Transsexuality, psychosis and originary femininity: between psychoanalysis and feminist theory

Abstract

This paper analyzes the theorizations about transsexuality in order to discuss its inclusion in the field of psychosis. Many concepts about transsexuality, ranging from the DSM to recent theorizations by Lacanian authors, are critically investigated in a dialogue with feminist theory authors. The hypothesis put forward is that originary femininity plays a different role in transsexuality and in some cases of psychosis, leading to the conclusion that transsexuality cannot be classified as pathology a priori.

Keywords:
transsexuality; transsexualism; psychosis; femininity; psychoanalysis

Resumo

O presente estudo procura analisar as teorizações sobre a transexualidade, com o objetivo de problematizar sua inclusão no campo das psicoses. Várias concepções sobre a transexualidade, que se estendem desde o DSM até as teorizações recentes de psicanalistas da vertente lacaniana, são analisadas de maneira crítica através de um diálogo com autoras da teoria feminista. A hipótese defendida é a de que o destino dado à feminilidade originária é diferente na transexualidade e em alguns casos de psicose, conduzindo assim à conclusão de que a transexualidade não pode ser classificada a priori como uma patologia.

Palavras-chave:
transexualidade; transexualismo; psicose; feminilidade; psicanálise

Résumé

Cet article analyse quelques théories sur la transsexualité dans le but de soulever des questions sur son inclusion dans le champ des psychoses. Plusieurs conceptions de la condition transsexuelle sont prises en compte de façon critique. Cette analyse englobe des positions prises par les responsables de la publication du DSM et va jusqu’à des contributions plus récentes de la psychanalyse lacanienne et des auteurs féministes. L’hypothèse que l’on cherche à soutenir propose que le destin donné à la féminité originaire n’est pas le memme dans la transsexualité et dans certains cas de psychose, ce que mène à la conclusion que la transsexualité ne peut pas être a priori qualifiée comme une pathologie.

Mots-clés:
transsexualité; psychose; féminité; psychanalyse

Resumen

El presente estudio busca analizar las teorizaciones sobre la transexualidad, con el fin de discutir su inclusión en el campo de la psicoses. Varias conceptualizaciones sobre el fenómeno transexual, que se extienden desde el DSM hasta las teorizaciones recientes de psicoanalistas de la vertiente lacaniana, son analizadas en forma crítica a través de un diálogo con autoras de la teoría feminista. La hipótesis defendida es la de que el destino dado a la feminidad originaria es diferente en la transexualidad y en algunos casos de psicosis, lo que lleva a la conclusión de que la transexualidad no puede ser clasificada a priori como una patología.

Palabras clave:
transexualidad; transexualismo; psicosis; feminidad; psicoanálisis

Transsexuality: definition and clinical and statistical data

Transsexuality can be broadly defined “by the intense feeling of non-belonging to one’s anatomical sex, with no manifestation of delusional disorders and no organic bases (such as hermaphroditism or any other endocrine abnormality)” (Arán, 2006, p. 50, our translation).

In the definition of the DSM-IV-TR (which is not free of problems, as we will see later), four criteria are identified for the diagnosis of the so-called “Gender Identity Disorder.” We will start out from this definition to make a few comments:

There must be evidence of a strong and persistent cross-gender identification, which is the desire to be, or insistence that one is of the other sex (Criterion A). This cross-gender identification must not be merely a desire for any perceived cultural advantages of being the other sex. There must also be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex (Criterion B). The diagnosis is not made if the individual has a concurrent physical intersex condition ... (Criterion C). To make the diagnosis, there must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion D). (American Psychiatric Association, 1995, pp. 547-548, our translation).

This definition is interesting in that it summarizes the thoughts of several authors on the subject, trying to establish consensus and sparing the need to categorize transsexuality into any fixed clinical structure. It is also important to note that this definition does not restrict transsexuality to a specific type of experience with the body. In this sense, the DSM definition is in line with social criticism, such as that of Berenice (Bento, 2006, pp. 44-45), who, in her research with several transsexuals at Hospital das Clínicas de Goiânia, reports that few of the subjects fit the category she calls “official transsexual,” described by Stoller and which includes, in the case of female transsexuals⁶, for example, feelings of penis aversion.

The DSM-V, in turn, adopts the term “Gender Dysphoria” to account for phenomena related to transsexuality, explaining that the emergence of the term “gender” is due to the need to consider the role played in society by the sex with which the subject identifies. In addition, the new edition of the manual considers the possibility of a concurrent diagnosis of gender dysphoria and biological disorders of sex development - in this sense, gender dysphoria could also occur in subjects with innate intersex characteristics, thus prevailing the contradiction between the gender experienced and the gender assigned to the subject. From the clinical point of view, the other diagnostic criteria did not change significantly.⁷

However, the very fact that the DSM classifies transsexuality as a disorder or dysphoria suggests that its view is far from neutral: gender identity, in this sense, draws the boundary between normal and pathological. Thus, it is implied that, in such a definition, sex is seen as biological data and normality, therefore, is defined as the continuity between such biological data and gender. The clear split between sex and gender, present in the DSM definitions, therefore contributes to the preservation of a sex/gender system that intends to be universal and eternal, thus generating marginal exclusions and identities that become unintelligible within current normativity. By this we do not mean to reject the anatomical difference, but to confer on it a role other than that of a direct determinant of sex - this role will become clear in the course of our argumentation.

