Does the APA consider hebephilia to be normal?

That question is being asked by Ray Blanchard in a letter to the editor (read entire letter here) of the Archives of Sexual Behavior. Blanchard is the former chair of the Paraphilias Subworkgroup of the APA’s DSM V Sexual and Gender Identity Disorders Workgroup. DSM stands for Diagnostic and Statistical Manual of the American Psychiatric Association. The new 5th edition is slated to be released any day now and has attracted much controversy for a variety of reasons.
Generally, there is no more controversial area of the DSM than the section on sexual disorders. Blanchard’s subworkgroup recommended including reference to hebephilia in the section on paraphilias in the new edition. Hebephilia is defined as primary sexual interest in children who are in early puberty (i.e., at Tanner Stages 2 and 3, often corresponding to development between ages 11 and 14). Blanchard begins his letter by noting that “on December 1, 2012, the American Psychiatric Association (APA) announced that its Board of Trustees (BOT) had voted to reject the changes to the diagnostic criteria for pedophilic disorder proposed by the Paraphilias Subworkgroup for DSM-5 and to retain the diagnostic criteria published in DSM-IV-TR [i.e., a sexual preference for prepubertal, i.e., Tanner Stage 1, children, nowadays about age 10 or younger].”
Blanchard believes the proposed change would have allowed more precise diagnosis and research of people who have sexual preferences for early pubescent children but not younger, pre-pubescent children or adults. However, for reasons that are not clear, the APA Board of Trustees did not accept the recommended changes.
The fact that the APA did not make this change raises questions. Blanchard asks if the APA wants to discourage research on hebephilia. Furthermore, Blanchard wonders if the current DSM allows for hebephilia to be diagnosed under the category “other specified paraphilic disorder.” In other words, can clinicians and researchers use the “other” category to give label to individuals with hebephilia.  Ultimately, according to Blanchard, the answers to these questions may provide insight into the APA’s stance on normal sexual preferences. He writes

It remains to be seen how the BOT [board of trustees] will respond to these questions when they start to arise in real-life settings, which they will. It seems to me that there are only two possibilities. If the BOT denies that it meant to assert that the sexual preference for children in early puberty is normal, then it has to allow the diagnosis of ‘other specified paraphilic disorder (hebephilia).’ If the BOT, or someone officially speaking on behalf of the BOT or the whole APA, states or testifies that the BOT intended to prohibit the diagnosis of ‘other specified paraphilic disorder (hebephilia),’ then that is tantamount to stating that the APA’s official position is that the sexual preference for early pubertal children is normal.

Elsewhere in his letter, Blanchard states that sexual preference for early pubertal children doesn’t “square with the average layperson’s concept of sexual normalcy and probably does not square with the average clinician’s either.” I agree and believe Blanchard raises some important issues which I hope the APA will address.
Note: On May 16, I asked the APA PR dept for comment on Blanchard’s letter. No response as of today (May 17). I will post anything I get.

Committee report suggested minimal changes to Uganda's Anti-Homosexuality Bill

Last week, one of the claims made by supporters of the Anti-Homosexuality Bill was that the death penalty had been removed. Some media picked up this claim and reported it without critical analysis. In fact, the bill never made it far enough to have any alterations, and, as noted here, the Legal and Parliamentary Affairs committee report did not, in fact, suggest the removal of the death penalty for aggravated homosexuality.
A paper designated as the final report of the Legal and Parliamentary Affairs committee was leaked last Thursday, just ahead of Friday’s final session. I have good reasons to believe that the report did come from the committee although I cannot say for certain that the report would have been presented on the floor of the Parliament had the bill gotten that far. You can read the report, converted to a .pdf, by clicking here.
To help see what a revised bill would have looked like, I compared the original Anti-Homosexuality Bill with the report. This version makes the changes called for in the Legal and Parliamentary Affairs committee report (Click the link). In this version the sections crossed out were in the original bill and those underlined are the ones suggested by the committee.
Even after the changes, the penalty for private, consensual  same-sex intimacy would still be life in jail and the death penalty would remain since it is the penalty provided for aggravated defilement in Uganda. Clauses 4, 7, 8, 14, 16 & 17 were deleted but a new penalty for participating in the marriage of a same-sex couples. Presumably, this would discourage ministers from performing the ceremonies. Even if the bill had been amended in the manner suggested by the committee, the bill would have defined homosexual behavior in a way that criminalized the most modest forms of intimacy with either life in prison or death for HIV positive individuals.
Reporters should carefully review  this committee report before taking statements from bill supporters at face value.

