The feminine and the transgender sinthome: clinical and theoretical issues¹

Feminino e sintoma transgênero: questões clínicas e teóricas

Féminin et sinthome transgenre: enjeux cliniques et théoriques

Feminino y síntoma transgénero: cuestiones clínicas y teóricas

Abstracts

In some contemporary psychoanalytic theories, a thesis has emerged according to which gender transition can constitute a sinthome. But gender remains a much-discussed notion in Lacanian psychoanalysis, especially in France. This article contributes to the debate by questioning the notion of femininity since it seems to be an essential point in how gender studies and Lacanian sexuation theory diverge. First, we clarify the Lacanian notion of femininity and its conceptual link to the notion of sinthome. Then, we discuss the clinical case of a transgender woman for whom the question of femininity was central during her transition. Finally, we argue how gender transition might function as a sinthome and the limits to such an understanding.

Key words
Gender; feminine; sexuation; sinthome

Em algumas teorias psicanalíticas contemporâneas, surgiu a tese de que a transição de gênero pode constituir um sinthoma. Mas gênero continua sendo uma noção muito discutida na psicanálise lacaniana, especialmente na França. Este artigo contribui para o debate ao questionar a noção de feminilidade, pois parece ser um ponto essencial na divergência entre os estudos de gênero e a teoria lacaniana da sexuação. Primeiramente, esclarecemos a noção lacaniana de feminilidade e seu vínculo conceitual com a noção de sinthoma. Em seguida, discutimos o caso clínico de uma mulher transgênero para quem a questão da feminilidade foi central durante sua transição. Por fim, discutimos como a transição de gênero pode funcionar como um sinthoma e os limites para tal compreensão.

Palavras-chave
Gênero; feminino; sexuação; sinthoma

Dans certaines théories psychanalytiques contemporaines, une thèse a émergé selon laquelle la transition de genre peut constituer un sinthome. Mais le genre reste une notion très discutée dans la psychanalyse lacanienne, notamment en France. Cet article contribue au débat en interrogeant la notion de féminité puisqu’elle semble être un point sur lequel divergent les études de genre et la théorie lacanienne de la sexuation. Pour ce faire, nous clarifions la notion lacanienne de féminité et son lien conceptuel avec la notion de sinthome. Ensuite, nous étudions le cas clinique d’une femme transgenre pour qui la question de la féminité a été centrale lors de sa transition. Enfin, nous discutons de la manière dont la transition de genre peut fonctionner comme un sinthome et des limites de cette thèse.

Mots-clés
Genre; féminin; sexuation; sinthome

En algunas teorías psicoanalíticas contemporáneas ha surgido la tesis de que la transición de género puede constituir un sinthome. Pero el género sigue siendo una noción muy discutida en el psicoanálisis lacaniano, especialmente en Francia. Este artículo contribuye al debate cuestionando la noción de feminidad ya que parece ser un punto esencial en la divergencia entre los estudios de género y la teoría lacaniana de la sexuación. Primero, aclaramos la noción lacaniana de feminidad y su vínculo conceptual con la noción de sinthome. Luego, discutimos el caso clínico de una mujer transgénero para quien la cuestión de la feminidad fue central durante su transición. Finalmente, argumentamos cómo la transición de género podría funcionar como un sinthome y los límites de tal comprensión.

Palabras clave
Género; femenino; sexuación; sinthome

Psychoanalysis is a practice directly linked to society and - regardless of its currents - is defined by its clinical dimension. Specifically, psychoanalysis is concerned by the social modifications of the relationships between the sexes and their subjective impacts (Gediman, 2004). One of the most significant cultural and clinical facts of the past decade is the exponential increase in people who identify or are diagnosed as trans and subsequent requests to transition (Habib, 2021). This article does not aim to identify the possible causes (Jorge & Travassos, 2017), but to situate the dimension of the feminine in trans sinthomatic solutions from a Lacanian perspective (Miller, 2022). We will therefore present the evolution of the notion of feminine from Freud to Lacan, as well as that of gender and the transgender sinthome in psychoanalysis today. In particular, we will show how in Lacanian theory the feminine is linked to the sinthome. Finally, we will discuss a case, which will allow us to clinically identify the dimension of the feminine in a transgender sinthome.

From gender to a transgender sinthome

Several authors (Gediman, 2004; Chodorow, 2005; Teodoro & Chaves, 2020) have noted that Freud participated in the deconstruction of the gender norms of his time and culture, but his works on female sexuality show that he was unable to fully free himself from all stereotypes, especially those concerning women (Kloppenberg 2016). His theory that women’s psychic life is directed by penis envy (Penisneid) was to be questioned by psychoanalysts from future generations.

