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This foundational book, which first appeared in 1886, “was the most influential among a growing number of medico-scientific studies which defined sexual pathologies in the second half of the nineteenth century.”

History of Medicine Book of the Week: Psychopathia Sexualis (1886)

Man seated wearing a pink tutu and shoes. Wellcome Library, London.

Psychopathia Sexualis: A Historic Peepshow of Sexual Pathology and Criminology Appealing to Scholars, Artists and Common People Alike

By Anastazia Schmid


(right) Man seated wearing a pink tutu and shoes. Wellcome Library, London. [i]

Sex and violence. The two appear to be inextricably bound across time and place. Perhaps intellectual intrigue, perhaps horror, perhaps morbid curiosity, humans have long harbored a desire to know, likewise possessing fascination over why people sexually behave as they do, and why sex is so often linked with acts of violence, sometimes criminally so. This sensational coupling certainly wasn’t lost for Austro-German, forensic psychiatrist, Dr. Richard von Krafft-Ebing, or those who have been attracted to his epic medico-forensic study, Psychopathia Sexualis.[ii] This foundational book, which first appeared in 1886 has attracted multiple genres of study and notably “was the most influential among a growing number of medico-scientific studies which defined sexual pathologies in the second half of the nineteenth century.”[iii] A twelfth edition and translation of the book, published in 1906, can be found in the Leo J. McCarthy, MD, History of Medicine Room and Collection at the Ruth Lilly Medical Library.

Dr. Krafft-Ebing served as a medical superintendent at a German mental asylum from 1872-1880. The institution functioned more as a prison than a hospital. Krafft-Ebing’s tenure at the asylum afforded him access to patients with a cadre of mental ailments, including those who committed crimes with sexual overtures. He began collecting case studies of his patients, which he used as fodder for his medico-forensic analysis. The original version of the text featured 42 case studies but expanded to 238 case studies by its twelfth edition. The predominant emphasis on the purportedly first-hand patient accounts, which could be considered as confessional narratives, may be the key factor in both the book’s longstanding interest and its voyeuristic cultish appeal.

Despite Krafft-Ebing’s work reflecting a typical Victorian ideology condemning as deviant any form of sex not originating from a heterosexual sexual desire to procreate, the work nonetheless laid a foundation for a critical analysis of homosexuality among other forms of non-traditional sexual practice. The book was the first of its kind to delve into the depths of sexual perversity, labeling pathologies associated with such, and purporting legal jurisprudence through therapeutic treatment for violent sexual behavior. He intended the text to appeal to medical scientific advancement; predominantly expounding upon notions of hereditary deviance, and legal forensics implications of subsequent behavior resulting from sexual degeneracy. When he realized the book was being read and discussed by the general public due to its content illustrating “the large number of variant forms of sexual behavior,”[iv] subsequent editions attempted to ensure its professional use and credibility. In these revised versions, he purposely used technical medico-legal jargon and wrote the sexually explicit portions in Latin as a public deterrent. To no avail. The book would continue to be read by common people, which led to chastising reviews claiming that, “There are many morally disgusting subjects which have to be studied by the doctor and by the jurist, but the less such subjects are brought before the public the better.”[v] These stark, albeit contrasting realities between professional and public use and the conflict between the real and the imagined heighten the books historical significance and its popularity as a form of fetishistic cult object.

So beyond the historic Cesare Lombroso[vi] influenced eugenic tone of hereditary defect and degeneracy used as the framework for scientific study of human sexual behavior, this book harbors a feel of fetishistic pornographic voyeurism; providing a place for what historian Henry Oosterhuis claimed as “a kind of forum that allowed homosexuals and others to breach the loneliness and alienation that characterized their lives within nineteenth-century bourgeois society.”[vii] Krafft-Ebing extensively and explicitly validates homosexual experiences. He was the first to claim innate homosexual tendency and advocated for its therapeutic treatment. There is no way of determining how much of Krafft-Ebing’s case studies detailed the actual sexual thoughts and experiences of his patients, and how much was a fabricated elaborate fantasy of the doctor himself. From a historical standpoint, this book is a classic example of medical science providing the only socially acceptable, albeit legal, outlet for the display, discussion, and venue of all matters sexual, in this case, the criminally deviant; hence the reason the book fell into public popularity, particularly with those who felt a sense of validation through Krafft-Ebing’s authentication of non-normative sexuality.

