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Clinical Encounters with Internet Pornography: An Introduction

Thomas P. Kalman, MD

Dr. Kalman is Clinical Associate Professor of Psychiatry at the Weill-Cornell Medical College in New York City
And Adjunct Associate Professor of Psychiatry at the New York Medical College, Valhalla, New York

Contact information: 11 East 87th Street, Apt. 1B, New York, NY 10128
Email: Tpk5943@pol.net
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Introduction

Alone on a Saturday night and curious about something she overheard colleagues discussing at work, a

young woman goes online to look at pornography. Not only are her questions answered, but she also finds

her imagination engaged at many levels and concludes her evening entertained, wiser, and reassured

about her own sexual fantasy life. Across town, another woman awakens at 2:00am to the flickering lights

of the bedroom computer, in front of which her husband, with whom she has not had sexual relations in two

months, sits transfixed watching an endless array of sexually explicit photos and video clips, oblivious to

her presence or awakening. These and many other experiences—manifestations of the marriage between

the Internet and pornography—reflect the reality, as Barak and King (2000) have contended, that:

The Internet has two faces, positive and negative. One aspect is modern, advanced, progressive,

efficient, friendly, and rich. It…enables people to best meet their needs and desires, thereby,

ultimately enriching and bettering their lives […]. The other face of the Internet is that of a virtual

monster, capable of ruining people’s lives in numerous ways…maliciously influencing people to

change beliefs and life styles…encouraging people to cheat on their spouses…disseminating

perverted images and ideas…or facilitating people to become hopelessly addictive. (p. 517-518)

Pornography and Technology

The Internet is new; pornography is not. The Greek origin of the word pornography

—“Pornographos,” literally, the “writing about harlots,” informs us that the depiction of sexual activities,

organs, and fantasies—herein considered defining characteristics of pornography—is probably as old as

the world’s oldest profession itself. Certainly, visual pornography has existed for more than two millennia,

thriving in Classical Greek and Roman sculptures, wall frescoes, and paintings. More recently, the

presence and popularity of pornographic material consistently has been linked to various technological
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innovations that transform methods of production and dissemination, as pornographers readily exploit new

publishing techniques. The history of pornography is also that of a thriving commercial enterprise, as

pornographers have always sought to capitalize on the powerful, universal and seemingly insatiable

curiosity in matters sexual. Among the first non-religious books published after the invention of the printing

press was Boccaccio’s Decameron (ca. 1438-1453) and Chaucer’s Canterbury Tales (ca. 1387-1400),

parts of which were considered obscene at the time, however tame or artistic by today’s standards.

Widespread circulation of pornographic material was evident in Europe by the mid-sixteenth century and by

the Enlightenment, pornography was a well-developed commercial enterprise. Written in 1749 by John

Cleland and acknowledged as the first pornographic novel, Fanny Hill might also be considered the earliest

example of a profitable pornographic work: the publisher of this novel earned over $10,000 from its sales

(Lane, 2000), a significant sum at the time that would today represent more than $1,500,000 (Broadie &

Filante, personal communication, November 15, 2007).

Just as the technology of the printing press had radically expanded the audience and industry of

pornographic literature, the development of photography in the late 1830s revolutionized the commercial

enterprise of pornographic imagery. Within two years of the invention of the daguerreotype in 1839, a

market for photographic depictions of “artistic,” erotic, and frank sexual subjects began to flourish. Similarly,

the development of movie technology in the late 1890s led quickly to the popularity of the stag film. The

development of 8mm technology in the late 1950s first enabled the viewing of pornographic films at home,

foreshadowing the truly explosive growth in pornography that would accompany the advent of video

recording and playback technology in the mid 1970s.

According to Griffiths (2000), “From the earliest days of photography to the latest innovation, sex

has played a defining role in the development and advance of new communication technology” (p. 540).

From the late 1970s into the early 1990s, the VCR and the availability of mail-order delivery provided the

pornography viewer with dramatically greater privacy and a reduced risk of discovery and embarrassment.
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Grandfather’s stack of old 1950s Playboy magazines were soon supplanted by infinitely more explicit print

and video materials as consumers celebrated this ease of access.

Video technology and then digital photography have also given birth to the “amateur”

pornographer. With relatively little expense (compared to film), a camcorder, imagination (sometimes not

much), and willing (and sometimes not-so-willing) participants, any videographer can create pornography

for sale or for private entertainment. The casual recording and viewing of explicit sexual activity have

become increasingly mainstream activities. Other elements of technology that have contributed to

pornography’s growth in the video—and now, perhaps more correctly, the “digital” age—include pay-per-

view, on-demand, and other cable television programming, such that even without the Internet,

opportunities for accessing pornographic material are without precedent. Indeed, in some countries and

some states one can now view pornographic content on one’s cell phone, as easily as checking the latest

sports score or stock price. Increasingly, given a lucrative market, corporations in the hospitality, telephone

and cable industries are thriving as distributors, if not producers, of pornographic material. Public venues of

distribution, such as the adult bookstore and the seedy porn theater, have all but vanished.

Pornography and the Internet

The Internet is the most recent technological development to benefit pornography and its

distribution. Pornographic sites are among the most popular on the Internet. In recent years, there has

been a dramatic growth in the number of pornographic sites, the number of visits to such sites, and the

amount of money spent by both consumer and producer of pornographic sites. The following statistics

(Tables 1-3) indicate the large scope of pornography consumption in the early twenty-first century.
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Table 1: 2006 Internet Pornography Statistics

Pornographic websites 4.2 million (12% of total websites)

Pornographic pages 420 million
Daily pornographic emails 2.5 billion (8% of total emails)
Internet users who view pornography 42.7%
Daily pornographic search engine requests 68 million (25% of total search engine requests)
Note. From http://www.internet-filter-review.toptenreviews.com/internet-pornography-
statistics.html#anchor4, 2007.

Table 2 presents information about United States pornography consumption. For purposes of

comparison, the U.S. porn revenues in 2006 ($13.3 billion) are 15% greater than the annual revenues from

ticket sales for all U.S. sporting events ($11.7 billion) for the same year (http://www.sportsbusiness

journal.com/index.cfm?fuseaction=page.feature&featureId=43).

