Abstract
The move from “paraphilias” to “paraphilic disorders,” where only the latter constitute mental disorders, has been hailed as a major change to the conception of non-normative sexualities in DSM-5. However, this is a claim that has been criticized by numerous activists and doctors working for removal of all diagnoses of so-called sexual disorders from the APA’s manual. This article, written from a critical humanities, queer theory-inflected perspective, examines the historical and ideological grounds underlying the inclusion of the newly branded “paraphilic disorders” in DSM-5. It argues that the diagnosis does nothing to overturn the conservative and utilitarian view of sexuality as genitally oriented and for reproduction that has colored sexological and psychiatric history. It suggests that despite homosexuality no longer being classed as a disorder, an implicit heteronormativity continues to define psychiatric perceptions of sexuality. In sum, this article proposes that (1) the production of the field of psychiatric knowledge concerning “perversion”/“sexual deviation”/“paraphilia”/“paraphilic disorder” is more ideological than properly scientific; (2) the “normophilic” bias of the DSM is a bias in favor of heteronormativity and reproduction; and (3) some sexual practices are valued above others, regardless of claims that the presence of a paraphilic practice itself is no longer a criterion for a diagnosis of mental disorder.
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Notes
Franke (2001) asks: “Why is it that we are willing to acknowledge that heteronormative cultural preferences play a significant role in sexual orientation and selection of sexual partners, while at the same time refusing to treat repronormative forces as warranting similar theoretical attention?” (p. 184).
Edelman (2004) writes that “reproductive futurism” is a “compulsory narrative” (p. 21) in which “the biological fact of heterosexual procreation bestows the imprimatur of meaning-production on heterogenital relations” (p. 13).
Lacan (1977) is perhaps best associated with this view of desire. Despite the conservatism of many of his adherents, the spirit of his discourse is a rejection of “the delusional ‘normality’ of the genital relation” (p. 245). (For a discussion of the inherent queerness of the Lacanian psychoanalytic model of desire, see Dean, 2000).
“SM” and “BDSM” are used interchangeably in this article. The former refers to “sadomasochism,” while the longer compound acronym denotes the activities and identities involved in the following: Bondage and Discipline; Dominance and Submission; Sadism and Masochism.
As a backdrop to this framing of DSM-5’s understanding of paraphilia/paraphilic disorder, one cannot ignore the fact that Blanchard was a controversial choice to head the work group, both for some clinicians and for some trans activists. Blanchard’s theory that MtF “transsexualism” is a form either of heterosexuality, which he named “autogynephilia” (sexual arousal at the thought of oneself as a woman), or of displaced homosexuality, rather than an issue of gender identity, has a number of opponents from various fields and political standpoints (e.g., Moser, 2008; Serano, 2010), as well as a mixed demographic of staunch defenders, including both self-defined “autogynephilic transsexuals” (e.g., Lawrence, 2013) and clinicians (e.g., Bailey, 2003). The publication of Bailey’s book The Man Who Would be Queen brought considerable public attention to the diagnosis but also drew criticism from trans activists and from some psychiatrists (e.g., Bancroft) (cited in Dreger, 2008, p. 391). Dreger (2008) wrote a long account in Archives of Sexual Behavior of the complex reaction to Bailey’s book, which, in turn, has faced criticism from a number of clinicians (e.g., Nichols, 2008). A key objection to autogynephilia is that, while some individuals doubtless experience and report the phenomenology associated with it, it is a very bold logical—and ideological—leap to conflate all MtF trans identity with a paraphilia (autogynephilia) or a sexual orientation (homosexuality), and to assume that trans women are (deluded) men. It fails to respect many trans women’s descriptions of their own experiences and identities. My own view is that the heteronormativity and repronormativity which I identify in DSM-5’s “paraphilic disorder” diagnosis are wholly in keeping with an institutional worldview in which trans men and women are not seen as “real” men and women, the latter still being defined primarily, if implicitly, by reproductive capacity.
Fedoroff (2011) rightly points out that this does not clearly distinguish between those who are aroused by being asphyxiated and those who are aroused by asphyxiating others: “The proposed specifier ‘asphyxiophilia’ is inadequate, because it fails to distinguish between people who are aroused by being asphyxiated, those who are aroused by asphyxiating others, or those who are aroused by both.”
“Cisgender” or “cissexual” are terms taken from trans* activism and Trans* Studies. They describe states of non-transness, i.e., people whose identities are congruent with the sex/gender to which they were assigned at birth. The language of “cis” is a way of destigmatizing transness as the marked other or abnormal way of being.
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Downing, L. Heteronormativity and Repronormativity in Sexological “Perversion Theory” and the DSM-5’s “Paraphilic Disorder” Diagnoses. Arch Sex Behav 44, 1139–1145 (2015). https://doi.org/10.1007/s10508-015-0536-y
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DOI: https://doi.org/10.1007/s10508-015-0536-y