Hamlet: ... What have you, my good friends, deserved at the hands of Fortune, that she sends you to prison hither?
Guildenstern: Prison, My lord?
Hamlet: Denmark's a prison.
Rosencrantz: Then is the world one.
Hamlet: A goodly one; in which there are many confines, wards, and dungeons, Denmark being one o' th' worst.
Rosencrantz: We think not so my lord.
Hamlet: Then 'tis none to you; for there is nothing either good or bad but thinking makes it so.
Hamlet, Act II, Scene II.
John Godfrey Saxe’s poem is a witty illustration of the problem of epistemology: how those of us with fundamentally different assumptions and experiences can talk about our personal realities in a way that we can understand one another. Epistemology is the study of how we know what we know. Often ‘knowing’ includes many different assumptions, and fundamentally different ways of understanding our experiences. Multiculturalism contends that we should all profit from sharing these diverse perspectives. Often, cacophony and alienation overwhelm the ballyhooed enlightenment.
While the study of epistemology could be brought to many fields, as luck would have it, I am a clinical sexologist by trade, and no field could be more ripe for deconstruction of its epistemological assumptions. Peggy Kleinplatz has summarized the field of sex therapy as a set of techniques in search of a theoretical model. If this criticism is taken seriously, we have no over-arching model of what makes sex good, therapy effective, or even what boundaries the field should have. Harsh perhaps, but perhaps deeper investigation will find reasons for solace even if Dr. Kleinplatz is on the right track.
Sex therapy as a field is young, having arrived on the map essentially with the publication of Master’s and Johnson’s Human Sexual Response in 1966. Two years later, The American Association of Sexuality Educators, Counselors and Therapists got organized. Sex research on a scientific basis started to surface in medical journals in the 19th century. Sigmund Freud, with his notion that sex was the fundamental motivation for practically everything--including writing about sex--made sex research semi-respectable. In the late 1940’s, Alfred Kinsey, started to use some of the methods of social research to study the social prevalence of sexual behaviors. But it wasn’t until the mid 1950’s that The Society for the Scientific Study of Sexuality was founded. Today, there are only a handful of graduate programs in American universities and colleges that offer a systematic graduate level human sexuality program, so perhaps Dr. Klienplatz’s criticism is understandable.
Furthermore, the illustrious therapists and sex researchers just mentioned are fabulously diverse in their training, interests and professional credentials. Freud was an early psychiatrist, interested in modeling the human mind and creating an overarching theory and practice for treating mental disorders. Kinsey was an entomologist, and worked to bring the detached neutrality of zoology to human sexuality through survey research. Masters and Johnson were physician and social worker, but obsessively focused on human physiology of sex. They got dragged into teaching others about therapy mainly because they were the first to actually see sex response going right, and going wrong. If I threw in more examples of great researchers in human sexuality; Helen Singer Kaplan, John Money, David Schnarch, Eli Coleman, and Beverly Whipple, their training backgrounds, theoretical perspectives, and research interests only become more diverse. So it is not always so easy to talk to one another in such a multidisciplinary field.
Relative to the challenges of talking amongst ourselves, however, the prospect of talking to the lay public, the other sciences, and to our clients is particularly daunting. Everyone knows that in modern society you can rivet people’s attention even faster by yelling “Sex!” in crowded theater than by yelling “Fire!” However, in the age of self help, sound bites, changing professional roles, and electronic communities, sex doesn’t sell the way it used to. Not only are we awash in sex, but the voice of our clinical community is dwarfed by politicians and pornographers, clergy and media, rock stars, porn stars, and reality TV celebrities. There are more professional dominatrices advertising (based on a quick sample of 5 sites –surely a dirty job someone had to do!) on the internet than Certified Sex Therapists listed on the AASECT membership database! And anyone in the public square can easily outspend the professional community to get their messages heard above ours. We do not have much of a bully pulpit. A week seldom passes when some legislative body isn’t introducing new legislation to regulate marriage, reproduction, and sexual behavior. And no, we professionals were not asked for our opinion in this process.
While this blog surely can’t be expected to fix all of that, it might promote dialogue and create more community among a diverse group of educators, researchers, advocates, alternate lifestyle enthusiasts and therapists about what the boundaries of our field should be, and how we can make it more ‘therapeutic’ for a group far larger than the clients we shall ever get to see, face-to-face. We will try to talk about sexual variation and psychotherapy in ways that are commonly overlooked, thus the analogy to the elephant in the room.
© Russell J Stambaugh, PhD, Ann Arbor, Michigan, May 2013. All rights reserved.