So What is Gender Anyway? And Who’s Having Sex with Whom?

Just as Ralph Roughton challenged us in 2001 to reexamine our theoretical understanding not just of homosexuality but of all sexuality (Roughton 2002), our panel aimed to challenge the psychoanalytic community to reexamine outdated theories of gender and their impact on our patients and on candidate education. We used an episode of the award-winning TV show Transparent to delve deeper into our personal experience of gender, our reactions to the problematizing of the gender binary, and the possibilities that come with a richer experience of gender boundaries.

The panel was arranged in response to a request from APsaA’s Program Committee to its Committee on Gender and Sexuality, which Susan McNamara and I co-chair, for a panel on transgender issues. It was held at the Chicago meeting of APsaA in June 2016 and was chaired by Ethan Grumbach. Robert Galatzer-Levy and Susan McNamara were presenters. I was asked to be the panel’s reporter and to speak about my perspective as a candidate. The panel takes us on a journey through the political, societal, and institutional forces that shape the gender binary, the violence engendered by counterphobic attempts to police this boundary, unconscious fantasies of the chaos that ensues if we loosen our mental grip on this boundary as portrayed by the series Transparent, and finally the creative potential of accepting the complex nature of gender boundaries, elegantly depicted as a fractal boundary by Galatzer-Levy.

In his introductory remarks to the panel, Grumbach dedicated the panel to the forty-nine people who died and the fifty-three who were injured at the Pulse Club mass shooting in Orlando earlier that same month. He noted that although huge shifts in LGBTQ rights have taken place around the world, there are still many who are traumatized, afraid, terrorized as they grapple with their sexuality and gender. This makes the massacre at Pulse all the more painful. For many, gay clubs are a uniquely safe place to explore their feelings and thoughts about their sexuality and gender, in dim lighting where they might not be recognized. Pulse wasn’t just a place to party; it was also a place to help people find community. We live in a world that continues to be consumed by implicit and explicit expressions of prejudice, internalized and externalized homophobia and transphobia, and ongoing cultural, societal, and governmental attempts to deny the civil rights of nonconforming individuals. Even within the psychoanalytic world, unrecognized and unacknowledged comments, thoughts, ideas, and actions can be found that not only hinder the evolution of our understanding of gender and sexuality but are fundamentally disrespectful and hurtful, despite the best intentions to be inclusive.

Grumbach reminded us that the psychoanalytic mind doesn’t rush to explain or understand. It is willing to go deeper and further into emotions and states of mind that may be uncomfortable, to gain a fundamental grasp of a patient’s experience and mind. It is our duty as analysts, he stated, to help people understand humanity so that peaceful revolutions are made possible and the potential for violence is decreased. We must start within our own community. Forty years ago we might have been discussing whether homosexuals are psychotic, unable to function well in society, and certainly considered them incapable of becoming analysts. There are parts of the world even today where psychoanalysts still view transsexuals that way. Potential patients are still uncertain about coming to treatment, concerned that analysts might consider their transsexuality something to be analyzed away, that they will be viewed as incomplete or undeveloped individuals. Grumbach hoped that our panel would offer other views and other perspectives on gender.

At this point he introduced the focal point of the panel, an episode from the award-winning Amazon TV series Transparent, created by Jill Soloway. In an extensive interview in the New Yorker in December 2015, Soloway described her father’s calling her in 2011 to say that he was transitioning to become a woman. Soloway’s “Moppa,” as she has come to call her parent (a combination of Momma and Poppa, which is also the name of the episode the panel focused on), was a retired psychiatrist in his seventies living in Chicago. Soloway said that Transparent is not overtly autobiographical but rather is an elaboration of her own struggle with gender identity, considered together with her family history. Soloway herself was in the process of separating from her husband during the first season of the show and began a relationship with Eileen Myles, a lesbian poet and protégée of Allen Ginsberg. Soloway and her sister began to keep notes as a way of grappling with their Moppa, and as time progressed realized they had a show to write.

