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American
Psychiatric Association Symposium Debates Whether Pedophilia,
Gender-Identity Disorder, Sexual Sadism Should Remain
Mental Illnesses
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."
Psychiatry's Method for Defining "Mental Illness"
Has Changed
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?
"People
with Paraphilic Sexual Interests Suffer Like Homosexuals
Did Before the 1973 Decision"
"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."
"More
Research" Will Not Provide More Answers
"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."
References
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.
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