A Fun Fact About Leo Kanner

I just started reading Roy Richard Grinker's book Unstrange Minds: Remapping the World of Autism, and in a chapter on the early history of autism (covering Kanner and Asperger, plus Eugen Bleuler's and Sigmund Freud's use of the term "autistic" to describe aspects of other conditions, and also stories of feral children, whom Grinker believes were probably autistic), I came across this anecdote:

In 1943, a New York psychoanalyst named Abram Blau wrote a paper in which he argued that whereas there were numerous words, proper and slang, for the penis, there were few words, and virtually no slang words, for the analogous organ in women, the clitoris. Based on this assumption, Blau made grand arguments about the universal symbolic importance of the penis to humanity. Kanner, as evidence-based as anyone in psychiatry at that time, was furious about Blau's assumption, based on no data collection at all, and quickly wrote a paper with the dry title "A Philological Note on Sex Organ Nomenclature," which he published in a psychoanalytic journal. In it, Kanner listed dozens of words for the clitoris, from languages all over the world, and all of them, he claimed, from memory. He destroyed Blau's argument.

Grinker included it to illustrate Kanner's prodigious memory, which Grinker believes was one of the "subclinical," autistic-like traits Kanner possessed that may have given him insight into the inner lives of the children he studied.

I'm posting it here because I think it's funny. Male psychoanalysts and their penis fixations never cease to amuse me.

(Unfortunately, the only copy of the article I can find online is here, with the full text only accessible to subscribers to that website. So I can't find any of the words Kanner listed, which is annoying.)

Andrea Dworkin on Female Rebellion

In her book Intercourse, Andrea Dworkin includes a chapter on female virginity, citing Joan of Arc and the two female saints who inspired her as examples of celibate women refusing to live the narrow, cramped lives to which their societies consigned them. For these women, their virgin state was both a practical strategy (since it's easier to risk your life when you have no children who depend on you, and no husband whose property you legally are) and a defiant gesture in itself:

The Church that killed [Joan of Arc] may now identify her as a martyr; but for women inspired by her legend, she is a martial hero luminous with genius and courage, an emblem of possibility and potentiality consistently forbidden, obliterated, or denied by the rigid tyranny of sex-role imperatives or the outright humiliation of second-class citizenship. Women have many martyrs, many valiant pacifists, sung and unsung; few heroes who made war. We know how to die, also how not to kill; Joan inexplicably knew how to make war. At her trial, Joan insisted that she had never killed on the battlefield, improbable since the combat was hand-to-hand; but she was known among her own men for standing against the commonplace practices of sadism on the battlefield. It is hard to believe that she did not kill; but whether she did or did not, she was an exemplary martial liberator -- nearly unique in the iconography and history of the European female, that tamed and incomprehensibly peaceful creature. Joan's story is not female until the end, when she died, like nine million other women, in flames, condemned by the Inquisition for witchcraft, heresy, and sorcery. Precisely because she was a hero whose biography brazenly and without precedent violates the constraints of being female until the terrible suffering of her death, her story, valorous and tragic, is political, not magical; mythic because she existed, was real, not because her persona has been enlarged over the centuries. Her virginity was not an expression of some aspect of her femininity or her preciousness as a woman, despite the existence of a cultish worship of virginity as a feminine ideal. She was known as Joan the Maid or, simply, The Maid ("La Pucelle"). Her reputation, her declaration, preceded her, established her intention and her terms; not in the context of being a holy or ideal female but in the context of waging war. Her virginity was a self-conscious and militant repudiation of the common lot of the female with its intrinsic low status, which, then as now, appeared to have something to do with being fucked. Joan wanted to be virtuous in the old sense, before the Christians got hold of it: virtuous meant brave, valiant. She incarnated virtue in its original meaning: strength or manliness. Her virginity was an essential element of her virility, her autonomy, her rebellious and intransigent self-definition. Virginity was freedom from the real meaning of being female; it was not just another style of being female. Being female meant tiny boundaries and degraded possibilities; social inferiority and sexual subordination; surrender to male force or violence; sexual accessibility to men or withdrawal from the world; and civil insignificance. Unlike the feminine virgins who accepted the social subordination while exempting themselves from the sex on which it was premised, Joan rejected the status and the sex as one thing -- empirical synonyms: low civil status and being fucked as indistinguishable one from the other. She refused to be fucked and she refused civil insignificance: and it was one refusal; a rejection of the social meaning of being female in its entirety, no part of the feminine exempted and saved. Her virginity was a radical renunciation of a civil worthlessness rooted in real sexual practice. She refused to be female. As she put it at her trial [a full transcript of which is available online here - Lindsay], not nicely: "And as for womanly duties. She said there were enough other women to do them."

...

We have role models; Joan had voices. Her voices were always accompanied by a radiance, illumination, an expanse of light. She saw angels and was visited by saints. Her two special voices, guides and consolation, were St. Catherine of Alexandria and St. Margaret of Antioch. While many of the elaborations on their legends show the iconoclastic individuality of the two saints, the main outlines of their lives -- the substance of their heroism -- were virtually identical. Both were desired by powerful men (heads of state), turned them down, were tortured and decapitated. Both were in mortal combat with male power, were militant in their opposition to it, did not capitulate, and were killed for resisting. Both were virgins.

