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Chapter 11
The Scientific and Medical Study of Sex
Introduction
The scientific study of human sexual behavior is a relatively recent phenomenon dating from the late nineteenth century. In the Western world at least, sex has typically been studied through the lens of religion and most often in terms of sinful action and thoughts. Christianity in particular has taken a rather restrictive view of sex and of sexual pleasure. And the Roman Catholic Church continues to believe that the only legitimate sexual activity is (potentially) pro-creational intercourse between a married man and woman. This book has of course been a philosophic exploration of sex, which has often engaged in a dialogue with and/or a critique of traditional sexual views. In this chapter we shall redirect our attention to an exploration of the scientific study of sex and its recent “medicalization,” a term we will explain later in this chapter. In particular, first we will investigate what is meant by a scientific study, considering two quite different views of the subject, one called positivism and the other social constructionism. Second, we will then examine briefly some of the history of sexology to see to what extent we can legitimately call sexology a science. We follow that by a consideration of a recent controversy in sexology and biology regarding female orgasm, and in particular whether it serves a biological, reproductive function. We will be on the lookout here to see whether scientific investigations into this matter have been guilty of the sort of male bias that has traditionally haunted sexology (along with other fields within science). Finally, we shall explore the recent medicalization of sex which has been the subject of considerable debate lately. A number of people believe that such medicalization has resulted in the construction of numerous sexual “dysunctions” that medical experts under the influence of big pharmaceutical companies say need to be treated by drugs. If this is true, then it puts the legitimacy of much recent scientific research into questionand raises the same sorts of concerns that people used to have about tobacco company sponsored ‘scientific’ research that concluded that smoking cigarettes was not dangerous to one’s health.
Defining science
One popular view of science is that it tells us what is the case as opposed to what ought to be the case. Hence, for example, while a religious view of sexual activity will tell us what sexual behaviors we are allowed to engage in and those we are not, a scientific view will tell us what activities we do engage in, whether those activities are religiously sanctioned or not. The Oxford English Dictionarypoints to this descriptive aspect of science when it defines scientific method as: "a method of procedure that has characterized natural science since the 17th century, consisting in systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses" (OED, 2010).There are a number of things to note about this definition. First, science must work with objects that are observable, at least in theory, even if one has to use powerful tools to observe them, or to ‘see’ them only indirectly through their effects. Many have said that this means that science is inherently materialistic, i.e., that it examines physical, material objects, forces and processes. Second, that science does more than observe this matter; scientists measure and perform experiments upon it. How these experiments proceed has been a matter of much philosophic debate. One influential account of the experimental method of science was first developed by a seventeenth century English scholar, William Whewell, which he called the hypothetico-deductive method, and which has been advocated in various forms by many contemporary thinkers. According to this theory, scientists must begin by formulating a hypothesis, which is a suggested answer to the question under investigation. The scientist then proceeds to see what is implied by the hypothesis. That is, what would be true if the hypothesis were true? The implication of the hypothesis is then tested in an experiment. If the experiment is ‘successful,’ the hypothesis is (inductively) confirmed; but if it is not successful, the hypothesis is proved false and must be rejected (See, e.g., Hempel, 1965).
Consider a simple example. Imagine that your car won`t start. You think that it may be out of gas. We can call this your hypothesis regarding the car’s inability to start. If this is indeed the cause of your problem, then putting gas in the car should start it. We can call this the implication of the hypothesis. In this case, it’s a prediction of sorts: if the car had gas, it would start. To test this, you put gas in the car. If the car starts, your hypothesis is confirmed; if it does not, then your hypothesis is falsified and you have to come up with an alternative hypothesis regarding the car`s failure to start. For example, it might have a faulty starter, or the battery is dead.
While actual hypothesis formation and experimental testing can be incredibly complex, the above simple example points to a number of important features of how science proceeds and how it differs from methods of inquiry in other fields, such as philosophy, religion, or English literature. According to the influential philosopher of science, Karl Popper (1959, 1963), scientific enquiries must be what he called “falsifiable.” Clearly, this doesn’t mean they are false. Rather, it means that the hypotheses that scientists put forward must be tested and it must be possible that the hypothesis fails the test. This is the case in our example given above. It was possible that our hypothesis that the car wouldn’t start because it was out of gas is certainly testable, and it’s possible that the hypothesis could fail the test. This view of science is often referred to as Positivism, Scientism, or Scientific Realism. It has been very popular and influential but started to come under attack in the middle of the twentieth century, which we discuss below. It needs to be noted, however, that despite attacks upon it, the Positivist view of science is still held by many people today, especially by people working in the natural sciences, such as chemistry, physics, and biology.
