Blechner, Polymorphous without Perversity



Blechner, Polymorphous without Perversity
1.5 6
Sp>: C h.ln ~(' ~
who ha s gotten her husband into a very protective, nurtu ra nt role with
her, and has pursued a wild sexual affair with a somnvhat younger man.
By the way, Susa n considers this si tu atio n banal , as if from a made-for-TV
~ovie, alth ough it is also the stuff of great literature, like Anna Karenil1a.
In any case , she eventually brings some of her sexual adventurism back to
her husba nd \-\'ho, she finds out, is more willing to experiment than she
had imagined.
Mitchell's patient, George, is a man who feels dominated and controlled
by his wife an d then , ironically, pays a prostitute to control him. The dif­
ference, he notes, is that the man has ultimate control with the prostitute,
not only by paying her, but by having a secret word between them that,
when he utters it, will stop her domination . One wonders , could Geo rge
devel op such a secret word with his \vife ? There are a number of couples
who have developed such code words, either to alert the spouse that they
afe acting in an offe n sive way or to indicate some other private message.
However, in my experience, trying to bri ng home th e insigh t gleaned from
the prostitute does not always work, since the patient him self may have
characterological reasons not to have it work, in which case it helps for the
patient to first work out his o r her character issues in the treatm en t.
Psychoanalysts have a histo ry of opening up discourse on sexuality and
love, but also of reinforcing the sta tu s quo of societal no rms. Any sex­
ual practice can be judged pathologica l, but such judgment does not help
clinically. Romance is important to mos t people, but psychoanalysts (and
our society in general) ought to appreciate its many forms; the quality of
feeling should be more important than any mon olithic standard of cor­
fect or normal behavior. Some psychoanalysts have conceived of relation al
maturity and romance in rather uniform terms. An alternative guideline
is the ability of the person to find love, sexual satisfac tion , security, and
happiness in a combination and arrangement that feels m os t satisfying
and that allows fo r interpersonal intimacy without coercing or harming
another person. Th at is what Harr y Stack Sullivan (1953) ob se rved more
than 50 yea rs ago, and psychoanalysis has yet to appreciate and integrate
his view fully. To adopt subjective satisfaction, without recourse to any
external standard , as the aim of clinical treatment is to d raw heavily on
the psychoana lyst and patient's tolera nce, creativity, and fleXibility. It will
lead clinicians to more varied and achievable psyc hoanalytic goals with
each patien t.
Polymorphous w ithout Perve rsity
A Qu ee r View of Desire
How fri ghtening i ~ the
P3 St
th at await s liS.
Ant('n in
~I n nllll 'h.,\
Author's Introdu cti o n
In th e ea rly 19905, a doctor re fer red a hctcrosoxu<l l vOYC' Ll r to Ille
in my pri vate prac tice. I did not know any thi ng C1bnu t treatin g \ ()\'­
eurs at the time and wa s puzz led about why I rc(Pi v('rl th e· r('lprr,l i
Eventuall y, I dis cov~ red his re<l so nin g. Th e refC' rrillg doctor th ou ght.
"Th is patient is a pervert, and Rlechner is a per ve rL so th ey' ll prol j­
ably work well togethe r." Afte r years of feeli ng m,lli gll C' d as ,1 p t"\'t' II.
I was discovering th at I Iva s nnw reap ing some \)cndit s ,\> ,1 pe r­
v ert, eve n developing a subspecialty as a pervert. It turn cri (llit t h.11 I
vvorked relati vely well \-vith voye urs and other SO-C oil ed pe rvert<; f'l r
several reasons, not least of whi Lh wa c; tha t I did not judge them i(l,
th eir supposed perversion, while prev ious analysts had .
In 2003, I was asked to be a panelist in an international con k- r­
enee on pe rversion, held over the Int ernet So now I \\Id S being cl~kcd
to speak as a professional pe rvert I All the pan elists we re ;1<;kcd to
circulate a sho rt biographical sketch. I included th e usual J( ,l dC'm i(
and profess ional affi liations, but I prefaced them with the statcmL'n l,
"Mark J. Blec hn er, PhD. is a pract icin g pervert in New York L il \
One of the parti cip an ts, Paul Williams, th e ed itor of the Intern alioll.l;
Journa l of Psychoanalysis, wi thdrew in a huff. He W dS shocke d Ih,lt
th e word "perve rt" co uld be us ed, ironicall y, oS a ca ll ing Glfci ;lnd
professional credential.
