Month: May 2013

Our Story So Far

Russell J Stambaugh PhD DST CSSP


John Godfrey Saxe (1816-1887)
This blog began with a 19th century American adaptation of a Jain poem about the near impossibility of communicating across different assumptions.  That cross-cultural communication is possible is admirably exemplified by John Godfrey Saxe’s adaptation of the parable from a religion that scarcely anyone in America has ever heard of.
 

A symbol of Jainism

The reason the Jain religion is little understood in America is that the Jain themselves were rather masters of assimilation.  Jainist beliefs underlie Hindu and Buddhist ideals of non-violence and respect for all life.  The concept of samsara, the illusion of temporal existence and reincarnation based on karma, stems from Jain beliefs.   Vedic Hinduism and Jainism lived side by side in ancient and medieval India (1500BCE to 500 AD) until they nearly merged.  Modern Jains comprise .4% of the Indian population, Hindus over 80%.  Saxe never visited India, but the parable is one of the exports of the British Raj.  The integration of Vedic rituals and Jain philosophy seems to have been accomplished through a great deal more scholarship and much less violence than the later Mughal and British colonizations.  With respect to the integration of Hinduism and Jainism, the blind men somehow thrashed it out without resorting to violence.

I then proceeded to suggest that studying kink was something like the epistemological puzzle posed in the poem:  that the different sexual variations themselves proceeded from a lot of different desires and abilities, experiences and epistemologies, and that studying them from the viewpoint of a therapist might be systematically different from being a participant, let alone an ardent enthusiast.  Kinky folk themselves might have had no small difficulties agreeing on a PR campaign!  Not only are the worlds of kink and therapy differing in many of their underlying assumptions, but language, goals, and expectations are often not shared.  In my discussion of consent, I contrasted the sexual freedom and sexual health agendas, and found areas of commonality.  In the last 4 posts, I have explored the differing epistemologies within the psychotherapy community regarding the field’s diagnostic manual. There is clearly plenty of disagreement about how we therapists know health when we see it, how we know sexual freedom when we see it, and when we think those two values are aligned.

Perhaps Saxe was a bit pessimistic.  He was a great lover of rail travel, and following a head injury, he struggled with depression.  In the Jain version of this parable, the six blind men visit the elephant in their various ways, and return to tell the king of their experiences.  The king affirms how they are right in their own ways; that the elephant is all these things and more.  The Jain version ends in harmony and peace rather than cacophony.
 

As it is with the elephant, so it is with the parable!  We will next turn to thinkers who believe that social reality is all about synthesis.

Umbra

Russell J Stambaugh PhD DST CSSP3 Comments

 

You don’t know the power…

The darkest sides, the umbra, of the shadows associated with sex addiction are twofold.  Despite the lack of inclusion of ‘hypersexuality’ as a diagnoses in DSM-5, a fairly large number of people find themselves craving sex, love, and relationships in ways they are cause for acute ambivalence, and socially undesirable behavior.  Somehow, both the kink community and the therapist community need to offer understanding and support to these efforts to have less sex and less craving.  Suffice it to say, not all sex is healthy or satisfyingly desired.  Some is self-destructive and criminal.

It shouldn’t surprise us that a concept of addiction that is based on neurophysiological accommodation to exogenous substances—drugs, in other words–doesn’t create unified behavioral criteria for psychiatrists who insist on repeatability and reproducibility to code a diagnosis.  Neither sex, love nor relationships are drugs, Bryan Ferry notwithstanding.  They are not even the same concept, psychologically or physiologically.  Addiction may be an excellent metaphor, but the analogy breaks down at some key points.  Perhaps the resistance Carnes, et al., are facing in trying to gain increased acceptance is appropriately scientific literal-mindedness.  A better life can often be achieved for addicts who get completely clean from alcohol or heroin addiction.  Some would be willing to trade the peace of a sex-free life for freedom from shame and excessive cravings for sex.  Fewer, perhaps, would so readily dispense with love.  And there are points in the typical natural history of relationships when craving is typical, and when love and sex are so similar as to be clinically indistinguishable.  This is a serious classification problem because the sex addiction theoretical model doesn’t fit observed behavior very well.

Limited metaphor

 
But there is strong evidence that our bodies’ and brains’ natural production of hormones and neurotransmitters underlie romantic craving, sexual desire, and healthy relationship behaviors.  The analogy may be imperfect, but even scientists and clinicians who are not persuaded by the sex addiction metaphor think we are looking in the right neighborhood. 
 
In 1983, an heir to the Upjohn fortune, plead guilty to first degree criminal sexual conduct with his 14 year old step daughter and 13 year old son.  Facing life imprisonment, he plead guilty in exchange for experimental injection of Depo-Provera, a powerful androgen-agonist that flatlines testosterone production in men.  Ironically, the drug was manufactured at that time by the company securing his personal fortune.  Famous sex researcher John Money had been the first to suggest, in 1966, that the basic chemical compound in Depo-Provera might be used to control deviant sexual urges.  In fact, it does a pretty fair job of controlling non-deviant sexual urges too. 

Depo-Provera’s primary use is as a contraceptive.  To reduce sex desire in men, 4 shots per year are needed.

 
The effects of blood level of testosterone in men are somewhat complicated.  If a man has a normal level of testosterone, his sexual desire is likely to be normal too.  More testosterone doesn’t raise sex desire, but can increase muscle formation and some secondary sexual characteristics, but these potential benefits come with serious risks, including androgen-induced psychosis.  These are among the reasons why steroid use is illegal in many sports, and a relatively dangerous practice.  Decreased testosterone, however, can definitely decrease sex desire.  This is a serious risk for anyone who has side effects from uro-genital forms of cancer where the testes may be affected by radiation, or need to be removed completely.  Depo-Provera had been approved in some states as a less expensive and potentially effective alternative to incarceration for sexual offenders.  Eventually, the Upjohn heir decided chemical castration was not such a great idea, and joined the prosecutor in suing to overturn his plea, and the Michigan Supreme Court ordered re-sentencing on the grounds that Michigan had no legal provisions supporting experimental chemical castration.  But physicians and mental health professionals who argue the importance of underlying hormones in sexual function are on solid scientific ground.  The idea of chemical castration as an inexpensive treatment for pedophilia continues to resurface periodically, much to the abhorrence of civil libertarians.

With solid evidence that sexual behavior can be heavily influenced by drugs, it is not surprising that those who treat chemical dependency would seek to help people treat other unwanted intense urges.  But this brings us to the even darker side of this story.  Because of the genesis of the sex addiction movement from Alcoholics Anonymous, it has become the treatment method if choice for religious people who define too much sex in terms of violations of absolutist notions of proper sexuality derived from their interpretations of the Holy Bible.  The community of Christians is very diverse, with many different forms of Biblical interpretation.  The sex addiction movement is home to many of the more socially conservative, absolutist, and fundamentalist beliefs.  These include hostility to Gays, sex outside of marriage, and any form of kinky behavior.  So a professional’s membership in and certification by SASH, the Society for the Advancement of Sexual Health, does not automatically protect consumers from a traditionalist agenda.

