Tuesday, November 17, 2015

AASECT Position on Sexual Expression including Orientation and Identity

Sexual Expression including Orientation and Identity: 
Treatment and Education Foundations

It is the position of the American Association of Sexuality Educators, Counselors, and Therapists that we oppose any and all therapy models and interventions as well as any educational programs and curricula that seek to pathologize, dictate, or prescribe a person’s sexual orientation, identity, and/or consensual, sexual expression, whether or not it is conventional or atypical.  Regardless of how such clinical interventions or educational programs are labeled or named, AASECT recommends all helping and educating professionals to utilize best practices and culturally relevant resources for foundation and reference.

Furthermore:  AASECT affirms that sexuality is central to the human experience and sexual rights must be honored in order for sexual health and overall well-being to be obtained.  Informed by the best empirical research, AASECT recognizes human sexual experiences as diverse and supports the acceptance of sexual diversity while embracing consensual sexual expression within the framework of human rights and social justice.

AASECT accepts the evidence that human sexual experience includes a vast spectrum of sexual expression, orientation, and identities. These sexualities, between consenting adults when agreed upon, with permission, and assenting, are typically not psychopathological behaviors. Indeed, recent peer-reviewed research on these sexual experiences shows no correlation to pathology.

AASECT further asserts that all people seeking treatment and education about consensual sexual behavior, identity, or orientation deserve accurate information.  AASECT accepts that the empirical evidence is reasonably complete on reparative and conversion therapies that attempt to change sexual orientation or identity and shows that these techniques are experimental at best and overwhelmingly ineffective, with harmful consequences for clients widely documented.

AASECT takes the position that social justice plays an essential and foundational role in the organization’s mission.  Individuals have the right to be free as possible from undue constraints (e.g. discrimination, stigmatization, oppression and violence) along with the freedom to consensual sexual expression. Destigmatizing human sexual expression and experiences as well as creating and maintaining safe space for those who have been traditionally marginalized are essential practices for AASECT members who are predominately mental health practitioners and educators.  This overarching goal compels AASECT to disavow any therapeutic and educational effort that, even if unwittingly, violates or impinges on AASECT’s vision of human rights and social justice.

We are here to make sure that you don't think AASECT wrote the remainder of this post!  And don't forget to read our fine print:  Of course you may use parts of this  post to improve therapy for kinky folk anywhere in the world you serve them!  Attribution is nice!

On November 12, 2015, the AASECT Board of Directors unanimously adopted this position statement as recommended by its Public Relations, Media, and Advocacy Steering Committee.  I was one of a large group of interested people in AASECT who participated in this process.  The policy statement is obviously the official position of the entire organization.  The remarks immediately below are my interpretations, not official AASECT policy:

Alfred Kinsey (1894-1956).  His pioneering research on American Sexuality revealed its diversity was far greater than conventionally imagined then, and even now.

With this passage of this position, AASECT is officially on record as supporting BDSM, polyamory and consensual non-monogamy as potentially sexually healthy lifestyle choices and behaviors.  This constitutes full implementation of Kinsey’s ideas about the broad range of sexually healthy behaviors.

This statement does not mean that sexual variability is always healthy, and it does not mean that it is usually without risks, but it does mean that educators and clinicians have the responsibility to remain neutral about these possibilities until given clinical data to question otherwise.   I would advise doing so even when sexual behavior is a specific axis of complaint in a client’s reasons for coming to treatment. 

This statement also bars devising treatments or educational programs specifically designed or marketed to stigmatize, marginalize or derogate unconventional but consensual sexual choices.  Society will continue to criminalize some forms of sexual conduct, and the clinical community must remain responsive to law, but the statement only applies to consensual activities.

The explicit target of this statement is reparative or conversion therapies, and it was crafted to include other therapies used for reparative purposes, regardless of how they are otherwise labelled or used.  A great example would be any measure of compulsive sexual behavior or ‘sex addiction’ that uses assessment measures that list such activities as polyamory, swinging, or BDSM to generate a score used to confer a diagnostic label.  While BDSM might be problem sexual behavior, any measure that automatically labelled it as such would be defective under the intent of this policy.   This targets the same bias that changes in the DSM – 5, published in May of 2013, partially implemented in the Paraphilias section.  There, a distinction was drawn between non-pathological variation, ‘paraphilias,’ and paraphilias that were non-consensual or the focus of client complaints; paraphilic disorders. Variant behavior is not pathological in and of itself.

Likewise, it would be an unethical and defective business practice to advertise that one changes sexual orientation, variant behavior, or sexual desire per se, even though one might ethically contract with an individual patient who complained that variant orientation or behavior was a problem.  Such advertising is doubly defective, in that it is not only stigmatizing of behaviors or identities that deserve protection as sexual human rights, but it is scientifically defective given that reparative and conversion therapies have repeatedly been found ineffective in rigorous scientific evaluation.  Thus it is also a violation of this statement to undertake a therapy to change orientation, desire or behavior without explicitly contracting up front with the client that such an attempt involves therapeutic techniques which are experimental and unproven for such purposes.

Note, however, that this is a position statement.  It does not specify how AASECT might deal with the problems of dual certification if an individual practitioner affiliates with an organization which has members that do any of these unprofessional things.  A Member might complain to AASECT Ethics Advisory Committee (EAC) about another Member who was perceived as violating the position statement, and the EAC might issue an advisory opinion to the Membership about such behavior.  In serious cases that could not be resolved by negotiation, the Board might choose to discipline a member who was found to be violating our Code of Ethics or practice standards.  This is an advocacy statement, not a disciplinary policy.

Anyone who encounters advertising, practitioners, or organizations that claim to be working in the fields of sexual health and education that seem to be violating this policy should contact them and request that they stop.  If they persist, The National Coalition for Sexual Freedom, the Woodhull Foundation, and/or the major LGBTQ organizations should be contacted.  All have reparative therapy policies in place, and actions they can take.  A few states have passed legislation specifically barring gay reparative therapies, and the list is growing.  Licensing and certifying bodies in those jurisdictions will be resources in stopping these practices. Similar legislation does not commonly protect consensual non-monogamy or BDSM practices.

