Chapter 1: "Now, We See as in a Speculum, Darkly": Robert Dickinson's Program for American Gynecology

--Robert Latou Dickinson (1861-1950)




Sexual behavior is not, as is too often assumed, a superimposition of, on the one hand, desires which derive from natural instincts, and, on the other, of permissive or restrictive laws which tell us what we should or shouldn't do. Sexual behavior is more than that. 1

-- Michel Foucault


Robert Latou Dickinson (1861-1950) was a man of conviction who sought to reformulate gynecology. In this, he struggled to engage what he conceived was the origin of a fundamental problem in American society, the instability of the family The most crucial threat was the mismanagement of desire; he thought this would lead to "marital maladjustment". As a physician, Dickinson thought he could lend his gyneco-scientific eye to the study of gender and sexuality to make an objective difference. By accumulating physical, sexual, and familial histories of his mostly female patients, he sought to unlock the secrets of sexual disharmony in the marital bed. The application of his discoveries was supposed to alleviate or prevent the pains of marital strife, divorce, and social maladjustment which he linked to sexual deviance. Dickinson's work represented an attempt to extend the medical gaze to tackle what he would come to call "sociologic problems".

Dickinson was one of the most prominent medical advocates of birth control and sex research of the early twentieth century. He published from 1887 to 1951. Dickinson attempted to bring the respectability that medicine could offer to these controversial subjects. To this end, he formed the Committee on Maternal Health2 in 1923 which studied contraception, fertility, abortion, and sexuality. The case studies that served as the basis for his conclusions were drawn from his own prior gynecological practice and from new studies which the committee undertook. During the 1920s, Dickinson became increasingly supportive of Margaret Sanger's untiring efforts for the legalization of birth control. He became one of her most important advocate in the medical community and lobbied fellow physicians to support the legalization of contraception. Dickinson sought to prove that the birth control methods of his time were safe and effective. He felt that contraception was an important tool that allowed for sexual happiness and could be medically necessary in many cases.3

Contraception was one among many other issues the Committee on Maternal Health focused on. Dickinson defined the aims of the committee as "studying marriage, premarital instruction, birth control, abortion, prevention of the unfit from producing their kind, and trying to find out what the normal in sex life is."4 Under the auspices of the committee, four major works were published which reflected these research objectives, Control of Conception (1931), Human Sex Anatomy (1932), A Thousand Marriages (1933), and The Single Woman (1934).5 Control of Conception was the most widely read with the first edition going to two subsequent reprints, with a second edition published in 1938.6 Dickinson was heavily involved in the research and publication of all these books. The last large publication he worked on was the Doctor as Marriage Counselor. Dickinson died before it was ready to go to press. The research for and the dissemination of the information in these works was the primary function of the Committee on Maternal Health, and its activities represented the culmination of Dickinson's life's work.

Dickinson brought his own liberal Episcopalian views to his sex research. As James Reed, Dickinson's most significant biographer, explains "one of Dickinson's functions as a reformer was to bear Christian witness that sex was a force to be accepted and enjoyed."7 Dickinson was not a sexual revolutionary, but he was a sex reformer. Specifically, types of sex and who should enjoy them were clearly prescribed in Dickinson's texts. Erotic acts needed to be understood, described, and directed to ensure the health of the individuals involved. Mutual, monogamous heterosexual satisfaction leading to orgasm was the idealized standard by which Dickinson judged all sexual acts. All other forms of desire were seen as pathological. This scientific management of desire would allow, in Dickinson's view, for societal acceptance of specific types of sexual fulfillment that were designated as healthy.

Dickinson's perspective on sexuality was fundamentally influenced by his European sexological precursors. European medical experts were becoming increasingly concerned with sexuality and its relationship to health in the late nineteenth century. This new interest of the medical establishment was exemplified by the sexological works of men such as Havelock Ellis, Richard von Krafft-Ebing, and Magnus Hirschfeld. Sexology attempted to extend medical control over bodies and minds. Death and disease were already under medicine's nearly exclusive jurisdiction; through the discourse of sexology, sexual life became medicine's new province. A preventive medicine that could protect the moral, mental, and physical health of individuals, and ensure the proper reproduction of the race by intervening before transgression, emerged in the late nineteenth century and early twentieth century in the work of these pioneering physicians. Sexologists viewed sexual deviance in terms of disease. Their work added socially prohibited sexual acts to the medical lexicon. Medical terms like "homosexuality," "sadism," and "fetishism" emerged and were seen as disease entities with their own specific etiology. Dickinson read much of this sexological literature.8

Michel Foucault concluded that the medicoscientific codification of sexual acts through the theory and praxis of sexology has produced a fundamental change in the construction of the individual as the subject of scientific discourse. In historical periods preceding the investigations of the sexologists, sex was an act that revealed little in and of itself. Such acts did not constitute the truth of an individual, a secret that needed to be explored in order to reveal health or pathology, nonetheless men and women were ascribed particular roles in and outside of the bedroom. Sexual acts signified gender, power, and pleasure, but were not a key to understanding the fundamental nature of individuals.9

The sexological discourse and its medical implementation disrupted the traditional gender-based evaluation of sexual acts. The active/passive binarism was no longer the primary analytical tool with which to understand sexual acts and to identify personages. The concepts of heterosexuality and homosexuality were introduced into the medical nosography by sexologists. Eve Kosofsky Sedgwick sums up the implications of what emerged in this new historical formation.

