by Frank Tallis
I was seeing Gordon at a time when psychologists believed that sexual orientation could be modified by ‘conditioning’. During normal sexual development, sexual preferences are consolidated through masturbation. A strong association is made between fantasies featuring favoured sex objects (usually adult men or women) and pleasure. It was assumed that this same process could be exploited to redirect sexual interest, and a treatment—orgasmic reconditioning—was devised to achieve this aim.
It worked like this.
A paedophile is instructed to masturbate employing his usual fantasies involving children; however, at the point of orgasm, he must think of an adult instead. This exchange of sex object—from child to adult—is brought forward, so that it occurs earlier and earlier in successive masturbatory sessions. If reconditioning is successful, sexual relationships with adults become possible and further consolidation follows.
I explained the theory to Gordon and he was extremely interested. I gave him a few additional instructions: ‘You might find that if you switch fantasies too early you lose your erection. If that happens, just return to the first fantasy until you reach the point of inevitability—then think of an adult woman again. Okay?’
‘Yes.’
‘But try to stick to the general principle of swapping fantasies earlier and earlier.’
‘Of course.’
‘Oh, one more thing—and it’s quite important. We’re trying to strengthen your interest in adult women while weakening your interest in children. So it’s essential that you never continue with a fantasy involving children through the occurrence of an orgasm. That will of course strengthen the association between children and sexual arousal, the very thing that we’re trying to weaken. Okay?’
‘I won’t do that,’ Gordon said gravely. ‘I promise.’
‘Do you have any questions?’
‘How often should I…’
‘Well, that depends on you and your physical functioning. If you masturbate too frequently, you’ll find it difficult to get aroused—and you must be aroused for this to work. You’ll have to discover the optimal frequency yourself.’
When Gordon rose to leave, he seemed more animated than usual. He even essayed a tremulous, appreciative smile.
Treatments based on conditioning theory are a form of behaviour therapy. On the whole, behavioural therapies have proved to be very effective—particularly when used to treat specific phobias like fear of spiders or fear of the dark. Many psychological problems are like bad habits that have been learned, and if they have been learned, it should also be possible to unlearn them. But there are limits to what can be learned and unlearned, and initial enthusiasm for procedures devised to change sexual orientation soon waned. It turned out that they were much less reliable than initial research findings suggested.
After a month, orgasmic reconditioning had had little or no effect on Gordon’s sexual preferences. ‘No matter how many times I ejaculate thinking of grown women I still find children more pleasing to look at.’ He stared at me through his tinted spectacles. He was very disappointed.
We discussed alternatives. He had already found out about anti-libidinal medication. ‘I don’t think I’d really be me any more on those drugs. They change who you are.’ Even paedophiles, full of self-loathing, have a sense of personal identity that they wish to preserve. He had read that oestrogen causes breast development and was understandably horrified.
I changed tack and began to challenge his romanticism, but he already knew that his idealisation of Molly was absurd. ‘I know,’ he would say, nodding his head. ‘As if it could work, it’s madness.’
He agreed that it would probably be in everyone’s interests if he stopped seeing Barry and his family. And after the decision had been made, he was like any broken-hearted individual. For a period he was lost.
There were some improvements—although always modest. He was more accepting, perhaps, of a life without the possibility of love. This, I suspect, was how he had been before he had encountered Molly. She had stirred him up and made him ‘romantic’. He also benefited, I am sure, from having the opportunity to talk openly about his sexuality. It was the antithesis of his counterproductive thought suppression.
‘Do you feel more in control?’ I asked.
‘Yes,’ he replied. ‘I do.’
But we both knew that his confidence would evaporate if he saw the play of light on Molly’s hair again.
After our last session, I felt uneasy. Gordon was a paedophile. He had walked out of my office and down the stairs, and he was now walking the streets, passing unsuspecting parents with their children, his gaze lingering too long on white socks and skinny legs as he passed the primary school gates. I had to remind myself that he had never offended. ‘I would rather die,’ he had said. His crimes were in his head, and we all commit crimes in our heads—to a greater or lesser extent. And in a Godless universe, thoughts are not behaviours and our transgressions occur only in the bony confinement of our skulls.
