A Case Example
An avoidant man with a Madonna complex felt uncomfortable when he saw his wife’s head turning to look at the display as they passed a pornography shop. He didn’t mind it if he did the looking because he felt that it’s OK to do if you are a man, but he hated to see his wife’s devaluing herself and all women by getting down into what he considered to be the mud and muck of sexuality. He also determined which movies they were allowed to watch at home and in the theater because he worried that his wife would laugh at the double entendres and dirty jokes, revealing that she was just a slut. Ultimately, they couldn’t even attend social events because the men and women there would always talk about sex, and he wanted his wife to neither see nor hear such evil. Central to his guilt-laden relationship with sexuality was the belief that sex was lowly, dirty, and disgusting, a belief that partly originated in his almost daily “appalling rediscovery” that the genitals were too close for comfort to the excretory organs so that touching his wife sexually could lead to his being contaminated by her and getting an infection.
Of course, also contributing to sexual avoidance are the interpersonal, fearful mind-sets characteristic of avoidance in general, especially as shown in table 4.1.
Table 4.1 Fearful Mindsets
Fear of exposure.
Fear of intimacy as confinement.
Fear of yielding, with yielding = dissolution of the self and ego.
Fear of dependency and with it helpless passivity; paradoxically associated with a fear of independence and that with isolative remoteness.
Fear of becoming too emotional and being flooded by overly strong feelings, associated with a fear of letting loose, as if the slightest stirring of emotion might cause all emotions to spin out of control and overwhelm the individual, leaving him or her no longer in charge of the self.
Fear that a demarcating moral line might be crossed.
Fear of failing and being humiliated, often based on a negatively distorted body image that leads avoidants to sell themselves short, expect little, then withdraw defensively to avoid being humiliated and, in a case of misplaced altruism, to keep from disappointing others.
Fear of succeeding then being defeated: in men, castrated, or in women, deemancipated.
Fear of rejection that in turn originates in sensitivity to and readiness to experience even the most positive feedback as shatteringly negative, based in part on excessively high and often perfectionistic expectations of the self and others.
Fear of pleasure on the part of ascetic masochistic individuals who so eschew having fun in any form that they make certain not to take any pleasure and enjoy themselves at all, or at least to do so as little as possible.
Fears that self-assertion = aggressivity, making sex = rape.
Fear of admitting one’s own problems so that others are to be avoided unless they agree to change and be the ones to make all the sacrifices.
SPECIFIC SEXUAL SYMPTOMS
Pathognomonic (characteristic pathological) psychodynamics can sometimes be linked to specific sexual symptoms. Broadly speaking, sexual symptoms tend to be mostly associated with the following:
• an inability to merge intimate and sexual feelings due to an overly scrupulous morality and fear of closeness
• a histrionic fear of genital vulnerability and mutilation
• a generalized regressive mind-set that promotes a throwback to infantilism and with it immature and so infantile sexuality
More specifically, using men as examples, many men with premature ejaculation tend to be excessively impulsive and show a narcissistic lack of concern for a partner’s fulfillment along the lines of “I come when I’m ready to, and who cares about you.” Such men are often also easily bored and want to get it over with so that they can go on to have sex with someone new and presumably more enticing.
Some men with erectile dysfunction may fear that penetrating equates to hurting because the penis equates to a weapon, so they spare the woman in order to avoid brutalizing her. Some are paranoid individuals who see in any mutual attraction the possibility that a woman is forcing them to perform. Still others are sadists, who, devaluing women emotionally and physically, come to feel that no woman deserves anything much from them, so “why give them what they want?”
Men with ejaculatio tarda are often insecure individuals who are spectatoring: observing themselves having sex and making each performance a test of their adequacy, while predictably disparaging themselves for not measuring up—brooding right throughout their performance about what might go wrong (e.g., they won’t be able to come to orgasm) as they constantly judge their sexual prowess as if they are on public display and about to embarrass themselves through failure. Ejaculatio tarda can also arise in the context of an intense fear of closeness due to the belief that closeness equates to merging, or in the context of the histrionic fear that being tender necessarily means being feminine and, as such, becoming emasculated. Further problematic, and perhaps most common of all, is a negative mind-set that won’t allow the man to deny the seamier aspects of sex, leading to frustrated excitement due to the intrusion of negative fantasies originating in disgust.
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CHAPTER 5 Course
Sometimes avoidant personality disorder (AvPD) can improve spontaneously as the individual grows older. This improvement often results when psychological maturity associated with increasing insight based on ongoing introspection and continuous learning are coupled with new fortuitous, corrective social experiences. As a result, the AvPD fades, leaving in its wake self-awareness in the form of the commonplace youth-to-age wisdom expressed as the retrospective amazement of “what was I thinking then, and why did I act as I did?”
At other times, AvPD may not have so favorable an outcome, as the avoidant, succumbing to his or her avoidance, fails to emerge from, or sinks further into, the beckoning quagmire. This often happens because adolescent hormonal fires that stoke relational neediness die down at about the same time that adult relational fears strengthen, societal prohibitions begin to wield greater influence, and new negative interpersonal experiences traumatize the individual, all leading to feelings of resignation and a pervasive sense of doom, accompanied by existential murmurings of hopelessness, creating a generalized inability to experience relational joy. As a result, paraphrasing Berne’s reference to the lonely consequences of playing off-putting games, because avoidants are “not stroked [their] spinal cord[s] . . . shrivel up.”1 Also, as the years go by, depression can become superimposed on the avoidance, leading to increasing awareness of how much one is missing in life. This depression can also be intensified by escalating isolation due to withdrawal and panicky agoraphobia. Consequences of the depression, such as neglecting one’s appearance and allowing antagonistic behavior toward others to proceed unchecked, may occur along with vicious cycling between withdrawal from, and rejection by, others, ultimately resulting in family members and potential friends and lovers leaving, really being driven away. Millon describes a typical vicious cycle where avoidants’ timidity and shyness antagonize people who withdraw from the avoidant, thinking not, “he is afraid of me,” but “she doesn’t like me”: “the patient’s discontent, outbursts, and moodiness frequently evoke humiliating reactions from others, and these rebuffs only serve to reinforce his self-protective withdrawal. . . . He often precipitates disillusionment through obstructive and negative behaviors [then] reports feeling misunderstood, unappreciated, and demeaned by others.”2