It was the age of the Cabbage Patch Doll, not that that had anything to do with it, but T’s mother collected them, and, in fact, had a room devoted to her “babies,” and this was a time that everything was blamed on mothers. T’s complaint: “I have a small penis.” Maybe T’s mother loved the dolls more than he, and so he developed poor self-esteem? Pretty reductionistic assumption, but that’s all I had to go on in the beginning. I certainly wasn’t going to look at his penis.
Let me back up a little. T was a man in his early thirties, married with two small children, when I saw him about twenty-five years ago. He was the youngest and shortest of five brothers in an Italian-American, working class family all of whom worked in their dad’s construction business. All the brothers pumped iron and took pride in their sculpted physique. T always felt inferior in size to his brothers, which was probably true until his maturity and remained true with regard to height. But he also insisted that he had a smaller genital. He was certain of this because he repeatedly compared penis size with his brothers as he was growing up, and surreptitiously still did so in the gym. As a result he was reluctant to go to the gym.
T’s wife was perfectly happy sexually…but what did she know? She was a virgin when she married him. Consequently, he started sleeping around to get more evidence of his adequacy. He had a dream: his wife was in the bedroom with the door closed. Someone, not T, was with her in bed. T was outside the door of the room. When he looked down he saw a pair of gigantic male shoes!..it doesn’t take a shrink to figure that one out!
I remember going through a litany of supportive comments — like, size of your penis doesn’t matter with regard to a woman’s sexual response; rather, it’s hardness, sensitivity and skill. Or, maybe it’s the angle at which you’re looking at yourself? None of these remarks were useful. T told me that my husband must be very sure of himself.
Recognizing transference, that is, T’s feelings about me ( always a good prognostic feature for psychoanalytic psychotherapy) I embarked on helping him explore his past. In other words, I encouraged him to connect the dots, to investigate how he came to feel this way about his body? His father was remote, a heavy beer drinker, and though he worked with his boys, he rarely talked to them.
Eventually we came to the subject of his mother. T’s mom had wanted a girl, not a fifth boy. Basically T felt that she overlooked him. She wasn’t neglectful per se, merely uninterested. T simple could not compete with his brothers and the Cabbage Patch Dolls for her attention. T was a good historian and he recalled much rich material for analytic work. He learned a lot about himself and his relationships. He ceased being unfaithful to his wife and deliberately sought to become a better father to his children (so as not to repeat the mistakes of his parents).
All this was well and good, but T remained obsessed with the idea that his penis was small. Finally I referred him to a psychiatrist for a prescription for Prozac, which had begun recently to be used widely.
After two weeks on Prozac, T told me that he still felt his penis was small, but that it no longer bothered him!
Though his symptom was ameliorated, he remained in therapy for another year. He told me that he felt it was useful.
(Note that the patient’s identity is disguised)