GLR November-December 2022

ESSAY

Rise and Fall of the Medical Model V ERNON R OSARIO

E DITOR ’ S N OTE : The following was originally published in the Fall 1999 issue, with a revised version appearing in a special issue #100, Nov.-Dec. 2012. I bring back this piece to kick off our salute to the 50th anniversary of the declassification of “ho mosexuality” as a mental illness in the DSM , because I think it provides an excellent introduction to the history of the medical model and takes us up to the fateful events of 1972-’73. O NE of the most dramatic revolutions in les bian and gay history, and perhaps the greatest victory of the gay rights movement, is the transformation in psychiatric approaches to homosexuality. Indeed, many current histori ans argue that late-19th-century doctors con structed modern homosexual identity. “Sodomites” and “pederasts” had long been studied by legal, religious, and medico-forensic experts as criminal or immoral because of their “perverse” acts. However, it was only in the 19th century that the “sexual invert” or “homosexual” emerged in the medical lit erature as a distinct category of human being. According to his or beyond the influence of European medicine had already de veloped identities as same-sex-loving people (whatever they or we might like to call that identity). It is, however, clear that Victorian doctors themselves be lieved that they had discovered a new phenomenon. Their writ ings also make it evident that they were baffled, disgusted, and terrified by it. Nevertheless, the emerging leaders in psychiatry and sexology believed that “contrary sexual sensation” had to be a profound mental aberration and had to have some biological explanation. Take, for example, one of the first discussions of “contrary sexual sensation” in the American medical press, an exchange of letters published in The Medical Record of New York in 1881. A physician (clearly embarrassed by the subject matter) wrote under the pseudonym Dr. H— to describe “a cu rious case of prolonged masturbation” currently under his care. The patient was “a highly cultivated gentlemen of high moral character, the father of three or four healthy children, the result Vernon Rosario is a historian of science and an Associate Professor of Psychiatry at UCLA. torian Michel Foucault, “the homosexual of the 19th century became a personage: a past, a case history and a childhood, a character, a form of life; also a morphology, with an in discreet anatomy and perhaps a mysterious physiology.” The accuracy and generalizability of this claim has been much debated as historians have examined new documents suggesting that individuals well before the 19th century

of an unusually happy marriage.” However, the patient had a lifelong fondness for “indoor games, female pursuits, and even attire,” especially corsets and tight ladies’ boots with French heels. He largely managed to abstain from masturbating with these articles until he had married and fathered two children. Then he abandoned himself to cross-dressing in painfully tight female clothing and even attended church in a black silk dress. He carried several pictures of himself as a ballet girl, as Queen Elizabeth I, as the Goddess of Liberty, etc. The dismayed and perplexed Dr. H— turned to the conventional remedies of the day: bromides and dietary manipulations (still known to us through Drs. Kellogg and Graham), but to no avail. He con cluded his cry for professional assistance: “Have any of your readers had a similar case within their experience? I proposed the name of Gynomania for it.” Unfortunately for Dr. H—, he never got to coin a new dis ease. Instead, a subsequent issue of the journal carried a reply from the president of the New York Neurological Society, Dr. Edward C. Spitzka, who was clearly better read in the latest medical literature. He was quick to pronounce a diagnosis of same-sex affections in his patient. However, as the terms “con trary sexual sensation” or “sexual inversion” suggest, any kind of cross-gendered behavior, tastes, erotic attraction, or even one’s occupation invoked the suspicion of homosexuality. Re lying on recent discoveries that all embryos are “bi-sexual” (i.e., possess both male and female primordial genital tissue), doctors viewed inverts as “psychosexual hermaphrodites.” Using this model, physicians desperately searched for hints of cross-sexed anatomical, neurological, or endocrinological traits that might “objectively” betray a person’s homosexual ity (especially if accused of sodomy). More importantly, such crossed-sexed biology might suggest therapies for restoring “normal” masculinity or femininity. These included castration and ovariotomies, implants of “normal” testicles, and hormone therapy. Even into the 20th century, homosexuality remained an obsession of psychiatry: the latest techniques of biological and analytic psychiatry were deployed to explain and treat it, and it became a key pathology for explaining myriad other mental illnesses. A biological explanation of homosexuality, however, did “contrary sexual sensation” and noted that twenty such cases had been described by German and French “alienists.” He lamented that there were undoubtedly more, but they went undetected and were not committed to asylums. They were a result of a “degenera tive psychosis” (a hereditary neuropsychi atric disease) and were incurable. One curious and telling aspect of the case is that Dr. H— never described any

It was in the 19th century that the “sexual invert”or “homosexual” emerged in the medical literature as a distinct category of human being.

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