An alternative view of science can be traced back to the work of Thomas Kuhn whose highly influential The Structure of Scientific Revolutions was published in 1962. One of Kuhn’s basic points is that scientific inquiry can occur only within a worldview or conceptual framework, which he called a paradigm. Such paradigms contain, he argued, answers to some basic questions about the area of scientific investigation under study, which scientists working in the discipline agree on. For example, contemporary biology assumes a (roughly speaking) Darwinian framework; that evolution occurs, and does so by the process Darwin called natural selection, and which often gets associated with the phrase, `survival of the fittest.` This is not to say that biologists have no good reasons for believing in Darwinian evolution or that they agree on everything. In fact, they can and do disagree, sometimes quite radically, about any number of things. But they agree on the paradigm, and indeed think that disagreements only make sense within that framework. We will look at an example of such a disagreement in a moment when we look at the disagreement scholars have had about the nature of female orgasm. The point we wish to make at the moment is a bit different. It is that what counts as facts in science are dependent upon scientists agreeing about a great many things about the nature of the universe. Critics of Positivistic science claim, however, that this agreement between scientists is as much a sociological fact as it is an objective claim about the basic truth of the external world. As a result, these critics claim, science has some subjective (or intersubjective) component at its base, as opposed to the positivists who tend to think that science gets at the objective truth of things. This point about subjectivity is especially important to people who come from historically marginalized groups, like women and racial and sexual minorities. Indeed, as we shall see in a moment, that is exactly what some have claimed about studies of female orgasm. It has been studied mostly by male scientists, and as a result has assumed certain things that are far more true of male sexual experience than of women`s.
Approaches such as the one described above have come to be called social constructionist views. The idea behind this position is that we actively interact with the surrounding world – reality, in other words – and through our beliefs about it, actually create or construct it, at least in part. The feminist philosopher of science, Ruth Hubbard (1989), has said that as a result of this, we must always be conscious of who the “fact makers” are. Typically, she argues, in the Western world, they have been wealthy white men, who have been the most dominant and powerful group. As a result we must scrutinize the so-called objective claims of science as being simply the views of a powerful group within society keen on keeping its dominant position.
The so-called ‘science wars’ of the 1990s was a sometimes heated dispute between people who espoused either a positivistic or social constructionist view of science. We don’t propose a solution to this dispute. Our point in raising the issue here is to determine whether sexology is a science on either of these two views. Our answer to this isn’t a straightforward yes or no. Rather, our discussion will reveal that different sexologists have adopted different views of science – some are positivists but others are social constructionists. Moreover, while some that have tried to be positivists have failed in their attempt to do so. This is particularly true of the first and second generation of sexologists.
Is Sexology a Science?
Sexology began in the late nineteenth century. While the first generation of sexologists tried to be what they believed was scientific, they were overly constrained by the morality of their day. Hence, they were particularly interested with examining what they considered to be deviant sexuality, and this including almost everything except pro-creational sex between a married couple. Some argued, moreover, that it was possible even for married pro-creational sex to be deviant or at least problematic. For example, Elizabeth Osgood Goodrich Willard, who coined the term sexology, thought sex for women was inherently dangerous. An orgasm, she said, was more debilitating to the system than a hard day’s work. We must be vigilant, therefore, to stop the waste of energy
through the sexual organs, if we would have health and strength of body. Just as sure as that the excessive abuse of the sexual organs destroy their power and use, producing inflammation, disease, and corruption, just so sure is it that a less amount of abuse in the relative proportion, injures the parental function of the organs, and impairs the health and strength of the whole system. Abnormal action is abuse (Willard, 1867; cited in Bullough, 1994, 26).
Two of the major sexual preoccupations and worries of that time were masturbation and homosexuality, which most researchers believed were deviant and unhealthy. The French physician, Tissot (1728-1787), for example, believed that because semen was vitally important to male health, excessive sex and onanism (his term for all non procreative sex, including masturbation) could lead to everything from unclear thinking and acne to tuberculosis, intestinal disorders, and impotence. He thought the case was even worse in women since, in addition to all the above problems, onanism could lead to lesbianism. And in prepubescent adolescents, the problems were worse once again since they could also lead to insanity (Bullough, 1994, 20-22).
