English Seksualpolitikk Sexual politics

Sexual Freedom NOW (published 1996/98)

Testimony from Physicians and Psychiatrists
for the NOW S/M Policy Reform Statement

Physicians and psychiatrists about SM as a valid expression of adult consensual sexuality and an important part of people’s sexual orientation.

Psychiatrist Susan D. Wagenheim, M.D.

As a board-certified psychiatrist and supporter of the National Organization for Women, I write in support of amending the policy statement on consensual S/M. It is my understanding that S/M practice is a valid expression of adult consensual sexuality. In my private practice, I hear patients tell me frequently that they were “born this way”; ie submissive or dominant in sexual nature. Their experience is that S/M is their sexual ORIENTATION, and they “come out” to themselves much as homosexual and lesbian people do. With that understanding, there is no place in NOW for discrimination against a woman’s right to choose; her right to choose how, when and with whom to express her sexual self.
Charles Moser, Ph.D., M.D.

S/M practitioners have been victimized by society as a whole and by many groups that should know better. There is no credible evidence that S/M practitioners have any more problems or issues than other sexual orientations. There is no data to suggest that S/M leads to violence. All research so far, indicates that S/M practitioners are indistinguishable from individuals with other sexual orientations, except by their sexual behavior. The revision of the NOW policy is long overdue.
June M. Reinisch, Ph.D., with Ruth Beasley, MLS. The Kinsey Institute New Report on Sex

St. Martin’s Press, New York, 1990.

“Researchers estimate that 5 percent to 10 percent of the U.S. population engages in sadomasochism for sexual pleasure on at least an occasional basis, with most incidents being either mild or staged activities involving no real pain or violence. It appears that many more individuals prefer to play the masochist’s role than the sadist’s. It also appears that males are more likely to prefer sadomasochistic activities than females. This means that male sadists may have difficulty in finding willing masochistic females to be sexual partners.

“If partners are located, an agreement is reached about what will occur. The giving and receiving of actual or pretended physical pain or psychological humiliation occurs in most cares only within a carefully prearranged script. Any change from the expected scenario generally reduces sexual pleasure.

“Most often it is the receiver (the masochist), not the giver (the sadist), who sets and controls the exact type and extent of the couple’s activities. It might also interest you to know that in many such heterosexual relationships, the so-called traditional sex roles are reversed — with men playing the submissive or masochistic role. Sadomasochistic activities can also occur between homosexual couples.”
Havelock Ellis Studies of the Psychology of Sex (early 20th cent)

“The essence of sadomasochism is not so much “pain” as the overwhelming of one’s senses – emotionally more than physically. Active sexual masochism has little to do with pain and everything to do with the search for emotional pleasure.” Ellis believed that culture tries to stifle our “natural impulses, which become expressed through various emotional/physical representations of the heirarchal structure of society.”
Iwan Bloch 
Strange Sexual Practices (1933)

“Sexual abnormalities” were common in ordinary people, and that aberrations and deviations were as essential to life as the “sex impulse” itself. Masochism exists among socially powerful men for whom it was a “liberation from conventional pressure and the professional mask.”
Theodore Reik’s 
Masochism in Modern Man (1941)

“Pleasure is the aim, never to be abolished and the masochistic staging is but a circuitous way to reach that aim. The urge for pleasure is so powerful that anxiety and the idea of punishment themselves are drawn into its sphere.”
Bill Thompson 
Sadomasochism (1994)

“As SM devotees carefully refine these simple acts, by dressing them up in role-play, it is easy to see how they are deliberately manipulating various forms of stimulation in the service of sexual arousal; and how this consenting scene where the submissive’s pleasure is carefully planned is obviously very different from a truly coercive act like rape, which involves aggressive action designed to inflict acute pain on a non-aroused victim.”
Dolf Zillmann (1984) [D. Zillmann along with Park Elliot Dietz are two of the world’s leading authorities on the relationship between sex and aggression.]

“As the arousing capacity of novel partners is likely to fade and acute emotional reactions such as fear and guilt are improbable accompaniments of sexual activity, what can be done to combat the drabness of routine sexual engagements that is expected to result from excitatory habituation? Rough housing, pinching, biting and beating emerge as viable answers. In terms of a theory it is the controlled engagement of pain that holds promise of reliably producing excitatory reaction for transfer into sexual behavior and experience…. Pain then always can be counted on to stir up excitement, however, pain must be secondary to sexual excitedness. It must be dominated by sexual stimulation. Only when thus dominated can it be expected to enhance sexual excitedness.”
Park Elliot Dietz (1990) [P.E. Dietz is a forensic psychologist who consistently tries to point out the absurdity of the link between s/m devotees and psychotic criminals.]

