This text is part of a series on psychoanalytic approaches to trans issues that began as a discussion of Patricia Gherovici’s Transgender Psychoanalysis but also aims at tackling the issue within current Transgender Studies more in general.

On April 20, 2016, Slovenian philosopher Slavoj Žižek described “transgenderism” as an attempt to undermine sexual difference. In other words, he contended that transpeople are reducing what is, for Lacanian psychoanalysis, an unavoidable sexual impasse to an identity-based human rights discourse (that fits nicely into the neo-liberal capitalist order).[i] He suggested that “transgenderism” relies upon a neutral formulation of difference that obscures a more fundamental difference constitutive of the subject: “they stand for difference as such before its determination.” Žižek’s analysis is not entirely new. It was originally developed by Catherine Millot in Horesex (1990). Millot writes that transsexuals (whom she calls transexualists) are trying to bypass sexual difference and, in so doing, mistake the organ for the signifier. In fact, she views transsexual women as psychotic but was undecided about how to understand transsexual men. Abe Geldhof and Paul Verhaeghe, both Lacanian psychoanalysts, refer to queer (in which they include “trans-“) as a “new shelter from castration.” They argue that identifying as queer or as trans- is an attempt to refuse castration. “By choosing not to identify with the symbolically determined difference between man and woman, one tries to hide from castration.”

One might be forgiven for assuming that to be Lacanian is to assume that trans-subjectivity is psychotic or, at the very least, pathological in its supposed refusal of sexual difference. Žižek is, in my view, correct to suggest that sexual difference is at the heart of trans* struggles for recognition, but wrong to conclude that trans* identifications are ways to overcome, as opposed to live creatively with, the aporia of sexual difference. There is a growing number of Lacanian-inspired theorists and psychoanalysts writing (mostly) in the North American context who offer important counters to what I have elsewhere called the psychotic thesis as it pertains to people identifying as trans.

The Psychotic Thesis

Psychoanalyst Patricia Gherovici’s careful read of Lacan enables us to see how he does not endorse the position that transsexuality is psychotic (see here and here). Focusing on his work with ‘Henri,’ ‘Primeau’ and Daniel Paul Schreber, Gherovici challenges Millot’s (1990) thesis regarding trans-subjectivity and psychosis. There is, for Gherovici, a distinction between a “transsexual delusion” and a “demand for gender reassignment” in Lacan’s clinical work. Unlike Freud, who viewed transsexuality as repressed homosexuality, Lacan was more nuanced and careful in his reading of it. As Gherovici explains, Primeau — who had the impression that his sex was shrinking — was not asking for gender reassignment. Rather, he felt like he was becoming a woman from without which was, according to Lacan, at least in part delusional. Although I am not convinced that Primeau may not also be trans because, in Gherovici’s own description, he did hope to become a woman, the ultimate point she makes is that Lacan did not take a moralistic stance against gender affirming surgeries. “Whereas Millot tends to see this as a sign that Lacan rejects all transsexual desires as psychotic, in fact he is distinguishing the hopeless case of a man that he sees as psychotic from a more legitimate demand for sex change, which was not Primeau’s situation.” Like Schreber, Primeau was psychotic, not transsexual in Gherovici’s analysis of the Lacanian case study. He suffered from “transsexual jouissance” in the mode of psychosis.

Unlike Millot, and later Geneviève Morel, Gherovici does not believe trans people are attempting to override sexual difference. Rather, they have a “heightened concern for sexual difference.” In fact, Gherovici suggests that clinical work with trans people shows us that there is for all of us, regardless of trans-status, a “disjunction between how subjects experience their bodies and the given corporeal contours of their flesh.” In other words, trans-experience may not be wholly different from cisgender experience at the level of the body. Although there are significant differences in the way the two demographics negotiate a gap, or schism, between subjective experience and corporeality, the difference is not absolute from a structural point of view. Gherovici notes that in her clinical experience she finds that “ trans patients often applies to patients who are cis.” By this, she means to suggest that coming to embody gender and symbolize sex is a universal human problem. More specifically, it is a Real problem concerning unconscious processes. Consequently, what the analyst sees (and treats) in the clinic is a universal problem with unconscious sexuality.