I slipped Gordon’s file into my briefcase and closed the hasp. Looking out of the dirty window, over the roof tops and chimneys, I saw clouds banking up in the distance. Soon, headlights would be turning rainfall into bright dots and dashes, and umbrellas would be angled towards the wind. I sat there for some time.
When I left the hospital I raised the collar of my coat and joined the stream of humanity—the impatient, bad-tempered rush through the dazzle and glare. It was already quite dark.
When I arrived home I was still feeling uneasy.
I still feel uneasy today.
Chapter 11
The Couple
Improbable love
The referral letter was somewhat cursory: a single paragraph and an illegible signature that looked like a hastily sketched profile. It was a request for me to see Malcolm and Maddie, a husband and wife whom the GP considered to be ‘personality disordered’. The doctor had discovered some bruises on Maddie’s body that Maddie claimed she’d got because she was ‘always bumping into things’. The GP, however, wasn’t satisfied with her explanation and suspected domestic abuse.
Personality disorder is a controversial diagnosis. Many psychologists believe that it is entirely inappropriate to pathologise ‘personality’ (the constellation of stable characteristics and dispositions that are expressed across situations). This view has some justification. I have met few actors, for example, who fail to meet diagnostic criteria for ‘histrionic personality disorder’, which is associated with attributes such as excessive emotionality, attention-seeking and ‘theatricality’. Indeed, the diagnosis might serve equally well as an entry requirement for drama school.
Deciding whether someone’s personality deviates markedly from cultural norms is fraught with difficulties and ultimately influenced by subjective factors. I would read referral letters in which patients were labelled as personality disordered with scepticism, because, more often than not, when those patients were seated in front of me I judged them to be entirely ‘normal’. I can only assume that in such cases the referring GP or psychiatrist’s concept of ‘normality’ varied substantially from my own.
Malcolm and Maddie were offered a joint appointment, but when I opened the door there was only one person standing outside, a very thin woman with a long face and pointed features. Her jacket, trousers and shoes were black and rather masculine; however, this general impression of sartorial restraint was contradicted by her hair, which was short, spikey and dyed red. Not a garish, bright red, but a red of sufficient intensity to surprise. I already knew from the referral letter that she was in her mid-forties, but she looked considerably younger. She entered the building and I led her into the consulting room. ‘Where’s Malcolm?’ I asked.
‘Oh,’ she replied. ‘Something arose…’
‘Work…?’
‘Well, there are always impediments, aren’t there?’
She sat down muttering something that sounded very much like: ‘The cows in the meadow…’
I thought I must have misheard her: ‘I beg your pardon?’
She smiled but didn’t respond.
I explained how couples therapy would work and she listened, nodding occasionally. Then I asked her what the problem was—from her perspective.
‘The problem,’ she began. ‘Yes. Yes. I suppose things could be better—but what can you do? Eh? And what can one expect? I’m not sure—nor ever have been. In fact, there’s so little one can say—for certain—that is. And yet, life goes on, doesn’t it? Years pass. We muddle along as best we can. Sometimes it goes well, and sometimes it doesn’t. And sometimes, in fact most times, it’s all much of a muchness betwixt the twain. Be that as it may, there are moments when questions are raised, I’ll grant you that. Doubts, equivocations… But how could it be any other way?’
She managed to talk at length without saying a single thing of substance. It was as if she were voicing her stream of consciousness. She wasn’t talking absolute nonsense, but her speech was rambling and imprecise. It occurred to me that she might be suffering from Ganser’s syndrome, the cardinal feature of which is responding to unfamiliar questions with approximate answers. This, however, seemed highly unlikely given that Ganser’s syndrome is extremely rare and almost exclusively diagnosed in men.
