DSMocking!

May 2013! Blue cover, maybe! No famous actress or model on the cover because that would be really weird! The major resource codifying the diagnosis of psychiatric disorders! Yes, folks, it's the proposed draft of the DSM-V! This being the Pervocracy, let's look at the sexy parts!



In my opinion, the entire Paraphilias section is coming at things wrong by listing out specific fetishes. I don't think it matters whether you're an exhibitionist or a masochist; what matters is the problems it causes. In my perfect world, all the specific paraphilias would be out of the DSM and replaced with:

Sexual Adjustment Disorder: A person has difficulty accepting their fetish, orientation, or form of sexual expression (often but not always exacerbated by the attitudes of their friends, family, and community). They experience significant distress or impairment not from the fact that they have the fetish, but from the fact that they haven't healthfully integrated the fetish into their identity.

Sexually Abusive Disorder: A person has a persistent desire to sexually coerce, exploit, or abuse others--the specific form of the coercion is not as significant as the fact that it is coercion.

I realize that the DSM is only intended for diagnosis and not treatment, but diagnosing someone as "your problem is that you have Fetishistic Disorder" suggests that the treatment is to get rid of the fetish, rather than to help them express the fetish in healthy ways.

The particular shame of the Paraphilias section is Transvestic Disorder.
A. Over a period of at least six months, recurrent and intense sexual arousal from cross‑dressing, as manifested by fantasies, urges, or behaviors.
B. The person has clinically significant distress or impairment in important areas of functioning.
The concept that there are "right" and "wrong" ways for people to dress according to gender is bad enough without codifying it into the medical literature.

It's also sexist, in that I wear "men's" clothing all the time, but I'm unlikely to be considered a transvestite because it's only weird when men do it. Which is sexism against men in limiting their clothing options; and sexism against women in saying that our clothes are so weird that you'd have to have some kind of funky fetish to want to wear them.

I realize that the language includes the "significant distress or impairment" loophole that almost everything in the DSM does, but this loophole isn't a "get out of bad idea free" card. For example, many people are significantly distressed or impaired by being gay, but we don't list homosexuality as a disorder with the "but don't worry, that's only if it's hurting you!" caveat, because the sexuality itself isn't a disorder. It's a matter of, as I described above, adjustment, and should be diagnosed as such.

I also wonder--and this isn't an accusation but a question--how much the "sufferers" of each condition have been included in the construction of the DSM-V. I get the impression that much of it is written from the perspective of "these are some patients that, I, a totally normal person who never does anything weird at all, have objectively observed," verus how much input was received from people willing to say "as someone with a thorough education in psychology who also happens to like wearing frilly panties, these are my experiences."



And then we have the minefield that is Gender Dysphoria. Unfortunately, this can't simply be tossed out with "being trans isn't a disorder!", because currently a diagnosis is often necessary for trans people to get drugs or surgery or alter legal documents listing their sex. And the wording has certainly improved from when it was "Gender Identity Disorder."--referring to "assigned gender" rather than "his or her sex," and being considerably more specific of what the manifestations of gender dysphoria might be.

Nonetheless, it still calls being transgendered a disorder. It still veers close to the "identifying the wrong part as the problem" issue present in the paraphilias section. And it also necessarily buys into gender roles and the concept of two fixed genders.

Being cis myself and not having a full view of either the legal or the psychological implications of a Gender Dysphoria diagnosis, I don't have specific alterations to propose, but I do want to point out that it's problematic.

Reading through this section, I couldn't help noticing that I would have handily qualified for a diagnosis of Gender Dysphoria in Children. Which is weird, because I'm cis; I'm somewhat masculine and rather uncomfortable with the entire idea of gender as a package deal, but ultimately I'm okay being called a lady and having lady parts. But I played "male" roles extensively as a child, to the point of asking to be called by various male names (including Batman, okay, but woe betide anyone trying to make me be dumb ol' Batgirl) and refusing to play with any toys or games I considered "girly." How much of this was true gender dysphoria, how much was internalizing the sexism of "boys are tougher and awesomer, so I want to be a boy!", how much was reaction to the fact that due to sexism a lot of boy games were awesomer, and how much was simple preference independent from gender? Shit, I still don't know.

I do know that "treating" me, either to make me into a proper girl or to transition me to a boy, would probably not have been a good course of action compared to simply allowing me to grow up as a masculine girl. I'm not saying this is the case for all non-gender-conforming kids, but it illustrates the difficulties in a diagnosis that hinges on accepting traditional gender roles.

The good news is that the people writing the DSM-V are accepting public comment, and they are still very actively in the process of revising the diagnoses. If you disagree with the way they're defining identities as disorders, you can do more than shake your fist at the sky; you can up and tell them. I'm going to.