Tag Archive: DSM

Bibliography 1 – ReviseF65


This bibliography is broken into two sections:

  1. Texts concerned with the F65 classification system
  2. Recommended general publications

This is an extract from Datenschlag’s BISAM bibliography. The complete version is available at www.datenschlag.org/english/bisam/. This version does not contain the abstracts, just the bibliographic notes.

Compiled by Kathrin Passig (picture left).
Please send corrections and additions tó [email protected].

This version: September, 2003

Bibliography 1 – ReviseF65
Texts concerned with the F65 classification system

[APA52] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders (DSM). American Psychiatric Association, Washington, D.C., 1952.

[APA68] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders. Second Edition (DSM-II). American Psychiatric Association, Washington, D.C., 1968.

[APA80] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders. Third Edition (DSM-III). American Psychiatric Association, Washington, D.C., 1980.

[APA87] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders. Third Revised Edition (DSM-III-R). American Psychiatric Association, Washington, D.C., 1987.

[APA94] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV). American Psychiatric Association, Washington, D.C., 1994.

[APA00] American Psychiatric Association (ed.). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revised (DSM-IV). American Psychiatric Association, Washington, D.C., 2000.

[Bay87] Ronald Bayer. Homosexuality and American Psychiatry: The Politics of Diagnosis. Princeton University Press, Princeton, New Jersey, 1987.

[Bre89] Norman Breslow. Sources of Confusion in the Study and Treatment of Sadomasochism. Journal of Social Behavior and Personality, 4(3), (1989), pp. 263-274.

[BRW93] Bernd Brosig, Klaus Rodewig, Regina Woidera. Die Klassifikation von Sexualstörungen in der ICD-10: Ergebnisse der ICD-10-Forschungskriterienstudie. In: Wolfgang Schneider (ed.), Diagnostik und Klassifikation nach ICD-10, Kap. V: eine kritische Auseinandersetzung; Ergebnisse der ICD-10-Forschungskriterienstudie aus dem Bereich Psychosomatik/Psychotherapie, vol. 17 of Monographien zur Zeitschrift für psychosomatische Medizin und Psychoanalyse. Vandenhoeck und Ruprecht, Göttingen, 1993. pp. 200-209.

[BB77a] Vern Bullough, Bonnie Bullough. Sin, Sickness, Sanity: A History of Sexual Attitudes. New American Library, New York, 1977.

[Bul76] Vern L. Bullough. Sexual Variance in Society and History. University of Chicago Press, Chicago, 1976.

[Bul94] Vern L. Bullough. Science in the Bedroom: A History of Sex Research. Basic Books, New York, 1994. www2.hu-berlin.de% /sexology/GESUND/ARCHIV/LIBRO.HTM.

[BDD94] Vern L. Bullough, Dwight Dixon, Joan Dixon. Sadism, masochism and history, or when is behavior sado-masochistic? In: Roy Porter, Mikulás Teich (eds.), Sexual Knowledge, Sexual Science: The history of attitudes to sexuality. Cambridge University Press, Cambridge, 1994. pp. 47-62.

[Cap91] Paula J. Caplan. How do they decide who is normal? The bizarre, but true, tale of the DSM process. Canadian Psychology, 32(2), (1991), pp. 162-170.

[FS99] L. Fischer, G. Smith. Statistical Adequacy of the Abel Assessment for Interest in Paraphilias. Sexual Abuse, 11(3), (1999), pp. 195-206.

[Gay97] J.J. Gayford. Disorders of sexual preference, or paraphilias: a review of the literature. Medicine, Science, and the Law, 37(4), (1997), pp. 303-315.

[Ger92] Bernard Gert. A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias. Journal of Medicine and Philosophy, 17(2), (1992), pp. 155-171.

[HS02] Russell B. Hilliard, Robert L. Spitzer. Change in criterion for paraphilias in DSM-IV-TR. American Journal of Psychiatry, 159(7), (2002), p. 1249.

[McC99] Nathaniel McConaghy. Unresolved Issues in Scientific Sexology. Archives of Sexual Behavior, 28(4), (1998), pp. 285-318.

[Mon84] John Money. Paraphilias: Phenomenology and classification. American Journal of Psychotherapy, 38(2), (1984), pp. 164-179.

[Mos01] Charles Moser. Paraphilia: A Critique of a Confused Concept. In: Peggy J. Kleinplatz (ed.), New Directions in Sex Therapy: Innovations and Alternatives. Brunner-Routledge, Philadelphia, 2001. pp. 91-108.

[MK02] Charles Moser, Peggy J. Kleinplatz. Transvestic fetishism: Psychopathology or iatrogenic artifact? New Jersey Psychologist, 52(2), (2002), pp. 16-17. http://home.netcom.com/~docx2/tf.html.

[MK03] Charles Moser, Peggy J. Kleinplatz. DSM-IV-TR and the Paraphilias: An Argument for Removal. Paper presented on May 19, 2003 at the Annual Meeting of the American Psychiatric Association, 2003. http://home.netcom.com/~docx2/mk.html.

[MO+93] Aribert Muhs, Christina Öri, Ingrid Rothe-Kirchberger, Wolfram Ehlers. Die Klassifikation der Persönlichkeitsstörungen in der ICD-10. Ergebnisse der Forschungskriterienstudie. In: Wolfgang Schneider (ed.), Diagnostik und Klassifikation nach ICD-10, Kap. V: eine kritische Auseinandersetzung; Ergebnisse der ICD-10-Forschungskriterienstudie aus dem Bereich Psychosomatik/Psychotherapie, vol. 17 of Monographie zur Zeitschrift für psychosomatische Medizin und Psychoanalyse. Vandenhoeck und Ruprecht, Göttingen, 1993. pp. 132-149.

[PF+92] Harold Alan Pincus, Allen Frances, Wendy Wakefield Davis, Michael B. First, Thomas A. Widiger. DSM-IV and New Diagnostic Categories: Holding the Line on Proliferation. American Journal of Psychiatry, 149(1), (1992), pp. 112-117.

[PT94] Roy Porter, Mikulás Teich (eds.). Sexual knowledge, sexual science: the history of attitudes to sexuality. Cambridge University Press, Cambridge, 1994.

[SZ+96] H. Saß, M. Zaudig, I. Houben, H.-U. Wittchen. Einführung zur deutschen Ausgabe: Zur Situation der operationalisierten Diagnostik in der deutschsprachigen Psychiatrie. In: American Psychiatric Association (ed.), Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Hogrefe, Verlag für Psychologie, Göttingen, Bern, Toronto, Seattle, 1996. pp. IX-XXIV.

[Sch95] C.W. Schmidt. Sexual psychopathology and the DSM-IV. American Psychiatric Press Review of Psychiatry, 14, (1995), pp. 719-733.

[Sho97] Edward Shorter. A History of Psychiatry. John Wiley, New York, 1997.

[Sup84] Frederick Suppe. Classifying Sexual Disorders: The Diagnostic and Statistical Manual of the American Psychiatrical Association. Journal of Homosexuality, 9(4), (1984), pp. 9-28.

[WHO48] World Health Organization (ed.). Manual of the international statistical classification of diseases, injuries and causes of death: sixth revision of the International lists of diseases and causes of death, adopted 1948 / compiled under the auspices of the World Health Organization. WHO, Geneva, 1948.

[WHO57] World Health Organization (ed.). Manual of the international statistical classification of diseases, injuries, and causes of death: based on the recommendations of the Seventh Revision Conference, 1955, and adapted by the Ninth World Health Assembly under the WHO nomenclature regulations. WHO, Geneva, 1957.

[WHO67] World Health Organization (ed.). International classification of diseases: manual of the international statistical classification of diseases, injuries, and causes of death, based on the recommendations of the Eighth Revision Conference, 1965, and adopted by the Nineteenth World Health Assembly. WHO, Geneva, 1967.

[WHO77] World Health Organization (ed.). Manual of the international statistical classification of diseases, injuries and causes of death: based on the recommendations of the Ninth Revision Conference, 1975, and adopted by the Twenty-ninth World Health Assembly. WHO, Geneva, 1977.

[WHO92] World Health Organization (ed.). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines, vol. I. WHO, Geneva, 1992.

[WHO93] World Health Organization (ed.). The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research, vol. II. WHO, Geneva, 1993.

 

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This bibliography is broken into two sections:

  1. Texts concerned with the F65 classification system
  2. Recommended general publications

This is an extract from Datenschlag’s BISAM bibliography. The complete version is available at www.datenschlag.org/english/bisam/. This version does not contain the abstracts, just the bibliographic notes.

Compiled by Kathrin Passig (picture left).
Please send corrections and additions tó [email protected].

This version: September, 2003

Bibliography 2 – Recommended general publications

[AS+01] Laurence Alison, Pekka Santtila, N. Kenneth Sandnabba, Nikolas Nordling. Sadomasochistically Oriented Behavior: Diversity in Practice and Meaning. Archives of Sexual Behavior, 30(1), (2001), pp. 1-12.

[All40] Clifford Allen. The Sexual Perversions and Abnormalities: A study in the psychology of paraphilia. Oxford University Press, London et al., 1940.

[Bau88] Roy F. Baumeister. Masochism as Escape from Self. Journal of Sex Research, 25, (1988), pp. 28-59.

[Bau89] Roy F. Baumeister. Masochism and the Self. Lawrence Erlbaum Associates, Hillsdale, 1989.

[Bau91] Roy F. Baumeister. Escaping the Self: Alcoholism, Spirituality, Masochism. Harper Collins, New York, 1991. 268 pages, masochism on pp. 115-138.

