jtoday asked you:
As a psych major you learn that anything in the DSM is only a “disorder” if one thing is present - it causes the patient DISTRESS or DISRUPTS their everyday life. If someone, say, was sexually active and enjoyed it, and then suddenly couldn’t, and it was causing them issues in their personal life, it would be that disorder. For asexual people whose lives/happiness are not affected by their disinterest in sex, it wouldn’t be a disorder. The DSM mostly exists to classify disorders for insurance. So if an asexual person went to see a therapist to deal with their stress/anxiety/depressing centering around their asexuality, the therapist WOULD put that down as a “disorder” just so the patient could get insurance coverage. But the actual therapy could be about accepting their sexuality, and arranging their life so that it causes them less stress. If that makes sense. So while the words “abnormal” and “disorder” are harmful, it’s not as drastic as it sounds? I suppose that’s my point?
Okay, first, I want to point everyone in the direction of the official DSM-5 website, where the various sexual dysfunctions are listed: go here. As you can see, listed there are Sexual Interest/Arousal Disorder in Women, Male Hypoactive Sexual Desire Disorder, and Other Specified Sexual Dysfunction. Those are the ones relevant to asexuals particularly. The others all have to do with more obviously physical/medical issues: erectile dysfunction, early/late ejaculation, genito-pelvic pain during penetration, substance-induced sexual dysfunction, sexual dysfunction related to a known medical issue, etc. I have read the descriptions of MHSDD and SIAD in Women and the “Other” and yes, one of the listed symptoms under each is, “causes clinically significant distress or impairment.”
But here’s the problem. First of all, the world is full of assholes, and some of those assholes are therapists. I can’t even count the number of times I’ve heard from asexuals, male and female and otherwise, who came out to a therapist only to have their identity dismissed, questioned, pathologized, etc. Having these new categories in the DSM? Isn’t going to make those situations any better. Those asshole, ignorant therapists who have never heard of asexuality or who simply don’t take it seriously do not need an official manual circulated throughout their professional community that they can point at and say, “Oh, look, it says right there that if you don’t want to fuck or if you don’t have a libido or if you don’t masturbate or if you don’t get aroused, there is something medically or psychologically wrong with you.” If homosexuality was still listed as a mental disorder or a medical disorder in any sort of major medical text, the queer community would be up in arms about that, and they’d have a right to be. I understand that there are legitimate cases where lack of interest in sex, loss of libido, lack of arousal response, etc are indeed problematic and can be treated and cured, but the asexual community doesn’t have the advantage of being a widely known, widely accepted (as real, not necessarily good) demographic, which means that our orientation and our experiences linked to that orientation can too easily get lost in the sexual majority’s treatment of sexual dysfunction. They’re already inclined to treat asexuality, willful celibacy, sex-aversion, lack of libido, lack of arousal responses, etc as innately pathological without actual medical support for that opinion, just because of our cultural consciousness about sex. Jesus Christ, some sexual people watched that episode of House, for fuck’s sake, and took it seriously! “Oh, a medical doctor on a TV show said that asexuality is bullshit, so that means it is!” People are idiots. And they’re idiots who are narrow-minded about sex and sexuality and relationships and love and intimacy right out of the gate. Medical doctors and psychologists and psychiatrists who believe that asexuality is bullshit and celibacy is wrong, etc—of which there are many because being a medical professional does not make you infallible or open-minded or anything other than a medical professional, really—only serve to confirm the public’s attitudes about sex and intimacy, etc.
Second of all, being an asexual in this world is fucking hard. And for many, if not most of us, we will inevitably go through a stage or periodic phases, where we DO feel distress about being asexual. Especially those of us who are celibate, sex-aversive, etc. We feel distress because we’re invisible, misunderstood, rejected, isolated from a physical community, have no media representation validating our identities and experiences, and because many of us want to have intimate, loving relationships with other people but can’t or don’t because we’re surrounded by sexual people who have no concept of how to relate to other humans beings in the ways we want to relate. Many of us suffer a lot of emotional pain over the possibility that we will always be alone and unloved and unattached, unless we agree to fuck, and those of us who are sex-aversive or repulsed either don’t want to do that or can’t do that. And that relationship fuckery is a legitimate reason for emotional and psychic pain! Human beings are social creatures. We have built-in intimacy needs. Without love and care and affection, we literally die.
So let’s say you’re a celibate asexual who never wants to have sex and you go to your therapist and you say, “I’m really depressed because I want to be loved but I’m an asexual and I can’t get romantically involved with sexual people, without fucking them, and I can’t form a primary platonic relationship with any of them either because they don’t even understand that concept or accept it and I don’t know any other asexuals and I don’t know how to meet other asexuals in real life, so I feel intensely alone and lonely and I’m afraid I’ll spend the rest of my life this way.”
And your therapist, who’s ignorant or an asshole, says, “Let’s explore why sex is a problem for you because if you can get over that, then you can be normal and have normal romantic-sexual primary relationships and live happily ever after just like the rest of us. Oh, look, the DSM says this is your problem.”
How many therapists are going to question the entire cultural/sociological system of sex supremacy and compulsory sexuality and romance supremacy and the view that sex and romance are innately linked? How many therapists are going to see that the problem isn’t the asexual person’s orientation but the rest of the world’s treatment of everything that orientation implies?
A queer person goes to a therapist and expresses deep psychological suffering over their queer identity, the therapist is quite likely to recognize that the reason this person’s in pain is not because being queer is an innately painful thing but because being queer in a homophobic, heterosexist society is a painful thing. If society were totally cool with queerness on every level—socially, legally, culturally, religiously, etc—how many queer people would you have in therapy, being depressed and suicidal over their sexuality? Probably not that many. And all of that is immediately clear to us. We know homosexuality and bisexuality and transgender identity are not mental illnesses. (Yeah, a lot of homophobic/transphobic people in America would say otherwise, but that’s the point: it’s their own prejudices, not the identities themselves, that are the problem).
