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


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

Oslo, November 11, 2011

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

Abstract

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 Because the ICD fetish and SM diagnoses are superfluous, outdated, non scientific and stigmatizing to the fetish/BDSM minority, these diagnoses have been removed in nearly all of the Nordic countries.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

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

Background

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and criticism on the ICD-10, concluding: The ICD diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism are outdated and not up to the scientific standards of the ICD manual.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

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

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

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

Introduction

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

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

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

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

Sweden, January 1, 2009 removed the following diagnoses:

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

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

F64.1 Dual-role transvestism
F65.5 Sadomasochism

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

Definitions

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

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

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

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

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

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

Sadomasochism was normative before Krafft-Ebing

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

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

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

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

Degeneration, perversion, and moralistic hierarchy

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

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

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

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

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

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

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

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

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

Prejudice disguised as science

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

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

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

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

Victorian stereotypes in the media

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

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

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

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

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

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

Research on pathology

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

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

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

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

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

Health promoting sexuality

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

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

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

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


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

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

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

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

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

 

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SM versus violence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pleasure and pain

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

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

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

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

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

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

What SM can teach us

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

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

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

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

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

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

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

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

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

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

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

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

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

SM and equality

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

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

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

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

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

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

Safe, sane and consensual

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

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

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

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

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

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

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

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

BDSM women

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

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

Female Fetishism

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

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

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

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

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

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

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Discrimination

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

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

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

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

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

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

Childhood trauma?

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

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

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

Prejudiced therapists

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

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

Animal kingdom

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

Ethology: Sign Stimuli.

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

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

Transvestic fetishism/Transvestism

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

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

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

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

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

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

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

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

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

Masturbation

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

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

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

SM/fetish and love

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

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

Identity building

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

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

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

Nordic sexual reform

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

SM and fetish identity

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

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

Conclusions

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

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

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

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

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

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

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

 

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References

Albury, Kath (2002). Yes Means Yes. Getting explicit about heterosex. Allen & Unwin, Australia.

Alison, Laurence; Santtila, Pekka; Sandnabba, N. Kenneth & Nordling, Nicklas (2001). Sadomasochistically-oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1–12. Retrieved November 11, 2011, from http://www.springerlink.com/content/g546j672m027t370/fulltext.pdf Retrieved November 11, 2011, from http://www.science20.com/alternate_allele/spanking_your_lover_improves_intimacy_finally_sadomasochism_gets_its_own_science_study

Apostolides, Marianne (1999). The Pleasure of Pain. Luc Granger, Ph.D. interviewed in Psychology Today, 32(5), 60-65. September 1999. Retrieved November 11, 2011, from http://www.psychologytoday.com/articles/199909/the-pleasure-pain

Bagemihl B. (1999). Biological Exuberance: Animal Homosexuality and Natural Diversity, New York: St. Martin’s Press, 1999. Retrieved April 29, 2011, from http://www.revisef65.org/febagemihl.html

Baldwin, Guy (1993). The Ties That Bind. San Francisco: Daedalus Publishing Company.

Basen, Anna & Langstrom, Niklas (2006). Pervers? Om sex utover det vanliga. [Perverse? On sex outside of the ordinary]. Bokforlaget DN, Stockholm.

Bass, Ellen & Davis, Laura (1988). The courage to heal: A guide for women survivors of child sexual abuse, New York: Harper Perennial.

Baumeister, Roy F. (1988a). Masochism as escape from self. Journal of Sex Research, 25, 28-59.

Baumeister, Roy F. (1988b). Gender differences in masochistic scripts. Journal of Sex Research 25, 478-499.

Baumeister, Roy F. (1989/1997). Masochism and the self. In J. K. Noyes, Ph.D. The mastery of submission: Inventions of masochism (p. 9). Ithaca, NY: Cornell University Press. (Original work published 1989).

Bean, Joseph W. (1994). Leathersex, A Guide for the Curious Outsider and the Serious Player. Los Angeles: Daedalus Publishing Co.

Bienvenue, Robert & Jacques, Trevor (1999). Patterns of Development and Practice in Today’s BDSM Subcultures. Results from a survey of SM practioners. Retrieved November 11, 2011, from http://www.sexresearch.com/SSSS/PDFs/SSSS_AASECT_1999_B_Jacques.pdf

Blanchard, Ray (2009). The DSM Diagnostic Criteria for Transvestic Fetishism. Report submitted to the DSM-V Workgroup on Sexual and Gender Identity Disorders. American Psychiatric Association. Archives of Sexual Behavior. Retrieved November 11, 2011, from http://www.dsm5.org/Documents/Sex%20and%20GID%20Lit%20Reviews/Paraphilias/DSMV.TF.pdf

Bloch, Iwan (1933/1994). Anthropological studies in the strange sexual practices of all races in all ages [excerpts and summary of his book]. In B. Thompson, Ph.D. (Ed.), Sadomasochism: Painful perversion or pleasurable play? (1994, pp. 35-39). New York: Cassell. (Original work published 1933).

Blos, P. (1991). Sadomasochism and the defense against recall of painful affect. Journal of the American Psychoanalytical Association, 39, 419-430.

Blum, H. P. (1991). Sadomasochism in the psychoanalytical process, within and beyond the pleasure principle: discussion. Journal of the American Psychoanalytical Association, 39, 431-450.

Brame, Gloria (2000). BDSM/fetish demographics survey. Retrieved April 4, 2011, from http://www.gloria-brame.com/therapy/bdsmsurveyresults.html [Sorry, dead link]

Brame, Gloria G.; Brame, William D. & Jacobs, Jon (1993). Different loving: The world of sexual dominance and submission. New York: Villard Books.

Breslow, Norman; Evans, Linda & Langley, Jill (1985). On the prevalence and roles of females in the sadomasochistic subculture: Report Of an empirical study. Archives of Sexual Behavior 14: 303-317. Retrieved November 11, 2011, from http://www.springerlink.com/content/m7276ut047xg5316/

Breslow, Norman (1999). SM Research Report, v1.1. Online publication of accumulated data from over 1000 questionnaires collected between 1981 and 1990 from people living in all 50 US states, as well as some from Canada, Europe and South America. Retrieved November 11, 2011, from http://www.sexuality.org/authors/breslow/nbres.html

Brodsky, Joel I. (1993/1995). The Mineshaft: A retrospective ethnography. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (pp. 195-218). Amherst, NY: Prometheus Books. (Original work published in Journal of Homosexuality 1993: 24(3/4), 233-251).

Brown, G.R., Wise, T.N., Costa, P.T., Herbst, J.H., Fagan, P.J., & Schmidt, C.W. (1996). Personality Characteristics and Sexual Functioning of 188 Cross-Dressing Men. The Journal of Nervous and Mental Disorders 184, 265-273.

Bullough, Vern L., & Bullough, Bonnie (1977). Sin, sickness & sanity. The New American Library, Inc. New York.

Bullough, Vern L.; Dixon, Dwight, and Dixon, Joan (1994). Sadism, masochism and history, or when is behaviour sado-masochistic? In Roy Porter & Mikulás Teich. Sexual knowledge, sexual science. The history of attitudes to sexuality (pp. 47-62). Cambridge: Cambridge University Press.

Califia, Pat (1979/1995). A secret side of lesbian sexuality. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (pp. 139-149). Amherst, NY: Prometheus Books. (Original work published in Advocate Dec. 17, 1979:19–23).

Califia-Rice, Pat (1993/2002) Sensuous Magic 2 Ed: A Guide to S/M for Adventurous Couples. San Francisco, Cleis Press.

Califia-Rice, Pat (1994/2000) Public Sex: the culture of radical sex. San Francisco, Cleis Press.

Campbell, Drew (2000). The Bride Wore Black Leather… And He Looked Fabulous. San Francisco: Greenery Press.

Connolly, Pamela 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. Retrieved November 11, 2011, from http://www.informaworld.com/smpp/content~db=all?content=10.1300/J056v18n01_05

Cornog, Martha (2003). The Big Book of Masturbation. From Angst to Zeal. Down There Press, San Francisco.

Courtois, Chistine A. (1988). Healing the incest wound: Adult survivors in therapy. New York: W.W. Norton.

Courtois, Christine A. (1993). Adult survivors of child sexual abuse. Milwaukee: Families International.

Cross, Patricia (1998). Understanding sadomasochism: An examination of current perspectives. (Doctoral dissertation, Carleton University, 1998). Dissertation Abstracts International, Oct. 1998.

Cross, Patricia A. & Matheson, Kim (2006). Understanding Sadomasochism: An Empirical Explanation of Four Perspectives. In P. J Kleinplatz & C. Moser (Eds.). Sadomasochism: Powerful pleasures, 133-166. New York: Harrington Park.

Cutler, A. Bert (2003). Partner selection, power dynamics, and sexual bargaining in self-defined BDSM couples. Unpublished doctoral dissertation, The Institute for Advanced Study of Human Sexuality, San Francisco. Retrieved November 11, 2011, from http://www.submissiveguide.com/wp-content/uploads/2009/09/Power-Dynamics-in-BDSM-Couples.pdf

Damon, Will (2003). Dominance, sexism, and inadequacy: Testing a compensatory conceptualization in a sample of heterosexual men involved in SM. J Psychol Hum Sex 2003;14:25–45.

Dancer, Peter L., Kleinplatz, Peggy J., and Moser, Charles (2006). 24/7 Slavery. In P. J Kleinplatz & C. Moser (Eds.). Sadomasochism: Powerful pleasures (pp. 81-101). New York: Harrington Park.

Dietz, Park Elliot (1990). Sexual Freedom Now. Retrieved November 11, 2011, from http://www.revisef65.org/NOWSM.html

Eisfeld, Justus (2011) Taking care of human rights: Placing Trans* healthcare in a framework of human rights (WHO symposium on (trans)gender identity disorder, human rights and health). Oral presentation at the 20th World Congress for Sexual Health, Glasgow, United Kingdom, June 13th, 2011.

Ellis, Havelock (1926/1995). Studies in the psychology of sex. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (1995, pp. 37-40). Amherst, NY: Prometheus Books. (Original work published 1926).

Ernulf, Kurt E. & Innala, Sune M. (1995). Sexual bondage; A review and unobtrusive investigation. Archives of Sexual Behavior 24, 631-654. Retrieved November 11, 2011, from http://www.springerlink.com/content/m3g8571880712307

Falco, Kristine L. (1991). Psychotherapy with lesbian clients: Theory into practice. New York: Brunner/Mazel.

Fantino, Edmund and Logan, Cheryl (1979): The Experimental Analysis of Behavior. A Biological Perspective, pp. 318-319, W.H. Freeman and Company, San Francisco.

Fedoroff, Paul J. MD (2008). “Sadism, Sadomasochism, Sex, and Violence”. Canadian Journal of Psychiatry (Canadian Psychiatric Association) 53 (10): 637–646.

Ford, C. S., & Beach, F. A. (1951). Patterns of sexual behavior. Scranton, Pennsylvania: Harper & Brothers.

Freud, Sigmund (1900/1954). The interpretation of dreams. London: Allen & Unwin.

Freud, Sigmund (1906/1953). My views on the part played by sexuality in the etiology of the neuroses. Standard Edition, VII. London: Hogarth.

Freud, Sigmund (1924/1961). The economic problem of masochism. In J. Strachey (Ed. And Trans.). The standard edition of the complete psychological works of Sigmund Freud, 19, 159-170.

Freud, Sigmund (1938). The basic writings of Sigmund Freud, trans. and ed. A. A. Brill. New York: Modern Library.

Gallagher, Bob (1989/1994). “Sex, Power and the Politics of Identity”. Interview in the Advocate. October 9, 1989, quoted in James Miller, The Passion of Michel Foucault, London: Flamingo, 1994, p.263.

Gamman, Lorraine and Makinen, Merja (1994). Female Fetishism, New York University Press.

Gebhard, Paul H. (1969/1995). Sadomasochism. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (1995, pp. 41-45). Amherst, NY: Prometheus Books. (Original work “Fetishism and Sadomasochism” published 1969).

Gebhard, Paul H. (1976). Fetishism and sadomasochism. In M. Weinberg (ed.), Sex research. New York: Oxford University Press.

Goffman, Erving (1963) Stigma: notes on the management of spoiled identity. Englewood Cliffs, Prentice-Hall.

Gosselin, Chris & Wilson, Glenn (1980). Sexual variations: Fetishism, transvestism and sado-masochism. Simon & Schuster NY.

Gosselin, Chris; Wilson, Glenn, & Barrett, P.T. (1987). The sadomasochistic contract. In G. D. Wilson (Ed.), Variant sexuality: Research and theory (pp. 229-257). Baltimore: John Hopkins University Press.

Grainger, Percy (1955/1999). National characteristics in modern flagellantic literature, in ”Grainger on music”. Edited by Malcolm Gillies and Bruce Clunies Ross. Manuscript dated May 11, 1955.

Haines, Staci (1999). The survivor’s guide to sex: How to have an empowered sex life after child sexual abuse. San Francisco: Cleis.

Halperin, David M. (1995). Saint Foucault. Toward a Gay Hagiography. Oxford University Press, New York-Oxford.

Haymore, Carrie (2002). Sadomasochism: The Pleasure of Pain. University of North Carolina, Charlotte. Undergraduate Journal of Psychology, Volume 15, 2002. University of North Carolina At Charlotte. Department of Psychology.

Heckert, Jamie (2005). Resisting Orientation: On the Complexities of Desire and the Limits of Identity Politics. Sociology Ph.D. The University of Edinburgh. Retrieved November 11, 2011, from http://independent.academia.edu/JamieHeckert/Papers/272754/Resisting_Orientation_On_the_Complexities_of_Desire_and_the_Limits_of_Identity_Politics

Helsedirektoratet (2010a). Helsedirektoratet friskmelder seksuelle minoriteter. Pressemelding fra Helsedirektoratet 1.2.2010 [The Norwegian Directorate of Health takes sexual minorities off the sick list. Press release from the Directorate of Health February 1, 2010]. Retrieved March 15, 2012, from http://www.revisef65.org/friskmelding_eng.html

Helsedirektoratet (2010b). Seksuelle minoriteter [Sexual minorities: Fetishists and Sadomasochists included in the Directorate of Health’ official list of sexual minorities]. Retrieved March 15, 2012, from http://www.helsedirektoratet.no/folkehelse/seksuell-helse/seksuelle-minoriteter/Sider/default.aspx

Herburt, Kim (2009).  Sadomasochism i svenska uppslagsverk 1876-2006 [Sadomasochism in Swedish Reference Books 1876-2006]. Historisk tidsskrift, 129:3, s. 411-428. Retrieved November 11, 2011, from http://www.historisktidskrift.se/fulltext/2009-3/pdf/HT_2009_3_411-428_herburt.pdf

Highleyman, Liz (1997). Playing with Paradox: the Ethics of Erotic Dominance and Submission. In P. Califia and D. Campbell (eds) Bitch Goddess. Greenery Press, San Fransisco. Retrieved November 11, 2011, from http://black-rose.com/articles-liz/bitchgoddess.html

Hoff, Gabriele (2003) Power and Love: Sadomasochistic Practices in Long-Term Committed Relationships. Electronic Journal of Human Sexuality (9). Retrieved November 11, 2011, from from http://www.ejhs.org/volume9/Hoff-abst.htm

Hoff, Gabriele (2009). Therapy experiences of clients with BDSM sexualities: Listening to a stigmatized sexuality. Electronic Journal of Human Sexuality, 12. Retrieved November 11, 2011, from http://www.ejhs.org/Volume12/bdsm.htm

Holland, Janet et al. (1998) The Male in the Head: young people, heterosexuality and power. London, Tufnell Press.

Hoople, Terry (1996). Conflicting visions: SM, feminism, and the law. A problem of representation. Canadian Journal of Law and Society 11(1), 177-220.

Jad Keres Report (1994). Violence Against S/M Women Within the Lesbian Community: A Nation-Wide Survey. Female Trouble, mars 1994. Retrieved November 11, 2011, from https://ncsfreedom.org/component/k2/item/453-violence-against-s/m-women-within-the-lesbian-community-a-nation-wide-survey.html

Johansen, Birgit (1988). Den skjulte lyst – en bog om fetishisme [The hidden desire – A book about fetishism]. Ekstra bladets Forlag, Copenhagen. .

Johansen, Birgit (1990). Smertens lyst [The Pleasure of Pain]. Om sadomasochisme. EkstraBladets Forlag, Copenhagen.

Kamel, G. W. Levi (1980). Leathersex: Meaningful aspects of gay sadomasochism. Deviant Behavior: An Interdisciplinary Journal, 1, 171–191.

Kamel, G. W. Levi (1983). The leather career. On becoming a sadomasochist. In T. Weinberg and G.W.L. Kamel (Eds.). S&M: Studies in sadomasochism (pp. 73-79), N.Y.: Prometheus Books.

Kinsey, Alfred, Pomeroy, Wardell, Martin, Clyde, and Gebhard, Paul H. (1953). Sexual Behavior in the Human Female. Philadelphia: W.B. Saunders.

Kleinplatz, Peggy J. (2001). A critique of the goals of sex therapy, or, the hazards of safer sex. In P. J. Kleinplatz (Ed.) New directions in sex therapy: Innovations and alternatives, (pp. 109-132). Phila., Pa.: Brunner-Rutledge.

Kleinplatz, Peggy J. (2006). Learning from Extraordinary Lovers: Lessons from the Edge. In P. J Kleinplatz & C. Moser (Eds.). Sadomasochism: Powerful pleasures (pp. 325-348). New York: Harrington Park.

Kleinplatz, Peggy, & Moser, Charles (2004). Toward clinical guidelines for working with BDSM clients. Contemporary Sexuality, 38(6), 1–3.

Kolmes, Keely; Stock, Wendy & Moser, Charles (2006). Investigating bias in psychotherapy with BDSM clients. In Kleinplatz & Moser (Eds.) Sadomasochism: Powerful pleasures (pp. 301-324). Binghamton, NY: Harrington Park Press, Inc.

Krafft-Ebing, Richard von (1886/1965). Psychopathia sexualis. (Franklin S. Klaf, Trans.). New York: Bell Publishing Company, Inc. (Translated from the 12th German edition; original work published 1886).