[Bau97] Roy F. Baumeister. The Enigmatic Appeal of Sexual Masochism: Why People Desire Pain, Bondage and Humiliation in Sex. Journal of Social and Clinical Psychology, 16(2), (1997), pp. 133-150.

[BB97] Roy F. Baumeister, Jennifer L. Butler. Sexual Masochism: Deviance without Pathology. In: Donald Richard Laws, William O’Donohue (eds.), Sexual Deviance: Theory, Assessment, and Treatment. Guilford Publications, New York, 1997. pp. ?-?

[Bie98] Robert V. Bienvenu II. The Development of Sadomasochism as a Cultural Style in the Twentieth-Century United States. Dissertation, Indiana University, 1998. www.americanfetish.net.

[BBJ93] Gloria G. Brame, William D. Brame, Jon Jacobs. Different Loving: The World of Sexual Dominance and Submission. Villard, New York, 1993.

[Bre89] Norman Breslow. Sources of Confusion in the Study and Treatment of Sadomasochism. Journal of Social Behavior and Personality, 4(3), (1989), pp. 263-274.

[BEL85] Norman Breslow, Linda Evans, Jill Langley. On the Prevalence and Roles of Females in the Sadomasochistic Subculture: Report of an Empirical Study. Archives of Sexual Behavior, 14, (1985), pp. 303-317.

[BEL86] Norman Breslow, Linda Evans, Jill Langley. Comparisons Among Heterosexual, Bisexual and Homosexual Male Sado-Masochists. Journal of Homosexuality, 13(1), (1986), pp. 83-107.

[BB77a] Vern Bullough, Bonnie Bullough. Sin, Sickness, Sanity: A History of Sexual Attitudes. New American Library, New York, 1977.

[BB94] Vern L. Bullough, Bonnie Bullough (eds.). Human sexuality: an encyclopedia. Garland, New York / London, 1994. www2.hu-berli% n.de/sexology/GESUND/ARCHIV/SEN/INDEX.HTM.

[Cap84] Paula J. Caplan. The Myth of Women’s Masochism. American Psychologist, 39(2), (1984), pp. 130-139.

[FM91] Gerald I. Fogel, Wayne A. Myers (eds.). Perversions and Near-Perversions in Clinical Practice: New Psychoanalytic Perspectives. Yale University Press, New Haven, Conn., 1991.

[Gat00] Katherine Gates. Deviant Desires. Juno Books, 2000.

[LC95] Law Commission. Consent in the Criminal Law: A Consultation Paper, vol. 139 of Law Commission Consultation Paper. Her Majesty’s Stationery Office, London, 1995.

[LMJ94] Eugene E. Levitt, Charles Moser, Karen V. Jamison. The Prevalence and Some Attributes of Females in the Sadomasochistic Subculture: A Second Report. Archives of Sexual Behavior, 23(4), (1994), pp. 465-473.

[Mos88] Charles Moser. Sadomasochism. Journal of Social Work \& Human Sexuality, 7(1), (1988), pp. 43-56. Special Issue: The Sexually Unusual: Guide to Understanding and Helping.

[Mos92] Charles Moser. Lust, lack of desire, and paraphilias: Some thoughts and possible connections. Journal of Sex and Marital Therapy, 18(1), (1992), pp. 65-69.

[Mos99] Charles Moser. Health Care Without Shame. A Handbook for the Sexually Diverse and Their Caregivers. Greenery Press, San Francisco, 1999.

[Mos99a] Charles Moser. The psychology of sadomasochism (S/M). In: Susan Wright (ed.), SM Classics. Masquerade Books, New York, 1999. pp. 47-61.

[Mos01] Charles Moser. Paraphilia: A Critique of a Confused Concept. In: Peggy J. Kleinplatz (ed.), New Directions in Sex Therapy: Innovations and Alternatives. Brunner-Routledge, Philadelphia, 2001. pp. 91-108.

[MK02] Charles Moser, Peggy J. Kleinplatz. Transvestic fetishism: Psychopathology or iatrogenic artifact? New Jersey Psychologist, 52(2), (2002), pp. 16-17.. http://home.netcom.com/~docx2/tf.html.

[MK03] Charles Moser, Peggy J. Kleinplatz. DSM-IV-TR and the Paraphilias: An Argument for Removal. Paper presented on May 19, 2003 at the Annual Meeting of the American Psychiatric Association, 2003.
http://home.netcom.com/~docx2/mk.html.

[ML87] Charles Moser, Eugene E. Levitt. An Exploratory-Descriptive Study of a Sadomasochistically Oriented Sample. Journal of Sex Research, 23, (1987), pp. 322-337. Also published in [Wei95].

[MM96] Charles Moser, J.J. Madeson. Bound to be Free: The SM Experience. Continuum, New York, 1996.

[Noy97] John K. Noyes. The Mastery of Submission. Cornell University Press, Ithaca et al., 1997.

[Oos00] Harry Oosterhuis. Stepchildren of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity. University of Chicago Press, Chicago, 2000. 321 pages.

[Sar88] Thomas O. Sargent. Fetishism. Journal of Social Work \& Human Sexuality, 7(1), (1988), pp. 27-42. Special Issue: The Sexually Unusual: Guide to Understanding and Helping.

[Spe77] Andreas Spengler. Manifest Sadomasochism of Males: Results of an Empirical Study. Archives of Sexual Behavior, 6, (1977), pp. 441-456.

[Sto91] Robert Stoller. Pain and Passion: A Psychoanalyst Explores the World of S\&M. Plenum Press, New York, 1991.

[Wei94a] Thomas S. Weinberg. Research in Sadomasochism: A Review of Sociological and Social Psychological Literature. Annual Review of Sex Research, 5, (1994), pp. 257-279. Also published in [Wei95], pp. 289-303.

[Wei95] Thomas S. Weinberg (ed.). S\&M – Studies in Dominance and Submission. Prometheus Books, New York, 1995.

[Wil87] Glenn Wilson (ed.). Variant Sexuality: Research and Theory. Johns Hopkins University Press, Baltimore, 1987.

[Wri99] Susan Wright (ed.). SM Classics. Masquerade Books, New York, 1999.


Love is no disease!

Text in this column by reviseF65

Europride Köln 2002. Photo: Smia-Oslo

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.


DSM Revision White Paper: http://ncsfreedom.org/index.php?option=com_keyword&id=305

Charles Moser and Peggy J. Kleinplatz:
DSM-IV-TR and the Paraphilias:
An Argument for Removal
http://home.netcom.com/~docx2/mk.html

Denmark withdraws SM from Diagnosis-list

Denmark has taken the political decision to remove SM as a diagnosis

In 1995, as the first European 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 at the bottom, 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 Berlin http://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.
sundhedsstyrelsenbrevstor

The former Health Minister Yvonne Herløv Andersen, who in 1995, on behalf of the Danish government, removed sadomasochism as a criteria of illness in Denmark.
“The acceptance of people with a different sexuality has increased, and in this area Denmark is a pioneer country”

Support the ICD project SM is healthy Remove SM/fetish diagnoses

Support the ICD project SM is healthy Remove SM/fetish diagnoses

SM and Fetishism are positive and healthful parts of peoples lives. To accept one’s SM orientation, preference, sexuality and love is essential for a healthy life, identity and decisive for the ability to protect oneself against sexually transmitted diseases.


SM is love – not a disease
Europride in Cologne 2002. Photo by Svein Skeid,
Smia-Oslo.

Love and respect are basic parts of SM relationships. Stigmatizing minorities by diagnosing their sexual orientation is on the contrary as disrespectful as discriminating people because of their race, ethnicity or religion.

For many years homosexuality has been abolished as a disease by the World Health Organization (WHO). But did you know that leather men and SM dykes are still not reported off the sick list? SM sex is even now considered an illness by the WHO, despite the fact that US psychiatrists removed it from their DSM manual eight years ago.

In connection with Europride 2002 the ICD project asks for testimony, quoted reference and supporting evidence from psychiatrists, psychologists, sexologists and reseachers of human sexuality in order to remove Fetishism, Sadomasochism and Transvestic Fetishism as paraphilic diagnoses from ICD, The International Classification of Diseases published by the World Health Organization (WHO).

The initiative of individuals is always to be welcomed, but even more efficient would be the formation of local and national working groups which are able to approach to the professionals in question.

Women suffer the most harassment
Branding perfectly healthy sexuality is an unacceptable insult to the dignity and integrity of the people who enjoy these safe, sane and consensual practices. Stigmatizing minorities by diagnosing their sexual orientation is as disrespectful as discriminating people because of their race, ethnicity or religion.

Even though the paraphilias in question are very rarely used, the stigma of being diagnosed make harassment of sexual minorities legitimate. The U.S. Leather Leadership Conference documents that between one-third and one-half of the leather/SM population suffer discrimination, violence or persecution because of their sexual orientation and identity. As with other assaults, women suffer the most harassment, losing their job or even their children, because of their SM love, lifestyle and self-expression.

Because lesbians also experience physical attacks – approximately one out of every four SM dykes consider or actually commit suicide because of severe persecution by their fellow-sisters – the U.S. National Organization for Women, NOW in 1999 erased previous censure of sadomasochism from their “Delineation of Lesbian Rights” policy.

The United Nations High Commissioner for Human Rights in 2001 became involved in the question of such abuses, and has registered individual cases of violence against SM practitioners worldwide.