Unconscious Sexuality

One of the major contributions psychoanalysis makes to gender and sexuality studies is that it prompts us to understand sexuality in ways that engage unconscious processes. For Jean Laplanche (1924-2012), the great translator of Freudian psychoanalysis, the sexual is “beyond the difference between the sexes and beyond even the diversity of genders.” The Rosetta Stone for the human subject is the unconscious, which is the sexual. In fact, Laplanche views the sexual as “the unconscious residue of the symbolization-repression of gender by sex.”

Unconscious sexuality is of ultimate concern to Gherovici’s discussion of trans-subjectivity. She reminds us of an important psychoanalytic distinction between sexuality (as practice, as orientation or as identity) and unconscious sexuality as understood by Lacan. For Lacanians, the Real is at the basis of unconscious sexuality. The Real is the psychic register in excess of language. Unlike reality, the Real defies representation and quantification. There is no signifier for what Lacan calls sex in the unconscious. Real sexual difference thus involves something fundamental relating to being that lacks inscription. As Gherovici explains, “sexual difference is not a norm but a real impossibility, which is to say, it is a limit to the speakable and thinkable.”

In order to understand the central importance of Gherovici’s contribution we must remember that sexual difference is a structural problem born of language and logic. It is not, as queer theorists sometimes suggest, operative (only) at the level of gender performativity or, as some trans-studies scholars suggest, at the level of gender identity.[ii] In psychoanalytic terms, identities are reactive formations to loss. Additionally, we must remember that unconscious sexual difference is not binary. There is no equivalence between masculine and feminine positioning in Lacanian terms. For this reason, there is no sexual rapport. The object cause of our desires has nothing to do with our partners. Sexuality, regardless of gender identity and sexual orientation is, for Lacanians, discordant and focused upon part-objects. What, ultimately, matters is sexual positioning, the positions we assume in relation to the phallus (as signifier).

Sexuation: A Question of Being

As indicated in Lacan’s sexuation graphs, one is either sexuated as a woman (on the right side of the graph) or as a man (on the left side of the graph). Sexual positioning has nothing to do with biology, anatomy or chromosomes. Sexual positioning is about being in relation to the Other’s desire and jouissance. Desire resides in the locus of the Other whereas jouissance is about the Thing (which is a property of the Real and thus inaccessible). Sexual positioning is, for Lacan, about the Other and the Real of the sexual impasse. How one resolves the question of the mother’s desire in relation to paternal law is the determining factor in whether one is sexuated into the masculine or feminine position.

To follow the logical development of Lacan’s argument, we must first remember that for Lacan “men” and “woman” are “signifiers of imprecise meaning, and they stand for sexed positions relative to a phallic premise.” The Lacanian phallus is not the penis. Gherovici explains that the phallus is a “symbol [that] compensates for a certain lack; it is an attribute that nobody can have, while everyone aspires to have it or embody it.” As such, the phallus is fallible. It cannot signify sexual difference as such. The phallus is, for Gherovici, a “theoretical speculation.” No one can “be” or “have” the phallus because it is a symbol without a signified-referent. It thus introduces the notion of lack. Sexuation is about what we do with, or make of, this lack at the heart of human sexuality.

Desire (as opposed to jouissance) is a response to lack. As sexuated subjects we must assume a position in relation to a fundamental lack. Gherovici writes: “The Lacanian subject is subjectivized by lack.” Lacan posits two universal sexual positions. He is not meaning to impose a cultural restriction on gender identity and expression but, identifying a structural limit imposed by logic and language. Lacan opines that one can either be the phallus which entails being the signifier or fictive-agent of the Other’s desire. Or, one can have the phallus which entails that he receives from a woman what she doesn’t have — namely, the phallus. Lacan (2006) notes that the tension between “being” and “having” the phallus in the economy of sexual difference takes place at the level of signifier.[iii] Lacan writes that sexual positionings “revolve around a being and a having which, since they refer to a signifier, the phallus, have contradictory effects: they give the subject reality in this signifier, on the one hand, but render unreal the relations to be signified, on the other.”

