Sexuality and Psychopathology - Psicologo dott. Boccadoro

Dott. Leonardo Boccadoro
Psicologo Psicoterapeuta
Dott. Leonardo Boccadoro
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Sexuality And Secret Psychopathology In Total Institutions
Author: Leonardo Boccadoro

An investigation has been performed on sexuality and correlated pathologies on a group of subjects confined in “total institutions” as prisons and rehabilitation communities. Sexual, relational and psychopathological characteristics of these subjects are taken into consideration.
Perhaps for the first time in Europe, this kind of research has been carried out thanks to a standardised, thus indisputable tool on a very sensitive and so long consciously neglected matter: the inmates' “sex planet”.
Despite being deprived of their personal dignity, these subjects still feel the need for affectivity and relationality, or better still, they feel it more than ever. Being barred from finding different ways to release it, they often express it through the excess of sexual perversions and through degenerations produced by psychopathology, all of these aberrations have been invariably found in the sample. Besides psychodynamic and sociological explanations, this study also provides likely and desirable solutions to the problem.

Sexuality; Psychopathology; Paraphilias; Tabagism; Alexithymia; Self-esteem; Aggressiveness; Prison; Rehabilitation community.

Sexuality and sexual-related psychopathologies have been studied in a group of subjects confined to Total Institutions (Boccadoro & Carulli, 2008). Following Goffman's propositions (Goffman, 1961), this research deals with prisons and rehabilitation communities. The idea of exploring affectiveness, sexuality and relationships within total institutions stemmed from the lack of specific and methodical studies on this subject: sexual- relational matters in confining settings had often been tested using theoretical and narrative methods based on personal experiences and observations. However, these writings, despite being remarkable in view of the period and/or their aim, have failed to represent a well-established research framework aiming at studying and analysing the subject-matters in a structured way.
The results of this research are drawn from the Reports produced by a software through processing of the questionnaires the surveyed subjects had previously filled in. The conclusions this survey has come to show mental and physical sufferings of people living in “a separate world”.
The elements drawn from the Reports show:
  • general data of the sample aggregate;
  • standardised scores of discomfort areas;
  • emerging critical traits.

Critical traits represent a sort of “afflictive marks” characterising the aggregates under examination: “single-condition” males (sub-aggregate M-S) and “couple-condition” males (sub-aggregate M-C) respectively.
Single condition means the absence of a stable sexual or affective relationship of the subjects with a partner, whether couple condition means the existence of a sexual and/or affective relationship with a partner lasting for at least six months.

The sample of this research is made up of 37 males (N=37) recruited in several total institutions. Among them, 26 were “single-condition” males, while 11 were “couple-condition” males.
Exploring affectiveness, sexuality and relationships of those subjects “separated” from society and having limited personal freedom can allow to know that obscure and sometimes impenetrable world hiding behind bars, regardless of whether they are visible like those of a prison, or invisible like those of rehabilitation centres and communities.
The research tool used in this assessment is a sexual-relational questionnaire called Sesamo_Win (Boccadoro, 2002), a standardised and validated test which can be anonymously filled in.
The survey is essentially aimed at those areas concerning previous and present sexuality. At the same time, all those elements which, even indirectly, could have affected the formation and expression of personality, affectiveness and relationality, are also taken into consideration.
The software processing the tests analyses and decodes the answers to the questionnaire, and generates a Report: a multifactorial "idiographic image" which evaluates the subject's sexual, relational and pathological condition. "Idiographic image" is the representation of a result which has been obtained thanks to a study or research method whose subject-matters are specific cases, i.e. a portrayal which avoids nomothetic generalizations.
A complete Report is made up of 9 parts. Specifications of those sections of the report which were used in the research are as follows:
• Personal data and household
It shows a summary of personal data (Body Mass Index included), household composition, present affective-relational condition and “off-the-cuffs” comments expressed by the subjects soon after completing the questionnaire.
• Questionnaire scoring per area
This section regards rough points, Z scores (standard scores) and the relative percentilerankings obtained by the subjects in each research area.
• Critical traits
It shows a synthesis of relevant and more significant (pathogenetic and pathognomonic) characteristics of the subjects' condition and of their sexual-relational fields.

Research hypotheses required evaluating a sample of people living in those structures defined as “total institutions”, i.e. those organizations that normally house people subject to loss or limitation of individual freedom, such as prisons and communities (i.e. rehabilitation centres).
In planning the survey, these bodies, besides possessing the independent variable imposed to the research, i.e. limitation of personal freedom of their residents, could also provide a reasonable chance to carry out the analysis using a pen-and-pencil version of the research tool.

Diagram 1 shows correlations of data: Age (arranged in a series of increasing values), Body Mass Index and Tabagism.