According to Dietz, the five main differences between psychotic sadistic serial murderers and SM devotees:

1. Psychotics search for unwilling partners. S/M devotees use a “safeword” that the submissive can say at any time to end the scene, thus the submissive retains real control throughout the encounter.

2. Psychotics force their acts on the victim rather than aiming at pleasing the submissive (as in s/m). The psychotic sadistic acts are quite different from s/m practices, and usually include: forced anal penetration, forced fellatio, or violent vagina-penetration with various foreign objects -rather than the penis.

3. The sadistic offenders’ demeanor is diametrically opposed to s/m devotees: usually the psychotic is detached and unemotional throughout the torture, while the s/m dominant appears to achieve a “high” or pleasure equivalent during the scene.

4. Psychotic criminals torture their victims, inflicting serious and permanent injury, trying to arouse terror in their victims. S/M devotees skillfully enhance the sexual arousal of their partner, following the rules and guidelines that were established before the scene, thus creating only the illusion that the submissive is not in control.

5. Psychotics usually have a past history of sexual crimes such as rape or incest. S/M devotees are average people who typically don’t have criminal pasts.
The sociologists took their lead from the anthropologist Paul Gebhard, whose 1968 essay “Fetishism and Sadomasochism” undermined the idea of individual pathology by pointing to sadomasochism’s cultural roots, and the futility of defining a widespread and diffuse sexual practice by reference to a few “extreme” examples. He stated that S/M practices were “only prevalent in its organized form in literate societies full of symbolic meanings.” This means that far from being a manifestation of a base instinct, sadomasochism required a considerable amount of intelligence and organization.
1929 Hamilton survey on marriage habits: 28% males and 29% females admitted that they derived “pleasant thrills” from having some form of “pain” inflicted on them.
William A. Henkin, PhD.; November 1992 letter to the committee that advocated changes to the entries on sexual sadism and masochism in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

“In conclusion: consensual sadomasochism offers its adherants an opportunity to explore paraphilic urges and fantasies, not in a dangerous or debilitating fashion, but in a safe and supportive manner, where those urges and fantasies can be pleasurably satisfied, and where their values in a person’s psychic life can be revealed.

“Within the past decade prominent clinicians and scholars in the fields of psychoanalysis, clinical psychology, and clinical sexology, eschewing the received wisdom of past masters who south to fit clinical observations to their theories, rather than the other way around, have instead made serious attempts to understand the activities of consensual sadomasochism as well as the dynamic processes that underlie them, and to devise theories that fit the evidence they found in the lab, in the consulting room, and in the field. They have proposed that consensual erotic power play is not a psychiatric disorder: that instead, it can simply be a form of sexual pleasure, and that as a path of psychological and spiritual development it can even be the evidence and experience of triumph over childhood adversity.

“Absent distress, harm, or functional impairment, to define such activity as a mental disorder is to place chains on the human spirit, and to produce a chilling effect on the very processes we as psychotherapists are trained and charged to abet: the healing and liberation of damaged and imprisoned personalities, and their integration in the full creative expression of human beings.”
Dr. William A. Henkin, 1989 presentation to the Society for the Scientific Study of Sex (now Sexuality) with Sybil Holiday, published in 1991 as “Erotic Power Play,” Sandmutopia Guardian.

A Clinical Introduction:

“Everyone accomplishes some degree of self-identification in the normal course of growing up. But the process of growing up is one of acculturation as well as one of maturation, so that as we are in the midst of discovering all those special attributes that make us who we are, we are simultaneously being trained to subdue, suppress, or otherwise disown important facets of ourselves. In the ensuing confusion, few people grow up whole. Instead we are to one degree or another dis-integrated, which the Oxford English Dictionary defines as being separated into component parts or particles; reduced to fragments; having had our cohesion or integrity broken up. Disintegration is the condition that as adults we either accept or try to alter.

“One of the most direct ways I know for a person to gain access to hidden facets of his self, and hence to move toward integration, is to explore his sexual personas ; and one of the most direct ways I know for a person to explore his sexual personas is to examine the attitudes he brings to sexual activity. But to examine sexual attitudes usually requires more than intellectual assessment: it first needs exposure, practice, and hands-on experience. It also requires a perspective concerning the variety of people’s experiences that is not influenced by cultural norms.”

