English

SM: Causes and diagnoses (2002)

SM: Causes and diagnoses (2002)

by Cand. Psychol Odd Reiersol
oddreiersolMIN
The Norwegian psychologist and sexologist Odd Reiersøl in this article makes an argument for abolishing the diagnoses of fetishism, fetishistic transvestism and sadomasochism from ICD-10, The International Classification of Diseases, version 10.

Introduction

In this paper I write mainly about SM, but since so many professionals talk about generalized “paraphilias” or about fetishism as being closely linked to SM, I will throughout the article make references to “fetishism”. I will make an argument for abolishing the diagnoses of “fetishism”, “fetishistic transvestism” and “sadomasochism”. I am mostly using the pronoun “he” rather than “she”, because there is still more knowledge about male “paraphilia”. It does not mean that I want to exclude women from my discussions.

What is SM?

Traditional viewpoints typically state that SM is a “perversion” where people take pleasure in sexual activities that inflict pain and/or humiliation. The person who gets sexually aroused by inflicting pain/humiliation is labeled a “sadist”. The person who becomes sexually aroused by receiving painful/humiliating stimuli is labeled a “masochist”. The word “perversion” was originally used within legal terminology; a more modern psychiatric equivalent is “paraphilia” or “sexual deviation”(DSM-IV, ICD-10).

I think of SM as an erotic or sexual power play between consenting adults. When the activities are non-consensual, or when one of the partners is treated with disrespect, they become abusive and may appropriately be labeled “perverse”. The healthy, consensual sexual power games, may give people pleasure. They are quite acceptable sexual variations or preferences. These power games may involve verbal or physical domination. Commanding, spanking, bondage and master/slave games are examples.

Since “Sadomasochism” for so many people carries connotations of violence, it may be better to use a different term, for example DS (Dominance and Submission), but it is difficult to change established terminology.

What kind of people practice SM?

The traditional viewpoints a hundred years ago state that these people are immoral, sick or degenerated. The viewpoints typically don’t distinguish between violence and consensual games. Psychiatric data was used to prove the viewpoints.

For example William Stekel (Stekel, 1930), a well-known psychiatrist and psychoanalyst, wrote a book about psychiatric case histories of fetishism and SM. These were truly desperate people, several of them in conflict with the law. His viewpoints were taken from these “cases”.

It is worth noting that traditional clerical views condemned all types of sexual activity that did not occur between a married man and woman, and sexual activity needed to have procreation as its purpose to be acceptable. Any kind of sex that was not an intercourse in the missionary position (the man on top!) between a married man and woman was considered “perverse”.

It was not until the 1970’s that social scientists tried to conduct objective studies of these sexual phenomena (although Kinsey had a few questions about pain inflicting activities, such as biting, in his famous study from the 1950’s). One of the first studies was conducted by Spengler (1977). A questionnaire was sent to advertisers in SM contact magazines and to members of SM clubs. Moser and Levitt (Weinberg, 1995) did a more extensive study a couple of years later also based on questionnaires. Robert Stoller (Stoller, 1991) used an “ethnographic” method for interviewing SM practitioners in the 1980’s.

These studies indicate that SM practitioners are very different as people. Many of them are very highly functional in society, well respected, with high education. There is no reason to believe that there is a higher prevalence of psychoses or personality disorders than in the general population.

What makes people develop a strong interest or preference for SM?

Even if psychiatrists and psychologists have traditionally been overly preoccupied with “etiology”, I think it is interesting to raise the question about the history of a preference or a strong interest. I often find people wonder about: “Why am I the one I am?”

Psychoanalytic thinking

In psychoanalytic thinking “sadism” is often understood as a primary and “masochism” a secondary reaction to trauma. “Masochism” is secondary in the sense that the “sadism” is directed inward, against oneself. If a child has a mother who denies him satisfaction of needs, he might as a grown up seek revenge in sadistic fantasies and possibly act them out sexually against women. “Oral”, “anal” and “phallic” sadism has been postulated. Thus revenge may come as a result of the castration anxiety from the Oedipal (“phallic”) stage. The Oedipal conflict may alternatively result directly in submission (thereby masochism) as an escape strategy. He “lets go” by giving up.

The repetition compulsion has a prominent place in psychoanalytic thinking. “SM people” need to recreate an old traumatic scenario in an attempt to resolve in the here and now what was impossible to solve back then. If, for example, the child got spanked by his mother, he might need to repeat that scenario by having his girlfriend do the same to him as an adult. Or he may attempt a reversal of the situation by spanking his girlfriend.

There are numerous explanations among psychoanalytically oriented professionals (perhaps as many explanations as there are professionals). Another popular one is about expiation: “Since I have sinned (by being sexual), I am bad and need punishment”. In this case “masochism” seems to be the primary reaction, “sadism” will be a projection and the sadist punishes the other instead of himself.

It seems that Freud had a broad view on SM in the sense that he acknowledged a continuum of states from “normally” to “extremely” sadistic and the same for masochistic persons. He associated men with the outgoing, assertive, dominating, “sadistic” type of sexuality and women with the receptive, submissive, “masochistic” type. It’s only when these normal impulses become exaggerated, that the person becomes “perverse”. Freud also looked upon fetishism as a “primary” perversion, which means that SM somehow has fetishism as a basis. It is also worth noting that Freud at first thought that sadism was the primary force (in relation to masochism), but later came to believe that masochism came first.

We also have to be aware that the words “sadism” and “masochism” are used in different (from sexual) ways within psychoanalytically oriented thinking. For example, Wilhelm Reich (Reich, 1945) talked about sadistic and masochistic “character structures”. These are ways of characterizing people’s personalities and do not necessarily have to do with sexuality.

Robert Stoller, a psychiatrist and psychoanalyst, shares traditional psychoanalytic viewpoints in the sense that conflicts from childhood contribute to the “etiology”. He is otherwise untraditional because he stresses the genetic makeup as well as other biological factors and cultural factors as important contributions. He criticizes psychoanalysis of being dogmatic, of not being interested in investigating the phenomena in real life. “Psychoanalytic theories that start by calling perverse people borderline, prepsychotic and so on do not do justice either to the massive areas of successful function present in many perverse people or to the massive areas of pathology present in those whom we do not label perverse” (in his book from 1991 he atypically uses the word “perversion” instead of “paraphilia”). Stoller draws more or less the following conclusions from his ethnographic investigations from the 1980’s as well as from other research as far as causes and dynamics go:

Biologic factors:

“It is sensible to assume that certain anatomic areas are constitutionally more pleasure-intensive or subdued in one person than in another; libidinal zonal development contributes to erotic style”.

Men have a propensity for fetishizing (by “fetishizing” Stoller describes a phenomenon that I would rather call “objectifying”) “that is, reducing one’s appreciation of another to anatomy only, or less (that fundamental dynamic of perversion) in contrast to the opposite desire in women for relationship, intimacy, and constancy.” He assumes that the phylogenetic evolution is responsible for these gender differences. He acknowledges, though, that the gender differences may be explained culturally.

“… postnatal hard-wiring induced by the environment is laid on the genetic and constitutional hard-wiring present at birth” (fixing, related to “imprinting”)

Cultural factors:

Culture is a source of conscience, for example: “.. when the medieval church accepted flagellation as a pious act, masochists had a wondrous, more-or-less guilt-free route to ecstasy that today’s church has blocked through its knowledge of perverse masochism”.

Culture is a source of suggestions to people for designing their erotic behaviors. Stoller refers to “perverse erotic games”, e.g., encouraging individuals to try on fashion practices for erotic pleasure, even while the culture disapproves of such practices.

SM versus abuse

Among other sources, this text is collected from Jay Wiseman’s book “SM 101” and Park Elliot Dietz, one of the worlds leading authorities on the connection between sex and violence
http://www.greenerypress.com/articles.htm
http://members.aol.com/NOWSM/Psychiatrists.html/#Psychiatrists

SM versus violence

1. Perhaps the biggest difference between a violent sadist and an SM Master is that the former destroys the self confidence, value and dignity of the victim. An SM Master does the opposite.

2. SM sexual games have neither perpetrators nor victims. An SM scene is a win-win situation for mutual satisfaction.

3. The submissive partner wishes and longs for the domination. Most people do not want to be abused, and consensual domination is not abuse.

4. Planning, communication and warming up (like in extreme sports) are essential for preventing damage. Sadistic psychopaths, on the other hand, damage their victims, physically and emotionally, deliberately.

5. A sadistic psychopath has usually a history of sexual abuse like rape and incest. Sadomasochists are, as a rule, ordinary people without criminal records or criminal interests.

6. SM is played out in safe settings and safe ways. Abuse is out of control.

7. SM games are negotiated beforehand by equal partners. They decide upon limits and safe words. A perpetrator decides unilaterally without any concern for the wishes, limits or the well being of the victim.

8. SM games contain rules that are mutually agreed upon. In an abusive relationship there is no agreement and the victim has no rights.

9. SM is built upon respect and confidence and is always consensual. Abuse is non consensual and ruins the relationship.

10. The violent sadist is cold and without empathy during the torture. The SM Master uses communication and empathy to find out what turns the slave on.

11. An SM relationship can be loving, intimate, and involve personal growth. Victims of violence experience anxiety, guilt, shame and powerlessness.

12. Many SM practitioners switch roles during the interaction, from time to time, or as a personal development. In an abusive relationship the roles, as a rule, are static.

13. SM is often practiced with support from friends and often in an SM environment. Abuse, on the other hand, requires isolation and secrecy.

14. The dominant in the SM relation respects the borders of the partner. To the extent the borders are stretched, it takes place according to mutual agreement.

15. Using a safe word (e.g. “red”) the slave can immediately stop the game for whatever reason, whether it is physical or emotional. A victim has no such possibility with a perpetrator.

16. SM role-playing typically ends with mutual cuddling and evaluation.

17. The SM slave typically feels grateful to the Master. A victim is not grateful.

18. SM people don’t feel that they have any rights to control their partners by virtue of gender, income or other external, circumstances. Perpetrators often do.

19. There are reasons to believe that SM, like other kinds of consensual sexual practices, liberate bodily and emotional energy, promotes health and prevent violence.

See also: Giddens, A. (1991). Modernity and self-identity. Self and society in late modern age. Stanford University Press. Stanford.

SM versus abuse

Among other sources, this text is collected from Jay Wiseman’s book “SM 101” and Park Elliot Dietz, one of the worlds leading authorities on the connection between sex and violence
http://www.greenerypress.com/articles.htm
http://members.aol.com/NOWSM/Psychiatrists.html/#Psychiatrists

SM versus violence

1. Perhaps the biggest difference between a violent sadist and an SM Master is that the former destroys the self confidence, value and dignity of the victim. An SM Master does the opposite.

2. SM sexual games have neither perpetrators nor victims. An SM scene is a win-win situation for mutual satisfaction.

3. The submissive partner wishes and longs for the domination. Most people do not want to be abused, and consensual domination is not abuse.

4. Planning, communication and warming up (like in extreme sports) are essential for preventing damage. Sadistic psychopaths, on the other hand, damage their victims, physically and emotionally, deliberately.

5. A sadistic psychopath has usually a history of sexual abuse like rape and incest. Sadomasochists are, as a rule, ordinary people without criminal records or criminal interests.

6. SM is played out in safe settings and safe ways. Abuse is out of control.

7. SM games are negotiated beforehand by equal partners. They decide upon limits and safe words. A perpetrator decides unilaterally without any concern for the wishes, limits or the well being of the victim.

8. SM games contain rules that are mutually agreed upon. In an abusive relationship there is no agreement and the victim has no rights.

9. SM is built upon respect and confidence and is always consensual. Abuse is non consensual and ruins the relationship.

10. The violent sadist is cold and without empathy during the torture. The SM Master uses communication and empathy to find out what turns the slave on.

11. An SM relationship can be loving, intimate, and involve personal growth. Victims of violence experience anxiety, guilt, shame and powerlessness.

12. Many SM practitioners switch roles during the interaction, from time to time, or as a personal development. In an abusive relationship the roles, as a rule, are static.

13. SM is often practiced with support from friends and often in an SM environment. Abuse, on the other hand, requires isolation and secrecy.

14. The dominant in the SM relation respects the borders of the partner. To the extent the borders are stretched, it takes place according to mutual agreement.

15. Using a safe word (e.g. “red”) the slave can immediately stop the game for whatever reason, whether it is physical or emotional. A victim has no such possibility with a perpetrator.

16. SM role-playing typically ends with mutual cuddling and evaluation.

17. The SM slave typically feels grateful to the Master. A victim is not grateful.

18. SM people don’t feel that they have any rights to control their partners by virtue of gender, income or other external, circumstances. Perpetrators often do.

19. There are reasons to believe that SM, like other kinds of consensual sexual practices, liberate bodily and emotional energy, promotes health and prevent violence.

See also: Giddens, A. (1991). Modernity and self-identity. Self and society in late modern age. Stanford University Press. Stanford.

DSM – Diagnostic and Statistical Manual of Mental Disorders

About The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)

By Svein Skeid

The American Psychiatric Association, APA, considerably revised their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. SM and Fetishism were considered to be healthy forms of sexual expression, as long as they do not impair the daily functioning of the subject.

According to DSM-IV, SM and Fetishism only become diagnosable dysfunctions when the urges, fantasies or behaviors “cause clinically significant distress or impairment in social, occupational or other important areas of functioning.”

In addition APA said that “a paraphilia must be distinguished from the non-pathological use of sexual fantasies, behaviors or objects as a stimulus for sexual excitement.”

The DSM-IV revision, in 1994, was seen as a step forward, but is far from satisfactory. Stigma knowledge shows that many psychological, physical and social problems are not caused by the individual afflicted, but by taboos, prejudices, and discrimination imposed by the environment.

According to Charles Moser, the diagnostic criteria changed yet again in 2000 for the worse introducing version DSM-IV-TR (2000).

According to The Differential Diagnosis of the Paraphilias “A Paraphilia must be distinguished from the non-pathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviors, or objects are paraphilic only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere in social relationships). (DSM, p. 568)

“The way this diagnosis is interpreted, any reason that you are seen by a physician or therapist (including court order, as to assess who should get custody of your children in the event of a divorce), can bring about the diagnosis even if it has nothing to do with the issue being investigated.”  Charles Moser on the ReviseF65 discussion group January 22, 2006.

In a press release November 25, 2008, NCSF, National Coalition for Sexual Freedom says about DSM-IV TR:

“We know from the hundreds of requests for help that NCSF gets every year through our Incident Response program that the Sexual Sadism, Sexual Masochism, Fetishism and Transvestic Fetishism diagnoses in the DSM reinforce the negative stereotypes and stigma against alternative sexual behaviors.”

From the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders

The DSM-IV defines mental disorders. Previous editions of the DSM listed sadism and masochism as diagnosable disorders just for having such fantasies or urges over a period of time. The new edition adds modifying criteria: with both masochism and sadism, both A & B criteria must be met in order to make a diagnosis. That is, you must have the fantasies, urges, etc., and the fact that you have them must make you effectively dysfunctional in an important area of your life.

