Tag Archive: ICD

Faglig grunnlag for å fjerne norske fetisj- og SM-diagnoser

Oslo 29. januar 2009

Faglige og helsepolitiske argumenter for å fjerne norske SM- og fetisjdiagnoser

Engelsk versjon sendt til Verdens Helseorganisasjon 24.9.2009

Notat til Helsedirektoratet v/ seniorrådgiver Arild Johan Myrberg fra Diagnoseutvalget Revise F65

Av Svein Skeid og Odd Reiersøl

1. januar 2009 tok Socialstyrelsen bort diagnoser knyttet til ”vissa sexuella beteenden” og ”företeelser som har med könsidentitet att göra” fra den svenske versjonen av sykdomsklassifiseringen ICD-10, International Classification of Diseases (1).

Det norske Diagnoseutvalget Revise F65 har i flere år arbeidet med diagnosene F65.0 Fetisjisme, F65.1 Fetisjistisk transvestisme og F65.5 Sadomasochisme. Det er disse vi primært ønsker fjernet fordi vi anser dem som overflødige, utdaterte, uvitenskapelige og stigmatiserende.

Ettersom F65.6 Multiple forstyrrelser i seksuelle objektvalg er en kombinasjonsdiagnose der både F65.0, F65.1 og F65.5 inngår, bør denne også utgå.

Diagnoseutvalget har ikke jobbet med F64-diagnosene. Men vi anbefaler at Norge i likhet med Sverige også fjerner F64.1 Transvestisme.

  • De fem diagnosene som ønskes fjernet er (25):
  • F65.0 Fetisjisme
  • F65.1 Fetisjistisk transvestisme
  • F65.5 Sadomasochisme
  • F65.6 Multiple forstyrrelser i seksuelle objektvalg
  • F64.1 Transvestisme


HELSEPOLITISKE ARGUMENTER

Den nasjonale fjerningen av sm- og fetisj-diagnosene i Sverige (2009), samt transvestisme- og sm-diagnosene i Danmark (1994/95) ble vedtatt av helsemyndighetene med overveiende helsepolitisk, helseforebyggende og menneskerettslig argumentasjon. Det er også tungtveiende faglige grunner for å følge Sveriges eksempel. Det kan i det nedenstående være glidende overganger mellom helsepolitiske og faglige vurderinger.

  • Socialstyrelsen:
    “inte perverst” (2,3)
    “inte sjukdomar” (1,2)
    “privat angelägenhet” (2)
    “fullvärdiga medborgare” (2)
    “inte förstärka fördomar” (1,2,4)
    “stammar från tidligare tider” (2)
    “risk för social stigmatisering” (1,4)
    “skal få självkänsla liksom homosexuella” (2)

Privatsak

Det danske vedtaket i 1995 ble foretatt av sundhedsminister Yvonne Herløv Andersen med den begrunnelse at denne type seksuell preferanse er et privat anliggende som samfunnet ikke har noe med å gjøre.

  • Herløv Andersen fant det beklagelig at sadomasochisme inngår i sykdomsklassifikasjonen ICD og var enig i at seksuell preferanse er et helt privat anliggende (5).
  • “De här individernas sexuella preferenser har samhället inte med att göra”. Generaldirektør i Socialstyrelsen Lars-Erik Holm i Dagens Nyheter 16.11.2008 (2).
  • “Det er ikke noe grunnlag verken i dagens samfunnsnorm eller helsefaglig tenkning for å kalle flere av disse diagnosene for sykdom”. Helsedirektør Bjørn-Inge Larsen i Nettavisen 17.11.08(3).

Stigmatisering

Den svenske endringen ble tatt av Socialstyrelsen ved generaldirektør Lars-Erik Holm, blant annet fordi sykdomsdiagnosene “kan bidra till att bevara och förstärka fördomar i samhället, vilket i sin tur ökar risken för social stigmatisering hos enskilda.” (1)

Det norske Helsedirektoratet skal ha ros for sitt arbeid med Antistigmaåret 2007 og det forhold at “stigmatisering og diskriminering av seksuelle minoriteter” siden 2008 har vært ett av hovedmålene ved tildelingen av offentlig tilskudd fra Kap. 719 post 70 (6).

  • Myndighetenes strategiplan for forebygging av hiv og seksuelt overførbare infeksjoner fra november 2001 poengterer “farene ved stigmatisering og diskriminering av utsatte grupper i det forebyggende arbeid, samt viktigheten av en helhetlig tilnærming til seksuell identitet, seksuell helse og seksuell atferd.”

En norsk avdiagnostisering i tråd med det svenske vedtaket vil etter vår oppfatning bidra til å redusere stigmatiseringen av fetisjister og sm-ere slik myndighetenes fjerning av homofilidiagnosen bidro til i 1982.

  • “Att vi tog bort homosexdiagnosen tror jag till viss del har bidragit till att folk har en annan syn på homosexuella i dag än på 60- och 70-talet. Det gav de homosexuella en självkänsla i och med att de inte längre hade en sjukdomsstämpel på sig. Och det hoppas vi att den här förändringen också ska åstadkomma”, uttalte Socialstyrelsens generaldirektør Lars-Erik Holm til Dagens Nyheter 16.11.08 (2).

Helseforebyggende tiltak

Fjerning av diagnosene kan også styrke det ”identitetsskapende arbeidet” overfor sm/fetisj-populasjonen og bidra til den “kollektive selvrespekt” som er påkrevet for å nå gruppen med hiv- og sos-forebyggende tiltak.

  • “Et menneskes mulighet til aktivt å beskytte seg mot et virus som smitter seksuelt … influeres bare i noen grad av ren kunnskap. Den følelse av egenverdi som skal til for å stille krav om, eller selv ønske å beskytte seg, påvirkes av samfunnsmessige faktorer hvorav de fleste ikke er under helsemyndighetenes innflytelse. Det er lagt vekt på at samarbeidet med marginaliserte og sårbare grupper har innflytelse på det som kanskje kan kalles en kollektiv selvrespekt.” (fra myndighetenes tidligere Handlingplan mot hiv/aids-epidemien sidene 25,33).I tilskuddsbrev til SMia-Oslo fra Sosial- og helsedirektoratet 25.4.2002 til via kap. 719 post 70, poengterer Direktoratet at “Formålet med aktivitetene er å bedre sm-gruppens selvfølelse og identitet og derved skape grunnlag for å øke evnen til å beskytte seg mot seksuelt overførbare sykdommer.”

Diskriminering

En psykiatrisk diagnose kan ha stor innflytelse på en persons jobbmuligheter og vurdering av evne til omsorg for barn for eksempel ved skillsmisse. Ved å bli kvitt sykdomsstemplet kan seksuelle minoriteter puste litt friere og bli mindre redd for privat og offentlig diskriminering.

  • LLHs case-materiale viser at F65-diagnosene fungerer stigmatiserende og legitimerer diskriminering (7).
  • I brev til Diagnoseutvalget 11.6.2003 uttaler Norsk Forening for Klinisk Sexologi: “NFKS vil med denne støtteerklæringen markere at bruk av psykiatriske diagnoser i forhold til homofile, heterofile og bifile fetisjister, sadomasochister og transvestiske fetisjister er stigmatiserende, og dermed et overgrep mot denne gruppen i sin helhet.”

Sunn, sikker, samtykkende

Det er liten tvil om at SM-bevegelsen også har blitt ”voksen” de siste 20 årene med etablering av stoppord, sikkerhetsrutiner og andre normgivende tiltak slik som det internasjonalt anerkjente moralsk-etiske verdigrunnlaget ”Sunn, sikker, og samtykkende”. I motsetning til skadelige overgrep, er SM en frivillig og samtykkende aktivitet som produserer lystfremmende og helsebringende hormoner.

  • Blant annet: Richters et al 2003 (8,9)

FAGLIGE ARGUMENTER

Diagnosene er overflødige

Eventuelle psykiske lidelser hos medlemmer av den aktuelle gruppen vil som for alle andre kunne dekkes av de vanlige psykiatriske diagnosene som for eksempel depresjon, tvang, angst, personlighetsforstyrrelse eller psykose.

Dersom en person for eksempel er så opptatt av sin fetisj at det blir et problem i hennes hverdag, så kan hun f.eks. diagnostiseres med “tvangslidelse”. Det er ikke fetisjen i seg selv som er hennes problem.

  • I forbindelse med fjerningen av homofili som diagnose i 1977 uttalte Norsk Psykiatrisk Forening det som ”betenkelig å anvende psykiatriske diagnoser på isolerte aspekter av atferd.” En person som utfører spesiell atferd får ikke diagnose etter atferden, men på bakgrunn av de symptomer han eller hun fremviser. ”Ideelt sett skulle psykiatriske diagnoser relateres til årsakssammenhenger i en videre forstand, et bredere aspekt av lidelse, nedsatt sosial funksjon og/eller et ønske om behandling”, uttalte de.

Sovende diagnoser

Liksom den tidligere homofilidiagnosen er fetisj- og sm-diagnosene sovende. De er ikke i bruk som redskap for å behandle folks sykdommer.

  • “The main objective of diagnosis is patient care”. (IGDA workgroup WPA 2003; The WPA International Guidelines for Diagnostic Assessment by the World Psychiatric Association 2003.)
  • I brev til SMil-Norge 19.12.2008 opplyser Helsedirektoratets Spesialisthelsetjenesteavdeling at “ingen av de aktuelle diagnosekoder er rapportert til Norsk pasientregister i 2007 eller 2008. Dette gir en sterk indikasjon på at kodene ikke brukes.”
    Helsedirektoratet opplyser til Dagens Medisin at ifølge Norsk pasientregister ble ingen av de tre tidligere nevnte kodene benyttet i fjor (10).
    Det ovenstående stemmer overens med tall fra den svenske Socialstyrelsen, samt norske SINTEF-data fra 2000, 2001 og 2002 innhentet av Revise F65 (1,11).

Diagnosenes eneste funksjon blir å stigmatisere en befolkningsgruppe og legitimere diskriminering. Dette bryter etter vår mening med legeyrkets hippokratiske etikk om ikke å volde skade (12).

Vitenskap og fordommer

Det vanlige i psykiatrien forøvrig, er å anse folk som friske, så lenge det ikke kan påvises alvorlig psykopatologi hos gruppen. Internasjonal forskning viser samme tendens om undersøkelsene er kvalitative eller kvantitative, om de foretas telefonisk, via internett eller ved personlige intervjuer: Sadomasochister har ikke flere psykiske problemer eller forstyrrelser enn andre. “Snarere tvert imot, psykologer og psykiatere har påvist en økt selvfølelse, ved at de tar egne følelser på alvor og aksepterer seg selv for den de er.”

  • Elsa Almås i Magasinet Dagbladet 10.1.09 (13a)

Det må etter vår oppfatning forventes at sykdomsdiagnoser på fetisjisme og SM i 2009 baserer seg på vitenskapelige bevis, ikke på kulturelt forutinntatte holdninger (8).

