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Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference

Patricia Gherovici

by Patricia Gherovici (2017)

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Synopsis

Patricia Gherovici's Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference (2017) argues that the "transgender moment" does not merely demand that psychoanalysis tolerate gender variance but, more radically, that trans experience can productively reorient the whole of psychoanalytic theory and clinical practice. The book's central thesis is that Lacanian psychoanalysis—unlike ego-psychological, object-relational, or biologistic models—is uniquely equipped to depathologize trans identity because it grounds sexual difference in modes of jouissance and unconscious "sexuation" rather than anatomy, social convention, or Oedipal teleology. Gherovici traces a double movement: a historical-critical arc exposing how psychiatry and psychoanalysis have systematically pathologized gender variance from Stekel and Gutheil through Cauldwell, Benjamin, and Stoller; and a constructive theoretical arc proposing that Lacan's late concept of the sinthome reframes trans experience as a creative symptom—a subjective "knowhow" for making life livable—rather than a sign of psychosis or structural defect. The book interweaves clinical vignettes from the author's practice (Jana, Abioye, Jay, Maxwell, Stanley, Melissa), readings of canonical cases (Elsa B., Henri/Anne-Henriette, Lacan's interview with Primeau, Schreber), and cultural analysis (Caitlyn Jenner, Janet Mock, Candy Darling, Lady Gaga, Ryan Trecartin) to demonstrate that hysteria, far from being a distinct pathological category, functions as a structural analogue to trans experience and as psychoanalysis's inaugural mode of listening to sexual suffering. A concluding argument, built around the figure of Tiresias and Lacan's concept of the clinamen, proposes that assuming a sexed position is itself a sinthome and that analysts must learn from trans patients how to inhabit the non-relation between the sexes with creativity rather than normativity.

Distinctive contribution

What distinguishes this book within the Lacanian corpus is its sustained, clinically grounded argument that trans experience is not an exotic limit-case that tests psychoanalytic categories but rather a privileged site that clarifies those categories—particularly jouissance, sexuation, and the sinthome—by making explicit what is usually invisible in normative subjectivity. Whereas most Lacanian engagements with transgender phenomena (notably Millot's Horsexe) have moved toward pathologization by conflating trans desire with psychotic foreclosure or with the literal confusion of organ and signifier, Gherovici systematically dismantles this tradition from within the Lacanian framework itself. She shows that Lacan's own clinical conduct with Henri/Anne-Henriette and Primeau was more ethically nuanced than his followers acknowledged, and she deploys the sexuation formulae and the sinthome to demonstrate that trans positioning is structurally continuous with the neurotic assumption of any sexed position—that is, with the universal impasse of sexual non-relation.

A second distinctive contribution is the book's rehabilitation of hysteria as a theoretical resource for understanding trans experience. Rather than opposing hysteria (neurosis) to transsexuality (pseudo-psychosis), Gherovici argues that hysteria names the universal structure of human sexuality—its indeterminacy of object, its resistance to anatomy-based closure, its productive untruth—and that trans discourse in particular carries this hysterical structure into the contemporary social field. The genealogy she constructs, from Charcot through Breton and Aragon's surrealist celebration of hysteria to Lacan's "discourse of the hysteric," places trans subjectivity within a long tradition of destabilizing truth-telling rather than pathological simulation. This move is absent from standard Lacanian clinical literature, which tends to treat hysteria and transsexuality as clinically separable and theoretically unrelated.

Third, the book's treatment of the sinthome as a clinical and ethical category—not merely a theoretical novelty—offers practical guidance for analysts working with gender-variant patients. By reading Lacan's Seminar XXIII through the lens of trans case material (the Jay case in Chapter 18 is especially developed), Gherovici shows how the sinthome reframes the goal of analysis: not normalization or the dissolution of symptoms but the cultivation of a creative solution to the non-rapport of the sexes. This allows the book to function simultaneously as a contribution to Lacanian theory, a clinical manual, and a work of cultural analysis, occupying a niche shared by no single other text in the corpus.

Main themes

  • Depathologization of trans experience through Lacanian sexuation and sinthome
  • Hysteria as the structural prototype of trans subjectivity and psychoanalysis's founding mode of listening
  • The sexual non-relation as the universal impasse that both trans and cisgender subjects must creatively negotiate
  • Jouissance, embodiment, and the body as a process of becoming rather than anatomical given
  • Historical critique of psychoanalysis's normative and pathologizing engagement with gender variance
  • The sinthome as creative symptom: trans transition as 'making life livable' rather than as pathology
  • Beauty, aesthetics, and the death drive as intersecting dimensions of gender transition
  • The ethics of analytic listening: the analysand as the only specialist on their own unconscious
  • Plasticity (Malabou, Giddens) as a framework for thinking bodily and sexual transformation
  • Tiresias as patron saint of analysis: the analyst's obligation to inhabit both sexes and learn from trans experience

