04 March 2012

Is there an asexual in the House?

recent episode of House featured a married couple who identified as asexuals, people who lack a sexual orientation towards women or towards men (or towards anyone/anything else).  As the character explained to Dr. Wilson: They were not celibate—they were not choosing to supress their sexual attractions. Rather, they did not experience sexual attractions.  Asexuality was their sexual identity.  House doesn't buy asexuality as an identity and bet he could find a medical reason that would explain their lack of sexual desire.  The asexual community (yep; there is one) greatly anticipated the episode: It would be the first time their identity would be described to such a large audience, addressing the big question: Is asexuality a sexual orientation?

03 March 2012

How realistic was the sex addiction in Shame?

I went to the theatre already pretty cynical about big-screen depictions of hypersexuality (my preferred term for the phenomenon). On the one hand, I've seen very many people in my clinic seeking help in controlling some aspect of their sex life. On the other hand, I have read very many commentaries about what hypersexuality means, usually based on hypotheticals or tid-bits from celebrity cases. None of those discussions, however, ever seem to describe the actual people I see.

So, popcorn in hand, I was expecting a re-telling of a daytime, self-help cliché: abuse in childhood, causing addiction in adulthood, hitting rock bottom, resolved by confronting past abuse.  (Probably followed by falling in love for the first time, after finally completing some period of sexual abstinence.)  Instead, I saw situations very close to what I do see in therapy.

01 March 2012

Dear Dr. James,

Dr. Cantor--

I'm a Licensed Psychologist and Psychiatric Examiner for my state.  My job is to evaluate recidivistic sex offenders, usually before they are released from prison, and to give the courts guidance as to whether the individual should be confined to a psychiatric hospital upon release, or be involved with "Strict and Intensive Supervision and Treatment (SIST)" in the community. 

Lately, attorneys have tried to put forth legal arguments involving individuals acting out sexually against small children.  They suggest that such was caused by the individuals having “repressed homosexuality” issues, and as such they may not be a threat to recidivate since they no longer “repress.”

Are you aware of any scientific research to back this up, or to refute this claim?  A case of mine is in trial this week and next, and the Assistant Attorney General handling this civil management the case is looking for some guidance.  He and I would appreciate any insight you could give in this matter.

P. E.

Open letter to the government of Alberta

Hon. Ron Liepert
Minister of Health and Wellness
#323 Legislature Building
10800–97 Avenue
Edmonton, AB  T5K 2B6

5 May 2009

Dear Mr. Liepert:

I write in response to media reports that Alberta plans to delist sex reassignment surgery as a benefit of Alberta’s health care system. I believe that health care is a basic right of every Canadian, and I believe that that includes transsexuals. I believe that Canadians have the right to appropriate health care for relieving the distress associated with major depression and with surviving trauma, and I believe that Canadians have the right to appropriate health care for the distress associated with transsexualism.

No type of psychotherapy has been effective in relieving what can be lifelong anguish from gender dysphoria, the psychiatric term for extreme discontent with the sex one is born as.  Research conducted throughout the world, however, has repeatedly demonstrated the effectiveness of surgical sex reassignment in relieving that distress in medically indicated cases.

No one chooses to have gender dysphoria. The only “choices” confronting transsexual individuals are whether to endure a lifetime of frustration and misery, to kill themselves, or to risk—and often lose—their families, friends, and job in hopes of finding a happier life as their new sex.  To remove the final option from these individuals and their physicians is to remove the universal from universal health care.

Sincerely yours,

Dr. James M. Cantor
Psychologist

Charles Silverstein on the origin of the 10% are gay statistic

From: Charles Silverstein [mailto:CSILVERSTEIN2@nyc.rr.com]
Sent: Sunday, June 14, 2009 12:21 PM
To: James Cantor
Subject: the 10% statistic

Dear Jim,

            I was looking through your webpage & found where you said that that the 10% of males are gay was incorrect & too lengthy to discuss. I can tell you where the figure came from because I was there. It came out of the Gay Activist Alliance (GAA) in the early 1970s. There was a Press or PR Committee headed by Bruce Voeller and Ron Gold. Ron was an experienced PR man & Bruce a researcher at Rockefeller. The media always wanted to know how many men were homosexual. When Bruce would talk to them about statistics and sampling problems, their eyes would glaze over. The press does not want to know about sampling probabilities. So Bruce decided to tell them that 10% of males were gay, since that was a neat and easily understood figure. It then became the mantra of gay liberation. I’m sure that Bruce got 10% from somewhere in the first Kinsey book, but can’t remember specifically where. Nor did anyone at the time care how accurate it was. We were fighting for our rights and publicity was extremely valuable to our cause.

