Let’s Talk About Sex: having the conversation about HIV status

A college professor in his early 40s, Jeff has been in therapy with me on and off for ten years. [I’ve changed his name and occupation to preserve confidentiality.] I’ve seen him through the ups and downs of a couple of relationships and a struggle with substance abuse. He’s currently single and reasonably happy with that. Like many gay men, when he’s in a relationship Jeff often has a hard time juggling his partner’s desire for together-time with his own desire for alone-time. (Gay men are far from alone in this. The great lesbian folksinger Ferron nailed the phenomenon in a couplet from her song, “Our Purpose Here”: “It’s a woman’s dream, this autonomy/Where the lines connect but the point stays free….”) Yet the freedom of being single rubs up against loneliness, the sheer pleasure of companionship.

Lately we’ve spent time exploring a split that he notices in his interactions with other men. He has no problem getting slutty with guys he meets on Grindr or Manhunt. But when he meets a guy that he likes and might consider dating, he suddenly becomes weirdly reserved, reluctant to show his sexual self. Some of that may be the residue of a Catholic upbringing; girls aren’t the only ones who internalize the Madonna/whore dichotomy. When he found himself repeating that pattern with another guy recently, a light bulb went off: Jeff realized that he drags his heels when it comes to having sex with a Nice Guy He’s Dating because he’s HIV-positive and he dreads having The Disclosure Conversation. With his characteristic bluntness, he says, “If I’m blowing a guy, I feel like I don’t have to tell him because I’m not putting him in any danger, and chances are I’m never going to see him again. But if it’s someone I might want to date, then I feel like I have to be honest. But then it’s scarier because I have more to lose if he can’t handle it and walks away.”

Now Jeff is an extremely outgoing guy and an unusually assured public speaker. He has no problem speaking, often without notes, to his classes and at professional conferences. Yet the prospect of having the intimate conversation about HIV-status with a guy he’s dating fills him with terror and, more to the point, shame. His friend Daniel, one of the few in his social circle who is also HIV-positive, has developed over time a matter-of-fact attitude about telling people in his life that he’s healthy-poz-undetectable. Jeff is not there yet. In his blackest moods, he considers himself to be “a filthy, diseased creature.” Mind you, that’s not how he views other people with HIV. And no one else has ever judged him that way. The people in his life that he has told have been kind and supportive without exception. And yet he struggles with the sense of being “damaged goods.” This is something probably every single person has wrestled with at some point after being told they’re HIV-positive. What about you? How have you coped with this personal/social dilemma?


I thought about Jeff when a Facebook friend shared a moving essay that appeared on Buzzfeed.com called “My Virus, My Husband, and Me.” Author Michael Broder, a long-term survivor of HIV, writes with honesty and some humor about the evolution of his feelings and practice around disclosing his HIV status. Check it out and let me know what you think. He references a “Puppet Service Announcement” about HIV awareness that was created by the cast of the Broadway musical Avenue Q and that aired on RuPaul’s Drag Race. You can view that video online here.

MEDIA: Habitat for Humanity and the spiritual benefits of generosity

“Generosity is the source of wealth.”   — Tibetan proverb

Last fall, I spent a couple of weeks in Brazil to participate in a program with Habitat for Humanity, the non-governmental agency that builds houses in poor communities. It was a big adventure for me that I’ve written about elsewhere.

10-19 habitat posse
Recently, my friend Harry Faddis invited me to appear on his radio show, “The Quest of Life” (broadcast live on WRPI-FM in Albany, NY, and streamed live online), to talk about Habitat for Humanity, community service, and the spiritual benefits of generosity. My segment is available as a podcast online here.

quest of life logo

Check it out and tell me what you think.