Chapter outline

  • Introduction: The Moment Is Now / Transitions — p.1-22
  • Chapter 1: Transamerica — p.11-18
  • Chapter 2: Depathologizing Trans — p.19-26
  • Chapter 3: Gender in the Blender — p.27-34
  • Chapter 4: Bring Sex Back — p.35-40
  • Chapter 5: Strange Bedfellows: Psychoanalysis and Sexology — p.41-47
  • Chapter 6: Changing Sex, Changing Psychoanalysis — p.48-54
  • Chapter 7: A Natural Experiment — p.55-62
  • Chapter 8: From Trance to Trans in Lacan's Revisions of Hysteria — p.63-68
  • Chapter 9: Simulation, Expression, and Truth — p.70-80
  • Chapter 10: The Sweet Science of Transition — p.81-86
  • Chapter 11: The Singular Universality of Trans — p.87-93
  • Chapter 12: Portraits in a Two-Way Mirror — p.94-101
  • Chapter 13: Plastic Sex, The Beauty of It — p.103-114
  • Chapter 14: That Obscure Object: From Beauty to Excrement — p.117-128
  • Chapter 15: Freud's Scatalog — p.128-134
  • Chapter 16: The Art of Artifice — p.135-139
  • Chapter 17: Clinic of the Clinamen — p.140-148
  • Chapter 18: Making Life Livable — p.149-158
  • Chapter 19: Body Trouble — p.160-167
  • Coda: Phallus Interruptus, or the Snakes' Lesson — p.168-169

Chapter summaries

Introduction: The Moment Is Now / Transitions *(p.1-22)*

The introduction situates the book within the 'transgender moment'—the rapid mainstreaming of trans visibility in American culture from roughly 2010 to 2016—and argues that this moment both demands and enables a realignment of psychoanalytic practice. Gherovici uses the high-profile transitions of Caitlyn Jenner and the racial-identity controversy around Rachel Dolezal to frame the book's central theoretical stake: identity is a construction, not a natural essence, and transgender experience makes this visible in a way that has implications for all forms of identity (gender, race, sexuality, nationality). The analogy between naturalization and gender amendment—both lengthy, authority-dependent processes of legal and social recognition—introduces Lacan's self-description as 'a poem being written' to ground the argument that the subject is an open, creative process.

The introduction also announces the book's double agenda: to assess psychoanalysis's historically normative, pathologizing stance toward trans people and to show that Lacanian theory—especially sexuation and sinthome—offers a genuinely depathologizing alternative. Gherovici previews the chapter arc, from cultural analysis and historical critique through clinical case material to the theoretical innovation of the clinamen and sinthome, making clear that the book moves from symptom to creative solution, from social visibility to subjective singularity.

Key concepts: Sexuation, Sinthome, Identity, Jouissance, Symbolic Castration, Phallus Notable examples: Caitlyn Jenner's public transition; Rachel Dolezal's racial identity controversy; Lacan's preface to Seminar XI describing himself as 'a poem being written'

Chapter 1: Transamerica *(p.11-18)*

This chapter opens by mobilizing Lacan's 1957 concept of 'urinary segregation'—from 'The Instance of the Letter'—to read the contemporary American bathroom debate as a structural impasse of sexual difference. The restroom signs 'Ladies' and 'Gentlemen' operate not as anatomical descriptions but as signifiers that force a binary choice, and Lacan's anecdote of the brother and sister on a train is reread as a parable of transition: neither child has actually arrived at the place the sign names, yet each is compelled to choose. This reframing insists that sexual difference is a linguistic, not biological, determination.

The chapter then turns to Jean Baudrillard's claim that 'we are all transsexuals now'—that trans bodies are symptoms of a universal simulation of sex—and subjects it to critique. For Gherovici, Baudrillard's reading reduces trans experience to a postmodern sign-game and dissolves the specificity of trans suffering: trans subjects are not escaping sexual difference but are caught more acutely within its impasse. The chapter closes by examining Janet Mock's trajectory as a media figure, arguing that Mock's strategic deployment of beauty and 'realness' constitutes an ethical affirmation of singular existence against the voyeuristic reduction of trans people to their genitalia.

Key concepts: Sexual Non-Relation, Imaginary, Symbolic, Phallus, Objet petit a Notable examples: Lacan's 'urinary segregation' from Écrits; Baudrillard on transsexuality as simulation; Janet Mock's 'Redefining Realness' and the Piers Morgan controversy; Zackary Drucker and Rhys Ernst's art project 'Relationship'

Chapter 2: Depathologizing Trans *(p.19-26)*

This chapter makes the book's core clinical and ethical argument: transgender identity is not a mental disorder, and the elevated rates of psychological distress and suicide in trans populations are caused by social stigmatization and marginalization, not by gender incongruence itself. Gherovici surveys epidemiological data (the 2011 Williams Institute study, the Karolinska Institute's thirty-year follow-up study, and the 41 percent suicide-attempt rate in the U.S. trans population) to establish that the mental health crisis is a product of injustice rather than intrinsic pathology. She argues that reclassification—removing trans identity from DSM—is both clinically necessary and politically urgent.

The chapter then introduces the key Lacanian concepts that underpin the book's theoretical alternative. The analogy between cisgender and naturalized citizenship—both processes through which an apparently 'natural' identity is legally and institutionally conferred—introduces the idea that gender is not destiny but construction. Drawing on Lacan's notion of sexuation, Gherovici argues that the unconscious sexual positioning that constitutes one's relation to sexual difference is neither anatomically determined nor socially prescribed but is rather a subjective, unconscious choice that may or may not align with the body or with social convention. The sinthome is introduced in its depathologizing register: a trans symptom is not a manifestation of disease to be eliminated but a creative solution—a way of making life livable.

Key concepts: Sinthome, Sexuation, Symptom, Clinical Structures, Identification, Psychosis Notable examples: Karolinska Institute thirty-year follow-up study on trans suicide; DSM-5 Gender Dysphoria classification; Lacan's preface to Seminar XI on identity as poem

Chapter 3: Gender in the Blender *(p.27-34)*

Opening with two clinical vignettes—Jana, a trans woman in her sixties beginning transition, and Abioye, a nineteen-year-old trans man already committed to hormone therapy—this chapter models the analytic stance Gherovici advocates: non-normative, open, and guided by free association rather than diagnostic expertise. The analyst is described as 'never a specialist' in the sense that analytic listening refuses to pre-determine what the patient's sexual truth should look like. Gherovici notes a historical shift in her clinical experience: questions have moved from 'Who do I desire?' to 'What am I?' and, for trans patients, 'Why can't I be loved for who I am?'

