Thursday, January 1, 2009

Review: Harry Oosterhuis, Stepchildren of Nature: Krafft-Ebing, Psychiatry and the Making of Sexual Identity, [University of Chicago Press, 2000]

Most English speakers know little about the Viennese psychiatrist Richard von Krafft-Ebing [1840-1902] beyond the facts that he was the author of Psychopathia sexualis and one of the founders of scientific sexology, who coined such words as sadism and masochism. Most often he is treated as a footnote in the history of psychoanalysis.
Harry Oosterhuis’s profound reading of published as well as unpublished sources does more than establish Krafft-Ebing’s place in the evolution of twentieth century ideas about sexual identity. It also provides a cogent and convincing alternative to Foucault’s view that concepts of sexual identity were simply imposed by doctors ‘from the top down.’ While Krafft-Ebing was a great classifier, he didn’t simply reduce his patient’s lives to symptomatic expressions of pathology.
Oosterhuis begins with the simple observation that Krafft-Ebing often quotes his patients directly and at length and that even when not directly quoting them, he still manages to give voice to their view of their distress. While Krafft-Ebing was certainly a psychiatrist of his times in his views about the role of heredity in sexual deviance, Oosterhuis makes it clear that he also listened closely to his patients and was influenced by their opinions.
In doing so Krafft-Ebing participated in transformation of attitudes about sexuality. In the early nineteenth century what mattered about sexuality was whether it contributed to reproduction. By the end of that century what mattered was a person’s sexual experience and identity. Not only did homosexuality become a category opposed to heterosexuality, but heterosexuality became more that having babies. It came to mean having sexual pleasure with a person of the opposite sex.
Because homosexual acts were illegal in Austria, Krafft-Ebing first became involved with cases of sexual deviance through his forensic work, where he examined many working class offenders. Acheiving some fame, he opened a private practice and began to see individuals from his own social background for consultations. Confronted with these patients, in a voluntary, private setting, Krafft-Ebing, like others in the history of psychiatry, could not help but recognize something of their humanity. Because his hereditarian theory provided no way for him to think about these people, he published their stories more or less as told to him.
Some of these patients insisted that they did not suffer from an illness, that they were perfectly happy and that their only problem was legal persecution. Others wrote to him saying that they had found it very helpful to read the stories published in his book, that they could see themselves in his case histories. Through Oosterhuis’ eyes, Psychopathia sexualis, begins to seem like a nineteenth century chat room, a space where anonymous discourse allows for the shaping of new identities.
All of this, as Oosterhuis makes clear, simply does not fit the model of the medicalization of sexual deviance given to us by Michel Foucault. In Krafft-Ebing’s work one can begin to see a negotiation between psychiatrists and patients about the scope and meaning of classificatory systems.
This vision of the negotiation of diagnostic catagories between psychiatrists and patients represents a profound revision of one of the principles that has influenced the history of psychiatry over the last thirty years. As such Oosterhuis’s meditation on the life and and work of Richard von Krafft-Ebing has broad significance and deserves a wide readership.

Edward M. Brown

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