Sexuality and Sexual Pathology. Introduction
Sexuality emerged as an important aspect of personal identity during the Enlightenment era. The evaluation of “normal” and “deviant” sexuality gradually shifted from religious and church authority to the domains of medical and later psychiatric expertise.
Over time, the position of psychiatrists on the root cause of sexual abnormalities shifted. The belief that abnormal sexuality caused brain dysfunction and, consequently, psychiatric illnesses was gradually abandoned. Instead, a n organic brain disorder was postulated as the primary root cause for abnormal sexual behaviour. This position found theoretical support in the emerging concept of degeneration, primarily taught by French psychiatrists Auguste Bénédict Morel and Valentin Magnan, and in Germany by Wilhelm Griesinger.
The concepts of sexuality and sexual pathology have been further elaborated at the end of the 19th century by Richard Kraft-Ebing, Albert Moll and Sigmund Freud.
Modern Concept of Sexuality
The modern concept of sexuality, as we understand it today, began to take shape in the late nineteenth century, primarily through the pioneering works of Richard von Krafft-Ebing (1840–1902) and the neurologist Albert Moll (1862–1939). This redefining of sexuality within the field of psychiatry was tied to the acknowledgment of sexual diversity. Around 1870, psychiatry transitioned from perceiving immoral acts as deviations, to recognizing them as innate disorder.
During the late nineteenth century, numerous psychiatrists studied and published case histories, tried to classify the broad spectrum of deviant sexual behaviours. This marked the emergence of medical sexology, which enabled the diagnosis and open discussion on these conditions defined as perversions.
Within this context, both Krafft-Ebing and Moll introduced a transformative perspective, not only on perversion but also on sexuality as a whole. They changed the psychiatric viewpoint explaining deviant sexuality as an episodic symptom of deeper mental disorders. They declared perversions as an integral component of an autonomous, and continuous sexual instinct.
Sexual Pathology and Degeneration Theory
Krafft-Ebing and Moll defined sexual abnormalities as the effect of degeneration. They assumed that various harmful influences of modern civilization, such as alcoholism, toxic environments, malnutrition, and venereal diseases, led to pathological changes in brain functionality within initially healthy families. Following this logic, they anticipated that pathogenic changes are inherited as a predisposition and accumulate across generations, resulting in progressively severe brain pathologies. Under the influence of intense emotions, trauma, physical injuries, and other factors, this predisposition could lead to various mental disorders, including perverse forms of sexuality.
This theoretical foundation gave rise to detailed clinical research rooted in comprehensive patient histories, complemented by findings from psychology, physiology, and neuropathology.
This shift in theoretical orientation also led to the recognition of psychiatry as an accepted academic discipline.
Inheritance versus External Factors
Within this discourse on sexuality in the 19th and early 20th centuries, figures like Richard Freiherr von Krafft-Ebing and Sigmund Freud played prominent roles on the path toward the establishment of sexual science.
In this context, the theoretical concept of sexuality and perversion by Krafft-Ebing and Freud are presented, highlighting their similarities and fundamental differences. These influential thinkers contributed significantly to the evolving understanding of human sexuality and its place in both individual and the social context.
Krafft-Ebing’s clinical-scientific approach to sexuality marked a significant paradigm shift within the psychiatry of his era. His etiological understanding of perversions was rooted in the theory of degeneration presuming that abnormal sexual behaviour was related to unspecified neuro-endocrine changes.
However, it was Freud who reinterpreted the relevant research of Krafft-Ebing on sexuality and sexual pathology. Freud’s explicit etiological focus pointing to early sexual traumas as the cause of hysterical symptoms posed a fundamental challenge to the degeneration theory. He also connected perversion and hysterical neurosis into an overarching pathogenetic model.
The etiological significance of sexual traumas in all “psychoneuroses,” would evolve into a novel model of psychodynamic psychiatry.
Sexuality and Its Pathology in Forensics
In the nineteenth century, medical interest in sexuality was closely tied to forensic medicine, which primarily focused on criminal sexual acts like rape, and public indecency. Forensic medicine initially concentrated on the personal characteristics of moral offenders.
A significant shift occurred when physicians no longer attributed mental and nervous disorders to abnormal sexual behaviours. Instead, psychiatrists began to view these disturbances as the root cause of sexual deviance. They argued that irregular sexual behavior should be seen as symptoms of pathology rather than sin or crime. Since mental and nervous disorders often diminished responsibility, they advocated for treating sex offenders as patients rather than punishing them.
Around 1870, influential German and French psychiatrists, including Wilhelm Griesinger, Carl von Westphal, Krafft-Ebing, Paul Moreau de Tours, Jean-Martin Charcot, and Valentin Magnan, considered perversions as innate morbid conditions.
During the late nineteenth century, psychiatrists introduced new labels and categories for various deviant sexual behaviours. Neologisms like exhibitionism, voyeurism, fetishism, paedophilia, sadism, and masochism emerged alongside terms such as homosexuality also called “contrary sexual feeling.”
