After two or three years, the couple with the club drifted out of touch; Berlin never heard from them again. He had only the weapon as a memento of the case that had stirred his fascination and started him on his career. At Hopkins, John Money became an early mentor. A decade earlier, Money had taken on the case of a baby boy whose penis had been seared off in a botched circumcision. The parents worried that he would never be able to live as a man, and Money, a pioneer in his work with hermaphrodites and a believer that gender and sexual orientation are determined through social learning in early childhood, persuaded the parents to raise the boy, Bruce, as a girl, Brenda. Bruce’s testicles were clipped, and a rudimentary vagina was constructed. Brenda took estrogen to help her grow breasts. Following his patient, Money wrote about her thriving as a girl, and the case was celebrated in Time magazine and in the New York Times.
He wrote, too, about paraphilias, cataloging and often coining the names of all the types, from acrotomophilia, “a paraphilia of the stigmatic/eligibilic type in which sexuoerotic arousal and facilitation or attainment of orgasm are responsive to and dependent upon a partner who is an amputee,” to zoophilia, the desire for an animal. The paraphilias were, in Money’s view, imprinted in childhood; they were the product of learning more than biology, nurture more than nature. Considering why sexual deviations are, so far as scientists know, mostly limited to the human species, he pointed to the sophistication of the human brain. Erotic “diversity,” he explained, “may be an inevitable evolutionary trade-off—the price paid for the freeing of the primate brain to develop its uniquely human genesis of syntactical speech and creative intelligence.”
Money’s thinking was defiantly humane. He spoke about men like Jacob, and about sexual sadists and necrophiliacs and pedophiles, as people living not merely with deviant lust but with “disorders of love.” He was willing to apply to paraphiliacs the typical connections between initial desire, falling in love, and long-term “pairbonding.” He might have argued that, condemned by his condition, a man like Michael Ross was searching not only for sex but for love, in his murderous way. He talked about the tenderness and love often felt by pedophiles for their victims; he insisted that these emotions had validity and could be returned. “If I were to see the case of a boy aged ten or eleven who’s intensely erotically attracted toward a man in his twenties or thirties, if the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way.”
Berlin was taken with the complexity and bravery of his mentor’s ideas, but he was more tempered in his thinking, and he never shared Money’s faith in the importance of nurture over nature. He felt, now, that time had proved him right. Brenda, with her surgically built semblance of a vagina, and with her drug-induced breasts, had, despite Money’s published reports, never taken on a girl’s psyche, though she’d been brought up as a girl by her parents and never told about the circumciser’s accident and psychologist’s experiment that had decided her gender. She had refused to have further surgery to construct more complete genitalia. She felt alien and violent and distraught, and at last, when she was fourteen, her father confessed all that had been done. Soon Brenda set out to become a man, to become what biology had made her. She underwent a double mastectomy. She had a penis and testicles created from grafts and plastic. She injected testosterone to give herself a man’s muscles. She named herself David. And eventually David killed himself.
Berlin talked about this failure, and another—with pedophiles. “Money was the first person to use medicines to lower testosterone. His theory back then, and I hope I’m doing justice to it, was that you give people a vacation from their sexuality and that gives psychotherapy time to work. Myself and some other researchers, with his permission, we took a look at the outcomes. And what we found was that as long as the people were still taking the medicine they were not reoffending, but a very high percentage who had the psychotherapy—once they stopped the medicine they did reoffend. We now don’t look at the medication as a treatment while you’re waiting for psychotherapy to work; it’s more like insulin for diabetes. This is what you need over the long haul to keep you in control of yourself.”
