In the 1990s, in the secluded space of my psychoanalytic practice in Philadelphia, I never thought that I was going to have to revise cis notions of gender and sexuality and dive into the deep waters of identity politics until one day I noticed something unusual in the complaints of one patient, who soon was followed by others. I heard them ask: "Am I straight, or am I bisexual?" More and more frequently, their questions were formulated as variations on: "Am I a man or a woman?" I linked their uncertainty about their sexual identity with the plight of some trans analysands, who can be considered as subjects for whom this issue is not a question but an answer. For instance, an analysand who identified as a trans woman affirmed her feminine identity by saying: "I have the worst birth defect a woman can have—I was born with a penis and a pair of testicles."
In 2010, inspired by my clinical practice, I published a book entitled Please Select Your Gender: From the Invention of Hysteria to the Democratizing of Transgenderism. In that monograph, I used gender theory, psychoanalytic theory, memoirs of gender transition, my own clinical experience, and the model of hysteria to move from the pathologization of trans to engage more radically with the political dimension of trans, and to question the institutional control of our sexual bodies. This was a few years before the meteoric rise of the trans experience in popular culture that has made "trans" a daily term. What followed has been described as a "transgender moment," which is no doubt changing our notions of gender, sex, and sexual identity. Unhappily, it did not grant sexual minorities a full voice or a vote; most of those in the transgender community continue to live in precarious conditions. [End Page 144]
Despite the increasing presence of transgender people in the public eye, the transgender community continues to be an understudied population, no matter which discipline is framing the work. This situation is even more pronounced in the psychoanalytic field. This is sad because I strongly believe that the trans experience can reorient psychoanalytic practice, while many contributions of Freud and Lacan hold great potential for a non-normative understanding of gender, particularly as it pertains to the lives of trans people. Psychoanalysis needs a major realignment, and the time is now.
Guided by my ongoing clinical work with psychoanalytic patients who identify as trans, in 2017 I published another book, Transgender Psychoanalysis, in which I argue that those who undergo gender transition often do so because they deal less with the problems of sexuality than with questions of life and death. When someone says, "If I hadn't transitioned, I'd be dead, I would have committed suicide," what is at stake is less gender fluidity than finding a livable embodiment, which means a new way of being. To cross the frontier between the sexes is often experienced as traversing a mortal threshold, a passage from an impending doom to a possible renaissance; above all what is at stake is the crossing of an ultimate frontier. Quite often the predicament of analysands identified as transgender hinges around existential issues. Beyond what has been called "gender trouble," one often finds issues of life and death.
If they could take seriously the question of death inscribed in sexuality, psychoanalysts should be able to rethink their practice, which is why psychoanalysts should engage in what I call "transgender psychoanalysis." This was anticipated by the psychoanalyst Jacques Lacan, who once called up the figure of Tiresias, the mythical man-woman who was also a seer, as a role model for all psychoanalysts, a special protector or guardian of psychoanalysis—a patron saint. Lacan turned his attention to this mythical figure, a character he discovered during World War II, when he started reading and then translating T. S. Eliot's poetry.
The legend formalized by Ovid's Metamorphoses book III has it that Tiresias became a prophet only after having changed genders twice. First, as a man, he came upon copulating snakes and separated them. The gods punished him for the interference with the natural...