Jonathan Banda History of Medical Research Ethics (MEHU 6332) February 26, 2014

Sex and Social Death: Deviant Sexualities and the Production of Biomedical Knowledge Introduction In the preface to their landmark work Human Sexual Response (1966), William Masters and Virginia Johnson argued the following: If problems in the complex field of human sexual behavior are to be attacked successfully, psychologic theory and sociological concept must at times find support in physiological fact. Without adequate support from basic sexual physiology, much of psychologic theory will remain theory and much of sociologic concept will remain concept.1 The existing knowledge about human sexuality was no longer adequate. According to Masters and Johnson, it would no longer suffice to ask subjects about their sexuality; the act of sex itself must be observed and dissected in the laboratory. Thus, at some point in the not too distant past, the sexual act became an object of biomedical knowledge production in the US. The aim of this essay is to explore this turn towards human sexuality within the public health and biomedical research endeavors, with a particular interest in how such research has been informed by societal norms that construct populations as sexually deviant. In constructing normal sexualities, Western societies have privileged certain typed of sexual practices (e.g., heterosexual, monogamous, self-controlled) over others. Medical research has been complicit in that project, while lending scientific validity to the devaluation of certain sexualities and the lives associated with them. In taking a social constructionist approach, my concern is not whether medical research is methodologically sound or if its conclusions have some material basis.

William Masters and Virginia Johnson, Human Sexual Response (New York, NY: Bantam Books, 1980), vi. Italics mine. 1

Instead, I am concerned with how both the research process and the knowledge produced relate to operations of power in society and construct reality. The first part of this essay will explore the role of sexual norms in scientific research in Europe and the United States since the 18th century. I am limiting my analysis to specific examples to demonstrate continuity in scientific discourse regarding two bodies that were symbolic of sexual deviance: the racialized Other and the prostitute. The second part of this essay will consider how the assumptions about these sexualities informed research in the mid-20th century that utilized the sex act to produce knowledge: the Guatemala Syphilis Study and the Masters and Johnson research project on human sexual physiology. Foucault, Sex, and Death In The Birth of the Clinic, Michel Foucault argues that French medicine went through a transformation in the 18th century: in addition to the power of the calculating clinical gaze, with the advent of anatomo-clinical dissection, death became part of the project of life. Within the bodies of the deceased, the study of pathology could be extended beyond death itself. According to Foucault, there was more at stake with this shift than simply making cadavers useful. Before this transformation, Foucault notes, death remained the great dark threat in which his knowledge and skill were abolished; it was the risk not only of life and disease but of knowledge that questioned them.2 With the turn towards anatomo-clinical dissection in the 18th century, however, he contends that the medical gaze pivots on itself and demands of death an account of life and disease, integrating death into a technical and conceptual totality in which it assumed its specific characteristics and its fundamental value as experience.3 In making death useful in

Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, trans. A.M. Sheridan Smith (New York, NY: Random House, 1994), 146. 3 Ibid. 2

the project of life, biomedicine appeared to subject death to its power. Death was no longer the end of the medical gaze, but instead became a site where it could generate knowledge. In Raising the Dead, Sharon Patricia Holland connects this discourse of death with the discourse of sex. Drawing on an ambiguous passage in Foucaults History of Sexuality, Vol. 1, Holland argues that sex, like death, becomes invested with a far-reaching power to transform a contested spaceone in which death is presentinto an approachable arena.4 It is this particular connection between death and sex that I would like to extend as a framework for this essay. Similar to the way that death became an object of the clinical gaze in the 18th century, the sexual act became an object of biomedical dissection in the US during the middle of the 20th century, in the name of scientific knowledge and public health. Sexual behavior via clinical interviews had long been under the domain of medicine. As Foucault demonstrates, the study and management of sexual behavior, the discipline of the body, and the regulation of populations are integral to modern biopolitics and life itself. Sex was a means of access both to the life of the body and the life of the species, he notes, later concluding: sex became a crucial target of a power organized around the management of life rather than the menace of death.5 On a population level, therefore, sex is implicated in the very livelihood of the nation; as a means of reproduction, sexuality has been deployed by the state with the goal of producing the kinds of life deemed worth living (e.g., birth control policies, sterilization, anti-miscegenation laws, etc.) and more generally via sexual norms in society.
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Sharon Patricia Holland, Raising the Dead: Readings of Death and (Black) Subjectivity (Durham, NC: Duke University Press, 2000), 36. The quote from History of Sexuality, Vol. 1, trans. Robert Hurley (New York, NY: Vintage, 1980), 156, reads: When a long while ago the West discovered love, it bestowed on it a value high enough to make death acceptable; nowadays it is sex that claims this equivalence, the highest of all. And while the deployment of sexuality permits the techniques of power to invest life, the fictitious point of sex, itself marked by that deployment, exerts enough charm on everyone for them to accept hearing the grumble of death. 5 Foucault, History of Sexuality, 146-147. 3

