Sunday, February 21, 2010

Asexuality and the "paraphilias"

Of the proposed changes to the DSM that are now up on, perhaps one of worst is the inclusion of Paraphilic Coercive Disorder. (See this editorial by Allen Frances--biggest bigshot of DSM-IV for info on other problematic suggestions.)

I've written about Paraphilic Coercive Disorder (PCD) before, and readers may wonder what this has to do with asexuality. By delving into some of the history, I think it has quite a bit more to do with asexuality than you might first guess. In this post, I argue that there is a strong historical and ideological connection between the pathologization of asexuality and of the "paraphilias." In my next post in this series, I'll give some of the historical background for making sense of what including PCD in DSM-V would mean and why it is problematic for civil liberties and for effectively working to reduce sexual violence.

First, what are paraphilias? DSM-IV-TR (published in 2000) gives the following definition:
The essential features of a Parapihlia are recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons that occur over a period of at least 6 months. (p. 566)

Included in this category are Fetishism, Sexual Masochism, Sexual Sadism, Pedophilia, Exhibitionism (exposing one's genitals to strangers), Frotteurism (rubbing ones genitals on strangers), and Transvestic Fetishism (no one actually knows, but it has something to do with men cross-dressing).

In DSM-I, the category was called "Sexual Deviation." In DSM-II, the name was changed to "Sexual Deviations." When homosexuality was (sort of) declared not to be a mental disorder in 1973, it had been listed in the "Sexual Deviations." Now, the logic of that decision made very problematic keeping any of the other "Sexual Deviations" in the DSM. (e.g. The Implications of Removing Homosexuality from the DSM as a Mental Disorder by Charles Silverstein.) It also made problematic having the "Sexual Dysufnctions" in there as well. (New York Times, Dec. 23, 1973, p.101). Yet, the development of sex therapy in the 70's caused the DSM-II's classification of sexual dysfunction--it just had two (frigidity and impotence)--to be considerably expanded in DSM-III (published in 1980). According to Spitzer, Williams and Skodol the sexual dysfunctions and the "sexual deviations" (renamed "paraphilias) had the same justification for being included in DSM-III in light of the DSM-III’s definition of mental disorder:
The concepts contained in this definition were helpful in deciding that it was not necessary to require distress before a psychosexual dysfunction, such as Inhibited Sexual Excitement (frigidity, impotence), would be diagnosed. Similarly, it was helpful in deciding that the diagnosis of such Paraphilias (Sexual Deviations in DSM-II) as Fetishism and Exhibitionism also need not require distress. The task force concluded that inability to experience the normative sexual response cycle (as in frigidity or impotence) represented a disability in the important area of sexual functioning, whether or not the individual was distressed by the symptom. The same logic applied to the requirement or preference for inanimate objects (as in Fetishism) or bizarre acts (as in Exhibitionism) for sexual arousal. (p. 153-154, italics original).

Now, this justification only works if the "paraphilic" interest was necessary or prefered for sexual arousal. (The DSM-III's definition of paraphilia said necessary. The definitions for most diagnoses said necessary or preferred, but exhibition and transvestism didn't even require this.)

Now, in DSM-III-R, the "requirement" that the sexual interest be necessary/preferred was changed so that the person only had to have "recurrent intense sexual urges and sexually arousing fantasies," along with a requirement that the person has acted on them or is distressed by them. In DSM-IV (1994), the acted-on-or-distressed requirement was changed to a distressed-or-impaired requirment, which was changed to an acted-on-or-impaired-or-distressed requirement for some of the diagnoses in DSM-IV-TR (2000).

A large part of the reason that the "paraphilias" are in the DSM is because people investigating sex-offenders find that they frequently have these sorts of "deviant" sexual fantasies. So such researchers say "Aha! This man has these sexual fantasies, and he acted on them causing harm to someone. Therefore he must have committed this crime because of his deviant sexuality!"

There are several massive problems with this. First, studies on non-clinical, non-criminal populations reveal that "paraphilic" fantasies are extremely common. (Research on "paraphilias" is pretty much exclusively done on men based on the belief that other than S&M, women don't have "paraphilias.") Studies on men pretty consistently have found that MOST men in whatever sample is used have "paraphilic" sexual fantasies. This means that regarding these fantasies as "deviant" is based on sheer delusion and denial of reality, and it means that having such fantasies is not an especially good explanation for why some people engage in illegal sexual acts and others don't.

Examining the ideology underlying regarding "paraphilias" as deviant demonstrates it to be the same as regarding asexuality as "deviant." In a textbook chapter on the Paraphilias by Gene Abel (a member of the DSM-III-R Paraphilias subcommittee), he chapter says in the first paragraph:
Although sexual behavior plays a role in the preservation of the species, its major function for human beings is to assist in bonding, to express emotion between individuals, and for recreation.(p. 1069)
(See B. Apfelbaum's article onSexual Reality and how we dismiss it for a devastating critique.)

Sometimes in queer and feminist discourses on sexuality, people will caricature our culture's sexual norms as based on a model where only heterosexual married coitus in the missionary position is acceptable. (I've never heard anyone support this despite the multitude of those attacking it.) While a focus on sex being for reproduction seems dominant is those relying on sociobiology/evolutionary psychology for pseudoscientific support for their sexual ideologies, the dominant view of sex in modern times seems to be the one that Abel gives. This seems to be what the DSM relies on. Charles Moser criticizes it as being "straight out of a bad romance novel" and "also pathologizes most of history." (p. 98). Still, this ideology pathologizes sexual interests that fail to conform to this bad-romance-novel based norm, including both asexuality (because we don't fall in love and get super interested in hot, steamy sex) and the "paraphilias" because people are interested (at least in their imaginations) in the "wrong" kind of sex (even if they are interested in the "right" kind as well.)

The inclusion of the "paraphilias" in the DSM has at least two very negative impacts. The first is that is stigmatizes people with kinky sexual interests who only carry out those interests with consenting adults. Second, it reinforces the myth that feminist researches have been fighting against for decades that sexual violence is principally erotically motivated.

Thus, it is clear that there is a historical and ideological connection between the pathologization of asexuality and the "paraphilias." They had the exact same justification for their inclusion in DSM-III, and they both are regarded as "deviant" by a sexual ideology that sees sex as being for love and romance and possibly recreation. (I'm not saying that sex is never about this, only that an inseparable connection between them is problematic.) In my next post in this series, I'll explain some of the historical background necessary for understanding the proposal for including PCD in DSM-V.


SlightlyMetaphysical said...

Not much to say, just that I agree. I was going to write something on asexuality and fetishes, and I'm glad you've covered this medicalising side of it so well. The rise of homosexuality from back when everyone used to think of it as a fetish really questions why we keep these 'disorders'.

ACH said...

A lot of people are wondering this and have been wondering it for quite some time. Hopefully, more people will start questioning it, and start questing it more vocally. If your interested, I would definitely suggest the book "Homosexuality and American Psychiatry: The Politics of Diagnosis." It is very informative.

kristen said...

Whoo boy! Good post, very much my thoughts on the paraphilias category as well. I definitely have a lot of problems with the suggestion of paraphilic coercive disorder as well, so I'm looking forward to your post on that.