-$ PRZHEVALSKY, N. M. gerbil, carp, and lizard; but above all Equus subjects. There is an assumption on the przewalskii, the only species of horse that part of the public-and often of psychia- survived undomesticated into modern trists themselves-that anything with times and caused a major revision of the which psychiatry deals falls into the cate- evolutionary history of the animal. gory of the pathological. The profession of WithFyodorEklon, whom hemet psychiatry has not always been interested in the summer of 1875, he had a liaison in the phenomenon of homosexuality, that lasteduntil the summer of 1883, when and when it has considered the subject its the youth summoned up the courage to approach has not been detached and tell him that he was to be married and that impartial, but reflected prevailing social he could not accompany him on the next attitudes, derived as these were from expedition to Tibet. This confession led to the cultural and religious beliefs of the a bitter scene and rupture, as Przhevalsky community. never forgave the women who deprived Origins of Psychiatry's Concern him of the male companionship that he with Homosexuality. It was only in the needed. But in the winter of 1881-82 he last third of the nineteenth century that met a distillery clerk, Pyotr Kozlov, who psychiatry began td study what it called proved to be "the youngmanwho hadbeen "sexual inversion," and it did so not spon- eluding him all his life: alert, submissive, taneously, but at the prompting of the loyal and handsome." Kozlov not only earliest spokesmen for the emerging accompanied his protector on his last and homosexual liberation movement, Karl most important journeys, but after his Heinrich Ulrichs and Kkoly MQriaKert- death went on to a distinguished career of beny. Thus it was not the psychiatrist's his own as explorer, archeologist, and own insight, or the data collected from author of travel books. He also fulfilled the patients under observation, that enabled dream that his mentor's premature death such authors as Karl Friedrich Otto prevented him from attaining: to visit Westphal and Richard Freiherr von Krafft- the forbidden city of Lhasa and meet the Ebing to reach the formulations which Dalai Lama. they published in their pioneering papers, Przhevalsky was a hunter and it was the claim of homophile writers that explorer who revived an almost archaic there were human beings without attrac- homosexual personality type: that of the tion to members of the opposite sex, but leader who willingly faces hardship and with a paradoxical inborn attraction to danger with only other males as compan- members of the same sex which they ions, and a younger male as his beloved experienced as perfectly natural and con- protCgC. sonant with their inner selves. However, the character of the BIBLIOGRAPHY. Donald Rayfield, The patient universe from which the earliest Dream of Lhasa: The Life of Nikolay Przhevalsky, Explorer of Central Asia, cases were drawn-mainly individuals Columbus, OH: Ohio State University observed in prisons, psychiatric wards, and Press, 1977. insane asylums-led the psychiatrists to Warren lohansson hold that sexual inversion was, if not an illness itself, at least a symptom of a psy- chopathic personality. At first homosexu- PSYCHIATRY ality was thought to be an extremely rare The discipline of psychiatry ad- condition: in fact the book published in dresses the problem of mental illness and 1885 by Julien Chevalier, De l'inversion its treatment, in contrast with psychol- de l'instinct sexuel, listed the total num- ogy, which is the academic study of men- ber of known cases in the entire world- tal processes and functions in human , 35! At that time the paper which Vladimir PSYCHIATRY 9

Fiodorovich Chizh had read in St. Peters- orientation in which Freudian psycho- burg in 1882 was still unknown in West- analysis was to occupy a prominent place. em Europe; in it the author remarked that Psychoanalysis began as a particular so far from being rare, the phenomenon in method for the treatment of mental and question could account for many of the emotional disturbances that were psy- cases of pederasty that daily came before chogenic in origin, but expanded into a the courts. psychology of all "unconscious" mental From the outset of the discussion processes, including those of normal in- in modern times, psychiatry has found dividuals. The psychoanalytic school itself in an ambivalent position: on the one claimed rather that homosexuality was hand, it sought to present itself to an in- the outcome of faulty psychological de- creasingly secular society as an objective velopment in childhood, that it represented discipline that couldreplacethe traditional an inhibition of the heterosexual potential moral authority of the Christianchurch- present in all human subjects. Thus homo- and for many the psychiatrist took the sexuality tended rather to be classified as place of the confessor in the religious cul- a neurosis or as the expression of a neu- ture of the past; on the other hand, it found rotic personality disorder'than as an erotic itself invoked as a source of scientific monomania. authority by the church