Masters and Johnson's sex research and sex therapy program: a critical appraisal from down under.
Sex Research and Sex Therapy." A Sociological Analysis of Masters and Johnson. By Ross Morrow. New York: Routledge, 2008, 212 pages. Hardcover, $120.00.
In 1966, the Masters and Johnson research team released Human Sexual Response, the groundbreaking work outlining their four-stage model of the human sexual response cycle (Johnson & Masters, 1966). The pioneering duo, gynecologist William Howell Masters and lay-psychologist Virginia Eshelman Johnson, released a follow-up text in 1970, Human Sexual Inadequacy, which established a biomedical nosology for the diagnosis and treatment of sexual dysfunctions based on their four-stage model (Masters & Johnson, 1970). Together, these works are credited for legitimizing and, even, igniting the burgeoning field of sex therapy, and their models continue to provide a basis for current approaches to sex research and sex therapy. The works of Masters and Johnson were so positively received that both Human Sexual Response and Human Sexual Inadequacy were best-sellers, translated into more than 30 languages; what's more, a photo of the researchers glossed the May 25, 1970 cover of TIME Magazine. In fact, there was so much optimism about the works of Masters and Johnson that it was widely, though perhaps naively, believed that sexual dysfunction could be eradicated, and the rising divorce rate might subside as a result.
That we are still reading about research on sexual dysfunction in this and other journals suggests that the works of Masters and Johnson did not provide the deliverance for which sex researchers, sex therapists and, especially, those living with sexual dysfunction had hoped. As is the case with much groundbreaking research, answers lead to more questions, the questioning of once-accepted answers and, eventually, a so-called Kuhnian revolution (see Kuhn, 1970). In Sex Research and Sex Therapy." A Sociological Analysis of Masters and Johnson, Ross Morrow (2008) reminds us that scientists' subjective experiences via their socio-cultural positioning makes science a relativistic experience. Morrow (2008) drives a sociological-infused paradigm shift in sex research and sex therapy by providing "a sociological analysis and critique of the conceptual foundations and practice of Masters and Johnson's (1966, 1970) sex research and therapy program, as articulated in their seminal texts Human Sexual Response and Human Sexual Inadequacy" (p. 1). A sociologist, who received doctoral training from the University of New England, NSW, and who currently teaches social theory and social science at the University of Sydney and University of Technology, Sydney, respectively, Morrow draws heavily on his previous work in the fields of sociology, social theory, and human sexuality. His publications in The Australian and New Zealand Journal of Sociology (Morrow, 1994, 1995), in the Revue Sexologique (Morrow, 1996), and contribution to the edited volume of Perspectives in Human Sexuality (Morrow, 2005) serve as foundations for this more in-depth critical analysis.
Before moving forward with this review, we as reviewers would like to point out that we are social and behavioral scientists with research interests in sexual and reproductive health, and not experts on sex research as it pertains to sex therapy. As such, we are not adequately equipped to comment on Morrow's text (2008) from a medical or clinical viewpoint. We do, however, feel that we have remarks to offer regarding Morrow's sociological analysis of sex research and Masters and Johnson's contributions. In fact, it is Morrow's sociological analysis that uniquely contributes to the literature on sex research, sex therapy and, more specifically, to critiques of Masters and Johnson's work. Morrow (2008) states the following in his introduction:
A key theme in my overall argument is that Masters and Johnson constructed their apparently scientific ideas about sexual function and dysfunction with reference to dominant Western beliefs and values about sexuality, and that their sex therapy program operated as an institution of control. (p. 1)
In chapter 2, Morrow (2008) tackles the sociological literature on sex, arguing that, despite a dearth of literature and the discipline's own stance that the sociology of sex did not emerge until the 1960s or 1970s, sociology was "part of the discursive explosion about sexuality that characterized Western societies from the eighteenth century" (p. 8). His rewritten history of the sociology of sex provides sufficient evidence that early sociological work on sex does emanate from the 18th century with extensive references to the works of Karl Marx, Friedrich Engels, August Comte, Herbert Spencer, Emile Durkheim, Charles Letourneau, and Max Weber, to name a few. So, why then has sociology overlooked its scandalous forays into sex research prior to World War II? Others have suggested that sociologists prescribe to the Repressive Hypothesis regarding their own history with sex and that the study was too quickly co-opted by the fields of biomedicine and psychoanalysis due to Masters and Johnson's medicalization of sexual function (Morrow, 2008). Morrow (2008), however, argues that it was the remaking of sociology in terms of the "classical canon" by the labor of Talcott Parsons, Robert Merton, and C. Wright Mills that worked to effectively marginalize the society of sex. Morrow (2008) explains:
The remaking of sociology's history in terms of the canon gave many sociologists a sense that because the canonical text did not deal very much with topics like sexuality, "race" and gender, that these topics were also unimportant for contemporary sociology. In effect, the process of canon making narrowed sociology's intellectual scope by excluding and discrediting what was not canonical. (p. 35)
In chapter 3, Morrow (2008) examines essentialism and social constructionism as the two dominant theoretical perspectives that have shaped sexual discourses in Western societies, including sociological discourses. He succinctly and accurately articulates the philosophical underpinnings and central disagreements between essentialists and social constructionists, and he succeeds in not limiting his discussion to sex research and sex therapy. While Morrow is critical of both theoretical strains--because sexuality is not innate, static, bounded, ahistorical or reducible to a physiological response--he disavows essentialism and draws on the position of Trigg (1989) favoring a social constructionist approach tempered by realist philosophy. Morrow (2008) claims:
This modified form of social constructionism has no need to deny that epistemological access to reality is possible and so it avoids the problems associated with a useless and incoherent Kantian notion of things-in-themselves as well as the problem of relativism. It also insists on maintaining the distinction between reality and how people conceive of it in order to escape that absurdity of those constructionist claims which confuse the two and end up stating, for example, that theories somehow literally create their own worlds. (p. 71)
After establishing a topical and theoretical sociological approach to sex research and sex therapy, Morrow (2008), in chapters 4 through 7, uses his tools to critically analyze Masters and Johnson's seminal texts. From a sociological standpoint, Morrow systematically describes and dismantles Masters and Johnson's laboratory research, their four-stage model of the human sexual response cycle, the classification of sexual dysfunction and, finally, their sex therapy program. To do so, Morrow provides the first synthesis of the existing critical literature on Masters and Johnson accompanied by his own sociological insights--the crux being that Masters and Johnson's work was ethnocentric, essentialist, and dominated by Western values regarding sexuality. Because their four-stage model narrowly defined sexual function as a man and a woman reaching female orgasm or male ejaculation through coitus, all other sexual functions would be classified as "unsuccessful" or "sexual dysfunction." Yet, contemporary and cross-cultural research indicates there are multiple and varying discourses and realities concerning sex, sexual function-dysfunction, and what Masters and Johnson failed to incorporate--sexual desire. Through Morrow's analysis, it is easy to see how Masters and Johnson's coital obsession and subsequent classification of primary and secondary impotence as sexual dysfunction has led us to our current sociological environment where erectile dysfunction is a medically recognized disease generating millions of dollars in revenue for big pharma each year. After all, "hardness matters," and Viagra[R] is "delivering the hardness men want" (see www.viagra.com).
