By Dr. Michael Aaron, originally posted on December 8, 2014 on DrMichaelaaronNYC.com/blog.
In a recent post, I wrote about how the field of sexology is uneven in its application and rife with regional and individual biases, largely due to general sex phobia and a subsequent lack of empirical research within the field. Recently, a debate on the mailing list of one of the sexological organizations to which I belong touched again upon discrepancies within the field. The discussion in question concerned whether or not it is possible to eradicate a fetish. Most respondents were in agreement that, like a sexual orientation, eradicating a sexual fetish is not only not possible, but particularly in fetishes that cause no harm, even unethical.
One clinician, however, stated not only that eradicating a fetish is possible, but then went on to describe exactly how (he/she believes) it is done. The methodology described was so disturbing, however, that I felt it necessary to challenge the ideas presented and to present both his/her perspective as well as my response here on my blog as a cautionary tale to individuals who may have questions regarding their own sexuality so that the know what to avoid in therapy. I have eliminated any details that could reveal the identify of the other clinician.
Below is what the clinician wrote in support of fetish eradication. I am highlighting and italicizing the most objectionable aspects:
I don’t see a fetish as similar to sexual orientation – it is something that does reflect “something wrong”, and in my own experience, DOES respond to therapy! One issue is that sexual fetishes – paraphilias – typically involve sexual activity with something that does not provide the rewards that sex with another human does. That is, talking, kissing, caressing, oral sex, intercourse, etc. Compared to these things, really, what does masturbating while doing something like holding on to a shoe, cross dressing, etc. have to offer? In the cases I have had good results with, I have used some combination of procedures to reduce the arousal value of the fetishistic practice; and, at least as importantly, procedures to make good, open, rewarding sexual activity with a consenting adult available to the patient. This procedure has seen been termed “cognitive negative conditioning”. Sometimes this been done with the patient sniffing disgusting aromas or unpleasant chemical agents, but I long ago stopped doing this, and went to the strictly cognitive negative conditioning procedures. The reason for this was that I had a patient confess that he had indeed used all 7 of his ammonia vials this week – but he had broken them out in the parking lot just prior to coming in to see me!
The “cognitive negative conditioning procedures” involve having the patient spend….
time thinking about – and saying into the small tape recorder I give the patient -all the things that are now going wrong in his life because of his fetish; and what is likely to happen in the future for him, because of his fetish, really does reduce the arousal value of the fetish – and this is something that can’t be done in a couple of minutes, on just one day. One thing I have also found often really strongly effective as a negative involves children, if the patient has any. For example, I had one man who had a shoe fetish think about his children coming home from school in tears, saying how they were being teased about “What a freak your old man is – him and his shoe —— (expletive deleted). In another case, we arrived at the man’s daughter saying her boyfriend was now forbidden to date her anymore: “His parents said, ‘Come on, his Dad is some kind of a weirdo pervert!’ Oh Dad, how could you do this to me?”
While I always do the cognitive conditioning procedure with fetish patients, I sometimes also do the “stimulus satiation procedure”, which involves changing the patients masturbation. This is not something I usually use – it is reserved for patients who have what might be called an “extreme” fetish, and are also very well motivated. This procedure involves having the patient (at home, of course) masturbate using normal – non-fetish- stimuli/fantasy. Immediately after reaching orgasm, the man switches to his fetish, and continues to masturbate, without stopping, for a time that is unpleasant- I usually start the man with something like 10 or 15 minutes. During this time, the man will lose his erection; will not be aroused; and will likely find it painful. Should any pleasure/arousal occur, he must immediately switch back to NORMAL stimuli. The major problem here is that it is some of the wives of the man with a fetish (I don’t think I am being sexist here; I just don’t recall ever seeing a female with what could be considered a genuine “fetish”) are so distressed by learning about his fetish that their interest/ability in sexual functioning with him are severely reduced. I have found some success with this problem by putting off this part of the problem until we can say that his interest in the fetish is genuinely gone.
So basically if someone shows up to this therapist with questions or concerns about a fetish, the patient will be subjected to shameful thoughts and experiences regarding his own children and will be pushed into unpleasant and painful physical sensations. Wonderful. Where can we all sign up? Look, whatever this therapist is up to is not only cruel and unusual, but according to the new changes in the DSM 5, in which paraphilias (fetishes) were de-pathologized, also highly unethical. New studies keep being published showing that fetishes are not correlated to pathology. And this person considers himself a sexologist and sex therapist. This sex phobia and negativity must be stopped, especially in clinical settings, before more unwitting people put their trust in ignorant practitioners and get hurt. There is a word for illness cause by doctors– iatrogenic. My call to the mental health field: No more iatrogenic harm to patients around issues of sexuality.
