Blanchard and the DSM-V, redefining paraphilia

As I pointed out in my previous post Ray Blanchard, who coined the term autogynephilia, seems to be obsessed with the classification of "paraphilias" or perversions.

It seems that any behavior out of the norm of middle-class WASP America must be included in the next edition of the US psychiatric Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

There is also a lot of controversy regarding the DSM's categorization of transgender issues. Many transsexual activists mean that gender identity issues are not to be categorized as mental illnesses, and that they therefore do not belong in this manual.

After having gone through the arguments underpinning the categorization in this manual, I must say I agree. This isn't science, this is the matter of stereotypes masquerading as science.

The DSM gender identity disorder work group

Blanchard is member of the DSM gender identity disorder work group, which is headed by Dr. Kenneth Zucker, one of Blanchard's colleagues in Toronto.

Zucker has never given up his effort to cure transgender children. Another member of the work group is recommending psychopharmacological treatment for crossdressing. Blanchard believes all M2F transsexuals are either gay men or fetishists. No wonder the transgender community is seriously pissed off.

Zucker and Co are willing to change the name of the condition, though. The term "gender identity disorder" is out, to be replaced by the less controversial term "gender dysphoria". But do not think that a new name will change the underlying understanding of these men; i.e. that the various forms of transsexual pheonomena are to be considered mental illnesses.

Gay people are now OK, transsexuals are not

Homosexuality has already been removed from the DSM. Homosexuals may still be considered to be in need of psychiatric help, but that is no longer because homosexuality is considered a mental illness. Instead homosexuals may be in distress because of matters totally unrelated to their sexual orientation, or because it continues to be hard to come out as gay in some circles.

If you tell a doctor that you are a transsexual, crossdress or have erotic fantasies of becoming a woman, then the manual will tell him or her that it is the condition itself that is the cause of your suffering.

Dr. Madeline H. Wyndzen puts it this way:

"If a man sought therapy due to unhappiness over his attraction to other men, a therapist would likely diagnose him with depression. If a transsexual sought therapy due to unhappiness over his or her biological sex, a therapist would almost certainly diagnose him or her with Gender Identity Disorder (GID). Whereas gay men are diagnosed for how they suffer, transsexuals are diagnosed for who they are. I find the mental illness labels imposed on transgenderism just as disquieting as the label that used to be imposed on homosexuality. "

As I have noted before there are several reasons gay people are now considered to be OK. The main reason is that the sociocultural context has changed. Homosexuality has become accepted in academic circles, and these doctors belong to this social group. Many of them have close friends that are homosexuals, and the ones that continue to believe that homosexuality is an illness, risk being ostracized.

Furthermore, many of these doctors are evolutionary biologists, i.e. they believe that a "sound" personality is one that can be explained as sensible from an evolutionary perspective. Although homosexuality continues to be a puzzle for these people -- as homosexuals are less likely to breed offspring -- there are just too many gay people around to be considered an anomaly.

It should therefore come as no surprise that Blanchard has spent a lot of time trying to find an explanation for homosexuality. He has suggested the so-called fraternal birth order effect or "older brother effect". This theory is that the more older brothers a man has, the greater the probability is that he will have a homosexual sexual orientation. According to this hypothesis, anti-H-Y antibodies produced by the mother pass through the placental barrier to the fetus and affect aspects of sexual differentiation in the fetal brain.

Whether this means that Blanchard considers homosexuality a biological error or not, is unclear. It seems to me that he does. If that is the case what he calls feminine homosexual men (i.e. M2F transwomen) continue to be outside the norm of normalcy. What is totally clear is that he believes crossdressers and autogynephiliacs are mentally ill.

Paraphilia redefined

Blanchard presented a paper at the Annual Meeting of the Society for Sex Therapy and Research (SSTAR) on April 3,2009 in Arlington, Virginia. In this presentation he described the working group's thoughts on the new DSM-V. This should be of great interest to autogynephiliacs because it so clearly reveals the way Blanchard and his compatriots are thinking about paraphilias (perversions).

Traditionally paraphilia has been defined, according to Blanchard, as recurrent intense sexually arousing fantasies, sexual urges, or behaviors generally involving

1. non-human objects [female clothing in the case of the crossdresser]

2. the suffering or humiliation of one self or one's partner [e.g. BDSM]

3. children or other nonconsenting persons [e.g. pedophilia and rape]

4. an atypical focus involving human subjects (self or others) that occur over a period of at least 6 months [this must be some kind of miscellaneous "anything else I don't like" caregory]

This is the current DSM definition. Blanchard now proposes a new one:

"The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically, consenting adult human partners. "

Woooow!!! You have to admire the persistence of this man. If we are to interpret this paragraph in a strict manner, it actually means that the only normal sexual acts are foreplay and gential sexual intercourse between a man and a woman.

Phenotypically means "the manifest characteristics of an organism collectively, including anatomical and psychological traits, that result from both its heredity and its environment." Given Blanchard's background as a traditional evolutionary biologist this should mean vaginal penetration by a penis.

What's in? What's out?

However, Blanchard knows that such an interpretation is impossible in today's America. In his presentation he therefore gives some examples on what kind of behavior that is paraphilic and what is not. The criteria for what is considered parahilic seems completely random:

Not paraphilic:

• cunnilungus
• fellatio
• anal penetration with the finger, penis or dildo
• anilingus
• intracrural intercourse [Masturbating the penis between the (lubrictaed) upper thighs of a partner]
• cross-masturbation
• kissing
• fondling

Note that in -- let's say -- the 195o's many of these acts would be considered perversions.

