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HEALTHY - SICK
Where the violation of sexual norms is defined as a medical or psychiatric problem, sexual conformity and sexual deviance are seen as mental health and mental illness. Conforming sexual behavior is described as "mature", "productive", and "healthy". Deviant behavior is called "immature", "destructive", and "sick".
Historically speaking, this is a relatively recent view. It originated in the "Age of Enlightenment" and its first proponents were chiefly concerned with obtaining better treatment for deviants. Before that time, sexual deviants had often been regarded as heretics or criminals, and thus they were hated, ostracized, tortured, and even killed with little compunction. After all, nobody doubted that their behavior was prompted by willful malice. On the other hand, the claim that they were, in fact, medical patients suddenly turned their deviance into a disease and relieved them of all responsibility for their actions. Instead of punishment, they now needed medical therapy.
There is no question that the new "enlightened" doctors were more considerate and sympathetic than either the inquisitors or the jailers, at least in the beginning. Instead of the stake or wheel they prescribed special diets, fresh air, cold baths, and moderate exercise. Instead of dark, fiithy dungeons they provided clean, bright, and airy hospitals. Even more important, there soon developed a special branch of medicine devoted exclusively to deviant behavior: "mindhealing" or "psychiatry". In short, as compared to their previous fate, the deviants seemed to have made a good bargain.
However, over the years it became rather obvious that the medical interpretation of deviance also had disadvantages. First of all, as the influence of psychiatry grew, many more individuals were said to suffer from sexual "psychopathology" than had ever been accused of sexual heresy or sexual crime. Psychiatrists treated not only cases of "sodomy", "bestiality", rape, and incest, but also many other forms of deviance which had been ignored by the Inquisition and the courts. For example, persons who changed their sexual partners frequently were said to be afflicted with "promiscuity", women who enjoyed sexual intercourse were declared to be victims of "nymphomania", children and adolescents who "abused themselves" had to be saved from "masturbatory insanity", and persons who felt an erotic attraction to members of their own sex, even if they never acted upon these feelings, were described as suffering from a pathological condition called "homosexuality". All of these people and many others who defied sexual convention became candidates for psychiatric treatment, and it was their moral duty to seek such treatment in order to "get well". While they were no longer responsible for their sexual behavior, they had a clear obligation to cooperate with their psychiatrist who tried to "correct" it. If they refused, they had to be treated involuntarily "for their own good".
As the list of sexual diseases expanded, so did the therapeutic arsenal. For instance, in the 18th century masturbators were usually treated with moral exhortations, cool room temperatures, and constant supervision. Later, with the perfection of surgical skills, they were circumcised or infibulated. In the 19th century their sex organs were burned or blistered, the nerves of the penis were severed, or the clitoris was cut out. (This latter operation was also recommended for "excessively" orgasmic women and "nymphomaniacs".) When operating techniques improved still further, the testicles or ovaries were surgically removed. In sum, eventually "medical treatments" of masturbation became so drastic that they began to resemble the medieval tortures which they once had been supposed to replace. The formerly progressive doctors had turned into agents of sexual oppression. (For details see "Types of Sexual Activity—Sexual Self-Stimulation".)
Today we may shudder at these barbarities and dismiss them as unfortunate aberrations or as horror stories from the dark ages of medicine. After all, we no longer believe in masturbatory insanity, and we know that even "excessive" masturbation is no threat to health. Indeed, there are some psychiatrists today who prescribe it as a means of overcoming sexual inadequacy. However, when we look back a little bit further into the past, we find that the problem has wider implications. Thus, we learn, for example, that masturbation had already been recommended as therapeutic in ancient Rome, and that this view was still held by medieval Islamic doctors. In other words, the medical crusade against masturbation turns out to have been a thoroughly modern phenomenon, restricted entirely to the Western world.
A similar observation can be made in regard to homosexual behavior. We know, of course, that in ancient Greece and Rome such behavior was considered healthy and moral, and that its later condemnation was due mostly to Judeo-Christian religious doctrines. Still, it is perhaps less commonly realized that even in Christian Europe it was, on occasion, used as medical treatment. For example, when, in the 17th century, William of Orange (later King William III of England) fell ill with the smallpox, his physicians suggested that he sleep with one of his pages in order to absorb some "animal spirits" from a young, healthy body. Since the patient was known to enjoy sleeping with his pages, the prescription was easily followed. Naturally, the young man caught the disease from his master, but eventually both of them recovered. (William did not fail to show his appreciation and, in due time, made his page Duke of Portland.) Less than two hundred years later, homosexuality was declared to be a mental disease, and homosexuals began to be treated for it by psychiatrists. Needless to say, in order to be ''cured", the patients had to forswear any further homosexual activity. However, in our own century some "radical" psychiatrists again rejected the "sickness theory" and told homosexuals to seek the liberation from their emotional problems in "gay activism" and satisfying sexual relationships. Thus, homosexual intercourse, far from indicating any illness, once more turned into a therapeutic measure. (According to the most recent official position of the American Psychiatric Association, homosexuality as such is not a disease.)
As these examples illustrate, over the years the concepts of sexual health and illness have undergone some extraordinary changes. Behavior which was seen as healthy at one time was regarded as sick at another time, and those who engaged in it found themselves alternately praised and condemned by medical authorities. Indeed, one can almost gain the impression that the "pathology" of sexual acts has never been more than a matter of fashion, and that, throughout history, doctors have .promoted or discouraged such acts on no other basis than popular prejudice.
Nevertheless, this cynical view would be wrong. It is, of course, obvious that the medical profession cannot operate outside the general framework of popular moral standards, but in many specific instances it can set its own standards and have them accepted by the public at large. In other words, there are times when the physician can lead and public opinion will follow. The annals of medicine record many such cases, and the "enlightened" conversion of sexual heretics and criminals into medical patients is itself perhaps the most striking example.
Still, even the most progressive physician or psychiatrist who approaches sexual deviance cannot proceed without making some value judgments about the "proper" role of sex in human life. His values may very well differ from those of the official sexual morality, but they will certainly influence every one of his actions. This remains true even if he decides not to take any action at all. Furthermore, any medical or psychiatric "treatment" involves certain fundamental, if sometimes unrecognized, professional assumptions. These have to do with the criteria for health and disease, with the choice between various disease models, the choice of therapy, and with the possibility and urgency of a cure.
It is this whole set of assumptions which has to be examined if one wants to evaluate the medical or psychiatric approach to sexual deviance. As a matter of fact, such a critical examination is essential for doctor and patient alike. If both of them keep an open mind, they may, in many cases, discover that they are not dealing with a medical problem and that any medical intervention would therefore be inappropriate. On the other hand, they may also find that in certain difficult life situations medicine and psychiatry offer the best hope.
In the following pages we will try to describe how some medical and psychiatric assumptions about sexual deviance originated, how they developed in Europe and the U.S., and how widely they are accepted today in other countries.
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