THE AMERICAN JOURNAL OF PSYCHOANALYSIS 38:143-154 (1978)
A PSYCHOANALYST'S EVALUATION OF THE SEXUAL REVOLUTION Harry Gershman
So many meanings have been attached to the words "psychoanalysis" and "revolution" that we must first define the terms. Karen Homey once said that a person perched on the shoulders of a giant can have a greater perspective than the giant himself. Although our theory of psychoanalysis is based on Freud's discoveries of dynamics, unconscious, transference, countertransference, resistance, free association, and dream interpretation, Homey went beyond Freud's instinctivistic libido theory and his notions of feminine psychology. Building on Freud's foundation, Homey placed greater emphasis on the constructive, humanistic potentialities and looked upon the multiplexities of varied forms of psychopathology as consequenses of obstruction in growth. She believed that the driving force in every individual was self-realization and that the neurotic self-idealization and self-despising that most of our patients suffer from are the results of the failure to realize one's potentialities. Her teachings focus on these universal conflicts that are common to both men and women. Since Horney's time, many other approaches to psychoanalysis have emerged; although they have not been totally original contributions, they have placed greater emphasis on different aspects of the nature of psychoanalysis. Examples are Esalen experiment, gestalt therapy, transactional analysis, behavior therapy, scream therapy, eastern-oriental philosophies, est, and meditation philosophies. Some of these therapies are predominently faddish and gimmicky. It was obvious that some were practiced by the lunatic fringe, by the untrained, undisciplined, narcissistically hungry, power-desirous charlatans, con men, and medicine men as magical, instant, and effortless cures. But others raised serious questions and could not fit with any preconceived theories. The recent avalanche of new and different approaches to emotional illness has stimulated a search for common denominators that are effective in psychotherapy. In spite of the parochial approach of each of the many schools of psychotherapy it stands to reason that if many obtain similar clinical results, Harry Gershman, M.D., is Dean of the American Institute of Psychoanalysisand Training and SupervisingAnalyst,American Institutefor Psychoanalysisof the Karen Horney Psychoanalytic Institute and Center. 143
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there must be factors that are common to all of them. After studying many different approaches, Judd Marmor has found the following common denominators in effective psychotherapy: 1 (1) good doctor/patient relationship; (2) release of tension through ventilation and talking to one in whom there is a measure of trust; (3) corrective emotional experiences with the therapist; (4) suggestion and persuasion (overt but more often covert); (5) reconditioning toward a more adaptive behavior patterned by explicit or implicit approval or disapproval cues; (6) repeated reality testing or practicing of new adaptive techniques; (7)implicit or explicit emotional support; and (8)identification with the therapist, especially with the therapist's constructive values. The term "sexual revolution" has become almost a household word, yet it is difficult to define. It does not refer to the biological aspect of sexuality, which is the product of the evolutionary biological changes over centuries. The changing sexual climate has not resulted from any biological changes occurring over the last three decades, but drastic changes in attitudes and mores toward sex have occurred during this period. During the last three decades, there have been social changes, scientific discoveries such as atomic energy and genetic engineering, political, economic, and philosophical changes that boggle the mind and promise even more "future shock" to come. It is small wonder then that our sexual attitudes have undergone changes too. History has shown repeatedly that when there is an avalanche of change within a short time, values and mores change radically too. Our sexual values and mores derive in Western culture from the ChristianJudaio religion, which placed emphasis on sexuality for procreation. We are confronted by a population explosion that threatens to outgrow not only our food supply, but our geographical space, and with the development of the pill, the IUD, and other contraceptive techniques, our attitudes toward sexuality are undergoing changes. Sex for recreation rather than procreation is emerging. Religious dictates are fast losing grip on believers. Orthodox religion has generally looked down upon body functions, including sexuality, as animalistic and therefore inferior to the spiritualistic dimensions of mankind. It is on ly during the last 50 years that holism has become a dominant theme of human nature. Dualism of mind and body gave way to the appreciation that the split between mind and body is only a mental abstraction. The sexual revolution is but one aspect of the changing values, attitudes, philosophies, and scientific discoveries of our current culture. Because of mass communication via television, radio, movies, and education, the process is greatly accelerated. The last decade of sexual freedom and liberation, the absence of obscenity laws, scientific sexual research, women's liberation, X-rated movies, and increased sexual education contributed greatly to our current revolution. Like all revolutions, there are positive and negative aspects. On the positive side, the cloak of hypocrisy, guilt, anxiety, sinfulness,
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duplicity, and mysticism that has draped the whole topic of sexuality is being removed. But on the negative side, there is changing focus on sex from the spiritual-psychological one to the technical-anatomical. Man's sexual appetite is as primary as any other biological or psychological drive such as hunger, security, companionship, and communication. The physical survival of the species depends on man's sexuality. In the lower forms of life, sexuality is controlled primarily by reflex action. As we ascend the evolutionary scale, the reflex nature of the sexual response changes as a result of more cerebral intervention. Nevertheless, the biological-sexual substrata remains as the core of our mammalian heritage. It can be said, however, that sexuality in man has moved upward. There is a lot of truth in the statement that sex is more what goes on between the ears than between the legs. This intervention by our brain on the fundamentally simple sexual reflex response creates all kinds of modifications. It can reach two extremes. At one end of the spectrum are all variants of psychopathology of the sexual response, including all forms of frigidity, impotence, and erectile and secretionary dysfunctions. At the other extreme is the integration of a healthy sexual response, integrated and embedded in a human relationship ,of warmth, affection, trust, love, intimacy, and commitment. Between these two extremes, of course, are all degrees of variation. What accounts for the differences? The answer lies in how the mind uses the underlying sexual capacity. Sex can be integrated into the bizarre, sick neurotic, or psychotic behavior, or it can be interwoven in the most sensual, loving, intimate relationship between two human beings. The key question is: for what purpose is sexuality being used by the individual, both consciously and unconsciously? Since the basic biological sex drive is dominated by the mind, it stands to reason that vicissitudes of the mind can and do affect our sexual functioning. Biological sexual drive is not a given quantum of energy remaining constant for all human beings. Just as there are variations in temperaments that are more or less fixed by constitution, so the sexual drive varies in intensity in different people within certain limits. The male sex drive is generally higher in the late teens and early twenties and then diminishes some with advancing years. In women, the sex drive matures at age 30. Nevertheless, the intensity of the sex drive is much more affected by the mind as it is used in the service of various emotional needs. A number of years ago, a very attractive girl in her early twenties consulted me because of what she called her "avaricious sexual appetite." She had slept with 35 different men in the past five to six days and was not satisfied with any of these experiences. "Doctor, can you help me with this uncontrollable urge?" she asked me. I suggested that I might if l could understand more about her. She remarked that I must have concluded that she was suffering from a psychological problem, to which I assented. She replied that I was on the