Table 2: 2005-2006 U.S. Pornography Revenues †

Type of media 2005 2006

Video Sales/Rentals $4.28 $3.62
Internet $2.50 $2.84
Cable/PPV/In-room/Tel $1.34 $2.19
Dance/Strip Clubs $2.00 $2.00
Novelties $1.50 $1.73
Magazines $1.00 $0.95
Total $12.62 $13.33
†
In billions
Note. From http://www.internet-filter-review.toptenreviews.com/internet-pornography-
statistics.html#anchor4, 2007.

The Internet, of course, knows no geographic boundaries and pornography on the Web is

consumed by all nationalities. The following table presents the approximate revenues from pornography

expenditures by country in order of spending. The United States, fourth behind China, South Korea, and

Japan in gross revenues, ranks seventh when translated into per capita data.

Table 3: 2006 Worldwide Pornography Expenditures †

Country Spending Per Capita Per Capita Rank

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China $27.40 $27.41 11

South Korea $25.73 $526.76 1
Japan $19.98 $156.75 2
United States $13.33 $44.67 7
Australia $2.00 $98.70 4
World Total $97.06
†
In billions
Note. From http://www.internet-filter-review.toptenreviews.com/internet-pornography-
statistics.html#anchor4, 2007.

The Internet has become a significant aspect of everyday life. Approximately 70% of Americans

now have Internet access, increasingly via high-speed broadband connections that enable the viewer to

see more websites at a progressively faster pace (http://www.pewresearch.org, retrieved December 29,

2007). The affordability of Internet access and accompanying computer hardware technological

advancements have enabled large portions of the population to access pornographic content with growing

financial and technological ease. As noted in Table 2, revenues from Internet pornography make up nearly

20% of the annual total of U.S. pornography revenues. Combined with other major sources of pornography

(DVD sales and rentals, pay-per-view, cable programming, and in-room hotel sales), exposure to Internet

pornography has become routine in contemporary American culture.

Table 4 shows information from a recent survey of a demographically reflective sample of

Americans that further indicates how common pornography use has become.

Table 4: 2006 Survey of U.S. Internet Pornography (IP) Use (ages 21-49)

Male Female
Internet pornography (IP) viewers 60% 17%
Avg. weekly IP use 2.6 hours 1.5 hours
IP use >3 hours/week 25% 11%
IP use at work 32% 14%
Note. From “How we have sex now,” 2007, Esquire Magazine, pp. 77-80.
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Indeed, as journalist and culture critic Pamela Paul has observed, “Call it the Porn factor. Whereas

pornography was once furtively glimpsed at dimly lighted newsstands, or seedy adult theaters, today it is

everywhere” (Paul, 2004). In her subsequent book Pornified (2005), Paul argued that pornography’s

influence is pervasive beyond the various technological media, to mainstream network television, pop

music, and general pop culture. This shift has been so effective that it is rarely questioned:

But while [pornography’s] place in American society has shifted radically, nobody—not the

government, not the private sector, not society or our cultural institutions—has done anything to

address the change. We have relaxed the social, practical, and cultural restrictions once placed on

pornography and it has wended its way into our lives, playing a more central role than ever before.

(Paul, 2005, p. 262)

The dramatic growth of Internet pornography and its insinuation into many aspects of culture logically leads

to questions about the consequences of such availability and massive consumption. Assessments

regarding the impact of Internet pornography on adults, children, adolescents, couples, and families have

been emerging steadily over the past decade, and prior research on pornography before the Internet is

being revisited. A brief summary follows.

Effects of General and Internet Pornography

In the 1980s and 1990s, a vast number of studies were conducted on general (non-Internet)

pornography. Despite some disagreements among academics about their validity and methodologies,

these studies offer significant conclusions regarding the effects of pornography exposure. Representative

of this scholarship are the well-known studies by researchers Dolf Zillman and Jennings Bryant, whose

investigations involved controlled exposure to pornographic materials using experimental settings (Zillman

& Bryant, 1982; Zillman & Bryant, 1988a). In their work, they found associations between pornography
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exposure and: i) increased callousness toward women; ii) trivialization of rape; iii) distorted perceptions

about sexuality; iv) increased appetite for more deviant and bizarre types of pornography (escalation and

addiction); v) devaluation of the importance of monogamy; and, vi) decreased satisfaction with partner’s

sexual performance, affection, and physical appearance.

A thorough review of the entire scholarship on the effects of general pornography and the disputes

related to it has been conducted by Manning (2006) and will not be restated here, but her assessment

follows:

In summary, research reveals that [general] pornography consumption is associated with many

negative outcomes related to individual functioning. Research, including meta-analyses [Allen,

D’Allesio, & Brezgel, 1995; Oddone-Paolucci, Genius, & Violeto, 2000], show pornography

consumption is associated with increased risk for (a) sexual deviancy, (b) sexual perpetration, (c)

experiencing difficulty in one’s intimate relationships, (d) accepting rape myths, and (e) behavioral

and sexual aggression. (p. 137)

There is a plethora of scholarly literature about various aspects of Internet pornography in many

disciplines, such as psychology, psychiatry, sociology, communications, gender studies, and human

sexuality. Yet, despite extensive speculation, no clear consensus has emerged in this scholarship

regarding the amalgam of pornographic content and cybertechnology and its impact on individual mental

health, interpersonal relationships, or personal sexual health and satisfaction. Clearly, the Internet’s

provision of sexual content involves many benefits for both individuals and society, including the availability

of information for the promotion of sexual health (i.e., on contraception, sexually transmitted diseases,

normal sexual functioning and anatomy), self-help and advice, and scientific research. For many, the

Internet enables a healthy expansion of one’s sexual knowledge, capacity, and fantasy life. Increasingly,

however, psychotherapists are encountering anecdotal reports of problems related to Internet pornography

use. In addition, many surveys and self-reports of problematic experiences have been published, lending
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support to concerns that Internet pornography consumption may be more complex than just good clean fun

(Cooper, Putnam, Planchon & Boies, 1999b; Meerkerk, Van de Eijnden, & Garretsen, 2006; Mitchell,

Becker-Blease, & Finkelhor, 2005; Mitchell, Finkelhor, & Becker-Blease, 2007). It is unclear whether the

effects of viewing general pornography correspond to the effects of viewing Internet pornography, or

whether the unique attributes of the Internet have created a different range of pornography-related

problems.

