Friday, January 15, 2016

Richard Frieherr von Krafft-Ebing (1840-1902)

Richard von Krafft-Ebing

Richard von Krafft-Ebbing is the father of modern Western sexology.  While the application of social science methods to human sexuality preceded him, and many of his terms and concepts were borrowed from others, he very deliberately reframed sexual deviance from a primarily religious, moral, and legal problem into a medical one.  He did this precisely in the period of the Second Industrial Revolution when the social, biological and medical sciences began to benefit from the innovations which the hard sciences had stared to use during the Enlightenment. 

Treponema pallidum.  Not a genetic weakness or product of too much masturbation, but a bacterium!

Educated at the University of Heidelberg and at work in the Catholic operated asylums in the Palatinate, von Krafft-Ebing was appalled at the quality of care provided in these facilities.  Starting in the 18th century, the entrepreneurial spirit had caught up with alienists, the precursor profession to modern psychiatry.  Like surgeons of the time, alienists were not high status professionals analogous to modern physicians.  But rationalism had made jailing the mentally ill untenable, and privately operated insane asylums had become a booming and shady business.  With very poor methods and theories for treating bizarre behavior, patients were warehoused indefinitely by providers who profited from long stays.   Much theory still rested on the foundations of Aristotle and Galen with emphasis on maintaining a balance between bodily fluids or ‘humors.’  In sexuality, Simon Andre Tissot’s Treatise on the Diseases Produced by Onanaism (1832) advanced the idea that excessive masturbation was a sign and cause of degeneracy and many sex related diseases.  Modern syphilis was then called ‘general paresis,’ and was a principal cause of madness.  So there was lots of overlap between sexual deviance and insanity in the Victorian era popular imagination and asylum populations.  And Krafft-Ebing advanced the goal of professionalizing psychiatry by sorting out the treatment of sexual deviance from the general asylum population.  He was one of the first practitioners to suggest that general paresis and syphilis were actually the same disease, a hypothesis eventually confirmed following Louis Pasteur’s (1860-4) demonstration of the germ theory of disease and later work in 1905 that identified Treponema pallidum as its bacterial agent.

One of the many modern editions of Psychopathia Sexualis.  You may bet Krafft-Ebing would not have approved a cover featuring bondage illustrator John Willie's Sweet Gwendoline after having translated the salacious parts into Latin!
In 1886, Krafft-Ebing published the first edition of his seminal work, Psychopathia Sexualis, a compendium of case histories of sexual problems and deviations.  Although his primary hypotheses of their origin was biological, Krafft-Ebing was still sufficiently concerned about the spread of morally degenerate ideas to write the more salacious parts of his volume in Latin.  In addition to protecting the public from dangerous ideas, his tactic had the consequence of professionalizing the conversation.  In the mid to late 19th century, the intellectual training for Roman Catholic clergy, medicine and law all requiring the study of Latin.  The medicalization of this sexual content was therefore advanced by the medium.  Serious scientific language played down the potentially provocative content by emphasizing its academic context!  It is just as well, almost as soon as Psychopathia Sexualis was published, helpful scholars translated the Latin for curious and salacious lay people!

Charles Darwin (1809-82)  Darwin's inferences from the careful observations of finches revolutionized the narratives underlying 19th century biology.  He inspired Krafft-Ebing, Freud, phrenology, and eventually Nazism.

Psychopathia Sexualis also promoted medicalization of sexual deviance by tying the various sexual practices it described into the emerging biological narrative sweeping medicine at the time following Charles Darwin’s publishing of On the Origin of Species in 1859.  While it would take well into the twentieth century for evolution based upon natural selection to become the unifying narrative of biological science, Origin provoked much scientific discussion from the outset of its publication.  Krafft-Ebbing used the relationship between different sexual behaviors and evolution by relating them to procreative function as the guiding principle for categorizing sexual problems he had encountered in the case histories.
Krafft-Ebing divided sexual problems into 4 categories with respect to procreativity:

Paradoxia referred to sex drive at times and places that would not be predicted by sexual functions, such as in the young, or in post-menopausal women.

Anaesthesia referred to problems of low or absent sex drive or desire.

Hyperaesthesia referred to problems of too much sex drive, such as nymphomania or satyriasis.

Paraesthesia referred to sex drive in the perversions or fetishes where the sexual impulse was not focused on its evolutionarily expected functions.

A gratuitous picture of boot fetishism, because this is, after all, a blog about kink!  Or perhaps a sign of genetic degeneration!


