Mr. A is a 22-year-old university student who sought treatment because of his "addiction" to pornography. He lives with his girlfriend of two years, whom he describes as "beautiful and good." He is very concerned, however, about the volatility of his feelings toward her. His admiration often vanishes. At these moments, he thinks of her as a "nag," dull and oppressive. So many others would be better for him: smarter, sharper, sexier, more adventurous. What he means by "better for him" is that they would have what it takes to make him feel better about himself. Concerns about his own standing preoccupy him: his goodness, his intelligence, his sexual attractiveness, his income, the loyalty of his friends and family. He is an exceptional student. Departments already have begun competing for his future at the university. He is proud of his intellectual accomplishments and feels triumphant when those accomplishments are recognized via awards and scholarships. The triumph is particularly satisfying in relation to his father. His father is also an academic, whose achievements, though substantial, have not won him national recognition. Patient and father agree that the son is on a path to far outdo him. They also agree that the son's girlfriend is herself a "better woman than my mom ever was."

From a recent session:

My wife and I were sitting at an outdoor cafe. We were barely speaking. There were all these other women I could see, beautiful and talking. They seemed intelligent, full of ideas. My wife said maybe we should find a better cafe. It wasn't the cafe, though, it was her. She had nothing to say. I shouldn't be with her. Someone else. She doesn't have the edge, the smarts, the wit I need. It's like not getting enough compensation. I'm worth more.

(Your wife ought to provide you with what is otherwise missing.)

That's right. Like that girl from a few years ago. She had it. She'd walk down the street and you could see how everyone wanted her. She'd walk into a room and guys would look at each other, each one knowing what the other one meant. What they meant was: "she's the one." That's it. That's what I deserve. That's what I want. A woman that guys look at and say "she's the one."

(The woman and the guys merge into one thing, don't they, the thing you call "that's what I want"?)

Yeah, if everything goes right, I get the woman and I get the guys.

It is impossible to listen to this sequence without being aware of its homosexual component: "I get the guys." Getting the woman seems here to be a means of getting the guys. And yet, on listening, I immediately sense this apparently central element of the material as located on its periphery.

The sense of where this homoerotic element belongs comes to me as a kind of perception. I have no awareness of any activity that precedes this "perception." The authority of this "perception" approximates the authority of a "fact"; although this is a "fact" of a special, suspect, kind. I know, or think I know, that "facts" like this one cannot be trusted. Nonetheless, given its first appearance to me as a "fact," my first, automatic, thought/impulse is to treat "getting the guys" as a marginal element, that is, as a disguised representation of what immediately seems to me the missing central element, fleeing the woman.

This thought/impulse is not a product of evidence; it certainly lacks the enduring force of conviction. It feels, instead, like a tilt, a reflex, a posture from which I begin to think. This tilt has a sensuous valence, not a cognitive one.

The tilt is undeniable and demanding; the demand it makes is for work. Freud describes a similar demand made by "drives" in general. Drives demand work of the mind. This demand is a direct effect of the mind's attachment to the body. Following Freud, then, I think of my experience of perceptual tilt as drive-related, that is, as a consequence of my mind's attachment to my body. The tilt I feel pulls my mind toward an alignment with demands emanating from my body. The mental work demanded of me is to satisfy this drive-based tilt: to provide it with theoretical cover, to adorn it with thought.

The work of adornment is effortless and instantaneous, which alerts me to the possibility that what I'm doing is more rationalization than rational thinking. In this first moment, though, I cannot clearly distinguish the two. So I get to work. I produce a "thoughtful" image: the wife who doesn't "have" the ideas, the wit, the edge, the smarts, who lacks what the patient wants. I am ready to orient further work around the question of what makes this image of "lack" unbearable.

In classical terms, then, my first thought/impulse is to organize what I am hearing around the notion of "castration anxiety." My patient's flight from his wife, I immediately feel, is a flight from an encounter with a dreaded ima ge of castration. In this initial moment, I feel my patient is in sensuous flight from a figure he "sees" as lacking the sexual essentials he needs.

