PATRICIA GHEROVICI is a Lacanian psychoanalyst practicing in Philadelphia whose work seeks to bridge several key divides: between psychoanalysis and activism, and between the complex language of theory and the needs of a broad readership. Gherovici’s work shows how psychoanalysis can have relevance in a trans discourse that has become simplified by pop culture journalism.
Writer and student of psychoanalysis Cassandra Seltman spoke with Gherovici about her book Please Select Your Gender: From the Invention of Hysteria to the Democratizing of Transgenderism (Routledge, 2010), in which she proposes new and depathologizing approaches to our understanding of transgenderism. Her upcoming book Psychoanalysis Needs a Sex Change: Lacanian Approaches to Sexual and Social Difference will be published by Routledge in 2016.
The following has been edited for clarity and length.
CASSANDRA SELTMAN: You’ve been an analyst and writer for a long time; how do those dimensions interact?
PATRICIA GHEROVICI: I was first a writer before I became an analyst. I was working as a journalist while I was a student and I did a lot of journalistic writing. There was a continuation of that early career in my practice of analysis. Indeed, the process of analysis could be seen as a process of writing, with the difference that the writing is made by the analysand. A successful analysis works like writing. In some cases, certain novelists use writing as an analysis. When an analysis functions successfully, something similar to what is at stake in writing has to have been produced, and in that sense they are perhaps an extension of each other. There is something that has to do with writing, inscription, and editing that takes place in analysis. They are parallel processes.
That makes me think about authorship. In analysis, is it co-authored? Does the analysand author it?
That’s an interesting idea, to think that maybe analysands come to analysis feeling like there is a text of which they are not authors. A narrative has been written and left certain traces in the body; these traces turn into symptoms; hopefully, through the process of analysis, that text will be rewritten, thus maybe authored, but also possibly forgotten. Sometimes I write to forget; I forget what I have written. It is a pleasant experience when you go back to something you’ve written and it’s as if someone else wrote it, and you are happy at times — or maybe not. An analysis reinstates the position of the author with the freedom that an author has. You might want to delete a paragraph or reduce a text to one page. At times, analysands come to see us when the effects of their texts are too great. The process of writing is always a process of rewriting, and analysands can relate to the text differently.
They’re more within the text when they first come to analysis?
Exactly. And sometimes they don’t know who wrote the text. An event that was traumatic may come out from the past and become more of a fictional character. You are given the opportunity of rewriting. In a process of inscription, things are at times written without your knowing. Such and such a text has been written on you, on your body, and often, if you can read it you can rewrite it. The analysand becomes an author, and also authorizes herself or himself.
I wonder if the patients who are trans have any specific characteristics to their texts?
That is something that makes me very curious whenever I go to a bookstore and find a section on gender, with all these memoirs on sex change. Why so many memoirs of sex change? Why is this testimony needed? My speculation is that when you hear stories of a person realigning the gender they identify as with the gender they present, it is not enough to just produce an embodiment in this new identity. There is the need for a process of writing, which entails making a name for themselves, their authorship, via publishing …
Literally writing their story and putting their name on it.
Exactly. It’s an effect of nomination — that is, not simply what Jay Prosser described as a new mirror, a new mirror stage — something at the purely imaginary level. However, it doesn’t fully explain this need to write. I think about it in terms of what Lacan says about creating an ego, not just an imaginary ego or mirror image, creating in fact an “ego scriptor.” The “ego” is always a writing ego. If you can write as an “I” then you can acquire an ego. Writing has effects on the body, here in an even more dramatic way. The embodiment is not simply a process of being seen in the public space, of passing or not passing. The verb “to read” in the trans community has contradictory meanings. It can mean to be seen in a gender you do not identify with, meaning “not to pass”. But with “reading” we have a transformation — the moment in which the person who is presenting gender trouble finds a memoir; then they find themselves no longer alone, they see other people in the same predicament, they discover a community, but it is an encounter with a text that has changed them.
Related to authorship, I wanted to ask you about citizenship. You’re an Argentinean doing French psychoanalysis in America. In your lectures you’ve talked about the relationship between psychoanalysis and citizenship. Can you elaborate on that? Does psychoanalysis naturalize you?
