Modern Ego Psychology and Human Sexual Experience

Front matter

“This book transcends the limitations of current approaches to sexuality by taking

practitioners on an extraordinary journey into understanding the unique emotional meanings of sexual feeling, fantasy, behavior, and physical experience.”

Francine Cournos, professor of Clinical Psychiatry, Mailman School of Public Health,

Contents

Preface X

Introduction 1 1 Meaning 3 2 Symbolic Alterations of the Body 13 3 Fetish 35 4 Fetish Enactments 46 5 Attachment 56 6 Masturbation 68 7 Threesomes 83 8 BDSM 95 9 ‘Treatment 104

Preface

This book is meant to fill a void in both the sexology and the psychoanalytic literature. The void has to do with the lack of detail about sexual experience and its emotional meaning, Even when there are descriptions of sexual behavior, there are rarely descriptions of the experience of that behavior, and even more rarely, descriptions of the meaning of the experience.

What has psychoanalysis to offer to sexology? It offers a technique for revealing the emotional meaning of sex to an individual. It reveals the emotional contents of sexual desires, fantasies, behaviors and avoidances. It reveals its growth and development sequence and relationships to growth and development of the personality. It shows how inextricably entangled with personality sexual desire, fears, fantasies and behaviors are. It is a method of clinical inquiry and as such reveals the individual meanings, not the so-called normative. It is a clinical method to help an individual; it is not an epidemiology. There can be, however, an epidemiology of sexual fantasy and of meaning, That is a psychodynamic social science issue.

What are some of the possible reasons descriptions of sexual experience and associated meanings are missing from the sexology literature?

One reason, perhaps, is that after the sexual revolution of the 1960s, everything became normal, but then also sex was just sex — anything, anywhere, with anyone, any time, like a sport — and specific meaning, even the deeper meaning of sport, was ignored. This was a political ideology, not a scientific accuracy. It was part of the liberation of women, and of human sexuality, a contribution of science that produced the birth control pill in 1964, and of the post-World War II baby boom generation bulge. Suddenly, there was a population bulge of emerging adults with their intense sexual drives and their yearning to take their place as movers and shakers in the adult world. Older teenagers and very young adults have little adult currency except their adult sexual bodies. Sex therefore became a political statement. It became part of a rebellion catalyzed by these demographics and the political times, the political awakening against the Vietnam War. Sex became a rebellion and a liberation. Make love not war.

Preface xi

At the same time, from the 1950s with Kinsey to the 1960s with Masters and Johnson, sex studies begin to reveal the ubiquity and physiology of sex. But a subtle prejudice remained. Normal became defined by common. Abnormal became defined by uncommon. This was no advance beyond the contributions of the sexual reports of sexual pathologies of the late 1800s of Krafft-Ebing and early 1900s of Havelock Ellis. They were called pathologies because they were assumed to be uncommon and, more importantly, because they did not lead directly to procreation possibility. There are the graphic descriptions of sexual acts and their categories into the various so-called perversions. Those descriptions, while accurate, often were sparse in the details of the sexual activities and almost absent in the description of the experience and emotional meaning of the sexual acts and their details.

Sexual behavior often enacts sexual fantasy. No matter how close the content of the activity, the behavior is never able to fully express the fantasy. In fantasy one can find emotional meaning.

During the 20th century, psychological and social science grew more quantitative, so sex studies emerged whose task was to quantify frequencies of sexual acts. An epidemiology of sexual behavior emerged. Frequency then got enshrined in a condensation with normative, perhaps leading to the assumption of normal and pathological categories.

The problem with normal is its definition. If it is a frequency definition, then uncommon becomes pathological and common becomes normal. Normative becomes normal. This is simply not true. It certainly isn’t always true. During the mid-20th century, cigarette smoking was widespread and considered normal. Therefore, one of the most common incidental findings at autopsy was carbonated lungs. Instead of pink, they were black. Nobody claimed that was normal. The proof of abnormality therefore shifted from frequency to pathology. There was a higher rate of lung cancer and chronic obstructive pulmonary disease in smokers. But there were clear markers in the carbon in the lungs and the frequency of disease. Therefore, the label normal at autopsy was changed to the word incidental. But what was incidental for one person was fatal for another; what was incidental for most, was fatal to some.

