Portnoy’s Complaint

Portnoy’s Complaint.

Carl Stuart

Stuart Medical Series

Abstract

This paper focuses on a psychoanalytic formulation. The formulation will be constructed from the life of Alexander Portnoy, as it is described in the novel, Portnoy’s Complaint. The formulation will be based on two psychodynamic theories: self psychology and object relations. Basically, a formulation has the following 4 parts: a summarizing statement, a description of relevant non-dynamic factors, a psychodynamic explanation of the patient’s conflicts, and a prediction of the patient’s responses to therapy.  Parts one and two are applicable across the two formulations, and parts three and four will be presented for each theory.

Introduction.

This paper presents two psychodynamic formulations of a patient named, Alexander Portnoy, the main character in the novel, Portnoy’s Complaint. Self Psychology and the Object-Relations theory have been used to construct the formulations which have been presented in this paper. The formulations are modeled according to the formulations presented by Perry, Cooper, and Michels (1987).  Basically, a formulation has the following 4 parts: a summarizing statement, a description of relevant non-dynamic factors, a psychodynamic explanation of the patient’s conflicts, and a prediction of the patient’s responses to therapy (Perry, Cooper & Michels, 1987).  Parts one and two are applicable across the two formulations, and parts three and four will be presented for each theory.

I)                   Formulation according to the Object-Relations Theory.

Part I: A summarizing statement.

Alexander Portnoy is a young male who presented, on his own volition, with complaints of impotence and sexual obsessions. He is single and he sought treatment after he was kicked out by one of his female companions. This occurred while he was on a trip to Israel, where he made sexual moves to a female army lieutenant who rejected him. He attributes this rejection to his flustered persona. However, despite this rejection, he attempted to force himself on Naomi, who subsequently kicked him and castigated him upon learning of his impotence. He attributes this action to his sexual obsessions, which he states that he no control over. Portnoy’s obsession with sex manifests itself in several aspects of his life. He is hypersexual, and he exhibits self doubt, avoidance and sexual ideation (Roth, 1969).

            Portnoy’s appear to have developed an oedipal complex during his early childhood. He states that he believed that he had replaced his father as the focus of his mother’s affection. His father, Jack Portnoy, suffered from incessant constipation. He also sold insurance to the poor neighborhoods of Newark. However, Portnoy states that his father infused within him the essence of Jewish masculinity (Roth, 1969).

His mother, Sophie Ginsky Portnoy, had become reverential of Portnoy’s achievements, irrespective of their contextual significance. He states that his mother was an intelligent woman, who loved her family. However, Portnoy believes that his mother felt let down by his father, and that is why she pampered him with love. Also, he believes that his father loved and exalted his mother, and that is why he worked hard to ensure that he met the basic needs of the family in order to maintain the integrity of the family (Roth, 1969).

Portnoy’s demonstrates his obsession with sex as he narrates his history in the most sexually-explicit manner. He narrates that he saw his mother’s menstrual blood. He also explicitly and candidly narrates his masturbation experiences, his first handjob with Girardi, his sexual escapades with The Monkey, his threesome in Italy and his sexual encounters with Naomi and an army lieutenant in Israel (Roth, 1969).

Portnoy’s stated that his impotence had cost him numerous sexual relationships. He gives the example of the Israeli army lieutenant who rejected him after she learnt that he was impotent. He also stated that Naomi was disgusted after she learnt that he was impotent. Portnoy thinks that his impotence is a form of punishment for his mistreatment of The Monkey in Italy. He attributes his impotence to a feeling that he contracted an STD (sexually transmitted disease) from a prostitute in Italy (Roth, 1969).

Part II: Non-dynamic factors.

According to the history of presenting complaints that were presented by Portnoy, there were no discernable non-dynamic etiologies (such as genetic abnormalities) and pathologies (such as chronic conditions, systemic diseases or trauma) that can be attributed to his psychological disorder. However, one cannot disavow biological predisposition as the cause of the psychosocial disorder condition of hypochondria (Perry, Cooper & Michels, 1987).

Part III: Psychodynamic explanation of central conflicts.