Krueger, Richard B. (2010). The DSM diagnostic criteria for sexual sadism. Archives of Sexual Behavior, 39, 325–345. Retrieved November 11, 2011, from http://www.springerlink.com/content/l72260vlk7142g0r/

Krueger, Richard B., & Kaplan, Meg S. (2002). Behavioral and psychopharmacological treatment of the paraphilic and hypersexual disorders. Journal of Psychiatric Practice, 8, 21–32.

Leather History Timeline (1999). Leather Archives & Museum, Chicago. Retrieved November 11, 2011, from http://www.leatherarchives.org/exhibits/deblase/timeline2.htm

Langstrom, Niklas & Zucker, Kenneth J. (2005) Transvestic Fetishism in the General Population: Prevalence and Correlates. Journal of Sex and Marital Therapy, 31, 87-95.

Lee, John Alan (1979). The social organization of sexual risk. Alternative Lifestyles, 2, pp. 69-100.

Levitt, Eugene E.; Moser, Charles; Jamison, Karen V. (1994). The prevalence and some attributes of females in the sadomasochistic subculture: A second report. Archives of Sexual Behavior 3(4), 465-473. Retrieved November 11, 2011, from http://www.springerlink.com/content/w3675ul343123725/

LLC (1998). The Leather Leadership Conference. Violence And Discrimination Against S/M Women. Retrieved November 11, 2011, from http://www.leatherleadership.org/library/violdiscwom.htm

Loge 70 (1990). Safer Sex für Ledermänner. Switzerland. Retrieved November 11, 2011, from http://schwulengeschichte.ch/inhalt/7-aids-und-seine-folgen/safer-sex-fuer-ledermaenner/

Magill, Martha S. (1982). Ritual and Symbolism of Dominance and Submission: The Case of Heterosexual Sadomasochism. State University of New York at Buffalo. (Unpublished manuscript)

Mains, Geoff (1984). Urban aboriginals: A celebration of leather sexuality. San Francisco: Gay Sunshine Press.

Maltz, Wendy (1991). The sexual healing journey: A guide for survivors of sexual abuse. New York: Harper Perennial.

Mass, Lawrence (1979). Coming to Grips with Sadomasochism. The Advocate, (April 5): 18-22.

McConaghy, Nathaniel (1999). Unresolved issues in scientific sexology. Archives of Sexual Behavior, 28, 285–318. Retrieved November 11, 2011, from http://www.springerlink.com/content/t1235w82x7l20213/

Miale, Janet P. (1986). An initial study of nonclinical practitioners of sexual sadomasochism. Unpublished doctoral dissertation, the Professional School of Psychological Studies, San Diego. In C. Moser C. (1999). The Psychology of Sadomasochism (S/M). S. Wright, ed., SM Classics, New York, Masquerade Books 1999, p. 47-61.

Miller, Philip & Devon Molly (1995) Screw the Roses, Send Me the Thorns: The Romance and Sexual Sorcery of Sadomasochism. Fairfield, CT, Mystic Rose Books.

Moliniere, Pierre (n.d.). Catalogue essays by Baerwaldt, Gorsen and Wilson. Plug In editions, Winnipeg/ Smart Art Press, Santa Monica.

Morel, Bénédict-Augustin (1857). Traité des dégénérescences physiques, intellectiuelles et Morales de l’Espéce humaine.

Moser, Charles (1988). Sadomasochism. Journal of Social Work and Human Sexuality, 7(1), 43–56.

Moser, Charles (1999a). Health Care Without Shame: A Handbook for the Sexually Diverse and Their Caregivers, Greenery Press, San Franscisco.

Moser, Charles (1999b). The Psychology of Sadomasochism (SM). Originally published in: S. Wright, ed., SM Classics, New York, Masquerade Books, p. 47-61. Retrieved November 11, 2011, from http://www2.hu-berlin.de/sexology/BIB/SM.htm#S/M_PRACT

Moser, Charles (2002, May). What do we really know about S/M: Myths and realities. Paper presented at the 34th conference of the American Association of Sex Educators, Counselors, and Therapists, Miami, Fla.

Moser, Charles & Levitt, Eugene E. (1987/1995). An exploratory-descriptive study of a sado-masochistically orientated sample. In T. Weinberg (Ed.). S&M: Studies in dominance and submission (1995, pp. 93-112). Amherst, NY: Prometheus Books. (Reprinted from The Journal of Sex Research 23 (1987): 322-337.)

Moser, Charles & Kleinplatz, Peggy J. (2002). Transvestic fetishism: Psychopathology or iatrogenic artifact? New Jersey Psychologist, 52(2) 16-17.

Moser, Charles & Kleinplatz, Peggy J. (2005). DSM-IV-TR and the Paraphilias: An Argument for Removal. Journal of Psychology and Human Sexuality (2005), 17(3/4), 91-109. Retrieved November 11, 2011, from http://www2.hu-berlin.de/sexology/GESUND/ARCHIV/MoserKleinplatz.htm

Moser, Charles & Madeson, J. (1996/1999). Bound to be free: The SM experience. (rev. ed.) New York: Continuum Publishing.

Naerssen, A.X. van; van Dijk, Mart; Hoogeveen, Geert & van Zessen, Gertjan (1987). Gay SM in pornography and reality. Journal of Homosexuality, 12 (2/3): 111-119.

NCSF (1999). The NCSF Violence & Discrimination Survey. Retrieved November 11, 2011, from https://ncsfreedom.org/component/k2/item/452-ncsfs-violence-and-discrimination-survey.html

NCSF (2008). Second National Survey of Violence & Discrimination Against Sexual Minorities. Retrieved November 11, 2011, from http://www.ncsfreedom.org/images/stories/pdfs/BDSM_Survey/2008_bdsm_survey_analysis_final.pdf

NCSF (2010). DSM Revision White Paper. Retrieved November 11, 2011, from https://ncsfreedom.org/key-programs/dsm-v-revision-project/dsm-revision-white-paper.html

Newitz, Annalee (2000). Whip me, spank me, gentrify me. Salon Magazine. January 15, 2000. San Francisco, US. Retrieved November 11, 2011, from http://dir.salon.com/health/sex/urge/2000/01/15/gentrification/index.html

Nichols, Margaret (2000). Therapy with sexual minorities. In S. Leiblum & R. Rosen, (Eds.), Principles and practices of sex therapy (3rd ed.) (pp 335-367). New York: Guilford.

Nichols, Margaret (2006). Psychotherapeutic Issues with “Kinky” Clients: Clinical Problems, Yours & Theirs. In P.J Kleinplatz & C. Moser (Eds.). Sadomasochism: Powerful pleasures (pp. 281-301). New York: Harrington Park.

Noyes, John K., Ph.D. (1997). The mastery of submission: Inventions of masochism, p. 30. Ithaca, NY: Cornell University Press.

Ovesson, Charlotte (2011).  Sextortyr eller frigjörelse: Konstruktioner av sadomasochism i svenska dagstidningar 2007-2011 [Sexual Torture or Liberation: Constructions of Sadomasochism in Swedish Daily Newspapers 2007-2011]. Mälardalens högskola, Akademin för hållbar samhälls- och teknikutveckling. Retrieved November 11, 2011, from http://mdh.diva-portal.org/smash/record.jsf?pid=diva2:431502&rvn=2

Pagh, Jørgen (1985). Behovet for spænding [The need of thrills]. Juvelen, Bagsværd, Denmark.

Panter, Amy L. H. (1999). An exploratory study of female sadomasochists’ sexuality: Behavior, fantasy, and meaning. Dissertation Abstracts International: Section B: The Sciences & Engineering, 60, Oct (4-B), 1867.

Politiken (1995:A7). Sadomasochisme er ingen sygdom [Denmark withdraws SM from Diagnosis-list]. Politiken April 1, 1995. Retrieved November 11, 2011, from http://www.revisef65.org/denmark.html

Powers, Heather J. (2007). BDSM in Psychotherapy: A Culturally Aware Curriculum. MS Thesis, Department of Psychology, California State University, East Bay, CA. Retrieved November 11, 2011, from http://www.heatherpowers.com/thesiscalstate.doc

Queen, Carol (1996). Women, sadomasochism and therapy. Women and Therapy, 19 (4), 65-73.

Ramsour, Paul J. (2002). Masochism, sexual freedom, and radical democrazy: A hermenneutic study of sadomasochism in psychoanalytic, sociological, and comtemporary texts. Retrieved November 11, 2011, from http://etd.library.vanderbilt.edu/available/etd-0320102-154155/unrestricted/etd.pdf

Reiersøl, Odd (2002). SM: Causes and diagnoses. Retrieved November 11, 2011, from http://www.revisef65.org/reiersol3.html

Reiersøl, Odd & Skeid, Svein (2006). The ICD diagnoses of fetishism and sadomasochism. In P. J. Kleinplatz & C. Moser (Eds.), Sadomasochism: Powerful pleasures (pp. 243-262). Binghampton, New York: Harrington Park Press. Published simultaneously in Journal of Homosexuality. Volume 50, Issue 2-3, 2006. Retrieved November 11, 2011, from http://www.tandfonline.com/doi/abs/10.1300/J082v50n02_12

Reiersøl, Odd & Skeid, Svein (2010). Fra samfunnsfiende til friskmeldt identitet [From Public Enemy to Healthy Identity]. Tidsskrift for psykisk helsearbeid [Journal of Psychological Health Care], Volum 7, Nr 4-2010, 312-320. Oslo, Universitetsforlaget. Retrieved November 11, 2011, from http://www.idunn.no/ts/tph/2010/04/art06

Reik, Theodor (1940). Aus Leiden Freuden. Imago, London 1940.

Reik, Theodor (1941). Masochism and modern man. New York: Toronto, Farrar & Rinehart.

Reuben, David R. (1969). Everything You Always Wanted to Know About Sex (But Were Afraid to Ask). McKay Publications, Philadelphia, USA. Retrieved November 11, 2011, from http://www.goodasyou.org/good_as_you/2008/12/every-lie-you-n.html

Revise F65 (1997). Norske myndigheter om forebyggende helsearbeid [Norwegian health authorities about health preventive work for the BDSM minority]. Retrieved November 11, 2011, from http://www.revisef65.org/forebyggende.html

Revise F65 (2004c). Discrimination and violence towards the SM/fetish population. Retrieved November 11, 2011, from http://www.revisef65.org/discrimination.html

Revise F65 (2004e). Sikker, sunn og samtykkende [Safe, sane, and consensual as a moral ethical principle and cornerstone of SM acticity]. Retrieved November 11, 2011, from http://www.revisef65.org/sikker.html

Revise F65 (2004f). Kink against racism. Retrieved November 11, 2011, from http://www.revisef65.org/antinazi.html

Revise F65 (2005/2011). Sovende fetisj- og SM-diagnoser [Diagnoses not in use]. Retrieved November 11, 2011, from http://www.revisef65.org/sintef.html

Revise F65 (2007). SM versus abuse. Retrieved November 11, 2011, from http://www.revisef65.org/violence.html

Revise F65 (2008). Fetish and SM diagnoses deleted in Sweden. Retrieved November 11, 2011, from http://www.revisef65.org/Sweden.html

Revise F65 (2009e). ICD Revision White Paper. Proposal to the ICD-11 Revision of Chapter V, Mental and Behavioural Disorders, F65 and F64. September 24, 2009. Retrieved November 11, 2011, from http://www.revisef65.org/icd_whitepaper.html

Revise F65 (2009g). The number of sm/fetish people. Retrieved November 11, 2011, from http://www.revisef65.org/antall_eng.html

Revise F65 (2009h). Årsrapport for Diagnoseutvalget Revise F65 [The annual report for 2009/2010 from Revise F65 to The Norwegian Directorate of Health]. Retrieved November 11, 2011, from http://www.revisef65.org/2009rapport.html

Revise F65 (2009k). No more psychopathology among SM-people. Retrieved November 11, 2011, from http://www.revisef65.org/psychopathology.html

Revise F65 (2010b). Transgender IML Winner Breaks Barriers and Makes History. Retrieved November 11, 2011, from http://www.revisef65.org/Folsom2010_6.html

Revise F65 (2010c). SM and fetish off the Norwegian sick list. Retrieved November 11, 2011, from http://www.revisef65.org/friskmelding_eng.html

Revise F65 (2011a). Vern mot diskriminering på grunnlag av seksuell fetisj- og SM-orientering [Report on discrimination and violence towards the Norwegian SM/fetish population delivered to the Minister of Children, Equality and Social Inclusion, Audun Lysbakken, October 11, 2011]. Retrieved November 11, 2011, from http://www.revisef65.org/diskrimvern.html

Revise F65 (2011b). Finland joins Nordic sexual reform, May 12, 2011. Retrieved November 11, 2011, from http://www.revisef65.org/finland_eng.html

Richters et al. (2007). Selected Abstracts of Presentations During the World Congress of Sexology, 2007: Demographic and Psychosocial Features of Participants in BDSM Sex: Data From a National Survey. Journal of Sex Research, 45(2), pp. 90–117. Australian Associated Press April 16, 2007. Retrieved November 11, 2011, from http://www.smh.com.au/news/national/kinky-you-cant-beat-it/2007/04/16/1176696736407.html

Richters et al. (2008). Demographic and Psychosocial Features of Participants in Bondage and Discipline, “Sadomasochism” or Dominance and Submission (BDSM): Data from a National Survey. Journal of Sexual Medicine. 5(7):1660- 68.

Ridinger, Robert B. (2006). “Negotiating Limits: The Legal Status of SM in the United States.” Sadomasochism: Powerful Pleasures. Binghamton, NY: Harrington Park Press. Co-published simultaneously as Journal of Homosexuality 50(2/3):189- 216.

Rubin, Gayle S. (1984/1993) ”Thinking Sex: notes for a radical theory of the politics of sexuality”. in H. Abelove, M Barale & D Halperin (eds) The Lesbian and Gay Studies Reader. New York, Routledge. P. 11-16.

Sagarin, Brad J., Cutler, Bert, Cutler, Nadine, Lawler-Sagarin, Kimberly A., & Matuszewich, Leslie (2009). Hormonal changes and couple bonding in consensual sadomasochistic activity. Archives of Sexual Behavior, 38, 186-200. Retrieved November 11, 2011, from http://www.niu.edu/user/tj0bjs1/papers/scclm09.pdf

Sandnabba, N. Kenneth; Santtila, Pekka & Nordling, Nicklas (1999). Sexual behavior and social adaption among sadomasochistically-oriented males. The Journal of Sex Research. 36, 273-282.

Sandnabba, N. Kenneth; Santtila, Pekka; Alison, Laurence; Nordling, Nicklas (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: a review of recent research. Sexual and Relationship Therapy, 17, 1, 39-55.

Santilla, Pekka; Sandnabba, N. Kenneth & Nordling, Nicklas (2000). Retrospective perceptions of family interaction in childhood as correlates to current sexual adaptation among sadomasochistic males. Journal of Psychology and Human Sexuality, 12, 69-87.

Schmidt, C. W. (1995). Sexual psychopathology and DSM-IV. Review of Psychiatry, 14, 719–733.

Schmidt, C. W., Schiavi, R., Schover, L., Segraves, R. T., & Wise, T. N. (1998). DSM-IV sexual disorders: Final overview. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, W. Davis, & M. Kline (Eds.), DSM-IV sourcebook (Vol. 4, pp. 1087–1095). Washington, DC: American Psychiatric Association.

Schnarch, David M. (1991). Constructing the sexual crucible: An integration of sexual and marital therapy. New York: Norton.

Scott, Gina Graham, Ph.D. (1980/1998). Erotic power: An exploration of dominance and submission. (rev. ed.) Secaucus, NJ: Carol Publishing.

Scoville, John W. (1984). Sexual Domination Today: Sado-masochism and Domination-submission. New York: Irvington.

Shorter, Edward (1997). A History of Psychiatry. New York: John Wiley & Sons.

Slemmings, Barry (2005). A response to the 2005 Home Office Consultation on the possession of “extreme” pornographic material. Retrieved November 11, 2011, from http://www.scotland.gov.uk/Resource/Doc/1099/0021445.pdf

SMil-Norge (2010). Retrieved December 9, 2010, from http://www.smil-norge.no

Spengler, Andreas (1977). Manifest sadomasochism of males: Results of an empirical study. Arch Sex Behav 1977;6:441–456. Retrieved November 11, 2011, from http://www.springerlink.com/content/xr3052m52714414n

Stein, David (2002). Safe, Sane, Consensual. The making of a Shibboleth (PDF). Retrieved November 11, 2011, from http://www.boybear.us/ssc.pdf

Stiles, Beverly; Clark, Robert E. & Hensley, John (2007). Aspects of healthy sexuality within the BDSM lifestyle. Paper presented to Achieving Health, Pleasure and Respect, 1st World Congress of Sexual Health (18th World Congress of World Association of Sexual Health), Sydney. Abstract OP2-11 in Abstract book, Boulogne Billancourt: Regimedia; 2007.

Stoller, Robert J. (1991). Pain & Passion: A Psychoanalyst Explores the World of S & M. New York, Plenum Press.

Sulloway, Frank J. (1979). Freud, biologist of the mind: beyond the psychoanalytic legend. New York: Basic books.

Thompson, Bill., Ph.D. (1994). Sadomasochism: Painful perversion or pleasurable play?. New York: Cassell.

Thomsen, Edith (2002). Techniques of SM that are helpful in gaining comfort with sexual intimacy for survivors of child sexual abuse who practice SM play. Unpublished post-doctoral dissertation. Center for Psychological Studies: Berkeley. Retrieved November 11, 2011, from http://cpsphd.com/dp_ediththomsen.htm

Tiefer, Leonore (1997). Towards a Feminist Sex Therapy. In Marny Hall, Ph.D. (ed), Sexualities, Binghampton, NY: Harrington Park Press.

Townsend, Larry (1972/1993). The Leatherman’s Handbook. Los Angeles, LT Publications. (Original work published 1972).

Ullerstam, Lars M.D. (1966). A Sexual Bill of Rights for the Erotic Minorities. Introduction by Yves de Saint-Agnes. Translated by Anselm Hollo. Grove Press, Inc.

