Excerpted from
Psychotherapy with Sex-Abuse Victims
True False and Hysterical

by Richard A. Gardner, M.D.
©1996 Creative Therapeutics, Inc. All Rights Reserved

Chapter One


There has been some misinterpretation and even misrepresentation of my views on pedophilia that I present in this article. For example, because I have stated that pedophilia is an ancient tradition and a widespread phenomenon, this has been interpreted by some to indicate that I am supportive of the practice and believe it is a good thing. Rape and murder have been widespread in the history of the world. To make that observation does not mean that one supports these practices. In order to clarify some of the misinterpretations, I reproduce here, appropriate segments from my document Misinformation vs. Facts about Richard A. Gardner, M.D.

Misinformation: Dr. Gardner supports and is fully sympathetic to the practice of pedophilia

Fact: There is absolutely nothing that I have ever said in any of my lectures, or anything that I have written in any of my publications to support this allegation. This is my position on pedophilia: I consider pedophilia to be a form of psychiatric disturbance. Furthermore, I consider those who perpetrate such acts to be exploiting innocent victims with little, if any, sensitivity to the potential effects of their behavior on their child victims. Many are psychopathic, as evidenced by their inability to project themselves into the position of the children they have seduced, and ignore the potential future consequences on the child of their abominable behavior.
    Accordingly, we all need protection from pedophiles. Jail is certainly a reasonable place to provide us with such protection. This is especially the case because the vast majority of pedophiles are not going to be cured, or even helped significantly with their problems, by psychotherapy --the assertions of some psychotherapists notwithstanding. By adulthood the pedophilic orientation has been deeply embedded in the brain circuitry and is not likely to be changed by such a superficial approach as "talk therapy." Nor is it likely to be changed to a significant degree by conditioning techniques, i.e., "behavior modification." It is as reasonable to believe that one could accomplish this goal as it is to believe that one could change an adult homosexual into a heterosexual and vice versa.
    I am also in favor of Megan's Law, which requires that communities learn about the presence in their midst of pedophiles who have just been released from prison. I do believe, however, that the same laws should be applied to those who have been convicted of certain other crimes such as rape (which in a sense is similar to pedophilia), murder, arson, and other felonies that present formidable risks to the community. In short, I have absolutely no sympathy for pedophiles, and the fact that I have testified in courts of law in defense of innocent parties "who have been wrongly accused of pedophilia" does not mean that I am in any way sympathetic to those who actually perpetrate such a heinous crime.

Misinformation: Dr. Gardner believes that pedophilia is a good thing for society

Fact: I believe that pedophilia is a bad thing for society. I do believe, however, that pedophilia, like all other forms of atypical sexuality, is part of the human repertoire and that all humans are born with the potential to develop any of the forms of atypical sexuality (which are referred to as paraphilias by DSM-IV). My acknowledgment that a form of behavior is part of the human potential is not an endorsement of that behavior. Rape, murder, sexual sadism, and sexual harassment are all part of the human potential. This does not mean I sanction these abominations.
    I have noted the historical fact that pedophilia has been and still continues to be a widespread phenomenon. Unfortunately, this has been interpreted by some to indicate that I condone the practice. This is the equivalent that saying that those who note the ubiquity of rape and murder are thereby condoning these atrocities.

Misinformation: Dr. Gardner believes that pedophiles should be granted primary custody of their children

Fact: I consider pedophilia to be a psychiatric disorder, an abominable exploitation of children. I have never supported a pedophile in his (or her) quest for primary child custody. Because I have testified on behalf of falsely accused defendants, there are some who claim that I am reflexively protective of pedophiles and sympathetic to what they do. There is absolutely nothing in anything I have ever said or written to support this absurd allegation. When I conclude in a custody dispute that an accused father has pedophilic tendencies, I will advise the court to provide protection for the children. I never have recommended primary custody for such a parent, nor can I imagine myself ever doing so. Misinformation: Dr. Gardner believes that everybody has pedophilic tendencies

Fact: I believe that all people are born with the potential to engage in every kind of atypical sexual behavior known to humanity. It behooves parents and other caretakers to suppress socially unacceptable behavior and to channel the child's sexual urges into socially accepted forms. This should happen in early childhood. In our society the pedophilic potential has been suppressed successfully for the vast majority of individuals. Those who have not experienced such suppression become pedophiles. There have been other societies in the history of the world that have not suppressed pedophilic tendencies. The fact that such suppression has not taken place is a fact of history. This does not mean that I suggest that we emulate such societies or that I approve of pedophilia. Human sacrifice has been widespread in many societies in the history of the world. This also is a fact of history. To state this fact does not mean that I approve of the practice. The suppression of primitive impulses is necessary for the existence of a civilized society. Abba Eban, a former Israeli Ambassador to the United States, put it well: "Man becomes civilized when his animal impulses are tamed, subdued, and transcended by his social nature."

Misinformation: Gardner believes that judges, lawyers, juries, and evaluators who involve themselves in sex-abuse lawsuits become sexually "turned on" in the course of the litigation

Fact: As the media well knows, sex and violence attract attention. People are more likely to read about these issues than less "interesting" topics. To deny prurient interests is to deny reality. This does not mean that I believe that people are sitting in the courtroom in a state of high sexual excitation while the trial is going on. What I am saying is that those in the courtroom are as likely to be extra-attentive to sex and violence as those outside the courtroom.
Be fruitful and multiply and fill the earth ....
- Genesis 1:28
I have found the missing link between the higher ape and civilized man: It is we.
- Konrad Lorenz
The lion is generally considered to be king of the beasts. This is not true.
Human beings are more properly designated king of the beasts.
- Richard A. Gardner
Man becomes civilized when his animal impulses are tamed, subdued, and transcended by his social nature.
- Abba Eban


I have never felt completely comfortable with the terms natural and unnatural when they apply to human sexual behavior. In a sense, one could say that any form of sexual behavior that can be exhibited by a human being must be considered natural in that it is part of the human repertoire. Generally, the term unnatural has been applied to those variations that have been considered unacceptable to a particular social group. In a somewhat grandiose fashion, each society considers natural (in compliance with God’s [or nature’s] purposes) those particular forms of sexual behavior that are widely practiced and accepted and deems unnatural (at variance with nature’s [or God’s] purposes) those forms of sexual behavior that are atypical and/or by social convention "wrong," "bad," "disgusting," etc. Sometimes sexual behavior that does not lead directly to procreation has been subsumed under the unnatural rubric. As I hope to demonstrate, even those forms of sexual behavior that do not lead immediately to procreation may still serve nature’s purposes and thereby do not warrant being excluded from the list of the so-called natural forms of human sexual behavior.


In order to appreciate fully the theory I propose, it is important first for the reader to understand my concept of the origins of gender differences in mating patterns. I believe that there is genetic programming for women to be more passive, coy, and seductive, and for men to be more assertive and aggressive in the courtship process. Although social influences certainly play a role in such patterns, I believe that the genetic factors are the more important. I recognize that this is an unpopular thing to say at a time when male/female egalitarianism is very much in vogue, yet I believe that I have good arguments to support my position. No one can deny that up until the 20th century men were primarily the hunters and fighters (protectors and warriors). Women, in contrast, were primarily the child rearers. I am making no judgments here regarding whether this was good or bad or right or wrong, only that it was the reality of the world up until the 20th century for the vast majority of people. Of course, there were and still are occasional societies in which this principle did not hold, but these exceptions do not in any way detract from the validity of my generalization. (There is always an island in the South Pacific that will demonstrate any point—in support or in refutation.)

It is reasonable to state that those men who were genetically strong in the hunting/fighting functions were more likely to survive than those who were not. Those who were weaker in these functions were less likely to have food for survival and/or the capacity to protect themselves from their enemies. Consequently, their genes were not as likely to have been passed down to subsequent generations. Also, those who were weak in these areas were less likely to attract women, in that women tend (then and now) to consider as desirable mates men who exhibit a high capacity for providing food, clothing, and shelter for themselves and their children and high capability for protecting the potential family from enemies. This is another reason why the genes of men who were weaker in these areas were less likely to survive in the genetic pool. Similarly, women who were stronger in the child-rearing realm were more likely to be viewed by men as desirable mates and their genes, as well, were more likely to be passed down to their progeny. The greater aggressiveness of the male was not, I believe, simply confined to hunting and warring; it was also utilized in the service of mating. More aggressive men, then, were more likely to be successful in acquiring mates. And so we have another factor favoring the selective survival of more aggressive men.

Youngsters today of both sexes carry within them these genetic programs. Although we human beings are less beholden to our instinctual drives than are lower animals, we are still affected by them. A bird, for example, during the mating season, may have no choice other than to go through the mating ritual of its species. We humans have procreative urges, but we are not required to mate in any particular season, nor are we compelled to follow rigid mating patterns of behavior. However, this does not preclude our being programmed for such mating patterns with the resultant pressure for their expression.

There is another factor operative in what I believe to be gender differences in mating patterns. This relates more directly to reproductive capacity. It is a principle of Darwin’s theory of natural selection and survival of the fittest that each species generally produces far more offspring than can possibly survive. Those particular forms that are most adaptable to the environment in which they have been born are more likely to survive and perpetuate the species. Those that are less adaptable to the particular environment will generally die off. This is the central element in the Darwinian theory. If one examines this further, one finds that there are two factors operative here: quantity and quality.

With regard to quantity, the number of offspring produced is far greater than can possibly survive in a particular environment. With regard to quality, the quality or type of offspring that is most adaptable to the specific environment is most likely to survive. Accordingly, one must consider both quantity control and quality control. Furthermore, with regard to quantity, the general thrust is for an organism to produce as many offspring as possible, i.e., the greatest quantity possible—most often far more than can possibly survive. With regard to quality, the general thrust is to select, narrow down, and restrict survival to those forms that will adapt best to and survive in a particular environment. The two processes of control, then, are antagonistic. The quantity control factors work toward the survival of the greatest number of offspring. The quality control factors operate to reduce and/or limit the number of offspring that will survive. Those forms that ultimately survive represent a balance of these two antagonistic forces.

In many forms of life, one of the sexes is specifically designated to provide quantity and the other quality. Often, it is not difficult to determine which sex is primarily involved in which function. This is certainly the case for the human being. Men are clearly the ones involved in producing the greatest quantity of offspring, whereas women are the quality controllers. If one were to simply view human beings as baby factories, whose main purpose is to perpetuate the species (a not absurd view), and if one were to ask which sex is more likely to produce a high quantity of offspring, it is clearly the male. If a man were to devote his whole life to the procreative process, it is reasonable that he could father one to two babies a day, providing, of course, he was provided with women who were in the fertile stages of their menstrual cycles. Accordingly, the male is reasonably capable of fathering 500 babies a year. We know that we could start using males for this purpose at about the age of 13 or 14, but we do not know the upper age at which such utilization would no longer be possible. There are men in their 90s who have viable sperm. But let us, more practically, end the male’s fecund period at 75, because most men do not live beyond that age, and older men are less likely to father 500 babies a year. Accordingly, it is reasonable to say that the average male has a fecund period of 60 years. Fathering 500 babies a year for 60 years would enable a man to father 30,000 babies. (I am not addressing myself here to practicality, only to the issue of maximum possible reproductive capacity if one were to make use of men and women for this purpose.) In contrast, if a woman were to devote her fecund life to being a baby factory, she could reasonably reproduce one child a year from age 13 to about 56 (the oldest "proven" age at which a woman has been demonstrated to give birth). This will give her approximately 40 to 45 babies. Accordingly, it is reasonable to conclude that the male is very much the one capable of producing the greatest quantity of offspring.

What I have said thus far relates purely to biological capacity. The next question relates to the actual behavior of each of the sexes regarding the procreative process. The potential for being a reproductive factory is there, but in practice individuals generally have other things to do with their lives besides fornicating and propagating. And probably the most important of these other functions is child rearing. If no concern is given to the protection of the young, then babies will not survive and there would be no point to devoting one’s life solely to manufacturing them. This brings us to quality control, the second step necessary for species survival. It is here that women have played the more formidable role. In order to carry out this function, it behooved women to be more circumspect with regard to mate selection. Those who were so were more likely to be chosen as mates and more likely to pass their stronger child-rearing genes down to their offspring.

