Arnold I. Davidson's "Closing Up The Corpses" from _The Emergence of Sexuality; Historical Epistemology and the Formation of Concepts_

Davidson

Arnold I. Davidson

The Emergence of Sexuality; Historical Epistemology and the Formation of Concepts

Harvard UP 2001

Chapter One: 

Closing Up The Corpses

Davidson begins with Foucault (and he'll be with us till the end) observing that in THE BIRTH OF THE CLINIC that Foucault had traced the "conjunction of pathological anatomy and clinical medicine" and "emphasize[d] the significance of pathological anatomy as a foundation for the description and classification of diseases"(1). After a bit of clarification he cites Foucault's conclusion about these matters, that "the great break in the history of Western medicine dates precisely from the moment clinical experience became the anatomo-clinical gaze"(2).

But Davidson will be concerned not with Medicine per se, but with psychiatry. 

"One of the great breaks in the history of Western psychiatry comes precisely during the time when the anatomo-clinical gaze is in steady decline. The story of psychiatry's emergence, in the nineteenth century, as an autonomous medical discipline, and specifically its autonomy from neurology and cerebral pathology, is, in part, the history of this decline. Pathological anatomy could not serve psychiatry either as an explanatory theory for so-called mental diseases or disorders or as the foundation for the classification and description of these diseases. But the gradual and virtually anonymous disappearance of pathological anatomy in psychiatry is not merely the history of decline. For with this decline came the proliferation of whole new kinds of diseases and disease categories, a revitalization and reworking of nosologies the consequences of which stamp us even today. Foremost among these new disease categories was the class of functional diseases, of which sexual perversion and hysteria were the two most prominent examples. Although the hope that these functional diseases would yield to pathological anatomy was held out long after there was any evidence for this hope, in clinical practice, and later in theory as well, these diseases were fully describable simply as functional deviations of some kind; in the case of sexual perversion, for instance, one was faced with a functional deviation or abnormality of the sexual instinct. Admitting pure functional deviations as diseases was to create entire new species of diseased individuals, and to radically alter our conceptions of ourselves"(2).

Davidson gives us a three stage model of the emergence of "sexual perversion". First "sexual perversion was thought to be a disease of the reproductive or genital organs (…) whose basis was some anatomical abnormality of these organs"(3). The second stage comes when, failing to find anything "wrong" with the organs in cases of "sexual perversion" it is asserted that the answer is to be found in "the neurophysiology and neuroanatomy of the brain"(3). So the first two are both still engaged with the "anatomo-clinical gaze" but directly their gaze differently. "The third stage took perversions to be pure functional deviations of the sexual instinct, not reducible to cerebral pathology" instead "Perversions were to be viewed and treated at the level of psychology, not at the grander level of pathological anatomy. The psychiatric style of reasoning emerged clearly and definitely at this third stage"(3).

"In the years between 1870 and 1905 psychiatry was caught between two conceptual grids; in one of which it was aligned with neurology, in the other with psychology"(3).

"During this span of time, no one really knew what it would mean to conceive of diseases like perversion in purely functional terms. It would be like admitting functions without organs, which, as Bouillard reminds us, was a palpable absurdity"(4).

"The real break, the new style of reasoning, is to be located at that point when the sexual instinct and its functional diseases were introduced together. Functional diseases were diseases of something - not an organ, but an instinct"(4).

Davidson is discussing the work of one Dr. Michea (late 1800s) and his ruminations on the causes of deviations of the sexual instinct (i.e., perversion, or homosexuality more accurately still) and a certain anatomical cause within the male body which explains these. 

"Nothing could be more natural than to expect these feminine tendencies to have some anatomical basis; and nothing could constitute a more appropriate anatomical basis than a masculine uterus. The uterus, that almost always diseased female organ, was responsible for masculine deviations as well!"

"Since it was natural to suppose that all behavioral disorders had an organic basis, and since the behavioral manifestations in question were diseases of sexuality, it seemed inevitable that the sexual organs themselves must be the seat of the perversions"(6).

"…to the consternation of the pathological anatomists, the conclusion is virtually always the same - genital organs, normal; no physical malformations of the reproductive organs"(7). Anatomy had proven in this case to be "a useless explanatory space"(7).

