Monday, March 21, 2016

The Psychotherapeutic Theories of Kink: Introduction

“History is more or less bunk!”  Henry Ford

“Those who do not learn history are doomed to repeat it.”  George Santayana

"Those who do learn history are doomed to repeat it anyway.  It's enough to give the repetition compulsion a bad name!"  Russell Stambaugh

"That hardly bears repeating!"  An anonymous wag

This section of Elephant in the Hot Tub: Kink in Context is about the many theories of kink, and some of the great contributions that past theoreticians have made to the clinical discourse on sexual variation.  This discussion requires a little setting up.

Starry Night, (1888) by Vincnet van Gogh.   
In this period, clinical research had only case-study methodology to rely on.

After Krafft-Ebing, very few clinical writers decided to stake their professional careers on sexual variation alone.  As we explore this survey, an important theme will be: why did this writer address sexual variation? And what were his professional purposes and clinical goals in so doing?  How might it have been persuasive at the time?  Sexual variation began to be seriously studied partly as a consequence of several important aspects of medical and academic sociology and illustrates how knowledge is created, disseminated and construed:

First, when medicine and psychology became professionalized, social discourse about sexuality, and particularly sexual variation, was greatly stigmatized.  Although the stigma surrounding sexuality is less today than in the past, addressing sexual variation has never been easy, particularly profitable or glamorous over the course of the last 130 years.

Second, sexual variation was primarily addressed not for its own sake, but because it illustrated some crucial point of theory or practice that was important, illustrative, or unavoidable to a theoretician’s larger argument.  For example, the Associationists weren’t especially interested in sexual variation when they borrowed the term 'fetishism' from anthropology in suggesting that attraction to strange objects was learned behavior.  They were making the argument that chance encounters could result in durable learned changes in behavior, and glamorizing their scientific theory by choosing an example that could make magic understandable.

Third, sexual variation was discussed from a detached professional point of view in order to legitimize as much as possible the professional conversation about it.  In this sense, remarks already quoted in this blog from M. Foucault remain highly relevant.

'"You want to write your dissertation on what!?"
Erotic literature and porn existed throughout this period, but only a little of it entered the clinical and academic discourse about sexual variation.  Likewise, the non-clinical variants that were known tended to involve gay men, and even that was only occasionally entered into the clinical literature.

Theoreticians often had undisclosed private agendas that contributed to their willingness to fight stigma and undergo the hazards and travails of swimming upstream against social and professional disapproval.

The professional language about sex variation itself was toxic, including terms like 'perversion', 'sexual deviation', 'abnormal', 'immorality', and the general social discourse did not offer non-judgmental alternatives.  Social unconventionality was often regarded as proof of inferiority.

Relatively few sexually variant clients came into treatment.  Most weren’t suffering, and stigma was a huge barrier.  It was not safe for a depressed or anxious sexual variant to disclose their kinks for fear of judgment.   Unlike other suffering populations like depressives, conversion hysterics, or post-traumatic stress victims, who were regarded as individual sufferers, most sexual variations were framed as moral, legal and societal problems by non-clients like law enforcement officials, educators, or journalists.  Often clinicians were offering extrapolations from what little experience they had. It should not be surprising that there was not a rich source of presenting patients and a large stream of clinical data about sex variations.

Most professional papers were written about single cases of sexual variation, often explored at considerable depth.  In instances where these clients were compellingly or even accurately described, the case study methodology that dominated the first 65 years of the history of psychotherapy provided rich ground for over-generalization.  It took the invention of data gathering methods, statistical and analytic techniques, and the de-legitimization of accepted knowledge-production standards to supplant case-study methodology as the primary means of knowing about sexual variation.

A PDP-11: computing in the age when your author began his training.
This monster lurked in the nether regions of the University of Michigan's Institute for Social Research.
It was kept in carefully air conditioned comfort, hand fed by legions of technicians in white lab coats.
The newer methods, like social surveys and controlled clinical studies were expensive and difficult to execute.  They required fundamentally different funding models and training and had methodological problems and limitations all their own, even when the theory and technology became available to conduct them.

Finally, as in most psychological research done over that period, what we know was based on research created by almost exclusively European males, mostly upper-middle class professionals, they were mostly cis-gendered and heteronormative.   At first, these are the only people who had access to the social legitimacy that clinical and academic positions conferred.  Whatever criticism you prefer to make about psychoanalysis, which could be very hidebound at times, this was one of the first places which admitted women to the discourse, even when their male colleagues had trouble listening to the insights women had to contribute.

With such a rich source of caveats about the sources of error and limitations of early work on sexual variation, the reader would be fully justified in demanding why this history is worth one’s time.  There are very good reasons for making this effort, and they are similar to the reasons I have provided a superficial overview of non-clinical thinking about sexual variation and deviance over the previous centuries of Western civilization:

Social constructionism emphasizes the importance of varying contexts in what is construed as knowledge.  As the social context in which clinicians work and the sexually variant present for treatment continues to change, sophistication about the role of context is crucial, and remains continuously relevant.  History is a great way to teach that.

Although the art of psychotherapy is rife with trends, fads and fashions, there remains a community of clinicians out there practicing almost every theoretical perspective and they continue to contribute to the discourse.  Old clinical communities never die, there merely fragment!  The more history and theory you know; the better critic of new thinking you will be.

The smart clinicians who made some of these mistakes are excellent reminders and role models for us, and keep us mindful that today’s insights are impermanent and will also not stand the test of time.  It is entirely possible that clinicians whose theories we currently regard as outmoded today were right about the patients they saw in their time, or that they were more right then because of context then that is different from the context now.  And the worst mistakes might teach us humility.  Many were made by the leading thinkers of their times.  We are not immune.

A richer variety of hypotheses entertained from all sources is helpful in the here and now.  That includes good ones that are viable today, and studying the problems of bad ones that are no longer viable.

If history is analogous to eating your vegetables, hopefully I have prepared them tastefully.
Bon appetit!

© Russell J Stambaugh, January 2016, Ann Arbor MI, All rights reserved

No comments:

Post a Comment