J acob miller loved Toronto. he thought of it every day. He was American, and lived in a snowy American city, but a Canadian flag, with its broad bars of red and its red maple leaf, hung in his home office. A printout of the flag, on a sheet of computer paper, was taped to the wall between his kitchen and dining room Pasted to the rear window of his car, a flag decal hinted at his love. When he dressed casually in wintertime, he favored a letterman’s-style jacket. The leaf, big and bright, adorned the back.
If he’d won the lottery, he would have retired and moved to Toronto. If he could have designed his own world, that city would have occupied his entire planet. “When we had our son, I wanted what I call a T-R name,” he said, laughing at himself. “Tristan. Troy. Trice. I didn’t tell my wife why. I didn’t tell her, ‘Because it would remind me of Toronto.’ She said, ‘I’m not naming him Tristan, kids are going to make fun of him I’m not naming him Troy.’ She said, ‘What kind of name is Trice?’”
Toronto was a realm where everyone was accepted. On Yonge Street, during a visit in his twenties, twenty years in the past, he’d seen the kids in their punk gear, the parents pushing strollers, the beggars with their cups, the prostitutes in their spandex, the gays hand in hand, all intermixed, passing each other on the sidewalk, tolerating each other, yes, but more than that, seeming tacitly to welcome each other. He’d filled the beggars’ cups. Toronto, he felt, was a place even for monsters, a city for men such as himself.
jacob owned a tidy wooden house not far from downtown in the city where he’d grown up. In the living room, plants cascaded from the mantelpiece; a flat-screen TV was mounted above the greenery. The furniture was soft and stylish. A small white-haired dog trotted across the carpet. The ashes of another, a terrier-beagle he still mourned a decade after its death, sat on a shelf in a box painted gold.
In the driveway, in the months when it wasn’t covered in snow, he played basketball with his eight-year-old son, his only child. Ben was dark-haired, frail. They shot at a portable hoop Jacob had bought, lowered to a height the boy could manage. Jacob himself had never been much for sports, but Ben had lately taught him to play Pig. “It’s easy, Pop!” he’d cried out. “It’s easy!” So they shot and talked, shot and talked. Ben had suffered a stroke during his fifth month in the womb and had cerebral palsy. In the winter months, Jacob was teaching him to ski.
He’d been married to Ben’s mother for sixteen years. He’d thought her beautiful when they met; he thought her beautiful now. “I’ve had men say to me, ‘You’re a lucky guy.’” She had a profusion of black hair and smooth olive skin and large dark eyes. She was petite and full-breasted. She’d come from a small town, and he took her, on their first date, to a restaurant she saw as dazzling. Over a dinner much more expensive than she was used to, he learned about her job for an airline, at a ticket counter, which allowed her to fly for free. This struck him as glamorous. And he told her about his success as a salesman. “This gorgeous woman,” he remembered. “She put me on a pedestal, and I put her on a pedestal.”
He still felt they were wonderfully matched. “We’re home-body people,” he said, listing the things they loved to do together: sit on the porch and watch Ben ride his bicycle or his electric scooter; go to craft shows and collect southwestern ceramics decorated with a flute-playing figure called Kokopelli. After sixteen years, they still called each other from work three or four times a day.
Jacob had put together this life of comfort and love despite at least two relevant obstacles. One was a learning disability so extreme that, in his mid-forties, he could read sentences and calculate numbers no better than most fourth-graders. He’d been given special glasses as a child, with cardboard frames and one green and one red lens. For much of each school day, he’d been made to wear this clownish gear.
The remedy hadn’t worked; the only way he’d kept up at all was that classmates read his assignments into a reel-to-reel, and at night he lay in bed, listening. When Jacob was in his late thirties, the head psychiatrist at the hospital of Johns Hopkins University had used him to instruct his students. With Jacob’s consent, the psychiatrist had placed him within a U of sixty pupils, and asked him to imagine having seventeen apples and giving away five—how many would he have left? Jacob couldn’t answer. There were more questions like it, and a simple paragraph he stumbled through and couldn’t comprehend. Then, after the stymied gasps of the psychiatrists-in-training, the head made his point about people’s ability to overcome. For Jacob was prosperous, thriving in his job. He kept his customers, across a vast swath of territory along the Great Lakes, unfailingly supplied in the goods he handled, and he supervised a team of junior salespeople. Painstakingly, he managed never to jumble his accounts. He could have carried out his business almost entirely by phone and the Internet, but, always anxious that no one should be unhappy with him, he drove for hours and hours each day to present himself in person, a slightly short, husky man, neatly dressed in a jacket and turtleneck or tie —just to shake hands and chat for a few minutes, just to ask his customers if they had any complaints and reassure them that he would make all adjustments.
The second obstacle had to do with sex.
Jacob was, in psychiatric terms, a paraphiliac, the word being an amalgam of two ancient roots, para meaning “alongside” or “beyond” andphilia meaning “love.” The focus of his love, the focus of his desire, fell outside the normal zones. He was drawn to women’s feet. The feet were the breasts, the legs, the buttocks, the genitals. He wanted, dizzyingly, to touch them, hold them, gaze upon them, lick them, suck them, press his cock against them, slide his cock across them, have a woman position her feet together—the sides of the paired arches forming a kind of footcunt—so he could fuck them
I should make two things clear about terminology. First, some among the psychiatric experts on sex—the sexologists, as the descendants of Kinsey are called—would have insisted that Jacob wasn’t a paraphiliac, that, rather, he had a paraphilia, the difference being one of identity versus affliction. Either he was defined by the paraphilia or it was something far from his center, something visited upon him, locked to him, asserting itself dictatorially within him, but defining him no more than anyone can be defined by a disease.
Second, Jacob would never have used a word like “fuck,” let alone “cunt.” He was a somewhat shy and very decorous man. He said “intercourse” if he had to say anything at all.
Decorous and dizzy, he felt mortified by his longing. A strange and nearly complete substitution had occurred, leaving him, he felt, infinitely different from other men. He cared about faces, and a woman’s figure wasn’t irrelevant. When he spoke about his wife’s beauty, he meant what other men do. But without the feet there was no palpable desire. When he recalled his first date with his wife, he couldn’t remember what she’d been wearing in the usual sense. It seemed that from the ankles up all had been attractive but vague. Yet he recalled, vividly, her open-toed shoes with modest heels and a beige leather strap crossing just above the base of her toes.
His erotic distortion made him hideous in his eyes. He clung to the concept of affliction but plummeted into the vortex of identity. Yet there were psychiatrists and psychologists, clinicians and researchers, who believed that he had a gift. For intensity, they told me, there was no comparison between the experience of someone like Jacob and the experience of those they termed “the normophilic.” For sheer driven need, for keen and exalted erotic hunger, for the loss of consciousness that typical desire and typical sex may never provide or may offer only at the instant of orgasm and even then not quite completely despite the brain’s dimness and the involuntary cries, for true negation of control and obliteration of self, Jacob had been granted something superior. He owned the chance for ecstasy.
next to the second-grade classroom of Jacob’s childhood was a cubby area where the kids had tugged off their rubber snow boots; sometimes their socks slipped off in the process. It was his earliest memory of the yearning which, as a child, he’d had no reason to think strange. The closest he came to touching, back then, was with a boy who played at his house. For a few years it was boys’ feet that transfixed him; with puberty the effect switched over to girls. One afternoon he scurried frantically to set something, anything, high in his closet while the boy was out of the room. He tossed a ball up onto a shelf, then told his friend he couldn’t reach it. The boy said he would try. Jacob told him to take off his shoes and to put his foot in the stirrup formed by his hands.
