Journal of Sex & Marital Therapy
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: http://www.tandfonline.com/loi/usmt20
Male pseudoheterosexuality and minimal sexual dysfunction Joseph P. Gutstadt MD To cite this article: Joseph P. Gutstadt MD (1976) Male pseudoheterosexuality and minimal sexual dysfunction, Journal of Sex & Marital Therapy, 2:4, 297-302, DOI: 10.1080/00926237608405336 To link to this article: http://dx.doi.org/10.1080/00926237608405336
Published online: 14 Jan 2008.
Submit your article to this journal
Article views: 10
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=usmt20 Download by: [University of Cambridge]
Date: 07 November 2015, At: 08:48
Journal of Sex & Marital Therapy Vol. 2, No. 4, Winter 1976
Male Pseudoheterosexuality and Minimal Sexual Dysfunction
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Joseph P. Gutstadt, M D
ABSTRACT: Male heterosexual activity is not always heterosexual. Frequently it only appears to be, but, in fact, it is an attempt at denial of underlying homosexual feelings. There is often a correlation between such “pseudoheterosexuality” and minor sexual dysfunctions. Insight alone is n o t sufficient to provide relief, but when the patient can be helped to a comfortable acceptance of his homosexual feelings as a normal and healthy facet of his personality, very often the dysfunction is relieved, and there is a marked change in the ability of the individuaI to achieve gratification in genuine heterosexuality.
The terms utilized in the titIe of this article are not generally employed either in psychoanalytically oriented psychotherapy or in sexual therapy as described by Helen Kaplan, Masters and Johnson, and others. However, they appear to be appropriate to describe the matters to be discussed in the following report. “Pseudoheterosexuality” here refers to sexual behavior that appears to be heterosexual in nature, i.e., heterosexual object choice and behavior that fulfills the traditionally accepted male-female, active-receptive, or, in some cases, dominant-submissive roles. However, closer examination reveals a lack of genuine gratification and the presence of goals other than those of sexual pleasure. “Minimal sexual dysfunction” refers to a lack of or low interest in sexual activity, occasional sporadic erectile impotence, sporadic retarded ejaculation, or premature ejaculation. These would be instances in which the complaints were not usuaIly either persistent or serious enough to present a problem of sufficient severity to lead a patient to seek help. The symptoms, as described under the category of minimal sexual dysfunction, seem to be affecting increasingly large groups of younger men who in previous years would never have questioned their virility. The concept of a pseudoheterosexual adjustment utilized in the service of Dr. Gutstadt is in Private Practice in Psychiatry, Psychoanalysis, and Sex Therapy. Reprint queries should be directed to Dr. Joseph P. Gutstadt, 1125 Sir Francis Drake Boulevard, Kentfield, California 94904.
29 7
Downloaded by [University of Cambridge] at 08:48 07 November 2015
298
Journal of Sex and Marital Therapy
a defense against and in the denial of underlying homosexual impulses is not new. As early as 1911, Ferenczi’ described the phenomenon of “compulsive sexuality,” or Don Juanism, as a phenomenon seen in certain men who were defending against the awareness of unconscious homosexual impulses. However, the contribution of this process to the problems of sexual dysfunction has not received much attention until recently. The direct, active treatment of sexual dysfunction has brought such matters into sharper focus. Also, the increasing manifestation of women’s liberation, with its assumption of more aggressive and assertive roles within sexual relationships, has brought some of these problems into greater prominence. The ritualized roles of men and women are changing. As a result, the man-woman relationship is no longer a traditional, structured one with relatively standard expectations. The traditional roles and role expectations no longer provide the sexual and emotional stability once available. For many years psychoanalysts and other therapists have been aware of the frequency with which men have attempted t o deny their conscious, or sometimes preconscious, awareness of underlying homosexual impulses by pushing themselves or, perhaps more correctly from a dynamic standpoint, allowing themselves t o be pushed into a traditional heterosexual male role. Such traditional roles are, at least in this culture, one further step in the lifelong educational process by which our society adjusts boys, and later men, to the accepted roles that are considered suitable to their male physical attributes. Traditional masculine activities, such as contact sports and mechanical proficiencies-as opposed t o activities of a more aesthetic sort such as art and music-are stressed, with much positive reinforcement