The Feminine position is characterized by a capacity to experience the Other jouissance while the masculine position is characterized by the capacity to experience only one phallic (paltry) jouissance. Jouissance is a French term usually translated into English as a painful-pleasure bound to repetition. Another name for jouissance is anxiety. Anxiety is that which remains after the cut of the signifier (Lacan 2014). Real jouissance is what remains after the signifier engenders the subject. Man’s desire imposes a limit whereas woman’s desire is infinite. Phallic jouissance stays within the register of the Symbolic. The Other jouissance doesn’t exist within the realm of the Symbolic. It exists in the Real. It is a bodily pleasure about which nothing can be said because it is beyond the signifier. It is thus difficult to say anything about the other (feminine) jouissance in particular. Bruce Fink does, however, suggest that it may “refer to the jouissance the Other gets out of us, or to our enjoyment of the Other, or our enjoyment as the Other.”

Transsexual Jouissance

For Gherovici, Lacan’s theory of sexuality is not sexist or bi-gender because it is concerned with the object causes of desire which are unisex: “Desire is partial, and not necessarily gendered, which suggests the potential to conceive of sexuality outside the confines of normative heterosexuality.” But more importantly, desire is independent of jouissance in Lacanian theory. As already stated above, jouissance is linked to anxiety. In order to understand the specificity of transsexual suffering, Gherovici suggests we examine the character of jouissance.

In the case of “Henri,” a transsexual woman that Lacan treated between 1952 and 1954, Gherovici speculates that there may be a “demand for a cut in the real of the body that would subtract a privileged piece of flesh from the Other’s jouissance.” Lacan, famously, defines anxiety as a lack of lack. It emerges when the object cause of desire (object a) is too close or threatens to reveal itself. The Other’s desire can be terrifying. It may be all encompassing, devouring even. Gherovici writes: “What causes anxiety is the fear of vanishing in the face of the certainty of the jouissance attributed to the Other.” Her observation is born of the acknowledgement that there is, in many trans-memoirs, autobiographies, selfies, vlogs, etc., a painful jouissance the body fails to contain. In other words, there is a feeling of inner vacancy, a suffocating enclosure oppressing the self, and/or the lack of an ego functioning as surface/container: “The body is experienced as a burdensome envelop, an exterior layer worn like an ill-fitting piece of clothing one is impatient to shed.”

Transitioning may, Gherovici suggests, be an attempt to “reclaim the body and regulate jouissance.” Certainly, other Lacanian-inspired psychoanalysts writing on trans-subjectivity agree. Referring to a patient named Aron, Oren Gozlan writes that his patient’s new genitals made a productive cut. In other words, his “finite” genitals (that could not reproduce in hetero-reproductive terms) imposed a cut into the claustrum of his parent’s projections. The newly made genitals imposed a limit to the jouissance of the Other as it enveloped Aron’s body. Through the transition, Aron was able to “become his own person.” According to Gozlan, “For Aron, surgery perhaps began as an unconscious way to close the possibility of being sucked into the Other’s grip.”

As Gherovici explains, there is always some degree of uncertainty regarding sexual positioning regardless of trans-status. This uncertainty is not immaterial because there is something fundamental to being at stake. It is, as Lacan writes, “the question of the subject’s existence [that] arises.” Questions about sex assignment are, ultimately, about the contingency in being. Speaking about the client who presents with the question:  What am I there?” (about sex and its imprecision), Lacan writes the “fact that the question of his existence envelops the subject, props him up, invades him, and even tears him apart from every angle, is revealed to the analyst by the tensions, suspense, and fantasies that he encounters.” He also adds that the questions, Am I a man or a woman? Or, am I either? are knotted in the “symbols of procreation and death.”

