March 31, 2007

The Good, the Bad and the Addictive

Read my recent op-ed in the International Herald Tribune

The good, the bad and the addictive
IHT | Richard DeGrandpre | Thursday, March 29, 2007

A new report by British researchers in The Lancet argues that alcohol and tobacco are more dangerous than some illegal drugs, including marijuana or Ecstasy.

The study, based on evidence of actual risks and harms associated with drugs, suggests that alcohol and tobacco be legally reclassified as among the top 10 most dangerous drug substances. The report follows an independent commission by the Royal Society of Arts that described Britain’s drug laws as driven by “moral panic.”

This “rational scale” for assessing harm and misuse has been hailed as a breakthrough. But the idea of reclassifying drugs legally in terms of harm is not so easy.

After all, several of the drugs that top the revised list are prescription drugs, such as barbiturates, benzodiazepines and Ritalin. Are we really to believe that users of these substances should be deemed drug abusers?

What this research really demonstrates is that the tangled idea of classifying drugs as good or evil has put society in knots.

As “patent medicines,” including cocaine and Heroin (a brand sold by Bayer pharmaceuticals), fell from grace early in the 20th century, the American Medical Association merged with the pharmaceutical industry to create a notion of “ethical” drugs. This meant in turn that psychoactive drugs expelled from the medical pharmacopeia were deemed “unethical.”

As the white market of prescription, “mind-altering” drugs developed, from benzedrine to barbiturates to benzodiazepines, a black market also emerged. This put into place a social rubric for understanding drugs based not on pharmacology, but on a drug’s social history.

By the end of the 20th century, this differential prohibition had evolved into a shameful situation in which those with access to legal medicines could become legal drug abusers while those purchasing drugs on the street were deemed criminals and incarcerated.

This was especially true in the United States.  As the opiate abuser Rush Limbaugh, the popular conservative radio talk-show host, kicked up his feet in rehab after years of railing against addicts, thousands were lying in prison after committing more or less the same acts.

The million little pieces of America’s drug problem was not to be found in rehab centers across the nation, but in the state and federal prison system.

Also woven into knots in the 20th century was the concept of addiction. Alcohol is indeed comparable in its addictiveness to heroin and cocaine, as the British study suggests, but we do not realize this because of the different lenses we wear when looking at different drugs.

These lenses are so powerful today that we do not even refer to alcohol as a drug. Nevertheless, alcohol is similar in harm to these other drugs, and this is not just because it is used by so many people.

When cocaine and morphine were used by the masses a century ago, people knew about them what we know about alcohol today: Most users do not develop addictions, although some people are more likely to develop them than are others - for developmental, personal and biological reasons.

A rational systems of drug classification is a good idea, but it must not only reclassify drugs. It must go further by tearing down the myth that some drugs are inherently good, bad, powerful or addictive.

The cult of pharmacology must be replaced, in other words, by a cult of reason, and one that emphasizes that drugs are us. What good or bad drugs do is first and foremost a social issue, not a pharmacological one, or a medical one.

– Richard DeGrandpre, a past fellow of the National Institute on Drug Abuse, is the author of a history of drugs in America, “The Cult of Pharmacology.”

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March 02, 2007

(11) THE GEOGRAPHY OF THE FLESH (part two)

From the second chapter – “Illicit Desire: On the Wrong Side of Meaning” – in my latest book project, The Wine Taster & The Bomb Maker:  Meaning and the Making of the Modern World.

This is a non-fiction book that blends history, social science, and natural science to offer a unique and compelling account of the making of the modern world, narrated from a psychological perspective that emphasizes humanity’s ongoing quest for meaning.

"All of you boys look at this elder. What do you think he has done? Heard this teaching this moment and grown big! All of [these men] ate the penis… and grew big! All of them can copulate with you; all of you can eat penises. If you eat them, you will grow bigger rapidly.”

Anthropologist Gilbert Herdt witnessed and translated these words, spoken by an elder of the Sambia of Papua, New Guinea to a group of boys about to be initiated into a traditional insemination practice. The practice, observed by Herdt from 1972 to 1974, consists of the ingestion of semen via fellatio ("oral sex"), and is believed by the tribe to be essential for a boy’s full masculine development. The boys are “inseminated” from the age of eight until about fifteen, at which time they become inseminators themselves until married, when they cease all such same-sex sexual practices.

