from Ethical Issues
By Linda Ames Nicolosi
On Monday, May 19th, 2003 in San Francisco, at a symposium hosted by the American Psychiatric Association, several long-recognized categories of mental illness were discussed for possible removal from the upcoming edition of the psychiatric manual of mental disorders.
Among the mental illnesses being debated in the symposium at the APA's annual convention were all the paraphilias--which include pedophilia, exhibitionism, fetishism, transvestism, voyeurism, and sadomasochism.
Also being debated was gender-identity disorder, a condition in which a person feels persistent discomfort with his or her biological sex. Gay activists have long claimed that gender-identity disorder should not be assumed to be abnormal, when, they say, it is usually an expression of healthy prehomosexuality.
Dr Robert Spitzer responded to the symposium as a discussant, urging that the paraphilias and gender-identity disorder be retained in the psychiatric manual.
Disagreeing, Psychiatrist Charles Moser of San Francisco's Institute for the Advanced Study of Human Sexuality and co-author Peggy Kleinplatz of the University of Ottawa presented a paper entitled, "DSM-IV-TR and the Paraphilias: An Argument for Removal." They argued that people whose sexual interests are atypical, culturally forbidden, or religiously proscribed should not, for those reasons, be labeled mentally ill.
First, they say, different societies stigmatize different sexual behaviors. Furthermore, the existing research cannot distinguish people with the paraphilias, they say, from "normophilics" (the term the authors use for people with conventional sexual interests), so there is no reason to diagnose paraphilics as either a distinct group, or psychologically unhealthy.
Besides, Moser and Kleinplatz add, psychiatry has no baseline, theoretical model of what, in fact, constitutes normal and healthy sexuality to which it could compare people whose sexual interests draw them to children or sadism/masochism.
Earlier, in the December 2002 issue of a prestigious journal, the Archives of Sexual Behavior, Moser--along with several other prominent mental-health experts--argued in favor of de-pathologizing pedophilia. Some of the commentators writing in that issue said that there is little or no proof that sex with adults is harmful to minors. Another mental-health expert argued that society should not discriminate against adults who are attracted to children--noting that many beloved authors and public figures throughout history have been high-functioning individuals who could actually be classified as pedophiles.
"Any sexual interest," Moser concluded in his Archives commentary, "can be healthy and life-enhancing."
Moser and Kleinplatz note that the A.P.A. once categorized a condition as a mental illness based on its psychological, emotional or developmental origins, along with the unconscious motivations that were theorized to cause the condition.
But during the last three decades, psychiatry has moved away from reliance on theories of causation--theories which, typically, cannot be verified--and instead sought direct, empirically provable evidence; not of the pathological origins of a condition, but of its disabling effect in the present. Without such evidence for observable distress and disability, a condition is generally not considered to be a mental disorder.
People with "sexually unusual" interests, Moser and Kleinplatz note, may in fact be quite happy and well-adjusted. But the APA's labeling of their conditions as "pathological" fuels social discrimination against them, Moser and Kleinplatz warn, which can lead to distress and discrimination that is psychologically damaging.
Furthermore, they say, since the A.P.A. has no concept of what "healthy sexuality" or even a "healthy personality" actually entails, then how can psychiatry presume to define "unhealthy" sexuality? And since many people engaging in these unusual behaviors are not "distressed" or "disabled" by their interests, how can the A.P.A. justify continuing to pathologize them?
"The situation of the paraphilias at present," Moser and Kleinplatz conclude, "parallels that of homosexuality in the early 1970's."
Following the presentation of the papers at the symposium, Dr. Robert Spitzer responded with a defense based on a concept of natural law, as established by evolution.. Spitzer is the author of a study on change of sexual orientation that he presented at the 2001 American Psychiatric Association convention.
"Dr. Moser is incorrect," Spitzer said, "when he argues that there is no scientific basis for distinguishing the paraphilias from more common sexual behaviors. In all cultures, as children become adolescents, they develop an interest in sexual behavior. That is how we are designed - whether you believe this design is the work of God, or by evolution through natural selection. This design is clearly for the purpose of facilitating pair bonding and interpersonal sexual behavior.
"The paraphilias, when severe, impair interpersonal sexual behavior," Spitzer continued. "Sexual behavior that facilitates caring bonding between people is normal - and that which impairs it is abnormal, not merely an atypical variation. What is needed is more research on the treatment of the paraphilias, particularly pedophilia. To remove them from DSM-V would be the end of this much-needed research."
"What is needed is not more research," NARTH's Joseph Nicolosi countered in response to reports describing the symposium. "What psychology really needs for its advancement is not another study, but a more accurate worldview. That worldview must take into account our creator's design, which inevitably involves gender complementarity.
"And," Nicolosi added, "we must agree on those things that genuinely enhance human dignity. It's a measure of how low the psychiatric establishment has sunk, that it would even debate the idea that pedophilia, transvestism, and sado-masochism could ever be expressions of true human flourishing."
Psychoanalyst Johanna Tabin, Ph.D., of NARTH's Scientific Advisory Committee, also commented on the A.P.A. symposium. "If the arguments prevail that are given for ignoring these psychological problems, then suicide attempts must be considered normal when they are desired by the participants. And what about the sociopath, who--having no conscience--feels quite content with himself?"
"Uncommon 'common sense,'" Dr. Tabin added, "is sure to reassert itself--but in the meantime, the mental health professions are failing many suffering individuals by rigidly adopting political correctness as the guide as to when people need help.
"And the saddest thing about the current climate," she added, "is that people who ask for help because they are not at ease with homosexual impulses, right now are frequently forbidden to obtain it."
1. Moser, Charles and Peggy J. Kleinplatz, "DSM-IV-TR and the Paraphilias: An Argument for Removal," paper presented at the American Psychiatric Association annual conference, San Francisco, California, May 19, 2003.
2. Special Section: Pedophilia: Concepts and Controversy, Archives of Sexual Behavior, vol. 31, no. 6, December 2002, pp. 465-510.