The Sexual Aberrations:
Freud defines libido as sexual desire, the sexual object as the person from whom the sexual attraction emanates (a fascinatingly passive orientation), and sexual aim as the aim towards which the instinct strives in order to begin discussing deviations 553. Homosexuals are “contrary sexuals, or inverts,” though they can be “absolutely inverted… amphigenously inverted… occassionally inverted” – all components of what we would think of as a spectrum of sexuality from “straight” to “bisexual” to “gay” 554. While some see their sexuality as “a morbid compulsion,” some demand to be treated normally (this seems interesting given that Freud never claims that hysterics demand the same treatment – they want to be cured, for the most part) 554. Freud is especially interested in those he believes have become “inverted” after a painful experience with the normal sexual object” 555.
Freud thinks inversion should not be called degenerative because it occurs in people who are otherwise not deviant, whose mental capacities are undisturbed (even “especially high intellectual development and ethical culture… some of the most prominent men known have been inverts and perhaps absolute inverts”), and was common among ancient and is still in “primitive” cultures 556. Freud also questions naming it as congenital, since though some people “know” their sexuality from youth, it is usually tied to “early affective sexual impressions,” “external influences” such as the army or prison, and hypnosis’ potential as a cure 556. At the same time, some people turn out “normal” despite these things, so Freud wonders if it is neither purely congenital nor acquired, and suggests hermaphroditism as a case of “blurred” sexual characteristics that could help explain this 557. This elucidates the normal for Freud because all humans keep certain traits of the other sex, and “there is an original predisposition to bisexuality” – by which he means physical traits – that ultimately yields to “monosexuality” 558. Ultimately he rejects physical and psychic hermaphroditism and concludes that inversion must be related in some way to development.
Inverts are attracted both to virile and feminine men – Freud mentions the attraction to male prostitutes in drag and to young boys with a “physical resemblance to woman as well as feminine psychic qualities, such as shyness, demureness and the need of instruction and help” 560. The sexual aim likewise is not uniform – whether sex “per anum” or masturbation (or oral sex in women) 562. For Freud, the issue is that “we have assumed a too close connection between the sexual instinct and the sexual object” 562. Freud cites pedophilia and bestiality as examples of people fulfilling their desires insufficiently because of a lack of available options: “we find with gruesome frequency sexual abuse of children by teachers and servants merely because they have the best opportunity for it” 563. For Freud, the causal relation is chance, not pursuit of those professions, and he finds such individuals otherwise mentally normal, in accordance with his ideas about homosexuals as well 563. The mentally ill are always sexually abnormal, but the mentally well are not always sexually normal.
If the normal sexual aim is “the union of the genitals” in temporary satisfaction akin to eating, almost everyone indulges in perversions along the way – acts that delay the ultimate aim 563-4. These include “touching and looking” 564 (recall how Crary links sight and touch as senses!) The kiss, too, is then a perversion. “The perversions represent either anatomical transgressions of the bodily regions destined for sexual union, or a lingering at the intermediary relations to the sexual object which should normally be rapidly passed” 564. This is because we “overvalue” the sexual object (essentially making metonymy the whole – here again, the opposition to the classical Greek logos, where the part articulates the whole, this approach is suspicious). In the male “alone the sexual life is accessible to investigation, whereas in the woman it is veiled in impenetrable darkness, partly because of cultural stunting and partly on account of the conventional reticence and insincerity of women” 565.
Why do mouths appall us in oral sex or toothbrushes, but not in kissing? Loathing stands in the way of the libido, though not in the case of hysterics, who all loathe the penis and can’t get over it 565. The anus, likewise, appalls because it excretes (though girls feel this for the penis and this act is not more common among inverts) 565. These other parts of the body “lay claim to be considered and treated as genitals” 566. In fetishism, a nonsexual part of the body, like feet or hair, stands in for the sexual object (like the totem or idol of “the primitive”). We all pass through this in delayed attainments of the object, but in some, it becomes pathological and replaces the normal sexual aim 567. Feet and hair are appropriate fetishes in fairy tales because the slipper is yonic and hair is pubic for Freud.
