Tuesday, December 6, 2011

The presence of absence: Asexuality and the creation of resistance

Hughes, L. (2011). The presence of absence: Asexuality and the creation of resistance, gnovis, 12.
This paper investigates the existence of asexuality or ace identity. The aim of the paper is twofold, to examine the emergence of a seemingly impossible identity and to consider the consequences of an asexual space in a sexual discourse. Since the term ‘asexual’ proves problematic in its dependence on the existence of sexuality, the first half of the paper attempts to renegotiate a definition of asexuality, focusing on the power of the term “ace”. I then explore the work of three exemplary authors, Anne Fausto-Sterling, Lillian Faderman, and Michael Foucault, who prove successful in constructing an alternative discourse to the dominant sexual regime. Using their work, I argue that not only does an asexual space help individuals articulate their existence; it also creates resistance against the dominant power regime. Outside of academia, I argue that technology takes the reins, as the Asexual Visibility and Education Network’s (AVEN) online presence continues to raise awareness and expand the asexual community.

Asexy Pioneer: Asexuality Versus Eroticism in Willa Cather’s O Pioneers!

Erro, N. (2011). Asexy pioneer: Asexuality versus eroticism in Willa Cather’s O Pioneers!, Inquire: Journal of Comparative Literature, 1.

No abstract.

Tuesday, November 1, 2011

Petition about DSM-5

A little over a week ago, the Society For Humanistic Psychology (Division 32 of the American Psychological Association) started a petition regarding DSM-5. It started without any big announcement and has spread largely by word of mouth, email, and a bit of blogging.

Having been put up on October 22, it already has nearly 3000 signatories, mostly mental health professionals. The open letter/petition addresses numerous problems with DSM-5. Some of these are problems that already exist in DSM-IV and are of the "easy to point out, but virtually impossible to fix in our current state of knowledge" variety. Others are particularly bad proposals for DSM-5 which they fear would be worse than the status quo, rather than better. A major part of it concerns turf battles among mental health professionals, and some history is in order here.

In 1977 (in preparation for DSM-III, published in 1980), there was a presentation by Robert Spitzer and Jean Endicott on defining "mental disorder" that defined "medical disorder" and claimed that "mental disorder" was a subset of that. Over the past several decades there had been a number of attacks on psychiatry (collectively these are often called anti-psychiatry) which argued that psychiatry is not a legitimate branch of medicine and that the concept of "mental disorder" is a metaphor at best and an outright lie at worst. Spitzer and Entidott's proposed definition was intended to challenge anti-psychiatric critiques, but it created quite a reaction among psychologists who feared that the American Psychiatric Association was doing turf-warfare, trying to get a bigger slice of the mental-health-funding pie. As a result, the "subset of medical disorders" language was not included in DSM-III and Spitzer had to write an editorial for the APA Monitor to alleviate the fears of concerned psychologists, insisting that the goal was not at all to devalue the work of psychologists or for psychiatrists to try to assert dominance in the mental health field.

Thirty years later, the DSM-5 people are doing a number of things which are setting off similar fears. Yet the fact is that physicians make up a small portion of the mental health professionals who use the DSM. Fears of turf wars remain, and one gets the suspicion that the DSM-5 folk aren't really all that sensitive to the political/guild concerns of those other guilds that use their book.

Interested readers, especially those who are mental health professionals or in related fields, are encouraged to go read the petition and sign it if you agree with it.

Spitzer, R. L. (1981, October). Nonmedical myths and the DSM-III. APA Monitor, pp. 3, 33.

Spitzer, R. L., & Endicott, J. (1978). Medical and mental disorder: Proposed definition and criteria. In R. L. Spitzer & D. F. Klein (Eds.), Critical issues in psychiatric diagnosis (pp. 15-39). New York, NY: Raven Press.

Sunday, October 2, 2011

History of asexuality group

I've recently created a google group for people interested in the history of asexuality. In my own view, the history of asexuality can usefully be divided into three categories. First, the history of asexual communities as "asexuality" is (generally) understood since the establishment of asexual communities in the past decade or so. Second, is cultural history involved leading up to the creation of such communities. Third, there are historical and cross-cultural categorizations similar to asexuality.

While I'm not limiting this group to any one of these, I expect the focus to largely be on the first of these (and a little bit of the second, especially in the years prior to the formation of [online] asexual communities). I've met a number of people participating in asexual communities who've been doing some important work in piecing together bits of the history--generally this has been for blog posts, the AVENwiki, or issues pertaining to the history of AVEN that are relevant to questions about how the site is run. The main purpose of the group is for people who spend time digging into the history, reading through old threads, websites stored in the Wayback Machine, and other sources for piecing together bits of the history.

