History, causality, and sexology.

In 1896, Krafft-Ebing published Psychopathia Sexualis. Popularly defined as hereditary weakness or taintedness in the family pedigree, degeneracy was called upon as a causal explanation for perversions of the sexual innstinct. Although Krafft-Ebing accepted Karl Ulrichs' proposal that homosexuality could be innate and probably located in the brain, he paid little attention to neuropathological sexology. Alfred Binet challenged Krafft-Ebing's orthodoxy by explaining fetishism in terms of associative learning, to which Krafft-Ebing's response was that only those with a hereditary taint would be vulnerable. Thus did the venerable nature-nurture antithesis maintain its rhetoric, even to the present day. Krafft-Ebing died too soon to meet the Freudian challenge of endopsychic determinism, and too soon also to encounter the idea of a developmental multivariate outcome of what I have termed the lovemap. Like other brain maps, for example the languagemap, the lovemap requires an intact human brain in which to develop. The personalized content of the lovemap has access to the brain by way of the special senses.

SANTAYANA'S ADAGE

"Those who cannot remember the past are condemned to repeat it." These are the words that Santayana actually wrote in The Life of Reason (1905), though they are often paraphrased as "those who do not study history are condemned to repeat it." Sexology today is, through inattention to its own historical doctrines, condemned to repeat them, as is evident in the contemporary antithesis between the biomedical versus the social constructionist model of causality in sexology, which is a reincarnation of the outmoded antithesis between nature and nurture. For its very existence, nature needs nurture, and likewise, nurture needs nature (Ridley, 2003; Wallen, 1996). They are not antithetical, but complementary. Otherwise there is a blank. Nothingness.

A dozen or more years ago I began a search of the sexological literature for causal postulates of sexuopathology or "sexual perversion" as it was formerly named. Until the end of the 19th century a juridical postulate almost exclusively held sway. Perverts, according to this postulate, committed sexual crimes by choice, voluntarily. It was their preference. Even today, no other causal explanation is needed according to the criminal justice system.

Formerly the criterion standard of perversion was procreation: Any manifestation of the sexual act in humankind except the procreative act of genital copulation was a perversion. Masturbation, known as onanism, was included, and so also were nocturnal pollution, anal or oral sex, pornography, harlotry, homosexuality and more.

The first sexological challenge to the postulate of perversion by choice was launched on behalf of homosexuals by a jurist. Karl Ulrichs, in the 1860s (Kennedy, 1988). Juridically, homosexuality was known us the perversion of sodomy. Based on the self-knowledge of being himself homosexual, Ulrichs postulated an inborn causality which he located in the brain.

HEREDITARY DEGENERACY

Ulrich's ideas influenced Richard von Krafft-Ebing: Witness the extended title of his benchmark book, Psychopathia Sexualis with Special Reference to the Antipathic Sexual Instinct: A Medico-Forensic Study, which first appeared in 1886. Krafft-Ebing followed the medical orthodoxy of the day in attributing psychopathology in general and sexual perversion in particular to degeneracy. However, unlike his 18th-century predecessor, the much-quoted Swiss physician Simon Andre Tissot (1832/1974), he did not attribute degeneracy to the loss of vital fluid by masturbation. The causal explanation of degeneracy that he most favored was hereditary taintedness in the family pedigree.

Under the name of atavism, the idea of hereditary taint was blended with Darwinian evolution in reverse by Cesare Lombroso (1876/1972). Atavism signified reversion to a more primitive evolutionary stage of development, which was manifested in not only criminal pathology but also in anomalies and deformities of body morphology (the so-called stigmata of degeneracy). Atavism has reached a dead end in today's theoretical sexology.

The concept of hereditary taintedness antedated the rediscovery of Mendelian genetics and was compatible with Lamarckian theory of the inheritance of acquired traits. Lamarckianism was widely popular in Krafft-Ebing's day. Hereditary taintedness became the basis of the theory of social eugenics and racial purity, which reached its apogee in Hitler's holocaust. The concept of heredity itself, however, look a new lease on life in sexology after the discovery of chromosome counting led to the discovery of the sex chromosomal syndromes of 47,XXY (Klinefelter syndrome), 47,XYY (supernumerary Y syndrome), and 45,X (Turner syndrome). Mapping and sequencing of the genome is applicable to sexuopathological behavior (violent and hypersexual) in genetic "'knockout" mice, but has yet to become applicable to the etiology and treatment of human sexuopathology (summarized in Money, 1997; Nelson et al., 1995).

NEUROPATHOLOGY 

Krafft-Ebing mentioned only 22 cases of brain disorder in Psychopathia Sexualis: 3 cases of idiocy were attributed to innate mental weakness, whereas 2 cases of brain injury, 5 of late stage syphilis, and 12 of epilepsy were attributed to mental weakness. In the meantime, the functional and structural neuropathological determinants of sexuopathology have become a rapidly developing field of human clinical and animal experimental research, as in the new technology of brain scanning. The neurohormonal chemistries of sexuopathology were unknown and unknowable to Krafft-Ebing or anyone else in the 19th century, as the sex hormones were not isolated and synthesized until well into the 20th century (Young, 1961).

