The Other Side of Desire: Four Journeys into the Far Realms of Lust and Longing

by Daniel Bergner

  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.

  Pedophiles, too, might learn to manage without their mother tongue. Fedoroff talked about putting them through a second puberty. His plan depended on the idea that everyone had once been pedophilic. As children we’d had our primary crushes on other children. For most of us, our preferred objects of desire grow older as we do, at least through puberty and for several years beyond. But for the pedophile, Fedoroff thought, something had gone awry around puberty’s onset—and the solution was to set the patient back into a prepubertal state. This could be accomplished, at least as far as the sex drive went, by giving anti-androgens. With the lust for children out of the way, emotionally romantic attachments with adults would be given a second chance to develop. Then the dosage of anti-androgen could be gradually reduced, allowing sexuality to join up with the romantic sentiments.

  It was a theory somewhat like the one Berlin had described as central to Money’s thinking—and as disproved. What made Fedoroff confident that an attraction to adults would gradually rival the longing for children wasn’t fully apparent. He hadn’t yet tested his idea, though he intended to soon. His self-assurance seemed to rely on another analogy: on thinking not only in terms of language but in terms of cuisine. “I tell my guys, ‘What you’ve been doing is like eating at fast food restaurants. Your fast food days are over. The gourmet dining experience is coming. If all you’ve experienced is sex with children, you have no idea what it’s like to have sex with someone who can actually reciprocate and play on the same level as you. Once you’ve had that, once you’ve had gourmet food, you won’t want to go back.’”

  The metaphors seemed to buoy him above all doubt. And to be around him was to float above darkness and to feel that desire need hold no threat, no anguish. “If you haven’t noticed,” he declared one evening at a dinner party at his home, “I’m very sex-positive.” The house embodied a mix of the intellectual and the sensual. A sculpted relief of three nude backsides decorated one bathroom. A large library, lined with built-in bookcases that rose from floor to ceiling, opened onto a small indoor swimming pool. On the floor above, a balcony in the living area overlooked the water and whoever might be swimming or floating languidly. Directly behind the house, which was a ten-minute drive from downtown, a tributary to the Rideau Canal ran past. Fedoroff could fish for carp from his back deck. And the force of this water, seen through the windows, seemed to stitch the bookish and erotic elements of the house inextricably together.

  At the opposite end of the dining table from where he sat, Fedoroff’s wife, who had served takeout Indian food for the occasion, joked about her cooking with one of his interns. “He has to put up with my experimenting.”

  Overhearing, he called across the table, “Are you talking about our sex life?”

  Someone asked whether his patients ever turned in any strange sex toys, whether he kept a collection.

  “I’m his sex toy,” his wife yelled out.

  She had a tousle of long hair, dyed blond with dramatic dark roots. She wore black pants that clung to her slender hips and a tank top that showed off her arms, her breasts. They’d met when she was a psychiatric nurse on a ward where he was doing rounds. To their guests, she told a story about being trained to wrestle unruly patients to the ground. She told stories, too, about a pornography convention she and Fedoroff had attended because of some research he’d done. She’d had her picture taken perched on Larry Flynt’s lap, in his wheelchair. And Candida Royale, a porn star “known for her ass,” she said, had patted her on the butt, which she had taken, she recounted, smiling half-ironically, as a particular tribute.

  Considering the perfect body and profligate hair and brazen conversation of his wife, I thought, No wonder he has such an optimistic vision of the erotic. Everything is easy—reality is fantasy—in his house. Then, amid the laughter that followed the Candida Royale story, his wife said, “I used to be insecure about my boobs,” and explained raucously that they had been much smaller before she’d contracted breast cancer and gone for prosthetics. The laughter doubled, hers the loudest of all. So they’d had their share of darkness, I thought. There had been anguish to fight through.