Because it is hard to establish such pathological markers for human sexuality, it makes the defining of normal difficult and contested. Any attempt to define normal in human sexuality, except at the extremes of damaging behavior, runs into subtle and not-so-subtle value systems. But what is wrong and disgusting to one person or one group, may be exciting and enticing to others.

It is a characteristic of human sexual experience to exist on a spectrum. All categories within that spectrum are also on a continuum. This should be no surprise. Human biology and, even more so, human psychology ate complex systems on multiple continuums, with fuzzy boundaries.

xii Preface

In addition, the measurement of normal and abnormal, common and uncommon, for psychoanalysts is riddled with the problem of meaning. For a psychoanalyst it isn’t just behavior but rather the meaning of the behavior and the meaning of the meaning, This cannot be found through observation nor reports of the behavior itself. For that we need the fantasy that reveals the emotional story of meaning about sexual behavior. Because there were very few social scientists who were also analysts, we don’t get the epidemiology of sexual fantasy. One of the first and only was by Person and Goldberg, both psychoanalysts. Theirs was a study of behavior and fantasy of college students. It was a social science self-report survey done by psychoanalysts. It produced frequencies of both behaviors and fantasies, correlated the two and gave frequencies of enactment of fantasy versus frequency of fantasy only. This is very interesting work, but it does not avoid the problem of normative versus normal, and it does not avoid the problem of surveys in social science research. The data you get from self-report surveys are the data that is produced by the method. The resulting data is about how people answered that survey. It tells you nothing about the correlation of the survey results with actual lived experience, either in behavior or fantasy.

Surveys are questions handed out to a group of people who reply to them, usually with yes or no answers. They are self-reports. So there are now two issues. The first is that the categories tend to be occurrence categories — “Do you or don’t you and how often.” They tend to eliminate the “neither do nor don’t,” and the “encourage another to do to you.” More importantly, they eliminate qualitative experience as well as meaning,

In addition, the accuracy of such data is notoriously bad. There are two reasons. The first is that shame operates even in anonymity. The second is that denial operates as well. So they don’t really tell the surveyor nor themselves. The behaviors and frequencies revealed are therefore reported frequencies whose relationship to actual behavior and frequencies is unknown.

But even assuming they are accurate, they are still based on the assumption that frequency will tell us something interesting other than frequency. And frequency is interesting. But its meaning and significance is not thereby frequently revealed. Something very important, even crucial, to a person may be rare. Something boring and not too meaningful may be frequent.

Human sex studies therefore went from phenomenology to surveys, from individual behavior to group behavior, from descriptions to categories, from the said to be uncommon to the said to be pathological, and from secret to public. All these changes in the growth and development of sexology have tended to minimize meaning and the descriptions of qualitative experience where an important part of meaning can be found.

More recent sexology surveys have been much more sophisticated by including more natural groups and by the sophisticated questions asked. They ate revealing the much more common frequency of variations among both men and women than was previously thought. Interestingly, Freud said

Preface xiii this. The recent studies are more sophisticated also about unmeasured confounders and accurate data gathering.

The turn of the 19th-century writer who did not pathologize, although accused of so doing, was Sigmund Freud. His book on human sexual experience was ahead of its time in its acceptance of non-pathological sexual variety. It is a lesson that many practitioners of psychoanalysis lost for a number of years in the mid-20th century.

This book makes no claim to knowing what normal is. It is probably best used as a fuzzy concept. It might be good to include in its definition what is good for the growth and development of the self and others and of relationships. Is that a biology imperative or a human values imperative, or both?