It is important to note that in most transsexuals, gender-related distress dominates their mental life. Even after surgery, such patients spend enormous amounts of time and energy trying to act according to the gender with which they identify. The gender theme thus becomes central in the lives of these people. (See, e.g., Stoller, 1982, American Psychiatric Association, 1995).

Regarding statistics, a very curious figure is recurrent in practically all surveys carried out around the world: the enormous discrepancy of the transsexual phenomenon regarding the male/female divide. In Australia, 1981 studies indicated a 6:1 prevalence of female transsexuals (male to female) compared to male transsexuals (female to male). In the United States in 1968, this ratio was 4:1. In Singapore in 1988, numbers point to a 3:1 ratio. Other statistics from countries such as Holland, England, Wales, Germany and Scotland corroborate this majority of male to female transsexuals (Saadeh, 2004, pp. 78-82). It is interesting to note how historical, cross-cultural and mythological data follow the same course: from Monsieur/Mademoiselle d’Eon, a French personage in the court of Louis XIV, to Tiresias of Greek mythology, from the Russian Skoptzy in the 18th century to India’s hijras, through American, Brazilian and African tribes, in almost all of these mythical and anthropological descriptions the reported cases are of men trying to become women (Teixeira, 2003; Saadeh, 2004). It is true that such prevalence in the description of female transsexuals also reflects the social invisibility of male transsexuals (Ávila & Grossi, 2010). However, the telling difference in these numbers goes beyond that observation, making us wonder what aspect of the formation of gender identity could explain it. We shall return to this question later.

In view of these data, for now one can affirm that transsexuality, being so absolutely dissymmetrical regarding the male/female divide, is, first and foremost, a phenomenon that, in most cases, opposes the phallocentric logic, according to which the phallus and the penis are understood as objects of desire and identification, whereas their absence can only be understood as negativity and deficiency. In the phallocentric logic, whose criticism will be developed throughout this article, no positivity other than the penis is considered, only its presence or absence. In short: in phallocentric reasoning, “having the penis” would be naturally better than “not having it.” In this sense, these surprising statistics of the transsexual phenomenon should not necessarily be understood as ignorance or denial of the symbolic value of the phallus, but as an inversion of the narcissistic values and the actual potential for satisfaction assigned to it. How, then, can we sustain the recurrent dualism of the positivity of the phallus versus the negativity of the “castrated” in the face of such data?

The controversial association between transsexuality and psychosis

Nowadays it is common to find works on transsexuality in which reference to Lacanian psychoanalysis links this condition more closely to psychoses (Frignet, 2002; Czermak, 1986; Millot, 1992; Teixeira, 2003; Lacan 1976/1996). Generally speaking, these authors’ formulations on transsexuality revolve around four main axes: 1) considering the “subjective certainty of being a woman imprisoned in a man’s body” (Teixeira, 2003, p. 44) as an elementary phenomenon of psychosis; 2) thinking of transsexuality as a psychosis (based on the hypothesis of the forclusion of the Name-of-the-Father) in which the penis is confused with the phallus; 3) understanding that such a condition emerges from (or is enhanced by) the incidence of the discourse of science and capitalism on the “formal envelope” of the psychotic symptom, and 4) postulating that in transsexuality, the imaginary acquires the same importance and meaning as in other psychoses.

We will present here a few aspects of the theorizations of two of those authors, Henry Frignet and Marina Caldas Teixeira, in order to locate the main points that define what we consider the prevailing Lacanian view, to then comment critically on that position.

Frignet, in his book Transsexualism (2002), denounces a pernicious mix of ideological and socioeconomic factors in modernity that works to exclude transsexualism from the category of pathology in order to mask it as a social phenomenon. The transsexual phenomenon would bring to the surface a mode of subjectivation based on imaginary processes, corresponding to the deletion of the real of sex by the illusion of gender:

This position [in which gender is adopted over sex] sanctions the abandonment of a concept of sexual identity founded on the interaction between the real and the symbolic. It replaces this concept with a grouping based on the mere recognition of an imaginary trait shared by all individuals in the group thus created: the group of transsexuals - in the image of the group of homosexuals and of several other contemporary groupings enrolled in the general category of the trans phenomenon. This imaginary mode of identification is not without consequences brought to light by psychoanalysis long ago. It relegates sex to the level of a simple characteristic, entirely disconnected from what constitutes, nonetheless, from the dawn of time, the essence of man, namely that speech, from birth, and even from conception, is a constituent part of the formation of sexual identity, and, as such, a consequence of the process of dimorphic sexual reproduction. It is their interaction with sex that allows a couple to produce not only a living body - what we could call, drawing on the Latin etymology of the word, “a person” - but a subject, a being endowed with speech and created by speech. (Frignet, 2002, pp. 91-92, our translation)

