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Identity, Gender, and Sexuality

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'While Freud opened the door on the formative and motivating power of sexuality, contemporary psychoanalysts, with some notable exceptions, have consigned sexuality to the psychoanalytic closet. This book not only re-opens the door on the broad subject of psychosexuality, but also provides fresh insights into heterosexuality, bisexuality, homosexuality, gender identity disorder, transvestism and transsexualism. This publication brings together some of the leading psychoanalytic authorities from around the globe to consider in depth the complex interweaving of identity, gender and sexuality from theoretical, clinical, historical and research perspectives. I strongly recommend "Identity, Gender and Sexuality" to those looking for a book that does not pull punches. The reader will find a debate about the relative merits of clinical, empirical, and conceptual research, critical assessments of interdisciplinary findings from infant and child development research, embodied cognitive science, academic psychology, neurobiology, genetics, ethology, and other fields of inquiry, and honest and illuminating psychoanalytic case studies. - Donald Campbell

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1: Psychosexuality and psychoanalysis: an overview

ePub

Peter Fonagy

The 1997 Congress of the International Psychoanalytic in Barcelona was spent discussing the relationship of psychoanalysis with sexuality. The title of the Congress—”Psychoanalysis and Sexuality”—already indicated that psychoanalysis and sexuality could be considered separately (Stein, 1998b). I doubt that the title would have made sense to the psychoanalysts of the pioneering, heroic generation. But the title reflected something real about the current status of sexuality in our theory and practice. It is as if there is no space for sexuality within psychoanalysis. We no longer consider it fundamental in all cases or even relevant to current theorization. I am reminded of a famous Victorian, who commented dismissively about sex: “The position is ludicrous, the pleasure is momentary, and the expense damnable.” Freud's discoveries are an emblem, a symbol of a worthy tradition, but of little actual relevance to clinical understanding or practice. Ruth Stein (1998b) put it thus: “Freud's early insight that diverse psychic phenomena, contents and symptoms are expressions of defences against sexual, mostly oedipal, themes has taken its full swing on the dialectical pendulum of psychoanalytic thinking” (p. 254). Psychosexuality is nowadays more frequently considered as disguising other, non-sexual self- and object-related conflicts than the other way round.

 

2: Sexuality: a conceptual and historical essay

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2

André E. Haynal

Some historical hints

Sexuality has been at the centre of interest of psychoanalysis. Is it still today? What was the novelty Freud brought into this domain? There is no doubt that sexuality was also at the centre of Freud's interest. He used bits and pieces of the then new observations and the discourse of the contemporary sexologists to lay the foundation for his own new science. But what were the news he put before the eyes of a stunned world of 1905, a century ago, provoking much admiration and much resistance?

First let us remember that at the time of the publication of The Interpretation of Dreams (1900a), he wrote to Fliess: “A theory of sexuality might well be the dream book's immediate successor” and its complement (1905d, p. 129, Letter 128). Why this? We may speculate that discovering the sexual nature and the unconscious wish at the root of the dreams led him more than other former experiences with sexuality to the elaboration of its theory. The instinctual drives became the foundation of fantasy life, and this has remained perhaps the most important element in psychoanalytic practice until today. It is perhaps no coincidence that he always tried to keep these two books, the one on dreams and that on sexuality—and only these—up to date. They were the pillars of his doctrine.In general terms, on the cultural scene, he allowed people to speak about sexuality. The author of the Aphasia Studies created a language and, together with others such as Krafft-Ebing, supplied terms like masochism, sadism, narcissism, inhibition, and many others, allowing what one thought about sex to be formulated. He brought the sexually determined contents out of the closet of medical consultation-room and the Latin jargon into everyday language. In a little circle of men—who also had some sexual problems of their own, as in the case of Stekel, Ferenczi, Jones, Tausk, Gross, Jung, and others—the sensitivity for this dimension was brought to life so that a scientific discourse could slowly emerge, partly borrowed from the sexologists.

 

3: Psychodynamic and biographical roots of a transvestite development: clinical and extra-clinical findings from a psychoanalysis

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3

Marianne Leuzinger-Bohleber

Clinical, conceptual, and empirical research in psychoanalysis

As André Haynal has described in his chapter, social factors have changed in the century since Freud's Three Essays on the Theory of Sexuality (1905d), influencing—among other things—our view on what could be considered “normal” and what as “deviant” sexual behaviour.

