Wednesday, March 31, 2010

New paper: What Asexuality Contributes to the Same-Sex Marriage Discussion

Scherrer, K. S. (2010). What Asexuality Contributes to the Same-Sex Marriage Discussion. Journal of Gay & Lesbian Social Services,, 22, 56-73

Abstract: While same-sex marriage debates have captured public attention, it is but one component of a broader discussion regarding the role of marriage in a changing society. To inform this discussion, I draw on qualitative, Internet survey data from 102 self-identified asexual individuals. I find that asexual relationships are complicated and nuanced in ways that have implications for a lesbian, gay, bisexual, transgendered, and queer (LGBTQ) political agenda, including same-sex marriage recognition. In addition, findings indicate that assumptions of sex and sexuality in relationships are problematic and that present language for describing relationships is limiting. Findings suggest a social justice agenda for marginalized sexualities should be broader in scope than same-sex marriage.

Friday, March 19, 2010

More DSM-V news

Regarding the proposed changes to the Sexual and Gender Identity Disorders for DSM-V, there has been considerable controversy, especially with the Paraphilias and (what is now called) Gender Identity Disorder, although things have been pretty quiet with respect to the Sexual Dysfunctions.

To try to build support for the changes to the paraphilias, two articles have been published:

James Cantor has posted an article called “Depathologize!”: A follow-up in which he argues that while the GID subcommittee is expanding that diagnosis by allowing intersex people to be diagnosed with it (though he prefers the term "Disorders of Sex Development"), the Paraphilias subcommittee is narrowing that category. It is a rather difficult case to make given that the paraphilias subcommittee is proposing two new diagnoses and is proposing changing pedophilia (sexual attraction to prepubescents) to pedohebephilia (sexual attraction to prepubescents and/or children going through puberty.)

Last month, Alice Dreger had an article published called Of Kinks, Crimes, and Kinds: The Paraphilias Proposal for the DSM-5. If you're interested in my take on that, yours truly is the commenter with the University of Illinois email address.

However, there have been some rather substantial attacks as well, most notably from Allen Frances, who has consistently been a powerful critic of the DSM-V process. The title of his most recent article leaves little doubt of where he stands:
DSM5 and Sexual Disorders -- Just Say No

Perhaps it should be no surprise that when it come to trying to define what is "normal" sexuality and how to deal with sexual deviance, especially when there are major civil liberties issues at stake, things have a tendency to get controversial...

Saturday, March 13, 2010

Paraphilic Coercive Disorder: Historical Background

The Paraphilias subworkgroup for DSM-V has suggested adding a disorder called "Paraphilic Coercive Disorder" in DSM-V. Here are the proposed diagnostic criteria:
A. Over a period of at least six months, recurrent, intense sexually arousing fantasies or sexual urges focused on sexual coercion.

B. The person is distressed or impaired by these attractions, or has sought sexual stimulation from forcing sex on three or more nonconsenting persons on separate occasions.

C. The diagnosis of Paraphilic Coercive Disorder is not made if the patient meets criteria for a diagnosis of Sexual Sadism Disorder.

A very similar diagnosis (under the name of "paraphilic rapism" and then "paraphilic coercive disorder) was suggested in the mid 80's to be included in DSM-III-R. There was strong political opposition to it, largely from feminists, which ultimately resulted in this diagnosis being rejected. Many of their concerns are just as valid today as they were then, so it is worth reviewing the matter.

A very good discussion of this history is found in the paper Commentary: Inventing Diagnosis for Civil Commitment of Rapists by Thomas K. Zander, which I will be relying on in this discussion. In the mid 80's the following diagnostic criteria were suggested:
A. Over a period of at least six months, preoccupation with recurrent and intense sexual urges and sexually arousing fantasies involving the act of forcing sexual contact (for example, oral, vaginal, or anal penetration; grabbing a woman’s breast) on a nonconsenting person.
B. It is the coercive nature of the sexual act that is sexually exciting, and not signs of psychological or physical suffering of the victim (as in sexual sadism).
C. The individual repeatedly acts on these urges or is markedly distressed by them.
(Note the use of AND in this version and the OR in the diagnostic criteria proposed for DSM-V.)

There was strong opposition to this diagnosis from a number of groups. Zander writes:
The American Psychological Association, the American Orthopsychiatric Association, the National Association of Social Workers, and the National Organization for Women mounted strong opposition to the proposed diagnoses. Even the U.S. Department of Justice, which rarely takes public policy positions on matters related to mental health, argued that the proposed diagnosis of PCD would be used by criminal defendants to avoid legal responsibility in criminal prosecutions for rape.

In addition to fears about the use of this diagnosis being used to lessen responsibility in rape cases, it promoted an idea of the cause of rape that strongly went against research at the time on the actual reasons for rape.
[B]y the mid 1980s, it was widely accepted that rape is a violent assault motivated by the rapist’s desire for power and dominance rather than by sexual arousal...and he gives an example of "a 1977 study that ranked the rapist’s motivation in accounts from 132 rapists and 92 victims found, '[T]he offenses could be categorized as power rape . . . or anger rape. . . . There were no rapes in which sex was the dominant issue; sexuality was always in the service of other, nonsexual needs.

A third line of objections to it involved scientific problems with it, including issues with validity (is this a real disorder?) and reliability (is it possible to distinguish paraphilic rapists from other rapists? If you get a bunch of clinicians to assess someone, can you get a moderate level of agreement among them on what disorder someone has?) (For discussion, see this and this.)

These issues remain as valid today as they did a quarter of a century ago. And now, in addition to these, there is a fourth major reason that this diagnosis needs to be kept out of DSM-V: the extremely disturbing civil liberties consequences it will have (and already does--many people are already being diagnosed with this under the name "Paraphilia NOS: nonconsent.)