Thus, Frignet views the transsexual phenomenon as a threat to the phallic/symbolic order, which structures society and enables from communication among its members to the process of dimorphic sexual reproduction. The author also denounces that such a manifestation is only possible due to the “social negation of the difference of sexes, henceforth identifiable in our cultures” (Frignet, 2002, p. 16, our translation). In his attempt to explain the phenomenon, Frignet distinguishes what he calls “true transsexuals” from “transsexualists,” borrowing the latter term from Lacan. In transsexuals, the existence of sexual identity would be impossible given the foreclusion of the Name-of-the-Father, which would render them hors sexe, out-of-sex. Transsexualists, on the other hand, would have their sexual identity assured, and the impasse would arise at the moment of choosing one side of the sex divide. The phallus is recognized, but they would refuse to “align themselves, concerning their sexual enjoyment, on the male or female side” (Frignet, 2002, p. 18, our translation). Refusing to guide their choice by the symbolic, they would then surrender to the imaginary, the realm of appearance. For Frignet, the transsexualists would ultimately refuse to submit to the phallic order, which leads him to affirm “the vital importance of setting the limits imposed by the sexual real on the individual in his subjectivity and on the social body in its action: not everything is possible” (Frignet, 2002, p. 136, our translation).⁸

A genuine indignation transpires in Frignet’s text, as if he meant to say: after all, someone has to put an end to this cynical rebellion of those who insist on defying the phallic order. What is curious is that Frignet, in trying to explain to the lay reader (the book’s target audience) the importance and organizing power of the phallic signifier, resorts to the Freudian theory of the phylogenetic heritage of the identification with the primeval father, merely postulating that it is the ultimate embodiment of the father, taken as a phallic object, that is responsible for generating this primary identification to the father, establishing the effectiveness of the Name-of-the-Father and positioning the child in the symbolic order of the world, which will then interact with the real of his or her sex to create the sexual identity and the very condition of language (Frignet, 2000, pp. 107-108). For the author, this embodiment “concerns the phallus, the paternal object par excellence, since, in the register of the real, it is the father who has it” (Frignet, 2002, p. 108, our translation). In other words, it is about the embodiment of the paternal penis, an operation seen as primary by Frignet, which occurs in an extremely naturalized way. Such a formulation, in this sense, becomes problematic insofar as it supposes a single and universal model, based on a mythical fiction, necessary for the sexual identifications of subjects to ascend to the symbolic order. In addition, we may also consider, using yet another example, that Frignet seems to disregard the decisive factor of the mother’s participation in this process. All the characteristics of the mother or of her surrogate, such as her femininity, her perception of the baby’s needs, her greater or lesser empathy with the state of helplessness in which it finds itself, her conscious and unconscious desires related to it, her holding ability, her conflicts and ambivalent feelings towards it, etc., all of this must be stored in the imaginary and discarded for the benefit of what really matters: the organizing power of the phallus.

We will see later on how this concept of the phallus contributes to a true transcendental dimension bestowed on this signifier.⁹ However, we will first turn to the theorizations of Marina Caldas (Teixeira, 2003; 2006a and 2006b) on the subject.

According to the author, based on the teaching of Lacan we can highlight three clinical operators that explain the nature of “transsexualism:” the foreclusion of the Name-of-the-Father, the push-towards-Woman and the “common error.” Such elements would be catalyzed by the incidence of the discourse of science (with the isolation of hormones and transgenitalization surgery) on the formal envelope of the psychotic symptom, thus offering transsexual subjects a possibility of imaginary identification, namely surgery, which would obturate the need for each one to invent their own sinthoma. Let us see, point by point, the arguments about such clinical operators, to then make our critical comments.

The foreclosed Name-of-the-Father results in the non-submission of the subject to symbolic castration: the phallic signification is absent, causing the psychotic to be dislodged from the sex divide, i.e., out-of-sex. What is foreclosed from the symbolic, therefore, returns in the real: in the case of transsexuals, the foreclosed phallic signification would return in the real in the form of the passage to the act of surgery, viewed by the author as a mutilation in the real of the body (Teixeira, 2003, pp. 36-42 and 2006b, pp. 72-73). Once again, we express our disagreement with this view, but will develop our own interpretation of the phenomenon below. For now, let us focus on understanding the author’s line of reasoning.

The push-towards-Woman, in turn, according to Teixeira, is an “orientation of enjoyment that may occur in psychoses in response to the foreclusion of the Name-of-the-Father and to the absence of phallic signification” (Teixeira, 2006b, p. 73, our translation). In this female orientation of enjoyment what prevails is the specular register, typical of cases of paranoia. There is a disconnection between the image of the body and its matrix, and the push-towards-Woman characterizes an “actual complexion of the being towards the configuration of a ‘being of exception’” (Teixeira, 2006b, p. 73, our translation), which, in transsexualism, would acquire the form of the desire to be seen as a woman, which the author considers as proof that it is the imaginary that prevails in such cases. “The being of the [transsexual] subject, driven by this desire, would be but the victim of a performative image, literally a composition” (Teixeira, 2006a, “As soluções transexualistas”, para. 3, our translation) The desire for transformation into a woman, then, is seen by Teixeira as a product of the push-towards-Woman, and also as an elementary phenomenon of psychosis, given the “delusional certainty” that one is a woman imprisoned in a man’s body. The famous case of president Schreber, analyzed by Freud, would be for Teixeira an example of the push-towards-Woman, as affirmed by Lacan, who dubbed as “transsexual enjoyment” the libidinal satisfaction included in his delusion (Teixeira, 2006b, p. 67).

