Gender and its clinical manifestations

Based on a study of five analytic cases (three reported here), and using a modern classical psychoanalytic perspective in which both biology and social forces are integrated, our study group on gender investigated why for some gender assumes a distorted and exaggerated role in the subjective sense of self. Clinical material was used because we wanted data allowing us to study patterns emerging from an exploration of patients' unconscious fantasies as they shed light on the psychological significance and function of gender. We found that in each case gender disturbances were never primary but secondary to difficulties in integration, cohesiveness, separateness, stability of solid sense of self and of the object, to depression and especially to problems with aggression and rivalry which had to be analyzed first. Conflicted gender gave rise to solutions that were literal and concrete. Not surprisingly, in each case mothers wished for a child of the opposite gender and treated gender expression in highly ambivalent ways. In terms of technique we learned that ways of coping with rejection, evolving paternal transferences which allowed for metabolisis of the maternal relationship, and ego building techniques had to take place before conflicts around gender could be analyzed productively.