I was talking with a friend the other day and we were laughing and horrified that her father still uses the term Orientals when describing anyone of Asian descent. I told her that my father in law learned many years ago not to speak like that in front of me for fear of having his head ripped off! My kids play with finger traps, and I remember when we used to call them “Chinese finger prisons”. I remember telling my dad not to “Jew” me when he only gave me 10 dollars for the movies when I was 12. I ignorantly didn’t even know what a Jew was at that time. I never forget that moment because my dad grounded me and didn’t allow me to go to the movies. He quickly explained that it was referring to someone who is Jewish and that their religion is Judaism. Funny story now that I am Jewish. Ignorance and knowledge can both be taught by parents in this day and age, things change, people change and thank god they do!
The DSM-5 is due in 2013. The DSM is the Diagnostic and Statistical Manual, which is the book that is used for diagnosis of mental and emotional disorders. Now, the DSM has experienced a lot of change in the past. Once upon a time, for example, homosexuality was pathologised and treatment included reversion therapy that brought the person “back to heterosexuality”. Now of course the psychiatric community has embraced the fact that homosexuality is certainly not a diagnosis and treatment of a person who grows up with different fantasies, etc. from their parent or caregiver should include whole- self-integration and acceptance.
Current anticipated changes in the DSM would be seen in the areas of addiction. According to a recent article in the LA Times, we will see for the first time behavioral addictions such as compulsive gambling included in the book. And a big change, a change about which I have been speaking all week is the possible addition of Hypersexual Disorder as a diagnosis. This diagnosis would represent the cluster of symptoms of risky, excessive sexual behavior, and compulsivity in the area of sexuality. Obviously, the Schwarzenegger love child news has prompted the recent spate of discussion on the topic, however the addition of this diagnosis would be a good move for the psychological community because it would offer specific, focused attention to symptomology and treatment planning. Some of the positive changes would include the move from treating this like an addiction to thinking of it more like an obsessive/ compulsive disorder. In fact there is a move away from the word addiction across the board, using the terms “substance use disorder” instead for example. What is accomplished by changes in the DSM is increased awareness and sensitivity as well as treatment plans and maybe most importantly, increased potential for empathy.
Look, I know that it’s hard to empathize with a former governor/ womanizer who seemed to lie to everyone around him and created an entire second family out of an affair with a domestic employee… especially, since, as a public figure we take it personally. Now imagine an individual who, due to potential childhood emotional, physical or sexual abuse, developed as a coping mechanism various catastrophic ways of acting out. The risky sexual behavior then, is really a symptom of unresolved trauma.
The inclusion of Hypersexual Disorder will have a secondary gain I believe, though it may take time. Our pattern now as a society is to feel betrayed by the affairs of Tiger Woods, Arnold Schwarzenegger, and other powerful men into whom we put our faith. The Psychiatric and Psychological community in the past has been incredibly influential in changing cultural attitudes, as we have seen, again, in homosexuality. In the case of substance use or, potentially Hypersexual Disorder, a move away from anger and outrage, toward understanding why someone behaves in the way they do and seems to be unable to control themselves, can also be incredibly therapeutic for ourselves. If we allow for flaws in others, and even more importantly, are open to understanding and reaching out toward treatment instead of destruction, we can be more open to our own fallibility and symptomology in whatever way it presents itself. It also creates boundaries where there used to be none. If bad behavior is simply bad behavior with little regard for others, then it is hard to manage. If instead, bad behavior is seen as symptom for a condition for which there is a treatment, then there is hope of resolution.
I am so glad my Jewish children will grow up in a world playing with finger traps, knowing that homosexuality is not a disease to be treated, and most importantly, a world that is changing and flexible and open to new understandings and insights.