On negotiation:

“Negotiation includes both initial and ongoing, verbal and non-verbal communications. In erotic power play, negotiation is the underpinning for consensuality: you cannot agree, or consent, to give something if you do not know it has been requested, or to accept something if you do not know it has been offered. In addition, the more completely and openly people negotiate about what they want or have to offer, the more they establish their parity, as it is difficult for unequals to negotiate truly: all parties know that ultimately the person with more inherent power can pull rank.”

On Ritual:

“A major function of ritual is to let us know who we are beyond the confines of our small, individual selves. Baptisms, confirmations, bar and bas mitzvahs, long pants, graduations, marriages – all ceremonies tell us, even as they announce it, who we are to ourselves, our families, our friends, our communities, and our world.

“Anthropologists, ethnologists, mythologists, and other psychologists of culture note that where a heritage of meaningful rites of passage does not exist, people will feel enough of a spiritual imbalance to make up rituals of their own. It’s become a cliché that our society offers us a paucity of rituals that touch the spirit, and that those that exist are for the most part competitive or not negotiated: football games, invasions of small islands, and the episodic opportunity to vote for more of the same.

“In erotic power play, rituals of substance can be conceived, developed, and executed in ways that can touch their participants on numerous levels at once: they can be physical, emotional, cognitive, or spiritual; sexual, political, and religious; they are simultaneously as sophisticated and creative as the human imagination can make them, and as basic and primitive as the psyche’s drives for power and sexual fulfillment.”

English Professional work

ICD Revision White Paper

Oslo, Norway, September 24, 2009
Dead links updated November 22, 2011

ICD Revision White Paper to WHO from Revise F65
Revise F65’s first report to WHO)

By Cand. Psychol Odd Reiersøl and Revise F65 leader Svein Skeid
Proposal to the ICD-11 Revision of Chapter V, Mental and Behavioural Disorders, F65 and F64.

Invitation from WHO to Revise F65

We want to thank classification coordinator Dr. T. Bedirhan Üstün M.D. at WHO in Geneva for inviting Revise F65 to collaborate with the work leading up to the ICD-11 revision.

In an email of May 7, 2007, Dr. Üstün wrote:
“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 Üstün, M.D., Coordinator, Classifications, Assessment and Terminology, World Health Organization, Geneva, Switzerland.

Revise F65 was formally established in Norway in 1997 with the purpose to abolish the SM and fetish diagnoses in the F65 category of the ICD.  Among the Revise F65 members are health care professionals and human rights activists. During these years, articles have been published and presentations have been given (1,2,3,4,5).

In our opinion the following four ICD diagnoses should be abolished:

  • F65.0 Fetishism
  • F65.1 Fetishistic transvestism
  • F65.5 Sadomasochism
  • F65.6 Multiple disorders of sexual preference

In addition the F64.1 Dual-role transvestism diagnosis should be abolished.

Health political and professional arguments for the human rights reform

In our opinion the five above mentioned diagnoses should be repealed because they are superfluous, outdated, non scientific and stigmatizing. The article by Reiersøl and Skeid in “Sadomasochism, Powerful Pleasures” (1) gives thorough argumentation for removing the F65.0, F65.1 and the F65.5 diagnoses.

As the F65.6 diagnosis combines several diagnoses including the three above mentioned, it should also be removed. The F64.1 diagnosis is a bit special in the sense that it is classified as a gender identity disorder type diagnosis, but it is very similar to the F65.1. A separate section describes the issue in more detail.


Health political arguments

The diagnoses were repealed at a national level in Sweden January 1, 2009 (6,7). The Dual-role transvestism and the SM diagnoses were repealed in Denmark respectively August 19, 1994 and May 1, 1995 (8). The health authorities in these two countries cited in their reasoning; health political, health promoting and human rights arguments.

The Swedish board of health used the following phrases:

  • “not perverse” (7,9,10)
  • “not illness” (7,9,11)
  • “private matters” (7,9)
  • “citizens entitled to equal rights” (9)
  • “no reinforcement of prejudices” (7,9,11,12)
  • “from earlier times in history” (7,9)
  • “risk of social stigmatizing” (11,12)
  • “entitled to self confidence in the same way as homosexuals” (9)

Private matter

The Danish decision was made by the health minister, Yvonne Herløv Andersen, referring to this type of sexual preference as a private matter that has nothing to do with society (8).

