You've got to be Crazy Baby

Well, you've gotta be crazy, baby to want a guy like me.
Yeah, you've gotta be out of your mind - crazy.
- Icehouse

From Feministing on the proposed changes to the "Psychiatrist's Bible" - the DSM:

First, Blanchard is proposing a significant expansion of the DSM's definition of "paraphilia" to include:

"any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting adult human partners."

Blanchard's proposals can be found in his presentation "Paraphilias vs. Paraphilic Disorders, Pedophilia vs. Pedo- And Hebephilia, and Autogynephilic vs. Fetishistic Transvestism" given at the Annual Meeting of the Society for Sex Therapy and Research (SSTAR), April 3, 2009, Arlington, Virginia.

To continue from Feministing:

The first concern here is the term "phenotypically normal" (meaning "normal" with regards to observable anatomical or behavioral traits). Thus, according to this definition, attraction to any person deemed by sex researchers to be "abnormal" or "atypical" could conceivably be diagnosed as paraphilic. So, do you happen to be attracted to, or in a relationship with, someone who is differently-abled or differently-sized? Or someone who is gender-variant in some way? Well congratulations, you may now be diagnosed with a paraphilia!

Seriously.

Blanchard and other like-minded sex researchers have coined words like Gynandromorphophilia (attraction to trans women), Andromimetophilia (attraction to trans men), Abasiophilia (attraction to people who are physically disabled), Acrotomophilia (attraction to amputees), Gerontophilia (attraction to elderly people), Fat Fetishism (attraction to fat people), etc., and have forwarded them in the medical literature to denote the presumed "paraphilic" nature of such attractions. This tendency reinforces the cultural belief that young, thin, able-bodied cisgender women and men are the only legitimate objects of sexual desire, and that you must be mentally disordered in some way if you are attracted to someone who falls outside of this ideal. It's bad enough that such cultural norms exist in the first place, but to codify them in the DSM is a truly terrifying prospect.

Another frightening aspect of Blanchard's proposal is that any sexual interest other than "genital stimulation or preparatory fondling" is now, by definition, a paraphilia. In his presentation, he claimed that paraphilias should include all "erotic interests that are not focused on copulatory or precopulatory behaviors, or the equivalent behaviors in same-sex adult partners." Copulatory is defined as related to coitus or sexual intercourse (i.e., penetration sex). So, essentially, all forms of sexual arousal and expression that are not centered around penetration sex may now be considered paraphilias.

So, do you and your partner occasionally role-play or talk dirty to one another over the phone? Or engage in arousing play that is not intended to necessarily lead to "doing the deed"? Do you masturbate? Do you get a sexual charge from wearing a particularly sexy outfit or performing any act that falls outside of "genital stimulation or preparatory fondling"? Well, then congratulations, you can be diagnosed with a paraphilia!

This is all true, but things are not quite as bad as they seem - at least from Blanchard's viewpoint. You see, according to him, typical males over 18 have a paraphilia. Pedophilia, to be exact. From his presentation:

..typical men show a slight but non-zero penile response to prepubescent girls when tested phallometrically.

He means by using the plethysmograph, a device that measures bloodflow in the genitalia, and from that it is assumed that there's a correlation with thought. Which is probably true, but the correlation is weak and unreliable, and anyone who has had significant surgical reconstruction in that area should only be compared to others who have had reconstruction, not the standard model, unless some calibration work is done. I know of no work that has been done to find such calibration. But no matter.

So a "paraphilia" is not a Mental Illness per se. Good luck in getting courts to understand that in custody cases by the way, or in trying to pass legislation. Unless this is really well emphasised in the DSM-V, it will be radically misused. Perverted, even. Blanchard seems to be as oblivious to that as he is to the legal effects of his hypotheses about trans people.

So what does make a paraphilia into a "mental illness"?

The next question is equally or more important than the general definition of paraphilia. That is, are all paraphilias ipso facto psychiatric disorders? Our subgroup is taking the position that they are not. We are proposing that the DSM-V make a distinction between paraphilias and paraphilic disorders.



In this formulation, only problematic paraphilias would be called paraphilic disorders. To underscore that point, we propose to use the verb ascertain when talking about paraphilias and the verb diagnose when talking about paraphilic disorders.

So you would not be diagnosed with a paraphilia for being sexually attracted to say, me - someone not phenotypically normal. You would be ascertained to be paraphiliac instead.

As I said, the Best of British Luck getting a Judge or Jury to understand the difference in a custody case.

You would only be diagnosed with a paraphiliac disorder if it would cause distress or impairment to you or others. For example, if your boss disapproved of intersexed people and fired you for being attracted to one.

Well, you've gotta be crazy, baby to want a gal like me.
Yeah, you've gotta be out of your mind - crazy.

And you be diagnosed insane too, if you found a gal like me sexually attractive. Or just wanted to hold hands, rather than scr... have intercourse.