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According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), fetishism may be diagnosed as paraphilia. The term “paraphilia” (from Greek “beside love”) is used in medicine to describe sexual arousal, gratification and behavior towards people, objects or situations which are not classified as normal sexual stimulators. Accordingly, there must be an official, legal or ideological norm to make the object of sexual arousal abnormal, alternatice, atypical or extreme. However, such a norm is not easy to be established and it is defined differently in different cultures. The current version of DSM (DSM-IV-TR) prevents the diagnosis of paraphilia until there is a distress to the patient or harm to the people around him or her. In DSM-IV (1994) fetishism is included into the category of “Sexual and gender identity disorders”. Being one of the eight sexual disorders, fetishism is described as “recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving nonhuman objects, that occur over a period of 6 months, which cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (American Psychiatric Association [APA], 2000).
The use of inanimate objects for gaining sexual excitement has not been paid significant attention until the end of the nineteenth century. Until that there were only religious as well as legal constructs of sodomy and perversion. As a mental disorder it was first approached by French psychologist Alfred Binet (1857-1911) who introduced the terms “sexual fetishism” and “erotic fetish” (the object or situation of unhealthy sexual arousal). In the French the word fétiche was borrowed from the Portuguese standing for “spell”, which in turn derived from the Latin words “artificial” and “to make”. In primitive and pagan societies a fetish was a natural or man-made object believed to have been provided with supernatural powers. In this way, Binet transferred the term to sexual life and, moreover, offered classification of fetishes. The first category, “spiritual love” referred to social interactions, attitudes, occupational roles and so on. The second one, “plastic love” included tangible objects (garments, animals, body parts, textures etc.). In 1920 the German sexologist Magnus Hirschfeld (1868 – 1935) introduced the theory of partial attractiveness. He underlined that every person had a healthy kind of fetishism while being involved by certain interests. The next essential contribution to the investigation of erotic fetishism was made by the Austrian neurologist and logotherapist Viktor Frankl (1905 – 1997). Being the follower of existential approach to mental disorders, he paid specific attention to complex personal meanings of fetishes (Frankl, 2004, p. 318). In 1951 the theory of transitional objects and phenomena was presented by the English psychoanalyst Donald Winnicott (1896 – 1971). According to this theory, all the sources of manifold adult behavior can be found in childish habits. Winnicott explained that an infant develops an illusion that his mother is an immediate provider of satisfaction whatever the need, but later has to discover that it is not so and frustrating realization is compensated by gratification sought in objects around (a teddy bear, a piece of cloth or other).
Currently, there is still no ultimate theory on why people become disposed to sexual fetishes. Most of the theories proposed through the twentieth century are still working. On the other hand, they are repeatedly criticized and substituted by new ones, and the debate is continuous. Behaviorism, for example, derives from classical conditioning. It is believed that fetishism may develop after “sexual stimulus and the fetish object are presented simultaneously causing them to be connected in the learning process” (Laws & O’Donohue, 1997, 230). Meanwhile, super stimulus theory explains the disorder through the phenomenon of generalization and preparedness theory states that fetishism could be useful for survival at some stage of the evolutionary process (Koksal et al., 2004, p. 1424). Neurologists, in their turn, suppose that some neuronal cross-links appear between neighboring regions in the human brain and these links result in unhealthy sensory and sexual responses.
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One of the latest approaches has appeared within psychodynamics. It links erotic fetishism with emotional problems, lack of parental love and premature suppression of sexuality. One of the explanations is that a child rejected by parents projects his affection to inanimate objects and learns to substitute a real person with a fetish due to the mechanism of displacement (Comer, 2010, p. 275).
Treatment of sexual fetishism is complicated first of all because it needs to be diagnosed properly. DSM-IV stresses that sexual fetishism is determined as a mental disorder only if it is disturbing for the person and affects his or her private or social life. The diagnostic criteria are found in the International Classification of Diseases code. According to these criteria, fetishism is to be treated when atypical sexual affections, fantasies or behavior provoked by nonliving objects not specifically designed for sexual stimulation last for at least half a year, hurt the person and interfere with his or her job, social contacts and so on (Shiah et al., 2006, p. 241).
Today there are three officially adopted treatments of erotic fetishism. The first one is based on the cognitive behavior therapy. Cognitive behavior therapy does not analyze the way fetishism has been imprinted and why it developed. Instead, it concentrates on the empirical study of the situations which caused the patient’s distress and investigates the associations between distress and interventions. It is believed that a person becomes a victim of automatic thinking about the object, so the task of the therapist is to prevent the patient from automatic thinking. When the patient is aware of his problem, he learns to control his irrational links and build new associations. Identifying with a disliked fetish is realized as irrational and self-judgments are worked out.
The second strategy is psychoanalysis and the third is behavior supervision. Psychoanalysis goes deeper into the childhood memories of the patient and tries to find a key to the problem there. If the reason is found, it is a half of solution. There is also a controversial therapeutic technique, aversive conditioning. It is based on provoking displeasing stimulus for the fetish. The thoughts of the patient are interrupted and due to irritation, the patient tries not to think about the dangerous object.