Jacob recognized his difference when, seeing the pictures of naked women that stirred other boys, he felt nothing. A retreat from the world, an isolation that had begun with the red and green lenses, deepened. His grandmother’s house had always been his refuge. When the days of clownish headgear grew unbearable, he sometimes sprang out of his chair and out of the classroom, crashed out the school’s side doors, and staggered through the snow on the school’s sloping field, making it to the road and running up the long hill to her home. She was somewhat strange herself, an old woman who drove a red Cadillac but kept her house frigid and sat in the dark to cut her bills, and she guarded him fiercely, refusing to send him back to school despite his parents’ pleas.
And later, when he was in his teens, she called him constantly to her house to make repairs. She pointed out a crack in the plaster of her ceiling, directed him to get her ladder, and handed him a roll of scotch tape. Crazy though he felt she was, he taped the fissure as he was told. “No one could have fixed that ceiling like you!” she exclaimed. It was the same with installing storm windows every autumn: “No one can put up storm windows like you!” And cutting her grass: “You’re the only one who can mow that lawn!”
The first girl he fell in love with walked into his life with her grandmother. He was working in a sporting goods store, having dropped out of college because every assignment was beyond him.
Standing beside her grandmother, the girl asked to try on a pair of Nike Cortez. It was the style he had on, his favorite sneaker: low and simple and streamlined, with a thin, serrated sole that resembled a long row of tiny teeth. And she wanted the very color scheme he was wearing: white with a red Nike swoosh. He didn’t have a fetish for shoes in themselves, but her choice seemed to him a sign. He was a romantic man, a sentimental man. A hint of destiny seemed to lie in their taste in sneakers.
He learned, too, the size and width of her feet. He’d always liked large feet; just to hear the words “size eight” or “size nine” could make him hard. Hers were a seven and a half, but wide. He sat on the salesman’s low stool; she placed her feet, one after the other, on the inclined platform between his legs. He slid the heels over her white sweat socks, tightened and tied the laces. She paced around, declared that they fit, tried on other styles, returned to her original choice, then lingered, chatting, apologizing: “I know you have to get going.” Her pale, pretty, tentative face spoke to him of tenderness, empathy. He told her he didn’t have to go at all, and as the conversation veered she mentioned that she lived with her grandmother.
“I live with my grandmother.” He had recently moved into her frigid, comforting house.
“Get out!”
“I do, I do! I’m telling you the truth!” But when at last she left with her sneakers—her name was Sara—he was sure he would never see her again.
He remembered: “Her grandmother and her were joined at the hip, exactly like my grandmother and I were. Her grandmother was petite, the same as mine. And she was extremely frugal, just like mine.”
He didn’t yet know these details when he spotted her a week later in the store, again with the old woman, and heard himself, witless: “You’re back.”
“I came back to see you.”
He turned right away to the woman, asking for their phone number, then blurted out an invitation to both of them, wondering if he could take them to dinner. They said he should come to their house instead. His first date with Sara—she was fifteen, he was twenty-one—was a kind of threesome. The grandmother cooked meat and mashed potatoes while he sat with the granddaughter in a porch room, her feet bare. They joked about their width. “Platypus feet,” he said, “you have platypus feet,” the two of them laughing, giggling. Her toes formed a perfect staircase, each one, from big toe to pinkie, successively smaller, defining a gentle descent.
When her grandmother called them in to eat he raced up and down his mind’s corridors, peering into corners, searching for something to distract him from his desire, something to diminish it. The old woman’s voice, like a glancing eye on the brink of noticing his perversion, had pierced his brain. He could find no distraction. His brain was a void, except for the one thing he wanted to escape.
But at the table he managed to function, and afterward, as he and Sara watched TV, she placed her feet on an ottoman. In her toes and tendons and arches and heels was concentrated all the combined power of all the more common erotic parts upon more common men. The staircase was his ideal, and the platypus-like width made her his version of a swimsuit model, and hesitantly he took her feet, each in turn, in his hands, and while she pretended to focus on the television he began to massage them—delicately, adoringly—as though nothing else existed in the world.
jacob was Jewish, and when he confided his love to his grandmother she asked about the girl’s religion. The answer wasn’t the right one. But soon his grandmother, who hated dogs and wanted them nowhere near, came to love the mutt—the terrier-beagle whose ashes now rested on his living room mantel—that he and Sara bought together after spotting it in a pet shop cage during a stroll at a mall. By that point he had moved into his own apartment, and one morning his grandmother phoned, demanding that he come over right away. She’d seen a mouse and declared herself scared to death. “Bring the hunt!” she ordered, using the Yiddish word for dog.
“His name is Max,” Jacob said.
“Just bring the hunt!”
He did, the mouse disappeared, and from then on she wanted the dog to visit all the time and deemed both Jacob and Sara heroes for owning it: “No one can scare mice like that hunt!”
Sara’s grandmother was grateful for the stability he offered; Sara’s high school friends struck her as wild. Her grandmother wanted only to know that he would be a gentleman, that he and Sara weren’t doing anything they shouldn’t during their hours in the TV room after the meals she prepared. He gave her his word, and for three years he kept it. His palms and fingers and lips and tongue traveled from her feet to her breasts and back again, the care of the trip upward masking the urgency of the trip down. Preserving her virginity wasn’t a problem for him He came explosively, in secret, in the bathroom, never confessing his desire. But with all the attention to her body, all the signals he sent surging through her calves and thighs and breasts, chastity became a problem for her. She begged him for sex; he held off until she turned eighteen, then entered her with her feet in his hands or glimpsed in the corners of his eyes or—he needed this at the very least—pictured in his mind.
She was still in high school when she began to talk about marriage. He insisted that they live together first, needing to be sure that all wouldn’t unravel. When she started college, she took up with a new set of friends, began smoking marijuana, grew distant from him “I started to feel like a sugar daddy,” he recalled. One day he turned a street corner and saw her hand in hand with someone else. Sara’s grandmother was as desolate as he was when they separated. She asked if he wanted to move in with her. For several weeks he ate her dinners, watched her television, slept under her roof.
And more than twenty years later, as I sat in his living room, he asked if I’d like to see Sara’s picture, and darted upstairs to slide it from wherever he kept it hidden. It was a small print with the posed and creamy look of a yearbook portrait. Her shoulder-length brown hair was carefully yet simply styled; her pale skin looked flawless to the point of appearing almost blurred; her smile was bright but seemed on the verge of collapse, like the smiles of so many teenage girls when faced with a photographer’s scrutiny and the prospect of a yearbook’s permanence. I couldn’t think of much to say as we gazed at her face together, but he filled the silence. “Not a day goes by when I don’t think about her. I had a psychologist once who told me, ‘Jacob, there’s a lid for every pot.’ There’s my lid.” He struggled to express exactly why, and returned, again and again, to their common love of their grandmothers, as though Sara was linked so strongly to the solace his grandmother had given him growing up that he needed nothing, in addition, besides the rush of attraction—and the perfection of her feet had offered him that. “There’s my lid,” he said again, then pleaded, “Don’t make me cry here.”
It wasn’t clear with whom he was pleading: I wasn’t talking, and the photograph seemed far too inexpressive to elicit tears. Yet he was seeing things I could not see, feeling things he could not communicate. His grandmother had been a woman of ultimate understanding, intuiting his shame and protecting him from the world that inflicted it. The miswiring of his brain had held him back a year in elementary school and made his advancement afterward a matter of sheer mercy, but she had provided a realm where this was irrelevant, and where his ability to scotch-tape a ceiling was a princely virtue. He never told her anything about the second way his brain had betrayed him, about the fact that he wasn’t driven at all to place himself inside a vagina but was desperate instead to be between a pair of feet, about the way his brain seemed to have set on the hood of his penis a pair of red-and-green glasses, about the way sex flooded him with self-loathing. He had no reason to think she had gleaned even a hint of it. Yet her acceptance and admiration had always been so unconditional and complete that they could seem to include his secret.
