NDJ:3 Sheldon Roth, M.D.

Love Between Men and Women

In discussing love, it is hard to hold one isolated element in mind without wanting to include all the others, simultaneously, by magic. Geometrically speaking, love is like a circle. The whole always implies all points. It is precisely this dilemma that confuses young lovers, because they wish to experience all elements of love from the start. Love, however, is subject to growth and development as well as trial and error. Through childhood into the far edges of longevity, love is ever evolving. Over time, though, four powerful realms of experience, separate but overlapping and synergistic, emerge in determining the nature of love: attachment, sensuality, understanding, and morality.

Training and Supervising Psychoanalyst, Psychoanalytic Institute of New England East, (PINE). Assistant Clinical Professor of Psychiatry, Harvard Medical School. The blend of these themes in any example of love creates a specific tone or harmony to that love, and analysis of the themes helps us to understand

why. The experience of attachment, sensuality, understanding, and morality is subject to the vagaries of constitutional endowment, personal experience, culture, and capricious fate – so naturally, there will be similarities and differences between the ways in which men and women process them.


In medical school I was charmed by my pathology professor’s observation that the five signs of inflammation were similar to the signs of love: rubor (redness), calor (heat), dolor (pain), tumor (swelling), and reductio functionis (loss of function). A delectable trifle of a remark, I had always thought. But, in considering our topic there is matter as well as jest in his free-associative jibe. Inflammation sets in to repair the loss of unified physiological functioning – it initiates healing – and love similarly restores a lost unity. ‘”Being in love’ is often preceded by separation or by an important object loss – real, imaginary or threatened” (Bak, 1973).

Plato deftly portrayed the driven nature of this seeking state in his tale of the gods’ original creation of humans as two-bodied people: a man-woman, a man-man, and a woman-woman. These Siamese-twin combinations proved threatening to the gods. With combined energies and intelligence, they prospered, grew powerful, and because of their inherent intimacy were, in addition, immensely happy. Fearing that this two-bodied race would overtake the gods themselves, Zeus descended from the heavens, knife in hand, and cut them in two. These severed creatures, inconsolable from the loss, spent the rest of their existence in search of their lost selves. Plato can be reformulated psychoanalytically through the “developmental” lens focused on childhood, with childhood’s mergers, identifications and ultimate losses followed by transference driven seeking behaviors — most commonly seen in early schooling and later uprooting for university.

In Chekhov’s short story, “Three Years,” Laptev’s older sister is dying of terminal cancer (Laptev’s mother had died during his childhood), and he is inexplicably stricken with love for the first time in his thirty-four years of life. Earlier he believed love unnecessary for existence, passionate love was an obsession, and between the sexes only physical attraction was possible. Interestingly, his beloved Yulia does not love Laptev initially, but in the aftermath of mourning their infant daughter (her “first love”), love for Laptev blossoms. Death produces passionate love in Laptev, but his older brother responds to the same loss with acute mental illness (Chekhov’s artful intuition of the connection between love and irrationality).

For both men and women, loss is integral and necessary in the motivation of new attachments. A woman patient told me: “I’ve had many relationships and boyfriends as well as a long marriage, but nobody ever touched me the way Robert did…. In retrospect, it was because he was in the same pain that I was…. He was a person who understood me, and I him; that was the bond. After we broke up I had the repetitive thought, ‘What would I do when my mother died, could I call him?’ He would be the only one who understood me…. How could I explain that to my husband?” This woman had become attached to Robert at the onset of her mother’s long and eventually terminal illness. Another patient, a man, had been unresponsive to women for two years after his divorce. One night he dreamed that his former wife was drowning in a swimming pool while he swam in a nearby lake. He felt agonizingly sad in the dream, but kept swimming and did not save her. The next week, at the ocean, he met a young woman and fell in love. In analytic therapy, the transference induces multiple feelings of loss and sadness — out of this fiery conflagration certain lucky patients then find love outside the office.

A commingling of losing and finding (Freud, 1905) lends a perfume of poignancy and sadness to the atmosphere of love’s beginnings. This sweet and simultaneously painful wistfulness often feels confusing, since our conscious rationality dictates upbeat feelings to accompany an obvious happiness.