Diagram 1. Age, BMI, Tabagism

The trend of the graphs shows an average BMI of the sample of 25.5 (SD=2.6). Moreover, none of the subjects was underweight while 67.5% of the sample was overweight. This could indicate they sought food reward as a substitute for other unavailable satisfactions owing to confinement.
Tabagism is widespread among the surveyed population (91.9%), with a per capita average of 13.7 cigarettes per day (pro die). Alcoholism, tabagism and drug addictions actually affect people in total institutions to a greater extent than general population. Tabagism, especially when started in early age, is often connected to various illnesses and to deviance-prone behaviours (Richard & Senon, 1999).
Numerical parameters expressed in Z scores (standard scores) obtained by each of the subjects in their respective research areas allow to evaluate those areas of greater suffering emerging from the sample. The results indicate that the average discomfort of the sample exceed the “statistical normality” limit both in the aggregate M-S (1.15 standard points beyond the limit), and in the aggregate M-C (1.35 standard points beyond the limit).
Consequently, it can be said that the sample shows a clear degree of discomfort compared to non-convict population which has been used to settle the normative scores of the test.
The average number of discomfort areas is 7.9 for singles and 9.8 for couple-condition subjects. This indicates that the latter have a greater discomfort degree compared to singles.
Cronbach's coefficient alpha was measured in order to check the reliability of the scores. This indicator synthesises the reliability of tests and allow to acknowledge the consistency of the subjects' attitude relatively to the items of the test (whenever alpha > 0.7). Cronbach's coefficient Alpha was 0.80 for aggregate M-S and 0.73 for aggregate M-C. These scores show a good internal consistency of the test and sufficient suitability of the answers of the sample.

The report provided by the data processing software shows several concise assessments, called “critical traits”, for each subject.
An inferential analysis of these traits has been carried out in order to gather those traits expressing a single “emerging trait”. This has been made in order to depict the discomfort of the sample as concisely as possible.
18 common elements have been extrapolated from the test. They have been called Emerging Critical Traits (ECT) and their value is very similar for single subjects and couple-condition ones. These data indicating predominance of discomfort have been placed in descending order, according to their percentage value of significance (see Diagram 2).

Diagram 2. Emerging critical traits (ECT)

A concise analysis of each “critical trait” leads to some considerations about the examined phenomenon:

Paraphilias (11.4%) or sexual deviances (the term “perversion” is old-fashioned having now only a derogatory meaning or expressing a moralistic prejudice). People experiencing a limitation of their personal freedom, which eventually affects affective, sexual and relational aspects of their life, can substitute sometimes extreme fantasies for the need for sexuality which is actually limited by imprisonment. This datum emerges from both sub-aggregates, however it is more evident in couple-condition males. This is probably because these subjects, having a partner to project their erotic fantasies on, amplify the latter as a way to compensate for the prolonged lack of actual and dyadic erotic sexual activities.

► Those traits regarding psychological dependence and egocentrism (9.6%) lead to consider how frequent can be the development of psychological dependence and solipsism in total institutions. The latter concept expresses the fact that the subject does not take into consideration anything but himself. A regression towards infantilism is also possible (Bernheim, 1982).

► The suffering relating to sexual desire (8.2%) lead to think that promiscuity, lack of privacy in places of imprisonment, absence of a partner and relative repressed sexuality, are the major aspects of conviction. Therefore, among the punitive elements of the sentence there are some aiming at destructuring intimacy of the convicts and contributing to the inhibition of their sexual desire.

► The phrase premature/absent ejaculatory incompetence (7.9%) includes all deficits affecting ejaculation such as premature, retarded or absent ejaculation, and primary, secondary, occasional or situational ejaculation. The answers to the question on ejaculatory incompetence can refer both to the experiences the subjects had before being confined and to episodes occurred during temporary permissions to leave the institution or to concomitant situations happening inside the institution (auto- or hetero-induced masturbation, homosexual intercourse in prisons and heterosexual intercourse in so-called “mixed” communities).

► The tendency to obsessiveness (5.7%) found in the sample refers to those mentalised behaviours considered as prodromes of obsessive ideas and rituals whose aim can be to bring those drives seen as dangerous and destructive (sexual drive among them) under control.
According to a Note by the European Council a characteristic of the “psycho-syndrome fonctionnel” (Comité des ministres du Conseil de l’Europe, 1977) caused by long-term convictions is the appearance of obsessive thoughts owing to hypocondriacal and paranoid ideations.

► The difficulty of accepting regression (5.7%) involves a difficulty of regressing functionally (that is letting oneself go) even in specifically sexual and relational situations.
There are several types of “regression”, from dysfunctional regressions described by Freud (Freud, 1926) to iatrogenic regressions of psychoanalysis indicated by Weinshel (Weinshel, 1966), to Ferenczi's thalassal regression (Ferenczi, 1989) where it can be found a desire to return to the ocean left behind in primitive ages. Ocean would represent mother or more specifically mother's womb which, transposed to a dyadic relationship, can allow to repeat the experience of a sexually functional, peaceful and reassuring surrender, as during pregnancy.

Depressive equivalents (5.4%) refer to those non-organic disorders whose major representative is depression. Reactive depression is the most spread psychic pathology in prisons and the main cause of attempted suicides among convicts (Serra, 2005). It is often combined with euphoric/dysphoric mood, being a bipolar disorder in as much as 35 percent of the cases (Calabrese, et al., 2005).

