Tuesday, September 12, 2017

Darkness

“Oh, you never turned around to see the frowns
 On the jugglers and the clowns when they all did tricks for you.
You never understood that it ain’t no good,
You shouldn’t let other people get your kicks for you.”
“Like a Rolling Stone” – B. Dylan

Mary Gaitskill in 2017, courtesy of the New York Times

Back in April, the New York Times printed a review of Mary Gaitskill’s new book, “Somebody with a Little Hammer: Essays”.  Those of you who have been paying close attention know that Gaitskill is the gifted author of the short story that became an iconic 2002 movie about kink, The Secretary.  In this review are included some remarks which serve as an excellent jumping off point for our exploration of a heretofore neglected discussion about kink that emphasizes its dark side.  Trite as it is to say, if you have been reading this blog closely, you may well fail to know the power of the dark side.

Despite the extreme good fortune of inspiring a commercially successful movie of our chosen subject, and there is only a handful of such films, Ms Gaitskill was not altogether satisfied with the transition of her oeuvre to the screen.  Here I shall quote directly from the Dwight Garner’s review.

“She was displeased with that movie, [Gaitskill] writes.  It was breezy and upbeat, absent the darker shading.  The takeaway, she writes, ‘is that S/M is not only painless; its therapeutic:  It has made both characters more confident, better looking, happier, freer, and self-actualized.  Best of all, it has led them straight to marriage!’”  How kinky is that?

It would be easy to dismiss this as the conventional culture and its agents; director Steven Shainberg; or the movie’s producers, cleaning up BDSM for mass market consumption.  For her part, screen writer of record, Erin Cressida Wilson, won a Sundance Festival Award for this work, her very first screenplay.   At least that awards committee didn’t see her work in such a critical light.  But if you have both read the short story and seen the film, there is no debating that Gaitskill’s original is truer, grittier, and the more sadomasochistic of the two works.  And in the rest of Garner’s review, it Is made clear that Gaitskill has enough sadism to recognize it for what it is in others and that she sees herself as the wielder of those little hammers, a characteristically kinky position.  In her own way, she is a social critic.

Kink and the problem of idealization:

Maggie Gyllenhaal in The Secretary (2002)  Nice blouse!

One might be tempted to accept the ‘cleaning up’ of Gaitskill’s story as evidence of the intrusion of ever present fetish elements into kink.  And it is true that the movie settings are lovely, Maggie Gyllenhaal’s blouses exquisitely pressed and silky as any fetishist might crave, but hardly consistent with her role as a down and out woman for whom a job as a secretary constitutes social advancement.  And kink itself has a somewhat convoluted relationship to erotic idealization.  Fetish itself represents the triumph of fantasy over utilitarianism, just as Krafft-Ebing warned us long ago.  For those not so inspired, it is difficult to imagine a brassiere, an opera-length glove or a well-turned boot could provoke more passion than a human body expressly designed by eons of evolution to stimulate procreative desire.  But fetishism is not simple idealization, as anyone who has encountered its intense specificity can attest.  As a teen, I remember reading those letters to Dear Playboy and Penthouse Variations in which fetishists would go on and on about how only barefoot hogtied cheerleaders would do, tennis shoes were completely outrĂ©!  There is something going on in fetishism beyond simple idealization.  But it also takes a certain optimism to believe that, with billions of people engaging in various forms of sexual intercourse around the planet, a specific regime as stigmatized, awkward, often alienating, and sometimes downright dangerous form of human expression could be transformative.  Good psychotherapy doesn’t routinely leave bruises except perhaps to the ego.  But there is a serious discourse about kink that it isn’t genuine if it isn’t dirty, doesn’t leave bruises, isn’t dark enough, and doesn’t break the rules.

As a therapist, I have encountered any number of people who earnestly represented to me how kink is therapeutic.  I believe them, as far as it goes, but I also take such declaration with a large grain of salt.  As beneficial as it can be to get what you want, so much human behavior is difficult to explain in terms of simple drive satiation.  If it was, millionaires would quit work when their earnings exceeded their initial ideas about how much money they need to spend, rock climbers would quit climbing El Capitan’s sheer face after a single success, and no one would go back to the exact same kind of lover who left them broken-hearted the conclusion of their last affair.  Often, exactly the opposite is observed.

El Capitan in Yosemite.  Granite sheared by glaciation makes for a steep ascent. "That was fun, let's climb it again"!  Photo by the author
People do accomplish therapeutic achievements sometimes in kink, but when it comes to shadow play, that process of knowing our dark sides, Freud and Jung, its original proponents, were frighteningly pessimistic about the possibilities.  In Analysis, Terminable and Interminable(1937), Freud wrestled directly with the observation that no amount of good psychoanalysis ever made the unconscious go away altogether even though therapy was the process of making the unconscious conscious.  For Freud, the process of confronting repression was valuable, but one could never know all of one’s dark side, and there were some impulses it would never be OK to enact no matter how insightful one became about them.  Jung was more optimistic, but, looking at the broad cultural sweep of symbols, he was the first to admit that darkness never really goes away.  So, what does it mean to ‘play’ with it?  It is a pathway with no clear destination.

Organized BDSM tries to create space for darkness to be expressed ‘safely’, and as might be expected, such safety is always a little bit relative.  Certainly, it is safer to lie at home in bed masturbating to fantasies of whipping someone and imagine they are loving it than it is to go out and find such a person, acquire the whipping skills to do this safely, get to know the partner well enough that you serve Goldilocks her porridge up at just the right temperature, and suffer the possibility that your partner will flee in terror somewhere in the middle of the process before you learn enough to make the enactment satisfying enough to both of you become sustainable.  For all of kink’s confrontation with conventional romantic idealization, there is a genuine dollop of optimism, if not wild-eyed idealization, in such attempts to find kinky liaisons.  Yet this was even more true in the past, before the internet, use groups, self-help references and FetLife, and people still attempted kink and succeeded in establishing relationships based upon conducting it.

Vlad,'the Outer', Putin, Kompromat King, courtesy of Getty Images.  "Your secret's safe with me"!

