The Incurable Romantic

by Frank Tallis

  Erotic revelations can arouse and excite. Under such conditions, if the therapist and patient also happen to be people who would ordinarily find each other attractive, they might well be tempted to become lovers.

  Is this acceptable?

  Instinctively, most people answer ‘no’.

  But is that rational? Doesn’t it rather depend on the people involved and the particular circumstance? Surely, there must be exceptions.

  What if a patient has gone to see a therapist because of a minor problem such as fear of spiders? The treatment of choice is behaviour therapy—a relatively brief intervention that involves graded exposure to spider-related stimuli. Hardly any self-disclosure is required. Let’s say that the course of therapy ends and subsequently the therapist and patient start dating. They are both consenting adults. They are an excellent match—have common interests—and make each other very happy. What’s wrong with that?

  Actually, there’s nothing wrong with that; however, this is a completely hypothetical scenario. It could happen that way—but it might not. One can justify any course of action with recourse to a thought experiment that results in a favourable outcome. Unfortunately, the real world is messy, complicated and unpredictable. Most patients do not have simple, straightforward problems. And even when a problem does appear to be straightforward, it might not be. It might prove to be part of a larger and more severe problem in the fullness of time. Patients share their most private thoughts in therapy, they show their weaknesses and their vulnerabilities—make admissions, make confessions—say things that they wouldn’t say in any other context. They bare their souls. And they do so because the consulting room is a safe place. Even when they choose to behave inappropriately they know that the therapist won’t collude. There will be limits, boundaries—containment—respect. They will be protected, even from themselves.

  As much as I try to be rational and non-judgemental about therapist-patient relationships, I remain completely unpersuaded by abstract thought experiments and permissive arguments. For those of us who live in the real world, it is always wrong to have sex with a patient. It is always a betrayal and ultimately abusive. The potential for emotional carnage is so great, I can think of no justification for taking such a risk.

  And yet, it happens: perhaps because it is human nature to want what we can’t have. That which is forbidden is often the most tempting.

  Carl Gustav Jung—who was venerated for his wisdom and transcendent, mystical insights—very probably slept with his first psychoanalytic patient, and Wilhelm Reich, when interviewed about the early days of psychoanalysis, said, ‘There were instances where psychoanalysts, under the pretext of genital examination… put their fingers into the vaginas of their patients. It was quite frequent.’

  I can remember being a student and being hugely impressed by a visiting clinician who gave a lecture that was—to me—revelatory. With extraordinary and impressive economy, he presented a model that laid bare the psychology of several complex psychiatric disorders. A few years later he was expelled from the profession. He had slept with a patient and it had all gone horribly, horribly wrong.

  Psychotherapists are human beings: flawed, imperfect, uncertain. We have feelings, preferences, and react to provocations. When one of my patients, an attractive woman in her early thirties, chose to repeatedly sit in such a way as to offer me an unrestricted view of her stocking-tops and underwear, I was distracted. Maintaining eye contact required effort. A braver psychotherapist might have seen this as an opportunity to discuss her transference issues. But she had been referred to me because of a phobic problem and we were making good progress. I just wanted to get the job done. I ignored the distraction of her lingerie—which wasn’t always easy—and she started sitting with her knees closer and closer together. I treated her problem and we parted on the best of terms. We might have had a marriage made in heaven. I will never know.

  Chapter 8

  Narcissus

  Desire reflected

  Revolving doors directed me into a vast white space of glass lifts and high walkways. It was the kind of futuristic interior that recollected the science fiction I used to read as a boy. The hum and whir of an approaching robot would have made the illusion complete but all that I could hear was the whine of an electric drill and repetitive hammering. The hospital was so new the air was fragrant with fresh paint. Only a few departments were staffed, and the building was largely empty.

  I decided to explore. I discovered an austere modern chapel and entered offices that resembled the photographs in a stationery catalogue. Some of the chairs were still wrapped in cellophane. I entered one of the lifts, pressed a button and enjoyed a vertiginous thrill as the floor below my feet receded. A musical chime declared my arrival at the uppermost level. The door slid open and I wandered along the highest walkway, admiring the colourful banners that had been suspended from the roof.

  By the time I reached the mental health centre my mood had changed. I was feeling less excited. I was accustomed to wandering around old asylums and I missed the presence of the past. I couldn’t people the rooms with imaginary Victorians. There were no secret messages scratched onto window panes and no curiosities to be found in abandoned desks.

  Hospitals are supposed to be impersonal places, but in actuality, they all have distinctive and unique atmospheres. A neglected asylum—like a flickering campfire—encourages the telling of strange stories, whereas a private psychiatric hospital (most of which resemble smart hotels) will buzz with tabloid gossip. While seated in a shabby common room or an empty canteen, I have often found myself playing the part of an incidental character in an uncanny tale.

