Medicalizing Difference: A Study in Oppressive Language

I was perusing the asexual blogosphere the other day and ran across this fairly disturbing post that looked at an abnormal psych paper. This paper was proposing a potential new diagnosis to be added to the DSM, which they term “Nonsexual Personality Disorder”. While this is the first I’ve heard of someone literally terming asexuality as a disease, it is not uncommon for people to medicalize it or treat it as something which needs to be fixed.

I’ve spent a fair amount of time with DSM definitions and looked at a lot of problems with the ways we currently define mental illness, but even one glance at what this person proposes as the definition of Nonsexual Personality Disorder tells me that this is a horrible definition for many reasons. At its root, it says that this is different from normal and thus it’s bad without actually taking into consideration whether or not the difference is harmful to anyone. This is the same thing that happens to people who are gay, people who are extremely sexual or kinky, or all sorts of things that constitute “different”, generally from the privileged and well off majority.

Looking closely at the definition, we can pull apart what’s wrong with it and see how medical language is often used to oppress difference. This particular case is a doozy as it manages to pack in all kinds of oppressive tendencies that happen to many different people, so this should be fun.

Let’s start at the beginning shall we?

“A.  A marked inability to experience sexual attraction, beginning in early adulthood and indicated by 5 or more:”

As far as I’m aware there is no other diagnosis in the DSM that hinges exclusively on the lack of one experience. Oftentimes an inability to feel certain things are part of a diagnosis, but rarely are they the whole diagnosis because the whole point of the diagnoses in the DSM is to have a way to treat something that is causing harm or lack of functioning in someone’s life. There is no need for sexuality to be able to live a happy and fulfilled life and this whole diagnosis rests on the idea that if you do not have sexuality in your life then there is something empty or unhappy about your life.

Moving on:

“Inability to interpret sexual signals”

Now there are all kinds of symptoms listed in the DSM that people who are not mentally ill have but that only become signs of mental illness when they move into a realm where they seriously inhibit someone’s functioning or lead to high distress. Now I can imagine how you might get into some awkward situations if you can’t interpret sexual signals, but overall it doesn’t seem like the sort of thing that should be medicalized: it’s pretty damn normal and unless the other party involved also has some difficulties with reading emotions it should just mean that you don’t get into sexual situations. Oh no. How horrible.

Another way this sort of symptom was used in the past was in medicalizing lesbians. If you can’t interpret or don’t respond to a romantic overture, there’s something wrong with you. If you can’t follow the scripts that have been laid down, there’s something wrong with you, something that needs to be treated. In reality, it may simply be that you follow your own script or no script at all and that’s totally ok.

“Uncomfortable in intimate situations with a partner”

So I have a serious problem with this particular criterion because this whole disorder is circulated around an inability to feel sexual attraction. That implies that the intimate situation here is sexual. That’s a whole lot of assuming that the only intimate situations you’d ever be in would be sexual. There are all sorts of intimacies and personally I think it’s a bit gross to eliminate them all because SEX. There are also many, many people who are uncomfortable in sexual situations with partners for a variety of reasons and this criteria doesn’t touch on ANY of them (including abuse, PTSD, different priorities, etc). It also doesn’t specify frequency of discomfort, which seems important as probably everyone has felt uncomfortable in intimate situations at one point or another.

Generally discomfort at a situation is only diagnosable when you need to be able to function in that situation in order to have a complete and fulfilled life. I think there are many people out there who could attest that sex is not necessary for a complete and fulfilled life with intimate relationships, which makes this criterion really bizarre. There’s really nothing wrong about having discomfort or preferences against some stuff, and saying that we all need to be comfortable in the same settings is really a set up to oppress some people. Yes, being uncomfortable in all social settings or all settings outside of the house might be something that really interferes with your life, but sexual situations are specific, private, intimate, and unnecessary for day to day functioning.

If you’re really not interested in something and another person tries to get you to do it, it is 100% reasonable to feel uncomfortable. Generally we only want to label something as mental illness if the emotions or reactions are far outside of reasonable or logical.

“Avoidance of situations in which sexual activity may occur”

Um…so if you’re a priest you have symptoms of mental illness? If you choose to be celibate? Lots of people can make it through their lives without sexual activity. In other news, not feeling sexual attraction does not imply that you have to avoid sex. Unrelated! Crazy! Throwing these symptoms together is just illustrating a complete misunderstanding of what it’s like to be asexual.

“Lack of attraction to the opposite or same sex”

This is extremely sloppily written. What kind of attraction? What about non-binary people? Do friend urges count? If they don’t then we’re really looking at something far more akin to antisocial personality disorder. I think it’s implied that those are not the kinds of attraction that the author is thinking of but rather sexual attraction. What is wrong with not feeling sexual attraction if there’s nothing about it that hurts you or anyone else? It’s not like a lack of empathy that leads you to undertake cruel behaviors, it simply leads you to seek out different relationships for yourself. I’m really failing to see the problem.

