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, cross dressing, fetishism, erotic role play, 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.