itself to bolster its Forensic Aspects. The forensic "revealed" teachings on the subject of evaluation of homosexuality has had its sexualmorality. Caught between two fires, own history since the 1870s. On the one most psychiatrists have opted for one party hand, psychiatric testimony was at times or the other; and by and large those who introduced in trials for sodomy with the accepted the principle that homosexuality aim of proving that the defendant was was inborn and unmodifiable have sup- suffering from a mental illness that dimin- ported the homosexual emancipation ished or abolished his legal responsibility; movement, while thosewho believed that on the other, the notion that the homosex- it was an acquired condition, a pathologi- ual was a "psychopathic personality" led cal fixation, a mental illness have sided to the introduction of many disabilities in with the theologians and formulated their civil and administrative law that were judgments in terms that amounted to added to the criminal statutes already in condemnation, when they did not openly force. In the English-speaking world the reaffirm the traditional attitudes. latter trend actually made the legal posi- HomosexuaLity as a Congenital tion of the homosexual even worse than it vs. Acquired Condition. At the moment had been when the defendant was simply when Krafft-Ebing summarized the early "guilty of unnatural vice." Down to the papers that had appeared in psychiatric 1960s the psychiatric profession remained journals between 1869 and 1877, psychia- largely indifferent to the legal problems of try was so strongly influenced by the belief the homosexual, even if individual psy- in the congenital origins of mental illness chiatrists would at times testify on behalf that homosexuality quite effortlessly fell of a particular defendant. The fact that into this category. His views were echoed psychiatrists obtain the largest segment of by many others down to the early decades their referrals from the clergy made them of the twentieth century: Arrigo Tamas- unwilling to argue for a change in the sia, Julien Chevalier, Albert Moll, Paul traditional punitive attitudes, or for liber- Nacke, Havelock Ellis. Only at the end of alization of thestatuteswhich maintained the nineteenth century did the pioneering penalties for private sexual acts far more work of Albert Freiherr von Schrenck- severe than those for such crimes as armed Notzing in the use of hypnosis open the robbery or beating or neglecting a small way to a developmental theory of sexual child. As late as 1956 a report by a group of + PSYCHIATRY

American psychiatrists could criticize the istrative law-a clear proof that their be- law only on the ground that "some inno- lief rationalizes the traditional condemna- cent persons" might be punished. tion of homosexual expression by Judaism Psychiatric "Cures" vs. Gay and Christianity. Rights. Also included in the psychiatric A number of psychiatrists have confrontation with homosexuality was the claimed success in "curing" homosexual- matter of enforced therapy-individuals ity, but their results have been questioned required by court order to undergo psychi- on a number of grounds, including the lack atric treatment, or in other cases com- of follow-up studies. In some instances the pelled by their parents to submit to ther- individual merely became far more inhib- apy for their unwanted "tendencies." This ited in expressing his homosexual desires, treatment could take exceptionally cruel which is to say more guilt ridden and and humiliating forms, including shock unhappy than before. Nearly all practitio- therapy and other painful procedures ners conceded that only carefully selected designed to create an aversion to homo- subjects could benefit from their proposed sexual stimuli. therapy; Edmund Bergler, for example, Even when the WolfendenReport maintained that the patient had to experi- (1957)heralded the movement for crimi- ence conscious guilt over his homosexual nal law reform, the psychiatric profession practices. Many practitioners would ad- remained indifferent, insisting only that mit that some foundation of heterosexual- homosexuality was "a serious disease" ity is necessary for even a temporary "cure" and that measures had to be taken to to be effected; that is to say, they choose to combat its spread. It was the gay liberation treat bisexuals in whom it is possible to movement itself that had to rouse the suppress one side of the equation. There psychiatrists out of their inertia, and spe- are few, if any, well attested cases of per- cifically put pressure on the American manent reversal from complete homosexu- Psychiatric Association to drop homosexu- ality to complete heterosexuality. In any ality from its roster of mental illnesses- event, the inability of the psychiatrists to which it did in 1973. In 1986 even the distance themselves from traditional substitute "ego-dystonic homosexuality" morality has often been striking, even if disappeared from the list (DSM-IIIR).The they were oblivious of the normative importance of this change, as mentioned dimension of their practice. above, was that in the meantime the no- Exclusion