Category: Men's Health-Erectile Dysfunction

GAMES FOR NARCISSISTIC COUPLES – INTRODUCTION

Narcissistic couples cannot bond adequately because of problems of the self. They generally suffer from low self-esteem and compensate via self-absorption, pride, and grandiosity. They tend to become enraged if their pride is hurt and can get quite nasty to a spouse by whom they feel betrayed. Since they are often “stuck on themselves” (as was the mythological figure Narcissus, after whom this character type is named), they do not feel much empathy for mates, viewing them instead as objects to exploit rather than to love.

There are two basic kinds of narcissistic relationships. One, designated a twinship transference by Heinz Kohut, a psychoanalytic specialist in narcissistic disorders, is an alliance of two grandiose individuals who mutually support each other’s proud and inflated self-perceptions while remaining blind to each other’s delusions. They typically view themselves as a pair of pearls among swine—or (perhaps a bit more graciously) among synthetic pearls. The other kind of narcissistic relationship is called an idealizing transference. Here, a narcissist who feels inferior and needs to idealize somebody attaches himself or herself to a narcissist who feels superior and needs to be idealized. The former hopes that, by coupling with the latter, some of the “superiority” of the idealized object will rub off. The latter hopes to bolster his or her esteem by being the object of idealization.

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GAMES FOR DEPRESSED COUPLES – GAME 5: SEXUAL BATTLE (PART 3)

This game can be played again and again. It can be a fun game, with the participants making faces and using various other means (kissing, fondling, talking dirty) to hasten their partner’s “defeat.” However, there are no real winners or losers here—only two people who are putting authenticity and fun back into their sex and rekindling their desire.

“Sexual Battle,” as with all other games described so far, will be successful to the degree that a couple can play it with sincerity. This goes without saying about any endeavor—you cannot cook a good meal without sincerity. However, when one is dealing with sex, people’s resistances multiply, and there is a natural tendency to be critical and perhaps derisive. Depressed people may want to negate this game (and all other games in this book), finding them silly or too complicated or too simple. I have found that I have had to give my own clients lengthy pep talks to properly orient them to the games. Because these are not miracle-workers, but only devices to help couples get closer, they are only as effective as the couples who play them allow them to be.

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GAMES FOR PASSIVE-AGGRESSIVE COUPLES – GAME 4: ROLE REVERSAL (PART 1)

Players: Husband and wife. Activists: Both. Setting: Bedroom.

Aim: Jolt each other out of their passive and aggressive defensive postures by mimicking each another.

Game Plan: Husband and wife lie virtually naked in bed. The husband wears an article of the wife’s clothing—could be a hat, a blouse, panties, or shoes. The wife wears an article of the husband’s clothing—hat, pipe, jockey shorts, T-shirt. They play out their continuing sexual conflict, but each impersonates the other, deliberately aping and exaggerating the other’s behavior.

If the couple were my aggressive female patient and passive husband, about whom I wrote in the beginning of this chapter, the wife might sit up in bed with her eyes closed and pretend to meditate. The husband might hit her (lightly) with his fists and complain that she is such a nerd. The dialogue might go something like this:

“Can’t you see I’m meditating?” (Wife impersonating the husband.)

“Oh, you’re such a nerd.” (Husband impersonating the wife.)

“Leave me alone. I’m meditating.”

“I don’t know why I married such a nerd. Why couldn’t I have married a real man?”

“Quiet! I’m trying to achieve cosmic consciousness! Stop trying to do dirty, earthly things to my body while I’m looking at universal harmony.”

“When I think about the kind of man I always dreamed of marrying and the one I ended up with, I want to puke!”

“Oh, God, save me from this witch!”

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GAMES FOR BORED COUPLES – GAME 2: SEDUCTION SURPRISE (BY THE HUSBAND) (PART 2)

“What’s going on?” she may ask.

“Shhhhh!” He holds a finger to his lips. “Sit down.” She sits. “Good,” he says. He then places an imitation (but attractive) crown on her head. “I hereby crown you queen for a night.”

“This is silly,” she may say; or, “I’m too tired for games”; or, “What are you up to?”

“Shhhhh!” Would my lady care for a glass of champagne now, or after her bath?”

“My bath?”

“Yes, your bath.”

If she is a difficult case, she will attempt to get out of this in some way: “This is all very nice, but I’m not in the mood,” or, “You look silly in that tuxedo.” She may even become obnoxious and insulting. The husband must persevere and not take anything she says personally. And he may cleverly (for once) use his knowledge of her to persuade her.

