In Practice

A practicing doctor's views on psychiatry and contemporary culture.

Perversion, and the Mystery of Sexual Desire

Perverse desire: still a mystery
Today's Slate features my review of The Other Side of Desire, by Daniel Bergner. In yesterday's magazine section, the New York Times showcased Bergner's reporting on scientific explorations of women's sexuality. The book deals mostly with a different topic, perversion, and here the contributions of formal research are limited, a fact that signals a major change in the psychiatric paradigm.

In Freud's time and for decades after, it was assumed that sexual deviance held clues to the nature of human development. After all, via the Oedipus Complex and its female equivalent, the human self was a product of incestuous lust. Today, research on sexual deviance is scattered and scarce - there is no dominant theory - a sure sign that the sex-centered psychoanalytic viewpoint has fallen by the wayside.

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Research on normal desire meshes poorly with observations about perversity. To quote from my review: "Shown erotic videos, Bergner writes, women undergo ‘swift vaginal engorgement to images of all sorts of human sexual activity.' Scenes of bonobo chimpanzees humping increase women's vaginal blood flow. But this equal-opportunity arousal is more in brain and body than in mind. Measures of genital response correspond poorly to women's reports of excitement. . . Men's desires are more focused. . . Bonobo intercourse has no appeal for men. In general, the penis and the mind are in reasonable agreement; men recognize when they've been turned on." But it's largely men who are paraphiliacs, people with odd or deviant sexual desires. Strange: shouldn't women, whose desires arise from the imagination, have the broader range of sexual interests? Again, the discord between the two lines of research, on mainstream and perverse erotic interests, underscores how far we have moved from the Freudian paradigm.

Even the science of ordinary desire is undeveloped. The Times piece focuses on the work of Meredith Chivers, who did the work with bonobo trigger tapes. Midway through his essay, Bergner reports on one of Chivers's forays into evolutionary biology. She speculates that, given the threat of rape, genital lubrication may be necessary "to reduce discomfort, and the possibility of injury, during vaginal penetration. . . . Ancestral women who did not show an automatic vaginal response to sexual cues may have been more likely to experience injuries during unwanted vaginal penetration that resulted in illness, infertility or even death, and thus would be less likely to have passed on this trait to their offspring." That is to say, genital arousal may be a poor indicator of "what women want" - so that research relying on the measure should be viewed with skepticism.

Peter D. Kramer is a psychiatrist and author. His books include Against Depression and Listening to Prozac.

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