One thing that stands in the way of more satisfying relationships is the fear in the sexual self that the sexual other will not enjoy the sexual self, nor what the sexual self wants to do and why. But when two people are intensely attracted to each other, their sexual fantasy experience may be linked; concomitant or concordant.

Another problem in relationships is that the sexual self may know what they want to do but not really why they want to do it, other than lustful satisfaction. The intense, driven meaning is mostly unconscious. Shame and guilt, denial and repression, may make the availability of this information difficult. In fact, one of the pleasures of the deepening of relationships is the exploratory discovery of each with the other, including of their sexual desires.

Another reason perhaps that sexual experience is not in the forefront in modern sexology is the emergence of and focus on the issues of sexual identity and gender. These are the new issues in sexology. They are important issues about which knowledge has accumulated and much more needs to be understood. But no matter the gender, no matter the sexual identity, all human beings have sexual experience and associated sexual fantasy. Sexual fantasy is lacking in the literature about gender and sexual identity.

This book makes no claim to adding some unique contribution to sexology. It means only to call attention to the added phenomenology of meaning, emotional meaning, of sexual experiences and how it is experienced. Fantasy as purveyor of meaning has been known from the dawn of history, elaborated by Freud, but then forgotten in the social sciences, and is in the process of being rediscovered. This is the path of the growth and development of ideas. It follows the approximate Hegelian progression of thesis, antithesis and synthesis. Psychoanalytic theory is in a beginning synthesis phase of its own development and may add to synthesis in allied disciplines.

Fantasy is crucial to psychoanalysis because emotional meaning is therein experienced and expressed. Meaning is revealed more in the fantasy than behavior. Fantasy is a mediator of behavior, a motivator of behavior, but also, crucially, the experience of emotional meaning,

The problem is that much of fantasy is not conscious, or not fully conscious. When fantasy becomes intense, it becomes partially conscious. And xiv Preface there is the opportunity for the analysis of sexual experience. The conscious experience can lead to the unconscious fantasy.

There are fantasies that ate common in a group and that can involve the politics of the acceptable in the historical moment. But fantasy is most importantly individual. It follows emotional rules of organization. It is multi-determined and overdetermined. It reveals the unique growth and development pathways and influences that make us, and reveals us as, the unique individuals we are.

The reason we should focus on sexual experience and its details is because emotional meaning, organized as fantasy about the sexual details, helps us to know ourselves and others. All fantasy tends to follow Freud’s rules of the organization of emotional concepts, which he called the primary process. Central to the fantasy organization is the putting together, called condensation in the displacement to the details in the fantasy. For sexual fantasy and sexual experience, the details are the qualities of the sexual experience in the experience of the sexual body, self and other. Because sex is not static but rather an enactment over time, the details of the sequence will also contain the condensations of emotional meaning,

There is another reason, perhaps, that sexual details are scarce in psychoanalytic writing. It is because analysts are interested in emotional meaning, but emotional meaning that is unconscious is revealed through associations, and sexual experience may have limited or no associations.

The reasons for this usually understood by analysts are repression due to shame and guilt. But there is another reason. This has to do with the intensity of the lust affect experience. Lust is so intense, such a reward in and of itself, so linked to the specific anatomic and physiologic details of the body, conveyed through the sensory system, that it seems as if it is only what it is — just a property of the sexual object and the sexual activity. It is exciting, It is fun. Or it is fun and anxious. Or it is fun and guilty and shameful. But it is what it is. That is all that it is. Guilt and shame seem reactions to it rather than part of it. It is what it is may be a major resistance to the discovery of meaning both in the patient and perhaps in the analyst.

The error that analysts may make is to seek only associations to the behavior rather than first a detailed description of the qualities of the experience and then the meaning of those qualities, to be found in the associations to the experience of the details. This is the meaning the details represent and express. Thus is the inherent fantasy revealed. When you get only associations to the behavior, you get the attitude about the fantasy, not the fantasy. Both are interesting, But the second is crucial. It is the core.

