Identity and Gender

People often ask me why I am concerned with the topic of gender. The answer is simple: as a clinical psychologist, as a psychoanalyst, as a psychotherapist, and as a human being, one of my main goals in life is the reduction of unnecessary suffering.

Several studies show that people who “identify as trans or gender non-confirming tried to commit suicide at least once — the percentage for the general population being 4.6 percent.” (Gherovici, 2017, p.20). The reason for this alarming number of suicide attempts is not something intrinsic to them, but related to social marginalization, transphobia, and lack of support from their parents.

This hypothesis is confirmed as research finds that social supportreduced transphobia, being able to change personal identification documents to an appropriate sex designation, and completing a medical transition with hormones or surgeries if needed, are associated with large relative and absolute reductions in suicide risk. Parental support for gender identity is also associated with reduced suicidal ideation (Bauer, G., et al, 2015).

Thus, any psychologist worried about the wellbeing of the population, or just about saving lives, should be concerned that trans people are not harassed and that they get the support they need. Especially because the choice of conceptualizing transgender identity as a mental disorder for decades has contributed to precarious legal status, human rights violations, and barriers to appropriate health care among them (Robles, R., et al, 2016).

But if transgender identity is not a mental disorder, what is it?

Patricia Gherovici, Ph.D. is a Lacanian psychoanalyst like myself, and has argued for a depathologization of the trans experience and prefers to think it in terms of sinthome, a Lacanian concept that refers to “something that may allow you to exist in the world — in other words, your idiosyncratic, creative strategy of survival. In this sense, the journey between genders could be a creative symptom, a way of making life livable” (Gherovic, 2017, p.23).

I would go one step further. I think any identity fits this description. In fact, I believe that gender is a useful tool to live in the world, as a pragmatic heuristic that conveys information to others — and to myself — about whom I am. As any other psychological phenomenon, it has some unconscious parts (no one consciously decides or chooses which gender we are), and a conscious side (how I feel and how I express it).

In our society, gender is associated with anatomical differences, but this is an arbitrary definition and not the only one possible. The definition of marriage used to be exclusively a contract between a man and a woman, until the definition changed. Language is a living organism in its diachronicity, and we should not let dead letters in a dictionary rule us. As Elizabeth Grosz (1994) stated “the body image cannot be simply and unequivocally identified with the sensations provided by a purely anatomical body. The body image is as much a function of the subject’s psychology and sociohistorical context as its anatomy” (p. 79).

Identity helps us to feel stable, and thus to reduce anxiety. Gender is one aspect of identity that serves this same purpose. I believe some people that oppose the right of trans men to call themselves men and trans women to call themselves women are unconsciously triggered by something trans people are showing them: the definition of gender they have used for their whole life — and thus something with which they have made sense of themselves and the world for so long — is arbitrary and can change.

People resist change; it’s understandable; but not at the expense of others people’s lives. We need to have a dialogue, to raise our level of awareness not only of trans identities but of our cis identities too.

I often give homework to the parents of trans kids: “How do you know you’re a woman?” (to cis women) “How do you know you’re a man?” (to cis men). They always have a hard time finding answers that seem conclusive even to them. They end up saying, “I just know.” And that’s exactly my point. Cis people also have a particular relation to their identity, to their gender, where the answers fall into clichés or into feelings, and the natural ground they want it to rest on crumbles into conventions.

Thus, we all have to deal with the issue of our gender, in relation to our body and to society. As Gherovici states in her book, “dealing with sexual difference, which also entails but is not limited to assuming one’s sexual and gender preferences, is a problem for everyone.” (2017, p.30).

Psychoanalysis, if it remains true to itself and refrains from entering the psychiatric discourse of normalizing or pathologizing, can be a useful tool to explore the way we all deal with our identity, in this case our gender, as Patricia Elliot, Ph.D already proposed in 2001, when she stated we have to face “the problem of sociopolitical and biological reductionism, and the need to analyze, not to pathologize or to normalize, complex psychosexual processes” (2001, p.295).

