Submission: January 12, 2025; Published: January 20, 2025

*Corresponding author: Alexandre Patricio de Almeida, Postgraduate Program in Clinical Psychology at PUC-SP, São Paulo, Brazil

How to cite this article: Alexandre Patricio de Almeida. Sexuality and Gender in the Thought of D W Winnicott. Psychol Behav Sci Int J. 2025; 22(5): 556097. DOI: 10.19080/PBSIJ.2025.22.556097.

Abstract

This article aims to discuss sexuality and gender in contemporary times, drawing on the theoretical contributions of the British psychoanalyst D. W. Winnicott. His research on spontaneous gestures, the exercise of creativity, and being as an essential condition for action are pivotal here. Thus, we broaden the scope of the research, illustrating that, according to Winnicott, we are the product of the union of the masculine and the feminine, without resorting to stereotypes or binarisms. These elements are embodied in being and doing, key features for our survival and enabling a genuine psychosomatic integration into our existence. Ultimately, we hope this essay contributes to dismantling a reductive view and expanding the understanding of the complex dimension that runs through human essence.

Keywords: Sexuality; Gender; Psychoanalysis; Creativity; Winnicott

Introduction

3. Introduction

Writing about Winnicott, sexuality, and gender is certainly not an easy task. Below, I mention three reasons to justify this statement. The first point to consider is that Winnicott's work is vast and was published in various collections, most of which were organized posthumously from lectures and conferences given throughout his life. The only book written by Winnicott in the traditional commercial format, which somewhat synthesizes his ideas, is Human Nature [1]. This book was edited after his death by his wife, Clare Winnicott, and is therefore considered incomplete.

Given this somewhat disorganized landscape for academic purposes – where we often spend more time searching for references than actually writing – understanding his ideas requires a significant amount of study and dedication. Additionally, many interpretations of Winnicott are reduced to caricatures that repeat terms he coined, such as “good enough mother”, “false self”, and “transitional object”. This approach diminishes the importance of his theoretical and clinical contributions, creating the false impression that Winnicott presents an excessively idealized world or that his work is only relevant in child psychoanalysis. Such simplifications contribute to a stereotypical image of the British author as the “kind grandfather of psychoanalysis”, an extremely superficial and limited view.

Secondly, many people read Winnicott by selecting only parts of his ideas to link with specific topics of interest. It’s as if we were building a structure without the foundation or, conversely, placing the pillars in solid ground but neglecting the finishing touches. The work of a great author should not be commented on or understood in a fragmented way unless these fragments engage with the full breadth of his epistemological reach. Curiously, this happens with one of the themes I will address in this article: sexuality.

It is common to think that by disregarding Freud's metapsychology [2] and the concept of the death instinct, Winnicott also abandons the psychoanalytic theories related to sexuality. However, the opposite is true: that is, through his theory of maturational development, the English psychoanalyst outlined a new understanding of sexuality that is intrinsic to human existence – with all its variations, as Freud pointed out in 1905.

However, when there is no willingness to dive deeply into an author's thinking, many researchers who identify with their ideas tend to produce more of the same, neglecting the many issues that touch upon our contemporary world—such as the debate surrounding gender issues and the dominance of heteronormative thinking that haunts analytical practice (and thought). I agree with Figueiredo [3], who states that it is essential for “the analyst to be engaged with culture and society” (p. 148). To do so, we must consider the social and political dimension of our work – which Freud did very well, it must be said.

Thirdly, I believe it is a great challenge to unfold these themes from a Winnicottian perspective. In addition to finding few references in the field, psychoanalysis, when discussing gender and sexuality, often finds itself, even if unconsciously, trapped by the theses of Freud and Lacan. This occurs both by covering up mistakes they made, especially in sexist and patriarchal assertions, with the excuse that “they were thinkers of their time”, and by using some retrogressive ideas to justify such premises, defending that both were sufficiently subversive to detach psychoanalysis from a moral and ethical framework based on good manners.

And this is not to say they weren’t. I believe, above all, that there must be a reconciliation of ideas; in other words, it is necessary to articulate tradition with the demands of contemporaneity – a movement that can currently be identified in various psychoanalytic fields and in the writing of numerous authors [4-6]. In short, we must read Freud carefully, as he himself was a humble scientist who constantly reinvented himself, adding footnotes to many of his own essays. In his vast work, the Viennese master raises various questions and, consequently, sketches a significant number of responses that are anything but categorical.

Evidently, I agree that Freud subverted many issues in his publication Three Essays on the Theory of Sexuality [7]. However, in the same work, he categorizes homosexuality as an aberration, referring to homosexuals as "inverteds." On the other hand, Lacan, in considering the phallus as a signifier and proposing the notion of the Name-of-the-Father, was also influenced by a moralistic and heteronormative logic, despite his efforts to conceptualize the functions of the mother and father. According to Lacan, the mother must provide care marked by a particular interest, including through her deficiencies, and the father must be responsible for the imposition of castration, “insofar as his name is the vector of an incarnation of the Law of desire” [8]. In these terms, the concepts of “maternal desire” and “paternal metaphor” emerge, which, despite efforts to progressively deconstruct them, remain impregnated by the rhetoric of a culture directly inherited from patriarchy and binary logic.

