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 CONTENTS

Contributorsxi
Preface to the First Edition xv
Preface to the Second Edition xxi
Preface to the Third Edition xxiii

SECTION ONE
Fundamental Knowledge and Skills 1

Introduction 1

1 Grasping the Intuitive: Why Sex Is Important 3

Stephen B. Levine, MD

2 The Sexual Narrative: A Story Waiting to Be Told 10

Candace B. Risen, LISW-S

3 Boundary Crossings in Clinical Practice 22

Candace B. Risen, LISW-S

4 The Rich Ambiguity of Our Key Concepts: Making Distinctions 32

Stephen B. Levine, MD

SECTION TWO
Treatment39

Part A: Women’s Major Sexual Concerns 41

5 Clinical Challenges of Sexual Desire in Younger Women 43

Rosemary Basson, MD, FRCP (UK)
vii
 Contents

6 Problems With Orgasm 60

Karen M. Donahey, PhD

7 Painful Sex 71
Sophie Bergeron, PhD, Natalie O. Rosen, PhD, and
Serena Corsini-Munt, MA

8 Sexuality and Menopause 86

Sheryl A. Kingsberg, PhD, and Michael Krychman, MD

Part B: Men’s Major Sexual Concerns 95

9 Low Sexual Desire in Men 97

Stanley E. Althof, PhD

10 The Sexual Challenges for Adolescent Boys and Young Men 111
Derek Polonsky, MD

11 The Mental Health Professional’s Treatment of Erection Problems 123

Stephen B. Levine, MD

12 Premature Ejaculation 134

Marcel D.Waldinger, MD, PhD

13 Delayed Ejaculation 150

Michael A. Perelman, PhD, and Daniel N.Watter, EdD

14 Problematic Sexual Behavior 164

I. David Marcus, PhD

Part C: Problems Common to Both Genders 179

15 Sexual Concerns and Dysfunction Related to Past Sexual Trauma 181

Christine A. Courtois, PhD, ABPP

16 Sexual Problems During Disrupted Reproduction and Pregnancy 195

Linda Hammer Burns, PhD

17 Treating Infidelity 209

Douglas K. Snyder, PhD, Donald H. Baucom, PhD, and
Kristina Coop Gordon, PhD

18 Transitions: Single Again, Partnered Again 221

Lin Myers Jovanović, PhD

viii
 Contents

19 Challenges of Sexual Life After Breast and Prostate Cancer 235

Lisa M. Anllo, PhD

20 Helping Those With Intellectual Disabilities 250

Deborah A. Richards, MA, CHMH, RP, and J. Paul Fedoroff, MD

21 Depression and Sexual Life 263

Anita Clayton, MD, and Veronica Harsh, MD

22 Recognizing and Reversing Sexual Side Effects of Medications 273

R.Taylor Segraves, MD, PhD, and Richard Balon, MD

SECTION THREE
The Diversity of Sexual Lives 285

23 The Biological Basis of Sexual Orientation 287

Qazi Rahman, PhD

24 The Gay Male 294

David L. Scott, MD

25 Unique Clinical Issues Among Lesbians 310

Dina L. Miller, PhD, PCC-S

26 Optimal Erotic Intimacy: Lessons From Great Lovers 318

Peggy J. Kleinplatz, PhD

27 Transgender Phenomena 331

Peggy T. Cohen-Kettenis, PhD

28 Managing Versus Successfully Treating Paraphilic Disorders:

The Paradigm Is Changing 345
J. Paul Fedoroff, MD

29 The Science and Politics of Diagnosis: Reflections on the DSM-5 Work

Group on Sexual and Gender Identity Disorders 362
Kenneth J. Zucker, PhD

SECTION FOUR
The Future 369

30 Partnering With the Pharmaceutical Industry: Cutting-Edge Work 371

Stanley E. Althof, PhD, and Tara Symonds, PhD

ix
 Contents

31 Persistent Genital Arousal Disorder 376

David Goldmeier, MD

32 Post-Orgasmic Illness Syndrome 380

Marcel D.Waldinger, MD, PhD

33 Asexuality as an Orientation 385

Anthony F. Bogaert, PhD

34 Social Trends and Their Impact on Sexuality 389

Kathryn S.K. Hall, PhD

Index393

x
 CONTRIBUTORS

Stanley E. Althof, PhD, is an emeritus professor in the department of psychiatry at Case Western
Reserve University School of Medicine in Cleveland, Ohio, and is executive director of the Center
for Marital and Sexual Health of South Florida in Palm Beach, Florida.

Lisa M. Anllo, PhD, is in private practice in Buffalo, New York.

Richard Balon, MD, is a professor of psychiatry in the department of psychiatry and behavioral
neurosciences at Wayne State University School of Medicine in Detroit, Michigan.

Rosemary Basson, MD, FRCP (UK), is a clinical professor in the department of psychiatry and
director of sexual medicine at the University of British Columbia in Vancouver, Canada.

Donald H. Baucom, PhD, is a professor of psychology in the department of psychiatry at the

University of North Carolina in Chapel Hill, North Carolina.

Sophie Bergeron, PhD, is an associate professor in the department of psychology at the University
of Montreal in Montreal, Canada.

Anthony F. Bogaert, PhD, is a professor in the department of health sciences and the department
of psychology at Brock University, St. Catharines, Canada.

Anita Clayton, MD, is David C. Wilson Professor and Interim Chair of the department of psy-
chiatry and neurobehavioral sciences and a professor of clinical obstetrics and gynecology at the
University of Virginia in Charlottesville,Virginia.

Peggy T. Cohen-Kettenis, PhD, is a professor emeritus of medical psychology at the VU Univer-

sity Medical Center, Amsterdam, the Netherlands.

Serena Corsini-Munt, MA, is a doctoral candidate in the department of psychology at University

of Montreal in Montreal, Canada.

xi
 Contributors

Christine A. Courtois, PhD, ABPP, is a licensed psychologist in independent practice and a na-
tional clinical trauma consultant at Elements Behavioral Health in Washington, DC.

Karen M. Donahey, PhD, is an associate professor in the Feinberg School of Medicine at North-
western University in Chicago, Illinois. She is in private practice in Chicago, Illinois.

J. Paul Fedoroff, MD, is an associate professor in the department of psychiatry at the University of
Ottawa. He is director of the integrated forensic program of the University of Ottawa Institute for
Mental Health Research and director of the Sexual Behaviors Clinic at the Royal Ottawa Mental
Health Centre in Ottawa, Canada.

David Goldmeier, MD, leads the Jane Wadsworth Sexual Function Clinic at St Mary’s Hospi-
tal and chairs the sexual dysfunction specialist interest group of the British Association of Sexual
Health and HIV. He holds an honorary senior lecturer post at Imperial College in London, United
Kingdom.

Kristina Coop Gordon, PhD, is a professor in the department of psychology at the University of
Tennessee, Knoxville in Knoxville, Tennessee.

Kathryn S.K. Hall, PhD, is in private practice in Princeton, New Jersey. She is the co-editor of the
fifth edition of Principles and Practice of Sex Therapy.

Linda Hammer Burns, PhD, is a licensed psychologist who is an associate professor in the depart-
ment of obstetrics, gynecology and women’s health at the University of Minnesota Medical School
in Minneapolis.