Members and the public are correct to feel that such a position changes the practice landscape.  The statement begs for extra care in making sure that kinks are the main problem that clients want to become the focus of treatment.  It pushes us to check to see if problems of occupational and life functioning stem primarily from the kink itself, or are primarily the consequences of identity problems associated with assuming a stigmatized social status.  It acknowledges that diagnostic labels function both ways; sometimes allowing access to treatment and as a source of reassuring meanings, yet also conferring shame, promoting dependency, and marginalizing some clients.

It is hoped that AASECT will challenge our partner sexual health organizations in the North American Federation of Sexuality Organizations (NAFSO) and The World Association of Sexual Health (WAS) to adopt this or similar language, and to bar sexuality organizations that decline to do so.  For this is an excellent, and much needed step in advocacy efforts to promote quality sexual health care for kinky clients, but it is far from the last step necessary to secure these ends.

Thank you AASECT!

© Russell J Stambaugh, May 2015, Ann Arbor MI, All rights reserved, but permission is granted for sexual health advocacy purposes.


Tuesday, November 3, 2015

Erving Goffman: The Presentation of Kink in Everyday Life

Erving Goffman (1922-82), Canadian sociologist

The Social Constructionist view was a product of the merging of sociology and psychology that resulted in sociology broadening its focus from social organizations to interest in the ways individuals participate in social life.  By far one of the most influential single contributors to this movement was Erving Goffman.

Goffman was born in rural Canada, his parents Jewish Ukrainian immigrants.  He worked on the stage and in film before starting his academic career.  He thus brought lessons of an outsider from the world of acting to his academic work as a sociologist.  So much so, in fact, that his discipline was often called dramaturgical analysis.

George Herbert Mead (1863-1931)  American sociologist and principle contributor to role theory, and the concept of 'self.' 
There already existed a powerful tradition within sociology to look at society in terms of social roles, the legacy of the early twentieth century sociologist George Herbert Meade.  Meade launched role theory as a consequence of his investigation of social structure.  He recognized that industrial society had an increasingly diversified division of labor, and the rules of work life varied tremendously depending on the kind of work role an individual held.  Managers had different roles than production workers, who had different roles than sales workers, etc.  By the 1950’s, however, sociology began to look at the idea that roles were important in private life as well as public life, in part influenced by the rising social and economic recognition that people were important social contributors not just in the roles as workers and voters, but as consumers.  Partly this reflected rising influence in sociology from Freudian ideas, and efforts to understand the rise of authoritarian political systems following World War I.  And partly it reflected the rise of radio and television in persuasive communications.  People were being investigated not just in their work roles, but as parents, neighbors, club members, consumers and voters.  So the renaissance in microsociology was partly a reflection of academic recognition that private life and public life followed some similar social laws.  Goffman arrived at the proper moment to articulate some of those.

The stage as metaphor for context for role performances in dramaturgical analysis.

Role theory terms people ‘social actors’ when they occupy a particular role, and dramaturgical analysis takes that term ‘actor’ literally.  Dividing role performance as ‘on stage,’ ‘off stage,’ and ‘backstage,’ Goffman looked at role performance as if role performance was all about social context.  When onstage, actors perform roles to manage audience expectations.  Backstage, the audience is not present, and actors engage in behaviors that are unsafe on stage for fear of damaging their performance.  Goffman also defined space outside the stage altogether, where the audience might be fragmented, and the actor might assume different roles with different goals and performance criteria.   For Shakespeare, ‘all the world’s a stage’; for Goffman, it is a whole series of stages.  Unifying all of this was the over-arching necessity to present a good performance in the eyes of the self, and all those audiences.  In dramaturgical analysis, Goffman defines a psychological dynamic of pride and shame that was the primary currency at stake in role performances.

In the Presentation of Self in Everyday Life, Goffman’s most influential work, he went on to expand this theory beyond its application to the theater and from the analysis of cons, games, and scams, to mundane social interaction.  This was an important improvement over the symbolic interactionist approach because the concept of self and desire of social actors to maintain a positive self-presentation unified many of the previous flaws in pragmatism that symbolic interactionism was designed to address.  Behavior became easy to explain when viewed as efforts to save face, rather than as materially pragmatic.

Insight into just how deeply and ruthlessly Goffman understood this can be achieved from a personal story about him.  Goffman had been invited to the University of Michigan to deliver its most famous annual lecture in social psychology.  After the successful presentation, a group of senior faculty met to accompany the speaker on a celebratory dinner at the hot new Szechuan place, which happened to have a package liquor policy that let you bring your own wine.  So the faculty assembled outside the party store next door, and Goffman took the opportunity to wager on the very theory he had just expounded:  he would get the wine, and he declared in advance he would be able to obtain it at a substantial discount.

So Goffman, accompanied by a rapt observer, went in and selected a fine bottle of wine and took it to the proprietor.  Goffman proceeded to closely question the gentleman about the vineyard, the vintage, the details of the terroir, sediment in the bottle, and the year, disagreeing and discrediting the proprietor’s defense of the wine at every turn, and eventually discrediting him for even trying to sell the bottle at half its listed price!  Goffman left with the wine at 40% off, just as he had predicted.  What he had failed to anticipate was the private reaction of his professorial audience.  They were shocked that an esteemed professor of sociology whose fame was world-wide at the time, and whose reputation was so great he had been invited to deliver the lecture in the first place, would feel the need to trash talk an immigrant business owner out of a measly bottle of wine!  They thought he was a sociopath!

