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Therapists at the Bridgewater, Massachusetts Treatment Center for Sexually Dangerous Persons are advising Bernard Baran, a 36-year-old gay inmate who is seeking a new trial, to have his erections monitored by penile plethysmograph (PPG).

Sentenced to three concurrent life terms, Baran has maintained his innocence since his 1984 arrest on flimsy, homophobia-driven charges of child molestation at a daycare center. (See The Guide, December 1999.) The PPG is supposed to reveal a male subject's sexual proclivities by measuring his erections in response to erotic stimuli. This test, notorious for false positives and false negatives, may or may not support Baran's insistence that he has never been sexually attracted to children. Any result could be put to questionable use. Despite the probability that his refusal will have a punitive outcome, Baran is resisting the procedure.

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Plethysmographs measure volume. They are often used in diagnosing vascular problems or to record respiratory flow. The penile plethysmograph (PPG) or phallometer, known to inmates as the "peter meter," is an instrument that measures the circumference of the penis and notes changes in penile width. Perhaps the one useful application of the device involves monitoring tumescence during sleep in order to tell whether cases of impotence are organic or psychogenic.

The PPG test for sexual interest, invented in mid-20th century Czechoslovakia to identify draft dodgers pretending to be gay (and to keep gay men out of the Czech military), found a home in the United States among therapists who incorporated it into aversion techniques designed to heterosexualize homosexuals. Today it is chiefly used as a diagnostic or forensic test to identify arousal responses to "deviant stimuli." In the US, PPG testing is administered at hundreds of hospitals, correctional institutions, and treatment facilities for sex offenders. It is commonplace in China, Brazil, New Zealand, Canada, and the UK. In Brussels, the Centre de Recherche-Action en Sexo-Criminologie has used PPG testing since the early 90s.

The Utah Department of Corrections has made PPG testing a standard intake procedure for newly imprisoned male sex offenders in order "to determine arousal patterns and establish baseline for future treatment and evaluation." Later, before treatment can be terminated, a plethysmography result showing progress has to be obtained. In Kansas, refusal to take the test constitutes grounds for expulsion from the state correctional system's Sexual Abuse Treatment Program.

The device resembles a polygraph or "lie detector," though it is more closely related to instruments measuring blood pressure. Its special feature is a mercury-filled strain gauge that wraps around the penis. This apparatus is wired to a machine that registers response time to a stimulus and traces changes in penile thickness. The object is to chart the subject's apparent levels of interest in females, males, adults, children, coerced sex, and consensual sex.

Manufacturers of the device include Farrall Instruments of Grand Island, Nebraska, which responsibly warns users of the danger of false positives. Parks Medical Electronics of Aloha, Oregon, advertises PPG models with names like Penilab V at its website. "If you've ever struggled with penile pressures," the accompanying blurb assures potential customers, "you'll welcome the sensitivity and simplicity of these instruments... the best instruments for studying arterial flow to the penis non-invasively."

Just slip this on...

Some would dispute the term "non-invasive." A Phoenix, Arizona, sex-offender program funded by the US Justice Department has used the test traumatically on children. Some adults who have experienced the test complain of feeling raped or degraded. In 1999, John Toomey, a British inmate who is not imprisoned for crimes of desire, accused the United Kingdom of violating Article 3 of the 41-nation Convention of Human Rights-- "No one shall be subjected to torture or to inhuman or degrading treatment or punishment"-- by subjecting him to penile plethysmography. He brought the case before the Court of the Council of Europe, and lost.

Some subjects have mainly found the test ludicrous. "It was a farce," says Scott Foster (not his real name), recently paroled from a New England correctional institution after serving time for consensual sex with a teenaged boy. "They brought me to a tiny room where I had to sit in this filthy overstuffed chair with a sheet thrown over it. There was a four-foot-high screen between the guy administering the test and me; he could look over the top whenever he wanted."

Foster was asked to lower his trousers, wrap the mercury-filled band around his penis, put on earphones, and listen to a two-hour succession of audiotaped erotic scenarios. The sexual narratives, delivered in a monotone by a male voice with a dese-dem-dose accent ("They think sex offenders sound like that," Foster conjectures), included a variety of sexual situations. Some involved consensual heterosexual sex, some depicted contact with minors, some depicted rape.

Foster and others recall simple stories told in simple sentences. "I'm driving down a country road," the voice might say. "It's a lonely road. Nobody's around. Just a boy standing next to the curb. He looks about 14. Blond. Blue eyes. I stop the car. He walks over and says, 'Hi.' This excites me...." In the online magazine PitchWeekly, journalist Allie Johnson quotes PPG scripts that escalate toward rape: "You lady bitch... with skin-tight pants and those boobs falling out of your low-cut blouse. You can't look at me and tease me and not give me something...."