Veronica Harsh, MD, is an assistant professor in the department of psychiatry and neurobehavioral
sciences at the University of Virginia in Charlottesville,Virginia.

Lin Myers Jovanović, PhD, is a professor of psychology at California State University in Stanislaus,
California, and maintains a private therapy practice.

Sheryl A. Kingsberg, PhD, is a professor in the departments of psychiatry and reproductive

­biology and psychiatry at Case Western Reserve University School of Medicine. She is chief of the
division of behavioral medicine in the department of obstetrics/gynecology at McDonald Women’s
Hospital at University Hospitals Case Medical Center in Cleveland, Ohio.

Peggy J. Kleinplatz, PhD, is a professor in the faculty of medicine and clinical professor in the
school of psychology at the University of Ottawa in Ottawa, Canada.

Michael Krychman, MD, is a gynecologist and is the director of the Southern California Center
for Sexual Health and Survivorship Medicine and the director of sexual medicine at Hoag Hospital
in Newport Beach, California.

Stephen B. Levine, MD, is a clinical professor in the department of psychiatry at Case Western
Reserve University School of Medicine in Cleveland, Ohio, and is co-director of the Center for
Marital and Sexual Health in Beachwood, Ohio.

I. David Marcus, PhD, is co-director of the SiliconValley Psychotherapy Center in San Jose, California.

xii
 Contributors

Dina L. Miller, PhD, PCC-S, is a clinical therapist staff member at Behavioral Healthcare Partners
of Central Ohio in Newark, Ohio.

Michael A. Perelman, PhD, is a clinical professor in the departments of psychiatry, reproductive

medicine, and urology at Weill Medical College, Cornell University. He is co-director of the human
sexuality program at the New York Presbyterian Hospital in New York City.

Derek Polonsky, MD, is an assistant professor of psychiatry at Tufts Medical School. He is in private
practice in Brookline, Massachusetts.

Qazi Rahman, PhD, is a senior lecturer in the department of psychology at the Institute of Psy-
chiatry at King’s College London, United Kingdom.

Deborah A. Richards, MA, CHMH, RP, is a co-director of DS Consulting—Developmental

Disability Services at the Pelham Psychotherapy Practice in Fonthill, Canada.

Candace B. Risen, LISW-S, is an assistant clinical professor of social work in the department
of psychiatry at Case Western Reserve University School of Medicine in Cleveland, Ohio, and is
co-director of the Center for Marital and Sexual Health in Beachwood, Ohio.

Natalie O. Rosen, PhD, R Psych, is an assistant professor in the departments of psychology, neu-
roscience, and obstetrics and gynecology at Dalhousie University in Halifax, Canada.

David L. Scott, MD, practices community psychiatry for Behavioral Health Services in San Joaquin
County, California, and treats a large number of lesbian, gay, bisexual, and transgendered patients.

R. Taylor Segraves, MD, PhD, is professor emeritus at Case Western Reserve University School
of Medicine in Cleveland, Ohio, and editor of the Journal of Sex and Marital Therapy.

Douglas K. Snyder, PhD, is a professor in the department of psychology at Texas A&M University
at College Station, Texas.

Tara Symonds, PhD, is a health psychologist who is a partner in the company Strategic Lead
Clinical Outcomes Solutions in Folkestone, Kent, United Kingdom.

Marcel D. Waldinger, MD, PhD, is adjunct professor in pharmacology and physiology, Drexel
University College of Medicine, Philadelphia, Pennsylvania. He is in private practice in psychiatry
and neurosexology in Amstelveen, The Netherlands.

Daniel N. Watter, EdD, is in private practice at the Morris Psychological Group in Parsippany,
New Jersey.

Kenneth J. Zucker, PhD, is the editor of the Archives of Sexual Behavior and the head of the Gender
Identity Clinic, Child, Youth, and Family Services, Underserved Populations Program, Centre for
Addiction and Mental Health in Toronto, Canada.

xiii
This page intentionally left blank
 PREFACE TO THE
FIRST EDITION

Each mental health professional’s life offers a personal opportunity to diminish the sense of baffle-
ment about how health, suffering, and recovery processes work. Over decades of work in a mental
health field, many of us develop the sense that we better understand some aspects of psychology and
psychopathology. Those who devote themselves to one subject in a scholarly research fashion seem
to have a slightly greater potential to remove some of the mystery for themselves and others in a
particular subject area. But when it comes to the rest of our vast areas of responsibility, we are far from
expert; we remain only relatively informed.
The authors of this Handbook devoted their careers to unraveling human sexuality’s knots. Their
inclusion in this book is a testimony to their previous successes in helping others to understand
sexual suffering and its treatment. Since one of the responsibilities of scholars is to pass on their
knowledge to the next generation, in the largest sense, passing the torch is the overarching purpose
of this book.
We humans are emotionally, cognitively, behaviorally, and sexually changeable creatures.We react,
adapt, and evolve. When our personal evolution occurs along expected lines, others label us as
mature or normal. When it does not, our unique developmental pathways are described as evidence
of our immaturity or psychopathology. Sometimes we are more colloquially described as “having
problems.”
Sexual life, being an integral part of nonsexual life processes, is dynamic and evolutionary. I think
about it as having three broad categories of potential difficulties: disorders, problems, and worries.
The disorders are those difficulties that are officially recognized by the DSM-IV-TR—e.g., Hypo-
active Sexual Desire Disorder, Gender Identity Disorder, and Sexual Pain Disorder. Many common
forms of suffering that afflict groups of people, however, are not found in our official nosology and
attract little research. I call these problems. Here are just two examples: continuing uncertainty about
one’s orientation and recurrent paralyzing resentment over having to accommodate a partner’s sexual
needs. Problems are frequent sources of suffering in large definable groups of the population—e.g.
bisexual youth and not so happily married menopausal women. Then there are sexual worries.
Sexual worries detract from the pleasure of living. They abound among people of all ages. Here are
five examples: Will I be adequate during my first intercourse? Will my new partner like my not-so-
perfect body? Does my diminishing interest in sex mean that I no longer love my partner? How long
will I be able to maintain potency with my young wife? Will I be able to sustain love for my partner?
Worries are the concerns that are inherent in the experience of being human.