Transparent explores the life of a family from a variety of perspectives, some humorous, some extremely painful, some evincing the characters’ insight, and some showing its complete lack. The show examines the life of Maura in her process of transitioning, but also allows us to witness the lives of her children and their experiences along the spectrum of sexuality and gender. People end up in our consulting rooms with concerns similar to those expressed by the characters. Grumbach suggested framing these experiences using Ken Corbett’s conceptualization of “regulatory force” (2009). Corbett wrote about the discourse that accumulated around feminine boys, constructing them as nonconforming, extreme, and disordered. Such discourse demonstrates the operation of a heteronormative regulatory force, a reliance on unquestioned presuppositions about what constitutes masculinity and gendered coherence, and the relationship of that coherence to psychological well-being. Grumbach challenged the audience to watch the Moppa episode with an open mind, not from the vantage point of unquestioned presuppositions, and to be available to sit in an unknown, perhaps extremely uncomfortable emotional state. In his paper Corbett references Adrienne Harris’s Gender as Soft Assembly (2009), which highlights the productive possibilities of gender variance: the place within masculinity for feminine masculinity, the place within femininity for masculine femininity, the place within boyhood for feminine boys, the place within girlhood for masculine girls. Grumbach argued that we must reconsider the supposed link between gender coherence and well-being. Though we exist in a world that traditionally has been ordered by a binary system of gender and sexuality, he questioned whether we can develop ways to respect and support variances, respond with empathy, and perhaps even acknowledge the pleasure of play involved in our gender and sexuality.

To accomplish that, Grumbach suggested that in thinking about gender and sexuality we shunt etiology to the side. By focusing on the spectrum of sexuality and gender, we can explore the identities of people through the lens of their subjective reality. By naming and processing the anguish that gender and sexuality bring to individuals (for a clinical discussion of the anguish felt in response to the body’s primary and secondary sexual characteristics, see Saketopoulou 2014), it is possible to help them explore its psychic meaning and to accept their gender and sexual feelings. In Transparent we witness the transitioning of a man in retirement after many years of conducting a secret life as a woman. In the Moppa episode we are not directly privy to the anguish and pain Maura, the lead character, may have experienced in mourning the fact that her natal body does not fluidly map onto her gender. Did she spend years feeling that she was misgendered, misrecognized, as belonging to her natal gender in contrast to the articulation of life in a different gender? How might she have struggled with feelings that her physical body and gender were misaligned? Maura does tell her eldest daughter that it isn’t that she is beginning to dress as a woman. Rather, all her life she has been dressing as a man.

To examine Maura’s family’s reaction to her transition and perhaps the audience’s reaction to the episode, Grumbach offered Diane Ehrensaft’s conceptualization of the variety of reactions family members have to a child’s creative gender development. In “Boys Will Be Girls, Girls Will Be Boys: Children Affect Parents as Parents Affect Children in Gender Nonconformity,” Ehrensaft (2011) describes a society that challenges, chastises, or cajoles toward normativity those who stray from their assigned gender box. She identifies three types of families: transformers, transphobics, and transporters. Transformers are parents who have worked through and are comfortable in their own gender authenticity, whatever it may be, have the ego capacities to hold and metabolize anxiety and conflict, have the capacity to decenter and recognize their child as a separate person, and possess bonds of love to their child stalwart enough to transcend adversities. They can meet their children where they are and advocate for them in the outside world. Transphobic parents are still not secure in their own gender authenticity, experience their child as an extension of themselves, respond to adversity in their relationship with their child as a narcissistic wound, and thus are unable to call on the bonds of love to shepherd them through the turbulent waters of coming to terms with a gender-nonconforming child. Finally, transporter parents are insidious in presentation. By all outward appearances they seem to have completely purged themselves of any transphobic remnants and to have fully embraced their transgender child. On closer examination, however, this stance is discovered to be a flight into health or a manic trajectory toward acceptance. Grumbach suggested we could adapt these qualities to families working to grapple with a member self-identifying as gay, lesbian, bi, etc. and also to Maura’s family’s reaction, and our own, to her transitioning. In particular, the Moppa episode portrays Maura’s family members’ flights into health and manic attempts to engage with gender nonconformity by questioning their own gender roles and sexual preferences.