In 1929 Rivière argued that femininity comes from neither a biological or anatomical foundation or essence: it is a masquerade. For Rivière this masquerade is a conceptual category, which allows for the thinking of femininity. She enhanced her point by illustrating the case of a man playing a masquerade. Indeed, Rivière does not draw on anatomical sex in her considerations on femininity, but from the use of a semblant - as Lacan would call it - of gender. To put it another way, the masquerade dissimulates the absence of any primary gender identity. As pointed out by Chodorow (2005), Rivière’s position is quite different from that developed by Horney (1939/1966). Horney pointed out the absence of consideration given to the impact of social and cultural determinants upon women, criticizing the prevalence accorded by Freud to biological and anatomical determinants. According to Horney, the issue of men-women relationships is not structured from the biological to the psychic dimension, but from the social to the psychic one.

The late 1960s marked a turning point in post-Freudian psychoanalytical research: the notion of gender was effectively integrated in North-American psychoanalysis by Stoller (1968) who borrowed it from the psychologist Money (1952; 1965).² With Stoller, the gender issue was propelled into the domain of psychopathology, based on his clinical experience with transsexuals adults (1968). As Stoller integrated gender into psychoanalysis, the notion was also adopted by sociologists, with the works of Oakley (1972; 1981) contributing to the development of an English, feminist sociology. Oakley studied stay-at-home women, a class she considered to be an oppressed, social minority similar to African Americans. In this way, the use of the term gender contributed to the establishment of the academic discipline of gender studies (Dorlin, 2008; 2009), which, generally speaking, seeks to demonstrate the historical construction of inequalities between sexes, and to suggest concrete alternatives. To do so, gender studies engages in a collaborationist and/or critical dialogue with the disciplines considered to be either useful for gender analysis or to contribute to the production of gender norms.

In this context, Judith Butler’s 1990 book Gender Trouble, in which she develops the thesis that the so-called natural, biological or anatomical sex is already a gendered construction, is pivotal. With regards to psychoanalysis, Butler’s hypothesis is that the Freud’s and Lacan’s concept of the phallus is a conceptual, gendered construction of the body, which reproduces man’s domination over women and that of heterosexuality over any other form of sexuality. Butler’s goal is to release the pressure of gender norms by revealing their facticity and their parodied dimension. According to Butler, this release is possible because the use of a sex’s semblant in order to represent oneself inside language always stems from a masquerade. Her references to Rivière and Lacan indicate the extent to which she based herself on psychoanalysis in order to deconstruct gender. Butler’s research, and more largely that of gender theorists, later nourished psychoanalytical works.

Thus some North American psychoanalysts consider, from a relational perspective, that mental life is constructed by the internalization of surrounding cultural constructions. As Gediman (2004) notes, the ‘‘post-moderns … argue that any conclusions, whether premodern or modern, that regard something as distinctly male or distinctly female when it comes to sex and gender are fictive, and derive from a ‘false binary’ … that requires deconstruction of outdated, mostly ‘sexist’ constructs’’ (pp. 1067-1068). Therefore, as Chodorow (2005) suggests, children only internalize male domination to the extent that culture is based on such domination. Chodorow outlines that psychological meanings, and not biological causes, determine gender. In this regard, she considers that certain Lacanian authors share the postmodern conception that “language rather than body creates the psyche” (pp. 1109-1110), which makes Lacanian theory also particularly suitable for discussing the question of gender in return, a point also underlined by Hansell (2011).

Be that as it may, a commonly held thesis in Anglo-Saxon psycho-analysis is that internalized binary gender norms are likely to have a deleterious mental impact. For Schiller (2018), analytic practice must not reproduce restrictive gender norms, but help rebuild gender when it is a source of suffering. Schiller (2018) develops in this sense the thesis according to which psychoanalysis could “disillusion” social and psychic constructions of gender, in order to reconstruct gender relations that are no longer damaging for individuals. As for Chodorow (2005), she notes the limits of the assumption that gender can be deconstructed. She underlines in fact that if such assumption is not backed by clinical practice, this leads to the development of idealistic philosophical theories on mental life. Hansell (2011) adds to this that the binary itself can prove to be structuring, as a result of which it is neither desirable nor possible to deconstruct identity on principle.

A further discussion on gender and psychoanalysis can be found in the work of Gherovici (2018), who links transgenderism to Lacan’s theory of the so-called sinthome. In her reading, Lacanian psychoanalysts systematically and pejoratively diagnose trans people as psychotics and/or as pathological. According to her, the sinthome helps to approach transgender in a non-pathologizing way.³ By approaching it as a sinthome, she thinks of transgender as a way of knotting the registers that, according to Lacan, make up human reality: the Imaginary, the Symbolic and the Real - we will come back to this. More precisely, Gherovici maintains that gender transition, whether it is done on the social and / or hormonal and / or surgical level, constitutes a systematic solution to treat a discomfort felt by an individual in relation to gender, and that psychoanalysis as a practice of speech (and therefore as a treatment of the enjoyment of the body) can come to consolidate this solution.