“Here—let me massage your temples,” he may say (or, “Let me massage your shoulders”). He can try a trade-off: “Humor me tonight and I’ll do something for you some other night.” If all else fails, he can explain that he is playing a therapeutic game recommended by a psychotherapist, and that if she wants to improve their marriage it would be beneficial for her to play along—at least for one night. Eventually, if the husband perseveres, he will wear down her stubbornness, and she will give in. Then he can proceed.

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JUNK SEX VS LOVING SEX – CULTURE OF JUNK BONDS AND JUNK FOOD

The New Sexuality of today is also likely to be hurried, since this is a generation that seems to have put relationships on the back burner while emphasizing careers. We eat, work, and sleep on the run. We have been raised in a culture of junk bonds and junk food, and what we practice may aptly be described as junk sex. It is junk sex because it is sex on the run, sex in avoidance of the hazards, sex attempting always to be correct, sex of convenience, sex sans merci.

Indeed, sex therapists across the country report that the most common complaint among couples today is lack of interest. Many men and women are having shallow, infrequent, or no sex whatsoever, simply because they do not care to. They truly live lives of quiet desperation, and often their underlying mood is apathy. Because of the hazards of sex and their own internal resistances to it, they have given up on it. Their sexuality remains only in the fantasy sphere.

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SEXUAL ATTRACTION: EARLY EXPERIENCES OF INTERCOURSE

A critical review of the evidence suggests that the age at which intercourse starts is mainly governed by the genetic blueprint as modified by earlier sexual and emotional experiences. Personality development and social skills have to be sufficiently well developed to attract a partner but their availability for sex and emotional exaggeration are also important ingredients.

On balance girls think they are looking for a romantic relationship and boys for a physical one. Girls generally are hoping for their search to end in security, while boys are looking for adventure, but there are probably more girls around today in an adventurous frame of mind and boys in a romantic one.

Emotional and sexual attraction are complex issues of which we know only a few dimensions. Variations in taste between individuals ensure that almost any man or woman will be attractive to someone of the opposite sex. Hairy women, for example, often believe themselves to be unattractive but some men prefer them. Physical differences and even disabilities can be attractive to others. Physical attractiveness is the most important factor to young adolescents and to adults looking for brief affairs. Distinguishing emotional attraction from the physical is mainly an adult skill.

For women particularly, how attractive they feel greatly influences how attractive they are. A good morale is vital to one’s sense of attractiveness.

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SEXUAL ATTRACTION: FACES AND HEIGHT

There is evidence to suggest that there is a widely held notion of the ‘ideal’ face. In one study people were shown photos of twelve young women between the ages of twenty and twenty-five and there was marked agreement as to which faces were the most attractive. The only people who disagreed to any extent were the over fifty-five-year-olds and some members of the unskilled occupations.

As so many people agreed about what is attractive they must clearly be making their judgement using certain shared standards. People shown photographs of physically attractive people readily assign them more socially desirable attributes than they do photos of unattractive people. On balance, we also assume that attractive people will be more likely to hold top jobs, be better parents, be more happily married and have better lives generally. It also seems that we are more likely to trust physically attractive people on a first meeting than the physically unattractive. This confers a tremendous advantage on the attractive because by definition almost all contacts are one-offs and will never get any further if there is no immediate attraction. There is a greater chance that this immediate attraction will happen with attractive people.

Height

As a man’s height increases so does our expectation of his socially desirable personal qualities. People tend to guess the height of authority figures and attractive people as taller than they actually are and one researcher has noted that every American president elected since at least 1900 has been the taller of the two major candidates. Women almost everywhere invariably prefer men who are taller than themselves.

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MID-ADOLESCENCE

Middle adolescence, or adolescence proper, starts at around the age of fourteen or fifteen in girls and fifteen or sixteen in most boys. By the end of early adolescence boys are still mainly homosexual in a social sense but an interest in girls has started to develop. Nevertheless the boy is still looking towards boys rather than girls for approval and friendship. Any social contacts with girls are usually undertaken along with other boys. Although for most girls the main friendship is with another girl, a girl’s heterosexual drive and interests have been much greater than those of boys throughout early adolescence. A girl with a boyfriend is likely to think of him as her best friend.

