How to delete SM/Fetish diagnoses
Workshop in the Sonntags-Club, Greifenhagener Strasse 28, Berlin
Sunday, 05. September 2004, 12.00
My name is Svein Skeid. I am leader of the Revise F65 project which aim is to delete SM and Fetish diagnoses from the International Classification of Diseases (ICD) published by the World Health Organization (WHO). I have been working in the field of SM human rights for two decades. I am a Norwegian registered physiotherapist. My professional background is in psychiatry. I am Gay Person of the Year in Norway 2003, and have a special membership of the Norwegian gay Leatherclub – Scandinavian Leather Men Oslo, SLM. Together with the mainly heterosexual organization SMil-Norway, SLM have financed this journey from Oslo, Norway for Ole Johnsen and myself. Ole Johnsen is moderator of the Revise F65 mailing list.
First of all I like to thank all you persons in BVSM, SMart Rhein Ruhr and BDSM-Berlin for making this lecture possible at a very short notice. I am impressed by the German work for SM human rights and what you in a short time have done with German Modification of the ICD-10 diagnoses.
Kathrin Passig in BDSM Berlin has helped The ReviseF65 group since 2000 among other things with translations and the special bibliography concerning the F65 classification system on our ReviseF65 website extracted from Datenschlag’s BISAM bibliography.
Uli – or Tai Gin edited a fantastic ICD-10 special number of SMart-Info in September 2002 after my visit to Europride in Cologne. Shortly afterwards you started to build up BVSM e.v. which was established in May 2003.
And Raven in BVSM e.v. is much of the reason for why Ole, Erik and I are here this weekend in Berlin. Raven wrote me 11th of August and offered us to have ReviseF65 flyers at their booth during Folsom Europe. I am overwhelmed by your helpfulness and the information you all have given about what is going on in Germany. On Monday Raven gave me the translated text to a BVSM-flyer stressing among other things the negative influence of these diagnoses on the trust and relationship between client and therapist.
Martin in SMart Rhein-Ruhr e.V. has told about the campaign you organised to the German Modification of ICD-10 this year including data protection and civil liberties.
And Manuela in BVSM e.v. wrote about challenges in the work and asked important questions that I will try to answer here today.
Manuela wrote in her mail:
Right now there are two main problems:
1. We don’t quite know how to bring the diagnosis codes (…) into the general public. Right know it’s just a fact that is known inside the scene. How do you deal with that problem?
2. Our proposal for removing the f65 diagnosis from the ICD-10-GM wasn’t successful. We need a better argumentation and more scientific works to quote. Because of that we’re interested in your literature list. Especially the argumentation that lead to the deletion of “Homosexuality” in the ICD could be interesting, too.
We do use the experience from the process that lead to the deletion of the diagnosis of homosexuality in the ReviseF65 work. Even though we are a pansexual SM and Fetish committee with both gay/straight activists and professionals in psychology and psychiatry, we have our mandate from the national (LLH 1998) and international (ILGA 1999) lesbian and gay movement.
The Gay Movement more than 30 years ago considered it of fundamental importance to first delete the diagnosis of homosexuality, before any further major human rights improvement was possible. The ReviseF65 movement apply the same appraisement today. We think that unprofessional and stigmatising SM and Fetish-diagnoses are possibly one of the biggest obstacles to the acceptance of our human rights. Abolishing them is a very important step to decrease prejudices towards the SM/Leather/Fetish- population.
We learned that it is a tradition to evaluate one single or several selected diagnoses, and then delete them from the international ICD or the national translated versions. The latter was what happened when Transvestism and Sadomasochism was no longer recommended to be used by the State of Denmark in 1994/1995. (They were very lucky because the Health Minister was a liberal lesbian. Danish psychiatrists were very angry and upset after the political decision. We also know that there has been a serious debate about sadomasochism in Denmark for decades, much longer than in Norway… and Germany. www.revisef65.org/denmark.html)
Prejudices and discrimination
For the rest of us, who are not so lucky as the Danes, we have to use the experience from the gay movement. And we have to realize that this can be a long-term project. Even though we see more and more SM and Fetish expressions in the media and the public space, there are still much prejudices.
