*100/196/1*

Aim: To join and mirror the depressed spouse’s defensive posture in order to facilitate him or her in developing more insight.

Game Plan: The depressed spouse has been rejecting all sexual overtures for some time. Let us say that in this case the depressed spouse is the husband. The wife now tries a different approach. She asks the husband to play this game with her.

They sit facing one another on a bed or rug. She fondles him to get him aroused. He fondles her too, although indifferently.

“It’s hopeless,” she says. “Everything’s hopeless,” he says. “Sex is hopeless,” she says. “Why bother?” he says. “I’m too depressed,” she says. “I’m too depressed, too,” he says. “It’s all so hopeless,” she says. “Why bother?” he says.

“What’s the use?” she says.

“I won’t get an erection,” he says.

“I won’t get wet,” she says.

“I’ll come too quickly,” he says.

“I’ll end up frustrated,” she says.

“Why bother?” he says.

“Yes, it’s hopeless,” she says.

*75/196/1*

“Wonderful.”

“What can I do for you now?”

“I don’t believe you.”

“What don’t you believe?”

“Why are you doing this?”

“Because I love you. What can I do now?”

“I can’t think of anything. I’m too shocked.”

“Well, if you do, let me know. I’m at your disposal.”

“And you don’t want sex?”

“I want it, but I know you have a headache and you’re not in the mood. I understand.” “You do?”

“Yes. I mean, I love you and I love making love to you, but I don’t want to make love to you unless you really want me. I don’t want you to do it out of duty or because I browbeat you into it. All these years I’ve just been thinking about myself, about my own selfish sexual needs, and I haven’t been thinking about you. So I thought that for once in my life I’d think about you.”

“I can’t believe my ears.”

“Believe it. It’s true.”

“So you really don’t expect sex?”

“No. I want it, but I don’t expect it. When you feel ready to give to me in that way, I’ll appreciate it from the bottom of my heart and loins. Until then, I’ll just be patient.”

“You know, that tie is kind of cute.” She reaches out to touch the bow.

“Don’t,” he says, pulling back.

“Why not?”

“You can’t remove the tie until we have sex.”

*50/196/1*

“What’s going on?” he may ask.

“Whatever you like,” she will answer.

If he is an easy case, he may drop his briefcase and enter the nest forthwith. If he is a more difficult case, he will resist this seduction in various ways. He may say, “This is silly,” or, “I’m too tired for this,” or, “What about dinner? I’m starved.” Or he may say, “Where’d you get this material? How much did all of this cost?” He may even get surly and insulting (his anger defending against the anxiety that this Seduction Surprise has aroused) and blurt out, “You look stupid lying there with that idiotic grin.”

*25/196/1*

1. A nineteen-year-old woman had a sexual response to chewing gum. Whenever she was in the presence of anyone chewing gum (the stimulus could be either visual or auditory), her sexual response was so strong that she would either have an orgasm then and there or she would have to rush to the nearest bathroom to masturbate. She herself traced this reaction to her early adolescence when she had trained her dog to masturbate her by licking her clitoris. The sexual response, however, was limited to the middle range of the phobic stimuli. At a lower level, pictures of a chewing gum pack would set off slight but definite anxiety. At higher levels, the sight of a dog or cat licking itself would set off panic.

This sexual response responded to a phobic reduction approach. Actually, systematic de-sensitization both to imagined situations and to the therapist chewing gum in her presence had no effect. She did respond to in-vivo-flooding with response prevention (Marks). She exposed herself to situations in which people were chewing gum and remained in that situation while actively inhibiting the sexual response and practicing deliberate muscle relaxation. In a telephone contact six months after termination of treatment, the patient stated that despite repeated exposure to chewing gum situations, only once was there any sign of sexual response.

2. A twenty-eight-year-old man was a fetishistic transvestite. At age thirteen he became attracted to his mother’s lingerie, particularly to the tactile sensations, and he would masturbate with the lingerie as a stimulus. At age nineteen he performed his first cross-dressing with the intent of heightening the tactile sensations. Over time he became more enamored of the visual impact of his appearance, although his greatest thrill was when walking in the street cross-dressed, someone would brush against his clothing. He would always cross-dress alone, never in the presence of his girlfriend with whom there was a normal pattern of heterosexual behavior.