Thinking about the sources of particular desires—Michael Ross’s for the sadistic; Jacob’s for feet; the most prosaic erotic preferences of the most prosaic heterosexual—Berlin acknowledged the potential role of childhood experience but couldn’t much credit it. The connections seemed loose and unlikely ever to be conclusively demonstrated. He believed that the sources would eventually be found, primarily, in the realm of biology, that they would prove to be “programmed in,” as technology advanced to better illuminate the brain. He lamented the loss of free will that his prophesy seemed to imply, worried that such biological determinism supplanted the idea of mind as opposed to brain, feared an Orwellian world where neurological understanding would be precise enough so that the sexual regions of the brain could be manipulated to eliminate variations of desire or so that sexual anomalies could be detected in the womb and fetuses could be aborted accordingly—but the truth of biology’s inborn power seemed inescapable.
To Berlin, the only solution with someone like Jacob was to fight biology on its own terms, no matter how crude the weapon—to prescribe an anti-androgen and hope that, with lust obliterated, Jacob would find within himself at least a faint version of conventional longings. This had happened not only with the sadist who’d handed Berlin his club but, more recently, with another patient. Berlin’s gynecologist voyeur, who’d lost his practice and barely avoided prosecution before coming to Berlin for help, told me that on Lupron sheer lust was completely killed but that other yearnings—for pleasing a partner, for conforming to the society’s notion that a married couple should be having sex—continued to motivate. “The skin on skin,” he added. “The feelings of being close to someone. And the orgasm still feels good. Though you’re not fired up by the primitive side of your brain. So sex can seem a very messy thing, like more trouble than it’s worth, like why bother.” He mentioned that he used Viagra, which Berlin prescribed for some of his patients on anti-androgens, patients who’d gotten control of relatively harmless paraphilias, so that, devoid of the urgency of lust, they might be able to become erect and carry out their more tender longings. He mentioned, too, that his penis had shrunken slightly since he’d started taking Lupron. Then he laughed: “I wonder what would happen if all men went on it for six months. Think about the advertising industry. All those commercials aimed at the primitive sexual urge. They’d have to find a new way to sell SUVs and beer.”
Berlin, thinking about the experience of men like the gynecologist, told me: “I guess the distinction I’d make would be between eating to satisfy an intense hunger versus eating to enjoy the taste of food. These guys, on the Lupron, are not responding to a hunger to have sex, but sex can still feel good; they can still enjoy that taste.”
He couldn’t know whether Jacob, on Lupron, would feel any wish at all for sex, any inclination to eat for taste, with hunger gone. But he felt compelled to prescribe the drug. He felt certain that he should wipe out the hunger, though Jacob had harmed no one.
ONE evening, several years after meeting Berlin and starting Lupron, Jacob led a support group for the bipolar and the depressed. He’d founded the group himself, with the help of his city’s mental health association, and he’d since become president of the association’s board. Tonight, with the March snowbanks high, he laid out pizzas and cookies and pamphlets on a Formica table. He always left home early for the twice-monthly group meetings, allowing enough time to buy food and get everything neatly set up before the members arrived. The thirty or so pamphlets, along with booklets and flyers, explained an array of emotional disorders and their possible remedies, from aromatherapy to treatment with electroshock. In the few years since he’d started the group, Jacob had never missed a meeting. In the worst blizzards, he’d dug out his car and made it to the office building that had donated a ba
sement conference room to his cause. Shoveling out his driveway, he was pushed on by the worry that a lone member would be waiting in the snowy parking lot, despondent, abandoned.
Four long beige tables were arranged in a square, and tonight all of the twenty-five chairs were taken. “We have a fairly large group this evening,” Jacob said, beginning efficiently within a few minutes of the scheduled time, “so we’re going to have to stay on track.” The members introduced themselves, going around the square, and so did two visitors, psychology majors from a nearby college. Then a woman spoke of skipping her pills and becoming delusional and seeing knives that tried to coax her to cut herself to shreds. “I wasn’t like this four years ago till I had the car accident,” she said. “People at work say, ‘Can’t you just snap out of it?’”
“People just can’t understand it,” Jacob affirmed quietly, soothingly.
Another woman wondered aloud about electroshock, first for the woman seeing knives, then for herself. Jacob confided to everyone that he’d had the therapy. “It’s not what it was. It’s not the barbaric treatment you see in One Flew Over the Cuckoo’s Nest or A Beautiful Mind.”
