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30 Sept 2021

Between BDSM and the DSM: The Relationship of BDSM and Psychology


I have posted a copy of  Between BDSM and the DSM: The Relationship of BDSM and Psychology, By: Doron Mosenzon (Instructed by: Dr. Otniel Dror) Seminar Paper for the Course “Gender and Science” 2013-14. 
You can read the full paper at: https://goo.gl/HK3r1F

Dominant Views in Psychology and Psychiatry
What is Sexual Deviance?
Early Sexology and the Creation of the Deviant

"Sex and sexuality were always an inflammatory subject, and every religion, ideology, and discipline has an interest in the way people relate and operate with their sexuality. More specifically, trying to decide what sexual acts and dispositions are “normal”, “healthy”, “natural”, and “moral” is an important part of any philosophy or area of study that deals with human sexuality.
That which lies beyond the lines of “normal” and “healthy” sexuality is the perverse. Delineating the normal and acceptable sexual expressions in contrast to those which are unacceptable and deviant creates a “hierarchy of sexual values”, which tends to have a moral accent (Weeks, 2003:70) - more explicitly so in religious and political fields, and more subtly in scientific accounts. Masturbation, homosexuality, rape, pedophilia, and others all had been marked and investigated at one period or another as harmful, immoral, and unnatural sexual perversions that are important concerns for the population’s health and moral hygiene.
The second half of the 19th century is an important turning point in our relation with sexual perversions, as a shift was made in the modern western world from viewing sexuality and sexual deviance from a Christian religious perspective of morality and immorality, sin, and acts against god to a more scientific medical view that tries to distinguish between normality and pathology, health and sickness (Schaffner, 2011:3-5).
The new field of sexology was the main arena where these inquiries took place. Since its inception with the publication of Krafft-Ebing’s “Psychopathia Sexualis” in 1886 sexology has obsessed over the causes, prevalence, and harm of all the various sexual perversions, from bestiality to transvestism, in sharp contrast to “normal” sexuality, which was not investigated as vehemently as its abnormalities (Weeks, 2003:70-71). Not dissimilar from the religious discourse of sexual perversity, sexology saw the perverted as a dangerous force both socially and medically, as “viruses of the social corps- polluting its national strength and purity” (Schaffner, 2011:8-9).
Krafft-Ebing, as one of founders of the new science of sexology, had an enormous influence on the way we view sexual deviance to this day. He was the first to systematically define the phenomena of homosexuality, fetishism, voyeurism, sadism, masochism, and many others (ibid., pg. 2), and his “Psychopathia Sexualis” marked the shift between understanding sexual perversion as a consequence of weak will or defective biology but rather as a fundamental psychological component of the pervert’s personality and being (De Block and Adriaens, 2013:280). Importantly, Krafft-Ebing’s view shifted the role of the pervert from a sinner or a criminal to that of a patient. Sexology, as a science, tries to understand and research abnormal sexual behaviors so that they may be controlled or even cured. This view, even with the sexologists’ advocating of a usually empathic and benevolent treatment of the perverts, easily translates for the wider community as positioning the sexual deviants as dangerous and contemptible others (Schaffner, 2011:12-13).
Later sexologists like Magnus Hirschfeld, Havelock Ellis, and Iwan Bloch, have tried to downplay the harmful aspects of sexual pathology. Even though they saw sexual normalcy as procreative (and thus penetrative, heterosexual, and coupled), they viewed sexual activities that didn’t conform to the natural procreative urge to be relatively harmless, and though these early sexologists’ explanations of sexual abnormality were mainly as hereditary biological traits, they did not view them as degenerative and dangerous to civilization or society (De Block and Adriaens, 2013:283-284).
Freud
An innovative and influential view of sexual perversion was provided in the early 20th century by the father of psychoanalysis, Sigmund Freud. Freud differs dramatically from the sexological explanations of perversions that focused on biological and hereditary causes as he viewed early childhood as the major site for the development of sexual perversion (Schaffner, 2011:138). Even more radically, he suggested that “perversions, far from being the unique property of a sick or immoral minority, are the common property of us all” (Weeks, 2003:72).
In his view, the child begins in a state of polymorphous perversity and innate bisexuality, from which both a normative and a pathological adult sexuality may develop (De Block and Adriaens, 2013:282). A successful process of socialization will result in the child becoming a healthy sexual individual and abandon the perversities of childhood by means of repression and sublimation. This achievement is by no means stable and static, and is part of a conflictual process of restriction that generates neurosis (Dollimore, 1991:175-177). This process of maturation and abandoning the polymorphous perversities of childhood is akin to a grander civilizing process of the entire human race that shifted from primitive promiscuity to reproductive monogamous heterosexuality- hence positioning the latter as preferable, healthy, and mature (Weeks, 2003:74).
But sexual perversity sometimes does persist into the adult’s life, as they deviate from the reproductive act of copulation. Freud differentiated between those perversions that deviate from the natural sexual object (A mature person of the opposite sex)- which include homosexuality, bestiality, and pedophilia, and those that deviate from the natural sexual goal (penetration and procreation)-which include those that focus on non-procreative regions of the body such as fetishism, anal sex, and oral sex, and those that linger on activities that may be precursory to genital penetration such as sadomasochism, voyeurism, or frotteurism (Schaffner, 2011:139-140).
The connection between perversion and childhood leads to the conclusion that an adult pervert had some form of arrested development as they have failed to grow out of perverse childhood sexuality. Various mechanisms of fixation and regression due to physiological causes (in his earlier works) or childhood trauma (in his later works) cause the pervert to be “stuck” in his sexual development (De Block and Adriaens, 2013:282). Thus, Freud infantilized the pervert as someone whose development was inhibited in early stages of life (Schaffner, 2011:143).
It is important to note the subversive power that Freud attributed to sexual perversions. The sexual repression of infantile perverse sexuality is a staple of modern civilization and is paramount to its stability and social order, yet sexual deviance continues to reappear and threaten the organization of normative and civilized sexuality on which the social order depends (Dollimore, 1991:180-181). The pressure for suppression of sexual instincts may actually intensify and produce deviant and perverse sexuality that undermines mainstream sexual morality and social institutions like marriage (ibid., pg. 186-187). Perversity, therefore, is inescapable: “No healthy person, it appears, can fail to make some addition that might be called perverse to the normal sexual aim” (Freud, cited in Weeks, 2003:72).

The DSM
As psychology and psychiatry became more widespread, organized and institutionalized, a need arose to create uniform and standardized disease categorizes for the purposes of diagnosis, treatment, and research. The “Diagnostic and Statistical Manual of Mental Disorders” (DSM) published by the American Psychiatric Association is perhaps the most influential international document devoted to the clinical description of the various mental illnesses (De Block and Adriaens, 2013:284-285).
