Does Shame over-medicalise the human condition?

Over at the Centre for the History of the Emotions blog, we’re holding a Shame Week, in which various historians of the emotions consider shame. Today, Katherine Angel of Warwick University has posted an excellent review of the Steve McQueen film, Shame. She loves the film, but wonders why Steve McQueen and Michael Fassbender have, in interviews about the film, very much pushed the angle that it’s a film about the medical condition, sex addiction:


The film is subtle and complex – something that contrasts somewhat with the Steve McQueen’s gloss on his own film in interviews.The film, he says, is about sex addiction – analogous to alcohol or drug addiction, but less recognised than these. The film was made in New York, he says, partly because of difficulties finding interviewees to discuss sex addiction in the UK; in the US, doctors and patients abounded. A model of sex addiction analogous to alcohol addiction, with similar 12-step programmes, has been around longer in the States than in the UK, and is a lay model that circulates increasingly widely.

But sex addiction is not an uncontested category. It is not listed as such in the current DSM, the manual of the American Psychiatric Association, although individuals can be and are categorized under Sexual Disorder Not Otherwise Specified. In the controversial process to revise DSM for its fifth edition due in 2013, Hypersexual Disorder is being discussed for inclusion. The criteria include excessive time consumed by sexual urges, and planning and engaging in sexual behaviour; repetitive engaging in sexual behaviour as a response to dysphoric mood states, or to stressful life events; repetitive engaging in behaviour while disregarding risks to self and others – all with the proviso that the behaviour must cause significant personal distress or impairment in functioning. (The International Classification of Disease is less loquacious than the DSM on this and other matters; but it includes Excessive Sexual Drive as a category, specified as satyriasis in men and nymphomania in women – preserving an older sexological language that the DSM’s nomenclature has sought to replace.)

Proponents of the disorder suggest that there is a significant clinical need for it, with many individuals seeking treatment – regardless of diagnosis – in psychotherapy and 12-step programmes. Moreover, they emphasise, those manifesting compulsive and high-volume sexual behaviour are at higher risk of acquiring and disseminating sexually transmitted diseases, as well as suffering the destructive impact on relationships and marriages. The public health implications of sexual appetite, of impulse control, and of internet pornography are key figures in concern about compulsive or addictive sexual behaviours.This terminology of sexual addiction, hypersexuality, or sexual compulsivity is controversial, with debates abounding over a pathologisation of sexuality and the norms of sexual behaviour embedded within them.

This is, as ever, a question of language – and McQueen’s insistence on sex addiction as the theme of the film is a strangely blunt tool to describe his work. Shame is a remarkable portrait of suffering – suffering that primarily manifests in, and is temporarily resolved through, though never entirely dislodged by, intense sexual activity. It ‘s about how suffering can be expressed; about the limited outlets for experience and suffering that Brandon allows himself. It’s about exquisite pain, and it’s testament to both McQueen and Fassbender that when we watch this portrait, we feel it too.

McQueen has also said that people struggle to understand the idea of a film about sex that is not sexy; that does not aim to excite or titillate. Here again, his own glossing of his work is a surprising contrast to it. To insist that Shame is not at some level erotic is to underplay how it brings to life both the intense pull and satisfaction of sex, and its shadow – its capacity to stand in for other kinds of pleasures, longings and disappointments, to obscure and muffle other feelings. The film both shows us how compelling the fulfilment of sexual desire can be, and shows us how desire, more widely understood, can get distributed within a person. Brandon doesn’t really want anything; at a restaurant, he is indifferent to his choices. His life feels anonymous, his apartment bland, inexpressive of anything he might want or love. And yet it is only within sexual desire that his desire in general can come alive.

McQueen’s work as an artist is complex and resonant, but his statements about his film are disappointing. This makes me think that he is either not fully cognizant of the beauty and complexity of his creation, or adopting a particular language – a medical language – through which compassion can be channeled, and through which discomforts about portrayals of both suffering and sexuality can be managed, in order to negotiate the press circus and to render the film more palatable.

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