Paraphilias: Psychiatric Diagnoses of Sexuality

Overview of psychiatric diagnoses related to sex and sexuality.
Emphasis on critical reflexivity surrounding the categorization of diverse sexualities as ‘abnormal’ or ‘pathological’.
Definition of critical reflexivity: Reflecting on our understandings and the potential impact within cultural contexts.

Historical perspectives on sexual behaviors and diagnoses.
Transition from viewing violent acts as resulting from 'beasts' (e.g., werewolves, vampires) to understanding them as psychological issues.
- Original views during the medieval period included:
- Acts interpreted as spiritual possession requiring religious intervention (e.g. exorcism).
- Sinful and feared activities like sodomy and masturbation.
Influence of Christian religious texts:
- Sex for pleasure deemed sinful; severe consequences included imprisonment and execution for ‘crimes against nature’.
Shift to criminal explanations for non-reproductive sexual acts, eventually moving towards psychological views.
Krafft-Ebing's “Psychopathia Sexualis” (1892):
- Helped define many paraphilias known today.

Reflection on contemporary views of sexuality.
Recognition of stigma and discrimination associated with psychiatric labels.
Medicalizing behaviors can lead to viewing diversity as ‘abnormal’.
- High risk of psychiatric patients facing lossof autonomy and forced treatments.

Coined to replace judgmental terms like ‘perversion’.
Definition: “Para” (abnormal) + “Philia” (love).
- This constructs non-normative sexual activities as ‘abnormal’.

Masturbation historically labeled a 'perversion' leading to fear and stigma (Hunt, 1998).
Change over time: recognized as normal, beneficial.
- Feminist sexual liberation in the 1960s focused on masturbation as a empowering activity.
Reflection on current strong views regarding sexual expression and future changes in perception.

Continuing debate on whether paraphilias represent crimes or mental health issues.
Some argue sexual diversity should not be criminalized or pathologized.
Moser’s argument against the concept of paraphilias.

Krafft-Ebing’s classification of homosexuality as a ‘perversion’.
Transition from criminality to medical diagnosis:
- Homosexuality included in DSM editions of 1952 and 1968 as a mental disorder.
Contrasting views by Hirschfeld, Kinsey, and Hooker:
- Stats indicated prevalent same-gender activity among the population.
Treatments attempted included aversive methods (shocks, nausea) to change sexual orientation, widely criticized for ethics and efficacy.

1973 APA decision to remove homosexuality from the DSM.
Continued attempts to pathologize homosexuality, such as the ‘ego-dystonic homosexuality’ diagnosis in 1980, also criticized.
Introduction of gender and sexual diversity affirmative therapy approaches.

John’s refusal to conform to gender norms led to psychiatric intervention at parents' insistance.
Therapist's response: Encouragement to present more masculine identity.

The conflation of gender and sexual identity in psychological diagnoses.
Krafft-Ebing's definitions included confounding cross-dressing with pathological terms.
Critique of autogynephilia, defining it as sexually aroused by the idea of oneself as a woman.
- Criticism for pathologizing consensual sexual diversity among cross-dressers and inconsistencies regarding male vs. female deviations.

Media portrayal linking trans individuals and serial killers amplifies stigma and stereotypes.
Overemphasis on violence in psychological literature detracts from the true experiences of the majority within gender diverse communities.
Elevating narratives around actual violent criminals distracts from societal violence against these communities.

Definitions rooted in Krafft-Ebing's work connecting violence with sexuality.
Differentiation of normal vs. abnormal violence based on context and function.
Sadism as a contested term in psychology, often conflated with harmful behavior rather than consensual practices within BDSM communities.

Proposal for diagnosing rapists as mentally ill raised concerns over legal implications.
- Attempts to distinguish different types of sexual violence were rejected, leading to variations in how consent was approached in sexual violence cases.

Paraphilias show the contradictory nature of psychiatric diagnoses over time.
Continued focus on sexual violence and unusual interests distracts from addressing the 'normal' population and the issues of consent and sexual diversity.

Moser, Kleinplatz (2005), Oosterhuis (2000), Robb (2003), Tosh (2015) - Critical analyses on the changing context of psychiatric diagnoses of sexuality.