Sykdom å være annerledes?

Et etter vår mening svært uklart, verdiladet og uvitenskapelig kriterium for å stemple folk som syke i kapittel F65, er ifølge hovedkriterium G1: ”[] begjær og fantasier som involverer uvanlige objekter eller aktiviteter”.

Fetisjister og sm-ere representerer kanskje en gruppe på 5-10 prosent av befolkningen og betraktes mer og mer som en normalvariant i samfunnet (14).

  • I 2007 gjennomførte MMI en landsomfattende undersøkelse om nordmenns seksuelle preferanser. 1 prosent av de spurte svarte at de tenner på seksuell dominans og underkastelse i ”meget stor grad”, mens 14 prosent svarte at de tenner på dette i ”ganske stor grad” eller i ”mindre grad”. Magasinet Dagbladet 10.1.09 (13b).

Vi spør: Er begrepet “uvanlig” statistisk eller normativt ment? Tidligere ble en rekke seksuelle praksiser ansett som unormale. Dette var for eksempel tilfelle med homoseksualitet, onani, oral og anal-sex. Ekstremsport og religiøs pisking kan også betraktes som uvanlige aktiviteter. Men så langt er verken basehoppere eller flagellanter blitt stemplet som perverse (15).

Syk uten samleie?

I hiv-forebyggende arbeid anses ikke-penetrerende fetisj- og sm-sex som én av flere metoder for å redusere nysmitte i målgruppen. Dette står i motsetning til ICD-10 der manglende samleie er et av hovedargumentene for å stemple fetisjisme som patologisk.

  • “Fetisjistiske fantasier er vanlige, men de er først sykdommer når de fører til ritualer som er så tvingende og uakseptable at de hindrer seksuelt samleie […]” Fra retningslinjene til ICD-10 (F65.0 Fetisjisme).

Kanskje bør Verdens Helseorganisasjon begynne å se på ikke-penetrerende sex som en av flere måter å stoppe hiv-epidemien og verdens befolkningseksplosjon på?

  • “De här diagnoserna stammar från en tid då allt annat än heterosexuell missionärsställning sågs som sexuella perversioner.”
    Generaldirektör för Socialstyrelsen Lars-Erik Holm (2)

Sammenblanding av SM og vold

  • Enhver form for seksualitet kan perverteres, ikke minst “normal” heteroseksuell aktivitet, når den ikke baseres på likeverd og samtykke.
    Esben Esther Pirelli Benestad.

Vold forstås vanligvis ikke bare som bruk av fysisk makt. Det må også foreligge manglende samtykke og et ønske om å skade.

ICD-10 skiller ikke mellom samtykkende SM og skadelig vold. Dette står i motsetning til moderne forskning og bidrar til å opprettholde et tyngende stigma overfor vår gruppe.

“Seksuell sadisme er til tider vanskelig å skille fra grusomhet i seksuelle situasjoner eller sinne relatert til erotikk. Der vold er påkrevet for seksuell opphisselse, kan diagnosen klart fastslås.”
Kapittel F65.5 Sadomasochisme.

  • I en undersøkelse fra 2006 fant professor i psykologi Pamela Connolly at SM-sadister ikke opplever større glede ved ikke-samtykkende grusomhet enn kontrollgruppen av ikke-SM-ere, og masochistene søkte ikke tvangsmessige eller skadelige former for smerte (8).
  • Dette bekreftes av psykologene Cross og Mathesons undersøkelse fra 2006. De fant ikke noe bevis for påstander om antisosiale, psykopatiske eller voldelige SM-sadister (8).
  • John Noyes (1997) går videre og sier: “Sadomasochisme som en iscenesatt aggresjon kan endog bidra til å redusere sosial vold og fremme alternative og sosialt levedyktige modeller for å mestre aggresjon på en måte som minimaliserer dens negative effekter (16).
  • Se også: ”Forskjellen på SM og vold” (17).

Psykologisk stress

Et annet hovedkriterium for kapittel F65 er G2:

“The individual either acts on the urges or is markedly distressed by them.” Begrepet “distress” forekommer også som kriterium under “F65.0 Fetisjisme”.

Kriteriet tar ikke høyde for oppdatert stigmakunnskap. Samfunnets stigmatisering fører til selvstigma, skyld, skam og psykologisk stress i minoritetsgrupper (22). Det er ikke nødvendigvis sm eller fetisj-aktiviteten i seg selv som er problematisk.

Den amerikanske DSM-listen (Diagnostic and Statistical Manual of Mental Disorders) innførte i 1994 et B-kriterium som sier at fetisjister og SM-ere ikke er syke med mindre det medfører vesentlige psykiske, fysiske eller sosiale problemer.

  • “The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (24)

DSM-revisjonen i 1994 ble den gang sett på som et fremskritt, men er langt fra tilfredsstillende. Stigmakunnskap viser at mange psykiske, fysiske og sosiale problemer ikke skyldes personen selv, men tabuer, fordommer og diskriminering som man påføres av omgivelsene. Se også Svein Skeid i Blikk online 19.1.2009 (23).

Ingen homogen helhet

Det er mulig at WHO sentralt foretrekker at enkeltdiagnoser ikke fravikes i perioden mellom hovedrevisjonene. Det er imidlertid et faktum at klassifiseringskoordinator Dr. Bedirhan Üstün MD (ustunb@who.int) ved WHO i Geneve, i mail av 7.5.2007 ønsket Revise F65 velkommen til samarbeid om den forestående av ICD-revisjonen (ICD-11):

  • “The revision process of ICD from 10 to 11 is about to start and will be revised for the 11th version tentatively in 2015. The revision work will include special attention to Chapter V Mental and behavioural disorders (F00-F99). Thanks for your interest in the ICD work and we hope to collaborate with you in the revision process.” T. Bedirhan Ustun, M.D., Coordinator, Classifications, Assessment and Terminology, World Health Organization, Geneva, Switzerland.

Kapittel F65 representerer heller ikke noen homogen helhet. Ulike diagnoser uten logisk sammenheng kombineres på en uklar og uvitenskapelig måte kun fordi de er ”uvanlige fenomener”.
Hovedkriterium G1 for kapittel F65.

Det er tradisjon for at enkeltdiagnoser fjernes fra de nasjonale ICD-versjonene. Dette var svært utbredt i tiårene før WHO fjernet homofili-diagnosen i 1990. Nok en gang fraviker nå enkeltland fetisjisme, transvestisme og sadomasochisme i sine nasjonale ICD-versjoner. Også denne gang er de skandinaviske land pionérer.

Felles nordisk holdning?

  • Socialstyrelsens generaldirektør Lars-Erik Holm vil også kontakte sine nordiske kolleger. “Men jag vet inte hur framgångsrika vi kommer att vara. Det finns enormt olika uppfattningar om detta i olika länder, men det vore ju bra om åtminstone vi i Norden har en samsyn”, sier han til Dagens Nyheter 16.11.2008 (2).

Revise F65 håper vi kan feire en norsk friskmelding under Skeive dager i slutten av juni 2009. Dernest håper vi at Helsedirektoratet i likhet med den svenske Socialstyrelsen vil arbeide for at Verdens Helseorganisasjon også fjerner tilsvarende diagnoser.

  • “Det framtidige målet blir at Verdens Helseorganisasjon (WHO) fjerner SM fra sine lister også, men dette vil eventuelt ikke skjer før om noen år”, sier seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg til Blikk 19.1.2009 (23).
  • “Socialstyrelsen tänker nu arbeta för att samma förändring ska göras i det internationella diagnossystem som tas fram av WHO och som utgör grunden för det svenska systemet”, uttaler Socialstyrelsens generaldirektør Lars-Erik Holm til Dagens Nyheter 16.11.2008 (2).

 

Se også:

Svein Skeid: ”SM – myter og fakta” (18).

Psykolog Odd Reiersøl (2008). Fetisj og SM-diagnosene i ICD-10. Tidsskrift for Norsk Psykologforening, 6, 754-756. (19).

 

Med vennlig hilsen

Svein Skeid (leder)                          Odd Reiersøl (psykolog)

Diagnoseutvalget Revise F65
Et utvalg i Landsforeningen for lesbiske, homofile, bifile og transpersoner (LLH) (21)

LLHs Diagnoseutvalg Revise F65 er nedsatt på tvers av kjønn og seksuell orientering med det mål å arbeide for at fetisjisme, fetisjistisk transvestisme og sadomasochisme ikke lenger bør anvendes som diagnoser. Utvalget består av fagfolk innen sexologi, psykologi og psykiatri, samt ressurspersoner fra norske sm og fetisj-organisasjoner (10,20,21).

LINKER OG FOTNOTER

Fotnote 1.

http://www.revisef65.org/Sweden.html [kun engelsk tekst]

Fotnote 2.

http://www.dn.se/nyheter/sverige/nu-ska-sara-claes-slippa-bli-stamplad-som-sjuk

Fotnote 3.

http://www.nettavisen.no/jobb/article2402153.ece

Fotnote 4.

http://www.qx.se/samhalle/8544/sa-blev-transvestiter-friska-over-en-natt

Fotnote 5.

http://www.revisef65.org/danmark.html

“Sadomasochisme er ingen sygdom”. (1.4.1995). Politiken, side A7.

Fotnote 6. (Helsedirektoratet: død link)

Fotnote 7.

http://www.revisef65.org/diskriminering.html

Fotnote 8.

http://www.revisef65.org/psykopatologi.html

Fotnote 9.

http://www.revisef65.org/sikker.html

Fotnote 10.

http://www.dagensmedisin.no//nyheter/2008/11/17/transvetittisme-ikke-lenge/index.xml

Fotnote 11.

http://www.revisef65.org/sintef.html

Fotnote 12.

http://no.wikipedia.org/wiki/Hippokratiske_ed

Fotnote 13a.

Fotnote 13b.

Fotnote 14.

http://www.revisef65.org/antall.html

Fotnote 15.

Reiersøl og Skeid i ”Sadomasochism, Powerful Pleasures” (2006). Utgitt parallellt i The Journal of Homosexuality Volum 50, issue 2/3 2006.

Fotnote 16.

Noyes, J. K., Ph.D. (1997). The mastery of submission: Inventions of masochism. Ithaca, NY: Cornell University Press, side 30.

Fotnote 17.

http://www.revisef65.org/voldNY.html

Fotnote 18.

http://www.revisef65.org/myter1.html

Fotnote 19.

http://www.psykologtidsskriftet.no/index.php?seks_id=52392&a=2&sok=1

Fotnote 20.

http://www.reviseF65.org

Fotnote 21.

http://no.wikipedia.org/wiki/ReviseF65

Fotnote 22.

Goffman, E. (1963) Stigma: notes on the management of spoiled identity. Englewood Cliffs, Prentice-Hall.

Fotnote 23.

http://www.blikk.no/arkiv/item/3859–gj-r-som-svenskene

Fotnote 24.