ASSOCIATIVE LEARNING

Krafft-Ebing's use of the principle of tainted heredity and degeneracy was challenged by Alfred Binet (of intelligence test fame), who propounded a theory of associative learning to explain fetishism (Hoenig, 1977; Pinkava, 1989). Krafft-Ebing accepted the challenge by adding the proviso that degeneracy predisposed one to the learning of fetishism. Binet's associationism, stripped of the proviso of hereditary degeneracy, eventually became incorporated into the theory of operant conditioning and behavior modification. Somewhat later, associative learning became epistemologically allied in some quarters with social constructionism and subject to being misconstrued as the antithesis of biological determinism (essentialism). Associationism has not been able to explain individual differences in susceptibility to sexuopathology. Sexual addiction, a newly invented diagnosis, has the same shortcoming.

My own contribution to associative learning in sexology is based on imprinting theory (Eibl-Eibesfeldt, 1971; Lorenz, 1952). It replaces the diffuse concept of instinct with the concept of phylism (Money. 1983, 1990)). A phylism is a building block of behavior that belongs to an individual by reason of that individual's phytogenic heritage as a member of its species. It is activated when three innate mechanisms--namely, the mechanisms of recognizing, releasing, and responding--are concordantly matched at a specified time or stage of development to produce a fixed action pattern that may be very long-lasting. Like associative learning overall, phylismic theory does not explain individual susceptibility to sexuopathology.

ENDOPSYCHIC DYNAMICS

Although Freud did not follow Krafft-Ebing's example and postulate hereditary weakness or taintedness as a predisposition toward sexual perversion (a term Freud consistently used, logistically he could have done so. His self-appointed task was to formulate an exclusively endopsychic explanation of perversion and sexuality in general not in terms of sexual practices only but also in imagery and ideation, conscious and unconscious. When he resorted to extrapsychic sources, it was to use them as metaphors for his own theory. Thus, the evolutionary stages of Ernst Haeckel's gastrea theory became metaphors for Freud's developmental stages of infantile "polymorphous-perverse" sexuality: oral, anal, phallic, and genital (Sulloway, 1979). The outcome of either arrest of development or regression to an earlier stage without repression was said to be perversion, and with repression, neurosis. Freud did not find a satisfactory answer to the question of who would be predisposed to develop either a perversion, a neurosis, or neither. There probably is no answer within the dynamics of an exclusively endopsychic theory. In other words, endopsychic theory is a universe of discourse unto itself.

MULTIVARIATE DEVELOPMENTAL LOVEMAPS

Today's term paraphilia has largely though not completely replaced perversion in the literature on sexuopathology. Since Krafft-Ebing's day until nearly the present, what has been missing from a causal explanation of paraphilia or perversion is a developmental theory based on longitudinal, not cross-sectional, studies. Such a theory will, of necessity, be not univariate but multivariate. The variables will be genomic status; hormonal history (prenatal and postnatal); sexual brain cell functioning; history of toxic, infectious, or traumatic exposure; infantile pairbonding; juvenile troopbonding; juvenile sexual rehearsal play; sex education; adolescent sexual history; amative history in imagery, ideation, and practice; and so on.

Funding for a long-term follow-up study is a serious obstacle, and all the more so when the subject matter is as sensitive as sex has been in the moral philosophy and theology of our society for longer than two millennia. Although informed consent and the right to privacy are important in any type of investigation that pertains to human subjects, both are subject to special scrutiny by institutional review boards when the investigation pertains to sex. The right to refuse or withdraw from participating in any investigation effectively prohibits random sampling in favor of availability sampling in sexology. In my own longitudinal research, I have not undertaken contrived experiments, but have taken advantage of so-called "experiments of nature" and real-life clinical situations to build up an outcome database. To deal with the issue of multivariate developmental determinism, I have formulated and named the concept of the lovemap (Money. 1986, 1999; Money and Lamacz, 1989). I have written about the development of lovemaps in two volumes, one entitled Principles of Developmental Sexology (Money, 1997) and the other Biographies of Gender and Hermaphroditism in Paired Comparisons (Money, 1991). To develop, a lovemap requires, like other brain maps (e.g., the speechmap), an intact human brain into which the layout of the map has access by way of the special senses.

For the future development of sexology, I think it is important that our theories of causation not be pitted against one another, but rather reconciled as components of a larger whole. To quote from physics, our ultimate search should be for "a theory of everything." Sexological specialization notwithstanding, we all should subscribe to the same periodically updated encyclopedia of sexological knowledge and the same dictionary for the definition of terms. For example, is gender a synonym for sex or does it have its own specific meaning? We should study our own history so as not to repeat it.