Likewise, is it rather optimistic to imagine that one’s life will be greatly improved if someone knows about your kink and accepts it.  Surely this achievement would be balm to life-long fantasies and case histories of actual rejection, but it won’t cure your herpes, fill your bank account, or stop your excess drinking. People in BDSM all face stigma over their behavior, and this is a powerful leverage to create community, although kink was stigmatized for years before such communities became common and above ground.  And just when it  appears that kink is making genuine headway to social acceptance, out comes evidence of the Ashley-Madison hack, or content changes at Fetlife due to credit card billing restrictions, or Russian kompromat trying to out the President of the United States for urophilia, to rub our noses in the fact that doing kink still carries substantial social vulnerability even for out practitioners who have taken reasonable steps to protect themselves from the consequences of the judgments of others.  If kink still carries risk, so too is idealization a potential motive to undertake risks in hopes that getting what one wishes for will be as good in reality as one has long imagined only in erotic daydreams.  And before we mistakenly attribute this kind of thinking exclusively to kink, please note how similar this kind of idealization is to conventional heteronormativity.

Despite the idealization surrounding fetish, and the optimism that facing risk will bring delights far beyond mundane sexuality, kink is rather contemptuous of conventional idealization.  Some of this goes back to de Sade’s confrontation with Rousseau and The Church, but modern kink is dismissive of conventional relationship structures, often surprisingly disparaging from conventional sex behaviors even though conventional folk (and kinksters) pursue them with durable enthusiasm, and kink is often strongly anti-romantic.  This is not to say that great loves are not built among kinksters, but many kinks can’t be pursued without eschewing romanticism.  While many new submissives dream of finding and all-knowing top, part of a good top’s role description is keeping submissives from over-whelming themselves and that involves denying them some of what the submissives imagine they desire.  Tops want to frustrate sometimes, and bottoms desire to be frustrated and give consent to exactly that treatment.

Perhaps stigma can be blamed for this variant of MKIBTYC (My Kink is Better than Your Kink is an occasional form of socially divisive behavior within the organized kink community, where it is actively discouraged.  Here I have creatively perverted the term to apply to kinksters’ occasional tendency to assume superiority over ‘Conventionality’ and use the term ‘vanilla’ as a put down for those who just aren’t hip enough to recognize that kink is ‘superior’.)  Cognitive dissonance alone might be sufficient to explain anyone preferring their chosen forms of sexual expression: having paid the costs of such ‘choices’, we are vulnerable to becoming wedded to their benefits.   Alfred Adler would have no trouble explaining the shaming of conventionals as a turning passive into active after enduring lifelong shaming of one’s kink, and seeking mastery over the very tools of one’s historically experienced vulnerability.

Serious leisure can be arduous.  Rhymes with sex work is real labor.  

Like other areas of human striving, BDSM is sometimes a great deal of work to get to the fun.  Dolling up for those sexy fetish pin ups can take many hours of perspiring in latex under klieg lights.  Good suspension rigs can take hours to do aesthetically.  Playing so quietly that you don’t wake the kids is mostly a turn off that needs to be overcome rather than central to the fun, just as it is for conventional folk.  And rough play requires days of self-care long after the endorphins have worn off.  For many sensation players, that discomfort is a source of pride, but it still hurts, too.

Similar routine inconveniences plague other forms of what DJ Williams refers to as ‘serious leisure’, and conventional sexuality, too.  Serious snow board enthusiasts just as regularly cope with the dangers of taking a spill, or from triggering avalanches.  In kink, it is not always sufficient to overcome routine negative emotions, but to court and intensify them to the limit of personal endurance.  Kinksters don’t just crave intense orgasms, but intense theater that evokes the darker emotions.  Transvestism, cuckolding, and other erotic role play are often shame-based even as participants complain about the social stigmatization of their kinks.  People who crave acceptance do so acting on impulses to do the unacceptable.  All the conventional fears and disgusts: rejection, abandonment, loss of control, loss of autonomy, loss of freedom, loss of identity, injury and loss of bodily integrity, racism, sexism, infantilization, even evil itself are sometimes directly courted. 



Dom/mes and tops, and even submissives deliberately dress to look scary.  They play in ways that routinely exceed any hope of plausible deniability.  Often, they appear to be showing off.  Edge play may be in the eye of the beholder, but being edgy is often seen as a source of status in the communities.  While many try to conceal their kinks, there is considerable pride and public esteem to be had in the community for being out about them; often, the edgier the better. This is not a new development, back in the forties and fifties, this was a characteristic of the S/M outlaw motorcycle cultures only a few of whom may have been presumed to have ever read de Sade or Genet.  There are many in kink who are openly contemptuous of being normalized, suburbanized, or commodified for mass market consumption.  There is a thrill to be enjoyed scaring children, and furry little animals.  It is not just sensation-seeking that keeps emergency room staffs telling tall tales of removing gerbils from the occasional rectum.  An otherwise respectable kink research organization nicknamed their survey of the health needs of the BDSM communities “The Gerbil Survey” in jest, but playing on precisely this dynamic.  An anonymous wag suggested to me that the survey needed a trigger warning!

Kink often embraces things that are despised, dirty and disgusting, from the scut work of polishing boots, to playing with urine and feces, to giving up power and social status, to eroticizing performing the dusting.  The problem of idealization is again illustrated by kink eroticism, which tends to veneer over the unpleasant implications of all this.  While cinematic depictions of Pauline Reage’s perverse training at Chateau Roissy are invariably clean stylish and resplendent with fetish appeal, cleaning up must be a fulltime job with all the blood, saliva and feces involved in all that slave training.  Laundry must be a constant preoccupation despite the scanty attire.  And the Marquis de Sade’s writings would have required an army of hired help he could never afford (He may have been an aristocrat, but the Divine Marquis was chronically short of money!) just to clean up after his literary parties, and that is before we get to the problem of disposing of the dead bodies.  In reality, the Divine Marquis got into plenty of legal difficulty precisely because, once the judgments made at the height of concupiscence were made, he was unable to clean up after their messy interpersonal consequences.  While many of these literary exploits are ‘only’ fantasies, they are willfully messy ones.  No one gets pregnant or an STI unless it serves a dark story line.  It should be noted that most kinky play does not require unwanted contact with dirt and disgust, but the critical term is ‘unwanted.’ What is the point of having a slave if they cannot be forced to sleep in the wet spot?  And how do you know you have surrendered any power unless you have to do things that are genuinely unpleasant?