And a Romanian last name, and a Spanish accent. I would say, perhaps, psychoanalysis reminds you of the irony in the process of getting American citizenship. You naturalize yourself by artificially acquiring a citizenship through a complex bureaucratic process. If there is a citizenship of a psychoanalyst, it is one of being always a foreigner. Someone like Betty Fuks has argued that it is a necessary condition, that the analyst must be a little of an “other” to the culture in which she or he happens to be practicing. Fuks reminds us of the example of Freud’s, that between the wars there was a man who asked him for advice — should I convert my son to Catholicism? And Freud says, “No no no don’t do that, don’t spare him this experience of alienation. To be a Jew in this society is something he shouldn’t miss.” For Freud, it is not necessarily a negative experience to be outside society. Freud would take an extended notion of Jewishness as the other. We have, all of us, a foreigner within. It’s a convoluted notion of nationality. I’ve worked for several years in the Spanish-speaking Puerto Rican community, a very divided community, to be sure, around this very issue. As Kristeva says, we are strangers to ourselves. There is an undocumented immigrant in each of us. Probably “illegal” is better; there is something illegal about the unconscious. It knows no contradiction, it knows no time. Stretching that parallel, let’s say that the process of analysis is a process in which this illegal immigrant could get a green card, become a permanent resident with documents, and you choose which documents you want to identify with. If you can help this illegal immigrant work and love, without fearing danger, that is a good objective for analysis.
Please Select Your Gender utilizes case studies, historical surveys, and theoretical discussions to explore changes (or continuities) in our thinking around sex and gender. Did one of these components come first, such as having a trans client? In other words, how did you first become interested in writing about trans?
The couch is a window into anthropology, a window through which we can see new things in society. I started hearing these from patients, mostly college-educated women, who were presenting questions about sexual identity, and were formulating them in a way that sounded new. It was a classical question about sexual identity and femininity and embodiment, like “Am I man or a woman?” But these women were asking, “Am I straight or bisexual?” My first hypothesis was — okay, they’re reading Judith Butler, they’re influenced by a postfeminist discourse, gender is performative, and then it occurred to me that you have on the one hand patients who suffer because there is a question for which there isn’t an answer: Am I straight or bisexual? “I am who I sleep with.” On the other hand, trans patients have an answer — the problem is to realize it. They ask: “Who do I go to bed as?”
It includes the other in a big way.
Exactly. How the other sees me is who I am. A few patients I had who identified as trans presented suffering created by the answer they had — for example, “I am a woman trapped in a man’s body.” This made me read more and think more about transgenderism. About 15 years ago, I started seeing something I called the democratizing of transgenderism. In the last 15 years, we have seen the emergence of transgenderism in the public eye. It has reached its climax with Caitlyn Jenner’s coming out. The revelation was received with fascination, which is one of the things that democratization brings about. There is a call for recognition and it is answered, but in a way that distorts the demand.
There is one example, Janet Mock, a journalist and activist who was aware of this manipulation. She felt somehow alienated by this idea that media distorts the image of trans women, and yet she decided to come out, in an interview for Marie Claire, a woman’s magazine. Of course, when the article was published the title was, “I was born a boy,” and the standard was repeated — which was what she wanted to avoid. What is interesting clinically is that the trans phenomena remind us that you cannot maintain as an analyst the limited, normative position that historically psychoanalysis has held toward non-normative sexualities. It is a position that is impossible to sustain, if you’re not too deaf in the office. If you look even at the three essays on sexuality that Freud published in 1905, you see that for human sexuality there is no normative sexuality. It forces you to see the absurdity of keeping a normative position in the office, it reminds you of how varied the sexual drive can be. The drive is indifferent to gender. The trans experience revives that theory.
That the unconscious doesn’t know sexual difference?
There is no division between the sexes in the unconscious. There used to be this idea that heterosexual genital relationships were “mature,” but this is not sustainable. It’s case by case. You cannot generalize for other analysands. Transgenderism has to do with issues of embodiment. We say we’re “somebody” or “nobody.” We say, “we have a body.” There is a psychic act, if you want to paraphrase Freud’s “On Narcissism,” that must take place to be embodied. With trans patients, the body is problematized and brought to the fore. But with anybody, there is a transformation that must happen to become embodied subjects. The trans experience reawakens psychoanalysis; it cannot fall asleep on the couch, theoretically. It reminds us of these issues — the assumption of sexual position, sexuality, and that there is always some psychic work, a process of inscription, necessary to assume the body. Sometimes it is literal writing, and sometimes it is a process that requires a creative act, and a recognition in the world.
It’s almost the other side of authorship — readership. The need to be read and recognized in a certain way. I wonder, with regard to being recognized, whether that’s satiable or not. Is there a point at which someone feels recognized? What is that point?
