This diary is about the proposed changes that American psychiatrists are very seriously entertaining regarding those who rape, changes that could only be conceived of and made possible in a rightwing sociopolitical environment such as ours today. I hope after you read this diary you will take the time to voice your opinions to the American Psychiatric Association (they say they want our input). I’ll provide details on how to do it (it’s really easy and you do it online). Even if you don’t contact the APA, know this: by the time you complete reading my 12-minute-long diary, nine women and two men in America will be raped—I’m not counting child sexual assault victims in my calculation either which is based on a report by the National Institute of Justice [pdf], just adults. More than half of female rape victims and nearly three-quarters of male victims are raped before their 18th birthday so you can do the math as to how many child sexual assaults will occur in the next dozen minutes or so. Thanks for reading/recc'ing. Double thanks to those who contact the APA.
The American Psychiatric Association periodically updates (revises) it’s Big Book of what’s considered mental illness. At present, that book, the APA’s Diagnostic and Statistical Manual (better known as the DSM), is in its fourth major incarnation. It’s fifth revision—to be called DSM-V—has been in the works for about ten years. One of the proposed changes to the DSM is to include for the first time a diagnosis tentatively called Paraphilic Coercive Disorder. From the DSM-V website here are the proposed criteria for the diagnosis of Paraphilic Coercive Disorder (a person must meet all three conditions):
A. Over a period of at least six months, recurrent, intense sexually arousing fantasies or sexual urges focused on sexual coercion. [23]
B. The person is distressed or impaired by these attractions, or has sought sexual stimulation from forcing sex on three or more nonconsenting persons on separate occasions. [24]
C. The diagnosis of Paraphilic Coercive Disorder is not made if the patient meets criteria for a diagnosis of Sexual Sadism Disorder.[25]
There it is: those thinking about and then "forcing sex on three or more nonconsenting persons on separate occasions" are to be called suffering patients, not rapists. Yes, as a culture we've veered so far to the right that there are forces in the used-to-be-liberal mental health fields—namely, psychiatry, psychology, and social work—who wish to blur the distinction between evil and mental illness. Remember, the DSM is supposed to be a diagnostic dictionary of mental illnesses, not a book listing permutations of evil. The DSM is a book from a group of psychiatric experts, not a group of experts on evil. We’re all too young to remember this, but in ancient, unenlightened and religiously repressive times—times we now have labeled The Dark Ages—mental illnesses were considered to be forms of evil. I guess we're entering a new dark age. With the proposed diagnosis of Paraphilic Coercive Disorder it’s a legitimate question to ask: whose pockets are being lined by whom and with how much cash in the push to include rapists as people who, because of their raping, are counted among those considered to suffer from a mental illness? Or, more snarkily: what’s being smoked at the American Psychiatric Association’s nomenclature meetings?
Rape, like other traumas, can lead to what is known as Post-traumatic Stress Disorder (PTSD), a legitimate psychiatric disorder; even if it doesn’t, rape has other horrific consequences. This from the World Health Organization [pdf]:
Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences (4, 7–16). Its impact on mental health can be as serious as its physical impact, and may be equally long lasting (17–24). Deaths following sexual violence may be as a result of suicide, HIV infection (25) or murder – the latter occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’ (26). Sexual violence can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families and others as a consequence (27, 28).
In addition, rape also results in about 32,000 unwanted pregnancies each year in the United States alone [pdf]. Those unwanted pregnancies too have physical and emotional ramifications for the rape victim.
