The Tenderness of Gender Meets the Harshness of the Psychoanalytic Clinic

Commentary following Jean Wolff Bernstein’s “A Matter of Choice”, book review of Patricia Gherovici’s “Please Select Your Gender” (DIVISION/Review, Vol. 1, Fall 2011, pp.4-5)

by Oren Gozlan, Psy.D.

Historically, psychoanalysis has had a difficult time working with two experiences: homosexuality and transexuality.  The positioning of the two in relation to each other is evident in Gherovici’s recent book, which leans upon Freud’s short paper ‘The Psychogenesis of a case of Homosexuality in Women”. Wolff Bernstein feels that Gherovici keeps returning to the case of Sidonie/Margareth because it elaborates a contemporary question that is confronted by transsexuals; that of “situating oneself as man or woman”, a process which “ is directly connected with the symbolization of the law and castration” (Gherovici, p.185 in Wolff Bernstein, p.4). That a book on transexuality,a question of gender choice,starts from a paper on homosexuality, a question of orientation, perhaps point to a confusion in psychoanalysis between sex and gender and brings to bear a current political scene in psychoanalysis: must we choose between the transsexual and the homosexual?

Wolff Bernstein suggests that transsexual certainty “knowing what (they) are” places the transsexual solution closer to the psychotic structure because what it represents is “a delusional system that substitutes for the foreclosed name of the father”. (p. 5). She critiques Gherovici’s suggestion that some transsexual solutions may be less pathologically structured”, arguing that “there are moments in her (Gherovici) own argument where her desire to depathologize transexualism outweighs her clinical observations”. Wolff Bernstein “as if” assumes the possibility of neutral clinical observation purified of the analyst’s own natality, anxiety and defences. But her comments also raise a question regarding the role of the analyst in listening to patients. Do we listen with the attempt to help the patient adapt to larger social structures, which the analyst comes to represent, or do we participate in a creative construction of psychic space?  How relevant is the clinic in terms of understanding social structures and political life? Indeed, clinical observations are never neutral as they are already taken through defences, unconscious of the analyst. Analysis is a relation between two unconscious and the clinic enacts this tension between singularity and universality, unconscious desire and its prohibition which the analyst comes to represent.

Wolff Bernstein fails to consider in her insistence on equating transexuality with psychotic “certainty”  that no one escapes the imaginary of gender and that each analysis concerns the question “what is the state of this imaginary”, which is tied to the specificity of the unconscious. As Derbyshire (2010) warns: “Psychoanalytic interpretation must emerge from a dialogue with the patient and the dialogic relation of the speech genre that is the analytic exert a form of resistance to the wilder form of speculation, (p. 88)”.  And: “When wider cultural phenomena are taken as objects of psychoanalytic investigation however, that is, when such phenomena are read symptomatically , controls and reciprocity are lost, and the object becomes amenable to an unlimited semiosis: there is no resistance to meaning evoked by the researcher, who now acts as an untrammelled interpreter” (2011).

Gender poses a universal dilemma in a way that every signifier inherits the problem of meaning which is expressed through one’s narrative.  Analysis brings to light the way in which the imaginary of gender certainty and identification is tied, universally, to a whole strategy of childhood anxieties and repressed wishes. However, analysis also reveals the ways in which these elaborations are specific to each unconscious. In analysis there is a shaping of one’s narrative through an arrangement of screen memories, associations and words. Referring to the transsexual as a universal group leaves the place of analytic ethics and enters the discourse of psychiatry and psychology, which aims at stabilizing the object. To speak of “transsexual patients” assumes we know our object and that the object is external and unrelated to us.

Lacan (Ecritis, p. 33) warned against this very thing when he cautioned against approaching concepts in a “deadening way” and insisted on treating concepts analytically by dislodging them from saturated, incurred conscious meanings and reflecting on their “subjective foundation”. At the imaginary level identity is conceptualized as discursively constructed and a “soft assembly” (Harris, 2005) that gives expression to multiple identities.  However, I suggest that we stretch the imaginary by returning to an analytic conception of identity as itself multiple; split from the outset, and therefore a signifier for a deeper split in the unconscious.

Transsexuality represents universal aesthetical dilemma with this split, that is enacted in gender; a psychic space. The transsexual body evokes unconscious phantasies and, in turn, is structured by phantasies related to a universal enigma around embodiment of psychic difference. By referring to radical exceptions such as an Female to Male transsexual who is having a baby; or a Male to Female transsexual who is  hyperfeminine,  to suggest a rule about transsexuals as a group, Wolff Bernstein allies herself with the medical discourse that unlike the analytic discourse does not take heed of the specificity of the unconscious and the polymorphous nature of the drive.  I believe that such approach is linked to foreclosure of thinking which itself enacts the inherent trauma which gender attempts and fails to signify, that of misrecognition and unintelligibility. In other words, to treat transexuality with certainty also expresses a wish for unity and omnipotence. Pathologizing transexuality is suggestive of tremendous anxiety around the phantasy of the transsexual as wreaking havoc on ‘nature’, of transgressing the law.

In ‘Transsexual Surgery: A novel reminder and a navel remainder’ (2011) I have argued that  “The act of analysis itself can be described as the act of “becoming a subject in gender: creating desire out of a place of meaninglessness, rather than an incessant desire for hidden or forbidden meaning that the phantasy of castration conceals” ( p.5). Taking castration literally as a matter of gender, reveals a belief in ultimate satisfaction (which castration then is constructed as a disruption). Sexual difference is not a matter of accepting one’s biological gender but rather, taking a stance in gender.  The transsexual body, as any “body”, can function much like free association—a technique whose aim is not to arrive at a final truth.