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wrong track, that she was suffering from a biological drive. "God gave me this insatiable need for sex[" Reluctantly, she admitted that for most of her life she suffered from feelings of ugliness, depression, inferiority, unlovability, emptiness, worthlessness, and anxiety. Objectively, she seemed to me as an unusually beautiful, very intelligent, charming, and talented girl, which was quite different from how she perceived herself. She was using sexual intimacy as a means of tranquilizing her numerous anxieties, a very common human psychological defense. After several years of psychotherapy, her whole level of anxiety diminished greatly. Her compulsive sexuality abated. Now she seems happily married and enjoys her two small children very much. Her intimate life with her husband is good. She is now convinced that her compulsive sexual drives were not biological in origin, but merely a sexual drive in the service of allaying anxieties stemming from neurotic sources. At the other end of the spectrum is another girl who has parallel objective qualities, but who was terrified of sex or any other form of human closeness. On her wedding night she had such a severe case of vaginismus that her Iovi~ng, sensitive, and perceptive husband could not even penetrate her vagina with his index finger. Gynecological examination disclosed no organic basis for this spastic condition. She had suffered many traumatic experiences with a sadistic father and brothers who had violated her physically and emotionally during her formative years. Many months of therapy finally resulted in a diminution of her fear of being penetrated. Her unconscious fears and bizzare fantasies of being ripped apart gave way to a more trusting attitude toward her husband. Thus we can see that biological sexual drive with which we are all endowed can be used by the individual in various ways to overcome underlying psychological conflicts--in one instance by insatiable compulsive sexuality, in another by completely closing off natural sexual desires. These two clinical examples might suggest that only successful psychoanalysis can correct sexual dysfunctions. Obviously, successful reports by other reliable and trustworthy workers in the field would cast doubt on such a conclusion. Nevertheless, the common denominators that Marmor has described constitute the core of all effective therapy, whether the therapy is relatively short and superficial or prolonged, intensive, and deep. When Masters and Johnson published their important study of human sexual inadequacy,21 must confess that I was rather skeptical of their optimistic published results of such well-known clinical syndromes of frigidity, impotence, premature ejaculation, and vaginismus, for I could not match such results in my clinical practice. I studied their methods and found myself almost surreptitiously incorporating some of their findings into my therapeutic techniques. I found myself becoming much more active, confronting, and
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involved with my patient's specific sexual problems. Nevertheless, I soon realized that these clinical syndromes varied greatly from patient to patient. The spectacular results first described by Masters and Johnson could be achieved where the sexual problem stemmed from superficial inexperience, lack of basic psychological knowledge, and general immaturity. In such instances, progress is rapid and results excellent. However, if the sexual dysfunction is interwoven in extensive psychopathology, affecting the whole character structure, the necessary time is greatly prolonged, much more difficult, and the results not nearly so gratifying. Only when the total personality is relatively intact and healthy and the sexual problem is compartmentalized is the prognosis good. When the sexual symptom is another expression of the total neurotic character structure, the analytic work is arduous. Psychoanalytic principles are the lifeblood of effective sex therapy as they are for the whole character therapy. For instance, if a man's premature ejaculation relates primarily to a fear of humiliation or anticipatory failure, that symptom could be more quickly resolved than if his premature ejaculation relates to a lifetime of hostility to women, conscious or unconscious, a need to frustrate and defile women, an irrational fear of losing control, a terror of feeling, extensive and prolonged patterns of alienation from the whole spectrum of his feelings, and a pattern of thinly disguised sadomasochistic interpersonal relations. Although the sexual experience is a biological response, its meaning to the participants is psychological. It can be used to satisfy both healthy and unhealthy needs. On the unhealthy side, sexuality is one of the oldest natural tranquilizers. Sexuality may quell doubts of losing attractive qualities that may rationally or irrationally be attributed to aging, putting on weight, illness, experiences of failure or rejection, surgical amputations, etc. People who have fears of emotional commitment may attempt to avoid facing such problems through multiple sexual encounters, focusing on mechanical orgastic or nonorgastic pleasure without the accompanying affection, tenderness, or mutual reciprocity. Sexuality, particularly heterosexuality, can be used to quell doubts of emerging suppressed perverse sexual impulses. The sexual experience can have different meanings to different people, depending on the value they attach to it. I have already mentioned the fact that it can be integrated into the highest level of human intimacy. On the other hand, it can be reduced to its lowest biological level. Then sexual intercourse is devalued and can be experienced as being no more important than the biological function of urinating or defecating. Sexuality in the service of neurotic needs is as multiple as the infinite variety of neurotic needs, Sexuality is one component of the spectrum of sensuality that is innate in every person. Although sexuality may be repressed or accentuated, generally it reflects the whole spectrum of sensuality. Thus, people