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

Sadomasochism is considered to be a healthy form of sexual expression as long as it does not impair the daily functioning of the subject, according to the latest 1994 edition of American Psychiatric Association Diagnostic & Statistic Manual (DSM-IV).

Denmark, as the first European country, totally removed the diagnoses of Sadomasochism from their national version of ICD in 1995 because this non-violent and healthy activity was considered as a private matter by the Health Authority.

In the rest of Europe and the world, fetishists, SM’ers and transvestites are still considered among the mentally ill by the ICD psychiatric authorities.

Ikke mer sykelighet blant BDSM-ere

Det er ikke dokumentert at fetisjister og bdsm-ere har mer psykopatologi enn andre mennesker.

Wismeijer & van Assen (2013):
Kinky sex ikke det spor sykt

En hollandsk studie av 902 bdsm-ere, publisert i Journal of Sexual Medicine, antyder at at sadomasochistene var friskere enn kontrollgruppen på 434 repondenter. SM-erene var mindre nevrotiske, mer utadvendte og opplevde større velvære enn kontrollgruppen.

Undersøkelsen, som ble offentliggjort 16. mai 2013, antyder også at bdsm-ere er mer samvittighetsfulle og mindre følsomme for avvisning. SM-erne var imidlertid mindre vennlige enn kontrollgruppen. Særlig gjalt det den dominerende parten. De dominerende sm-erne hadde best helse, dernest kom sm-slavene og kontrollgruppen skåret dårligst.

Kinky sex er ikke spor sygt. Ekstrabladet 22. mai 2013. http://ekstrabladet.dk/sex_og_samliv/article1982549.ece

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):

To studier ved Northern Illinois University i USA tyder på at SM eller sadomasochisme som er praktisert på en samtykkende måte kan bidra til å bedre forholdet og øke intimiteten mellom partene. Sagarin, B. J. (bildet), 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://ekstrabladet.dk/sex_og_samliv/article1155640.ece#ixzz15g8Ft0Gi

Cross and Matheson (2006):

Forskning publisert i boka ”Sadomasochism: Powerful Pleasures” (2006), spenner ben under psykiatriens tradisjonelle forestillinger om selvskadende masochister, antisosiale sadister og syke sadomasochister. Boka som utgis parallelt i verdens kanskje mest anerkjente homotidsskrift, the Journal of homosexuality, publiserer forskning som viser at sadomasochister ikke har mer sykelighet enn normalbefolkningen.

De kanadiske forskerne Cross and Matheson (2006) fant ikke noe bevis for Krafft-Ebings påstand om at masochister lider av noen form for psykisk sykdom eller at SM-sadister er antisosiale eller voldelige. De fant heller ikke støtte for Freuds teori om selvskadende masochister eller id-drevne psykopatiske SM-sadister.

Sadomasochister hadde heller ikke mer anti-feministiske patriarkalske verdier eller tradisjonelle kjønnsrollemønstre enn kontrollgruppen av ikke-SM-ere.

Patricia A. Cross PhD and Kim Matheson PhD i boka “Sadomasochism: Powerful Pleasures” (2006) som ble utgitt parallellt i tidsskriftet The Journal of Homosexuality.

Connolly et al (2006):

De amerikanske forskerne Pamela Connolly (bildet) et al fant “ikke noe støtte for oppfatningen at det er mer sykelighet – inkludert depresjon, angst, manisk depressiv sykdom eller tvangshandlinger – blant medlemmer av BDSM-samfunnet enn i befolkningen forøvrig”.

SM-sadister opplevde ikke større glede ved ikke-samtykkende grusomhet enn kontrollgruppen av ikke-SM-ere, og masochistene søkte ikke tvangsmessige eller skadelige former for smerte.

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:

Til overmål, så viser en landsomfattende australsk studie av 20.000 kvinner og menn, at SM faktisk gjør folk lykkeligere. SM-menn skåret signifikant bedre på en skala over psykologisk velvære enn andre menn.

SM-menn og kvinner hadde ikke opplevd flere seksuelle problemer, seksuelle overgrep, tvang eller angst enn andre australiere.

– Dette ser ut til å innebære at disse mennene faktisk er lykkeligere som resultat av sin adferd, selv om vi ikke vet hvorfor, sa Dr. Juliet Richters (bildet), ved Universitetet i New South Wales.

“Det kan rett og slett være at de er mer i harmoni med seg selv fordi de har en uvanlig praksis og trives med det. Det kan sies mye om verdien av å akseptere seg selv som en er”.

Forskerne sier studien kan være med på å bryte ned de rådende stereotypiene om at folk med interesse for bondage og disiplin ble skadet som barn og derfor skulle være “dysfunksjonelle”.

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):

En studie presentert på verdenskongressen for sexologer på Cuba 2003, antyder at ikke-konvensjonell seksuell praksis ikke kan brukes til noen form for diagnostiske kriterier. Det eneste som skiller BDSM-ere fra andre mennesker, er deres seksuelle praksis.

Bilde: Maria Cristina Martins, klinisk psykolog og spesialist i sexologi, Brasil.  Psykolog Paulo Roberto Ceccarelli. PhD i psykopatologi og psykoanalyse, Paris, Frankrike.

www.revisef65.org/cuba1.html

Tidligere studier:

I følge Moser (1999), viser tidligere mer begrensede studier ingen signifikant forskjell i psykopatologi mellom SM-gruppen og kontrollgruppen. Gosselin & Wilson (1980), Miale (1986), Moser (1979).
http://www2.hu-berlin.de/sexology/BIB/SM.htm#S/M_PRACT
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.


Freud og Krafft-Ebings (bildet) teorier om selvskadende masochister og antisosiale SM-sadister ble ikke støttet (Cross and Matheson 2006).

SM som seksuell orientering

Leger og psykiatere om SM som en normalvariant av voksen menneskelig seksualitet og en viktig del av folks seksuelle orientering.
http://members.aol.com/NOWSM/Psychiatrists.html

Psychological Surrender

Is Sadomasochism a mental pathology?
From Kraft-Ebing to Carl Jung, through years of research on the ground, Dorothy Hayden express her conclusion about masochism. The proposal for a new Psychological approach to BDSM.

PSYCHOLOGICAL DIMENSIONS OF MASOCHISTIC SURRENDER

By Dorothy C. Hayden, CSW

“Proud to be a perv”. Picture from SM Pride 2003 in London by Svein Skeid.62AkselProudPerv7

A number of years ago, in connection with my work with sexual addiction, a number of lifestyle submissives started coming to me for treatment. Some of these people were extremely hesitant to discuss their reasons for seeking therapy; they were so ashamed of their fantasies and behaviors that it took years of working with them until I knew their real names or their telephone numbers. Patients who able to be forthcoming about their masochistic behaviors and fantasies were as confused as I was. One of my patients, giving me a written masochistic fantasy after months of resistance, said, “Here it is. This is what I came to therapy for. It’s terrible. It’s sick. It’s wonderful. I hate it; it’s my favorite fantasy. I can’t stand it, I love it. It’s disgusting. I don’t want to stop it.”

Learning about the world of S&M has been an invaluable experience to me. I had to admit to myself that, viewed from the perspective of what I knew about the nature of the individual self, masochism puzzled me by flying in the face of everything that was rational about the nature of the human personality. People want to be happy and to avoid pain and suffering. They seek to maintain and increase their control over themselves and their surroundings. And they desire to maintain and increase their prestige, respect, and esteem. Viewed from the perspective of these three principles about the self, masochism is a startling paradox. The self is developed to avoid pain, but masochists seek pain. The self strives for control, but masochists seek to relinquish control. The self aims to maximize its esteem, but masochists deliberately seek out humiliation.

UNCOVERING A WORLD

I heard stories of whips, canes, racks, cock-and-ball torture, dripping wax on naked skin, electronic devices designed to deliver just the right amount of pain, the difficulty of finding the right mistress, and the surprising number of “dungeons” that existed within a few block radius of my mid-town office. Time and again, men would talk of the frustration of being unable to entice their wives or partners, who found these sexual activities to be perverse, into engaging in the sexual behaviors that they most longed for. I suspected that there was a vast number of people who felt tremendous shame and isolation about masochistic submissive longings. I decided to check the clinical literature on masochism to better arm myself with some psychodynamic understanding of why these men, who so often felt shame-bound, were so keen to be dominated, hurt, tortured and humiliated by strong, dominate women.

This is what my research revealed: According to the Diagnostic and Statistical Manual of the American Psychiatric Association, (the shrink’s bible), anyone who engages regularly in masochistic sex is mentally ill by definition. There is a long tradition of regarding masochism as the activity of mentally ill sick individuals. Freud described masochism as a perversion. One of his followers linked masochism to cannibalism, criminality, necrophilia and vampirism. Another analyst said that all neurotics are masochistics. In short, clinical perspectives have regarded masochists as seriously disturbed.

THE THERAPEUTIC APPROACH

Krafft-Ebing, the nineteenth-century psychiatrist who coined the term, subsumed masochism under the broad heading of “General Pathology” in this famous volume, Psychopath Sexualize, in 1876. Masochism became a pathological, sexual and psychopathic phenomenon all at once.

“By masochism I understand a particular perversion of the psychical sexual life in which the individual affected, in sexual feeling and thought, is controlled by the idea of being completely and unconditionally subject to the will of a person of the opposite sex; of being treated by this person as a master — humiliated and abused. This idea is colored by lustful feeling; the masochist lives in fantasies, in which he creates situations of this kind and often attempts to realize them. By this perversion his sexual instinct is often made more or less insensible to the normal charms of the opposite sex – incapable of a normal sexual life – psychically impotent.”