Nevertheless, as noted above, sex also has its counterpart in death. Since, as Foucault concludes, modern biopolitics involves the power to make live and let die,6 the promotion of life via the management of sexuality also depends on the vulnerability and death of certain populations. While Foucault links sexual politics with the turn towards a racist eugenics in the latter half of the 19th century (and, as in the case of Nazi Germany, systematic genocide), it is not the link to biological death that concerns me here. For sexuality also plays a central role in relegating certain individuals and entire populations to a social death. By social death, I am referring to those who are not recognized as fully human in relation to the hegemonic norms of society. Historically, discourse regarding racialized, sexually deviant subjects in the US has been used to justify the subordination of populations. Roderick Ferguson demonstrates how the non-normative practices of African Americans, constructed as wild, unstable, and undomesticated, were used as proof of the uncivilized, irrational nature of slaves and to explain why African American poverty persisted after emancipation.7 Lisa Marie Cacho points to the contemporary deployment of racialized discourse in the US to construct populations that are permanently criminalized, and ineligible for personhood . . . populations subjected to laws but refused the legal and moral credibility necessary to question them.8 She points to racialized assumptions about sexuality as one means by which populations are excluded from the realm of personhood. For example, Cacho demonstrates how Hmong refugees in Minnesota have been characterized by law enforcement as prone to sexual violence, while female gang members who are raped have been portrayed as passive accomplices in their own victimization, rendered both Michel Foucault, Society Must Be Defended: Lectures at the Collge de France, 1975-76, trans. David Macey (New York: Picador, 2003), 241. 7 Roderick Ferguson, Aberrations in Black: Toward a Queer of Color Critique (Minneapolis, MN: University of Minnesota Press, 2003), 87. 8 Lisa Marie Cacho, Social Death: Racialized Rightlessness and the Criminalization of the Unprotected (New York, NY: New York University Press, 2012), 6. 4
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irrational and less than human (they are not rape-able).9 Yet these assumptions regarding nonnormative sexualities have a long history, and, as we shall see, have gained legitimacy from the scientific enterprise since the birth of modern medicine. Thus, biomedicine and public health (and, some may argue, all of us) are implicated in a system that has supported the social death of populations, while reserving their very bodies as objects of knowledge production. Dissecting Sex The production of knowledge regarding human anatomy in the West, on which modern biomedicine is based, has always relied in part on the dissection of bodies of the socially dead. The famed Renaissance anatomist Andreas Vesalius heavily depended on the bodies of executed criminals for his work. Criminal bodies not only represented a violation of the social body, but their cadavers were produced via spectacles of violence, whether the criminal was hanged, decapitated, or quartered. Vesalius was particularly open about this aspect of his work. In De Fabrica, Katherine Park notes, he seems to have gone out of his way to underscore the distasteful and occasionally illicit origins of his cadavers, recounting gory details with gleeful satisfaction.10 While Vesaliuss openness about the mistreatment of these bodies may be surprising, it must be remembered that, the convicted criminal in life was already condemned to social death, ineligible for personhood. Nevertheless, their bodies still proved useful as objects of biomedical knowledge. Socially (and sexually) aberrant bodies have continued to be useful for the production of biomedical knowledge and medical training. David Humphrey describes how both black and white lower-class bodies were pilfered from graves throughout the 18th and 19th centuries for the

