The Other Side of Desire (15 page)

It was different two hundred miles to the northeast, in Ottawa, where Paul Fedoroff—like Berlin and Blanchard, one of the world’s best-known sexologists—spoke about how he’d come to treat a legion of paraphiliacs, among them a man who had sex with horses, a woman who had stroked herself so frequently her vagina was covered in sores, and an array of pedophiles, all of whom, Fedoroff believed, could change. During medical school, he said, he’d met a psychologist, a researcher whose focus was sexuality. “He told me about the case of an NFL football player who’d been arrested for exhibitionism. The man was a quarterback, a star. He’d married a Miss America or someone like that. And this psychiatrist said, ‘Think about it. Here’s a guy who’s the envy of every man in the States. He’s the quarterback of a winning football team. Every weekend literally millions of people watch everything he does. He’s married to the prettiest woman of the year in the U.S. And even with all that, for some reason he goes out and exposes himself.’ The league had known about the problem and covered it up for some time, but this apparently was one time too many. He lost his job, his huge salary, his wife. And this psychologist said, ‘There’s something interesting here.’”

Fedoroff had padded cheeks and a sharp nose, a soft middle amid a stretch of height. There was a mix of softness and superiority in his face and body. And then there was the sheer enthusiasm of his clothes. His suits flaunted the thick pin-stripes of the moment; they were so current in their style, he looked almost like a dandy. A rim of gray hair, some of it tossed untidily over the top of his head, undercut the dandyism. But the enthusiasm, the energy—he saw patients and met with colleagues and addressed seminars from early morning till after dark without even a break for coffee—were unmitigated.

“I’ve fooled around with dogs,” a patient told him one afternoon, his eyes shut tight, as though against the truths he was confiding. “Not mounting—masturbating. I have relationships with horses. I don’t know if I want to stop. If given the choice, I’d choose a horse over a woman.”

“Why?” Fedoroff asked quietly. He leaned back in his leather desk chair, a bright tie bringing extra flourish to the high fashion of his suit, while across from him, on the couch, the man sat upright in a dingy T-shirt and dusty khakis. He was portly, with a light brown mustache.

“The trust factor,” he said. He added that he had a girlfriend.

“Isn’t that preferable?”

“I find I’m closer to horses.”

Fedoroff’s office was in a small, square hospital building with low ceilings and floors of bleary linoleum. Above Fedoroff’s head hung a print by Chagall: a floating couple engaged in an airborne kiss. The scene looked, at first, blissful, banal; the woman clutched a bouquet of flowers while her lips met her lover’s. Yet on second glance, all was askew.

The patient acknowledged that there might be emotional limitations in his relationships with horses. He explained that he’d had some run-ins within the zoophile community over this very point. “They say there’s a husband and wife bond between the human and the animal.” His feelings didn’t go quite that far. Still, he kept returning to the trust factor. “You’re not going to have an animal try to hurt you emotionally. You’re not going to have an animal make fun of you.” He didn’t think he’d always been attracted this way. He believed it was a product of human betrayal.

When he touched himself, he did so with horses in mind. Whenever he could, he made love to one of the mares at a local stable. He’d come to Fedoroff’s office out of fear: he didn’t want to change, but he didn’t want to get caught; sex with horses could be punished with years in prison. His dream was of a life across the border and down in Missouri and back in the past. “Missouri,” he said, “was once a legal state.”

He saw his lovemaking as part of natural progression. “People have been training horses for thousands of years. Long ago horses didn’t have people on their backs. They didn’t have bits in their mouths. Now they do.” He was merely taking the next step. And he was careful to do no harm, to take no advantage, never to mount the young. “They don’t really know what sex is. Their drive isn’t there. It’s like a child—they don’t really know what’s going on.” Nor would he persist with an unwilling adult. He could tell when desire was returned. “Mares are very vocal.”

Fedoroff took all this in without reaction except, once, to straighten his tie and, now and then, to suggest gently that change was possible. The patient stayed focused on immediate fears: arrest, disease. He asked Fedoroff if illness was communicable between animals and humans, and in reply the psychiatrist asked if he used condoms.

