Pathologizing Sexual Deviance: A History
De Block, Andreas, Adriaens, Pieter R., The Journal of Sex Research
Before the dawn of modern psychiatry, many philosophers, physicians, and so-called naturalists had already attempted to construct theoretical accounts of the nature and incidence of what they considered unusual sexual behavior. The advent of psychiatry as a medical discipline both reflected and redefined this age-old interest in sexual deviance. Here we focus on psychiatry's historical struggle with the conceptualization and categorization of unusual sexual desires and practices, starting with the publication of Richard yon Krafft-Ebing's Psychopathia Sexualis in 1886 and ending with the preparation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, to be published in 2013).
To this end, we review the recent historical literature on the topic, which we gathered by consulting the main databases that index and abstract articles and books in history (EBSCO's Historical Abstracts), psychology (PsycINFO), and the biomedical sciences (PubMed), and by systematically screening the major historical journals in the field (Journal of the History of Sexuality, History of the Human Sciences, History of Psychiatry, Journal of the History of Medicine and Allied Sciences, among others). This selection was further narrowed by focusing on a limited number of canonical or iconic authors, publications, and movements. They are called canonical and iconic because they figure prominently in all the existing historical overviews and introductions that deal with the topic at hand (e.g., Beccalossi, 2011; Cocks & Houlbrook, 2004). By focusing on these authors, publications, and movements, we do not claim that they have somehow single-handedly shaped and steered psychiatric history. Rather, they became "icons" because their ideas mirrored those of contemporary psychiatrists and society at large. Admittedly, however, writing the history of psychiatry is much more challenging than writing the history of any other scientific discipline (Porter & Micale, 1994). Reflecting the historian's intellectual, political, cultural, and ideological background, psychiatric history writing is a many-headed monster. Either implicitly or explicitly, the study of the (psychiatric) history of sexual deviance has often been a normative rather than a descriptive discipline. Reviewing the history of sexuality, Havelock Ellis and Magnus Hirschfeld, for example, openly pursued an ethical and political course. In their view, the sexual instincts did not change much over time, but what did change were the social reactions to the expression of these instincts. The historical study, then, simply served to record the progress that was made in the attitudes toward unusual or bizarre forms of sexuality. This "repression versus expression framework," as Duggan (1990) dubbed it, was uncritically endorsed by most historians of sexuality (and psychiatry) until the 1970s. Often described as "Whiggish," their method of making history idealized the history of sexology and psychiatry as a triumph of scientific progress and ever increasing emancipation (Porter & Micale, 1994).
In the late 1960s, the French historian and philosopher Michel Foucault fundamentally altered psychiatric history writing (see, e.g., Duggan, 1990; Halperin, 2002; Peakman, 2009; Weeks, 2000). Although many contemporary historians of medicine and sexuality have distanced themselves from some of Foucault's all-too-sweeping claims and often uncritical allegiance with antipsychiatry, Foucault's lasting influence on these fields cannot be denied (Weeks, 1982). Foucault's legacy (Foucault, 1961,1976) reveals itself in the view, still widely adhered to in the contemporary historical literature, that what is accepted as normal and healthy sexuality is not determined by nature but changes with the values and norms of a particular society at a particular place and time (Crawford, 2006). Some historians and philosophers also follow Foucault in suggesting that some sexual conditions and behaviors have been created, at least partially, by a growing body of legal and medical thought (Hacking, 1999). …