Just as the Sambian infant sucked white milk from his mother’s breast to grow bigger and stronger, he is told that he must now as an older boy also suck white semen from the penises of older, pubescent boys. This belief system, rooted in the myth that repeated semen insemination is required for pregnancy and, later, for the male child to ensure full masculine development, is held throughout the group, and is in fact common historically among many Papuan tribes. Dwelling on a boy’s developmental potential is no surprise, moreover, since these are warrior cultures where fitness and courage as well as hard physical labor have been vital to their survival for hundreds, even thousands, of years.

Here, again, meaning lies at the heart of the “sexual” behavior. Because semen is understood to be a limited, vital substance for preserving the strength of the tribe, the entire village is focused on ensuring that not a drop is wasted. This even applies to intercourse between men and women, where sex for anything but procreation is considered indulgent and reckless, since it needlessly drains the man of his masculine essence. Semen insemination is not practiced on females, moreover, since it is believed that their maturation occurs naturally as the body grows. The female’s sexual essence is her menstrual blood, which symbolizes the sexual and reproductive power of women.

The practice of semen insemination, Herdt found, takes place within a larger induction process that reflects the highly gendered nature of the society. Between the age of 7 to 10, the boys are taken away from their mothers to live in a kind of men’s clubhouse in the village. There they will live for the next several years, out of the reach of women. The elders spend the first three or so years teaching the ritual secrets of the village’s men, threatening them with death if they disclose them to any women. This includes the necessary instruction for establishing the association between the penis ("oral sex"), the sacred flutes played by the adult men to influence powerful spirits, and the role of the semen in transmitting these spiritual powers into the bodies of the boys. This also includes lessons on ritual nose bleeding, a technique used by the men to remove the “pollution” they inevitably take in as adults when mixing with women to procreate. These are quite violent nose-bleeds that function as a kind of blood-letting.

Once the indoctrination process has been completed, the practice of semen insemination begins. This is done in private at a mutually agreed upon time. Putting the penis of the male in their mouth, the prepubescent boy engages in regular fellatio with a pubescent teenager who is eligible because he is physically and sexually mature. Herdt calls the latter “bachelors,” or “junior warriors.” The younger brings the older to orgasm and then swallows the sexual fluid. The “bachelor” affirms his superior position by standing, while the other acknowledges his inferior status by kneeling. Typically, according to Herdt, the young boys are initially reluctant, and many have to be told to do what the older partner demands, or in the case that no one has sought them out, to find a partner to inseminate them. Later, however, the boys accept the practice and readily initiate the meetings. Semen insemination being the reason for these sexual encounters, fellatio must always be non-reciprocal: the older males must always be fellated, and never younger males, no matter what attraction might arise between pairs.

The influence of sexual desire in this institutionalized system of “oral sex” is complicated. Herdt’s study makes it clear that, however forced and aversive the indoctrination process is initially, the practice ultimately becomes a pleasurable one for many if not most boys. As the younger males developed, they showed sexual excitement by becoming themselves aroused with erections. As they matured further and took on the role of the bachelor, becoming the receiver of fallatio, they continued to experience pleasure, albeit a mixed one, knowing that their vital fluids were being drained from them. Herdt noted, for instance, that some bachelors commented and joked with others about which boys they found especially attractive.

Once the Sambian bachelors aged beyond their teens, they entered into their first sexual relationship with an adult female partner – a partner who is preselected at the time of their birth. Sexual behavior at this first stage of marriage excludes intercourse, and the young men continue being fellated by younger males, defining a short period of ongoing bisexuality. This is followed by a second stage of marriage in which the man now cohabitates with his wife and engages in sexual intercourse for the purpose of procreating his children. The exposure of the man’s penis to a woman’s vagina means that the penis is contaminated. He must therefore cease all same-sex encounters with the boys. Interestingly, Herdt did find that some young husbands continued seeking out illicit male fellatio for a year or two – a practice that would be considered pedophilia by Western standards. Ultimately, as elders of the village, the men often reflected back on their boyhood erotic pleasures, much as seniors in the Western world look back on their own innocence of youth.

The ritual of male semen insemination is rooted in a myth with little biological validity. Still, it is true that semen is necessary for procreation, and one can imagine how, upon this realization, other beliefs involving the power of semen arose. It is also clear that the ritual, although harsh, aversive and, from a contemporary Western point of view, abusive for the boys, does have positive, self-reinforcing social effects, not the least of which is the cultivation of strong and brave men who become successful warriors in protecting their village against neighboring enemies. Indeed, sexual acts that have been deemed immoral and damaging to modern society and institutions such as marriage – namely, homosexuality, oral sex, pederasty – are deemed here to be of absolute necessity. The survival of the ritual, not to mention the continued survival of the village, shows these sexual practices to be historically constructive. This is not a popular conclusion, of course, which accounts for why earlier investigators of Papuan groups, dating at least as far back as the 1930s, kept hush about them.

