The Psychoanalytic Crisis: The Place of Ego in a Contemporary World

Abstract

Psychoanalysis rose at the end of the nineteenth century as a possibility of reintegrating the mind and body. This came up as proposing a theory that empirically demonstrates that emotions create symptoms in the body. Psychoanalysis introduces a subject moved by desires, governed by the unconscious. Since then, in a dialectic perspective, search and offer to society a counterpoint view of current thought, offering new insights and reflection, bringing enlightenment of what is obscure in individuals’ internal life. The contemporary psychoanalytic crisis comes from conflict avoidance, not worrying in the integrative view, falling into a trap of “politically correct,” that is, accepting what is advocated, without questioning, not putting on the agenda the obscure side effects in human beings, the Unconscious. Therefore, in a psychoanalytic theoretical perspective, this chapter has the aim to reflect about the psychic suffering inside a body identity, without getting into sociological and anthropological meanings about the shaping of social identity. This study seeks to present the psychic suffering of the unidentified body, which not always will find resolution in an aesthetic procedure that might be belonging to a fantasy and identity recognition.

1. Introduction

“I mean Negative Capability, that is when a man is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact & reason” John Keats (1817)

Psychoanalysis emerged at the end of the nineteenth century as a possibility of reintegration between body and mind. From an empirical perspective, psychoanalysis demonstrates that emotional aspects interfere in the body, producing symptoms. The human being is presented as a subject of desire and ruled by unconscious thought. This knowledge was built by Sigmund Freud [1] in analyzing hysterical patients, provoking a revolution in Cartesian thinking from that time. The Freudian subject goes beyond the rational, which was studied and reached by The Age of Enlightenment. Therefore, psychoanalysis brings a new possibility of treatment to a patients’ burden. Psychoanalysis is presented as healing through talking, that is, it gives place to emotional expression through signs.

Freud [2] also introduces a being with ambivalent drives, life and death, a being reigned by desire. He highlights that the psychic structure is developed in the family context, between the first object relations of the baby, that is, with their mother and father or caregivers [3]. Thus, the family context is the child’s first social place, in which the baby becomes a body in the world, and the world’s action over that body shapes a history in it. In this way, the game between biology and society is established, once that baby’s perception about what it receives is influenced by innate factors [4].

With regard to the psychoanalytical crisis, the question in mind is not the science itself, but rather those who represent it. Hence, given that psychoanalysis endorses a human being with instincts, desire, phantasy, and affection, who are dealing with an external reality. And, as ambivalents beings, they need limits to live in society [5].

Psychoanalysis does not have the intent to be “politically correct,” once that it seeks to bring to light the obscure side of human beings, in order to be seized, understood, and developed. When we become trapped in the social discourse, we are denying the affective ambivalence, the anguish of helplessness that rose since birth trauma [2], in face of fragility of the human body and which accompanies life in its relation with reality [6].

When psychoanalysts become speechless ahead of a movement that is growing massively with identitary questions, with countless definitions, denouncing a huge egoic split in search for integration made from the outside to the inside, we can say there is a crisis in psychoanalysis.

Humans are primarily biological beings, with individual physical characteristics. The mind arises from our body with the parents or caregivers’ intermediation, who names the external and internal world of their children [7, 8].

Biology brings objective aspects that guide the actions of those who take care of the baby, who is born with a body that has characteristics of skin color, weight, sex, etc. This information guides parents and society about their roles and expectations over this subject. The baby is born as a social being when it registers inside a familiar and cultural boundary that defines where one came from, which family one belongs to, and how to interact with the world [4, 9]. Those expectations might bring consequences on many levels, from disastrous to wonderful. Consequently, these biological bodies will develop according to cultural-context influences and according to its internal perception about what is received [10]. The projection and introjection are moving inside the baby’s internal world, allowing the possibility of emotional development.