Diagnosic criteria for 302.83 Sexual Masochism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound or otherwise made to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Diagnostic criteria for 302.84 Sexual Sadism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

LEOP-What is SM?

Written by Susan Wright and Dr Charles Moser

In the last decade, SM awareness has exploded into popular culture. SM is commonly depicted in advertising, books, movies, music, and is becoming commonplace on television. SM has been positively covered by Newsweek, Time, Ms. Magazine, the New York Times and many other national publications. SM fashion accessories have become commonplace, as have jokes about SM play. Yet separating the truth about SM from the stereotypes can be difficult.

The present booklet is an attempt to educate the public about sadomasochism (SM). The following are some answers about consensual SM that are supported by scientific research.

1. SM is a Sexual Orientation or Behavior *

2. SM is Safe, Sane and Consensual *

3. SM is not Domestic Violence *

4. The Psychiatric Opinion about SM *

5. Should I be Afraid of People Who Enjoy SM? *

6. How Many People Engage in SM Activities? *

7. More Information About SM *

APPENDIX A *

Excerpt from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. *

1. SM is a Sexual Orientation or Behavior

SM is a sexual orientation or behavior among two or more adult partners. The behavior may include, but is not limited to, the use of physical and/or psychological stimulation to produce sexual arousal and satisfaction. Usually one partner will take an active role (top or dominant) and the other will take a passive role (bottom or submissive). SM practitioners can be heterosexual, bisexual, homosexual, transgendered or intersex individuals.

SM is not easily defined; the range of behaviors are quite broad and most participants do not enjoy all of the activities or roles. The problems with the definition are discussed at length in an article by Weinberg, Williams and Moser. They found five features present in most SM interactions they studied:

 

      1. Dominance and submission – the appearance of rule and obedience of one partner over the other;

         

         

      2. Consensuality – a voluntary agreement to enter into SM “play” (interaction) and to honor certain “limits” (ground rules of how involved and in which direction the play can proceed);
      3. Sexual content – the presumption that the activities have a sexual or erotic meaning;
      4. Mutual definition – the assumption of a shared understanding by the participants that their activities are SM or a similar concept.
      5. Role playing – the participants assume roles either for the interaction or for the relationship that they recognize are not reality.

Weinberg, M.S., Williams, C.J., & Moser, C.A. (1984). “The social constituents of sadomasochism.” Social Problems, 31, pg. 379-389.

2. SM is Safe, Sane and Consensual

SM-Leather-Fetish educational and social organizations consider the cornerstone of SM activity to be the guidelines: “safe, sane, and consensual.” While it is possible to do any activity in a reckless and dangerous manner, SM is no more dangerous than skiing or other thrilling activities.

*Safe*

Safe is being knowledgeable about the techniques and safety concerns involved in what you are doing, and acting in accordance with that knowledge. Safety includes the responsibility of protecting yourself and your partner from STD (sexually transmitted disease) infection including the HIV virus.

While the media often portrays the more extreme SM behaviors, the reality is that a lot of SM play never goes beyond a playful spanking. Just as there are ways to reduce the risk in activities such as scuba diving or driving a car, there are ways to reduce the risk and engage in SM behavior safely.

The organized SM community is active in promoting safety seminars and teaching the practitioners how to engage in these behaviors safely. The fact that SM practitioners are not clogging the emergency rooms every weekend, is an indication that these programs are working. If SM injuries were occurring, it seems obvious that the press would be highlighting this for the entertainment of its readers/viewers.

*Sane*

Sane is knowing the difference between fantasy and reality. Fictional accounts of SM are often distorted for fantasy sake, and are not representative of real situations and relationships.

Sane also distinguishes between mental illness and health. A real distinction between mental illness and health is when a behavior pattern causes problems in a person’s life. Washing your hands until the skin is peeling off, or so frequently that you can not otherwise function is a sign mental illness. SM, like any other behavior, can be a sign of psychiatric problems. However the vast majority of its practitioners find that SM enriches and promotes functionality in the other areas of their life.

*Consensual *

Consensual is respecting the limits imposed by each participant at all times.

Consent is the prime ingredient of SM. One difference between rape and heterosexual intercourse is consent. One difference between violence and SM is consent. The same behaviors that might be crimes without consent are life-enhancing with consent.

The type and parameters of control are agreed upon by the people involved, and the ongoing consent of all participants is required. Some practitioners use a safeword, which is a designated word that signals the scene must slow down or stop. Rick Houlberg writes in “The Magazine of a Sadomasochism Club: The Tie That Binds”:

“The only “cardinal” rules which the Club’s membership insists each member must uphold are that all SM activities must be consensual, nonexploitative, and safe. As children are not considered to be able to consent, all activities must be between adults. The consensual and safety rules of the Club are constantly being reinforced. Safety and etiquette issues, including restrictions on overt and heavy drug use, are strongly stressed at new-member orientations and in all written materials produced by the Club.”

Rick Houlberg (1993). “The Magazine of a Sadomasochism Club: The Tie That Binds.” Journal of Homosexuality 21 (1/2), Haworth Press: pg. 167-83.

3. SM is not Domestic Violence

Domestic violence is a pattern of intentional intimidation of one partner to coerce or isolate the other partner without consent. Abuse tends to be cyclical in nature, escalates over time, and characterized by apologies between the episodes that it will never happen again.

SM is not abuse or domestic violence because:

      1. SM is voluntary. The partners agree to erotic power exchange of their own free will and choice. Either partner is free to leave at any time. The fact that SM relationships do split (amiably or not) without retaliation or violence supports the importance of this distinction.
      2. SM is consensual. All partners involved agree to what is going to happen. Discussion of limits is usual and customary. Violation of those limits is a serious offense within the SM community.
      3. SM partners are informed. Participants involved in erotic power exchange have an understanding of the possible consequences.
      4. SM partners ask for and enjoy the behavior; they are often disappointed if the behavior does not happen. There is no apology for the behavior after it is over, rather both partners are happy and satisfied that it occurred.
      5. SM partners take great care to make sure that their activities are as safe as possible. To truly damage their partner would deny themselves of being able to participate in the behavior. Individuals that violate their partners limits soon find that they are lacking partners in which to engage in the behavior. To emphasize the point, SM groups frequent hold educational meetings on how to safely engage in the behavior.

Nonetheless, as with any group of people, you will find cases of domestic violence among SM practitioners. The organized SM-Leather-Fetish community does not condone domestic violence and actively encourages victims and abusers to seek help.

Sociologist Thomas S. Weinberg is the author of numerous professional articles on human sexuality in various scholarly journals. In Studies in Dominance & Submission, Dr. Weinberg says:

“While the individuals we have discussed are different in many ways there are, nevertheless, some common themes running through them. These similarities are all related to S&M as a form of social interaction. For example, the importance of learning both attitudes and techniques through a socialization process is evident in all of these … In order for an S&M scene to be successful, from the viewpoint of both partners, it must be collaboratively worked out. Unless there is satisfaction on the part of both master (or mistress) and slave, the relationship will terminate. Thus, there must be agreement on the scene and consent given by both parties. Adjustments must be made by participants so that they are both stimulated.”

Thomas S. Weinberg (1995). Studies in Dominance & Submission, Prometheus Books: pg. 89.

4. The Psychiatric Opinion about SM

In recent years as more research has been published, the mental health and medical communities have begun to accept that SM is a safe, legitimate pursuit.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) which defines currently recognized mental disorders, SM per se is NOT a mental disorder. In their diagnostic criteria for both sexual masochism and sexual sadism, the DSM-IV states that SM only becomes a diagnosable dysfunction when:

“the fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational or other important areas of functioning.”

In addition, the DSM-IV clearly allows for non-pathological sexual behavior:

“a paraphilia must be distinguished from the non-pathological use of sexual fantasies, behavior or objects as a stimulus for sexual excitement.”

[The entire diagnostic criteria for sexual masochism and sexual sadism are reproduced Appendix A.]

5. Should I be Afraid of People Who Enjoy SM?

You do not have to be afraid of people who engage in SM. SM players are doctors, lawyers, teachers, construction workers, fire fighters, secretaries and everything else you can imagine.

In her 1983 book Erotic Power, sociologist Gini Scott examined the dynamics of the heterosexual SM subculture. She stated:

“Unlike the psychiatrists and psychologists who deal primarily with psychologically troubled individuals who are also interested in D&S [Dominance and Submission], I did not find them to be psychologically troubled or socially inept; rather, a spirit of good humor and fun prevailed, and the participants appeared to be mostly attractive, quite ordinary-looking people who had ordinary relationships outside the D&S scene… A vast variety of people with a diverse range of erotic interests participate in sadomasochism. Their backgrounds, activities and attitudes are quite unlike the social stereotype that depicts sadomasochism as a form of violence, mischief, or mayhem perpetrated by the psychologically unstable who seek to hurt others or to be hurt themselves… At the core of the community are mostly sensible, rational respectable, otherwise quite ordinary people. Thus, quite unlike its public image, the community is a warm, close and supportive one.”

Gini Scott (1983). Erotic Power, Citadel Press: pg. x.

6. How Many People Engage in SM Activities?

A handful of significant sociological studies have been done to determine percentage of the population engages in SM activities:

The 1990 Kinsey Institute New Report on Sex reports:

“Researchers estimate that 5-10 percent of the U.S. population engages in sadomasochism for sexual pleasure on at least an occasional basis, with most incidents being either mild or stage activities involving no real pain or violence. Most often it is the receiver (the masochist), not the giver (the sadist), who sets and controls the exact type and extent of the couple’s activities. It might also interest you to know that in many such heterosexual relationships, the so-called traditional sex roles are reversed — with men playing the submissive or masochistic role. Sadomasochistic activities can also occur between homosexual couples.”

June M. Reinisch, Ph.D. with Ruth Beasley, M.L.S (1990). Kinsey Institute New Report on Sex, St. Martin’s Press: pg. 162-163.

A new Playboy poll by Dr. Marty Klein appeared in November, 1998, p. 81:

18% of the men and 20% of the women have used a blindfold during sex.

30% of the men and 32% of the women have tied someone up or have been tied up during sex.

49% of the men and 38% of the women have spanked or have been spanked as part of sex.

A survey by Hunt (1974) of 2,026 respondents found that 4.8% of men and 2.1% percent of women had obtained sexual pleasure from inflicting pain and 2.5% of the men and 4.6% of the women obtained sexual pleasure from receiving pain. These numbers are probably underestimates, because the erotic response to “pain” is only one aspect of SM. (M. Hunt, Sexual Behavior in the 1970s, Chicago: Playboy Press.)

A mid-1970s independent research organization poll funded by Playboy surveyed 3,700 randomly selected students from 20 colleges found that 12% women and 18% of the men had indicated a willingness to try bondage or master-slave role-playing. (Playboy, “What’s Really Happening on Campus”, October 1976.)

A survey by E. Hariton (1972) found that up to 49% of women fantasize about submissive scenarios during sexual intercourse with 14% doing so frequently. (E. Hariton, “Women’s Fantasies During Sexual Intercourse with their Husbands: A Normative Study with Tests of Personality and Theoretical Models'” unpublished doctoral dissertation, City University of New York.)

Paul H. Gebhard, is an anthropologist and was the executive director of the Institute for Sex Research at Indiana University from 1956 to 1983. Gebhard noted in Fetishism and Sadomasochism (Dynamics of Deviant Sexuality, 1969, pg. 79.) that “consciously recognized sexual arousal from sadomasochistic stimuli are not rare.” The Institute for Sex Research found that one in eight females and one in five males were aroused by sadomasochistic stories.

In 1929, Hamilton’s marriage habits survey reported that 28% of men and 29% of women admitted they derived “pleasant thrills” from having some form of “pain” inflicted in them. (G.V. Hamilton, A Research in Marriage, Boni, New York.)

7. More Information About SM

*Why do you call it SM instead of S&M?*

The term “S&M” stands for Sadism and Masochism, and the historical definitions and depictions of S&M are often stereotyped and nonconsensual. The term “SM” stands for sadomasochism, which is a type of sexual orientation or behavior. Many people call it SM to emphasize the need for consent since both behaviors are united in a single word. SM is also sometimes referred as “leather,” “Dominance & Submission,” “D&S” and “BDSM”.

*Where did the terms Sadism and Masochism come from?*

As the language has evolved, the contemporary definitions of sadism and masochism are changing. Sadism no longer implies non-consensuality, nor does it imply violence. It simply means that someone receives erotic gratification from the infliction of psychological or physical stimulation on a consenting partner. Conversely, a masochist is someone who enjoys receiving that psychological or physical stimulation.

The term ‘sadism’ was popularized by psychiatrist Richard von Krafft-Ebing in 1886 and stems from the writings of the Marquis de Sade (de Sade’s writing style had been referred to as “le sadisme” for years, Krafft-Ebing was the first to use the term in a clinical manner). The case histories he reported primarily concerned nonconsensual sexual violence and were not about what we now call SM.

Krafft-Ebing also coined the term ‘masochism’ to describe the enjoyment of sexual servitude. He took the term from the writings of Leopold von Sacher-Masoch, a prominent Austrian novelist, who wrote about his own masochistic desires in novel form. Sacher-Masoch was alive at the time and not very happy about having a perversion named after him, as it defamed his grandfather. Sacher-Masoch was given his hyphenated name as an honor to his maternal grandfather; his mother was the only daughter of an esteemed public health physician. Dr. Masoch convinced the Austrian government to install the sewer system of Vienna, thereby preventing uncounted epidemics. It is ironic that this public health physician is remembered for a sexual diagnosis rather than for the good he actually accomplished.

*Why do people do SM?*

We do not know why some people are heterosexual and others are homosexual. We do not know why some people eroticize breasts and others legs. We do not understand how people develop any particular eroticism. We do know that no one has found any characteristic in childhood history, birth order, etc., that is more common among SM practitioners than the general public. Specifically, there is no indication that SM practitioners are more or less likely to have been spanked as children, or to have been the victim of sexual or other abuse as children.

Andreas Spengler did the first major study of those who identified as SM practitioners (1977). The only thing these devotees had in common was their high standard of living, social status, and education. 90% were perfectly happy with their sexual preferences, with their biggest burden being the social stigma attached to these acts. (A. Spengler, “Manifest Sadomasochism of Males: Results of an Empirical Study,” Archives of Sexual Behavior, vol. 6, pp. 441-56.)

*SM is about love and pleasure*

SM is about sensation and stimulation, exchanging power, trusting one’s partner, and sharing love and pleasure. Some SM practitioners seek “pain” but they want the sensation administered in a way that is ultimately pleasurable to them.

Sociologists Weinberg and Kamel wrote in 1995:

“Much S&M involves very little pain. Rather, many sadomasochists prefer acts such as verbal humiliation or abuse, cross-dressing, being tied up (bondage), mild spankings where no severe discomfort is involved, and the like. Often, it is the notion of being helpless and subject to the will of another that is sexually titillating… At the very core of sadomasochism is not pain but the idea of control–dominance and submission.

Thomas S. Weinberg and G.W. Kamel (1995). “S&M: An Introduction to the Study of Sadomasochism,” S&M: Studies in Dominance and Submission, Prometheus Books, pg. 19.