The theoretical core of the chapter develops Lacan's sexuation formulae as a framework for thinking beyond the boy/girl binary. Lacan's 1972 reformulation locates sexual difference not in anatomy but in two modes of jouissance—phallic (masculine side) and Other (feminine side, the 'not-all')—such that 'man' and 'woman' are signifiers of uncertain meaning, positions relative to the phallus rather than biological categories. Gherovici follows Ian Parker's formulation that gender is 'an imaginary effect of a real difference' to argue that the sexuation formulae can accommodate trans and non-binary analysands who do not identify with either pole of the binary or who inhabit a space 'between genders.' The chapter concludes that body-gender consistency is a fiction constituted through identification, and that trans experience makes this universal fiction explicit.

Key concepts: Sexuation, Jouissance, Phallus, Imaginary, Real, Identification Notable examples: Jana case (trans woman in transition); Abioye case (trans man beginning HRT); Facebook's 56–71 gender options; Ian Parker on the phallus as signifier

Chapter 4: Bring Sex Back *(p.35-40)*

This chapter diagnoses what Gherovici calls psychoanalysis's 'major sex problem': the progressive desexualization of the field through the dominance of object-relations, attachment theory, and relational frameworks, at the expense of Freud's foundational insight into the constitutive negativity of human sexuality. She cites André Green's exasperated question 'Has sexuality anything to do with psychoanalysis?' as symptomatic of this regression and argues that the suppression of sexuality from psychoanalytic discourse constitutes both a clinical failure and a theoretical betrayal of Freud.

The chapter recruits Alenka Zupančič's argument—that the sexual is inherently identity-disrupting, that it introduces a 'non-all' that prevents any identity from closing upon itself—as a resource for diagnosing this suppression and calling for a renewed engagement. Gherovici argues that transgender discourse, far from being peripheral to psychoanalytic theory, is a site of 'fruitful contestation' (Carlson) that restores sexuality to the center of psychoanalytic inquiry. The clinical literature on trans analysands—when it exists at all—tends to be dominated by discussions of countertransference, which Gherovici reads as confirming Lacan's observation that 'there is no other resistance to psychoanalysis than the analyst's.'

Key concepts: Jouissance, Sexual Non-Relation, Unconscious, Drive, Transference, Ethics of Psychoanalysis Notable examples: André Green's 'Has Sexuality Anything to Do with Psychoanalysis?'; Alenka Zupančič on sex and ontology; Lothstein's 1970s paper on negative countertransference with trans patients

Chapter 5: Strange Bedfellows: Psychoanalysis and Sexology *(p.41-47)*

This chapter reconstructs the prehistory of psychoanalysis as a theory of sexuality by narrating the famous 'whisperings' Freud overheard or received before he formalized the sexual aetiology of neurosis: Charcot's 'c'est toujours la chose génitale,' Breuer's remark about 'secrets d'alcôve,' and Chrobak's prescription 'penis normalis, dosim repetatur.' These anecdotes are read not as curiosities but as demonstrations that the sexual truth of symptoms was already 'known' by medicine before Freud, and that Freud's contribution was to formalize what others could not say—a retroactive discovery in the psychoanalytic sense.

The chapter then traces the parallel history of sexology—Ulrichs's argument for 'a woman's mind trapped in a man's body,' Hirschfeld's biological turn, Steinach's gonadal experiments—to show how the biologization of sexuality produced categories (homosexuality as brain difference, transsexuality as hormonal condition) that still haunt contemporary neuroscience. Foucault's History of Sexuality is cited to argue that psychoanalytic categories are not merely referenced but foundational to any theorization of transsexuality: the interrelatedness of psychoanalysis and trans experience 'is not just referential, it is foundational.' The chapter establishes Freud's constitutive non-essentialism—his separation of the drive from instinct and from any predetermined object—as the theoretical basis for a non-normative psychoanalytic approach to trans.

Key concepts: Drive, Unconscious, Partial Drive, Oedipus Complex, Castration, Jouissance Notable examples: Charcot's Salpêtrière anecdote on 'la chose génitale'; Ulrichs and 'anima muliebris corpore virili inclusa'; Hirschfeld and Steinach's gonadal experiments; Foucault's History of Sexuality as 'archaeology of psychoanalysis'

Chapter 6: Changing Sex, Changing Psychoanalysis *(p.48-54)*

Gherovici provides an intellectual history of the terminology of trans identity in psychoanalysis, beginning with Stekel's systematization of 'paraphilia'—a term she reads as semantically parallel to 'parapraxis,' which normalizes deviation by placing it on a continuum with everyday slips of ordinary life. The chapter gives a detailed reading of Emil Gutheil's case of Elsa B. (early 1920s), described as probably the first psychoanalytic treatment of a transgender patient. Elsa, a thirty-four-year-old government official, entered analysis not to be 'cured' but to obtain the analyst's endorsement for wearing male clothing in public—a situation Gherovici reads as anticipating the contemporary requirement that trans people obtain a clinician's letter to access gender-affirming care.