One can of course envisage a transition with therapeutic effects, as well as the analytic treatment that can support this. But Gherovici’s thesis seems to us to be representative of the difficulties to which the integration of the notion of gender in psychoanalysis leads today, in particular, in the North American field where this integration has taken place in a not very nuanced way - despite the reservations of some authors (Chodorow, 2005; Hansel, 2011). We end up believing that the pathogenic effects induced by sex in the speaking being are only a question of gender construction, which could be cured by a deconstructivist psychoanalysis.⁴

To be sure, we have to take the notion of gender seriously, recognizing that gender theories have forced psychoanalysis to recall or to restate that in this matter no norm is of natural or biological origin (Leguil and Fajnwaks, 2015; Leguil, 2015). But the two paradigms (gender and sexuation) are quite incommensurable. In effect, Leguil reminds us that according to psychoanalysis, each subject is susceptible to feelings of uneasiness within his or her gender. This unease might stem from one’s infantile history and the way one’s parents have enforced their own gender model. This is irreducible to the effects of social norms since, in the case of every subject, there is a singular interpretation of his or her gender. Leguil thus considers that behind gender norms there is, for every subject, an ontological lack. This lack allows the subject to desire and to invent his or her own sexuated position. On the therapeutic level and according to Leguil, psychoanalysis can accompany the subject in his or her invention of a singular way of dealing with his or her gender choices, but the leeway in inventiveness is not there conceived or promised as a therapeutic model.

To put it another way, sexuation is conflictual and never finds a definitive answer in the psyche - it is symptomatic. This is the reason why no absolute therapy is to be expected from psychoanalysis, notably for, but in a manner not limited to, gender-related suffering and whatever existing medical therapies there may be. But more precisely, we are going to show that the conflictuality in sexuation is linked to the feminine, and that the feminine according to Lacan is neither resorbable within nor subsumable to gender. On the other hand, it’s precisely Lacan’s discussion of femininity that brought him to formulate his theory of sexuation, which is conceptually linked to his subsequent notion of sinthome. Thus we will show that if in clinical facts and from a theoretical point of view a transgender sinthome can be envisaged, it must not and cannot mask the psychic conflictuality which remains linked to sex and to the dimension of the feminine.

From the feminine to the sinthome

At the beginning of his elaboration on the feminine, Lacan (1956-57/1994) started by taking Freud’s phallocentric theory and quickly distinguished himself from it. He reminds us that according to Freud both boy and girl first see the penis as a masculine attribute. The boy, because he has it, is afraid to lose it, whilst the girl, because she doesn’t have it, wants to have it. Lacan also notes that the perception of sexual difference is an object of discussion between the child and his adult entourage. Hence, the possibility that the penis could go missing grants it a symbolic dimension: it is seen and talked about as an element that could disappear. This is why Lacan (1958/1966) distinguishes the penis from the phallus. “The phallus is a signifier” (Lacan, 1958/1966, p. 690) and more precisely, it is the signifier of lack and of desire since desire originates from lack (Ruti, 2008). Thus, Lacan reestablishes parity between the sexes in regard to the phallus: we all possess the phallus on the basis of absence and can compensate for that lack with substitutes. This compensation is first and foremost effectuated by language, which allows us to move from one signifier to another, to say and specify what we desire. This is the reason why the phallus is a particular kind of signifier since it cannot be expressed as such (Lacan, 1958/1966). It simply grounds the lack that structures desire.

Thus, by framing lack as structural Lacan departs quite radically from an interpretation of the feminine as a deficit. He also departs radically from an interpretation of the feminine as something that could be filled: because of the logic of the phallus, the child is not an equivalent of the penis (it is only desired against the background of the lack, and hence in the name of the phallus), and women are not psychically determined to desire a strictly determined object, like a child, or a missing penis (Miller, 1994/2015; Hamon, 2010).

Furthermore, responding to Lévi-Strauss (1949/2017) Lacan (1956-57/1994; 1957-58/1998) suggests that while heterosexual relationships are founded on a patriarchal order, women are not simply exchanged as objects according to rules of alliance and filiation. Such object position is a priori untenable since it is in contradiction with a woman’s position as desiring subject, in other words, with the fact that all subjectivity is grounded in lack and in speech. This is how Lacan ultimately understands Dora’s speech: she refuses to be exchanged like an object between her father and Monsieur K. Freud not perceiving this, Lacan notes that he “brings into play his ego, the conception he himself has of what girls are made for - a girl is made to love boys” (Lacan, 1953-54/1975a, p. 207). Dora teaches us how much her desire cannot be reduced to a heterosexual norm (Bourlez, 2018).

Henceforth, Lacan questioned what characterizes femininity essentially, beyond motherhood and the relationship to men. Insofar as language is founded on the symbolic order, which is characterized by phallic lack, the difficulty resides in finding a way to name the feminine without ending up in generalizing and normative statements about women. Therefore Lacan (1972-73/1975b) uses logics to explore how the specificity of femininity, which cannot be expressed in words, can nonetheless be situated logically. His point is that femininity cannot be represented in an affirmative way, which he makes clear in the aphorism “Woman does not exist” (“La femme n’existe pas”), and which is why he wrote ‘Woman’”.