Havelock Ellis, M.D., produced a groundbreaking study of sexuality: Studies of the Psychology of Sex, in which he wrote that the concept of pain is much misunderstood:

“The essence of sadomasochism is not so much “pain” as the overwhelming of one’s senses – emotionally more than physically. Active sexual masochism has little to do with pain and everything to do with the search for emotional pleasure. When we understand that it is pain only, and not cruelty, that is the essential in this group of manifestations, we begin to come nearer to their explanation. The masochist desires to experience pain, but he generally desires that it should be inflicted in love; the sadist desires to inflict pain, but he desires that it should be felt as love….”

Havelock Ellis, M.D. (1926). Studies of the Psychology of Sex, F.A. Davis Company, pg. 160.

APPENDIX A

Excerpt from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.

These criteria are listed in the Paraphilia section, pg. 525.

Diagnostic criteria for 302.83 Sexual Masochism

      1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound or otherwise made to suffer.
      2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Diagnostic criteria for 302.84 Sexual Sadism

      1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
      2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Denmark withdraws SM from Diagnosis-list

Denmark has as the first European country taken the political decision to remove SM as a diagnosis.

In 1995, as the first EU country, Denmark withdrew sadomasochism completely as a diagnosis by a political decision in the Government. The decision is founded on research showing SM or sadomasochism to be no disease. The Dual-role transvestism diagnosis were repealed in Denmark August 19, 1994.

– Not a disease

In a letter to Anders Sørensen, chairman of the SM association Det Sorte Selskab (The Black Society), the former Health Minister Yvonne Herløv Andersen (picture) wrote that she finds it deplorable that sadomasochism is included in the ICD, the International Classification of Diseases.

“I think there is good reason to abandon the international disease classification on this point,” wrote Andersen, who was the Danish Health Minister from 1994 to 1996, and Social Minister before that. The Minister agreed that sexual preferences are an entirely private matter. “The acceptance of people with a different sexuality has increased, and in this area Denmark is a pioneer country”, she concluded in her letter.

The Black Society’s chairman Anders Sørensen received the decision with enthusiasm. “Many sadomasochists all over the world wish that this attitude were current in their own country, including neighbours like Sweden, Norway and England, which in other matters are regarded as enlightened and civilised states with a human attitude in the administration of justice”, the SM chairman declaired to the Danish newspaper “Politiken” (The Politics 1995, April 1, p. A7).

In the picture on the right, you can see a facsimile of the letter from Sundhedsstyrelsen (the Danish Board of Health), where the decision to stop using the diagnose F65.5 Sadomasochism, is announced. Click the picture for a larger version of the letter, which naturally is written in Danish. (English translation below).

Violence and SM in the same diagnosis

In today’s ICD classification there is no difference at all between voluntary and consensual SM sex on one side, and violence, harassment and spouse abuse on the other.

The above-quoted documents how Denmark in 1995 withdrew SM as a diagnose, for the precise reason that research shows that SM’ers are no more unsound than other people.
http://www.revisef65.org/psychopathology.html

On the web site
http://members.aol.com/NOWSM/Psychiatrists.html/#Psychiatrists;
Park Elliot Dietz – one of the worlds leading authorities on the relationship between aggression and sex – documents the basic differences between violent sadism and SM sadism.

On the same web site, the Kinsey Institute’s research report from 1990 is referred to. This report shows that 5-10 percent of the population exercise some form of SM or sadomasochism.

National rejection of diagnoses

Also in Norway and other countries we have seen, in relation to homosexuality, that single countries may reject individual diagnoses in ICD, which is controlled by the World Health Organization, WHO. The more countries that succeed in rejecting the disease classification F65 on fetishism and sadomasochism, the greater the possibility that WHO will withdraw it.

Kink Aware Professionals

Changes in the diagnosis classification ICD are now taking place almost continuously. History shows that the DSM list of the American Psychiatric Association, APA, very often affects the international ICD.

You can find a list over “Kink aware professionals” on http://www.ncsfreedom.org/index.php?option=com_keyword&id=270

This list, originating in the USA, now includes the whole world, also Europe. A few European resources have already started to emerge. See also: Kink aware professionals Berlinhttp://www.bdsm-berlin.de/kap.html

Kink aware professionals Canada http://www.vancouverleather.com/kap

The letter from Sundhedsstyrelsen (the National Board of Health)

From the Board of Health

To: head physicians at psychiatric wards
The Psychiatric Central Register
The hospitals’ centres of information technology
County data
Ministry of Health

April 24, 1995

J.no. 6702-15 1994
Local no. 6201

 

From the Health Minister the Board of Health has received a request that the disease classification’s code for sadomasochism be no longer used in the indexing of diseases.

Consequently we request that the use of the code

DF65.5 Sadomasochism

be blocked for use with effect from May 1, 1995.

Best regards

head physician G. Shiøler (sign.)

Board of Health, Amaliegade 13, Po. box. 2020, DK-1012 Copenhagen K. Telephone 33 91 16 01.

 

The number of sm/fetish people

More BDSM people than homosexuals

Oslo pride 2008. Photo: Svein Skeid

 


 

 

 

 

 

BELGIAN BDSM:

7,6% self-identified as BDSM practitioners and some degree of BDSM interest found in 70% of the population!

This is the conclusion from a Belgian survey published in The Journal of Sexual Medicine in 2017.

Holvoet L, Huys W, Coppens V, et al. Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. J Sex Med 2017;14:1152–1159.

”The survey indicate that there is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests”, the researchers emphasize.

46.8% of the total sample (N=1027) had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. 26% saw themselves as being interested in BDSM, and 7.6% self-identified as BDSM practitioners.

The rate of correspondents who identified themselves as BDSM practitioners (ie, 7.6%), is in line with the findings of Bakker and Vanwesenbeeck (2006) reporting that 7% of the population in the Netherlands acted on their SM desires (Bakker F, Vanwesenbeeck I. Seksuele gezondheid in Nederland 2006. 1st ed. Deft, Netherlands: Eburon; 2006).

The cross-sectional survey was carried out from February 2017 to March 2017. A digital invitation for participation in the survey was e-mailed to 8,041 subjects by iVox (Leuven, Belgium), a market research and polling agency with access to a panel of 150,000 Belgian citizens representative of the general population. Of the 8,041 invitees, 2,764 participants opened the survey (34.4% responders) of which 1,027 (37.2%) completed it, leaving 1,737 non-completers and 5,277 non-responders.

Lien Holvoet, MD, Wim Huys, MSc, Violette Coppens, MSc, PhD, Jantien Seeuws, MSc, Kris Goethals, MD, PhD, Manuel Morrens, MD, PhD. in The Journal of Sexual Medicine p 1152, July 9, 2017.

http://www.jsm.jsexmed.org/article/S1743-6095(17)31318-8/fulltext

 

 

 

CANADA/QUEBEC:

FETISHISM AND BDSM ARE NEITHER ATYPICAL, UNUSUAL, NOR ANOMALOUS

The two researchers Christian C. Joyal, Ph.D. and Julie Carpentier, Ph.D. (picture) at Université du Quebec à Trois-Rivières, Departement de Psychologie, in 2016 published the study “The Prevalence of Paraphilic Interests and Behaviors in the General Population: A Provincial Survey” in The Journal of Sex Research.

Their findings contradict the DSM-5, as they demonstrate that a number of legal sexual interests and behaviors considered anomalous in psychiatry are actually common in the general population. Joyal and Carpentier found it erroneous to qualify interest in noncriminal sexual behaviors, such as fetishism and BDSM as paraphilia, as they are neither atypical nor unusual, let alone anomalous.

Here is some of the results concerning consensual ”paraphilias”:

Joyal and Carpentier found that 46.3% of the respondants (N=1040) acknowledged a desire for (wished to realize) some sort of fetishism and 22,8% had experienced fetishism “sometimes or often”.

23,8% of the respondants acknowledged a desire masochism and 13,7% had experienced masochism sometimes or often.

7,1% of the respondants acknowledged a desire for sexual sadism and 3,2% had experienced sadism sometimes or often.

The study also provides further support (e.g., Richters et al., 2008) for rejecting the popular view that paraphilic interests, especially sadomasochism, are associated with childhood sexual abuse or trauma.

The result also supports the clinical impressions of Khar (2008) and Brenot (2012) that individuals (especially women) with masochistic/submissive) sexual proclivities are the most satisfied, driven, and active sexually.

Joyal concluded in Eurekalert news that: “We have reasons to believe that this study’s results which are based on Quebec’s population can be applied to the population of North America and Europe as well”.

Respondents were selected and interviewed by three female professional interviewers from an independent private firm, the Bureau of Professional Interviewers (http://www. bip-sondage.com), between August 9 and September 8, 2014. Data were obtained from 1,040 adults ages 18 to 64 years old who matched as closely as possible the corresponding population of the province of Quebec.

Christian C. Joyal & Julie Carpentier (2017):

The Prevalence of Paraphilic Interests and Behaviors in the General Population: A Provincial Survey. The Journal of Sex Research, Feb;54(2):161-171. DOI: DOI: 10.1080/00224499.2016.1139034. Epub 2016 Mar 3.

https://www.tandfonline.com/doi/full/10.1080/00224499.2016.1139034

https://www.eurekalert.org/pub_releases/2016-03/uom-qst030816.php

Richters, J., De Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. (2008). Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism,” or dominance and submission (BDSM): Data from a national survey. Journal of Sexual Medicine, 5 (7), 1660–1668. doi:10.1111/j.1743-6109.2008.00795.x

Khar, B. (2008). Who’s been sleeping in your head? The secret world of sexual fantasies. New York, NY: Basic Books.
Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Indianapolis: Indiana University Press.

Brenot, P. (2012). Les femmes, le sexe et l’amour: 3000 femmes témoignent [Women, sex, and love: Report from 3,000 women]. Paris, France: Arènes.

 

The American Kinsey Institute estimate that 5-10 percent of the population practise some kind of sadomasochism.
“Researchers estimate that 5-10 percent of the U.S. population engages in sadomasochism for sexual pleasure on at least an occasional basis, with most incidents being either mild or stage activities involving no real pain or violence.”
The 1990 Kinsey Institute New Report on Sex (June M. Reinisch, Ph.D. with Ruth Beasley, M.L.S., New York: St. Martin’s Press, pp. 162-163).

 

A British NetDoctor 2001 survey of over 850 adults, showed that 18 per cent of women and 14 per cent of men described themselves as ‘into bondage’. 16 per cent of women and 13 per cent of men described themselves as being ‘into’ bedroom spanks. 5 per cent of women and 13 per cent of men had interest in fetishism. 8 per cent of both male and female respondents had tried cross-dressing. Only 2.1 per cent of women and 7 per cent of men described themselves as ‘gay or bisexual’. 5 per cent of women and 12 per cent of men reported that they had had lesbian/homosexual experiences inthe past.

 

According to the world’s largest ever survey of sexual attitudes and behaviour, undertaken by Durex in 2004, with more than 350,000 respondents from 41 countries, 19 per cent practise spanking, which probably is the most common SM activity. 22% indulge in blindfolding or handcuffing, which we presumably can call “bondage”. 15 per cent enjoy various kind of role play and 13 per cent appreciate “dressing up” or fetishism.

Retrieved October 19, 2004, from http://www.durex.com/cm/GSS2004Results.asp [dead link]

 

See also: How many people engage in SM activities? A handful studies done to determine the percentage of the population engaging in SM activities. By Charles Moser, Ph.D., M.D. and Susan Wright, spokesperson for NCSF, National Coalition for Sexual Freedom.

http://www.leatherleadership.org/library/whatsm.htm


 

No more psychopathology among BDSM-people

There is no evidence that SM/fetish people have a higher degree of psychopathology than the rest of the population.

Link to Norwegian version: http://www.revisef65.net/2015/10/04/ikke-mer-sykelighet-blant-bdsm-ere/


Wismeijer & van Assen (2013):
More heathy BDSMers

A Dutch study of 902 BDSM practitioners, published in the Journal of Sexual Medicine, suggests that the BDSMers had more favorable psychological characteristics than a control group of 434 respondants.

The BDSM practitioners were less neurotic, more extraverted and had higher subjective well-being than the control group.

The study, that was publised May 16, 2013, also suggests that the BDSM group was more conscientious and less rejection sensitive. BDSMers were however less agreeable than the control group. The doms scored lower than both the subs and the control group with respect to agreeableness. BDSM scores on health were generally more favorably for those with a dominant than a submissive role, with least favorable scores for controls.

Andreas A.J. Wismeijer PhD, Marcel A.L.M. van Assen PhD: Psychological Characteristics of BDSM Practitioners. The Journal of Sexual Medicine, Volume 10, Issue 8, pages 1943–1952, August 2013.
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12192/abstract

Psychological Characteristics of BDSM Practitioners
http://www.andreaswismeijer.nl/wp-content/uploads/2013/05/BDSM_JSM_Wismeijer_van-Assen.pdf

Brad Sagarin et al (2009):

The implication of two studies at the Northern Illinois University into hormonal changes associated with Sadomasochistic activities including spanking, bondage and flogging, suggest that it could bring consenting couples closer together. The increases in relationship closeness combined with the displays of caring and affection observed as part of the SM activities offer support for the modern view that SM, when performed consensually, has the potential to increase intimacy between participants. Sagarin, B. J. (picture), Cutler, B., Cutler, N., Lawler-Sagarin, K. A., & Matuszewich, L. (2009). Hormonal changes and couple bonding in consensual sadomasochistic activity. Archives of Sexual Behavior, 38, 186-200.
http://www.niu.edu/user/tj0bjs1/papers/scclm09.pdf
http://pubget.com/paper/18563549

Cross and Matheson (2006):

Cross and Matheson (2006) found no support for the traditional theories that sadomasochism is an illness.

The researchers found no evidence for the psychopathology/medical-model contention that masochists suffer from any kind of mental disorder and that SM-sadists are antisocial (Krafft-Ebing 1886/1965).

There was no support for the traditional psychoanalytic view of self-harming and guilt-ridden masochists or id-driven and psychopatic SM-sadists (Freud 1900/1906/1953/1954).

Cross and Matheson neither found any evidence for Baumeister’s contention that masochists were more inclined to engage in escapist behaviors such as drug-taking, day-dreaming, or fantasizing than the comparison group (Baumeister 1988, 1989).

Cross and Matheson did however find that SM participants were overall more likely than non-SM respondents to report bisexual/homosexual orientations.

No evidence was found suggesting that sadomasochists espoused anti-feminist, patriarchal values or traditional gender roles to a greater extent that the non-SM-group.

And the sadomasochists were relatively more likely to be in ongoing relationships than the comparison group.

Patricia A. Cross PhD and Kim Matheson PhD in the book “Sadomasochism: Powerful Pleasures” (2006), published simultaneously as the Journal of Homosexuality, Vol. 50, Nos. 2/3.)

