Can Psychoanalysis En(-)gender Its Trans(-)cendence? Which Side Are You On? (Book Review)

It Gets Better: Coming Out, Overcoming Bullying, and Creating a Life Worth Living
Author:  Savage, Dan and Miller, Terry
Publisher:  New York: Dutton, 2011 
Reviewed By:  Richard Ruth and Helen Devinney, Summer 2012, 352 pp.

Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children
Author:  Diane, Ehrensaft
Publisher:  New York: The Experiment, 2011 
Reviewed By:  Richard Ruth and Helen Devinney, Summer 2012, 304 pp.

Transvestism, Transsexualism in the Psychoanalytic Dimension
Author:  Ambrosio, Giovanna
Publisher:  London: Karnac, 2009 
Reviewed By:  Richard Ruth and Helen Devinney, Summer 2012, 144 pp.

To the delight of some and the horror of others, the world is alive with transgressive social movements—fractious, colorful, awkward, provocative, and as important as ever. The streets are full of dissent and questioning, principles said to be part of the character and social fabric of the United States. In considering these movements, lurching toward challenge and change, we find ourselves wondering, what role does psychoanalysis play? Can it play a role? Does it desire to play a role?

Such questions have diverse answers, implications, and centers of gravity. We approach them from the perspective of the emergent transgender movement.

Transgender: once a specific term, now grown to embrace and hold space for all who find something slippery or incongruent about regarding birth-assigned gender as the definitive, indisputable, or “correct” expression of their true gender. Under the vernacular umbrella, “trans,” one finds those who the medical community identifies as transsexuals, along with those who self-identify as gender-queer. It is impossible to reduce all of the potential the terms hold into a satisfying sound bite. The terms’ very resistance to being oversimplified mirrors the ways the transgender movement questions and subverts rigid, linear ideas about development and reified concepts of gender as a strict binary. Trans issues have moved out of the shadows and into our collective face. The evidence is in the news media (recent Washington Post headlines about empowered trans protests against police inaction in the face of the latest round of brutal attacks), popular culture (this summer’s hit reality show, The Glee Project, had an African American teen who does drag), academic discourse, and talking points from the Republican presidential candidate race.

And, of course, the fight for trans issues to be heard and understood continues in the streets, likely in your neighborhood—maybe even in your office—whether you are aware of it or not.

One way to appreciate our current moment, the potential for change, as well as the diversity of people working to create and support that change, is the It Gets Better project, the first publication (in this case, a website that spawned a book) under review here. Trying to do something about the rash of suicides of gay teenagers in 2010, Dan Savage—sex columnist in gay media, journalist, author, imaginative genius—began a project where people could post videos telling LGBT adolescents struggling with isolation, bullying, and hopelessness that life gets better after high school. In September 2010, Savage and his partner launched the project by uploading their first video to a dedicated YouTube channel. Savage repeatedly notes that the idea for the project came from his belief, hearing about these suicides, that—if he had just been able to talk to one of the bullied kids and share the message that “it gets better”—he might have been able to make a difference.

The project soon went viral. Take a look at the It Gets Better Website. Thousands around the globe—President Obama, rock stars, religious leaders, pro athletes, celebs, and just folks—have submitted videos. More get posted every day. In the videos, people talk to an imagined listener. They reflect on the roads they have traveled; they hold, and give, hope for others who cannot yet hold it for themselves. Warning: once you start watching, you may be at your computer for hours. And you may weep, with joy and grief and wonder.

Some things of interest in this project:

• It is interactive—the medium allows responses, dialog, blogging—and it saves lives. The empirical evidence is inscribed in the postings. Lots of lives. Perhaps Savage’s own anecdote captures the essence of the project’s emotional pull: Savage began the project in September 2010. His goal: collect 100 videos. By February 2011, the project included approximately 10,000 videos that had been watched over 30 million times.

• The It Gets Better project makes the term “LGBT” tangible in a way its slippage into popular lingo (in some quarters, anyway) often does not. Lesbian, gay, bisexual, and every variety of trans reality is here, part of a shared psychological, social, and communal space. The voices are public and private, transgressive and conformist, activist and (formerly) closeted.

• The project inspired a book (another challenge to rigid developmental sequencing and a worthy publication in its own right). Websites do some things better; books do others, even in the age of Kindle, Nook, and iPad. While the website resists neatness and categorization, the book features 100 carefully selected essays, designed to both move and give pause. Gape in one way when you browse the website; gape perhaps more refl ectively when you read the book.

• And perhaps no surprise: you won’t fi nd psychoanalysis taking the lead here. Therapists are a welcome and appreciated presence, as voices and frequent references, and the savvy listener/reader can at times detect an analytic or at least a dynamic sensibility (no allusions could we find to zippy manualized treatments). But no analysts. Or at least they haven’t come out.

