Step Children of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity.

Step Children of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity. By Harry Oosterhuis. Chicago: University of Chicago Press, 2000, 321 pages. Cloth, $30.00.

This well-documented book is the kind of historical study essential to understanding how current concepts of sex and sexuality developed. It challenges the Foucaultian interpretation, and moves Krafft-Ebing from what some have regarded as a negative influence on sexual attitudes to a position of having been a positive influence. Long in the making, this book is based on Krafft-Ebing's files, lovingly preserved by his family in the attic of his home where they remained undamaged by the destruction of two world wars. In addition to manuscripts of his publications, summaries and notes, and letters and postcards from friends and colleagues, the files include 1,386 case histories of his patients, dating from 1871 to 1902. In about 200 of these client records, letters, and autobiographical accounts, as well as correspondence with third parties, are also included.

Oosterhuis, a Dutch historian, discovered this treasure trove of documents by simply knocking on the door of Rainer Krafft-Ebing, the great-grandson of Richard von Krafft-Ebing, in the summer of 1992. The house was the same one in which his great-grandfather had lived and the files were still in the attic where they had been gathered together when he died in 1902. Ultimately the family gave him free access to the files and even invited him to stay with them while he researched the papers.

Importantly, this book is more than a biography of Krafft-Ebing; it is essentially a history of sex research in the last part of the nineteenth century and of changing ideas about sexuality. The book also reveals just how much Freud owed to Krafft-Ebing and his contemporaries. Perhaps inevitably, in recent years as the history of sex research is finally being recovered it turns out that Freud's ideas about sex were heavily dependent upon what others had written (to whom Freud did not always give credit).

Krafft-Ebing is best known to American audiences for his Psychopathia-Sexualis, which went through 11 editions in his lifetime and continued long after he was dead (the book was updated and edited by others, including 2 editions by Albert Moll). However, this one book was but a small part of Krafft-Ebing's total scholarly output, since he wrote more than 25 other books and hundreds of specialized monographs. His subject matter was varied: from pedophilia to flagellation, from menstruation to hypnotism, from clinical case studies to historical essays. He also modified his position over the years, and these changes can be followed in the various updates of Psychopathia Sexualis as he continually added new cases (based more and more on his own clinical practice). This growth and change, however, is not evident in the English translations of his work, which covered only 2 of the many editions.

All editions of Psychopathia Sexualis give more concern to homosexuality than some other issues, but this is because understanding homosexuality seemed to be one of the dominating interests in Krafft-Ebing's own research and clinical studies. This interest seems to have been first aroused by Ulrichs, the influential writer on homosexuality. Ulrichs became a client of Krafft-Ebing's in 1869 and the two became friends, exchanging ideas on homosexuality. Greatly influenced by what Ulrichs said, Krafft-Ebing eventually became an advocate for decriminalization of homosexuality and was often called upon by the courts for advice on the topic.

It was Krafft-Ebing who popularized the term homosexuality. The use of such a term, he felt, was important to his clients because it emphasized what he believed was their psychological need for an identity which existed independently of conduct. In fact, he came to believe that a person could be homosexual without necessarily showing what was regarded as homosexual behavior. Krafft-Ebing also found in many of his case studies, much to his initial surprise, that love played a significant role in many same-sex relationships.

Although Krafft-Ebing conceptualized homosexuality as an inversion, what constituted inversion changed as he found that large numbers of homosexuals (whose autobiographies he collected) did not consider themselves effeminate at all. He began to regard homosexuality as an object choice rather than a gender inversion. Krafft-Ebing stressed that homosexuals were different from sodomites or pederasts, not only because he came to believe that most male homosexuals recoiled from anal intercourse and preferred other (in his eyes less offensive) sexual activities, but because of their homosexual state of mind which had begun to express itself from early childhood, independently of their sexual conduct. This notion allowed Krafft-Ebing to differentiate along a rigid line between contrary sexual feeling, be it inborn or acquired, and "irregular" same-sex behavior of normal men which he condemned as immoral.