Alice, enter Wonderland. Now the medical subspecialty of psychiatry wants us believe that those who sexually assault are psychiatrically afflicted folks to be pitied. By extension, I guess they aren't to be punished (we don't criminally punish people because they carry a specific psychiatric diagnosis). If Paraphilic Coercive Disorder gets included in DSM-V expect to be reading about the poor souls who suffer from this new mental illness, PCD (we Americans love our acronyms). I know what you’re thinking: there is something wrong with someone who rapes. Yes, there is. As I've already more than implied, it's called evil of which there are many varieties, sexual predation being one of them. Was evil something the Ohio neo-conceptual artist Jenny Holzer was thinking of when she created the phrase-as-art slogan, THE ABUSE OF POWER SHOULD COME AS NO SURPRISE, back in the 1980s? I’m not sure, but her slogan keeps intruding into my consciousness when I think of a powerful group of mostly male doctors in a patriarchal society trying to bring medical validity to something misogynistically evil like rape—a group planning to strip something evil of its evilness. Holzer's haunting 1994 work, Lustmord [pdf] (German translation: rape-slaying), also pushes its way into my mind.
Rape victims of course include children and men, but as I’ve already said, rape’s victims are usually female (one in six women, and one in 33 men), it’s perpetrators men. I suspect too that the transgendered among us are also at-risk for being raped, although there is scant research on this. Thus, rapes are largely misogynistic acts. It’s probably why a good friend of mine, upon learning of the proposed diagnosis, summed it up this way: "it’s the ultimate mind-fuck for women." I agree with him. Rape is a social ill, not an individual illness. We know this, if not from our common sense, then from what the Center for Disease Control has shown to be risk-factors for being a rapist [pdf]: being male; having friends that are sexually aggressive; and, importantly, being exposed to social norms that support sexual violence.
As a social ill, rape’s reduction rests not in so-called sex offender treatment, which unsurprisingly fails and which is obscenely expensive. Rather, the reduction in rape can and will happen when the male gender role is cleaved from the notion that others (especially women) are to be dominated. Not an act of sex, rape is an act of forced domination and humiliation of one over another. From the perspective of the perpetrator, it’s an entitlement that is owed. Yes, that’s "sick" but it’s not "mental illness sick"—not the kind amenable to psychiatric treatments—it’s socio-politically sick, akin to the hate crime perpetrator who feels entitled to burn his African-American neighbors out of their home because it’s "his" neighborhood. Those people rightly wind up in prison, where rapists belong, not in some psychiatric treatment program to treat their racism. Rape is a sickness of our gender roles and our notions of power; it’s not a mental illness. It’s why the CDC points to a number of social (not psychological) prevention measures, such as educational programs that focus on sex education and dating-related skills-building, and developing mass media messages that promote norms about healthy sexual relationships, among others.
Calling rapists sufferers of Paraphilic Coercive Disorder requires things of me I am not willing to give: sympathy and empathy. I’ll save those for the rape victim, thank you, not the rapist. I can and do sympathize with someone coping with, say, schizophrenia, major depression, or PTSD. And yet the psychiatry profession in the United States is telling us that it’s time to feel sorry for rapists. Judging from this exchange, the head of the DSM5 Workgroup on Sexual and Gender Identity Disorders—a man, no doubt, of wealth and fame—sounds quite biased and in favor of adopting a host of proposed sex- and gender-identified "disorders;" yet, you'd think (and hope) that someone in his position would be more neutral. (I wonder how many feminists, and how many transsexuals are part of the DSM5 Workgroup on Sexual and Gender Identity Disorders?)
Sticking rape into a book of legitimate mental illnesses by calling rapists sufferers of a specific syndrome has legal and economic consequences too, and these consequences also disturb me. As someone who pays into a pool of the health insured (yep, I’m lucky to have health insurance) and as someone who pays into the Medicare and Medicaid systems, some of my health care money would likely go toward "treating" those labeled as suffering from Paraphilic Coercive Disorder as health insurance companies and state agencies would receive pressure to treat those seen by psychiatry to have a legitimate psychiatric problem. That would, of course, suck money away from those with, say, mood disorders and other real mental problems. Money is the name of the game when giving legitimacy to the misogynistic notion that rapists are ill and need treatment. The sex-offender treatment cottage industry—its engines already quietly humming throughout the United States—will grow exponentially. Tax and research dollars will go to those making a living off the disorder. To treat an illness you need qualified treaters; those people need to be properly educated, so there will need to be ample resources to train them. Thus, you need to train specialists to provide that education. And of course, you’ll need a pantheon of researchers and continuing education specialists to bring the latest Paraphilic Coercive Disorder treatment "breakthroughs" to those in the sex-offender cottage industry. Every medical school would thus need to offer some sort of education about the "diagnosis" the American Psychiatric Association plans to dub Paraphilic Coercive Disorder. Mental health clinics could have waiting rooms with rapists and rape victims seated side-by-side, each waiting for their therapy appointment. God, if all of this weren’t so grotesque, so socially oppressive, it would be laughable.