Bridging two extremes, Psychopathia Sexualis historically inspired theoretical critique across disciplines and created a type of cult following inspiring photographic and film representations.  Two literary critics emphasize Krafft-Ebing’s foundational book, particularly his in-depth analysis and the purported first-hand accounts illustrated as case studies on homosexuality or “inversion,” as character inspiration for Thomas Mann’s Buddenbrooks (1901) and Radclyffe Hall’s The Well of Loneliness (1928). According to literary scholar Heike Bauer’s analysis of Hall’s work, Krafft-Ebing’s physical sexually charged case studies provided the fodder for the development of Hall’s protagonist, who displayed a “sophisticated understanding of the infinite preferences lesbian sexuality might encompass.”[viii] Bauer contends the complicated gender identity of Hall’s character stems from Krafft-Ebing’s construction of lesbianism provided reference points, for the complicated gender identity of Hall’s character, while further inspiring the novel’s sex scenes, as Hall reconstructed the “sexy bits” of Psychopathia Sexualis’ case studies.[ix] Likewise, Schaffner explores Krafft-Ebing’s use of literary sources in his own work as the inspiration for “the conceptual exchange between medicine, psychology, and literature, between fact and fiction.”[x] In this sense, Mann’s literary representation of sexual deviance in the form of homosexual sadomasochism was inspired by the meticulous life stories of Krafft-Ebing’s case studies. The narrative style of the case studies, although told through the lens of the medical authority figure as the sole chronicler of medical history, still privileges the voices and gives validity to the living experiences of homosexuals and others with non-traditional sexual proclivities. Similarly, Krafft-Ebing’s concepts of sadomasochistic perversion provided foundational legitimacy for the future analytic work on human aggression by Freud and others.[xi]

The explicit sexual accounts Krafft-Ebing provides tracing his patients into the asylum or onto the criminal side of the law inspired voyeuristic representations. Stylistically, this becomes most apparent in Bret Wood’s 2006 film of like title. The 98-minute Kino International produced film has a documentary quality. Variety’s movie review of the film claims Wood’s genre mixing to include “everything from German Expressionism and silent cinema to puppet theater and true-crime reality tv” in its dramatization of historical psychopathological case studies.[xii] The film leaves the viewer noting how sex was medically fetishized in the nineteenth century through the provision of explicit voyeuristic sexual imagery, including full frontal male nudity, that one may argue is only acceptable in medicine and pornography. Period costume and classical music add to the film’s historic feel, giving way to the secrets of deviant sexual behavior marked for criminality and institutionalization. Yet the “tepid” feel of these deviant historic renderings lean toward the film’s propensity to become a cult classic, much like The Rocky Horror Picture Show as reviewer Leydon claims.[xiii]

Krafft-Ebing’s Psychopathia Sexualis has proven to be both monumental as a ground-breaking work in the history of sex, science and forensics, as well as (sexual) inspiration for countless other fields of study and expression across time. The work speaks volumes about the human proclivity toward voyeuristic curiosity, be it for the sake of knowledge and advancement in a particular field, or into the human condition in general. The taboo and sensational, particularly in the vein of narrative accounts and the (purported) validity of first-hand experience, laid a foundation for our historical understanding of human sexuality in this epic work that continues to shape our views on aberrant behavior while titillating our senses.


This post was written for the course HIST H364/H546 The History of Medicine and Public Health (Instructor: Elizabeth Nelson, IUPUI School of Liberal Arts).



[i] "Inside the Book That 19th Century Experts Used To Diagnose And Explain Sexual Deviancy," All That’s Interesting, March 21, 2018,

[ii]  Dr. R.V. Krafft-Ebing, Psychopathia Sexualis: with Especial Reference to the Antipathic Sexual Instinct, A Medico-Forensic Study (New York: Rebman Company, 1906). Title translation: “Pathology of Sexuality.”

[iii] Anna Katharina Schaffner, “Richard von Krafft-Ebing’s Psychopathia Sexualis and Thomas Mann’s Buddenbrooks: Exchanges between Scientific and Imaginary Accounts of Sexual Deviance,” The Modern Language Review, 106, No. 2 (April 2011): 477. DOI: 10.5699/modelangrevi.106.2.0477. 

[iv] Vern L. Bullough, “The Physician and Research into Human Sexual Behavior in Nineteenth-Century Germany,” Bulletin of the History of Medicine, 63, No. 2 (Summer 1989), 254.

[v] Review of Psychopathia Sexualis by Dr. R.V. Krafft-Ebing, British Medical Journal, June 24 1893: 1326.

[vi] Italian criminologist and physician (1835-1909). Lombroso’s theory of criminal atavism suggested that criminals were distinguished from non-criminals by physical anomalies and a reversion to primitive or subhuman type of characteristics reminiscent of lower primates.

[vii] Harry Oosterhuis, Reviewed works: Stepchildren of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity (Chicago: University of Chicago Press, 2000), 505.

[viii] Heike Bauer, “Richard von Krafft-Ebing's Psychopathia Sexualis as Sexual Sourcebook for Radclyffe Hall's The Well of Loneliness,” Critical Analysis 15, No. 3 (2003): 25.

[ix] Ibid, 26.

[x] Schaffner, 479.

[xi] Jens De Vleminck “Sadism and Masochism on the Procrustean Bed of Hysteria: From Psychopathia Sexualis to Three Essays on the Theory of Sexuality,” Psychoanalysis and History, 19, No. 3, (2017): 379–406

[xii] Joe Leydon, “Psychopathia Sexualis,” Variety, Film Review, June 12-18, 2006, 28.

[xiii] Ibid.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Safar Saydshoev