Elsa B (1888? - ?) government clerk, Gutheil patient

Emil Gutheil (1889-1959) was born in Czerlany close to Lviv, which was originally in Poland, but then part of Austria-Hungary and now is in the Ukraine. He was educated at the University of Vienna. He became a neuro-psychiatrist at the university Psychiatric Clinic, and was mentored by psycho-analyst Wilhelm Stekel (1868-1940), who is credited with coining the term ‘paraphilia”.

In the early 1920s a trans man then 34-years old, whom Gutheil refers to only as ‘Elsa B’ came to Gutheil. He states: 

“Case 70. Introductory remarks: This patient agreed to an analysis under one condition: that under no circumstances should we destroy her particular sexual strivings. She was only desirous of enlisting our aid in gaining permission from the police to wear men’s clothing.”

B was a government clerk and also played the violin. Despite being there only to get support in obtaining a Transvestitenschein, a legal permit to ‘cross-dress’, he did attend 33 sessions with Gutheil, during which the psycho-analyst continued to refer to him as ‘she’ and as a ‘woman’. B’s father had died when the child was two, and B had been rejected by his mother, who had wanted a boy, and raised by his grandparents. His mother's second husband repeatedly told B that he was ugly. B had dressed as male since teenage, and urinated standing up. His hair was short in a male style. Religious scruples inhibited him from having sex with women (what others would regard as ‘homosexuality') and personal taste from having sex with men. He found wearing men’s clothing to be erotically arousing, even to the point of orgasm. When wearing male attire “a great oppression leaves me and instead of feelings of inferiority, I feel free and easy”. B saw himself as the father of a family. 

With the outbreak of war in 1914, B was suspected of being a Serbian spy and severely beaten on the street. That was the first time that he begged the police for a Transvestitenschein so that he could legally wear male clothing. He was held for six days, at first examined by a police surgeon, and then by a psychiatrist. But he was not given a Transvestitenschein.

Gutheil’s paper on B was included as Chapter XVI of Stekel’s book on fetishism. The two psycho-analysts criticised Hirschfeld for overlooking latent homosexuality as an important factor in transvestism, although as Bullough points out they take every denial of homosexuality as an admission. This despite Gutheil’s final twist that 

"the transvestitism is an anchorage of the patient’s heterosexuality, the difference being that instead of the forbidden incestuous object she has fixed upon a symbol : the clothing. … the chief cause of the flight being an active castration complex expressed in a manifestly sadistic phantasy”.

Stekel’s book title was (in translation) Sexual Aberrations: The Phenomena of Fetishism in Relation to Sex, and his idea was to systematize the structure of all paraphilias as a single entity under the model of fetishism. He was in reaction to Magnus Hirschfeld’s biologically oriented model of sexual intermediaries. However B’s transgender orientation does not fit the model.

They conclude: 

“Despite its striking inner resemblance with fetishism, we cannot consider transvestitism as a form of genuine fetishism. It is a special form of a compulsion neurosis in which the patient’s desire for the genital of the other sex is displaced to the clothing.

The transvestite satisfies himself with the appearance of belonging to the opposite sex; he makes use of the clothing in order to possess some rudiment of reality in the fictitious transformation which he has accomplished. Whereas the fetishist reconstructs an infantile scene and becomes a child again in order to experience something definite, the transvestite projects his wish into the future and anticipates the great miracle, the miracle of his sexual metamorphosis.

Fetishism is thus retrospective and transvestitism prospective in purpose.”

We are not told if B was granted his Transvestitenschein.

Havelock Ellis, in the 1928 edition of his Eonism, included a four page summary of Gutheil’s chapter. He regarded B as “female Eonist”.

In 1937, Los Angeles psycho-analyst Ralph Greenson was in Vienna to be analysed by Wilhelm Stekel. However 12 March 1938 saw the Anschluß Österreichs, the Nazi takeover of Austria. Stekel and his wife immediately fled via Switzerland to England where he killed himself in June 1940 for medical reasons. Greenson returned to Los Angeles. Gutheil had emigrated to the US in 1937 where he founded the Association for the Advancement of Psychotherapy and the American Journal of Psychotherapy.

We do not know what happened to B in the Third Reich.

• Emil Gutheil. “XVI. Analyse eines Falles von Transvestitismus,” in Wilhelm Stekel. Der Fetischismus, vol. 7, Störungen des Trieb- und Affektlebens. Urban & Schwarzenberg, 1923: 534-570. Translated by S Parker: “Analysis of a Case of Transvestism” inSexual Aberrations: The Phenomena of Fetishism in Relation to Sex. John Lane The Bodley Head Ltd, 1930: 281-318.
• Havelock Ellis. “Eonism” In Eonism and Other Supplementary Studies, Random House, 1928: 17-23.
• Vern L. Bullough & Bonnie Bullough. Cross Dressing, Sex, and Gender. University of Pennsylvania Press 1993: 214-6.
• Clare L Taylor. Women, Writing, and Fetishism 1890-1950: Female Cross-Gendering.Clarendon Press, 2003: 90-3.
• Patricia Gherovici. Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference. Routledge, 2017: 48-54.
• Katie Sutton. Sex between Body and Mind: Psychoanalysis and Sexology in the German-speaking World, 1890s–1930s.University of Michigan Press, 2019: 186-7, -191.

Despite the cisplaining, the misogyny of Stekel and Gutheil, it is a shame that this case is not better known. The real-life persons behind Sigmund Freud’s case studies have been identified and we know what happened to them afterwards. With B we do not know.

It is heartening that B does not want to be ‘cured’. He is and wants to be a man, but male hormones will not be available until the late 1930s.

He is also quite open about finding male attire to be erotic. It is a misfortune of sexology and psycho-analysis that it came to be dogma that a) women are not fetishistic, b) cross-dressing by women was pragmatic, not transvestic - that they did so to get a better job and/or to marry a woman, not as an end in itself. This of course did erase many female assigned persons from discourse and from history, but not from reality.

As it happened, we had to wait for Louis Sullivan in the 1980s and Pat Califia in the 1990s to explain that, for some trans men, male clothing is erotic.