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Week 11.docx

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PSYC 3390
Mary Manson

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WEEK 11 - CHAPTER 13: SEXUAL VARIANTS, ABUSE, AND DYSFUNCTIONS (pg. 458-494) - Three categories covered in book: (1) psychological problems that make sexual fulfillment difficult for some people (Ex: exhibitionism, transsexualism, fetishism); (2) sexual abuse: pressured, forced, or inappropriate sexual contact; (3) Sexual dysfunction: problems that interfere with satisfactory performance of sexual acts (Ex: premature ejaculation) - Not much is known about these disorders because sexual deviations, abuse and dysfunctions are not studied as much as they should be, are not well-funded and are often not allowed to be studied because they are considered too taboo and controversial in our society, despite sex being part of life. SOCIOCULTURAL INFLUENCES ON SEXUAL PRACTICES AND STANDARDS: - Some aspects of sexuality seem cross-culturally universal (such as men's greater emphasis on their partner's physical attractiveness), while others seem to vary across cultures (such as one's beliefs towards premarital sex). - Influences of time and place are so influential in shaping our sexual behaviour, so what is right to us in a certain culture/time, may not be right to others in other cultures/times in history - The following three cases help illustrate how opinions on normal and acceptable sexual behaviour change... Case 1: Degeneracy and Abstinence Theory: - 1750s: physician Simon Tissot developed degeneracy theory: belief that semen is necessary for physical/sexual viour in men and for masculine characteristics. Based theory on human eunuchs and castrated animals. However we know this is testosterone and not semen that give men their male characteristics. - Asserted that two practices were especially harmful: masturbation and patronizing prostitutes. Believed these wasted semen and overstimulated/exhausted the nervous system. Recommended married people engage in sex solely to procreate to avoid wasting semen -1830s: Reverend Sylvester Graham developed abstinence theory. Believed three things essential for health: healthy food, physical fitness, sexual abstinence. - His famous successor Dr. John Harvey Kellogg, published paper which disapproved of masturbation and urged parents to be wary of the signs that their children were masturbating. Wrote about "39 signs" to detect this "secret vice". His treatments for this "secret vice" were extreme, including persistent masturbation in boys be treated by sewing the foreskin with silver wire or as a last resort, circumcision without anesthesia. For girls masturbation was to be treated by burning the clitoris with carbolic acid. - Other physicians warned against practices that could be used as a form of masturbation, such as women bicycling. - Many believed masturbating caused insanity for 2 reasons: many patients in mental asylums openly masturbated (rather than in private like sane people), and masturbation precedes by several years the age when first signs of insanity appear (late adolescence/young adulthood) - 1960s/1970s: masturbation recognized as a normal part of sexual development, although the Roman Catholic Church still holds that masturbation is sinful Case 2: Ritualized Homosexuality in Melanesia: - 10-20% of Melanesian socieities practice a form of homosexuality, part of male initiation rituals that all male members must experience. - Two beliefs in Sambian sexual practices: semen conservation and female pollution. Believe semen is important for physical growth, strength and spirituality. Believe semen cannot be replenished by the body and must be conserved or obtained elsewhere. Female pollution: belief that female body is unhealthy to males, primarily because of menstrual fluids. - To obtain adequate amounts of semen, young Sambia males exchange semen with eachother through oral sex/penetration. Believed it is exchange of sexual pleasure for vital semen. - When males well past puberty, they make transition into heterosexuality. Female body is thought to be less dangerous, and men may begin to have relationships with females while still having sex with younger males. Must stop homosexuality after having their first child, and problems with transitioning to heterosexuality is seen as abnormal Case 3: Homosexuality and North American Psychiatry: - Homosexuality removed from DSM (1973), previously thought of as a "sexual deviation" Homosexuality as sickness: - Before thought of as "sickness", was thought of as a crime, punishable by death. Not until 1861 was maximum penalty reduced to 10 years imprisonment. - Late 19th C./Early 20th C. sexologists such as Magnus Hirschfeld and Havelock Ellis suggested homosexuality is natural and