And you can’t have a sex-offender treatment cottage industry without lawyers! As certain as I’m typing this, you can bet criminal defense attorneys will use the diagnosis of Paraphilic Coercive Disorder to try to get their rapist clients less time incarcerated. They’ll use the diagnosis as a way to have the judge pity their "afflicted" client. They'll beg, "Your Honor, my client needs treatment, not a long prison sentence." Or, criminal defense attorneys will argue for no time in prison at all. They’ll use an insanity defense to get their clients into mental hospitals instead of prison...into mental hospitals where they can prey on vulnerable mentally ill patients! The thought of rapists sucking up scarce public inpatient mental health resources at the expense of someone who suffers from an actual mental illness, like schizophrenia, makes me sick. Remember too that the lawyers will need to haul their mental health experts into court to help make their case, so forensic mental health professionals (called "whores of the court" by one psychologist) also have a stake at legitimizing the Paraphilic Coercive Disorder. They are also part of the sex-offender treatment cottage industry. Whoever is behind the proposed diagnosis, you can be sure that they have a lucrative career either on the line or in the making.
Because psychiatry reflects society’s values—if it didn't reflect our values, the APA would not seek input from the general public—we have to be truly frightened that American culture has veered so far to the socio-political right that Paraphilic Coercive Disorder could be created. What next from the American Psychiatric Association? Concocting a Jewish Animus Syndrome, perhaps, so that we can feel sorry for anti-Semites? Race-based Rage Disorder? Gay-induced Panic Disorder? Genocidal Personality Disorder? How about a free pass for those who beat up or kill illegal immigrants or those perceived to be illegal immigrants? Why not create an Immigrant Coercive Disorder? That would require only a few minor changes in wording to the proposed Paraphilic Coercive Disorder and could read something like this:
A. Over a period of at least six months, recurrent, intense violence-arousing fantasies or violent urges focused on someone perceived to be an illegal immigrant.
B. The person is distressed or impaired by these fantasies or urges, or has sought to do violence toward three or more persons known to be or thought to be illegal immigrants on separate occasions.
C. The diagnosis of Immigrant Coercive Disorder is not made if the patient meets criteria for another diagnosis.
I hope that example brings home just how fucking grotesque it would be if psychiatry adopts Paraphilic Coercive Disorder.
The APA has not yet decided on adopting Paraphilic Coercive Disorder; and, they are seeking the public's input. So, if you know in your heart that rapists should not be deemed mentally ill because they rape, I urge you to please take a few minutes to let the APA know how far off-base they are. The more people who tell them that they would be making their profession a laughing stock by including Paraphilic Coercive Disorder in DSM-V the better (feel free to share this diary with feminists and feminist groups). I really do believe lives (mostly women's and children's lives) are at-stake here. Since, over 3,100 kossacks recently identified as being feminists, I know this community will come through and contact the APA. I also would bet that sexual assault victims who weigh in on this proposed diagnosis would have some very powerful things to say to the APA. Here's how to contact them. Go to this website and at the bottom of the page where it reads "Want to comment on this proposal? Please Login or Register Now", click on the "Register Now" link, follow the instructions, and tell the APA what you think. You have until April.