But with asexuality? With celibacy? With the idea that romance can be nonsexual and nonromantic love can be primary? How many sexual people get that? How many sexual people have even HEARD of those concepts? A fucking negligible percentage.
This culture is so intensely sex supremacist (and romance supremacist) that no matter where you go and no matter who you talk to, no matter what their backgrounds are—conservative, liberal, gay, straight, male, female, religious, atheist, whatever—the likeliest reaction an asexual (especially a sex-aversive asexual who wants primary nonsexual love and intimacy) will get is something along the lines of, “That’s not normal, that’s not right, that’s unnatural, that’s caused by some separate issue, sex is the greatest and most important thing in the history of existence, why don’t you see that, what’s wrong with you?”
Who wouldn’t feel like shit if that’s what they constantly had to hear about themselves?
And therapy isn’t going to fix that. There is no immediate solution to that. There’s no way to magically snap our fingers and make a loving, compatible partner appear, there’s no way to snap our fingers and change the way our entire society functions and thinks, there’s also not a way to instantly transform ourselves into romantic-sexual people with normative ideas about relationships. So basically, there is justification for a celibate asexual person to feel hopeless and depressed. Our pain is not an overreaction. We are not exaggerating the seriousness of our circumstances. Our pain does not come from chemical imbalances in the brain or an inability to self-soothe or whatever. It comes from being in a really shitty situation, much of which we have no control over.
It’s not a matter of a therapist or anyone else “helping” to make the situation better, to actually change the circumstances or suggest ways for the asexual to change them. All anyone can do is help the celibate asexual make as much peace with the way things are as they can and instill some sense of hope that maybe one day, that individual will find at least one other person who can relate to them in a satisfying way. And they can’t make promises.
And like I said, therapists are people too. They have normative upbringings and normative friends and normative families and normative sexual experiences. They go see mainstream movies and watch mainstream TV and read mainstream books and listen to mainstream music, all of which is saturated with sex and sexual romance and the supremacy of those things. Are they supposed to be professional and impersonal in session with a patient? Yes. But they aren’t infallible. They can’t just leave all of their personal opinions and experiences of humanity at the door of their office and approach each patient with total neutrality and a blank mind.
I haven’t had extensive experience with psychotherapy, but what I’ve had…. I once spoke to the head of health services at my college, when I was a freshman and deeply depressed and suicidal, and tried to explain being asexual and why I was in so much pain over the future of my friendships and my own future in terms of relationships, and I guess she thought she was being nice and sweet but in retrospect, she absolutely did not get it and was totally condescending to me. Following that, I had a therapist I saw on campus for a while who I really liked and who knew about my identity and who I talked to as I was going through relationship angst and bullshit, and he never once made a negative comment about my asexuality or my celibacy or my views of relationships….. But do I know for sure that he was as accepting as he seemed? No. I don’t know. Maybe he was sitting there the whole time thinking, “What the hell is wrong with this girl?” or “She’s just 18, she’ll have sex eventually and find out it’s great and live happily ever after in Normative Relationship Land.” I can never know what he was really thinking. If he was thinking dismissive thoughts, I appreciate that he kept them to himself, but…. My point is, I would never see a therapist again even if I was having psychological distress because I don’t trust them—they being sexual—and I don’t need my therapist of all people making me feel as if there’s something wrong with me and my relationship desires. No, thanks. If I have shit to deal with, I’ll deal with it on my own.
^this is an excellent description on why having a distress clause is not enough to counter the problematicness the DSM with regards to asexuality.
Simply put, the problem is that it can be difficult to separate distress from an actual problem from distress from society being dumb - whether you have an actual problem or not, if society is constantly telling you that you are broken, wrong, unnatural, then of course you will be distressed!
In addition, although ideally a diagnosis should only occur if the patient is distressed, all too often therapists will hear that a patient has no sexual attractions and simply conclude that they MUST be distressed - whether they actually are or not.
Consider the case of “ego-dystonic homosexuality”, which was what was in the DSM after simple homosexuality was removed as a mental disorder. Basically, it stated that homosexuality was only a problem if you were uncomfortable with it - but as was said before, many people are still uncomfortable with their homosexuality not because it’s any kind of disorder but because society is pretty f’d up and keeps telling them that they are broken, sinful, wrong. It was in fact later removed from the DSM - for reasons that may be understandable.
(And for what it’s worth, there’s a lot of other pretty screwed up stuff about MHSDD and SIAD - consider the “situational” subtype which is characterized not by general lack of interest, but specifically lack of interest in a current relationship partner - which is really pretty much part of the normal spectrum of human behavior - sometimes they just aren’t that into you anymore. These “disorders” are also problematic in that they group together phenomena that are wildy different - lifelong general HSDD would be completely different than acquired situational HSDD, grouping them together as the same phenomenon is problematic. The fact that there’s no real scientific basis for this disorder (other than some spsychologists thinking it doesn’t seem “normal” certainly doesn’t help things either. )
FWIW, though, at least they’ve removed “interpersonal distress” as a qualifier - under previous versions of the DSM, you could technically be diagnosed just because your partner wanted more sex than you did. (which is rather ridiculous).
It’s rather long, but there’s an excellent discussion of the history DSM in dealing with non-normative sexual behaviors/identities (actual disorders or otherwise) here: http://www2.hu-berlin.de/sexology/BIB/hinderliter2010.htm#_Toc272740746