Connolly et al (2006):

Results from a research project by Dr. Pamela Connolly (picture) et al, among a group with bondage and sadomasochistic interests (BDSM) showed that

“no evidence was found to support the notion that clinical disorders – including depression, anxiety, and obsessive-compulsion – are more prevalent among the sample of individuals with BDSM interests than among members of the general population. Moreover, this sample did not show evidence of widespread PTSD, trauma-related phenomena, personality disturbances, psychological sadism or psychological masochism”, disorders in which the sufferer either derives pleasure out of genuine cruelty (not the play-acting kind) or compulsively seeks out harmful levels of pain. ”Similarly, no prominent themes were found in a series of profile analyses.”

”There were, however, som exceptions to this general pattern, most notably the higher-than-average levels of nonspecific dissociative symptoms and narcissism in this sample. That said, this body of findings suggests that, contrary to longstanding assumptions in the psychoanalytic literature, there is very little support for the view that psychopathology underlies behavior.”

Connolly, P.H.; Haley, H.; Gendelman, J.; Miller, J. (2006). Psychological functioning of bondage/domination/sado-masochism practitioners. Journal of Psychology and Human Sexuality, 18(1), 79-120.
http://www.informaworld.com/smpp/content~db=all?content=10.1300/J056v18n01_05

Richters et al 2005:

A survey using computer-assisted telephone interviews with 20,000 Australian men and women, showed that BDSM may actually make men happier. Men into BDSM scored significantly better on a scale of psychological wellbeing than other men.

BDSM’ers were no more likely to have suffered sexual difficulties, sexual abuse or coercion or anxiety than other Australians.

– This seems to imply that these men are actually happier as a result of their behaviour, though we’re not sure why, said Dr. Juliet Richters (picture), of the University of New South Wales. “It might just be that they’re more in harmony with themselves because they’re into something unusual and are comfortable with that. There’s a lot to be said for accepting who you are.”

Researchers said the study helps break down the reigning stereotype that people into bondage and discipline were damaged as children and were therefore “dysfunctional”.

Richters, J., & Rissel, C. (2005). Doing it down under: The sexual lives of Australians. Sydney: Allen & Unwin.
http://www.smh.com.au/news/national/kinky-you-cant-beat-it/2007/04/16/1176696736407.html

http://www.foxnews.com/story/0,2933,266344,00.html

Martins & Ceccarelli (2003):

A study, presented at the 16th World Congress of Sexology in Cuba 10-14 March, 2003, suggests that non-conventional sexual practices cannot be used as a diagnosed criteria of any kind, which means that the only aspect that distinguishes these individuals from others is their sexual practices.

Picture: Maria Cristina Martins, Clinical Psychologist and Specialist in Human Sexuality. Campinas, SP, Brazil and Paulo Roberto Ceccarelli, Psychologist, Psychoanalyst, PhD in Psycopathology and Psychoanalysis by Paris VII, Paris, France.

www.revisef65.org/cuba1.html

Earlier studies:

According to Moser (1999), limited earlier studies show no differences in psychopathology between the S/M group and the control group. Gosselin & Wilson (1980), Miale (1986), Moser (1979).
http://www2.hu-berlin.de/sexology/BIB/SM.htm#S/M_PRACT
C. Moser C. (1999). The Psychology of Sadomasochism (S/M). S. Wright, ed., SM Classics, New York, Masquerade Books 1999, p. 47-61.

Gosselin, C, & Wilson, G. (1980). Sexual variations. New York: Simon and Schuster.
Miale, J. P. (1986). An initial study of nonclinical practitioners of sexual sadomasochism. Unpublished doctoral dissertation, the Professional School of Psychological Studies, San Diego.
Moser, C. (1979). An exploratory-descriptive study of a self-defined S/M (sadomasochistic) sample. Unpublished doctoral dissertation, Institute for Advanced Study of Human Sexuality, San Francisco.

SM as a sexual orientation

Physicians and psychiatrists about SM as a valid expression of adult consensual sexuality and an important part of people’s sexual orientation.
http://members.aol.com/NOWSM/Psychiatrists.html

US Safer S&M Web Sites Closes Down

UK proposal
Prison sentences of three years for private possession of SM images

In the last few months the US and UK governments have announced plans to crack down on personal SM profiles on the internet. Prison sentences of three years are being reported in the press for British inhabitants who download SM images from the Internet or have them stored at home if the legislation comes into force.
http://www.unfettered.co.uk/bdsmrights/backlash.html

The US Justice Department June 22. tightened up the Law 18 U.S.C. 2257, so that several web pages with personal SM profiles had to shut down or self-sensor their content. This far, www.boundandgagged.com, malebots.com, www.bondagezine.com and www.LeatherNavigator.com has closed down or has self-sensored their sites.

These proposals will also concern Norwegian and other European users of UK and US web communities, Svein Skeid in ReviseF65 say. Such restrictions can harm the work to stop hiv, and hinder prophylactic health work for the SM population, he says.

September 22. the US attorney General Alberto Gonzales, The Department of Justice and the FBI announced that any website hosted in the US that has content containing “bestiality, urination, defecation, as well as sadistic and masochistic behaviour” should be forewarned that obscenity prosecutions is possible. Additionally, Federal sentencing guidelines state that any obscenity-related punishment should be “enhanced for sadomasochistic material”.

Please support the Free Speech Coalition and the The National Coalition for Sexual Freedom, which have challenged lawsuits against the Justice Department and the Communications Decency Act, respectively. www.freespeechcoalition.com
www.ncsfreedom.org/

Midori, an author who teaches classes on bondage, has removed her website BeautyBound.com citing fear of obscenity prosecution. The SM site www.mrsdungeon.com now ask their members to remove all pictures showing genital SM-activity from their personal profiles.

Read the columne of John Pendal, International Mr Leather 2003
www.iml2003.com/being27.htm

www.rubberzone.com/apm/article.php?id=536 [dead link]

www.ncsfreedom.org/news/2005/102005ObscenityWave.htm [dead link]

The ICD-11 Revision: Scientific and political support for the Revise F65 reform Second report to the World Health Organization


The ICD-11 Revision:
Scientific and political support for the Revise F65 reform
Second report to the World Health Organization

Oslo, November 11, 2011

By Cand. Psychol Odd Reiersøl and Revise F65 leader Svein Skeid

Abstract

The interdisciplinary research-based knowledge in Revise F65’s second report to WHO, emphasizes that sadomasochism and sexualized violence are two different phenomena and that fetishists and sadomasochists do not present more psychopathology than the general population. The fetish/BDSM group is an equal contributor to the society and scores on the level with most people on psychosocial features and democratic values such as self control, empathy, responsibility, love, equality, and non-discrimination. Because the ICD fetish and SM diagnoses are superfluous, outdated, non scientific and stigmatizing to the fetish/BDSM minority, these diagnoses have been removed in nearly all of the Nordic countries. The diagnoses are so seldom in use, that neither care, statistics, nor research are affected by their abolition. The report concludes that a removal of the fetish- and SM diagnoses in the forthcoming edition of ICD-11, may have health promoting effects and be valuable to the society, in addition to an improved human rights situation regarding legal safety, real freedom of speech, and less experienced discrimination based on fetish- and BDSM identity and orientation.

Keywords: sadomasochism, fetishism, fetishistic transvestism, transvestism, SM and fetish identity, SM and fetish orientation, human rights

Background

As contributors to the book ‘Sadomasochism, Powerful Pleasures’, “Reiersøl and Skeid (2006) focused their efforts [with the Revise F65 reform project] and criticism on the ICD-10, concluding: The ICD diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism are outdated and not up to the scientific standards of the ICD manual. Their contents have not undergone any significant changes for the last hundred years. They are at best completely unnecessary. At worst, they are stigmatizing to minority groups in society” (Krueger, 2010).

May 7, 2007, Classification Coordinator Bedirhan Ustun, MD, at the World Health Organization in Geneva invited Revise F65 to cooperate with the work leading up to the ICD-11 revision.

In accordance with this invitation, Revise F65, September 24, 2009, sent the ‘ICD White Paper’ with the professional and health political foundation for completely removing fetishism, sadomasochism, transvestism and fetishistic transvestism in the new, revised version of the ICD, that is, the ICD-11 (Revise F65, 2009e).

In a mail to Revise F65 September 25, 2009, and a 40 minutes long phone conversation November 18, 2009, Senior Project Officer Dr. Geoffrey M. Reed, responsible for WHO’s revision of ICD-10 Mental and Behavioural Disorders, invited Revise F65 to provide additional scientific and political support for the Revise F65 reform to the ICD revision process.

Introduction

In accordance with this second invitation from WHO, additional scientific and political support follows for the Revise F65 sexual rights reform, consisting of research, empirical data, official national health decisions, law commissions and consultative statements, expert opinions, testimony and careful considerations from mental health professionals, researchers, historians, national health bodies and acknowledged fetish- and BDSM authorities.

In messages to WHO’s Senior Project Officer Dr. Geoffrey M. Reed February 4, 2010 and May 20, 2011, respectively, Revise F65 informed that Norway (Revise F65, 2010c) and Finland (Revise F65, 2011b), have completely removed their national versions of five SM and fetish diagnoses. Sweden removed six diagnoses of sexual behaviours in 2009 (Revise F65, 2008), among them the same classifications as Norway and Finland deleted. Denmark withdrew the diagnoses of dual-role transvestism and sadomasochism in 1994 and 1995, respectively (Politiken, 1995:A7).

Norway and Finland removed the following diagnoses February 1, 2010 and May 12, 2011, respectively:

F65.0 Fetishism
F65.1 Fetishistic transvestism
F65.5 Sadomasochism
F65.6 Multiple disorders of sexual preference
F64.1 Dual-role transvestism

Sweden, January 1, 2009 removed the following diagnoses:

F65.0 Fetishism
F65.1 Fetishistic transvestism
F65.5 Sadomasochism
F65.6 Multiple disorders of sexual preference
F64.1 Dual-role transvestism
F64.2 Gender identity disorder in youth
(Note: Revise F65 and Norwegian health authorities did not recommend deleting the F64.2 diagnosis because it may possibly give rights to children for important medical care).

Denmark, August 19, 1994 and May 1, 1995 respectively, removed the diagnoses:

F64.1 Dual-role transvestism
F65.5 Sadomasochism

Norwegian authorities describe BDSM and fetish as ‘sexual identities’. Finnish health authorities say that fetish/SM “has to do with sexual orientation”. The Swedish National Board of Health and Welfare says that as a fetishist or a BDSM practitioner, “You are not diseased. You are not perverse. You are a fully valued citizen!”

Definitions

The following terms are being used synonymously: ‘sadomasochism’, ‘SM’, ‘S/M’, and ‘BDSM’. They denote the phenomenon of consensual power exchange between adults.

Sigmund Freud connected the concepts of ‘sadism’ and ‘masochism’ into ‘sadomasochism’ in 1938 (Moser & Madeson, 1996:23). The concept of ‘BDSM’ was introduced in 1991 as a substitute for ‘sadomasochism’ which was often associated with an outdated notion of mental illness. While ‘sadomasochism’ is often abbreviated to ‘SM’, the acronym ‘BDSM’ implies a wider definition of three activities which may, but does not always, occur within sadomasochistic practice: ‘Bondage and Discipline’ (BD), ‘Dominance and Submission’ (DS), and ‘Sadism and Masochism’ (SM) (Ernulf & Innala, 1995; Reiersøl & Skeid, 2010).

Synonymously with ‘sadist’ and ‘masochist’, we will use the terms ‘dominant’ and ‘submissive’, ‘master’ and ‘slave’, ‘giver’ and ‘receiver’, ‘S’ and ‘M’, plus ‘top’ and ‘bottom’. ‘Leathermen’ may be used synonymously with ‘homosexuals into fetish and BDSM’.

‘SM or fetish orientation’ (Levitt et al., 1994:472; Wagenheim, 1998; Moser 1999b; Cutler, 2003; Hoff, 2003; Powers, 2007) includes inclination or interest for BDSM and fetishism.

We define ‘fetishism’ as a sexual orientation characterized by the desire for seeing, hearing, smelling, tasting or touching certain objects, pieces of clothing or body parts of a real or imagined partner.

The terms ‘Transvestic Fetishism’ and ‘Fetishistic transvestism’ are used interchangeably. The former is the DSM term which is widely used for research purposes, the latter is the ICD term supposedly used in diagnostic practices world wide.

Sadomasochism was normative before Krafft-Ebing

According to the American historian and sexologist Vern Bullough, sadomasochism was neither classified as a sickness nor a sin before the Austro-German psychiatrist Richard von Krafft-Ebing published the book ’Psychopathia sexualis’ in 1886 (Bullough & Bullough, 1977:210; Moser, 1999b). Bullough documents that our Christian cultural tradition is permeated with sadomasochistic behavior and that Krafft-Ebing constructed a new pathology of a behaviour which had been endemic and normative in Western culture (Bullough, Dixon & Dixon (1994:59,58).

Both physical and mental pain were important in the Judaeo-Christian tradition and punishment was best if the one who did the punishing did so on a person he loved. ”Accompanying the suffering were ecstatic visions which involved a ’high’ similar to what some participants in sado-masochistic activities of today recount” (Bullough, Dixon & Dixon, 1994:57,54).

The Christian ideology accepting both pain and suffering as necessary has long made the Western world prone to accept and tolerate a wide variety of behaviors which have come to be called sadomasochistic but which before the term was coined were more or less normative in our culture. ”Krafft-Ebing, without quite knowing it, made much of Western history a study of pathological behaviour” (Bullough, Dixon & Dixon, 1994:51-59).

This view is supported by a submission to the British Home Office (Slemmings, 2005):
”The history of modern prejudice against BDSM appears to date back to the publication of Psychopathia Sexualis by Richard von Krafft-Ebing in 1886. Prior to this date BDSM appears to have been accepted as an eccentricity (especially among the rich) and as a form of non-penetrative ‘safe sex’ at a time when syphilis was still a killer disease. Among the working classes the sexual act itself was often referred to as “a bit of slap and tickle” which implies BDSM was also acknowledged and practised even by the poor and less well educated.”

Degeneration, perversion, and moralistic hierarchy

Krafft-Ebing constructed the terms ‘sadism’ and ‘masochism’ from the authors Marquis de Sade and Leopold von Sacher-Masoch. In a letter to Krafft-Ebing Sacher-Masoch fruitlessly objected to the misuse of his family name (Moser & Madeson, 1996:22).

According to Thompson (1994:20), Krafft-Ebing’s theory was based on “a Victorian stereotype about male and female sexual responses”. According to Krafft-Ebing sadism was a pathological intensification of the masculine character and masochism a pathological degeneration of the distinctive psychical peculiarities of women (Bullough, Dixon, & Dixon, 1994:48).

In 1879 Krafft-Ebing wrote ’Lehrbuch der Psychiatrie’ that became ’the German bible of degeneration theory’.

He described sadism and masochism in terms of the theory of degeneration as published by Bénédict Morel. This stated that characteristics such as perversions can be inherited (Morel, 1857). In 1886, Dr. Krafft-Ebing defined SM as ‘a disturbance in the evolution of the psychosexual processes sprouting from the soil of psychical degeneration‘.

Even though Freud rejected the degeneration theory of Morel and Krafft-Ebing, and made his own theory of psychoanalysis, the doctrine of degeneration, according to Sulloway (1979:297), was long retained as a coordinate concept by many, including Freud. Freud also adhered to Krafft-Ebing’s concept of perversion and developed it further.

