For decades the psychoanalytic explanation of "impotence" was that it represented fear and hatred of women. This explanation was more a deduction from the model than a clinical discovery—not unusual for such theorists. Since this was the drive theory—the purposivistic model—it proceeded from the assumption that symptoms express warded-off impulses and that these could be inferred from the effect of the symptom. In the maddenly unworldly world of the model, it was assumed that if a man was impotent it frustrated the woman, therefore the symptom represented his unconscious wish to frustrate her, and if he had that wish it meant, of course, that he was angry at women.
           Believe it or not, no one thought to check on whether a man was still impotent with a woman who engaged in sex with him only reluctantly and would be relieved if he had erection problems. Since the way to frustrate such a woman would be to subject her to prolonged thrusting, that should mean that he would not be symptomatic with her. Obviously, it doesn't work that way, and that at least needed to be accounted for.
           This pre-empirical appeal to authority rather than to data could be OK if the explanations derived from the model had heuristic value. Unfortunately, they led us up blind alleys.
           Here's how that is. Let's consider this possibility that the impotent man has this unconscious hostility toward women—or men, if he's gay. The idea is that he is being disabled by fear of his anger, by self-reproaches about it, fear of retaliation, etc. So it gets expressed in this indirect, passive-aggressive way. What, then, is the cure?
           Wouldn't you expect that the cure would be for him to go from being a poor hater to being a good hater? That has some plausibility since some of our greatest sexual virtuosos may have hated women. One could even argue that hating women frees many men to perform successfully and that being afraid of women does not inhibit them, it goads them to perform.
           But this is not the cure envisioned by the classical psychoanalytic model. The cure is for this man to get over his hostility toward women. Why if his problem is his anxieties about his anger wouldn't the cure be for him to be able to be more directly, consciously angry and to get some satisfaction from expressing it Maybe to then be free to fuck women
          The answer is no, that possibility is not even raised. It's as if he has been caught red-handed having this neurotic impulse, and he needs to be confronted with it, and then to realize that it is inappropriate in the present (if he can't realize that, i.e., is sociopathic, he's not treatable. He'll just say, OK so I hate women; what's so bad about that ). So the problem wasn't that he inhibited the impulse; it is the impulse itself. The inhibiting force is reality, what we can call the reality ego.
           Now you might say that this is raking up old theories that no one subscribes to anymore. My answer is that the old theory sent us off in a direction that is by now hard to reverse. To take any everyday example that fits what I have just been laying out, when someone is considered passive-aggressive, we all agree that the problem is that he/she can't be directly aggressive. So do we then try to help them be more directly aggressive? No, we try to help them get over being aggressive. Why? Because we caught them red-handed having a bad impulse. We confront them with the evidence and expect them to concede that they've been bad. Id analysis is still with us.
           What do I mean by that? Especially early on, Freud thought that our basic drives are a threat. This is the tragic view. The idea that our sexuality has to be repressed for civilization to survive (a quintessentially male notion). The badness is built into the impulse. From the ego-analytic perspective and, of course, many others nowadays, what needed to be analyzed was taken as a given, making analysis impossible. Inevitably, then, you come in on the side of the repression—on the side of the superego. To put it another way, it is a moralistic system.
           So we now think that someone who is passive-aggressive is being mean and trying to get away with it by feigning innocence. So we confront them with it, expecting that they will mend their ways. "Passive aggressive" is rarely applied non-moralistically, even though it should mean that the problem is the passivity, not the hostility.
 
Bernard Apfelbaum, PhD