Rethinking Asexuality as a Disorder

I have been unusually busy this week, so I am reposting something from my blog.  This post was inspired by an essay by Natalie Reed explaining why she thinks Gender Identity Disorder is a disorder, and the subsequent comments by Crip Dyke.

Asexuality shows some superficial similarity with Hypoactive Sexual Desire Disorder (HSDD) in the DSM-IV.  It’s a similar situation to when homosexuality was classified as a mental disorder in the 70s.  Many asexuals argue that HSDD should be more narrow so as to definitively exclude asexuals.  Others argue that the validity of HSDD itself should be questioned.

I largely agree with these arguments, but I want to discuss one line of argument which is wrong.

“Categorizing asexuality as a disorder means asexuals are dysfunctional and broken, but we’re not.”

The basic problem presented by HSDD is the following equation: Asexuality = pathologization = stigmatization.  The above argument seeks to break the connection between asexuality and pathology, but takes for granted the connection between pathology and stigma.  This does a disservice to all other people with stigmatized mental disorders and medical conditions.  People with AIDS don’t have the privilege of being able to excuse themselves from the medical category just so they can avoid the stigma.  Nor do people with bipolar disorder or OCD.

As a practical matter, breaking the connection between asexuality and pathology may reduce stigmatization. If we truly believe that asexuality is not a pathology, then this is a reason to make our case forcefully.  But the stigmatization is not in itself a reason to believe that asexuality is not a pathology.

Mental disorders are not really meant to stigmatize.

Roughly speaking, the purpose of the mental disorder category is to say, “The best response to these things is through the caregiver/patient paradigm, and possibly through public accommodations.”[1]  For example, if a person has seizures, this can be treated with drugs, and if they can’t drive we can provide public accommodations such as mass transit.

There is some disagreement over what things are best treated with the caregiver/patient paradigm, but one guideline is that it should cause an impairment in an essential function, or marked distress.  But note that this is not the same as saying people are “broken” or “dysfunctional”, since these terms are tools of stigmatization.

I do not think asexuality is best treated through caregiver/patient models.  Asexuality itself is not a problem to be solved.  Asexuality may interact with society and culture to cause problems, but the best response is an education campaign and new community structures.  That’s the real reason why asexuality is not a disorder.*  That’s the real reason homosexuality is not a disorder either.

*Mind you, there are additional more subtle reasons beyond the scope of this post.

Politics should follow facts.

We should not start with “Asexuality needs to be destigmatized” and immediately go to “Asexuality is not a disorder”.  Rather, we should consider the question, “Is asexuality a disorder?” and then in light of its answer choose the best political strategy.  If the answer were “Yes,” then we should campaign for destigmatization of disorders.  But the actual answer is “No,” so we should campaign for the depathologization of asexuality, while keeping in mind that people with disorders should not be stigmatized either.

[1] Suggested reference:  Spitzer, R. The Diagnostic Status of Homosexuality in DSM-III: a reformulation of the issues.  The American Journal of Psychiatry, Vol. 138, No. 2, 1981.

About Siggy

Siggy is a physics grad student in the U.S. He is gay gray-A, and makes amateur attempts at asexual activism. His interests include godlessness, scientific skepticism, and math. While not working or blogging, he plays video and board games with his boyfriend, and folds colored squares.
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One Response to Rethinking Asexuality as a Disorder

  1. Andrew says:

    Labeling something as a disorder involves a value judgment that that is not how ought to be. In general, it means that the condition/state is something we want to prevent/reduce the incidence of, it’s a condition we want to make the person not have (if possible), and (if not) to lessen (things we deem) problems associated with it. Further, the disorder label means that public health campaigns (which can include education) may be involved, as are medical and/or mental health professionals.

    Now, these value judgments are in some cases quite uncontroversial, as when the condition causes (or likely will cause if left “untreated”) a) death, b) considerable pain, c) considerably increased difficulty in accomplishing everyday activities. (Though even here, these can be controversy involving “normal pain” such as the current controversy about the bereavement exclusion for major depressive disorder. There can also be controversy involving what “everyday activities” should be deemed normative.) As such some things are rather uncontroversially considered pathological such as AIDS, liver cancer, and heart attacks (myocardial infarction).

    In other areas, the values involved are extremely controversial, as with HSDD and homosexuality. In other cases, it is quite controversial whether certain (morally) negatively valued things should be put under the category of “disorder”, as this creates concerns about crossing boundaries of appropriate roles for health/mental health professionals vs. the criminal justice system, as in the case of pedophilia, some of the impulse control disorders, and some of the Cluster B Personality Disorders.

    With asexuality, one of the questions is whether it is the value/norm itself that is primarily responsible for the problems that asexuals face. Telling asexuals, “Hey, there’s nothing wrong with being asexual” seems to help a lot of people. With cancer, we seem generally disinclined to challenge the normative status we give to being alive.

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