This does not mean that women do not exist in reality or from a biological point of view; nor that they cannot form a social group or have political intentions. The aphorism indicates that there is no standard symbolic representation of femininity, and for that reason, it cannot be thought in terms of a fixed category. Expressions of femininity are singular, and the subject’s responses to femininity are also unique. Thus, from the experience of castration, the child has to work out a response to the hole he perceives in the body of the mother. According to Lacan following Freud, most of the responses for the infant, and which will be maintained in the unconscious, are of a phallic order. The paradigmatic case is the election of a fetish (Freud, 1927/1999; Lacan, 1956-57/1994). But some answers are not all phallic, and this is what Lacan identifies on the side of the feminine - we will come back to this.

According to Lacan, the phallus is the only standard representative of sex, either in the social structures of masculine domination and/or in the unconscious, which means that there is a vacuity in the naming and expressing of the feminine (Hamon, 2010). Lacan does not think we should identify women with this lack. On the contrary, and as Ruti (2011) has indicated, this point of non-representability and non-generalizability prevents any identificatory reduction. It maximizes singularity, and therefore enables each subject, irrespective of biological sex, to invent particular responses to this non-representability. Consequently, womanhood and femininity are a possibility for biological men, just as phallic identification is a possibility for biological women.

In order to formulate this hypothesis on femininity, Lacan takes into consideration Freud’s impasses, as well as Rivière’s (1929/1991) and Horney’s (1939/1966) developments, which indicate that femininity is non-reducible to the phallus. Also, his method takes into account other Freudian concepts that allow, in retrospect, to work around Freudian abutment points, in particular the idea of gratification beyond the pleasure principle (Freud, 1920). Lacan (1954-55/1977) translates this gratification beyond the pleasure principle, where the body’s libido is indistinguishable from death, into his concept of jouissance. “We do not know,” Lacan clarifies, “what it is to be alive except for this: that a body enjoys” (1972-73/197b, p. 26).

According to Lacan, the body is the site of a primordial jouissance, but this jouissance is subject to the law, to a castration that is due the incidence language. The symbolizing dimension of language limits jouissance. Once subjected to castration and to the signifier, jouissance is said to be phallic. Its apparatus is language (Lacan, 1972-73/197b, p. 52) and is brought about by semes (Lacan, lesson of 11/06/74), so that it proves to be limited and discontinuous like the signifier itself. To put it another way this phallic jouissance gravitates around the phallus qua signifier. It is provoked by letting desire gravitate around experiences of lack (Lacan, 1958//1966).

Specifically, Lacan distinguishes two types of jouissance. The second jouissance is called Other or feminine (Lacan, 1972-73/1975b) and cannot be reduced to any desire. It is a matter of the body that is touched by contingent events, and it is not mediated by the phallus (Brousse, 2000). More specifically, what Lacan proposes is that women, for their part, cannot be made into a set because of the absence of a specifically feminine identity, but also because they are, variously, “not-all” subjected to the phallic function. They are “all there,” so to speak - that is, they are not not submitted to the phallic function - but in addition to this latter and its effects, there is also “something more” (Lacan, 1972-73/1975b, p. 69). To be clear, then, this is not to say that women are anti-phallic by nature, or that they evade castration by inscribing themselves in opposition to it. No speaking being escapes it. However, castration does not regulate the entire field of their jouissance. A part of this latter remains not linked to the phallic reference.

Feminine jouissance thus “splits” between that of the said - phallic jouissance - and a supplement - rather than a complement - that can be qualified as beyond the phallus insofar as it is composed outside the field of representation (Lacan, 1972-73/1975b, p. 75). This supplementary jouissance is not supported by any object. It is not restricted to the signifiers of the Other by symbolic phallus that is the master signifier par excellence. As a result, it turns out to be “crazy,” unaccountable, unordered and unregulated. Excluding meaning, it develops outside the symbolic, between the imaginary and the real. A woman experiences it when she is no longer subject to the phallic function, with which she maintains a relationship of contingency. The experience of this jouissance thus dispossesses a woman of language, absenting her from herself. In effect, it temporarily eclipses her status as subject of the signifier, leaving an outside language of which the symbolic preserves a vivid trace. Unable to be assumed subjectively, its proliferation thwarts the phallic regime of the unconscious, eradicating the foundations of identification. This opaque jouissance belongs to the body itself, alive rather than mortified by language. It affects it with uncertain sensations that are not articulated to the signifier and that oscillate between pleasure and suffering. The blissfully painful subjective defections it produces remain marked by the seal of ignorance in the aftermath of their ordeal which is experienced in a mode of exteriority.

