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How the Psychiatrist Who Co-Wrote the Manual on Sex Talks About Sex

"I’m not one of these guys who goes out of his way to be politically incorrect."

Dr. Ray Blanchard knows sex. He is handy with a penile plethysmograph, which he uses to measure a guy's penis to see if he’s turned on. What turns Blanchard on? Science. Why do we care? Because he helped prep the chapter on sexual and gender identity disorders for the American Psychological Associations’ diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders. 

The APA’s manual of mental disorders is the nexus of the psycho-pharmaceutical industrial complex in the United States. Its reach extends into the workings of insurance companies, criminal courts, and psychiatric care worldwide. It is currently in its fourth iteration, DSM-IV, while the newest update, DSM-5, is being worked on. Blanchard served on the DSM-IV sub-working group for gender identity disorders, which led to him serving as chair of the paraphilia sub-working group for DSM-5.


The criteria arrived at by Blanchard and the rest of the APA’s task force of shrinks could determine whether an eight-year-old girl who pees standing up is labeled with gender dysphoria and given hormones, or if a convicted child molester is involuntarily committed to a mental hospital based on a pedophilia diagnosis.

Then there is the stigma that comes of calling sexuality and gender identity a disorder. Understandably, many trans people don’t like being treated as though they have an illness. The problem is, a diagnosis of some kind is required by most insurance companies to reimburse a patient for gender reassignment therapy. In the DSM-5, gender identity disorder was replaced with the more neutral term gender dysphoria. On the other hand, transvestic disorder replaced the only slightly less offensive transvestic fetishism, based on the recommendation of Blanchard.

Blanchard headed up the committee on paraphilias, which describe sexual arousal by anything that isn’t sex or foreplay with a consenting partner. It’s a broad category that includes something as benign as a man who is turned on by wearing his wife’s underwear to someone who gets off on touching little boys.

The doctor likes to flout political correctness, he can’t resist an off-color joke, and his ideas about gender and sexuality are archaic, even by the standards of the peddlers of pathology at the APA. It has been 40 years since homosexuality was removed as a mental illness from the DSM. But given a clean slate, Blanchard said he would still classify homosexual sex as abnormal.


Blanchard is very fond of the word normal, but even he will tell you, its use in sexual psychology is verboten. But he’ll also say it’s a valuable scientific concept – and if you aren’t performing coitus three times a week with your heterosexual life partner in the hopes of spawning progeny, you don’t make the cut. It’s a small club, the normal people. Here’s what Blanchard has to say about everyone else:

Motherboard: When does a paraphilia become a disorder?

Blanchard: There are two ways by which a paraphilia could be converted into a paraphilic disorder: the individual is distressed by their desires, or they are acting in a way that is noxious to people. So a pedophile could have a pedophilic disorder if the guy is tortured by the fact that he is a pedophile, or he is perfectly happy with the fact that he is attracted to children, and he is molesting a lot of them.

So if someone cross dresses and they are cool with it, then they don’t have a disorder, correct?

Yes, under my proposal you can now be a happy transvestite, or you can have a transvestic disorder.

You coined the term autogynephilia, which refers to a man who is aroused by the thought of himself as a woman. This term is kind of your baby. Is it going to make it into the DSM-5?

That comes under the heading of what I can’t tell you, because of the confidentiality agreement I signed with the APA.

Do you think autoandrophelia, where a woman is aroused by the thought of herself as a man, is a real paraphelia?


No, I proposed it simply in order not to be accused of sexism, because there are all these women who want to say, “women can rape too, women can be pedophiles too, women can be exhibitionists too.” It’s a perverse expression of feminism, and so, I thought, let me jump the gun on this. I don’t think the phenomenon even exists.

Some trans activists object to the inclusion of transvestic disorder in the DSM because they feel it pathologizes gender non-conformity. How do you respond to these criticisms?

To say that transvestic disorder pathologizes all trans people is rhetoric with no logic behind it whatsoever. If you actually open the DSM-4, it’s very explicit that it applies to people who get sexually excited by dressing in women’s clothes. They really object to the fact, (which is a fact established beyond any conceivable doubt), that in a lot of men there is some connection between cross dressing and sexual excitement.

"I think that a transsexual should be considered as whatever their biological sex is plus the fact that they are transsexuals."

Is the objection based on the idea that it fetishizes gender non-conformity?

Some activists are trying to sell the public on the idea, “We really are women where it matters–in our brains–and women don’t get sexually excited when they put on their bras and panties, so we don’t either.” And for a lot of them that’s just a lie.

So you don’t see a male-to-female transsexual as being female?


I think that a transsexual should be considered as whatever their biological sex is plus the fact that they are transsexuals. That’s how you would do research on them. There’s no other way to do it. If you’re interested in whether the brains of transsexuals are different in some way, you’re interested in seeing if they differ from other individuals with the same biological sex.

So in a way psychiatric research is inherently gender normative?

I would say medical research is inherently gender normative.

