Surviving vs Living: Eroticism Through All Stages of Life

So, people, it’s the middle of the afternoon, and you have been listening to all kinds of perspectives on the human condition. Yet there is one primary dimension of our lives that has basically been left out, which is sex.

The ancient Greeks understood that alongside Thanatos, the god of death, there is Eros, the god of love, unbridled feeling and desire.

As a couples and family therapist, I often work on the perilous edge between Eros and Thanatos, between fear and fascination. I help people, or facilitate conversations, about their sexual and relational lives.

Interestingly, when I think about death in my practice, I don’t always think about it in the completely literal sense. I think of it as a concept and a metaphor.

People talk about many deaths: the death of love, the death of intimacy, the death of desire, the loss of identity and the death of pleasure. From there, I work with them to resuscitate those parts, even if the resuscitation comes with intermittent eclipses, so that they can once again experience aliveness, vibrancy, vitality, renewal and energy.

All of that is what I call erotic intelligence.

I want to talk with you about a definition of eroticism that goes far beyond a repertoire of sexual techniques or a collection of unbridled urges. I want to look at it in the mystical and existential sense of the word.

What does it mean to maintain a sense of aliveness in the face of death, adversity, loss, trauma and grief?

That is a paradox people often don’t think they can hold. It is as though these things should never meet. Yet I am sure there are people in this room who have experienced their most intense sense of aliveness in the midst of intense grief.

For me, the personal connection to this subject relates to how I grew up.

I grew up in Antwerp, Belgium, in a community made up entirely of Holocaust survivors and their families. I always thought there were two groups of people in my community: those who did not die and those who came back to life.

You can apply this to all forms of trauma. This was simply my context.

The people who did not die, who survived, often lived tethered to the ground. They struggled to trust. The world remained a dangerous place, and they often lost the ability to experience pleasure.

You cannot experience vigilance and pleasure at the same time. You cannot remain in the grip of worry while also experiencing the freedom and lack of self-consciousness that accompany pleasure.

The people on the other side, those who came back to life, taught me something very important about maintaining a connection to life, hope, possibility and freedom, even in the midst of five years of imprisonment and slavery.

My father talked about falling in love with a woman while he was in the camps. From him, I learned that continuing to talk about sex in places designed to dehumanize you can help preserve your dignity and humanity.

That is what I focus on now, but I do so within a relationship landscape that is changing dramatically.

I want to briefly summarize what I think is happening and how some of it intersects with illness, death and dying. I will leave it to you, the experts in this field, to make connections between the micro and the macro.

One of the biggest changes in our societies is the shift away from deeply structured communal life. I was recently in Mexico, Romania and South Africa, and what we call “the past” remains very much the present in other places.

In structured communal life, the ties were tight and not easily broken. We were given a clear identity, clear rules and clearly defined gender roles, which included expectations around caregiving and illness. We were given responsibility for the well-being of others. We knew where we belonged and had a strong sense of continuity.

You did not have to ask yourself where you would die, how you would die, what would happen when you were buried or whether you would be buried at all. The religious structures in which you grew up told you what would happen, and you did not argue with divine commandments.

We moved from certainty and clarity, with virtually no personal freedom, into urban life, with unprecedented freedom, choices and options.

Everything that used to be governed by rules is now a negotiation. Everything has to be figured out.

As a result, the burden of the self has never been heavier. There is tremendous uncertainty and self-doubt about what the right thing is for me. Answering that question requires a great deal of relational and personal self-awareness, and that is not an obvious or easy thing to develop.

The traditional promise was, “Till death do us part.” But I work with relationships, marriages and couples, and today it is often, “Till love dies.”

The threshold has shifted.

You can be married for 25 years and build a complete system of interdependence, then separate or divorce. Two years later, one of you becomes sick, and everything you thought would happen is disrupted. The narrative flow of your life changes.

Marriage was always a pragmatic institution. It was primarily about children, economic survival, companionship, social status and succession.

Then we transformed marriage from an economic arrangement into a romantic one. It became based on affection and trust. We brought love into marriage, connected sex to love and connected sexual satisfaction to marital happiness.

