Is Psychology 'Perverse'?

by Dr. Jem Tosh



(Content warning: discussion of s*xual violence and the pathologization of trans people)


As I write a proposal for the second edition of my first book, Perverse Psychology, I thought it might be useful to outline exactly what I mean by that term and the theory behind it.


Perverse Psychology


per-verse

adj.


  1. Directed away from what is right or good; perverted

  2. Obstinately persisting in an error or fault; wrongly self-willed or stubborn*


My analysis of psychological and psychiatric constructions of sexual abuse started with the 'paraphilias' - sexual activities and behaviours that psychiatry and psychology (controversially) deem to be 'abnormal'. My work started with the 'paraphilias' because the proposals for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were released shortly after I started my PhD. They included the troubling concept of 'paraphilic coercive disorder', despite it being rejected several times before. 'Paraphilic coercive disorder' referred to rape in the main criteria and I argued that the proposed diagnosis medicalised sexual violence. It was a focus of the protest and academic activist intervention I co-organised in 2010, which also addressed problems with the psychiatric treatment and diagnosis of 'gender identity disorder' (now called 'gender dysphoria'**).


One thing that struck me in the critiques of 'paraphilic coercive disorder' was how often it was framed as new - both in terms of those who did not mention the feminist protests and critiques from the 1980s, but also how sexual abuse has been pathologized in psychology and psychiatry throughout the DSM's history and long before it. Whether a part of the (also problematic) 'sexual sadism disorder' or the pre-DSM 'satyriasis', sexual violence has been included as a 'symptom' of mental 'illness' for well over a century.


Instead of challenging abuse and those who enact it, psychiatry and psychology pathologize the victims and subject them to invasive therapies and pathologizing theories that result in discrimination and stigma. This most certainly could be considered an example of being 'directed away from what is right and good' - (Tosh, 2015, p.115)

What I noticed about this construction, which troubled me even more, was the boundary that was put around it. What gets categorised as 'abnormal' sexual violence and what is 'normal' sexual violence? Is there really a concept of 'normal' sexual violence - is it 'normal' at all? What are the implications of framing certain kinds of sexual violence in this way?


I was troubled by this paradox, on the one hand sexual violence was positioned as symptomatic of disorder, and on the other hand it was framed as 'normal' in some situations. That latter group coincided with the normalisation of masculine violence - harmful theories and narratives that centred 'rough and tumble play' as key to boys' development but not girls.*** It framed sex and sexuality in (heteronormative and) oppositional terms, with men being described as active (and 'aggressive') participants with a high sex drive and women framed as the passive and asexual complement that required pursuing and even coercion to 'awaken' a sexual interest.****


Gender Nonconformity


To understand this dichotomy, I needed to examine psychological and psychiatric constructions of gender. What I noticed was, when the violence fit into psychological narratives about masculinity (the 'norm' constructed by psy disciplines) it was most often positioned in that 'normal' violence category. Those instances that were positioned in the other category, the 'abnormal' rape concept, tended to represent gender nonconformity; a combination of 'masculine' violence with (what psychiatry constructed as) a 'feminine' 'over-emotionality'. Like discourses about 'hysteria' (and the present-day version, 'histrionic personality disorder'), it was not the 'masculine' violence that was framed as 'abnormal', but the overly emotional display or expression of it in certain contexts that would result in its pathologisation. I looked again and again and found repeatedly that distinction - 'normal' violence was controlled, functional, necessary, and 'abnormal' violence was emotional, uncontrollable, irrational. The latter replicated psychology and psychiatry's constructions of pathologized femininity (not only through hysteria discourse, but others too, like 'borderline personality disorder').


The persistence of psychiatric interventions with children who defy gender norms continues the profession's stubbornness to acknowledge wrongdoing... - (Tosh, 2015, p. 115)

The other parallel I noticed, was the similarities in the pathologization of gender nonconformity in these psychological and psychiatric texts. From 'transsexualism' and 'transvestic disorder', to 'gender identity disorder' and 'gender dysphoria' (which have a history as long as psychiatric constructions of rape), it was not just femininity being pathologised but also the gender nonconformity - in other words, psychiatry had a problem with the existence of trans women and girls*****. For the constructions of 'abnormal rape', they pathologised the problematic construct of 'feminine' 'over emotionality' as well as (what psychiatry considered to be) the gender nonconformity of it existing or being expressed by a (cisgender) masculine body.


I found this conceptualisation deeply problematic and harmful - to frame gender nonconformity (and transgender and nonbinary people) as 'abnormal' but 'masculine' violence as 'normal'. This is because I don't think we should consider any kind of violence as 'normal', regardless of the gender of the perpetrator.****** Nor do I think that gender nonconformity should be pathologised. So, based on the definition of perversion given at the beginning of this blog post (and the final chapter of the book), I conclude that because of this backward understanding of violence, abnormality, and gender, it is psychology and psychiatry that are perverse:


If psychology considers transgender people to be 'abnormal' and rape to be 'normal', or argues that certain genders should be prevented but masculine violence should be encouraged, then it sounds to me like psychology is the one that is perverse and in need of an intervention. - (Tosh, 2015, p. 116)


Reviews for the First Edition:


"Highly original, closely argued, and ingenious analysis"

Professor Erica Burman, University of Manchester


"A captivating critique of the disciplines of psychology and psychiatry"

Shari Fitzgerald, Memorial University


"At last a book that speaks about the unspoken. Well written, well referenced, a highly stimulating read"

Kirsten Nokling, The Psychologist


"Well written, insightful, interesting, informative, and an excellent resource"

Joan Strutton, PsycCRITIQUES


"Invigorating and provocative"

Pierre Brouard, University of Pretoria


"A very important book about how modern psychology has been used to invalidate and suppress sex and gender diversity"

Jack Molay, Crossdreamers


Nominations


Shortlisted for The British Psychological Society Book Awards, 2016


Preface by Professor Ian Parker:


"Instead of subjecting those labelled as 'abnormal' to the gaze of psychology, [Jem] Tosh invites us to turn around and look carefully at that gaze. How is it structured, and how is it linked to power? What are the consequences of the proliferating categorisation of sexual disorders, and what does that tell us about knowledge production in psychology? And how are the borders between masculine and feminine policed, and the many different attempts to cross those borders treated by psychology as 'perverse'?"