Actually, you would think that a Holy Bible which features slavery, crucifixion, and polygamous prophets (all the Old Testament prophets had multiple wives!) would be a poor bulwark against sexual variation.  In fact, I have had patients who attributed their first kinky sexual fantasies to Bible stories.  But the role of such experiences in causing kinks is highly ambiguous.  It is fair to say that if any story, idea, or imagery is in the culture, someone might pick it up, and that the Bible definitely contributes immensely to the Western culture from which modern kink has emerged.  But non–Western societies in Japan, India, and the Moslem world spawned plenty of sexual variation without recourse to Biblical instruction.  And the religious are perfectly correct to point out that the behaviors in the Bible had entirely different contexts, and many different meanings than their modern kinky analogues have.

Indian erotic art at Khajuraho.

Part of the resistance to the sex addiction model comes from people who have seen years of sexual judgments from people of faith, dislike the consequences and feel like they need to resist the judgments of others.  In kink, that may even mean flagrantly provoking the orthodoxy for the thrill of defiance.  But in closing my discussion of sex addiction and the conflict over the DSM I feel constrained by fairness to point out that there are many thoughtful therapists, in SASH or AASECT, who have religious beliefs but do their utmost to keep these from influencing their work with clients who do not share their views.  There are some very fine therapists in SASH. The sex addiction model has helped thousands of patients. In a later post, we will examine some of the component behaviors of successful therapy that 12-step, psychodynamic, and cognitive behavioral approaches have in common. 
 
I find it reassuring that, in the psychoanalytic model to which I ultimately subscribe, we each have a little darkness in us, and often the sources of our weaknesses are our greatest strengths in a different context.  The trick remains to be open anyway, even when it would feel safer to be closed-minded.  In the end, we are no better served to make sex addiction therapists the Other, than we are to do this to the kinky.

Three Program Notes:

The AAECT 45th Annual Conference convenes at the Miami (FL) Hilton Downtown June 5-9.  There will be some interruption in our regularly scheduled programming here during that convention. 
 
Thursday evening, 7-8:15; our opening Schiller Plenary will feature Michael First. MD, from the DSM-4TR Committee and Kenneth Zucker, PhD, Chair of the DSM-5 Sexual and Gender Identity and Sexual Disorders Committee.  They will present on the development of DSM-5 with special emphasis on the sexuality sections Ken chaired.

Friday Afternoon, 3:30-4:30; Mollena Williams, kink educator, storyteller extraordinaire, International Ms Leather 2010, and founder of Safewords: a 12-step group for kinky folk in recovery from addictions in the Bay Area will discuss her coming out as a black woman into sexual submission and what that means to the ethics and ethos of pan-sexuality in the BDSM community.

On Saturday morning, 7:45-8:45AM; I will chair the annual face-to-face meeting of the AASECT AltSex Special Interest Group.  There are rumors, patently false, that this meeting was scheduled early to hold down attendance.  Don’t let ‘em get away with it!

Reference:
More information on SASH and their programs can be found at:  http://sash.net


© Russell J Stambaugh, May 2013, Ann Arbor MI, All rights reserved.
 

Out of the Shadows

Russell J Stambaugh PhD DST CSSP


Romulans?  What are they doing in here?


A good example of the problems in DSM’s use which Foucault’s insight explains is the massive electronic database that a consortium of the country’s major insurance companies uses to keep track of all medical diagnoses and procedures.  If your insurer ever paid a claim for your care for a hang nail, drug overdose or suicide attempt, the medical procedures used needed to justified as appropriate to your diagnoses, and these diagnosis, cost and procedure data are kept so that the companies can estimate the economic risks associated with your health, and that of all other insured patients.  This central database is presumably a more valid indicator of the actuarial risks insurance companies face than the data from any single company would be since individual company data might be distorted by regional business models, or variations in their clientele. Some regions of the country have different health risks than others, as do different occupations. By associating diagnostic codes with demographic information, insurance companies save money and manage their own risk.  But they also are allowed to use this data to determine if you have a preexisting condition, and increase the costs of your policy.  The Affordable Healthcare Act, aka ‘Obama Care’, when fully implemented, will prevent limiting coverage for preexisting conditions.  But it will not prevent a diagnostic code from following you for life within the insurance industry, even if you change jobs, jurisdictions or insurers.  Of course, the government has access to the information too and their ‘big data’ projects could associate it with other information they keep on you.  All of this sounds like bedtime stories for conspiracy theorists.  It has been going on for 20 years, so whether there is any immediate cause for alarm depends on your personal diagnoses and comfort level with them.

Because individual clinicians; medical doctors and allied healthcare professionals alike, have professional ethical commitments to their individual clients, the insurance and government data requirements create considerable professional conflict for those who treat socially controversial diagnoses.  This came up in HIV/AIDS reporting, and it applies to diagnoses of psychosexual disorders, personality disorders and paraphilic disorders too.  If a doctor interprets his responsibility to ‘first, do no harm.’ strictly, s/he will decline to diagnose conditions that create socially risky consequences for clients.  Many mental health professionals have been doing this with consensual paraphilas for years.  If any other diagnosis fits, paraphilias won’t be mentioned.  There is also considerable debate about what techniques can effectively treat paraphilias, so few patients have been exposed to dangers of not getting reimbursed if they do not get the diagnostic label.  Most insurers decline to cover paraphilias entirely.  

This is all well and good, but more or less defeats any epidemiological research that searches medical records for data on paraphilias.  It is quite likely these are dramatically under-reported in clinical settings, especially private practice, where variant consensual behaviors are most often encountered.  It is time to switch science fiction genres:  this is analogous to Star Trek’s Romulan Cloaking Device.

A Romulan Warbird decloaking

 
Which brings us to the problem of hypersexuality.  In the DSM-5, hypersexuality is in the glossary but it is not a diagnosis.  Hypersexuality is defined therein as ‘a stronger than usual urge to have sexual activity.’  The literal–minded will immediately find lots of objections to the ambiguous “I’ll know it when I see it” diagnostic approach, but those are precisely the basis for a very large and political debate about what hypersexuality might be and what to call it.  Hypersexuality enjoyed a considerable prospect of making the DSM-5 list of diagnoses earlier in the process before the objections of Dr. Francis and others described in the previous post.  Historically, it has been turned back at the gate of the last 4 DSM revisions all the way back to 1980.  In 1987, it managed a near miss, achieving mention in the Sexual Disorders, Not Otherwise Specified example descriptions of DSM-IIIR.  Martin Kafka, MD, who sat on the Sexual and Gender Identity Disorders Committee that revised DSM-5, forcefully made the case for inclusion in an article in the Archives of Sexual Behavior in 2009, but it was not included in the published edition.

Although this is the sex addiction movement’s best seller, AA groups were treating ‘sex addiction’ for several years before Carnes published the first edition in 1983

 
All of which is a great disappointment to Patrick Carnes and his adherents, who, following Carnes publication of Out of the Shadows: Understanding Sexual Addiction in 1983, have been treating people who get into difficulties with those stronger than usual urges.  ‘Sex addiction’ ‘compulsive sexual behavior, ‘hypersexuality’, ‘impulsive/compulsive sexual behavior,’ and ‘problem sexual behavior,’ are all terms that have been applied to excessive sexual desire or behavior.  Leaving aside the fact that the neuroscience that sex addiction theorists use to justify their analogy to chemical addictions is very much a work in progress, different professional and consumer constituencies have varied epistemologies for understanding this concept of ‘excessive’ sexual urges.  This is another example where science isn’t strong enough to silence most critics.
 