St. Catherine was the patron saint of unmarried girls and also of philosophers and students. She was famous for her erudition, one of the rare and great women of learning. Her father, a king, wanted her to be married but she kept turning down suitors. One night she dreamed that Mary, holding Jesus, asked her if she wanted to be his bride. She said yes, but Jesus turned her down because she was not a Christian. She got baptized; that night Jesus, surrounded by angels and saints, put a wedding ring on her hand. When the Emperor Maxentius ordered all the Christians in Alexandria killed, Catherine went to him to argue for her faith. The Emperor made her debate fifty learned men, skilled orators; she won each debate and the fifty men were burned. The Emperor wanted Catherine for his mistress and promised that her image would be worshipped everywhere if only she would make a sacrifice to the gods. She refused, for Jesus and her faith. The Emperor threw her into prison and she was terribly tortured. The Catherine wheel, an instrument of torture, was invented for the purpose of eviscerating and killing her; but an angel destroyed the wheel. Catherine was killed by decapitation.

St. Margaret was the patron saint of peasants and women in childbirth, the latter not because she had children but because she was swallowed by the devil in the form of a dragon, and her purity and resistance were so great that he had to spew her up again whole and unhurt. Viewed as someone miraculously reborn uninjured, she became a symbol of hope in the life-and-death agony of childbirth. Margaret's father was a pagan priest, but she was secretly baptized. She tended animals in the fields. The governor, Olybrius, saw her, wanted her, and had her brought to him. She refused him and declared her faith. She was imprisoned, flogged, and terribly tortured. In prison she was swallowed by the dragon; and when she triumphed over the dragon, the devil confronted her again, this time in the form of a sympathetic man who told her that she had suffered too much:

But she seized his hair, hurled him to the ground, and placing her foot on his head, exclaimed:
"Tremble, great enemy. You now lie under the foot of a woman."

She was burned, torches applied to various parts of her body, but she acted as though she felt no pain. She was killed by decapitation.

The legends of both saints were well known in Joan's time and environment, common stories for everyone, not arcane anecdotes for the educated. The narrative details were so familiar that an evil and stupid person was even referred to, in the common parlance, as an "Olybrius." Women were named after these saints and celebrated name days. These saints were figures of mass adoration in stories of adventure, romance, and heroism. There was an elaborate and epic imagery in the churches to communicate visually the drama and scale of their bravery and martyrdom. The artifacts and paintings in the churches told the stories of the saints and their heroism and suffering in dramatic, graphic pictures; a bold, articulate, mesmerizing iconography not rivaled for effect until the invention of the wide screen in cinema. St. Catherine was pictured with the wheel named for her, St. Margaret with a dragon, both with swords. They were shown with swords because they had been decapitated, but the abridgement of the narrative into a martial image conveyed militance, not just martyrdom. Each faced what amounted to a state-waged war against her person: the whole power of the state -- military, physical, sadistic -- arrayed against her will and her resistance and the limits of a body fragile because human. This goes beyond the timorous ambition of today: a woman fights off a rapist. Each of these women fought off a rapist who used the apparatus of the state -- prison and torture -- to destroy her as if she were an enemy nation. Each refused the male appropriation of her body for sex, the right to which is a basic premise of male domination; each refused a man in whom male power and state power were united, a prototype for male power over women; and each viewed the integrity of her physical body as synonymous with the purity of her faith, her purpose, her self-determination, her honor. This was not a puerile virginity defined by fear or effeminacy. This was a rebel virginity harmonious with the deepest values of resistance to any political despotism.

Joan identified deeply with these women ... [s]he learned from them the way a genius learns: she did not repeat them in form or in content; she invented new form, new content, a revolutionary resistance. Joan did not die because men desired her; but because she refused the status, including the outward trappings (female clothing), of one who could be so desired at all. Virginity was one dimension of her overall strategy, one aspect of her rebellion; and, interestingly, her refusal to have sex with a man was not a dogmatic or ideological one. As Marina Warner points out in her book on Joan, the name Joan called herself and by which she was widely known, La Pucelle, "denotes a time of passage, not a permanent condition." Her own testimony at her trial seems to confirm this nuance:

Asked whether it had been revealed to her that if she lost her virginity she would lose her good fortune, and that her voices would come no more to her.
She said: That has not been revealed to me.
Asked whether she believes that if she were married the voices would come to her,
She answered: I do not know, and I wait upon Our Lord.

Had Joan simply learned a Church precept by rote or had she wanted to conform to a theological code of sexual purity, she would have held virginity to be a sacred state of being, one that would ennoble her for the duration of her life, a passive state intrinsically holy and magical with God's blessings. In her society, virginity was "an ideal wreathed in the finest poetry and exalted in beautiful Latin hymns and conventual chants." It was a common belief cited as fact by Church authorities with whom she came into contact that "God had revealed to virgins ... that which He had kept hidden from men." Instead for Joan -- and Catherine and Margaret -- virginity was an active element of self-determined integrity, an existential independence, affirmed in choice and faith from minute to minute; not a retreat from life but an active engagement with it; dangerous and confrontational because it repudiated rather than endorsed male power over women. For all three women, virginity was "a passage, not a permanent condition," the precondition for a precocious, tragic passage to death. As rebellion, virginity amounted to a capital crime. No woman, however, had ever rebelled the way Joan of Arc, virgin, rebelled.

