Pathologizing Sexual Deviance: A History

Abstract

This article provides a historical perspective on how both American and European psychiatrists have conceptualized and categorized sexual deviance throughout the past 150 years. During this time, quite a number of sexual preferences, desires, and behaviors have been pathologized and depathologized at will, thus revealing psychiatry's constant struggle to distinguish mental disorder--in other words, the "perversions," "sexual deviations," or "paraphilias"--from immoral, unethical, or illegal behavior. This struggle is apparent in the works of 19th- and early-20th-century psychiatrists and sexologists, but it is also present in the more recent psychiatric textbooks and diagnostic manuals, such as the consecutive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). While much of the historical literature revolves around the controversy over homosexuality, this article also reviews the recent medicohistorical and sociohistorical work on other forms of sexual deviance, including the diagnostic categories listed in the latest edition, the DSM-IV-TR: exhibitionism, voyeurism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, and transvestic fetishism.

The role of orgasm in the development and shaping of partner preferences

“…In humans, this process may account for the crystallization of individual ‘types’ that are sought out as partners, based on a conglomeration of distal, proximal, and interactive cues (Pfaus et al, 2012). It may also account for the fixation on inanimate objects or other fetish behaviors that were present and acted upon during an individual's first experience with sexual arousal and/or pleasure (De Block & Adriaens, 2013; Gross, 2014; Krafft-Ebing, 1894; Pfaus, Erickson, & Talianakis, 2013). …”

Pedophilia

“…Both ICD-10 and DSM-5 criteria for this condition are not without controversies. Much of the debate has focused on distinguishing mental disorder from illegal or immoral behaviour [8]. Most individuals with pedophilia do not voluntarily seek treatment due to distress or functional impairment.…”

The Palgrave Handbook of the Psychology of Sexuality and Gender

“…Historically, homosexuality was considered a form of psychopathology and was listed in forensic psychology textbooks as a disorder and in psychiatric diagnostic manuals (De Block & Adriaens, 2013). Psychometric tests were developed in military settings in order to detect homosexuality in men, and to detect men claiming to be homosexual in order to get discharged (Hegarty, 2003a).…”