Tabagism (5,4%) is indicated as a likely cause of vascular and endocrine pathologies which in turn can significantly affect sexual functionality. Several European studies have found significant correlations between tabagism and depression and/or attempted suicides (Richard & Senon, 1999).

Alexithymic indicators (5.2%) refer to those pathological conditions which characterise the impossibility to express emotions and feelings verbally. Inability to identify and process one's own feelings combines with a tendency to somatise emotions. In other words, individuals with alexithymical traits of personality are especially lacking in phantasmal activity, emotions and feelings.

Reported diseases (4.6%) are those pathologies, such as venereal diseases, Aids, etc., which can intervene in an aetiological sexual context and interfere with normal sexual activities and with relationships, even though indirectly. The sample as a whole has reported several somatic disorders whose psychosomatic correlations can foster a "pathogenic noxa" which is capable of affecting sexual and relational aspects, sometimes in a significant way.

Relationship with parental figures (4.5%) indicates how a disrupted familial context, that is to say unbalanced affectiveness and power in parental figures, can produce disturbed social, family, relational and sexual behaviours. In the history of a deviant subject there can often be traumatic events resulting from unstable familial situations, lack of parental care, inaffectivity, negligence, frustrations, abuses, physical and psychological violence. Some family conditions can produce disparagements and humiliations leading the subject to create a belittled image of himself called negative identity (Erikson, 1968) which is capable of generating an evolution towards deviance or criminality.

► It is no accident that shyness, relational inhibition and aggressiveness (4.2%) reached a similar level of significance in the sample: according to several authors, these components have common roots. Shyness and aggressiveness can seem opposed attitudes, however, it has been found that some young people show both in their very early years. The frustration-aggression theory by Dollard (Dollard, et al., 1939) assumes an early frustrating environment which would cause aggressive behaviours to emerge later on together with shyness and avoidance conducts.

Social-environmental conditions (4.0%) in convicting institutions entail a limitation of personal freedom forcing the subjects to a process of self-despoiling, to cancellation of privacy and to so-called contaminant exposures: these monotonous and obsessively repeated conditions easily lead to mental boredom and annihilation.

Dysfunctional body perception (3.7%) in convicting conditions can be seen in a psychopathological perspective where it can be found a morbid dissociation of body experience: the mind refuses the body, dissociates from it and sometimes punishes it (mutilations) as if the subject would like to express all his uneasiness through his “convicted body” (Gonin, 1991) as it was defined by Gonin (a French prison doctor).

Anxiety (3.7%) is often found in total institutions. It is also found in the prisonization syndrome which expresses itself in a wide range of psychopathological frames, from anxiousdepressive reaction to Ganser syndrome.

Lack of self-esteem (3.7%) is one of the elements which, together with the absence of identity and status, tends to more easily destructure the individual's personality. It is quite obvious then, that a prisonization condition can affect a convict's self-esteem in a significant and lasting way. This, in turn, impairs the cohesion of the ego whose negative consequences will affect sexuality and affective relationships.

Erectile dysfunctions (3.0%). Apart from those physical pathologies directly involved in functional alteration of the organ, such as diabetes, vascular and cardiac diseases, or iatrogenic ones, such as surgeries (aortoiliac bypass and prostatic resection); several studies have confirmed that erectile dysfunctions are frequently correlated to psychogenic disorders, depression first of all, but also anxiety, psychosocial factors, stress and tabagism. Although in different degrees, all these concomitant factors have been found in the sample of the research through emerging critical traits.

At the end of this excursus relating to social-affective and sexual-relational disorders found in the examined population, it can be useful to think about the need for an evolution in the field of total institutions. This would allow to acknowledge the possibility to maintain affective bonds in decent and dignified conditions in all those places where people live in confinement.
It is basically a question of understanding that convicts, despite their difficulties, are in evolution and that their reintegration involves restoring their capability to have relationships with their relatives and that these relationships cannot be reduced to superficial hygienic sexuality. Probably, it is more a question of right to affectivity than to sexuality (Gravier & Lamothe, 1988).
It must be highlighted that a “crossover” is likely to happen between the disorders extrapolated thanks to this survey and criminal records: several clinical pieces of research on rapists, for instance, describe weak, unsuitable men who are insecure of their masculinity and socially maladjusted, suffering from anxiety, depression and rage in addition to sexual conflicts and dysfunctions, such as impotence and premature/retarded ejaculation (Kaplan, 1979).
In the final analysis, after carrying out this research on the universe of total institutions, it can be said that the subjects of the sample, all of them belonging to that category of individuals who live in a condition of limited personal freedom owing to their deviant past, show more affective, sexual and relational sufferings and discomforts than people who are not confined to convicting institutions.
What is still to be established is whether these subjects entered rehabilitation institutes as a consequence of their deviant affective-relational characteristics or the dysfunctional elements were created or worsened by their convicting condition.
In order to ascertain this possibility, a longitudinal study keeping cohorts of subjects under observation during their entrance in the institution and after a certain period of conviction would be needed. The latter would be a further objective and a future development of research on sexuality and affectivity in total institutions.

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