. . .  "But if pathological anatomy was to survive this startling claim [that perversions were not correlated with deviations in sexual anatomy], it had to retreat. And it quickly found its site of retreat in the brain"(7).

"At this time in the history of psychiatry only certain kinds of statements about disease processes could count as either true or false; not every such statement was a possible candidate for the status of truth or falsehood. Specifically, explanations of disease states had to be referred to organs; any explanation not of this type was not so much false as not even in the domain of the true and false. An explanation that did not at least attempt to anatomically localize the disease was more a part of theology than of science. Since it was believed that there were distinct diseases of sexuality, and since these diseases could not be explained by defects of the reproductive organs, the only plausible organ that remained to provide an explanation was the brain. (…) Indeed for these early psychiatrists it does not seem as if anything could have counted as evidence against the proposition that sexual perversions are ultimately traceable to brain disease. Postmortem examinations that demonstrated no pathological lesions, and should have constituted such evidence, were always explained away; the necessary changes in brain structure were undoubtedly 'so fine that with ordinary instruments they are not demonstrable postmortem'. (…) To affirm explicitly that sexual perversions or other mental diseases were functionally autonomous from the brain would have been to pass from basic truth to palpable absurdity, something beyond falsity"(10).

"The epistemological stranglehold of pathological anatomy on psychiatry is perhaps best illustrated by Moriz Benedikt's Anatomical Studies upon Brains of Criminals" … this series of studies was hoping to lay the "foundations stones of a Natural History of Crime" (Benedikt qtd 10)… and here is Bnedikt's (shouted?) conclusion;

THE BRAINS OF CRIMINALS EXHIBIT A DEVIATION FROM THE NORMAL TYPE, AND CRIMINALS ARE TO BE VIEWED AS AN ANTHROPOLOGICAL VARIETY OF THEIR SPECIES, AT LEAST AMONG THE CULTURED RACES. (Benedikt qtd 11)

"The appropriate way to understand the sexual instinct is in functional terms, not anatomical ones"(13).

"By acknowledging the subservience of the genital organs to the function of the sexual instinct, Legrain makes overt what by 1896 nobody should have doubted. And by claiming that the seat of the sexual instinct was everywhere and nowhere, he told us to look for diseases everywhere and nowhere. This 'everywhere and nowhere' sometimes had a more common name in psychiatric discussion - it went under the name of personality"(13).

The first modern usage of "perversion" per the OED "occurred in 1842 in Robley Dunglison's Medical Lexicon"(14).

OED: " 'Perversion,' one of four modifications of function in disease; the three others being augmentation, diminution, and abolition"(14).

"Once one offers a functional characterization of the sexual instinct, perversions become a natural class of diseases; and without this characterization there is really no conceptual room for this kind of disease"(14). 

Krafft-Ebing saw the sexual instinct in functional terms (14-5).

"In order to be able to determine precisely what phenomena are functional disturbances or diseases of the sexual instinct, one must also, of course, specify what the normal or natural function of this instinct consists in. Without knowing what the normal function of the instinct is, everything and nothing could count as a functional disturbance. There would be no principled criterion to include or exclude any behavior from the disease category of perversion. So one must first believe that there is a natural function of the sexual instinct and then believe that this function is quite determinate. One might have thought that questions as momentous as these would have received extensive discussion during the nineteenth-century heyday of perversion. But, remarkably enough, no such discussion appears. There is virtually unargued unanimity both on the fact that this instinct does have a natural function and on what that function is"(15).

"Krafft-Ebing further divides the perversions into sadism, masochism, fetishism, and contrary sexual instinct"(15).

"It is not at all obvious why sadism, masochism, fetishism, and homosexuality should be treated as species of the same disease, for they appear to have no essential features in common. Yet if one takes the natural function of the sexual instinct to be propagation, it becomes possible to see why they were all classified together as perversions"(15).

"Had anyone denied wither that the sexual instinct has a natural function or that this function is procreation, diseases of perversion, as we understand them, would not have entered psychiatric nosology"(16).

"We can conveniently place the origin of contrary sexual instinct, as a medicopsychological diagnostic category, in 1870, with the publication of Carl Westphal's 'Die conträre Sexualempfindung'"(16).