Attachment and Some Ego Functions Attachment has far-ranging influences on mental life, such as enhancing the capacity for reality testing and reality sense. Auschwitz is an unlikely setting for a love story, yet, Dr. Louis Micheels, now a retired psychoanalyst in New Haven, CT, survived the nightmare as an inmate-physician along with his fiancee, a nurse. Anticipating the final concentration camp evacuation and death march through a winter blizzard to Dachau, she miraculously obtained wool and knitted him gloves and a headband. During the grueling, sub-zero exodus, the S.S. were shooting all stragglers. Micheels became delusional, hallucinating a warm farmhouse, with a bench and food. As Micheels felt drawn to sit on the hallucinated bench, he looked downward and saw the gloves. In a flash, he remembered her love and thought, “These gloves, that is what is real.” His mind cleared and he continued the march (Micheels, 1988,1989).

How Men and Women Cope with Attachment The complexities of attachment’s smooth sailing, hurricaned shipwrecks, or windless stagnation defies summary in this presentation. But, generally, women meet attachment’s beckoning with less dread than men do. A woman has a triple psychological advantage when she falls in love with a man. She returns to unconscious images of her mother that potentially reinforce her identity, and she also finds her father, whose difference enhances her female boundaries. Additionally, mother, not father, stimulated her primary ambivalence (Freud, 1931, Roth 1988), a wellspring of disintegrating hate. A woman gains a temporary buffer against the ravages of hate, an emotion that constantly threatens love relationships.

Men fear that profound dependent intimacy will obliterate a hard-won and often tenuous sexual and gender differentiation from their cherished mothers. This differentiation is fostered not only by their fathers, but, in desirable circumstances, also by their mothers. These dependent fears toward women induce defensive hate and reactive guilt in men, resulting in a tendency to avoid intimacy, as a means of protecting themselves and those they care about.

These initial different attitudes of men and women toward attachment tend to fade over time – usually years are required – especially if the other ingredients of love (sensuality, understanding, morality) are active. Later in love, men and women have rather similar attitudes toward attachment.

Interpersonal Orcadian Rhythm While part of the initial fascination of our attachment stems from the link the lover has to our past, attachment develops a compelling history of its own. An interpersonal circadian rhythm, a warm safety of regularity based on the endless details of shared daily living, creates a mutual past that often equals or supersedes the power of our original attachments while also incorporating them. In an interview with Larry King (2004), Nancy Reagan isolated the most devastating impact of her husband’s Alzheimer’s disease as the inability to share common memories with him; no one else could comprehend the mutual experience.

Unlike the history of the slanted parent-child relationship, the interpersonal circadian rhythm is a history of two equals finding pleasure and struggling with pain together. Childhood fantasies of an afterlife featuring mother and father are replaced with images of eternal union with our beloved. This shift is reminiscent of Bergmann’s (1987) definition of love: “the yearning to be forever united with another person.”


Attachment, when enmeshed in love, never withers. Indeed, it becomes increasingly apparent with age as other more striking features of love recede – sensuality, sexuality, and the sparkling animal beauty of the young in love – while the gentle but indestructible strands of attachment remain sturdily intact.

At a mountain resort, for years each summer, I watched an Old-world Russian couple, then in their nineties. I often heard how they spent hours getting each other dressed each morning, and virtually never parted except perhaps while sitting outside the house doctor’s office waiting for each other. Wearing glasses thicker than the heel of one’s shoe, arm in arm, they daily coursed the lengths of the enormous hotel’s corridors and passed their afternoons on unpredictable reaches of the formidable mountain. How they got there and back, I could never comprehend. Occasionally, while hiking, I would hear the steady whisper of their joint Russian blending with the sounds of nature.

The appearance of this couple had a wondrous impact on any people they happened upon. Their slow grace and peaceful aura mesmerized those of us nearby, causing a contagious modulation of pace as we paused in quiet awe at the mystery of human relationships – and, no doubt, also wished that we might be as lucky. They seemed like one of Plato’s severed pairs, at last reunited! Perhaps they also revived childhood awe at the mystery of parental union.