Why? Didn’t psychoanalysis transform the whole culture’s notions of gender and sexuality? Well, maybe yes, maybe no. Our fi eld struggles, among other things, with notions of neutrality. Does it mean we stand aloof from social movements and social changes, dispassionate observers and analyzers from the abstinent sidelines? Or does it mean we take a stand in favor of freedom, because it is only from that stance that genuine potential space can be generated? Freud, it could be argued, made both arguments.

Diane Ehrensaft, a prominent member of Division 39, has written Gender Born, Gender Made (2011), the second publication under review here, which simultaneously advances the psychoanalytic understanding of trans children and adolescents, their families, their needs, and how mental health professionals can support and assist them and speaks directly to the parents of trans kids. Part of its message is the mixture of discourses and audiences it embraces—something Dr. Spock did, but that analysts, these days, more often shy away from. The book makes space for the professional and the personal, the supportive and the unsure, using a gentle yet knowledgeable voice to humanize and personalize an issue that often can become too clinical, sterilized, and diagnostic.

In Ehrensaft’s book is a blend. She juxtaposes personal experience—she is the mother of a gay adult son, gender-transgressive as a boy, and her own developmental journey was hurt, as well as enriched by, the psychoanalytic thinking that shaped her training—with scientifi c fi ndings, material from her clinical work, and advocacy.

But unambiguously, this is a pro-trans book. While in no way oversimplifying complexities of gender, sexuality, and being trans—Ehrensaft recognizes, for instance, that some kids are transiently trans, in response to trauma or other developmental dynamics, and advocates that trans kids presenting to professionals get careful, thorough professional assessment—she takes a stand: it’s OK to be trans. Some kids just are. And not in a cookie-cutter way—some are gender fl uid; some are gender hybrid; some are on a pretty linear trans trajectory, know their preferred gender to be other than the gender of their birth assignment, and just want the help and support to get there. Most, therefore, do not need therapy, though their parents may well need some professional support, information, and assistance. In this way, Ehrensaft offers a perspective that perhaps parents, and support systems of children who identify as trans, may benefi t the most from exploring feelings and thoughts related to gender and sexuality—not the trans child, who may already know, all too intimately, what s/he thinks, feels, and needs. Ehrensaft’s work pushes against toofacile liberal assumptions in an admirable way, because she asks readers—especially, in this context, psychoanalytically informed mental health professionals—to move beyond tolerance to take informed, involved, and committed pro-trans stands. This means, for instance, both challenging the DSM’s transphobic notions of gender identity disorder and using our authority, when asked, to support trans kids’ needs for cross-gender hormone treatments. It means being willing to work as part of professional teams, something that does not always come readily to the analytic sensibility. It means creating potential space by beginning from a place of unambiguous affirmation: the difficult juxtaposition of advocacy with abstinence. It means there is an essential place for us, but not always as therapists. Welcome to contemporary psychoanalytic life.

In 2009, a year before the It Gets Better project began, the International Psychoanalytic Association published the third publication under review here, Transvestism, Transsexualism in the Psychodynamic Dimension, its take on advancing current thinking on trans issues. It is a troubling and problematic book that often feels deeply offensive.

Psychoanalysis is concerned with the uncanny, the unconscious, and often the counterintuitive, and, therefore, it is—or should be—inherently countercultural. Freud offended the bourgeois sensibilities, both liberal and conservative, of his Vienna, and our most important and enduring contributions have always depended on degrees of freedom to extrapolate from clinical data, to challenge social and scientifi c convention, and to speak freely in our own idiom.

It may also be risky to parse trans issues from a gay and lesbian sensibility, but it is fair to read the IPA’s publication on trans issues against the background of the contentious history and lingering presence of psychoanalytic justifi cation of homophobia. Freud did not, but subsequent generations of analysts undertook treatments of gay men and lesbians, beginning from the assumption that something was wrong with them, and then used the analytic material that arose from the couch to “reveal” gay lives as pathological. Some—no longer the majority, but too many—still do. If you want another opportunity to weep, with outrage, check out the website of the National Association for Research and Therapy of Homosexuality, an odd coalition of psychoanalysts and the religious right. Some of its members are quoted, without acknowledgment or critique of their known views and histories, in the book under review.

The writers in the IPA volume are intelligent, respected, well trained, and diverse in their beliefs, approaches, and recommendations. But all begin with the assumption, never questioned in this book, that it is not normal to be trans. A pall hangs over each of the essays that suggests the real (latent?) work of the book is to identify where the trans lives took a wrong turn and became perverse. And, on close reading, there is an uncomfortable feeling that at least some of  the authors still think of gay and lesbianlives as somehow developmentally arrested.

