Friday, March 19, 2010

Paraphilias as Kink: Healthy or Unhealthy?

Will you be surprised to read that my answer is, "It depends"?

The observation stems from a conversation my beloved and I had about paraphilias. It's Dr. Kafka's preferred term, part of "Prudence"s ill-considered advice to the mother of the young man with the latex fetish.

Our conversation started from my telling her about the prior post. Elderly parents are presenting management issues around health care and it became obvious how many control issues my mom exercises over my dad. She recently decided on the timing of some surgery for him and it became apparent that after 50 years of living together, he can't decide for himself.

I commented to my beloved that I seem to be working out my control issues in a much more ritualized fashion, with my interest in submission and control in sexual relationships. This got us to talking about how things have changed for me, from "this is who I am" to "this is something I like to do in relationships.". That's a big change, about which more later, unless I've already written about it.

This got me to my shrink, who I liked, and Kafka, who I didn't like when he was my shrink, and it got us talking about paraphilias. Figuring out where thy come from seems pointless. One can imagine FMRI studies that might illustrate how they're "caused" by brain chemicals "leaking" from one are to another adjacent areas of neural activity interfering with each other, but that's entirely conjectural not so interesting.

What's more interesting is the role paraphilias can play in a relationship. It's basically the old question thatcomes up in a bunch of relationships where one person has a paraphilia: the other person asks, "are you relating to me, or to the boots, corset, latex, leather, whatever?"

The answer, I think, is that it depends on how that partner relates to the fetish item. By example: if she wears boots because they make her feel attractive or sexy, and I have a passion for boots and can't keep my eyes or hands off of her, then WE are having a relationship, and boots are part of that. If she, out of the goodness of her heart, wears boots because she knows it will make me happy, and I have the same reaction and can't keep my eyes or hands off of her, I'm not relating to her, I'm relating to the boots. It could, at the extreme, be practically anyone wearing the boots.

For it to be a functional "good" situation, there's a three way relationship happening: us to each other and each of us to the item.

To bring this full circle to the young man with the latex glove fetish, like a person with any unusual sexual interest, it may make his life more complicated, or it may limit his voice of (satisfying) partners, but it may well make his life more interesting. And as there is no "magic pill" to cure him, his process of understanding himself and his partner is more likely to make for a satisfying life, if you believe Thoreau that "an unexamined life is not worth living."

Monday, March 15, 2010

Advice About Curing a Kink

Bear with me here, the set up is a little involved....

So, over on Devastating But Inconsequential, there was a reference to a Slate Magazine Dear Prudence column, in which a concerned Mom was wondering whether or not to intervene with her teenage son over his fetish for latex gloves. "Prudence" cited Dr. Martin Kafka, a "noted expert" on treatment of fetishes. The gist of the advice was, "Save him now, or he'll destroy his life." "Abby" cited an article about Kafka in the New York Times, back from 2000.

Now, comments from ex-patients of a psychiatrist often read like rants from a jilted spouse, so I'm going to try to avoid doing that. But I was a patient of Dr. Kafka's back in the early '90s and I was supremely unimpressed. In fact, when I told the shrink with whom I ended up, about Kafka's theories and methods, I got an amused and ever-so-slightly satirical reaction - way more reaction than I expected to get from one professional about another.

But "Prudence's" comment did motivate me to read the article about Kafka. While I find the main thrust of his argument to be deeply deeply flawed, there was just enough thought-provoking substance in the article to, well, get me thinking.

First thing, Kafka's theory about treating appetite "disorders" with selective seritonen uptake inhibitors (SSRIs - Prozac and the family of drugs that followed it) is complete bullshit, at least at the level at which he promotes it. I think it would be fair to say that sexual appetites in *some* people may be related to "appetites" as we more traditionally think of them. But to say that the two are identical is facile. And then to build on top of that the conjectural notion that something about brain chemisty in those with this "appetite disorder" means that treating them with massive doses of SSRIs will "solve" the "problem" seems entirely unwarranted.

It's not like you couldn't do the study, or anything. And I'm sure big Pharma would love to make that possible. But based on a study of one (that would be me), his whole logic chain and intervention doesn't hold water.

By the time he was done with me, I was taking large doses of SSRIs - so large that I routinely fell asleep in the back seats of taxis in the developing countries where I did business. After about a month or two of that, I realized that we were on the wrong track here. And that's when I found the shrink I worked with for several years.

So, was I "cured" by Kafka? In no way, shape, or form. I don't recall my "fixations" be diminished in any significant way, and I don't know how Kafka would claim to know, since his "interviews" were limited to a small number of rapid-fire questions, and one-or-two word answers (he explicitly said he didn't want anything longer).

So was I "cured" by my more traditional "talking therapy" shrink? I'd have to say "No" and "Yes." The "No" is first for a reason: there were periods with him where all of my interests in control and domination (to use a short-hand) just seemed irrelevant. And obviously, those were simpler times to deal with with my beloved. But they didn't last, and while there were some "aha!" moments, there was never anything big that seemd to cut the Gordian knot. But "Yes" in the sense I, and my beloved, have a much much better sense of what is going on here, and who I am, and why this is important to me, than we had before.

And I think that is directly a result of all the talking I did with my shrink. He (and I) didn't "solve" a "problem", but we built structures around which inquiry could take place so that my "problem" is less of a "problem" and more of something that fits in to my (and our) life.

Is that to say that there is nothing about Kafka's formulation that makes sense? Not at all. The metaphors of "addiction" and "appetite" are compelling in some ways, and there have been many times in my life when I am not in control of my interests in pornography (definition of that later) and what I choose to call "outre" sexuality.

But to cut back to the chase, "Prudence's" advice to the parent borders on the criminal, especially when she gets to the part about refering him to counselors who specialize in treating abusers. But is going to a shrink a bad idea? Certainly not. A skim of most of the self-identified "kinky" respondants to "Prudence's" post would seem to find them sympathetic to the notion of inquring as to what part this fetish will play in this 13-year-old's life, and helping him come to terms with it - "Know theyself" as the old saying goes. Where he chooses to go with that knowledge is his decision.