In modern medicine and psychology, individuals are not typically diagnosed with a (mental) pathology or dysfunction unless they experience “marked distress or interpersonal difficulty” (DSM-IV-TR) (American Psychiatric Association, 2000, p. 539).[33] For example, the most common type of disorder that asexual people may be diagnosed with is hypoactive sexual desire disorder, which is characterized by a marked lack of desire for sex, accompanied by, as mentioned, distress or interpersonal difficulty.
Currently, we have only a modest amount of data on the mental health of asexual people, so definitive conclusions about distress or other psychological disturbance issues in this group await future research. However, the research to date does not suggest that asexual people, as a whole, are distressed by their lack of sexual interest. Psychologists Nicole Prause and Cynthia Graham, and Lori Brotto and colleagues, found no evidence that self-identified asexuals were distressed by their asexuality (Prause & Graham, 2007; Brotto, Knudson, Inskip, Rhodes, & Erskine, 2010). For example, one participant in the Prause and Graham (2007) study reported, “I’m not worried about it or I’m not concerned about it…. My life is interesting enough and it’s not really, um, a necessity” (p. 346).
Related research suggests that a high percentage of people (as many as 40 percent) in the United States report being very or extremely happy even if they have not had sex in the last year (Laumann, Gagnon, Michael, & Michaels, 1994). Of course, many of these people would not define themselves as asexuals or be defined as asexual using a common definition (i.e., enduring lack of sexual attraction). However, these results do indicate that a lack of sexuality, at least broadly defined, is not necessarily a reliable indicator of mental health or happiness. In addition, even if new research finds that some asexual people do have, on average, elevated rates of distress or other mental health issues, what would this actually mean? Well, let’s consider some related research on other sexual minorities.
Elevated distress and mental health issues have been found in some gays and lesbians (Meyer, 2003). Does this mean that being gay or lesbian is a disorder? No. There is, for example, other evidence that many gays and lesbians are also happy, content, and free from serious mental health issues (Busseri, Willoughby, Chalmers, & Bogaert, 2006; Diamond, 2003a). Moreover, from a modern medical or psychological perspective (e.g., in the DSM), homosexuality is not viewed as pathological. So, even if some gays and lesbians do have an elevated level of distress or other mental health issues, this fact should not be used to pathologize all gays and lesbians or homosexuality in general. Similarly, if future research shows that asexual people do have an elevated level of distress or other mental health issue, this fact should not be used to pathologize all asexuals or asexuality in general.
Another important issue to consider is the source of the distress. Should we pathologize someone for feeling distressed because they do not fit in with the larger group or because the majority of people do not like them? Or, alternatively, should we pathologize the society itself for not tolerating minorities and diversity? In sum, there are several arguments against using distress (e.g., lack of evidence of increased distress, questions about the source of any distress that does exist) as a basis for pathologizing asexuality.
The second criterion often used to diagnose a mental disorder is interpersonal difficulty. Thus, should we consider asexual people disordered because they lack an important interpersonal dimension—sexuality? Again, not necessarily. Interpersonal relations do not only include sex. There are many aspects of social relations beyond sexuality, in which asexual people may function normally; that is, similarly to the majority of other people. Indeed, a sexual dysfunction is only diagnosed in modern medicine and psychology (e.g., in the DSM) if it has an effect on interpersonal relations beyond the specific sexual domain that is of issue. So, for asexual people, a lack of sexual interest is not per se a criterion for having a disorder, unless it causes other interpersonal issues. And, of course, celibates (e.g., nuns), by choice, never have sex with others and are not considered to have a pathology by modern medicine and psychology. Similarly, it does not make sense to pathologize asexual people, who by their natures lack sexual interest and attraction, for not engaging in sex with others.
But how about other (nonsexual) aspects of interpersonal relations—do asexual people have a broad level of interpersonal impairment beyond sexuality?[34] There is evidence that some asexual people may have an elevated level of atypical interpersonal functioning, such as increased social withdrawal (Brotto et al., 2010), but even if additional research bears this out, this, again, does not necessarily mean that we should pathologize all asexual people or asexuality in general.
An additional consideration is this: If an atypical biological process or physical health condition underlies asexuality, does this mean that asexuality is a disorder? For example, there is some evidence that health issues and atypical prenatal development may underlie the development of asexuality in some people (Bogaert, 2004). This research is important when we consider the origins of asexuality (see chapter 13), but, for two reasons, it should not guide our thinking on whether asexuality is a disorder. First, it is unlikely that physical health issues and atypical prenatal development underlie all instances of asexuality (Bogaert, 2004). Thus, even if many asexual people do have health issues (and/or atypical prenatal development), we cannot use this evidence to conclude that all asexual people are disordered or that asexuality per se is pathological. Second, using atypical sexual development as an indicator of a current mental health problem is a dubious approach. If so, we should also pathologize gays and lesbians as having a (current) mental disorder, as atypical prenatal development probably underlies, at least to some degree, the development of same-sex attraction (LeVay, 2010). If so, perhaps we should diagnose individuals with great musical talent as having a disorder, for atypical prenatal development (e.g., exposure to high prenatal hormones) may predispose one to having this talent (Manning, 2002). It is important, then, not to confuse the cause of a human psychological variation with a determination of whether that variation is currently construable as a mental illness.
It is also notable that the historical record does not show consistent evidence of asexuality as pathology; indeed, the opposite may be the case. For example, a lack of sexuality has been not seen as a disorder throughout the much of the history of Western medicine (Sigusch, 1998). Even today, some religions and cultures would not pathologize an absence of sexuality; instead, a lack of sexuality (or at least abstinence) is often considered a virtue. Thus, an absence of sexuality has not been considered a disorder consistently across time or across current cultural contexts.
Another issue relates to stigmatization. When we label someone as having a disorder, we often stigmatize them, and stigmatization itself can be a source of distress and mental health concerns. After all, who would not be stressed by being labeled “disordered”? The impact of stigmatization has been raised in the context of other sexual minorities (e.g., gays and lesbians) (Meyer, 2003). In short, why go down the road of labeling something as a disorder when there is evidence that it is not a disorder, and when we know that such labels themselves have negative consequences?
33
Note that the most important reference/source for understanding and diagnosing mental disorders in North America is the
34
This is assuming, of course, that we can agree on the definition of an interpersonal impairment.