Biological development also depends on interactions with the environment. That is, the plasticity of the nervous system depends on what is offered as stimuli to the baby, which goes from emotional regulation to cognition [11, 12]. This new member of the family leads to countless fantasies in their parents. The first contact that they have with the baby is with its body, in which it will be recognized and known by them. Parents will be in contact for the first time with the real baby, who is different from their fantasies [13, 14]. The baby’s sex also will interfere with parental fantasies, that is, it will move the internal world of those who will receive it in the external world.

Presently exists the defense of a neutral gender, which makes us reflect about the formation of Ego in the contemporary world. We observe a risk in denying a human being’s external biological reality and denying the importance of others’ look over a body.

We live in a social moment where one may be/have almost everything through technology. It might be possible to change our body to a different sex, changing our phenotipical characteristics, denying genotypical issues. However, the emotional difficulties require an internal place to welcome and understand them.

In 1911, Freud [15] presented his famous case of Dr. Daniel Paul Schreber, former president of Saxon Court of Appeal, who in his years of psychiatric internment wrote: “Memoirs of my nervous illness” [16]. This renowned judge described in his book paranoid delusions, which allowed the first psychoanalytic discussion about psychoses, demonstrating how a body deconstruction is linked to an egoic disintegration.

Therefore, the present chapter has the objective to highlight a topic that seems obscured by what is “politically correct” inside the same psychoanalytic circle, in which we cannot think about what is behind transsexuality, body mutilation, and moreover, the sexual organ, which identifies humans with their internal parents. The search for physical alteration has increased a lot [17] and is being accepted as something regular. We see it as barbarian when sexual transition is encouraged in children, who are still in psychic and physical development.

We notice a lack of recognition of the psychic suffering, which might indicate a disconnection with the body. We also see a denial of looking at narcissistic identitary suffering that is in the center of the question when you want to become somebody else.

In what follows, we will go through the formation of Ego and the symbolic process, in order to understand the narcissistic identitary suffering inserted at the search of a social naming to define identity. Also, we will attempt to understand the meaning of transexuality and how this theme might be brought to a psychoanalytic clinical setting. So, is there a crisis in psychoanalysis? What is the place of the analyst in the contemporary world?

2. The formation of ego

Garcia-Roza [18] calls attention to the fact that the Freudian Unconscious was a true rupture in relation to early understanding of the concept, taking into consideration that Freud was not the first to speak about this concept. The biggest novelty was the affirmation of the Unconscious as a decisive factor to subjectivity and consequently the subversion of the subject notion that would find expression in the elaboration of the first topic of Freudian theory, that is, at the conception of a split subjectivity, marked by the dialectical articulation between two intricate psychic systems.

As psychoanalytic theory advances, especially in conjunction with the second topical elaboration, the vision about subjectivity acquires more complexity in a way that goes beyond the unconscious, preconscious, and conscious. Psychoanalytic theory creates a model of personality articulated in three psychic instances—Id, Ego, and Superego—which indicates, as Laplanche and Pontalis [19] point out, the emergence of an intersubjective field conceived in the molds of intersubjective relationships, that is, where the psychic instances act as internalized “subjects” (objects).

Freud, in his reflection about the character of Ego in the text The Ego and Id [20], assumes the existence of a certain heterogeneity or gradation in the constitution of this psychic instance, adding complexity to the structure of the Ego. Freud argues that this internal differentiation has a strict relation with the mechanisms of identification, in a sense that this makes the Ego altered by processes of internalization of objects that passed through intense libidinal investment. In other words, the mechanisms of identification would be a constitutive process of Ego. Consequently, the classical Freud affirmation states “the character of the Ego is a precipitate of abandoned object-cathexes and that it contains the history of those object-choices” [20].

The father of psychoanalysis supports that the identification and the object cathexis happened at the same time; hence, the Ego assumes to itself certain object characteristics in a transformation process from object libido to narcissistic libido [21]. By carefully analyzing this process, Freud notes a certain tendency of Ego fragmentation due to numerous identifications and questions himself about the power of those identifications that happen in the early childhood or the primary identification. Such identifications would have a special character in a sense that is independent of id object cathexis. The primary identification would happen in a direct way, being influenced by the triangular nature of Oedipal complex and by the constitutional bissexuality of the individual.