A few times, in the four and a half years he and Sara had been together, as he licked and kneaded her feet yet again, she whispered, teasing, “I think you like my feet better than anything.”
“What are you talking about?”
“I think,” she breathed, “you’ve got a problem” But she whispered it sweetly, as though suggesting that she didn’t mind, and the flood of self-loathing was drowned in a tide of gratitude.
“Don’t make me cry here,” he repeated in his living room, and turned, and stepped past the printout of the Canadian flag and up the stairs to return her portrait to its dark, sacred place.
in winter, Jacob tried not to listen to the weather report. A blizzard might easily bring a foot of snow, or over a foot, or two or three feet in the serious storms. The blizzards came one after another, and he couldn’t bear the word. “Imagine if snowfall was measured in breasts and you were the only man with that sick desire,” he tried to explain. “If you had to hear the weatherman saying, breasts, breasts, breasts, breasts, breasts, and you were the only one who knew. You’d kept it hidden since you were a kid.”
With each passing year, through his late twenties and into his thirties, the craving, compounded by the secrecy, grew in strength. “You have to laugh,” he said, and did, at himself. “People don’t realize it. How many times that word comes up. If you said, ‘Jacob, I’m renovating my house, how many square feet do you think the study needs to be?’ I’d think, Square feet, I wouldn’t mind looking at some square feet.”
The winter was difficult, too, because guests at his house thought they should take off their shoes or boots. It was simple courtesy. “‘Not in my house,’ I’ll say. ‘We don’t do that.’
“‘Oh, I don’t want to mess up your floor.’
“‘Don’t worry about it.’
“‘But it’s no trouble, really. I don’t want to track up your carpet.’
“‘No, no, please, we’ll clean it up, we don’t mind, we clean all the time, we’ll vacuum the carpet. Please.’”
But late spring was the worst of all, with its sudden sandals and flip-flops, its abrupt emergence of feet that seemed especially bare for being untanned. Once, driving, with the traffic clogged at a construction site, a car came to a stop next to him The young woman in the passenger seat had her feet up on the dash, and he exploded within seconds, scarcely touching himself. Sometimes he didn’t need any contact with his penis at all. He could reach orgasm simply from the feel of feet in his palms or against his tongue, or from the sight of a high arch or a broad instep.
Television besieged him. On a cop show, a tough female detective warned a suspect, “I’m going to stick my size eight where the sun don’t shine.” It seemed that every movie had a scene with bare feet. Yet sitting in a doctor’s office he picked up a magazine that listed Hollywood celebrities according to their best body part. “They had every part but one,” he remembered, feeling utterly alone. He understood that the existence of pornographic Web sites catering to his desire could only mean that there were other men like himself, but the others, he was sure, had milder, more passing interests. No other mind was so thoroughly scrambled as his own. “My point,” he said, after describing the magazine that hadn’t praised the feet of a single movie star, “is that obviously it’s not acceptable.” He paused, then asked me, “Do you think your wife would accept it?
“I’ll be honest with you,” he answered himself. “I wouldn’t want my wife to accept it.”
He confided in no one. He conducted surveys. They would begin with a photograph in the sports section, a college or high school girl on a softball field or basketball court; he’d always been taken with the idea of athletic feet. Working from the caption, he would call information for the girl’s number. The survey stuck to a script: “Hello, I’m calling from Nike, and we’re putting out a new sneaker. We’re doing a sixty-second survey today. Would you mind answering a few questions?.. .Do you wear sneakers? .Do you play sports?… Can you tell me what size you are?… Are your feet narrow or wide?…Now, if you saw two girls sucking on each other’s toes, would you find that disgusting or would you find that funny?” He thanked them politely as soon as he’d come, felt beset by guilt as soon as he’d hung up.
In restaurants, he sometimes knocked a woman’s dangled pump from her toes as he edged between tables. When he apologized, the woman would give her reassurance: “Don’t worry, it’s nothing.” But it wasn’t nothing. “No matter where you go,” he said, “there are people, and people have feet. Unless I lived in a center for amputees. That would be peace.”
The ads for massage parlors filled the back pages of the city’s alternative magazine, and he’d stared at them countless times, warning himself, “You can’t do that, you can’t just pay your money and take a girl’s body, you can’t.” But in his late thirties, he found himself in a dimly lit greeting room Six young women stood in front of him—in stilettos, in lesser heels, in sandals—instructing him to choose. His eyes scanned faces and swooped toward the floor; he picked a woman with toes that formed the staircase of his fantasy.
He followed her along a corridor into a small room of their own. “Okay,” she said, turning to face him, “whatever you want.”
He didn’t answer.
“I’m going to give you a condom.”
He stayed silent.
“Is it a blow job you’re interested in?”
“No, I’m not interested in that.”
“You’re not?” Her voice climbed slightly.
“No.”
“Well, what interests you then?”
He couldn’t speak. She held the condom out toward him a second time.
“We’re not going to need that.”
Something shifted in her eyes. “You paid me sixty dollars, what are we going to do?”
“Take your shoes off.”
“What?”
“Don’t worry.”
She did as she was told, and stood in her bare feet.
“Now lie back on the bed.”
He let down his pants. She asked if she should undress; he whispered that she didn’t have to. His hands and mouth had begun.
“You got to be kidding,” she said. “You’re paying me to do this?”
He couldn’t force himself to pull his lips away to answer. But he lifted them away to put his cock where he’d always dreamed of sliding it. The sensation swallowed him, spirited him into unconsciousness.
“I’m going to give you my card,” she said, afterward. “Anytime you want to come back, please, you let me know. You’re going to be my favorite customer.” the guilt he felt for renting her body; the humiliation of her words, You ’re going to be my favorite customer; the relentless urge to have her again; the jolt of panic that came with learning, some weeks later, that the place had been raided, that he could have been among the men rounded up—all of this pushed him toward treatment.
He’d been in therapy before, the standard sessions of talking. Nothing had changed, except that he had tried to tell his wife. The therapist had demanded it, saying she could not work with him if he didn’t, and so one October night, as they were driving home on an empty highway after a dinner with friends, he forced himself to speak, relieved at least to have his face in darkness and his eyes fixed on the road. But he used general phrases, “I have a sexual problem,” “I have a sexual addiction,” and his wife started crying, asking only if he’d had an affair. It wasn’t an unlikely fear: he avoided sex with her, as he always had, out of dread that he would reveal the hideous need at his core. He assured her he hadn’t. He alluded to the Internet, the telephone, barely mentioning the word “feet.” Sobbing, she said she didn’t understand. He told her he didn’t either. He invited her to join him with the therapist, but she refused, didn’t talk to Jacob for two days, and when the silence was over it was almost as though, on that desolate October highway, nothing had been said.
Now, after his session with the prostitute, he flew to Baltimore to seek the help of a psychiatrist who, he’d read, was among the greatest experts in the country on sexual disorders. Fred Berlin worked in a vast and grand Victorian house, with a facade of rust-colored bricks and turrets at the corners. It stood on a hill above the harbor. The stoop was high, the outer vestibule was towering and dark, the massive wooden front doors were elaborately carved. There was no sign on any exterior wall of the building, nor on the doors nor below the doorbell, to name what was inside. Once, he’d seen nearly all his patients at his office at the hospital of Johns Hopkins University, and he still taught at Hopkins and did rounds at the hospital (where, after becoming Berlin’s patient, Jacob would help the head psychiatrist to instruct his students). But the university, it seemed to Berlin, had grown terribly uncomfortable with his practice—most of which involved not only the aberrant but the criminal—so he had moved his main work away from the campus to this private castle.
Inside, the floorboards had a soft gleam, as did the banisters, which were capped at each landing by an intricate wooden sphere. All was dim and quiet and burnished. But the immense waiting room held plants and small trees with leaves the size of platters; they stretched their anarchic limbs toward each other and over the backs of the plush couches. A glass coffee table was supported not by legs but by part of a contorted tree trunk, aggressively gnarled and adding to the suggestion of encroaching jungle.