Susan McNamara began her presentation by noting that the attack at Pulse pointed out something that LGBTQ folk have always experienced: consistent targeting by those who hate them, including themselves. Most hate crimes are either never reported to police or are not categorized as hate crimes by local authorities. Approximately two percent of the U.S. population is LGBT, but according to the FBI about twenty percent of violent hate crime victims were targeted because of sexual orientation or gender identity (U.S. Department of Justice 2015). There were twenty-three known killings of transgender women in the United States in 2015, most of them poor and people of color, nearly double the number reported in 2014 (Tourjée 2015). In addition, there have been scores of attacks on LGBTQ spaces. Attacks on gay bars have occurred in New York, Seattle, New Bedford, Galveston, and Roanoke, Virginia. But with such extreme homophobia comes the suspicion that the perpetrators of this violence were uncomfortable with their own sexuality. The Orlando massacre narrative raises questions about the killer’s sexuality, including whether he was gay himself. Was the killer sexually conflicted? Does it matter?

After showing the Moppa episode, McNamara noted the opportunity it offers to examine the analytic community’s ideas about gender and sexuality, and perhaps our own homo- and transphobia. McNamara chose to focus on Maura’s first experience in the women’s bathroom at a mall, as representative of the aggression that queer people, including McNamara herself, face every day. In the episode, Maura is reluctant to use the women’s bathroom, but her daughter Sarah urges her on. Once they enter that fluorescent-lit mirrored environment, confusion arises—Sarah calls Maura “Dad,” which is picked up on by two teenage girls standing at the sinks. “Is that a man?” they ask their mother, who scrutinizes Maura, categorizes her, and threatens to call security. After some very tense name-calling, Maura and her daughters leave the mall. Maura is next seen in the dim blue light of a Porta-potty at a construction site.

McNamara noted the prescience of this episode. It was only in 2015 that same-sex marriage became legal in the United States, a judicial decision that occasioned considerable backlash. In the following year, more than two hundred bills were introduced by state legislatures and localities around the country, seeking to strip LGBT people of equal rights and to deny them protection from discrimination. These bills reinforced the gender binary. For example, the Texas Supreme Court ordered the city of Houston to either repeal or put on the ballot an equal rights ordinance that prohibited discrimination based on sex, race, color, ethnicity, disability, sexual orientation, or gender identity. The campaign hinged on the issue of trans folk using bathrooms consistent with their gender identity, even though the ordinance was intended to create much broader protections, as in employment and housing. More recently, in reaction to a Charlotte city ordinance permitting transgender people to use facilities corresponding to their gender identity, the State of North Carolina passed a law requiring public agencies, including the University of North Carolina, to deny transgender persons access to multiple-occupancy bathrooms and changing facilities consistent with their gender identity.

McNamara explored why bathrooms are such a flashpoint. Bathrooms are one of the few places in our society that remain explicitly labeled by gender, the only places where a line is drawn between men and women. The social response to a newborn’s genital sex is intense, marked by the colors pink or blue, gendered clothes, and gendered toys. No account is taken of the fact that babies have by birth five layers of sex: chromosomal sex, fetal gonadal sex, fetal hormonal sex, internal reproductive sex, and genital sex (see Fausto-Sterling 2012). These layers do not always agree with one another. After birth, being sexed begins the gender socialization of the newborn. Being sexed gives way to being gendered, as one’s body image develops and social gender fortification sets in. In our culture, we become masculine and feminine through “performativity,” which involves constructing and performing an identity. Judith Butler (1993) has argued that even commonplace communication and speech acts are performative in that they serve to define identity. More than a social imposition, performativity is a mode of “self-making” through which we become intelligible. And how we perform masculinity and femininity occasions us great anxiety. Am I masculine enough? Feminine enough? Am I intelligible? It is “as if we all ‘really are’ what our culture tells us our genitals mean, and as if genitals always, inevitably, outweigh agency” (Hale 1998, p. 316).