Men, I believe, have been programmed to crave sex indiscriminately with large numbers of women, i.e., to impregnate as many women as possible. From the roving bands of men in perpetual heat, a woman must select the man who is most likely to remain around after impregnation and serve the role of food gatherer and protector. In order to realize this important goal, women do best to be less impulsive with regard to gratifying indiscriminately their sexual urges—in order that they assess more objectively a potential father of their children. Women who were slower in sexual arousal were more likely to be judicious in mate selection and, therefore, more likely to survive. They were more likely to select men who would provide food, clothing, shelter, and protection. Accordingly, I believe that the average (I did not say all) present-day woman is slower in sexual arousal than the average man. Once aroused, however, a woman is more likely to attempt to maintain an ongoing relationship with her mate. In contrast, the average (I did not say all) present-day man is quicker in sexual arousal than the average woman. Once gratified, he is less likely to be desirous of maintaining the relationship. I believe that most women would confirm this statement in that the most common complaint single women have is that men are less interested in "commitment" (the in-vogue word for this phenomenon) than women are.

The old saying is applicable here: "Men are looking for girls, and girls are looking for husbands." Men are on the prowl. They are not only out hunting for prey to kill and eat, but hunting for female prey to serve as sexual companions. I believe that if one were able to create a printout of the average adult male’s sexual thoughts throughout the course of the day, they would be formidable, especially printouts associated with day-to-day experiences in which the individual is not fully preoccupied with work. I believe that one would find that sexual thoughts would be associated with a large percentage of the man’s encounters with females from the teen period and upward. These would involve some kind of sexual encounter. Secretaries, stewardesses, nurses, receptionists, waitresses, and the wide variety of other women that men inevitably encounter in the course of their day become stimuli for such sexual fantasies. Some confirmation of this "fantasy" of mine is to be found in Shanor’s study (1978) in which he found that men between ages 12 and 40 think of sex an average of six times per hour. But the distribution over age ranges is not even. Between ages 12 and 19 the frequency is 20 times per hour (approximately once every three minutes). Things slow down somewhat after that, so that between ages 30 and 39 it is four times an hour.

In short, most men are extremely promiscuous (if not physically, at least psychologically). The main difference between those to whom this label is applied and those to whom it is not relates to the degree to which the man overtly tries to gain gratification for these urges. From the roving bands of men in heat, the woman must reject the large majority or else she will find herself impregnated by a man who has already gone on to the next cave or condo. She is much more concerned with relationships. I believe that this phenomenon is one of the factors involved in women having greater orgastic capacity than men. Although the woman is more likely to need caressing and tender overtures to be aroused, once aroused she is more likely to remain aroused longer. The male reaches his orgasm and immediately goes into a refractory period ("zonks out," falls asleep). The majority of women have the potential for multiple orgasms. This, I believe, serves the purpose of enhancing procreative capacity. Her multiple orgasmic capacity enables her to "hang in there longer" and ensure that the male who is slow to ejaculation is likely to be sustained in his interest and involvement.

Last, I believe that what I have said here is one explanation for the fact that men are generally more likely to be sexually excited by visual stimuli, whereas women are more likely to respond to tactile stimuli. The roving bands of men spot their prey at a distance and can get excited merely at the sight of a woman. This is in part a derivative of their hunting functions and it also serves to enlarge the potential population of sexual partners. This phenomenon also serves to explain the fact that it is the men who stand around peering lasciviously at women, whereas it is far less common for women to do this as obviously and exhibitionistically as men. Many years ago there was a popular song entitled, "Standing on the Corner, Watching the Girls Go By." And it was not women who were standing on the corner, but men! Women, in contrast, need caressing, tenderness, and reassurance that the man will remain around for supplying food and protection for herself and her children. This is one of the reasons why men are more likely than women to be sexually aroused by visual pornographic material.


I wish to emphasize that the theory proposed below may very well have been thought of previously by others. Although I have not either read about or heard about it from others, it rests heavily on one proposed by Dawkins (1976). In fact, one might consider my theory an extension of Dawkins’s applied specifically to the various forms of human sexual behavior. This theory, as is true of Dawkins’s, rests heavily on Darwinian theory—especially the concepts of natural selection and the survival of the fittest. My theory, like Darwin’s and Dawkins’s, does not address itself to such ultimate questions as those related to the forces (entities, God, etc.) that created these principles and might very well be involved in their implementation. It does not concern itself with how atoms and molecules got to be here, nor does it concern itself with the origin of the principles that govern their interactions, both simple and complex. Rather, it concerns itself with the implementation of these entities and principles and the physical manifestations of their interactions—from the simplest to the most complex levels, from the earliest to the most recent. Nor does it concern itself with the ultimate purpose(s) of all of this, considering the fact, for example, that all life on earth will ultimately perish and that all forms of sexual behavior—both the "natural" and the "unnatural" varieties—will no longer serve any purpose, at least on this sphere, which we call Earth.

It is well to begin at the beginning, which (as Maria in The Sound of Music said) is a very good place to start. This sphere, like many other celestial bodies in the universe, began with its complement of elements, among which were to be found carbon, hydrogen, oxygen, and nitrogen—the fundamental building blocks of life. Under the influence of environmental conditions (influences emanating from the sun as well as those in the intervening space), simple molecules formed by atomic union. Most important for the purposes of this discussion were water (H2O), carbon dioxide (CO2), methane (CH4), and ammonia (NH4). After exposure to ultraviolet light and electric currents (probably related to primordial lightning), more complex molecules were formed—especially amino acids, the building blocks of proteins. Scientists have been able to reproduce such transformations in a flask by subjecting the aforementioned simple molecules to ultraviolet radiation and electric currents. Laboratory simulations of the chemical conditions on Earth before the beginning of life (as we know it) have produced organic substances such as purines and pyrimidines, which are the building blocks of the genetic molecule DNA. One can readily envision, then, a primordial "soup" in which the simpler and more complex molecules floated. The main method of production (or "creation") of the more complex molecules was the exposure of the simpler ones to the environmental conditions conducive to their formation. This method of formation of complex molecules depends upon the influence of external forces and, presumably, without their presence there would be no creation of the more complex forms.

The next step was the one in which certain molecules exhibited the capacity to reproduce themselves, a process that Dawkins (and others certainly) refer to as replication. The method that appears to have been most successful (in fact, it appears to be the only one on Earth that we know of) was the one utilized by the DNA molecule. This molecule, made of segments that are to be found floating around in the primordial soup, reproduces itself by absorbing onto itself from the surrounding mixture those particular building blocks that correspond to those already strung on its helical (spiral) chain. The original molecule serves as a mold or template. It attracts corresponding smaller molecules from the soup, each free molecule attached to its own kind on the original model. Ultimately, this results in the formation of a clone of the original DNA molecule. In the next step the two strands separate: Voilà, reproduction! Each new strand then becomes a model for further replications, thus producing geometric growth in population.

If all the DNA molecules were cloned from the original, there would be few errors. However, with this kind of geometric progression, in which each new DNA molecule becomes a template for the reproduction of itself, there is a greater likelihood that "errors" or alternative forms may result, each of which may also survive. We have, then, the introduction of variety. Some of the forms have a greater likelihood of survival than others, depending upon the internal stability of the molecular chain.

Ultimately, the free-floating smaller molecules in the primordial soup become scarce as they are utilized ("eaten up") in the formation of the larger DNA molecules. Some sort of competition, then, arises as the DNA molecules compete with one another for the ever scarcer simpler radicals. The next step, according to Dawkins, was basically the phase of cannibalism. Because of the scarcity of free-floating smaller molecules in the primordial mixture, the DNA strands began breaking off segments of their neighbors in order to be provided with "food" for the replication process. The next step—and this was an extremely important one—was the formation by DNA molecules of protective coatings, a physical wall that served as a kind of armor that protected the DNA strand from being cannibalized by its neighbors. These entities (DNA strands, surrounded by protective shells) are basically what we are talking about when we discuss viruses. The protective shell is necessary for the survival of the internal core of DNA. Dawkins refers to this entity as a "survival machine," and this is the term he uses for all subsequent living forms, the function of which is to provide a housing for DNA molecules, especially with regard to their protection.

The next step involved the union of different types of DNA strands (which I will now call genes) to combine their efforts in the service of enhancing the likelihood of survival of the protective coating. Each could serve a different function and thereby increase the likelihood of survival over those with less complex mechanisms for adaptation in the primordial soup. We see, then, the formation of the simplest cells in which the genes are clustered together in the nucleus and the survival wall being represented by the surrounding cytoplasm and cell membrane (for animals) or cell wall (for plants). Obviously, we are describing here one-cell animals and plants. The next step in the evolution of living forms was the bringing together of individual cells into colonies. Here different parts of the colonies could perform different functions—enhancing, thereby, the chances of the DNA surviving. Those cells that were able to live together as colonies, each performing separate but unifying functions, would be at an advantage over those cells that floated about in isolation.

Dawkins then continues:

A major branch of survival machines, now called plants, started to use sunlight directly themselves to build up complex molecules from simple ones, reenacting at much higher speed the synthetic processes of the original soup. Another branch, now known as animals, "discovered" how to exploit the chemical labors of the plants, either by eating them, or by eating other animals. Both main branches of survival machines evolved more and more ingenious tricks to increase their efficiency in their various ways of life, and new ways of life were continually being opened up. Subbranches and sub-subbranches of survival machines evolved more and more ingenious tricks to increase their efficiency in their various ways of life, and new ways of life were continually being opened up. Subbranches and sub-subbranches evolved, each one excelling in a particular specialized way of making a living: in the sea, on the ground, in the air, underground, up trees, inside other living bodies. This subbranching has given rise to the immense diversity of animals and plants which so impresses us today. (p. 133)

Every survival machine, then, can be viewed as a colony of DNA strands surrounded by successive layers of protective mechanisms. Its purpose, however, is not simply to protect the genes from cannibalistic destruction, but to provide mechanisms for the reproduction of the DNA strands. Here we are talking about the methods by which the particular form of life enables the DNA strands to pass down from generation to generation, each time ridding itself of the housing in which it temporarily resides and providing itself with a new and temporary survival machine. Dawkins states:

Another aspect of the particulateness [sic] of the gene is that it does not grow senile; it is no more likely to die when it is a million years old than when it is only a hundred. It leaps from body to body down the generations, manipulating body after body in its own way and for its own ends, abandoning a succession of mortal bodies before they sink in senility and death. (p. 133)

Although the gene itself is in a constant state of equilibrium with surrounding atoms and smaller molecules available for its replication, its basic structure and appearance are always the same. It can be compared to a skyscraper that periodically and continually replaces its bricks with others provided externally. Both new bricks and old bricks are essentially immutable in that atoms do not "grow old."

Each cell has the information necessary to re-create the whole survival machine. Furthermore, it has the power to influence various parts of the survival machine, especially with regard to the protective mechanisms necessary for survival and the mechanisms necessary for reproduction, i.e., transmission of DNA replications from one temporary survival machine to the next and so on down the generations.

The millions of different kinds of plants and animals are testimony to the wide variety of survival machines that have evolved over eons. All the cells, all the tissues, all the organ systems, and all the plants and animals that incorporate DNA molecules share in common this one principle: the protection of the genes and their transmission to the next generation. The human brain is but one example of such a system. It is one of the latest and most complex examples of a part of the housing machine that serves to protect the DNA as well as enhance the likelihood that it will be transmitted to the next generation. Although designed by and in a sense controlled by DNA, it has a certain autonomy of its own in that it exerts some influence over the automatic control that genes have over the survival machine, especially with regard to the time of expression of the protective and procreative forces. For example, lower animals appear to have no choice but to perform their specific mating patterns at prescribed times and places. We have the ability to suppress somewhat these cravings, but still we are often obsessed with and sometimes even enslaved by them.

