Monday, December 20, 2010

More on SIAD

The DSM-5 Sexual Dysfunctions Subworkgroup is currently proposing to merge (Female) Hypoactive Sexual Desire Disorder (HSDD) and (Female) Sexual Arousal Disorder, and make a new diagnosis, Sexual Interest/Arousal Disorder (SIAD). I have previously reported on this and on commentary and criticisms on this proposal (here, here, and here). A couple months ago, another commentary was published in Archives of Sexual Behavior: Should Sexual Desire and Arousal Disorders in Women Be Merged? (So far, ASB has published a number of commentaries on proposed changes to the paraphilias and at least one about proposed changes to Gender Identity Disorder, but this is the only one about the sexual dysfunctions, presumably because a number of commentaries have been published in the Journal of Sexual Medicine.)

Recently, a response has been published--Should Sexual Desire and Arousal Disorders in Women Be Merged? A Response to DeRogatis, Clayton, Rosen, Sand, and Pyke (2010) by Lori A. Brotto, Cynthia A. Graham, Yitzchak M. Binik, R. Taylor Segraves and Kenneth J. Zucker--that I wanted to draw interested readers' attention to.

In reading the commentaries about this proposal a curious observation that I couldn't help but make is that there appears to be a rather strong correlation between supporting the merger and lack of pharmaceutical connections. It troubles me, but it's hard not to notice.

Brotto et al. address a criticism that the new proposal is based on expert consensus rather than data:
There is simply no justification for asserting that the proposal for Sexual Interest/Arousal Disorder was based on‘‘theoretical speculations or expert opinion.’’ Comprehensive and critical reviews of the empirical literature were undertaken (Brotto, 2010;Graham, 2010)and these formed the basis for the proposals. It should also be noted that the DSMIV-TR diagnoses of HSDD and FSAD were not based on any systematically collected body of data. The diagnosis of HSDD was the result of the expert opinion of Helen Singer Kaplan and Harold Lief: FSAD appears to have initially resulted from the early theorizing concerning the human sexual response cycle by Masters and Johnson and was probably saved from extinction by the hope that PDE-5 inhibitors would be effective for women.


They then make a not-so-subtle suggestion of industry based motivation for criticism:
In their letter, DeRogatis et al. reported on data from two nontreatment studies funded by Boehringer Ingelheim (BI).
and then later
Similarly, in DeRogatis et al.’s analysis of baseline data fromthreeBI-funded clinical trials of flibanserin

I counted no few that 5 references to BI having funded relevant studies.

And then their ending:
The basic pre-requisites for any clinical category include demonstrations of diagnostic reliability and construct validity. In fact, there are no published reliability studies for either HSDD or FSAD. We doubt that either diagnosis could withstand a serious reliability check. Considering that both of these diagnoses were created on the basis of expert opinion, have no efficacious treatments, and cannot be differentiated by current psychometrics suggests lack of validity. Other than habit, the motivation to preserve unreliable and invalid diagnostic categories escapes us. On the other hand, there is significant empirical evidence and theory, which we have reviewed, suggesting the overlap between current conceptualizations of desire and arousal. This evidence and theory has motivated our new diagnostic proposal to merge HSDD and FSAD. We hope that the clearly specified criteria for SIAD will motivate definitive studies to address this important diagnostic issue.

The Plan B ad ordeal--now things are getting weird

As many readers already know, there's been a recent stir in the asexual community regarding an advertising campaign for the contraceptive Plan B Onestep. Using the slogan Get a Real Plan, they had two youtube videos, one of which involved a white female character who had recently had sex with a male whose condom somehow-or-other fell off during sex, and she is worried about becoming pregnant. In the video, Sexy Lingerie, the female character promises that if she isn't pregnant, then she vows to become "asexual, asocial, a-everything."


Along with that were some pictures (which seem to have been taken down, although there were independently captured by at least two people.) As many have noted, the colors--purple and gray against a white background--bear an uncanny resemblance to the recently adopted asexual flag.


The matter has been much discussed after a thread about it was started on AVEN: Plan B ad - Offensive?. There have now been threads on Apositive about it, been subject of discussion and outrage on Tumbler, Twitter, and generally blogged about. A lot of people sent it letters and people are thinking about getting a conference call together to talk about what to do. Those who wrote in letters have gotten a response (it seems that everyone got the same email):

Thank you for reaching out to us about Teva Women’s Health “Get A Real Plan” YouTube campaign. We appreciate you bringing to our attention the unintended misrepresentation of the word “asexual” and want to alert you that new content is being developed that will address your concern. It was never our intention to offend any individual or community of individuals. The purpose of the campaign is to educate viewers about what can be done after an act of unprotected sex or contraceptive failure. We believe that contraception is a serious topic and want to ensure that women have the facts they need about emergency contraception, as not all options are the same.

Again, thanks for bringing this to our attention - we should have the updated video posted very soon.

Just before someone posted one of these letters, I was doing some research on the word "asexual" and was then about the look into "asocial" on the The Corpus of Historical American English, and discovered a passage from the novel Big Sur by Jack Kerouac, published in the early 1960s. It is written in first person, from the perspective of a character who has had a fair amount of wine and wonders if they have been drugged as well:
Romana is handing me a bite and I take it from her big brown hands and chew... She's wearing purple panties and purple bras, nothing else, just for fun, Dave's slappin her on the can joyfully as he cooks the supper, it's some big erotic natural thing to do for Romana, she believes in showing her beautiful big body anyway - In fact at one point when Billie's up leaning over a chair Dave goes behind Billie and playfully touches her and winks at me, but I'm not of all this like a moron and we could all be having fun such as soldiers dream the day away imagining, dammit - But the venoms in the blood are asexual as well as asocial and a-everything -Billie's so nice and thin, like I'm used to Romana maybe I should switch around here for variety, " says Dave


It would seem very curious that a cultural reference to a 1960s novel would be used in an advertisement aimed at teens and twenty-somethings, and yet this appears to be what is going on here. No doubt, we haven't heard the last of this recent episode, but as I stated in the title of this post...now things are getting weird.

Friday, November 26, 2010

New chapter--How much sex is healthy? The pleasures of asexuality

Kim, EJ. (2010). How much sex is healthy? The pleasures of asexuality. in J. M. Metzl and A. Kirkland (eds). Against Health: How Health Became the New Morality. New York: New York University Press. pp. 157-169

The book that this chapter appears in was just recently published, and this chapter addresses issues pertaining to asexuality and disability. Parts of the book can be found in google books. For those unable to get a print version, it should be possible to obtain a copy by emailing the author.

Friday, November 12, 2010

Conference paper--(A)Sexuality: Challenging What it Means to be Sexual

This one isn't actually new, but I only recently became aware of it:

Bedley, C. , 2009-08-08. (A)Sexuality: Challenging What it Means to be Sexual. Paper presented at the annual meeting of the American Sociological Association Annual Meeting, Hilton San Francisco, San Francisco, CA Online

Very little scholarly attention has been directed towards the study of asexuality, and what attention has been given has conceptualized asexuality in direct opposition to sexuality. I argue that rather than conceiving of asexuality as outside the realm of sexuality, scholars interested in asexuality should instead reframe explorations of asexuality within the realm of sexuality. By doing so, it becomes imperative to take into consideration the complex ways in which the dimensions of intimacy, romance and emotional connectedness shape and are shaped by the desires, behaviors and identities of (a)sexual beings. Relying
primarily on discursive analysis of an online asexual community, this is a first attempt at showing how self-identified asexual persons construct asexual identities with an emphasis on the intimacy, romance and emotional connection asexual partners share


I've contacted the author about the paper, and I was told that it was okay to add it to my bibliography, but that I should remind readers that this is a conference paper and it is in a fairly rough form.

Tuesday, November 9, 2010

Updating the AVENwiki

AS many of you know, I was elected to be part of AVEN's Project Team (PM) a few months ago. Since joining, one of the projects that I am particularly wanting to get going is a major overhaul of the AVENwiki. It was started several years ago with considerable ambition--and with hopes that it would be regularly updated. It does have a fair amount of useful static content, but the ambitions for it to be updated regularly haven't been lived up to.

As a result, there are a lot of pointless pages, there is a lot of out-dated content, and there is a lot of new material to be written about. Oven on AVEN, the PT started a thread Updating the wiki to get discussion going about what people would like to see for the wiki. We had some really valuable feedback, and based on that, I summarized what I saw to be the main points people had raised.

Since having these discussions, some AVENites have starting making some serious changes to the wiki, and it looks a whole lot better. (Just check out the new design for the first page you see when clicking on it.)

I encourage people to go check out the changes that have been made, and if there are any articles that you think it needs, feel free to write an article on that subject. Or if you don't feel up to it (or might feel better collaborating with someone), then go post on the thread in AVEN that you would like to see someone write an article on that subject. This is going to be a big project, but I am excited about it, and there have already been some encouraging results.

AVEN Wiki

Friday, November 5, 2010

Book Chapter--Asexuality: Dysfunction or Variation?

Bogaert, A. F. (2008). Asexuality: Dysfunction or variation. in J. M Caroll & M. K. Alena (eds). Psychological Sexual Dysfunctions. New York: Nova Biomedical Books. pp. 9-13.

