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BDSM Versus the DSM

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A history of the fight that got kink de-classified as mental illness

A history of the fight that got kink de-classified as mental illness

By Merissa Nathan Gerson

Asking your partner to tie you to the bedpost, telling them to slap you hard in the throes of lovemaking, dressing like a woman if you are a man, admitting a fetish for feet: Just a few years ago, any of these acts could be used against you in family court.

This was the case until 2010, when the American Psychiatric Association announced that it would be changing the diagnostic codes for BDSM, fetishism, and transvestic fetishism (a variant of cross-dressing) in the next edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 2013. The new definitions marked a distinction between behavior—for example, playing rough—and actual pathology. Consenting adults were no longer deemed mentally ill for choosing sexual behavior outside the mainstream.

The change was the result of a massive effort from the National Coalition for Sexual Freedom (NCSF), an advocacy group founded in 1997 “to advance the rights of and advocate for consenting adults in the BDSM-Leather-Fetish, Swing, and Polyamory Communities.” At the time, these types of sexual behavior, by virtue of their inclusion in the DSM, were considered markers of mental illness—and, as a result, were heavily stigmatized, often with legal repercussions. In family court, an interest in BDSM was used as justification to remove people’s children from their custody.

“We were seeing the DSM used as a weapon,” says Race Bannon, an NCSF Board Member and the creator of Kink-Aware Professionals, a roster of safe and non-judgmental healthcare professionals for the BDSM and kink community. (The list is now maintained by the NCSF.) “Fifty Shades [of Grey] had not come along,” says Bannon, an early activist in the campaign to change the DSM. “[Kink] was still this dark and secret thing people did.”

Since its first edition was published in 1952, the DSM has often posed a problem for anyone whose sexual preferences fell outside the mainstream. Homosexuality, for example, was considered a mental illness—a “sociopathic personality disturbance”—until the APA changed the language in 1973. More broadly, the DSM section on paraphilias (a blanket term for any kind of unusual sexual interest), then termed “sexual deviations,” attempted to codify all sexual preferences considered harmful to the self or others—a line that, as one can imagine, is tricky in the BDSM community.

The effort to de-classify kink as a psychiatric disorder began in 1980s Los Angeles with Bannon and his then-partner, Guy Baldwin, a therapist who worked mostly with the gay and alternative sexualities communities. Bannon, a self-described “community organizer, activist, writer, and advocate” moved to Los Angeles in 1980 and soon became close with Baldwin through their mutual involvement as open participants in and advocates for the kink community. “I’m fairly confident that I was the first licensed mental-health practitioner anywhere who was out about being a practicing sadomasochist,” Baldwin says.

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The pair was spurred to action after the 1987 edition of the DSM-III-R, which introduced the concept of paraphilias, changed the classifications for BDSM and kink from “sexual deviation” to actual disorders defined by two diagnostic criteria. To be considered a mental illness, the first qualification was: ‘‘Over a period of at least six months, recurrent, intense sexual urges and sexually arousing fantasies involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.’’ The second: ‘‘The person has acted on these urges, or is markedly distressed by them.’’

“1987 was a bad shift,” Wright recalls. “Anyone who was [voluntarily] humiliated, beaten, bound, or any other alternate sexual expression was considered mentally ill.”

With the new language, Baldwin says, he quickly realized that laws regarding alternative sexual behavior would continue to be problematic “as long as the psychiatric community defines these behaviors as pathological.”

“I knew there were therapists around the world diagnosing practicing consensual sadomasochists with mental illness,” he says.

At the time that the new DSM was published, Baldwin and Bannon were planning to attend the 1987 march on Washington, D.C., in support of gay rights; after the new criteria came out, they decided to host a panel discussion for mental-health professionals in the State Department auditorium, where they announced the launch of what would come to be known as “The DSM Revision Project.”

“We asked how many people in the room were mental-health professionals,” Baldwin says, and “two-thirds of the people in the room raised their hands. And we said, ‘The way this needs to happen is, licensed mental-health practitioners need to write the DSM committee that reviews the language of the DSM concerned with paraphilias.’”