Jack Morin, reworking John Money’s theory of love maps--or personal erotic templates--could not escape a conclusion that would have nonplussed the late 19th century learning theorists:  rather than mainly stemming from early but repressed positive experiences, eroticism in Morin’s view was equally likely to be erected on earlier experiences of fear, loss and emotional travail.  Robert Stoller for a time considered that kinks might be caused by childhood medical ordeals.  Von Sacher-Masoch believed his love of being beaten by imperious women and his erotic fixation on fur stemmed from a preadolescent experience of being whipped for disrespecting his haughty aunt.  Suffice it to say, she had not specifically intended to awaken his eroticism, but to punish him into submission.  In this way, turning an oppressor’s intended punishment into a source of lust constitutes a kind of mastery.  It restores some personal agency to a story in which the victim rescues something symbolic from maltreatment.  These examples illustrate Morin’s idea that sexual excitements come as frequently from ‘troubling’ experiences as they do from routine drive expression or the desire to repeat good times.

 Lambert Wilson as the chief Merovingian in the Matrix Reloaded (2003)
Well dressed, but what the heck is a Merovingian?  The short answer: bad guys.
The long answer: an early Frankish dynasty (457-752) that established French rule of Gaul.

In conventional media, kink is just emerging from a period in which sadomasochistic attire is used to denote villainy.  Only in the last few years have immaculately suited villains in haute couture duds been opposed by good guys who look like they emerged from the fringes of punk rock (for example, The Matrix)!  Ordinarily, a kinky costume is an unsubtle device to spare us the trouble of character development.  Kink is bad, and everyone knows it.  But not only is it sometimes highly erotic to be bad, it can be socially productive and necessary.

Perversity, creativity, and transgression:

I have pointed out that when Krafft-Ebing first used the term perversion to characterize his kinky psychopathologies, he expropriated a term from moral, religious and legal cultures to characterize erotic preferences that did not serve obvious Darwinian and reproductive purposes.  But he was persuading the professional class on the strengths of medicalizing sexual problems when he did so, and trying thereby to ease the acceptance of his model of sexually variant behavior.  When the Freudians appropriated this language, the lay understanding of psychoanalysis was that kink was moral perversion.  Never mind that Freud believed that we are all perverted in the unconscious, the public understanding lagged the psychoanalytic one.  Freud thought perverse desires were normal, even if their expression in behavior was atypical.  The part the public understood is that these unconscious desires were in opposition to all good conventional social norms.  But Freud laid the intellectual foundation for dramatic philosophical and artistic changes.


A still from the notorious razor/eye sequence from Un Chien Anadalou (1929), Luis Bunel's and Salvador Dali's surrealistic silent film.
The artistic and intellectual works of Pablo Picasso, Andre Breton and Salvador Dali, Jean Genet, Michel Foucault and Mick Jagger all keep us mindful that the unconscious and kinky were meant to be seen as transgressive, somewhat turning Freud on his head.   Kinks aren’t normal, they are shocking, crazy, and bad!

All those towering creative figures were transgressive, as they took a current line of thinking about art and society and overthrew conventional understanding for a new one that emphasized differences with the old ways of seeing and interpreting social reality.  Picasso attacked the illusion that experience is contiguous, and reality was concrete.  Breton sought beauty in ugliness, and emphasized ways in which the primitive and modern were contiguous, not opposites;  he reveled in making scary and incomprehensible narratives.  Genet made a mockery of morality; Foucault of professionalism.  Where Elvis Presley and Black R & B made the emerging rock n roll explicitly sexy, Jagger reminded us that what makes us hot isn’t orderly, obedient, or even all that good for us.  In the 1970 movie Performance, getting in touch with your dark side involves not only hot wax play, but bending your mind, light, and gender before getting you killed.  Maybe I’ll skip the cinema this evening and stay in and just listen to Their Satanic Majesties Request on the hi-fi!


A promotional poster for the 1970 movie, Per
In 1984, Janine Chasseguet-Smirgel outlined this relationship between perversion and the creation of new artistic paradigms in her book, Creativity and Perversion.  Although she was careful not to license all kink as creative, she did recognize that the impulse to transgression played a key role in looking at things in new ways.  Like psychoanalysis itself, perversion sometimes provided the impulse to look at the world in new ways, and for artistic, scientific and intellectual progress to occur, sometimes the old ways needed challenged or even to be overthrown.  The perverse impulse to reject conventional wisdom could provide that motivation and freedom of thought.  Although Chasseguet-Smirgel is writing in the Freudian tradition, she goes well beyond Freud in this assertion.  Where Freud thought we all had a little perversion in us, erotic variation only became pathology when it displaced healthy sublimations of the (re)productive sexual impulse.  Chasseguet-Smirgel suggests that rejection of conventionality could be personally productive and good for society.  Carried to its logical extreme, well beyond her limited argument, kink could be, is some cases, the healthiest adjustment for some individuals.




This, of course, is congruent with the argument that Richard Sprott and David Ortmann; Michael Aaron; Chris Donahue, and others who think the first order of business in any therapy of someone coming in disturbed by their kink is to hook them up with the kinky communities.  There the client(s) can learn to put their kinks in perspective and profit from the stories of others who are somewhat out about their own kinks.  Of course, not all kinks are created equal, and genuine destructiveness and non-consent can limit this for rare individuals, but it rests upon the assumption that out kinksters are healthier than closet ones, which we simply have no data to demonstrate.  And, according to the 2014 Consent Violations Survey, 80% of kinksters are not out to someone.  So there is good reason to question whether every person who comes in the door is ready to profit from attending BDSM social organizations despite the excellent educational sessions and sound consent ideology to be found there.  But plunging clients into the steamy world of social kink where they will learn what they like to the accompaniment of the drumbeat of the lusts of others is a far cry from Freud’s idea that making the unconscious conscious in the quiet meditation of the consulting room will sublimate desire.




