Title: Paraphilias and therapy
Author(s): A. Fog
Citation: Fog, A., “Paraphilias and Therapy,” Nordisk Sexologi, vol. 10, no. 4, pp. 236-242, 1992.
The traditional procreation oriented paradigm of sexology based on individual psychology prevents a full understanding of non-procreational sexual behaviour. In order to improve our understanding of the so-called paraphilias, the research must be supplemented by sociological and evolutionary biology paradigms. A new model called the isolated minority syndrome is introduced in order to explain the behaviour of sexually deviant persons. The symptoms of this syndrome include a stereotypic and uncontrolled sexual behaviour and several unspecific social symptoms. The cause is a lack of appropriate identification model and non-acceptance of own sexual feelings. Group therapy in self-help groups is an effective treatment. There is reason to warn against traditional behaviour therapy which is ineffective, causes unnecessary psychological trauma, and increases the risk of violent sexual crimes. Traditional behaviour therapy is also criticized for ethical reasons.
Traditional sexology, based on psychology and psychiatry, has generally found non-procreative sexual behavior difficult to understand. That is because it tends to look at the individual only, and seek the causes of any problem in the life history of the individual. The author calls this the ontogenetic paradigm.
Social scientists, anthropologists, and historians argue that an understanding of behavior requires an understanding of the structure of the society in which it occurs—its norms, values, concepts, and scripts. Even the concept of sexuality itself is a relatively new construct, and does not have the same meaning in other cultures as in our own. The sociogenetic paradigm has improved our understanding of homosexuality considerably during the last few decades, and shows promise for helping us understand the paraphilias.
The least explored area of research is the phylogenetic paradigm, which explains general phenomena by the evolutionary history of the human species. It has been shown by ethologists that non-procreative sexual behaviors, including what are called "homosexuality" and "pedophilia," are common among non-human primates. When such behaviors occur among humans they may violate moral norms, but not biological laws.
The reason why the paraphilias are difficult to understand in the traditional sexological paradigm is that this paradigm assumes that sexuality has only one ultimate biological function: procreation. The phylogenetic paradigm discloses, however, that sexuality has many functions, and the sociogenetic paradigm tells us that many of these functions are suppressed in our culture but not in certain other cultures. The integration of all three paradigms is necessary for a full understanding.
This article discusses some of the problems encountered by sexually deviant persons and how these problems can be solved. The main theoretical focus is on the sociogenetic paradigm.
The author introduces a model which describes the situation of a person whose sexual peculiarities are suppressed by the surrounding society. He calls it the "isolated minority syndrome."
The cause of this syndrome is a lack of identification model. The "pervert" has no contact with experienced paraphiliacs who could teach him the most appropriate way to express his sexuality and the pitfalls to avoid. He does not have an understanding of his own identity, and he tries to suppress his paraphilic fantasies because he does not accept them himself.
The symptoms involve extremely stereotypic, inflexible and uncontrolled sexual behavior. Sexual frustration, low self-esteem, social stigmatization, and isolation may lead to substance abuse, anti-social behavior, non-sexual crimes, political extremism, or suicide. Psychological defense mechanisms may include suppression and repression of the deviant impulses, projection of the deviant impulses on other persons, and violence against the object of desire.
However, a paraphiliac who has contact with similarly disposed persons and who accepts his own feelings does not show these symptoms. His sexual behavior is more flexible and controlled by rational thinking. If he chooses not to have sex, he can do so and still preserve his mental health and self-control despite the sexual frustrations.
The isolated minority syndrome can be seen in pedophiles, exhibitionists, bisexuals, sadomasochists, fetishists, transvestites, transsexuals, and others. The symptoms described above are often believed to be characteristic of the paraphilias per se, but they are in fact secondary symptoms of the social suppression.
It is not possible to change the sexual orientation, but it is possible to cure the isolated minority syndrome, thereby improving the client's psychological and social well-being. The client will gain self-control so that uncontrolled, aggressive, and perhaps dangerous sexual acts will be replaced by more harmless and well-controlled acts.