for success. In contrast, there is negative reward, criticism, and even ostracism directed toward those boys and young men who choose to go counter to the mainstream. More and more therapy centers, public and private, report an increasing frequency of complaints o n the part of young men who are unable t o function sexually with women who are assertive or aggressive or who merely take the initiative in sexual activity. This “ain’t according to Hoyle,” and in our basically macho culture brings men face to face with an increasing awareness that “playing the stud” somehow doesn’t work. Their response, if not immediate or gradually increasing impotence, is frequently a lessening of libidinal tension, often rationalized by complaints of fatigue, excess tension, having exercised too vigorously earlier, etc. If this situation continues, it is frequently aggravated by the “understanding” partner who reassures the man, tells him everything will be fine next time, she really does not mind, and the like. Such reassurances help to recreate the maternal-reassuring, nurturing role of the woman and merely serve t o reinforce and reactivate the man’s underlying sense of inadequacy and incompetence. It thus reinforces the vicious cycle already under way. Freud initially stressed the basic biological bisexuality of the human
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Joseph P. Gutstadt
299
animal. Much of his examination of the complexities of early preoedipal relationships that lead ultimately t o the resolution of the oedipal complex was based on his attempts to explain the manner in which the initial biological differences arising out of a bisexual precursor later became reinforced by educational and cultural influences. Of interest in this particular regard are the contributions of more recent embryological studies2 that find that the fetus is not basically and originally bisexual but is, in fact, female. The male characteristics make their appearance about the fifth week of fetal development. One may speculate on the possibility that some primal awareness of the fact of these feminine origins may contribute t o the energy that has been exerted in so many cultures t o assure that the male will be properly trained t o eschew every last vestige of the female precursor within. Certainly in Western cultures the macho phenomenon has a tremendous influence on the education and training of the male-from the time that he is a young boy through adolescence and into adulthood. Boys are always being reminded that boys d o not cry nor show tenderness. They are under constant pressure to participate with peers in vigorous physical activities considered masculine and therefore acceptable. In the area of aggressiveness the “manly art of self-defense” is only one example of this particular state of affairs. In the area of sexuality the “stud phenomenon”-how many women the man can make, how large one’s genitals are, how long one can last, the sense of competition with other men over the ability t o satisfy a particular woman-all of these and many other elements of sexual “game playing” ubiquitously express the need for the average man to use sex as a proving ground for his masculinity rather than for its more exciting potential as a source of sensual pIeasure. Utilizing the concept of sex as a source of sensual pleasure and reasoning that therapeutic advantages might accrue if men could be helped t o accept their bisexuality as a normal and natural element of their sexuality, I decided to make this area of awareness, when appropriate, a goal of insight therapy, particularly in the treatment of sexual dysfunction. In addition, I have had the opportunity to gauge its effectiveness even where n o specific dysfunction existed. The following brief case histories are offered in elucidation of the theory and in support of its therapeutic validity. 27, where father was a policeman, was raised in an atmosphere of minimal affection, particularly as demonstrated between male members of the family. L had a long series of frustrating and basically unsatisfying sexual relationships. The physical side of these relationships seemed empty, and there was a sense of ungratified longing for something else, never really clarified. Proceeding from his sense of distance from his father and also utilizing his feelings of warmth felt for me as his therapist as an expression of something that he felt had been missing from his life, we spent considerable time discussing his longing for closeness with men and his previous inability to express it. Fortunately, he was peripheral to a group of students where hugging was quite acceptable as an expression of warmth between men. Encouraged to avail himself of this oppor-
Case 1: L, age
Downloaded by [University of Cambridge] at 08:48 07 November 2015
3 00
Journal of Sex and Marital Therapy
