THE LETTER 26 (Autumn 2002) pages 162-186

This paper is a structural account of a clinical case. The analysand, whom I will call by the pseudonym Simon, is thirty-five years old and a full-time student. I will start with a presentation of Simon’s psychosexual history, which centres around questions of the drive, fantasy and puissance. This will be followed by a discussion of his presenting complaint, its signifying history and puissance value. I will then trace the development of the analytic work with Simon and raise issues of diagnosis, transference and the direction of treatment.

Psychosexual history

Although elements of Simon’s psychosexual history were produced from the very beginning of the work, it took about a year for a more detailed picture to emerge, mainly because of Simon’s inhibitions around talking about his sexuality to his important others.

As far back as Simon can remember he wanted to be a girl, he fancied girls and was turned on by wearing his sister’s clothes. This intensified during early adolescence, when he systematically cross-dressed and wanted a sex change. During adolescence he had a series of S&M relations with much older women partners and actively participated in the S&M scene. He was a heroin addict and in order to get money for drugs he was involved in drug dealing and he also prostituted himself with men. He came out of this period as a physical wreck. His closest friends died of AIDS, he lost his support networks and realised that if he continued with this way of life he would end up either in prison, or in a psychiatric institution, or he would die. At the end of this period he went through a detoxification treatment. He decided that since he could not have a sex-change operation to become a woman, he should accept that he is a man. …