Sexual Psychology

The field of psychology had an enormous positive influence on 20th-century sexual attitudes.  From before the time of the Protestant Reformation up until Freud came along, Western culture had no reputable intellectual framework for thinking or talking about sex.  Before the advent of psychiatry, the likes of Sylvester Graham and John Harvey Kellogg Graham could declare sex to be unnatural and unhealthy with little serious opposition (see the sexual phobias page for more information about anti-sex propaganda).

Freud, together with Jung and other pioneers, recognized and articulated the central importance of sex in our emotional lives, and gave us a "legitimate" context in which to understand our sex lives.  In his wake, a new profession grew up, composed of relatively respected psychiatrists, psychologists and counselors who deal on a daily basis with the central role of sex in their clients' lives. 

The attitudes of psychologists towards sex have been informed by the nature of their profession.  In thinking about their insights, it's useful to understand the context within which they work and the limitations which that context may impose. 

Medical culture

Psychology, like other fields of medicine, is primarily interested in pathology, in what has gone wrong and how to fix it.  The vast majority of psychologists have a clinical practice that involves a daily struggle to help their clients deal with serious real-life problems. 

They therefore face a dilemma that is central to any practice of medicine — in order to help patients, all doctors are required to make decisions and judgments that can have enormous consequences, but for which they often lack adequate information or understanding:  Doctors must often make informed guesses.  While the guesses of a smart and conscientious doctor may be remarkably accurate, inevitably some of them turn out to be wrong, and then the doctor's actions may not only fail to help, they may even cause serious harm. 

Thus, in professions dedicated to healing, all intelligent practitioners must come to terms with their responsibility for injuring and failing people who trust and depend on them.  This is the healers' paradox.

The recognition of how easy it is to jump to the wrong conclusion, how easy it is inadvertently do the wrong thing in an overly-optimistic desperation to help, has informed the skepticism and caution (some would say the rigidity) of main-stream Western medicine. 

The recognition of failure also leads to a necessary level of detachment — doctors dealing with mortal illness can't afford to die along with each patient they lose.  They must protect themselves by avoiding the kind of emotional investment in success that will wear them down under an unbearable burden of failure. 

Some doctors can achieve this detachment without losing the ability to connect emotionally with their patients, but for many, it can lead to cynical alienation and the kind of blustering arrogance that tries to deny the possibility of error, or its importance should it occur. 

For example, when a friend of mine arrived as an intern at a well-regarded urban hospital in the 1970's, she found the doctors and nursing staff referring to patients as POS's as in, "Please move this P-O-S down to room 417." After a couple of weeks, she asked one of the nurses with whom she had some rapport what the acronym stood for.  The nurse looked uncomfortable, then shrugged and told her, "piece of shit."

I would have thought that kind of attitude would not be possible among professional healers, but one of the factors that allowed it to develop was the emphasis in that medical culture on viewing patients as problems rather than as people. 

Psychology of Psychology

Psychologists have had to cope with the healers' paradox described above, while also proving themselves to a medical culture which tended to regard their discipline with skepticism as too "soft," subjective and unscientific to be taken seriously. 

Psychiatry managed to overcome this cultural barrier in part by requiring a medical degree before psychiatric studies could commence.  By gradually legitimizing the field in the eyes of doctors, psychiatrists opened the door for psychologists and counselors who lacked medical training and were not imbued with medical culture. 

Nonetheless, there remains in psychology a desire to fit the medical model of diagnosis and treatment.  This is difficult in the case of mental illness, because so little is actually known about the underlying mechanisms that cause it.  Diagnosis remains to this day in so many cases an arbitrary grouping of symptoms under long, suitably jargony names.  Treatment by psychotherapy is protracted and expensive, and its effectiveness is generally much harder to assess objectively than is the case for medical procedures. 

In many ways, teaching may be a better underlying analog for psychotherapy than medicine is.  Psychoanalytic techniques are basically a particular refinement of the Socratic method, and the success of therapy depends at least as much on the patient's desire to learn as on the therapist's technique.  Also, the best teacher is not one who provides the most information, but the one who helps you learn to teach yourself.  The doctor model, however, is still deeply entrenched in many parts of the profession, not least because doctors have much higher status in American society than teachers. 

Also, psychologists tend towards conservatism and insularity as do professionals in other disciplines — many have the attitude that, "If I didn't learn it in school and it doesn't fall within my field of expertise, I can and should ignore it."  Such an attitude makes quite a bit of sense from a practical standpoint, but greatly limits the infusion of valuable discoveries and insights from other fields. 

As a result, there exists a variety of psychotherapeutic traditions, whose members perform for their clients therapeutic rituals of greater or lesser formality and structure in much the same way that spiritual traditions practice different rituals based on divergent theological perspectives.

In both cases, the formal ritual structure and rationale is much less important than the ritual's power to create the kind of safe space that's needed to work on your psyche. 

Some psychologists still fear and pathologize sex

In 1973, a little more than 30 years ago, the American Psychiatric Association finally deleted homosexuality from its list of mental disorders.  Even afterwards, it's taken a long time for that change to percolate out to all corners of the profession. 

I've had close friends who were gay since well before 1973, and all my experience throughout my life has taught me over and over in countless different ways that specific sexual activities are much less significant than the emotional responses they evoke.  As a result, I find it a bit shocking that psychologists could so long have believed homosexuality to be a disorder, and that still, so many years later, a huge number of "average" Americans don't seem to know any better either. 

Psychologists, however, are only people, and in most cases their own sex lives are no better regulated (and not much different) than those of the population at large.  Aside from the tools that their trade gives them, and the wisdom that enforced intimacy with many other people can bring, they have no easier job than the rest of us in making sense of sexuality.

I've had quite a number of friends and acquaintances who have gone into therapy and whose therapists have seized on features of their sex lives that disturbed the therapist but which were working fine for the client.  In some cases, they wasted a lot of time discovering that the "problems" they were working on in therapy were not theirs at all. 

So when you seek a therapist, look for someone who understands your cultural and subcultural context, whom you can trust not impose their own life agenda on you.  While almost no professional therapist would ever consciously set out to do so, keep in mind that therapists too are entirely human, and they are required all the time to make important judgments based on totally inadequate data. 

A few neglected topics in sexual psychology

At least to start with, this site is barely scratching the surface of what psychology has had to say about sex and sexuality.  We present just a few interesting topics that have not received a great deal of attention elsewhere:

• Shame:  The study of shame has long been neglected in psychology, in part because it's been viewed as a "mistaken" reaction.  More recently, a variety of people have recognized that it's a basic and very important human emotion. 
• Taboos:  Every culture has its taboos, arising out of and reinforcing shame.  What are ours? 
• Fantasy:  Ever wonder why your fantasies are so weird?  A psychoanalyst has some pretty convincing answers. 

Please help us cover more topics in sexual psychology that people would find interesting and helpful — we would welcome your article!