Gherovici is attentive to the ways Gutheil's analysis, while framing Elsa's gender variance through the categories of fetishism, penis envy, and castration anxiety, also inadvertently reveals a subject who clearly does not regard her sexuality as pathological, who insists it 'not infringe upon the rights of anyone,' and who wants only to 'live a more human and happy life.' Elsa's self-understanding anticipates a non-pathological, subject-centered account of trans identity. The chapter uses this historical case to demonstrate the systematic subordination of clinical nuance to normative medical categories, a pattern it identifies as constitutive of the post-Freudian tradition.

Key concepts: Symptom, Analysand, Castration, Phallus, Hysteria, Clinical Structures Notable examples: Elsa B. case (Gutheil, early 1920s); Stekel's 'Sexual Aberrations' and the concept of paraphilia; Freud's 'Psychopathology of Everyday Life' and parapraxis as normalizing frame

Chapter 7: A Natural Experiment *(p.55-62)*

This chapter traces the construction of 'transsexualism' as a clinical category from Cauldwell (1949) through Harry Benjamin and Robert Stoller, showing how the fundamental tension between biological and psychological etiologies structured the field. Cauldwell, despite his initial pathologizing, eventually asked 'Are transsexuals crazy? One may as well ask whether heterosexuals are crazy'—a proto-depathologizing move that the mainstream failed to pursue. Benjamin's somatic/psychic distinction and advocacy for surgical treatment represented a pragmatic intervention that effectively excluded psychoanalysis from trans care, while Stoller's 'natural experiment' framework—treating trans patients as a 'petri dish' for testing Freudian theories of sexual development—maintained an Oedipal teleology that continued to produce pathologizing conclusions (excess mother-son symbiosis, absent father, 'wrong' identifications).

Gherovici uses the historical analysis of Stoller to argue that the systematic blame directed at trans experience on identifications with the 'wrong' parent reveals the normative assumptions built into the Freudian-Oedipal model itself. She introduces the historical parallel of homosexuality—once classified as pathology by psychoanalytic institutes for decades after the APA's 1973 declassification—as an epistemological model for how psychoanalysis might now revise its stance on trans identity. Freud's own non-pathologizing view of homosexuality ('a variation of the sexual function, as inexplicable as heterosexuality') is cited as evidence that the normative tradition betrayed the Freudian spirit.

Key concepts: Clinical Structures, Psychosis, Identification, Oedipus Complex, Sexuation, Symptom Notable examples: Cauldwell's 'Psychopathia Transexualis' (1949); Harry Benjamin's somatic/psychic distinction; Stoller's 'excess mother-son symbiosis' theory; Freud's 1935 letter to the mother of a gay son

Chapter 8: From Trance to Trans in Lacan's Revisions of Hysteria *(p.63-68)*

This chapter introduces Karl Abraham's case of 'E'—a biological male who wished to be a woman and entered trance-like dream states of ecstatic femininity—and argues that Abraham's framing of the case as one of repressed homosexuality and hysterical day-dreaming is clinically more revealing than it appears: it demonstrates the intimate structural relationship between trans desire and hysteria. Gherovici uses the case to introduce the concept of jouissance as the organizing principle of sexual positioning in Lacan's framework: the body represents the descent into death (the death drive), and jouissance emerges in the body as the site where the drive inscribes the subject's mode of being.

The chapter then engages with Lacan's 1951 'Presentation on Transference' and his reading of the Dora case as the pivot through which Lacanian theory reconceptualizes hysteria. Lacan's application of Hegel's concepts—the 'beautiful soul' and 'dialectical reversals'—to Dora's case shows that the hysteric's desire is the Other's desire, that hysteria names the indeterminacy of the sexual object. The drive's circuit 'swerves' through partial objects (Lacan's montage image from Seminar XI—'a dynamo connected up to a gas-tap, a peacock's feather emerges, and tickles the belly of a pretty woman'—is quoted), and this swerve is homologous to the 'skewed relation' (rapport de travers) that separates the subject from sex. Hysteria and trans experience share this structural feature.

Key concepts: Hysteria, Jouissance, Drive, Partial Drive, Death Drive, Objet petit a Notable examples: Karl Abraham's case of 'E' (hysterical day-dreaming and trans wish); Lacan's 'Presentation on Transference' on the Dora case; Freud's 'Fragment of an Analysis of a Case of Hysteria' (Dora); Lacan's montage image of the drive from Seminar XI

Chapter 9: Simulation, Expression, and Truth *(p.70-80)*

This chapter traces the suppression and reinvention of hysteria in early twentieth-century France, focusing on Babinski's 'pithiatism'—the reduction of hysteria to simulation curable by suggestion—and the Surrealists' counter-celebration of hysteria as 'the greatest poetic discovery of the end of the nineteenth century.' Gherovici shows that Lacan's intellectual formation was shaped less by medical literature than by Surrealism, and that his 'return to Freud' was fundamentally a return to hysteria as the royal road to the unconscious truth. Lacan's early case of the war veteran with abasia (co-authored with Trénel, 1928) is cited as his first clinical engagement with the problem of hysteria, and the chapter reads Lacan's move from 'simulation' (Babinski's thesis) to 'stimulation' (the demand for truth) as the key transformation.

The theoretical centerpiece is Lacan's theory of the four discourses, developed in Seminar XVII. Gherovici focuses on the 'discourse of the hysteric' as an innovation that allows Lacan to address hysteria not as a clinical entity but as a form of social bond—a way of producing knowledge by posing an unanswerable question. Hegel is identified as 'the most sublime of the hysterics' (Lacan's formulation from Seminar XVII), and Gherovici argues that the hysterical discourse has a structural affinity with trans discourse: both challenge normativity, demand truth-telling, and operate through a productive lie (prôton pseudos). The chapter closes by urging analysts to receive trans patients as Freud received his first hysterics—listening rather than displaying.