A recent survey of nearly 800 fifteen-year-olds revealed that girls, compared with boys, were more concerned about their personal safety, their ‘looks’, criticism from others, arguments with their parents, confusion about life, speaking-up in class, the health of their mothers, obtaining a job eventually and their ability to do it well. The concerns of girls are thus more mature and adult than those of boys at the same age. Worries about their mothers’ health may reflect the tendency of mothers generally to use emotional blackmail to control older girls by making remarks about the consequences of the girls’ behaviour on their health. The phase of conflict between mother and daughter can become ferocious and may result in the girl running away or becoming pregnant to punish the mother. If a girl feels she receives only criticism instead of help and understanding she may think these or other dramatic acts are necessary.

A lot of this kind of trouble could be avoided if parents recognised that most girls are in a conflict over their desire to please their parents but also to grow up and fulfil their own needs. Adolescents, both boys and girls, criticise themselves enough and require little in the way of external help in the matter! Approval and success at home increase their self-confidence and protect them from excessive peer-group pressures and also from flagrant rebellion.

Survey evidence shows that the majority of mid-adolescents get on well with their parents and respect and admire them. A survey of 1000 teenage boys revealed that most felt understood by their parents, regarded their discipline as reasonable and were proud of them. Nevertheless, mid-adolescence is the time when the instinctual sex drive is finally withdrawn from the direction of the opposite-sex parent and is invested in the adolescent him- or herself. Masturbation rates tend to rise, as does a preoccupation with the self and the body. The capacity for abstract thinking which starts in early adolescence increases and results in mid-adolescence being a potentially creative period. Girls may begin to keep diaries recording their moods and activities. Emotional and romantic feelings can be inspired by things such as literature and landscapes. Poetry writing may start. Although mid-adolescents can be savage, more in the way of mindless violence than for any purpose, the stage is usually one in which inner feelings of tenderness and beauty develop.

Sexual fantasies keep in step and, although they may include unusual or even ‘deviant’ elements, active involvement with the opposite sex begins to emerge in fantasies. Although girls may have earlier explored their vaginas and many may have used tampons, the vagina becomes more significantly incorporated into the body-image at this age. Earlier, unsophisticated fantasies give way more to fantasies of ‘making love’. Psychosexual history-taking from a spectrum of girls and women, not just those with sexual problems, shows that by the age of sixteen something like three-quarters of girls have included vaginal activity both in their fantasies and their masturbatory practices. The physically relatively insensitive vagina now becomes psychologically valuable and can give her physical pleasure.

Thoughts of using her vagina to show her emotional feelings to a boy, and the pleasure he will obtain from it, become exciting.

Mid-adolescents may be involved in heterosexual relationships and intercourse is common. A 1987 study of 6000 readers of a UK woman’s magazine found that the average under-zo had lost her virginity at 15.8 years. This is also a time of sexual rehearsal in fantasy and self-generated romanticism which may be placed on a member of the opposite sex though almost always in a play-acting way. This is not to deny that, for example, a sixteen-year-old girl can love a boy, but it must be said that she can only love him to the extent to which a sixteen-year-old is capable. Although mid-adolescents may wax lyrical about their boyfriend or girlfriend, when seen a year or two later, they not infrequently have some difficulty in recalling their names. Early and pre-intercourse heterosexual experimentation may arise in this stage and fondling of the breasts and vulva may occur, but most girls are too shy and most boys too ignorant for this to progress to mutual masturbation. Most girls do not handle their boyfriends’ penises during this stage. However, many mid-adolescent and some early-adolescent girls behave provocatively, not so much with the intention of having intercourse but more to reassure themselves that they can attract male attention. Such behaviour can be misunderstood by boys and men and rape, or something close to it, may be the result.

Mid-adolescence is the true turning point from childhood to adulthood. As well as sexual, emotional, social and personality development taking place, career choices are usually being explored. It is a time of expansion but the mid-adolescent still relies heavily on his or her parents. Moods can change rapidly from feelings of despair to exaltation and day-dreams are common. Everything and yet nothing seems possible.

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BABY AND CHILDHOOD SEXUALITY: THE PRE-ADOLESCENT STAGE

Hormonal changes occur as puberty approaches. Girls who stopped masturbating at the end of the phallic stage often start again around the age of nine or ten. It is still an ‘innocent’ activity which the girl may feel little guilt about unless she was criticized or punished for earlier masturbation or sex games. This increase in eroticism may be reflected in an increasing interest in portrayals of nude adult females and the father who was previously welcome in the bathroom is now banned.