tunity, he acted on this and found it highly gratifying, even allowing himself an occasional kiss. He had n o desire for further physical intimacy with other men. He found himself playfully fantasizing homosexual relationships but at the same time felt disinclined to act on these fantasies. As his ease and acceptance of this area of his sexuality increased and he no longer felt a need to deny these interests, he found to his surprise that his heterosexual relationships were not only increasing in frequency, but were, in addition, much more gratifying from a physical standpoint. Associated issues, such as anxieties about his performance, the size of his penis and his body (he was relatively small in stature), and, most specifically, an underlying, gnawing fear of loss of the woman, were no longer present. He volunteered on one occasion that he felt a new kind of response to women that had never been present before. He found this particularly puzzling and strange as a response to a greater acceptance of the homosexual side of his personality. Case 2 : D, a 35-year-old professional man, had little sense of personal gratification with his work. One marriage had failed after he and his wife had almost eliminated sexual relations from their life because of discouragement and mutual frustration. Numerous experiences with other women before and after the marriage had offered little more than a minimal satisfaction that D had successfully made a conquest. There was little foreplay, and orgasm was almost anesthetic. Interestingly enough, masturbation had been indulged in for years with much guilt and shame and was always an act to be gotten over with as soon as possible. An initial complaint in this patient’s analysis had been fears over the possibility of being “homosexual,” b u t this was mainly diagnosis by exclusion and based on his lack of heterosexual satisfaction. He felt so dissatisfied with his sexual relations and so unfulfilled in his professional life that he assumed that the failure and lack of fulfillment must be an expression of what to him seemed to be the worst of all possible fates-“ [he] must be homosexual.” Even though his initial anxieties were dealt with, with some relief of the phobic anxiety, IittIe seemed to change. Later, the area of his real underlying homosexual feeling, partly expressed in the transference, was worked through, not defensively, but with an attitude of permission. D was encouraged to accept this part of himself as positive. (The acting out of these feelings was not necessary.) He then was able to experience the full gratification of orgasm, and concomitantly he experienced a greater appreciation of himself as a functioning individual, capable of real achievement.
In this instance there were other dynamic forces operating to bring about his sense of self-fulfillment, but unquestionably, the marked improvement in his sexual and professional adjustment, in my opinion, can be ascribed to his increasingly comfortable acceptance of his bisexuality and the no longer present need to utilize energy in defending against such awareness. Case 3 : A, a young man, first seen as a college student at 19, presented himself with complaints of lack of initiative, a failure to find any vocational area that interested him, a very poor self-image, and a number of other symptoms that could be considered consistent with a long-standing chronic depressive personality. He was a virgin, and although he masturbated with moderate frequency, he did so with little excitement or enthusiasm. During the first period of treatment he began a successful relationship with a young woman. Not long after termination of treatment, during which he worked through a great deal of negative feelings about his parents and his older brother, he was married to the same young woman. The marriage has continued successfully. However, approximately two years later, he returned with some recurrence of the oId symptoms, this time much more closed related to a focus on his identity. His identity problem was. intricately involved with a desire to accept his father’s offer and fervent wish that he join his business in a junior executive capacity. He felt that to d o this represented a compromise of his integrity; yet he felt quite confused by his whole response to the situation.
Joseph P. Cutstadt
3 01
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Again the issue of bisexuality presented itself when he belatedly admitted having had homosexual fantasies in adolescence. Sometimes these fantasies occurred when he masturbated, sometimes when he was having intercourse with his wife. His acceptance of his bisexuality resulted in a sense of excitement and exhilaration, as the energies that were earlier tied up in suppression and self-hate, guilt, etc. were released for more productive use. As therapy continued, he noted an increased excitement in sexual relations and, in addition, a greater and warmer acceptance of his father. He showed a real enthusiasm about the work situation that was to start in a few months.