As mentioned, Dawkins’s theory could be considered the inevitable extension of the Darwinian theory. The major determinant as to whether a particular survival machine will indeed perform its functions is related to the efficiency of the mechanisms devised for protecting DNA and enabling it to transmit its replications down to form the next generation of survival machines. There is selective survival of those machines that are most likely to perform these functions in a particular environment, and there is selective failure to survive (and thereby destruction of DNA) of those housings that are less capable of survival in the particular environment in which the genes find themselves.



There is no problem applying Dawkins’s theory to adult heterosexuality. We can view the human body as the survival machine for our sperm and ova, which are basically housings for our DNA. The sexual act is the step by which DNA replications are transmitted to the next generation of housing machines (our children). All the things we do in our lives can be viewed as steps toward this end. Just about every activity of our daily lives, throughout the 24-hour cycle, can be viewed either as an attempt to protect and preserve our DNA or as a step toward its transmission. Every meal we eat, every breath we breathe, every penny we earn, every bit of work we do, can easily be considered part of this grand plan. When we sleep, we are recouping and saving up our energy for the next day’s round of survival activities. Other activities, which might initially be considered exceptions to this principle, on careful inquiry may very well be found to be related.

Everything we learn has the potential to serve us in the enhancement of our capacity to survive, either immediately or remotely. Purely scientific inquiry, although initially unrelated, might ultimately find practical applications that serve human survival. What about art and music? Here again they might not initially appear to fit this scheme. However, art is used to enhance female and male attractiveness (in clothing styles and cosmetics), and the artist, in part, wants to impress the lady of his choosing. ("You must come up to my place sometime and view my etchings.") Or, the artist may wish to earn money, again in the service of providing himself (herself) with food, clothing, and shelter—which all serve in the survival of the temporary machine in which his (her) genes are housed. Music can serve similar purposes, for both musician ("She will certainly love me when she hears the music I have created") and the listener ("I love him for the music he has created"). Pleasure, like sleep, is necessary for us when we need to recoup our energies. When I try to think of examples of human endeavor that might not fit under this grand rubric, I am unable to do so. Accordingly, I will stop giving examples that support the theory and go on to a discussion of the forms of sexuality that do not initially appear to do so.

With regard to the atypical forms of sexuality, those that may not initially appear to serve the purposes of procreation, I wish to state at the outset that each of these has, I believe, a genetic and an environmental contribution. The genetic contribution may very well be the result of "gene error," the kind of error that brings about a form of atypical sexual behavior. If a mutation is not of survival value, it is not maintained for long in the genetic pool, and the housing in which it is incorporated is destroyed by natural processes (both the housing and the DNA within decompose and in many cases are "eaten by worms"). The kinds of atypical human sexuality discussed here are not in this category because the human beings who exhibit these variations have definitely survived. One does well, also, to view the combination of genetic predisposition and environmental influences as varying. Accordingly, in some individuals the genetic loading may be very high, so much so that little if any environmental contribution may be necessary for the quality to become exhibited. In others the genetic contribution may be low or even nonexistent; however, environmental (especially family) influences are so formidable that the sexual pattern becomes the primary mode of expression for that individual. One does well, also, to view these two examples as the extremes and to view all individuals who exhibit the particular sexual behavior as lying at some point in between these two extremes.

I am in full agreement with Freud’s (1905) theory of the "polymorphous perversity" of the human infant. The infant will exhibit every form of sexual activity known to humanity. Each society suppresses those forms that it considers unacceptable and allows expression of those that it considers acceptable. However, residua of the unacceptable variations often press for expression and may be found in various aspects of adult sexuality, both typical and atypical. All, however, are natural if one is defining the word as a sexual form of behavior that exists in human beings, regardless of the particular society’s attitude toward that specific mode of sexual expression.

There is good reason to believe that most, if not all, children have the capacity to reach orgasm at the time they are born. (I am not recommending that we conduct any scientific studies to prove or disprove what I have just said.) Certainly, infants in the first few months of life may rub their genitals as they lie on their abdomens, and their associated facial expressions are strongly suggestive of orgasm. There are people who claim that they cannot remember a time when they did not masturbate. And not all of these people have been sexually abused as children. Like all things in this world, there is a bell-shaped curve, and the age at which people first experienced orgasms also lies on a bell-shaped curve. Most people would date their first orgasm to the pubertal period, but there are many who can go much further back. It is reasonable to assume that there is a small fraction of the population who, without any particular external stimulation (sexual molestation or otherwise), normally experienced such high sexual urges in early infancy and found relief through masturbation. (Recently, sonograms have shown baby boys holding their penises in utero.) This, too, is "natural" and this, too, lends credibility to my belief that children are not only naturally sexual but that they may be the initiators of sexual activities. Although these overtures do not initially serve procreative purposes, they ultimately do because the child who is sexually active at an early age is more likely to be sexually active in adolescence and thereby provide his (her) DNA for the next generation of survival machines.

The common childhood game, aptly called "You-Show-Me-Yours-and-I’ll-Show-You-Mine" is yet another example of childhood sexuality. Certainly curiosity plays a role in such games. Parents begin teaching children, at a very early age, that certain parts of their bodies are to be strictly covered up and not to be exposed to others. Such prohibitions, of course, engender enormous curiosity, a curiosity that can be satisfied by voyeuristic/exhibitionistic games. But the games often go beyond the visual level and frequently involve touching, even with sexual excitation and intent. We see here the influence of DNA already at work. I suspect (but I am not certain) that boys are more interested than girls in these games because of the aforementioned high visual loading to their sexual interest.

Some further examples. A common practice for little children is to play with their genitals, even to the point of orgasm. Furthermore, it is also common for little girls to smell their fingers after such play and they will often find the odors enjoyable to sniff. Commonly, they will be taught by their mothers that such a practice is unacceptable. Boys smelling their fingers after touching their genitals is less common, but it is the analogous practice. This olfactory gratification is much more highly developed in lower animals for whom scents play an important role in sexual activity. Residua of this phenomenon certainly exist in humans. We recognize it as "normal" for men to enjoy cunnilingus, a part of which pleasure comes from the olfactory stimulation that such activity provides. And women as well (again, in many segments of our society) enjoy immensely this activity. Here again, we see the residua of a childhood form of sexuality expressing itself in adult heterosexual behavior.

Moreover, orgastic pleasure may very well be the most intense known to the human being. The craving for this gratification is extremely strong and, of course, is the driving force behind the procreative process. The reduction of high sexual tensions and the craving for orgastic gratification is DNA’s main method of bringing about reproductive activity and, by extension, its passage to the next generation.

Another example. All agree that infants enjoy immensely the breastfeeding experience. Mothers in our society are encouraged to express deep involvement in this practice and are permitted to speak about how psychologically and physically pleasurable breastfeeding is. However, few women will speak openly about orgasmic gratifications associated with the breastfeeding of their infants. It is more acceptable to describe breast stimulation pleasure as part of adult heterosexual activities. It is also acceptable to describe physical pleasure in association with a male partner’s breastsucking as part of foreplay. I am not claiming that most women experience orgasms when breastfeeding their infants. I am only claiming that some women do, and that more probably would if they were to overcome the social inhibitions against such gratification.

Women’s potential for pleasurable response to breastfeeding serves important biological purposes. It increases the likelihood that she will breastfeed her child, increasing thereby the likelihood that her progeny will survive. It increases the likelihood that she will want to breastfeed subsequent babies, either her own or those of others. It produces in general a heightened level of sexuality, keeps the sexual juices flowing (not only the milk), and increases thereby the likelihood that she will have heterosexual sexual encounters. It increases also the likelihood that she will enjoy her breasts being sucked by adult males during heterosexual encounters. Her pleasure, which is a residuum of both her own breastfeeding in her own infancy (via projective identification with her breastfeeding infant) and the pleasurable sensation provided by the sucking of her breasts, serves to enhance the man’s pleasure (via her excitation). Residua of the man’s breastfeeding gratifications in his own infancy also contribute to the pleasure experienced by the man when engaging in breastsucking during the heterosexual encounter. These residua, one in each of the parties, enhance the likelihood of copulation and thereby the passage of DNA to the next generation.

It is important for the reader to appreciate that I am making no value judgments on any of these sexual activities. Each society does this and our society is no exception. My purpose here is to present a valueless explanation of these activities. The reader should recognize that I, as a product of the society in which I live, have my biases, prejudices, etc., but these are irrelevant to my presentation here.

The Paraphilias of DSM-IV

At this point I address myself to each of the forms of atypical sexuality described in DSM-IV (American Psychiatric Association, 1994). These are the forms of atypical sexuality that are considered by the DSM-IV nomenclature committee to be manifestations of psychiatric disorder. It would be a naive reader who is not appreciative of the fact that there is not a disorder here that was not considered the norm in some other society at some time and some place. This list, therefore, represents the beliefs and even the biases of the nomenclature committee. One confirmation of this point is the fact that homosexuality was considered a bona fide disease in DSM-II (American Psychiatric Association, 1968) and the previous DSM (American Psychiatric Association, 1952) (which has no number and is now retrospectively sometimes referred to as DSM-I). The authors of DSM-III (American Psychiatric Association, 1980) took the position that if a person is homosexual and wishes to change his (her) orientation, then the individual might then be considered to be suffering with a psychiatric disorder and might thereby be justifiably treated for such. To the best of my knowledge, this is the first time in the history of medicine that patients themselves make the decision regarding whether or not they have a disease. The homosexual person, then, who was seeking treatment under DSM-III criteria had to "enter through the back door" to qualify for a diagnosis under this system.

In DSM-III-R (American Psychiatric Association, 1987) homosexuality was not even listed as a disorder per se. However, if one looked up the word in the index, there was a reference under the very last of the list of sexual disorders: "302.90 Sexual Disorder Not Otherwise Specified." Here were listed sexual disorders that were not to be found listed in any of the previous categories. Three examples were given, the third of which was: "Persistent and marked distress about one’s sexual orientation." It was only here that a homosexual person— who was distressed about his (her) sexual orientation—could justifiably be considered to have a disorder. It is of interest that the just-quoted lines are the very last ones in the section on sexual disorders. One cannot even find the word homosexuality in the index of DSM-IV. However, the category "Sexual Disorder Not Otherwise Specified" is still to be found, as is the requirement that the individual experience "persistent and marked distress about sexual orientation." Accordingly, to carry the back door analogy further, the homosexual person who is entering treatment under the DSM-IV provisions must creep through a little trap door that is cut into the back door (the kind that a dog might use). Enough said about the vicissitudes, biases, and unreliability of DSM-IV.

A paraphilia is defined as a form of sexual expression that is atypical or "off the beaten track." It is a sexual activity that is found on a parallel track (thus the prefix "para" [Greek: besides]) but is still a form of lovemaking (thus the word "philia" [Greek: love]). DSM-IV considers the paraphilias to be "sexual disorders," which is a more recent term for "diseases." I will address myself to each of the paraphilias, in the order in which they appear in DSM-IV, and comment on each, especially with regard to the aforementioned theory. I will give particular attention to the issue of the "justification" for such atypical sexuality, especially with regard to the question of its function and purpose if it does not serve the immediate aims of reproduction and species survival. DSM-IV emphasizes that the paraphilic label is justified when the activity is the primary or one of the primary sources of sexual gratification of the individual. The label might not be justified if it exhibits itself only rarely and is a minor part of the person’s sexual repertoire. The committee uses the six-month cut-off point for a duration that justifies the diagnosis but, I am certain, recognizes this as somewhat artificial.