Sometimes, interpretable fragments would surface in Maddie’s speech: ‘Malcolm is the way he is—and I am obliged to accept that. We are who we are.’ But then she would continue, skirting around meanings, erecting the linguistic equivalent of an Escher print. Nothing quite joined up—everything she said was oblique or tangential. She was also in the habit of using old-fashioned or idiomatic words. ‘I have my limits of course. I won’t tolerate any jiggery-pokery.’
I had to remind her—again and again—that she was supposed to be answering a specific question. She would reply, ‘Ah, yes.’ And then immediately resume her circumlocutions. After thirty-five minutes, I hadn’t made a single note. I had written the date, but nothing else. Looking down at the whiteness of the page made me feel vertiginous, as if I was looking into a void. I didn’t have the slightest understanding—not the faintest idea—of what had gone wrong with Maddie and Malcolm’s relationship.
It felt remiss to let the session end without broaching the subject of domestic violence. Subsequently, I asked Maddie about the bruises.
She got up from her seat and started to walk around the room. ‘Each to his own, eh? Look—I’m not a wool puller. I can stand tall in the sun—if the need arises. But context is everything.’ As she passed the window she stopped and did a double take. ‘What’s that building over there?’
‘It’s a research institute.’
‘And what do they research?’
‘Psychiatric illnesses, neurological diseases…’
‘All very lunar…’
She continued walking and then drifted out of sight. I could sense her, standing behind my chair. It is difficult to express how unnerving this feels if you’re a psychotherapist. Your patient is always in front of you. With much difficulty, I resisted the urge to look over my shoulder. I could hear regular expulsions of air and guessed that she had started doing exercises. ‘It isn’t a question of denial,’ she said. ‘What would be the point of that?’
I addressed the vacant chair in front of me. ‘Denial?’
‘Well, yes.’
‘I’m sorry. What are you referring to, exactly? It isn’t a question of denying what?’
‘There’s the rub—surely. What indeed!’
‘With respect,’ I said, ‘could I ask you to sit down?’ I heard her sitting on the floor, at which point my resolve broke and I turned my head. ‘No—not there—I’d like you to sit in front of me, in the chair.’ She got up and obediently returned to her seat. I thanked her and added: ‘Perhaps you could stay where you are for the rest of the session? That would be very helpful.’
At first she looked puzzled, then she wagged her finger and said, ‘Ah yes, I see. Helpful.’ She gave me a smile which was obviously meant to communicate more than just goodwill. There was a hint of mischief in her expression. It was as though she had made a clever, witty remark and she was waiting for me to catch up.
At the end of the hour, I still hadn’t made any notes.
The following week Maddie arrived with Malcolm. He was a short, plump man in his early sixties. He had the ruddy complexion of a drinker, but his erect posture and nimble carriage suggested a vigorous constitution. His handshake was strong, energetic and prolonged.
I ushered them into the consulting room and when they were both seated, I invited Malcolm to explain why he thought the GP had made the referral. He raised his shoulders, expanded his chest and replied: ‘The issue, as I see it, and have seen it, past times and as of this instant, is one of compromise and fidelity to values. For where would we be without values? Lost, without direction, adrift on the wide ocean.’
His manner of speech was as peculiar as his wife’s. He continued talking but it was difficult to ascertain what, if anything, he was actually saying. After a while, I let the numerous clauses, sub-clauses and qualifications wash over me. Arresting phrases would suddenly become differentiated and sometimes it was difficult not to laugh. ‘A gimcrack philosopher on a one-trick pony’, ‘trembling like a vole beneath the counterpane’, ‘queer bedfellows in the household of a royalist’, ‘a gingerbread catchpenny of ill repute.’
At one point, I asked Malcolm a very simple question about whether or not he and Maddie were happy together. The reply that he gave followed a chain of loose associations and was of labyrinthine complexity. Eventually, he adopted a rather smug expression and concluded: ‘It was once our wont to frequent the Institut Français, but not any more—oh no. The place is heaving with the hoi polloi—the rank and file.’ His upper lip curled before he exclaimed: ‘Let them eat cake.’ Maddie looked at Malcolm, nodded, and her expression suggested admiration—even pride, perhaps?