Around 40 or 50 people left the session with the information needed to write the letters. “We did not know exactly what would result,” Bannon recalls. “We did not think we would see dramatic changes suddenly.”

They didn’t—but the changes they did see were positive. The next edition of the DSM, published in 1994, added that to be considered part of a mental illness, “fantasies, sexual urges, or behaviors” must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

“This was a definite improvement from the DSM-III-R,” says Wright, who later took over leadership of the DSM Revision Project from Bannon and Baldwin.

“These criteria gave [health professionals] wiggle room to say, ‘They have issues, but it is not about their kink. For the vast majority, it is just the way they have sex,’” Bannon explains. “Rather than saying, ‘Because you are into this method of sexuality, you are sick,’ [they could say], ‘Pathologically, if this impacts your life negatively, then you have a problem.’”

But the new language in the 1994 DSM also allowed for wiggle room of a different kind: The threshold of “significant distress” was often loosely interpreted, with the social stigma of kink, rather than kink itself, causing the negative impact on people’s lives. Workplace discrimination and violence were on the rise, according to a 2008 NCSF survey, and people were still being declared unfit parents as a result of their sexual preferences: Eighty of the 100 people who turned to the NCSF for legal assistance in custody battles from 1997-2010 lost their cases.

A few years after the 1994 DSM was published, Wright decided it was time to fight for another revision. When she founded the organization in 1997, the NCSF’s goal was a change to the APA’s diagnostic codes that separated the behavior (e.g., “he likes to restrict his breathing during sex”) from the diagnosis (e.g., “his desire to restrict his breath means that he must be mentally ill”). The next DSM, the group argued, should split the paraphilias from the paraphilic disorders, so that simply enjoying consensual BDSM would not be considered indicative of an illness.

Their efforts were largely ignored by the APA until early 2009, when Wright attended a panel discussion at New York City’s Philosophy Center on why people practice BDSM. Among the panelists was psychiatrist Richard Krueger, whose expertise included the diagnosis and treatment of paraphilias and sexual disorders.

During the meeting, Wright says, “I brought up the point that the DSM manual caused harm to BDSM people because it perpetuated the stigma that we were mentally ill. [Krueger] heard me and said that was not what they intended with the DSM.” Krueger, it turned out, was on the APA’s paraphilias committee, and following the meeting opened up an email dialogue between Wright and the other committee members, in which Wright provided documentation about the violence and discrimination kinky people experienced. “I credited that to the DSM,” she says. “Courts used it. Therapists used it. And it was being misinterpreted.”

Over the next year, “I sent him information, he gave it to the group, they asked questions, and I responded. It was very productive,” Wright recalls. “We [the NCSF] felt we were heard, we were listened to—and they took [our arguments] into account when they changed the wording” of the DSM in 2010.

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Another major factor in the NCSF’s favor was a paper, co-written by sexual-medicine physician Charles Moser and sexologist Peggy J. Kleinplatz and published in 2006 in the Journal of Psychology and Human Sexuality, titled “DSM IV-TR and the Paraphilias: An Argument for Removal.” According to Wright, the paper, which “summed up opinions of mental-health professionals who thought you shouldn’t include sexual activity in the DSM,” played a significant role in the paraphilia committee’s eventual shift in language.

In February 2010 the proposed change was made public—clarifying, Wright says, that “the mental illness [depends on] how it is expressed, not the behavior itself.” The new guidelines drew a clear difference, in other words, between people expressing a healthy range of human sexuality (for example, a couple that likes to experiment, consensually, with whips, chains, and dungeons) and sadists who wish others genuine harm (for example, tying and whipping someone in a basement without their consent).

The DSM-5 was released in May 2013, its contents marking a victory for the NCSF, Bannon, and Baldwin. The final language states: “A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.”

“Now we are seeing a sharp drop in people having their children removed from their custody,” Wright explains. Since the change, according to the NCSF, less than 10 percent of people who sought the organization’s help in custody cases have had their children removed, and the number of discrimination cases has dropped from more than 600 in 2002 to 500 in 2010 to around 200 over the last year.

