1Author’s note: Subsequent to the writing of this article I discovered the book by H. Fofana: “Mariama, l’écorchée vive”, which tells, amongst other things, of her excision at the age of five. These are two different stories; however, they do present some similarities, hence my choice of keeping this borrowed name for my patient.

2We know that sexual identity is the fruit of a psychological construct that begins early in a child’s life. A construct whose preambles have often been written even before the child’s birth. This is an observation that brings P. Benghozi (2014) to underline the link sexual identity has with filiation and affiliation. We all situate ourselves in our linage, according to our sexual identity; through a twofold recognition by oneself and by others. The construction of sexual identity is based on the gaze, speech, and the behaviour of those around us; through what these say, consciously and unconsciously, about the parental investment. P. Aulagnier (1975), for example, points out to what extent the anatomical sex of the child encourages the parents’ projections; occasionally also indicating a first separation with their desire. What then, becomes the destiny of that separation? Will it be processed, allowing for the actual child to be welcomed? Or will it be filled by the unconscious demand made on the child to embody the other sex?

3With these elements the child will establish his/her sexed identity, in response to the conscious and unconscious psychological reactions of those around him/her; discovering very early on the differences between masculine and feminine, well before being able to integrate the differences of the sexes. In the best-case scenario, he/she will be able to play with different identification, masculine and feminine, under the gaze of parents tolerant of this expression of a psychic bisexuality. At the heart of this process lies the positive and negative Oedipal dynamic, and the interdict on incest. These are all things that will enable the child – in this case, the girl – to renounce having her mother for sexual object, so as to become like her. In this way, the girl will be able to project herself into a future where she in turn will become a woman, the lover of a man other than her father, and, perhaps, a mother.

4Thus, all through childhood a process of identification will unfold, reinforcing the certainty of being a girl, or a boy, which generally becomes fixed around three years of age. This certainty may sometimes be questioned again in adolescence, through the prism of the choice of object; and all the more so if the adolescent discovers themselves to be homosexual. [1]

5If the construction of a sexual identity cannot be understood without considering the unconscious reactions of the subject, and his/her place within a transgenerational history, it is also fundamental to question the role played by the social group, and the culture within which he/she is born and grows up. [2] In this way, some cultures will mark the body of the child, seeking to inscribe through rituals a difference between the sexes, a difference that is perceived as awaiting confirmation. This, for example, is one of the functions attributed to excision, and circumcision, in Sub-Saharan Africa. Excision is thus intended to remove from the female body any element that is evidence, so it is thought, of the other sex: the clitoris and, depending on the ethnic groups, the labia minora, sometimes also the labia majora.

6However, as patients’ accounts demonstrate, a ritual of this kind, due to the mutilation that characterises it, does not always produce the effects hoped for. This is the case with the young women who – discovering when they reach adolescence that they were excised as babies – choose to position themselves in the category of male (Andro et al., 2010). This highlights the traumatic dimension of excision; and the failure of the ritual, when it consists in a mutilation, to take on a symbolic form (Brousselle, 2014). Indeed, both what patients say, and written accounts, refute any evidence that makes these rites a potentially maturational stage in the development of these young girls (Couchard, 2003; Micco, 2003). All too often, research in this field is based solely on the conscious discourse of adult women who, to survive this mutilation, have internalised its cultural justification (Guittonneau-Bertholet, 2016). A situation that leads them to subsequently repeat the same rites on their daughters.

7Seen in these terms, sexual identity appears as a combination, in each case singular, between the psyche, the body, and culture; a situation that can on occasion give some surprising configurations. Thus, it was only possible to approach Mariama’s phantasies surrounding her sexual identity by making the link with her interpretation of the partial excision undergone in infancy. An interpretation which, we hypothesise, came to resonate with the phantasies of her parents: to bring to life in her, through her, a son who died before her.

8Through this personal story, we will also explore the temporal psychical stages that accompany the analytical work in cases of trauma. Cases where are woven the threads of trauma, and those of infantile neurosis; something that can offer the subject new possibilities for processing this psychic material. Indeed, we chose Mariama for this reflection as much for the richness of the work undertaken with her, as for the complexity of the trauma that we uncovered; trauma that combined all the aspects that make up a human: reality, fantasy, the body, family and culture.

1 – Mariama, an Uncertain Sexed Identity: Girl, Boy, or Mutilated?