xv
 Preface to the First Edition

Sexual disorders, sexual problems, and sexual worries insinuate themselves into the therapy ses-
sions even when therapists do not directly inquire about the patient’s sexuality.This is simply because
sexuality is integral to personal psychology and because the prevalence of difficulties about sexual
identity and sexual function is so high.
Unlike the frequency of sexual problems and worries, the prevalence of sexual disorders has been
carefully studied. Their prevalence is so high, however, that most professionals are shocked when
confronted with the evidence.The 1994 National Health and Social Life Survey, which obtained the
most representative sample of 18- to 59-year-old Americans ever interviewed, confirmed the find-
ings of many less methodologically sophisticated works. In this study, younger women and older men
bore the highest prevalence. Overall, however, 35% of the entire sample acknowledged being sexually
problematic in the previous 12 months. There are compelling reasons to think that the prevalence is
even higher among those who seek help for mental or physical conditions. Although people in some
countries have unique sexual difficulties, numerous studies have demonstrated that the population in
the United States is not uniquely sexually problematic.
To make this point about prevalence and, therefore, the relevance of this book even stronger, I’d
like you to consider with me a retrospective study from Brazil. The authors compared the frequen-
cies of sexual dysfunction among untreated patients with social phobia to those with panic disorder.
The mean age of both groups was mid-30s. The major discovery was that Sexual Aversion, a severe
DSM-IV diagnosis previously thought to be relatively rare, was extremely common in men (36%)
and women (50%) with panic disorder but absent in those with social phobia (0%). The sexual lives
of those with social phobia were limited in other ways.
I find this information ironic in several ways. This finding probably would not have shocked
therapists who were trained a generation or two ago because it was then widely assumed that
an important relationship existed between problematic sexual development and anxiety symptoms.
Modern therapists, however, tend to be disinterested in sexuality and so are likely not to respond to
these patients’ sexual problems. Adding insult to injury, the modern treatment of anxiety disorders
routinely employs medications with a high likelihood of dampening sexual drive, arousability, and
orgasmic expression.
For most of the 20th century, sexuality was seen as a vital component of personality develop-
ment, mental health, and mental distress. During the last 25 years the extent of sexual problems
has been even better defined, and their negative consequences have been better appreciated. Men-
tal health professionals’ interest in these matters has been thwarted by new biological paradigms
for understanding the causes and treatments of mental conditions, the emphasis on short-term
psychotherapy, the constriction of insurance support for non-pharmacological interventions, the
political conservatism of government funding sources, and policy to consider sexual problems as
inconsequential.
As a result of these five forces, the average well-trained mental health professional has had limited
educational exposure to clinical sexuality.They are neither comfortable dealing with sexual problems,
skillful in asking the relevant questions, nor able to efficiently provide a relevant focused treatment.
It does not matter much if the professional’s training has been in psychiatric residencies, psychology
internships, counseling internships, marriage and family therapy training programs, or social work
agency placements. Knowledgeable teachers are in short supply. The same paucity of supervised
experiences focusing on sexual disorders, problems, and worries applies to all groups.
In my community, Cleveland, Ohio, there happens to be a relatively large number of highly qual-
ified sexuality specialists. Most moderate to large urban communities, however, have no specialists
who deal with the entire spectrum of male and female dysfunctions, sexual compulsivities, para-
philias, gender identity disorders, and marital relationship problems. Although many communities
have therapists who deal with one part of this spectrum, the entire range of problems exists in every
community.

xvi
 Preface to the First Edition

A remarkable bit of progress occurred in the treatment of erectile dysfunction in 1998. Since
then, primary care physicians, cardiologists, and urologists have been effectively prescribing a
phosphodiesterase-5 inhibitor for millions of men. But, despite the evidence of the drug’s safety
and efficacy, at least half of the men do not refill their prescriptions. There is good reason to
believe that this drop-out rate is due to psychological/interpersonal factors rather than a lack
of the drug’s ability to generate erections. This fact alone has created another reason for mental
health professionals to become interested in clinical sexuality. Most physicians who prescribe
the sildenafil are not equipped to deal with the psychological issues that are embedded in the
apparent failures. The non-responders to initial treatment need access to us. But mental health
professionals need to be better educated in sexual subjects. So there are three reasons for devel-
oping this Handbook: (1) to pass the torch of knowledge to another generation; (2) to better
equip mental health professionals to respond to sexual disorders, problems, and worries as they
appear in their current practice settings; and (3) to help patients to take advantage of the emerging
advances in the medication treatment by helping them to master their psychological obstacles to
sexual expression.
Stephen B. Levine, MD

You Can Do This!

We use this exhortative heading for a reason. “You Can Do This!” is our way of saying that the
Handbook provides coaching, encouragement, and optimism that aim to inspire others to turn their
interests to clinical sexuality. Mental health professionals can learn to competently address their pa-
tients’ sexual worries, problems, and disorders.

How We Created the Handbook

Once the editors decided to say yes to the publisher’s invitation to develop a Handbook, we set our
sights on creating a unique book. We imagined it as a trustworthy, informative, informal, supportive,
and highly valued volume that would encourage and enable mental health professionals to work
effectively with patients with sexual concerns.To attain this lofty goal, we knew that the book would
have to be a departure from the usual excellent book on clinical sexuality.
We created the Handbook through seven steps.
The first step we took was to define the intended audience. We quickly realized, having valued
teaching so highly during our careers, that it was the mental health professional with little formal
clinical training in sexuality.While we thought some readers might be trainees in various educational
programs, we envisioned that most of the readers would be fully trained, competent professionals.We
thought that experienced clinicians would have already had many clients who alluded to their sex-
ual concerns and might have already perceived how their sexual problems may have contributed to
their presenting depression, substance abuse, or anxiety states. We wanted to help the general mental
health professional think about sex in a way that diminished their personal discomfort, increased
their clinical confidence, piqued their interest in understanding sexual life better, and increased their
effectiveness. We wanted professionals to stop avoiding their clients’ sexual problems. We also clar-
ified that we were not trying to create a book that would update sexual experts. We were writing
for those who knew that they needed to learn both basic background material and basic practical
interventions.
The second step was to realize that since we were writing an educational text, our authors were
going to have to be excellent teachers. Excellence as a researcher or a clinician would not be a com-
pelling reason to put a person on the author list.

xvii
 Preface to the First Edition

The third step was to define our strategy for making the Handbook unique. We decided it would
be through our instructions to the authors about how to compose their chapters. We gave them 10
instructions:

1. Use the first-person voice—use I as the subject of some sentences.

2. Imagine when writing that you are talking privately to the reader in a supervisory session.
3. Reveal something personal about your relationship to your subject—how you became inter-
ested in the subject, how it changed your life, how your understanding of the subject evolved
over the years.
4. Imagine that you are guiding your readers through their first cases with the disorder you are
discussing. Do not share everything that you know about the subject! Try not to exceed your
imagined readers’ interest in the topic.
5. Keep your tone encouraging about not abandoning the therapeutic inquiry even if they are
uncertain what to do next.
6. Discuss your personal reactions to patient care as a model for the appearance of countertransfer-
ence. Illustrate how a therapist might use his or her private responses to better understand the
patient.
7. Either tell numerous short patient stories or provide one case in depth. Do not write a concep-
tual paper without clinical illustrations.
8. Annotate at least half of your bibliography.Your reference list is not there primarily to demon-
strate your scholarship; it is there to guide the interested supervisee.
9. Be realistic about the reality of life processes and the limitations of professional interventions.
While we want the readers to be encouraged to learn more, we do not want to mislead them
into thinking that experts in the field can completely solve people’s sexual difficulties.
10. Be cognizant when writing that you are trying to prepare your reader to skillfully and comfort-
ably approach the patient, to gain confidence in his or her capacity to help, and to rediscover the
inherent fascination of sexual life.