Since the first edition of the DSM from 1952 it has featured sexuality related disorders. In the DSM-I they were classified as part of the “sociopathic personality disturbances”, charting “sexual deviance” as disorder of the personality and using the language of “deviation” from “some implicitly understood norm” (Hinderliter, 2010:242-243). The DSM-II from 1968 created a separate category for the “sexual deviations” and listed eight ones in particular: homosexuality, fetishism, pedophilia, transvestism, exhibitionism, voyeurism, sadism, and masochism. They were set aside other “non-psychotic mental disorders” such as alcoholism and were divided into those who describe sexual interest toward objects that are not people of the opposite sex, toward sexual acts not associated with coitus, or toward coitus under “bizarre” circumstances (De Block and Adriaens, 2013:286-287).
The DSM-III from 1980 marked an important shift from etiological approaches to diagnosis (fueled from the psychoanalytic tradition) that try to search for the causes of the various mental disorders to a more symptomatic approach that focuses on the consequences of the condition (fueled by the growing biological psychiatric approach). Relatedly, an attempt was made for the first time to define what mental disorder actually is, and the definition was based on two major criteria: the subjective distress and the functional impairment it causes to the sufferer (ibid., pg. 289). This definition aided the historical removal of homosexuality from the DSM: “since many homosexual individuals were socially functional and not distressed by their homosexuality, homosexuality per se was not a mental disorder” (Hinderliter, 2010:244).
And yet, most other “sexual deviations” reappeared under the new name of “paraphilias”, which are defined as conditions in which “unusual or bizarre imagery or acts are necessary for sexual excitement” (American Psychiatric Association, 1980:266) and that are “characterized by arousal in response to sexual objects or situations that are not part of normative arousal-activity patterns and that in varying degrees may interfere with the capacity for reciprocal affectionate sexual activity” (ibid., pg. 261), even though many of the actual diagnostic criteria for the specific paraphilias do not align with these general definitions as they mostly required that the paraphilic object be repeatedly preferred for sexual excitement (Hinderliter, 2010:247). The revised version of the DSM-III even changed the criteria for paraphilias so that “according to the DSM-III-R some urges and fantasies needed only to be acted upon to indicate disorder” (De Block and Adriaens, 2013:291), even without the presence of distress.
The view presented in the first four editions of the DSM simply assumes that normophilic (non-paraphilic) sexual desire and behavior involves positive affection, intimacy, and reciprocity in contrast to paraphilic desire and behavior, even though this assumption is not empirically grounded and relates to a certain ideal of sexuality rather than any specific behavior (Steward, 2012).
The current, fifth edition of the DSM has differentiated between a “paraphilia”, which is “any sexual interest greater than or equal to normophilic sexual interests” that is not pathological by itself, and a “paraphilic disorder” which is “a paraphilia that is currently causing distress or impairment to the individual or a paraphilia that had entailed personal harm or risk of harm, to others” (American Psychiatric Association, 2013:685-686). This distinction helps “emphasize that nonnormative sexuality need not necessarily be a mental disorder” (De Block and Adriaens, 2013:293), even though the criterions for distress and impairment are problematic as will be discussed in the next chapter.
Sadism and Masochism in Psychiatric Writing
Alongside perversions like homosexuality and exhibitionism, two of the most discussed sexual abnormalities were sadism (sexual pleasure by means of inflicting pain and humiliation) and masochism (sexual pleasure by means of receiving pain and humiliation). Even though practices eroticizing pain and humiliation are present in many parts of human history and across many cultures, both western and non-western, it is only with the emergence of the sexological science that they have started to attract attention from the medical professions and the general public (Taylor, 2002:108-109). Both in literature and popular culture and in psychology and psychiatry from the sexological writings of Krafft-Ebing to the latest edition of the DSM we can find attempts to describe and explain both sadism and masochism.
Sadism and Masochism in Early Sexology
Both terms were coined and popularized in their sexual context by Krafft-Ebing in his “Psychopathia Sexualis”. The origins of the terms stem from two historical writers of the 18th and 19th century: Leopold Ritter von Sacher-Masoch, who wrote the novel “Venus in Furs” which featured themes of his submission, humiliation, and pain inflicted by a mistress he is infatuated with, and the Marquis de Sade, who wrote many stories and essays depicting sexual cruelty and violence in a shocking and pornographic manner (Weinberg, 2006:18).
Krafft-Ebing’s theory of masochism and sadism was inherently gendered: he viewed it as intensification of the normal (hetero)sexual tendencies of men and women (Weeks, 2003:88), sadism being a pathologically intensified masculine character, and masochism as an intensification of the feminine sexual character (Beckmann, 2001:67). A gendered view of sadomasochism was also taken up by Magnus Hirschfield, who viewed male sadism and female masochism as simply an escalation of normal sexuality, while the male masochist and female sadist were sexual inverts that switch between the appropriate gender roles of masculinity and femininity and “become complete metaphoric deviations from normality” (Taylor, 2002:110).
This approach to sadism and masochism is part of a larger tendency among the early sexologists to create an image of normal sexuality that rests upon essentialist assumptions of appropriate heterosexuality, masculinity, and femininity (Schaffner, 2011:17). Krafft-Ebing and his associates’ explanations of sadomasochism suffered from the same biological reductionism and hereditary explanations as most of their other depictions of sexual deviance, and have been shown to lack empirical grounding having been based only on clinical and forensic populations of patients and criminals (Taylor, 2002:109), in addition to being soaked with a moralistic Victorian outlook with a very specific view on what consists normal, natural, and mature sexuality. Even though, their ideas have had a great impact on our contemporary views and understandings of sadism and masochism (Beckmann, 2001:67; Weinberg, 2006:18).
Freud and Sadomasochism
For Freud, Sadism and Masochism have a special place in the exploration of sexual perversions as he viewed them as the most common and most significant of them all. In a way quite similar to the early sexologists, he viewed sadism as an exaggeration of the aggressive aspect of sexuality, while masochism was sadism whose object became the self, even though he didn’t necessarily connect this to gender roles and sexual expectations. Interestingly, Freud saw sadism and masochism as undividable, as all sadists are also masochists and all masochists are sadists, with one side of the sadomasochistic tendency simply more prominent and developed than the other (Schaffner, 2011:140).
Another important area where Freud’s exploration of sadomasochism differs from his predecessors is in his etiological explanation of the phenomenon. While Krafft-Ebing and Hirschfield ascribed to hereditary models of explanation, Freud focused on the way early childhood experiences can cause sadomasochistic inclinations in an adult. As described above, Freud saw sexual perversity as a quintessential aspect of childhood which is repressed in the process of maturation by the cultural principals of shame and disgust (Dollimore, 1991:179-180).