Mutual devotion, uninterrupted over decades, unfazed by bodily fragility, suggests a powerful force of nature. The organs of attachment may not be so obvious as those of sexuality, but its persistent appearance and it recognizable forms through diverse cultures imply a basic grounding in our physical architecture.


Because sexual experience can occur independent of love or a lover, a brooding doubt is cast over sexuality’s primacy in love. Adults as well as adolescents find sexual stirrings toward people who are not their lovers. Erotic literature, art, cinema and theatre elevate the sexual instinct to a realm that is independent of the object. In these imaginative leaps of mind to body, stimulation of pure sensation is sought rather than the complicated amalgam of love.

Yet, more than one man or woman has confided to me that despite the multiple virtues of his or her lover or spouse, “something is missing.” That “something” usually turns out to be the vitality and enveloping mystery engendered by sexual passion. For such people, when the car pulls into the driveway or the key turns in the lock of the front door, their hearts do not race; they may be pleased, but they are not excited. It is not possible to dictate or teach romantic passion to the body. Sexual excitement, yes – but gourmet sexuality born of love, no.


The senses of the body – touch, smell, hearing, sight, kinesthesia, and so on – express a person’s history and potential future. For love to flourish, these senses must be developmentally integrated in relation to one person.

Early in life, those who love and nurture us become sharp students of what kind of physical stimulation elicits joy, pleasure, calm, rising excitement, hugging, kissing and so on. Satisfaction and security are constantly linked to mutual bodily contact. To take the most common of examples – nursing – consider the holding, relaxation of muscle, stroking of skin, smells of bodies mingled with the taste of food, the feel of heat, moisture, and vocal/auditory soothing through murmuring, humming, singing, bodily sounds, perhaps capped off with a blissful postprandial nap. Our life begins in world where physicality is coaxed out, elaborated on, repeated, and identified in the presence of a caring, nurturing, and growth-enhancing person. Our senses are ‘sens-itized’ to a loving figure. The full sensuality of our bodies is dormant until awakened and echoed by another person.

From this perspective, the well-worn adage that the way to a man’s (or woman’s) heart is through his (or her) stomach is cannily perceptive. Taste buds at work in a fine restaurant while operating at a table prepared for a solitary diner perform quite differently when the exact, same meal is shared with someone we love. Most adults will not cook elaborate full meals at home unless the food can be eaten with another person, especially if it is a lover.

The counter direction may also be traversed; taste may heighten or lead a sensual path back to lost love. In “Under the Jaguar Sun,” one of Italo Calvino’s fascinating stories devoted to the five senses, a marriage whose sexual passion has virtually suffocated is revived through taste. Vacationing in Mexico, the couple indulges in a series of gourmet gustations. “In eating…Olivia… was…communicating to me what she was tasting: communicating with me through flavors,.. .through a double set of taste buds, hers and mine… .Olivia’s need to involve me in her emotions pleased me greatly, because it showed that I was indispensable to her and that.. .the pleasures of existence could be appreciated only if we shared them. Our subjective, individual selves, I was thinking, find their amplification and completion only in the unity of the couple… .It was the sensation of her teeth in my flesh that I was imagining, and I could feel her tongue lift me against the roof of her mouth, enfold me in saliva, then thrust me under the tips of the canines… .The situation was not entirely passive, since while I was being chewed by her I felt also that I was acting on her, transmitting sensations that spread from the taste buds through her whole body. I was the one who aroused her every vibration—it was a reciprocal and complete relationship, which involved us and overwhelmed us… .in the universal cannibalism that leaves its imprint on every amorous relationship and erases the lines between our bodies.” The love-hungry pair follow the slaking of gustatory desire with that of sexual passion: “And for the first time.. .the spell whose victims we had been was broken, and the inspiration that had blessed the finest moments of our joint life came to visit us again.”

Another of Calvino’s tales focuses his literary microscope on the perfumed pairing of olfaction and attraction. In a darkened series of rooms, filled with post-rock concert youths, a musician blindly crawls across a woman whose scent totally enraptures him. Lovemaking ensues, but a call of nature interrupts, taking him in search of a bathroom. He spends the rest of the night, on hands and knees, blindly sniffing every skin available in search of this feminine olfactory miracle who had opened his soul. Out of a multitude, one specific fragrance unleashed his passion. This example is not meant to demonstrate enduring passionate love (although it might have, if our instance provided a better tracker of odor). It does reveal, however, the intricate fingerprint embedded in body program of receptivity. One matching molecule unlocks a world of sensation beyond the isolated sensory path of entry. The Russian monk, Rasputin, was known to award an intended seductee his arm-pit-sweat drenched handkerchief as a promise of things-to-come.