Peter Chirinos and Caroline Shabaz refer to the potential benefits of shadow play in their recent book on Kink Aware Psychotherapy.  They, like myself, have seen individuals whose kinky ‘play’ takes an important constructive role in their response to traumatic experiences in the clients’ personal histories.  Michael Aaron and Dulcinea Pitagora also write about this.   Tops and Dom/mes also say that they see this in their play partners.  While clinical anecdotes can be highly persuasive, they cannot inform us of whether the client we are just starting to see is engaged in such constructive ways, any more than good epidemiological data can.  They do, however, show that others have found such ways can be healthy for some clients.

Transgression is not an unlimited virtue, however.  Kinksters can be ashamed and guilty in unhealthy ways about their kinks, or they can take so much satisfaction from their kinks that this overpowers the empathy they need to moderate their behavior with others.  Willful rebelliousness is a constant problem for those who try to establish norms and provide safety in the kink community.  Recognition of the flaws of authority and conventionality can feed narcissism, romanticize defiance, and fuel anarchy.  I side with Chasseguet-Smirgel in her opinion that perversity can be highly adaptive and creative, but it can also be compulsive and reductionist.  One hates to imagine two kinky ships devoted to hogtied cheerleader bondage passing in the night over the obstacle of bare feet vs tennis shoes!  It should be expected that kinky folk will be conflicted about their perversity, and simply offering permission and affirmation of it in treatment is not likely to resolve deeper internal conflicts.
  
The best initial place to begin work on perversity in treatment is from a suspension of judgment that does not privilege conventionality.   It is important to empathize with the client’s experience of this dimension of their personality, both in perversity’s constructive, neutral, and damaging aspects.  The rush to confront or affirm these feelings makes no sense until you can understand the complexity of the client’s relationship to them.  That takes time, and is not usually possible in brief treatment.  To help with many problems, it is not necessary.  But it is often necessary with people who are deeply conflicted about their kinks, and who are torn between their desires to be accepted as conventional but remain fascinated with their darkness.  In such struggles, ‘authenticity’ may not lie in identification with our light sides, or our dark sides, but in the interplay between light and shadow, which is often experienced as struggle.  In her own way, Gaitskill is trying to tell us that kink is not for the faint of heart.  Then again, conducting psychotherapy isn’t for the faint of heart either!


© Russell J Stambaugh, September, 2017, Ann Arbor MI, All rights reserved


Friday, June 30, 2017

Consent 301: Consent, It's Discontents and Safety

In the first half of 2017, Susan Wright and I took our Consent Roadshow to the Society for Sex Therapy and Research (SSTAR) in Montreal on April 21, and I took the 2014 Consent Violations Survey to the 8th Community-Academic Consortium for Research on Alternative Sexualities (CARAS) in Chicago, May 26th.

I have finally posted the slides here.  The 2014 Consent Violations Survey slides follow the context material about consent and safety in the kink community.  Most of this material is already known to kink insiders such as those who frequent CARAS.  But we wanted more context for interpreting the data for therapists who might be less familiar with the social organization and ideology of BDSM social groups.


Consent 301: Consent, It's Discontents, and Safety

Tuesday, June 27, 2017

Kink’s Evelyn Hooker Moment

Cabaret

“Start by admitting from cradle to tomb
It isn’t that long a stay.
Life is a cabaret, old chum
Only a cabaret, old chum
And I love a cabaret”
Fred Ebb and John Kandler

From its modern inception, psychiatry regarded homosexuality as a sexual perversion and as psychopathology. You heard the beginning of this story on Elephant in the post on Richard von Krafft-Ebing, here: .Richard von Krafft-Ebing  In the early 1950’s, flush with huge administrative responsibilities for 16 million service personnel and veterans of World War II and the Korean War, the US army demanded an official classification system for all of the mental disorders. At that point, hundreds of different local nosologies were in use.  After all, the armedforces needed a systematic way to determine who was crazy, who was malingering, and a reasonable basis for knowing how to allocate their medical resources.  As a minor after thought, sexual perversions were included in the resultant volume:  Diagnostic and Statistical Manual of the Mental Disorders I constructed after much debate, by the American Psychiatric Association.  Sexual deviations were mentioned, but not described, in the initial 50-page mimeographed publication, which sold for the entirely manageable price of 50 cents, when a Coca-Cola sold for a nickel and a Saturday matinee cost 25 cents.  The so-called ‘Kinsey Report’ cost more!

The second half of the Kinsey Report (1953) was a close contemporary of the DSM - 1

And there the matter might well have rested but for the twist of fate that found a psychologist at UCLA living next door to an expatriate British writer.  Both had spent time in Germany during the rollicking period of sexual license that comprised the waning years of the Weimar Republic.  She was well acquainted with the gay life, and generally accepting of homosexuality.  Both were deeply affected by the rise of Nazism, and the holocaust that became World War II.   She had barged her way into the nascent psychology profession in the 1930’s when it was less than friendly to women, mainly through her reputation as a brilliant researcher.  He was working on a screenplay that would eventually become a brilliant little send up of the funeral industry.  Your blog author saw that film, The Loved One at age 14 at the recently reopened Heights Art Theater in Cleveland Heights, Ohio in the company of his parents.  It played not long after the foreshortened run of a more famous film, Louis Malle’s The Lovers (1958), which had played there just a few years earlier and had been shut down as obscene, leading to the Supreme Court Case Jacobellis v Ohio, in which Justice Potter Stewart entered the famous opinion the he couldn’t define pornography, but “I know it when I see it.” in the process of overturning the theater owner’s conviction.

Evelyn Hooker

Christopher Isherwood

The writer was Christopher Isherwood, who you are far more likely to know for his Berlin stories which included the tales of American expatriate Sally Bowles, and became the basis for the famous Broadway musical Cabaret.  The psychologist was Evelyn Hooker, an ardent early advocate for de-pathologizing homosexuality.  Isherwood challenged Hooker to use her skills to conduct what became  one of the most famous studies in diagnostic history.
 
As the professional discourse arose about whether homosexuality might not be a disease began to heat up, advocates for retaining the diagnosis claimed that they could use psychological testing to prove it was a mental disorder.  They could diagnose it using psychological testing protocols derived from projective testing.  Hooker arranged to test exactly that assertion, by taking three of the best projective tests, and challenging their star practitioners to blindly sort the protocols of homosexuals from those of heterosexual men.