Key concepts: Hysteria, Jouissance, Unconscious, Symbolic, Desire, Sinthome Notable examples: Babinski's 'pithiatism' and dismemberment of hysteria; Breton and Aragon's 1928 surrealist manifesto on hysteria; Lacan and Trénel's 1928 case of abasia in a war veteran; Lacan's four discourses and the 'discourse of the hysteric' (Seminar XVII); Freud's 'prôton pseudos' in the Emma case

Chapter 10: The Sweet Science of Transition *(p.81-86)*

Drawing on Juan-David Nasio's argument that the hysteric is fundamentally 'outside sex'—neither man nor woman, structured by an irreducible indecision about sexual positioning—Gherovici proposes a structural parallel between hysteria and trans experience that has both clinical and political implications. Nasio's claim that the hysteric has not managed to 'appropriate the sex of his body' is compared to Millot's concept of horsexe ('outside sexuality' as the defining feature of transsexuality), and Gherovici argues that being 'hors-sex' is not necessarily a sign of psychosis but of the most classical neurotic structure. As Shanna Carlson observes, the difference between trans subjects and cisgender subjects may be that the latter enjoy a 'false monopoly' on the 'psychic experience of the semblance of gender certainty.'

The chapter introduces clinical material on trans men in the author's practice who identify as hysterics—subjects for whom the question 'Am I a man or a woman?' is experienced as genuinely open—and argues that this openness is the normal condition of human sexuality, temporarily stabilized by the fiction of gender identity. Preciado's Testo Junkie is cited to link pharmacological self-experimentation to the hysteric's demand for knowledge about the body. The chapter concludes with a reading of the Olympics controversy over intersex athletes to argue that the hysteric's discourse is a collective social bond—a demand for sexualized knowledge—that the trans moment makes particularly visible.

Key concepts: Hysteria, Jouissance, Sexuation, Sexual Non-Relation, Clinical Structures, Phallus Notable examples: Nasio's 'Hysteria from Freud to Lacan' on hysteria as 'outside sex'; Millot's 'horsexe' concept; Preciado's 'Testo Junkie' on pharmacological self-experimentation; Olympics controversy over Caster Semenya

Chapter 11: The Singular Universality of Trans *(p.87-93)*

This chapter focuses on two clinical encounters Lacan had with trans patients—Henri/Anne-Henriette (treated weekly at Sainte-Anne Hospital between 1952 and 1954) and the psychotic Primeau (interviewed before a clinical audience and transcribed by Stuart Schneiderman)—to argue that Lacan's clinical conduct expressed an ethics of sexual difference that his followers, particularly Millot, subsequently distorted. Henri's case is presented in detail: born with cryptorchidism and assigned female at birth, Henri lived as a man from age sixteen under paternal injunction ('You can't help but make a choice'), sought gender realignment surgery, and found in Lacan 'an unrivaled understanding.' Gherovici reads this case as evidence that Lacan did not approach trans requests as categorical manifestations of psychosis but rather with ethical prudence and attention to the particular.

The Primeau case is used to examine Lacan's formulation that transsexuals 'confuse the organ with the signifier'—conflating the penis (organ) with the phallus (signifier)—and to argue that this confusion, while it can lead to 'push towards woman' (pousse-à-la-femme) in psychotic structures, does not define all trans experience. Gherovici critically examines Millot's reading of Lacan's 'mon pauvre vieux' remark to Primeau as an ethical reminder of masculinity, contrasting it with Schneiderman's transcription, which shows a more dialogical and curious engagement. The chapter deploys the Schreber case as a further triangulation point, noting Lacan's attentiveness to the dimension of transsexual enjoyment in Schreber's memoirs as distinct from Freud's hypothesis of repressed homosexuality.

Key concepts: Psychosis, Phallus, Jouissance, Sinthome, Symptom, Name of the Father Notable examples: Henri/Anne-Henriette case (Lacan at Sainte-Anne, 1952–54); Primeau case (Lacan's clinical interview, transcribed by Schneiderman); Schreber's 'Memoirs of My Nervous Illness'; Millot's 'Horsexe' and critique thereof

Chapter 12: Portraits in a Two-Way Mirror *(p.94-101)*

This chapter consolidates the historical and clinical survey by asking what unifies the disparate cases examined so far—Elsa B., E, Primeau, Henri, Schreber—and what a contemporary analyst should do with this convergence. Gherovici argues that the analyst's first obligation is to distinguish clinical structures: the range extends from hysteria (Elsa, E) to paranoia (Schreber), and the symptom's content is always drawn from the cultural materials available in a given historical moment (what Schreber experienced as divine rays would become, for later patients, radio transmitters, then computer hackers). Clinical structures are distinguished; cultural contents vary.

The chapter's theoretical core is a reading of Freud's two 'mistakes'—the presentation of a case of male hysteria that violated the etymology of hystera (uterus), and the invention of the castration complex through a confusion of penectomy with castration—as productive errors that, like the hysteric's prôton pseudos, opened new theoretical vistas precisely by failing to be definitionally correct. Gherovici uses Lacan's more rigorous distinction between symbolic castration and anatomical mutilation to show that castration is a signifying operation, not a biological event, and that the Oedipal model's apparent reliance on anatomy conceals a more radical claim about the relationship between the subject and the signifier. A clinical vignette of Melissa—a heterosexual female analysand tormented by anxiety about her desire—is introduced to show that castration anxiety is not a uniquely trans phenomenon but a universal feature of sexuated subjectivity.