If anyone wants to join, please email me and let me know so I can add you.

Thursday, September 22, 2011

Asexual scripts: A grounded theory inquiry into the intrapsychic scripts asexuals use to negotiate romantic relationships

Haefner, C. (2011). Asexual scripts: A grounded theory inquiry into the intrapsychic scripts asexuals use to negotiate romantic relationships>Asexual scripts: A grounded theory inquiry into the intrapsychic scripts asexuals use to negotiate romantic relationships. (Unpublished doctoral dissertation). Institute of Transpersonal Psychology, Palo Alto, California.

Abstract: This grounded theory inquiry sought to generate a mid-range theory proposing how asexuals negotiate romantic relationships. Two online surveys were posted on the Asexuality and Visibility Education Network (AVEN) website. Sixty-four participants completed either 1 or both of the surveys for a total of 74 responses. As demonstrated through thick description culled from the data, an important feature of negotiating romantic relationships for the participants in this study was a process called naming. There were 3 areas of naming found in the datAa: Naming the Norm, Naming Asexuality in Relationship, and Naming Asexuality for Self. Though the areas of naming identified in this study represent the internalized meaning of being asexual in a sexualized society, the areas of naming also correspond to the 3 categories of scripting identified by Simon and Gagnon and explained in sexual script theory (SST). The areas of naming suggest that the heteronormative paradigm, with its prescriptive model of what a romantic relationship is and how individuals should engage in romantic relationships, affects asexuals at many levels including experiencing themselves as different from the norm, engaging in or choosing not to engage in romantic relationships, and perceiving themselves as asexual beings.

The author identifies as asexual, and as far as I know, this is the first doctoral dissertation on asexuality. Expect it to be the first of many, as I am aware of several asexuals pursuing doctoral level degrees who are planning on doing their dissertations on asexuality.

Edit: I realized that I had forgotten to include a link, so I have now added one.

Wednesday, September 14, 2011

Asexual Awareness Week 2011 Census

As part of the preparation for Asexual Awareness Week 2011 next month, a census of the asexual community is being held and to goal is to have as many people to fill it out as possible.

This survey is only intended for people who identify as asexual, demisexual, gray-asexual, or any combination of these. If you do not identify as one or more of these, please do not take this survey. This survey is entirely anonymous, but if you are uncomfortable answering any question, please feel free not to answer it.

AAW2011 Asexual Community Census

Saturday, September 10, 2011

The upcoming PT election on AVEN

On AVEN, nominations are currently going on for the new Project Team (PT). Beginning this next term, there are a few important changes:
1) No one can be on PT and be an admod at the same time.
2) Terms are for 2 years, rather than one.
3) There are now four general positions and one position for a specific Research Contact position.
4) When someone steps down, their replacement will be elected to a 2 year term starting from when they were elected (which should help stagger elections so that to avoid the possibility of the whole team getting replaced all at once and thus not having anyone to show them the ropes.)

The requirements for being the Dedicated Research Contact are as follows:
Research is a little different to other PT activities, in that it requires a specialist on the team. Thus, to run for the position of Research Contact, the candidate must be qualified in a field relevant to asexual research. A minimal set of requirements are
(i) to hold or be in the process of obtaining a Masters Level degree or higher in a relevant field,
(ii) a familiarity with the existing research literature on the subject of asexuality,
(iii) a sound grasp of the field of online research ethics.

If anyone is interested in running for either of these positions, the nominations threads are here:

Project Team nominations (general positions)

Dedicated Research Contact nominations

Because of the research issues, I think that joining the PT can be a good way for undergrads and graduate students wanting to get involved in researching asexuality in a few years to get a feel for the field and to make contacts with people researching asexuality.

Friday, September 9, 2011

Asexuality and Mental Health

In honor of national suicide prevention week, I thought that I ought to share the results of some data I recently discovered.

Lucassen, M. F. G., Merry, S. N., Robinson, E. M., Denny, S., Clark, T., Ameratunga, S., & Crengle, S. (2011). Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students. Australian and New Zealand Journal of Psychiatry, 45(5), 376-383.

Their analysis was based a large-scale sampling secondary students in New Zealand. The study required everyone taking it to identify themselves as either male or female (thus preventing analysis for transgender youth), and in the sexual orientation question, people were asked if they were sexually attracted to the opposite sex, the same sex, both, neither, or unsure. Around 2% said neither. (2.4% of those 15 or younger, and 0.7 of those 16 or older, although the population of asexuals is small enough that this still allows for considerable room for random error, especially as the 16 or older group was much smaller overall.)