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revised). Washington DC.

Fotnote 25.

World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva, Switzerland.

World Health Organization (1993). The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva, Switzerland.

Fotnote 26.

Ansvar og omtanke – Strategiplan for forebygging av hiv og soi (bl.a. sidene 3, 13, 21, 26 og 40.)
[død link]

Fotnote 27.

Feilaktig informasjon på ABC-nyheter og Klikk.no:

http://www.abcnyheter.no/node/80935

http://www.klikk.no/samliv/sex/article394225.ece

Fotnote 28.

Brev til Helsedepartementet 28.11.03 som aldri ble besvart.

http://www.revisef65.org/helse.html

Fotnote 29.

SMia og ReviseF65: 15 års kamp for å fjerne sm- og fetisjdiagnosene.

http://web.mac.com/olavtrygg/iWeb/1ReviseF65/kamp.html [død link]

Fotnote 30.

SMias ”Sikrere SM ABC” 2002.

http://www.smia-oslo.no/sikrere1.html

Fotnote 31.

”SM- og fetisjsex mellom menn” 2005.

http://www.helseutvalget.no/tpl.html?catid=33

Fotnote 32.

http://www.revisef65.org/fesveinhomoaerespris.html

Fotnote 33. [se fotnote 9]

http://www.revisef65.org/sikker.html

Fotnote 36.

http://www.revisef65.org/indexnorsk.html

Fotnote 39.

http://www.regjeringen.no/upload/BLD/Høringer/2007/Felles%20ekteksapslov/Sosial_og_helsedirektoratet.pdf

Fotnote 40.

http://www.smia-oslo.no/

Fotnote 41.

http://www.revisef65.org/SMfilm.html

Fotnote 42.

Syke sadomasochister? Svein Skeid i tv-programmet Studio FEM 3.2.09

http://www.fem.no/programportaler/studio_5/studio_5_sesong_3/nyheter/164019

Fotnote 43.

Studio 5 med Svein Skeid på web-tv 3.2.09

http://www.fem.no/programportaler/studio_5/studio_5_sesong_3

Fotnote 44.

Er dette sykt?

http://www.dagbladet.no/tekstarkiv/artikkel.php?id=5001090033658&tag=item&words=sadomasochisme

Fotnote 45.

Hva er SM:

http://www.dagbladet.no/tekstarkiv/artikkel.php?id=5001090033657&tag=item&words=sadomasochisme

Fotnote 46.

Svenskene friskmelder SM

http://www.dagbladet.no/tekstarkiv/artikkel.php?id=5001090033656&tag=item&words=sadomasochisme

Fotnote 47.

I tilskuddsbrev til SMia-Oslo fra Sosial- og helsedirektoratet 25.4.2002 via kap. 719 post 70, poengteres det at “Formålet med aktivitetene er å bedre sm-gruppens selvfølelse og identitet og derved skape grunnlag for å øke evnen til å beskytte seg mot seksuelt overførbare sykdommer.”

Fotnote 48.

“Et menneskes mulighet til aktivt å beskytte seg mot et virus som smitter seksuelt […] influeres bare i noen grad av ren kunnskap. Den følelse av egenverdi som skal til for å stille krav om, eller selv ønske å beskytte seg, påvirkes av samfunnsmessige faktorer hvorav de fleste ikke er under helsemyndighetenes innflytelse. Det er lagt vekt på at samarbeidet med marginaliserte og sårbare grupper har innflytelse på det som kanskje kan kalles en kollektiv selvrespekt.” Handlingplan mot hiv/aids-epidemien 1996 sidene 25,33).

Fotnote 49.

Helsedirektoratets utlysningstekst for tilskudd over kap. 719 post 70 der ett av tre hovedmål er å ”motvirke stigmatisering og diskriminering av seksuelle minoriteter […].

Fotnote 50.

Sosial- og helsedepartementet omtaler SLM direkte og SMia indirekte (som undergruppe i LLH) som sentrale aktører “i det hiv-forebyggende og identitetsskapende arbeidet.” Handlingplan mot hiv/aids-epidemien 1996 side 46).

Fotnote 51.

RFSUs henvendelse til Socialstyrelsen kom én måned etter de hadde mottatt dokumentasjon fra Revise F65

http://www.thelocal.se/13974/20080827/

Sverige fjerner SM- og fetisjdiagnoser

Opprinnelig artikkel publisert 23.1.2009.
Norsk artikkel lagt ut på nytt 9.8.2011 etter å ha ligget nede i lengre tid.

Fetisjisme og sadomasochisme ikke lenger sykdomsdiagnoser i Sverige

 

 

Sverige fjerner fetisj- og bdsm-diagnoser

Som første land i verden fjernet den svenske Socialstyrelsen sadomasochisme, fetisjisme og fetisjistisk transvestisme som psykiatriske diagnoser fra 1.1.2009. Inspirasjonen kom fra Norge. Det samme gjorde de helsepolitiske og faglige premissene for vedtaket.

Av Svein Skeid

Svenskene har her fulgt de faglige rådene de har fått av det norske Diagnoseutvalget Revise F65. Det er gledelig å se at svenskene nå fjerner de samme diagnoser på samtykkende seksualitet som Revise F65 anbefaler. Argumentasjonen fra Socialstyrelsens generaldirektør, Lars-Erik Holm er ord for ord sammenfallende med den som det norske Diagnoseutvalgets har benyttet i bøker, tidsskrifter og på nettet.

Blant annet:

http://www.tandfonline.com/doi/abs/10.1300/J082v50n02_12

http://www.psykologtidsskriftet.no/index.php?seks_id=52392&a=2&sok=1

Allerede 23. november 2006 henviste Mika Nielsen til det norske pionérarbeidet da hun i en artikkel i homoavisa QX oppfordret den svenske seksualpolitiske bevegelsen om å følge Norges eksempel. En arbeidsgruppe ble dannet etter norsk mønster med deltagere fra Club Sade, LASH, Club Sunrise, Dekadance and RFSL.

http://www.qx.se/nyheter/artikel.php?artikelid=4727

Arbeidsgruppen fikk innpass i RFSU, Riksförbundet för sexuell upplysning og Mika Nielsen fremhevet nok en gang, i Ottar nr 2-2007, Norges eksempel i deres blad “Ottar” [dessverre død link]:

http://www.rfsu.se/smisk_eller_vanilj_-_hur_gor_du_det_.asp

Vinteren 2007 vedtok RFSU kongress å arbeide for å fjerne sykdomsdiagnosene på fetisjisme og sadomasochisme og motvirke fordommer gjennom opplysning.

Under Europride i Stockholm 2008 ble jeg som leder i Revise F65, invitert til å ha samtaler med RFSU, delta i to paneldiskusjoner og ikke minst; presentere Diagnoseutvalgets arbeid overfor RFSU 29.7.08.

Vi overleverte dem i helhet vårt faglige materiale og vår menneskerettslige argumentasjon, inkludert argumentene om stereotyper og stigmatisering. En måned etter foredraget sendte RFSU 27.8.08 en henvendelse til Socialstyrelsen om å fjerne diagnosene med de norske argumentene. I brevet henviser de til samarbeidet med Revise F65 (“cooperating with an international group working to change the WHO’s classification.”)

http://www.thelocal.se/13974/20080827

BDSM-gruppen i RFSU har gjort en veldig bra jobb overfor den nytenkende generaldirektøren for Socialstyrelsen, Lars-Erik Holm (bildet). Den svenske friskmeldingen ble vedtatt blant annet fordi sykdomsdiagnosene ifølge Holm ”kan bidra til å bevare og forsterke fordommer i samfunnet, hvilket i neste omgang øker risikoen for sosial stigmatisering hos den enkelte”. Dette vil vi bidra til å forandre”, sa generaldirektør Lars-Erik Holm. “Ved å endre den svenske klassifikasjonen vil Socialstyrelsen gi et tydelig signal om at disse diagnosene ikke skal ses på som sykdommer” (Socialstyrelsen, 2008).

En lignende forandring skjedde for nesten 30 år siden da homofilidiagnosen ble tatt bort i 1979.

– At vi fjernet homofilidiagnosen tror jeg til en viss grad har bidratt til at folk har et annet syn på homoseksuelle i dag enn på 60- og 70-tallet, uttalte generaldirektør Lars-Erik Holm til Dagens Nyheter. “Det ga de homoseksuelle en selvfølelse i og med at de ikke lengre hadde et sykdomsstempel på seg. Og det håper vi at denne reformen også skal føre til”, sa Holm.

– Det er veldig viktig for disse menneskene at samfunnet anerkjenner dem som fullverdige samfunnsborgere, påpekte han. “Socialstyrelsen vil med denne reformen understreke at dette er atferd som ikke er sykdommer og heller ikke er perverst”, sa Lars-Erik Holm (Dagens Nyheter, 2008).

Revise F65 er stolt over å ha hjulpet svenskene til seier og vi håper at den svenske suksessen fører til at diagnosene også blir fjernet i Norge.

Så langt har helsedirektør Bjørn-Inge Larsen (til venstre) uttalt seg i positive vendinger.

– Det er ikke noe grunnlag verken i dagens samfunnsnorm eller helsefaglig tenkning for å kalle flere av disse diagnosene for sykdom, sier han til Nettavisen.

Seniorrådgiver i Helsedirektoratet, Arild Johan Myrberg, sier til Blikk Nett at de stiller seg veldig åpne for at SM-diagnosene vil bli kuttet ut i Norge. – Svenskene bestemte seg for å kutte det ut, og vi i Norge ønsker også å følge opp, forteller Myrberg.

– Alle signaler går ut på at dette er en lite relevant diagnose som er en rest fra tidligere tiders syn på seksualitet. Norge ønsker å følge den faglige utviklingen og ser fram til en opprydding i dette. Det framtidige målet blir at Verdens Helseorganisasjon (WHO) fjerner SM fra sine lister også, men dette vil eventuelt ikke skjer før om noen år, sier Myrberg.

Nestoren blant norske sexologer, Thore Langfeldt (bildet), gir i en uttalelse sin uforbeholdne støtte til svenskenes vedtak. Det er første gang Langfeldt tar så klart standpunkt for å fjerne de stigmatiserende diagnosene.

http://www.nettavisen.no/jobb/article2402153.ece

Den svenske endringen trådte i kraft 1. januar 2009 og omfatter fetisjisme, sadomasochisme, transvestisme, fetisjistisk transvestisme, kjønnsidentitetsforstyrrelse i barndommen og multiple forstyrrelser i seksuell preferanse. Bortsett fra kjønnsidentitetsforstyrrelse i barndommen, så er dette de samme diagnosene som Revise F65 anbefaler fjernet.

– Annen seksuell adferd som for eksempel transseksualitet, ekshibisjonisme, voyeurisme og pedofili kommer fortsatt til å eksistere som diagnoser, sier Socialstyrelsens generaldirektør, Lars-Erik Holm. Transseksualitet trengs som diagnose for å kunne gjennomføre kjønnsskifteoperasjoner og de øvrige er kriminelle handlinger som skader andre, sier han.