The nature of the same-sex practices of the Sambia differ from those in ancient Athens, since the two set of practices have quite different cultural origins and cultural functions. This notwithstanding, the example of the Sambia reinforces the same point as the Greeks regarding the geography of desire: sexual desire is less a product of individual inclination than it is of cultural norms. Certain same-sex relations were accepted and expected among the men (including teens) in both these cultures, with most men engaging in behavior that by contemporary definitions is bi-sexual. Thus, even if the path of any one individual’s sexual desire cannot be easily predicted, explained, or controlled by society, as highlighted by the example of pedophilia, the general pattern of people’s sexual desires are clearly open to societal pressures. For better or worse, by constructing meaning via soft or hard socialization practices, culture organizes sexual desire.

* * *

When Portuguese explorer Pedro de Magalhales de Gandavo traveled in northwest Brazil in 1576, he discovered a fierce group of warriors among the Tupinamba Indians. They would not have seemed terribly noteworthy except for one important characteristic: they were women. As he later wrote, “there are some Indian women who determine to remain chaste: these have no commerce with men in any manner, nor would they consent to it even if refusal meant death… They wear the hair cut in the same way as men, and go to war with bows and arrows and pursue game ... each has a women to server her, to whom she says she is married, and they treat each other and speak with each other as man and wife.” It is said that de Gandavo named the nearby river the “Amazon” because the female warriors reminded him of the Amazon women of Greek mythology.

A similar and older story concerns the Spanish conquistador and explorer Francisco de Orellana. In December 1541, at what is known today as the Napo River, Orellana’s ship was separated from the main body. In a most improbable voyage, Orellana sailed the length of the Amazon River, arriving at its mouth in August 1542. When he returned from his exploration, he reported an unusual encounter: a race of courageous women warriors. According to Orellana’s account, these women mated with males captured from neighboring tribes, killed and drank the blood of the male offspring, and reared the female offspring in their own image.

These accounts have been viewed historically as far-fetched. As noted in a report in Time magazine in 1971, however, evidence of the women warriors surfaced four centuries later, found by Jesco von Puttkamer. A German ethnologist and photographer, von Puttkamer was studying the Galeras Indians, a primitive people who live deep in the rain forests in Brazil’s Rondonia territory. Like Herdt in New Guinea, he befriended the tribesmen and learned their language. Subsequently they led him to three secret caves with mysterious markings on the walls. Struck by their potential significance, von Puttkamer sought help from anthropologist Altair Sales. Sales explored the caverns and probed what knowledge the Indians had, ultimately emerging from the jungle with a dramatic conclusion: the caves were inhabited long ago by warrior women similar or the same as those described by Francisco de Orellana.

Studying the cave illustrations, Sales identified the recurring theme of a triangle marked by a deep cut running from one apex into the center. Sales interpreted the triangle as a symbol for the female, noting that the same symbol had been observed on the jewelry of the Amazons by Father Caspar de Carvajal, a chronicler of Orellana’s expedition. Seeing that one of the cave triangles has a smaller triangle carved inside it, Sales speculated that it represented pregnancy, while another triangle with two stripes symbolized a tribal leader. Others triangles were positioned side by side, suggesting the “lesbian” relationships described by de Gandavo. Based in this and various other evidence, the Time report noted, Sales concluded that there may have once been many feminist tribes roaming through the Brazilian jungles.

In actual fact, despite the skepticism with which these stories of woman warriors have been treated, Sales’ conclusion is consistent with a vast amount of evidence concerning tribes in the Americas before and after Columbus. This evidence suggests that the “cross-gender” phenomenon demonstrated by the warrior women in the Amazon was even more common among men.

The Papago people of the American southwest, for example, believed that children experience dreams derived from the supernatural realm that then guide their gender development. Like many other North American tribes, the Papago viewed development as reflecting a spiritual path, and one that was not to be meddled with. The anthropologist Ruth Underhill studied the Papago as late as the 1930s, and described an interesting test that today would be viewed as a kind of psychiatric assessment. Sometimes a boy would be suspected by his mother as having a feminine spirit. When such a suspicion arose, the mother tested the child’s tendencies by placing a bow and arrows as well as a women’s basket in some bushes. After telling the child to go into the bushes, they would be set fire. If the child ran out with the basket, the suspicious was confirmed: his spirit had crossed over to the wrong side of meaning. Or had it? Unlike today’s psychiatric assessment, this confirmation did not lead to the pathologizing of the child. To the contrary, the boy was usually deemed a special person and subsequently accepted either as a female or as a member of a third gender.