Anyway, here are some numbers for asexuality and ethnicity (absolute number in the sample followed by percent of total in parentheses.)

NZ European 69 (1.3)
Maori 10 (1.3)
Pacific 531 (3.6)
Asian 768 (4.3)
Other 346 (2.1)

Neither-attracted had comparable levels of depressive symptoms as opposite-sex attracted people, which was considerably less than that of same-sex-attracted, both-sex-attracted, and unsure groups. The neither-attracted group had a rate comparable to (and sometimes lower than) the opposite-sex-attracted people for reported deliberate self-harming behavior, and having seriously thought about attempting suicide, and suicide attempts. Rates for same-sex-attracted, and both-sex-attracted youth was considerably higher. (The "unsure" group sometimes patterned with the heterosexual group and sometimes with the same-sex-attracted and opposite-sex-attracted groups.)

While it is problematic to try to generalize this data to other populations in other countries (although the trends they report on for heterosexual, homosexual, and bisexual groups is similar to what has been found in the US), the data that we do have suggests that asexuals are not at elevated risk for suicide.

Monday, August 29, 2011

Asexual Awareness Week 2011 to include screenings of “(A)sexual” documentary

For Immediate Release

Asexual Awareness Week 2011 to include screenings of “(A)sexual” documentary

August 29, 2011 – Asexual Awareness Week is excited to announce that part of this year’s events will include several screenings of the new documentary “(A)sexual”. The film will be shown in cities around the United States in the month of October. Organizers who would like to bring the film to their city should contact sbb@asexualawarenessweek.com for more information.

A fundraising campaign to pay for the copies of the film, as well as an online advertising campaign, will be announced later this week. The fundraising goal is $1,000. “I know the asexual community can raise this money to secure these screenings of (A)sexual and the online advertising campaign,” said Sara Beth Brooks, who is helping organize the screenings. “Angela Tucker and Arts Engine are great allies. We are working together to make sure that this film is used as a resource to promote awareness of the asexual community in as many cities as possible.”

Cities that have already confirmed screenings include Las Vegas, NV, and Bloomington, IN. More cities will be announced as they are added.

Other projects that will be happening during this year’s Asexual Awareness Week include a demographic survey called the “Asexy Census,” a series of guest blogs, a small online advertising campaign, and a website. The committee has also drafted open letters to academic researchers and the LGBT community which will come into circulation soon. The website is expected to launch within the next week and will be at www.asexualawarenessweek.com.

Asexual Awareness Week is an international grassroots project to promote awareness about the asexual community across the globe.

Tuesday, August 16, 2011

Three new articles on asexuality

The most recent issues of the journal Sexualities has three articles on asexuality.

Przybylo, E. (2011) Crisis and safety: The asexual in sexusociety. Sexualities, 14, 444-461.

Abstract: This article provides a discussion of the implications that asexuality, as an identity category emerging in the West, carries for sexuality. Asexuality provides an exciting forum for revisiting questions of sexual normativity and examining those sex acts which are cemented to appear ‘natural’ through repetition, in the discursive system of sexusociety. Drawing especially on feminist and postmodern theories, I situate asexuality as both a product of and reaction against our sexusocial, disoriented postmodern here and now. This article also addresses the question of whether or not, and on what terms, asexuality may be considered a resistance against sexusociety.

Carrigan, M. (2011)There’s more to life than sex? Difference and commonality within the asexual community. Sexualities, 14, 462-478.

Abstract: Asexuality is becoming ever more widely known and yet it has received relatively little attention from within sociology. Research in the area poses particular challenges because of the relatively recent emergence of the asexual community, as well as the expanding array of terms and concepts through which asexuals articulate their differences and affirm their commonalities. This article presents the initial findings of a mixed-methods research project, which involved semi-structured interviews, online questionnaires and a thematic analysis of online materials produced by members of the asexual community. The aim was to understand self-identified asexuals in their own terms so as to gain understanding of the lived experience of asexuals, as well as offering a subjectively adequate grounding for future research in the area.

Kim, E-J. (2011). Asexuality in disability narratives, Sexualities, 14, 479-493.

Abstract: This essay explores normative regulations of disabled people’s sexuality and its relationship with asexuality through narratives of disabled individuals. While asexuality has been persistently criticized as a damaging myth imposed on disabled people, individuals with disabilities who do not identify as sexual highlight the inseparable intersection between normality and sexuality. Disabled and asexual identity and its narratives reveal that asexuality is an embodiment neither to be eliminated, nor to be cured, and is a way of living that may or may not change. Claims for the sexual rights of desexualized minority groups mistakenly target asexuality and endorse a universal and persistent presence of sexual desire. The structurally and socially enforced asexuality and desexualization are distinguished from an asexual embodiment and perspective disidentifying oneself from sexuality.

