Posts Tagged ‘diagnosis’
What historically distinguishes “homosexuality” as a sexual classification is its unprecedented combination of at least three distinct and previously uncorrelated conceptual entities: (1) a psychiatric notion of a perverted or pathological psychosexual orientation, derived from nineteenth-century medicine, which applies to the inner life of the individual and does not necessarily entail same-sex sexual behavior or desire; (2) a psychoanalytic notion of same-sex sexual object-choice or desire, derived from Sigmund Freud and his coworkers, which is a category of erotic intentionality and does not necessarily imply pathology or deviance (since, according to Freud, most normal individuals make an unconscious homosexual object-choice at some point in their fantasy lives); and (3) a sociological notion of sexually deviant behavior, derived from nineteenth-and twentieth-century forensic inquiries into “social problems,” which focuses on sexual practice and does not necessarily refer to erotic psychology or psychosexual orientation. (1)
What Halperin in “Forgetting Foucault” (1998) is talking about here is the process by which the homosexual became (in direct reference to Foucault) a species. More specifically, he is highlighting the technologies by which sexuality became a legible, knowable and distinguishable regulatory category. The three entities of the homosexual, as Halperin describes them, are:
- A “pathological psychosexual orientation” – basically an internal homosexuality that doesn’t require homosexual acts but is still constitutive of all homosexuals,
- A “same-sex sexual object choice” that is separate from deviance yet constitutive of one’s sexual desire, and
- A set of norms dictating the homosexual (in terms of actions) as a problematic behavioral deviant.
The combination of these aspects of “the homosexual” creates a situation in which homosexuality becomes known as an ontological, drives-based, social problem. What I am interested in within this construction are two things. First, how has the “ontological” nature of homosexuality come to be known as a legitimate and definite (all-encompasing, ie: one defined by same-sex sexual object rather than, say, class) naturalized identity? Second, how, if at all, have the norms which dictate the homosexual as deviant changed within the United States so that the naturalized identity has become (or is becoming) separate from it’s personal ontology? (Even the linguistic shift away from the term “homosexual” is sign of this shift.)
As I have written about before, the Diagnostic and Statistic Manual is coming up for its revision in 2013 and one of its changes is a re-writing of the language and diagnosis of pedophilia. In “The DSM Diagnostic Criteria for Pedophilia” by Ray Blanchard (2009) (1), the arguments behind the changes are laid out and debated. One of the most important changes in the upcoming DSM V, as I have already argued, is the distinction between being ascertaining a paraphilia and being diagnosed with a paraphiliac disorder. In the DSM III-R and the DSM IV-TR (the current publication), one of the criterions for diagnosis is whether or not the person has “acted on these urges [sexual urges and fantasies about children] or is markedly distressed by them” (2).
What then defines distress? Because there are people who are attracted to children who are not personally upset by their attraction, the slippery term of “distress” can be problematic for diagnosis. This issue, however, gets solved in a troubling way:
“In the DSM definition of mental disorder (e.g., DSM-IV-TR, p. xxxi), ‘an important loss of freedom’ (presumably including imprisonment) is listed along with other sequelae that make a behavioral or psychological syndrome clinically significant: present distress (e.g., a painful symptom), disability (i.e., impairment in one or more important areas of functioning), and an increased risk of suffering death, pain, or disability. Since sexual acts against children are serious criminal offenses, they are closely associated with criminal conviction and incarceration (loss of freedom).”
In a confusing circular argument, the illegality of having sex with those under the legal age of consent is a sufficient cause for one to be considered under distress due to sexual urges, simply because it leads to imprisonment. This very diagnosis then goes on to further reify the pedophile as someone who needs to be imprisoned. All one needs to do to see this connection between societal disgust, imprisonment and diagnosis is read any of the reactions to Amazon’s listing of the Pedophile’s Guide to Love and Pleasure (2010), another issue I have previously written about.
There is another argument made by the DSM in regards to diagnosis. This argument, instead of privileging distress due to the potential loss of freedom, posits pedophilia as an impairment because it is non-normative:
“This has led to the unsatisfactory result that it is necessary to be distressed or impaired by a paraphilia in order to have a paraphilia. The problem has been partially patched over in DSM IV-TR by substituting societal judgments about impairment for the patient’s. Thus, a man who has an erotic preference for children and who engages children sexually in real life is a pedophile, regardless of his feelings about his situation, because sexual acts with children count as impairment” (1).
This “substitution” for the judgements about impairment – which really means judgements about normative sexuality and normative childhood – allows the diagnosis of pedophilia through its societal status as a perceived disorder. Therefore, the illegality and non-normativity of pedophilia, two things that are partially dependent on the diagnosis of pedophilia as a disorder for their very rationality, are two of the means by which the disorder is diagnosed.
What this means for the upcoming revision for the DSM is important. In making two types of understandings of pedophilia, the DSM may allow for a break in this circular hyperbolizing of the pedophile, although presumably the second condition, that of a pedophiliac disorder, may still be partially determined by the distress that its illegality causes. Read the rest of this entry »
From Fast Feminism (2010) by Shannon Bell: ”When I asked Sharpe in 2001, ‘Are you comfortable with the term pedophile?’ he replied:
“It is a technical term applied to prepubescents who don’t interest me; I didn’t want to go into the court and try and defend hebephiles, to always be making distinctions, trying to establish that ‘I am not one of them.’ This was a political move; I chose to become a generic pedophile. I believing in defending people’s freedom rather than trying to carve out a nice for myself.”(1) Read the rest of this entry »
In the struggle for gay rights, the removal of homosexuality from the Diagnostic and Statistic Manual II (DSM) and the official acknowledgement by the American Psychological Association (APA) that homosexuality is not a psychological disorder is considered both a turning point in the general perception of homosexuality as normative, as well as a critical moment in the narrative telos of progress for the gay rights movement. This change was in large part made because of a distinction in the assessment of sexual disorders within the psychiatric field; a change that began with the questioning of the science behind the diagnosis of homosexuality. Up until 1957, all studies on homosexuality were done with subjects who were already under psychiatric treatment:
“In the history of psychiatric research, no one had ever conducted a study on a homosexual population that wasn’t either in therapy, prison, a mental hospital, or the disciplinary barracks of the armed services.” (1)(2)
The realization that all studies on homosexuality were conducted with a limited and skewed pool of subjects, and the subsequent challenge to the APA by psychologist Evelyn Hooker in her 1957 paper, “The Adjustment of the Male Overt Homosexual” caused the APA to reconsider what biases were present within the very meaning of sexual disorders. The removal of homosexuality from the DSM II (for the 1974 revision: the DSM III) was in part due to the fact that homosexuality was no longer seen as an ipso facto disorder. Until the DSM III-R (the revision of the DSM III, which removed all references to homosexuality) the APA created the diagnosis of “ego-dystonic homosexuality” – stating that homosexuality could only be a diagnosable disorder if the mere fact of one’s homosexuality was causing emotional or psychological distress (3).
It is this distinction: between understanding a sexual orientation as an in-and-of-itself disorder, and acknowledging that specific sexual orientations are only disorders if they causes personal distress, that holds much promise for the reassessment and reconsideration of other diagnosable “deviant” sexualities. Read the rest of this entry »