A paraphilia is not, by definition, a pathology. Rather, it becomes pathological when it becomes too severe, too insistent, and too noxious to the partner, or to the self. In mild form, paraphiliac imagery and the behavior it engenders may be simply a part of love play. For example, a playful degree of biting, slapping, or pinching qualifies as sadistic but is harmless when the play is between consenting partners.
In medicine generally, and in sexology in particular, there are many occasions when one is confronted with the issue of how to establish criteria of pathology. When, for example, does an elevation in temperature become a fever? Or a shortness of stature, dwarfism? Or an insufficiency of food, malnutrition? The criterion point adopted in answer to such questions may have great practical significance. In Peking, for example, Westerners in the diplomatic corps recently may have been denied a Chinese driving license because their blood pressure, judged normal at home, would be elevated according to the norms of the Chinese who have a lower average blood pressure.
There is always something arbitrary about the choice of a criterion of normalcy. It is arbitrary even to choose the statistical norm—it may be normal to be infested with hookworm or schistosomiasis in certain locales, but it is not healthy. The criterion of health versus pathology involves a chain of logical reasoning that sooner or later brings one into direct confrontation with a value judgment. The personal criterion of pathology may be too much pain, suffering, and loss of the feeling of well-being. The social criterion may be too much harm to, or threat of endangering the health or well-being of others. The well-being of others may be covertly or implicitly defined as their political, legal, moral, spiritual, or religious well-being.
In matters of sexual health, as in behavioral health in general, social criteria have traditionally dominated personal ones. They have been powerfully religious and legalistic, but politically and ethnically arbitrary. This arbitrariness is presently under fire, and to some extent there is today a social re-examination of criteria and standards. In their 1974 referendum, for example, the membership of the American Psychiatric Association confirmed the action of their committee on nomenclature in changing the status of homosexuality from disease to non-disease.
The mood of society today is toward the greater tolerance of the principle of live and let live sexually, provided both partners are consenting adults or, if young, of like age. There is no fixed dividing line between the tolerable and the intolerable, socially, and no criterion for establishing one. A workable criterion, which is both expedient and pragmatic, is the criterion of mutual consent between erotic partners, up to the point of noxious injury to health and well-being. This criterion rules out lust murder, rape, abusive sadism, a masochist’s self-arranged torture and death by homicide, enforced amputation of the partner by an amputee fetishist, enforced celibacy or erotic deprivation of the partner by a transsexual, and the like. Other forms of erotic expression, subject to the proviso of mutual consent, are not ruled out. Any individual whose form of erotic expression engenders too great a loss of well-being is, however, eligible for whatever therapy sexological medicine may be able to offer.
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