Sex and the Psyche, by Brett Kahr

Books on sexuality, however thoughtful and well researched, attract wide publicity in our culture. Now that the first fanfare of publicity has receded, it is time to take on board what a major classical piece of work Kahr's beautiful, brave book Sex and the Psyche is. It is also timely to note the psychoanalytic context from which such a book has emerged, and for our relatively small contingent to take heart from this.

At a psychoanalytic conference on masturbation, organized by the APP (Association for Psychoanalytic Psychotherapy in the NHS) some years ago, we hoped for a large audience of interested professionals. We had booked Donald Meltzer to talk on anal masturbation, Eglé Laufer to raise the normal developmental issues involved in masturbation, and Brendan MacCarthy to talk about the connection between masturbation and sexual abuse. We expected a large audience but there were, literally, only a handful of us. (Metaphors about fingers and hands were prominent throughout the day!) The speakers and audience humorously commented that masturbation was clearly something to be discussed privately at home and people did not want to think about it in company. We also wondered whether the fact that only one paper was about abuse and the rest were on universal developmental issues raised private fears about the meaning of masturbation that broke through the comfortable divisions of treater and treated. While Freud was such a revolutionary thinker about sexuality, it seemed that courage has diluted and dwindled over the years in his descendants within our part of Europe.

However, at around the same time as the APP meeting, I attended a conference on torture in Tromso, Norway. There was a presentation of a pioneering outcome study with the most vulnerable aggressive male clients with severe learning disabilities who had been abused. They had been self-injuring to a dangerous extent, as well as aggressive to others, and had been treated by the sexology unit, which was house