Westphal Advocates Medical Treatment for Sexual Inversion

Karl Friedrich Otto Westphal developed a psychiatric diagnosis for same-gender sexual attraction that he called “contrary sexual feeling,” or “sexual inversion,” and thus advocated medical treatment rather than criminal punishment for those diagnosed as sexual inverts.

Date 1869

Locale Berlin, Germany

Key Figures

• Karl Friedrich Westphal (1833-1890), German neuropsychiatrist
• Karl Heinrich Ulrichs (1825-1895), German lawyer and writer, who influenced Westphal and others working in sexology
• Richard von Krafft-Ebing (1840-1902), professor of psychiatry, who promoted a medical- psychiatric theory of homosexuality
• Havelock Ellis (1859-1939), British psychologist, who pioneered studies in the psychology of sex and sexual inversion
• Sigmund Freud (1856-1939), Austrian psychiatrist, who wrote on sexual nature and development

Summary of Event

Karl Friedrich Westphal, a German neuropsychiatrist, published an article in 1869 in the prestigious medical journal Archiv für Psychiatrie und Nervenkrankheiten (archive for psychiatry and nervous diseases), which described a phenomenon he termed “contrary sexual feeling,” a newly identified psychiatric diagnosis for people attracted to members of their own gender. In his article describing two case histories—one male and one female—he advanced the theory that homosexuality was the result of a congenital “reversal of sexual feeling.” According to Westphal, male inverts exhibited effeminate behaviors and were sexually attracted to other men, while female inverts displayed masculine characteristics and were sexually attracted to women.

Because he believed that the mental disorder was congenital in most cases, he advocated for the medicalization of homosexuality and the elimination of laws against same-gender sexual practices. He believed also that patients with the diagnosis of “contrary sexual feeling” typically had other associated mental illnesses. Westphal’s publication legitimized discussion of this “new” medical condition, opening the floodgates to other medical and scientific works on homosexuality.

Westphal’s approach to sexual “inverts” was more humane in the context of a society that considered individuals who engaged in same-gender sex to be criminals. Inverts were thought to have acquired same-gender sexual desire because of, for example, early masturbation. Westphal and other physicians interested in sexology in the late nineteenth century were heavily influenced by the writings of German lawyer Karl Heinrich Ulrichs, who is credited with being the first homosexual to advocate, publicly, for gay civil and legal rights. Ulrichs wrote a series of pamphlets advocating theories that homosexuality was caused by congenital anomalies, was as natural as heterosexuality, and should not only be tolerated but also decriminalized.

An interesting aspect of this piece of gay history is the evolution of terms used to describe the mental disorder that Westphal named “contrary sexual feeling” in 1869. In 1871, in a review appearing in an English medical journal, Westphal’s term was translated as “inverted proclivity.” In 1878, in an Italian translation, the German term was translated inversione sessuale. Translated from the Italian into English, the term “sexual inversion” became the most widely used technical psychiatric term in the late nineteenth century. Richard von Krafft-Ebing, author of Psychopathia sexualis, an influential book of case histories published in 1886, used the phrase “contrary sexual instinct” in 1892 to advance the belief that homosexuality is a congenital anomaly and a natural biological variation. In 1897, the book Sexual Inversion was published by the English psychologist Havelock Ellis as part of his seven-volume series, Studies in the Psychology of Sex. Ellis’s book ultimately became popular with general audiences, extending the term from strictly medical usage to popular usage.

Sigmund Freud’s groundbreaking work, Three Essays on the Theory of Sexuality (1910), his earliest (first published in German, 1905) and major statement on the nature and development of sexuality and on theories of inversion, differs from the work of Westphal. Freud first used the word “inversion” in this text. By 1915, however, the term “sexual inversion” mostly had been replaced in psychiatric literature by the term “homosexual,” preferred by Freud and coined in 1868 by German journalist and translator Karl Maria Kertbeny in a letter to Ulrichs.

Significance

Karl Westphal’s public stance on contrary sexual feeling as a medical condition, along with the beliefs of other sexologists of his era, stimulated a trend away from the criminalization and one toward the medicalization of the condition that first came to be called sexual inversion and, then, homosexuality. This shift from the legal-moral model to the medical-scientific model is significant, though not surprising in the social context of the late nineteenth century. Westphal’s efforts to diagnose and classify new mental disorders fit with the progressive movement toward the professionalization of psychiatry, a field of medicine based on scientific inquiry into “illnesses of the nerves and brain.”

This medical approach also had its downside, however, as it set in motion a period of more than one hundred years during which homosexuality was viewed as pathological and therefore medically treatable. Aversion therapy by shock treatment was one such method developed to “help” inverts change their behaviors; the first recorded aversion therapy treatment for homosexuality was reported in 1935. In 1952, the American Psychiatric Association (APA) included homosexuality as a “sociopathic personality disturbance” in its first official list of mental disorders, but then recategorized the diagnosis as a “sexual deviation” in 1968. In 1973, the APA officially stated that homosexuality did not meet the criteria for being a psychiatric disorder. Twenty years later, in 1993, the World Health Organization withdrew “homosexuality” from its list of diseases, and the American Medical Association made it clear that it opposed medical treatments thought to “cure” lesbians and gays.

Bibliography

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