My next oppo rtunity to app ea r ;)5 a profes sional pe rve ,·t came in
the fall of 2004, whe n the White In sti tu te spons0rc'rl a confere nce
o n "Longing and Desire." It was ju st a few wee ks before the pivotill
presidential election of Bush vers us KE'rry. Alth ough 1 hrtd origi nLlilv
Polymorp hous wi thout Pcr\ ('rsl t\
Sex Cha nges
planned to spc:1k about strictlv clini cal problems of patients w ith
difficulties fee ling or sustaining desire, the political climate led me
to cha nge my course. Th e dark d o urls of reli gious censorship were
gathering on the American hori70n. George W. Bush had 3ssembl ed
in his government a group of religi0usly minded ideologues who
vvere reinst(lti ng taboos that restricted hard -won American freedom
and libert )'. It see med more important than ever for psychiatry and
psychoanalysis to speak clearly about the importance of sustaining
and expanding va lues of tol erance and independence in private mat­
ters, sexual ami otherwise.
I had felt the dilnger in a ve ry personal way. I had an article in press
that included some "dirt y" words, that is, colloquial sexual wordS'.
The tex t had already bee n set in galleys, but the editor asked me if
we could "tra nslate" those passZl ges using more sc ientific terms. He
wa S afr'l id th at. In the current climate, the publication of the collo­
quial sexuill words could lead to legal trouble and mZlybe C\i,'11 shut­
ting down the journJI. I did not want to tri gge r the journal's demise,
so I Jgrccd to the chan ge, but it made me shiver to think that th e
political climate had led free -thinking editors to fear such reprisals.
The re had already been precedents of television and radio stations
being fined for indecency. How far will we allow such a resurgenc e
of Puritanism to go? I hope the reader will share my sense of urgency
that oppression of minorities and ce nsorship of ideas are gn '<lt dan ­
gers. Psychoanal ysis was once at the forefront of progressive social
attitudes, ilnd I hope psychoanalysis will reclaim that position.
Freud had written about the "polymorphous perversity" of chil­
dren, meaning that children are inclined to do many things with their
bodies and bodily products that would be considered perversions in
adulthood While it was courageous for Freud to discuss th(~sl' behav­
iors scientificallv (things that mothers and nursemaids already knew),
Freud 's use of the word perversion bro ught in a value judgment that
I thought WJS destructive. So I entitled my paper "Polymorphous
without Pr.r\'(>rsity." I am publishing it here for the first time, blended
with another talk I gi'We on "Sexual Facts and Values./f
'o lymorphous without Perversity: A Q ueer Vi ew of Oesire*
'Th ere is wisdom in turnin g as often possible from the familiar to the unfa ­
miliar: it keeps th e mind nimble, it kill s prejudice, and it fosters humor.
George Santayana
Port ions of thi s chapter "we ori ginallv puhlished in "Sexu al r acts and Values," Sr I/dies jn Gen de r
lind Scx l/allry. 2007, fl. 373-3 BO.
' '1 '1
The word "queer" was once common ly used as a derogator y reference to
a homos ex ual, but tod ay "queer" has been rehabilitated , wit h a ne\', a I1d
expanded mea ning. In all ironic twis t, wha t was once .m insu lt is now
a compliment in some circles. "Queer" has been revived to em brace all
kinds of expressions of sex and gende r, both th ose co nsidered "normal "
and "deviant." In its modern form, "qu ee r" h as come to d escribe tranc;gcn ­
dered individuals, transvestites, gay m eo, lesbi an s, bisex ua b , in terscxed
people , as well as just plain old hekrosexuals. Aet ua Ilv. h etero sex ua l
ity is quite queer when yo u look closel y at all of its va riel icc; (8Icc h l1cr,
1998a). As Jack Morin (1 995) has written: "No one who explores honestly
the innermost realities of his or her eroticism finds com plete 'norm aJc(...
\ Vhen we deny or reject our sexu al idiosyn crasi es, we renounce who we
are" (p . 320).
If you consider yourself predomina ntly hetero ~cx ua l, m ayhe you arc
thinking, "What do I care about q ueern ess" I a m norm al. \V h at doe~ 1his
have to do wi th me?" But queerness is not a bou t a parti cu br form of ~exu­
ality; it is about a n attitud e-an attitude of accepta nc e: in stead of tn· jn g
to prescribe normalcy, it takes a different approach to men tal hea lth. It
proposes that we define mental health in terms o f a person's ow n happi ­
ness, \",hether the person's mental functionin g provides sati sfa cti on a nd
integrity. Queerness tries to free psych oa nalys ts and other m enta l healt h
practitioners from being unwitting en forcers of dy"fu ncti o naJ cultur<1 1
norms and prejudices. It is possible that r syc h o ~1nal)'sis could acq uire a
new vitality today by becoming once aga in a mo re queer science .'