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who feel detached, alienated, and empty either use their sexual experience as a bridge toward feeling something in relation to another human being or become resigned and avoid any measure of human intimacy, becoming completely asexual. The ultimate of such a condition can be observed in regressed schizophrenics who are cut off completely from the world and who probably derive some sense of aliveness through their compulsive masturbation. Among less emotionally debilitated individuals, sexuality serves a variety of functions. Sexuality is an antidote to the anxiety stemming from feelings of unloveability, boredom, undesireability, and worthlessness. An inability to communicate effectively is often replaced by compulsive sexuality. This phenomenon is often particularly observed in some homosexuals and heterosexuals who engage either in one-to-one relationships or in group orgies completely anonymously, often without seeing each other except for genital contact. In some instances, when personal interactions are established, their sexual interest in one another evaporates. Where self-contempt and self-deprecation predominate, sexuality is often characterized by a desire for masochistic defilement, such as wanting to be urinated or defecated on, beaten, tortured, or physically tormented. Horney's character typology of the self-effacing, expansive, and resigned types, 3 while not occurring in pure forms, can be delineated in the use of sexuality. More often a mixture of all three solutions can be observed in how an individual uses his or her sexuality. The self-effacing person will welcome defilement and belittlement and preoccupation with fulfilling the other person's sexual expectation. The expansive individual will use sexuality to dominate, frustrate, and control, and feel omnipotent in the process. The resigned person may use sexuality only to overcome extreme isolation, loneliness, and unrelatedness and will passively absorb any humiliation and belittlement in order to overcome the overwhelming void and emptiness of his existence. Occasionally, the resigned person will adopt a rebellious strategy and use sexual experience as a means of defying the partner by frustration, bringing him to the height of passion, and then letting him down without full consummation of the sexual act. Circumscribed sex therapy, with which I have little experience, is an outgrowth of our current sexual revolution. As I understand it, it is a technique directed predominantly to sexual dysfunctions. Although it incorporates psychoanalytic principles when necessary, it is primarily a here-and-now experience with a couple who desire to resolve sexual problems. Utilizing one or two sex therapists, its goal is to resolve this problem by educating, prompting communication, dissolving distorted and anxiety-ridden fantasies about sexuality, and building up the confidence of the couple to overcome the anxieties, conflicts, and fears connected with sexuality. The therapists
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serve as catalysts to achieve this through emotional support, persausiveness, and matter-of-fact acceptance that sexuality is an unalterable dimension of men and women who, if rid of their fears, and who--when they develop a degree of trust, affection, and commitment~can overcome their resistance and discover that sexual functioning can occur with pleasure and fulfillment. Now to get back to the main theme of this paper. Above, I mentioned the positive elements of the radical changes in our sexual attitudes. I stated that getting away from centuries of deprecation of sexuality as something sinful, dirty, clandestine, and secretive is a healthy change. Freud stated that if man could discover an effective contraception, neurotic symptoms would disappear. "It cannot be denied that contraceptive measures become a necessity in married life at some time or other, and theoretically, it would be one of the greatest triumphs of mankind, one of the most tangible liberations from the bondage of nature to which we are subject; were it possible to raise the responsible act of procreation to the level of a voluntary and intentional act, and to free it from its entanglement with an indispensible satisfaction of a natural desire. ''4 Now we can see that Freud was far too optimistic about the disappearance of neurosis when and if adequate methods of contraception could be discovered. Certainly, we have achieved adequate contraceptive control. Yet the incidence of neurosis, I think we would all agree, has not diminished; on the contrary, it seems to have increased. Hence the notion that tile cause of neurosis lies in sexual frustration becomes dubious. The sexual revolution is far from completed, and it is difficult to predict its final form; but I believe we can begin to perceive its outlines. Sexuality has come out of the closet. It has become an open, honest, guiltless, and shameless topic for discussion. Its liberation from multiple taboos of long duration has exposed it to direct inspection, research, and understanding. The women's liberation movement has tried to diminish the long-standing double standard. Men and women are on almost equal footing in dealing with their innate sexual drives. Hence, if relatively mature, they can exercise choice in their fulfillment. For a man or woman to accept his or her sexual ity as a natural endowment to be integrated with man's highest potential for closeness, commitment, affection, tenderness, pleasure, and caring is an ideal that, although while not frequently achieved, is worth striving for. Using sexuality in the service in the infinite variety of neurotic needs is to pervert it to a weapon that can only harm both participants in the long run. Unfortunately, so far, the sexual revolution is placing too much emphasis on achieving physiological-mechanical success. Plays that often reflect the current status of society more often emphasize the orgasm--number, frequency, and intensity--than the content of the emotional relationship of the partners. We are observing evidence of tremendous peer pressure, not only
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among adolescents but adults, to experience the gamut of sexual experiences rather than responding to feelings and inclinations. Thus, we see youngsters who engage in various forms of sexuality because it's the thing to do. At one time, a young girl was ashamed to lose her virginity; now she's ashamed to retain it. I am not defending the notion that a girl or boy should remain a virgin, but rather am deploring that sexual exploration is encouraged by peer pressure rather than occurring in response to innate growth, development, feelings, and commitment to a relationship. On the negative side, the sexual revolution has resulted in a number of adverse effects on human relationships. Creeping subtly into our mores is the notion that any form of sexuality is acceptable--that bisexuality, homosexuality, transsexuality, sadomasochism, exhibitionism, fetishism, and any other form of compulsive sexuality is "just as good" and meaningful as heterosexuality. Currently, in the "jet" set, bisexuality is considered the most desirable form of compulsive sexuality, is "just as good" and meaningful as heterosexanonymous sex in a group setting, orgies, and even switching partners just for kicks--particularly under the influence of powerful drugs--are quite common. These activities cut across all levels of society. The removal of legal restrictions and prohibitions has opened the doors to widespread prostitution associated, as it always seems to be, with crime, pimps, venereal disease, and general degradation of human interrelationships. Often as a consequence, there results a reduction of sexuality to a simple physiological response similar to other biological responses. On the less sordid side, there certainly has been an increase in sex for immediate pleasure without any intent of commitment to a relationship, simply to fulfill a necessary "recreational" function. John Money, professor of medical psychology at Johns Hopkins, asserts that there is an imperative need for a new ethic of "recreational" sex in view of contemporary contraceptive methods and the world population excess. He predicts a new ethic of recreational sex with minimized sex-coded roles. He dismisses established and traditional sexual codes as "anti-sexual, antiheretical and antiscientific." He states that the meaning of sex and sexual behavior must undergo drastic revisions. If these revisions result in diminution of mutuality of physical and emotional love and dependece existing between two individuals--a bond that is being continually deprecated by many of the new "sex researchers"--then I can foresee radical devaluation of sexuality. What he is predicting is that pair relations will become less permanent and that couples engage openly in a wide range of sexual relations with friends, other couples, and third parties, under the illusion that this will not affect the primacy of their own relationship. I believe that he is wrong. Unfortunately, such patterns are already emerging in the United States and elsewhere. It is a fallacy that this will not devalue sexual relationships.