  FEDOROFF didn’t deny that his metaphoric reasoning was imperfect, that his own analogies could work against him. A person might gain fluency in a second language, and might live for years far from his native soil, but still have a longing to return home and speak his mother tongue. A person might discover haute cuisine, develop his palate, and take keen pleasure in the food’s complexity, but still have a hankering for McDonald’s. Yet Fedoroff believed that stubborn desires could be dealt with in the pedophile—partly through pornography. He and Patrick Liddle thought in opposite ways. Liddle wanted his men nowhere near pornography, not even images of adults; he wanted lust circumscribed, narrowed, in some ways negated, for fear that it could lead so easily to the uncontrollable. For Fedoroff, desire wasn’t pervaded by threat. He ran groups like Liddle’s, gathered molesters around him in circles of chairs, gave them a place to gain self-control. Yet he didn’t seem anxious that they might be one step away from molesting again. At the dinner party, he said that staring at child pornography could help the men; they could masturbate, diminishing their urges, their yearning to speak the mother tongue, their wish for fast food. He mentioned a study showing that during a period when the availability of child pornography had increased in Denmark, sexual offenses against children had declined. The same had been shown in Japan. Fedoroff encouraged his molesters to fantasize. Fantasy hurt no one. Touching yourself hurt no one. And with the craving sated, the patient could turn his attention back to developing the second language, the taste for the gourmet.

  One evening, as Fedoroff led a group that held a range of offenders—against children, against adults, against animals—a patient who’d assaulted a woman confided that he’d been looking at pornography online. A Muslim in the circle, another patient, inveighed against this: “Our scholars tell us that looking leads to touching and this will destroy.” He had a thick black beard and wore white leather Converse high-tops. He could have been speaking for Liddle. And Fedoroff replied, “Billions of people find pornography pleasurable. It’s okay. There’s nothing in the Koran about Playboy. There’s nothing in the Koran about X-rated videos.”

  “Not specifically.” The Muslim stared Fedoroff down.

  But nothing could shake him. One morning, a patient settled himself on Fedoroff’s couch for one of his periodic check-ins. With neatly cropped dark hair and a blue crewneck sweater, the man talked about having just found a girlfriend online, using the dating service Lavalife.

  “Do you have a profile?” Fedoroff asked blandly.

  “Uh-huh.”

  “What do you say about yourself?”

  “Just a paragraph.”

  “Now, you have some special sexual interests—do you mention any of those?”

  “Nah.”

  The special sexual interests included binding women in a certain position, arms behind their torsos, accentuating their breasts. Twice the man had kidnapped women from parking lots, driven them out into the country, forced them from the car, used large screw clamps to bind their ankles and arms and a knife to slice off outer clothing. During one of these assaults, the sight of the woman in his favorite position had been enough to make him come without any touching. The other time, he’d bee
n about to rape his victim, threatening her with an ice pick, but stopped when she begged him not to go on. He’d spent a few years in prison. A few months ago he’d been arrested for soliciting a prostitute. As he talked with his patient, Fedoroff turned to me and explained that in Ottawa prostitution was legal but soliciting a prostitute was not. The irony amused him. He seemed concerned by the societal schizophrenia reflected in the policy. He didn’t seem worried by the fact that his patient had been negotiating to bind the prostitute in his preferred way. He didn’t seem too concerned that the man was free and courting women on Lavalife. He didn’t seem panicked that the man’s dose of medication was apparently not enough to subdue a desire that, the patient told him, sometimes felt “like anticipating a fix of heroin.” Fedoroff told me later that trying to arrange for a prostitute to be tied up was a sign of significant progress—a move away from the violently coercive and toward the consensual. He didn’t see it as a sign that the man might soon again be wielding an ice pick.

  The patient went on his way, out Fedoroff’s door and out into the world. The psychiatrist mentioned to me that successful phallometric testing for tendencies toward violent, coercive sex was difficult. Among all men, sexually violent pictures and audiotapes were “too generally arousing.”

  At the dinner party, he mused about giving sex offenders Viagra. A parallel approach had worked with AIDS patients. “People say, ‘Men with AIDS on Viagra?’ They’re incredulous. But men with AIDS get erection problems, especially when they’re put on all these drugs. They stop using condoms. Instead, you prescribe Viagra so they’ll have safe sex.”

  For offenders who had trouble getting erect “in appropriate contexts,” he went on, Viagra might help in learning second languages. He imagined writing prescriptions for pedophiles. Then came another metaphor to go with language and cuisine: his plan to interrupt the sex drive with anti-androgens was “like an orthopedic surgeon breaking an arm intentionally in order to let it mend and redevelop into a healthy limb.”