Therefore, it is not about either ‘cancelling’ Freud or ‘saving’ him. “The psychoanalyst himself faced theoretical impasses, and to avoid creating impasses is to obstruct critique, to render psychoanalysis stagnant [...], a product of the moral demands of its time, rather than on par with epochal symptomatic transformations” [9]. Indeed, it is necessary, then, to produce self-criticism within psychoanalysis, starting from the conditions and contradictions provided by it. After all, as Winnicott himself once said: “[...] it is impossible to be original, except based on tradition” [10].

Nevertheless, it is essential to recognize another significant issue. In psychoanalytic circles discussing gender, sexuality, and psychoanalysis, it is rare to find analysts who master theories beyond the Freudian and Lacanian frameworks. Thus, I believe that if we truly wish to deconstruct in order to reconstruct, we must consider alternatives that allow us to do so without excessively elevating the “father of the primal horde”, which could lead to a kind of doctrinal alienation. It is curious to observe that, recently, there has been a movement of idealization within psychoanalysis, which seems to primarily emphasize male, white, and heterosexual authors – just observe the growing number of Brazilian analysts who identify as Lacanian or Winnicottian, especially.

Despite the strong presence of Kleinianism, a movement inspired by Melanie Klein, in Brazil during the 1970s and early 1980s, there are now few analysts who identify as “Kleinians” [11]. It is remarkable that the name of Melanie Klein, a divorced woman affectionately referred to by Lacan as “the inspired tripe-maker” (la tripière inspirée), who also lacked a university degree, is being gradually and silently erased from the history of Brazilian psychoanalysis [12].

With that in mind, my premise is as follows: if we struggle to read and listen to different perspectives within our own science, we are likely to encounter similar resistance when faced with voices that diverge from our usual melodies. By limiting ourselves to a single author, we create a gap between what is theorized and what is applied in practice. Often, an author’s writings can and should be enriched with other sources, provided these sources are studied deeply and with seriousness. However, in the search for an intellectuality that tends to feed only our egos, we end up distancing the true recipients of our research – such as the LGBTQIA+ community, marked by deep scars of violence and exclusion.

On the other hand, when addressing this subject, we must do so in a clear and engaging manner. It is crucial to bring in practical examples, whether from daily life, clinical practice, suffering, or the various forms of subjectivation. This approach was a hallmark of Winnicott, who advocated: “A writer who delves into human nature needs to meet a simple language and move away from the jargon of the psychologist, even though that jargon may be valuable in contributions to scientific journals” [13].

If our goal is to explore new ways of understanding gender and sexuality, it is crucial to begin by questioning our own formative process. I am referring here not only to the almost religious adherence to Freud and Lacan but also to the way we approach all the authors studied and defended in a partial manner, which leads to the formation of the well-known “-ian” analysts, fervent followers of a single school or thinker. It is therefore essential to broaden our theoretical-clinical perspective and embrace a more diversified and critical approach in our training [12].

Once, I heard a professor, who possessed admirable sensitivity, say: “If we prioritize theory in our clinical practice, the patient will automatically be annulled”. What do I hope to convey with all of this? It is that the goal of this work, although it aims to weave a “télos”, a dialogue between Winnicott’s theory and the issues of sexuality and gender, is in no way to explain why this or that happens – namely, the origin of the ways of being and existing in the world.

Moreover, I aim to cast a wide gaze on the multiple facets of anguish and psychic suffering related to these themes. Perhaps the Winnicottian theory can enter this space to serve as a magnifying glass, both in terms of our understanding of clinical phenomena and in the ways we conduct and manage patients who bring such unique stories, marked by pain, exclusion, and prejudice.

Introduction

4. The Spontaneous Gesture

The central question that has guided psychoanalytic investigation into homosexuality is: how does it originate? And not, how can I help this individual deal with their homosexuality, which is not something that needs to be changed. One might argue that psychoanalysis also asked about the origin of neurosis, but herein lies a trap: neurosis is a difficulty that must be overcome (to the extent possible) in the life of the individual; “neurosis” refers to the barriers that the person faces in their process of self-realization, while homosexuality is a characteristic of how someone lives their sexual desires, pleasures, and loves, not a problem to be solved [14].

At this point in my work, I would like to share with the readers a glimpse into my personal life: when I was about seven years old, my mother was called in for a meeting at my school to discuss my “atypical” behavior with the educational coordinator. In short, the coordinator expressed concern about my unusual performance for a boy, particularly regarding my preference for friendships and play with girls, as well as my “aversion” to soccer, the only activity available in physical education classes for boys. She also emphasized that my behavior (and being) wasn’t very masculine, which could bring certain “social disadvantages” – as she put it – both at the time and in the future.

I clearly remember the image of my mother coming home that day: she was visibly shaken and depressed. Her gaze towards me was filled with pity and disbelief, as tears slid down her face. Even though I knew, it was hard to understand. I realized that some of my actions were considered “wrong” because some classmates teased me, calling me “sissy”, but I didn’t understand why. After hours of deafening silence, my mother decided to share the details of the conversation with the coordinator and said she would try to find more “friends” for me and that we would do more “masculine activities” together. I was very confused by this: about my mother’s tears, the need for new friends, and the purpose of that conversation at school. All of this formed a tangled web of emotions that generated immense guilt in both of us. Thus, we formed a pact based on a “mistake” without origin; it was neither mine nor hers. I remember a phrase often said by one of my patients: at that time, I didn’t know, I just existed. And why did my way of existing disturb the coordinator and, by extension, the school so much?

