Taking an Orbitoclast to the Head of the APA

(AKA Weeks 1 and 2: The Introductions, Part the Second)

SUMMARY

You cannot do it in the dark. You cannot do it in a park. You cannot do it on a train. You should probably do it if you have something weird with your brain, though, and/ or if you have been entangled with the psychiatric system from the age of nine like I have— you should read the Diagnostic and Statistical Manual of Mental Disorders. You don’t have to read it from start to finish (unless, of course, you do, but my OCD is in remission). Instead, you should read all the introductory and how-to bits (Section I), since this is where the sad little soul of the DSM is hidden.

I expected to unreservedly loathe the DSM-5 (the latest edition) based on my interactions with so many dozens of its owners and also this terrifically amusing review in the The New Inquiry that assess the tome as “a new dystopian novel” with obvious Borgesian influences. The DSM-5 explicitly cautions against the New Inquiry reading—which also happens to be the reading of a good number of psychiatric professionals—  “that every person’s illness is somehow their own fault, that it comes from nowhere but themselves: their genes, their addictions, and their inherent human insufficiency.” The shocking plot twist of the DSM-5 is not that “its originator can’t even tell that they’ve subsumed themselves within its matrix” as an obsessive-compulsive cataloguer with poor insight (the TNI review again); it’s that the originator has perfect insight into its own limitations but knows its reader will refuse to heed these same limitations. As such, it’s more compelling than repelling.

It is even occasionally likeable. Consider, for a moment, it’s necessity. Something like the DSM-5 would have to exist even in a perfect world, because it allows for “guiding treatment recommendations, identifying prevalence rates for mental health service planning, identifying patient groups for clinical and basic research, and documenting important public health information such as morbidity and mortality rates” (5). In other words, we need to have some sort of taxonomy of mental dysfunction in order to so much as discuss it. The problem is (wait for it, wait for it, wait for it) how such taxonomy must function under capitalism and within an adversarial mental healthcare system that pits patient against doctor against insurer.

The DSM-5 sucks primarily because it is the bible for a mental healthcare system in which care has been commoditized and therefore rationed and therefore must be explicitly justified through pathologization. Pathologization in turn creates its own problems, including overly rigid diagnostic criteria and diagnostic boundaries that exclude and obscure more problems than they delineate. (“We recognize that mental disorders do not always fit completely within the boundaries of a single disorder,” the author writes pitifully in the Preface.) This tragedy is captured in the prosody of the index listings: “312.34 (F63.81) Intermittent Explosive Disorder (466)/ __.__ (__.__) Conduct Disorder (469) /Specify whether:/ 312.81 (F91.1)”… and so on and so forth, lists of numbers and letters that have significance only in the bureaucratic bowels of the insurance industry.
The competence and foresight of the DSM-5 render it compelling, but the ultimate fact is that the DSM-5 knows what evil ends it will be used for. Don’t mourn the scribes at the American Psychiatric Association; they aren’t the victims of this tragedy. Their ranks are swarming with the villains, and those who aren’t directly guilty are the complicit sad saps who whine to the victim-cum-hero when she returns for revenge wielding an orbitoclast, “Well what did you expect me to do?” I expected you to do better, my dudes, but you didn’t, and so now I have to fuck you up.

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Where the DSM goes, all other psychiatric texts follow, and so I bring my metaphorical orbitoclast to bear down on Principles and Practices of Sex Therapyand New Directions in Sex Therapy as well. Most of my ire is reserved for the former, which is preternaturally invested in preserving the abusive power of the psychiatric establishment, especially as it affects transgender people (ugly details below). New Directions seems to be written directly in response to its brutality, the liberal wing of the sex therapist profession responding to the violence of men like Dr. Kenneth Zucker with suggestions of alternative treatments that are more aptly described as ‘toothless’ than ‘compassionate.’
Both books repeatedly demonstrate the absurdity of pathologizing dysfunction and professionalizing therapeutic approaches to sex. The editors seem acutely aware that the informal psychiatric specialization of ‘sex therapy’ describes nothing more than a mixture of regular psychiatric therapy, sex work, and sex education, though of course they don’t describe it as such. Instead, they moan about sex therapy being ill defined and wring their hands over whether it is becoming outmoded. Ultimately, like a petition for a multinational corporation to feature more same-gender couples in their advertisements, these textbooks aren’t offering up critiques so much as spinning their wheels within the system.