Abstract: Bogaert (2006) discussed whether asexuality, defined as a lack of sexual attraction, should be viewed as a dysfunction. He concluded that asexuality should not necessarily be viewed as a dysfunction. Here I review and expand on these arguments, including on the possible overlap with existing sexual dysfunctions (e.g., Hypoactive Sexual Desire Disorder.) I also review existing research that bears on this question. For example, recent research (Bogaert, 2004, 2007) has suggested that physical health problems are not likely to be elevated in asexual people. Finally, I discuss what it might mean to have no sexual attraction to others, and whether some people who lack sexual attraction (but who still have sexual desire, e.g., masturbate) may have a paraphilia.

(Comment: This one isn't actually new, but I just became aware of it. Also, the Bogaert 2007 citation refers to something that, in the references is called a "Manuscript submitted for publication.")

Tuesday, October 26, 2010

More encouraging news about the DSM-5 paraphilias debacle

Earlier this week, forensic psychologist Karen Franklin blogged about a debate and then a (non-binding) vote at the recent annual meeting for the American Association of Psychiatry and Law. Now she has informed readers of another (non-binding) vote that occurred earlier (I assume that she was informed of this in repose to her post):
At last month's meeting of the International Association for the Treatment of Sexual Offenders (IATSO) in Oslo, Norway, the vote was approximately 100 to 1 against the controversial diagnosis of "pedohebephilia," according to two reliable sources. The lone dissenting voice was a member of the DSM-5 committee.

Well, so much for trying to achieve professional consensus.

Franklin is spot-on in her assessment of the situation:
I hope the DSM revisers are listening. If not, they are going to end up the laughingstock of the world.

It will be interesting to see how the Paraphilias subworkgrouop responds. So far, they seem to have taken the strategy of having James Cantor post articles on his website, having Alice Dreger writing blogs, and getting an SVP prosecutor drool over a new diagnosis that would make it easier to deprive people of constitutional rights. Evidently, this hasn't been working very well.

Sunday, October 24, 2010

AVENues relaunched!

As most readers probably know, AVEN's newsletter--AVENues--hasn't had any recently issues for a while. The Jan 2009 issue remains the one on AVEN frontpage, although the most recent issue is actually March 2009. After that, Hallu (who was in charge of it at the time) just didn't have much of anything in terms of submissions, and despite a lot of talk about reviving it, nothing happened. The 2009-2010 Project Team talked a lot about reviving it, they got some submissions, but never managed to produce another issue.

I am very pleased to announce that first issue of AVENues in over a year and a half has been published, thanks to the new Project Team, especially +Arielle.

High Quality

Low quality

Paraphilias debate at the annual meeting of the American Association of Psychiatry and Law

On forensic psychologist Karen Franklin's blog, she recently posted about some very interesting news about the current DSM-5 paraphilias controvercy: Psychiatrists vote no on controversial paraphilias.

The DSM-5 Paraphilias Subworkgroup has made a number of controversial proposals (many of which I've blogged about before), among these are expanding Peophilia (attraction to prepubescent chilren) to Pedohebephilia (attraction to prepubescent or pubescent children), adding Paraphilic Coercive Disorder, and adding Hypersexuality. At the annual meeting of the American Association of Psychiatry and Law (AAPL), they had a debate on the matter (stirring the DSM cauldron), and afterwards, it seems, they had a (non-binding) vote. The results:
The votes were 31-2, 31-2, and 29-2, respectively, against Paraphilic Coercive Disorder, Pedohebephilia, and Hypersexual Disorder.

Based on a presentation at last year's AALP meeting, in a comment in the Psychiatric Times, one forensic pyschiatrist one forensic psychiatrist asked
"Is this workgroup immune to critique? Has it "gone rogue"? What is its agenda?"

I'm coming to suspect that they have indeed "gone rogue," and their agenda seems rather transparent to many. Franklin writes:
The "pro" debate team repeatedly insisted that these diagnoses are being proposed based on their scientific merit, not their utility to government evaluators in civil commitment cases. They said these new diagnoses are needed so people suffering with these conditions can get adequate treatment...

The audience of forensic psychiatrists clearly did not buy the clinical justification. As more than one audience member asked the panel, If the rationale is strictly clinical, why are attorneys serving as advisors to the work group?

A very good question indeed. Especially given that they had one of these advisor's--a prosecutor--write a report about how much he would love to have Paraphilic Coercive Disorder in DSM-5.

Sunday, October 10, 2010

National Coming Out Day

In the US, October 11, and in the UK, October 12, has been designated as National Coming Out Day. (This strikes me as a rather odd thing to call what is supposed to be an international event.) Many asexuals are thinking about various ways to get involved in this, and there has been considerable discussion of the matter on AVEN: National Coming Out Day--the revised thread.

If you choose to participate, please consider talking about your experiences in the thread National Coming Out Day: A follow up, or discussing the matter in the comments.

For myself, it is something of a time to reflect. While I have done lots of stuff regarding asexual visibility and education (i.e. writing this blog, among a number of other things), I'm not all that out about my asexuality in real life. Some of my family and friends back home know, and here in Champaign-Urbana, I've been slowly becoming more open about it. (Often, this has been by informing people of the topic of my blog--which I even did in a conference presentation about scalar implicatures one time as I used my blog to recruit participants, and several faculty members know that I am interested in doing sociolinguistic research on the asexual community.)

And yet, I don't feel very comfortable doing any kind of large-scale coming out anything, so I feel sort of awkward writing about it here encouraging other people to do so. And yet because I'm on the PT and the PT is very much trying to promote this event, I feel like I should. I'm not entirely sure what to make of this.

Tuesday, September 28, 2010

Recruiting participants for a study

Here's the description for a study being done by the UBC Sexual Health Laboratory that is wanting asexual participants:
This study will help researchers understand the potential biological underpinnings of sexuality in individuals of different sexual orientations. In this study, we will employ a series of questionnaires asking about physical and mental health, sexuality, and biological markers of sexual orientation.

We hope that the data from this study will help to further our understanding of the health correlates and biological features of sexual orientation, and impact on the greater community to decrease stigma associated with individuals of all sexual orientations.

If you are over 19 years of age, and identify as either asexual, heterosexual, bisexual, or homosexual, please participate in this important research, which is described in more detail in the following consent form.


It takes about an hour to fill you. If you participate, you have the chance to win $100, and it should be very helpful in advancing our understanding of asexuality.

EDIT: This survey has been closed.

Monday, September 27, 2010

New Paper: Physiological and Subjective Sexual Arousal in Self-Identified Asexual Women

Brotto, L. A., & Yule, M. A. (in press). Physiological and Subjective Sexual Arousal in Self-Identified Asexual Women, Archives of Sexual Behavior, DOI: 10.1007/s10508-010-9671-7.

Abstract: Asexuality can be defined as a lifelong lack of sexual attraction. Empirical research on asexuality reveals significantly lower self-reported sexual desire and arousal and lower rates of sexual activity; however, the speculation that there may also be an impaired psychophysiological sexual arousal response has never been tested. The aim of this study was to compare genital (vaginal pulse amplitude; VPA) and subjective sexual arousal in asexual and non-asexual women. Thirty-eight women between the ages of 19 and 55 years (10 heterosexual, 10 bisexual, 11 homosexual, and 7 asexual) viewed neutral and erotic audiovisual stimuli while VPA and self-reported sexual arousal and affect were measured. There were no significant group differences in the increased VPA and self-reported sexual arousal response to the erotic film between the groups. Asexuals showed significantly less positive affect, sensuality-sexual attraction, and self-reported autonomic arousal to the erotic film compared to the other groups; however, there were no group differences in negative affect or anxiety. Genital-subjective sexual arousal concordance was significantly positive for the asexual women and non-significant for the other three groups, suggesting higher levels of interoceptive awareness among asexuals. Taken together, the findings suggest normal subjective and physiological sexual arousal capacity in asexual women and challenge the view that asexuality should be characterized as a sexual dysfunction.

Thursday, September 23, 2010

Asexual Awareness Week

The week of September 20-24 (this Monday to this Friday) has been designated as Asexual Awareness Week, an online event to spur asexual visibility, especially through Facebook, Twitter, Youtube, and somewhat with blogging.

As explained in this video the purpose of this is largely to create asexual visibility among people in the LGBT community, as they are probably our strongest potential ally in our vis/ed efforts.

As part of this campaign, a number of "Dear LGBT" videos have been created, many of these being a part of HPoA:

Dear LGBT -- With love, Aim
Dear LGBT Community - From, Heidi
Dear LGBT Community - Love, Jenni
Dear LGBT Community - Love, Ally
Dear LGBTQ - Love (THAT'S RIGHT), Arne
Dear LGBT, Smoochies- Sassy
Dear LGBTQ Community — Love, Wojtek

In addition to these, there have also been some additional videos:

Dear LGBT Community-From, Holly
Dear LGBT Community - Love, PyroNeko

In addition to these videos, there has been some substantial blogging work, including some guest posts at The Bilerico Project: The X-Factor and Redefining Intimacy. There have also been a number of individual blog posts.