When French explorers and missionaries discovered such individuals in the mid-eighteenth century they labeled them “berdache.” This is a french term for male homosexual, and it has since become the historical term to describe cross-gendered individuals in North American tribes. The understanding of the berdache among the tribes is, as in the semen-insemination example of the Sambia, governed by a larger, cosmological framework. The Navajo, for example, embrace a creation ("Adam and Eve") myth in which the first man and women are said to have lived a miserable life until they were taught the skills of farming, pottery, etc, by two twins, Turquoise Boy and White Shell Girl. According to myth, the twins are the first two berdaches, or what the Navajo called nadle, meaning “the one who is transformed.”

The berdache were usually men who dressed as women and took up female roles, sometimes becoming respected for their exception skills in crafts such as weaving and pottery. Sometimes they took on special roles, however, such as the group’s shaman (medicine man). Berdache were also sometimes women who dressed as men and engaged in what were otherwise exclusively masculine pursuits. The Mohave Indians, for instance, called berdache women “hwame.” As girls, the female berdache usually played boy’s games, and, like the Papago, were required to pass a ritual test. Once passed, they were assigned masculine name, male clothing, and were taught the warrior and hunting skills of the other boys. Like the women warriors encountered by de Gandavo in northwest Brazil in the sixteenth century, these females, when old enough, were expected to marry a woman. If the latter had a child from a deceased husband, the child would be adopted by the berdache as her own.

More often the berdache were men who took on a female identity, however, as Underhill reported concerning the Papago. Contrary to earlier accounts of women warriors, the Europeans who first came across male berdache were not impressed. The individuals were labeled “sodomites dedicated to nefarious practices” who had “abandoned themselves to the most infamous passions,” writes Francis Mark Mondimore in A Natural History of Homosexuality (p. 11). Even more disturbing to early missionaries and explorers was the fact that the tribes had allowed these sexual deviants to take up respected roles within their society.

Needless to say, the early European understanding of the berdache was distorted by a certain prejudice. The berdache were not in fact the equivalent of their persecuted “sodomites” back home. For instance, men who had sexual relations with a male berdache were not viewed within the tribe as having same-sex relations; the meaning of sexuality was as normal and accepted as were standard male-female relations. The spirit interpretation was felt deeply enough, in other words, that these cross-gendered individuals were simply not viewed as men. It is thus equally wrong to view these tribes as being sexually permissive. At least in some tribes, sexual relations between one berdache and another were viewed as perverse and incestuous. Still, there are always exceptions. In some tribes, male berdache engaged in bi-sexual relations, whereas others were sometimes celibate or sometimes strictly heterosexual.

The homosexual habits of the berdache might appear on the surface to be similar to the Sambia of Papua, New Guinea. In each example there is widespread acceptance of same-sex desire, although there were also rules that constrained sexual behavior. If homosexual desire is viewed as a perfectly normal expression of human sexual desire, neither account, nor the account of the ancient Greeks, should be viewed as radical or surprising.

Significant differences also exist, however. In the case of the berdache, gender and sexual preference are uncommon and arise in a unpredictable fashion. In the example of the Sambian boys, by contrast, such preferences could be predicted based on institutional norms. The berdache example thus reinforces the view that the pathways of sexual desires for a specific individual cannot be easily predicted or controlled. The Sambia example does not contradict this, but reinforces the other side of the equation, that the general pattern of a society’s sexual desires are shaped by the sexual norms of the larger culture.

Constructing, reinforcing, and institutionalizing meaning, culture organizes and institutionalized certain sexual desires, whether it is the same-sex desire of the berdache, of the Sambian boys, or the ancient Greeks.

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February 07, 2007

The Days of Patent Medicines

A weakening of drug agency oversight has brought back the days when medicines were more potent in their toxicity than in their efficacy

In recent weeks we have seen several new and damning reports involving the drug industry. A study found that most all direct-to-consumer television ads for prescription drugs in 2004 failed to note risk factors, and painted too rosy a picture of life on their medication (spending for TV ads exceeded $1 billion in 2004). A jury in Philadelphia found the hormone replacement therapy Prempro to be responsible for an Arkansas woman’s breast cancer, and the company, Wyeth, responsible for failing to provide proper warnings about the drug’s risks. Eli Lilly concealed the risks of weight gain and diabetes for their best-selling medication Zyprexa, according to insider documents obtained by the New York Times, and ignored the law by marketing it for unapproved uses. And finally, a BBC investigative report showed that GlaxoSmithKline engineered positive clinical trial results for teens taking Paxil – a drug from the SSRI class of antidepressants – and concealed its link to teen suicide.