I am Ilsing the wo rd "q ueer" in a pos iti ve way. Q ueerness mc~n ~ tha t we
do not gloss over or prejudge individual diffe rences; instead, we seek them
out, identify them, appreciate them, and try to u nderst and th em, w itlwut
automatic stigma or correction. We recogni ze t hat we are all m Ll ch more
simply hLlman than otherwise; but within that simple huma nness, there
are many variations, and variation does no t necessarily mean pa th ol ogy.
A psychoanalyst is privileged, during yea rs of pract ice, tCl learn how
variable people's desires call be. What one p erso n m ay most desire in lhc
world may be something that you cannot imagin e \vallt ing yoursel f It
might even di sgust you. It is an easy step for you to judge th e other per,
son's d esire to be pathological, espeCia lly if you have mos t p eople in vour
society agreeing with your judgm en t. Psychoa nalysts and a 11 cl i n iciaJ1s
must learn to resist such judgments, or at leas t to ques tion th em .
, I had ma de this poi nt earlier,
bee p. R4).
II, ,
Sex Change5
Po lymorphous w iI hout Pl 'l \ ('r511\ . v"hen the AID S epidemic started, Abraham Vergh cse (1994), who was
a physician working in rural Tennessee, realized how little he knew about
homo sex uality, and he coined the term "homo -ignorance." It was an
important word that helped distinguish between the simple lack of know1­
edge in well-meaning people and th e perni cious bigotry of homopho­
bia. Homo-ignorance was rampant among psyc hoanalysts, too, who had
learned littl e about gay men and lesbians during their training, and much
of what they had lea rned wa s fal se.
Besides hom o -ignorance, there is also tran sgender-ignorance, tran s ­
ve stit e-ignorance, voye ur-ignorance, and more. There is a dearth of
knowledge among m any contemporary psychoanalysts about ~arious
ex.pressions of sexuality. This is ironic b eca use Freud 's stress on the
importance of th e sexual drive as a motivator gives many people the
impre ssion th at psychoanal ys ts must be very knowledgeable about sex.
But tod ay, mo st are not. Relatively little is taught abo ut the varieties of
se x ual expression in most psychoanalytic in s titut es- about hetero sex­
ual t ra nsvestites, tran sge ndered individual s, men who are attracted to
"c hicks-with-dick s," voye urs, exhibitioni sts, "stone-dykes," and apotem­
nophilia.' I wa s taught little or not hing about these in m y tr aining, and
what I was taught was often hapha za rd , anecdotal, a nd not very well
informed . At the end of my training, I reali zed that I needed to educate
myse lf abo ut these things. As a gay man , I had often been displ eased with
the ign orance of heterosexual analysts about th e basics of homosexual
experience. I rea li zed that I could be faulted m yself for not understand­
ing other sex ual minorities.
I h ave come to espou se a ba sic principle: When 1 am referred a perso n
who ha s a sexual predilecti on about which 1 have littl e or no knowled ge,
I go out of my way to edu ca te myself about that predilection as thor­
oughly and as soon as possible. If the case is one 1 am sup ervising , I do
the same, and 1 recommend that my supervisee do so, too. In olden days,
that required a trip to the librar y to do a literature search. Today, a search
of the Internet w ill bring you m o re complete and up-to-date information,
and you do not have to leave home.
Besides havi n g ba sic, fac tual informat io n, there is a question as well of
the psychoanalys t's basic ap proach when beginning treatment of a person
wit h unu sual sexua l procliv ities. How much does the analy st ask and pay
serious attention to a patient 's sta ted aims and w ishes? How str ~1ig ht for­
ward is the anal yst about whe ther he is w illi ng and a ble to wo rk tnwa rJ lh(:
pati ent's staled goals? H ow clearly have psyc hoan aly sts ~ ta kc d out \\hJt is
possible and d esirable clinicall y ill sllch cases? vV h at arc the d ata abou t
outcome? A nd how aware is the psyc hoanal ys t of th e ques tion (If psycho ­
pathology versus cultural pathology, n a m ely, that is, whe ther th e un u~ua l
sexuality is intrinsicall y prob lematic fo r the perso n or prorI em;1tic beca use
soc iety condemns tha t sexua lity?
Our judgmcnb about sex ual experi ence an d behavior can be qui te ~u h ·
jective. Consider what yo u think about male cross-dr e~se rs . D es pi te the
popula r ima ge of the gay dra g queen who dresse s up as Ba rbra St re i ~a nel,
the fact is that m os t men who want to dress up as wom en arc predom i­
nantl y heterosexual. It is much m ore co m m on tha n usually th o ug h t '
may have changed in 2007, a special time in hist ory \\'he n a h ctermcxua l
man who had been photographed scveral ti mes in wom en's cloth ing. i.c.,
Rud y Giuliani , sought nomination as p res ident of th t' Un ited States.