One of the purposes of this is for people to be able to link to these on twitter and (I assume) Facebook.

Sunday, September 19, 2010

Call for Papers: Asexual Studies

Call for Papers: Asexuality Studies

Asexuals are commonly defined as “a person who does not experience sexual attraction” and research estimates their prevalence at 1% of the population. Asexuality has been the subject of increasing media attention, with some high profile television and popular press coverage. This attention has stimulated academic interest in asexuality and considerable research is being conducted in a number of disciplines.

This volume will be an edited book focusing on all aspects of asexuality and the asexual community. It will collect cutting-edge research across all areas relating to this topic with the intention of constituting the foundational text for the burgeoning field of asexuality studies.
Papers are welcome from any discipline and on any topic relating to asexuality. Possible topics include:
- Identifying as asexual
- Experiences of living as asexual
- Social history of the asexual community
- Diversity within the asexual community
- Asexuality and the Internet
- Asexuality and romantic relationships
- Asexuality and wider sexual culture
- Medicalization of a/sexuality

If you have any questions or would like to discuss a submission, please contact m.a.carrigan@warwick.ac.uk

Submissions Due May 2011
Up to 8000 words

Thursday, September 16, 2010

A discursive look at the friend/partner distinction: Implications for asexual people

I am pleased to announce that Asexual Explorations is now hosting its first poster, so be sure to go take a look.

Chasin C. J. (2008, June). A discursive look at the friend/partner distinction: Implications for asexual people.. Poster session presented at the annual meeting of the Canadian Psychological Society, Montreal, Quebec.

Wednesday, September 15, 2010

Pathology and Asexual Politics

I was invited to write a piece about my work regarding asexuality for the online magazine The Sociological Imagination, and I wrote a piece called Pathology and Asexual Politics, in which I address the relationship between asexuality and HSDD, as well as what approaches the asexual community and our allies can take. I've wanted to blog about this topic for some time, but kept having writers block. This article is an attempt on my part to articulate things I've been trying to make sense of for some time.

After the formation of the asexual community, it was not too long before the community became aware of the fact that in the DSM, there is a disorder about not being interested in sex. (The diagnosis is also in the ICD, but the ICD attracts less controversy). As one of the major political goals of the community is to convince people that there is nothing wrong with not being interested in sex, this diagnosis is not especially helpful for that goal.

In considering what kind of approach the asexual community should take toward the matter, one question that seems like a good starting place is whether asexuality is a sexual dysfunction. I have sometimes seen the question posed as an either/or: Is asexuality a sexual orientation or a sexual dysfunction? Some authors (e.g. Prause & Graham, 2007) have done data collection regarding asexuality and claimed that their results suggest that asexuality is not a sexual dysfunction. Such claims are likely good for our politics, but they make absolutely no sense to me.

After discussing the issue of how to define disorder, I continue:
As I do not think that asexuality objectively is or is not a sexual dysfunction, the question I think we should be asking is whether regarding it as such makes sense conceptually and pragmatically. Conceptually, I do not think that it does. Pragmatically, we need to be cautious—what effect, if any, this diagnosis has on asexuals is unknown. We simply do not have the data. Posing the question in this way motivates us to ask another essential for asexual politics: how is asexuality different from HSDD? There are two kinds of answers to this question: extensional and valuational/practical. Extensional differences—who fits which group—are often the only ones that come to mind. They are, for instance, the only ones addressed in Bogaert’s (2006) discussion of the matter. This line of thinking seems to stem from treating asexuality and HSDD as somehow “objectively existing” rather than as more nominalist type categories. I am more interested in valuational and practical differences.

One such difference is that HSDD focuses on lack of sexual desire, and asexuality on lack of sexual attraction. HSDD is a more negative valuation of sexual disinterest and asexuality a more neutral/positive one. HSDD was created by physicians (Kaplan, 1977; Leif, 1977) and is diagnosed by clinicians. The conceptualization “asexuality” was created by asexuals, and the designation—an identity—is self-assigned. Moreover, the conceptualizations HSDD and asexuality will give rise to very different research questions. However, one important similarity should be noted: lack of interest in sex often causes difficulties in people’s lives that they want help with. [3] Both asexual identity and HSDD are conceptualizations that exist to try to help people deal with these issues.

Also, the a few weeks ago, the same magazine published another article on asexuality that is well worth reading Reflections on a year spent studying asexuality by Mark Carrigan. I found especially interesting some of his comments about how asexuality can inform our understanding of sexuality more generally:
I think that a wider recognition of asexuality would inevitably give rise to a much deeper understanding of what it is to be sexual. Despite the pervasiveness with which the importance of sex is affirmed within our culture, we’re often profoundly inarticulate about the role that sex plays in our lives and why it is important to us. At least in terms of the younger generation, we’re far more likely to discuss sex (good sex, bad sex, weird sex ) then we are the place we presume it ought to occupy in our lives. We’re so prone to seeing sexuality as a marker of personal fulfilment that we rarely stop and ask ourselves where we, as individuals, stand in relation to it and what importance it genuinely holds in our lives. Crucially some of us don’t feel particularly free to say that, while we may want sex, it holds no great importance in our lives (at least not relative to other things like friends, romance and love).

Tuesday, September 7, 2010

New Paper: Patterns of Asexuality in the United States

Poston, D. L., & Baumle, A. K. (2010). Patterns of Asexuality in the United States. Demographic Research, 23, 509-530.

Abstract: In this paper we use data from the 2002 National Survey of Family Growth (NSFG) to ascertain and analyze patterns of asexuality in the United States. We endeavor to extend the earlier work of Bogaert (2004) on this topic, which focused on patterns of asexuality in Great Britain. Using a social constructionist perspective to study asexuality, we conceptualize and measure the phenomenon in several ways, according to behavior, desire, and self-identification. We use the NSFG respondent sampling weights to produce several sets of unbiased estimates of the percentages of persons in the U.S. population, aged 15-44, who are asexual; each set is based on one or more of the various definitions of asexuality. Finally, we describe some of the characteristics of the asexual population using logistic regression.

It is in an open access journal, so you don't have to pay anything to read it (or need a library with a subscription).

Saturday, August 21, 2010

Defining Paraphilia: Excluding Exclusion

I am pleased to announce the publication of my paper Defining Paraphilia: Excluding Exclusion, published in the Open Access Journal of Forensic Psychology. This is the first of my peer reviewed articles on DSM-5. Also, because it is an open access journal, you don't need to have a library with a subscription.

Abstract: The development of the classification of the paraphilias is considered, with emphasis on justifications for their inclusion in DSM-III in light of the declassification of homosexuality. These justifications are found to be tenuous and do not work for the paraphilias in DSM-III-R because of changes made. Rationale for these changes is discussed based on inquires made to DSM-III-R paraphilias committee members. Changes in DSM-IV and DSM-IV-TR are also discussed. After considering and critiquing more recent arguments for including the paraphilias in the DSM, recommendations are made regarding proposals for DSM-5, whether the paraphilias belong in the DSM, and whether they should be used in SVP commitment.

Sunday, August 15, 2010

My first publication about the paraphilias

As long time readers know, in addition to talking about asexuality, in the past 9 months or so, I've also started blogging about DSM-5 and the "paraphilias." What I haven't told you is that my blogging activities are only a small part of the work I'm doing regarding these. I've also been doing some writing for academic journals because I think that's where the main arguments need to be made. The first of my publications to come out has now been published online.

Disregarding Science, Clinical Utility, and the DSM’s Definition of Mental Disorder: The Case of Exhibitionism, Voyeurism, and Frotteurism, a letter to the editor in Archives of Sexual Behavior, where the DSM-5 Paraphilias Subworkgroup's literature reviews were published and where the editor issued a call for commentary of these. So I commented.

But rest assured, the best is yet to come.

(p.s. For anyone wanting a copy who doesn't have free access to the journal, you can email the author requesting one.)

Thursday, July 22, 2010

LGBT rhetoric and responses: Part III

This past semester, a U of I adjunct religion professor sent an email to one of his classes arguing that utilitarian logic that would lead to the approval of gay sex would also lead to the approval of human/animal sex and adult/child sex, and then argued that any disconnection between sex and procreation was wrong. The email resulted in the head of the Religion Department telling him he would no longer be teaching at the university, which has created considerable conservative backlash. I have been using this as a springboard for discussion of anti-LGBT rhetoric and common responses.

In my first post, I examined his argument that utilitarian reasoning behind the acceptance the acceptance of same-sex sexuality would lead to the acceptance of sex between children and adults and between humans and animals. I argued that a) there is an important element of truth the his argument, and that b) standard LGBT responses (to get offended and be highly dismissive or such arguments) are unproductive for two reasons. First, to advance their own politics, they are far too accepting of irrational hatred of people attracted to children. Second, such responses communicate to persuadable but as yet unpersuaded people that there is no good response to such arguments. (In fact, such LGBT rhetoric made it a much slower process than it might have been for me to change my own beliefs on the matter.)

