The Incurable Romantic

by Frank Tallis

  ‘Yes, but they can always make use of the obvious alternative if their wife objects.’

  ‘True. But that might not be as subjectively satisfying; perhaps they experience anal intercourse as something special, more intimate—more exciting.’

  ‘I guess so. I hadn’t thought about it like that before.’

  I didn’t want Mark to make a lazy link between his sexual difficulties and his homosexuality. The point registered and it was gratifying to see him smile.

  In the late nineteenth century, human sexual behaviour became a subject considered fit for scientific inquiry. Case studies of homosexuals—or ‘sexual inverts’ as they were then called—began to appear in the medical literature. The general view was that sexual inversion was a congenital condition comparable to a physical deformity or disease. Homosexuality was included in psychiatric text books alongside phenomena such as lust, murder and necrophilia. Although there were some physicians who argued that homosexuality was not a sickness, and that homosexuals—like Leonardo da Vinci, for example—were responsible for many outstanding cultural accomplishments, these enlightened voices were drowned by the braying majority. As the twentieth century progressed, attitudes changed, and by the 1960s and early 1970s many psychotherapists and psychiatrists were questioning the propriety of classifying homosexuality as a form of mental illness. It was removed from the DSM diagnostic system in 1973. A revised form of the diagnosis—ego-dystonic homosexuality (dissatisfaction with homosexual orientation) survived until 1987.

  The eradication of homosexuality from diagnostic manuals raises an interesting question. Should other forms of sexual behaviour traditionally described as deviant continue to be classified in the same way?

  Psychotherapy is usually reserved for individuals whose sexual predilections are illegal, non-consensual, harmful, invasive, excessively time-consuming or associated with significant inner conflict or distress. Paedophilia, voyeurism, exhibitionism and frottage (rubbing against a non-consenting individual in a public place) are undeniably antisocial, and most would agree that treatment is desirable. There are, however, other ‘Paraphilic Disorders’ included in the current edition of the DSM that merit professional attention only when they present in an extreme or debilitating form. Merely having a fetish was once regarded as clinically significant, but this is certainly not true today. Many men (roughly a quarter) have fetishes—stockings, high heels or leather—but this doesn’t mean that they automatically qualify for a diagnosis of ‘Fetishistic Disorder’. If an individual’s sexual preference, however irregular, can be safely enjoyed, either alone or in the company of a consenting adult partner, then treatment is usually considered unnecessary. When such an individual insists that his or her sexual preference is the cause of distress, then the emphasis of therapy is much more likely to fall on acceptance than ‘cure’.

  Sex is fundamental. All of our major social institutions recognise the importance of sex. Our myths, literature and drama feature sexual encounters and we are constantly exposed to erotic imagery on TV, online and in advertisements and art galleries. Why, then, is sex so frequently the cause of embarrassment, guilt and shame? Surely we should have come to terms with it by now.

  Religion is usually blamed for attaching guilt to sex, but there are many people who, even when they were children, rejected religious teachings and still feel uneasy about sex in adulthood.

  The problem exists, most probably, because of a mismatch. We all have a cortex, sometimes called the grey matter, a 4 millimetre–thick outer layer of the brain with which we think and make judgements, and a sub-cortex, which contains organs associated with the production of primitive appetites and emotions. For many decades, neuroscientists referred to the triune brain, a term which reflects the view that our brains have undergone a three-fold expansion, and that each of these expansions corresponds with reptilian, mammalian and human stages of evolutionary development. This is almost certainly an oversimplification, but the general idea that we are divisible along a cortical-subcortical rift is beyond question. It is a division that corresponds roughly with the conscious and unconscious stratification of the mind—the Freudian agencies of ego and id. When a man looks at a sexually attractive woman, he will be able to appreciate how her features conform to the idea of classical beauty, but he will also be viewing her with the alert and attentive eyes of a dog.

