Motherboard: When does a paraphilia become a disorder?
Blanchard: There are two ways by which a paraphilia could be converted into a paraphilic disorder: the individual is distressed by their desires, or they are acting in a way that is noxious to people. So a pedophile could have a pedophilic disorder if the guy is tortured by the fact that he is a pedophile, or he is perfectly happy with the fact that he is attracted to children, and he is molesting a lot of them.
So if someone cross dresses and they are cool with it, then they don’t have a disorder, correct?
Yes, under my proposal you can now be a happy transvestite, or you can have a transvestic disorder.
You coined the term autogynephilia, which refers to a man who is aroused by the thought of himself as a woman. This term is kind of your baby. Is it going to make it into the DSM-5?
That comes under the heading of what I can’t tell you, because of the confidentiality agreement I signed with the APA.
Do you think autoandrophelia, where a woman is aroused by the thought of herself as a man, is a real paraphelia?
No, I proposed it simply in order not to be accused of sexism, because there are all these women who want to say, “women can rape too, women can be pedophiles too, women can be exhibitionists too.” It’s a perverse expression of feminism, and so, I thought, let me jump the gun on this. I don’t think the phenomenon even exists.
Some trans activists object to the inclusion of transvestic disorder in the DSM because they feel it pathologizes gender non-conformity. How do you respond to these criticisms?
To say that transvestic disorder pathologizes all trans people is rhetoric with no logic behind it whatsoever. If you actually open the DSM-4, it’s very explicit that it applies to people who get sexually excited by dressing in women’s clothes. They really object to the fact, (which is a fact established beyond any conceivable doubt), that in a lot of men there is some connection between cross dressing and sexual excitement.
Is the objection based on the idea that it fetishizes gender non-conformity?
Some activists are trying to sell the public on the idea, “We really are women where it matters–in our brains–and women don’t get sexually excited when they put on their bras and panties, so we don’t either.” And for a lot of them that’s just a lie.
So you don’t see a male-to-female transsexual as being female?
I think that a transsexual should be considered as whatever their biological sex is plus the fact that they are transsexuals. That’s how you would do research on them. There’s no other way to do it. If you’re interested in whether the brains of transsexuals are different in some way, you’re interested in seeing if they differ from other individuals with the same biological sex.
So in a way psychiatric research is inherently gender normative?
I would say medical research is inherently gender normative.
Some members of the trans community object to the stigma they feel accompany DSM diagnoses, but because of the impact of the DSM on insurance payments, it’s necessary they be labeled mentally ill. To what extent is a diagnosis from the DSM necessary to receive reimbursement for gender reassignment therapy?
In the US I would say most insurance companies probably require a DSM diagnosis. The point that sticks in the craw of a lot of activists is that in order to get sex reassignment surgery paid for by a third party, it has to be deemed a disorder. The transgender community has tried to get around this in a way that they seem to think is very creative.
Their argument is, “Well, public health insurance plans pay for the cost of child delivery in a hospital, and childbirth is not a disorder. Therefore transsexualism could be covered under public third party health insurance payers without it being a disorder.” That’s how they’ve tried to square the circle.
And have they been successful?
No. How many people do you know regard sex reassignment surgery as part of the life cycle like having a baby?
Do you think that classifying transgender people as having a disorder does contribute to stigma against the trans community?
No. I mean how many people who make a joke about trannies consult the DSM first?
Do you think that transgender identity might get to the point where homosexuality is now, where it is considered offensive and inaccurate to call it a disorder?
I think there are some glaring differences between acceptance of transsexualism and acceptance of homosexuality. Let’s say that a friend comes to you and says she’s a lesbian, you aren’t seeing your friend performing cunnilingus on her girlfriend. All this requires is acceptance of what you don’t have to see.
With transsexualism, if a friend comes to you and says I feel like I’m actually a woman, and starting tomorrow I’m going to be showing up wearing dresses, this is not happening offstage, you are now part of their movie.
Read more: http://motherboard.vice.com/blog/heres-how-the-guy-who-wrote-the-manual-on-sex-talks-about-sex#ixzz2SSORkDVM
[Images added to this post by me- GM]