The Repression of Sexuality in Contemporary American Psychoanalysis

Two weeks ago I had the pleasure of reading Conci’s biography of Harry Stack Sullivan entitled Sullivan Revisited – Life and Work: Harry Stack Sullivan’s Relevance for Contemporary Psychiatry, Psychotherapy and Psychoanalysis. It’s a wonderful work that contextualizes the radical innovation of Sullivan’s contribution to interpersonal psychoanalysis. Sullivan is the grandfather of contemporary American psychoanalysis and Stephen Mitchell recognized his work as foundational to the contemporary movement. Sullivan began his work at Washington DC’s storied St. Elizabeths Hospital. He then went on to work at Sheppard Pratt Hospital, outside of Baltimore. While at Pratt, he began a therapeutic wing for young male psychotics who recently had psychotic breakdowns. He collaborated and influenced Frieda Fromm-Reichmann’s work at Chestnut Lodge, a hospital located in the DC suburbs (in Rockville, MD).

What was interesting about Conci’s story about Sullivan’s theoretical and therapeutic innovations was the ways in which he re-worked psychoanalytic theory. Although he relied heavily on Freud’s notion of transference (which he re-named) and had an appreciation of unconscious processes, Sullivan was innovative in stressing the social nature of human beings. Sullivan (like many other early dissenters such as Fromm, Thompson, Fromm-Reichmann, etc) argued that Freud had overemphasized the sexual in human nature. Sullivan also collaborated with many social scientists, believing that the cultural and political background greatly informs the ways in which society understands mental illness.

Although I greatly appreciate Sullivan’s contribution to the theory and treatment of schizophrenia (along with the other notables in the interpersonalist tradition such as Fromm-Reichmann and Searles), I was astounded to find how quickly these psychoanalysts dropped sexuality from their theory. When Freud (accompanied by Jung and Ferenczi) traveled to Clark University in 1909 to present his famous introductory lectures on psychoanalysis, he was surprised by how receptive his American audience was to his ideas. It is likely that the disorganization of American psychiatry, at this point in history, made psychoanalysis attractive to the psychiatric community.

Yet Freud remained suspicious of the US and never returned. What’s surprising about contemporary psychoanalysis is the minor role afforded to infantile sexuality. Open up the pages of a contemporary journal and one will find that attachment theory now reigns supreme as the primary theory of human development. Early infant attachment studies populate these journals and now serve as the guide to inform contemporary psychoanalytic treatment. Modern psychoanalysis’ goal is for the patient to install the analyst as a “new object”, which will help to heal the patient’s chaotic and ruptured internal world. Interestingly, although most contemporary psychoanalysts still see a place for aggression as a primary motivational system, sexuality has now been superseded by the need for human connection and attachment.

So what is going on here exactly? The basic conclusion I made from reading Sullivan’s biography and from my knowledge of contemporary psychoanalysis is that America’s puritanical legacy continues to blind us to the foundational role that sexuality plays in the life of human beings from birth to death. It is arguable that psychoanalysis was quickly sanitized of its dirtier, sexual parts to make it more palatable for its American audience. One of my past psychoanalytic supervisors pointed out that the current generation of psychotherapists is more repressed than the baby boomers are when it comes to discussing sexuality with patients. This became apparent to me when I attended a recent lecture on erotic transference. The speaker (whose leanings were in the relational school of psychoanalysis) spoke about how patients often eroticize the transference to avoid their needs for dependency and nurturance. According to her, the sexualization of the relationship serves a defensive function to hide these more primal attachment needs. During the discussion section, I raised the following question: “Is it possible that the patient who develops a dependent attachment on the therapist might be avoiding their repressed sexual wishes that remain hidden underneath the dependent, nonsexual transference?” Her response was dismissive.

This allergy to sexuality has to be held in tension with another cultural belief of the conservatives that America is becoming hypersexual. Sexuality saturates the media and there are even TV shows that feature little girls in beauty pageants wearing scandalous and sexual clothing. Yet, despite these cultural trends, Americans seem to be unable to speak about sexuality. Sure, there are sexual images flooding the airwaves, although we should remember that our censorship laws on television appear to be more sexually conservative than other countries. Ironically, the violence shown on basic cable is overwhelming. For instance, the other night I watched a TV show that featured the beheading of two villains! Beheadings at 9 PM CST!