New, institutionalized taxonomic discourses - medical, legal, literary, psychological - centering on homo/heterosexual definition proliferated and crystallized with exceptional rapidity in the decades around the turn of the century, decades in which so many of the other critical nodes of culture were being, if less suddenly and newly, nonetheless also definitively reshaped. Both the power relations between the genders and the relation of nationalism and imperialism, for instance, were in highly visible crisis. For this reason, and because the structuring of same-sex bonds can't, in any historical situation marked by inequality and contest between genders, fail to be a site of intensive regulation that intersects virtually every issue of power and gender.10

The construction and proliferation of sexualities, as Sedgwick insightfully viewed the late nineteenth and early twentieth centuries, impacted not only the individuals directly spoken about in these texts, but the culture as a whole. The sexological discourse had an impact beyond the bounds of a constructed sexuality. It spawned a cultural shift that changed the structure of power, gender, and subjectivity in Western Culture. These ideas became part of the cultural lexicon.

On a more minute scale, the new taxonomy defined the pathological nature of distinct personages to whom particular biological attributes were ascribed. Who they are became defined by who they experienced desire for. For example, men were only supposed to be women's lovers. If a man found pleasure in the arms of another man it was a result of some congenital defect. Socially inappropriate love was a disease for the sexologists. Not only was sexual deviance pathological, but it was a mark. When read by the trained eye, sexologists believed such markings could reveal pathology and possibly degeneration. The meaning of sex was being reduced to what could be recorded by scientific observation. What was healthy was always already defined by what was shown to be pathological.11

Richard von Krafft-Ebing (1840-1902) was the first major sexologist to get wide medical recognition. His vision of sexuality permeated most sexological thinking into the twentieth century.12 His monograph Psychopathia Sexualis, originally published in Germany in 1886, was a milestone in the study of sex. It was influential among medical experts long after it was published. He did not intend for the book to be read by the general public. The basic precept of Krafft-Ebing's sexology was that sexual proclivities were biologically based. He did not believe this was true in every case; sexual pathologies could be acquired. However, the locus of sexual desire was firmly placed in the body.13

Sexual desire during the years of sexual maturity is a physiological law. The duration of the physiological processes in the sexual organs, as well as the strength of the sexual desire manifested, vary, both in individuals and in races. Race, climate, heredity and social circumstances have a very decided influence upon it.14

Krafft-Ebing has located activity of the sexual organs and sexual desire in biology. He created a paradigmatic way of looking at sexual acts. Varying differences in sexual appetite were explained by race and heredity. Environmental or developmental factors that could lead to sexual difference were seen as secondary by Krafft-Ebing. This biological way of looking at desire led him to oppressive conclusions especially when he turned to the subject of sexual pathology. For example, Krafft-Ebing spoke of "fully developed masochism" as being "hereditarily transferred to a psychopathic individual in such a manner that it becomes transformed into a perversion."15 "Perversion" existed as a hereditary trait that led to disease. Sexual deviance was primarily seen as the result of biological degeneration throughout his work.

Krafft-Ebing tried to explain what was sexually healthy through exploring what was pathological. He cataloged perversity. Through medically defining "perversion", Krafft-Ebing created a scientific language for discussing sexual morality. His most significant contribution to sexology was transposing the discussion of sexuality from the moral, political, and economic spheres to the realm of medical science. This fundamentally changed the relationship of society to sex acts in Krafft-Ebing's discourse. Sexuality became a question of health, above and beyond morality. Krafft-Ebing's medicalized vision of sexuality laid the ground work for further sexological investigations in the late nineteenth and early twentieth centuries.16

Foucault demarcated this historical shift in the history of pleasure in terms of Scientia Sexualis. This new perspective on sexuality emerged under the auspices of a science of desire that linked confession with the empirical project in which both gender behaviors, sexual acts, and sexual personages could be medically analyzed.17 In light of this emerging sexological tradition, Dickinson saw sex as an empirical question which his society knew all too little about. Sexology was producing new data and research potentialities. It was a scientific discipline that Dickinson was determined to disseminate to American medical audiences.18

Dickinson continued the work of European sexology in the American context. Of all the medical experts on sex, it was Havelock Ellis that principally influenced Dickinson. Ellis had Dickinson's respect. Dickinson was impressed by the multifaceted approach to the study of sexuality that Ellis employed. Dickinson would combine Ellis' use of the case study with his own gynecological expertise. It was through this combination of sexology and gynecology that made Dickinson unique. Through continued sexological research and its proper application, Dickinson believed the constitutional and social future of Americans would be safeguarded. Dickinson, like Ellis, viewed sex not only as a question of health but also as the culmination of desire.19

In this formulation of the role of medicine in regard to culture, an investigation of individual bodies would lead to the understanding of the collective social body. Armed with new knowledge, social reformers of the Progressive Era through to the 1930s sought to develop more effective techniques to arrest deviance, and thereby promote societal cohesion. Moral and political problems increasingly became empirical questions as positivistic science attempted to extend its focus into what would be called the social sciences. Dickinson believed that through education most social problems could be alleviated. What stood as education for him was based in scientific observation and conjecture. Dickinson was a positivist.20

Dickinson was not alone in his faith that empirical investigation could solve nearly all problems. This positivist evaluation of science was intrinsically tied to the eugenics and sexological movements which were particularly influential in the early twentieth century.21 Dickinson was an important player in a wider social contest which was defining the nature of acceptable familial relationships, gender roles, and sexual practices.