The fourth step was the definition of relevant sexual topics.We did not want to deal with uncom-
mon problems—e.g., there was not going to be a chapter devoted to females who want to live as
men, female impersonators, or serial sex murderers. This book was to help with common problems,
ordinary ones, the ones that are often lurking behind other psychiatric complaints. This task was
relatively easy.
The fifth task was slightly more difficult: to decide what basic information was necessary as back-
ground preparation for dealing with the common sexual problems. After this we set about matching
authors to the intended topics.
The sixth step was really fun.We had been told that it was often difficult to get people to write for
edited texts and that it might take 6 months or more to complete the author list. The vast majority
of our esteemed colleagues who were asked said yes immediately and thought that the idea for the
book was terrific. A few needed several weeks to agree. Four pled exhaustion and wished us luck.
The final step—the seventh—involved the review of the manuscripts. It was during this 5-month
process that we, the editors, more fully realized what modern clinical sexology is.While reading these
25 chapters, we realized that as a group we vary considerably in our emphasis on evidence-based,
clinically based, or theory-based ideas. All of us authors, however, speak of having been enriched as
we struggled to better understand and assist people with various sexual difficulties. All of us have seen
considerable progress in our professional lifetimes with our specialty issues. Some of the chapters are
stories of triumphs (treatment of rapid ejaculation, erectile dysfunction, female orgasmic difficulties),
others of disorders still awaiting the significant breakthrough (female genital pain, sexual compulsiv-
ity, sexual side effects of SSRIs). A number of authors address essential human processes that are part

xviii
 Preface to the First Edition

of life (boundaries and their violations, menopausal changes, love), while others are coaching their
readers about how to think of their roles and attitudes (sexual history taking, diagnosis of women’s
dysfunction, transgenderism). Some chapters focus on grave difficulties (aversion, sexual avoidance,
sexual victimizations), and yet others on hidden private struggles that tend to remain unseen by those
around them (homoeroticism in heterosexuals, paraphilias, unhappy marriages). All in all, we find
the field of clinical sexuality fascinating and hope that our readers will rediscover what they used to
know: sex is very interesting!
We designed this Handbook with the idea that the vast majority of readers will look at only the
few chapters that are relevant to their current clinical needs at one sitting. Those who are taking a
course in clinical sexuality and reading the entire Handbook, however, will quickly discover some
redundancy. In editing we objected to any redundancy within a chapter, we were reassured by it in
the book as a whole. This was because it meant to us that teachers of various backgrounds focusing
on different subjects shared certain convictions about the importance of careful assessment, how to
conduct therapy, the limitations of medications, the possibility of being helpful despite not being
expert, etc.
We are deeply indebted to the authors of the Handbook for their years of devotion to their subject
that enabled them to write such stellar educational pieces. As editors, it was a privilege to have been
immersed in their thinking. We hope that our readers feel the same way.
Stephen B. Levine, MD
Candace B. Risen, LISW-S
Stanley E. Althof, PhD

xix
This page intentionally left blank
 PREFACE TO THE
SECOND EDITION

The field of clinical sexuality evolves in response to changing general cultural trends, scientific ad-
vances, shifting professional ideologies, and the personal maturation of its practitioners. In less than
a decade much seems to have changed in how we think about and offer care for sexual problems.
These usually slight, occasionally dramatic shifts are the main reason for bringing out a second edi-
tion of this handbook.
The purposes of this edition are both obvious and subtle.Writers were asked to imagine that they
were directly addressing clinicians who are inexperienced in dealing with people with sexual prob-
lems. Their task was to try to replace their readers’ natural anxiety with a quiet, confident eagerness
to begin the work. Each of these 26 presentations has been designed to provide therapists new to
these problems with what they need to know in order to be credible with their patients. This is the
Handbook’s primary goal.
A more subtle purpose focuses on experienced therapists and teachers. The editors presume
that these readers have sufficient immersion in clinical sexuality to anticipate that our distinguished
assembly of authors would display no uniformity of ideology, agreement about etiology, or consen-
sus about how to think about therapy. When they attentively plunge into a chapter, they are likely
to differ with something being conveyed and to emerge with a novel concept that will refine their
thinking or their teaching. Experienced clinicians already know that they learn from exposure to
the richness of thought of their gifted colleagues. We hope that these readers will appreciate that the
Handbook reflects the state of the art of clinical sexuality in 2010.
Another vital, although understated goal of the Handbook is to set a tone of respect for the unique
challenges that every clinician faces. With almost each patient that they see, inexperienced and vet-
eran therapists alike confront a separate new reality that is complex beyond any author’s capacity
to capture. While we clinicians aspire to base some of our decisions on well-established scientific
evidence, it is apparent that most decisions require us to integrate a set of unique factors that no
single study has yet addressed. This integration creates the challenge, the joy, and sometimes the dis-
appointment of clinical work.
Authors discuss the scientific work that justifies some of their decisions. They recognize that
there are limitations inherent in these studies as well as in their preferred theories and ideologies. As
readers move from chapter to chapter they will notice a differing emphasis on clinical processes and
on scientific findings. This is also reflected in the lengths and annotations of the reference sections.
While all authors are trying to integrate their clinical approaches with seminal work in the literature,
they combine science, theory, and clinical experience in individual ways.

xxi
 Preface to the Second Edition

After using the Handbook a number of times, we hope our readers will feel that numerous authors
have facilitated their understanding that sexuality is an integral part of the ordinary processes of life
and that sexual concerns spring directly from these same processes. If our readers are able to approach
patient care with a heightened awareness of patients’ hopes for their therapy, of the limitations of
modern interventions, and of their professional obligations, we will deem ourselves to have been
successful.
Welcome to the second edition.
Stephen B. Levine, MD
Candace B. Risen, LISW-S
Stanley E. Althof, PhD

xxii
 PREFACE TO THE
THIRD EDITION

This book has a distinct editorial strategy. It is not a typical clinical science book because these are
constructed in the passive voice, employ no first-person pronouns, and by design obliterate the pres-
ence of the writers. Such texts focus on facts gleaned from studies. We have gone out of our way to
enable our readers to realize that our authors, whom we imagine as supervisors of the readers, are
real people with definable personalities, capacities, allegiances, belief systems, and life experiences.
This departure from the time-honored writing style was undertaken because we understand that the
treatment of sexual disorders does not depend only on established facts. In the last analysis treatment
is an amalgam of previously established facts and personal art. Clinical sexuality is a niche psycho-
therapy field, even when a medication is prescribed to diminish a problem. Every form of psycho-
therapy relies on person-to-person interaction, mutual assessment, and the timely artful transmission
of ideas that address the patient’s private psychological or physical concerns. We did not want the
voice of any author to be hidden behind transient facts or theories. We encouraged the authors to
share what they thought was important for their supervisees to understand as they encountered spe-
cific sexual difficulties. It is up to the readers to judge our editorial strategy.
Certain themes recur in many of the Handbook’s chapters. Although authors enunciate these
themes in different ways, a collective experience is being reflected in them. Here are some of the
themes that we have discerned: Sexual problems have multiple determinants. Therapists rarely have
a simple problem to treat; the typical case involves a complex person or an even more complex
entity—the couple. Problems are not typically completely resolved by therapy. Optimism about
improvement and honesty in our efforts are necessary. There are few data sets that demonstrate the
effectiveness of clinical interventions.Therapists grow professionally by maintaining their interest in a
particular problem. What such themes mean, we surmise, is that there are different ways of knowing.
Behavioral science, clinical science, pharmacological science, clinical experience, intuition, political
ideology, and personal experience interact in unknowable ways to generate our concepts of what
is therapeutic. This is the fascinating, humbling, and sometimes confusing state of our art in 2015.
This third edition of the Handbook documents the maturation of its returning authors. The new
authors provide readers with topics that fill in some of the gaps in the second edition. Many authors
comment on powerful new cultural changes that have affected or will affect sexual patterns and
their treatment. The overarching goal of this edition is to provide valuable guidance for therapists to
approach their patients with interest, knowledge, and confidence. Some of our readers will be new
to the field, while more seasoned therapists may be new to a particular problem.

