Ever since the term "sexual fetish" was first used over a century ago, there's been a raging scientific debate over what it means. Why does one person get off on shoes, while another gets off on certain large body parts? Are these erotic feelings signs of illness, or simply preferences that are as inexplicable and harmless as liking spaghetti more than sausage?


Though sexual fetishism started out as a fairly neutral term over a century ago in early psychiatry, it's become one of the most contested ideas in medicine. Here's why.

The term "sexual fetish" was first used in the late nineteenth and early twentieth centuries by psychiatrists like Magnus Hirschfeld to describe — in a neutral fashion — the many ways that people experience sexual desire. Specifically, Hirschfeld and his contemporaries defined fetishism as the act of eroticizing any non-living object or body part. It wasn't a mental illness, but a description of a mental state. However, in a world where wanting even the most ordinary kinds of sex can be difficult and embarrassing, having a fetish could make people neurotic. As a result, psychiatrists like Richard von Krafft-Ebing, author of the influential 1886 book Psychopathia Sexualis, often associated sexual fetishism with mental illness.


Derangements of the Sexual Instinct

Most of the people writing about sexual fetishes before the 1930s were psychiatrists dealing with people who had come to them because they were uncomfortable with their lust for rubber aprons, bondage, fur, machines, and hundreds of other sexytime items that are listed exhaustively in books like Psychopathia Sexualis, Havelock Ellis' Studies in the Psychology of Sex, Wilhelm Stekel's The Sexual Aberrations, and many early essays of Sigmund Freud. Each of these researchers took a slightly different view on sexual fetishism, though Freud is perhaps most famous for his idea that neuroses can arise when people desire any deviation from heterosexual sex where the penis goes into the vagina and stays there for a reasonable amount of time.

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Given that many of their patients were no doubt neurotic, many doctors dealing with sexuality at that time were surprisingly supportive of a variety of sexual choices. Havelock Ellis, who wrote about homosexuality extensively, was in an open marriage with a lesbian and championed women's right to choose their own sexual paths.

Hirschfeld, who deals with fetishes in his book Derangements of the Sexual Instinct, was perhaps the world's first gay rights advocate. Through his Institute for Sexual Science in Berlin, he published a number of essays, and made public health films, about how homosexuality was a legitimate lifestyle and not a sickness. You can see excerpts from one of the movies he made, Different from the Others, here. The film depicts a romance between two men, and was made in 1919.


Even Wilhelm Stekel, credited with inventing the term paraphilia for "extreme" sexual fetishes, also noted in his work that there are many "normal" sexual fetishes — including bondage and domination — that are perfectly healthy and that are shared by many people without any detriment to society or themselves.

Though the Nazis destroyed Hirschfeld's Sexual Sciences Institute, and burned most of the books and art in its collection, the work he had begun was continued in America by researchers like Alfred Kinsey. A zoologist who studied wasps, he turned to studying human sexuality in the 1940s and published two books — dubbed the "Kinsey reports" — which were summations of thousands of interviews he and his research team conducted with Americans about their sex lives. Though Kinsey never advanced any theories about whether fetishes were normal or not, the fact that he presented the whole range of sexual interests (from Missionary position and homosexuality, to piss fetishes and bestiality) from a detached, non-judgmental perspective was fairly remarkable.


Given that so many of the scientists describing sexual fetishes did not consider them to be pathological, how did the term "sexual fetish" come to be so strongly associated with sickness and perversion?


The Paraphilia Controversy

Stekel's term "paraphilia" is still used in medicine today to diagnose any sexual activity that is "extreme" or deviates from the norm. The controversy here isn't so much about whether people with fetishes feel bad about themselves — obviously, some people are comfortable with getting off on balloon porn, while other people are weirded out by it and seek help. Instead, the issue is that some fetishes are defined by the medical community as paraphilias, with all the stigmas such a diagnosis entails — including committing people with paraphilias to mental health facilities.


To understand why this is controversial, simply consider the strange history of paraphilias in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a compendium of mental illnesses used by the psychiatric community in the United States to classify people's mental health. Sometimes, paraphilias are defined based on politics rather than objective research. For example, homosexuality was included in the DSM until 1974, as was "nymphomania," or female promiscuity, until 1987. Both "diagnoses" were found to be a reflection of cultural biases, and were removed from the DSM after protests from doctors and civil rights groups.

Today, the DSM is undergoing its fifth revision and the controversy over paraphilia definitions rages on. Some doctors are pushing to revive the nymphomania category under the new name "hypersexual disorder." Others want to continue blurring the line between fetish and paraphilia, by using terms like "fetishistic disorder" or "unspecified paraphilic disorder." According doctor and sex researcher Charles Moser, who has long argued against the idea of including fetishes and paraphilias in the DSM:

The DSM may be merely pathologizing practices that many psychiatrists find distasteful. However, patients may find their sexual behavior neither distasteful nor a source of distress or dysfunction.


In other words, whether something is a paraphilia may be in the eye of the beholder — and therefore it isn't a good category to include in a manual that's used for medical diagnoses.

Psychiatrists like Ray Blanchard, who currently serves as chair of the DSM Paraphilias Sub-Work Group, argue that medical professionals need to retain the idea of paraphilias because there are some "paraphilic disorders that cause real anguish to the individual or predispose the individual to violate the rights of other people or harm them in serious ways." The question is, what do you mean by "harm"? Does a consensual BDSM relationship count as a paraphilia if somebody gets a bruise?


Sometimes a Fetish is Just a Fetish

Today the scientific community remains divided on the questions of sexual fetishes and paraphilias. Some doctors, like Moser, believe that sexual fetishes are simply personal preferences — perhaps strange, but definitely harmless. Others want to lump a fetish for spanking or threesomes in with crimes like pedophilia or rape. As a result of expert testimony from such doctors, courts have removed children from the custody of parents who have a private interest in everything from bondage to polyamory. Whether your community defines your preferences as a harmless fetish or a harmful paraphilia can still alter the course of your life — and the lives of your family and friends, too.


Still, the early work of Hirschfeld and Kinsey has accomplished one thing, especially in the age of the internet. Sexual fetishes are, as Stekel said almost a century ago, "normal." Instead of medical tomes with pathologizing titles, today we have self-help books devoted to finding your kink, and enjoying your (safe, consensual) fetishes. You can shop for sex toys at boutiques, and learn about erotic role playing from famous bloggers.


In fact, some of us revel in trying to find (and cultivate) the most obscure possible fetishes just for our own lascivious amusement. For example, I've always loved mind control erotica. Why? Who knows, and who really cares? Tried to do it in real life a couple of times (consensually!), but that was a bit of a fail. Luckily, though, there are enough stories about mind control sex on the internet to fill the rest of my life with fetishistic glee. I'm sure you can think of a dozen other weirdly obscure fetishes off the top of your head, too.


What I'm trying to say is that there's a very important corollary to Internet Rule 34, which states that if you can think of something, somebody has already made porn out of it online. And that corollary is: When you have a sexual fetish, you are never really alone.

Images by, from top to bottom: Maksim Shmeljov via Shutterstock; Aptyp_koK via Shutterstock