Sex, Mind, and Emotion

Innovation in Psychological Theory and Practice

Winifred Bolton, Janice Hiller, Heather Wood, Winifred Bolton, Janice Hiller, Heather Wood

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429918988
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Sex, Mind, and Emotion is a collection of predominantly clinical papers, exploring innovative work in the field. The central tenet of the book is that sexual behaviour cannot be divorced from the emotional context in which it occurs or the meaning of that behaviour to the individual and therefore no chapter is about sex without also addressing mind and emotion. The book uses a fusion of psychoanalytic, systemic and cognitive theories in conjunction with public service practice. It deals with important and relevant topics such as the treatment of sex offenders; the compulsive use of internet pornography; the psychosexual development of adolescents growing up with HIV; the psychodynamics of unsafe sex; refugees and sexuality; services for people with gender dysphoria; psychological treatment for survivors of rape and sexual assault; and loss of sexual interest.

Part I
Developments in Theroy

Chapter One
Sex, mind, and emotion through the life course: a biopsychosocial perspective

Janice Hiller

Introduction

Humans seek social and sexual bonds for security and nurturance, as well as for pleasure and procreation. Nevertheless, social warmth, a sense of belonging and rewarding sex do not always co-exist in intimate relationships, and the inability to achieve a balance between these drives can lead to powerful feelings of despair. Fulfilling sex, in contrast, can create emotional closeness and shared joy that contributes to the sense of attachment in ongoing relationships. Sexual expression in humans then, is multidetermined, and serves several functions. For interpersonal sexual behaviour, what people feel and think about each other sexually and non-sexually is as important as the physiological responses to erotic stimuli. This means that sexual activity between people is part of a repertoire of communications signifying what is wanted and needed from the other, and must therefore be conceptualized within an interpersonal framework (Friedman & Downey, 2002).

As a clinical psychologist specializing in sexual and relationship therapy, I have always been aware that a purely psychological model is inadequate to describe the complexities of sexual functioning. Sexual behaviour is an interpersonal, affective, and biological phenomenon; people’s sense of gender, responsiveness, and attractiveness is founded in their mind’s appraisal of their bodies. Moreover, many people present for help when mind and body fail to synchronize: despite feeling love and desire the body does not respond; someone can experience anxiety about being wanted even when others express desire; it is possible to feel like a woman when the body is anatomically male. Sometimes, psychological intervention is sufficient to effect a change at a biological level: a decrease in anxiety that facilitates arousal, or a reduction in hostility that enables responsiveness between people. Often it is not, and the work of therapy is to understand the relationship between mind and body and their respective developmental paths in the hope of fostering greater integration.

Psychological approaches can, I think, only be enriched by recognizing the extensive research on the neuroanatomical and neurophysiological substrates of gender identity, the sexual response, bonding and attachment. Rigid distinctions between “nature” and “nurture” are no longer upheld in other areas of scientific enquiry, and cannot be sustained in psychological therapies. During individual development, our genetically programmed neurobiological systems will interact with, and be modified by, the psychological and social environment. A multitude of overt and covert messages will be transmitted from environmental cues, to gradually build an internal world, unique to each individual, that imbues the external world with particular meanings. Despite a considerable amount of literature in each area, there is still much to learn about how the inner and outer world interact in sexual expression.

While sexual desire and reproductive urges are not essential for the survival of any one individual, they are, along with many mating patterns and subtle brain and bodily mechanisms, vital for survival on a population level. Central to sexual function is the emotional limbic brain, an evolutionarily primitive neural system that is regulated by hormones, from which sexual urges emanate. Research into brain differentiation and hormonal release in the womb has shown that human sexual and gender potentials are laid down during foetal development (Friedman & Downey, 2002; Panksepp, 1998). These potentials continue to develop and to influence behaviour patterns throughout our lives. Investigations into the brain substrates of sexuality indicate that female and male sexual urges derive from different neuroanatomical and neurochemical pathways, and are therefore subservient to different brain controls (Panksepp, 1998). This results in frequent dissimilarities between women and men in the expression of emotional and sexual needs. Although many neural systems are shared, differences between the genders are significant and are one of the factors contributing to relational and psychosexual issues that can lead to considerable distress in adult life.

In another area of neuroscience, recent theories differentiate between emotions (visceral states) and feelings that are the private, mental experiences of emotions represented in the mind, whereas emotional states are collections of responses that can be partly observed by others. Feelings arise from neural activity in the evolutionarily modern part of the human brain, the neocortex, which is in constant interaction with the (subcortical) emotional limbic system. A specific part of the neocortex, the prefrontal cortices, has direct connections to every motor and chemical response occurring in the brain and has been identified by Damasio (1994) as the area dedicated to categorizing the unique features of individual experiences and personal identity. Neural activity in the prefrontal cortices gives rise to conscious processes, which add the capacities of reasoning, reflection, and decision-making to our more primitive emotional states. What differentiates humans from other mammals is the availability of a mind with consciousness, which allows us to plan and reflect, and to use reason to control “the pervasive tyranny of emotion” (Damasio, 1999, p. 56). Our ability to control these primitive responses is, however, far from complete. This is because there is an interaction between the subcortical systems in the brain registering emotions (bodily states) and the neocortical circuits that are involved in reasoning; emotions can impact on reasoning as well as reasoning exerting some influence over emotions. In the area of sexual behaviour it is apparent that conscious thought impacts on biological urges to varying degrees in people, at different life stages. This chapter represents a selective review of recent research, in an attempt to describe a truly biopsychosocial model of human sexual development that interweaves sex with mind and emotion throughout the life-course.