In 2007, the journal Studies in Gen der and Sexuality asked me tc" d i s CLl ~ S
a pap er by a senior psycho analys t, D r. Irwin Hir sc h, about cro ss- dres sing.
I have the highest respect for Hirsc h. His clini ca l accou nts a re a lwap clea r
and frank, and, more tha n with most clini cia n s, yo u teel like YOLl k now
what really happened. Also, like Freud , Hirsch rep o rts his failures , w ith­
out defe nsi veness. Hirsch (2 007) rep o rted a case in w hich he t re3tcd a ma n
whom he ca lls Z., who had a girlfr ien d and an extc nsivc he terosex u al h tS ­
tory, and w ho liked to dress in wo men 's clothes. Hir sch t ri ed to i l1 tl Ll~ n (e
him away from cross-dressing, even though the pat ient never cx prl.'s~t:'d a
wish to stop the prac tice. He w rites:
. Apote m noph ilia is ~ term [otn(' d by th e sexologiSt. Jo h n ,10nc)', for pe ople \\'h0 desire to h ave a
li mb amp utated (Mo nev, Job ar is & I ur t h, 19/i). It is ques tip nabl e whether. or to what deg ree, th is
\I'ish is connec ted to sex ua l wi ~ ht s . To dal', it is more often ref~ rr e d to as Body Integrit y Ide ntit y
Disorder (BllD) (F urth & Smith, 2000)
I beli e\'e d that Z. wo uld ha ve a good li k wi th th i,; girl fri e nd , ;In d th oug ht
she would help him se ttle into tJl e hard work of his demand ing p wft: <;sion, Mid
as well, help him actuali ze what I felt would be hi s consid erable pote n t i ~1 ,IS
a lov ing father to his yet unb or n children ... . ln my misgu ided zea l to help I.
actualize hi s career and to solid ify his relati onsh ip wit h hi s girli fi end, m~' iIl ler
pretive schema accented the immaturity o[ hi s sexu al i nterests, main tainin g h iS
arc haic girly-bov ident ifica tion with hi s mo the r and avoidi ng the '\ Irongcr "
and more masculine emphasi s o n caree r a nd co mmitment to th is , in nw mind.
wonderfully flexible young woman. rvc n if J had been la rgdv 0 11 target with
my in link ing h istor y to present, th e mo rc sa lient message th is semi
tive man heard fro m m e was to <.: ontro l his c rLl~ s- dres s in g dis tractions ~ nd In
se ttle down to a promising career, and a mon oga mC'llS rciali lll1sh ip w il h I hi~
girlfriend with whom I was so taken. In hi ~ cha rmin g a nd seductive "'01\' 7
quit th erapy for "practi cal " reasons, never cha llengin g me [0 1' my cgrc'gi(11hl y
unwarranted im positions on ele ments of a lite that he desired . (rp. 356-35:-)
SC'x Changes
Pol ymorphou s w ithout IJ c r versi l ~ Tbe consensu s about thera py with heterosexual cros s-dressing see ms to
be quite similar to the rapies that claim to change homosexuals to hetero­
sex uals. They waste a lot of money, put the patient through hell, and they
do n ot work in the long run . For maoy a heterosexual cross -dresser, what
he roost wa nts is not to lose his desire to cross-dress; instead, what he most
wants is to be able to dress up in the clothes of his "vife or girlfriend and
then make love to her. This was the case with Hirsch 's patient, Z.
Interestingly, the p athologizing of cross-dressing is skewed by certain
cult ural factors . If you think about it, you will reali z e that heterosexual
cross-dress ing is se en in our culture as much more of a problem f01:; men
than fo r women. In our culture, if a woman wears her husband 's shirt
to bed, it is not cons ide red a perversion; it is usually considered normal,
eve n se xy. But if a man wears his wife's negligee'to bed, he is considered
abnorm al. Marlene Dietrich in a tuxedo was consid e red ver y sexy; Jack
Lem mon or Rudy Giuliani in a dress was considered comic.
It is e vidence of the same "gender ethic" that brings many more boys
wh o are acting girlish into treatment than girls who are acting boyish. Our
s ociety still seems to value masculinity above femininity. It is considered
I11uch more problematic for a man to act female than for a woman to act
male. The so-called "symptoms" of Gender Identity Disorder may be as
common in girls as in boys , but parents are more likely to seek treatment
o f a so n who is a sissy than of a daughter who is a tomboy.
And why should male hetero sexual cross- dres sing be a problem? After
all, does it hurt anyone if a man wears a dress? Does it hurt anyone more
than if a woman wears pants (which was once considered unwomanly, but
nO longe r)? M aybe it is not that heterosex ual cross-dressing patients need
to stop putting on dresses; maybe society needs to change, to allow them
to do so without censure or puni shment.
