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Sexualities: Contemporary Psychoanalytic Perspectives.Alessandra Lemma and Paul E. Lynch, Eds. (2015) New York, NY Routledge. 244 pp.

Joy, Michelle T. MD

The Journal of Nervous and Mental Disease: May 2016 - Volume 204 - Issue 5 - p 404–405
doi: 10.1097/NMD.0000000000000508
Book Reviews

PGY4 Psychiatry Resident Hospital of the University of Pennsylvania Philadelphia, PA

Psychoanalysis is all about sex, right? Mothers, fathers, infants, and oral, anal, genital sex. Or has psychoanalysis become about everything except for sex? Where do we stand? In Sexualities: Contemporary Psychoanalytic Perspectives, Alessandra Lemma and Paul Lynch have compiled a volume of essays that addresses the very complicated relationship of psychoanalysis with sex, now and over time: a relationship marked by prominence, absence, and an oscillating conflict between those 2 states.

The book begins with an introduction by the editors entitled “Let’s talk about sex or… maybe not…,” which frames the book’s (successful) attempt for analysis to re-engage with sexuality. “(Re)Sexualizing psychoanalysis,” they call it, and this is truly the triumph of the book (4). It is honest about the difficulty that psychoanalysis has had with sex, despite Freud’s original “boldness with respect to sexuality” (4). Throughout my clinical training as a resident, I personally have had the distinct impression that psychiatrists—and even, perhaps particularly, psychoanalysts—have a discomfort surrounding sex despite its importance in individuals’ lives, in the mind, and in the field itself. “Sexual conservatism is an odd centre for a profession originating in sexual radicalism,” states the text, echoing my own experiences and concerns (Barden, 81). With this in mind, the book brings sex back to the forefront of the analytic dialogue—with a particular emphasis on sexual orientations, transgressive practices, and some discussion of gender expression.

Dagmar Herzog explains psychoanalysis’ inherent conflict with sex in the book’s first chapter on historical foundations. Just what happened to sex—and particularly homosexuality—after Freud? asks Herzog. Well, the answer appears to be that within psychoanalysis; sex became framed much more conservatively and moralistically. Psychoanalysis lost the dominance it held over sex—previously shared only with the church—with the arrival of Kinsey’s sexual pluralism, Masters and Johnson’s behaviorist sex, the sexual revolution, feminism, and general liberalizing tendencies over time. The way in which analysis attempted to maintain its grip on sex was with the proclamation that homosexuality was abnormal, alongside other conservative family values including the psychological primacy of attachment love over sexual behaviors and desires. With this context, Herzog frames the importance of taking a close look at psychoanalytic theories about sex, including its conflictual history. Of course, homosexuality eventually was removed from the DSM in 1973, and in 1991 the American Psychoanalytic Association began to admit openly gay and lesbian analysts, but with such a sordid past, it is no wonder that psychoanalysis and even psychiatry in general have difficulty speaking comfortably about sex.

How do we move forward? The book lays forth some groundwork: we talk about sex, and in doing so, we question the field’s relationship with sex. The book brings sex back even by talking about its actions, by talking about anal sex, sucking on penises, and the image of an adolescent boy with a “cucumber, broomstick, or dildo in his anus” (146). The text is at once real and theoretical, placed in the experiences of the body while examining the very theories that have so far explained those experiences, using verbs and -isms, physically intimate and simultaneously theoretical.

Mary Target expands on the chapter 1’s depiction of psychoanalysis’ historical distancing from sex by exploring the conceptual move away from sex toward theories of relationships, attachments, and objects (43). Target brings sex back to the foundation of theory by emphasizing the importance of infant psychosexuality as central to the human experience with nods to Peter Fonagy (and their collaborative work) and to Jean Laplanche—2 thinkers who are repeatedly referenced throughout the entire book. If there is 1 theory recurrently explored as a starting off point in the text, it is the idea that sexual feelings are normally inadequately mirrored in childhood—leading to an incongruous feeling surrounding sexuality, which needs to be regulated and integrated with seeking partners outside the self.

