Transsexuality as Sinthome: Bracha L. Ettinger and the Other (Feminine) Sexual Difference

ABSTRACT

This article uses Bracha L. Ettinger’s theory of the matrixial borderspace in relation to Jacques Lacan’s analytic of sexuation to argue that transsexuality isn’t reducible to psychosis. Rather, transsexuality taps into an Other (feminine) sexual difference that is subjectifying and can be understood in relation to Ettinger’s conception of metramorphosis and the matrixial. Transsexuality involves the somatization of the Other sexual difference and the creative use of this difference as sinthome. The sinthome of transsexuality can enable the subject to negotiate the aporia of sexual difference. I establish parallels between the (neurotic) hysteric and the transsexual to argue that transsexuality can be a subset of neurosis. The transsexual transition (which often involves Sex Reassignment Surgery) can be understood as a metramorphical becoming, a borderlinking enabling separation and distance in proximity. It is not as Catherine Millot (1990) contends an attempt to abolish the “nature” of the Real but rather a means to achieve a sinthomatic reknotting of the 3 Registers such that one’s relation to a parental image and to an Other’s primordial traces can be reconfigured.

This article is written in the spirit of depathologizing transexuality in Lacanian psychoanalysis and to call for more progressive theorizing using Lacan’s (1998) later works on sexuation alongside Bracha L. Ettinger’s (2006) work on the matrixial borderspace. Ettinger is an artist, theorist, and feminist psychoanalyst who has critiqued and offered a supplement to Lacan’s writing on feminine sexuality. She conceives of the trans-subjective and metramorphosis in relation to Lacan’s analytic of sexuation and I use her conceptualization to contend that the sinthome of transsexuality can be understood in relation to an Other (feminine) sexual difference. Whereas most Lacanian writing on transsexuality has followed the writings of Catherine Millot (1990), who concludes that male to female transsexuality is psychotic, this article begins with the premise that transsexuality is not reducible to psychosis and that it may be understood as a subset of neurosis and in terms of the matrixial substratum. More specifically, I contend that transsexuality isn’t caused by a failure of the paternal function (as in psychosis) but that it indexes an Other sexual difference (Ettinger, 2006) predating phallic sexuation as theorized by Lacan (1998).

Although there has been a steady stream of scholars using Lacan’s (1998) writing on desire and jouissance in trans studies to offer alternatives to Millot’s (1990) formulation there has yet to be a sustained engagement with Ettinger’s (1997, 2001, 2006) work on the Other sexual difference. This is surprising when we consider that she offers a means to think about sexual difference outside the terms prescribed by the Lacanian Symbolic (which is phallic and cisgender) and in terms of an Other axis of sexual difference. The Other sexual difference “produces for men and women a different, non-Oedipal sublimation where, in the search for non-I(s), the jouissance is of the borderlinking itself” (Ettinger, 2001, p. 110). It is felt “in/by the Real” (Ettinger, 1997, p. 401). The borderlinking is an event in the Real at the basis of the Other sexual difference. In other words, the Other jouissance is responsive to an uncognized memory of the early mother-to-be/late fetal sexual relation that leaves trace inscriptions, mediates affects, and produces internal sensations that operate in a matrixial substratum. The matrix is a nonexclusive “symbol for the feminine, a symbol for a non-phallic sphere of not-oneness … which includes a recognized unknown” (Ettinger, 1992, p. 11). The matrix is an Other axis of sexual difference accessible to us all, regardless of trans status and is not reducible to femininity or to gender identity.

My contention is that transsexuality can be understood in relation to the feminine not-all and in relation to the matrixial substratum. Transsexuality may, as I suggest later, be understood as a metramorphical becoming and co-fading in a trans-subjective space of feminine difference that reconfigures and reinscribes the traces of a primordial m/Other. Metramorphosis involves a process of “joining-in-separating with/from the other” (Ettinger, 2001, p. 104). In Ettinger’s theory, the trans-subjective refers to subjectivizing encounters in the matrixial whereby links between subjects and objects (or, rather I and non-I’s) co-exist in asymmetrical exchanges. As Griselda Pollock (2004) explains, Ettinger’s conception of the matrix is not essentialist or even reducible to female bodied people. The feminine is here conceived of as a relation, a life-generating borderlinking based on uncognized memories of the mother-to-be/subject-to-be encounter felt by those who will later become men and women. The feminine is not set up in opposition to the masculine in the matrix. The masculine, and indeed everyday discourses of masculinity and femininity, are unthinkable in the matrix because it is predicated upon borderlinkings, trace connections, not absolute (castrating) cuts that in Freud and Lacan produce sexually individuated subjects. There are no individuals in the matrixial, only partial-subjects, borderlinkings, becomings and co-fadings which are relevant to the Other sexual difference. “First encountering Ettinger’s ideas, people often rush to misinterpret what is proposed in terms that already condemn the feminine to its impossible place in phallic thought” (Pollock, 2004, p. 21). It must be stressed that Ettinger’s notion of the feminine preexists phallic sexuation where (and when) it is possible to talk about men and women. “The Matrix is not about women, but about a feminine dimension of plurality and difference of the several in joint subjectivity” (Ettinger, 1996, p. 152). It is thus relevant to those sexuated as men (as well as women) and, as I argue in what follows, to transsexuals (those identifying as trans men and trans women alike).

My claim is that transsexuality involves a unique somatization of this Other sexual relation and the creative use of this relation as sinthome. In what follows, I contend that the sinthome of transsexuality can be a therapeutic means to negotiate the impossibilities of sexual difference in the phallic stratum. Transsexuality is here used to refer to those who experience discomfort with their sex assignment at birth and desire to alter, modify or resignify their bodies in ways that enable or are akin to sex reassignment. My use of the term transsexuality includes trans men and trans women along with those who transition using medical and surgical interventions and also those who transition without such interventions. It should be noted that most psychoanalytic writing on transsexuality focuses on trans women but my discussion of the sinthome of transsexuality pertains to both trans women and trans men. I draw parallels between transsexuality and the hysteric who questions the ontology of sexual difference but remains firmly in the neurotic structure. Sex Reassignment Surgery (SRS) can be a means of negotiating (or, perhaps, making visible) the enigma of sexual difference in the phallic economy but also of symbolizing an Other sexual difference that is characterized by what Ettinger calls the trans-subjective in the matrixial.

The psychotic thesis

Trans studies has grown exponentially in North American cultural studies over the course of the last decade (Stryker, 2006; Stryker and Aizura, 2013) and is largely critical of the tendency in Lacanian psychoanalysis to reduce transsexuality to psychosis (Shepardson, 2000; Chiland, 2003; Fiorini and Vainer, 2003; Morel, 2011). Trans studies is focused on trans expression; sexed embodiment; gender identity; and the unruly assemblages of nature, culture, technology, power, discourse, and so forth, as they pertain to gender identity and sexed morphology. Trans studies emerged in the domain of cultural studies and it is not rooted in clinical studies of transsexuals as patients. It does, nevertheless, focus on the sensory, corporeal, affective, autobiographical, and identificatory life of the subject—much of which is relevant to the clinic. Equally important, trans theorists have challenged understandings of transsexuals as overinvested in normative gender binaries (and thus dupes of gender) and also as unable to accept the aporias of sexual difference (as argued in much Lacanian psychoanalytic writing on the subject).