There was, too, a seven-foot-high grandfather clock that stood in one corner. Within the glass case the brass pendulum swung along its gentle, unremitting arc, its face bearing the Hopkins seal. It sometimes seemed that this steadiness, this emblem of prestige, tamed the plant life. At other times, when a waiting patient decided to turn on the large television, and to turn the volume up high, the wordless battle between the jungle and the clock felt irrelevant. All was consumed by the human need to drown out one’s inner voices with the blaring voices of TV.
The offices Berlin shared with his few partners were furnished with antiques. Stately desks and lush, splendid chairs filled the rooms. He’d done much of the decorating himself, and took pride in the ambience of age and grandeur. But one object didn’t fit. A detailed model of a sports stadium, made of wood and metal, sat on a desk in a room used for evaluations—the stadium of the University of Pittsburgh, where he’d played football during his freshman year on a team that starred a future NFL Hall-of-Famer and that finished the season ranked second in the nation. Berlin had been a benchsitting linebacker, but the memory of going out for the team, of taking on that challenge four decades ago, still fed his resilience, his determination to be kind toward those whom others would only condemn.
Something of the linebacker lingered in his body, in the barrel-like build, though all had been layered and softened by years. As a sophomore, he’d won a research stipend in psychology, and he never played competitive football again. But the eagerness and energy that impelled him to try out for the team still radiated from his broad shoulders and from the scalp of his round head through his thin, closely cropped hair.
He might have been related to Jacob; they might even have been brothers: both men were short and wide and compressed in the neck, stubby. Both had full cheeks that were beginning to fall toward their crisp shirt collars. Jacob’s head, too, was covered minimally in well-trimmed hair; a warm energy emanated from both their skulls. And even their voices shared a slightly high pitch and faint scratchiness.
Yet there were differences that added up to something unmistakable. Berlin’s body was more solid, his face more firm. His entire presence held a combination of sensitivity and stubborn, quiescent embattlement, while Jacob’s spoke of caring but not an immovable core. It was as though they had been carried together in the same womb, but that some prenatal event, some seemingly insignificant but unequal firing of hormones or brief jarring of the amniotic sac, had routed Jacob’s life toward the precarious and Berlin’s toward strength.
Berlin liked to consider human erotic life from the vantage of a Martian scientist gazing down at Earth. “He would see that a lot of different sexual interests exist within the people who live on this planet. He would note people attracted to adults of the opposite gender and people attracted to adults of the same gender and a percentage of people on Earth attracted to children and people attracted to all sorts of other things and aroused by all sorts of behaviors, but the Martian scientist would simply observe these Earthly desires and define their differences, with no judgment or value attached to them”
He had worked with Jeffrey Dahmer, who’d killed seventeen boys and young men, copulating with and cannibalizing the dead bodies. He had testified at trial that Dahmer was afflicted with necrophilia, that he was nearly incapable of becoming aroused with a living person. Berlin had spent time, too, with Michael Ross, who’d confessed to raping and strangling to death eight girls and young women. After two decades of investigations and trials and appeals, Ross wanted to die. He’d told his lawyers to stop filing briefs and arguing on his behalf, to surrender, and as execution approached Berlin hoped that the prisoner would allow him to visit, to say good-bye, perhaps to be there for him in his last moments.
Ross was, by Berlin’s diagnosis, a sexual sadist. “God or nature put sex into each of us,” Berlin said, as we sat on the ornate red chairs in one corner of his expansive office. “If we don’t eat, we die.
If we stop having sex, we perish as a species. We are talking about a powerful, biologically based appetite. And if that drive gets aimed in the wrong direction it still wants to be satisfied. You know, sleep is another biologically based drive—you could promise yourself all you want that you’re not going to give in to that craving for sleep, but let me tell you, eventually you’re going to. That’s the struggle some people are having sexually.”
And that was the way he saw even a case so extreme: that here was a man for whom sexual release depended on inflicting terror and torture, a man who had, in effect, restrained himself except for those eight times, those eight acts of primal gratification—such a tiny fraction of the number that most adults seek and find.
“Ultimately,” Berlin went on, thinking about the period of the killings, “there was a man in there struggling to do right. He says he tried to talk himself out of leaving the house, fought with himself not to leave, so he wouldn’t kill. People want not to believe this. People can’t deal with the humanity within a man like Ross. He never wanted to be this kind of person. We can all say, ‘Well, he should have turned himself in.’ But people,” Berlin’s voice rose as he addressed an invisible outraged throng, “let’s take even something as simple as getting a traffic ticket. You don’t say to the policeman, ‘Oh, and by the way, I do speed frequently. ’ And you don’t turn yourself in for something that will get you executed. What he would tell himself is, ‘I’m never going to do it again, and if I turn myself in it doesn’t bring back the people who are dead.’”
Berlin’s brown eyes glanced abruptly almost straight upward. Then he hunched forward, tight fists held half an inch from his lowered forehead. “I know this all must sound insane to the families of the victims, but to say that Michael Ross is evil just is not accurate, given my knowledge of sexual disorders and the impairment of both cognition and volition. Society can’t consider the complexity. You might read about a sexually sadistic serial killer, and the neighbors say, ‘Gee, we knew him, we can’t believe he’s someone who could do that. If you had a flat tire he was going to come over and help you change it.’ But the criminal behavior never was a reflection of the personality, the visible aspects of it—it was part of the privacy of the sexual makeup. You and I could sit next to each other, and I don’t ask you about your sexuality and you don’t ask me about mine, so if the only thing that makes me dangerous is what’s driving me sexually, you could be the next-door neighbor, you could be the wife, and never know. I had a patient, a serial rapist, who’d had a girlfriend he wanted to marry. But the urge to engage in coercive sex was so much stronger than the arousal by consenting sex that he would leave the consenting relationship to go out and engage in the coercive. And the girlfriend had no idea until he was arrested.”
On death row, with Berlin counseling and encouraging him, Ross had begun injections of Depo Lupron, an anti-androgen. For most patients, at a sufficient dose, the drug cuts the production of testosterone to the degree that desire is severely attenuated; the effect, though reversible if the drug is stopped, is known as chemical castration. Before taking “the medicine,” Berlin said, Ross was contrite about his crimes, but there was something robotic about his compunction. “He confessed everything, but he himself described that he knew how he should feel about what he’d done, and that the emotions simply wouldn’t well up inside. Intellectually he was sorry, intellectually he felt for the families, but he knew he should be overwhelmed.”
With the Lupron in his system, thwarted, compulsive lust was replaced by storms and floods of regret. It was as though desire, so rarely satisfied, had stymied everything else. Now, Berlin said, “He is no longer sitting in prison masturbating to fantasies about strangling someone.” The medication, in the psychiatrist’s mind, allowed the self to emerge, permitting Ross his own humanity. Sorrow drowned him He couldn’t bear what he had done, couldn’t endure the thought of the mothers and fathers of the dead being put through more waiting, more testimony, more memory, so he had started the campaign to quicken his execution. With sex eliminated, Ross became who he truly was.
Berlin seemed, at times, to see Ross’s new resolve as proof that sex and the self existed in opposition. Erotic desire wasn’t the essence of the self; eros wasn’t even essential to the self; Freud was far in the past. In expunging the libido, Lupron had liberated Ross’s very being, his soul, and granted him excruciating guilt and the expiation of choosing death. It was at once a medical and religious vision, and Berlin was both a medical and religious man. The paraphilias were diseases, almost surely rooted in biology. He felt that the treatment he often prescribed—Depo Lupron or another anti-androgen, Depo Provera—was horribly imprecise. “It’s a club,” he said. The antiandrogens bludgeoned the hormonal foundation of desire rather than addressing specific aberrance. But he believed that, for now, until the brain was better understood and more delicate drugs were found, there was frequently no other choice. And once the medication spread through the system, redemption came quickly. The sexual sadist could become—purely—the good Samaritan who helped to change flat tires, and Michael Ross could become a man seeking his own sacrifice, asking to die for what he’d done.