The truth is, my mother was never able to implement the “containment” measures for my homosexuality – suggested by the school. Although the coordinator’s words haunted her thoughts for years, shaking the foundations that supported her maternal role, my mother immediately realized the extent of the suffering that would be imposed on me if she interrupted the spontaneity that characterized my essence.

Being an only child, raised mainly by my mother and paternal grandmother, where and how could I find references for the “masculine standards” that were expected? My own father, a truck driver who spent most of my childhood traveling – but always present during crucial moments – also hated soccer and never watched games on our TV. On the contrary, he considered it all a huge waste of time. Fortunately, he loved reading newspapers on Sundays and playing video games with me in his spare time. I have affectionate memories, among many others, that shaped my being, preserving my most precious core. Perhaps it is not a coincidence that Winnicott once said: “At the center of each person, there is an incommunicable element, and this is sacred and deserves to be preserved” [15].

In this context, it is important to understand the concept of health or a healthy individual from a Winnicottian perspective. Unlike Freud, Winnicott did not categorize homosexuality as perversion, sexual aberration, or paranoia. Although influenced by the heteronormative standards of his time, he seemed to have more easily freed himself from certain imposed models, especially those by culture and psychiatry. For the British psychoanalyst, health is based on the premise that the individual feels real, living in a creative way. “To be creative, a person must exist, and have a sense of existence, not in the form of conscious perception, but as a basic position from which to operate” [16]. In this sense, “creativity is the doing that, generated from being, indicates that the one who is, is alive”. Therefore, “the most important thing is that a man or woman feels that they are living their own life, taking responsibility for their actions or inactions, and are capable of taking credit for successes and accepting blame for failures” [17].

Winnicott proposes that we are all born with an innate tendency toward integration, which is primarily realized through the care we receive from our environment, such as holding (supporting, comforting, warming, etc.) and handling (bathing, changing, etc.). During the infant’s phase of extreme dependence and vulnerability, the presence of a mother fully dedicated – whom the author calls the “good enough mother” – to the baby’s needs is crucial, as the mother and child are merged, and the baby does not yet distinguish between the self and the non-self. Hence, Winnicott’s famous phrase: “There is no such thing as a baby” [18].

The term “integration”, as used by Winnicott, refers both to the innate predisposition for maturation and to the various partial integrations that gradually occur throughout life, starting from a state of non-integration. Thus, the task of integration in time and space stands out as the most basic and vital for the development of the infant. Without it, there is no way to establish a sense of reality, and the infant will be lost in an endless abyss.

Although this process of integration begins in the first years of life, it unfolds throughout childhood, acquiring new forms and connections that may or may not favor this space-time dynamic.

As an example, I recall the case of a homosexual patient who, while recounting passages from his childhood, shared how, when watching recordings of family gatherings, he was struck by the realization that every time the camera focused on his “feminine mannerisms”, his father – the one filming – would cut the scene and move to another part of the family. He was four years old at the time. These “cuts” resonated in his ways of being and existing in the world. He often stated that he felt out of place in certain situations, even though people welcomed him with tenderness. Moreover, he would often switch day for night, needing medication to fall asleep. “When I have insomnia crises, I notice that the hours don’t pass, and every second on the clock reveals a gap in my existence”, he would say, distressed.

As an example, I share the case of a homosexual patient who, while revisiting some childhood videos, noticed that during family gatherings, whenever the camera captured his “feminine mannerisms”, his father, who was responsible for filming, would cut the scene and focus on other family members. He was four years old at the time. These cuts had a significant impact on his way of being (and existing) in the world. He often felt out of place, even in welcoming environments, and struggled with insomnia, requiring medication to sleep. “When I suffer from insomnia, I realize that time doesn’t pass, and every second on the clock seems to highlight a gap in my existence”, he shared, distressed.

Let’s return to Winnicott’s theory. Integrating a child into time and space does not necessarily mean introducing them to the external world, especially in the early stages of life, when no one is sufficiently mature to sustain or even perceive the sense of reality. The newborn lives in a line of continuity, in an existence that extends to the other – possessing a completely evanescent self. Despite some temporal notions, such as the mother’s heartbeat, the sound of her breath, and the alternation of her movements, this subtle perception of time is limited to the continuity of being [19]. Since the baby initially inhabits a subjective world, introducing them to the sense of time and space means ensuring these aspects are also subjective, that is, respecting the limitations of the newborn.

The infant is not aware of the mother’s existence but feels the effects of her presence and gradually creates a memory of this presence. To maintain the continuity of their being and preserve their subjective world, the baby needs the security of constant presence, forming what Winnicott called the “illusion of omnipotence”. “I am referring to the bidirectional process in which the child lives in a subjective world and the mother adapts, aiming to give each child a basic supply of the experience of omnipotence” [17]. It is as if what satisfies the need is something created by the only thing that exists, namely, the baby. Everything external comes from this creation or from spontaneous creative gestures [8].