In addition, a growing literature about “Internet addiction,” the content of which frequently includes

the use of pornography, now abounds. It is becoming apparent that when Internet use becomes

problematic for an individual, especially when it comes to the attention of a clinician, pornography use or

some other sex-related activity is likely to be involved. The recent study by Meerkerk et al (2006)

determined that gaming and erotica (by this author considered synonymous with pornography) websites

were most closely associated with the subsequent development of Compulsive Internet Use (CIU), but only

erotica use clearly predicted the development of CIU at a one-year interval (p. 98). Another recent survey of

mental health practitioners by Mitchell et al (2005) formulated eleven categories of Internet Related

Problematic Experiences, including General Overuse, Pornography, Infidelity, Sexual Exploitation, Gaming,

and Role-playing. In their survey population of 929 adult patients, the overwhelming majority acknowledged

problems related to pornography use or other Internet-mediated sexual activity far more frequently than any

other type of use problem. Their findings also support the connection between Internet pornography use

and other Online Sexual Activities (to be discussed later). Most recently, an article in The New York Times

detailed the emergence of Internet addiction boot camps in South Korea designed to help individuals

manage their out-of-control Internet use (Fackler, 2007).

Surprisingly, the voluminous literature about Internet pornography includes few straightforward,

clinical descriptions of the subjective experiences of those who use (view, read) pornography on a regular,

habitual, or addictive basis. Indeed, in contradistinction to researchers’ usual appeal for more “systematic
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research” in a given area, one group investigating Internet pornography use in the workplace has noted

that:

A more sophisticated understanding of the various profiles of Online Sexual Activity [pornography]

users, as well as other distinguishing features of each unique case (such as where they go, why

they go, and how much time they spend when they go) might be particularly important. (Emphasis

mine; Cooper, Safir & Rosenmann, 2006, p. 27)

A few clinical scenarios involving heterosexual males seen in private outpatient psychotherapy will

now be presented. Each case illustrates how the use of Internet pornography played a significant,

problematic role in an individual’s life. These anecdotes are representative of others reported in the

literature and of the types of problems being communicated to therapists. While privacy considerations

understandably limit the details that can be presented, these case vignettes provide the type of clinical

description that would address the need for richer clinical specifics in the literature. The descriptions further

elaborate upon some of the issues related to Internet pornography use and reveal some problems related

to the exploration of this subject.

(Author’s note: the following case vignettes have been contributed by different, anonymous

psychotherapists in addition to the author. Every effort has been made to disguise any identifying

information and to preserve patient confidentiality. While the problems related to pornography are exactly

as occurred for each individual, details about personal and family histories have been disguised while

preserving core psychodynamic variables. Some of the historical material has been reconstructed.)

Clinical Material

Case 1

A 31-year-old male in analytic psychotherapy for mixed anxiety problems reported that he was experiencing

difficulty becoming sexually aroused by his current partner. After much discussion about the woman, their

relationship, possible latent conflicts or repressed emotional content (without arriving at a satisfactory
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explanation for his complaint), he provided the detail that he was relying on a particular fantasy to become

aroused. Somewhat chagrined, he described a “scene” of an orgy involving several men and women that

he had found on an Internet pornography site that had caught his fancy and become one of his favorites.

Over the course of several sessions, he elaborated upon his use of Internet pornography, an activity in

which he had engaged sporadically since his mid-twenties. Relevant details about his use and the effects

over time included clear descriptions of an increasing reliance on viewing and then recalling pornographic

images in order to become sexually aroused. He also described the development of a “tolerance” to the

arousing effects of any particular material after a period of time, which was followed by a search for new

material with which he could achieve the prior, desired level of sexual arousal.

As we reviewed his use of pornography, it became evident that the arousal problems with his

current partner coincided with use of pornography, whereas his “tolerance” to the stimulating effects of

particular material occurred whether or not he was involved with a partner at the time or was simply using

pornography for masturbation. His anxiety about sexual performance contributed to his reliance on viewing

pornography. Unaware that the use itself had become problematic, he had interpreted his waning sexual

interest in a partner to mean that she was not right for him, and had not had a relationship of greater than

two months’ duration in over seven years, exchanging one partner for another just as he might change

websites.

He also noted that he now could be aroused by pornographic material that he once had no interest

in using. For example, he noted that five years ago he had little interest in viewing images of anal

intercourse but now found such material stimulating. Similarly, material that he described as “edgier,” by

which he meant “almost violent or coercive,” was something that now elicited a sexual response from him,

whereas such material had been of no interest and was even off-putting. With some of these new subjects,

he found himself anxious and uncomfortable even as he would become aroused.

Case 2
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A 39-year-old married father came for a consultation seeking to find a new psychiatrist after abruptly

terminating with a prior physician following an angry “falling out.” His treatment history dated back to his

mid-twenties, when he had first sought help for persistent, intense obsessions about his health, with a

particular focus on defecation and the functioning of his bowels. He had experienced some relief with

SSRIs and cognitive psychotherapy, such that he was able to progress through graduate school, earning

both a Ph.D. and a law degree from a prestigious university. Sometime in the late 1990s, however, the

subject of his obsessions shifted from personal bodily health to pornography with particular preoccupations

with excretory fetishes and humiliation. With this shift came new problems.

At the first meeting, he resentfully reported that he was seeking out a new psychiatrist simply

because he needed his medication. He noted that his preoccupation with Internet websites dealing with

bondage excretory functions had become particularly intense over the preceding year, and this was now

dangerously problematic because he used his office computer to visit such websites. Currently a senior

associate, he was hoping to become a partner at the law firm where he had established a strong record of

accomplishments. He was quite concerned that he would be denied partnership because either his habit

would be discovered or the diminished quality of his work would reflect the amount of time he spent on

these activities. This individual felt that, in the past, the use of SSRIs, both employer and self-imposed

blocking software and filters, and occasional attendance at 12-step meetings (Sex and Love Addicts

Anonymous (SLA) and Sexaholics Anonymous (SA) had been sufficient to maintain his functioning. These

measures were now losing their efficacy as the pressures related to his promotion increased. He regularly

found ways to disable or circumvent the technological barriers, and he was inconsistent in attending self-

help meetings.

