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Plethysmograph: a disputed device
A genital plethysmograph (pronounced pluh-THIZ-muh-graf) is a controversial device that measures blood flow in the genitals. Sensing equipment is attached to the subject's genitalia and the subject's reactions are measured while exposed to images or audio recordings of materials some people find erotic.
Proponents claim the devices are an accurate gauge of sexual arousal, although results are highly variable and open to interpretation and manipulation by both the test subject and the observer.
Most work with plethysmographs has been done on males with penile plethymography (PPG), but some researchers have recently attempted to create vaginal plethysmographs. Researchers note that like its penile counterpart, vaginal probing has many disadvantages, including the lack of a sound theoretical basis for interpreting what exactly the signal means (Meston 2000).
Some researchers and clinicians in the field of sexual offender treatment accept penile plethysmography as a useful tool in assessing and treating admitted offenders and in monitoring offenders post-incarceration. However, even among those clinicians who accept and use plethysmography, the majority do not feel that plethysmography has any usefulness as a diagnostic tool or as a reliable predictor.
Plethysmography and gender variance
The study of penis measurements is called phallometrics, and Kurt Freund is considered a primary influence in that field of study. Freund developed the device in the 1950's to catch recruits in Czechoslovakia trying to get out of the military by claiming to be gay. Freund later immigrated to Canada and was the head of the gender program at Toronto's notorious Clarke Institute, where he continued his work on penile plethysmography.
Ray Blanchard replaced Freund at the Clarke Institute in 1995.
Since Freund's suicide in 1996, his legacy has continued to have a damaging effect on gender-variant people. Freund and Blanchard used their sex offender assessment methodologies to assess gender-variant children and adults, under the assumption that gender variance is a type of mental disorder.
The only places where this device is still used on gender-variant people are countries where Freund worked. A transgender activist in the Czech Republic writes:
Most mental health professionals do not consider this device a useful or reliable diagnostic tool, but the Clarke Institute and Ray Blanchard continue to assert that the device allows them to diagnose and predict the life trajectories of gender-variant clients. Blanchard used it to help formulate his opinions that gender variance is a psychosexual pathology in those not attracted to males (a disease he made up called "autogynephilia").
As with many quacks, some of Blanchard's work is legitimate science. Blanchard has made several important scientific contributions regarding birth order and sexual preference (Blanchard 1996), and has done some interesting anthropometric work looking for patterns among other demographic groups.
However, his greatest error has been the overemphasis on interpretation of subjective data from PPG. My work in the field of consumer fraud has trained me to spot overpromotion in the field of health, and Ray Blanchard's work with PPG is textbook quackery.
I am a proud affiliate of QuackWatch, whose founder Stephen Barrett, M.D. describes how quacks like Blanchard operate:
Blanchard's plethysmograph promotion has remarkable similarities to many of the quack hair removal devices I have helped put out of business:
There are two types of penile plethysmographs in use:
A vaginal photoplethysmograph is more complicated, because it measures the amount of blood in the genitalia by monitoring minor changes in skin color inside the vagina. It is essentially similar to a lie detector that measures blush response.
The plethysmograph and the "fruit machine"quack device
The plethysmograph wasnt the only device Canadians were using to identify homosexual and nonhomosexual citizens when Freund arrived from Czechoslovakia. Since almost two decades earlier, Royal Canadian Mounted Police (RCMP) were developing a "fruit machine," a slang term for a failed program to develop a device which could detect sexual orientation by measuring the involuntary responses of subjects exposed to erotic pictures.
Subjects were placed in a dental office style chair with a pulley attached to a camera going towards the pupils. A black box in front showed pictures of men and women that ranged from non-sexual to sexually explicit. Subjects were made to view pornography, and the device measured the pupils of the eyes, perspiration, and pulse for a supposed erotic response. Subjects were told the machine measured stress.
The "fruit machine" was employed in Canada in the 1950s and 1960s
during a campaign to eliminate all homosexuals from civil service, the RCMP,
and the military. In 1981, the Royal Commission received a "massive report
on RCMP wrongdoings" by Justice David McDonald after four years of research.
The report confirmed "what was already known and widely feared. The RCMP's
Security Service has committed numerous illegal acts, ranging from mail- tampering
to kidnapping and arson. It has lied to responsible government ministers. It
has carried out surveillance of Canadian citizens on a far grander scale than
anyone suspected." (Loos 1981) RCMP had files on 800,000 citizens -- one
out of every 30 Canadians.
The McDonald Report confirmed surveillance of all known homosexuals in Ottawa. The effort included a "plan to record the movement of all known Ottawa gays on a gigantic map of the city. More bizarre and sinister are the activities, beginning in the 1950s, of RCMP Security Service subsection A-3, whose sole purpose "was the identification and dismissal of every gay person in the employ of the public service" (Sawatsky 1980).
After knowledge of its real purpose became widespread, few people volunteered for it. A substantial number of workers did lose their jobs. Although funding for the "fruit machine" project was cut off in the late 1960s, the investigations continued, and the RCMP collected files on over 9,000 suspected gay men and lesbians. The McDonald Report recommended "that the existing Security Service files on homosexuals be reviewed and that those which do not fall within the guidelines for opening and maintaining files be destroyed."
Clearly, devices like these are not scientific and prone to massive abuse.
That's why the "fruit machine" and plethysmograph are not allowed
as evidence in court cases.
Scientifically unreliable in the eyes of the law
In the United States, a scientific technique can't be used as evidence in court unless the technique is "generally accepted" as reliable in the relevant scientific community. This was decided by the Supreme Court in 1993 and is called the Daubert Standard (Daubert 1993).
