In “Destruction as the Cause of Coming into Being” (1912), Sabina Spielrein theorized the death drive as the relational drive toward the death of the I, with the possibility of a future rebirth as part of a We. Spielrein’s conceptualizations, when reinterpreted through the lens of contemporary social theory, can provide a theoretical framework for understanding the possibilities of psychic and social transformation available to marginalized subjects and groups. Queer practices of psychic death and rebirth are analyzed in the light of Spielrein’s theory. Psychoanalytic practice with intersectionally disadvantaged trans* and queer patients is discussed, with an emphasis on the struggles with violence, suicidality, and becoming. In addition, Spielrein’s social positioning at the time of writing “Destruction” is analyzed, both in contemporary terms and from within her own cultural and generational context. Implications for socially responsible psychoanalytic practice are considered.