June 20, 2011

The British Psychological Society asks for crossdressing and other types of sexual behavior to be removed from the DSM-5

The British Psychological Society has been asked to give the American Psychiatric Association a comment on  the new proposed edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

They argue that many of the classifications in the proposed manual lacks scientific foundation and that they are mostly based on social norms. As they say: "The criteria are not value-free, but rather reflect current normative social expectations."

As i have noted before, the transvestic disorder/autogynephilia chapter clearly reflects the personal hang ups of the researchers.

The Brits also point to the need to understand the social context of many of the conditions included as "disorders". They believe many of these conditions may just be reflections of natural variation shaped by social forces.

On paraphilias

This is what they say about paraphilias ("sexual perversions"), crossdressing included:

"As stated in our general comments, we are concerned that clients and the general  public are negatively affected by the continued and continuous medicalisation of their  natural and normal responses to their experiences; responses which undoubtedly  have distressing consequences which demand helping responses, but which do not  reflect illnesses so much as normal individual variation.  

We believe that classifying these problems as 'illnesses' misses the relational  context of problems and the undeniable social causation of many such problems. For  psychologists, our well-being and mental health stem from our frameworks of  understanding of the world, frameworks which are themselves the product of the  experiences and learning through our lives. 

All these comments apply also here.  Again, of particular concern are the subjective  and socially normative aspects of sexual behaviour.  It is a matter of record that  homosexuality used to be considered a symptom of illness.  The Society would not  be able to support considering sexual differences as symptoms of illness. 

We, finally, have severe misgivings about the inclusion of "Paraphilic Coercive  Disorder" in the appendix.  Rape is a crime, not a disorder.  Such behaviours can, of  course, be understood, but we disagree that such a pattern of behaviour could be  considered a disorder, and we would have grave concerns that such views may offer  a spurious and unscientific defence to a rapist in a criminal trial."

On gender dysphoria

They would also like to see the removal of the Gender Dysphoria category, making more or less the same argument. They add:

"Of particular concern are the subjective and socially normative aspects of sexual  behaviour.  We are very concerned at the inclusion of children and adolescents in  this area.  There is controversy in this particular area – the concept of a 'diagnosis' of  a 'psychiatric disorder' disputed."

Again the argument is that the research is not solid enough to support such a label. They are right about this.

Psychology versus psychiatry

The British Psychological Society, incorporated by Royal Charter, is an academic and professional body for psychologists in the United Kingdom.

I note that they mostly focus on social factors in their comment. They point out that there is little evidence of biological causation.

I am not sure this should be made into a major point. After all, a mental condition may be a disease even if it is spurred by social factors (poverty and alcoholism comes to mind). And natural variation may also have a biological basis -- like some personality traits. Being at one or the other end of a gradient of natural variation does not mean that the condition is a mental illness. 

In many ways the disagreement between the British Psychological Society and the psychiatrists manning the DSM-5 committees reflect their different academic background. The psychologist focus on the life experience of the individual. They know that this variation cannot be fully captured by simple labels. 

The psychiatrists, on the other hand, -- who are trained as doctors -- focus on the medical part of the analysis.They look for the broad patterns, as is the case in the natural sciences. They therefore risk forcing complex processes into narrow categories that do not really fit the complexity of the human mind.

The truth, as is often the case, requires both perspectives.

Note that the DSM-5 web site period for comments has been extended to July 15.

Discuss crossdreamer and transgender issues!