Sunday, May 17, 2009
Boston Globe: Masters and Johnson and Sex and Love - The New Debate
The new romantics
Should we get the doctor out of the bedroom?
By Drake Bennett, Globe Staff | May 17, 2009
A half-century ago, the researchers William Masters and Virginia Johnson brought sex into the laboratory. For thousands of years, sex had been the object of philosophical inquiry and religious stricture, occupying everyone from shamans to psychoanalysts, and giving the world an oceanic supply of marital and extramarital strife. But it hadn't really been studied, not in the clinical, moment-by-moment manner that Masters proposed.
The problem, believed Masters, a stern ob-gyn at Washington University in St. Louis, was that you couldn't study sex solely by asking people about it, because they were so often unaware of - or dishonest about - what was going on in their own bodies. Along with Johnson, an assistant who soon rose to the rank of co-researcher, Masters brought people, singly and in pairs, into examining rooms and observed them closely with the tools and technologies of modern medicine as they passed into and out of sexual arousal.
As recounted in Masters of Sex, a new biography of the pair by Thomas Maier (Basic Books), Masters' and Johnson's approach - and their willingness to risk social and professional stigma by doing such work - gave the world its first frank, authoritative portrait of human sexual behavior. Masters and Johnson made the medical investigation of sex legitimate, and inspired a generation of researchers. They helped clear away much of the shame and myth that had perpetuated a communal ignorance about human sexuality.
But in the age of Viagra, a few sex therapists and sex researchers are now arguing that this legacy has gone too far. The model of sex research that Masters and Johnson pioneered, with its focus on physiology and the language of function and dysfunction, has led inexorably, these critics argue, to a mindset where sexual functions are seen as simply physical ones, with cures that are pills or creams or gels or patches. As this view has become mainstream, they argue, it has reduced a complex cloud of desires and preferences to questions of blood flow and hormone levels, and has created a world where we feel deficient when our own desires don't match up with the norm. At its worst, they warn, it is pushing us into a sort of sexual arms race as people engage in sex acts that hold little interest for them, partake of a growing pharmacopeia of sex drugs, even get formerly unheard-of cosmetic surgeries to measure up to a fictional sexual ideal.
"It's misleading, it leads people to have inappropriate expectations and to make inappropriate choices," says Leonore Tiefer, a therapist and an associate professor of clinical psychiatry at New York University. "When things don't go right I think it's a mistake to rush off to the doctor and say, 'Gee, I'm not happy with my sex life.' It makes as much sense as going to a policeman to ask how to scramble eggs."
Tiefer is the most vocal of a loose coalition of sex therapists and researchers who, in books and at conferences and with their own sex therapy clients, are pushing for a more "humanistic" model of sex. They want sexuality to be seen through the lens of preference, not function and dysfunction, and sexual problems to be understood less as physiological breakdowns than reflections of the dynamics of the relationships in which they occur. Tiefer has dubbed it the "New View" campaign. What worries its members more than anything else is the race to develop a female sexual dysfunction drug, a so-called "pink Viagra." If a successful one makes it to market, these critics worry, perfectly healthy women will be medicating themselves to approximate a false norm. And damaged relationships in which deep emotional issues trigger sexual problems will be that much more likely to break apart, or to limp along with the root problems unaddressed.
But while plenty of sex researchers share these concerns about the "medicalization" of sex, at least to some degree, many caution that we shouldn't throw Masters & Johnson overboard just yet. Many people - starting with the earliest clients of Masters' and Johnsons' own sex therapy clinics - will testify that the medical approach has made their lives much happier by turning sex into something that can be discussed frankly in the doctor's office. For its critics, the question is whether that approach has begun to create as many dysfunctions as it cures.
Compared with the mid-century world of Masters and Johnson, ours is awash in sex.
To the list of usual suspects blamed or credited for this - Elvis, Helen Gurley Brown, the birth-control pill, the Internet - one might add Viagra, which in recent years has had an outsized role in shaping how we think and talk about sex, love, and the relationship between the two. The drug, first released 11 years ago, has not only helped millions of men revive sex lives diminished by age or disease, it has also made sexual dysfunction a topic of public discussion, with Bob Dole endorsing the drug and with commercials coyly broaching the topic of erectile dysfunction to prime-time television audiences.