USA Today (2002). Sex scores its own museum in the city. Maria Puente in ‘USA Today’ Sept. 30, 2002. Retrieved November 11, 2011, from http://www.usatoday.com/travel/news/2002/2002-09-23-sex-museum.htm

Vail, D. Angus & Goode, Erich (2007). S&M. An Introduction. Extreme Deviance, p.202. Los Angeles, CA: Pine Forge Press. Retrieved November 11, 2011, from http://www.sagepub.com/upm-data/19083_PART_VII___Engaging_in_S&M_Sexual_Practices.pdf

VG (2002). Sex like bra som morfin mot smerte [Sex as good as morphine against pain]. The Norwegian newspaper VG, March 31, 2002. Retrieved November 11, 2011, from http://www.vg.no/helse/artikkel.php?artid=2918924

Wagenheim, Susan D. (1996/98). Testimony from Physicians and Psychiatrists for the S/M Policy Reform Statement from Susan D. Wagenheim, M.D. A board-certified psychiatrist. Retrieved November 11, 2011, from http://www.revisef65.org/NOWSM.html

Weinberg, Martin S., Williams, Colin J., and Moser, Charles (1984). The social constituents of sadomasochism. Social Problems 31: 379-389.

Weinberg, Thomas S. & Falk, Gerhard (1980). The social organization of sadism and masochism. Deviant Behavior: An Interdisciplinary Journal 1, 379-393.

Weinberg, Thomas S. & Kamel, G.W. Levi (1983). “S&M: Studies in sadomasochism”, N.Y.: Prometheus Books.

Weinberg, Thomas S. (1995). S&M: Studies in dominance and submission. Amherst, NY: Prometheus Books.

Weinberg, Thomas S. & Kamel, G. W. Levi (1995b). S&M: An introduction to the study of sadomasochism. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (pp. 15–24). Amherst, NY: Prometheus Books.

Weinberg, Thomas S., Ph.D. (1978/1995). Sadism and masochism: Sociological perspectives. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (pp. 119-137). Amherst, NY: Prometheus. (Original work published 1978).

Weinberg, Thomas S., Ph.D. (1994/1995). Sociological and social psychological issues in the study of sadomasochism. In T. S. Weinberg, Ph.D. (Ed.), S&M: Studies in dominance and submission (1995, pp. 289-303). Amherst, NY: Prometheus Books. (Original work published 1994).

Weinberg, Thomas S. (2006). In Kleinplatz & Moser (Eds.) Sadomasochism: Powerful pleasures, p.32-35. Binghamton, NY: Harrington Park Press, Inc.

Whipple, Beverly (1986). Effects of Vaginal Stimulation on Pain Thresholds in Women, (Doctoral Dissertation, Rutgers, The State University of NJ, Newark, NJ), Dissertation Abstracts International, 47.

White, Chris. 2006. “The Spanner Trials and the Changing Law on Sadomasochism in the UK.” Sadomasochism: Powerful Pleasures. Binghamton, NY: Harrington Park Press. Co-published simultaneously as Journal of Homosexuality 50(2/3):167-87.

Wiseman, Jay (1996). SM 101: A realistic introduction. San Francisco: Greenery Press. Arch Sex Behav (2009) 38:186–200.

Wright, Susan (2006). Discrimination of SM-identified individuals. In P. J Kleinplatz & C. Moser (Eds.). Sadomasochism: Powerful pleasures, 217-231. New York: Harrington Park.

Wright, Susan (2010). Depathologizing Consensual Sexual Sadism, Sexual Masochism, Transvestic Fetishism, and Fetishism. Archives of sexual behavior. Volume 39, Number 6, 1229-1230. Retrieved November 11, 2011, from http://www.springerlink.com/content/p1314043464r7560

Young, Ian (1973/1979). Sado-Masochism. The New Gay Liberation Book. Len Richmond and Gary Noguera (Eds.). Ramparts Press, Palo Alto, Calif. Also published as the article “S/M” in the Sweedish magazine Revolt #9, 1973.

 

Finland joins Nordic sexual reform

Finland joins Nordic sexual reform

 

Finland joins Nordic sexual reform

Fourth country to completely remove fetish and SM diagnoses:
“Neither care, statistics nor research are harmed by abolition of the diagnoses”

A Nordic sexual rights reform model now challenges the World Health Organization since Finland removed five diagnoses of sexual preferences, sexual identities and gender expressions related to sexual orientation from their national ICD version. WHO is currently revising the International Classification of Diseases to an updated ICD-11 edition within 2015.

By Svein Skeid and Odd Reiersøl

Based on the Norwegian model and the groundbreaking work of the Revise F65 group, the Finnish National Institute for Health and Welfare (THL) announced May 12, 2011, that Finland next year will remove the diagnoses of Fetishism, Fetishistic transvestism, Sadomasochism, Multiple disorders of sexual preference and dual-role transvestism from the Finnish ICD edition (THL, 2011).

These are exactly the same five diagnoses that Norway repealed more than one year ago, and the same diagnoses that Revise F65 has worked a decade to delete from the International Classification of Diseases published by The World Health Organization, WHO (Revise F65, 2010). Sweden removed six diagnoses of sexual behaviours in 2009, among them the same classifications as Norway and Finland now have deleted (The Local, 2008). Denmark withdrew the diagnoses of dual-role transvestism and sadomasochism in 1994 and 1995, respectively (Revise F65, 1995).

– The Nordic sexual rights reform movement is putting pressure on The World Health Organization to follow suit, says Svein Skeid, leader of the Revise F65 group. Revise F65 is a subdivision of LLH, The Norwegian LGBT Association. Currently four Nordic countries have repealed fetish- and SM diagnoses from their national ICD-versions.

– I am happy to inform you that the proposition to revise the ICD-10 classification concerning sadomasochism, fetishism and transvestism has passed in Finland, says Tommi Paalanen, Chairman of the Sexpo Foundation, the Finnish Foundation for Sex Education and Therapy. The proposition was made by SETA, The National LGBT rights organization in Finland and the Sexpo Foundation with a group of experts from many different fields.

Sexual orientation

In their official press release, The Finnish National Institute for Health and Welfare writes that “Changes in the categories related to sexual orientation in the Finnish version of ICD-10 have been proposed to THL.” The press release continues:

“After having evaluated information on the use of the categories in question therapeutically, their medical grounds, opinions of experts on the correctness and the necessity of the classification and general practices in Nordic countries, THL has, by the decision of the Director General, ended up removing the following categories from the Finnish version of ICD-10:

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

The Nordic Revise F65 model

– To date, we estimate that one to two million people in the Nordic countries belong to groups that primarily benefit from the sexual rights reform based on the well-documented Revise F65 model, says Svein Skeid. The Finnish decision strengthens Revise F65’s strategy to motivate more countries to remove their national versions of the ICD SM/fetish diagnoses.

– As four of the Nordic countries have now abolished the diagnoses for use at the respective national levels, this will be a significant professional and political signal to the World Health Organization in the revision process of the ICD-11. We strongly encourage WHO to follow the Nordic Revise F65 model and completely remove the five fetish, SM and trans-diagnoses in the forthcoming updated ICD 11-edition, Svein Skeid concludes.

ICD-11 Alpha Draft

According to the current ICD-11 Alpha Draft (picture left) retrieved May 20, 2011, Fetishism, Fetishistic transvestism, Sadomasochism and dual-role transvestism are not yet taken off the list of disorders of psychological development and gender identity. According to Senior Adviser Arild Johan Myrberg at the Norwegian Directorate of Health, WHO’s ICD revision process isdelayed by a year.

 

The diagnoses are so seldom in use, that neither care, statistics nor research are harmed by their abolition.

”We studied all cases over a period of ten years and found only occasional ones”, reports Dr. Jorma Komulainen, the chief physician at THL.

”These are not rare behavioural patterns, but only seldom is there any reason to seek medical treatment”, Komulainen notes. In fact, so seldom that the abolition of the categories will have no effect on statistics whatsoever. – More harm has been inflicted on people who have felt that they have been labelled by such diagnoses, he says.

During the last decade, the diagnoses in question have been used for therapeutic reasons less frequent that once a year. This can be understood as though neither physicians consider SM, fetishism and transvestism to be diseases, and that they reluctantly use the diagnoses.

”A year and a half ago, we made a decision to attempt at abolishing this category”, reports Minna-Maaria Lax, the chair of DreamWear Club, which is an association representing Finnish transvestites. ”The major problem is that when examining himself or herself, a transvestite may have noticed that he or she has a mental disorder, thereafter starting to regard himself or herself ill”, Lax notes. In conflict situations, for example during a divorce, the classification may have given a weapon to the other party. When it comes to social thinking, the use of these categories is likely to raise public disapproval of transvestites.

Stigmatizing diagnoses

The official reasons for the Finnish removal, are:

1) The medical criteria for the removed classifications are not clear.

2) The use of the categories in treatment records is rare, and their removal does not significantly influence the practice of health care statistics.

3) The use of these categories may cause harm to persons classified according to them.”

The Finnish arguments are similar to the documentation that Revise F65 has sent to The World Health Organization. Revise F65 argues that “the ICD diagnoses of Fetishism, Transvestic fetishism and Sadomasochism are superfluous, outdated, non scientific and stigmatizing” (Revise F65, 2009).

An internet-based survey carried out by the National Coalition for Sexual Freedom (NCSF) with 3,058 respondents, showed that 37.5% of the participants indicated that they had experienced some form of discrimination, harassment or violence due to the social stigma attached to their fetish/BDSM orientation or behavior. The study included respondents from 41 countries, including Europe, in addition to the United States (83,4%). The survey concluded that “pathologizing unusual sexual interests has led to increased discrimination and discouraged individuals from seeking treatment for physical and mental health problems.” (Wright, 2008, 2010).

 

References:

THL (2011). ICD-10-tautiluokitusta päivitetään 2011. Announcement by THL, the National Institute for Health and Welfare in Finland. Retrieved May 12, 2011, from http://www.thl.fi/doc/fi/25489

Revise F65 (2010). Fetish and SM no longer diseases in Norway. Retrieved May 12, 2011, fromhttp://www.revisef65.org/friskmelding_eng.html

The Local (2008). Transvestism ‘no longer a disease’ in Sweden. Retrieved May 12, 2011, fromhttp://www.thelocal.se/15728/20081117/

Revise F65 (1995). Denmark withdraws SM from Diagnosis-list. Retrieved May 12, 2011, fromhttp://www.revisef65.org/denmark.html

Revise F65 (2009). ICD Revision White Paper. Retrieved May 12, 2011, fromhttp://www.revisef65.org/icd_whitepaper.html

Wright, S. (2008). Second National Survey of Violence & Discrimination Against Sexual Minorities. NCSF. Retrieved May 12, 2011, from http://www.ncsfreedom.org/images/stories/pdfs/BDSM_Survey/2008_bdsm_survey_analysis_final.pdf

Wright S. (2010). Depathologizing Consensual Sexual Sadism, Sexual Masochism, Transvestic Fetishism, and Fetishism. Archives of sexual behavior. Volume 39, Number 6, 1229-1230.

Sovende fetisj- og SM-diagnoser

Liksom homofili-diagnosen for 30 år siden, var fetisj- og SM-diagnosene i praksis sovende i rettspsykiatrien, som diagnostisk hjelpemiddel og som forskningsmessig kriterium i de nordiske landene inntil friskmeldingene kom i Sverige (1999), Norge (2010) og Finnland (2011). Det var i realiteten ingen presedens for å bruke den, ifølge tall fra norske, svenske, finske (og amerikanske) helsemyndigheter. Diagnosens eneste funksjon var å stigmatisere seksuelle minoriteter.

I følge overlege Jorma Komulainen ved Det finske nasjonale instituttet for helse og velferd (THL) “er disse fem diagnosene uklare og benyttes så sjelden at verken behandling, statistikk eller forskning tar skade av at de forsvinner.” (Revise F65, 2011b)

Diagnosenes eneste funksjon var å stigmatisere en befolkningsgruppe og legitimere diskriminering. Dette bryter etter vår mening med legeyrkets hippokratiske etikk om ikke å volde skade. “The main objective of diagnosis is patient care”. (IGDA workgroup WPA 2003; The WPA International Guidelines for Diagnostic Assessment by the World Psychiatric Association 2003.)

I brev til SMil-Norge 19.12.2008 opplyser Helsedirektoratets Spesialisthelsetjenesteavdeling at “ingen av de aktuelle diagnosekoder [fetisjisme, fetisjistisk transvestisme og sadomasochisme] er rapportert til Norsk pasientregister i 2007 eller 2008. Dette gir en sterk indikasjon på at kodene ikke brukes.”

Helsedirektoratet opplyser til Dagens Medisin at ifølge Norsk pasientregister ble ingen av de tre tidligere nevnte kodene benyttet i 2007 [fetisjisme, fetisjistisk transvestisme og sadomasochisme]. (Dagens Medisin, 2008)

“Diagnosene som nå fjernes [fetisjisme, fetisjistisk transvestisme og sadomasochisme] rapporteres i praksis i svært liten utstrekning og har derfor liten relevans som grunnlag for statistikk basert på innholdet i Norsk pasientregister.” (Helsedirektoratet, 2010)

“De spesielle koder som nå utgår (fra den svenske ICD-klassifikasjonen) anvendes meget sjelden.” (Socialstyrelsen, 2008)

Undersøkelser utført av amerikanske National Ambulatory Medical Care, viser at av totalt 446 millioner polikliniske konsultasjoner til terapeuter og leger, ble ikke én eneste person diagnostisert med seksuell sadisme eller seksuell masochisme (Krueger, 2010).

I følge overlege Jorma Komulainen ved Det finske nasjonale instituttet for helse og velferd (THL), har fetisj- og sm-diagnosene de ti siste årene “blitt oppgitt som årsak til behandling mindre enn én gang i året. Det kan tolkes som at heller ikke leger anser fetisjisme, transvestisme og SM som sykdommer og at man helst ikke benytter diagnosene.” (Revise F65, 2011b)

Referanser:

Dagens Medisin (2008). Transvestisme og SM ikke lenger en sykdom i Sverige. Dagens Medisin 17.11.2008. Lastet ned 19. mai 2011 fra http://www.dagensmedisin.no//nyheter/2008/11/17/transvetittisme-ikke-lenge/index.xml

Helsedirektoratet (2010). Helsedirektoratet friskmelder seksuelle minoriteter. Pressemelding fra Helsedirektoratet 1.2.2010. Retrieved April 29, 2011, fromhttp://www.helsedirektoratet.no/seksuell_helse/fagnytt/helsedirektoratet_friskmelder_seksuelle_minoriteter_671694

Krueger, R. B. (2010). The DSM diagnostic criteria for sexual sadism. Archives of Sexual Behavior, 39, 325–345. Lastet ned 19. mai 2011 fra http://www.springerlink.com/content/l72260vlk7142g0r/

Revise F65 (2005). Diagnostisering av sm- og fetisj-diagnoser i Norge. Tall fra Sintef 9. mars 2005. Lastet ned 19. mai 2011 fra http://www.revisef65.org/sintef.html

Revise F65 (2011b). Finland slutter seg til nordisk seksualreform. 12. mai 2011. Lastet opp 19. mai 2011 frahttp://www.revisef65.org/finland.html

Socialstyrelsen (2008). Koder i klassifikationen av sjukdomar och hälsoproblem utgår. Pressemelding fra den svenske Socialstyrelsen 17.11.2008. Lastet ned 19. mai 2011 fra http://www.revisef65.org/socialstyrelsen.html

Tall fra Sintef for 2000, 2001 og 2002 viser at diagnosene fetisjisme, fetisjistisk transvestisme og sadomasochisme er i svært sjelden bruk i Norge. Det dreier seg om ca 1-3 ganger per år for de tre diagnosene. (Revise F65, 2005)

STATISTIKKEN FRA SINTEF:

Driftsåret 2000
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2000.


Ullevål sykehus og Buskerud sentralsykehus har ikke levert data i det hele tatt og Modum Bads Nervesanatorium har ikke registrert diagnoser.

Driftsåret 2001
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2001.


Molde sykehus og Ålesund sjukehus har ikke levert data. Ingen institusjon i Nord-Trøndelag, Telemark eller Buskerud fylke har levert data.
Fem døgninstitusjoner som tilhører Aker Universitetssykehus har ikke kunnet levere døgndata.

Driftsåret 2002
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2002.


Aker universitetssykehus mangler data på dag- og poliklinisk omsorgsnivå og Molde Sykehus data er ikke brukbar for året.
Sykehuset Buskerud, Sykehuset Telemark og Notodden sykehus har problemer ved registrering av data, dermed usikker datakvalitet og kompletthet.

Driftsåret 2000
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2000.


Ullevål sykehus og Buskerud sentralsykehus har ikke levert data i det hele tatt og Modum Bads Nervesanatorium har ikke registrert diagnoser.

Driftsåret 2001
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2001.


Molde sykehus og Ålesund sjukehus har ikke levert data. Ingen institusjon i Nord-Trøndelag, Telemark eller Buskerud fylke har levert data.
Fem døgninstitusjoner som tilhører Aker Universitetssykehus har ikke kunnet levere døgndata.

Driftsåret 2002
Datagrunnlag:
Diagnoser fra dag- og polikliniske behandlinger er tatt ut fra avsluttede avdelingsopphold og døgnopphold er tatt ut fra avsluttede institusjonsopphold, MBDS 2002.


Aker universitetssykehus mangler data på dag- og poliklinisk omsorgsnivå og Molde Sykehus data er ikke brukbar for året.
Sykehuset Buskerud, Sykehuset Telemark og Notodden sykehus har problemer ved registrering av data, dermed usikker datakvalitet og kompletthet.

SM, fetisjisme og transvestisme ikke lenger sykt i Norge

1. februar 2010 kom meldingen om at Helsedirektoratet fjerner fem diagnoser på seksuelle preferanser, seksuelle identiteter og kjønnsuttrykk fra den norske versjonen av diagnoselista ICD. Nedenunder kan du lese pressemeldingen som direktoratet offentliggjorde på sine hjemmesider.

Bildet: Diagnoseutvalget feirer friskmeldingen på sitt møte 6.2.10: Foran: Svein Skeid (leder). Bak fra venstre: Kai T. Støyva, Ann Kristin Tangerud, Rolf Østvik, Anita Nyholt og psykolog Odd Reiersøl.

