HSDD and asexuality: a question of instruments

Abstract

The relation between the American Psychiatric Association's (APA) Diagnostic and Statistical Manuals (DSMs) and asexuality is likely to constitute a prolific direction in research, especially because of the diagnostic category ‘hypoactive sexual desire disorder’ (HSDD). This article investigates the concept of sexual desire as outlined by psychiatry and explores the ways in which asexuality disrupts that knowledge. By extension, I consider the model of sexuality that the DSM vehiculates. The manuals themselves provide no measures, no scales, and no defined norms, yet, simultaneously, assume a normative sexuality against which all others can be measured and classified. This article discusses the conceptualisation of ‘sexual dysfunctions’ in the DSM, of which HSDD is a part, and questions how it operates in clinical research into asexuality. I also pay attention to the clause of ‘personal distress’ in HSDD, since it appears to be one of the main differences between HSDD and asexuality. HSDD, asexuality, and the role played by the DSM poses questions such as what discourses, forms of knowledge, and institutions, have shaped, silenced, and eventually erased, asexuality.

Keywords:

• HSDD
• asexuality
• instruments
• desire
• diagnosis

Acknowledgements

I would like to acknowledge the contribution of Dr Jennifer Germon to this article. She has been central to the development of many of the ideas presented here. I am thankful for her support, dedication and continuing help to further my research into asexuality.

Notes

1. See Kirk and Kutchins (1992) for an in-depth discussion on the topic.

2. Additionally, under the guise of scientific and biological evidence, the authority of the clinicians was, and still remains preserved; as Foucault has wryly noted, ‘Our science enables us to call your madness a disease, and consequently doctors are qualified to intervene and diagnose’ (1994, p. 49).

3. The DSM-III also borrows from the work of German sexologist and sex reformer Havelock Ellis; see Arnold Davidson's The emergence of sexuality: Historical epistemology and the formation of concepts (2001) or see his shorter article in The science studies reader, p. 134 especially.

4. I use ‘civilised’ to point to the fact that many ‘perversions’ (now termed ‘paraphilias,’ see Stekel, 1930) identified by von Krafft-Ebing have either been removed from the DSM or, include (as all disorders) the clause mentioning that for paraphilias to be problems requiring care, they must cause distress to the individuals. Hence, the DSM in its constant refining of diagnostic categories endeavours to offer a scientific foundation to its types of ‘sexual dysfunctions.’ However, as Didier Eribon (2004) comments, the division and subdivision of paraphilias stem from a clear attempt to control identities. For an extensive discussion on the paraphilias and the DSM, see, for example, Hinderliter (2010).

5. As noted by Robert Padgug, while biological sexuality might be required for human sexuality, it is ‘only a precondition, a set of potentialities’ (2007, p. 21). Moreover, the reduction of human beings to their reproductive potentials in the DSM can be linked to Leo Bersani's comment: ‘It is perhaps unfortunate, but no less true, that we have learned to desire from within heterosexual norms and gendered structures that we can no longer think of as natural, or as exhausting all the options of self-identification’ (1995, p. 6, emphasis original).

6. This relates to the asexual lexicon to describe nuances of attraction and desire, and I get to that later in my article.

7. For an in-depth study of different theories of orientations, see Stein (1999). I especially think that ‘multiple-origins theory’ is relevant to asexuality studies because it accounts for both cultural practices and individual accounts.

8. Interestingly, this would refer to an individual experiencing no romantic or sexual attraction and desires raising questions as to the supposed universal need for human contact and relationships.

9. As observed by Chasin, the ‘asexual discourse’ complies with the Kinsey et al. scale, which conceptualised sexuality in a continuum from heterosexual to homosexual with sexual desire as a constant (1948, p. 638), with the important distinction that Kinsey et al. viewed humans as sexual only.

10. But it should be noted that this overlooks potential asexuals, people who are asexual but have never heard of the term, or do not identity as such.

11. In his discussion on the ethics of classifications in the DSM, medical ethicist and psychiatrist John Sadler asks the interesting question, ‘Should a DSM sexual category emerge from a condition of extremity?’ (2005, pp. 212–213), to which I would add, should a perceived extreme signify abnormality?

12. See Scherrer (2008) for an ethnographic study on asexuality. Her study reveals that some practices that are understood as sexual, such as masturbation, are not necessarily perceived as such by asexuals. This is something that Prause and Graham's study (2007) highlighted as well.

13. For example, in a situation of group sex between people of various genders, with varied preferred practices, from double penetration to individual masturbation, how can object choice be applied?