“I pray to a god I cannot see; I depend on a god who may not be,” Berlin said, smiling a bit sheepishly. He attributed the line to a patient from long in the past; he could not remember who. But the words had always stayed with him, and had become a credo of his own. The moment of uneasiness, as he acknowledged his measure of belief, seemed to arise from a feeling of unbelonging, an awareness that both the strictly religious and the devoutly scientific would scorn his statement of faith, the religious because he was far too tentative and the scientific because he depended on anything at all that was beyond the reach of proof and disproof. “I want there to be a higher power. I don’t see that as a threat or alternative to science. I’m not going to be able to find a god, but as a human being I yearn. I desperately would like to believe, but if I’m really honest with myself, I’m just hoping that he’s there.”
Berlin affirmed what he could, proved what he could. The most depraved people were moral beings. With the aid of medicine, God, through a patient like Michael Ross, nearly came into view. Berlin worked with a necrophiliac who had a job at a funeral parlor; he treated a gynecologist voyeur. He welcomed uncountable pedophiles and child molesters into his office, invited them to his group therapy sessions, offered them—calmly urged upon them—medication. These, the most reviled of sex offenders, were the majority of his patients. Testifying in the state legislature, he fought against a mandatory reporting law that would require psychiatric professionals to notify the police if patients who came for treatment voluntarily, with no record of sexual offenses, confided incidents of abuse. Berlin didn’t want a law that would deter the undetected from approaching him for help. In this way, he guarded his role as confessor, his ability to redeem, his immersion in the chaos of eros.
From that chaos he needed refuge. A huge and majestic saltwater aquarium was mounted in his office, dominating the room, the brilliant colors of the fish overwhelming the deep red of the antique furniture. A sea apple, like a purple and yellow balloon with white tentacles sprouting from the top, migrated slowly, searching for invisible particles of food. A surgeonfish, its blue scales set off by streaks of ebony, glided above pink coral. A yellow tang darted around a flaming red angel. Cowfish, with their strange horns and broad gray bellies, hovered above a crab, a clam “Even that clam has an existence there,” Berlin said, at once marveling at the thought of a clam’s reality and laughing at his own wonderment. “And that sea apple—he moves to the front of the tank, where he can get the best nutrition. I don’t know what in nonhumans constitutes a feeling or thought, but it would be very presumptuous of us to believe we’re the only living entities capable of having some sort of subjective existence. To watch something like that, that almost looks like a balloon, and to see that it makes purposeful movements and has a life, it makes you think, it makes you wonder, and I find it very relaxing and very fascinating.”
He liked simply to sit and stare into the tank, and to imagine a world of subjective experience that included no torment. He was mesmerized, too, by the compatibility of the underwater beings, the coral and crabs, the lone clam and all the species of fish. “Everything in there is alive, there’s nothing artificial, and there’s a symbiotic way in which they all survive together.”
Within each creature, and for all of them combined, he perceived a tranquility denied to humans. “These species,” he added, “rarely mate in captivity.” when Jacob arrived, Berlin gave him the “Multiphasic Sex Inventory” and the “Million Clinical Multiaxial Inventory,” two long questionnaires designed to elicit a patient’s sexual preferences and his disorders of mind or mood. There were three hundred items on the sexual test, each requiring an answer of true or false: “Occasionally I think of things too bad to talk to others about…. I have exposed myself one hundred times.. It does not interest me to learn that a woman may not be wearing panties.. It would peak my interest to learn that a child is curious about sex.. I would like to be tied up and made to have sex.” And there were one hundred and seventy-five more on the multiaxial. With his labored reading, Jacob took several hours to get through. “I can remember one of the questions was about interest in animals,” he recalled. “And I’m thinking, What? That’s disgusting. That’s ridiculous. And then I thought, I’m a hypocrite.”
He felt a degree of comfort in Berlin’s mansion, partly because the facade bore no name, nothing to broadcast the perversions that brought people here; partly because he was now, for the first time in his life, ensconced within a world constructed for deviants like himself; and partly because he admired and trusted Berlin, though as Jacob struggled through the questionnaires the two men had scarcely talked. Jacob had formed an opinion based on the only thing he’d ever read about foot fetishism, a short article he’d come across in Psychology Today. The writer quoted Berlin saying that without attention to the feet the fetishist “usually can’t get aroused”—from these and a few other words, Jacob felt that the psychiatrist was able to stare into his soul. Soon he would think of Berlin “like a god.” And soon he would renounce going to synagogue, because he felt so betrayed by a god who could make him so alien. Berlin became his deity, soothingly Jewish, with a torah scroll sitting atop one of the bookcases in his office. The psychiatrist seemed all-knowing. He seemed unconditional in his forgiveness and sympathy. His mansion felt like Toronto, a haven.
Berlin reviewed the tests and called Jacob into his office to talk. Jacob showed him the copy he’d kept of the article from Psychology Today: an offering. The snow boots and socks and first memories of desire at the age of seven, the phone surveys taken sometimes several times in a day, the electric effect of the feet on the dashboard, the terror of late spring, the unendurable mortification— Jacob gave his history.
“I think I can help you,” Berlin said.
“You do?”
The doctor talked of a patient drawn to earlobes, assuring Jacob that he was not so strange. “I think I can help,” he repeated.
“I don’t,” Jacob said.
“I can’t cure you. I don’t want you to have false expectations, because this will always be there. But I can help.” Berlin explained the anti-androgens, their effect on the sex drive, on physical arousal, and, too, their side effects, the possibility of developing breasts, the chance that his bone structure would weaken and warp.
Jacob was too desperate to take pause. “You might be able to control the physical, but not the mental,” he insisted, trying not to hope, straining to protect himself against disappointment. “You can’t control my thoughts.” And it was his thoughts, as much as anything, that he wanted to purge. He wanted to poison their source in what felt like the center of his hideous being.
“You’re wrong,” Berlin said.
“I hope I’m wrong.”
“You are. There will be a difference mentally.”
Jacob thought, You’re full of crap. You don’t know how strong this is. He said, “I’ll do whatever you tell me to do. I’ll pay you whatever it is. I just can’t take this anymore, I just can’t be this way anymore. Just tell me what to do.”
“I’ve never met someone so agreeable.” Berlin laughed gently.
“Usually I have to fight with people.”
“You’re not going to have to fight with me.”
Berlin hardly knew why he’d begun to steer, in college in the 1960s, from psychology to psychiatry —and toward a vision that focused on the biological, that saw nature as a more promising area than nurture in which to search for understanding of the sexual mind. He recalled learning, as an undergraduate, about a scientist who was altering drives like thirst by implanting electrodes in the brain, and he remembered studying the Heinrich Kluver and Paul Bucy experiment on the brains of monkeys: the surgical lesions inflicted on the monkeys’ temporal lobes, followed by the eruption of crazed sexual activity, not only with other monkeys but with an array of inanimate objects. And injury to the same region in the human brain could lead to the same sort of indiscriminate and unrestrained desire.
