On taking sides: they/them pronouns, gender and the psychoanalyst

Dr. Ann Pellegrini, Ph.D.
 Dr. Avgi Saketopoulou, Psy.D.

The gender plurality analysts are increasingly encountering in the clinic has ties to the patient’s futural becoming; and it points to what psychoanalysis can, and must, become.


We cannot organize ... our individual identities and desires without [categories]. The fact that these categories invariably leak and can never contain all the relevant ‘existing things’ does not render them useless, only limited. Categories like ‘woman,’ ‘butch,’ ‘lesbian,’ or ‘transsexual’ are all imperfect, historical, temporary, and arbitrary.  We use them, and they use us.
(Rubin 1992, p. 477)
After much layered psychoanalytic work, your 30 year-old patient Kyle announces, with some anxiety, if not trepidation, their decision to change gender pronouns. Kyle has been moving towards a gender they describe as non-binary. They are now ready, they say, to switch to using ‘they/them’ to refer to themselves, and plan to ask others to do the same. Kyle makes explicit that those others include you, their analyst. You are asked to follow suit. You are asked, we might say, to take sides. 

How is an analyst to understand such a request? What are you being asked to side with?

Psychoanalysis has struggled with how to understand gender transitions in the context of transgender patients.  But, just as we are beginning to contend seriously with trans experience and embodiment (Harris, 2009; Hansbury, 2011; Gherovici, 2017; Gozlan, 2019; Langer, 2016; Pula, 2015; Saketopoulou, 2014) – a beginning that is finding us, as a field, both outpaced and out of breath – the gender horizon seems to recede yet again. Beyond the presumed ideality of a full transition that starts in one gender and has a clear, coherent, and identifiable gender destination (male-to-female or female-to-male) lies, it turns out, a cornucopia of genders. These wildly plural genders are strange in the most elemental meaning of the word: they are strangers, outsiders, foreign importations to the world of normative gender, a world that is itself a fantasized construction.[1]These genders expose those who think of themselves as ‘gender normals’ (as many cis analysts do) to gendered concoctions that may strain thinking.[2]

Unfamiliarity, surprise, and countertransferential difficulties can defensively mutate into the formulation that such genders are endemically pathological. Unusual gender forms that do not contour themselves around male/female presentations, but dart, instead, to and from male/female may be responded to by the analyst with bewilderment, incredulity, even anger. At times, they are responded to with debilitating anxiety (Hansbury, 2017), or primitive terror (Saketopoulou, 2015), that can interfere with the analyst’s ordinary capacity to wait for material to emerge, and to reflect on her countertransference. Such genders can challenge the expansive theoretical efforts even of thoughtful analysts who are willing to concede that some patients are indeed better off transitioning (see, e.g., Lemma, 2018). A growing number of analysts are starting to recognize that social and medical transitioning may be a viable psychic option for some patients (rather than a concretization of psychotic operations [Kubie, 1974; Chiland, 2000]), making it possible for psychoanalysis to imagine good adaptations for patients seeking full transitions (Gherovici, 2017). Nevertheless, more complex genders, such as non-binary ones, are yet to be addressed with similar sensitivity and imaginative capacity in our analytic literature.
What, however, is non-binary gender?

