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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 Because the ICD fetish and SM diagnoses are superfluous, outdated, non scientific and stigmatizing to the fetish/BDSM minority, these diagnoses have been removed in nearly all of the Nordic countries.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and criticism on the ICD-10, concluding: The ICD diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism are outdated and not up to the scientific standards of the ICD manual.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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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.

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.

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).

Delete SM and fetish diagnoses!

Despite new research, the views of psychiatry on the subject of SM, Fetishism and Fetishistic transvestism, have hardly changed in the last 100 years.

Leather people have been considered healthy the last ten years by most researchers, by US psychiatrists, and by the health authorities of Denmark and Sweden. Despite this fact, Fetishism, Fetishistic transvestism and Sadomasochism are still branded as mental illnesses by the World Health Organization (WHO), in expectation of the next revison of WHO’s diagnostic manual ICD-10. This revision is going to start fall 2009/winter 2010.

Sweden deleted their national fetish and SM diagnoses January 1, 2009. Denmark repealed Dual-role transvestism and the SM diagnoses fall 1994 and May 1995. The American Psychiatric Association, APA, considerably revised their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) spring 1994.

Like the earlier diagnosis of Homosexuality that is no longer applied by the WHO, the SM and Fetish diagnoses are rarely used in clinical practice as a means to assist people. On the contrary the stigma attached to the diagnoses justifies various forms of harassment and discrimination of this sexual minority by the society. ReviseF65 can document that people are losing their jobs, the custody of their children etc., because of their SM-love, lifestyle and self-expression. Much of the discrimination is directly or indirectly a result of the diagnoses.

The Gay Movement more than 30 years ago considered it of fundamental importance to first delete the diagnosis of homosexuality from the International Classification of Diseases (ICD), before any further major human rights improvement was possible. If a group is considered mentally ill, very few people will listen to your arguments aiming at reducing prejudice in society.

ReviseF65 apply the same judgement today. We consider unscientic and stigmatising SM and Fetish-diagnoses as possibly one of the biggest obstacles to the acceptance of our human rights. Abolishing them is a very important step in the effort to reduce prejudices towards the SM-Leather-Fetish-population.

The pansexual ReviseF65 committee, located in Norway, sets focus on the lack of scientific basis for today’s diagnoses and tries to stimulate the building-up of an international activist and professional network to delete these diagnoses.

What can you do in your country?

As with the earlier diagnosis of Homosexuality; the more countries that drop their national SM and Fetish diagnoses, the greater is the possibility that the World Health Organization will follow suit. National ICD-diagnoses can only be abolished by groups in each country. This work must be done by the SM-Leather-Fetish-movement itself. Don’t expect anybody to fight for your freedom from such discrimination, if you don’t do it yourself.

The initiative of individuals is always very welcome, but the formation of local and national working parties would be even more effective in approaching the mental health professionals in question.

Examples of national strategies

We think that the strategy should be determined either locally or nationally, depending on the professional and political situation in each country.

  • Gain support from sexologist-, psychologist- and psychiatric-federations on a national level. Experience from the homosexual diagnoses show us that the latter organization can be the key to the national removal of diagnoses.
  • Lobby the political health administration to withdraw SM and Fetish diagnoses from the national list of psychiatric diagnoses as the Danish health minister did in 1995.
  • Spread the word about the ICD-work of ReviseF65 and make a link to the web page from your own website. To be informed and have your voice heard – join our e-mail discussion group at http://www.revisef65.org/moderator.html and inform others about it.
  • Cooperate with other gay&lesbian and fetish&SM groups to plan national strategies for the abolition of the diagnoses.

Support to the ICD project
The Revise F65 project was established on the initiative of the 1996 and 1998 National Conventions of the Norwegian National Association for Lesbian and Gay Liberation (LLH).

The 21st European Conference of ILGA in Pisa, October 1999, decided to support the Revise F65 project and ask the Board to assist by giving access to channels of information.

The General Assembly of the ECMC in Milano, August 2000 adopted a motion establishing a project group with the same mandate.