He was treated with phobic reduction methods. A desensitization tape was prepared for him to play at home. With this tape, he first relaxed, then he imagined a transvestite or fetishistic scene. Upon the first feelings of any sexual arousal, he would then relax again. The tape has eight repetitions of such scenes, takes about twenty minutes to run, and he plays it once a day. A somewhat similar procedure is followed during his office visits. At the present time he reports a complete cessation of all transvestite thoughts or feelings. This in itself is not conclusive, for on a number of occasions these have spontaneously disappeared for periods of up to two-and-a-half months. This time, however, he reports that there is a different feeling; he has a feeling of being in control. Further follow-up is of course necessary to determine if the phobic reduction method really did work.

3. This patient was a twenty-six-year-old man with a history of sexual exhibitionism. Since age fourteen he has had exhibitionist urges a minimum of three times a week (by his report). He has acted them out on a number of occasions, usually using girls in the six-to-eight year range as targets. On several occasions he moved into actual pedophilic behavior by having the child stroke his penis. He had been arrested twice and is currently on probation. Several years of traditional treatment had no effect on this behavior. He too has a girlfriend and has an apparently normal pattern of heterosexual behavior with her.

The urges tended to come about under similar circumstances, some in actuality, some imagined. He would be bored or would have nothing special to do. There would be an opportunity or a possible opportunity for contact with suitable girls. In the office, when he imagined being in such situations, he would experience a sexual arousal which, by his subjective estimate, went up to a sixty-percent level.

The phobic reduction method used was aversion relief desensitization (Wolpe). He was given a moderately uncomfortable electric shock to the forearm. When the shock ceased, he imagined being in the excitement-arousing situation. With repetition of this procedure, the intensity of the sexual reaction decreased. After five to fifteen repetitions for each imagined situation, there was no feeling of sexual arousal at all. In other words, pairing an image of the excitement eliciting situation with relief from shock brought about exactly the same kinds of reduction in sexual feeling as we find when we use aversion relief desensitization with fear-eliciting situations and automatic fear reactions.

This conditioning was carried over to the life situation. The patient reported that for the first time in twelve years (his words), he has been completely free of exhibitionistic impulses for as long as one week. At this writing he has had no such urges for six weeks but is being monitored on a regular basis.

In each of these cited cases the variant behavior does indeed appear to be a true phobia. This does not mean that all sexual variant behavior falls into the phobic category. As always, a careful evaluation and formulation is necessary.

*235/187/5*

Some transvestites live for years before they seek therapy or before an incident with the law requires them to do so. Others undoubtedly never seek therapy. Some associate with other transvestites, sometimes in bars where they congregate, or by joining a society formed for the purpose of sociability and self-help.

Transvestism is closely related to the hysterical, dissociative phenomenon of dual personality. It is to be expected, therefore, that the symptom of cross-dressing may in some instances undergo spontaneous remission, or that it may go into remission under the influence of some form of psychotherapy, including hypnotherapy, behavioral modification (aversive conditioning), or even religious exorcism. It has been known also to remit, at a time of formidable personal crisis, to a combined therapy of antiandrogen (medroxy-progesterone acetate) plus counseling. However, since transvestism is also a form of addiction—addiction to female clothing—it is not surprising that it has proved singularly resistant to today’s known methods of therapy.

For the most part, the treatment of transvestism is ameliorative and supportive. Often it is necessary as well as wise to include the family in the counseling program. In the case of the married transvestite, effective counseling can ameliorate a separation, if separation is inevitable, and equally well ameliorate continuance of the marital relationship.

Prognosis

The prognosis for complete and permanent remission of symptoms is poor, but not totally negative. The possibility of relapse is such that, in any instance of remission, the patient should be kept in follow-up at least four to six times a year, indefinitely.

Most patients with transvestism will not have a remission of symptoms. They can be helped in rehabilitation, however, to find a modus Vivendi as transvestites.

