-- AN  ONLINE  PUBLICATION --


Note: This section starts a 99 series of articles by 
      Fred Cutter. Please send comments to the PsychNews 
      Int'l mailbox:


One-trial learning is an effort to explain some human 
behaviors like patterns of sex choice, substance use, 
self injury. It also can serve as a model to explain post-
traumatic stress disorders, wife beating, tics, phobias 
and other learned or compulsive patterns. In this series 
I will act as editor in selecting which topic to present.

I will start with my own essays and welcome others to 
submit their thoughts, experiences, data, and of course 
new topics.

My career in psychology started with sexual deviations 
at Atascadero State Hospital, moved to heroin 
addicts at the California Rehabilitation Center, 
and then to the VAs unit for unpredicted death 
at Wadsworth VA Medical Center. All in California.
These clinical experiences led to the three major themes 
of my professional life; sex, drugs, and suicide. 
I wrote three books "coming to terms with death", 
art and the wish to die, the suicide prevention triangle. 
I noticed that the established mental health professionals 
were largely disinterested. It was only the new or the 
traumatized professional that expressed interest in the 
books, and my APA workshops. The situation changed when 
I was able to write a software program in basic that 
sorted out the various risk factors to yield an estimate 
of who needed mental health services most to reduce the 
probabilities of self injury  behavior. This too fell to 
the same professional fate.  

These prior efforts were put together in a website
WWW.SuicidePreventTriangle.Org "where people thinking about 
suicide" can find anything they wish to know. My audience 
is the general public, which includes people at risk.  
In the spirit of "surfing the web", the page includes 
"suicide in the recent news, a survey of "user" suicide 
history, links to other helpful web pages, a guest 
book for comments, etc.  It represents  a "home" for 
my books, programs, and other professional efforts. 
Thanks to Yahoo there are 50 to 100 visitors per day 
perusing this  information. In that spirit, this section 
will offer three essays on, sex, drugs, & suicide. These 
are based on my clinical experience, buttressed by my 
research and the relevant psychological literature in 
the period of writing.  

The reader is invited to comment, supplement, or 
qualify my rules of thumb. I will collect these and 
publish them in subsequent issues as addenda. 

Fred Cutter,Ph.D. Licensed Psychologist  CA psy193 
San Luis Obispo CA 93401

               Fred Cutter, Ph.D.

   All sex functions have a history of one-trial learning 
where the first sexual contact (usually in childhood)
is imprinted with fear, pleasure, or mixtures of both. 
Subsequent repetitions are reinforced by the pleasure
of arousal and orgasm, or the release from intense anxiety 
whether or not it is enhanced by sexual climax. 

A. Sex functions usually allow the full range of sexual 
   arousal, performance and orgasm within the physical 
   limitations of the individuals and the mutual consent 
   of the couple. 

B. Sexual dysfunction include erectile difficulties in men, 
   and anorgasmia in women, whose medical histories document 
   sufficient health, but expected performance is disappointing. 

C. Sexual deviations (exhibitionism, pedophilia, fetishism, 
   rape, etc) are more compulsive disorders with less responsiveness 
   to any known psychotherapy or medication specifics. Incest is 
   includable with the above, but has additional characteristics 
   worthy of note. 


A. Normal sexual functions: When dissatisfactions occur, one or 
   both partners are said to have a sexual dysfunction. 

B. Sexual dysfunction: Sex therapy today uses a Masters 
   and Johnson type reconditioning of behaviors associated with 
   orgasm, and allows attitudes towards sexual activities to change. 
   Prerequisite to starting a couple accepts a ban on orgasms 
   during the period of therapy. This is needed to give both
   partners a non demand environment in which to seek improvement 
   of their dysfunctions. Sex therapy includes assigned homework 
   which often stimulates recollections, and debriefing of first
   sexual events. Such reviews help to change attitudes, which 
   allows more satisfying sexual performance in the areas of 
   dysfunction. As improvements are experienced couples will 
   often elect to stop therapy when they are comfortable with 
   their personal and joint sexuality, 

   Specific medications for erectile dysfunction can play a role, 
   but are usually subordinate to attitude changes. Some couples 
   will abort sex therapy at the prospect of medication options, 
   such as the recent availability of Viagra. The psychological 
   risk of continuing sexual dysfunction, is very real, but no 
   harm in trying since the motivation for sex therapy is 
   distracted by the prospect of an easy fix. 

   Female specifics are minimal. There are suggestions that Viagra 
   may help. Antidepressants often contribute something to women 
   with anorgasmia, since a case can be made for "masked depression"; 
   i.e. the usual depressive symptoms are absent, and the distress 
   is masked from visible expression by displacement to sexual 
   dysfunction. The same may be true for eating disorders or other 
   behavior patterns, e.g pms. 

C. Sexual deviation: People who seek orgasms through deviant 
   sources share the history of one-trial learning in the origin 
   of their desire for gratification from the unusual. Pedophilia 
   is the most common of all. Girl molesting occurs twice as often 
   as boy molesting, assuming male perpetrators. Female perpetrators 
   do not present very often. Child molesting for same sex partners 
   is likely to lead to adult homosexuality. However, not all 
   molested boys nor girls grow up to be gay. Those child victims 
   that become heterosexual adults, have detectable attitudes in 
   their sexual activities (counterphobias, Don Juan or womanizing 
   for men; arousal failures, and anorgasmia for women).
   Opposite sex boy or girl molesting victims are also at risk for 
   changes in their attitudes towards adult sexual activities as 
   suggested above. 

   Early and mutual sex play among same age children is included in 
   the one-trial learning ideas, but do not take on negative adult 
   attitudes unless parents detect and over react in how they define 
   the behavior. 

    Psychological care for all of these conditions is less 
    effective than usual because the emotion that should be 
    associated with deviant behavior is not experienced by the 
    client. The deviant behavior is said to be ego syntonic 
    rather than alienated or distressing. 

    Sometimes with the pressure of family, or police, sexually 
    deviant perpetrators get anxious enough to be reachable, but 
    the therapeutic window of opportunity tends to be of very 
    short duration. 

    Psychotropics are not reported as helpful medications for sexually 
    deviant people. 

    Incest behavior is a special case of deviant sexuality. It is 
    mentioned separately because it perverts a current parental 
    relation into that of a lover between a father and an underage 
    daughter; or also, but less often a mother and a son. Families 
    where this occurs are more disorganized, meaning closer to 
    nonfunctionality, divorce, or frank psychotic disorders in 
    at least one member. Sibling sexuality is includable here 
    and associated with the same kinds of family breakdowns. 

    Psychological care for incest is also quite limited, unless 
    anxiety or distress can be induced by the social or legal 
    consequences. When these strong feelings of distress are 
    resolved, removed, or denied; usually before the achievement 
    of stated goals, the client stops psychotherapy. There are no 
    known specific Psychotropics that can be applied to the 
    perpetrator of incest.