psychologically normal. Others such as Freud had positive attitudes towards homosexuals which were seen as progressive at the time - 1940s: Psychoanalysts began to take pessimistic view. Some, such as Sandor Rado, claimed homosexuality develops in people whose heterosexual desires are too psychologically threatening Homosexuality as nonpathological variation: - 1950s: scientists and homosexual people began to challenge idea that homosexuality was a sickness - Alfred Kinsey, for example, found that homosexual behaviour was more common than had been believed. Influential studies showed that psychologists could not distinguish psychological test results of homosexuals from heterosexuals. - Gay men and lesbians protested idea that homosexuality is a mental disorder, many openly gay psychologists/psychiatrists worked to get homosexuality removed from the DSM-II. Fortunately, vote to remove it won, was a milestone for homosexuals and embarrassment to psychiatry. *13.1 Developments in Thinking: Homosexuality as a Normal Sexual Variant (pg. 462)* SEXUAL AND GENDER VARIANTS: THE PARAPHILIAS: - People with paraphilias have recurrent, intense sexually arousing fantasies, sexual urges, or beahviours that generally involve (1) nonhuman objects, (2) the suffering or humiliation of oneself of one's partner, or (3) children or other nonconsenting persons - Paraphilic person distinguished by insistence or relative exclusivity with which his sexuality focuses on the acts or objects in question-- without which orgasm is often impossible - Nearly all are male. In rare cases whre women have paraphilias, they are most likely to have pedophilia, sexual sadism, and/or exhibitionism - DSM-IV recognizes 8 specific paraphilias (1) fetishism, (2) transvestic fetishism, (3) voyeurism, (4) exhibitionism, (5) sexual sadism, (6) sexual masochism, (7) pedophilia, and (8) frotteurism (rubbing against a nonconsenting person). Additional category, Paraphilias not Otherwise Speicified include rarer disorders. Fetishism: - Individual has recurrent, intense sexually arousing fantasies, urges, and behaviours involving the use of some inanimate object to obtain sexual gratification - Female fetishists are extremely rare. Range of fetishistic objects includes hair, ears, hands, underclothing, shoes, perfume and similar objects associated with the opposite sex. - *Case study: Panties (pg. 464)* - Many theories emphasize importance of classical conditioning and social learning. Men high in sexual conditionability would be prone to developing one or more fetishes. Transvestic fetishism: - Heterosexual men who experience recurrent, intense sexually arousing fantasies, urges, or behaviours that involve cross-dressing as a female. Typical onset is during adolescence and involves masturbation while wearing female clothing or undergarments - Psychological motivation of transvestite’s autogynephilia: paraphilic sexual arousal by the thought or fantasy of being a woman. - Survey: majority are heterosexual (87%), married (83%), married at time of survey (60%) - *Case Study: A Transvestite's Dilemma (pg. 466)* Voyeurism: - Recurrent, intense sexually arousing fantasies, urges, or behviours involving the observation of unsuspecting females who are undressing or of couples engaging in sexual activity. - Viewing of attractive female is sexually stimulating for many, if not most, heterosexual males. The privacy and mystery that have traditionally surrounded sexual activities tends to increase curiosity about them. If young man has such curiosity but feels shy and inadequate in his relations with the opposite sex, he may accept substitute of voyeurism, which satisfies curiosity and to some extent meets sexual needs without approaching a female. May provide feelings or power and secret domination over unsuspecting victim - *Case Study: A Peeping Tom (pg. 467)* - Adults movies, videos and magazines have removed much of secrecy from sexual behaviour, but effect of these on voyeurism is matter of speculation, there is no good data on its prevalence. Exhibitionism: - Defined as indecent act in legal terms, and known as indecent exposure in lay terms. Diagnosed in perosn with recurrent, intense urges, fantasies or behaviours that involve exposing his genitals to others (usually strangers) in inappropriate circumstances and without their consent. - For male offender, typical victim is young or middle-aged female not known to the offender, although children and adolescents may be targeted as well - Usually begins in adolescence or young adult hood, is most common sexual offense reported to police in Canada, US and Europe, accounting for about one-third of all sexual offenses - 20% of women have been target or either exhibitionism or voyeurism Sadism: - Derived from name of Marquis de Sade who sexually inflicted cruelty on his victims