Wednesday, August 20, 2014

Etiology and Other Aspects of Sexual Sadism Disorder

Sexual sadism disorder as defined by the current version of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) is a paraphilic disorder that involves one individual inflicting physical or psychological acts of violence on another non-consenting person, while receiving sexual gratification from the suffering of the victim (APA, 2013).  It has been 20 years since consensual sadomasochistic behavior left its old place among mental disorders. As society progressed towards more liberal views, policy-makers finally realized that the harm comes when there is an evidence of it, i.e. when a person experiences distress or deals damage on someone who never consigned himself to such treatment. On the other hand, if a person is agreeable with sadomasochistic behavior and doesn’t harm others by it, that should not be considered pathological. Although sadistic behaviors are certainly a part of the continuum and exist in everyone to some degree, such as the phenomenon of “cute aggression” may attest (Arnold, 2013) or findings by Buckels, Jones, and Paulhus (2013) that confirmed existence of everyday sadism, we have to recognize malevolent or clinical forms of sexual sadism. Thus, the population of primary focus of this paper is that of offenders and extreme sadists. The DSM-5 states that up to 75% of sexually motivated homicides were committed by sexual sadists (APA, 2013). It follows that the extreme (clinical) form of sexual sadism, found mostly in criminals is of particular interest for forensic and investigative psychology. Studying sexual sadism disorder may potentially have influence in practical world, such as helping police to construct a profile of sexual offender. When studying sadism, among other things, researchers must consider the etiology. When does it become dangerous? Why would some be predisposed to such behavior? The answers to these and other questions will be necessary for prevention, treatment of sexual sadism disorder and, ultimately, for the better understanding of the human nature.

First coined by Austro-German psychiatrist Richard von Krafft-Ebing in 1899, term sadism is derived from the name of 18th century French aristocrat Marquis de Sade, who practiced and described sadism in the novels he wrote. It doesn’t mean, however, that violent sexual practiced didn’t exist before de Sade. In fact, there is evidence in the depiction of both humans and satyrs on historical artifacts in the form of vase paintings from Ancient Greece that Greeks certainly fantasized about what we call these days BDSM (an acronym for  bondage, discipline, sadism and masochism)(Jones, 2010), a set of sexual practices, which include consensual or nonclinical sadism. Other evidence comes from the accounts of eminent historical figures, such as Chinese and Roman emperors, Qin Shi Huang (260 - 210 BC) and Caligula (12 - 41 AD), who were known for their cruelty and sexual orgies. It is a pity, that certain records never survived to modern days to give us complete understanding of changes that underwent in human sexual behavior over the decades.

(Depiction of de Sade by  H. Biberstein)

There are other sources of information about human behavior. Nature often provides analogies of human behaviors in animals and one might question if sadism can be found among those behaviors. However, research of sadism in animals is virtually non-existent. There is research on other violent behaviors related to sex, such as resisted mating (or rape) in ducks and orangutans, which is usually found to have some evolutionary purpose (Crawford & Galdikas, 1986), unlike human extreme sadistic behavior, which is not necessary aiding the survival or reproductive capabilities of the individual, but rather does the reverse. Feelings and emotions experienced by animals constitute a part of an ambiguous and highly controversial area of study. Very few facts about it can be stated with certainty. Human sadists, on the other hand, torment others in order to gain some form of pleasure for themselves, which brings us into discussion of other symptoms of sexual sadism disorder.                                                                                 (Head of Emperor Caligula)

The definition of sexual sadism disorder depends largely on its symptomology. One characteristic common to all paraphilias is an increased sexual drive with some individuals masturbating as many as ten per day (Butcher, Hooley & Mineka, 2014). It is not quite a symptom, but it also appears that most paraphilias, including sexual sadism disorder occur almost exclusively in males. In his essays, Freud attributed the occurrence of sadism in men to the fact that male sexuality always contained a component of aggression (Strachey & Freud, 2000). Moreover, in some cases killing his victim would facilitate an orgasm in a sexual sadist (Stone, 2010), which exemplifies the extreme of male sexual aggression. Current version of the DSM (unlike older versions) specifically states that for sadism to be considered a mental disorder it must be enacted on a non-consenting person or the fantasies associated with sadism must bring severe distress or impairment in functioning (APA, 2013). There are other general characteristics shared by sexual sadism with all paraphilias such as, generally speaking, sexual gratification through the means that are directed either towards inanimate object or an abstract feeling (such as pain of others in sadism). In other words, libido is misdirected in some way or another, but how and why it is so misdirected, is the issue of etiology.

