Changing Sexualities and Parental Functions in the Twenty-First Century, edited by Cândida Sé Holovko and Frances Thomson-Salo, undertakes to introduce North American analysts to the work of a diverse group of Latin American thinkers and clinicians, all working in the interrelated arenas of gender, sexuality, and parenthood. From the patriarchal family of Freud’s time to the post-modern arrangements we find today—blended families, single-parent families, single-sex couples, families that rely on assisted technology for pregnancy and childbirth—our notions of who is and what comprises a family have changed dramatically, while our theory has not necessarily kept up. Covering a wide range of concepts, including the oedipal complex, parental function, and male and female psychosexuality, the book aims to contribute to an international dialogue among analysts working with a range of clinical issues relating to gender, sexuality, childbirth and childrearing, and to changed and changing family configurations.

The book is divided into three sections. The first revisits psychoanalytic theory in the context of changes in current thinking within the discipline, as well as societal changes that call for reexamination of established concepts relating to sexuality and gender; paternal and maternal functions within a more traditional mother-father-child configurations are explored from a variety of new angles, as are changing family dynamics and the intergenerational transmission of trauma. The second section explores a range of more contemporary family configurations, with a focus on the effects of assisted fertilization technology and same-sex parenting on unconscious notions of maternity, paternity, parenthood, and gender identification. The third section, on sexual diversity, comprises essays on intersexuality, asexuality, gender dysphoria, and parental functions in same-sex parenting couples. Each section contains both theoretical material and clinical discussion, as well as at least one essay on the importance of attending to the social and cultural contexts in which patients and analysts struggle to carry out their changing psychic and emotional tasks. Each essay is rewarding in its own right, and read together the essays constitute a very strong overview of the challenges to and evolution of theory and clinical work being carried out in Latin American over the last several decades. As the editors note, the uncertainty created by changing notions of family and sexuality has led to great controversy in the field of psychoanalysis; but these essays demonstrate the fluidity, creativity, and intensity with which Latin American analysts have met the challenges resulting from new family, gender, and sexual identifications as they present themselves in the consulting room and beyond.

None of the clinicians whose work is represented here is widely known in the U.S., and exposure to different ways of practicing and thinking about psychoanalysis is not just the rationale for the book but one of the things that recommends it most strongly to an American reader. The knowledge base for much of the writing is more heavily French-inflected than is common here (Lacan, Derrida, Kristeva, and Irigaray), with a stronger emphasis on symbolic unconscious identification and communication than in some contemporary interpersonal and relational theory. The resulting abstract language can occasionally make for slow going, but the book is grounded in the clinical work of its authors, who work with clients not only in private offices but also in community-based clinics and institutions, where psychoanalytic approaches to the psychological and behavioral problems caused by transgenerational social trauma, loss, violence and drugs are almost non-existent in the United States. Especially in the areas of gender and sexuality, where much has been written in recent years, the new ideas and approaches described may lead to a strengthening and refinement of both theory and clinical practice. In the U.S., for example, much of the psychoanalytic writing relating to gender dysphoria takes as an implicit starting point the imperative to validate patients’ desires to inhabit the bodies they want, an approach which can lead to a too-concrete focus and consequent neglect of children’s identifications, parents’ identifications, fantasies of both parents and children, and the role played by parents’ mechanisms of disavowal of their own early and transgenerational history. Encountering a more symbolic exploration of identification with parents’ gender and sexuality, as presented here in a strong series of chapters devoted to intersexuality, “neuter” gender, and countertransference with gender identity disordered patients, reminds us that much can be lost in a purely pragmatic approach.