Later in the chapter, Dworkin contrasts Joan's rebellion with the rebellion of a much later --- and fictional --- French heroine, this one created by a male novelist:

[Gustave Flaubert] wrote what a current paperback edition of his masterwork hails as "the greatest portrait ever written of a woman's soul in revolt against conventional society." The book is not about Joan of Arc. It is, instead and on the contrary, about Emma Bovary, a petite bourgeois whose great act of rebellion is to commit adultery. With this woman, called "my little lady" by her creator, the modern era begins: the era of the petite bourgeoisie seeking freedom. Female freedom is defined strictly in terms of committing forbidden sexual acts. Female heroism is in getting fucked and wanting it. Female equality means that one experiences real sexual passion -- driven to it, not faking. There is an equation between appetite and freedom, especially promiscuity (as one form of appetite) and freedom. A romantic distinctly not in the traveling, lyric tradition of Shelley or Byron, indeed, a female romantic with lightness in the head and fragmented fantasies feverish on the brain, "she had a cult for Mary Stuart and enthusiastic veneration for illustrious or unhappy women ... who stood out to her like comets in the dark immensity of heaven ..." For Emma, Joan was such a comet, a figure of fantasy, in the ether, not ever having lived on earth in the framework of real human possibility. Emma's mind, murky with religious and romantic fantasy, wanted "the rare ideal of pale lives, never attained by mediocre hearts." In her sentimentality, "she loved the sick lamb, the sacred heart pierced with sharp arrows, or the poor Jesus sinking beneath the cross he carries"; and in her effete impotence, "[s]he tried, by way of mortification, to eat nothing for a whole day. She puzzled her head to find some vow to fulfill." Alternately agitated and bored, having a mind filled with fantasies rather than ideas or possibilities, having no purpose or commitment, having no action, no vocation, only the boring chores and obligations of domesticity; too self-involved to find either passion or emotion in commonplace human relations, including motherhood, she is incapable -- to use the language of Iris Murdoch -- of moral or artistic excellence, defeated because she is immersed in personal fantasy, "the chief enemy of excellence," "the tissue of self-aggrandizing and consoling wishes and dreams which prevents one from seeing what is outside one." ...

Preoccupied with fantasy, Emma does not see or experience the world outside herself except as a deprivation of attention from her inner fog, and so she remains essentially untouched -- by the husband who fucks her and by human possibility in the wider world of real events. Virginity is redefined through her, given a modern meaning: a woman untouched is a woman who has not yet felt sexual desire enough to be made sick by it, experienced sexual passion enough to crave it, and broken rules in order to be carnal; a woman fucked by her husband but feeling nothing, or not enough, no lust, no romance, no brilliance of sensation, is still a woman untouched. This new virginity of body and soul survives marriage, and marriage itself generates new, incoherent fantasies of romantic or sexual grandeur: "Domestic mediocrity drove her to lewd fancies, marriage tenderness to adulterous desires." There is no freedom, no heroism, no ambition, no equality, outside the domain of sex experienced as carnal passion and also as the breaking of a rule. Danger is in the extremity of feeling and the risk of flouting convention; and the danger verifies the authenticity of the event, hidden from history yet having the significance of a male act of freedom inside history. The large, brave world of Joan becomes the tiny, suffocating world of Emma: and in it we still live. The old virginity -- with its real potential for freedom and self-determination -- is transformed into the new virginity -- listless, dissatisfied ennui until awakened by the adventure of male sexual domination: combat on the world's tiniest battlefield. It took Freud to call the refusal to fight on that little battlefield "repression" and to name the ambition to fight on the large one "penis envy." The cell door closed behind us, and the key turned in the lock.

A Popular Mis-Conception

This post of Urocyon's, about zoologists who can't seem to stop describing animal behavior in terms that reflect the values and norms of one particular human culture*, reminded me of the chapter in Natalie Angier's Woman: An Intimate Geography about the ovum and how its role in reproduction is commonly (and wrongly) understood in terms of traditional Western conceptions of gender: Man acts, Woman is acted upon; Man creates, Woman nurtures, etc.
One of the more obvious, and literal, examples of applying this gendered binary to human reproductive biology is the understanding of conception shown in Book I of Aristotle's On the Generation of Animals:

That, then, the female does not contribute semen to generation, but does contribute something, and that this is the matter of the catamenia [menstrual blood?], or that which is analogous to it in bloodless animals, is clear from what has been said [earlier in the passage], and also from a general and abstract survey of the question. For there must needs be that which generates and that from which it generates; even if these be one, still they must be distinct in form and their essence must be different; and in those animals that have these powers separate in two sexes the body and nature of the active and the passive sex must also differ. If, then, the male stands for the effective and active, and the female, considered as female, for the passive, it follows that what the female would contribute to the semen of the male would not be semen but material for the semen to work upon. This is just what we find to be the case, for the catamenia have in their nature an affinity to the primitive matter.
...
[W]henever one thing is made from two of which one is active and the other passive, the active agent does not exist in that which is made; and, still more generally, the same applies when one thing moves and another is moved; the moving thing does not exist in that which is moved. But the female, as female, is passive, and the male, as male, is active, and the principle of the movement comes from him. Therefore, if we take the highest genera under which they each fall, the one being active and motive and the other passive and moved, that one thing which is produced comes from them only in the sense in which a bed comes into being from the carpenter and the wood, or in which a ball comes into being from the wax and the form.