It has become practically a dogma of psychoanalytic thought that masochism is a sexual condition in which punishment is required before satisfaction can be reached. Freud understood the phenomenon as resulting from an “unconscious feeling of guilt” as “a need for punishment by some parental authority. Writing in 1919, Freud found the genesis and reference point for masochism in the Oedipus-complex. Masochism, he said, actually begins in infantile sexuality, when the wish for the incestuous connection with mother or father must be repressed. Guilt enters at this point, in connection with incestuous wishes. The parent figure then becomes the dispenser of punishment instead of love and appears in desires for beating, spanking, etc. The fantasy of being beaten becomes the meeting place between the sense of guilt and sexual love. Whether it involves literal pain or not, the punishment desired by the masochist is enjoyed in and of itself. Punishment and satisfaction both give pleasure – and humiliation. Freud, in referring to masochism as a “perversion”, cemented it forever in the ghetto of the aberrant and deviant.

My research, however, did not jibe with my clinical reality. The people who presented to me were not immature or inferior. In fact, the reverse seemed to be the case. Masochists are more likely to be successful by social standards: professionally, sexually, emotionally, culturally, in marriages or out. They are frequently individuals of inner strength of character, possessed of strong coping skills with an ethical sense of individual responsibility. A famous study of the “sexual profile of men in power” found to the researchers’ surprise, a high quantity of masochistic sexual activity among successful politicians, judges and other important and influential men.

FROM PATHOLOGY TO LIFESTYLE

It became obvious to me that psychology’s theories of masochism were obsolete. In the 1960’s, homosexuality was deleted from the DSMIV and was recognized not as a pathology, but as a lifestyle choice.

It is my contention that the same should be done with masochism and that, like homosexuality, it needs to be removed from the rubric of “psychopathology” and be seen for what it is: a sexual lifestyle choice. It is the intention of this paper to suggest ways of understanding masochism without invoking theories of mental illness.

The questions, however, remained. I puzzled as to why so many men, raised in a culture that valued masculine initiative, assertiveness, and dominance, want to be relieved of these qualities and surrender their will to a strong, dominant woman who might torture, control and humiliate them. What was the basis of this compelling urge to surrender and serve, to relinquish control, to accept physical pain and emotional humiliation?

As I listened to my patients over the years, I began to see masochism less as a sexual aberration and more as a metaphor through which psyche speaks of its suffering and passion.

There was a definite connection between suffering and pleasure the intrigued me.

Clients spoke of the rapturous delight in submission, the worship, in wild abandon and the deliverance from the confining bondage of “normalcy”.

Ritualized suffering seemed to be a way of giving meaning and value to human infirmities. After all, there is no paucity of suffering in human life. None of us need go looking for pain. The suffering of helplessness, disappointment, loss, powerlessness and limitation, is a part of the human condition. It is my hunch that there is something like a universal need, wish or longing for surrender completely to certain aspects of human life and that it assumes many forms. This passionate longing to surrender comes into play in at least some instances of masochism. Submission, losing oneself to the power of the other, becoming enslaved to the master is the ever-available lookalike to surrender.

THE SUBSPACE

Submissives speak of a quality of liberation, freedom and expansion of the self in a scene as a situation similar to the letting down of defensive barriers. They speak of the experience of complete vulnerability. I believe that buried or frozen, is a longing for something in the environment to make possible surrender, a sense of yielding of the false self. The false self is an idea developed by a famous psychoanalyst who posited that most parents need their children to behave in circumscribed ways in order for the child to receive their love. For a child, parental love is a matter of survival, and so the child forges a “self” that they think will ensure parental love and approval. The false self is usually a “caretaker” self. A Scene sometimes allows for years of defensive barriers that support the false self to be broken through. It carries with it a longing for the birth of the true self. Deep down we long to give up, to “come clean”, as part of a general longing to be known or recognized. The prospect of surrender may be accompanied by a feeling of dread and or relief or even ecstasy. It is an experience of being “in the moment”, totally in the present. Its ultimate direction is the discovery of one’s identity, one’s sense of self, of one’s sense of wholeness, even one’s sense of unity with other living beings. Joyous in spirit, it transcends the pain that evokes it. One’s exquisite pain is sometimes akin to mystical ecstasy. Within the context of that surrender, a self-negating submissive experience occurs in which the person is enthralled by the dominant partner. The intensity of the masochism is a living testimonial of the urgency with which some buried part of the personality is screaming to be released. The surrender is nothing less than a controlled dissolution of self-boundaries.

The deeper yearning is the longing to be reached, known and accepted in a safe environment which narcissistic, dysfunctional or preoccupied parents were unable to provide the child at a young age.

Fantasies of being raped, which are very common, can have all manners of meanings. Among them, one will almost always find, sometimes deeply buried, a yearning for deep surrender. The submissive longs for and wishes to be found, recognized, penetrated to the core, so as to become real, or, as one analyst says it “to come into being.”

RITUALS AND CREATIVITY

In addition to the longing to surrender into a truer sense of self, masochistic behaviors have another meaning. People need and take delight in fantasy production. Ask the Disneyland folk who cater to adults as much as to children. Scenes have tremendous potential for potentiating fantasy. Costumes, rituals, scenarios, an endless variety of sex props, and elaborate sets reveal of the richness the creative inner life and speak to the very real human need for fantasy play. The fantasies are the carriers of a full spectrum of human feelings: to control, to be controlled, to tease, to be teased, to play, to please, and to achieve solace from the confines of the mundaness of ordinary life. They represent the suspension of normal reality that is an occasional necessity for all healthy people.

Probably the last thing masochism appears aimed at is balance. In keeping with its paradoxical nature, masochism provides not so much a state of weakness, but a sense of surrender, receptivity and sensitivity. Masochism is the condition of submitting fully to an experience, which counters lives that, in our Western society, are ego-centered, constrained, rational, and competitive. Strength can be a terrible burden. It is a constraint, which can be relieved in moments of abandonment, of letting down and letting go. So it is hardly surprising that the pull of masochistic experiences should be so strong in a culture the overvalues ego strength at the expense of a fuller experience of all dimensions of psychic life.

In conclusion, I believe that therapists need to radically alter their approach to doing psychotherapy with masochistic patients. My colleagues complain that masochists are difficult to “cure”. Perhaps because the paradigm from which these therapists operate are faulty. The recognition of value and meaning in the desire to suffer humiliation runs counter to the prevailing attitude in psychology. The main thrust of modern theory and practice has been toward ego psychology. The values of psychotherapy have been aimed, for the most part, at building strong, coping, rational problem-solving egos. Ego-values are certainly worthy ones, yet it costs something to gain strength, to cope, to be rational and to solve problems. This may account for the dissatisfaction many people feel after years of psychotherapy. Building a strong ego is only one side of the story; it neglects other, crucial parts of the human psyche. Modern psychology has been in large measure dominated by helping people develop independence, strength, achievement decisive action, coping and planning. What’s missing is attention to the more subtle dimensions of soul.

THE CHARM OF SHADOWS

The psychoanalyst most in tuned with the missing element in psychotherapeutic work with masochism is Carl Jung. Masochism may be imagined as cultivation of what Jung called the “shadow” – the darker, mostly unconscious part of the psyche which he regarded not as a sickness, but as an essential part of the human psyche. The shadow is the tunnel, channel, or connector through which one reaches the deepest, most elemental layers of psyche. Going through the tunnel, or breaking the ego defenses down, one feels reduced and degraded. Usually, we try to bring the shadow under the ego’s domination. Embracing the shadow, on the other hand, provides a fuller sense of self-knowledge, self-acceptance and a fuller sense of being alive. Jung’s idea of the shadow involves force and passivity, horror and beauty, power and impotence, straightness and perversion, infantilism, wisdom and foolishness. The experience of the shadow is humiliating and occasionally frightening, but it is a reduction to life&Mac220;to essential life, which includes suffering, pain, powerlessness and humiliation. Submission to masochistic pain, loss of control and humiliation serves to embrace our shadow rather than deny it. The result is the achievement of an inner life that accepts and embraces all aspects of our selves and allows us to live with a deeper sense of our true selves.

In conclusion, the psychotherapeutic community needs to re-examine masochistic submissions to see it not as a pathology but as a healthy vehicle for surrendering fixed defense mechanisms, for relinquishing control to something or someone greater than themselves, for achieving freedom from the pervasive and relentless need to cultivate, promote and assert the self, for gaining some relief from having to make innumerable choices and decisions, for engaging in healthy fantasy enactments, and for the exploration, acknowledge and acceptance the “darker” or “shadow” side of their personalities. In addition, many patients speak of achieving a loss of self-awareness that they describe as ecstasy or bliss in which the individual transcends his normal limits and ceases to be aware of self in ordinary terms.

A travesty of our profession is that we continue to try to “cure” a systems of beliefs and behaviors that enrich and enlivens the lives of so many people. The continuing pathologizing of masochism by keeping it in the DSMIV as a psychopathology and by most therapists’ efforts to “cure” masochists is in part responsible for the continued , shame, isolation and low self-esteem of these creative, spontaneous and courage people who want to be afforded the dignity of choosing their own form of non-exploitative sexuality.

ABOUT THE AUTHOR:

Dorothy Hayden, MBA, CSW, received her masters degree in clinical social work from New York University and has received advanced clinical training at the Post Graduate Center for Mental Health. She is a psychotherapist in private practice in New York City.

