Comments: Comprehensive paper, with four clinical cases, written by a psychiatrist who became aware of the negative effects internet porn was having on some of his male patients. A bit of the intro and clinical case #1 are reproduced below. The case describes a 31 year old man who escalated into extreme porn and developed porn-induced sexual tastes and sexual problems. This is one of the first peer-reviewed papers to depict porn use leading to tolerance, escalation, and sexual dysfunctions.
Kalman, Thomas P.
Weill-Cornell Medical College, New York City, NY, USA. [email protected]
Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 36, no. 4 (2008): 593-618.
Abstract
Pornography, if understood to involve the depiction of sexual activity, organs, and experiences, is perhaps as old as human civilization itself. Historically linked to various technological innovations, pornography viewing in the Internet age has reached epic proportions, with large numbers of individuals taking advantage of ease of access, affordability, and presumed anonymity to explore sexual material online. Within the mental health professions substantial research exists on the effects of viewing general pornography; however, the distinctive effects of the marriage of pornography and cyberspace is only beginning to be examined. In addition to reviewing some historical and statistical material about pornography and the relevant psychiatric and psychoanalytic literature, four detailed clinical vignettes are presented to illustrate the types of problems related to Internet pornography use that are being presented to practicing psychotherapists.
A bit of the introduction
In the 1980s and 1990s, a vast number of studies were conducted on general (nonInternet) pornography. Despite some disagreements among academics about their validity and methodologies, these studies offer significant conclusions regarding the effects of pornography exposure. Representative of this scholarship are the well-known studies by researchers Dolf Zillman and Jennings Bryant, whose investigations involved controlled exposure to pornographic materials using experimental settings (Zillman & Bryant, 1982; Zillman & Bryant, 1988). In their work, they found associations between pornography exposure and: (1) increased callousness toward women; (2) trivialization of rape; (3) distorted perceptions about sexuality; (4) increased appetite for more deviant and bizarre types of pornography (escalation and addiction); (5) devaluation of the importance of monogamy; and, (6) decreased satisfaction with partner’s sexual performance, affection, and physical appearance.
A thorough review of the entire scholarship on the effects of general pornography and the disputes related to it has been conducted by Manning (2006) and will not be restated here, but her assessment follows:
In summary, research reveals that [general] pornography consumption is associated with many negative outcomes related to individual functioning. Research, including meta-analyses [Allen, D’Allesio, & Brezgel, 1995; Oddone-Paolucci, Genius, & Violeto, 2000], show pornography consumption is associated with increased risk for (a) sexual deviancy, (b) sexual perpetration, (c) experiencing difficulty in one’s intimate relationships, (d) accepting rape myths, and (e) behavioral and sexual aggression. (p. 137)
There is a plethora of scholarly literature about various aspects of Internet pornography in many disciplines, such as psychology, psychiatry, sociology, communications, gender studies, and human sexuality. Yet, despite extensive speculation, no clear consensus has emerged in this scholarship regarding the amalgam of pornographic content and cybertechnology and its impact on individual mental health, interpersonal relationships, or personal sexual health and satisfaction. Clearly, the Internet’s provision of sexual content involves many benefits for both individuals and society, including the availability of information for the promotion of sexual health (i.e., on contraception, sexually transmitted diseases, normal sexual functioning and anatomy), self-help and advice, and scientific research. For many, the Internet enables a healthy expansion of one’s sexual knowledge, capacity, and fantasy life. Increasingly, however, psychotherapists are encountering anecdotal reports of problems related to Internet pornography use. In addition, many surveys and self-reports of problematic experiences have been published, lending support to concerns that Internet pornography consumption may be more complex than just good clean fun (Cooper, Putnam, Planchon & Boies, 1999; Meerkerk, Van de Eijnden, & Garretsen, 2006; Mitchell, Becker-Blease, & Finkelhor, 2005; Mitchell, Finkelhor, & Becker-Blease, 2007). It is unclear whether the effects of viewing general pornography correspond to the effects of viewing Internet pornography, or whether the unique attributes of the Internet have created a different range of pornography-related problems In addition, a growing literature about “Internet addiction,” the content of which frequently includes the use of pornography, now abounds.