The latter findings involving Paxil (Seroxat in the UK) are hardly the first of their kind, but they are noteworthy for what they revealed – namely, a concerted and sophisticated effort on the part of Glaxo to pervert the regulatory process. Data from clinical trials showing unfavorable results were either buried or edited; “independent” ghostwriters were employed to conceal the company’s “spin” in journal articles; and only those researchers producing positive results were rewarded with generous, new contracts.

Nor are the charges involving the SSRIs specific to Glaxo. As reported in 2003 by Sarah Boseley of The Guardian, JAMA published data from two trials supporting the pediatric use of Pfizer’s SSRI antidepressant sertraline (Lustral, Zoloft). In actual fact, 17 children left the trial because of side effects (compared to five taking placebo) – a rate that is unacceptable given that only 10 percent more children improved on the drug than on placebo. The lead author of the study was, oddly enough, also among the authors of studies supporting the pediatric use of Glaxo’s Paxil. When British regulators reexamined these data, they concluded that a number of children had become suicidal on the drug.

The industry defends its billions of dollars in profits, meanwhile, stressing that it is the “engine of innovation.” Perhaps it is, but it is worrying to find that this innovation seems directed less at the creation of new and more effective therapies and more toward litigation, advertising, and data engineering. Some have suggested that civil lawsuits are viewed inside the industry as “the cost of doing business,” but you cannot disregard human life and expect to sustain public confidence for long. As a Harris Poll in 2004 showed, fewer than 1 in 7 Americans now believes the pharmaceutical industry to be “generally honest and trustworthy.”

If this is the same path the tobacco industry broke decades ago, as appears to be the case, then this is especially worrying. Even some industry executives have acknowledged that there are problems. An executive at drug maker Roche openly said in 2004 that the industry exaggerates the prevalence of psychiatric disorders to increase profits. A year earlier a vice president at Glaxo admitted, “our drugs do not work on most patients.”

It might appear to be a contradiction to suggest that medicines can be a direct cause of illness and death, yet not be effective in most patients. In fact, there is no contradiction. The creation of the Food and Drug Administration in 1906 and the passage of the Food, Drug, and Cosmetic Act of 1938 were motivated by this very scenario, where a patent medicine was found to have powerful effects on the body, but was not very powerful in doing what it was claimed to do. While a variety of the patent medicines had little hope of ever working as advertised, except as placebos, moreover, their active ingredients posed an immediate hazard to the public health.

Consider one physician’s experience, from 1937: “To realize that six human beings, all of them my patients, one of them my best friend, are dead because they took medicine that I prescribed for them innocently, and to realize that that medicine which I had used [was] recommended by a great and reputable pharmaceutical firm..., that realization has given me such days and nights of mental and spiritual agony as I did not believe a human being could undergo and survive.”

The medicine prescribed was Elixir Sulfanilamide. Sulfanilamide had been used safely and effectively in tablet and powder form to treat streptococcal infections. After a salesman suggested a demand existed for the drug in liquid form, the company – S. E. Massengill – formulated a mixture in diethylene glycol (antifreeze). After testing it for flavor, appearance, and fragrance, the company distributed its raspberry and caramel flavored-medicine throughout the country. Within a few months the drug, said to be “entirely suitable for children,” was responsible for the painful and protracted deaths of at least 34 of them, and twice as many adults.

Within a year new drug regulations were signed into law by President Roosevelt. Thirty-two years after the creation of the FDA, the Food, Drug, and Cosmetic Act finally established regulations requiring safety tests be conducted for new drug products. The FDA had become the regulatory watchdog America needed to safeguard the public health.

The social history of drug regulations is a useful reminder of where we are headed without effective government oversight. Indeed, there is already evidence of a significant backward trend: In 1998, Britain’s leading medical journal The Lancet published a report showing that adverse reactions to drugs “properly prescribed and administered” had become the fourth leading cause of death (accounting annually for 100,000 hospital deaths in the US). This finding was echoed four years later in a JAMA report by five physicians from Harvard Medical School.

It is true that drug companies are often under enormous pressure to secure their profits from one or two drugs that might generate billions of dollars in sales, and that this pressure encourages abuse. Because the FDA has not held steady in applying equal, opposing pressure, however, this abuse appears to have grown out of control.

The latest changes being proposed at the FDA, to ensure that marketed drugs are as safe as advertised, for example, and to assess new drugs 18 months after their introduction, are not enough. The Institute of Medicine’s damning report of the FDA, in 2006, suggested it give officials who assess existing drugs more authority to act. The FDA declined. As Senator Charles Grassley has noted, the agency is simply too “cozy” with drug makers to fix itself. If external pressures are not put on the FDA, we can expect more stories the likes of Vioxx, Prempro, and Paxil.