Danske helsemyndigheter fjernet transvestisme og sadomasochisme som diagnoser i henholdsvis 1994 og 1995.

Tilsvarende endring skjedde da svenske og norske myndigheter fjernet homofili som sykdomsdiagnose henholdsvis i 1979 og 1982.

– At vi fjernet homosexdiagnosen tror jeg til en viss grad har bidratt til at folk har et annet syn på homoseksualitet i dag enn på 60- og 70-tallet. Det ga de homoseksuelle selvfølelse i og med at de ikke lenger hadde et sykdomsstempel på seg. Og det samme håper vi at denne forandringen skal føre til, sier Lars-Erik Holm.

Den svenske Socialstyrelsen ønsker nå å arbeide for at samme endring skal skje i det internasjonale diagnosesystemet ICD som forvaltes av Verdens helseorganisasjon WHO. Lars-Erik Holm vil også kontakte sine nordiske kolleger.

Diagnoseutvalget Revise F65, et utvalg i Landsforeningen for lesbiske, homofile, biseksuelle og transpersoner, startet allerede i 1997 arbeidet med å fjerne fetisj, sm- og transvestitt-diagnoser fra det nasjonale og internasjonale sykdomsregisteret.

Revise F65 har i en årrekke hatt kontakt med Helsedirektoratet med faglig foredrag og helsefaglig argumentasjon. I 2003 overleverte vi et formelt brev til Helseministeren som vi aldri fikk noe svar på.

(De tilsvarende norske fetisj- og SM-diagnosene ble fjernet av Helsedirektoratet 1.2.2010.)

Referanser:

Dagens Nyheter (2008). Nu ska Sara-Claes slippa bli stämplad som sjuk. Dagens Nyheter 17.11.2008.

Socialstyrelsen (2008). Koder i klassifikationen av sjukdomar och hälsoproblem utgår. Pressemelding fra den svenske Socialstyrelsen 17.11.2008. Retrieved April 29, 2011, fromhttp://www.revisef65.org/socialstyrelsen.html

 

Call to action

Revise F65: Annual report 2009 and a request for support

The ICD diagnoses of Fetishism, Sadomasochism and Transvestism

WHO has started the revision process of ICD from version 10 to 11. Revise F65 asks for your support.

First of all we want to thank all our friends at home and abroad for the cooperation in 2009. Not at least we thank our Swedish friends who made it possible for Sweden to remove fetish and SM diagnoses from January 1, 2009. We can assure you that the Swedish decision has made a great impression on the people responsible for the ICD revision in The World Health Organization, WHO.

WHO is now undergoing the 11th revision of the International Classification of Diseases, and the ICD-11 alpha draft is expected to be ready by May 10, 2010.

According to Senior Project Officer Dr. Geoffrey M. Reed, responsible for the revision of ICD-10 Mental and Behavioural Disorders at WHO’s Department of Mental Health and Substance Abuse, substantial changes in the ICD are dependent upon broad scientific and political support.

”It will be helpful for the recommendations to come from as broad an international coalition as possible, if possible with the formal involvement or endorsement of scientific and professional societies or governments.”
Mail to Revise F65 September 25, 2009.

Revise F65 therefore asks for testimony, quoted reference and supporting evidence from psychiatrists, psychologists, sexologists, researchers of human sexuality and organizations world wide in order to remove Fetishism, Sadomasochism and Transvestic Fetishism as diagnoses from ICD, the International Classification of Diseases published by WHO. Such statements should be sent to Revise F65 (mail: sskeid(A)online.no), and will be forwarded by us to WHO’s Department of Mental Health and Substance Abuse.

As Dr. Reed also emphasizes, it is of great importance that as many countries as possible change their national diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism. The more countries that change their national ICD versions, the bigger is the chance that WHO will follow suit.

Denmark removed the Transvestism and Sadomasochism diagnoses from their national version of the ICD in 1994/95 http://www.revisef65.org/denmark.html

Sweden removed all their fetish and SM diagnoses 1st of January 2009  http://www.revisef65.org/Sweden.html

After several delays in 2009, the Norwegian Directorate of Health has been instructed by the Ministry of Health and Care Services to remove the diagnoses of Transvestism, Fetishism and Sadomasochism from the Norwegian version of ICD-10. “The Directorate of Health aims to bring the decision into force by February 1, 2010″, the Directorate writes in a letter to Revise F65, December 21, 2009.

Revise F65 recommends to abolish the following ICD diagnoses because they are superfluous, outdated, non scientific and stigmatizing.

F65.0 Fetishism

F65.1 Fetishistic transvestism

F65.5 Sadomasochism

F65.6 Multiple disorders of sexual preference

F64.1 Dual-role transvestism

See health political and professional arguments at:

http://www.revisef65.org/icd_whitepaper.html

Regards,

Svein Skeid,

Leader of Revise F65

Examples of statements, quotes and evidence of support:

http://www.revisef65.org/europride3.html

Read our ”annual report” 2009 (included Revise F65 efforts since 1994):

http://www.revisef65.org/about3.html

The Swedish board of health (Socialstyrelsen) on BDSM 2008


Koder i klassifikationen av sjukdomar och hälsoproblem utgår

The content of this page was retrieved August 1, 2009. The link is now dead: http://www.socialstyrelsen.se/Aktuellt/Nyheter/FirstPage/2008/Q4/081117nyhet.htm

Socialstyrelsen tar nu bort vissa koder i den svenska klassifikationen av sjukdomar och hälsoproblem. Bland annat utgår ”Transvestism” samt ”Fetischism”och ”Sadomasochism” från och med den 1 januari 2009.

– Att koder för till exempel vissa sexuella beteenden finns i klassifikationen uppfattas av många som stötande och kan bidra till att bevara och förstärka fördomar i samhället. Det vill vi inte medverka till, säger Lars-Erik Holm, generaldirektör på Socialstyrelsen.

De senaste åren har Socialstyrelsen kontaktats flera gånger av RFSU och andra intresseorganisationer som vill att förändringar görs i den svenska versionen av ICD-10 –  ”Klassifikation av hälsoproblem och sjukdomar 1997”. De ändringar som nu genomförs bygger på konkreta förslag från dessa organisationer.

ICD (International Statistical Classification of Diseases and Related Health Problems) är ett klassifikationssystem som bland annat används för att gruppera sjukdomar, olika tillstånd, beteenden och sociala faktorer som kan vara anledning till kontakt med sjukvården.

Flera kritiska röster

Systemet utgör också en grund för att få information om vilket arbete som utförs inom hälso- och sjukvården: vad patienter vårdas för, vilken behandling de får och vad resultaten blir. Informationen är viktig för att kunna följa upp och utvärdera sjukvårdens resultat och kvalitet.

Kritikerna menar att klassifikationen, som den är utformad idag, på ett olyckligt sätt ger en sjukdomsstämpel åt företeelser som har med könsidentitet att göra, exempelvis transvestism, men även vissa sexuella beteenden. Genom att ändra den svenska klassifikationen vill nu Socialstyrelsen ge en tydlig signal om att vissa diagnoser som specificeras i klassifikationen inte ska ses som sjukdomar. De specifika koder som nu utgår används i praktiken mycket sällan.

Förändringen innebär att följande koder utgår: ”Transvestism med dubbla roller”, ”Könsidentitetsstörning i barndomen” samt ”Fetischism”, ”Fetischistisk transvestism”, ”Sadomasochism” och ”Multipla störningar av sexuell preferens”.

Flera av de aktuella koderna togs bort i Sverige redan 1981 ur Klassifikation av sjukdomar 1968 (fjärde upplagan), motsvarande WHO:s ICD-8, och fanns inte heller med i den svenska versionen av ICD-9. I samband med att den svenska versionen av ICD-10 infördes år 1997 återinfördes vissa koder som en konsekvens av att man strikt följde den nya internationella versionen av ICD.

Tar upp frågan internationellt

– Vi vet att klassifikationens koder ofta uppfattas som sjukdomar, oavsett vad de egentligen står för. Det är olyckligt eftersom det kan bidra till att bevara och förstärka fördomar i samhället, vilket i sin tur ökar risken för social stigmatisering hos enskilda. Det vill vi bidra till att förändra, säger Lars-Erik Holm.

– Vi tänker också fortsätta att ta upp den här frågan internationellt i samband med att WHO nu har inlett arbetet med att ta fram nästa version av klassifikationen, ICD-11. Men det kommer att ta tid och WHO:s arbete kommer sannolikt inte att vara avslutat förrän tidigast 2016, säger Lars-Erik Holm.

Kontakt

Lars-Erik Holm (Nås via presstjänsten 075-247 30 05)

Uppdaterad: 18 november 2008

 


English
text


This press release in Swedish from The Swedish board of health (Socialstyrelsen) was retrieved from their home page August 1, 2009. The link is now dead.

Socialstyrelsen announced on their home page November 17, 2008, that six diagnoses of sexual behaviours will be deleted from Sweden’s national version of ICD diagnoses starting on January 1, 2009. The six diagnoses include sadomasochism, fetishism, transvestism, fetishistic transvestitism, multiple disorders of sexual preferences and gender identity disorder in youth.

The Swedish revision was done because these psychiatric diagnoses “may contribute to preserve and reinforce prejudices in society, which in turn increases the risk of social stigmatizing of individuals”.

Read more here!

 

Fetish and SM diagnoses deleted in Sweden

Fetishism and Sadomasochism no longer diseases in Sweden

Inspired by Revise F65, Fetishism and Sadomasochism, along with four other sexual behaviours, were repealed from Sweden’s official list of medical diagnoses January 1, 2009.

By Svein Skeid

November 17, 2008, the Swedish National Board of Health and Welfare (Socialstyrelsen) announced that six diagnoses of sexual behaviours will be deleted from Sweden’s national version of ICD diagnoses. The six diagnoses include sadomasochism, fetishism, transvestism, fetishistic transvestitism, multiple disorders of sexual preferences and gender identity disorder in youth.

Except for gender identity disorder in youth, these are  the same diagnoses that Revise F65 recommend to remove from ICD, the International Classification of Diseases.

The first seed

According to RFSU secretary Wiktor Södersten, the very first seed was sowed at the RFSU congress in 2005, when he talked with the present RFSU coordinator and educator Helene Delilah about the Norwegian Revise F65 web pages.

November 23, 2006 Mika Nielsen wrote an article in the biggest gay and lesbian Swedish newspaper QX. She encouraged the Swedish sexual political movement to follow the example of the Revise F65 pioneer group and start the work to remove transvestism and BDSM-diagnoses from the ICD-10.

A working group was established after the model of Revise F65 with members from Swedish gay, lesbian and heterosexual fetish and SM groups (Club Sade, LASH, Club Sunrise, Dekadance and RFSL). Mika Nielsen wrote a new article in “Ottar”, the newspaper of RFSU (the Swedish Association for Sexual Education). Once again she referred to the Norwegian Revise F65 efforts.