xxiii
 Preface to the Third Edition

It is no easy task to write a chapter, even for those who have written many. Professionals are busy
individuals with multiple life demands. Writing does not come easily to many otherwise accom-
plished people. The reward for carving out many weeks to prepare and refine a chapter is neither
money, fame, nor academic promotion. Rather, it is the knowledge that one’s efforts will be helpful
to readers and that the readers will, in turn, benefit patients. Thus, although the names of the authors
may soon be forgotten, the writers’ reward is to be able to help individuals they will never meet. It
is difficult to express our gratitude in words to the 37 professionals who contributed to this volume.
We honor the professional altruism that generated their fine contributions.
Stephen B. Levine, MD
Candace B. Risen, LISW-S
Stanley E. Althof, PhD
May 2015

xxiv
Another random document with
no related content on Scribd:
 ‘That man was made to mourn.’ The title and refrain of ‘A
Dirge’ by Burns.
10. ‘Between the acting,’ etc. Julius Cæsar, Act II. Sc. 1.
With Atlantean shoulders,’ etc. Paradise Lost, II. 306.
11. ‘Grinned horrible,’ etc. Ibid. II. 846.
‘Like two clouds,’ etc. Cf. Ibid. II. 714–716.
12. Jackson. Presumably John Jackson (1769–1845), the well-
known pugilist (retired 1803), known as ‘Gentleman
Jackson.’
Note. Scroggins. Jack Scroggins, another well-known
prizefighter.
Note. ‘In doleful dumps,’ etc. Chevy-Chace, st. 50.
13. Procul este profani. Æneid, VI. 258.
14. Ned Turner. Ned Turner (1791–1826), the conqueror of
Scroggins.
Broughton and George Stevenson. Jack Broughton’s (1704–
1789) fight with George Stevenson ‘The Coachman,’ took
place, not in 1770, but in 1741.
 MERRY ENGLAND
First republished in Sketches and Essays.

16. ‘I have been merry,’ etc. Cf. 2 Henry IV., Act V. Sc. 3.
‘He chirped over his cups.’ Rabelais. See vol. I. (The Round
Table), p. 52.
‘There were pippins,’ etc. Sir Hugh Evans in The Merry
Wives of Windsor, Act I. Sc. 2.
‘Continents,’ etc. Hobbes, Human Nature (Works, ed.
Molesworth, IV. 50).
‘They ... amused themselves,’ etc. Cf. vol. I. (The Round
Table), note to p. 100.
‘Eat,’ etc. S. Luke XII. 19.
17. ‘Hair-breadth ‘scapes.’ Othello, Act I. Sc. 3.
Old Lord’s cricket-ground. Hazlitt refers to the original
‘Lord’s,’ established about 1782 by Thomas Lord, on the
site now occupied by Dorset Square, where the game
continued to be played till 1810. The present ‘Lord’s,’ dates
from 1814.
18. ‘A cry more tuneable,’ etc. Cf. A Midsummer Night’s Dream,
Act IV. Sc. 1.
Note. ‘The gentle and free passage of arms at Ashby.’
Described by Scott in Ivanhoe, chap. viii.
19. ‘Brothers of the angle.’ The Compleat Angler, part I. chap. i.
‘The Cockney character,’ etc. This sentence was omitted in
Sketches and Essays.
20. ‘Book of Sports.’ James I.’s declaration (1618) authorising
certain forms of recreation after divine service on Sundays.
The declaration was republished by Charles I. in 1633.
 ‘And e’en on Sunday,’ etc. Burns, Tam O’Shanter.
Gilray’s shop-window. Miss Humphrey’s shop, 29 St.
James’s Street, where James Gilray (1757–1815), the
caricaturist, spent the last years of his life, and where his
works were on view. Sketches and Essays prints ‘Fore’s
shop-window.’
22. ‘Merry and wise.’ ’Tis good to be merry and wise,’ a
frequently quoted old proverb.
‘That under Heav’n,’ etc. The Faerie Queene, I. vii. 32. Cf. also
Marlowe’s Tamburlaine the Great, Part II. Act IV. Sc. 4.
24. Nell, etc. Nell in The Devil to Pay; Little Pickle in The Spoil’d
Child, a part created by Mrs. Jordan, March 22, 1790;
Lingo in The Agreeable Surprise; Nipperkin in Sprigs of
Laurel, a part created by Munden, May 11, 1793; old
Dornton in The Road to Ruin; Ranger in The Suspicious
Husband; the Copper Captain in Rule a Wife and Have a
Wife, one of Lewis’s great parts; Filch in The Beggar’s
Opera; Hodge in Love in a Village; Flora in The Wonder;
Lady Grace in The Provoked Husband.
‘Tut!’ etc. Cf. Cymbeline, Act III. Sc. 4.
‘What’s our Britain,’ etc. Ibid.
25. As I write this, etc. See vol. IX. (Notes of a Journey through
France and Italy), pp. 281 et seq.
‘And gaudy butterflies,’ etc. Cf. Gay, The Beggar’s Opera, Act
I. Sc. 1.

‘All appliances,’ etc. 2 Henry IV., Act III. Sc. 1.

ON PERSONS ONE WOULD WISH TO HAVE
SEEN
Republished in Literary Remains and Winterslow.

26. ‘Come like shadows,’ etc. Macbeth, Act IV. Sc. 1.