 

Den nedenstående teksten er sakset fra Helsedirektoratets nettsider 1.2.2010 (Helsedirektoratets linker oppdatert 27.11.2011):

http://www.helsedirektoratet.no/folkehelse/seksuell-helse/seksuelle-minoriteter/Sider/default.aspx

http://www.helsedirektoratet.no/folkehelse/seksuell-helse/seksuelle-minoriteter/Documents/endringer-i-norsk-versjon-av-icd-10-notat.pdf
Helsedirektoratet friskmelder seksuelle minoriteter

[01.02.2010 : Bente Steinnes] Helsedirektoratet har besluttet at enkelte diagnosekoder gjøres ugyldige for bruk i Norge ved å endre den norske versjonen av det internasjonale diagnoseregisteret (ICD-10).

Diagnosene som tas ut av registeret er fetisjisme, fetisjistisk transvestisme, sadomasochisme, mulitiple forstyrrelser i seksuelle objektvalg og transvestisme.

Seksuelle preferanser, seksuelle identiteter og kjønnsuttrykk

– Vi mener at det ikke er grunnlag verken i dagens samfunnsnorm eller helsefaglige tenkning for å klassifisere disse diagnosegruppene som sykdom, sier helsedirektør Bjørn-Inge Larsen (bildet). Ved å utelukke kodene for bruk i Norge ønsker direktoratet å bidra til å svekke en allmenn oppfatning om at enkelte seksuelle preferanser, seksuelle identiteter og kjønnsuttrykk kan sees på som en sykdomstilstander.

 

Vil unngå stigmatisering

Helsedirektoratet legger stor vekt på at en rekke interesseorganisasjoner og fagmiljøer gjennom lang tid har frembrakt kunnskap om at diagnosene i seg selv av mange opplevelses som støtende og bidrar til stigmatisering av gruppers og enkeltmenneskers seksualitet.

De aktuelle diagnosene er utdaterte og ikke på høyde med de vitenskapelige standarder som ellers preger den internasjonale diagnosemanualen ICD-10.

Innholdet i de aktuelle diagnosene har ikke blitt vesentlig endret på over hundre år. De oppsto på bakgrunn av teorier basert på datidens kunnskaper om og syn på seksuelle variasjoner blant mennesker i samfunnet. I beste fall er diagnosene slik de står fullstendig overflødige. I verste fall virker de stigmatiserende på minoritetsgrupper i samfunnet.

Uhensiktsmessige diagnosekoder for helsetjenesten

Hovedformålet med klassifikasjonene av sykdommer og helseproblemer er å muliggjøre en oversiktlig og sammenlignbar statistikk for beskrivelse av helsehjelpen som ytes når en pasient er i kontakt med helsetjenesten. Diagnosene som nå fjernes rapporteres i praksis i svært liten utstrekning og har derfor liten relevans som grunnlag for statistikk basert på innholdet i Norsk pasientregister.

Beslutningen gjelder fra 1. februar 2010 og oppdateringen i kodeverket vil skje så raskt det praktisk lar seg gjøre.

Ved å foreta denne revideringen føyer Norge seg inn i rekken sammen med Danmark og Sverige som foretok tilsvarende revideringer i henholdsvis 1995 og 2009. Verdens helseorganisasjon, WHO, er i ferd med å utarbeide en ny versjon av diagnosemanualen; ICD-11. At alle de skandinaviske landene nå har fjernet de aktuelle diagnosene for nasjonal bruk vil være et viktig faglig og helsepolitisk signal til WHO i arbeidet med utarbeidelsen av ICD-11.

Praktisk/teknisk gjennomføring

I praksis gjøres dette ved at man umiddelbart redigerer den nasjonale kodefilen og søkeverktøyet som ligger på nettet og de aktuelle kodene fjernes. Dette gjøres av KITH. Parallelt må både Helsedirektoratet og KITH informere sektoren om denne endringen. For at endringen skal virke, må den også effektueres i PAS-systemene i alle helseforetak.  På lengre sikt vil endringen også påvirke bokversjonen av ICD-10 slik at kodene ikke lenger er gyldige ved neste publikasjon.

Diagnosen transseksualisme forblir uendret

Diagnosene som omfatter transseksualisme hos voksne og barn (F64.0 og F642) er ikke berørt av denne revideringen. For disse gruppene finnes det konkrete behandlingstilbud. Helsedirektoratet skal i løpet av 2010 foreta en gjennomgang av behandlings- og oppfølgingstilbud til transseksuelle og transpersoner, samt vurdere eventuelle forbedringer av dagens praksis på feltet. Det vil i den forbindelse også være naturlig med en gjennomgang av diagnosekriteriene og bruken av disse.

[Publisert: 01.02.2010]

SM and fetish off the Norwegian sick list

Fetish and SM no longer diseases in Norway

The Norwegian Directorate of Health announced February 1, 2010, that the diagnoses of Fetishism, Fetishistic transvestism, Sadomasochism, Multiple disorders of sexual preference and dual-role transvestism, have been repealed from Norway’s official list of medical diagnoses by 1.02.10.

Picture: Revise F65 celebrates the victory February 6, 2010: In front: Svein Skeid (leader). Behind from left: Kai T. Støyva, Ann Kristin Tangerud, Rolf Østvik, Anita Nyholt og psychologist Odd Reiersøl.

What follows is translated to English from the Norwegian Directorate of
Health’s website February 1st 2010 by psychologist Odd Reiersøl (URL to the websites updated November 27, 2011 by the Directorate of Health):

The Norwegian Directorate of Health takes sexual minorities off the sick list

[01.02.2010: Bente Steinnes] The Norwegian Directorate of Health has decided that certain diagnostic codes are now invalid in Norway, thus changing the Norwegian version of the international diagnoses register (ICD-10).

The following diagnoses are taken out: fetishism, fetishistic transvestism, sadomasochism, multiple disorders of sexual preference, and transvestism.

Sexual preferences, sexual identities and gender expressions

– In our opinion there is no basis, neither in today’s societal norms nor in professional health thinking, to classify these diagnostic groups as disease, says head of the Health Directorate Bjørn-Inge Larsen (picture). By excluding the use of these codes in Norway the Directorate wishes to contribute to the weakening of a general opinion that certain sexual preferences, sexual identities and gender expressions may be seen as states of illness.
We want to avoid stigmatizing

The Directorate of Health gives considerable emphasis to the fact that several interest organizations as well as health professionals from various environments have for a long time presented knowledge that these diagnoses in and of themselves, are experienced by many people as offensive and that they contribute to stigmatizing both groups and individuals.

The diagnoses mentioned are outdated and not at the level of the scientific standards that otherwise characterizes the international diagnostic manual (ICD-10).

There have been no essential changes to these diagnoses for over one hundred years. They came into being as a result of theories based on the current knowledge and viewpoints on human sexuality in society of those long gone days. At best these diagnoses, are completely superfluous. At worst they are stigmatizing minority groups in society.

These diagnoses are not useful to the health care system

The main objective of the classification of illnesses and health problems is to enable clear and comparable statistics describing the health care assistance to patients in contact with the health care system. The diagnoses which are now deleted are very seldom reported, and are therefore of minor relevance as a basis for the contents of the Norwegian Patience Register.

The decision applies as of February 1st 2010, and the code register will be updated as soon as practically possible.

By making this revision Norway has now joined Denmark and Sweden which made similar revisions in 1995 and 2009 respectively. The World Health Organization, WHO, is currently working on a new version of the diagnostic manual: ICD-11. As all the Scandinavian countries have now abolished the diagnoses for use at the respective national levels, this will be a significant professional and health political signal to WHO in the compilation process of the ICD-11.

The diagnoses of Transsexualism remain unchanged

The diagnoses that cover transsexualism among adults and children (F64.0 and F64.2) are not affected by this revision. Concrete treatment offers are available to these groups. In 2010 the Directorate of Health shall investigate the treatment options which are available to transsexuals and transpersons, and evaluate possible improvements. In that connection it will be reasonable to evaluate the diagnostic criteria and how they are being used.

Pressemelding fra LLHs Diagnoseutvalg Revise F65

Oslo 30.11.2009

Åpent brev til Helseministeren til Verdens aidsdag:
Norge trenerer menneskerettighetsreform

Friskmelding av norske transvestitter, fetisjister og sadomasochister er et viktig hiv-forebyggende tiltak
Manglende oppfølging, uriktig informasjon, ubesvarte henvendelser og avvisende holdning fra norske helsemyndigheter

Pressemelding fra Diagnoseutvalget Revise F65, utvalg i Landsforeningen for lesbiske, homofile, bifile og transpersoner.
Det er nå over et år siden Socialstyrelsen kunngjorde (1) at Sverige fjernet fetisj- og SM-diagnosene fra sin nasjonale versjon av sykdomslista ICD, International Classification of Diseases. En viktig begrunnelse for reformen var å motvirke fordommer og bedre gruppens levekår, slik resultatet ble etter at homofili-diagnosen ble tatt bort på 1970-tallet.

Etter den svenske beslutningen har norske helsemyndigheter uttalt seg i positive vendinger og lovet å følge opp Socialstyrelsens vedtak. Men i praksis utsettes avgjørelsen igjen og igjen, siste gang på ubestemt tid. Dette kommer i tillegg til uriktig informasjon om saksgangen, ubesvarte henvendelser de siste seks årene, samt avvisende holdning gjennom 15 år (2).

Utsettelsene er uheldige fordi Norges drahjelp, ifølge WHO, kan være avgjørende for revisjonen av sykdomslisten ICD som nå foregår i Verdens Helseorganisasjon. Dr. Geoffrey Reed, som leder WHOs revisjon av kapittel F65, uttrykte i en telefonsamtale med Revise F65 18.11.09 forbauselse over at Norge ligger etter Sverige med å fjerne stigmatiserende og utdaterte sykdomsdiagnoser. Norge er nå det eneste landet i Skandinavia der SM eller sadomasochisme fortsatt regnes som sykdom. Danmark fjernet transvestisme og sadomasochisme fra diagnoselisten allerede i 1994/95 (3).

LLHs Diagnoseutvalg har sendt nedenstående åpne brev til Helse- og omsorgsdepartementet for at ord skal følges av handling, og at den store minoriteten (4) som rammes av diagnosene kan få en rask friskmelding. Det er viktig for revisjonen i Verdens Helseorganisasjon at dominobrikkene faller i land etter land. At det blir flere og flere huller i “diagnose-muren” før alfa-versjonen av WHOs reviderte diagnoseliste foreligger 10. mai 2010.

I brevet påpeker vi at reformen også har en vesentlig hiv-forebyggende effekt. Hiv-viruset diskriminerer ikke! Alt for mange i våre miljøer er hiv-smittet. Å ta bort stigmatiserende diagnoser er kanskje det enkelt-tiltak som kan ha størst betydning for sm/fetisj-populasjonens selvfølelse og identitet på kort og lang sikt, med derav følgende mulighet til å ivareta egen helse og beskytte seg mot seksuelt overførbare sykdommer, inklusive hiv (8).

Brevet støttes av norske fagpersoner og organisasjoner. Folk oppfordres til å gi sin støtte på underskrift.no og melde seg inn i Diagnoseutvalgets gruppe på Facebook.

Vennlig hilsen Svein Skeid
Leder for LLHs Diagnoseutvalg Revise F65

Åpent brev til Helse- og omsorgsminister Anne-Grete Strøm-Erichsen

Fra Diagnoseutvalget Revise F65, et utvalg i LLH, Landsforeningen for lesbiske, homofile, bifile og transpersoner.

Oslo 30.11.2009

ICD-10 revideres nå – kappløp med tiden

Tredje gangs utsettelse av utredning

Fjerning av transvestisme, fetisjisme og sadomasochisme som sykdomsdiagnoser

Se også oppdatert pressemelding av 30.11.2009 (øverst)

Etter at Sverige fjernet sine fetisj- og sm-diagnoser 1. januar 2009 (1), har norske helsemyndigheter lovet å følge opp det svenske vedtaket. Undertegnede ber innstendig om at denne saken nå prioriteres og at de nødvendige ressurser tilføres for en rask ferdigstillelse.

Vi fikk bekreftet i mail av 12. oktober 2009 og telefonsamtale samme dag med seniorrådgiver i Helsedirektoratet Arild Johan Myrberg at utredningen for å fjerne fetisj- og sm-diagnoser er utsatt for tredje gang (5).

Vi viser til brev fra Revise F65 til Helse- og omsorgsminister Bjarne Håkon Hanssen av 14. april 2009 der vi ber om møte med Helsedirektoratet og uttrykker bekymring over utsettelse av fristen for utredning (5).

Det er med beklagelse vi konstaterer at arbeidet med å fjerne fetisj- og sm-diagnosene fra den norske versjonen av ICD igjen er utsatt, denne gang på ubestemt tid. Dette kommer i tillegg til ubesvarte henvendelser til Helsedepartementet, Sosial- og helsedirektoratet og Statens helsetilsyn gjennom 15 år (2).

Saken ble før jul 2008 oversendt fra Helsedepartementet til Helsedirektoratet som har mandat til å gjøre ICD-koder inaktive på nasjonalt plan. Helsedirektoratet satte seg en frist til 1. mai 2009 med å utrede saken. Deretter ble saken utsatt til 31. mai 2009. I møte med SMil Norge og Revise F65, 11. mai 2009 opplyste Helsedirektoratet at utredningen nok en gang var utsatt til høsten 2009 med intensjon om ikraftsettelse 1. januar 2010. I mail av 12. oktober 2009 opplyser Helsedirektoratet at utredningen er ytterligere utsatt, denne gang til nyttår uten noen planlagt dato for ikraftsettelse (5).

Kappløp med tiden

Med tilskudd fra Helsedirektoratet har Revise F65 utarbeidet et veldokumentert brev (6) som ble oversendt Verdens Helseorganisasjon 24. september 2009 med faglige og menneskerettslige argumenter for å fjerne fetisj- og sm-diagnoser i forbindelse med at WHO oppdaterer sin sykdomsliste fra ICD 10 til ICD 11. En alfa-versjon av ICD 11 forventes i følge WHO å foreligge 10. mai 2010.

Til og med Dr. Geoffrey Reed, som leder revisjonen av ICD-10 Mental and Behavioural Disorders i Verdens Helseorganisasjon, er overrasket over at Norge ligger etter Sverige med å fjerne nasjonale sm- og fetisj-diagnoser (40 minutters telefonsamtale mellom Dr. Reed og Revise F65 18. november 2009). I følge Dr. Reed er en endring av disse diagnosene i WHO-systemet avhengig av bredest mulig faglig og helsepolitisk støtte.

Revise F65 vil i tiden fram til alfa-versjonen av ICD 11 arbeide for å samle slik internasjonal støtte. I den forbindelse er det avgjørende å ha våre egne nasjonale helsemyndigheter i ryggen.

Både norske og svenske helsemyndigheter har uttalt (1) at neste skritt blir at WHO fjerner sine fetisj- og sm-diagnoser (blant annet Arild Johan Myrberg til blikk.no 19. januar 2009) (7).

Dersom Helsedirektoratet mener noe med sine uttalelser, så går toget nå! Det er nå premissene legges i Geneve. Det er nå norske myndigheter har mulighet til å påvirke den internasjonale prosessen ved å fjerne de norske fetisj- og sm-diagnosene eller kunngjøre at de vil bli fjernet en fastsatt dato.

Vi minner om at dette er en viktig menneskerettighetsreform for en stor minoritet i samfunnet og at Norge nå er eneste land i Skandinavia som fremdeles sykeliggjør sadomasochisme. Som tidligere påpekt kan en friskmelding ha en vesentlig helseforebyggende effekt. Å ta bort nasjonale stigmatiserende diagnoser er kanskje det enkelt-tiltak som kan ha størst betydning for sm/fetisj-populasjonens selvfølelse og identitet på kort og lang sikt, med derav følgende mulighet til å ivareta egen helse og beskytte seg mot seksuelt overførbare sykdommer, inklusive hiv. Les mer i notat til Helsedirektoratet 29.1.2009 fra Revise F65 (8):

http://web.mac.com/olavtrygg/iWeb/ReviseF65/notat.html

Arbeidet for å fjerne fetisj/sm-diagnosene står ved en viktig korsvei. Vi ber om at denne saken prioriteres og tilføres de nødvendige ressurser for en rask avgjørelse.

Følgende fem diagnoser ønskes fjernet fra den norske ICD-versjonen:

F65.0 Fetisjisme

F65.1 Fetisjistisk transvestisme

F65.5 Sadomasochisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

F64.1 Transvestisme

Vi stiller gjerne opp til et møte for ytterligere informasjon, bakgrunnsmateriale og foredrag om ønskelig.

 

Med vennlig hilsen

Revise F65 ved leder Svein Skeid

Kopi til Helsedirektør Bjørn-Inge Larsen og Seniorrådgiver i Helsedirektoratet, avdeling miljø og helse – faggruppe for seksuell helse, Arild Johan Myrberg

 

Dette oppropet støttes av:

Andrès Lekanger (Skeivt Forum), Eirik Rise (Skeivt Forum), Kamilla Eidsvik (nestleder i Skeivt Forum) og Assad Nasir (leder i Skeivt Forum)

Anette Trettebergstuen, stortingsrepresentant (A)

Ann-Kristin Tangerud, leder i SMil Norge

Anne Kristin Dobbe Eikaas, leder i Norsk forening for klinisk sexologi

Espen Evjenth, leder i Skeiv Ungdom

Gunnar F. Olsen, leder i Homofile og lesbiske legers forening 

Håkon Haugli, stortingsrepresentant (A) og leder i Homofile og lesbiske sosialdemokrater

Jordmor og sexolog Trude Aarnes, Sexologiakutten

Karen Pinholt, leder i LLH, Landsforeningen for lesbiske, homofile, bilfile og transpersoner

Lege og sexolog Esben Esther Pirelli Benestad

Prest og sexolog Knut Hermstad, tidl. leder i Norsk forening for klinisk sexologi

Psykiater og sexolog Haakon Aars

Psykolog Odd Reiersøl

Psykolog og familieterapeut Paal Rasmussen

Psykolog og sexolog Elsa Almås

Psykolog og sexolog Thore Langfeldt

Psykolog og sexolog Anita Skrautvol

Psykolog Petter Lohne

Psykologspesialist Anders Lindskog, spesialist i klinisk sexologi

Psykologspesialist Stéphane Vildalen, spesialist i klinisk sexologi

Reidun Campbell, leder FTP, Foreningen for transpersoner Norge

Rolf M. Angeltvedt, leder i Helseutvalget for bedre homohelse

Sexolog Astrid Krog

Sexolog Arild Sjong

Siv Gamnes, daglig leder i Sex og samfunn (tidligere Klinikk for seksuell opplysning)

Solveig Hokstad, daglig leder i Sex og Politikk

Sosiolog Hanne Grasmo, redaktør i Cupido

Styret i SLM-Oslo

Spesialist i sexologisk rådgiving – NACS, Tore Holte Follestad

Psykolog Inge Jarl Støylen

Spesialist i psykiatri Reidar Kjær


Skriv under oppropet til Helseministeren på underskrift.no

Meld deg inn i Diagnoseutvalgets gruppe på Facebook

Fotnote 1. Den svenske reformen (engelsk).

