Harry Oosterhuis, Stepchildren of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity, Chicago and London: University of Chicago Press, 2000. Pp. X + 321. £19.00. ISBN 0-226-63059-5

One of the major achievements of this important work is to redeem Richard von Krafft-Ebing from the far worse than mere condescension of history, which has largely regarded him as the great pathologiser (stigmatised him as a stigmatiser, in fact). Working from extensive but hitherto unexplored archival materials, Oosterhuis presents a convincing case that he was open-minded, flexible and eclectic in his thinking, a pioneer constantly and dynamically reworking his theories about sexuality. Oosterhuis repositions the notorious Psychopathia Sexualis as no longer the archetypal handbook of oppressive stereotyping but a plurivocal text in which Krafft-Ebing gave unusual space, increasing with every successive edition, to relatively unmediated 'patient' voices describing their own cases.

Krafft-Ebing was a good liberal prepared to subscribe his name to petitions for the repeal of homophobic laws, an anti-anti-Semite (even if, as with other otherwise liberal-minded figures of the day, some of his private comments about Jewish colleagues are jarring to present-day sensibilities), who demonstrated practical support for Sigmund Freud in the fraught medical-political world of late nineteenth-century Vienna. For a medical man of his day he was relatively moderate in his ideas about masturbation, seeing it as symptomatic rather than causative of disease (though this may have related to more general attitudes within German, as opposed to Anglo-American, medicine).

Oosterhuis breaks through the still too-frequent sterile depiction of power-crazed classification-made doctors and scientists on the one hand, and their poor oppressed victims on the other, to demonstrate the constant circulation of ideas and influence within a complex system. On the one hand, Krafft-Ebing learnt from his patients. Presented with a significant constituency of 'inverts' and other practitioners of (or at the very least, dreamers about) non-mainstream forms of sexuality (in particular male masochists), many of them of respectable and even superior social position and making valuable contributions to society, who could not simply be dismissed as the scum of humanity, he was prepared to reconsider the messages society was putting out about what was sexually normal and abnormal. On the other hand, those who found themselves at a tangent to conventional assumptions about gender and sexuality were provided with a language, and the narrative form of the case-history as evolved by Krafft-Ebing, to make sense of their own lives.

The limitations of Krafft-Ebing's project are not glossed over. It is clear that while a liberatory figure to many men, he was less interested in, and thus less useful to, women who did not fit gender norms. This may have been due to his acceptance of the nineteenth century assumption that lust (however unconventionally directed) was essentially male. It may also have been due to the fact that unlikely the mostly privileged male inverts and masochists who consulted Krafft-Ebing in person or by post, women were not economically, socially or culturally in the same position of being able, firstly to choose a doctor to consult as a private patient, and then, having chosen a doctor, to enter into a relatively equal dialogue with him. They would seldom have had the opportunity, unlike the male patients, to demonstrate that they were living a valuable and active life in the world, pursuing a profession or leading a respectable gentlemanly or aristocratic life, as a counter-balance to their 'perversion'. Oosterhuis perhaps insufficiently emphasises the class dimension in Krafft-Ebing's writings. The patient voices he privileged were those of men who already had a fair degree of social privilege. One sometimes wonders if a degree of social deference entered into his willingness to consider that a 'Count Z' - who had studied law and had a career in the army, was 'intelligent and talkative', 'well-mannered', a writer of poetry - was indeed a 'highminded... and sensitive character' rather than a specimen of degeneracy.

There are a few quibbles. There are one or two minor errors of fact (e.g. the British 1885 Criminal Law Amendment Act said nothing about incest). It would have been good to have seen, in the discussion of Krafft-Ebing's early career in psychiatry, and in particular the role of the asylum, some engagement with the recent work on Anglo-American psychiatric institutions by Mackenzie, Dowbiggin, Bartlett, Wright, Digby, etc, if only to locate Krafft-Ebing more specifically in the Germanic context. There are some very occasional infelicities of translation.

However, there is no doubt that this is a significant historical work, which makes a substantial contribution to a range of debates and raises a number of stimulating and provocative questions.

Lesley A. Hall

Wellcome Library for the History and Understanding of Medicine