SM: Causes and diagnoses (2002)

Psychodynamic factors:

Trauma: Like other psychoanalysts Stoller lists trauma as a strong contributing factor. He is more cautious than many of the traditional in that he raises important questions about how the trauma contributes exactly and under which circumstances. Why do some people become SM interested and others not, given the same type of trauma? He speculates from his ethnographic data and his psychoanalytic practice that people practicing consensual SM are “neurotic, like the rest of us”, whereas the non-consensual “practitioners” are more severely damaged showing strong signs of personality disorders or (in the worst cases) psychoses.

“Symbiosis anxiety”: Boys must perform an act of separation from their mothers not required of girls. When that is difficult, they may fear becoming female and they may fear being intimate with girls and women. “Much of masculinity in all cultures is made up of manifestations of this conflict: the emphasis on the phallus, the fear of intimacy with women, the fear of being humiliated by women, the need to humiliate women, and the fetishizing of women”. He claims that symbiosis anxiety may be the base for most perversions, e.g., fetishism, voyeurism and SM. In his thinking these are different ways of creating or preserving a distance to the woman.

Defense against anxiety, shame and guilt

Learning theory

Rosenhan and Seligman (Rosenhan and Seligman, 1995) present a behavioral view of the causes of “paraphilias”. They use a Pavlovian paradigm where a conditioned stimulus (CS) is paired with an unconditioned stimulus (US) of genital stimulation and the unconditioned response (UR) of sexual pleasure. As a result, in the future CS will produce the conditioned response (CR) of sexual arousal. Foot fetishism can be used as an example. The sight and feeling of a foot, which touches the penis, can become a CS, the resulting erection (or orgasm) the US. The CS does not get extinguished in the paraphilic, due to masturbation that reinforces the connection between CS and the UR. But why some people will masturbate to the CS, and others won’t is still a mystery.

In addition, they use “preparedness” as a way of explaining the fact that a limited set of objects become paraphilic. This preparedness is probably “hard wired” (i.e. biologically determined) and species specific.

“Modern” sexology

John Money (Money, 1986) is one of the most authoritative and well-known sexologists that have written extensively about the origin of paraphilia. He uses both psychoanalytically oriented theories and learning theory as bases for his way of thinking. One prominent statement of his is “turning tragedy into triumph”, the tragedy being vandalizing someone’s sexuality or “lovemap”. The triumph is the sexual satisfaction obtained being paraphilic. Money defines “lovemap” as: “a developmental representation or template existing synchronously in the mind and brain (midbrain) depicting the idealized lover, the idealized love affair, and the idealized program of sexuoerotic activity projected in imagery or actually engaged in with the lover”(Money, 1998). A person’s lovemap is supposedly as characteristic of that person as is his fingerprint. A person with paraphilia as part of the lovemap has had his lovemap vandalized.

Lovemaps may be vandalized in many ways, for example by parents interfering with the sexual development of the child. He claims that paraphilia is virtually non-existent in societies that do not place taboos on children’s sexuoerotic development. On the other hand, he emphasizes both heredity and environment as contributing to paraphilia. Hereditary components are not necessarily genetic, but could for example be hormonal influences in the intrauterine environment.

Money is well known for an extensive classification of the paraphilias, dividing them into categories and sub-categories and giving them specific names (e.g. “acrotomophilia”) that he makes up from Greek and Latin. His classification is much more extensive than in any of the main diagnostic manuals (DSM and ICD).

Sexologists vary in their viewpoints on the origins of paraphilia. One common opinion is that the development of paraphilia is connected to the person’s rejection of sexuality, body and intimacy, and that there is an emotional conflict in relation to the parents. The emotional conflict causes the person to disconnect his sexuality from individuals and connect it to objects or situations.

My own comments on “etiology”

I think it is reasonable to believe that there are as many origins as there are “paraphilic” persons. According to both my experience and the studies I have read, SM people constitute a very diverse group that has not necessarily anything in common except for being people interested in SM.