The Boards of the Norwegian Association of Gay and Lesbian Physicians HLLF (right), and the Norwegian Society for Clinical Sexology NFKS (left), decided to support the Revise F65 efforts in 2003.

Organizations involved
The Revise F65 project group consists of SM/Leather/Fetish men and women representing organizations of leather and SM gays, – lesbians, bi- and heterosexuals, as well as professionals in sexology, psychology and psychiatry.

LLH, Landsforeningen for lesbisk og homofil frigjøring – Norwegian National Association for Lesbian and Gay Liberation

SLM-Oslo, Scandinavian Leather Men, Oslo

Verkstedet Smia-Oslo

SMil Norge

Call to action

Revise F65: Annual report 2009 and a request for support

The ICD diagnoses of Fetishism, Sadomasochism and Transvestism

WHO has started the revision process of ICD from version 10 to 11. Revise F65 asks for your support.

First of all we want to thank all our friends at home and abroad for the cooperation in 2009. Not at least we thank our Swedish friends who made it possible for Sweden to remove fetish and SM diagnoses from January 1, 2009. We can assure you that the Swedish decision has made a great impression on the people responsible for the ICD revision in The World Health Organization, WHO.

WHO is now undergoing the 11th revision of the International Classification of Diseases, and the ICD-11 alpha draft is expected to be ready by May 10, 2010.

According to Senior Project Officer Dr. Geoffrey M. Reed, responsible for the revision of ICD-10 Mental and Behavioural Disorders at WHO’s Department of Mental Health and Substance Abuse, substantial changes in the ICD are dependent upon broad scientific and political support.

”It will be helpful for the recommendations to come from as broad an international coalition as possible, if possible with the formal involvement or endorsement of scientific and professional societies or governments.”
Mail to Revise F65 September 25, 2009.

Revise F65 therefore asks for testimony, quoted reference and supporting evidence from psychiatrists, psychologists, sexologists, researchers of human sexuality and organizations world wide in order to remove Fetishism, Sadomasochism and Transvestic Fetishism as diagnoses from ICD, the International Classification of Diseases published by WHO. Such statements should be sent to Revise F65 (mail: sskeid(A)online.no), and will be forwarded by us to WHO’s Department of Mental Health and Substance Abuse.

As Dr. Reed also emphasizes, it is of great importance that as many countries as possible change their national diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism. The more countries that change their national ICD versions, the bigger is the chance that WHO will follow suit.

Denmark removed the Transvestism and Sadomasochism diagnoses from their national version of the ICD in 1994/95 http://www.revisef65.org/denmark.html

Sweden removed all their fetish and SM diagnoses 1st of January 2009  http://www.revisef65.org/Sweden.html

After several delays in 2009, the Norwegian Directorate of Health has been instructed by the Ministry of Health and Care Services to remove the diagnoses of Transvestism, Fetishism and Sadomasochism from the Norwegian version of ICD-10. “The Directorate of Health aims to bring the decision into force by February 1, 2010″, the Directorate writes in a letter to Revise F65, December 21, 2009.

Revise F65 recommends to abolish the following ICD diagnoses because they are superfluous, outdated, non scientific and stigmatizing.

F65.0 Fetishism

F65.1 Fetishistic transvestism

F65.5 Sadomasochism

F65.6 Multiple disorders of sexual preference

F64.1 Dual-role transvestism

See health political and professional arguments at:

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

Regards,

Svein Skeid,

Leader of Revise F65

Examples of statements, quotes and evidence of support:

http://www.revisef65.org/europride3.html

Read our ”annual report” 2009 (included Revise F65 efforts since 1994):

http://www.revisef65.org/about3.html

Bibliography 1 – ReviseF65

This bibliography is broken into two sections:

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

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

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

This version: September, 2003

Bibliography 1 – ReviseF65
Texts concerned with the F65 classification system

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

<!–nextpage–>

 

This bibliography is broken into two sections:

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

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

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

This version: September, 2003

Bibliography 2 – Recommended general publications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Healthy SM and fetish people!
Text in this column by reviseF65