More specifically, Freud explained sadism and masochism through his instinctual theories of the pleasure instinct (that which seeks pleasure and gratification) and the death instinct (that which seeks self-destruction). According to Freud,
“primary sadism and masochism represent neurotic distortions of instinctual drives resulting from regression or fixation, due to unresolved Oedipal conflicts, to a pre-Oedipal anal-sadistic stage of sexuality” (Taylor, 2002:111)
The origin of deviant sexuality such as that of a sadomasochist can be found, in Freud’s conceptualization, in certain experiences of early childhood that could have possibly sabotaged his progression into normal and civilized sexuality due to a certain fusion between the pleasure and death instincts (ibid.). This idea regarding the origin of sexual psychopathology in general and sadomasochism specifically still echoes today, as some researchers view sadists and masochists as victims of childhood abuse that has caused them to deviate from sexual normality and implant them with feelings of guilt and rage with a lack of boundaries between themselves and others (Weinberg, 2006:18-19).
Sexual Sadism and Masochism in the DSM
As described above, the first two editions of the DSM only featured general descriptions of sexual deviation, and though the DSM-II had specific subdivisions for the most common sexual disorders- including sadism and masochism- they did not have any specific diagnostic or clinical information (American Psychiatric Association, 1968:44).
The DSM-III broke from this tradition and devotes a section for each of the “psychosexual disorders”, including sexual masochism (sexual excitement from the individual’s own suffering) and sexual sadism (sexual excitement from the infliction of physical or psychological suffering on another). Both diagnosis require either that the sadomasochistic activities be the preferred or exclusive means of sexual excitement- demanding not just sadomasochistic fantasies but behavior, or that the activity has caused serious bodily injury in order to achieve sexual excitement. Sexual sadism may also be diagnosed if it was done on a non-consenting partner (American Psychiatric Association, 1980:273-275).
In strike contrast to the aforementioned attempt to base mental illness classification on distress and dysfunction, the diagnosed sexual sadist or masochist need not feel distressed about their sexual activities and preferences, and they may similarly be perfectly functional. The reasons given for this inclusion is that having a paraphilia was considered by itself an impairment in social functioning, as it was assumed that sadist, masochists, and the like could not possibly achieve mutual affectionate relationships (De Block and Adriaens, 2013:290), even though there is no empirical reason to believe that masochists will have more difficulties in their interpersonal relationships than normophilic people (Stewart, 2012).
The fourth edition of the DSM added a criterion to all paraphilias including sexual sadism and masochism, which requires that the individual be distressed or functionally impaired by their paraphilic sexual urges. In both descriptions it is the possible harm of the actions that raises the most alarm and attention- the section on masochism describes “hypoxyphilia” (sexual arousal through breath control) as a major example of the dangers of sexual masochism, and the section on sadism had the situation of a sadist acting on their urges with a non-consenting partner as the potential dangerous outcome of the disorder (American Psychiatric Association, 2000:572-574). But besides these extreme examples, it is not clear why or how sexual sadism and masochism may cause distress or impairment in the individual.
In the current edition of the manual, both diagnoses were retained despite evidence that sadomasochism can occur in perfectly functioning and mentally healthy parts of the population (described in depth in the next chapter), due to the small number of cases of sexual masochism that do result in severe harm, the prevalence of sexual sadism in offender populations, and to facilitate further research (Krueger 2010a; 2010b).
Thus, the diagnostic criteria for both sexual sadism and masochism were left as is from the last edition of the DSM, while the description that followed was slightly altered. With the DSM-V’s differentiation between paraphilias and paraphilic disorders there is an attempt to make more explicit the difference between unusual sexual interest and a mental disorder (De Block and Adriaens, 2013:293), and consequently the descriptions of both disorders state more explicitly what distress may entail, and that without it the diagnosis cannot be made. They also state that they apply to individuals that freely admit to their paraphilic interests, with the exception of a sadist with a non-consenting victim. Such a sadist need not profess any sexually sadistic fantasies or distress regarding sexual assault, theoretically allowing any sexual assailant to be diagnosed as a “non-admitting sexual sadist”. Another interesting addition of note is that the DSM-V admits that knowledge about the prevalence, development, and functional consequences of sexual sadism or masochism are scant (American Psychiatric Association, 2013:694-697).
We can see through this rough sketch how the clinical approach in psychology and psychiatry to sadism and masochism has shifted slightly over the years, and yet they still seem to retain their status as pathological and deviant to normal and healthy sexual desire and behavior, even against challenging both from within and from without the medical community, which we will explore in the following chapter.


Challenging the Dominant Paradigm
Challenges From Within the Psychological Disciplines
Assessing the Psychology of BDSMers
As noted, most of the psychological and psychiatric theories of sadomasochism were not based on empirical research, but rather on literary representations and clinical or criminal populations that cannot represent the entire community of practitioners, and are therefore based on unchallenged assumptions regarding sadomasochists’ well-being and psychological functioning (Taylor, 2002:116). A few recent studies have tries to fill this empirical blind spot to better understand and help people who engage in sadomasochistic, and more broadly BDSM activities.
The prevalence of BDSM activities is tricky to measure. Kinsey’s famous (yet empirically problematical) study in the 1950s found a very high rate of people that were aroused by sadomasochistic stories (24 percent of men and 12 percent of women), while studies from the 1970s found between 2 to 4 percent that enjoyed inflicting or receiving pain, bondage, or master-slave sexual role-play (ibid., pg. 108-109). Two more recent studies found that approximately 2 percent of the population have participated in BDSM activities or have used pain in a sexual context, while another study found that relatively large numbers (16 percent of men and 12 percent of women) agree that pain and pleasure “go together” in sex, though this does not necessarily imply any actual sadomasochistic activities (Santtila et al., 2006:22; Wismeijer and van Assen, 2013:1944).
The persistent pathologization of sadism and masochism would imply that people who engage in BDSM behaviors should have psychopathological traits and behaviors. Yet when assessed, studies have found that sadists are not antisocial or psychopathic and masochists are not more prone to mental instability and disorders or engaging in escapist behaviors (Cross and Matheson, 2006:145-147), that BDSMers do not have anxious or avoidant attachment styles (Wismeijer and van Assen, 2013:1948) or clinically significant levels of neuroticism, psychoticism, or obsessional characteristics (Taylor, 2002:117), they are not more depressed, anxious, borderline, or obsessive-compulsive than the general population, and have lower trauma related phenomena and paranoia (though they do appear to have higher narcissistic and dissociative features) (Connolly, 2006:94-100), and are generally well adjusted (Santtila et al., 2006:22). It seems that BDSM practitioners do not have a higher propensity for psychopathological traits despite the dominant psychoanalytic and psychiatric explanations and theories about the nature of sadomasochism.
Another important finding is that most BDSMers continue to engage in non-BDSM sexual activities (only 5 percent do not), though some report that they are only satisfied by sadomasochistic sex (Weinberg, 2006:21; Santtila et al., 2006:24). This data undermines the ideas concerning the definition of paraphilia as the necessary or exclusive path to sexual arousal, which would warrant much higher numbers of BDSMers that do not engage in non-BDSM sex. It also negates theories that would assume that sadomasochistic tendencies would cause sexual dysfunction and hurt the ability to function in a “normal” sexual scenario.