"He believed that contrary sexual instinct was a congenital perversion of the sexual instinct, and that in this perversion 'a woman is physically a woman and psychologically a man and, on the other hand, a man is physically a man and psychologically a woman.' I have called this the firth modern definition because it presents a purely psychological characterization of homosexuality, and detached from Westphal's meager explanatory speculations, it provides us with the clinical conception of this perversion operative in almost all of the subsequent medical literature"(16).

"Westphal's psychological characterization of homosexuality is, in effect, the psychiatric transformation of a previous, although nonmedical, understanding of this disorder"(17). ---> links this to Ulrichs and the "urnings" of his thinking

"…throughout the 1870s and 1880s there were the obligatory anatomical claims that these desires were the result of 'the brain of a woman in the body of a man and the brain of a man in the body of a woman'. These three ideas of same-sex behavior represent three central places where the phenomenon was thought to reside - the soul, the brain, and the psyche or personality. And, although not always in this historical sequence, theology, pathological anatomy, and psychiatry each took its own opportunity to lay claim to a complete explanation of perverse desires"(17).

"None of the writers I am familiar with ever suggest that these so-called functional diseases are not true diseases, are not part of the legitimate domain of medical science. Yet, at the same time, where was no already clearly formulated concept of disease under which they could readily fall. Clinical practice came first; explanatory theory lagged far behind. No doubt the circumstances are complicated by the fact that all of the early writers expressed allegiance to pathological anatomy. But even after pathological anatomy became an obvious explanatory failure, psychiatry did not regroup and address itself to the question to whether these perversions were really diseases. One unequivocal path to take would have been to claim that because no anatomical changes underlay the perversions, they could not be considered diseases, and physicians must leave there regulation to others more qualified. But clinical practice had already constituted the perversions as diseases, and by // the time the hold of pathological anatomy was loosened, they were already a recognized part of psychiatric nosology. This precedence of clinical practice to theory is officially endorsed by the American Psychiatric Association, whose Diagnostic and Statistical Manual is meant to be theoretically neutral. But such theoretical neutrality is as unprincipled as it is expansive; indeed, its expansiveness is partially a function of its lack of principle. On a straightforward interpretation, it sanctions the view that whatever psychiatrists do in fact treat as diseases are diseases"(19-20).

"To count something as a disease is to make a theoretical classification. The hope of reading diseases straight off of nature, independent of theory, is as philosophically naive as it is historically suspect"(20).

Theories of functional disease were proposed, but what Davidson sees as crucial is that they come along after the classificatory work has already been done. "These new diseases appeared almost full-blown in clinical practice, and silently, anonymously, became part of psychiatric nomenclature"(21).

Krafft-Ebing "These anomalies are very important elementary disturbances, since upon the nature of sexual sensibility the mental individuality in greater part depends"(21).

"Sexuality individualizes, turns one into a specific kind of human being - a sadist, masochist, homosexual, fetishist. This link between sexuality and // individuality explains some of the passion with which psychiatry investigated perversions"(22).

"One will not be able to understand the importance of these new diseases of sexuality if one conflates them with sodomy. Sodomy was a legal category, defined in terms of certain specifiable behavior; the sodomite was a judicial subject of the law. Homosexuality was a psychic disease of the instinct, of one's sensibility, not to be reduced to merely behavioral terms"(22).

"Homosexuality was a disease, a 'perversion' strictly speaking, whereas sodomy was a vice, a problem for morality and law, about which medicine has no special knowledge"(23).

"Every psychiatrist writing during this period acknowledged the difference between perversions and perversity, even if they also quickly admitted that it often proved difficult to distinguish the two. Only minutely detailed examination could help to determine that a given patient was a genuine pervert, and not merely evil or wicked"(23).

"The reassignment in regulating the perversions, from law/morality to medicine, was not simply a new institutional division of labor; it was to signal a fundamental transformation, and the inauguration of whole new ways of conceptualizing ourselves.

