Responding to the "New Woman"

Dickinson's concern with the wife and her sexuality was linked to two important trends in American society in the early twentieth century. Women were redefining their position in the social hierarchy. The "new woman" was being born. This reformulation of female gender roles allowed for increasing autonomy for women which was a concern for many middle-class men. The second concern was the decline in birth rates among the middle classes. This trend combined with fears about immigration, led to cultural anxiety about the future of the "Anglo-Saxon stock." These wider cultural fears were represented in Dickinson's perspective on birth control, marriage, and fertility.

The "new woman" assumed a variety of forms and meanings in the cultural lexicon of early twentieth century America. She existed in both middle-class and working-class arenas advocating for the advancement of women's legal rights and significant social change. Radical women in the period such as Emma Goldman and Elizabeth Gurley Flynn were part of the second wave of feminism.16 Standing firmly on the side of labor, they argued for the redistribution of political-economic power in America. Social, intellectual, political, economic, and sexual equality between men and women were their goals. Those involved in this feminist project sought to overturn the bourgeois order on a multiple of fronts.17

Many feminists were involved in the struggle for reproductive and sexual freedom. They argued that motherhood fundamentally was a choice but not a limiting one. Although this articulation of female autonomy was an important and radical one, it lead to some difficulties for the movement. The sexuality of women came under increased cultural scrutiny. This drew attention away from the main focus of feminists which was political, economic, and social equality for all.18

Dickinson was not particularly supportive of women publicly advocating for their own rights. He saw such political actions as a possible result of sex maladjustment. Dickinson focused on the sexuality of the "new woman".

Compensation for love impulses thwarted in marriage does not necessarily take the form of requiring physical satisfaction. To atone for spiritual loneliness, compensation magnifies the personality by extraordinary egotism and by material acquisition. Of these attempts, fear, girlish ways, gourmandism, the arts, religion, morals, culture, social and political "causes", the overassumption of family responsibility, worry and financial extravagance are indications told in about 250 cases. 19

Dickinson saw political activity and taking a stronger position in the family as the results of women not being sexually satisfied. Dickinson pathologized women who resisted traditional gender roles. Dickinson's sexually undernourished woman was hysterized; her sublimated desires became his rationale for her deviant behavior. Dickinson did not comprehend the oppression caused by the unequal status of woman, and how that sent women into action. The inequalities of gender in American society were naturalized in Dickinson's work; every resistant act a woman took was somehow a result of the misuse of her sexuality. Dickinson thought women should remain in the private sphere of the home.20 (see figure 2 and 3)


--Figure 2: Idealization of the wife and her children in the domestic sphere as the "happy family"


--Figure 3: Depiction of gender dimorphism in humans

Dickinson delegitimized feminism through an attack on women's sexuality. At least in theory, controlling sexuality gave him a way of regulating the status of women in society. He thought that the use of sex instruction would ensure the proper place of women in society as wife and mother. To implement this, Dickinson would teach the perspective couples how to sexually satisfy each other. He believed that this would prevent sublimation from occurring in women; thereby ensuring their docility.21


Feminism was not the only cultural force Dickinson was reacting to; the general decline in birth rate and the growth of immigration led to an increasing nativistic concern for the survival of the "American stock". These concerns were based both in race and class. Many members of the professional classes were concerned that birth rates among the better-educated, economically advantaged middle and upper classes were declining. Their fear was compounded by the fact that the birth rates among the working class and non-whites were not declining nearly as fast. Men like Theodore Roosevelt scolded economically advantaged women to have as many children as possible to prevent "race suicide."22 Half the growth in American population from 1900-1915, was the result of immigration. Many eugenicists wanted to stop immigration to prevent the "outbreeding of the native stock".23 Being involved in the eugenics movement, Dickinson articulated these issues by trying to make eugenics the concern of marriage counseling.