That is a singular decision. It depends what sexual or social or symbolic agent you place in the position of the other that can say you are/you are not. Who or what is ascribed within that position? That recognition could materialize when walking on the street and being seen and looked at in a desirable way by a gay man. Or it could just be seen in your gender in your workplace, or seen by a family member, or a lover, or simply by looking at yourself in the mirror, whether you see an illusion or what you’ve constructed as your authentic self. This is a complex issue. Traversing genders is presented as a return to authenticity through technology.
In your practice, how do you negotiate your position as an analyst who can “sign off” or not “sign off” on a patient’s demand for a sex change? How do you understand that power as a medical gatekeeper alongside your position as an analyst?
If you’re a medical gatekeeper you cannot be an analyst. They are mutually exclusive. The question of signing off is being negotiated in the medical community by what was set up several decades ago by Harry Benjamin as the standard of care for sex reassignment. The standards may no longer be needed. One of them was that the person, before doing any physical intervention, will need to first need to live in the gender they identified with for at least one year, and then get a letter from a mental health professional. Harry Benjamin himself had a conflicted relationship with psychoanalysis and with psychiatry. If there is one authorization needed in this process, it should come from the analysand. But as soon as you sign off, you are in the position of the pedagogue, of the priest, of the master, of the doctor — you lose the possibility of intervening as an analyst. The protected space should prevent the analyst from playing the role of master. The analyst is there to conduct treatment, not to tell the patient what to do or not to do. And I have heard from patients that the letter is not always required, and also can be acquired in other places. I had an analysand who quipped, and I think rightfully so, “Isn’t it interesting that to have what is colloquially called a ‘top surgery’ you need a letter, but if the top surgery is a breast augmentation rather than a reduction, the plastic surgeon will not ask any questions. Besides maybe the fee.” From an analytic perspective, it’s always helpful to analyze these decisions to make permanent modifications in the real of the body, before acting them out, because it could be a realization of a wish or simply a quest for recognition — which, as you said, may not be satiated by that.
Do you think the desire to change genders is ever a fantasy of escaping sexual division altogether? And if so, can a physical transformation grant relief in the psychic structure of lack and desire? You quote Tim Dean in your book: Can removing the testes truly elude a fear of castration? Where and what are the ethics there?
Many traditional Lacanian analysts read any demand for a sex change as a sort of strategy to avoid sexual difference altogether, to avoid castration. I was paraphrasing Dean — the paradox that in order to avoid castration you give up your testes. When Freud talks about castration, he’s operating under the castration complex himself: as anyone who’s dealt with animals knows, castration means cutting off the testes — and when Freud talks about castration he talks about cutting off the penis, which is something that’s never cut off. Indeed, occasionally a demand for sex change may be meant to avoid sexual difference altogether, but it could also be all about sexual difference, and at times it could be a strategy to reinstate that difference.
Trans is such an umbrella word. Let us note that the demand for a sex change is a demand, and in the French, demand means a question — and it could also be a question of recognition. If there’s a cosmetic intervention to satisfy an authority outside — namely the fashion of this year — the nose or breasts will become the ideal, but this will last for the season and no longer be satisfying in a matter of months. Where does the authority come from? That may be the place where identity politics intersect with clinical practice. Happily, I think, because we are protected with the fundamental rule “say whatever comes to mind,” we try to bracket off identity politics, all the while knowing that ideology is permeating.
When reading your book I wondered if you’ve received any pushback from the transgender or analytic community — if people became offended.
Indeed, there was pushback at times. I try to maintain the position of an analyst, but there has been among the trans community, understandably, some reticence. Psychoanalysis has a terrible history and a terrible reputation when dealing with non-normative sexualities. There was a fear that I, as an analyst, would fall into this tradition of overpathologizing. I have not found a confirmation in my practice of something that I read in the Lacanian field, which is the belief that all trans people are psychotic. I argue for depathologization and tend to think of trans symptoms. And some people may ask, why do you call it a symptom? But for an analyst, a symptom may be what you enjoy — as Zizek says. Or it could be something that is paralyzing and a source of unbearable pain. Or if we borrow from Lacan’s later theory of the sinthome — that is, not the symptom in the way the medical field thinks of a symptom, but rather, using the archaic French spelling of the word symptom — the symptom is a sort of creative solution that makes life livable. Often in the media, a gender change is presented as a consumerist choice —you change your diet, you no longer smoke, you change genders. This is an absurd way of presenting it, because what I have learned in my practice is that gender is all consuming, but not a commodity. Some people can afford a more successful gender embodiment. The economic variable is there, the market rules apply; but nevertheless, assuming a body is not a consumer choice.