Sexual abuse and the perception of children: Jerome Kagan and The Nature of the Child

In graduate school, I read and thoroughly enjoyed Jerome Kagan’s The Nature of the Child. I have excerpted the beginning of chapter 7 below as a means of continuing the conversation about the relevance of childhood events for sexuality. This chapter is titled, “The Role of the Family” and the excerpt comes from pages 240-242.

I have said little about the influence of experience on the child, especially the consequences of parental behavior. The most important reason for this omission is that the effects of most experiences are not fixed but depend upon the child’s interpretation. And the interpretation will vary with the child’s cognitive maturity, expectations, beliefs, and momentary feeling state. Seven-year-old boys who are part of a small isolated culture in the highlands of New
Guinea perform fellatio regularly on older adolescent males for about a half-dozen years; but this behavior is interpreted as part of a secret, sacred ritual that is necessary if the boy is to assume the adult male role and successfully impregnate a wife (Herdt, 1981). If an American boy performed fellatio on several older boys for a half-dozen years, he would regard himself as homosexual and pos­sess a fragile, rather than a substantial, sense of his maleness.
Children growing up in Brahmin families in the temple town of Bhubaneswar in India hear their mothers exclaim each month, “Don’t touch me, don’t touch me, I’m polluted.” These children do not feel rejected or unloved, because they know this command is a regular event that occurs during the mother’s menstrual period (Shweder, in press). And a small proportion of American children, whose affluent parents shower them with affection and gifts out of a desire to create in them feelings of confidence and self-worth, become apathetic, depressed adolescents because they do not believe they deserve such continuous privilege.
As these examples make clear, the child’s personal interpretation of experience, not the event recorded by camera or observer, is the essential basis for the formation of and change in beliefs, wishes, and actions. However, the psychologist can only guess at these interpretations, and the preoccupations and values of the culture in which the scholar works influence these guesses in a major way. For example, Erasmus (1530), who believed the child’s appearance reflected his character, told parents to train the child to hold his body in a controlled composure – no furrowing of brows, sagging of cheek, or biting of the lip, and especially no laughter without a very good cause.
Educated citizens in early sixteenth-century London, who were disturbed by the high rate of crime, begging, and vagrancy among children of the poor, blamed the loss of a parent, living with lazy parents, being one of many children, or a mental or physical handicap. These diagnoses ignored the possible influence of genetics, parental love, or social conditions existing outside the home. Two centuries later, a comparable group of English citizens concerned with identical social problems, but still without any sound facts, emphasized the influence of the love relation between mother and child (Pinchbeck and Hewitt, 1969 and 1973).
Many contemporary essays on the influence of family experience also originate in hunches, few of which are firmly supported by evidence. This is not surprising; the first empirical study to appear in a major American journal that attempted to relate family factors to a characteristic in the child was published less than sixty years ago in The Pedagogical Seminary (Sutherland, 1930). The fact that a hunch about the role of family originates in a society’s folk premises about human nature does not mean that it is incorrect. Eighteenth-century French physicians believed that a nursing mother should bathe the baby regularly and not drink too much wine – suggestions that have been validated by modern medicine. But those same doctors also believed – mistakenly, I suppose – that cold baths will ensure a tough character in the older child. The absence of conclusive evidence means that each theorist must be continually sensitive to the danger of trusting his or her hunches too completely, for at different times during the last few centuries of European and American history, the child has been seen as inherently evil, or as a blank tablet with no special predispositions, or, currently, as a reservoir of genetically determined psychological qualities. Modern Western society follows Rousseau in assuming that the infant is prepared to attach herself to her caregiver and to prefer love to hate, mastery to cooperation, autonomy to interdependence, personal freedom to bonds of obligation, and trust to suspicion. It is assumed that if the child develops the qualities implied by the undesirable members of those pairs, the practices of the family during the early years – especially parental neglect, indifference, restriction, and absence of joyful and playful interaction – are major culprits.
I cannot escape these beliefs which are so thoroughly threaded through the culture in which I was raised and trained. But having made that declaration, I believe it is useful to rely on selected elements in popular theory, on the few trustworthy facts, and on intuition in considering the family experiences that create different types of children, even if my suggestions are more valid for American youngsters than for those growing up in other cultures.

