The Shrink Files

Penis Worry

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! 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)


The Swimsuit Issue

It was January, 1990. In other words, it was pre-Prozac. My patient was becoming frantic. She was convinced that her husband was scoping out other women. He was a letter carrier and he had plenty of opportunity to observe women in various states of deshabille as they collected their mail. But the first week in February posed a particular threat, a threat exceeding that of any other week of any month…..the swimsuit issue of Sports Illustrated. Her husband would be delivering the magazine to many homes. Surely he would look at it. The thought of this was unbearable to her.

Reading between the lines, as therapists are wont to do, I realized that my patient’s husband’s “looking” behavior was probably no different than any other straight man’s “looking” behavior. It was her problem, not his. Because of her worry, she held held her husband on a short leash and restricted his travel. He was not even permitted to go fishing lest he observe women in bathing suits on the shore. Interestingly, he did not seriously object to these limitations. Eventually she recognized the absurdity of her rules for him, and she came to see me.

Deconstructing her  fear of her husband’s wandering eye, my patient recollected that as an adolescent she noticed that her father spied on her when she showered. She tried to lock the bathroom door, but, somehow, the lock would never stay fixed. Her father disgusted her. He smelled of cigarettes, and when he died in his sixties of emphysema, she felt relieved. His legacy to her:  an aversion to tobacco and a fixed belief that all men relentlessly engage in  lascivious looking.

My patient was able to use this insight about her past to undo her needless anxiety about her husband. She endured the the first week in February issue of S.I. without incident. She released her husband from geographic confinement. She stopped monitoring his “looking” behavior. She wanted to to party, to go into the city to the theater and restaurants, to have fun.

That’s when the real trouble in their marriage started. The more she wished to expand their horizons, the more he resisted. He was happy to stay within the boundary of his neighborhood and mail route and became anxious when he strayed. It turned out that he was suffering from agoraphobia, but had never noticed because he had never tested himself.  He simply never left town. Their neuroses perfectly balanced each other….but now that she was better, the marriage came apart. Eventually they divorced.

I wonder, in retrospect, if I did anyone any favors.


A Hates B

Patient A viscerally hated B, about whom she had murderous fantasies. Both were women in their twenties who had  met on the job, but B had moved on and up. Though B was gone from Patient A’s life, Patient A’s bitterness remained steadfastly in place. How could B have so much, when she, the truly deserving one had so little? B was rich, sophisticated, a world traveler with European parents who spoke multiple languages….and, most humiliating of all, the boss preferred B.

Patient A grew up with few advantages. Her father fled  the nest when she was about five years old, leaving her, her mom and two younger sisters to fend for themselves. Her chronically aggrieved mother did not warm to her girls, especially Patient A, and Patient A, in turn, warmed to no one — including me.

In session after session, I dutifully listened to a laundry list of grievances, notably her resentment of  the good fortune of B.  Her hostility crystallized on the other, now absent,  young woman. When I tried to empathize with her feelings of deprivation and sibling rivalry, she shot me down. She wanted me to loathe B as much as she did. She wanted me wallow in her hate-fest, to talk about B’s awfulness in elaborate detail. I wasn’t being helpful, she said. Talking to me was a waste of time.

After a few weeks, I was shocked to realize that I knew B, that she was, by coincidence, another client. Neither patient was aware that I was seeing the other. To be sure, Patient B was nothing like Patient A described her. She was timid, polite, self-deprecating, a little depressive. Far from being rich, she had grown up on welfare. It was hard for me to understand how such a mild-manner individual could ignite such passionate dislike. Of course, Patient A’s hatred of Patient B was not about B at all. It was entirely impersonal.

Though they were no longer in contact with each other, I  worried that they would cross paths in my neighborhood, or worse, in my waiting room. I felt guilty that I was harboring a secret —  that I knew and was kindly disposed toward the object of her intense hatred. I was rigorous about scheduling wide spaces between their appointments. The whole dynamic made me anxious.

Through it all, Patient B never mentioned Patient A…not a word…not even a subtle reference. Patient A was not on her radar screen. Patient A never knew about her own triviality to Patient B. She quit therapy, and, I suspect, is still nursing her grudge.

.(Note that the patient’s identity is disguised)