Perverse Psychology is part of Professor Ian Parker's Concepts for Critical Psychology: Disciplinary Boundaries Re-Thought book series with Routledge. Check out the full range here.


Contents of the First Edition


1. Introduction

Anti-psychiatry

Critical psychology

Discourse Analysis

Feminism

[Trans psychology]


PART 1 - SEXUAL VIOLENCE


2. Psychology and sexual violence: A historical review

Rapere

Rape as perversion

The DSM

Online research

Psychiatric Discourses

Reverse Discourses

Conclusions


3. Remedicalizing rape

Forensic Psychology

Feminism

Sexology

Remedicalizing psychiatry

Paraphilic Coercive Disorder

Paraphilia NOS

DSM-5

Conclusions


PART 2 - [GENDER NONCONFORMITY]


4. Psychology, homosexuality, and 'feminine boys'

'Sodomy'

Perversion

Psychoanalysis

The DSM

'Feminine boys'

Conclusions


5. [Gender Nonconformity] and psychology: Transforming gender identity (into) a disorder

Gender nonconformity

Perversion

Gender identity

The DSM-5

Gender dysphoria

Conclusions


PART 3 - PERVERSE PSYCHOLOGY


6. Rape: A perversion of gender

Stranger rape, strangely fascinating

Psychiatrization

Normalizing rape

Pathologizing gender nonconforming victims

Paraphilic rape

The 'unreasonable' rapist

Feminization

Conclusions


7. Conclusions: Perverse psychology

'Directed away from what is right and good'

'Obstinately persisting in an error or fault'

Perverse psychology



A note on 'transgenderism'


I also thought that it would be a good idea to explain the context around the problematic word 'transgenderism', how it ended up being in the book title, and what it could be replaced with in the second edition.


The word 'transgenderism' is currently considered an offensive term and its use is discouraged. This is because it has become associated with those who invalidate trans people and can be used in discussions and analyses to dehumanise transgender people.


When I was writing the book (between 2010 and 2013) the word didn't have the same association, being used often in texts that discussed transgender people from a clinical and non-transphobic context. But language changes, particularly in discourses where there is so much hostility, stigma, and growth.


I wasn't 100% comfortable with the word 'transgenderism' then but I couldn't yet put into words why. I argued that it wasn't quite the word I was looking for and that it didn't actually describe what I was talking about, but I was advised to use the word because otherwise no one would discover my book.


I walked away from many publishing opportunities that requested I remove the 'transgender piece' entirely from my work, so compromising on language in some ways seemed like the best I could ask for at that time. I don't compromise anymore.

I wanted to use the term 'gender nonconformity' because my analysis was about how psychiatry framed gender, created gender norms, and then pathologised nonconformity to those norms. That includes the pathologisation of transgender and nonbinary people, but my analysis was on how psychology and psychiatry constructed the expressions and behaviours of gender nonconformity, as it is this observable behaviour that tends to be the main focus of psychiatric texts and perspectives in this area.


That was the problem when I started writing about these topics over a decade ago - these terms weren't as well known, understood, or critiqued. Every paper I submitted and every chapter I wrote, the feedback from editors and reviewers alike requested that I define all the terms I was using because they (and they expected the readers too) were not familiar with them. I was asked for detailed backgrounds of each diagnosis I mentioned regarding gender dysphoria based on the assumption that it would be new information to most readers. That's not the case now. Everyone and their granny seems to have an opinion on transgender people. Even if they don't know the details of the gender dysphoria diagnosis, these concepts are more recognisable and familiar than they were then.


I wish I had stood my ground more. I walked away from many publishing opportunities that requested I remove the 'transgender piece' entirely from my work, so compromising on language in some ways seemed like the best I could ask for at that time. I don't compromise anymore.



Notes


* From www.thefreedictionary.com


** I use quotation marks to highlight that I am talking about a psychiatric concept, not to undermine or invalidate people's lived experiences of gender distress or gender dysphoria.


*** They did not consider nonbinary children and when they did consider transgender youth, they were most often misgendered and pathologized as having a 'disorder'.


**** These perspectives rarely considered queer relationships or asexuality, tending most often to pathologize them if they were mentioned.


***** While there is work on trans men and gender nonconforming and 'masculine' girls (e.g. cisgender tomboys) psychiatry and psychology have a well-documented disproportionate interest in trans women and femininity. To read about constructions of sexual abuse in psychology and psychiatry and experiences of cisgender and transgender men, see my latest book The Body And Consent in Psychology, Psychiatry, and Medicine: A Therapeutic Rape Culture (Tosh, 2020).


****** Not to be conflated with aggression. I have discussed my conceptualisation and differentiation between consensual aggression and (nonconsensual) violence elsewhere.