In the meantime, hypersexuality is mostly diagnosed as an anxiety disorder.  This effects not only the avoidance of social stigma and makes treatment reimbursement possible, but it masks the prevalence of sex addiction as a separate category of disease, and does not classify the Alcoholics Anonymous treatment methodology of 12-Step programs run by lay group members as a treatment for excessive sexual urges.  The American Psychiatric Association retains professional jurisdiction for licensed mental health professionals in this instance by not legitimizing a diagnosis.  The science suggesting that hypersexuality is an anxiety disorder isn’t conclusive either.
 
All of which leaves sex addiction very much still in the shadows.  With no diagnosis and no data, from a purely epidemiological point of view, it is as if it does not exist!

Cloaked, it looks just like the final frontier

References:

 Out of the Shadows: Understanding Sex Addiction by Patrick Carnes. (Hazelden, 1983) ISBN 978-1-56838-621-8 http://www.amazon.com/Out-Shadows-Understanding-Sexual-Addiction/dp/1568386214
 
Kafka, M. P. (2010). “Hypersexual Disorder: A proposed diagnosis for DSM-V” (PDF). Archives of Sexual Behavior 39: 377–400.

© Russell J Stambaugh, May 2013, Ann Arbor MI, All rights reserved

Arrival of the Deathstar

Russell J Stambaugh PhD DST CSSP

“I wouldn’t be too proud of this technological terror you have constructed.  It’s power is insignificant compared to that of the Force!”
Today, the American Psychiatric Association’s diagnostic Deathstar, the Diagnostic and Statistical Manual-5, arrived in the bookstores.  Clinicians everywhere will be taking a ball peen to their piggy banks to fork over the approximately $199.00 list price for the 947-page volume that describes the psychiatry association’s views of the mental health diagnoses they propose as the foundation for all clinical and research purposes.  Twelve years in the making, and proceeding from the work 13 work groups, 8 study groups and considerable APA administration, the tome could hardly be expected to arrive without some fanfare.  In the past 36 months, the primary note has been one of controversy.  How could so few contributors wield so much power in defining such an important document?  Is it fair?  Is it political?  Is it scientifically valid?  Treatment, insurance reimbursement, the outcome of divorces and civil suits, criminal prosecutions, mental hospitalizations, forced medication, even life and death itself may turn on the nuances on this crucial document.   As the demarcation of the no-man’s-land between the pathological and the merely unusual, it is important to the sexually variant, too.

A major project of this blog will be to trace the development of modern thinking about sexual variation. As the culmination of all of that work, the DSM-5 is indeed an important document.  It arrives just in time (or should I say, I finished the Michel Foucault entry just in time, because that entry was far more a consequence than cause of the manual’s release date) for us to recognize that for all its importance, the arrival of the manual is pretty much a non-event.  The rebel base on Yavin is in little more danger than it ever was, in part because of insights derived from Foucault.

Despite the controversy, the DSM-5 is a carefully worked, and fairly incremental change from its predecessor, DSM–IV.  The former volume was developed early in the age of selective serotonin reuptake inhibitors (SSRI’s)–Prozac is the first and best known example–and slightly revised in 2000.  So psychiatry has many more pharmacological tools than it did in 1994 when DSM-IV was issued.  Much of the revision centers on nuances of those conditions for which drugs are major form of treatment.  If there is a bright center of the psychiatric galaxy, paraphilias are the place that is farthest from it.
 

The central warfare over the DSM – 5 has centered on two kinds of arguments within psychiatry.  Is the diagnostic manual valid in its representation of its classification system relative to a cohesive theoretical system, and is it practical?  To guide research, it must be valid.  To be useful, fair, impartial and justify APA’s leadership in its construction, it must be practical.  There have been enough fireworks so that reasonable outsiders might have doubts on both these points.

DSM or not?
 

Much to the discomfiture of David J Kupfer, Chair of the APA’s DSM-5 Design Task Force, in the last 6 months, Thomas R Insel, Director of the National Institute of Mental Health, has publicly announced “as long as the research community takes DSM to be a bible, we’ll never make any progress” researching mental illness. As head of the US government’s highest mental health research agency, those are commanding heights from which to be raining such powerful critical salvos against the DSM’s research usefulness. Insel believes, quite correctly, that the diagnostic nosology, even though it purports to serve as a guide for research on all psychopathology, has no unifying underlying model of what causes the symptoms that comprise the diagnostic criteria.  That integral relation to theory is what good construct validity requires.
 

Long ago and in a galaxy rather close to home, psychiatry had such a DSM, then numbered ‘two.’  It was based on psychoanalytic theories about unconscious causes of symptoms that had been elaborated extensively by the intellectual descendents of Sigmund Freud.  In 1980, that system was overthrown because psychiatry became dissatisfied that the cohesive underlying explanations were built on shaky foundations since the practitioner community couldn’t agree on the diagnoses themselves.  For there to be any hope of validity, there needed to be reliability: different therapists need to be able to diagnose the same patient close to the same way.  So the DSM was redesigned to be so symptom-focused that different diagnosticians could agree on any given patient’s symptoms pretty well.  This was highly agreeable to consumers of psychiatry like courts, government, insurance companies, and patient’s themselves.  In the 1960s through the 1980s, psychoanalytic theory became so discredited that, with the adoption of DSM–III, graduate psychoanalytic training was largely driven from medical and psychological training at colleges and universities.  Since 1980, mental health diagnoses has been saying “look ma, no hands!” with respect to underlying theory.  If that doesn’t quite sound like the Holy Bible to you, it didn’t seem that way to most mental health workers either.
 

Which brings us back to NIMH Director Insel, who is advocating for underlying theory that is frankly, just not scientifically ready yet.  Insel is a neuroscientist by training, and he is looking to establish a diagnostic system based up neuroanatomy and pathways.  “Research domain criteria,” Insel’s preferred classifications of symptoms based on neuroscientific causality, is still many years from realization.  President Obama’s initiative to map the human brain will be a very lengthy and ambitious project, an important step toward Insel’s vision, but probably will be far from sufficient.  Psychiatry has no choice but to proceed without construct validity in the interim. With respect to construct validity, the DSM-5 is about to function in the next 20 years pretty much as its last two predecessors did over the previous 30.  The book itself might be as bright and shinny as a new penny, but it will be used in the same old ways.