Key concepts: Hysteria, Psychosis, Castration, Symbolic Castration, Oedipus Complex, Clinical Structures Notable examples: Freud's 1886 Vienna lecture on male hysteria; Schreber's rays vs. Tausk's 'influencing machine'; Melissa case (anxiety and castration); Lacan's distinction between symbolic and real castration

Chapter 13: Plastic Sex, The Beauty of It *(p.103-114)*

This chapter introduces 'plasticity' as a conceptual framework spanning Hegel's aesthetics of Greek sculpture, Catherine Malabou's philosophical elaboration of plasticity as form-giving and form-receiving capacity, Anthony Giddens's sociological concept of 'plastic sexuality' (the malleability of erotic expression freed from reproduction), and the clinical reality of gender transition. Gherovici argues that trans experience makes explicit a universal process of embodiment—the need for every subject to bridge the gap between the given corporeal contours of flesh and the livable body—and that Lacan's mirror stage provides the psychoanalytic framework for understanding how specular identification 'dresses the flesh.'

The chapter develops this through a clinical vignette of Maxwell, a trans man in his late thirties whose account of transition as 'the most amazing and horrific experience one can go through' is read alongside Angelina Jolie's preventive double mastectomy to argue that sexual identity transcends anatomy. The figure of Candy Darling—Andy Warhol's transgender icon whose beauty oscillated between camp femininity and androgyny—is analyzed as an aesthetico-ethical affirmation of existence against the death drive: Darling's final photograph, taken by Peter Hujar as she lay dying, presents beauty as a 'denial of death.' The chapter concludes with Ryan Trecartin's video art as an example of how plasticity can free sexuality from phallic constraint and turn gender variance into a 'joyous, even riotous celebration.'

Key concepts: Jouissance, Death Drive, Mirror Stage, Sublimation, Phallus, Objet petit a Notable examples: Candy Darling (Andy Warhol superstar); Maxwell case (trans man); Angelina Jolie's preventive mastectomy; Catherine Malabou on plasticity; Ryan Trecartin's video art; Anthony Giddens's 'plastic sexuality'

Chapter 14: That Obscure Object: From Beauty to Excrement *(p.117-128)*

Beginning with Daniel Paul Schreber's wish that it would be 'rather beautiful' (recht schön) to be a woman submitted to God's copulation, this chapter traces the connection between beauty, aesthetics, and the trans-sexual delusion through a detailed reading of Schreber's Memoirs and Lacan's engagement with the case. Lacan's reading of Schreber is distinguished from Freud's (repressed homosexuality) by its focus on the dimension of 'transsexual enjoyment' and the aesthetic dimension: the coexistence in Schreber's delirium of the most repulsive excrement and the most beautiful image. The elder Schreber's pedagogical obsession with bodily beauty (Callipedia or Education towards Beauty) is read as the paternal background against which the son's 'miraculous' feminine transformation must be understood.

From this aesthetic-excremental paradox, the chapter develops Freud's equation of feces, money, gift, baby, and penis as a chain of symbolic equivalences in the unconscious, and Lacan's extension of this chain through the concept of objet petit a. The anal object is introduced as the model of primordial subjective loss—the first part of the body one must give up as a token of love—and as the entryway into the castration complex. Gherovici argues that this object is non-gendered and therefore a more universal model of subjective loss than the phallus, applying equally to cis and trans subjects. The chapter draws on Deleuze and Guattari's anti-Oedipal reading of Schreber's body as a 'body without organs' but ultimately maintains a Lacanian insistence on the structural necessity of loss.

Key concepts: Objet petit a, Jouissance, Sublimation, Psychosis, Castration, Drive Notable examples: Schreber's 'Memoirs of My Nervous Illness'; Elder Schreber's 'Callipedia or Education towards Beauty'; Deleuze and Guattari's Anti-Oedipus on Schreber; Freud's anal erotism and symbolic equivalences

Chapter 15: Freud's Scatalog *(p.128-134)*

This chapter elaborates the theory of the anal object developed in the previous chapter through a reading of Freud's preface to John Bourke's Scatological Rites of All Nations and of Lacan's development of excrement as the model for objet petit a. Lacan's claim that the anal object is not gendered—that 'whether or not we're all missing the phallus, certainly we've all lost objects from the anus' (Tim Dean is cited)—establishes excrement as the universal model of subjective loss and the inaugural form of the gift-to-the-Other.

Gherovici traces how potty training—the mother's demand that the child control its sphincter—elevates excrement to the status of agalma, the precious object hidden in Socrates's ugly body, and how this demand institutes the child's first encounter with symbolic castration. The chapter connects this theory of the anal object to the beauty/ugliness paradox from the previous chapter: Schreber's aesthetic trans-formation and the excremental Real that subtends it are two faces of the same subjective structure. The film The Crying Game is read as a cultural illustration of the reversibility of desire and disgust, and Freud's reflections on the 'hidden parts' of the body as simultaneously most arousing and least 'beautiful' are used to introduce the concept of sublimation as a detour from genital ugliness toward art.

Key concepts: Objet petit a, Jouissance, Sublimation, Castration, Symbolic Castration, Drive Notable examples: Freud's preface to Bourke's 'Scatological Rites of All Nations'; Lacan on excrement as agalma (Seminar X); Film 'The Crying Game' (1993); Freud's Three Essays on sexuality and disgust

Chapter 16: The Art of Artifice *(p.135-139)*

This chapter takes as its subject Swift Shuker's online performance project This Damned Body: A Living Archive of Transformation, a multi-year digital art project documenting the transition from a male body to an androgynous one, presented at Philadelphia's Fringe Arts festival. Gherovici reads the project as an exemplification of the sinthome-as-art: the body becomes an archive, writing is inscribed on skin ('NOT IDEAL,' 'FAKE,' 'HIGH'), and the performance enacts the process of embodiment as a creative act that bridges the gap between flesh and livable subjectivity.