Despite well-documented tensions between trans scholars (and activists), psychiatrists, and psychoanalysts, there have been instances of cross-pollination. As a result, some psychoanalytic scholars have been rethinking what I call the psychotic thesis as it pertains to transsexuality. Lacanian writing in the clinical domain, for example, is beginning to challenge the reduction of transsexuality to the psychotic structure (where transsexual women are almost uniformly the objects of analysis); the perverse structure (where, e.g., Oren Gozlan writes that the “resistance to identifying as either a man or a woman—is often treated as a feature of perversion, a denial of difference, an inability to mourn the desire to be ‘both,’ and a refusal to accept the ‘law’” [2008, p. 542]); and, finally, to any one of the three subjective structures (psychotic, pervert, or neurotic) outlined by Lacan in particular. My argument is based on the premise that a distinction can be made between what Lacan (1973) calls the Push-Toward-Woman in psychosis (as in the Schreber case) and transsexuality. The first may be indicative of a failure of the paternal function (and also a means to compensate for the absence of the paternal function by establishing a bodily limit at the level of the signifier), but transsexuality (as I define it in this article) is better understood to be a subset of neurosis (where the paternal function is operative). I make this claim to prompt a more varied and nuanced discussion of transsexuality, which has, unfortunately, been stifled in psychoanalytic theorizing due to what has become an essentialist linking of transsexuality to the psychotic position. This is not to suggest that the psychotic position isn’t generative or a viable way to live but rather that transsexuality is not a telltale sign of any given psychic structure.

Lacanian clinicians too often understand the transsexual trajectory to be a failure on the part of the paternal function to enable a cut between the subject-to-be and the m/Other, thus reducing transsexuality to psychosis. The psychotic thesis was set in motion by Catherine Millot. She claimed that the transsexual symptom was analogous to the act of writing for James Joyce in the sense that both offset psychosis. In Horsexe she argued that the “transsexual symptom … corresponds to an attempt to palliate the absence of the Name-Of-The-Father, that is, to define an outer limit, a point of arrest, and to achieve a suspension of the phallic function” (1990, p. 42). Although Millot noted that there may be no “psychotic symptoms” in transsexuality and that what she called the “transsexual symptom” can also be of the “hysterical type,” she didn’t mine what I interpret to be the creative, sinthomatic elements of the transsexual transition. She did observe that transsexuality may be a way to “escape the requirement of being the object of the Other’s jouissance” (p. 140) but concluded that SRS is doomed to fail because it is presented as a solution to the aporias of sexual difference.

Millot (1990) notes that transsexuality issues a demand to the Other and as such involves the Other’s desire. Rather than imagining how this appeal to the Other may operate sinthomatically for the trans subjects (as in the case of the neurotic who, in the course of analysis, finds consistency in the desire of the Other through the work of the analyst, where the symptom is grounded), she limits the Other to a doctor or psychologist who, through SRS, promises a resolution to the enigma of sexual difference. Should she have adopted a broader understanding of who this Other might be (a lover, a parent, a friend, or kin) and theorized SRS as insighting new ways of negotiating the enigmas of sexual difference by producing new signifiers, her understanding of transsexual transitions may not have led to one, telltale prognosis. Instead of understanding transsexuality to be, as she suggests, in opposition to the neurotic symptom (which ideally through analytic treatment becomes coupled with another signifier), she could have understood transsexuality to be another means to negotiate the traces of the Other’s desire, a strategy dependent upon the generation of new signifiers and inscriptions on the body through SRS.

Bracha L. Ettinger and the other (feminine) sexual difference

In the late 1990s, Bracha L. Ettinger began to publish her notes on the feminine and the matrixial borderspace inspired by her art and her psychoanalytic work with patients. The corpus of her theory is inspired by the writings of Wilfred Bion, Sigmund Freud, Jacques Lacan, Emmanual Levinas, Maurice Merleau-Ponty, Gilles Deleuze and Félix Guattari, and Donald Winnicott (among others). Ettinger does not supplant Lacan’s writing on sexuality but rather adds another, supplementary dimension she names the matrixial. She gives sustained attention to Lacan’s later writings on sexuation where, as Pollock (2004) suggests, he struggles with questions of the feminine. In his discussion of feminine sexuality and the not-whole Lacan (1998) admits the subject is “obviously giving me a hard time” (p. 57) and that there is a “jouissance of the body” (p. 71). Building upon Lacan’s conceptualization of the Other (feminine) jouissance, his writing on the sinthome and the Real (which is most often linked to female body specificity), Ettinger conceives of a matrixial substratum where (and when) a sexual rapport was (and is) possible. The feminine matrixial substratum is the other of Oedipal, phallic sexual difference explicated by Lacan (1998) in Seminar XX. Brian Massumi (2000) writes that the matrixial is the “other of the masculine-feminine opposition. Since the matrixial is generative, its otherness to phallic oppositional structure may still be considered a sexual difference. In fact, it is the sexual difference, as against the difference between the sexes” (p. 26).

This primary, feminine sexual difference is the one I contend to be relevant to transsexual embodiment. It is difficult to read the work of Bracha Ettinger (2006) on the matrixial borderspace without transsexuality coming to mind. Indeed she speaks about the “trans-subjective,” the “trans-generational,” “trans-mission,” “trans-connectivity,” “trans-missibility,” “trans-inscription,” and so on. But to the best of my knowledge she has not written explicitly about transsexual people—with the exception of a brief mention of the Schreber case (Ettinger, 1997, p. 373).¹ Ettinger’s notion of the trans-subjective does not refer to transsexual people per se but rather to a modality of experience in the matrixial borderspace (relevant to everyone regardless of trans status) predicated on becomings and co-fadings, severality and interlinkings between I and non-I. In this substratum Ettinger posits an originary feminine sexual difference predating the phallic order of sexual difference. This feminine sexual difference is predicated upon a sexuating co-emergence between an I and non-I that isn’t sexed and/or gendered—which, in the phallic stratum depends upon a castrating cut—but upon a becoming and co-fading that is subjectivizing and life-generating (and not psychotic).

Lacan’s sexuation graphs are relevant to what Ettinger refers to as the phallic stratum. In this stratum subjects are sexuated as men or women depending upon their relations to the Other and by jouissance. According to Lacan, how one resolves the question of the mother’s desire in relation to paternal law is a determining factor in whether one is sexuated into the masculine or feminine position. Ettinger’s theorization of the matrixial borderspace posits another matrixial substratum that operates alongside but is irreducible to the phallic model of sexuation. In the matrixial it isn’t possible to speak of subjects (masculine or feminine positions); one must instead speak of subjective grains, partial encounters, becomings, and existence in-relation. This existence in-relation is not based on fusion or symbiosis. It can be signified in an expanded Symbolic. The matrixial functions at the level of the Real and the unconscious. It offers a way to theorize the not-all in the realm of the feminine position and, as I argue, in transsexuality.

Ettinger’s theory of the matrixial must also be distinguished from the writing of Luce Irigaray (1985), who posits a feminine doubling (two lips speaking together), fusion and symbiotic relations. Ettinger’s matrixial includes “more-than-one and/or less-than-one … not the Other but rather a network of subject and Other in transformation linked in a special way to subjectivity” (1992, p. 11). The matrix must also be differentiated from Julia Kristeva’s (1980) writing on the Chora, which also means womb and uterus. Although both the Chora and the Matrix are anchored to prenatal encounters with the soon-to-be mother, the Chora can’t be symbolized in Kristeva’s theory and is relegated to psychotic discourse or to poetic discourse. The Matrix, as theorized by Ettinger, can be symbolized and is not psychotic. The matrix is linked to what Ettinger calls metramorphosis, which involves changes in borderlines and thresholds and thus more suited to conceptualizing a transsexual transition. Recognition is also possible in the matrixial encounter and this recognition is not necessarily structured by aggression, fusion, or negative orality (as theorized by Melanie Klein). “The Matrix is a concept concerning early recognition of invisible difference” (Ettinger, 1992, p. 193). The Matrix gestures to a link between the “feminine and unknown others” (Ettinger, 1992, p. 12). In other words, the matrixial taps into an otherness that is feminine—not in an identitarian or demographic sense but rather as a condition of becoming that recalls and is predicated on a relation to otherness (which is later symbolically coded as feminine).