Like the earlier diagnosis of Homosexuality that is no longer applied by the WHO, the SM and Fetish diagnoses are rarely used in clinical practice as a means to assist people. On the contrary the stigma attached to the diagnoses justifies various forms of harassment and discrimination of this sexual minority from laymen. The ReviseF65 group can document that people are losing their jobs, the custody of their children etc., because of their SM-love, lifestyle and self-expression.
The US National Coalition for Sexual Freedom and the Leather Leadership Conference documents that between one-third and one-half of the leather/SM population suffer discrimination, violence or persecution because of their sexual orientation and identity. As with other forms of assault, women are often the chief sufferers. And much of the discrimination is directly or indirectly a result of the diagnoses.
A Norwegian example:
In 1997, a 42–year-old woman in Eastern Norway let herself be pressured by her own lawyer to give up the custody of her two daughters after a divorce. The lawyer considered that the woman had a poor legal case because SM is defined as a psychiatric illness in Norway. This happened after her ex-husband got hold of the woman’s holiday photographs which showed her interest in SM – sadomasochism. He passed the photographs on to his lawyer. The children were also informed about the woman’s orientation. Today, the woman lives 250 English miles away from her children, but has partially regained contact with them after many years without contact.
Source: SMil-bladet, no. 2, 2002. The whole case is described in more detail at www.revisef65.org/febarn.html (unfortunately currently only in Norwegian).
Two members of SMart Rhein Ruhr and the previous BDSM-Netzwerk e.V. in 2002 learned me the expression “Blind Activism” as a waste of effort when you go public without a good plan and a solid professional foundation. Before we go public, we need professional mental health arguments directly concerning the three ReviseF65 codes and we need to gain support from mental health professionals.
And as with the earlier diagnoses of homosexuality, ReviseF65 aim at support from professional mental health organizations. Last year we asked for and got support from the Norwegian Association of Gay and Lesbian Physicians (HLLF) and the Norwegian Society for Clinical Sexology (NFKS). The next goal is to get support from the Norwegian Psychiatric Association. Experience from the homosexual diagnoses show us that this latter organization is the key to the national removal of diagnoses!
As with the diagnosis of homosexuality: In 1977 homosexuality was no longer recommended to be used by the Norwegian Psychiatric Association. Several years later it was taken out of the list with the next ICD revision that came in the early nineties.
Just as with Homosexuality 30 years ago, the ReviseF65 and the German Modification of ICD-10 is a groundbreaking pioneer work. Nobody has formed the basis for us. We have to do it ourselves. And that is just what the ReviseF65 professionals are in the process of doing. A work that will be of importance for SM activists and kink friendly professionals worldwide.
The process is started to establish a professional basis for the removal of SM and Fetish diagnoses. Psychologist and member of the ReviseF65 group Odd Reiersøl and myself have written an article about the diagnoses and on the Revise 65 project that will be published in a forthcoming special, double issue of the US periodical Journal of Homosexuality on SM. The article will be published simultaneously by The Haworth Press INC as a book on SM. (The article is “in press”).
This magazine and book will moreover contain a lot of other scientific SM-material and information that can be used in the ICD work. Therefore we all have to be a little bit patient.
In addition, psychiatrist and member of the ReviseF65 group, Reidar Kjær, held an important lecture about F65.0 Fetishism, F65.1 Fetishistic transvestism and F65.5 Sadomasochism in June 2003 at the International Conference on Diagnosis in Psychiatry in Vienna Austria, arranged by the World Psychiatric Association. This lecture is essential because it is directed specially towards psychiatrists. The profession that is in the position to revise the F65 chapter of ICD. Dr. Kjaer‘s article will soon be published. But it is not “in press” yet.