Europride Köln 2002. Photo: Smia-Oslo

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

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

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

INTRODUCTION

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

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

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

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

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

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

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

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

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

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

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

METHOD

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

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

DISCUSSION

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

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

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

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

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

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

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

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

Joyce McDougall and the concept of “Neo-Sexuality”

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

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The Manuals of Mental Health and Project ReviseF65

Svein Skeid is one of the responsibles for the Project ReviseF65 or Project ICD (www.revisef65.org) that aims to mobilize, through a website and a discussion group on the Internet, SM/Leather/Fetish groups and professionals in the field of mental health in all the world, with the purpose of taking away the psychiatric diagnoses (“paraphilias”) of Fetishism, Transvestism and Sadomasochism from the International Statistical Classification of Diseases and Related Health Problems (www.revisef65.org/ICD10.html), published by the World Health Organization (WHO). The diagnoses of “paraphilia” may serve as a justification for stigmatization and violence against sexual minorities. Several reports of violence against Sadomasochism and Fetish practitioners may be found in the ReviseF65 website (www.revisef65.org). The U.S. Leather Leadership Conference reports that thirty to fifty percent of the SM population suffers discrimination, violence or persecution due to their sexual orientation. Project ICD states that “Stigmatizing minorities by diagnosing their sexual orientation is on the contrary as disrespectful as discriminating people because of their race, ethnicity or religion”. It is, undoubtedly, a legitimate proposal in defense of the human rights of sexual minorities.

Countries as Denmark, in consonance with the legitimate needs and rights of sexual minorities, have totally withdrawn the diagnoses of sadomasochism from their health manuals in 1995.

The Diagnostic and Statistical Manual of Mental Disorder – Fourth Edition (DSM-IV, 1995, pp 495) also classifies Fetishism and Sexual Sadism and Masochism as “paraphilias”, in which, besides the existent recurring and intense fantasies and sexual impulses or behavior involving those practices (Criterion A), those fantasies, sexual impulses or behaviors must cause a clinically significant suffering or damage in social or occupational functioning or in other important areas of the individual’s life (Criterion B) [DSM-IV, 1995, p 495]. In case Criterion B is not met, the sexual variants above are not considered pathologic or symptomatic, configuring only a variation of adult human sexuality.

Due to the lack of information and knowledge of what consensual erotic practices are about, their practitioners are erroneously classified as victims or perpetrators of coercitive acts of violence and sexual abuse.

BDSM Concepts and Practices

Consensual fetishist and sadomasochist practices are not easily defined, for they include a wide range of behaviors from which many practitioners do not appreciate all roles and activities, being the detailed description of each BDSM or Fetishist practice beyond the scope of the present study. We will focus, however, on the most general terms.

The term “BDSM“, that refers to the sadomasochist universe as a whole, involves all its aspects – dominance, submission, bondage, discipline, sadism and masochism, while SM means “sadomasochism” (Paschoal, 2002, p 14). However, the relationship between them is analogous to the distinction between the terms “homosexual” and “gay” (Moser, 1996, p 24).

According to this author’s theoretic perspective, “Dominance and Submission (DS) implies the deliberate transference of psychological and sexual control from one partner to the other without, necessarily, elements of physical pain or humiliation”.

The term “Bondage and Discipline“, “B&D” or “B/D” refers to sexual practices with various kinds of immobilization or physical restraint, while “Discipline” indicates the acting out of fantasies that relate to punishment/penalties like, for example, the “teacher/student” fantasy.

Humiliation” refers to role-playing scenes in which the dominant partner detains control of power over the submissive partner, inflicting and ritualizing psychologic tortures, like verbal insults of a sexual conotation.

Regarding the terms “sadist” and “masochist“, there is a more physiological conotation, in which people experiment pleasure sensations in giving and/or receiving carefully controlled spanking with slippers or whips (Moser, 1996, p 25).

The word “leather” is used in the sadomasochist community by gays and lesbians (Moser, 1996, p 63).