Dickinson wanted to increase the medical surveillance of sexuality in America to protect and promote marriage. His final work which was left unfinished before his death The "Doctor as Marriage Counselor" was an attempt to convince his colleagues to get more involved in the sex lives of their patients.24 Dickinson's plan was radical. It represented the culmination of his life's work. Dickinson's unfinished manuscript was his final attempt to convince American medicine to get more deeply involved in the regulation of sexuality. Dickinson published a summary of the manuscript in the Journal of the American Medical Association before his death.25

The article that appeared in the journal summarized much of the work Dickinson had been involved with throughout his life. Particularly, Dickinson wanted doctors to directly intervene to save the institution of marriage. The belief that marital unhappiness could be prevented by medical means permeated Dickinson's work.

It took twenty years in practice for me to come to the belief that marital maladjustments were mostly preventable; then as many more to earn enough to retire to devote a last twenty to a closer study of marriage counseling and its relation to general sex education and to character training.26

Recounting his clinical experience in marital sexuality, Dickinson was seeking to influence the focus of American medicine. He wanted to convince doctors that they should be especially involved in premarital consultation. Dickinson saw marital problems in the same light as he did organic disease. Dickinson believed that all forms of pathology, whether organic, social, or psychological, should be under medical scrutiny. He recognized social discontent as a disease that emanated from individual bodies.27

If the medical profession did not assume the responsibility for sexual management of its patients, Dickinson saw grave consequences for American society and for American medicine itself. Speaking polemically, he warned medicine of its responsibilities.

Any community that waits to give training that anticipates marriage until patterns are set - or well on the way toward setting - into frigidity and impotence and divorce - or in any degree toward promiscuity and homosexuality - is guilty of an unpardonable lack or courage and foresight. 28

Dickinson argued here for prevention. Frigidity, impotence, divorce, promiscuity, and homosexuality were linked in his thesis. Frigidity and impotence resulted in marital maladjustment because of the lack of sexual fulfillment. Divorce, promiscuity, and homosexuality troubled Dickinson because they involved sexual gratification outside of marriage. All of these represented in his work great threats to family stability and marital fulfillment. Dickinson warned doctors that if they did not take steps to eliminate sexual deviance they would be responsible for devastating consequences; he held the medical community responsible for familial breakups. The consequences were, of course, the gradual overturning of oppressive ideologies of sexuality and gender. Social change of this sort was very disturbing for Dickinson and other members of the medical establishment. For them, gender and family were biological issues, not social ones. Physicians like Dickinson had a stake in maintaining the sexual status quo. Seen in a essentialist perspective by medical professionals, transgressing gender boundaries was analogous to infection. Physicians felt it was their duty to return their patients to biological health.

The belief that sexual behavior was a purely technical question allowed Dickinson the freedom to simplify issues of marriage and sexuality. He saw marriage as analogous to other forms of employment, albeit, an important one. Therefore, Dickinson wanted to make sure perspective parents were suited for the job.

Examination for fitness is becoming the rule of all occupations save for the two most vital and difficult - marriage and parenthood. How to start marriage counsel as custom, how to do it well, yet rather simply, - this is the immediate problem.29

Dickinson wanted to alter the fabric of American society to allow strict medical surveillance and regulation of marriage. He wanted to make marriage counsel a cultural institution that would teach and enforce "sexual health". Dickinson wanted marriage counseling to become part of everyday life. He wanted medicine to have broad powers to implement a moral-scientific code of heterosexual hegemony. Women and men were to be taught what their proper roles in the family were so they would be ready for marriage. Along with these gender prescriptions, the grounds for parental "fitness" would be based in eugenics.

Dickinson looked to Europe as an inspiration for the marriage counseling system he wanted to implement in America. He was particularly impressed by German eugenic policies as were many others in the American eugenics movement.30 He included a great deal of material published on the subject in the manuscript. The German eugenic law which took effect on January 1, 1934, Dickinson wrote, allowed for the sterilization of nearly 400,000 people seen as "unfit to bear children". He quoted the policy in more detail.