Krafft-Ebing regarded perversions and anesthesia as proof of genetic weakness because of the obvious problems they might cause with effective reproduction and evolutionary fitness.  This was congruent with the pre-existing medical theories left over from the ancients that health and disease were determined by the balance of bodily fluids and humors.  The concepts of compromised reproductive fitness and physical degeneracy, and moral degeneracy dovetailed seamlessly.  The vast majority of Krafft-Ebing’s case histories were men, and many took the form of bemoaning the poor wretch’s dissipation and poor fitness for procreative success.

In his first edition of Psychopathia Sexualis, Krafft-Ebing assembled 238 case histories of sexual problems.  His main thesis is that most should be treated medically, not handled as criminal matters.  He would go on to become a powerful opponent of phrenology, a pseudo-scientific theory during the late 19th century that personality, and especially criminality could be accurately assessed by careful measurement of individuals’ heads.  By the time he died in 1902, Psychopathia Sexualis had made 12 editions, over 400 case histories, and had been translated out of German and Latin into 30 languages.

The Marquis de Sade, an 18th century author and libertine Krafft-Ebing selected for 'sadism'

Leopold von Sacher-Masoch, a 19th century novelist whose name Krafft-Ebing selected for 'masochism'.

Although he was in no case the first person to use these terms, he is responsible for the use of Donatien Alphonse Francoise, the Marquis de Sade’s name for sadism, and Leopold von Sacher-Masoch’s name for masochism in the Western imagination.  This is primarily because of the primacy and success of his work and the fact that it led a wave of psychological and medical interest.  It didn’t hurt that he was a professor at the University of Vienna contemporaneously with the more famous Sigmund Freud, although Krafft-Ebing was not enamored of his former pupil’s later theories.

Krafft-Ebing's bust at University of Vienna,  The dates are his tenure there.  Photo by the author.

There is a famous story circulating in Vienna as recently as last month that a steel magnate brought his teenage son to a sanitarium in Vienna for consultation because of the son’s ill-socialized aggressiveness.  After the son assaulted the first doctor who tried to interview him, the father called for the famous Dr. Krafft-Ebing.  Krafft-Ebing went into the room and emerged almost immediately with a hematoma above his left eye.  The magnate then insisted that he then see the junior Dr. Freud.  The staff were taking bets on how long Sigmund would last in the consulting room.  In he went, and came out after 50 minutes as planned and proceeded to provide a diagnosis and treatment plan to the attending physician.  This doctor expressed some amazement, given that the great authority on criminality had immediately been socked in the eye.  “What could we expect of a middle aged goy to understand about alienation in youth?” quipped Freud.

While Freud may have easily dismissed Krafft-Ebing in this anecdote, Krafft-Ebing produced an enduring nosology of sexual deviations that has only been modestly dismantled in the ensuing 130 years. He identified sadism, masochism, voyeurism, exhibitionism and homosexuality as ‘perversions’ of sexual desire.  This was a stroke of marketing genius.  Although Krafft-Ebing meant that the sexual drive had been perverted from its evolutionary purpose to behaviors that were evolutionarily degenerate, the similarity between his language of biology and that of moral authorities was sufficiently similar that it would be easy for moralists to understand. He termed homosexuality an ‘inversion’ but nonetheless thought it degenerative in the evolutionary sense.  All of these variations would remain standard definitions, with some modification, until after the mid-twentieth century when disunity about other diagnoses led to the creation of the ICD system and the Diagnostic and Statistical Manuals of the Mental Disorders after World War II.
 
Paradoxia failed to stand the test of time and suffered from the false narrative that sexual expression was not widespread in children.  While it is easy for us to dismiss paradoxia as product of Krafft-Ebing’s  Victorian times, all of his work was conducted then, framed by Victorian social assumptions.  Other contributors like Albert Moll and Sigmund Freud would challenge the idea that childhood was free of sexual desire or behavior, and it was eventually acknowledged by science, if not in the popular imagination even today. 
In the modern nosology, Anesthesia has been replaced by various sex dysfunctions, and hyperaesthesia has failed to achieve inclusion due to disagreement about how much sex is ‘too much’ across widely varying social contexts.  It has found expression in some systems as nymphomania and satyriasis as in DSM -III, and in the persistent concept of sex addiction.

W. K. Kellogg, cereal magnate and philanthropist, typified Victorian ideals about health, fitness, and repressed sexuality.  
Krafft-Ebing continued a long tradition of failing to recognize the sexual agency of women.  Between Victorian era prejudices and the misconception that women were primarily the passive recipients of male sexual attention, women did not manifest paraesthesias but often did show excessive sexual reluctance and occasional paradoxia when they were lusty after menopause.  Prostitution, while often criminalized, was evolutionarily unobjectionable, and was later blamed on male enthusiasms well into the late twentieth century.  The romantic idealization of female purity and innocence has led to the idea, still persistent, that women are only lured into prostitution by male desire and most are coerced slaves of sex traffickers. Likewise, Krafft-Ebing viewed rape as criminal behavior, but sexually, it was unobjectionable from an evolutionary point of view, thus not pathological.
 