Klein [22] went even further, after extensive study of the primitive mind, developing a theory of positions, which involved the paranoid-schizoid position and depressive position. She defends a constellation of anxieties, defenses, and internal and external object relations specific to each position. Therefore, the infants after the birth do not differentiate themselves from their mothers, and they are considered an extension of their mother’s breasts. When the baby has a good experience, the breast becomes a good breast (love), and when the breast is not present or does not satisfy their needs, the breast becomes a bad breast (hate); this is the paranoid-schizoid position. At this moment, the infant lives a complete fusion, where there is no differentiation of what is inside and outside, from what is one or another. Omnipotence and idealization are important aspects of this activity as well as the splitting. Klein assumes the very young infant to have a rudimentary Ego, although unintegrated.

At the entrance of a third in the relationship, the infant starts to realize its dependence on another outside, the mother starts to be recognized as another and separate from “I.” At this moment starts the depressive position. The feelings are characteristically ambivalent; hate being transformed by the infant’s own love into remorse. Typically, the anxiety that is felt is a fear of damaging a loved one. Objects become threatened, or damaged, and that brings out concern for their suffering. Relationships with objects then begin to allow more separateness; less control (omnipotence) is demanded. And defenses that operate against anxiety and remorse are different from the primitive and violent ones previously described against the paranoid fear of being persecuted.

Since the beginning of life, human beings need to deal with ambivalence: life and death. The deflection of death drive would be the first projection, the most primitive mechanism of the internal world in front of helplessness generated by the birth trauma. The infant’s body internal and external perceptions are anxious to the rudimentary psychic apparatus. The infant mind creates primitive defense mechanisms to deal with the anxiety arising from these feelings (good/bad breast, life/death). These primitive relations are the first identifications with external objects. Klein does not give as much importance to mothers’ emotional development as the precedents Bion and Winnicott. Although she has talked a lot about the environmental context, she kept the attention to the infant’s internal world, together with several innate emotions, that will allow or not the good fruition of the good internalized object [23].

Ogden [24] argued about Winnicott’s idea that a baby does not exist separate from a mother’s provision, and at the same time mother and baby are separated individuality [25]. And yet, Bion [26] and Rosenfeld [27] traced their own understanding about mother-baby relationship under the conception of projective identification as an unconscious interpersonal psychology in which mother and baby think together at the same time that remain separate since the first year of life.

Winnicott, Bion, and Rosenfeld [25, 26, 27] highlight the importance of mothers in the infant’s psychic constitution, that is, the development of children’s psychological life is not conceived only in terms of infant individual progress, but also in terms of a bond created by mother and baby. The initial unconscious fantasies of the baby are supported in its primitive mind, in the mother’s psychological mature life and in the interaction of both. Thus, in this perspective, the mother as a developmental context includes the mother as an environment for the baby, but also the mother as functional aspects, such as the metaphoric interior of the baby mind built by two [28].

To Winnicott, the mother’s look is the life’s mirror to the baby. By handling and holding, the baby understands the world and sees themselves projected in the mother’s desire. Therefore, the mother’s affective expression helps the baby to understand their own identity, to separate themselves, and to live [25].

Consequently, the importance of dealing with reality, the emotional maturation, and the consequent integration of Ego (good and bad together, bringing the idea of human incompleteness), the perception and acceptance of an internal object, which is separated from Ego and might be respected and loved, as happens in the differentiation in breast, in the depressive position, helps the development of the negative capability [29], that means to tolerate the uncertainties, in accepting the unknown as integrant part of life, which inside the analytic setting might be represented as not known. The daily search is the resultant of this first relation, that is, deal with the pleasure principle versus reality principle without draining out of what is good inside.

The principle of reality is a modification of the pleasure principle. The origin of thought resides in the process of testing the fantasy (mental expression of instinct) against reality. The fantasies derive from instinct in the frontier between the somatic and psychic activity, so, the fantasies might be lived somatically or mentally, being the beginning of emotional life, of infant world. The fantasized objects and their satisfaction are lived as physical experiences, the reality moment in interaction with the unconscious fantasies and the memory traces are incorporated in mental life; they are changed by reality contact, conflict, and maturation. Consequently, the mind develops from the body [30].