Accordingly, Lacan notes that the Other jouissance cannot be captured with language and is associated with a specific suffering, oscillating between voluptuousness and ravishing (Hamon, 2010). Lacan articulates this using the case of women who, when bringing forward certain subjective moments or wishing to express their most intimate experiences, find that words are missing (Lacan, 1972-73/1975b). He specifically mentions Christian mystics that call their ecstatic experiences “divine” since they cannot refer them to the community of men. Lacan qualifies such jouissance as “radically Other”, because it differs fundamentally from phallic jouissance (1972-73/1975b). Obviously, Lacan did not believe all women are mystics but that this dimension outside of language could be singularly felt by each and every woman and that it can coexist with phallic jouissance. He also indicates, contrary to Freud, that men can experience this Other jouissance too. With Lacan, anatomy is not destiny: a biologically masculine sexed individual can situate himself, psychically, in a feminine position.

Indeed, Lacan (1973-74) develops what he calls a theory of sexuation: sexuation that, in itself, is a “sexed identification option” (Lacan, 1973-74, May 14^th 1974’s lesson)⁵, meaning it results from an unconscious, subjective choice. He positions the phallus as a universal that is valid to all subjects due to the vacuity, in the unconscious, of a signifier that would identify the feminine. Hence, according to Lacan, a “man” is whoever is entirely subjected to phallic logic, whereas a “woman” is whoever is not completely (‘pas tout’) subjected to such logic. Phallic jouissance, whose device is language, is something both ‘men’ and ‘women’ relate to, but Other jouissance, which is rebellious to the rule of the phallic function and generates a creativity that shakes up the norms, is specific to the female position (Lacan, 1972-73/1975b).

Consequently, according to Lacan the “male norm” does not constitute a model of subjectivity: masculine sexuation should not dominate and is not preferable to the feminine one. On the contrary, by the end of his teaching, Lacan (1975-76/2005a) developed a concept of the subject that builds on his previous elaborations on femininity. With respect to femininity, he noted that for each woman there is both a need to define herself and to find her own signifiers. The logical difficulty is that in doing so, she can only make use of language, which, as a structure, is normative and assigning.

A difficulty of the same logical order also arises for men: they must find an answer to what the feminine, with which they are confronted (right from the start of the Oedipus complex in the experience of castration), is. Thus the psychic conflictuality for all the sexes is organized around the unrepresentability of the difference between the sexes. The subject according to Lacan is fundamentally tormented by the experience of jouissance associated with having a sexed body but which as such has no precise identity (Martins, 2019). Lacan will also situate the phallus as a semblant, which offers a semblance of a response to masculine sexuation but which is not absolute and certainly does not give a response to the feminine (Lima, 2021).

By the end of his teaching Lacan (1974/2005b) recognizes this difficulty as that of every speaking being, regardless of one’s sex. As Miller indicates, “Lacan was able to generalize the instance of this mute jouissance that he discovered in feminine sexuality. Basically, he later extended it to the male as well, to say that it is what gives the fundamental status of jouissance as opaque to meaning” (Miller, 2011)⁶. It is why he then prefers to no longer use the term “subject” (which by definition, is subjected to the symbolic order of signifiers) but “parlêtre”, meaning a speaking being who experiences in his or her body the point where words are unable to define oneself, since the Real is not entirely representable, neither imaginarily nor symbolically. There is always a remainder of Jouissance; henceforth Jouissance names what a subject feels in the body, assuming that subjectivity and corporeality never coincide. It is situated beyond the desire arising from lack and thus it is also beyond the words we use when expressing desire. Ruti (2011) has brilliantly indicated that Lacanian psychoanalysis offers a solution to this impasse by defining the subject as a negativity, as that which is excepted from the order of language and which therefore allows for creativity. This creativity is implemented by the constitution of a sinthome, as a knot to be made between the three registers of the Symbolic, the Imaginary, and the Real.

Cauwe, Vanheule and Desmet (2017) highlight that there is “a change in Lacan’s initial perspective on the nature of analytic experience; he turns from the Symbolic, stressing how subjectivity is shaped and expressed discursively, to the Real, pointing to a dimension beyond signification where chance or contingency, uncertainty, shock, and senselessness become principal topics’’ (pp. 610-611). This Real point concerns not only women, since men, as speaking beings, are equally confronted with the paradox of language. At the end of his teaching, Lacan says: “men, women… are nothing but signifiers” (Lacan, 1972-73/1975b, p. 34).

Lacan thus affirms that, with regard to the jouissance which fails to say itself completely, there is no difference between women and men. But this no difference is not to be understood as an equivalence (Marty, 2021). Indeed, the feminine outside the scope of the symbolic is precisely not measurable and therefore is not comparable to the masculine. The elaboration of the feminine in Lacan, which gives the way to the sinthome, does not therefore imply that it can be absorbed into a transgender sinthome. Certainly, there is no definitive response in the psyche to sexuation due to the feminine, and therefore the subject must invent a sinthome. But this sinthome is not an annulatory therapy of the feminine.