Goffman was very interested in scams, shills, cons, and games.  His outsider mentality, and ruthlessly strategic view of social interactions was powerfully predictive of how con artists and their victims behaved.  And his willingness to criticize such performances was to revolutionize psychiatry.  In Asylums, Goffman took up the persistent problem of institutionalization just as the community public health movement was getting started.  Due to institutionalization, criminals in prisons and psychiatric in-patients faced great difficulties in adjusting to their release to everyday life.  Goffman explained institutionalization as adjustment to the complementary roles imposed by institutional life. Of course they were ill-prepared for release, explained Goffman, they obtained release by playing the role of good in-patients.  The qualities that made one a good role player in a mental ward constituted catastrophic role failure in life outside the institution.  The pressure of role failure outside led many to seek readmission.  And psychiatry was complicit in all of this.  By playing their roles well of diagnosing and labeling these patients and rewarding them for submissive, institutionalized behavior, they were not improving anyone’s mental health, only promoting smooth institutional functioning and furthering their careers.

The power of social roles with extreme power differences:  The Stanford Prison Experiment unwittingly replicated  at Abu Gharib prison in 2004.  
Goffman was soon to achieve confirmation in the laboratory.  In one of the most famous social psychology experiments, Stanford University Professor Philip Zimbardo conducted his 1971 prison simulation in the basement under Stanford’s social psych offices.  Merely by arbitrarily dividing his volunteers into guards and patients, the role play had so escalated in violence that some of the inmate volunteers were showing severe anxiety symptoms and the experiment had to be stopped in less than one week on ethical grounds.  Although Goffman advocated qualitative methods in sociology, and many of his observations were not easily and ethically put to empirical tests by a field that was increasingly struggling to achieve greater legitimacy through quantitative methods, Zimbardo had demonstrated the power of Goffman’s observations.  This ugly scenario repeated itself at the notorious Abu-Gharib prison in Afghanistan in 2004.

That randomly assigned student volunteers would do violence to one another served as a powerful challenge to both Freudian and Kraepelinian models of mental illness at the time, and remains a powerful challenge to the DSMs and social discourse that mental illness is an attribute of a person, rather than primarily an interaction between individual and context.  Asylums would become a cornerstone of efforts to reform psychiatry, pressure on The American Psychiatric Association to revise the Diagnostic and Statistical Manuals from a nosology based upon the construct validity of Freudian theory to one of symptom-based diagnosis achieved through inter-rater reliability.  While this change did not completely solve the problem of whether behaviors were an attribute of personality types or social context, it began the rollback of spreading definitions of sexual perversion ascendant in psychology since Krafft-Ebing invented the concept back in 1869.  Homosexuality, in the later versions of DSM-II, and then all sexual diagnosis beginning in 1972 with DSM-III, received more limited and behavioral definitions.

A Pieta by 16th century painter Luis de Morales prominently emphasizing Christ's stigmata.  Goffman's social stigma are wounds to the self.
By far the most important gift of Erving Goffman, however, was the pervasive recognition of the importance of social stigma.  It followed from his analysis of everyday interaction that if shame at role failure was a pervasive social motive, social stigma was a crucial analytic concept.  The term ‘stigma’ is derived from the Latin word for wound.  It was in pervasive use before Goffman with reference to the wounds—stigmata--of Jesus Christ incurred during his torture and crucifixion, and pervasively represented in artistic depictions.  These wounds, symbolic in Christianity of the offense of sin against the teachings of God, and graphically represented in art and central in doctrine stressing the magnificence of God’s forgiveness, were the perfect term for Goffman’s social interactions since they evoked the shame of social failure analogous to Christianity’s shame at moral failure.

This is precisely what I am referring to in this blog when I allude to the social stigma that attends open expression of sexuality, and of social discrimination against BDSM’s diversity of sexual expression.  Because sexual variation is stigmatized, the dominant cultures in which it occurs have norms, mores, laws, rules and stories that legitimate social sanctions against BDSM.  All of this makes social discrimination against kink easy to understand, even if it remains hard to combat.
But stigmatization does not just function in the larger society to limit and marginalize kink, but it functions within the kink community as well.  Every potential kinkster must struggle in some manner against their own internalization of social stigmatization that is prevalent in the larger social arenas in which they participate.  This has variously been represented as homophobia, transphobia, and kink phobia, but often the fear in these ‘phobias’ is the fear of stigma, rather than the fear of specific behaviors.  Many people who have never had any meaningful contact with sexual variation are afraid of the social consequences, rather than afraid of pain, anal sex, variant gender expression or other behaviors they would not otherwise have considered because they prefer not to think of themselves as the type of people who do such things.  This is precisely the cause of a steady stream of government officials who daily preach sexual conventionality while indulging in vigorous alternative behaviors in their private lives.  Such stories always raise questions about these officials’ personal beliefs, but it is not hard to understand their reluctance to pay the price of actively confronting social stigmatization when most people are doing much the same by keeping private and public life separate because of conflicting role demands. Often those internal conflicts bring kinksters into therapy, and in those cases, the kink itself may be less of a problem than the problems of stigmatization.

But stigma works within the community to.  Although many in the BDSM communities are open-minded about precisely the sexual behaviors the surrounding societies most often judge, the community itself participates in setting up the role definitions of roles like top, bottom, switch, service Dom’s, and tourists.  These have varying degrees of legitimacy, and there are role prescriptions about how to do them properly.  ‘Smart ass masochists,’ ‘topping from the bottom,’ or people who ‘betray’ the community by outing people are all examples of behaviors that are somewhat stigmatized within the community as it provides its own system of guidelines about ‘proper’ kinky behavior.  Kink is sometimes a performance, and subject to the painful consequences of role stress, role failure, and the problem of needing to subordinate selfish goals to communitarian demands that Goffman talked about, even if he didn’t write specifically about kink.