It is also important to note that in Lacan’s analytic of sexuation a sexed position is not reducible to the sex of the body or to what sociologists call gender identity, which, as is discussed later, operates primarily in the register of the Imaginary. Teresa de Lauretis (2011) further explains that gender, unlike sexuality, “pertains to the ego, not to the unconscious” (p. 251). Gender is about the visual apprehension of the body. Sexuation, in Lacanian theory, is also not about sexual orientation (object choice). Although Lacan (1998) uses the signifiers “masculine” and “feminine” to designate two distinct modes of jouissance and, consequently, two distinct relations to the m/Other, he doesn’t theorize “gender,” “sex,” or “sexual orientation” per se. Sexed embodiment and gender identity have little to do with sexuated positions in the Lacanian frame. Suzanne Barnard (2002a) notes that “gender is typically understood as a function of identification with idealized norms regarding sex” (p. 10). Our own personal gender identities are imaginary, meaning that they exist in the realm of imagination and fantasy. It must also be said that for Lacan there is no gender in the unconscious and that, according to Paul Verhaeghe (2001), gender formation is a defensive reaction to a primal loss that occurs in the Symbolic and Imaginary registers.² For Lacanians following Verhaeghe (2002), gender identity is a compromise formation that can be understood as a pathology leading to anxiety and crisis. This is due to the fact that gender identity—as a defensive strategy—is not well equipped to manage the aporia of sexual difference. I understand “gender” or “gender identity,” in this article, as an ego-based defense essential to the subject (like Verhaeghe) and primarily relevant to the Imaginary register. Referencing Lacan in her discussion of Sexed Ethics, Collette Soler writes, “As far as being a man or a woman goes, ‘they’—subjects—‘have a choice’” (Soler quoting Lacan, 2006, p. 175).

The bodily ego

Jay Prosser was, perhaps, the first trans studies scholar to utilize Freud’s conception of the “bodily ego” to consider what Lacanian scholars might understand to be the Imaginary, or image-based components of transsexual embodiment. Prosser references the work of Oliver Sacks on the phantom limb whereby a “sensory memory of the lost body part, a feeling of presence that remains in its very absence” (Prosser, 1998, p. 84) impacts upon body image. The problem is that the transsexual never had or lost the body part he or she remembers and so this begs the question of how one can remember what never was (even if, as Prosser writes, it should have been). An answer to this question emerges in Ettinger’s work on the matrixial substratum shaped by the feminine/prebirth encounter. She contends that each of us stores archaic traces of this encounter that are laced by trauma and fantasy and thus touch upon desire. “They are remembered without being recollected and are revealed in a phantasm saturated with imprints of the trauma of a partial and shared subjectivity” (Ettinger, 2001, p. 109). Traces of these imprints circulate “by affects and by waves” (p. 109), which Ettinger calls erotic antennae of the psyche. Speaking of the skin-organ (and in relation to Didier Anzieu’s [1989] seminal writing on the Skin-ego), Ettinger hypothesizes that matrixial links “founded in the Real on psychic events of tactile encounter[s]” (2001, p. 125) are so libidinally charged that they can impact upon the scopic realm: what is there to be seen. It thus stands to reason that body image is shaped by unremembered encounters and can signify in ways that depart from a corporeal form intercepted by the gaze. The gaze of the Other, the naked eye, and the bodily schemata do not cohere. A compatible claim is made by trans studies scholar Gayle Salamon (2004) who argues that the body can signify in ways that depart from its mirror image; there is, for her, a productive gap, tension, or fissure between psyche (Imaginary and Symbolic) and soma (Real). “That is, the body that one feels oneself to have is not necessarily the same body that is delimited by its exterior contours, and this is the case even for any normatively gendered subject” (p. 96).

Ettinger also hypothesizes that the feminine symbolic (occluded by the phallic Symbolic stratum) touches upon the Real and forges a link (in the phallic Symbolic stratum) to a female body schemata linked to the m/Other. Elements of this schemata that remain unsymbolized are, I suggest, libidinally cathected and somatized by transsexuals in ways that call up the other sex. This is not to say that transsexuals are women but that they are attuned to the matrixial substratum predicated upon a feminine otherness or, rather, an axis of difference yet to be cognized. The otherness can be signified by an identification with masculinity and maleness in trans men, an identification with femininity and femaleness in trans women, or a combination of the two. The feminine is here demarcated by a physical incorporation of otherness into/onto the self that is, of course, relative and individual to any given subject (not delineated or determined by one’s gender identity). In the matrix Woman is a “border-Other, a becoming in-ter-with the Other, never a radical alterity” (Ettinger, 2001, p. 129). There is no women in the matrixial, only Woman, which, according to Ettinger (2006) can be a father-and-son relation. Matrixial traces exist in women and men. In Pollock’s reading, “Woman means different conditions: not just object or subject but the structure of transitivity” (2004, p. 46).

The Other sexual difference in the matrixial is, as I argue, important for understanding a transsexual bodily schemata that not only departs from its mirror image but also conjures up the other sex and recognizes this otherness as a property of the self. Again, this is not only the case for transsexual women who recognize female bodily specificity as a component of their own bodily schemata or, alternatively, as what Ettinger might call an a-link (a borderlink) or trace of the Other in the self. It is also true for transsexual men who may be extracting elements of that same female bodily specificity in the form of a corporeal signifier (breasts, for example). Indeed Ettinger supplants Lacan’s equation “Phallus = Symbol” with “Phallus + Matrixial (+ possibly other concepts) = Symbol” (1992, p. 190).³

Lacanians (correctly in my view) claim that the bodily imago is not determined by an actual reflection so much as it is determined by an external identification with the gaze of the Other. But the uncognized memories of the matrixial borderspace must also impact upon bodily ego functioning. The conventional Lacanian logic underscores the importance of the identificatory dimensions of bodily ego. For Lacan (2006), the ego is established in and through the mirror stage. It inaugurates subjectivity. “The starting point of human subjectivity has to be looked for in the gap between what the subject is and what it is forced to be by another” (Verhaeghe, 2001, p. 67). The body, Verhaeghe (2001) tells us, is like a “writing pad” (p. 68) upon which the Other’s signifiers are writ large. Eve Watson (2009) also emphasizes the centrality of language and fantasy (the indexical trace of the Other) on the “totality of the bodily form” (p. 137). It thus follows that transsexuality is not distinguishable from cisgender (non trans) identifications at the level of the bodily imago (or schemata). Everyone identifies with an externalizing reflection from the position of the Other. Gender identity and sexed embodiment is structured by the Other’s traces, by language and our psychically invested projections. But the way and extent to which we have been affected by the trauma, pleasure, and fantasy of the prebirth encounter does, however, differ. It thus follows that matrixial relations bear upon bodily ego functioning in ways that are highly individual. Furthermore, components of the “feminine body schema are not inscribed in the Symbolic” (Ettinger, 1992). Matrixial awareness is uneven and, as Ettinger argues, elaborated through art. But it may also be evident in bodily inscriptions:

Engravings of affected events of others and of the world are unknowingly inscribed in me, and mine are inscribed in others, known or anonymous, in an asymmetrical exchange that creates and transforms a trans-subjective matrixial alliance [Ettinger, 2001, p. 128].

My reading of Ettinger’s inscriptions in a trans-subjective matrixial alliance calls up transsexual transitions. A transsexual transition (along with the remaining scar tissue to be discussed later) can etch, transform, and reinscribe “affected events of others,” traces and tactile imprints of the primordial relation to the m/Other in the prebirth encounter.