This understanding dominated biology from the days of ancient Greece until the 18th century; some early biologists, like Nicolaas Hartsoeker, took this idea of sperm-as-seed/womb-as-flowerpot to its logical extreme of thinking there was a tiny person already fully-formed inside the sperm cell! (Hartsoeker is the one who drew the cute little sketch shown near the top of this post. There's even a little star inside its tiny head, which I'm guessing represents a soul).

Even once the actual mechanics of fertilization became known, and people realized that women's ova also contain genetic material**, there was still a tendency to describe the male and female gametes' roles in Aristotelian terms of passive, receptive egg and moving, active sperm. The sperm are said to compete against each other to reach the egg, thereby ensuring that the hardiest, best one goes on to develop into an embryo.

The truth is actually more complicated, and involves more of an interplay between egg and sperm.

I don't currently have Angier's book on hand --- my partner, a sometime anatomy teacher and amateur sex educator, is borrowing it --- but I do have my developmental-biology textbook from college, Scott F. Gilbert's Developmental Biology, Seventh Edition. It ought to include everything Angier mentioned, and probably more, too.

Anyway, four processes that occur in the egg stick out to me as giving the lie to the notion of the female gamete as an inert substrate, awaiting the action of the "winning" male gamete:

1) In order to find the egg at all, sperm depend on signaling molecules secreted by the egg, which allow the sperm to track where the signals are coming from and adjust their trajectories accordingly.

2) Sperm undergo a chemical transformation called capacitation once they've been in the uterus for a while, without which they're unable to pass through the cumulus, or layer of ovarian follicular cells associated with the egg. During capacitation, the sperm cell membrane changes composition: uterine proteins remove cholesterol, and some of the proteins and carbohydrates embedded in the sperm cell membrane are also stripped away. The membrane also hyperpolarizes (i.e., the difference in net electrical charge between opposite sides of the membrane becomes bigger), which somehow triggers a cascade of protein phosphorylations (which, as I've mentioned before, can either activate or inhibit a protein) which ultimately allows the sperm to recognize, bind to and fuse with the egg.

3) For the sperm to be able to release its genetic material into the egg, a protein in the egg's zona pellucida, or thick outer coating of glycoproteins, has to bind to the sperm and initiate a process called the acrosome reaction, which is a signaling cascade involving G proteins (I've written about them before, too) and a mass influx of calcium ions, set off by surface proteins on both sperm and zona pellucida weaving together, and which results in the release of the protein-digesting enzymes contained in the acrosomal vesicle. These enzymes bore a tunnel through the zona pellucida that allows the sperm to reach the egg cell membrane.

4) Once a given sperm cell has fused membranes with the egg, another chemical reaction takes place, modifying zona-pellucida proteins so that they can no longer bind to any additional sperm-cell surface proteins. This causes the swarm of sperm cells that has gathered around the zona pellucida to lose their grip on it and disperse before any more of them can deposit genetic material inside the egg.

So, the egg guides the sperm toward it, draws it in as it approaches, triggers the acrosomal reaction that allows the sperm to penetrate the dense zona pellucida, and, once that sperm has fused with the egg and deposited its genetic material inside it, it prevents any others from doing likewise.

"Material for the semen to work upon," indeed!

*Have a guess as to which one. No prize if you said "white Christian Anglo-American capitalist patriarchy," sorry!

**The egg actually contributes a bit more DNA to the eventual embryo than the sperm does, for two reasons: 1) sperm cells can have either an X or a (much smaller) Y chromosome, while the egg always has an X; and 2) sperm cells are super-streamlined, containing only a nucleus and a sac of cell-membrane-dissolving chemicals called an acrosomal vesicle within their cell bodies, while the egg has a normally-sized and -populated cytoplasm, which includes mitochondria, which have their own vestigial genomes. (Sperm have mitochondria, too, but they're associated with the flagellum and do not enter the egg during fertilization).

I Wanna Be Sedated

(Cross-posted to Turner & Kowalski)

A few weeks ago, the German pharmaceutical company Boehringer Ingelheim completed a Phase III clinical trial (results of which were presented at the 12th Congress of the European Society for Sexual Medicine last month in Lyon, France) of a drug it hopes to market as a treatment for Hypoactive Sexual Desire Disorder in women.

The drug in question is flibanserin, which had been tested as an antidepressant in the 1990s and found not to be very effective. It has also been studied in animals, to test for anti-anxiety and anti-psychotic properties, but neither of those effects were demonstrated sufficiently to warrant any clinical trials in humans.

Flibanserin interacts with three major receptors in brain, nerve and blood-vessel tissue: first, there's the 5-HT-1A receptor (5-HT, or 5-hydroxytryptamine, being another name for serotonin), to which flibanserin binds with relatively high affinity. Though it exhibits a huge preference for this receptor in cloned tissue, it binds with about equal affinity to it and to the 5-HT-2A receptor in vivo. (See this review article for a detailed discussion of the pharmacology of flibanserin; I will attempt to summarize what I think is most relevant here).

