ABSTRACT
Freed from its traditional role of procreation, sex is the climax that releases tension, the surrender that eases control, and the control that binds anxiety. So tightly bound to a man’s sense of self, powerfully yielding both intrinsic and utilitarian needs, sexual behavior is sensitive to psychic pressures both past and present. A man gets all this with a rush that comes for some in the pursuit of a partner, for others in the seduction, and for yet others in the climax, leading many of our patients to report an exhilaration, a high that is difficult to match in more stable relationships. With such psychological and
physiological payoffs, many of these men center large parts of their lives around preparing for, engaging in, and covering up their sexual activities. We have patients who use the high to self-medicate, to break through their pervasive malaise, to experience some vitality in their lives, and to distract themselves from uncomfortable emotions. Sexual compulsivity is a quasiconnection with another person in a ritualized, constricted, and “safe” manner. Our job is to offer the patient a “real” relationship where emotions are exposed, engaged, and tolerated; where superficial and damaging highs are replaced by a satisfaction that endures, so that looking in the mirror is a more pleasant activity. The patient’s inclination is to focus on how others see him and to seek acceptance from the outside; we encourage him to focus on how he sees himself.