DID YOU SEE: mating habits and medicating the human condition

It’s undeniable that antidepressant medications have improved many people’s lives, allowing them to enjoy social functioning and a range of emotional experience that would otherwise be out of reach. I think it’s also indisputable that some people are over-medicated. There’s a multi-billion-dollar pharmaceutical industry that depends upon — we could say exploits — the human tendency to look for a magic pill for everything and doctors who are willing to write a prescription rather than take the time to step back and look at the root cause of physical and mental distress. As the publication date approaches for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the field has been engaging in serious debate about proposed changes in how mental health is categorized and treated. The DSM was created in the interest of establishing industry standards for diagnosing and treating patients, and insurance companies rely heavily on DSM terminology when deciding coverage of claims for treatment. The number of ailments classified as disorders requiring pharmaceutical treatment continues to increase. Although I’m willing to believe that the people making these decisions have good intentions, I’m often distrustful of what seems like a misguided if not sinister impulse to pathologize the human condition — that is, to treat ordinary human emotions such as grief, melancholy, fear, and defiance as if they were illnesses to be eradicated at all costs.

Christopher Lane (above) is one of the major critics of modern psychiatric theory and practice. I recently got around to reading an extensive interview with him that appeared last year in The Sun, one of my favorite literary magazines. Doing research about how the editors of the DSM arrive at their conclusions, Arnie Cooper writes in his introduction to the interview, “Lane was troubled by what he found: evidence of drug-company influence, especially in the promotion of ‘panic disorder’ by Pharmacia & Upjohn, maker of the anti-anxiety drug Xanax. He also uncovered extensive evidence of questionable research (sometimes involving just one patient), sloppy thinking, dismissal of nonmedical approaches to psychiatric problems, and a degree of inventiveness with terms and symptoms that struck him as playing fast and loose with the facts.

“All of this served as the basis for Lane’s 2007 book, Shyness: How Normal Behavior Became a Sickness, in which he observes that behaviors once understood as reactions to one’s environment and upbringing are increasingly seen as innate conditions of brain chemistry, resulting from problematic levels of neurotransmitters, especially serotonin. He suggests that because of the open-ended language in the DSM and the wide range of behaviors it pathologizes, anyone who is shy, as he was as a teenager, now risks being diagnosed as mentally ill. The new disorders were ‘obviously music to the ears of drug companies,’ he says, ‘insofar as they massively increased the market for their products, which the media greeted with incredible enthusiasm.’ ”

sun 3-12
The interview is well worth seeking out and reading, considering, critiquing, and discussing. A lengthy excerpt is available online here. As a sex therapist, I took particular interest in this passage (not available online) about the dubious prospects of applying medical criteria to standardize human sexual behavior:

Cooper: Let’s talk about some disorders that have been proposed for the DSM-5. After golfer Tiger Woods’s adultery scandal, we began to hear about “hypersexual disorder.” It’s being considered for inclusion.

Lane: A number of articles have been written that tried to attribute promiscuity or adultery in men to a brain disorder. I find this questionable for a number of reasons.

First, it’s worrying to me that a group of psychiatrists is trying to determine how much sexual activity and how many encounters we can want or fantasize about before we’re considered “mentally ill.” Given the embarrassing history of the DSM revisions and all the shoddy science informing them, why should we trust the APA to dictate yet another norm to us, much less accept its judgment about something so personal and intimate? People have markedly different appetites for sexual experiences. I’m uncomfortable with the idea that the APA would determine implicit guidelines, even quotas, for sexual activity, with a view to pathologizing behavior that is, in its estimation, “excessive.”

Even if you were in favor of creating such a disorder should the parameters for young adults be the same as for retirees with, most likely, much lower sex drives? Would the standard for “excessive” sexual activity be identical for a newly formed relationship and one that’s lasted decades? Why should we see a man’s cheating on his wife with multiple women as a result of brain chemistry rather than, say, marital unhappiness or personal recklessness? Personally I think expecting lifelong fidelity to one partner may be asking too much of certain people who are ill-suited to it, or who simply don’t believe monogamy is the best way to achieve emotional and sexual happiness. That’s surely up to them, isn’t it? Yet there’s an expectation, even a kind of demand, in our culture that one person will meet all of our needs – emotional and sexual. That can happen, and it’s great when it satisfies both parties, but those choices don’t work for everyone, and an organization seeking to pathologize “excessive” sexual activity needs to recognize that. We need broader public discussion of this complex issue rather than the kind of psychiatric judgment and ritualized shaming that goes on right now for those who prefer to remain non-monogamous. Good for them if that’s what they want.