Although feelings of excitement and attraction were acknowledged toward other men, in this case there was no desire expressed for actual physical intimacy with them. Case 4: N, age 33, married about 10 years with three children, was referred because of an inhibited, low energy sexual life, which had been present throughout his adult life. His overt behavior (more than the others previously described) suggested bisexual trends. When this was pointed out to him, he reacted initially with surprise but quickly followed this with a rather enthusiastic acceptance of the possibility. He recalled fantasies, long suppressed, involving same-sex activity. He began to look at his marriage with a new perspective. In this particular instance it appears likely that the marriage will be terminated, but not without good reason. Both the patient and his wife are aware that their relationship has been mainly a business arrangement, in which most of their energies were focused on his business success and the social activities related to it. Their sexual life was a total failure, ultimately leading to the wife having a very self-destructive affair. Despite his awareness of the destructiveness of the affair, N felt mainly relief as a result of the lack of sexual pressure from her, With his increased awareness and acceptance of his bisexuality, he was beginning to consider the possibility of relating to other women as well as the possibility of exploring his same-sex interests more deeply. Cases 5 and 6: Finally, in brief, two other patients, both overtly psychotic, both having considerable paranoid anxiety about the implications of homosexuality, decided, separately, in response to discussions in a men’s consciousness-raising group, to arrange to have a homosexual experience. Both of them experienced it as pleasurable and no longer felt the same anxiety about their homosexual impulses as they had previously. One, seriously psychotic at the time, began his remission and showed marked evidence of improvement during the few days following his experience. The other, much better integrated, less overtly psychotic, and with considerably more insight into himself from an extensive period of treatment, found his interest in and excitement about heterosexual relationships stimulated and strengthened by the experience. Both patients, although initiating the experience, participated in the acts passively.
DISCUSSION Several cases have been described in which it seemed apparent that defensive operations focusing on the denial of and repression or suppression of homosexual impulses had resulted in a loss of energy and initiative, as well as in some cases, actual sexual dysfunction of a limited sort. In all of the cases therapy not only focused on a confrontation of the denial, but also was accompanied by some form of dynamic interpretation. In addition, therapy offered a great deal of support and encouragement of the patient to accept
Downloaded by [University of Cambridge] at 08:48 07 November 2015
302
Journal of Sex and Marital Therapy
the homosexual element of his personality as a normal and natural part of himself, and not an expression of pathology. The resulting therapeutic benefit seems in all of the cases t o have led t o increased energy, enthusiasm, and a greater ability t o participate in heterosexual relationships with more real pleasure rather than engaging in some form of performance-oriented act, behavior that I have termed “pseudoheterosexuality.” It should be reiterated that the therapist’s attitude must be one that is not just a noncritical and nonjudgmental one nor that of the father-confessor. Rather, it must be more active in helping the patient to an affirmative and positive acceptance of this element of himself, to view it as an area that expresses part of his overall sexuality. This article, and the case material presented, is not meant to be a denial of the instances in which homosexuality can be an expression of some pathological conflict. There is no question but that there are many instances in which it represents an expression of immature sexual development, castration-anxiety, etc. However, there is much evidence to suggest that same-sex object choice and neurotic symptomatology do not always go together. What is apparent is that there are innumerable men who have responded to the pressures of society by suppressing homosexual feelings and thereby have disabled themselves t o varying degrees out of needless anxiety, guilt, shame, and self-hate, Unfortunately, there are many members of our profession who, by their insistence on always dealing with homosexuality as a pathological process t o be in some way “changed or cured,” have done little t o alleviate the problem and have in many instances aggravated it by adding the label of “sickness” t o the already excessive burden of guilt and shame. I recognize that most of the patients discussed in this presentation are not those on whom this heavy burden lays. However, it is vital, in my opinion, that the therapist who proposes to treat the forms of minimal sexual dysfunction described, and in the manner detailed be very clear and accepting of those same elements in his own personality that he is dealing with in his patient. Hopefully, we shall reach a stage in our own knowledge of personality and sexuality when we will be able t o deal with our patients as sexual beings, whatever their object choice, and see our therapeutic goal as truly that of self-acceptance, unencumbered by outmoded hangovers of our Puritan heritage couched in ostensibly scientific and biological terms.
REFERENCES 1. Ferenczi S: Sex in Psychoanalysis. New York, Basic Books, 1950. 2. Sherfey MJ: The Nature and Euolution of Female Sexuality. New York, Random House, 1966.