After 1933 degeneration became a part of the Nazi ideology (Shorter, 1997:102). The first social circles of heterosexual sadomasochists in the USA can be traced back to sexual refugees from Nazi Germany (USA Today, 2002).

“Those who combine homosexuality with sadistic and masochistic aberrations are among the cruelest people who walk this earth. In ancient times they found employment as professional torturers and executioners. More recently they filled the ranks of Hitler’s Gestapo and SS” (Reuben, 1969:135). In other words, Reuben is talking about a “double perversion” and so did several other educators. US psychiatrist Dr. David Reuben is probably the most well known. The title of his book ‘Everything You Always Wanted to Know About Sex (But Were Afraid to Ask)’ was one of the first sex manuals that entered mainstream culture in the 1960s, and it had a profound effect on sex education and in liberalizing attitudes towards sex. It was the most popular non-fiction book of its era and became part of the Sexual Revolution of modern America. The book was translated into 54 languages and sold in 52 countries and ultimately reached more than 150 million readers. In 1972 it was parodied by Woody Allen in the comedy film of the same name. The chapter on male homosexuality has received much criticism for perpetuating stereotypes and negative images of gay men as sex obsessed beings, of homosexual expression of sexuality as almost entirely impersonal, and of abusive “butch-queen” relationships as being typical where relationships exist at all. The author asserts very clearly that he considers homosexuality to be a perversion. Also calling into question the objectivity and usefulness of the book is its assertion that all prostitutes are lesbians and all lesbians are prostitutes.

The American National Organization for Women (NOW,) that initially condemned SM lesbians as perverse, removed their 20 years old official policy against SM from their ‘Delineation of Lesbian Rights’ policy in 1999 (Wright, 2006).

The feminist writer and cultural anthropologist Gayle S. Rubin Ph.D., observed that sexual identities are arranged in a hierarchical system ranging from monogamous married heterosexuality at the top to sex workers, sadomasochists, fetishists and those who desire across generational boundaries at the bottom. Those at the top of the hierarchy are privileged while those at the bottom are stigmatized and punished (Rubin, 1984/1993). Tiefer (1997) noted in her essay, ‘Towards a Feminist Sex Therapy’: “By ignoring the social context of sexuality, the DSM nomenclature perpetuates a dangerously naive and false vision of how sex really works,” separating what Gayle Rubin (1984) once called “the charmed circle [of] good, normal, natural, blessed sexuality” from “the outer limits [of] bad, abnormal, unnatural, damned sexuality.”

Prejudice disguised as science

The american psychoanalyst and researcher Robert Stoller (Stoller, 1991), cautioned his fellow psychoanalysts against accepting as facts about sadomasochism a set of assumptions made plausible by repetition but based on very little evidence.

He noted: “…psychoanalysts, Freud included, cooked up a soup with too few ingredients. For me, most psychoanalytic theories of sadism and masochism are boiled water masquerading as gourmet’s delight….Until recently, before loading up on facts, I had no reason to doubt the psychiatric and psychoanalytic wisdom… But then I began meeting sadomasochists…” (Stoller, 1991:9,21)

Stoller described how he changed his mind after having studied bondage and SM houses in California. “Presuming that almost everyone else is as I was, it may interest you to note my change in attitude”… “So, though I found my informants’ games unappealing (just as they may find our ‘vanilla’ practices), I no longer extrapolate and think these people are freaks” (p. 21). ”Psychoanalytic explanations will have to be more precise, more anchored in clinical data, and more modest…. it is immoral for psychoanalysts to hide their moralizing in jargon-soaked theory…. when we have little or no evidence, we do best, regarding theory making, to tread lightly, and…when we recognize the low quality of our evidence, we should go out and collect better evidence….” (Stoller 1991:9,21).

The National Coalition of Sexual Freedom (NCSF) criticizes the DSM for not considering the latest research: “Because the scientific evidence contradicts the statements currently within the DSM, we must conclude that the interpretation of the Paraphilias criteria has been politically – not scientifically – based.” “Because of this, BDSM practitioners, fetishists and cross-dressers are subject to bias, discrimination and social sanctions without any scientific basis” (NCSF, 2010).

Victorian stereotypes in the media

Charlotte Ovesson points out that Krafft-Ebing’s outdated theories are still alive in Swedish reference books (Herburt, 2009) and daily newspapers. She describes this thoroughly in a social psychological oriented sociological study (Ovesson, 2011:37,44).

Words are manipulated, and quotes are taken out of context to increase sales and to promote the stereotype of the unpredictable male sadist without moral limits (Ovesson, 2011:26,31,33,37). Phrases like “violent sex”, “torture”, and “sex torture networks” are being used regardless of consent or non consent (Ovesson, 2011:37).

The media also construct a stereotype of the woman as a victim even though she participated actively and voluntarily in the SM relationship (Ovesson, 2011:23). At the same time dominant women are non existing and women enjoying SM sex are made invisible in the spirit of the victorian stereotype (Ovesson, 2011:32,40,44).

Even where sadomasochism is described positively it is evident that it is considered as a deviation from the heteronormative sexuality (Ovesson, 2011:35). Due to internalized shame, many SM people retain the stereotypes by repeating the prejudices. The word ‘sadomasochism’ is being used in reports about accidents and crimes that have nothing to do with sadomasochism (Ovesson, 2011:34).

The confounding of SM with violence also permeates dictionaries and encyclopedias. In a study of sadomasochism in Swedish reference books 1876-2006, Kim Herburt at the Historical Faculty at the University of Stockholm points out how the reference books seldom describe sadomasochism within a consensual context (Ovesson, 2011:6; Herburt, 2009:418,419).

Nowhere was it clearly stated that sadomasochism and other sexual deviations were illnesses, but they were described in the same way as illnesses because causes and treatments were part of the articles. The reader will therefore interpret the described phenomena as illnesses (Herburt, 2009:417; Ovesson, 2011:6).

Research on pathology

The Revise F65 literature review shows that regardless of how the research is conducted, whether qualitative, quantitative, via telephone, via Internet, or by face to face interviews, there is the following tendency: sadomasochists do not have any more psychopathology than others. This is supported for example by Gosselin and Wilson (1980). They did not find anything pathological about the SM group. SM people did not display particularly high guilt levels nor were they more obsessional than other people. Breslow, Evans, & Langley (1985) also found SM play practitioners to be non-pathological. “These figures do not indicate that depression plays any greater part in the lives of sadomasochists than it does in non-sadomasochist’s lives. It can be concluded that, on the whole, sadomasochists seem to have accepted their SM interest” (Breslow, 1999). Breslow underlines that there is no typical sadomasochist. “The average sadomasochist is unremarkable, he or she is just like anyone else, with the one exception of having an interest in SM” (Breslow, 1999).

A lack of psychopathology is corroborated in studies by Miale (1986), Moser & Levitt (1987/1995:109), Sandnabba et al. (1999), Spengler (1977), Levitt et al. (1994), Sandnabba et al. (2002), Damon (2003), and Stiles et al. (2007).

Connolly et al. (2006), among a group with bondage and sadomasochistic interests (BDSM) showed that “no evidence was found to support the notion that major disorders — including depression, anxiety, mania/bipolarity, and obsessive-compulsivity — are more prevalent among the sample of individuals with BDSM interests than among members of the general population” (Connolly et al., 2006:117). Of special interest is the Connolly investigation of personality disorders. ”Paranoia and borderline pathology, the severe personality disorders described in the psychoanalytic literature as ubiquitous among BDSM practitioners, were remarkable in their absence from this sample” (Connolly et al., 2006:108). However, “While this finding does not support those psychoanalytic notions that imply a narcissistic personality structure is present in all, or even most, it does point to the likelihood that some BDSM practitioners (in this case 30.23%) are ‘clinically significant’ on this measure, indicating the presence of greater-than-average levels of narcissistic features and possibly suffer from narcissistic personality disorder” (Connolly et al., 2006:108). There was also evidence of a significantly higher level of histrionic features compared with general population estimates. The authors caution against interpreting this as pathology in the BDSM population, for example: “It has been noted that people in the Los Angeles BDSM community meet frequently for ‘play parties’ in which a high level of exhibitionism is deemed appropriate” (Connolly et al., 2006:109). On dissociative identity disorder (DID): “there is no evidence of a higher-than-average likelihood of DID” (Connolly et al., 2006:110). As with all other research there are methodological issues and the authors of this study have a thorough discussion about it. They conducted a very high number of comparisons: “After conducting over 100 statistical comparisons, a significant result on one or more disorders seemed almost guaranteed on the basis of chance alone” (Connolly et al., 2006:111).

Schmidt (1995) and Schmidt, Schiavi, Schover, Segraves, and Wise (1998) on the DSM-IV Sexual Disorders Workgroup reported that literature reviews completed for DSM-IV revealed a paucity of data supporting the scientific conceptual underpinning of current diagnostic terminology for sexual psychopathology. McConaghy (1999) suggested that, in view of the lack of a relationship of SM with psychiatric pathology, that sadomasochism, like homosexuality, should not be classified as a DSM disorder.

There is more information on the Revise website (Revise F65, 2009k). While the situation is better now than it was in 1998, we acknowledge there is still a paucity of data and that more research is welcome.

Health promoting sexuality

An early sexual rights reform advocate, the Swedish psychiatrist, Lars Ullerstam had a book published about the sexual minorities, including homosexuality, fetishism, transvestism, SM, as well as other ‘perversions’ that don’t harm anybody. He argues in length for the rights of these people to enjoy their sexuality: “One more thing we can be dead certain of: the “perversions” allow considerable chances to achieve human happiness. And therefore the “perversions” are in themselves good, and therefore they ought to be encouraged” (Ullerstam, 1966:43)

Even though Moser & Madeson (1996:40) and Breslow (1999) warn against probable sampling bias, research indicates that sadomasochists are well educated with higher income than the average population (Breslow et al., 1985; Moser & Levitt, 1987/1995; Levitt et al., 1994; Sandnabba et al., 1999; Breslow, 1999; Alison et al., 2001; Haymore, 2002; Connolly, 2006:88).

A survey using computer-assisted telephone interviews with 20,000 Australian men and women, showed that BDSM may actually make men happier. Men into BDSM scored significantly better on a scale of psychological well-being than other men. BDSM’ers were no more likely to have suffered sexual difficulties, sexual abuse, coercion or anxiety than other Australians. “This seems to imply that these men are actually happier as a result of their behaviour, though we’re not sure why”, said Dr. Juliet Richters, of the University of New South Wales. “It might just be that they’re more in harmony with themselves because they’re into something unusual and are comfortable with that. There’s a lot to be said for accepting who you are” (Richters et al., 2007, 2008).

The implication of two studies by Sagarin et al. (2009) into hormonal changes associated with sadomasochistic activities including spanking, bondage and flogging, at the Northern Illinois University, suggests that it could bring consenting couples closer together. The increases in relationship closeness combined with the displays of caring and affection observed as part of the SM activities offer support for the modern view that SM, when performed consensually, has the potential to increase intimacy between participants. This result is supported by a qualitative study by Thomsen (2002). Several SM techniques were helpful in gaining comfort with sexual intimacy, including control/power role play, communication, trust, a sense of safety, mutual respect, an emotional bond/intimacy, and being able to get in touch with one’s body. Respondents also gained self-esteem, self-respect, and knowledge of one’s self all of which are vital to achieving comfort with sexual intimacy. Cutler (2003) and Panter (1999) also found that SM participants use SM scenes to increase the intimacy of their relationships and experience a greater sense of personal and interpersonal empowerment.


ICD Revision White Paper
Revise F65’s first report to the World Health Organization, September 24, 2009.

Reiersøl, Odd & Skeid, Svein (2006). The ICD Diagnoses of Fetishism and Sadomasochism.  In P.J. Kleinplatz and C. Moser (Eds.). Sadomasochism, Powerful Pleasures (pp. 243-262). Published simultaniously in The Journal of Homosexuality, Volume 50, Issue 2&3, May 2006.

Odd Reiersøl is educated as a psychologist at the University of Oslo. He has been working at Solverv Psychotherapy Institute in Oslo for the last 23 years as a psychotherapist with adults, couples and groups as well as educating other professionals. He also has a university degree in mathematics and mathematical statistics.

Svein Skeid is the leader of Revise F65, and has been working with gay and BDSM human rights for 30 years. He has been awarded prizes several times, included ‘Gay Person of the Year Award’ in 2003, the greatist honor of the Norwegian gay movement.

The Revise F65 project was established in 1996 with a mandate from the Norwegian National LGBT Association of lesbians, gays, bisexuals and transgenders (LLH). Revise F65 consists of gay and straight BDSM human rights organizations as well as mental health professionals. The purpose of Revise F65 is to remove Sadomasochism, Fetishism, Fetishistic Transvestism and Transvestism as psychiatric diagnoses from the International Classification of Diseases (ICD) published by the World Health Organization (WHO).

 

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SM versus violence

The Canadian researchers Cross and Matheson (2006:144-145) found no evidence for Krafft-Ebing’s claim that masochists suffer from psychiatric illness or that SM sadists are antisocial or violent (Krafft-Ebing, 1886/1965). They neither found any support for Freud’s theory about self mutilating masochists or id-driven psychopathic SM sadists (Freud, 1900/1954, 1906/1953, 1924/1961).

‘The Leatherman’s Handbook’ by Larry Townsend was the first pioneer book that describes the psychology, communication and precautions in SM. In this way he gave the first safety rules that have been carried on for generations of gay leather men world wide. Townsend points out that emotional involvement is just as prevalent in SM as in other sexual relationships, that empathy is “the key to the game” and that the S’s “degree of insight into the M’s responses will make or break the scene” (Townsend, 1972:28).

A study by Weinberg (1994/1995) of the type and nature of SM play practices, revealed the importance of control in SM play, as well as mutual concern among its practitioners. The actual power in BDSM may lie with the ‘bottom’, who typically creates the script, or at least sets the boundaries, by which the S&M practitioners play.

The researchers Ernulf and Innala (1995) observed discussions among individuals with such interests, one of whom described the goal of “hyperdominants“. “A good top is an empathetic person who knows how to tell with the least possible feedback exactly what will blow the bottom’s mind. The top enjoys his pleasure vicariously” (Ernulf & Innala, 1995:644).

Luc Granger, Ph.D., head of the Department of Psychology at the University of Montreal, created an intensive treatment program for sexual aggressors in La Macaza Prison in Quebec; he has also conducted research on the S&M community. “They are very separate populations,” he says (Apostolides, 1999)

Fedoroff, Paul J. MD (2008:644,637) points out that sexual sadism is a heterogeneous phenomenon and sexual sadism within the context of mutual consent should not be mistaken for acts of sexual violence or aggression. “Sexual arousal from consensual interactions that include domination should be distinguished from nonconsensual sex acts.”

