I usually stick with visuals here but queries from various people asking my take on the the new DSM revisions, both as a sexologist and a BDSMer myself, prompts me to indulge in a bit of textualization.
I have long opposed the APA's framework for human sexuality, which, as I see it, is still fettered to a long-outdated Judeo-Christian, Victorian, reproductive model of sex (i.e., anything that isn't regular intercourse is suspect, and the further away from man-on-top vaginal penetration, the more suspect it is and the more likely to be viewed as a "disorder"). In other words, I don't believe that consensual adult sex, enjoyed for PLEASURE (and not reproduction) should be listed in the DSM in the first place.
I was much more excited by the news two weeks ago that Norway was removing BDSM from its version of the DSM, now joining Denmark and Sweden as the third progressive nation to base its diagnostics on FACTS rather than the very profitable fictions that have been fed to the American public about so-called sexual normalcy. Yay for the facts about sexuality. Boo to the people who still think sexual diversity is wrong, immoral, symptomatic of a mental disorder or -- as the APA has repeatedly insisted throughout the history of the DSM -- that falling outside the reproductive model is in itself a mental disorder.
To my mind, the DSM is so intellectually and scientifically outdated on matters of sex that it's almost irrelevant to sex therapists. In my private practice, I've seen way too many patients who visited psychiatrists, received bad, even insulting diagnoses or a fistful of scripts, and show up in my office feeling far worse than if they'd muddled through their sexual conflicts on their own. This "Bible" of psychiatric diagnoses has always been flawed, sometimes to dangerous, unscientific and harmful levels (such as keeping masturbation listed as a pathological behavior until 1961, and thus offering quack cures throughout the 1950s, including the medical torture and involuntary institutionalization of hundreds if not thousands of trusting patients; and continuing to do the same to homosexuals into the 1980s).
Whether or not the APA believes that BDSM/fetish sex is a pathology, as someone who has researched and written on the subject in the past (most notably in Different Loving, where I include a brief critique of the DSM), and as a practicing sex therapist, my view to the DSM is that it's an institutional, political document whose biases are not always based on the science but routinely based on the prejudices of the people charged with its revisions. This new revision will not change how I diagnose or work with my clients.
I respect the work of radical psychiatrist Thomas Szasz, who made it his life's mission to illustrate the cynicism, greed, and poor critical thinking that often goes into the APA's official views of psychiatric diagnoses and treatment. I am not opposed to psychiatry for the treatment of severe mental disorders; I support the use of drugs to mediate depression and mental illness. But I am opposed to psychiatry for the treatment of sexual disorders, if only because of their shameful history of quack sexual treatments.
Perhaps when they finally apologize for the harm they've caused, I'll review my long-standing animosity towards their diagnostic criteria. Perhaps then I would be a lot more impressed that their goal is to help people through a truly scientific, humanistic approach to human sexuality. Meanwhile, whatever they may put in the DSM, BDSM or fetishes are not symptomatic of anything but the normal range of sexual diversity in human beings.
I highly recommend another critique of the DSM in Psychology Today on the APA's new (and profitable) view towards Internet addiction.
If you aren't familiar with Thomas Szasz, his classic work, "The Medicalization of Everyday Life' is a must read.