of Homosexualityfrom tion of homosexuality as disease had been the Realm of Mental Illness. The contem- used to deny homosexuals a whole range porary gay liberation movement has been of civil rights, including immigration, characterized by an effort to remove the employment, adoption, service in the stigma of "mental illness" from homo- armed forces and other benefits accorded sexuality and therefore to renounce any to the rest of the population. But the deci- benefits that might have accrued from the sion of the American Psychiatric Associa- appeal to psychiatry as a shield from the tion was more the outcome of political law. The virtual cessation of prosecutions pressure and manipulation than an expres- for consenting homosexual activity be- sion of the sincere belief of the members. tween adults has made this degrading The psychiatrists who have been the most demarche a thing of the past. A number of outspoken in proclaiming homosexuality psychiatrists now practice a line of ther- to be a "diseasen-Edmund Bergler, Abram apy that enables the patient and his family Kardiner, Irving Bieber, Charles to accept the homosexuality as an integral Socarides-usually express reservations if part of his personality, and then to opti- not outright opposition to any demand for mize his personal adjustment to a society gay rights in the sphere of civil or admin- with many vestiges of intolerance. Self- PSYCHOANALYSIS 4 acceptance and openness are recognized as offers views and speculations on human preferable to a forced adherence to the destiny and the nature of civilization. asceticmoralityonceregardedastheabso- Finally, psychoanalysis has had an lute norm. enormous influence over modem litera- ture and art, where it may be said to play a BIBLIOGRAPHY. Ronald Bay er, role similar to that of mythology in the Homosexuality and American Psychia- creativeworkof classicalGreece andRome. try: Politics of Diagnosis, Znd Princeton: Princeton University Press, Increasingly questioned by scientists, the 1987; Peter Conrad and Joseph W. lasting significance of psychoanalysis is Schneider, Deviants and Medicalization: now seen more and more to reside in this From Badness to Sickness, St. Louis: C. cultural realm. V. Mosby, 1980; Martin S. Weinberg and History. Freud founded the Vi- Alan P. Bell, Homosexuality: An Annotated Bibliography, New York: enna Psychoanalytic Society in 1902 and Harper & Row, 1972. the International Psychoanalytic Society Warren Tohansson in 1910. His organizations attracted a number of talented followers, but their history was marred by defections, notably PSYCHOANALYSIS those of Alfred Adler in 1911 and Carl is the movement Gustav Jung in 1914. Although, as has that takes its start from the ideas set forth been noted, F~~~~I~theories are not exclu- by Sigmund Freud at the Of the pres- sively or even centrally sexual, he rightly ent century. The movement1 which has criticized both men for their excision of had a vast On many Of the sexual element from psychoanalysis. modem thought, remains hard to classify. At first psychoanalysis was largely The lay public tends to confuse it with restricted to German-Speaking countries, psychology, yet academic psychologists but it was diffusedto some extent in France remain among themost determined doubt- thanks to thework of MarieBonaparte and ers of the value of ~s~choanal~tictech- in England through Freud's faithful fol- niques and concepts. Although psycho- lower Ernest Jones. Although Freud vis- analysis claims to be a form of mental ited the United States in lgll (in the therapy-indeed the only truly serious company of Jung), he came to dislike the one-the efficacyof its procedures in Pro- country, in part because of personalfinan- moting mental health has never been cial losses in World War 1. conclusively demonstrated, and indeed an On at least two occasions, in 1905 increasing number of observers question and 1935, Freud gave statements that were whether they Possess any intrinsic thera- remarkably sympathetic to homosexuals peuticvalue.The popular mind associates as individuals. The lesbian tendencies of the views of Freud and his followers with his favorite daughter Anna were sex1 believing that ~s~choanal~~i~is cen- quietly, though discreetly acknowledged trally concerned with the erotic, or that it in his immediate circl.ej may have helped was the first disciplinetodiscuss thematter to soften his views. Yet, when all is said in an ordered way. These assertions are and done, his theory relegates homosexu- false. Freud actually arrived as a late-comer als to a category of the mentally second at the crest of a period Of sex research, the class. Human psychosexual development main center of which lay in Berlin, not in Freud sees as an arduous journey through Vienna. Moreover, the views of Freud and the oral and anal to the mature genital his followers are addressed primarily to stage, which he equates with heterosexu- nonsexual issues. In addition to its con- ,Iity. Instead of obeying the summons to cem with the mind, ~s~choanal~sisalso complete this journey, homosexuals have has a meta~s~chologicalside1 in which it lingered along the way. Important psychic