sex therapy: beyond masters and mens clinic

Sex Therapy, Identity and Intimacy

‘I was,’ wrote St. Augustine, ‘bound down by this disease of the flesh…that only You, God, can cure.’ To the Great Doctor of Christianity in the fourth century, sexual desire was a disease; to the great doctors of coitus today, lack of desire is a disease. ‘Inadequate Sexual Desire,’ asserts Helen Singer Kaplan, ‘is probably the most prevalent of the sexual dysfunctions’..

Doctors of theology and doctors of medicine, clerics and clinicians, have much in common, especially when it comes to sex. What they share, above all else, is an arrogant certainty that they and they alone know how God or Nature intends us to enjoy ourselves – sexually and otherwise. Hence they have always been…great meddlers. From time to time, clerics as well as clinicians have changed their minds about what we must do to be in harmony with the designs of God or Nature – but this has never caused them to entertain the least doubt that they are the proper interpreters and enforcers of those designs. Sexual self-satisfaction (now usually called masturbation) is a good case in point.

For more than two hundred years – well into the 20th century – the leaders of Western science and thought maintained that masturbation caused a host of diseases and was itself a disease. Now they maintain that it cures a host of diseases and that abstinence from it is disease. Diogenes and his contemporaries knew better: they understood that desire, whether for food of sex, is not a disease and that the satisfaction of desire, whether it involves alimentary or erotic acts, is not a treatment. (Thomas Szasz. Sex by Prescription. Anchor/Doubleday (USA) and Penguin Books (UK) 1980. Pp xi-xiii)

‘(legitimately)…contraception and venereal disease have formed two of the portals through which the physician entered the area of human sexuality. A third portal – perhaps the most important one for modern sexology – was formed by the so-called disturbances of the sexual function, such as impotence and frigidity…(But).. Frigidity can be a medical or a moral condition.. (and) depends both on the condition of the body and the character of the person. ‘ (op.cit.xv)

‘Next to the need for sleep, water and food, the sexual urge is our most powerful biological drive. Nevertheless, neither releasing this drive nor inhibiting it constitutes or causes disease. This remarkable fact alone ought to make us sceptical about contemporary medical claims concerning the pathology and therapy of sexual dysfunctions. Yet, the very acceptance of such terms as “sexual dysfunction”, “sexual disorder” and “sexual pathology” makes us believe that such conditions exist.’ (op.cit. p4)

‘I am not saying, of course, that the sexual (conditions affecting) performance I have described do not actually occur or are not real. I deny only that these phenomena are ipso facto medical diseases or problems.’ (op.cit. p7)

‘Instead of regarding sexual dysfunctions as diseases, we could more profitably regard them as the solutions of certain life tasks – that is, as the expression of the individual’s life-style.  (This is almost a Hillman-shuffle approach. Although Szasz, in the text that follows, moves elsewhere, this point would be a major key in understanding ‘sexual dysfunctions’ from an Archetypal therapy point of view. We would need to ask, not what this person is doing wrong, but what the possible purpose or perceived payoff of such behaviour might be to that person. Only when that is addressed can we begin to question whether and what behavioural changes might be desired or required. Treat the cause, not the symptom.) Consider the man who completes the sex act very quickly (now called premature ejaculation). The man himself may be dissatisfied with his performance or he may not be. We may look upon him as we do on a man whose idea of eating a meal is to gulp down a hamburger and french fries in three minutes flat. Such a person is assuredly no gourmet – that is, how to stretch a seven course meal with drinks over three hours and enjoy every minute of it. Similarly, the quick sexual performer is not a sexual gourmet; he does not know – for whatever reason – how to have leisurely sex. If he wants to change this, he must learn new patterns of sexual performance. (op.cit. p9)

‘Clients seeking sex therapy accept their therapists as authorities – as expert healers, physicians, scientists. This enables the expert to grant patients absolution for sexual ignorance or ineptness and permission to engage in sexual acts that they formerly feared or considered forbidden.’ (op.cit p10)

OK. That should give you something to think about. But something else was bothering me and it took me a while to find it.

Part of the answer comes in the revealing final paragraph in Helen Singer Kaplan’s book, The New Sex Therapy ( USA 1974; Penguin Books 1978, 1981). This is a ‘bible’ in sex therapy and everyone who writes after her refers to this work. The very last page of the book, on page 574, has a half a page of writing that begins: ‘7. Love. Upon reviewing this book on sexuality, I am struck with the conspicuous absence of the word love.’ (p574).

We are also similarly struck! But there is more. All the books on sex therapy mention that, for example, a woman may not feel comfortable to orgasm if, say, she was sexually abused as a child. Or a man may have erectile problems if he was brought up in strict home and punished by his father for masturbating, and so on. The response to these issues is essentially one of two approaches, which we discussed in the lectures on Madness and Sanity, namely that the therapy offered is either ‘behavioural’ or one of its endless mutations, or else based on the more ‘psychological’ approach offered by psychoanalysis, in other words, based on the theories propounded by Freud and the endless mutations of that. Kaplan continually refers to ‘unresolved Oedipal conflict’ and other such joyless Freudian concepts throughout her work.