Furthermore (and this is important), for each of the paraphilias there is included an important diagnostic proviso: "The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." Accordingly, if an individual does not suffer distress or impairment in functioning, then the presence of this form of sexuality would not be considered a manifestation of a disorder. This too presents us with problems, especially from the point of view of a therapist who may be consulted regarding treatment. These are strange kinds of disorders indeed. They are disorders if the person suffers distress or functional impairment, but not disorders if these sequelae are not present. The issue of distress presents problems for the consultant who is being asked to make a decision as to whether a disease is present. Most would agree that a person who is not distressed by homicidal thoughts is still suffering with a disease. Here again we have the problem attendant to the patients making the decision regarding whether or not a disease is present. I mention these problems because they lend confirmation to my belief that the nomenclature committee has had significant difficulties with the paraphilias, especially with regard to the question of whether they are indeed diseases (or, to use the committee’s euphemism, "disorders"). Such ambivalence is relevant to my theory about the etiology and purposes of the paraphilias.

The main point I will be making with regard to each of the paraphilias is that they do, in a way, serve the purposes of species survival and are therefore part of the natural repertoire of humanity. They serve this end by their ability to enhance the general level of sexual excitation in society and thereby increase the likelihood that people will involve themselves in activities that are more directly contributory to the reproductive (and, by extension, species survival) process. I recognize that for each of the paraphilias there are a wide variety of psychodynamic mechanisms that may be operative in producing the behavior. However, it is not my purpose here to discuss these in detail. Rather, I will only discuss those psychodynamic aspects that pertain to the aforementioned theory.

Exhibitionism is defined as:

Over a period of at least six months, recurrent intense sexual urges and sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one’s genitals to an unsuspecting stranger.

Although exhibitionism is primarily a male characteristic in its "raw form" (that is, as exhibited by "flashers"), it certainly does exist in women in a more subtle form. Seductive gesturing, provocative dancing (not necessarily by burlesque queens and go-go girls), and hysterical behavior generally involve some degree of exhibitionistic sexuality. Accordingly, when one considers these common forms of female exhibitionism, the behavior is much more common among women than men. Although the flasher may wish to startle and gain a sense of power and importance, much more than arouse sexuality, there is still that element operative in this clearly sexual act. And although the exhibitionistic woman may want flattery and attention, more than sexual gratification, the activity is still a form of foreplay and may very well lead to more overt sexual activity. For both sexes the behavior is designed (at least in part) to produce sexual hormone secretions into the bloodstream of the observer and enhance thereby the likelihood of sexual activity and reproduction.

We have strict rules in our society regarding when and where one can be sexually exhibitionistic. Furthermore, exhibitionism is more acceptable in women than in men. The principle is well demonstrated by the old observation: If a woman undresses in front of a window, a man in the street looking at her may be charged with being a voyeur ("peeping Tom"). In contrast, if a man undresses in front of a window and a woman in the street looks at him, he may be charged with exhibitionism (indecent exposure). These differences in social attitude notwithstanding, exhibitionism has survival value in that it provides visual stimuli that result in the kinds of hormonal secretions that may result in procreation.

Fetishism is defined as:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments).

The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., vibrator).

Here, too, the same principles hold. Often the object may be used in place of "the real thing" when sexual encounters with humans are not available. The fetishistic object may become the symbol of the human sexual object and bring about the same degree of excitation. Fetishism not only serves the purposes of sexual release, but also lessens the likelihood of the sexual organs "drying up." The practice thereby keeps sexual cravings alive and increases the possibility of reproduction. Even the person who may fear sexual encounters at that point, and uses the fetishistic object as a substitute, is keeping himself (herself) in the pool of sexually craving individuals and thereby increases the likelihood of species survival. Here again we see the principle that some of the fetishistic objects (such as vibrators) are borrowed from normal sexuality but are considered pathological when they are used in preference to the interpersonal type of sexual experience. I trust that the DSM-IV committee did not consider the use of vibrators per se to warrant the diagnosis of fetishism and recognized that their use as a "sexual aid" is "normal."

Frotteurism is defined as:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person.

These are the people who rub up against others in subways, buses, elevators, and other crowded places. They are people who are considered to be getting their "cheap thrills" in a socially unacceptable way. Once again, men are far more likely than women to be involved in this paraphilia and, once again, they are most often the initiators. This is consistent with what I have said previously about the male being genetically programmed to play the more aggressive role in mating pattern rituals. Women, however, cannot be considered to be completely free of this disorder. As every frotteur knows, there are a certain fraction of women who will not immediately recoil and withdraw, and thereby get across the message that they have no wish to participate in this activity. In spite of "rejections" by the majority of women, there are still enough around who will go along with the secret game and thereby gratify their own frotteuristic cravings without suffering social stigma.

I once interviewed a man who was a frotteur and who claimed that approximately 25 percent of all the women against whom he rubbed his penis responded. Most allowed him to masturbate himself against them, using the motions of the moving vehicle as the cover-up for their own more active participation in the process. Some even rubbed their vulvas against him, thereby gratifying themselves as well. On a few occasions the activity ultimately resulted in their going off together for a sexual encounter. Frotteurism also serves survival purposes. It increases the general level of sexual excitation and thereby increases the likelihood of sexual reproduction.

Pedophilia is defined as:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

The person is at least 16 years old and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

It is obvious that the DSM-IV nomenclature committee had great difficulty with this definition. The requirement that the person be "at least 16 years old" presents problems if a 15-1/2-year-old boy has a sexual experience with a five-year-old girl. Although he has satisfied the requirement that there be at least a five-year age difference between the two, he would not be considered a pedophile by this definition. In contrast, the jury before whom he is tried for this act (and for which he might get life imprisonment) might very well consider him to be a pedophile. Actually, the DSM-IV committee is not alone here. There is no good definition of pedophilia.

Whatever definition one uses, there are loopholes. One must make exceptions, such as the DSM-IV committee did. If one uses the dictionary definition, i.e., a sexual act between an adult and a child, one is immediately confronted with the problem of what constitutes an adult and what constitutes a child. Does adulthood begin at puberty, at 16, at 18, at 21? All of these ages (and others) have been used at various times by different societies (and even within the same society) as a cutoff point for the definition of adulthood. If one wants to use puberty as the point of differentiation, there are still difficulties. If a postpubertal 13-year-old has sex with a prepubertal 11-year-old, is that pedophilia? Most would say no. If a postpubertal 11-year-old has a sexual activity with a prepubertal 13-year-old, is the younger one then considered to have sexually molested the older? Again, we see that there is no end to the complications with any of these definitions. All of them attempt to define the parameters of unacceptability (whether psychiatric/diagnostic or legal/criminal) and all fail. Basically, the definition of a pedophile for a psychiatrist is what the nomenclature committee of the American Psychiatric Association considers to be a pedophile for that particular edition of DSM. And the definition by the legal system is not only the one recorded in the statutes of the particular state (and there is great variation), but what the jury decides is pedophilia on the basis of the evidence presented at the accused’s trial.

Pertinent to my theory here is that pedophilia also serves procreative purposes. Obviously, it does not serve such purposes on the immediate level in that children cannot become pregnant, nor can they make others pregnant. However, the child who is drawn into sexual encounters at an early age is likely to become highly sexualized and crave sexual experiences during the prepubertal years. Such a "charged up child" is more likely to become sexually active after puberty and more likely, therefore, to transmit his (her) genes to his (her) progeny at an early age. (I will have more to say about pedophilia in the next chapter because of its central importance to this book.)

The younger the survival machine at the time sexual urges appear, the longer will be the span of procreative capacity, and the greater the likelihood the individual will create more survival machines in the next generation. The ideal then—from DNA’s point of view—is for the child to be sexually active very early, to have a highly sexualized childhood, and begin procreating at the time of puberty. This increases the likelihood that more survival machines will be produced for the next generation.

Sexual Masochism is defined as:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.

Sexual Sadism Sexual masochism is intrinsically associated with sexual sadism. In fact, the two together are often referred to as "sadomasochism." Accordingly, I will present here the DSM-III-R definition of sexual sadism and then discuss both together:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.

Clearly, sadomasochism allows gratification of hostile impulses for the sadist. The motives for the masochist are not so obvious, but from the psychological point of view the individual is gaining some kind of gratification. For some people masochism serves to alleviate their guilt over sexual expression. Punishment can assuage guilt. Some people need the punishment afterward, and some before, and some at the time of the guilt-provoking act. Masochism may relate to identification with masochistic models, the feeling that this is the best that one can get, that more benevolent relationships would not be possible, and other psychological mechanisms that are beyond my purposes here.

Sadomasochism may also serve survival value. Sexual courtship patterns in our society have often been compared to a "hunt." The man, traditionally more assertive (as mentioned, I believe there is some genetic programming here, although environmental factors are certainly operative), seeks his "prey," the woman. If successful, he may consider himself to have made a "conquest." The woman’s role is generally one of passivity, coyness, and seductivity in which she lures the man to approach her and make sexual advances. (Here, again, I believe genetic factors play an important role, although environmental ones are certainly operative.) Domination enters here and, in extreme cases, rape. Accordingly, we see a continuum from the normal courting pattern of female passivity and male aggressivity to the more aggressive forms of sexual approach and domination, with a culmination in rape—the extreme example of domination. Every point on this continuum increases the likelihood that the woman will engage in a sexual act and thereby procreate.

Our society encourages women to be seductive, coy, and enticing and encourages men to be forthright, aggressive, and pursuing. The more coercive elements enter into the male’s behavior, the greater the likelihood our society will condemn him. The theme of pursuit and domination, however, is widespread. Many years ago I read a survey in which women were asked about their favorite movie scene. The one that took first place was a scene from "Gone with the Wind" in which Rhett Butler, overcome with sexual passion and frustration, grabs Scarlett O’Hara, picks her up in his arms, and runs up the stairs into the house and presumably up to the bedroom. We accept this as normal, but we will not accept more coercive elements. This reflects society’s repression of the animal within us: a male animal who has the potential for rape and a female animal who, by merely a small extension of permissible attitudes, may become masochistic—thereby gaining sexual pleasure from being beaten, bound, and otherwise made to suffer.

It may very well be that for some masochistic women, allowing themselves to be beaten into submission is the price they are willing to pay for gaining the gratification of receiving the sperm. When less aggressive partners are not available, partners who don’t take the domination factor too far, they will accept sperm from a sadistic individual, rather than not have any sperm at all.

I wish to emphasize again that I am placing no value judgments on these behaviors at this point. Rather, I am trying to explain the purposes of certain forms of sexual behavior that are found in every society and are dealt with differently by each society, and even by the same society at different times. Their ubiquity is a testament to the fact that they are natural, i.e., they are part of the human repertoire. We should not let our revulsion and condemnation of them interfere with our ability to understand them. In fact, it is through such understanding that we will be in a better position to decide how to deal with these atypical forms, from both the psychiatric and legal points of view.

Transvestic Fetishism is defined as:

Over a period of at least six months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

The comments I have made previously about fetishism are applicable to transvestic fetishism. In this form of fetishism the objects that cause the sexual arousal are not only female clothing, but cross-dressing, a particular utilization of female clothing. As noted in the DSM-IV definition, these men are usually heterosexual, are sexually aroused by wearing female attire, and are thereby more likely to engage in heterosexual activities—increasing thereby the likelihood of procreation and the passage of their DNA down to the next generation.

It may come as a surprise to the reader to learn that the majority of transvestic fetishists are heterosexual. Certainly, there are homosexuals who wear female clothing as a way of attracting men for sexual purposes. However, these people are different from transvestic fetishists. Female impersonators are probably the most well known examples of transvestic fetishists. With rare exception, they are heterosexual. It is of interest that DSM-IV does not have a pathological category for homosexual men who cross-dress, but only for heterosexual men. This is just one of the paradoxes that is to be found in DSM-IV, a paradox that derives from the diagnostic problems attendant to removing homosexuality from the list of psychiatric disorders.

Voyeurism is defined as:

Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.

Voyeurism is much more common in men than women. This is not surprising considering the fact that men are much more likely to be excited by visual stimuli than women. It is the men who stand on the street corner jeering at the women passersby. It is men who are much more likely to be sexually excited by pin-up magazines, pornographic movies, and videotapes. As mentioned, I believe this phenomenon relates to the hunter qualities that are much more apparent in males than females. Traditionally, men were the hunters and protectors. It was they who went out to kill animal prey and thereby provide food for their families. Hunting involves (and even requires) visual surveillance. And hunting animals for food is akin to hunting women for procreative purposes. Similar male attributes are involved. It is reasonable to speculate that there was a selective survival of men who were visually powerful and who were good at hunting prey for food and females for procreative purposes. We see here, then, an overlap with the domination element applicable to the understanding of sadomasochism.