The following passage will help us follow the author’s line of reasoning on the subjects of phallus and the penis:

According to the logic of sexuation, what specifies the male/female sexual opposition, designated man or woman, would not be the organ itself [the penis], but the value of that organ as a utensil (instrument, signifier) in the phallic signification. Utensil because it lends itself, by its characteristics, to be taken, in the sexual discourse, for the signifier of the phallus, the sign of sexual difference: if the subject has the phallic instrument, then he is a boy; if the subject doesn’t have phallic instrument, then she is a girl... . In the sex divide, the subject is required to submit his or her position of enjoyment to the economy ruled by the phallic function. The transsexualist refused to submit his position of enjoyment to the sex mode. From his position of enjoyment, he does not accept this logic and denounces the universal order of the world, for he is sure to be a woman, despite the phallic instrument. (Teixeira, 2006b, p. 74, our translation, emphasis added)

One concludes from these considerations that, despite the use of the notion of utensil, the old dichotomy of the presence/absence of the penis persists as the defining element of sex. What, then, is the use of speaking of a utensil if what defines “utility” is the anatomical real of the organ? Curiously, a few pages earlier Teixeira comments on Stoller’s theory, affirming that it is totally wrong to consider biology as the definer of sex and that psychoanalysis, in turn, “did not fail to point out that sexuality would be an effect of the responses of each subject to the real of the sexes, and that the body would be but a subjective experience completely apart from the functionalist perspectives of the biological organism” (Teixeira, 2006b, p. 70, our translation). The contradiction is clear: Is there anything more functionalist than considering the use value of an organ? And is there anything more organic and biological than to base this use value on a biased understanding of the anatomical real of the body, namely the presence or absence of the penis?

According to Lacan, we all make the common error of confusing the organ with sexual enjoyment and with the very foundation of our sexual identity. Transsexuals, in this sense, also makes this common error, but in their anxiety not to be labeled by the phallic signification, they extrapolate (or take the error too seriously) and believe that by getting rid of the organ, they will get rid of “being signified phallus by the sexual discourse, which is impossible. They are even further mistaken in wanting to force the sexual discourse through surgery: it is a passage to the real” (Lacan, 1971, 8 Décembre, p. 7, our translation). After all, “although the subject may seem to be a woman, that is no more than a mirage” (Teixeira, 2006b, p. 75, our translation). For these authors, the transsexualist, in this sense, denounces the “order of the world, which makes the common error of confusing the organ and the phallus in differentiating the sexes” (Teixeira, 2006b, p. 75, our translation). We might ask, not without irony: If the “order of the world” (which we may view here as social normativity) makes the common error of inappropriately considering the organ as the basis of identity, would not it be desirable that someone denounce it? Would not such a denunciation ultimately point to the possibility of greater flexibility in identifications, which would no longer need to be bound to the illusion of an essence? In this sense, it is worth here to make a long parenthesis and show the consonance between this supposed denunciation of transsexuals and another theory that proposes to attack the common error, or the essentialization of the sex and gender categories, namely feminist theory, especially the ideas of Judith Butler.

The fallacy of naturalization, the “common error” and the performatic

Is the symbolic eligible for social intervention?

Judith Butler, in Undoing Gender

In an attempt at genealogical criticism of the notions of sex and gender, in the light of the ideas of Nietzsche and Foucault, Butler, in her book Gender Trouble, argues that both categories, rather than being considered as the origin and cause of identities, are actually the effects of discourses, practices and institutions “with multiple and diffuse points of origin” (Butler, 2003, p. 9, our translation). In trying to denaturalize the sex-gender pair, Butler speaks of the metaphysics of substance (in reference to Nietzsche) and warns that in most gender theories, sex is seen as substance, as something self-identical through time and history. Nietzsche had already denounced the fact that all metaphysics is essentialist because it fails to perceive the historical evolution of concepts and thus gives them a much longer lifespan than they should have. This would be the case with sex, since, for Butler, one cannot have a discussion of identity that is totally divorced from the discussion of gender identity, given the degree of naturalization and essentialization involving these constructs, which binds them together. In other words, in order to ascend to the status of human, a person must have a gender identity that is consistent with social normativity. In our culture, then, where heterosexuality is the norm and where sex, gender and desire must adapt to each other to meet the norm, the naturalization effect acquired by these categories is extreme. Thus, certain identities are excluded from the symbolic domain and assigned discriminatory categorizations. The cause of this naturalization effect is, therefore, linked to the metaphysics of substance alluded to by the author. As a consequence, “certain kinds of ‘gender identities’ appear only as developmental failures or logical impossibilities, precisely because they fail to conform to those norms of cultural intelligibility” (Butler, 2003, p. 39, our translation).