In my second post, I examined his positive arguments for his own position, and (I feel) generally demolished them. In this post, I wanted to give serious consideration to the argument that acceptance of gay sex leads to the acceptance of adult/child sex. I wanted to do this to help promote critical thinking in such discussions, and to help in the persuasion of the unpersuaded but persuadable. Much of this will be based on my own thinking as I as I tried to understand the matter when my religion was leading me one way and my conscience another.

Argument 1: In regarding the Divine as the basis of ethics, there is a serious question raised at least as early as Plato (in the Euthyphro): Is that which is good good because it is what God commands? Or does God command it because it is good? (For Plato, there was the additional issue of the possibility of the god disagreeing with each other, a problem that monotheism does not have.) If what is good is good because God commands it, if God says to love your neighbor, that would be good, but if God says to go commit genocide, that would be good. In such a view, it is as though God should be obeyed not because God is good, but because God will give you the ultimate smack down if you don't. In the other case (God commands it because it is good), then there must be some sort of absolute goodness that exists above God, in which case God is not God.

One attempt of monotheist theologians to address this problem has been something of a natural law approach--that which is good is good because it is in accord with how God made things (and God's character), and God commands it because it is consistent with that--God, having created us, knows what it best for us and commands us accordingly. In such a case, there should (generally) be some rational basis for knowing the Divine commands apart from scripture. (Something like this is the Natural Moral Law position discussed in my last post.) In such a case, to maintain a belief that sex is only okay within heterosexual marriage, some reason must be given why same-sex sexuality is wrong. In my previous post, I addressed one (rather unconvincing) attempt to answer this. For me, I felt it was necessary to have some reason other than "because." I felt that somehow it had to be shown that this rule protects people or prevents harm.

I have seen some attempt to make this argument. Sometimes they will argue that anal sex is unhealthy or whatever. (The "logic" here seems to be that unprotected anal sex with people whose STD status is unknown is risky, therefore anal sex is dangerous.) I've seen other attempts at arguing that there is an increased risk of harm with gay sex, therefore it is wrong. I've seen this bolstered by evidence that in many cases adult/child sex causes no harm, but surely that does not mean it is okay. Therefore, they argue, only a likelihood of harm is necessary. Then to argue that gay sex causes an increased likelihood of harm, they'll argue that gay men tend to have more sexual partners than straight men and that this is because of (inherent) sex differences between men and women. More sex-partners means greater likelihood of getting an STD, such people tend to be (nominally) big supporters of monogamy, etc. (Those making this argument seemed to ignore the fact that, even if valid, the argument would not lead to a prohibition of lesbian sex.)

I do think there is something important recognized by this logic. In order for some act to be morally wrong, it is not necessary that it cause harm in all instances. A good example is drunk driving. This does not always cause harm, but it has a high risk of (very severe) harm. This can be usefully contrasted with another dangerous behavior: driving. Numerous people are killed every year in automobile accidents, many of whom were not engaging in particularly risky behavior.

In contrasting driving with drunk driving, an important point can be seen. In the case of the former, there are plenty of risks associated with it, but there are numerous means that can be taken to reduce those risks--requirements for drivers licenses, requiring a certain level of vision, traffic signals, police monitoring, prohibiting particularly risky behaviors such as driving under the influence, etc. In the case of drunk driving, however, there do not seem to be any good ways to allow non-harmful instances (ones where no one ends up getting hurt) and prohibiting the others. As such, the behavior should be completely prohibited.

Applying this logic to sexuality, I think the point is clear as to why the attempted argument against gay sex simply does not work. Both gay sex and straight sex can be practiced in highly risky ways (often called high risk sexual behavior.) The gender of the partner is of little relevance to the basic means of avoiding high-risk behavior and practicing safer sex.

Now apply the same reasoning to adult/child sex. There is plenty of evidence (a link for those wanting references) that adult/child sex is not always harmful; sometimes the child feels both at the time and in retrospect that it was a positive experience; sometimes it is the child who initiates it. However, children are a vulnerable population and therefore particularly vulnerable to sexual exploitation. Childhood sexual abuse is a very real problem and there is a very real need to protect children. A key consideration for the moral question is whether adult/child sex is more like driving or drunk driving. I will let readers attempt to answer that question for themselves.

Argument 2: In addressing the likelihood of harm question, there is another direction that it needs to be asked from. All prohibitions cause harm, and there is the question of whether the good brought about by the prohibition outweighs this harm. (A prohibition against murder, for instance, brings about harm to those convicted of murder. This is generally considered acceptable because it is much better than just allowing anybody to go around killing anybody they wanted and getting away with it.) With same sex sexuality, it is clear that quite a lot of harm to people is done by such prohibitions (as even the slightest understanding of the experience of gay men and lesbians makes clear. It harms bisexuals as well, and it harms trans people given that many acts of violence against trans people are committed on the basis of believing them to be gay, rather than trans, blurring the boundary between homophobia and transphobia.)

While much harm comes from such prohibitions, I really can't think of any good that comes from them. Note that this line of logic is a kind of utilitarian ethic, but it is one that looks at a level above individual acts, considering larger social consequences. Applying this line of reasoning to consensual adult/child sex, I think it is clear that the situation is quite a bit more complicated than it is for sex between consenting adults.

Argument 3: My third argument is one I will not develop, but it long troubled me when I still believed that sex is only okay in heterosexual marriage. I think that if I had seen/heard someone else make it, it would have troubled me (in a good way) even more. Can "hate the sin; love the sinner" possibly be the basis for a sufficiently strong opposition to homophobic violence? A similar question applies to transphobic violence. By getting conservatives worked up about how this is such an important moral issue, how our morals are being degraded by acceptance of "the gay lifestyle", and all that jazz, is this going to help convince people how serious and how wrong homophobic violence is? Is it going to get them motivated to seriously combat it? I am skeptical.

Sunday, July 18, 2010

More thoughts on LGBT rhetoric

I recently addressed some topics in LGBT rhetoric (and anti-LGBT rhetoric), using an email by former adjunct professor of religion at University of Illinois Dr. Ken Howell as a springboard. (He was dismissed because of it.) I did this for a few reasons. First, I wanted to challenge some LGBT responses to conservative arguments on the grounds that it a) is too accepting of the stigmatization of groups even more hated than LGBT people, and b) it is too dismissive of conservative arguments, with the result that convincable moderates may be left unconvinced. As such, I want people to take conservative arguments seriously--seriously enough to be able to give reasoned responses that display genuine engagement with those arguments.

There I addressed his argument against (popular versions of)utilitarian sexual ethics in which he attempt to use a reductio ad absurdam to show that acceptance of homosexuality requires the acceptance of sex between humans and animals and sex between children and adults. At that point in his argument, he feels that he has successfully refuted utilitariamism. He then makes a positive argument for his own position: sexual ethics should be based on Natural Moral Theory, which basically says that sexual acts have inherent meaning, and that rightness and wrongness should be based on this inherent meaning:
Natural Moral Theory says that if we are to have healthy sexual lives, we must return to a connection between procreation and sex. Why? Because that is what is REAL. It is based on human sexual anatomy and physiology. Human sexuality is inherently unitive and procreative. If we encourage sexual relations that violate this basic meaning, we will end up denying something essential about our humanity, about our feminine and masculine nature.

In further discussion, he applies this same reasoning to trans-issues and also tries to make a connection between it and contraception:
A survey of the last few centuries reveals that we have gradually been separating our sexual natures (reality) from our moral decisions. Thus, people tend to think that we can use our bodies sexually in whatever ways we choose without regard to their actual structure and meaning. This is also what lies behind the idea of sex change operations. We can manipulate our bodies to be whatever we want them to be.

If what I just said is true, then this disassociation of morality and sexual reality did not begin with homosexuality. It began long ago. But it took a huge leap forward in the wide spread use of artificial contraceptives. What this use allowed was for people to disassociate procreation and children from sexual activity. So, for people who have grown up only in a time when there is no inherent connection between procreation and sex –- notice not natural but manipulated by humans –- it follows "logically" that sex can mean anything we want it to mean.

Now, the conservative background I came from was Evangelical, and the Evangelicals differ from the Catholics regarding contraception. The standard Evangelical opinion seems to be that using sex (in heterosexual marriage) for the purposes of pleasure and increasing emotional intimacy are also legitimate. This in itself is interesting: it suggest that accepting non-procreative sex does not necessarily lead to acceptance of homosexuality, contrary to Dr. Howell's argument. The difference between Evangelical and Catholic arguments is essential to understand to have meaningful discussions of the matter. Far too often, queer rhetoric makes claims about how "society" values above all else heterosexual, procreative sex in the missionary position. This is simply not true of "society" nor is it true of most Evangelicals. No, it is merely a straw man that makes for nice rhetoric to embolden your supporter in opposing your opponents, but at the same time it alienated your opponents as well as moderates sympathetic to them.