The central problem of Portnoy is sexual obsession and low self-esteem. The sexual obsessions experienced by Portnoy can be attributed to Obsessive-Compulsive Disorder (OCD). This is exemplified by the fact that Portnoy stated that he started to masturbate after unsettling and objectionable thoughts (and mental images) began to invade (and thereafter remain in) his mind. This condition can be attributed to the oedipal phenomenon, whereby he felt that he has replaced his father as the sole companion of his mother (St.Clair, 2000). He stated that he noted that after masturbation, these images and thoughts disappeared. After that, Portnoy resorted to masturbation whenever unwelcome thoughts entered his mind. Thus, he attributed masturbation to these repetitive sexual thoughts. Within a short time, masturbation became repetitive and increasingly involuntary. This is despite the fact that Portnoy knew that masturbation was a taboo according to the Halacha. This contravention of the Halacha made Portnoy to have the feelings of self-guilt, and as his attempts to suppress the urges of masturbation (alongside his sexual obsession) failed, he began to hate his Jewish background and his Jewish upbringing. This caused him to think lowly of himself, and this resulted in him having a low self-esteem. Portnoy’s theme of sexual obsession was mainly centered on avoidance of contamination and fear of illness; as is exemplified by the fact that the inner fear that he had contracted an STD in Italy made him to become impotent at the time when his sexual urge was at the peak (Roth, 1969). However, psychological assessment links his impotence to his fantasy life (St.Clair, 2000). This linkage is explained below using the object-relations theory.

According to the Object-Relations Theory, the family experiences of a person during childhood shapes and influences his personal interrelationships as an adult, and also the way that he relates to dissimilar life situations. For instance, a person like Portnoy who experienced affection and care during his childhood would anticipate a similar behavior from the people whose actions remind him of his mother. This expectation was not forthcoming, as most of Jewish girls and women that Portnoy dated did not show him any deep affection and care (St.Clair, 2000).

During childhood, Portnoy formed images of persons and the accompanying contextual events. These formed images were converted into objects within his subconscious mind, and he thereafter carries these objects into his adult life. During adulthood, Portnoy used these objects to evaluate and comprehend his current relationships, and also to predict the behavior of a person. When his predictions about the girls he dated were proved to be false, he felt disconnected to the real world. This led him to form a fantasy world where he lived his fantasy life. The resulting unconscious phantasy was influenced by plastic images and the following perceptions: auditory, visual, olfaction, kinaesthesia and proprioceptive sensations. This unconscious phantasy adversely affected his psychomotor functions, thus causing impotence (St.Clair, 2000). There are strong indications that Portnoy sought expert psychological help after failing repeatedly to cause an ultimate realization of his unconscious phantasy, thus causing him to feel depressed and thus have a low self-esteem.

During the Portnoy’s childhood, projective identification enabled him to self-soothe (he was assured that his mother would always defend him). During adulthood, his projection of good objects to his female friends did not live up to his predicted results. This is because his expected mode of communication failed to convey the correct information. Thus, he created an unconscious phantasy where he projected good objects to imaginary fantasy women, and this strengthened the internalization of masturbation into his psyche. Hence, it is clear that Portnoy’s problem arose due to failure to harmoniously integrate the good and bad objects (St.Clair, 2000).

Part IV: Treatment.

The treatment will be aimed at alleviating anxieties while concurrently fostering the externalization of introjected objects through a process of transference of internal experience. Moreover, since sexual obsession has caused low self-esteem, it follows that treatment of sexual obsession will also simultaneously eliminate the problems of low-self esteem (St. Clair, 2000).

Initially, the psychiatrist will have to confine Portnoy, so that the triggers (visual images) of compulsive sexual behavior are eliminated. Moreover, the psychiatrist must explain to Portnoy that his preconceptions about sex are self-contradictory and objectionable; and that he needs to erase them from his mind if he wants to overcome his obsession. Furthermore, the psychiatrist must ensure that Portnoy has an adequate comprehension of sexual obsession. Also, by this act, the psychiatrist will be projecting an image of a mother figure, and this would foster the transference of a caring and affectionate mother who would enable Portnoy to regain his composure, and form new objects which would mould a new internal experience. It is expected that Portnoy will be willing to cooperate with the management strategies. Also, pharmacotherapy is necessary, and thus the psychiatrist must prescribe the following drugs: Sildenafil (a phosphodiesterrase-5 inhibitor that treats erectile dysfunction), anxiolytics such as SSRIs (Selective Serotonin Reuptake Inhibitors, for example fluoxetine, citalopram and sertlaline) (St.Claire, 2000).

II)                Formulation according to the Self Psychology Theory.

Part I and Part II outlined in the earlier material (formulation according to the Object-Relations Theory).

Part III: Psychodynamic explanation of central conflicts.