In fact , cross-dresse rs a re beginning to come out of the closet more. In
003, the Briti sh potter, Grayson Perry, won the prestigious Turner Prize
(jones, 2006). Accompanied by his wife and daughter at the award cer­
emony, Perry wore a purple silk frilly dress that cost $10,000. He said,
"Well, it's abo ut time a tran svestite potter won the Tu rner Pr ize."
Many psychoan alysts have a vague notion of normalcy, and they have a
basic approach to work ing w ith people with unu sual sexual predilec tions,
which is to seek out the roots of the predilection in the early relationship
with the p a re nts, with the aim of "understanding" the sex uality and per­
haps changing it. Psychoanalysts are expert at coming up with plausible
accounts of a nythin g b ased on early parental relations, and a t th at they
rarely fail , but unfo rtunately these accounts oft en make lit tle difference in
the patient 's sexual pattern a nd e xpe rience .
The Basic Ps ychoana/vtlc Premise
This is what I call the basic psychoanalytic premise: If you can u nder­
stand the role of a symptom in someone 's li fe as well as its funct ion in the
patient's history, you can thereby help the p e rson to get ove r the symp ­
tom. When applied to sexual behav ior, the ~ a me premi:;e is often appl ied;
Exploration of the developm ental h istory of the pat ient will cl ari fy tht'
causative psychod y namics of the seXUa l patterni ng, and suc h an aly s i~ wi ll
lead to the patient's understandin g of his or her sexualit y a n d no b)nger
needing the familiar pathological sex ua lity, or, failing th at , a t leas t being
able to foster a normal sexual life in addition to the pat ient's no n- n o r­
mative sexual ity. This soun.ds plausible, but it is often false; but because
there is so little empirical outcome research in psych oa n al ys is, pr<lct il iD­
ners continue to proceed as if this approach will work. Th e fact is t l, 31
so me non-normative sexual pattern s, like cross -dressi ng, wi ll likely n eve r
disappear. It is proba bly unethical to hold out the hope for s u ch change 10
someone who may d esi re it.
Hirsch (200 7) applies the basic psychoanalytic premise in h is acco unt.
He writes, "I attributed his cross-dressin~ as well as his infi delity la rge ly to
his identification with an d his desi re to overco me hi s infantili zin g mot h er,
and his early life as her soft and ove rwe ight mom m a's boy" (p. 356 ) . It
so unds perfectly plaUSible. But is it true? I don't know. A nd if it is tr u e, did
it make any difference in whether the patient continued to cr o ~~- dr ess?
There we have a fact: absolutely not.
A psychoanalyst who is going to work with a heterosexual cross- dresser
needs to know many facts about c ross-dr essin g . Some of th ose fact s a re:
1. The urge for
cross-dressing rarelv or never disa prca rs dunng
2. Some cross-dressers eventually decide they are transgender and seek sex
reassignment surgery. Some never go a long that path. They maint ~ i n a
primarily hete rosexua l desire th rougho ut th eir lives, a nd h ope that t heir
wife or girlfr iend will allow the cross-d ressin g to be integrated inlo t hei r
sexual lives. (And this was true of Hirsch's pat ient. "A t llCl point d id Z.
indicate to me that he clearly wished to stop cross-dressing. He ac tua lIy
hoped th at he m ight integr ate thi s in to hi s sex life wit h his acceptin g
current g irlfr iend" [po356])
164 Sc'\ Changes
3. There are social support organizations, such as CHIC (Crossdressers
Hetero'>cx ual Intersocial Club) specifically for male heterosex ual cross ­
dressers, which allow such ml'rJ to get mor al support and information
from others. They may also benefit from reading autobiographical
account s, sti ch as Rowe (J 997) and Jones (2006).
4. Som e women react wi th di sgust to revelations about their husband's
cross-dressing, but some adapt and decide that they want to sustain th e
relationship. Some require their hu sba nds to keep it private, wh ile oth­
ers allow th eir husbands to go out publicly in women 's clothing. Women
married to cross-dressers can learn from other women in that situ ation,
e.g., Helen Boyd's book (2003), My Hli sband Betty Love, Sex, and Lije
with a Cross-Dresser.
5. The later in the relationship that the man reveals the cro ss-dressing to
hi s female partner, the more likely it is thal she will feel betrayed and
end their relation ship.
These are just some of the practical facts about cross -dressing that the
analyst and patient need to know if they are to proceed with treatment.