Sunday, June 19, 2011

Asexual History graphic

There's a recent thread on AVEN called A history of asexuality, by an AVENite who's been doing a lot of research in this area. They made a pretty cool timeline about asexuality that I thought readers might be interested in:

Saturday, June 4, 2011

Radical refusals: On the anarchist politics of women choosing asexuality

So, I knew that it was just a matter of time. Until recently, all academic articles about asexuality had been supportive of us. It's not so much that all academics in any field at all are supportive, or even that all who have learned something about asexuality are. I believe that the main factor in this is that those who aren't are too dismissive to care enough to publish on the matter.

Still, I had expected when the dismissive/hostile finally did take notice and respond in the academic literature, it would be an proponent of pathologization, the sort of person function as the designated hater in media articles. Instead, it has come from radical feminism.

Fahs, B. (2010). Radical refusals: On the anarchist politics of women choosing asexuality. Sexualities, 13, 445-461.

This article examines how women consciously choosing asexuality might inform both radical feminist politics and anarchic concepts of positive and negative liberty. By resituating some of the lesser-known narratives of the 1960s’ and 1970s’ radical feminist movement (e.g. Valerie Solanas’ SCUM Manifesto and Boston’s Cell 16 and No More Fun and Games), asexuality is shown to disrupt key intersections between sexuality and the state, particularly institutions that control reproduction, pleasure, and women’s bodies. Using interview data with Cell 16 members, content analysis of early radical feminist writings, and theoretical and historical analyses of separatism, the piece argues that, by removing themselves from sexuality, women can take a more anarchic stance against the entire institution of sex, thereby working toward more nihilistic, anti-reproduction, anti-family goals that severely disrupt commonly held assumptions about sex, gender, and power.

Up to this point, when I have announced articles, I've decided to that I should keep my opinions to myself regarding what I thought of the article. This one has convinced me not to do that anymore, largely because I feel that it needs to go in my bibliography, but also needs a comment/warning.

When I first saw this article some months ago, I saw the abstract and figured it wasn't relevant to us. But later, it was suggested on the Asexual Studies listserv and I also talked to someone who felt it should go in my bibliography, so I decided to read it.

From seeing the title and reading the abstract, it was clear that "asexual" is being used to mean celibate and not how we understand it. I assumed that this was because this is how the term is used in the literature she discusses. As it turns out, this appears to be wrong. Fahs distinguishes between "asexuality" (meaning permanent celibacy) and "celibacy" (meaning temporary celibacy). This distinction is not made in any of the quotes that she gives from the literature she discusses. Indeed, there, they just use "celibacy" to mean "celibacy" so probably Fahs just made up the distinction in order to use the word "asexuality."

In the paper, Part I is "Sex and Pleasure as Freedom" and Part II is "Remembering Radical Histories." I don't know that much about radical feminism from the 60s, and some of the stuff in the paper was interesting, but I felt that the asexuality/celibacy distinction imposed onto the texts was utterly forced. Basically, the texts talked about celibacy and Fahs tries to force "asexuality" onto them.

Then in Part III (Asexuality as a political identity and strategy of reform), the paper begins to completely and totally suck through "misreadings" so awful that I suspect to them be deliberate falsifications. This falsification is used in order to critisize asexual identity in order to promote her agenda. That agenda can be seen in the beginning of that section:
When examining asexuality and separatism, their political use differs greatly from their implications for pathology, identity, and sexual classification. Most existing research on asexuality, for example, asks questions that have relatively little social and political significance. For example, some studies address prevalence rates, with most research reporting that between 1 and 6 per cent of the American population describe themselves as asexual, with numbers rising consistently during the past five years (Bogaert, 2006; CNN, 2004).

Now, almost everything she says later about the "social and political significance" of asexuality is based on the definition that she herself invented at the beginning of the paper. Taking a careful look at this passage however, the utter disregard for getting the facts right is staggering. The 1% figure came from Bogaert's 2004 paper; it relied a British sample--not an American one--and it operationalized things in terms of lack of sexual attraction, not asexual self-identification. Furthermore, "asexuality" only can have anything to do with separatism (in the sense Fahs discussed about) if we mean it in her sense of "permanent celibacy" which is NOT the meaning these others are using, as so citing them as such is simply dishonest. There is nothing in the things she cited to say anything about numbers rising in the past five years. The 6% percent figure was a CNN poll which probably got linked to on AVEN, which is why the number is so high, so no one seriously thinks this should be taken as an estimate of prevalence.