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: http://www.tandfonline.com/loi/usmt20
Male pseudoheterosexuality and minimal sexual dysfunction Joseph P. Gutstadt MD To cite this article: Joseph P. Gutstadt MD (1976) Male pseudoheterosexuality and minimal sexual dysfunction, Journal of Sex & Marital Therapy, 2:4, 297-302, DOI: 10.1080/00926237608405336 To link to this article: http://dx.doi.org/10.1080/00926237608405336
Published online: 14 Jan 2008.
Submit your article to this journal
Article views: 10
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=usmt20 Download by: [University of Cambridge]
Date: 07 November 2015, At: 08:48
Journal of Sex & Marital Therapy Vol. 2, No. 4, Winter 1976
Male Pseudoheterosexuality and Minimal Sexual Dysfunction
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Joseph P. Gutstadt, M D
ABSTRACT: Male heterosexual activity is not always heterosexual. Frequently it only appears to be, but, in fact, it is an attempt at denial of underlying homosexual feelings. There is often a correlation between such “pseudoheterosexuality” and minor sexual dysfunctions. Insight alone is n o t sufficient to provide relief, but when the patient can be helped to a comfortable acceptance of his homosexual feelings as a normal and healthy facet of his personality, very often the dysfunction is relieved, and there is a marked change in the ability of the individuaI to achieve gratification in genuine heterosexuality.
The terms utilized in the titIe of this article are not generally employed either in psychoanalytically oriented psychotherapy or in sexual therapy as described by Helen Kaplan, Masters and Johnson, and others. However, they appear to be appropriate to describe the matters to be discussed in the following report. “Pseudoheterosexuality” here refers to sexual behavior that appears to be heterosexual in nature, i.e., heterosexual object choice and behavior that fulfills the traditionally accepted male-female, active-receptive, or, in some cases, dominant-submissive roles. However, closer examination reveals a lack of genuine gratification and the presence of goals other than those of sexual pleasure. “Minimal sexual dysfunction” refers to a lack of or low interest in sexual activity, occasional sporadic erectile impotence, sporadic retarded ejaculation, or premature ejaculation. These would be instances in which the complaints were not usuaIly either persistent or serious enough to present a problem of sufficient severity to lead a patient to seek help. The symptoms, as described under the category of minimal sexual dysfunction, seem to be affecting increasingly large groups of younger men who in previous years would never have questioned their virility. The concept of a pseudoheterosexual adjustment utilized in the service of Dr. Gutstadt is in Private Practice in Psychiatry, Psychoanalysis, and Sex Therapy. Reprint queries should be directed to Dr. Joseph P. Gutstadt, 1125 Sir Francis Drake Boulevard, Kentfield, California 94904.
29 7
Downloaded by [University of Cambridge] at 08:48 07 November 2015
298
Journal of Sex and Marital Therapy
a defense against and in the denial of underlying homosexual impulses is not new. As early as 1911, Ferenczi’ described the phenomenon of “compulsive sexuality,” or Don Juanism, as a phenomenon seen in certain men who were defending against the awareness of unconscious homosexual impulses. However, the contribution of this process to the problems of sexual dysfunction has not received much attention until recently. The direct, active treatment of sexual dysfunction has brought such matters into sharper focus. Also, the increasing manifestation of women’s liberation, with its assumption of more aggressive and assertive roles within sexual relationships, has brought some of these problems into greater prominence. The ritualized roles of men and women are changing. As a result, the man-woman relationship is no longer a traditional, structured one with relatively standard expectations. The traditional roles and role expectations no longer provide the sexual and emotional stability once available. For many years psychoanalysts and other therapists have been aware of the frequency with which men have attempted t o deny their conscious, or sometimes preconscious, awareness of underlying homosexual impulses by pushing themselves or, perhaps more correctly from a dynamic standpoint, allowing themselves t o be pushed into a traditional heterosexual male role. Such traditional roles are, at least in this culture, one further step in the lifelong educational process by which our society adjusts boys, and later men, to the accepted roles that are considered suitable to their male physical attributes. Traditional masculine activities, such as contact sports and mechanical proficiencies-as opposed t o activities of a more aesthetic sort such as art and music-are stressed, with much positive reinforcement for success. In