Surprisingly, he reported that his marriage was not at risk because of his pornography usage. He

acknowledged that his sexual relationship with his wife had diminished dramatically, especially since the

birth of their now 4-year-old son. However, the lack of marital sex was not felt to be a problem, since he
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described his wife’s interest in sex as minimal at best. Indeed, he had been open with his wife about his

viewing of Internet pornography and reported that she was quite tolerant of this activity as long as his use

was not for the purpose of masturbation (which it often was not) and as long as he was careful not to

expose their child to anything related to his obsession (which he was).

This man was the only son of cruel, intimidating, alcoholic parents who physically abused each

other and their children. Not surprisingly, his relationships with authority figures had always been tenuous,

marked by defiance, competitiveness, and the lurking fear of humiliation should he have to defer to, or even

simply agree with, someone. Coming for psychotherapeutic help was extremely difficult, and he

emphasized at the outset that he was not interested in resuming any sort of psychotherapeutic dialogue.

He revealed that a major reason for the rift with his prior psychiatrist was his perception that the therapist

was too interested in hearing descriptions of the pornographic material that he was using. He allowed his

new psychiatrist to review his medication, adjusting doses of the SSRI when appropriate, and explored (as

much as he would allow during infrequent sessions) other tactics that might enhance control of his

behavior. His new therapist, heeding the man’s treatment history, took a very permissive, un-authoritarian

stance with him, allowing him to control the frequency and intensity of sessions. Within this “benign”

therapeutic relationship the patient crafted a solution to his career-threatening Internet use: he actually

chose to discuss the problem with an important male superior at his firm, and by giving this individual

password access to his computer created the possibility that his online activity might become known. This

added deterrent enabled him to stop using Internet pornography at work, and he was able to function better

and achieve partnership.

Case 3

At a routine quarterly follow-up visit, a 66-year-old married grandfather and business executive described a

pattern of increasing Internet pornography viewing at his office. While acknowledging that the activity

presented what he called a “potential for awkwardness,” he nonetheless found it very exciting and hard to
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curb voluntarily. This activity had begun about two months earlier following the closing of a local video

rental business in his suburban hometown, which had been his valued supplier of X-rated videos and DVDs

for over two decades. Deprived of this source, he had begun to arrive early for work, when the office was

empty, in order to access Internet porn sites, and he found this to be intensely enjoyable and compelling.

As his amazement at the wealth of material available on the Internet whetted his appetite to see more, he

began to look forward to these “sessions.” He arrived earlier and earlier for work and actually experienced a

“Friday letdown” when faced with a forced interruption of his new pastime; holiday weekends were

especially unwelcome. At the time of his description of these activities, he had been getting to work by 5:00

- 6:00 a.m.—about three hours before the next employee would usually arrive. He described his computer

sessions as fun, fascinating, and compelling, but not necessarily sexually arousing; there was no

accompanying urge to masturbate.

This affable, gregarious and outwardly happy church-going father of five daughters had first

consulted a psychiatrist thirteen years earlier when he developed an obsessive preoccupation with a

younger, unmarried, female professional colleague. He had found himself unable to stop thinking about her,

and had eventually sought psychiatric consultation when he felt his work was suffering. His psychiatrist

diagnosed a major depressive disorder with prominent obsessive symptoms, and he began psychotherapy

and was given antidepressant and anti-anxiety medication. That acute episode resolved without any

significant disruption to his personal or professional life.

After 2 years of once and twice-weekly psychotherapy, the patient continued sessions sporadically,

using the acquired awareness of his psychodynamics and treasured supportive and trusting relationships

with his therapist and other doctors to help him through many life-crises. These included a number of life-

threatening health problems, the treatment of which required him to take several medications that severely

compromised his sexual potency. The son of a loving, capable mother and bipolar, involved, supportive,
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athletic father, he was raised to respect authority, propriety, and the basic tenets of “a good Christian

household”. Beginning with his separation from this conservative, ordered home to attend college, he was

surprised by an eruption of sexual energy and interest which he sought to contain within the bounds of

intense, serial, monogamous relationships, eventually marrying a high school sweetheart with whom he

enjoyed an initially electric romantic life. With fond remembrances of his sexually active early adulthood, he

described his pornography use as a personal “walk down memory lane.” He identified his choice of explicit

web sites as “pretty ordinary stuff” depicting “straight, man-woman sex” sometimes involving one man with

multiple partners. A robust drinker, especially as a young man, he described himself as able to handle his

alcohol well, but had recognized a diminished tolerance over the last fifteen years.

After revealing his pattern of Internet use and preoccupation, he was receptive to his therapist’s

dynamically informed, authoritative directive that he must stop this behavior immediately as he was

jeopardizing his professional career. The therapist also suggested that he paste photographs of his female

grandchildren to the sides of his computer monitor, taking advantage of the predictable incompatibility of

such visual imagery for this man. The patient found a company that provided a printed catalogue of X-rated

DVDs with mail-order delivery and thus easily replaced both the defunct video outlet and the Internet

pornography sites. At work he limited his non-professional computer use to sites dealing with numismatics,

a less provocative hobby should he be noticed going online.

Case 4

A single, 36-year-old successful male professional returned to his psychotherapist after a year’s hiatus for

help with an acute depressive episode following the breakup of an important romantic relationship with a

woman. In his prior dynamic psychotherapy, an important focus had been his passion for cross-dressing,

an interest dating back to his teens and a source of great pleasure, excitement, conflict, shame and tragedy

in his life. He hoped to marry and have children, and over time he had enjoyed several long romantic

relationships with women who descriptively seemed appropriate partners, depicted by him as quiet,
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conservative, “wholesome” individuals. Not unexpectedly, however, his fetish inevitably interfered with

these relationships as he repeatedly tried to share his penchant, hoping that this could be both a joint erotic

and lifestyle activity for them.

This man was the only child born abroad to older American parents. Three miscarriages before his

birth had left them worried about ever having a child, and when he arrived, he was treated as special—a

“premium baby.” His mother stayed home to raise him and he described a blissful, extremely close

relationship with her. Before starting school he had been his mother’s constant companion, including her

trips to the beauty parlor and clothes-shopping expeditions. She made little attempt at integrating herself

into the foreign society in which they lived, as she was content to be at home with her “little partner.” His

father, quite involved in a successful career, was home primarily on weekends and spent time with his son

whenever he could, but the patient recalled never feeling as close to him as he did with his mother. He

recalled having the idea in childhood that his mother probably really wanted to have a daughter, but this

was never stated and she never engaged in some of the more overt “feminizing” behaviors that some

mothers impose on their sons (i.e., dressing them in girls’ clothing). But she did not encourage typical boys’

play either, expressing worries about his safety if he were to engage in “rough” activities; from an early age

she encouraged quieter things they could do together, like board games and puzzles.

