Monday, December 28, 2009

The Pathologization of Asexuality?

Since finding the asexual community, two terms that have entered my vocabulary are “pathologize” and “medicalize.”

The OED defines "pathologize" (in its modern sense) as a transitive verb meaning, "To regard as pathological or a suitable subject for pathology; esp. to regard as psychologically unhealthy or abnormal," with the first quote coming from 1980. In OED's quotes, it always carries a negative connotation (though some authors use the term with an air of skepticism towards this judgment.) Medicalize is defined as, " trans. To give a medical character to; to involve medicine or medical workers in; to view or interpret in (esp. unnecessarily) medical terms." Likewise, it has a negative connotation. The OED's second quote:
1979 Daily Mail 27 Jan. 7/7 The drug industry, the Government, the chemist, the taxpayer and the doctor all have vested interests in ‘medicalising’ problems that should not really belong in the sphere of medicine at all
The terms are often used to criticize what is seen as regarding “normal behavior” or “normal variation” as disease, disorder, or dysfunction. They are used to critique regarding as a medical problem what might be better seen as a legal problem, a social problem, or maybe just an everyday-life sort of problem--or maybe not even a “problem” at all, arguing that the only problem is the perception as such.

While asexuality is not, strictly speaking, presently regarded as a mental disorder, the diagnosis Hypoactive Sexual Desire Disorder is too close for comfort for many in the asexual community.

A question that I have long wrestled with is this: Why does it bother us that asexuality is (almost sort of) considered a mental disorder? Why do we feel that this is a problem?

When I get sick, I don’t protest against medicalization or insist that there is nothing wrong with me. I don’t feel that I am somehow less of a person for having an illness. There are many things that I readily regard as pathological, and few would argue that nothing is properly the domain of medicine. (The only ones I can think of do so from a mystical bent.)

The question concerning the pathologization of asexuality is this: If there is nothing wrong with admitting one has an illness/disorder/dysfunction when one does have one, and if we often find nothing wrong with saying that various things about ourselves or others may be pathological without negative judgment on our (or their) value as people, why are we so opposed to regarding asexuality as (psycho)pathological?

I don’t mean this as a rhetorical question, nor do I mean to suggest we accept without comment HSDD. Intuitively, I want to say, “That's different.” For some things, it feels appropriate to classify them as pathological; for many, this will be very uncontroversial (like liver cancer.) There seems to be something different about calling asexuality disordered than does make is problematic when, for many of these others, calling them pathological does not seem problematic. The question is, “What is the difference? How is it different?” And not just, "How is it different from liver cancer?" But "How is it different from other things of much less severity that we readily regard as pathological?"

I'm not going to try to answer the question now, but hope to start to do so over the next few months. I attempted this in a series over the summer, but, as my most recent blog summary notes, I got through all of two posts before hitting a serious case of writer's block. I've done more reading and thinking, and I think I'm ready to attempt it again.


Ily said...

You might already be hinting at this, but I think one major difference between pathologizing cancer and pathologizing asexuality is that mental illness comes with a stigma that physical illness doesn't have. Even though there are some oddballs who would call cancer a manifestation of negative thinking, there's the pervasive idea that mental illnesses aren't "real" illnesses, that people are just making them up to get attention, that the person needs to just snap out of it, that you'd feel better if you just took vitamins or went for a walk, etc. I don't think anyone would sign up for being pathologized unless it got you a direct benefit, like treatment in a hospital that you couldn't get otherwise. There also seems to be a small movement to de-medicalize more "traditional" mental illnesses. I found this article on that topic:

As to why medicalization bothers us, I think it might simply come from our desire to have ourselves and our experiences understood by others. I don't think I'm alone in saying that it bothers me when people ascribe qualities to me that I don't really have. I know it's hard to really understand another person, and so I try to not let those kinds of things get to me, but I feel like the desire to be understood is up there with the desire for love.

SlightlyMetaphysical said...

I'm interested to see your thoughts on this, but I think, with sexuality, saying that something is all in the head means that it's not genuine, that it's unnatural, unhealthy. You're right, it's an odd view to have. All sexualities are in the head.