  Freud believed that the conflict between our higher and lower selves, our humanity and bestiality, is at the root of the pervasive discontent that affects modern, civilised society. We are constantly struggling to reconcile the contradictory parts of our totality, constantly trying to negotiate compromises. It is confusing being a rational animal, a creature that can derive pleasure from the transcendent complexities of a Mozart symphony and anal-oral contact. How do these two identities fit together? This perplexing duality led many of Freud’s contemporaries to conclude that sex is a vulnerability, a slippery slope down which we can easily slide, recapitulating earlier stages of evolutionary development until we finally sink to some unspeakable, chaotic nadir. Masturbation was thought to be a cause of insanity in the nineteenth century and it was still linked with psychiatric illness well into the twentieth century.

  The mammalian sex drive is associated with a fairly restricted repertoire of aims and behaviours, for example, the investigation of orifices as a preamble to intercourse; however, because human beings possess a large and powerful cortex, the same impetus can be channelled in any direction and connected to almost anything.

  Sexual interests are determined by biological dispositions, learning experiences and masturbatory fantasies (which serve to elaborate and consolidate objects of desire). For most people the process of sexual maturation, which begins around the age of ten and continues through adolescence, results in a preference for members of the opposite sex. A narrow class of associated stimuli (such as sexy clothing) might also acquire arousing properties. Perversions develop when biological dispositions provide a different starting point or chance associations capture unconventional stimuli. Some objects and materials are more likely to get captured by masturbatory fantasies than others because they possess a quality or qualities that are naturally appealing. The particular fascination men have with stockings, for example, might be explained, at least in part, because silk and nylon exaggerate the already pleasing smoothness of female skin. An object like a kettle has no such dispositional advantage, which is why so few of them feature in sexual fantasies. It has been demonstrated that a fetish can be created in a laboratory: men shown images of naked women, interspersed with boots, eventually found images of boots presented alone arousing. The effect subsequently generalised to shoes.

  A single process, subject to minor variations, can explain both normal and ‘abnormal’ development. This very much closes the gap between those who are considered sexually normal and those who are considered sexually deviant.

  One of my patients, a middle-aged businesswoman, could become fully aroused only if sex was accompanied by the sound of rhythmic knocking or creaking. The reason for this was that she had discovered masturbation early, while sitting on a rocking horse. A strong association had been formed between knocking, creaking and sexual excitement. There have always been opportunities for chance events to divert the course of sexual development. They can be found even in a nursery.

  Klaus had reached a point in his singing career where he was becoming more successful. He had been invited to take part in a number of international music festivals and he was travelling a great deal. This meant that Mark was spending more time alone. He had begun to masturbate with greater frequency. I was surprised that he had felt the need to tell me about this and I assumed that he had done so as a prelude to further disclosures of guilt and shame. When I questioned him, however, he wasn’t at all conflicted. Indeed, he was relaxed and open—perhaps too open—and spontaneously described his masturbatory practices in some detail. He would relax in a fragrant bath, light candles and place a silk sheet on hi
s bed. He would then lie on the sheet, naked, masturbate using massage oil and enjoy sexual fantasies. Then he would stand in front of a full length mirror and masturbate to orgasm.

  I wondered—given his history of OCD—whether he was offering me a chance to comment on the ritualistic nature of his routine.

  ‘Do you feel compelled to follow this sequence?’

  ‘Not really.’

  ‘Would you feel uncomfortable if you did things differently?’

  ‘No. Not really.’

  Over time, new elements were introduced into his routine, and his masturbatory sessions became quite prolonged. He would use a vibrator. Occasionally he would wear a bondage hood and articles of clothing that he associated with his clubbing days—usually PVC or mesh items.

  Was his masturbation becoming an addiction?

  ‘I don’t feel out of control, I just do it when I feel like it. This is all okay, isn’t it?’

  ‘Yes, of course.’

  Mark was expending a considerable amount of energy getting the conditions right for pleasurable masturbation, while making no comparable effort to create an atmosphere conducive to intimacy when Klaus returned. They continued to have problems.

