Transvestism, Transsexualism in the Psychoanalytic Dimension

Giovanna Ambrosio

• Publisher: Routledge
• Year: 2020
• ISBN:
  9780429923265
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book is an outcome of the European Conference on the theme of transsexualism held in Catania, Italy in 2006. It shows how psychoanalysis can reflect, discuss, dialogue and formulate useful insights on one of the most challenging situations that confront the mental health community.

Chapter One
Transvestism, transsexualism, transgender: identification and imitation¹

Simona Argentieri

Retrieval of a psychoanalytic vertex

During the course of a few decades, there has been a dramatic change, both psychologically and in civil rights, in the convulsive social and cultural arena in which transvestites, transsexuals, or the so-called transgendered, live, define themselves, and are defined. Although it is a numerically limited phenomenon, the attention of the media and the consequent involvement of public opinion have been high profile, even though concentrated on certain exceptional cases to which the press has given particular emphasis; for example, two elderly ladies who, thanks to the new British legislation on gay weddings, decided to get married. The bizarre fact was that they had already been married before when one of the couple was a man, before he decided to change sex. Then there was the recent tale of Mrs Sarah Jones, born Colin Jones, who, after a surgical operation, and with the blessings of the ecclesiastical authorities, has become an Anglican pastor.

But apart from these extreme situations, there has certainly been a huge increase in the cases of “trans” both on the stage and on the street, as well as a growing number of more discreet requests for “reassignment of sexual gender” in the specialized centres (more than fifty per month in a public health structure in Northern Italy alone) that would seem to indicate a wish for integration and “normality”. It remains to be seen whether there really is an increase in this pathology or whether it has merely come out into the open. Or whether—as I am inclined to think—it is the psychosocial circumstances that favour this type of defence organization.

The problem is that, between scandals and civil disputes, the wish to understand becomes progressively weaker. There are many opinions and not much thought, while the battle continues (mainly in the media), in the form of slogans and proclamations, between the repressive invocations of the conventional thinkers and the demands of the “trans” associations and groups for legal and civil rights.

I think, therefore, that psychoanalysis must laboriously regain an autonomous theoretic and clinical space of its own away from the confusion and blackmail of ideologies.

Some history

From the psychoanalytic viewpoint, disorders of sexual gender identity at first bore the imprint of the psychiatric nosography of the beginning of the twentieth century, according to a criterion that was prevalently descriptive and phenomenological. A clear distinction was made between transvestism (men who had a compulsive urge to dress in women’s clothes but who wanted to preserve their psychophysical masculinity) and transsexualism (men who hated their own anatomy and desperately wanted to change it into that of a female, whatever the cost). Both syndromes were in any case firmly placed in the category of perversions.

As we know, the great Freudian revolution changed the scientific and cultural statute of the perversions; from being the “hereditary taint”, “crime”, or “sin” of the pre-psychoanalytic age, perversions were traced back to the fountainhead of infancy and of everyday life, even though they were the pathological outcome of drive conflicts in the confrontation with the Oedipal crossroads. There followed the well-known (and then much discussed) axioms of the child as “little perverse polymorph”, of perversion as the “negative” of neurosis, of the absence (or almost) of perversions in the female sex, etc.

The various perversions—always listed on a behavioural base, according to the known catalogue of horrors and miseries—were therefore to be defined as fragments of pregenital sexuality, partial undeveloped and unrepressed drives that, deformed by defence mechanisms, take over the leadership of adult sexual organization.

Psychoanalysis, therefore, traces the psychosexual structure back to the developmental history of each individual, and reduces almost to zero (as confirmed by the experiences of R. J. Stoller) those biological factors that had been so emphasized in the past and that, today, have inauspiciously been revived both by those who invoke the laws of nature as well as by those who want to correct a mistake of nature.

Nowadays, however, the language above all has changed, a phenomenon that is never banal when referring to the slippery ground of sexuality. We speak of “gender dysphoria” or “sexual identity disorders”; we use the all-inclusive term of “transgender” that moves the accent from the sexual drive on to gender identity and which, in colloquial terms, has become “trans”. Since 1980, in the DSM-III, even the term “perversion” has been replaced by the politically correct but ambiguous “paraphilia”.