*198/187/5*

Eli Zaretsky argues that nineteenth-century capitalism brought two interrelated changes which re-defined the notion of “family.” Labor was taken effectively outside the family unit and placed in factories and centralized corporate settings. Women continued to “work” in the home, but that work was defined as a marital and maternal obligation rather than as labor. At the same time, a sphere of activity, the activity of “private” life, was separated from public activity, including work, and came to represent those spaces and times preserved for “leisure,” for personal creativity and entertainment: “As a result ‘work’ and ‘ life’ were separated. . . . Just as capitalist development gave rise to the idea of the family as a separate realm from the economy, so it created a ‘separate’ sphere of personal life, seemingly divorced from the mode of production” (Zaretsky). Laws concerning sex and sexuality must be understood in light of this history. The state maintains its interest in laws of marriage, and the society maintains a comprehension of sex as ideally represented in and representative of the family (Schneider). Yet, laws concerning sex have been altered and generalized in accord with notions of the increasing importance of “private” life (as opposed to “working” life). Sexuality itself has become another commodity, one through which the individual attempts to underscore and sustain a personal meaning to life.

However poignant—or annoying—Biblical stories of sexual encounter may seem, we learn relatively little about contemporary sex law from their example. It is not the metaphors of Dinah, raped by Shechem, nor of Potiphar’s wife, who falsely accused Joseph of the same crime, which are basic to this analysis. Rather, the analogies and comparisons of importance to the consideration of current sex laws are those of the consumer and of the structures and assumptions underlying corporate law.

*161/187/5*

The Trader is usually entirely correct and gets to know more than the anthropologist can about such doings. He also discovers from the woman or women of his own how a Dobuan woman may teach her daughter that the way to keep a man faithful is to keep him as exhausted as possible.

By implying that the “with-the-native-living Trader,” to use Fortune’s phrase, had opportunities routinely denied to anthropologists, Fortune acquiesed to past and current ethical and scientific limitations on anthropological propriety.

With the exception of archaeologist Suggs who monitored the sexual talk of large gangs of men excavating sites in the Marquesas, basic research strategy has been simply to ask questions about sexuality, within the bounds of propriety. These bounds may be a severe obstacle in some societies, but not in others. Anthropologists seldom can check the accuracy of what they are told, and only a few will even speculate on the veracity of verbal reports. Berndt is an exception when he suspects “an element of exaggeration” in the tales of sexual conquest told by highland New Guinea men which add to their prestige in sexual matters. Likewise, Suggs is aware that in the Marquesas, “Females . . . tend to underplay the extent of their sexual activities, while men tend to exaggerate”. Such exaggeration is itself valuable data for constructing culture theory.

A related matter is the literalness of speech about sexual matters. For example, Marquesan men prefer to have intercourse with women who are not overly pregnant. They say, however, that men must do so “to make the baby strong”. We do not know if this statement is to be taken at face value, or whether it is something of a joke or hedge. Note that in comparison, Mangaian men in referring to this jokingly express fear that “baby would bite” (Marshall).

Marshall reports that his study of sexuality on Mangaia was relatively easy to investigate; people would readily talk with him about sexual matters. In contrast, Bailey felt compelled to give special thanks to the Navajo “who have shared their lives with us and permitted unusual intrusions into their privacy”. No wonder material on sexuality from Polynesia is so much richer than that available on native Americans!

The strength of the traditional anthropological approach to sexuality is best represented by Margaret Mead in her classic comparative study, Male and Female. The complexity and diversity of our own way of life and our uncritical involvement in this life style, obscures our vision and impairs our objectivity. By looking instead to the Arapesh, Balinese, and Iatmul for examples, Mead is able to make a reasonable comparison of maleness and femaleness in her own society.

In that work Mead comments on the tendency of Westerners to move away from the body itself. Closeness to the body is dangerous; one may lose control and behave irresponsibly, thereby jeopardizing decency:

The solution for the peculiar difficulties of a puritan society does not lie in a series of pin-up girls whose breasts, tailored for love, are explicitly not meant for the loving nourishment of their children. It lies rather in developing greater ease with our clothes on.

Given the erotic breast/nourishing breast alternatives, as well as other Western cultural fantasies, it is no wonder that the description of human sexuality in other cultures has been so uneven and devoid of analysis. Mead addresses several Western assumptions, such as our sexual understanding of adult nakedness, which she ascribes to many exotic peoples as a climatic adaptation and not a simple erotic custom.