Freud (1923, p. 26) wrote that “the ego was first and foremost a bodily ego,” and so it stands to reason that that the ego’s attachments to gender identity are somatized and have a sexuating corporeal component that must, in turn, be signified. In the case of transsexuality, gender identity is not reliably recognized and thus symbolically validated. It must also be stressed that the Symbolic doesn’t register “traces of the beyond-the-phallic sphere” (Ettinger, 2001, p. 131). Although transsexuals may require medical intervention to bring the body into alignment with an internal identification the compulsion to signify gender is in no way unique to transsexuality. The critical difference may, however, be in one’s capacity to mobilize gender identity as a defense and, simultaneously, harness it as a fiction essential to subjectification. In other words, a transsexual identity may be functioning as a sinthome—a fourth ring or narrative weave particular to the subject—that knots the Imaginary, Symbolic, and the Real. But again, this knotting is accomplished in relation to one’s own unique matrixial traces.

The sinthome

In Please Select Your Gender (2010), Patricia Gherovici convincingly argues that Lacan’s analytic of sexuation can be used to understand the sinthome of transsexuality. In two important articles Oren Gozlan (2008, 2011) makes a similar claim about the sinthome and its relation to transsexuality. In what follows, I build upon their precedent-setting work to argue that the sinthome of transsexuality taps into a matrixial domain whereby the subject is attempting to write and reinscribe a relation to a primordial feminine sexual difference.

The sinthome is a critical fiction that allows the subject to knot the Imaginary, the Symbolic, and the Real. It enables the subject to live with the sexual impasse: the impossibility of a sexual relationship in the phallic stratum. The sinthome is highly individual and can involve what Lacan calls “transsexual jouissance” (2006, p. 476). Oren Gozlan (2011) writes that “we create a sinthome when we identify with our symptom, that is, when we no longer believe in the truth of the symptoms but see it as a creative product of the self and hence take ownership of it” (p. 2). In the clinic of transsexuality, a sinthome can be orchestrated by a change in gender pronoun, a name change, hormone treatments, SRS, an autobiographical account of one’s gender journey, and so forth. The sinthome, in this example, involves the formation of a language, a story of one’s Oedipalization and associated medical interventions, and so on, that enables a transition. It must, however, be noted that the memory traces of the matrixial substratum underpinning the autobiographical narrative—and the wish to transition itself—can’t be fully represented by any one oration; it must be continually retold and rearticulated. As Lacan suggests in Seminar XX we are signifiers and enjoy by “corporatizing (corporiser) the body in a signifying way” (1998, p. 23).

For Lacan, the other sex can be a sinthome and although the Woman is a sinthome (symptom) of man she may also be a sinthome for another woman. In both instances, the sinthome is the other sex. “The sinthôme is precisely speaking the sex I don’t belong to, which is to say a woman” (Lacan, as cited in Ettinger, 2006, p. 60). Ettinger (2002) suggests that viewed from the perspective of the feminine matrixial the sinthome may be seen as an “intersection that creates/invents/reveals/releases a potential desire from its dangerous … archaic zone” (p. 225). In other words, it involves a swerve and a borderlinking “from/with-in and in contact with a Real ‘touched’ by the feminine Thing” (Ettinger, 2004, p. 86). The sinthome is, for Ettinger, indicative of a failure on the part of the phallic economy to knot the Imaginary and the Symbolic with the Real, which engages a feminine (nonphallic) sexual difference.

Transsexuality may be productively understood with recourse to Lacan’s notion of the sinthome. A sinthome can be understood as an ongoing story, a changing narrative through which one can negotiate the aporias of sexual difference. By identifying with one’s symptom, one ideally creates a sinthome and uses it to manage or, rather, to create a supplement for the nonexistent sexual relation in the phallic stratum. In the case of transsexuality, the sinthome may be somatized and understood as a corporeal appendage. The auxiliary part (or missing part) may, in this case, be incorporated into (or extracted from) the Imaginary and require Symbolic ratification by, for example, the use of gender pronouns consistent with one’s gender identity. The sinthome is, as Lacan notes, the other sex, “a sinthome-she or a sinthome-he” (Gherovici, 2010, p. 185). As evident in her discussion of transsexual (and cisgender) patients, Gherovici (2010) shows how “identifications can stabilize a sexual positioning” (p. 190).

Regardless of the particular form the sinthomatic stitch may take for any given individual, it can be an active and creative reworking of a symptom that involves what Lacan (1963) in Seminar X calls a “passage to the act.” The passage to the act enables the patient to loosen his or her identification with the Other’s desire and to forge an identification with his symptom—hence Žižek’s (2013) urging to “Enjoy your symptom!” If we are to understand the transsexual trajectory as a creative sinthome it must be functioning at the level of the Real (and not exclusively at the level of the Imaginary and the Symbolic where most Lacanians apprehend sex embodiment and gender identity). Ettinger (2001) suggests that Lacan’s notion of the sinthome gestures to a new phase in his theorizing (however incomplete) in which he signals to the possibility of a feminine rapport, an Other possible axis of sexual difference. This sinthome is, for Ettinger, a nonphallic sublimation (p. 120).

Ettinger suggests that the sinthome gestures toward what she calls a supplementary feminine sexual rapport that is unthinkable in the phallic stratum, a rapport that is sexual and life-generating. Resonances of this sexual rapport are present in what Ettinger (1992) calls a “feminine dimension of the symbolic order dealing with asymmetrical, plural, and fragmented subjects composed of the known as well as the not-rejected and not-assimilated unknown, and to unconscious processes of change and transgression in borderlines, limits and thresholds of ‘I’ and ‘non-I’ emerging in co-existence” (p. 1). Ettinger contends that the feminine dimension is foreclosed in the Lacanian Symbolic demarcated by the phallus. The phallus is, for Lacan, the universal signifier that anchors all relationships between the subject and the signifier. It is the only signifier of sexual difference. Ettinger (1997) explains:

The phallus mainly stands for a symbolic principle: it is a signifier of signifiers of absence and of difference—or of feminine difference conceived as absence from a male’s side. But it is also the only imaginary representation of sex-difference, with “castration” as its only passageway to significance [p. 373].

The Symbolic that is phallic and thus conscious deals with “Oedipal subjectivity, whole objects, one-ness, sameness, all-ness, and symmetry” (Ettinger, 1992, p. 193). In his later work on sexuation, Lacan did acknowledge an other (feminine) jouissance (beyond the phallus) but insisted that nothing could be said about it because it was outside the Symbolic. Hence, Lacan’s conjecture that “the woman does not exist and does not signify anything” (1998, p. 69). But, paradoxically, the Woman’s lack in the phallic economy inscribes a trace in the Symbolic. In Ettinger’s (1997) formulation, woman’s lack in the “Real inscribes a lack in the Symbolic” (p. 373). The lack in the Symbolic leaves a trace connection to the matrixial.

Ettinger, by contrast, conceives of a matrixial substratum whereby Woman “digs an-other area of difference with its specific apparatus, processes, and functions” (1997, p. 367). The matrixial is based on the feminine/prenatal encounter and demarcates a nonphallic sex-difference. The Other (feminine) sexual difference is predicated upon “several/trans-subjectivity and hybrid objects, and informs an-Other desire” (p. 368). There is a subsymbolic dimension to the matrixial that is outside the tentacles of the organ and image. Ettinger notes that the matrix is an “unconscious borderspace” that remembers female bodily specificity (the m/Other) but is not based on “essence, identity, or negation” (p. 368). The matrixial is not feminine in the phallic sense because it is an originary, primordial difference that predates phallic sexuation during the Oedipal stage. Ettinger thus conceptualizes a phallic and matrixial dimension to the Symbolic, the former phallic dimension involving “one-ness, totality, sameness, and Oedipal, symbolic castration” (1992, p. 2), the latter involving the feminine as an “otherness beyond the phallus” (p. 2). The feminine dimension encompasses the following:

Multiplicity, plurality, partiality, difference, strangeness, relations to the unknown other, prenatal passages to the Symbolic, with processes of change of I and non-I emerging in co-existence, and of change in their borderlines, limits, and thresholds within and around them [Ettinger, 1992, p. 2].