Outdated, unprofessional and stigmatising
The mental health specialists Reiersøl and Kjær in their articles conclude that the ICD diagnoses of Fetishism, Fetishistic transvestism and Sadomasochism are outdated, unprofessional, inaccurate, illogical, stigmatising… and even moralistic and ridiculous in my own point of view.
Although established by the WHO in 1948, their contents have not undergone any significant changes the last hundred years. They are not up to the scientific standards of the ICD manual because new research has not influenced the paraphilias concerning safe, sane and consensual behaviour between adult persons. The SM and Fetish diagnoses are at best completely unnecessary. At worst, they are stigmatizing, cause minority stress and discrimination.
Let me mention a few examples from my point of view. I have to say, there is also something ridiculous about the so-called paraphilias – which earlier was called perversions.
Unusual. According to the diagnostic criteria, the F65 chapter focus on “unusual objects or activities”. A traditional attitude that victimize minorities. We can ask: Is this a statistical or normative issue? How much or how little is unusual? Nevertheless a very inaccurate and little scientific referral. Extreme sports and flagellation ceremonies can also be considered unusual activities, but this far, base-jumpers and flagellants has not been labeled perverts.
Distress. Another diagnostic Criteria for F65 is that “The individual either acts on the urges or is markedly distressed by them.” But as we know it is society’s reactions to SM activities that causes the distress, not the SM activities itself. Yet, “traditional” intercourse may result in emotional distress as well.
As you can see from the leaflet I have given you, there is some importantant differences between the official version from the World Health Organization, and the German Modification (ICD-10-GM).
German psychiatrists have taken away to of the most ridiculous sentences when they translated the Fetishism and Sadomasochism paragraps.
Intercourse. According to the World Health Organization Fetishism is an illness because it does not have procreation as its purpose and interferes with intercourse! Yes, you are correct. That’s the argument or the moral basis. “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 intercourse and cause the individual distress”. Today non-procreative sex is regarded as a healthy pursuit also by most psychiatrists, but obviously not by the WHO. This is more moralistic than scientific if you ask me. I suppose German psychiatrists have understood this. But remember that the WHO version still is the official one that we have to fight against in our argumentation.
Violence. My most serious objection to the F65 chapter from the WHO, is the mix up of voluntary and consensual SM sex on one side, and violence, harassment and spouse abuse on the other side. ICD-10 mix together consensual and nonconsensual sexual behaviors. Abusers are being classified and diagnosed in the same general category as individuals with non-abusive interests. This violence part has also been removed by German translaters.
“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.”
On the web site http://members.aol.com/NOWSM/Psychiatrists.html/#Psychiatrists, Park Elliot Dietz – one of the worlds leading authorities on the relationship between aggression and sex – documents the basic differences between violent sadism and SM sadism.
Human rights movements
This is the way we work in the ReviseF65 committee. We try to pick apart the inconsequences of attitudes and texts that are more than hundred years old. Yes, Richard von Krafft-Ebing, who in 1886 introduced the “perversions” in “Psychopathia Sexualis”, was also an eagers spokesman for the “degeneration theory”. Not only was homosexuals, sadomasochists and fetishists degenerated. The scientific incorrect degeneration theory also included women in general, poor people and other races. May be today’s alternative sexualities experience the “racism” or “sexism” of our time. Some researchers talk about the phenomena of “sadomasophobia”. I have myself introduced the word “fetishphobia”.
Thanks to the women liberation movement, the gay movement and the civil rights movement in the US, the scientific “truth” of the attitudes leading to sexism, homophobia and racism has become history. Now it is up to the SM movement to get rid of the “science” that leads to sadomasophobia and fetishphobia.
Picture left is from the CSD, Gay and lesbian Days in Oslo, Norway 2003, when Svein Skeid received Gay Person of the year award.