Pattern Seeking In Science: An Evolutionary Process

Despite what some write off as phenomenological, hypothesis seeking is as important as hypothesis proving. When we notice something important clinically, we at best can report it as a case example. This patient did exist with these important characteristics which are not what has been reported so far. When enough patients are gathered and if there are enough data, the facts documenting the characteristics inform us beyond clinical experience or even intuition. As the process evolves within data sets, new facts emerge to form patterns that we had not seen before which help us understand in a more significant way. An aggregate knowledge comes from evolutionary verification of those original observations. The integration of real clinical experience with real research expertise is a vital bridge to detecting patterns which can be vital for working with our patients. This issue of the journal collects examples of connecting dots among data sets and provides new ways of looking at sexual behavior, addictive and not.

My first two patients were exhibitionists. The first was a very shy man whose behavior was secretive, yet he still was arrested. He and his family attended nudist camps and were part of a group of fellow travelers. Only his public behavior was against the law and still offending. He clearly was not a dangerous man but very wounded in his history. In that sense he conformed to what I had learned in graduate school and from the literature. Exhibitionists were regarded by law enforcement and clinical literature at the time as “pathetic but seldom dangerous.” My second client was also an exhibitionist, but he also did some frotteurism and voyeurism. I thought I knew him well after a year in group, but was stunned when he disclosed to me that he was a rapist as well. For a young clinician there was learning on many levels.

Almost a decade later (1985) I was working on a book called Contrary to Love, Counseling the Sexual Addict. We had data on specific behaviors and had conducted a series of correlations. Out of that we found that some behaviors were highly associated with others. We called them linked pairs (p. 207). One of the combinations was exhibitionism and voyeurism. In the data set there emerged another link to that pair: rape. Unfortunately it was at the.06 level of significance, missing the standard.05 cutoff. With that result, I could not report what I had experienced. I immediately thought of my early client and knew that there were more out there like him.

The first article in this collection, “Varieties of Intrusion: Exhibitionism and Voyeurism” (Hopkins, Green, Carnes, & Campling), profiles each behavior separately, producing unique profiles. Patients who reported both were much more disturbed and the behaviors were highly associated with violence including rape. For me it was a 40 year journey from the original patient to this level of understanding. The verification is important but so is the process. It is the integration of the “phenomenological” into a higher level of understanding.

Sometimes the evolving understanding is accelerated by the lens used. Latent probability is a psychometric strategy which scans across groups and detects new groupings that would have been missed. The contribution “Empirical Identification of Psychological Symptom Subgroups of Sex Addicts: An Application of Latent Profile Analysis” (Nino de Guzman, Arnau, Green, Carnes, S., Carnes, P., & Jore), is one of the first of a series of papers using highly documented personality measures, sex addiction measures, and latent probability analysis. There is much to learn about subgroups of sex addicts this way because it helps us to see a mid range of analysis between the global term “sex addiction” and a specific collection of behaviors such as exhibitionism or compulsive affairs. One of the many striking findings about this analysis (and the ones to follow), is that there is a substantial subset of patients who fit the criteria for sex addiction who have very minimal comorbid psychopathology. Parallel to alcoholism for example, some alcoholics are addicted only to alcohol with no comorbidity. Some sex addicts also have little or no comorbidity.

Often discussed but poorly defined are patients who are compulsive in relationships. The phenomenon takes many forms but always involves preoccupation with another person or persons. In the literature for some time there has been speculation and even data supporting attachment dysfunction. What we have lacked are systematic studies of the attachment characteristics of these patients. “Attachment Dysfunction and Relationship Preoccupation” (Jore, Green, Adams, & Carnes) addresses the complex array of attachment styles with addictive relationships, with special attention to binge purge and sexual recycling issues. A companion paper looks at sexual isolation from the same attachment perspective. The contrast suggests some remarkable findings. For example, the authors point to sexual aversion or sexual anorexia having common characteristics. However, men and women have very strong attachment issues which bring them to being compulsively non-sexual.

Researchers who have written about sadomasochism have concluded in general that BDSM behavior does not have any mental health correlates. These studies conclude that it is a normal and healthy expression of human sexuality. They were done on general populations, not clinical. This issue contains a paper using MMPI -2 on a clinical sample of sex addicts and contrasts men and women. This paper emerges from a study of people seeking help with sexual problems and finds a high density of mental health issues. Further, comparing men and women who participate in the same behaviors reveals very different patterns of associated psychopathology. Because of the associated intensity and differences of viewpoint, this finding reminds me of Redish and his colleagues writing in 2008 (Redish, Jensen, & Johnson, 2008) about parallel happenings in addiction research. They point out that conflicting conclusions do not mean bad research. They speak to the importance of moving a meta level in which the findings that the researchers had different parts of the same elephant. Each was accurate about what they were looking at. One aspect of evolutionary verification is the pieces do not always fit together at first.

Finally, there has been much speculation about the impact of sex addiction on partners. There are common characteristics but also diversity in reactions. Further questions have emerged about matching disclosure processes depending on the nature of the partnership. This issue concludes with “Confirmatory Analysis of the Partner Sexuality Survey” (Carnes, S. & O’Connor). It sheds light on a dark corner in the coupleship aspects of disclosure. Healing the hurt requires specificity of how it hurts. Another well-structured piece of data will now be added to the meta picture.

ACKNOWLEGEMENTS

It has been an arduous but very rewarding process to do these special issues. I wish to thank Charles Samenow and Jennifer Schneider for their ongoing support of this venture. The board of SASH came through especially in the effort to create meaningful peer review. The contributors put an extraordinary amount of work bringing their research to light. For me the support of the Meadows, The International Institute for Trauma and Addiction Professionals (IITAP), the cooperating institutions and CSAT therapists, and the American Foundation for Addiction Research, made it possible to finish this. Finally, to my colleagues in crime, Brad Green and Randy Arnau at the University of Southern Mississippi, who helped create the platform and connect the dots, I am beyond grateful.

And then there is a profound gratitude to have the gift of being able to watch the process from cases to data to more complex understandings ….