BDSM activities are not generally associated with higher levels of distress or sexual difficulties (Wismeijer and van Assen, 2013:1944), and almost all of the practitioners had a positive emotional reaction to their first sadomasochistic sexual experience, as they wanted to do it again, felt happy, and stated that the experience was good. Interestingly, about one fourth of the practitioners in the sample also reported negative reactions to their first SM experience such as guilt, fear for the future, or feeling troubled (Santtila et al., 2006:25).
This may show us the ambivalent relation between distress and BDSM activities. Though a significant amount of BDSMers reported negative feelings along with positive ones, we must ponder whether feelings such as guilt or fear for the future are elicited due to the nature of the activity itself or the harsh social stigma and taboos that are attached to it. The previously mentioned studies that do not find a link between BDSM sex and psychological distress or pathology would support such a hypothesis. Additionally, many BDSMers are shown to be secretive about their sexual habits due to fear of job loss, child custody issues, and harm in interpersonal relationships (Meeker, 2011:156), which undoubtedly might cause feelings of emotional distress concerning their sexual behavior (as will be expanded upon below).
It should be noted that BDSMers have scored better than the general population on attachment styles, openness to experience, conscientiousness, subjective well-being (Wismeijer and van Assen, 2013:1948-1949), intelligence, and imagination (Taylor, 2002:118), while scoring lower than the general population on trauma related phenomena, paranoia (Connolly, 2006:96-100), neuroticism, and rejection sensitivity (Wismeijer and van Assen, 2013:1949). These results may point to ways in which BDSM activities or identity might not only be harmless, but also be helpful to one’s psychological health. Although, as stated above, the same studies show that BDSMers may also have more narcissistic traits and dissociative features (Connolly, 2006:98, 100), along with lower agreeableness (Wismeijer and van Assen, 2013:1949).
Concerning gender differences, most studies find slightly more men than women that practice BDSM (ibid., pg. 1946; Cross and Matheson, 2006:139; Meeker, 2011:155; Richters et al., 2008:1662), and that there is a significant amount of LGBT practitioners of BDSM (ibid., pg. 1663; Connolly, 2006:89; Cross and Matheson, 2006:143-144), which can be explained by the prominent leather and BDSM gay and lesbian subcultures (Langdridge, 2006:302). In general, the studies also find strong and significant connections between gender, sexuality, and BDSM role- most tend to find that more women prefer the submissive role while more men prefer the dominant role (Wismeijer and van Assen, 2013:1947; Connolly, 2006:89), and there is a higher proportion of dominants\sadists among gays and lesbians in contrast to heterosexuals (Santtila et al., 2006:28).
Sexual orientation also appears to affect preferences of sexual activities: gay men emphasized BDSM practices that have been coded as relating to hypermasculinity, such as rimming, fisting, enemas, or water sports, in addition to other activities that might be viewed as masculine like uniform scenes and wrestling. Straight men, on the other hand, preferred practices that have been coded as related to humiliation, such as verbal humiliation, gagging, and flagellation, in addition to activities like cross-dressing or rubber outfits that downplay the masculine aspects of sexual practice. The pain-related practices of BDSM were more intense and real for gay men while they were more symbolic for heterosexual men and for women (such as the increased use of flagellation and humiliation) (ibid., pg. 29-30; Weinberg, 2006:23).
These correlations certainly show that gender roles play a significant role in BDSM, just as they do in non-BDSM sexuality, as we see that women are relatively more inclined to take submissive and masochistic roles while men tend to take more dominant and sadistic roles, similar to societal expectations of female and male sexuality. The fact that gay men were more involved in practices that emphasized masculinity than straight men may be because both groups use BDSM as a means of escaping their effeminate and masculine sexual gender roles. Though this may clash with the aforementioned preference of dominance among male BDSMers. Further demographic studies about BDSM, gender, and sexuality may help provide a clearer view of this issue.
Arguments for Depathologization
These empirical inquiries to the psychological nature and characteristics of BDSMers that have shown that their functioning and well-being is usually high and healthy, in addition to more theoretical critical arguments regarding the place of paraphilias in psychiatry, have fueled an attempt to remove sadism and masochism (and the paraphilia category more broadly) from the DSM.
Such a move to do away with the category of paraphilia has a number of practical and theoretical reasons behind it: classifying certain sexual behaviors as pathological can cause bias and discrimination in legal contexts (Moser, 2009:323; Weinberg, 2006:31-32), therapeutic contexts (Kolmes et al., 2006:303-304), and can more generally cause the individual to be stigmatized and shamed (Moser and Kleinplatz, 2005:92; Meeker, 2011:158-159), sometimes to the point of violence (ibid.). On a more theoretical level, including certain sexual behaviors as pathological (or potentially pathological) while excluding others reinforces an imagined boundary between what is normal sexual behavior and what is deviant (Hinderliter, 2010:259; Stewart, 2012).
Just because an activity is dangerous, painful, or illegal does not warrant its inclusion as a mental disorder (Moser and Kleinplatz, 2005:95), and that carries over to the field of sexual behavior. Similarly to extreme sports that might cause harm or even death, sadism and masochism need not be viewed as an indication of mental instability or dysfunction. The whole concept of dysfunction that is part of the definition of mental illness according to the DSM-V is problematical:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (American Psychiatric Association, 2013:20)
The idea of what constitutes “functional” psychological, biological, and developmental processes is hard to disentangle from cultural norms and social values (Singy, 2010:1231). Can we truly say that becoming aroused from pain or humiliation is a universally wrong and dysfunctional trait, despite its potential harmlessness and historical ubiquity in human culture, rather than being something that is simply socially unacceptable and deviant from sexual norms (Taylor, 2002:108)? Continuing to include paraphilias in the DSM as has been suggested (and later accepted) by the paraphilia workgroup for the DSM-V transforms “psychiatrists into the guardians of cultural values. The pathological would simply be whatever society deems bizarre and morally unacceptable” (Singy, 2010:1232).
While a person’s sexual interests and activities can be related to mental problems, these can be tied to an expression of another disorder rather than a problem of the sexual interest itself. If someone is obsessed or addicted to a certain sexual behavior, it is an obsessive or addictive disorder, not a sexual disorder (Moser, 2009:323). And most individuals who have “deviant” sexual interests can, and do, control their sexual behavior, including BDSMers who, as we have seen, have no more psychological dysfunctions than the general population.
For example, if a sadist hurts others due to their being psychopathic or antisocial, it is a problem of psychopathy or antisociality, not a problem of sexuality which is simply the medium of expression for these psychopathological characteristics (Hinderliter, 2010:258-259). The paraphilias do not represent a unique type of dysfunction, and “just having an unusual sexual interest is not pathological anymore than having an unusual hair color is” (Moser, 2009:324).
Regarding the second component of mental disorder, that of distress, the DSM itself acknowledges that distress regarding paraphilias is rare and the problematic aspects of sexual behavior and interests usually comes to the fore when it clashes with societal norms that are expressed by their environment, family, and partners. The extensive stigma, isolation, and discrimination of those with non-normative sexual interests can also cause distress, but that should not cause the individual to be diagnosed with mental illness. Such a diagnosis has more chances of causing more distress than alleviating it (Moser and Kleinplatz, 2005:100-101), and serves to reinforce the behavior’s status as deviant and pathological and thus less deserving of equal rights and treatment in everyday life (Brouwers, 2011:16).