Krafft-Ebing on Sexual Pathology
Richard von Krafft-Ebing, a prominent psychiatrist in Central Europe, held positions at the University of Graz and Vienna. He made significant contributions to various fields of psychiatry and became a leading forensic expert. Krafft-Ebing is perhaps best known as one of the founding fathers of medical sexology, thanks to his renowned work, “Psychopathia Sexualis,” and several other works on sexual pathology.
The initial edition of “Psychopathia Sexualis” was penned by Krafft-Ebing in 1886, primarily targeting lawyers and doctors involved in sexual crime cases. This groundbreaking book quickly gained popularity, leading to numerous revised and expanded editions, along with translations into multiple languages. Krafft-Ebing continuously refined his work, incorporating additional case histories and introducing new sexual categories. He effectively synthesized the evolving psychiatric knowledge surrounding sexual perversions by naming and classifying nearly all non-procreative sexual behaviours.
Albert Moll on Sexual Pathology
Moll, operating as a neurologist and psychotherapist in Berlin from around 1890, also worked as a forensic expert. He gained recognition as an expert in therapeutic hypnosis and suggestion, treating various conditions, including sexual perversions.
In 1891, Moll published one of the first medical textbooks solely dedicated to homosexuality, “Die Conträre Sexualempfindung,” which Krafft-Ebing praised in its preface.
Moll considered Krafft-Ebing the founder of sexology and corresponded with him, sharing case histories. In 1924, several years after Krafft-Ebing’s death, Moll reedited and published the sixteenth and seventeenth editions of Krafft-Ebing’s “Psychopathia Sexualis.”
Krafft-Ebing’s work primarily relied on empirical clinical observations and case studies while his theoretical reflections were not systematically structured. Moll introduced innovative perspectives on sexuality further refining and organizing these ideas into a more methodical framework.
Moll’s book on “Libido Sexualis” offered a comprehensive and sophisticated general theory of sexuality before Sigmund Freud’s “Drei Abhandlungen zur Sexualtheorie” and Havelock Ellis’s monumental “Studies in the Psychology of Sex.”
Classifying the Normal and Abnormal
The main problem in sexual modernism was the definition and classification of sexual abnormalities and how to distinguish normal from abnormal. Late nineteenth-century psychiatrists formulated various taxonomies, but Krafft-Ebing’s framework, later embraced by Moll, became influential not only within medical circles but also in common perception.
While Krafft-Ebing and Moll explored a range of sexual variations, they identified four foundational forms of perversion.
- First, contrary sexual feeling or gender inversion, encompassing blends of masculinity and femininity, later evolving into categories like homosexuality, bisexuality, transvestitism, and transsexuality.
- Second, fetishism, an erotic fixation on body parts or objects.
- The third was sadism.
- Fourth, masochism.
The last two terms were coined by Krafft-Ebing. Sadism originated its name from Marquis de Sade and masochism related to Leopold von Sacher-Masoch.
Remarkably, some of Krafft-Ebing’s neologisms, such as sadism, masochism, and paedophilia, remain in use today. Moreover, the terms homosexuality and heterosexuality, previously sporadically used but not widely adopted, were reintroduced by Krafft-Ebing and Moll around 1890.
This classification of sexual deviance significantly shaped the understanding of sexuality in the early twentieth century and laid the groundwork for contemporary discussions on sexual orientation and preferences. The distinction between normal and abnormal, once rigid, has evolved as society grapples with a more nuanced understanding of human sexuality.
Krafft-Ebing on Sexual Instinct
In his most important work, “Psychopathia Sexualis,” Krafft-Ebing writes:
“The propagation of the human species is not committed to accident or to the caprice of the individual, but made secure in a natural instinct, which, with all-conquering force and might, demands fulfilment.“
Krafft-Ebing assumes that this natural drive, under normal circumctances, developing itself only at puberty in the form of an attraction to a person of the opposite sex. He thus presupposed a functional conception of sexuality, as a vehicle for reproduction and proliferation of species. He didn’t analize the nature of the sexual instinct.
Krafft-Ebing’s view of sexual pathology stems from this foundational assumption. His work primarily focuses on deviations from what he perceives as the norm.
In the subsection on “Perversion of the Sexual Instinct” he writes:
“With opportunity for the natural satisfaction of the sexual instinct, every expression of it that does not correspond with the purpose of nature, – i.e. propagation, – must be regarded as perverse.“
Albert Moll on Sexual Instinct
Albert Moll’s work on sexuality and sexual pathology is based on the same functional conception of the sexual instinct. His best-known work, first published in 1891, is “Die konträre Sexualempfindung”, translated into English as “Perversions of the Sex Instinct”.
Albert Moll delved into analyzing the very concept of the sexual instinct in his work. His “Untersuchungen über die Libido Sexualis” (“Investigations into the Libido Sexualis”), published in 1897/8 and closely studied by Freud, begins by scrutinizing the sexual instinct. Moll contends that understanding this instinct is vital for distinguishing between normal and abnormal, healthy and pathological manifestations of the drive.
Moll aligns with Krafft-Ebing’s definition of perversion, considering any sexual expression not serving the purpose of reproduction as a perversion. He emphasizes that the “Geschlechtstrieb”, the sexual drive, guiding man toward man, falls under Krafft-Ebing’s definition of perversion.