Verging on catatonic, with matted blond hair, a college-age girl complained about the group sessions her therapist had told her to attend at a state facility “with people less fortunate than me.” It was clear that she couldn’t bear to sit with patients she saw as more lost than herself. “I just want to skip past this phase and be normal,” she said, her voice a hollow monotone. “Do I need to go?”
“Yes,” Jacob answered. “Yes, yes you do. It’s important to get out of the house. It’s important not to isolate.” He took off his watch and set it in front of him, mindful of the time so that everyone who wished would have the chance to speak.
“Today is my birthday,” a man who was attending for the first time shared. “And this group is my treat to myself. I am in some pain, I am in some pain.”
“Happy birthday,” Jacob said softly, when the man had finished explaining the harrowing emotional journey that had led him here.
“Happy birthday,” the group echoed, welcoming him.
A bipolar man said that his medication was running low, that there were problems with his insurance. A woman offered some of her pills. “No,” Jacob cautioned. “See me after. I’ll point you in the right direction. We can get that problem addressed.”
Someone asked about the Vagus Nerve Stimulator, and Jacob explained how it worked. The battery-powered generator was implanted in the chest; electrodes were threaded to the neck, to where the vagus nerve ran up into the brain stem; the pulsations of current seemed to temper depression.
“I’ve joined a writing group,” a young woman announced. “I’m working on three novels, and I’ve got some short stories.” She allowed that she didn’t fully trust her current optimism, that she wondered if she was entering a manic phase.
“Manic!” people called out, laughing knowingly. “Manic!”
“The first time I became manic,” a partially toothless black woman joined in, “this was a good ways back, I was hitchhiking down the main drag in Houston dressed—how do you call it?—voluptuous, on my way to a lip-synching contest, thinking that’s how I can make some money. And the police picked me up for a hooker. So there I was in the clink, saying, ‘I’m not a hooker, I’m a lip-syncher.’”
“Well, there’s your novel,” a man said.
Everyone howled.
“It’s just nice to be around people who get it,” a woman said.
“Happy birthday,” the newcomer mouthed, wishing it to himself, welcoming himself.
JACOB had created this twice-monthly world, and he conducted it as though his own agony was in the past. No one in the group knew that he was so tortured by his sexuality that he chose to eliminate it. No one knew that the electroshock he’d described, which he’d had both before and since Berlin, was an attempt to get free of a keen and relentless depression with sex enmeshed at its source.
Berlin had been right in at least one way. Lupron’s attack on testosterone, on this single hormone, had been an attack on his thoughts. It wasn’t only that physical arousal seemed to fade from possibility. The fantasies evanesced as well, along with the constant awareness of feet, the constant susceptibility to desire. A profound shift in consciousness occurred, as though the mind had emptied itself of eros.
Yet the emptying wasn’t quite complete. Eros lingered and lurked, allowing him hours of numb tranquility and then edging forward to seize him with a yearning that was no less painful for being slightly abstract. A commercial on TV contained a scene of barefoot teenagers. A young saleswoman asked to measure his son’s feet when Jacob took him to buy ski boots. At such moments his longing was perhaps even greater than it had once been, because the possibility of release was remote. He wasn’t going to masturbate at the first opportunity, as he would have in the past. He wasn’t going to explode without touch. He no longer grew hard easily, and he wouldn’t permit himself to work himself up. He forbade himself to masturbate. Seeing the barefoot teenagers on TV, he slammed his fist down onto his coffee table.
Sex with his wife was gone entirely. He didn’t know what she understood about the desire he drugged into submission. He’d always evaded candor, and Berlin, at their first long meeting, had advised that he keep things vague. She seemed to collude in his omissions.