Other behaviors also generally included in the sadomasochist practice are “age play”, a fetish that demands a partner to act as being of a different age, sometimes older, sometimes younger (playing as a baby, for example); forced or voluntary feminization of male submissives who wear high heel shoes, lingerie and female dresses (“crossdressing”), and also sexual plays involving urine and excrements. Paschoal (2002, p 16) maintains that “each of these concepts has personal, individual and unique aspects, like the people who practice them… Each one is free to choose which and how they prefer them… It is impossible to follow them in a literal way, since human creativity and individual freedom are what is the most precious in the human being”.

With the same creativity, the BDSM community created the term “vanilla“, for referring to conventional sexual practices that do not involve any SM component (Scott, 1997, p3). The “Safety, Sanity and Consensuality” triad (Brame G, Brame W & Jacobs, 1993, p 49) is considered a basic norm for consensual unconventional practices and may never be ignored or neglected. Paschoal (2002, p 22) states that the non-existence of any of the SSC aspects makes any and all BDSM relationship totally inviable.

By “Consensuality“, Moser (1996, p 31) understands the voluntary agreement firmed between the participants of the erotic play, in which the limits of each participants are honored. He explains that domestic abuse that occurs between a couple cannot be named “SM”, for SM is consensual, and abuse imposed on a partner is not. We may use as an example sexual intercourse and rape, where the former is consented and the latter is imposed by coercion. Therefore, the difference between sadomasochism and true violence is to be found in “informed consent” (Moser, 1996, p 31).

Sanity” refers to being aware of what the participants are doing in an SM scene: it is a fantasy that does not correspond to reality. Certain BDSM practices imply considerable risk. In this sense, the knowledge of the partner, the establishment of limits and knowing the risks inherent to each practice are very important factors for the erotic BDSM play to be safe and pleasant. It is also worth saying that safety involves some prohibitions. As it is extremely important that one has complete awareness of what one is doing, the use of alcohol or any kind of drugs is severely unadvisable before or during the BDSM scene or play (Paschoal, 2002, p 27). In case any physical or psychological limit is surpassed, the use of a “safeword” reestablishes the limits of physical and emotional safety of the participants and the play is immediately interrupted (Paschoal, 2002, p 25).

According to Brame, G, Brame, W & Jacobs (1993, p 358), the word fetish comes from the Portuguese word feitiÁo and it is said to be used for the first time by Portuguese explorers in the 15th Century, for describing sacred images. In its anthropologic meaning, fetish is linked to sacred artifacts that are invested of spiritual powers. For fetishists, the erotic fetish is the symbol of the divine itself, being able to arouse and even to induce their devotees to ecstasy. Examples of erotic fetishes are found in those who admire a pair of shoes, instead of the feet that wear them; or the feet are considered extremely arousing, in detriment of the human body as a whole. All human beings are fetishists to some degree. In Brazilian culture, buttocks are the object of national adoration, while in American culture, breasts are extremely valued. In China, small female feet are extremely sexy. This demonstrates that different cultures elect their own fetishes. As Paschoal (2002, p 68) illustrates very well, “a fetish would be a specific preference in a universe of possibilities… BDSM is more like a fantasy full of fetishes. So as a masochist prefers (or has the fetish of) receiving pain, or being tortured exclusively with ropes, or with candles, or with ice, or with all alternatives, or with none of them, the sadist prefers (or has the fetish of) causing pain. They are all fetishes”.