Fotnote 2. Dokumentasjon på uriktig informasjon, manglende oppfølging, ubesvarte henvendelser og avvisende holdning fra norske helsemyndigheter

Fotnote 3. Danmark fjerner SM som diagnose.

Fotnote 4. Størrelsen på sm/fetisj-populasjonen.

Fotnote 5. Korrespondansen mellom Helsedepartementet/Helsedirektoratet og SMil Norge/Revise F65

Fotnote 6. Argumenter for å fjerne diagnosene (engelsk)

Fotnote 7. Blikks nettsider 19.1.2009.

Fotnote 8. Argumenter for å fjerne fetisj- og sm-diagnosene (norsk)

Se også:

15 års kamp overfor norske helsemyndigheter.

Utfyllende historikk og bakgrunn for Diagnoseutvalget Revise F65 på engelsk

Historikk på norsk

Åpent brev til Helsedepartementet

Åpent brev til Helse- og omsorgsminister Anne-Grete Strøm-Erichsen

Fra Revise F65, utvalg i LLH, Landsforeningen for lesbiske, homofile, bifile og transpersoner.

Oslo 23.11.2009

ICD-10 revideres nå – kappløp med tiden

Tredje gangs utsettelse av utredning

Fjerning av transvestisme, fetisjisme og sadomasochisme som sykdomsdiagnoser
Etter at Sverige fjernet sine fetisj- og sm-diagnoser 1. januar 2009, har norske helsemyndigheter lovet å følge opp det svenske vedtaket. Vi ber innstendig om at denne saken nå prioriteres og at de nødvendige ressurser tilføres for en rask ferdigstillelse.

Vi fikk bekreftet i mail av 12. oktober 2009 og telefonsamtale samme dag med seniorrådgiver i Helsedirektoratet Arild Johan Myrberg at utredningen for å fjerne fetisj- og sm-diagnoser er utsatt for tredje gang.

Vi viser til brev fra Revise F65 til Helse- og omsorgsminister Bjarne Håkon Hanssen av 14. april 2009 der vi ber om møte med Helsedirektoratet og uttrykker bekymring over utsettelse av fristen for utredning.

Det er med beklagelse vi konstaterer at arbeidet med å fjerne fetisj- og sm-diagnoser fra den norske versjonen av ICD igjen er utsatt, denne gang på ubestemt tid. Dette kommer i tillegg til ubesvarte henvendelser til Helsedepartementet, Sosial- og helsedirektoratet og Statens helsetilsyn gjennom 15 år. Dokumentasjon på manglende svar:

http://www.revisef65.org/aboutrevisef65.html

http://web.mac.com/olavtrygg/iWeb/1ReviseF65/kamp.html

http://www.revisef65.org/omutvalget.html

Saken ble allerede før jul 2008 oversendt fra Helsedepartementet til Helsedirektoratet som har mandat til å gjøre ICD-koder inaktive på nasjonalt plan. Helsedirektoratet satte seg en frist til 1. mai 2009 med å utrede saken. Deretter ble saken utsatt til 31. mai 2009. I møte med SMil Norge og Revise F65, 11. mai 2009 opplyste Helsedirektoratet at utredningen var ytterligere utsatt til høsten 2009 med intensjon om ikraftsettelse 1. januar 2010. I mail av 12. oktober 2009 opplyser Helsedirektoratet at utredningen er utsatt nok en gang, denne gang til nyttår uten noen planlagt dato for ikraftsettelse. Se korrespondansen i saken på

http://www.revisef65.org/korrespondanse.html

Kappløp med tiden

Med tilskudd fra Helsedirektoratet har Revise F65 utarbeidet et veldokumentert brev som ble oversendt Verdens Helseorganisasjon 24. september 2009 med faglige og menneskerettslige argumenter for å fjerne fetisj- og sm-diagnoser i forbindelse med at WHO oppdaterer sin sykdomsliste fra ICD 10 til ICD 11. Link til brevet:

http://www.revisef65.org/icd_whitepaper.html

En alfa-versjon av ICD 11 forventes i følge WHO å foreligge 10. mai 2010. Slik vi oppfatter mail av 25. september 2009 fra Dr. Geoffrey Reed, Senior Project Officer for revisjonen av ICD-10 Mental and Behavioural Disorders, er en endring av disse diagnosene i WHO-systemet avhengig av bredest mulig faglig og helsepolitisk støtte.

Revise F65 vil i tiden fram til alfa-versjonen av ICD 11 arbeide for å samle slik internasjonal støtte. I den forbindelse er det avgjørende å ha våre egne nasjonale helsemyndigheter i ryggen.

Både svenske og norske helsemyndigheter har uttalt at neste skritt blir at WHO fjerner sine fetisj- og sm-diagnoser (blant annet Arild Johan Myrberg til blikk.no 19. januar 2009).

Dersom Helsedirektoratet mener noe med sine uttalelser, så går toget nå! Det er nå premissene legges i Geneve. Det er nå norske myndigheter har mulighet til å påvirke den internasjonale prosessen ved å fjerne de norske fetisj- og sm-diagnosene eller kunngjøre at de vil bli fjernet en fastsatt dato.

Vi minner om at dette en en viktig menneskerettighetsreform for en stor minoritet i samfunnet og at Norge nå er eneste land i Skandinavia som fremdeles sykeliggjør sadomasochisme. Som tidligere påpekt kan en friskmelding ha en vesentlig helseforebyggende effekt. Å ta bort nasjonale stigmatiserende diagnoser er kanskje det enkelt-tiltak som kan ha størst betydning for sm/fetisj-populasjonens selvfølelse og identitet på kort og lang sikt, med derav følgende mulighet til å ivareta egen helse og beskytte seg mot seksuelt overførbare sykdommer, inklusive hiv. Les mer i notat til Helsedirektoratet 29.1.2009 fra Revise F65:

http://web.mac.com/olavtrygg/iWeb/ReviseF65/notat.html

Arbeidet for å fjerne fetisj/sm-diagnosene står ved en viktig korsvei. Vi ber om at denne saken prioriteres og tilføres de nødvendige ressurser for en rask avgjørelse.

Følgende fem diagnoser ønskes fjernet fra den norske ICD-versjonen:

F65.0 Fetisjisme

F65.1 Fetisjistisk transvestisme

F65.5 Sadomasochisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

F64.1 Transvestisme

Vi stiller gjerne opp til et møte for ytterligere informasjon, bakgrunnsmateriale og foredrag om ønskelig.

 

Med vennlig hilsen

Revise F65 ved leder Svein Skeid

Kopi: Seniorrådgiver i Helsedirektoratet, avdeling miljø og helse – faggruppe for seksuell helse, Arild Johan Myrberg

 

Dette oppropet støttes av:

Anette Trettebergstuen, stortingsrepresentant (A)

Ann-Kristin Tangerud, leder i SMil Norge

Anne Kristin Dobbe Eikaas, leder i Norsk forening for klinisk sexologi

Espen Evjenth, leder i Skeiv Ungdom

Gunnar F. Olsen, leder i Homofile og lesbiske legers forening 

Håkon Haugli, stortingsrepresentant (A) og leder i Homofile og lesbiske sosialdemokrater

Karen Pinholt, leder i LLH, Landsforeningen for lesbiske, homofile, bilfile og transpersoner

Lege og sexolog Esben Esther Pirelli Benestad

Psykiater og sexolog Haakon Aars

Psykolog Odd Reiersøl

Psykolog og familieterapeut Paal Rasmussen

Psykolog og sexolog Elsa Almås

Psykolog og sexolog Thore Langfeldt

Reidun Campbell, leder FTP, Foreningen for transpersoner Norge

Rolf M. Angeltvedt, leder i Helseutvalget for bedre homohelse

Sexolog Astrid Krog

Siv Gamnes, daglig leder i Sex og samfunn (tidligere Klinikk for seksuell opplysning)

Solveig Hokstad, daglig leder i Sex og Politikk

Sosiolog Hanne Grasmo, redaktør i Cupido

Styret i SLM-Oslo

 

 


Helsedirektoratet sier én ting og gjør noe annet:

“Seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg, sier til Blikk Nett at de stiller seg veldig åpne for at SM-diagnosene vil bli kuttet ut i Norge.
– Svenskene bestemte seg for å kutte det ut, og vi i Norge ønsker også å følge opp, forteller Myrberg. Nå skal Helsedirektoratet fram mot 1. mai gjøre en vurdering etter at de har fått beskjed fra Helsedepartementet om å utrede saken.
– Alle signaler går ut på at dette er en lite relevant diagnose som er en rest fra tidligere tiders syn på seksualitet. Norge ønsker å følge den faglige utviklingen og ser fram til en opprydding i dette. Det framtidige målet blir at Verdens Helseorganisasjon (WHO) fjerner SM fra sine lister også, men dette vil eventuelt ikke skjer før om noen år, sier Myrberg.”
Seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg til Blikk.no 19. januar 2009

“Vi ser jo nå når svenskene endrer på dette at det kan være noe vi også bør gjøre noe med. Her er det flere seksuelle atferder som har diagnosekoder som kan medføre en sykeliggjøring av folk. Vi er helt åpne for å gå i dialog med fagmiljøene om dette. Det er ikke noe grunnlag i verken dagens samfunnsnorm eller helsefaglig tenkning for å kalle flere av disse diagnosene for sykdom”, sier Helsedirektør Bjørn-Inge Larsen til Nettavisen 17.11.2008.

”Helsedirektoratet sitt forslag er under bearbeidelse og er omtrent ferdig.”
Seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg i møte med Diagnoseutvalget Revise F65 11. mai 2009

Korrespondanse Helsemyndigheter

Saken utsatt på ubestemt tid – korrespondanse

– Det er ikke noe grunnlag verken i dagens samfunnsnorm eller helsefaglig tenkning for å kalle flere av disse diagnosene for sykdom. Helsedirektør Bjørn-Inge Larsen til Nettavisen17.11.2008.

Nestoren blant norske sexologer, Thore Langfeldt, sier i en kommentar til Nettavisen at han støtter at svenskene stryker seks sexrelaterte diagnoser.

Seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg, sier til Blikk Nett at de stiller seg veldig åpne for at SM-diagnosene vil bli kuttet ut i Norge. – Svenskene bestemte seg for å kutte det ut, og vi i Norge ønsker også å følge opp, forteller Myrberg.
– Alle signaler går ut på at dette er en lite relevant diagnose som er en rest fra tidligere tiders syn på seksualitet. Norge ønsker å følge den faglige utviklingen og ser fram til en opprydding i dette. Det framtidige målet blir at Verdens Helseorganisasjon (WHO) fjerner SM fra sine lister også, men dette vil eventuelt ikke skjer før om noen år, sier Myrberg.


Her kan du donere et beløp til ReviseF65

Ta kontakt!
Formålet med ReviseF65 er å fjerne fetisjisme, transvestisme og sadomasochisme som diagnoser fra sykdomslisten til Verdens Helseorganisasjon.

Kontakt ReviseF65

Meld deg på diskusjonslisten

Om ReviseF65

Til engelsk hovedside

Til norsk hovedside

ReviseF65 er ikke ansvarlig for eksterne lenker. Vi har ikke kontroll over deres innhold, som kan bli endret av andre. Tips oss dersom du finner rasistiske, nazi, bareback eller ulovlige lenker – og vi vil fjerne dem.


På denne siden ligger den skriftlige korrespondansen mellom Helsedepartementet/Helsedirektoratet og SMil Norge/Revise F65 angående fjerning av fetisj- og sm-diagnoser fra norsk versjon av ICD-10, etter at den svenske Socialstyrelsen 17.11.2008 annonserte at de ville fjerne sine fetisj- og sm-diagnoser.

Saken ble allerede før jul 2008 oversendt fra Helsedepartementet til Helsedirektoratet som har mandat til å gjøre ICD-koder inaktive på nasjonalt plan. Helsedirektoratet satte seg en frist til 1. mai 2009 med å utrede saken. Deretter ble saken utsatt til 31. mai 2009. I møte med SMil Norge og Revise F65, 11. mai 2009 opplyste Helsedirektoratet at utredningen nok en gang var utsatt til høsten 2009 med intensjon om ikraftsettelse 1. januar 2010. I mail av 12. oktober 2009 opplyser Helsedirektoratet at utredningen er ytterligere utsatt, denne gang til nyttår uten noen planlagt dato for ikraftsettelse.

Sverige fjerner fetisj- og sm-diagnoser etter inspirasjon fra Revise F65.
Fetish and SM diagnoses deleted in Sweden (sist oppdatert)
Sverige fjerner sm- og fetisjdiagnoser fra 1.1.2009

Oslo 18. november 2008

Åpent brev fra SMil Norge 

til

Helse og Omsorgsminister Bjarne Håkon Hanssen

Helse og Omsorgsdepartementet

 

Smil Norge er en ikke-kommersiell, frittstående og partipolitisk uavhengig interesseorganisasjon for sadomasochister og fetisjister i Norge.

I Norge har vi fremdeles flere diagnoser som definerer transvestitter, fetisjister og sadomasochister som psykisk syke, ref. WHO sin diagnoseliste:

(ICD 10 F65.00, ICD 10 F65.01, ICD 10 F65.05)

Tidligere omfattet diagnoselisten også homofile, men dette ble fjernet tidlig på 70 tallet.

Det kan ikke være noen tvil om at dette på generell basis har bidratt til en bedre hverdag for homofile og lesbiske.

Homofile og lesbiske har ikke bare fått sin seksuelle orientering ”friskmeldt”. De har også oppnådd en allmenn forståelse for at de har sine selvsagte krav på respekt for det livet de lever, sammen med en spesifikk lovmessig beskyttelse mot diskriminering og forfølgelse.

Tidligere bekymring for at de var psykisk syke ble med dette endret til at de fikk et styrket egenverd. Homofile og lesbiske fikk svart på hvitt at de hadde de samme rettighetene som heteroseksuelle og såkalt ”seksuelt normale” medborgere av Kongeriket Norge.

Danmark fjernet transvestisme, fetisjisme og sadomasochisme fra diagnoselisten i 1995, og nå i 2008 har Sverige fulgt etter.

Smil Norge ber om at alle de menneskene i Norge som definerer seg selv innen disse gruppene, også skal få sin ”friskmelding”.

Diskriminering og forfølgelse på grunn av politisk orientering, religion, kjønn og seksuell orientering er noe Norge som nasjon arbeider mot.

Smil Norge mener det er på høy tid at transvestitter, fetisjister og sadomasochister også kommer inn i samme kategori, og at det samme rettsvern skal gjelde for alle som forholder seg til lover og regler.

På denne måten kan vi sidestilles med holdningene danske og svenske sadomasochister møter i sine respektive hjemland.

Dette bør i 2008 være en menneskerett, og vi ber om at vi kan møte det nye året med blanke ark.


Med vennlig hilsen

SMil Norge ved leder og styret.

SMil Norge

F79 boks 3456 Bjølsen

0406 Oslo

 

Deres ref                                   Vår ref                                       Dato

                                                200804988-/CAM                        19.12.2008


Fjerning av transvetisme, fetisjisme og sadomasochisme fra diagnoselisten – Sveriges fjerning av ICD 1065 – Synspunkter

Vi viser til brev fra Smil Norge til statsråd Bjarne Håkon Hanssen datert 18.11.2008 om diagnoser for transvestitter, fetsijister og sadomasochister. Spesialisthelsetjenesteavdelingen besvarer henvendelsen.

I henvendelsen vises det til at Danmark fjernet transvetisme, fetisjisme og sadomasochisme fra diagnoselisten i 1995 og at Sverige har fulgt etter i 2008. Smil Norge ber om at alle som definerer seg selv innen disse gruppene, også skal få sin “friskmelding” ved at disse diagnosene fjernes fra diagnoselisten.

Ingen av de aktuelle diagnosekoder er rapportert til Norsk pasientregister i 2007 eller 2008. Dette gir en sterk indikasjon på at kodene ikke brukes. Det er mange koder i ICD-10 som etter hvert har blitt utdaterte. ICD-10 er imidlertid et WHO-kodeverk som også brukes i Norge. Vi kan ikke endre selve kodeverket, men kan la være å bruke kodene. Det finnes noen eksempler på dette og “inaktive” koder er merket i selve kodeverksboka med “brukes ikke i Norge”. Det er Helsedirektoratet som forvalter selve kodeverket. Helse- og omsorgsdepartementet vil be direktoratet vurdere hvordan henvendelsen fra Smil Norge kan følges opp.

 

Med vennlig hilsen

Heidi Langaas e.f
ekspedisjonssjef

Cathrine Meland
Avdelingsdirektør



2. februar 2009: Dokumentert notat med faglige og helsepolitiske argumenter for å fjerne sm- og fetisjdiagnoser i Norgeoverlevert Helsedirektoratet fra Revise F65.

Fra: sskeid(A)online.no
Emne: Re: SV: notat
Dato: 2. februar 2009 09.14.00 GMT+01:00
Til: arildjohan.myrberg(A)helsedir.no
Kopi: solverv(A)solverv.com, Bente.Vinaes(A)helsedir.no

Hei, og takk for hyggelig prat 9. januar!