Changing Sexualities is also a tribute to a psychoanalytic thinker who was also unknown to me: Mariam Alizade, a physician, psychoanalyst, and head of the Committee on Woman and Psychoanalysis of the IPA, who died in 2013. Alizade’s work focused on three areas: femininity, death, and positivity; her 2010 text, “The liberation of parentality in the twenty-first century,” is presented in full at the end of the book, and to a large degree provides the starting point for many of the essays presented here. Alizade writes that “expressions of desire to generate a family organization outside the social and cultural framework established centuries ago constitute a liberation movement” (p. 204), and proposes a “liberation of parentality and for these phenomena to be included in new ways of parentality” (p. xxx) that take into account changing power relations between men and women, and new configurations of sexuality and family formation. Her core concepts, presented in an essay by Graciela Cardó Soria (“women-only space,” “intrapsychic maternalization,” non-maternal psychic space,” “giving oneself a body,” “stone core”) are original and stimulating; her reflections on narcissism and death, for example, while beyond the direct scope of the book, connect subjectivity and parenthood to immortality through the idea of “tertiary narcissism,” an ideal of mature parenting and a mature concept of death that lead to pleasure in the idea of generativity of love and joy in a child that exists in a future beyond the self. She writes that the “capacity for love, sacrifice, and responsibility” (p. 205) are what enable someone to fulfill the “parental function,” not gender or sexual orientation, and challenges analysts to attend to the effects of changing family structures on the psychic development of children.

In the clinical realm, Alizade introduced the concept of “positivity”—in contrast to the more conventional psychoanalytic focus on “seriousness and suffering”—focusing on reframing trauma through the exploration of “joy-related affects” in order to detoxify the psyche from “displeasure” (p. 220). Alizade’s writing is profound, joyful and soothing; her notion of a “psychic that’s it,” for example—related to Klein’s notion of an internalized good object—proposes that there are people “who are balanced and have a capacity for sound judgment and who are able to find balance, peace, and sanity” (p. 222) based on childhood experiences of the good mother’s body. While the book concludes with a somewhat essentialist falling-back on the notion of the mother, the essays in the book more readily lend themselves to the idea of a “good parent’s body,” regardless of gender identification.

While there is so much to be commended, there are a few minor flaws that make reading Changing Sexualities a bit slow, given the salience and timeliness of the topics. The translation is awkward in places, and the clinical material at times lacks vitality; many of the case studies are flat, short on detail, and somewhat schematic, and do not provide the rich narrative illustration of the theory that would have brought it to life. More importantly, even with the book’s explicit focus on progressive ideas relating to changed and changing gender and sexual identifications and family constructs, the tone is occasionally jarring, and there are a few almost-pejorative-sounding references to same-sex couples (“these couples”) and “transsexuality.” In one essay, the authors point out that “homosexuality does not involve pedophilia“ (p. 119), and though they themselves do not subscribe to such a view, it is nevertheless surprising to see that it must still be invoked, even if only to be dismissed. (The same essay explores potential “perversion” of children at the hands of parents in cases of gender dysphoria; while the authors do not imply a direct correlation, and the argument they make is important, the consideration of “same sex parenting” and “perversion” in the same essay nevertheless leads to some uneasiness.) The tension between avant-garde thinking and retrograde language may simply be a result of the fact that, as the essays demonstrate, psychoanalysis—and psychoanalysts—are still grappling with the psychic and social implications of changing family structures; but the language we use influences our theories and contributes to the construction of our own and our patients’ reality.

Despite these drawbacks, Changing Sexualities is a challenging and worthwhile read for the American psychoanalyst interested in issues of gender, sexualities, and families, and the ways in which old theories are being given new life as they are applied by compassionate and socially conscious analysts in clinics and in private practices around the world. The shift in family configurations has led these authors to rethink psychoanalytic paradigms, parental functions, and identifications in ways that are compelling and thought-provoking. As Mariam Alizade writes, “The child is a symbolic character that influences all life, whether s/he materializes in parenthood, remains as a postponed project, is rejected, or is never realized,” and families are created by “people who wish to build a nest of primary links beyond their gender identities and object choices” (p. 204), and investigating the “social, cultural, historical and political factors in psychic organization” (p. 207), as the authors in this collection do, can only enable the growth of healthier psyches in both parents and children.