Kagan refers to Gilbert Herdt’s book, Guardians of the Flutes, published in 1981 which describes the masculinity rituals of the Sambian tribe (not the actual tribal name) in Papua New Guinea. Essentially the tribe “believes” boys become men by ingesting the semen (“male milk”) of older boys. And of course, by the teen years, it “works” and the boys attain manhood. At that point, the vast majority of males choose a female partner.
Kagan’s reference to this practice reminds us that these experiences are embedded in a culture. In our own, such experiences would not be normalized and contextualized as a contributing to masculinity but rather detracting from it.
I cannot improve on Kagan’s description of his thesis. He is a gifted writer. However, I will elaborate for sake of discussion. He proposes that perception drives the psychological impact of a given experience. How differing perceptions effect the development of sexuality seems to me to be highly individualistic. Thus, for some, sexual maltreatment might push an essentially heterosexual person toward same-sex preoccupations. For others, abuse might strengthen the budding heterosexual impulses toward heterosexual preoccupations. For others, the abusive events may have no effect on attractions but rather influence attachment security. My point here is not to describe all possible trajectories, but rather to illustrate the potential of many variations.
A related point made by Kagan is that our culture looks at parenting as causative of adult personality. I believe many people do not question this assumption. In the last several years, I have looked for data to support or contradict it. I find little support that individual personality traits or conditions are strongly related to particular family dynamics. However, some broad trends can be observed. Fatherlessness is associated with a variety of problems in children and society. However, not having a father around may be interpreted in different ways by different children. For some, having the wrong kind of father around might lead to anti-social behavior. Thus, simply isolating childhood variables and relating them to adult outcomes is insufficient. These points are often lost on reparative therapists and other advocates who want to reduce homosexuality to a set of family dynamics or childhood experiences. On the other hand, biological determinists err on the side of discounting these social experiences as potentially influential for some people.
A satisfying position to me is to consider homosexual behavior to be determined by different factors in different ways for different people. For some, there is a very early awareness of romantic and sexual attraction for the same-sex independent of any trauma or parenting actions. For others, trauma and poor parenting occur but the same-sex attractions appeared prior to these unhappy events. For yet others people, the unhappy experiences may serve to create a disconnect between impulse to same-sex behavior and internal desire and attraction which may be toward the opposite sex. While these complexities create PR problems for culture warriors on both sides, I believe we must recognize the existence of multiple pathways to adult sexuality if we are to be true to the data and experience.

Let's take a vote: Is this worth your money?

The Planned Parenthood of Columbia/Willamette (OR) has a site called Take Care Down There which apparently receives some Title X money (your money originally).
Goofy, if you ask me. Goofy enough to be chuckled at and ignored, which means I vote no.
Take care

Should HIV status ever be disclosed?

This is a question often debated among therapists in situations where an identifiable potential partner can be identified. For instance, here is a case where a husband’s sexual activities will be made a part of an action by an ex-wife where the husband may have (alleged by the ex-wife) infected her with the virus.

If you were a friend of this couple and you knew one of them had HIV, would you tell the other? If you were their marriage counselor? Recently, on the BoxTurtleBulletin blog, Daniel Gonzales said that HIV status should never be disclosed. His advice was in contrast to advice given on a gay dating website (although I don’t fully agree with the advice columnist either) Essentially, the question posed by the scenario was this: If a friend knows the HIV+ status of someone who might be a dating or sex partner, should the knowing friend warn the unsuspecting friend? The gay dating website published advice suggesting that the friend should be warned. Daniel said the unknowing friend should not have been told.

I disagree with Daniel. I would probably inform a friend about much less, if I knew it. And certainly in this case, I believe that such disclosures should be made where there is a clearly identified partner. I sometimes link to Box Turtle Bulletin when Jim and the gang discuss research since he often provides thoughtful commentary and analysis of research on gay related issues. However, I strongly disagree here. While I do not think that HIV status should always be disclosed, and I am sensitive to the issue of stigma, but, in a case like this, I cannot understand why privacy should trump safety. I do not believe it does.

UPDATE: Jim Burroway posted a lengthy response to the dust-up over the advice on his blog regarding HIV+ disclosure. I still disagree and left a comment about it there:

Bottom line, if I knew two friends who might hook up and I knew one of them had a disease that could be spread via intimate contact, I would tell my unsuspecting friend as well as the friend who had the condition that I was going to do so. Sure, I might have to deal with fall out; but I believe I might have to deal with a different kind of fall out if I say nothing.

Christian Post covers MRSA controversy

Today’s Christian Post has an article by Lillian Kwon regarding recent responses to the Annals of Internal Medicine article regarding MRSA among gay men. Yours truly is quoted:

While Throckmorton believes it’s good to give warning to groups at greater risk of infection, he said the latest study to him is “just a warning about sexual purity” in general.