The newspaper Dagens Nyheter November 16, 2008 quoted the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm: “Society has nothing to do with the sexual preferences of these individuals” (7,9).

According to Nettavisen November 17, 2008 the head of the Norwegian Directorate of Health (Helsedirektoratet), Bjørn-Inge Larsen, said: “There is no basis, neither within today’s social norms nor within health political thinking, for labeling several of these phenomena as illnesses” (10).


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” (11).

“The abolition of  the diagnosis of homosexuality I believe to a certain extent has contributed to a different view than in the 60’s and 70’s of homosexuals in the general population. The abolition gave the homosexuals self confidence because they no longer have a psychiatric stigma. We hope that the current revision will give a similar result”, said  the head of the Swedish National Board of Health and Welfare (Socialstyrelsen), Lars-Erik Holm (9).

In a press release NCSF, National Coalition for Sexual Freedom, applauds the Swedish decision, and says:

“We know from the hundreds of requests for help that NCSF gets every year through our Incident Response program that the Sexual Sadism, Sexual Masochism, Fetishism and Transvestic Fetishism diagnoses in the DSM reinforce the negative stereotypes and stigma against alternative sexual behaviors.” (13)

The Norwegian Directorate of Health has since 1996 as a goal to work for counteracting the stigmatizing of sexual minorities (14).

The strategy plan for prevention of HIV and STD points out “the danger of stigmatizing and discriminating against vulnerable groups when doing  preventive work, and the importance of a holistic approach to sexual identity, sexual health and sexual behavior” (15) (pdf file).

Preventative measures

In our opinion, outdated and non scientific diagnoses such as these, constitute an infringement of the human rights of the minorities that are described, and they hinder prophylactic health care efforts that are needed in these groups of people. Deleting the diagnoses may strengthen the “identity building” of the SM/fetish population and contribute positively to the “collective self respect” which is necessary for reaching the group with preventative measures like HIV and STD prevention.

According to Norwegian health authorities “A person’s possibility for self protection against a virus that is sexually transmitted is only to a certain extent influenced by knowledge. The feeling of self value necessary for demanding or having a wish to protect oneself is influenced by societal factors, and only a few of these factors are under the control of the health authorities. We emphasize that the cooperation with marginalized and vulnerable groups has an influence on what could be called a collective self respect” (16).

The Norwegian health authorities have taken an active interest in improving the self respect and the identity of the SM group, to increase the ability of protection against sexually transmitted diseases (17).


For many people, SM and fetishism is more than just behavior, it is part of their sexual orientation and identity (23). In our opinion, stigmatizing minorities by considering their personal orientation as a psychiatric condition is as disrespectful as discriminating against people because of their race, ethnicity or religion.

Like the earlier diagnosis of Homosexuality that is no longer applied by the WHO, the SM and Fetish diagnoses are rarely used for therapeutic purposes. Instead, these definitions are abused to justify harassment and discrimination of the SM/fetish population from laymen and judicial institutions.

Much of the discrimination is directly or indirectly a result of the diagnoses. A psychiatric diagnosis may have a major influence on a person’s possibility of getting work and on the evaluation of a person’s ability to raise children, for example after a divorce.

As with other forms of abuse, women are the main sufferers, losing their jobs, or even their children, because of their SM/fetish love, lifestyle and self-expression (18).

The Norwegian National LGBT Association (LLH) and the National coalition for sexual freedom (NCSF), have published respectively a case study and a survey indicating the stigmatizing function of the F65 diagnoses and that these diagnoses legitimize discrimination (18,13,19).

By repealing the diagnoses, the sexual minorities in question may breathe a bit more easily and be less afraid of private and public discrimination.

In a letter of June 11, 2003 to Revise F65, the Norwegian Association for Clinical Sexology says:  “The Norwegian Association for Clinical Sexology in its support wishes to emphasize that the use of psychiatric diagnoses in relation to homosexual, heterosexual and bisexual fetishists, sadomasochists and transvestic fetishists is stigmatizing and therefore an encroachment upon this group as a whole”.

Safe, sane and consensual

There is no reason to doubt that the SM movement has  “grown up” and taken responsibility over the last 20-30 years, by establishing safe words, security routines, pride symbols and normative measures like the internationally recognized moral and ethical principle “Safe, sane and consensual”. As opposed to dangerous perpetration, SM activities are mutually wanted and consensual activities that produce health promoting and pleasurable hormones (20,21,22,23,38).