There seems to be a difficulty defining what constitutes “healthy” versus “unhealthy” sexuality, without falling into value judgments that simply categorize all non-normative sexual practices as a priori pathological, while problems arising from non-deviant sexual activities and interests are given a different, non-sexual diagnosis and treatment (Moser and Kleinplatz, 2005:96). The DSM fails to apply its own criteria for mental disorders to the paraphilias (Brouwers, 2011:15).
Thus, the DSM and the psychological professions hang on to certain idealistic views of “pure” and “correct” sexual behavior, namely one that is procreative, heterosexual, and genital-centric (Stewart, 2012; Moser, 200:324) - which effectively reinforces the constructed boundaries between acceptable and unacceptable sexual modes of expression and identity by positioning the paraphiliac, in this case the sadist and the masochist, as pathological others to the unnamed normative sexual person (Brouwers, 2011:18-20).
We must remember that the processes of pathologization and depathologization are not simply objective scientific advancements but rather social constructions inspired by political, economic, and cultural factors, and that the field of psychiatry serves as a major locus of social control that defines the “normal” and the “deviant” forms of thought and expression (Taylor, 2002:120). Sexuality always has been and always will be political, but the use of “objective” scientific terminology and discourse obscures these moral and political aspects (Weeks, 2003:90).
These problematic constructions of the paraphilic disorders in the DSM and in psychiatry in general, combined with numerous factual errors regarding prevalence, demographics, and potential for injury or harm (Moser and Kleinplatz, 2005:103-105) lead a significant group of psychologists, psychiatrists, and sociologists to call for the removal of the category of paraphilia from the DSM in order to help those with non-normative sexual interests like BDSMers to be treated in a nonpathological light and to help end their discrimination in legal, professional, and interpersonal settings (ibid., pg. 106-107; Hinderliter, 2010:256-261; Singy, 2010).
BDSM-Conscious Therapy
Trying to put these critical understandings about BDSM and its problematical place in psychology, a few researchers and therapists have tried to examine ways to help BDSM clients in therapy by helping shift the attitude and informing more psychologists, social workers, and psychiatrists about the correct way to deal with BDSM in the context of therapy.
While in most cases BDSM and sexual practices have no relation to the issues that bring clients to therapy (Kolmes et al., 2006:312), there are many incidents where the therapist may have a negative attitude towards BDSM practice, and consider it as unhealthy, confuse it with abuse, or require the client to give it up in order to continue treatment, and clients also tend to find themselves in situations where they have to educate and explain to the therapist what BDSM is and why it is harmless (ibid., pg. 314).
These attitudes stem from misconceptions about BDSM: that it involves exploitation of the submissive by the dominant; that it is not consensual; that it escalates to dangerous extremes; that it is self-destructive; that it originates from childhood abuse or other trauma; or that it serves as a mechanism of avoiding intimacy. All these assumptions have been proven to be false and unfounded (Nichols, 2006:283-284). Most texts and courses for therapists do not deal with BDSM or bother to shatter these prevalent myths (Barker et al., 2007:112).
It is safe to assume that some BDSM clients might hide this important aspect of their life from their therapist due to this rational fear of being judged and shamed for their sexual desires and activities. This can significantly harm long-term treatment (Nichols, 2006:288). The stigma attached to BDSM can have immense negative effects on therapy, as clients report almost equal amounts of negative and positive responses (Kolmes et al., 2006:320; Hoff and Sprott, 2009), and thus they cannot know what response they will get. Since negative responses can cause termination of treatment or having the therapist adamantly try to “fix” their BDSM orientation and/or present it as “sick”, “harmful”, or “immoral”, many BDSM patients hide their sexuality from their therapist (ibid.).
But even beyond theoretical misconceptions about the harm or nature of BDSM, many therapist who are strangers to this sexual domain may have direct averse emotional reactions to it as it can seem frightening and weird, and can cause the therapist to feel shock, disgust, fear, and general discomfort (Nichols, 2006:286), even without any judgments about the morality or harm of BDSM. Some have named this “uncontrollable physical revulsion that includes no moral judgments” “being squicked” (Nichols, 2011:28-29). Becoming “squicked” by the seemingly strange sexual practices of the client can cause negative countertransference that cause the therapist to be convinced that these behaviors are a sign of self-destruction, low self-esteem, or any other speculative psychological theorizing concerning the damaging causes and effects of BDSM (Nichols, 2006:286-287).
This phenomenon of “squiking” can be fought by having the therapist try to fully understand what it is in BDSM activities that might cause pleasure, even though it may seem at first as painful and bizarre (Nichols, 2011:28-29). At the same time, the therapist should learn how to distinguish between harmless and enjoyable BDSM behavior and behavior that is abusive or problematic, by focusing on issues of mutual enjoyment, consensually, compulsivity, and interference with everyday functioning to correctly assess the potential harm of a situation and avoid unnecessary blame, guilt, or even legal consequences (ibid., pg. 29-30; Nichols, 2006:297-298). By using processes of self-reflection and relational reflexivity the therapists can work beyond their preconceptions and prejudices regarding sexuality to help better the treatment of BDSM clients and avoid the negative consequences of these deeply imbedded biases (Barker et al., 2007:117-119).
Another significant area which should be considered in creating more helpful therapy for BDSM clients is by connecting to the BDSM community. Many BDSMers are involved in a BDSM organization and go to BDSM-related events to become part of a larger community of fellow BDSMers, as well as acquiring relevant skills and seeking personal relationships. Many cities as well as internet sites have groups dedicated to BDSM and there is a wealth of educational books and websites explaining the subject (Meeker, 2011:157-158). Connecting BDSM clients to these resources, especially when the client is new to the world of BDSM and is only now acknowledging their kinky sexual inclinations, can greatly alleviate the prospective shame and self-hatred that may arise from having an interest in non-normative sexual behaviors (Nichols, 2006:290-291). Support groups are an important empowering tool to deal with social stigma and potential distress regarding one’s BDSM orientation (Moser and Kleinplatz, 2005:100-101).
Awareness to these possible pitfalls in therapy of BDSM clients can help therapists to develop more beneficial attitudes and habits regarding such treatment: for example by asking non-judgmental questions about BDSM, creating a BDSM friendly environment in the therapeutic space, being open minded and accepting, helping the patient overcome issues of shame and stigma, and being well informed about BDSM practice and its complexity (Kolmes et al., 2006:317). This will aid the institution of therapy overall, BDSMers who seek clinical aid regarding or regardless of their sexual behavior, and help widen the acceptance of non-normative sexual practices in the psychological fields.