From the observer's perspective, it is the environment that satisfies the child's needs, but for the infant, there is no external environment; there is only themselves, and objects appear and disappear according to their needs, as if they were their own creations. Simply put, this happens as follows: 1. the baby feels hungry; 2. the mother offers the breast (or bottle); 3. for the baby, the breast seems to have been created by them (illusion of omnipotence). Therefore, “the environment should avoid frustrating the child, not prematurely forcing the recognition of the external reality; not imposing a unity that they are not yet mature enough to handle” [8].

However, it is important to emphasize that the state of absolute dependence mentioned by Winnicott is not based solely on the infant’s fragility, nor does it suggest a total influence of the environment over an individual who is born as a tabula rasa. Additionally, it is not tied to a specific type of “emotional dependence”, as the baby is not yet mature enough to experience (and recognize) the variety of affections present in human relationships.

By acting this way – devoted to the initial care of the child – the mother enables the baby to begin experiencing the periodicity of time, using their own bodily rhythm as a reference. With the repetition of experiences, a sense of the future, albeit initial, begins to form: the baby learns to anticipate what is to come, based on their needs being met by maternal response and care. If the mother or the environment, in a broader sense, imposes an external rhythm on the baby, both the subjective temporality and psychosomatic cohesion may be harmed, if not completely prevented. The patient mentioned earlier, for example, suffers from various physical pains, and this was one of the main complaints that led him to seek analysis.

In addition to integration, the development of the sense of being within one’s own body, or the stage of “personalization,” is equally important. “Once again, it is the instinctual experience and the reiteration of the silent experiences of bodily care that gradually build what we can call satisfactory personalization” [18]. At this stage, through “bodily imaginative elaboration,” the infant gradually associates their psyche with their body. This complex and delicate process once again requires the constant support of the caregiving figure. As Winnicott states: “I suppose that the word psyche here means the imaginative elaboration of the parts, feelings, and somatic functions, that is, of physical liveliness” [20].

The imaginatively elaborated body is the body that breathes, moves, rests, feeds, plays, etc. Everything experienced [21] by the baby, through their body, will be personalized by imaginative elaboration. Broadly speaking, the gradual conquest of the body is closely related to the baby’s process of spatialization. As long as psychosomatic cohesion is occurring through maternal care, the mother’s arms and the baby’s body are one and the same, so it can be said that “the first dwelling of the baby is the baby’s body in the mother’s arms” [19].

On the other hand, it is essential for the initial adaptation that the mother gradually knows how to withdraw, dissolving the child’s illusions. According to Winnicott, the child does not abandon the basic illusion, which remains throughout life if there is health, but rather the illusion of primary omnipotence – a crucial stage for the development of healthy social relationships. Over time, with the gradual withdrawal of the maternal figure, the infant begins to understand that they are not the creator of the world, realizing that the external reality existed before their birth – independent of their existence.

The child needs to free themselves from the mother’s arms, but they should not be left in a vacuum; they must transition to a larger space of control, a space that can metaphorically symbolize the place from which they departed. This leads to the emergence of the “transitional space” – one of Winnicott’s most well-known and widely discussed concepts [22]. This space represents an intermediate zone of experience, where the infant begins to explore external reality while maintaining a connection to the caregiving and security environment provided by the mother (contact with subjective reality).

However, the emergence of transitional phenomena and objects is only possible if the mother – or the primary environment – has provided the necessary care for the baby’s maturational development. If there is a failure at this beginning stage – that is, in the period of absolute dependence – the space for transition may not develop. The transitional object, therefore, occupies a space that is neither entirely internal nor exclusively external. It resides between the illusion of infant omnipotence and gradual disillusionment, representing a unique and exclusive choice of the child.

This movement of liberation, effectively initiated in the stage of transition, maintains its authenticity throughout life. After all, don’t we spend much of our existence in a dilemma between going and staying, holding on and letting go, fearing and confronting? In moments of extreme anguish, who among us has never sought solace in a prayer, meditation, chant, or comforting memory? In facing these challenges that touch our human essence, it is our right to regress to the most primitive stages. In this context, the reliability of the environment proves essential, always keeping open the possibility of return, a need that persists until our death. This opens us up to the idea of a plural and continuous existence, which dialogues with plasticity, enabling the conception of various ways of being and existing in the world.

In conclusion, we can say that the “self” achieved is the fruit of a long and arduous process of integration, initiated at the very beginning of existence. However, the unity of this self is not completely cohesive, without fractures, or free of conflicts. On the contrary, it is a state of space-time integration where the self gathers all its characteristics, in contrast to dissociated, fragmented, or abandoned elements [19]. Paradoxically, this achievement marks both an end and a beginning, for the state of “I AM”, the feeling of being real and existing as an identity, “does not constitute an end in itself, but a ‘position from which life can be lived’” [23].

Childhood play is the most tangible example of these hypotheses. A patient shared that, since childhood, she had a very dear friend with whom she engaged in extraordinary games. In this transitional world, there were no rules or limits. It was a shared dream where both could be whoever they wanted: man, woman, mother, father, baby, teacher, king, queen, police officer, or thief. The nature of these identities was irrelevant, representing a life shaped by endless possibilities.

For her, those were the most precious moments of her childhood, colored by a genuine freedom, free from censorship or imposed rules. This freedom is primarily distinguished from the “law of man”, a concept that radically differs from the “law of the infant”. Ferenczi [24] wisely points out this distinction when discussing the “confusion of tongues”, where the adult speaks the language of passion and the child speaks the language of tenderness.