I sensuously identify with him. I "see" him "seeing" female lack and I then cover my "sighting" with thought. With this, the demand for bodily alignment and conceptual adornment is met.

Of course, castration anxiety, as a concept, is not the culprit here. Were the identity-driven demand different, I might use the same concept to ask an entirely different question, to "see" an entirely different patient, for example, what makes the woman a necessary appendage in this patient's aim of "getting the men." Perhaps I might have thought that without the possession of the woman to signify his own phallic integrity, the encounter with "the men" would bring this patient too close to a dreaded image of himself as lacking the essentials that he needs. The notion of "flight from men" does not occupy my tilted castration anxiety, oriented center, though; the notion of "flight from women" does.

The concept castration anxiety, like all concepts, seems to tilt me neither in one direction nor another. What then is responsible for the tilt? This question, what tilts the clinical analyst away from neutrality, informs all psychoanalytic work. What are the forces that make achieving neutrality so difficult and preserving it impossible? When this two-part question arises here, in regard to homo- and heterosexual object choice, I presume myself to be in the midst of a particularly vivid and local example of an often obscured, but always fundamental problem.

Patients, of course, are not neutral. They have no obligation toward neutrality. If anything, they are obliged away from it, obliged and loyal to their own particularity, their own identity. The essence of identity resides in its deviation from neutrality. In some sense, this is what we mean by "identity", an enduringly nonuniversal and nonneutral presence that organizes and structures experience, that gives experience personal rather than neutral meaning. Patients in analysis mean to call the analyst toward them, toward their identities, and therefore, in effect, to call the analyst away from any preexisting obligation to neutrality: "I get the woman and I get the guys," for instance, represents such a call, as though the weight of the phrase lies in its unspoken, "You see what I mean, don't you?"

The analyst contends with an identity fueled impulse similar to the patient's: the analyst feels this impulse in the form of calling the patient toward himself, calling for the patient to see things, experience things, as the analyst does. That is, like the patient, the analyst feels the desire to have his own identity carry weight; that is, in response to the patient's call, the analyst might, in effect, be inclined to make a complementary one, something like: "It won't work, your aspiration to get the woman and the guys. We both know, don't we, that you will, sooner or later, have to renounce one and (melancholically) settle for the other." Or, to put it more bluntly, to give it the sensuous pull demanded by, in this case, my identity: "You ought to internalize the men you currently desire. Then you will be better able to tolerate the anxiety-provoking otherness of a desired woman."

What distinguishes analyst and patient from each other, however, is that, in addition to the pull of identity, the analyst also feels at least two other pulls: toward conceptual clarity and toward interpretive neutrality. Whatever the analyst ends up doing represents the combination of these converging forces: the pull of identity, shared with, but in direct opposition to, the patient's pull toward identity, and the pulls of conceptual clarity and interpretive neutrality, which are the analyst's alone.

So, then, to return to the issue of my own tilt, it must be me, the analyst with a personal identity, who is responsible for the initial tilt: no concept, no idea, no theory. The first use of theory and concept is to provide cover for, to account for, the identity-fueled pull that precedes their utilization. In that first impulse, some element of my own identity manifests itself as a force that feels deeper and more reliable than any concept or theory, including the concept of "neutrality." Said another way, my identity, like everyone's, I think, is decidedly nonneutral.

This nonneutral identity lives in open opposition to my aspirations toward conceptual clarity and interpretive neutrality.

Conceptual clarity and interpretive neutrality each demand to be treated as ideals. Yet, my own identity, on the other hand, demands that I treat each of them with skepticism, more as sirens than as ideals.

For the analyst, while conceptual clarity and interpretive neutrality position themselves as ideals still to be achieved, identity claims itself as an ideal already accomplished. Before getting on to some further reflections on what seems to me the irresolvable tension between identity and neutrality, I want to present another pertinent clinical example, this one involving my treatment of a homosexual man.