B——. B—— here and throughout the essay is Lamb. The
essay professes to describe a conversation which took place
at one of Lamb’s ‘Wednesdays’ at 16 Mitre Court Buildings,
where Lamb resided from 1801 to 1809. Hazlitt (p. 27)
describes the conversation as having taken place ‘twenty
years ago.’
The defence of Guy Faux. See vol. XI. pp. 317 et seq. and notes.
‘Never so sure,’ etc. Cf. Pope, Moral Essays, II. 51–2.
A——. Here and throughout the essay William Ayrton (1777–
1858), the musician.
27. ‘In his habit,’ etc. Hamlet, Act III. Sc. 4.
Fulke Greville. See vol. V. (Lectures on the Age of Elizabeth),
p. 231 and note, and Lamb’s Specimens of English
Dramatic Poets.
‘And call up him,’ etc. Il Penseroso, 109–110.
28. Wished that mankind, etc. Religio Medici, Part II. Sec. ix.
The portrait prefixed to the old edition. Mr. W. C. Hazlitt, in
Memoirs, etc. (1867), vol. I. p. 276 note, suggests that
Hazlitt refers to the 12mo edition of 1669 which Lamb
possessed.
‘Here lies a She-Sun,’ etc. Poems (‘Muses Library’) I. 86,
Epithalamion on the Lady Elizabeth and Count Palatine.
29. ‘Lisped in numbers,’ etc. Pope, Prologue to the Satires, 128.
30.
 His interview with Petrarch, etc. The editor of The New
Monthly Magazine adds a footnote: ‘Query, did they ever
meet?’ Chaucer was in Italy in 1372–3, and may have met
Petrarch. Cf. The Canterbury Tales, The Clerk’s Prologue,
to which Hazlitt no doubt refers. Chaucer may have met
Boccaccio also.
A fine portrait of Ariosto. Hazlitt possibly refers to the
‘Portrait of a Poet’ in the National Gallery, now ascribed to
Palma. Titian’s portrait of Aretine is in the Pitti Gallery.
‘The mighty dead.’ Thomson, The Seasons, Winter, 432.
‘A creature,’ etc. Cf. Comus, 299–301.
‘That was Arion,’ etc. The Faerie Queene, IV. xi. 23.
Captain C. Captain Burney; M. C., Martin Burney. See vol. VI.
Table-Talk, note to p. 209.
31. Miss D——. In Literary Remains this name is given as ‘Mrs.
Reynolds,’ presumably the lady who had been Lamb’s
schoolmistress. See Lamb’s Letters, ed. W. C. Hazlitt, I. 121.
A harsh, croaking voice. Not to be identified. As to Johnson’s
life during 1745–6 see Boswell’s Life (ed. G. B. Hill), I. 176
and notes.
‘With lack-lustre eye.’ As You Like It, Act II. Sc. 7.
‘Despise low joys,’ etc. Imitations of Horace, Epistles, I. vi. (to
Mr. Murray), 60–62.
‘Conspicuous scene,’ etc. Ibid. 50–53.
‘Why rail they then,’ etc. Epilogue to the Satires, II. 138–9.
32. ‘But why then publish,’ etc. Prologue to the Satires, 135–146.
E——. In Literary Remains and Winterslow this blank is
filled with the name of ‘Erasmus Phillips,’ but Hazlitt must
refer to Lamb’s lifelong friend, Edward Phillips, secretary
to Speaker Abbott (see Lamb’s Letters, ed. W. C. Hazlitt, I.
76; II. 346), or, possibly, to Colonel Phillips (Ibid. II. 148,
346).
33. ‘Nigh-sphered in Heaven.’ Collins, Ode, On the Poetical
Character, 66.
J. F——. According to Literary Remains this was Barron Field
(1786–1846).
34. ‘A vast species alone.’ Cowley, The Praise of Pindar, l. 2.
G——. Godwin, according to Literary Remains.
Eugene Aram. Eugene Aram (1704–1759), hanged in 1759 for
the murder of Daniel Clark several years earlier at
Knaresborough.
H——. Literary Remains reads ‘Hunt.’
35. The Duchess of Bolton. Lavinia Fenton (1708–1760), the
original Polly, married the third Duke of Bolton in 1751.
Captain Sentry. See The Spectator, No. 2.
36. Giotto, etc. Giotto di Bondone (d. 1337), Giovanni Cimabue (?
1240–? 1302), and Domenico Bigardi (1449–1494), known
as Ghirlandaio—three of the most famous early Florentine
masters.
‘Whose names,’ etc. See vol. X. (Contributions to the
Edinburgh Review), note to p. 63.
37. The Duchess of Newcastle. Lamb is never tired of praising
her. See, e.g., The Two Races of Men (Elia).
Mrs. Hutchinson. Lucy Hutchinson (b. 1620). Her Life of her
husband, Colonel Hutchinson, was first published in 1806.
One in the room, etc. Mary Lamb.
Ninon de l’Enclos. Ninon de Lenclos (1616–1706), the famous
beauty.
‘Your most exquisite reason.’ Cf. Twelfth Night, Act II. Sc. 3.
G——. Godwin, according to Literary Remains.
‘Oh! ever right,’ etc. Cf. Coriolanus, Act II. Sc. 1.
‘There is only one other person,’ etc. It should be noted that
Literary Remains and Winterslow wrongly attribute this
speech to Lamb. The Magazine clearly gives it to H——, that
is, to Leigh Hunt. It is, of course, conceivable that the editor
of Literary Remains silently corrected an error in the
Magazine, but that does not seem likely, because, in the
first place, the speech seems more characteristic of Hunt
than of Lamb, and, secondly, because the volume of the
New Monthly (XVI.) in which the essay appeared contains a
list of errata in which two corrections (one of them relating
to initials) are made in the essay and yet this ‘H——’ is left
uncorrected.
 ON THE CONVERSATION OF LORDS
Published in Sketches and Essays.

PAG
E
‘An infinite deal of nothing.’ The Merchant of Venice, Act I.
38. Sc. 1.
39. ‘The wish,’ etc. 2 Henry IV., Act IV. Sc. 5.
40. ‘Bestow his tediousness.’ Cf. Much Ado About Nothing, Act III.
Sc. 5.
41. ‘Treatise on Horsemanship.’ The Duke of Newcastle (1592–
1676), husband of Lamb’s favourite (see ante, note to p.
37), wrote two works on horsemanship, (i) La Methode et
Invention Nouvelle de dresser les Chevaux (Antwerp,
1657), and (ii) A New Method and Extraordinary
Invention to Dress Horses, etc. (1667). Hazlitt probably
refers to the first, which was published in English with 43
plates in vol. I. of A General System of Horsemanship
(1743).
‘A question,’ etc. 1 Henry IV., Act II. Sc. 4.
‘The act’ [art], etc. Henry V., Act I. Sc. 1.
42. ‘The feast of reason,’ etc. Pope, Imitations of Horace, Satire I.
l. 128.
‘Catch glimpses,’ etc. Cf. Wordsworth’s sonnet ‘The world is
too much with us,’ etc.
43. ‘Face to face,’ etc. Cf. 1 Corinthians xiii. 12.
‘With jealous leer malign.’ Paradise Lost, IV. 503.
‘Best can feel them,’ etc. ‘He best can paint them who shall
feel them most.’ Pope, Eloisa to Abelard, 366.
The Roxburgh Club. Founded in 1812 to celebrate the sale of
the third Duke of Roxburgh’s great library.
 ‘With sparkling eyes,’ etc. Cf. Watts, Hymns and Spiritual
Songs, Book II. Hymn 65.
44. ‘Pure in the last recesses,’ etc. Cf. Dryden, Translations from
Persius, Sat. II. l. 133.
‘Or write,’ etc. Cf. Pope, Epilogue to the Satires, I. 137.
45. ‘Held on their way,’ etc. See vol. IV. (Reply to Malthus), note
to p. 42.
‘The labour’ etc. Macbeth, Act II. Sc. 3.
46. ‘From every work,’ etc. The Faerie Queen, I. iv. 20.
Otium cum dignitate. Cicero, Pro P. Sestio, c. 45.
N——. Probably Northcote.
A celebrated critic. ? Jeffrey, whom Hazlitt had visited at
Craigcrook.
47. ‘That there are powers,’ etc. Wordsworth, Expostulation and
Reply, 21–24.
50. ‘A man’s mind,’ etc. Cf. Antony and Cleopatra, III. 13.
The Letter to Sir William Wyndham. Published by Mallet in
1753.
Lord Bolingbroke had, it seems, etc. This cannot be true,
though Chatham’s admiration of Bolingbroke’s eloquence is
well known.
‘As if a man,’ etc. Coriolanus, v. 3.
 ON A SUN-DIAL
First republished in Sketches and Essays, where it is said to have
been written in Italy in 1825.