contrast, there is negative reward, criticism, and even ostracism directed toward those boys and young men who choose to go counter to the mainstream. More and more therapy centers, public and private, report an increasing frequency of complaints o n the part of young men who are unable t o function sexually with women who are assertive or aggressive or who merely take the initiative in sexual activity. This “ain’t according to Hoyle,” and in our basically macho culture brings men face to face with an increasing awareness that “playing the stud” somehow doesn’t work. Their response, if not immediate or gradually increasing impotence, is frequently a lessening of libidinal tension, often rationalized by complaints of fatigue, excess tension, having exercised too vigorously earlier, etc. If this situation continues, it is frequently aggravated by the “understanding” partner who reassures the man, tells him everything will be fine next time, she really does not mind, and the like. Such reassurances help to recreate the maternal-reassuring, nurturing role of the woman and merely serve t o reinforce and reactivate the man’s underlying sense of inadequacy and incompetence. It thus reinforces the vicious cycle already under way. Freud initially stressed the basic biological bisexuality of the human
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Joseph P. Gutstadt
299
animal. Much of his examination of the complexities of early preoedipal relationships that lead ultimately t o the resolution of the oedipal complex was based on his attempts to explain the manner in which the initial biological differences arising out of a bisexual precursor later became reinforced by educational and cultural influences. Of interest in this particular regard are the contributions of more recent embryological studies2 that find that the fetus is not basically and originally bisexual but is, in fact, female. The male characteristics make their appearance about the fifth week of fetal development. One may speculate on the possibility that some primal awareness of the fact of these feminine origins may contribute t o the energy that has been exerted in so many cultures t o assure that the male will be properly trained t o eschew every last vestige of the female precursor within. Certainly in Western cultures the macho phenomenon has a tremendous influence on the education and training of the male-from the time that he is a young boy through adolescence and into adulthood. Boys are always being reminded that boys d o not cry nor show tenderness. They are under constant pressure to participate with peers in vigorous physical activities considered masculine and therefore acceptable. In the area of aggressiveness the “manly art of self-defense” is only one example of this particular state of affairs. In the area of sexuality the “stud phenomenon”-how many women the man can make, how large one’s genitals are, how long one can last, the sense of competition with other men over the ability t o satisfy a particular woman-all of these and many other elements of sexual “game playing” ubiquitously express the need for the average man to use sex as a proving ground for his masculinity rather than for its more exciting potential as a source of sensual pIeasure. Utilizing the concept of sex as a source of sensual pleasure and reasoning that therapeutic advantages might accrue if men could be helped t o accept their bisexuality as a normal and natural element of their sexuality, I decided to make this area of awareness, when appropriate, a goal of insight therapy, particularly in the treatment of sexual dysfunction. In addition, I have had the opportunity to gauge its effectiveness even where n o specific dysfunction existed. The following brief case histories are offered in elucidation of the theory and in support of its therapeutic validity. 27, where father was a policeman, was raised in an atmosphere of minimal affection, particularly as demonstrated between male members of the family. L had a long series of frustrating and basically unsatisfying sexual relationships. The physical side of these relationships seemed empty, and there was a sense of ungratified longing for something else, never really clarified. Proceeding from his sense of distance from his father and also utilizing his feelings of warmth felt for me as his therapist as an expression of something that he felt had been missing from his life, we spent considerable time discussing his longing for closeness with men and his previous inability to express it. Fortunately, he was peripheral to a group of students where hugging was quite acceptable as an expression of warmth between men. Encouraged to avail himself of this oppor-
Case 1: L, age
Downloaded by [University of Cambridge] at 08:48 07 November 2015
3 00
Journal of Sex and Marital Therapy
