INDECENT EXPOSURE AND EXHIBITIONISM IN PAPUA NEW GUINEA : A CASE REPORT
Umadevi Ambihaipahar Felix Y Attah Johnson
University of Papua Guinea, New Guinea, P.O. Box 5623, Boroko, Papua New Guinea
RESUMEN
La exhibición incidente es el deseo compulsivo de mostrar los órganos genitales ante personas extrañas en un lugar público. Es una de los contravenciones heterosexuales más frecuentes. Este articulo describe el primer caso de exhibicionismo en un hombre melanésico de Papúa Nueva Guinea(donde hasta hace unos años la desnudez era habitual), ilustrando así un caso de “desorden de cotejo” en un melanesio como resultado de un cambio cultural.
Palabras clave: exhibicionismo, Papúa-Nueva Guinea, cambios culturales.
ABSTRAT
Indecent exposure is the urge to expose the genitals, usually before strangers, in a public place. It is one of the most common heterosexual offences. This paper reports the first case of exhibitionism in a Melanesian male from Papaua New Guinea, (where nudity was not rare a few years ago), illustrating "
courtshisp disorder" in a Melanesian male that results from cultural change.
Key words: exhibitionism, Papúa-Nueva Guinea, cultural change.
In 1824 indecent exposure was first specified as a criminal offence. Indecent exposure remained firmly in the realm of crime for another fifty years until Lasegue (1877) made the first of a series of medical attempts to have the behaviour recategorized ( Indecent Exposure ana Exhibitionism by Rooth in British Journal of Hospital Medicine, April 1971).
The term exhibitionism is confined to those exposers for whom genital display to a member of the opposite sex is an end in itself. They are distinguished from those other exposers in whom the behaviour simply expresses a wish for intercourse or masturbation, or is the preliminary to an intended sexual assault (Rooth, 1971).
"Indecent exposure of the male person with intent to insult a female is the statutory definition of the offence colloquially known as flashing".
(Gunn and Taylor 1995).
Clinically, it is the urge to expose the genitals, usually in front of strangers in a public place. It is one of the most common of heterosexual offences (Gunn and Taylor).
Despite its superficially innocuous nature, exhibitionism is a form of sexual
disturbance that can be extremely persistent and disruptive. Sometimes the act is a crude form of sexual invitation used by the mentally impaired. (Gunn an Taylor 1995). Conviction rate for indecent exposure per one million males in England and Wales ( figures from Home Office) shows that adult conviction rate remained steady from 1948 to 1969 whereas the rates for those under 21 years of age have doubled since 1948 (Rooth 1971).
Diagnostic Criteria: ICD-10 Code F65.2 WHO 1992 states:
Exhibitionism is " a recurrent or persistent tendency to expose the genitalia to strangers ( usually of the opposite sex) or to people in public places, without inviting or intending closer contact. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation."
Diagnostic Criteria for DSM- IV Code No 302.4
Exhibitionism are as follows:
"(A) Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviours involving the
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exposure of one's genitals to an unsuspecting stranger".
"(B) The fantasies, sexual urges, or behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning".
(DSM-IV of the American Psychiatric Association 1994 ).
Exhibitionism is mainly a disorder of males, but women sometimes indecently expose their genitals too. This may be done to please inmates, for exemple, during a prison visit (Gunn and Taylor 1995). The " flash" or "flash- up" may occur during prison visiting when a wife, girlfriend or even paid prostitute will briefly expose her breasts or lift her skirt having gone to the prison without the relevant items of underclothing (Morris and Morris 1963). The fantasies which accompany acts of exhibitionism, or during masturbation to memory of the scene of exbibitionism, give some clue to the complex inner meaning of this superficially irrational behaviour. If the victims appear shocked, or at least impressed by the act, this gives a feeling of sexual power and control, even though at a safe distance, and thus compensates for feelings of inferiority and inadequacy in real life ( Rooth 1971) .
According to Gunn an d Taylor (1995): The conditioning effect resulting from constant repetition of their ritual act"may permit these men to attain maximal sexual arousal more easily in these situations than in what are for them nore threatening personal relationships".
Gebhard et al. (1965) found that the majority of exhibitionists do not resort to violence, but 10% attempt or contemplate rape.
The present case report is the first published report in a Melanesiam from Papua New Guinea.
Case Report
Patient is a 21 year old Melanesian male whose home in in the Central Province of Papua New Guinea. He was first admitted to hospital in early 1994. He had never married and was unemployed.