What I believe is going on in this paper is that Fahs is aiming to exploit the visibility and currency that "asexuality" has gained in the literature (i.e. Bogaert, Prause & Graham, and Scherrer's work) and through the visibility and education work of the asexual community and then to use this to in order to advance her own ideological agenda, which is accomplished largely through equivocation, misrepresentation of others, and possibly even outright lying. If she had just said "celibacy" (which is what she is talking about and is the term used in the radical feminist literature cited in Part II), the paper wouldn't have had a Part III. So instead she created a new meaning for "asexuality" (that I've never seen anyone else use before) and then force it onto how others use the term.

This paper is academic dishonesty plain and simple. It should never have been published.

Edit: On doing a little more research, it seems that this article was discussed on AVEN last fall around the time that it came out. Not surprisingly, people didn't like it much.

Wednesday, May 11, 2011

Hypersexual Disorder

One proposed addition to DSM-5 has been Hypersexual Disorder. Formerly, it was being proposed by the Paraphilias Subworkgroup for inclusion as a new disorder, and they have now retreated from that somewhat, and the Sexual Dysfunctions Subworkgroup is now considering including it in the appendix. (All this was made public with the recent revamp of the dsm5.org site).

On this subject, there was a recent article on asexualnews.com titled Asexuals should worry about the inclusion of hyperactive sexual desire disorder.

I wrote a follow-up to this (also on asexualnews.com): Hypersexuality in the DSM: A threat to constitutional rights and copy-pasted it in the feedback section on the dsm5.org site.

Interested readers are encouraged to go check these articles out!

Tuesday, May 10, 2011

New Paper: Theoretical Issues in the Study of Asexuality

Chasin, CJ DeLuzio. (in press). Theoretical issues in the study of asexuality. Archives of Sexual Behavior. DOI: 10.1007/s10508-011-9757-x

Abstract: Academic interest in asexual people is new and researchers are beginning to discuss how to proceed methodologically and conceptually with the study of asexuality. This article explores several of the theoretical issues related to the study of asexuality. Researchers have tended to treat asexuality either as a distinct sexual orientation or as a lack of sexual orientation. Difficulties arise when asexual participants are inconsistent in their self-identification as asexual. Distinguishing between sexual and romantic attraction resolves this confusion, while simultaneously calling into question conceptualizations of the asexual population as a single homogenous group. Arguments are considered in favor of exploring diversity within the asexual population, particularly with respect to gender and romantic orientation, proposing that the categorical constructs employed in (a)sexuality research be replaced with continuous ones. Furthermore, given the recently noted bias toward including only self-identified asexuals, as opposed to non-self-identified asexuals or “potential-asexuals,” in research about asexuality, the nature and meaning of asexual self-identification are discussed. Particular attention is paid to the theoretical importance of acknowledging asexual self-identification or lack thereof in future research into asexuality. This article discusses what these current theoretical issues mean for the study of asexuality and sexuality more generally, including a brief consideration of ethical implications for research with asexual participants. Finally, directions for future research are suggested.

Wednesday, May 4, 2011

DSM-5 site greatly updated

The site dsm5.org has just been greatly updated, and can be found here: http://www.dsm5.org/Pages/Default.aspx (For some reason, just entering dsm5.org gets you a page that says it's under construction).

Anyway, we find some interesting changes: The sexual dysfunction, paraphilias, and gender dysphoria are in three different sections (rather than subsections of Sexual and Gender Identity Disorders.) It seems that rather than changing "Gender Identity Disorder" to "Gender Incongruence" they're planning on changing it to "Gender Dysphoria." (I think this is a very positive change because it makes the disorder based on distress, not on gender identity.)

They're now thinking about putting Paraphilic Coercive Disorder in the appendix, and it seems that the diagnostic criteria for Exhibitionism is now a weird blend of DSM-III and DSM-III-R language, putting the emphasis on the behavior (as in DSM-III), rather than the sexual desire (as in DSM-III-R). Similar things seem to be done for some other paraphilias.

They're now proposing to add Hypersexual Disorder to the sexual dysfunctions rather than the paraphilias. (I'm very curious to find out what the sexual dysfunctions subworkgroup thinks about this idea.)

Something that had already been said on the website (but they never announced it) is that they're proposing to have HSDD for men, and SIAD for women.

Thursday, March 31, 2011

Asexual Studies CFP reminder

I've posted about this before, but it was a long time ago, and I wanted to remind people about it.