One of the book’s most admirable achievements is its repeated ability to take an honest inventory of the flaws of the field and acknowledging the awkwardness with which it must try to move forward: reflecting on the purportedly reflective profession. Nicola Barden accomplishes this by acknowledging analysis’ sexual conservatism and hetero-normative stance, largely after Freud (81). She puts forth remedy in a postmodern analysis that calls for deconstructing the very idea of normality and destabilizing the ontological process of conferring psychoanalytic knowledge through authority (96). She is not afraid to frame the field as universalistic, conservative, and often rigidly acting without reflection or context.

As such, perhaps the book’s most significant accomplishment is its metanarrative—sometimes overt, sometimes inferred—about why psychoanalysis has had such a difficult time with sex. And why has it been so rigid and firm with explanations and categories—wrong, bad, perverse, homosexual, heterosexual, male, female, trauma, sadistic, promiscuous, normal, abnormal—despite being a field that looks into all that is fluid and amorphous? Vittorio Lingiardi paints analysts as police of the categorical boundaries of sex and gender, “forgetting that there are no identities and sexual orientations in the unconscious” (113). Rather than necessarily answering all the questions, the book lets us take a step back and query the basic moral and categorical thinking of the field. Peter Fonagy and Elizabeth Allison ask us to examine “misplaced wishes for definition in our patients… our wish for simplicity” and instead question normativity in search of more “nuanced and subtle exploration of particular subjectivities… embrac[ing] de-legitimization” (135). Paul Lynch similarly explains that psychoanalysis has tended to settle “instead for distinct categories of people that no real person has ever actually fit into” (138). Why does psychoanalysis keep trying to contain the very uncontainable? It seems to come from a fundamental and historical anxiety concerning the subject matter of sex. As the analyst well knows, sometimes anxiety is contained by defensively overly simplifying. We observe this tendency in patients all of the time with regard to their own lives, but the field nonetheless continues to moralize and categorize—normal versus pathological, moral versus corrupt—out of the swirling lived experiences of all.

With an ear to particular theories, however, among the most interesting in the book concern the fate of forbidden homosexual desires as outlawed from intimacy (Lynch, 153), the hypermasculinity of bearness as a protective masquerade (Lingiardi, 110), and my personal favorites: the sometimes important developmental function of prostitutes in integrating psychosexuality (Lemma, 202) and the potential significance of transgressive sexuality in accessing unrepresented psychic fragments (Saketopoulou, 205). Saketopolou’s chapter describes psychoanalysis’ tendency—particularly with regard to transgressive sex—to look for genetic material, trauma, repetition compulsion, and cause rather than embracing exploration and freedom of experience, which can be extracted as another recommendation for the field’s forward progress. In these chapters, the book reads as new and exciting, moving the field in a fresh direction.

At the same time, there are some chapters that the book might have been better served to exclude given the apparent goal of contemporizing and moving forward a relatively archaic field view about sexuality. For example, Chapter 3’s discussion on “Desire and Its Discontents” reads as an unnecessary inclusion of 2 discussions of desire in Freud’s early texts without adding much else. Perhaps the most off-base chapters, however, are Donald Moss’ “Sexual Aberrations: The Concept” and Heather Wood’s “Working With Problems of Perversion.” While Donald Moss’s exploration of the progression of sexual order over the time is appreciated for its self-reflective honesty—as well as its acknowledgement of the potential dual rigidities of conservative regulation and radical liberation—the difficulty the author has even acknowledging a patient’s transmasculine child’s gender and horror at surgery seems misplaced with the intent of the book. Similarly, the book ends on a backward step with Wood’s simplistic description of “compulsive sexual behaviors” and “sexual perversions” through more moralizing and nosologically categorizing language—language that the book otherwise asks us to move forward from, likely derived from the clinical work the author describes with individuals convicted of sexual offenses.

However, for the most part, the book is a successful attempt to (re)sexualize psychoanalysis while examining its history, deconstructing its concepts, and calling for more flexible, understanding, democratic, and nuanced ways forward. By bringing sexuality back to our minds, conversations, and offices, this text is offering a first step. Instead of letting the anxiety and rigidity of psychoanalysis concerning sexuality obscure its importance, let us reengage sex in all of its complex and oftentimes incommunicable spaces.

Michelle T. Joy, MD

PGY4 Psychiatry Resident

Hospital of the University of Pennsylvania

Philadelphia, PA

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The author declares no conflict of interest.

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