“The APA basically came out and said, ‘These people are mentally healthy,’” Wright says. “‘It’s had a direct impact on society.”

Complete Article HERE!

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Don’t Be Afraid of Your Vagina

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By Nell Frizzel

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Lying across a turquoise rubber plinth, my legs in stirrups, a large blue sheet of paper draped across my pubes (for “modesty”), a doctor slowly pushes a clear plastic duck puppet up my vagina and, precisely at that moment, Total Eclipse of the Heart comes on over the radio and it’s hard not to love the genitourinary medicine, or GUM, clinic.

I mean that most sincerely: I love the GUM clinic. It is wonderful beyond orgasm that in the UK anyone can walk into a sexual health clinic—without registering with a doctor, without an appointment, without any money, without a chaperone—and get seen within a few hours at most. It brings me to the point of climax just thinking about the doctors and health professionals who dedicate their life to the nation’s ovaries, cervixes, vaginas, and wombs.

And yet, not all women are apparently so comfortable discussing their clitoral hall of fame with a doctor. According to a recent report commissioned by Ovarian Cancer Action, almost half of the women surveyed between the ages of 18 and 24 said they feared “intimate examinations,” while 44 percent are too embarrassed to talk about sexual health issues with a GP. What’s more, two thirds of those women said they would be afraid to say the word “vagina” in front of their doctor. Their doctor. That is desperately, disappointingly, dangerously sad.

In 2001, I went to see a sexual health nurse called Ms. Cuthbert who kindly, patiently and sympathetically explained to me that I wasn’t pregnant—in fact could not be pregnant—I was just doing my A-Levels. The reason I was feeling sick, light-headed, and had vaginal discharge that looked like a smear of cream cheese was because I was stressed about my simultaneous equations and whether I could remember the order of British prime ministers between 1902 to 1924. My body was simply doing its best to deal with an overload of adrenaline.

Back then, my GUM clinic was in a small health center opposite a deli that would sell Czechoslovakian beer to anyone old enough to stand unaided, and a nail bar that smelled of fast food. I have never felt more grown up than when I first walked out of that building, holding a striped paper bag of free condoms and enough packets of Microgynon to give a fish tits. My blood pressure, cervix, heartrate, and emotional landscape had all been gently and unobtrusively checked over by my new friend Ms. Cuthbert. I had been given the time and space to discuss my hopes and anxieties and was ready to launch myself, legs akimbo, into a world of love and lust—all without handing over a penny, having to tell my parents, pretending that I was married or worry that I was being judged.

My local sexual health clinic today is, if anything, even more wonderful. In a neighborhood as scratched, scored, and ripped apart by the twin fiends of poverty and gentrification as Hackney, the GUM clinic is the last great social leveler. It is one of our last few collective spaces. Sitting in reception, staring at the enormous pictures of sand dunes and tree canopies it is clear that, for once, we’re all in this together. The man in a blue plastic moulded chair wishing his mum a happy birthday on the phone, the two girls in perfect parallel torn jeans scrolling through WhatsApp, the guy with the Nike logo tattoo on his neck getting a glass of water for his girlfriend, the red-headed hipster in Birkenstocks reading about witchcraft in the waiting room, the mother and daughter with matching vacuum-sized plastic handbags talking about sofas, the fake flowers, Magic FM playing on the wall-mounted TV, the little kids running around trying to say hello to everyone while the rest of us desperately avoided eye contact—the whole gang was there. And that’s the point: you may be a working mum, you may be a teenager, you may be a social media intern at a digital startup, you may be a primary school teacher, you may be married, single, a sex worker, unemployed, wealthy, religious, terrified, or defiant but whatever your background, wherever you’ve come from and whoever you slept with last night, you’ll end up down at the GUM clinic.

Which is why it seems such a vulvic shame that so many women feel scared to discuss their own bodies with the person most dedicated to making sure that body is OK. “No doctor will judge you when you say you have had multiple sexual partners, or for anything that comes up in your sexual history,” Dr. Tracie Miles, the President of the National Forum of Gynecological Oncology Nurses tells me on the phone. “We don’t judge—we’re real human beings ourselves. If we hadn’t done it we probably wish we had and if we have done it then we will probably be celebrating that you have too.”