It has been my therapeutic experience that while individuals freely discuss their aggressive wishes and intense relational needs there is a much greater anxiety when the patient attempts to articulate his or her sexual feelings and fantasies. The de-sexualization of psychoanalysis has served a defensive function for our culture. Sexuality is still censured. It is not to be spoken about. Perhaps it is time to return to the fundamental discovery of psychoanalysis, namely, of the dynamic unconscious and of the relationship between infantile sexuality and neurosis. The depressing rates of childhood sexual abuse in this country validates Freud’s discovery that childhood sexuality continues to fascinate and terrify us. If nothing else, opening up conversations about sexuality (particularly infantile sexuality) might help us provide a better future for vulnerable children. These children are exposed to sexually immature adults who have yet to work out their own sexual conflicts and unfortunately discharge these repressed sexual wishes on the innocent, leading to the tragic victimization their own children.

13 thoughts on “The Repression of Sexuality in Contemporary American Psychoanalysis

  1. Do you think the modern patient’s (and clinical technique, now that I think about it) fixation on “feeling better” might be a manifestation of repressed sexuality? Since it cannot be talked about or tolerated as a conscious fantasy, might it be acted out in this weird, “Make me feel good!” dynamic?

  2. It calls to mind the paper we read recently by Winnciott where he discussed his idea of “ego orgasm”. There is a demand for relief and tension-reduction from the symptom. One of Lacan’s fundamental insight is that the patient comes to treatment because they can no longer derive the jouissance embedded in the symptom.

    It would be wrong to attribute the anxiety and repression only to therapists. Bringing up sexuality with patients is often experienced as an inappropriate invasion of privacy. There are all sorts of fantasies about the voyeuristic therapist who is attempting to cast a quick gaze into the patient’s bedroom (which might be true sometimes). At the same time, the onus is on therapists to have the courage to ask these questions. I recall our professor who always said that patients want to speak about masturbation fantasies but fear that they will be judged or criticized by the rigid therapist. Yet, we know that an exploration of these fundamental fantasies are very deeply revealing about the foundation of the individual’s personality organization.

  3. As far as I understand it, Lacan’s thoughts about jouissance are very helpful for understanding symptoms. It brings to my mind questions about the patient’s desires and terrors, pointing to the most profitable (and least superego-y) avenues for treatment.

    I also think it does damage to the collective idea of “humanity” to remove sexuality. Among other practical considerations in regard to raising children, are we all just to pretend that parents fearfully avoid their infants’ genitals when changing diapers? Whatever arguments can be had about libido being pleasure- or object-seeking (which is a dumb dichotomy, if you ask me), no one can deny that it feels good to get a vigorous rubbing of your private parts. By my earlier metaphor, patients then come for treatment expecting a good rub-down along with their therapy.

  4. Your point about the false dichotomy between libido as pleasure-seeking (Freud) and as object-seeking (Fairbiarn) does frame the question nicely. Freud scholarship demonstrates that he understood that relational/attachment needs are satiated through sexual connection. However, modern psychoanalytic literature seems to insist on the fantasy of the non-libidinal attachment relationship. To bring this conversation down to earth, everyone has heard the question asked before: can men have non-sexual relationships with women? Of course, the answer to this question is “no”. Yet, I think the question should be expanded: can any two people have a non-libidinal connection? The answer is also “no”. All relationships have a sexual component, even connections between people who have non-compatible sexual orientations. It’s just a matter of how strongly we repress the sexual connection inherent in all relationships. Generally, these impulses are repressed, allowing us the fantasy of having non-sexual feelings for one another.

  5. I would argue that there are times when the censorship barrier fails in all relationships, allowing us brief glimpses into our sexual feelings for one another. Typically, these brief impulses are dissociated. Individuals who have obsessive-compulsive personalities often fail at dissociating these moments, contributing to their anxiety about their sexual impulses.

  6. It also brings to mind another fundamental point about infantile sexuality: it isn’t sexual. I was reminded of the line of analytic theorizing that talks about excitement, and how this is much closer what Freud was talking about. I think some of the problem has to do with translation, but what I think is lost is that people do not only seek connection to others, people are also excited by connection.