3. The symbolic process

According to Freud, the mechanism of sublimation referred to the plasticity of drive and about the capability of the psychic system in converting energy initially destined to direct motor discharge in more accepted social actions [31]. This line of thought opens a question about the nature of representation, and considering the technical psychoanalytical preponderance in the use of word as a symbol or verbal representation, Freud reflects about the word’s characteristic and function, adopting a descriptive point of view.

Therefore, Freud [2] works about the function and characteristic of representation in the field of memory, articulating two dimensions of the concept: the Thing representation, related to the unconscious system, and Word representation, related to the preconscious system and conscious. Besides that, to Freud, representation and motor discharge were an exclusionary process. So if representation happens, then no motor discharge will be involved. The Freud’s systematization launched the basis to think about the symbolic formation process, especially, in the context of verbal language, with lower consideration about forms of representation, except by dream. It is from this point that the Kleinian thought took another direction.

To Klein [22], children developed the capability to symbolize early as a way to deal with situations of anxiety, highlighting the role of symbolizing as a defensive resource. This capability rose from very early stages of life, and its first activities would be related to body experience. In other words, the children’s experiences in relation to body parts would be their first stimulus to create an archaic form of mental representation, which constitutes elements that are fundamental to posterior elaborations.

When thinking about the construction of emotional development, it became necessary to understand the unconscious fantasies. Isaacs [30] proposed a different writing to the term fantasy to differentiate from conscious. In his text, Isaacs endorses the definition of Rivière over phantasia as “the subjective interpretation of experience.” Isaacs also suggests that the activity of phantasia constitutes the early symbolic function consciously and unconsciously, in that the experience is meaningful to the subject that understands/interprets it.

To Ogden [28], the unconscious phantasia is the first form of thinking. He concludes that phantasia is the creative process of meaning, it is the form in which all the meaning, including feelings, defense mechanism, impulse, body experience exist in unconscious mental life. So, it is understood that unconscious phantasia is a force in the development of the internal world. Thus, the primary object, the mother (caregiver) has an enormous contribution to the way of dealing with others and with one’s own body.

It is with the ground of archaic representations connected to its own organic workings that the child will experience its first relation with the external constitutive world, at this moment, through the mother’s body. Klein [32] states that success or not in this stage will determine the relation between the external child’s world and its counterpart with reality. Specifically, Klein argues that the child’s primary reality possesses a fantasmatic character and that the path to true reality would come with the development of Ego. Such development is driven by the anxieties arose from this first relation and its measure defined by the capability to support them. This capability is related to the symbolic formation process and by the settlement of a fantasy life, being both dependent on an optimal amount of anxiety to develop.

Thus, the symbolic formation is configured as a primary resource that constitutes at the same time a way for life expression, fantasy, and a defensive strategy to deal with anxieties, according to Klein’s studies on the field of defense mechanism. At the next developmental stages will be the intensity of intrinsic affective ambivalence with the primary objects that boost the infantile psychic searching for new objects by symbolic processes. Those objects will be represented by primary objects and inherit the relational dynamic established with them. Therefore, is this legacy that will make the child keep zooming into its symbolic world, maintaining constant the search for new objects in order to escape the anxieties rooted in the affective ambivalence for the primary objects [33].

Segal [34] accomplished a distinction between symbolic formation process and symbolic equation, denoting its relation with two forms of psychic functioning. To Segal, the symbolic formation would port the true symbolism, in the sense that this is known as such, that is, with an object that occupies the place of another without being another. The true symbolic has its own characteristic and amplifies the representation ability, being able to condense representation of diverse objects simultaneously. Thereby, it is understood that the symbolic formation has an evolutionary character that acts as a force in permanent expansion.