After all, Freud (1915/1946) explained with his concept of drive how the relationship with our body is mediated through the way we represent it in our minds, something that is not only supported by the work made by Lacan on the symbolic order and its signifiers, but also by current neuroscience; for example in Damasio (2010) with his concept of maps of what’s going on in our brains and the external world, “experienced as images in our minds” (p.19). This is one of the reasons Freud didn’t talk about instinct, whose object is singular and determined by nature, but of drive [Trieb], in which the object is not fixed and that as a concept is neither psychological nor physiological, but a bridge between them. We are not minds and we are not bodies, but a mind/body unity.

If how we feel about ourselves, how we see ourselves, is not a natural phenomenon but one that needs to go through the “word-mill” [moulin à paroles] (Lacan, 1957/1998) or represented in words [Wortvorstellung] (Freud, 1915/1946) to be a content in our conscious minds, then expecting gender or any part of our identity to be a mere result of anatomical differences is either naïve or disingenuous.

Freud believed that the mechanisms of poetic creation are the same as that of hysterical fantasies, “a poetic defense” (Masson, 1985). I would expand this idea to consider that our identity is also a creation: parts given to us by biology and by society, we assemble them as a poet — both consciously and unconsciously — becoming a work of art ourselves.

As Gherovici wisely asserts, “when an analyst receives into the office an analysand who might identify as transgender, the analyst has the opportunity to repeat Freud’s gesture when confronted with his first hysteric patients. While Charcot reduced them to objects of display in the Salpêtrière’s amphitheater, Freud restored their dignity by listening to them. Let us follow Freud and listen to trans patients in the plurality of their presentations.” (2017, p.79). Not only does their creation deserves as much respect as any other identity assembled by cis people, but we are privileged in listening to a creation that “attempts at transcending social limitations and the ideology of subjective normativity.” (p.79).

In sum identity, i.e. who we believe we are, is something we construct ourselves — consciously and unconsciously. The stimuli that come to us from our own bodies and from the world are both mediated in the same way, through how we represent them in our minds. That mediation depends heavily on the symbolic world we inhabit, the words and meanings our societies grant us, so there is nothing natural and immediate about it. Identity, just as any other representation we have, even if it’s about ourselves, is socially constructed and mediated.

Why is this relevant? Because once we understand our identity — including our gender identity — is a construct and not a given, we can focus on the pragmatic side of it, of how to give it the best use we can. Once we understand cis identities are as artificial and constructed as trans identities, and if we are honest our understanding, then there is no more bigotry or discrimination possible, at least based in the false belief that one is natural and the other is a distortion, or even worse, a mental illness.

Instead of saying traditional painting is art, and abstract painting is not, we embrace that they are both ways of representing something, both valid works of art. What this analogy lacks, however, is that when we are talking about gender identities, disregarding the validity of trans identities is not just a matter of opinion, but something that can have lethal consequences.


Bauer, G., Scheim, A., Pyne, J., Travers, R., Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 515:525.

Damasio, A. (2010). Self comes to mind: Constructing the conscious brain. New York: Pantheon/Random House.

Elliot, P. (2001). A Psychoanalytic Reading of Transsexual Embodiment. Studies in Gender and Sexuality, 2(4), 295–325.

Freud, S. (1915/1946). Triebe und Triebschicksale. In A. Freud, E. Bibring, W. Hoffer, E. Kris, & O. Isakower, in collaboration with M. Bonaparte (Eds.), Gesammelte Werke, Chronologisch Geordnet (Book X, pp. 210–232). London: Imago.

Ghoreci, P. (2017). Transgender Psychoanalysis. New York: Routledge.

Lacan, J. (1957/1998). Le Séminaire. Les formations de l’inconscient. France: Seuil.

Masson, J. (1985). The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887–1904. Translated and edited by Jeffrey Moussaieff Masson. Cambridge, Mass./London: The Belknap Press of Harvard University Press.

Robles, R., Fresán, A., Vega-Ramírez, H., Cruz-Islas, J., Rodríguez-Pérez, V., Domínguez-Martínez, T., & Reed, G. M. (2016). Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. The Lancet Psychiatry, 3(9), 850–859.