Equally disturbing to the APA has been the criticism of DSM–5 from an unlikely source, the Director of the DSM–IV Task Force, Allen J Francis MD.  Francis has complained about secrecy in the development process, risks of over-medicalizing mental disorders, sub-standard inter-rater reliability for newly proposed diagnoses, and most seriously, that the manual represented huge power grab by psychiatry to shrink the boundaries of ‘normal’ behavior and generate the opportunity for immense new revenue for the companies that manufacture psychiatric medicines.  That Frances was chair of the previous task force was a major defection and embarrassment to APA, but his criticisms probably have scaled back parts of the plan to expand most areas of practice.  Two of the biggest controversies surround definitions of attention deficit disorder that might justify increasing prescriptions for stimulants, and the medicalization of bereavement, and opportunity for the prescription of anti-depressants.  If you were aggrieved by the loss of your life partner and you could take a drug to take the pain away, how many weeks after the loss would be too soon to pursue pharmaceutical relief?  In setting that time at 2 weeks, is the DSM-5 rendering a judgment on how long we should grieve, creating a boon for drug makers, or offering a service that suffering patients desire?  Without a system of construct validity, that is not really a scientific question, but one of social values ripe for further deconstruction.
Not analogous to depression or bereavement

The definitional problem of mental disorders defined by symptoms is a morass because of mufti-causality, because of multidimensionality, and because different interventions can cure the same ‘disease’.  We cannot cure bereavement by placing a cast on an unbroken leg that would have been perfectly effective for a leg that is actually fractured.  But a drug might very well decrease anguish that talk therapy, the passage of time, or religious faith might heal.  So is it a mental disorder, or just a problem we can fix, or a threat to our humanity, because we can make a bereavement disappear with medicine?
Michel Foucault “He’s baack!”
 

This observation returns us to Michel Foucault, who would remind us that the power of the APA to mold our sense of what is normal and what is not is partially an emergent process for which we are all responsible.  That the DSM-5 has warts, frailties and defects is unarguable, but it is the DSM’s role in the regulation and expression of social power that is suspect.  It is the uses our other institutions make of the DSM that are the principle source of the social troubles of which it is a part.  We have let business and government credence the volume, and allowed the APA to create it unilaterally.  Someday, that is going to change.  Until then, the Deathstar will go unfought, and very little will be different for the next 20 years than for the last twenty. The arrival of DSM-5 may not have altered the balance of power in the psychiatric galaxy, but it has preserved it. Incremental change sustains APA’s legitimacy and power, and keeps conflict manageable.
Perhaps in response to Dr Francis’s criticisms, and push back from consumer advocates like NCSF, very modest additional protections have been instituted against over-pathologizing kink in DSM-5.  The manual institutes a two step process for determining whether kinky behavior deserves a diagnosis.  If behavior is unusual, then it may well be a paraphilia, but absent coercive and nonconsensual behaviors and significant patient complaints about the adverse life consequence of kink, it is not a diagnosable Paraphila Disorder.  How much protection does this distinction afford if you ever wind up, say, in court?  Probably very little, since after all, there is evidence of adjustment problems and adverse consequences since your partner is leaving or your credit limit is exceeded, or your employer is firing you.  The manual does offer some protection by discouraging mental health professionals from diagnosing any identifiable variation as pathological if you come in to treatment for a condition that has nothing to do with your variation.  As far as Diagnostic and Statistical Manual-5 goes, the acceptance or social persecution of kink will unfold with incremental changes much like those in the immediate past.  I guess the struggle to restore freedom to the galaxy remains to be continued…


© Russell J Stambaugh, May 2013, Ann Arbor MI, All rights reserved 

Michel Foucault and The History of Sexuality

Russell J Stambaugh PhD DST CSSP
Michel Foucault (1926-84)


Michel Foucault (1926-1984) was a French philosopher and social theorist who has become a major figure in critical theory.  His central thesis is that the social construction of ‘knowledge’ is really an emergent process serving the preservation of power relations in society.  Power as defined by Foucault is not a simple political or economic process, but emerges from the social order by controlling discourse about social reality.  As such, he expands on the work of the earlier social constructionists in sociology, Marxists, and the structural-functionalists, all of whom he would later partially disavow.   It is fair to say that Foucault’s ideas about power required Marxist, existentialist, Nietzschean and Kantian insights to flourish.
Foucualt’s central idea about sexuality, as outlined in History of Sex, an Introduction, published in English in 1976, is that the central hypothesis preoccupying academic study of sex in the 18th and 19th centuries; that social order was primarily about sexual repression, was wrong.  Actually, during that period, sexuality became freer, was much more openly discussed than previously, and that the encouragement of confession, discussion, professionalization and commercialization of sex served emergent modern power structures.  In this blog, I will be using the term ‘medicalization’ frequently to describe the process by which sexuality came to be construed as a medical problem to be defined, diagnosed and treated by medical doctors and allied health care professionals. 
 
Foucault was concerned with the philosophy of knowledge and power much more broadly than this focus on sexuality.  He wrote works explaining how man came to be the focus of academic study, and how medicine came to define the madness as defective reason and segregate ‘lunatics’ in asylums away from ordinary social discourse during the 18th century.  As such, he was a seminal thinker in the growing criticism of psychiatry.  This process will get some attention in this blog as well.

 

The Rake’s Progress: the Rake in Bedlam (1735) William Hogarth

A Freudian interpretation might subsume Foucault’s energetic deconstruction of the repressive hypothesis as an elaborate rationalization of his homosexuality.  They might present as evidence Foucualt’s confession that he became smart by energetically doing a high school classmate’s homework because of Foucault’s attraction to his male beauty.  Or cite his criticism of the concept of perversion as affording professionals pleasure and power over sexual deviance (like homosexuality) through study!  But Foucault’s idea’s are far too influential to dismiss, whatever their psychogenesis.  Foucault was an ardent homosexual with many affairs.  Foucault lived a polyamorous lifestyle, and was among the first prominent French persons to die of complications associated with HIV/AIDS.

Reference:  History of Sexuality: An Introduction: http://www.amazon.com/The-History-Sexuality-Vol-Introduction/dp/0679724699/ref=sr_1_1?ie=UTF8&qid=1369188649&sr=8-1&keywords=history+of+sexuality+foucault 

© Russell J Stambaugh, May 2013, Ann Arbor, MI.  All Rights Reserved.

Sexual Deviation to 500 AD.

Russell J Stambaugh PhD DST CSSP1 Comment

Hamlet:  There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.

Hamlet, Act I, Scene V — William Shakespeare

Whether modern Western society considers the sexual variations discussed in this blog ‘deviations’ or not, understanding where psychiatric diagnosis comes from requires consideration of how sexual variations have been construed in the Western tradition. For much of history, ‘variation’ has meant  ‘deviation.’  For a large number of up-coming posts, this story is going to look like the ‘great man theory of history,’ as biographies of various thinkers and their contributions are presented.  This means a lot of white men, and a very European profile.  But the start of this story looks a great deal more like a Western Civilization class.  That is because the Western ideas about kink and conventionality are embedded in a very Western context.
“Look here upon this picture, and on this; the counterfeit presentment of two brothers.”  The Bedroom Scene in Hamlet

When I was in school back in 1980AD, I had room and requirement for only two cognates in my Clinical Psych grad program.  I chose Comparative Family Systems, an Anthropology course about family structure as one of them.  On the first day my professor announced that in an Anthro Department ethnographic database, U of M had entries on over 500 cultures.  There were almost no cultural universals, with the exception of some sort of incest taboo.  97% of the database cultures specified that some group of people couldn’t engage in some sort of sexual activities with another group of people.  These groups were almost always defined by genetic relationships or marriage ties.  But the prohibited activities and which relationships were defined as incestuous were all over the map.  Incest taboos were still maintained in monogamous and in polygamous (mostly polygynous, men taking multiple wives) cultures–there were only a handful of mostly south Asian cultures that practiced limited polyandry (the practice of a woman taking multiple husbands).  Later I would learn of some of the great scams and errors of ethnography, and come to recognize that reports to outsiders had no guarantee of accuracy, so 97% constitutes a very high mark of universality.  It is fair to say that some social definition of sexual deviation is part of every society.   This will prove a serious problem for sexual libertarians who would like to argue that individual freedom is a natural condition abused by modern societies.  Whatever the merits of sexual freedom, the historical and cross-cultural evidence suggests that it has been a prerogative of the powerful few, rather than the historical norm for most.
The Mask of King Tut, who married his half-sister.
  