It is becoming apparent that when Internet use becomes problematic for an individual, especially when it comes to the attention of a clinician, pornography use or some other sex-related activity is likely to be involved. The recent study by Meerkerk et al. (2006) determined that gaming and erotica (by this author considered synonymous with pornography) websites were most closely associated with the subsequent development of Compulsive Internet Use (CIU), but only erotica use clearly predicted the development of CIU at a one-year interval (p. 98). Another recent survey of mental health practitioners by Mitchell et al., (2005) formulated eleven categories of Internet Related Problematic Experiences, including General Overuse, Pornography, Infidelity, Sexual Exploitation, Gaming, and Role-playing. In their survey population of 929 adult patients, the overwhelming majority acknowledged problems related to pornography use or other Internet-mediated sexual activity far more frequently than any other type of use problem. Their findings also support the connection between Internet pornography use and other Online Sexual Activities (to be discussed later). Most recently, an article in The New York Times detailed the emergence of Internet addiction boot camps in South Korea designed to help individuals manage their out-of-control Internet use (Fackler, 2007).
Surprisingly, the voluminous literature about Internet pornography includes few straightforward, clinical descriptions of the subjective experiences of those who use (view, read) pornography on a regular, habitual, or addictive basis. Indeed, in contradistinction to researchers’ usual appeal for more “systematic research” in a given area, one group investigating Internet pornography use in the workplace has noted that:
A more sophisticated understanding of the various profiles of Online Sexual Activity [pornography] users, as well as other distinguishing features of each unique case (such as where they go, why they go, and how much time they spend when they go) might be particularly important. (Emphasis mine; Cooper, Safir & Rosenmann, 2006, p. 27).
Clinical Material
A few clinical scenarios involving heterosexual males seen in private outpatient psychotherapy will now be presented. Each case illustrates how the use of Internet pornography played a significant, problematic role in an individual’s life. These anecdotes are representative of others reported in the literature and of the types of problems being communicated to therapists. While privacy considerations understandably limit the details that can be presented, these case vignettes provide the type of clinical description that would address the need for richer clinical specifics in the literature. The descriptions further elaborate upon some of the issues related to Internet pornography use and reveal some problems related to the exploration of this subject. (Author’s note: the following case vignettes have been contributed by different, anonymous psychotherapists in addition to the author. Every effort has been made to disguise any identifying information and to preserve patient confidentiality. While the problems related to pornography are exactly as oc curred for each individual, details about personal and family histories have been disguised while preserving core psychodynamic variables. Some of the historical material has been reconstructed.)
Case 1
A 31-year-old male in analytic psychotherapy for mixed anxiety problems reported that he was experiencing difficulty becoming sexually aroused by his current partner. After much discussion about the woman, their relationship, possible latent conflicts or repressed emotional content (without arriving at a satisfactory explanation for his complaint), he provided the detail that he was relying on a particular fantasy to become aroused. Somewhat chagrined, he described a “scene” of an orgy involving several men and women that he had found on an Internet pornography site that had caught his fancy and become one of his favorites. Over the course of several sessions, he elaborated upon his use of Internet pornography, an activity in which he had engaged sporadically since his mid-20s. Relevant details about his use and the effects over time included clear descriptions of an increasing reliance on viewing and then recalling pornographic images in order to become sexually aroused. He also described the development of a “tolerance” to the arousing effects of any particular material after a period of time, which was followed by a search for new material with which he could achieve the prior, desired level of sexual arousal.
As we reviewed his use of pornography, it became evident that the arousal problems with his current partner coincided with use of pornography, whereas his “tolerance” to the stimulating effects of particular material occurred whether or not he was involved with a partner at the time or was simply using pornography for masturbation. His anxiety about sexual performance contributed to his reliance on viewing pornography. Unaware that the use itself had become problematic, he had interpreted his waning sexual interest in a partner to mean that she was not right for him, and had not had a relationship of greater than two months’ duration in over seven years, exchanging one partner for another just as he might change websites.
He also noted that he now could be aroused by pornographic material that he once had no interest in using. For example, he noted that five years ago he had little interest in viewing images of anal intercourse but now found such material stimulating. Similarly, material that he described as “edgier,” by which he meant “almost violent or coercive,” was something that now elicited a sexual response from him, whereas such material had been of no interest and was even off-putting. With some of these new subjects, he found himself anxious and uncomfortable even as he would become aroused.
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