Goffman would go on to inspire many other important contributors to kink theory.  He contributed to the practice of viewing gender as performance, and his work underlay advocacy by Jean Kilbourne and her Killing Me Softly series of documentaries on gender performance in advertisingThis gave rise to the modern media education movement and influenced Lenore Teifer, PhD to launch the New View Campaign to deconstruct the medicalization of female sexuality.
Goffman profoundly influenced Michel Foucault who has deconstructed the idea of sexual repression in Western society as a myth primarily serving to legitimate the professionalization of sex and to marginalize homosexual expression.  Foucault, like Goffman, is a mainstay of the movement to deconstruct psychiatry and efforts to prevent the medicalization of everyday life.

As Goffman aged, his work progressively widened to scope of the social contexts of interaction.  While he denied being a Social Constructionist, his focus on context is characteristic of that school and has led many later observers, including this one, to so-label him anyway.  His interest in social games, deception and bluffing made him a natural to try to wed social constructionism with game theory, and his final major work, Frame Analysis continued this ambition to transcend categorization.  We will never know how far he might have taken this, Goffman died at the peak of his career, having been elected President of the American Sociological Association.  He died of stomach cancer in 1982, leaving a very rich legacy to those of us interested in mental health, social deviance, sub-cultures, and variant social expression of all kinds.

Act Up in the streets.  Sexual advocacy worked because of the sacrifices of activists, and Goffman and others had prepared society to deconstruct traditional institutions.

Kink is largely personal behavior conducted off stage in the realm of private life.  Much of the work to create above-ground BDSM social organizations that can advocate for the legitimacy of kink lifestyle choices is the legacy of prior work by gay and lesbian organizations whose struggles have partially legitimated these lifestyles.  But they succeeded in this context because of work deconstructing psychiatry and mental health diagnoses, and by challenging the legitimacy of conventional social discourse about sexual variation.  Goffman played a crucial role in the rise of this discourse, and made social activism fruitful. 

Monday, October 26, 2015

Pink Therapy Event Guidelines for Organizers and Participants

Pink Therapy is a British kink education and therapy group.  They have been known to attend the Community-Academic Consortium for Research on Alternative Sexualities annual conference, which will next meet immediately prior to the 2016 Folsom Street Fair in San Francisco, September 24. 2016..  

They have produced excellent educational materials about the handling of power and the ethical obligations of participants, leaders, facilitators, educators and therapists.  I get questions all the time from therapists in training about their responsibilities at kink events.  Should they even go?  Do they need to sacrifice their personal sex lives to serve their clients?  How long after a therapeutic relationship stops is it safe to be seen by a client at an event?

These documents, which do not answer all questions, do outline the ethical responsibilities of informed consent among participants at different levels of power and experience.

Pink Therapy has produced two sets of guidelines that can be downloaded from their website:

Guidelines for Community Members Attending Parties or Events, downloadable here:

Guidelines for Community Members

Guidelines for Facilitators, Organizers and Community Leaders, downloadable here:

Guidelines for Leaders

How needed are these?  The 2014 Consent Violations Survey reported that over 30% of the over 4000 respondents who volunteered to complete the survey had experienced a violation.  This must not be confused with all kink event participants due to a self-selected sample, and we have no way of knowing what percentage of kinksters saw our survey, and how many of those decided to respond. But 20% of the violations involved kink event organizers or leadership in the event sponsorship.  This violations were perceived not just as mistakes, but abuse of institutional authority within the community.  

Please feel free to reproduce these, distribute them, and modify them as best suits your community.

Pink Therapy can be found on the web at: 

Saturday, October 24, 2015

Sexual Deviation in the Renaissance

Mehmet II using canons in the Siege of Constantinople, 1452

When, in 1453, Sultan Mehmed II brought canons to Constantinople, he did not intend to bring the Middle Ages to a close.  This was not even the very first use of newfangled firearms in the West.  These had been brought from China, which had been using them for years.  But at Constantinople, they proved decisive.  In just seven weeks they battered the previously impregnable vertical walls that had propped up the Roman Empire for almost 1500 years.  Ever since, it has been hard for historians not to credit this event with a sea change in Western Civilization.

The term ‘renaissance’ literally means rebirth.  Just as the old Roman Empire was dying, Italy was discovering interest in its classical roots.  The dis-unified, contentious, innovative Italian city states were nothing like their powerful Roman predecessors, but they were built on those ruins, the evidence of antiquity was all around them, and their new found curiosity about that classical world was part of a re-framing of everything from the medieval world.

The story of Joan of Arc’s heretical transvestism from the earlier post is actually a great transitional Renaissance story.  In it, Joan’s state of mind is of central interest.  This is the primary difference between the Middle Ages and the Renaissance.  In the Middle Ages, the states of mind of kings, bishops and popes matter, but commoners do not.  St. Joan is unique in being a commoner whose state of mind was worthy of official notice.  Even then, it was only noteworthy because warring elites were citing her behavior as proof of divine intervention.  In the Renaissance, inquiry and interest in everyone begins to matter.  This change was not brought about by the Fall of Constantinople, nor by the use of canons, although that technological change is important.  Canons are not a class of weapon wielded by aristocratic warriors, but by commoner technicians whose technical skills in chemistry, metallurgy and physics have become decisive on the battlefield.  In the military, as in religion, and in sexuality, what commoner specialists know makes all the difference.  And that led to renewed interest in the classical philosophers, and a tectonic shift in which institutions centralized the authority to decide what reality was.

A modern replica of Johannes Gutenberg's printing press

The other crucial event that is often said to demarcate the boundary between the Middle Ages and the Renaissance is the invention of the printing press.  This example is a case study in social construction.  For the printing press was not invented in the Middle Ages, it had been around since antiquity in the form of the wine press, where it spared everyone the labor-intensive practice of stamping grapes into juice with bare feet.  Sometime in the 7th century, the Chinese made the first woodblock printed books.  In the 11th century, the Koreans had invented wooden movable type.  But Chinese bureaucratic class structure was not transformed by this innovation, and Johannes Gutenberg’s 15th century use of metallic movable type and the printing of the Gutenberg Bible was transformative.  The technical and trading classes of Europe who had been making incremental technical innovations in the thousand years since the fall of the Western Roman Empire had developed the literary skills to read, and a technology that could put books in their hands en mass changed everything.