In Western culture the feminine dimension has been eclipsed and an-otherness beyond the phallus is largely unacknowledged and consequently rendered unconscious. For this reason, it is difficult to make feminine desire and transsexual desire signify in a phallic Symbolic that reads whole objects, individuated subjects, and sex and gender in terms of absolute cuts and binary differentiations between subject and m/Other.⁴

Transsexuality and the feminine position

The trend in Lacanian psychoanalysis to associate transsexuality with psychosis is linked to a concordant tendency to view the feminine position in close proximity to psychosis. In other words, the reduction of transsexuality to psychosis is wrapped up in the way Lacan theorized the feminine position and its supposed proximity to psychosis. Millot’s (1990) work is a case in point. She doesn’t fully distinguish between what Lacan calls the feminine position in neurosis and the Push-Toward-Woman in psychosis or transsexuality in neurotics more generally. The Other jouissance (had by those sexuated into the feminine position) lacks inscription and phallic individuation for Millot (and her theorizing here follows Lacan). This Other jouissance is not restricted by the Father and, unlike phallic jouissance (characterized by the masculine position), it is uniquely animated by and attuned to the desire of the Other. The feminine-Other is not fully prohibited by the phallic Symbolic. Not-all of the woman is subject to the phallic prohibition. For Millot, women occupy a curious position in so far as they are “both related and unrelated to the phallic function; their relation to the phallic function is of an indeterminate, contingent order” (p 40).

Consequently, there is the ever-present risk of reducing the feminine position to psychosis. Indeed Millot (1990) poses a relation between the feminine position and the psychotic position. She writes that both experience the

absence of a limit to the phallic function, together with the absence of prohibition on incest, two terms that are to be interpreted as expressing the lack of what might deprive the subject of the possibility of identifying with the imaginary phallus—the lack of what would thus prohibit absolute jouissance – relate the feminine position to that of the psychotic [p. 41].

The “feminine drive” in psychosis, for Millot, is caused by a foreclosure of the Name-of-the-Father. This is the point where there is a meeting between the feminine position and transsexuality, which, according to Millot (and later Geneviève Morel, 2001), rejects the Name-of-the-Father and thus the Symbolic.

Although there are transsexuals (and cisgenders) who are psychotic, transsexuals may also (and more commonly) be neurotic and understood in relation to the hysteric. Transsexuality is not, however, based on a “hysterical idealization of the Other’s completeness, [or] an urgency to settle the question of identity, and hence foreclose the uncertainty of which subjectivity depends” (Gozlan, 2011, p. 1). By contrast, it creatively animates the impossibility of gender wholeness in the domain of biology and identity.

The hysteric (who can be male or female, trans or cisgender) is always questioning sexual difference; they never fail to underscore the inability of the phallus to signify sexual difference in the phallic axis. Through their questioning alone, hysterics don’t become women or men in the Lacanian sense. Although Millot’s (1990) analysis of transsexuality is based on transsexual women she does note that the transsexual symptom in trans men ranges from psychotic episodes to hysterical neurosis. For example, Millot writes that trans men, like hysterics, may cultivate imaginary identifications with maleness. The male position is chosen “for want of knowing how to place oneself on the women’s side” (p. 117). She does note, however, that she has never observed psychotic symptoms in transsexual men. The wish to transition is represented as either a “delusion of bodily transformation” (p. 115) indicative of psychosis or as a hysterical demand caused by indecision about one’s sexed position. Millot writes, “For transsexuals a book may be read by its cover, and the bodily frame is thought of as another article of clothing, to be retouched at will” (p. 116). The characterization of a patient’s wish for surgery as whimsical is at odds with Millot’s earlier sentiments about the pressing need to palliate the lack of a paternal metaphor through transsexuality.

In his discussion of the Schreber case, Thomas Dalzell (2011) elaborates upon what he views to be a structural difference between the feminine position and transsexuality. “While it might be legitimate for femininity to question the exception [of the father’s function],” he writes, “we would argue that it is another thing for psychosis to foreclose the exception so that neither it nor the limiting phallic function exist at all” (p. 328). In other words, feminine questioning is neurotic because it asks a question of sexuality, whereas transsexuality is presumed to foreclose upon sexual difference entirely. Moreover, trans subjectivity is incorrectly read as psychotic. The difference, in Dalzell’s view, can also be understood as the difference between repression (in hysteria) and foreclosure (in psychosis) of the paternal function.

According to Ettinger, the hysteric modifies Freud’s question about what it is that women want. As Pollock (2004) summarizes, Ettinger asks, “What is a woman for another woman?” (p. 45). It is important to note that for the hysteric questions about “sexuality and subjectivity [are posed] to a feminine Other” (Pollock, 2004, p. 45). We might read Lacan as gesturing to a convergent thesis when he writes that the true hysterical question is “Is there One or not?” (1998, p. 102). In other words, the not-whole (Woman who cannot be written) implies the “existence of the One that constitutes (fait) an exception” (1998, p. 102). In Seminar XX Lacan links the woman who can’t be written (the not-whole) to the Other. “Being the Other, in the most radical sense, in the sexual relationship, in relation to what can be said of the unconscious, woman is that which has a relationship to that Other” (1998, p. 81). The Other (feminine) sexual difference is the dimension Lacan gestures to in relation to the Other but cannot articulate in full. He does write, “I is an other” (2006, p. 96) and that the “unconscious is the Other’s discourse” (2006, p. 316), thus pointing to a state of being in transitivity. But he continues to stumble on the original Freudian question: “What does a woman want” (1998, p. 80). He knows the Other jouissance is not “wholley occupied with man … [or] at all occupied with him” (1998, p. 87) and wonders about this Other knowledge.

Lacan (2006) notes that the tension between “being” and “having” the phallus takes place at the level of signifier but that it also “renders unreal the relations to be signified” (p. 582). In other words, libidinal processes “bear on the body as a container and on its orifices” (2006, p. 566) and these processes can be engaged at the level of the signifier. Just as the English language makes it impossible to conceptualize a subject outside of (or even before) sex and gender, it similarly makes it impossible to conceptualize the subject in-relation. The signs and symbols of the matrixial substratum are foreclosed in the phallic economy. In Lacan, what is unsymbolized is psychotic. Just as the feminine axis of difference is more likely to be interpreted as psychotic—because nothing can be said about it—the transsexual is, similarly, caught in a trap whereby his or her bodily schemata is unintelligible in the phallic Symbolic. It is, however, decipherable in a matrixial substratum where there is an Other sexual difference predating the phallic order of sexual difference. Transsexuality thus becomes psychotic in a conceptual frame that lacks an understanding of the matrixial, which is based on an Other (feminine) sexual difference. It is thus vital to develop feminist and trans-generative language to give voice to what is matrixial and thus coded as other, psychotic, or nonexistent in the phallic paradigm.

Transsexuality and the hysteric

Although a comprehensive discussion of Lacan’s writing on the Lacanian hysteric is beyond the scope of this article, I build upon Shanna T. Carlson’s (2010) claim that trans subjects and hysterics may be comparatively animated by, and attuned to, the impasse of sexual difference. More specifically, I suggest that both structures are attuned to an Other sexual difference in the matrixial that can’t be apprehended in the phallic stratum. The hysteric’s will to reckon with the phallus as a master signifier is, however, not always somatized in the way it is for the transsexual. Trans subjects somatize elements of the m/Other or, rather, recognize and inscribe sexual difference within the self. Those who are cisgender (non trans) tend to apprehend sexual difference between themselves and others in an intersubjective relation. My supposition is that transsexuals animate and reinscribe (literally, on the body) a subterranean matrixial zone where sexual rapport is and was a possibility and underwrite the phallic signifier with a change of address (or, rather, a transition) that introduces another axis (or mapping) of difference, one that is transitive (not intersubjective). The incorporation of sexual difference within the self is a distinguishing feature of transsexuality. Transsexual identifications with the other sex can be total, whereas the hysteric usually identifies with the lack in the other as Real.