Once it does bind to the 5-HT-1A receptor, flibanserin acts to boost its activity. This activity consists of setting the receptor's associated G proteins loose in the cell to block the production of cyclic AMP, a "second messenger" molecule that can go on to tell the cell to do all sorts of different things. (There's a cartoon illustration here of this process occurring in a neuron, with the anti-anxiety medication busiprone acting as the 5-HT-1A agonist. Though flibanserin acts a little differently than busiprone does --- it acts preferentially on somewhat different tissue types --- the general process within the cell is the same; the only difference would be where exactly it binds to the receptor, and what exact conformational changes it induces in the receptor to lead to the dissociation of the G proteins).

Though it might seem like blocking this receptor would cause the cell to do nothing, it's a bit more complicated than that. Due to the different ways in which different biological processes are regulated, the absence of a signal might activate some processes even as it suppresses others.

Some of the physiological processes which are activated by suppression of cyclic AMP (through the action of serotonin receptor 1A) include: peripheral vasodilation (i.e., dilating blood vessels throughout the body), which leads to both lower blood pressure and lower body temperature; stimulation of the vagus nerve, which causes the heart rate to slow; release of dopamine in the brain, which leads to, among other things, feelings of pleasure and satiety; faster, shallower breathing; release of norepinephrine in specific parts of the brain, which induces pupil constriction in the eyes; and reduction in extracellular levels of serotonin, glutamate and acetylcholine in the brain (the latter two of which are excitatory neurotransmitters that encourage neurons to fire; having less of them around will have a dampening effect on brain activity in general).

Flibanserin also acts on two other receptors: the aforementioned 5-HT receptor 2A, and the dopamine receptor D4.

It acts as an antagonist on 5-HT receptor 2A, binding to it and inhibiting its function. This is a somewhat complementary mechanism to its activation of 5-HT receptor 1A, since the latter receptor triggers an inhibitory cascade, while the former's action is excitatory --- i.e., rather than blocking cAMP synthesis, 5-HT receptor 2A, on ligand binding, stimulates it, leading to a variety of intracellular activities: in neurons, it leads them to fire, or to be more receptive to passing along electrical signals from adjacent neurons; in smooth muscle cells, it triggers contractions; in platelet cells, it leads them to clump together and speed up blood clotting and wound healing; through stimulation of the "pacemaker" neurons that control the heartbeat, it leads the heart to beat faster, and, through stimulation of neurons in the cortex (5-HT-2A receptors are particularly dense in sensory areas of the brain; according to Wikipedia, this receptor is a major target for a lot of powerful hallucinogenic drugs, like mescaline, psilocin and LSD), heighten sensory perception and sharpen learning, thought and emotion, particularly anxiety.

In short, both of the major pathways by which flibanserin affects the nervous system serve to slow down physiological processes, quiet the mind, and dull the senses. It's a sedative, as Borsini et al. make clear in the "Behavioral Effects" section of their review article on the "Pharmacology of Flibanserin":

Rats seem more sensitive than mice to the inhibitory effects of flibanserin on motor activity. In fact, reduced motor activity was observed at doses of 8 to 16 mg/kg, i.p. [intraperitoneally], in rats, and no reduction in motor activity was seen with doses up to 32 mg/kg, i.p., in mice. Flibanserin induced failure to grasp the wire in the traction test ... in 50% of mice at a dose of about 45 mg/kg, i.p., or 95 mg/kg, p.o. At 64 mg/kg, p.o., mice also displayed hypomotility and hypothermia. These effects were more pronounced at 128 mg/kg. At this high dose, the following additional alterations were also observed: reduced grip strength, ptosis [droopy eyelids] and head weaving, and occasional catalepsy.

Sedating effects were also apparent in the recently-released results of the clinical trials in humans, which Neuroskeptic summarizes here:

What about the side effects? There's a whole poster about them. 100 mg nightly caused 14% of patients to drop out [of the trial] due to side effects, vs. 7% of placebo - so 7% of people decided it wasn't worth it. It caused dizziness, nausea, fatigue, somnolence - and bizarrely, also insomnia. 50 mg daily was worse than 100 mg nightly, which suggests that taking this at night, rather than in the morning, is a good idea. But given what it's meant to treat, you'd want to do that anyway, right?

But this leads into my biggest problem with this data. It's obvious from the side effects data that the drug is a sedative - it makes you tired and sleepy. The animal data confirm this. It's much more likely to put you to sleep than it is to make you enjoy sex in any given month. Off the top of my head I suspect it's a sedative because it's a 5HT2A antagonist.

(Neuroskeptic also points out the cheesy names of individual trials --- the overall study was made up of several trials at different sites in North America and Europe, each one involving about five hundred participants, and each one named for a different kind of flower. DAHLIA, DAISY, VIOLET, and --- of course --- ORCHID. Subtle.)

Neuroskeptic also raises the point --- which I agree with --- that that flibanserin's mild aphrodisiac effect might be an artifact of its sedating effect. A sedative that's not so powerful it just knocks you out relaxes you, lowers your inhibitions:

Any sedative can increase sexual desire as anyone who has ever been to a bar will know. So whether this drug actually has an aphrodisiac effect, as opposed to just being a sleeping pill, is anyone's guess. To find out, you'd need to compare it to a sleeping pill, say, Valium. Or a couple glasses of wine. Until someone does that, we don't know if this drug is destined to be the next big thing or a big disappointment.

