I recently wrote a piece about so-called “Unusual Sexual Fantasies”, and how a recent study has found that to be a remarkably unhelpful phrase. The fact remains, however, that doctors and mental health professionals are still using our sexual histories and proclivities as diagnostic criteria - and for people like us, that can be a huge problem.

Sex, Mental Health & 21st-Century Hysteria

or

WTF is Paraphilia?

 

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The Misdiagnosis of Personalities

Someone who was probably Hippocrates came up with the bright idea that a woman’s uterus had a tendency to amble around inside her body, buggering everything up and making her an unstable nagging bitch. I don’t really have much of a hate on for Hippocrates - he had a lot of cool ideas, after all - but it would have been nice if medical science had noticed he was spouting bullshit on that particular point before literally the nineteenth fucking century.


Over the intervening two thousand years there were plenty of interesting theories about how to solve this little problem. Most of them centered around the idea that women were inherently inferior as a result of their itinerant uteri and that as a result we should treat them like a sort of cross between children, servants and breeding stock. This wasn’t universal, of course, but it was often a general theme. Many others were locked up in asylums. Society in general was pretty convinced of the idea that the only way to get a woman’s uterus to stay in one place was to put a baby in it. This line of thinking eventually led to the invention of the vibrator, but that’s another story entirely.


It did eventually fall out of fashion, thankfully, though the notion wasn’t entirely eradicated until women started being let out of the madhouse for long enough to become doctors in their own right. Once we were permitted medical degrees we could finally tell the ghost of Hippocrates to piss off and leave us the fuck alone, and all was well.


And then along came the idea of Borderline Personality Disorder...

Now, I’m not saying it’s the same kind of sexist fiction as the wandering wombs of yore. I know plenty of people who have found a BPD diagnosis to be a useful and valuable thing, and I’m happy for them; if it’s useful it should most certainly be used. I just worry sometimes that we’re approaching the diagnosis of this disorder in a way uncomfortably similar to the ways that doctors used to diagnose hysteria in women who didn’t seem to want to behave.


Around 75% of people diagnosed with BPD are women, and there’s some evidence to suggest that it’s sometimes used as a way for health professionals to flag up to each other that someone is a “difficult patient”. It’s not just the doctors, either. A quick glance at nonsense like this is enough to tell you that there are plenty of people using the idea of BPD to reinforce a nasty, sexist narrative we’re all better off without.


The diagnosis of BPD involves taking many aspects of a person’s life and personality and trying to decide whether or not they’re a ‘symptom’. One of these is their sexuality: people with BPD are said to be “promiscuous”, “sexually impulsive” and “prone to reckless sexual behaviour and paraphilias”. This can easily lead to people who probably shouldn’t be diagnosed BPD picking up the diagnosis and its associated stigma anyway, just because they happen to be One Of Us - someone who enjoys a sex life a little away from the norm.


Players & Sluts?

I’m twenty-seven, and I’ve slept with something in the region of forty people. Amongst my kinky friends, this puts me on the lower side of average. In some of my other social circles I sometimes get to feel like a bastion of sexual wisdom and experience, something I’ll confess to getting a bit of a kick out of. According to the national average I’m some kind of raddled old whore - but that’s something I share with one in four other people, because averages are complicated and maths is weird.


While we’ve got the nation’s most prominent sexpert spewing out misogynistic garbage that reinforces the very narrative it claims to want to attack, we’re probably never going to move away from the old story about players and sluts. The trouble is that nobody actually knows what that means: articles about the damaging effects of “a large number of sexual partners” are ten a penny, but none of them seem willing to tell you what a “large number” actually is. Five? Fifteen? Fifty? This is the one reasonable point Tracey Cox makes in that horrible piece I linked above: if you’re middle-aged and have mostly been single, you could end up with a “large number” just from one sexual partner a year from the age of majority onwards.


This isn’t simply a point of interest, either. ‘Promiscuity’ is on the list of diagnostic criteria for any number of mental health disorders, BPD prime amongst them, and defining that term is left entirely to the professional making the diagnosis - meaning that two different doctors could give the same person a different diagnosis based on the same evidence simply because they were viewing that evidence with their own social prejudices and mores. There are problems with the way personality disorders are diagnosed anyway, of course - this isn’t the right place for one of my enormous rants about nominalist vs. essentialist thinking as applied to the medical model of mental health, but there are some excellent papers on the subject - but if variable diagnoses are going to be caused by anything, it certainly shouldn’t be “my doctor is socially conservative and disapproves of my orientations and lifestyle choices”.


What Makes a Paraphilia?

Anyone who has ever woken up with a hangover and started panicking that they might have a brain tumour is familiar with WebMD. It’s the go-to place for diagnosing yourself with eighteen different conditions you hadn’t even heard of ten minutes ago, and it’s often a pretty comprehensive guide. It’s also got shit like this, though: a horribly subjective piece on the definition of ‘paraphilia’ dressed up as actual medical fact. Perfectly positioned to make someone just exploring their sexuality start panicking that they’re every bit as broken and fucked up as they had feared.


Thankfully many doctors and medical academics are moving away from the idea that a recurrent unusual sexual fantasy is automatically “a paraphilia”, not least because it turns out that very few sexual fantasies are actually all that unusual. The current party line is that something is only a problem if it causes a problem: if it causes someone to violate the consent of others (which is an excellent line to draw) or if they need it to achieve sexual satisfaction (which seems vaguely reasonable at first glance and falls over completely the second you start thinking about it too hard).


I have no particular interest in “vanilla” sex. I’ve done it, certainly, but it never really grabbed me (so to speak) - I choose to have sexual relationships exclusively with people who define themselves as sexually dominant, and for those relationships to have a frisson of kink and a Dom/sub dynamic. The kink community doesn’t think this is a particularly weird life choice, though it’s not one shared by everyone in it. I’ve met plenty of mental health professionals who simply shrug and accept that I appear to be wired up that way.


Technically, though, this is a mental illness. We don’t use the DSM here in the UK, IV or otherwise, but our own equivalent - the ICD-10, which as been in use since 1992 and won’t be updated till 2018 at the earliest - would count me as a sufferer of sexual masochism, “a disorder characterized by recurrent sexual urges, fantasies, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer”.


We’re not helping anyone by trying to teach people like me that it’s unhealthy to have only the kinds of sex we most enjoy. The truth is that I find so-called ‘vanilla’ sex anything from vaguely boring to actively unpleasant; I sometimes have this weird “eurgh, actually just STOP TOUCHING ME” response that can be extremely strong and seems to clearly indicate that it’s not a healthy or enjoyable kind of sex for me to be having. I’m not into it. It doesn’t do it for me. And you know what? That’s okay.

Abi Brown is a freelance writer and general pen-for-hire devoted to sexual deviancy, far-left politics and wearing too much jewellery. Find her at her website or @see_abi_write.


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