He had tried Viagra in high doses. It didn’t help. Jacob thought that if he focused on his wife’s feet, if he gazed at them and caressed and clutched them, he would generate enough craving to overcome the Lupron and grow hard, especially if he added Viagra. But he wanted nothing to do with these grotesque pleasures, and the Lupron diminished his drive sufficiently so that he could succeed in self-denial. He didn’t gaze, didn’t caress. Her feet remained under the covers when they attempted to make love. He stayed soft. They stopped trying.
It was Greg Lehne and another of Berlin’s colleagues, Kate Thomas, who told me that people like Jacob are not merely cursed, that they possess a special capacity for ecstasy. “There’s no comparison between what they experience and normal sexuality,” Lehne said. “It’s a hyper-positive sexual experience.” And Thomas added, “I don’t think we, in our sex lives, have a hint of what they feel.” One explanation, in Jacob’s case, was that in his second-grade classroom his anxiety about being called on reached the level of full-blown panic attacks—as he’d aimed his eyes downward, his fear was reconfigured as sexual arousal that was equally extreme. But Lehne stressed that this was only theory; the reasons, in all cases, remained mysterious.
With a paraphilia that was harmless, Lehne and Thomas felt that their primary role was to listen; their hope for the patient was self-acceptance. Cure—in the form of the transformation of desire—might never be possible, but a measure of peace could be reached. To treat someone like Jacob meant trying to lift the shame and to incorporate the focus of desire into the marriage.
Why couldn’t his wife’s feet be shown and gazed upon, flaunted and craved, offered and touched? Why couldn’t these gestures and responses sometimes be part of foreplay and other times lead to the pairing of her feet and to his penetrating between them? Weren’t analogous things done with breasts and buttocks? Weren’t they put on display in all manner of clothes and swimsuits and lingerie, to be stared at and reached for? Why couldn’t feet be objectified and included in the erotic life—and in the love live—of a couple, just as the common secondary sexual characteristics were incorporated between so many men and women?
“‘I’ve got three shit dates lined up in one weekend.’” Winston Wilde, a psychologist in Los Angeles, told me that a patient, a coprophiliac, had just spoken these words to him. Wilde didn’t disparage his patient’s wish to be smeared with or eat a partner’s feces. He quoted the man in a celebratory, even exultant tone, as an emblem of therapeutic success. “A big aspect of sex therapy is permission-giving,” he said. “It’s important to give an education. Sometimes people’s whole lives can c
hange if you direct them to an Internet site. I always like to normalize their situation.”
Berlin didn’t talk much in terms of “permission-giving.” It was hard to imagine him advertising a patient’s “shit dates” as evidence of successful therapy. He did hope that one day he would be able to help Jacob and his wife toward erotic intimacy, but the eros he envisioned seemed to have nothing to do with feet. For all the compassion in his thinking, Berlin seemed no more willing to accept Jacob’s desire than Jacob was himself. When I asked him, at one point, about the possibility of encouraging Jacob and his wife to include her feet as a spark to intimacy, he didn’t really answer the question, and when I pressed, he said, “I think Jacob is somewhat content not having sex at all and doesn’t necessarily feel deprived.”
I’d heard nothing like this from Jacob. I’d heard him describe slamming his fist onto his coffee table. I’d heard him tell about trying to go off Lupron against Berlin’s advice. He’d stopped the medication for a short period, but self-revulsion over his desire had chased him back onto the drug. Knowing about this attempt, Berlin nevertheless suggested that Jacob didn’t mind living without sex. It sometimes seemed he was driven, consciously or not, to medicate aberrant lust out of Jacob’s life.
Then Jacob decided to try once more to go without the injections. He pushed the experiment to a year, but still couldn’t bring himself to open up to his wife about his longing. “Because it’s not normal! Because it’s not right! Because I love her!” he answered when I asked, again, why. He would not taint her with his perversity, include her in his monstrosity; instead, he mortified himself all the more with a series of prostitutes until he crawled back to Berlin and the Lupron.
The Other Side of Desire: Four Journeys into the Far Realms of Lust and Longing Page 4