until he was eventually committed insane. Diagnosis: person must have recurrent, intense sexually arousing fantasies, urges, or behaviors that involve inflicting psychological or physical pain on another individual. - Sometimes sadistic activities lead up to or terminate in actual sexual relations, in others, full sexual gratification is obtained from the sadistic practice alone. Act may vary in intensity, from fantasy to severe mutilation and even murder. - Mild degrees of sadism (and masochism) are involved in sexual foreplay customs of many cultures, and some couples regularly engage in such practices. As many as 5-15% of mena nd women enjoy sadistic and/or masochistic activities voluntarily on occasion. - Extreme sadists may mentally replay their torture scenes later while masturbating. Serial killers, who tend to be sexual sadists, sometimes record or videotape their sadistic acts. - Some men report the God-like sense of being in control of life and death of another human being to be exhilarating. 85% report consistent violent sexual fantasies, 64% collected materials with a violent theme such as audiotapes, videotapes, pictures or skethces of their sadistic acts or sexually sadistic pornography. - *Case Study: Paul Bernardo and Karla Homolka (pg. 469)* Masochism: - Derived from name of Austrian novelist Leopold V. Sacher-Masoch whose fictional characters dwelt lovingly on sexual pleasure of pain. Person experiences sexual stimulation/gratification from experience of pain and degradation in relating to a lover. - Diagnosis: person must have recurrent, intense sexually arousing fantasies, urges or behaviours involving the act of being humiliated, beaten, or bound, often in a ritualistic pattern of behaviour. - Arrangements of this in mild form are not uncommon in either heterosexual or homosexual relationships. Masochism appears to be much more common in both men and women. - Dangerous form of masochism, autoerotic asphyxia involves self-strangulation to the point of oxygen deprivation, which appears in individuals to increase intensity of orgasm by constriction of blood flow to the brain during masturbation. Usually a single male aged 15- 29 years. - *Case Study: "I got tangled in the rope" (pg. 470)* Causal Factors and Treatments for Paraphilias: - Nearly all people with paraphilias are male, they usually begin around the time of puberty or early adolescence, and people with paraphilias often have more than one. - Money (1986) and others suggest that male vulnerability to paraphilias is closely linked to their greater dependence on visual sexual imagery. If so, meh may be more vulnerable to forming sexual associations with nonsexual stimuli, which may occur after puberty when the sex drive is high. - Many believe associations arise as result of classical/instrumental conditioning and/or social learning that occurs through observation and modelling. Ex: observing paraphilic stimuli (e.g. photos of models in their underwear), boys may masturbate, and reinforcement of orgasm-release may serve to condition an intense attraction to paraphilic stimuli GENDER IDENTITY DISORDERS: - Gender identity refers to one's sense of malesness or femaleness and may be distinguished from their gender role, which refers to the masculinity or femininity of one's overt behaviour. -Some individuals feel extreme discomfort or unhappiness with their biological sex and strongly desire to change to the opposite sex. In the DSM-IV-TR, gender identity disorder is characterized by: (1) a strong persistent cross-gender identification--the desire to be, or the insistence that one is, of the opposite sex--and (2) gender dysphoria--persistent discomfort about one's biological sex or the sense that the gender role of that sex is inappropriate. Gender Identity Disorder of Childhood: - Boys with gender identity disorder show marked preoccupation with traditionally feminine activities. Girls with gender identity disorder typically enjoy traditionally male activities. Young girls with gender identity disorder treated better by their peers than boys with gender identity disorder, because cross-gender behaviour in girls is better tolerated - Boys outnumber girls 5 to 1 - *DSM-IV-TR Criteria for Gender Identity Disorder (pg. 472)* - Most common outcome for boys with gender identity disorder appears to be homosexuality rather than transsexualism (10-20% later diagnosed as transsexual by 16-18, and 40-60% homosexual or bisexual, % may have increased as they got older). Females: 35-45% transsexual, approx. half homosexual. *13.1 Canadian Focus: The Role of Biology and the Environment in Shaping Gender Identity (pg. 473)* Treatment: - Parents often bring children with gender identity disorder to psychotherapy. They often have other behavioral problems such as anxiety and mood disorders. Gender dysphoria is usually treated psychodynamically Transsexualism: - Adults with gender identity disorder who desire to change their sex, and surgical advances have made this possible. Adults with gender identity disorder who do not desire to change their sex are transgendered - Rare disorder, approx. 