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It remains for the future to tell whether this solution will not accelerate the destruction of the nuclear family. I consider the nuclear family as the cornerstone of society, not just from a moral point of view; gender identity is an outgrowth of such a social structure. If the nuclear family structure is destroyed, there will be more confusion in gender identity than prevails now. The cement of the family structure is in the quality of the relationship of the parents. If sexuality is practiced solely for immediate gratification, without respect, affection, love, commitment, sincerity, honesty, and mutuality, the offspring will, to my mind, suffer greatly. As analysts, we see all too frequently the psychological havoc that prevails when the environment of the family atmosphere lacks these necessary ingredients. It seems to me that the current sexual revolution is swinging too far in encouraging participation in such sexual practices that derive not from one's feelings and inclinations but rather from the mistaken notion that "everything goes." In healthy sexuality, the experience is integrated in the entire personality. The relationship is characterized by a measure of affection and mutuality and a desire to obtain, as well as to give, pleasure. There is communication between the partners, whether it is verbal, tactile, olfactory, visual, or auditory; caring and tenderness are ever-present. The mechanical aspects are suffused with a spirituality, joy, pleasure, and fulfillment; this experience is the most intimate that two human beings are capable of achieving. The physiology of the act occurs quite naturally, and the participants are not self-conscious about what they are doing. Since man's capacity to adapt to various patterns of behavior is almost infinite, different cultures have evolved many different attitudes and mores and values, particularly toward sexuality. Inasmuch as we are particularly concerned with our own culture, we have to focus on the rapidly changing attitudes toward sexuality in our own culture over the past decade. Contraception, the increasing freedom from religious dogma that constrict sexuality only to procreation, the pervasive mobility away from the nuclear family, and changing values including the breakup of the stereotyped male and female roles, and the increased basic knowledge of human sexual physiology have all contributed to our current sexual revolution. Like all radical changes, the consequences are both positive and negative. Surely the removal of sexuality from the web of ignorance, superstition, and religious dogma is positive. The realization that the sexual physiological response can get entrapped in a web of psychological conflicts and take many distorted forms, referred to as psychopathological patterns, has stimulated a great number of therapies calculated to free this basic physiological sexual response so that it be experienced freely, guiltlessly, joyfully, and pleasurably, and bring the partners to a high level of human intimacy and fulfillment. These gains have been inevitable as scientific knowledge has increased at an ever-accelerating
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pace. The gains are tremendous. But it is also time to assess the losses and to see if anything can be done to minimize them. The losses seem to me to come out of the changing focus about sex from a spiritual-psychological one to a technical-anatomical one. Some people have somehow forgotten that the essence of human sexuality has always been and still is in the mind. Learning 40 different positions is not necessarily going to make sex more exciting. Powerful and exciting orgasms have occurred during dreams, yet there is no technique or anatomical stimulation necessary. Lightly touching the hand of a person you are romantically in love with or a person who is taboo may be more excitingthan participating in any orgy. Some of us have somehow forgotten this in the past decade. The first look at pornography can be a tremendous turn-on, but the tenth or twentieth hardly is. Similarly, we have been turned on by recent license and the removal of restrictions and inhibitions. But now the excitement is greatly diminished. Perhaps our scientists could slow down a bit in measuring clitoral length and cutting clitoral adhesions and teaching us the squeeze technique for our premature ejaculators. Let us stop worrying whether our orgasms are clitoral or vaginal and whether we maintain our erections for 5.2372 minutes. Analysts used to approach these problems by deep inquiry into what was wrong with mind, soul, and feelings of a person with a sexual dysfunction. Subsequently, we became involved in trying to understand the measuring of his existence, his emotional needs self-concept, and the way he related to other people. Throwing him offthis route and focusing on practical pragmatic aspects of his sexual functioning may help him to function. But one of the important ills of our society is our focus on functioning and adaptation rather than on our emotional and spiritual relationship to the world and to ourselves. It is not uncommon for a patient in analysis to come in functioning perfectly in sex and in the rest of his life, but to feel cut off from himself and the rest of the world--namely, deeply alienated from his feelings. By helping people to adapt, adjust, and function, we may very well be helping them get into a frame of mind--highly endorsed by our industrial society--that functioning is more important than being. Horney's concept of the "real" self vs. the "idealized" self or "false" self--the facade that we show to the world--is crucial to our discussion. In the past decade, the way we have dealt with sex has strengthened the "false" self. It makes people look good on the outside and perform well. But is this our real self--the "core" of our genuine feelings--the real feelings? Too many people in our times are alienated and disconnected from their feelings and depend solely on intense stimulations. Are we becoming dehumanized, wellfunctioning sex machines that do not really connect with our inner selves, from which spring the feelings of warmth, tenderness, caring, communication, affection, and love? I think that too often sex has become as plastic as
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most other things in our society. Sex used to be the last bastion of individuality and selfhood that is unique for each individual. Now it is too often cast into mass-production molds with focus on the right technique and the right kind of orgasm. The paradox is that one can function well and pass all the current tests, and yet be totally alienated from the experience, except for the neurotic pride that one has achieved all the standards currently expected by our society. Clinically, we have all had experience of working with schizophrenic people who almost always have serious problems with intimacy, yet retain orgasmic capacity. In writing this paper, I have hoped to share with you my reflections, as a psychoanalyst, on the current sexual revolution in our ever-changing mores. I have tried to outline the many positive consequences of these radical changes. Yet I have misgivings that negative consequences may outweigh the positive changes for the time being. It is not unusual in times of radical change for the pendulum to swing to extremes in either direction until it finds its reliable range. I am not a prophet and cannot foresee what that range will be. Although values and mores change as culture changes, I believe that there are values that will remain universal as long as human beings remain human beings. Sexuality, which is the core source of the perpetuation of our species, will not be relegated to a transitory experience of pleasure. Sexuality, when freed from centuries of our cultural-religious repression because it was considered animalistic, sinful, dirty, and taboo for discussion, will come more into.its rightful place--namely, a human experience that can bring the participants greater pleasure, mutuality, affection, and relatedness than any other experience. Then it can serve as a model for healthier children wl~o can then be brought up in an atmosphere that is truly loving, spiritual, and caring. I think that the current overswing of the pendulum that focuses mostly on the functional, orgastic and performance-achievement is a transitory phenomenon and that it will swing more toward the spiritual-psychological experience. I do not see any inherent incompatibility between our increasing knowledge of the physiology and psychology of sexuality. The core source of the pleasure in sexuality will remain the feelings of the participants for each other. Hopefully, as the incidence of neurosis diminishes, the motivation for sexuality will be less neurotic in origin and spring much more from the healthy feelings of the individual--namely his "real" self. This, of course requires a great diminution in the alienation that is so prevalent in our current society.
References
1. Marmor cites common factors in therapies. Psychiatric News, 10 (21): 1, 1975.
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2. Masters, W. H., and Johnson, V. E. Human Sexual Inadequacy. Boston: Little, Brown, 1970. 3. Homey, K. Neurosis and Human Growth. New York: Norton, 1950. 4. Freud, S. Sexuality in the etiology of neurosis. Collected Papers of Sigmund Freud, Vol. 1. Ernest Jones (Ed.). New York: Basic Books, 1959. Address reprint requests to 322 Central Park West, New York 10025.