Paraphilic:

• enemas
• feces or urine
• generalized sexual interest in amputees, paralyzed persons, physical deformities
• bondage
• whipping
• cutting
• hypoxia
• sneezing or smoking persons [!!!]
• obscene telephone calls

Note that some of these acts, like bondage, would be considered normal by many. It seems to me that the lists are based purely on Blanchard's personal idea of what is normal and what is not. This has nothing to do with science.

Transvestic disorder and autogynephilia

In the old (an apparently the new) manual a transvestic fetich/transvestic disorder is present if

1. over a period of at least six months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing. [This is called a paraphilia]
2. The fantasies, sexual urges, or behaviors causes significant distress or impairment in social, occupational or other important areas of functioning. [This is called a paraphilic disorder].

Blanchard proposes two new so-called specifier options:

• With Fetishism (Sexually Aroused by Fabrics, Materials or Garments)
• With Autogynephilia (Sexually Aroused by Thought or Image of Self as a Female)

Blanchard says:

"I made this recommendation according to the results of unpublished research, which I conducted specifically for the Paraphilias Subworkgroup. The results showed that transvestic patients who acknowledged autogynephilia had higher odds of reporting past or current desires for sex reassignment than transvestic patients who denied autogynephilia. The opposite result was found for fetishism, that is, transvestites who reported fetishism were less likely to report a desire for sex reassignment. It is noteworthy that these predictors were independent to a large extent."

If you find this explanation confusing, it is probably because he seems to reverse the order of categorization. Autogynephilia is normally a term that encompasses both crossdressers and what I call crossdreamers (men who dream about having a female body). Here "transvestism" seems to be a term that encompasses both fetishists (crossdressers?) and autogynephiliacs (crossdreamers?).

What he says is in essence that crossdreamers (men who fantasize about having a woman's body) are more likely to transition than crossdressers who do not (admit to have) have such erotic fantasies. In short, I am therefore more paraphilic than your average transvestite and deserves a separate "specifier option". This makes me so proud!

Freaks again

Blanchard now wants to include autogynephilia in the DSM and make everyone understand that we are either mild fetishists or suffering from a paraphilic disorder. This means that it will be impossible for transsexuals who have had erotic fantasies about having a woman's body or who have crossdressed to be considered a genuine woman. She will forever be labelled as a paraphilic freak.

And the thing is that this categorization is not based on Blanchard's research. Blanchard's data say nothing about what is a fetish or what is not, what is a paraphilia or what is not. His data just tell us what a specific selection of transsexuals have responded to a specific questionnaire. The design of that questionnaire and the interpretation of the date is solely based on the prejudices of him and his colleagues.

Gay men and women are left out

This disorder is only about heterosexual men. A homosexual man who crossdress is not considered a paraphiliac, probably because Blanchard expects homosexual men to be feminine and are therefore outside the realm of normal male behavior anyway.

Women are also allowed to crossdress. Why? Well, given today's fashions a woman can dress up as a male (boots, jeans and a t-shirt) and nobody will notice the difference. Besides, for some reason Blanchard seems to give women more freedom than men. Why, I wonder? I doubt there is a scientific reason for this.

Note also how the paraphilic disorder is defined by distress. It is understood that it is the transvestic condition that causes the disorder, not the reaction of the surrounding society. Blanchard does not understand that the very labeling of crossdressers as paraphiliacs could be the cause of such distress.

But this is a blog for autogynephiliacs, isn't it?

Some of my reader's may find it strange that I, as one of the few online bloggers who identify with the term autogynephilia, should be so upset with the inclusion of it in the DSM.

I do find the term useful, because I do believe there is a separate subcategory of transpeople that consists of men who :

• Are predominantly gynephile (attracted to women)
• Get sexually aroused by imagining themselves as women
• Often (but not always) crossdress
• Often have an ambiguous gender identity, that is they have -- to a varying degree -- a strong feminine side. Some of them identify as men, some as women.

The term helps us, because -- truth to be told -- important parts of the transgender community are reluctant to recognize us. We therefore have to develop a language that helps us understand ourselves.

But I have not concluded that this is a disorder, a fetish or a paraphilia. Nor do I believe that science has proved that is a paraphilia. It may be, but we do not know that, and because of that it does not belong in such a manual.

Besides, history shows us that what is considered a perversion in one culture or historic period, is considered a virtue in another. This means that we should be very careful when defining what is natural and what is not.

A petition against the work group gained more than 9000 signatures online.

DSM-V WorkGroup for Sexual & Gender Identity Disorders (All mixed up)

Why feminists should be concerned with the impending revision of the DSM (feministing.com)

Transvestic Disorder and Policy Dysfunction in the DSM-V (GID Reform Weblog)

Autogynephilia: The Infallible Derogatory Hypothesis, Part 1 (GID Reform Weblog)

See also: Ray Blanchard's Definition of Paraphilia (Perversion)
"I feel pretty!" (On the "Autogynephilic" Woman, Erotic Crossgender Fantasies and More)


UPDATE ON TERMINOLOGY

Since this blog post was written I have stopped using the terms "autogynephilia" and "autoandrophilia" to describe people. The reason for this is that the terms implicitly communicates an explanation for why some people get aroused by imagining themselves as the opposite sex . This explanation, that this is some kind of autoerotic paraphilia,  is both wrong and stigmatizing. Instead I use the neutral term "crossdreamers".

Click here for a discussion of the dark side of the autogynephilia theory.