The more you examine how flawed and changeable psychoanalytic judg­
ments of pathology were in the twentieth century, the more you have to ques­
tion the entire psychoanalytic approach to psychopathology. The concept of
perversion has been especially problematic. Freud (1905b) defined perver­
sions as follows: "Perversions are sexual activities which either (a) extend, in
an anatomical sense, beyond the regions of the body that are designed for
sexual union, or (b) linger over the intermediate relations to the sexual object
which should normally be traversed rapidly on the path towards the final
sexual aim" (p. 150). Sexual activity ought to end in penis-in-vagina inter­
course. If you got there, congratulations. If you did not, you are a pervert.
Thus, for Freud, cunnilingus and fellatio, which do not lead to intercourse,
were considered perversions. Today, in America, they are considered nor­
mal parts of se xuality, acceptable and even expected in some subcultures.
And then there is masturbation: The circle of psychoanalysts around
Freud spent many evenings debating the pathology or normalcy of mas ­
turbation, never coming to any consensus. But if the European psycho­
analysts were undecided about whether masturbation was pathological,
American psychiatry was not. When I was growing up in the 1950s, mas­
turbation was listed in the DSM-1 as a psychopathology. If it was a pathol­
ogy, then I and most of my friends were pathological , as were most of the
people who wrote the DSM. There is the old quip: "95% of men mastur­
bate. The other 5% are liars." How cou ld the authors of the DSM-I dissoci­
ate so much from their own experience"
POl vm() l p h u IJ~
wi th nut
I )f' r\'(',~l l\' 11>')
I th ink th at :1 hidd en infl uence on psychiatric a nd p\yc hoa n:l lr t ll ! h in k­
ing about psychopa thology has been the Judea -Chri stian trad it ion, which
outlaws any genital sexual behavior that cannot lead to im pregna ti on .
Much of th e behavior considered pathologica l by psych iat rists was t he ~a me
behavior that was considered sinful by the strictest few s and Ch ri<;[ia ns.
For Orthodox Jews, masturbation is still considered a sin , as is oral sex
and homosexuality, and the Catholic Church holds similar views. I th ink
it is important for psychoanalysts, other mental health practiti o ners, ami
society in gene ral to disentangle their views of what is ps),c hop at hologi( al
from what is sinful among traditional religions.
In fact, the word perversion ha s its roots in religion. If vou look it up
in the Oxford English Dictionary, you will find: Perversio n: "t u rni ng the
wroI1,g way; turning aside from truth or right; diversion to an im proper usc;
corruption, distortion; speCifically, change to error in reli gious belie!"."
You see the trouble with the whole concept of perve rsion: In orth odox
religion, there is a right way to do thin gs. and if you do thin gs cii ll('r('n tl v.
even if it makes you happy and YOLl do not harm Zlilyo ne, ),ou arc sti ll
wrong, perverted, and sinful. Many clinicians hav e bought into such a
translation from sin to psychopathology, even if the connect ion between
pathology and sin is not fully conscious. That has caused a lot of cl inic )1
mischief and a good deal of suffering for pati ents.
So, it may be that ifyOLl think perversion, you are Zll sn impl ic ith thi nk­
ing, "I know the right way to behave." Not just the ri ght way for me tn
behave, but the ri ght way to behave .
In this respect, the great American psychoanalyst H Zl. 1T )' Sta ck Su ll ivan
gave us an important alternative. Most people kn ow th at Sulli\" a n \\' ;1., the
founder of Interpersonal psyc hoanalysis, and that his th eo ry formed th e
groundwork for what tod ay has become relational psyc hoanalysis. Ye t few
people know well what Sullivan wrote about sexuality, and he w rote abo ut
it quite a bit. Sullivan was queer, in the old sense of the ,"ord and the
new one; he was homosexual and he was a rat her unusual person . Because
many of Sullivan's students had difficulty with his hom o ~ex ualit y, thev
tended to selectively inattend to his exten sive writings on sexuality. 'n, ese
writings are part of what I call the lost Interperson al trad ition. Ma n\' r eo­
pie have thought that Sullivan gave short sh rift to sex ual ity and bodil y
experience, which is simply not tr ue.
Sullivan was raised as a Roma n Catholic a nd was acutely awa re of the
influence of religious taboos on psychopathology. Sulli van tried to f(l rmu ­
late a view of sexuality that would evade old religiOUS for mulas an d would
instead define sexu al health in prac tical terms. He arg ued that there are
166 Sex Ch a m~('s
ma ny sexual practices and preferences for both heterosexuals and homo­
sexuals , and what is most important for psychoanalysis about these prac­
tices is how much they allow for pleasurable intimacy \,v ith another human
being, In Sullivan's own words, in Th e Interpersonal Theory of Psychiatry
(1953, discussed in Chapter 10), "In this culture the ultimate test of whether
you can get on or not is whether you can do something satisfactory with
your genitals or somebody else's genitals without undue anxiety and loss
of self-esteem" (p, 294).