A PSYCHOANALYST'S EVALUATION OF THE SEXUAL REVOLUTION Harry Gershman
So many meanings have been attached to the words "psychoanalysis" and "revolution" that we must first define the terms. Karen Homey once said that a person perched on the shoulders of a giant can have a greater perspective than the giant himself. Although our theory of psychoanalysis is based on Freud's discoveries of dynamics, unconscious, transference, countertransference, resistance, free association, and dream interpretation, Homey went beyond Freud's instinctivistic libido theory and his notions of feminine psychology. Building on Freud's foundation, Homey placed greater emphasis on the constructive, humanistic potentialities and looked upon the multiplexities of varied forms of psychopathology as consequenses of obstruction in growth. She believed that the driving force in every individual was self-realization and that the neurotic self-idealization and self-despising that most of our patients suffer from are the results of the failure to realize one's potentialities. Her teachings focus on these universal conflicts that are common to both men and women. Since Horney's time, many other approaches to psychoanalysis have emerged; although they have not been totally original contributions, they have placed greater emphasis on different aspects of the nature of psychoanalysis. Examples are Esalen experiment, gestalt therapy, transactional analysis, behavior therapy, scream therapy, eastern-oriental philosophies, est, and meditation philosophies. Some of these therapies are predominently faddish and gimmicky. It was obvious that some were practiced by the lunatic fringe, by the untrained, undisciplined, narcissistically hungry, power-desirous charlatans, con men, and medicine men as magical, instant, and effortless cures. But others raised serious questions and could not fit with any preconceived theories. The recent avalanche of new and different approaches to emotional illness has stimulated a search for common denominators that are effective in psychotherapy. In spite of the parochial approach of each of the many schools of psychotherapy it stands to reason that if many obtain similar clinical results, Harry Gershman, M.D., is Dean of the American Institute of Psychoanalysisand Training and SupervisingAnalyst,American Institutefor Psychoanalysisof the Karen Horney Psychoanalytic Institute and Center. 143
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there must be factors that are common to all of them. After studying many different approaches, Judd Marmor has found the following common denominators in effective psychotherapy: 1 (1) good doctor/patient relationship; (2) release of tension through ventilation and talking to one in whom there is a measure of trust; (3) corrective emotional experiences with the therapist; (4) suggestion and persuasion (overt but more often covert); (5) reconditioning toward a more adaptive behavior patterned by explicit or implicit approval or disapproval cues; (6) repeated reality testing or practicing of new adaptive techniques; (7)implicit or explicit emotional support; and (8)identification with the therapist, especially with the therapist's constructive values. The term "sexual revolution" has become almost a household word, yet it is difficult to define. It does not refer to the biological aspect of sexuality, which is the product of the evolutionary biological changes over centuries. The changing sexual climate has not resulted from any biological changes occurring over the last three decades, but drastic changes in attitudes and mores toward sex have occurred during this period. During the last three decades, there have been social changes, scientific discoveries such as atomic energy and genetic engineering, political, economic, and philosophical changes that boggle the mind and promise even more "future shock" to come. It is small wonder then that our sexual attitudes have undergone changes too. History has shown repeatedly that when there is an avalanche of change within a short time, values and mores change radically too. Our sexual values and mores derive in Western culture from the ChristianJudaio religion, which placed emphasis on sexuality for procreation. We are confronted by a population explosion that threatens to outgrow not only our food supply, but our geographical space, and with the development of the pill, the IUD, and other contraceptive techniques, our attitudes toward sexuality are undergoing changes. Sex for recreation rather than procreation is emerging. Religious dictates are fast losing grip on believers. Orthodox religion has generally looked down upon body functions, including sexuality, as animalistic and therefore inferior to the spiritualistic dimensions of mankind. It is on ly during the last 50 years that holism has become a dominant theme of human nature. Dualism of mind and body gave way to the appreciation that the split between mind and body is only a mental abstraction. The sexual revolution is but one aspect of the changing values, attitudes, philosophies, and scientific discoveries of our current culture. Because of mass communication via television, radio, movies, and education, the process is greatly accelerated. The last decade of sexual freedom and liberation, the absence of obscenity laws, scientific sexual research, women's liberation, X-rated movies, and increased sexual education contributed greatly to our current revolution. Like all revolutions, there are positive and negative aspects. On the positive side, the cloak of hypocrisy, guilt, anxiety, sinfulness,
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duplicity, and mysticism that has draped the whole topic of sexuality is being removed. But on the negative side, there is changing focus on sex from the spiritual-psychological one to the technical-anatomical. Man's sexual appetite is as primary as any other biological or psychological drive such as hunger, security, companionship, and communication. The physical survival of the species depends on man's sexuality. In the lower forms of life, sexuality is controlled primarily by reflex action. As we ascend the evolutionary scale, the reflex nature of the sexual response changes as a result of more cerebral intervention. Nevertheless, the biological-sexual substrata remains as the core of our mammalian heritage. It can be said, however, that sexuality in man has moved upward. There is a lot of truth in the statement that sex is more what goes on between the ears than between the legs. This intervention by our brain on the fundamentally simple sexual reflex response creates all kinds of modifications. It can reach two extremes. At one end of the spectrum are all variants of psychopathology of the sexual response, including all forms of frigidity, impotence, and erectile and secretionary dysfunctions. At the other extreme is the integration of a healthy sexual response, integrated and embedded in a human relationship ,of warmth, affection, trust, love, intimacy, and commitment. Between these two extremes, of course, are all degrees of variation. What accounts for the differences? The answer lies in how the mind uses the underlying sexual capacity. Sex can be integrated into the bizarre, sick neurotic, or psychotic behavior, or it can be interwoven in the most sensual, loving, intimate relationship between two human beings. The key question is: for what purpose is sexuality being used by the individual, both consciously and unconsciously? Since the basic biological sex drive is dominated by the mind, it stands to reason that vicissitudes of the mind can and do affect our sexual functioning. Biological sexual drive is not a given quantum of energy remaining constant for all human beings. Just as there are variations in temperaments that are more or less fixed by constitution, so the sexual drive varies in intensity in different people within certain limits. The male sex drive is generally higher in the late teens and early twenties and then diminishes some with advancing years. In women, the sex drive matures at age 30. Nevertheless, the intensity of the sex drive is much more affected by the mind as it is used in the service of various emotional needs. A number of years ago, a very attractive girl in her early twenties consulted me because of what she called her "avaricious sexual appetite." She had slept with 35 different men in the past five to six days and was not satisfied with any of these experiences. "Doctor, can you help me with this uncontrollable urge?" she asked me. I suggested that I might if l could understand more about her. She remarked that I must have concluded that she was suffering from a psychological problem, to which I assented. She replied that I was on the