    So, is the original infantile sexual fantasy about sex? Of course not. I imagine that a person’s infantile fantasies are quite idiosyncratic and specific, but they are certainly not about coitus. Freud’s attempt was capture the energy, compulsion, and excitement inherent in relationships. Otherwise, why is the connection to family so powerful? I assume a relational account would have to do with some sort of memory, but this is highly unconvincing to me. For one thing, parents are not perfect, and so memories of them would be ambivalent without some splitting mechanism (which cannot be explained relationally); also, memory theories are notoriously problematic in so far as they are learning theories. Why not learn new things?

  7. I can agree that if we conceive of the child’s experience as the same as the adult’s sexual experience then we are likely mishandling the notion of infantile sexuality. So when you use the word excitement, I can safely assume you are referring to pleasurable bodily sensations that the child feels. The child’s stimulation of certain excitable body parts elicits pleasure. Whether or not we then use the word “sexual” to describe this event is where resistance comes into play. It’s an undeniable fact that children masturbate and they perform these actions in ways that are different than the way adults engage in this activity. While the child’s experience of libidinal pleasure and the ways in which it is experienced throughout different bodily regions is primarily physical, they eventually use language to make sense of these events and form memories. At this point, the body becomes overwritten with language, and this helps to explain why psychoanalysis has always been about the relationship between language and libido. They are intimately connected, as language helps to package and contain these ecstatic experiences.

  8. I’ve been reading Freud in German for the last month, and I can confirm that the word “sexual” is far from being a translation error. He does use words meaning something like excitement, stimulus, etc., and as far as I can tell, they are generally translated appropriately when they occur.

    Lately I’ve been wondering about the insistence on sexuality from another direction. Yes, it’s subversive and uncomfortable, etc., and probably valuable for that reason alone — but I wonder if calling all those wild partial drives “sexual” implies the teleological goal of “normal” sexuality. That is to say, if development goes well, these drives are what will be disciplined and shaped into adult sexuality. But then you could turn it around: we name those drives after sexuality because that’s the most difficult and uncertain aspect of human development, which remains inconclusive and uncontrollable to some extent in essentially everyone.

  9. The sanitization of sexuality also occurs over the course of Freud’s career. Even his original abandonment of the seduction theory was in part because Freud found it hard to imagine–was horrified to think–that that much actual childhood sexual abuse was occuring among the middle classes in Vienna. The children must have imagined it, not done it! But I think you can trace how sexuality becomes a much more expansive, less sex-qua-sex concept over the course of Freud’s metapsychological papers of the WWI era- the drives always being “fused,” etc. etc. In 1920 he writes in the preface to the third ed. of the Three Essays (orig. 1905): “…remember how closely the enlarged sexuality of psychoanalysis coincides with the Eros of the divine Plato.” (He repeats that in Group Psychology, and this expand-the-concept “sanitization” first seems to appear in a 1915 letter to Abraham.) That’s a very confusing, if not downright counterproductive, thing to try to “remember” as you drive into the first essay, all about homosexuality and masturbation!

    Thanks for your post. The suppression of the sexual component of analysis, for theory, technique, and actual clinical practice (which often seems to have little to do with “technique”), has been going on pretty much since 1896. It’s always good in this field to be reminded of what we’re all so inclined to repress or forget. I’m pretty sure it was a Sullivanian who wrote that in sessions with patients, he likes to think, “what am I not thinking about right now?”

    (Just last year at the clinic at my training institute, someone bought the “erotic” version of the fridge poetry magnets for our staff/candidate lounge- and one of the members of the training committee threw a fit when he saw them, claiming that it created a “hostile workplace environment.”)

  10. I want to clarify, since I broke my rule about not posting when I am tired when I was talking about libido:

    Infantile sexuality is not equatable with adult sexuality, and in that sense, is not sexual. It is not characterized by fantasies of sexual activity in the way that adults fantasize. Otherwise, I think, sex ed classes would be unnecessary. So I was much to flip in what I said earlier.

    Otherwise, Adam, I think you make an interesting point. I need to think about it for a while.

  11. Jason, I guess I don’t quite follow your point. Of course if we treat childhood sexuality as equivalent to adult sexuality then we are likely going to be projecting the sophistication of adult sexuality back onto children. Freud specified this which is why he differentiates pre-genital sexuality from genital sexuality.

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