She chose a leading authority on each test to evaluate the subjects’ protocols, into homosexual and heterosexual piles, and to evaluate the extent of each subject’s signs of psychopathology on the tests. She also collected their sexual preferences and gave each an IQ test.  Bruno Klopfer was a top expert in the Rorschach test which was widely regarded as the best projective test for assessing psychopathology.  His book was so famous that I read it in my first projective testing course in graduate school 25 years later in 1981.  Edwin Schniedman, the inventor of the Make a Picture Test, interpreted the protocols from his test, and Mortimer Mayer interpreted the Thematic Apperception Test protocols.  Hooker gathered the data in her home, typed up the testing transcripts, counterbalanced them for IQ, and then farmed them out to the experts for interpretation.  The ratings were blind because the test evaluators never actually saw the test subjects, only these protocols, as a protection against the possibility that some sort of information irrelevant to the hypothesis might account for the experts ratings of the tests.  When the results came in, the three experts all agreed that they could not sort the protocols effectively through test interpretation.  Contrary to the opinions of the clinical profession, their best experts could neither detect psychopathology differences in these two samples, nor could the correctly sort the heterosexuals from the homosexuals.  In 1961, Evelyn Hooker got a lifetime achievement award from the American Psychological Association for this work and became an ardent professional advocate of removing homosexuality from the DSM.  In the mid 70’s, it was replaced by the diagnosis ‘Ego-Dystonic Homosexuality’ in later versions of DSM – II, and taken out altogether in DSM -III in 1978.  Hooker’s study was the fatal blow to the idea that homosexuals were all suffering from psychopathology that prevented them from being healthy heterosexuals.



Christian Joyal is a thoroughly French sounding Quebecois sex researcher with a crew cut, winning smile, and wry sense of humor.  In his SSTAR presentation on his 2014 Journal of Sexual Medicine article,  Joyal asked the awkward question, “Diagnostic and Statistical Manual?  Where are the statistics?” which left me imagining the Monty Python skit about the cheese shop with zero kinds of cheese.  The DSMs have not included these data since 1978!  In his day job, Joyal investigates subjects convicted of pedophilic crimes in a lab with fabulous virtual reality facilities.  There he can arrange all manner of stimuli and see how these effect patient's brain function using fMRIs.  He was utterly innocent of any interest in undermining the Paraphilia Section of DSM - 5 until he found himself wondering about the relationship of his subjects’ sexual fantasies and their illegal behaviors.  Joyal found many of his subjects had clear deficits in that portion of their brains related to executive function, which is implicated in processes of planning and impulse regulation.  But before he could draw conclusions about the relationship between pedophiles’ fantasies and their behavior, he would first like to have a baseline about the general population’s fantasies and behavior.  Having read the best books on fantasy and seen no studies worth reviewing, he concluded that his efforts to examine this connection required that he gather the data about ordinary peoples’ fantasies for himself.

Variant, perhaps, but far from statistically unusual!

He was aware that the diagnoses of the paraphilias, of which pedophilia was an example, depended on the recognition that paraphiles have ‘anomalous’ fantasies or behaviors.  So he made sure to include questions in his survey of fantasies examples that included all the major paraphilia categories from DSM – 5.  These are essentially eight classes of these fantasies and behaviors.  Voyeurism (looking at someone non-consensually for the purposes of sexual arousal) Exhibitionism: (exposing oneself to someone non-consensually for sexual arousal) Frotteurism: rubbing up against someone’s body without their consent for the purposes of sexual arousal) and pedophilia.  These acts were unethical, and in most cases heavily criminally sanctioned in Quebec.  He also looked at the consensual paraphilias:  Sadism, Masochism, Transvestism, and Fetishism.  These, of course, are the core interests of BDSM.  These are also the specific fantasies and behaviors that constitute the ‘anomalous’ content of the vast majority of paraphilias, even though countless other variations exist.

With the exception of pedophilia, none of these thoughts are criminal.  In some jurisdictions in the United states, any visual material of children under the age of consent (which itself varies depending on what state you are in) can be a serious criminal matter.  In Quebec, Christian can do fMRI scans of any image he wishes to construct on his fancy VR equipment as long as no real life child was used to make it.  In many places in the United States, it would be illegal to construct images of any sort that were intended to provoke pedophilic desires, even in a controlled research environment, and no IRB could approve such a research design that involved a researcher in criminal conduct.   So Dr Joyal is in a position where exploring the relationship between fantasies and behavior is important, and such research is possible to conduct, which might determine just when some fantasies might be genuinely dangerous, and when they are actually helpful to people who are trying to control behaviors that might be criminal or damaging.

The results of Joyal’s study, as summarized in his 2014 Journal of Sexual Medicine article, completely exploded the idea that sexual fantasies involving paraphilia content were ‘anomalous’.  Far from it.  A great many fantasies involving multiple partners, power exchange, sadism, masochism, and bondage, casual sexual encounters, and encounters with multiple partners were reported by more than half of Joyal’s samples of Quebecois. Individuals who reported none of these fantasies were in the extreme minority.  Only three of the 55 things he asked about were so uncommon that less than two standard deviations (a little under 2%) of his respondents reported ever having them.  Thus, hardly any fantasy was anomalous, and fantasies seemed to have no respect whatever for conventional sexual practices.  It is true that intimate relations with romantic partners, and romantic encounters on the beach were very popular, enjoyed by a large majority of respondents (85-90%).  But far more fantasies that the psychiatry manual referred to as ‘anomalous’ were extremely widespread, even among a nearly representative sample of Quebecois.

None of this should be surprising to professional sexologists, who have known since Alfred Kinsey’s landmark studies in 1948 and 1953, that sexual behavior is more varied than conventional wisdom endorses.   Later works by Friday (1973), Playboy (1974), and Janus and Janus (1993), Laumann, Gagnon, Michael and Michaels (1994), have reminded us that of that variability, although the latter study elided direct assessment of kinky behavior.  Recent studies suggest an uptick in interest and behavior, but most, with the exceptions of Richter et al, of Australia and Langstrom et al of Sweden, lacked representative national samples.

For over thirty percent, some variant behavior was acted upon one or more times in their lifetimes.  Here, Black Leatheramn cavort in front of the camera at the Folsom Street Fair in San Francisco.  The Folsom Street Fair is exceptional among kink events in its widely publicized open photography policies.  Cameras and smart phones are often banned at most kink events.