Plethysmography cannot meet most legal thresholds as a valid or relevant diagnostic tool for the following reasons:
In State v. Spencer (1995), the North Carolina court reviewed the literature and case law and concluded that penile plethysmography was scientifically unreliable: "Despite the sophistication of the current equipment technology, a question remains whether the information emitted is a valid and reliable means of assessing sexual preference" (Barker 1992).
Scientifically unreliable in the eyes of mental health professionals
The doubt expressed by legal and scientific experts in the citations above echoes the same concerns by professional trade groups involved in psychology and mental health.
The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)
of the American Psychiatric Association ("DSM-IV"), universally accepted
by courts and mental health professionals as authoritative in the area of the
diagnosis of mental disorders and diseases, states:
Because the DSM-IV is the diagnostic "bible" for mental health professionals
engaged in assessment of mental illness and disorders, its rejection of penile
plethysmography as an assessment tool signifies "non-acceptance" of
the methodology within the scientific community.
Experts speak out on plethysmograph abuses
Robert M. Stein, Ph.D. from the Center for Neurobehavioral Health, Ltd. Lancaster,
PA comments on Carroll 2003:
Although studies suggest that arousal and sexual activity do not necessarily
go hand in hand, thats not going to stop people like Bailey, Blanchard,
and Lawrence, who see that their plethysmograph is about to go the way of the
doornail in favor of brain scans. They need funding and they need it now. Other
researchers are beating them at their own game, so they seem to be jockeying
plethysmograph-based arousal results from last year (Chivers 2003) as some sort
of brain scan data. Most legitimate scientists are moving away from this outdated
and error-prone device to functional magnetic resonance imaging, or fMRI, and
other brain scanning procedures. Unfortunately, Blanchard and his protege Bailey
have an aspiration to fame which has them seeking the limelight (Dotinga 2004)
and doing science by press release (Tremmel 2003).
The real long-term issue with Bailey and Blanchard is thought crime described by Orwell in 1984 or future crime described by Philip K. Dick in "The Minority Report." Their claims about the predictive value of neurometrics sound a lot like phrenology revisited.
Bailey, Blanchard, and Lawrence embrace a model in which gender variance is associated with sex offenses, criminality, mental illness, and lying. Blanchard asks in one paper "what defect in a male's capacity for sexual learning" could cause gender variance (Blanchard 1991). This parole officer mentality permeates their theories and methods, which are carried out under the assumption that those who agree with them are "honest and open" (Bailey 2003, 147) or "unusually candid" (Lawrence 1998). Those who disagree are lying.
When challenged by transsexual women, they frequently try to discredit critics by accusing them of deception. In his widely denounced book, Bailey quotes a Blanchard employee who asserts that "most gender patients lie" or "provide misleading information" (Bailey 2003, 172-175). Bailey also attempts to dismiss scientific criticism as "political correctness" (Pinnel 2003) or "identity politics" that are "a hindrance to scientific truth" (Bailey 2003a). He claims that "there is good scientific evidence that you should believe me and not them" (Dreier 2003).
The level of hostility they show towards gender-variant people and peers who
take issue with their methods puts the author in mind of the study (Adams 1996)
that linked homophobia to homosexual arousal and is reminiscent of the abuses
Bailey, Blanchard, Lawrence, and plethysmograph abuse
No test can determine whether a person will act on feelings and desires. There is no controlled scientific data demonstrating that a person who gets aroused by certain imagery or sounds is significantly more likely to seek feminizing procedures than one who does not get aroused. On the other hand, there is no compelling evidence that a person who does not get aroused by certain imagery or sounds is significantly less likely to to seek feminizing procedures.
That hasn't stopped Bailey and friends from making sweeping unsubstantiated claims about sexuality in gender-variant women based on plethysmographic guesswork (Latty 2003):
The authors of "Men Trapped in Men's Bodies" (Lawrence 1998) and The Man Who Would Be Queen (Bailey 2003) did not choose their titles just for provocation. They seek to prove that gender-variant women are really men, with "brains of men" (Tremmel 2003) who display "male-typical" sexual arousal (Lawrence 2003). They also want to use us to claim that sexual orientation is immutable by asserting gender-variant women who change their dating preferences after transition didn't really change their orientation:
However, Lori Brotto and colleagues completely refute Lawrence's assertions in a 2005 study which determined the "movement artefacts interfered with our assessment of the genital arousal response":
The most insulting and aggravating assertion made by Bailey, Blanchard, and Lawrence is that any gender-variant woman not exclusively attracted to males exhibits a paraphilia, and that in any relationship after transition, their partner is nothing more than a prop in a paraphilic script. While this may explain Anne Lawrence's obsession with ritualized genital modification (Smith 1997) and inappropriate sexual behavior in professional settings (James 2003), Lawrence's insistence that this behavior is typical or even diagnostically indicative of transsexualism seems less about science and more about an axe to grind with a community that frequently rejects Lawrence's divisive and confrontational assertions.
Our community cannot stand by while we are treated like sex offenders (or more accurately, gender offenders) by a handful of pseudoscientists who must assert transsexual women are males in order to validate their theories and identities.
Until gender-variant children and adults are no longer subjected to outdated and humiliating plethysmographic procedures in order to get access to treatment, activists have considerable work to do. The potential for abuses with plethysmography will continue to remain a threat as long as people like Bailey, Blanchard, and Lawrence have any influence in their field.
We need to make sure these publicity-hungry hacks take a back seat to real neuroscientists and biologists, while they stick to "peter meters" and other anthropometric pursuits worthy of their talents.
Acknowledgement: This article is heavily indebted to the outstanding plethysmography research of Susan K. Smith, attorney.
Revision of 12 April 2006. Originally published 16 May 2004.
Citation: James AJ (2004). Plethysmograph: a disputed device. From tsroadmap.com. Version of 12 April 2006.
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