Alexander Portnoy is the title character and the narrator of Portnoy’s Complaint. The novel’s title is revealed to be the name of a medical condition that is named after Alex. His doctor outlines the anxieties that make up Alex’s diagnosis: Alex is caught in a constant tension between his unrelenting sexual urges and the guilt and shame that he feels because of them. Dr. Spielvogel outlines this diagnosis thanks to the therapy sessions which constitute the bulk of the novel. These sessions function as an extended monologue in which Alex talks by himself. These monologues are nonlinear; Alex jumps between memories without any regard for chronology, simply associating thoughts, feelings, and perceived insults to leap from one memory to the next. The entire medical theory of Portnoy’s Complaint is based on these vivid, self-contained recollections.

In this sense, Alex is not a reliable narrator. He is so concerned with his guilt and shame that the version of himself that he presents to the therapist is thoroughly subjective. Alex admits to many profane acts during the sessions, but he also makes a concerted attempt to bond with the therapist. Whether through his intellectual vanity, his attempts to make self-deprecating jokes, or the parts of his life that he leaves out of the stories altogether, Alex presents a version of himself that is self-loathing, sympathetic, and ultimately cursed to live the life he leads.