He was admitted to hospital mainly for repeatedly exposing his external genitalia to female strangers and his female cousins who
are lodging with his adoptive family. Other complaints were mutism ( not answering or responding to simple questions) and occasionally laughing inappropriately.
His adoptive father reported that the patient had the above symptoms for about one year before consultation and admisssion. He did not respond to persistent psychosocial counselling to stop him from exposing his external genitalia to females.
On the day before admission to hospital, the man indecently exposed his external genitalia to his adoptive father's sister, who is a married woman in her middle age.
The patient was legally adopted by his present social parents shortly after birth through Social Welfare Services. There is no information about his biological parents. The adoptive father, aged about 50, is a retired school teacher. His adoptive mother ( aged about 45 years ) is a housewife. He has two other adoptive brothers aged 23 and 15 years.
The patient's childhood was normal until he was 16 years old, later on he showed some signs of mixed emotional and conduct disorder.
He was disobedient and played truant from school until he eventually stopped attending on the fifth grade. He also started drinking beer in moderation and was caught somoking cigarettes occasionally. He denied any history of abusing cannabis.
He has never been arrested by the police for breaking any law.
A complete physical examination ( including neurological examination) showed no abnormality. pulse rate was 80 beats per minute, with regular rhythm and normal volume, and blood presure was 120/80 mm of mercury.
This patient was admitted to the Psychiatric Unit of the Port Moresby General Hospital for a month. He responded well to supportive psychotherapy and pharmacotherapy with chlorpromazine Tablets 100 mg three times daily and benzhexol Tablets 5 mg daily.
He was discharged home under the supervision of his adoptive father on maintenance medication with chlorpromazine 50mg Tablets three times daily. He was offered outpatient follow-up appointment at monthly intervals.
His father reported that he had not exposed himself eighteen months later. He
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continued to attent the psychiatric outpatient clinic for a review of his mental state, which has remained normal, at three month intervals.
Discussion
Two important factors have been proposed to explain the aetiology . The first aetiological factor is enhancement of the infantile component of sexual drives and the second is a disturbance in early objets relations. Parental attitude can exert a particular influence at puberty by enforcing rigid prohibitions against sexual enjoyment. The development of exhibitionism is associated with a seductive relationships with the mother and severe castration anxiety arising from the child's incestuous yearning (Rooth 1971) .
Comings and Comings (1985) in their clinical and psychological study of 250 patients with Tourette Syndrome showed that 15.9% of males and 6.1% of females had exhibitionism along with other psychiatric disorders. Grob (1985) published a case report of a woman whose emotional deprivation led to feelings of rejection and inability to develop an empathic relationship.
Her self- esteem relied on success in her profession and when she lost her position she sought validation through exhibitionism. This case report demonstrated the existence of such phenomena in women.
The present case-report is the first published report of exhibitionism in a Melanesiam male from Papua New Guinea.
The case- report is also important for two reasons, namely,from the point of view of clinical practice and that of medico-legal ( forensic psychiatric) practice. Our case - report is supported by the concept of " courtship disorder". which was described by Freund and Blanchard (1986) . They described four phases of normal human male courtship behaviour as follows: (1) location and appraisal of a potencial partner. (2) pretactile interaction, for exemple, smiling at, posturing for, or talking to a prospective partner. (3) tactile interaction, for exemple, embracing and petting and (4) effecting genital union. They further suggested
the existence of a discrete syndrome, which may be described as " courtship disorder" (Freund and Blanchard 1986).
References
1. American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DMS- IV). 1994 pp: 525-526. APA, Washington, D.C.
2. Comings, D.E., and Comings B.G.
Tourette Syndrome: Clinical and psychological aspects of 250 cases.
American J. Human Genetics 1985, 37:
pp: 435-450.
3. Freund, K. and Blanchard. The Concept of Courtship Disorder. J. Sex and Marital Therapy 1986. 12: 79-92
4. Gebhard, P.H., Gagnon, J.H., Pomeroy, W.B., and Christenson, C.V.
Sex Offenders 1965. Heinneman:
Londres
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Nerv. Ment. Dis. 1985, 173: pp 253- 256.
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7. Lasegue, C. Union Medicale, 1877, 23:
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8. Morris, T. and Morris P. Pentoville: A Sociological Study of an English Prison.
1963. Routledge and Kegan, P.
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Med. Legal J. (Camb.) 1970, 38, pp:
135-139.
10. Rooth, F.,G. Indecent Exposure and Exhibitionism. British Journal of Hospital Medicine, 1971, 5: pp: 521- 534.
11. World Health Organization.
International Classification of Mental and Behavioural Disorders, Tenth Edition (ICD-10), 1992 P. 219.WHO.
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