Richard Freiherr von Krafft-Ebing (1840-1902), who published Psychopathia Sexualisin 1886, was perhaps the most significant writer about sexuality in the nineteenth century. A medical doctor and psychiatrist, Krafft-Ebing shared many of the rather conservative beliefs of his time while struggling to think of sex, and of sexual ‘deviancy’ in newer, less judgmental ways. Thus, while he believed, for example, that homosexuality was not necessarily degenerate and perverse and that homosexuals could be ‘normal’ in the non-sexual parts of their lives, he also believed that sexual desire was always potentially dangerous and hence had to be tightly controlled. Uncontrolled sexual desire, he felt, was like a “volcano which scorches and eats up everything, or an abyss wherein everything is walled up – honor, property, health. [By establishing monogamous marriage and reinforcing religious bonds] Christian peoples obtained a spiritual and material pre-eminence over other peoples, particularly thoseof Islam” (cited in Bullough, 48). Clearly, Krafft-Ebbing has here crossed entirely over the line of describing sexual behavior and entered the realm of moral pontification. Claims such as this are surely not scientific in any recognizable sense of that term.
The most significant figure in the second generation of sexologists was Sigmund Freud (1856 – 1939), the Austrian neurologist and father of psychoanalysis. His theories were the most influential within psychiatry for at least half a century, and he continues to be influential in fields as disparate as literature and sociology. Freud believed that sex was at the root of almost all human behavior and believed in particular that the vast majority of our psychological problems stemmed from some sexual cause. In fact he claimed at some points in his career that all neuroses had a sexual cause.
Freud’s overarching theory is complex and the subject of intense debate and so we won’t be exploring it any detail here. Instead, we will provide a brief overview of his theory and indicate on what basis he came to think as he did in order to see whether his views were scientifically based.
The historian of sexology, Vern Bullough (1994, 88), provides a nice summary of Freud’s overarching thoughts in the following passage:
[At the end of] his own self analysis …(about 1902), Freud emerged with the conviction that he had discovered three great truths: that dreams are the disguised fulfillment of unconscious, mainly of infantile wishes; that all human beings have a Oedipus complex in which they wish to kill the parent of the same sex and possess the parent of the opposite sex; and that children have sexual feelings. He later added two ideas to these emerging principles of psychoanalytic thought, namely the division of the human mind into superego, ego, and id, and the concept of the death instinct (thanatos).”
The first sentence of this passage gives us a clue as to the basis of Freud’s beliefs, namely “analysis,” in this case, self analysis, which is a form of introspection or a “case study” of oneself. Indeed, case studies really form the basis of Freud’s beliefs, though this is true only in a complicated way, as we shall see. Indeed, many of the early sexologists relied heavily on case studies when formulating and/or defending their views about sex. While case studies have a veneer of scientific acceptability behind them since they are based, theoretically, on empirical evidence, this can be far from the actual truth. Properly done, a case study can tell us a great deal about a particular person (see, e.g., Levin, 2007 and Elliott, 1998), but they become problematic when (1) they are used to generate claims about large groups of people or even of all people, and/or (2) they are not properly done. Freud, along with the rest of the first and second generation sexologists, suffered from both of these problems.
Regarding problem (1), consider as an example the highly influential early English sexologist, Havelock Ellis (1859 – 1939). His theories were drawn largely from case studies of himself, his wife, and their friends. Unfortunately, from a research perspective, they weredistinctly un-representative of the populous at large. Ellis’s wife was a lesbian and Ellis suffered through long periods of impotence, and had a fascination with urolagnia. And their friends, especially Mrs. Ellis’ friends, tended to be part of the gay and lesbian community and certainly were not part of mainstream sexuality in Victorian England. This isn’t to attack Ellis, his wife, their friends, or their sexual orientations or proclivities;rather, it is to say that the data acquired through case studies of these people may not be generalizable to the population as a whole. Freud made a similar mistake by drawing almost all of his ‘empirical’ data from his patients whosuffered from some neurosis or other.It was for reasons such as this that Beatrice Faust (1980) claimed that “it is always possible to discover a few case histories to support any particular argument but case histories only illustrate they don’t verify.” And even Freud himself said of this method that, “It strikes me as strange that the case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science” (Freud, 1895).
For reasons such as this, contemporary medicine has largely rejected case studies and claims that rely mostly or exclusively on the physicians’‘clinical experience’, and turned to what is called “evidence based medicine,” which relies on more scientifically legitimate evidence, theoretically at least.