly linked to analysands, I shall call Ari. Ari is a biological anatomy. As a child, she thought that one day female who has had ‘top’ surgery (breasts the ‘error’ was going to be corrected. Chal- removed) and takes testosterone. Ari is ma- lenged by her father’s adamant disagreement nipulating his/her body to transform it into a on gender issues, she concluded that even if surface with an undecided readability: What s/ she was not yet a boy, she would become he wants is to pass as neither male nor fe- one, unlike her mother, who had chosen to male, thus rejecting altogether the phallus as become a woman. a signifier of difference. If, according to phallic signification, we write two sexes with one sig- Lou’s wish to defer her difference took the nifier, Lou denounces the aporia of sex by re- unexpected turn of sending back to her fusing to be seen as either. If the phallus is mother her own maternity: She decided to just a parasite, if it is just the conjunction of wait a little before the ‘top’ surgery that she an organ and the function of language fixed at a certain date, but it happened that it (speech). Ari elevates “the limp little piece of would take place just 9 months later. Lou’s prick” (Lacan, 2005, p. 15) to the status of art hysteria apparently worked in relation to the and supplements it, transforming physical ap- mother. This time, it was to give birth to her pearance into the art of divination. own body via an imaginary transformation that could put the father at some distance It is true that the phallus, often confused with since her surgery was something that the the limp little prick, is not much more than a mother openly supported and of which her signified of jouissance that sexual discourse father quietly disapproved. Lou’s hatred of her transforms into a signifier. Lacan’s dictum that body’s female characteristics suggests a re- ‘there is no sexual relation’ is another way of nunciation of her femininity, a renunciation saying that for the unconscious there is no that we can interpret as acting out the representation of the female sex, that the un- mother’s own hatred of femininity. Indeed, conscious is monosexual or homosexual; there Lou’s mother had had a first child while still a is only one signifier for both sexes, the phal- teenager, a boy who was born prematurely lus. The phallus refers only to phallic jouis- and died a few days after the delivery. Lou sance; other forms of nonphallic jouissance had identified with this dead child by becom- exist and can be experienced, although they ing the boy that was but could not be. remain outside signification. Sexual positioning is predicated on an ‘error’ that consists of tak- The wish to correct the ‘error of nature’ is of- ing the real organ for a signifier of sexual dif- ten observed in transsexual practices; it is the ference. The error is to take the phallus as a refusal to accept a sexual discourse that is signifier of sexual difference. This common built on an error, that of taking the phallus for error can be what the rectification proposed a signifier of sexual difference. As we have by some transsexuals is all about: “If you ascertained, the phallic criterion only accounts think that because I have a penis I am a man, for one sex. And, when this sexual discourse is that is an error; I can be a woman who has a foreclosed, the error is no longer symbolic, it penis.” Or conversely, “If you think that not becomes nature’s error and has then to be having a penis makes me a woman, this is an repaired in the real. Often, the demand for a error because I am a man without a pe- sex change is meant to rectify this error in the nis” (Morel, 2000, p. 186). And, they are ab- symbolic register by correcting the error in the solutely right, because for the unconscious real of the body. The paradox is that human somebody with a penis can be a woman or

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someone without a penis can be a man. Sex- One can see why her sinthome was neces- ual positioning is not based on organ attribu- sary: It was necessity itself. In Morris’ case, tion. The transgender phenomenon proves the sinthome has produced less a ‘woman’ that there is nothing natural that would direct than a ‘woman of letters’. Sex may have its us to the opposite sex. Sexual identity is a reasons but they remain unknown since sex- secondary nature. Since the unconscious has ual difference obstinately resists symboliza- no representation of masculinity or femininity, tion. This impossibility can produce a sin- we cannot speak with certainty in terms of thome. This sinthome is something that can- sexual identity of being a man or a woman, not be rectified or cured. The sinthome is a but only of an assurance, a happy uncertainty. purified symptom, it remains beyond symbolic representation and exists outside the uncon- Similarly, Dean (2000) observes that “it is not scious structured as language. In this sense, so important that the phallus may be a penis, the sinthome is closer to the real. Lacan or in Judith Butler’s reading, a dildo, as it is a reached the final conclusion that there is no giant red herring” (p. 14). As such, the phallus subject without a sinthome. Lacan’s conten- is clearly a misleading clue comparable to the tion that there is no sexual relation entails that use of smoked herrings to mislead hounds there is no normal relation, and therefore that following a trail. To pun somewhat on the the relationship between partners is a sin- phrase, I would like to suggest that the phal- thomatic one. lus is less a red herring than a ‘read’ herring— in fact, like gender, it is subject to interpreta- Here we can see, then, that Lacan, who was tion, and it will always be read like a text. Cer- the first psychoanalyst in France to work with tainly in some cases, writing about one’s a patient in gender transition, clearly distances transsexual transformation is of the order of himself from a traditional reading of Freud in the sinthome; there are many cases when the which sexuality would lead to an object of the transformation is reported as achieving a re- opposite sex. He remains close to Freud’s knotting of the three registers of the real, (1905) ‘queer’ early claims in Three Essays on symbolic, and imaginary. Then, the sinthome the Theory of Sexuality that we, as human shapes the singularity of an ‘art’, a techne that animals, are all bisexual (p.141) and perverts reknots a workable consistency for the sub- (p.160), a contention that been seen as a ject; this movement can best be evoked by promising meeting ground for the discourses saying that it moves the subject from a certain of gender studies and psychoanalysis contingency to absolute necessity. This can be (Carlson, 2010, p. 48). It is precisely in this clearly observed in Jan Morris memoir Conun- decisive text where Freud discusses at length drum (1974/1986). Morris describes her tra- and in detail the then experimental first sex- jectory as inevitable, predestined, as if the sex change surgeries by removal of sex- glands in change had always been bound to happen: animals and where he shares a piece of infor- mation one imagines quite shocking for read- I do not for a moment regret the act of ers in 1905: “It has become experimentally change. I could see no other way, and it has possible (E. Steinach) to transform a male into made me happy. ... Sex has its reasons too, a female and conversely a male into a fe- but I suspect the only transsexuals who can male” (parenthesis in the original, Freud, achieve happiness are those ... to whom it is 1905, p. 81) The discovery of sex-hormones not primarily a sexual dilemma at all—who offer no rational purpose to their compul- soon after was something on which Freud sions, even to themselves, but are simply himself had been working as early as 1896, as driven blindly and helplessly. ... We are the it can been seen in his letters to Fliess (Freud, most resolute. Nothing will stop us, no fear letters 42 and 44, March 1 & April 2, 1896; of ridicule or poverty, no threat of isolation, Moussaieff-Masson, 1985). not even the prospect of death itself (pp. 168–169). The technologies of gender modification have

