Sex Changes: Transformations in Society and Psychoanalysis (Book Review)

Author:  Blechner , Mark J. 
Publisher: Routledge, 2009
Reviewed By: Karen Weisbard, PsyD, January 2011, pp. 214

Mark Blechner's book, Sex Changes: Transformations in Society and Psychoanalysis is a collected volume of essays written by Dr. Blechner, spanning 38 years of his clinical writing on the topics of sexuality, prejudice, gender and psychoanalysis. It is the 10th volume in Psychoanalysis in a New Key Book Series, edited by Donnel Stern, and offers the reader a personal, historical, and clinical account of psychoanalysis' responses to homosexuality, the AIDS epidemic, and gender identity. It is both richly informative for those new and old to the literature and powerfully persuasive about the detrimental role psychoanalysis has played in the lives of gay and lesbian people. Inspiringly, Dr. Blechner does not end with his critiques. Rather, he calls upon the reader to challenge his/her own prejudices and assumptions, particularly homophobia. He wishes to "sensitize and educate heterosexual readers to the special problems gay people face" (p.15), and restore psychoanalysis to its standing as a progressive and disruptive discipline, "as the solver of irrational problems instead of the reinforcer of problematic irrationality" (p.55).

This book is organized into two sections with seven chapters in the first section and nine in the second. Each chapter is introduced with a piece of personal information or reflections from about the period he and the culture were in at the time of the original writings. The first section, entitled, Psychoanalysis, Sexuality, and Prejudice focuses on the prejudice shown to gay and lesbian people by the field of psychoanalysis. Two statements early in this section set the stage for his views that resonate throughout the book and organize much of how the book is written. Blechner states, "This is the essence of most prejudice—in words and deeds, the very identity of the minority group is denied its existence as present, living humans" (p.8) and then, "If you study the facts, you may find that people may be quite wrong when they assume things have always been the way they are today" (p.9). In this first section, Blechner confronts the reader with facts regarding the prejudices that used to be present and may still exist within our discipline. Some examples are: In 1972, Dr. John Fryer testified to the American Psychiatric Association about whether homosexuality should be a diagnosable disease. In 1979, Dr.Blechner himself went through psychoanalytic training at the William Alanson White Institute as a closeted gay man. As of 2004, there was only one openly gay training analyst in the American Psychoanalytic Association. There are no openly lesbian training analysts.

Blechner points out how "well-meaning heterosexual psychoanalysts" didn't have the facts or the experiences that gay analysts had to change or at least challenge their own beliefs. He demonstrates that it is not and was not homosexuality per se that created suffering in gay and lesbian people but the homophobia in individuals and our culture. With deep passion, Blechner shares his dream that "one day there will be no more coming out." (p.72) because he hopes that one day one's sexuality and identity will be a matter-of-fact issue, just as it is now a matter of fact issue that a woman can run for president of the United States. He asks his students and the reader to think of things that we now see as abnormal or unusual and imagine a world fifty years from now. Would that be unusual then? What things were unusual 50 years ago that are now take for granted?

The power of Blechner's book to increase our awareness was evoked for me by the memory of a comment I made to a friend in graduate school, somewhere around 1984-1985. I said, "Boy, you sure do have a lot of friends dying". He looked at me with an expression of horror and hurt and said, "Karen, they are dying of AIDS". I as a white, heterosexual woman, who was then 23 or 24 years old, knew no one with this experience. I bring my memory to this review to highlight Blechner's view that we have to at least become educated about the lives of others that are different than ours, examine our responses to these differences, and then recognize the limits of our perceptions based on our own gendered, sexually-oriented, culturally informed place. The truth is I do not know the pain of losing countless friends to AIDS nor the pain of being judged as perverted because I identify myself as homosexual. The first section of the book brings all of us face to face with these painful realities.