So what ever happened to the S. E. Massengill Company? Well, Samual Evans Massengill never apologized. Presenting the bold face that would later be worn by the executives of Big Pharma, the company hid behind the claim that thorough and complete clinical tests had been done. “My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. We have been supplying a legitimate professional demand and not once could have foreseen the unlooked-for results. I do not feel there was any responsibility on our part.” A $26,000 fine was paid, for mislabeling their medicine an elixir when it contained no alcohol, and S. E. Massengill Company carried on diong business. In 1971 they were acquired by what is now GlaxoSmithKline.

Richard DeGrandpre is an independent scholar of psychiatric medicine. His new book is The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

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February 05, 2007

(10) GEOGRAPHY OF THE FLESH

From the second chapter – “Illicit Desire: On the Wrong Side of Meaning” – in my latest book project, The Wine Taster & The Bomb Maker:  Meaning and the Making of the Modern World.

This is a non-fiction book that blends history, social science, and natural science to offer a unique and compelling account of the making of the modern world, narrated from a psychological perspective that emphasizes humanity’s ongoing quest for meaning.

Pedophile – yes, the word is loaded with meaning. Homosexual – there’s another. At least in the case of the “homosexual” there are grounds for understanding. Unlike the pedophile in modern society, the homosexual is not by definition a destructive creature – one who relies on the vulnerabilities of others, or transgresses in such a way as to harm others. In fact, homosexual acts between two adults are not transgressions at all. Some might disagree, but at this point in the history of the western world it is easy to stand firm and declare such moralizing as deeply wrongheaded. If there is evil in the realm of homosexuality (and bisexuality), it lies squarely with those who wish to single it out and dwell on it, whether as a sin, a sickness, or a crime.

It may seem excessive to write about the plight of the homosexual, but for much of modern history the homosexual has lived a life of fear and self-loathing. As with the “pedophile,” this fear has resulted from a deep revulsion within society to sexual behavior deemed pathological, if not criminal. Self-loathing has similarly flowed from feelings of being an outcast and from seeing oneself as some kind of “pervert."* Unlike cases of pedophilia, however, there is no vicitim in adult homosexuality among men or women. Instead, it has been the persecution of homosexuals that has been the harmful act, and the hate crimes that this persecution has tacitly authorized. “It is not sexuality which haunts society,” writes anthropologist Maurice Godelier, “but society which haunts the body’s sexuality.”

Some useful illustrations of the plight of the homosexual could be found in books and film at the turn of the twentieth century, including the 2004 film on the life of sex researcher Alfred Kinsey ("Kinsey," 2004). One from the latter is the story of a middle-aged lesbian woman who found her homosexual desires validated by Kinsey’s work. She comments in an interview: “We’d been married for years, with three marvelous children. And as soon as my youngest left to go to college. I took a job in an arts foundation. I met a woman there – secretary in the grants office. We became fast friends, and before long, I fell in love with her. This came as quite a shock, as you might imagine. The more I tried to ignore it the more powerful it became. You have no idea what it’s like to have your own thoughts turn against you like that. I couldn’t talk to anyone about my situation so I found other ways to cope. I took up drinking. Eventually, my husband left me. Even my children fell away. I came very close to ending it all… After I read your book, I realized how many other women were in the same situation. I mustered the courage to talk to my friend and she told me, to my great surprise, that the feelings were mutual. We’ve been together for three happy years now.”

The “sexology” research by Kinsey in the 1940s, preceded by the pioneering if sometimes dubious work of figures such as Krafft-Ebing, Freud, Wilhelm Reich, Otto Gross, and Magnus Hirschfeld, was the beginning of a sexual liberation movement. Kinsey’s extensive survey data publicly “outed” what people do sexually, and this by itself altered the meaning of sexuality at its core in America. In short, it cracked a nut that, while open, still remains largely shut. The gay rights movement that followed, with it growing achievements marching alongside the long shadow of AIDS in the twentieth century, also transformed the meaning of homosexuality, but again only partly. Mixed meanings persist in the heterosexual mind, which continues to see homosexual behavior as transgressive and the homosexual as deviant, but also understands that it is no longer politically correct to castigate the homosexuality publicly. “Love the sinner, hate the sin” remains the dominant ethos in a please just-say-no, just-don’t-tell society.