In bathrooms we are engaged in primitive bodily functions, urinating and defecating. Bathrooms are both intimate and edgy. There are smells contained in those windowless, fluorescent-lit spaces, and the urinary echo off the tile. One is exposed at a urinal. Bathrooms are hot—they are spaces for illicit sex, for anal aggression, for rape. Bathrooms are a “repository for the societal unconscious: all that Western modernity forgets, disavows, and casts asunder in polite discourse” (Cavanaugh 2010, p. 29). Bathrooms are disturbing and evoke tremendous anxiety. Gender, sexuality, primitive bodily functions, and one’s vulnerability and confusion all come into play when one passes through those iconic doors. Bathrooms are designed to discipline and regulate gender. Allowing queer people into bathrooms calls into question “the grid upon which normative heterosexuality depends for cogency and intelligibility” (p. 4), and thereby creates anxiety about gender incoherence. There is nothing rational or legitimate about gender panic in modern bathrooms: “the upset is irrational and about what Richard Juang calls ‘heterosexual genital security’” (p. 4). The toilet disciplines gender by imposing a rigidly gendered and heteronormative dividing line.

McNamara reminded the audience that while categories help us manage the huge amount of information we receive, the process of categorizing is not innocent; it alters what we actually see. Research has found that when we put things into categories, things in the same category become more similar in our minds, whereas things placed into distinct categories become more different. Crucially, categorization affects not just how we perceive things, but how we feel about them. When we struggle to categorize something, we like it less: “Results suggest that the variation in attractiveness of gender-ambiguous faces may derive from context-dependent requirements to determine gender membership” (Owens et al. 2016, p. 1).

McNamara referenced Ken Corbett’s A Murder over a Girl (2016) as a compelling depiction of the power of categorizing. In it he writes of the murder of Larry King, a fifteen-year-old brown boy who had recently begun to identify as Leticia, by Brandon McInerney, who shot and killed King during first-period English class. Corbett describes how in framing trans or gay or queer people as a problem, we are engaging in splitting. Paranoia exquisitely splits good and bad: “Murder, one could argue, is the ultimate turning away from mortal vulnerability. Murder is the ultimate paranoid solution. All that is bad is split off, put in another, and killed. . . . I am not a girl. You are. I am not gay. You are. I am not guilty. You are” (p. 210).

McNamara next introduced the audience to a proposal by the Committee on Gender and Sexuality to eliminate gendered requirements at APsaA. The association and its training institutes currently use binary gendered categories in applications for training, for training cases to meet graduation requirements, for clinic cases, for certification cases, and for cases for appointment as a training and supervising analyst. Overall, there is an emphasis on having conducted both “male” and “female” analyses or at least having treated “patients of different genders.” The proposal notes that no other health-related discipline has such requirements, obstetrics and gynecology excepted. In fact, many psychoanalytic institutes outside of APsaA have no gendered requirements. APsaA’s, McNamara asserted, discriminate against certain patients: those who are queer, trans, or gender-variant. This imposition of gendered requirements is troublesome, especially as the gender binary is everywhere implicit in APsaA’s approach. As is true for sexuality (Phillips 1998), focusing on the binary gender of the analyst and the gender of a particular patient is a radical reduction that runs counter to the analyst’s attempt to foster a process in which “the broadest range of unconscious meanings can enter into experience” (LaFarge 2014, p. 1269). According to Grossman and Kaplan (1988), all similarities and differences—in age, ability, race, ethnicity, religion, sexual orientation, socioeconomic status—“are invested with intense feeling by all people” (p. 352). “Every aspect of human experience—its form, its content, how it emerges, and when—is shaped by an interplay of contemporary external reality and phantasy” (LaFarge 2014, p. 1267), an interplay crucial in understanding the process that unfolds between analyst and patient. If gender is given priority, “unwitting stereotyped attitudes shared by both therapist and patient may invade the analysis” (Grossman and Kaplan 1988, p. 352). By voicing and reinforcing the criterion of gender, and insisting on the recognition of difference, psychoanalytic practice becomes part of a disciplinary frame. Psychoanalysis has a history of regulating gender, “as opposed to recognizing and assisting patients as they turn to us with gendered fantasies, states, and embodiments that may feel unrecognized, unrecognizable, debased by power, and unmet by justice” (Corbett 2011, p. 447). Thus, McNamara and the Committee on Gender and Sexuality recommend that gender be considered in the widest possible terms by removing dichotomously gendered requirements, thus promoting APsaA’s vision of “a world in which psychoanalytic knowledge advances human potential and relieves suffering” (http://www.apsa.org/content/apsaa-mission-vision).

