Prescription for Heterosexuality

Sexual Citizenship in the Cold War Era

Carolyn Herbst Lewis

• Publisher: The University of North Carolina Press
• Year: 2010
• ISBN:
  9780807899540
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

In Prescription for Heterosexuality, Carolyn Herbst Lewis explores how medical practitioners, especially family physicians, situated themselves as the guardians of Americans' sexual well-being during the early Cold War years. She argues that many doctors believed that a satisfying sexual relationship with very specific attributes and boundaries was the foundation of a successful marriage, a source of happiness in the American family, and a crucial building block of a secure nation. Drawing on hundreds of articles and editorials in both medical journals and popular and professional literature, Lewis traces how medical professionals affirmed certain heterosexual desires and acts while labeling others as unhealthy or deviant.

Chapter 1
American Physicians and Sexual Defense

“Civil defense in this country becomes a very serious problem and responsibility of the doctor of medicine,” wrote physician Lawrence Drolett in the Journal of the Michigan State Medical Society in 1955. “It is our duty as physicians to be prepared to render a heroic service to the people of our nation in the event of a disaster, either of local or national significance”.¹ Many of Drolett's colleagues agreed that, in terms of both preparation and response, physicians had a special burden to bear in civil defense. Their medical training, of course, made physicians well equipped to manage the injuries and illnesses that might accompany major disasters. But Drolett and other physicians looked beyond their abilities to set broken bones, reduce fevers, and treat all manner of ailments. In their estimation, the heroic service that they could provide to the nation went much further than medical expertise. Physicians also could serve as models of respectability, morality, and decorum in both their professional and personal lives. Doing so would provide their families, neighbors, and patients with examples of rational, moral,and appropriate behavior to emulate in times of crisis; it also would reinforce the authority of the physician to manage the health of his patients.

Physicians' assertions regarding their role in civil defense both reflected and reinforced the larger cultural authority that the medical profession held in American life in the mid-twentieth century. Between the mid-1930s and the mid-1960s, medical science developed at an extraordinary rate, and testaments to the wonders of modern medicine quickly brought physicians into positions of respect, admiration, and authority. Antibiotics, vaccinations, organ transplants, blood transfusions, and even childbirth's “twilight sleep” made it seem as if there was not a malady, disease, or condition that medicine could not make better. As physician Charles H. Calvin stated in his 1964 inaugural address before the Medical Society of New Jersey, “The practitioners of today . . . are able, as no generation of physicians was ever able before, to vanquish hitherto deadly diseases, soften the effects of the ravages of time, and defer the inevitable triumph of death.”² The promise of future discoveries and improvements only enhanced the profession's prestige. By 1966 the editors of the Journal of the American Medical Association (JAMA) could quote University of Oklahoma professor of psychiatry James L. Mathis, who boasted that “no other person can exercise respect and authority so well as the physician.”³

In the 1950s and 1960s, physicians used this cultural authority to reinforce their command over matters of sexuality. As the field of family medicine emerged to stake its professional territory, family practitioners both paralleled and overlapped discussions of civil defense in their insistence that the overall well-being of the individual was essential to the stability of the family unit, the larger community, and even the nation. As medical care in general shifted to an interest in preventive medicine, physicians increasingly applied this logic to sexuality as well, arguing that preventing sexual dysfunctions from emerging was the best course of action in ensuring their patients' psychosexual health and happiness. Medical professionals, like other observers, worried not only about the effects of the Cold War on American life, but also about rising rates of teen pregnancy and divorce, a greater cultural acceptance for pre- and extramarital sexual activity, and ongoing shifts in gender roles. To many, it seemed that at the very moment that American society needed to be the most durable, many of the nation's values and traditions were crumbling. The manner in which physicians responded to this perceived crisis might be called “sexual defense“; they sought to safeguard the sexual health of their patients and, by extension, to enhance the stability of their patients' families and the security of their local and national communities. The success of this endeavor rested on the ability of physicians to exercise this authority over their patients' sexual health.

Professionalized, Specialized, and Profitable

Physicians had not always been well respected, either as individuals or as members of a profession. In fact, the organized medical profession itself is a fairly recent phenomenon. It was not until the mid-twentieth century that physicians began to claim authority on matters relating to their patients' emotional, physical, mental, and even sexual well-being. This is due, in part, to the fact that American medicine did not develop standardized practices of diagnosis, treatment, and prevention of diseases until the early twentieth century. Prior to that, much was left to the whims of the individual physician. Hence, the public often viewed physicians as members of competing theoretical sects. Although some might “win personal authority by dint of their character and intimate knowledge of their patients,” most physicians did not receive a measure of professional respect until later in the century.⁴

The process of professionalization began in 1846, when the American Medical Association (AMA) organized to create a mark of distinction between “real” physicians and the “irregulars” and midwives who practiced without what the members of the new organization considered to be the proper education or training. But the practice of medicine was neither a lucrative nor well-respected career, for even in the best of hospitals and under the care of the most highly trained physicians, patients still died at relatively high rates. Not until after the First World War, when new methods of sterilization and treatment helped to improve patient survival rates, did physicians experience greater respect and value in American society.

The standardization of medical education and licensing furthered this development. During the early twentieth century, physicians embarked upon the process of reviewing the existing medical schools, identifying which were worthwhile and which were an embarrassment and a danger to the profession. In 1900 there were 160 medical schools in the United States, with a total enrollment of 25,171 students.⁵ By contrast, in 1922 there were only eight medical schools in the entire nation, and they graduated only 2,529 new doctors annually.⁶ This housecleaning produced a greater homogeneity and ideological cohesion within the profession. With the advent of standardized education and licensing, physicians soon gained the monetary and social prestige appropriate to a professional field.