Feminist psychoanalytic theorists have noted that hysterics, who are insistent in their questioning of sexual difference, and who never fail to underscore the inability of the phallus to signify sexual difference, are, through their questioning alone, neither women or men in any simple way. It is interesting to note that hysterics are animated by the Other’s symptom but not women in a Lacanian sense. Nor are hysterics exactly men (although Lacan sometimes inscribes them on the masculine side of the sexuation graphs). There are, for Lacan, three positions a woman can occupy: she can “be” the phallus (what a man lacks), the object cause of desire (object a), or condescend to being his symptom upon which his jouissance is fixated (Soler, 2002, p. 102). Hysterics have no interest in being symptoms but are rather animated by epistemological questions about desire’s lack (as opposed to the object of desire). Collette Soler (2002) contends that a hysteric (unlike the Woman) does not make a couple but rather a triangle insofar as they refuse to be part of the asexual jouissance of the nonexistent sexual relation. Their nonexistent relation to a man is not structured by a positioning as a symptom but rather by an interest in his symptom.

Just as the hysteric is compelled to signal their nonexistence in the phallic economy, the transsexual may be, similarly, compelled to signify a feminine matrixial relation through a surgical transition. The transition can be a means of negotiating (or, perhaps, making visible) the aporias of sexual difference in the phallic stratum. Gherovici (2010), for example, interprets the demand for SRS as a way to refuse the primacy of the phallus as the signifier of sexual difference—and this may correspond with the hysteric’s desire to reckon with the phallus as it underwrites two sexes with one signifier. There are, however, significant differences between the hysteric and the transsexual. Whereas the hysteric wrestles with the question of sexual difference and must come to terms with the impossibility of ever finally answering the question the transsexual (after a comparable inquiry into the nature of sexual difference) posits an answer in the form of an affirmation: I am the other sex. As Gherovici (2010) notes in her clinical work, “Hysterical identifications are always partial, whereas the identification with the sinthome [in the case of transsexuality] is total” (p. 212).

Despite the differing solutions, I contend that both positions are animated by a subterranean knowledge of one’s matrixial borderlinkages in the Real along with the inability of the Symbolic to symbolize feminine sexual difference. I also maintain that the transsexual (like the hysteric) often has a neurotic structure: the hysteric because they are unhappy with the phallus as primary signifier, and the transsexual because he or she is committed to a sinthomatic reknotting of the three psychic registers, both of which are in tune with the matrixial substratum. In other words, transsexuals don’t register the phallic signifier as a primary signifier (underwriting sexual difference) but only one of others that can be animated and resignified. In actual fact, there is overlap between the hysteric and the transsexual. There is no analytic need to treat the positions as mutually exclusive. Both challenge the primacy of the phallus as it tries to underwrite two sexes with one signifier. The signs and symbols of the matrixial substratum are foreclosed in the phallic economy and both the hysteric and the transsexual attempt to signify the barred feminine in the Symbolic.

Both groups do, however, arrive at different solutions to what Pollock (2004) refers to as the “effects of the non-acknowledgment of the meaning-creating dimension of feminine sexual difference for subjectivity in general” (p. 35). For transsexuals, a transition is often required at the level of the flesh, whereas the hysteric is usually content to keep the question of sexual difference as an epistemological inquiry. Just like the feminine position doesn’t exist wholly in the phallic stratum, the transsexual position must, also, be understood from within the matrixial substratum. For psychoanalysts, the clinic offers an important arena for talk about symptoms. As a Lacanian psychoanalyst, Geneviève Morel (2011) believes (following Lacan) that through analysis the patient is invited to articulate a symptom that will ultimately lead to an ongoing exploration of sexual difference, desire, and the limits of the Other.

But, according to Morel (2011), the availability of a scientific solution (surgery) to the symptom of transsexuality offers the client an unhelpful and, in fact, detrimental means to bypass the psychoanalytic process. In Lacanian psychoanalysis, one should never respond to client demand but answer only to the subject’s desire. Morel is concerned that a total identification with the other sex (in the case of transsexuality) will come at the cost of the client’s unconscious desire (to be distinguished from conscious demand). Again, we hear echoes of Millot’s original thesis reducing trans subjectivity to psychosis. Morel writes, “Madness here lies in choosing the wrong target: the organ instead of the signifier” (p. 187). In these cases, SRS only responds to the demand of the Other whose jouissance is all-encompassing. Charles Shepardson (2000) similarly claims that this demand is one “in which desire is lost, a demand that the subject appears to make, but which has come from the Other, and with which the subject has complied” (p. 104).

Although I support the psychoanalytic attempt to engage patient desire I don’t believe trans surgeries are ultimately (or even often) at odds with the psychoanalytic cure as theorized by Lacan. Transsexuality is not about a fantasy of phallic totality or, conversely, an attempt to override the question of sexual difference. Transsexuality enables the subject to explore the sexual impasse. This exploration operates through the phallic and matrixial stratums—both of which must come into analytic play. As I explain in what follows, a surgically or hormonally induced transition will ideally leave the patient in a position to generate new significations and fantasies about his or her bodily morphology such that the impossibility of sexual difference can be lived creatively, that is, sinthomatically.

Transexuality as sinthome

A surgically constructed or extracted organ must leave the patient in a position to generate new significations, new discourses and fantasies about his or her gender, sex embodiment, and relation to the Other. If the transition is to engender a new sinthome it must allow the patient to live productively with the impossibility of ever finally signifying sexual difference. It is critical to note that sexual difference is in these instances mapped internally (as opposed to externally). As Gozlan (2008) notes, sexual difference can be mapped within the self as opposed to between the self and the Other (p. 552). We may better understand this process of mapping sexual difference internally in reference to the Other (feminine) sexual difference theorized by Ettinger. She reminds us that when Lacan said there is no sexual relation he was talking about the nonexistent relation from the men’s side, that is, from the phallic dimension. He did say that other possibilities may exist from the “ladies’ side” (Lacan, 1998, p. 57). Whereas Lacan remained unable to conceptualize this relation (from the “ladies’ side”), Ettinger suggests that it may be thinkable in a “supplementary unconscious zone in subjectivity” (1997, p. 374) that is matrixial and where a sexual relation can exist. “Only in a psychic zone where traces of the feminine difference and of the failure of the phallus would make intelligible sense, that “from the ladies’ side,” can an-Other feminine dimension be claimed” (Ettinger, 1997, p. 376). In other words, a sexual rapport does and can exist in the matrixial web. The prenatal encounter is incestuous. It is trans-subjective (in an Ettingerian sense) and pivots on an uncognized awareness of difference, otherness, and metramorphosis. In the matrixial sexual difference is not demarcated between bodies (male and female, man and woman) as it is in Lacan’s sexuation graph.⁵ Rather, sexual difference in the matrixial substratum is in, between, of, becoming, and about co-emergence and trans-subjectivity. Ettinger (1996) notes that “passages are made between the matrixial stratum and the phallic stratum in the same subject” (p. 153). These passages must not be understood in terms of fusion, symbiosis, or even in terms of what Kristeva calls the Chora. They are subjectivating, not psychotic, and can be signified in an enlarged Symbolic. Sexual embodiment for transsexuals is, similarly, not psychotic and consequently without symbolization. It involves a complex lacing of the phallic stratum and the matrixial substratum (the latter of which is in tune with the Other sexual difference) that is sexuating and subjectifying. In other words, sexual difference is recognized within the self and signified (through a transition) such that it can be written. In this way, transsexuals are responsive to an unconscious, matrixial trace where otherness is not foreign to the body proper.

