Apparatus XY

16After the publication of Psychopathia Sexualis, other psychiatrists quickly embraced Krafft-Ebing's degenerationist interpretation of sexual perversions, especially homosexuality. Kraepelin (1915) in his seminal nosological treatise, for instance, stated that "the morbidity of the condition [of contrary sexual instinct] depends not upon impulses which are perverted from the outset, but upon a characteristic tendency originating in a hereditary state of degeneracy" (511). Berlin psychiatrist Albert Moll, whose The Sexual Life of the Child (1912 [1909]) was widely disseminated in medical circles, also adopted Krafft-Ebing's degenerationist framework when discussing homosexuality. In his Perversions of the Sex Instinct (1931 [1891]), the first medical monograph exclusively devoted to the topic of homosexuality, Moll remarked that "just as in degenerates heredity manifests itself for one in the form of the idea of persecution, for another in the form of epilepsy, degeneration, in Uranists takes the form of sexual inversion…It is therefore certain, as we have seen, that a great many Uranists are the progeny of families possessing a neuropathic heredity" (149). The endorsement of Krafft-Ebing's familial degenerationist language grounded in a Darwinian conception of evolution was most pronounced in the writings of Swiss psychiatrist August Forel, then the Director of the Insane Asylum in Zurich. According to Forel, "even homosexual love that does not affect minors nor insane persons, is a sign of degeneracy, but produces no offspring and consequently dies out by means of selection. We hope, therefore, that this type may be extinct some day" (247, emphasis added). Kraepelin, Moll, and Forel thus all agreed with Krafft-Ebing in principle how mental health practitioners should approach the clinical problem of homosexuality by using the common language of degeneration, even though they may have differed in their respective theories of how degeneration was specifically linked to homosexuality.[15]On the distinction between therapeutic principle and therapeutic theory, see Warner, p. 5. In exploring a fresh realm of therapeutic intervention, members of the psychiatric community recognized that Krafft-Ebing's degenerationist paradigm provided them a systematic convention, so that by constantly referring to it in their own work, those outside the community-including other medical professionals-would be able to appreciate the internal coherence of psychiatric authority.

17Because the concept of degeneration provided the psychiatric profession such powerful leverage, Krafft-Ebing rigidly adhered to it until the very end of his career (Oosterhuis 103). And even when other psychiatrists such as Forel and Kraepelin wrote about homosexuality in the first two decades of the twentieth century, they still insisted on citing and applying Krafft-Ebing's degenerationist language (Kraeplin 1915, 511; Forel 247). The emerging new psychiatric discourse of sexual psychopathology towards the end of the nineteenth century, then, entailed two distinct but concomitant commitments: first, the systematic reference to the concept of degeneracy, and second, the systematic investigation of a psychological notion of sexuality that emphasized one's erotic tastes, inclinations, and impulses. While the former signaled the persistence of biological explanations, which was fundamental to pre-1880 psychiatric thought, the latter brought to surface the importance of focusing on the human psyche, which was gradually pushed to the forefront of post-1880 psychiatric thought (and would later completely characterize the approach of psychoanalysts in the 1930s and 1940s).[16]For an account of how psychoanalysis dominated the American psychiatric practice starting especially from the 1930s and 1940s, see, for example, Alexander and Selescnick, pp. 181-265; Shorter, pp. 170-81; Starr, p. 345; and Zaretsky, chap. 11.

18It is thus important for historians to interpret medical opinions about sexual pathology between 1880 and 1920 in terms of these two contradictory yet concurrent threads of psychiatric discussion. Writing in 1891, for example, Moll contended that the "seat of sexual inversion" was in the brain, in line with the somatic strand of psychiatric discourse:

The genital sense of the man are in a normal state excited by the image of a woman; in the Uranist the excitation is caused by the idea of a man. In him, the influence of ideas on the sexual urge are consequently misdirected. We are thus led to place the seat of sexual inversion in that place where the ideas awaken the sexual instinct. That is to say according to modern notions of psychology in the central nervous system or more particularly in the brain. (1931, 165-6)

When offering advice on the treatment of homosexuality later on in the book, however, Moll quickly shifted to a position that interpreted homosexuality as an intrinsic psychical problem: "the most ardent champions of the use of medicines are in accord that in the treatment of the Uranist not medicines but psychic means should be used. Inclinations and emotions are overcome not by the use of hydrochloric acid or the juice of the aloe; they should be fought with elements of a psychic order like their own" (199). The underlying tension in Moll's understanding of homosexuality, as if it was biologically caused but should be psychologically cured, could be resolved from the perspective that the entire psychiatric enterprise of medicalizing human sexuality from the 1880s onward fundamentally rested upon the dual-faceted attempt to study sexual behavior as a mental problem but without entirely leaving behind its biological grounding. As such, psychiatrists' effort to legitimate their field in the closing decades of the nineteenth century both reflected and reinforced a transitional phase in the history of psychiatry not only in terms of a new topic of investigation, but more importantly in terms of etiological emphasis.

19To recapitulate briefly, between 1880 and 1920, in hoping to gain a better understanding of sexual deviance specifically and diseases of the mind more generally, psychiatric experts shifted from an emphasis on bodily causes to psychogenic accounts; brain localizations of mental defects slowly lost their appeal and psychical considerations came to the fore. While most historians of medicine have attributed the root of this transition to Freud, I have shown that by turning their attention to sexual perversion, psychiatrists had also created a new platform of professional discourse that played a catalytic role in the transformation of their therapeutic emphasis, while sexuality was for the first time in history interpreted as psycho-pathological in nature. This new psychiatric discourse, originally intended for the medical surveillance, regulation, and control of sexuality, inadvertently constituted a distinct ground for the emergence of a modern notion of sexual freedom.

Sexological Impulse: 1900-1920

20In compiling and classifying patient case studies of sexual aberration, psychiatrists in the late nineteenth century invented an abundance of medical vocabularies whose pathological meanings could then be reworked by a subsequent generation of experts in the opening decades of the twentieth century. "Sexual inversion," "homosexuality," "sadism," "masochism," and "fetishism" were concepts now to be studied intensively, extensively, and not just medically but more importantly scientifically. A second wave of sex scientists, including Iwan Bloch, Havelock Ellis, and Magnus Hirschfeld, represented a group of individuals at the beginning of the twentieth century who published monographs, edited disciplinary journals, founded learned societies, and organized conferences, all devoted to the goal of establishing a comprehensive scientific discipline of human sexuality that incorporated a variety of research methodologies. In this process, they often advocated more liberal attitudes toward both the medical and legal aspects of sexual behavior, directly reflecting their conviction that social reform could be achieved through sexual science.