The beauty of this story, in my view, lies in the way both individuals handle their sexuality to this day. They are free to be whoever they want, without being bound by standards or the obligation to follow truths imposed by morality and societal norms. Despite this, they do not see themselves as transgressors, but as independent souls who move away from the limiting logic of binary thinking.

When the spontaneous gesture is respected in the family environment, as in this case, we witness the development of a being that is constituted around autonomy – namely, their own existential freedom.

Introduction

5. Sexuality for D W Winnicott

“As they move beyond this stage, adolescents begin to feel real and develop a sense of self and a sense of being. This is health. From being comes doing, but there can be no doing before being – that is the message they send us” [17].

This quote highlights the importance that Winnicott places on being over doing. As we discussed earlier, it is essential to have an environment that respects, above all, our otherness and our spontaneous gesture. For the English author, any external imposition that serves the desires of the caregiver at the expense of the cared-for individual can be seen as an act of extreme violence – a violation of the intimacy of the self.

Indeed, Winnicott links health to the magic of intimacy, to what we are able to discover in our most private cores, free from external disturbance or cultural influences, which are often imposed in an objective and cruel manner.

He points out that creativity is a common denominator between men and women. “In another language, however, I would say that creativity is a prerogative of the woman, and in yet another language, it is a male characteristic” [25]. Rather than emphasizing differences that create dichotomy and polarization, Winnicott understands that, to reach the stage of “I AM”, both masculine and feminine elements must be aligned, working together, rather than being dissociated. This is essential to sustain creative potential.

In our predominantly patriarchal culture, we often see the masculine and feminine elements mentioned by Winnicott acting independently (dissociated). For example, in superhero movies, it’s not uncommon to find a strong and courageous male character alongside a more nurturing and delicate sidekick, symbolically representing femininity. There is a tendency to deny space for sensitive heroes, as masculinity, as understood in popular culture, seems too fragile to be questioned. This social movement reflects the need to create standards that lead us to reject subjective elements that are part of our psychic geography, sometimes creating radical divisions. The French historian Ivan Jablonka addresses this theme in his book Just Men: From Patriarchy to New Masculinities. He writes: “The demonstration of strength, aggressiveness, the imposition of a role, the obligation to succeed, and the culture of prowess are traps that society sets for men, and those who have the strength to resist are judged by their masculinity” [26].

In this context, if a boy plays at sweeping the floor, he can quickly be labeled as “effeminate” – a behavior stemming from patriarchy that reflects a deep cultural insecurity in accepting individual authenticity. In response, extreme polarizations arise: everything or nothing, black or white, pink or blue, male or female, right or wrong, often aligning heterosexuality with “right” and considering its opposite as “wrong” [27].

According to Winnicott, the “masculine” element can be understood as transitioning between an active or passive relationship, both influenced by instincts and impulses that direct the separation from the fused mother-baby unit. On the other hand, the “feminine” element is related to the breast (or the maternal figure), in the sense that the baby transforms the breast (or the one who feeds them) into something significant. In other words, there is activity present in this phenomenon – this perspective certainly does not limit the feminine to a passive entity.

The feminine element enables the emergence of a gesture that creates illusion, a crucial perspective of the masculine element. While the feminine provides continuous calm, the masculine inaugurates the illusory experience. The illusion manifests when the baby perceives the breast as an object, stemming from their need.

The “pure feminine element” allows existence through silent communication, contrasting with the masculine, which “creates” objects without any preexisting representations. In this way, two distinct modes of creative perception emerge: one arising from the gesture and the other from being. The perception generated by the gesture allows the individual to access reality subjectively, only later understanding it objectively. Influenced by the masculine element, the individual seeks the world, fueled by the expectation and hope of finding the desired object, paving the way for a personalized objectivity.

However, the perception stemming from the masculine element requires the experience of the feminine. It is essential to both be and be present for the gesture to reshape the world. Both facets, originating from the feminine and the masculine, allow for the coexistence of the subjective and the objective. The existence of these dualities – personal objective and personal subjective – constitutes what Winnicott calls the creative life. This way of living involves the ability to exist both subjectively and objectively, reaching an objective understanding of the world without losing personal identity. It is no coincidence that Winnicott emphasizes that creativity is often simply being alive. He says, “The masculine element does, while the feminine element (in both men and women) is. [...] This is also a way of indicating the profound envy men feel toward women, whose feminine element men take for granted, sometimes mistakenly” [25].

In addition to proposing the idea of a dynamic existence (a continuity of being) that allows for regression to the early stages of maturational development, reflecting the plasticity of being and the conception of sexuality, Winnicott [25] challenges Freud’s notion of “penis envy”. He asserts that, in reality, it is the man who envies the feminine aspects, especially when dissociated from the self. However, it is important to note that when addressing the Oedipal issue, Winnicott was influenced by the psychoanalysis of his time and ultimately agreed with Freud on the concept of penis envy.

However, from a Winnicottian perspective, it becomes essential to reconcile, within ourselves, the masculine and feminine elements that make up our identity. Winnicott encourages us to rethink the traditional binary view of gender, promoting a more complex understanding. He emphasizes that these elements are intrinsic and fundamental to our existence, transcending the simplistic biological limitations of the XX and XY genetic categories. According to this view, the true essence of being is the premise for action; without “being”, “doing” remains unattainable.