tunity, he acted on this and found it highly gratifying, even allowing himself an occasional kiss. He had n o desire for further physical intimacy with other men. He found himself playfully fantasizing homosexual relationships but at the same time felt disinclined to act on these fantasies. As his ease and acceptance of this area of his sexuality increased and he no longer felt a need to deny these interests, he found to his surprise that his heterosexual relationships were not only increasing in frequency, but were, in addition, much more gratifying from a physical standpoint. Associated issues, such as anxieties about his performance, the size of his penis and his body (he was relatively small in stature), and, most specifically, an underlying, gnawing fear of loss of the woman, were no longer present. He volunteered on one occasion that he felt a new kind of response to women that had never been present before. He found this particularly puzzling and strange as a response to a greater acceptance of the homosexual side of his personality. Case 2 : D, a 35-year-old professional man, had little sense of personal gratification with his work. One marriage had failed after he and his wife had almost eliminated sexual relations from their life because of discouragement and mutual frustration. Numerous experiences with other women before and after the marriage had offered little more than a minimal satisfaction that D had successfully made a conquest. There was little foreplay, and orgasm was almost anesthetic. Interestingly enough, masturbation had been indulged in for years with much guilt and shame and was always an act to be gotten over with as soon as possible. An initial complaint in this patient’s analysis had been fears over the possibility of being “homosexual,” b u t this was mainly diagnosis by exclusion and based on his lack of heterosexual satisfaction. He felt so dissatisfied with his sexual relations and so unfulfilled in his professional life that he assumed that the failure and lack of fulfillment must be an expression of what to him seemed to be the worst of all possible fates-“ [he] must be homosexual.” Even though his initial anxieties were dealt with, with some relief of the phobic anxiety, IittIe seemed to change. Later, the area of his real underlying homosexual feeling, partly expressed in the transference, was worked through, not defensively, but with an attitude of permission. D was encouraged to accept this part of himself as positive. (The acting out of these feelings was not necessary.) He then was able to experience the full gratification of orgasm, and concomitantly he experienced a greater appreciation of himself as a functioning individual, capable of real achievement.
In this instance there were other dynamic forces operating to bring about his sense of self-fulfillment, but unquestionably, the marked improvement in his sexual and professional adjustment, in my opinion, can be ascribed to his increasingly comfortable acceptance of his bisexuality and the no longer present need to utilize energy in defending against such awareness. Case 3 : A, a young man, first seen as a college student at 19, presented himself with complaints of lack of initiative, a failure to find any vocational area that interested him, a very poor self-image, and a number of other symptoms that could be considered consistent with a long-standing chronic depressive personality. He was a virgin, and although he masturbated with moderate frequency, he did so with little excitement or enthusiasm. During the first period of treatment he began a successful relationship with a young woman. Not long after termination of treatment, during which he worked through a great deal of negative feelings about his parents and his older brother, he was married to the same young woman. The marriage has continued successfully. However, approximately two years later, he returned with some recurrence of the oId symptoms, this time much more closed related to a focus on his identity. His identity problem was. intricately involved with a desire to accept his father’s offer and fervent wish that he join his business in a junior executive capacity. He felt that to d o this represented a compromise of his integrity; yet he felt quite confused by his whole response to the situation.
Joseph P. Cutstadt
3 01
Downloaded by [University of Cambridge] at 08:48 07 November 2015
Again the issue of bisexuality presented itself when he belatedly admitted having had homosexual fantasies in adolescence. Sometimes these fantasies occurred when he masturbated, sometimes when he was having intercourse with his wife. His acceptance of his bisexuality resulted in a sense of excitement and exhilaration, as the energies that were earlier tied up in suppression and self-hate, guilt, etc. were released for more productive use. As therapy continued, he noted an increased excitement in sexual relations and, in addition, a greater and warmer acceptance of his father. He showed a real enthusiasm about the work situation that was to start in a few months.