Regarding Brazilian reality, the Internet became a powerful vehicle for the search of information and contacts for people who are interested in the erotic sadomasochist and fetishist practices, largely contributing for the formation of a “virtual” subculture of sexual minorities. The Brazilian BDSM movement is at an embryonary state, but growing, with hundreds of websites and discussion groups (www.yahoo.com.br and www.msn.com.br), trying to form a gathering movement that provides recognition, visibility and contacts outside “virtual” reality, following an international tendency proposed by American organization “The National Coalition for Sexual Freedom” (NCSF), that fights for equal rights in the legal, political and social fields for adults who are engaged in the practice of alternative sexual expressions. According to articles on SM available in their website (www.ncsfreedom.org.), NCSF explains that Sadomasochism is not abuse or domestic violence, being the latter “a pattern of intentional intimidation of one partner to coerce or isolate the other partner without consent” (www.ncsfreedom.org/what.htm), as opposed to what happens in BDSM practices, in which the partners involved agree on everything that will happen in the erotic play, besides being well informed about possible consequences of the erotic power exchange game. It also explains that domestic violence may occur in any group of people, including SM practitioners, but with the difference that within the sadomasochist community domestic violence is not forgiven, and victims as well as abusers are encouraged to look for specialized help.

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RESULTS

Table 1

As we may see from table 1, the great majority of the total sample (n = 111) is composed by heterosexuals, but only seven (6,3 %) respondents are female, being four (4) officially married and three (3) single. The number of people who have partners and practice the same sexual fantasies, 36,1%, was larger than expected.

It is interesting to point out that in sexual practices involving Submission and Masochism (43,3%) only six (6) are heterosexual women, while the rest of the group are males, regardless of sexual orientation. Catholic religion (53,2%) has more representatives (which reflects Brazil’s religious proportions). The education level is high, 70,3 being graduated and 13,5% post-graduated.

CONCLUSION

We will quote below excerpts from some reports for illustrating the qualitative part of the study, in which respondents talk about how they feel regarding their sexual experiences and the topics that were approached in the questionnaire they answered.

– SS, post-graduated, fetishist, 35, married: “When I was about five years old, I remember getting aroused by wearing satin gowns, I liked to urinate on them and feel the smell of urine for many days… Since I was a child I realized I had “different” desires, but I was only able to understand that in fact these fetishes are not an “aberration of nature” three years ago, with the Internet… on the net I saw, talked to and knew there are people with the same tastes”.

– S., enterprise administrator, masochist, 34, married, remembers: “There was this game of police and thieves and the girls were always the police and the boys were the thieves. Girls ran after, caught and arrested the boys. I remember that when I was arrested, I always asked to be tied up, or I would run away; so I developed, unnoticing, my instinct of submission to females… A fantasy that impressed me in my child and teen years was “Catwoman” from the Batman series… Today, seeing it again with experienced eyes, I can perceive a very explicit fetishist citation. Catwoman was beautiful, that latex suit tight on her body… Whenever she captured the heroes, they were tied up and were at her feet… She was always shown, in her hideout, sitting on a throne on a pedestal, and her helpers sat on the floor at her feet… sometimes she found a way to step on a helper… pure fetish”.

– Fbond, importer, bondage fetishist, 31, married: “I take bondage and fetishism very seriously, I don’t like anything that causes pain, but I like the seduction allied to bondage, underwear, insinuating clothes (but not vulgar), I am cultured… I found out I was a fetishist at age 8 watching a Jerry Lewis movie and now I have more than 150 tapes of that kind… I consider myself a very friendly person, so I think it’s absurd that a fetishist should be put in the class of “abnormals”. Maybe there are even cases like that, but it’s not the majority”.

– Al Z, dominator, post-graduated in System Analysis, 38, married, reports: “Since I was a child, I appreciated scenes with bound or spanked women (generally in movies), when I knew nothing about sex… I think it was instinctive… I awoke to my fantasies five or six years ago, when I accidentally entered a site… at that time, I was 32 or 33 and that fact totally changed my life… Bondage and spanking (female buttocks) arouse me a lot, and also other forms of physical and psychological domination like, for example, transforming my partner into a dog, putting on her a collar and a leash… My relationship with my spouse is “standard”, that is, it follows religious and social rules for marriage… She doesn’t know about my incursions into the virtual world, not even that I look for someone to make my fantasies come true in the “real”. I feel like an absolutely normal person… What I think is that society is really afraid to admit that who likes BDSM (within the erotic context, of course) is a normal human being. People always look forward to living with more pleasure and BDSM is one more alternative form of reaching it fully… I never opened up to someone as much as I’m doing to you now, but I feel very good, because it was suffocating me”.