Furthermore, Winnicott approaches sexuality from a more empirical standpoint, distancing himself from traditional psychoanalytic concepts. He rejects the idea of archaic fantasies and instinctual forces, or drives, that are central in Freudian theory. His view on the Id, one of the key psychic structures in Freud’s theory, is also unique: he believed that the Id is initially outside the newborn’s experience.

For Winnicott, the Id is internalized only through the appropriation of instincts by the individual, which occurs through a process he describes as “bodily imaginative elaboration”. This idea, highlighted by Naffah Neto [28], indicates that the British psychoanalyst understood sexuality and psychic development not as a preordained play of instincts, but as a creative and dynamic process, grounded in individual experience and imaginative capacity. For this reason, childhood sexuality will only solidify with some consistency and permanence after the self-integration process, at which point the child can experience and enjoy erotic sensations within a continuous temporal experience, grounded in a functional relationship between body and psyche. This allows for the evocation of pleasurable sensations without relying on the transient integrations provided by the presence of instinct [28].

Anchored in his theory of maturational development, Winnicott explores the development of childhood sexuality from a unique approach. According to him, sexuality begins to form around the age of twelve months, a stage in which the child’s self has already achieved good integration, following the phase of “I AM”. During this period, a significant fusion occurs between aggressive and destructive impulses and erotic impulses.

This fusion results from the repeated experience of what Winnicott calls the benign cycle, which occurs during the stage of concern (or the stage of consideration, according to current translations). In this phase, the baby is able to perceive the mother as a unified object, and fantasies of attacks on the maternal body are common. These attacks must be supported by the mother’s survival, allowing the infant the opportunity for repair. Through this repetition – attack, survival, and repair – the child begins to integrate their own aggressive and destructive impulses, learning to appropriate them with less fear.

Finally, it is important to highlight that, for Winnicott, childhood sexuality is genuine and tied to creative potential only when it emerges from the baby’s own experience; that is, it needs to occur from the inside out, after the integration of masculine and feminine elements. As we have seen, this integration goes beyond binary cultural structures. If sexuality is formed from the outside in, through environmental impositions and invasions, it will result in a false sexuality, predominantly constructed through mimicking the environment [28].

Introduction

6. Conclusion

We know that Winnicott’s theory still requires much exploration, even within psychoanalytic circles dedicated to studying his work. Winnicott never intended for his constructions to become dogma. Quite the opposite, while the British Psychoanalytical Society was “in flames” with the heated discussions promoted by Anna Freud and Melanie Klein, the English analyst chose to remain prudent and not take sides in the conflict, founding what became known as the Middle Group, positioning Winnicott outside of any partisanship.

Once, while attending an international colloquium on this author’s ideas, I was forced to listen to a speaker assert that homosexuality could be a pathology resulting from insufficient maturation, leading to a dissociated false self, which would be the source of the suffering of “these” individuals. This is absurd, because when we base our understanding on the Winnicottian premise that the root of most mental illnesses stems from a relationship of submission, it would make more sense to consider that many “heterosexualities” are false, imposed from the outside in – as the school coordinator I encountered as a child would have liked.

What bothers me most about this account, however, is not the fact that someone misunderstood Winnicott’s theory, but the prejudice embedded in that statement, especially when associating homosexuality with a supposed dissociated false self of “these individuals”.

The same mistake is made, even more frequently, regarding transgender identities, which represent an infinite possibility of being and existing in the world. This can range from the complex hormonal and surgical transformation of one gender to another (considering the figures of man and woman) to the costly change of civil registration, as well as the use of different genders and appearances, whether permanent or transitional. Here, we might even find some support in Winnicott’s definitions of transitional space. Sexuality, in this sense, would cease to be something rigid and predetermined, occupying a space dedicated to play, fantasy, dreaming, and freedom.

Some critics of psychoanalytic theory accuse it of working with a “binary epistemology of gender”. I think this is not entirely wrong. We still need to evolve a great deal and promote reinterpretations that expand concepts that were conceived years ago and no longer align with our current reality. Either we evolve, or we will continue to create more of the same, shouting jargon to the winds. A sad fate for a science that originated from the deconstruction of paradigms – although it was still influenced by the norms of its time.

For Winnicott, we are products of the union of the masculine and the feminine – without appealing to any stereotypes or binary thinking – which are further reflected in being and doing; aspects that shape our survival and enable a legitimate psychosomatic existence for the individual.

It is true that society assigns roles to each sex, subjugating them to their corresponding gender, meaning their customs, clothing, walk, professions, etc. From this perspective, the Winnicottian subject, as such, objects to culture and its symptoms, resisting any form of doctrinal submission. This premise could inspire some psychoanalysts who still insist on staying within the confines of a morbid repetition of theories and concepts but fail to engage with texts that offer life stories, clinical insights, possibilities, and transformations.

In this context, every dualism carries with it a moralistic weight, associated with the idea of a “good principle” or “right path”. In the case of the male/female dualism, we have already seen how the masculine side has been favoured throughout our history. While nature imposes certain limits on humanity, it is human culture that acts as the active pole of this pair: it is culture that has the ability to transform and, in a way, dominate nature. In other words, we fall into a trap when we establish an opposition between two dimensions and try to organize our understanding and clinical interventions based on this division: body/psyche, nature/culture, male/female [26].