In immediate follow up to the JSM study, Joyal and Carpentier drew a representative provincial sample of Quebec, compared telephone and on-line admirations, and followed up their inquiries about fantasies with questions about abuse history, fantasy satisfaction, and behaviors.  They replicated a considerable body of research that has failed to demonstrate any statistical evidence for the widely held mythology that interest in kink is linked to early abuse.  This nearly representative sample established that 34 percent of Quebecois had acted on one or more of their variant fantasies within the DSM – 5 consensual paraphilia spectrum at least once in their lifetimes.   In yet a later article, they would demonstrate that 3 in 10 subjects had engaged in a knky behavior one or more times lifetime, up considerably from the 1.4-2.1% rate for behaviors in the past year Julia Richters et al had found in data from 2001 in Australia.  Joyal also found that subjects who admitted to masochistic fantasies had significantly more intense and satisfying fantasies than those who did not enjoy masochistic fantasy. 

Overall, this series of papers by Joyal and Carpentier fail to answer the larger question that interests him concerning the relationship between fantasy and behavior.  Are fantasies a compensatory safety valve we use to salve our frustration for experiences which we prefer not to undertake the full risks of living out in reality?  Or are they precursors to plans and actual behavior?  The answer is not simple.  It is clear that many people in Joyal’s studies day dreamed of behaviors they did not actually carry out:  The fantasy endorsements were far higher than the behavior rates in all categories.  But some people actually do things in the kinky categories they also dream about.  The study design could establish base rates, but could not establish causality.  Furthermore, pedophilic fantasies were so infrequent in these studies that few inferences could be generalized from such tiny numbers.  So clearly Joyal has much more work to do in that fabulous lab.



ICD -11:


But on another level, Joyal’s research comes at just the right moment.  The revision of The Diagnostic and Statistical Manual of the Mental Disorders – 5 is not the end of the process of struggling to define the proper diagnosis and treatment of problems in variant sexuality.  In 2017 and 2018, the further revision of medical diagnoses continues with the revision of the IDC – 11, the International Classification of Diseases - 11, a system of categorizing all diagnoses and conditions that affect medical health.  The current recommended revisions of this document can be found on the NIH website, and is conducted under the auspices of the World Health Organization, part of the United Nations.  WHO offical site for the ICD -11 revision  This is extremely important, as this system of classification underlies the DSM -5, and serves as the basis for diagnosis and treatment for every billable medical code and procedure everywhere in the world.  Struggles over some of these codes have huge implications for epidemiology, insurance reimbursement, and public health in all western countries, and the behavior of NGO’s in the developing world.

The current beta draft of this document drops the consensual paraphilias; transvestism, fetishism, consensual sexual sadism, and consensual sexual masochism, from the classification system altogether.  Where ICD – 11 is adopted as recommended, these will no longer be paraphilias at all, as Kinsey had suggested 65 years ago and as Joyal has demonstrated again in his recent research.  These standards are recommended by WHO, but they are adopted on a country by country basis.  Indeed, the four Scandinavian countries, Norway, Sweden, Denmark, and Finland have already dropped consensual paraphilias from their national coding systems derived from ICD -10.  It is unlikely that places dominated by traditional thinking and religious conservatism will adopt the ICD – 11 as recommended.  In Uganda, homosexuality is still regarded as a both criminal and psychopathological, even though it was already dropped before ICD -10 in most other countries.  But the ICD – 11 is likely to have a major impact in the Europe, the West, and in parts of Asia such as Korea, Japan, and China.

Evelyn Hooker did not end psychiatric discrimination against homosexuality with a single study.  It took the work of Frank Kameny, Barbara Gittings and the Gay Liberation Front, and the inside work of gay psychiatrists, and disruption of APA’s annual conference by activists to force consideration of this data.  Compared to that difficult struggle, National Coalition for Sexual Freedom’s negotiations with the DSM – 5 Paraphilia Committee and Norwegian activists editing of the ICD – 10 have proceeded with little conflict.  But just as the data would never have provoked change without the hard work of activists, Evelyn Hooker and Christian Joyal and Julie Carpentier’s data armed activists with the scientific power they needed to complete the political work required to change diagnoses.

Those of you who read my summary of Michael First and Ken Zucker’s presentation at AASECT 4 years ago may recall that Zucker’s last words in that piece were a response to my concern about the DSM-5’s two-tiered diagnostic system because psychiatrists might fail to attribute distress of a paraphilia to social stigma, rather than anything intrinsic to sexual variation.  He had said to wait until ICD -11.  Ken Zucker and Michael First's DSM - 5 plenary at AASECT
’ 
That moment has arrived.  Much of the credit for the ICD – 11 change rests with this research.

© Russell J Stambaugh, June 2017, Ann Arbor MI, All rights reserved



Sunday, December 18, 2016

Further Discussion of the AASECT Position Statement

There has been considerable discussion of the AASECT Position Statement - Sex Addiction, and a great deal of media coverage, most of it favorable.  Despite the fact that no professional organizations were mentioned in the statement, there has been strong reaction from addiction organizations who vigorously disagree. 

The function of this post is to aggregate my further contributions to the discussion of this topic.


The International Institute for Trauma and Addiction Professionals is not a professional organization, but a privately held LLC operated by Patrick and Stephanie Carnes and directors picked by themselves.  It provides certification training in 'sex addiction'.  The link to their response can be found here:

IITAP Response to the AASECT Position Statement

That link was posted to the AASECT List on December 14, 2016 by Geoffrey Goodman, PhD, ABPP, FIPA, CST, CSAT-S, CMAT-S, RPT-S 

I responded December 16, 2016:

I, for one, am not very impressed.   That is code language for this being my official opinion, not necessarily that of AASECT.  So lets put on our decoding decoder rings.

This IITAP 'decoding' document is an attempt to reframe the AASECT statement a sort of promise of future support because it is less absolute than AASECT's previous statements on sex addiction is simply incorrect. 

1) AASECT has not had a previous advocacy position on sex 
addiction, at least as far back as 1990. But there was no time when we had the mechanism to do it before 2004.  For more on that, please see my blog post  from elephantinthehottub.blogspot.com.  Individual AASECT Members, however, have often ardently opposed it.