Foetal development and sexual brain differentiation

Although the view taken in this paper is that sexuality acquires meaning through the interpersonal context (real or fantasized) and the cultural setting within which the response occurs, abundant evidence on neurobiological factors in brain organization indicates how prenatal sex steroid hormones influence male and female brain differentiation, sexual tendencies, and gender role behaviour. Whether an embryo is genetically female (two X chromosomes) or genetically male (XY chromosomes) it will develop initially along female lines, sometimes called the “default” plan. Sexual differentiation is determined by the presence of a Y chromosome in an XY embryo due to the sex-determining gene region of the Y chromosome (the SRY), which is responsible for male differentiation (Haqq & Donahoe, 1998). Influenced by the SRY a testis will develop rather than an ovary. This produces testosterone to stimulate male reproductive organs and an inhibitory factor to suppress parts of the embryo which would otherwise develop into internal female organs (Bancroft, 2002).

The emergence of maleness in an XY embryo starts when testosterone manufactured in the male gonadal system is converted, in separate biochemical reactions, into dihydrotestosterone (DHT), which mediates body masculinization, and into oestrogen which mediates brain masculinization. For a brain to be masculinized (from the female template) means many things, but the most widely studied brain differences are found in subcortical areas that contain high levels of sex-steroid receptors. In particular, the hypothalamus, situated at the base of the brain, has anatomically distinct areas that govern complex patterns of sexual responses (Friedman & Downey, 2002; Panksepp, 1998). In males it is the medial preoptic area (POA) of the hypothalamus that regulates sexual behaviour, whereas the ventromedial hypothalamus (VMH) has a central role in female sexual responses. These hypothalamic brain areas are the sites where the peptide hormones oxytocin and vasopressin are synthesized, after pubertal changes, for release into the bloodstream during sexual activity. Oxytocin and vasopressin (manufactured from oestrogen and testosterone respectively) have been the focus of much laboratory research into mammalian attachment behaviours and are now viewed as essential components of the neurochemical underpinnings of sexual and social bonding and love (Carter, 1998). Their manufacture in the VMH and POA brain areas provides a neural substrate for the balance between anxiety and attachment in human sexual behaviour, a balance that is central to both sexual function and to emotional bonds, and will be discussed more fully in later sections of this chapter.

During a sensitive period of prenatal life (between 18 and 24 weeks), testosterone secreted from the foetal testis is converted into oestrogen, which changes the structure of the hypothalamus and masculinizes the brain as described above. This eliminates the female hormonal reproductive cycle, decreases female-typical sexual behaviours and increases behaviour more typical of males, including the choice of a female as a sexual partner (Friedman & Downey, 2002). In a female embryo, the absence of testosterone secretion results in female brain development. It is possible, though, for circulating maternal oestrogen to masculinize the female embryo, unless the embryo manufactures steroid-binding proteins that prevent this happening. When these proteins are below a certain level, or maternal oestrogen levels are high, male pattern development of the brain or the body can occur in a female foetus. Thus, the manner in which female and male brain and body development proceeds in the womb is determined by two distinct hormonal signals based on the timing and intensity of testosterone, oestrogen, and DHT release (Panksepp, 1998). Foetal brain differentiation in terms of sexual circuitry is complex, and psychoendocrine evidence for the determining effects of brain structures and hormones on erotic desire and sexual object choice appears to be strong. Researchers working in the sensitive area of gender differences in brain chemistry and sexual expression are careful to explain that describing behaviours as male- or female-typical refers to behaviours that are more common to one gender than another. Such terminology does not imply in any way that atypical behaviours are either pathological or undesirable, merely less usual (Le Vay, 1991). Throughout this chapter, a similar biostatistical concept is used when describing female and male behaviour patterns and brain structures.

Of relevance to understanding the link between biological factors and sexuality is evidence concerning the gender identity and sexual orientation of people with the genetically determined disorder AIS (androgen insensitivity syndrome). Infants with this unusual condition have XY chromosomes (genetically male), but the developing embryo has lacked androgen receptors to enable testosterone, secreted by the testes, to influence target tissues in the brain or body (Meyer-Bahlberg, 1999). Such infants therefore have female external genitals and female brain organization and appear in every way to be normal girls. Without ovaries and internal female reproductive organs (due to genetic maleness) they are unable to menstruate at puberty and seek medical help, when the condition is often diagnosed. Despite a male chromosomal configuration, the brain structures, gender identity, and sexual orientation of such individuals remains typically female and their romantic and sexual interests are directed towards men, thereby demonstrating the centrality of foetal hormones in the shaping of gender identity and sexual orientation (Friedman & Downey, 2002).