A similar phenomenon can be observed with hearing. A philosophy professor in psychoanalysis was bedeviled by a choice between two women. One seemed to have all the rational criteria for marriage, including beauty, intelligence, devotion, and a steady reasonableness. The other woman was also physically lovely and intelligent, but possessed of a highly problematic personality, forever in turmoil. With this latter woman he recognized the powerful impact the mere sound of her voice had on him. When she spoke to him, his muscles eased into relaxation, a hypnotic calm spread through his racing thoughts, and he experienced an indescribable but exact feeling of “familiarity.” Her voice had a specific intonation, rhythm, and amplitude that, during the times when they were not fighting, aroused contentment and security. When not with her, he could forget this impact, but like a forgotten melody, it leapt full-blown into experience when he heard her. He had no such experience with the first woman’s voice, or with any other woman excepting one from his past for whom he had felt intense romantic passion. The special voices, obviously, tapped direct memory lines to deep loves of childhood.

Love that endures and develops merges sensations and sensibilities so that they are primarily responsive to one’s lover. In general, men are slower at integrating these sensory elements than are women, in part for the same reasons as those that complicate attachment. The barriers to merger of senses focused on one person affect both men and women and are legion, but major ones are histories of sexual, physical and emotional trauma, and sensitivity to loss, confusion over sexual identity, conflicts of competition, and the incest taboo.

Freud invoked the incest taboo to explain the Madonna/prostitute split in the erotic experience of men and called it “the universal tendency to debasement” in love (Freud, 1912). Clinically, I have been equally impressed by the role of traumatic object loss in either preventing integration of sexuality or promoting fragmentation of self-states that in extreme cases presents as dissociated behavior.

One of my male patients had a grand passionate affair in his early twenties with a woman who absorbed all his sensibilities, physical and mental. He hoped to marry his love, but


The Romantic Quartet Sheldon Roth, M.D.

in the penultimate months she abruptly broke off and took up with another man. After several months of devastation my patient became attracted to a recently divorced woman, a “sexual dynamo.” He noticed, however, that this woman “held back her emotions” and mostly wanted just sex. An uncalculated but relentless mental process ensued, whereby he slowly reduced their interactions to pure sex that veered increasingly toward what he called “dirty bookstore pornography.” He said, “I could sense how I was protecting myself from real involvement; I wasn’t going to get hurt again by anyone.. .but, it was all automatic.” Simultaneously, he met a woman who did not have these sexual proclivities, but was emotionally available in other ways. He married this second woman and maintained the relationship with the other. He came to me at the point where his sexualized relationship had evolved to pure eroticism, and he was desperate to reverse the process and bring the passion into his marriage.

Fragments of Self in Fragments of Sexuality Anna Freud noted that we learn how the ego functions only when its silent, smooth operations are disrupted (1966). The face of undisturbed love is masked because of the tight integration of multiple layers of psychology. Disrupted love, however, reveals its powerful determinants. Musical art offers us a glimpse of an element of love that, while ubiquitous, is also buried from awareness because of the disruptive, dis-integrating anxiety it arouses— bisexuality.

The Marschalhn in the Strauss opera Per Rosenkavalier is a middle-aged woman whose love, begun passionately in youth, is turned to grief when her husband grows uninterested. She becomes attracted to a youthful male of her entourage. The male role is written for and always sung by a female soprano, who later is dressed as a woman by the Marschallin. (A very similar scenario occurs in Mozart’s The Marriage of Figaro.) There are several passionate love duets between the two women singers. We are asked to watch this ravishment while ignoring the actual sex of one of the players. How might we understand the psychology of this aesthetic?