Referencing a comment made on his blog, Throckmorton said, “When you single out one group, the unintended consequence is people in other groups would say ‘it’s not a health hazard for me’ when it’s the behavior that’s the issue, not the social group identified with.”

The discussion on this issue has been vigorous and I hope helpful to inform an accurate picture of the situation.

Is MRSA the new HIV? Open Forum

Lots of buzz the last few days about an Annals of Internal Medicine article noting the increase in MRSA (methicillin-resistant Staphylococcus) among gay men. MRSA is treatement resistent and is often referred to as a flesh eating bacteria since it can lead to necrotising fasciitis. The San Francisco Chronicle did a story about it that focused on the prevalence among gay men and especially the Castro district. Peter LaBarbera has sounded an alarm which attempts to elevate the issue to the level of HIV/AIDS.

Now I think MRSA is a serious issue and anything that can be done to prevent the spread is important news. Sexual activity is apparently one way to spread the bacteria and so it seems smart to choose wisely when it comes to sex. Whether gay or straight, this seems to be good advice. Broader warnings seem prudent such as offered by Annals of Internal Medicine commenter Arlen J Peterson regarding the article:

First, let me thank the dedication and development of understanding MRSA clone (USA300) from the medical community to the public. I work for a sexual health centre, which includes providing extensive education and treatment of STI’s to sexually active individuals. I understand the relation between how the community of men who have sex with men increases the risk of MRSA infection (risky behaviors, more sexual partners, drugs, etc), Annals article highlights the risk is associated with skin-to-skin contact primarily by unprotected anal intercourse. My concern is the community of men who have sex with men are the only population emphasized in the article when anal intercourse is practiced fluently in men who have sex with women. Men who have anal intercourse with women do so for reasons mainly of pleasure and a form of birth control, usually unprotected for the latter. So, if an average person were to read a synopsized version in the news based on this article, particularly the young, they might get a message of: ‘It’s a risk for men who have sex with men, I am not of this population, therefore I am not affected.’ Can this article emphasize that it is the unprotected anal intercourse causing the risk of MRSA infection and that is not limited to men who have sex with men? I appreciate it and thank you for your time.

This is a volatile issue as indicated by the 600 plus comments the San Francisco Chronicle received on the news report. I am interested in comment here on the topic of MRSA among sexually active people. Is there something inherent in homosexuality that leads to this spread (I know what I think but I am interested in rational comment)? Or is this a matter of sexual practice only and not sexual attractions?

Salt Lake City program examines cruising behavior, sexual identity

Here is an article that bring together several topics covered here on the blog. The Healthy Self-Expressions program works to curb sexual cruising in Salt Lake City and is run by Pride Counseling, a GLBT oriented counseling center. Many men are married and identify as straight.

Buie says many of the program’s participants identify themselves as straight. Many are also active members of The Church of Jesus Christ of Latter-day Saints, and roughly 40 percent are married, he says. The average length of those marriages is 23 years. Two of the men with whom he is currently working have been married for more than 40 years…

…”Just because you have an attraction to men doesn’t mean you have to be a slave to those attractions,” he says. “As a therapist I try to encourage people to be honest with themselves.”

“Abomination: Homosexuality and the Ex-gay Movement” hits film festivals

Exgay Watch reports that the 2006 video Abomination: Homosexuality and the Ex-gay Movement will premiere in New York City on Wednesday, October 24.

I have previously reviewed this video but will give it another look over the next week and add comments in another post. I plan to make some comments about the harm that can result from some reparative therapy approaches and other misguided efforts to change sexual orientation.

One of my prinicipal concerns about Abomination is that the Shidlo and Schroeder study is treated as providing accurate and representative rates of change. Here is a clip from a Canadian talk show where Alicia Salzer again quotes the 4% change rate (as she did on the Montel Williams Show).

Maine school board votes to allow birth control in middle school

This story has been all over the media but I wanted to post it as a starter for discussion. The link leads to a NPR discussion a bit more in depth than the AP reports.

I can think of several reasons why this could backfire. I do not believe middle school kids are likely to be consistent in taking the pills but may have a false sense of safety. We know kids aren’t very consistent in implementation of most birth control methods so I suspect this will not have much effect on births and inasmuch as sexual activity increases, so might the incidence of STDs. Seems to me the best birth control method at this age is the presence of an adult. Maybe the school board could spend some money on adult supervision. I do not know what the fact on the ground are there but I sure hope this doesn’t catch on elsewhere.