Erwin J. Haeberle

Abstract Within the last few years, a number of academic training programs in sexology have sprung up in Europe, a fact that has gone largely unnoticed in established academic circles and even among the European sexologists themselves. The Robert Koch Institute has conducted a survey of these programs and has collected the various, now existing, Czech, Polish, Belgian, British, French, Italian, and Spanish curricula and graduation requirements in a brochure "Sexology in Europe«. As the collections shows, there are two basic types of training programs: 1. Training in medical sexology and 2. in non-medical sexology. The latter can be divided again into two groups: 1. Nonmedical sex therapy, and 2. sex education. In view of the rapid process of European integration, leading to a mutual recognition of academic degrees, the paper will discuss the common elements in all of these programs as well as the discrepancies. It will then also make a few suggestions as to the next practical steps to be taken.

In recent years, the demand has been raised that most health professionals should have some basic scientific knowledge about human sexual behavior. That is to say, physicians and psychotherapists, nurses, hospital administrators, marriage and family counselors, family planing officials, community health workers and even epidemiologists should receive at least some sexological training.

This demand is the result of several historical processes which converged early in our century in Europe and later in the USA, and which, among other things, produced a new special science of sexuality. This science was at first a private, rather marginal enterprise, and even today it is still marginalized in our universities, but, in some indirect fashion, it has nevertheless had some surprisingly strong influence on modern social and political thinking. In any case, it is useful to cast a brief glance backward to the beginnings.

There were, I believe, three importart milestones on the way to the present situation:

1. The initial concept of sexology as an interdisciplinary scientific enterprise in Europe before WW I,

2. the acceptance of sexology as an academic field of study in the USA after WW II, and

This publication convincingly illustrates several developments:

There is a considerable and still growing number of sexological institutions and organizations in Europe, although their distribution among the various countries is quite uneven. Many of them keep in contact with each other as members of a European Federation of Sexology, which, in 1992 held its first congress in Taormina, in 1994 its second in Copenhagen, and which, in March 1996, will organize its third congress in Marseille.

There is quite a number of sexological resource centers in various European countries. Some are part of governmental agencies, others are private. Some offer their services free of charge, others ask for small or large fees. Some are open to the public, others restricted to members. Some have only a few selected materials, others have enormous collections. In short, as of now, the general picture is varied indeed.

Nevertheless, the fact that so many sources of sexological information should exist at all, comes as a welcome surprise. Uncoordinated as they are, their very existence is proof enough that they fill a need for many social groups. Professionals as well as the general public are increasingly interested in questions of sexual health, and, in response to this interest, a great variety of initiatives have been and are being taken. Obviously, in the long run, it would be very helpful if many or at least some of these resource centers could form a network in order to maximize each other's strengths. If, for example they could pool their catalogues and transform them into a central data base, the combined resources could be made easily and instantly accessible to very large numbers of people through Internet or by CD-ROM.

As all of these centers know from their own experience, sexological information is regularly - and all too often unsuccessfully - being sought by a great variety of interested parties: Students and professors from all disciplines journalists in both print and electronic media, government agencies, non-governmental organizations, professional associations and private citizens.

At the moment, this enormous need cannot easily be satisfied. Therefore, sooner or later, it will be necessary to avoid duplication and to make more efficient use of the available resources, especially since funding is becoming increasingly scarce everywhere. Our survey of European resource centers may serve as a starting point for the long-overdue process of informational integration. It will undoubtedly produce great benefits for the promotion of Public Health in Europe.

Even more impressive is another development in sexology: There is now a number of academic and professional training programs.

Apart from a few older examples, this has been a rather recent phenomenon. Moreover, such new programs are now being created at an accelerating pace. Of the countries inside the European Union, especially France, Italy, Spain and Great Britain are becoming very active, while the German-speaking countries have fallen far behind. A middle position is being occupied by Belgium and Sweden.

Because of the continuing progress of European integration, however, this asymmetrical development cannot long be ignored. There is no question, for example, that sooner or later legitimate academic degrees in any one of the EU member countries will also be recognized in all all of the other countries. Add to this the free personal and professional movement within the EU, and you have a situation that cries out for immediate attention.