If deviation was nearly universal, socially approved practices were widely various, and many things that, for one reason or other, I suspected were likely to be universally prohibited were nonetheless practiced somewhere.  My understanding of evolutionary biology suggested incest taboos functioned to insure exogamy and protect from the consequences of genetic inbreeding.  This did not stop the Egyptians from marrying brothers and sisters (Tutankhamun, for example, married his half-sister) to keep power in the family, an occasional practice among the Inca and other societies where rulers were thought to be divine.   

A Papuan longhouse circa 1922 taken by Australian anthropologist Frank Hurley.  New Guinea has many tribes and varied coming-of-age customs, but separate gender residences are common.

Modern notions of child sexual abuse aren’t universal.  Certain tribes in Papua New Guinea perform coming-of-age rituals in which male members of the tribe attain their majority by fellating their potency from tribal elders, who graciously gave up semen to make men out of their charges.  These tribes tend to have very restrictive relations between the sexes, with men and their wives sleeping separately, the men in longhouses; the women in family huts where they care for the children.  These Melanesians had strong beliefs surrounding spiritual practices that must be kept secret from the other sex.  You might have sex with your wife anytime, but you would never sleep with her lest she learn your gender secrets while you slept!  Stories like these are outliers, but great sexual diversity is just as much the rule as definitions of deviance.
Oedipus by Ernest Hillemacher, 1843
 

In Western antiquity, many ideas that are now highly conventional existed side by side with practices that are not.  The obvious example is the Golden Age of Greece, where homosexual attraction between men and boys was regarded by male writers as the highest form of love, (Sappho notwithstanding, very few female writers left work for later scholars to pore over.)  However this Greece also gave us the myth of Oedipus, and his inadvertent but catastrophic story of patricide and mother-son incest.  Freud would later seize upon this mythology selectively.  Classical Greece had notions of sexual deviance.  Some look like ours today, others do not.

 

The Andrians (Bacchanalia) by Titian 1488

 

In the Roman period, the Greek polytheistic religion, Judaism, and Christianity existed side by side. Before 331AD, Jews and Christians were persecuted.  Following the Christian conversion of Constantine I, in 337, Christianity became much more influential, aided by the migration of the Roman capitol to Constantinople.  Early roman sexual customs were much more various than accepted traditions today, including slavery, Dionysian orgies, and sacred prostitution.  Modern notions of sadomasochism make little sense where society sanctioned sex with slaves and routinely granted unlimited coercive power to their owners. 
 

In fact, fellatio among the Papuans, sacred prostitution, homosexual love between Greek youth and their mentors, or transgendered shaman among certain Native American cultures had fundamentally different meanings than modern subcultural sexual variation has.  Some critics have gone so far as to say that these ethnological examples are not really about sex or gender as we understand them.  I am unwilling to go quite that far, but in many ways, modern ideas of sexual variations are not contiguous with these examples.  Rather they show the breadth of human social and sexual variability, and demand further explanation of how our approach to sexual diversity serves power in modern societies.  And that will bring us to discussion of the thinking of Michel Foucault.

 

Foucault’s Pendulum  Unfortunately, that was invented by Leon, not Michel!  As far as I know, they are not related.

© Russell J Stambaugh, May 2013, Ann Arbor, MI.  All Rights Reserved.

 

Consent Counts

Russell J Stambaugh PhD DST CSSP


Before leaving the topic of consent too far behind and beginning a series of posts about where the idea that sexual variation might be pathological came from, I want to end this very abbreviated exploration of consent with a description of the Consent Counts Project.  This is a very significant effort by The National Coalition for Sexual Freedom (NCSF) to advocate for changes in US law to support legal protection for consensus in kinky sex, to promote public awareness of the importance of consent, and to promote dialogue within the BDSM communities about the concept of consent and its application.  Again, this is a slogan about the social reality that NCSF is working to bring about, rather than an apt description of current social conditions.  A program like Consent Counts is essential precisely because often, consent is observed in the breech, rather than the observance.
The National Organization for Sexual Freedom was founded in 1997 to advocate for the freedom to practice sexual variations safely and legally.  Along with The Woodhull Sexual Freedom Alliance, named after nineteenth century sexuality activist Victoria Woodhull, NCSF is a leader in the advocacy effort for sexual freedom.  NCSF maintains a list of Kink Aware Professionals (KAP) who understand the medical, legal, mental health and other needs of the sexually variant communities.

The Consent Counts Program is directed by Susan Wright, who is an AASECT Member of longstanding, and a founder of NCSF.  It has many dimensions, and she will be expanding on them in her AASECT presentation “Understanding Consent in BDSM Practices” at the fast-approaching AASECT 45th Annual Conference in Miami, Saturday Morning, June 8 at 9-10AM.  I will only outline Consent Counts’ dimensions here:

  •          Legal reform, including advocacy efforts and legal database of applicable state laws so users can understand the applicable laws in their jurisdiction(s).
  •          Community Assistance Guides to best practices for BDSM groups and individuals, including ways to determine if assault has occurred, handing of consent violations, and legal defense when these arise.
  •          A very sophisticated set of threads on FetLife about what consent is and how its violation happens and matters in the community.
  •          A survey of consent violations in the community is under development.

This program is thus focused not just on advocacy for more favorable legal statutes covering BDSM, but education of professionals who service kinky clients, resources to help kinky organizations in the self-educational efforts, and direct support for kinky individuals who may not consume the services of the existing organizations.  And it is focused on sophisticated discussion of consent in BDSM by kinky individuals.

References:

The National Coalition of Sexual Freedom Website:  https://www.ncsfreedom.org/

Fetlife.com, one of the primary, and least commercial, on-line communities for BDSM:  Fetlife.com

The Consent Counts main thread on FetLife (You will need to open a Fetlife account to visit):  https://fetlife.com/consentcounts

The Woodhull Sexual Freedom Alliance, another organization working to protect sexual freedom: http://www.woodhullalliance.org/

Consent

Russell J Stambaugh PhD DST CSSP


“Sexual Health and Sexual Freedom:

AASECT believes that healthy sexual activity is always ethically conducted, freely chosen, individually governed, and free from undue risk of physical or psychological harm.  AASECT believes that all individuals should be supported in seeking and finding opportunities to pursue a healthy and happy sex life of their own choosing.  AASECT believes that all individuals are entitled to enjoy:

  • Freedom of their sexual thoughts, feelings and fantasies.
  • Freedom to engage in healthy modes of sexual activity, including both self-pleasuring and consensually shared-pleasuring.
  • Freedom to exercise behavioral, emotional, economic and social responsibility for their bodily functioning, their sexual liaisons, and their chosen mode of loving working and playing.