Challenges From Without Psychology: Pro-Sex Feminism
Challenges to the dominant views on BDSM did not only come from within the psychological disciplines. Feminists also had some important social criticisms regarding BDSM. During the 1980s there were important and deep disputes and debates in feminist circles regarding sex-related issues such as pornography, sex work, lesbianism, and BDSM. According to the anti-pornography feminist camp, led by figures like Andrea Dworkin and Catherine MacKinnon, male sexuality and heterosexuality are based on unequal power relations that subordinate women and keep men as the dominant gender. Thus, institutes like pornography and prostitution are an unredeemable part of the larger exploitation of women in the patriarchal system (Richardson et al., 2013:143-144).
Similarly, BDSM in this view is just a ritualized version of the existing power relations between men and women. It is a mere extension of heterosexuality in a more direct fashion- “business as usual” (ibid.). It follows that according to the anti-pornography school of thought BDSM is antifeminist and fundamentally misogynistic as it celebrates the culture of violence towards women. Even if the dominator is a women, BDSM subscribes to the patriarchal dogma of tying degradation, pain, and unequal power relations to sex (Cross and Matheson, 2006:135-136), and eroticizes this tradition of gender hierarchy and control- thus reinforcing it (Ritchie and Barker, 2005:3-4). Women who seek sadomasochistic enjoyment are viewed as internalizing misogyny into self-hatred to the point that they seek out their own abuse (ibid.).
The opposing camp of the feminist sex wars is that of pro-sex feminism, whose primary spokespersons included Pat Califia and Gayle Rubin, members of the lesbian-feminist BDSM organization Samois. The connection to lesbian sexuality is important- the figure of the lesbian, though accepted by the feminist National Organization of Women, was highly desexualized by positioning it as affection-centered “women-identified women”, rather than a woman who has libidinal impulses and sexual desires towards women (and acts upon them!), which may be viewed as a masculine property that mainstream feminists of the time wanted to abolish and exile from their circles (Hart, 1998:40-43). This can also be seen significantly in the panic regarding transsexual women, whose essential biological masculinity had them barred from certain venues in feminist and lesbian groups, such as the “Michigan Womyn’s Music Festival” (Hale, 1997:225).
This group of feminists has a very different view of BDSM: they see it as a way to play with power. BDSM is “ridiculing, undermining, exposing and destroying patriarchal sexual power” (Ritchie and Barker, 2005:4). BDSM can challenge traditional gender roles by having the woman be the ‘top’ and the man the ‘bottom’, or having them switch between being dominating and dominated, while also deviating from heteronormative sexual scripts that focus on penetration and reproduction (Barker et al., 2007:110). BDSM involves a direct and open playing with notions of power and power relations that turns power into a toy of pleasure rather than a tool of oppression.
A paramount aspect of the subversive power of BDSM that is constantly emphasized by pro-sex feminists is that of choice. The fact that the sexual scenes in BDSM are negotiated beforehand, that there are safewords to stop in case something is unpleasant to one of the parties, and that one can choose and switch between the position of dominant and submissive according to their preferences is highly contrasted to heteronormative “vanilla” sexuality and violent sexual assault in particular (Califia, 2000:171-173). Even if a woman chooses to submit to a man, this may be an empowered choice that she does out of her free will and with the aim of her sexual gratification (Ritchie and Barker, 2005:16-18). This idea is heavily repugnant to anti-pornography feminists who see such “free and empowering choice” simply as women who are repressed and need to be freed from their internalized oppression and ritualistic enslavement (Hart, 1998:56-59).
The fact that people can switch between roles in and between scenes, combined with the ability of anyone to take on any role regardless of their gender, race, or sexual orientation can dislodge fixed categories of sexuality and accentuate the fluidity and performativity of sex and sexual desires (Barker et al., 2007:110). BDSM and its plethora of roles and activities “reflect rich and subtly nuanced embodiments of gender that resist and exceed and simply categorization into female, male, woman, man, and thus into homosexual, bisexual, or heterosexual” (Hale, 1997:223, original emphasis).
Another insight of pro-sex feminism is breaking the myth that a submissive has no power and thus is used and abused by the dominant partner. The BDSM scene is negotiated to fulfill the desires and pleasures of all parties, and some even say that the submissive effectively holds more power than the dominant (Ritchie and Barker, 2005:12-13), as the top must care for and nurture the bottom, be aware of their limits and be attentive to their reactions (Hart, 1998:78-79). Yielding yourself to another can be a process of healing and growth in an almost therapeutic manner, as the top is the one who must assess and control the flow of the scene, they do so only in accordance with the bottom’s needs (Califia, 2000:165-166). Being restricted and bound (both literally and metaphorically) can allow the bottom to relieve their stress and responsibility and enter a state of being taken care of and expressing vulnerability (Califia, 2002:387).
In sum, this branch of pro-sex feminism views BDSM not as a part of a system of oppression, but rather as a queer practice that can fight and weaken the heteronormative gender hierarchy. BDSM’s manipulation, exaggeration, and parodying of power relations do not strengthen but weaken them. Through this perspective, BDSM can thus become a radical tool of sexual revolution.



BDSM as Experience
A Sexual Experience
When we examine the experiences and narratives of BDSM practitioners, one of the strongest recurring themes is that of consent. BDSMers a quick to differentiate their activities of pain and humiliation from those who are done without consent, and the premeditated negotiation of a sexual scene’s contents and safewords is paramount to the BDSM experience. Those who do not respect others’ boundaries and limits are quickly marked as dangerous and refused from BDSM gatherings (Taylor and Ussher, 2001:297-298). Parties and gatherings have strict rules of behavior and play regarding behaviors which are allowed or banned in both the sexual and the social parts of interaction. Alcohol and drugs, for example, are commonly banned from BDSM parties (Weinberg, 2006:28-29).
Explicit open communication regarding sexual desires and limits is a hallmark of the BDSM scene, sometimes even in the form of legal contracts (Langdridge and Butt, 2004:46-47). Even in the extreme situations of 24/7 master-slave relationships, where the use of safewords is not common, many slaves report being able to refuse orders and most say that their master or mistress will not force them to do things that will damage them physically or psychologically, and they can leave relationships when they feel unsafe or that their limits are not respected (Dancer et al., 2006:90-92). BDSMers can find this relational aspect of BDSM makes their sexual experiences much more meaningful, with a heightened sense of trust and safety (Beckmann, 2001:81-82).
The related issue of safety is also an important part of BDSM, as much attention is given to “safe play”, which includes the physical and the psychological safety of those involved in the scene. The elements of consent featured above such as safewords, planned scripting, and negotiation are an important part of this adhering to safety, in order to avoid physical injury or psychological distress and abuse (Langdridge, 2006:304). These are complemented by technical expertise regarding various techniques used in BDSM scenes ranging from appropriate use of tools like whips and canes to emotional skills of reading the partner’s ability to endure. Those who are more capable of following the rules of safe play are awarded community prestige and those who do not are shunned and have difficulty finding new partners (Lindemann, 2013:172-173; Newmahr, 2010:319-321; Weinberg, 2006:34).