One heterosexual convicted rapist who remained limp insists he found the male voice a turnoff. Others complain that sharply different narratives ended and began without a pause. Some say the presence of PPG technicians inhibited them. Foster, who failed to become aroused, remembers the therapist in charge interjecting, "Now, didn't that interest you?" Dr. Barbara Schwartz, a respected clinical psychologist who believes that the PPG has diagnostic value, admits nevertheless that more than a third of the subjects flatline-- i.e., never get aroused.

Nothin's up

Therapists often interpret flatlining to mean that the subject remains unwilling or unable to acknowledge the reality of his crime-- not that the test might be flawed. PPG proponents recognize that subjects can cheat by masturbating just before the test, interfering with the gauge, or blocking out the audiotapes, but many seem unaware that the test situation itself might inhibit arousal in some subjects, or serve as the primary source of arousal in others.

Many men are likelier to respond to visual stimuli than to audio-porn, but the use of visual materials in conjunction with the PPG have largely been discontinued. Until the mid-1990s, there was widespread, non-standardized, occasionally oddball use of sexually explicit videotapes, films, and photographs. In Arizona, children without prior exposure to B&D were shown bondage imagery while hooked up to a PPG, and labeled "deviant" if they responded. Audiotapes avoid charges of inappropriate use of putative illegal images, like confiscated kiddie porn, and of "revictimizing the victims" depicted in pornography-- assuming proof of such victimization exists.

The cock makes the man?

PPG defenders tend to share particular notions about male sexuality. Testifying about the efficacy of the PPG in North Carolina v. Robert Earl Spencer, a 1993 case in which a man was accused of molesting his five-year-old daughter, Dr. Eugenia Gullick claimed, "It's a one-to-one relationship: we know that when the penis becomes engorged, we are measuring sexual arousal."

But engorgement of the penis can be caused by fear, tension, or the factors that produce a morning hard-on. The PPG cannot even determine beyond a doubt that an erection indicates a sexual response. Equating engorgement with sexual excitement reflects the "penis as machine" attitude, widespread among psychologists, that Andrew Kimbrell, cofounder of the Men's Health Network, decries in The Masculine Mystique. "In reality," Kimbrell points out, "the penis is among the least mechanistic of body parts."

Because arousal itself can be difficult to trace back to a particular cause, plethysmographic data can also be misleading when arousal does occur. Men who are not sexually interested in children can respond to kiddie porn; some perpetrators of serious sex crimes have difficulty getting erections under any circumstances. No correlation between arousal by a particular stimulus and predisposition to commit a crime has ever been conclusively demonstrated. "Using plethysmography to suggest the guilt or innocence of an alleged sex offender," says Dr. Robert M. Stein of the Center for Neurobehavioral Health in Lancaster, Pennsylvania, "is like using a personality test as evidence of the guilt or innocence of an alleged burglar."

Barbara Schwartz stresses that PPG results are useful only when they show "clear, repeated patterns of arousal" that are corroborated by other means. Most state agencies managing sex offenders claim to comply with guidelines formulated by the Association for the Treatment of Sex Abuse (ATSA), a professional organization for clinicians and researchers. ATSA plethysmography standards ("Initial physiological assessments should only be interpreted in conjunction with a comprehensive psychological examination," etc.) are intended to insure that the test is properly conducted, and that its results are interpreted in the light of collateral data.

This ethical stance does not always serve as a reality check. Testifying in 1992 before an Arizona Senate subcommittee, Lois Yankowski of the Arizona Civil Liberties Union cited examples of children being labeled offenders or likely offenders primarily as a result of sometimes "heavy-handed and coercive" plethysmography testing. PPG data are frequently thrown before parole boards and cited in hearings determining one-day-to-life civil commitments. While experts agree that plethysmography is useless in pinpointing potential offenders within a "normal" population, some therapists persist in dishing out PPG results as if they could predict behavior accurately.

Alternatives to the PPG include conventional polygraph procedures and newer, non-physiological methods. The Abel Assessment, developed by Dr. Gene Abel of Atlanta's Behavioral Medicine Institute, measures the amount of time subjects spend looking at individual slides of naked people, sexual activity, and fetish paraphernalia. The test has achieved sufficient notoriety to insure that many subjects know in advance what it entails-- thus eroding its validity. While some therapists nonetheless consider the Abel Assessment more reliable than the PPG, the test is not used at the Massachusetts Treatment Center; the State of Pennsylvania has dropped the technique from its forensic repertoire.