I find the argument based on REALITY quite interesting. While Sexual Reality and How We Dismiss it makes some very interesting points (worth looking at but that I won't be discussing here), I will bring up a few points worth considering. First, the "naturalness" arguments based on "compatibility" of male and female anatomy (which seems to underlie his argument) actually seems to ignore female anatomy and physiology. What exactly are female orgasms for? How about clitorises? Because of the connection of male orgasms to ejaculation, the importance of male orgasms for procreation is clear enough, but what about female orgasms? What's their point? If you want to say that sex is "for" pleasure, you can find a purpose for them, but if sex is "for" procreation, it's much more difficult. Likewise, what are clitorises for? Many females do not orgasm from vaginal stimulation only, but also require clitoral stimulation. How does this part of REALITY fit with "complementary=natural" arguments? Probably not very well. It would be interesting to see how he would deal with intersex people as well. Are they required to be celibate?

Furthermore, the argument that this view of sexuality is based on REALITY makes a fundamental is/ought error. It is though to say that one function of sex is procreation (quite true), therefore that is THE purpose. Yet, if you look at actual sex in the real world, it is clear that sex is used for quite a lot of things: procreation, intimacy, feeling feminine, proving one's virility, asserting dominance, humiliating others, enhancing one's social status, revenge, pleasure, release of sexual tension, exploring one's sexuality, making money... The list goes on. How we you get from "this is what sex is used for" to "this is what sex is for"? It seem to me that the way is via an entirely an after-the-fact justification.

His argument has still more problems: even if we accept that sex if for procreation, why does it follow that this is its only legitimate use? If you believe that "books are for reading" does it then follow that it immoral to use a book as a paperweight? Or that it is immoral to use a box of old journals as a doorstop? (If it is, then I'm guilty of that one!)

Towards the end of his article, he then makes an argument that is rather popular in Catholic Natural Law philosophy:
As a final note, a perceptive reader will have noticed that none of what I have said here or in class depends upon religion. Catholics don't arrive at their moral conclusions based on their religion. They do so based on a thorough understanding of natural reality.

The idea is that their position is one that people should be able to arrive at completely independently of Catholic doctrine, though I am inclined to wonder, if this is the case, why have so few arrived at such a conclusion. Still, it highlights an important (and disturbing) observation I made about argumentation several years ago. Most of the arguments for positions that we think of (and that we think are convincing) are arguments developed after the fact to justify a position that we already hold (for entirely different reasons)--arguments that never persuaded us of anything. And yet we tend to think that they should be persuasive to others.

I still have more to say on this subject, especially regarding the arguments/reasons/positions that eventually led me to change my own views on these matters.

Friday, July 16, 2010

Thoughts on LBGT politics

At the University of Illinois-Champaign Urbana (where I am a student), there has recently been something of a stir regarding the firing of a member of the religion faculty for opinions about homosexuality expressed in an email he sent to his Modern Catholic Thought class.

I wanted to use this opportunity to address something in LGBT rhetoric that has long bothered me. I grew up Evangelical and, while my views have changed considerably, it was a long process, and there was a long time in which I felt my religious views taking me in one direction regarding homosexuality and my conscience taking me in another, and I was trying hard to figure out what to think. One of the major things that made it take so long was standard LGBT arguments--I wanted to be convinced by them, but there were serious objections and questions I had that simply weren't addressed. In retrospect, there were arguments that I think could have convinced me (as my views eventually did change), and I wanted to blog about this both to increase LGBT people and their allies's understanding of more conservative views and to help them to be more persuasive in their arguments.

A Facebook group challenging his dismissal posts the email that prompted this situation. His argument isn't especially novel, but I want to summarize it for the purpose of analysis. I encourage readers to take his argument seriously, rather than quickly dismissing it or being offended by it.

The email was, purportedly, about ethical theory and utilitarianism, and he decided to use homosexuality to "illustrate" his position:
Before looking at the issue of criteria, however, we have to remind ourselves of the ever-present tendency in all of us to judge morality by emotion....Empathy is a noble human quality but right or wrong does not depend on who is doing the action or on how I feel about those people, just as judging an action wrong should not depend on disliking someone.

So, then, by what criterion should we judge whether sexual acts are right or wrong? This is where utilitarianism comes in. Utilitarianism in the popular sense is fundamentally a moral theory that judges right or wrong by its practical outcomes. It is somewhat akin to a cost/benefit analysis....I think it's fair to say that many, maybe most Americans employ some type of utilitarianism in their moral decision making...

One of the most common applications of utilitarianism to sexual morality is the criterion of mutual consent. It is said that any sexual act is okay if the two or more people involved agree. Now no one can (or should) deny that for a sexual act to be moral there must be consent. Certainly, this is one reason why rape is morally wrong. But the question is whether this is enough.

In standard anti-gay fashion, he then brings up two rather popular analogies:
If two men consent to engage in sexual acts, according to utilitarianism, such an act would be morally okay. But notice too that if a ten year old agrees to a sexual act with a 40 year old, such an act would also be moral if even it is illegal under the current law. Notice too that our concern is with morality, not law. So by the consent criterion, we would have to admit certain cases as moral which we presently would not approve of. The case of the 10 and 40 year olds might be excluded by adding a modification like "informed consent." Then as long as both parties agree with sufficient knowledge, the act would be morally okay. A little reflection would show, I think, that "informed consent" might be more difficult to apply in practice than in theory. But another problem would be where to draw the line between moral and immoral acts using only informed consent. For example, if a dog consents to engage in a sexual act with its human master, such an act would also be moral according to the consent criterion. If this impresses you as far-fetched, the point is not whether it might occur but by what criterion we could say that it is wrong. I don't think that it would be wrong according to the consent criterion.


The part where he argues for his own position will be reserved for a later post.

I am going to suspect that few readers of my blog are especially convinced by his argument. In my critique, I do not want to simply tell people who already agree with me how incredibly wrong he is. Rather, I want to give a critique that takes seriously his arguments, finding what genuine insights they have, and on that basis make arguments that may help to allow for more meaningful dialogue rather than simply angry shouting--and, I hope, making more LGBT allies.

A very common response in LGBT politics is to quickly condemn anyone who makes a parallel between homosexuality on the one hand, and adult-child sex or human-nonhuman sex on the other. I don't think this is helpful because, quite frankly, there is an important truth that this argument recognizes. Accepting gay sex as morally okay requires giving up "Because it's a rule, dammit!" and "Ewww!!!!!" as the basis for sexual ethics. I also suspect that there is a universal cross-culturally tendency for some conservatively minded people to have a deep fear that abandoning certain current norms and rules will inevitably lead to an anything-goes antinomianism. This fear seems to be connected to the many anti-gay slipper slopes that are used.

By bringing up adult-child sex and bestiality, there is a profound irony given the professor's initial statement that we shouldn't "judge morality by emotion." The only reason that these reductio ad absurdam arguments might work is if people strongly feel that of course those things are wrong. I think it's safe to say that these views were not the result of long and careful thinking, but a strong emotional attachment to the societal norms they grew up with (many societies have rather different views on both of these). Pedophilia is an incredibly emotion-laden issue in our society around which rational discourse is genuinely difficult. There was a paper published in a highly respected journal in the late 1990's (Rind et al. controvercy) that did a meta-analysis of previous studies and found that in many cases, adult-child sex is not harmful, that it is more likely to be perceived as positive or neutral if the child consented (in the sense of feeling they were a willing participant), and if the child was male. At first, there wasn't much of a response to it, but then someone on the radio talked about it, and then Dr. Laura got a hold of it, and eventually congress passed a resolution condemning the study. If empirical results that don't fit the received wisdom in this area can get condemned by congress, it doesn't exactly encourage people to do research in this area. Yet in the absence of good research and good data, it is impossible to create informed public-policy.

People do not choose to be attracted to children, and this group of people is one of the most hated groups in American society (and likely other societies too.) "Pedophiles" (a very loosely used term to lump together anyone who is attracted to children and anyone who has engaged in sex with a child [except as a peer of the child]) are an utterly abhorred group of people. They grow up being told that they are monsters, that there is no hope for them, and that they to destroy the lives of numerous children. The organization B4U-ACT, a Maryland non-profit organization aiming to promote mutual understanding between "minor-attracted people" and mental health professionals, has a powerful sideshow that I would strongly encourage all readers to take a look at it. The current situation in the US towards sex-offenders is based on intense hatred and irrational prejudice, often ignoring basic questions necessary for good public policy like "Would this work? What side-effects might it have? Is it an effective use of public resources? Are there other more cost-effective ways to achieve the same goals?" Furthermore, because of SVP commitment and sex-offender registration laws, our current position is that the Constitution simply does not apply to sex-offenders. These have only been upheld by the courts on the fiction that they are not punishment. I think the irony, then, of bringing up sex between children and adults--while encouraging basing opinions on "reason" rather than "emotion"--is rather hypocritical. In modern American society, questioning the received wisdom on the matter is utter heresy, as is even suggesting that the reality of the situation may be more complicated than people want to admit. (And neither of these requires approval of sex between children and adults.)

The typical LGBT response, to get offended by the comparison of homosexuality and pedophilia, is harmful in two ways. First, it accepts and contributes to the stigmatization of a much more hated group. Second, it's not convincing to "moderates"--people conflicted on the subject of homosexuality who could be convinced but aren't. By responding to an argument by getting offended (and in this case getting a professor fired), it communicates that there is no good answer to the argument, that the only way to address it is by attacking a straw man, or attacking the most scary anti-gay people out there, as though everyone with traditional views of sexual ethics was just like Fred Phelps.