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of course evolved in one century, even when however, seems quite different. He describes many of them were launched by pioneers like Freud as very serious, but says that they Steinach, but they are now grafted onto a dis- laughed briefly when Benjamin jokingly de- course of essentialist identity. For many trans- clared that a disharmony of souls might per- sexuals, starting as they do from a perceived haps be explained by a disharmony of endo- problem presented as a birth defect, the issue crine glands. Freud spoke of Eugen Steinach, is simply how to change their bodies to reach fully recognising the great value of his biologi- the ideal of being just the other sex. The ap- cal experiments. He told Benjamin that he parently infinite progress of surgery and hor- himself had undergone a Steinach monal treatments has lent credence to an ‘rejuvenation’ operation. The ‘rejuvenation’ ideal of bodily reassignment collapsed with a was, in fact, a vasoligation, and it had been new psychic holism. It is now possible to performed by a close collaborator of Steinach, change one’s gender on demand by specific Professor Kun, a chief urologist. In Benjamin’s interventions on the biology of sexuality. How- view, Freud was very much biologically ori- ever, developing sex change technologies that ented, and, in this sense, he [Freud] was not allow people to move more easily from one a Freudian: “... Freud asked me not to tell sex to another have highlighted a question anyone about his operation until after his that often remains unanswered: What makes death, and I have kept that promise. He also a man a man and a woman a woman? asked me if I had been analyzed. I mentioned my relative short analysis by Arthur Kronfeld Conclusion in Berlin. Freud warned me that Kronfeld had ‘a very bad character’” (Haeberle, 1985). What makes a man a man and a woman a woman is a question that has come to psycho- Thus, the sex change doctor and the psychoanalysis from hysteric patients. The position analyst met and had a friendly exchange that on bisexuality held by Steinach and Benjamin started with a lighthearted admission of psy- seems closer to a queer notion of sexuality in chic and endocrinal disharmony. Now here in which genders are placed in a continuum be- 2011 might be a good time to continue a de- yond a strict binary. Paradoxically, the liberal bate that was cut short by the widening dis- discourses of gender identity support a sort of tance between the two discourses, psycho- essentialism about gender identification. A analysis and the clinic of transsexualism. collaboration between psychoanalysis and transgender discourse would thus open the Author Note way for an alternative. Patricia Gherovici, Ph.D. is a psychoanalyst In one visit to Vienna by Harry Benjamin, a at Philadelphia, USA. She is the author meeting with Freud was arranged. According of Please Select Your Gender: From the Inven- to Pfaefflin (1997), Benjamin wanted to meet tion of Hysteria to the Democratising of Trans- Freud to consult him because of problems genderism (Routledge, 2010.) She is the win- with sexual potency. Freud suggested Benja- ner of the Gradiva Award and of the Boyer min’s erectile dysfunction was due to his la- Prize for her book The Puerto Rican Syn- tent homosexuality. Pfaefflin claims that this drome (Other Press, 2003). Email: short interaction between the two men re- [email protected] sulted in Benjamin’s permanent skepticism against psychoanalysis, if not a thorough dis- References like, which since then has been claimed to be a marker of many encounters of transsexuals Ambrosio, G. (Ed.) (2009). Transvestism, and their clinicians. transsexualism in the psychoanalytic di- mension London: Karnac. Benjamin’s own recollection of the encounter, Barnard, S. (2002). Introduction. In S. Bar-

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