Robert Galatzer-Levy began his presentation by noting that it is our good fortune to live in a time when the complexity of gender has come into focus. He believes, however, that the series Transparent is actually about reactions to transgendered people rather than a statement about them. He reminded us that the history of psychoanalytic thought can be viewed as a cautionary tale about attempts to say psychologically meaningful things about people based on their sexual desire alone. The only meaningful commonality between people with same-sex desires is that they have grown up in communities offended by those desires and often bear the mark of oppression associated with that experience. The same is true of transgender people. Transgendered persons are as diverse in every respect, including their depth psychology, as any other group of people. They will be found to share only their personal transcendence of conventional gender boundaries, the experience of being the object of community fantasies about the meaning of that transcendence, and the suffering that results from the hatred addressed to them, which leaves a mark on the psyche.

Galatzer-Levy then focused on how Transparent speaks to those communal fantasies. On a manifest level the series portrays transgendered people as victims; by the second season, the equation of anti-trans attitudes with Nazism is made explicit. Much of the positive response to the program arose from its portrayal of the victimization of trans people and their noble struggle against it. As analysts, however, he suggested that we approach the Moppa episode as a dream or fantasy and examine its latent content. The elderly father’s revelation to his daughters of his being transgendered, after having remained closeted his entire adult life, precipitates an experience that Sarah describes to Ali as “weird”—in our language, uncanny, resonant with an unconscious fantasy that has been present all along. Galatzer-Levy interpreted the rest of the episode as fantasies about the consequences of his long-hidden transgender state. He noted that the scenes unfold very rapidly, likely disorienting an audience watching the episode for the first time. He believes this pace was deliberately chosen by the creators of the series to give the audience a sense of the experience of these characters, who, traumatized by what is happening, cannot meaningfully organize it.

In quick succession the audience learns that among other transgressions, Josh, the son, was having sex with his female baby-sitter. Although he consciously viewed the experience as “every fifteen-year-old boy’s wet dream,” he is also shown as compulsively promiscuous, incapable of actualizing his wish to be a father, and angry at his parents for having turned a blind eye to his relationship with the sitter. In the next scene the difficulties of assuming a female appearance are underlined, as Maura’s idea of what it is to be a woman seems limited to wearing dresses, having long hair, and applying the appropriate makeup. In other words, her idea of femininity remains in many ways that of a latency-age child. One problem is that Maura’s “male privilege is leaking all over the place” (a quote from the series)—a wonderful eliding of the continued presence of male genitals and the difficulties of abandoning the presumptive power associated with masculinity. A third scene then shows how this transformation in appearance resonated with the initial pleasure of dressing as a woman. The audience is taken back to the early transition of Mort to Maura in a fabulous ’90s maroon and orange hotel room, with Maura being seen and named as Maura for the first time ever by her transgender friend. Her experience was dominated by painful hiding from her family but also the emergence of a name and identity, Maura, that had a more complex feminine quality than the “strippery” name she initially chose, Daphne Sparkles.

The scene then shifts to Sarah, the bisexual daughter who has left her husband for a woman. This lover is unwilling to confront her own wife with the new relationship, a problem the lover tries to solve by a transition to lust. Lust as a solution recurs when Josh confronts his baby-sitter and they have sex. The next scene depicts an emotional conversation between the sisters, who feel “weird” about Maura’s transition, the burden of keeping her secret, and the puzzles of their own sexuality.

