Figleaf's Real Adult Sex

What does “cis” mean? Is this jargon for those in the know?

You can stick “philia” on anything, but generally paraphilias require either the involvement of non-consenting people or “significant distress or impairment” to be considered diseases—if you’re a sexual sadist who plays safely with willing partners and doesn’t feel bad about it, that’s just fine with the DSM.

The problem isn’t that someone who likes fat people and is happy about it is going to have treatment thrust upon them, the problem comes when someone likes fat people, feels guilty about it, and goes to a therapist. Classifying the philia itself as the problem encourages the therapist to try and change someone’s sexuality when they should really be working on the guilt.

Personally, I’d eliminated the specific sexual behaviors entirely from the DSM and just have two paraphilias: “Sexually Abusive Behavior Disorder” and “Sexual Identity Adjustment Disorder.” It doesn’t matter if someone feels bad because they like panties or amputees or asparagus, what matters is that they feel bad and that’s what treatment should be focusing on.

[“I’d eliminated the specific sexual behaviors entirely from the DSM and just have two paraphilias…” I think that’s probably the way to go, in part because you’re right that it’s, say, compulsive behavior however it manifests, not compulsive behavior oriented about a specific thing. (For instance I’ve got OCD whether I worry about leaving the stove on, locking the door, or turning off lights before I go out. Yet the trend would seem to be that if those are specified as disordered and I show up being OCD about making sure the answering machine is on before I go out then… I’m not covered till the next DSM update.) But more to the point, yeah, as DaisyDeadHead points out, you wind up with these implicit assumptions that desiring only stacked Swedish supermodels named Svenga is perfectly normal. I’m so promoting this comment. Thanks, Holly. —fl]

I’m getting the idea that people don’t know about the “devotee” community and the unethical lengths to which many go, compromising others’ privacy and safety. While there are good points here, the mental health community probably needs to find the balance in understanding the acceptability of attraction to nonconformist bodies versus the extreme this can take. People definitely shouldn’t be labeled as mentally ill for attraction, but there’s a line somewhere.

[The term “devotee,” which you run into a lot, gives me the jimmies when used in reference to people-as-things. I don’t have a lot of experience with fetishists but it seems like there’s more than one category of “disorder” when one is dealing with fetishes specific kinds of people — whether the disabled or the stereotypically “stacked” or “redhead.” Thanks, F. —fl]

Hi Holly,

I definitely recognize that some medical costs are prohibitively expensive. But I also know (in part because I’ve seen it first hand) that in some cases the insurance company is charged more than you would be if you paid cash. Prescriptions are one area where costs are often prohibitively high without insurance, and I don’t think paying in cash would make a difference.

I was also responding to Figleaf’s mention of a hypothetical OCD situation, because that’s where he had an aside about health insurance. I don’t know what the standard treatment is for OCD, but I do know how expensive it is to see a therapist out of pocket, and have been fortunate enough to be able to do that when I needed to.

I haven’t thought about the question “should health insurance cover gender reassignment?” enough to have any kind of opinion. In the current US system, typically the cost would be distributed across the employees of the company with higher premiums starting the following year. At least, that’s what happened at my company in 2000; in 1999 a bunch of us were able to get LASIK according to the insurance documentation. We did, and everyone in the company paid for it the next year. I (naively) didn’t realize what would happen when I got the surgery, although I doubt it would have kept me from doing it. I probably would just have felt moderately guilty. (Not that I’m comparing LASIK to gender reassignment in terms of need; more in terms of distributed cost burden.)

The same thing can happen at companies, especially small companies, when an employee has a catastrophic illness or accident.

Whenever things like this come up, I start to think that if they keep narrowing and narrowing the definition of “normal”, it will soon become (if it isn’t already) the norm to be abnormal, and eventually the whole thing will become pointless. I’ve already given up on it personally, to the point where I think they’re the freaks, not us!

My new slogan: “We’re all mad, so stop worrying and enjoy life!”

Did my comment evaporate?

It’s probably just as well.

[Hi Daisy. My publishing system is a little wonky — to reduce server load it rebuilds pages on a schedule instead of each time a change is submitted. Sorry about the scare. Your earlier comment is now visible. —fl]

“Interestingly, there’s been a lot of pressure to back off the so-called gender identity disorders that umbrella transvestism, transgender, and transsexualism.”

A great deal of the recent activism around that is because of the involvement of Zucker and Blanchard, who have enormous professional investment in the continued/increased pathologization of trans* issues.

I’m short on time, so I’ll just direct you to what Questioning Transphobia’s posts tagged DSM-V; between the posts themselves and the links, you should be able to get an idea what’s up with that.

Sunflower