NYC Sex Therapist Talks: Fetishes- Interest in Kink or Psychological Problem?

Fetishes Do Not Exist : clinical and popular conceptions of paraphilias are fundamentally wrong

Perhaps the greatest revolution in psychiatry occurred in the 1970s, with the transition from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM2) to the third edition (DSM3). This also marked the transition from unreliable, low-validity, non-evidence-based categories of mental disorders (mostly influenced by psychoanalytic theory) to reliable, high-validity, symptom-based categories of mental disorders (mostly adopted from research-based criteria from psychiatrists at Washington University in St. Louis.) Until the Internet, most scientific understanding of paraphilias was based upon one-off case studies from individual clinicians (such as John Money's fascinating account of formicophilia) and small samples of patients at clinical institutions. Reliable prevalence numbers were impossible to come by; in fact, Kinsey's surveys from the 1950s have remained the only systematic quantification of paraphilias in a large, non-clinical population, though his samples were convenience-based and mostly middle-class Caucasians from the mid-West and northeast of the USA. Theories about paraphilias lacked coherence and predictive power. In other words, the classification of paraphilias has been closer to the diagnostic criteria of the DSM2 than the DSM3. (Read article)


There is so much coming out right now about the many problems with the DSM, the book mental health clinicians use to diagnose (and presumably then guide the process of therapy).  It is no question that there are questionable entries in the chapter about sexuality.  I can tell you that my studies in clinical sexology, we were taught that fetishes and kink were interests, and that paraphilias (as described in the DSM) were problematic.  Showing your naked self on webcam with consenting partner(s)?  Interest.  Showing yourself off (compulsively) so unsuspecting strangers without their consent (and without a hope that they will show off for you)- paraphilia called exhibitionism. The way I deal with kink and fetishes in therapy is basically- if you are in the driver's seat, we're good.  If you feel compelled to treat people as objects or objects as people and this causes you and others emotional conflict, then it might be paraphilic behavior, and might be self-defeating.

I can see the need to study and label, no problem there.  But when we use these labels to define healthy/normal sexuality based on one dominant group's definition of healthy/normal, then I have a problem.  It seems like throughout the history of the mental health field, clinicians have been sometimes used as tools of the oppression.  Not sure what to do with your autistic daughter?  Send her to the insane asylum.  Can't deal with your gay son?  Send him to the insane asylum.  Shock therapy (ECT) will cure what ails 'em!  Or how about cold water enemas?  Or leeches?  Have uncommon (and often harmless) sexual tastes?  Fetishes!  Get thee to the head shrinker!

Modern therapists who have any experience at all with dealing with fetishes and kink will tell you- if it's safe, sane and consensual, then you're definitely more sexually liberated and healthy than a good number of so-called normophilic sexually active people.


Interested in talking to someone about your fetishes?  Schedule with a sex therapist in New York



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