Lacan’s Symbolic Law, organized by the phallic signification, can also be included in this sense in the so-called metaphysics of substance, as Butler herself points out in saying that “the symbolic law in Lacan can be subject to the same kind of critique that Nietzsche formulated of the notion of God” (Butler, 1993, p. 14, our translation). Here, Nietzsche’s criticism can be compared with Lacan’s criticism of (Derrida, 1980) when he denounces the fact that the phallus becomes a transcendental signifier, chosen arbitrarily to be the only one capable of preventing the infinite sliding of signifiers and establishing the possibility of knowledge. “Phallogocentrism” (an amalgamation of phallus, logos and center) is the term coined by Derrida to classify the Lacanian symbolic that deletes the immanent character itself and its need for reiteration to exist. Resuming the transsexual issue, we can conclude that if the law is thus formulated as an immutable and transcendental structure, it cannot be modified without the threat of psychosis.

Therefore, sex and gender are not nouns, but effects that are performatively produced and imposed by cultural regulatory practices. There is no being behind the doing, and at every mention of the naturalization of gender or sex it is reiteratedly produced. No wonder these categories need to be infinitely reiterated in cultural discourses (such as a contract, for example, where the contracting party’s gender is required for no reason), because reiteration shows the need for control, control over something that totally eludes the cultural norms that aim to regulate how one feels pleasure, how one should be a man or a woman. In this sense, closely scrutinized, reiteration denotes precisely this nomadic character of desire. When, for example, a female transsexual mimics all the stereotyped phenomenology of a woman, she causes discomfort for exposing the denaturalized character of the impersonated woman. This relationship, Butler tells us, is not “as copy is to the original, but, rather, as copy is to copy” (Butler, 2003, p. 57, our translation). Such allegations, in a subversive way, may be related to the point of view of the abovementioned Lacanian authors, according to which transsexuals would be the victims of a mirage, a performatively constructed imaginary composition, with the impersonation of a woman who could never become an actual woman. Lacan, in 1976 at the Sainte-Anne Hospital Center, when interviewing a female transsexual who wanted to operate, makes this quite clear:

Jacques Lacan: You must know that one cannot transform a man into a woman.

Michel H.: It can be done.

Jacques Lacan: How? A woman has a uterus, for example.

Michel H.: Regarding organs, yes. But I’d rather sacrifice my life, not have children, have nothing, but be a woman.

Jacques Lacan: No, not even emasculation will make you a woman. (Lacan, 1976/1996, pp. 331-332, our translation)

We believe Butler would agree that the female transsexual is a mirage and is putting on a performance. However, for that author, the same is true for any other woman and also for all men: the real of the body is not the essence of nothing, but a construct on which significations will be performatively assigned.¹⁰ For authors like Lacan, Frignet and Teixeira, however, the real of the body, sometimes mediated by the notion of utensil, is what defines the sex. For our part, we believe that the anatomical difference matters in that it provides the caregivers of the baby with a hermeneutic matrix which, when associated with the cultural apparatus in which we live, indicates to them how to designate the gender of the child: a “he” or a “she.”

We must further emphasize what we consider a misconception of the cited authors, namely to consider that the subjective certainty of being a woman, in the case of female transsexuals, is an elementary phenomenon of psychosis. If we take as evidence of psychosis the certainty of belonging to one of the categories of the sex divide, a great problem emerges, for we must admit that the certainty of knowing one is a man or a woman is also present in all persons who are not transsexuals. In the same way that a female transsexual is sure she is a woman, Freud and Lacan, for example, were sure that they were men. Certainty about sex is also a “common error,” to use that term, and if it were a sign of psychosis we would all have to be diagnosed as psychotic.

Before finally turning to the proposition of our hypothesis, it is worth asking if the theorizations and reactions of these authors to the transsexual issue do not reveal an excess that goes beyond the concern to elucidate this problem clinically and theoretically. One thinks, for example, of Lacan’s undue confrontation with Michel H. in the interview at Saint-Anne (a confrontation that contradicts his own theory of clinical handling of psychosis), or Teixeira’s insistence on male names and addressing the female transsexuals she studied by their former male names, as well as Frignet’s exhortative opposition to the supposed category of “transsexuals.” Such excesses would have us speculating whether, in fact, they are not attempts by these authors to preserve the order of the world in accordance with their theory; a phallic and transcendental order, safeguarding the symbolic against any changes it might point to? Would not a true phallic moralism ultimately be at stake?

Originary femininity as a marker of the distinction between transsexuality and psychosis

Psychoanalysis carries with it the proposal to promote the freedom of human beings by expanding their knowledge of the unconscious. In this sense, the hypothesis of the non-correspondence between the drive and its object endows the latter with a variable character, subjecting it, among other vicissitudes, to the historical and social context of its time. The drive, understood as the impact of the sexuality of another in the psychic life of a new human being, has the precise role of diverting human beings from any kind of natural instinct and directing them towards the partial, the cultural, to what we ultimately understand as sexual. However, with the Oedipus model and castration, psychoanalysis also runs the risk of working in favor of a new social normativity, crystallizing concepts that could remain open to its own evolution. It is important, therefore, to handle this two-lane street and opt for proposals that are better aligned with this ethical-political implication of psychoanalysis (See, e.g., Arán, 2006, Laplanche, 1992, Deleuze & Guattari, 1976).