In the text “Notes about the symbol formation,” Segal [35] indicates the importance and contribution of Jones [36], where he defends that “a desire, coming from a conflict, has to be abandoned, repressed, and might express the symbolic mode, and the object of desire that has to be abandoned can be substituted by a symbol.”

The author developed her theory from the beginning of mental life, that is, the anterior moment to repression. Afterward, she starts from the principle that the first interest and children’s impulses are driven by the parents body and to its own, and the existence of those objects and child’s impulses in the unconscious that provide origin, by symbolization, to all other interests [35].

The beginning of those physical sensations when unpleasant are felt by the infant as persecuted objects, would the external world attack it, that is, projection. These sensations are the origin of primary phantasies, as well as pleasurable experiences. Therefore, the primary unconscious phantasia is the psychic representation of drive [37].

The symbolic equation is the first mental moment to develop a symbolic formation, in other words, in this moment the symbolic-substitution of the original object is felt as the proper object. It is used to deny the absence of an ideal object or control the persecutory object. Remembering that this moment is inserted in the esquizo-paranoide position, that is, there is no differentiation between external and internal world, neither between Ego and external object. There is also at this moment a predominance of the omnipotence fantasy, object control, among other primitive defense mechanisms [38].

On the other hand, the symbolic equation also could be located in the pathological projective identification, in a way that the new object would receive the integral projection of the primary object, not preserving its own characteristic. This emptiness or obliteration makes that the new object can be perceived as its own primary object and get all the loaded conflict and anxiety. Thus, the object taken by symbolic equations does not suit as an instrument of primary resource expansion or defensive Ego capability. On the contrary, it establishes a closed circle in that new objects are totally identified with primary objects, multiplying the sources of anxiety and impoverishing the Ego’s resources to deal with difficulties. By its strong correlation with the projective identification mechanism, it is noticed that the symbolic equation integrates the function mode of paranoid schizoid position. Therefore, the symbolic equation is linked to a concreteness while the symbolic formation is the capability to think, create [37, 38, 39, 40].

From a contemporary perspective, Cintra [41] reflected that the repeated elaboration of depressive positions is necessary for life, because this is made of constantly objects lost and found next, in a new form. Those elaborations can be translated into symbolic processes that involve the continuous search for new objects as a defensive strategy to deal with anxiety. The new search movement implies the abandonment, in a certain way, of the anterior object. Consequently, it is part of the symbolic formation process, the fortification of the capability to deal with loss and create new paths to emotional experience.

Ribeiro [42] presents a theoretical articulation based on two key concepts—narcissistic trap [43] and symbiotic illusion [44]—united by the expression “empire of the same,” described by Jacques Andre [45]. This expression, although, did not work as a concept, points out to a constant challenge in the mother and daughter relation, which involves the unfinished psychic work of frontiers’ elaboration against the risk of fusion and the different needs. To be cited:

“The empire of the same navigate by narcissistic water, in which the differentiation, the frontier between me and the other are not welcome guests. It resembles the projective identification by the frontiers erasure, as in the communication mind character, as in a more pathological way. The similarity between mother and daughter seems to generate pathways of facilitation for narcissistic trap, as a formation of a double.” (p. 59)

The narcissistic trap [43] and symbiotic illusion [44] are deeply related and reveal nuances of the same phenomena related to “The empire of the same.” Specifically, the narcissist trap refers to the double formation, phenomena stated by Freud [46] in the text “The Strange” in 1919. To Freud [46], the formation of a double reveals an accentuated process of identification, in which the subject lost the other, by the confusion between identitary frontiers, or by the self-adoption of Ego from another as itself. Ribeiro [42] asserts that the double is easily found in clinical setting and might be formed by mother and daughter, son and father, brothers of the same sex.

Therefore, when it is thought on the diversities of possible identities presently, it might be possible to question if the symbolic formation of the subject could be against wavering symbolism and narcissism in which the other could be an Ego extension of parents or even the physician.