DSM-IV then lists seven other paraphilias that are not only less common, but would probably be considered more pathological than the aforementioned. They all share in common, however, their capacity to enhance sexual arousal and to increase, thereby, the likelihood of heterosexual experience.

Telephone Scatologia (Obscene Telephone Call)

The man who involves himself in telephone scatologia (lewdness) is clearly trying to arouse a woman. (It is rare for women to involve themselves in this kind of activity.) Although one may claim that the man so involved is basically afraid of women (and this is probably the case), he is still getting sexually aroused by the practice, even though the arousal often culminates only in masturbation. There are occasions, I am certain, in which the woman is receptive and the overture ultimately results in heterosexual activities and therefore procreation. But even when this aim is not realized (certainly more often the case), the man is still keeping his "juices flowing" and preventing them from drying up, thereby not removing himself from the heterosexual potentially procreative scene.

Necrophilia (Corpses)

One could argue that necrophilia cannot possibly serve procreative purposes. I am in agreement that a dead woman is not going to conceive a child, but this is only half the story. Obviously, a man who must resort to having sexual intercourse with dead bodies has serious difficulties in his ability to relate well to live human beings. (Again, it is not my purpose here to discuss in detail the many possible psychological factors that are operative in each of these activities.) Yet, the necrophiliac is still keeping his juices flowing and increasing, thereby, the likelihood of heterosexual involvement with a person who is more likely to conceive. (For obvious reasons, necrophilia is almost unknown in females.)

Partialism (Exclusive Focus on Part of Body)

The factors operative here are very similar to those operative in fetishism. For reasons peculiar to that individual, a particular part of the body becomes the primary source of gratification. However, this symptom is not a strange one, considering the fact that all men (and to a lesser extent women) engage in it to a certain degree. Men’s breast fetish is probably the most well known example of this phenomenon. This preoccupation stems, in part, from the fact that the breast is the first "sex object" of the male (at least according to Freudian theory), and we live in a society in which breasts are indeed worshiped. Furthermore, we enhance the importance of these organs (which are basically bags of fatty tissue intermingled with milk ducts) by social conditioning. Covering them, under most circumstances, makes them more alluring, seductive, and therefore objects of interest. There are men who are similarly turned on by buttocks and vulvas. Interestingly, women are far less likely to exhibit this symptom. This is in part related to their being less aroused by visual stimuli and more aroused by caressing, cuddling, and activities that ensure the kind of depth relationship that will increase the likelihood that the lover will stay around after conception and provide protection for themselves and their children.

Zoophilia (Animals)

Zoophilia, which is reputed to be a traditional activity among farm boys, also provides for sexual release when other outlets are not available. It may also be attractive to those who may have fears and inhibitions regarding overtures to females, who are more unpredictable than animals regarding their sexual receptivity. Contrary to popular opinion, zoophilics do not generally have sexual intercourse with animals; rather, their main source of gratification comes from hugging, cuddling, and talking—in a manner similar to a child with a pet. The zoophilia then represents a fixation at an earlier level of psychosexual development. Although progeny are obviously not possible from such relationships, the individuals engaged in such zoophilic activities might be considered to be getting practice for more appropriate partners for the purposes of evolutionary survival.

Coprophilia (Feces)

Once again, one cannot ascribe immediate survival value to this practice. It is a derivative, however, of the polymorphous perversity of children who have to learn that touching their fecal eliminations and then putting their fingers (or feces) in their mouths is generally viewed in our society as a disgusting practice. Here, too, this enhancement of sexual stimulation increases the likelihood that the individual may turn to others and thereby contribute to the procreative process.

To the best of my knowledge, most people who are involved in coprophilic activities do not actually engage in putting feces into their mouths (although a small percentage do); rather, the activities most often involve defecating on one’s "loved one." The term also refers to the partner who becomes sexually excited by being defecated upon. Coprophilia is also related to sadomasochism in that the person who enjoys this activity is often involved in a sadomasochistic act with domination/submission and hostile release ("shitting on someone").

Klismaphilia (Enemas)

Anal stimulation in itself can provide sexual pleasure. Most people enjoy the gratification of a "good bowel movement," although it is not considered proper to talk about it in most circles. Furthermore, deep anal penetration, beyond the anus, can produce stimulation of the pubococcygeal muscles, which play an active role in orgasm for both males and females. Hence, an enema can be to the anus what the vibrator is to the vagina. Association of the enema with mothers who provided them in childhood may play a role in producing this type of sexual behavior. What is important for my presentation here is the fact that this kind of stimulation may serve as a prelude to heterosexual intercourse and thereby contribute to procreative purposes.

Urophilia (Urine)

One could argue that urophilia cannot possibly serve procreative purposes. There are children who continue wetting their beds—beyond the time when they should be "trained"— because they like the warm feeling the urine gives them when first passed. Of course, when it gets cold, they change their attitude about this practice. Here, again, the most common activity is not drinking urine (but a small percentage do), but urinating on the "lover." And there are those who become sexually excited by being urinated upon. This practice is analogous to coprophilia and relates to sadomasochism. Once again, the arousal may serve as a part of foreplay and ultimately results in procreative sexual acts.

Further Comments on the Paraphilias

It would be an error for the reader to conclude here that I view the paraphilias to be primarily, if not exclusively, genetically determined biological variants. Although I believe there to be a genetic loading for the paraphilias, I also believe that environmental factors are extremely important in bringing about such behavior. In fact, I consider environmental factors to be playing a more important role in the development of the paraphilias than I do in the development of homosexuality, which, as I will describe below, I also believe warrants being listed as one of the paraphilias. I say this because of the bizarreness of many of the paraphilias, a bizarreness akin to the kinds of "craziness" that justify placement in DSM-III-R. Many of the paraphilias are developed in an attempt to avoid intimacy, e.g., fetishism, telephone scatologia, partialism, zoophilia, and necrophilia. Others clearly allow for the release of hostility, which may be a more important factor than the sexual act that is serving as a vehicle for such gratification, e.g., sexual sadism, coprophilia, urophilia, and klismaphilia. Others derive from severe feelings of inadequacy, e.g., voyeurism, exhibitionism, sexual sadism, and pedophilia. Obviously, the psychodynamic factors operative in each of the paraphilias are quite complex, and it goes beyond the scope of this book to discuss these in detail. Even the aforementioned outline is an oversimplification in that there is much overlap and complexity to the many psychodynamic factors operative in each of the paraphilias.

One could argue that psychodynamically determined sexual inhibitions (which may contribute to the development of paraphilias) result from psychological problems that work against the expression of the primary sexual goals of DNA. Accordingly, one could claim that the very existence of the paraphilias weakens my theory. My response is this: Each of the paraphilias may be viewed as an atypical variant, as a mutant that does not primarily serve the purposes of procreation, but that may survive anyway because it can contribute (admittedly in an inefficient way) to the primary DNA goals. Similarly, the psychological inhibitions that interfere with DNA’s primary expression also work against its goals, but not completely so. The fact that some forms fail to live up to the high standards put down in the optimum configuration of genetic programming does not negate the theory. My reasoning here is similar to that which holds for the sexual dysfunctions (see below) in which there are failures of genital functioning, which may then interfere with the procreative process. The presence of these weaknesses or abnormalities does not negate the theory.

Sexual Dysfunctions

The sexual dysfunctions are essentially forms of pathology in which there is some inhibition and/or impairment in the individual’s capacity to engage in heterosexual intercourse. A psychogenic component is considered to be important in bringing about such disorders, but physiological factors may also be operative, especially in the presence of physical disease. These include: impairments in sexual desire, aversion to sexuality, impairment in the ability of a man to attain or maintain an erection, a man or a woman’s inability to achieve orgasm, premature ejaculation, dyspareunia (pain on sexual intercourse), and vaginismus (vaginal spasm on penile entry). Clearly, all of these difficulties interfere with the likelihood of procreation and thereby warrant being included as disorders or "diseases." Obviously, they represent a failure in the fulfillment of the individual’s capacity to achieve this important goal. The presence of these disorders in no way weakens my theory that there is no biological function (all of which have survival value) that may not be compromised by some disease process.


As mentioned, the last DSM-IV section on the sexual disorders allows for the diagnosis of homosexuality (as a sexual disorder) through the "little doggie door," a subsection of the "back door" of the sexual disorders diagnoses. I, myself, would include homosexuality as one of the paraphilias, whether or not one considers any or all of them to warrant placement in DSM-IV. (I recognize that I am in the minority of my colleagues when I take this position, but I believe that political factors, much more than scientific, determined its strange and somewhat confusing placement in the manual.) The argument that homosexuality is "unnatural" because it does not serve procreative purposes is not valid. It certainly is a natural variant, is within the potential of all human beings, and to the best of my knowledge has appeared in every society. Furthermore, as I will elaborate below, it also serves the procreative aims of the species, although not directly.

There are some who claim that the purpose of homosexuality is similar to that of nonreproductive variants that are to be found in many species. Worker ants would be an example. They play an important role in the survival of the ant colony but are not actively involved in the reproductive process. The argument is also proposed that homosexuals serve artistic purposes in that they are traditionally more artistically sensitive (art, literature, dance, theater, etc.). This theory never rang true for me in that these activities are very recent developments in the history of the human race and would not explain the existence of homosexuality at earlier times and the survival of genes that may very well predispose people to this type of sexual variation.

Although the homosexual genetic loading may very well have arisen as a mutation (as may have been the case for other paraphilias for which there is a high genetic loading), it has survived. There is great variation among mutations with regard to their survival capacity. Some mutants are incompatible with life and the particular form dies in utero. And there are a wide variety of diseases that are manifestations of mutations that can be lethal at any age and at any stage of life. If the mutation allows survival beyond puberty, then the individual is likely to transmit the mutant genes down to the next generation. Medical science may contribute to this process by allowing for the survival of certain mutations that in earlier centuries might not have survived to the pubertal level of development but, as the result of modern medical techniques, are doing so. This is just another example of the fact that medical progress may often be a mixed blessing.

Another theory to justify homosexuality is that it serves the purposes of population control. Although I believe that this theory has more to justify it than the one that holds that homosexuals serve artistic purposes, it also does not sit well with me. Nonreproductive variants usually serve some purpose, a purpose that is readily recognized. This does not appear to be the case for homosexuals. We are certainly witnessing a population explosion that is becoming ever more serious, and even dangerous. There is no question that we will ultimately have to provide more effective methods of population control than exist at this point. The longer we allow population to grow geometrically, the greater the weight one will have to give to this theory of the purpose of homosexuality. Perhaps at this point, when the dangers are not as grave, it is a less compelling theory. But acceptance of it must presuppose considerations (by DNA or some master planner) that go very much into the future. And this does not appear to be the way DNA works. It is very much oriented to the here-and-now for the purposes of immediate transmission to the next survival machine. Impulsivity and pleasure-of-the-moment considerations appear to be much more pertinent factors in its behavior than considerations of some remote future event. It is for these reasons, as well, that I am not significantly enthusiastic about the population-control theory of homosexuality.

Homosexual genetic programming has survived not only because we have not routinely killed all homosexuals (although certain societies have attempted to do so), but because homosexuals have not confined themselves sexually to people of their own sex, but have engaged in heterosexual activities as well. In fact, it is safe to say that the vast majority of homosexuals have had some heterosexual experiences. It is also a fact that male homosexuals are typically highly sexualized individuals, much more so than the average male heterosexual, and are well known for their "promiscuity," i.e., their strong need for frequent sex with a large number of sexual partners. Male homosexuals also will typically date the onset of their strong sexual urges to earlier periods of life than heterosexuals (Kinsey et al., 1948; Tripp, 1987). Homosexuality, then, if my theory is correct, serves the purpose of heightening the general level of sexual activity and increases the chances, thereby, that such individuals may involve themselves in heterosexual activities as well.