9Mariama, eighteen years old, comes from a Soninke family – a patrilineal ethnic group from West Africa – and has grown up in France. It was her general practitioner who referred her to me: he felt that she was depressed, withdrawn into some complex questioning.

10In the first instance this questioning evolves around her feminine being: what is, “being a woman”? Indeed, Mariama expresses her difficulties with conforming to the model imposed by her mother: “a woman should be without desire or pleasure”, a woman must be submissive to her husband, after having been submissive to her parents. Mariama however, rejects that model: she cannot recognise herself in it, she expresses her wish to be independent, to study, to live her sexuality freely: “I want to choose my life, choose whether or not to have children”.

11A conflict then begins to take shape, between two differing models: being a woman like her mother, an African woman; or being a French woman, like her friends, and like her analyst, since inevitably this conflict invites itself without delay into the transference. However, this model of French womanhood inexorably leads her towards behaviours that are judged transgressive by her community, since, according to its codes, they belong to the masculine. Thus, growing out of this initial questioning, another area of reflection becomes apparent, pertaining to her sexual identity: “who am I? Am I a man, or am I a woman? I think this is a question that has been haunting me for a long time”. Mariama had, up until now, not been able to directly confront this line of thinking, and she only does so once the framework of the analysis had been firmly established.

12In this way, the irreconcilable positions of being both girl and boy, that she has been attempting to occupy in response to the conscious and unconscious expectations of her parents, appear. Indeed, on the one hand the conscious maternal discourse recognises her as a girl, even issues codes of conduct that will enable her to become a “respectable” woman. Running in parallel though, the maternal discourse around the feminine is so disparaging – associated with “dirtiness”, with “vice”, and with the undervalued – that it seems to rekindle the childhood fantasy of castration, the purpose of which is to explain the difference of the sexes. [3] For example, the requirement that she wear a headscarf, something Mariama refuses, exposes her to comments such as this one “Your uncle [step-father] and I feel like spitting on you when we see you. You disgust us”. In this way a negative representation of femininity, with which Mariama finds herself in part identified, is forged. [4] This representation is all the more destructive for being combined with the fact that Mariama has always heard her mother bring into question her very existence. Indeed, has not the mother often repeated to Mariama that she and her husband would a thousand times have preferred that it had been she, the daughter, who had died; rather than the darling son who died aged five, a few months before Mariama’s birth?

13If the manifest discourse of this mother expresses the impossibility of mourning for a dead child, we can also hear the unconscious injunction made to Mariama to bring back to life the son that had died, to incarnate that son, to be him: “When I was a little girl, I thought that my mind was in the body of my brother, and that my body would disappear”. It is in effect this unconscious injunction that Mariama is trying to obey, she who, up until puberty, seems to have been considered like a son by her father: “I was my father’s son”. In this way, all the father’s behaviour appeared to vouch for the position of boy, given to Mariama: the closeness he had with her, the manner in which very early on he asked her to second him (notably by acting as a translator). [5] This position brought to Mariama an obvious narcissistic gain, notably by allowing her to keep a distance between herself and the image of a dirty, impure, uninteresting girl, presented by the mother. The Oedipal investment she was the object of should be overlooked either. On the mother’s part, this unconscious wish was acted upon, it seems to me, when, during the ritual that took place a few days after the birth of her daughter, she decided to not completely excise her. [6] Indeed, was this not a way for her to respect the custom, while unconsciously preserving the masculinity of her child’s body? [7] Consequently, Mariama could incarnate, in the mother’s unconscious desire, the dead son, since in her eyes the excision had not happened. For the mother there had only be a pretence of the ritual, a “pretending”. Does she not say to Mariama: “It didn’t even bleed”? A statement that seems to vouch for her denial of the mutilation inflicted on her daughter.

