Sex and the Psychiatrists

There have always been controversies within and about psychiatry, and certainly when it comes to human sexuality. Freud shocked the Victorians with his assertion that even children had libidos. Researchers and clinicians debated whether homosexuality was indeed a “disorder”, and even after the American Psychiatric Association removed it from the Diagnostic and Statistical Manual in the 1970’s, a small minority persist in labeling it a mental illness and even trying to “cure” it.

Now the controversy has been focusing on the so-called paraphilias, defined in the current Diagnostic and Statistical Manual as:

“recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s sex partner, or 3) children or other nonconsenting persons, that occur over a period of at least 6 months … [which] cause clinically significant distress or impairment in social, occupational, or other areas of functioning.”

Got that?

So, let’s say your “paraphilia” involves a blow-up doll. You have to think about it, or do it, or both, for at least six months. And it has to “cause clinically significant distress or impairment.” Otherwise, it’s not really a paraphilia – it’s just getting it on with an inflatable plastic doll.

Now imagine that you fantasize about a sexy Olympic gymnast, who has never heard of you and probably never will. You can’t get this person out of your head. It’s distracting you no end, so much so that you consider it distressing, even impairing your ability to function. Is that a paraphilia?

Well, if those vagaries don’t bother you, it could get worse. Ray Blanchard, a member of the committee tasked with proposing a revision to this section, has put forward a new definition: "any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting adult human partners." In simple English, if you’re turned on by anything other than consensual sex with a “normal” adult, Blanchard thinks you’re sick.

And before you think I’m jumping the gun, Blanchard and others who share his views have even given paraphilic labels for people who are attracted to large people, older people, and transgender people. Blanchard also stated in a presentation that he believes any "erotic interests that are not focused on copulatory or precopulatory behaviors [read: intercourse], or the equivalent behaviors in same-sex adult partners" ought to be considered paraphilic.

So, oral sex would only be healthy if it led to “copulatory behaviors” or was done by same-sex partners as an “equivalent behavior”?

The logic of this would do the Victorians proud. Sex is for procreation, so any sexual desire or action not contributing to procreation must be “disordered”. Now apply this to food. Since food is for nourishment, any desire or action involving food which does not contribute to nourishment must be an eating disorder. Do you do wine tastings where you spit what you taste into a bucket, never taking in nourishment? Then there must be something wrong with you.

In every other area, psychiatrists and other mental health professionals determine something to be a disorder when it impedes your ability to function. Thousands of people are able to enjoy all sorts of consensual, non-procreative, non-copulatory erotic activities without disrupting their lives or the lives of others. If anything, it is the stigma and shame which our culture still attaches to sexuality of all kinds that is truly debilitating. Perhaps our efforts should be focused on dealing with that “disorder” instead of trying to label the sexually different with questionable diagnoses.