            I’ll be at APA in Toronto & hope that we’ll get a chance to meet. I enjoy both your good humor on the list-serve and your research – not necessarily in that order.

Charles Silverstein
212-799-8574
www.doctorsilverstein.com

A Bill of Transsexual Rights

Statements like these are long overdue. People choose whether to transition, but one does not choose to be dysphoric about the sex they were born into. In this Bill of Rights, I refer specifically to people who are transsexual, rather than use the broader terms, such as transgender or gender variant. Although everyone has the right to respect in my view, I assembled these rights to pertain mostly to the process of transition (either male-to-female or female-to-male), which is a feature of transsexuality specifically.  I hope other individuals and groups modify this Bill or suggest alternative ones, suitable for employers and legislators to adopt and enact.

It’s easy to forget how little we know about paraphilias

On a listserv I belong to, mostly of psychologists, someone described a man who was sexually aroused by touching the plaster cast of persons with a broken limb. The psychologist wondered whether the patient’s behavior should be called toucherism (sexual interest in touching an unsuspecting stranger), whereas other psychologists in the discussion argued for acrotomophilia (sexual preference for amputees).
Similar debates are often had for the boundaries of other paraphilias.  I find most such debates to be uninformative, however.  With only few exceptions, such as pedophilia, the state of the scientific literatures on the paraphilias is not sufficiently advanced for making any clear demarcations around them.

Although it is rarely made explicit, opinions about whether a case fits in one or another category follow from what the clinician sees as the most important feature (or, more typically, the most dramatic feature) that makes the paraphilic interest distinct from typical sexual interests: To the toucherism-thinker in the above debate, it was the touching of the an unsuspecting stranger that was the defining feature of the patient’s sexual interest; to the acrotomophilia-thinkers, it was the lack of a healthy limb that was the defining feature. In truth, however, we do not know which behavioral feature of a paraphilia is its defining one, if any at all.

Depathologize! A follow-up

If I had to pick the top theme that sexologists and sexuality interest groups were discussing in the lead up to the proposed DSM changes, that would be it: Depathologize, depathologize, depathologize.  From blogs to letters to editors of research journals, there have been demands that the DSM declare as officially normal various sexual phenomena, ranging from purely consensual situations (like transsexualism and BDSM) to those that motivate sexual offenses (such as pedophilia and hebephilia). With the release of the DSM5 proposals from their various workgroups, I thought it was worth revisiting.  I was actually quite surprised by which of the DSM committees did and did not remove the label mental illness and from whom:
  

Dear Dr. James,

I am a professional Canadian woman aged 33 with a high awareness of issues relating to addiction and pedophilia, due to an alcoholic mother and father who was convicted of inappropriately touching his girlfriend’s young boy.

My problem is that I have a long list of ‘suggested traits’ of a pedophile written down on my notepad that appear to be present in my current boyfriend. My boyfriend hasn’t shown any overt signs of being a pedophile or having been abused himself, but he is only 30 and I guess I fear that something will emerge later, as it did with my dad later in his life.

Could you possibly tell me whether you feel that someone can technically tick all or most of the biological or social ticklist boxes of traits and not be a pedophile? The things that make me nervous about my boyfriend are learning issues/poor grades in school, poor memory, short in stature, left-handed, and a strong view that men should be able to interact with children and not be called pedophiles. He is constantly injuring himself and funnily enough he sometimes reminds me of a brain injured person—I worked with acute brain injury patients for four years.

Thank you so much in advance for taking the time to read my email.

Kind regards,
T. C.

Dear Dr. James,

Is there a professional term for one who derives sexual pleasure from watching himself masturbate in the mirror?  I assume I’m not the only one who sees cases like this (albeit only 2 over the last 5 years—both with totally different personality disorders and sex crimes). Does anyone have a reference for literature on the phenomenon?

Thanks, David