One the most fascinating and important questions we can ask about sexual sadism concerns the etiology or the cause of it. What is the reason for such behavior? What drives an individual to inflict suffering on a non-consenting person? Just like phenomenon of cute aggression, sadism may be the extension of our experience of one another (Arnold, 2013). Martens (2011) says that sadistic behavior is a manifestation of the desire of the sadist to establish deep emotional communication with the victim. So, is it the lack of interpersonal communication that drives people to commit extreme acts of sexual violence? Martens (2011) argues that sadism is not an isolated phenomenon and does not involve a single emotion, but involves many other different needs and factors, while loneliness is just one of them. Indeed, Mokros, Weiss, Schilling, Nitschke, and Eher (2014) found evidence for dimensionality of sadism, suggesting that it is not separated into distinct categories but is part of the continuum. The fact that everyday sadism is not as rare as one may think supports this idea (Buckels et al., 2013). If regular people, who have no sadistic fantasies can, nevertheless, experience pleasure from inflicting suffering on others, means that extreme sexual sadism is not a separate category, but an escalated and multiplied severity of symptoms, present in each of us to a much smaller extent. This universality leads us to explore some psychodynamic factors.

The researchers, like Berner (1997), for instance, theorize that traumatic childhood experiences, which involved physical or psychological pain, witnessing traumatic events (later eroticized or reenacted) and having a cold parent lays at the core of sexual sadism. These longitudinal and psychodynamic elements describe the factors that influenced person’s overall development, not just what drives him at a particular moment, such as, for instance, the desire for communication (Martens, 2010). Freud related sadism and masochism to the manifestations of universal characteristics of sexual life, such as activity and passivity, respectively (Strachey & Freud, 2000). Again, concepts of passivity and activity lay on the continuum and describe universal aspects of sexual behavior. A number of studies found that childhood abuse may serve as a predictor of sexual sadism (Fedoroff, 2008; Nordling & Sandnabba, 2000). Nordling and Sandnabba (2000), for instance, found a small but statistically significant portion of higher childhood sexual abuse in the group of people sampled from two BDSM clubs (i.e. subclinical sadomasochist population). Another study found that isolation in childhood can serve as a predictor of development of sadistic tendencies (Hill, Habermann, Berner, & Briken, 2006), which is true even for women (in terms of both early neglect and abuse) (Southern, 2002). This finding provides some support for Berner’s theory of early traumatic experiences (1997).

There are some, who attribute sexual sadism to a single main factor, such as aggression (Proulx, Blais, & Beauregard, 2006) or coercion (Mokros et al., 2014), but just as objects of tantalizing lust in fetishism are different (bras, shoes, etc.), so are the main themes for each individual sexual sadist may be idiosyncratic as well. The study by Harris, Lalumière, Seto, Rice, and Chaplin (2012) that measured erectile responses of rapists versus non-rapists to the cues of violence and coercion (non-consent) shows that there is no significant difference between responses to those cues. Mokros et al. (2014) found that items of their scale that pertained to sexual violence and sexual coercion, in fact, constitute a single factor. These findings suggest that attributing sexual arousal in sadism to a single factor would be fallacious.  