But to New View critics, the benefits of Viagra and similar pills have to be balanced against the fact that they have made our sex lives seem like something that can - and should - be fixed with a drug. The use of erectile dysfunction drugs has spread far beyond their narrow original indication to become a gray-market "quick fix" for men who have nothing wrong with them aside from mild anxiety about their sexual performance, or who want to amp up their performance to abnormal levels. Anyone with an Internet connection is familiar with the unending bombardment of spam playing off just those desires and worries.
Eager to replicate the outsized profits that erectile dysfunction drugs have brought, several pharmaceutical firms are in hot pursuit of a women's version. Because female sexual desire is far less straightforward than men's, success has been thus far elusive, but there are several candidates in the pipeline. Whether any of them will work well enough - and without significant adverse health effects - to gain FDA approval remains to be seen. (In Europe, a testosterone patch to boost sex drive in post-menopausal women has been approved, but its efficacy is debated.)
For critics, the problem is not whether a women's Viagra will work, but what happens if it does. They argue that the very concept of "female sexual dysfunction," the condition that such drugs would be targeting, is not an actual medical condition so much as a creation of the pharmaceutical industry. While surveys show that 20 to 40 percent of women describe themselves as having a lack of interest in sex (the higher figures tend to come from studies funded by pharmaceutical companies), only about a quarter of those women describe that as a problem. It's hard to call something a disorder or a dysfunction, some sex researchers argue, if the people who experience it don't tend to see it that way.
"The problem is that we don't have any real base rate of what normal desire is for a woman, so it's incredibly open to interpretation," says Marta Meana, a professor of psychology at UNLV who studies female sexual health.
As a result, Tiefer and others fear, women will feel pressure - perhaps from their husbands, perhaps just because they feel stigmatized in their low-wattage desire - to boost their sex drive through drugs, and to risk whatever side effects come with them.
A more fundamental problem, though, is that turning to a pill or some other medication leaves unaddressed larger issues in people's lives - anything from household resentments to a deeper lack of trust in a partner - that might be manifesting themselves in the bedroom.
Mainstream models of sexual disorders, argues Tiefer, simply ignore the ways those dynamics can work their way into sex. "There's nothing in [those models] about romance or power dynamics or taking out the garbage," she says.
This focus on the physiological, others suggest, also means certain kinds of potentially useful sex research just don't get done. Amy Allina, program director at National Women's Health Network, points out that little is known about how a couple's sex life is altered by a major personal crisis. "We don't really know - and this is a timely one - how unemployment affects a couple's sex life," she says.
Among the researchers working on the puzzle of human sexuality, there are many who, unsurprisingly, object to the characterization of the field as dominated by crude materialists focused only on the body and in thrall to the pharmaceutical industry.
"With respect to sex research as a whole, I don't think that's a fair characterization. There are quite a lot of people who do not believe that physiology trumps psychology," says Meredith Chivers, a female sexuality specialist and assistant professor of psychology at Queen's University in Ontario.
There's strong resistance, as well, to the idea that we'd do better by setting aside questions of bodily function so we can focus more completely on the dynamics of relationships. "Sex does have a physiological component, and the more we know about the physiology the better," says J. Michael Bailey, a psychology professor at Northwestern University who studies sexual orientation and arousal. And to be sure, medical solutions can bring their own emotional benefits, as for couples where the desire survives but some physiological obstacle - erectile dysfunction, or pain during sex - stands in the way of a full sex life.
But even the scientifically minded will often acknowledge that parts of the New View critique have it right: when we treat sex as simply another metabolic process, we're turning a matter of personal taste into a medical norm, and making it easier to ignore the ways that sex can be a barometer of other, deeper difficulties in a relationship. At a time when the number of options for sex treatment and enhancement is growing fast - not only pills and patches, but physical therapy for the pelvic floor and procedures like vaginal cosmetic surgery - it's an important conversation for society to have.
These are concerns that, despite the nature of their research, even Masters and Johnson shared. Johnson in particular, according to their biographer Maier, was careful both in presenting their research and in applying it in therapy to emphasize the emotional backdrop of sex. Johnson, who carried on an affair with Masters for years before he left his wife to marry her - later on he would divorce her for a childhood sweetheart - was well aware, Maier says, that people "can become walking encyclopedias about sexual information, but can remain woefully ignorant of the needs of their partner."
Drake Bennett is the staff writer for Ideas. E-mail firstname.lastname@example.org.
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