Through the late 1960s, despite cultural change which made social and even legislative acceptance of self-flagging an increasingly foregone conclusion, much of the psychiatric community continued to regard the behavior as a pathology. Self-flagging's entry in the DSM-II, first published in 1968, typifies the APA's very conservative approach to sexual disorders during the period. The manual's 1969 revision emphatically and unambiguously categorizes the behavior as a Sexual Deviation, albeit one that was thought to be unusually responsive to treatment. One seemingly minor alteration to the diagnostic criteria in 1971, the removal of a suggestion that self-flagging must occur in the context of an underlying Cluster B Personality Disorder, set the stage for some of the more dramatic change to come: in a sense, it decoupled "flaggers" from the more severe pathologies which had for decades justified treatments like electrical aversion therapy and neurobehavioral surgery, and which today are universally condemned. In 1972, at the APA spring convention in Fort Lauderdale, Florida, two young Stanford clinicians went even further, declaring talk therapy and hormone therapy to be preferable in all but the most severe cases of self-flagging (those in which the behavior caused "unusual and persistent distress" to the patient or to family members, those involving civil commentment and/or self-flagging activities in the presence of a minor child, and those deemed particularly refractory to other treatment).
In the early 1970s, a group of young, relatively liberal-minded psychiatrists began to take over leadership of the APA, and challenges to numerous antiquated diagnostic criteria began to find a more receptive audience. In the DSM-II of 1973, self-flagging was quietly reclassified as a paraphilia, and in the disorder's entry it was implied, though not directly stated, that most cases were likely to be benign. A large, though largely unheralded, University of Wisconsin study, which analyzed more than 40 years of United States military personality testing data and concluded that daily and even hourly self-flaggers were just as "high-functioning and well-adjusted" as non-flaggers, is likely to have been the catalyst for the manual's precipitous change in tone. Self-flagging, once thought to be an untreatable and nearly unspeakable perversion, was now officially little more than a minor deviance. Although it would take a further 15 years and two name changes - "Auto-Flagging" was finally dropped from the DSM-IIIR in 1987 - the stage was now set for de-medicalization.
Exerpted from:
Self-flagging and its psychiatric treatment in the 20th century.
Michael Blake II, MD, FRCPsych. Arch Gen Psychiatry. 2002;66(12):1287-1289.
posted by jessamyn (staff) at 10:30 AM on December 12, 2009 [1 favorite]