The patient is a 50-year-old man who has been married to another man for 8 years. Though committed to his spouse, my patient is plagued with doubt as to whether the relationship ought to continue. "Fundamentally," he says, "I do not feel loved." Sessions are peppered with examples of what he means: a lack of tenderness, suspicions of infidelity, sustained periods of indifference, a lack of sexual desire. In spite of all of this, however, the patient remains uncertain. "Perhaps it's me," he repeatedly says. "Perhaps I'm making it up. Who knows? He thinks the relationship is great, just as it is. He says I'm crazy."

From a recent session:

I spent the weekend with Joan, one of my oldest, closest friends. It was wonderful. The main thing about it was how delighted she seemed to be with me. She wanted to talk and talk. She was so happy for me when I told her about the deals I was putting together for work. She heard me out. She wanted to hear me out. I could tell by her face that nothing I said was causing her to feel burdened. And then it went the other way too. Once I knew she wanted to be with me, I wanted to be with her. Listening, whatever she wanted. She doesn't have an easy life. Kids aren't doing well. Husband is no gift. This is what I want. This kind of being together. It's possible. I know it is. I used to get it at school. They loved me. Kids who graduated after me remembered me in their graduation speeches.

Why do I put up with all of this? I know it's not necessary. But I can't state my case. I can't really draw a line.

(You're appealing to me to judge the soundness of your sense of things, of what you deserve, and of what you have.)

I don't trust myself. It could all be wrong.

Unlike in the first case, here, listening to this man, I do not wonder about the patient's flight from intimacy and connectedness to his spouse. Unlike the patient himself, I do indeed trust him. I do not think he is "wrong." Here, just as in the first case, my initial thought/impulse tilts me toward orienting the material around a flight from women, and not around a flight from a man. My hunch, another word, I think, for a thought grounded in sensuousness and identity ("gut"), is that the patient is "right," that his husband in fact denies him access to love and that the patient's pursuit of it, in this marriage, and perhaps even with men in general, is a doomed one. I do not immediately wonder what might be dangerous about homosexual intimacy, but rather what might be dangerous about heterosexual intimacy.

And, as with the first case, "flight" here refers to castration anxiety: flight from an encounter with a category of person, in this case, "woman", who too closely coincides with a dreaded image of irreparable deficiency.

I think the notion of flight qualifies as neutral. It may be wrong, but if so, I consider it "neutrally" wrong. Orienting myself around an axis of flight simply means giving anxiety a central place in the determination of sexual object choice. The operative force of anxiety is flight. The impulse to flee is the central identifying marker of anxiety. Any impulse toward an object includes a contribution from an impulse to flee that object's negative complement, to pursue an object of desire is to flee its absence.

As in the first case, what is decidedly nonneutral here is the presumptive tilt I take regarding the flight's direction. This presumptive tilt precedes and informs my thinking. Of course, I hold myself back from voicing the tilted thought directly or even, I hope, indirectly. And it is precisely this "holding myself back" that warrants further scrutiny.

My ideal of neutral listening is in direct conflict with the actual nonneutrality that precedes and informs my listening. Nonneutrality, here, and, I think, more generally, infiltrates my mind as a kind of sensuous experience: pressing its own implicit claim to be interpreted as authentic, reliable, and self-evident. Neutrality, on the other hand, lacks sensuousness. Its appeal is more abstract, conceptual, and counterintuitive. It demands renunciation, more precisely, it demands the renunciation of the authority of sensuousness. Neutrality, in order to be realized, not only demands that I achieve a neutral posture in relation to my patient, but also that I achieve the same posture in relation to my own sensuousness. By "sensuousness," I refer to the entire set of meaningful experiences, grounded in my body, through which I position myself in relation to issues of reality and of pleasure. Neutrality demands that I foreswear allegiance to sensuousness, to the use of my own body as a moral/conceptual compass. It is a demand I cannot meet. The claims of sensuousness persist; I trust them no less than I trust the claims of neutral reason. In fact, I spot an important parallel here.