14However, puberty seems to have come as a denial of this unconscious hope, making it clear that it is a girl who is there. This denial that comes from the body, triggers some very violent words from the mother; most markedly the unrestrained expression of the desire that Mariama should die. “My mother could not accept that I was growing up. At first, she would pull out every pubic hair that she saw appearing, and when my periods started she called me a slut”. As for the father, he now ignored his daughter. Thus, in becoming fully a girl in the eyes of her parents, Mariama finds herself expunged from their desire: she becomes nothing, nothingness. Under these conditions, the announcement a short time later that she was excised as a baby, seems to have been a great shock for Mariama. The fact that she has no memories, no mental images, of what took place on her body, is intolerable for her; and only increased the horror she feels. Indeed, this announcement, preceded by the appearance of her first menstruation, for which she had been given no verbal preparation, is experienced by Mariama as an “identification of anxiety”, an “identification with formlessness”. A circumstance which S. Le Poulichet has demonstrated “ascribes to the body a core of disintegration or of decomposition” (Le Poulichet, 2003, p. 30) [translated for this publication], thus plunging the subject into a state of terror. This does appear to be what Mariama experiences: not only has she had to recognise herself as a girl, that is to say as “nothing”, but she also discovers that she is mutilated. At that point she is no longer “Mariama” girl or boy, but a heap of bleeding flesh, “I am a corpse, a mutilated body, without gender, a dead body”. Suddenly, she is nothing but that peace of flesh, ripped away, mutilated; that blood, that every month, trickles from her genitals. Indeed, from that moment on the menstrual blood, unconsciously appeared to her like the blood of the excision. Later, the desire to be pregnant came as the expression of a wish for the blood-flow to cease, “to be pregnant is first and foremost no longer to menstruate”.

15From this, we can suppose that these identifications of anxiety reawaken her pain, and her terror, experienced as a new-born. This in turn solicits to the pictographic representations that had been sketched out, leaving her now with the same previously experienced feeling of Hilflosigkeit (Freud, 1926a), and with no means of psychologically processing her physically and mental experience. Many connections seem to then form between her feelings regarding the excision – at the moment when it took place and when she was made aware of it – and other desubjectifying infantile situations.

16Thus, we might conclude that the absence of any images of what was for her a primal scene, throws her back to a physical and psychological feeling of annihilation, of the disappearance of her self, of failings in the gaze of the Other, as well as an inability to recognise herself as subject. Indeed, in the mirror of the maternal (and paternal) gaze, she had only every seen a shadow, the ghost of her dead brother. However, as M. K. Yi (2012) points out, the traumatic dimension in such situations is not so much the presence of a ghost – all of us being to a greater or lesser extent accompanied by a few shadows – but the being assigned to a place from which one cannot escape. A place where all interplay between presence and absence is impossible. Thus, it can happen that the presence of the subject is constantly solicited, allowing him no failings; and it is this that most often prevents the process of subjectivation. To this we must add situations where, on the contrary, the subject disappears, is made absent by a gaze that sees through him, ultimately leaving him to see only the shadow behind him (Le Poulichet, 2012). This is what has happened in Mariama’s case, since the shadow of her dead brother has, apparently, covered over, erased, her own reflection. Consequently, there has never been any image of her, in which she can recognise in herself a sufficient singularity, and thus take shape. Now, such situations are, according to S. Le Poulichet (2003) particularly favourable to the formation of “fears of formlessness”:

17

The fear of formlessness, and the identification of anxiety, that motivate the creation of infantile theories of formlessness, develop more specifically when the face has remained uncovered; in the anguish of being basically gazed at from nowhere and by no-one, this face having not been given sufficient form, or endowed with the sign of recognition by the primordial Other.”

18If the announcement of her excision is truly traumatic, because of the manner in which it brings Mariama back to the attribution of identity, another just as traumatic moment follows shortly after: the discovery of a body that feels pleasure, which brings about a further crisis of identity. Faced with this mutilation of which she has no conscious remembrance, Mariama seeks to find traces of it on her body, a body that has become unknown to her. However, the exploration of her genitals confronts her with an unexpected, extraordinary, discovery: contrary to what her mother had told her, her genitals are still the focal point of pleasurable sensations, where “something” remains, the bud of a clitoris, mutilated but still sensitive. Owing to the sudden convergence between fantasy and reality, this discovery seems to have awakened in her a sense of the uncanny (Freud, 1919). For, if there are sensations of pleasure, coming from that “something that remains”, it is, according to her, that the excision did not take place, and therefore, she is a boy. Thus, she finds herself confirmed in the position that she had always held, that of incarnating the dead son. It would seem that this interpretation then causes a twofold dis-identification: on the one hand it allows her to think that she had escaped the castration, previously invoked to explain the differences between the sexes; on the other hand, the resurgence of this fantasy could also constitute a distancing from identifications with the anguish of formlessness. [8] In her fantasy, to be a boy becomes a mode of being, of ceasing to be “nothing” or the formlessness of mutilated flesh. However, this revelation – that she is a boy – seems to be immediately supressed, for consciously she knows well that she is a girl; all the more so since the arrival of her periods, every month, are there to remind her of this. However, a body/genitalia that give pleasure are not compatible with her identity as a woman, since this is prohibited by her mother. Something she had not failed to internalise, unconsciously reviving this conflict within herself.

