Consider for a moment that we have difficulty discussing typical human sexuality in our normally open and frank discourse. Somehow discussing sex is considered taboo, dirty, or titillating. When Kinsey published his text books on both male and female sexuality in the 1950’s, they were read in secret and could never have been the subject of polite conversation. Even later, Masters and Johnson jointly wrote two classic texts in the field: Human Sexual Response and Human Sexual Inadequacy, published in 1966 and 1970 respectively. Both of these books dispelled long held myths about “normal” and “unusual” sexual behavior. Again, neither made the conversation around the water cooler at work and were relegated to secret reading. And, even more currently, Fifty Shades of Grey, a 2011 erotic romance novel by British author E. L. James is being discussed by the media as a voyeuristic peek at the world of sexual arousal. But, there is no conversation as to how this translates into real life.
Part of the problem of placing parafillia in context with regard to mental health is the cultural divide. For, example, homosexuality was considered deviant as far as mental illness was concerned. It was not removed from the DSM, (Diagnostic Manual of the American Psychiatric Association), until 1973. But, as we look at the culture today, we have civil unions, and gay marriage in several states, and a more liberal cultural view of gays and lesbians. But, if we dig deeper, several parts of the country still consider homosexuals as deviants. There is also a generational divide with regard to the practice. In addition, what may be considered “acceptable sexual practice” for example, oral sex in heterosexual couples is considered abnormal by some segments of society. In fact, some legislators seek to make it a crime. So then, we come to the most problematic aspect of placing parafillias in context; privacy.
If a man is sexually aroused by wearing women’s undergarments, is that a deviant act or simply an expression of individual choice? Or are any of the sexual acts that we consider “normal” valid across societal norms? These are the questions that perplex mental health professionals as well as the general public. I would submit that the concept of placing the diagnosis of parafillia effectively, we have to consider the impairment factor. If any behavior, sexual or otherwise, impacts the daily life of an individual, then there may be a mental health issue. Without impairment, the desire to label an individual as a deviation is misplaced.