If, however, the person has internalized society's condemnation and tries to suppress not only the paraphilic behavior but also the paraphilic fantasies, then the safety valve is closed and the vessel will explode in an outburst of uncontrollable sexuality.
Traditional studies of paraphiliacs are based on psychiatric and forensic populations. The vast majority of these populations suffer from the isolated minority syndrome to various degrees. This has created an image in the psychiatric literature of paraphilias as uncontrollable and dangerous compulsions. Members of sexual minority organizations, however, suffer only slightly or not at all from the isolated minority syndrome and they do not match the image presented by psychiatrists.
The best treatment for the isolated minority syndrome is thus group therapy or self-help organizations. Experienced members of such groups can function as positive identification models for less experienced members with the same or a similar paraphilia.
The formation of such organizations for all common paraphilias should be encouraged and supported, and any person who suffers from the isolated minority syndrome should be encouraged to become a member of such organizations and subscribe to their publications. The author has had personal experience as a counselor working with several sexual minority groups.
He warns against the cognitive-behavioral method used in sex offender therapy, calling it "ineffective as well as dangerous." The philosophy behind it is limited to the ontogenetic paradigm, which prevents a complete understanding of the paraphilias. Proponents of behavior therapy admit that it is not very effective at changing sexual feelings. Throughout the history of sexology, numerous therapists have claimed an ability to cure paraphilias, but later investigations have always shown that the therapies were ineffective, and not infrequently the patients had fooled the therapists in order to escape further treatment.
Where the goal of self-help or group therapy is to make the paraphilic feelings ego-syntonic to the clients, the traditional therapist wants to make them ego-dystonic. He requires that his patients suppress not only the paraphilic behavior but also the paraphilic fantasies. The inevitable result is that the isolated minority syndrome grows worse. The safety valve is closed and the risk of uncontrolled outbursts of aggressive sexuality increases. This is why behavior therapy is dangerous, not only to the patient but also to his sex objects.
Occasionally the author has had the task of helping survivors of behavior therapy. In these cases, the behavior therapy not only failed to accomplish its goal, it also caused severe psychological trauma. For example, one middle-age pedophile said that his sexual feelings for boys went away partially for about a year, and at the end of the year he started waking up screaming with nightmares. He developed a fear of sex itself, but his feelings for boys returned.
During therapy, he faked his feelings in order to prove he was straight so he could get through with the therapy. He said his penis stopped showing arousal to boys, but he continued to have feelings for them. He said, "I really don't think that feelings for boys or whoever we have feelings for has all that much to do with how much erection you have, but this is what they were reducing it to."
The author writes that this kind of therapy suffers from some basic ethical problems. The first is the use of the psychiatrist to enforce social conformity. The fact that this kind of treatment is recommended for transvestites and fetishists but not homosexuals indicates that the normality criterion it enforces is arbitrary.
The second problem is that aversion therapy may be regarded as torture. The physical pain may be severe, yet bearable, but the psychological pain is worse.
The third issue, and the one which involves the greatest ethical problems, is that of cognitive therapy. The rationale behind cognitive therapy is that the world view of the therapist is correct and when the world view of the patient is different he is said to suffer from cognitive distortion. The patient may have a better knowledge of his own situation than the therapist, and the latter has no justification for saying that his perception is more true than that of the patient.
Proponents of cognitive therapy give as examples of cognitive distortions the belief by the fetishist that he is merely sexually liberated, and the belief by the pedophile that children can consent to sex with adults. In fact, the fetishist may be sexually liberated, and the pedophile may have personal experiences in which some children consented to sex because they enjoyed it.
The therapist refuses to believe this because he mistakes social and moral norms for scientific absolutes. Actually, he must have read the literature very selectively if he has overlooked the considerable amount of evidence that some children under some circumstances do enjoy sex with adults and deliberately seek such experiences.
The author writes that mind control is an abuse of psychiatry and violates one of the most precious of all human rights: the right to think freely.