1 per 30,000 adult males and 100,000 adult females seek sex reassignment surgery -*Case Study: "I Never Did Fit Well as a Girl" (pg. 474)* - There are two kinds of male-to-female transsexuals: homosexual and autogynephilic transsexuals. Homosexual transsexual men: generally very feminine, have same sexual orientation as gay men. However, because transsexual men experience their gender identity as female, they often define their sexual orientation as heterosexual. Autogynephilic transsexuals appear to have autogynephilia: a paraphilia in which their attraction is to thoguhts, images, or fantasies of themselves as a woman. - Most transsexuals had gender identity disorder as a child, but not all children with gender identity disorder are transsexuals. Another factor may be that there are some prenatal hormonal influences affecting which children develop gender identity disorder and later become transsexuals - Autogynephilic (sometimes called heterosexual) transsexualism almost always occur in genetic males with transvestic fetishism. Fantasize they have female genitalia, which can lead to acute gender dysphoria, motivating them to change their sex. Unlike homosexual transsexuals, they do not appear to have been especially feminine in childhood/adulthood and seek sex reassignment surgery much later Treatment: - Psychotherapy is usually not effective. Only treatment that has shown to be effective is surgical sex reassignment. -Transsexuals awaiting surgery are given hormone treatment (estrogen for males wanting to become females, testosterone for females wanting to become males). Surgery includes artificial vagina or penis, they must learn to change the pitch of their voice, often have hysterectomies/mastectomies and various plastic surgeries (e.g. to Adam's apple). - Artificial penises still somewhat primitive, not capable of normal erection, so those with this must rely on other supports to have intercourse. The rest function without a penis. - 87% of male-to-female transsexuals had satisfactory outcomes (did not regret decisisons); 97% of female-to-male transsexuals had satisfactory outcomes (survey) SEXUAL ABUSE: - Sexual contact what involves physical/psychological coercion, or at least one indiviual who cannot reasonably consent to the contact (e.g. child). Includes rape, pedophila, incest - Only pedophilia is included in DSM-IV-TR. All are treated as crimes Childhood Sexual Abuse: - Childhood sexual abuse is more common than once was assumed, there are possible links between childhood abuse and some mental disorders, and some dramatic and well-publicized cases involving allegations of childhood sexual abuse have raised controversial issues such as validity of children's testimony and accuracy of recovered memories of sexual abuse Prevalence of childhood sexual abuse: - Definition of "child" differs (upper age limit ranging from 12-19). Some include only genital contact, only physical contact, not physical contact (e.g. exhibitionism), some include consensual sexual contact with a minor. Prevalence figures: less than 5% to more than 30% Consequences of childhood sexual abuse: - May have immediate and long-term consequences. Most common: fears, posttraumstic stress disorder, sexual inappropriateness, poor self-esteem. 1/3 of sexually abused children show no symptoms. - Association between childhood sexual abuse and adult psychopathology (borderline personality disorder, somatization disorder with dissociative symptoms, dissociative identity disorder, dissociative symptoms). Sexual symptoms, such as sexual aversion and promiscuity also common result of childhood sexual abuse Controversies about childhood sexual abuse: - Children have accused adults working in daycare settings of extensive, often bizarre sexual abuse, and controversial issues have been raised about the degree to which children's accusations can be trusted - Adults claim to have repressed and completely forgotten memories of early sexual abuse and then to have "recovered" the memories during adulthood, typically while seeing a therapist Children's testimony: - Most notorious case of alleged sexual abuse in daycare settings: McMartin Preschool case in California. Judy Johnson complained to police her son had been molested by Raymond Buckey (helped run preschool) where her son went. Accusations included sodomizing her son while he stuck the boy's head in a toilet, making him ride naked on a horse. Judy had acute paranoid schizophrenia and alcoholism. - Children at preschool
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