The crystallization of concepts in psychoanalysis prevents this area from being able to follow historical forms of subjectivation. As with the issue of transsexuality, we also see within psychoanalysis prejudiced positions towards homosexual parenting and marriage, always based on the symbolic value of the phallus, treated as immutable and transcendental. An example of such a discourse can be found in the words of the psychoanalyst Charles Melman, who criticizes the adoption of a child by a female couple:

Evidently, for structural reasons, that is, the fact that such a child will be - due to the parents’ homosexuality - completely detached from any phallic genesis that might concern it... will be placed in the sheer position of an object a. (Melman, 2003, pp. 65-66, our translation)

What transpires in such kinds of discourse is the difficulty arising from the confrontation of a theory whose underlying aspects intend to be ahistorical with the various ways in which subjectivities present themselves today. Flávio Carvalho Ferraz reminds us of the consequences of this type of reasoning in psychoanalysis, in which theory, symbolism and the phallus must be safeguarded from any change:

I believe that one of the consequences of this line of reasoning is that, in view of the structural changes affecting the family, the social roles of men and women, in short, the regulation of sexualities, new configurations can only be seen as perversion, delinquency or madness, since they elude the phallic logic of the analytic discourse and therefore automatically align themselves with psychotic or perverse structures. To simplify: the world is going wrong and psychoanalysis remains right in its diagnostic power, of both people and culture. (Ferraz, 2008, “Perspectivas críticas”, para. 4, our translation, author’s italics)

Opposing this phallic moralism which we have just denounced in the above-cited authors, we can recognize in an alternative psychoanalytic trend a different process, related to the growing importance that femininity has acquired in psychoanalytic investigations and research. This trend may help us understand transsexuality, and we will try to outline it in a simple way.

Freud himself sometimes admitted (1933/1996, for example) the possibility of a first identification with the mother, as well as the association between the repressed and femininity: “One might suspect that the essentially repressed element is always what is feminine” (Freud, 1897/1996, p. 300, our translation).

Ralph (Greenson, 1966, 1968), in postulating a first identification with the mother, described what he called “dis-identifying:” an initial relationship between the boy and the mother - in which there is a correspondence between the desire to possess the mother and identification with her - should be undone so that identification with the father can take over, enabling a male identity.

It was Robert Stoller, however, who became one of the most prominent authors in the study of femininity, proposing a primary feminine identification resulting from the first experiences of the baby with the mother. What is most interesting is the way he describes the emergence of this identification: it is a process that is not carried out by the ego, but rather occurs as a kind of imprinting, in which children receive femininity passively, “by way of the excessive imposition of the too tender bodies of their mothers” (Stoller, 1975, p. 54, our translation). The marks of this femininity, according to Stoller, participate in configuring both the child’s gender identity and his or her sexuality in general. Both sexes (boys and girls) need to dis-identify with their mother to reach other identifications, but for men such a task requires a greater effort: that is why (Stoller, 1978) speaks of the “difficult conquest of masculinity,” which is highly distressing. In the case of girls, the necessary changes concerning identification would not be so severe. Such a formulation is in clear opposition to Freud’s theses. Instead of the importance given to the penis, for example, it is the female attributes that the child most desires, and, as Flávio Carvalho Ferraz notes, a possible consequence of this way of thinking would be that “when men in fantasy assign a penis to a woman, it is not to deny her inferiority, but rather her superiority” (Ferraz, 2008, “A subversão stolleriana”, para. 7, our translation).

If we can recognize in the task of dis-identifying with the mother a process equivalent to repression, we will be led to conclude that the ideas of Stoller and Greenson find resonance in some of Freud’s actual propositions (1897/1996, 1937/1996), in his reiterated affirmations of femininity as the repressed par excellence. In defending his thesis on the feminine origins of sexuality based on Laplanche’s concept of originary seduction, Jacques (André, 1995) explores in depth this aspect of Freud’s thinking and demonstrates clearly the defensive effect that a certain degree of alignment between femininity and castration produces in the theory. In arguing, for example, that the Freudian concept of female masochism is wholly based on the logic of the phallic primacy, J. André emphasizes that conforming to castration, renouncing claims and accepting a position of inferiority are characteristic of a “castrated masochism,” far removed from that which can be deduced from the originary situation of seduction. Its effect on theory is therefore as repressing as that which is produced by castrated femininity on an orificial femininity. The latter, conceived with the aid of Laplanche’s ideas, is seen by J. André as a first representation that children are capable of making of their passivity in the face of the traumatic force of originary seduction. The originary position of the ego in the face of sexual intrusion and the drive attack requires, incessantly, paths of symbolization and restraint that encounter in the aptitude to be penetrated the model that allows it to derive and circumscribe the trauma. It is in this sense that J. André can affirm that the vagina, as a site of penetration, lends itself to evoking and symbolizing the intrusion of adult sexuality in the body and psyche of the child.