Surgery as a form of writing on the body and narrating makes the body into a centre of memory that carries inscriptions of separation and as such a formation of a sense of an “I.” Surgery in itself becomes irrelevant to the question of pathology, because what distinguishes an Act from an acting out is not the activity but its ability to be enjoyed as lacking. Some transsexual subjects may indeed reside in this suspended place of creativity. They may “come enjoy the incomplete body in a way that gives expression to its accidental identifications that are an inherent aspect of desire’s polymorphous nature, yet may lean on these identifications as mythical embroidery or tress rather than a filler for the empty container that these identifications truly are” (Gozlan, 2011, p. 5). Through analysis, language and sexuality, can be as if “sutured” together and contained by what Lacan calls an “Act”—a transgressive move away from complete identification with the Other’s desire, to identification with lack. I suggest that an “Act” does not describe movement or a physical action. It refers to a signifying act that captures both certainty and doubt. It allows for desire but anchors it in a fleeting imaginary—an “as if.” It is both concrete and symbolic—a “thing” (e.g., a body) and its representation that does not completely let go of the unreachable and unintelligible kernel. I argue that, within the Lacanian framework, transsexuality can function as this “Act”—a way the subject inscribes difference to bridge the gap between lack and satisfaction, where the phantasy of the body’s imagined “wholeness” (its imaginary unity through gender) is linked with absence of the Other (e.g., there is no preordained meaning to femininity or masculinity)—a realization that there is no Other of the Other,” (Gozlan, 2011).

What changes in analysis is one’s relation to those childhood ties that become elaborated through one’s relationship to one’s body.  These changes can take many shapes. Indeed one assembles one’s narrative in a way that no longer attaches to certainty of origin but becomes a creation. The transsexual no longer says “I am an accident of nature/birth” but instead, takes authorship over one’s own decisions. The armature is rearranged and becomes a question of “how do I want to reply to the other”. The surgery may be an address to a different relationship rather than a hysterical place of certainty. Histories of transsexuals reveal that following surgery transsexual narrative does not represent a mere repetition of old material. Theirs is no omnipotent denial of history or a simple triumphant view of oneself as Real man. Rather, there’s a different relation to gender. In this way technology also help to create looser subjects or “soft assemblies” (Harris, 2005). Surgery is a solution to a society that is overly biological today. The biological /psychiatric is the new malady of the soul that can be addressed creatively. It requires psychoanalysis to question its own categories and its usage of these categories that re-establish themselves over and over again in a repetition that refuses to think or step out of the trauma of gender.

Freud tells us that we already “have it all”, in the unconscious and in the polymorphousness of the drive. However, Lacan reminds us that we do not have it all in language. Language is a consequence of internal limits to symbolization — the body presents us with an excess that is always outside language. Sexual difference then can be articulated in terms of desire, which is non-gendered. In the unconscious we are in search of a forever lost object, a non-existent fragment related to phantasied history of primal pleasure, an eternal failure that is a source of generativity. Gender as an imaginary, an ego defence against loss and a site of misrecognition, permits us to misrecognize our incoherence and deny our own lack. We may feel we are in possession of that which guarantees desire, or are the object of desire (be or have the phallus). In this way, any claim to gender is a phallic one, being feminine or masculine, not in a sense that the penis is a signifier (a metaphor for object ‘a’, with imaginary attributes) that connotes sexual difference, but rather a signifier  that is used to veil  sexual difference, that is, lack. We are all subjected to the Real.

The Real is veiled through the ego defence of gender identification that becomes centre stage to greatest hysterical and psychotic anxiety over transgression, unintelligibility and fragmentation. Wolff Bernstein’s concerns over transexuality disrupting women’s rights and wrecking havoc with nature exemplify the ways in which these anxieties are replayed in psychoanalysis in relation to gender. They also reveal the fact that no discourse, not even psychoanalysis, can escape its own trauma.


  • Derbyshire, Philip (2010).  Unlimited Semiosis: The Problem of Researching Culture Psychoanalytically in Tim Dean’s Unlimited Intimacy. Zeitgeist 5:87-99.
  • Gozlan, Oren. (2011). Transsexual Surgery: A novel reminder and a navel remainder, International Forum of Psychoanalysis vol. 20, No. 1
  • Harris, Adrianne (2005). Gender as Soft Assembly. Hillside, NY: Tap
  • Lacan, J. (2006). Écrits: The first complete edition in English (Bruce Fink, Trans.) (NewYork, Norton Press).
  • Wolff Bernstein, J. (2011). DIVISION/Review, Vol.1 No.3 Fall.

Dr. Oren Gozlan, C. Psych., ABPP is a registered clinical psychologist and psychoanalyst, Diplomate in Psychoanalysis with the American Board of Professional Psychology. He is the Chair of the Committee on Sexuality of the International Forum for Psychoanalytic Education. He acts as Treasurer for the American Board of Professional Psychology, Psychoanalysis in Psychology section (commencing in January 2013). Dr. Gozlan also serves as Director of Clinical Training and Professor of Psychology & Psychoanalysis at the Adler Graduate Professional School in Toronto and is also in private practice. Dr. Gozlan has published articles in the Psychoanalytic Review, International Forum of Psychoanalysis, European Journal of Psychoanalysis, and in Other/Wise, the on-line journal of the International Forum of Psychoanalytic Education. He is on the editorial board of Rodopi Press and is currently working on a book on transsexuality.

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