On June 18, 2024, a discussion panel titled “Sex and Gender – One or Two Realities, Harmony or Potential Conflict with Oneself?”, was held at the Belgrade Youth Centre, organised by the Section for Dialogue in the Public Sphere of the Missionary Department of the Archdiocese of Belgrade and Karlovci. The event attracted a lot of public attention, and was very well attended. Unfortunately, due to the complexity and scope of the topic and the limited time for discussion, many important issues were not addressed, or were not sufficiently clarified. To address these issues and further clarify the problems related to this important and complex topic, we have asked the Coordinator of the Section for Dialogue in the Public Sphere of the Archbishopric’s Missionary Department, Deacon Dr. Aleksandar Milojkov, who has been dealing with this subject matter for some time, to provide additional explanations of some of its vital aspects, through a series of texts in our blog section.
The second text by Dr. Aleksandar Milojkov on this topic follows below:
While translating a beautiful sermon by Saint Augustine, in which he discusses love, by interpreting Christ’s “two greatest commandments” (Mark 12:28-31), I came across a phrase that initially seemed like a contradiction in terms. Namely, while expounding that the Holy Bible teaches perfect love, he claims that -amores hominum perversi – the perverse human loves, also exist. On the other hand, Saint Augustine also speaks of licitus amor – the permissible, legitimate, or legal love. The first expression seemed to me to be a contradiction in terms because love, by its very nature, cannot be perverse. Love cannot be described as “perverse” because, in doing so, it ceases to be love. On the other hand, the second phrase – licitus amor – sounded rather juridically harsh to me, as the adjectives “permissible”, “legitimate”, or “legal” seem incompatible with the idea of love. In effect, while the first definition seemed to be a contradiction in terms, the second one sounded like a pleonasm – since love inherently implies legitimacy and legality, such adjectives seem completely unnecessary.
However, a lightbulb went off when I connected these seemingly odd phrases from Augustine with the topic I am writing about – with gender ideology and, more broadly, LGBTQ+ ideology and the influence of these ideologies on science, particularly medicine. The following question, through which I want to demonstrate how things are changing in medicine, with a justified suspicion that these changes are the result of activist pressures from various LGBTQ+ organisations and movements, concerns the status of paraphilia in medical treatment. Here is an expression which could be used to translate Augustine’s seemingly odd phrase amores perversi (perverse loves), namely, the paraphilias. This Greek-coined term has a meaning similar to Augustine’s phrase. Philia means love in Greek, while the prefix para in this context signifies “deviation from” (the healthy and normal) – so paraphilia could be translated as Augustine’s “perverse love”. In the end, I concluded that Augustine’s phrase “perverse love” is not a contradiction in terms, but rather an oxymoron, in the best sense of the word. It is a “wise folly” (an oxymoron), because it accurately expresses the perversion of something that aspiries to be called love. Precisely because of these perversions and the fact that today almost anything can be considered “love,” it is necessary to speak about licitus amor as well -that which alone legitimately bears the name of love.
Now, let us continue with the analysis of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association and the International Classification of Diseases (ICD) of the World Health Organisation (WHO) in order to better understand the influence of the gender, queer, and what we might call “sexual revolution” ideologies. This text will discuss sexual behavior disorders, specifically paraphilias.
We will once again compare the two most recent revisions both of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4 and DSM-5) and that of the International Classification of Diseases (ICD-10 and ICD-11). In both versions of these documents, the lists of paraphilic disorders, or sexual preference and behaviour disorders, are provided. These disorders remain classified as mental disorders in both documents and their revisions. However, it is evident that some things are nevertheless changing in this area. Let us first look at the list of diagnoses for sexual behavior disorders. In DSM-4 (revised in 1990), we find the following diagnoses of paraphilic disorders.
