Psychoanalysis and Sexual Issues

Abstract

Psychoanalysts were once thought to be experts on sexual issues, but that is less true today. The rift between psychoanalysis and scientific sexology that occurred in the mid-20th century may be partly responsible. In this article, I suggest ways this situation can be remedied. Psychoanalysts can best become more literate about variant forms of sexuality by reading first-person accounts and by garnering information from empirical research and Internet sites for specific forms of sexuality. In addition, psychoanalysts need to examine their own attitudes to different forms of sexuality, make sure they learn a patient's goals in treatment, be honest and open about whether they can help achieve those goals, and pay attention to the difference between psychopathology and societal pathology. In addition, the analyst needs to be aware of how sexual excitement can unconsciously bind erotic experience with other complex emotions and motivations. A case of coercive voyeurism is presented to illustrate these principles.

Keywords:

• sex
• psychoanalysis
• perversion
• voyeurism
• sado-masochism
• clitoris

Notes

1 Familiarity with sexological findings did not necessarily prevent psychoanalysts of the time from being judgmental and pathologizing, but it tended at least to make them more knowledgeable and inquisitive about the details of their patients' sexual experiences.

2 For example, I learned that there are masochists who seek to inflict pain, but there are also masochists who seek only domination, without sensory pain. The desire to have physical pain inflicted is sometimes called “algolagnia” and is distinguished from masochism in general. Some masochists seek no physical pain, only dominance, a relinquishment of their own will. The analyst may presume that such a position is in itself a humiliation, but that may not be universally so.

3 Sometimes, as treatment progresses, patients change their minds about their goals, but these remain the patients' goals. As a general rule, the psychoanalyst should avoid as much as possible imposing personal beliefs about what is the right kind of sexuality on the patient.

4 Janine Chasseguet-Smirgel (1985) vilified homosexuality as a denial of difference. Yet Chasseguet-Smirgel, a female French-speaking Jewish psychoanalyst, married Béla Grunberger, her male French-speaking Jewish psychoanalyst. Was that a denial of difference? And should such difference deniers be cured? Is sameness of gender in a relationship problematic, but is sameness of nationality, religion, and profession not problematic? This is an example of what I call the “gender fetish” (Blechner, 1995b)—disproportionate attention to gender over other significant dimensions of human identity.

5 This highlights the issues of values in psychotherapy. Among gay men in New York today, it is common for gay male couples in marriages and other long-term relationships not to take monogamy for granted, but to negotiate whether to be monogamous (Mitchell et al., 2016), and their choices often evoke pathologizing judgments among couples therapists (Shernoff, 2006). Although many gay couples choose monogamy, it is not as much of a cultural given as it is, at least officially, among heterosexual married couples (Blumstein & Schwartz, 1983). The data seem to vary widely with time and method of sampling. McWhirter and Mattison (1984) claimed that all gay male couples, after five years of being together, had some provision for sexual activity outside the relationship, what Morin (1999) calls “modified monogamy.” A more recent study (Spears & Lowen, 2010) of 556 male couples found that approximately 50% had sex outside their relationships, whereas Campbell (2000) found that 70% of his sampled gay couples were monogamous. Parsons, Starks, DuBois, Grov, and Golub (2013) found 58% monogamous, 22% had “open relationships,” and 20% had “monogamish” relationships (Savage, 2012) in which sex with other men occurred only when the other partner was present (which seems to have been so in Saketopoulou's case).

6 “Barbara's Song” from Die Dreigroschen Oper (The Threepenny Opera) by Bertolt Brecht and Kurt Weill (1928) captures this fact. A man who is wealthy, kind, clean, and knows how to treat a woman comes along, and she says “No!” to him. Then a man with no money, is not kind or clean, and who doesn't know how to treat a woman comes along, and she is smitten.

7 It is worthwhile to do a self-study of personal reactions to nonnormative sexual practices, to learn one's personal boundaries, and perhaps expand them, such as by watching a film like Beyond Vanilla (Lilja, 2001).

8 See Blechner (1994) for a related example of the enactment of sado-masochism in psychoanalytic treatment.

9 Harris (1991) noted how a putative homosexual sexual orientation may mask an alternative gender identity and therefore a psychically heterosexual relationship.

10 The references here are representative readings; the actual reading list was more extensive, but cannot be presented here in its entirety.

11 Bak (1968, case 5) also wrote about Richards, so one can compare the accounts of analyst and patient.

12 Urolagnia is the presence of sexual excitement at the thought or perception of urine or urination. Zoophilia is a sexual attraction to and love of animals (Earles & Lalumière, 2009). BIID is Body Integrity Identity Disorder, in which one feels that part of a limb does not belong to one's body and wishes to have that part of the limb amputated. Dyspareunia is pain experienced during sexual intercourse.

13 One could see this interaction as an enactment. The patient's fantasy may express his fear of penetrating a woman, being penetrated himself, and wishing to control a woman, and this is enacted by the therapist's reluctance to penetrate further into his fantasy.

14 Karpman (1954) defined voyeurism as a “pathological indulgence in looking at some form of nudity as a source of gratification in place of the normal sex act.” I have coined the term “coercive voyeurism” to distinguish those who enjoy seeing nudity from those whose main pleasure is seeing someone's nudity against her will.

15 Freud (1905/1953) also suggested that exhibitionist impulses precede voyeuristic impulses.

16 This was noted by Yalom (1960) in a landmark study of eight voyeurs, most of whom had been incarcerated. One man said, “Looking at a nude girl friend wouldn't be as exciting as seeing her the sneaky way. It's not just the nude body but the sneaking out and seeing what you're not supposed to see. The risk of getting caught makes it exciting. “Another said, “It must be clandestine, she must be a stranger and she mustn't see me watching.”

17 Yalom (1960) states that all coercive voyeurs are male heterosexuals, and that there are no reports of either female or homosexual voyeurs. There are dangers in asserting, however, that something does not exist. It was once presumed that men found it exciting to watch pornography of two women interacting sexually, but that women did not find pornography with two gay men exciting. Person (1999) proposed a psychodynamic account of why this might be so. However, it emerged that this asymmetry was factually incorrect (Blechner, 1998). Some Japanese girls like to read comics with romantic stories between two men, called yaoi (boy's love; see Thorn, 2004), and some lesbians like to watch gay male pornography (Bernstein, 2010), as was made widely known by the film The Kids are Alright.

18 Fantasized coercion or intrusion is quite different, from a legal and social perspective, from actual physical coercion or intrusion.

Additional information

Notes on contributors

Mark J. Blechner

Mark J. Blechner, Ph.D., is training and supervising analyst at the William Alanson White Institute, and faculty and supervisor at the New York University Post-Doctoral Program in Psychoanalysis. He has published three books: Hope and Mortality: Psychodynamic Approaches to AIDS and HIV (1997), The Dream Frontier (2001), and Sex Changes: Transformations in Society and Psychoanalysis (2009). He is former Editor-in-Chief of the journal Contemporary Psychoanalysis and former director of the HIV Clinical Service at the William A. White Institute.