You may remember my previous post on the revisions being made to the DSM (Diagnostic and Statistical Manual of Mental Disorders). Over the past few years the existing DSM (IV) has been revised and the public invited to consult on its content. The DSM covers a range of mental health issues, which other bloggers and activists have been reflecting on. For the purpose of this blog I’ve focused on how the DSM will be approaching psychosexual issues – although it is worth noting concerns have been raised about how gender will also be approached (particularly around transgender issues).
The provisional DSM-V is now available for public comment, you have until June 15 to read, critique, question and add your views. Information about how to do this can be found via the DSM-V website .
To help us reflect on the psychosexual aspects of the provisional DSM-V I’ll draw your attention to the thoughts of the indomitable Leonore Tiefer who has shared these thoughts:
“Within the whole sexuality area, there are separate working groups (and webpages) dealing with Gender Identity Disorders and Paraphilias, but I will just comment here about the stuff on Sexual Dysfunctions since that has been our focus in the New View.
1) Without the introductory material, we cannot know the status in the DSM-V of “the human sexual response cycle.” Long-time New Viewers will know that our New View Manifesto is particularly critical of the reliance of the diagnostic nomenclature on the definition of “dysfunctions” as “disturbances in an assumed universal physiological sexual response pattern (“normal function”) originally described by Masters and Johnson in the 1960s” known as “the [sic] human sexual response cycle.” Our manifesto devotes quite a bit of space to criticizing “the shortcomings of the framework” and it remains to be seen how the DSM-V deals with this presumed biological bedrock.
2) Many many small details are changed in each and every category, and it is interesting to compare the wordings from the DSM-IV to the DSM-V as they are given on each dysfunction’s website. You don’t need a copy of the DSM-IV, as the DSM-V webpage for each dysfunction gives the proposed definition, the DSM-IV definition, the rationale for the change, and other material.
3) Those familiar with the New View will recognize the new and expanded qualifiers and modifiers that are attached to almost every dysfunction, including partner/relationship, individual psychology, and culture/religion as coming directly from our insistence that these contributing factors be recognized. While we were not the only ones arguing this need for contextualization, I think we were the most persistent, consistent, and insistent! However, we were arguing that these factors made a difference to sexual life, norms, experience, and expectations, and to see them here “used” to modify the presence, nature, and intensity of “disorders” is NOT altogether thrilling!!
4) The modifiers are absent from the “sexual aversion disorder” now renamed “Sexual dysfunction not elsewhere classified” which is preposterous, since every woman or man with sexual aversion that I saw in many years of sex therapy was chock full of partner, individual and sociocultural red flags. However, under “rationale” is the comment that the group isn’t yet finished with this category, so I assume we will see the modifiers in ALL the dysfunctions when the working group is finished.
5) It seems to me that larger swaths of experience are captured (i.e. medicalized/pathologized) in each category. I think this represents an attempt to do greater justice to the variability and diversity of sexual experience, and yet, paradoxically, it ends up putting more aspects of sexual experience under the medical gaze. Thus if simple-minded journalists ask us if the DSM-V represents a step forward or a step backwards, I suggest we say “Both”!
6) For example, look at Female Orgasmic Disorder. In the DSM-V you have a dysfunction if you are distressed about not having orgasms often enough OR concerned that they aren’t strong enough, whereas in the DSM-IV the only female orgasmic dysfunction was distress about frequency. Take a look at the rationale, and you see the apparently benign justification that since some women complain of reduced intensity, this should be included. Does this represent a more female-friendly approach to diagnosis? Yes, and no. Ultimately, it’s a more disease-mongering approach. I think the New View perspective is that women are being spooked by media, science, and “experts” on all sides to self-monitor their sexuality, inevitably creating distress insofar as sexual response and experience are notoriously variable and influenceable.
7) When you write to the DSM-V, don’t go on and on (the way I have here!!), but pick one point and make a strong argument. Maybe 200 words. Pick a dysfunction that you feel strongly about E.g., are you glad to see the disappearance of vaginismus and dyspareunia in favor of Genito-pelvic pain/penetration disorder? Do you think the changes in the orgasm category encourage hypervigilance? Do you think combining arousal and desire makes sense? Do you like the new modifiers/qualifiers or do you think they are window-dressing? Have they left anything out you wish were there (e.g., Male romance disorder)? etc.”
Tiefer makes some important points here about how psychosexual disorder is being characterised within the proposed DSM-V but you may also have your own thoughts about the way sex/relationships/intimacy is being constructed/pathologised when you read through the DSM-V draft.
Do please add your thoughts, send in your observations and particularly record any concerns that you have. It’s important we all try and do this if we are worried about medicalisation, commercialisation and sex. Many of the discussions on this topic have focused on female sexual functioning/medicalisation, but it’s important to note the DSM-V is also focusing on how male sexual problems are viewed, so focus your critiques here also. This is particularly important given how often male psychosexual issues and the manipulation of male anxieties around premature ejaculation and erectile dysfunction are ignored.
If you’re a journalist you may also want to use the pointers above to think critically about the provisional DSM-V, or more widely about how we conceptualise sex, gender and relationships.
Remember you’ve until June 15 to do this so get lobbying, write about this on blogs, share on twitter and where possible within the mainstream media and healthcare settings.