But if the vagina, as a site of penetration, plays a decisive role in the orificial character of femininity (as opposed to castrated), it does not follow in J. André’s view that the femininity of the origins of sexuality is restricted to girls. Femininity is also the element of symbolization of the original intrusion in boys, insofar as the fantasies of penetrating and being penetrated do not depend exclusively on a specific orifice, since they have all the bodily orifices and, strictly speaking, the whole body surface to represent the deeply intrusive and internal effect of the originary seduction. We can therefore add to the formulations of J. André the idea that the seductive activity of the adult, precisely for making the skin and the mucous membranes of the child a surface exposed to more general penetration, calls for symbolizations that do not always obey normative and traditional anatomical availabilities, thus expanding femininity well beyond vaginal receptivity. Therefore, to the feminine origins of sexuality converge all the fantasies stemming from the originary invaded body (another expression coined by J. André), which is thus inserted in the domain of sex and gender difference, generating subsequent consequences in the identificatory constructions.

Unable to develop here a more extensive exposition of the theories that deal with the convergence of femininity and feminine identifications with the origins of sexuality and the psychic subject, we will limit ourselves to indicating a few psychic consequences of this convergence as we proceed with our argumentation about transsexuality.

If we therefore relate this line of reasoning to the issue of transsexuality and the intriguing statistics concerning the uneven frequency of cases of male to female transsexuals compared to female to male transsexuals, we can understand that this difference emerges as an authentic remnant of the first constitutive identifications of the subject and of the sexual drive. Moreover, analyzing the psychic role of originary femininity in cases of female transsexuality (male to female), we can find another important point. Femininity emerges, in these cases, as an ideal of the ego, insofar as, beyond the experienced identity, it also constitutes an identity sought by subjects. In this sense, a constant effort is often observed in female transsexuals to attain a specific stereotyped feminine ideal. Were there a bound and imaginary position, as would be expected from the Lacanian theory of psychoses, this would not occur, for they would have no doubts about how to behave. The ideal of the ego is thus established as the ideal of femininity. It is established with such prägnanz that the presence of stereotyped idealization of femininity is a common phenomenon in these cases of male to female transsexuality, as pointed out by several authors who dedicate themselves to the subject (Stoller, 1982; Bento, 2006; Teixeira, 2003; American Psychiatric Association, 1995). In other words, as a general rule of transsexuality, identities are built based on the phallic logic (even if inverted), with well-defined ideals. We believe that in the case of transsexuality, this stereotypy is related to strict social normativity, which demands from female transsexuals an absolutely “feminine” posture as a way of trying to counteract the cultural unintelligibility of their bodies.

Well, if we compare the place that femininity occupies in transsexuality and in psychosis, we will obtain important distinctions that may support our clinical-diagnostic point of view. We believe that one of the fundamental characteristics of psychosis is the fact that this originary femininity cannot integrate the psyche - what Lacan described by the expression “push-towards-Woman.” In cases of psychosis, it often happens that this expelled and forcluded femininity returns in the real in a deadly, persecutory form, non-integrated to the ego. The case of president Schreber is a prime example of this: the need to transform into a woman is something that is imposed on him from outside. In transsexuality, on the other hand, femininity inhabits the psychic space in an integrated way and establishes itself as an ideal of the ego. The push-towards-Woman experiences of a paranoid are therefore radically different from the relationship that the female transsexual establishes with femininity. Thus, we can postulate that, at the ideational level, transsexuality and psychosis differ insofar as the role played by originary femininity is divergent in both conditions, and, as far as this psychic role of femininity is concerned, transsexuality is the negative of psychosis.

However, such a distinction does not prevent a female transsexual from being psychotic as well. In this sense, we must consider that the role played by originary femininity is only one of the decisive factors in the constitution of the psychosis, and that there are other determining factors, such as the identifications established by subjects in the first years of life, the greater or lesser holding and restraining ability of their caregivers, the early exposure to situations that are difficult to symbolize, among others. We must, however, make the proviso that when subjects, due to a condition of psychotic delusion, believe themselves to be of the opposite gender to that assigned to them, they should not necessarily be considered transsexual - transsexuality requires that the conviction of belonging to the opposite gender be part of what is recognized as intrinsic to the subject, i.e., it is integrated with the ego and therefore does not manifest itself as the product of a split or as the invasion of something external. To illustrate this difference between one case and another let us take the simple example of a woman who, in her psychotic delusion, believes she is the next Dalai Lama. Surely the gender of the character of her delusion is not sufficient for us to consider her a transsexual, just as Schreber’s feminizing delusion does not make him a transsexual either. Mayer and Kapfhammer’s description of a case in which identification with the opposite of the assigned gender only occurs during the subject’s crises also follows along the same line of reasoning: “We report the case of a 32-year-old male transsexual patient with unipolar mania. Since the onset of his affective psychosis, alternating states of male and female identification were observed. The patient himself behaved as a woman only in manic phases” (Mayer & Kapfhammer, 1995, p. 225, our translation). Eventually, such delusions may be accompanied by demands for medical procedures, such as use of hormones and surgery. In such cases, compliance with those demands would be obviously disastrous.