19Suppression then gives way to a symptomatic behaviour that she keeps secret for a long time: scratching the area of the clitoris until a wound is formed. It becomes clear in our sessions that this polysemic behaviour seeks, more specifically, to complete the excision that had remained unfinished; with the aim of submitting to the maternal injunction of “being a respectable African woman”, and in order to do that, replace pleasure with pain. However, with this behaviour, that was repeated over many years, Mariama is also trying to create a visual image of the event for which she had no conscious memories. This compulsive gesture of scratching can therefore be seen as an attempt at primary symbolisation, something that has been defined by Roussillon (2003) as the transformation of the perceptual experience into something mental, a prerequisite for subsequently putting it into words. Various research (McDougall, 1989; Dejours, 1989; Dumet, 2014) demonstrates how often attempts at primary symbolisation are realised in and by the body. However, without the presence of an other who acknowledges these expressions coming from the body, they are often doomed to repetition. This is the case for Mariama, since the blood that appeared, the wound that she feels under her fingers, has only reinforced her identification with the formlessness of a mound of bloodied flesh. In this we can imagine that the uncanny felt by Mariama when she discovers her pleasure-giving-genitals also belongs to a wavering of identity; and is not only restricted to the re-emergence of the fantasy via which she revives the idea of castration.

20In this story, we can see that the trauma comprises aspects of gender, of sexuality, but also the more archaic aspect of formlessness. Something that is even more singular is its temporal construction. Indeed, if we can identify the two moments of trauma described by Freud in A Project for a Scientific Psychology (Freud, 1895a), with the announcement of the excision as the aftermath, the process does not appear to end there. A third moment seems to have intervened, marked by the interruption of the sexual when Mariama discovers genital pleasure, thus reviving infantile sexuality. In this third moment we witness a surge in the sexual, something that is all the more intrusive and surprising as it leads to a crisis of identity. The excessiveness that characterises it, then resonates with the sensorial traces previously left by the excision. At the same time, the first indications of a process of symbolisation begin. This third stage thus resembles a “subsequent effect” [coup d’après], to use the expression of J. André (2010). This term aims to highlight that the aftermath is both a constituent of the trauma, and a possible moment for its elaboration. We could add to this, “on condition that this aftermath allows a link with the sexual”, since as J. André (2010) emphasises:

21

[…] trauma is not always sexual, or not only. Its treatment however, that, is always sexual. If the (infantile) sexuality, its polymorphism, its libidinal plasticity, fails to make its way in, to impose its requirement for transformation, it is the psychic processing itself that is compromised”.

22Sometimes, as is the case with Mariama’s story, the second moment only draws the trauma more tightly around a confrontation/identification with formlessness, with no possibility of an opening. In such cases, it would seem that a third moment is needed so that the link with the sexual can take place. Often, the potential for symbolisation of this third stage will only become apparent at a later date, within a clinical encounter.

23It is in effect the connection made between these different moments, and aspects, that allow Mariama to begin the work of elaboration at the end of which she is able to recognise herself as a woman. A woman with a pleasure giving body, even if it is mutilated. A woman who has the right to share moments of pleasure with her companion, without finding that doubts about her sexual identity immediately spring up. [9]

2 – Trauma and Psychological Time, the Different Moments of the Analysis

24Based on this account, with the different stages of trauma as they were reconstructed within the cure (Freud, 1937), it seems important to consider the different moments of the analytical work undertaken with Mariama. It had, indeed, been necessary to proceed in stages, in successive layers, in order for the unconscious links that she had made to be revealed: the links between her singular place in the family history, and in the parental desires, the rite of excision, her infantile phantasies, and her doubts about her sexual identity. Contrary to the logical progression proposed by Freud (1895), according to which the analysis begins with the more superficial material to reach, layer after layer, the deepest recesses of the psyche, we can see that the analytical work done with Mariama is organised slightly differently.