  ‘Maybe you should try introducing Klaus to some of the things you enjoy when you’re on your own. You know, the clothes, the toys.’

  ‘Why would I do that?’

  ‘If sex were more exciting then maybe you’d feel different about intercourse?’

  ‘Klaus doesn’t like dressing up. He thinks it’s ridiculous. You see, he’s from a different generation—and actually quite conservative. I think we’d both end up feeling very embarrassed.’

  Something had changed. Mark didn’t seem so concerned about his relationship with Klaus. I began to think that Mark was actually looking forward to Klaus being away.

  ‘Perhaps we’re just incompatible.’ It was said without regret or sadness. ‘I don’t think I’d appreciated how deeply our differences were affecting me: the constant demand, the feeling of having failed him. It hasn’t been good for me.’

  Mark enjoyed being alone. And the sex was so much better: the provision of pleasure being always precisely matched to the recipient’s wishes. Like Narcissus, Mark had discovered his ideal partner in a reflective surface.

  According to classical psychoanalytic theory, Narcissism is a perversion in which the individual’s preferred sexual object is his or her own body. It should not be confused with Narcissistic Personality Disorder, which is a pervasive pattern of grandiosity, need for admiration and lack of empathy.

  Since the advent of the internet and social media, it is becoming increasingly clear that human beings are highly prone to self-obsession. For an entire generation, latterly described as digital natives, taking selfies and updating photo galleries comprised entirely of self-portraits has become a near full-time occupation. The internet is overloaded with images of scantily clad, pouting teenagers, alone in bedrooms and bathrooms, lifting T-shirts, exposing flesh and staring out into cyberspace with smouldering eyes. Whose attention are they trying to catch? Probably no one’s. Cyber-psychologists have suggested that this epidemic of narcissistic display is linked to increasing levels of celibacy and sex-aversion. Oscar Wilde presciently observed that: ‘To love oneself is the beginning of a lifelong romance.’

  One day, Mark arrived and announced that he and Klaus had decided to separate. ‘It wasn’t working.’

  ‘How do you feel?’

  ‘Not too bad, under the circumstances.’

  He had made a choice. But it was a choice that made me feel slightly uncomfortable. Psychoanalysis warns that Narcissism is potentially very damaging. It is a characteristic associated with the megalomania of infancy. If we love ourselves too much then we have no love left for others.

  ‘Do you want another relationship?’

  ‘To be honest, it isn’t a priority.’

  ‘Maybe after you’ve had some time to reflect…’

  ‘Perhaps.’ His strange smile was distinctly unnerving.

  The progression had been logical if not predictable. Mark’s disturbed family history and subsequent guilt explained his aversion to intercourse. Klaus’s absence had resulted in more opportunities for masturbation. Then, by continually pairing his own image with orgasm, Mark had refined and focused his sexual interest.

  A man falling in love with himself: it could be the subject of a piece of weird fiction. In the unpromising, bland consulting room of the flagship hospital, with its white walls and blue synthetic carpet, I experienced, once again, the thrill of the uncanny.

  ‘I don’t think I need any more therapy. Do you?’ Mark’s obsessional problems hadn’t returned and he had found our conversations helpful—particularly with respect to what he had originally called ‘the whole gay thing’.

  ‘Are you missing Klaus?’ I asked.

  ‘No,’ he replied.

  Was this a satisfactory outcome?

  Sexual development is haphazard. It is frequently influenced by chance experiences and associations. Consequently, we all take different trajectories that take us to varying destinations: a preference for a particular position, a penchant for thongs, a liking for sex games involving being tied up. Only a few minutes spent surfing internet pornography is required to persuade anyone that human sexuality is remarkably plastic. A sophisticated cortex can interact with animal appetites in such a way as to generate unlimited sexual possibilities.