A major part of much anti-gay rhetoric is to make a big distinction between desire and behavior. Having gay feelings isn't wrong, they say, only acting on gay feelings is. Much of the pro-gay rhetoric tends to collapse these, making it necessary to accept the latter to accept the former. (Interestingly, while pro-gay rhetoric tends to minimize the difference between attraction and behavior, pro-asexual rhetoric emphasizes this difference in our attempt to distance ourselves from celibacy.)

Going back to the issue of pedophilia, many who argue for treating people attracted to children as human beings certainly do not think that doing so will necessitate approving adult-child sex. (Interestingly, some of the most virulent anti-pedophile websites actually do seem to accept this. For instance, the blog absolute zero opposes B4U-ACT claiming that their "real goal" is to make adult-child sex legal. Absolute Zero's logic--if you can call it that--only works on the assumption that not demonizing people attracted to children will necessarily lead to the acceptance of adult-child sex. If this premise is rejected, there is no reason whatsoever to oppose the work of B4U-ACT.)

If the logic "accepting the person requires accept the desired behavior" is not accepted for pedophilia, it does not apply straightforwardly to homosexuality either. Some reason must be given why the logic works in one case but not the other. (Which is not to say that such logic is impossible to give.)

I have a lot more to say on this subject, but hopefully this post will give some food for thought. I imagine that it should prove to be controversial.

Special theme issue of Psychology and Sexuality about asexulaity: Call for Papers

There is going to be an upcoming issue of the new Journal Psychology and Sexuality about asexuality. The call for papers has just been released. For anyone interested in writing something, contact information is given below.

CALL FOR PAPERS
I Do Not Miss What I Do Not Want: Asexual Identities, Asexual Lives
Special theme issue of Psychology and Sexuality

Within the past decade, a growing number of individuals, self-identifying as asexual, have come together to form asexual communities. Although self-definitions vary widely, many of these individuals describe themselves as experiencing little or no sexual desire. In addition, they do not regard asexuality as a pathological condition but, rather, as a variant of human sexual expression. For researchers in the field of psychology and related disciplines, the elaboration of asexual identities and the growth of online asexual communities raise a range of empirical and theoretical questions which have heretofore gone largely unaddressed. This special issue of Psychology & Sexuality invites papers which contribute to the academic and social understanding of asexuality.

We welcome papers from the discipline of psychology and allied disciplines. We also welcome papers from outside the discipline that speak to the field of psychology. Interdisciplinary and multidisciplinary work is most welcome.

Possible topics include though are not limited to:

- Asexual identities
- Asexuality and assumed pathology
- Asexuality and sexual normativity
- Asexuality and love
- Asexual relationships
- Asexuality and the LGBT community
- The universality and/or particularity of sexual desire
- Marginalization of asexuality
- Asexuality and the internet
- Social and political goals of the asexual community

This issue will represent a significant contribution to our understanding of asexuality by bringing together a range of papers on the topic for the first time. It will also provide an opportunity both to map the current state of research on asexuality and to provide a direction for future scholarship and inquiry.

For information about the journal Psychology & Sexuality visit: http://www.tandf.co.uk/journals/journal.asp?issn=1941-9899&linktype=1

If you have questions, please conduct one of the guest editors for the issue:
Mark Carrigan - m.a.carrigan@warwick.ac.uk
Kristina Gupta - kgupta2@emory.edu
Todd G. Morrison - tgm003@mail.usask.ca

Submission Due Date: Feb 2011
Full length papers (6000 words) and shorter articles (1000-2000 words)

Thursday, July 15, 2010

More on sexual dsyfunctions and DSM-5

As I've reported before, the DSM-5 Sexual Dysfunctions Subworkgroup's literature reviews have been published online. They divided them up into male and female disorders with the ones for females published in Archives of Sexual Behavior and the ones for males published in the Journal of Sexual Medicine. All are available for free here except for the one on HSDD in males.

For the male sexual dysfunctions, commentary was published with the original article, except for the one of HSDD, and for the female ones, a number of commentaries were recently published in the Journal of Sexual medicine: Responses to the Proposed DSM-V Changes. Recently, the DSM-5 Sexual Dysfunctions Subworkgroup has published overall responses to the commentary: Response of the DSM-V Sexual Dysfunctions Subworkgroup to Commentaries Published in JSM.

Of the changes, the ones most relevant to the asexual community are those regarding HSDD. The current proposal is to change this diagnosis to Sexual Interest/Arousal Disorder and make separate diagnoses for men and for women. (No indication is given regarding individuals who do not fit neatly into a gender binary.) As of now, there is no published commentary on the proposed male SIAD, but there is some commentary on the proposal for female SIAD.

Here are a number of points/arguments that were made:
The current proposal is to merge HSDD and Sexual Arousal Disorder (in women) into SIAD. Some authors opposed this. Others supported it. One commentary argued that the proposal be taken even further and that desire, arousal, and orgasmic disorders be lumped into a single diagnosis.

One commentary argued that one of the currently proposed criteria should be made necessary for diagnosis: "(5) Desire is not triggered by any sexual/erotic stimulus (e.g., written, verbal, visual, etc.)" One reason they wanted to add this was because of the possibility that lack of arousal could be because of relationship problems, poor partner technique or the like.

Some commentaries raised the question of whether it makes sense to base a diagnosis on distress, and at least one

In response to these, the Sexual Dysfunction Subworkgroup has argued

-They still think that merging HSDD and Sexual Arousal Disorder is a good idea, but also merging Female Orgasmic Disorder is not such a good idea.

-Whether (5) (quoted above) should be required for a diagnosis will be a matter that will be considered and data from the field trials will be relevant in answering it.

-They are planning on adding the phrase "consideration should be given to context" in the diagnostic criteria for both SIAD and Female Orgasmic Disorder.

For those who are interested, I would definitely recommend reading the full articles, which you may be able to downloaded from the above links, or they can be obtained from the authors.

No mention of asexuality was made in any of the commentaries or the response to them.

Tuesday, July 6, 2010

Flibanserin rejected and HSDD questioned

As many readers likely already know, the FDA did not approve Flibanserin.
The efficacy was not sufficiently robust to justify the risks," said Dr. Julia Johnson, the panel's chairwoman and head of obstetrics and gynecology at the University of Massachusetts Medical School. (link)


In a recent editorial in the Psychiatric Times, Ronald Pies, the editor of that publication uses this opportunity to raise a fundamental question: FDA Lacks Desire for Flibanserin—But Does Hypoactive Sexual Desire Disorder Even Exist?
He gives a much-deserved rebuttal to an argument for regarding this as a disorder and why we should be so concerned about it
Dr Sue Goldstein, who oversees clinical trials at the San Diego Sexual Medicine Center, writes that:

“We are the forgotten gender,” she said. “We’ve been told to accept this dysfunction. Do we accept cancer or heart disease?” she said. “Do we or do we not have the right to choose whether we want treatment?”


Comparing reduced sexual desire to heart disease or cancer seems quite a stretch to me.

Then citing a different expert saying that a sexual problem is only a disorder if it causes the person distress, he comments:
what if the woman’s “distress” is related solely or primarily to the expectations of her sexual partner, as in the case of Mrs M? If Mrs M were suddenly marooned on a desert island, without her demanding husband (now there’s a fantasy!), would she experience any sexually-related “distress”? I have argued in several contexts that true disease generally ought to meet 2 criteria: the presence of intrinsic suffering and substantial incapacity. I have used the “desert island test” to distinguish between conditions, such as major depression and schizophrenia; and, for example, antisocial personality disorder (APD).

The first 2 usually meet the desert island test, whereas the third (APD) usually does not (although there are undoubtedly exceptions). For example, the person with severe, melancholic major depressive disorder is likely to experience both intrinsic suffering and incapacity, even on a desert island—despite the absence of interpersonal contact and responsibilities. He or she is still likely to feel guilty, worthless, suicidal, and have difficulty concentrating (for example, on building a raft), difficulty eating, sleeping, etc. All other things being equal, the stranded person with APD is likely to feel just fine, thanks--except perhaps for missing those exhilarating Ponzi schemes. (I acknowledge that these hypotheses require confirmation through actual research, which I suspect would not pass muster with most institutional review boards). By these lights, APD is not usually an instantiation of disease (dis-ease), though I am aware that some “sociopaths” are subjectively distressed and certainly provoke distress in others.

He fully supports providing help for people distressed about sexual problems--clinicians often provide help for people without any disorder, and the DSM has a section in the back called V-Codes which is for conditions that are not disorders but may be the object of clinical attention. (A number of relationship problems are involved.)

His argument raises a fundamental question about what is a disorder. Generally, people feel that it must involve something having gone wrong in the individual (this is necessary to exclude "normal pain") and that the condition causes distress or disability. With distress, there is the fact that all sorts of things can cause distress. (People can be distressed about being too tall or too short, having a nose that is too big or too large, about wanting to be an artist while their parents want them to be a lawyer, etc.) Many feel that something must be inherently distressing for the distress requirement to count. (Migraines and panic attacks, for instance, are generally considered to be inherently distressing.)