On the other hand, it is possible to think of cases in which the certainty of belonging to the opposite of the assigned gender is solidly integrated with the ego, but such integration does not prevent the emergence of important psychopathological effects stemming from the social difficulties affecting the transsexual condition and that are added to the effort of every transsexual to maintain an egoic cohesion in such adverse conditions, that is, seeing themselves as prisoners of a body in permanent conflict with the gender identity. Such cases would require a more accurate diagnosis which could take into account these difficulties inherent to the transsexual condition. In a case study published in the journal Psychopathology, the authors emphasize the greater difficulty in diagnosing the coincidence of transsexuality and psychosis in a subject: “The case report shows the problematic nature of the distinction between transsexualism and psychosis-induced transsexual desires. If there is a true comorbidity of these disorders, a subtly differentiated process to guide medical expert opinion and therapy is necessary” (Habermeyer, Kamps, & Kawohl, 2003, p. 168, our translation). In the case of a confirmed concomitant diagnosis of psychosis, indication or not of possible transsexualization procedures would depend on continuous care and the subject’s history, with the option of resorting to other possible subjective solutions available at all times, obviously.

Resuming the discussion about ideals and the stereotypical identification often present in transsexuality: we have previously pointed out that transsexuals, due to this form of identification, frequently avoid being different as a means of conforming as much as possible to the normative categories of society and thus try to partially escape the symbolic and real violence of transphobia. Thus, we would like to emphasize that transsexual distress is not composed solely of the desire to adapt to a gender identity, but also of the desire to recognize oneself and to be recognized as belonging to humanity:

Humanity exists only in genders, and gender is only recognizable, only comes to life and acquires intelligibility, according to gender norms, in male bodies and female bodies. That is, the ultimate claim of transsexuals is the social recognition of their human condition. (Bento, 2006, p. 230, our translation)

Therefore, it is also understood that transgenitalization surgery, despite being a legitimate option in most cases, entails the following complexity: society will often continue not to accept the operated female transsexual, since she will remain outside current normativity - she does not become a woman in the eyes of society, but a transsexual. Thus, as (Arán, 2009) reminds us, because these people are constantly confronted with such issues of an “existential nature,” narcissistic or borderline symptoms may appear in these cases, and we should always keep in mind the relation of these symptoms with the broader social context to which they belong. The same is true of the stereotypy of their identifications, which cannot be dissociated from the social normativity that rules the sex-gender system. However, such stereotypy is not the sole rule in transsexual identificatory constructions, and there are certainly other forms of transsexuality that build gender identity in more open ways.

As an example of these transsexualities, we briefly recall here the character Agrado, from the Pedro Almodóvar film “Everything About My Mother” (1999). At a certain point in the film, Agrado finds herself on a theater stage as a stand-in for a play that cannot be staged because the actresses did not turn up. Agrado then fascinates and seduces the audience with the following speech:

They call me Agrado because all my life I have only tried to please others. Besides being agreeable, I’m very authentic. Look at this body. Made to perfection. Almond-set eyes: 80 thousand. Nose: 200 thousand. A waste, because I ended up like this in a fight [shows the crooked nose]. I know it gives me character, but if I’d known, I wouldn’t have touched it. Continuing. Breasts: two, because I’m no monster. Seventy thousand each, but they’re totally paid for. Silicone... . - Where? [A man shouts from the audience]. Lips, forehead, cheekbones, hips and butt. 100 thousand a liter. You do the math, I’ve lost count. Jaw reduction, 75 thousand. Complete laser hair removal, because women also come from apes, as much or even more than men. Seventy thousand per session. Depending on how hairy you are. Usually two to four sessions. But if you are a flamenco diva, you’ll need more. As I was saying, it costs a lot to be authentic, ma’am. And one can’t be stingy with these things, because you’re more authentic the more you resemble what you’ve dreamed of being. (Maluf, 2002, pp. 144-145, transcription and comments in brackets by the author, our translation)

Contrary to the stereotypy described earlier, resulting from the attempt to conform as much as possible to the gender binary, Agrado publicly describes the process of building her female body, revealing her openness to otherness.

The transsexual phenomenon, in this way, may present itself in different ways, although it is often linked to stereotypical forms of identification with the normativity of the sex-gender system. The role of psychoanalysis is to welcome transsexual distress, neither being enthusiastic about this condition nor viewing it with prejudices derived from unfounded moralism. Surgery may be an option, but we must always be open to other solutions (such as a female transsexual, for example, whose desire to keep the penis does not conflict with her gender identity), since transsexualities far outweigh the common idea of the “official transsexual” and do not submit to being reduced to any kind of theory.

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Publication Dates

• Publication in this collection
  Jan-Apr 2017

History

• Received
  30 Sept 2014
• Reviewed
  26 Feb 2015
• Accepted
  05 Feb 2016