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Docter: Let me summarize what I think is your problem. You have been very depressed and upset since you lost your job. We call that Adjustment Disorder with Depressed Mood.

Patient: I certainly agree with that.

Doctor: In addition, you have told me that ever since you were adolescent, the only way you can be sexually aroused is by women’s shoes. We call that Fetishism.

Patient: Wait a minute. That doesn’t bother me

Doctor: Well, as a matter of fact, whether you are bothered by it or niot, according to the new diagnostic and statistical manual of the American Psychiatric Association, DSM-III, you have a mental disorder.

Patient: Wait a minute! I have done some reading on this area and I find it very confusing. Why us my preference for women’s shoes a mental disorder?

Doctor: You must admit that your behaviour is extremely atypical. Hardly anyone needs women’s shoes to be turned on.

Patient: Certainly you are not using a statistical concept of normality; otherwise you would have to classify genius as pathology.

Doctor: You have a point there. However, from the evolutionary point of view, if all individuals had your condition, the human race would die out.

Patient: But I have understand that your APA has decided that homosexuality itself is not a mental disorder, so certainly you can not use that argument. And if everyone were psychiatrist, we would also be in big trouble.

Doctor: Well, maybe it comes down to our view that certain critical life experiences and inner conflicts explain your behaviour.

Patient: I am sure that is correct, but I understand that all behaviour, including your sexual preferences, whatever they are, are also determined by your life experiences and the way you have resolved your inner conflicts. I am beginning to think that there is something about my preferences itself that your profession doesn’t care for.

Doctor: Well, I think you may have hit on something there. We do believe that optimal sexual functioning involves two human beings (at least) and not exclusively or preferential inanimate objects.

Patient: Why do you believe that?

Doctor: I guess we believe that if you are unable to be sexually aroused by antoher human being you are at a disadvantage.

Patient: Why is it a disadvantage? Shoes are easy to get.

Doctor: I guess that deep in our bones we must believe that sex is more fulfilling between human beings.

Patient: That doesn’t sound like a scientific fact but only your value judgement.

Uit: Spitzer, R. L. (1981) ‘The Diagnostic Status of Homosexuality in DSM-III: A Reformulation of the Issue, American Journal of Psychiatry, Vol. 138:2, pag. 214

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