I can think of several possible instances in which that might be enough to dramatically improve someone's sex life. It might be that for women with vaginismus (a condition in which the vagina clenches and spasms, sometimes painfully, whenever anything enters it) who want to have penetrative sex but can't*, the sedating effect might allow us to relax enough to do that. Along similar lines, people who have PTSD from being raped, but who are now in a relationship they chose with a partner they trust, and genuinely want to have sex with, but who nevertheless find certain sex acts (or maybe even all sex acts) triggering, might want something to help minimize the reflexive physiological effects of their trauma. Finally, women who lose interest in sex in the context of a long-term relationship, which might well include shared spaces, shared responsibilities, and shared relationships with both/all partners' friends and relatives, might find this medication helpful in banishing everyday stresses that might otherwise kill the mood.

However, as both of those articles (as well as this one) indicate, a purely mechanical "fix" is only a good idea when the problem is also mechanical --- as in my first example, of the straight woman with vaginismus who wants to have penetrative sex but can't, because her vaginal muscles contract uncontrollably. (I would actually recommend this pill more wholeheartedly to people who are suffering from some kind of overarousal --- "arousal" here in the physiological sense, not the strictly sexual --- that actually interferes with sex, as in vaginismus, or an anxiety/overload problem, than I would to people whose libidos have greatly diminished over time for unknown reasons, because, while the latter group might be in just as much distress over their impoverished sex life, I am less confident a sedative would actually help them much in that department).

In some (most?) of the other cases, where an underlying problem in the woman's --- or the couple's --- life, like, say, an unequal distribution of household labor, leads her not to want as much sex with her partner because she's exhausted, angry, depressed, alienated or feeling unappreciated, no pill can correct that, and implying that any problems the relationship may have are the woman's fault because she's "frigid" or "wired wrong" or whatever seems to me like it would only aggravate any feelings of anger or alienation she might have.

This About Sexuality column spells out all the additional, not purely physiological factors that influence sexual desire:

Defining Sexual Desire

Sexual desire is not an easy thing to define, as even researchers involved in the flibanserin studies acknowledge. The model presented by BI [Boehringer Ingelheim] researchers involves breaking down desire into three elements, which include:

Drive, referring to spontaneous sexual interest that is somehow biological or hardwired (what this actually looks like is only a guess).

Belief & values, including social, cultural, ethnic, religious, and other factors that impact how often we might feel sexual desire, how intensely we feel it, and how comfortable we are with it.

Motivation, which considers all the psychological and interpersonal factors creating a willingness to be sexual and feel sexual desire.

The pitch from BI researchers is that while good treatments exist for low sexual desire caused by beliefs, values, and motivation, we don't have anything to treat the drive component (which they call the "biologic" component). They believe that flibanserin treats the drive component of sexual desire.

...

BI conducted several studies in North America and Europe involving over 5,000 pre-menopausal women who had been diagnosed with HSDD. In their publicity campaign, they focus on the North American studies (more on that below) and included just over 1,300 women. The average age was 35 and most of the women were married and the average length of relationships was over 10 years.

...

They haven't offered any rationale for why the drug produced statistically significant results in the "biologic" component in North America but not in Europe. I suspect the answer to that question may be messy as it would likely refer back to non-"biologic" elements of sexual desire, thus pointing out a problem with the premise of the research.

After the six month study there were participants who stopped taking the drug [and] reported that their sexual desire did not diminish. Whether this suggests that the drug is having a permanent effect on their brain chemistry, or that brain chemistry is not in fact a significant factor in most cases of low sexual desire remains to be explained.

Finally, I was interested to hear one of the researchers say that most women in the study reported that their low sexual desire crept up on them over a period of time. If, as the researchers argue, problems with low desire are drive related, hard-wired or biological, why would they appear slowly? Are they suggesting that there are precipitating factors influencing low sexual desire? If so, would effective treatment not want to address those factors before they go altering the brain chemistry of otherwise healthy women? One consideration in a low desire creep may be age, but these studies were of pre-menopausal women with an average age of 35.

Besides the brushing aside of interpersonal or environmental factors, like relationship difficulties, stress, or an unequal division of labor (whether inside the home, outside it or both), and the assumption that, in any heterosexual relationship where one partner wants sex a lot more than the other (and, of course, it's assumed that the "one partner" is male and the "other" female --- women with high levels of sexual desire and men with low levels are heavily stigmatized, and either ignored or pathologized in most discussions of sexual health), the third feminist qualm I have about a libido-boosting pill for women (and, specifically, this particular libido-boosting pill for women) relates to agency.

People who are socialized into a feminine role** in this culture are already bombarded, almost from birth, with lessons in objecthood. Our bodies, our time, our attention, our space --- none of these things are really seen as ours; they're all considered more or less public property, and the things we choose to do with them not important or legitimate in their own right. We learn to be passive, especially in the company of men. Whatever it is, he needs it more than you do. His needs, wants, ambitions, and dreams are real. What are yours?

In the face of this training, women learn to seriously second-guess their own wishes. For me, personally, this means that I set much higher minimum standards for "no" than I do for "yes." I have to be really, really averse to something to say "no" to it, while to say "yes," all I have to do is not have any serious qualms about it. Mildly ambivalent? That's a yes. Apathetic? A yes. Vague distaste that can't be explained or articulated? Yes again.

This is, of course, a very bad thing when the propositions being agreed to so dutifully, but with so little real enthusiasm or volition, involve doing fairly invasive things to one's body.

