Sexual Fetish vs. Mental Illness

A 40-something man living in a Chicago suburb is like most of his neighbors in many ways. He is happily married, a father of two, works in management for a tech company and enjoys playing a good game of golf. But unlike anyone—anyone he knows, at least—he derives sexual pleasure from wearing women’s undergarments. He kept his fetish a secret from his wife for many years, but now she knows and even sometimes helps him purchase women’s lingerie—for him to wear.

A woman in Austin is a new grandmother and loves the role. She adores her infant grandson and has a great time socializing with family members during holidays and other occasions. She’s described as “bubbly” and is frequently sought out for advice by relatives and friends. Like the man outside Chicago, she also has a sexual fetish. She enjoys sadomasochism and is involved with a man who sexually dominates her—employing bondage, whips, canes and other instruments of sexual “torture.”

A young man in Alabama is the youngest of three and attends high school with his brothers. While his brothers talk endlessly about the girls in school and go through girlfriends like they do hair products, he isn’t interested in any of the girls their age. He has discovered that only older women—his teachers, friends’ mothers, older women in town—are sexually interesting to him. He has an intense fantasy involving one of his teachers and was disciplined by his parents after a 45-year-old librarian complained that he’d made a lewd pass at her.

Erotic fascination with feet or shoes, with asphyxiation, with pain, with exposing oneself publically or spying on others while they undress—these are just some of the nearly infinite expressions of sexual fetishism.

Social Stigma = Mentally Ill

While the practices of psychology and psychiatry (a medical degree) are part and parcel to healthcare and wellness, their practices have not always proven purely altruistic. Hippocrates himself might strain at the imperatives of psychiatry over the decades since its inception, even while many have worked tirelessly to improve the systems that govern policies and practices in order to make them more knowledgeable, compassionate and humane. In Victorian times, unruly wives and daughters could be locked away in asylums for issues such as “dwelling on impure thoughts, reading novels and eating too much chocolate” which were eventually considered to be symptomatic of nymphomania and classified as sexual deviation by 1951 in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Women simply ought not be “too sexual,” or even like Ghirardelli and Jeanette Winterson so much.

Homosexuality was previously considered a mental disorder, as well, and wasn’t removed from the DSM until 1973. Transgender people have found themselves facing the stigma of a mental illness known as gender identity disorder (GID) until this year’s revision to the DSM in which GID was replaced with gender dysphoria. In essence, sexual behaviors that social groups find unusual tend to become stigmatized, sometimes greatly so, and may even become classified as mental illness.

Normality vs. Disorder

Today, the mental healthcare professions attempt to take a broader view regarding normality vs. disorder. The paraphilias are defined by psychologists as unusual objects or behaviors that produce sexual interest or arousal. A paraphilia may be benign, such as a foot fetish, or criminal and reviled, such as pedophilia—sexual attraction to children. But even individuals who enjoy giving or receiving pain during sex (or in lieu of sex) may not be considered disordered, as long as their behavior is “safe, sane and consensual”—a maxim of the BDSM (bondage, dominance, submission and sadomasochism) communities.

What separates simply unusual but acceptable sexual behavior from mental illness can be explained by this set of criteria:

1. The behavior or attraction causes significant distress

2. The behavior or attraction impairs function

3. The behavior or attraction presents potential or real harm to self or others

So transvestic fetishism, for example—sexual arousal from and extreme interest in cross-dressing—may be disordered for one person and simply a way of operating for another. A man who experiences sexual arousal from wearing women’s clothing is arrested for changing in a women’s locker room, loses his job for looking up sexually explicit cross-dressing websites while at work and/or loses his marriage as a result of his fetish, may be said to be experiencing both distress and dysfunction.

While society continues to evolve on issues of sexuality and equality, new developments in psychology will be impacted by emerging trends. As Stephanie Pappas wrote for Livescience.com, “It’s hard to separate value judgments from what’s considered ‘sick.’ ” Such value judgments have been dividing the well and the unwell since before the time of Sigmund Freud, who argued that clitoral orgasms were a sign of immature sexuality. It’s important that mental healthcare workers assess any potential value judgments before labeling individuals as unwell, and that individuals experiencing paraphilias have access to informed mental healthcare when they do require