What do you think?

MEDIA: What does a session of sex coaching look like?

Have you ever checked out my website and wondered what a session of sex coaching might look like? If so, you might want to have a look at this column that my friend Brian Moylan wrote for the online version of Vice magazine called “How to Quit Porn and Not Entirely Ruin Your Life.”

Brian spent a few years blogging about what is euphemistically called “adult video” for Fleshbot and recently decided, as an experiment, to take a break from masturbating to porn. To his consternation, he found that his libido evaporated without the high-intensity video stimulation he was used to. So he came in for a session with me to consult about this situation, and then he wrote about it in some detail.
brian moylan
Brian is a good writer who’s also hilariously matter-of-fact about sexual matters (“filthy” is a term of high praise for him). Describing our session, he says:

“After talking to him about my past habits and current predicament, he told me that my mind was so used to the excess stimulation of bodies rutting on screen that it was having trouble remembering how to enjoy a good old fashioned stroke like my grandparents used to. He suggested breaking all of my usual habits during “gentleman’s time.” He told me to experiment with a new time of day, new positions, new lube, and maybe even some new hand movements to shock myself out of complacency. We did some “body awareness” exercises, where I explored parts of myself other than the organs surrounding the taint to see what else gave me an erotic charge. He also taught me some new strokes—taking your dick and rubbing it with both hands like you’re trying to start a fire sounds ridiculous until you give it a whirl.

“All of those things helped, but the most important thing he told me was to not worry about squirting. I should enjoy playing with myself just for how good it made me feel, he said. With that advice, I started self-molestation all the time: in the morning, at work, in an empty row at the movies, while watching Real Housewives of New York… just about everywhere. Well, at least everywhere that wouldn’t put me in legal danger.”

He took away from our session a few useful principles that he was able to apply on his own at home. He describes finding some old sexy magazines, getting turned on by them, but choosing to stick by his determination to take a break from porn as an aid to self-pleasuring. “I decided to try everything that Don had told me: a new room in the house (bathroom), a new position (sitting perilously on the edge of the tub), some different lube (something called Stroke 29)… everything out of my comfort zone. … As I had done for the past few weeks, I enjoyed it for just what it was, but after a couple of minutes I knew I was finally going to cross the finish line (and after a week, what a finish line that was). While cleaning up I felt triumphant, albeit in a sort of Lance Armstrong-y way. Yes, porn had given me the initial, um, courage, but I relied on all my other senses and training to get the job done. Maybe this was a way of weaning myself off? I decided this meant I wasn’t 100 percent cured, but I was definitely on the way to becoming porn-free.”

Have you ever found yourself consumed with looking at porn in a way that felt excessive to you? Ever tried taking a break? I’d love to hear how that turned out for you.

Glossary: GOONING


A client mentioned to me: “The other day on Craigslist I saw an ad that mentioned the word goon. I had never heard that term before so I went to the Urban Dictionary to see what it meant. I have decided I like the word!” The word gooning was new to me as well, though when I read the description the practice sounds a lot like edging:

“gooning: The act of a very addicted or chronic masturbator; getting so into masturbating, or jacking off, that the dude becomes a total goon; becomes dazzled by his own cock. Can think of nothing else but P3 — Pure Penile Pleasure…

‘Gooning’ may be most simply defined as that state usually achieved after a prolonged edging session, when a man becomes completely hypnotized by the beautiful sight of his own erection, so that he no longer really needs other stimulation such as pornographic words and imagery. He’s turned on by witnessing his own sexual arousal.”

Do you have any experiences of gooning? Let me know.