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Outlawed by Nature? A Critique of Some Current Psychiatric and Psychoanalytic Theories of Sexual Perversion Andreas De Block and Lode Lauwaert In 1973, the American Psychiatric Association organised a symposium under the title ‘Should Homosexuality be in the APA Nomenclature?’ The second edition of the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM) had unambiguously qualified homosexuality as a mental disorder. But throughout the 1960s, this view came under increasing attack from a variety of theoreticians and lay people. Anti-psychiatrists and biological psychiatrists joined forces with gay activists against the majority of (psychoanalytic) psychiatrists, because they felt that labelling homosexuality a disease was more a matter of ideology than of science. The participants in the symposium had to come up with an answer to the question of what distinguishes sexual variation from sexual disorder. A number of proposed criteria or norms were discussed. Most participants to the APAsymposium agreed that not all sexual variations were pathological. Moreover, they also agreed on two criteria to make that distinction. In their view, a sexual variation is only disordered when it is both unnatural and harmful. However, no consensus was reached over what should count as unnatural and/ or harmful. Likewise, the experts that participated in the Symposium remained divided in their opinion on whether homosexuality could be healthy. Socarides and Bieber, two prominent psychoanalytic psychiatrists, argued that all the available scientific evidence supported the view that was found in DSM II. The other participants (Stoller, Marmor, Spitzer, etc.) dismissed that evidence as irrelevant or flawed, and argued for the removal of homosexuality from the APA nomenclature.1 In order to get out of this stalemate, the APA resorted to the political solution of a vote. Eventually, 58% of the APA members decided that homosexuality as such had to be deleted from the seventh printing of the DSM-II.2 This whole episode illustrates how difficult it is to distinguish normal from pathological behaviour, especially when the behaviour is negatively valued 1 C. W. Socarides, ‘The sexual deviations and the diagnostic manual’, American Journal of Psychotherapy , 32, 1978, pp. 414-426. 2 S. A. Kirk and H. Hutchins, The Selling of the DSM: The Rhetoric of Science in Psychiatry. New York: Aldine De Gruyter, 1992. Andreas De Block and Lode Lauwaert 186 by society. This is probably nowhere more true than in the case of sexual perversions. In this paper, we will first claim that, in general, sexual perversions are difficult to differentiate from non-pathological sexual behaviours that are legally or morally unacceptable. In the second section, we will sketch how this problem pervades today’s DSM approach to the sexual perversions. In the third section, we will analyse to what extent our critique of the DSM dealing with paraphilias can be applied to psychoanalytic accounts of perversion. Does psychoanalysis provide a solution or this problem? Or does it rather aggravate the problem by conceptualising perversion as a condition that is defined by the persons relation to the law? 19th Century psychiatry and early sexology Modern sexology defined itself explicitly as a progressive science. Early sexologists saw themselves not just as scientists, but also as activists against sexual oppression. They believed that the successes of sexology had to be measured both by scientific standards and by political standards. The battle of the sexologists against the legal prohibition of homosexuality is a good case in point. Magnus Hirschfeld, Iwan Bloch and Henry Havelock Ellis, three of the founding fathers of modern sexology, considered their advocacy for homosexual rights and their pleas against the criminalisation of homosexuality to be the natural outcomes of their scientific work.3 In other words, they did not see their political activism as opposed to scientific neutrality, but rather as the kind of activism that was necessitated by their ‘objective’ findings, given that many of the laws against homosexuality were based on – or legitimated by – claims that sexology has proven to be wrong. Havelock Ellis, who was married to the openly lesbian Edith Ellis, expanded this view to include other so-called sexual pathologies. He devoted a supplementary volume of his Studies in the Psychology of Sex to a discussion of fellatio,cunnilingus,coprophilia,sadism,masochism,frotteurism,necrophilia, transvestitism, and undinism or urolagnia.4 According to Havelock Ellis, these unusual or even bizarre sexual desires, behaviours and preferences were 3 N. Matte, ‘International Sexual Reform and Sexology in Europe, 1897-1933’, Canadian Bulletin of Medical History, 22, 2005, p. 257; but see J. Crouthamel, ‘Male sexuality and psychological...

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