AASECT believes that these rights pertain to all peoples whatever their age, family structure, backgrounds, beliefs, and circumstances, including those who are disadvantaged, specially challenged, ill or impaired.

Sexual Variability and Rights:

AASECT recognizes the many varieties of sexuality including, but not limited to, the full range of sexual orientations, gender, transgender and intersex positions, as well as erotic preferences and lifestyles.  AASECT opposes the application of labels such as “normal’ and “abnormal” to the variations in the healthy sexual expression of adults, and AASECT believes that all sexual and cultural minorities should enjoy sexual freedom, equal rights, and parity of social opportunities and privileges.”
    

Excerpt from the AASECT Vision of Sexual Health (2004)  http://aasect.org/vision.asp

Kinky people who participate in lifestyle organizations and professionals in the psychotherapy community share deep philosophical commitments to ideologies featuring informed consent and personal responsibility.  Anyone who works seriously with the concept of consent not only recognizes its importance, but also how problems arise in its proper application.  In the therapeutic communities, this takes the form of discussions of professional standards, ethics and therapeutic techniques and boundaries.  How is informed consent to be protected, and how can clients make informed free choices?  We have already seen that kinky communities have tried hard to reassure interested potential members that they are not into coercive practices or dominating the unwilling.  They are fighting public notions that BDSM is non-consensual violence.  They want to protect free choice too.  The epistemologies of kink and therapy can be far apart sometimes, but here the two communities share a great deal in common.  Yet the concepts of individual responsibility sometimes get handled very differently and kink plays with consent in ways that would be unethical for professionals to attempt.  It is the opposite of the standard safety disclaimer:  “Don’t try this at home, folks, we are trained professionals.” means we pros can’t do the dangerous and entertaining presentation, which can only be safely attempted by amateurs!
 Mythbusters’ Caveat!

Several characteristics of BDSM make consent a challenge.  Many clients want risky activities, but give consent in anticipation that things will go well, but not so much if they go wrong.  Intense emotions and the very manipulation of mood and consciousness that BDSM attempts to effect can drastically alter feelings, cognition, and the capacity to evaluate risk.  I have already suggested that fantasies of how BDSM practices feel and their reality may be widely divergent, and the inexperienced can easily have eyes that are too big for their stomachs.  Mostly we worry that people will get in over their heads, which certainly happens, but there are risks of being scared off too easily and missing out on pleasure to be considered also.  The kink community uses different language about risks and feelings, part of the glue that holds communities together is private argot that the unaware don’t share, so communication is far from automatic, especially for novices and outsiders, despite a very serious commitment to public education.

Contracting:

One of the primary strategies the kink community uses to counter these risks is by promoting the practice of explicitly negotiating scenes.  This negotiation often takes the form of a contract, that is rather like the things we therapists ask client’s to sign when they consent to treatment.  Contracts talk about things that must go into a play session or ‘scene’ (yes, the jargon for a play session and the larger community of BDSM is the same word!), things forbidden, safewords or signals that participants can use to stop play in an emergency, and safety arrangements.  They may discuss duration, who can watch or participate and how.  When relationships deepen and players become more intimate, this negotiation becomes less explicit.  But often the negotiation results in far more explicit conversations about not only sexual activity, but emotions, symbolic meaning, and intimacy than the non-kinky typically undertake.  In kink, communication is often deeper and more detailed, assumptions more challenged, and consent far more explicit than is customary or valued in vanilla sex.  We may imagine that contracts primarily protect submissives and masochists, but they equally protect Dom/mes who do not want to over-step, want to feel powerful, in control and effective—it requires staying within boundaries to do that.  Dominants may be doing things that would put them at considerable risk without prior explicit authorization from a submissive they can trust.  Pat Califia has an erotic story about a gay submissive being kidnapped and shaken down for sex by uniformed police officers.  That’s prima facie evidence of the crime impersonating a police officer, not something you are going to want to face if you think the ‘victim’ might complain.

This does not mean that such negotiations are risk-free, or even that partners are always open and honest in negotiations.  Excessive desire to please the other and unrealistic expectations can infiltrate these discussions just as they do with vanilla relationships.  Having an explicit conversation about your limits isn’t a whole lot of protection if you don’t know them.  But the acceptance that negotiation of scenes and boundaries is a routine part of play does mitigate many emotional risks and promotes awareness of self and others. 

Mental Health:
 

To be released May 22, 2013

Consent is problematical in other ways.  Because of psychiatric diagnoses that kink behaviors may be pathological or compulsive, this legitimates questions of what activities may be consented to on a genuinely informed basis.  Mostly people in the BDSM world avoid direct discussions of psychiatric diagnosis, and maintain that the Diagnostic and Statistical Manuals of the Mental Disorders over-pathologize kink.  There were several serious organizational efforts to have consensual sexual sadism and consensual sexual masochism removed from the Paraphilias Section of DSM-5. This blog will eventually present a very extensive series of posts regarding the history, social construction, and professionalization of sexual deviance, a topic way beyond the scope of this post.
 

There is understanding of concepts that are not unlike psychopathology in BDSM.  The tendencies of novice submissives to become like kids in a candy store and crave everything imaginable is understood and discussed by dominants, and respected dominants know and deal with this by setting limits.  The same is true for ‘sub-drop,’ a kind of adrenaline and endorphin crash the follows intense scenes, and manifests a great deal like Major Depressive Episode.  Emotional aftercare for heavy scenes is a part of the expectations of effective tops.  It is also part of the folklore that breakups of intimate BDSM relationships of longstanding are especially difficult for dominants and submissives alike, and that people need special support during such losses.  Because of the troubled relationship between organized scene activity and professional mental health, most of these problems are dealt without professional interventions.
 

Do Not Forget Your Safeword!

Safewords:  The epistemology of “No!”

Perhaps the most common but provocative core concept in BDSM relative to consent is the safeword, a signal that the submissive can use to communicate that there is an emergency that should stop play.  Obviously, submissives would not need this protection if they were free to stop the action any time they felt like it.  But this is no fun for the submissive, who would then feel responsible for everything that transpires, and enjoy no sense of giving up control.  Neither is it any fun for dominants, who want to feel like they are driving the action, not slavishly obeying the submissive’s instructions.  So both parties in a BDSM scene have a stake in agreeing to ditch active consent.  Contracting inevitably constitutes a surrender of consent, and the safeword acts as a device for restoring part of it.  But one of the main effects of safewords is to assert the reality in BDSM that “no” doesn’t really mean “No!”, and that the dominant in any scene doesn’t have to stop simply because the submissive says so.   The existence of safewords is proof  that most BDSM activities involve some degree of consent play–that freedom to stop the scene is given up.  But it serves the symbolism and theater of the play, and the psychological needs of the players to feel power is genuinely exchanged in the scene.
 