Happiness used to belong to the heavens. You suffered on Earth, and if you did a good job, you might be rewarded afterward.

But we common mortals brought happiness down to Earth. First it became an option. Now it is a mandate.

We no longer divorce only because we are unhappy. We divorce because we believe we could be happier.

That is a major shift when you work with relationships facing crisis, distress, illness and death.

Intimacy has also fundamentally changed its meaning.

Intimacy used to mean sharing the vicissitudes of everyday life, including everything we have been discussing today. Now intimacy means sharing our inner lives with each other.

The contemporary romantic ideal asks one person to provide what an entire village once provided. Then we add stress, distress, illness and vulnerability.

People constantly ask me about the fate of desire over the long haul, and as we have heard, the long haul keeps getting longer.

What happens to desire when we are no longer living within the story we expected? What happens to sexuality in this context?

It is not only at this conference that it has taken this long for someone to mention sexuality.

As a systemically trained family therapist, family medicine literature is among the first places I look. Sexuality is largely absent from that literature. It is also absent from much of the health literature.

We rarely include sexual health as part of overall health, let alone discuss what happens to our sexuality when we become sick.

The expectation is that we stop thinking about it.

It is taboo. How can you think about pleasure, sensuality, tenderness, touch, fantasy, aliveness, curiosity and all of these erotic ingredients when you are in the midst of death?

That is exactly when we think about them. But it does not feel acceptable, so we do not say it aloud.

The person who is sick may be asking: Am I still attractive? Can I still give pleasure? Can I still receive pleasure? Am I still desirable?

And if I ask whether I am desirable and I am not well, please tell me yes. Tell me yes and lie to me, because a good amount of self-deception can go a long way.

There are moments when you do not want truth and transparency. Remaining connected to my imagination, to how I think of myself and to how I have always known myself allows me to continue loving myself.

That is essential to the intimate connection between two people.

The partner’s experience is also very interesting.

When I ask people around the world, “When do you find yourself most drawn to your partner?” they typically say, “When I see my partner onstage, at the piano, in the studio or in their element. When they are competent, radiant, self-sufficient and passionate about what they are doing.”

All of those answers imply the same thing: They do not need me.

When you need me, I can be very loving. I can care for you, feel responsible for you, worry about you and attend to you.

Love and desire relate to each other, but they also conflict. Herein lies the mystery of eroticism.

One of the fundamental elements of sexuality is surrender, a loss of control. It is very difficult to experience that when you are beside someone you perceive as fragile or feeble.

Once I am watching to make sure you are okay, I cannot turn inward, let go and surrender. That becomes part of the systemic de-eroticization of a relationship.

If sexuality within the relationship is missing from the literature, imagine what happens when desire begins looking elsewhere.

Infidelity becomes the true unmentionable.

I have seen many patients who come out of surgery, after breast reconstruction or any number of other experiences, and throw themselves into a reckless affair.

They do this because they want to leave what they have become. They are trying to find lost parts of themselves and cannot imagine doing so in the same place where they have just experienced everything they have endured.

Often, it is brief and reckless. When we interpret it without understanding its context, we may misunderstand what is happening.

The same thing occurs on the caregiver’s side.

What happens when you visit a nursing home three times a week, knowing this will continue for the long haul? What are you supposed to do with yourself?

Someone once helped me think about this in a much less glamorous way. He made me understand that there can be deep loyalty in people who are not sexually faithful.

He asked me, “Is it still called cheating when the person no longer knows your name?”

That question will keep you thinking for a while.

He was distinguishing between different forms of loyalty. His experience outside the relationship allowed him to continue doing what he needed to do within it.

Sometimes this is a deep rebalancing of the relationship. For the person who is sick, an outside experience may be an act of reclamation. For the caregiver, it may provide balance and stability.

Specific illnesses are not really my field. I am interested in how vulnerability, crisis and disruption recalibrate the complementary dynamics of a relationship.

Every relationship straddles multiple complementarities. One stands out to me: the relationship between security and adventure, stability and change, familiarity and novelty.