What is interesting is that he never even considers the possibility that HSDD could be a disorder because it is inherently impairing. Why this is interesting is that such (rather far fetched) logic was the justification for first including it in the DSM in the first place--it was an impairment in ability to experience the "normative" full human sexual response cycle that was then in vogue. If we reject that lack of interest in sex is a disability and that only inherent distress counts, there is no logical basis for including HSDD in the DSM.

Saturday, July 3, 2010

Further explorations of the landscape of the paraphilias and DSM-5

A few weeks ago, I wrote about some of the background relevant to understand the current controvercies regarding this part of the DSM. In this post, I want to continue on that focusing specifically on events beginning in May 2008 when the American Psychiatric Association (APA) announced the membership of the various workgroups (although some additinoal people were added later. (See here for short biographies of the members of the Sexual and Gender Identity Disorders Workgroup.) The Sexual and Gender Identity Disorders Workgroup is divided into three subworkgroups: The Gender Identity Disorder Subworkgroup, the Paraphilias Subworkgroup, and the Sexual Dysfunctions Subworkgroup.

There was substantial negative reaction on the part of the trans community to the committee's membership, especially regarding the appointment of Kenneth Zucker as the chair of that committee and Ray Blanchard as the chair of the Paraphilias subworkgroup, as they are not necessarily the most popular psychologists among some in the trans community. (See this article as an example of an article unhappy about this appointment.) There was even a petition urging the APA to remove them. The petition was later modified to urge the removal of Martin Kafka (who is currently on the Paraphilias Subworkgroup) on the grounds that he has supported pharmacological treatment for cross dressing. The petition got over 9500 signatures.

The next major controversy regarding the Paraphilias Subworkgroup occured in response to the article Pedophilia, Hebephilia, and the DSM-V by Ray Blanchard, Amy Lykins, Diane Wherrett, Michael Kuban, James Cantor, Thomas Blak, Robert Dickey, and Philip Klassen. The abstract states:
The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory....[The] results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.

There were seven letters to the editor published in Archives of Sexual Behavior in response to this article, which, along with the original article and a response by Blanchard to the seven letters to the editor, were published in the June 2009 issue of that journal. In general, the responses pointed out that the argument "It exists; therefore it is a mental disorder" is missing some crucial steps in the middle. They also pointed out methodological problems with the study (because when you don't like someone's politics, you attack their methodology; that's just how stuff works in scientific areas with potentially significant political consequences.) For those interested in this, the forensic psychologist Karen Franklin has a page on her website about Hebephilia and the DSM-5 Controversy that has a bibliography including some more recent articles on the subject.

There's plenty more to write about regarding controversies surrounding DSM-5, and I'll definitely have more to say about the matter.

Monday, June 14, 2010

Asexuality, HSDD. amd DSM-5: More news

Recently, I've been blogging a fair amount about the DSM-5 and the work of the Paraphilias Subworkgroup, but I haven't spent much time on the Sexual Dysfunctions Subworkgroup--the group whose work originally got me interested in the DSM process.

The main reason for this is that there has simply been less news on that front. Well, now there is some news to report on. Previously, all but one of the reports of the Sexual Dysfunctions Subworkgroup had been published online--the ones for diagnoses for women in Archives of Sexual Behavior and the ones for men in the Journal of Sexual Medicine. The one that hadn't been published was the report on HSDD in men, which has now been published in the Journal of Sexual Medicine, along with commentary from a number of authors. The report on HSDD in men was written by Lori Brotto, who also wrote the report on HSDD in women.

Of particular interest to the asexual community is a section in Brotto's report titled "Is Loss of Sexual Desire in Men Equivalent to Asexuality?"
There has been increasing media and academic interest in asexuality, defined as the lifelong lack of sexual attraction [68,69]. Such individuals will describe limited, if any, sexual encounters, an inability to relate to others who pursue sexual activity, and little to no sexual desire [69–72]. The latter finding has raised concern that, perhaps, asexuality represents the polar low end of the
sexual desire continuum, and therefore, individuals identifying as asexual might better fit within the category of HSDD. There has been strong opposition to this suggestion from the asexuality community on the Asexuality Visibility and Education Network (AVEN; ttp://www.asexuality.org)—the largest online community of asexuals which is involved in education and advocacy efforts. In fact, an AVEN DSM Task Force prepared a 75-page document which included interviews on seven academics with expertise in human sexuality, which concluded that the DSM-5 should explicitly exclude asexual individuals from receiving a diagnosis of HSDD. Part of the rationale stems from the finding that asexuals are not distressed by their lack of sexual interest [72], unlike individuals with HSDD who are usually motivated to seek treatment to restore their low libido. Moreover, the AVEN community views asexuality as an identity, and feel that it is better placed within the different sexual orientations, and not as a sexual dysfunction [70]. Although data are extremely limited on the characteristics of asexual individuals, the available data do support this view of asexuality as not being a sexual dysfunction, and argue that a thorough assessment of the man presenting with low/no desire should be assessed to rule out asexuality.

I'm not entirely sure what "assessed to rule out asexuality" would mean. In practice, it could mean that people could be referred to the asexual community and asked whether they thing identifying as asexual would make more sense for them than being diagnosed with HSDD. The alternative would be that there is some kind of "real asexuality" and the clinician should try to identify whether the individual meets that. This latter possibility troubles me--and is my biggest reason for being wary of an exception clause for asexuals. (Everyone other than me in the "AVEN DSM Taskforce" other than me supported an exception clause for asexual. I withheld judgment on the matter, and I continue to withhold judgment on the matter.)

After I get a chance to digest these documents better, I'll be writing more about them.

Tuesday, June 8, 2010

Exploring the landscape of DSM-5 and the Paraphilias: Background

There has long been a certain amount of discontent with this group of diagnoses--most therapists simply ignore them, they're mostly used by groups who focus on the treatment of sex offenders, and many involved in the treatment of sex offenders ignore these diagnoses finding them useless.

In 2003, there was an issue of Archives of Sexual Behavior on the issue of pedophilia. There was an article by Richard Green arguing that it makes no sense to regard pedophilia as a mental disorder and paper on ethical issues; these were followed by a number of peer commentaries. Green's article can also be found here.

Also in 2003, the American Psychiatric Association had a symposium about the Sexual and Gender Diagnoses of the DSM, the papers from which resulted in this book which is a reprint of these articles appearing in Journal of Psychology and Human Sexuality.

In the introduction to that issue, the authors make a telling statement:
Toward that end, this volume was originally conceptualized as dialogic, with contributors from psychiatry and other mental health disciplines both criticizing and defending the existing DSM diagnoses. However, things did not work out as originally planned. Critics of the DSM abounded, but its defenders were more difficult to enlist. Furthermore, all of the criticism came from non-psychiatric contributors. Non-psychiatric criticism of the DSM is not in itself problematic; the DSM was always intended to represent the up-to-date collective wisdom of all mental health professionals. Consequently, mental health experts who are not psychiatrists have routinely participated in developing earlier editions of the DSM.

However, none of the non-psychiatric contributors who participated in developing the DSM-IV (and who might ostensibly be willing to defend the diagnostic criteria of sexual and gender identity disorders) were willing or able to contribute to this volume. We were, however,fortunate to have two eminent psychiatrists, Paul Fink, MD, and Robert L. Spitzer, MD, provide some brief commentaries on the papers dealing
with Gender Identity Disorder (GID),

One paper, DSM-IV-TR and the Paraphilias: An Argument for Removal, by Charles Moser and Peggy Kleinplatz, as the title suggests, argued that the paraphilias should be removed from the DSM. (A another version is also available.)

The paraphilias are something of an odd collection of sexual interest in activities that are illegal and ones that are legal and essentially harmless. However, arguing for the removal of the paraphilias entail arguing for the removal of pedophilia--an extremely hot button issue. Because of this, they made a rather explicit statement about the matter:
We wish to clarify that our suggestion to remove the paraphilias, which includes pedophilia, from the DSM does not mean that sexual acts with children are not crimes. We would argue that the removal of pedophilia from the DSM would focus attention on the criminal aspect of these acts, and not allow the perpetrators to claim mental illness as a defense or use it to mitigate responsibility for their crimes. Individuals convicted of these crimes should be punished as provided by the laws in the jurisdiction in which the crime occurred. Any interpretation of our work as supporting adult-child sexual interactions is misguided and wrong.

Nevertheless, highly selectively chosen parts of their presentation were leaked to the media and to organiations like NARTH. Fear-mongering and outright deception resulted in alarm that the APA might "normalize" pedophilia. In response to this, APA issues a press-release regarding pedophilia. It opens:
Pedophilia, included in the American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders (DSM) since 1968, continues to be classified as a mental disorder. The DSM is the standard classification of mental disorders used by mental health professionals and provides clear, objective descriptions of mental illnesses, based upon scientific research. Pedophilia is categorized in the DSM-IV-TR as one of several paraphilic mental disorders. The essential features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges, or behaviors that generally involve nonhuman subjects, children, or other nonconsenting adults, or the suffering or humiliation of oneself or one’s partner.