[quote]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[/quote]

And while I'm on the subject of reminders, AVEN recently created a new set of procedures for people wanting to use AVEN for research purposes, and if you're in joining the growing group of people involved in the emerging area of asexual studies, there is an asexual studies mailing list that I would highly recommend joining.

Friday, March 11, 2011


I finally gave in and made a twitter account. Everyone else was doing it, and it's supposed to be a useful way to engage in shameless self-promotion.

Erm, I mean, Follow me on Twitter!

Sunday, February 27, 2011

Get involved with Asexual Awareness Week

Sarah Beth Brooks has started a thread on AVEN about starting the planning for Asexual Awareness Week. Last year's proved quite successful, and I think we can expect even bigger and better things for this years'.

If anyone is interested in helping out with it this year, head on over to AVEN and watch the video.

Saturday, February 26, 2011

Grandfathering in diagnoses

As people following the DSM-5 process know, both Robert Spitzer, chair of the DSM-III and DSM-III-R Task Forces, and Allen Frances, chair of the DSM-IV Task Force, have made severe criticisms of the DSM-5 process. Dr. Frances has since become very active, having a blog on the Psychiatric Times, which is also posted in Psychology Today. (DSM5 in Distress).

Responding to some of his criticisms, this years' first issue of the Bulletin of the Association for the Advancement of Philosophy and Psychiatry contained a number of authors' responses to these. The issue concluded with a brilliant and provocative piece by Dr. Frances, DSM in Philosophyland: Curiouser and Curiouser.

This article then served as the basis for this year's second issue, along with 22 responses, a response from Dr. Frances' to each, and some authors responding to his response. The whole thing is fascinating reading, if somewhat long.

One of the issues in this debate is whether to take a more conservative or a more innovative approach to change (i.e. how high of a threshold of support do we require for making changes?) Dr. Frances argues for a more conservative approach. When his arguments are applied to main disorders that mental health professionals deal with, I find his argument convincing. However, it has a serious problem that I felt hadn't been adequately addressed, and I emailed Dr. Frances about this issue. Resulting from this has been a dialog on issues very relevant to both HSDD and the paraphilias (the two parts of the DSM my own work has focused on.)

In A Conservative Approach to Diagnosis Grandfathers in Weak Links frames the issue by quoting my email:

A DSM critic, Andrew Hinderliter sent this perceptive email questioning the wisdom of the most fundamental decision we made in preparing DSM IV-- ie, our goal of keeping the system stable.

A problem with your conservative approach to psychiatric nosology is that it grandfathers in the good and the bad alike and provides no way of changing really bad parts of the system. Unquestionably, there are things in DSM that couldn't pass a risk-benefit analysis (the Paraphilia section is one example). In a previous email to me, you gave the following explanation for its continued presence in DSM-IV: "I think they are there only because of history and inertia, but these are powerful forces.' Quite possibly, the single most powerful force of diagnostic inertia in psychiatric nosology in the past half century was the strongly conservative approach to diagnostic change that you yourself chose to implement in DSM-IV. A conservative approach to diagnostic change has much to be said for it, but in all the arguments back and forth about it, I feel like there is an elephant in the room regarding the much-harder-to-justify diagnoses. I have no doubt that you've thought about this before, but I was just curious as to your thoughts on the matter.

Dr. Frances then discusses the issue, followed by a response from myself, and then a response from him. It's not a very heated debate, and his assessment (which I think is correct) is that:
Mr Hinderliter and I have no conceptual disagreement. We do, however, weigh differently the risks of diagnostic stability versus vigorous pruning.

Following up on this, is a second article in which Charles Moser, a long time advocate for sexual minorities and an internist committed to evidence based medicine, responded to the first article, and suggests a means for Solving The Problem Of Questionable Diagnoses Grandfathered Into DSM.

Moser writes:

Psychiatry, the APA, and the DSM editors should be dedicated to straightforward presentation of the facts (or lack thereof), exploring the problems with these diagnoses while adhering to the highest level of accuracy and completeness in reporting the data on which these decisions are made. Unfortunately, the DSM editors have not acknowledged any of the problems inherent in listing these grandfathered diagnoses in the DSM. Instead they keep suggesting that the DSM is a scientific document supported by an extensive empirical foundation. In fact, for some diagnoses (eg, the Paraphilias) there is minimal science to support inclusion, some studies refuting that they are even mental disorders, and serious risks attached to misuse.