  A consultant I once worked for was renowned for his warmth and kindness. He had studied medieval history before becoming a doctor and spoke with a mellifluous, cultured baritone. He was entertaining and compassionate, and his clinical supervision sessions were a pleasure to attend. A colleague told me, confidentially, that this same consultant was also in charge of a ward located in another hospital where patients were bound in restraints, force-fed and abused by a team of sadistic nurses. ‘It’s like a torture chamber,’ my colleague said, lighting a cigarette and exhaling a cloud of smoke. ‘He does horrible things there.’ Was the kindly consultant for whom I had so much respect an authentic Jekyll and Hyde? I doubt I would have remembered this story—it still sounds to me like an urban legend—were it not for the fact that I had had first-hand experience of equally odd characters and situations in other hospital settings.

  When I was very junior, a psychiatrist whom I didn’t know particularly well explained to me that his clinical judgements were informed by his Chinese spirit guide—a healer born in the time of Confucius. The man was evidently quite mad and I was astonished that nobody seemed to have noticed.

  On another occasion, I attended a ward round with a consultant who introduced a patient in his thirties called William. Prior to the onset of his psychotic illness, William had been the consultant’s senior registrar. This unfortunate young man was trapped in a Kafkaesque nightmare, incarcerated behind locked doors on the ward that he used to manage. I can remember the notes of querulous desperation in his pleas, as he tried to persuade his former superior that he was sane and should be released. The memory still evokes a certain cinematic chill.

  The new hospital didn’t seem like a place where I would encounter the strange. It was too modern, too bright. Yet, it was in this sterile, antiseptic environment that I saw a patient whose desire took such an irregular course that once again I found myself crossing into the twilight zone.

  Mark was a fastidious gay man in his early forties. He had developed some mild obsessional symptoms: doubts about whether he had performed past actions (such as switching off kitchen appliances) linked with checking rituals and an excessive need for symmetry and order. His treatment with CBT was successful and his problematic behaviours all but disappeared. He asked me if he could continue seeing me as he had other issues he wished to discuss.
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  ‘What do you want to talk about?’

  Mark rocked on the chrome frame of his chair. ‘The whole gay thing…’

  ‘I’m not sure what you mean by that.’

  ‘I’m not sure I do either.’

  ‘You’re confused?’

  ‘No—I wouldn’t say I’m confused—it’s just… I want to understand myself better.’

  Mark was an academic. He was in a committed relationship with a younger man called Klaus, who was a professional singer from Berlin. They lived together in a spacious house that Mark had inherited from his uncle.

  ‘I love Klaus,’ said Mark. ‘But somehow, the sex has never felt quite right.’

  Typically, their love-making involved mutual masturbation. Klaus wanted penetrative sex, but Mark was rarely interested.

  ‘I just don’t find it as pleasurable as I should.’

  ‘Why do you say should?’

  ‘Other people find it pleasurable.’

  ‘Some do—some don’t.’

  Mark loosened his tie knot and pulled his shirt collar away from his neck. ‘I feel like it’s an obligation.’ He tapped the chrome tubing of his chair and it made a faint ringing sound. ‘And it shouldn’t feel that way. I should want to do things for Klaus, because I love him. I should be more willing to make the effort.’

  Contamination fears are a common feature of obsessive-compulsive disorder. Although Mark hadn’t mentioned such fears before, I thought that a preoccupation with cleanliness might be the reason why he was avoiding intercourse. Sometimes patients disclose the symptoms that they find most embarrassing only at a late stage, but it turned out that Mark wasn’t worried about germs, faeces or HIV (for which he and Klaus had been tested). Later in the same session, Mark admitted that rectal intercourse had always been associated for him with a degree of ‘moral discomfort’.

  ‘You think it’s wrong?’

  ‘Well, I don’t think there’s anything wrong with other people doing it. But if I do it…’

  ‘You feel what?’

  ‘Disgust, I suppose.’

  ‘Are you disgusted by the act or are you disgusted at yourself?’

  ‘Both.’

  Disgust is a very primitive emotion that evolved to protect our remote ancestors from disease and infection. Thus, spoiled foods, body fluids and body products, signs of decay or illness, and organisms associated with infestation will all reliably provoke revulsion. Disgust is an emotion highly relevant to sex, because sex involves contact with body fluids and orifices associated with excretion. It is easily triggered and kills desire instantly. As such, the degree to which couples can suppress disgust is probably a good indication of their closeness. It demonstrates that they can do things with each other that would be unthinkable with anyone else.

  ‘Klaus says he misses the intimacy…’

  The idea of drinking another person’s spit revolts most people, but of course that is exactly what we do when we kiss. It is worth remembering that even this relatively minor violation of the body boundary is not a universal feature of sex. In a study of 168 cultures, it was found that people in only 46 per cent of them kissed romantically. Over half of relationships never progress further than the first kiss. Couples kiss and break up more than they kiss and make up. Closeness is a finely balanced trade-off between disgust and desire—a delicate compromise negotiated between two powerful evolutionary imperatives.

  ‘I can see what Klaus means and if I don’t do this for him—who will? But when we try to make love the way he wants, it turns me off.’