While the first section of the book drives home points that Blechner wants the reader to know, the second section of the book, entitled, Sex, Gender and the Good Life, presents issues that Blechner would like the reader to consider. This section offers more for the reader to be curious about regarding gender and sexual practices and weaves in important contemporary concepts of relational and interpersonal psychoanalysis. In Chapter 8, Blechner speaks of the problems of binaries, the power of language to shape identity and behavior, and the limiting effects of cultural stereotypes to male identity and intimacy. Chapter 9 deepens this point in his discussion of Muriel Dimen's 2005 paper on "the Eew! Factor" when he offers the possibility that "gay people may learn to mentalize their disgust more readily than most straight people" (p.96) because that which has been a way of life for years has been seen as sick and disgusting by others. To the dialectic of disgust and desire, Blechner thinks we should add the relation between disgust and fascination. He again reminds the reader to think of from what place do they speak and feel, and how can these be modified by taking another perspective.

This section of the book also exposes the reader to little known facts or dissociated historical information about Harry Stack Sullivan. Blechner illustrates how Sullivan's homosexuality influenced his interpersonal theory. He painstakingly dissects Sullivan's use of language that both describes and hides his ideas about gay sexuality and his own identity as a gay analyst. In Chapter 10 and subsequent ones in this section the analyst reader will see Sullivan's influence on Blechner's theory and practice, notably the interaction between body, sexuality, culture, and the effects of these on interpersonal interactions. Sullivan's concept of "not-me" is used to illustrate how we might psychologically protect ourselves from frightening things by telling ourselves that AIDS is a disease of gay men and drug users, or how we use it to pathologize others. Sullivan's ideas on relational maturity and health are restated by Blechner in Chapter 13 as "the ability of the person to find love, sexual satisfaction, security and happiness in a combination and arrangement that feels most satisfying and that allows for interpersonal intimacy without coercing or harming another person" (p.156). And in Chapter 14, Blechner asks the question that interpersonal theory begs, "…how aware is the psychoanalyst of the question of psychopathology versus cultural pathology, namely, that is, whether the unusual sexuality is intrinsically problematic for the person or problematic because society condemns that sexuality? (p.161). In this chapter and section, Blechner asks the reader to reflect on where our notions of right/wrong, healthy/unhealthy, perverse/normal come from. If we think we know what is right, healthy, or normal than we should think again. Toward the end of this section, Blechner does an excellent job, without so stating, of illustrating a relational sensibility and way of working psychoanalytically. In Chapter 15, he writes, "The erotic transference, when explored in analysis, can be a precise and vivid way to learn about your own (italics added) lovemap; it can be the "royal road" to understanding and accepting your (italics added) sexuality". This is a wonderful example of how analytic work with one's patients must involve the analyst understanding him/herself, and how the treatment is a reciprocal though asymmetrical relationship in which the analyst cannot be out of the discourse/dialogue. Blechner ends his book with the chapter, The Political is Psychoanalytic, and profoundly states, "A psychoanalyst cannot adequately address the mental health issues of stigmatized people without also taking a stand against discrimination and bigotry in society…" (p.182). Whether one agrees with Blechner's stance, he is clearly stating a particular position within interpersonal and relational psychoanalysis. Influenced by feminist theory, this stance considers the interrelationship of patient, analyst and culture and the impossibility of escaping the mutually influencing effects of all three.

In all that is positive and a must-read in this book, a few comments about what doesn't go well seem in order. While Blechner's writing style is jargon-free and allows the reader a practical and anxiety-reducing way to approach uncomfortable material it unfortunately leaves readers seeking a deeper understanding of the topics no further place to go. One is left hoping that Blechner would explore the issues of gender, sexuality, and perversity more deeply and complexly, especially in regard to the unconscious influences on prejudice, homophobia, and gender identity. The reader is left having to turn to other theorists and clinicians for this type of exploration. I read this book as one continuous narrative my first time and felt I was hearing some of the same stories and some of the same points over and over again. This is an unfortunate outcome as the repetition breeds boredom. In my second reading, I pulled out chapters at random and this had a more fulfilling effect and many of the gems stuck out more. Once the appetite was whetted and I was shaken from my homogenous state, the result was to become excited again about the richness and complexity of psychoanalytic thinking. 

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