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Avgi Saketopoulou provides a stunning integration of theory, empirical studies, and clinical work. She continues the process by which a broadening view of transsexual people both enriches our understanding of gender and helps us assist them with the challenges they commonly face. It is fitting that the paper won the Roughton Award, not only because of its excellence, but because, like the existence of that award itself, the paper marks a sea change in psychoanalytic outlook and practice from a time when analysts acted as part of the oppressive dominant community by pathologizing sexual and gender variation to a time when analysts have largely recognized that these variations represent life ways deserving of respect and support, while at the same time maintaining a commitment to an understanding of their multiple significance for people.
In late-nineteenth-century Europe and the United States, the possibility of separating sexual activity from reproduction, combined with the relaxation of antisexual moral attitudes and the recognition that sexual frustration contributes significantly to psychological distress, converged to create an intellectual and medical environment that invited exploration of the complexities of gender and sex. In the latter part of the nineteenth century Kraft-Ebing (1886) conceptualized the variations he found as forms of pathology, thereby moving discourse about sexuality away from morality and law and toward medicine. He began a catalog of the range of human sexuality and gender. Sigmund Freud and Havelock Ellis continued this exploration, noting that the variation in manifest behavior that was considered immoral or pathological in fact reflects processes that