Perversion was not a disease that lurked about in nature, waiting for a psychiatrist with especially acute powers of observation to discover it hiding almost everywhere. It was a disease created by a new (functional) understanding of disease, a conceptual shift, a shift in reasoning, that made it possible to interpret various types of activity in medicopsychiatric terms. There was no natural morbid entity to be discovered until clinical psychiatric practice invented one. Perversion was not a disease candidate until it became possible to attribute diseases to the sexual instinct, and there were no possible diseases of the sexual instinct before the nineteenth century; when the notion of diseases of this instinct loses its last remaining grasp upon us, we will rid the world of all of its perverts."(24)

"The theory of degeneracy was used as a pseudoexplanatory framework for practically every  serious psychopathological state dealt with by nineteen-century psychiatry."(25)

Nature and nurture make plenty of appearances too - notably when the issue of treatment appears. Kraeplin thought these things were congenital, ergo there could not be eradicated. But this position would undermine any treatment and there was a lot of push behind the idea of treatment. Kraeplin; "There can be no thought of treatment of an anomaly like this, which has developed with the development of the personality and has its origin deep within it" (qtd 26)

"Schrenck-Notzing was perhaps the first to argue in detail that extraneous influences and education were actually the most significant etiological factors in the genesis of perversions"(26).

Morton Prince tackled the problem somewhat differently, but restating the conflicts between nature and nuture. Davidson writes "If it was not congenital, then therapeutic intervention would be required. This is exactly where Prince relied on his theory of habit neuroses and true functional diseases. He believed that in order to maintain that perversion, although acquired, was nevertheless a disease, one had to demonstrate that intensely cultivated habits could eventually become automatic, independent of volitional control. The pervert was then subject to 'real imperative sensations and ideas.'

[...embedding Prince] "analogy with what takes place in other fields of the nervous system would make it intelligible that sexual feelings and actions may by constant repetition (cultivation) become associated together and developed into the sort of quasi-independent neural activities, which may then become practically independent of the will - or, in other words, a psychosis." [back to Davidson...]

Google Image > "19th Century
Psychiatry"

Prince could then argue that, given this theory, it us up to 'counter-education to replace the morbid processes by healthy ones'. Under counter-education one could include almost anything one pleased, and so psychiatry was on its way to an unlimited disciplinary regulation of the sexual life. This theory of perversion as an acquired disease induced one to leave completely the domain of pathological anatomy and embed oneself firmly in psychology. Morton Prince, after all, founded both the Journal of Abnormal Psychology (1906) and the American Psychological Association (1910). The sexual personality was created so much the better to control the body"(27).

"The categories and conceptualizations of the self determine not only how others view us, but also how each person conceives of him- or herself. And conceptions of ourselves greatly influence how we actually behave"(28).

"The concept of perversion, once exclusively a part of specialized nineteenth-century discussion, became, in the twentieth century, a dominant way of organizing our thought about own sexuality. People diagnosed as perverts came to think of themselves as diseased, morbid, an experience that was not possible before the heyday of the pervert that I have described"(28).

"Being classified as a pervert could alter everything from one's self-conception to one's behavior to one's social circumstances. And even those of us who are not full-fledged perverts have had to reconceive of ourselves; every little deviation may be a sign of our impending perversion. We are all possible perverts. It is perversion as a possible way of being, a possible category of self, that is the legacy of nineteenth-century psychiatry"(28).

"Moreover, we cannot think away the concept of perversion, even if we no longer claim to believe that there is any natural function of the sexual instinct. We are prisoners of the historical space of nineteenth-century // psychiatry"(28-9).

Without having an argument against this last observation, I do wonder at its stability. Admittedly the term has taken off, been taken up, and means variously to many people even now. But I wonder first whether as a term it might have been detourned one too many times to really function any longer - without qualification - as the bars of our 19th C psychiatric cage. Secondly, it seems to me that, often, when on encounters the word used spontaneously these days, that it isn't really employed in an othering or pathologizing way. Perhaps that is symptomatic of the people I talk to/read etc (?) but it often seems to be used as self-description or when applied to another's interests, used to denote the suspicion of a sexual motivation or of some manner of jouissance involved, but in a way that is nascently complimentary, as if, under it all, the comment also says "good on you for figuring out how to get off on that stuff!"

Hartwood Hospital, a 19th Century psychiatric Hospital
Cheery, ain't it?