Apart from that, there are some medications which can assist in treating sexual fetishism. These are pharmaceutical drugs inhibiting the production of sex steroids (testosterone and estrogen mainly). Medications become necessary when fetishism develops into obsessive-compulsive disorder or is only one of the symptoms of it. In this case, psychiatric drugs (serotonin reuptake inhibitors and dopamine blockers) are prescribed. One more alternative medication is topiramate, but its effectiveness is still understudied (Shiah, 2006, p. 243). Whatever the choice, it is recommended not to have sexual intercourse during the treatment at all.
As there are different hypotheses concerning the causes of sexual fetishism, it is rather difficult to outline all the preventive measures one may take not to become the victim of this disorder. Most of the theories go back to the patient’s childhood to find reasons and premises there, but it is impossible for a person to come back to the past and change something in it. Still, if parents are eager to prevent their child from paraphilia, they need to be at least caring and loving parents. For an adult the best way to prevent the sexual arousal to material objects is to have healthy sexual relationships with a reliable partner. It is important to be honest with oneself, because the things denied by consciousness are placed into subconsciousness and become much more difficult to control. While almost any thing (clothing or footwear, soft or shining materials, music instruments or food) may turn into fetish, it would be useless to prevent a person from using any of them.
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On the other hand, if sexual fetish is approached as a neurological problem, brain symptoms can be hardly prevented. There is still a lot of unknown about brain functions, and some of scientific myths are challenging. In addition, there is a genetic factor widely discussed. Genetic disposition is a physical factor hard to control as well. What a conscious person can do to protect his or her brain from negative affects is to have a healthy way of life, going in for safe sports, eating healthy food and, again, having healthy sexual relationships.
Cross-Cultural Understanding of the Problem
For primitive societies, it is still normal to believe that inanimate objects may have some power over a human being. They see the source of the link between this power and the object in the outside world, whereas for the civilized world it is obvious that the source is inside a human being. Fetishism has been widely recognized as an illness which can be treated, but at the same time the question is still open.
There are numerous claims that DSM and other international codes interpret unusual sexual interests with pejorative comments. By contrast, the sexologist from New Zealand John Money (1921 – 2006) has offered a more tolerant definition of paraphelia describing it as a “sexuoerotic embellishment of, or alternative to the official, ideological norm” (Laws & O’Donohue, 1997, p. 137). It is significant to underline that paraphilias are not viewed as disorders universally. Some groups in Europe and the United States seeking wider understanding and acceptance of sexual diversity demand unusual sexual interests and practices to be protected at legal and medical levels. Some of the specialists (including physician Charles Allen Moser and psychiatrist Glen Gabbard) insist that the diagnoses associated with paraphilia should be excluded from diagnostic manuals. “Diagnostic and Statistical Manual of Mental Disorders (DSM) system of classification makes unjustified categorical distinctions between disorders, and between normal and abnormal,” Moser & Kleinplatz (2005, p. 99) argue.
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It becomes obvious that there is essential scientific and political controversy regarding sexual fetishism in context of other sex-related diagnoses. Nevertheless, the excitement is apparently exaggerated because sexual fetishism is diagnosed and treated only when there is significant psychosocial distress for the person who suffers from detrimental effects of the fetish on different areas of his or her life and, consequently, the person him or herself is willing to get rid of obsession.
From a spiritual point of view, an inanimate object having power over a person is generally associated with witchcraft. It is strictly condemned by the Bible. In Deuteronomy 18:9 (New Jerusalem Bible) it is noted that anyone who deals with spells are an abomination to the Lord. Furthermore, in Isaiah 47:9-14 it is passionately stated that the one who believes in magic, exercises enchantments or turns to astrologers for advice will be cruelly punished and nothing will defend them. From that point of view, fetishes are evil because they are not real, but have power of deception. However, this deception is hidden not in the thing, but in the person’s mind. Hence, sexual fetishism is a sin because one willingly plays along with the deception of his or her own mind. What is more, a fetish becomes an object of lust, and following such desires is a wrong way as well. Self-focus is not justified by Christianity. It is written: “Therefore, since Christ suffered for us in the flesh, arm yourselves also with the same mind, for he who has suffered in the flesh has ceased from sin, that he no longer should live the rest of his time in the flesh for the lusts of men, but for the will of God” (I Peter 1:1-3). Only healthy sexual relationships within marriage are justified by the Bible. Otherwise, it is necessary to care about others and distract from personal sinful desires. “It is a sin rooted in the pursuit of selfish pleasure where you falsely gave power to your fetish over your sexual behavior” Wise (2002, p. 13) resumes. It is added that physical response to an object is linked with sexual pleasure because of repeated dwelling. An ingrained habit turns into pattern, but it can be broken by a new pattern of behavior. While not all the medical strategies are accepted by Christianity, the establishment and reinforcement of a new pattern is the responsibility of the fetishist who may be assisted by his or her mentor.
Sexual fetishism is widely recognized as a type of paraphilia. However, it is diagnosed as a mental disorder only when there is significant disturbance for the patient or the people around. The causes of sexual fetishism are still debated, and each theory offers its own strategy to solve the problem. Usually this or that type of psychological therapy is prescribed, but sometimes they are supported with medications, inhibiting the production of sex steroids. Sexual fetishism is regarded as sinful activity in Christianity, but the advocated of social diversity tend to fight for the abolishment of medical stigma in diagnostic manuals.