Aside from theoretical etiologies of sexual sadism disorder, there are various biological factors that may be relevant. It was found, for instance, that EEG of sexual sadists differs from non-sadists by significant desynchronization of EEG rhythms and abnormalities in temporal lobes (Aggrawal, 2008; Stein, 2000; Young, Justice, and Edberg, 2010). Langevin et al. (1988) found significant association between sadism and right temporal horn damage. Although there is no association between brain structure and sexual sadism of single importance, further research in the area may be helpful to establish causal relationship between brain or endocrine abnormalities and sexual sadism disorder. 

There is an uncertainty in defining and diagnosing sexual sadism disorder. Aggrawal (2008) stated that it is very hard to prove that inflicting pain is what actually brings sexual gratification to the patient in question. Self-report has never been esteemed as a reliable measure. When research is conducted on subclinical  (or general) population, there is a chance that people will not report the full extent of their sexual fantasies and, therefore, the rates of sexual sadism will be lower than they really are (Nitschke, Mokros, Osterheider, & Marshall, 2013). There is a chance that offenders may commit sexual crime along with robbery not because they are actual sexual sadists, but because there was an opportunity to commit violent sexual act. Some researchers advocate the decrease in reliance on self-reporting measures when making the diagnosis; instead, they suggest diagnosing based on actions revealed through examination of the crime scene and exact biographical details, both of which are evident and known for certain (Mokros et al., 2014). 
Several scales were developed as a diagnostic aid for identifying sexual sadism disorder. The Severe Sexual Sadism Scale seems to be gaining most of the reverence from the psychological community. It consists of 11 dichotomous (yes or no) questions, which bear relation to forensics.  Nitschke, Osterheider, and Mokros (2009), found it to have a high reliability (rtt = .93), while others found it to have good validity and reliability (rtt = .86), (Mokros, Schilling, Eher, & Nitschke, 2012). Introduction of this scale into regular use will improve diagnostic accuracy of sexual sadism disorder. As a result, less people will be needlessly civilly committed due to misdiagnosis as a part of the doctrine established in Kansas v. Hendricks (1997). 

In that case, Leroy Hendricks was diagnosed with pedophilia. Under the Kansas's Sexually Violent Predator Act, any individual who has “mental abnormality” or “personality disorder” and, therefore, poses threat via his uncontrollable predatory sexual behavior, can be involuntarily civilly committed (Kansas v. Hendricks, 1997). Although committing someone after he served his prison sentence may appear unconstitutional due to the double jeopardy (convicting twice for the same crime), Kansas v. Hendricks (1997) was decided in favor of such civil commitment. It became an avenue to commit some misdiagnosed (or overdiagnosed) individuals. 

The DSM states the onset of the sexual sadism to be around nineteen years old, while sexual sadism by itself to be a lifelong feature (APA, 2013). Interestingly, in the interview with Stone Philips, serial killer Jeffrey Dahmer states that the less he was able 
           (Leroy Hendricks)
to share his thoughts with his family (especially father, who was generally unresponsive and inattentive to his son’s needs), the worse became his perverted fantasies (Phillips, 1994). The DSM states that preoccupation with sadism-themed pornography is one of the factors associated with sexual sadism disorder (APA, 2013), which, in terms of the course of the disorder may serve as a sign of its early development. Increasing age will likely be related to subsiding symptoms. It is likely that a lot of severe sexual sadists will be imprisoned for sexual offence later in life. Thus, it is unclear, whether sadism actually decreases or it is only absence of the opportunity that prevents researchers from seeing what is really happening.

Sexual sadism disorder is often comorbid with other paraphilias and mental disorders. In one study, 95 % of sexual sadists also presented dysthymia (Aggrawal, 2008). Psychopathy is almost universally believed to be related to sadistic behavior (Juni, 2010), as well as narcissism (Rosegrant, 2012). Myers,  Burket, and Husted (2006), found significant overlaps in diagnosis of sadistic personality disorder and other Axis II disorders. Although axial system has been dropped from the DSM-5, the extensiveness (as that of personality disorders) and the dimensionality of sexual sadism disorder is bound to be considered in future research when seeking explanations of the comorbidities. Ultimately, the relation of sexual sadism disorder to other paraphilias and traits (e.g. psychopathy), may reveal deeper secrets of the sadism itself. As Martens (2011) postulated, sexual sadism is a dimensional construct and involves many different needs and drives, thus, in order to unveil the full complexity of it, the researchers must see possible connections and overlaps with other disorders.