Although feelings of excitement and attraction were acknowledged toward other men, in this case there was no desire expressed for actual physical intimacy with them. Case 4: N, age 33, married about 10 years with three children, was referred because of an inhibited, low energy sexual life, which had been present throughout his adult life. His overt behavior (more than the others previously described) suggested bisexual trends. When this was pointed out to him, he reacted initially with surprise but quickly followed this with a rather enthusiastic acceptance of the possibility. He recalled fantasies, long suppressed, involving same-sex activity. He began to look at his marriage with a new perspective. In this particular instance it appears likely that the marriage will be terminated, but not without good reason. Both the patient and his wife are aware that their relationship has been mainly a business arrangement, in which most of their energies were focused on his business success and the social activities related to it. Their sexual life was a total failure, ultimately leading to the wife having a very self-destructive affair. Despite his awareness of the destructiveness of the affair, N felt mainly relief as a result of the lack of sexual pressure from her, With his increased awareness and acceptance of his bisexuality, he was beginning to consider the possibility of relating to other women as well as the possibility of exploring his same-sex interests more deeply. Cases 5 and 6: Finally, in brief, two other patients, both overtly psychotic, both having considerable paranoid anxiety about the implications of homosexuality, decided, separately, in response to discussions in a men’s consciousness-raising group, to arrange to have a homosexual experience. Both of them experienced it as pleasurable and no longer felt the same anxiety about their homosexual impulses as they had previously. One, seriously psychotic at the time, began his remission and showed marked evidence of improvement during the few days following his experience. The other, much better integrated, less overtly psychotic, and with considerably more insight into himself from an extensive period of treatment, found his interest in and excitement about heterosexual relationships stimulated and strengthened by the experience. Both patients, although initiating the experience, participated in the acts passively.
DISCUSSION Several cases have been described in which it seemed apparent that defensive operations focusing on the denial of and repression or suppression of homosexual impulses had resulted in a loss of energy and initiative, as well as in some cases, actual sexual dysfunction of a limited sort. In all of the cases therapy not only focused on a confrontation of the denial, but also was accompanied by some form of dynamic interpretation. In addition, therapy offered a great deal of support and encouragement of the patient to accept
Downloaded by [University of Cambridge] at 08:48 07 November 2015
302
Journal of Sex and Marital Therapy
the homosexual element of his personality as a normal and natural part of himself, and not an expression of pathology. The resulting therapeutic benefit seems in all of the cases t o have led t o increased energy, enthusiasm, and a greater ability t o participate in heterosexual relationships with more real pleasure rather than engaging in some form of performance-oriented act, behavior that I have termed “pseudoheterosexuality.” It should be reiterated that the therapist’s attitude must be one that is not just a noncritical and nonjudgmental one nor that of the father-confessor. Rather, it must be more active in helping the patient to an affirmative and positive acceptance of this element of himself, to view it as an area that expresses part of his overall sexuality. This article, and the case material presented, is not meant to be a denial of the instances in which homosexuality can be an expression of some pathological conflict. There is no question but that there are many instances in which it represents an expression of immature sexual development, castration-anxiety, etc. However, there is much evidence to suggest that same-sex object choice and neurotic symptomatology do not always go together. What is apparent is that there are innumerable men who have responded to the pressures of society by suppressing homosexual feelings and thereby have disabled themselves t o varying degrees out of needless anxiety, guilt, shame, and self-hate, Unfortunately, there are many members of our profession who, by their insistence on always dealing with homosexuality as a pathological process t o be in some way “changed or cured,” have done little t o alleviate the problem and have in many instances aggravated it by adding the label of “sickness” t o the already excessive burden of guilt and shame. I recognize that most of the patients discussed in this presentation are not those on whom this heavy burden lays. However, it is vital, in my opinion, that the therapist who proposes to treat the forms of minimal sexual dysfunction described, and in the manner detailed be very clear and accepting of those same elements in his own personality that he is dealing with in his patient. Hopefully, we shall reach a stage in our own knowledge of personality and sexuality when we will be able t o deal with our patients as sexual beings, whatever their object choice, and see our therapeutic goal as truly that of self-acceptance, unencumbered by outmoded hangovers of our Puritan heritage couched in ostensibly scientific and biological terms.
REFERENCES 1. Ferenczi S: Sex in Psychoanalysis. New York, Basic Books, 1950. 2. Sherfey MJ: The Nature and Euolution of Female Sexuality. New York, Random House, 1966.
