Cinderella finds liberation

Richard von Krafft-Ebing was a key figure in the establishment of sexology, yet he is dismissed in fashionable social constructionist analyses of sexuality as an originator of the medicalisation of sexual identities. His legacy is identified with the compendious Psychopathia Sexualis . It is regarded as a prime example of 19th-century science: the taxonomisation of sexuality, which, to paraphrase Michel Foucault, has "produced the object of which it speaks". Harry Oosterhuis has returned to Krafft-Ebing's personal papers, case histories and published work, to re-evaluate him. His analysis portrays Krafft-Ebing as someone whose psychiatry contributed as much to the liberation of sexuality as to its medicalisation. It is also salutary reading for anyone who uncritically embraces Foucault.

Oosterhuis knits a close reading of Krafft-Ebing's case histories with analysis of changes in European society in the second half of the 19th century. The emergence of the individualised self linked to Romanticism and a new culture of intimacy are described as factors influencing sexual identity as much as the scientific efforts of psychiatrists. Oosterhuis avoids generalisation by carefully describing decadent fin de siècle Vienna. He traces psychiatry's move from a Cinderella status within medicine, largely confined to the lunatic asylum, to academic respectability. Krafft-Ebing moved from working in the asylum to a professorship in Graz, and later Vienna, where he opened a private practice. He established his reputation as a forensic psychiatrist and he made psychiatric diagnosis central to cases in which the mental state of the defendant was in question, becoming increasingly involved in sexual offence cases. He took the view that mental disorders originated in physical lesions, but later embraced degeneration theory, which posited congenital causes linked with environmental factors.

Oosterhuis stresses that Krafft-Ebing's approach was less positivistic than is usually assumed. He published large extracts of case histories without judgement, along with the autobiographies of patients who, after reading Psychopathia Sexualis , began to narrate their lives as case histories. Many of these cases were of homosexuality, yet the case material reveals self-accounts that are positive as well as pathological. Many considered their "contrary sexual feeling" to be natural, and believed that the problem lay with society's attitude.

This is not to deny that self-understanding was linked with psychiatric models: the urning was conceived as something like a male personality in a female body (or vice versa), and many patients so described themselves. There were a few, though, who thought themselves fully male or female. They prefigured the western notion of sexual identity based on object choice and described via the triad homo-hetero-bi-sexuality. These voices revealed a more robust sense of self than was assumed for the 19th-century pervert, and Krafft-Ebing enabled them to speak. Oosterhuis changes our view of the man, and challenges the anti-psychiatry movement.

Philip Gatter is senior research fellow in social sciences, South Bank University.