Cochem, Germany, as viewed from Reichsberg Castle

Which brings us to the town of Cochem on the Moselle River, some 75 miles from bustling Mainz where Johannes press first started the mass production of the Bible.  This sleepy little wine town is nestled on the narrow flood plain of the Moselle between the steep vine-covered slopes that have been devoted to its primary craft for the last 2000 years.  Before us is a fountain of a goat being crushed in a wine press.  Lest you think its resident’s unduly harsh and bloodthirsty, the story of this fountain is actually proof of the importance of wine and of their piety.

Cochem's Goat Fountain (photo by the author.)

For the town has always observed that, in the last week of the growing season, when the grapes are most sweet and tempting, the vines are off limits to residents and animals alike.  It is death to be found stealing from the vines during the crucial final period of greatest ripeness.  Yet a boy and a goat have been found in the fields.  The boy has gone in to retrieve his pet.  He is a good and god-fearing son of a vinter whose disclaimer is to be believed by all.  But how is the animal’s innocence to be determined?  The vinter finally suggests the goat be placed on the press.  If the goat is guilty of eating grapes, his blood will flow purple with the color of the juice.  If he is innocent, his red blood will flow clear of corruption.  Eventually the goat dies, his blood flowing clear, verifying the boy’s story and proving the goat was a good animal and had not partaken of the grapes, and the citizens are satisfied of the sanctity of their crops, the boy and the goat.  All is well in Cochem!

Reichsberg Castle as seen from Cochem (photo by genuine professionals!)
Overlooking the town is Reichsberg Castle.  Originally built in the 11th century, Louis the XIV knocked most of it down in 1689 during his devastation of the Palatinate during the War of the League of Augsburg.  In the mid-19th century, Reichsberg Castle was rebuilt in the neo-romantic style, with only the Hexenturm, or ‘Witches Tower’ preserved from the original 11th century ruins.  This tower got its name from the practice of trying witches by throwing them from the 40-foot-high window.  Since no mortal could survive the fall, a suspect was obviously acquitted if she died from the fall.  Those few who survived were immediately put to death for witchcraft.

The Hexenturm is on the left, a Neo-Romantic turret occupies the center.  Witches were thrown from the arch. (photo by the author.)
The similarity of these two Cochem stories, with their devotion to a less-than-modern conception of empiricism, reads as Pythonesque today.  But like the Spanish Inquisition, which sentenced prisoners to death as the inevitable choice between two goods; the inquisitors contrived to preserve the protagonists soul, not their lives.  An innocent was consigned directly to Heaven, and their purity preserved.  The guilty were dispatched to hell and the purity of the community preserved.  Intention and adherence to law mattered more than life itself.
"And how do we know she's a witch?" (still from Monty Python and the Holy Grail -- 1975)
It is not surprising at this time that people became less tolerant of sexual variations that previously did not provoke much notice.  Sex stopped becoming a merely animal matter, or a simple function of power, and started to attain symbolic significance not unlike the Augustinian battle against paganism.  Before the Renaissance, behavior proved belief.  Pagans were converted or put to death because of their behavior.  Now that belief mattered, the boundaries changed, and you could be persecuted for thinking the wrong thing.

Not that the church found sex behavior beneath its notice after paganism had largely been replaced by Christian belief.  Thomas Aquinas declared it unnatural in his disquisition on natural law, and church doctrine had been vaguely opposed to sensuality since St Augustine.  But, like St Joan’s heresy of wearing armor, church doctrine around variant sexual expression was there as a basis for prosecution if a dissident defied Church teaching.
The first recorded execution for sodomy was in the 13th century in Ghent.  This etching, a contemporary of the printing press, probably depicts persecution of anabaptists.  Anabaptists, including Mennonites, Amish, Hitterites and other Protestant sects, believed in deferring baptism until the age of consent.  This was objectionable to Catholics and other Protestants who believed children went directly to Hell if they died having not first been baptized. 
It is quite difficult from the vantage point of the early twenty-first century to recognize the extent of the cataclysm this would provoke.  The 30 Years War, the French Wars of Religion, The English Civil War, and, and Spanish attempts to subdue the low countries were catastrophes that depopulated the Rhine, bankrupted major powers, and drove emigration to the New World.  An increasingly urbanized population had more opportunities for sexual deviance, but the rising power of states and decreased privacy meant more opportunities for sexual pogroms and repression.  And both the church and the state cared about what one thought, not just how they behaved.

A contemporary production of Romeo and Juliet  "It was the nightingale and not the lark, that pierc'd the fearful hollow of thine ear!"

The new liberalism and repression are evident in the work of William Shakespeare.  Full of bawdy references, Shakespeare is ribald enough today that social conservatives are often made uncomfortable teaching it in high school.  But Shakespeare and all London theater went through periods in which the theaters were regarded as hotbeds of immorality and were periodically shut down entirely on religious grounds.  All the female parts were played by teenage males because the theater was associated with vice and prostitution.  It was commonly thought that many actors were gay.  After the reign of Elizabeth I the theaters were closed altogether following the English Civil War. At the conclusion of Cromwell’s puritanical reign, the theaters would reopen with a ribald vengeance during the Restoration.   This same conflict about representation of the erotic could be seen in Dutch and Flemish painting as the interest in peasant and interior life gave rise to eroticism, and this was alternately exposed, repressed, and restored.  Sex lives mattered during the restoration and Counter-Reformation, but mainly in the context of a contested set of social constructions aimed at demonstrating the superiority of one form of religion over another.