Climactically, in a women’s restroom, the daughters invite a confrontation by referring to Maura as “Dad,” precipitating the bizarre but all too common fantasy of the transgender woman as a potential molester of young girls, and then defend her right to be there. This scene, which when first aired anticipated the equally bizarre political to-do around the rights of transgender people to use the bathroom matching their gender identity, resonates with the civil rights movement of the 1960s, when the use of white-only bathroom facilities by blacks was a major issue. Maura, the victim in all this, is forced to relieve herself in the Porta-potty. She then returns to her apartment, where, enraged by a gay party going on next door, she calls the neighbors “motherfuckers” and “faggots.” The scene ends with her alone, yelling to the neighbors, “You’re not alone.” In the episode’s final scene, Ali and Josh dance together in a way that suggests affection and being together, with only a hint of incest.

In summary, Galatzer-Levy interpreted the underlying fantasy of the episode: “If the patriarch is transgendered and closeted, then the son will be abused and aspects of his masculinity diminished, the father will have a limited vision of femininity, the daughters will be traumatized, the fidelity associated with erotic love will be lost, and the transgendered person will be left alone.” As Ivan Karamazov asserts in the great novel, “If God is dead, then all things are permissible.” This episode elaborates on this idea as applied to a reality based on the binary conception of gender. Maura has announced her death as the patriarch, and the overarching principle of the gender binary is not merely abandoned, but is asserted to have all along been a lie. Throughout the episode disorientation is a major theme. The gender binary is experienced by many people, including some analysts, as foundational to reality. Deprived of this basic principle, all of the characters are either befuddled and confused or react to their befuddlement with oversimplification: Maura equates being a woman with wearing dresses and makeup and having long hair; gay men, portrayed as never over forty, spend their lives in gyms preparing themselves to wear tight-fitting clothing and dancing the night away; straight women center their lives around childbearing and masochistic submission to abusive men.

While Galatzer-Levy commended the value of exploring the complexities of a world in which the gender binary and patriarchy are disrupted, he deplored the show’s reinforcement of the fantasy that the existence of transgender people inevitably generates unmanageable anxiety and confusion from which the community is not delivered, and which leaves the transgendered person as a tragic character, ultimately a victim and the target of psychological and physical violence. He suggested other meanings the community might assign transgendered people by playing for the audience the Kinks’ song Lola. In the song, Lola is a transgendered woman who inhabits a world where “they serve champagne and it tastes just like cherry cola” and they dance lit by “electric candlelight.” In this “mixed-up, muddled-up shook-up world” Lola “walks like a woman but she talks like a man,” her squeeze “almost broke my spine,” and finally, though the observer is not the “world’s most masculine man,” he knows what he is and is “glad” he’s a “man, and so is Lola.” In this world Lola’s existence is not the cause of disorder: “Girls will be boys, and boys will be girls. It’s a mixed-up, muddled-up, shook-up world, except for Lola.” It is Lola who is at home with her gender and its relationship to her body.

Galatzer-Levy then referenced another powerful portrayal of a strong trans character—in the movie The Crying Game—whose sanity transcends a mixed-up world. Such characters, he noted, have also existed historically, such as the antique dealer Charlotte von Mahlsdorf, who survived the Nazis and supported a queer community in post-war East Berlin under the Communist regime. Thus, fantasies about transgendered people are available other than those implicit in Transparent. There is the fantasy of an orienting, rather than disorienting, image of gender complexity, in which sanity comes from living flexibly. The historian Pablo Ben has observed that the idea of gender is a common cultural meme (personal communication to Galatzer-Levy). Like other memes that bear a loose relationship to people’s biological features (e.g., race, age), the idea of gender, while actually signifying little beyond its own presence, can easily turn oppressive. One route out of the oppression of gender is through its recognition and deconstruction as a culturally determined meme. In other words, we can learn from transgendered people how silly the whole issue is.