Finally, in chapter 8 (Morrow, 2008, p. 179), Morrow closes his analysis by delineating the following implications for contemporary sex therapy: (a) Sex therapists should be critical of Masters and Johnson's model "as a universal norm of healthy sexual functioning," (b) Masters and Johnson's classification of sexual dysfunction is so problematic that it should be reconstructed, (c) sex therapy needs to expand its focus on the individual patient to take into consideration how the broader sociocultural environment impacts sexual functioning, (d) to avoid being agents of social control, sex therapists must be "more reflexive and sociologically aware", (e) more rigorous treatment outcome studies are needed for sex therapy to advance, and (f) sex therapists need to critically evaluate the commoditization of their services.
Unlike the writing style of Masters and Johnson, Morrow's (2008) sociological analysis is not "taxing, turgid, and often imprecise" (p. 162). Rather, it is a highly accessible, intriguing, and quick read---even for those who are not astute in the fields of sex research and sex therapy--that makes significant contributions to the sociology of sex. First and perhaps foremost, Morrow rewrites the history of the sociology of sex by resurrecting texts from the 18th century onward to demonstrate that sexual inquiries have long been a part of the sociological tradition, despite canonical misrepresentation. Second, in the first text to do so, Morrow skillfully synthesizes the critiques of Masters and Johnson's methods and results and provides his own sociological analysis.
While Morrow (2008) gives the reader a taste of sociological analysis, his critique does not quite satiate our socio-cultural hunger. Perhaps because so much of the previous work critiquing Masters and Johnson has focused on methodological errors, Morrow, too, seems overly concerned with Masters and Johnson's methods and results, with limited attention to the specific sociological connections. For example, Morrow devotes a great deal of time to describing Masters and Johnson's sample selection, experimenter, and gender biases. Yet, when Morrow points out that Masters and Johnson's endeavor was, in part, driven by a desire to address the breakdown of marriages in the United States, this concurrent sociological picture is scantily painted. How was the institution of marriage socially constructed in the United States at the time of Masters and Johnson's research? What were the social, political, and economic responses to the breakdown of American marriages? Moreover, although Morrow does not purport to do so, we suggest that a more comprehensive sociological analysis might incorporate a discussion of the impact of Masters and Johnson's biases on contemporary sex research and sex therapy. For example, what are the connections between the Viagra phenomenon and Masters and Johnson's work? Nonetheless, Morrow's sociological analysis provides sex researchers and sex therapists an appetizer for critically examining sexual function and dysfunction, beyond the individual. For sociologists, Morrow provides an alternative disciplinary discourse that regards the work of Masters and Johnson. For researchers and practitioners alike, Sex Research and Sex Therapy: A Sociological Analysis of Masters and Johnson is a worthwhile reference book.
Johnson, V. E., & Masters, W. H. (1966). Sexual human response. Boston: Little Brown & Co.
Kuhn, T. S. (1970). The structure of scientific revolutions (2nd ed.). Chicago: University of Chicago Press.
Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Boston: Little Brown & Co.
Morrow, R. (1994). The sexological construction of sexual dysfunction. The Australian and New Zealand Journal of Sociology, 30(1), 20-35.
Morrow, R. (1995). Sexuality as discourse--Beyond Foucault's constructionism. The Australian and New Zealand Journal of Sociology, 31(1), 15-31.
Morrow, R. (1996). A critique of Masters' and Johnson's concept and classification of sexual dysfunction. Revue Sexologique, 4, 159-180.
Morrow, R. (2005). Sexual dysfunction and sex therapy. In G. Hawkes & J. Scott (Eds.), Perspectives in Human Sexuality (pp. 187-202). Melbourne, Australia: Oxford University Press.
Morrow, R. (2008). Sex research and sex therapy: A sociological analysis of Masters and Johnson. New York: Routledge.
Trigg, R. (1989). Reality at risk. New York: Harvester Wheatsheaf.
Reviewed by Hollie J. Fuhrmann and Eric R. Buhi, Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL 33612; E-mail: email@example.com