Through the donning of a fetish object, disavowal acts to ignore an upsetting reality while the traumatic truth remains intact. In particular, Freud's writings on fetishism and disavowal reveal some of the unconscious roles at play in the repeated medicalization of trans people and the restricting of transition-related resources. When separated from stereotypical acts and identities, perversion proves to be quite valuable in understanding clinical transphobia.

Through an unconventional use of psychoanalytic theories of perversion, I argue that DSM-5's new diagnosis criteria work defensively, functioning as an antidote to the clinician's anxiety in the face of difference. This article therefore investigates the taxonomical movement away from the transgender subject as perverse toward the current diagnosis of gender dysphoria, which instead consolidates the transgender subject as distressed and suffering. For example, many early versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) infamously categorized any gender variance as sexual deviance or paraphilia. Transgender people have long been associated with sexual perversion. Attention to unconscious fantasy and its transformations shows the importance of helping transgender patients whose bodies are a source of suffering to be able to psychically represent their pain as a critical step in the process of a psychologically healthy transition. Through a detailed, in-depth account of work with a five-year-old trans girl (female-identified, male-bodied), the developmental implications of the natal body’s not becoming suffi- ciently mentalized in the course of treatment are tracked and explored. However, patients’ body dysphoria is often left unaddressed even by analysts who seek to work within their analysands’ gendered experience. Consequently, the field is increasingly hospitable to considering the psy- chic risks inherent in misgendering.

Analysts have become increasingly aware in recent years of the complex interactions between psyche, soma, and culture. This paper introduces the concept of massive gender trauma, a clinical syndrome arising at the onerous intersection of the misgendering of transgender patients and the subjective, anguished experience of the natal body.

Avgi saketopoulou