the measuring stick

Jack Molay brought to my attention a paper written by Charles Moser on the topic of paraphilias called “Paraphilias and the ICD-11: Progress but Still Logically Inconsistent”.

In this paper, Dr. Moser examines some of the logic (or lack thereof) of labeling conditions as paraphilias while others are not. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) is charged with reviewing and recommending changes for categories related to sexuality in the International Classifications of Diseases and Related Health Problems (ICD), published by the World Health Organization (WHO). Moser then questions the distinguishing between what is and is not a paraphilia and the criteria used.

For example he states:

• What is the rationale for diagnosing individuals distressed about their ‘‘atypical’’ sexual arousal with a Paraphilic Disorder, but not to diagnose individuals who are distressed about their homosexual or bisexual sexual orientation?
• Are atypical sexual interests a sign of a mental disorder? One should remember that masturbation, homosexuality, heterosexual sodomy, and non marital sex were once seen as atypical and as evidence of a mental disorder.

More from the paper:

“There are some basic tenets of the ICD which seem to have been lost: Medicine is based on science; researchers and clinicians should acknowledge and try to minimize their biases; the patient—not society—is our focus; and we strive to apply the diagnosis of a mental disorder consistently, despite our own possible distaste for any associated behaviors. In the age of evidence-based medicine, we do not create diagnoses because experts, the lay public, or our political leaders think we should. We try to anticipate how these diagnoses can be misused and take steps to prevent that misuse. Although Krueger et al. (2017) appear to understand these challenges, their proposals do very little to prevent the misuse or abuse of these diagnoses. The leadership of WHO and the ICD-11 should demand answers to the questions above and clarify the purpose of including these diagnoses before codifying them in ICD-11.

The conflation of mental disorders and crimes is a human rights issue. People with paraphilias and Paraphilic Disorder diagnoses throughout the world experience major violations of their civil, cultural, economic, political, and social rights. We cannot protect their rights if we act as agents of social control or confuse crimes and moral beliefs with mental disorders. To be crystal clear, the preceding comments should not be construed as supportive of any sexual activity involving no consenting individuals or those incapables of consenting. Any interpretation of my comments as supporting the decriminalization of nonconsensual sexual interactions is misguided and wrong.”

We must remember that although LGBT people are not mentally ill every effort was made in the past to convince the public that they were. Moser’s point is that we avoid the use a subjective compass to establish guidelines as to what is abnormal and attempt to serve the cause of justice to people who fall outside of the boundaries of the majority.

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