The federal cabinet has enacted a law for the prevention of offspring with serious hereditary defects... to be regarded: insanity, hereditary epilepsy, hereditary chorea minor, hereditary blindness, hereditary deafness, severe hereditary bodily deformities. Of especial importance is the regulation that sterilization can be performed on persons who are suffering from severe alcoholism. 31

Dickinson subscribed to ideas of eugenic sterilization. He believed it was part of the responsibility of American physicians to promote social well-being. Dickinson hoped to bring to the United States a kind of reproduction management similar in spirit to the German law. His tactics were different, however. He was not interested in direct state intervention. Dickinson sought an indirect measure; he wanted the state to allow voluntary sterilization. He wanted doctors to be able to advise their patients to sterilize themselves or family members. Dickinson placed the responsibility to handle these issues firmly upon the medical community. He believed physicians could implement eugenic policies with a much subtler form of coercion.32

Marriage counseling could implement eugenic birth regulation if it were given the power by the state to certify marriage. Dickinson thought it would be more effective to stop the "unfit" from reproducing by preventing them from marrying at all. Dickinson wrote about the medical, marriage certification requirement in European states such as Sweden and Denmark. In these countries the doctor would present to the authorities a "declaration by the couple covering mental trouble, epilepsy, venereal disease, leprosy, consanguinity, previous marriage, and children born out of wedlock." 33 He wanted the marriage counselor to serve the same function in America.34

Dickinson did not believe that "marital legislation" was the answer for America at his point in time. He thought state regulation of marriage would be counter-productive to the struggle for racial purity through social hygiene. Dickinson wanted to study the situation further; he maintained that scientific inquiry should guide social policy.35

The need now is for the development of a practical clinical procedure, experience with which will give the basis for the development of a broad social policy. This responsibility weighs equally upon the individual, the social mind and the technician, in this case the physician.36

By working as marriage counselors, Dickinson believed himself and others could gather enough scientific evidence through clinical undertakings to make a strong case for the changing of social policy concerning marriage. He hoped this would eventually change American marriage customs enough to be codified into law. Dickinson was seeking to make marriage a purely scientific problem. He saw that the facts obtained from the study of marriage should be used to influence social policy.37

Dickinson's hopes for the reformation of marriage based on eugenic principles were summarized in this 1913 article.

Looking toward the time when law and custom will require the exchange of certificates of physical and mental soundness before marriage is permitted or even finally pledged, and with the character of the examination for such certificate standardized, [Dickinson] urged that the profession should get ready by formulating the type of the examination and certificate.38

Having the medical profession intimately involved in marriage was Dickinson's goal early on. He wanted doctors to certify the physical, mental, and moral fitness of perspective couples. He sought to further a medico-moral agenda based on eugenic principles. Furthermore, he wanted to make sure the couple was prepared for sexual life and advised the offering of sex instruction to perspective couples. Dickinson even devised a rudimentary marriage certification form.39

Dickinson believed the marriage counselor could offer advice about family planning to the young couple. Dickinson felt that birth control was quite necessary; "the ability to give advice on bearing all the children compatible with well-being of parents, progeny, and community calls for knowledge of the best methods of spacing births."40 Dickinson wanted continued research into new birth control methods. Dickinson also sought their greater availability and widespread use. He was critical of coitus interruptus which he thought could lead to the "limitation of male gratification" and/or prevent female orgasm. The lack of pleasure was seen to lead to marital maladjustment and "nerve strain." Dickinson was particularly enthusiastic about spring-loaded pessaries, spermicidal creams, and condoms. Whatever the method, medical professionals would be the ones to decide when contraception should be used. He did not want to give women unlimited free access to contraception control.41

Although Dickinson was a vehement public supporter of women's access to birth control, he was still concerned about contraception's effect on fertility. He saw birth control as a way to improve marital harmony and also as a means to implement negative eugenics. For Dickinson, birth control was a way of upholding the status quo, not disrupting existing power inequalities. The disturbances in power relations between men and women brought about by the feminist challenges to the status quo were a problem for Dickinson. He thought changes in familial power dynamics would upset health.