Touching and looking both supply anticipation and excitement (heightened by the barriers of social convntion and clothing). The sexual aim is either active or passive, and is characterized and regulated by shame. Pathologically, activity is sadism (masculine) and passivity is masochism (feminine) 569. The latter is further from the sexual aim and may be conditioned by the experience of the former (in combination with castration complex or guilt) 570. S&M desires often both occur in the same individual: “we thus see that certain perverted tendencies regularly appear in contrasting pairs” 571. “In no normal person does the normal sexual aim lack some addenda which could be designated as perverse” 571. Some are “morbid,” however: “those in which the sexual instinct, in overcoming the resistances (shame, loathing, fear, and pain)… lic[k] feces and violat[e] cadavers” 571. The perversion is not “in the content of the new sexual aim, but in its relation to the normal” (another extrapolation) 572. Shame and loathing, which the libido must overcome, precede the sexual instinct.
Sexuality is at the center of all neuroses for Freud, seemingly as both disease and symptom 573. “The hysterical character shows a fragment of sexual repression, which reaches beyond the normal limits… an exaggeration of the resistances against the sexual instinct which became known to us as shame and loathing… an instinctive flight… a complete sexual ignorance” 574. It is coupled with an immense sexual desire, befitting the “pair” theory Freud has already discussed. The hysteric “transform[s] the libidinal strivings into symptoms” so that sex is at the root of seemingly unrelated issues 574. All neurotics are sexual inverts, obsessed with oral and anal sex, and characterized by the odd pairings of loathing and desire, S&M, and looking & exhibiting, and there are usually multiple perversions present.
“Every active perversion is here accompanied by its passive counterpart. He who in the unconscious is an exhibitionist is at the same time a voyeur, he who suffers from sadistic feelings as a result of repression will also show another reinforcement of the symptoms from the source of masochistic tendencies” 575-6.
Freud mentions that the oral & anal fixations are somewhat justified in that they mimic the genitals as “erogenous zones” 577. The eye (from looking) and skin (from touching) can be extrapolated as erogenous zones as well. In perversion, sexuality is like a dammed river – the water finds a way out by other means if normal attainment is impossible 577. The greatest perverts are the result of both congenital and experiential factors – “if constitution and experience cooperate in the same direction” 578.
“By demonstrating perverted feelings as symptom-formations in psychoneurotics, we have enormously increased the number of persons who can be added to the classification or group of perverts… neurotics represent a very large portion of humanity… neuroses in all their gradations run in an uninterrupted series to the normal state… we are all somewhat hysterical” 578.
“There is indeed something congenital at the basis of perversions, but it is something which is congenital in all persons, which as a predisposition may fluctuate in intensity, and that is brought into prominence by influences of life” 578.
(This is like Foucault’s assertion that psychoanalysis pathologizes all of sexuality.) Between the poles of perversion and repression is the normal sexual life 579. If all stems from sexuality, we must attend to the sexuality of the child.
Children are not asexual until puberty, and we focus too much on heredity over childhood in studying sexuality, Freud explains 580. We find instances of sexuality in children described as aberrations, but no one has “recognized the normality of the sexual instinct in childhood” 580. This is in part due to the amnesia we experience as adults about the first 6-8 years of our own lives, left with “a few incomprehensible memory fragments,” despite knowing from others that “we have vividly reacted to impressions” 581. Why does our memory lag as our experience and judgment blossom? Like neurotics, we repress childhood, as if it were a trauma 582. But if it were not for infantile amnesia, hysterical amnesia could not exist. The sexual life of the child, in fact, is usually visible by age 3 or 4 583.
Education and organically determined forces both bring shame and loathing to the initially uninhibited child over time 583. Though educators pathologize sexuality in the child as “evil,” there are multiple common “interruptions of the latency period” 584. Thumbsucking, based on breastfeeding, often leads to touching and even orgasm, acting as a gateway to masturbation. Autoerotism is striking because it acts out the attempted repetition of this pleasure on the child’s own body 586.