You can contact her with the E-mail: [email protected]
Dorothy Hayden, CSW
209 East 10th Street #14
New York, NY

Web site: www.sextreatment.com/

THE SO-CALLED “DEVIANT” SEXUALITIES: PERVERSION OR RIGHT TO DIFFERENCE?

This 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, whichmeans that the only aspect that distinguishes these individuals from others is their sexual practices.

Author: Maria Cristina Martins, Clinical Psychologist and Specialist in Human Sexuality. Campinas, SP, Brazil

Co-author: Paulo Roberto Ceccarelli, Psychologist, Psychoanalyst, PhD in Psycopathology and Psychoanalysis by Paris VII, Paris, France; Appointed Professor of the Psychology Dep. of Pontifice Catholic University of Minas Gerais, Brazil.

INTRODUCTION

The Internet became one more vehicle where people, occasionally or routinely, may enjoy or accomplish sexual fantasies and desires, often unconfessable and frustrated in their love and sexual relationships, safely and anonymously, without their real identities being revealed.

Similarly, the Internet provides opportunities for men and women, regardless of sexual orientation, marital status or age, and with distinct sexual preferences, to make come true, in the “real” world, a contact started and kept through online communication (Martins & Grassi, 2001).

Starting from the premise that the definition of “normality” is historically and culturally built, concepts such as “normal”, “healthy” and “pathological” are being questioned by all professionals who are interested in the study and comprehension of human sexuality.

The innumerable manifestations of human sexuality, so as the most varied searches for pleasure, confirm once more that, for the human being, sexuality is not linked to procreation.

The dynamics of human sexuality – what leads an individual to have the sexuality one has – has been an object of study since ancient times, without a consent being reached, which has lead to the search of new paradigms for understanding the so-called “deviant” sexual behaviors.

One of the reasons that make the comprehension of unconventional sexual interests difficult is that the traditional sexual paradigm, based on psychology and psychiatry, as well as on popular opinion, assumes that procreation is the most important biological function (Fog, 1992).

Most collected and studied data about so-called “deviant” behaviors were based on cases considered pathological.

Such studies were made under the legal medical view, or having as reference people who sought for psychiatric and/or psychological treatment because their sexual preferences “deviated” from “normal” sexual behavior (Ceccarelli, 2000) – understood as heterosexual relationship, ending on genital penetration and with the intention of procreating.

Certain so-called “deviant” practices, such as Sexual Sadism and Masochism and also Fetishism, are categorized as “paraphilias” and disfunctional behaviors in the Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition), DSM-IV, by the American Psychiatric Association (APA) and in the International Statistical Classification of Diseases and Related Health Problems – 10th revision (1999), by the World Health Organization, which has generated many debates regarding diagnostic criteria, with which many professionals who are interested in the study of “alternative” sexual practices do not agree.

This study aims to explore human sexuality in its most diverse variations such as BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism) or SM, and Fetishism, through an online questionnaire sent to a group of people who describe themselves as BDSM and Fetish practitioners, and who have in the Internet their referential for the exchange and search of information, as well as the search for partners who share the same sexual fantasies.

This study has no intention of encouraging or condemning the choice of sexual practices, but of exploring the diversity of adult human sexuality of a group of people in the context of the contemporary Brazilian society.

METHOD

An e-mail was sent to the various discussion groups and classified ads posted on websites directed to consensual BDSM and Fetish practitioners in Brazil, and who use the Internet as a means of exchanging and obtaining information and contact with people who share the same sexual fantasies. The exploratory character of the study was explained, that it would be conduced basically via e-mail, and that the real identity of the participants would be preserved. Those who were interested should be over 18 years old, their sexual orientation or marital status notwithstanding. It was asked to the volunteers that they got in touch by replying the sent e-mail. One hundred and eleven people from various Brazilian states manifested their interest in participating. They were sent, then, a questionnaire with questions such as why they used the Internet, which sexual practices they were involved in, how and when they became interested in sexual activities that were considered “different” and how they felt about having pleasure with practices that are considered unconventional.

Information on their age, religious formation, sex, marital status, education and sexual orientation were also the object of interest for the research. It was not the aim of the present study to establish diagnostic criteria of the researched sample, or describing in details the unconventional sexual practices.

DISCUSSION

In spite of the growing evolution observed along the years in human sciences and in the technologic and scientific fields, sexuality is still the object of much speculation, prejudice and taboo. If we observe the diverse current reactions in face of sexual manifestations, we will see how much such reactions remain unchanged throughout History. Although the sixties‘ “sexual revolution” and the innumerous movements aiming at the recognition of human rights (especially the feminist) have changed the social scenery, sexuality is still an enigma for the human being and the object of many discussions since antiquity.

From the 5th Century on, due mainly to the leading Christian Fathers – Augustine, Jerome and Thomas of Aquinas – sexuality was linked to and procreation: the unquestionable example that follows is the “naturally heterosexual” life of animals. All sexual practice that falls out of that norm would bring what is known as the “negative pleasure stigma”.

Then, a form of morality that is essentially a sexual morality appeared. Practices “against nature” – considered offensive to decency, to custom and to public opinion – bring out severe sanctions, so that “normal” may be kept.

However – History shows that – such an objective was never reached: sexuality always escaped all attempts of normatization (Ceccarelli, 2000).

In the late 19th Century, the contemporary psychiatric discourse appears, marked by the same moralistic view;

it maintains the theological and juridical positions, bringing to the medical order what was, until then, from the juridical. The great psychopatologists of that epoch, among them Havellock-Ellis (1888) and Kraftt-Ebing (1890), classified and labeled the sexual practices that escaped moral rules.

A detailed inventory of the so-called “deviant” sexualities was traced, in which new forms of sexual practices (those which use the other for obtaining pleasure and in which the natural finality of sexuality – procreation – is subverted) were created: homosexualism, voyeurism, exhibitionism, sadism, masochism, joining the endless psychiatric nosography of that time. It is also when some terms, that later became classical, are introduced: perversion (1882, Charcot and Magna), narcisism (1888, Havellock-Ellis), auto-erotism (1899, Havellock-Ellis), sadism and masochism (1890, Krafft-Ebing) [Ceccarelli, 2000].

In the late 19th Century and, in a stronger way, in the early 20th Century, Sigmund Freud, in his most important text on sexuality, the “Three Essays on the Theory of Sexuality” published in 1905, sustains that subordinating sexuality to the reproductive function is “a too limited criterion”. In Freudian perspective, sexuality is against nature, that is, as far as sexuality is concerned, there is no “human nature” (Ceccarelli, 2000).

Joyce McDougall and the concept of “Neo-Sexuality”

Contemporary author Joyce McDougall (1997) made an important and innovative reading of Freud, regarding perversion. According to the theoretical perspective of the author, the word “perversion” has a depreciative conotation and points towards negativity, since one never hears of someone who was “perverted” to good. The author maintains that, besides the moralistic implication in the vernacular use of the word, the current standard of psychiatric and psychoanalytic classification is equally questionable. When labeling and diagnosing someone as “neurotic”, “psychotic”, “psychosomatic” or “perverted”, the innumerable variations of psychic structures of each clinical category are not taken into account, losing sight of the most remarkable aspect of human beings in their genetic structure, which is their “singularity” (McDougall, 1997, p 186). Regarding the so-called perverted sexualities like fetishism and sadomasochist practices, she verifies that those occur in the quality of erotic games in sexual activities of non-perverted adults, be they heterosexual or homosexual, so that such practices do not provoke conflict, for they are not experienced as compulsive or as exclusive conditions for sexual pleasure. But heterosexual or homosexual adults who only have fetishist or sadomasochist erotic scripts, for whom those sexual practices are the only means of access to sexual relations, there must be care as to want those people to lose their heterodox versions of desire, simply because they may be considered symptomatic. Instead of “perversion”, McDougall (1997, p 188) prefers to name them “neo-sexualities”. According to the author, the term “perversion” would be more appropriated as a label for acts in which an individual imposes personal desires and conditions on someone who does not wish to be included in that sexual script (as in the case of rape, of voyeurism and exhibitionism) or seduces a non-responsible individual (as a child or a mentally disturbed adult) [McDougall, 1997, p 192].

SM: Causas e diagnósticos (portuguese)

SM: Causas e diagnósticos

por Odd Reiersøl
(agradecemos a tradução por: blueshine)

O psicólogo e sexólogo norueguês Odd Reiersøl, neste artigo, argumenta pela abolição do diagnóstico de fetichismo, fetichismo de transversão, sadismo e masoquismo do ICD-10, Classificação Internacional de Doenças, versão 10.

Introdução

Neste artigo escrevo principalmente sobre SM, mas já que muitos profissionais falam sobre “parafilias” generalizadas ou sobre fetichismo como sendo intimamente ligadas ao SM, farei, por todo o artigo, referências a “fetichismo”. Argumentarei sobre a abolição do diagnóstico de “fetichismo”, “fetichismo de transversão”, “sadismo” e “masoquismo”. Usarei, na maior parte das vezes, o pronome “ele” em vez de “ela”, porque há mais conhecimentos sobre a “parafilia” masculina. Isso não significa que eu queira excluir as mulheres da minha discussão.

O que é SM?

Pontos de vista tradicionais comumente definem que SM é uma “perversão” onde pessoas têm prazer em atividades sexuais que inflijam dor e/ou humilhação. A pessoa que se excita sexualmente por infligir dor/humilhação é chamada de “sádico”. A pessoa que se excita sexualmente por receber estímulos dolorosos/humilhantes é chamada de “masoquista”. A palavra “perversão” foi originalmente usada dentro da terminologia legal, o equivalente psiquiátrico mais moderno seria “parafilia” ou “desvio sexual”(DSM-IV, ICD-10).