The following clinical case will show why the gender transition must be analyzed by sexuation, and how the feminine or the Other jouissance have a central place there, which can find a form of satisfactory answer - but doubtless neither definitive nor absolute - to the transition.

Case study

The case is drawn from the work of the fifth author (a clinical psychologist oriented by psychoanalysis) in a gender consultation service. The service offers free talking therapy for people requesting gender reassignment, and for those who have reassignment related questions and issues afterwards. Such talking therapy offers possibilities to freely explore the discontent experienced around gender-related challenges. The underlying assumption is that people struggling with such issues don’t necessarily need long-term treatment (Freud, 1918). Thus, in contemporary clinical practice many Lacanian analysts (or psychologists oriented by Lacanian psychoanalysis) engage in therapeutic formats that allow such encounters, especially for people who consult after destabilizing events and moments of transition in life (Miller, 2005). People struggling with gender-related issues are par excellence confronted with situations and choices that challenge the way they have been living, which is why a series of psychoanalytic encounters can be suitable for them (Miller, 2022). In such psychoanalytic encounters the focus may be directed towards helping a patient find ‘sinthomatic’ ways to moderate jouissance and give shape to desire.

Kim, a 35-year-old transgender female, books an appointment with the analyst, stating that she feels “safe” bad with her transition and family problems. In all there will be seven sessions, over a two-month period.

In the first session, Kim cries when speaking about what brought her here: she is facing some problems with the education of her child, who has been particularly aggressive towards her since she transitioned. Kim is unable to react other than with anger, which makes her desperate to the point of considering suicide. To her the breaking point was when, while screaming at her child, she heard her “coarse voice from before come back”. She was upset because, as she transitioned into a woman, she strove to distance herself from the internal violence she had always felt and that she considers to be “masculine”. During this first session she is unable to further associate and the analyst proposes a second appointment in order to ascertain the origin of her suffering.

During the second session Kim begins to associate her inner violence with the traumatic violence afflicted by her father: she realizes that while she has been the object of her father’s violence, she simultaneously identified with him. Moreover, her past career, in construction, was the same as her father’s. Kim states having wanted to change her sex after an argument with a colleague when she was working at a construction site: “whenever there were conflicts with my male colleagues, I always defended myself with my deep voice, which impressed them. But that day I felt an uncontrollable violence build up inside me that scared me a lot. I’d had enough of being a man and I told myself, in all logic, that life would be smoother if I became a woman”.

At the third session, Kim specifies the context in which the transition happened. She explains that her partner accepted the procedure and that the transition was a moment of “blooming and emancipation”. She also decided to stop working in construction and went back to school. Today she works at a LGBTQI+ organization where she is in charge of the prevention of sexist violence, a job which she finds fulfilling.

At the fourth session, Kim reports a traumatic event. A few weeks after her transition, she found herself struggling when a transgender friend asked her for help when she was being attacked by a group of men in the street. Kim intervened: “I managed to push away the men who were attacking my friend thanks to my coarse voice but once again I felt this escalating violence inside of me and I no longer felt like a woman”. She cries once again. The analyst replies with two answers. On the one hand, saying that even if her intention of protecting her friend had been an admirable one, she should not forget to protect herself from the violence emanating from others and from the violence this can awaken inside of her. He also adds that normally it is the police’s role to intervene in this type of situation. On the other hand, the analyst points out that the fact she stepped up to protect her friend does not make her a man but on the contrary, might reveal a sort of feminine solidarity; about which she must be watchful in order to avoid being carried away by this violence that masculinizes her and that she does not wish for. These words clearly reassure Kim.

When Kim comes in for her fifth session, she discusses what was going on with her relationship with her son. She feels like she is unable to be both a woman and have a constructive authority over her son. The analyst replies: “You can be a woman with authority without being authoritarian, if this is what you are worried about.” Kim agrees with the analyst’s remark and continues by noticing that effectively it is “the fear of not having authority” that makes her “authoritarian” with her child. She then realizes it is this that her son is opposed to, more so than his mother’s transition. Kim remembers that before the transition she was already facing difficulties with him. “I realize,” she says, “that having become a woman hasn’t changed my way of playing the male part, that it can always reappear despite me”.

At the following session, Kim associates her masculine part with her authoritarianism. The analyst asks her: “To you, playing the male part means being authoritarian?” Kim seems relieved and answers, smiling: “Yes, I realize sometimes I don’t listen to my child, and I blame it on my masculinity, although being a man doesn’t necessarily mean being abusive”. Kim continues: “I thought my transition would be the miraculous solution to all my problems, but I now realize, thanks to my son, that this is not the case, that my life is not entirely determined by a gender issue”.

Kim starts the seventh session by saying: “When I became a woman, I thought I would need to become a mother, the best possible mother, I mean the one who defuses all her child’s crises, that makes him as happy as possible. I now realize that he also needs me to let him express what is wrong and that I don’t feel attacked by his anger. Now, when that happens, I try to listen to what he wants to tell me and I let my wife take more care of him. To me it’s simpler to be a militant than to be a mom, but I am learning to be a mom thanks to my son, and am starting to grant him his share of freedom; I feel relieved, I feel better and I am more serene when I’m with my family”.