Ettinger (1997) writes that “feminine jouissance aspires to release itself and shape a feminine dimension of desire” (p. 376). The transmission of this other desire into the Symbolic is, however, thwarted to the extent that jouissance is reducible to a phallic signifier. What counts as feminine desire in Ettinger’s discourse is based on a “non-prohibited incestuous in/outside rapport, interlaced between the becoming-subject and the archaic m/Other-to-be” (1997, p. 376). In her discussion of the matrixial desire, Ettinger (1997) notes that it “sprouts not from a phantasy about sharing but from a border shareability in trauma and phantasy” (p. 399).

If we remember that the feminine is not phallic (and thus has nothing to do with sex and gender identity but rather with a mode of being-in-relation and becoming in-togetherness), it may be akin to what counts as transsexual desire—specifically the wish to transition. Transsexual transitions may be understood as an attempt to embody “differentiation-in-co-emergence” (Ettinger, 1997, p. 379). The fantasy that one is the other sex functions in the domain of the Real where the Other (feminine) sexual difference resides. Bodily imprints from the matrixial web are also recorded in the Real. In the case of transsexuality, I suggest there is an acute sensitivity to what Ettinger calls a “traumatic jouissant corpo-Real of the late uterine/late pregnancy severality” that complicates phallic sexuation (Pollock, 2004, p. 47). Feminine jouissance in the matrixial produces a kind of sub-knowledge of “feminine difference between trauma and phantasy … impregnating an-Other-desire in subjectivity-as-encounter” (Ettinger, 1997, p. 401).

If we imagine the transsexual transition to be a kind of metramorphosis it would thus allow “what is lost to one to be inscribed-in-difference in the other, and the passages of these traces, transformed, back to I” (Ettinger 1997, p. 402). In other words, transsexual transitions may tap into unconscious body memories of the prebirth encounter and reconfigure these memories as sinthomatic traces (like scar tissue, for example). The transition will ideally enable the subject to establish a sense of body integration. Indeed Didier Anzieu (1989) makes a related observation in his cisgender patients who cut and scratch when he notes that body modifications are “dramatic attempts to maintain the boundaries of the body and the Ego and to re-establish a sense of being intact and self-cohesive” (p. 20). The difference in the case of transsexuality, however, is that the other sex is used as a sinthome.

Just as Ettinger finds traces of the matrixial in art, I suggest along with Gozlan (2014) that transsexual transitions can be acts of artistry that reassemble a borderspace between the subject and m/Other (the I and the non-I) that enables subjectification. A surgical cut, for example, leaves a scar that signifies a borderspace where the m/Other was but is no more or, alternatively, where the other remains but can’t be apprehended. Similarly, hormone injections alter the shape, contours, and muscularity of the body such that the subject can establish and create new limits and boundaries. It may also be the case, as Gozlan (2011) suggests, that the sinthomatic knotting of SRS and transsexual autobiography enables the subject to be released from a “phantasized hold of the Other’s determinations” (p. 4). In other words, transitions (surgical and otherwise) may enable a patient to cut or establish a limit to the jouissance of the Other as it envelops the subject. The common trope that one is trapped in or, rather, confined to a body at odds with his or her gender identity (or bodily imago) is suggestive of an excess jouissance that is experienced by the subject as unlivable. We might also think about this excess jouissance as being transmitted through sensate traces of the prebirth/mother-to-be encounter. Judith Butler (2011) notes that Ettinger’s work is about the “problem of the trace, or what she sometimes calls the ‘grain’ of another’s suffering, what has registered traumatically for another” (p. 151). This trauma, for the parent, has not been introjected and so, as Butler further notes, we are dealing with “what remains an alien and dead trace of someone else’s lost mourning” (p. 153). Neither shared nor foreclosed the intergenerational transmission is, according to Butler, transitive and functions like a phantom in the visual field. Bits and pieces of the mother’s uncognized trauma (which are dead to her) live in the subject. The subject isolates these traces on the body. For transsexuals, the trace(s) impacts upon sexuation and so it follows that surgery is focused on the genital (or other sexualized) region of the body. The relevant traumatic trace(s), in the case of transsexuality, is aestheticized but not introjected because it is experienced as foreign. This accounts for a feeling of acute discomfort comprised of a discrepancy between the body-image, the sensate body, and corpo-Reality.

Although a discussion of the relation between fantasy and trauma is beyond the scope of this article, it is important to note that what psychiatrists call Gender Dysphoria is often experienced by the patient as a crisis needing immediate intervention. SRS can enable patients to disidentify with a parental image or a matrixial trace connection that the subject experiences as unbearable. The surgical cut is not about an actual severance so much as it is about a reinscription (or, perhaps, removal) of a matrixial trace that has become traumatic. A surgically induced transition can have a palliative impact insofar as it enables the patient to establish subjective limits on the body. Scar tissue may function here as such a limit or, as Ettinger (2002) might say, borderlinking enabling separation and metramorphosis but with a difference. A mark left on the skin postsurgery delimits a point of jouissant contact and a surgical cut. Scar tissue becomes a surface inscription whereby the Other was but is no longer present. The scar may also be functioning on the matrixial substratum insofar as it signals to a “psychic event encounter” whereby a prior borderlink with, for example, a parental image (or screen) has been changed (Pollock, 2004, p. 32). A metramorphosis involves the “process of change in borderlines and thresholds … limits, borderlines, and thresholds … are constantly transgressed or dissolved, thus allowing the creation of new ones” (Ettinger, 1992, p. 201). In her discussion of matrixial subjectivity, Ettinger (1997) further notes that metramorphosis is trans-psychic and that it generates unthought knowledge that is independent of the signifier. In other words, it occurs in a “sexual rapport from a feminine beyond-the-phallus prism” (p. 401).

A borderline can’t be stabilized by an isolated cut, split, or division because it is “subject to a perpetual retuning and rehoning” (Pollock, 2004, p. 32), which is why surgery alone is not enough to complete a transsexual transition. SRS must enable the client to produce new signifiers and to desire. A sinthomatic knotting between the Real (the flesh), the Imaginery (embodiment), and the Symbolic (gender pronoun) is needed. A transition demands a corporeal and/or linguistic reinscription of the m/Other’s traces on one’s body such that the subject can forge a new—and ideally more comfortable—relation to the desire of the Other. The grafting that takes place in double-incision bilateral mastectomy, for example, is, like art, a creation as opposed to an alienating identification with an external image in the mirror stage. Although one must rely upon medical (and often psychiatric) personnel for SRS there is an active, authorial component to the procedure on the part of the patient. The surgery, ideally, inaugurates a sinthomatic knotting that enables the body to materialize through new signifiers.