Many of the professionals that have tried to explain the origins of SM have good points, but I don’t think the explanations are universally valid. It is just too easy to postulate that “conflict” and “trauma” are necessary contributing factors, especially when patient data are being used. If that were correct, I would expect a much higher prevalence of psychopathology among SM people than in the general population. From the studies done, so far, there is no reason to believe so. As Stoller says: “Most informants are stable in employment; most are college graduates or beyond, lively in conversation, with a good sense of humor, up-to-date on politics and world events, and not more or less depressed than my social acquaintances.” “Like everyone else they are neurotic”.

So, if (as Stoller says) SM is a PTSD (Post Traumatic Stress Disorder) from childhood, we all probably have some kind of PTSD, SM people or not. And SM is a healthy solution compared to for example an OCD (Obsessive Compulsive Disorder).

One of the weak points in the explanations is that they almost always talk about men. Of course, men have been less suppressive of their sex drive than have women traditionally, so they have acted on their sexual impulses to a much higher degree. Some of them have gotten into trouble (sometimes with the law) and ended up in the doctor’s office where they have been diagnosed. That leads us to another weak point: most of the data collected are from pathology cases.

I think it is reasonable to assume (like Stoller and Money) that there are several contributing causes. Upbringing is obviously not enough, since there are strong reasons to believe that equivalent treatment from the environment can give very different results. People, who were spanked as children may, or may not, be attracted to spanking. And there are people who (at least claim) never got spanked that like to be spanked during SM games. Perhaps some people are more attracted to strong stimulation than others. The ass is an erogenous zone for most people, and maybe more for some than for others. Since there are genetic differences in people’s body parts, why not genetically determined differences in how different body parts respond to various kinds of stimuli?

I agree with Stoller that there are biological, cultural and environmental causes, which most often operate simultaneously and in interaction. I think that “fixing” (Stoller) plays an important part, because the sexual interest is so “resistant to extinction”. I don’t think learning theorists are on the mark with masturbation being the crucial factor in maintaining the interest. More likely the interest has been invoked once and for all (“fixing”) and therefore compels the person to continue masturbating.

The interest may be invoked in many different ways, not necessarily in a traumatic way. If there is trauma involved, that may explain the “fixing” because the arousal may have been so high that the emotional impact of the experience sticks in the brain and nervous system forever. But I can well imagine that the hyper aroused states may have different causes. A big sister who puts her boot on the boy’s penis just in the right moment during play could be an example of strong arousal resulting from the vigorous playing plus the touching of his penis. His boot fetish and possibly a masochistic interest may be due to the intense pleasure in a hyper aroused state without any trauma involved. Of course, his genetic makeup may be influential at the same time. However, one might argue that if the grown up man can relate sexually only to boots and not to people, there must be some trauma in his life that makes it impossible to be in a sexual relationship. The trauma(s) will in that case be related to his inability to make relationships, not to the fetish or the SM interest. I am sure psychiatry often confuses these issues. In addition there is reason to believe that most of us have suffered some kind of “trauma”, and that could in individual cases be made “proof” that trauma is the cause of SM interests. “See, these SM people have all had trauma in their lives!”

Anyway, I agree with Stoller that those that abuse others, sexually or otherwise, are damaged people. They must have suffered “traditional traumas” (like having been abused themselves) or been grossly neglected, so that their ability for empathetic and respectful interactions with other people is severely damaged.

One point about the interaction between biology and environment: There is reason to believe that some boys have a more “effeminate” biologic makeup than others (Bateson). Such a boy may be especially inclined to play with girls and in submissive ways. His biologic makeup gives an impetus to choose environments that will give opportunities to experience strong sexual arousal with girls that dominate him. Hence masochistic interests may develop. Of course, I don’t claim that all masochistic men are “effeminate”. There are many different reasons for all the sexual interests and preferences.