Justin Varney's recent posting about "self-harm" is powerful stuff. Not just in the 'emotionally powerful' sense. It's all about the power of medical discourse to moralise matters of the body and pleasure. I know that sounds very intellectual, and that's to cover for the intense dismay I felt upon reading and re-reading Justin's post. It creates a pathology in which pleasure is (mis)taken for harm, collapsed together with later and separate consequences which diminish wellbeing.

By pathology, I mean something which can be medically defined, explained and diagnosed. When I say that Justin's entry 'pathologises' bodies and pleasures, this is another way of saying that Justin is making a claim that the discipline of medicine should take control of how to distinguish between good and bad bodies and pleasures. Justin is himself a medical and public health practitioner, and he seems unaware of the conflict of interest or the disciplinary power underpinning his work and world view.

Across the course of our lives, we are subject to a steady stream of State and industry-funded health education intended to shape us into good sexual, nutritional, and consumer citizens by inducing us to scrutinise ourselves in those moral terms of good and bad bodies and pleasures. I am constantly doing battle with slender, gym fit gay men who are utterly unable to enjoy their dessert without counting the calories. The pleasure of sweet, rich chocolate on wet, willing tongues is overwritten by the tart and astringent pleasure of torturing themselves later about their indulgence and making a ritual social confession of their sins (complete with photos).

In case that sounds like a healthy and therefore excusable obsession, think for half a second about what happens when unprotected sex gets reframed in the same way as guilty pleasure. Instead of interrogating that guilt, Justin's post seeks to repaint pleasure as harm. That's just another entry in a long log of arguments by medical and public health practitioners who, refusing to acknowledge the social and emotional reasons for human behaviour, have sought to pathologise any behaviour not based on rational individual self-scrutiny. Let me give an example:

Negotiated safety is where regular partners negotiate an agreement to have condomless sex with each other, after testing together to establish they have the same HIV status, and discussing whether sex outside the relationship is allowed, and what should happen if the agreement is broken. It was a social research concept codifying something gay men had long before figured out for themselves.

Nonetheless, when it was published, North American public health practitioners denounced it and insisted on calling it 'negotiated danger' - as though they knew better than gay men themselves what those gay men had set out to negotiate. Pleasure? No no, says Justin, 'self-harm'. Safety? No no, said David Ostrow, 'danger'. No wonder gay men resist public health, when it recognises so little of the responsibility we take over the authorship of our own lives.

Acknowledgments

In this little tirade, I'm referencing work by Michel Foucault, Eric Rofes, Michael Hurley, and Trevor Hoppe. I don't agree with Justin but I acknowledge the courage and strength it takes to raise the issues he raises.