LGBTQI EMPOWERING REALITIES

Lacanian psychoanalytic clinical practice

with queer transgenders.

Mary Nicotra
Istituto Psicoanalitico di orientamento Lacaniano (IPOL)
Scuola Lacaniana di Psiconanalisi - Associazione Mondiale di Psicoanalisi,
Spo.t, Maurice GLBTQ, Turin.

Abstract

The theme of transsexuality and transgenderism mobilize on the cultural, health and legal
fields. In the last decades there is a proliferation of researches and theories of transsexuality and
transgenderism developed by gender and queer theorists which goes in the direction of the social in-
clusion and depathologization. This paper aim to questions some points of the clinical practice with
queer and transgender subjects who dont fit in mainstream transsexuality. The research is made in
the contest of Spo.t, a project of Maurice GLBTQ of Turin which give assistance and services - a
spot - also for social inclusion .
By referring to lacanian psychoanalytic theory of sexuation and topology, this paper aim to
point out which elements are involved in the psychoanalytical treatments with subjects who express a
desire to transcend the limits of sexual difference. The discussion aims to stress a reflexion regarding
some crucial notes concerning the medical legal procedure.

Keywords:: Lacanian psychoanalysis, transgender, transsexuality, queer, Lacan

Introduction
Many researches around issues of gender have been carried out in the last fifty years .
Indeed nothing more than the issues related to identity and to its sexual connotation can put to work on
a cultural, social and scientific level as a questioning effect of the axiom of the two sexes, male-
female, and of the two gender, man-woman.
The DSM in its successive publications shows the unceasing work in progress to define the
transgender and transsexual phenomenon.
Some associations were established worldwide and at a local level with the aim of keeping alive the
debate. For example in Italy the National Observatory of Gender Identity (ONIG) is an association
that brings together health professionals, institutions and associations.
Interesting reflections also come from the researchers at the Unit of Clinical Psychology and Applied
Psychoanalysis of the Department of Neuroscience and Behavioral Sciences, of the University of
Naples 'Federico II '. They well highlight in L'enigma del transessualismoi some key issues with
respect to the practice as organized. They emphasize the clinical related institutional problems and
question the assumptions that underlie the practice, whereby the request of psychological interviews
systematically comes from a subject-other-than-the-patient, particularly by an institutional subject, as
the medical corps. In their experience generally the doctor, within specialized units, requires the
psychiatrist, psychologist or psychotherapist to 'assess the transsexual condition' before proceeding
with surgery. The individual therefore have to undergo a compulsory path structured in a given time.
Interviews and tests which have the function of determining whether exist the conditions to diagnose a
'gender dysphoria' are required depending on the protocol. The psychologist assumes a role that has to
do with the verification of the transsexual condition.

With regards to the cultural studies, scholars have articulated and divergent readings Kate Bornsteinii
argues that transgender individuals are not trapped in the wrong body, but they combine the concept of
male and female in a new way. She believes that the medicalization and the sex (re)allocation process,
which encourages the majority of transgender and transsexual people to transit with their body from
one gender category to the other, is a source of pain and suffering, and move them away from their
desire, creating significant distortions in their stories.iii
Jay Prosser, however, in his book Second Skinsiv, stresses that transgenders and transsexuals are not
constantly looking for subversion of gender categories, but they are rather looking for a house/body
sufficiently strong and stable.
The question is therefore very complex and probably someone will agree with Kate Bornstein,
whereas others with Jay Prosser.
In between there are the life stories of everyone. Each one with their own symptoms. One by one.

Lacanian psychoanalytic clinic: from the primacy of the symbolic to the clinic oriented by the
real
In his former teaching, from Seminar I to V, Lacan emphasizes and develops the centrality of the
symbolic, mainly dealing with the language issues, and the theory of the signifier. In this period, not
only he includes the specular pair 'a-a' (scheme L) in the imaginary, but also the entire field of
significations. The signifier, which is in the field of symbolic, produces multiple significations, that
become part of the imaginary field. The same signifier - for example 'woman'- can generate many
imaginary meanings.
In L'istance de la lettre dans l'inconscient ou la raison depuis Freud, Lacan writes that the cabin
offered to the Western man to satisfy his natural needs submits his public life to the law of urinary
segregation. In this way, recalling the sign of the two toilets for men and women, he shows us how the
subject is called to assume the signifier 'man' or 'woman' in order to cross one doorway or the other.
Lacan coined the neologism parltre to condense in a word the indissoluble relationship between
human beings and language. We are born immersed in the language and the human being does not
coincide with the biological organism. It is rather a spoken body, marked by the language from the
very beginning, and then a body that suffers a loss, a division, because of the signifier. The body has to
build up itself, we are not born with a body. The body is built, it is effect of the word and to nominate
oneself man or women it is an effect of the language.
To assume ones proper own sexual being requires a symbolization, but it will not be enough to
assume ones proper own sex, because the difference between sexes is not written in the unconscious.
There is a real at stake, an unspeakable referent, that affects the relationship of the subject with his
own sex.Real is not reality.v
In the R.S.I. Seminar, 1974-75, Lacan returns on the triad consisting of the real (R), the symbolic (S)
and the imaginary (I), leveling the three registers, RSI, and producing the redefinition of reality. The
latter does not exist by itself but it is the result of how the three registers RSI are kept together. The
Borromean knot will hold them together.
The Borromean knot is a topological figure composed of three rings ringed between them so that if we
separate any of the three, the other two are released too. From the knots theory on, it has been
produced a major change in the clinic: the starting point is no longer the Other and the lack-to-be in
the desire, but rather the jouissance, which is always autistic itself.
The borromean knot is a clinic writing. The first clinical writing, the classical Freudian writing is the
Oedipal one. It places the subject's position with respect to the coordinates of the Oedipus, and the
family complexes. It consider the symptom the heir of the paternal function.
The borromean writing allows us to go beyond. This clinic allows us to talk about those structures that
have not reached the Oedipal configuration and to identify the significant differences. In the case of
the psychosis where it was not possible to integrate the castration, because of the missed registration
of the paternal function in the symbolic, they will be the symptoms of compensationn to allow a
knotting. This indication makes to gather in the clinic as the knotting of imaginary, symbolic and real
through a fourth element, the symptom, which is the necessary condition in order to keep a significant
concatenation. The syntome is than a way to keep together the three registers, a solution the subject
finds.
Lacan introduce the formulas of sexuation during the lesson of April 9th, 1974, in the seminar 'Les
non-dupes errent'. He declares that letre sexu ne sautorise que de lui-memevi which means that
sexual being authorize him-her/self by him-her/self. The fact that they are classified as male or female,
does not prevent them from the choice.
In the complex sexuation formulas Lacan elaborates a logic to explain how the position related to the
phallic signifier produce the choice of the sexual position for each 'parltre'
The phallic signifier is undoubtedly a compass of the desire of the subject, but it is not a guarantee of
the personal word act. Each subject is in relation with sexuality through his own word. The process of
sexuation does not come from the biology or the cultural context but by the logic of the discourse. The
subject is alone in front of the personal act of the word, utterance, that determines a personal sexual
position.