25Very quickly, it is the mutilation caused by the excision that takes up all the space. It is probable that the acknowledgement of this reality, was essential for putting in motion the psychic process. This is the stage in which she puts all her effort into giving from, into putting into images, in her dreams and in her body, what had happened in the past, and for which she has no representation. Up until then, her attempts at representation had unconsciously taken place in her romantic relationships – systematically marked by violence – where the experience of violation, of pain, and of wrenching apart, is repeated: “under him, I am just a piece of meat”. Thus, the loss of her virginity was experienced by her as a repetition of the excision, mingling once again wrenching apart, pain, and blood. The identification of the repletion taking place allows her to make a connection with some enigmatic dreams, some of which are old; dreams whose function as visual representation suddenly becomes clear to her. Her attempts to grasp these dreams of a scene without images, and to put it into words, demonstrates in the first instance the elusive nature of this scene: everything within it is hazy, undefined menace, frightening feelings of being touched, an enveloping sense of anxiety…: “In this dream, I am a baby, in a foetal position. I am surrounded by shadows that want to devour me”. Then, other images appear in her dreams, re-actualising the mutilation experienced in the past: a body ripped apart, drawn and quartered, searing pain: “I am in a room, I am small, in a foetal position. Strangers arrive. They are pulling me, each in a different direction. I am drawn apart. They are hurting me. They are going to kill me, then they let go of me. I cry out, and I fall.”

26At this point, my task as analyst is to acknowledge and contain Mariama’s horror at having discovered herself to have a mutilated body; which as we have seen throws her back to an image of herself that is intolerable: “bits of flesh”, a “cadaver”. With these words through, even if they conjure up terrifying images, she is nevertheless attempting to process psychologically the ripping apart that she senses within her genital organ. Indeed, how could the pain inherent to the mutilation undergone as a baby make sense? What recourse did she have at her disposal, other than the internal attempt to “eject out of herself”, to rip from her body, this experience of mingled terror and pain? [10] At a stage that is dominated by the primary processes described by P. Aulagnier (1975), we can suppose that pictographic representations of these feelings, which were the only means of rendering them conceivable, had formed themselves. Without having been acknowledged and shared, they had remained unresolved. Under these conditions, to be able to put into words the pictographic representations of rending apart, of tearing, that these feelings had given birth to, was a significant first stage; and this all the more so since these word-images could then be heard in their literal dimension. [11] For it is these pictographic representations that reveal the unconscious means through which Mariama had come to identify with a formless mass. In this way, the opportunity for a place to “be”, and to be heard, allowed the emergence of these word-images from which, little by little, she is able to detach herself. This work of elaboration involved as much the psyche of the analyst, as that of Mariama; it being impossible to hear such words without being stunned oneself, almost psychologically mutilated, in echo with the violence meted out on Mariama’s body. Finally, it is from the starting point of theses word-images, that she is able to envisage the possibility of a body that is at once an object of fantasy, as well as rendered/inscribes, in the symbolic register.

27The theme of the excision then becomes absent from her speech. It reappears more than a year later, following a documentary that she sees on reconstructive surgery. It is in this second stage that her words let escape, here and there, beyond the reality of her mutilation, the questions of the little girl confronted with the difference of the sexes. Words with double meanings appear, suggesting both the mutilation and “penis envy” as described by Freud (1925). “My genitals are very small.” This is a key moment, where the actual mutilation cesses to occupy the psychological centre stage, to make way for fantasy. A fantasy that it is important to acknowledge and accept, just as it had initially been necessary to create a space for the reality of the excision. Here again, this stage is crossed together; for it is not so simple, to give room to fantasy, to interpret it, when there has been real damage done to the body. Thus, it becomes necessary to hear the different registers – traumatic and sexual – that appear in transference. For, as Ferenczi, and more recently F. Davoine, point out, the analyst must accept being the executioner. Thus, I become, in her speech, the maternal figure, somewhere between an ogre and the person who performed the excision, someone who wants to own her, control her, transform her, mutilate her. Likewise, I have to hear the fantasy of seduction that is also present; this reveals homosexual phantasies, against a backdrop of infantile sexual play with her younger sister who have not been excised. In those instances, I represent one of her younger “entire” sisters.

28At the same time as the childhood questions about the differences of the sexes resurface, the Oedipal attachment of Mariama for her father also emerges. The closeness in which her father held her, had at once fixed her in the place of both a beloved boy and daughter. Whilst she had thought to win out and supersede her mother, she had then felt relegated to second place when her father took a second wife, to whom he devoted all his attention. “When my father came back from Africa with his second wife, I began having a nightmare: my father is with the other woman, he embraces her, they laugh together. She mocks me and sends me an enormous snake”. This gesture made by the second wife is perceived by Mariama as announcing the danger that this woman represented for her, as though she was indicating to her that henceforth the father – and his penis – belong to her. From that moment on, Mariama invested her all into her position of son, in an attempt to retain her singular place in the paternal psyche, even if that place is that of a dead son.

