It does not work. Our classification uses too many different methods to arrive at a diagnosis. In other words, the rationales for making a diagnosis slip and slide from category to category, revealing that makeshift convenience, more than logic or data, controls the arrangement. Without effort I can think of a number of unrelated ways currently used for diagnosing, and you can easily add more.
1. Diagnosis as it is employed in the rest of medicine; examples are “autosomal trisomy of group G” or “psychosis with brain trauma.”
2. A syndrome; an example is the label “schizophrenia," which most of us feel is actually a group of conditions with different etiologies, courses, and prognoses.
3. An outstanding symptom (regardless of the underlying character structure and the other neurotic symptoms also present); examples are “anxiety neurosis” or “phobic neurosis.”
4. An outstanding sign (ditto 3); examples are “homosexuality” or “fetishism.”
5. A single symptom; examples are “tic” or "speech disturbance.”
6. A single sign; examples are “enuresis” or “encopre-sis.”
7. A chronic uiay of life; examples are “paranoid personality” or “inadequate personality.”
8. Body-organ pathology due in part to mental states; an example is “psychophysiologic skin disorder.”
9. Drug dependence; examples are “alcohol addiction” or “drug dependence, heroin.”
10. Potpourri; examples are “social maladjustment” or “marital maladjustment."
This is a system?
If the diagnosis in most cases gives only the illusion of exactness, it will be safer for us to make do with simple descriptions that summarize the observable; we can manage that way right now, and we will not be forced to do the impossible—to measure if someone is perverse enough to be labeled as having a perversion. Our work will not suffer; we will still be able to make our usual wise or foolish decisions about, say, treatment or criminality.
The definitions outlined here need extended discussion; but before looking more closely at the differences between “variant” and “perversion,” I want to consider recent sex research against the background of traditional psychoanalytic findings and theory that have dominated ideas about sexual behavior for several generations.
Chapter 2
Impact of New Advances in Sex Research on Psychoanalytic Theory
Psychoanalytic theory is Freud’s creation; most modifications introduced by others have not only been minor but are elaborations of theoretical positions he had already explicitly introduced. Therefore this chapter will examine the sexual theories of Freud alone. While one cannot usually discuss any sector of his work without remembering how it changed as the years passed, this is less true for his sexual theories.
Reviewing these theories, one recognizes that Freud did not clarify what he meant by “sexuality,” and so at times his discussion was blurred. If one is searching for explanations that cover a universe, then systematic precision may be an encumbrance; but for our present needs, it will help to note different areas of observation or discourse covered by “sex,” “sexual,” and “sexuality.” Certainly, recent research has assumed that the following are distinct.
First, “sexual” for Freud meant any attribute of living tissue expressing negative entropy; he called this libido, a mystical tendency toward being alive, staying alive, and reproducing livingness.
Next, there are biological attributes that define an organism as male or female; these can be genetic, anatomical, or physiological. In themselves, they usually have no psychological connotation, though Freud’s predilection for biologizing had him reading primeval psychological motivation (for example, life versus death instincts) into such mechanistic processes as cell function and even molecular chemistry.
Next, “sexual” described the same experiences that others called “sensual”; if an activity brought body pleasure, that pleasure was to be labeled “sexual” because Freud found in infants’ first experiences of pleasure from birth on the origins of the later activities that all recognize as erotic.
Next, “sexual” meant masculinity and femininity.
Next, it referred to reproductive behavior.
And finally, “sexual” meant erotic, that is, intense sensations in various parts of the body, especially the genitals, which are accompanied by fantasies (conscious or unconscious) of intimacy with other objects, creating a desire for genital satisfaction.
With connotations as broad as this, covering all activities and tendencies of living tissues, we are in trouble if our discussion is not confined to the more habitually accepted meanings of “sexual.” This has practical value, keeping my presentation within bounds; and we are also forced to such a strategy because the grander and more mystical a piece of Freud’s theory is, the less likely it is that any research procedure can be developed to test it.
So let us focus this discussion almost completely on the two areas of behavior for which the term “sexual” is commonly used: the search, originating in the drive toward reproduction, for erotic pleasure, and the development and maintenance of masculinity and femininity.
Another few orienting remarks. Brought up in a great neurophysiological tradition, yet by nature speculative, Freud was forever drawn to the mind-body problem. A fine observer, perhaps the greatest naturalist of human
behavior ever, he was also at least as much enthralled by biological speculation. He wished to bridge the gap between the findings of biology, both experimental and natural, and that mysterious product of neurophysiology, the mind. His unending ruminations on instinct— a term he used to bridge that gap—are evidence. So, if he was to solve this problem, his search might well place him from the start in the issues of sexuality, where body and mind seem so patently to interact (“The concept of instinct is thus one of those lying on the frontier between the mental and the physical” [24, p. 168]). That same search had him extending the meaning of “sexuality” more and more as the years passed, till he made it synonymous with “life.” He let a word—“instinct”—do the work that would better have been attempted by scientific methodology: observation followed by controlled attempts to confirm. (Whether the mind-body problem can ever be solved, even whether there is such a problem in reality, is still uncertain.) Of course, he realized early on that neurophysiological knowledge was too rudimentary and deferred his hopes for these data to the future. We can take pleasure in our fantasy that the new advances in sex research would have pleased Freud; he was never one long to flinch at new findings or at giving up old positions.
My presentation is based on five concepts of sexuality that run through Freud’s writings from almost the beginning of his great work—-just before and after 1900—to his death, and I shall test each one against recent advances in sex research. The five concepts are bisexuality, infantile sexuality and the oedipus complex, libido theory, the primacy of the penis, and conflict. While each is interwoven with the others in making up Freud’s coherent theory of sexuality, I shall separate them for ease of discussion. In doing so, I shall emphasize the impact more than the details of the “new advances.”