In one sense homosexuals are indeed deviant, because they do what a majority of the public wishes they would not do, and because they simply will not shut up or go away. The homosexual makes trouble, in families, in marriages, in schools, in the military, in organized religion. And for this agitation alone, they remain deviant. Why, though, do they insist on being deviant? Why pursue these deviant desires?

Society’s answers to why homosexuality exist (or persist) have not been terribly surprising, nor terribly original. Some scientists have suggested that same-sex desires are the product of certain genes and certain differences in the brain. Others believe homosexuality represents unresolved problems in child development. There is, however, another possibility: Perhaps the seeming paradox of homosexual desire is the same set of problems posed by the case of pedophilic desire. Is sexual orientation hard-wired by biology or soft-wired by an errant development, or is it simply governed by the same processes of meaning making that underlie most all other sexual desires?

On the one hand, there is evidence on sexual orientation that is statistical, on genetics and brain. On the other, there is evidence that is historical, on cultures and their sexual practices. The former is interpreted as suggesting a biological cause of homosexuality. The latter is interpreted as suggesting that desire is readily graphed onto cultural expectations and rituals. This apparent conflict can be resolved with little technical difficulty if we remember one thing, that whatever sexual propensity might lie in our genes, how that propensity is expressed will be determined, however contingently, by cumulative experiences in the world. As Gayle Rubin put it, comparing the drive of hunger with the drive for sex, just as the “belly’s hunger gives no clues as to the complexity of cuisine… we never encounter [sexual desire] unmediated by the meanings that cultures give to it” (p. 276). Some of us might be genetically more likely to become homosexual than others in this society, but what biological studies cannot tell us is how many more or fewer of us might develop deviant desires if raised (or living) in another one.

Consider the example of the lesbian woman interviewed by Kinsey. Like the sexual offender “Tom” described above, the desire that pushed her over to the wrong side of meaning did not appear until well into adulthood. What kind of biological determinism is this? Even if identical-twin males are more likely to have the same sexual orientation than nonidentical twins, what should be obvious is that this likelihood is far from a certainty. Who we become, and how meaning comes to shape our lives, is part of a great journey, and this journey is affected but not determined by our biology.

From the chaste Catholic nun to the male pedophile there lies a vast sexual terrain, much of which has been regarded at some point in history as sexually deviant. But history and cultures are as deviant and diverse as are people, especially when it comes to sexuality. And life in ancient Athens was no exception.

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Athenian society had strict social rules governing sexual relations, and what is immediately striking about them is the way in which they categorized sexual behavior. Today one can speak of heterosexual and homosexual relations, defined generally as mutual sexual relations between same-sex or opposite-sex pairs. In ancient Greece there was a different consideration of the sexual relation because sexual relations were not mutual, nor could they be. Athens was a highly stratified society in which a minority male elite held all the power in the social sphere. Women, children, foreigners, and slaves had varying degrees of rights and privileges, and all were subordinate to these governing citizens. Sexual stratification was mapped onto this larger system, which meant that sex involved a dominant adult citizen, a social superior who was the actor that employed his penis (or phallus) with a passive subordinate who received it. Thus, less important than whether the man’s partner was male or female, or whether it was a boy or adult, was, crudely speaking, who was doing what to whom. Plato writes in Charmides (380 BC), “‘What do you think of the young man, Socrates?’ said Khairephon. ‘Doesn’t he have a handsome face?’ ‘Marvelously so!’ I said. ‘Well,’ he said, ‘if he’d only take his cloak off, you’d forget he has a face at all, he’s so overwhelmingly beautiful to look at’.”

If there is an equivalent to the modern homosexual as “sexual deviant” in ancient Greece it would be the adult male citizen who subordinated himself to others. Such a relationship would be frowned upon and would indeed represent a deviant desire. This also had to do with meaning. In ancient society, penetration meant domination, whether over women or boys – or over conquered enemies who were raped to inflict humiliation upon them. The elite male who succumbed to others would be a sexual deviant not because he engaged in homosexual behavior but because he allowed himself to be molested. On the other hand, engaging an appropriate male in a dominant role had no negative meaning because the role affirmed one social status, which was accepted and reinforced.

Proper sexual relations for the adult male citizen thus included women, pubescent males who would eventually be citizens, as well as foreigners and slaves of either sex. As suggested, these elite males would not have sex with one another, for that would require at least one of them to subordinate himself to the other, thus accepting humiliation and forfeiting his social standing. Instead, the stereotypical governing male had a wife as well as a specific “eromeno,” or boy, all of which was perfectly accepted, even by the wife. In the Symposium, for instance, Plato describes love of a women as “common love,” it having the function and thus meaning of procreative sex. He elevates the love of a boy to “heavenly love,” though, it being a sexual luxury and a matter of pleasure.