Sexual masochism disorder is often seen as the other side of the same coin with sadism (Strachey & Freud, 2000). Indeed, it may be helpful to understand masochism, in order to study sadism. In sadomasochist relationships the two counterparts fit their sexual fantasies precisely to fulfill the needs of one another and, thus, obtain sexual gratification. Pain and humiliation inflicted by sadists is precisely what masochists crave, hence, a masochist would probably know more about sadism than a regular person.

The treatment of sexual sadism, just as the treatment of psychopathy is almost impossible even at the early stage, when patient is in his teens (Stone, 2010). Another problem is that few sadists will actually come to seek treatment. Most sex offenders who are released after serving their prison sentence but diagnosed with sexual sadism may be indefinitely civilly committed (Kansas v. Hendricks, 1997), which seldom has any real effect on their treatment. In psychotherapy, patients will often try to influence therapist into entering sadomasochistic relationship, which poses additional obstacle to improvement (Rosegrant, 2012). Overall, the treatment of sadism appears to be stuck in one place and further research will be required in this area.
Sexual sadism disorder is too complex to be defined by a single factor. Etiology of sadism points to the interplay of several factors (Morkos et al., 2014). Although there is research that found some predictors of sadism (Hill, Habermann, Berner, & Briken, 2006), it is still quite sparse. This suggests that we may not be able to foresee and prevent severe forms of clinical sadism. Treatment of sexual sadism disorder doesn’t offer any optimistic insights either. Perhaps, due to its relation to psychopathy (Juni, 2010) and other mental disorders (Myers et al., 2006; Rosegrant, 2012), sexual sadism is just as embedded in someone as if it was a part of his innate character.  There is progress to be made in research that involves subclinical sadist populations, such as representatives of BDSM subculture (e.g. Nordling & Sandnabba, 2000). Research and analysis of this specific population will be helpful in determining more tenets of sexual sadism. Researchers can’t possibly know the idiosyncratic and ritualized behaviors of every individual who displays sadistic tendencies. Finding a response from BDSM communities and establishing cooperative relationship will prompt forward the research of sexual sadism disorder in a new direction.

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Aggrawal, A. (2008). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual 
Practice.  Florida: CRC Press

Arnold C. (2013). Cuteness inspires aggression. Scientific American Mind, 24(3), 18 

Berner, W. (1997). Forms of sadism. Journal For Psychoanalytical Theory And Practice, 12(2), 

Buckels, E., Jones, D., & Paulhus, D. (2013). Behavioral confirmation of everyday sadism. 
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Fedoroff, J. (2008). Sadism, sadomasochism, sex, and violence. Canadian Journal Of 
Psychiatry. Revue Canadienne De Psychiatrie, 53(10), 637-646.

Harris, G., Lalumière, M., Seto, M., Rice, M., & Chaplin, T. (2012). Explaining the erectile 
responses of rapists to rape stories: the contributions of sexual activity, non-consent, and violence with injury. Archives Of Sexual Behavior, 41(1), 221-229. doi:10.1007/s10508-012-9940-8

Hill, A., Habermann, N., Berner, W., & Briken, P. (2006). Sexual sadism and sadistic personality 
disorder in sexual homicide. Journal Of Personality Disorders, 20(6), 671-684.

Jones, G. (2010). Queer BDSM in ancient Greece. Leather Times, 38(2), 5-8.

Juni, S. (2010). Conceptualizing psychopathy: A psychodynamic approach. Journal Of 
Aggression, Maltreatment & Trauma, 19(7), 777-800. 