The actual therapy being offered to resolve even basic psychodynamic conflict is extremely limited, as any book (and there are plenty of those to be found) on ‘surviving rape’ or ‘getting through childhood sexual abuse issues’ will reveal. These are complex matters and deep traumas and often the resolution of them requires the ritualisation of some behaviours within a loving relationship. There is no healthy model for this in all of contemporary Western sex therapy. On the contrary, the retaining of ‘perverse’ ideas, fantasies and wishes, and especially the desire to act these out, is itself an indication that sexual health has not been achieved and more therapy would be required. Kaplan is too glib in saying that, in some cases, ‘therapy may be required to resolve these issues’, as if everyone’s problems will be resolved and disappear if they have orgasms and good erections.

Memory is deep and lasting and the images evoked by primary conflicts and traumas do not simply fade into smoke-like images because a person is able to ‘perform well’ sexually and enjoy themselves. The seriousness of childhood trauma and lesser conflicts cast a very long shadow over the adult’s behaviours and Freud and the post-Freudian models simply has insufficient depth of complexity to offer much in the way of resolution of these matters. It is well documented, for example, that Freud was never able to adequately explain, within his theoretical model, the common human impulse for Sadism and Masochism. (I will give the sources later, when I check) and that the reason that Freud eventually came up with the (all-pervasive and key) theory that the majority of his clients were really telling him fantasies and not reality, was that he simply could not believe that the extent to which his patients told him stories of overt childhood sexual abuse was actually true! Now we know a little more of how wide-spread this actually is.

Thus far, I have mentioned more or less overt sexual trauma. But often it is more subtle, or at least not overtly sexual conflict, that later becomes sexualised and played out in the adult’s behaviour. A need to please the mother; a fear of loss of love; fear of punishment, a need to over- or under-achieve to play out family-of-origin expectations; the roots of (non-sexual) addictions translated into human sexuality; isolation; fear of loss of control; a need to punish and on and on. We will discuss these at some depth in the next group. These issues are at the heart of, and maybe the most serious criticism of, the complete farce that currently offers itself as ‘sex therapy’ and where a Freudian ‘primal scene’ scenario is hopelessly inadequate. Think about it.

However, there are still two further aspects that need to be addressed. The first leads on from the point just raised. Naturally, from our point of view, we would also have to consider, in addition to the psycho-dynamic aspects, however important they are, the input also of the peri-natal and transpersonal dimensions. Much of Grof’s work is precisely geared to understanding how the peri-natal generally and especially the actual birth process (BMP-3) imprints directly on the adult’s sexuality, with or without later childhood trauma or conflict. There is no model at all for factoring this into conventional sex therapy, in spite of continued and published information on the subject. The transpersonal dimensions open entire worlds to be factored in.

But in addition to the severe limitation on the therapeutic models available and usually used in actual practice, the entire range of ‘valid’, that is, ‘acceptable’ human sexual experience is also seriously limited. For example, there is no concept of adequate male sexual performance without ejaculation as a conscious choice, such as within Tantric or Taoist practice. Or the fact that all the ‘authorities’, and in the face of major evidence to the contrary, still deny that women ejaculate (‘In contrast to the male, there is no ejaculation in the woman, of course’ Kaplan, p56; ‘Some women do appear to pass a small amount of fluid from the urethra at orgasm. However, it is uncertain whether this fluid is simply urine. The possible association of such fluid emission with stimulation of the Grafenberg spot also remains unproven’ Keith Hawton, Sex Therapy, Oxford Medical Publications, Oxford University Press, 1985, 1987).

There are more examples of this, where even the basic biology and performance of human sexual behaviours is currently defined as ‘we, the authorities, know what is right and good, that is, healthy. And if you do or claim something else, then you are unhealthy and, by definition, need treatment’. Masturbation was unhealthy for 200 years and required treatment. Now it is the very acme of health. Masters and Johnson, in one of their Mastur-strokes of the ol’ Johnson, even defined a new ‘bona fide medical disease’ called MOA, Masturbatory Orgasmic Insufficiency. A person has this treatment-requiring disease if they ‘cannot achieve orgasmic release through self-stimulation, even if they can reach orgasmic expression in coital connection’. Really. I kid you not!

The entire story of the American Medical Fraternity’s chameleon act regarding homosexuality (as defined by the DSM-bible over the past 40 years) further proves this. The Americo-centric dominance defining and informing sexual health needs to be seriously questioned. For example, if a man pays a woman to suck his penis, that is called prostitution and it is criminal act. However, if someone films a man who pays a woman to suck his penis, then that is called ‘making pornographic films’ and it is protected by the US constitution as an expression of personal freedom. As I heard someone say, ‘George Bush, the man who put the USA back in sausage.’

It is time to revision sex therapy, and this does not mean a few cosmetic modifications on what is unsound foundations, but a radical (means ‘to the roots’) approach that leads to real sexual health. And brings the word ‘love’ onto the first, not the last page.