The RFSU winter congress in 2007 decided to work for education about fetishism and BDSM and to work for abolishment of the same diagnoses as is on the agenda of Revise F65. However, the Swedish Lesbian and Gay Organization RFSL was not willing to support this agenda in the same way as the Norwegian LGBT Association, LLH (FRI) does.

July 29, 2008. During Europride in Stockholm, the Revise F65 leader Svein Skeid had talks with RFSU, participated in panel discussions and gave a presentation about the Revise F65 work. We gave them our memory stick with all relevant political health arguments and scientific evidence.

Four weeks later, August 27, 2008, referring to the cooperation with Revise F65, RFSU sent a formal letter demanding the removal of fetishism and sadomasochism from the National Board of Health and Welfare (Socialstyrelsen) registry of diseases.

Health political arguments

Agency head Lars-Erik Holm’s (picture) arguments for the Swedish revision announced November 17, 2008, were word by word concurrent with the health political premises of Revise F65.

http://www.revisef65.org/icd_whitepaper.html

The Swedish revision was done because these psychiatric diagnoses “may contribute to preserve and reinforce prejudices in society, which in turn increases the risk of social stigmatizing of individuals”.

“The abolition of  the diagnosis of homosexuality 30 years ago gave the group self confidence because they no longer had a psychiatric stigma. We hope that the current revision will give a similar result.”

“These diagnoses are rooted in a time when everything other than the heterosexual missionary position were seen as sexual perversions. The changes emphasize that these behaviours are not illnesses in and of themselves, nor are they something perverse. It is very important for these individual that the society acknowledge them as equal members of society“, said Lars-Erik Holm, Director General of the Swedish National Board of Health and Welfare.

In line with recommendations from Revise F65, other F65 diagnoses like transsexualism and pedophilia will remain as diagnoses and not be removed at a later stage. “Transsexualism needs to be left to carry out gender reassignment in health care, and pedophilia is a criminal act that harms others”, according to Lars-Erik Holm.

Victory for Revise F65

In a press release immediately after the Swedish announcement November 17, 2008, the Revise F65 leader Svein Skeid characterized the decision as a victory for the fetish/SM population and for the Revise F65 strategy to motivate other countries to remove their national versions of the ICD SM/fetish diagnoses.

http://www.nettavisen.no/jobb/article2402153.ece

Revise F65 is happy to have succeeded with that strategy. Now we hope to bring about the same changes in Norway and in the World Health Organization, WHO.

The BDSM Organization SMil November 18, 2008, sent a letter to the The Ministry of Health and Care Services asking him to remove the fetish and SM diagnoses in Norway. In an answer December 19, 2008 the Ministry of Health and Care Services said they had given the Directorate of Health the responsibility of taking a decision in the case.

Positive Norwegian reactions

So far, Norwegian health authorities have responded positively to the Swedish decision.

According to Nettavisen, the head of the Norwegian Directorate of Health (Helsedirektoratet), Bjørn-Inge Larsen (picture), said: “There is no basis, neither within today’s social norms nor within health political thinking, for labeling several of these phenomena as illnesses”.

Senior adviser in the Directorate of Health, Arild Johan Myrberg, was also “very positive to the idea of removing the SM diagnoses in Norway”. – This is not a very relevant diagnosis and has to do with past times view of sexuality. Norway wants to follow up the professional development and looks forward to cleaning up this matter. The future objective is that the World Health Organization removes SM from their list of classifications, but this will possibly take some years, he said.

Also the prominent Norwegian sexologist and psychologist Thore Langfeldt (picture) supported the Swedish decision.

February 2, 2009, psychologist Odd Reiersøl and the Revise F65 leader Svein Skeid had a short meeting at the office of the Norwegian Directorate of Health where we delivered a memorandum with health political and professional arguments for why the SM and fetish diagnoses should be removed from the Norwegian ICD-edition.

http://www.revisef65.org/icd_whitepaper.html

At a meeting with the Revise F65 committee and the Norwegian Directorate of Health May 11, 2009, Senior adviser Arild Johan Myrberg informed that a decision to repeal Norwegian fetish and SM diagnoses can be announced fall 2009 with the intention to bring the decision into force January 1, 2010.

Denmark repealed the dual-role transvestism diagnosis and the SM diagnosis respectively August 19, 1994 and May 1, 1995. The American Psychiatric Association considerably revised the criterion for SM and fetish diagnoses in 1994.

Workshops during Europride Manchester + London


“How to remove SM and Fetish diagnoses”

Workshop Manchester
Sunday, August 24th at 1pm
Malmaison Hotel, Piccadilly (Gore St), (the mezzanine lounge)

Workshop Manchester (women only)
Sunday, August 24th at 2pm
The Lesbian and Gay Foundation, 15 Pritchard Street (off Charles Street)

Workshop London
Thursday, August 28th 7pm-9pm
Central Station, 37 Wharfdale Road, Kings Cross, (main bar)

You can also read the introduction to the workshop online at www.reviseF65.org/workshop.html

  • The stigma attached to SM and Fetish diagnoses is used to justify violence, harassment and persecution because of people‘s SM-preference.
  • SM people lose their jobs and the custody of their children because their love and lifestyle is still considered as a disease.
  • Even law court verdicts acquit self-identified murderers and rapists because the victims are stigmatized as sick perverts.

Fetishism, transvestism and sadomasochism are still considered mental illnesses by The World Health Organization and most countries, despite the fact that US psychiatrists revised their DSM manual nine years ago, and Denmark, as the first European country, totally removed the SM diagnosis in 1995.

Join the ReviseF65 efforts to remove diagnoses from the International Classification of Diseases!

The ReviseF65 project is established with a mandate from the 1998 Convention of the Norwegian National Association for Lesbian and Gay Liberation (LLH). Our efforts is so far supported by the Norwegian Association of Gay and Lesbian Physicians, the Norwegian Society for Clinical Sexology, the 1999 European Conference of the International Lesbian and Gay Association (ILGA) and the 2000 General Assembly of the European Confederation of Motorcycle Clubs (ECMC).

The ReviseF65 group consists of Leather/SM/Fetish men and women representing organizations of Leather and SM gays, lesbians, bi- and heterosexuals, as well as professionals in sexology, psychology and psychiatry.

Join the mailing list: to be informed and have your voice heard, join the e-mail discussion group at www.revisef65.org/moderator.html.

From Thursday 21st August to Monday 25th August, you can contact Svein Skeid and Eric Barstad at The Rembrandt Hotel, 33 Sackville Street, Manchester, rembrandthotel@aol.com, tel: 0161 236 1311.

From Tuesday 26st August to Sunday 31st August, you can contact us at Blades Hotel, 122 Belgrave Road, Victoria, London, tel 020 7976 5552.


www.reviseF65.org
founded in Norway – serving the world
 

THE SO-CALLED “DEVIANT” SEXUALITIES: PERVERSION OR RIGHT TO DIFFERENCE?

THE SO-CALLED “DEVIANT” SEXUALITIES:
PERVERSION OR RIGHT TO DIFFERENCE?

This study, presented at the 16th World Congress of Sexology in Cuba 10-14 March, 2003, suggests that non-conventional sexual practices cannot be used as a diagnosed criteria of any kind, which means that the only aspect that distinguishes these individuals from others is their sexual practices.

INTRODUCTION

The Internet became one more vehicle where people, occasionally or routinely, may enjoy or accomplish sexual fantasies and desires, often unconfessable and frustrated in their love and sexual relationships, safely and anonymously, without their real identities being revealed.

Similarly, the Internet provides opportunities for men and women, regardless of sexual orientation, marital status or age, and with distinct sexual preferences, to make come true, in the “real” world, a contact started and kept through online communication (Martins & Grassi, 2001).

Starting from the premise that the definition of “normality” is historically and culturally built, concepts such as “normal”, “healthy” and “pathological” are being questioned by all professionals who are interested in the study and comprehension of human sexuality.

The innumerable manifestations of human sexuality, so as the most varied searches for pleasure, confirm once more that, for the human being, sexuality is not linked to procreation.

The dynamics of human sexuality – what leads an individual to have the sexuality one has – has been an object of study since ancient times, without a consent being reached, which has lead to the search of new paradigms for understanding the so-called “deviant” sexual behaviors.

One of the reasons that make the comprehension of unconventional sexual interests difficult is that the traditional sexual paradigm, based on psychology and psychiatry, as well as on popular opinion, assumes that procreation is the most important biological function (Fog, 1992).

Most collected and studied data about so-called “deviant” behaviors were based on cases considered pathological.

Such studies were made under the legal medical view, or having as reference people who sought for psychiatric and/or psychological treatment because their sexual preferences “deviated” from “normal” sexual behavior (Ceccarelli, 2000) – understood as heterosexual relationship, ending on genital penetration and with the intention of procreating.

Certain so-called “deviant” practices, such as Sexual Sadism and Masochism and also Fetishism, are categorized as “paraphilias” and disfunctional behaviors in the Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition), DSM-IV, by the American Psychiatric Association (APA) and in the International Statistical Classification of Diseases and Related Health Problems – 10th revision (1999), by the World Health Organization, which has generated many debates regarding diagnostic criteria, with which many professionals who are interested in the study of “alternative” sexual practices do not agree.

This study aims to explore human sexuality in its most diverse variations such as BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism) or SM, and Fetishism, through an online questionnaire sent to a group of people who describe themselves as BDSM and Fetish practitioners, and who have in the Internet their referential for the exchange and search of information, as well as the search for partners who share the same sexual fantasies.

This study has no intention of encouraging or condemning the choice of sexual practices, but of exploring the diversity of adult human sexuality of a group of people in the context of the contemporary Brazilian society.

METHOD

An e-mail was sent to the various discussion groups and classified ads posted on websites directed to consensual BDSM and Fetish practitioners in Brazil, and who use the Internet as a means of exchanging and obtaining information and contact with people who share the same sexual fantasies. The exploratory character of the study was explained, that it would be conduced basically via e-mail, and that the real identity of the participants would be preserved. Those who were interested should be over 18 years old, their sexual orientation or marital status notwithstanding. It was asked to the volunteers that they got in touch by replying the sent e-mail. One hundred and eleven people from various Brazilian states manifested their interest in participating. They were sent, then, a questionnaire with questions such as why they used the Internet, which sexual practices they were involved in, how and when they became interested in sexual activities that were considered “different” and how they felt about having pleasure with practices that are considered unconventional.

Information on their age, religious formation, sex, marital status, education and sexual orientation were also the object of interest for the research. It was not the aim of the present study to establish diagnostic criteria of the researched sample, or describing in details the unconventional sexual practices.