But in Berlin’s own telling, there was no moment, or series of moments, of decision or inspiration that had formed his vision. He didn’t seem to think in such terms. It was as though his way of seeing had happened to him for reasons impossible to know—exactly as he thought about the erotic directions of his patients. All the talk and introspection in the world couldn’t unbury the causes. When Jacob asked, during their first meeting, “Why am I like this?” Berlin answered, “It’s the way you’re wired.” When Jacob asked, at every meeting afterward, “Why? Why? I want an answer why. I need an answer why,” Berlin gave the same response, sometimes adding rhetorically, “Why are people gay?” When Jacob tried Berlin with a theory offered by his first therapist, that back in the second grade, frantic to avoid being called on because he couldn’t read, he’d kept his eyes on the floor, and that somehow, in those highly charged moments of yearning for escape, he’d started to eroticize his classmates’ feet, Berlin dismissed it.
And probably most in his field had grown doubtful of experiential explanations. But his sexologist colleague at Hopkins and at the mansion, Greg Lehne, told me that the link to Jacob’s second-grade classroom made “perfect sense. People’s sexual interests are very specific. Scientists now are inclined to look at genetic or prenatal issues, but why people become lovestruck at certain qualities, why we’re taken with a body type, or a shape of mouth or what a person’s nose looks like, or an aspect of warmth or a sadistic side—where do these interests come from? They must come through experience, through the senses.”
Lehne, with graying hair combed tightly back from a padded face, talked about how the prevalence of certain fetishes shifted with changes in the prevailing culture. Rubber fetishes had faded after the era of rubber training pants; hair fetishes had become less common as mothers and older sisters no longer made a ritual of letting down their tresses and brushing a prescribed number of times. It was impossible to quantify such shifts precisely, impossible to cite numbers for particular paraphilias, he said, but the changes could be traced by studying pornography and the hungers it catered to.
Lehne didn’t fully discount the genetic, the prenatal, but the physiology of the brain was, he suspected, profoundly affected by what the mind took in. He studied paraphilias as a way to peer in at the workings of all desire, and mostly he saw the directions of eros as learned, not inborn. “The lovemap cartographic system,” he had written, borrowing language from the legendary Hopkins psychologist John Money, “may operate like a multi-sensory camera that episodically takes photos of the immediate environment and stores them as depictions of the sexual terrain.” a young married couple had led Berlin to his career in sex. When he’d been a general psychiatric resident-in-training at Hopkins in the mid-seventies, a husband and wife had walked onto his ward. The husband carried a wooden club, about a foot long, with a heavy chain attached to it. They told of a guillotine-like hole he’d cut in their bedroom door. No permanent injury had been inflicted yet, but his fantasies were brutal, and their fear, Berlin remembered, was that “this was about to get very out of hand. He was afraid he would kill his wife, and she was afraid it could happen. They were simple people. She wasn’t even sure how many couples did or didn’t do this kind of thing.”
When he tried to discuss the case with his supervisors and fellow residents, Berlin ran into trouble. They seemed repelled by the subject, and Berlin was criticized merely for quoting the man’s crude language from his case notes, for reciting the phrase “jerk off.” Acutely he sensed the particular taint that attached itself, even amid a group of psychologists and psychiatrists, “to anyone who acknowledged something different about their sexual makeup.” He sensed a visceral unease with sex in general.
And hearing Berlin relate this story reminded me of an interview I’d done with a couples’ counselor in Manhattan. She told me that she and a group of colleagues spoke often about the fact that not only in individual but in marital counseling sex is frequently the last thing the therapist asks about —and that the subject may never be raised at all.
Berlin still kept the club the husband had turned over. It lay in a hulking antique safe in the basement of his mansion. He’d treated the man with an anti-androgen, and, he said, the patient reported that his sadistic fantasies had faded away but that he could still become erect and function sexually. It was a long time ago, and it was impossible to know to what extent this had been true. That anti-androgens could attack the sex drive in such a way as to neutralize a paraphilia while leaving some degree of conventional desire and potency intact was unusual but known to happen. Nothing about the brain’s and body’s system of arousal was understood well enough, then or now, to predict when it would. No one could explain it. Understanding of the forces of eros was as crude as the original comprehension of testosterone itself, a hundred and fifty years ago, when a German zoologist had snipped off the testes of young roosters and watched their bright red combs atrophy along with their interest in nearby hens. If he took the severed balls and implanted them in a rooster’s belly, all returned to normal, suggesting that the testes secreted a substance crucial to sexuality—a hormone that was discovered ninety years later by a Dutch scientist, who used almost a ton of bulls’ testicles in isolating less than a third of a gram of testosterone.
After two or three years, the couple with the club drifted out of touch; Berlin never heard from them again. He had only the weapon as a memento of the case that had stirred his fascination and started him on his career. At Hopkins, John Money became an early mentor. A decade earlier, Money had taken on the case of a baby boy whose penis had been seared off in a botched circumcision. The parents worried that he would never be able to live as a man, and Money, a pioneer in his work with hermaphrodites and a believer that gender and sexual orientation are determined through social learning in early childhood, persuaded the parents to raise the boy, Bruce, as a girl, Brenda. Bruce’s testicles were clipped, and a rudimentary vagina was constructed. Brenda took estrogen to help her grow breasts. Following his patient, Money wrote about her thriving as a girl, and the case was celebrated in Time magazine and in the New York Times.
He wrote, too, about paraphilias, cataloging and often coining the names of all the types, from acrotomophilia, “a paraphilia of the stigmatic/eligibilic type in which sexuoerotic arousal and facilitation or attainment of orgasm are responsive to and dependent upon a partner who is an amputee,” to zoophilia, the desire for an animal. The paraphilias were, in Money’s view, imprinted in childhood; they were the product of learning more than biology, nurture more than nature. Considering why sexual deviations are, so far as scientists know, mostly limited to the human species, he pointed to the sophistication of the human brain. Erotic “diversity,” he explained, “may be an inevitable evolutionary trade-off—the price paid for the freeing of the primate brain to develop its uniquely human genesis of syntactical speech and creative intelligence.”
Money’s thinking was defiantly humane. He spoke about men like Jacob, and about sexual sadists and necrophiliacs and pedophiles, as people living not merely with deviant lust but with “disorders of love.” He was willing to apply to paraphiliacs the typical connections between initial desire, falling in love, and long-term “pairbonding.” He might have argued that, condemned by his condition, a man like Michael Ross was searching not only for sex but for love, in his murderous way. He talked about the tenderness and love often felt by pedophiles for their victims; he insisted that these emotions had validity and could be returned. “If I were to see the case of a boy aged ten or eleven who’s intensely erotically attracted toward a man in his twenties or thirties, if the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way.”
Berlin was taken with the complexity and bravery of his mentor’s ideas, but he was more tempered in his thinking, and he never shared Money’s faith in the importance of nurture over nature. He felt, now, that time had proved him right. Brenda, with her surgically built semblance of a vagina, and with her drug-induced breasts, had, despite Money’s published reports, never taken on a girl’s psyche, though she’d been brought up as a girl by her parents and never told about the circumciser’s accident and psychologist’s experiment that had decided her gender. She had refused to have further surgery to construct more complete genitalia. She felt alien and violent and distraught, and at last, when she was fourteen, her father confessed all that had been done. Soon Brenda set out to become a man, to become what biology had made her. She underwent a double mastectomy. She had a penis and testicles created from grafts and plastic. She injected testosterone to give herself a man’s muscles.
She named herself David. And eventually David killed himself.
Berlin talked about this failure, and another—with pedophiles. “Money was the first person to use medicines to lower testosterone. His theory back then, and I hope I’m doing justice to it, was that you give people a vacation from their sexuality and that gives psychotherapy time to work. Myself and some other researchers, with his permission, we took a look at the outcomes. And what we found was that as long as the people were still taking the medicine they were not reoffending, but a very high percentage who had the psychotherapy—once they stopped the medicine they did reoffend. We now don’t look at the medication as a treatment while you’re waiting for psychotherapy to work; it’s more like insulin for diabetes. This is what you need over the long haul to keep you in control of yourself.”