This knotting is overlooked by analysts like Morel (2011), who insists that the transsexual is mistaking the organ for the signifier or, more specifically, mistaking the surgical cut (which would remove an organ) for the phallus, which “lies at the juncture of the real and the symbolic, where language and jouissance are articulated” (p. 186). Whereas for Gozlan (2011) and for Gherovici the “demand of the extraction of an organ can be the demand of the extraction of a signifier that has become all too real” (Gherovici, 2010, p. 194), this possibility is eclipsed in Morel’s theorizing. For her, the transsexual position is necessarily delusional and thus psychotic. Although some transsexuals may be psychotic (as some cisgenders are), clinical case studies demonstrate that this is by no means common. The demand for SRS is for Morel (2011), the result of a “foreclosure of the signifier of the sexual norm, the phallus” (p. 187). This foreclosure of sexual difference is normally enabled by the passage to the Symbolic or by what Barnard (2002b) calls the “cut of sexual difference” (p. 176). The position taken by Morel on transsexuality, as de facto psychotic, is surprising when we consider that for Lacan patients in analysis think as a “consequence of the fact that a structure, that of language—the word implies it—a structure carves up his [or her] body, a structure that has nothing to do with anatomy” (Lacan, 1990, p. 6). Although Lacan is speaking specifically about the hysteric, those who are transsexual are not foreclosing upon the phallus as (failed) signifier but rather are all too aware of the alienating effect of language on their subjectivity along with the vital role of language in remedying the alienating effects of language. Perhaps a significant difference is in the way this alienating effect is somatized for the transsexual and thus seen to play out on the body at the level of the flesh.

Despite the direction of the transsexual trajectory—from male to female or vice versa—the transition (whether or not it involves medical intervention) is a way to “rectify this error in the Symbolic register by correcting the error in the real of the body” (Gherovici, 2010, p. 195). Carlson, like Gozlan, challenges the idea that transsexuality is a “solution-less solution to the impasses of sexual difference … an unconscious scene of undecidability” (Carlson, 2010, p. 65). It is rather a means to negotiate the problem of sexual difference in the phallic stratum. Carlson contends that “transgenderism figures not as a solutionless solution to the impasses of sexual difference, but rather as an expression of the logic of sexual difference: a feminine solution” (p. 65).

As Gherovici (2010) notes, “Schreber’s delusional transformation into a woman … gave new meaning to a phenomenon often observed in psychotic patients: feminization” (p. 156). But the Push-Toward-Woman was not, for Lacan, unique to psychosis or to transsexuality. It was, in fact, the basis upon which he developed his theory of sexuation as it is negotiated by everyone regardless of whether we are neurotic, perverse, or psychotic. The problem is in the generalizability of the Schreber case and an uncritical tendency, among some Lacanian clinicians (although certainly not all), to extrapolate the particulars of that case to all transsexual clients. A universal transsexual (and thus psychotic) structure is produced making it difficult to imagine transsexuality as one among other ways to negotiate an all too human need to assume a relation to jouissance and to the Other’s desire that is not nullifying to the subject.

Referencing Ettinger’s work, Gherovici (2010) explains that the sinthome puts into “operation the difference between “man” and “woman,” and at the same time it never reduces the difference between “woman” and “woman,” that is, an originary feminine difference” (p. 153).⁶ Gozlan (2011) also agrees that transsexuality is “trans-subjective,” involving components of the masculine and feminine, a “swerving/touching/not touching relation without relating (p. 6). Ideally, one makes due with the difference that marks a detachment from the Other and also with the possibility of living (imaginatively and symbolically) otherwise. This is, as Gozlan (2011) contends, a feminine difference because it doesn’t “rely on phallic opposition” but, rather, upon what Ettinger calls matrixial borderlinking (Gozlan, 2011, p. 7). Regardless of the gender identity of any given transsexual subject there is an entry into what has been designated a feminine space of difference in Lacanian scholarship. If, however, we are to understand the feminine not as a gender identity but rather as a complicated “borderlinking” with the not-all (not universal) or, alternatively, with that which creatively animates a place of difference within the self, we may conceptualize transsexuality in relation to neurosis and in relation to the matrixial sub-stratum.

Conclusion

My contention is that transsexual subjectivity indexes another (matrixial) order of sexual difference that can’t be understood at the level of phallic difference (Lacan’s castration, being or having the phallus) alone. The feminine in Ettinger’s matrixial borderspace is trans-subjective. The transsexual transition is, I suggest, a metramorphosis that refolds and reinscribes a matrixial trace (where one is unhappily linked to a parental image) such that one’s gender can signify (as difference) in the phallic stratum. Transsexual scar tissue, for example, might materialize nonconscious traces of an originary borderlinking in the matrixial. Ettinger (2001) notes that these “archaic traces” are “remembered without being recollected and are revealed in a phantasm saturated with imprints of the trauma of a partial and shared subjectivity” (p. 109). The matrixial reinscription and refolding of primordial traces is thus unconscious and operating at the level of the Real as it also involves the Symbolic and the Imaginary. The jouissance here is to be found in the borderlinking enabled by the scar as a trace connection to the matrixial. For Ettinger (2001), this borderlinking puts into operation a “joining-in separating with/from the other” (p. 104), a metramorphosis. A scar is thus a visible inscription of a trans-subjective experience of metramorphosis. In this sense, it interlinks the matrixial and phallic stratums and forges a new way of being in relation to the impossibility of a sexual rapport in the phallic axis. Metramorphosis is a “noncastrative process of passability and conductivity, repression and dispersal that creates transformations-in-differentiation and ‘makes sense’ beyond distinct representations and discourse” (Ettinger, 1997, p. 368). Transsexual transitions can be understood as metramorphical becomings, borderlinkings enabling separation and distance in proximity. It is not as Catherine Millot (1990) contends an attempt to abolish the “nature”’ of the Real but rather an attempt to achieve a sinthomatic reknotting of the three Registers such that one’s relation to a parental image and to an Other’s primordial traces can be reconfigured.

Acknowledgment

I wish to acknowledge the intellectual contributions made by Caitlin Janzen.

Funding

This work was supported by the Social Sciences and Humanities Research Council of Canada [Grant number PDG 890-2014-0026].

Additional information

Funding

This work was supported by the Social Sciences and Humanities Research Council of Canada [Grant number PDG 890-2014-0026].

Notes on contributors

Sheila L. Cavanagh

Sheila L. Cavanagh, Ph.D., specializes in gender and sexuality studies with a focus on queer and psychoanalytic theories. She is an associate professor of sociology and former sexuality studies coordinator at York University, Toronto, Ontario, Canada.

Notes

¹ Daniel Paul Schreber (1842–1911) was a German judge who wrote an influential book titled Memoirs of My Nervous Illness (2000). Schreber lived with dementia praecox and his case was analyzed by Sigmund Freud and Jacques Lacan.

² Colette Soler (2002) argues that for Freud there is no feminine mark of difference in the unconscious.

³ There is a (dis)similar axis of difference operating in the phallic stratum whereby boys and girls are subject to symbolic castration. Boys give up what they allegedly have (the phallus) under the paternal function and girls must “renounce what they do not have” (Ettinger, 1997, p. 373) and what is, consequently, not part of their bodily schemata. In the phallic stratum men deal with the anxiety of having/not having the phallus while women deal with the question of being/not being.

⁴ Freud (1997) was confounded by the question of what a woman wants because his understanding of the feminine was confined to the phallic frame. His focus was thus on hysteria in women (in the case of Dora, for example), which is a defensive response to the positioning of the feminine in a phallic economy. Hysteria is impossible in the matrixial and occurs in the Symbolic when a “woman can’t give meaning to a nonphallic feminine difference” (Ettinger, 2006, p. 57). Desire au féminin (Ettinger, 2006, p. 184) is foreclosed. In other words, hysteria is only thinkable in the phallic stratum when subjects have been sexuated as men or as women.

⁵ In Lacan’s sexuation graphs one is either sexuated in the masculine or feminine position. This positioning isn’t determined by biology but rather by one’s relation to the Other and by one’s jouissance.

⁶ One of the limits of Lacanian theorizing on transsexuality is that differences between trans men and trans women are often obfuscated. It is thus difficult to know how divergent sexuated positions impact upon transsexual subjects. Much attention has been given to the so-called Push-Toward-Woman (modeled upon the Schreber case analyzed by Lacan), but how might we understand a push-toward-Man given that, according to Freud, “regardless of one’s sex, the opposite sex is always female” (Gherovici, 2010, p. 179)?