Ibid., 88. Katherine Park, Secrets of Women: Gender, Generation, and the Origins of Human Dissection (New York, NY: Zone Books, 2006), 215.
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purposes of anatomo-clinical dissection in US medical schools. Their powerlessness and their marginal social status, he argues, afforded little protection for their dead in the face of persistent shortages of cadavers needed for medical dissections.11 According to Humphrey, the passage of anatomy acts in the 19th and 20th centuries to regulate access to cadavers did little to change the fact that cadaver dissections were largely reserved for the bodies from the social margins.12 The inherent paradox of using bodies of the socially dead (deviant) to generate knowledge that could be applied to the dominant (normal) classes has been explained in several ways. In discussing the paradox of the black body that was seen as degenerate yet used for productive labor and medical research, Harriet Washington claims that scientists described these bodies to fit their political means at the moment, later concluding that most physicians chose to simply ignore these inconvenient contradictions.13 Others have argued that physicians and biomedical researchers have cognitively separated the symbolic, or social body, from the biological body. This disassociation not only allowed researchers to apply findings from these dehumanized bodies to the to those intelligible as humans, but has also facilitated, as Jason Glenn notes, a dehumanized body of knowledge.14 Nevertheless, there are dimensions of the biological body that challenge the ability of medical research to sever the social life (or death) of the person. Sex constitutes one such dimension. This is clear when we consider how biomedical

David C. Humphrey, "Dissection and discrimination: the social origins of cadavers in America, 1760-1915," Bulletin of the New York Academy of Medicine 49, no. 9 (1973): 819. 12 Ibid., 824. 13 Harriet Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York, NY: Random House), 108. Italics mine. 14 Jason Glenn, Dehumanization, the Symbolic Gaze and the Production of Biomedical Knowledge, in Black Knowledges/Black Struggles: Essays in Critical Epistemology (London, UK: Liverpool University Press, 2013). 6

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and public health research regarding sexuality have treated the bodies of the racialized Other and the prostitute. Black Bodies, Deviant Sex The sexuality of the racialized Other, in particular those of African descent, has been consistently framed in scientific discourse as distinct from white normative sexuality.15 For example, Washington notes that the stereotype of the hot-blooded African framed scientific discourse about blacks in the US during the period of slavery and after Emancipation.16 This perception of black sexuality overtly framed medical research and public health interventions well into the 20th century, and, I would argue, persists even today, though perhaps in less explicit terms. In discussing the social conditions that led up to the Tuskegee Syphilis Study, James Jones shows how pervasive this sentiment was in the published views of physicians in the early 1900s. A Negro man will not abstain from sexual intercourse if there is the opportunity and no mechanical obstruction . . . his sexual powers are those of a specialist in a chosen field, one Southern physician wrote.17 This sexual impetuosity was also assumed of black women, who were conventionally perceived as hypersexual, unable to control their sex drives.18 The social construction of black sexual deviance, therefore, was materialized on black bodies through the clinical gaze. Physiological and neurological characteristics became signs of their pathological sexual indulgence, which was attributed by some in the late 19th century to both the formidable penis of the black man and the smaller brain of the Negro, who, like

It is clear that racial categorizations also delimit norms of personhood, and race and sexuality are mutually constructed. For the purposes of this essay, however, I will treat sexuality as a separate dimension. 16 Washington, Medical Apartheid, 45. 17 James Jones, Bad Blood: The Tuskegee Syphilis Experiment, 2nd Ed. (New York, NY: MacMillian, 1993), 25. 18 Washington, Medical Apartheid, 45. 7

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animals, was unable to control sexual urges.19 Perhaps the most notable example of this scientific obsession with black sexuality is seen in the case of Saartjie "Sarah" Baartman, the Hottentot Venus, a Khoi woman (a tribe from what is now South Africa) who was paraded around Europe during the early 19th century. Baartman became a symbol of the lascivious appetite of the black woman, and, as Sander Gilman argues, for black sexuality in general.20 Of interest for this analysis is the treatment of her physical sexual characteristics, which were seen through the lens of social norms and dominant stereotypes. Because their primary sex characteristics were believed to be different from the normal European, the Khoi were classified as a human subspecies by 18th century taxonomist Carl Linnaus.21 The name he gave them, homo monstrosis monorchidei (monstrous one-testicle man), reflected the belief that Khoi men only had one testicle.22 The later display of Baartmans body, therefore, was seen through sexual and genetic difference. While previous depictions of African female sex characteristics focused on their primitive genitalia (the hypertopophy of the labia or Hottentot apron), Gilman argues that the display of Baartmans body while she was alive focused on her steatopygia (high fat concentration in the buttocks); nevertheless, during the dissection of her body after death, her sexual organs were displayed to show the nature of the labia.23 Thus, he concludes: the figure of Sarah Baartman was reduced to her sexual parts.24