Exhibitionism (302.4)
Fetishism (302.81)
Frotteurism (302.89)
Pedophilia (302.2)
Sexual Masochism (302.83)
Sexual Sadism (302.84)
Transvestic Fetishism (302.3)
Voyeurism (302.82)
Other paraphilias, not included in the above categories (302.9)
All these categorised paraphilic disorders remain in DSM-5 as well (revised in 2013), with an additional code (302.9), for the Unspecified Paraphilic Disorder. The DSM-4 provides examples of such paraphilias: telephone scatologia, necrophilia, partialism, zoophilia, coprophilia, klismaphilia, and urophilia. The same explanation of this diagnosis is given in DSM-5. When looking at the list of paraphilic disorders in DSM-4 and DSM-5, there are almost no changes. What then has changed? Something critically important. Specifically, the diagnostic criteria that must be met for a diagnosis of a particular paraphilic disorder have changed. If one pays close attention, it is clear that a quiet depathologisation of the paraphilic disorders themselves has been carried out. Many of the above-mentioned sexual perversions (paraphilias) in DSM-5 are no longer considered disorders in and of themselves, but only if there is a lack of consent from “the other party.” This is not only unacceptable from the standpoint of Christian anthropology, but is also inherently nonsensical and illogical. The DSM-5 in this respect seems rather like the criminal code which prohibits (i.e. pathologises) the act of coercion (the criminal offence of rape). I do not wish to delve into the medical criteria that define the concept of disorder; I leave that to the medical profession – but they certainly owe us an explanation of how sadistic and masochistic sexual behavior, the compulsion to torture and humiliate, is no longer an evident psychological problem, in and of itself. For Christian anthropology, the presence of such and similar compulsions is – to use the Christian terminology – a failure, a perversion, or, as we most often say, a sin. And it is a sin, regardless of the supposed “consent” of “both parties.” The psychiatric profession, in the aforementioned document, is indeed dictating a particular value system, or it is itself being dictated by these value principles. But more on that in the conclusion.
Now let us examine the situation in the two mentioned versions of the International Classification of Diseases (ICD) of the World Health Organisation. In ICD-10 (revised in 1990), under code F-65, which denotes the Disorders of Sexual Preference, (it is important to note that this is a list of mental disorders) we find the following disorders:
Fetishism (F65.0)
Fetishistic Transvestism (F65.1)
Exhibitionism (F65.2)
Voyeurism (F65.3)
Pedophilia (F65.4)
Sadomasochism (F65.5)
Multiple disorders of sexual preference (F65.6)
Other disorders of sexual preference (F65.8)
Disorder of sexual preference, unspecified (F65.9)
We see that ICD-10 primarily lists the same sexual preference disorders as DSM-4 and DSM-5. What is very important to note when comparing DSM (both revisions) and ICD-10 is that DSM-4, and subsequently DSM-5, do not consider the existence of paraphilic tendencies, which are not acted upon and do not cause distress to the individual, to be a disorder, but only an inclination. Therefore, the inclination itself is not considered a disorder according to DSM. On the other hand, ICD-10 treats paraphilic tendencies as disorders, as indicated by the title of the list itself – (in Latin), they are called Disordines inclinationis sexualis, or Disorders of Sexual Preference. In this sense, ICD-10 is much stricter in its diagnostic definition of paraphilias compared to both versions of DSM. It should also be noted that even a pedophilic sexual inclination in DSM, if the person has never acted on it and does not experience any distress related to this inclination, is not considered a disorder. According to ICD-10, it certainly is, and pedophilia is specifically described as “a sexual inclination for children, boys, or girls, usually of prepubescent or early pubescent age.”
However, in ICD-11 (revised in 2019), significant changes have been made to the list of sexual preference disorders. Not only have the ideas adopted in DSM been embraced, but ICD-11 also seems to have gone a step further. Firstly, the list of sexual disorders in ICD-11 is noticeably shorter:
Exhibitionism (6D32)
Voyeurism (6D31)
Pedophilia (6D32)
Compulsive Sexual Sadism (6D33)
Frotteurism (6D34)
Other Paraphilic Disorder Involving Non-Consenting Persons (6D35)
Paraphilic Disorders Involving Consenting Individuals (6D36)
Unspecified Paraphilic Disorders (6D3Z)
Furthermore, what is new in ICD-11 is the cessation of diagnosing the paraphilic inclination itself as a disorder. A disorder can only be diagnosed if the paraphilic person experiences significant distress and/or if the other person does not consent to the paraphilic relationship. Thus, what we saw in DSM-5 has been clearly implemented here, namely, the depathologisation of the paraphilic inclination as such.