29Based on the emergence of this unconscious material, of its recognition within the transference, Mariama is able to speak of the symptomatic action that condenses masturbation and self-mutilation; the polysemic aspect of which, we mentioned earlier. Because the identifications of anguish are recognised and acknowledged, these phantasies of castration (or non-castration) can find their place and make sense for her. In this way, it is possible for the connection between early trauma – the aftermath of which became apparent at puberty – and infantile phantasies to take place. From there Mariama revisits a number of infantile sexual theories; not only those that touch on castration, but also those that turn conception into an oral act, and makes birth the result of expulsion through the anus. This revisiting of past phantasies within transference make it possible for Mariama to then rework these identifications, and the unconscious image she has of her body.

30Thus, as I have tried to demonstrate, the analytical work done with Mariama first leads us through the formless areas of the psyche, before reaching the embankment of infantile neurosis. For the connections with her infantile phantasies to become possible, so that Mariama can start to perceive herself as something other than a piece of mutilated flesh, it is necessary for the grip of the identifications with anguish to loosen. This second stage, that brings back to infantile neurosis, is also essential since, according to P. Aulagnier (1991), it opens onto “the moment of understanding”, that is to say the moment during which the child renounces being the one who will fulfil the mother. A moment that bears its trauma certainly, but a foundational trauma, a necessary passage towards the construction of the subject. The importance become apparent then, of being able, when the time is right, to measure the presence of trauma (early or not) against infantile neurosis; that is, if the latter has been able to take shape. This can only take place in a second phase: indeed, each of these problematics seem to inhabit a distinct area of the psyche, and are kept separate by different mechanisms, splitting for one and repression for the other. In the first instance therefore, it is necessary to hear the traumatic reality, by decoding its presence, sometimes from the crudeness of its language, in the words or the images of dreams. Then this traumatic reality can begin to exist differently, to transform little by little, through the words that alter as much as they reveal it (Guittonneau & Le Poulichet, 2011).

31The necessity to first approach the split areas of the psyche, so as to bring to light early events, before being in a position to access the infantile neuroses, seems to be inherent to situations where there is early trauma. Indeed, as we pointed out in connection with the compulsive scratching, these situations involve a work of primary symbolisation (Roussillon, 2014), a very different problem to that of secondary symbolisation. These primary symbolisations are very much defined by their reliance on the sensorial, they tend most often to represent an early means of relation to the object. However, R. Roussillon (2014) specifies that for these processes to become inscribed, for them to be named pictograms (Aulagnier), formal signifiers (Anzieu), they still need to be “recognised and validated through the relation to a significant object from early childhood” (Roussillon, 2014, p. 155) [translated for this publication].

32Now, as we have seen with Mariama, this recognition, and this validation, are sometimes missing: hence the relevance of the clinical work, to hear them and acknowledge them, so that their transformative purpose can be realised. Then, a new stage of analytical work can take place, one that give a place to the infantile neurosis. Once the contact with infantile sexuality is restored, the grain of sand that is the event, can, to use the image given by S. Vidermann (1977), become a pearl.

Conclusion

33In many stories like that of Mariama, early trauma and infantile neurosis are mingled. In such cases, it is the unconscious connections between them that must be brought to light, so that an internal process of change can take place. In Mariama’s story, it is the question of her sexual identity that appears at the heart of this unconscious link, opening onto the excision suffered as a baby, the position she occupied in the parental investment, and her infantile phantasies. Thus, as this clinical case study demonstrates, it is in the always singular encounter between a subject, a family history, and a cultural web, that feminine (or masculine) identity can take shape. Only by taking into account this complex knotting together, can the psychological solutions that the psyche gives itself to recognise itself as either man or woman, be heard. However, as we witness with Mariama, awareness of the culture, the models it conveys, and the rites that it imposes, can only be fruitful if we do not lose sight of the fact that the subject will appropriate this baggage, interpret it, and modify elements here and there, according to the unconscious challenges that confront it.

34The clinical work sees several stages unfold before the unconscious intricacies of this construct are revealed. Very often it is necessary first to access the archaic regions of the psyche, to then be able to put into words and images the scene of trauma that had left no apparent traces. It is only after this that links can be made to more classic Oedipal material.

35This stage is often full of shared surprises, when the unconscious connections that had formed become apparent. These unconscious connections can create striking images, images that can be strange, but which are always unique.