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Martens, W. J. (2011). Sadism linked to loneliness: Psychodynamic dimensions of the sadistic 
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Mokros, A., Schilling, F., Eher, R., & Nitschke, J. (2012). The severe sexual sadism scale: 
Cross-validation and scale properties. Psychological Assessment, 24(3), 764-769. 

Mokros, A., Weiss, K., Schilling, F., Nitschke, J., & Eher, R. (2014). Sadism in sexual offenders: 
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illness in adolescent psychiatric inpatients. The Journal Of The American Academy Of 
Psychiatry And The Law, 34(1), 61-71.

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Nordling, N., & Sandnabba, N. (2000). The prevalence and effects of self-reported childhood 
sexual abuse among sadomasochistically oriented males and females. Journal Of Child 
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Psychology, 68(8), 935-942. doi:10.1002/jclp.21897

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I wrote this review initially as a college paper for Abnormal Psychology class.

Forgot: Burning Down, 2001 (Review)

Human folly explodes like missiles upon the face of civilization; crazy whistle of the falling bombs foreshadows imminent destruction. Nothing is bound to survive this catastrophe by the name of Forgot.
I found a copy of Burning Down in a cult black metal store in New York City provided by Hospital Productions, which sadly no longer exists. As a Russian myself, I was baffled to see my favorite Russian band CD in NY. I grabbed it without hesitation.

Deep and philosophical is the Burning Down. This is the story told by a melancholic witness of human self-destruction and human vice, someone, who is blessed with disability and, yet, able to see the true nature of the world. Such vision is not surprising for the far-eastern Russian band, which never gained as much attention as its neighboring national-socialistic bands. Forgot had never been involved in the NS trend pursued by many Russian black metal bands of that time and, perhaps, that's the reason why the project never received as much attention. Nevertheless, Forgot is well known and bears cult status among more advanced listeners of black metal. But, let me tell you, the Far East of Russia is not the prettiest place in terms of culture and living, which surely leaves its mark on the music by making it grim and hopeless. Last two or three years a lot of Russian bands were pulled out of the oblivion and this band deserves rebirth no less than others, especially in light of the new album, which has been finally released.

Fast-paced drums with clear blast-beats span through the whole album (sometimes repetative). Tremolo of the guitars flow up and down with god-like frenzy striking with the bolts of clear and captivating melody. Fourth track, on the other hand is slow and meditative, with ambient guitar solo halfway through and some deep guttural voice on the background.

Authentic and touching, melodies on the album trigger not only  deep feelings, but deep thoughts, which is very rare for the music in general. These are not ordinary melodies usually used by the next bm project; here you can actually enjoy something new and authentic. It forces you to inspect the surrounding environment and inner self for the presence of any flaw and fix it. Misanthropic texts on one hand and furious hymns of war on the other push you toward change by showing you the bitter truth. Renewal by destruction. This is another reason why the music of Forgot can be easily remembered, not due to its simplicity, but rather the beauty and thoughts it creates. Guitar sound is critical of the reality in a way that it rips open the soul of the listener exposing all the sadness and flaws that may be hidden within.

The overall atmosphere created by the album is apocalyptic and dystopian. It takes quite a while to regain former optimistic attitude toward the world (if you had one initially, of course). A proper imagery for such music will be  "The Sacrifice", a film by another great Russian artist Andrei Tarkovsky. It is not only my opinion, because in one of the interviews Wizard states his appreciation of Tarkovsky's films as well.

The only minor flaw of the album may be the drum parts, which are not as elaborate, as you would want to hear alongside such amazing melodies. Hopefully, the new album will create more rumors and attention this band really deserves.

* * *

I wrote this little review a while ago, before the new album came out, which deserves mention of its own. 

William Shakespeare's Sonnet 147: Disease sanctification

The genius of this sonnet is fairly remarkable. I had a few morbid thoughts in relation to it, which I'm going to commit to this humble blog entry.