I call this Sullivan's postulate on sexual functioning, If you really take
this postulate seriously, you may have to reconsider most of your judg­
ments of sexual health and pathology. Sullivan does away witK the reli­
gious idea that healthy sexuality must culminate in at least the potential
for pregnancy, as well as the psychoanalytic derivative of this so-called
"mature genitality." Sullivan does not judge whether a ny sexual desire is
in itself healthy or pathological; instead, he focuses on how feasible it is to
integ rate any particular sexual desire with interpersonal intimacy, without
excessive anxiety or danger. Queer forms of sexuality, oddnesses of various
kinds, are not a problem if you can find a willing and satisfying partner.
Think how this might have changed psychoanalytic practice for the
better In the last century, if psychoanalysts had paid more attention to
Sullivan's postulate, cunnilingus, fellatio, and homosexuality just would
not have seemed problematic. In addition, where in her body a woman had
an orgasm, whether in her vagina or clitoris, which was a concern of many
psychoanalysts, would not have mattered, only whether she could enjoy
her orgasm with a consenting other person.
So, within Sullivan 's postulate, are any forms of sexuality inhe rently
problematic? I would say yes, that there are problems with anything that is
nonconsensual or coercive or seriously damaging to another person, One
example is what I call "invasive voyeurism," For most male voyeurs, at
least the ones who have sought treatment with me , the pleasure is not just
in seeing a woman naked; they require that she be seen naked against her
will. There is no thrill for a voyeur, for example, in going to a strip club,
since seeing the nakedness of a woman who wants to show off her body is
of no interest The th r ill is to see the woman against h er w ill. Sometimes
it is without her knowledge, although there seems, for some voyeurs, to be
a special thrill for her to discover that she is being watched, and although
she wants to stop it, she cannot It thus becomes a form of ocular rape,
I once worked with a man who had found a way to enjoy his voyeur­
ism without getting in trouble with the law, He had an arsenal of cameras
w ith powerful telephoto lenses a n d infra-red lighting, which allowed him
Polv lllorphClU<' w il hout P('rv('r~il\ 1(­ ,-
to see close- u ps of women many blo cks away in thc i r ho mes , 0Jew York
City, with its hu ge number of high- ris e apar tm ents wh o se o cc u pan ts Ic,\vc
their blinds open, was a paradise for him. ll1e trou ble was, he cou Id n't ,ust
rem a in satis fied with h is long- distance lo oking, He started to ()b.,e~., aho ul
one particul a r woman, whom he tracked down, a nJ eventuall y st art ed
calling a nd harassing, which put him in lega l da nge r. W hat start ed as a n
expression of long-dista nce aggression go t in tensi fi e d an d m ixed in w ith
desires for love and intim acy, and he needed to an a lyze a nd di sen t angle
thos e conflicting desires before he dam aged both hi mself a nd her.
Sullivan's postulate has broader ram ifi cations, beyond sex ua li t y. for th e
basic principles ofbioethics. 1he pressure in our soc iety aga in st quee r ness,
against tolerance of the unusual, is very st rong, a n d so m e lead ing meJi ­
cal ethi cists argue th at we can and should path(1logize thing!'> tha t di sgm t
u! , Leon Kass (1997), who wa s the hea d of Presid en t Rush '" c0mmission
on bioethics, argues for what he calls "th e '\visdom (If repugna nce ," K.lsS
beli eves th at the disgust reaction has a primal w isd om a nJ is rcason to
judge some things unethical. He has w ritten: "In cr ucia l cases, repug­
nance is the emotional expression of deep wisdom, beyond rea son's p owe r
to fully articulate, , , we intuit and feel, immediately a nd w ithou t argu ­
ment, the violation of things we rightfully h old dea r , . ," (£1, 20).
