Tuesday 22 November 2011

What is mental health? Paraphilias

When charities like Mind go on about distress and stigma they will always avoid mentioning paraphilias. They're not very public friendly mental illnesses.

I'm talking about things like frotteurism and paedophilia. These diagnoses elucidate another aspect of mental illness.

These are disorders of sexual preference and, I think, mainly related to behaviour or action.

Let me and try and explain what I mean. There is a fetish and there is a diagnosis related to rape. Some people are only aroused by raping someone (usually). Some people also have a rape fetish and find suitable safe communities and people with whom they can share and act out this fantasy. I'm made a differentiation because the person with the fetish is in control and they never cross the lines of antisocial or criminal conduct. It sounds condradictory to say rape which is consenting is but this is available and used by people in alternative sexuality communities.

Fortteurism is the rubbing of gentials on strangers. Peadophilia is sex with children. This, again, needs a little dissecting because peadophilia is also a criminal charge. I don't know the difference between the law and the medicalisation I'm afraid but I guess with one the person is deemed in control.

There's another aspect too. A friend of mine is was a GP and he told me about a patient he was having a conundrum about. The patient had come to him admitting strong paedophile thoughts. The patient was a mental health academic so he understood the risk of disclosure and what he expected from treatment. He was having trouble coping with and controlling his urges and wanted treatment. He told the doctor he had had them for a long time and had never done anything about the sexual thoughts.

My friend was unsure whether to report him to the police or detain him in a psychiatric ward. The patient was an average, law abiding person. My friend was worried about the consequences if he didn't do something about the revelation.

I said to him the individual had come to his doctor admitting these pathologised and stigmatised thoughts and urges. He had never been overcome by them and had sex with a child nor groomed one nor anything like that. He came to his doctor because he needed help maintaining this.

He posed no risk and he had done nothing wrong. He had come to his doctor, at great risk, to seek treatment.

Some people might take exception to me defending the rights of a peadophile. I don't think he was a paedophile. He had never crossed the line - from what he told his doctor - and took a big risk telling his doctor.

This quality he showed is called insight in psychiatric terminology, if I know my terms....I suppose I should say this is what the psychiatric term insight means to me. Some people lack insight and don't know they're ill.

Perhaps I'm wrong or perhaps I'm right that readers would have an issue with me defending a potential peadophile. I have extended the paedophile the same compassion I would extend a depressed person because they're both mentally ill.

There is an aspect to mental illness which is all about the extension of a compassionate understanding to something which might otherwise be treated with the discompassionate understandings which exist outside mental health.

A depressed person is lazy and weak without a compassionate understanding. Part of the medicalisation still attempts to differentiate between the lazy and the depressed because it is percieved only one deserves the privilege of the invalid. But clinical depression can look like laziness.

It can slo be antisocial. After 4 days without showering I must smell disgusting. I feel ashamed when I go to buy my wine and stink but...well...I don't think much of myself anyway. This change in pride has happened over the last couple of years and it's happened before. I wasn't always like this though.

I have to be very careful about this next example because I shouldn't speak about it. There are people who have unusual fetishes. Very unusual. They are the sort of things which are embarassing or shameful rather than illegal. The example I'm talking about isn't copraphilia but it might as well be. This diagnosis and sexual preferemce is used to describe people who get sexual pleasure out of feaces.

I don't give a shit. I don't care what people do to get turned on. I don't care unless someone is harmed and it is all done with consent by people (or animals) who are capable of consenting.

Irrespective of my personal feelings towards people's choices and behaviours, I know this person suffers. They suffer because they're unusual and in a way which has shame attached to it. There's something they enjoy and they can enjoy with certain people on the fringes of society or who are openminded enough to see beyond the kink.

This person has a double life. Well..more than one. They have to hide this part of them from society. It causes them intense distress and it is hard to feel that anyone understands enough to talk about it let alone indulge them in their fetish. Everyone's distress is unique and this individual suffers the pain of mental illness.

People who

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"