The chapter connects this to the theory of the sinthome as an Ego scriptor—a writing self that reclaims the body and crafts a livable life when corporeal reconstruction alone is insufficient. Gherovici argues that for some trans subjects, transition is not merely a medical process but an artistic one in which the body becomes the medium of a creative symptom. This connects to Lacan's reading of Joyce—whose enigmatic writing in Finnegans Wake functioned as a corrective device to repair a fault in the knotting of Real, Symbolic, and Imaginary—and to the general principle that the symptom's 'formal envelope,' as Lacan observed in his doctoral thesis on Aimée, can become 'pure creativity.'

Key concepts: Sinthome, Jouissance, Real, Symbolic, Imaginary, Sublimation Notable examples: Swift Shuker's 'This Damned Body: A Living Archive of Transformation'; Lacan's reading of Joyce's sinthome (Seminar XXIII); Lacan's doctoral thesis on Aimée

Chapter 17: Clinic of the Clinamen *(p.140-148)*

This chapter develops the theoretical concept of the 'clinamen'—Lucretius's Latin term for the unpredictable atomic swerve that, for Epicurean atomism, produces bodies out of the void by introducing irregularity into parallel streaming—as a figure for the logic of the sinthome. Gherovici draws on Lacan's deployment of the Aristotelian couple tuché/automaton in Seminar XI to show that the encounter with the Real always involves an accident, a 'clinamen,' that determines the subject's trajectory. The sinthome, like the clinamen, is a fourth term that introduces a singularity into the lawful repetition of the Borromean knot, holding together Real, Symbolic, and Imaginary when the knot begins to unravel.

The clinical implications are developed through a reading of Lacan's Seminar XXIII on Joyce: Joyce's writing compensated for a fault in the knotting of his psychic structure and saved him from insanity by creating a new ego through artifice—a 'signature' of singularity. Gherovici argues that a similar logic applies to trans transition: where the sinthome fails, the body 'falls away like the skin of a fruit' (Lacan's phrase about Stephen Daedalus), and only an Ego scriptor capable of reclaiming the body as creative work can repair the fault. The chapter positions this 'clinic of the clinamen' as a practical alternative to both normative cure and permanent pathologization.

Key concepts: Sinthome, Real, Imaginary, Symbolic, Jouissance, Symptom Notable examples: Lacan on Joyce and the sinthome (Seminar XXIII); Lucretius's clinamen from 'On the Nature of Things'; Lacan on Stephen Daedalus and the body as foreign wrapping; Lacan's Seminar XI on tuché and automaton

Chapter 18: Making Life Livable *(p.149-158)*

This is the book's most extended clinical chapter, presenting the case of Jay in detail. Jay is a trans man in his late thirties who entered analysis presenting with what he described as a 'mild addiction problem'—drug and alcohol use organized as calculated self-infliction of pain. His gender transition (testosterone, top surgery a decade earlier) had 'more or less reconciled' him with his body, but new somatic symptoms—constantly evolving body pains—resisted symbolic interpretation and appeared closer to the Real of the body-as-flesh than to the jouissance of the speaking body. Gherovici tracks the treatment's evolution: Jay's initial resistance to speaking, the emerging transference, the volatile relationship with a younger partner (Marty), the gradual recognition that his quasi-manic drive to create an omnipotent Other was a defense against a foundational solitude.

The therapeutic turning point arrives when Jay's drug 'crises'—read as 'cry-ses,' appeals to an absent Other—give way to a new engagement with music: he sells his restaurant, opens a music shop, begins performing. Gherovici reads this as the emergence of a sinthome through the invocatory drive (voice/sound), transforming an 'aphonic' internal voice of reproach into an acoustic field shared with others. The case exemplifies the book's argument that assuming a sexed body sometimes requires the knowhow granted by a sinthome—a creative solution to the non-rapport of the sexes—and that this solution need not take the form of anatomy but can be an artistic, relational, or vocational practice that 'makes life livable.'

Key concepts: Sinthome, Jouissance, Analysand, Transference, Drive, Objet petit a Notable examples: Jay case (trans man, drug use, music as sinthome); Lacan's Seminar XXII (RSI) on the Borromean knot; Verhaeghe on romantic relationships and the sexual non-rapport

Chapter 19: Body Trouble *(p.160-167)*

The chapter opens with the remarkable early twentieth-century memoir of N. O. Body—Karl M. Bauer, born intersex in 1884, raised as Martha, who transitioned to Karl at twenty-two following a doctor's declaration 'You are as much a man as I am!'—to demonstrate the historical depth and universality of trans experience. Gherovici uses the memoir's author's pseudonym ('N. O. Body' / 'Nobody') to articulate the psychoanalytic claim that the body is not a given but a construction: 'one has one's body, one is not one's body in any degree' (Lacan). The memoir, endorsed by Magnus Hirschfeld's epilogue, is positioned as an early document of depathologized trans identity.

The chapter then turns to Lady Gaga's 'Born This Way' and J. Jack Halberstam's concept of 'Gaga feminism' to argue that the celebration of gender artifice—'pheminism'—represents a political aesthetics of body trouble. Gherovici is not uncritical: Halberstam's warning to 'forget about Born This Way' (its essentialism) is noted, but the chapter finds in Gaga's contradictions a liberatory anthem precisely because those contradictions replicate the structure of the drive—non-normative, non-teleological, attached to partial objects. The chapter closes with a clinical meditation on the drives, following Lacan's claim in Seminar XI that drives are 'the echo in the body of the fact that there is a saying,' connecting bodily trans experience to the speaking subject's fundamental constitutive incompleteness.