I think that Kass's argument is not only flawed but d a ngero u s , A big
problem with his statement is the wo rd "we," "We in tui t a nd fed , i m me­
diately a nd w ithout argu ment , the violation of thi n g~ we right fu lly hold
dear. .. " W hom does he mean by "we"? Statem e nts tha t appeal to the
common sense and wisdom of the m ajor it y have a lo ng history ('I f abus
ing the rights of innocen t minorities based on stron g feeli ngs ( )f di sgust
and contempt. In N azi Germany, the m ajo rit y " we " th o ugh t lewe; were
disgusting and inferior and should therefore he os tra ci7 ed or ki lled , In
tradition a l India, upper castes con sider that the "u nto uch ables" are di s­
gusting and inferior and should have limited ri ghts . Before th e C iv il War,
many A mericans thou ght Black people were disg u sti n g a nd infe ri or. and
therefore deserved to be slaves,
Unlike Kass , I would say that personal di sg ust is n o t a reli abl e gu ide
to evalu ate ot her p eo ple's behavior.* Recall Kass's statement: "We intuit
and feel, immediately and without arg ument, th e \" io\ at i(\11 of th i ngs we
rightfully hold dear., ," I would say, o n the co nt rary, tha t when you feel
• Ma r tha Nussballm (2004) argu es stro ngl ), again ",t I\a<s 's pOSit io n from ~ mor.II-lrga l ,Idndp"ln l
MoJern neuro sci cllC< re <~arc h has demons trated th a i there is a common , often U[1( n l1l''''lL'. dll~US
reaction to old people, Would Ka,s argue that there fore we sh(luld .:"ndcm n pc')p le 1'01 hClng old'
Sex Changes
a disgust reaction about someone else's behavior, immediately and with­
out argument, you should pause. YOLl should consider, not immediately
and not without argument, but with delay and 'with rational argument,
whether the person's seemingly di sg usting behavior harms anyone. You
should put yourself in that person's place and imagine being told that your
innermost de sire is immoral or forbidden or pathologicaL You should try
to con~ider some way to empathize with that person's experience. That is
a very hard thing to do and takes a concerted effort. It requires you to be
in an open dialogue with the person about whom you feel disgust, and to
be hon est wi th yo urself and others about your own practices that might
disgust someone else.
The risks are enormous to allowing disgust reactions or old religious
prejudices to pat hologi ze the desire of a harmless minority and take away
th eir rights. Sullivan 's postulate shows a way for psychoanalysts to avoid
these pitfalls. We can consider the value of each individual's desire on its
ow n terms, whether it provides happiness, whether it is harmless to other
people, and whether it can be integrated with interpersonal intimacy.
,Nith this approach, we can be more clinically effective at helping people
create a life in which they can explore their desires and live them out with
satisfac tion and joy.
Erotic and Anti - Erotic Transfe ren ce
Author's I nl in duction
The vC,lr 2007 marke d th e deb ut of Ihi" te l('vio;inll sc ri c<; In Trm lnll'f1 ,.
which tra c ked the wo rk of a middl e-olgcd. married f' w ch(1;) CI ;1 Iv<; [
with four different patients. The seriesgencrClled ,\ grCdl de,l l uf pul,.
Ilc interest in psycho analvtic trcatme nt Jild th e principles h,~hin rl It
The "Monday" patient, Laura, is passionatel) in 10\ c w ith her .1 nal ),<,I ,
and he gradually admits to her that he is in 10\lf' with her. tUG . Th i~ I'>
th e sl<111rla rd idea of an erotic tra n s fl~ r enl c and c. ountcr1IJnsfere n( t' ,
ancl it gen(~rJle d a 101 of discussion in the ge neral public Clnd th e
press. uS well as amon g analysts. Ma nv peoplf:' we re very judgmc nt 'l i
about the behavior of the anal yst; my colleagues reported sqlllrmi ng
when th ey saw the an alyst sitting on the cOllch wilh his pJt iL' rl l or
huggi ng her. In the ('nd, he IlPVC' r ;-lCl uJ ll y had in[(.'rcoursc with he r,
altho ugh in th e reell world. milny psyc hOil nillysts Jnd other r ,vc ho­
thera piSts do. It has hee n estimateci that 12"), ni nl.11( , th cr'l p l st~ ,1ml
3% of fema le th erapi sts have had ~ e ." u 'll cnlltilll 'vv ilh their r ctlicnt ~,
wh ich is il lar mingl v high, considering thJt it is lInetili c<l 1 h(;:'h avlor
that ca n le;lcl to th e loss of one's profess ional li cense (Po pe. F J9 4).
In my view, there we re as pects of eroti c trans ferm ce in all the
cases portrayed by In Treatm ent, eve n if th ev \Vcrf' not S() onvious.
The "Tuesday" pati ell t, Alex, a fighter pilot who fe lt gu ilt y dhnut hdv­
in g killed many citi7e ns with a ho mb, di~ r uss es ,1 d reilm in \'vhi c. h
one pdot pursues a noth er pilot fro m I)('hinci . Al ex Sil yS he "W<l llts t
put a missil f~ up his rca r" and iclenti fies this as a hornm cxual \0\ Ish
The "We dnescJay" patient, a tee nJ~W girl with her ,urn in J ( <1S t. asks
the psychoanalys t to change he r wei clot hes. an d liller shf)\\'s orf h('­
body as she docs acrobatics on his couch. The "Th ur,>cb v" pJ ti f'nt,
are a hete rosexual married couple, and th e wife flirts hra zenl v w ilh
the analyst Th ese are all vc rsiom of e rotic. tril nsfe renn:>.