The first question we must ask ourselves, therefore, is whether transvestism and transsexualism can be considered together as one syndrome. The second question is whether it is right to place them among the perversions. This inevitably depends on how we theorize the concept of perversion. In post-Freudian times the term has, in fact, acquired different and progressively extended, diluted, and diversified meanings. The literature on the subject is infinite, although it is not always easy to understand how much the new authors owe to Freud’s primary statements. As far as the pathologies are concerned, there is a disparity of views: some place trans-sexuality among the psychoses (Socarides, 1970), others consider it a precursor of transvestism or homosexuality (Limentani, 1979), a narcissistic disorder (Oppenheimer, 1991; Chiland, 2000) or a borderline disorder (Green, 1986); others, following Lacan, distinguish between psychotic transsexuality and neurotic or perverse forms of transsexualism.

Clinical work today

The clinical material relevant to transvestites and transsexuals is, of necessity, composite and fragmentary. Personally, I have drawn information from psychoanalytic as well as psychotherapeutic experiences, and also from consultations and supervisions. Inevitably, there are few cases of classic psychoanalysis; as we know, these are patients who are unlikely to seek help from our instruments, both because their symptom is egosyntonic and also because they are dominated by the concreteness of the “acting out” in the body and on the body. More often, and unfortunately, our therapy takes place when the damage has already been done following the failure of other strategies (Quinodoz, 1998). This is confirmed by consultations in specialized centres which provide information that, although it is valuable, concerns patients who are already self-selected and who only rarely commit themselves to a classical analysis. On the other hand, I am very sceptical about the clinical work in the centres that carry out sex “changes”, where the patients know that they must convince the psychologist of their authentic motivation. Moreover, the precarious conditions of our public health services usually offer only group therapy or occasional individual interviews of a cognitive type that are of little significance to us.

However, I find that indirect clinical material is useful, such as “occasional findings” during the course of psychoanalysis or psychotherapy undertaken for other reasons.

I take as an example a married man with four children whom he loves dearly. The sexual relationship with his wife is tepid but affectionate. In compensation, he enthusiastically takes part in secret and promiscuous orgies with men. With complete lack of conflict, he greatly enjoys dressing up as a woman at carnival time, or in amateur theatricals, where he acts female parts. He is a successful fashion designer who voluptuously models silks and velvets on himself.

Sometimes, it is the partners of transvestites or transsexuals who ask for a consultation.

A well-dressed and intelligent woman comes to me for treatment. Since childhood she has had a relationship with a pleasant intellectual who makes love—with her consent—dressed and made-up like a woman and calling himself with a woman’s name, but only when they make love. In their own way they have a happy relationship and they would like to have a baby.

The baby is born and the couple separates. She continues her analysis while he withdraws in solitude to meditate whether or not to “come out” about his transvestism to his ten-year-old daughter.

It is important to try to understand analytically the relational dynamics of those who accompany, love, or sometimes sexually exploit transvestites and transsexuals in the “grey zone” on the boundary of so-called normality.

I am thinking of an impeccable, highly-placed civil servant who has come to analysis because of troublesome obsessive symptoms, and who occasionally goes in search of transvestite street prostitutes; he greatly enjoys being penetrated by them and feels no conscious conflict.

We must also remember that the peculiarity of the psychoanalytic approach is that it is more interested in the fantasies that accompany sexuality than in the manifest behaviour. Nowadays, there are frequent cases of parents who are alarmed by the phenomenon of so-called infantile cross-dressing, manifested perhaps in the second year of life. They worry that the infantile transvestism will persist, or that it is the prelude to future homosexuality, while psychoanalysis teaches us that there is no direct correspondence between infantile symptoms and adult pathologies.

Oscar, a little boy of five, with a twin sister, does up his hair with his sister’s ribbons and hair-bands and insists on going to open the door to his father, who reacts with anxiety and anger.

The case of Letizia/Leo

Leo telephones me at the insistence of his doctor who is exasperated by Leo’s insatiable requests for steroids and diets to increase his muscle mass that is always less than he would like it to be in spite of tough and exhausting sessions in the gym every day. For Leo was born twenty-seven years ago as Letizia, a name that seems like a mockery in view of his constant unhappiness.

He comes for a consultation with me: a very small young man, with a simple, clean-looking face, a nice smile and a slight beard. He is dressed simply, in jeans and a black T-shirt that shows off his biceps; his gestures and posture are spontaneously masculine, and it comes naturally to me to address him as a male. I perceive his need for dignity and respect.