While consensual sexual sadomasochism may include 5-10 percent of the population (Revise F65, 2009g), ‘‘virtually all of the published papers using DSM criteria for Sexual Sadism have been done on studies of forensic populations’’ (Krueger, 2010). Even if Krueger doesn’t want to remove any diagnoses, in a report for the forthcoming DSM-V, he stresses that it is important “to distinguish individuals practicing S & M as part of consensual sexual activity from individuals who have been arrested for such activity and are in the forensic system”. “One might anticipate that therapy for those practicing S & M may involve issues other than their S & M or involve ‘‘normalizing’’ (i.e., making acceptable) their sexual fantasies or behavior (Kleinplatz & Moser, 2004; Nichols, 2006). With forensic populations, the focus would be on controlling or suppressing sadistic arousal and behavior (Krueger & Kaplan, 2002)”.

Park Elliot Dietz is a forensic psychologist who consistently tries to point out the absurdity of the link between S/M devotees and psychotic criminals. According to Dietz (1990), there are five main differences between psychotic sadistic serial murderers and SM devotees:

1. Psychotics search for unwilling partners. S/M devotees use a ‘safeword’ that the submissive can say at any time to end the scene, thus the submissive retains real control throughout the encounter.

2. Psychotics force their acts on the victim rather than aiming at pleasing the submissive (as in S/M). The psychotic sadistic acts are quite different from S/M practices, and usually include: forced anal penetration, forced fellatio, or violent vaginal-penetration with various foreign objects – rather than the penis.

3. The sadistic offenders’ demeanor is diametrically opposed to S/M devotees: usually the psychotic is detached and unemotional throughout the torture, while the S/M dominant appears to achieve a “high” or pleasure equivalent during the scene.

4. Psychotic criminals torture their victims, inflicting serious and permanent injury, trying to arouse terror in their victims. S/M devotees skillfully enhance the sexual arousal of their partner, following the rules and guidelines that were established before the scene, thus creating only the illusion that the submissive is not in control.

5. Psychotics usually have a past history of sexual crimes such as rape or incest. S/M devotees are average people who typically don’t have criminal pasts.

John K. Noyes, Ph.D. sees SM play as symbolic acts in the form of staged aggression, a kind of consensual play or acting, as distinguished from actual aggression in the form of violent, nonconsensual behavior. “As a staged aggression, it may even be in a position to defuse social violence and to put forward alternative and socially viable models of coping with aggression in a manner that minimizes its negative effects” (Noyes, 1997:30).

The sociologists took their lead from the anthropologist Paul Gebhard, whose 1969 essay ‘Fetishism and Sadomasochism’ undermined the idea of individual pathology by pointing to sadomasochism’s cultural roots, and the futility of defining a widespread and diffuse sexual practice by reference to a few “extreme” examples. He stated that S/M practices were “only prevalent in its organized form in literate societies full of symbolic meanings.” This means that far from being a manifestation of a base instinct, sadomasochism required a considerable amount of intelligence and organization (Gebhard, 1969/1995).

In a manuscript dated May 11, 1955, the Australian composer, pianist and self-documented sadomasochist Percy Grainger wrote: “Flagellantic interests may be grouped together with such games as football, wrestling, boxing in this respect: they all represent something that originally was harsh, cruel, violent and destructive, but which have now become playful rather than cruel, teasing rather than destructive, friendly rather than hostile. In other words, they are typical of a world that has shed much of its warlikeness and become really peaceable, that has replaced competition and hostility with comradeship and co-operation” (Grainger, 1955/1999).

See also: SM versus abuse (Revise F65, 2007).

Pleasure and pain

The British psychologist and medical doctor Havelock Ellis (Ellis, 1926/1995) was among the first who understood that SM practitioners are seeking pleasure, not pain. He also understood that sadomasochistic practices are confined to consensual situations. Among supporters of these viewpoints were (Thomsen, 2002), Iwan Bloch (Bloch, 1933/1994), and Theodor Reik (Reik, 1940, 1941).

Morphine receptors in the brain have been known since the 1970s; these are designed to receive endorphins, morphine-like substances produced by the body that are both powerful pain-killers and antidepressants (Bullough, Dixon & Dixon, 1994:50). The American medical doctor Lawrence Mass was wondering if the newly discovered endorphins could influence SM interactions (Mass, 1979:292). The Canadian writer, Geoff Mains, introduced the notion of endorphins as a critical component of S/M sexuality (Mains, 1984:11,64). The Danish psychiatrist Birgit Johansen, in her book “Smertens lyst” (The pleasure of pain), pointed out how the painkilling endorphins can be a possible explanation for the pain management in sadomasochists (Johansen, 1990).

Professor Emerita, Beverly Whipple PhD, and her colleagues in the 1980s did research on women, sex and pain. They found that sexual stimulation elevates pain threshold by 40 per cent and over 100 per cent during an orgasm (Whipple, 1986). Before orgasm, oxytocin, which is released from the brain, surges up to five times the normal level, which in turn causes the release of endorphins, our natural pain-killing hormones. In addition to decreasing pain, endorphins produce a spiritually elevating effect and positive perception of the environment. Most surveys are done with women, but it is certain that the pain threshold before and after an orgasm is elevated in both men and women, according to Specialist in Neurology Per Olov Lundberg, MD, PhD (VG, 2002).

Even anticipation of pain can activate a general physiological arousal which can be channelled into sexual feelings or be regarded as such by its participants. Weinberg, Williams and Moser (1984) argued that whether pain was real or apparent, light or heavy, was not important to their definition but only to the interpretation that the participants put upon it. Their definition gives as much emphasis to the psychological as to the physical (Bullough, Dixon & Dixon, 1994:50).

The balance between pleasure and pain is dependent on the situation. In a philosophical dissertation at Vanderbilt University, Nashville Tennessee, Ramsour (2002) points out that the only pain that works is what is thoroughly planned and with the correct dosage. The masochist does not gain pleasure or sexual satisfaction from accidental pain. Sadomasochists do not obtain more pleasure than others by visiting the dentist. The intensity of the pain does not determine the pleasure, but the individual balance between pain and pleasure (Bullough, Dixon & Dixon, 1994:50; Reiersøl & Skeid, 2010).

Research by Alison et al. (2001:10) indicate that tops used flagellation as a method of administering pain rather than as a way to inflict humiliation: “for the gay male group the administration and reception of pain was a more intense and real perception and that the symbolic representation of pain (humiliation) was more important for the women and the heterosexual men.”

What SM can teach us

However, most other authors point out that contrary to pain, dominance and submission or power exchange is the essence of SM/BDSM (Gebhard, 1969; Califia, 1979; Scott, 1980/1998; Kamel, 1983; Scoville, 1984; Ernulf & Innala, 1995; Cross, 1998; Weinberg, 2006:33; Cross & Matheson, 2006:158). “Pain is not the central or guiding principle of S&M. Indeed, it is not even essential to sadomasochistic activities” (Baumeister, 1988a:37; Weinberg, 1995:291). “Pain is far from unknown in S&M, but the pain is secondary” (Vail & Goode, 2007:202).

This research indicates that pain is only one of several ways to stage the illusion of dominance and submission. “The only power he’s got is what I let him have”, one of the participants in a study commented. And one master said: “To say I have the power and the control is misleading. We are out to please each other” (Cross & Matheson, 2006:157). In order to emphasize his/her authority, it is not uncommon for the master to push the limits a little to add a feeling of authenticity to the scene (Weinberg, 2006:34).

But as the examples cited above indicate, the participants do not regard the role playing as “real” (Weinberg, 2006:33). Both the power of fantasy and a mutually agreed upon definition are required to fulfill the illusion that the receiver is under total control of the master (Weinberg, 1995:300; Magill, 1982; Brodsky, 1993; Sandnabba et al., 1999; Lee, 1979:87,92).

“The imitation of humiliation is carefully constructed never to produce true humiliation. The imitation of trauma, such as when being humiliated is enacted, is not traumatic. Constant, high attention to one’s partner’s experience is more caring and safer than the blundering, ignorant, noncommunicating obtuseness that governs so many “normal” people’s erotic motions” (Stoller, 1991:21).

Besides pain, for example bondage, various fetishes and responsibility and care on part of the (almost parental) sadist may be used to maintain the illusion of a power and status differential (Cross og Matheson, 2006:157; Reiersøl & Skeid, 2010:313). In line with the results of their research, Sagarin et al. (2009) state that various aspects of care and intimacy are present at every stage in BDSM (foreplay, interaction and aftercare).

SM is symbolic power playing where the receiver as an equal partner voluntarily transfers control to the master. The master takes and administrates the control, while adapting to the wishes and reactions of the receiver (Reiersøl & Skeid, 2010; Moser, 1988:50; Weinberg, 1978/1995; Weinberg & Falk, 1980; Baumeister, 1988b; Brame et al., 1993; Miller & Devon, 1995; Hoople, 1996).

Furthermore, Weinberg (2006:33) states that “sadomasochistic scenes are both consensual and collaboratively produced (Baumeister, 1988b; Hoople, 1996; Weinberg, 1978/1995; Weinberg & Falk, 1980). What may appear to the uninitiated observer to be spontaneous behavior is often carefully planned.” “All parties to the interaction must agree to participate. Forced participation is not acceptable within the subculture; it is only the illusion that individuals are coerced that is approved by sadomasochists” (Weinberg, 2006:34).

As expressed by the American author Annalee Newitz: “Games in which power is exchanged, granted and, most importantly, controlled, can teach players how power works and what it means to defy it. As experienced players often report, S/M games are as much about trusting your partner(s) to take or relinquish power as they are about shiny boots and luscious whips. It’s for this reason that theories of consent are at the very core of S/M thought” (Newitz, 2000).

The researchers Patricia A. Cross Ph.D. and Kim Matheson Ph.D. (Cross & Matheson, 2006:147) found no evidence for Baumeister’s contention that masochists were more inclined to engage in escapist behaviors such as drug-taking, day-dreaming, or fantasizing than the comparison group (Baumeister, 1988a, 1989). Breslow (1999): There is a myth that masochists are high level corporate executives who need to be dominated and humiliated in order to help relieve business pressures. The people responding to the questionnaire had a large range of occupations, including, but not limited to: Medical doctors, lawyers, college professors, psychologists, social workers, fireman, policeman, carpenters, computer programmers, communication systems analysts, forest service employees, members of the armed forces, artists, housewives, clerks, postal employees, as well as welfare recipients, etc. Although a myth exists that SM interests are limited to corporate executives who have high pressure jobs and need SM to “unwind,” or “relax,” it is apparent from this list that sadomasochists have a variety of occupations, which range across all socioeconomic groups.

According to Reiersøl & Skeid (2010) both the dominant and the submissive must be involved in all the phases of foreplay, interaction and aftercare to achieve the important balance of safety and excitement (Pagh, 1985:56, Mains, 1984:65; Califia, 1979; Kamel, 1980; Lee, 1979; Weinberg, 1995:294). During the foreplay, or negotiation phase, security procedures, personal limits and safe words are agreed upon, so that the game can be interrupted in case something feels wrong to either party (Moser, 1998; Califia-Rice, 1994/2000, 1993/2002; Miller, 1995; Wiseman, 1996). This phase may also be non verbal, communicated by clothing, body language and various signals. 90 percent of the communication that takes place during the interaction phase is probably non visible for the uninitiated. The authority of the master is dependent upon her ability to empathize and communicate, as well as knowledge about what turns the partner on. The aftercare, or the landing phase, gives an opportunity to evaluate the session, for example by talking and cuddling to get grounded after the high that was produced by the endorphins during the interaction phase.

The author Annalee Newitz writes: “It’s from S/M theory that we’ve developed the concept of ‘safe words’: established phrases that signal the end of a scene (many people use the easy-to-remember ‘yellow’ to request a slow down, and ‘red’ for stop). But more importantly, S/M theory has inaugurated a whole new way of engaging in sexual communication. In the S/M community, communication is at the root of all sexual satisfaction” (Newitz, 2000).

Charlotte Ovesson writes in her study of sadomasochism in Swedish daily newspapers, 2007-2011, that “when sadomasochism is regarded as sick, that is a problem for those who are sadomasochists, but it is also a problem for the rest of society that does not learn what people with a non normative sexuality know” (Ovesson, 2011:28). Clinical psychologist Edith Thomsen Ph.D. thinks that society could learn a lot by listening to SM negotiation, because it applies to sex in general just as much as to SM (Thomsen, 2002).

The australian writer, broadcaster and researcher Kath Albury Ph. D., points out how “the practice of BDSM offers heterosexual women a structure for sexual negotiation that can also be seen to undermine the conventions of compulsory heterosexuality. ”Unlike the high level of risks — of unplanned pregnancy, STIs, regret or insufficient consent — involved in traditional heterosex, where sex ‘just happens’ (Holland et al, 1998), BDSM is generally expected to involve advanced negotiation and preagreed signals (i.e., a ‘safeword’) to indicate slow down or stop (Califia-Rice, 2000, 2002; Miller, 1995; Wiseman, 1998). This participatory approach offers a radical alternative to relationships, sexual or otherwise, in our lives in which we do not feel empowered to negotiate, sexual or otherwise (Albury, 2002:176-181). Summary by Heckert (2005:25).

SM and equality

Unlike Krafft-Ebing, Sigmund Freud saw sadism and masochism as being two forms of the same entity, and he noted that they were often found in the same person. Sadism and masochism are flexible roles where the sadist and the masochist often switch the dominance during the interaction, depending on the type of activity, from time to time, or as a means of personal development (Freud, 1938:570; Weinberg & Kamel, 1995b:17; Miller & Devon, 1995; Reiersøl & Skeid, 2010).

According to Weinberg (1995:293) many authors have found that a significant number of sadomasochists are flexible, with the ability to switch their chosen role. (Breslow et al. 1985; Moser and Levitt, 1987; Califia, 1979; Gebhard, 1969/1995; Kamel, 1980; Moser, 1988; Naerssen et al., 1987; Spengler, 1977; Weinberg, 1978/1995). Weinberg points out that for many people it seems like the content of the role play is essential and not the particular role that each participant takes (Weinberg, 1995:293).

“Pat Califia (Califia, 1979/1995) discusses the politics of society, men usually being the ones in positions of authority, and how in SM play that is not necessarily the case. She feels that is one of the reasons that many members of society, especially those with authority, dislike SM play” (Thomsen, 2002). Liz Highleyman (1997), argued that, “SM play involves interpersonal power exchange, which is diametrically opposed to real world authoritarian roles, which are typically unidirectional. One participant is always on top, and the other is always on the bottom. Except in rare circumstances, the victim of the cop, soldier, or warden does not have the opportunity to ‘exchange’ any power whatsoever” (Highleyman, 1997). Research on 184 Finnish sadomasochistically oriented individuals found that two-thirds indicated having much flexibility in being able to switch from masochistic to sadistic positions (Sandnabba et al., 2002).

The French philosopher, sociologist, historian and self-identified sadomasochist Michel Foucault emphasizes how SM differs from social power: “What characterized power is the fact that it is a strategic relation that has been stabilized through institutions. (Through) courts, codes and so on . . . the strategic relations of people are made rigid. The SM game is very interesting because it is a strategic relation, but it is always fluid. Of course, there are roles, but everybody knows very well that those roles can be reversed. Sometimes the scene begins with the master and slave, and at the end the slave has become the master. Or, even when the roles are stabilized, you know very well that it is always a game: either the rules are transgressed, or there is an agreement, either explicit or tacit, that makes them aware of certain boundaries” (Halperin, 1995:86; Gallagher, 1989/1994).