As our survey shows, there are now many different academic and professional degrees being awarded. Some of these are officially recognized by governments and/or other universities, some are fighting for such recognition, and still others are recognized only by various professional organizations. The content of the programs also varies greatly, although there seems to be a general consensus about some canon of basic knowledge. Generally speaking, however, the present programs can be divided into three major groups:

Training in sexual medicine or medical sex therapy, - training in the non-medical psychotherapy of sexual problems, - training in sex education.

Needless to say, this does not exhaust the list of possible sexological training programs (there should at least also be some special training for sex researchers), but our present survey has found only the three kinds of training mentioned above.

It seems safe to predict that, at least within the European Union, both the now existing and all future training programs will have to be brought into agreement with each other. Some form of standardization, at least of the degree requirements, seems unavoidable in the long run. Indeed, some sexological core curriculum will have to be agreed upon in order to facilitate the general acceptance of sexology as a legitimate field of study.

This development will be greatly accelerated by the present rapid spread of computer technology. Once certain basic courses can be made available through Internet or on CD-ROM, some universities will undoubtedly take advantage of this new teaching tool and offer certain smaller or larger segments of their curriculum to long-distance students. This will greatly reduce the time students spend on location. In short: Sexological training will, at least in part, become both cheaper and more widely accessible.

This, in turn, will broaden the academic spectrum within sexology. Even medical schools which now offer nothing more than continuing education in medical sex therapy, will begin to see the merits of a more comprehensive program. After all, there is also an enormous potential market for courses in sex education and non-medical psychotherapy. Such additional curricula, on the other hand, must contain courses on sexual anatomy, physiology, STD's, and other medical matters. Therefore, sheer economic expediency will produce more and more interdisciplinary, integrated schools, departments, or programs of sexology.

In view of all this, it seems prudent to intensify the communication between all interested parties. A strict separation between medical and non-medical sexology is a luxury we cannot afford much longer. Undoubtedly, the former requires especially high standards and therefore must remain restricted to physicians, psychiatrists and paramedical personnel. However, it is important to remember that most actual human sexual behavior is neither sick nor criminal. Nevertheless, it needs to be studied all the more, and therefore a broadbased non-medical sexology is absolutely necessary, both for its own sake and as a corrective for a too narrowly defined medical perspective. In fact, the number of potential non-medical students of sexology is vastly greater than that of medical students can ever be. Sexological knowledge is increasingly useful to a wide variety of professionals: Educators, psychologists, lawyers, criminologists, sociologists, social workers, drug counselors, epidemiologists demographers, ethnologists, historians, journalists, and theologians, to name just a few. It follows, then, that sexological research and teaching institutions ideally should be truly interdisciplinary enterprises open to all serious students.

Let me be very clear about this: We would all make a very serious mistake, if we were to contend ourselves with the rapid progress of medical sexology. Sex is not a disease, and the study of sex must not be restricted to the study of its dysfunctions. Just as geology cannot be restricted to the study of earthquakes and vulcanic eruptions, just as history cannot be restricted to the study of wars and revolutions, and just as economics cannot be restricted to the study of bankruptcies and stock market crashes, sexology cannot be restricted to the study of sexual disease and crime. Any such restriction would be not only shortsighted, but fundamentally unscientific. Indeed, sooner or later it would cut medical sexology off from the very sources of its success, would isolate it from the rest of the scientific community and finally turn it into an obsolete, esoteric and harmful kind of quackery. Society would lose patience with it, and its well-deserved demise would then also threaten all other sexological specialties.

I am not talking about a vague and distant danger here. Indeed, as the history of psychiatry and sex therapy amply illustrates, the clinical treatment of real and alleged behavior problems always runs the risk of becoming too rigid, too strict, too orthodox, too sure of itself. Very often, clinicians have not only been unhelpful, but positively destructive. Instead of alleviating problems, they have created new ones. Instead of helping patients they have produced victims. Examples abound, from the medical persecution of masturbators and the oppression of sexually vigorous women to the stigmatization of homosexuals and the psychiatric torture of transvestites and other gender non-conformists. If, over the last century, sex therapy has succeeded again and again in climbing out of the trap of self-indulgent dogmatism, it was only because it was wise enough to correct its own professional myopia, to broaden its perspective and to listen to colleagues from other disciplines, such as biologists, sociologists, ethnologists, historians and philosophers.