Ultimately Krafft-Ebing also concurred with his bourgeois patients and correspondents that homosexual love was equivalent to heterosexual love and that it, therefore, was legitimate in a moral sense. In the last article that he wrote on the subject, and one which has particular meaning for today, Krafft-Ebing agreed that Ulrich's striving for the recognition of homosexual marriage proved that this kind of love was genuine and profound. Krafft-Ebing, however, continued to think that the masculine type of homosexuality was more respectable and sincere, and much more advanced than the effeminate types.

Krafft-Ebing was not only a major figure in sex research, but, according to Oosterhuis, a pioneer in the founding of modern psychiatry. In the first part of the nineteenth century, it had been the aim of alienists (as psychiatrists were then known) to cure a relatively small group of lunatics. By the end of the nineteenth century, however, the mission had changed to concern for the fundamental irrationality of the human mind in general and the omnipresence of abnormality within society. Psychiatrists extended their scope from pervasive dysfunction to mental states that fell within the range of normal human experiences but yet might lead to mental disorders. Early on Krafft-Ebing himself turned away from the insane in the asylum (where he had started) and concentrated on his career in academia, his private practice, and his psychiatric writing.

In his work on sexuality, Krafft-Ebing hinted that the very boundary between the normal and the insane, which psychiatry had originally helped to institute, was fragile and permeable, an explanation which Oosterhuis believes is the key to modern psychiatry. In each succeeding edition of his Pyschopathia Sexualis, Krafft-Ebing, relying on his correspondents and case studies, exhibited a growing understanding of the need to educate his readers about the sources of their sexual awareness, self-knowledge, and identity formation. By so doing he prepared the way for the acceptance of sexual variance in society at large. This positive and liberal-minded sexologist, in Oosterhuis' view, countered the biases of church, government, and the legal system by his more scientific approach, aimed at understanding. Although Krafft-Ebing never quite reached the favorable views of sexuality accepted at the end of the twentieth century, he prepared the way for them.

In short, though Krafft-Ebing had many of the attitudes and prejudices of the nineteenth century culture, he was a liberating force for change, and anticipated the attitudes of the last part of the twentieth century toward sexuality and identity. It might well be that we had to await for nearly a century after his death to have a biography because so many of his contemporaries were hostile to his liberalizing views about sex, and when societal attitudes began to change it was only a distorted version of Krafft-Ebing that survived, discouraging further research into his life. Although I have written some on Krafft-Ebing (Bullough, 1994), and was much more favorable toward him than most of my contemporary American readers, I must admit that if I was writing now, I would give him even more favorable treatment.

As a historian, Oosterhuis' book emphasizes to me once again the necessity of searching out the writings of our predecessors in sexology and doing so in the languages in which they wrote. Translations, as Krafft-Ebing's story exemplifies, are so often inadequate if not erroneous. The writings of only a few of our predecessors in sexual science have been available to readers in English. Freud was an exception, but the more we know about his contemporaries and predecessors, the more we realize how much he depended on them for his ideas (although he often adjusted them to his own use). As more sources become available in English, which unfortunately for most American sexologists is the only language they can read, the more we realize just how much we have been reinventing the wheel. Fortunately, the major writings of Ulrichs (1994) and some of Hirschfeld's (1991, 2000) have recently been translated into English by Lombardi-Nash, and now Oosterhuis has given us new insights into Krafft-Ebing. However, this is just a beginning.

Oosterhuis' book is a pioneering work about a pioneer who was a major force in changing ideas and concepts about sexual identities. Oosterhuis is to be commended for making us once again aware of just how much we owe to those who struggled with the problems of sex research long before any of us were born.

REFERENCES

Bullough, V. L. (1994). Science in the bedroom. New York: Basic Books.

Hirschfeld, M. (1991). Transvestites. Translated by Michael Lombardi-Nash. Buffalo, NY: Prometheus Books.

Hirschfeld, M. (2000). The homosexuality of men and women. Translated by Michael Lombardi-Nash. Buffalo, NY: Prometheus Books.

Ulrichs, K. H. (1994). Man-manly Love, 2 vols. Translated by Michael Lombardi-Nash. Buffalo, NY: Prometheus Books.

Reviewed by Vern L. Bullough, Ph.D., R.N., 3304 West Sierra Drive, Westlake Village, CA 91362; e-mail: [e-mail].