by Dr. Jem Tosh
(Content warning: discussion of psychiatric diagnoses regarding s*xual abuse)
I just received my copy of Meg-John Barker's new graphic guide on sexuality, which is beautifully illustrated by Jules Scheele. The comprehensive and accessible text includes discussions on sexual diversity and fluidity, the concept of sexual 'normality' (and its problems), as well as the #metoo movement and consent. It's a great overview of the topic that veers into territory often left out of most general introductions. A handy guide for long-standing academics, as well as a great introduction for students and those with a general or personal interest who find this format more engaging than your standard textbook or journal article.
I was very pleased to be asked for my work to be included in the text, not only because I'm a big fan of comics, but because it's rare for academic work to be presented in this way. My mention is in the ethics section and includes a comment relating to my work on 'paraphilic coercive disorder' (PCD).
I began studying PCD during my PhD in 2010. I was completing my thesis on psychology and sexual violence when the American Psychiatric Association released potential diagnoses and changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) - the book used by most psychologists and psychiatrists when describing or diagnosing mental health conditions/distress.
There were concerns that this medicalised rape and that the diagnosis would be misused within the legal system.
It is a highly contested text, because who can accurately define what is 'normal' and what is not in such an eclectic world, or how emotional distress feels for one person when we have no way of knowing their experience other than from an outsider perspective? Even those who have gone through similar traumas can experience and respond to them very differently. The DSM, then, attempts the impossible task of creating broad general categories to be applied to specific individuals with unique lived experiences, identities, and cultures. It attempts to be a universal guide for billions of people, with regard to their personal experiences of distress and trauma, as well as their bodily and neurological uniqueness.
Criticisms abound, from the stigma attached to the labels it produces, to the problems with constructions of gender and race. On the other hand, some folks find that having a diagnosis in this authoritative text brings validity to their experiences and a label that helps them define themselves and find community. A big difference here is self-determination and consent - the difference between someone in a position of authority telling you who you are (and assigning a label to you, one that you may not agree with or find helpful) and having a professional agree and validate your own way of understanding and describing yourself. Not to mention, the health services and resources that are often tied to having an official diagnosis.
It also had a troubling conceptualisation of sexual violence that I examined in-depth for my research.
With the release of new potential diagnoses in 2010 there was a description and criteria for PCD, a diagnosis that was first suggested during DSM revisions in the 1980s. It was rejected then and it was ultimately rejected again. It is not included in the current edition of the text, but it does represent an ongoing construction of (some forms of ) sexual abuse as 'pathological' within psy discourse - which creates a deeply problematic binary of 'normal' and 'abnormal' rape. It is this discursive boundary that I analyse.
The diagnosis centred on sexual violence and framed the social issue as an individual behaviour that was a mental disorder. There were concerns that this medicalised rape and that the diagnosis would be misused within the legal system. It also had a troubling conceptualisation of sexual violence that I examined in-depth for my research. This led to my qualitative analysis of archival material on 'paraphilic coercive disorder', which later became a much larger genealogical discursive analysis of psychiatric constructions of sexual abuse - starting with Krafft Ebings' Psychopathia Sexualis from the late 19th century and included a vast array of diagnoses. This analysis, and how it relates to the pathologisation of gender nonconformity, can be found in my first book Perverse Psychology (2015)*. More recently, I have continued this project by examining constructions of consent, coercion, and sexual abuse in therapy in my latest book The Body and Consent in Psychology, Psychiatry, and Medicine: A Therapeutic Rape Culture (2020). Both publications examine the concept of sexual abuse alongside analyses of gender and sexuality, and like Sexuality: A Graphic Guide, these analyses foreground queer perspectives and trouble gender binaries.
Check out Meg-John Barker's book launch here.
* Please note that the language in 'Perverse Psychology' was not what I wanted (i.e. 'transgenderism') and is outdated. The book includes an analysis of how gender norms and gender nonconformity are constructed and pathologised by psychiatry, from a nonbinary perspective.