He begins by saying that he doesn’t really know why he has come to me, but he feels that “there is something not right”. He tells me that he has always felt alone and misunderstood, but the real tragedy was when he began to menstruate and was forced to admit that he was a girl. From that moment on, he was determined to change sex, which he finally managed to do three years ago, with great sacrifices, in a public health structure. Unfortunately, there have been endless medical–surgical complications that have caused him unspeakable physical suffering, disillusion, and deep anger.

I do not ask him anything about the technical aspects of his operations, for fear of seeming to be invasive and voyeuristic, and I think that this enables me to focus his attention on other aspects of his history.

Gradually, I have the impression of a sensitive, intelligent person, slightly melancholy; in other words, an average neurotic who can benefit from psychoanalysis, except for the nucleus regarding his gender identity that he resists with a rock-hard will. Once, when speaking about his past, I addressed him using a feminine pronoun; he completely froze: “This is not under discussion”, his look seemed to say.

Later on, he tells me that for a long time he has not had love or sexual relationships; he even avoided masturbation because he felt disgusted by his genitals. When he was a teenager he fell in love with a girl who, however, was not interested in him. At the moment, he has a deep relationship with a professional man who is ten years older than himself. More precisely, he, too, is a transsexual: a woman who has become a man. He had been introduced to him by the psychologist of the public health structure (!) with whom he had a long period of group therapy before and after the “re-assignation”.

I point out to him that while, for him, anatomical sex is extremely important, it seems that the sex of the person he loves does not carry the same weight.. “Yes, it was easy! I never thought about it”, he says, struck by my remark. I also think, but I do not tell him, that they have constructed a partnership that is fairly solid, but based on mutual help and affection rather than on sexuality and love.

He then tells me that his mother, devoted and distressed, cared for him while he was in hospital although she was very much against the operation, and this finally brought about a slight reconciliation between the two. Only after many months did he explain to me that he had had breasts, uterus, and ovaries removed, but he had not wanted to have plastic surgery on his genitals. “That wasn’t important”, he said calmly.

He has no plans for further surgery on his genitals that would suit them to his new identity; and I do not think that this is only due to his disillusionment over the mess made by his surgeons. However, he continues to be obsessed by the inadequacy of his muscle mass and his lack of facial hair, the so-called secondary sexual characteristics that should transmit a bodily image of his masculine self that is credible and recognizable as such to other people in his everyday life.

In fact, in Leo’s life, there has been very little space for sexuality as pleasure, either through masturbation or as an encounter with another person. At the conscious level he has desperately pursued his project of becoming a man, or, rather, of having a masculine body corresponding to his life events; but, at the unconscious level, he has had to destroy and eliminate his feminine part which was equivalent to a “bad”, intolerable part that could not be integrated. His masculine pseudo-identity, of an imitative type, must serve to keep away the threat of persecutory anxieties. The deep equivalence is between bad part and drives, expressed within the concreteness of the flesh. The real drama is that, as the therapy proceeds, he will inevitably have to come to terms with the impossibility of becoming a real man, and, on the other hand, the irreparability of the destruction that has been perpetrated on his body as a woman, with his own complicity, and particularly the definitive renunciation of having children.

The case of Claudio/Claudette

Claudio is a big man aged forty-three with the face of a little boy. He has come to consult me from a small town in the south, at the strong insistence of his wife. He owns a small, successful business and they have been married for eight years.

In a childish way, self-accusingly but seeking for my indulgence, he tells me that he has a “nasty habit”: in his free time he likes to dress up exactly like a housemaid, from the frilly cap to the shoes. For some time now he has also worn a brassière and knickers under the uniform. Dressed up like this, he enjoys doing all the housework. Every now and then he lets the neighbours see him from the window or balcony as he shakes out th...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• CONTROVERSIES IN PSYCHOANALYSIS SERIES
• ABOUT THE EDITOR AND CONTRIBUTORS
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Transvestism, transsexualism, transgender: identification and imitation
• CHAPTER TWO Some thoughts on transsexualism, transvestism, transgender, and identification
• CHAPTER THREE Between Scylla and Charybdis: exploring atypical gender identity development in children and adolescents
• CHAPTER FOUR Atypical gender identity development: on biological and psychological factors. Discussion of Domenico Di Ceglie’s paper
• CHAPTER FIVE Transference and countertransference in group analysis with gender dysphoric patients
• CHAPTER SIX Counterpoints
• INDEX