Venus, Cupid, Bacchus, and Ceres (1612-13) by Peter Paul Rubens in the Counter-Reformation's return to eroticism.
Foucault would later criticize the idea that the Western relationship to sexuality was primarily one of Freudian repression.  But in the Renaissance, as society became increasing professionalized by a tiny but rising middle class, there was an initial struggle over repression.  This was not primarily about sex itself.  In the rural Middle Ages and Renaissance, it was hard to come down too hard on reproduction when children were and economic asset and the countryside depopulated by war and disease.  But sex became one more battle ground in the war over belief and the forced decentralization of church authority to dictate what reality was.

© Russell J Stambaugh, October 2015, Ann Arbor, MI.  All Rights Reserved.

Tuesday, October 13, 2015

The Social Construction of Reality

The Social Construction of Reality (1966)

The intellectual foundation of this blog is social constructionism.  It is my claim that you just can’t   understand kink without it.  If kink is partly a subculture, then it is necessary to understand the larger societies of which it is a part.  That larger culture is the context.  Try as we might to define our individual identities, we do so from the material provided by the larger society.  Social constructionism offers important insight about how societies work.

Social Construction is a theory that holds that the key truths of our social world are made up in an interplay with social actors; individuals and organizations who pursue various agendas or purposes.  Social constructionists don’t dispute that there is such thing as a concrete reality.  They all agree that a table is a table, and apple, is an apple, and The Empire State Building has 102 stories.  But much of the social world is ambiguous and its rules and meanings are determined in an ongoing social exchange.  Different social actors advocate and operate under differing views.  Collectively these define the cultures, subcultures and micro-cultures in which all humans are embedded.  Essentially, the epsitemologies of social knowledge flow through social interaction.

Peter Berger
Thomas Luckman

In 1966, Peter Berger and Thomas Luckman formally recognized this with their book, The Social Construction of Reality.  It is one of the most influential intellectual frameworks in social science.  

Portions of Saigon destroyed during Tet, 1968

It arrived just in time for an elaborate demonstration of its power, as Americans, who by then had all acquired the recent technological innovation of television, tuned it to see the North Vietnamese 1968 Tet Offensive.  After years of escalating guerrilla warfare, the US military leadership had taken to demonstrating the success of their counter insurgency campaign by reporting the body counts of the many Viet Cong insurgents US forces had killed.  US officials used these body counts to create a narrative of an increasingly weakened enemy. By taking the offensive over the Vietnamese New Year holiday, and simultaneously attacking 38 population centers, the Viet Cong and their allies demonstrated that the body counts meant nothing about their capacity to fight.   To attack simultaneously and ferociously, they appeared strong despite sustaining many additional casualties. Americans watched the destruction of Hue, the old Vietnamese capitol, on the nightly news and heard doubtful news commentators openly questioning the official stories of victory.   It two weeks of fighting in battles that they consistently lost on the metric of body count, the Communists completely reframed the meaning of the Vietnamese War.  The American public stopped believing that victory in the Vietnam War was in sight.  A domestic anti-war movement grew in power and eventually forced the United States government to the negotiating table and military withdrawal.

CBS News anchor Walter Cronkite.  When he questioned administration claims about the progress of the war during Tet, U S President Lyndon Baines Johnson said privately, "If I've have lost Cronkite, I've lost the Middle America!"
Social meaning can be shockingly fragile and subject to sweeping changes when the conditions were conducive to such change.  The social construction of reality provided the intellectual basis for recognizing this.  The Vietnam War on TV provided the experiential basis.

That social reality is constructed has many corollaries.  For example, individuals know a great deal about the social reality of their everyday lives, their ethnicities, social roles or occupations, and have only indistinct notions about other cultures, occupations or roles in which they do not participate. Those of you who live in New York City, have visited the Empire State Building, have a passion for the architecture of skyscapers, or have read Michael Chabon may already know that the Empire State Building has 102 stories.  But most of us do not. Our personal knowledge is like a camera with increased resolution in areas of greatest interest or experience. 

The Amazing Adventures of Kavalier and Clay (2000) is one of many ways you might know how many stories the Empire State Building has.  Now this blog is another!
Much of what we come to know is socialized into us from birth, indistinguishable from objective reality as our parents present it to us.  Many of our assumptions are ingrained by habit before they are intellectually examined.  Social constructionism assumes that the formation of social knowledge is socially interactive, and often full of conflict, with competing advocates clashing over differing interpretations of reality.  While this is obvious in areas like politics or religion, such clashes occur at every level, not just the public square discourses of political apparatchiks, but in the bedroom among intimates.  It is easy to see how traditionalists could construe this as moral relativism.

Karl Marx (1818-1883)  One of sociology's Founding Fathers, Marx recognized that institutions clashed over the production of social knowledge.  

The notion that ideologies clashed was not new to sociology in 1966.  Political Science was already an established discipline, and indeed America and the Soviet Union were in the midst of the Cold War, an ideological clash of which the Vietnam was but a minor part.  Since Marx in 1848 had argued that the role of a properly communist press was to maintain class consciousness among the proletariat, sociologists recognized the large social institutions such as governments and universities were responsible for producing knowledge, and that knowledge producers sometimes clashed.  Berger and Luckman began a Renaissance in sociology by emphasizing that knowledge production happened just as intensely at the individual level.
Berger and Luckman owed a considerable debt to George Herbert Meade and the later symbolic interactionist school.  That school believes that people do not so much deal with reality as it is, but in terms of how they believe it to be.  Much of symbolic interactionism evolved out of efforts to resolve the limitations of Meade’s pragmatism; the theory that people mostly behaved in their rational self-interest and pursued their goals with reasonable efficiency.  While it is often true that people behave pragmatically, symbolic interactionism developed to cope with the imperfections of pragmatism.  Often people don’t know reality directly, and instead act in accordance with incorrect perceptions.  Sometimes they act from their identities, other times from their social roles.  Freud would go on to suggest that many reasons for action are unconscious.  Pragmatism survives to this day in its influences on rational emotive and cognitive behavior therapies.  That cognitive behaviorism has replaced radical behaviorism is largely a concession to the influences of Freud and Meade.

