Posted at 22:25 on 6 May 2009 by Pandora / Blake
The DSM, the official diagnostic list of mental disorders for medical practitioners in the US, gets updated every so often. It's about to undergo its fifth major re-write; each revision so far has resulted in the list of recognised mental disorders substantially increasing. Whether this expansion constitutes discovery or invention is an open question.
Obviously there is a need for constant revision and improvement of criteria, especially in areas where new research and knowledge is available. But the overseeing body that writes the manual is the American Psychiatric Association, an academic group who have very little interaction with patients. Practicing psychologists, licensed professional counsellors, and clinical social workers are not directly involved with defining diagnostic criteria.
The suggested revisions to the gender and sexuality section of the DSM are a cause for alarm. They propose hugely expanding the "paraphilia" section to include any sexual interest that is not:
a) an interest in genital stimulation or preparatory fondling;
b) an interest in anyone other than phenotypically normal, consenting adult human partners.
This new language risks classifying anyone who has alternative sex or who is attracted to gender-variant people, disabled people or even fat people as mentally disordered. Julia Serano writes on Feministing:
Blanchard and other like-minded sex researchers have coined words like Gynandromorphophilia (attraction to trans women), Andromimetophilia (attraction to trans men), Abasiophilia (attraction to people who are physically disabled), Acrotomophilia (attraction to amputees), Gerontophilia (attraction to elderly people), Fat Fetishism (attraction to fat people), etc., and have forwarded them in the medical literature to denote the presumed "paraphilic" nature of such attractions. This tendency reinforces the cultural belief that young, thin, able-bodied cisgender women and men are the only legitimate objects of sexual desire, and that you must be mentally disordered in some way if you are attracted to someone who falls outside of this ideal.
The proposed revisions on cross-dressing are quite simply revolting. They classify any transgender or transvestite behaviour as a "fetish", regardless of whether the individual's motivations are sexual. They also set up a sexist double standard whereby "heterosexual males" who experience "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing" are classified as paraphilic.
As Kelly Winters explains:
Curiously, women and gay men are free to wear whatever clothing they chose without a label of mental illness. This criterion serves to enforce a stricter standard of conformity for straight males than women or gay men. Its dual standard not only reflects the social privilege of heterosexual males in American culture, but promotes it. One implication is that biological males who emulate women, with their lower social status, are presumed irrational and mentally disordered, while biological females who emulate males are not. A second implication stereotypically associates femininity and cross-dressing with male homosexuality and serves to punish straight males who transgress this stereotype.
The proposed revisions risk stigmatizing countless sane individuals with erotic tastes outside a strictly-sanctioned norm. They would lend credibility to those who wish to condemn or discriminate people on these grounds. They would also risk adversely affecting people who are happy in their alternative sexuality but seeking treatment for other mental health problems, by giving judgmental medical practitioners authority to mis-diagnose their sexual practices as being the source of the problem. Labelling any form of gender or sexual expression as a "mental disorder" has the potential to be hugely damaging, and ignores the vast spectrum of natural sexual and gender variation that exists in the world.
Some argue that the criteria would only apply if the individual were deeply distressed by their sexual interests, but this is problematic for two reasons. Firstly, someone might only be upset because of the social stigma attached to their fetish; if it were widely understood and accepted they would have no need to fear. Secondly, the wording is vague enough to allow scope for abuse of the criteria by unethical or ignorant practitioners imposing their personal morality on a diagnosis.
This is worrying whether you're in the US or not. If you agree, Feministing has some suggestions about what you can do to help.