Homosexuality also increases the likelihood that children will become involved earlier in sexual activities, increasing thereby the likelihood of their becoming actively sexual in the postpubertal period. I am referring here to the homosexual who is also a pedophile (again, much more common in males than females). Like his heterosexual pedophilic counterpart, both contribute to the likelihood that children will become active heterosexual adults.

When I presented the above theory to a colleague of mine, Dr. Jonathan Greene, he suggested that homophobia may also have survival value. Homophobes are revolted by homosexuality and may actively attempt to constrain their behavior. In extreme cases they may even attempt to eliminate homosexuals entirely. (Adolph Hitler is a well-known example of a person who tried to do this.) One traditional explanation for homophobia given by psychoanalysts is that homophobes are basically uncomfortable with their own unconscious or dimly conscious homosexual urges. By eliminating homosexuality they protect themselves from the stimulation of their own "latent homosexual impulses." I do not deny that this may certainly be a mechanism in some (if not many) homophobic individuals. And, I do not deny that there are probably other psychological mechanisms operative in this aversion. Nor do I deny social influences that teach that homosexuality is an undesirable and even disgusting form of sexual expression. However, Greene has a good point in that homophobia has survival value in that a society cannot tolerate ubiquitous homosexuality. To do so would threaten its very survival. On a very primitive level, then, the battle between homosexuals and heterosexuals is a battle for DNA survival, even though homosexuality—in a more indirect way—does ultimately contribute to DNA survival. It is an inefficient method, however, and a society has to limit the degree to which it can tolerate inefficient methods of reproduction. And all paraphilias are inefficient when compared to the traditional heterosexual reproductive modes.

One could argue, then, that homosexuality justifiably belongs among the paraphilias. It certainly satisfies the basic requirement for such inclusion, namely, that the sexual behavior is atypical (practiced only by a minority of individuals in our society) and that it does not directly serve procreative purposes.

One could argue that all of the paraphilias (whether or not one wants to include in them homosexuality) should not be included in DSM-IV because the manual is devoted primarily to diseases. Although the term disorder is used, insurance companies still consider these variations diseases or illnesses. Exclusion of the paraphilias might deprive paraphilic individuals of the opportunity for insurance coverage if they want treatment for them. Should we therefore consider the insurance companies to be the final arbiters with regard to whether a behavioral manifestation warrants inclusion in DSM-IV? DSM-IV deals with this question somewhat obliquely by stating that in addition to the paraphilic behavioral manifestation, the individual must experience "significant distress" over the desire to engage in the paraphilic sexual practice. This, then, brings us back to the problem of patients making the decision as to whether or not the disease in fact exists. As a physician I would like to believe that a disease exists in its own right, separate from whether the patient considers it to exist and separate from whether an insurance company decides to provide coverage.

One could argue that something must be seriously deranged in a man who would prefer to have intercourse with a dead body than with a beautiful young woman. One could argue that there must be something seriously wrong with a man who would spurn sexual intercourse with an attractive and receptive young woman and, in preference, put his penis into the anus of another man. When we say that "something is wrong" with a person who engages in certain activities, we are basically saying that the individual is suffering with a psychiatric disorder. One could argue also that the probable genetic predisposition factor, a factor related to a mutation, also argues for the paraphilias to be considered psychiatric disorders. There are other psychiatric disorders that are considered to have a genetic basis, e.g., bipolar disorder and obsessive compulsive disorder (OCD). These certainly are "natural" in that they are to be found in nature, yet they are still considered to be diseases (or, euphemistically, "disorders").

It is a strange paradox that pedophilia is included as a paraphilia, but not homosexuality. Accordingly, if an adult’s primary source of sexual gratification is an individual of the same sex, the behavior is not considered to warrant inclusion among the paraphilias (or anywhere else in DSM-IV). However, if the adult desires sex with a child (whether of the same or opposite sex), that behavior is considered to warrant inclusion among the paraphilias. This paradox lends confirmation to my aforementioned statement that the exclusion of homosexuality from DSM-IV has much more to do with political than psychiatric considerations.

Another paradox derives from DSM-IV’s exclusion of homosexuality, namely, its considering cross-dressing among heterosexuals to be a disorder (Transvestic Fetishism) but not a disorder if the individual is homosexual. Accordingly, if a homosexual cross-dresses to entice and excite another homosexual, that is normal. If a heterosexual engages in such behavior, he (she) has a disorder. An even more important paradox is the inclusion of the Gender Identity Disorder of Childhood. There is an enormous body of research that demonstrates compellingly the high correlation between childhood gender identity disorder and homosexuality during adulthood. Some of the more well known of such studies include those of Bell and Weinberg (1978), Bell et al. (1981), Bieber et al. (1962), Green (1985, 1987), Money and Russo (1979), and Zuger (1970, 1976, 1984). Friedman (1988) provides an excellent review of these studies and states, "At present, I believe that this is the only correlation between psychopathology and homosexuality that may be taken as an established fact." We see here a strange inconsistency in DSM-IV. An effeminate boy would be considered by DSM-IV to be suffering with a disorder. Yet, when this same boy becomes an adult homosexual (a highly likely outcome), he no longer is considered to have a disorder; rather, his atypicality is viewed as a normal human variant. Again, I believe that political considerations, far more than psychiatric, have brought those who have made this decision to this inexplicable and even absurd inconsistency.

Although I could argue both ways, my preference would be that all the paraphilias (including homosexuality) be included in DSM-IV as paraphilias and, like bipolar depression and OCD, be considered diseases (or disorders) per se. I would exclude the proviso that the individual has to have distress in order to justify the diagnosis. The fact is that the person is not going to go into treatment if he (she) does not suffer distress, the DSM-IV statement notwithstanding. Atypicality, per se, has traditionally been a justification for inclusion in a list of psychiatric disturbances. There are societies in which paranoia and hallucinations are the norm. There are others in which catatonic people may be worshiped and/or considered to be invested by divine spirits. As Shakespeare’s Hamlet put it: "There’s nothing either good or bad, but thinking makes it so." Because atypical sexuality is "bad" in our society and because people who exhibit such behavior are going to have difficulties in our society, even though often (but not always) unjustified, we must make special provisions for dealing with them, both in the legal and psychiatric professions.


Social and Cultural Factors

It is extremely important that the reader appreciate that sexual activities between an adult and a child are an ancient tradition and have been found to exist to a significant degree in just about every society in history that has been studied in depth. The reader who is somewhat incredulous about what I have just said does well to read the very enlightening and well-researched article by Demause (1991), which documents the ubiquity of adult-child sexual activities in the United States, Canada, Latin America, Puerto Rico, Mexico, Scandinavia, Great Britain, Germany, Italy, India, China, Japan, Thailand, and the Middle East. His review covers the wide span of history from ancient times to the present. Demause’s 41-page article has 200 footnotes, each of which cites a list of further references supporting the statements made in the main body of the article. It provides compelling evidence that sexual activities between adults and children have been a worldwide phenomenon, the main difference between cultures being the attitudes toward this universal practice.

It is of interest that of all the ancient peoples, it may very well be that the Jews were the only ones who were punitive toward pedophiles. According to Kahr (1991):

The Hebrews of yore seem to have maintained a somewhat more progressive attitude toward pedophilia, and, according to the ancient Jews, anybody who engaged in sexual activity with a boy older than nine years of age would be stoned to death; however, those who copulated with boys under the age of nine received only a whipping, because the Jews did not consider boys under nine as sexual beings. (p. 201)

Early Christian proscriptions against pedophilia appear to have been derived from the earlier teachings of the Jews, and our present overreaction to pedophilia represents an exaggeration of Judeo-Christian principles and is a significant factor operative in Western society’s atypicality with regard to such activities.

Kahr (1991) provides further documentation of the ubiquity of child sex abuse, in the past as well as the present, with particular focus on ancient Greece, ancient Rome, ancient Egypt, and modern Western society—especially Europe and the United States. Kahr divides Western society’s attitudes toward adult-child sexuality into four stages:

1. The Ancient Period (comprising the times of the Greeks and the Romans). Adults seduced and violated their children in an unashamed and socially acceptable manner.

2. The Medieval Period (from the rise of Christianity through the Renaissance). Under the influence of Christianity, parents were made to feel guilty over their sexual inclinations toward their children and could not abuse them with impunity. A prominent feature during this period was the phenomenon of adults projecting their own sexual impulses onto children and assuming, thereby, that the children were the initiators of sexual activity.

3. The Early Modern Period (the 18th-early 20th centuries). The enhancement even further of guilt and shame over adult-child sexuality. Pedophilic impulses are gratified pornographically, and sub rosa.

4. The Late Modern Period (latter half of the 20th century). Progressive increase in the awareness of the ubiquity of the problem. Practically no social sanction. Abused children viewed as victims.

Konker (1992) also provides an extensive review of the literature on a wide variety of cultural attitudes toward adult-child sexuality. She provides compelling evidence for the conclusion that adult-child sexual behavior is ubiquitous and has been present in just about every society studied, both past and present. For example, she states:

In a variety of contemporary cultures it appears that adults may affectionately sniff, kiss, blow upon, fondle, and praise the genitals of young male and female children. . . . Valued adult-child sexual contact routinely occurs as part of initiation activities in at least twenty countries throughout the world. (p. 148)

Among contemporary indigenous groups in New Guinea there are some conscious cultural constraints on father-son incestuous relationships, but male children are traditionally sexually initiated by other adult males. Sexual sadistic practices are also widespread.

Again, in New Guinea, Konker (1992) states:

Various adults’ initiation practices may include sexual insults and threats, fellatio, sodomy, urethral piercing and bloodletting, and men rubbing semen on young boys. . . . Also, at initiation, Arapesh girls may have stinging needles rubbed on their bodies and thrust up their vulvas. (p. 148)

No knowledgeable individual seriously believes that the Judaic practice of circumcision (also practiced by Muslims and, interestingly, more recently by Christians) arose from the appreciation that such a procedure would protect an individual from the acquisition of certain diseases. Even now, most recognize this as a retrospective rationalization. I am convinced that the ritual is basically sexual-sadistic and that it is close enough to the obvious sexual-sadistic rituals described in detail by Demause, Kahr, and Konker to warrant this conclusion. The act is sexual in that it involves the penis. It is sadistic in that it involves a mutilation. To this day, certain Orthodox Jews require the circumciser to suck directly the blood from the circumcised penis. I myself personally observed this ritual when I was about 5 or 6 years of age and still remember it clearly. This too is sex in that it is clearly fellatio. And this too is sadistic in that the material being sucked from the penis is blood.

Accordingly, the view that pedophilia is a sickness and a crime is a reflection of Western society’s present position on this subject. I am a product of my culture and I am affected by the mores of the society in which I have grown up. I too have come to believe that sexual activity between an adult and a child is a reprehensible act. However, I do not believe that it is intrinsically so; in other societies and in other times it may not be psychologically detrimental. However, I live in my society and it is my job to help people who come my way to adjust—to a reasonable degree—to the society in which they live. I am not claiming that it is my job to make them rubber stamps of the prevailing mores of the majority, only to recognize what these mores are and to appreciate that if they are ignored the individual may be in deep trouble. The indicators listed here, then, are only applicable to our society, at this point, and are in no way presented as applicable to other societies, now and in the past.

I wish to emphasize the point that there is no such thing as "the typical personality" of the adult male pedophile. There are many kinds of individuals who engage in pedophilic behavior, and they cover a broad spectrum of personality types, with much overlap regarding personality qualities. Furthermore, it is rare to find a person who is exclusively pedophilic. Most pedophiles engage in other forms of sexual behavior, especially atypical behavior (Abel et al., 1988). Also, there are varying degrees of exclusivity, ranging from those whose sexual practices include a very high percentage of pedophilic acts and those whose pedophilia may be transient and circumstantial. And this is especially the case for female pedophiles.