These emphases on consent and safety are part of the popular BDSM mantra “Safe, Sane and Consensual” (SSC) which is used by many BDSMers as a central pillar of their sexual philosophy that requires no harm done to any party during play. Others use the term “Risk Aware Consensual Kink”, which accentuates that every BDSM scene is always entered in full awareness and consent of potential risk and unsafe consequences of the included activities (Richardson et al., 2013:146-147). Issues of security and responsibility regarding sexual endeavors which are important in mainstream sexual practice are given even more attention and stress in BDSM contexts (Beckmann, 2001:83-85).
These slogans represent a type of sexuality that does not completely reject the ideals of vanilla sex, but rather extends them and builds upon them, as safety and consent are important in both BDSM and non-BDSM sexual activities (Langdridge and Butt, 2004:42-44). This is in stark contrast to conservative views of sadism and masochism that view them as radical perversions from normative sexuality, while keeping in line with the findings that most BDSMers do not completely abandon vanilla sexual practices (Santtila et al., 2006:24).
Another important aspect in the sexual experience of BDSM is the distinction between fantasy and reality. Sadomasochistic behavior is explicitly in the realm of fantasy- which can be seen very clearly by the terminology of “play”, “roles” and “scripting” that are prevalent in the BDSM community. Inside the BDSM scene the actors can take roles that they cannot in their everyday lives- whether these are specific role-plays like parent and child, boss and employee, or owner and pet, or simply the more generic roles of dominant and submissive. Through the rigorous scripting and consent to certain roles and activities the scene participants engage in a collective illusion of power exchange, and clothing, language, bondage, and pain are utilized to reinforce this illusion (while the safeguards of agreed upon limits and safewords are positioned to set its boundaries) (Weinberg, 2006:33-35).
Giving and receiving pain and humiliation along with being restricted physically and psychologically help sustain the fantasy of helplessness, dependency, and domination. This play of power is the heart of BDSM experience (Taylor and Ussher, 2001:298-300). The creation of an authentic and believable fantasy is crucial to the sexual enjoyment of BDSM, as it allows the participant to immerse themselves in the scene and its pleasures. The intense sensations and activities of BDSM, which involve pain, concentration, sound, and many other embodied experiences, help maintain the feeling of being “in the scene”. Its position as fantasy and not reality also allows feeling safe from “real” physical harm and emotions of guilt and shame, and the carful cooperative construction of the scene ensures the satisfaction of all parties involved (Turley, 2011:253-255, 263-264; Newmahr, 2010:327-328). In the previously mentioned example of 24/7 slavery, many symbolic devices such as collars, responsibility for household chores, and being bound while sleeping are used to help sustain the constant fantasy of the master-slave relationship, while these symbolic forms of control were altered and downplayed in certain predetermined public and social situations to ensure the participants’ safety (Dancer et al., 2006:93-95).
Situations which would never be accepted by BDSMers in reality (domestic violence, incest, slavery, rape) are sharply contrasted with their illusory reenactments in BDSM scenes, especially by invoking the intentional and consensual choice that exists in the latter but not in the former (Ritchie and Barker, 2005:14-18). Behaviors of cruelty, control, and passivity in a BDSM setting need not be related to the players’ characteristics and behaviors outside the fantasy, in the “real world”: “Outside the sadomasochistic scene, dominants are not cruel, nor are submissives necessarily passive. It is only within the sexual context that such behavior is perceived as appropriate” (Weinberg, 2006:33).
These elements of consented fantasy are vital to the sexual experience of BDSM. They show us that BDSMers are more sensible than presented in pervasive psychiatric literature and popular imagination- they are heavily concerned with safety and the well-being of their partners and themselves, and the creation of scenes who might have disturbing overtones is always part of a highly elaborate fantasy that is not confused with an affirmation of such behaviors in “real life”.
A Therapeutic Experience
Moving beyond the sexual dimensions of BDSM, in many cases people who engage in BDSM practices report therapeutic effects resulting from their sessions. This is especially evident in the reports of pro-dommes (women who exchange their professional sexual dominatrix services for money), who have seen how their clients’ sexual submissiveness helps them in various ways. Many clients let loose of their sexual desires instead of repressing them, giving them an important sexual outlet. Others use them as a penance for their mistakes and misdeeds in their life, thus relieving themselves from their guilty conscious. Still others use the pro-domme’s dungeon as a place to heal past traumas by gaining control and reappropriating the causes of their anxiety. This is also related to the psychological process in humiliation scenes where the submissive is torn down and shamed only to be rebuild and reaffirmed later (Lindemann, 2011a:156-162). Even beyond the pro-domme’s dungeon, BDSM can be characterized in many cases as being a cathartic process, more so than other forms of sexuality due to the intense emotional and sexual energy invested in it. The powerful stimulations of BDSM help revitalize and provide a source of release (Newmahr, 2010:324).
These insights might explain some of the positive findings from the recent psychological research discussed previously, as they help us understand the ways in which giving power away and submitting to another have a beneficial effect on the submissive’s psyche. BDSM can thus be seen as a potentially useful as an outlet for people who feel that their sexual urges are repressed or have a great amount of responsibility in their day to day lives, or part of dealing with guilt and trauma. It is crucial to note that this view can confine BDSM as a practice for people who are “defective”- have something wrong in their lives or their psychological growth and cannot deal with everyday stress, past trauma, or feelings of guilt without the use of BDSM (Lindemann, 2011a:162-163), in a way which reminds the more dominant Freudian and psychosocial explanations for BDSM that still see it as part of the realm of the deviant and the ill.
There are, though, other beneficial aspects of BDSM. The BDSM scene provides for many of its members a nonjudgmental space and thus a sense of sexual freedom and release, allowing a more authentic expression of their selves and their desires, however deviant they may seem to the general population (Beckmann, 2001:85-87). BDSM allows people to escape “the ordinariness or alienation of everyday life” and to dispel boredom and loneliness by entering the sexual fantasy world of BDSM (Taylor and Ussher, 2001:304-305). For some, BDSM can serve as a catalyst for self-exploration and self-growth by experimenting with different sensations, sexualities, gendered positions, and more (Hale, 1997:227-229), to a point where it can be understood as a transcendent, even spiritual experience of enlightenment and change (Taylor and Ussher, 2001:305-306 ). BDSM can also give players a sense of accomplishment and empowerment, for example by enduring or delivering a high amount of pain, by honing specific skills, or by seeing the influence one has on their counterpart (both physically and psychologically) (Newmahr, 2010:322-324).
This facet of the BDSM experience gives us a glance of its emotional powerfulness and psychological potency. BDSM does not only help handle stress, trauma, or repression, but functions for many as a tool of self-development and individual expression in a fashion that cannot be grasped with the statistical and analytical methodologies of the research presented in the previous chapters.