Below is my reasoned response (which went unanswered):
Do you have any empirical evidence for the efficacy of your negative conditioning and aversive techniques for fetishes? Do you have supporting documentation on what percentage of fetishes “prevent, good, open rewarding sexual activity with a consenting adult”? Many of the clients I’ve seen who have discussed their fetishes have described them in ways that enhance, rather than diminish, their sexual functioning with consenting adults. And I’m also wondering why, when working with distressed wives of the fetishist, your first option appears to eradicate the fetish rather than help the wife process her distress and understand more about the fetish, as well as take a systemic look at what else is going on in the relationship. It also appears that you are lumping all fetishes together, including those that are merely optional, preferred, as well as exclusive. Are you aware that the DSM 5 differentiates between paraphilias (which are not pathological) and paraphilic disorders?
Cross-posted from The Sex Workers Project event page:
Come celebrate the success, community, and future of the Sex Workers Project! SWP is the only US organization offering client-centered legal and social services for sex workers and trafficking victims.
All tickets include an open bar and hors d’oeuvres until 9pm. Allies, Activists, and Sponsors will also receive access to VIP mezzanine with a private bar, and added bonuses. Stay and mingle for 2-for-1 drink specials while getting treated to great performances by friends of SWP.
Honor Weil Gotschal & Manges LLP for their wonderful work with SWP on Thursday, June 11th at Taj II Lounge at 48 W21st Street, and acknowledge the many accomplishments for equal human rights achieved through SWP’s work.
Originally posted on August 6, 2014 on What’s Wrong With You?
When I tell people I’m an Acupuncturist there are always the inevitable questions. “Does it really work?” or a variation thereof, throwing in “placebo” for good measure. Sometimes it’s followed up with “Isn’t it expensive?” or “I don’t think my insurance covers it.” And, of course, the perennial favorite: “Oh, needles! Doesn’t it hurt?”
When I began studying Acupuncture I would vociferously defend the validity of the medicine from every angle I could think of. I would go on and on about research, past and present. Discuss which ailments the World Health Organization or the National Institute of Health currently list as showing improvement with acupuncture. Medical conditions such as high blood pressure, chronic pain, insomnia and Bell’s Palsy, among many others.
I would point out the sheer volume of hospitals around the US that have integrated some aspect of acupuncture into their facilities. Hospitals here in New York like Sloan Kettering, New York Presbyterian and Mount Sinai. In fact, a recent survey by the American Hospital Association showed that 42% of hospitals in the US has at least some kind of acupuncture available. Even the US Military has recognized the efficacy of acupuncture for better pain management, treatment of PTSD, and speeding the rehabilitative process. A recently released report from the office of Veteran Affairs, highlighting the concern over their skyrocketing addiction and suicide rates, emphasized the efficacy of acupuncture versus pain medications for Afghan returnees.
Then I’d inform people most health insurance plans cover some CAM (complimentary/alternative medicine) treatments. Lots of people could use their insurance, they just don’t know. The New York State House and Senate has even passed a bill adding acupuncture to workman’s comp coverage. Now the Governor just has to sign it.
I started on the journey to become an acupuncturist after it effectively cured my arthritis. I know, I can’t say “cured” to a patient I ever plan to treat. It’s disingenuous and illegal. It is, however, exactly what I experienced. I saw a wonderful Acupuncturist in midtown for 3 months. After 10 treatments all of my symptoms were alleviated and have not had a reappearance since. All the standard western interventions had done nothing for me except mask my pain and disrupt my digestion. I was amazed that pain I had been living with for 3 years diminished and disappeared in such a short time. It sparked a light in me and I decided I had to know how to do this, too. So my journey began.
Now that know for myself, I just keep it simple and answer the questions.
Does it hurt? Not really. The needles we use are pre-packaged sterile, single use stainless steel needles that are roughly the thickness of one of the hairs on your head.
Does it work? Yes. Speaking from both sides of the needle, I know firsthand how effective a handful of needles can be. I have treated or helped treat patients with a myriad of conditions, virtually all of whom saw definitively positive results from their time in treatment. I don’t bother with the naysayers; they like staying skeptical in the face of mounting evidence and that’s their prerogative.
Seriously though, if you and I were sitting around, talking about our health and life and stuff, drinking some coffee or whatever, and you asked me about it I’d say:
“Look, if you’ve been shot or you broke something or any other emergency, of course go to the emergency room. If you’re bleeding profusely or can’t breathe, please, go.”
Then I would pause, just a moment, maybe take a sip of that coffee or whatever…
“But if you’ve got anything else going on, and I really do mean anything, physically, mentally or emotionally, go see your acupuncturist.”
Guest blog post by Stephanie Schroeder, a freelance writer and activist based in Brooklyn, New York.
Three years ago I published memoir about my struggle with bipolar disorder, Beautiful Wreck: Sex, Lies & Suicide. I got a little press, didn’t make a dime, but I did somehow become an instant go-to person in the Brooklyn LGBTQ consumer community on where to find no/low cost mental healthcare care and treatment, and especially how to afford expensive psychiatric meds without insurance or with insurance, but without adequate coverage. I’m a self-taught expert on how to do workarounds of the shitty healthcare systems we have in the US. I call this the NYC Healthcare Hustle, and healthcare professionals and friends alike refer folks in need to me regularly to see if I can help.