The prefix trans refers to the crossing of boundaries, the disappearance or softening of separation. To translate is to place information into a language in which it was previously unavailable. To transport is to end the separation between two places by moving objects between them. Transgender and transsexual suggest an image of a boundary that is being crossed, in some sense unexpectedly, or at least in a way that surprises sufficiently to require comment. Geopolitical boundaries, which are set up with the conscious intention of separating and avoiding conflict about boundaries, are arbitrarily hard. They are almost always the outcome of conflicts and an attempt at their resolution: “Good fences make good neighbors.” Natural boundaries are very different: often of a highly complex character, rich in structure, they as much create communication between separated areas as impede traffic between them. Galatzer-Levy also offered the example of fractal boundaries, with infinitely complex interstices and enormous possibilities. He thought that gender can similarly be conceived of as a multidimensional space whose social exploration has led to some regions of the space becoming relatively clear, with boundaries that are complex and rich in structure. Trans people can be thought of as living closer to these rich boundaries than people with more conventional gender experiences. He suggested that if we imagine life in a fractal universe of gender, we can do away with the destructive aspects of the gender binary without producing the kind of disorder portrayed in Transparent. Instead the world will become richer and more interesting.

After the audience discussed the Transparent episode and the presentations in small groups, they were reconvened. At that point, I discussed my experience as a candidate learning about gender and sexuality and what the Committee on Gender and Sexuality is doing to develop model syllabuses on gender and sexuality that can guide institute curriculums ( http://www.apsa.org/gender-sexuality-curriculum ). Many candidates are introduced to psychoanalytic theory on gender and sexuality through Freud, whose deficiency on the topic of female sexuality is now well recognized. Take these quotes for example: “In this respect children behave in the same kind of way as an average uncultivated woman in whom the same polymorphously perverse disposition persists. Under ordinary conditions she may remain normal sexually, but if she is led on by a clever seducer she will find every sort of perversion to her taste . . .” (Freud 1905, p. 191); “Girls feel deeply their lack of a sexual organ that is equal in value to the male one; they regard themselves on that account as inferior, and this ‘envy for the penis’ is the origin of a whole number of characteristic feminine reactions” (Freud 1926, p. 212). I criticized the fact that the only model of femininity presented to candidates early in training is a model of moral inferiority, castration, and sexual passivity. There has been a great amount of writing on the topic in the last fifty years, by writers including Balsam, Fast, Suchet, Butler, Kulish, Harris, Benjamin, and Goldner, but at my institute their writing was not introduced until the courses on gender and sexuality in the final years of training. Nor was any reference made to their ideas as context for the early reading of Freudian texts. These writers described women showing off, being tomboys, women who are aware of their inner spaces and excited about them, who have complex feelings, both envious and desiring, toward both their mothers and their fathers. They theorized all gender and sexual identities as compromise formations, the result of conflicting feelings toward and identifications with both parents (and with siblings), and of cultural imagery and prohibitions, the wish to be both genders, and the vicissitudes of one’s temperament and biology. There were still elements of a grounding universal theory (see, e.g., a paper by Irene Fast [1990] that postulates that feminine and masculine traits are the result of internalized identifications with important men and women in development), but there was now much more room for divergent individual narratives. The theoreticians who intrigued me most were those who were equally suspicious of universalizing, biologically based models of healthy gender identity, on the one hand, and of attempts on the other to dispense with them altogether in favor of idiosyncratic, individualized narratives of gender. Hansell (2011) has stressed the importance of maintaining a dialectic between the universal and the idiosyncratic, the biological and the cultural:

the gender binary cannot be explained simply in cultural terms and denounced as pathogenic; it can also represent a stabilizing structure, consistent with the child’s cognitive and emotional capacities during critical periods of early development. Indeed, children need culturally available models from which to develop the ego ideals that serve as a bridge between the individual’s idiosyncratic developmental story and the cultural surround. . . . In optimal development, as Benjamin, Bassin, and others point out, the more rigid and defensive “use” of the gender binary gives way, throughout the lifespan, to more complex, nuanced, and flexible gender models and ideals, provided that the mourning necessary for this continuing development can be tolerated. . . . a dialectical view of both the facilitative aspects of the gender binary (it can provide cultural material for adaptive identifications and compromise during early development) and its limiting aspects (it can be used as a rigid defense against cross-gender identifications) provides the richest picture [p. 66].