Roudinesco [47] points out that the evolution of the concept related to gender identity brought changes to the form in which body and subjectivity are seen, which can be observed by the radicalism between biological and social, excluding the transit between these two realities. That is, from the end of the cold war and the advances of existentialist philosophy, it established an idea that the biological body is not preponderant over culture, and some experiments were conducted to prove this argument. It can be cited that the study conducted by John Money [48], who was influenced by this thought and was determined to prove that gender is built by social experiences finding the perfect individual for that, a child, D.R., who has a lesion on his penis after a phimosis surgery. Money convinced the boy’s parents to change his name, pronoun and conducted the testicle ablation surgery, raising the child as she. However, during teenagehood, D.R. starts to identify himself as male and decides for a penis reconstruction surgery unfortunately, facing burden and chirurgical traumas, he committed suicide.

The example above is a portrait of how denying the biological reality over a social desire can be dangerous, inflicting subject to become lord of the self, to the point of not integrating the parts that are perceptually recognized for a sake of subjective domination, that is, a denial of the reality principle and appreciation of a fantastic and magic world.

Considering that the society becomes the sovereign of others, over to the empire of the same, how might this other individual build a symbolic identity in this place that imposes a subjective recognition above corporal recognition? In other words, the subject easily becomes the target of Ego projection from another. Therefore, what is supposed to be a symbol of freedom became a prison or a fusion of other’s projection.

4. Transsexuality

The diagnosis of gender dysphoria presented by the DSM-V was an attempt to de-pathologize transsexuality, which was classified as a disorder of gender identity in the previous manual. This transition in diagnosis is marked by a classification that is justified in the name of health, which favors insurance programs and at the same time brings “normalization” to the diagnostic. According to the new criteria of DSM-V, the gender dysphoria can be defined as: “a strong desire to be free from one’s primary and/or secondary sexual characteristics, because of a marked incongruence with one’s expierience/ expressed gender,” and “a strong desire to be of the other gender” and additionally “a strong conviction that one has the typical feelings and reaction of the other gender.” Besides that, it also states that “is associated with clinically significant impairment in social, occupational, or other important areas of functioning” [49].

The diagnostic changes mark a medical effort in medicalizing the transssexualiy and consequently proposing a way to treat it. From that idea that the gender nature has to do with something subjective and from a symbolic order distorted, mischaracterizing the symbolic formation along the development with concepts that validate the normatization of transsexuality. Thus, in a rush to satisfy parents’ wishes and their own medical service, an interruption of the physiological process is proposed in order to facilitate surgical procedure.

The case Bell versus Tavistock is an example of the new position that is rising against this diagnosis. In 2020, the British Court brings to question if children under 16 years old are able to decide by themselves if they can take hormones suppressants to facilitate in future the sex changing. This case was based on a patient from the Tavistock Clinic that decided with 16 years old to use suppressants and after the transition preferred to return to the biological gender. At last, the Britannic Justice decided that the children under 16 years old hardly have the competence to decide over the use of medication, modifying the conduct line that has been carried out by the only Britannic public health service that offers this treatment [50].

Some psychoanalysts critical to the vision that promotes hormone suppressants in children see the identity problem as requiring a symbolic work, and the body intervention is a mistake, a psychotic solution [51]. According to Bell [52], there are under-explored factors from a social point of view contributing to the current emergence regarding gender dysphoria that includes misogyny internalization, seeing patients as products, and social media influence.

From the epidemiologic point of view, the prevalence of gender dysphoria is from approximately 4.6:100.000 [53], and yet according to that reference there is no correlation with social status, intelligence, or ancestry. However, it is more common a transsexual transition from male to female (6.5%) than a female to male (2.6%), and for children, the literature states that the prevalence is from 1% to 4.7% [17].

Gender dysphoria is correlated to high taxes of affective disorders and anxiety (18–80%), personalities disorder (20–70%), suicidal tendencies, suicide, and self-harm. Consequently, gender dysphoria is a delicate diagnosis that needs extreme caution from development, once in children the gender incongruence fluctuates over time. Children that manifest gender dysphoria might feel comfortable 85% of the time with their gender after adolescence [54].