Thinking about the sources of particular desires—Michael Ross’s for the sadistic; Jacob’s for feet; the most prosaic erotic preferences of the most prosaic heterosexual—Berlin acknowledged the potential role of childhood experience but couldn’t much credit it. The connections seemed loose and unlikely ever to be conclusively demonstrated. He believed that the sources would eventually be found, primarily, in the realm of biology, that they would prove to be “programmed in,” as technology advanced to better illuminate the brain. He lamented the loss of free will that his prophesy seemed to imply, worried that such biological determinism supplanted the idea of mind as opposed to brain, feared an Orwellian world where neurological understanding would be precise enough so that the sexual regions of the brain could be manipulated to eliminate variations of desire or so that sexual anomalies could be detected in the womb and fetuses could be aborted accordingly—but the truth of biology’s inborn power seemed inescapable.
To Berlin, the only solution with someone like Jacob was to fight biology on its own terms, no matter how crude the weapon—to prescribe an anti-androgen and hope that, with lust obliterated, Jacob would find within himself at least a faint version of conventional longings. This had happened not only with the sadist who’d handed Berlin his club but, more recently, with another patient. Berlin’s gynecologist voyeur, who’d lost his practice and barely avoided prosecution before coming to Berlin for help, told me that on Lupron sheer lust was completely killed but that other yearnings— for pleasing a partner, for conforming to the society’s notion that a married couple should be having sex—continued to motivate. “The skin on skin,” he added. “The feelings of being close to someone. And the orgasm still feels good. Though you’re not fired up by the primitive side of your brain. So sex can seem a very messy thing, like more trouble than it’s worth, like why bother.” He mentioned that he used Viagra, which Berlin prescribed for some of his patients on anti-androgens, patients who’d gotten control of relatively harmless paraphilias, so that, devoid of the urgency of lust, they might be able to become erect and carry out their more tender longings. He mentioned, too, that his penis had shrunken slightly since he’d started taking Lupron. Then he laughed: “I wonder what would happen if all men went on it for six months. Think about the advertising industry. All those commercials aimed at the primitive sexual urge. They’d have to find a new way to sell SUVs and beer.”
Berlin, thinking about the experience of men like the gynecologist, told me: “I guess the distinction I’d make would be between eating to satisfy an intense hunger versus eating to enjoy the taste of food. These guys, on the Lupron, are not responding to a hunger to have sex, but sex can still feel good; they can still enjoy that taste.”
He couldn’t know whether Jacob, on Lupron, would feel any wish at all for sex, any inclination to eat for taste, with hunger gone. But he felt compelled to prescribe the drug. He felt certain that he should wipe out the hunger, though Jacob had harmed no one.
one evening, several years after meeting Berlin and starting Lupron, Jacob led a support group for the bipolar and the depressed. He’d founded the group himself, with the help of his city’s mental health association, and he’d since become president of the association’s board. Tonight, with the March snowbanks high, he laid out pizzas and cookies and pamphlets on a Formica table. He always left home early for the twice-monthly group meetings, allowing enough time to buy food and get everything neatly set up before the members arrived. The thirty or so pamphlets, along with booklets and flyers, explained an array of emotional disorders and their possible remedies, from aromatherapy to treatment with electroshock. In the few years since he’d started the group, Jacob had never missed a meeting. In the worst blizzards, he’d dug out his car and made it to the office building that had donated a basement conference room to his cause. Shoveling out his driveway, he was pushed on by the worry that a lone member would be waiting in the snowy parking lot, despondent, abandoned.
Four long beige tables were arranged in a square, and tonight all of the twenty-five chairs were taken. “We have a fairly large group this evening,” Jacob said, beginning efficiently within a few minutes of the scheduled time, “so we’re going to have to stay on track.” The members introduced themselves, going around the square, and so did two visitors, psychology majors from a nearby college. Then a woman spoke of skipping her pills and becoming delusional and seeing knives that tried to coax her to cut herself to shreds. “I wasn’t like this four years ago till I had the car accident,” she said. “People at work say, ‘Can’t you just snap out of it?’”
“People just can’t understand it,” Jacob affirmed quietly, soothingly.
Another woman wondered aloud about electroshock, first for the woman seeing knives, then for herself. Jacob confided to everyone that he’d had the therapy. “It’s not what it was. It’s not the barbaric treatment you see in One Flew Over the Cuckoo’s Nest or A Beautiful Mind”
Verging on catatonic, with matted blond hair, a college-age girl complained about the group sessions her therapist had told her to attend at a state facility “with people less fortunate than me.” It was clear that she couldn’t bear to sit with patients she saw as more lost than herself. “I just want to skip past this phase and be normal,” she said, her voice a hollow monotone. “Do I need to go?”
“Yes,” Jacob answered. “Yes, yes you do. It’s important to get out of the house. It’s important not to isolate.” He took off his watch and set it in front of him, mindful of the time so that everyone who wished would have the chance to speak.
“Today is my birthday,” a man who was attending for the first time shared. “And this group is my treat to myself. I am in some pain, I am in some pain.”
“Happy birthday,” Jacob said softly, when the man had finished explaining the harrowing emotional journey that had led him here.
“Happy birthday,” the group echoed, welcoming him.
A bipolar man said that his medication was running low, that there were problems with his insurance. A woman offered some of her pills. “No,” Jacob cautioned. “See me after. I’ll point you in the right direction. We can get that problem addressed.”
Someone asked about the Vagus Nerve Stimulator, and Jacob explained how it worked. The battery-powered generator was implanted in the chest; electrodes were threaded to the neck, to where the vagus nerve ran up into the brain stem; the pulsations of current seemed to temper depression.
“I’ve joined a writing group,” a young woman announced. “I’m working on three novels, and I’ve got some short stories.” She allowed that she didn’t fully trust her current optimism, that she wondered if she was entering a manic phase.
“Manic!” people called out, laughing knowingly. “Manic!”
“The first time I became manic,” a partially toothless black woman joined in, “this was a good ways back, I was hitchhiking down the main drag in Houston dressed—how do you call it?— voluptuous, on my way to a lip-synching contest, thinking that’s how I can make some money. And the police picked me up for a hooker. So there I was in the clink, saying, ‘I’m not a hooker, I’m a lip — syncher.’”
“Well, there’s your novel,” a man said.
Everyone howled.
“It’s just nice to be around people who get it,” a woman said.
“Happy birthday,” the newcomer mouthed, wishing it to himself, welcoming himself.
jacob had created this twice-monthly world, and he conducted it as though his own agony was in the past. No one in the group knew that he was so tortured by his sexuality that he chose to eliminate it. No one knew that the electroshock he’d described, which he’d had both before and since Berlin, was an attempt to get free of a keen and relentless depression with sex enmeshed at its source.
Berlin had been right in at least one way. Lupron’s attack on testosterone, on this single hormone, had been an attack on his thoughts. It wasn’t only that physical arousal seemed to fade from possibility. The fantasies evanesced as well, along with the constant awareness of feet, the constant susceptibility to desire. A profound shift in consciousness occurred, as though the mind had emptied itself of eros.
Yet the emptying wasn’t quite complete. Eros lingered and lurked, allowing him hours of numb tranquility and then edging forward to seize him with a yearning that was no less painful for being slightly abstract. A commercial on TV contained a scene of barefoot teenagers. A young saleswoman asked to measure his son’s feet when Jacob took him to buy ski boots. At such moments his longing was perhaps even greater than it had once been, because the possibility of release was remote. He wasn’t going to masturbate at the first opportunity, as he would have in the past. He wasn’t going to explode without touch. He no longer grew hard easily, and he wouldn’t permit himself to work himself up. He forbade himself to masturbate. Seeing the barefoot teenagers on TV he slammed his fist down onto his coffee table.
Sex with his wife was gone entirely. He didn’t know what she understood about the desire he drugged into submission. He’d always evaded candor, and Berlin, at their first long meeting, had advised that he keep things vague. She seemed to collude in his omissions.
