The Other Side of Desire (4 page)

“I think I can help you,” Berlin said.

“You do?”

The doctor talked of a patient drawn to earlobes, assuring Jacob that he was not so strange. “I think I can help,” he repeated.

“I don’t,” Jacob said.

“I can’t cure you. I don’t want you to have false expectations, because this will always be there. But I can help.” Berlin explained the anti-androgens, their effect on the sex drive, on physical arousal, and, too, their side effects, the possibility of developing breasts, the chance that his bone structure would weaken and warp.

Jacob was too desperate to take pause. “You might be able to control the physical, but not the mental,” he insisted, trying not to hope, straining to protect himself against disappointment. “You can’t control my thoughts.” And it was his thoughts, as much as anything, that he wanted to purge. He wanted to poison their source in what felt like the center of his hideous being.

“You’re wrong,” Berlin said.

“I hope I’m wrong.”

“You are. There will be a difference mentally.”

Jacob thought, You’re full of crap. You don’t know how strong this is. He said, “I’ll do whatever you tell me to do. I’ll pay you whatever it is. I just can’t take this anymore, I just can’t be this way anymore. Just tell me what to do.”

“I’ve never met someone so agreeable.” Berlin laughed gently.

“Usually I have to fight with people.”

“You’re not going to have to fight with me.”

BERLIN
hardly knew why he’d begun to steer, in college in the 1960s, from psychology to psychiatry—and toward a vision that focused on the biological, that saw nature as a more promising area than nurture in which to search for understanding of the sexual mind. He recalled learning, as an undergraduate, about a scientist who was altering drives like thirst by implanting electrodes in the brain, and he remembered studying the Heinrich Kluver and Paul Bucy experiment on the brains of monkeys: the surgical lesions inflicted on the monkeys’ temporal lobes, followed by the eruption of crazed sexual activity, not only with other monkeys but with an array of inanimate objects. And injury to the same region in the human brain could lead to the same sort of indiscriminate and unrestrained desire.

But in Berlin’s own telling, there was no moment, or series of moments, of decision or inspiration that had formed his vision. He didn’t seem to think in such terms. It was as though his way of seeing had happened to him for reasons impossible to know—exactly as he thought about the erotic directions of his patients. All the talk and introspection in the world couldn’t unbury the causes. When Jacob asked, during their first meeting, “Why am I like this?” Berlin answered, “It’s the way you’re wired.” When Jacob asked, at every meeting afterward, “Why? Why? I want an answer why. I need an answer why,” Berlin gave the same response, sometimes adding rhetorically, “Why are people gay?” When Jacob tried Berlin with a theory offered by his first therapist, that back in the second grade, frantic to avoid being called on because he couldn’t read, he’d kept his eyes on the floor, and that somehow, in those highly charged moments of yearning for escape, he’d started to eroticize his classmates’ feet, Berlin dismissed it.

And probably most in his field had grown doubtful of experiential explanations. But his sexologist colleague at Hopkins and at the mansion, Greg Lehne, told me that the link to Jacob’s second-grade classroom made “perfect sense. People’s sexual interests are very specific. Scientists now are inclined to look at genetic or prenatal issues, but why people become lovestruck at certain qualities, why we’re taken with a body type, or a shape of mouth or what a person’s nose looks like, or an aspect of warmth or a sadistic side—where do these interests come from? They must come through experience, through the senses.”

Lehne, with graying hair combed tightly back from a padded face, talked about how the prevalence of certain fetishes shifted with changes in the prevailing culture. Rubber fetishes had faded after the era of rubber training pants; hair fetishes had become less common as mothers and older sisters no longer made a ritual of letting down their tresses and brushing a prescribed number of times. It was impossible to quantify such shifts precisely, impossible to cite numbers for particular paraphilias, he said, but the changes could be traced by studying pornography and the hungers it catered to.

Lehne didn’t fully discount the genetic, the prenatal, but the physiology of the brain was, he suspected, profoundly affected by what the mind took in. He studied paraphilias as a way to peer in at the workings of all desire, and mostly he saw the directions of eros as learned, not inborn. “The lovemap cartographic system,” he had written, borrowing language from the legendary Hopkins psychologist John Money, “may operate like a multi-sensory camera that episodically takes photos of the immediate environment and stores them as depictions of the sexual terrain.”