The European Fetish and SM movement has a long tradition working against racism and Nazism. For example, in 1998 the homosexual umbrella organization ECMC, with its 50 European member clubs clearly condemned “racist and Nazi attitudes, statements, actions, and membership in such anti democratic organizations”. Such manifestations are according to their objectives incompatible with membership in ECMC (European Confederation of Motorcycle Clubs) (Revise F65, 2004f).

Tyler McCormick was elected International Mr. Leather 2010. McCormick, a female-to-male transgender man who uses a wheelchair, bested a field of 50 contestants, from across the U.S. and around the world. This is another example of non discrimination policies within the SM and fetish movement (Revise F65, 2010b:6).

Safe, sane and consensual

Weinberg, Falk, Lee and Kamel (1983) studied the SM environment in San Francisco and New York during a seven year period from 1976. They found that the SM community had developed their own techniques, rules, tenets, structures, language and organizations in order to reduce possible damage (Thompson, 1994:122).

Likewise, the clinical psychologist Edith Thomsen found in a qualitative study (Thomsen, 2002) how “the different techniques and activities involved with SM play are infused within a structure consisting of rules, that are mutually agreed upon in advance by the participants, and framed within a context of mores held by the SM community”.

Kama Sutra, written by Vatsysayana, year 100-400, described safe practice of several types of activity which we today can call sadomasochism: erotic striking, biting, scratching, and different accompanying cry of pain. According to Moser “SM behaviors are seen throughout history, dating back at least to ancient Egypt and the Hindu culture in India…” (Moser & Madeson 1996/1999:34). There is evidence of the masochistic side of SM play in the 1500s, in Europe, of its spreading during the 1600s, and being widespread by the 1700s” (Baumeister 1989/1997:9).

“In 1788, the French doctor Francois Amedee Doppet, at the end of his article “Das Beisseln und sein Auswirkung auf den Geschlechtstrieb”, gave safety tips for flagellants. This is the first known SM safety text in modern time.” (Leather History Timeline, 1999)

Larry Townsend who wrote “The Leatherman’s Handbook” in 1972 was the pioneer who described the psychology, communication and the safety rules in SM. Technical and psychological skills were transferred from experienced to inexperienced leathermen. Even though the value of Townsend’s book has been doubted, by for example Scott (1998:xi), he did give the first hints about security rules which have been taken, expanded, and carried further by later generations of leathermen (Townsend, 1972).

As a stigmatized minority within a minority, gay leathermen were hit hard by the AIDS crisis in the beginning of the 1980’s. Simultaneously the epidemic resulted in more focus on non-penetrative sexual practices as alternatives to unsafe sex. SM is relatively safe sex that does not produce children nor does it result in sexual diseases. The latter may have contributed to the increasing popularity of sadomasochism among homosexuals (Newitz, 2000).

In the wake of the AIDS epidemic, the American gay SM group GMSMA for the very first time used the phrase “safe, sane, consensual” in 1983. Since then “safe, sane, and consensual” has become one of several recognized moral ethical principles and cornerstones of SM activity (Stein, 2002; Revise F65, 2004e).

Townsend’s message about empathy and practical SM advice were expanded to contain prevention of HIV and AIDS. In Europe, the half hundred member clubs of the gay leather umbrella organization ECMC, European Confederation of Motorcycle Clubs, published Safer sex-manuals, in many countries financed by the national heath authorities. Switzerland and Norway were the first, in 1990 and 1991 respectively (Loge 70, 1990). In Norway, this cooperation with the health authorities was the first seed that in 2010 led to the repeal of the fetish and SM diagnoses. People are not protected against STDs by labelling them as ill (Revise F65, 1997).

BDSM women

According to Weinberg (2006:32), the assumption that there were few women in the BDSM culture has been rejected. There is an increasing amount of research on this issue (Alison et al., 2001; Moser and Levitt, 1987/1995). Breslow, Evans, & Langley (1985) reported a significant number of women in the SM subculture. By combining the data of Breslow et al. (1985) and Levitt et al. (1994), a ratio of four male masochists to each female masochist was found (Moser & Kleinplatz, 2005). Fedoroff (2008:640) argues that “surveys have found no difference in frequency of sadistic fantasies in men and women.” On an internet questionnaire of 6997 Fetish/BDSM practitioners, 43 percent were female and 57 percent male (Brame, 2000). In the national Norwegian fetish and SM association SMil Norway 40 per cent of the 356 members are female (SMil-Norge, 2010).

Breslow (1999) pointed out that the Freudian myth that women don’t have SM interests doesn’t stand up to examination. ”It is evident that there are enough SM women to allow many men and women to find each other and enter into long term relationships.” The Canadian researchers Cross, PhD and Matheson, PhD (2006:146) found no evidence suggesting that sadomasochists espoused anti-feminist, patriarchal values or traditional gender roles to a greater extent that the non-SM-group.

Female Fetishism

The ICD is stuck with the notion that fetishism is almost exclusively a male phenomenon. “Fetishism is limited almost exclusively to males” (from the diagnostic guidelines in the ICD-10).

Gamman and Makinen (1994) refer to numerous studies that document female fetishists. These authors have reviewed psychoanalytical reports. After extensive reading of clinical data they concluded: “women made up a significant number of the case studies cited and yet the clinicians each claimed their own female patient was a ‘rarity’” (Gamman and Makinen, 1994:6). “At least a third of the psychoanalytic literature we have looked at contains detailed references to women who fetishise” (Gamman and Makinen, 1994:96). They further claim that more examples of female fetishists have gone undetected. “This is because, on the whole, fetishists do not see their problem as abnormal; case studies tend to arise when a fetishist enters analysis because of some other personal problem” (Gamman and Makinen, 1994:98). They think that the “phallocentric” theory of fetishism in psychoanalysis contributes to the ignoring of female fetishism: “The primacy Freudian theory gives to the fear of castration and the phallic mother has, we feel, created a blindspot that prevents the analysts and psychologists from seeing the evidence in front of their own eyes” (Gamman and Makinen, 1994:98). Being psychoanalytically oriented themselves, they offer an alternative theory of the origin of fetishism based on conflict at the oral stage, resulting in separation anxiety which in turn can create fixation on certain objects that may be sexualized (Gamman and Makinen, 1994:117). A conflict at the oral stage could of course be at least as troublesome as at the phallic stage, but conflicts do not necessarily result in pathology. Neither do “fixations”. Developing fetishes might just as well be considered healthy adaptations.

Female fetishism is underestimated also because women traditionally, for cultural reasons, were more sexually inhibited than men. Women have in fact been regarded as non sexual. As women become more aware of their sexuality, they let themselves fantasize and take initiative to various types of sex. It is reasonable to assume that there will be a lot more evidence of female fetishists as the years pass by. Unfortunately there has been very little, if any, demographic research on fetishism.

There has been several studies on SM populations, but even in that area more research is needed. We have, in our experiences, encountered many fetishists, both men and women. In our experience it is not unusual that women get sexually turned on by wearing men’s clothing, for example male underwear.

The authors of the book Different Loving (Brame et al., 1993), say:

“We believe that both genders are equally likely to be fetishistic, but that from childhood on, men are apt to be more aware of the erotic connection because their arousal is visible. As adults they are more assertive in seeking out encounters and discussing the interest. Women are liable to be unaware of the connection between object or act and personal arousal. And since women are usually discouraged from acting on their sexual impulses, they probably are more likely to hide their desires, even from themselves” (pp. 360-361).

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Discrimination

The American lesbian SM-group Female Trouble in Philadelphia in 1994 published the study “Violence against SM Women within the Lesbian Community” (The “Jad Keres Report”). Based on 539 questionnaires completed by lesbian sadomasochists, the study documents that 56% of them were subjected to some form of violence from vanilla lesbians because of their SM orientation (Jad Keres Report, 1994; LLC, 1998).

Even though it seems that women are more likely than men to be discriminated against, both men and women are targeted on a large scale. The NCSF Violence & Discrimination Survey, 1999, found that 1/3 of over 1000 leather/fetish/SM persons surveyed suffered violence, discrimination and persecution — losing their job or even their children because of their sexual lifestyle and identity (NCSF, 1999).

The most up to date and the largest material that we have found is an online, internet-based survey carried out by the National Coalition for Sexual Freedom with 3,058 respondents (NCSF, 2008), showed that 37.5% of the participants indicated that they had either been discriminated against, had experienced some form of harassment or violence, or had some form of harassment or discrimination aimed at their BDSM-leather-fetish-related business. 60% of the respondents were not ‘‘out’’ about their BDSM interests; the stress of being closeted and/or coming out promotes distress and impairment in these individuals, similar to that experienced by homosexuals. 11.3% of the total number of respondents reported being discriminated against by professional or personal service providers like medical doctors and mental health practitioners. The study included respondents from 41 countries, including Europe, in addition to the United States (83,4%). More women than men responded to the survey and more women than men were discriminated against (NCSF, 2008). Susan Wright states that “Legal complications and interpersonal difficulties are common consequences of the stigma and discrimination against BDSM practices.” “Pathologizing unusual sexual interests has led to increased discrimination and discouraged individuals from seeking treatment for physical and mental health problems” (Wright, 2010).

Revise F65 has written two reports, including case studies from Norway, that confirm the NCSF’s findings (Revise F65, 2004c; Revise F65, 2011a). The latter was submitted to the Norwegian Minister of Children, Equality and Social Inclusion, Audun Lysbakken, October 11, 2011.

NCSF’ finding that 60% of the respondents were not ‘‘out’’ about their BDSM interests, illustrate an important point about non visibility of the BDSM group. People in the pride parade in Oslo, 2011, typically wore masks as a protection against being identified. This is a problem when fighting against discrimination and for equal rights. We do not know how many of the BDSM people in Oslo who chose not to participate in the parade, were ashamed of showing themselves in public. But we do know that even though the diagnoses are removed from the Norwegian diagnostic register, there is still a danger of discrimination, for example in the work place. Shame is apparently a problem that is related to discrimination. When people are shamed by others, they often internalize that shame. This is particularly true for people in a group subject to discrimination. Knowledge on stigma (Goffman, 1963) shows that many psychological, physical, and social problems are not due to the person herself, but due to taboos, prejudices, and discrimination imposed by the surroundings (Reiersøl, 2002; Reiersøl & Skeid, 2010).

Repressed sexual desires and distress over BDSM interests may signify socially imposed, internalized BDSM negativity (Nichols, 2000) similar to feelings of shame and internalized homophobia sometimes experienced by gay clients (Nichols, 2006; Falco, 1991). Richters et al. (2008) point out that distress to BDSM participants also can be caused by legal persecution (Ridinger, 2006; White, 2006) or social or professional disapproval (Kolmes et al., 2006; Nichols, 2006). Double minorities are especially vulnerable. For example people who are both homosexual and fetishists may have to come out of at least two closets, first as homosexual, then as a fetishist, and maybe also as an SM practitioner (Reiersøl & Skeid, 2010).

Childhood trauma?

According to Powers (2007), various case studies have tried to show a connection between sadomasochism and pathological family relations during childhood (Blos, 1991; Blum, 1991), but these reports lack empirical data. Others have asserted that the majority of BDSM people have been subjected to childhood sexual abuse (Bass & Davis, 1998). Empirical studies indicate, however, that the frequency of SM people who report early damage or sexual abuse are about the same as for the rest of the population (Santilla et al., 2000; Brame, 2000; Moser, 2002). The SM group had not experienced more corporal punishment during childhood (Gosselin & Wilson, 1980). A survey using computer-assisted telephone interviews with 20,000 Australian men and women, BDSM’ers were no more likely to have suffered sexual difficulties, sexual abuse or coercion or anxiety than other Australians. Researchers said the study helps break down the reigning stereotype that people into bondage and discipline were damaged as children and were therefore “dysfunctional” (Richters et al., 2007, 2008).

One would think that if sadomasochism is due to childhood trauma, the SM diagnosis would be applied more than it actually is. Information from Norwegian, Swedish and Finnish health authorities show that the diagnosis has virtually not been in use in modern time (Revise F65, 2005/2011). American studies show that out of a total of 446 million outpatient ambulatory consultations to therapists and medical doctors, not a single person was diagnosed with sexual sadism or sexual masochism (Krueger, 2010).

A study by Powers (2007) indicate that some participants find BDSM activities to be an empowering, erotic exploration that resolves emotional or physical pain from childhood abuse, physical disability and illness. While trauma is no more common in BDSM participants than in the general population, erotic encounters can lead to “transformative intrapsychic, spiritual and interpersonal growth” (Powers, 2007; Schnarch, 1991; Maltz, 1991). In this way, healing may occur via corrective emotional experiences that transform and reintegrate a participant’s relationship with the past (Kleinplatz, 2001). This should not be surprising since clinical work with survivors of child sexual abuse (Courtois, 1993) suggests techniques paralleling those described by observers and practitioners of BDSM play (Powers, 2007; Kleinplatz, 2006; Thomsen, 2002). Adult survivors of childhood sexual abuse have difficulty trusting others and often have a great need to be in control (Courtois, 1988). The consensual exploration of trust and control are two integral elements of most BDSM play that allow participants to discover sexuality in an environment that may feel safer to them. It allows participants to consensually redefine past and present trauma through new, positive experiences (Haines, 1999). BDSM play provides a structure in which the participants can experiment with sexual activities and emotional intimacy within specific boundaries to overcome inhibitions that have evolved from part interactions (Thomsen, 2002). This may allow them to achieve emotional and sexual communication in ways that they had not been previously able to obtain. A qualitative study of eight SM practitioners in long-term committed relationships showed that SM enactments can be healing tools and tools for transformations (Hoff, 2003).

Prejudiced therapists

Reiersøl and Skeid (2010) write in the Journal of Psychological Health Work that “therapists holding prejudiced attitudes towards BDSM are at best unable to help their clients. In the worst case, they risk making their patients worse. This situation is parallel to the problems that lesbians and homosexuals used to encounter within the health care system” (Revise F65, 2011a).

Quantitative and qualitative studies confirm that psychotherapists show negative, uninformed and judgmental attitudes towards SM practice. The negative attitudes ranged from the therapist asking ignorant and judgmental questions to instances of client abandonment. Some of the SM practitioners reported avoiding any reference to SM to their psychotherapist because they feared the therapist’s reaction (Hoff, 2003, 2009; Moser & Levitt, 1987/1995; Moser, 1988; Queen, 1996; Kolmes, Stock and Moser, 2006). The psychologist and sex-therapist Margareth Nichols (2006) found that stigma will cause the practitioner to narrow the focus of therapeutic interaction to the BDSM sexuality against the will or desire of the client. Moser (1999a) stated that “health care professionals cannot give top-notch care to someone whose lifestyle they don’t understand or don’t approve of. Sexual minorities cannot get the best that the health care system has to offer if they refuse to use that system, or if they withhold information out of fear or shame.”

