Sunday, August 1, 2010

On homosexuality, the DSM, and Pedophilia...

When I was younger people used to tell me that homosexual people were bad, that they were defective, that they were evil. These people were well-meaning religious clerics, family, family friends, school teachers, and other respectable adults. I emphasize well-meaning because their attitudes were not what we now commonly refer to as homophobic, discriminatory, judgemental, ignorant, or bigoted. Their views reflected a common majority view. They weren’t bad people saying derogatory things about a minority group of people; they were just repeating what was common thought at the time. These were good people.

Now, the common view at the time –that homosexual persons were sexual deviants, less than healthy “normal” humans- was grounded in the scientific and medical descriptions accepted until very late in human history. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classified homosexuality as a mental disorder until as late as 1973, as did the World Health Organisation in its International Classification of Diseases (ICD). Gradually in a period since the mid 1970s the classification of mental illness was ratified with increasing knowledge of prevalence and non-observance of the common disclaimer in these classification systems: “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. If a behaviour is sufficiently common and does not cause significant negative outcomes, then it is a tough call to call it a mental disorder.

Of course, the other thing that happened since the inception of the DSM and similar classification systems and the 1970s was the so-called “sexual revolution” of the 1960s. The sexual revolution abolished many taboos (or perhaps constraints) on sexual activity. One such taboo was that of sexual activity between members of the same (phenotypic) sex. As a result of the sexual revolution a lot of people came to experiment with all different forms of sexual expression, although most commonly this was frequent non-monogamous heterosexual intercourse. So one could pose the question, did this social breakdown of a variety of sexual taboos (at the time they called it something akin to generalised immorality or looseness) lead to the increased acceptance of the people who engage in homosexual activity just because homosexual interaction happened to be one of those taboos? Perhaps, but it most likely was also (at least in addition) due to the lack of findings of “dysfunction” from medical and scientific point of views.

Recently I attended a talk on psychopathology, or, actually, the classification of mental disorders. The question was posed: what is a mental disorder? Something that is inherently bad? Something bad because some scientists and medical doctors said so? Something that makes the affected person or ones associated to him or her feel bad? Something that makes the affected person unable to function effectively or satisfactorily in his micro- or macrocosm? A behaviour that is uncommon in a particular environment or situation? A behaviour politicians and lawmakers decided is bad? A behaviour that a large proportion of the person’s peers would judge unreasonable or bad? Now, regarding homosexuality and its transition in classification systems from “bad” to “normal”, we could answer this question in many of the dimensions posed above. But my point is not to argue “homosexuality: good or bad?” but rather to provide a backdrop to one scenario posed to me, which at first sight scared me deeply, so I want to finally address it and put it to rest.

Now, to speak of the scenario posed to me (and that use to plague me), I have to first emphasize I’m playing devil’s advocate here. As I mentioned before, I grew up being told that homosexuality is bad, homosexuals are deviants, abnormal, less than, etc. Gradually that story changed and homosexual persons became persons (foremost) who happened to engage in homosexual activity. What if it were possible that this happen to other behaviours currently considered "abnormal"; that they also went from being described by others as “bad” to now being described as “normal”? And this change could come about through change in social attitude or the discovery of a high prevalence of the condition. After all, if all the people of the town are crazy and the king is sane, then for being a sane minority the king will be considered crazy by the townsfolk. The scenario posed was about pedophilia.

The DSM-IV-TR classifies pedophilia as a paraphilia in which there are “over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviours involving sexual activity with a pre-pubescent child or children; and the person is at least age 16 years and at least 5 years older than the child”. Of course, it includes the common DSM disclaimer, “the fantasies, sexual urges, or behaviours cause clinically significant distress or impairment in social, occupation, or other important areas of functioning”. Now consider a world where pedophilia occurs in every culture and ethnic group, in members of different socioeconomic classes, includes members from across all professions and trades; a world where 1 in 4 girls and 1 in 7 boys are sexually interfered with by an adult; and a world where people have become too accustomed to saying “it’s OK because everyone does it”. This is exactly the world we live in! So is it purely OK, really “normal”, if prevalence rates are high enough? (I hope not.)

In a hypothetical new and vile world, imagine seeing children talking to each other in a playground. One asks, ‘so when did your daddy devirginize you’? The other answers, ‘I was six. Hurt like hell. Now we only do it in the shed every week when mum’s not home’. A third one says, ‘you’re lucky. My mum’s friend did me when I was four – and I can’t even remember the first time’. Cut ahead to a generation from that and cutting scars on human forearms have become the norm so much that you’d think this is how we were born, with multiple lacerations tracking from our wrists to our shoulders. There’s no taboo about it. The kids go out with daddy for their fishing and “playing” trips. Mum knows, dad is not ashamed, and the children all share their common carnal knowledge amongst themselves at school. The mental disorder classification books no longer include any lifestyle choices or paraphilias anymore....

But wait, to wake yourself up from this nightmare, remember that one disclaimer in the definitions of illness: “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. Despite the unfortunately high prevalence of pedophilia in this world, the fact that it is harmful makes it not classifiable as a variant of normality we will/should all just accept. Child sexual abuse has no advantages except to the perpetrator, it’s an abuse relationship, a two-party transaction with only one person benefiting. In legal terms they would equate this to at least theft. You can’t steal from a child and say he consented because he would trade in a bar of gold for a simple candy, lacking that knowledge of how things done today can affect your whole life to come. You can’t just say homosexuality is the same as pedophilia because they are both types of sexual interactions; so is heterosexual intercourse, and why do less people compare that to pedophilia? Because there are differences!

From 2006 to 2010 there existed a political party in the Netherlands (PVND) that provided political advocacy for pedophile groups and organisations. One of their agendas was to legalize child pornography and to lower the legal age of consent to sex down to 12 years old. Commonly pedophile groups argue that children have the ability (and so the right) to enjoy sexual activity alone, with their peers, or with an older adult. Consequently, they argue, if the child consents to the sexual contact, then it should be legal for the adult/s to engage so with them. They’ll go so far as to argue that sexual contact with children is “good for them” and their development. Of course the issue that is of concern to other (non-pedophile) adults is that children’s ability to consent is limited by their experience and knowledge of consequences. A child can know that candy has a pleasant flavour, for example, and he can decide / consent to eat that given to him by his parent or friend, but the consequences of eating a piece of candy (e.g. early tooth decay, or not wanting to eat the rest of his dinner afterwards) are hardly the same as “consenting” to sexual activity. The consequences of childhood sexual abuse are commonly seen in our psychiatric wards, in the patients we all struggle to interact with: the personality disordered, the limitless cases of deliberate self-injury and drug abuse, the repeat victims of domestic abuse who go around either recreating or trying to erase their childhood experiences. This is too sad – and the worst thing we can do is blame the child, say he or she “consented”.

Pedophiles abuse people; they cause harm. This is not a time- or era-dependent opinion. It is so not the same as homosexuality or heterosexuality or any other way competently-consenting adults choose to interact sexually. And I think we have all come to that same conclusion. The only thing for us as a society still to debate about this and many other negative actions towards other human beings (e.g. murder) is whether such acts constitute criminality or mental illness, and which are the best ways to decrease our childhood sexual abuse rates.

(Sorry for the discussion on homosexuality together with pedophilia, I was obviously mainly aiming to contrast not compare.)

No comments:

Post a Comment