His father, enamored of both his wife and son, and removed from their day-to-day life, did not seem

troubled by the intense mother-son relationship and did nothing to alter it. When it was time to start school

the patient had no difficulty with separation from his parents, and life seemed fine until age eight when they

returned home to the States. Seen as different by other children because of his manners and accent, he

struggled socially and remained attached to his comforting mother. A few years later, with the onset of

puberty, their closeness was compounded by the development of terrible acne, which further hindered his

socialization and which his mother tried to help (after first taking him to dermatologists) by using her

knowledge of makeup to conceal the blemishes. The same hormonal surge that destroyed his skin also
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brought forth sexual maturation, and with it a strong sexual attraction to girls. Around age sixteen he first

became aware of a growing interest in female clothing and accoutrements, and he developed a rich fantasy

life, which he used for masturbation, involving the use of lingerie. His reveries evolved over the next several

years into elaborate scenarios in which he found a “perfect,” loving partner who not only tolerated his cross-

dressing, but loved him more for it and joined with him in pursuit of the pleasures of the activities. His ideal

mate was a woman with whom he could shop, model, experiment with makeup, hairstyles, and

accessories, and with whom he could have a romantic relationship leading to marriage and parenthood.

While this fantasy was not much diminished during psychotherapy, he did come to appreciate the

potency and destructive effects of his repeated attempts to enact the scenario with an otherwise viable

partner. Reluctantly, over time, he had come to realize through his psychotherapy and repeated rejections

that it was not realistic to expect such sharing of his “different” passions.

The most recent, extremely painful breakup, again initiated by a partner, had been triggered when

he again attempted to introduce his passion for cross-dressing into a relationship. He had been in control of

trying to actualize his fantasy until he discovered a number of websites dedicated to the practice of cross-

dressing, one of which he felt “spoke to me, to my true core.” Although fully aware that he was viewing a

commercial site designed to attract business, he was susceptible to messages like:

Don’t hide away your beautiful feminine self—allow her to step out with confidence and her inner

beauty truly blossom…I can make a difference to your experience and embrace your

transformation with the respect you deserve in your own feminine right. It is not much fun dressing

yourself in a state of fear and guilt […]. (2007, http://www.truecrossing.com)

With the help of medication and psychotherapy, he made a full recovery from this latest episode of

depression, but shortly thereafter, he stopped treatment coincident with an out-of–town work assignment. In

his last therapy session, he had expressed a renewed resolve not to pursue the fantasy of sharing his

transvestic fetishism with the next romantic partner.

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Discussion

The above background material and clinical vignettes constitute an introduction to the topic of

Internet pornography and its potential for pathogenic influence in susceptible individuals. While the

following remarks predominantly represent behavioral, phenomenologic, and epidemiologic perspectives, it

is also important to include prior psychoanalytic contributions on the subject. Patient problems with Internet

pornography spoon-feed therapists with material about sexuality and arousal, masturbation, fantasy and

imagination, eroticism and aggression, perversions, object relationships, the integration of love and

sexuality—topics that have historically been among the most central to psychoanalysis.

No practitioner has written more fearlessly, prolifically, or creatively about pornography, the erotic

imagination, and perversions (now, paraphilias) than Robert Stoller. Also passionately interested in gender

formation and identity, Stoller (1975) defined pornography from a dynamic perspective that helps to

understand the vast proliferation of Internet pornography:

Pornography is a complex daydream in which activities, usually but not necessarily overtly sexual,

are projected into written, pictorial, or aural material to induce genital excitement in an observer. No

depiction is pornographic until an observer’s fantasies are added: nothing is pornographic per se.

(p. 63)

This definition addresses the importance of the pornography viewer’s unique psyche; it explains why one

person’s pornography is another’s erotica, and why the same image might drive one individual to distraction

while putting another to sleep.

Prior to his untimely death in 1991, Stoller’s seminal work on the role of hostile fantasies (the

desire to harm) in sexual excitement influenced the work of many others (both to agree and to differ),

including notable theorists Otto Kernberg and Ethel Person. He studied pornography extensively, believing

that by examining a commercially successful enterprise, he would be studying the erotic lives of the
 19

audience. In PORN: Myths for the Twentieth Century (1991), Stoller argued that:

Complex fantasies (beliefs, daydreams, commitments, relationships, myths, preoccupations) held

en masse (that is, “culture”) can be discovered, confirmed, dissected, and transformed into their

components by inquiring into what the people who make pornography are thinking of, feel, imagine

they are doing, why, and to and for whom as they ply their trade. (p. vii)

Before Stoller, of course, Freud (1927) theorized extensively about fetishism; if he did not directly

comment on pornography, he nonetheless would not have been surprised by the prominence of fetishistic

material in pornography, as he clearly recognized the importance of this dynamic in male psychology.

And male psychology, for the most part, remains the dominant focus of most commercial pornography.

While Freud and classical analytic thinkers would have emphasized castration anxiety as a dominant motif

informing the scripts and depictions of much pornography, current thinkers focus on male-female power

dynamics and self-esteem reparations. Discussing the representation of women in much heterosexual

pornography, Williams (1999) notes “The value of such an analysis is that it locates castration fear and

fetishization where they really belong: in the self-perceived inadequacies of the body and mind of the male

consumer of pornography” (p. 116).

Other analysts have written about problematic pornography use encountered in patients (Peterson

(1991) and Fenchel (2000), but in general, the topic of pornography does not much appear in analytic (or

psychiatric) literature. Stoller’s premature death preceded the rise of the Internet, of course, and few

analytic papers even address the role of the cybertechnology in current practice. Notable exceptions

include Gabbard’s (2001) description of an erotic transference communicated via email by a patient, and

one of the major psychoanalytic journals has formally acknowledged the importance of addressing the

influence of the Internet by dedicating a recent issue to this topic ( The Psychoanalytic Review, 94(1),

February, 2007), but this topical collection makes scant reference to Internet pornography.