“Me and my human partner use protection. Me and my equine partners don’t.”

Fedoroff scheduled another appointment for him several weeks away. He tended to see his patients individually every month or so, though many came weekly to group sessions. He monitored them and often medicated them and checked up on the therapy some of them received elsewhere. The zoophile didn’t yet want treatment of any kind. “If he agreed,” Fedoroff told me after the man left, “I would try to steer him more strongly toward humans.” Then he went out into the waiting area to greet his next patient.

Lust, Fedoroff believed, was analogous to language. “People are born without language,” he said, “but with a genetic makeup that allows them to acquire and express any of the languages that exist in the world. And the language they end up speaking is determined by who they’re raised by. At about the age of two their mother tongue is set, so that even though a person can learn new languages the fact is that there’s a basic hardwired one. Even with people who are multilingual, if you ask what their mother tongue is, they can tell you. And if they can’t, if they say ‘I speak these languages equally well,’ and you ask, ‘When you calculate numbers in your head what language do you use?’ there will be one answer.” It was similar with sexuality. Infinite possibilities narrowed early on; what John Money, Berlin’s mentor, had called “the lovemap” took shape. But all was not over; the lovemap was not unmalleable. “If you buy that it is,” he went on, “then you tend to think like neurologists do: diagnose and
adios
. It’s a fatalistic approach, and over the years I’ve discovered that it’s not right. Because of course people are capable of learning and developing second languages. I’m not sure that you can get rid of the original interest. But you can become less dependent on it by developing new desire.”

Fedoroff assumed that desire was shaped by all sorts of factors, biological and experiential, weighted differently in different people. Unlike Blanchard and Cantor, he wasn’t bent on proving nature’s predominance over nurture, though he was fascinated by the evolutionary, the biological. Thinking about why certain body parts and objects were frequent targets of paraphilic desire, he said, “People have asked exactly the same question about why there are certain things we are more likely to be phobic about. Heights, the dark, wiggly objects—these are phobogenic across cultures. One answer is that people have been naturally selected for these fears. People with fear of heights are probably more likely to have children than people who don’t. So using the analogy with fetishes, there are things we’re genetically predisposed to sexualize. Characteristic odors. You can look at animals and see the power of odors in reproductive behavior. It’s not too much of a leap to say that humans have odor-driven sexual pathways, and that many of the things that are fetishized have or are associated with musky smells—feet, shoes, undergarments.” Fetishes, like phobias, were a legacy of evolutionary advantage, an expression of desired traits taken to excess or diverted to related targets.

Sometimes Fedoroff’s mind seemed close to exploding with theories. “I resist single answers because they all turn out to be wrong.” His etiological explanations included the role of shame and fear in spurring orgasm. Some paraphiliacs, he thought, suffered from a “sticky switch” governing their parasympathetic and sympathetic nervous systems, two branches of the autonomic circuitry that regulates heart rate, sweating, breathing, salivation. The parasympathetic system controls arousal while the sympathetic sends us into the ecstasy of orgasm. “The natural progression during sex is that the parasympathetics are set off, and at some point when we become sufficiently aroused a switch flips and the sympathetics kick in and we start to have an orgasm. But the poor paraphiliac has a sticky, sluggish switch and needs to do something extreme to get the sympathetics going.” Besides orgasm, the sympathetic system takes control in situations of emergency, and Fedoroff’s theory was that some paraphiliacs use the deviant or forbidden to stoke their sense of mortification or danger—to create the emotional emergency that would open up the sympathetic pathways and drive things on toward climax.

He mentioned a patient, a heterosexual woman, who sought treatment because she’d lost the ability to climax with her regular partner. Sex with a succession of men in the same evening; videos of women copulating with animals; making videos of herself masturbating—these sent her toward orgasm. Satisfying sex with her partner seemed a hopeless cause “until,” Fedoroff wrote in a journal article, “it was discovered that she consumed large amounts of L-tryptophan, available in health food stores, to help her sleep. This substance is metabolized into serotonin, which is known to cause difficulty reaching orgasm. She was advised to discontinue taking L-tryptophan. Soon afterward, her ability to reach orgasm through intercourse with her partner returned, and with it, her paraphilic interest in group sex, exhibitionism, and zoophilia disappeared.”