The Transformation of Puberty
The word on the street is that psychiatry has lost the mind in its quest for the brain. Is discussing this paper going to change that? My task is simply overwhelming. First, I will review the essay. Then, I will find my teaching points.
According to Freud, this essay was his second most important work (the first being The Interpretation of Dreams). In this essay he states that sexual tension promotes development from infancy through adulthood. For turn of the century Vienna, this was a revolutionary concept. He describes that the sexual experiences from 0-5 create the underpinnings of personality, yet are also sequestered from narrative memory. At 5, the child enters a period called latency in which dams in the form of disgust, shame and morals, allow the child to enter into a period of learning at school. Freud, ahead of his time, said that these dams are "organically determined". In essence, our DNA (yet to be discovered) creates a latency period so that a child can learn in school and not be preoccupied by sexual urges. This sexual energy gets buried and then resurfaces in the form of productive activities. Freud calls this reaction formation and sublimation.
His evidence that sexual forces occur throughout life is based on the child's way of self-soothing. He points to thumb-sucking as an example of a rhythmic repetition of a sucking contact by the mouth. The baby has transformed the location for nourishment into the location for sensual pleasure. This constitutes the oral phase of development. Likewise, the anal zone is transformed from an area responsible for somatic functions into an area where control can be exerted and the child can feel a sense of power.
Children can find sexual pleasure in a variety of ways. Freud said that children have a "polymorphously perverse disposition". Instincts can center around an erotogenic zone such as the mouth or the anus, or it can be a component instinct where the child is sexually excited by looking at other people (voyeur) or by having other people look at them (exhibitionism). Children are also extremely curious about sexual activities. Freud called this "the sexual researches of childhood". In this "sexual research" boys try to find out why they are different than girls. In so doing, boys realize they have a penis and that this is so precious that they then develop castration anxiety. Girls, on the other hand, realize they don't have a penis and so, according to Freud, they develop penis envy. These feelings quiet down as the child enters school-age, but then resurface in puberty. Freud calls this trajectory "diphasic".
Freud was the first one to describe how children experience sexual pleasure. This sexual pleasure comes in the form of mechanical excitations. For example, children love being thrown up in the air and they love to rock. The thrill of a child's rocking horse would be another good example. The familiar play of "rough housing' would be another example of a child's sexuality. Further, Freud goes on to say that feeling states are innately sexual. The child's fear is a source of sexual excitement in that jumping from high up creates fear followed by a sense of mastery in a parallel way to sexual activity. Finally, he says that passion about intellectual work is also a form of sexual satisfaction.
An interruption....a drug representative for Abilify comes to my office....I happily take some samples...I am invited to a dinner program chaired by my highly esteemed colleague.....I return to thinking about Freud and sexuality.....the mind and the brain converge.
The ever-present force of sexuality is described in this 1905 paper. Our skin and our sense organs are stimulated and we are excited. Certain areas are particularly excitable and these are termed our erotogenic zones. Pleasure can end and pain can begin when the intensity exceeds our tolerance. Freud then does self-promotion. He touts the "novelty" of his approach to this sensitive subject of child sexuality. Although lacking in humility, Freud importantly reminds us that there are varieties of sexual constitution. That is, each person is different (thanks to our DNA-which again, the discovery came after his time). Second, that sexuality and bodily functions are forever linked and that disorders of the body (such as Irritable Bowel Disorder) could result from sexual excitation which cannot find a suitable outlet and so the energy gets turned towards an organ.
So, I conclude by asking myself what I want these residents to learn from this "classic" article. First, I want them to read Freud like great literature. In fact, Freud won the Goethe prize. Second, I want them to see motivation as a complicated force, which in no small measure is determined by sexual energy and our pre-programmed need to reproduce. Finally, I want them to think developmentally, both that childhood history is always important to adult assessment, but in particular, I want them to think about the adult patient in terms of how his sexual needs were dealt with as a small child. This way of thinking might help them understand the underpinnings of their patient's symptoms.
Abilify helps a lot of patients be "more able". Psychoanalytic thinking does likewise.