In the first three lines, Shakespeare compares love to a disease, but the most amazing thing about it is that he feeds the illness willingly, which represents the masochistic aspect of it. The fourth line admits that body has unhealthy appetites. The twist I propose is to imagine disease and decay of the body as the literal objects of love. The disease provides altered conditions of the body and mind, which often were deemed as sacred and holy. For instance, in On the Sacred Disease, one of the works of Hippocratic Corpus, written in 400 BCE, author opposes the sacredness of what is thought to be a first description of epilepsy. Hippocrates disagrees with the common opinion of the time, which calls epilepsy sacred. I don't want to call disease sacred in a superstitious sense or pertaining to Christian God. I want to view the disease as a god on and of itself. Deterioration, decay and disease for some reason entail such greatness that they must be sanctified. Your body slowly deteriorates like a flower that is prepared for the herbarium; like human skin, a petal drys and slowly deteriorates becoming a messenger of sorrow and autumn. Instead of lively pink we have a more complex, beautiful and eternal texture of art and dark piety. In other words, I want to glorify the aesthetics of decay by sanctifying it and giving a divine status.

Sadly, there are few primary sources where disease is viewed as sacred or where the decay is sanctified. In Finnish mythology, for instance, there is a goddess Kalma, which represents death and decay. Little is known about this goddess, but the precedent plays important role. Kalma was believed to be in charge of disintegration of bodies. Once the process was finished, souls of the dead would leave their fragile vials and proceed to the Kingdom of Manala. The Kalevala mentions Kalma very few times. From that I could deduce that this goddess leaves in the underworld and is in possession of certain plain where castles and halls can be found (also belonging to Kalma). It is considered an honor for the body to decay or "laying on the lap of Kalma", which is stated in the dialog between the messenger and Kullerwoinen (son of evil):

"Lo! thy brother too has perished,
Dead he lies within the forest,
Manalainen's trumpet called him;
Home return and do him honor,
Lay him in the lap of Kalma."
Kullerwoinen thus replying:
"Has my hero-brother perished,
There is home a sable stallion
That will take him' to his slumber,
Lay him in the lap of Kalma."

In the same way perished Kullerwoinen's sister and mother. Full text can be found here: Among other things, Kalma would guide spirits to the afterlife and lurk around cemeteries. The aspect of decay in itself, however,  is not elaborated at all.

Less authoritative (or inspiring) source comes from the imagination of game creators, in particular Forgotten Realms universe and its goddess Talona, whose symbols are that of disease and poison. There is book called Lady of Poison by Bruce Cordell, which is so badly written that I wasn't even able to finish it. It doesn't detail the priesthood of this interesting goddess (dedicating only about 20 pages to it) , but it at least sets a modern precedent of human thought that arrived in its development to sanctification of death and disease. It is very possible that the creators of said imaginary world have drawn their ideas from Finnish mythology, because there is a goddess Loviatar that bears the same name both in the game and its primary source.

Sonnet 147 may serve as a guide for the imaginary followers of Kalma or Talona. The elegance of Shakespeare sounds like a piece of divine text or verse. There are some interesting and twisted passages in existing sacred texts, such as Bible, where Paul the Apostle, in his Second Epistle to the Corinthians 12:7–9 (my favorite quote from the Bible) says:  "Thorn in thy flesh was given to me, a messenger of Satan to torment me, so that I would not become conceited." (This is not any particular translation; I compiled it from different once, because Satan sometimes is called angel of death or adversary, while instead of the word 'torment' some versions use different words, which don't sound as exhilarating). Someone might argue that masochism was embedded in Christianity by the very deed of Jesus Christ. Paul's message is directly related to the idea of sacredness of the disease or "thorn", which serves as a tool sent by Satan, but obviously ordained by God to inflict potentially painful and damaging wounds. These wounds, however evil, are still directed towards the good end. Again, another favorite theme of mine, i.e. evil does good or is directed towards the good end. There's a whole book dedicated to the idea of the disease and this biblical passage by by Andrew Crislip called Thorns in the Flesh: Illness and Sanctity in Late Ancient Christianity, which I'm yet to read.

Photo of thorns is by me; the whole series can be found here: