Pills for Cheap

It may be wise to comment briefly on the analytic attitude toward homosexuality. It should be remembered that Freud was the first to approach homosexuality without condemning it and to see it as a form of psychopathology, which required understanding and treatment rather than condemnation. Perhaps the best expression of this attitude, which has been and continues to be the basic attitude of psychoanalysts, is contained in a letter which Freud wrote in 1935 to a desperate mother who wrote to him from America requesting help for her homosexual son

April 9, 1935

Dear Mrs. . . .

I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question you, why avoid it? Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime, and cruelty too. If you do not believe me, read the books of Havelock Ellis.

By asking me if I can help, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

What analysis can do for your son runs in a different line? If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. . . .

Sincerely yours with kind wishes,

Freud.

In more current times psychoanalysts and psychoanalysis have been attacked on more or less political grounds, as adopting a prejudicial attitude toward homosexuals because analysis deals with homosexuality as a form of pathology. It should be clear from the preceding discussion and particularly from Freud’s letter that there is no necessary connection between the persecutory or judgmental treatment of homosexuality and the more objective and scientific position that it is a form of psychopathology. Psychoanalysis has solid reason based on clinical experience gathered over many years, to sustain its position and its understanding of the homosexual dynamic. To deal with human psychopathology as pathology, in relation to homosexuality as in relation to all forms of human suffering associated with psychopathology, is neither unfeeling, rejecting, nor judgmental.

I would argue in fact that just the opposite is true: to respond to human distress in terms other than to see it as human psychopathology which can be treated, modified, or alleviated in some degree or manner, is to be less than human and in fact is to condemn such individuals to a lifetime of frustration and unhappiness. The psychoanalytic attitude condemns all prejudicial treatment of homosexuals, but that is not its concern or its business. Its concern is to help to alleviate neurotic suffering and the impediments to self-fulfillment and self-realization. To deny individuals that form of assistance, as is so often the outcome of attempts to deny the pathology of homosexuality, a posture too often adopted by homosexual advocates without sufficient sensitivity or discrimination, is itself a form of cruelty and lack of sensitivity.

It may be appropriate to interject a comment on the current status of the diagnosis of homosexuality according to the Diagnostic and Statistical Manual II. First of all, one would have to decry the method by which the revision was made. To my way of thinking it was a crass example of yielding to political and social pressures in a process of bending scientific statement to expediency. The ultimate step of putting the decision to a vote makes a travesty of any scientific pretext in the formal diagnostic categories of institutional psychiatry. If any demonstration were needed of the unscientific status of psychiatry (even, or should I say especially, at the highest levels of organized psychiatry in this country), little else would be required.

The tragedy of that revision is that it takes homosexuality out of the realm of pathological diagnoses and undermines a long-standing and clinically sound view that homosexual behavior can be regarded as significant symptomatology. Moreover, it does not seem farfetched to argue that it substantiates the view of the most outspoken, and often most disturbed and resistant to treatment, homosexuals and provides a rationalization for avoiding treatment. I have argued here that psychoanalysis is not a specific treatment for such disorders, but I would never infer that homosexuality and other sexual disorders are not diagnosable and treatable disorders. The confusion of legitimate diagnoses with political or prejudicial positions is to my mind unfortunate and unscientific.

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Gender identity/role disorders occur most frequently in people with normal external and internal reproductive anatomy. Sexual pathways of the central nervous system (CNS) do not show gross morphological changes to which gender identity/role disorders might be attributed. This is not surprising, since one would expect CNS functions mediating such disorders to be related to the dynamics of neurochemistry, specifically of neurotransmitters, and thresholds of arousal and inhibition in neuro-sexual pathways. Identification and measurement of these functions is not technically possible at the present time.

Some clinicians use the term disorder in connection with gender identity/role, to refer only to male-female transpositions. Sometimes known as gender dysphorias, these transpositions contain the syndromes of transsexualism and transvestism. They also may include homosexualism and bisexualism, though neither of these need be considered pathologies or disorders (see below).

Other clinicians include in the category of disordered gender identity /role all the paraphilias. Paraphilia refers to a condition in which sexual arousal and performance is dependent on highly specific imagery, perceived or remembered, other than imagery of the erotic partner. A paraphilia may be benign or noxious. The imagery of a paraphilia, as in fetishism, for example, may be in the nature of an imagistic intrusion, to be associated with the erotic image of the partner, or it may be rather a displacement or substitute for the erotic image of a partner, in whole or in part. A paraphilia can be regarded as a part of gender identity/ role in that it is essential to the person’s masculine or feminine erotic functioning. Thus for the male sadist, his masculine gender identity/role in its erotic manifestation is dependent on remembered or enacted sadistic imagery.