*This category, you can see in this comment thread at IBTP, does not include all women with vaginismus or vulvar pain. Many of the commenters there are perfectly happy with their penetration-free sex lives, or with their voluntary celibacy. This latter notion --- that there are people who either do not feel sexual desire, or who don't feel it particularly strongly and are more or less indifferent to sex, and that these states of being are perfectly healthy --- is still not shared by many people, as this asexual blogger demonstrates.

**Not all of whom grow up to be women

"Autogynephilia" and the Clinical Gaze

Starting last fall, when I wrote these posts on the American Psychiatric Association's ongoing project of drafting/revising the DSM-V, I've been kicking around a draft of a third post in that vein, this time concentrating on the doings of the Sexual and Gender Identity Disorders Work Group.

As you might infer from how long it's taken me to write said post, this entails opening up a huge can of worms.

I've also found I'm in way over my head with a lot of the issues involved, so I think I will intentionally avoid delving too deep into them; instead, I will point you to other people's writings that I've found illuminating.

Briefly, what's at stake is whether trans sexualities and gender identities will continue to be seen as "disordered" --- whether the category of Gender Identity Disorder* will be retained in the DSM-V. While the Gender Identity Disorders sub-workgroup is reportedly consulting trans advocacy organizations as part of its literature-review process, the makeup of the larger workgroup, and the prominence in leadership positions of two of its particularly worrisome members, introduces a strong bias towards viewing transgenderism and -sexuality as pathogies.

Here are some links that discuss the Sexual and Gender Identity Disorders Work Group --- and what its inclusion of Kenneth Zucker and Ray Blanchard means for trans people --- in greater detail:
Julia Serano, "Why feminists should be concerned with the impending revision of the DSM" (a guest post at Feministing.com)
Kelley Winters, "Transvestic Disorder and Policy Dysfunction in the DSM-V" (GID Reform Weblog)
Lena Dahlstrom, "Drafts from the DSM-V workgroup are out, and they're continuing to pathologize trans people" (Trans Group Blog)
Helen G, "APA Task Force reviews possible Gender Identity Disorder treatment guidelines" (Questioning Transphobia)

Now, I'd like to discuss one of the many trans-unfriendly ideas being brought to the DSM-V table: autogynephilia.

This nouveau-Greek concoction (meaning, I guess, "love of oneself as a woman") encapsulates Ray Blanchard's ideas about trans lesbians --- i.e., that they are straight men who fantasize about being women. (Blanchard also tends to refer to trans women as men: in his taxonomy, straight trans women are "homosexual transsexuals," while trans lesbians are "non-homosexual transsexuals." This can be quite confusing, apart from being just plain disrespectful to the people being talked about). Their femininity is thus taken for a sexual fetish rather than a component of their core identity.

Julia Serano has a lot to say on this topic --- not just about autogynephilia, but also about what she sees as the "sexualization" of MTF transgenderism by psychiatry.

Here's a summary of how she sees this sexualization play out (quoted from this description of a paper she presented at a 2007 conference for women in psychology, which became a chapter in her book, Whipping Girl):

The fact that MTF spectrum transgender people bear the brunt of our culture's fascination with, and demonization of, transgenderism, indicates that they are culturally marked, not for failing to conform to gender norms per se, but because they "choose" to be female and/or feminine. The notion that MTF transgender people are conceptualized within a traditionally sexist framework (i.e., one where femaleness/femininity are viewed as subordinate to maleness/masculinity) is perhaps most evident in the way that transsexual women (but not transsexual men) are hyper-sexualized in pornography and the media, wherein they are typically depicted as sex workers or as "sexual deceivers" who supposedly lure innocent straight men into sexual encounters. Implicit in all of these representations is a rigid, dualistic, heterosexual male-centered dichotomy in which only men can be viewed as legitimate sexual initiators and where womenare invariably viewed as sexual objects. In the context of this "predator/prey" dichotomy, transsexual women are consistently viewed as inviting their own sexualization by virtue of their feminine expressions and their physical transitions to female.

Understanding this predator/prey dichotomy allows us to make sense of psychological/psychiatric discourses of transgenderism, which have historically focused almost exclusively on MTF transgender individuals, while largely discounting female-to-male (FTM) transgenderism. For many decades, the diagnostic criteria devised for MTF transsexuals required them not only to be heterosexual and gender-conforming in the female role, but also to be sexually desirable in the eyes of heterosexual men. Those MTF spectrum transgender individuals who were unable or unwilling to meet all of the prerequisites for sexual object have typically been cast as sexual initiators and relegated to a distinct "paraphilic" category --- e.g., transvestic fetishism or autogynophilia. The positioning of this latter group (who are conceptualized as "men" who inappropriately fetishize female/feminine expressions in themselves) in opposition to "true" or "primary" MTF transsexuals (who are cast as willing objects of heterosexual male desire) reiterates the predator/prey dichotomy, thus preserving both the male/female and heterosexual/homosexual binaries. In this context, the invisibility and under-theorization of FTM transgenderism within psychology and psychiatry can be viewed as a direct result of the predator/prey dichotomy, which assumes that FTM spectrum individuals cannot be legitimate sexual initiators in their assigned sex (female), nor can their identified/preferred sex (male) be legitimately objectified.