The crucial beginning of meaning of sexual experience is to be found in the sexual experience. Behavior and qualities of experience are condensed with emotional meaning, Attraction is meaning, Qualities are mediating and express emotional fantasy. The marvelous qualitative sensory human brain is being

Preface xv harnessed as an information pathway for symbolic representation using the intense affect of lust.

So submerged is sexual meaning in the sexual action, that patients may say their experience would be true for anybody, a property of the sexual object and the sexual action. The answer is maybe yes, maybe no, but it has special meaning to the self, and the question is, what is that special meaning. The goal is to help the patient understand that sex in the sexual object or things in themselves are arousing as sensory stimuli but the arousal and the meaning are in the patient’s emotional self.

Because the analyst is also human, we are subject to sexual arousal and lust affect. We are therefore vulnerable also to reactions against and resistance to the sexual fantasy that lust triggers in us and that organizes our lust experience.

Our own unconscious neurosis may prevent the elicitation or elaboration or contemplation of significance or empathic reception of sexual material by the patient. While a hindrance, this can also be a growth and development pathway for the analyst over the course of a career. The observation of selfresistance can lead to the self-analysis of sexual fantasy scrupulosity. The opportunity for self-analysis and self-care, in parallel with care of the patient, is another reason for this book.

This book may help general psychiatry in its goal of the categorization of sexual pathology. Psychiatry has made considerable progress in the expanding of its categories. It must now relax its definitions so that categories are continuums and not rigidly boundaried. Rigid boundaries trap, and exclude, even as they specify. Data then gets sorted a priori. Categories rather should emerge from observational data. Psychoanalysis of the individual has to give to psychiatric diagnosis and epidemiology, the two concepts of individuals on a continuum and the qualitative as data, not just quantities of occurrences. Taken into account, these two most human features will make general psychiatry and its epidemiology more accurate and more useful.

For psychoanalysis, the book helps to contribute to phenomenology, treatment and theory. These three are linked. They are linked as well to a fourth, which is empathic attitude. Psychoanalysts are interested in the emotional, in the unconscious emotional, and therefore the analytic phenomenology must include, if not center on, that. Accurate treatment depends on it. It will help empathic attitude. It will also help theory, because in psychoanalysis, theory is about clinical theory of mind. Clinical theory of mind is about the phenomena of human experience, including emotional meaning. Lack of accurate information about qualitative experience and associated fantasy limits the objective observational clinical science that psychoanalysis strives to be.

This is where modern ego psychology comes in. Embracing observational experience of the human mind, trying to describe it accurately in its complexity, conscious, preconscious, unconscious, modern ego psychology tries xvi Preface through accurate and complex description to develop a general psychology including all aspects of the human mind: the emotional, the cognitive, the sensory, and the relationships among them. This branch of psychology theory takes as its epistemological base, objective phenomenology. It therefore strives to describe our observations of what we categorize as reality experience and therefore by implication only, but importantly, the real world. It then takes the crucial step of including the observation of mental phenomena as an aspect of the natural world. Because of the nature of mind, the theory takes another step to include the qualitative under the purview of objective phenomenology. Then it takes the next step of including the description of mental qualities in the science of mind. Importantly, the science of qualities is more akin to social science than to physical science. Social science in the 20th century shifted to quantitative science but has rediscovered qualitative science in the 21st century.

Interestingly, one can quantify qualities. One can run certain mathematical and statistical operations on them. But in order to usefully do so, they must be counted without diminishing or changing the qualitative information. This requires a technique of science wherein the categories emerge from the data. Categories are not a priori imposed. If you do so, you will eliminate that which is most important to be counted, the individual qualities. Therefore care must be taken to preserve the original qualitative meanings. Otherwise you ate counting the counting and not the phenomena.

One must also be careful about the purpose to which the counting is put. For some purposes, counting is appropriate. For other purposes, counting is both useless and misleading. The story of meaning is an emotional narrative, a story, not just a sequence of event occurrences. Different narratives or similar narratives from different people may have similar elements and similar meanings the quantifying can help clarify, but, ultimately, for each individual, the meaning is unique.

