ARLINGTON, Va. — Controversy surrounds the American Psychiatric Association in the aftermath of news reports that presenters at its annual conference in May called for pedophilia and other sexual problems to be considered sane behavior.
Psychiatrist Charles Moser of the Institute for Advanced Study of Human Sexuality in San Francisco and psychologist Peggy Kleinplatz of the University of Ottawa argued before the American Psychiatric Association membership that the logic of the association's Diagnostic and Statistical Manual for mental disorders is flawed.
Citing the 1973 decision to removed homosexuality from the third edition of the authoritative manual, Moser said the fact that some abnormal sexual preferences are not considered mental illness means none can be classified as mental illness, even if they are morally objectionable or even, as in the case of pedophilia, illegal.
The current edition of the manual, with revisions, is referred to by professionals as DSM-IV TR. It speaks of disorders known as paraphilias and defines them as “recurrent intense sexually arousing fantasies, sexual urges or behaviors that generally involved nonhuman subjects, children or other non-consenting adults, or the suffering or humiliation of oneself or one's partner.”
Defending his position in a prepared statement, Moser said, “Some individuals have interpreted interpreted [the report] as suggesting that we support child sexual abuse. We are strongly opposed to child sexual abuse and believe that anyone convicted of this crime should be punished.”
Quoting from his presentation to the American Psychiatric Association conference in late May, he said, “We would argue that the removal of pedophilia from the [Diagnostic and Statistical Manual] would focus attention on the criminal aspects of these acts and not allow the perpetrators to claim mental illness as a defense nor use it to mitigate responsibility for their crimes.”
Also in a prepared statement, the American Psychiatric Association disavowed any implied support for Moser's proposal or the possibility that paraphilias would be removed from the diagnostic manual. The association reiterated its position that “mentally ill” is defined as “anything that harms an individual or others,” and said, “There are no plansor processes set up that would lead to the removal of the paraphilias from their consideration as legitimate mental disorders.”
Although controversial, Moser's proposal is not the first to challenge the American Psychiatric Association's standard for mental illness as vague and subjective. Since 1973, some psychologists and psychiatrists have been arguing that lacking a scientifically provable definition of normal behavior, the mental health field cannot accurately define abnormality without referenceto legal or moral definitions specifically rejected by the American Psychiatric Association as a standard.
Dr. Michael First, text editor for the DSM-IV TR, insists that this is unjustified.
“The issues surrounding the concept of the definition of mental disorder are no different than issues involved in the definition of medical disorder in general,” he said. Citing the changing definition of “high blood pressure” as an example, First said, “There are, in fact,no hard boundaries separating normal from disorder, and as we learn more about the negative consequences of conditions, boundaries could change. [For both] the condition must represent a biological or psychological dysfunction in the organism and it must be of sufficient severity as to result in harm to the individual or others.”
First said psychological dysfunction is defined as causing distress, functional impairment or future significant risk for harm.“Empirical data that sheds light on the nature of the dysfunction as well as the manifestation of harm,” he said, “can be helpful in readjusting normal-abnormal boundaries.”
Dr. Janet Gebelt, assistant professor of developmental psychology at the University of Portland, calls these “fuzzy criteria.” She agrees with Moser that the definitions are subjective and personal.
“Is a person feeling unhappy because of the behavior or because of other people's reaction to the behavior?” she asked.
“Distress caused by prejudice or discrimination is not a form of distress that meets the definition of disorder,” she said. “I don't think any psychologist would say society is always right.”
While Gebelt insists psychology can be based on scientific experiments and observations, she said the studies will only define normal as “common” behavior, not necessarily “right” behavior. “Normal is anabsence of abnormality,” she said.
Noting that a 1963 study by Dr. Stanley Milgram induced a large number of randomly selected people to deliver what they believed to be fatal electric shocks to another person, she said, “You can take perfectly ordinary people and make them do evil. This doesn't constitute mental illness, but that doesn't make these actions excusable.”
Oblate of St. Frances de Sales Father John Harvey disagrees with Moser's claim that sexual disorders rest on cultural definitions.
“Cultural concepts can change the definition somewhat,” said Father Harvey, director of Courage, an organization for Catholics with homosexual tendencies. “However, it's one thing to say you don't know where the line is and another entirely to say you can't define normal.”
However, Dr. A. Dean Byrd,vice president of the National Association for Research and Therapy of Homosexuality and clinical professor of medicine for the University of Utah, disagrees with some of Moser's conclusions — but not his assertions about the subjectivity of the diagnostic manual. He calls the American Psychiatric Association's standards political activism masquerading as science.
I do not object to the [American Psychiatric Association] presenting a worldview,” he said. “I do object to the [American Psychiatric Association] presenting one worldview and labeling it as science.”
Science neither has nor can provide answers to moral dilemmas,” Byrd said. “So, how do we resolve this disagreement about the definition of mental illness? The [American Psychiatric Association] could begin by acknowledging the value-ladenness of the mental health enterprise.”
“An open dialogue and spirited debate is needed to discuss these issues. What factors enhance human dignity? How do we define human flourishing?” Byrd said. “The [American Psychiatric Association] slides down a slippery slope when it advocates what amounts to a virtual censorship of the scientific investigation of politically unpopular views. Science advances by asking interesting questions, not by avoiding questions whose answers may not be helpful in achieving a particular political agenda.”
Philip S. Moore is based in Vancouver, Washington.