Somnophilia, the “Sleeping Beauty” Disorder

Becky Huting, MJLST Editor

To date, at least 19 women have come forward accusing Bill Cosby of some type of sexual abuse. The majority of the women have told similar stories that involve some variant of being drugged, sexually assaulted, or being drugged and also sexually assaulted by Cosby. The New York Times recently published a piece entitled “When a Rapist’s Weapon is a Drug” that talks about a particular kind of paraphilia that some hypothesize is present in Cosby: a sexual deviation that involves drugging and raping unconscious partners. While it is important to note there is no indication of any formal diagnoses of Cosby (nor of criminal charges), this narrative has opened the dialogue about the contours of sexual disorder diagnosis and what it might mean in our legal regime.

The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is authored by the American Psychiatric Association (APA) and offers a standardized classification of mental disorders. According to the APA, the DSM is “intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems).” The DSM’s 5th Edition (DSM 5) is the 2013 update to the APA tool, superseding the last (DSM-IV-TSR), which was published in 2000.

Paraphilic disorders are defined by an unusual sexual preference that becomes compulsive. The DSM 5 contains eight distinct groups of disorders that constitute paraphilia. They include: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder (arousal from touching or rubbing against a stranger), pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestite disorder, and voyeuristic disorder.

Now returning to Cosby: date rape incidents involving drugs being dosed to victims are very common. Alcohol is the most commonly used drug in sexual assaults, but some perpetrators use so-called “knock-out” drugs. Experts view the motives for the former simple opportunism, but some of the latter category of druggers have a different motive in mind: they like unresponsive partners. This preference for unconscious partners, and the erotic arousal dependent upon intruding upon an unresponsive partner, and sometimes waking the person, is being labeled “sleeping beauty syndrome” or “Somnophilia.” Somnophilia is a less common compulsion, but under a more common umbrella of a motive guided by coercion where the perpetrator is aroused by domination of their drugged partner.

According to Dr. Michael First, a psychiatrist and editorial consultant on the new DSM 5, the kind of coercion and domination achieved by drugging a partner is common enough that the APA actually contemplated adding it as a distinct diagnosis as a paraphilia disorder, but the idea was shelved in part because of concerns that doing so would give rapists added recourse in legal cases. This should be of interest for legal practitioners: it begs the question – should doctors be thinking about legal implications when they classify disorders? If they are indeed guided by what might be a legal defense, one could imagine the whole composition of the DSM changing tomorrow. Just a couple examples come quickly to mind. Schizophrenia is a widely accepted mental disorder included on the DSM, and yet is not infrequently used to bolster a legal defense for very horrific crimes. Consider also sleep-walking disorders. These too are on the DSM 5, and yet, criminal defendants have been known to use sleep-walking as a legal defense for equally ghastly crimes. It seems incongruous to say that leaving these kind of “excusing” mental disorders off is the policy here. They are already on the DSM, and criminal defendants have used them for quite some time. If the APA is willing to sacrifice classifying valid mental disorders in the name of some sense of legal responsibility, they must also consider the consequences for the field of psychiatry and the name of treatment.

Clearly here the concern by the American Psychiatric Association is that giving disorders like Somnophilia a name legitimizes it – those ostensibly like Bill Cosby will now have a diagnosis to stand behind in court. They can say: “it wasn’t my fault, it’s my disposition. I have a disorder.” (It is also unclear that a jury would give any sympathetic weight or credence to this). But the clear question is whether lawyers want doctors doing the legal work for them behind the scenes. Will psychiatry and its patients actually benefit by this kind of legal policy gut-checking, or should we just ask politely ask doctors to do what they do best – classify, diagnose, and treat?