Serano's thesis, in other words, is that the fear and hatred directed at trans women --- and the particular scrutiny the psychiatric profession directs at them --- derives from misogyny. If women are loathsome and inferior, then what kind of boy or man would choose to become a woman? The answer most commonly proposed by trans-misogynists is that such a man would have to be extremely, pathologically obsessed with sexuality (because, of course, women are sex!) of a particularly questionable stripe --- either the predatory sexuality of the transsexual "deceiver" of straight men, or the masturbatory and fundamentally narcissistic sexuality of the autogynephile.

Hopefully, you can now see where the "gaze" of my title comes in. The "autogynephilia" model does two things to the interaction between doctor and (trans lesbian) patient that skew it from a neutral, professional interaction to an exercise in sexualized power relations: first, it places the patient's sexuality on the clinical agenda, even when she has not made it an issue. Sexuality is seen as fundamental to her identity in a way that it would not be if she were cisgendered. Second, her sexuality is assumed to be wrong --- immature, paraphilic, disordered --- before anything is even said. She can therefore be silenced, or dismissed, or have her words twisted around, if what she says doesn't fit with the theory; because she is decided a priori to have deep-seated psychosexual issues, everything she says regarding her gender expression or sexuality can be considered suspect.

I think these two tendencies within this theoretical model constitute a pretty serious double standard --- the sexualities of trans women are probed and interrogated to a degree that no other sort of person's would be, unless that person had asked for help with a sexual problem. Thus, both because of a disproportionate rummaging through trans women's sexual quirks, and because of a selective attention to those trans women's own stories, the theory of autogynephilia as a cause of MtF transsexualism can't really be falsified. Nobody asks cis women if they find their own femaleness or femininity arousing, and Blanchard, Bailey and other "authorities" see no problem ignoring trans women who claim not to experience that.

*While the existence of GID as a category of mental illness perpetuates some seriously transphobic assumptions --- i.e., that trans people have something horribly wrong with them and need to be fixed, one way or another --- it also makes sex-reassignment surgery more accessible to those trans people who desire it, since by being the recommended "treatment" for the "disease" of GID, the surgery becomes much more justifiable in the eyes of insurance companies. I take this more as an indication that the U.S. health-care system sucks than a ringing endorsement by trans advocates of the medical model of transness, though.

Wacky Magazine Ads from 1934

While perusing some old pulp magazines from the 1930s, mostly of the true-crime variety, I ran across a couple of ads that stopped me right in my tracks with their hilarious zeitgeistiness.

They were both for books; books which I imagine have vanished in the mists of time.

First, this one, for what seems to be a sex book of the "marriage manual" subtype:

Notice the title of the book: "Sex Harmony and Eugenics."

(You can find a clearer image of an ad for the same book, with some of the same text, on the last page of this reprint of a 1937 "Modern Mechanix" article. One thing that differs between the two is the identity of the book you get for free with your order of "Sex Harmony and Eugenics" --- in the ad pictured above, you get "Why Birth Control?", while in the ad from "Modern Mechanix" you are offered the expansively titled "Philosophy of LIFE," which is described as a frank discussion of "the difference in construction and function of man and woman.")

The above ad, besides astonishing me with "Eugenics" as apparently part and parcel of the sex ed of its day, also amused me with its purple prose about "The Forbidden Secrets of Sex" and the alternately swoony and disapproving faces in the accompanying photo.

Some samples:

Away with false modesty! At last a famous doctor has told all the secrets of sex in frank, daring language. No prudish beating around the bush, no veiled hints, but TRUTH, blazing through 576 pages of straightforward facts.

Some will be offended by the amazing frankness of this book and its vivid illustrations, but the world has no longer any use for prudery and false modesty.

Lost love ... scandal ... divorce ... can often be prevented by knowledge. Only the ignorant pay the awful penalties of wrong sex practices. Read the facts, clearly, startlingly told ... study these illustrations and grope in darkness no longer.

(Hee hee. "Grope in darkness" --- there's a double entendre for you!)

There are also two (separate, of course) lists of what the author thinks "EVERY MAN SHOULD KNOW" and "EVERY WOMAN SHOULD KNOW." The men's list features such items as The Sexual Embrace, Secrets of the Honeymoon, How to Regain Virility, Glands and the Sex Instinct, and Sexual Starvation, while the women's list includes How to Attract and Hold Men, Intimate Feminine Hygiene, a Birth Control Chart, What to Allow a Lover to Do, and the requisite horror stories on Prostitution and Sexual Slavery of Women. In other words, men learn how to perform sexually (and, with the chapters on "sexual starvation" and regaining "virility," they learn that they are expected to perform sexually, whenever presented with the opportunity) while women learn that they are to be sexual gatekeepers, "allowing" lovers to do only what Good Girls Do, and shouldering all the responsibility for birth control and proper mate selection while making sure to stay attractive and receptive enough to hold the man's interest.

I was able to find pages from this book on the Eugenics Archive website, and I think this image taken from there illustrates perfectly the book's attitude toward women's sexuality:

The woman who is truly educated about sex, y'see, doesn't endeavor to find out anything for herself, by reading novels or erotica or seeking out sexual experiences. No, she is content to let her mother tell her everything she needs to know, and to remain a virgin until marriage and then dutifully have procreative sex with her eugenically-approved husband.

Good to know that, then as now, talk of liberated, informed sexuality is really only meant to apply to one gender.