I endeavoured once again to address the issue of the bruises. I tried to approach the topic sensitively, but neither of them seemed to be aware of what I was getting at. I became more explicit and Malcolm and Maddie glanced at each other as though they were sharing a private joke. They didn’t look embarrassed or uncomfortable.
Eventually, I had to be blunt. ‘Malcolm,’ I asked, ‘have you ever hit Maddie?’
He began to move the upper half of his body like a bird preening itself. Indignation and confusion were followed by a certain amount of bluster—and then some loud huffing and puffing preceded another torrent of words: ‘Maddie is a strong minded woman, as you’d expect, but a fine woman—a woman of mature understanding, a woman of refined taste and unqualified candour. There are altercations—of course there are—swords cross, sparks fly. But it’s all so much squally weather, the proverbial storm in a teacup. And what am I to do—I ask you—when I am bereft, crestfallen, outcast—like the dog—on the rooftop—who howls in the night?’
Maddie extended her hand, touched Malcolm’s knee, and then slowly withdrew it. The gesture, in spite of its brevity, was tender and affecting.
I saw Malcolm and Maddie for only two more sessions. Maddie returned for a final session—then failed to attend subsequent appointments. I was going to write a letter to the GP anyway, suggesting that they were unsuitable candidates for therapy. To help someone, you have to have a formulation, some idea of what the problem is and how you intend to deal with it. But I had nothing. Moreover, I wasn’t even sure that there had ever been an actual problem in the first place. Had Malcolm hit Maddie? I couldn’t get him to give me a straight answer no matter how hard I tried. And Maddie was just the same. The GP—on seeing Maddie’s bruises—and being disturbed by her oddity, may have overreacted. A consequence of this, perhaps, was that two eccentric (but compliant) people accepted a referral to a psychiatric hospital without question.
Were they personality disordered? They didn’t meet diagnostic criteria for any of the specific personality disorders in the DSM. More significantl
y, neither Malcolm nor Maddie complained of clinically significant distress. They did argue—and when they argued they both became upset—but not exceptionally so. Clearly, they were odd. And their inability to answer questions was bizarre. But they weren’t out of touch with reality; they simply engaged with reality and the social world in a different way than most.
The fascinating thing about Malcolm and Maddie was that they had found each other. Given their unique peculiarities, the likelihood of either of them finding a kindred spirit in the world must have been very low. Yet, somehow—consistent with the romantic ideal—love had found a way. I still wonder how it happened, how they met and what kind of courtship followed. One must suppose that they spent many happy hours ensconced in the Institut Français—before it was overrun by the hoi polloi—discussing gimcrack philosophers and gingerbread catchpennies.
We are all odd behind closed doors. I’m inclined to agree with Alfred Adler, who wisely observed: ‘The only normal people are the ones you don’t know very well.’
Chapter 12
Brain Cuts
Love dissected
The timetable said ‘Brain Cuts: Anatomy’. Accompanied by two other students, I went to the dissection room, where a professor with an East European accent welcomed us. By the window a plumber was examining the pipes. The professor lifted the brain from a plastic container and held it under a running tap. He squeezed the formalin out and positioned the gelatinous mass on a marble slab. We sat, like three hungry children, our chairs tilted forwards in eagerness. After pointing out the main surface features, the professor made a number of delicate incisions and gently pulled the hemispheres apart. I had heard the sound before in kitchens and restaurants—a succulent tearing. We considered the subcortical structures. Then, after producing a large carving knife, the professor sliced the brain from anterior to posterior, producing a spread of transverse sections. When he bowed his head, we looked at each other furtively and smiled. Each slice of brain revealed interesting patterns of grey and white matter. The cerebellum contained a particularly beautiful branched configuration called the tree of life. The plumber went out to get a screwdriver, but didn’t return.
