Downing Lisa
College of Arts and Law, University of Birmingham, Ashley Building, Birmingham, B15 2TT, UK,
Arch Sex Behav. 2015 Jul;44(5):1139-45. doi: 10.1007/s10508-015-0536-y.
The move from "paraphilias" to "paraphilic disorders," where only the latter constitute mental disorders, has been hailed as a major change to the conception of non-normative sexualities in DSM-5. However, this is a claim that has been criticized by numerous activists and doctors working for removal of all diagnoses of so-called sexual disorders from the APA's manual. This article, written from a critical humanities, queer theory-inflected perspective, examines the historical and ideological grounds underlying the inclusion of the newly branded "paraphilic disorders" in DSM-5. It argues that the diagnosis does nothing to overturn the conservative and utilitarian view of sexuality as genitally oriented and for reproduction that has colored sexological and psychiatric history. It suggests that despite homosexuality no longer being classed as a disorder, an implicit heteronormativity continues to define psychiatric perceptions of sexuality. In sum, this article proposes that (1) the production of the field of psychiatric knowledge concerning "perversion"/"sexual deviation"/"paraphilia"/"paraphilic disorder" is more ideological than properly scientific; (2) the "normophilic" bias of the DSM is a bias in favor of heteronormativity and reproduction; and (3) some sexual practices are valued above others, regardless of claims that the presence of a paraphilic practice itself is no longer a criterion for a diagnosis of mental disorder.
从“性偏好障碍”到“性偏好障碍症”(只有后者才构成精神障碍)的转变,在《精神疾病诊断与统计手册》第五版(DSM - 5)中被誉为对非规范性取向概念的重大改变。然而,这一说法遭到了众多活动人士和医生的批评,他们致力于从美国精神病学协会(APA)的手册中删除所有所谓性障碍的诊断。本文从批判性人文主义、受酷儿理论影响的视角出发,审视了将新命名的“性偏好障碍症”纳入DSM - 5背后的历史和意识形态基础。文章认为,这种诊断丝毫没有颠覆将性取向视为以生殖器官为导向且用于生殖的保守功利主义观点,而这种观点一直影响着性学和精神病学的历史。文章指出,尽管同性恋不再被归类为一种障碍,但一种隐性的异性恋规范仍然继续界定着精神病学对性取向的认知。总之,本文提出:(1)关于“性变态”/“性偏离”/“性偏好障碍”/“性偏好障碍症”的精神病学知识领域的形成,更多是意识形态层面的,而非真正科学的;(2)DSM的“正常偏好”偏见是一种有利于异性恋规范和生殖的偏见;(3)某些性行为比其他行为更受重视,尽管声称存在性偏好行为本身不再是精神障碍诊断的标准。