  The structures in the brain that become active when we experience visceral disgust have been amalgamated into a larger and more complex system that developed sequentially over the course of our evolutionary history. The newer parts of this system—the most recent wiring, as it were—enable thought. Because the higher and lower levels of the system are connected, intellectual assessments of moral impropriety are also accompanied by feelings of visceral disgust. This relationship is reflected in the language we employ to describe wrongdoing: political corruption is ‘rotten’, a heinous person will tell a ‘filthy’ lie and a crime can be ‘sickening’.

  ‘When the passion dies,’ I asked Mark, ‘how do you feel?’

  He tapped his chair again. ‘Dirty.’

  It was late afternoon and the sun was framing Mark in a trapezium of light. He raised his hand to shield his eyes.

  ‘Excuse me.’ I stood, released the blind, and the room was plunged into lilac shadow. ‘That’s better.’

  Mark waited for me to sit before continuing: ‘I’ve always felt a certain amount of guilt—it’s always been there.’

  In spite of changing attitudes and progressive legislation there is still a great deal of prejudice directed against homosexuals. Many people object to homosexuality on religious grounds, others because it is considered unnatural. Beliefs based on scripture cannot be challenged by rational argument; however, homosexual behaviour is observed across a wide range of species and it is therefore unquestionably a natural phenomenon. The negative consequences of internalised homophobia are numerous, but guilt is a common denominator.

  I had supposed that tracing the roots of Mark’s guilt would be a lengthy undertaking. Yet, when I invited him to talk about his childhood he immediately identified a number of relevant experiences. Sometimes he would stop talking and wince—touching the side of his face as though he had suddenly developed a very bad toothache.

  ‘What is it?’ I asked.

  ‘I feel ashamed.’

  He found disclosing his early history very difficult. Even so, over the course of three sessions he revealed enough to highlight some fairly obvious links between his upbringing and the guilt that was interfering with his sex life. Sadly, his story was not unusual and I had heard many others like it.

  Mark had grown up in a very traditional working-class household. His mother was supportive but rather distant, and his second-generation Italian father—a man whose behaviour conformed to the worst stereotypes of Mediterranean machismo—was constantly making homophobic remarks and seemingly obsessed with the idea that his son might be gay. Mark had two older sisters who, following their father’s example, responded to any mention of homosexuality with grimaces and expressions of revulsion. When Mark was about fifteen, his father showed him a kitchen knife and said, ‘If you think you’re queer, do yourself a favour and slash your wrists.’ It is likely that Mark’s father was also homosexual and that his macho posturing was a form of denial. One of my gay patients told me that when he was a teenager he would go ‘queer bashing’ with a gang of skinheads. Failure to accept one’s sexuality can have catastrophic consequences.

  The toxicity of Mark’s early years resulted in frequent episodes of extreme emotional distress that he sought to relieve through self-harm. ‘I used to hold my hand over a candle flame until I couldn’t bear the pain any longer.’ This behaviour served several purposes. It was simultaneously a demonstration of strength that contradicted the idea that all homosexuals are effeminate; a symbolic ‘burning out’ of corruption; and a punishment for entertaining homoerotic fantasies.

  Mark was a gifted linguist. He went to university where he excelled and formed his first romantic attachments. He stopped self-harming and was, on the whole, a much happier young man; however, the transition from life on a university campus to life in the ‘real’ world was not easy for Mark.

  ‘In a way, my father was right…’

  ‘I’m sorry?’

  ‘I was directionless and fell in with a crowd I didn’t really have much in common with. I hung out in some very dodgy clubs—doing things that I now regret. It was as though everything my father said was true. Queers were disgusting—bum boys, shit stabbers. I didn’t enjoy any of these casual encounters—it’s not me at all—and I joined in only because I didn’t have anywhere else to go. I guess I wanted to belong.’

  People will do extraordinary things to escape from loneliness and be accepted. While working
in a genito-urinary medicine clinic I saw a significant number of young men—some in their teens—who engaged in frequent unprotected sex because they wanted to contract HIV. This was at a time when HIV was almost exclusively associated with homosexuality, the development of AIDS and premature death. For many reasons, mostly social and cultural, HIV had become mixed up with sexual politics and notions of selfhood. These young men wanted to be HIV-positive to strengthen their sense of being gay and acquire status within the wider gay community. Many of them achieved their aim—and subsequently died. The utter pointlessness of their misconceived militancy still fills me with sadness.

  The shadowed recesses of the room darkened to purple as the sun descended. I made some notes and said: ‘Perhaps these feelings of guilt will diminish now that you’re in a meaningful relationship.’

  ‘But we’ve already been together for eight months.’

  ‘That isn’t very long—not really.’

  Mark looked uneasy. His expression was doubtful and his voice was edgy with scepticism. ‘All right, let’s say I come to terms with all this guilt. Do you really think it’s as simple as that?’

  ‘It might be.’

  ‘But what if it’s not? What if I still don’t want to make love the way Klaus wants, even after I’ve talked through all my hang-ups?’

  ‘All successful relationships involve making compromises.’

  ‘But sex is so significant. And if I wasn’t gay…’

  ‘You might be in exactly the same situation. There are plenty of heterosexual men who enjoy anal sex.’