Another aspect of social constructionism worth emphasizing is its relation to role theory.  Often people participate in the production of social knowledge from a particular role, rather than with the entire persona.  They may be a group leader or spokesperson.  They may comment from a position of privilege or as an outsider.  Perhaps they are a mother, submissive, or a teacher.  Our expectations of these roles, and the special knowledge and perspectives we take from our roles inform the knowledge construction process.  The importance of role theory can be readily seen in understand BDSM role play, and role conflict, such as between the roles of parent and kinky submissive, can shape peoples insights about how kink works.

Jean Genet's The Maids (1947).  This play is proof that that roles were undergoing deconstruction long before Berger and Luckman.  But how we know good and bad role play is crucial to satisfying BDSM play, yet relies on social context.  These maids are very 'bad' indeed!
 Another corollary of social constructionism:  ‘The personal is political!”  For many readers, this rallying cry of the women’s liberation movement is rather before their time, but the struggle over the relationship between personal and political life began at this time and built on sociologies new focus on social knowledge and production at the individual level.  How you lived your roles became a political statement whether you intended it to be construed that way, or not.

The geocentric model of the solar system might be a disadvantage in space exploration.  Yet for an estimated 26% it is their perceived reality.  For some, dinosaurs belong in historical fiction.
The acknowledgement of the importance of roles is a special case in social constructionism of the insight that context is all important in social knowledge.  If we only know very much about the part of the social world we occupy, and much of our perception and knowledge is role dependent, context matters tremendously in our epistemology.  Pew Research published results earlier this year that only 74% of a random sample of American adults could correctly answer the question, ‘Does the Earth circle the sun or the sun circle the earth?’  74% might look like quite a lot of correct answers, until you appreciate that the chance of getting this question correct is 50% if you don’t have the slightest idea and guess randomly!  Even the basic tenets of astronomy and earth science cannot be assumed to form the context of about half of all Americans if this question is an accurate indication.  Likewise if the President of the United States is expected to know and understand the United States Constitution, but if a candidate says he would oppose an otherwise qualified candidate for President if that candidate had the wrong faith, the statement is not merely alarming because of the candidate’s possible shortcomings as an impartial leader, but also because the candidate believed that in the context of his constituency, those beliefs are fair, valid, and/or persuasive.  People who know and understand the Constitution should be shocked at the suggestion that religion alone would disqualify a candidate for serving.  But if few people understand the constitutional provisions on religion, mere unpopularity might be a persuasive political argument to them.  Social constructionism provides a basis for understanding the differences in how our actual behavior differs from our professed ideologies, one of the greatest intellectual benefits of modern social science.

The DSMs.  Look carefully to see the spiral bound DSM - I on top.  The summation of the struggles to define psychopathology, including paraphilias.  Also ripe for social constructionist deconstruction!
Regular readers of this blog have seen many prior posts that discuss the details of the social conflict over diagnosis of the paraphilias.  This is one of the most concrete ways in which social constructionism provides insight into how kink gets stigmatized.  In fact, psychiatry and the societies in which it arose were stigmatizing sexual variation for many years before this sociological behavior had a label.  To understand more about social stigma, and role theory on kink, we need to spend a little time considering the work of Erving Goffman coming soon to a blog near you.

© Russell J Stambaugh, October 2015, Ann Arbor, MI.  All Rights Reserved.

Tuesday, September 29, 2015

Porn Addiction Study and the DSM – 5 Debate over Whether to Include Hypersexuality.

This blog has repeatedly commented on the problems of diagnosing ‘sex addiction’ and hypersexuality.  See “Arrival of the Death Star,” “Out of the Shadows,” “Umbra,” and “Ken Zucker, PhD and Michael First, MD’s DSM – 5 Plenary at AASECT” on this blog for additional discussion of this issue. To summarize those problems briefly:
       1)      Disagreement exists on how ‘too much sex’ might be recognized behaviorally, a      requirement needed for reliability,
       2)      The model postulating that ‘sex addiction’ might be similar to chemical addictions      might not be valid,
       3)      If the criteria for too much sex cannot be objectively operationalized, psychiatry might be discredit for making illnesses of ordinary behaviors, thereby loosing legitimacy and
       4)      If the diagnosis is intrinsically stigmatizing, the costs of labeling need to be proven to be offset by medical benefits of treatment that require that disadvantage, otherwise alternate means need to be used where the cost benefit is superior.
       5)      Additional obstacles to ‘sex addiction’ treatments include the legitimating of past addicts as paraprofessional therapists.  This biases such treatment by making acceptance of the label ‘addict’ a quantification to do treatment, and makes that acceptance an integral part of treatment for clients. 
       6)      While there can be little objection to self-labeling in chemical addictions where the behavior of taking drugs for recreational purposes is illegal, it is objectionable to advocate complete abstinence for otherwise healthy sexual behaviors,
       7)      This labeling problem becomes particularly problematic when social prejudices and religious attitudes contest with the scientific criteria for defining sexual behaviors that are in social dispute such as homosexuality, variant gender expression, BDSM and polyamory.

All of which might seem to be a damning case, but sex addiction practitioners have five crucial advantages which perpetuate use of their terms and ideology:

      1)      The public has already come to accept the term ‘sex addiction’.  Its wide use and recognition make it an effective marketing tool.
      2)      Because psychiatry has weak construct validity, sex addiction therapies that make clients feel better cannot easily be removed from the professional cant,
      3)      The biological mechanisms that underlie all perceptions of pleasure have neurological similarities, and it is quite difficult to conduct research that identifies whether these mechanisms are causes or effects.  The scientific jury is still largely out as to whether effective neurological agents might not be developed to treat excessive or unwanted sexual behavior, and their is big money at stake, and
      4)      The therapeutic techniques of ‘sex addiction’ therapies and less stigmatizing treatments overlap considerably.
      5)      Psychiatry, psychotherapy, and religious ideologists all have some vested interest in showing that they have explanatory power in understanding problems of sexual behavior above and beyond the client’ self-definition.  After all, if we do not know something special, why should anyone expect us to offer special relief for their discomforts.