DISCUSSION

In spite of the growing evolution observed along the years in human sciences and in the technologic and scientific fields, sexuality is still the object of much speculation, prejudice and taboo. If we observe the diverse current reactions in face of sexual manifestations, we will see how much such reactions remain unchanged throughout History. Although the sixties‘ “sexual revolution” and the innumerous movements aiming at the recognition of human rights (especially the feminist) have changed the social scenery, sexuality is still an enigma for the human being and the object of many discussions since antiquity.

From the 5th Century on, due mainly to the leading Christian Fathers – Augustine, Jerome and Thomas of Aquinas – sexuality was linked to and procreation: the unquestionable example that follows is the “naturally heterosexual” life of animals. All sexual practice that falls out of that norm would bring what is known as the “negative pleasure stigma”.

Then, a form of morality that is essentially a sexual morality appeared. Practices “against nature” – considered offensive to decency, to custom and to public opinion – bring out severe sanctions, so that “normal” may be kept.

However – History shows that – such an objective was never reached: sexuality always escaped all attempts of normatization (Ceccarelli, 2000).

In the late 19th Century, the contemporary psychiatric discourse appears, marked by the same moralistic view;

it maintains the theological and juridical positions, bringing to the medical order what was, until then, from the juridical. The great psychopatologists of that epoch, among them Havellock-Ellis (1888) and Kraftt-Ebing (1890), classified and labeled the sexual practices that escaped moral rules.

A detailed inventory of the so-called “deviant” sexualities was traced, in which new forms of sexual practices (those which use the other for obtaining pleasure and in which the natural finality of sexuality – procreation – is subverted) were created: homosexualism, voyeurism, exhibitionism, sadism, masochism, joining the endless psychiatric nosography of that time. It is also when some terms, that later became classical, are introduced: perversion (1882, Charcot and Magna), narcisism (1888, Havellock-Ellis), auto-erotism (1899, Havellock-Ellis), sadism and masochism (1890, Krafft-Ebing) [Ceccarelli, 2000].

In the late 19th Century and, in a stronger way, in the early 20th Century, Sigmund Freud, in his most important text on sexuality, the “Three Essays on the Theory of Sexuality” published in 1905, sustains that subordinating sexuality to the reproductive function is “a too limited criterion”. In Freudian perspective, sexuality is against nature, that is, as far as sexuality is concerned, there is no “human nature” (Ceccarelli, 2000).

Joyce McDougall and the concept of “Neo-Sexuality”

Contemporary author Joyce McDougall (1997) made an important and innovative reading of Freud, regarding perversion. According to the theoretical perspective of the author, the word “perversion” has a depreciative conotation and points towards negativity, since one never hears of someone who was “perverted” to good. The author maintains that, besides the moralistic implication in the vernacular use of the word, the current standard of psychiatric and psychoanalytic classification is equally questionable. When labeling and diagnosing someone as “neurotic”, “psychotic”, “psychosomatic” or “perverted”, the innumerable variations of psychic structures of each clinical category are not taken into account, losing sight of the most remarkable aspect of human beings in their genetic structure, which is their “singularity” (McDougall, 1997, p 186). Regarding the so-called perverted sexualities like fetishism and sadomasochist practices, she verifies that those occur in the quality of erotic games in sexual activities of non-perverted adults, be they heterosexual or homosexual, so that such practices do not provoke conflict, for they are not experienced as compulsive or as exclusive conditions for sexual pleasure. But heterosexual or homosexual adults who only have fetishist or sadomasochist erotic scripts, for whom those sexual practices are the only means of access to sexual relations, there must be care as to want those people to lose their heterodox versions of desire, simply because they may be considered symptomatic. Instead of “perversion”, McDougall (1997, p 188) prefers to name them “neo-sexualities”. According to the author, the term “perversion” would be more appropriated as a label for acts in which an individual imposes personal desires and conditions on someone who does not wish to be included in that sexual script (as in the case of rape, of voyeurism and exhibitionism) or seduces a non-responsible individual (as a child or a mentally disturbed adult) [McDougall, 1997, p 192].

<!–nextpage–>

 


PAGE 2

The Manuals of Mental Health and Project ReviseF65

Svein Skeid is one of the responsibles for the Project ReviseF65 or Project ICD (www.revisef65.org) that aims to mobilize, through a website and a discussion group on the Internet, SM/Leather/Fetish groups and professionals in the field of mental health in all the world, with the purpose of taking away the psychiatric diagnoses (“paraphilias”) of Fetishism, Transvestism and Sadomasochism from the International Statistical Classification of Diseases and Related Health Problems (www.revisef65.org/ICD10.html), published by the World Health Organization (WHO). The diagnoses of “paraphilia” may serve as a justification for stigmatization and violence against sexual minorities. Several reports of violence against Sadomasochism and Fetish practitioners may be found in the ReviseF65 website (www.revisef65.org). The U.S. Leather Leadership Conference reports that thirty to fifty percent of the SM population suffers discrimination, violence or persecution due to their sexual orientation. Project ICD states that “Stigmatizing minorities by diagnosing their sexual orientation is on the contrary as disrespectful as discriminating people because of their race, ethnicity or religion”. It is, undoubtedly, a legitimate proposal in defense of the human rights of sexual minorities.

Countries as Denmark, in consonance with the legitimate needs and rights of sexual minorities, have totally withdrawn the diagnoses of sadomasochism from their health manuals in 1995.

The Diagnostic and Statistical Manual of Mental Disorder – Fourth Edition (DSM-IV, 1995, pp 495) also classifies Fetishism and Sexual Sadism and Masochism as “paraphilias”, in which, besides the existent recurring and intense fantasies and sexual impulses or behavior involving those practices (Criterion A), those fantasies, sexual impulses or behaviors must cause a clinically significant suffering or damage in social or occupational functioning or in other important areas of the individual’s life (Criterion B) [DSM-IV, 1995, p 495]. In case Criterion B is not met, the sexual variants above are not considered pathologic or symptomatic, configuring only a variation of adult human sexuality.

Due to the lack of information and knowledge of what consensual erotic practices are about, their practitioners are erroneously classified as victims or perpetrators of coercitive acts of violence and sexual abuse.

BDSM Concepts and Practices

Consensual fetishist and sadomasochist practices are not easily defined, for they include a wide range of behaviors from which many practitioners do not appreciate all roles and activities, being the detailed description of each BDSM or Fetishist practice beyond the scope of the present study. We will focus, however, on the most general terms.

The term “BDSM“, that refers to the sadomasochist universe as a whole, involves all its aspects – dominance, submission, bondage, discipline, sadism and masochism, while SM means “sadomasochism” (Paschoal, 2002, p 14). However, the relationship between them is analogous to the distinction between the terms “homosexual” and “gay” (Moser, 1996, p 24).

According to this author’s theoretic perspective, “Dominance and Submission (DS) implies the deliberate transference of psychological and sexual control from one partner to the other without, necessarily, elements of physical pain or humiliation”.

The term “Bondage and Discipline“, “B&D” or “B/D” refers to sexual practices with various kinds of immobilization or physical restraint, while “Discipline” indicates the acting out of fantasies that relate to punishment/penalties like, for example, the “teacher/student” fantasy.

Humiliation” refers to role-playing scenes in which the dominant partner detains control of power over the submissive partner, inflicting and ritualizing psychologic tortures, like verbal insults of a sexual conotation.

Regarding the terms “sadist” and “masochist“, there is a more physiological conotation, in which people experiment pleasure sensations in giving and/or receiving carefully controlled spanking with slippers or whips (Moser, 1996, p 25).

The word “leather” is used in the sadomasochist community by gays and lesbians (Moser, 1996, p 63).

Other behaviors also generally included in the sadomasochist practice are “age play”, a fetish that demands a partner to act as being of a different age, sometimes older, sometimes younger (playing as a baby, for example); forced or voluntary feminization of male submissives who wear high heel shoes, lingerie and female dresses (“crossdressing”), and also sexual plays involving urine and excrements. Paschoal (2002, p 16) maintains that “each of these concepts has personal, individual and unique aspects, like the people who practice them… Each one is free to choose which and how they prefer them… It is impossible to follow them in a literal way, since human creativity and individual freedom are what is the most precious in the human being”.

With the same creativity, the BDSM community created the term “vanilla“, for referring to conventional sexual practices that do not involve any SM component (Scott, 1997, p3). The “Safety, Sanity and Consensuality” triad (Brame G, Brame W & Jacobs, 1993, p 49) is considered a basic norm for consensual unconventional practices and may never be ignored or neglected. Paschoal (2002, p 22) states that the non-existence of any of the SSC aspects makes any and all BDSM relationship totally inviable.

By “Consensuality“, Moser (1996, p 31) understands the voluntary agreement firmed between the participants of the erotic play, in which the limits of each participants are honored. He explains that domestic abuse that occurs between a couple cannot be named “SM”, for SM is consensual, and abuse imposed on a partner is not. We may use as an example sexual intercourse and rape, where the former is consented and the latter is imposed by coercion. Therefore, the difference between sadomasochism and true violence is to be found in “informed consent” (Moser, 1996, p 31).

Sanity” refers to being aware of what the participants are doing in an SM scene: it is a fantasy that does not correspond to reality. Certain BDSM practices imply considerable risk. In this sense, the knowledge of the partner, the establishment of limits and knowing the risks inherent to each practice are very important factors for the erotic BDSM play to be safe and pleasant. It is also worth saying that safety involves some prohibitions. As it is extremely important that one has complete awareness of what one is doing, the use of alcohol or any kind of drugs is severely unadvisable before or during the BDSM scene or play (Paschoal, 2002, p 27). In case any physical or psychological limit is surpassed, the use of a “safeword” reestablishes the limits of physical and emotional safety of the participants and the play is immediately interrupted (Paschoal, 2002, p 25).

According to Brame, G, Brame, W & Jacobs (1993, p 358), the word fetish comes from the Portuguese word feitiÁo and it is said to be used for the first time by Portuguese explorers in the 15th Century, for describing sacred images. In its anthropologic meaning, fetish is linked to sacred artifacts that are invested of spiritual powers. For fetishists, the erotic fetish is the symbol of the divine itself, being able to arouse and even to induce their devotees to ecstasy. Examples of erotic fetishes are found in those who admire a pair of shoes, instead of the feet that wear them; or the feet are considered extremely arousing, in detriment of the human body as a whole. All human beings are fetishists to some degree. In Brazilian culture, buttocks are the object of national adoration, while in American culture, breasts are extremely valued. In China, small female feet are extremely sexy. This demonstrates that different cultures elect their own fetishes. As Paschoal (2002, p 68) illustrates very well, “a fetish would be a specific preference in a universe of possibilities… BDSM is more like a fantasy full of fetishes. So as a masochist prefers (or has the fetish of) receiving pain, or being tortured exclusively with ropes, or with candles, or with ice, or with all alternatives, or with none of them, the sadist prefers (or has the fetish of) causing pain. They are all fetishes”.