Psykolog Odd Reiersøl og jeg har utarbeidet et notat med helsefaglige argumenter til deg og Bente Vinæs som vi håper kan være til nytte i arbeidet med å ta bort sm- og fetisj-diagnosene. Notatet finnes i skriftlig underskrevet versjon og online versjon med klikkbare linker.Odd og jeg overleverer papirversjonen til Bente Vinæs på Helsedirektoratet kl 11 i dag mandag.

Her finner du en link til notatet:

http://web.mac.com/olavtrygg/iWeb/ReviseF65/notat.html

Vennlig hilsen Svein Skeid

 

Den 18. nov. 2008 kl. 10.01 skrev Bente Vinæs:

Hei Svein,

Tusen takk for info, Svein

Arild Johan Myrberg er på saken herfra.

Vennlig hilsen

Bente

              Fra:     sskeid(A)online.no

Emne: Fjerning av transvestisme, fetisjisme og sadomasochisme fra norsk versjon av ICD-10

  Dato: 14. april 2009 22.27.44 GMT+02:00

              Til:     postmottak(A)hod.dep.no, bjarne-hakon.hanssen(A)hod.dep.no, postmottak(A)hod.dep.no

   Kopi:   postmottak(A)hod.dep.no, postmottak(A)hod.dep.no, bjorn-inge.larsen(A)helsedir.no, ajm(A)helsedir.no, arildjohan.myrberg(A)helsedir.no, bev(A)helsedir.no

 

Fjerning av transvestisme, fetisjisme og sadomasochisme fra norsk versjon av ICD-10

Oslo 14.4.2009

Om utsatt frist for behandling

Åpent brev til Helse- og omsorgsminister Bjarne Håkon Hanssen

Kopi til

Spesialisthelsetjenesteavdelingen i Helse- og omsorgsdepartementet

Direktør i Helsedirektoratet Bjørn-Inge Larsen

Seniorrådgiver i Avd. miljø og helse Arild Johan Myrberg

Rådgiver i Avd. miljø og helse Bente Vinæs

Undertegnede takker for positivt svar fra Spesialisthelsetjenesteavdelingen av 19.12.08 der det blant annet fremgår at SMil Norges forespørsel av 18.11.08 til statsråd Bjarne Håkon Hanssen er oversendt til Helsedirektoratet, som har mandat til å gjøre ICD-koder inaktive på nasjonalt plan.

Vi takker også for positive uttalelser per telefon, mail og i media fra seniorrådgiver Arild Johan Myrberg og helsedirektør Bjørn-Inge Larsen, noe som gir oss håp om en menneskerettslig reform for en minoritet som kanskje utgjør 5-10 prosent av befolkningen (14,3,23).

Diagnoseutvalget Revise F65 overleverte 2.2.09 et dokumentert notat til Helsedirektoratet ved rådgiver Bente Vinæs med faglige og helsepolitiske argumenter for å ta bort de overnevnte ICD 10-kodene på samtykkende seksualitet som Sverige fjernet 1. januar, ettersom vi anser diagnosene som overflødige, utdaterte, uvitenskapelige og stigmatiserende (1,38).

Hva som imidlertid gjør oss bekymret er seniorrådgiver Arild Johan Myrbergs opplysning til diagnoseutvalgets leder Svein Skeid på telefon 31. mars om at Helsedirektoratets frist med å komme med en vurdering er forlenget til 31. mai 2009. Da er det straks ferietid og rett over sommeren er det stortingsvalg 14. september.

Diagnoseutvalget mener at denne saken bør ferdigstilles med nåværende politiske overbygning for departement og direktorat, basert på vår erfaring fra 2003 med manglende svar fra Helsedepartementet (28). Med et positivt vedtak før sommeren vil Norge fremstå som et foregangsland for menneskerettigheter, også i forhold til det internasjonale forskningsmiljøet som samles til verdenskonferansen WPATH (The World Professional Association for Transgender Health) 17.-20. juni i Oslo.

Dertil kommer at LLHs undergruppe SMia-Oslo og diagnoseutvalget hvert år siden 2006 uten hell har anmodet Helsedirektoratet om et møte. Undertegnede har forståelse for at direktoratet har stor arbeidsmengde og begrenset bemanning, for eksempel sammenlignet med tilsvarende avdeling i den svenske Socialstyrelsen. Vi anmoder likevel Helsedirektoratets avdeling for miljø og helse om et snarlig møte. Diagnoseutvalget Revise F65 sitter på viktig kompetanse etter å ha jobbet med dette spørsmålet i 15 år (29,38). Toveiskommunikasjon, idéutveksling og strategisk tenkning mht progresjon i saken både nasjonalt og internasjonalt kan etter vår vurdering forebygge misforståelser og kvalitetssikre et endelig vedtak.

Brevet er også sendt som vanlig brev til cc-adressatene

Fotnoter: http://web.mac.com/olavtrygg/iWeb/ReviseF65/fotnoter.html

Med vennlig hilsen

Diagnoseutvalget Revise F65

Utvalg i Landsforeningen for lesbiske, homofile, bifile og transpersoner

Ved:

Leder; Svein Skeid

Psykolog Odd Reiersøl,

SMil Norge; Ann Tangerud

Sexolog og familieterapeut Astrid Krog

Sosiolog og redaktør i Cupido; Hanne Grasmo

Styremedlem i SMil Norge; K. Støyva 

Fra: sskeid(A)online.no
Emne: Møte før 17. mai
Dato: 17. april 2009 13.55.12 GMT+02:00
Til: arildjohan.myrberg(A)helsedir.no


Til Seniorrådgiver Arild Johan Myrberg

Jeg takker for hyggelig telefonsamtale i går 16. april der jeg forsto det slik at den norske versjonen av ICD 10-kodene er en fagsak under Helsedirektoratets forvaltning og ikke er gjenstand for politisk behandling.

Jeg setter også pris på at du nok en gang fremhevet psykolog Odd Reiersøls foredrag i Sidney 2007 i regi av World Association for Sexual health, der du var tilstede som representant for Helsedirektoratet. Slik jeg oppfattet deg, fikk foredraget deg til å se det solide faglige og menneskerettslige grunnlaget som Diagnoseutvalget Revise F65 bygger på.

Slik sett er Reiersøls foredrag, som ifjor ble publisert i Tidsskrift for Norsk Psykologforening, kanskje en milepæl i arbeidet med å fjerne stigmatiserende fetisj- og sm-diagnoser (19).

Vi ble enige om å avholde et møte mellom Helsedirektoratet og Diagnoseutvalget Revise F65 før 17. mai, for å kvalitetssikre et snarlig vedtak om å fjerne fetisj- og sm-diagnoser nasjonalt og på lengre sikt internasjonalt i regi av WHO, i tråd med din uttalelse til Blikk 19.1.2009 (23).

Vi ble enige om at jeg tar kontakt med deg 27. april for å avtale dag og tid for et møte.

Undertegnede sier seg vilig til å komme med forslag til dagsorden i god tid før møtet.

Vennlig hilsen Svein Skeid

Leder i Diagnoseutvalget Revise F65

Kopi til Helsedirektør Bjørn-Inge Larsen, rådgiver Bente Vinæs og diagnoseutvalgets medlemmer, inkludert psykolog Odd Reiersøl og SMil Norge.

Fotnoter: http://web.mac.com/olavtrygg/iWeb/ReviseF65/fotnoter.html

Fra:   sskeid(A)online.no

Emne: Møte mandag 11. mai kl 10-11

Dato: 6. mai 2009 18.27.04 GMT+02:00Til:  arildjohan.myrberg(A)helsedir.no, bente.vinaes(A)helsedir.no,
Kopi:   bjorn-inge.larsen(A)helsedir.no, postmottak(A)hod.dep.no, bjarne-hakon.hanssen(A)hod.dep.no, heidi.langaas(A)hod.dep.no, postmottak(A)hod.dep.no, cathrine.meland(A)hod.dep.no, karen(A)llh.no, post(A)llh.no, oslo(A)llh.no, post(A)helseutvalget.no, rolf(A)helseutvalget.no, espen(A)llh.no, post(A)llhoa.no, elsa.almaas(A)sexologi.com, hakon(A)homonettverket.no, post(A)homonettverket.no


Møte mellom Diagnoseutvalget Revise F65 og Helsedirektoratet mandag 11. mai kl 10-11.

Hei igjen!

Siden sist har jeg blant annet vært i kontakt med Wiktor Södersten, sekretær i RFSU Stockholm. Han forteller at de seks diagnosene nå er fullstendig fjernet fra den svenske web-versjonen av ICD (se bildefil vedlagt), og at den vil bli trykket opp i samme ajourførte versjon i løpet av 2009. Svaret fra Södersten ligger nederst i denne mailen. Dessuten kunne han fortelle at det ikke har kommet protester verken fra psykologer eller psykiatere etter at Sverige fjernet de seks fetisj- og sm-diagnosene. Som dere ser, så takker han for “den inspiration Revice-F65 varit för det arbete vi gjort i RFSU i Sverige”.

Helene Delilah i RFSUs BDSM-gruppe, skriver:

“Utan Revise F65 så hade vi kanske aldrig ens blivit uppmärksammade på problemet, så ni har såklart betytt mycket som både informationskälla och förebild!!!”

Som lovet, så har jeg skrevet forslag til en saksliste/dagsorden til mandagens møte.

Møte mellom Diagnoseutvalget Revise F65 og Helsedirektoratet 11. mai kl 10-11.
Forslag til saksliste.

1. Valg av referent.

2. Kort presentasjon av deltagerne.

3. Praktisk iverksettelse av vedtaket. Web-baserte og trykte kodeverk.

4. Hvilke diagnoser tas bort?

5. Når vil et vedtak offentliggjøres og når trer det i kraft?

6. Hvordan markeres vedtaket offentlig og av hvem?

7. Oppdatering av bakgrunnsinformasjon.

8. Videre arbeid overfor WHO? Midler til engelsk fagnotat?

9. Eventuelt.

Vennlig hilsen Svein Skeid
Leder i Revise F65

Den 5. mai. 2009 kl. 22.31 skrev Wiktor Södersten:
Hej Svein, jag tror inte att vi mejlats tidigare men jag vill passa på
att tacka för den inspiration Revice-F65 varit för det arbete vi gjort
i RFSU i Sverige. Jag vill minnas att jag och Helene pratade om er
webbplats redan på RFSU-kongressen 2005 då vi sådde det första fröet
till det som blev det sexualpolitiska arbetet kring BDSM och
fetischism i RFSU.

Jag kan i varje fall försöka svara på en del av dina frågor direkt
nämligen hur det ser ut konkret i den svenska versionen av ICD-10.

Den svenska versionen av ICD-10 heter “Klassifikation av sjukdomar och
hälsoproblem 1997 (KSH97)”. Den tryckta versionen är just nu slut men
ett nytryck baserat på den senaste versionen planeras under 2009. Det
som finns att tillgå idag är en PDF-version och där är de diagoner som
togs bort under F64 och F65 vid nyår 2009 i Sverige redan borttagna.
Jag bifogar en fil med kapitlet om psykiatriska diagnoser direkt från
deras webbplats.

Jag är själv snart färdig psykolog men fokus på sexologi och jag vågar
påstå att det inte varit någon som helst diskussion bland varken
psykologer eller psykiatiker kring att man tog bort diagnoserna.
Delvis så tror jag att det kan bero på att väldigt få har något
intresse av sexologi. Möjligen kan det också ha spelat in att den
psykodynamiska skolan som var mer intresserad av människans sexologi
och företrädde många underliga förklaringsmodeller kring BDSM och
fetischism har fått stryka på foten under senare år till förmån för
Kognitiv Beteendeterapi. Men det sista är verkligen bara en teori från
min sida.

Vad gäller arbetet kring att städa innehållet i läroböcker och lexikon
så tror jag inte att vi har stött på så mycket störande innehåll ännu
att vi fokuserat på det arbetet.

Om Socialstyrelsen eller RFSU centralt påbörjat något lobbying arbete
mot WHO så känner jag inte till det.

Där lite snabba svar från mig så att ni har en början att nysta i. Det
kommer kanske fler svar från andra i gruppen längre fram.

Lycka till med ert möte 11 maj!


Wiktor Södersten
Sekreterare i RFSU Stockholm

Den 4. mai. 2009 kl. 10.51 skrev Helene Delilah:
Hej Svein,
[…]
Utan Revise F65 så hade vi kanske aldrig ens blivit uppmärksammade på problemet, så ni har såklart betytt mycket som både informationskälla och förebild!!!
[…]

med vänlig hälsning
// Helene Delilah

Referat fra møte mellom Diagnoseutvalget Revise F65 og Helsedirektoratet

Dato:          11. mai 2009

Sted:          Helsedirektoratet, Universitetsgata 2

Tid:            Start 10, avsluttet 11.

Til stede:         Arild Johan Myrberg, Seniorrådgiver Avd. miljø og helse

                  Bård Nylund, Førstekonsulent Avd. miljø og helse

                  Ida Erstad, rådgiver Avd. miljø og helse

Svein Skeid, Leder Diagnoseutvalget Revise F65

Ann-Kristin Tangerud, Leder SMil Norge 

Kai T. Støyva, Sekretær SMil Norge

Odd Reiersøl (psykolog)

1. Valg av referent.

Kai


2. Kort presentasjon av deltagerne.

Det ble foretatt en runde rundt bordet hvor de fremmøtte presenterte seg.

3. Praktisk iverksettelse av vedtaket. Web-baserte og trykte kodeverk.

Det ble informert fra Helsedirektoratet at det vil ikke bli gitt ut nye trykte revisjoner av kodeverket. Det er kun den web baserte versjonen som vil bli oppdatert.

4. Hvilke diagnoser tas bort?

Helsedirektoratet opplyste at de går for den ”svenske modellen” som innebærer at seks diagnoser fjernes fra kodeverket.

F65.0 Fetisjisme

F65.1 Fetisjistisk transvestisme

F65.5 Sadomasochisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

F64.1 Transvestisme

F64.2 Kjønnsidentitetsforstyrrelse i barndommen [denne diagnosen blir stående, se senere korrespondanse]

Berørte dokumenter er oppdatert i forhold til dette siste punktet:

http://web.mac.com/olavtrygg/iWeb/ReviseF65/notat.html

http://www.revisef65.org/icd_whitepaper.html

5. Når vil et vedtak offentliggjøres og når trer det i kraft?

Det ble informert om at et vedtak kan tidligst offentliggjøres høst/vinter 2009, med intensjon om ikraftsettelse 1. januar 2010. Diagnoseutvalget Revise F65 vil bli informert om saksgangen og når vedtak fattes.

 

6. Hvordan markeres vedtaket offentlig og av hvem?

Vedtaket offentliggjøres gjennom en pressemelding fra Helsedirektoratet.

 

7. Oppdatering av bakgrunnsinformasjon.

Arild Johan Myrberg informerte om prosessene som pågår og hvordan saksgangen vil være videre.

Helsedirektoratet utarbeider et forslag og legger dette frem for ledergruppen.

( Bjørn-Inge Larsen Direktør, Bjørn Guldvog Assisterende direktør).

Videre så går forslaget til en referansegruppe sammensatt av fagfolk innen aktuelle profesjoner.

Om forslaget blir vedtatt sendes dette over til KITH (Kompetansesenter for IT i helse- og sosialsektoren) som foretar revisjonen av kodeverket.

Helsedirektoratet sitt forslag er under bearbeidelse og er omtrent ferdig.

 

8. Videre arbeid overfor WHO? Midler til engelsk fagnotat?

Om det gjøres en revidering i Norge vil Helsedirektoratet arbeide videre med dette via Skandinavisk klassifikasjonssenter i Uppsala med det formål å påvirke WHO sitt kodeverk.

ICD er nå under revisjon og vil i løpet av kommende år komme i revisjon 11.

Diagnoseutvalget Revise F65 har i årets tildelinger av støtte fra Helsedirektoratet fått tildelt støtte til et engelsk fagnotat.

 

9. Eventuelt.

Det ble foreslått nytt møte til høsten, tidspunkt avtales nærmere på et senere tidspunkt.

Arild Johan Myrberg informerte om at det hver fredag mellom klokken 9 og 10 blir holdt foredrag for alle i Helsedirektoratet hvor en har mulighet for å få presentert en sak. Tildelt tid for foredraget er 50 minutter, og det avsluttes presis klokken 10.

Dette foredraget holdes i Helsedirektoratets Auditorium.

Det ble da foreslått at Diagnoseutvalget Revise F65 presenterer saken sin i dette forum.

Dette forslaget ble akseptert og Helsedirektoratet foreslår passende tidspunkt og informerer Diagnoseutvalget om dette.

Det ble informert fra Diagnoseutvalget om et par faktafeil i SMil Norges første henvendelse til Departementet. Dette gjelder årstall for fjerning av diagnosene i Danmark og hvilke diagnoser Danmark har fjernet. Se http://www.revisef65.org/danmark.html

Fra: sskeid(A)online.no
Emne: ICD-10 diagnosen F64.2 Kjønnsidentitetsforstyrrelse i barndommen
Dato: 22. juni 2009 19.38.54 GMT+02:00
Til: ajm(A)helsedir.no, arildjohan.myrberg(A)helsedir.no
Til Seniorrådgiver Arild Johan Myrberg

ICD-10 diagnosen F64.2 Kjønnsidentitetsforstyrrelse i barndommen

Vi takker for hyggelig og informativt møte 11. mai 2009.

Som vi skrev i notat til Helsedirektoratet 29. januar 2009, har Diagnoseutvalget i flere år arbeidet med F65-diagnosene. Samtidig presiserte vi at Diagnoseutvalget ikke har jobbet med F64-diagnosene, men at vi anbefalte at Norge i likhet med Sverige også fjerner F64.1 Transvestisme og F64.2 Kjønnsidentitetsforstyrrelse i barndommen.

Å fjerne F64.1 er ønskelig fordi den er klart diskriminerende i forhold til transvestitter. Den gir ingen rettigheter til dem som eventuelt får denne diagnosen. Dette understrekes av at Danmark allerede 19. august 1994 blokkerte F64.1-diagnosen ved en forordning fra Sundhedsstyrelsen. Transvestisme er heller ikke definert som en diagnose under Gender Identity Disorders i DSM-IV TR.