Doctors are not horrified by women who have sex. Doctors are not grossed out by vaginas. So to shy away from discussing discharge, pain after sex, bloating, a change in color, odor, itching, and bleeding not only renders the doctor patient conversation unhelpful, it also puts doctors at a disadvantage, hinders them from being able to do their job properly, saves nobody’s blushes and could result in putting you and your body at risk.

According to The Eve Appeal—a women’s cancer charity that is campaigning this September to fight the stigma around women’s health, one in five women associate gynecological cancer with promiscuity. That means one in five, somewhere in a damp and dusty corner of their minds, are worried that a doctor will open up her legs, look up at her cervix and think “well you deserve this, you slut.” Which is awful, because they won’t. They never, ever would. Not just because they’re doctors and therefore have spent several years training to view the human body with a mix of human sympathy and professional dispassion, but more importantly, because being promiscuous doesn’t give you cancer.

“There is no causal link between promiscuity and cancer,” says Dr. Miles. “The only sexually transmitted disease is the fear and embarrassment of talking about sex; that’s what can stop us going. If you go to your GP and get checked out, then you’re fine. And you don’t have to know all the anatomical words—if you talk about a wee hole, a bum hole, the hole where you put your Tampax, then that is absolutely fine too.”

Although there is some evidence of a causal link between certain gynecological cancers and High Risk Human Papilloma Virus (HRHPV), that particular virus is so common that, ‘it can be considered a normal consequence of sexual activity’ according to The Eve Appeal. Eighty percent of us will pick up some form of the HPV virus in our lifetime, even if we stick with a single, trustworthy, matching-socks-and-vest-takes-out-the-garbage-talks-to-your-mother-on-the-phone-can’t-find-your-clitoris partner your entire life. In short, HRHPV may lead to cancer, but having different sexual partners doesn’t. Of course, unprotected sex can lead to an orgy of other sexually transmitted infections, not to mention the occasional baby, but promiscuity and safe sex are not mutually exclusive. And medical professionals are unlikely to be shocked by either.

We are incredibly lucky in the UK that any woman can stroll into a sexual health clinic, throw her legs open like a cowboy and receive some of the best medical care the world has ever known. We can Wikipedia diagrams of our vaginas to learn the difference between our frenulum and prepuce (look it up, gals). We can receive free condoms any day of the (working week) from our doctor or friendly neighborhood GUM clinic. We can YouTube how to perform a self-examination, learn to spot the symptoms of STIs, read online accounts by women with various health conditions, and choose from a military-grade arsenal of different contraception methods, entirely free.

A third of women surveyed by The Eve Appeal said that they would feel more comfortable discussing their vaginas and wombs if the stigma around gynecological health and sex was reduced. But a large part of removing that stigma is up to us. We have to own that conversation and use it to our advantage. We need to bite the bullet and start talking about our pudenda. We have to learn to value and accept our genitals as much as any other part of our miraculous, hilarious bodies.

So come on, don’t be a cunt. Open up about your vagina.

Complete Article HERE!

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What’s going on w/me?

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Name: Paul
Gender: Male
Age: 59
Location: Rhode Island
Dear Dr Dick: I am a 59 yo man, married, masculine and very much attracted to women. I have, however, in the past few years felt an attraction to men as well. I can remember as a pre-puberty boy being turned on to other boys in magazines. Watching male porn does nothing for me and I have no desire to have anal sex. But I do often fantasize about being with a naked man and performing oral sex. I am in my second marriage, which like the first, is not very happy and there is virtually no physical relationship. I have never been much of a “ladies man” although I am very outgoing and have a good sense of humor. Is my inability to score with women turning me towards men, as they are easier to meet? I have not acted on any fantasy although I do go to a gay massage therapist and very much enjoy his hands on my body and the great hand job at the end. Too much to lose to pursue men. What’s going on w/me?