The list of the paraphilias is long. It includes, for example, masochism and sadism, rape and lust murder, voyeurism and exhibitionism, pedophilia and gerontophilia, amputeephilia (apotemnophilia), zoophilia, klismaphilia, coprophilia, urophilia, necrophilia, fetishism, and so on.

The transposition syndromes generally are classified along with the intrusion or displacement syndromes as paraphilias. There is not total professional consensus, however, especially in those cases of homosexualism (and by extension, bisexualism) in which the perceived or remembered imagery of erotic arousal and performance is concordant with the body and the person of the same-sexed, pair-bonded partner, the latter itself being the only unorthodoxy. Transvestism, because of its associated fetishistic dependency on clothing, qualifies as a paraphilia. So also does transexualism, for the transsexual person can function erotically only by reason of having or imagining having a body reassigned and transformed from that of the sex of birth.

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Self-assertion of women and their distinct gains in economic, political, and cultural life combined with sexual freedom have undermined the foundations of the traditional marriage and family. A great many people experiment with various forms of male-female coexistence ranging from permanent singlehood to various forms of cohabitation, trial marriage, and group marriage.

It is impossible at the present time to predict the future of male-female relationships. One thing is obvious: the traditional subjugation women in marriage which so closely resemble colonialism is dead. One may project a type of relationship based on a reevaluation of the distinct roles of males and females. Most probably the differences between men and women in economic, political, and cultural life will disappear as women enter all areas of life hitherto monopolized by men. With the growing self-respect and mutual respect of men and women the one-to-one relationship may prevail, for r man and no woman would accept a subservient role. This new type of relationship based î equal rights and equal expectations will resemble an alliance of two independent countries. Each country is free to lead its own life and follow its own interests, but at the same time each pledges full support to the well-being of its ally. Instead of the old contest of power within the colonial government that tries to exploit the colony, and the efforts of the colonic people to rebel against or to outsmart their rulers, a new relationship may evolve based on genuine friendship and cooperation.

The women’s movement against discrimination must encompass all aspects of life, such as the upbringing of children, equal opportunities in education, and equal rights in sexual life. So far only men have enjoyed sexual freedom be cause, biologically speaking, men are in a privileged position. When a man and a woman have sexual relations, only one of them can become pregnant. The pill must be regarded, therefore as a major step toward equal rights for all human beings paving the road toward a new era in human relations between men and women. If one of them transgresses these rights, this entitles the other person to transgress them, too. Usually, when people have a strong affection and respect for each other, they prefer to stay away from other involvements, and they keep their relationship clean and honest. Honesty is a two-way street and must be binding on both sides. The double standard is a remnant of the past era when women were enslaved to men. The new era of equal rights for both sexes must be based on genuine equal rights and equal respect for each other.

One need not, however, be naive and expect an era of perfect love and ideal relationships. Human beings compete with one another, and they often are involved in contests of power. This contest of power among various groups frequently includes the male-female relationship. Cooperation and competition are fundamental aspects of social life, and it would be impossible to exclude the male-female relationship from all other social patterns of interaction. But competition and cooperation are not discrimination.

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The processes of identification during childhood have become the most important element in the formation of personality. Because the central issue in the struggle for identification is sexuality and the loss of the love object, the psychoanalytic theory of personality formation is tied closely to psychosexual development.

Bronfenbrenner’s of the concept of identification showed that identification is a condensation of at least three components. First is behavior, especially observable behavior, as a means by which the child can relate to the person with whom he or she identifies by emulating that person’s behavior. Second is motivation, Freud considered the motive for identification to be defensive, an attempt by the child to deal with the loss of the love object, through incorporation, introjection, and identification. In other words, he or she comes to possess the love object internally. Kohlberg’s and Kagan’s views stress even more the child’s wish to be similar or to possess the person to whom he or she feels deeply attached. Recent developments in psychoanalytic ego-psychology also emphasize the conflict-free aspects of identification, especially the role of object relationships in this respect. The third component of identification is the process involved. As we have mentioned, the process is a shift of cathexis by which the child gives up his or her tie with an infantile love object, either early in life through anaclitic (primary) identification, or later during the Oedipal struggle in response to castration anxiety and guilt for hostile fantasies about the ambivalently regarded parent.

Another major theory of behavioral differences among sexes is the social learning theory, which relies not upon identification but upon the imitation concept. Using imitation as a prototype of social learning, this theory does not single out sex-type behavior and sexuality as central. To social learning theorists, the same principle governs all social learning, regardless of sex. In fact, childhood sexuality is not considered at all, and sex-typed behavior is not examined as related to sexuality but more as a prototype of certain social conduct. In the works of social learning theorists, there are very few references to such behavior among children as masturbation, inquiries about sexual functions or portrayals of various erotic relations between parents (Issacs, Malinowski).

Despite the major controversies among investigators over identification versus imitation, there seem to be many similarities between the two concepts. Often, the opponents seem merely to be describing the same concept in different terms (Bandura and Walters), referring to the child’s development of attitude, behavior, and emotional patterns as similar to those of significant people in his or her life.