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wrong track, that she was suffering from a biological drive. "God gave me this insatiable need for sex[" Reluctantly, she admitted that for most of her life she suffered from feelings of ugliness, depression, inferiority, unlovability, emptiness, worthlessness, and anxiety. Objectively, she seemed to me as an unusually beautiful, very intelligent, charming, and talented girl, which was quite different from how she perceived herself. She was using sexual intimacy as a means of tranquilizing her numerous anxieties, a very common human psychological defense. After several years of psychotherapy, her whole level of anxiety diminished greatly. Her compulsive sexuality abated. Now she seems happily married and enjoys her two small children very much. Her intimate life with her husband is good. She is now convinced that her compulsive sexual drives were not biological in origin, but merely a sexual drive in the service of allaying anxieties stemming from neurotic sources. At the other end of the spectrum is another girl who has parallel objective qualities, but who was terrified of sex or any other form of human closeness. On her wedding night she had such a severe case of vaginismus that her Iovi~ng, sensitive, and perceptive husband could not even penetrate her vagina with his index finger. Gynecological examination disclosed no organic basis for this spastic condition. She had suffered many traumatic experiences with a sadistic father and brothers who had violated her physically and emotionally during her formative years. Many months of therapy finally resulted in a diminution of her fear of being penetrated. Her unconscious fears and bizzare fantasies of being ripped apart gave way to a more trusting attitude toward her husband. Thus we can see that biological sexual drive with which we are all endowed can be used by the individual in various ways to overcome underlying psychological conflicts--in one instance by insatiable compulsive sexuality, in another by completely closing off natural sexual desires. These two clinical examples might suggest that only successful psychoanalysis can correct sexual dysfunctions. Obviously, successful reports by other reliable and trustworthy workers in the field would cast doubt on such a conclusion. Nevertheless, the common denominators that Marmor has described constitute the core of all effective therapy, whether the therapy is relatively short and superficial or prolonged, intensive, and deep. When Masters and Johnson published their important study of human sexual inadequacy,21 must confess that I was rather skeptical of their optimistic published results of such well-known clinical syndromes of frigidity, impotence, premature ejaculation, and vaginismus, for I could not match such results in my clinical practice. I studied their methods and found myself almost surreptitiously incorporating some of their findings into my therapeutic techniques. I found myself becoming much more active, confronting, and
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involved with my patient's specific sexual problems. Nevertheless, I soon realized that these clinical syndromes varied greatly from patient to patient. The spectacular results first described by Masters and Johnson could be achieved where the sexual problem stemmed from superficial inexperience, lack of basic psychological knowledge, and general immaturity. In such instances, progress is rapid and results excellent. However, if the sexual dysfunction is interwoven in extensive psychopathology, affecting the whole character structure, the necessary time is greatly prolonged, much more difficult, and the results not nearly so gratifying. Only when the total personality is relatively intact and healthy and the sexual problem is compartmentalized is the prognosis good. When the sexual symptom is another expression of the total neurotic character structure, the analytic work is arduous. Psychoanalytic principles are the lifeblood of effective sex therapy as they are for the whole character therapy. For instance, if a man's premature ejaculation relates primarily to a fear of humiliation or anticipatory failure, that symptom could be more quickly resolved than if his premature ejaculation relates to a lifetime of hostility to women, conscious or unconscious, a need to frustrate and defile women, an irrational fear of losing control, a terror of feeling, extensive and prolonged patterns of alienation from the whole spectrum of his feelings, and a pattern of thinly disguised sadomasochistic interpersonal relations. Although the sexual experience is a biological response, its meaning to the participants is psychological. It can be used to satisfy both healthy and unhealthy needs. On the unhealthy side, sexuality is one of the oldest natural tranquilizers. Sexuality may quell doubts of losing attractive qualities that may rationally or irrationally be attributed to aging, putting on weight, illness, experiences of failure or rejection, surgical amputations, etc. People who have fears of emotional commitment may attempt to avoid facing such problems through multiple sexual encounters, focusing on mechanical orgastic or nonorgastic pleasure without the accompanying affection, tenderness, or mutual reciprocity. Sexuality, particularly heterosexuality, can be used to quell doubts of emerging suppressed perverse sexual impulses. The sexual experience can have different meanings to different people, depending on the value they attach to it. I have already mentioned the fact that it can be integrated into the highest level of human intimacy. On the other hand, it can be reduced to its lowest biological level. Then sexual intercourse is devalued and can be experienced as being no more important than the biological function of urinating or defecating. Sexuality in the service of neurotic needs is as multiple as the infinite variety of neurotic needs, Sexuality is one component of the spectrum of sensuality that is innate in every person. Although sexuality may be repressed or accentuated, generally it reflects the whole spectrum of sensuality. Thus, people
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who feel detached, alienated, and empty either use their sexual experience as a bridge toward feeling something in relation to another human being or become resigned and avoid any measure of human intimacy, becoming completely asexual. The ultimate of such a condition can be observed in regressed schizophrenics who are cut off completely from the world and who probably derive some sense of aliveness through their compulsive masturbation. Among less emotionally debilitated individuals, sexuality serves a variety of functions. Sexuality is an antidote to the anxiety stemming from feelings of unloveability, boredom, undesireability, and worthlessness. An inability to communicate effectively is often replaced by compulsive sexuality. This phenomenon is often particularly observed in some homosexuals and heterosexuals who engage either in one-to-one relationships or in group orgies completely anonymously, often without seeing each other except for genital contact. In some instances, when personal interactions are established, their sexual interest in one another evaporates. Where self-contempt and self-deprecation predominate, sexuality is often characterized