Key concepts: Drive, Partial Drive, Death Drive, Jouissance, Mirror Stage, Identification Notable examples: N. O. Body's 'Memoirs of a Man's Maiden Years' (Karl Bauer, 1907); Lady Gaga's 'Born This Way' and Halberstam's 'Gaga Feminism'; Hirschfeld's epilogue to N. O. Body's memoir; Lacan's Seminar XI on drives as echo of the saying

Coda: Phallus Interruptus, or the Snakes' Lesson *(p.168-169)*

The coda proposes the mythic figure of Tiresias—the seer who changed sex twice after intervening in snakes' copulation, and who revealed to Jupiter that women enjoy sex nine times more than men—as the patron saint of the psychoanalyst. Lacan had invoked Tiresias in 1963, and Gherovici reads his double sex-change as a figure for the analyst's obligation to have experienced both sides of the sexual divide and to embody 'a desire for pure difference.' The analyst must, like Tiresias, have something to say about jouissance from both sides of the sexuation formulae.

The coda makes explicit the book's final argument: that for transference to take place, the analyst must embody the objet a for the analysand—being 'analysts only insofar as they are object, the object of the analysand' (Lacan). Lacan's remark that 'it is not enough that the analyst should support the function of Tiresias; he must also, as Apollinaire tells us, have breasts,' is read as an injunction for analysts to learn from the trans experience rather than to treat it. Tiresias's wisdom—that what matters fundamentally is jouissance, not anatomy—is the book's concluding formulation of a Lacanian ethics of sexual difference.

Key concepts: Jouissance, Sexuation, Transference, Ethics of Psychoanalysis, Objet petit a, Sexual Non-Relation Notable examples: Tiresias myth (Ovid's Metamorphoses); Lacan's invocation of Tiresias as patron saint of analysts (1963 Seminar on Anxiety); Apollinaire on the analyst needing 'breasts'; T. S. Eliot's Tiresias (Lacan's wartime translation)

Main interlocutors

  • Jacques Lacan, Écrits
  • Jacques Lacan, Seminar XI (The Four Fundamental Concepts of Psychoanalysis)
  • Jacques Lacan, Seminar XVII (The Other Side of Psychoanalysis)
  • Jacques Lacan, Seminar XIX (... ou pire)
  • Jacques Lacan, Seminar XX (Encore)
  • Jacques Lacan, Seminar XXIII (Le sinthome)
  • Sigmund Freud, Three Essays on the Theory of Sexuality
  • Sigmund Freud, Beyond the Pleasure Principle
  • Sigmund Freud, Fragment of an Analysis of a Case of Hysteria (Dora)
  • Hegel, Phenomenology of Spirit
  • Catherine Millot, Horsexe
  • Daniel Paul Schreber, Memoirs of My Nervous Illness
  • Paul B. Preciado, Testo Junkie
  • Slavoj Žižek, The Sublime Object of Ideology
  • Jean Laplanche
  • Alenka Zupančič
  • Karl Abraham
  • Robert Stoller
  • Magnus Hirschfeld
  • Michel Foucault, History of Sexuality
  • Catherine Malabou, The Future of Hegel
  • Deleuze and Guattari, Anti-Oedipus
  • Joan Copjec
  • Gayle Salamon
  • Juan-David Nasio
  • J. Jack Halberstam

Position in the corpus

Transgender Psychoanalysis occupies a singular position in the Lacanian secondary corpus as the most sustained, clinically grounded, and theoretically comprehensive attempt to think trans experience through Lacanian categories while simultaneously using trans experience to revise those categories. Its nearest neighbors are Gherovici's own earlier Please Select Your Gender (Routledge, 2010), which covers some of the same historical and clinical ground but lacks the full elaboration of the sinthome and clinamen frameworks developed here; Oren Gozlan's Transsexuality and the Art of Transitioning: A Lacanian Approach (Routledge, 2015), which takes a more aesthetically focused approach; and Catherine Millot's Horsexe (1990), which is the foil against which Gherovici consistently argues. Readers approaching the book should be familiar with the basics of Lacanian sexuation (Seminar XX), the four discourses (Seminar XVII), and the sinthome (Seminar XXIII), as well as with the standard Lacanian account of hysteria; Bruce Fink's A Clinical Introduction to Lacanian Psychoanalysis or Colette Soler's Lacanian Affects would serve as useful preparation. The book also engages substantially with the history of sexology (Benjamin, Stoller, Hirschfeld) and with feminist critiques of psychoanalysis, making it valuable for readers in gender studies approaching Lacanian theory for the first time.\n\nWithin the Lacanian corpus on ethics and clinical practice, this book should be read alongside Lacan's Seminar VII (The Ethics of Psychoanalysis) for the framework of an ethics of desire, and alongside writings on the end of analysis and the sinthome. For readers interested in the interface between Lacanian theory and contemporary cultural analysis, Transgender Psychoanalysis pairs well with Joan Copjec's Read My Desire and Jacqueline Rose's Sexuality in the Field of Vision, both of which develop Lacanian approaches to the politics of sexual difference without the explicit trans focus. The book should be read before attempting the more technically demanding literature on the Borromean knot (Seminar XXII–XXIII) with clinical applications, since Gherovici provides an accessible but rigorous account of how the sinthome functions as a clinical and not merely theoretical concept.

Canonical concepts deployed