It also points us towards the important social aspects of the BDSM experience. The aforementioned spaces of sexual freedom are created as part of a BDSM community of like-minded individuals who gather to celebrate and indulge in their sexual diversity and mutual interests. Gathering together allows the BDSMers not only to socialize with others or experiment with BDSM play, but also to feel a sense of belonging and normality in contrast with their difference from mainstream society (Weinberg, 2006:29). BDSM can thus become a community that gives its members a sense of belonging, and many different centers emerge, each with distinct norms, practices, and levels of commitment, allowing people with different social needs regarding their BDSM to find their answer (Lagndridge, 2006:301-303). The BDSM community provides a social solution to many who do not feel comfortable and able to express themselves in public, mainstream society, as well as serving other social functions such as facilitating social interaction and serving as places to find sexual and romantic partners (Newmahr, 2010:325).
As we see through these explorations of the BDSM experience, BDSM indeed serves many important functions for its practitioners. This encapsulates intra-psychological functions such as personal and spiritual growth, self-empowerment, or dealing with negative emotions and experience, and also social and interactional functions such as finding people with similar sexual interests or creating a sense of belonging and acceptance. Though these benefits of BDSM are definitely related to some of the positive results found in the psychological studies in the second chapter, they go beyond them to show us the significant positive personal impact the BDSM has on many of its participants and the way it shapes their psychological experiences beyond the aspect of mere sexual gratification.
A Transgressive Experience
Lastly, attention must be given to the transgressive potentials of BDSM as championed by pro-sex feminists. For many BDSMers, vanilla sex was simply not as enjoyable and satisfactory as BDSM sex (Turley, 2011:265). BDSM is experienced as more varied, more meaningful, less limited, and all around better than non-BDSM sexual activities (Beckmann, 2001:81-83). Vanilla sex is seen as “conformist, uninteresting, unadventurous, and unerotic” (Taylor and Ussher, 2001:303). At the most basic level, the sexual experiences of BDSM seem to those involved as superior to normative sexual expression, which can explain why many find vanilla sex to be unsatisfying and have positive reactions to their first BDSM experience (Santtila et al., 2006:24-25).
For some, the disparity between BDSM and vanilla sexuality is not only about its superior eroticism, but rather about the conscious rejection of normative sexual ideals which are resisted through BDSM’s “deviant” sexual expression (Langdridge and Butt, 2004:44-45). This may be part of an explicit or implicit feminist undermining of patriarchal heteronormativity by using BDSM to expose, exploit, and parody the gendered power imbalances in society (Taylor and Ussher, 2001:302-303; Ritchie and Barker, 2005:19).
This type of feminist resistance is achieved by opening up the body to pleasures that go beyond the genital- and orgasm-centered paradigm of heteronormative sexuality, along with increased openness to active feminine sexuality, non-monogamy, and bisexuality. Additionally, participants in BDSM activities can frequently play with genderbending techniques that transgress norms of sexuality and gender, for example by cross-dressing, acting a different gender (including many non-binary genders), or taking roles usually ascribed to another gender (e.g. a submissive male or a dominant female) (Turley, 2011:266-268).
More generally, BDSM expands and explores taboo, foreign, and alternative embodied sensations and affects and thus breaches both the individual and society’s boundaries and limits of sexual behavior and emotion. The fact that BDSM roles and activities are prescribed solely according to one’s interest and desire in them rather than one’s gendered, sexual, or racial position exacerbate its potential transgressive power and pleasure in a way that disrupts preconceived notions of gender, sexuality, and sexual identity (Richardson et al., 2013:145-148; Beckmann, 2001:86-88; Monceri, 2009:131-132).
This subversive performance of gender and sexuality is not unequivocal throughout BDSM practices. Significantly, many BDSMers do not switch between a multitude of roles and activities, but rather stick with a particular role that they may feel is a fixed and innate part of their sexual being (Sullivan, 2009:443), a situation that substantially hinders the transgressive affects mentioned above. Even in cases where there is a clear insubordination of normative gender scripts, such as the pro-domme and her male client seemingly reversing the patriarchal power dynamics by making the man submit to the women, the pro-dommes must rely on conventional gendered appearance and behavior: their normative feminine beauty, the use of scripts valuing “manners” similarly to heteronormative courting, or withholding sexual favors as part of their womanly power. Thus, they are both subverting and reinforcing gendered norms (Lindemann, 2011b:28-33).
We can thus conclude that though BDSM certainly has transgressive potential due to its diverse sexual practices and destabilization of gender and sexual identities, this potential is not necessarily always realized, as different applications of its practices and social restraints on BDSM activities and participants can curb its subversive influence by preventing them from deviating too far from the established norms of sexual and gendered conduct.


Conclusion
We have seen through this exploration of BDSM and its relationship with psychology and psychiatry the great discrepancies between recent research and the actual experience of BDSMers and the official psychological treatment of BDSM. While the latter see sadism and masochism as potential catalysts of distress and dysfunction, insisting on retaining their place in psychiatric diagnosis- which fuel both professional the popular imaginings of BDSM as dangerous, twisted, and unhealthy, the former find that BDSMers emphasize safety and healthy enjoyment of their sexual activities, and do not exhibit significant psychopathological tendencies compared to the general public. BDSM can sometimes even have a helpful, freeing effect on its practitioners, aiding them rather than harming them- especially when one becomes part of a BDSM community that grants support, training, and a sense of belonging.
Though there are slight movements that reduce the perceived severity of BDSM, both in the latest edition of the DSM-V and in public interest and acceptance of the BDSM subculture, they are not sufficient, and the arguments to remove sadism and masochism (along with the other paraphilias) have not been adequately answered. More importantly, the voices of BDSMers themselves have not been given significant weight in the legal and medical approaches to the subject, which can have devastating effects in therapeutic and juridical treatment (not to mention the discrimination and violence from the general public). Examining the actual experience of BDSM as I have in the third chapter can illuminate and expand upon the findings of recent psychological research and therapeutic viewpoints of the subject as described in the second chapter.
Lastly, we should consider the possible radical aspects of BDSM that were acknowledged by pro-sex feminists. Comparing these revolutionary philosophies with the actual BDSM subculture show that claims of the consciousness-changing potential of BDSM must be regarded carefully. Though the technologies of BDSM practice definitely have strong subversive elements that destabilize heteronormative and patriarchal ideas of sexuality and identity, they do not necessarily translate into the everyday practice of all BDSMers. Continuing to investigate how the transgressive capacities of BDSM can be realized will help this critical feminist endeavor.
Though I have tried to show the problematic and complicated treatment of BDSM in the psychological sciences, this paper is far from encompassing the entire intricate relationship between BDSM and psychology, and as more research- both psychological and ethnographic- is done on this subject we could help fight discrimination and open up sexual alternatives to the wider public. We must remember to be critical of the ways cultural norms and values regarding sexuality impose themselves upon us by using scientific venues of social control, and the ways that this can harm and repress us. By opening up and accepting BDSM as a healthy and viable manifestation of the infinite possibilities of human sexuality we can perhaps help release ourselves from restricting preconceived notions of normality and deviance.

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Practice makes perfect

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