Those whose pedophilia appears to be a lifelong pattern are generally referred to as "fixated pedophiles" (Groth, 1979b). These are people who generally never marry and present with a history of ongoing pedophilic acts extending back into adolescence and sometimes even earlier. At the other end of the continuum are individuals who are sometimes referred to as "regressed pedophiles" (Groth, 1979b). They are individuals who may have engaged in pedophilic behavior on one, or only a few, occasions. Often they are married and do not present with a history of significant involvement in a variety of atypical sexual behaviors. The closer the individual is to the fixated end of the continuum, the greater the likelihood the term pedophile would be warranted; in contrast, the closer the individual is to the regressed end of the continuum, the less the likelihood one could justifiably apply this label.

Early experiences play an important role in determining later patterns of behavior. This is especially the case if the early experience is an extremely powerful and gratifying one. Take for example a prepubertal child who has never experienced an orgasm, or may not have even experienced strong sexual urges. Imagine, then, this child being seduced into a relationship in which there is not only enormous flattery, and enjoyable caressing, but orgastic gratification as well. It is easy to see how a child might become "hooked" by such an experience and crave frequent gratifications of the same kind. It is easy to see also how this particular pattern may become the model for subsequent sexuality when the child grows older. As I will elaborate in Chapter Two, the pattern may become embedded in the brain circuitry and can thereby have a formidable effect on future sexual orientation. Furthermore, the older the child becomes, the more autonomy and the greater the likelihood that he (she) can be the initiator of such encounters. Even when the encounters may not be particularly gratifying, and even when there may be a fear element associated with threats regarding disclosure, the child may still become accustomed to this pattern and it may still become deeply ingrained. Even when associated with fear and pain, such early experiences may still become imprinted as the primary pattern of sexual encounter, so powerful are these early influences. When repeated, it may become the only pattern the child knows. We see here a similarity to sadomasochistic individuals who are brought up in homes in which that is the primary form of interaction between people, both in and out of the bedroom scene.

There are homosexuals who date the onset of their homosexuality to just such a childhood seduction. Years later, they may still recall it as one of the most dramatic and memorable experiences of their lives. It is easy to imagine how a youngster, who never previously had an orgasm, is not only introduced to this experience at that time, but the orgasm occurs in association with adoration and flattery unlike that ever previously received. For the youngster it may be a "mind-blowing" experience (the reader will please excuse the pun), one that may affect the future course of the child’s life. And, if such seduction occurs on a few occasions, the likelihood of the youngster’s going down the homosexual path may be even greater. Some of these youngsters go on to become homosexuals who confine themselves to adult relationships; others become pedophiles, their own pedophilic experience having played a role in that choice (more unconscious than conscious). There are many types of individuals who cause such imprinting in children. Sometimes the seducer is the child’s father (far less often the mother), uncle, grandparent, or other relative. It may have been a babysitter, teacher, neighbor, or lover of a parent. There are pedophiles for whom the imprinting process took place in the context of their serving as juvenile prostitutes. In some cases their families were living at poverty levels and relied upon their children’s proceeds from prostitution to contribute to the family’s support (Reeves, 1981; Phongpaichit, 1982).

Children’s normal childhood exploratory play may have a role in producing a subsequent pedophilic orientation. This is especially the case if such play becomes an ongoing pattern. The sexual object, then, becomes a child. Furthermore, if high emotional charge is associated with such activities, there is an even greater likelihood that the experiences will become embedded in the brain circuitry and contribute to the pedophilic orientation. In Chapter Two I describe a patient who attributes his pedophilic orientation to such childhood experiences. In his case, the emotional charge was intensified by his mother who, after discovering the exploratory activities, embarked upon weeks of tirades of condemnation.

It is important for the reader to appreciate that the imprinting factor is not so compelling that the child who is sexually abused will automatically and inevitably become a pedophile. Throughout Melanesia and New Guinea, childhood pedophilia is a common practice, yet most of the children involved in such activities do not become pedophiles as adults (Herdt, 1981). A dramatic example of this is to be found among the Sambia tribes of New Guinea. In that tribe, as is so true of other Melanesian societies, the ejaculate is viewed as a powerful vehicle for transmission of masculine power. It is not hard to see how it could symbolize such power, considering the ubiquity of the penis as a symbol of power, even in Western society. In the Zambian tribes boys live with their parents until the age of 8, at which time they move to a men’s longhouse, where they live only in the company of males. From ages 8 to 13 they engage in fellatio with adolescent boys in order to enhance their masculinity. Then, at around the time of puberty, they switch roles and become the providers of semen to the younger boys. Then, at age 19, they marry and pedophilic practices cease entirely.

Identification with the Aggressor

The imprinting factor refers primarily to neurological imprinting that may contribute to the development of pedophilia. Here I focus on the psychological elements that complement the biological brain circuitry element. The two may operate together. Stoller (1975, 1979, 1985) considers the identification-with-the-aggressor factor to be an important one driving pedophiles to involve themselves in pedophilic behavior. Specifically, many pedophiles have had childhood experiences in which they were sexually abused—experiences that were traumatic. (As mentioned, sexual activities with children need not be traumatic for the child.) One way of dealing with this trauma is to reenact it as an adult, with another victim. In this way the individual symbolically attempts to gain mastery over a childhood sexual trauma in which the individual was helpless. By reenacting the sexual activity as an adult, the individual temporarily turns a passively endured childhood trauma into an actively controlled adult triumph (Garland and Dougher, 1990). In addition, the pedophilic act may also serve to enable the individual to gain a feeling of revenge for having been subjected to the trauma, the built-up anger vented now on the abused child. Some confirmation for this theory is provided by the fact that pedophiles often reenact in great detail the same kinds of pedophilic activities that they were subjected to as children. Of course, one could attribute this simply to learning and the modeling effect, but it does provide some confirmation for the aforementioned theory. Longo (1982) and Groth (1979a) studied incarcerated pedophiles and found that they frequently recapitulated in great detail their own childhood sexual experiences. Sometimes the identification is with an adult who has not sexually traumatized the child in the course of the pedophilic act. In such circumstances, the concept of identification with the aggressor is not applicable. Here one might refer to it as "identification with the lover" and need not invoke the aforementioned more complex mechanisms.

In addition to the more specific identification with the sexual acts, the sexually molested child may identify with the general personality characteristics of the abuser. This is almost invariably the case in situations in which the abuser is a family member because children most often identify with their parents and other significant figures with whom they live. Under such circumstances, the identification is predictable. When, however, the abuser is not a family member one is also likely to see identifications, especially when there has been an ongoing relationship. This is most commonly seen in situations in which the abuser is a scoutmaster, teacher, or clergyman. The abuser may have served as a mentor, confidant, and model over many months and even years and so it is not surprising that the child will take on this person’s characteristics and behavioral patterns, both sexual and nonsexual.

The Domination Factor

I have already mentioned the importance of domination in species survival and how domination is an extension of the aggression and assertiveness that the male exhibits in the courting pattern. Children, because they are weaker than females, are more easily dominated and so are even more likely to be subdued by an aggressive male. Furthermore, in our social structure, children and females are generally viewed to be of lower status. This contributes to their attractiveness as objects for pedophiles for whom the domination factor is important. And this is one of the factors, as well, explaining why pedophilia is much more common in males than females, so much so that one could say that it is a male form of behavior. Demause (1991) states, "As an adult, the pedophile must have sex with children in order to maintain the illusion of being loved, while at the same time dominating the children as they themselves once experienced domination, repeating actively their own caretakers’ sadism."

Passivity and Impaired Self-Assertion

In contrast to the kinds of aggressive and domineering behaviors described above, there are some pedophiles who exhibit the opposite kind of behavior, that is, they are passive and inhibited in their capacity to assert themselves. Ayalon (1984) describes the nonviolent type of sex-abuse perpetrator. Peters (1976) also describes sex offenders as being characteristically passive and emotionally dependent. Overholser and Beck (1986) also found many of the offenders they studied to be unassertive. Sometimes individuals in this category have intellectual impairments or serious psychiatric disturbance and are willing to engage in a wide variety of atypical and even illegal behaviors into which they are coerced by more dominant individuals (such as gang or group leaders).

Similarities Between Children and Females

Children are much more like females than males. This is not only true with regard to their appearances, but their personalities as well. Children and females have less hair than males. The skin of the child is smooth, much more like that of a female than a male (Medicus and Hopf, 1990). The behavioral patterns that women exhibit in the courting process are much more like those of the normal patterns of children than those patterns exhibited by males in the courtship process. Flirting, cuteness, coyness, and seductive smiles are all part of the average child’s repertoire. Such patterns are reflected in many of the comments men make to women in lovemaking, e.g., "You’re my baby," "You’re my sex kitten," and "You’re very cute."

Furthermore, children are more like females than males in their desire for affection, intimacy, security, and trust in their relationships (Strassmann, 1981). Moreover, the adoration that the child has for the adult is similar to that which men strive for in their relationships with women. Such adoration is much more easily acquired from a child than an adult—thus the attraction of pedophilia. Of particular importance here is the esteem-enhancement element in such adoration, and this is one of the reasons why (as described above) pedophilia is particularly attractive to men with profound feelings of low self-worth. Also related is the eroticization of the parent-child love relationship. This, too, easily derives from the aforementioned factors (D’Udine, 1990; Garland and Dougher, 1990; Money, 1990). Pedophilia, then, may be viewed (at least in part) as a natural downward extension of the male’s attraction to the female. It may be viewed as a generalization of the male’s sexual courting pattern beyond what our society considers proper. The love/tenderness factor may be one of the reasons why a sexual encounter between an adult and a child is not necessarily psychologically traumatic.

Compensation for Feelings of Emotional Deprivation

Pedophiles often come from homes in which they grew up emotionally deprived and, in many cases, homes in which there was significant family dysfunction. An adoring child can provide a pedophile with compensation for feelings of deprivation that may have persisted from the pedophile’s childhood. And if the child involved is also the product of a home in which he (she) is suffering privation, then sexual involvement with an adoring adult may become even more attractive. Mention has been made previously of the somewhat complex psychological mechanism that may be operative here, namely, the one in which the pedophile projects himself psychologically onto the child who is the object of his ministrations and thereby satisfies vicariously his own need to be the object of intense affection. He thereby provides his projected self with the love that was not obtained during his own childhood. Furthermore, the boundaries between parental love and romantic love may become blurred. This not only contributes to the gratification provided by the projected self, but also the adoration provided the pedophile by the loving child (Eibl-Eibesfeldt, 1990).

Many authors have described this relationship between pedophilia and a family background of emotional neglect. Ayalon (1984) considers emotional neglect to be a factor in the nonviolent type of incest perpetrator. Weinberg (1962) considers emotional deprivation in childhood to have been present in most of the incest offenders he studied. Gebhard and Gagnon (1964) also found that the vast majority of incestuous fathers were products of emotionally depriving homes. Money (1990) describes indifference and neglect to be part of the family background of many pedophiles. Accordingly, there is strong support in the scientific literature for this relationship.

There is strong support in the scientific literature for this factor in the development of pedophilia. Finkelhor (1986) states that "this [sexual abuse in childhood] is one of the most consistent findings of recent research." Money (1990) also describes this phenomenon, with particular emphasis on the feelings of entrapment and dilemma that such youngsters experience. When this occurs, it may result in the eroticization of parental love (Eibl-Eibesfeldt, 1990). Longo (1982) reported that approximately half of the adolescent sex offenders he studied had been sexually molested in the prepubertal years. Becker et al. (1986) found that 23 percent of adolescent sex offenders had been the subject of pedophilic experiences. Frisbie (1969) found that 24 percent of a group of sex offenders of children reported childhood histories of sexual contact with an adult. Groth (1979a) found that 25 percent of sex offenders of children had childhood sexual experiences with adults. Condy et al. (1987) found that 37 percent of sexual offenders in his study had childhood sexual experiences with an adult at least five years older than themselves. Hanson (1991) reviewed the literature on the percentage of child molesters who themselves had been sexually abused as children. When the sample size was relatively small (less than 50), the rates of child sexual abuse varied from zero to over 60. However, as the sample sizes increased, the rates converged to between 20 and 30 percent, with an average for all studies of 28 percent.