A French Stop Sign.  We will revisit this when we discuss Jacques Lacan, who was not kinky, but was disinclined to stop!  But in the interim, this is a poor safeword.

 

The mechanics of safewords differ somewhat.  Typically a word the submissive would not be inclined to chose is ‘Stop!’, or ‘No!’ or any word s/he commonly uses when excited.  ‘Yellow’ is a more common choice.  Sometimes there is a hierarchy of safewords, so the submissive can stop action to discuss something, without permanently ending play.  There is considerable incentive not to use safewords in a cavalier manner.  Submissives feel like they may be giving in too readily to their anxieties, or fear judgment from the top or observers, or dread the Dominants possible disapproval.  It can take courage to use a safeword, and tops are encouraged to make sure the bottom really knows and will use a safeword in a genuine emergency.  Debriefing scenes is sometimes a part of aftercare, to see if the bottom had feelings about safeword use.  Sometimes tops give the submissive the safeword, and make it long or complicated when no real danger is expected, but they do not want the bottom using it to escape a stressful situation too quickly.
 

A romanticized Western view of ‘oriental’ sex slavery.

The most challenging problems of consent in BDSM for most in the therapy community is cases where submissives want to give up consent in ways that expose themselves to irreversible dangers, such as David Cronenberg’s movie Crash, in which protagonists are aroused by automobile crashes that are far from accidental.  I have never encountered serious practitioners of that particular kink, which is based on the novel by English writer J G Ballard who also wrote Empire of the Sun.  But serious kinks do involve giving up consent more or less permanently as can be enacted in 24/7 lifestyle sexual slavery.  The Dominant in such a scenario may have total control of the slave’s money, work life, relations with family and the community, as well as explicitly sexual activity.  Lesser variations, involving temporary and permanent surrender of the right to safewords may be consensually negotiated.  Although it is the view of this author that most kink is not psychopathological, every clinician who treats sexual variation needs to decide for him or herself where the limits to healthy sexual expression end.  Some consensual sexual expression goes directly to the boundary where the values of sexual health and sexual expression are in conflict, and the support of one value necessarily must compromise the other.

Resources:
Crash By G J Ballard:   Crash, by G J Ballard
Macho Sluts By Pat Califia  Macho Sluts

©2013 Russell J Stambaugh, Ann Arbor, All Rights Reserved.

Slogans

Russell J Stambaugh PhD DST CSSP


Shortly after it was recognized that AIDS was embedded in the Gay community, sex educators and health activists started talking about “Safe Sex”.  Of course, with a deadly virus in the population, homosexual practices in which blood to blood or blood to semen contact might occur could not be rendered as ‘safe’ even as similar heterosexual practices.  As the epidemic spread, the pressure to use protected means never let up, but we gradually realized that ‘Safe Sex’ was a wish.  It reflected an unattainable ideal and a wish to return to an age innocent of the risk of infection that was now lost.  Not long after, heterosexual transmission was recognized as a serious risk, too.  Sex was a great deal less safe, and everyone became less innocent about the grim reality that sex sometimes leads to loss.  Our discourse changed.  Now we talk of ‘safer sex’ or ‘protected sex.’
This symbol is a triskelion, representing BDSM.

BDSM faced much the same difficulty in the early days of its social organizing efforts.  By their very nature many BDSM activities are both scary and potentially exciting.  In building a larger community for sexual adventurism, the natural ambivalence of people who are interested, but have yet to join, must be addressed.  To precisely that end, david stein, a submissive member of New York’s Gay Male S/M Activists, devised copy using the phrase ‘safe, sane and consensual’ in August of 1983 to promote his nascent community.  (Incidentally, the omitted capitalization is not an oversight, but idyomatic etiquette for many members of the BDSM community.  submissives and slaves names are written in lower case, and personal pronouns capitalized for dominants and lower case for subs.)  Efforts to characterize S/M practices as ‘responsible’ ‘caring’, and safe had been tried by many different groups before.  But this SSC language slowly went viral because it addressed often unarticulated fears that activists thought served as barriers to joining.  They were aware of these because Gay sadomasochists were facing considerable pushback from non-kinky Gay liberation organizations which saw kink as a risky, frightening fringe activity that only made their efforts at gaining social and political acceptance more difficult.  And they knew from friends and acquaintances who showed reluctance to join, and from the barriers they had to overcome themselves.
 

S/M necessarily involved putting yourself in a situation where others would question your motives and sanity.  If you were planning to inflict pain on others, why would they want that?  Wasn’t hurting others hostile and degrading to them?  To the general public it seemed dangerous and crazy to comply with such demands. What good reason could explain placing yourself in the power of someone intent on hurting you? And sexual sadism and sexual masochism were both diagnosable mental disorders.  With the full weight of psychiatry labeling this behavior sick and dangerous, anyone who wanted to do it was suspect.  Thousands of historical and contemporary media examples used the terms sadism and masochism to describe criminal, deadly and anti-social conduct.  So the slogan went to the heart of the fears that deterred the curious, and to the mindset of the general public.

Lewis, Clark and Sacajawea.  How’d they get in here?

The only problem being that it wasn’t absolutely true.  The initial set of bleeding-edge early adopters who formed the BDSM community of the 70’s and 80’s were even more adventurous, driven, and tolerant of the inevitable misfortunes than the average kink community members are today.  They learned much through experimentation that can now easily be learned through community.  They joined much smaller groups of elite partners in setting up the early organizations and did the necessary experimentation, and endured the adverse results when edgy behavior didn’t work out.  The analogy comes to mind to traveling west in the nineteenth century.  The pioneers of kink performed feats like Lewis, Clark and Sacajawea, where later settlers had the significant but lesser challenge of following the Oregon Trail.   BDSM has a much broader knowledge base of safe practices than they did 30 years ago, and the epistemology of learning the ropes has changed somewhat.  You can learn safe practices in books, on-line, or from educational sessions at BDSM events, assuming you aren’t affiliated with a local organization where more experienced members provide direct instruction and answer your questions. S/M practices weren’t always all that safe, and participants were hardly actively certified as ‘sane.’    The language actually implied something more like “You can mostly expect to have a rational conversation with us.”  No one was offering free psychological evaluations as evidence.  
 

The rapid and widespread adoption of ‘Safe, Sane and Consensual’ was not a panacea.  david and his collaborators had never intended to launch a sloganeering campaign, or to suggest that S/M practices were particularly safe.  They were advocating SSC as a minimal standard of ethical conduct, and to promoting thoughtful play.  Although the wider SSC campaign has through the years successfully changed the zeitgeist in which BDSM is conducted, it has also become somewhat of a mantra.  No one ever intended it to be applied unthinkingly, or accepted as a money-back guarantee of satisfaction! 

  

Laura Antonieu, kink activist and author.  She wrote a famous objection to SSC.