Notably absent from this is the fact that a) it's widely recognized that disorder is a value-laden concept and is not entirely scientific, and b) the scientific foundation for this group of diagnoses is much weaker than for many in the DSM. The press release included a statement from Darrel Regier saying:
“there are no plans or processes set up that would lead to the removal of the Paraphilias from their consideration as legitimate mental disorders.


In fact, in the 2003 symposium, Robert Spitzer, who has a tendency to speak candidly at times, suggested what may be the biggest reason for keeping the paraphilias in the DSM:
What are the consequences if we go the route that Drs. Moser and Kleinplatz suggest and remove the paraphilias from the DSM? First of all, it is not going to happen because it would be a public relations disaster for psychiatry. There was already a little disaster when the initial DSM-IV put in the “clinical significance” criterion that had the effect of requiring distress or impairment before pedophilia could be diagnosed. The APA wisely corrected that in DSM-IV-TR.
(He is referring to the fact that DSM-IV said that pedophilia was only a mental disorder if the person was distressed or impaired because of it. DSM-IV-TR changed that to add that it is also a disorder if the person "has acted on it.")

Moser and Kleinplatz's response was rather bluntly titled: Politics versus Science: An Addendum and Response to Drs. Spitzer and Fink

Thursday, June 3, 2010

DSM-5 Controversy and the Internet

Hanna Decker, a historian of psychiatry, recently wrote a very informative and ballanced account of the controvercy surrounding DSM-5, especially with criticsms repetedly made by Robert Spitzer (chair of the DSM-III Task Force) and Allen Frances (chair of the DSM-IV Task Force): A MOMENT OF CRISIS IN THE HISTORY OF AMERICAN PSYCHIATRY

In her observations at the end of her history, she makes a remark that I certainly found relevant to my blogging efforts:
The role of the Internet in popularizing and spreading the arguments and charges made by Robert Spitzer and Allen Frances cannot be overstated. Without the Internet, the ease and rapidity of their frequent attacks and challenges would have been impossible. It is worth repeating the trite observation that the Internet is the printing press of the 21st century, well adapted to fomenting upheavals.


Allen Frances, has written a rather interesting response in which he reflects on this point.
This leads to an interesting, if unanswerable, corrolary question. Has the internet debate on balance helped or hurt DSM5- or has it had no meaningful effect at all? It is, of course, too early to tell how this very small piece of history will play out. The attention drawn to the DSM5 process has led to some improvements in its methods and a more realistic timetable. But on the larger substantive issues, it is my view that DSM5, despite all the debate, remains stubbornly lost in the wilderness.

Later, he furthers his query about the role of the internet, and his decision to make his criticsms in a public forum, aiming for external pressure, rather than trying to privately influence decisions:
But the long term pluses and minuses of internet vs private influence remain unclear. The internet certainly played a large role in stimulating debate-but the resulting debate has not so far accomplished anything of lasting value. It is an open question whether things might have gone better if there were no public debate and I instead quietly proffered advice to the DSM5 leadership, the Work Group members, and the APA Trustees? In all likelihood, the private approach would not have had any influence whatever (I think all were pretty resistant and, on the down side, DSM 5 might then have gone ahead with the premature field trial). But we will never know.

It certianly gives a blogger room for reflection.

And then, as a good blogger, I left a comment:


While reading Professor Decker's history, I had this considerable urge to go blog about it and your article (which I had not yet read.) After finishing that history, and while reading your article, I couldn't help but note the irony of this impulse. So, being a good blogger, I decided to leave a comment about it.

And now I think I'll go do my blogging :-)

Wednesday, June 2, 2010

More on the petition about Flibanserin

Yesterday, I made a post encouraging people to sign a petition urging the FDA not to approve the drug Flibanserin, developed by Boehringer Ingelheim. I made this post after reading about the petition on Shades of Gray and reading up on it (I had already read a number of things on the matter and posted parts of a few of them here with specifically mentioning this drug.)

Feeling that this is a very important matter--and a matter that is very much relavant to the asexual community--I made a post on AVEN and another version on Apositive. I also copied a version of my blog onto the Asexuality community on LJ.

The responses have been very mixed, and I wanted to respond to a lot of the negative responses and (what I see as) the misunderstandings behind them.

I'll summarize the main arguments against my position:

1) Even though asexuals aren't distressed about not being interested in sex, many people are distressed about it. It's not our place to prevent them from getting help.

2) If the drug works, the FDA should approve it. If it doesn't, they shouldn't. Why should potentially bad consequences (especially bad consequences for a small minority like asexuals) play any role?

3) No one is going to force us to take it, so why should we care?

4) Even if this is a bad idea, why would the FDA even care about this petition?

I'll address these in reverse order.

Even if this is a bad idea, why would the FDA even care about this petition?

On the New View Campaign Website they explain the purpose of the petition:
Please go to Change.org and look for the Low Sexual Desire petition and sign it and circulate it to others. ASAP, please. We will take these petitions to the June 18 Flibanserin hearing.

It seems that the purpose of the petition is to bolster support for their position, giving them more credibility in making their arguments. I don't know how much this petition will help, but I doubt it will hurt.

No one is going to force us to take it, so why should we care?
This objection can take either one of two flavors, and, for those making it, I'm not sure which was intended. One version is a "live and let live" approach. If it's not hurting me and it helps others, great. Why should I prevent that? This version essentially boils down to (1) above (addressed below.) The other flavor this can take is, "It's not my problem, so why should I care?" If that's your position, I probably can't do much to change it.

If it works, the FDA should approve it. If it doesn't, they shouldn't. Why should potentially bad consequences (especially bad consequences for a small minority like asexuals) play any role?

I think that the social effects are a legitimate concern. Essentially, the question should be "Will approving this do more good than harm?" For the possible harm of approving it, cost, side-effects, and social consequences are all legitimate areas of concern.

Neuroskeptic copies a chart about side effects, summarizing it as follows:
100 mg flibanserin nightly caused 14% of patients to drop out due to side effects, vs 7% in the placebo group - so an extra 7% decided it wasn't worth it. It caused dizziness, nausea, fatigue, somnolence - and bizarrely, also insomnia. Notably, 50mg daily was much worse than 100 mg nightly, which suggests that taking this at night, rather than in the morning, is a good idea. But given what it is meant to treat, you'd want to do that anyway, right?


Further troubling facts about this drug have to do with how it's marketed. If you look at the site Sex, Brain, Body (with hard to read text at the bottom saying, "This content was developed with the support of a sponsorship from Boehringer Ingelheim Pharmaceuticals, Inc."), it's clear that they're painting a picture of this "disorder" that fits with what the drug supposedly does. As Dr. Petra explains:
In the past five years we’ve seen some interesting (and worrying) developments in the area of drug development for HSDD. For several years the general view was women’s lack of desire was linked to hormonal deficits (specifically Testosterone) with hormonal patches designed to ‘treat’ the problem. These performed poorly at trial and were not approved by the FDA (although did get approval for use in Europe). A systematic review of all trial data indicated the Intrinsa patch was not effective at dealing with low desire in women.

The focus has now shifted to seeing women’s lack of desire as a neurological problem, with Flibanserin working in a similar way to an antidepressant (indeed it was developed as an antidepressant but was not fit for purpose). The naming of the promotional site as ‘Sex. Brain. Body’ particularly shifts attention towards female desire problems as being psychological, complex and emotional.

Intrinsa was only designed for women who had low desire following surgical menopause, whereas Flibanserin can be taken by any woman diagnosed with low sexual desire. Already we have seen practitioners associated with Boehringer Ingelheim working on Flibanserin also suggesting the contraceptive pill reduces desire which is one market which may benefit from having a pill to boost arousal.


Furthermore, the troubling social consequences of this would not be limited to the asexual community (not remotely). It is largely sex-therapists troubled by the medicaliaztion of sexuality--setting up a universal sexual norm, and ignoring relational, social, and political factors--who are leading the work against this. For an interesting perspective on a related issue, I would suggest an article by Allen Frances: Should Practical Consequences Influence DSM5 Decisions? Yes, Of Course.

Even though asexuals aren't distressed about not being interested in sex, many people are distressed about it. It's not our place to prevent them from getting help.
I am most certainly not opposed to people distressed about lack of interested in sex from getting help. In my history of Hypoactive Sexual Desire Disorder and the Asexual Community (which provides useful historical background for those interested) I explained the position members of the AVEN DSM Taskforce (as we called ourselves) found ourselves in:
[One] big difficulty is that a lot of people to see therapists complaining of low sexual desire. In the US, being diagnosed with something is an important part of getting insurance reimbursement, so simply advocating that the diagnosis be deleted did not seem a viable option. We knew we wanted a more asexual-friendly way of diagnosing low sexual desire, but we weren’t even sure what that would be.

The objection to this drug is largely that it barely does anything positive, but the negatives are considerable.

As before, I feel that this is something that we, in the asexual community, should be very concerned about, which is why I strongly encourage people to sign the petition. I would also encourage other bloggers to read up on it and blog about it.