The most common manifestations of narcissism are low tolerance for criticism; a grandiose sense of one’s importance; exaggeration of one’s achievements and talents, the feeling that one is particularly unique; preoccupation with fantasies of one’s success, power, brilliance, and beauty; a sense of entitlement, especially that one is particularly deserving of favorable treatment; the craving for constant attention and admiration; and impairment in the ability to give sympathy and empathy.

The narcissism so frequently seen in pedophiles is compensatory for underlying feelings of inadequacy. Many pedophiles have few if any accomplishments to point to, accomplishments that could enhance feelings of self-worth. They commonly present with a history of poor school and work performance, unsuccessful marriages, and significant impairments in their ability to form age-appropriate friendships. They have a strong craving to be loved and will gravitate toward children because children will so predictably be adoring of an adult who treats them kindly. Children are somewhat indiscriminate in their affection for and even admiration of adults. Accordingly, they are more likely to provide pedophiles with those adoring responses that can gratify the pedophile’s narcissistic needs. In addition, children are less likely to be aware of sexual inadequacies, such as impotency and premature ejaculation, which would obviously be a source of embarrassment to the narcissist who is clearly unable to handle the ego debasement associated with such inadequacies. Some pedophiles, like homosexual men, are so narcissistic that they actually masturbate looking at themselves in the mirror, using their own image as the source of sexual stimulation. Lang (1994) has also made this observation.

Many homosexuals—both those with and those without pedophilic tendencies—are extremely narcissistic. They are constantly "on stage" and are ever thinking about how they appear to others. This is one of the reasons why they may gravitate to an acting career. Their sexual attraction to other men (people who look like themselves) is yet another manifestation of this narcissism. Just as there is a segment of the heterosexual population that is pedophilic, there is a segment of the homosexual population that is pedophilic.

Leahy (1991) states, "The most common diagnosis of the child abuser is that of narcissistic personality disorder. It is thought that these individuals are seeking from their intimate encounters with children some affirmation that they are both loved and desired." Kohut (1977) also comments on the narcissism of pedophiles as a mechanism for compensating for their fragile sense of self-worth and their frequent experience of self-fragmentation. Crewdson (1988) considers the pedophile’s narcissism to be a direct result of the childhood sexual abuse to which many pedophiles have been subjected. Overholser and Beck (1986) found the pedophiles they studied to be socially inept, which is yet another source of feelings of inadequacy and often a result of it. Children are somewhat indiscriminate in their affection for and even admiration of adults. Accordingly, they are more likely to provide pedophiles with those responses that can serve to compensate for the pedophile’s feelings of inadequacy.

Peters (1976) found the offenders he studied to be suffering with deep feelings of inferiority and inadequacy. Medicus and Hopf (1990) state:

Because of their small size, lack of experience, and sense of insecurity, children and adolescents of either sex do not arouse feelings of inferiority, fear, and anxiety in adult males. Thus, children and adolescents can become "sexual objects" for males who in sociosexual relations with adults feel inferior or anxious. (p. 141)

Therefore, because children are so craving for affection, pedophiles may seek the affection of children, who are less likely to reject them and are more easily seduced into providing affection. In a more complex way, pedophiles may project themselves psychologically onto the children who are the objects of their affection. By observing the child’s pleasure, they satisfy vicariously their own need to be provided love by an adult. In this way they are reenacting and satisfying a childhood frustration. They identify themselves with a loving adult (something they had little experience with in childhood) and identify themselves with the recipient of their affections by projecting themselves simultaneously into the position of the child to whom they are providing affection.

Masochistic Factors

Involving oneself in pedophilic behavior in a society that condemns it vehemently and punishes it terribly, often providing mandatory life sentences for a first offense, makes one wonder about the motivations of individuals who involve themselves in this form of behavior. Mention has already been made of the poor judgment often exhibited by pedophiles, as well as my belief that people of lower-than-average intelligence are probably overrepresented in the pedophilic population. I suspect, also, that a strongly masochistic trend may exist in many pedophiles. After all, the risk of discovery is very great in that children are not famous for their ability to keep secrets. The threat of severe punishment does not seem to deter many pedophiles. Silva (1990), the incarcerated physician who wrote his autobiography from jail, describes himself to have continued to involve himself in pedophilic behavior even when he was out on bail for previous offenses.

Recent Social and Cultural Factors Operative in the United States

We live in a youth-oriented society. Younger women are generally considered much more attractive and desirable than older women. One factor in pedophilia may very well be the result of the downward extension and expansion of our youth-worshiping culture. A recent contribution may very well relate to the AIDS epidemic. Since the early 1980s, when AIDS was first described, there has been a growing expansion of the disease into the adult population. Children, having less sexual experience, may be viewed as safer sexual companions. At the time I write this (mid-1995), newspapers and magazines are describing an explosion of child prostitution in Southeast Asia, the clients being primarily Europeans and Americans. In accordance with ancient traditions, these children are often sold into sexual slavery, are sold to pimps by poor families, or are picked up off the streets after having been abandoned by their families.

Perhaps the "sexual revolution" that began in the ’60s is playing a role. The more permissive attitude toward all forms of sexual behavior may very well increase the prevalence of pedophilia. Perhaps the increasing psychopathy of our society in the last quarter century has played a role. Previously, people were more reluctant to indulge themselves in unacceptable and antisocial impulses; perhaps indulging in child sex abuse is yet another manifestation of the basic psychopathy that has been increasing in recent years.

Concluding Comments on Pedophilia

I am certain that other psychological factors are operative in the development of pedophilia. I have delineated here those that I consider to be the most important. The reader does well to approach each patient without preconceived notions regarding which particular factors may have been operative in bringing about the particular patient’s pedophilia. When interviewing pedophiles, I routinely ask the individual his (her) theory regarding its causes. Although the patient may initially claim ignorance, I have found that persistent questioning and encouragement of "guesses" will often provide me with valuable information regarding the psychogenic factors operative in its etiology. Generally, the individual provides a response that includes one or more of the factors described here.


I present here a theory that attempts to bring together a wide variety of human sexual phenomena and provides a common explanation for what may initially appear to be different disorders. Although each of these types of human sexual activity has its own set of causes (both genetic and environmental), they share in common the thread that they all potentially serve the ends of procreation (directly or indirectly), and therefore specifically the transmission of DNA down to the next survival machine.

Freud (1930) in his Civilization and Its Discontents points out that society must suppress and repress sexuality if any constructive work is to be done. If all individuals were free to indulge themselves in any form of sexual encounter, we would have little time to involve ourselves in the constructive work necessary for the survival of society. Gibbon (1776-1788) considers widespread licentiousness to have been an important factor in the decline of the Roman Empire. The biblical story of God’s destruction of the cities of Sodom and Gomorrah is certainly (at least) a metaphor for the same phenomenon. It may very well be true, as well, that intrafamilial sex, especially, had to be suppressed because of the rivalries that it engendered. Certainly most people in our society (sexual revolution notwithstanding) view sex as a special kind of relationship. This is especially true of women, who are much more oriented to the emotional-relationship element in sex. Women are much more oriented toward sexual exclusivity. The opposite side of the exclusivity coin is jealousy. A man, too, is not free from such jealous feelings, especially when another man has sexual opportunities with a woman with whom he is enamored. If it is true that such feelings are of ancient tradition and may have even existed in primitive times, then taboos against incest might have arisen in order to protect people from the devastating effects on the family of such jealous rivalries. Inhibitions have a way of spreading, often to areas that were not part of the central focus at the time of their origin, and this is what might have happened with regard to the widespread sexual inhibitions that we observe in Western society today.

I do not believe it is likely that inhibitions against incest arose from the appreciation that inbreeding may bring about the clinical expression of recessive genes and thereby produce an increase in maladaptive forms. First, I believe that this is a relatively late development in our understanding. In fact, it is probable that the relationship between sexual intercourse and pregnancy has only recently become understood, and this is especially likely to have been the case in societies in which a wide variety of sexual practices were engaged in at all ages. Furthermore, when a family is relatively free of undesirable genes, inbreeding can be beneficial in that it preserves the "purity" of the strain. I am certain that a wide variety of other factors have been involved in the development of sexual inhibitions, but it is beyond the purposes of this book to discuss them.

Mention has already been made of the fact that the paraphilias are much more common in males than females. I believe that the main reason for this difference relates to the aforementioned theory in which I consider men to be primarily involved in the quantity-control aspect of reproduction and women in the quality-control aspect. The biologically programmed "promiscuity" of men easily spreads to their being far less discriminating with regard to the receptacle in which they are willing to deposit their sperm. Accordingly, receptacles that may not immediately bring about an increase in the population may still be utilized, so pervasive and compelling are the urges. The obsessive-compulsive nature of the male sexual drive and the overrepresentation of males in the paraphilic population enhances, I believe, the credibility of my theory.

The presentation of my theory would not be complete without some discussion of masturbation. One could argue that it does not support the theory because this widespread practice serves absolutely no procreative function. In fact, it can be viewed as a "waste" of sexual urges because it does not lead to the transmission of DNA into the next generation of survival machines. I could argue even further that it defeats DNA’s purposes in that it allows for a reduction in sexual drive and therefore lessens the likelihood of the immediate quest for procreation. These arguments notwithstanding, I believe that masturbation also serves DNA’s purposes. It keeps the juices flowing and thereby contributes to the prevention of disuse atrophy of the reproductive apparatus. More importantly, it serves DNA survival in another way. It allows for the release and gratification of sexual tensions and cravings so that the individual may then be free to direct attention to other survival considerations such as the acquisition of food, clothing, and shelter. Without this form of release, individuals might be continually in a state of excitation and frustration and thereby not be able to provide proper attention to other activities necessary for the survival of the temporary housing machines. The genitals do not exist in isolation from the rest of the body. They require nourishment and protection. The survival machine cannot merely focus on providing opportunities for the copulatory organs to perform their function. Rather, it must also direct itself to other necessary matters that keep the genital organs in good health, functioning properly, and protected from danger. Such activities are not likely to be accomplished effectively and efficiently if the housing machine is distracted significantly by unsatisfied sexual cravings.

As mentioned, I have been particularly careful to avoid making any judgments about these atypical forms of human behavior. I believe, however, that many societies have been unjustifiably punitive to those who exhibit these paraphilic variations and have not been giving proper respect to the genetic factors that may very well be operative. Such considerations might result in greater tolerance for those who exhibit these atypical sexual proclivities. My hope is that this theory will play a role (admittedly small) in bringing about greater sympathy and respect for those individuals who exhibit these variations of sexual behavior. Recognizing that they do play a role in species survival may contribute to some alteration of this unfortunate attitude.

It would be an error for the reader to conclude that I am condoning all of these forms of sexual behavior. I think each one must be considered in its own right with regard to the judgments that one passes on them. An important determinant of my own judgments relates to the coercive element, especially when the coerced person is weaker and/or younger. Although pedophilia may ultimately serve nature’s purposes, it is still a form of exploitation of an innocent party. Sadomasochism may also serve the purposes of the survival of the human species, but it is basically a form of cruelty that we could well do without. I have mentioned that we differ from lower animals with regard to the development of the human brain, which has the capacity to suppress and repress those forces that press for indiscriminate reproduction of DNA and its passage down the generations from one survival machine to another. Also, consideration must be given to the social attitude toward a particular variation. It is a disservice to guide children along an atypical developmental track (especially when there is no evidence that their genes are propelling them along that path), because they will predictably suffer for their atypicality. I am not suggesting that we submit to every social prejudice. What I am suggesting is that we try to educate society to be less prejudiced and to be less condemning of those with paraphilias (especially those that do not cause harm to younger and/or weaker individuals).

Excerpted from Psychotherapy with Sex-Abuse Victims
True False and Hysterical
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