“We live in a sex-normativity scenario incapable of challenging clichéd phrases like ‘sex is health.'”
~Vivyane Garbelini, “Asexuality: Recognizing the Invisible”
Prejudice is inseparable from the roots of psychiatry. If a diagnosis is an avenue in which the world can perceive a “sick mind,” an “illness,” then this means all with a mind are dictated by the psychiatric system’s threshold: every behavior, every thought, every action. The psychiatric system decides whether or not you can trust yourself or if anyone can trust you. The psychiatric system decides what communities of people are deserving of socioeconomic exile, isolation, and physical detainment. The psychiatric system’s roots and origins are of white, cisgender, heterosexual, Christian men supporting the maintenance of dictatorship for this group of people and this group of people alone. All others under its traumatic widespread prejudice are conditioned to live as a form of sub-humanity and/or object. The entire history of psychiatry stands on proving the intellectual inferiority of black people, women, and queer people.
Benjamin Rush, the father of modern psychiatry, created the diagnosis of “negritude,” claiming that all black people inherited this “disease” and declaring that “the color and figure of negroes is derived from what is known as leprosy,” which was used as the reason why black people were “inferior.” This diagnosis was used to justify segregation and slavery for many years to come. Hysteria, a once pervasive diagnosis, was thought to be “an exclusively female disease.” Women’s sexual thoughts were considered a “symptom” of this disease that could be “cured” by either sex or sexual abstinence. Pelvic massages, vibrators and even physically hosing women down with water were considered forms of “treatment.” Hysteria and all of its evolutions didn’t come to an end till 1980. Homosexuality has also been categorized as various disorders, and numerous mental health professionals have attempted to “treat” it. For example, David Matheson, a licensed professional counselor, created a version of conversion therapy specifically for men called “gender wholeness therapy,” which focused on men addressing emotional issues and building relationships with other men in an effort to reduce “homosexual desire.” These lists go on and on; trans communities have been given diagnoses such as “transsexualism,” “gender identity disorder,” “gender dysphoria,” “transvestic fetishism,” and “transvestic disorder.” As we delve further into this critical analysis of the sexualized roots of prejudice in psychiatry, we find asexual people are being misinformed and misunderstood as well.
An asexual person could be diagnosed with “Male or Female Hypoactive Sexual Desire Disorder” under the list of “Sexual Dysfunctions” in the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.1 These diagnoses are used to pathologize asexuality. In recent years, revisions have been made to these two diagnoses to address asexuality and make an exception for people who identify as asexual. However, these revisions do not remove the DSM’s inherent prejudice against asexual people and may further contribute to their marginalization and pathologization. The Manual specifically states:
“Distress may be experienced as a result of the lack of sexual interest/arousal or as a result of significant interference in a woman’s life and well-being. If a lifelong lack of sexual desire is better explained by one’s self-identification as ‘asexual,’ then a diagnosis of female sexual interest/arousal disorder would not be made.” – American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.
“The presence of another sexual dysfunction does not rule out a diagnosis of male hypoactive sexual desire disorder, there is some evidence that up to one-half of men with low sexual desire also have erectile difficulties, and slightly fewer may also have early ejaculation difficulties. If the man’s low desire is explained by self-identification as an asexual, then the diagnosis of male hypoactive sexual desire disorder is not made.” – American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.
There are a few issues with these descriptions. First, the quotation marks around “asexuality” serve to delegitimize asexuality as a valid sexual orientation and identity. Second, the DSM requires a person to self-identify as asexual in order to not receive a diagnosis of Male or Female Hypoactive Sexual Desire Disorder. However, what if a person doesn’t know what asexuality is? A person may be asexual but still be diagnosed with Male or Female Hypoactive Sexual Desire Disorder if they have not heard of the term “asexual” or done enough research to understand what this identification means.
The final issue with these revisions is the requirement that there must be “clinically significant distress” observed in order to diagnose someone. The problem is that being told something is wrong with you repeatedly by society and those around you can lead to this described “clinically significant distress.” It is very difficult, if not impossible, for a clinician to distinguish whether a person’s distress is inherently caused by their lack of sexual interest/arousal, or rather by societal prejudice and bigotry against people with a lack of sexual interest/arousal.
After all, how could an asexual person not experience distress as a result of living in our oppressive society? Our society is that of a hypersexualized culture. If you are a person who is not interested in having sex because you do not experience varying levels of attraction, or if your varying levels of attraction differ — for example, if you do not experience sexual attraction but do experience romantic attraction, or if you experience sexual attraction infrequently and/or romantic attraction frequently — you are called a “prude who doesn’t know what you’re missing” or you are just plain “dysfunctional.”
I once was part of an asexual online group, where a gay man managed to comment on a group post wishing a sexual assault on an asexual person in the group, so this person could discover “how good sex actually is.” I was shocked initially and then recalled how many layers of privileges and injustices are present in our society. Our education systems and media as a whole have never respected or supported the representation of lived experience. For example, in the human services field, we have people educating others without having lived experience of the issues they claim to be experts on, all while failing to acknowledge all of the intersectionalities of the human experience. In the media, we have coded sexualization and under-representation of marginalized groups of people. The media represents not those with lived experience but those who are white, cisgender, and heterosexual; it perpetuates sex-normativity for people not within marginalized groups. What occurs both in education and media is misinformation, perpetuation of prejudice, and biases in favor of those with the most privilege.
The problem with the DSM, and especially the criterion of “clinically significant distress,” is that it not only pathologizes asexuality, but also pathologizes the distress asexual people feel due to marginalization and prejudice. In automatically attributing people’s distress to their lack of sexual attraction or interest, rather than their environment, psychiatry fails to recognize oppression and in turn perpetuates systemic biases.
It’s time we stop the objectification inherent within the psychiatric system and society. It is time that we stop feeling the need to comment or base our judgements on the way people experience not only their attraction but also their gender, race, ethnicity, nationality, and culture. The way in which we experience trauma, community, attraction, gender, race, ethnicity, nationality and culture etc. are crucial for us all to think about as often as we can. We are not defined by how we are assigned or labelled. Human experiences should not be viewed “dysfunctions” or something “wrong” with someone, but instead exactly as they are — natural. We need to think about how the language we use and our actions affect others. Above all, it is time to use our lived experience to create a more trauma-informed, culturally responsive mental health system and society.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.