Listening to my two patients, I cannot achieve an actually neutral position as I contend with the problematic of flights-from vs. movements-toward. A similar predicament holds between the claims of sensuousness and the claims of neutral reason: no matter in which direction I move, I cannot confidently distinguish between flight from and movement-toward.

After all, sensuousness may represent a regressive retreat, a flight from, the ruthless and disorienting demands of reason. Sensuousness also may represent a deep clear contact with a most basic stratum of human life: and movement toward it. Reason may represent a beacon of possibility, the only way forward, the only way to counteract the primitivity of sensuous givens. It may also represent flight, an anxious movement away from essential structure, a kind of denial of sensuous authority, an authority that, in fact, may, ironically, function as the ground for the neutral reason it seems, in the moment, to oppose.

Here, contending with the flight from movement-toward problem as it shows itself in the tension between sensuousness and reason, I feel capable of what seems a more neutral position than the one I'm in with my patients. I am uncertain of which of the two, sensuousness or reason, to actually trust, and my uncertainty seems to extend all the way down. I can think of no third term, no potentially reliable adjudicating referent. That is, I can maintain neutrality as long as I can refrain from action. Action itself, especially interpretive action, demands a momentary break from neutrality, a kind of lunging, toward or away from the pull of identity, toward or away from the pull of reason. One takes a stab at it and gets ready for the uncertainties to show up again in the form of apparent consequences. This, then, is the clinical labor of pursuing neutrality, as best I know it, a state characterized by full engagement, too much information, insufficient confidence, and the intermittent necessity to act. The result, as with these two patients, is a continuous series of "looks," each made up of perceptually grounded flashes, of sensuous pulls, of conceptual correctives, a sequence of images cinematically strung together into a story whose sense simultaneously provides a balm, a relief, and a lure.

So, then, I return to the two patients and the ongoing problem of maintaining neutrality. From the point of view of "identity," heterosexuality makes immediate "sense" to me. That is, it rings sensuously true. It is more than a temptation; it is, and has been, a source. And although it carries a clear element of flight, a turn away from men, that turn, made perhaps long ago, feels sensible. Confronting heterosexuality, then, in order to approach neutrality, I must work against the identificatory tilt demanded of me by way of my body's connection to my mind.

Homosexuality, on the other hand, makes less immediate sense to me. It feels like a temptation, a possibility best left abandoned, a risk too costly to take. I can imagine it, but, like imagining diving from cliffs, the images I find come to me in the form of warnings more than of enticements. That is, from the point of view of identity, I must work to give homosexuality sensuous sense. And here I must work against my own disidentifying identity in order to achieve a neutral position.

In both cases, the pursuit of neutrality demands ongoing work against the sensuous demands of identity. And, simultaneously, the necessity to speak from a position of sensuous identity demands ongoing work against the universalist claims of conceptual thought.

The analyst navigates in a zone bracketed on one side by the idiosyncratic demands of sensuous identity and on the other by the universalist claims of conceptual thought. The direct, and complex, navigational aim is to optimally utilize both sides, while running in to neither. Avoiding crashes, this is the analyst's direct aim. The indirect aim is always-elusive neutrality.

About the Author

Don Moss, MD is in the private practice of psychoanalysis and psychotherapy in NY. He is on the faculty of the Institute for Psychoanalytic Education, NYU Medical Center, on the Editorial Boards of JAPA, Psychoanalytic Quarterly, American Imago, DIVISION/Review, and Studies in Gender and Sexuality, and author of numerous articles over the past 25 years. A revised and elaborated version of this paper will appear in his book, 13 Ways of Looking at a Man, forthcoming July 2012 with Routledge.