by a desire for masochistic defilement, such as wanting to be urinated or defecated on, beaten, tortured, or physically tormented. Horney's character typology of the self-effacing, expansive, and resigned types, 3 while not occurring in pure forms, can be delineated in the use of sexuality. More often a mixture of all three solutions can be observed in how an individual uses his or her sexuality. The self-effacing person will welcome defilement and belittlement and preoccupation with fulfilling the other person's sexual expectation. The expansive individual will use sexuality to dominate, frustrate, and control, and feel omnipotent in the process. The resigned person may use sexuality only to overcome extreme isolation, loneliness, and unrelatedness and will passively absorb any humiliation and belittlement in order to overcome the overwhelming void and emptiness of his existence. Occasionally, the resigned person will adopt a rebellious strategy and use sexual experience as a means of defying the partner by frustration, bringing him to the height of passion, and then letting him down without full consummation of the sexual act. Circumscribed sex therapy, with which I have little experience, is an outgrowth of our current sexual revolution. As I understand it, it is a technique directed predominantly to sexual dysfunctions. Although it incorporates psychoanalytic principles when necessary, it is primarily a here-and-now experience with a couple who desire to resolve sexual problems. Utilizing one or two sex therapists, its goal is to resolve this problem by educating, prompting communication, dissolving distorted and anxiety-ridden fantasies about sexuality, and building up the confidence of the couple to overcome the anxieties, conflicts, and fears connected with sexuality. The therapists
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serve as catalysts to achieve this through emotional support, persausiveness, and matter-of-fact acceptance that sexuality is an unalterable dimension of men and women who, if rid of their fears, and who--when they develop a degree of trust, affection, and commitment~can overcome their resistance and discover that sexual functioning can occur with pleasure and fulfillment. Now to get back to the main theme of this paper. Above, I mentioned the positive elements of the radical changes in our sexual attitudes. I stated that getting away from centuries of deprecation of sexuality as something sinful, dirty, clandestine, and secretive is a healthy change. Freud stated that if man could discover an effective contraception, neurotic symptoms would disappear. "It cannot be denied that contraceptive measures become a necessity in married life at some time or other, and theoretically, it would be one of the greatest triumphs of mankind, one of the most tangible liberations from the bondage of nature to which we are subject; were it possible to raise the responsible act of procreation to the level of a voluntary and intentional act, and to free it from its entanglement with an indispensible satisfaction of a natural desire. ''4 Now we can see that Freud was far too optimistic about the disappearance of neurosis when and if adequate methods of contraception could be discovered. Certainly, we have achieved adequate contraceptive control. Yet the incidence of neurosis, I think we would all agree, has not diminished; on the contrary, it seems to have increased. Hence the notion that tile cause of neurosis lies in sexual frustration becomes dubious. The sexual revolution is far from completed, and it is difficult to predict its final form; but I believe we can begin to perceive its outlines. Sexuality has come out of the closet. It has become an open, honest, guiltless, and shameless topic for discussion. Its liberation from multiple taboos of long duration has exposed it to direct inspection, research, and understanding. The women's liberation movement has tried to diminish the long-standing double standard. Men and women are on almost equal footing in dealing with their innate sexual drives. Hence, if relatively mature, they can exercise choice in their fulfillment. For a man or woman to accept his or her sexual ity as a natural endowment to be integrated with man's highest potential for closeness, commitment, affection, tenderness, pleasure, and caring is an ideal that, although while not frequently achieved, is worth striving for. Using sexuality in the service in the infinite variety of neurotic needs is to pervert it to a weapon that can only harm both participants in the long run. Unfortunately, so far, the sexual revolution is placing too much emphasis on achieving physiological-mechanical success. Plays that often reflect the current status of society more often emphasize the orgasm--number, frequency, and intensity--than the content of the emotional relationship of the partners. We are observing evidence of tremendous peer pressure, not only
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among adolescents but adults, to experience the gamut of sexual experiences rather than responding to feelings and inclinations. Thus, we see youngsters who engage in various forms of sexuality because it's the thing to do. At one time, a young girl was ashamed to lose her virginity; now she's ashamed to retain it. I am not defending the notion that a girl or boy should remain a virgin, but rather am deploring that sexual exploration is encouraged by peer pressure rather than occurring in response to innate growth, development, feelings, and commitment to a relationship. On the negative side, the sexual revolution has resulted in a number of adverse effects on human relationships. Creeping subtly into our mores is the notion that any form of sexuality is acceptable--that bisexuality, homosexuality, transsexuality, sadomasochism, exhibitionism, fetishism, and any other form of compulsive sexuality is "just as good" and meaningful as heterosexuality. Currently, in the "jet" set, bisexuality is considered the most desirable form of compulsive sexuality, is "just as good" and meaningful as heterosexanonymous sex in a group setting, orgies, and even switching partners just for kicks--particularly under the influence of powerful drugs--are quite common. These activities cut across all levels of society. The removal of legal restrictions and prohibitions has opened the doors to widespread prostitution associated, as it always seems to be, with crime, pimps, venereal disease, and general degradation of human interrelationships. Often as a consequence, there results a reduction of sexuality to a simple physiological response similar to other biological responses. On the less sordid side, there certainly has been an increase in sex for immediate pleasure without any intent of commitment to a relationship, simply to fulfill a necessary "recreational" function. John Money, professor of medical psychology at Johns Hopkins, asserts that there is an imperative need for a new ethic of "recreational" sex in view of contemporary contraceptive methods and the world population excess. He predicts a new ethic of recreational sex with minimized sex-coded roles. He dismisses established and traditional sexual codes as "anti-sexual, antiheretical and antiscientific." He states that the meaning of sex and sexual behavior must undergo drastic revisions. If these revisions result in diminution of mutuality of physical and emotional love and dependece existing between two individuals--a bond that is being continually deprecated by many of the new "sex researchers"--then I can foresee radical devaluation of sexuality. What he is predicting is that pair relations will become less permanent and that couples engage openly in a wide range of sexual relations with friends, other couples, and third parties, under the illusion that this will not affect the primacy of their own relationship. I believe that he is wrong. Unfortunately, such patterns are already emerging in the United States and elsewhere. It is a fallacy that this will not devalue sexual relationships.
