If you’re a little lusty for leather or predisposed to prefer pain, does that spell trouble for your mental or sexual health? While plenty of the kink-inclined assert that foot fetishes and a fondness for bondage has nothing to do with your state of mental wellbeing, wellness experts have surmised that such interests may land you in the psychiatrist’s bible of diagnoses; the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The DSM-5 sets the standard criteria for psychiatric diagnoses, which means it is crucial to mental health treatment. Within its pages, unusual sexual fixations, or “paraphilias,” get their own category as odd, but not necessarily signs of mental illness. However, you will be eligible for a diagnosis of a “paraphilic” disorder if you are distressed by your fetish, or if your fetish causes harm to others. Ray Blanchard, a psychiatrist at the University of Toronto and chair of the working group on sexual and gender identity disorders for the DSM-5, explained, ‘This was a way of saying it’s OK to have a benign paraphilia. That does not automatically give you a mental disorder.’
Still, even including the benign paraphilias in the DSM in any capacity is thought one step too far by certain psychiatrists, as other diagnoses within the DSM can cover any harm and distress caused by sexual fixations. The argument is that by giving paraphilias it’s own special mention in the DSM, people who enjoy non-mainstream but harmless sexual activities will become stigmatised – even more so than they are already. Alan Shindel, an urologist and specialist in sexual problems at the University of California, Davis Health System, noted, ‘I’ve heard people at meetings talk about “those paraphiliacs,” “those people.” I think that’s always a dangerous road to go down when you’re talking about othering people in that way.’
This is not the first time that the DSM’s approach to sexual preferences has caused controversy. Even though homosexuality was removed from the DSM in 1974, for the next 12 years – until 1986 – psychiatrists still had the option of declaring gay people mentally ill if their sexuality caused them distress. Today’s mental health experts have drawn parallels between the treatment of homosexuals in the 1980s and people nowadays who get aroused by bondage or unusual objects. These advocates argue that the problem is not that the shoe fetishist or BDSM practitioner has sexual preferences that are somehow wrong; rather, the real problem behind their woes is that society judges them harshly.
It’s not hard to understand the advocate’s point of view, especially when you consider the fact that evidence for consensual paraphilias causing harm is lacking. Shindel commented, ‘There doesn’t seem to be a lot of harm to someone having a preference that’s unusual or different from what we consider mainstream.’ He said that the DSM have made a step in the right direction by swapping out “paraphilic disorders” for “paraphilias,” but the change still leaves plenty of wiggle room for prejudiced psychologists to blame their clients’ problems on their sexual fetishes. Shindel clarified, ‘I think it’s loosely applied and not really used the way it’s supposed to be.’
However, those who have framed the DSM reject the parallels made by such advocates as Shindel, with experts such as Blanchard making the point that not every sexual interest is comparable to homosexuality. ‘Homosexuality preserves a lot of what is in heterosexuality,’ he said. ‘There is a capacity for pair-bond formation, there is a capacity for long-term loving relationships. … I think it’s a special case, and I’m not afraid to say that it’s a special case.’