NOTES

THE PROFOUNDLY QUESTIONABLE PARTS Continue reading

The Scaffolding of Trump’s Gilt Elevators

AKA: Weeks 1 and 2: The Introductions, part the first

Weeks One and Two were mostly spent in bed, first with a cold and then with a sinus infection and also, since the 9th, wrestling with a depressive episode. I did all the reading, took notes, thought too much, wrote something else, refreshed and refreshed my phone to see the newest round of photos of a different white supremacist looking bilious in the gilt glow of the Trump Tower elevators, and didn’t write about learning about sex. Everything feels very pointless, but nihilism is the philosophy of fascism, and I promised I’d write something by today so here I am. I’ll try again tomorrow, tackling the Sexuality Now excerpts and posting those responses first so things feel more manageable.


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Weeks One and Two: Take Two. Here are my reflections on the main text, Sexuality Now, Ch. 1: Exploring Human Sexuality Past and Present and Ch. 2: Understanding Human Sexuality: Theory and Research.

SUMMARY

         I don’t know much about the formal art of education, but I do know this: there are a few things about which it’s better to teach nothing than very little. One of these things is Freudianism, and another is nonwhite foreign cultural mores. Janell L. Carroll briefly touches on— by which I mean, prods and pinches and then impatiently flicks away— both of these things in the first two chapters of Sexuality Now, and she herself should know better. After all, she begins chapter one by assuring us of her expertise.

“I’ve travelled extensively throughout the United States and around the world,” Carroll writes in the chapter introduction, “consulting with sexuality teachers, experts, researchers, and interviewing ordinary people about their sexuality” (xlii). I would’ve delighted in an explanation of the term ‘ordinary people,’ as I’ve diapered at least a dozen of them, smeared peanut butter on the taints of a few more, and kicked, like, fifty of them in the nuts but still have no idea who or what they might be.  Alas, ‘ordinary people’ is not one of the highlighted vocabulary terms. But enough about me and what I don’t know. We were talking about Carroll, about how “[her] education, training, and research about the interplay of biology, society and culture gave [her] knowledge, but experiencing other societies and cultures gave [her] understanding [italics in the original]” (xlii). It must have been the academic hubris that gave her the idea she could write informatively about Freudianism in nine simplistic paragraphs. Carroll did her best (I guess? I don’t know, I’m just being nice here) but her intended reader would still come away from the text thinking Freud had discovered something called the ‘Electra complex’, and that ‘thanatos’ is “aggressiveness motivation” (p. 28).

But pretty much everyone gets Freud wrong! Who cares?; he was a jackass. What’s morally repugnant is the collection of microwaved stereotypes Carroll passes off as “Sexuality in Ancient Asia.” It must be her unchallenged white supremacy that allows her to call herself an expert on other cultures while writing racist drivel like, “Chinese and Indian civilizations also had unique views of sexuality. In Indian culture, Hinduism and rebirth give life direction. In Chinese culture, people work to live in harmony with the Tao, which is made up of yin and yang” (7).

Literally no part of that is true. “Ancient Asia” is far greater than the sum of Chinese and Indian cultures. There is not and never was one coherent ‘Indian culture’ or ‘Chinese culture.’ “Indian” does not equal Hindu which does not equal rebirth. “Chinese” does not equal Tao which does not equal yin and yang. And the following paragraphs on karma, patriarchy, female infanticide, the Kama Sutra, and polygamy (all highlighted vocab terms!) are a horrorshow whose only value lies in demonstrating the ways in which white supremacy indoctrinates white students and alienates students of color. If you’re wondering how the fuck America has a President-Elect whose chief strategist is a neo-Nazi propagandist, look right here at the building blocks of our liberal education, in this textbook our public-school-destroying future Secretary of Education would ban for being too progressive. Here is the scaffolding for Trump’s gilt elevators.

White supremacy is not the only oppression that is built up from misinformation; all systemic domination starts with the mythologizing of history. In this process, causality suddenly becomes easy to follow: evil is inevitable and so is the eventual triumph of good; economics is rendered as the afterthought of culture, which is the driverless car of social change; whole classes of perpetrators are invisibilized in passive sentence construction or subsumed into singular historical figures (‘slaves were brought to America’, ‘Hitler killed 11 million people’) and victims are rendered completely without agency. In these chapters on the histories of human sexuality and the study of human sexuality, Carroll performs the same ritual she did with Asian people again with Jews, Muslims, African Americans, women, trans and gender nonconforming people, same-gender attracted people, the working classes and sex workers. The best that I can say of her historical accounts are that, in certain parts, like the history of feminism, you come away feeling like you’ve learned nothing at all instead of several deeply damaging and incorrect things.

Thank fuck the historical accounts come to an end halfway through chapter two. At this point Carroll tackles contemporary sexuality research, and her overview of various theoretical approaches and methodologies, their strengths and weaknesses, is decent enough. Almost all of the interesting and useful information in the first two chapters is in these last thirteen pages.

NOTES

THE PROFOUNDLY QUESTIONABLE PARTS Continue reading