BDSM is a 6-for-4 deal of an acronym: Bondage, Discipline, Dominance, Submission, Sadism and Masochism. It’s sometimes referred to as S&M, B&D, leather, or fetish. As an S&M writer and educator, I get lots of questions about the psychology of S&M. People ask whether it’s a disorder, how psychologists would describe it, etc. I’m an advocate, not a psychologist, but I’ve read up on the history and done my best to keep tabs on current research.

First things first: S&M is not a pathology, and people who practice S&M are not “damaged” in some way. There aren’t many S&M studies, but in 2008, this conclusion was supported by a large and well-designed survey that reached 20,000 people. The survey was done by public health researchers at the University of New South Wales in Australia, and it found that S&Mers “were no more likely [than non-S&Mers] to have been coerced into sexual activity and were not significantly more likely to be unhappy or anxious.” Another recent study found that consensual S&M usually increases intimacy for a couple.

I’d like to note briefly that people have told me about using consensual, intimate, trusting S&M activities in order to work through previous non-consensual, abusive experiences that they’d had. There’s nothing wrong with that. Indeed, the psychologist Peggy Kleinplatz once published a scholarly article called “Learning From Extraordinary Lovers: Lessons From The Edge,” which discusses how therapists can help their clients by studying alternative sexualities. Kleinplatz included a case study of a couple whose S&M experiences helped them process and deal with past abuse.

Still, as the 2008 Australia survey shows us, most people don’t practice S&M because they’ve been abused or because they’re unhappy. People who practice S&M have the same record of unhappiness and abusive history as non-S&M people. Yet S&M was first described as a disorder in 1886, when a doctor named Richard Krafft-Ebing published the manual Psychopathia Sexualis. This landmark tome hauled many sexual practices into the light, then attempted to categorize them. Of course, the doctor’s ideas hewed close to contemporary mainstream ideas of what was acceptable, and so he thought that basically everything was a disorder — including, for example, homosexuality.

It’s interesting to imagine what our mental health paradigm might be if Psychopathia Sexualis had never existed. It had a huge influence on psychiatry. Later, the psychiatric establishment began publishing a text called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM doesn’t specialize in sexuality, but it includes quite a lot of it. The first edition of the DSM came out in 1952; it’s currently undergoing its fifth revision, and the proposed new language can be found at the DSM-5 website.

Like Psychopathia Sexualis, the original DSM called homosexuality a disorder. This changed in 1973, partly in response to gay activists. But subsequent versions of the DSM are still criticized for many reasons. Our cultural diagnoses of mental illness are shaped by lots of people with very different motives, and truth is hard to find. A 2010 New Yorker article by Louis Menand outlined many critiques of the DSM, such as the allegation that today’s psychiatry “is creating ever more expansive criteria for mental illness that end up labelling as sick people who are just different.” Naturally, the medical establishment has an incentive to do this, since it makes money selling treatments for illness, and more illness means more treatment.

S&M is currently in the DSM (heh, you see what I did there?). My understanding, however, is that S&M occupies a strange space within the much-edited manual. S&M is no longer listed as all-disorder-all-the-time, though it once was. But if a person has an urge towards S&M, and that person feels unhappy about it, then it is classified as a disorder. In other words, an S&Mer is labeled “healthy” if she’s happy about S&M, and “unhealthy” if she’s unhappy about it.

Actually, this is basically the spot that homosexuality occupied for a while. And the reason homosexuality was taken out is the same reason S&M should be taken out: because a person who wants a completely consensual type of sexuality, and who is unhappy about it, is probably better off working to change the unhappiness rather than the sexuality. Like homosexuality, S&M is stigmatized and misunderstood. A person who is stigmatized and misunderstood is likely to be unhappy, but that doesn’t mean there’s something wrong with her.

Within the S&M community, we have ways of working around this problem. Some people are campaigning to change the DSM directly. Others are more indirect. Years ago, the activist Race Bannon made a handwritten list of doctors and lawyers who were S&M-friendly, and began passing it around to his friends. Names were quickly added to Bannon’s list, and when the Internet became popular, the list migrated online. Now, the Kink Aware Professionals list is enormous and includes profession categories from accounting to web design — not just doctors. When I was going through my own complicated and difficult S&M coming-out process, I was lucky enough to find the list. My S&M-friendly therapist talked me through my anxiety and socially-created disgust, rather than diagnosing me with a spurious “disorder.”

There’s a great organization called the Community-Academic Consortium of Research on Alternative Sexualities; one of their projects is an annual conference to sensitize psychologists and therapists to the needs of alternative sexuality communities. The next conference will be Thursday, May 24th, and this year it’s in Chicago. Also in my home city of Chicago, there’s a project based at DePaul University that seeks to change the representation of S&M in human sexuality textbooks. The Kink Representation Outreach Project involves talking to different S&Mers about their actual experience (what an idea!) and getting their recommendations about how these texts might better represent S&M. And finally, if you want some idea of the sparse and scattershot research that’s been done on S&M, the blog Kink Research Overviews is a good place to start.

Within the S&M community, there’s some talk of S&M as its own “sexual orientation.” I have mixed feelings about this, and I’ve written about those mixed feelings. I think it can sometimes be helpful, but I’d rather move to a paradigm where we encourage people to see any consensual sexual act as awesome, rather than talking like “orientation” is what legitimizes sexuality. Nothing legitimizes sex except consent.

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The image at the top of this post shows an old-school phrenology diagram from the 1800s. (Phrenology was a ridiculous pseudo-science that was nevertheless popular, back in the day.) I found the image at the BibliOdyssey blog, which showcases eclectic historic science and art prints.

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