Transvestite patients, like “Mr M”, about whom I speak in this chapter, react seismographically to individual and social developments and changes in the realm of sexuality, attachment, and gender; hence I focus on this issue first. But as my professional competence is mainly in the field of research in psychoanalysis and not in social psychology, cultural studies, or anthropology, I concentrate on the illustration of the current position in the Research Subcommittee for Conceptual Research: that the three branches of clinical, conceptual, and empirical research in psychoanalysis can supplement each other in a productive way.

Therefore, first I present one aspect of clinical research that focuses on the psychodynamic and biographical roots of a transvestite development based on clinical findings of a five-year high-frequencypsychoanalysis and a recent follow-up 24 years after termination of treatment. In a second part I summarize some of the conceptual reconsiderations concerning the psychodynamics, the biographical roots, and the psychic function of this sexual deviation and report on an interdisciplinary, empirically based conceptual research on memory, trying to illustrate that those interdisciplinary research findings may be helpful to conceptualize and to understand clinical material more precisely and deeply.

 

4: The issue of homosexuality in psychoanalysis

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4

Richard C. Friedman

Freud's views about sexuality provoked controversy, of course, and controversy stimulated by open discussion of human sexuality is still with us—even among psychoanalytic audiences!

I began research and scholarship in the area of human sexual orientation in the 1970s (Friedman, Green, & Spitzer, 1976; Friedman, Wollesen, & Tendler, 1976). During the three decades or so that I have presented talks in this area, I have found the intellectual atmosphere to be turbulent. Once, at a well-attended talk at a psychoanalytic association, an older man (I now qualify for that dubious distinction) interrupted my presentation by standing up and screaming: “You're wrong!! Don't you realize that homosexuality will lead to the end of civilization!!!” (He objected to my view that homosexuality is not inherently pathological.) On a number of occasions scheduled and publicized events by psychoanalytic associations—were suddenly cancelled on grounds that the topic of homosexuality was too controversial for discussion by psychoanalysts. After publication in 1994 of a special article on homosexuality in the New England Journal of Medicine (Friedman & Downey, 1994), Jennifer Downey and I received a fair amount of—what can only be described as hate—mail from health professionals. One editor of a major psychoanalytic journal told me—in the 1990s—that they were interestedin my ideas about sex but would not consider any submission about homosexuality. What this meant was that there was no possibility of adequate peer review of this topic!

 

5: Developmental research on childhood gender identity disorder

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5

Susan Coates

Children with childhood gender identity disorder (CGID) are obsessed with the wish to be the other gender. One 3-year-old expressed it clearly: “I hate myself. I don't want to be me. I want to be someone else. I want to be a girl.”

The problems with gender identity that I am interested in are those in which gender is recruited to solve unresolved issues of trauma in the parental generation, where unconscious anxieties over power and/or abuse have haunted parents and where these issues have become represented in the parental mind in gender preoccupations. In effect, the child's mind is recruited to solve these problems for the parents, but at great cost to the child in terms of his or her own autonomy and authenticity. The boy with extreme cross-gender identification is perceived by the parent as sweet, adorable, and loving and, in the parent's mind, unlike other boys, whom they perceive to be aggressive and destructive and who would have the potential to be triggers to their often unbearable memories of psychological misuse.

 

6: Research, research politics, and clinical experience with transsexual patients

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6

Friedemann Pfäfflin

When reflecting on the century since the publication of Freud's (1905d) Three Essays on the Theory of Sexuality (1905d), we are not far off the one-hundredth anniversary of the first sex reassignment surgery (SRS) performed in 1912. The term transsexualism did not exist in those days, and the phenomenon described by it was not mentioned in Freud's Three Essays. Yet none of all the sexual abnormalities mentioned in his book has hitherto attracted as much attention as transsexualism. Although the number of transsexuals is comparatively small, the challenge they pose is tremendous.

I start with my first clinical encounter with a transsexual patient (see also Pfäfflin, 1994, 2003) and then, embedded in a narrative of own experiences, add some general research data before turning to very few psychoanalytic findings.

