Concepts of love and sexual desire lurk around clinical discussions of sexual dysfunction. Love is frequently dismissed as hopelessly unscientific, whereas desire is simplified as if it were a thing called libido. Decreased libido per se tells us little about a patient’s sexual complaints; the key is to differentiate between:
- those with sexual drive but no motivation for their partners
- those with no driveFemale sexual dysfunction”).
Psychiatrists avoid talking about love; it has too many meanings and nuances, too many avenues of defeat, and is too abstract. All you have to say to a patient is, “Tell me about your marriage,” and listen closely as he or she comes to grip with love’s complexity.
This article’s aim is to help you counsel patients more effectively about relationship and sexual problems by exploring two questions: “What is love?” and “What is sexual desire?”
What is love?
Mrs. C, age 41, is being treated for depression and wonders why she has lost desire for her husband. The antidepressant she is taking improves her mood and diminishes her considerable anxiety but makes her feel sexually dead. “My husband doesn’t mind how I feel, as long as he can have sex,” she says.
After adjusting her medication, you explore other problems that might be contributing to her sexual dysfunction. She expresses uncertainty about what love is. Though faithful and committed to her husband, she has stopped enjoying the way he interacts with her, their two grade-school children, her family, and friends.
Love is the usual context within which sexual activities are viewed. Among adults, unhappiness in love predisposes to sexual concerns, and sexual concerns interfere with loving and being loved.
Our patients’ expectations for feeling and receiving love and experiencing satisfying sex are disappointed through a myriad of avenues. Clinicians may overlook it, but demoralization about love can precede the onset of anxiety, panic attacks, and lingering depression.2 Sexual love is expected to begin with connecting with a partner and to evolve for 65 or more years. Most individuals harbor the secret that they are not certain what love is (Table 1) or are surprised by their lack of words to explain it.
1. Love as transient emotion. The assumption that love is a feeling leads too many people waiting to experience the pure feeling. But unlike sadness, fear, anger, or shame, love does not indicate a discrete feeling. Saying, “I love you,” connotes at least two feelings: pleasure and interest.
- Pleasure begins with pleasantness and moves up through delight to exhilaration.
- Interest ranges from mild curiosity to preoccupying fascination.
Most events simultaneously provoke more than one feeling. Discovering that your beloved wants to marry you usually brings about at least happiness, pride, gratitude, and awe. Even if only one feeling is produced, our attitude towards that feeling complicates the experience. When a child is taught that feeling envy is wrong, for example, his experience of it evokes anxiety (from the guilt) and shame (if someone is watching).
After the family, culture, and the person have worked on a simple feeling, it becomes a layered complexity called an emotion. Love, the emotion, is quickly layered with attitudes (which are the product of feelings and defenses against them) based on the person’s sense of safety stemming from earlier attachments.3 When someone says “I love you,” he or she knows the motive for saying it and hopes for a particular response from the listener.
Sexual desire is an ingredient of love’s emotional complexity. Because “I love you” can create sexual arousal in the listener, the speaker can use the phrase when his or her primary pleasure and interest in the person is the anticipation of sex.
Meanings and motives for expressing love change all the time. When someone tells us “I love you,” we have to discern both meaning and motive. Love’s emotions and their expression to another person are always complicated by past, present, and future considerations.
2. Love as an ambition. Love is so intensely celebrated in every culture that few people grow up without longing to realize it. Table 2 shows one version of the ambition to love and be loved.4 Many clinical declarations of love for a partner signify that the person has not yet given up on this ambition.
3. Love as an arrangement. All adult sexual relationships are quid pro quo exchanges of hopes, expectations, and assets. During courtship, both people are preoccupied with answering the question: “What will this person bring to my life?”