Moralizing about sexuality is a widespread, indeed universal, phenomenon. For rural blacks in the South, it is something of a disgrace and a failure for a young woman not to know the paternity of her child, so that he or she later will not, unwittingly, commit incest (Dougherty). Because Ashanti men expect their brides to be virgins at marriage, women who are not have been known to put stinging ants into their vaginas just before their wedding day so as to bleed during the first sexual intercourse (Herskovits). Selby reports that rules of sexual continence for Zapotecs are not absolute; whether behavior is moral or not depends on if it violates the best interests of the kindred group, or if it can be taken as an affront to the moral order. Among the Gahuku of the New Guinea highlands, Read found that natives tended to blame all violations of sexual rules entirely on women, rather than sharing the blame with the involved men. A final example comes from central Brazil where short Mehinaku men are saddled with a moral failing. An adult male is not tall or short in stature due to genetics or diet, as we know. Rather, the Mehinaku believe that the loss of seminal fluid during a critical adolescent period weakens males and retards growth. Men suspected of having violated the rules of adolescence, including a ban on contact with women, have only themselves to blame if their adult stature is short (Gregor).

*124/187/5*

Changes in sexual physiology occur with aging in both sexes. Some of these are in common and are related to the general effects of aging: strength and energy are reduced, and body responses are generally slowed and attenuated. However, both men and women continue to respond as before, though frequency and intensity of sexual response are reduced. Both remain capable of orgasm. Exceptions to this are produced by factors other than normal physiology, that is, loss of orgasmic capacity is not an inevitable part of aging.

Most studies support the idea that women have a more stable sex drive than men have and that it is less susceptible to the effects of aging. Although many men remain potent and sexually active into their eighties, impotence is a common problem after middle age. Studies of sexual inadequacy revealed that 83% of the impotent males were past forty years of age, and 75% were past fifty (Masters and Johnson, 1968). There are a number of reasons for male impotence, such as the ego-shattering “fear of failure” which sometimes leads men to seek newer or younger partners to reassure them of their virility. Since women often marry men who are older than they are, it is inevitable that some who are still as interested as ever in sex will find themselves with a husband who has withdrawn from sexual activity or is directing it elsewhere. Also, some husbands in the older age groups may have physical problems or disabilities associated with advancing age which may make their accustomed form of sexual activity impossible. Still, Comfort reports studies showing that as many as one-third of men past seventy are still sexually active. It appeared that those most active as youths continued to be active longer in their later years, but those with a low sex drive in their younger years were less likely to be having sex as they grew older.

Most important to sexual behavior in older women is the availability of a partner and the opportunity for regular sexual expression (Williams). With these, many women in their fifties and sixties have an increased interest in their sexuality for a number of reasons. The cessation of the menses brings a freedom from fear of pregnancy, so that the woman, perhaps for the first time, can abandon herself to the enjoyment of sex without apprehension. This release from “pregnancy phobia” is probably one of the most plausible reasons for increased sexual interest given by postmenopausal women who did not have effective birth control methods available to them in their reproductive years. The problems which may beset a young marriage, such as finances, in-laws, and adjustment to the marital relationship, all may be in the past. For both members of the couple the draining demands of having and rearing children, and of establishing and succeeding in a job or career, may no longer exhaust and preoccupy them, leaving more time and energy for the renewal of interest in each other.

Sviland has described a “sexual liberation” program for elderly couples with basically sound marriages who want to get rid of their inhibitions and to increase their repertoire of sexual behavior. The program focuses on attitude restructuring and relationship enhancement. The therapist gives permission for sexual curiosity and exploration, and gives exercises designed to replicate the fun of dating, such as candlelight dinners, love notes, and making love by the fireplace. She reports that the program has changed attitudes and behavior within weeks, helping couples to communicate, to increase intimacy, and to enjoy without guilt sexual pleasures usually restricted to youth.

*87/187/5*

And if s not just men of Peter’s generation who don’t know important information about how the male bodyworks. Adam is 39, a college-educated hotel manager, married for 12 years. “We grew up on a farm, so we learned some things just from seeing the animals. But not enough. When I was 15 I started having Vet dreams’, and I was sure I was terribly abnormal in some way. I used to have this one dream about a naked woman swinging through the air on a trapeze. I had the same dream and the same results for several months.” He smiles at the recollection, clearly enjoying the picture in his mind. “Finally I went to my older brother—he was about 23 at the time—and he explained what was happening to me. He was helpful and supportive. At that point in time I had no understanding of the basic physiology of erection, and I’m pretty sure I don’t know too much to this day. I went to a big state university and belonged to a fraternity. We never talked about sex seriously, just about it as a conquest. We never talked about any problems with sex. .” Even now, Adam acknowledges, the subject makes him nervous.

*6\184\8*