“Contrary Sexual Feeling”
While Krafft-Ebing and Moll shared some foundational ideas, their moral judgments on perversion, especially homosexuality, diverged over time.
Krafft-Ebing’s perspective evolved towards leniency and humanitarianism. From the early 1890s, he opposed penalizing homosexual acts and supported the abolition of Germany’s Section 175, which criminalized “unnatural vice.” In his final article on homosexuality, published in Hirschfeld’s “Jahrbuch für sexuelle Zwischenstufen,” Krafft-Ebing admitted his earlier views were one-sided. He acknowledged the legitimacy of his homosexual correspondents’ pleas for sympathy and compassion.
In contrast, Moll initially exhibited an open-minded and pragmatic stance on sexual matters, particularly before World War I. However, he later adopted a more conservative and nationalistic outlook towards homosexuals.
Sigmund Freud on Sexuality
Freud’s “Three Essays on the Theory of Sexuality” appears in the versions of his collected works in the 1905 volume. “Three Essays” bacame the cornerstone of psychoanalysis.
In the “Three Essays,” Freud compiles three interconnected essays on sexuality. The first, titled “Sexual Aberrations,” delves into the nature of sexual perversions, emphasizing the need to examine the development of early childhood sexuality. This theme is explored further in the second essay, “Infantile Sexuality.” The third and shortest essay, “The Transformation of Puberty,” serves as an extension of the second, offering a concise summary of the findings.
Within these essays, Freud introduced revolutionary concepts and terms, notably the differentiation between sexual aim and sexual object, challenging the conventional notion of a singular sexual drive.
Freud’s concept of sexuality extends far beyond the mere biological act. Freud assumed that sexuality is the source of live energy he called libido. He proposed the concept of child sexuality, which subsequently unfolds during childhood, only to undergo temporary repression around the age of five, reemerging during adolescence. The concept of child sexuality is today controversial.
Freud saw neurotic symptoms as a manifestation of inhibited libido revealing repressed desires. Neurotics experience a conflict between their sexual drive and exaggerated inhibitions caused by disgust and shame. Neurotic symptoms serve as an escape from the conflict, masking abnormal aspects of the sexual drive.
Neurosis and perversion are intertwined, as neurotic suppression or repression of sexuality diverts libido away from normal sexual goals and objects toward previously dormant possibilities.
Sexuality and Sexual Pathology. Summary
In the past, the concept of sexuality was quite different from what we understand today. Before the 19th century, the term “sexual” was mainly used in botany. When applied to humans, sexuality was largely viewed through the lens of physical attributes, including genitals, secondary sexual characteristics, and reproductive capability with a partner of the opposite sex.
However, things began to change in the latter half of the 19th century. During this time, the terms “sexual” and “sexuality” started to encompass a more complex behaviours, desires, and passions. This marked a shift from the purely physiological perspective to a psychological one. The alignment of one’s body with their sexual behavior was rarely questioned, emphasizing male-female distinctions.
Physicians of that era sought to incorporate their explanations of sexual deviations into the prevailing biomedical framework. Many of them, influenced by Darwinism and research on embryological development, began to emphasize the role of heredity in shaping sexuality. They considered both phylogenetic (evolutionary) and ontogenetic (individual development) factors as key causal factors in understanding human sexuality.
This transition from a narrow focus on physical attributes to a comprehensive understanding of sexuality defined by psychological factors paved the way for modern conceptions of human sexuality. It laid the groundwork for modern discussions on sexual orientation, desire, and behavior, moving beyond a purely anatomical perspective.
Changing the Paridigm
Krafft-Ebing made significant contributions to the understanding of sexuality. His pioneering empirical work paved the way for a more systematic exploration of human sexuality by subsequent scholars like Moll, contributing to the development of modern sexology.
Krafft-Ebing’s made a distinction between perversity and perversion. He saw perversity as a contingent, immoral conduct of otherwise normal individuals, while perversion indicated inevitable and permanent characteristics traits that were an integral part of one’s nature.
While developing the cornerstone of modern sexology, especially in regards to differenttion and classification of sexual abnormalities, both, Krafft-Ebing and Moll were wrong in their view on the rootcauses of the sexual disorders. Krafft-Ebing was strongly influenced by the bio-medical approach in German psychiatry as well as by the current theory of degeneration, and he, as well as Moll, adhered to biogenetic and evolutionary explanations of sexuality.
This concept has been corrected by Freud’s sexual theory. The Freudian notion that the libido consisted of “component drives” and that normal heterosexuality was the result of a healthy conversion of various impulses, whereas perversions arose from developmental disturbances.
Sexual identity, closely tied to one’s psychological experience of sexuality, represents a fundamental aspect of sexual modernity. This shift in perspective transcended the notion of temporary deviations from the norm to the recognision of sexual deviance as a permanent facet of personal identity and individual’s inner self, whether pathological or not.
This reevaluation of sexual identity had profound implications for how society perceived and addressed sexual deviance, acknowledging it as an intrinsic aspect of human diversity rather than mere aberration.