Regarding Brazilian reality, the Internet became a powerful vehicle for the search of information and contacts for people who are interested in the erotic sadomasochist and fetishist practices, largely contributing for the formation of a “virtual” subculture of sexual minorities. The Brazilian BDSM movement is at an embryonary state, but growing, with hundreds of websites and discussion groups (www.yahoo.com.br and www.msn.com.br), trying to form a gathering movement that provides recognition, visibility and contacts outside “virtual” reality, following an international tendency proposed by American organization “The National Coalition for Sexual Freedom” (NCSF), that fights for equal rights in the legal, political and social fields for adults who are engaged in the practice of alternative sexual expressions. According to articles on SM available in their website (www.ncsfreedom.org.), NCSF explains that Sadomasochism is not abuse or domestic violence, being the latter “a pattern of intentional intimidation of one partner to coerce or isolate the other partner without consent” (www.ncsfreedom.org/what.htm), as opposed to what happens in BDSM practices, in which the partners involved agree on everything that will happen in the erotic play, besides being well informed about possible consequences of the erotic power exchange game. It also explains that domestic violence may occur in any group of people, including SM practitioners, but with the difference that within the sadomasochist community domestic violence is not forgiven, and victims as well as abusers are encouraged to look for specialized help.

<!–nextpage–>

PAGE 3

RESULTS

Table 1

As we may see from table 1, the great majority of the total sample (n = 111) is composed by heterosexuals, but only seven (6,3 %) respondents are female, being four (4) officially married and three (3) single. The number of people who have partners and practice the same sexual fantasies, 36,1%, was larger than expected.

It is interesting to point out that in sexual practices involving Submission and Masochism (43,3%) only six (6) are heterosexual women, while the rest of the group are males, regardless of sexual orientation. Catholic religion (53,2%) has more representatives (which reflects Brazil’s religious proportions). The education level is high, 70,3 being graduated and 13,5% post-graduated.

CONCLUSION

We will quote below excerpts from some reports for illustrating the qualitative part of the study, in which respondents talk about how they feel regarding their sexual experiences and the topics that were approached in the questionnaire they answered.

– SS, post-graduated, fetishist, 35, married: “When I was about five years old, I remember getting aroused by wearing satin gowns, I liked to urinate on them and feel the smell of urine for many days… Since I was a child I realized I had “different” desires, but I was only able to understand that in fact these fetishes are not an “aberration of nature” three years ago, with the Internet… on the net I saw, talked to and knew there are people with the same tastes”.

– S., enterprise administrator, masochist, 34, married, remembers: “There was this game of police and thieves and the girls were always the police and the boys were the thieves. Girls ran after, caught and arrested the boys. I remember that when I was arrested, I always asked to be tied up, or I would run away; so I developed, unnoticing, my instinct of submission to females… A fantasy that impressed me in my child and teen years was “Catwoman” from the Batman series… Today, seeing it again with experienced eyes, I can perceive a very explicit fetishist citation. Catwoman was beautiful, that latex suit tight on her body… Whenever she captured the heroes, they were tied up and were at her feet… She was always shown, in her hideout, sitting on a throne on a pedestal, and her helpers sat on the floor at her feet… sometimes she found a way to step on a helper… pure fetish”.

– Fbond, importer, bondage fetishist, 31, married: “I take bondage and fetishism very seriously, I don’t like anything that causes pain, but I like the seduction allied to bondage, underwear, insinuating clothes (but not vulgar), I am cultured… I found out I was a fetishist at age 8 watching a Jerry Lewis movie and now I have more than 150 tapes of that kind… I consider myself a very friendly person, so I think it’s absurd that a fetishist should be put in the class of “abnormals”. Maybe there are even cases like that, but it’s not the majority”.

– Al Z, dominator, post-graduated in System Analysis, 38, married, reports: “Since I was a child, I appreciated scenes with bound or spanked women (generally in movies), when I knew nothing about sex… I think it was instinctive… I awoke to my fantasies five or six years ago, when I accidentally entered a site… at that time, I was 32 or 33 and that fact totally changed my life… Bondage and spanking (female buttocks) arouse me a lot, and also other forms of physical and psychological domination like, for example, transforming my partner into a dog, putting on her a collar and a leash… My relationship with my spouse is “standard”, that is, it follows religious and social rules for marriage… She doesn’t know about my incursions into the virtual world, not even that I look for someone to make my fantasies come true in the “real”. I feel like an absolutely normal person… What I think is that society is really afraid to admit that who likes BDSM (within the erotic context, of course) is a normal human being. People always look forward to living with more pleasure and BDSM is one more alternative form of reaching it fully… I never opened up to someone as much as I’m doing to you now, but I feel very good, because it was suffocating me”.

– J., System Analyst, submissive, 32, single: “I feel perfectly normal and even – why not – privileged, for knowing how to explore my sexuality in a different and much more intense way than most people do. I’m very happy to have enough capacity to understand my fetish and to enjoy it in a healthy, safe and very peculiar way”.

– N., administrative assistant, bondager, 26, single: “I like to be bound and completely immobilized, to feel completely vulnerable in the hands of my partner, not being passive but struggling because I was tied up, as if I was forced to be in that situation, not accepting passively that the other ties me up, but trying to “escape”, to get free, and end up being “defeated” by his strength and technique… the deprivation of senses, like vision and speech… this way they become sharper, but not knowing what the other person is going to do is an incomparable sensation… being gagged is an indescribable sensation… Putting all that together is an inexplainable sensation… Sincerely, I feel more normal than other people, I accept myself. I think what is abnormal is people neglecting themselves, or even living a faÁade relationship and looking beyond for the fulfillment of their fantasies… I believe that people can only be totally happy when they look for a relationship that fulfills them totally… (that is) difficult, but living a double life is still more difficult… in one of them you will be acting out… The society in which we live in is hypocrite… everyone has fantasies, but to fit the “normal” standard, they don’t recognize it and even criticize and get shocked with other people’s opinion. I believe that each one owns their life and owe no explanation to others about what they like or dislike within four walls; better yet, I think we must be free to live out our fantasies and other quotidian things too; of course, respecting the other’s limits and space. For me, BDSM is a form of pleasure, it is a vast world with many branches and each person chooses among those what really gives them pleasure… I chose mine and I am not bothered by the fact that society does not accept it or thinks I am an aberration… I feel more normal than everyone, for I am sincere with myself, I recognize and accept myself like that and it makes me happy…”

– M.H., dentist, crossdresser, submissive, 39, married: “I am married and my wife takes part in everything and has dominated me for over one year… As you may see, I’m a submissive crossdresser and I behave accordingly. I’m my wife’s sissy. I dress as a woman everytime I can, do all housework and I’m a woman for my wife. I’m totally passive and she is active… I often get spanked and humiliated, and I love it… I found out that what I felt and did was in tune with the BDSM universe when I was 18. But not knowing it was a BDSM attitude, ever since I can remember… since 6 or 7… I loved to play house with my cousins and I was always the housemaid, always working and humiliated. This was the role I chose. It gave me pleasure and, in my point of view, it fits BDSM. When I was 10 I came for the first time, when putting on an aunt’s skirt… I came without even touching myself. Since then I was always out of standards, but at 16 I noticed I was “different”. Would I be gay? But how would I be gay if I never had interest in men? But if I wasn’t gay, why would I fantasize myself in the female role?… Unfortunately, people live in a standard, hipocritely proposed by this machist and repressive society we live in.”

<!–nextpage–>


PAGE 4

– ZZ, billing assistant, submissive foot fetishist, 34, married: “My relationship with my wife is the best possible, in all senses. She knows about my attraction for feet, so much that she began taking more care of them and sometimes, when we make love, she spanks me with her slippers and I like it a lot. Since there is no physical or emotional damage to anyone and both agree on it, any practice is worth it, between a couple. The way society sees or judges my acts is not at all relevant to me.”

– JP, lawyer, sadist, 38, married: “I feel privileged for having certain sexual interests that are different from most people’s and for always being able to make them come true. BDSM is very complex, for there are different levels of SM and I’m in an intermediate one… some practices are indigestive for me, like coprophagy, public humiliation, cuts or burning, but as the word goes, “if done with their consent, the problem is theirs”…”

We may suggest that the people that took part in the researched sample, far from representing the totality of individuals with unconventional sexual practices in Brazilian society, feel in tune with their diverse sexual preferences, which are experienced as pleasant, and also feeling privileged for having a “differenced” sexuality from those who see in sex and in conventional roles the only form of expression for love, intimacy and fulfilling their sexual fantasies.

We cannot affirm, by the collected and reported data, that BDSM and Fetish practitioners who took part in this study may be called “paraphilic”. We would rather describe them as aware and well informed practitioners, and conscious of what we consider as variants in the complex adult human sexuality expression.

The use of the Internet is clearly important in the formation of a consensual BDSM subculture in Brazil, not only for communication and obtaining information among similar practitioners, but also as a mechanism of social inclusion, gathering thousands of people who share the same unconventional fantasies and practices. This study was made possible exactly because of the easy access, anonymity and the facility that the Internet provides to its users. Cooper et al (2000, p 6) states that the Internet offers the opportunity for the formation of virtual communities, in which the isolated and discriminated, like, for example, gays and lesbians, may communicate about sexual topics that interest this community.

When they realize the number of “equal” people, the sensation of isolation and of being “different” decreases or disappears and a new sense of “belonging” and identity appears for those who, before the advent of Internet, felt “abnormal” and “out of standard” for not having someone to share their longings and fantasies due to the prejudice and stigma regarding everything that deviates from the “norm” or “standard”.

We may suggest that the Internet may serve as a virtual “life-boat” for, when giving the opportunity to BDSM and Fetish practitioners and other sexual minorities to “come out of the closet”, it provides them an environment with no repression, prejudice, and where everything is possible in the fantasy world, and also giving the opportunity for those fantasies to come out of “virtuality” and be made true in the “real” world. According to Bader (2002, p 259), the question why some people act out their fantasies, while others do not, has no easy answer. In his theoretical perspective, it is easier to understand why someone develops some sexual fantasy or practice, but one can rarely affirm why this person acted it out or simply kept it in the fantasy level.

The world has gone through technological changes that are almost impossible to keep up with in the field of human life conception: the “test-tube” baby and artificial insemination are now current practices, once impossible to be imagined and made true, as is now the possibility of human cloning in laboratories. Novelty is frightening, provokes fears and feelings of unprotection.

But it is undeniable that changes in mentality are on their way, in this new millenium. Judeo-christian tradition, that has shaped the basis of Brazilian society for centuries, shows to be anachronic before the mentioned facts and what is yet to come.

The propagated “naturally heterosexual” animal life, that served as justification for the inprisonment of sexual desire and pleasure by religious institutions, begins to fall down with the latest scientific researches about the animals’s sexual life, which demonstrate that the “practices against nature” are also part of animal sexuality (www.subversions.com/french/pages/science/animals.html).

