The transsexual wish in a psychotic character

The case discussed here illustrates one type of transsexual wish. The paper clarifies the dynamic considerations and treatment process in a patient who was psychotic and who, from time to time, wished to change his sex. One of the patient's chief difficulties was an inability to regulate adequately the intrapsychic distance between the self and objects. In the relatively nonpsychotic state, the patient used coercive behavior and splitting to establish a tenuous balance between fusing with the object and losing it entirely. When these defenses were adequate, the patient did not experience wishes to be a woman. However, when threatened with the loss of an important internal object (the mother or therapist), the patient would attempt to fuse with the object by experiencing strong transsexual wishes. The wish thus served to stabilize and control internal objects at a comfortable distance. The wish also served a restitutive function, holding off a frightening psychotic state; a loss of an important object threatened the patient with feelings of fragmentation. It was thus somewhat similar to a delusion or hallucination.