By Kenneth Paul Rosenberg, MD
I am neither a film critic, nor a sociologist, but to me, “Fifty Shades of Grey” is neither groundbreaking cinema, nor does it herald a new cultural shift in sexual mores. It is, nonetheless, a fascinating narrative for any student of psychology, let alone for a psychiatrist with a specialty in treating sexual disorders. Hence, when asked to write about the movie, it was my pleasure to offer a few thoughts.
“Fifty Shades” is the story of Christian Grey and college-aged Anastasia Steele, whom he sweeps off her feet and into his den of bondage, whipping and domination. Christian is a concert-level classical pianist and helicopter and glider pilot. He is ridiculously handsome, under 30 and a billionaire. His Achilles’ heel is that he is the unfortunate victim of childhood physical and sexual abuse at the hands of older women, and, as a consequence, can only connect by inflicting sexual pain on the beautiful virgin, Anastasia.
For all his power and sadism, Christian is also partly a victim himself. He teaches us about the lingering effects of childhood abuse, and introduces the audience to the practices of bondage, domination, sadism and masochism (BDSM). Although being a “dominant” is Christian’s ‘thing,’ clinically, one would expect Christian to be a submissive who would seek out reenactments of his abuse at the hands of an older woman.
Ana is essentially a young woman who falls in love with an older, extremely powerful and rich man – a story taken out of the Harlequin romance novels of a previous era. But there is a psychological twist as well. Ana lost her dad when she was young, and her mother appears to be an unrepentant romantic. Mom is so enthralled by handsome men that she smiles when Christian arrives unannounced, even though he is stalking her daughter. Hence, Ana’s psychological backstory is that she is vulnerable to an older, abusive man because of her own losses and trauma.
There is a debate in the popular media how evil Christian is, and about the degree of abuse that Ana tolerates. Certainly, the fictional relationship between Christian and Ana could hardly be called healthy. Spoiler alert: if it’s any consolation they both leave the relationship with higher levels of insight and knowledge, ending up in better places than they started. (No doubt, their plots will thicken in the sequels!)
It may be pointless to discuss Christian and Ana in psychological terms since they are Hollywood creations. Yet, in the real world, BDSM is a group of accepted sexual practices among consenting adults and common among those seeking BDSM sex workers (or Dominatrices as they are called.) Often BDSM involves more pain than gain – in other words more tying up and humiliation with less emphasis on the sex and orgasm for the seeker or submissive. When occurring with little harm, most psychiatrists see BDSM as a variant of normal. When it consumes the person and prevents intimacy, the practice may rise to the level of a sexual disorder, sexual compulsivity or even addiction. When the person focuses on a particular inanimate object, like a whip or stiletto heel in lieu of any other sexual or romantic contact, the diagnosis of a fetishitic disorder may apply.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), once an unusual sexual practice causes impairment and harm to oneself or others, it is labeled as a paraphilic disorder with subcategories such as sadism and masochism. The American Psychiatric Association has made it clear that non-normative or unusual sexual behaviors are not, in of themselves, signs of mental illness unless the behaviors cause great anguish or real harm to the participants. This distress has to be beyond the guilt and distress that comes from engaging in behaviors that deviate from societal norms. In the case of BDSM, the DSM-5 is careful to discourage labeling atypical behaviors as mental conditions. However, when the behavior rises to the level of causing grief or harm, DSM-5 offers the diagnoses of sexual sadism disorder and sexual masochism disorder. Psychiatrists can treat these sexual disorders with a variety of modalities ranging from psychotherapy, medication, peer support groups and family counseling with excellent outcomes. As psychiatrists, we need to make the public aware that when these sexual illnesses occur, real help is available.
Whatever we may think about the sex and stories depicted in “Fifty Shades of Grey,” as psychiatrists, the popularity of the movie provides us with an opportunity to educate the public about the possibilities of improving the lives of those who have serious illnesses and who may suffer in silence and shame.
Kenneth Paul Rosenberg, MD, is Director of Upper East Health (UpperEastHealth.com), a comprehensive practice in Manhattan that focuses on addiction and sexual disorders. Dr. Rosenberg is also Clinical Associate Professor of Psychiatry at the Cornell Weill Medical Center.