Another thing to mention regarding the ICD-11 is that in the previous revision, in ICD-10, among the Psychological and Behavioural Disorders Associated with Sexual Development and Orientation (F.66), there was also the Egodystonic Sexual Orientation (F66.1). Its description was as follows: “Without doubting their sexual identity (homosexual, heterosexual, bisexual, or prepubescent) or sexual preference, the individual wishes to be different due to the existing psychological or behavioural disorders, and may even seek treatment to change it.” To clarify further, a person, for example, may have a homosexual orientation, but does not want to accept it, feeling great distress because of it, and a desire to change it (in Christian terms – feeling repentance and a desire for ascetic struggle against sin). The diagnosis did not pathologise the sexual orientation itself (homosexuality was already depathologised in DSM-3 in 1973 and in ICD-10 in 1990), but rather the distress it causes the person with that sexual orientation. However, this diagnosis has been removed from ICD-11. Sexual orientation can no longer be associated with pathology, even when it is egodystonic!? The question for the psychiatric profession is – how will the individuals with a clearly egodystonic sexual orientation be treated from now on? Will paraphilic disorders, given that distress in paraphilic individuals has become one of the main diagnostic criteria, be similarly removed as the diagnosis F66.1 has been, in some future revision of the ICD? Is the introduction of the criterion of “consent” from the sexual partner in the diagnostic criteria for paraphilias a step towards the possible future depathologisation (read: normalisation) of pedophilia? Given that in many so-called “Western democracies,” the “arguments” are increasingly being heard that children have the right to determine their gender, and that some proponents of gender ideology even encourage the use of puberty blockers in such cases, we should not be fooled by the force of the currently prevailing argument that pedophilia is viewed as the same offence today as it has always been. Thus, the current argument that children do not possess sufficient psychosomatic maturity in order to “freely consent” to a relationship with an adult could burst like a soap bubble in the face of the pseudo-liberal ideological avalanche in the field of medicine. Some may argue that it is not medicine that determines what is normal and what is not, in a sociological and ethical context, and that the medical concept of depathologisation is not the same as the ethical concept of normalcy. This is, of course, true. However, it is more than evident that the activism of gender ideology, as well as the activism of the proponents of the so-called sexual freedoms, certainly equates these two concepts. Specifically, this activism always starts with the demand for depathologisation, which actually serves as the foundation for the societal normalisation of something that definitely used to be a medical pathology and a social and ethical anomaly. We are witnessing a phenomenon whereby the official depathologisation of certain conditions or behaviours, precludes them from being publicly labelled a perversion and an anomaly ever again. All existing normative worldviews have been suspended, including the Christian Orthodox one, and speaking out against such perversions and anomalies is labelled as hate speech and discrimination. Therefore, it is not the job of Orthodox Christian theology and anthropology to interfere in the field of medicine and the methodology of medical sciences. However, it is indeed our duty to act as a bulwark against the instrumentalisation of medicine which serves to support ideologies that directly contradict both the Christian ethos (and one could argue elementary common sense as well) and the Christian understanding of our humanness. As we have seen in this text, the field of medicine, particularly psychiatry has, by transforming a sociological construct of “gender” into a medical one, and elevating it above the concept of “sex”, indeed become an instrument of ideological LGBTQ+ activism through the depathologisation of gender identity disorders, and the quiet depathologisation of sexual perversions (paraphilias).
After the expert analysis presented in this and the previous text, the final one will offer a detailed examination of the same issue from the standpoint of Christian anthropology.
Deacon Dr. Aleksandar Milojkov