Dreams or fantasies of appearing partially or wholly nude occur and are exciting. Sex games are undertaken now only with other girls and under the guise of dressing-up games or sexual enactment games such as kiss-me-like-a-boy-would and mutual genital inspection and bottom smacking may occur. The phase is a sort of ‘homosexual’ one and is perfectly normal. Girls rarely teach each other to masturbate-unlike boys. The reason may be that sexual skills are more innate in girls whereas in boys, as in higher primate males generally, there is a larger learned component to sex. Girls can seem to be very mature just before puberty and often take a special interest in relationships between the sexes, both human and animal.

Boys tend to gang together even more strongly in pre-adolescence and although there may be mutual showing of genitals it is not really a homosexual stage. They tend at this stage to denigrate women, presumably because of residual fears of them from earlier childhood arising from encounters with them in the form of mothers and teachers, and they also tend to regress towards the anal stage. Talk about excretion and breaking wind, making noises, eating crudely and failing to wash adequately are signs of this regression.

At this point, the end of latency, the first half of childhood is complete. The child has largely been reared within the small world of his or her own family with its particular combination of advantages and disadvantages. Any harm done in the process of psychosexual and other development will, from now on, become increasingly evident. It is this long incubation period between cause and effect which makes it so difficult to be sure about the significance of earlier events. The distortion of memory, the inaccessibility of the unconscious and the repression of painful thoughts and family myths make it hard to disentangle the facts. The most important lessons in life, the very early ones, do not even register in the conscious memory. And yet, in spite of the problems, it is possible to use the information given briefly in this chapter to understand what lies behind the difficulties experienced by adolescents and adults in their relationships with others and themselves. From what they say and avoid saying, from the way they say it and their associated emotional changes, from their dreams and fantasies, from their preferences and practices, and in other ways, it becomes possible to know what happened to them and how they felt, even unconsciously, during childhood. Sometimes repressed material is retrieved from the unconscious and the person then relives it as vividly as if it had occurred only an instant before and all the emotions originally associated with it return.

Of course everyone is different, but three patterns constantly recur in clinical practice though they appear in many guises. The first is a poor relationship with the self, involving excessive self-criticism, excessive self-consciousness, self-detestation or depression and excessive

self-blame. The two main causes are disturbed parental relationships, the child perhaps having been at least partly unwanted or believing himself or herself to be, and poor child spacing. The second is the suppression of sexuality, resulting in the child being frozen at some particular stage, perhaps making him or her regress to an earlier stage or deviating him or her from ‘normal’ development. The third is a persistent attachment to the opposite sex parent which can arise, amongst other reasons, if that parent was over-close or over-rejecting. The consequences can be profound not only for the individual’s future sexuality but for his or her emotions, personality and inter-personal relationships.

Although this brief account of baby and childhood sexuality can be verified by the average observant person, it is still not universally accepted. Some people find it hard to believe that events in childhood can exert such a profound effect on such matters as the ability to enjoy intercourse later in life. If it is accepted that infant and childhood sexuality and the way it is handled are the foundation for what comes in adulthood, then its enormous importance can be readily appreciated. To argue that childhood experiences have no bearing on events in later life is contrary to all the available evidence and also to common sense. After all, we happily accept such reasoning on non-sexual matters.

A more subtle and difficult criticism arises in the question of why children who are treated in virtually the same way with regard to sexual and emotional matters display totally different sexualities and sexual problems in adulthood. One answer lies in the fact that apart from one-egg twins no two individuals are genetically the same. Another answer is that no two people can really be subject to exactly the same influences and therefore any two people will respond differently to similar experiences. How secure children feel in their place in the family also affects their vulnerability to experiences. Also, the child’s own perceptions of what is happening may be different from those of a brother or sister who is going through the same experience.

For these, and no doubt other reasons, the long-term consequences of a similar upbringing can vary enormously. Parents too are not static personalities — they change as the years pass and react differently to, and therefore have a different influence on, each of their children.

All of this makes the study of childhood sexuality a minefield but an understanding of the processes outlined in this chapter can put problems into some sort of perspective. We are a product of all our yesterdays as well as of our genetic blueprint.

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THE STAGE OF THE MOUTH (THE ORAL STAGE)

Once it is realised that sexuality and genitality are not the same thing it becomes possible to discuss infant sexuality without impugning a baby’s ‘innocence’. The notion that a baby’s lips and mouth are sources of intense pleasure is acceptable to almost everyone, especially anyone who has watched a baby feed at the breast. Later, following the blueprint, other areas become the focal point of peak pleasure, the mouth remaining pleasurable but not primarily so as in a baby.

