The Pathologizing of Kink and BDSM

Humans have engaged with kink for, at the very least, as long as humans have been recording their sexuality. Some of the earliest recorded examples are the Kama Sutra, Khajuraho Temple, and Shibari rope binding. Even some of the earliest found dildos date back 28,000 years. So, when did these ancient practices become surrounded by so much shame and stigma? In this upcoming series of blog posts, I will be going over the history of the pathologizing of these practices, the potential positive outcomes of engaging in kink and BDSM, what it means to be a kink-affirming therapist, and how to make therapeutic spaces more affirming.  

The terms sadism and masochism are traced back to the rise of Psychoanalysis. In 1855, psychologist Richard von Krafft-Ebbing published Psychopathia Sexualis, which coined the terms sadism and masochism as sexual disorders because they were considered acts of “cruelty and bodily punishment.” They were seen as two separate disorders; sadism as finding sexual pleasure in inflicting pain on another person, and masochism as relinquishing control to the sexual desires of another person. Krafft-Ebbing claimed that people with these, and other “deviant” desires, were “degenerate” and would “pass off bad seed to their children.”

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Freud followed this in 1889 when he combined these two terms into “sadomasochism” and considered it one of many of disorders that he believed were caused by repression of the subconscious. He asserted that masochism was a perversion common in women, and sadism was a perversion common in men. Von Kraft-Ebbing and Freud both considered these to be non-consensual violent acts rather than consensual practices for pleasure. This conflation led to sadomasochism being listed in the Diagnostic and Statistical Manual of the American Psychological Association (DSM) as a disorder. This diagnosis was only changed in the most recent version: the DSM-5.
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In 1929 psychologist and founder of sexology, Henry Havelock-Ellis, published seven volumes entitled Studies in the Psychology of Sex. In his work, he refuted Freud's gendered divide of sadomasochism as Ellis believed they were complementary emotional states. Havelock-Ellis created the modern-day understanding of S&M as it relates to utilizing pain to create pleasure. However, he agreed that these behaviors were related to brain abnormalities.

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The diagnosis of sadomasochism has been used to discriminate against people in child custody proceedings, places of employment, and when trying to get housing. Although this diagnosis has now been changed, much of the stigma it created remains. These stigmas include beliefs that kink/BDSM is abusive, that it results from sexual trauma, that it is addictive, and that it is solely focused on a desire for pain.

A study by Kolmes et al. (2006), found that half of the participants who practice kink chose not to disclose that to their therapists due to fear of judgment. This number is justified by a high number of clients who report bias and inadequate care after disclosing their kinks to their therapists. Some participants even noted that their therapists told them their behaviors were unhealthy and required them to stop practicing kink in order to remain in their care. Due to this history within the field, many therapists will note that they are kink-affirming to signal their acceptance and knowledge to clients.
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It took a lot of activist work to have sex-related diagnoses, including those related to BDSM, changed and/or removed in the DSM. Notably, the National Coalition for Sexual Freedom fought to normalize desires and move away from pathologizing them. Although this led to positive changes in the DSM, there is still resistance around the current standards for Paraphilic Disorder which covers “atypical sexual arousal patterns.” Although this diagnosis requires significant distress in the client, this distress is often caused by the stigma, shame, and guilt of the desire rather than the desire itself.

In recent years, BDSM has been mainstreamed by media such as Fifty Shades of Grey, How to Build a Sex Room, Nymphomaniac, etc.. While these are not all realistic or entirely positive portrayals of kink, the interest in watching them shows a growing desire for people to understand more about this form of sexuality. It also suggests an urge to bring these practices out of the shadows. But what does this mean in terms of the mental health field? Stay tuned for the next blog in the series on potential positive outcomes of engaging in BDSM and Kink.  

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References/Resources:

• Ferenchak, S. (2022). De-pathologizing BDSM: Towards an Integrated Kink-Affirmative Acceptance and Commitment Therapy Model. Widener University ProQuest Dissertations Publishing. https://doi.org/29212056
• Kolmes K, Stock W, Moser C. Investigating bias in psychotherapy with BDSM clients. J Homosex. 2006;50(2-3):301-24. doi: 10.1300/J082v50n02_15. PMID: 16803769.
• Lowrey, A. M. (2004, October 28). From Freud to America: A Short History of sadomasochism.Retrieved March 17, 2017, retrieved here.
• ‍Wismeijer, A. A., & Assen, M. A. (2013). Psychological Characteristics of BDSM Practitioners.The Journal of Sexual Medicine,10(8), 1943-1952. doi:10.1111/jsm.12192
• Sagarin, B., Lee, E., & Klement, K. (2009). Sadomasochism without sex? exploring the parallels between BDSM and extreme rituals. Journal of Positive Sexuality, 1(3), 50–55. https://doi.org/10.51681/1.132