Breathe deeply, please

PPG testing at the Massachusetts Treatment Center often accompanies an olfactory aversion program in which the subject is instructed to write down his own erotic "behavioral script," and crush an ammonia capsule known as a "smelly tab" under his nose whenever he gets an erection. (At some sites using olfactory therapy, subjects are made to whiff the odor of rotting meat.) "They had me sucking ammonia for 15 weeks," complains one Massachusetts exhibitionist, who still masturbates for the delectation of female guards. The PPG is administered before the aversion therapy is introduced, and repeated later to check on its progress.

Some inmates are sickened by the ammonia; others consider an ammonia rush the next best thing to a jolt of poppers. Most clinicians fail to note that some individuals may find the ammonia smell itself, evocative of sleazy urine-soaked men's rooms, intensely erotic. Robert Stein maintains that this behavioral-script approach to aversion therapy is, in any case, highly unreliable. "They can just write a script for something they'd never do anyway," he says. "Given the coerciveness of the correctional system, they're handed a strong motivation to fake results."

"I played along and wrote what they wanted and sniffed the ammonia," says an inmate who completed his original seven-year sentence in 1990, but remains behind bars on a civil commitment. "It was bullshit."

A model camp?

The Massachusetts Treatment Center's program, anchored in cognitive therapy, has earned the facility a citation by the US Justice Department as a National Mentoring Site. It utilizes the PPG as one component in a varied menu of diagnostic techniques and therapies. A staff member who spoke anonymously to The Guide (employees who wish to remain employed cannot discuss the institution without clearance from the Massachusetts Department of Correction) describes the curriculum, provided by the independent Justice Resource Institute, as "heterogeneous, holistic, adaptable to individual needs, and quite comprehensive."

In addition to PPG monitoring and ammonia therapy, some inmates are given medications like the anti-depressant Stellazine. Inmates are offered courses with titles like "Negotiating Conflict through Drama Therapy" and "Victim Empathy;" curricula depend upon an individual's classification or treatment phase. There are workshops in anger management and "alternatives to violence." Inmates are asked to write their autobiographies, compose a two-page "insight paper," and draft a series of letters on assigned themes-- including letters to themselves from their victims' perspectives. Various exercises are taken from Facing the Shadow: A Guided Workbook for Understanding and Controlling Sexual Deviance, coedited by Barbara Schwartz. There are frequent group therapy sessions.

Margaret Alexander's 1999 meta-analysis of 79 sex-offender outcome studies suggests that offenders who have undergone treatment have an 13 percent recidivism rate-- five percent lower than those who have not. The Treatment Center's methods do help some individuals. Scott Foster, who questions many aspects of the program, admits that he derived some benefit from group therapy and certain classes.

One missing component at the Treatment Center and at many similar facilities, however, is individual therapy. Most psychologists believe that group therapy should be balanced with one-on-one closed-door sessions. "I won't do one without the other," says Dr. Stuart Nixon, a California therapist who specializes in treating sex offenders. Individual therapy was eliminated at least five years ago to help keep down escalating treatment costs; Treatment Center staff portrays the current "cooperative group effort" as if it were an improvement.

The integrity of that effort has been compromised by several factors, one of which is the Massachusetts legislature's reorganization of the correctional system. The Treatment Center, now overpopulated with close to 600 prisoners, was originally set up as a facility for civilly committed "sexually dangerous persons" under the jurisdiction of the state Department of Mental Health. The Department of Correction (DOC) provided security. But in July 1995, DOC took the administrative reins and began introducing non-civilly committed sex criminals and others from the Massachusetts prison system. Civilly committed inmates, outnumbered more than two to one, are awkwardly segregated from the rest of the population.

Some question the dedication of therapists employed by the present regime. "The Treatment Center is a way-station for minimally qualified therapists to gain experience at the expense of patients they hate and fear," says Boston attorney John Swomley, who has represented scores of sex offenders.

Therapists' biases can be decisive in determining who goes free. "Since there is no confidentiality," Swomley adds, "anything a patient says can be used against him. The aspect of this 'treatment' that is probably most detrimental to a person's sanity and well-being is that working on your problems means pounding nails into your own coffin. In order to embrace therapy, you have to buy into the system and accept its Orwellian doublethink. You have to kiss Big Brother."

Confess, or else

In ruling against plaintiff John Toomey, the British PPG veteran who tried to have phallometric testing declared a human rights violation, the Court of the Council of Europe stated that the procedure had been humanely administered, noting that Toomey had been told in advance what to expect. For American defenders of civil liberties, however, the notion that the test is humane may blunt its Eighth Amendment "cruel and unusual punishment" implications, but fails to address, among other concerns, its violation of Fourth Amendment privacy rights and Fifth Amendment protections from self-incrimination.