We are born with two fundamental sets of human needs. We need connection and freedom. We need togetherness and separateness.

We emerge from childhood with some of us needing more protection and others needing more freedom. We often partner with someone on the opposite side.

As a result, many relationships contain a fundamental dynamic. One person is more in touch with the fear of losing the other. The other is more in touch with the fear of losing themselves.

One person fears abandonment. The other fears suffocation.

Illness brings the fear of both losses at the same time, and that disrupts the balance.

I want to play a short clip from my podcast, Where Should We Begin? These are three-hour sessions in which I invite you into my office.

In this case, I am speaking with a young couple. He is in his late 30s and has early-onset Parkinson’s disease, which has progressed rapidly. They have three young children.

The wife said something that gripped me: “I don’t just want to attend caregiver groups. I don’t just want to be a caregiver. I want to be his wife. If I can think of myself as his wife, I can think of him as many things beyond the new definition that has been placed on us.”

That definition is supposed to become more than a situation. It becomes an identity.

“We were looking forward to this year because the little one was getting bigger. It becomes easier to go out. Babysitters become easier. Everything gets easier once they are out of diapers and closer to sleeping through the night.

“We thought we were going to do all these things again, and now the energy is not there. We have to figure out how to rebalance. Every time it feels like we have rebalanced, the disease progresses, and we have to rebalance again.

“We are constantly trying to get our feet underneath us. It leads to this horrible cycle of survival, survival, survival, rather than living.

“I don’t want my children to grow up like that. I want them to enjoy things.”

I asked her, “Are you able to enjoy things with them?”

She said, “Some days. He is trying, but it is like bringing a rain cloud along.”

There is a difference between energy and attitude.

This is still early. First, there is the shock. Then there is the question of what this means. There is the speed at which the disease is progressing. There is the attempt to continue normally, followed by the new normal and then the unknown.

There is a great deal to absorb, and I do not know that it can be avoided. It is what it is.

Then a new phase begins: How am I going to live with this? What can I control? What can I determine? What attitude do I want to bring to it?

Attitude is different from energy.

There are physically healthy people with terrible attitudes. There are also very sick people with extraordinary attitudes. They radiate.

Sex is not simply something we do. Sex is a place we go.

I once worked with a radiology team at a major hospital that treated people with prostate cancer. I wondered what kind of sexual conversation they could have with their patients.

I said, “What you are basically telling your patient is, ‘I can’t save your ejaculations. I will try to save your erections.’

“What if, instead, you said, ‘You have had a sexuality that was primarily focused on your genitals. You are about to discover an entirely new world of sexuality that you did not know existed, because you are going to learn that you have a whole body and do not need to rely on one organ. Tell me how it goes.’”

That is the conversation that does not happen.

Why? Many of these doctors were men who, I assume, had castration anxiety.

The quality of our relationships determines the quality of our lives.

I thought of a story while preparing this talk that I have never told before, and I want to leave you with it.

When my mother died, my father was still quite healthy. He had taken her to the hospital the day before, and everything had seemed fine.

After her death, he went into what I came to understand as shock-induced dementia. I did not know such a thing existed, but learning about it was very helpful.

I knew nothing about dementia, but I knew a great deal about trauma.

He had no idea who he was, what he was, where he was or who I was. He was completely gone.

I thought, I have to find a way to give him back his story, his narrative and his memory.

The best way I could do that was not by placing him in a home, which was what people were pressuring me to do.

I flew him from Belgium to the Catskills, where his best friend lived. They had been in the camps together.

I put them together for a month. One had the head and the other had the legs. I figured together they would make one whole person.

His friend talked to him and talked to him. We gradually brought back my father’s sense of continuity and identity.

It was through intimate connections with other people that he was able to recover his health.

There was no medical intervention. The doctors had not told me to do any of it. It was simply good old common sense.

When you meet people facing illness and dying, remember two things.

First, do not feel embarrassed to talk about sex. In the context of illness and dying, it is crucial.

Second, remember the pleasure of being with other people. Caring for others matters, but the pleasure of being with them can give someone a few more years of life.

Thank you.