CONCLUSION

It is risky to don a cap of prophesy, but if I do, then my prophetic utterance is that increase in sexological knowledge will occur not at a fixed rate but in unforeseen saltational leaps: witness the unforeseen Internet leap. The cutting edge of research will be in the animal lab rather than in human investigation. Thus it will be more about sexual practices than about erotic imagery and ideation. Social constructionism will be sidelined in social science and the humanities, where it will be used to explain shifts in sexological ideology rather than the development of individual sexuality. Freudian sexual doctrine will become the secular counterpart of ecclesiastical sexual doctrine.

We live in an era when science is on the gallop. We do not know what to expect. So I now discard my hat of prophesy and admit my ignorance. Thanks again to the Eastern Region of the Society for the Scientific Study of Sexuality for the honor you bestow on me annually in naming The John Money Award for Significant Contributions to Sexology.

REFERENCES

Eibl-Eibesfeldt, I. (1971). Love and hate: The natural history of behavior patterns. New York: Holt, Rinehart and Winston.

Hoenig, J. (1977). The development of sexology during the second half of the 19th century. In J. Money & H. Musaph, (Eds.), The handbook of sexology. Amsterdam: Excerpta Medica/Elsevier.

Kennedy, H (1988). Ulrichs: The life and works of Karl Heinrich Ulrichs, pioneer of modern gay movement. Boston: Alyson.

Krafft-Ebing, R. von. (1931). Psychopathia sexualis with special reference to the anticipathic sexual : A medico-forensic study (12th ed., F. J. Rebman, Trans.). Chicago: Logan Brothers. (Original work published 1886)

Lombroso, C. (1972). Criminal man (Trans.). Montclair, NJ: Patterson Smith. (Original work published 1876)

Lorenz, K. (1952). King Solomon's ring: New light on animal ways. New York: Crowell.

Money, J. (1983). New phylism theory and autism: Phathognomonic impairment of troopbonding. Medical Hypotheses. 11, 245--250.

Money, J. (1986). Lovemaps: Clinical concepts of sexual/erotic health and Pathology, paraphilia and gender transposition in childhood, adolescence, and maturity, New York: Irvington.

Money, J. (1990). Pedophilia: A specific instance of new phylism theory as applied to paraphilic lovemaps. In J. R. Feierman (Ed.), Pedophilia: Biosocial dimensions. New York: Springer-Verlag.

Money, J. (1991). Biographies of gender and hermaphroditism in paired comparisons: Clinical supplement to The Handbook of Sexology. Amsterdam: Elsevier

Money, J. (1997). Principles of developmental sexology. Amherst, NY: Promentheus Books.

Money, J. (1999). The lovemap guidebook: A definitive statement. New York: Continuum.

Money, J. & Lamacz, M. (1989). Vandalized lovemaps: Paraphilic outcome of seven cases in pediatric sexology. Buffalo, NY: Prometheus Books.

Nelson, R. J., Demas, G. E., Huang, P. L., Fishman, M. C., Dawson, V. L., & Snyder, S. H. (1995). Behavioral abnormalities in male mice lacking neuronal nitric oxide synthase. Nature, 378, 383--386.

Pinkava, V. (1989). Logical models of variant sexuality. In G. D. Wilson (Ed.), Variant sexuality: Research and theory. Baltimore: Johns Hopkins University Press.

Ridley, M. (2003, June 2). What makes you who you are. Time, 161, 55--63.

Santayana, G. (1905). The life reason. New York: Scribner.

Sulloway, F. J. (1979) Freud, biologist of the mind. New York: Basic Books.

Tissot, S. A. (1974). A treatise on the diseases produced by onanism (Trans.). In C. Rosenberg & C. Smith-Rosenberg, (Eds.), The, secret vice exposed! Some argument against masturbation. New York: Arno Press. (Original work published 1832)

Wallen, K. (1996). Nature needs nurture: The interaction of hormonal and social influences on the development of behavioral sex differences in rhesus monkeys. Hormones and Behavior. 30, 364--378.

Young, W. C. (Ed.). (1961). Sex and internal secretions. Baltimore: William and Wilkins.

Manuscript accepted June 16, 2003

This paper was written in response to the inauguration by the Eastern Region of the Society for the Scientific Study of Sexuality of The John Money Award for Significant Contributions to Sexology. The author was supported in research by the National Institute of Child Health and Human Development, Department of Health and Human Services. Grant #R25-HD00325-46.

Address correspondence to John Money, Ph.D., Professor Emeritus of Medical Psychology and of Pediatrics. Psychohormonal Research Unit, The Johns Hopkins Hospital, 1235 E. Monument St., Suite LL120, Baltimore, MD 21202-5300: e-mail: [e-mail].