Eu vejo o SM como um jogo de poder erótico consentido entre dois adultos. Quando as atividades não são consensuais, ou quando um dos parceiros é tratado com desrespeito, elas se tornam abusivas e podem ser apropriadamente chamadas de “perversas”. O saudável, consensual jogo de poder erótico, pode dar prazer às pessoas. São variações ou preferências sexuais muito aceitáveis. Esses jogos de poder eróticos podem envolver dominação verbal ou física. Ordens, espancamentos, imobilizações e jogos de mestre/escrava são exemplos.

Já que “sadomasoquismo”, para muitas pessoas, carrega uma conotação de violência, pode ser melhor usar um termo diferente como, por exemplo, D/s (Dominação e Submissão), mas é difícil mudar terminologias estabelecidas.

Que tipo de pessoas pratica o SM?

A opinião tradicional de cem anos atrás definia que essas pessoas eram imorais, doentes ou degeneradas. Os pontos de vista não distinguiam entre violência e jogos consensuais. Dados psiquiátricos eram usados para provar esses pontos de vista.

Por exemplo, William Stekel (Stekel, 1930), um famoso psiquiatra e psicanalista, escreveu um livro sobre casos psiquiátricos em fetichismo e SM. Eram pessoas realmente desesperadas, muitas delas em conflito com a lei. Esses pontos de vista eram tirados desses casos.

Vale a pena observar a opinião clerical tradicional condenando todo tipo de atividade sexual que não ocorresse entre homem e mulher, e a atividade sexual necessária para a procriação como objetivo ser aceitável. Qualquer tipo de sexo que não usasse a posição de missionário (o homem por cima!) entre o homem casado e sua esposa era considerado “perverso”.

Foi apenas nos anos 70 que cientistas sociais tentaram conduzir estudos objetivos desses fenômenos sexuais (embora Kinsey tivesse umas poucas questões sobre atividades de infligir dor, como mordidas, no seu famoso estudo dos anos 50). Um dos primeiros estudos foi conduzido por Spengler (1977). Um questionário foi enviado a anunciantes em revistas de SM e a membros de clubes de SM. Moser e Levitt (Weinberg, 1995) fizeram um estudo mais extenso alguns anos mais tarde também baseado em questionários. Robert Stoller (Stoller, 1991) usou um método “etnográfico” para entrevistar praticantes de SM nos anos 80.

Estes estudos indicaram que os praticantes de SM são pessoas muito diferentes. Muitos deles ocupam posição elevada na sociedade, respeitados, com alto nível de educação. Não há razão para crer que há maior prevalência de psicoses ou desordens de personalidade do que na população em geral.

O que faz as pessoas desenvolverem um forte interesse ou preferência por SM?

Se até os psiquiatras e os psicólogos têm tradicionalmente se preocupado com a “etiologia”, acho que seria interessante levantar essa questão sobre a preferência ou forte interesse. Freqüentemente encontro pessoas que se perguntam: “Por que sou como sou?”

Visão psicoanalítica

Na visão psicanalítica o “sadismo” é quase sempre entendido como reação primária e o “masoquismo” como reação secundária ao trauma. O “masoquismo” é secundário no sentido de que o “sadismo” é dirigido para dentro, contra si mesmo. Se a criança tem uma mãe que nega satisfazer suas necessidades, ela pode, quando adulta, procurar vingança em fantasias sádicas e possivelmente realizá-las sexualmente contra mulheres. Sadismo “oral”, “anal” e “fálico” foram postulados. Dessa forma, a vingança pode vir como resultado da angústia de castração na fase edípica (“fálica”). O conflito edípico pode, alternativamente, resultar diretamente em submissão (sendo assim, em masoquismo), como estratégia de fuga. Ele “deixa estar” por desistência.

A compulsão à repetição tem lugar proeminente no pensamento psicanalítico. “Pessoas SM” precisam recriar um velho cenário traumático na tentativa e resolver, aqui e agora, o que foi impossível de resolver no passado. Se, por exemplo, a criança foi espancada pela mãe, ela pode precisar repetir esse cenário tendo uma namorada lhe fazendo o mesmo quando adulto. Ou ele pode reverter essa situação espancando sua namorada.

Há numerosas explicações entre profissionais psicanaliticamente orientados (talvez tantas explicações quanto profissionais). Outra bem conhecida é sobre expiação. “Já que pequei (por ser sexual) sou mau e preciso punição”. Nesse caso, o “masoquismo” parece ser uma reação primária, o “sadismo” será a projeção e o sádico pune o outro ao invés de punir a si mesmo.

Parece que Freud tinha uma visão ampla do SM no sentido de que ele conhecia a seqüência dos estados “normais” aos “extremamente” sádicos, ambos em pessoas masoquistas. Ele associou homens sociáveis, assertivos, dominadores, como tipos sexualmente “sádicos” e mulheres receptivas, submissas, como tipos “masoquistas”. Apenas quando esses impulsos se tornam exagerados que a pessoa se torna “perversa”. Freud também entendeu o fetichismo como uma perversão “primária”, o que significa que o SM de alguma forma tem o fetichismo como base. É também importante notar que Freud, inicialmente, pensou o sadismo como força primária (em relação ao masoquismo), mas, posteriormente passou a crer que o masoquismo veio primeiro.

É preciso alertar que as palavras “sadismo” e “masoquismo” são usados em diferentes sentidos (dos sexuais) dentro da visão psicanalítica. Por exemplo, Wilhelm Reich (Reich, 1945) falou sobre “estruturas de personalidade” sádicas e masoquistas. Há formas de caracterizar tipos de personalidades e isso não tem necessariamente a ver com sexualidade.

Robert Stoller, um psiquiatra e psicanalista, se divide quanto ao pensamento psicanalítico quanto aos conflitos da infância contribuam à “etiologia”. Ele foge ao tradicional porque acentua a formação genética assim como outros fatores biológicos e culturais como importantes contribuições. Ele critica a psicoanálise de ser dogmática e não se interessar em investigar os fenômenos da vida real. “Teorias psicoanalíticas que comecem por chamar de perversos as pessoas fronteiriças, pre-psicóticas e que tais, não fazem justiça às áreas maciças de funções bem sucedidas presentes em muitas pessoas perversas ou às áreas maciças de patologia presentes naqueles que não são classificados como perversos” (nesse livro de 1991 ele atipicamente usa a palavra “perversão” ao invés de “parafilia”). Stoller delineia mais ou menos a seguinte conclusão de suas investigações etnográficas dos anos 80 bem como de outras pesquisas em relação às causas e às dinâmicas:

Fatores biológicos:

· “É sensato pensar que certas áreas anatômicas são constitutivamente mais prazerosas em uma pessoa do que na outra; o desenvolvimento de zonas libidinais contribuem para um estilo erótico”.
· Homens têm uma propensão para fetichizar (por “fetichizar” Stoller descreve um fenômeno que eu preferiria chamar “objetificar”)”ou seja, reduzir a apreciação de alguém a apenas sua anatomia, ou menos (isso sendo a dinâmica fundamental da perversão) em contraste ao desejo oposto nas mulheres por relacionamento, intimidade e constância. Ele supõe que a evolução filogenética é responsável por essas diferenças de gênero. Ele acrescenta, no entanto que essas diferenças quanto ao gênero sexual podem ser explicadas culturalmente.
Fatores culturais:
· Cultura é uma fonte de consciência, por exemplo: “.. quando a igreja medieval aceitou a flagelação como um ato piedoso, os masoquistas tiveram um assombroso caminho, mais ou menos livre de culpa, ao êxtase que a igreja de hoje bloqueou através de sua compreensão do masoquismo perverso”.
· A cultura é uma fonte de sugestões para as pessoas definirem seus comportamentos eróticos. Stoller refere-se aos “jogos erótico perversos”, isto é, um encorajamento aos indivíduos experimentarem práticas para o prazer erótico, mesmo quando a cultura desaprova essas práticas.
Fatores psicodinâmicos:

Trauma: Assim como outros psicanalistas, Stoller inclui o trauma como um fator de forte contribuição. Ele é mais cauteloso do que muitos dos tradicionais pois levanta importantes questões sobre como o trauma contribui exatamente e sob que circunstâncias. Por que algumas pessoas tornam-se interessadas em SM e outras não, tendo tido o mesmo tipo de trauma? Ele especula a partir de seus dados etnográficos e de sua prática psicanalista que as pessoas que praticam SM consensual são “neuróticas, como nós todos”, enquanto que os praticantes não-consensuais são mais severamente afetados demonstrando fortes sinais de desordens da personalidade ou, nos piores casos, de psicoses.
· “Ansiedade de simbiose”: Os meninos precisam desempenhar um ato de separação de suas mães que não é requisitado às meninas. Quando isso é difícil, eles podem temer tornarem-se femininos e podem temer tornarem-se íntimos de meninas e mulheres. “Muito da masculinidade, em todas as culturas, é construída a partir da manifestação desse conflito: da ênfase ao falo, do medo da intimidade com mulheres, do medo de ser humilhado pelas mulheres, da necessidade de humilhar as mulheres e da fetichizição das mulheres.” Ele apregoa que a ansiedade da simbiose pode ser a base para a maioria das perversões, por exemplo, fetichismo, voyeurismo e sadomasoquismo. Na sua maneira de ver essas são diferentes maneiras de criar ou preservar distância das mulheres.