Briefly, the term pertains to a wide array of gender constitutions and embodied possibilities. Unlike other categories of gender outlaws (Bornstein, 2016), it does not have fixed referents, making non-binary gender impossible to theorize as a singular category.[3]Non-binary gender does not anchor itself in assigned sex, does not point towards a final destination, nor does it aim towards a cohesive gender presentation. If the subject’s presentation does, at some point, end up reading male or female, it may do so ironically, perhaps with an element of camp (Sontag, 1966). Additionally, not all non-binary people choose medical interventions. When they do, such individuals may not approach gendered embodiment as a matter of aligning bodily morphology to gender – as is usually the case with full transition. Instead, they may treat their gendered body as inhabiting multiple, distinct zones that don’t cohere into a unified presentation. For example, someone assigned female at birth (AFAB) and identifying as gender non-binary, or trans non-binary, may opt for top surgery but not seek androgenizing treatments. Another non-binary AFAB may use hormones with an eye towards modulating or blurring masculinizing effects.  
Psychoanalysts are particularly likely to be challenged by this mix-and-match aspect of non-binary genders, because we are trained to think of bodies as needing to function as coherent wholes organized around binary gender. As such, a body not ordered around maleness or femaleness may be seen as being a de facto manifestation of psychic fragmentation. But gender is not the only way to organize and ‘cohere’ the body. Psychoanalysis is, in fact, exquisitely equipped to illuminating other avenues by which the body can be organized and inhabited – sexuality being one of them. This is not to say that non-binary genders are not propelled by psychodynamics or do not fall under the aegis of unconscious forces. Quite the contrary: no psychic operation, including gender, normative or not, operates outside these. It is only to say that non-binary genders are idiosyncratic assemblages that need their own unpacking and require time for their elaboration. Psychoanalytic treatments have much to contribute towards such endeavors. 
Indeed, this is one generative way to understand Kyle’s request.  Although Kyle speaks as if they are in possession of some final knowledge about their gender, our clinical experience suggests that patients like Kyle may be best thought of as embarking on a project towards forming new representations, with gender and gendered embodiment being only one, and perhaps the most psychically organized dimension of that process. The process itself will unfurl within the analytic treatment, if the latter makes itself hospitable to such use. Sometimes, the process has to start not with reflection, but with action (Perelberg, 2018) – here, the act of pronouncing oneself non-binary, of requesting a shift in pronouns. 

In contrast, then, to those who would argue that the analyst defer Kyle’s request for they/them pronouns until the dyad explores the meanings and terms of that request, we opt for a both/and position: acceding to Kyle’s request as a way of facilitating this exploration. We see it as the analyst’s job to hold time and space for Kyle to be able to work on the dynamic process that underlies what ‘gender’ means to them; it is not Kyle’s responsibility to lucidly and convincingly articulate themselves to their analyst before such work can proceed. 
Certainly, as analysts we want to be mindful of the numerous implications of being asked by our patients, implicitly or explicitly, to take sides. Relational psychoanalytic thinking has long alerted us to the fantasy that there is a way not to; refusing to take sides is itself a taking of a(n other) side (Aron, 2001; Aron and Starr, 2013). Refusing to use they/them pronouns would not be a neutral act – unless one uncritically adopts the perspective that Kyle’s gender is known and that what the analyst is asked to become complicit with is its distortion, a perspective we urge analysts to question. In agreeing or disagreeing with Kyle’s request, the analyst necessarily tips her hand.  

But, for the purposes of thinking about patients like Kyle, and about non-binary genders and they/them pronouns more generally, we want to stress that the issue is not a matter of taking sides (ie. on ‘deciding’ what Kyle’s gender really is), and more a matter of tending to this shift’s processual and futural unspooling. The patient announces a pronoun change as a fait accompli. In doing so, they are also trying to craft a space for self-definition. We would all agree that Kyle’s need and growing capacity to stake such a claim deserves our analytic attention, but rather than focus on the claim’s content per se, an analyst might be better off prioritizing the patient’s effort to craft new meanings about themselves. We even wonder if there is a kind of hot potato in the room: the analyst thinks the patient is being “too concrete” and won’t keep gender hybridity where it belongs, in the realm of fantasy.  But what if it is the analyst who is becoming overly concrete in narrowing her sights and refusing to join the patient in exploration?  To remain vibrantly curious, the analyst will need to interrogate her own concreteness, her own wish to stabilize herself by holding onto the familiar.  

Said differently, what if, in keeping with Corbett’s incitement that analysts ask ‘how homosexuality’ as opposed to ‘why homosexuality’ (2001), and Hansbury’s proposal that we think ‘how trans’ rather than ‘why trans’ (2018), we consider that Kyle’s pronoun shift announces something that is in the process of becoming? What if we see it as our task not to explore what the pronoun request already means – a focus that privileges represented, even if disguised or repressed meanings – but what this new form of address may enable, what futural hatchings it may permit?