2). It is pure fantasy that AASECT will change its position in the light of new data that hasn't come in yet.  

That statement reflects IITAP's belief that such research is just around the corner, but that has been their position for thirty years.  I know the feeling,  I have believed that cheap nuclear fusion power was only 20 years away since the early 1970's!   Just between you and me, it's still more than twenty years away now!  

In fact, the existence of a similar mechanism for sex addiction and chemical addictions is a major piece of the puzzle neuroscientists need to achieve to make the analogy work.  They more or less have that now.  They must also reliably demonstrate that ordinary sexual response, non-addictive substance use, and other sources of pleasure that are not about drugs and alcohol do not respond in the same manner.  Otherwise, we are probably seeing evidence of generalized pleasure circuitry, not evidence of addiction.  Likewise, it would be advantageous to see overlap with other colloquial addictions in their conceptual model that addiction treatment is appropriate for the wide range of things they call addictions is correct..   

I am working on a blog post for Elephant that address this relatively high conceptual bar.   To put it very briefly, to show that correlation is probably causality you must demonstrate that your measures are reliable; that they correlate with those things you intend to predict, and they do not correlate as well or better with other measures deemed close to your concept, but yet which lie outside of it; and that they correlate even less well with extraneous things that your model doesn't include at all.  Frankly, we can rarely meet that standard with the evaluation of other treatment methods, including our prefered models.  But that is what you need to be able to do to defeat Roger Libby's awkward assertion that behavior is nearly impossible to interpret outside of its context.  Please remember that, reparative and conversion therapies have been found to be unscientific and ineffective, (here I'm referring to the late Robert O Spitzer's conclusion that 200+ anecdotes  of reparative treatment success did not constitute scientific evidence sufficient to oppose banning them altogether at American Psychiatric Association) not just inhumane, and that the overall efficacy of sex offender programs, in which treatment must be focused on changing sexual behavior, failure rates are extremely high according the O"Donahue and Law's pessimistic Chapter 1 in Sexual Deviance:  2ed (2008) Guilford Press.  There is no unambivalent changing of sexual behaviors that are persistent enough to raise problems severe enough that they might be seen as powerful as chemical addictions.

3). IITAP still comes around to implying they are much more open and inclusive than they are, mainly by grossly falsifying their history, and end by urging us to play nice. They have, in effect, over-personalized the statement.  

My brief version of the history reflects that of Eli Coleman, who lived it.  I was in grad school at the time and not at any of those meetings.  After a few years of working together on hypersexuality, the addictionologists broke with the sexologists over language, particularly the term 'addiction'.  Any characterization of AASECT minimizing that sexual problems are real is unfounded.  We demurred years ago that sex problems constituted, in and of themselves, 'addictions' and diagnosable mental disorders.  We still demure today.   Not because there are no diagnosable sexual conditions, but that that is a distinct minority of problem sexual behaviors.  Intimacy problems, relationship conflict, reaction to stigma, unmanaged stigma are all best conceptualized in psychological terms even though they have neurological concomitants.

In the meantime, members of other organizations who wish to work together on problem sexual behaviors are welcome!  This is what that work looks like.

4). When working on this statement, we were focused on principles, not organizations.   We are against shaming techniques, pathologizing sexual minorities, and over-grand conceptual schemes that are not backed by quality data and inference regardless of which organization does what.  Please do not do it here, either.  And we are for sexologically-informed treatment, not just that done by AASECT Certified professionals.

It is my opinion that the term sex addiction is indefensible.  If later proof validates the concept, well, we can rethink that.

I might add, that I do not think much of the argument that we must use the sex addiction terminology willy nilly simply because the client might bring it in.  I would not call my client a rabbit simply because he claimed to be one, and when organizations that broke with the larger community of mental health researchers over the use of this term sold it to the lay community, it is not the clients' term that we are seeing brought in, but the organizations' premature and incorrect construction.  And with it has come problems of labeling, shame, blaming, flight form personal responsibility, and confused public discourse that make treatment more challenging rather than easier in many instances.  Having resisted the term ineffectively, we are now stuck with the problem discourse.  

If we are on record as opposing this language, for every person who defensively declines to admit they have a problem because there is no such thing as sex addiction, perhaps there is a perfectionist somewhere who won't kill themselves in despair because they are too ashamed to face such a scary problem.  Perhaps routine desire differences between couples will be easier to address if one person is not prematurely labeled as having the identified problem.   Those are the hoped for benefits of putting this sex addiction Djinn back in the bottle.  Djinn gold  disappears with the sunrise, so spend it quickly if you are planning to rub that lamp!

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This provoked a further post from Dr Goodman addressing sex positive activist Roger Libby and myself but talking past us directly to the AASECT Membership.  He suggested that IITAP was much bigger than AASECT, that 1000's of 12-step sex addiction groups met every week in the US and they must be helping or people wouldn't come to them, and that the AASECT Position Statement reflected a desperate bid of AASECT, an organization in decline in numbers and relevance in the face of a veritable tsunami of public and political endorsement of the sex addiction model.  He urged AASECT readers to keep an open mind about sex addiction in the face of AASECT's position statement.  I paraphrase here as it would be a violation of AASECT listserv guidelines to quote any post but my own. 

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Dr Goodman also posted this excellent link to the work of Dr Voon, which IITAP feels definitively validates the sex addiction model 

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I then responded:

First, the process for writing to individual members of this list is to back channel them to their private email accounts.  But Geoff is already aware of that.

Second, he lost most readers here on the 'IITAP Decoding Statement', or should have, when he suggested that AASECT and sexology had a long history of undifferentiated enthusiasm for all sex activity regardless of consequences or contexts.  He suggested maybe we are finally coming around now to right-thinking about sex addiction.  How many times we have heard this lame criticism from moral entrepreneurs in the past?  Aside from being just a trifle patronizing, its just not grounded in history.

AASECT and our sex researcher and mental health allies participated in the original efforts to define and treat hypersexuality out of belief that sometime sexual desire could be too much of a good thing. We could have simply stayed away from those initial joint meetings if we believed that too much sex couldn't ever be troublesome.  