As culture develops this "independent" woman, does it develop a complementary child man or a superman? If it develops equals can it promote fertility? If the child woman is the type preferred for marriage, with which sex shall education begin and what education?42

These statements summed up Dickinson's concerns about the effects of redefining gender roles on the family structure. Since the "child woman" was seen by him as the preferred female "type" for marriage, the mature and self-reliant woman presented a problem. The independent woman was seen as a threat to the family by Dickinson even though her independence was called into question by the quotes that encircled the word. It would cause a redefinition of male gender roles in response to the rise in status of the new woman. Dickinson thought the family would create a new power equilibrium in response to the feminist challenges to it. Dickinson's "family" was always already hierarchical in structure. This change in the distribution of familial authority would entail for Dickinson either a reduction of the husband to a "child-man" who would be dominated by his wife or a "superman" whose authority over his wife would rise so that he would still be dominant. Hypervirility would somehow counter the effects of female autonomy according to Dickinson.43

As Dickinson stated above, he believed greater female autonomy could lead to a lower birthrate. He directly linked changes in the family structure to a drop in fertility. Dickinson believed some independent women were reneging on their responsibility to reproduce the "native stock". Yet, this problem could be resolved through proper sex instruction and marriage counseling according to Dickinson. He did see that birth control could lead to "race suicide." On the other hand, Dickinson viewed controlling contraception as an opportunity to implement negative eugenics especially for those who were "economically disadvantaged." The languages of racism and class warfare are intertwined in Dickinson's discourse. A tension lingered in his work between the problems and possibilities of birth control. This tension made it clear to Dickinson that medical oversight of birth control was all the more necessary.44


Dickinson thought marriage counselors needed to have a knowledge of sexology, birth control, organic disease, and eugenic theory. Besides these issues, the qualifications for becoming a marriage counselor were relatively lenient. The most important attribute of potential marriage counselors was if they had a medical background. Dickinson wanted the marriage counselor to be a physician like himself who was "clean of mind and happy in his marriage."45 Dickinson was particularly excited about the possibilities of psychiatrists, gynecologists-obsetricians, and urologists being involved in marriage counseling. Dickinson thought the combination of their expertise in psychology, genital anatomy, and general physiology would connect understandings of mind and body. This combination of medical disciplines would allow Dickinson and future marriage counselors to reduce the sexual life to something easily interpreted by physicians; that being, something that was written on body as an anatomical abnormality. As in much of Dickinson's sexological work, interpretation of the body led to technologies of sexual regulation.46

The actual practice of marriage counseling Dickinson advocated involved interviews similar to the studies he undertook throughout his sexological career. The most important technique was the interview. The marriage counselor would question the perspective couple and physically examine them. He used this to discover what he thought were sexual aberrations, for example, excessive autoeroticism, homosexuality, and sexual activity in women who were presumably virginal. Such discoveries could lead the counselor to recommend that the marriage not proceed.47

Dickinson offered some indications of what signs marriage counselors should be watchful for. The female body, as discussed in the previous chapter, was a place where Dickinson felt he could find objective sexual knowledge by reading the vulva. He used this perspective on the body and its sex as a means to make the premarital interview more efficient and effective.

Where the doctor is a stranger to his patient he does well to establish a friendly relationship before examination. Where that has been already established, the examination is done promptly, as it is likely to give direction to the questions and the instruction and thus save much time. For instance, a wide and worn hymen and free self-exposure suggest direct speech with shortened preambles, whereas, other things being equal, embarrassment and infantile genitals and a small sharp-edged opening give warning that instruction is to be approached in a somewhat gradual fashion.48

Dickinson was using his particular way of reading behavior into the body as effective medical praxis. Two basic stereotypes of femininity were constructed in this text, the sexually free woman and the virgin. The sexually free woman's genitals were described as open and freely presented to the doctor. To this woman, Dickinson, recommended frank and direct speech about sexual matters in the interview. In contrast, the virgin's genitals were childlike and closed. She apparently did not want to be examined. Dickinson advised that with the virginal woman, which he sometimes defined as imparous, the discussion of sexuality take a slower pace.49

Here as well, Dickinson connected psychology with anatomy. This medical myth-making assumed that there was two basic types of women that would come before the marriage counselor: a woman who has known sex and one who has not. A woman well aware of sexuality would somehow have larger, more open genitals for the doctor to view. As for the less sexually experienced women, she would necessarily have small genitals and be resistant to gynecological examination. Dickinson used this anatomical stereotyping to easily categorize women under his examination. He saw it as an expedient method to accomplish his medical goals.50