The book is also intended as an illustration of intense emotional qualitative experience called thing presentation phenomena and experience. Thing presentations are sensory-emotional experiences, both at once, that illustrate as we experience. The meaning of what we experience is illustrated in what we experience. They are a basic aspect of human mental function. They are an important information highway. They are an important aspect of creativity. They present themselves to the mind preformed as an “aha” experience. They play a role in all creativity, from poetry to science, from Yeats to Einstein. They are an experience of a thing in itself. The mythical Kantian “das ding,” It was first described as a neuro-mental phenomena by Freud. They are consciously apparent in dreams, in delusions and hallucinations, in art and, now the point, in sexual experience. It seems as though the qualities of meaning are inherent in the physicality of the thing. This is why it will be hard to analyze, because the patient experiences it as an other. The experience is therefore of an arousing body part, arousing because of

Preface xvii the body part, not because of the meaning of the body part to the person aroused. Therefore, it seems as though there’s nothing to talk about except the qualities of the body part. It is the analytic task to focus on that experience, the qualities of the body part, qualities of action on the body part, because in the experience is condensed the emotional meaning, The place to look is in the qualities of the body part as experienced in the patient’s sensory emotional system. Just like a dream.

This book is primarily intended for teaching. Used for information and description of phenomenology, it can then lead to the discussions that help work through the material so that the beginning analyst and therapist can approach sexually charged patient reports and use them to help.

An immediate problem in teaching is either the avoidance of or provocation by explicit sexual material, particularly in those just starting out. Because it is exciting and arousing, the young therapist and analyst immediately worry that it is wrong for the therapist and analyst to feel it. Reassurance about countertransference doesn’t quite work because they don’t experience it as countertransference. They experience as independent arousal to listening to sexually arousing material. It is like porn. This feels like voyeurism. It doesn’t feel as though it is in response to the patient but rather an independent reaction in the student analyst. This is true, but it also involves the countertransference fantasy to sexual material itself that frequently troubles the beginner. It may be more troubling to the non-physician who hasn’t already had to wrestle with the emotional evocation and burden of nakedness, exposure, intrusive physical procedures, patient reactions and physician counterreactions. Having come to some equilibrium with that, the sexual material is actually less of a challenge, although not easy. But the challenge for them is that medical training teaches the suppression and repression of emotional response to the physical. So the physician can tolerate the material but not the fantasies that it provokes. The non-physician analyst or therapist may be overwhelmed by the actual sexual descriptions and the fantasies it provokes.

The next is the beginner’s unconscious assumption of normative. Often they think, without full awareness, that they know what is normal. Like the famous supreme court justice, they know abnormal when they see it. They may have been taught in medical school and graduate school about sex surveys and what epidemiology shows to be normative. The normative is then taken without sophisticated explanation as equivalent to normal. On the other hand, the young may say that sex is just sex and anything goes and why go deeper because there isn’t any deeper. But that, of course, is a fantasy of its own. It’s a fantasy about sport fucking, It’s a fantasy that sex is what it is and is all that it is. To the experienced analyst, that’s OK because that is actually a fantasy about sex and an experience of sex. Sport has deep meanings. It has its own object relations. It’s the object relations of a sport, somewhat competitive, somewhat mutual, give to get and get to give, transactional, with the goal of orgasm and no intimacy or permanence implied. This can be true xviii Preface for both parties. Web apps have made the sport an easily available hobby. But it has that deeper transactional meaning, and the meaning of that meaning.

Now can be the time to teach growth and development of psychology, with a focus on emerging adult challenges of linking sex and intimacy. This will introduce the growth and development trajectory of object relations in human relationships, and the lines of development of ego functions and ego processes that organize, enclose, condense, symbolize and integrate object relations. These processes are so well illustrated by the growth and development of sexual experience.