51. ‘To carve out dials,’ etc. 3 Henry VI., Act II. Sc. 5.
52. ‘Morals on the time.’ Cf. As You Like it, Act II. Sc. 7.
54. ‘How sweet the moonlight,’ etc. The Merchant of Venice, Act
V. Sc. 1.

The account given by Rousseau, etc. Hazlitt is probably

referring to a somewhat similar story told in Les
Confessions, Partie II. Livre XI.
55. ‘Allons, mon fils,’ etc. Les Confessions, Partie I. Livre I.
‘Lend it,’ etc. Cf. Hamlet, Act I. Sc. 2.
‘With its brazen throat,’ etc. Cf. King John, Act III. Sc. 3.
‘Swinging slow,’ etc. Il Penseroso, 76.
56. Even George IV., etc. This sentence is omitted in Sketches
and Essays.
‘The poor man’s only music.’ Coleridge, Frost at Midnight,
29.
57. Goes to church, etc. Cf. Twelfth Night, Act I. Sc. 3.
‘Sing those witty rhymes,’ etc. Cf. Wordsworth, The
Fountain, 13–15.
58. ‘As in a map,’ etc. Cowper, The Task, VI. 17.
‘With light-winged toys,’ etc. Cf. Othello, Act I. Sc. 3.
‘Diana and her fawn,’ etc. Hazlitt seems to be quoting from
himself. See vol. IX. p. 107.
59. ‘With lack-lustre eye.’ As You Like It, Act II. Sc. 7.
I have done something of the kind before. Hazlitt probably
refers to the sketch of his father in ‘My First Acquaintance
with Poets’ (post, pp. 262–3). Cf. also vol. III. (Political
Essays), pp. 265–6.
 WHY THE HEROES OF ROMANCE ARE
INSIPID
Published in Sketches and Essays.

60. ‘To gild refined gold,’ etc. King John, Act IV. Sc. 2.
‘Faultless monsters.’ John Sheffield, Duke of Buckingham,
Essay on Poetry.
61. The grand Cyruses, the Artamenes. Mlle. de Scudéry’s
Artamène ou le Grand Cyrus was published in 10 vols.,
1649–53.
Oroondates. In La Calprenède’s Cassandra.
‘Mistress’ eyebrow.’ As You Like It, Act II. Sc. 7.
62. ‘Be mine,’ etc. Gray, Letters (ed. Tovey), I. 97.
‘The Princess of Cleves.’ By Madame de la Fayette (1678).
The Duke de Nemours. In La Princesse de Clèves.
‘Ugly all over,’ etc. See vol. II. (Life of Holcroft), note to p.
130.
64. Narcissa and Emily Gauntlet. Narcissa in Roderick Random;
Emily Gauntlet in Peregrine Pickle; Winifred Jenkins in
Humphry Clinker.
‘Her heroes,’ etc. Cf. ‘Most women have no characters at all.’
Pope, Moral Essays, II. 2.
Theodore, Valancourt. Theodore in The Romance of the
Forest; Valancourt in The Mysteries of Udolpho.
65. Miss Milner. Miss Milner and Dorriforth in A Simple Story
(1791); Lord Norwynne in Nature and Art (1796).
67. ‘All germins,’ etc. King Lear, Act III. Sc. 2.
‘Tears such as angels shed [weep].’ Paradise Lost, I. 620.
 THE SHYNESS OF SCHOLARS
Republished in Literary Remains.

68. ‘And of his port,’ etc. The Canterbury Tales. The Prologue,
69.
‘If you have not seen,’ etc. Cf. As You Like It, Act III. Sc. 2.
70. ‘Fools rush in,’ etc. Pope, An Essay on Criticism, III. 625.
71. ‘In peace,’ etc. Henry V., Act III. Sc. 1.
72. ‘Gods of his idolatry.’ Cf. Romeo and Juliet, Act II. Sc. 2.
73. ‘Will not have,’ etc. Cf. Coriolanus, Act II. Sc. 2.
‘Vix ea nostra voco.’ Ovid, Metam. XIII. 141.
75. ‘Scholar’s melancholy.’ As You Like It, Act IV. Sc. 1.
‘He held,’ etc. Cf. Gray’s Elegy, Stanza III., which Hazlitt
seems to have had in mind.
‘From humble porter [port],’ etc. Townley, High Life Below
Stairs, II. 1.
76. ‘Modest as morning,’ etc. Troilus and Cressida, Act I. Sc. 3.
‘Deprived of its natural patrons,’ etc. Cf. Burke, Reflections
on the Revolution in France (Select Works, ed. Payne, II.
93).
 THE MAIN-CHANCE
Published in Literary Remains with omissions and a few
additions. The additions are printed in the text within square
brackets. In other respects the Essay is printed verbatim from the
Magazine.

78. ‘Search then,’ etc. Pope, Moral Essays, III. 174–179.

82. ‘Sown,’ etc. Cf. Middleton, The Witch, Act I. Sc. 2.
83. Mr. F. Beckford sold Fonthill to John Farquhar in 1822.
86. Note. ‘Men act from calculation,’ etc. Cf. Principles of Morals
and Legislation, Ch. XIV. Sec. xxviii.
Note. ‘A Mad World.’ etc. John Taylor, Wandering to see the
Wonders of the West (1649).
88. ‘Now all ye ladies,’ etc. These lines by Scott form the motto of
chap. xii. of The Betrothed, where they are entitled ‘Family
Quarrels.’
Note. ‘Have I not seen,’ etc. The Betrothed, chap. XII.
Note. ‘I would take,’ etc. Hamlet, Act III. Sc. II.
Note. Dr. Jamieson. John Jamieson (1759–1838), whose
Etymological Dictionary of the Scottish Language
appeared in 1808.
90. ‘Some trick,’ etc. Coriolanus, Act IV. Sc. 4.
91. Mr. Bartholine Saddletree. In The Heart of Midlothian.
Peter Peebles. In Redgauntlet.
The Baron of Bradwardine, etc. In Waverley.
‘The age of chivalry,’ etc. Burke, Reflections on the
Revolution in France (Select Works, ed. Payne, II. 89).
‘Smack of honour.’ Macbeth, Act I. Sc. 2.
93. ‘An ounce,’ etc. Cf. The Faerie Queene, I. iii. 30.
95. ‘Masterless passion,’ etc. Cf. The Merchant of Venice, Act IV.
Sc. 1.
 SELF-LOVE AND BENEVOLENCE
These two papers were republished in Sketches and Essays (1839),
but were omitted in the second edition (1852). Mr. W. C. Hazlitt
restored them in his edition in Bohn’s Standard Library, where he
states that they were written in Italy in 1825, and represent a
conversation between the author, Landor and Captain Medwin.

