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Number 13: Spring 2018

The Defrocking of Psychoanalysis within the Gender Clinic: On Smelling a Rat

Guy Millon

Gozlan argues that pathologising the trans subject is inherently defensive, and that “psychoanalysis is haunted by its own unconscious trauma, that is, by its resistance to the fundamental insight that sexuality is thoroughly traversed by the unconscious” (2015: 8). The trans subject’s destabilisation of traditional essentialist perspectives on gender produces “a tremendous anxiety around the phantasy of the transsexual as wreaking havoc on ‘nature’” (10). We could easily imagine how this anxiety might lead to oppressive practices, social marginalisation and a pathologising discourse. Perhaps the traumatic marks that psychoanalysis has left on the trans community are too deep to recover any possibility of trust? The most recent draft of the national service specification for gender identity clinics across the UK (NHS England, 2017) recommends a range of specific psychological therapies that are deemed appropriate in working with the transitioning individual; psychoanalytic and psychodynamic therapies are conspicuous by their absence. This defrocking – a stripping from psychoanalysis of its function within the clinic – should not be surprising given its history of attempting to effectively remove the frock from the trans subject. While there are attempts to practice psychoanalysis in ways that do not pathologise the trans individual, many of which spring from Lacanian theory (e.g. Gherovici, 2017; Gozlan, 2015), there seems to be very little space for psychoanalytic thinking within mainstream UK healthcare provision for gender diverse individuals. Through treating the trans person as a pathology to be cured or an object of study that serves only to bolster theory, psychoanalysis has contributed to a process of dehumanisation. In order to have any chance of offering something of value to this societal moment in which gender issues are at the fore, it must reckon with its history and, in doing so, take responsibility for its abuses. It is only in doing this that it may perhaps find a way of better serving those trans subjects who seek someone to whom they may address their suffering in speech. 

I wish to present a case from my work as a psychotherapist within an NHS gender identity clinic, not as an argument that psychoanalytic practice must hold a place in such a setting but rather as an invitation to interrogate one’s own position with regards to gender, and to add another voice to the call that psychoanalysis must undergo its own transition if it is to respond to contemporary questions of gender, desire and subjectivity. 

My patient, in her mid-60s now, was identified as male at birth and given the name Julian, but for most of her life she has gone by the nickname, Dick. I will refer to her as Diane, a name she has been using in recent years since she began spending time in female role. Last year, she got divorced from Sarah, her wife of 25 years with whom she has two adult children. I assessed Diane over four sessions and, since then, I have been seeing her fortnightly for therapy over the last two years. The broad aim of our work is to help Diane address the conflicts in her gender identity so that she is able to make a decision about whether and how to proceed with a full social and physical transition.