Provisional DSM-V available for comment – add your views now!
You may remember my previous post on the revisions being made to the DSM (Diagnostic and Statistical Manual of Mental Disorders). Over the past few years the existing DSM (IV) has been revised and the public invited to consult on its content. The DSM covers a range of mental health issues, which other bloggers and activists have been reflecting on. For the purpose of this blog I’ve focused on how the DSM will be approaching psychosexual issues – although it is worth noting concerns have been raised about how gender will also be approached (particularly around transgender issues).
The provisional DSM-V is now available for public comment, you have until June 15 to read, critique, question and add your views. Information about how to do this can be found via the DSM-V website .
To help us reflect on the psychosexual aspects of the provisional DSM-V I’ll draw your attention to the thoughts of the indomitable Leonore Tiefer who has shared these thoughts:
“Within the whole sexuality area, there are separate working groups (and webpages) dealing with Gender Identity Disorders and Paraphilias, but I will just comment here about the stuff on Sexual Dysfunctions since that has been our focus in the New View.
1) Without the introductory material, we cannot know the status in the DSM-V of “the human sexual response cycle.” Long-time New Viewers will know that our New View Manifesto is particularly critical of the reliance of the diagnostic nomenclature on the definition of “dysfunctions” as “disturbances in an assumed universal physiological sexual response pattern (“normal function”) originally described by Masters and Johnson in the 1960s” known as “the [sic] human sexual response cycle.” Our manifesto devotes quite a bit of space to criticizing “the shortcomings of the framework” and it remains to be seen how the DSM-V deals with this presumed biological bedrock.
2) Many many small details are changed in each and every category, and it is interesting to compare the wordings from the DSM-IV to the DSM-V as they are given on each dysfunction’s website. You don’t need a copy of the DSM-IV, as the DSM-V webpage for each dysfunction gives the proposed definition, the DSM-IV definition, the rationale for the change, and other material.
3) Those familiar with the New View will recognize the new and expanded qualifiers and modifiers that are attached to almost every dysfunction, including partner/relationship, individual psychology, and culture/religion as coming directly from our insistence that these contributing factors be recognized. While we were not the only ones arguing this need for contextualization, I think we were the most persistent, consistent, and insistent! However, we were arguing that these factors made a difference to sexual life, norms, experience, and expectations, and to see them here “used” to modify the presence, nature, and intensity of “disorders” is NOT altogether thrilling!!
4) The modifiers are absent from the “sexual aversion disorder” now renamed “Sexual dysfunction not elsewhere classified” which is preposterous, since every woman or man with sexual aversion that I saw in many years of sex therapy was chock full of partner, individual and sociocultural red flags. However, under “rationale” is the comment that the group isn’t yet finished with this category, so I assume we will see the modifiers in ALL the dysfunctions when the working group is finished.
5) It seems to me that larger swaths of experience are captured (i.e. medicalized/pathologized) in each category. I think this represents an attempt to do greater justice to the variability and diversity of sexual experience, and yet, paradoxically, it ends up putting more aspects of sexual experience under the medical gaze. Thus if simple-minded journalists ask us if the DSM-V represents a step forward or a step backwards, I suggest we say “Both”!
6) For example, look at Female Orgasmic Disorder. In the DSM-V you have a dysfunction if you are distressed about not having orgasms often enough OR concerned that they aren’t strong enough, whereas in the DSM-IV the only female orgasmic dysfunction was distress about frequency. Take a look at the rationale, and you see the apparently benign justification that since some women complain of reduced intensity, this should be included. Does this represent a more female-friendly approach to diagnosis? Yes, and no. Ultimately, it’s a more disease-mongering approach. I think the New View perspective is that women are being spooked by media, science, and “experts” on all sides to self-monitor their sexuality, inevitably creating distress insofar as sexual response and experience are notoriously variable and influenceable.
7) When you write to the DSM-V, don’t go on and on (the way I have here!!), but pick one point and make a strong argument. Maybe 200 words. Pick a dysfunction that you feel strongly about E.g., are you glad to see the disappearance of vaginismus and dyspareunia in favor of Genito-pelvic pain/penetration disorder? Do you think the changes in the orgasm category encourage hypervigilance? Do you think combining arousal and desire makes sense? Do you like the new modifiers/qualifiers or do you think they are window-dressing? Have they left anything out you wish were there (e.g., Male romance disorder)? etc.”
Tiefer makes some important points here about how psychosexual disorder is being characterised within the proposed DSM-V but you may also have your own thoughts about the way sex/relationships/intimacy is being constructed/pathologised when you read through the DSM-V draft.
Do please add your thoughts, send in your observations and particularly record any concerns that you have. It’s important we all try and do this if we are worried about medicalisation, commercialisation and sex. Many of the discussions on this topic have focused on female sexual functioning/medicalisation, but it’s important to note the DSM-V is also focusing on how male sexual problems are viewed, so focus your critiques here also. This is particularly important given how often male psychosexual issues and the manipulation of male anxieties around premature ejaculation and erectile dysfunction are ignored.
If you’re a journalist you may also want to use the pointers above to think critically about the provisional DSM-V, or more widely about how we conceptualise sex, gender and relationships.
Remember you’ve until June 15 to do this so get lobbying, write about this on blogs, share on twitter and where possible within the mainstream media and healthcare settings.
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