At its heart this criterion says there’s one way to be human and that’s a sexual way, not because asexual people say they’re unhappy but because the author can’t imagine a different way. Why is this any less discriminatory than making it an illness to have a lack of attraction to the opposite sex?

“Complete lack of sexual thoughts”

My biggest problem with this is that I don’t think it exists unless you’ve got a hormonal imbalance, which is not related to mental illness but simple physical health. There are absolutely people that don’t feel sexual thoughts towards anyone or who rarely have sexual thoughts, but our bodies are filled with hormones that give us certain reactions and that doesn’t stop happening just because of your orientation. As an analogy, if a gay man is given a blowjob by a woman, oftentimes his body will react even if he doesn’t feel an attraction or particularly want the blowjob. It is possible to orgasm during rape. Our bodies react to things.

The other problem is that things like age can also play a role here. Hormones change with age, and some people’s testosterone and other happy sexy hormones just go down as they age. And then they stop thinking sexual things. It’s actually super normal and healthy. So why the compulsory sexuality?

“Touch aversion”

Ok so this is one of the criteria that I think has a little bit of merit in that there is a fair amount of research that shows that human contact is really good for your mental health. People who get hugs or hold hands or what have you tend to be happier. But there is also a lot of evidence that people simply exist on a spectrum of sensory sensitivity and for those who are extremely sensitive touch can be overwhelming. That’s a simple fact about the way their bodies process touch. Perhaps it has something to do with a medical condition (physical), but probably it’s just like different pain thresholds. We have them and for people with high pain thresholds it’s kind of a nuisance but you adapt.

I am one of those people who is fairly touch averse. I am not a hugging type person. I am not a kissing type person. I generally like my space. I cannot cuddle through the night (except with a cat). But that doesn’t mean that there aren’t times that I feel incredibly comforted by touch with someone I trust and care about. It doesn’t mean that I’m broken, just that I need touch in a different way. It really hasn’t been a big deal in a lot of my relationships except that I yell “STOP TICKLING ME!” fairly often when the other person is not intending to tickle me at all. People get their boundaries, move on.

“Inability to experience romantic relationships”

This is unrelated to sexual attraction. Sex and romance are not the same. Romantic relationships are possible without sex. Not feeling romance is also not a super big deal. Someone needs to read asexuality 101. I really have no more ways to say “it is possible to have a fulfilled and happy way full of great relationships without sex and romance”. These symptoms are basically saying “I prioritize romance so much that the only way I could imagine not having it is if I was crazy”.

“Social isolation”

Where did this come from?? Especially because later in the definition it specifies that you would be capable of holding down close personal relationships of a nonsexual or romantic nature, so it contradicts itself. Not dating is not the same as social isolation. Saying that it is is basically telling everyone there’s one way to have a family or be around other people and if you don’t do it that way you’re sick.

“Inability to become sexually aroused”

This is seriously not on par with nor related to a lack of sexual attraction. The symptoms that they give as evidence of “lack of sexual attraction” for the most part have nothing to do with sexual attraction. The ability to become aroused is 100% biological: does your body respond to certain stimuli. Attraction has to do with feelings towards someone. If you can’t become sexually aroused at all and you have a problem with it, it’s probably a question for your medical doctor not your psychologist. But of course none of these symptoms can be the result of something medical as per criterion b.

“It would manifest as something similar to schizoid PD, in which the individual is rather socially detached. However, unlike schizoid PD, this person would take enjoyment in other types of close relationships, such as with family or platonic friends. Additionally, they would not exhibit flattened affect, excepting in sexual situations. In this dimension, this individual does not possess the skills to understand or interpret social cues. A person may develop this due to either a predisposition to a schizotypal-like PD, lack or disregulation of hormones, or a lack of physical contact in childhood.”

So basically nothing would be wrong with this person except that they don’t want to have sex. Oh no! How horrible! Their life must be empty! The basic take home message is that if someone is not feeling a desire for sex then they must be unhappy or wrong. This is a pretty common feeling among a lot of people: if you’re not having or wanting sex, there must be something wrong with you and you should probably fix it. But simply having different desires, priorities, ways of relating, or ways of expressing intimacy doesn’t mean anything about your ability to live a good life. Throughout history psychology and medicine have turned difference into illness so that they have a legitimate way of trying to eradicate it. You’re a woman who likes sex a lot? Medicate. You’re gay? Stamp it out, it’s a disease. You’re a kinkster? Better see your doc.

Many of the symptoms presented above boil down to “you don’t feel the way that I’m used to people feeling”, or tie together something painful but unrelated with the different way of feeling. Many of them point at things that are often a sign of illness (lack of sex drive) and say that they are ALWAYS a sign of illness. Together, these allow a doctor to say that difference is actually a problem because it causes unhappiness. In reality the unhappiness is more likely caused by stigma and oppression.

So if you’re thinking about introducing a new medical definition let’s think about whether the symptoms are actually causing pain in someone’s life rather than just are something that doesn’t make sense to you, shall we?

 

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