The Sinthome

Lacan’s theorization of knots is developed in his writing on the sinthome. Lacan argued that James Joyce staved off psychosis by writing. In a year-long seminar on Joyce (whom Lacan calls a “man of letters”), he develops his theory of the sinthome. One of Gherovici’s important contributions to transgender psychoanalysis is to consider transgender in terms of the Lacanian sinthome. Sinthome is the older French spelling of the word symptom. The sinthome is associated with the Real. It is a distilled symptom. Lacan likens it to a fourth knot linking the three Lacanian registers: the Symbolic, the Imaginary and the Real. As such, a sinthome has a palliative function. It can organize and regulate jouissance. We make a sinthome when we identify with our symptoms and thus enjoy our unconscious. For Lacan, a symptom is not something that needs to be cured but, rather, engaged as a creative supplement. Gherovici writes that it is a “creation that is not trying to ‘make up’ for the disharmony between the sexes; it is a creation that ‘makes do” around the disjunction.”

Another way to understand the importance of the sinthome is to say that it is something we create in the place of a void. The void is Real (and thus without symbol). A sinthome is a way to name something of/in the Real that causes anxiety. Unlike the ego which is troubled by difference and clings to identity, as defense against difference, the sinthome creatively animates and enjoys difference; it puts sexual difference into play as supplement. The only identities we can psychoanalytically engage are sinthomatic. To put this in yet another way, the psychoanalytic subject emerges when/where identity breaks down. What is interesting about the sinthome is that it enables a subject to assume a sexual positioning without recourse to the phallus (as signifier).

Gherovici suggests that for those identifying as bi-gender, non-binary, agender and so forth, the phallus (as signifier of sexual difference) may be inoperative. She writes: “Most importantly, they seem to be able to deal with sexual difference without relying on the phallus.” There is a creative (sinthomatic) supplement in the place of the phallus. While Lacan originally identified two types of jouissance in his sexuation formulas (described above), in his later work on the sinthome he found another way to organize and manage jouissance through the making of sinthomes.

By assuming a sexual position without recourse to the phallus, Gherovici writes, trans-subjects reveal that “sexual discourse…is built on an error, that of taking the phallus for a signifier of sexual difference.” Gherovici contends that the phallus can only demarcate one sex (man) — it cannot signify the other sex (which is woman). The phallus (as signifier) grounding the Symbolic depends on the taking of an organ (the penis) as a “signifying instrument.” This is a mistake because one organ-signifier cannot arbitrate sexual difference: “The paradox is that human sexuality is always defective, always erroneous because the phallic order is a classification system based on an organ taken for a signifying instrument.”

As explained above, the function of the phallus is to delimit two structural positions as solutions to the aporia of sexual difference. Another way to think about the “function” of the phallus and the nonsymmetrical sexual positions is to say that the “man” and the “woman” show us, in dissimilar ways, how “language fails to signify sex.” The phallus gives us an unsatisfying solution to the sexual impasse. The phallus is a “failed answer to the conundrum of sexual difference.” Any linguistic system dependent upon an organ to function as a signifier for both sexual positions must, it follows, be founded on an error.

This is the error that trans-people right (or write) through the making of a sinthome. More precisely, the “demand for a sex change is meant to rectify this error in the Symbolic register by correcting the error in the real of the body.” There is no symbol of sexual difference in the unconscious as we have already established. What we see in the clinic of transsexuality, is, for Gherovici an all-too human “inconsistency of the subject’s relation to sex.” Sexual difference produces symptoms for everyone. Indeed, Lacan refers to sinthome-she and to sinthome-he.