– J., System Analyst, submissive, 32, single: “I feel perfectly normal and even – why not – privileged, for knowing how to explore my sexuality in a different and much more intense way than most people do. I’m very happy to have enough capacity to understand my fetish and to enjoy it in a healthy, safe and very peculiar way”.

– N., administrative assistant, bondager, 26, single: “I like to be bound and completely immobilized, to feel completely vulnerable in the hands of my partner, not being passive but struggling because I was tied up, as if I was forced to be in that situation, not accepting passively that the other ties me up, but trying to “escape”, to get free, and end up being “defeated” by his strength and technique… the deprivation of senses, like vision and speech… this way they become sharper, but not knowing what the other person is going to do is an incomparable sensation… being gagged is an indescribable sensation… Putting all that together is an inexplainable sensation… Sincerely, I feel more normal than other people, I accept myself. I think what is abnormal is people neglecting themselves, or even living a faÁade relationship and looking beyond for the fulfillment of their fantasies… I believe that people can only be totally happy when they look for a relationship that fulfills them totally… (that is) difficult, but living a double life is still more difficult… in one of them you will be acting out… The society in which we live in is hypocrite… everyone has fantasies, but to fit the “normal” standard, they don’t recognize it and even criticize and get shocked with other people’s opinion. I believe that each one owns their life and owe no explanation to others about what they like or dislike within four walls; better yet, I think we must be free to live out our fantasies and other quotidian things too; of course, respecting the other’s limits and space. For me, BDSM is a form of pleasure, it is a vast world with many branches and each person chooses among those what really gives them pleasure… I chose mine and I am not bothered by the fact that society does not accept it or thinks I am an aberration… I feel more normal than everyone, for I am sincere with myself, I recognize and accept myself like that and it makes me happy…”

– M.H., dentist, crossdresser, submissive, 39, married: “I am married and my wife takes part in everything and has dominated me for over one year… As you may see, I’m a submissive crossdresser and I behave accordingly. I’m my wife’s sissy. I dress as a woman everytime I can, do all housework and I’m a woman for my wife. I’m totally passive and she is active… I often get spanked and humiliated, and I love it… I found out that what I felt and did was in tune with the BDSM universe when I was 18. But not knowing it was a BDSM attitude, ever since I can remember… since 6 or 7… I loved to play house with my cousins and I was always the housemaid, always working and humiliated. This was the role I chose. It gave me pleasure and, in my point of view, it fits BDSM. When I was 10 I came for the first time, when putting on an aunt’s skirt… I came without even touching myself. Since then I was always out of standards, but at 16 I noticed I was “different”. Would I be gay? But how would I be gay if I never had interest in men? But if I wasn’t gay, why would I fantasize myself in the female role?… Unfortunately, people live in a standard, hipocritely proposed by this machist and repressive society we live in.”

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– ZZ, billing assistant, submissive foot fetishist, 34, married: “My relationship with my wife is the best possible, in all senses. She knows about my attraction for feet, so much that she began taking more care of them and sometimes, when we make love, she spanks me with her slippers and I like it a lot. Since there is no physical or emotional damage to anyone and both agree on it, any practice is worth it, between a couple. The way society sees or judges my acts is not at all relevant to me.”

– JP, lawyer, sadist, 38, married: “I feel privileged for having certain sexual interests that are different from most people’s and for always being able to make them come true. BDSM is very complex, for there are different levels of SM and I’m in an intermediate one… some practices are indigestive for me, like coprophagy, public humiliation, cuts or burning, but as the word goes, “if done with their consent, the problem is theirs”…”

We may suggest that the people that took part in the researched sample, far from representing the totality of individuals with unconventional sexual practices in Brazilian society, feel in tune with their diverse sexual preferences, which are experienced as pleasant, and also feeling privileged for having a “differenced” sexuality from those who see in sex and in conventional roles the only form of expression for love, intimacy and fulfilling their sexual fantasies.