PAG
E ‘Sound significant.’ Hazlitt was perhaps thinking of Milton’s
96. words, ‘the sound symphonious.’ Paradise Lost, VII. 558.
‘These needs,’ etc. Hamlet, Act I. Sc. 5.
99. ‘Nihil humani,’ etc. Terence, Heauton-Timoroumenos, I. 1.
‘Greater love,’ etc. Cf. St. John XV. 13.
102. ‘Letting I should not,’ etc. Cf. Macbeth, Act I. Sc. 7.
104. ‘Throw honour,’ etc. Cf. Ibid. Act V. Sc. 3.
104. Very’s. A well-known restaurant in Paris. Cf. Moore’s The
Fudge Family in Paris, Letter III.
The Count de Stutt-Tracy. See Vol. VII. (The Plain Speaker),
p. 323 and note.
105. ‘This one entire,’ etc. Othello, Act V. Sc. 2.
‘Precious jewel,’ etc. Cf. Ibid. Act III. Sc. 3.
‘Plain truth,’ etc. Cf. Pope, Imitations of Horace, Epistles, I. 6,
l. 3.
C. D. See post, note to p. 119.
‘I shall be ever,’ etc. Cf. Garrick’s verses in reply to Dr. John
Hill. They are quoted in Doran’s Annals of the English
Stage, II. 326.
106. ‘No more of that,’ etc. 1 Henry IV., Act II. Sc. 4.
108. ‘Come, but no farther,’ Job xxxviii. 11.
112. ‘Come, let me clutch thee.’ Macbeth, Act II. Sc. 1.
113. ‘And coming events,’ etc. Campbell, Lochiel’s Warning.
115. ‘Made and moulded of things past.’ Troilus and Cressida, Act
III. Sc. 3.

‘Thou art to continue,’ etc. Measure for Measure, Act II. Sc. 1.
‘Here and hereafter,’ etc. Byron, Sardanapalus, Act IV. Sc. 1.
116. ‘I do not think,’ etc. See vol. VII. (Essay on the Principles of
Human Action), pp. 430–3.
119. J. D. Mr. W. C. Hazlitt, in his edition of Sketches and Essays,
states that on a folio leaf in his possession, the initials are J.
L. and C. L., and that Lamb and his brother are evidently
the persons intended. If that be so, A. and C. can hardly be
Landor and Medwin. Possibly A. represents Ayrton and
Captain C. Captain Burney, but all the initials are merely
matter for conjecture, and it is extremely unlikely that the
dialogue ever took place in anything like its present form.
‘This is the strangest tale,’ etc. 1 Henry IV., Act V. Sc. 4.
 THE FREE ADMISSION
Now republished for the first time. See Mr. W. C. Hazlitt’s
Memoirs, etc., I. xxx.

120. ‘Loop-holes of retreat.’ Cowper, The Task, IV. 88.

121. ‘He is all ear and eye,’ etc. Cf. Comus, 560–2.
‘The fly,’ etc. The Beggar’s Opera, Act II. Sc. 2.
‘Oh! leave me,’ etc. Cf. Gray, The Vegtam’s Kivitha.
My beloved corner. See Mr. W. C. Hazlitt’s Memoirs, etc., I.
205.
‘The arm-chair at an inn. ‘A tavern chair is the throne of
human felicity.’ Johnson (Boswell’s Life, ed. G. B. Hill, II.
452, note 1).
‘Witching time of night.’ Hamlet, Act III. Sc. 2.
‘Like bees in spring-time,’ etc. Paradise Lost, I. 768–9.
122. ‘A discipline of humanity.’ Bacon (Essays, ‘Of Marriage and
Single Life’) applies the phrase to wife and children. Hazlitt
himself applies it to books (vol. I. The Round Table, p. 123).
‘Retire, the world shut out,’ etc. Young, Night Thoughts, IX.
‘Still, small voice.’ 1 Kings xix. 12.
Miss Ford. Hazlitt refers to Miss Forde as Cherry in The
Beaux Stratagem (revived Covent Garden, Dec. 31, 1828).
In Lectures on the Comic Writers (VIII. 88) he refers to the
dialogue in Act III. Sc. 2 as a ‘love catechism.’
Mrs. Humby. Mrs. Humby (fl. 1817–1849) played Luise in
Planché’s The Green-eyed Monster at the Haymarket, Aug.
18, 1828. Wilkinson played Krout.
Mrs. Goodall’s Rosalind. Charlotte Goodall, after acting at
Bath, made her first appearance in London (Drury Lane,
 Oct. 2, 1788) as Rosalind. Nothing is known of her after
1813, when she was divorced.
122. ‘Blow, blow,’ etc. As You Like It, Act II. Sc. 7.
‘Strut and fret,’ etc. Macbeth, Act V. Sc. 5.
123. ‘See o’er the stage,’ etc. Cf. Thomson, The Seasons, Winter,
646–8.
‘Takes his ease.’ Cf. 1 Henry IV., Act III. Sc. 3.
124. ‘All that mighty heart,’ etc. Cf. Wordsworth’s Sonnet, Earth
has not anything to shew more fair, etc.
‘Thy freedom,’ etc. Cf. ‘Thy beauty hath made me effeminate.’
Romeo and Juliet, Act III. Sc. 1.
‘Teddy the Tiler.’ A farce by G. H. B. Rodwell (1800–1852),
produced at Covent Garden, Feb. 8, 1830.
‘Robert the Devil.’ A ‘Musical Romance’ by Raymond,
produced at Covent Garden, Feb. 2, 1830.
‘What avails,’ etc. The Rev. Sneyd Davies, To the Honourable
and Reverend F. C. (Dodsley, A Collection of Poems, VI.
138).
‘The frozen winter,’ etc. Hazlitt is quoting loosely from
Paradise Lost, IV. 267–8.
Cowley’s Gallery. The reference is to Cowley’s The Chronicle.
 THE SICK CHAMBER
First republished in the volume of Selections edited by Mr.
Ireland, who states, apparently upon the evidence of dates and the
nature of the subject, that this was the last essay which Hazlitt wrote.
This cannot be certainly known, and it seems more likely that the
essay on ‘Personal Politics’ (post, pp. 456–61) was written later. The
essay on ‘Footmen’ appeared in a later number of the New Monthly.
Hazlitt died on Sept. 18, 1830.

PAG
E ‘The body of this death.’ Romans vii. 24.
125. ‘Cooped and cabined in.’ Cf. Macbeth, Act III. Sc. 4.

‘Peep through the blanket,’ etc. Macbeth, Act I. Sc. 5.

‘A consummation,’ etc. Hamlet, Act III. Sc. 1.
Hoc erat in votis. Horace, Satires, II. vi. 1.
126. ‘Our very gorge,’ etc. Cf. Hamlet, Act V. Sc. 1.

‘Hermit poor,’ etc. These lines are quoted in Lamb’s John

Woodvil, Act V.
‘Vows made in pain’ etc. Paradise Lost, IV. 97.
‘The Devil,’ etc. This old proverb is quoted by Rabelais, Liv. IV.
Chap. 24.
127. ‘Like life and death,’ etc. Cf. Lamb, John Woodvil, Act II.
‘Trouble deaf Heaven,’ etc. Cf. Shakespeare’s Sonnets, No.
XXIX.

‘Moralise our complaints,’ etc. Cf. As You Like It, Act II. Sc. 1.
‘They have drugged,’ etc. Cf. Macbeth, Act II. Sc. 2.
‘Puzzling o’er the doubt.’ Cf. Cowper, The Needless Alarm,
77–78.