Jones, Bad Blood, 23. Sander Gilman, Black Bodies, White Bodies: Toward an Iconography of Female Sexuality in Late Nineteenth-Century Art, Medicine, and Literature, Critical Inquiry 12, no. 1 (Autumn, 1985): 212. 21 Washington, Medical Apartheid, 83 22 Encyclopedia of Antislavery and Abolition, eds. Peter P. Hinks, John R. McKivigan, and R. Owen Williams (Wesport, CT: Greenwood Publishing Group, 2007), s.v. Sarah Baartman. 23 Gillman, Black Bodies, White Bodies, 213. 24 Ibid.
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Other scholars have challenged the essentialization of Baartmans experience as representative of the perception of black sexuality as a whole. In response to Gilmans portrayal of the Hottentot, sociologist Zine Magubane argues that ideologies about racial and sexual alterity display the same basic characteristics as other ideologies do. They are internally inconsistent, they are constantly subject to struggle, and they reflect the structural locations of their adherents.25 It is true that assumptions of black sexuality cannot be represented in one allencompassing stereotype that has persisted unchanged over the centuries; within racialized categories, hierarchies still exist, and social value is attributed unevenly. What is consistent, however, is the role that medical science plays in validating or reinforcing perceptions that devalue life. What I also aim to show in these examples is how perceptions of deviant sexualities not only became materialized in the body but in the act of sex itself. Washington notes the pervasive scientific belief in the pre-abolition American South that blacks were unable to control their powerful sexual drives, which were frequently compared to those of rutting animals.26 The comparison to rutting animals suggests a bestial, violent, and frenzied act. Even in the early 20th century, it was believed by some that sexual practices among blacks could cause more abrasions of the sex organs, and therefore open them up for more venereal infections.27 Thus, for some, black sexuality was not only seen as deviant in its frequency, but in how it was performed.

Zine Magubane, Which Bodies Matter? Feminist Post-structuralism, Race, and the Curious Theoretical Odyssey of the Hottentot Venus, Gender and Society 15, no. 6 (December 2001): 81634 26 Washington, Medical Apartheid, 45, italics mine. 27 Jones, Bad Blood, 25. 9

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The Prostitute, Disease, and Social Hygiene Belief in the pathological physiology of the sexualized Other can also be seen in depictions of prostitutes during the 19th century as well. European studies on prostitutes during this time looked for physical abnormalities, such as excessive weight, asymmetry of the face, and misshapen ears to account for their primitive nature.28 The pathology of the prostitutes body went further, however. According to French and Russian public health studies of the era, prostitutes were especially prone to certain pathologies of the genitalia that were rare in the general population; gradually their organs took on an abnormal appearance similar to depictions of the Hottentot woman.29 Gilman concludes: In the nineteenth century, the prostitute is perceived as the essential sexualized female. She is perceived as the embodiment of sexuality and of all that is associated with sexualitydisease as well as passion.30 Thus, the prostitutes sexual deviancy materialized itself in her marked body. As Allan Brant argues in No Magic Bullet, US public health concerns about venereal disease during both World Wars reflected not only concerns about military efficiency, but also about female sexuality. Prostitution was no longer just a moral issue, but became problematized as a target of public health research and intervention. Prostitutes in particular bore the brunt of the social hygiene campaigns, and the prostitute became a symbol of a deviant lower-class female sexuality that threatened the social order and the very life of the nation. As one social hygiene advocate warned during WWI: It is generally recognized that a bad and diseased woman can do more harm than any German fleet of airplanes that that has yet passed over London. One woman of such character as effectually destroys a soldier as a German gun would,

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Gilman, Black Bodies, White Bodies, 223. Ibid., 226. 30 Ibid., 221. 10

and more so.31 The bad character of the prostitute manifested itself physically in the form of venereal disease, estimated by some during the Progressive Era as high as 90 percent.32 When large numbers of women convicted of prostitution were incarcerated during WWI, it was clear that the majority came from working-class populations, and arrests disproportionately affected women of color and immigrants.33 As one might expect, therefore, instead of considering the wider social determinants of prostitution, a genetic or hereditary explanation prevailed. Based on research data regarding women convicted of prostitution, some public health physicians concluded that prostitution must be inherent to their feeblemindedness or constitutional inferiority.34 Eugenicist Charles Davenport noted regarding these findings: Evidence is accumulating that the primary factor is an inherited predisposition toward an exceptionally active sexual life . . . The heightened licentiousness is favored by an additional germinal determinant that less licentious persons do not have.35 The majority of prostitutes, therefore, were unreformable, permanently marked by mental and physical defects. In contrast to depictions of Sarah Baartman, the emphasis on abnormal sexual organs shifted to a deeper genetic level. In both cases, however, the non-normative nature of their sexualities was reinforced by medical research and tied to the body itself. Conclusion As Foucault argues in The History of Sexuality, Vol. 1: What is peculiar to modern societies, in fact, is not that they consigned sex to a shadow existence, but that they dedicated

Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York, NY: Oxford University Press, 1985), 73. 32 Ibid. 72. 33 Ann M. Lucas, "Race, Class, Gender, and Deviancy: The Criminalization of Prostitution." Berkeley Women's Law Journal 10 (1995): 58. 34 Ibid. 91. 35 Ibid. 39. 11

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themselves to speaking of it ad infinitum, while exploiting it as the secret.36 Instead of a repression of discourse about sex, therefore, one could argue that in the US over the past two centuries we have seen a veritable obsession with sex in scientific discourse, in particular regarding the sexual activity of the Other. The sexualities of the racialized Other and the prostitute, as symbols of deviance, became targets of research and interventions in the name of life, at times reinscribing the very perceptions that already relegated many of them to the social margins. To say that researchers merely projected social deviance onto the body would be too simple; the process of scientific knowledge production is much more complex than that. Yet the episodes outlined here demonstrate that medical knowledge of sexuality is deeply tied to social norms, and we should be critical of the dehumanizing work it can effect. Like the cadavers of African Americans and poor whites that were pilfered for medical education in the US during the 19th century, the sexuality of the Other, the very act of sex itself, was made useful in the middle of the 20th century. This turn will be explored in the second part of this essay. The imperative to establish norms in human behavior and physiology, however, continued to mark certain populations as aberrations, via the clinical gaze and within the social field.

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Foucault, History of Sexuality, 35. 12

References Brandt, Allan M. No Magic Bullet: a Social History of Venereal Disease in the United States Since 1880. New York: Oxford University Press, 1987. Cacho, Lisa Marie. Social Death: Racialized Rightlessness and the Criminalization of the Unprotected. New York: New York University Press, 2012. Ferguson, Roderick A. Aberrations in Black: Toward a Queer of Color Critique. Minneapolis: University of Minnesota Press, 2004. Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage Books, 1994. Foucault, Michel. Society Must Be Defended: Lectures at the Collge de France, 1975-76. New York: Picador, 2003. Foucault, Michel. The History of Sexuality Vol. 1: An Introduction. New York: Vintage Books, 1990. Gilman, Sander. Black Bodies, White Bodies: Toward an Iconography of Female Sexuality in Late 19th-century Art, Medicine, and Literature. Critical Inquiry 12 (1985): 204242. Glenn, Jason. Dehumanization, the Symbolic Gaze and the Production of Biomedical Knowledge, in Black Knowledges/Black Struggles: Essays in Critical Epistemology. London, UK: Liverpool University Press, 2013. Hinks, Peter P., John R. McKivigan, and R. Owen Williams. Encyclopedia of Antislavery and Abolition. Greenwood Publishing Group, 2007. Holland, Sharon Patricia. Raising the Dead: Readings of Death and (Black) Subjectivity. Durham, NC: Duke University Press, 2000. Humphrey, D. C. Dissection and Discrimination: The Social Origins of Cadavers in America, 1760-1915. Bulletin of the New York Academy of Medicine 49, no. 9 (September 1973): 819827. Jones, James. Bad Blood: The Tuskegee Syphilis Experiment. New York: Maxwell McMillan International, 1993. Lucas, Ann. Race, Class, Gender, and Deviancy: The Criminalization of Prostitution. Berkeley Journal of Gender, Law & Justice 10, no. 1 (September 24, 2013): 47. Magubane, Zine. Which Bodies Matter? Feminism, Poststructuralism, Race, and the Curious Theoretical Odyssey of the Hottentot Venus. Gender and Society 15, no. 6 (2001): 81634.

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Masters, William and Virginia Johnson. Human Sexual Response. New York, NY: Bantam Books, 1980. Park, Katharine. Secrets of Women: Gender, Generation, and the Origins of Human Dissection. Cambridge, MA: Zone Books, 2006. Washington, Harriet A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Harlem Moon, 2006.

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