The addictionologists are the ones who broke up these efforts when they left the other mental health professionals working of hypersexuality over use of the unproven addiction terminology.  

Neither was it minimizing of our concerns about Problem Sexual Behavior to devote an entire 2016 Summer Institute to educate about how to treat it in ways that are less exploitive of social stigma and more empowering of clients than other treatments like 12-step groups and sexologically uninformed addiction programs that have been promoting shame for sexual variations for years.

IITAP, as you well know, has a pretty poor history, up to and including the present, of failing to expel reparative and conversion practitioners and certified addiction professionals who brazenly include advertisements for attempts to change homosexual orientation in their websites and publicity materials.  In the past, IITAP has graciously cooperated with the Family Resource Center, which the Southern Poverty Law Center classifies as an anti-gay hate group.  Likewise IITAP cooperate with the ridiculous Anti-FAP, Fight the New Drug, and Your Brain on Porn cultists who's hyperbolic readings of the existing science are embarrassments to their field and to ours.  So these addiction certifying bodies and their paneyrists are in a poor position to lecture AASECT about our boundaries.

I am a Member of AASECT because it is an alternative to that kind of destructive mis-contexting and mis-conceptualization of the normal variability of human sexual behavior.

It surprises me to see that numbers argument, having just read AASECT President Debby Herbenick's eloquent and ardent defense of quality studies and sound inference over citing quantities of publications and over-interpretation on this list.  Why would anyone would suggest the AASECT Position Statement -- Sex Addiction is a response to the sheer numbers of people in our organization, or in IITAP?  The problem isn't how many lemmings are out there, but whether they are going over the metaphorical cliff.  By now, you are all aware that lemmus lemmus does not actually hurtle over cliffs to their doom in the real world, but they are doing this constantly in polemics.  You'd almost mistake them for humans!  I cite this as just one more example of why science matters!

All of this reminds me of a great Gary Larson cartoon in which a desperate lobster is saying to an obdurate chef, while the pot steams in the background.  "Did I say three? I'll grant you four wishes"!   This is not a popularity contest, the fighting for quality education and treatment for sexuality.  AASECT has always been a minority specialization, and it is our responsibility to know things most others have been discouraged from pursuing.  Our Membership is at the highest level since I joined back in the mid-1990's, but that is beside the point.  Twenty-two hundred is a small portion of 320 million.

(C) by Gary Larson, used under fair use.


Well organized political minorities, many who are allies of organizations like IITAP, have militated successfully against broader implementation of sexual health programs against the wishes of a majority of Americans.  They have opposed women's right to chose to carry their pregnancies to term.  They have opposed the right of America's youth to have scientifically valid and emotionally honest sexual health instruction.  They are claiming there is a porn epidemic and it constitutes a health crisis on the basis of zero evidence beyond the fact that porn is widely available on-line.  They claim rising crime despite the fact that the best criminology data shows a 25 year long decline of 30-70% for most offenses.  And despite Diamond's work strongly and repeatedly suggesting that the increased social availability of erotica is negatively correlated with sex crimes.  Yes, correlation is not causality.  But such statistical links as we have suggests masturbation is associated with health benefits, not harms, and erotica availability is associated with less crime, not more.

So anyone opining on this site about our history would be at an advantage to know it, and not just post material that suits the author.  

I am here to encourage you not just to keep an open mind, but to do it in the skeptical way that scientists do.  Not to just listen to some ad hoc concoction that suits your immediate personal interests.  Scientists read and review the best literature, and find the places where their skepticism can be tested.  They argue and discuss the best tests.  They develop their theories, then test against themselves, rejecting the hypothesis that they are wrong only when the evidence is too great to discard their pet theory.  They are as rigorous about their own theories as they are about those they disagree with.

Test not just with statistics, but with empathy, a knowledge of history, and with your sense of social justice.  Test with context.  Just as liking sex doesn't make you a slut, rejecting somebody's poor track record at setting boundaries doesn't make you permissive.  That is just the same old slut shaming in new drag.

You want my personal decoding of the AASECT Position Statement?

1). No slut shaming.  Often people with problems only magnify them with shame.
2). Be scientifically rigorous and conservative.  Works great with sexological treatments and addiction treatments alike.
3).  Put the client first and don't power play them, or let others power play you.
4).  The numbers that matter are in carefully constructed statistical tests, not popularity contests.  We just saw millions of voters be wrong.  Happens all the time.  Don't let it happen to you!

Having overcome my heretofore unconscious fears of declining relevance, I'll close here for the time being.

"Did I say four wishes?  I'll grant you five wishes!  They used to feed lobsters to Confederate  prisoners, you know.  We're highly over-rated.  Shrimp, now shrimp are very tasty...

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Whether we agree with their reading of the data or not, there is great resonance to the observation that sex addiction advocates are not going to simply abandon their models willingly.  Certainly the collective scientific judgments that reparative and conversion therapies are not just a human rights violation, but are ineffective has not prevented their proponents from advertising them.  They claim that If the public demands snake oil, it i it is their responsibility to provide it.  I find this a disingenuous argument for these outlier sex-addiction therapists to make.  They come from a tradition in which the unrealistic demands of clients are confronted, not gratified.  

But in truth, sex addiction therapists are not coming to AASECT because they are looking to find clients for conversion therapies.  They want to do effective, sexologically-informed work.  They take the reality that people have problems sexual behaviors so seriously they have made it their life's work.  And the data suggest that, while sex addiction clients are mostly wealthy, white and male, and there is certainly defense of privilege involved in their selection of this method of treatment, our clients are often similar to theirs in race and class.  And the data show that, as of 2016, severe conflicts of desire have been difficult to treat since the inception of sex therapy.  

In this we are allied, and being scientifically open-minded means being respectful of the limits of our theoretical models and the effectiveness of our techniques.  It means subjecting our best techniques to rigorous evaluation even when it is expensive and hard to raise money for sex research. It is by no means clear that the sex addiction emperor is the only one with no clothes here.  The proof isn't all that great for calling most sexual disorders diagnosable mental disorder in the first place.  Behavior needs context.  And in the current research environment, the hope is that neuroscience will overcome this truth.  Do not bet the farm on that assumption.  We have been wrong so many times before.