A
young married couple had led Berlin to his career in sex. When he’d been a general psychiatric resident-in-training at Hopkins in the mid-seventies, a husband and wife had walked onto his ward. The husband carried a wooden club, about a foot long, with a heavy chain attached to it. They told of a guillotine-like hole he’d cut in their bedroom door. No permanent injury had been inflicted yet, but his fantasies were brutal, and their fear, Berlin remembered, was that “this was about to get very out of hand. He was afraid he would kill his wife, and she was afraid it could happen. They were simple people. She wasn’t even sure how many couples did or didn’t do this kind of thing.”

When he tried to discuss the case with his supervisors and fellow residents, Berlin ran into trouble. They seemed repelled by the subject, and Berlin was criticized merely for quoting the man’s crude language from his case notes, for reciting the phrase “jerk off.” Acutely he sensed the particular taint that attached itself, even amid a group of psychologists and psychiatrists, “to anyone who acknowledged something different about their sexual makeup.” He sensed a visceral unease with sex in general.

And hearing Berlin relate this story reminded me of an interview I’d done with a couples’ counselor in Manhattan. She told me that she and a group of colleagues spoke often about the fact that not only in individual but in marital counseling sex is frequently the last thing the therapist asks about—and that the subject may never be raised at all.

Berlin still kept the club the husband had turned over. It lay in a hulking antique safe in the basement of his mansion. He’d treated the man with an anti-androgen, and, he said, the patient reported that his sadistic fantasies had faded away but that he could still become erect and function sexually. It was a long time ago, and it was impossible to know to what extent this had been true. That anti-androgens could attack the sex drive in such a way as to neutralize a paraphilia while leaving some degree of conventional desire and potency intact was unusual but known to happen. Nothing about the brain’s and body’s system of arousal was understood well enough, then or now, to predict when it would. No one could explain it. Understanding of the forces of eros was as crude as the original comprehension of testosterone itself, a hundred and fifty years ago, when a German zoologist had snipped off the testes of young roosters and watched their bright red combs atrophy along with their interest in nearby hens. If he took the severed balls and implanted them in a rooster’s belly, all returned to normal, suggesting that the testes secreted a substance crucial to sexuality—a hormone that was discovered ninety years later by a Dutch scientist, who used almost a ton of bulls’ testicles in isolating less than a third of a gram of testosterone.

After two or three years, the couple with the club drifted out of touch; Berlin never heard from them again. He had only the weapon as a memento of the case that had stirred his fascination and started him on his career. At Hopkins, John Money became an early mentor. A decade earlier, Money had taken on the case of a baby boy whose penis had been seared off in a botched circumcision. The parents worried that he would never be able to live as a man, and Money, a pioneer in his work with hermaphrodites and a believer that gender and sexual orientation are determined through social learning in early childhood, persuaded the parents to raise the boy, Bruce, as a girl, Brenda. Bruce’s testicles were clipped, and a rudimentary vagina was constructed. Brenda took estrogen to help her grow breasts. Following his patient, Money wrote about her thriving as a girl, and the case was celebrated in
Time
magazine and in the
New York Times
.

He wrote, too, about paraphilias, cataloging and often coining the names of all the types, from acrotomophilia, “a paraphilia of the stigmatic/eligibilic type in which sexuoerotic arousal and facilitation or attainment of orgasm are responsive to and dependent upon a partner who is an amputee,” to zoophilia, the desire for an animal. The paraphilias were, in Money’s view, imprinted in childhood; they were the product of learning more than biology, nurture more than nature. Considering why sexual deviations are, so far as scientists know, mostly limited to the human species, he pointed to the sophistication of the human brain. Erotic “diversity,” he explained, “may be an inevitable evolutionary trade-off—the price paid for the freeing of the primate brain to develop its uniquely human genesis of syntactical speech and creative intelligence.”