For these reasons, one cannot meaningfully critique the writers’ views. Their discourse does not allow it. The gauntlet thrown down, in the volume, is that other voices meaningfully reflecting on trans issues are antipsychoanalytic, or at minimum that pro-trans authors are insuffi ciently appreciative of the space and value of a discussion of trans issues among psychoanalysts. By which is meant, interestingly, not members of the IPA—two of the seven writers here are analytically oriented, but not analysts, according to their included bios—but something more in the way of innuendo. It is not innuendo, however, to say that the IPA, apparently, chose not to include one single pro-trans analytic voice in this volume. So we will interpose. Each of the trans patients I [RR] have seen as an analyst or for psychoanalytic psychotherapy or assessment, over 30 years of experience, has presented with significant psychopathology. So do most people who seek my professional help. But part of my job is to parse what is the effect of a discriminatory environment from what begins from within the psychic constitution, and how the two vectors dance together—picking up, as it were, where Freud’s never quite finalized attempt to sort out the seduction theory of hysteria left off.

Every single one of my trans patients has been hated, and has lived contending with the impact, often violent, of such hatred. Even with treatment, they never fully recovered from hatred’s impact, in a transphobic world. But they got better. The society they live in has been a parameter on their well-being; with my gay and lesbian, ethnic minority, and women patients, I have found something analogous. I do not conclude from my experience that there is something wrong with being gay or lesbian, an ethnic minority, or female. Or trans. Rather, I think that my belief otherwise is a starting point for being able to help, and help analytically. My colleagues writing in the IPA’s volume disagree.

The world around us is moving. And the center of gravity of our field needs to move.

The two authors of this essay share life in a graduate program in psychodynamic clinical psychology. Our training clinic runs an unambiguously trans-affi rmative therapy group for trans people every Tuesday night. It is in its fourth year. One of us [RR] supervises the group. The other [hD] co-leads it.

What happens in the group is the subject of another article, but this much merits saying here: when the members of the group meet in potential space with affirmative psychoanalytic psychotherapists, growth and change happen. Our unique psychoanalytic tools, put at the service of helping the group members understand the nuances and motion of their inner lives, help them become who they want to be. We share that understanding, interestingly, perhaps not with all of psychoanalysis, but most assuredly with the majority of all the mental health professions. Trans-affirmative treatment is embedded in the American Psychological Association’s code of ethics.

Being involved with a trans-affirmative therapy group makes it diffi cult to read the IPA’s book without thinking about the questions we psychoanalytic psychotherapists must take up as individuals and as a larger community. Every member in this psychotherapy group has experienced interpersonal trauma in his/her life as a trans person. Often, the trauma has been violent or sexual, repeated, and targeted. Research has demonstrated that trauma, particularly trauma that is not random and that involves physical or sexual assault, is more likely to predispose an individual to symptoms of posttraumatic stress disorder, and to feel unsafe and unsure of others.

Trans-specifi c trauma remains beyond consideration in the selection of essays in the IPA book, skewing the writers’ clinical refl ections and theorizing. The writings thus steer away from deepening thinking about how trans presentations may be far more based on experience than on intrapsychic wellsprings. The essays keep a “safe” distance. Rather than considering daily trans experience— often far from ordinary, for most transidentifi ed people—the authors prefer a stance overly removed and clinical. The authors pass up the potential for collaborative engagement with a community who could benefit from our understanding and support. They wonder instead about the point, if at all, where trans individuals can meet others’ (Other’s) ideas about how to benefi t from psychoanalysis.

We understand better than an earlier analytic generation that empathy and respect, not the “surgical stance,” are mutative. But perhaps the deepest question here is where psychoanalysis stands, because that is part of what determines what we accomplish, and how we negotiate our somewhat precarious survival. To juxtapose language from earlier generations, will we be part of the problem or part of the solution, as the transgender movement advances in its social assertion? Which side are we on?

In the recent protests at Berkeley, part of the Occupy movement, students and faculty stood together to communicate something as a group—a community— knowing that collective voices offer a possibility distinct from individual voices. The police later clashed with the protesters; several students and faculty were injured in the confl ict that ensued. Following the confl ict, police told the protesters to take down their tents or risk arrest. Remove the tents; dissolve the protests; silence dissenting and problematic voices.

The community had a choice about how to respond; their response, rather than the politics of the situation, suggests our lead here. Rather than thinking about what was not possible, some students found potential space for something simultaneously new and familiar. Where the tents had once been erected, the students flew helium balloons on kite strings—lots of them, enough to take full-size tents skyward.

Our field can most benefit from an expansion and full realization of all we do—not a restriction of it. There are ways of both honoring and subverting the traditional psychoanalytic stance as we think about how both to do good clinical work and support important social change. In reading these three books, it seems we have ideas about the work that has been done, the work we could do, and the work that remains to be undone.

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