J. Grubb et al from Case Western Reserve University recently showed that belief one had a porn addiction was more strongly associated with a variety of problem symptoms than the extent of actual porn use.  In a series of careful studies, Grubbs replicated his findings and used a design that allowed for imputing causality.  The end results; moralistic religious attitudes and belief that one is a porn addict cause more depression, anger and anxiety than the degree of porn actual use.  The adoption of the label does seem to cause the negative feelings.

This Grubb study was not bullet proof.  One might argue that the porn addiction attitudinal measure, Grubb used, the CUIC, is not the best measure of that condition, and that it not the best operationalization of the concept. It does have a high degree of face validity in assessing whether a respondent is troubled by their porn use. The subjects were self-selected to participate, with a high degree of porn use, and these conclusions might only be valid among relatively frequent porn users, and that people troubled by their porn use might be over represented in such a sample.  That would tend to justify conclusions about people coming into therapy with complaints, but not for the general population.  However, these arguments might all be true and the study’s conclusions still be valid.  Criticisms and all, the study has certainly shown that for some populations, the label is worse than the underlying behavior it attempts to describe in causing subjective distress.

Aside from the evaluation of what intellectual substance might underlie 'porn addiction' ideology, the study presented in this thread also elucidates a critical problem that led to the decision not to include hypersexuality in the DSM – 5.

If the frequency of sexual activity is unrelated to negative psychological symptoms, but the holding of an idea or a social label is, different raters will have a hard time agreeing on the threshold for a diagnoses more reliably than by simply asking the client's opinion.  M.Foucault had no trouble recognizing the philosophical obstacles to professionalizing any conversation about sexuality in which the client is a more authoritative source of information than the professionals.  To be a persuasive demonstration of the superiority of professional opinion, the precision of a diagnosis needs to stem from special professional expertise.
Note also how similar this argument about the possible harm in the idea of ‘porn addiction’ is in structure to Moser's and Kleinplatz's arguments about paraphilia in the DSMs.  Since DSM - IV, we have operated under a two part diagnostic system.  Part 1 determines whether a behavior is weird: sadistic, masochistic, or centered on a child, or transvestic for example.  These are all pretty easy to code as different from hetero-normative sexuality and different from each other, thus meeting the reliability criteria well. But Moser and Klienplatz have argued that these behaviors don’t have a great deal in common beyond social stigma, and the concept that all paraphilias are somehow alike is culturally biased, not scientific.  Part 2 assesses either work and life disruption, or subjective dissatisfaction by the client.  It is this second part that is problematical in the view of Foucault cited above.  While some raters can be trained to objectify work or life disruption using criteria like divorce, legal trouble, job loss, etc., the degree of life dissatisfaction remains primarily within the domain of the client’s internal and subjective experience.
Thus the reliability for paraphilia as research criteria depends heavily on the culturally biased and stigmatized dimensions that can be coded consistently to overcome the ambiguity and subjectivity of client complaints.

As an advocate for better mental health treatment on this list, I have a duty to expose any psychotherapeutic practice that labels variant (non-heteronormative) behavior as pathological on its face.  That is pretty obvious in those that label homosexual, consensually non-monogamous, or consensual BDSM behaviors as pathological or addicted by definition.  But that is exactly what the DSM - IV and 5 systems do if they go beyond subjective client distress.

Given these findings by Grubb et al, suggesting that even where the client reports high subjective distress, the poison may well lie in the label and stigma, not the behavior.  I would suggest this evaluation should be a top priority of evaluation on any variant behavior that enters the consulting room. 

Furthermore, labeling and stigma are the prime suspects in guilty and ashamed clients whose behavior is highly consensual. In most cases, a therapeutic goal of overcoming the stigma will be justified.  It is a disadvantage for many such clients to start with an authoriatative-sounding diagnosis.

Personality disorder is the likely characteristic of persons whose variant behavior harms others while the client reports low subjective distress.  Behavioral control, empathy for others, and accepting painful labels are likely therapeutic goals.
Many problems of life functioning are partner relational problems or failure to find community that are best solved by counseling about how to find and use community resources, or how to handle conflict in the relationship.

None of these require a paraphilia diagnosis from the DSM -5, and none require a hypersexuality or ‘sex addiction’ diagnosis that isn’t even in the manual.


Grubb, J, Stauner N, Exeline J, et al. Perceived Addiction to Internet Pornography and Psychological Distress:  Examining Relationships Concurrently Over Time Psychology of Addictive Behaviors. 2015

Moser, C and Kleinplatz, P DSM-IV-TR and the Paraphilias Journal of Psychology and Human Sexuality 02/2006; 17(3-4)

Kleinplatz, P and Moser, C Politics versus Science Journal of Psychology and Human Sexuality 02/2006; 17 (3-4)

C Moser When is an Unusual Behavior a Mental Disorder? Archives of Sexual Behavior 11/208; 38(3): 323-5

Shindel, A and Moser, C Why are the Paraphilias Mental Disorders? Journal of Sexual Medicine 11/2010; 8(3):927-9

Moser, C Hypersexual Disorder:  Searching for Clarity Sexual Addiction and Compulsivity 01/2013; 20

Moser C A Rejoinder to Carpenter and Krueger:  It is about Clarity and Consistency Sexual Addiction and Compulsivity 01/2013

Moser C Hypersexual Disorder: Just More Muddled Thinking Archives of Sexual Behavior 10/2010; 40(2)

Foucault, M (1979) History of Sexuality, Volume 1: An Introduction London: Allen Lane

Copyright Russell J Stambaugh Ann Arbor, MI September, 2015