In the introduction to the book From Pediatrics to Psychoanalysis (2021), Masud Khan writes: “It was this characteristic of being inexorably oneself that allowed him to be so many different people for each person. Each of us who knew him had our own Winnicott, and he never overrode the way the other invented him by asserting his own personal way of being” [29].

Perhaps, not listening to the educational coordinator was the most subversive thing my mother could do for me. With her maternal sensitivity, she realized that it would be futile to mold me according to the desires of others. The greatest mistake a parent can make is to yield to moralistic conventions, repeating dominant ideologies that erase individuality. Thanks to my mother’s insight and my father’s emotional understanding, I was able to be who I truly am. And, by being myself, I could walk between the lines that mark the vastness of Winnicottian thought, creating my own Winnicott. This is one of the proofs that psychoanalysis and gender theories can come together to promote a less suffocating and more liberating world.

References

1. Terlizzi EP, Schiller JS, Estimates of Mental Health Symptomatology, by Month of Interview: United States, 2019, in National Health Interview Survey. 2021, National Centers for Disease Control and Prevention: National Center for Health Statistics.
2. Bandelow B, Michaelis S (2015) Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci 17(3): 327-335.
3. RuthAnne K, Haley W , deMauri SM , Kushal MM , Anita M (2023) The burden of anxiety among a nationally representative US adult population. Journal of Affective Disorders 336: 81-91.
4. Yang X, Fang Y, Chen H, Zhang T, Yin X, et al. (2021) Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiol Psychiatr Sci 30: e36.
5. Mishra AK, Varma AR (2023) A Comprehensive Review of the Generalized Anxiety Disorder. Cureus 15(9): e46115.
6. Penninx BWJH, Daniel SP, Emily AH, Andreas R (2021) Anxiety disorders. The Lancet 397(10277): 914-927.
7. Olatunji BO, Cisler JM, Tolin DF (2007) Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev 27(5): 572-81.
8. Szuhany KL, Simon NM (2022) Anxiety Disorders: A Review. Jama 328(24): 2431-2445.
9. Kandlur NR, Ashmica CF, Suzanna RG, Shruthi R, Shalini Q (2023) Sensory modulation interventions for adults with mental illness: A scoping review. Hong Kong J Occup Ther 36(2): 57-68.
10. Case LK, Jaquette L, Micaela VM, Megan B, Aaron N, et al. (2021) Pleasant Deep Pressure: Expanding the Social Touch Hypothesis. Neuroscience 464: 3-11.
11. Reynolds S, Lane SJ, Mullen B (2015) Effects of Deep Pressure Stimulation on Physiological Arousal. The American Journal of Occupational Therapy 69(3): 6903350010p1-5.
12. Keizer A, Heijman JO, Dijkerman HC (2022) Do transdiagnostic factors influence affective touch perception in psychiatric populations? Current Opinion in Behavioral Sciences 43: 125-130.
13. Strauss T, Fabian R, Uta S, Julia S, Hamilton JP, et al. (2019) Touch aversion in patients with interpersonal traumatization. Depress Anxiety 36(7): 635-646.
14. Tinker VC, Trotter PD, Krahé C (2023) Depression severity is associated with reduced pleasantness of observed social touch and fewer current intimate touch experiences. PLoS One 18(8): e0289226.
15. Eron K, Lindsey K, Ashlie W, Christina L, Weisner-Rose M, et al. (2020) Weighted Blanket Use: A Systematic Review. AJOT: American Journal of Occupational Therapy 74(2): 7402205010p1-7402205010p14.
16. Dawson S, Kimberly C, Lorraine N, Jenny C, Lemma B, et al. (2024) Weighted Blankets as a Sleep Intervention: A Scoping Review. The American Journal of Occupational Therapy 78(5): 7805205160.
17. Wong S, Nicholas F, Brandon L, Chanhee S, Arnav G, et al. (2024) The effect of weighted blankets on sleep quality and mental health symptoms in people with psychiatric disorders in inpatient and outpatient settings: A systematic review and meta-analysis. Journal of Psychiatric Research 179: 286-294.
18. Yu J, Zhenqing Y, Sudan S, Kaili S, Weiran C, et al. (2024) The effect of weighted blankets on sleep and related disorders: a brief review. Front Psychiatry 15: 1333015.
19. Ekholm B, Spulber S, Adler M (2020) A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. Journal of Clinical Sleep Medicine 16(9): 1567-1577.
20. Losinski M, Katie C, Shanna H, Sara Sanders (2017) The Effects of Deep Pressure Therapies and Antecedent Exercise on Stereotypical Behaviors of Students With Autism Spectrum Disorders. Behavioral Disorders 42(4): 196-208.
21. Chen HY, Hsiang Y, Huang-Ju Chi, Hsin-Ming Chen (2013) Physiological Effects of Deep Touch Pressure on Anxiety Alleviation: The Weighted Blanket Approach. Journal of Medical and Biological Engineering 33(5): 463-470.