  Mark’s trajectory had landed him in a bedroom, communing with his own reflection. Mindful of homosexuality as a cautionary tale for overzealous diagnosticians, I was disinclined to construe Mark’s Narcissism as pathological or recommend further treatment.

  The psychoanalyst Jacques Lacan believed—somewhat pessimistically—that romantic love is always narcissistic. He suggested that love is more about taking than giving—getting our own needs met, rather than satisfying the needs of another. An idealised partner embodies our wants. He or she is a being in whom we can see a reflection of our own desires. When we look, adoringly, at the person we love, just like Mark, we are also looking into a mirror.

  Chapter 9

  The Night Porter

  Guilt and self-deception

  Jim was a shy, articulate man in his late twenties. He found continuous eye contact embarrassing and had a tendency to look away. He was softly spoken and faultlessly polite, and he would often say things like: ‘I feel as though I’m wasting your time. There must be lots of other people who need your help—people with more significant problems.’ His thoughtfulness was endearing. He had been referred to me by a genitourinary medicine consultant because he had caught gonorrhoea from a prostitute. This had happened twice before and he had been classified as an HIV risk. My job involved developing psychological treatments that would help patients to modify their behaviour and stop them from participating in potentially dangerous sexual activity. Generally, working women are diligent practitioners of safe sex. The fact that Jim was having unprotected intercourse suggested that he was buying sexual services from prostitutes who were either uninformed or desperate. I suspected that he had seen some very seedy interiors: stained mattresses and peeling wallpaper—the stench of overcrowding. Although he had contracted gonorrhoea three times, the number of prostitutes he had visited was well in excess of this figure. Thirty would be a conservative estimate.

  We were sitting in the basement of a genitourinary medicine clinic. It was a tight space with grubby walls and iron bars in the single window casement.

  ‘Whenever I walk past a public telephone box, I have to step inside and look at the cards.’ I was treating Jim at a time when prostitutes used to solicit by leaving business cards in telephone boxes. These usually showed a scantily clad woman above a shout-line like ‘Buxom Brunette, will do anything’ and a telephone number. ‘I have to look at each card and eventually there will be a particular face that leaps out—and I just have to take the card away with me.’

  ‘How long is it—befo
re you call the number?’

  ‘Not more than a few hours. I just can’t resist… once the particular face has leapt out—I have to call. It’s like…’ He acknowledged the absurdity of what he was about to say with a bashful smile. ‘Love at first sight. I just feel this need, this incredibly strong desire.’

  ‘But surely the women shown on the cards are glamour models.’

  ‘Yes, of course. Most of the photos are nothing like the women I actually see. But by the time I get to their flats, it’s too late—I’m there—and it doesn’t seem to matter what they look like any more.’

  Jim lacked confidence. ‘I’m not very good with women. I get nervous and my mind goes blank. I’ve never been any good at chat-up lines and stuff like that. It feels so awkward, so artificial.’

  His behaviour was motivated by loneliness. ‘Have you had girlfriends in the past?’

  ‘Not many. But it was different back then, they were easy to talk to. I knew them already—from school.’

  ‘If you were in a relationship now, do you think you’d still feel the need to visit prostitutes?’

  ‘I’m not going to meet anyone—not the way I live. There aren’t the opportunities.’

  ‘Okay. But just for the sake of argument…’

  Jim gave the hypothetical circumstance of having a girlfriend lengthy consideration.

  ‘I can’t be certain.’

  ‘You’d still feel the need?’

  ‘I’m not making sense—am I?’ He blinked and added: ‘When I step into those telephone boxes…’

  ‘What?’

  ‘It’s like… I’m not myself.’

  ‘And what do you mean by that—not yourself?’

  He shook his head and deflected the question with a defensive gesture. He didn’t know.

  Jim was totally defeated by his own behaviour. He would often fall silent, assume a glum expression—and after protracted reflection—say: ‘I’m not sure why I go to see them, why I keep going back. I just don’t know.’