First encounters

As a medical student I appreciated the opportunity to regularly assist a famous psychiatrist, Eberhard Schorsch, at the Department of Sex Research at Hamburg University Clinic. He saw the most extraordinary people who had committed serious crimes, in order to preparepsychiatric expert evaluations for courts. He enabled his patients to talk by being reserved, treading softly, and listening attentively. Although not a psychoanalyst, he was regarded by the courts, by lawyers, and by the public at large as the psychoanalytic forensic psychiatrist in the country because of his capacity to create insight into the motives for and circumstances of the patients’ horrible deeds.

 

7: Drive and affect in perverse actions

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7

Rainer Krause

Some general thoughts about perversions

Within the thinking and writing about perversion, two perspectives, which are not mutually exclusive, can be distinguished. On the one hand, perverse creations could be regarded as creative play forms of human life, which are in no way concerned with either the courts or therapy. Kernberg (1995) has shown that sadomasochistic fantasies are an important part of normal love relations. Much creative production is closely related to perverse acts, as Chasseguet-Smirgel (1985) has worked out. Perverse behaviour is so widespread and at the same time kept so secret that it is not surprising that in most epidemiological studies it does not even register (Schepanck, 1987). From that perspective, modern epidemiologists have given up the term altogether, talking about paraphilias instead admitting that the prevalence rate must be very high because the commercial market is overabundant (Sass, Wittchen, & Zaudig, 1996, p. 595).

On the other hand, most experts agree in that perversions represent a severe disturbance, with links to psychosis, fragmentation, and alienation (Khan, 1979). Again, Chasseguet-Smirgel (1983) considers perversion as an indicator for severe pathology, first at the level of the individual but also at the level of society, relating the amountof perversion to the collapse of the law that should be embedded in a culture through the internalization of a loving yet powerful father counteracting the infantile incestuous mother–child universe. Indeed, after years of treating such patients I can say that very often the perverse enactment is the major stronghold against the laws of treatment and at the same time against change. The perverse universe is often re-enacted in the treatment without the conscious knowledge of the therapist. One patient was in treatment for his “depression” for three years without ever mentioning his severe perverse constructions. Seeing me, as his second analyst, he began after a year to talk about bits of these constructions, talking very contemptuously about the lady therapist to whom he had lied all the time without realizing that he was breaking all rules and laws of treatment. He had asked me for a consultation knowing that I had a reputation for the treatment of perversions. Nevertheless, he lied to me also. Of course, the term “lying” is not suitable for the process because—as I will argue—patients will not be able to renounce these secret constructions before they can be sure that the world at large—that is, the analyst—has something better to offer. This is nearly impossible, because hope based on a minimum of idealization is counteracted by secret scripts of enacting contempt and disgust to regulate the density of cathexis and to keep the oedipal figures powerless. I will argue that such constellations are very frequent, and usually they go unnoticed. In order to understand the structural commonalities of perverse solutions disregarding the phenomenology of perverse behaviour, it is helpful to use our research knowledge about affects and drives.

 

8: Conclusion: future clinical, conceptual, empirical, and interdisciplinary research on sexuality in psychoanalysis

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8

Marianne Leuzinger-Bohleber

It is to learn, for example, that love and history are related that betrayal of love is conditional upon time that faithfulness and faithlessness depend on the nature of the era in which all of it happens. The respective situation of each historical society strongly affects all procedures of love and betrayal; it influences the structure of feelings and the vitality of passion. Your way of feeling is influenced by particular patterns of the era anyway. The question of how these patterns come about and under which conditions they may alter, basically depends on the accessibility of historical changes to the field of Analysis…. [p. 105]

Today, stories about faithlessness, betrayal and vengeance are neither subject of studies dealing with the difference of characters of both sexes—Frailty, thy name is woman; La donna e mobile—nor are they pedagogical endeavours to salve civil matrimony and family as it was understood during the nineteenth century. Moreover, these stories are dramatic inquiries coping with the issue of loneliness of moral subjects in Modernity. Law and order are not only missing for betrayal and its retaliation, but also for one's own guilt and the guilt of the others. Characters regard themselves as being murderers, victims and perpetrators, covered by blood just like in the ancient tragedy. At the same time they are being tapped on their shoulders by many well-meaning, eloquent understandingly people, saying: live has never been easy for you…. [p. 419]

 

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