Most social learning investigators today emphasize the importance of observation and information processes to social learning based on imitation, as compared with an earlier emphasis on reward and punishment. According to the former view, the child becomes aware of sex differences in personality around four to five years of age and begins to emulate one parent in particular because of the power attributed to that parent (Kohlberg). Recently, however, many social theorists have been able to bridge the gap between the psychoanalytic concept of identification and the social learning concept of imitation as based on the model’s power and status. Whiting, in anthropological studies of six cultures, explained sexual identification not solely as an outcome of the Oedipal struggle but also as a part of the cultural context, in which the child envies the status of the more influential and powerful parent and thus is apt to identify with that parent. For example, in cultures in which the father is frequently absent and the mother sleeps with the child, the predominant identification in boys is feminine, because of the mother’s presence and the control she exercises over him.

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Taboos against intercourse with a pregnant woman are very common in undeveloped countries and have been observed historically as a religious rule among some people. A study of sexual behavior in sixty preliterate societies found that twenty-one of them forbade sexual intercourse during most or all of the pregnancy (Ford & Beach). Among a Ghana group, the Ashanti, the taboo begins with the discovery of the pregnancy, and husbands, tiring of abstinence, often take another wife (Saucier).

In our society the continuation of sexual activity by pregnant women is not only common practice but is generally sanctioned by physicians. For example, a study of sexual attitudes and behavior in pregnancy (Tolor and DiGrazia) noted that the subjects’ physicians placed no restrictions whatever on their sexual activity from conception to delivery, unless complications such as bleeding, occurred. After delivery the women were advised to refrain from intercourse for four weeks and then to let their own preferences and comfort be their guide.

A study of 101 women revealed an increase in sexual tension and performance during the second trimester, attributed by the authors to the increased pelvic vascularity associated with pregnancy (Masters and Johnson). But other studies are in general agreement that sexual interest and activity fall off during pregnancy, especially during the last trimester. An example is a study (Tolor and DiGrazia) of a sample of 216 women who were patients of a group of obstetricians. The women comprised four groups: first trimester, second trimester, third trimester, and six weeks postpartum. The median frequency of sexual intercourse for all groups combined was 2.10 per week. Separately, the median reported frequencies for the first, second, and third trimesters and for the postpartum period were 2.25, 2.39, 1.08, and 2.65, respectively. Except for the third trimester group, about two-thirds of each group expressed satisfaction with the frequency of intercourse they were having. The third trimester group, however, had the strongest preference for less intercourse than they were having.

In a study of a large sample of Thai women, Morris, reporting similar findings of marked decline in frequency of intercourse with advancing pregnancy, suggested that the cross-cultural consistency of this phenomenon raises the question of a biological reason. This would be difficult to test because of cultural norms, perhaps medical advice, and psychological factors which no doubt also play a part in such behavior.

Coital techniques and positions also are affected by the course of pregnancy. The preferred sexual practice for the first trimester women in the Tolor and DiGrazia study was vaginal stimulation, whereas the later pregnancy groups preferred breast and clitoral manipulation. These women also reported a very strong need for physical contact, for wanting to be held. Given a choice of alternatives when they did not wish to have intercourse, most of them wanted just to be held. As for positions in coitus, Solberg and others found that side-by-side or rear entry became the preferred modes as pregnancy advanced.

Women who reported a change in their sexual behavior during pregnancy gave these reasons: physical discomfort, 46%; fear of injury to the baby, 27%; and loss of interest, 23%. Less frequently reported reasons included awkwardness and loss of attractiveness (Solberg and others). Of the 260 women in this study, 29% were instructed by their physicians to abstain from coitus from two to eight weeks before the delivery date. Ten percent were advised about positions that might be more comfortable than the male superior position, and only two percent received suggestions about sexual activities that could be substituted for coitus (hand stimulation for both partners in all cases). This finding suggests a notable paucity of discussion between doctor and patient of sexuality in pregnancy.

The resumption of coitus after the woman has given birth follows no particular pattern, and its regulation and prescription vary widely from culture to culture. Ford and Beach reported postpartum taboos in sixty-six societies ranging in length of time from a few weeks to the end of lactation, sometimes three years. When there are no religious or cultural taboos against postpartum intercourse, abstention may be practiced for a few weeks for a variety of reasons relating to the woman’s health and comfort (Saucier). Four out of six women in one study (Masters and Johnson) experienced erotic arousal four to five weeks after delivery, but their physiological responses— vasocongestion of the labia, lubrication, and orgasmic contractions—were reduced in degree and intensity. About half of this large sample reported a low level of sexual response; their reasons included fatigue, fear, pain, and vaginal discharge. By three months, however, most of the women had returned to their pre-pregnancy level of activity.

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