He had tried Viagra in high doses. It didn’t help. Jacob thought that if he focused on his wife’s feet, if he gazed at them and caressed and clutched them, he would generate enough craving to overcome the Lupron and grow hard, especially if he added Viagra. But he wanted nothing to do with these grotesque pleasures, and the Lupron diminished his drive sufficiently so that he could succeed in self-denial. He didn’t gaze, didn’t caress. Her feet remained under the covers when they attempted to make love. He stayed soft. They stopped trying.
It was Greg Lehne and another of Berlin’s colleagues, Kate Thomas, who told me that people like Jacob are not merely cursed, that they possess a special capacity for ecstasy. “There’s no comparison between what they experience and normal sexuality,” Lehne said. “It’s a hyper-positive sexual experience.” And Thomas added, “I don’t think we, in our sex lives, have a hint of what they feel.” One explanation, in Jacob’s case, was that in his second-grade classroom his anxiety about being called on reached the level of full-blown panic attacks—as he’d aimed his eyes downward, his fear was reconfigured as sexual arousal that was equally extreme. But Lehne stressed that this was only theory; the reasons, in all cases, remained mysterious.
With a paraphilia that was harmless, Lehne and Thomas felt that their primary role was to listen; their hope for the patient was self-acceptance. Cure—in the form of the transformation of desire— might never be possible, but a measure of peace could be reached. To treat someone like Jacob meant trying to lift the shame and to incorporate the focus of desire into the marriage.
Why couldn’t his wife’s feet be shown and gazed upon, flaunted and craved, offered and touched? Why couldn’t these gestures and responses sometimes be part of foreplay and other times lead to the pairing of her feet and to his penetrating between them? Weren’t analogous things done with breasts and buttocks? Weren’t they put on display in all manner of clothes and swimsuits and lingerie, to be stared at and reached for? Why couldn’t feet be objectified and included in the erotic life—and in the love live—of a couple, just as the common secondary sexual characteristics were incorporated between so many men and women?
“‘I’ve got three shit dates lined up in one weekend.’” Winston Wilde, a psychologist in Los Angeles, told me that a patient, a coprophiliac, had just spoken these words to him Wilde didn’t disparage his patient’s wish to be smeared with or eat a partner’s feces. He quoted the man in a celebratory, even exultant tone, as an emblem of therapeutic success. “A big aspect of sex therapy is permission-giving,” he said. “It’s important to give an education. Sometimes people’s whole lives can change if you direct them to an Internet site. I always like to normalize their situation.”
Berlin didn’t talk much in terms of “permission-giving.” It was hard to imagine him advertising a patient’s “shit dates” as evidence of successful therapy. He did hope that one day he would be able to help Jacob and his wife toward erotic intimacy, but the eros he envisioned seemed to have nothing to do with feet. For all the compassion in his thinking, Berlin seemed no more willing to accept Jacob’s desire than Jacob was himself. When I asked him, at one point, about the possibility of encouraging Jacob and his wife to include her feet as a spark to intimacy, he didn’t really answer the question, and when I pressed, he said, “I think Jacob is somewhat content not having sex at all and doesn’t necessarily feel deprived.”
I’d heard nothing like this from Jacob. I’d heard him describe slamming his fist onto his coffee table. I’d heard him tell about trying to go off Lupron against Berlin’s advice. He’d stopped the medication for a short period, but self-revulsion over his desire had chased him back onto the drug. Knowing about this attempt, Berlin nevertheless suggested that Jacob didn’t mind living without sex. It sometimes seemed he was driven, consciously or not, to medicate aberrant lust out of Jacob’s life.
Then Jacob decided to try once more to go without the injections. He pushed the experiment to a year, but still couldn’t bring himself to open up to his wife about his longing. “Because it’s not normal! Because it’s not right! Because I love her!” he answered when I asked, again, why. He would not taint her with his perversity, include her in his monstrosity; instead, he mortified himself all the more with a series of prostitutes until he crawled back to Berlin and the Lupron.
After this second attempt, Berlin spoke to me in more ambivalent terms about Jacob’s treatment. “Because his situation is less dangerous than others’, because it poses little threat, it’s harder to make a decision about what should be done, about whether to medicate or not.” But in the end, Berlin believed it was necessary, that it was the less painful option for his patient. He spoke about “freeing up the mind from sex. When we’re young, eliminating sex may be inconceivable, but when we’re older we may find that it’s more peaceful, that companionship is more fulfilling. If we’re hungry we want to eat, but if we’re not we may not miss it.”
Berlin talked as well about anti-androgens as an antidote, for patients like Jacob, to the tendency to “objectify women”—talk that sounded enlightened. But did Jacob objectify any more than any man? Or did a difference like his simply spotlight what was universal? To be drawn to a woman’s feet, to isolate such an odd body part, was, it could seem, to dissect her, to give physical attraction a brutal primacy. To be lured by breasts or legs or buttocks was to have base desire softened by convention, blurred by normality—the body was left intact, along with the possibility of loving a woman’s soul. The distinction was arbitrary. Jacob’s desire put all desire under a glaring light, and the view, I sensed, made Berlin uncomfortable.
He had fought through all kinds of discomfort in his career. His compassion for sex offenders had brought vilification. His children had been teased by classmates because their father stood up for serial killers. But it was as though the stark physicality of desire, the animal aspect of it, was too much to face. He needed sex to be soulful, “human.” Jacob’s eros seemed to frighten him Jacob was, in Berlin’s eyes, thoroughly human. His lust was not.
“you’re making me cry,” Jacob said one afternoon. We sat in a restaurant in one of the other snowy cities along his salesman’s route. The decor had a pioneer theme. Wagon wheels and paintings of buffaloes hung on walls made of knotted wooden planks. The waitresses wore gingham, and the shelves and buckets in the gift shop were filled with statuettes of cowboys and Native American chiefs. It was lunchtime, and the place was packed with men and women in crisp, informal work clothes: khakis, sensible skirts, sports jackets, high-collared blouses. Nothing in the way they looked suggested that their lives bore much similarity to Jacob’s. And maybe very few of them were holding secretly anything like his agony. Yet Jacob dressed like them, worked in business like many of them, lived in a comfortable, modest home like many of them, and it was easy to think that many of them were consumed by invisible battles with their erotic selves, their central selves. The husband whose longing for other women had reached the point of daily pain; the wife whose yearning for someone or something else was just as excruciating; the middle-aged man who had never told anyone that he was gay and felt that it was far too late to reveal himself now; the young woman who craved violence in the faultlessly tender arms of her fiance—they all ate their french fries amid the wagon wheels.
“You’re making me cry,” Jacob said, because I had asked him to imagine a world where almost all men—ninety-four percent was the number I picked out of the air—saw feet as the locus of desire. He removed his glasses, pinching the corners of his eyes and the bridge of his nose to stanch the welling tears. “How about those Yankees?” he joked to stop himself from breaking down. He waited to gain control before he spoke again.
In Toronto, he told me, he’d seen The Phantom of the Opera for the first of seven times. It was another reason the city was the place of his dreams. “Colm Wilkinson’s singing,” he said, recalling the actor who played the Phantom, “was the most beautiful thing I’ve ever heard in my life. I was shaking during some of those scenes.” Jacob recounted the story of the hideously disfigured man who lives beneath the opera house in subterranean secrecy, thwarted in love. He quoted the Phantom’s wail, “I’ve been denied the pleasures of life.” He described waiting outside the theater’s back door after the performance, the temperature below zero, to have Wilkinson autograph a poster. “I bought the tape and listened to it three thousand times,” he said. Then, for a while, he was silent.
“I can’t imagine being in the ninety-four percent. It would be like I was able to climb up and live in the world.”