We cannot affirm, by the collected and reported data, that BDSM and Fetish practitioners who took part in this study may be called “paraphilic”. We would rather describe them as aware and well informed practitioners, and conscious of what we consider as variants in the complex adult human sexuality expression.

The use of the Internet is clearly important in the formation of a consensual BDSM subculture in Brazil, not only for communication and obtaining information among similar practitioners, but also as a mechanism of social inclusion, gathering thousands of people who share the same unconventional fantasies and practices. This study was made possible exactly because of the easy access, anonymity and the facility that the Internet provides to its users. Cooper et al (2000, p 6) states that the Internet offers the opportunity for the formation of virtual communities, in which the isolated and discriminated, like, for example, gays and lesbians, may communicate about sexual topics that interest this community.

When they realize the number of “equal” people, the sensation of isolation and of being “different” decreases or disappears and a new sense of “belonging” and identity appears for those who, before the advent of Internet, felt “abnormal” and “out of standard” for not having someone to share their longings and fantasies due to the prejudice and stigma regarding everything that deviates from the “norm” or “standard”.

We may suggest that the Internet may serve as a virtual “life-boat” for, when giving the opportunity to BDSM and Fetish practitioners and other sexual minorities to “come out of the closet”, it provides them an environment with no repression, prejudice, and where everything is possible in the fantasy world, and also giving the opportunity for those fantasies to come out of “virtuality” and be made true in the “real” world. According to Bader (2002, p 259), the question why some people act out their fantasies, while others do not, has no easy answer. In his theoretical perspective, it is easier to understand why someone develops some sexual fantasy or practice, but one can rarely affirm why this person acted it out or simply kept it in the fantasy level.

The world has gone through technological changes that are almost impossible to keep up with in the field of human life conception: the “test-tube” baby and artificial insemination are now current practices, once impossible to be imagined and made true, as is now the possibility of human cloning in laboratories. Novelty is frightening, provokes fears and feelings of unprotection.

But it is undeniable that changes in mentality are on their way, in this new millenium. Judeo-christian tradition, that has shaped the basis of Brazilian society for centuries, shows to be anachronic before the mentioned facts and what is yet to come.

The propagated “naturally heterosexual” animal life, that served as justification for the inprisonment of sexual desire and pleasure by religious institutions, begins to fall down with the latest scientific researches about the animals’s sexual life, which demonstrate that the “practices against nature” are also part of animal sexuality (www.subversions.com/french/pages/science/animals.html).

Where are we going to, since psycho-social, religious and cultural concepts and norms, that once defined the notion of “normality”, no longer apply to the pluralist society that we see? Our traditional sexual ethic, followed for a hundred years, no longer fits socio-cultural changes and the new challenges of the 21st Century. We live in a plural society, in which the most diverse expression of adult human sexuality are becoming visible and want to be accepted, recognized and legitimated. Sexual expressions that demonstrate maturity, respect and awareness among those who practice them. It is worth pointing out that feeling comfortable and in ego-syntonia with their sexual practices may have been the reason that took these individuals to take part in this study. The line that separates consensual BDSM practices and the so-called “perverted” practices is very thin. But is important that one knows how to distinguish one another.

And, based on that distinction, the present study has demonstrated that, in spite of its limited range, it is a human right to be “different” from majority and, consequently, to have that “difference” respected and accepted by all others.

REFERENCE

Animals prefer Homossexuality to Evolution. Retrieved January 17, 2003, from www.subversions.com/french/pages/science/animals.html

Bader, M. J. (1997). Arousal. The Secret Logic of Sexual Fantasies. Thomas Dunne Books, pp 259-260.

Brame G, Brame W & Jacobs (1993). Different Loving. The World of Sexual Dominance & Submission. Villard Books, NY, pp 49, 358.

Ceccarelli, P.R (2000). Sexualidade e Preconceito. Article published in the Revista Latinoamericana de Psicopatologia Fundamental, SP, III, 3, 18-37. Retrieved October 10, 2002, from www.geocities.com/HotSprings/Villa/Villa/3170/PauloCeccarelli.htm

Classificação Estatística Internacional Das Doenças e Problemas da Saúde (ICD-10). Retrieved May 7, 2002, from www.desejosecreto.com.br/revisef65.html [Dead link]

Cooper A et al. (2000). Cybersex. The Dark Side of the Force. Taylor& Francis, p 6.