A common enough complaint, Paul. You’re apparently awakening to the realization that there is more to your sexuality than you’ve allowed yourself to consider in the past. And no, I don’t think you’re interest in men is connected to your track record with women. But it certainly could be the other way around. You aren’t overly successful with the ladies, because you’re much more interested in the gents. Does that sound more like it?

You say you haven’t acted on your newly uncovered fantasies, but you do, from time to time, get a nice hand job from the gay masseur you frequent. Aren’t you just splitting hairs with this artificial and arbitrary boundary? And aren’t you saying that if you’re not the “active” partner, you have some credible deniability? Bollocks!  I gotta tell ya, that kind of thinking make my flesh crawl.try-it-youll-like-it

It appears to me that you’re not gonna be satisfied till you finally get some mighty fine cock in your mouth. And there’s any number of ways you can get that to happen. You’re already seeing a sex worker for your massages; why not look for one who will let you blow him. Look for an escort or ask your masseur for a referral. Hell, he may even oblige you himself. All ya gotta do is be upfront with what you are looking for. Tell the provider you are unversed in the whole cock sucking department, but you’ve been wanting to try it. Remember, you’ve not committing yourself to anything, you’re just doing some research. Right?

My only concern is that you seem to have already put the kibosh any possible research when you say: “Too much to lose to pursue men.” Oh really? How much is too much? Is your over all happiness, your sexual fulfillment, or your integrity TOO MUCH? Think about it some and get back to me.

Good luck

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Happy Winter Solstice 2015

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Hey sex fans,

We begin our Winter Holiday Break today. So yay for that!

Postings and whatnot will resume the first week in January.

snowman

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To Be Or Not To Be (Nude)

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Name: Denise
Gender: Female
Age: 35
Location: Colorado
My husband and I have two beautiful sons, 11 and 13. We are a naturist family. Our children have grown up in this way of life and they have a healthy appreciation for the human body and are comfortable with nudity. Recently, both our sons said they did not want to join my husband and I at our yearly naturist retreat. We are honoring their wishes, but we are disappointed by their decision. Any thoughts on were we might have gone wrong?

Let’s give our readership a little background first, shall we Denise? For the uninformed, nudists or naturists practice social nudity. While nudity is an obvious aspect of nudism, it is just part of a much larger lifestyle and life philosophy.

The nudist/naturist lifestyle promotes a wholesome appreciation of the human body, mind, and spirit. They believe that this wholesomeness comes easiest to those who shed the psychological and social encumbrance of clothing.Naturist_Freedom

Naturists also promote health through complete contact of the whole body with the natural elements. Nudism is practiced, as much as possible, in environments free of the pollution and the stress of modern living. It also involves a holistic approach to nutrition, physical activity, mental health, and social interaction.

As Denise suggests, nudism fosters family participation. Children in naturist families learn to appreciate the human body as part of their natural environment. They often grow up with healthier attitudes toward the physical body and do so with much less fear or shame their non-naturist peers.

Now on to your concern, Denise. I don’t think you’ve done anything wrong. On the contrary, I think you are navigating this seeming change of heart by your kids very well. You’ve decided, and rightly so, to honor their wishes to not participate in the whole naturists thing for the time being.

Naturists 1 boys are going through puberty and that alone is enough to set their whole world on its head. They may also be facing intense peer pressure from their non-naturist mates. Societal pressures to fit in and conform, even to unhealthy cultural dictates about “proper” behavior and injurious hyper body consciousness is particularly demanding during the early teenage years. Somehow the desire to be popular distorts a kid’s perception and can screw up his/her self-esteem.

Ideally, your son’s nudist upbringing would give them the ability to look past these superficial elements, and maybe they will in time. Right now, they need to feel they have more of a control over some of the externals of their life. And it is easy enough for you and your husband to grant them this. I would hasten to add that you and the hubby ought not sink to the lowest common denominator. I encourage you to continue to live your life as before. Your kids need to know that if they want their wishes respected, they’ll need to respect yours.

With a little luck, the body acceptance, self-respect and confidence you’ve instilled in your sons will once again kick in once their hormones simmer down. Just know that the anxiety you and your husband are experiencing is simply part and parcel of being parents to teens…nudist or non.

Good luck

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