Constructing perversions: the dsm and the classification of sexual paraphilias and disorders.

Author:Stewart, Robert Scott
Position:Diagnostic and Statistical Manual of Mental Disorders - Essay

Notions of sexual perversions have a long history in philosophy, dating back at least to those two pillars of Western thought: Plato and Aristotle. The position advanced by Aristotle, who understood all phenomena within a framework of a teleological universe, has been particularly influential. The telos of sex has traditionally been taken to be reproduction, and hence all uses of the sexual organs outside this purpose were thought to be unnatural and condemned as perverse. When the Catholic Church adopted the basic conceptual framework of Aristotelianism, via St. Thomas Aquinas in the thirteenth century, it also adopted this view of sex and turned perversions into sins. This view is, of course, still with us today. But in the past century or so, there have been attempts to alter fundamentally our conception of sexual desire and of sexual perversion. In this paper, I shall explore several current philosophical and psychological conceptions of perverse sex, broadly construed to include sexual disorders as well as paraphilias. As we shall see, these conceptions of perversity overlap in significant ways. Both disciplines have presented a normative and 'perfectionist' view of sex that defines normophilic sex as reciprocal, affectionate and interpersonal, and have derivatively defined sexual perversions, paraphilias, and dysfunctions as failures to attain this end. In this, while it's true that contemporary versions of these concepts has avoided talk of sin, they continue to retain a teleological framework in which 'normal' sex has to attain its 'proper end'--in this case, reciprocal, affectionate, and interpersonal sex. Though there is nothing wrong with such sexual relationships, I suggest that this conception of sexual normality and perversion is deeply problematic when failures to match the ideal are viewed as forms of mental illness standing in need of medical correction.

In 1969, the American philosopher, Thomas Nagel, published "Sexual Perversion," which was part of a trend that attempted to understand perversion outside the traditional context of unnatural and sinful sex. Borrowing heavily from Sartre, Nagel maintained that paradigmatic cases of sexual desire begin as self conscious desires for another that can only be completed in mutual desire. That is to say, sexual desire must not only involve awareness that another feels sexual desire towards you, but also that that awareness increases your sexual desire, and vice-versa: it is, then, a "multi-level interpersonal awareness" of escalating desire. (Nagel, 1969) On this account, sexual perversion is any incomplete version of this complex of mutual desire thus making all narcissistic practices sexual perversions which could include many of the sexual paraphilias listed in the Diagnostic and Statistical Manual of Mental Disorders: e.g., pedophilia, sadism, masochism, exhibitionism, fetishism, and partialism (the exclusive focus on part of the body) (APA, DSM IV TR, 2000, 566-576). It is important to note here that while these paraphilias can be narcissistic in Nagel's sense, they need not be, with the probable exception of pedophilia. For example, while an exhibitionist might not care whether those he flashes appreciate his behavior, some exhibitionists may only become aroused when 'performing' before a willing and sexually aroused audience. That is, for this later group of exhibitionists, there could be a multi-level interpersonal awareness of escalating desire.

One of the reasons we find such commonality between what Nagel offers as perversions and the DSM offers as paraphilias is that the American Psychiatric Association (APA), which publishes the DSM, sees normophilic sex in much the same way Nagel does. This becomes clear when considering how the APA describes a deviation from the norm. "The Paraphilias," they claim, "are characterized by arousal in response to sexual objects that are not part of normative arousal-activity patterns and that in varying degrees may interfere with the capacity for reciprocal, affectionate sexual activity (APA, DSM III-R, 1987, 279: emphasis added). In defending the APA's current description of sexual desire, Robert Spitzer says that just as the function of the heart is to pump blood and of the eyes to see, "sexual arousal brings people together to have interpersonal sex. Sexual arousal has the function of facilitating pair bonding which is facilitated by reciprocal affectionate relationships" (Spitzer, 2006, 114. Emphasis added). Clearly, then, Nagel, Spitzer, and the APA all view normophilic sexual desire as necessarily involving a reciprocal, interpersonal awareness of some sort. Moreover, as Spitzer adds: "There is a normal development of sexual arousal and sometimes it can go wrong" (Spitzer, 2006, 114).

Note that the claims being made here about perversion and normophilic sexual behavior are prescriptive in some way. There is no attempt to present them as a description of the way in which people actually behave sexually. Nor is there any empirical evidence to suggest even that the majority of people behave in such a manner sexually. Indeed, Nagel at least explicitly admits that his view of 'non-perverse' sex is "evaluative in some sense" even though the type of evaluation he is doing is complex. (Nagel, 1969, 16). As he says, the evaluation isn't a moral one, nor does the evaluation even distinguish between 'good' and 'bad' sex. "It is not clear that unperverted sex is necessarily preferable to the perversions. It may be that sex which receives the highest marks for perfection as sex is less enjoyable than certain perversions; and if enjoyment is considered very important, that might outweigh considerations of sexual perfection in determining rational preference" (Nagel, 1969, 16,17). So what sort of evaluation is Nagel making regarding non-perverse sex? In answering this question, special...

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