· Defesa contra ansiedade, vergonha e culpa.
Teoria comportamental
Rosenhan e Seligman (1995) apresentam uma visão comportamental das causas das parafilias.Eles usam o paradigma pavloviano onde um reflexo condicionado (CS) é associado a um reflexo incondicionado (US) de estimulação genital e a uma resposta incondicionada (UR) de prazer sexual. Como resultado, futuramente um CS produzirá uma resposta condicionada de excitação sexual. Fetichismo por pés pode ser usado como exemplo. A visão e o toque de um pé no pênis pode se tornar um CS resultando em ereção ou orgasmo, o US. O CS não se extingue na parafilia, devido à masturbação que reforça a conexão entre CS e US. Mas por que algumas pessoas se masturbam com o CS e outras não é ainda um mistério.
Além disso, eles usam um “prevenção” como forma de explicar o fato de que um limitado conjunto de objetos tornem-se parafílicos. Essa prevenção é talvez “meio programada”(i.e. biologicamente determinada) e de determinadas espécies.

Sexologia “Moderna”
John Money (Money, 1986) é um dos mais importantes e conhecidos sexologistas que escreveu exaustivamente sobre a parafilia. Ele usa tanto a psicoanálise quanto a teoria comportamental para como bases para seu pensamento. Uma de suas definições mais proeminentes é a de “transformar a tragédia em triunfo”, a tragédia como vandalização da sexualidade de alguém ou um “gráfico do amor”. O triunfo é a satisfação sexual obtida por ser parafílico. Money define o “gráfico do amor” como “uma representação ou padrão de desenvolvimento existindo simultaneamente no pensamento e no cérebro retratando o amor idealizado, o caso de amor idealizado, e o programa idealizado de atividade sexo-erótica projetada no imaginário ou mesmo realizada com o parceiro” (Money, 1998). O gráfico do amor de uma pessoa é, supostamente, tão característico dessa pessoa como suas digitais. Uma pessoa com parafilia como parte de seu gráfico do amor teve seu gráfico vandalizado.
Gráficos do amor podem ser vandalizados de muitas formas, por exemplo, por pais que interferem no desenvolvimento sexual de uma criança. Ele afirma que a parafilia é virtualmente não-existente em sociedades que não colocam tabus no desenvolvimento sexo-erótico das crianças. Por outro lado, ele enfatiza que tanto a hereditariedade quanto o ambiente contribuem para o aparecimento das parafilias. Componentes hereditários não são necessariamente genéticos, pois podem, por exemplo, ser fruto de influências hormonais no ambiente intrauterino.
Money é conhecido pela extensiva classificação das parafilias, dividindo-as em categorias e sub-categorias e dando-lhes nomes específicos (como “acromotofilia”) que ele pegou do grego e do latim. Sua classificação é muito mais extensa do que as encontradas nos mais importantes manuais de diagnósticos (DSM e ICD).
Os sexologistas variam em sua maneira de pensar sobre as origens da parafilia. Uma opinião comum é que o desenvolvimento da parafilia está conectado à rejeição do indivíduo à sexualidade, ao corpo e à intimidade, e que há um conflito emocional em relação aos seus pais. O conflito emocional faz o indivíduo desconectar sua sexualidade de outros indivíduos e conectá-la a objetos ou situações.

Meus comentários sobre a “etiologia”
Acho razoável acreditar que há tantas origens para a parafilia quanto indivíduos parafílicos. De acordo com minha experiência e com os estudos que li, indivíduos de Sm constituem um grupo diverso que não tem necessariamente nada em comum exceto o fato de serem interessados em SM.
Muitos dos profissionais que tentaram explicar as origens do SM têm bons conceitos, mas eu não acredito que as explicações são universalmente válidas. É muito fácil postular um conflito e um trauma como necessariamente fatores fundamentais, especialmente quando dados do paciente são usados. Se isso fosse correto, eu esperaria uma maior prevalência de psicopatologias entre indivíduos SM do que na população em geral. Pelos estudos feitos, no entanto, não há razão para acreditar nisso. Como Stoller diz: “Muitos dos pacientes informantes são estáveis profissionalmente; a maior parte graduados ou mais, conversadores animados, com bom senso de humor, atualizados na política e nos eventos mundiais, e nem mais nem menos deprimidos do que a sociedade como um todo. “Como todo mundo, eles são neuróticos”.
Então, se, como Stoller diz, SM é uma PTSD (Desordem Pós Traumática por Stress ou Tensão) da infância, nós todos provavelmente temos algum tipo de PTSD, indivíduos SM ou não. E SM é virtualmente uma solução saudável comparando-se, por exemplo, a uma OCD (Transtorno Obsessivo Compulsivo).
Um dos pontos fracos nessas explanações é que quase sempre falam só de homens. Naturalmente, os homens tradicionalmente reprimiram menos suas inclinações sexuais do que as mulheres, assim sendo manifestaram seus impulsos sexuais de forma mais abrangente. Alguns deles tiveram problemas (algumas vezes até com a Lei) e terminaram num consultório médico sendo diagnosticados. Isso nos leva a um outro ponto fraco: muitos dos casos coletados vêm de casos patológicos.
Acho razoável perceber (como Stoller e Money) que há várias causas que contribuíram. A educação é obviamente insuficiente, já que há fortes razões para crer que ambientes equivalentes podem dar resultados diferentes. Indivíduos que foram espancados quando crianças podem ou não ser levados a espancar. E indivíduos que nunca foram (ou pelo menos dizem que não) espancados gostam de o ser durante os jogos SM. Talvez alguns indivíduos sejam mais atraídos a uma forte estimulação do que outros. O ânus é uma zona erógena para a maioria das pessoas e talvez mais sensível em umas do que em outras. Já que há diferenças genéticas nas partes do corpo de cada um, por que diferenças geneticamente determinadas em diferentes partes do corpo não respondem a vários tipos de estímulos?
Concordo com Stoller de que há causas biológicas, culturais e ambientais, que freqüentemente operam em interação simultânea. Acredito que a “fixação” (Stoller) ocupa uma parte importante, porque interesses sexuais são muito “resistentes à extinção”. Não acho que os teóricos comportamentais tenham acertado em que a masturbação seja um fator crucial para manter o interesse. Mais provável que o interesse tenha sido invocado uma vez e para sempre fixado, compelindo portanto o indivíduo a continuar se masturbando.
O interesse pode ser despertado de várias formas, não necessariamente traumáticas. Se há um trauma envolvido, talvez isso possa explicar a fixação pois a excitação pode ter sido tão grande que o impacto emocional da experiência fica gravado para sempre no cérebro e no sistema nervoso. Mas posso bem imaginar que os estados hiper-excitados tenham diferentes causas. Uma irmã mais velha que coloque sua bota no pênis do menino durante uma brincadeira pode ser o exemplo de forte excitação resultante do vigor do jogo mais o toque em seu pênis. Seu fetiche por botas e possivelmente um interesse masoquista pode ser devido ao intenso prazer num estágio de super-excitamento sem nenhum trauma envolvido. Naturalmente, sua estrutura genética pode ser de grande influência nessa hora. Entretanto, alguém pode argumentar que se um indivíduo adulto pode relacionar-se sexualmente apenas com botas e não com pessoas, deve haver algum trauma em sua vida que faz ser impossível uma relação sexual com outras pessoas. O(s) trauma(s) será, nesse caso, relativo à sua inabilidade em criar relacionamentos, não a fetiches ou interesses SM. Tenho certeza de que psiquiatras quase sempre se confundem sobre esses assuntos. Além disso há uma razão para acreditar que a maioria de nós sofremos algum tipo de trauma, e que isso poderiam, em casos individuais, ser prova de que o trauma é a causa para o interesse no SM. “Veja, esses SM todos tiveram traumas em suas vidas”.
De qualquer maneira, concordo com Stoller em que, aqueles que abusam de outros, sexualmente ou não, são indivíduos comprometidos psiquicamente. Eles devem ter sofrido traumas tradicionais (como terem sido vítimas de abusos) ou terem sido severamente negligenciados, de tal forma que suas habilidades para relacionarem-se com outras pessoas de forma respeitosa e empática tenha sido profundamente prejudicada.
Um ponto sobre a interação entre a biologia e o ambiente: há razões para crer que alguns meninos têm uma estrutura biológica mais feminina do que outros (Bateson). Um menino assim pode se sentir especialmente inclinado a brincar com meninas e de forma submissa. Sua estrutura biológica dá-lhe impulsos para escolher ambientes que lhe dê oportunidades de experimentar uma forte excitação sexual por meninas que o dominem. Aí, o interesse masoquista pode se desenvolver. É claro que não afirmo que todos os homens masoquistas são “efeminados”. Há diferentes razões para todos os interesses e preferências sexuais.

Por que o SM (e o fetichismo) ainda é passível de diagnóstico?

O SM não é apenas categorizado como uma “parafilia”, ele é também diagnosticado como tal. Sexualidade desviante tem sido vista como imoral (“perversa”) pelo clero como também pelos leigos. Essa avaliação tem servido como ferramenta para a opressão política. O controle da sexualidade das pessoas toca profundamente em suas personalidades. Com a medicalização da sociedade, imoralidade foi substituída por doença. Inúmeras práticas sexuais foram rotuladas de “desvios”, o que significa “doente” no contexto diagnóstico. Muitas dessas práticas são hoje consideradas normais, ou pelo menos não como doenças (por exemplo sexo oral, sexo anal, homossexualidade). Uma razão para isso é a crescente aceitação de atividades sexuais como prazeres legítimos (tanto para homens quanto para mulheres); a atividade sexual não necessariamente tem a procriação como objetivo atualmente.