Conceptualizing the organization of body and brain development along two distinct biochemical pathways allows for the existence of female-like circuitry in a male body and male-like circuitry in a female body. Panksepp (1998) describes the brain differentiation possibilities on a gradient from female to male sexuality, thereby creating a range of sexual potentials from same sex to opposite sex object choice that eventually become fully manifest at puberty. This model takes into account the extensive neurobiological findings of recent years to offer a way of thinking about thevarieties of sexual preferences and orientations found in all societies. Writing from the perspective of psychiatrist-psychoanalysts interested in sexual orientation, Friedman and Downey (2002) point out that many aspects of Freudian theory, including instinct and libido theory, as well as the role of the Oedipus complex in sexuality, have not withstood the test of time. They urge psychoanalytically-orientated therapists to consider empirical research on gender identity formation and the role of sex steroids in utero, in order to revise clinical theory and practice, especially with respect to same-sex attraction. Separate hormonal triggers for brain and body differentiation can also explain why intrinsic gender identity and body morphology do not always match up. Zhou, Hofman, Gooren, and Swaab (1995) found that a part of the brain that is larger in men than women (the bed nucleus of the stria terminalis) was female-sized in the six maleto-female transsexuals they investigated. It is conceivable that brain organizations of this type give rise to the sense of mind and anatomy not “matching” that is encountered in gender dysphoric states, outlined in Chapter Seven. In Panksepp’s (1998) view, both gender identity and sexual object choice are firmly rooted in the biochemistry of foetal development.

A wider understanding of the naturally occurring variations in sexual brain differentiation, and their implications for gender and sexual potentials would, hopefully, increase tolerance and enhance therapeutic approaches for those who are troubled by feelings that occur less commonly in the population. How brain organization results in later sexual expression will, of course, be determined by ongoing psychosocial influences throughout the life span, which can encourage and promote, hinder or suppress particular aspects of an individual’s sexual behaviour.

Infancy and genital integration

As well as different neural circuitry and potentials, the girl and boy baby have different sets of genital anatomy to assimilate psychologically. Exploration of genital organs is similar to play with other bodily parts at this stage, and is important for the formation of mental representations or schemas of the body, which require integration with other aspects of psychological maturation. For healthy, integrated psychosexual functioning, the child’s body schematizations will eventually create a link between physical and sensory processes to form a psychosomatic whole.

Initially the infant is entirely dependent for physical and emotional care on the primary caregiver, usually the mother, in what Winnicott (1960) described as the “maternal holding environment”. He suggested that primitive sensory exchanges in this phase create a “psycho-somatic partnership”, which enables the growth of symbolic functioning and the organization of a personal psychic content as a basis for future relationships. Attachment theory research into the quality of the early bond indicates that caregiver sensitivity—the parent’s capacity to think about the feelings, thoughts and desires of the infant—is related to secure attachment and fosters the child’s self-development (Fonagy, 2001). Intimate skin contact and sensitivity to psychological needs is central to successful mother–infant attachments. Scharff and Scharff (1991) have linked this early psychosomatic partnership to the adult sexual relationship, which can re-evoke the experiences between caregiver and baby in complex ways. It is suggested that these interactions form part of a couple’s sexual bond, which is also referred to in object relations couple therapy as a psycho-somatic partnership (Scharff and Scharff, 1991). Although this concept has theoretical appeal, Fonagy (2001) points out that evidence for object relations theory assumptions that later adaptation is shaped by early attachments is inconsistent and unreliable at this stage. Most studies do not show developmental continuity, which is thought to depend on mediating aspects of family life that were not measured by the research. Rather than a straightforward process whereby early relationship patterns form the basis for adult relationships, the current view is that the quality of caregiver sensitivity enables the infant to form mental processing systems or psychological templates. These mental mechanisms will then generate relationship representations that influence actual relationships in adult life (Fonagy, 2001).

Cowan and Cowan’s (2001) longitudinal study on the transmission of attachment patterns was encouraging and found that some individuals with insecure working models were able to establish a relationship that buffered their newly-formed family from the repetition of destructive patterns in the next generation. Results from this research suggested that there was a definite tendency for patterns to be repeated, but that mental templates were not fixed by early attachment patterns. Although predictions from early attachments to later relationships cannot be made reliably, attachment theory research has clearly demonstrated that a secure base, in attachment terms, is significant for exploratory behaviour and a range of social and cognitive competencies (Fonagy, 2001). These skills, which include naming, role-labelling and identification with parents, contribute to a core g...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ABOUT THE EDITORS AND CONTRIBUTORS
• INTRODUCTION
• PART I: DEVELOPMENTS IN THEORY
• PART II: CLIENT GROUPS POSING NEW CHALLENGES
• PART III: INNOVATIVE THERAPEUTIC APPROACHES
• INDEX