A close reader will note that despite the robust durability of Krafft-Ebing’s nosology, there are rather severe weaknesses in his degenerative argument.  Oral and anal sex are surely as devastating to reproductive success if indulged in to the exclusion of coitus.  Don’t these variant activities deserve as prominent a place in the paraesthesia nosology as sadism or boot fetishism?  In fact, those behaviors were criminalized and regarded as perversions in many places during the Victorian era through the modern one, but have not been pathologized in the modern ICD and DSM systems.  Birth control in any form was stigmatized during this period, and became a cause celebre of the nascent women’s movements in the West.  Their opponents characterized sexual expression freed of the risk of reproduction as the gateway to license and perversion.  And this was done in the face of medical recognition that death in childbirth was the leading cause of death to women of reproductive age.

Alfred Binet (1857-1911)  Founding father of  associationism and inventor of the first practical intelligence test.

The biggest challenge to Krafft-Ebing’s views on sexual variation came from the associationists.  This branch of nascent experimental psychology argued that sexual expression was learned behavior.  Rather than expressing constitutional factors, different sexual behaviors were mostly learned.  The leading proponent of associationism was the French psychologist was Alfred Binet, who argued that fetishism was simply learned by early association between pleasure and some article not essential to procreation.  Binet’s primary research interest was in assessing intelligence, and he is responsible for devising the original version of the famous Stanford-Binet Intelligence Scale.

A break in this nature/nurture logjam was to come in 1905 when Sigmund Freud published his Three Contributions to a Theory of Sexuality.  Freud recognized that variant sexual expression was widespread, but many of Freud’s cases showed variations that were eventually subordinated to ‘genital’, and thus procreative sexual expression.  Thus, Krafft-Ebing’s paraesthesias, now termed, sexual perversions, did not often substitute completely for procreative sex.  Freud would make a name for himself by explaining that they arose from pre-genital sexual instincts arising from psychological development in childhood.  Perhaps these variations, if they were so common, should be diagnosed only when they entirely substituted for procreative sexual expression?  This idea looks modern indeed when compared with the recent paraphilia revisions in DSM – 5.  But Freud’s broadest interpretation of perversions and sexual dysfunctions was that they resulted from individuals’ internalization of societal repression.

By 1905, Krafft-Ebbing had died, and we do not know how he would have replied to Dr. Freud’s claims.  Krafft-Ebing was no lover Freud’s work, and he would not have counted himself a psychoanalyst despite that the two great thinkers addressed many of the same issues.  But the verdict of the popular imagination rendered at the time had largely held for 100 years.  Even in the face of Kinsey’s work in the mid-century, sexual variation which was primarily moralized before Krafft-Ebing was still moralized after him, after Freud’s liberalizing observations, after Kinsey’s survey research and has moderated only somewhat following the so-called sexual revolution, rise of feminism, and the partial success of gay rights advocacy and the removal of homosexuality as a diagnosis within the DSMs.  Krafft-Ebing succeeded in medicalizing sexuality, but he did little to destigmatize it.

But Freud’s 1905 work was a huge advance to the psychology of sexuality.  It provided a middle ground in the stiffening debate between evolutionists like Krafft-Ebing who thought sexual expression entirely in terms of essentialist drive expression, and the associationists who argued that sexual expression was learned.  Despite his defense of the idea of degeneracy, Krafft-Ebing decision to publish his opus partially in Latin to prevent the vulnerable from being damaged by disturbing ideas shows some fear that sexual deviance could be learned.

Charles Gray, as 'The Criminologist, sending up 1920's pups in The Rocky Horror Picture Show (1975)
Still doesn't have a neck!
Neither was his concern entirely misplaced.  In the 1920’s, a new form of pornographic literature would arise in which real and pornographic medical case studies were compiled precisely for sale to persons of esoteric tastes.  They took a medical tone, but were not written in proper medical jargon, designed to evade the censor’s knife.  Their production and sale would play a pivotal, bur circuitous role in the creation of modern kink organizations.  But that is another story altogether, well told in Rob Bienvenue’s dissertation, a subject for another post!  Krafft-Ebing had started the classification for modern paraphilias, but Psychopathia Sexualis, despite his best efforts, gave rise to the titillating faux case study.

© Russell J Stambaugh, January 2016, Ann Arbor MI, All rights reserved




   

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