Tuesday, December 1, 2009

More news on the DSM: Women who want to want

Women who want to want, an article published his past weekend in the New York Times Maganize, discusses the future of the diagnosis female Hypoactive Sexual Desire Disorder (HSDD) in the DSM-V, focusing on Lori Brotto, the member of the sexual of DSM-V subworkgroup for Sexual Dysfunctions who wrote the report on female HSDD (which I have discussed here). (She has also been involved in research on asexuality.)

It was an interesting article that I would definitely encouraged readers to take a look at. Here's my favorite part:
Brotto knows too that there are sexologists who maintain that desire by any definition — whether the sheer lust Basson minimizes or the responsive variety she trumpets — is almost entirely a cultural invention rather than a biological reality; that it has been made to seem essential by the sex scenes in movies and the advice columns in magazines; and that it is best deleted from the D.S.M. Leonore Tiefer, a professor in the psychiatry department at New York University and the author of a collection of essays titled “Sex Is Not a Natural Act,” argues that the contrivance is compounded by the pharmaceutical industry, which offers research money to sexologists who find ways, no matter if unconsciously, to inflate hugely the numbers of women suffering from an already-fictive condition — a disorder that the drug companies intend to cure. High numbers help to increase awareness, which stokes demand. To what extent this theory represents truth, as opposed to being merely plausible, is hard to sort out.

I wouldn't exactly endorse the claim that lust is a cultural invention without qualification--like many claims about this or that being "social constructs" (whatever that means), the statement seems to conflate "the sheer biological/psychological fact of the experience of lust" one the one hand, and "the conceptualization of lust and corresponding beliefs" on the other. (The former, presumably is rather biologically rooted; the later much less so, except to the extent to which all human conceptualizations of anything are rooted in general abilities of reasoning, conceptualization, thinking etc. based on how human brains work.)

Other than that, I'm generally inclined to agree. (Although, the facts are somewhat more complicated in the sense that the medicalization of low sexual desire considerably preceded the release of Viagra, which is when, according to Tiefer's analysis, the pharmacuticals realized just how much money they could make were they ever to invent "the pink pill.")


Ily said...

It seems like the main thrust of this article was to go, "Hey, look, there are more questions than answers here!" Good times. I think the concept of a "social construct" can be useful, but it's also really vague-- just saying something is socially constructed isn't enough, unless you're also saying whether it's solely a construct or something, like lust, that has a real basis. I guess there's a whole spectrum of construction within that concept.

Isaac said...

My favorite part is the claim that a placebo for testosterone produces mustache and pimples.

By the way, I think that your comments about lust may also be applied to love.

Bat Sheva Marcus, LMSW, MPH, PhD said...

The New York Times article poignantly expresses both the deep distress felt by women with the loss of their libido as well as the complexity of understanding and treating the condition. Women’s loss of desire, while experienced sharply and distinctly, can be extraordinarily varied in both its primary cause, its contributing factors and in the range of treatment options.

Women’s sexual problems, of necessity, must be assessed by integrating the emotional, physical, chemical and psychosocial perspectives in order for us to be successful in treating them. Most often, recommended treatment protocols are unilateral; the underlying assumption being that one “magic bullet,” should alleviate the problem. Often we find that this leaves women who have tried a single approach feeling as though they have failed; and more hopeless, resigned and unhappy.

Only with an integrated approach to diagnosing and treating women with female sexual dysfunction, more will have a better chance at achieving what they are looking for, a full and satisfying sex life. While critics may believe this is yet another “luxury” health problem, we’re certain none of them would want to settle for a tepid sex life. And if what we see in our practice is any indication, they’re in good company.

pretzelboy said...

Ily, there are some people who use "social construct" principally for things that seem to have no biological basis (or something like that), but there are others who feel that this is a misunderstanding of the term. (There is considerable variability in usage and meaning, which, I think, just makes it more confusing.)

Isaac, I found that part interesting as well.

Bat Sheva Marcus, if you read Brotto's report on female HSDD for DSM-V, you will find the following regarding distress surround low sexual desire in women: "As reviewed in an earlier section and summarized in Table 1, the prevalence of low desire without distress is significantly higher (in some cases double) than the rates of low desire with distress."

So it is quite misleading to emphasize how distressing it is--it is very distressing for some women. But not all. Or even most. I have a suspicion that the emphasis on how oh-so-distressing it is may actually function to cause distress by communicating that if people aren't distressed about it, they should be. This is, I think, at the heart of much of the criticism of HSDD, FSD, and the like.

[i]While critics may believe this is yet another “luxury” health problem, we’re certain none of them would want to settle for a tepid sex life.[/i]

I'm certain that you're wrong. I'm asexual. I don't even know anyone that I want to have sex with. I have no sex life, nor have I ever, and it's not a problem for me. Have you even read the title of my blog?

Colin said...

I notice that post by Marcus appears on centerforfemalesexuality.com here, and wasn't written specifically in reply to this post, which explains why it seems irrelevant and obtuse.