Other non-analytic mental health professionals have more aggressively pursued the topic of
 20

Internet pornography, perhaps heeding one research group’s warning that on-line sexual activities (one of

which is pornography use) constitute “a hidden public health hazard exploding, in part because very few

are recognizing it as such or taking it seriously” (Cooper, Delmonico & Burg, 2000, p. 25).

The four cases described in this paper offer detailed, subjective experiences to illustrate

phenomena that have been documented by other clinicians and researchers. These individuals share

problematic experiences related to their use of Internet pornography, including loss of control, intrusion of

an obsessive preoccupation into their conscious daily lives, and a potentially serious threat to either their

professional or interpersonal romantic life. The man described in the first vignette reports a combination of

recognizable experiences that are often briefly recounted in both the lay and professional literature and in

casual discussions among clinicians (Paul, 2005; Doidge, 2007). The development of tolerance to the

arousing effects of pornography and changes in the nature of sexual material to which an individual

responds or to which one is pulled are fascinating, recognized experiences of the frequent pornography

viewer. Doidge (2007) has presented these two phenomena as reflecting neuroplasticity, the process by

which the brain is able to change, both anatomically and functionally, such that sexual tastes, interests, and

disinterests transform over time with exposure to the arousing effects of pornography. He has noted:

The current porn epidemic gives a graphic demonstration that sexual tastes can be acquired.

Pornography, delivered by high-speed Internet connections, satisfies every one of the prerequisites

for neuroplastic change…in fact the content of pornography is a dynamic phenomenon that

perfectly illustrates the progress of an acquired taste. During the mid-to-late 1990s, I treated or

assessed a number of men who all had essentially the same story. Each had acquired a taste for a

kind of pornography that, to a greater or lesser degree, troubled or even disgusted him, had a

disturbing effect on the pattern of his sexual excitement, and ultimately affected his relationships

and sexual potency…Typically, while I was treating one of these men for some other problem, he

would report, almost as an aside and with telling discomfort, that he found himself spending more
 21

and more time on the Internet, looking at pornography and masturbating…these men also reported

something else, often in passing, that caught my attention... increasing difficulty in being turned on

by their actual sexual partners…although they still considered them objectively attractive. (p. 102-

104)

Young (2007), an experienced researcher of problematic Internet use, has observed that, “for those

suffering online addictions to pornography…changes in sexual behavior offline often occurred. In several

cases, Internet addicts used online pornography to replace sexual intimacy with real-life partners and, over

time, completely withdrew into the computer to meet all their sexual needs” (p. 672).

Young’s (and many others’) use of the word “addiction” and Doidge’s elaboration of the neural

mechanisms of pornography dependence and tolerance suggest that neurophysiology and neurochemistry

(involvement of the brain’s appetitive and reward systems) are crucial to any understanding of Internet

pornography-related problems. Mapping brain activity of sexual arousal in relation to visual stimuli is in its

infancy, but early efforts suggest the importance of occipitotemporal, anterior cingulate, Insula, orbitofrontal,

and caudate regions, as well as the thalamus, hypothalamus, and amygdala (Kim, 2006; Stark et al, 2005).

Differences in male and female response to visual stimuli correspond to documented gender differences in

hypothalamic and amygdala activation when studied by fMRI (Karama, 2002; Hamann et al, 2004).

Certainly, the scientific rigor of such neuroimaging technologies helps contribute to the appeal of a

neurobiological approach towards the study of viewing Internet pornography. However, it seems likely that

a truly satisfying understanding of these clinical phenomena will involve an integrated synthesis of

psychodynamic, behavioral, and neurobiological perspectives.

With respect to the content of the pornographic material viewed via the Internet, there seems

nothing new, nothing that differs from the content of general pornography or the pre-Internet imagery and

narratives of twenty, two hundred, or even two thousand years ago. Orifices, organs, body parts and

usages, sexual positions, permutations of participants (and species), perversions, fetishes, themes,
 22

secretions, excretions, and utterances are the same as they have always been in pornography, indeed in

the human experience. We can therefore conclude that the problematic developments depicted in the case

vignettes and cited research studies specifically relate to the medium of delivery, and the particular

technological attributes of the Internet. The clinical material illustrates that a central issue is ease of access:

never before, in the history of pornography, has so much been so cheaply available to so many.

In 1998, Alvin Cooper first proposed the “triple-A engine” effect of Accessibility, Affordability, and

Anonymity, a concept that encapsulates essential differences between standard, historically-marketed

sexual materials (general pornography) and Internet pornography, and indicates the latter’s potential for

virulence. In another study, Cooper, Putnam, Planchon and Boies (1999b) observed, “Users can

comfortably log on [at] any time of the day or night, at little or no cost, and can choose to observe or

misrepresent their true identities” (p. 85). As Manning (2006) has explained:

The Triple-A Engine effect, in particular, is widely accepted as the primary reason why many pre-

existing problems with other forms of pornography have been exacerbated in the last decade, and

why many individuals who would not have been involved with this material prior to the advent of the

Internet, have been drawn into problematic pornography consumption. (p. 134)

The marriage of pornography and the Internet thus provides a perfect climate for the emergence of

experiences, potentially problematic for many, that would not otherwise surface. As documented in Cases 2

and 3 of this paper, conditions now exist so that Internet pornography can be viewed, surreptitiously, while

at work. This contributes to an overall increase in the amount of time dedicated to pornography use, and a

greater likelihood that such activity will negatively impact one’s professional life and personal relationships

“Personal inhibition levels, social controls, and the lack of willing partners and sexual scenes that may limit

sexual activity in everyday contexts are obsolete in cyberspace. It is easy for latent desires to be realized in

cyberspace” (Lieblum & Döring, 1998, p. 23).

In addition to the concept of the “Triple-A Engine” effect, Internet pornography might be further
 23

examined through the lens of Delmonico’s (2002) formulation—the “Cyberhex of the Internet”—which

delineates six significant features of the Internet: Imposing, Inexpensive, Integral, Interactive, Intoxicating,

and Isolating. While many of the particulars of these two concepts may seem self-evident, some additional

clarification may be helpful.

The Internet’s characteristics of being Integral, Imposing, and Inexpensive are linked to the Triple-A

characteristics of Affordability and Accessibility. High-speed service and wireless access to the Internet are

becoming rapidly universal, with some cities, like many colleges and universities, planning wireless zones

and neighborhoods. Pornography sites, as shown in Table 1, abound on the Internet and provide much

material at no charge. The commercial pornographer, of course, seeks to entice site visitors with free

material such that additional downloads or site subscriptions are purchased. The success of this strategy is

supported by the recent decline in (non-Internet) pornographic DVD sales:

The Internet was supposed to be a tremendous boon for the pornography industry…But now the

established pornography business is in decline–and the Internet is being held responsible […].