Even today, sex therapy is not yet free of unscientific or rather prescientific concepts, unquestioned false assumptions, misleading terms and other ideological ballast. The recent, repeated revisions of American and other diagnostic manuals indicate that the awareness of these problems is growing, but the process of revising and updating must continue, and the necessary dialogue between different sexological specialties in both the natural and the social sciences must therefore be institutionalized. Obviously, the best way of doing this is the creation of truly interdisciplinary Institutes of Sexology. Experience has shown, however, that these have the best chance to grow if they are not part of a medical school. On the contrary, it is in the best interest of all sexologists, including medical sexologists, if such institutes are independent or tied to non-medical programs.

It is to be hoped that European universities will soon recognize all of this and draw the inescapable conclusions. In any case, the processes of European integration and the fast advancing computer technology are now making many traditional academic approaches obsolete. For sexology, however, a hitherto marginalized science, these recent developments are a boon. The already existing programs, taken together, form a very promising basis for a consensus and rapid progress as a result of mutual support.

Finally, looking at the European scientific journals in sexology, it is striking that most of them are still devoted to medical and therapeutic aspects of sex. This has not always been so.

True, the first scientific journal devoted entirely to sexual questions was published 1896 in Italy: »Archivio delle psicopatie sessuali«, edited by the psychiatrist Pasquale Penta. However, three years later, in 1899, the Berlin physician Magnus Hirschfeld began publishing his »Jahrbuch für sexuelle Zwischenstufen« (Yearbook for Intermediate Sexual Stages), which championed the cause of homosexual emancipation. Accordingly, the Yearbook presented mostly biological, legal, political, historical, literary, sociological and ethnological articles along with medical and psychological case histories. It was also Hirschfeld, who, in 1908, published the first »Zeitschrift für Sexualwissenschaft« (Journal for Sexology) which lasted only for one year but was refounded in 1914 by Iwan Bloch and Albert Eulenburg. Eventually edited by Max Marcuse, it appeared regularly until 1932, when the growing threat of Nazism forced it to cease publication. Again, this journal covered an enormous spectrum of scientific and scholarly approaches, from dermatology and gynecology to psychoanalysis, history, anthropology, law, literature and art. There is no doubt that, during the 18 years of its life, it was the leading periodical in the field. Hitler's rise to power and the following Second World War, however, destroyed the work of our sexological pioneers all over Europe.

It was only in 1948 that the Australian-born physician Norman Haire began to publish »The Journal of Sex Education« in London. He had been a close friend of Hirschfeld's and was, in fact, one of the last survivors of the pre-war generation of sexologists. In the meantime, a considerably number of sexological journals has newly appeared, and new one are constantly being added. In their totality they are a strong testimony to the increasing vitality of our field.

However, the preponderance of therapeutic journals in Europe is worrisome. This is in contrast to American sexological journals, which, taken together, show a much wider spectrum of approaches: They represent not only clinical disciplines, but embrace many other research interests. There is no compelling reason, why, in sexology, the social or cultural sciences should be left to Americans. Indeed, European sexologists should take up the challenge and publish their own journals of the history, economy and sociology of sex, sexual politics and sex education.

It remains to be seen, if the American outline is ever made available electronically either on Internet or on CD-ROM. It would certainly be an excellent teaching tool that could be used world-wide. In the meantime, one could distribute this outline gratis in printed form at sexological congresses, provided, one finds a sponsor. As a matter of fact, such a sponsor could hardly find a more potent vehicle for his advertising than the free distribution of a twovolume set: »Sexology in Europe« and »An Outline of Sexology«.

Both of these works, of course, need adaptation in other countries, constant revision and periodic updating, and therefore their ideal medium is an electronic one. Still, at the present time and for the next two ore three years a printed set could do wonders for the field. It could provide the ignition for a rapid and spectacular take-off of sexology in Europe. No other tool can hope to be as effective in furthering a professional consensus, setting internationally recognized standards or providing so much sexological information so quickly to so many. However, this information will not reach all those who need it, if it is not provided free. That is to say, the package cannot be a commercial product. Indeed, it must be delivered at no cost whatsoever to anyone who is interested in it.