The Bell versus Tavistock case is a portrait of the crisis that psychoanalysis has been facing in relation to gender identity. Whereas a group is favoring a gender transition for subjects afflicted with the pathology, including the early interventions, another group became critical, as they understood and valued the search for a bigger understanding about symbolic processes from these subjects and how this suffering might indicate that there are other questions about Ego formation.

According to Sakteopoulou [55], the maintenance of children in a non-identity body creates a “massive gender trauma,” which implies an emergence of a trauma from the gender dysphoric experience. What calls the attention is that according to this author “some psychic conflicts cannot be resolved within the psychic realm, requiring action” [55], escaping from the analyst’s place, that is in search for the subject psychic realm understanding, which implies, many times, in welcoming the anxiety lived in the analytical field.

Osserman and Wallerstein [50] assert that we are witnessing the growth of psychoanalytic literature that validates the access of teenagers and children to medical intervention, medication, and body mutilation, related to gender identity. This is an alert to the anxieties that emerge from analysts to countertransferential reactions.

Therefore, while on one side a group is gender affirmative and believes that the suffering by feeling in a body that is not their own is severe and so needs an early intervention, on the other side a group is gender critical and believes that the early intervention does not give time to explore another aspect that surrounds the identity formation of a child.

The defense of a neutral identity, in which the subject chooses what one’s intend to be, for instance, it is offered to a child the “choose” of how one’s want to be bodily recognized in the world, in a developmental moment that depends on environmental feedback to that end, in order to avoid the suffering that the reality principle brings also may affect the developmental process. According to Winnicott [56], a child is not born alone; therefore, it is a parent and caregiver’s role to protect them, including in face of situations that require mature decisions about the child’s life.

Afterward, it can be said that in order to avoid children’s future suffering, these interventions could stop the development of the identity against inevitable traumas from life, that is, boundaries.

5. The place for the analyst

“In choosing theater as a metaphor, psychic reality was perhaps following in the footsteps of Anna O., who, at the turn of the century, evoked her “free associations”, on the occasion of her treatment with Breuer, as her “private theater”. For the analyst, it is a theater that his patients want to share with him and which he is invited to play in various roles. But, unlike Breuer, who was frightened by the role Anna O. made him play, the analyst tries to observe his own inner theater well and interpret it as best he can before playing his patient’s.” [57]

The term created by those analysts, who want to validate the social speech instead of analytical work, is mistaken by definition when the gender affirmative is the confirmation of gender; however, it is not possible to confirm what is neutral, out of binary, or yet, out of innate human bissexuality defined by Freud in the perverse polymorph sexuality [2]. And put those searching for a work inside the psychoanalytic approach in a delicate position of gender critical, as if thinking about gender was something critical, and maybe it is, critical in a sense, referring to a crisis. It is critical to think about the denying of the body in favor of a psychotic society, that is, the one that has seen the difference of others as an enemy, a persecutor that must be eliminated.

Therefore, the present authors disagree with that term created for those psychoanalysts who value the analytical work, “where there was id, that have an Ego,” that is, the reality principle prevails over the pleasure principle [31].

The “trans” children in this sense do not transit between natural genders, as they are supposed to do in childhood [31]. Given that according to gender affirmative they must decide prematurely what is their object choice and who will identify concretely with one’s body [55].

The analyst’s work is trying to be a continent, decoding one’s feelings, giving them meaning and names to their emotional experience [58]. Consequently, the analyst work is not work with the concreteness thought [26].

The symbolic formation begins very early, primarily comes the symbolic equation (in paranoid-schizoid position); however, it changes its character and function by the maturation of Ego and objects relation and consequently, Ego integration. The problem of symbolic formation must be always examined in the context of Ego relation with its objects, the analytical work is done by analyst and patient relation [59].

The symbol represents the absence, it can be the presence in the absence too, as long as the Ego develops and integrates, three changes in relation with the object affect the sense of Ego reality: a major consciousness of the ambivalence, the diminish of intensity by the projection, and the increased differentiation between self and the object. By these three processes, the subject might bear the object separation, due to introjection, there is a rise sense of reality, both internal and external. The internal world became different from the external world [20, 23, 60].

