Stepchildren of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity

Richard von Krafft-Ebing (1840-1902) was one of the most prominent psychiatrists in Central Europe before Emil Kraepelin on the one hand and Sigmund Freud on the other set the tone. He started his career working in asylums, but the desire to escape the constraints of institutional psychiatry, which had become more akin to routine custodial care than to a gratifying scientific calling, drove him to broaden his professional territory. As a professor of psychiatry at the Universities of Strassburg (1871-1872), Graz (1872-1889) and Vienna (1889-1902), he became actively engaged in the process in which the main institutional locus of this medical specialty shifted from the asylum to the university. Also, he transcended the institutional confines of psychiatry by developing a private practice, founding a private sanatorium, and advancing its moral role in society. Krafft-Ebing's general theories of psychopathology were rather incoherent: his work embraced biological models of mental illness, including degeneration-theory, as well as a psychological understanding of mental disorders. His ideas about the proper explanation and treatment of mental disorders were more or less geared to the changing institutional contexts in which he worked and the shifting social background of his patients. Moving from the public asylum to the university clinic, and founding a sanatorium and a private practice, he tried to enlarge psychiatry's domain as well as to attract a new clientele. Whereas the somatic model of mental disease and degeneration-theory promoted the scientific status of psychiatry, a psychological approach was more fruitful to attract middle and upper class patients suffering from rather mild disorders like nervousness, neurasthenia, or sexual perversion.
Krafft-Ebing was working in many fields of psychiatry, but he is remembered nowadays chiefly as the author of Psychopathia sexualis. This book made him one of the founding fathers of medical sexology. The first edition of this bestseller appeared in 1886, followed soon by several new and elaborated editi¬ons and translations in several languages. Krafft-Ebing revised it several times, especially by adding new categories of sexual deviance and more and more case histories. By naming and classifying virtually all non-procreative sexuality, he synthesized medical knowledge of what then was labeled as perversion. Although he also paid attention to voyeurism, exhibitionism, pedophilia, bestiality, and other sexual behaviors, Krafft-Ebing distinguished four fundamental forms of perversion: (1) contrary sexual feeling or inversion, including various mixtures of manliness and femininity that in the twentieth century would gradually be differentiated into homosexuality, androgyny, and transvestitism; (2) fetishism, the erotic obsession with certain parts of the body or objects; (3) sadism and (4) masochism, neologisms actually coined by him, the first inspired by Marquis De Sade and the second by the writer Leopold von Sacher-Masoch. Krafft-Ebing's interest in sexual deviance was linked to forensic psychiatry in which he was a leading expert. Psychopathia sexualis was written for lawyers and doctors dis¬cussing sexual crimes in court. His main thrust was that in many cases sexual deviance should no longer be regarded as simply sin and crime, but as symptoms of pathology. Since mental and nervous disorders often diminished responsibility, he pointed out, most sex offenders should not be punished, but treated as patients. Like other psychiatrists in the late nineteenth century, Krafft-Ebing shifted the focus from immoral acts, a temporary deviation of the norm, to a pathological condition. Influenced by the natural-scientific approach in German psychiatry as well as by degeneration theory, he explained perversions as inborn instincts, as deviations of normal biological evolution.
Krafft-Ebing's work appears to be typical of what Michel Foucault, in his influential The History of Sexuality: An Introduction (1978), designates as the medical construction of sexuality. Under the influence of Foucault, it has become a truism that physicians, by describing and categorizing non-procreative sexualities, were very influential in effecting a fundamental transformation of the social and psychological reality of sexual deviance from a form of immoral behavior to a pathological way of being. By differentiating between the normal and the abnormal and by stigmatizing deviance as illness, thus the argument runs, the medical profession, as the exponent of a "biopower", was not only constructing the modern idea of sexual identity, but also controlling the pleasures of the body. Following Foucault, several scholars have associated the emer¬gence of sexology with a deplorable medical colonization, replacing religious and judicial authority with scientific control. However, some recent historical studies suggest that medical labeling and its disciplining effects have been overemphasized as the major determinants in the process creating sexual identities. Too readily the conclusion has been drawn that the individuals labeled as perverts were passive victims, trapped in the medical discourse.
To be true, like other psychiatrists, Krafft-Ebing surrounded sexual deviance with an aura of pathology and he echoed nineteenth-century stereotypical thinking on sexual issues. However, his views were all but static or coherent and there were many contradictions and ambiguities in his work. It was open to divergent meanings and contemporaries, among them many of Krafft-Ebing's patients, correspondents and informants, have indeed read it in different ways. Psychopathia sexualis did not only gratify one's curiosity about sexuality and make sexual variance imaginable, but individuals concerned viewed it also as an endorsement of their desires and behavior. Its numerous case histories revealed to them that they were not unique in their sexual desire. Krafft-Ebing's work was the impetus to self-awareness and self-expression and many suggested that it had brought them relief. What is striking is not only that life histories were so prominent in Psychopathia sexualis and his other publications, but even more that the autobiographical accounts were not forced into the straitjacket of his sexual pathology. Many of the life histories were submitted voluntarily and although their authors demonstrated a considerable degree of suffering, this did not necessarily mean that they conside¬red themselves to be immoral or ill. The medical model was employed by many of them for their own purposes to mitigate feelings of guilt, to give perversion the stamp of naturalness and to part with the charge of immorality and illegality. Several perverts went to the psychiatrist, not so much seeking a cure, but to develop a dialogue about their nature and social situation. In fact, Krafft-Ebing responded to these "stepchildren of nature", as he characterized them. Even if they criticized medical thinking and the social suppression of their sexual desires, he still published their letters and autobiographies uncensored, and he also acknowledged that some of them had influenced him. Lay views and medical views of sexuality overlapped.
As more and more private patients and correspon¬dents came up with life histories that did not fit the established perception of psychiatry and bourgeois morality, the more Krafft-Ebing's approach became enmeshed in contradictory views and interests. The psychiatric understanding of perversions moved between scientific control and the realization of the liberal ideals of individual self-expression, self-realization, and emancipation. Whether the scale tipped to one side or the other depended to a large extent on the social position and gender of the psychiatrist's clients. Upper and middle class men capitalized on psychiatric models in order to explain and to justify themselves. But lower class men, prosecuted sexual offenders, and most female patients were generally not in a position to escape the coercion which undeniably was part of psychiatric practice as well.