After the man who mounted horses, Fedoroff’s next patient was a girl who looked to be in her late teens. Her blue hair formed a spiky plumage above her pale, round face. She wore heavy black boots and a beige fleece with a stitched outline of a lion’s head decorating the front. The stitching wasn’t prominent; the lion’s face and mane were ethereal, like the specter of something aggressive or untamable that lived within her. Once, she’d masturbated compulsively, abrading herself until her genitals were disfigured by sores. She’d humped herself with broom handles. She’d fondled dogs. She’d been living in a group home; her groaning during masturbation had unsettled the staff, and there had been accusations that she molested younger residents. Now, under Fedoroff’s care, an anti-androgen curtailed her erotic drives. But he didn’t think her problems were permanent. He didn’t think the chemical restraint would always be needed. He suspected that she had an obscure genetic disorder, that her particular array of symptoms pointed to a certain missing chromosome, yet as he leaned toward her, from his chair toward the couch, he drew her a comforting graph with a line that zigged and zagged but climbed ever upward, the zags representing setbacks but the climb representing inevitable overall improvement. “I know you want to live a normal life,” he said. “There are going to be some bumps along the way. But I think you will.” It wasn’t clear exactly how normality would be accomplished and maintained as the drugs were removed, but the girl listened, un-questioning, looking at least a little reassured.

Her case reminded him of another, and after he’d led her out with a few more soft, upbeat words, he described a patient with an even more rare genetic disorder, Lesch-Nyhan syndrome. The young man had to live strapped down to a chair; unrestrained, he would gnaw off his own fingers and tear off his penis. The compulsion to mutilate and get rid of his own extremities was caused by a deficient supply of a single enzyme. “It’s amazing that it’s just one enzyme that keeps us from doing these things,” he said. Another symptom, for his patient, was that change—any change—was excruciating, unbearable. But the man’s parents, whom he lived with, had learned to adapt. Every night they moved pieces of furniture, so that change was the soothing constant. And understanding that their son needed some sort of sex life, they designed a special apparatus that allowed him to masturbate without granting him the freedom to dismember himself.

Fedoroff adored the ingenuity of the parents; it fed his faith in solutions. His trust in the possibility of setting things right dated back to a truck driver transvestite decades ago. At the time, Fedoroff had been a psychiatric resident going through a required period of psychoanalytic training, but when more than a year of talking brought no change in the cross-dressing, a mentor suggested that he shift his focus from treating the paraphilia to addressing the patient’s anxiety. Fedoroff decided to try a new medication, buspirone.

“Soon I get a call from the guy’s wife. I’ve never heard from this woman before. She said, ‘What is that medicine you put my husband on?’ I said, ‘Well, it’s this new antianxiety drug; is he less anxious?’ And she said, ‘No, he’s as anxious as he ever was, but don’t ever take him off it.’ ‘Why’s that?’ And she said, ‘Because we’re having the best sex we’ve ever had in our lives.’

“So I had the truck driver come in. This was a macho guy, but during sex he’d had to have lingerie on, or have intense fantasies about wearing it. And his wife had picked up on the fantasies; she described it as his being completely tuned out. And now he said, ‘I don’t know why, but I don’t have to do that anymore. I can have sex with my wife, and I don’t have to think about lingerie at all. This has never happened to me in my life.’

“We took him off the medication, and six weeks later he couldn’t function unless he was thinking about lingerie. Put him back on and the problem disappeared again. But a long while later I called him and asked, ‘Are you still taking it?’ He told me no. He kept a bottle of it in the cupboard, just in case. But he didn’t need it. I’m quite convinced there had been a fundamental change in his lovemap.”

Fedoroff’s theory was that the buspirone had eased the “sticky switch” that engaged the sympathetic nervous system during sex. With the switch working smoothly, making ordinary love with his wife became a thorough pleasure. He’d been able to develop a second language, to become fully functional within it, and eventually the drug was no longer necessary.