Animal kingdom

(Wiseman, 1996:14: “If you think there’s such a thing as “natural” sex, consider the variety of sexual expression found among animals.”)
Not only are SM and fetishism natural parts of human diversity. SM-type behavior is known even in the animal world where Ford & Beach (1951) contend that biting and aggressive behavior are common. Kinsey et al. (1953) found SM-type behavior prevalent in animal cultures. They noted that twenty-four different mammals other than humans bite during coitus, and Gebhard (1976:163) concluded that “from a phylogenetic viewpoint, it is no surprise to find sadomasochism in human beings”. According to Bagemihl (1999) the animal kingdom embraces a whole spectrum of sexual behaviour like different kinds of fetishism, transgenderism, erotic biting and even non-violent play-fights.

Ethology: Sign Stimuli.

Research by Tinbergen and others showed that stimuli stronger than the naturally appearing sign stimulus may be more effective in releasing behavior. For example, oyster catchers and other birds prefer to sit on a huge super-normal egg rather than on a normal-sized egg. This phenomenon is seen in other types of intimate behavior among birds. For example, an artificial, super-normal model of the beak of a herring gull has been perceived as more attractive than the real one (Fantino & Logan, 1979). In our thinking this can be interpreted that fetishism is a phenomenon occurring not only among humans, but also among other species. That means that fetishism is not uncommon. Rather it is a natural variation that may occur depending on the kind of exposure an individual is subjected to.

Birgit Johansen is a Danish psychiatrist who wrote a book about fetishism, largely based on her own psychotherapy practice. One of her objectives is to normalize fetishism. She equates a fetish with an ‘erotic pleasure point’. Such pleasure points can be animate and inanimate objects, scenarios, behaviors and erotic zones in a person’s body. In her thinking, everybody is a fetishist to some extent. She sees nothing problematic about fetishism. To the extent that people may be bothered by their inclinations, she helps them accept their sexuality and sometimes expand their range of pleasure points for more satisfaction (Johansen, 1988).

Transvestic fetishism/Transvestism

Blanchard (2009) acknowledges implicitly that there are ego-syntonic well-adjusted transvestites. He still argues for keeping the diagnosis with some alterations.

In his reference list is a survey by Langstrom and Zucker (2005). The sample for the study consisted of 2450 randomly selected men and women aged 18 to 60 from the general population of Sweden who agreed to participate in a larger study of sexual attitudes and behaviours. Items concerning cross-dressing behaviours were embedded in the survey questionnaire. One item asked (the dependent variable): “Have you ever dressed in clothes pertaining to the opposite sex and become sexually aroused by this?”

A total of 2.8% (n = 36) of the men and 0.4% (n = 5) of the women reported that they had ever become sexually aroused by cross-dressing. Most of these men (85.7%) reported that they were only sexually attracted to women and none reported a main or exclusive attraction to men. Among the variables that were NOT significantly associated with cross-dressing behaviour among men were socioeconomic status, history of sexual victimization, satisfaction with life in general, psychological and physical health, or current psychiatric morbidity. Among the variables that were significantly associated with cross-dressing among men were being separated from parents during childhood, being easily sexually aroused, having same-sex sexual experiences, use of pornography, and masturbation frequency.

Blanchard is following a traditional basic assumption about a “syndrome” of Transvestism (also called Transvestic Fetishism) consisting of four elements. “These four elements are: (1) cross-dressing (2) associated with sexual arousal (3) in a biological male (4) with a heterosexual orientation. ”This clinical consensus is supported by the available epidemiological data (Langstrom & Zucker, 2005)” (quotes from Blanchard, 2009). While Langstrom’s study supports the notion that there are more men than women who fit the (1) and (2) criteria above, it does not, however, support the idea that this constitutes a syndrome or that it should be diagnosed. If a phenomenon is to be called a “syndrome”, there must be strong enough evidence that this phenomenon constitutes medical or psychiatric pathology. In our opinion this is not sufficiently substantiated in Langstrom’s article. Blanchard does not refer to any other “epidemiological data” in the article mentioned.

Potentially problematic results from this study were: “Transvestic fetishism also was strongly related to experiences of sexual arousal from using pain, spying on others having sex, and exposing one’s genitals to a stranger.” There is no clarity in the report of what this really means, if for example these strangers were informed, whether they consented or not. The authors point out some limitations of this study, and cautions about the fallacy of drawing conclusions about cause and effect. One could speculate that people who get specially easily sexually aroused are more likely than others to be sexually aroused by just about anything, including “exhibitionism” and “voyeurism”. There is no reason to believe that problematic sexual behaviors or transgressions originate in transvestism. We will also argue that people who may have their sexuality diagnosed may be more likely to be sexually transgressive than others, because acting out some kind of alternative sexuality will likely be perceived as a transgression. A self image of somebody sexually transgressive could easily create self fulfilling prophesies. Also: diagnosing a specific kind of sexuality will probably increase the likelihood of becoming ego dystonic which in turn could increase the likelihood of transgressions.

An earlier study from 1996 (Brown, et. al., 1996) suggests that cross-dressers not seen for clinical reasons are virtually indistinguishable from non-cross-dressing men using a measure of personality traits, a sexual functioning inventory, and measures of psychological distress.

In an article, Moser and Kleinplatz provide a case study of a person who could be diagnosed with transvestic fetishism. They give a convincing argument for removing this diagnosis: “Should this behavior, which can be regarded as adaptive rather than distressing, be construed as psychopathological? The rationale for pathologizing a coping skill is questionable.” (Moser and Kleinplatz, 2002).

Basen together with Langstrom (2006) published a book about “unusual sex”. They try to evaluate the current thinking about the paraphilias including SM, fetishism and transvestic fetishism. Included in the book are interviews with several practitioners. ”Our goal when starting on this book was to try and understand sexual deviation or paraphilia. We encountered the project with some prejudice. We were mentally prepared for meeting “weird” people who could even be dangerous. But we met people who, apart from having statistically unusual sex, for the most part were obviously ‘usual’ ” (Basen & Langstrom, 2006: 255,256). “Socially speaking, we experienced people who comprised an average segment of the Swedish society” (Basen & Langstrom, 2006:256). “Our basic view is that every one has the right to assert his or her sexual peculiarity as long as it does no harm. It is of course not acceptable that people suffer due to intolerance and prejudice. If so, the attitudes of society should be targeted – rather than giving treatment to the individuals” (Basen & Langstrom, 2006:260, 261). We want to point out that one year after the survey by Langstrom and Zucker (2005), Langstrom in 2006 has taken a more accepting position to these sexual minorities. And we again want to emphasize that Blanchard (2009) mistakenly claims that Langstrom and Zucker’s article corroborates the notion of a “syndrome” of Transvestic Fetishism. We will further argue that such a claim could contribute to intolerance and prejudice.

According to Eisfeld, who in 2011 gave an oral presentation at the 20th World Congress for Sexual Health, there have been instances of Transvestic Fetishism being used against male to female transsexuals. People who have been seeking help for sexual reassignment have been rejected by psychiatrists who have diagnosed them with Transvestic Fetishism and therefore they have not been taken seriously as having Gender Identity Disorders. If the diagnosis of Transvestic Fetishism stands in the way of giving people appropriate treatment, this is in our opinion an additional reason to repeal that diagnosis. Eisfeld also had a comment concerning the B criteria of the paraphilias: It would be important to add that the distress, as expressed in the B criteria, is not caused by discrimination or external prejudice. (Eisfeld,J., 2011)

Masturbation

Since fetishism is very often practiced with masturbation, we have chosen to devote a section to this topic. Mostly, at least up till now, masturbation has been looked upon as a substitute for sexual intercourse. What if we reverse the order and say that intercourse could be a substitute for masturbation? There are indeed fetishists, and others, who prefer masturbation to intercourse, even if intercourse is available to them. That the ICD puts such a premium on intercourse (as seen in the definition of fetishism), sometimes creates a pressure to have intercourse for the sake of performing. These kind of performances are probably not the healthiest ones. Masturbation, whether performed as solo activities or in settings with a partner (or partners) may under certain circumstances be more satisfying, especially when it comes to fetishistic practicing.

Even though masturbation no longer has the kind of stigma that it used to a hundred years ago, when it was mostly thought to create severe illnesses and degeneration, it still is largely looked upon as a second rate activity. That is for example implied in the ICD definition of fetishism. We don’t see any advantage in always having intercourse as the ultimate goal of sexual activity in this day and age when the population explosion is threatening the planet. If masturbation is perceived as an equally valid sexual practice, much of the stigma connected to fetishism could be avoided, and the pathologizing of fetishism, due to lack of intercourse, would be absurd.

So far the most extensive written work we have found on masturbation is the 300 page plus book by Martha Cornog. It contains thorough accounts of the history of attitudes towards masturbation, as well as more modern viewpoints, whether solitary or shared pleasures (Cornog, 2003). Masturbation and intercourse may also blend into one unified act. A documented example with a known visual artist, who was a stocking fetishist, Pierre Moliniere, can be found in an essay by Peter Gorsen (Moliniere, p.22).

SM/fetish and love

Baumeister (1989, 1997) asserted that long lasting and committed love relations between SM people were rare and non functional. The sparse research in this area contradicts that assumption. Steady, committed, relationships between SM practitioners are according to Cutler (2003) reported by several authors (Young, 1973/1979; Baldwin, 1993; Califia, 1993/2002, 1994/2000; Bean, 1994; Campbell, 2000). According to Dancer et al. (2006:85), there is no reason to assume that deep and caring emotions contradict the establishing and maintaining of long lasting SM relationships, as reported by Brame et al. (1993), Gosselin, Wilson & Barret (1987) and Moser (1988). Qualitative and quantitative studies by Cutler (2003) and Dancer et al. (2006:82), respectively, indicate that “SM relationships are numerous and often highly functional” and that “SM relationships were long-lasting and satisfying to the respondents.” The latter consisted of committed relationships where the respondents live in a full-time so-called 24/7 SM slavery.

Bienvenu and Jacques (1999) found that 89% of 940 BDSM respondents had been involved in a BDSM relationship at some point in their lives and that 77,3% of 816 BDSM respondents were currently involved in a committed BDSM relationship. In a BDSM/Fetish Demographic Survey by Brame (2000) 55 per cent of 6997 respondents were ’permanent partnered/Married’ (38%) or lived in ’committed relationships’ (17%). It is, however, unclear whether the relationships in the Brame study were BDSM or ‘vanilla’ relationships.

Identity building

Norwegian health authorities have since 1996 pointed out the necessity in health preventive work to fight stigma and discrimination and give gay leathermen a positive SM-identity in order to stop the HIV and AIDS epidemic (Revise F65, 1997).

Revise F65 has all along cooperated with the Norwegian health authorities. This includes working on the repeal of the stigmatizing fetish and SM diagnoses. According to the governmental HIV prevention plans, the life circumstances of a group affects the ability to protect oneself against sexually transmitted diseases. One key concept in the prevention strategy is “identity building”. A central part of the strategy is to help marginalized and stigmatized groups to boost their “collective self respect” in order to empower the individual to feel the self value needed to protect oneself against STD.

“As for the repeal of the homosexuality diagnosis in 1982/1990, the deletion of the national and international fetish diagnoses is maybe the human rights reform that will have the highest significance for the self confidence and identity of the SM and fetish population. This gives increased possibilities for taking responsibility for own health and to protect oneself against sexually transmitted diseases, including HIV” (Revise F65, 2009h).

Nordic sexual reform

As Finland repealed the diagnoses of Fetishism, Fetishistic transvestism, Sadomasochism, Multiple disorders of sexual preference and Dual-role transvestism May 12th 2011, these sexual preferences, sexual identities and gender expressions related to sexual orientation are no longer diseases in Norway, Sweden and Finland (Revise F65, 2011b). Denmark withdrew the diagnoses of dual-role transvestism and sadomasochism in 1994 and 1995, respectively (Politiken, 1995:A7). Revise F65 regards this as an important human rights reform affecting a sizable minority (a low estimate is probably one million people) of the Nordic population (Revise F65, 2009g).

SM and fetish identity

Norwegian and Nordic health authorities now officially use the concept of “sexual identities” to describe the fetish/SM population (Helsedirektoratet, 2010a). In 2010 fetishists and sadomasochists were explicitly and officially included in the group of sexual minorities together with the rest of the Norwegian LGBT population (Helsedirektoratet, 2010b).

There are several reasons to consider fetish and SM sex as identities or orientations. First of all, more and more of the people coming out tell us that they feel their sexuality as an orientation or identity. Secondly, this feeling of identity starts very early in life, during childhood. It is also common knowledge among clinicians trying to “cure” these conditions, that such efforts in general are futile. This is the same as for homosexuality (Hoff, 2003; Wagenheim, 1998; Moser, 1999b).

Conclusions

The interdisciplinary research-based knowledge in Revise F65’s second report to the World Health Organization concludes that sadomasochism and sexualized violence are two different phenomenona. The fetish/BDSM group is an equal contributor to the society and scores on the level with most people on psychosocial features and democratic values as self control, empathy, responsibility, love, equality, and non-discrimination. There is no typical fetishist, transvestite or sadomasochist. Except from the sexual interest and identity, he or she is like everyone else. These people do not present more clinical psychopathology or severe personality pathology than the general population.

Revise F65’s first report to the World Health Organization concluded that the ICD-10 does not distinguish between consensual SM and harmful violence, and that the ICD fetish and SM diagnoses are superfluous, outdated, non scientific and stigmatizing to the fetish/BDSM minority.

Research in this second report indicates that reference books, dictionaries, encyclopedias and daily newspapers, pass on this confounding of SM with violence, subjecting BDSM practitioners, fetishists and cross-dressers to discrimination and social sanctions because of their fetish/BDSM interest, identity and orientation.

Based on these professional and health political reasons, Sweden (2009), Norway (2010) and Finland (2011) decided to totally remove the diagnoses of Fetishism, Fetishistic transvestism, Sadomasochism, Multiple disorders of sexual preference and Dual-role transvestism. Denmark withdrew the diagnoses of dual-role transvestism and sadomasochism in 1994 and 1995, respectively. This sexual rights reform probably affects one million people of the Nordic population, as a low estimate, and the Finnish National Institute for Health and Welfare concludes that the diagnoses are so seldom in use, that neither care, statistics, nor research is harmed by their abolition.

This second report concludes that the society can have somewhat to learn from the participatory approach of people with an alternative and non normative sexuality. At the same time every democratic society must be evaluated on the basis of how it treat it’s minorities.

The Nordic countries and the rest of the world experience a wave of sexual reform that gives hope to millions of people with fetish and BDSM orientation. The World Health Organization is the only instance that has the power to remove the badge of stigma from the forehead of millions of people.

On the basis of these two reports, it is our opinion that a removal of the fetish- and SM diagnoses in the forthcoming edition of ICD-11, will liberate human resources which will benefit society. Resources that today are used to live disguised in fear of social sanctions, may in the future be used differently. Then these resources will have health promoting effects and contribute in valuable ways to the society. We will see an improved human rights situation regarding legal safety, real freedom of speech, and less experienced discrimination based on fetish- and BDSM identity and orientation.

 

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