F64.2 derimot er en diagnose, som vi nå har forstått, kan brukes til å gi barn rettigheter, for eksempel pubertetsutsettende behandling. Dette ble klart etter diverse informasjon på WPATH konferansen i Oslo 17.-20. juni 2009. Ettersom rettighetene blir ivaretatt av andre diagnoser enn F64.2, er det muligens greit å fjerne den, men det er pr idag reell fare for at hjelpeapparatet ikke har nok oversikt til å kunne forvalte disse barnas rettigheter dersom F64.2 diagnosen blir tatt vekk.

Vi må derfor korrigere antall diagnoser vi ønsker fjernet til fem:

F65.0 Fetisjisme

F65.1 Fetisjistisk transvestisme

F65.5 Sadomasochisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

F64.1 Transvestisme

For ytterligere informasjon, kontakt psykolog Odd Reiersøl på telefon 22505190 eller via mail solverv(A)solverv.com

Med vennlig hilsen

Odd Reiersøl og Svein Skeid

24. september 2009. Med tilskudd fra Helsedirektoratet sender Revise F65 et veldokumentert brev til Verdens Helseorganisasjon med faglige og menneskerettslige argumenter for å fjerne fetisj- og sm-diagnoser i forbindelse med at WHO oppdaterer sin sykdomsliste fra ICD 10 til ICD 11.

Fra: sskeid(A)online.no
Emne: Fjerning av diagnoser
Dato: 29. september 2009 22.53.42 GMT+02:00
Til: arildjohan.myrberg(A)helsedir.no

Til Seniorrådgiver Arild Johan Myrberg

Hei

Vi viser til mail fra Revise F65 til Helsedirektoratet 22. juni 2009 som vi ikke kan se å ha fått noen tilbakemelding på. Vi håper det ikke medfører noen forsinkelse om Norge fraviker Sveriges mønster og lar F64.2 Kjønnsidentitetsforstyrrelse i barndommen bli stående som diagnose. Som fremgår av mailen (kopiert nedenunder), innebærer det at følgende fem diagnoser ønskes fjernet fra den norske ICD-versjonen:

F65.0 Fetisjisme

F65.1 Fetisjistisk transvestisme

F65.5 Sadomasochisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

F64.1 Transvestisme

Som oppfølging av SMia og Diagnoseutvalgets tilskuddssøknad til Helsedirektoratet av 15. februar 2009, og påfølgende støtte fra Helsedirektoratet, har vi nå ferdigstillet et engelskspråklig strateginotat til Verdens Helseorganisasjon, WHO. Notatet kan leses på

http://www.revisef65.org/icd_whitepaper.html

Samtidig har vi foretatt en betydelig oppdatering av diagnoseutvalgets nettsider, med spesiell vekt på de engelskspråklige sidene som er referanser til WHO-brevet.

I følge Dr. Geoffrey Reed, Senior Project Officer for revisjonen av ICD-10 Mental and Behavioural Disorders, vil første utkast til ICD-11-diagnoser foreligge på nyåret 2010. Det vil derfor etter vår oppfatning være en fordel at en norsk avdiagnostisering annonseres høsten 2009 og trer i kraft 1. januar 2010, som skissert på møtet mellom Revise F65 og Helsedirektoratet 11. mai i år. Slik vi oppfatter Dr. Reed, er en endring av overnevnte diagnoser i WHO-systemet avhengig av bredest mulig internasjonal støtte.

Med håpefull hilsen

Odd Reiersøl og Svein Skeid

Revise F65

Kopi til diagnoseutvalgets medlemmer

           Fra:           ArildJohan.Myrberg(A)helsedir.no

Emne:        SV: Fjerning av diagnoser

Dato: 12. oktober 2009 14.02.04 GMT+02:00

           Til:   sskeid(A)online.no

         Kopi:            solverv(A)solverv.com, OleTrygve.Stigen(A)helsedir.no

Hei,

Jeg beklager at det tar lang tid å få svar fra oss, noe som skyldes en sedvanlig strøm av oppgaver som er vanskelige å prioritere skikkelig mellom.

Vi er imidlertid stadig innstilt på å følge den tidsplanen som vi skisserte i møtet vi hadde i mai, nemlig at vi tar sikte på at den interne prosessen her hos oss forhåpentligvis kan landes på denne siden av året. Med det mener vi at den interne utredningen og saksbehandlingen her hos oss vil være fullført innen den tid, men vi kan dessverre ikke nå gi en dato for når en eventuell endring vil kunne skje. Det er uansett fint at dere har vært i kontakt med WHO i Geneve og fått opplysninger om prosessene med ICD-11 som foregår der parallelt.

Vi har notert oss Revise F65 sitt synspunkt om at F64.2 (Kjønnsidentitetsforstyrrelse i barndommen) bør bli stående som diagnose og vil ta med oss dette videre i vår behandling av saken.

AJM

Vennlig hilsen Arild Johan Myrberg,

seniorrådgiver, avdeling miljø og helse, faggruppe for seksuell helse, tlf. 810 20 050, dir. 24 16 35 60, mobil 90 83 00 64, Helsedirektoratet, Pb 7000 St Olavs plass, 0130 Oslo, Universitetsgata 2, www.helsedirektoratet.no

(Fra Helsedirektoratet som svar på cc-kopi av korrespondanse med WHO:)
Fra: [email protected]
Emne: SV: VL: ICD Revision White Paper from Revise F65
Dato: 12. november 2009 09.33.11 GMT+01:00
Til: [email protected]


Hei Svein,

Takk for både denne og forrige mail. Vi forsøker å prioritere dette nå, midt oppi alt annet. Håper å kunne gi dere en klarere framdriftsplan før jul.

AJM

Vennlig hilsen

Arild Johan Myrberg
seniorrådgiver
avdeling miljø og helse – faggruppe for seksuell helse
tlf. 810 20 050, dir. 24 16 35 60, mobil 90 83 00 64

Helsedirektoratet
Pb 7000 St Olavs plass, 0130 Oslo, Universitetsgata 2
www.helsedirektoratet.no

Fra: Svein Skeid [mailto:[email protected]]
Sendt: 11. november 2009 23:03
Til: Reed, Geoffrey
Kopi: Vogel, Ulrich; solverv Reiersol; Arild Johan Myrberg
Emne: Re: VL: ICD Revision White Paper from Revise F65

Dear Dr. Reed.
Thank you for your supportive mail of November 5 (at the bottom of this mail). I will try to answer you in three sections. I take the liberty to also send this mail as a cc copy to Senior counselor, Arild Johan Myrberg, at the Norwegian Directorate of Health [Helsedirektoratet]. I hope that it is ok with all parties (special attention to the very last paragraph(s) of this mail).
Best regards,
Svein Skeid

ICD Revision White Paper

Oslo, Norway, September 24, 2009
Dead links updated November 22, 2011

ICD Revision White Paper to WHO from Revise F65
(
Revise F65’s first report to WHO)

By Cand. Psychol Odd Reiersøl and Revise F65 leader Svein Skeid
Proposal to the ICD-11 Revision of Chapter V, Mental and Behavioural Disorders, F65 and F64.

Invitation from WHO to Revise F65

We want to thank classification coordinator Dr. T. Bedirhan Üstün M.D. at WHO in Geneva for inviting Revise F65 to collaborate with the work leading up to the ICD-11 revision.

In an email of May 7, 2007, Dr. Üstün wrote:
“The revision process of ICD from 10 to 11 is about to start and will be revised for the 11th version tentatively in 2015. The revision work will include special attention to Chapter V Mental and behavioural disorders (F00-F99). Thanks for your interest in the ICD work and we hope to collaborate with you in the revision process.”
T. Bedirhan Üstün, M.D., Coordinator, Classifications, Assessment and Terminology, World Health Organization, Geneva, Switzerland.

Revise F65 was formally established in Norway in 1997 with the purpose to abolish the SM and fetish diagnoses in the F65 category of the ICD.  Among the Revise F65 members are health care professionals and human rights activists. During these years, articles have been published and presentations have been given (1,2,3,4,5).

In our opinion the following four ICD diagnoses should be abolished:

  • F65.0 Fetishism
  • F65.1 Fetishistic transvestism
  • F65.5 Sadomasochism
  • F65.6 Multiple disorders of sexual preference

In addition the F64.1 Dual-role transvestism diagnosis should be abolished.


Health political and professional arguments for the human rights reform

In our opinion the five above mentioned diagnoses should be repealed because they are superfluous, outdated, non scientific and stigmatizing. The article by Reiersøl and Skeid in “Sadomasochism, Powerful Pleasures” (1) gives thorough argumentation for removing the F65.0, F65.1 and the F65.5 diagnoses.

As the F65.6 diagnosis combines several diagnoses including the three above mentioned, it should also be removed. The F64.1 diagnosis is a bit special in the sense that it is classified as a gender identity disorder type diagnosis, but it is very similar to the F65.1. A separate section describes the issue in more detail.

 

Health political arguments

The diagnoses were repealed at a national level in Sweden January 1, 2009 (6,7). The Dual-role transvestism and the SM diagnoses were repealed in Denmark respectively August 19, 1994 and May 1, 1995 (8). The health authorities in these two countries cited in their reasoning; health political, health promoting and human rights arguments.

The Swedish board of health used the following phrases:

  • “not perverse” (7,9,10)
  • “not illness” (7,9,11)
  • “private matters” (7,9)
  • “citizens entitled to equal rights” (9)
  • “no reinforcement of prejudices” (7,9,11,12)
  • “from earlier times in history” (7,9)
  • “risk of social stigmatizing” (11,12)
  • “entitled to self confidence in the same way as homosexuals” (9)

Private matter

The Danish decision was made by the health minister, Yvonne Herløv Andersen, referring to this type of sexual preference as a private matter that has nothing to do with society (8).

The newspaper Dagens Nyheter November 16, 2008 quoted the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm: “Society has nothing to do with the sexual preferences of these individuals” (7,9).

According to Nettavisen November 17, 2008 the head of the Norwegian Directorate of Health (Helsedirektoratet), Bjørn-Inge Larsen, said: “There is no basis, neither within today’s social norms nor within health political thinking, for labeling several of these phenomena as illnesses” (10).

Stigmatizing

The Swedish revision was done because these psychiatric diagnoses “may contribute to preserve and reinforce prejudices in society, which in turn increases the risk of social stigmatizing of individuals” (11).

“The abolition of  the diagnosis of homosexuality I believe to a certain extent has contributed to a different view than in the 60’s and 70’s of homosexuals in the general population. The abolition gave the homosexuals self confidence because they no longer have a psychiatric stigma. We hope that the current revision will give a similar result”, said  the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm (9).

In a press release NCSF, National Coalition for Sexual Freedom, applauds the Swedish decision, and says:

“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.” (13)

The Norwegian Directorate of Health has since 1996 as a goal to work for counteracting the stigmatizing of sexual minorities (14).

The strategy plan for prevention of HIV and STD points out “the danger of stigmatizing and discriminating against vulnerable groups when doing  preventive work, and the importance of a holistic approach to sexual identity, sexual health and sexual behavior” (15) (pdf file).

Preventative measures

In our opinion, outdated and non scientific diagnoses such as these, constitute an infringement of the human rights of the minorities that are described, and they hinder prophylactic health care efforts that are needed in these groups of people. Deleting the diagnoses may strengthen the “identity building” of the SM/fetish population and contribute positively to the “collective self respect” which is necessary for reaching the group with preventative measures like HIV and STD prevention.

According to Norwegian health authorities “A person’s possibility for self protection against a virus that is sexually transmitted is only to a certain extent influenced by knowledge. The feeling of self value necessary for demanding or having a wish to protect oneself is influenced by societal factors, and only a few of these factors are under the control of the health authorities. We emphasize that the cooperation with marginalized and vulnerable groups has an influence on what could be called a collective self respect” (16).

The Norwegian health authorities have taken an active interest in improving the self respect and the identity of the SM group, to increase the ability of protection against sexually transmitted diseases (17).

Discrimination

For many people, SM and fetishism is more than just behavior, it is part of their sexual orientation and identity (23). In our opinion, stigmatizing minorities by considering their personal orientation as a psychiatric condition is as disrespectful as discriminating against people because of their race, ethnicity or religion.

Like the earlier diagnosis of Homosexuality that is no longer applied by the WHO, the SM and Fetish diagnoses are rarely used for therapeutic purposes. Instead, these definitions are abused to justify harassment and discrimination of the SM/fetish population from laymen and judicial institutions.

Much of the discrimination is directly or indirectly a result of the diagnoses. A psychiatric diagnosis may have a major influence on a person’s possibility of getting work and on the evaluation of a person’s ability to raise children, for example after a divorce.

As with other forms of abuse, women are the main sufferers, losing their jobs, or even their children, because of their SM/fetish love, lifestyle and self-expression (18).

The Norwegian National LGBT Association (LLH) and the National coalition for sexual freedom (NCSF), have published respectively a case study and a survey indicating the stigmatizing function of the F65 diagnoses and that these diagnoses legitimize discrimination (18,13,19).

By repealing the diagnoses, the sexual minorities in question may breathe a bit more easily and be less afraid of private and public discrimination.

In a letter of June 11, 2003 to Revise F65, the Norwegian Association for Clinical Sexology says:  “The Norwegian Association for Clinical Sexology in its support wishes to emphasize that the use of psychiatric diagnoses in relation to homosexual, heterosexual and bisexual fetishists, sadomasochists and transvestic fetishists is stigmatizing and therefore an encroachment upon this group as a whole”.

Safe, sane and consensual

There is no reason to doubt that the SM movement has  “grown up” and taken responsibility over the last 20-30 years, by establishing safe words, security routines, pride symbols and normative measures like the internationally recognized moral and ethical principle “Safe, sane and consensual”. As opposed to dangerous perpetration, SM activities are mutually wanted and consensual activities that produce health promoting and pleasurable hormones (20,21,22,23,38).

 

 

Dead links updated November 22, 2011

Lack of homogeneity

Chapter F65 does not represent a homogeneous totality. Different diagnoses without any logical connection are combined in an unclear and non scientific way only because they are “unusual” phenomena.

The diagnoses are superfluous

Any psychiatric condition that members of the group may suffer from is as for the rest of the population covered by the other, non paraphilic, diagnoses as for example depression, OCD, anxiety disorders, personality disorders or psychoses.

If for example a person is preoccupied with her fetish to the extent that it becomes a problem in her daily life, she could for example become diagnosed with an obsessive compulsive disorder.

When homosexuality was removed as a diagnosis in 1977, the Norwegian Psychiatric Association stated that they were “doubtful towards the application of psychiatric diagnoses on isolated aspects of behavior”. A person showing a particular behavior is not diagnosed according to that behavior, but on the basis of a set of symptoms. “Ideally speaking, psychiatric diagnoses should be related to causal connections in a wider perspective, a broader aspect of suffering, reduced social functioning and/or a desire for treatment”, they stated.

Sleeping diagnoses

As for the former homosexuality diagnosis, the fetish and SM diagnoses are virtually not being used by the medical profession today, at least not in Norway. They are not being used to treat people’s illnesses.

  • “The main objective of diagnosis is patient care”. (IGDA workgroup WPA 2003; The WPA International Guidelines for Diagnostic Assessment by the World Psychiatric Association 2003). 
  • In a letter to the SM organization Smil-Norway of Desember 19, 2008 the health authorities inform that “None of the diagnostic codes in question were reported to the Norwegian Patient Register in 2007 or 2008. This gives a strong indication that the codes are not in use”. 
  • The Norwegian Directorate of Health informs the medical publication “Dagens Medisin” that according  to the Norwegian Patient Register the diagnostic codes in question were not used last year, i.e. in 2007 (24). 
  • Senior counselor, Arild Johan Myrberg at the Norwegian Directorate of Health, reported that it was difficult to find any health care professional in Norway that was willing to defend the diagnoses (25).

The only function of the diagnoses, in our opinion, is to stigmatize a subpopulation and to make discrimination legitimate. That contradicts the hippocratic ethics of the medical profession not to harm (26).

Science and prejudice

Psychiatry otherwise usually regards people as healthy as long as there is no evidence of psychopathology. International research shows the same tendency whether the surveys are qualitative or quantitative, whether they are performed by telephone, on the Internet or by personal interview: Sadomasochists have no more psychiatric problems or disorders than others(22).

In our opinion, diagnoses of fetishism and SM should be based on a scientific foundation, not on cultural prejudices.

Is being different an illness?

In our opinion the following criterion, G1, labeling people as ill, is unclear, judgmental and unscientific: “[]urges and fantasies involving unusual objects or activities” (27).

Fetishists and SM-people represent a group of perhaps 5-10 percent of the population and is increasingly considered a normal variation in society (28).

“Unusual” sexual interests are commonly found in the general population (29).

An important question: Is  “unusual” meant as a statistical or a normative concept? In earlier days several sexual practices were regarded as abnormal, for example homosexuality, masturbation, oral and anal sex. Extreme sports and religious flagellation may also be regarded as unusual. But so far neither  base jumpers or bullfighters nor flagellators have been labeled perverse (1).

Sick without intercourse?

In the HIV preventative efforts in Norway, non penetrating fetish and SM sex is regarded as one possible way  to reduce contagion in the target group. This stands in opposition to the ICD-10 where lack of intercourse is one main argument for labeling fetishism as pathological.

“Fetishistic fantasies are common, buy they do not amount to a disorder unless they lead to rituals that are so compelling and unacceptable as to interfere with sexual intercourse[….]”(ICD-10, F65.0 Fetishism).

Perhaps the World Health Organization should start looking at non penetrating sex as one of several ways to stop the HIV epidemic and the population explosion?

“These diagnoses are rooted in a time when everything other than the heterosexual missionary position were seen as sexual perversions”. Head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm (7).

Confusing SM with violence

Any kind of sexuality may be perverted, not the least “normal” heterosexual activity, if it is not based on equality and consent.

Violence is usually understood  as use of physical force, and there must also be a lack of consent and a wish to do harm.

ICD-10 does not distinguish between consensual SM and harmful violence. This non distinction stands in opposition to modern research and contributes to maintaining the stigma towards that group of people.

“Sexual sadism is sometimes difficult to distinguish from cruelty in sexual situations or anger related to eroticism. Where violence is necessary for erotic arousal, the diagnosis can be clearly established” (Chapter F65.5 Sadomasochism).