By doing the gynecological examination early on in the premarital interview, Dickinson thought he could bypass a lengthy dialogue between the woman and the doctor. He focused on her genitals and her willingness to show them, first. The observations Dickinson made from this examination procedure were understood to be able to tell him more than the verbal exchange. In his work, Dickinson preserved the long practiced medical ritual of opening the body; such observations were thought to lead to the medical "truth" more precisely than unverifiable speech.51

Dickinson used the scientific presumptions of his past linkage of homosexuality and genital morphology to give marriage counselors techniques to prevent same-sex eroticism.52 The prevention of same-sex love was crucial to preserving his notion of marital stability. Dickinson made sure the future marriage counselors would understand that homosexuality was pathological.

Unalterable fixation of desire and response on members of the same sex, psychologically or physically, is an important condition for the Counselor to recognize. It is his function to prevent marriage in the presence of such irremediable clash and to diagnose post-marital maladjustments of this sort in their relation to reeducation. Familiarity with any behavior or with any bodily form or genital variation met with in examination which may point to sex deviance belongs in the Counselor's armamentarium (bold mine).53

Dickinson conjured the spirit of war as he attempted to use the counselor as a tool to eliminate difference. Whether homosexuality was seen to be caused by psychological or congenital factors, Dickinson wanted potential counselors to be aware of the signs of sexual deviance. The counselor was charged to point out these dubious signs and prevent the potential marriage. If the marriage had already occurred, Dickinson thought a medical reeducation could possibly remedy sexual deviance.54

Dickinson used the pelvic exam to discover more than homosexuality. The certification of virginity came under the jurisdiction of the marriage counselor. Dickinson believed it was still an issue, even though he saw its importance on the wane.55

There is a fear of removal of evidence of virginity as well as apprehension of discovery of nonvirginity... as to the hymen after the doctor's examination, we give assurance that virginity remains, anatomically. Neither the male size index finger nor... the virgin-sized vaginal speculum expands the opening... of the virgin hymen to that size required to admit the male.56

Dickinson assured the medical reader that marriage counselors would not disturb the "anatomical virginity". There was a discomfort inherent in this text. Dickinson was trying to allay fears concerning the male doctor's intrusion into the husband's sphere; access to the woman's body was seen as the husband's right. Mary Poovey has observed a similar discomfort with the gynecologists' interaction with his female patients and the use of ether in the late nineteenth century. Gynecologists were trying to "desexualize" women by either anesthetizing them or letting them experience pain during labor. The sexuality of the doctor was rendered problematic by gynecologists' own discourse. Dickinson was still experiencing some degree of anxiety over his relationship with the female body in the first half of the twentieth century.57

By examining the "virgin hymen," Dickinson thought he could prevent future sexual difficulties. He believed that the hymen needed to be stretched to avoid pain on the wedding night. This could be done by the bride or the groom. If the hymen was too thick for stretching to make a difference, Dickinson proposed surgical methods to open the vulva. He sometimes performed such operations but only rarely.58

Beyond the pelvic examination, Dickinson wanted the marriage counselor to notice apparent psychological traits of the perspective couple. Here as well, the repression of homosexuality was central to his thinking. He believed the marriage counselor should be watchful for signs of femininity in men and masculinity in women. Dickinson argued that these "gender inversions" were signs of homosexuality or other forms of sexual deviancy. The marriage counselor should seek to prevent marital union in such cases.59

The marriage counselor functioned more than just as a disseminator of medical sex knowledge. Marriage counseling involved the direct enforcement of gender roles. If gender roles were deviated from, Dickinson wanted the marriage to be discouraged to prevent future marital maladjustment. Any disturbance in the family structure that he thought could be avoided, fell under what he called "preventive" medicine.


The examples outlined above highlight what he thought gender roles should be and the techniques Dickinson devised to ensure them. He had a clear idea of what women's roles in society should be. Dickinson stated in the foreword to the 1941 version of "Doctor as Marriage Counselor" the goals of the marriage counselor which reflected his vision of gender.