In the analytical work, the impotent thought gradually gives place to a more realistic thought. Simultaneously, there is a certain driving primary object modification. The Ego starts worrying to save the object from its own aggression and possess, which implies a certain measure of direct driving object inhibition, both aggressive and libidinal [22].

This situation is a powerful stimulus to a symbol creation, and these acquire a new function that alters its character. The symbol is necessary to move the object originally aggressive and diminish the fault and fear of loss. The symbol here is not an equivalent of the original object, it is only a partial object—once the displacement object is to save it—and the guilt lived in relation to it is lower than those coming from the original object. The symbols are also created by the internal world as a mean to restore, re-create, re-capture, and possess again the original object. Thus, the sexual organ that is presented in the external reality of subject is not only an organ, but also a symbol, and symbolic, full of unconscious phantasies [35, 36, 37, 38, 39].

Consequently, the capability of living a loss and the desire to re-create the object inside of self gives freedom to the individual unconscious in the symbol’s use. And how a symbol is recognized as a subjective creation, differently from the symbolic equation, it might be freely used by its creator. In this sense, the analytical work would come through the expansion of object symbolic sense, allowing the body appropriation [34].

In the symbolic equation, the symbol-substitute is felt as being the original object. The substitutes of their own properties are not recognized or admitted. It is used to deny an ideal object’s absence or control a persecutory object [35]. In this individual emotional developmental moment, the lack of body integration could be seen as a failure in this maturation symbolic process. There is no metaphorical thought [37].

The proper symbol available to sublimation and Ego development enablers is felt as representing the object. Its own characteristics are recognized, respected, and used.

The symbolic formation emerges when the depressive feelings prevail over the paranoid schizoid, when the object separation, the ambivalence, the guilt, and the loss can be lived and tolerated [23]. The symbols are not used to deny the loss, but to overcome it.

The contemporary Ego presents a symbolic emptiness, as there is a concreteness solving the self-issues and being in the world. However, the analyst place is the same since the creation of psychoanalysis, that is, to help the patient to name own anguish, accept own limits in face of external reality without emptying oneself of what possess of good to allow a space to think emotionally and create possibility of change.

Hence, the crisis that is seen today in psychoanalysis is when the “analyst” tries to occupy a place that is not own, but of a socialist, anthropologist, or even a physician, with fast solution and with high acceptance.

6. Conclusion

To conclude, the psychoanalytic crisis brings a reflection on the role of the analyst in a contemporary world, which can lose in some moments the historical dimension of the knowledge by theory in the function of a social narrative acceptance and a globalized politics to not live the anxieties in the countertransference relation, which leads to an acting-out position of the analyst in the analytic setting and outside it.

From that, there are two groups, those who want to take action represented by this analytical approach and those who demand reflection, searching for analytical work to help the patient to cope with the psychic burden.

Nowadays, the analyst’s anxieties about being part of social media might interfere in the investigative and inquisitive work, in order to attend to social demands. It can be argued that the analyst’s narcissism in a world where we are connected and judged all the time, the view is focused on the outside, in trying to reach the ideal Ego. There is no way to please everybody, and this means tolerating the narcissistic wound without the fantasy that one will fall in the anguish of annihilation.

It is necessary to be attentive to the fact that the fear of prejudice does not obscure the psychic suffering that is behind the corporal issues. Consequently, this work has not the intent to question the existence of a diagnosis or a pathology, but rather to reflect on the analyst place and counterbalance the procedures that are being imposed as parameters and are referenced as “gold standard” with protocols that many times withdraw the subjective identity in favor of a rule of how this individuality must act in the world. Therefore, we think that analysts have a role in questioning the medicalization of identity, in order to assist the subject in its broad spectrum, to be precise, in its full identity.

Acknowledgments

We thank Aloysio Kouzak Campos da Paz, Erasmo Jardim, and Jacquelline Reimann for the support in the English language revision.

Conflicts of interest

The authors declare no conflict of interest.