When the emergent PR campaign started to gain real traction, many experienced players inthe kink community became  contemptuous, suggesting the overzealous effort to make kink safe threatened the exciting and edgy purposes of playing in the first place. Dominants likened negotiating a scene with submissives under the SSC ethos to the PC efforts of anti-date-rape activists on campuses who demanded that every move towards sexual intimacy be made explicit like a game of ‘Mother, May I?’  The last thing they wanted to feel during play was ‘safe’ and they didn’t want their subs to stop feeling the frisson of risk.    But the most serious criticism was the same as has been leveled against ‘safe sex;’  it is bad policy to indulge idealized expectations about risk-free BDSM.  It recruits unsophisticated participants and damages the community for noob and experienced members alike.

In 1999 Gary Switch proposed an alternative to SSC, Risk-Aware Consensual Kink or RACK.  This elided discussion of sanity altogether, and attempted to frame the risk issue without over-simplification.  The goal is not ‘safe’ practice, but aware practice, and this is probably closer to the goals of the original GMSMA boilerplate than the original writers actually constructed.  The kink community being a fractious place, no one is signing away their rights to object to the limits of any guiding principle.  But many responsible participants, and most groups, adhere to and promote SSC, RACK, or both, now.

Nonetheless, it is important that the one concept common to both slogans is consent.  Consent is so crucial and problematical; it will be the focus of the very next post.  For those in the therapist community who have read this far, however, I would hope you would take away a few key insights:

Kink is not made safe by slogans, or even by intention, but by awareness.  Individual responsibility is the order of the day.

Kink isn’t usually dangerous, but can become so, and it is important to see how your clients represent the dangers when they arise.

Our clients, not ourselves, decide what risks they take in kink, just as they decide what risks to take in non-kinky life.

Responsible community greatly mitigates risk.

All-in-all, much kinky activity is quite safe relative to many other recreational activities.  Reading quietly at home is safer.  Make sure the doors are locked.

Often, intense feelings make it hard for clients to manage their ambivalence when they do confront risks.  Intense desire coupled with lack of hands-on experience amplifies risk considerably.

References:

This essay owes a great deal to david stein’s excellent essay on the ‘Safe Sane and Consensual, the Making of a Shibboleth.’ http://www.boybear.us/ssc.pdf

© Russell J Stambaugh, PhD, Ann Arbor, Michigan, May 2013. All rights reserved.

   

Operation Spanner

Russell J Stambaugh PhD DST CSSP


The stark potential consequences of lack of empathy for the Other are illustrated by the Operation Spanner case.  
Inspector Morse Probably wouldn’t have approved.  Fortunately he was in Oxford.

As a result of investigation of another case, the Manchester, England police Obscene Publications Squad (OPS) came into possession of a video tape they believed depicted acts of nonconsensual sexual torture.  Although it is not known precisely which of several videos was seen first, acts included genital piercing, cutting of the scrotum and penis, and acts the defendants described as ‘heavy S&M’.  Convinced of the depravity of these acts, and anticipating that ‘snuff’ films were being made, the OPS launched a major investigation.  In late 1987, the police descended and arrested ‘dozens’ of gay men in the Manchester S&M scene.  Initially, the police were incredulous that the acts depicted on tape were consensual.  In the face of indisputable video evidence, and believing that consent would mitigate charges of committing gross bodily harm, 16 defendants, tops and bottoms, plead to charges of assault occasioning actual bodily harm.

The authorities took 21 months to proffer charges, but eventually proceeded with the legal claim that British case law in a nineteenth century boxing prosecution disallowed consent as a defense against assault charges.  The Spannermen, as they came to be known in the BDSM world, were sentenced to prison terms of up to three years.  Many decided to appeal the case, and the attempted defense of consensual BDSM in Britain would drag on for years.  After losing in appeals court, the case was heard by the equivalent of the British Supreme Court; 5 Members of Parliament from the House of Lords appointed to hear the case in March of 1993.  They refused to overturn the convictions 3-2.  Lord Templeton spoke for the majority in ruling: 
 

Appointees of the House of Lords serve as Britain‘s highest court.

“In principle there is a difference between violence which is incidental and violence which is inflicted for the indulgence of cruelty. The violence of sadomasochistic encounters involves the indulgence of cruelty by sadists and the degradation of victims. Such violence is injurious to the participants and unpredictably dangerous. I am not prepared to invent a defence of consent for sadomasochistic encounters which breed and glorify cruelty […]. Society is entitled and bound to protect itself against a cult of violence. Pleasure derived from the infliction of pain is an evil thing. Cruelty is uncivilized.”
“Incidental” not “Cruel”
 

A number of interesting arguments were made in criticism of the convictions.  The routine injuries of sports and other dangerous recreational activities ruled legal in England were compared with the degree of actual damage inflicted on the consenting defendants.  The prosecution of defendants as accessories in their own victimization was challenged.  All the defendants claimed that they were ignorant of the possibility that they could have been guilty of assault because they thought consent was a defense, a claim of some justice since the case that it wasn’t was largely constructed during the prosecution and appeals.  And it was observed that acts of equal severity in heterosexual S&M had been ruled as noncriminal because the defense of consent was allowed, thus creating a double standard inherently discriminatory against homosexual activity.

The prosecution also made some rather novel and cogent points, the most important being that police commonly encountered repeated domestic assault cases in which (mostly female) victims would complain, then recant that domestic violence was consensual.  If post traumatic stress or pathological dependency could undermine consent, how were the police to intervene to protect victims of domestic violence?  Furthermore, there were a great many more domestic violence cases at risk than S&M prosecutions.  This argument helped frame the Lords’ decision that the acts depicted in the videos turned on cruelty, rather than autonomy.
 

The European Court of Human Rights in Strasbourg, France.

By the time the case was referred to the European Court of Human Rights in Strasbourg, a number of BDSM organizations in Britain and the US had taken up the cause of fund-raising for the defense.  These organizations, such as SM Pride, and the Spanner Trust, continue today, long after the unanimous adverse human rights court ruling in 1997 that Britain was within its legal rights to make law to protect public morals.  Fund raisers for legal defense are held at many BDSM events.

This decision has been cited in some courts in the United States, and is at the cusp of a serious definitional struggle about tolerance of sexual minorities in the US.  American BDSM organizations lobby and educate constantly about safety, and differentiating kink from abuse.  The bandwidth of BDSM activities is so broad that it is impossible to imagine that all actions by all participants are legal.  There are still many jurisdictions in the US where relatively common non-sadomasochistic sexual acts are unlawful among consenting adults. It is fair to say that most kinksters and many therapists, this writer included, are not fully aware of the legal status of some activities.
SM Pride Marching in London 2003

Perhaps the most significant outcome of Spanner is that the British government commissioned a study of consensual S&M in 2007, and has been issuing reports that reflect problems stemming from the Spanner verdicts.  Chief among these is that fear and alienation among the BDSM community constitutes a barrier to investigation of more serious crimes and protection of kinky citizens.  The chance of such a prosecution being repeated now is greatly reduced and the British authorities are mending fences with the BDSM communities.  But consent is not a defense against charges of assault in the united Kingdom

References:

Aside from the obvious, here are two good links for those interested in more detail about the Spanner case and its consequences:

For reports by the British government about consensual BDSM:  http://www.barnsdle.demon.co.uk/span/lwus.html

 

© Russell J Stambaugh, PhD, Ann Arbor, Michigan, May 2013. All rights reserved.