Inexpensive digital technology has paved the way for aspiring amateur pornographers, who are

flooding the market, while everyone in the industry is giving away more material to lure paying

customers. (Richtel, 2007, p. A1)

The Internet is considered Integral because it has become an omnipresent and indispensable component

of contemporary society. Indeed, it is not just available and used on a daily basis, but furthermore, the

Internet is Imposing, because it is effectively unavoidable in modern life. For an individual struggling with

impulses to use the Internet (or look at pornography), the choice not to go online is virtually untenable.

The three other components of the Cyberhex—Intoxicating, Isolating, and Interactive—significantly

contribute to the development of problems with Internet pornography by some individuals. According to

Delmonico, “Cybersex addicts know that the Internet is one way of getting a “quick fix” that allows for

immediate gratification” (p. 244), and Grohol (2005) has theorized that the interactive features of the
 24

Internet (abetted by anonymity) provide anxiety-free, instantly gratifying socialization for individuals who

may be challenged in this area. Consequently, Grohol (2005), and Yoder, Virden, and Amin (2005) have

proposed that loneliness, a yearning for social contact, and frustration of personal needs predispose

susceptible individuals to addictive Internet use, with pornography consumption constituting a principal

expression of this vulnerability. Ferraro, Caci, D’Amico, & Di Blasi (2007), like Grohol, observed a phasic

element to the process of Internet overuse problems, beginning with behaviors like frequent checking of

email and general Web-surfing, and progressing to potentially more problematic behavior (pornography).

The previously described physiological change to an individual’s sexual function—specifically, the

diminished capacity for sexual interest, arousal, and involvement with an actual, available partner—is but

one way in which relationships may be negatively impacted by one partner's problematic use of Internet

pornography. Internet pornography use, while sometimes a shared activity among individuals, is

predominantly a solitary pursuit. This isolation is responsible for much of the disruption of relationships that

has been linked to its use. One study reported that married, heterosexual women, compared to their

single, dating counterparts, felt that a partner’s consumption of Internet pornography represented a

significant threat to the relationship (Bridges, Bergner, and Hessou-McInnis, 2003).

Another survey by Schneider (2000) reported a range of findings with respect to the effects of a

partner’s use of Internet pornography and cybersex activity on the primary relationship. Survey

respondents, in response to partners’ on-line sexual activities, experienced hurt, betrayal, rejection,

abandonment, loneliness, shame, isolation, diminished self-esteem, humiliation, jealousy and anger. Being

lied to repeatedly was a major cause of distress. Cybersex addiction (of which pornography use was the

dominant activity) was a major contributing factor to separation and divorce of couples in this survey: 22.3%

of the respondents were separated or divorced, and several others were seriously contemplating leaving. In

68% of the couples, one or both partners had lost interest in relational sex, and partners reported that more
 25

than 50% of the on-line pornography viewers had diminished interest in sexual relations with their primary

partner (p. 56).

Manning (2006) has reported the findings of an informal survey of attorneys at the November 2002

meeting of the American Academy of Matrimonial Lawyers:

At this meeting, 62% of the 350 attendees said the Internet had played a role in divorces they had

handled during the last year. Additionally, the following observations were made by the lawyers

polled with regards to why the Internet had been a significant factor in divorces that year: 68% of

the divorce cases involved one party meeting a new love interest over the Internet, 56% of the

divorce cases involved one party having an obsessive interest in pornographic websites, 47% of

the divorce cases involved one party spending excessive time on the computer, and 33% of the

divorce cases cited excessive time communicating in chat rooms… In response to this survey data,

J. Lindsey Short, Jr., then president of the American Academy of Matrimonial Lawyers, poignantly

stated, “While I don’t think you can say the Internet is causing more divorces, it does make it easier

to engage in the sorts of behaviors that traditionally lead to divorce.” (p. 141)

Two of the vignettes described above (Cases 2 and 3) point to the significant impact of Internet

pornography use on the individual’s professional life.There is reason to believe that Internet pornography

use in the workplace is not an infrequent matter. In my practice, I have heard several accounts (by men and

women) of pornographic images displayed on monitors in their offices, and of graphic images circulated via

email. Invariably these anecdotes reflect a negative experience at work and specifically, an instance when

pornography’s seemingly innocuous banality is often responsible for creating counterproductive or adverse

working conditions. Additionally, at least two studies suggest that workplace pornography use may be a

significant problem in our society. Cooper, Safir, and Rosenbaum (2006), surveying over nine thousand

respondents, reported that 20% of men and 12% of women had used their workplace computers for sexual

purposes. A survey of 40,000 adults revealed that 20% had used their office computers for sexual reasons,
 26

and it was also reported that “sexual content sites are the fourth most visited category while at work, and

that 70% of all sexual traffic occurs during the 9-to-5 workday” (Cooper et al, 2006, p. 23). This last statistic

seems remarkable, and suggests that for many viewers of Internet pornography, the risk of use in the

workplace is less than at home. The implications for diminished productivity and the creation of a negative,

counterproductive climate in the workplace seem obvious. Finally:

In a survey of 1,439 workers by Vault.com, an online analyst firm, 37% admitted to surfing

constantly at work, 32% surfed a few times a day, and 21% surfed a few times a week. In a survey

of 224 corporations by Websense, Inc., an electronic monitoring firm, 64% of the companies have

disciplined, and more than 30% have terminated, employees for inappropriate use of the Internet.