The Marschallin is seeking and loving her lost, youthful femininity through the youthful male whose feminine meaning is plainly represented by a female singer. This motif is elaborated when the Marschallin dresses her young “male” lover in female clothing (in an effort to disguise him to keep their affair secret). Simultaneously, the Marschallin also seeks the lost youthful male who once wooed her, and possessed an innocence that identified him as similar to and part of her.

And let us emphasize that although the opera spotlight is on women, implicit is a shuffling of the bisexual deck of cards by male lovers as well.

With the breakup of marital love, the fragments of love shatter, exposed to magnified observation. The Marschallin gazes into a mirror, and while looking at her middle-aged self, ponders on the sweet, innocent “Resi” that she was, simultaneously singing of her terrifying future as an ugly “old woman.” She is stunned by the contrast between her inward youthful feelings and the ever-uncontrolled turn of events her body shows outwardly. “How does God do it? she wonders with grieving amazement. In an effort to preserve the life gone by, she intuits an amatory alter ego in whom this tender personal magic is deposited for safekeeping.

Sexuality in full love is an integrative nostalgia; it blends all we cherish into one. That is its power. Loss of a beloved induces a disintegrative breakdown into love’s partial impulses. The grieving person seeks respite where he or she can, and the special quality of the resultant sexuality is its partial, restorative nature. These partial answers to grief, while soothing and sustaining, do not remedy loss of full love. When love persists into old age, although nostalgic memory is very much alive —especially in sexuality— an integration persists, leaving the lovers feeling whole and not chasing fragments of themselves.


Intelligence and its application through learning have an essential impact on attachment and sensuality, but only in certain ways, and to a limited degree.

For example, the feminist movement has profoundly altered contemporary women’s roles and expectations in love. One hundred years ago some medical texts stated that women did not have sexual desires, and they submitted to sexual intercourse solely as a sacrifice to motherhood (Gay, 1984). One result of “consciousness raising” has been an awakening of sexuality in women that is both satisfying and at times highly confusing.

Not uncommonly, I see women in consultation who are successful professionally, enjoy sexuality with men, but are deeply grieved over their failure in love. Manifest sensual proficiency may mask underlying conflicts and attitudes that are barriers to intimacy. “Consciousness raising” does not raise the unconscious.

Predilection to Object Type

In both men and women, when unconscious barriers to love are sufficiently eroded, a very specific predilection in object type is uncovered. Although thoughtful psychotherapy can alter a tendency to self-destructive relationships, at times even totally dissipate promiscuity, and change many other fruitless patterns of romance, we do not alter an underlying tendency toward a particular imago to whom we are deeply attracted and by whom we are passionately aroused. Psychotherapy or psychoanalysis unleashes this potential, but it does not create it.

A female patient tried desperately to learn to love a man who had all the “right” attributes but did not stir her heart. They planned a dream weekend in Paris. On her return, she stated succinctly: “Ego orgasm doesn’t work!” I recall a cartoon that depicted two women sitting on a sofa, confiding, one says to the other: “He is attractive, thoughtful, attentive, kind, generous, sociable, helpful, and absolutely boring!”

Once one is attached to the proper person, however, active learning becomes essential in supporting the ever-evolving state of love. A perceptive young man, in the midst of complaining about his inability to remain committed to a woman, stated: “I’m very good at falling in love, but I’m just terrible at staying in love.” I asked him what he understood of this state of affairs (no pun intended), and he replied: “Well, you know, falling in love, that is basically me! I am attracted to a woman who shares my illusions, my tastes, and my intellectual interests. I’m falling in love with myself, with my own images. Staying in love, that means loving the other person. That’s why I have trouble. Whenever they show their imperfections, I can’t tolerate it. I want to get rid of them. I can’t stand their nose… or face… or walk… or the movies that they want to see.”

Realism and Empathy Conscious empathic attunement to one’s lover is essential for furthering love. Several years ago, a study was done in a small, established community of 2,500 families that contained about 250 families whose marriages had lasted twenty to thirty years. These couples were studied to learn what qualities enabled them to hold onto their relationships. A key concept was “self-image,” the personal view an individual held of him- or herself. The self-image of each spouse corresponded very closely to the image the other spouse held of him or her. These couples had developed a very realistic perception of who their partner was. Such tenets of adult life hark back to essentials of childhood life, including recognition and acceptance of differences.