The phase of development when the mouth is the primary source of pleasure is called the oral stage. We know that the oral stage starts before birth because foetuses have been seen both on

X-rays and scans to suck their thumb in utero. The bliss and contentment a baby displays on sucking after birth, if all goes well, is very plain to see. Mothers usually hug their babies to their bodies, talk soothingly and rock them. In doing so they are giving the child much more than milk. They are building up a sense of trust and confidence and are laying the foundations for the child to see itself as a person who is loved and valued. Provided the baby is not allowed to become too frustrated when he or she needs food or maternal attention, he or she will slowly begin to experience feelings which eventually lead to a sense of optimism, self-assurance and perhaps even self-esteem.

If the mother repeatedly leaves the baby to scream untended she will lay the foundations for self-doubt, depression and distrust of the world. It is quite possible to see that repeated and severe frustrations of the baby’s oral drives and needs, even at this early stage, could result in their excessive persistence in later life. They may not remain primary but they may remain so strong that they influence both sexuality and other behaviour. It is certainly widely held that babies that do not enjoy and fulfil this oral stage as they should are more likely to want ‘oral’ gratification in adulthood. This can manifest itself in cigarette smoking, in certain cases of alcoholism, in persistent eating (especially under stress), or even in an unusually high level of interest in oral sex.

Although sucking at the breast or bottle relieves a baby’s hunger it is also pleasurable in its own right and children, when they can control the movement of their muscles effectively, suck their thumbs if no other source of oral pleasure is available. Later still the child learns to suck, or at least to put in his or her mouth, almost anything appealing in the environment. These are

self-pleasuring or auto-erotic activities and may, without stretching the imagination too far, be seen as a forerunner of masturbation. The opposition that thumb sucking, especially in older children, often encounters from parents, presumably recognises this fact, no matter how unconsciously. Of course at the conscious level the parents’ fear is that others will think the child is babyish, unloved or that his teeth will be displaced.

This can be used to illustrate a point of general importance. Although we all want pleasurable experiences, the ways in which we obtain them most naturally may not necessarily be socially acceptable. Because of this, restraint is taught in childhood. For example, an adult man sucking his thumb would be considered very odd but sucking a pipe is quite acceptable.

To generalise further, many of our pleasure drives are opposed, at least in part, by cultural conditioning and are, as a result, displaced on to other activities which gratify a particular need in a way that is, perhaps, less satisfactory but more socially acceptable, thereby possibly leading to a mild degree of frustration. These displacements are taken to be the mark of civilisation and the process is thought to account for many great achievements in the area of creative thinking, writing, painting, music, sculpture, and so on.

In a humbler form the displacements probably enrich our lives and comfort in many ways. For example, a woman’s displacement of pleasure drives to her home, social life and children usually improves life for all concerned. Men, or some men, may, perhaps for a genetic reason, be capable of more distant displacements and this may account for male supremacy in areas of achievement. This is not to deny that women are capable of more distant displacements or men of displacements closer to the family and home; it is simply to say that the main focal points for such displacements may be slightly different for the two sexes, so enabling each to contribute slightly differently to civilisation. Men, on balance, tend to push society forwards and women to keep it there.

To return to the oral stage, parents, of course, make use of the oral drive to pacify their baby in the early stages of life. Giving him or her something to suck will lead to pacification even if no milk or food is involved.

Two further points should be made. Presumably the infant is, at first, incapable of realising that it is the mother who relieves the tension of hunger or who provides the comfort of cuddling and rocking. At first the baby must think that it is the breast that does these things. Eventually, he or she realises that the breast is part of his mother and, if all is well, the baby starts to develop the capacity to love. A newborn baby expresses love through the mouth, and attachments between the mother and child develop which build up a capacity to form stable, affectionate relationships later in life. If this stage is not happily achieved the child’s later relationships may be less than full. Sexual and emotional development are first linked in this way. Through constant contact with the mother’s body and her various attentions to his or her needs, a baby becomes aware of his or her own body and its pleasures. Self-exploration of the body follows and much later the exploration of other people’s bodies.

When an infant boy is at the breast he may have an erection. He may also have one during urination, nappy changing, bowel emptying, or as a result of any excitement. Similarly, girls may roll their thighs and, according to some mothers, even lubricate vaginally. Children learn to touch their genitals fairly early and babies have been observed to stimulate themselves to orgasm. At this stage, however, the genitals are not the baby’s primary source of pleasure. The mouth ensures survival and is still the main source of delight.

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