At the end of this session the analyst asks her if she wants to book another appointment and Kim enthusiastically declines: she believes that throughout the treatment she has found a “balance” in her thoughts, in her body and in her relationship to others. The analyst says he is available if she ever wishes to come back and talk to him.

Case discussion

In the first part of his adult life, Kim seems to have led the conventional life of a heterosexual man: married, with a child, and working in a typically masculine environment. In this way, from a social point of view, everything suggests that Kim placed herself on the “masculine” side. She chose to pursue the same career as her father and, in a sort of virile battle, she possessed and demonstrated her “coarse voice” to dominate masculine colleagues. The second moment occurs when during a fight with a co-worker, Kim feels this voice arise again, provoking a violence she cannot control. Kim then no longer qualifies this coarseness as powerful. Rather, it articulates a bitter harshness that disrupts her functioning. It bears witness to a jouissance that starts interrupting the Symbolic order (Cauwe, Vanheule and Desmet, 2017). Indeed, Kim does not remember what the fight was about but what this colleague said made Kim step out of the masculine register she had so far identified with: “logically” she concludes life would be smoother if she became a woman.

Kim’s first way out, was changing her anatomic sex, but the fact that the coarse voice qua jouissance-laden element could still manifest itself confronts her with how the sexual assignation didn’t provide a sufficient solution against harshness. Associatively, it made her think of her father’s violence, to which Kim had been subjected as a child, and with which she still seemed to identify. In the beginning of the treatment, Kim has her own gendered theory concerning violence, situating it on the side of masculinity. The sessions helped her identify that the association she makes between unlimited violence and masculinity only make up a personal interpretation and construction. While this unconscious construction has guided her through the first thirty years of her life, she was able - during the sessions - to identify its illusory and “damaging” dimension (Schiller, 2018).

However, it is with this semblance of gender construction that Kim was able to lead the first part of her life (as a man). This semblance lasted a considerable time, so we do not subscribe to the simple thesis according to which the genre would have an “illusory” and therefore “damaging” dimension. Therefore, we also do not subscribe to the general thesis that the purpose of analysis is to reveal this illusion. Because are we sure that there is something behind the illusion? This thesis paradoxically involves assuming a deep essence of gender identity. Clinically, we also perceive with the case of Kim the subjective risks when the semblance of gender from which a subject had been able to construct his mode of sexuation is undone.

With the help of free association, the sessions led Kim to rearrange her genre but without ideals and without the requirement of deconstruction. She defines herself as a woman but she knows that she can sometimes play a masculine role. The effect is quite immediate: she can detach herself from this violence, make herself responsible for it and not repeat it. She finds a new way of being a woman: by being less of a man (in other words, by limiting the violence that she considers masculine) and also less of a ‘good’ mother (by being less invasive to her son). The deconstruction of her own gendered theory allowed her to live her gender role and her maternal role with more ease. In the end, she was able to find a new balance between femininity and masculinity, without completely identifying with either position. She also freed herself from the necessity to construct rigid and normative interpretations of what it means to be a man or a woman.

But the relative balance that was rediscovered, and which can be formulated in terms of gender, should not hide the fact that the patient is basically experiencing a psychic conflict that bears on sexuation and therefore on the real of feminine jouissance. While ideas about gender always have an imaginary component, this imaginary dimension is by definition tied to the Symbolic and the Real as well (Cauwe, Vanheule and Desmet, 2017). Indeed, for Kim, gender-discourse is a symbolic frame of reference that ties ideas about how she defines herself as a man and/or a woman to the Real of the sexed body in its dimension of jouissance. Yet, how can we specify the jouissance Kim relates to? It could seem phallic, since it is associated with her father and his violence, but such interpretation is flawed as it equates phallus to what, for some, is socially connoted as being masculine.

If we question instead Kim’s relationship to her body and to language we can see that this violence is not asserting desire. On the contrary, it is transgressive and expresses an excess of jouissance that damages the security provided by the Symbolic. Kim experiences it as an indescribable force that overtakes her body, which is baffling: she cannot say anything about it. The associative chain of thought reconstructed during the sessions carries no further development, and instead she is overwhelmed by a bodily experience that language cannot express. What is more, this flooding of language’s phallic limits opened up, as Kim says, “logically” to the desire of being transformed into a woman.⁷ It pushes her to question her sexuation, as if along that way she attempts at erasing this disruptive violence.

Yet, while her female identity helps in warding off ‘male’ violent behavior, its protecting impact is not complete. This is why she is painfully surprised that the husky voice full of violence could return as she has become a woman, both anatomically and at the level of her identity. In this sense, similar to what Gherovici (2018) describes in her work with transgender patients, the psychoanalytic sessions helped Kim in a second step to frame the dystopic violence and strengthen the sinthome that was constituted by means of the medical transition.

