Verordnete Lust. Sexualmedizin, Psychoanalyse ....1870-1930

In contrast to sexual science, the beginnings of professional sex medicine and sex therapy in the late 19th century have hardly been investigated. The text at hand wants to close this gap for the German speaking areas by showing, how doctors approached, defined and cured sexual complaints of men and women in a scientific way at that time. Sex medicine is analyzed as an object of knowledge which is in the making, but also as a social and cultural factor. It is put into the context of gender relations and argued, that sex medicine was an attempt to facilitate changes in marriage towards a more sexual love and to cope with the resulting problems by seeking help in medical therapeutics. The corpus of sources used for this discourse analysis consists of 110 published texts (1865-1935) from doctors of various medical disciplines (psychiatry, gynaecology, urology, dermatology, psychoanalysis, sex research e.g.). The last chapter is dedicated to a separate analysis of cases. The text was initially written as a Phd at the European University Institute (Florence). For the publication, it was made shorter, rewritten in many parts, corrected and revised all over. The following results are presented in the individual chapters: Around 1880 doctors try to put forward the idea of male impotence as a scientific concept and an independent disease. It is rewritten from a more organic, local disease of the genital organs into a nervous affliction. Smaller troubles with potency and disorders of erotic sensation are now also conceived as pathological conditions. In female patients, the lack of sexual satisfaction in marriage is first "discovered" around 1890 and much debated. Psychoanalysis deepens the interest in disturbances of erotic intensity and satisfaction. Until the 1930`s psychoanalysts increase and detail corresponding diseases (Chapter 1). The formulation of sexual disorders as objects of knowledge is accompanied by a fundamentally new understanding of sex: For healthy and normal "sexuality" it is not sufficient to perform a procreative act, in which two genital organs meet and exchange body fluids. Now it is expected that the subjects run through a course of erotic excitement, psychic tension and relief. Subjective factors as lust, intensity and satisfaction are moved in the center of this new conception of sex and become themselves objects of scientific observation and discussion. The individual "sex mechanism" is considered a complex and vulnerable machinery. Females don`t rank behind: Doctors ascribe also to them an active sex drive and erotic needs, though they tend to be less strong and intensive and more deficient than in males. Gender relations are conceived as antagonistic. All these factors make mutual sexual satisfaction a complicated affair (Chapter 2). Though such sexual normality is practically difficult to achieve, sexual satisfaction becomes a more and more important factor in love relationships within the broader cultural context. Sociologists and historians speak of a change in marriage from a "sentimental" to a more "sexual" ideal: Love is broadly accepted as the basis of marriage, but is interpreted in a new way as a dominantly sexual feeling. Spontaneous, sensual attraction may now play a central role when choosing a partner and it is expected to maintain it during marriage. But this ideal remains in itself controversial - and widely difficult to achieve. A public debate about a "crisis of marriage" is the consequence: Marriage is criticized for neither meeting the personal nor the political expectations (decline of the birth rate, high number of divorces). Sex doctors and psychoanalysts defend - against law, religion and politics - a modern conception of love relationships in this debate (Chapter 3). This commitment to modern marriage is not completely unselfish: As a result of the growing public awareness of marriage problems, therapeutics become a relevant field of work for doctors. Nevertheless, the field of sex therapy is (and remains) institutionally weak, unordered and marked by conflicts about competence and specialization among doctors. Moral considerations additionally complicate the treatment of females. The applied methods of treatment are of a great variety, but hardly original. The doctors apply them generally in a gentle and mostly non- invasive way. Until the 1920`s, the "settings" of sex therapies meet the expectations of middle-class customers (Chapter 4). In case histories voluntariness and mutual consent between patient and doctor are important. The subjects are expected to address their selves as a problem (not to blame somebody else for their misery). They have to identify their sexual desire, put it into a chronological narrative and become aware of possible abberations from a normal and healthy course. The doctor then locates the symptom either on the body, in the nervous system or in the psyche and decides upon the therapeutic procedures. The aim of the therapies is to sustain sexual desire on a high level and to concentrate it on heterogenital acts within marriage (Chapter 5).