It is also a good time to teach empathic holding, because lustful excitement can disrupt the taking in, the experience of, the associations to and the contemplations about patient experience. It gives a chance to discuss what empathic holding is, in all its complexity and attitudinal requirements, as well as some of its disruptors and defenses. It is this complicated process that is basic to psychoanalysis and to psychodynamic psychotherapy. Lustful excitement is often a greater disruptor then patient rage.

Both are the challenges of tolerating affect intensity and associated evoked fantasies and perhaps painful conflict of memories. The patient may be a step ahead of the analyst in the toleration of the lustful fantasy. This is because the analyst has worked hard on the defenses against it in the patient but not necessarily in themself. Particularly if the sexual material touches on and evokes sexual fantasy that is in neurotic conflict within the analyst, then the difficulty can be intense. But it also offers the opportunity for self-analysis, or within their therapeutic analysis if that is going on for the therapist. Hither way, the experience of listening to and therapeutically holding intense sexual fantasy offers the opportunity for growth and development in both parties of the therapeutic alliance as it potentially does with any two people in their everyday sexual life with each other.

This book can also be used to teach and discuss technique, both in general and specifically with sexual behavior and fantasy. It is all the same technique with different degrees of difficulty because of different degrees of resistance in the patient and in the analyst, depending on the content of the fantasy of which sexual fantasy is one of the most intense and the most triggering of guilt and shame.

One problem that authors of books like this have is the claim of their colleagues that examples are all made up by the author and show their proclivities not patients. This accusation is particularly from analysts who have not been able to elicit such fantasy material in their patients. The accusation is logically a bit irrelevant because even if it’s true, the made up is also a revelation of sexual fantasy and the only question is its accuracy and applicability to patients. Masud Khan is thusly accused, but I have found his descriptions very consistent with patient reports. If he made them up, was talking about his own fantasies, he reported them accurately, perhaps based on his experience not only of himself but of his patients. In any case, because of

Preface xix privacy considerations, the analyst must disguise and thereby change, thus to contaminate and create. It is inevitable. But again, this is always the problem even in the consulting room, listening to intense sexual material. Better to read and learn then reject and attack.

The other worry that analysts have about human sexuality in the consulting room is the fear of boundary crossing where analyst and patient become sexually involved with each other in reality behavior. This is an important and real worry. It is one of the burdens placed upon us and requires us to mentally lash ourselves to our chaits as we pass the sirens of desire, like brave Odysseus. By doing the work, we accept this challenge; to experience fantasy mentally yet keep it separate from action. But this is a daily struggle in all human beings about many different emotions and fantasies. It is very hard if vulnerable in our own lives. It is why psychoanalytic treatment is not only helpful but probably mandatory for anyone who wants to do this work. It is obviously helpful if the analyst’s own therapeutic analysis includes sexual behavior and sexual fantasy. If it does not, what chance will there be for it to be explored safely or at all with patients. Granted those who can’t do teach, but, in this case, treating a patient is not only teaching but doing. The problem is to feel but not to do; to contain the doing to fantasy.

A problem of pedagogy is when a course on human sexuality involves a grade. This adds a burden of resistance to the discussion because the student may feel they will be graded on their normalcy. This is a particular problem if they have more unconscious guilt and shame than they realize. The burden will be placed on the teacher to discuss this openly and create a pedagogical attitude and learning environment that can receive sexual information and discuss it.

One boundary that is useful is the boundary against too much selfdisclosure in the classroom by the students. This is what is frightening for them. They will usually regulate it as tolerated by them, especially if they are not expected to be, nor are called upon to be, revelatory. They can sometimes be more revelatory than they realize in their discussion but it then behooves the teacher never to interpret them. The focus is on the patient’s material and what is evoked by the patient’s material, and is therefore relevant to the patient not the student. Of course, this does not preclude, but even more so requires, a discussion of guilt and shame in relationship to sexual fantasy. Students nowadays, can be quite comfortable with sexual activity in all its varieties but the teacher should not make the mistake of thinking that means they are comfortable with sexual fantasy, neither the patient’s nor especially, perhaps, their own.