Gherovici likens the sinthome to an act, as opposed to an acting out. By acting out, one deals with anxiety by addressing the Other, remaining caught in the Symbolic scene (whereby nothing actually changes). By making a passage to the act, the subject encounters the “a” (as object cause of desire), in the register of the Real, without mediation by the Imaginary (in the form of fantasy). The act is, in other words, an encounter with anxiety without an imaginary defense. The passage to the act dissolves the social bond with the Other and enables the subject to exist as a Symbolic scene.

The exit is reminiscent of the of the many references to a “second birth” appearing in trans-memoirs. Oren Gozlan reads this second-birth in terms of the Lacanian act. He writes: “The new narrative [of rebirth] holds the possibility of changing the structure of the subject in that the Other no longer plays an important part in it, and this very gap between the self and the Other is mourned.” He further narrates this “rebirth” in terms of postsurgical scars. He productively compares scar tissue to a navel that offers a novel take on gender. The scar works like a suture, literally and metaphorically. It also harkens up the Lacanian Borromean knot: the sinthome, a fourth ring that knots the three registers. The quadruple binding is a sinthome. For Gozlan, the postsurgical scar inscribes a difference that ultimately bridges “lack and satisfaction.” The scar is, paradoxically, a cut and a link in psychoanalytic terms. As a sinthome, a scar is a “link born of the impossibility of unity.” As an “act,” surgery enables the subject to “traverse a phantasy of union, giving up the phantasized Other, but having to live with the scar.”

Through his discussion of scars, Gozlan’s theorization inadvertently touches upon what the unconscious cannot represent: life and death. As Gherovici notes in her discussion of Lacan, “Sex represents a portion of death for the living being.” Sex is, also, a cut in being that is a by-product of language. Language carves up the body. This is why sexuality is associated with life and death. She adds: “Sex and death are what we cannot look in the face — they are a reality we find it impossible to confront, that we cannot represent, about which we know nothing.” Please Select Your Gender (2011) ends with commentary on whether or not the “fantasy that one can change one’s gender on demand [is] the continuation of an old dream of immortality?” Likewise, Transgender Psychoanalysis ends with a reference to the ancient Greek prophet Tiresias (who changes sexes and survives seven Theban generations). What Gherovici seems to emphasize in her second book is the way trans-clients are, ultimately, less concerned with gender identity and sex than they are with “existential issues…life and death.” She suggests that a gender transition is “more about mortality, the limit between life and death, than about sexuality, the border between male and female.”


For Gherovici, “transsexuality is a way to instate a border, a difference between life and death where being is ultimately at stake. In fact, in Transgender Psychoanalysis (2017), she writes that being trans is a “strategy of ‘being’.” She adds: “To cross the frontier between the sexes is often lived as traversing a mortal threshold, a passage from an impending doom towards a renaissance; what is at stake is precisely crossing an ultimate frontier.” What counts as a transsexual transition does not negate the Real problem of sexual difference. Rather, transitioning is one viable way to negotiate the sexual impasse and to identify (creatively) with the symptom that authorizes our being. Gherovici’s formative writing on the art, act and creativity of the sinthomatic solution is a welcome contribution to an emergent body of literature on trans-psychoanalytics.

Sheila L. Cavanagh (PhD), Associate Professor, York University, Toronto, Canada. Cavanagh’s scholarship lies in queer theory; transgender studies and psychoanalysis. She is a former co-editor of the Somatechnics journal at Edinburgh University Press and past president of the Canadian Sexuality Studies Association.

[i] I use trans- in the broadest possible terms to include those identifying as transsexual, transgender, non-binary, two-spirit, a-gender, non-gender, etc.

[ii] Gender, as identity, can be a deterrent to analysis because it is an ego-based defense. Identities erase and negate difference; not just difference between the subject and the Other, but difference within the subject.

[iii] Lacan defines the signifier as that which has “meaning effect (effet de signifié)…[and urges us to remember that] between the signifier and meaning effect there is something barred that must be crossed over.” For Lacan, there is something arbitrary about the signifier and more precisely the relation between the signifier and the signified, “the signified misses the referent. The joiner doesn’t work.”