But I know we stand a lot more chance of clearing up that you can be mentally healthy and still asexual, reclassifying asexual as not a mental 'disorder' than trying to reclassify heterosexuality and the rest as pathological again.

In fact, while writing that, an even more pressing reason occured. In a medicalised context, anything that deserves a label is automatically a problem, any mental condition is automatically one that ought to be cured, one that has to be seen as wrong.
Unless this stigma is removed, and I think it's going to require a heck of a lot of work, it's best to play by the current definitions and say asexuality's not a mental condition, because a medical condition is, in the current definition, not just a condition of the mind, but an undesired condition of the mind.

pretzelboy said...

Both of you make some important points, but the direction of your arguments would seem to tend more in the direction of abandoning the concept of "mental disorder" entirely than accept the concept but reject that asexuality is one. I'm not sure if that's a position either of you support--it is an intellectually credible position because there is a definite sense that mental illness is less real than physical illenss--not in the sense that people are just making it up (well, some argue that mental health professionals and the pharmaceuticals are doing just that, but you meant the individuals with the mental illnesses) but in the sense that with physical illness, you can identify a tumor or bacteria or a virus or parasite or whatever--there are tests that can be run. With mental illness, you don't have that. Whether any of these things are "real" in the way that small pox is real is, essentially, unknowable. The problem is that, given the current state of our knowledge, psychiatry and clinical psychology are forced to a) not deal with it or b) pack up their bags and get a different job.

Ily said...

I'm having some trouble putting this into words, but...while I don't think I'd support abandoning the concept of "mental disorders" altogether, I think we have a situation where all that matters in an illness is what's going on inside your own body. So I feel like we never really examine the root causes of a lot of illnesses, or the reasons why certain illnesses, both mental and physical, are getting a lot more common. For example, everyone is saying that depression is getting more common, but where are the studies examining why this is? Is there some resistance to the possibility that depression may actually be a "normal" response to...something, since it's so common now? So, I accept the mental illness concept, but I think it needs some work, and I think on some level excessive medicalization can impede our understanding of things. I'm wary of completely accepting anything that comes totally from on high, with no collaboration with the people who actually have the issue (and this is where we are now with mental illness).

But I think it does matter whether or not asexuality is seen as a disorder, because if it is, there are probably a certain number of people who'll not question that. They'll walk around thinking something is seriously wrong with them, when that doesn't necessarily have to be the case.

Shades of Gay said...

Coming late into this discussion...

However, to suggest that asexuality is a mental illness is to suggest that a person who is asexual is in need of being fixed, of being made sexual.

Besides the fact that this will cause the medical community to attempt to "treat" asexuality (i.e. devote time, energy, and money to researching and prescribing "cures"), it will also encourage people who are asexual--especially young people--to try to make themselves non-asexual. This will cause these young people to become depressed and possibly suicidal, as happens when a person who is gay, bi, or trans tries to force themselves to become straight, on the grounds that there is something wrong with them or their feelings.

There is enough suicide among non-heterosexual youth as it is. Let's not encourage asexuals to become statistics as well by labeling them as "mentally ill".

pretzelboy said...

Shades of Gay, I think that there is some truth to what you're saying, but there is an important fact that you've overlooked. Essentially, asexuality has been considered a mental disorder from about 30 years now. Inhibited Sexual Desire/Hypoactive Sexual Desire Disorder has been in the DSM since 1980. Since '94, it says it's only a disorder if it causes distress or interpresonal difficulties. One subtype of this "disorder" if "life long," which not identical to asexuality is related. However, I have not been able to find a single study on the matter despite it being in the big book of mental disorders for three decades.

NancyP said...

"Hypoactive Sexual Desire Disorder" is effectively a behavior-based label for the less interested person in a couple having mismatched libidos. He wants sex daily, she'd be happy with once a month. She feels that she must "put out" more frequently and enthusiastically to keep him. He has unrealistic expectations of his overworked woman partner. She doesn't catch on that her hubby is a closet case.