Where are we going to, since psycho-social, religious and cultural concepts and norms, that once defined the notion of “normality”, no longer apply to the pluralist society that we see? Our traditional sexual ethic, followed for a hundred years, no longer fits socio-cultural changes and the new challenges of the 21st Century. We live in a plural society, in which the most diverse expression of adult human sexuality are becoming visible and want to be accepted, recognized and legitimated. Sexual expressions that demonstrate maturity, respect and awareness among those who practice them. It is worth pointing out that feeling comfortable and in ego-syntonia with their sexual practices may have been the reason that took these individuals to take part in this study. The line that separates consensual BDSM practices and the so-called “perverted” practices is very thin. But is important that one knows how to distinguish one another.

And, based on that distinction, the present study has demonstrated that, in spite of its limited range, it is a human right to be “different” from majority and, consequently, to have that “difference” respected and accepted by all others.

REFERENCE

Animals prefer Homossexuality to Evolution. Retrieved January 17, 2003, from www.subversions.com/french/pages/science/animals.html

Bader, M. J. (1997). Arousal. The Secret Logic of Sexual Fantasies. Thomas Dunne Books, pp 259-260.

Brame G, Brame W & Jacobs (1993). Different Loving. The World of Sexual Dominance & Submission. Villard Books, NY, pp 49, 358.

Ceccarelli, P.R (2000). Sexualidade e Preconceito. Article published in the Revista Latinoamericana de Psicopatologia Fundamental, SP, III, 3, 18-37. Retrieved October 10, 2002, from www.geocities.com/HotSprings/Villa/Villa/3170/PauloCeccarelli.htm

Classificação Estatística Internacional Das Doenças e Problemas da Saúde (ICD-10). Retrieved May 7, 2002, from www.desejosecreto.com.br/revisef65.html [Dead link]

Cooper A et al. (2000). Cybersex. The Dark Side of the Force. Taylor& Francis, p 6.

Fog, A (1992). Paraphilias and Therapy. Nordisk Sexology, vol10, pp 236-242. Retrieved October 1, 2002, from www.ipce.info/ipceweb/Library/98-053r_fog_eng.htm

Manual Diagnóstico e Estatístico de Transtornos Mentais – 4a Edição DSM-IVtm (1995). EditoraArtes Médicas, Porto Alegre, 1995, p 495.

Martins M C, Grassi M V F C (2001) American Women and Internet Infidelity. Abstracts Book. 15th World Congress of Sexology, June 24-28, Paris, p 149.

MCDougall, Joyce (1997). As Múltiplas Faces De Eros. Martins Fontes, SP, 2001, pp 186, 188, 192.

Moser C, Madeson JJ (1996). Bound to be Free. The Continuum Publishing Company, NY, 2000, pp 24, 25, 31, 63.

Paschoal H, (2002). Sem Mistério. Uma Abordagem (Na) Prática de Bondage, Dominação, Sadismo e Masoquismo. Editora Cia do Desejo, Campinas, SP, pp 14, 16, 22, 27, 68.

Scott, G G (1997). Erotic Power. An Exploration of Dominance and Submission. Carol Publishing Group, p3.

The National Coalition for Sexual Freedom. Retrieved July 24, 2002, from www.ncsfreedom.org/what.htm

www.associacaobdsm.com.br. Retrieved May 7, 2002 [Dead link].

www.msn.com.br. Retrieved April 02, 2002.

www.revisef65.org. Retrieved April 02, 2002.

www.subversions.com/french/pages/science/animals.html. Retrieved January 10, 2003.

www.yahoo.com.br. Retrieved April 02, 2002

 


Author: Maria Cristina Martins, Clinical Psychologist and Specialist in Human Sexuality. Campinas, SP, Brazil

Co-author: Paulo Roberto Ceccarelli, Psychologist, Psychoanalyst, PhD in Psycopathology and Psychoanalysis by Paris VII, Paris, France; Appointed Professor of the Psychology Dep. of Pontifice Catholic University of Minas Gerais, Brazil.

Remove SM/fetish diagnoses (spring 2002)

Examples of statements, quotes and evidence of support

Will be forwarded to the WHO’s Department of Mental Health and Substance Abuse

The ICD diagnoses of “Sadism” and “Masochism” are certainly messy because abuse and violence is mixed into the same category as consensual sexual games.” “Any kind of sexuality may be perverted – even heterosexuality. I think it may be useful to reserve the words “perversion” and “paraphilia” for abusive, disrespectful and other harmful sexual activities.
Psychologist and sexologist Odd Reiersøl.

SM practitioners have been victimized by society as a whole and by many groups that should know better. There is no credible evidence that SM practitioners have any more problems or issues than other sexu al orientations. There is no data to suggest that SM leads to violence. All research so far, indicates that SM practitioners are indistinguishable from individuals with other sexual orientations, except by their sexual behaviour.
Charles Moser, Ph.D., M.D.

To stigmatize, diagnose and marginalize consenting SM and leatherpeople, is not going to help the victims of domestic violence. On the contrary, false reports, blackmailing and diagnosing healthy and innocent people weakens the credibility of true sexual abuse victims.
The lesbian and gay SM support group Smia-Oslo.

Sexual [SM] impulses form a strong part of each person’s day to day life, so that their suppression can effect the development or balance of the individual’s emotional life, happiness and personality.
Paras 10.46 and 10.49 in the official appointed Law Commission’s document No 139 1995 issued by the UK Home Office.

Unlike the psychiatrists and psychologists who deal primarily with psychologically troubled individuals who are also interested in D&S [Dominance and Submission], I did not find them to be psychologically troubled or socially inept; rather … their backgrounds, activities and attitudes are quite unlike the social stereotype that depicts sadomasochism as a form of violence, mischief, or mayhem perpetrated by the psychologically unstable who seek to hurt others or to be hurt themselves. … Thus, quite unlike its public image, the community is a warm, close and supportive one.
Sociologist Gini Scott in her 1983 book “Erotic Power” about the dynamics of the heterosexual SM subculture.

Revise F65! The ICD-10 paraphilia diagnoses

In Norwegian

 

The relevant sections in “F65 Disorders of sexual preference”:

2. CHAPTER F65

In the ICD-10 the Sexual deviation category is called Disorders of Sexual Preference (DSP) and given the code F65.

“Disorders of Sexual Preference, Includes: paraphilias,

Excludes: problems associated with sexual orientation”

“Diagnostic Criteria for Research”, characterize these disorders by the following general criteria:

G1. The individual experiences recurrent sexual urges and fantasies involving unusual objects or activities.

G2. The individual either acts on the urges or is markedly distressed by them.

G3. The preference has been present for at least 6 months.
F65.0 Fetishism

Reliance on some non-living object as a stimulus for sexual arousal and sexual gratification. Many fetishes are extensions of the human body, such as articles of clothing or footware [sic]. Other common examples are characterized by some particular texture such as rubber, plastic, or leather. Fetish objects vary in their importance to the individual: in some cases they serve simply to enhance sexual excitement achieved in ordinary ways (e.g. having the partner wear a particular garment).

Diagnostic guidelines. Fetishism should be diagnosed only if the fetish is the most important source of sexual stimulation or essential for satisfactory sexual response.

Fetishistic fantasies are common, but they do not amount to a disorder unless they lead to rituals that are so compelling and unacceptable as to interfere with sexual intercourse and cause the individual distress.

Fetishism is limited almost exclusively to males.

F65.1 Fetishistic transvestism

The wearing of clothes of the opposite sex principally to obtain sexual excitement.

Diagnostic guidelines. This disorder is to be distinguished from simple fetishism inn that the fetishistic articles of clothing are not only worn, but worn also to create the appearance of a person of the opposite sex. Usually more than one article is worn and often a complete outfit, plus wig and makeup. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. A history of fetishistic transvestism is commonly reported as an earlier phase by transsexuals and probably represents a stage in the development of transsexualism in such cases.

Includes: transvestic fetishism

F65.5 Sadomasochism

A preference for sexual activity that involves bondage or the infliction of pain or humiliation. If the individual prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities.

Mild degrees of sadomasochistic stimulation are commonly used to enhance otherwise normal sexual activity. This category should be used only if sadomasochistic activity is the most important source of stimulation or if necessary for sexual gratification.

Sexual sadism is sometimes difficult to distinguish from cruelty in sexual situations or anger unrelated to eroticism. Where violence is necessary for erotic arousal, the diagnosis can be clearly established.

Includes: masochism sadism

F65.6 Multiple disorders of sexual preference

Sometimes more than one disorder of sexual preference occurs in one person an none has clear precedence. The most common combination is fetishism, transvestism, and sadomasochism.

Diagnosene som ReviseF65 jobber med

In Norwegian

 

Hentet fra ICD-10: Den internasjonale statistiske klassifikasjonen av sykdommer og beslektede helseproblemer. Helsedirektoratet. – 10. rev., norsk utgave.


“Diagnostic Criteria for Research”, characterize these disorders by the following general criteria:

G1. The individual experiences recurrent sexual urges and fantasies involving unusual objects or activities.

G2. The individual either acts on the urges or is markedly distressed by them.

G3. The preference has been present for at least 6 months.

F65 Forstyrrelser i seksuelle objektvalg
Inkl:
parafilier

F65.0 Fetisjisme

Et ikke-levende objekt blir brukt som stimulus for å oppnå seksuell opphisselse og tilfredsstillelse. Mange fetisjer har relasjon til menneskekroppen (f eks klær eller fottøy). Andre vanlige eksempler på fetisjer er materialer som gir en særlig virkning ved syn eller berøring (f eks gummi, plastikk eller lær). Fetisjene varierer i sin betydning for individet. I noen tilfeller tjener de bare til å øke den seksuelle opphisselsen som oppnås på vanlige måter (f eks ved å få partneren til å bruke en spesiell påkledning).

F65.1 Fetisjistisk transvestittisme

Individet kler seg som det annet kjønn for å oppnå seksuell opphisselse og for å skape inntrykk av å være en person av motsatt kjønn. Fetisjistisk transvestittisme skilles fra transseksuell transvestittisme ved sin klare forbindelse med seksuell opphisselse og et sterkt ønske om å fjerne klærne når orgasme er oppnådd og den seksuelle opphisselsen avtar. Forstyrrelsen kan forekomme i en tidlig fase i utviklingen av transseksualisme.

F65.5 Sadomasochisme

Preferanse for seksuell aktivitet som innebærer å påføre andre mennesker smerte, ydmyke dem eller undertrykke dem. Hvis individet foretrekker å bli utsatt for slik handling, kalles det masochisme, og hvis individet foretrekker å utøve handlingen, kalles det sadisme. Ofte blir et individ seksuelt opphisset av både sadistiske og masochistiske aktiviteter.

Inkl:
masochisme
sadisme

F65.6 Multiple forstyrrelser i seksuelle objektvalg

I noen tilfeller foreligger det hos samme person mer enn én forstyrrelse av seksuelle objektvalg, uten at noen av dem får forrang. Den vanligste kombinasjonen er fetisjisme, transvestittisme og sadomasochisme.