All diagnoses should be subjected to a risk/benefit analysis and ideally the risk/benefit to the “patient” should take precedence over the risk/benefit to Psychiatry. For many of these grandfathered diagnoses, there is no clear benefit and many people so labeled have been harmed. The APA and the DSM editors should not need to be reminded that a guiding principle of all Medicine is “First, do no harm.” Ethically, the editors should explain the benefit and announce plans to limit the harm, or just remove these diagnoses. At the very least, the DSM editors need to minimize the potential harm from these diagnoses by acknowledging their problems and limitations.

There is a middle ground between continuing the status quo and complete removal. The DSM editors could acknowledge clearly which diagnoses do not meet the stringent criteria, either by creating and applying objective criteria or by creating a level of evidence system similar to those used evaluate medical interventions (for example, see http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm). Alternatively, they could drop the pretense that the DSM is a scientific document based on an extensive empirical foundation.

Dr. Frances' response is, to sum up:
Dr Moser offers an excellent idea, although one that has little chance of being accepted in the current climate and would be difficult to implement even under the best of circumstances...There are problems large and small. The immediate block to the implementation of Dr Moser's suggestion is the reluctance of the DSM-5 to allow open and independent review of any aspect of its work....Dr Moser's suggestion will likely fall on deaf ears and would be tough to accomplish-- but it is clearly the right way to go.

Recently, James Phillips has written a follow up: Solving The Problem Of Questionable Diagnoses Grandfathered Into DSM.

This post is already too long, so I'll have to continue my thoughts on the matter at another time. I encourage readers to go and read these! (If you can't read stuff on the Psychiatric Times page and don't want to sign up, you can read everything but Dr. Phillips' piece on via the Psychology Today link above.)

A new blog for my new bibliography

Yesterday, I announced a bibliography about DSM-5 and the paraphilias that I've put together on my webpage. As this is intended to be as comprehensive as possible, on a subject in which publication are continually coming out (in much greater numbers than publications regarding asexuality), I've made a new blog for updates to that bibliography: DSM-5 and the Paraphilias.

Thursday, February 24, 2011

Bibliography on DSM-5 and the paraphilias

On my webpage, I have assembled a fairly comprehensive bibliography regarding the upcoming DSM-5 and the paraphilias.

The time frame for the documents is 2008-present, mostly dealing with the proposals of the DSM-5 Paraphilias Subworkgroup, responses to these, responses to responses, etc. The organization is somewhat chronological and somewhat topical.

[url=http://www.asexualexplorations.net/home/paraphilia_bibliography]Bibliography on DSM-5 and the paraphilias[/url].

Sunday, February 6, 2011

New Paper: New Orientations: Asexuality and Its Implications for Theory and Practice

Cerankowski, K. J. & Milks, M. New Orientations: Asexuality and Its Implications for Theory and Practice, Feminist Studies, 36, 650-664.

It seems that articles in this particular journal don't have abstracts, but there is a (publicly accessible) description of it in preface to the issue:
In heir ambitious commentary, “New Orientations: Asexuality and Its Implications for Theory and Practice,” Karli June Cerankowski and Megan Milks make the case that “asexuality”–the inability or unwillingness to experience sexual desire–needs a place in scholarly inquiry and radical politics. The small but growing international community of people who identify as asexuals has recently gained media attention; it projects varying visions of asexuality as a conscious decision or as an innate condition. Cerankowski and Milks strive to go beyond important efforts in social psychology to de-pathologize asexuality, suggesting that serious engagement
with asexuals and asexuality will transform both feminist and queer studies

Monday, January 10, 2011

Sex, Lies, and Pharmaceuticals

Ily has written a number of book reviews in the past, but I think that this is my first one ever. So, here goes...

Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (2010) by Ray Moynihan and Barbara Mintzes.

For a book titled Sex, Lies, and Pharmaceuticals, I was surprised at how well balanced this book is. The authors track the creation of the category "Female Sexual Dysfunction" (FSD) by Big Pharma in the 90s, and the many subtle ways that Pharma's generous financial support of research, conferences, and the "education" of doctors blurs the lines between science and marketing in very disturbing ways.

The picture that is painted is troubling, but is not a picture of science being bought and paid for by Pharma or a picture that ignores the real sexual problems that some people have. The complexities of the situation and the admirable motives that often lead researchers to work with Big Pharma are acknowledged. It's not that getting industry money automatically makes someone their puppet, but people with views that Big Pharma likes have access to a lot of money, thereby getting their voices amplified. Money for sex research is very limited, and industry money has enabled a lot of research to happen that couldn't have otherwise. Some people's labs couldn't exist without industry money. Close collaboration with industry offers to the promise of making "sexual medicine" a legitimate branch of medicine, a very desirable prospect given the way that sexology has long been a marginal branch of academia. Dissatisfaction with the efficacy of talk-therapy leads people to want medical solutions to (at least some of the) problems that people present with when seeking clinical help for sexual problems.