Some members of the trans community object to the stigma they feel accompany DSM diagnoses, but because of the impact of the DSM on insurance payments, it's necessary they be labeled mentally ill. To what extent is a diagnosis from the DSM necessary to receive reimbursement for gender reassignment therapy?

In the US I would say most insurance companies probably require a DSM diagnosis. The point that sticks in the craw of a lot of activists is that in order to get sex reassignment surgery paid for by a third party, it has to be deemed a disorder. The transgender community has tried to get around this in a way that they seem to think is very creative.

Their argument is, “Well, public health insurance plans pay for the cost of child delivery in a hospital, and childbirth is not a disorder. Therefore transsexualism could be covered under public third party health insurance payers without it being a disorder.” That’s how they’ve tried to square the circle.


"I mean, how many people who make a joke
about trannies consult the DSM first?"

And have they been successful?

No. How many people do you know regard sex reassignment surgery as part of the life cycle like having a baby?

Do you think that classifying transgender people as having a disorder does contribute to stigma against the trans community?

No. I mean how many people who make a joke about trannies consult the DSM first?

Do you think that transgender identity might get to the point where homosexuality is now, where it is considered offensive and inaccurate to call it a disorder?

I think there are some glaring differences between acceptance of transsexualism and acceptance of homosexuality. Let’s say that a friend comes to you and says she's a lesbian, you aren’t seeing your friend performing cunnilingus on her girlfriend. All this requires is acceptance of what you don’t have to see.

With transsexualism, if a friend comes to you and says I feel like I’m actually a woman, and starting tomorrow I’m going to be showing up wearing dresses, this is not happening offstage, you are now part of their movie.

You wrote in a blog post the word normal has been effectively off limits for describing erotic interest for decades. Why do you think people object to the word “normal”?

I always say "normal" is the other n-word. You just aren’t allowed to say it. I would say I have almost never written the word normal because for decades now, since I was a graduate student, and I’m an old man, normal has been a dirty word.


So why do you keep using it?

I guess because I think it’s a perfectly good concept. I don’t aggravate people if I don’t have to, but I’m not going to say that there is no gold standard of what sexual behavior’s purpose is.

And what is that?

I would say if one could start from scratch, ignore all the history of removing homosexuality from the DSM, normal sexuality is whatever is related to reproduction. Now you have everything else. I would distinguish between behaviors which are anomalous and benign vs. those that are malignant. So homosexuality would be not normal but benign. Whereas something like serious dangerous sadism would be a malignant variation.

But for people who engage in BDSM, sadistic sex presumably helps them reach a climax, which then would encourage reproduction.

Well, no. I’ve worked a long time with sex offenders. Don’t think about those nice BDSM people, think of the guy who kidnaps a woman off the street, confines her, tortures her and kills her, in many cases there is never even penile penetration, the only penetration of the woman is with a bottle, or a broken bottle, or god knows what.

"I mean, there is a huge decrease in fertility in gay men, and I don’t think that makes them more abnormal than a foot fetishist who can only have sex with his wife if he’s thinking about her feet."

But maybe some of the other benign variations would encourage reproduction. I mean it’s possible fetishes evolved because they help people climax, right?


Well, helping them climax is not the same thing as climaxing in a vagina. I would say in general paraphilias take away to some extent from ordinary copulatory activities.

Because they are a distraction?

Because they are a competition. I don’t think it’s important how much a paraphelia impairs reproduction. I mean, there is a huge decrease in fertility in gay men compared with heterosexual men, and I don’t think that makes them more abnormal than a foot fetishist who can only have sex with his wife if he’s thinking about her feet.

With all of this tension around political correctness, I was shocked to see you wrote, “Behaviorally boys and girls with gender identity disorder resemble extreme sissies and tomboys respectively.” I actually laughed out loud when I read this. How in this minefield surrounding terminology do you get away with using the words “sissy” and “tomboy”?

Sissy is still used occasionally, especially if one wants to write for a more general audience. It’s not a technical word. But it’s a word that everybody understands perfectly well. It’s used carefully and in special contexts. I mean, what are you going to do? Nobody says you throw a ball like a cross-gender identified boy.

Do you think terminology is significant in perpetuating bigotry, or do you think a word is just a word used for the sake of precision?

I think that words used with the deliberate intent to be derogatory have an effect because the person who hears them doesn’t just hear a word, they hear a word plus a message from the speaker that I despise you. So if you call somebody a nigger, it’s different from calling someone African-American, because "nigger" means you’re African-American and I don’t like you.

Ok, so what do you see is the role of political correctness in all of this?

I’m certainly not in favor of saying things in a hurtful or mean way if there’s an equally precise way of saying the same thing that is not hurtful or mean. I’m not one of these guys who goes out of his way to be politically incorrect. But I don’t think we should promulgate untruths for the sake of political agendas, even if they are worthwhile political agendas.

So, in your point of view, science rules. Scientific inquiry is the first priority, whatever it might mean for social justice?

If you put it in abstract terms, it makes me sound vaguely lunatic.