“Understanding peoples’ attitudes about whether states of being should be considered diseases can inform social discourse regarding a number of contentious social and health public policy issues,” says Kari Tikkinen, MD, PhD.
“The word disease seems to be as difficult to define as beauty, truth or love, although the concept of disease lies at the heart of medicine,” Tikkinen says. But why is it that the medical community has no hesitation in defining dozens of new diseases every year, most of which have no scientific justification?
Most of these nonsensical medical terminologies and inventions seem to be centered around children being children and a society determined to turn our youngest generations into robots. Intermittent Explosive Disorder, Oppositional Defiant Disorder or what about Mathematics Disorder? Yes, these are all real and officially recognized diagnoses by doctors.
The newest Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-5, is due out in May. The book sets the standard criteria for psychiatric diagnoses (not to mention health insurance reimbursement), making its pronouncements crucial to mental health treatment.
Proposed changes discussed online by the American Psychiatric Association researchers who worked on the new edition suggest that foot fetishists and bondage aficionados who hoped to get out of the book altogether won't see that wish come true.
Instead, unusual sexual fixations, or "paraphilias," will likely get their own category as odd.
Psychiatrists argue that leaving benign paraphilias in the DSM goes too far. Sexual fixations that cause harm and distress can be dealt with under other diagnoses, they say, ones that don't stigmatize people who enjoy non-mainstream but harmless sexual activities.
"I've heard people at meetings talk about 'those paraphiliacs,' 'those people,'" said Alan Shindel, an urologist and specialist in sexual problems at the University of California, Davis Health System. "I think that's always a dangerous road to go down when you're talking about othering people in that way."
Some psychiatrists and paraphilics even draw parallels between their position and that of gays and lesbians, who were considered mentally ill until homosexuality was removed from the DSM in 1974. [The History of Sex in the DSM]
The proposals and discussions posted online by the American Psychiatric Association suggest the new DSM will take that DSM-IV-TR qualification further. Turned on by obscene phone calls or spanking? You've got a paraphilia.
The DSM-5 may also, for the first time, clearly define "paraphilia" (previous incarnations have simply listed odd sexual targets). They proposed a definition describing paraphilia as "any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting human partners between the ages of physical maturity and physical decline."
In that study, researchers found the most common paraphilia was voyeurism (spying on an unknowing person), followed by fetishism (sexual fixation on a nonliving object).
Who is Really Crazy?
Sex has a controversial history in the DSM. Up until 1986 (12 years after homosexuality was removed from the DSM), psychiatrists still had the option of declaring gay people mentally ill if their sexuality caused them distress. Now, people who get aroused by bondage or unusual objects say they're in the same position as gay individuals in the 1980s: stigmatized, with any problems they do have unfairly blamed on their sexuality. The real problem behind the woes of the shoe fetishist or BDSM practitioner is that society judges them harshly, not that their sexual desires are somehow wrong, these advocates say.
A similar argument helped to oust homosexuality from the DSM. And many psychiatrists agree that the evidence for consensual paraphilias causing harm is lacking
Part of the challenge of classifying the paraphilias is that they range from undoubtedly harmful to benign. Sexual excitement over urine (urophilia) may seem icky to most people, but it's unlikely to hurt anyone. Similarly, many individuals consensually engage in sexual activities meant to inflict pain, such as spanking.
"The act of specifying particular, sexual behaviors as pathological leads to discrimination against all practitioners of those behaviors, even when their behavioral expressions are appropriate and benign," wrote psychiatrists Charles Moser and Peggy Kleinplatz in 2005 in the Journal of Psychology and Human Sexuality.
It's hard to separate value judgments from what's considered "sick." This also applies to paraphilias that typically don't harm others: As long as mental illness remains tangled in cultural ideas about morality and right and wrong, handling sensitive subjects such as sexual desire will remain complicated.
Health conscious communities have recently bonded together to prevent fictitious medical advances and the accompanying flood of new drugs for a range of ills that threaten to "medicalize" every human condition and behavior, according to some experts.
In addition, they say the advent of genetic screening could eventually mean that apparently healthy people will be labeled "sick" decades before an actual diagnosis.
"Illness is always a social construct," notes Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and author of the book "Worried Sick: A Prescription for Health in an Overtreated America."
"People have to agree -- both people, in general, and those in the medical community -- that a life experience shouldn't be labeled an illness," Hadler says. "For example, the Victorians medicalized orgasm, and we medicalize the lack of it."
So who is really crazy? Those who they attempt to diagnose or the psychiatrists themselves?
Marco Torres is a research specialist, writer and consumer advocate for healthy lifestyles. He holds degrees in Public Health and Environmental Science and is a professional speaker on topics such as disease prevention, environmental toxins and health policy.