Psychiatry's list of sexual 'deviations' once put homosexuality at the very top
Before 1973, the American Psychiatric Association's diagnostic manual classed homosexuality as a sexual deviation, first on its list. Its removal that year shows how unstable the line between unusual and disordered desire has been, a line clinicians still argue about under the label paraphilia.
The word itself is older than the manual. The ethnographer Friedrich Salomon Krauss is credited with coining it in 1903, from Greek roots meaning loving beyond or outside, and the psychoanalyst Wilhelm Stekel used it regularly in the 1920s. The sexologist John Money popularised it in the 1980s as a deliberately neutral replacement for older words like perversion, which had long served as slurs against gay men. It entered the diagnostic manual in 1980, replacing the phrase sexual deviation used in the first two editions. The psychiatrist Glen Gabbard nonetheless judged that the term remains pejorative in most settings.
Defining it is harder than naming it. One definition is intense, persistent arousal by anything not sexual by nature; another is interest in anything other than a consenting adult human partner. There is no agreed boundary between kinks, fetishes and paraphilias, and the forensic scientist Anil Aggrawal has listed as many as 549 types. Some researchers want the diagnoses dropped from manuals entirely because of the stigma, while Ray Blanchard has argued the category should be defined by exclusion instead of by a list.
Research has also punctured the assumption of rarity. In one sample of men, 62 percent reported at least one paraphilic interest, and some such interests are linked to more lifetime partners, contradicting theories about stunted social development. Individual case studies can be startlingly specific, including a man aroused by sneezing and a teenager fixated on car exhaust pipes. Causes remain unclear, with neurological, cultural and developmental factors all proposed, and brain lesions or epilepsy occasionally triggering new interests.
A 2012 review by the psychologist James Cantor compared homosexuality with paraphilias and found they differ on handedness, IQ profile and brain anatomy, supporting the view that they are distinct categories, a conclusion he called quite tentative.
Source: Paraphilia