As Philip Jenkins states in Moral Panic: Changing Concepts of the Child Molester in Modern America, "Official responses to sex offenders provide glaring exceptions to customary constitutional protections, but exceptions that may yet expand beyond their current scope." In 1999, the Kansas Supreme Court let stand a lower court ruling against 60 prisoners attempting to challenge PPG testing. A growing number of attorneys and activists consider the partnership of therapists and correctional institutions a civil libertarian nightmare.

Penile plethysmography has, at least, become increasingly inadmissible in court. In North Carolina v. Spencer, the trial court excluded PPG testimony, accepting forensic psychologist Dr. Michael Tyson's assertion that in plethysmography "the possibility of misleading the trier of fact... is very high, dangerously high." (In 1995, the state appeals court agreed.) In 1993, the US Supreme Court affirmed in Daubert v. Merrill Dow Pharmaceuticals that "expert opinion based on a scientific technique is inadmissible unless the technique is generally accepted as reliable in the relevant scientific community." This has rendered PPG evidence unacceptable in many jurisdictions.

Plethysmography has had visibility in recent struggles over the rights of real or imagined sex offenders. A principal goal of contemporary sex-offender treatment is that offenders acknowledge their guilt and recognize the impact of their crimes; release in Kansas and other states is contingent upon admission of guilt backed by cooperation with treatment. This presents the wrongfully convicted with a cruel dilemma. In a case now before the US Supreme Court, Robert Lile, a Kansas inmate who insists that his sexual encounter at 25 with a 17-year-old girl was consensual, is challenging coercive treatment on Fifth Amendment grounds. He is also attempting to overturn the Kansas Supreme Court's ruling that constitutional protections do not, in effect, apply to sex offenders. Lile sought legal help after he was ordered to accept treatment, beginning with a PPG evaluation, or be moved from a minimum-security prison to a maximum-security facility full of violent offenders.

Bernard Baran, who began his incarceration at such a facility, was raped four days after his arrival at the Walpole, Massachusetts state penitentiary. For over three years, he endured attacks. Perceiving the Treatment Center as a place of relative safety, he sought admission there via civil commitment-- which he obtained by fudging answers during a psychiatric interview. In his 13 years at the Treatment Center, he has insisted on his innocence while walking a fine line between participating in treatment and refusing to cooperate.

A yellow star? No, a blue dot

In the Treatment Center's color-coded hierarchy of privilege, Baran has achieved "blue dot" status, the highest level, by earning points through good behavior and participation in classes. His privileges, including library time and access to a word processor, help facilitate his campaign for release. Increasingly, however, his therapists have been using the threatened loss of his blue dot status to break his "denial." Last year he managed to accrue enough points to preserve his blue dot by agreeing to fill out the form requesting a PPG assessment "just as an exercise." This year, with the application in place, his status may depend on his actually submitting to the "peter meter."

"It raises serious constitutional issues when the granting of some benefit is made dependent on the results of such a test," says Harvey Silverglate, a former president of the ACLU of Massachusetts and a member of the defense team in the high-profile Amirault daycare case. Silverglate doubts that coerced PPG evidence could survive a due-process challenge.

But in the Wonderland of sex-offender treatment, innocent and guilty are enmeshed in a system whose links to reality are disappearing. "It's all gone downhill," says Quaker activist Richard Callahan. "Serious rehabilitation is out. It's all about retribution and revenge, especially toward sex offenders." Yet government statistics show that while about a third of all released prisoners re-offend, recidivism rates for sex offenders are lower in all categories.

Writing in a 1992 issue of Medicine and Law, Jerome Miller of the National Center on Institutions and Alternatives (NCIA) observed, "In the current national mood, psychiatrists, social workers, psychologists, and others who have traditionally defined themselves as helpers now stand in line to lend a gloss of scientific or clinical validity to criminal justice spectacles often inspired by... political winds, ambitious prosecutors, and pop psychology.... As the politics of crime and punishment in this country have taken a turn for the vicious-- particularly with regard to [sex] offenders... [w]e see the enshrinement of attitudes which are antithetical to authentic therapy."

Justice Department figures show that between 1990 and 2000, a period when crime rates declined, the American rate of incarceration rose from one out of every 218 US residents to one out of every 142. The US now imprisons a higher percentage of its citizens than any other nation.

In this punitive atmosphere, fantasies of unchecked sex predation are fueled and refreshed by media hype surrounding cases like that of alleged child-eater Nathan Bar-Jonah; political and corporate propagandists respond with popular, unconstitutional, soundbite-ready solutions. As long as the corrections industry gives the public what it wants, coercive penis measurements included, sex-offender treatment and criminal justice will remain oxymorons.