Money’s thinking was defiantly humane. He spoke about men like Jacob, and about sexual sadists and necrophiliacs and pedophiles, as people living not merely with deviant lust but with “disorders of love.” He was willing to apply to paraphiliacs the typical connections between initial desire, falling in love, and long-term “pairbonding.” He might have argued that, condemned by his condition, a man like Michael Ross was searching not only for sex but for love, in his murderous way. He talked about the tenderness and love often felt by pedophiles for their victims; he insisted that these emotions had validity and could be returned. “If I were to see the case of a boy aged ten or eleven who’s intensely erotically attracted toward a man in his twenties or thirties, if the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way.”

Berlin was taken with the complexity and bravery of his mentor’s ideas, but he was more tempered in his thinking, and he never shared Money’s faith in the importance of nurture over nature. He felt, now, that time had proved him right. Brenda, with her surgically built semblance of a vagina, and with her drug-induced breasts, had, despite Money’s published reports, never taken on a girl’s psyche, though she’d been brought up as a girl by her parents and never told about the circumciser’s accident and psychologist’s experiment that had decided her gender. She had refused to have further surgery to construct more complete genitalia. She felt alien and violent and distraught, and at last, when she was fourteen, her father confessed all that had been done. Soon Brenda set out to become a man, to become what biology had made her. She underwent a double mastectomy. She had a penis and testicles created from grafts and plastic. She injected testosterone to give herself a man’s muscles. She named herself David. And eventually David killed himself.

Berlin talked about this failure, and another—with pedophiles. “Money was the first person to use medicines to lower testosterone. His theory back then, and I hope I’m doing justice to it, was that you give people a vacation from their sexuality and that gives psychotherapy time to work. Myself and some other researchers, with his permission, we took a look at the outcomes. And what we found was that as long as the people were still taking the medicine they were not reoffending, but a very high percentage who had the psychotherapy—once they stopped the medicine they did reoffend. We now don’t look at the medication as a treatment while you’re waiting for psychotherapy to work; it’s more like insulin for diabetes. This is what you need over the long haul to keep you in control of yourself.”

Thinking about the sources of particular desires—Michael Ross’s for the sadistic; Jacob’s for feet; the most prosaic erotic preferences of the most prosaic heterosexual—Berlin acknowledged the potential role of childhood experience but couldn’t much credit it. The connections seemed loose and unlikely ever to be conclusively demonstrated. He believed that the sources would eventually be found, primarily, in the realm of biology, that they would prove to be “programmed in,” as technology advanced to better illuminate the brain. He lamented the loss of free will that his prophesy seemed to imply, worried that such biological determinism supplanted the idea of mind as opposed to brain, feared an Orwellian world where neurological understanding would be precise enough so that the sexual regions of the brain could be manipulated to eliminate variations of desire or so that sexual anomalies could be detected in the womb and fetuses could be aborted accordingly—but the truth of biology’s inborn power seemed inescapable.

To Berlin, the only solution with someone like Jacob was to fight biology on its own terms, no matter how crude the weapon—to prescribe an anti-androgen and hope that, with lust obliterated, Jacob would find within himself at least a faint version of conventional longings. This had happened not only with the sadist who’d handed Berlin his club but, more recently, with another patient. Berlin’s gynecologist voyeur, who’d lost his practice and barely avoided prosecution before coming to Berlin for help, told me that on Lupron sheer lust was completely killed but that other yearnings—for pleasing a partner, for conforming to the society’s notion that a married couple should be having sex—continued to motivate. “The skin on skin,” he added. “The feelings of being close to someone. And the orgasm still feels good. Though you’re not fired up by the primitive side of your brain. So sex can seem a very messy thing, like more trouble than it’s worth, like why bother.” He mentioned that he used Viagra, which Berlin prescribed for some of his patients on anti-androgens, patients who’d gotten control of relatively harmless paraphilias, so that, devoid of the urgency of lust, they might be able to become erect and carry out their more tender longings. He mentioned, too, that his penis had shrunken slightly since he’d started taking Lupron. Then he laughed: “I wonder what would happen if all men went on it for six months. Think about the advertising industry. All those commercials aimed at the primitive sexual urge. They’d have to find a new way to sell SUVs and beer.”