The sexued being authorizes himself by himself… and a few others
Gender dysphoria is described in the DSM-V as “the distress about the incongruity between experienced/expressed gender and the one assigned at birth”. It replaces the Gender Identity Disorder of the DSM-IV edition.
The criteria for diagnosis according to the latest DSM-V proposed guidelines is specified for children, adolescents and adults.
In any case, the incongruity between experienced/expressed gender and the one assigned at birth has to last 6 months.
The criteria for children and adolescents are: the desire to be of the other sex or insistence that they belong to the other sex; preference for cross-dressing, toys, games or activities typical of the opposite sex; aversion to own sexual anatomy; desire to acquire the primary and/or secondary sex characteristics of the opposite sex. While the criteria for an adult is underlined by the incongruity between the assigned gender and the experienced/expressed one.
Gender dysphoria is considered independent of sexual orientation, even if children show a persistent attraction to individuals of the same sex “of birth”. This is because Gender dysphoria concerns the ego, the identity. The Tom Hooper film, The Danish Girl which is based on a true story, illustrates how identity detached from desire and jouissance can be dangerous. Lili Elbe was born as Einar Wegegener and “feels” a new feminine identity growing inside himself and with the help of his wife with whom he shared an artists’ life up to that moment, he decides to undergo several surgeries of sex reassignment.
Following the perspective of the LGBTIQ movement, the film supports this heroic pioneer in trying to achieve her maximum aspiration – of a woman that could have children – at the cost of her life. In actual fact, this occurred at the fifth surgery which was a uterus transplant, with the help of a doctor who became complicit in this delirium. But the term “dysphoria” used by psychiatry to indicate a mood alteration in a depressive way, is a symptom of the return of the big thing repressed by this classification: the object. As Freud says about melancholia, the shadow of the object falls upon the ego, so the ego is identified to the lost object and suffers the reproval of the moral conscience. Dysphoría points at a lack that concerns the object and not the ego. DSM-V also notes that among the children “born female” there is the desire to have a penis or the affirmation of having one or that it will grow later. An affirmation that reminds us…
Freud describes in this way the response of the little girl to the discovery of sexual difference: “she has seen it and knows that she is without it and wants to have it”! Later, the verification of her own castration guides the little girl to different possible solutions, one of which is the “masculinity complex” that can develop in homosexual choice. Desire and object choice are the bearings orienting psychoanalysis and supporting the subject in assuming his/her own sex.
“S” was born with a disorder of sexual differentiation – as an infant she had her first surgery and grew up as a little girl. As an adult she decided to have surgery to give her a vagina. “S” never had doubts about her sexual identity but after the surgery she started to question herself about the meaning of being a woman, or, what makes her a woman? A question that is not so simple to solve as the question is undecidable because a feminine sexed identity doesn’t have a consistency and the only answer is to be found through the encounter with the Other that will occur in the contingencies of her life.
So, the solution to Gender from the perspective of the DSM-V and the LGTBQ movement is a kind of self-nomination: each one chooses the desired for sex both through the legal solution and the medical-surgical one. Psychoanalysis has a different solution: for Lacan – “the sexed being authorizes himself by himself…and a few others” – it is a nomination that includes the Other in whom the subject has put back his own objects and from whom he depends.
Translated by Sabrina Di Cioccio
 American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-V, Italian Edition edited by Massimo Biondi, Raffaello Cortina Publisher, Milan 2014, p. 528.
 LGBTIQ: Lesbian, Gay, Bisexual, Transgender, Queer.
 S. Freud, Some Psychical Consequences of the Anatomical Distinction Between the Sexes, SE, vol. X, p. 211.
 S. Freud, Female Sexuality, SE, vol. XI, p. 67.
 J. Lacan, Les non dupes errent, lesson 9 April 1974.