The central conflicts in Alexander Portnoy are sexual obsession and narcissism, alongside the rejection of the limitation within oneself and others. The sexual obsession developed out of the Oedipus complex. According to self psychology, psychopathology occurs due to a disruption of developmental needs. This results in a void in the entirety of the self. Alexander Portnoy was born as a nuclear self into the Portnoy family, while his parents had an image of his virtual self. The virtual self is attributed to the perceptions and hopes of both the father and mother. The harmonious interaction of the nuclear self and the virtual self would have led Portnoy to develop an appropriate cohesive self. However, his father was suffering from chronic constipation, and his job as an insurance broker meant that he was unavailable (to interact with his son) most of the time. The partial absence of his father led his mother to direct all her affection and care to Alexander Portnoy.  Thus, the partial absence of his father disrupted his developmental need of forming a cohesive self, as the paternal input into the virtual self was minimal. This led Portnoy to develop a grandiose self, whereby he believed that he was the main focus of his mother, and as such he ‘owned’ his mother. Moreover, he believed that his mother has substituted him in place of his father; and this led to the development of an inappropriate and superfluous Oedipus complex (St.Clair, 2000).

Portnoy’s father was not emphatically attuned to the needs of his son, and this led Portnoy to sustain and even develop his childhood phantasies. During his adolescence, his emphatic connection to his mother was also lost; and as such his phantasies took a new dimension of unrestrained sexual phantasies, and he thus started to engage in masturbation (St.Clair, 2000).

During his early childhood, Portnoy considered his mother as a self object who was an integral part of his self. This is due to the close relationship that he had formed with his mother. During adolescence, he lost this self object, and he experienced optimal frustrations. He was forced to use idealizing transference of the attributes of self objects into transitional objects. This attempt ensured that his optimal frustration was attenuated into a suboptimal frustration. His grandiose sexual phantasies and need for transitional objects was fulfilled by Girardi. This ingrained his sexual phantasies into his mind. Idealizing transference promoted the development of Portnoy’s narcissism and hedonism. However, the void created by the loss of the self object was supposed to be filled. Alter ego and twinship needs forced Portnoy to attempt to fill his void by dating several women, but none of the women he dated ever filled this void, and this made him depressed and he realized that he had a problem; and that is why he sought professional psychological assistance. Moreover, Portnoy has realized that his tripolar self is self-contradictory. This is because his grandiose sexual phantasies and his needs to achieve an idealized self image are diametrically opposed to his twinship needs that strive to ensure that he bears likeness to the people around him (St.Clair, 2000).

Part IV: Treatment.

The most appropriate management plan for Portnoy must encompass and integrate the following elements: emphatic immersion, vicarious introspection, mirroring transference, idealizing transference and twinship transference. The psychiatrist must use Portnoy’s aim for twinship need to his (the psychiatrist) advantage. Portnoy will attempt to elicit admiration from the psychiatrist through a process of idealizing transference. However, he will idealize the psychiatrist and himself. The psychiatrist must respond with emphatic immersion, or else Portnoy will be disappointed and reject any form of psychological counseling. The psychiatrist must use Portnoy’s own vicarious introspection to show him that the problems he is experiencing can be solved. The psychiatrist will formulate a hypothetical case of an imaginary person who successfully overcame sexual obsession. Thereafter, he must tell Portnoy about this imaginary person and how he overcame his obsessions, and it is likely that Portnoy will apply mirroring transference, and thereafter use the strategies of that imaginary person to solve his own problems (St.Clair, 2000).

Formulation summary.

Alexander Portnoy is a young male who presented with complaints of impotence and sexual obsessions. He is single, and he sought treatment after he was kicked out by one of his female companions. It appears that he developed an oedipal complex during his early childhood. Biological predispositions are thought to contribute to his hypochondria. The central conflicts in Alexander Portnoy are sexual obsession, low self-esteem and narcissism, alongside the rejection of the limitation within oneself and others. The most appropriate management plan for Portnoy must encompass and integrate the following elements: emphatic immersion, vicarious introspection, mirroring transference, idealizing transference, twinship transference and the alleviation of anxieties while concurrently fostering the externalization of introjected objects through a process of transference of internal experience. Also, pharmacotherapy using sildenafil and anxiolytics is necessary.

References.

Perry, S; Cooper, A & Michels, R. (1987). The Pyschdynamic Formulation: Its Purpose, Structure and Clinical Application. The American Journal of Psychiatry, 144, 543-550.

Roth, P. (1969). Portnoy’s Complaints. New York, NY: Vintage Books.

St. Clair, M. (2000). Object Relations and Self Psychology: An Introduction (3rd Ed.). New York, NY: Thomson Learning.