For health and happiness in homemaking, childbearing and childrearing, the doctor is called upon to define normal function, to foster sane attitudes toward sex conduct, to develop sound schedules for examination and instruction, and to aid in planning programs to prevent discontent and disruption.60

The focus was firmly on women. The woman in Dickinson's text was domesticated. He romanticized the role of the wife as the ideal member of the "saintly half of the race." Dickinson's woman was a mother, homemaker, and (hetero)sexually "awakened." This construction of femininity placed women in the domestic service of men. Female domesticity was seen as the norm; Dickinson used an idea of an innate sexual drive in women to naturalize the censored role of women. He thought women could only find pleasure in the keeping of the home, the rearing of children, and sex with their husbands. The possibilities of women finding pleasure in other ways were seen in direct opposition to their nature. Defining actions that were outside of the norm as against nature, Dickinson could justify them as the result of pathology. Women's diseases were either in the mind or the pelvis for Dickinson. He did not see that the actual difficulties women faced were inherent in the norms he was trying to uphold. From Dickinson's reductionistic perspective, an idea like that would be absurd; he could not truly see the world outside of the body.

Dickinson's biological focus failed to consider that gender was a product of a particular historical moment. Dickinson drew the majority of the justification for his work from what he saw were the physical facts of womankind. If a woman deviated from the role she was ascribed then Dickinson thought marriage counseling should reeducate her to perform her "biological" destiny. The destiny for women in Dickinson's work was marriage and pregnancy.

The reproductive possibilities of women's bodies were managed by Dickinson. Through the use of "planning," he wanted to instruct women when and if they should bear children to prevent "discontent and disruption." He wanted to ensure that marital harmony would continue under the added stress of childbirth and childrearing. Yet, marital harmony was not the only goal he was seeking to implement. The idealized wife of Dickinson's work also implemented birth control properly to protect the race. Dickinson's marriage counselor should educate the wife about eugenics. He felt it was her duty to humankind to reproduce or not according to the "hereditary traits" she and her husband carried. Dickinson advised marriage counselors to take steps to ensure this would occur.61

Education was crucial to marriage counseling. The marriage counselor would use his or her discursive authority as an expert to instruct couples on how they should live, love, and bear children. A dialogue between the counselor and the couple did not exist. The couple could either accept or reject the counselor's advice. The discussion in the premarital interview was about how the couple should emulate the bourgeois familial ideal; the validity of the family structure could never be the subject of argument. Dickinson thought this education would necessarily transform the single man and the single woman into the perfect couple.62


As we have seen in this discussion of marriage counseling and sex instruction, female sexuality was central in Dickinson's thinking. Male sexuality was also a focus but it was not as significant; it did not need to be analyzed in the same fashion because it was apparently more understood. Female sexuality represented both the problem and solution to marital difficulties. Through sexual reeducation, Dickinson believed he could manage female sexuality to ensure the heterosexual marriage. Without the scientific management of women's libidinal economy, he thought marriage could be in jeopardy.

Here, sex instruction was crucial to preserving the sanctity of marriage. Dickinson constructed a world were a crisis of misinformation was leading to the instability of marriage. He wanted to inform women of the "sexological truths" that could apparently save this heterosexual institution. Dickinson prescribed this role to the doctor and called it marriage counseling. The doctor as marriage counselor would ensure proper heterosexual adjustment through examining and instructing the bride and groom.

The primary focus of Dickinson's work was the preservation of the bourgeois family structure. In order to do this he needed to maintain women in a subservient position in the private sphere. She was deemed pathological when she transgressed the familial role she was ascribed. Whether by loving another women instead of a man or by entering the public sphere, what was central to Dickinson's understanding of women's behavior was that she transgressed her gender role as wife and mother. By not performing gender in the way Dickinson approved of she therefore was pathological.

Instead of focusing his energy on how the family could benefit from the equality of men and women, he sought to prevent egalitarian relations between the sexes. He thought the disparity in power between men and women was a product of nature, not culture. Dickinson wanted women to desire to enter the private sphere of the home; he saw it as the aim of their innate sex drive. Yet, this "aim" was something Dickinson felt needed to be controlled. He wanted marriage counselors to shape women so they would desire nothing more than marriage. Marriage counseling was a disciplinary technology designed to make women conform to the desires of the husband and enjoy doing so.