Specifically, accessing pornography (42%), online chatting (13%), gaming (12%), sports (8%),

investing (7%), and shopping at work (7%) were the leading causes for disciplinary action or

termination. (Young & Case, 2004, p. 105)

Internet pornography use is just one of many behaviors that fall under the general heading of On-Line

Sexual Activity (OSA). Other Internet-mediated pursuits include: identifying sexual partners on-line for a

rendezvous in person; engaging in cybersex; participating in sex-related chat rooms, Usenet discussion

groups, Web-cam or text-based interactive sites; purchasing sex-related merchandise or prostitution; online

sexual harassment and cyberstalking; digital manipulation of images for sexual purposes; involvement in

virtual realities; and, experimentation with gender-swapping and the creation of alternative identities for

sexual purposes (Griffiths, 2000). Delmonico (2002) has differentiated between asynchronous and

synchronous OSA according to whether or not the parties involved in an exchange of sexual material and

information are online simultaneously. In general, pornography use that involves photographs, video clips,

text-based stories, and animations is an asynchronous OSA. An exception involves the use of Web-cam

setups that allow a consumer to direct pornographic behavior by live subjects at a remote site, thus a

synchronous form of pornography consumption. Chat rooms and instant messaging are other common
 27

synchronous activities that can be implemented for sexual purposes. Obviously, OSAs are linked, in that

many individuals will engage in one or more OSAs (for example, an individual might go from viewing

pornography to visiting a chat room to a pickup site to an online store to buy condoms). Many pornography

websites are literally linked, so that a visit to one site offers the viewer the opportunity to jump to many

others. By far, pornography use is the most common OSA, and it is probable that individuals engaging in

one of the other OSAs have also used Internet pornography. Just as some substance-abuse clinicians

consider Marijuana to be a “gateway” drug that may lead to other substance use, Internet pornography use

probably precedes other on-line sexual activities for most individuals.

Despite the problems that may arise with Internet pornography use for certain individuals, it seems

reasonable to assert, based upon the data indicating the general public’s extensive use, facilitated access,

and exposure to such material, that the vast majority of Internet pornography viewers do not develop any

significant problems related to it. Surveys, questionnaires, and clinicians’ anecdotes only bring to light the

problematic situations and individuals. Those individuals and couples that use Internet pornography

enjoyably and without unwanted intrusion (loss of control)—be it for entertainment, amusement, curiosity,

information, or self-exploration—are not likely to participate in surveys and do not come to clinicians’

offices, at least not initially for such reasons. Similarly, others who engage non-problematically in other On-

Line Sexual Activities, such as meeting partners for consensual sex or on-line social interaction, do not

enter into the spotlight of professional literature or popular media. A challenge to professionals, then, is to

clarify which individuals are at risk of experiencing problems with Internet pornography use, such as those

described in the above case studies.

Cooper’s (1999b) seminal paper on the interface between Internet use and sexuality offered a

useful classification of individuals who use the Internet to consume pornography. Recreational viewers are

those for whom Internet pornography use can be entertaining, perhaps occasionally useful for sexual

purposes (with a partner or for masturbation), and is unproblematic. For this group, the use of pornography
 28

remains entirely within their control, and boredom, not compulsive use, becomes the norm. “For individuals

who are not true sexual obsessives, the repetitiveness of the images and the unreality of the activity are

doomed to eventually disappoint” (Lieblum, 1997, p. 23). Sexual compulsives, Cooper’s second group,

include those with pre-existing problems related to sexuality such as paraphilias, preoccupation with

pornography, other sexual activities (i.e., phone sex), or risky promiscuity. Such individuals are no

strangers to relationship difficulties stemming from their sexual problems and preoccupations and may

have a history of related legal or professional problems as well. The patient described in Case #4, with his

clear history of transvestic fetishism, would be considered to fall into this second group.

The third group, which Cooper (1999b) has called “at-risk” individuals, are those most likely to

come to the attention of psychotherapists and other clinicians in practices not specializing in sexual

problems:

The third type of Internet users does not have histories of sexual compulsivity. However, their on-

line sexual pursuits have caused problems in their lives. In some ways this is the most interesting

group as it appears that these are people who may never have had difficulty with sexual

compulsivity if it were not for the Internet. They may have a vulnerability to or proclivity for sexual

compulsivity but have sufficient internal resources and impulse control to have resisted acting on

these behaviors until faced with the power of the Triple-A Engine . (Emphasis mine; p. 88)

An important goal of future research in this area is the further delineation of the dynamic and historical

characteristics of this “at-risk” group.

When psychiatrists have written about Internet pornography use, online sexual activities, or

Internet “addiction,” it is often from the perspective of diagnostic considerations, modern psychiatry’s great

passion. Addictive, Obsessive-Compulsive, and Impulse-Control disorders are the usual suspects, with

Attention-Deficit Disorder frequently suggested as a predisposing vulnerability. I will not now pursue this

topic further, other than to mention and encourage reference to the work of Martin Kafka, the Harvard
 29

psychiatrist who has elegantly discussed the pros and cons of various diagnostic formulations and has

proposed the additional category of paraphilia-related disorders (Kafka, 2001). These include, among

others, “pornography dependence,” and “cybersex dependence,” as discrete conditions reflecting repetitive

volitional impairment and adverse psychosocial consequences. This new classification, not yet officially part

of the DSM, reflects creative nosological thinking that keeps pace with the new types of problems being

presented to clinicians, particularly as they may not neatly fit our established diagnoses.

Conclusion

“Scholars who examine pornography do so at their own risk. Grants, funding, promotions—the

bread and butter of academic life—are generally not supportive of the study of pornography. And few other

topics are at once so nebulous and heated” (Sigel, 2005, p. 5). Sigel’s comment suggests further insight

about the paucity of work on Internet pornography by psychoanalysts or psychodynamic psychiatrists.

Already marginalized by biological treatments, other more rigorously studied psychotherapies, changing

cultural values, and the economics of mental health care, many in the profession may understandably be

reluctant to study a topic that still provokes raised eyebrows and concealed smirks. If this is the case,

perhaps the compelling experiences of individuals such as those described can surmount therapists’

reluctance to engage in open dialogues about this topic.

Arising from a series of clinical observations, this paper is intended to provide practicing therapists

with an overview of the topic of Internet pornography and to encourage them to inquire, when appropriate,

about their patients’ use of such material. Pending further research in this area, I propose that the vast

majority of Internet pornography consumption by adults is without significant clinical sequelae, but that a

population of vulnerable individuals exists for whom the viewing of Internet pornography can create severe

difficulties. Deliberately missing from my remarks is the issue of Internet pornography exposure to children

and adolescents, a question perhaps of infinitely greater import and urgency given the inherent
 30

vulnerabilities of a younger population. Here, too, much work has been done, but as with the adult

literature, much more remains to be clarified; since neither the Internet nor pornography are about to

disappear, this is a great time to be curious.

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