Thus, what happens when the subject cannot fit himself/herself as a man or a woman?
What happens to those people who cannot find even a place in the mainstream of transsexualism, that
are individuals who request the institutions to go from one gender to another through surgery?

What happens on a medical-legal level to those subjects who declare their uncertainty and who
subjectively cannot or do not want to accept the medical offer?
It opens up a world that is contemporary. The transgender subjects exist. They seek their place in the
world, demanding their rights to exist.

Effects of clinical experience with individuals who call themselves queer and transgender
The Maurice GLBTQ have been developing in Turin, in the last four years a project called 'Spo.T', that
offers paths dedicated to the social inclusion of transgenders and transsexuals, and the possibility to
access psychotherapy and endocrinologic counseling.

With regards to psychotherapy, this is not an alternative to institutionalized paths and protocols that
are provided within the hospital operational units. This is another way.
When the Spo.T team met the colleagues of CIDIGEM, the Turin Molinette Hospital specialized team
in transsexualism, they realized that although the two paths can interact in certain moments, the people
who turn to Spo.T, do not turn to CIDIGEM and vice versa.

Thus, why 'Spo.T'?

Spot translated in Italian means 'place'. I do not know if the project designers are aware of it. Actually,
after four years of this experience, they can understand it from the effects. 'Maurice' makes a spot for
the individuals, who find in it a spot to include themselves socially, through groups of peers and activi-
ties of the association.
For a psychoanalyst, due the assumptions that guide its practice, as I tried to say with reference to the
teaching of Lacan,also it is a question of doing place, a spot to the subject, to the subject of uncon-
scious. For a psychoanalyst it is not a question 'to ascertain the transsexual condition'.
A psychoanalyst choose to be oriented by the particular speech of each individual, one by one, in order
to field the conditions where the subject of the unconscious can arise.

*author mary nicotra , telephone +39-3347005982 email address marynicotra1@gmail.com

In this case, by accepting the demand of the subject, he let the speech of the subject teach him without
applying to the theory put in the position of the truth. The truth comes always from the subject.
The subject - one by one need to bring his own word, his own speech and in the setting it is impor-
tant that he can produce his own position of enunciation , beyond utterance, the statement coming in
the speech.
There is something very interesting in my clinical practice with individuals who define themselves
queer. and transgender. What is gathered in each session with each individual is that if you drop any
supposition to know and you let the uniqueness of each person to find its own way, without any uni-
versalization attempt, the subject finds unique solutions and singular inventions, that have nothing to
do with the adaptation to a standard nor with a high or wrong behavior.
I think of someone for whom the sessions themselves serve as a place to deposit the anguish as he/she/
* tries to build a crutch to walk in the world, although limping. Or someone else who no longer wants
to resort to surgery. Or even somebody who has found a way to give a place to his strong desire, who
has decided to call himself a man rather than a woman. Others realize that what seemed impossible to
bear is not that much their own body, but the gender roles they turn against. Everybody with their own
story, their own symptoms, each one in a new bond of transference.
What I learned is that it is necessary to accept those new signifiers -queer - transgender - that emerge
in the speech of the subjects, so that each one can find a way to define himself/herself /*in a singular
possible way, beyond new labels

i ,P.Valerio,R.Vitelli ,Lenigma del transessualismo, Ed.Franco Angeli, Milano 2004

ii K.Bornstein, Gender Outlaw: On Men ,Women and the Rest of Us, Routledge, New York and London 1994.

iii P.Califia, Sex Changes. The Politics of Transgenderism, : Cleis Press. San Francisco 2003.

iv J.Prosser, Second Skins: TheBody Narratives of Transsexuality, Columbia University Press, New York1998.

v The real is that inaccessible place for the subject, that resists to any signification or sense, together with the other
two registers, the symbolic and the imaginary. The real has not to do with ideas or immutable and inaccessible essences
opposed to the imaginary world that we perceive, in the Platonic sense of the term. The real is related to 'jouissance',
repetition, sex and death drive. It cannot be reduced to a sense. We can catch something about it only in relation to the other
two registers: the symbolic and the imaginary.

vi J. Lacan, Le Sminaire, livre XXI, Les non-dupes errent (indit), leon 9 avril 1974.

*author mary nicotra , telephone +39-3347005982 email address marynicotra1@gmail.com