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VOLUME 4, ISSUE 1 PSYCHNEWS INTERNATIONAL March 1999
-- AN ONLINE PUBLICATION --
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SECTION D: PSYCHNEWS SERIES 1999
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Note: This section starts a 99 series of articles by
Fred Cutter. Please send comments to the PsychNews
Int'l mailbox:
psychnews@psychologie.de
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INTRODUCTION TO "ONE-TRIAL LEARNING"
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 VAŒs 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
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SEXUAL FUNCTION, DYSFUNCTION, & DEVIATION
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.
POSSIBLE SOLUTIONS
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.
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