Yet Pharma's financial influence tends to lead to surveys that focus on the kinds of problems that drugs could potentially be solutions for, and tend to ignore problems where they wouldn't. There is a tendency toward biological reductionism that ignores the social and relationship factors of sexuality. Advertising campaigns reinforce insecurities and dissatisfaction. The benefits of drugs are exaggerated and side-effects swept under the rug.

There is a curious fact of history that the book doesn't get into as its effects are yet to be seen: at the same time that Big Pharma is trying to sell FSD and create distress and insecurity around lack of interest in sex, there is a growing community on the internet identifying as asexual, and they're asserting that there's nothing wrong with not being interested in sex, and they're getting themselves plugged into the LGBT community and working with people's beliefs about sexual orientation and sexual diversity to promote their own visibility and acceptance. In the Prause and Graham's 2007 paper about asexuality, they sum it up nicely:
Implicit in the debate about what constitutes a “normal” level of sexual desire is an assumption that some level of sexual desire is normative.
Asexuality draws this assumption into question. The affirmation by the asexual community that it's OK to not be interested in sex is fated for collision with the ongoing debates about female sexual function/dysfunction that have been prominent in sexology for the past decade or so, and probably most of the papers on asexuality so far have at least made mention of some relationship between asexuality and HSDD, often noting that asexuality may challenge some common assumptions.

Right now, some people up at UBC are among the leaders in the study of asexuality; they are some of the very same people very much involved in ongoing debates about FSD. Recall that the study that I just linked to a few days ago (by UBC folk) is about differentiating asexuality from HSDD.

I see asexuality as coming to play an increasing role in these ongoing debates. So far, only people favorably disposed towards us have even cared enough to take us seriously, but I wonder how long this will last. Given my own position in the asexual community (and my interest in the relationship between asexuality and HSDD), it seems inevitable that I will play a role in the coming controversies.

Reading this book made me very circumspect about what the role of the asexual community--and myself in particular--will be as what I see as an inevitable debate arises. For anyone interested in the future asexual politics, especially regarding medical diagnosis, this book is a must read. It's not that long, and is a very engrossing read. I highly recommend it.

Friday, January 7, 2011

Defining Paraphilia in DSM-5: Do not disregard grammar

In the ongoing DSM-5 paraphilia controvercy, I now have another publication.

Defining Paraphilia in DSM-5: Do Not Disregard Grammar published in the Journal of Sex and Marital Therapy.

Blanchard (2009a, 2009b, 2009c) proposed a definition of paraphilia for Diagnostic and Statistical Manual (DSM)-5, delimiting a range of so-called normative sexuality and defining paraphilia as any intense and persistent sexual interest other than that. The author examines the wording and intended meaning of this definition, and he argues that there are many problems with it that “correct” interpretation requires ignoring what it says. Because of these problems and the possibility of civil commitment under sexually violent predator/person laws on the basis of a diagnosis of paraphilia NOS, caution and careful consideration of grammar and wording is urged in drafting a definition for paraphilia for DSM-5.

As many will recall, another one of my publications also had "defining paraphila" in the title. This is because these two papers were originally a single paper divided into two. The first part became "Defining Paraphilia in DSM-5: Do not disregard grammar" and argues that the particular definition of "paraphilia" proposed is unworkable. The second part became Defining paraphilia: Excluding exclusion and argued that any "definition by exclusion" would be incompatible with the DSM's definition of mental disorder and the logic behind the declassification of homosexuality. However, the "second paper" was published in an open access journal, and so was published before the "first paper."

For anyone who can't get a copy of this paper but would like to read it, just send me an email requesting a copy.

Tuesday, January 4, 2011

Recruiting participants

The folks at UBC are currently conducting another study on asexuality and would like participants.

Online Study of Low Sexual Desire

This study will help researchers understand the difference(s) between asexuality and hypoactive sexual desire disorder (HSDD). In this study, we will employ a series of questionnaires asking about physical health, mental health and sexuality.

We hope that the data from this study will help to further our understanding the difference(s) between asexuality and HSDD, and impact the greater community to decrease stigma associated with asexuality, while better understanding who would benefit from treatment for low sexual desire.

If you are at least 19 years of age, and identify as either asexual, heterosexual, bisexual, or homosexual, please participate in this important research, which will take approximately 20-30 minutes to complete, and is described in more detail in the following consent form.