I expressed my regret that traditional, universal theories of gender and sexuality are to this day heavily emphasized in training, as well as the split between cultural and biological models of gender. Further, candidates are not always taught to think about psychoanalytic theories in the historical context of cultural swings between biology and psychology, the universal and the individual. Psychoanalytic institutes, I urged, should create a more integrative, contextualized curriculum, more consistent with what is now known about the mind as a complex, dynamic system. This is crucial because theory powerfully organizes what the analyst is able to see and hear about patients, about their identities and sexual practices, and in large measure determines what is regarded as perverse. Theory can be used defensively to pathologize patients who make the analyst uncomfortable, and to justify questionable therapeutic practices. I quoted, by way of example, the abstract of a recent symposium on gender and sexuality presented in New York: “I think most of us would agree with the right of a gay couple to marry and even raise children. But what if your kid’s teacher is a she-male or if he wants to have a play date with a friend who cross-dresses?” (Friedberg 2016).

I concluded by stating that theory can also be used to help us recognize themes in our patients that we might otherwise be blind to, as well as to ground us sufficiently that we may tolerate not knowing what will be best for our patients as they grow, enrich, and expand their sense of self, identity, and desire. My hope is that APsaA institutes will begin to teach models of gender and sexuality that are more experience-near and helpful in the consulting room and will integrate these models with the rest of psychoanalytic training and education.

At this point the panel opened onto a discussion with the audience, many of whom shared their sense of anxiety and vertigo in response to the Moppa episode, and to a more fluid conceptualization of gender overall. They appreciated Galatzer-Levy’s explicit discussion of the dizzying effects of the show. Barbara Marcus found in her clinical work that it was important to understand the diversity and complexity of gender, not only in patients who present as trans or queer or questioning, but in every patient and in herself as well. She believed it is just as important to problematize patients who do not question their gender or sexuality during the course of an analysis or depth therapeutic work; restriction and rigidity, though clearly important to understand, are often not taken up in analyses. Several audience members spoke to the training requirement for a male and a female case and its pedagogical purpose. If it has to do with treating someone in analysis fundamentally different from oneself, someone asked, why not require a patient from a different race or socioeconomic status?

The discussion then helpfully centered on the importance of discussing analysts’ feelings, blind spots, and countertransferences and the need for the APsaA community to acknowledge and correct its internalized homophobia, transphobia, and hatred. Connections were made to the larger theme of hating the Other, and racial hatred such as demonstrated by the events in Ferguson, Missouri. Dorothy Holmes eloquently pointed out that as psychoanalytic clinicians we need to come out with our own fear, biases, and stumbles; we cannot leave the burden of coming out to our patients. We are too used to hiding behind psychoanalytic silence. Another audience member pointed out how many analysts struggled with the tension between the desire to be culturally sensitive and the analyst’s task of probing deeper or pointing out things that don’t affirm the patient’s identity. Another responded that the analyst is tasked also with self-analysis, including an examination of one’s own perspective, which is never truly neutral.

One of the small breakout groups had earlier discussed patient statements such as “I always was a boy (or a girl) in the wrong body” and how they imply a model of transition that is corrective of biology, which itself implies a false binary. The group offered instead the model of a constructive choice to embody one gender or another that best fits one’s gender identity as a whole. In response, several in the audience raised the issue of omnipotent defenses. They acknowledged the need to respond openly to a patient’s gender transition and to have a more fluid conception of sexuality, but thought the analyst should also keep in mind the possibility of omnipotent defenses like the child’s wish to be both genders. When to bring up reality issues is still a problem, even with expanding possibilities for altering reality. If one can no longer turn to gender as a hard-and-fast reality, how does one respond to a defensive reliance on omniscience? I responded that omnipotent defenses and difficulties in mourning figure in many of our patients’ conflicts, yet are less likely to be considered when efforts to change reality conform to a heteronormative gender binary, as when a forty-five-year-old woman undergoes fertility treatment to become pregnant (at great financial cost and with significant health risks), or when a woman chooses to get breast implants after a mastectomy, or an individual with Klinefelter syndrome, born XXY, takes testosterone to maintain a male gender identity.