Sexual relations with (pubescent) boys was not to involve penetration, however. The dominant adult, known as the “eraste,” was only to place his erect penis between the thighs of the boy while both were standing, and it was only the adult who was expected to show pleasure. Eventually the eromeno would become of age and, as a citizen, or eraste, would have to end his relationship with adult males.

This “intracrural intercourse,” as it is called, was not a mere ritual, and there is little doubt that, driven by desire and hidden behind the walls of Athens’s brothels, sexual relations often transgressed beyond these boundaries. This claim has a basis in images and writings from the time, which depict and describe anal intercourse. Attachments were also no doubt common, and there can be little question that some men displayed a strong “homosexual” preference. Notable among such figures are the philosophers Zeno and Bion, as well as Alexander the Great.

The Greeks had no language for labeling someone as a homosexual, which some have interpreted to mean that no such preferences exists. But not all preferences people display are named. There is, for instance, no terminology today for, say, sexual proclivities by while males for hispanic women. We can only conclude that, in ancient Athens, a male preference did not warrant a designation because it was not significant enough, or deviant enough.

One reference for probing the sexual lives of ancient societies is Artemidorus, a professional interpreter of dreams from the second century who wrote a five-volume Greek work on the subject. These writings contain considerable material from other writers that has since been lost, and are therefore considered to be historically important. The work also happens to reinforce the view of ancient sexual behavior as characterized more by roles and status than by personal preferences or orientations. In one passage, Artemidorus reflects upon the meaning of dreams involving sex, noting that “... the mere act of intercourse by itself is not enough to show what is portended. Rather, the manner of the embraces and the various positions of the bodies indicate different outcomes.” Different sexual positions reflect activity vs. passivity, and dominant vs. subordinate, and thus for the dream interpreter they also foreshadow things about the individual’s future, whether rosy or grim.

Thus, while Freud interpreted sexual content in dreams as signifying unconscious wants and needs rooted in past experience, Artemidorus considered it to be telling of one’s future public life. If the “manner of the embraces” and “the various positions of the bodies” are indicative of one’s public standing in society, then their presence in dreams foretells one’s impending success or failure in it, from the realms of money to politics to work. Sexual acts had significant meaning, just as they do today, but the nature of this meaning was dramatically different. Acts reflected and affirmed a social status that was publicly known, they did not reveal a hidden mind that was diagnosed as either healthy or sick.

Life among the ancient Greeks also suggests something about deviant desire as a kind of meaning, namely, that sexual preference is not constitutionally fixed within a person. Much has been written about whether the “homosexual” existed in ancient times, an argument that carries with it the idea that if individuals do not have a fixed sexual preference, then preference could never be a matter of biology or psychopathology. But this is not quite the view I am taking here. There may have been no language for labeling someone a homosexual, as noted, but it seems clear that individuals with a homosexual preference did exist in ancient times. The issue is, as usual, more complicated.

From the point of view of meaning, it makes little sense to suggest that sexual desire existed without sexual preferences, whatever they might be. Preferences are not something that one can switch on and switch off, as though a young man could become interested in gay culture and suddenly choose to be attracted to men. Meaning is not so easily willed. Desires may show a mutable quality for some people at certain times, as reflected in the desire of “Tom” the pedophile above, or the case of Kinsey’s middle-aged lesbian woman. But such migrations of meaning occur at the developmental pace of the human lifespan, pushed and pulled by poignant life events and countless other cumulative life experiences. Most of these experiences are too minor or invisible to identify or quantify, moreover, which is why individuals often describe these shifts in desire as coming out of the blue.

In ancient Athens, desire and meaning seem to have had these same spontaneous qualities. Rather than being chosen, desires arose “naturally” in a society that, like ours, expected them to take a certain form. The fact that male elites engaged in sexual relations with both women and pubescent boys poses no paradox. Greek society shows that when the social and political terrain concerning sexual behavior is radically different from our own, the general forms of sexual expression may vary in dramatic ways. Our sexual demographics are not normal while the Greek’s are perverse, however; both are shored up within cultural borders. And thus it bears repeating that, while some of us might be genetically more likely to become homosexual than others in our society, biological studies could never tell us is how many more or fewer of us might develop deviant desires if raised in another one.

All this is not to say, finally, that the particular path of an individual’s desire must therefore also be straightjacketed by societal norms. To say someone’s gay or straight is to say something about meaning making for that particular individual. As we have seen, whether in modern America or in ancient Greece, individual desires will sometimes stray from the primary paths of culture. Culture, like biology, is a force, but it is not an absolute one.

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