Here are a few inquiries I’ve received/exchanges I’ve had on social media in just the past month:
I signed up for “Obamacare” for $490 on January 1. I still don’t have a card and I don’t show up in the system. I’ve made several calls and just get the runaround. Still can’t get the abilify. I wonder if i will ever see a national healthcare plan in my lifetime. I need medical care with this fucking diabetes!!! Fuckers! I feel helpless with this shit.
I would love to have health insurance… That I could afford. The rates are just too expensive for the crap coverage I would be getting honestly. I think the cheapest plan I could get was $250 a month and it was really shabby insurance! I just couldn’t in my heart pay that much for something that wasn’t really covering me… And I do need it, for mental health. I’ve been lucky to find things like the shine program that help get these services for free.
I can’t find a new fucking psychiatrist who takes my insurance or reach my GP to talk about someone prescribing for me moving forward!
I have a question about medication and suicidality. My mind isn’t working well due to a dismal trial on Geodon (which helped me a lot once in the past, but this time the side effects and the side effects of the medicines I tried that treat Geodon side effects are very devastating and not at all tolerable) and due to just its nature, I guess. Abilify. I think you said it saved your life. I don’t want to live my life any more, but at the same time I wish I could at least have a chance at life. My psychiatrist is on vacation (until April 1) and I can’t wait that long. Do you know of a clinic or some other place where I could see a psychiatrist without being hospitalized? I have a private therapist who I adore – she doesn’t have any leads on a psychiatrist (she is a social worker.) I am on Wellbutrin SR (generic) and I think it has stopped working. Do you know of anywhere that I can just walk in for help…?
The Affordable Care Act has not made healthcare better for most people I come into contact with, including myself. The reality is that the actual lack of affordable healthcare is making us sick(er). There are a lot of folks both within and outside the LGBTQ community who need help, need it now, and need it to be free or very low cost. The government of this country, state and city won’t help. I’ve appealed to many elected and appointed government officials in my lifetime mostly without response—or with the most lame, inane and canned responses ever. It’s not surprising, but it is disheartening.
I recently convened a group of radical queers to mobilize on behalf of our community. We are a small group—consumers and providers, and some who identify as both—concerned about the lack of information about and resources, in NYC, for quality, LGBTQ-affirmative, culturally competent affordable mental healthcare treatment and affordable prescriptions. We are concerned about the lack of choices, of various barriers to access as well as the lack of actual providers who are affordable, especially in light of the ACA. We aim to act as a resource/clearinghouse to our community/communities to find and publicize existing free and low-cost resources as well as develop new options.
Following are some ideas we initially conceived:
- Establishing and maintaining a website listing relevant and updated resources for free/low-cost healthcare. This would provide detailed information and tips, not just a web links. We also discussed creating and distributing a zine.
- Creating a cooperative of psychotherapists and psychiatrists who volunteer to take on one pro bono client for as long as they need assistance. This might also involve a community fundraising campaign on a crowdsourcing platform asking folks to donate the cost of one of their own therapy sessions to another community member in need to fund this project.
- Training and coordinating peer counselors to support those in the community with mental health needs.
I’m also personally interested in coordinating a medication exchange. I’m more about rogue than my brethren, even while I respect the limitations of those colleagues with professional licenses. My idea is that folks donate surplus psychiatric medications whether they have extra, no longer take a certain drug, get free samples, etc. These are then passed along to others who need psych meds, but who cannot afford to purchase them, and there are a lot of folks in dire need. I had to stop taking Abilify for several months a few years ago because I could not afford the almost $700 price tag. I lived very precariously without my antipsychotic medication, thank goodness I have an excellent support network who helped me get through it, not everyone does. We created medication exchanges for HIV drugs—we can do it with psych meds.
I’ve applied for a few small seed grants, mostly to get a website with resources up and running. I envision this resource to not be a simple web listing of people and places, but one where those who have worked with, or tried to access, various resources, give tips and where commentary/narrative from those who have researched different resources accompanies listings.
Stay tuned for the NYC Healthcare Hustle Project to launch sometime in the fall of 2015.
Dr. Eli Mayer will be presenting a talk on Saturday, March 28 at the 40th annual conference of the Society of Sex Therapists and Researchers (SSTAR) in Boston. The theme of this year’s conference is: Healthy Sexuality as a Human Right: Making Sex Therapy Available to Diverse Populations. The conference provides an opportunity to educate “mainstream” sex therapists and researchers about how to provide quality Sex Therapy to those of us whose sexual interests and gender identities diverge from what has traditionally been considered the norm.
It was forty years ago that modern sex therapy to shape with Dr. Helen Singer-Kaplan’s book: The New Sex Therapy was published. At this conference, Dr. Eli Mayer hopes to help bring the members of the organization in line with contemporary thinking, and has titled his talk The New New Sex Therapy: Working Productively With Nonnormative Populations. He looks forward to sharing information from the conference with everyone when he returns. To be continued…