  • In a survey from 2003, professor in psychology Pamela Conolly found that SM masters do not experience greater pleasure during non consensual cruelty than do the control group of non SM people, and the masochists did not seek compulsive or harmful forms of pain (22).
  • This finding is corroborated by the psychologists Cross and Matheson in their research from 2006. They found no evidence for contentions about antisocial, psychopathic or violent SM sadists (22).
  • John Noyes goes even further and says that SM may even contribute to the reduction of societal violence: “As a staged aggression, [sadomasochism] may even be in a position to defuse social violence and to put forward alternative and socially viable models of coping with aggression in a manner that minimizes its negative effects.” (30)

See also: “SM versus abuse” (21)

Psychological stress

Another main criterion for chapter F65 is the G2:

“The individual either acts on the urges or is markedly distressed by them”. The concept of “distress” also appears under “F65.0 Fetishism”.

The criterion does not take into account updated knowledge on stigma. Stigmatization by society causes self stigmatization, guilt, shame and psychological distress in minority groups (31). It is not necessarily the SM or fetish activity in and of itself that is problematic.

The American DSM manual in 1994 introduced a B-criterion which states that fetishists or SM people are not ill unless the activities cause significant psychological, physical or social problems.

“The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (32).

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(33). See also “DSM Revision White Paper” (29).

The dual-role transvestism diagnosis

Although the F64.1 diagnoses is not within the F65 category, we find it logical to include it in the list of  diagnoses we want to repeal. It resembles the F65.1 Fetishistic transvestism. The main difference seems to be that there is no sexual excitement involved in the F64.1. In our opinion it is just as discriminating and stigmatizing as the F65 diagnoses, so the general arguments for removing the F65 diagnoses also apply to the F64.1.

Modern gender research shows that there is no longer any basis for claiming only two genders.  In later years individuals have presented with gender variations beyond woman and man, and these individuals are not confused, even though they may confuse people around them (34). A few people, on the other hand, may suffer from gender dysphoria. These people may need medical attention and intervention, and the basis for that should be covered, if not in the other F64 categories, then certainly somewhere in the diagnostic system. Another interesting fact is that there is no transvestism diagnosis under Gender Identity Disorders in the DSM IV. This supports our contention that the phenomenon of “transvestism” is not something to diagnose.

Cooperation between DSM and ICD

We understand that there is substantial cooperation between revisions in the American DSM and revisions in the ICD. In that context we would like to point out the NCSF website (29) which has references to among others Charles Moser who has written several articles about the DSM paraphilia diagnoses over the last years (35,36,37,23,38).

 

Sincerely,

Revise F65

Svein Skeid (leader)                         Odd Reiersøl (psychologist)

 

 

 

Dead links updated November 22, 2011

Footnote 1.

Reiersol O. & Skeid S. (2006). The ICD Diagnoses of Fetishism and Sadomasochism.  In P.J. Kleinplatz and C. Moser (Eds.). Sadomasochism, Powerful Pleasures (pp. 243-262). Retrieved September 19, 2009, fromhttp://books.google.no/books?id=iHkT5Eyj7H0C&printsec=frontcover#v=onepage&q=&f=false

Published simultaniously in The Journal of Homosexuality, Volume 50, Issue 2&3, May 2006, pages 243-262. Retrieved September 19, 2009, from http://www.haworthpress.com/store/ArticleAbstract.asp?sid=M6XM7W1WEHBQ8K7CX9SA3CDGU3SU9LUB&ID=65910

Footnote 2.

Fetisj og SM-diagnosene i ICD-10 [The Fetish and SM Diagnoses in ICD-10]. (2008, June). Tidsskrift for Norsk Psykologforening [Journal of the Norwegian Psychological Association, Vol 45]. Pp 754-756. Retrieved September 19, 2009, from http://www.psykologtidsskriftet.no/index.php?seks_id=52392&a=2&sok=1

Footnote 3.

Retrieved September 19, 2009, from http://www.reviseF65.org

Footnote 4.

Retrieved September 19, 2009, from http://en.wikipedia.org/wiki/ReviseF65

Footnote 5.

About the ReviseF65 project. Professional and health political work 1994-2009. Retrieved September 19, 2009, fromhttp://www.revisef65.org/aboutrevisef65.html

Footnote 6.

Fetish and SM diagnoses deleted in Sweden. Retrieved September 19, 2009, fromhttp://www.revisef65.org/Sweden.html

Footnote 7.

Transvestism ‘no longer a disease’ in Sweden (2008, November 17). The Local. Retrieved September 19, 2009, fromhttp://www.thelocal.se/15728/20081117/

Footnote 8.

Denmark withdraws SM from Diagnosis-list (1995, April 1). Politiken, page A7. Retrieved September 19, 2009, fromhttp://www.revisef65.org/denmark.html

Footnote 9.

Nu ska Sara-Claes slippa bli stämplad som sjuk [Sara-Claes will not any longer be stigmatizised as sick]. (2008, November 16). Dagens Nyheter. Retrieved September 19, 2009, from http://www.dn.se/nyheter/sverige/nu-ska-sara-claes-slippa-bli-stamplad-som-sjuk

Footnote 10.

Dette er ikke perverst lenger [This is not any longer perverse]. (2008, November 17). Nettavisen. Retrieved September 19, 2009, from http://www.nettavisen.no/jobb/article2402153.ece

Footnote 11.

Koder i klassifikationen av sjukdomar och hälsoproblem utgår [Codes in the Classification of Diseases are removed]. (2008, November 17). Socialstyrelsen [The Swedish National Board of Health and Welfare]. Retrieved September 19, 2009, from http://www.revisef65.org/socialstyrelsen.html

Footnote 12.

Så blev transvestiter friska över en natt! [Transvestites taken off the sick list overnight]. (2008, November 17). QX. Retrieved September 19, 2009, from http://www.qx.se/samhalle/8544/sa-blev-transvestiter-friska-over-en-natt

Footnote 13.

Sweden takes sexual behaviors off their disease list. (2008, November 25). NCSF, National coalition for sexual freedom. Retrieved September 19, 2009, from https://ncsfreedom.org/key-programs/dsm-v-revision-project/dsm-v-program-page/item/316-press-release-sweeden-takes-sexual-behaviors-off-their-disease-list.html

Footnote 14.

Norwegian health authorities about healt preventive work. Retrieved September 19, 2009, fromhttp://www.revisef65.org/forebyggende.html

Footnote 15.

Ansvar og omtanke – Strategiplan for forebygging av hiv og soi [Responsibility and consideration – Norwegian national strategy plan to prevent hiv and sexually transmitted infections]. Helsedirektoratet [The Norwegian National Board of Health]. Pp. 3, 3, 13, 21, 26 and 40. Retrieved September 19, 2009, fromhttp://www.helsedirektoratet.no/vp/multimedia/archive/00002/Ansvar_og_omtanke_2200a.pdf

Footnote 16.

Handlingsplan mot hiv/aids-epidemien 1996-2000 [Norwegian national strategy plan to prevent HIV and STD 1996-2000]. Helsedirektoratet [The Norwegian National Board of Health]. Pp 25 and 33.

Footnote 17.

Tilskuddsbrev til fetisj & SM gruppen SMia-Oslo fra Sosial- og helsedirektoratet via kap. 719 post 70 [Letter to the Fetish & SM group SMia-Oslo from The Norwegian National Board of Health]. (2002, April 25).

Footnote 18.

Discrimination and violence towards the SM/fetish population. Revise F65. Retrieved September 19, 2009, fromhttp://www.revisef65.org/discrimination.html

Footnote 19.

NCSF’s Violence and Discrimination Survey. Retrieved September 19, 2009, fromhttps://ncsfreedom.org/component/k2/item/452-ncsfs-violence-and-discrimination-survey.html

Footnote 20.

Safe, sane, and consensual as a moral ethical principle and cornerstone of SM acticity. Retrieved September 19, 2009, from http://www.revisef65.org/sikker.html

Footnote 21.

SM versus abuse. Revise F65. Retrieved September 19, 2009, from http://www.revisef65.org/violence.html

Footnote 22.

No more psychopathology among SM-people. Revise F65. Retrieved September 19, 2009, fromhttp://www.revisef65.org/psychopathology.html

Footnote 23.

Sexual Freedom NOW. Physicians and psychiatrists about SM as a valid expression of adult consensual sexuality and an important part of people’s sexual orientation. Retrieved September 19, 2009, fromhttp://www.revisef65.org/NOWSM.html

Footnote 24.

Transvestittisme og SM ikke lenger en sykdom i Sverige [Transvestism and SM are no longer diseases in Sweden]. (2008, November 17). Dagens Medisin [Medicine Today]. Retrieved September 19, 2009, fromhttp://www.dagensmedisin.no//nyheter/2008/11/17/transvetittisme-ikke-lenge/index.xml

Footnote 25.

Meeting at the Norwegian National Board of Health, May 11, 2009.

Footnote 26.

The Hippocratic Oath. Wikipedia. Retrieved September 19, 2009, from http://en.wikipedia.org/wiki/Hippocratic_Oath

Footnote 27.

World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva, Switzerland.

World Health Organization (1993). The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva, Switzerland.

Footnote 28.

Quantity of the sm/fetish-population. Retrieved September 19, 2009, from http://www.revisef65.org/antall_eng.html

Footnote 29.

DSM Revision White Paper. NCSF, National coalition for sexual freedom. Retrieved September 19, 2009, fromhttps://ncsfreedom.org/key-programs/dsm-v-revision-project/dsm-revision-white-paper.html

Footnote 30.

Noyes, J. K., Ph.D. (1997). The mastery of submission: Inventions of masochism. Ithaca, NY: Cornell University Press, page 30.

Footnote 31.

Goffman, E. (1963) Stigma: notes on the management of spoiled identity. Englewood Cliffs, Prentice-Hall.

Footnote 32.

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revised). Washington DC.

Footnote 33.

About The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Retrieved September 19, 2009, from http://www.revisef65.org/DSM.html

Footnote 34.

Heino Meyer Bahlburg: Presentation at the WAS (World Association for Sexual Health) conference in Goteborg, June 2009.

Footnote 35.

Moser, Charles & Kleinplatz, Peggy J. (2005). DSM-IV-TR and the Paraphilias: An Argument for Removal. Journal of Psychology and Human Sexuality (2005), 17(3/4), 91-109. Retrieved November 11, 2011, from http://www2.hu-berlin.de/sexology/GESUND/ARCHIV/MoserKleinplatz.htm

Footnote 36.

Moser, C. & Kleinplatz, P.J. (2002). Transvestic fetishism: Psychopathology or iatrogenic artifact? New Jersey Psychologist, 52(2) 16-17. Retrieved September 19, 2009, from http://home.netcom.com/%7edocx2/tf.html

Footnote 37.

Moser, C. (1999). The Psychology of Sadomasochism (S/M). In S. Wright (Ed.) SM Classics (pp. 47-61). New York, Masquerade Books. Retrieved September 19, 2009, from http://www2.hu-berlin.de/sexology/BIB/SM.htm#S/M_PRACT

Footnote 38.

Moser, C. & Wright S.. What is SM? Retrieved September 19, 2009, fromhttp://www.leatherleadership.org/library/whatsm.htm

 

ICD Revision White Paper

Oslo, Norway, September 24, 2009
Dead links updated November 22, 2011

ICD Revision White Paper to WHO from Revise F65
(
Revise F65’s first report to WHO)

By Cand. Psychol Odd Reiersøl and Revise F65 leader Svein Skeid
Proposal to the ICD-11 Revision of Chapter V, Mental and Behavioural Disorders, F65 and F64.

Invitation from WHO to Revise F65

We want to thank classification coordinator Dr. T. Bedirhan Üstün M.D. at WHO in Geneva for inviting Revise F65 to collaborate with the work leading up to the ICD-11 revision.

In an email of May 7, 2007, Dr. Üstün wrote:
“The revision process of ICD from 10 to 11 is about to start and will be revised for the 11th version tentatively in 2015. The revision work will include special attention to Chapter V Mental and behavioural disorders (F00-F99). Thanks for your interest in the ICD work and we hope to collaborate with you in the revision process.”
T. Bedirhan Üstün, M.D., Coordinator, Classifications, Assessment and Terminology, World Health Organization, Geneva, Switzerland.

Revise F65 was formally established in Norway in 1997 with the purpose to abolish the SM and fetish diagnoses in the F65 category of the ICD.  Among the Revise F65 members are health care professionals and human rights activists. During these years, articles have been published and presentations have been given (1,2,3,4,5).

In our opinion the following four ICD diagnoses should be abolished:

  • F65.0 Fetishism
  • F65.1 Fetishistic transvestism
  • F65.5 Sadomasochism
  • F65.6 Multiple disorders of sexual preference

In addition the F64.1 Dual-role transvestism diagnosis should be abolished.


Health political and professional arguments for the human rights reform

In our opinion the five above mentioned diagnoses should be repealed because they are superfluous, outdated, non scientific and stigmatizing. The article by Reiersøl and Skeid in “Sadomasochism, Powerful Pleasures” (1) gives thorough argumentation for removing the F65.0, F65.1 and the F65.5 diagnoses.

As the F65.6 diagnosis combines several diagnoses including the three above mentioned, it should also be removed. The F64.1 diagnosis is a bit special in the sense that it is classified as a gender identity disorder type diagnosis, but it is very similar to the F65.1. A separate section describes the issue in more detail.

 

Health political arguments

The diagnoses were repealed at a national level in Sweden January 1, 2009 (6,7). The Dual-role transvestism and the SM diagnoses were repealed in Denmark respectively August 19, 1994 and May 1, 1995 (8). The health authorities in these two countries cited in their reasoning; health political, health promoting and human rights arguments.

The Swedish board of health used the following phrases:

  • “not perverse” (7,9,10)
  • “not illness” (7,9,11)
  • “private matters” (7,9)
  • “citizens entitled to equal rights” (9)
  • “no reinforcement of prejudices” (7,9,11,12)
  • “from earlier times in history” (7,9)
  • “risk of social stigmatizing” (11,12)
  • “entitled to self confidence in the same way as homosexuals” (9)

Private matter

The Danish decision was made by the health minister, Yvonne Herløv Andersen, referring to this type of sexual preference as a private matter that has nothing to do with society (8).

The newspaper Dagens Nyheter November 16, 2008 quoted the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm: “Society has nothing to do with the sexual preferences of these individuals” (7,9).

According to Nettavisen November 17, 2008 the head of the Norwegian Directorate of Health (Helsedirektoratet), Bjørn-Inge Larsen, said: “There is no basis, neither within today’s social norms nor within health political thinking, for labeling several of these phenomena as illnesses” (10).

Stigmatizing

The Swedish revision was done because these psychiatric diagnoses “may contribute to preserve and reinforce prejudices in society, which in turn increases the risk of social stigmatizing of individuals” (11).

“The abolition of  the diagnosis of homosexuality I believe to a certain extent has contributed to a different view than in the 60’s and 70’s of homosexuals in the general population. The abolition gave the homosexuals self confidence because they no longer have a psychiatric stigma. We hope that the current revision will give a similar result”, said  the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm (9).

In a press release NCSF, National Coalition for Sexual Freedom, applauds the Swedish decision, and says:

“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.” (13)

The Norwegian Directorate of Health has since 1996 as a goal to work for counteracting the stigmatizing of sexual minorities (14).

The strategy plan for prevention of HIV and STD points out “the danger of stigmatizing and discriminating against vulnerable groups when doing  preventive work, and the importance of a holistic approach to sexual identity, sexual health and sexual behavior” (15) (pdf file).

Preventative measures

In our opinion, outdated and non scientific diagnoses such as these, constitute an infringement of the human rights of the minorities that are described, and they hinder prophylactic health care efforts that are needed in these groups of people. Deleting the diagnoses may strengthen the “identity building” of the SM/fetish population and contribute positively to the “collective self respect” which is necessary for reaching the group with preventative measures like HIV and STD prevention.

According to Norwegian health authorities “A person’s possibility for self protection against a virus that is sexually transmitted is only to a certain extent influenced by knowledge. The feeling of self value necessary for demanding or having a wish to protect oneself is influenced by societal factors, and only a few of these factors are under the control of the health authorities. We emphasize that the cooperation with marginalized and vulnerable groups has an influence on what could be called a collective self respect” (16).

The Norwegian health authorities have taken an active interest in improving the self respect and the identity of the SM group, to increase the ability of protection against sexually transmitted diseases (17).

Discrimination

For many people, SM and fetishism is more than just behavior, it is part of their sexual orientation and identity (23). In our opinion, stigmatizing minorities by considering their personal orientation as a psychiatric condition is as disrespectful as discriminating against people because of their race, ethnicity or religion.

Like the earlier diagnosis of Homosexuality that is no longer applied by the WHO, the SM and Fetish diagnoses are rarely used for therapeutic purposes. Instead, these definitions are abused to justify harassment and discrimination of the SM/fetish population from laymen and judicial institutions.

Much of the discrimination is directly or indirectly a result of the diagnoses. A psychiatric diagnosis may have a major influence on a person’s possibility of getting work and on the evaluation of a person’s ability to raise children, for example after a divorce.

As with other forms of abuse, women are the main sufferers, losing their jobs, or even their children, because of their SM/fetish love, lifestyle and self-expression (18).

The Norwegian National LGBT Association (LLH) and the National coalition for sexual freedom (NCSF), have published respectively a case study and a survey indicating the stigmatizing function of the F65 diagnoses and that these diagnoses legitimize discrimination (18,13,19).

By repealing the diagnoses, the sexual minorities in question may breathe a bit more easily and be less afraid of private and public discrimination.

In a letter of June 11, 2003 to Revise F65, the Norwegian Association for Clinical Sexology says:  “The Norwegian Association for Clinical Sexology in its support wishes to emphasize that the use of psychiatric diagnoses in relation to homosexual, heterosexual and bisexual fetishists, sadomasochists and transvestic fetishists is stigmatizing and therefore an encroachment upon this group as a whole”.

Safe, sane and consensual

There is no reason to doubt that the SM movement has  “grown up” and taken responsibility over the last 20-30 years, by establishing safe words, security routines, pride symbols and normative measures like the internationally recognized moral and ethical principle “Safe, sane and consensual”. As opposed to dangerous perpetration, SM activities are mutually wanted and consensual activities that produce health promoting and pleasurable hormones (20,21,22,23,38).