Battling over Masochism

By John Leo

The women came to reason. But just in case reason did not suffice, they thought to mention the possibility of a massive lawsuit against the American Psychiatric Association, charging it with violating the civil rights of all women. The meeting was "very heated," according to its affable chairman, Psychiatrist Robert Spitzer, and in the end reason prevailed: "masochistic personality disorder," a red flag to feminist scholars for at least two decades, will not be an official diagnosis of American psychiatry after all. Instead, the proposed category will be known as "self-defeating personality disorder."

"They expected a fuss, but they didn't think the issue was important enough for the size of the fuss we made," said Denver Psychologist Lenore Walker. She was one of seven feminist psychologists and psychiatrists who were invited to Manhattan last week, all expenses paid, to sit in on a closed meeting dealing with proposed revisions in psychiatry's diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (Third Edition). DSM-III is of crucial importance to the profession. Its diagnoses are generally recognized by the courts, hospitals and insurance companies.

Walker, who chairs the women's caucus of the American Psychological Association, knows the conditions under which masochism is casually diagnosed in many women--she is an expert on battered wives. Freud thought women were naturally masochistic. Weighed down by this intellectual baggage, feminists say, therapists often speculate that victims of wife beating stay with their mates because of a secret liking for punishment, failing to observe that the women are demoralized or terrorized.

Spitzer and his colleagues were happy enough to give up the word masochism, but seemed stunned by the determination to chip away at the concept behind it. The feminists seemed surprised and indignant that the meeting descended into the usual picturesque result of successful lobbying: a bit of old-fashioned horse trading. "At one point they offered us a deal," said Walker. "If we backed off on masochism, they would create a sadistic disorder to cover wife beaters." No deal. The group began to discuss a supposed hallmark of masochism, the willingness to endure pain. "Oh, you mean, like early-morning joggers?" inquired one of the feminists. "No, football players," said another; and a third chimed in, "What about high heels or girdles?" The hallmark was dropped. As compromise clauses hummed through the air, "we sat there horrified," said Walker.

To Psychologist Renee Garfinkel, a staff member of the American Psychological Association, "the low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. You feel like Italian, I feel like Chinese, so let's go to a cafeteria. Then it's typed into the computer. It may reflect on our naivete, but it was our belief that there would be an attempt to look at things scientifically."

Spitzer's rebuttal: "They have never developed a category. It's easy to say it's chaotic and mock the use of the computer, but that's how a committee works. You put it on the screen so everybody can see it." He spoke in the aggrieved tones of a man who has just spent five hours bending over backward and is now being attacked anyway. Hanging in the air was the belief that masochism exists but henceforth no woman will ever be diagnosed as suffering from it because the women's movement would be disappointed. Some of the women even doubt that a masochistic personality exists. Garfinkel believes there "simply is no research" to prove it. Walker thinks the group should "junk the whole thing." "Basically," said the beleaguered Spitzer, the feminists are "against what we are trying to do ... They are so enmeshed in spouse abuse that they can't focus on what we see as a problem--that there are people whose pain and suffering can't be explained by objective reality."

Richard Simons, a Colorado psychoanalyst and writer on masochism who attended the session, agreed with Spitzer. "It's not scientifically valid to throw out a category merely because it might be misused," he said. Otherwise, Simons seemed to embrace the entire feminist position. Psychiatrists confronting battered women should not sit around pondering categories, he said. They should get out of their chairs and get the woman some physical protection. "The first thing you do is protect life and limb. A psychiatrist has that responsibility like anyone else." But in the current climate, could a psychiatrist find that a battered woman actually had masochistic symptoms? Admitted Simons: "You could do it, but only in your mind."

Agility has long been the name of the game in defining diagnostic categories. In 1973 the psychiatrists placated a powerful gay lobby by deciding that homosexuality, "per se," is not a mental disorder. This left in limbo those homosexuals who are dissatisfied with their condition. So the association created "ego-dystonic homosexuality," the world's first mental disorder that is only a disorder if the afflicted person thinks it is. DSM-III, published in 1980, officially listed tobacco dependence and transsexualism as disorders. "Tobacco dependence" may have been discovered to be a special disorder, worthy of its own category, so that smokers could collect from insurance companies for therapy. When "transsexualism," or discomfort about one's anatomic gender and the desire to change, was made an official disorder, Psychiatrist Thomas Szasz derisively claimed to be suffering from "transchronologism" because he was dissatisfied with his current age and wanted to be younger.

Next week Spitzer and some of his colleagues will address two more highly charged issues, both of intense interest to feminists: proposed categories for premenstrual syndrome and for men who rape compulsively. Feminists, aghast at the possibility of a legal defense built around the new disorder of "paraphilic rapism," are likely to see that it remains no category at all. --By John Leo