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It remains for the future to tell whether this solution will not accelerate the destruction of the nuclear family. I consider the nuclear family as the cornerstone of society, not just from a moral point of view; gender identity is an outgrowth of such a social structure. If the nuclear family structure is destroyed, there will be more confusion in gender identity than prevails now. The cement of the family structure is in the quality of the relationship of the parents. If sexuality is practiced solely for immediate gratification, without respect, affection, love, commitment, sincerity, honesty, and mutuality, the offspring will, to my mind, suffer greatly. As analysts, we see all too frequently the psychological havoc that prevails when the environment of the family atmosphere lacks these necessary ingredients. It seems to me that the current sexual revolution is swinging too far in encouraging participation in such sexual practices that derive not from one's feelings and inclinations but rather from the mistaken notion that "everything goes." In healthy sexuality, the experience is integrated in the entire personality. The relationship is characterized by a measure of affection and mutuality and a desire to obtain, as well as to give, pleasure. There is communication between the partners, whether it is verbal, tactile, olfactory, visual, or auditory; caring and tenderness are ever-present. The mechanical aspects are suffused with a spirituality, joy, pleasure, and fulfillment; this experience is the most intimate that two human beings are capable of achieving. The physiology of the act occurs quite naturally, and the participants are not self-conscious about what they are doing. Since man's capacity to adapt to various patterns of behavior is almost infinite, different cultures have evolved many different attitudes and mores and values, particularly toward sexuality. Inasmuch as we are particularly concerned with our own culture, we have to focus on the rapidly changing attitudes toward sexuality in our own culture over the past decade. Contraception, the increasing freedom from religious dogma that constrict sexuality only to procreation, the pervasive mobility away from the nuclear family, and changing values including the breakup of the stereotyped male and female roles, and the increased basic knowledge of human sexual physiology have all contributed to our current sexual revolution. Like all radical changes, the consequences are both positive and negative. Surely the removal of sexuality from the web of ignorance, superstition, and religious dogma is positive. The realization that the sexual physiological response can get entrapped in a web of psychological conflicts and take many distorted forms, referred to as psychopathological patterns, has stimulated a great number of therapies calculated to free this basic physiological sexual response so that it be experienced freely, guiltlessly, joyfully, and pleasurably, and bring the partners to a high level of human intimacy and fulfillment. These gains have been inevitable as scientific knowledge has increased at an ever-accelerating
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pace. The gains are tremendous. But it is also time to assess the losses and to see if anything can be done to minimize them. The losses seem to me to come out of the changing focus about sex from a spiritual-psychological one to a technical-anatomical one. Some people have somehow forgotten that the essence of human sexuality has always been and still is in the mind. Learning 40 different positions is not necessarily going to make sex more exciting. Powerful and exciting orgasms have occurred during dreams, yet there is no technique or anatomical stimulation necessary. Lightly touching the hand of a person you are romantically in love with or a person who is taboo may be more excitingthan participating in any orgy. Some of us have somehow forgotten this in the past decade. The first look at pornography can be a tremendous turn-on, but the tenth or twentieth hardly is. Similarly, we have been turned on by recent license and the removal of restrictions and inhibitions. But now the excitement is greatly diminished. Perhaps our scientists could slow down a bit in measuring clitoral length and cutting clitoral adhesions and teaching us the squeeze technique for our premature ejaculators. Let us stop worrying whether our orgasms are clitoral or vaginal and whether we maintain our erections for 5.2372 minutes. Analysts used to approach these problems by deep inquiry into what was wrong with mind, soul, and feelings of a person with a sexual dysfunction. Subsequently, we became involved in trying to understand the measuring of his existence, his emotional needs self-concept, and the way he related to other people. Throwing him offthis route and focusing on practical pragmatic aspects of his sexual functioning may help him to function. But one of the important ills of our society is our focus on functioning and adaptation rather than on our emotional and spiritual relationship to the world and to ourselves. It is not uncommon for a patient in analysis to come in functioning perfectly in sex and in the rest of his life, but to feel cut off from himself and the rest of the world--namely, deeply alienated from his feelings. By helping people to adapt, adjust, and function, we may very well be helping them get into a frame of mind--highly endorsed by our industrial society--that functioning is more important than being. Horney's concept of the "real" self vs. the "idealized" self or "false" self--the facade that we show to the world--is crucial to our discussion. In the past decade, the way we have dealt with sex has strengthened the "false" self. It makes people look good on the outside and perform well. But is this our real self--the "core" of our genuine feelings--the real feelings? Too many people in our times are alienated and disconnected from their feelings and depend solely on intense stimulations. Are we becoming dehumanized, wellfunctioning sex machines that do not really connect with our inner selves, from which spring the feelings of warmth, tenderness, caring, communication, affection, and love? I think that too often sex has become as plastic as
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most other things in our society. Sex used to be the last bastion of individuality and selfhood that is unique for each individual. Now it is too often cast into mass-production molds with focus on the right technique and the right kind of orgasm. The paradox is that one can function well and pass all the current tests, and yet be totally alienated from the experience, except for the neurotic pride that one has achieved all the standards currently expected by our society. Clinically, we have all had experience of working with schizophrenic people who almost always have serious problems with intimacy, yet retain orgasmic capacity. In writing this paper, I have hoped to share with you my reflections, as a psychoanalyst, on the current sexual revolution in our ever-changing mores. I have tried to outline the many positive consequences of these radical changes. Yet I have misgivings that negative consequences may outweigh the positive changes for the time being. It is not unusual in times of radical change for the pendulum to swing to extremes in either direction until it finds its reliable range. I am not a prophet and cannot foresee what that range will be. Although values and mores change as culture changes, I believe that there are values that will remain universal as long as human beings remain human beings. Sexuality, which is the core source of the perpetuation of our species, will not be relegated to a transitory experience of pleasure. Sexuality, when freed from centuries of our cultural-religious repression because it was considered animalistic, sinful, dirty, and taboo for discussion, will come more into.its rightful place--namely, a human experience that can bring the participants greater pleasure, mutuality, affection, and relatedness than any other experience. Then it can serve as a model for healthier children wl~o can then be brought up in an atmosphere that is truly loving, spiritual, and caring. I think that the current overswing of the pendulum that focuses mostly on the functional, orgastic and performance-achievement is a transitory phenomenon and that it will swing more toward the spiritual-psychological experience. I do not see any inherent incompatibility between our increasing knowledge of the physiology and psychology of sexuality. The core source of the pleasure in sexuality will remain the feelings of the participants for each other. Hopefully, as the incidence of neurosis diminishes, the motivation for sexuality will be less neurotic in origin and spring much more from the healthy feelings of the individual--namely his "real" self. This, of course requires a great diminution in the alienation that is so prevalent in our current society.
References
1. Marmor cites common factors in therapies. Psychiatric News, 10 (21): 1, 1975.
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2. Masters, W. H., and Johnson, V. E. Human Sexual Inadequacy. Boston: Little, Brown, 1970. 3. Homey, K. Neurosis and Human Growth. New York: Norton, 1950. 4. Freud, S. Sexuality in the etiology of neurosis. Collected Papers of Sigmund Freud, Vol. 1. Ernest Jones (Ed.). New York: Basic Books, 1959. Address reprint requests to 322 Central Park West, New York 10025.