Intelligence and Love

In general, there appears little difference between the sexes in their use of intelligence to master the barriers to love. However, the synergism of attachment, sensuality and understanding is often dramatic. One’s intelligence doesn’t work the same way in love and out of love.

A theoretical physicist in psychoanalysis, as was his wife, provided a remarkable example of activation of intelligence and love. This man loved his wife deeply but had suffered for many years because of her lack of sexual abandon. This implied withholding meant to him that he was not truly loved. At a point in their ever-turbulent relationship when mutual neurotic barriers were reduced, one night they found their way to sexual passion with harmonious contentment. He felt the potential for them that he always knew had existed had been realized. The same night he had a dream in which he solved a series of mathematical equations that had eluded his intellectual grasp for almost twenty years. He saw the formula written out in neon lights in the dream, and awoke in the morning feeling radiant as he copied out the miraculous nocturnal vision. “It was obvious,” he said, “but I had never seen it that way before.”

At the same time, consider that an eminent contemporary philosopher, Martha Nussbaum, entitles her recent book, which includes a study of love, “Upheaval of Thought” (2001). Nussbaum elaborates how love produces “geological upheavals” of thought in which previously flat landscapes become mountains and valleys: self-sufficiency is replaced with an irreplaceable need for another that alters the complexity of cognition, self-appraisal, and personal goals.


Traditionally, through most of history, relationships between men and woman began with morality. Marriages were arranged according to the dictates of economics, politics, religion and culture (institutionalized superego). These calculated matches were believed to safeguard and promote essential needs and values for all concerned — family, community and nation. In contrast, contemporary love fashions morality slowly and increasingly, out of a long synergism of attachment, sensuality, and understanding. In any sustained, productive love relationship, there are transference storms similar to those in psychoanalytic therapy. These negative legacies of the past are inherent to love, and when worked-through become part of the fabric that holds people together; indeed, one of love’s painfully expensive gifts is tranferential redemption.

Morality in love is a guiding, affective imperative of an ego-ideal shaped by past loving nurturance and continued growth through love. Love begins with a narrow, egocentric perspective that gives way to acknowledging the difference of two separate but connected people. Emerging from this long, productive process are affect self-states — characterological dispositions to action — that include optimism, forbearance, responsibility, humility, and patience. One of La Rochefoucauld’s maxims on love is “We pardon to the extent that we love.” The intensity of these dispositions spills over beyond the boundaries of the two lovers as their excitement extends to children, family and often into the larger community.

When one of my analysands married, he said: “To get married is to come to grips with death.. .loss.. .and admit all that is precious to me and know that I have to work at keeping it.” A few years later, as his first child was about to be born, he told me: “We were looking at our wedding pictures.. .and both of us had the same thought of looking at our parents’ wedding pictures. I want my children to experience their grandparents before they are gone… .1 feel the urge to pass everything on to the next generation.”

Because of innumerable opportunities for disillusionment and pain in love relations, the potential for disintegration through reactive hate and fragmented behavior is a constant risk. The affective moral dispositions guide against precipitous behavior, although our awareness of their influence may be very minimal. These moral attitudes become a parental framework within which the two lovers are protected. Psychotherapy’s protective boundaries are derived from these moral aspects of love, especially long lasting therapies that permit grappling with transferences

As an agent of the ego-ideal, self-love and increased self-esteem are motivating rewards in the maintenance of morality as well as toward the pleasure of expanding beyond oneself into one’s lover and the larger world. I find little difference between men and women in this kind of morality, especially because it develops much later in love relations, at the time when attachment and sensuality are also handled more similarly by the sexes. What is quite remarkable is that breaking with the traditional past of arranged marriages does not hinder the passing on of culture, although the passage is distinctly subject to the creative dialectic of culture and psychology.


In summary: Each realm of experience in love — attachment, sensuality, understanding, morality — contains multiple nuances of affect, our succinct, animal summary of personal history, present life, and future potential. Each realm influences the others, melding, molding and merging like the dream, into the ineffable state we call love. Despite their marked initial differences, the longer men and women shape a mutual love, the more they resemble one of Plato’s disconsolate creatures, at last reunified.


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