22. Chen HY, Hsiang Y, Ling-Fu M, Pei-Ying SC, Chia-Yen Y, et al. (2016) Effect of deep pressure input on parasympathetic system in patients with wisdom tooth surgery. Journal of the Formosan Medical Association 115(10): 853-859.
23. Mullen B, Tina Champagne, Sundar Krishnamurty, Debra Dickson, et al. (2008) Exploring the Safety and Therapeutic Effects of Deep Pressure Stimulation Using a Weighted Blanket. Occupational Therapy in Mental Health 24(1): 65-89.
24. Champagne T, Brian Mullen, Sundar Krishnamurty, Debra Dickson (2015) Evaluating the Safety and Effectiveness of the Weighted Blanket With Adults During an Inpatient Mental Health Hospitalization. Occupational Therapy in Mental Health 31(3): 211-233.
25. Whittemore R, Knafl K (2005) The integrative review: updated methodology. Journal of Advanced Nursing 52(5): 546-553.
26. Page MJ, Joanne EM, Patrick MB, Isabelle B, Tammy CH, et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372: 71.
27. Baumgartner JN, Haupt MR, Case LK (2023) Chronic Pain Patients Low in Social Connectedness Report Higher Pain and Need Deeper Pressure for Pain Relief. Emotion 23(8): 2156-2168.
28. Becklund AL, Rapp-McCall L, Nudo J (2021) Using weighted blankets in an inpatient mental health hospital to decrease anxiety. J Integr Med 19(2): 129-134.
29. Dickson DA, Gantt L, Swanson M (2023) Effectiveness of the Weighted Blanket With Psychiatric Patients in the Emergency Department: A Pilot Study. Journal of the American Psychiatric Nurses Association 29(4): 307-313.
30. Harris ML, Titler MG (2022) Feasibility and Acceptability of a Remotely Delivered Weighted Blanket Intervention for People Living With Dementia and Their Family Caregivers. Journal of Applied Gerontology 41(11): 2316-2328.
31. Ohene R, Christina L, Figaro L, Ashlie W, Kathryn E, et al. (2022) Assessing the Impact of Weighted Blankets on Anxiety Among Patients With Anorexia Nervosa and Avoidant– Restrictive Food Intake Disorder: A Randomized Controlled Trial. The American Journal of Occupational Therapy 76(6): 7606205100.
32. Payne DR, Jaime V, Jan P, Brandon TMD, Cherise S, et al. (2024) Effect of Weighted Blanket Versus Traditional Practices on Anxiety and Pain in Patients Undergoing Elective Surgery: A Multicenter Randomized Controlled Trial. Aorn Journal 119(6): 429-439.
33. Telhede EH, Susann A, Staffan K, Andreas I (2022) Weighted Blankets' Effect on the Health of Older People Living in Nursing Homes. Geriatrics 7(4): 79.
34. Vinson J, Powers J, Mosesso K (2020) Weighted Blankets: Anxiety Reduction in Adult Patients Receiving Chemotherapy. Clin J Oncol Nurs 24(4): 360-368.
35. Warner SM, Stacey LT, Sohni P, Jose SL (2023) Weighted Blankets for Pain and Anxiety Relief in Acutely Injured Trauma Patients. J Pain Palliat Care Pharmacother 38(3): 244-253.
36. Jacobsen PB, Bovbjerg DH, Redd WH (1993) Anticipatory anxiety in women receiving chemotherapy for breast cancer. Health Psychol 12(6): 469-75.
37. Hallegraeff JM, Ronald K, Emiel van T, Michiel FR (2020) State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study. Journal of Physiotherapy 66(1): 39-44.
38. Rogers AH, Farris SG (2022) A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain 26(8): 1611-1635.
39. Tang J, Gibson SJ (2005) A Psychophysical Evaluation of the Relationship Between Trait Anxiety, Pain Perception, and Induced State Anxiety. The Journal of Pain 6(9): 612-619.
40. American Psychiatric Association p, American Psychiatric Association D.S.M.T.F. a Diagnostic and statistical manual of mental disorders: DSM-5™ (5^th edition), DSM-5. 2013, Washington, DC; American Psychiatric Publishing, a division of American Psychiatric Association.
41. Bontula A, Rhian CP, Emily S, Cristina W, Naomi TF (2023) Deep Pressure Therapy: A Promising Anxiety Treatment for Individuals With High Touch Comfort? IEEE Trans Haptics 16(4): 549-554.
42. Rapaport MH, Pamela JS, Erika RL, Dedric C, Margaret S, et al. (2018) Massage Therapy for Psychiatric Disorders. Focus (Am Psychiatr Publ) 16(1): 24-31.
43. Sherman KJ, Evette JL, Andrea JC, Rene JH, Peter PRB, et al. (2010) Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depress Anxiety 27(5): 441-50.
44. Scholten W, Adrie S, Adriaan H, Renske B, Anna M, et al. (2023) Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 80(8): 822-831.
45. Gold AK, Dustin JR, Daniel N, Caylin MF, Spencer YD, et al. (2024) Does baseline psychiatric symptom severity predict well-being improvement in low-intensity mindfulness interventions? Psychiatry Research Communications 4(3): 100182.
46. Meth EMS, Luiz Eduardo MB, Lieve T van E, Pei X, Anastasia G, et al. (2023) A weighted blanket increases pre-sleep salivary concentrations of melatonin in young, healthy adults. J Sleep Res 32(2): e13743.