Psychiatrists Don’t Just Talk About Sex

I think this was said to me for the first, last, and only time at the first, last and only mixer for singles I went to in Wichita, Kansas.

I don’t remember the man’s name or face, but I do remember how he responded to my answer to his inquiry about what I did for a living.

“Psychiatrist? That sounds like a fun job.  You probably get to talk about sex all the time.”

My response was undistinguished.  “No, not really.”

But his response to my response was even worse.  “Huh?  What do you talk about, then?  I mean they pay you for talking.  It still doesn’t sound like a bad job….”

Strange how some conversations stay with you.  I guess this one shocked me at the time because it was my first serious brush with what “just plain folks” thought about psychiatrists.

I went on to tell him how people usually talked about emotional pain and worries, being really nervous or sad and depressed or worrying a lot.

By this time, he found a way to curtail the conversation as his gaze became fixed on a woman somewhere across the room who he had obviously perceived as more attractive than me.

I guess I have been a bit of a manual laborer when I was a surgeon.  But aside from that, I never saw myself as doing anything but “talking for a living.”  Not that it is anything like conversational or “fun” talk.  Very focused.  Often I have to interrupt or “redirect” a patient to ask pointed questions in order to get the information I need to make a crucial decision about diagnosis or treatment.  Most folks don’t mind much – but some live this as extremely difficult.

I do try to get a marital history, maybe a relationship history.  When sexuality comes into it, there is certainly nothing titillating about it.  Usually it seems to be a woman telling me about poor treatment by a husband or lover.  Such treatment ranges from insensitivity or indifference to severe physical abuse.  I thank them for honoring me with their confidence.

There are certainly male victims of abuse, too.  But it says something about sex roles that women rarely try to impress me with their physical attributes.  Oh, sometimes one will complain to me about what a terrible burden it is to go through life with excessively large (and seductive) breasts, even pointing out to me that I do not look like someone who would empathize with that sort of problem.

But it is not terribly rare to see a male human who is a bit on the manicky side tell me about his great sexual prowess and abilities.  I plead professionality (which generally seems to accomplish surprisingly little) and show off my lovely wedding ring, which generally seems to wield a bit more power of dissuasion.

I don’t think anyone is actually terribly shy about discussing sex, in this day and age.  I see some people, however, who tell me “things are just fine,” and it may not be necessary or helpful for me to try to dig deeper.  I see other people who are downright obsessed with sex — people to whom I often hear myself saying something like “You just can’t do sex 24/7.  You have to at least talk to other people, maybe earn a living or such.”

So what I do hear, if someone tells me about sex, can be cruel and even repulsive.  In the days when I took some lectures in psychoanalysis at the Menninger Clinic in Topeka, KS (now relocated to Houston, TX), the full-time students of psychoanalysis underwent a “desensitization” process that included —  they told me —  standing in the middle of a room with pornographic movies, perhaps a bit heavy on the sadomasochism, being projected on all four walls.

I was not enrolled in that particular curriculum.

Me, I was turned off of the study of psychoanalysis early on, when a bearded Freudian scholar told me that women could not have “real” friendship with each other as they had to compete with each other for mates.  Me, I thought then (and still think now) that sisterhood is powerful and that men sublimate (or at least repress) an inclination to murder or violence by engaging in competitive sports.

Nevertheless, the classic (Freudian) notion that we all have deep “animalistic” urges that need to be “sublimated” (or “repressed”) to get through life rings true.  His concepts of “id,” “superego,” and “ego” are useful, and cannot be disregarded, even by a medical-model pharmacologist like me.

I am surely not the first one who noticed their similarity to “nefesh,”  “ruah” and “neshumah,” ancient rabbinical (yes, Jewish) concepts.  But the medical society of Vienna was doubtlessly not terribly evolved in any knowledge of or interest in such matters.

(NOTE: Freud was Jewish, in case you didn’t know)

Basically, the “superego” is our high-minded morality, the “id” is our animal nature, and the “ego” is our daily reality, the part of our lives that tries to get things done, schlogging through life trying to reconcile the two.

Sometimes I see people who surprise me a bit by being “feral” – more like a wild beast than a civilized human.  Me, I am all kinds of citified and gentrified.  Some have even opined that I am “overeducated,” but that was usually the opinion of men I dated prior to dating my husband, some of whom engaged in manual labor although they did not appear to have yet evolved opposable thumbs.

I have been surprised, for example, by men who live in rural areas who have told me about expressing feelings of ownership of or dominion over land, by urinating on it.

I really don’t know how to explain this any other way except “id,” or animal instinct.

The concepts of “transference” and “counter transference” are another precious gift from the Freudians.

Every time a person enters into a room to start a new relationship, they carry the “baggage” of every relationship they had before.  People relate to me in certain ways because I am female.  A female with authority and, as some friends have said, “more degrees than a thermometer.”  This is transference — the aspect of “sex” I have to deal with every day.

When I was heavier, people thought I reminded them of their mothers.  Now that I am thinner, even though I am older, it is sometimes an old girlfriend or sister or (heaven help us all) an ex-wife.

These feelings and memories are so powerful, so real, that they can be a serious handle on understanding relationship patterns and problems.

Ours is still a young and imperfect specialty, but this is far cry from getting jollies by talking about sex.

If there is a new taboo that has replaced sex, it might be talking about money.  People who don’t know where their next meal is coming from are often ashamed to tell me, even though I have pretty much figured out how to get them financial benefits and send emergency food to their houses.

Money and Sex – society’s major taboos.

It’s not all that we shrinks talk about – but I have to admit these topics take up a lot of our day.