Medical science and the modernisation of sexuality

In his influential History of Sexuality (1976) Michel Foucault argues that the modern idea of sexuality was histo¬rically constitu¬ted in the nineteenth century when medical science delimited perversion. Whereas earlier historians saw the 'medicalization' of sexuality as a change only of attitudes and labels - for them, unchanging deviant sexual behaviours and feelings were no longer regarded as unnatural, sinful or criminal but simply became diseases, relabeled by physicians - Foucault and other social constructivist historians have challenged this interpretation. Not only are they critical of the view that the medical model was a scientific and humanitarian step forward, but also they argue that the conception of nonprocreative sexuality as a sign of sickness was not merely a substitution for earlier denouncements of such activities as immoral. They emphasize that nineteenth-century physicians, by describing and categorizing nonprocreative sexualities, were very influential in effecting a fundamental transformation of the social and psychological reality of sexual deviance from a form of immoral behaviour to a pathological way of being. By differentiating between the normal and the abnormal and by stigmatizing deviance as illness, thus the argument runs, physicians, as exponents of a 'biopower', were not only constructing the modern idea of sexuality but also controlling the pleasures of the body. Following Foucault, scholars have also argued that sexuality is a cultural and historical construct and thus makes no sense except as inscribed in language, discourses, meanings and 'representati¬ons'. Not only the attitude of people towards sexual behaviour, but also the meaning and concept of sexuality itself are subject to cultu¬ral varia¬tion and historical chan¬ge. Socially created out of disciplining powers and discourses of knowledge, sexuality was a nineteenth-century invention. Before medical theories emerged that lumped together behaviour, physical characteristics, and the emotional make-up of individuals, there was no entity, according to Foucault, which could be delineated as sexuality.
I would be the last to reject this account totally, but my basic assumption is that the picture which has been drawn of the medicalization of sexuality is rather one-sided. The disciplining effects of medical interference with sexuality have been overemphasized. Medical theories have played an important role in the making of sexual categories and identities. However, this does not necessarily mean that these were only scientific inventions, shaped systematically by the logic of medicine and imposed from above by the power of organized medical opinion. In order to explain how sexuality was shaped by nineteenth century medical science, which is the subject of this article, the wider social context has to be taken into account. Ar¬guing that new ways of understanding sexuality emerged not only from medical thinking in itself, I will focus on the connections between the contents of medical theories and their institutional and social settings. This article relies on my current research of the work of the German-Austrian psychiatrist Richard von Krafft-Ebing as well as on work of other scholars.