Can the unconscious be commodified?
What is more American than choosing your gender at will? But that’s an illusion. It’s sold to us, but not everyone has the same access. Medicare very recently started covering sex realignment surgery. The unconscious is the last activist. The unconscious is there, and that is why it tends to be forgotten so much. Now I am working on a follow-up project to Please Select Your Gender, under the title “Psychoanalysis Needs a Sex Change.” Indeed, psychoanalysis has to catch up. The sooner the better. Often, trans tendencies are presented as if there’s something wired in the brain that determines gender identity, and I wonder why that biological explanation — which hasn’t been confirmed, which is just as speculative — is more acceptable? Perhaps because it is more easily commodified. The unconscious is this bothersome reminder that not everything is a commodity. Happily, we have an unconscious that resists. It’s an interesting internal advocate. When Lacan puts forth his notion of jouissance, of a surplus of enjoyment, he does this from the standpoint of a political economy of the unconscious.
The unconscious is not beyond political economy, but it is also not commodifiable. What produces surplus, enjoyment, is a symptom of capitalism. I want to reinstate the idea of a symptom. There are trans symptoms that emerge in different structures. You can have a psychotic structure with a trans symptom, as with the case of Schreber, or you can have a neurotic person with a trans symptom. I actually use this word, “symptom,” exactly not to pathologize. Even the idea of choice can be read as a symptom. We choose things, and these choices give us a sense of identity. They’re presented as consumers’ choices, but we don’t know why we chose them. There is something in the unconscious that happily resists.
Can you speak to the language around transgender? For example, front hole versus vagina, female-bodied versus female. As a Lacanian analyst, do you think that by changing the signifier, swapping it out, we change our psychic structure?
The pronouns! Very interesting issue. It’s a back-and-forth. Giving up the word is just the beginning. This process is the opposite of censorship — adding new pronouns to the language, new uses of language. If you see one person who has to be conjugated in the plural by using “they,” this is something new that has been added to our language. It’s a process of enrichment. We are both coming into being and alienated in language. New ways of being in the world are reflected in language — although the person who is alienated in the world as a “he” or “she” may be just as alienated as a “they.” What we have to give up is the illusion that if we choose the right gender or pair of shoes we’ll be happy. There may be new ways of being in language and of being alienated in language that are less constrictive. This is the idea of the sinthome. It is still a solution that makes do in a difficult situation, maybe one that makes life more livable. I don’t believe in perfection. Perfection often has devastating effects. One should try to keep a distance from perfection. Winnicott proposes “good enough.” In commodification you have to find the “perfect” object, and it becomes a fetishized solution.
You say the language is enriching and less constricting — but something still gets censored, right? It’s the other side of the coin. The original word — you can never use the “he” in that context again. There are lots of constrictions around it, no?
True. And having that word covered, what kind of prohibition is that? Here is a parallel with castration. Castration could be interpreted as having limits and generating frustrations. The better we learn to deal with them, the less painful life is. It could be, then, that maybe a word that is not used is functioning as a limit that allows for things to happen. It is a certain inscription of the law that sets a limit and opens possibility. Or it becomes a kind of totalitarian regime where nothing can be said. If you change the words you are still trying to name something — something that will have existed and be named with a different signifier. The unconscious doesn’t do very well with sexual difference. There are many things language can talk about, but in terms of sexual difference, language falls short. When you think of creative writing, at times limitations or constraints offer an opportunity for creativity. At times this will be too inhibiting and oppressive. What is important is to make room for the unnamable and to maintain the space for the conundrum of sexual difference. That wouldn’t be an attitude of censorship.
What does hysteria and its positioning in relation to the phallus teach us about this conundrum of sexual difference?
One should problematize what is called the phallus; it could be read as associated with the male sex, but that is already a construction. The phallus is a prop. In ancient comedy, the phallus was a ridiculously enormous prop that, as soon as it was brought onto the stage, would produce laughter. It was something ridiculous no one could have or be. It is more helpful clinically to think of it this way. Maybe sexual difference does not have to rely on this absurd prop. It has an aspect of caricature. The phallus is a joke. Or a red herring. The binary is with the phallus or without it. Maybe there are other ways of thinking about it.
Cassandra Seltman is a writer and social worker. She studies psychoanalysis at the Institute for Psychoanalytic Training and Research in New York. She is the author of Palimpsest: Down (Inpatient Press, 2014).