But unlike Gherovici, we cannot be sure that this solution through analysis is sustainable. It is indeed possible that Kim will need to return later. We also think that the fact that the solution is valid in this case does not imply that it is so for all trans subjects. And finally, we measure how the feminine has been central: when the feminine Other jouissance that she had kept at a distance until then is revealed, the idea of being a woman imposes itself on the patient. The transition intervenes as a conformity of the body with this idea, but the process is incomplete because the Other jouissance has no signifier and therefore no representative in the body. Certainly, the treatment can give another destiny to this enjoyment, but a transitional solution does not constitute a guarantee.

Conclusion

What is especially interesting about Lacan’s theory of sexuation is that it shifts the question of masculinity and femininity from the field of sex to that of jouissance. In this way, Lacanian psychoanalysis shares with gender studies the denaturalization of sexuality, but without reducing it to the deconstruction of normative social and/or psychological identities. On the contrary, it can even be stated, and this is undoubtedly the fundamental point of divergence, that the Lacanian perspective subverts gender theories by questioning, beyond social and psychological reality, the relationship maintained to the Real of jouissance. Sexuation concerns the question of knowing how a subject experiences this jouissance: is it attuned to the phallic reference and thus to the signifier’s symbolic order or does it also develop outside of the symbolic realm by rebelling against the unconscious’ phallic regime?

We have shown that the Other jouissance qualified as feminine is central both at the psychic level and at the theoretical level: at the psychic level, it is the mainspring of psychic conflict, and at the theoretical level it prefigures the sinthome. The two are linked since Lacan tried to grasp what was at the heart of subjective experience, and what destiny to give it in the treatment. Gender transition manifests this conflictuality, but one must be naive to believe that it can find an unequivocal solution in a practice, an identity or a physiological aspect.

Indeed, from a Lacanian perspective, people’s choice to identify with any gender-related position always bears witness to a subjective and social mode of dealing with sexuality and love. Along this way it gives shape to a subjective manner of living with desire and jouissance, which is why it can constitute a sinthome. Beyond the question of social identity, which is always relative to the civilization and time one is living in, Lacanian psychoanalysis helps people to question what they make of gender categories: for which question is a (change in) gender identification an answer? And how might this answer provide a solution? Thus considered, gender transition does not automatically provide a way out of a troubling confrontation with jouissance (Gherovici, 2018), even if at the level of the self-image the transition is strongly wanted. Depending on the contingencies of life, everybody might encounter discomfort with their gender position. The added value of psychoanalysis consists of enabling people to question this discomfort, such that a new equilibrium can be found.

Starting from the case of Kim, we highlighted the relevance of Lacan’s theory of sexuation and of his concept of sinthome for conceptualizing and treating clinical transgender problems. Yet, the transgender clinic is diverse, which is why generalization is difficult, and this precisely because of the presence of feminine jouissance: it objects to representation and generalization. The point of a psychoanalytic intervention does not reside in deconstruction of gender out of political principles but out of the subject’s suffering because of the psychic conflictuality linked to the paradoxes of feminine jouissance.

• 2
  In the 1950s, Money was a practitioner in a pediatric and surgical service that treated children presenting anatomical intersex characteristics at birth.
• 3
  But indeed, Gherovici underscores a central Lacanian hypothesis in making the point that gender transition is to be studied as a sinthome (Millot, 1983; Castel, 2003; Morel, 2008; Metreveli, 2016; Maleval, 2019). Furthermore, we have shown (Bonny, 2021) that the possibility of a transgender sinthome should also not exclude the possibility of an underlying psychotic structure in the patients concerned.
• 4
  This approach also exists in France and and basically consists in a Butlerian way of considering that the notion of gender should replace sexuation because it would be more modern and heuristic (Laufer & Rochefort, 2014; Ayouch, 2014; Bourlez, 2018). For a more international summary, see also: Pombo, 2018.
• 5
  Free translation from unpublished manuscript (Translator’s note).
• 6
  Free translation from unpublished manuscript (Translator’s note).
• 7
  If the question of the structure in the cases of transition is not the object of this article, it must be mentioned here nonetheless. In the Lacanian structuralist theory, this saying of Kim can indeed lead to the hypothesis of a psychotic structure, according to the Schreberian model of the push-to-the-woman. In this case, jouissance is not only not-all phallic, it is strictly non-phallic. The jouissance of the psychotic and feminine jouissance thus have the common point of coming from beyond the phallus, so that when the psychotic feels jouissance he readily qualifies it in terms of a feminine voluptuousness (Maleval, 2000). For more details on the issue of psychosis in transitional cases, see our article (Bonny, 2021).

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Publication Dates

• Publication in this collection
  09 Oct 2023
• Date of issue
  2023

History

• Received
  27 Feb 2023
• Reviewed
  26 May 2023
• Accepted
  03 June 2023