We don’t yet know, nor does Kyle, who or how they will become through the taking on of this new pronoun – as they speak it, and think it, and as others speak it, and think it of and for them.  In this regard, their decision does not close down possibility, but may, in fact, open up to something still very much in process, something that we may think of as gesturing towards futural possibilities (Muñoz, 2009) for the crafting of new representations. In that sense, again, as analysts we are being asked not to take sides but to be part of something yet to be known and to do so by providing opportunities for something new, alien, and strange to become subject to exploration, to be tried on, discarded, un-done, re-done, over-done, done-over.   
It is easy under such conditions of uncertainty, and with patients in such a fundamental state of becoming, for the analyst to find herself impatient, anxious, perturbed, and even paranoid in the face of analysands who are not just challenging the gender binary[4]but who bend the grammars of gendered subjectivity as well as protocols of psychoanalytic diagnosis. Without a distinct and discernible symptom to diagnose and hold onto, the analyst may decide that the gender being declared, customized, and enacted is the symptom.  

At minimum, we often hear the muted protest that ‘they’ is grammatically incorrect—and that expecting the analyst to use an odd locution is a constraint on the analyst’s freedom to think and dream the patient. And yet, in English, they/them/theirs are less new gender pronouns than renewed ones.  The use of ‘they’ as a singular pronoun has a much earlier history, with attested uses as early as 1315 and well into the 18th century (Baron, 2018). Further, English speakers routinely rely on ‘they’ when referring to a person whose gender is unknown to the speaker (as in: ‘my daughter’s doctor prescribed medication; they think it might help’). This is all to say that language changes, and so do gendered possibilities – though not always in sync with each other.  The ongoing mutation of language and of categories is no trivial matter, as fiery political debates in the United States, and not only there, over new gender pronouns confirm. Some seem to worry that it is gender itself that is being destroyed, a claim that quickly assumes cosmic proportions, as if the pronoun ‘they’ can cancel out natural and divine orders at once.[5]

An analyst may well feel that her mind and reality are under attack when she is asked to use new gender pronouns to refer to and mentalize a patient. Such an analyst is not entirely wrong; she isn’t just being paranoid. Put differently: if paranoia comes into play, it is also because there is indeed a challenge, though not one mounted by a particular patient against a specific analyst. Paranoia may be an exaggerated response to radical challenges to external reality.  Where gender is concerned, the world as ‘we’ know it is giving way to new forms – in the clinic and beyond. This can indeed feel vertiginous, the ground shifting beneath couch and chair.

The struggle of psychoanalysis to keep pace with changing possibilities of gender and embodiment is taking place against the backdrop of contentious and often violent debates in the wider public in many national contexts. The difficulties and anxieties some analysts may have are thus not theirs alone. But it is also our strong hope that psychoanalysis can live up to the challenge of making the world bigger, and more livable for the “wild profusion of existing” genders (Foucault 1970; Rubin 1992). And for those yet to come.
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[1]Space constraints don’t permit us to discuss this in depth here.
[2]A child patient poignantly described her reaction to an atypically gendered person, protesting that she  “makes my brain hurt” (see Saketopoulou, 2011).
[3]This is not to suggest that normative gender is easy or even possible to capture in terms of theorizing a singular dynamic constitution or unconscious determinants. It is only to highlight that non-binary gender is as much an umbrella term as is any other gender category, and should be treated with equal complexity when it comes to grappling with its psychic underpinnings. As such, the polyvalent meanings and dynamic factors that underwrite non-binary gender are beyond the scope of this short communication.
[4] Many versions of trans also challenge the gender binary, as do many feminist deconstructions of gender stereotypes. We are not arguing that non-binary genders are exclusively capable of such challenges nor that this is their underlying motivation: to mess with gender.
[5] We see this ratcheting up in the Vatican’s recent attack on ‘gender theory’ for questioning the ‘reciprocity and complementarity of male-female relationships, [and] the procreative end of sexuality’ (Versaldi, 2019).