Outra razão é a permissividade e a relativa abertura sobre a diversificação, e os homossexuais tornaram-se um forte e influente grupo lutando por seus direitos humanos. O mais autorizado sistema de diagnóstico psiquiátrico mundial é o DSM-IV (Manual Estatístico e Diagnóstico de Doenças Mentais, Quarta Edição) pela Associação Psiquiátrica Americana e o “Desordens Mentais e Comportamentais” subgrupo do ICD-10 (Classificação Internacional de Doenças, versão 10) pela Organização Mundial da Saúde.

Há, provavelmente, muitas diferentes razões do porquê SM e fetichismo são diagnosticados como “parafilias”:
· Categorização e estigmatização da minoria não a elimina. Indivíduos estigmatizados precisam falar e exigir aceitação, especialmente quando o grupo é invisível. Estabelecer categorias tendem a continuar sua existência (apenas porque eles existem) até que alguém lute por mudança.
· Muitos praticantes de SM nem sabem que eles são diagnosticados. A maioria deles estão “dormindo” nessa parte do mundo. Indivíduos com interesses em SM e em fetiches normalmente não procuram por terapia para mudar seus interesses sexuais. Esses indivíduos que foram diagnosticados são normalmente os reincidentes a que se referem o sistema legal.
· Dentro do diagnóstico de sádico e de masoquista não há distinção claro entre jogos consensuais e abuso sexual.
· Psiquiatras, pelo menos os tradicionais, tendem a acreditar que o SM é causado por severo trauma e, portanto, é um fenômeno anormal.
Na verdade houve algum esforço para mudar, o que resultou no “critério B” adicionado a todas às sub-categorias das parafilias no DSM-IV: “As fantasias, impulsos ou comportamentos sexuais causam, clinicamente, significantes aflições ou prejuízos nas importantes áreas de funcionamento social, ocupacional etc.”. Este critério precisa ser encontrado como condição para que o diagnóstico de “parafilia” seja feito. O critério não é (ao menos não claramente, explicitamente ou consistentemente) implementado no ICD-10. Ambos os sistemas de diagnóstico aboliram o diagnóstico de homossexualidade.

Por que os diagnósticos de “fetichismo” e de “sadomasoquismo” deveriam ser abolidos?

· Isso é um assunto de direitos humanos. Diagnosticar tipos de sexualidade é um desrespeito assim como discriminar pessoas baseando-se na raça, etnia ou religião.
· Pessoas podem usar o diagnóstico para usar o abuso legítimo. Há ainda muito respeito e crença nos diagnósticos médicos. .
· Os “desviados” freqüentemente vêem a si mesmos como menos valorizados (eles sentem o estigma).
· Diagnósticos são confusos. Por exemplo, o critério de diagnosticar o “fetichismo de transversão” (DSM-IV) aplica-se apenas a homens heterossexuais. Fico feliz que homossexuais e mulheres estejam isentos (e eles têm sido bons em se agrupar contra a discriminação), mas homens e heterossexuais também deveriam. Uma razão pela qual mulheres estejam isentas desse diagnóstico é, provavelmente, que mulheres usam roupas masculinas de forma melhor aceita socialmente do que homens degradam seu status se usarem roupas femininas. O diagnóstico de “Sadismo” e “Masoquismo” são certamente confusos porque abuso e violência estão na mesma categoria que jogos sexuais consensuais. O diagnóstico de “Pedofilia” não tem nada a ver com fetichismo ou SM consensual, mas é diagnosticado como “Parafilia” do mesmo nível.
· O rótulo de “Parafilia” no sistema de diagnóstico parece inconsistente. Muitos tipos de parafilia (como o, por exemplo, definido John Money) não são mencionados. Desde que muitos tipos de abuso sexual são diagnosticados como parafilia, parece estranho que o estupro não o seja. Um estuprador não é necessariamente sádico porque ele pode não ter necessariamente excitação sexual advinda do sofrimento da vítima. A prática de sexo sem segurança também não é diagnosticada como tal (pelo menos não como uma desordem sexual).
· As categorias do DSM-IV para fetichismo e SM são redundantes, porque se as fantasias causam aflição ou prejuízo funcional, há muitas outras categorias (fora da parafilia) para serem diagnosticadas.
· Interesses por SM e fetichismo são basicamente “normais” (assim como algumas pessoas são atraídas por pernas com meias, outras pés com sapatos “sexies”, etc., e a dimensão desse poder é usualmente presente em algum grau, isto é, quem fica por cima e quem fica por baixo durante a atividade sexual). O interesse só é passível de ser diagnosticado se for excessivo, mas esse excesso pode ser aplicado a qualquer coisa na vida. Um colecionador de selos não será diagnosticado como “filatélico” só porque fica excessivamente absorto com essa atividade.
· O ICD-10 privilegia as relações sexuais: “Fantasias fetichistas são comuns, mas não são consideradas desordens a menos que levem a rituais tão compulsivos e inaceitáveis que interfiram na relação sexual causando um esgotamento no indivíduo”. Então, se as pessoas não querem relações sexuais, isso pode ser sério! Sadomasoquismo, no entanto, não significa causar um esgotamento no indivíduo (inconsistência).
· Independente do que cause o SM e o fetichismo, não há razões para diagnosticá-los como doenças. É um absurdo tão grande quanto diagnosticar as pessoas “judias”, “cristãs” ou “muçulmanas”.
· Não é a sexualidade em si que é um problema. Entretanto, qualquer tipo de sexualidade (até a atividade heterossexual “careta”, “normal”) pode ser pervertida quando abuso e desrespeito fazem parte dela.
· Diagnosticar pode afetar os indivíduos de muitas maneiras negativas.
Possíveis conseqüências por ser diagnosticado
· Pessoas podem acreditar que estão doentes porque autoridades médicas assim o dizem.
· Imagem negativa de sis mesmo, baixa auto-estima.
· Obsessões e compulsões, por exemplo, o alcoolismo, o abuso das drogas e o vício em trabalhar.
· Suicídio ou tentativa de suicídio.
· Ansiedade sexual, dificuldades sociais.
· Vários tipos de comportamento auto-destrutivo (por exemplo, mutilação própria e passividade).

Comentários finais: Qual é o problema realmente?

Stoller diz: “Mas agora, o ponto principal. Embora estudar o sentido da perversão valha a pena, o que interessa é a questão básica: Que ameaça qualquer indivíduo, não apenas o sadomasoquista, inflige a qualquer outra criatura? Não apenas na imaginação ou no teatro do comportamento erótico (como, por exemplo, no dos sadomasoquistas consensuais)”. Stoller usa a palavra “perversão” mais ou menos como sinônimo de “parafilia”. Eu acho que seria útil reservar a palavra “perversão” para atividades sexuais ameaçadoras e outras abusivas e desrespeitosas. A categoria de “perversão” poderia então incluir atividades como: estupro, coerção sexual, dolo sexual, pedofilia e inúmeras práticas sexuais perigosas. Estou falando realmente sobre a moral na nossa cultura, em nossos dias e época, e isso é que é importante. Se nós, por qualquer razão, precisarmos manter uma categoria diagnóstica de “desvio sexual”, eu certamente incluiria as práticas imorais nessa categoria.
De qualquer forma, qual é realmente o problema dos indivíduos “perverso” neste sentido? É um problema sexual ou alguma coisa a mais? Quando uma pessoa ultrapassa os limites de outra pessoa ou se comporta de forma auto-destrutiva, esta pessoa tem um problema e pode ser um bem sério, mas não um problema sexual. O homem que bate na esposa (sendo sexualmente excitado com isso ou não) tem um sério problema, como um transtorno de personalidade (o que também não é um problema sexual). O indivíduo adulto que se envolve sexualmente com crianças tem um problema grave. Ele provavelmente tem dificuldades em desenvolver intimidade com outros adultos, ou seja, em outras palavras ele tem um problema de contato.
Ainda umas poucas palavras sobre intimidade: Muitas pessoas, sejam “normais” ou “parafílicas”, têm dificuldade em tornar-se íntimo do parceiro apropriado. Se a pessoa é “parafílica”, a psiquiatria é rápida em atribuir o problema a um desvio de sexualidade. Seria mais apropriado ver a dificuldade com a intimidade como um problema, do que estigmatizar o tipo de sexualidade. Não há nenhuma evidência de que pessoas SM ou fetichistas são menos aptos a amar seus parceiros do que qualquer outra. Se a pessoa tem problema com intimidade, isso não é um problema sexual. Entretanto, isso pode ser muito sério.

Bibliografia

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association, Washington DC.
ICD-10: The ICD-10 Classification of Mental and Behavioral Disorders, World Health Organization, Geneva.
Money, John: “Lovemaps”, Irvington Publishers, Inc., N.Y., 1986.
Money, John: “Sin, Science and the Sex Police”, Prometheus Books, Amherst, New York, 1998.
Reich, Wilhelm: “Character Analysis”, Farrar, Strauss and Giroux, N.Y. 1945.
Rosenhan, D.L. and Seligman, M.: “Abnormal Psychology, third edition”, Norton, N.Y. 1995.
Stekel, Wilhelm: “Sexual Aberrations”, Liveright Inc, N.Y., 1930
Stoller, Robert: “Pain and Passion – A Psychoanalyst Explores the World of S&M”, Plenum Press, N.Y., 1991.
Weinberg, Thomas (Ed.): “S&M – Studies in Dominance and Submission”, Prometheus Books, Amherst, New York, 1995.

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.

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.