Fog, A (1992). Paraphilias and Therapy. Nordisk Sexology, vol10, pp 236-242. Retrieved October 1, 2002, from www.ipce.info/ipceweb/Library/98-053r_fog_eng.htm

Manual Diagnóstico e Estatístico de Transtornos Mentais – 4a Edição DSM-IVtm (1995). EditoraArtes Médicas, Porto Alegre, 1995, p 495.

Martins M C, Grassi M V F C (2001) American Women and Internet Infidelity. Abstracts Book. 15th World Congress of Sexology, June 24-28, Paris, p 149.

MCDougall, Joyce (1997). As Múltiplas Faces De Eros. Martins Fontes, SP, 2001, pp 186, 188, 192.

Moser C, Madeson JJ (1996). Bound to be Free. The Continuum Publishing Company, NY, 2000, pp 24, 25, 31, 63.

Paschoal H, (2002). Sem Mistério. Uma Abordagem (Na) Prática de Bondage, Dominação, Sadismo e Masoquismo. Editora Cia do Desejo, Campinas, SP, pp 14, 16, 22, 27, 68.

Scott, G G (1997). Erotic Power. An Exploration of Dominance and Submission. Carol Publishing Group, p3.

The National Coalition for Sexual Freedom. Retrieved July 24, 2002, from www.ncsfreedom.org/what.htm

www.associacaobdsm.com.br. Retrieved May 7, 2002 [Dead link].

www.msn.com.br. Retrieved April 02, 2002.

www.revisef65.org. Retrieved April 02, 2002.

www.subversions.com/french/pages/science/animals.html. Retrieved January 10, 2003.

www.yahoo.com.br. Retrieved April 02, 2002

 


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

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

Remove SM/fetish diagnoses (spring 2002)

Examples of statements, quotes and evidence of support

Will be forwarded to the WHO’s Department of Mental Health and Substance Abuse

The ICD diagnoses of “Sadism” and “Masochism” are certainly messy because abuse and violence is mixed into the same category as consensual sexual games.” “Any kind of sexuality may be perverted – even heterosexuality. I think it may be useful to reserve the words “perversion” and “paraphilia” for abusive, disrespectful and other harmful sexual activities.
Psychologist and sexologist Odd Reiersøl.

SM practitioners have been victimized by society as a whole and by many groups that should know better. There is no credible evidence that SM practitioners have any more problems or issues than other sexu al orientations. There is no data to suggest that SM leads to violence. All research so far, indicates that SM practitioners are indistinguishable from individuals with other sexual orientations, except by their sexual behaviour.
Charles Moser, Ph.D., M.D.

To stigmatize, diagnose and marginalize consenting SM and leatherpeople, is not going to help the victims of domestic violence. On the contrary, false reports, blackmailing and diagnosing healthy and innocent people weakens the credibility of true sexual abuse victims.
The lesbian and gay SM support group Smia-Oslo.

Sexual [SM] impulses form a strong part of each person’s day to day life, so that their suppression can effect the development or balance of the individual’s emotional life, happiness and personality.
Paras 10.46 and 10.49 in the official appointed Law Commission’s document No 139 1995 issued by the UK Home Office.

Unlike the psychiatrists and psychologists who deal primarily with psychologically troubled individuals who are also interested in D&S [Dominance and Submission], I did not find them to be psychologically troubled or socially inept; rather … their backgrounds, activities and attitudes are quite unlike the social stereotype that depicts sadomasochism as a form of violence, mischief, or mayhem perpetrated by the psychologically unstable who seek to hurt others or to be hurt themselves. … Thus, quite unlike its public image, the community is a warm, close and supportive one.
Sociologist Gini Scott in her 1983 book “Erotic Power” about the dynamics of the heterosexual SM subculture.