This was especially true for physicians who practiced in an area of specialization rather than in general medicine. In the burgeoning urban areas of the late nineteenth and early twentieth centuries—such as Boston, Philadelphia, Cleveland, Chicago, and New York—philanthropists poured funds into research and charity hospitals. Physicians working in these units made many important discoveries. They also made the most money. Competition drove the specialization of medicine during this period. Although in theory any doctor could become a renowned specialist, only those able to secure the time and money to engage in research could, in reality, aford to do so.⁷ Virtually all of the physicians who achieved this success were white, upper-middle-class males. As historian Thomas Neville Bonner explains, in the early twentieth century, American medicine became an occupation that was “open to only the most exceptional among the less affluent.” Race further complicated class barriers. By midcentury, civil rights groups frequently picketed the AMA for the organization's failure to take decisive action against racial discrimination in the medical profession, including its exclusive member associations, segregated schools, and hospitals that discriminated in hiring or treatment practices. At the same time, only 4 to 5 percent of medical-school students were women before the 1960s. Throughout the first half of the twentieth century, then, race, class, and gender barriers meant that most physicians who were not white, male, or middle-class most often practiced general, rather than specialized, medicine.⁸ Specialists—particularly those with continual research funding—became the leaders of regional, state, and national medical associations, the editors and contributors to the medical journals, and the individuals credited with the modernization of American medicine. Thus, specialization, access to clinical research, and career success were intimately connected.⁹

In the early twentieth century, medical specializations seemed to be growing exponentially. Graduates of the nation's medical schools pursued careers as experts in areas such as cardiology, pulmonary infections, neurology, obstetrics, and, after the First World War, orthopedics and plastic surgery.¹⁰Human sexuality was not one of these specialties, although it was slowly gaining a reputation as a legitimate field of research. This was due in large part to three developments: the spread of Freudian psychoanalysis in the United States; reports of successful practices geared toward matters of sexual health and identity in Europe, especially the work of Magnus Hirschfeld; and, finally, the growing research in human reproduction, including artificial insemination and the impact of psychosomatic factors in infertility.¹¹

Most Americans, however, did not come into contact with the physicians who immersed themselves in the science of sexual reassignment, assisted reproduction, or even psychoanalytic therapy. In the early twentieth century, most people saw a doctor only when they were ill, and outside of urban centers and for those who could not aford the fees of the specialists, the generalist continued to be the primary means of medical treatment. In rural communities, there were no hospitals or specialists available. Even within urban areas, the health-care needs of patients who were not white, middle-class, or interesting enough to inspire a research investigation into their ailments did not warrant the training of a specialist. Instead, they saw a general practitioner who treated all illnesses, ailments, and emergencies, including performing any and all necessary surgeries. Yet rather than being lauded as someone with multiple areas of expertise requiring a broad range of skills and a high-level of intelligence and competence, the generalist was viewed as more of a “jack-of-all-trades, master of none.” His lack of expertise in one specific area of specialization seemingly discredited his abilities in all areas of medicine. Consequently, general practice often was “perceived to be a second choice for (presumably) second-rate doctors.” By the early decades of the twentieth century, writes Jaclyn Duffin, “general practice became the equivalent of rural practice and was characterized by culture-based assumptions about the 'modern city' and the 'backwards country.'”¹² Physicians who wanted to succeed in the medical profession understood that they needed to develop a specialization, secure a position in a well-funded hospital, and claim a space for themselves in the hierarchy of medical specialties.

Not surprisingly, by the 1940s generalists in the United States were in the midst of an intense “identity crisis.”¹³ Only 23 percent of physicians practicing in the United States considered themselves full-time specialists, as many doctors combined specialization in one area with general practice.¹⁴The absence of a state-regulated structure such as Great Britain's National Health Service meant that U.S. general practitioners found themselves becoming virtually redundant, as specialists frequently functioned as generalists as well. This was especially true in the case of obstetrics, gynecology, and pediatrics, since it often seemed appropriate to bring pregnant women or children to physicians who specialized in their care rather than to a gen-eralist who did not.¹⁵ At the same time, an intense turf war waged between general practitioners and surgical specialists over who was the best equipped to perform common procedures such as tonsillectomies.¹⁶

The wartime reliance upon surgical specialists meant that their careers and the medicine they practiced advanced rapidly during the 1940s. Physicians who could demonstrate a specialty field were given higher military rank than general practitioners during the Second World War.¹⁷ This encouraged physicians considering military service to pursue certification in a specialty rather than general practice, especially in a field that would be useful to the war effort. In addition, beginning in 1941, the U.S. Office of Scientific Research and Development coordinated much of the wartime medical research. Funding poured into the fields of general surgery, anesthesia, neurological surgery, physical medicine, and plastic surgery. At the war's end, the G.I. Bill continued the flood of physicians seeking to specialize in those fields.¹⁸ In the face of this war-inspired shift, Rosemary Stevens explains, the general practitioner continued to be “identified by what he lacked, rather than by what he had” while specialists profited financially, professionally, and personally from their distinction from the generalists.¹⁹ A study performed by the U.S. Commerce Department in 1950 found that the annual income of general practitioners was 70 percent less than that of most specialists. Indeed, a general practitioner in private practice earned an average of $8,835 annually, while a neurological surgeon netted $28,628.²⁰

Of course, general practitioners themselves felt dissatisfied by this trend and wholeheartedly sought to reverse it. Committed to maintaining a well-respected place for the GP, they sought to enact several measures that promised to shore up their professional status in the post-World War II years. Most important, they attempted to turn general practice itself into a specialty. In 1945 the AMA created a section on general practice. Two years later, the American Academy of General Practice formed as a specialized association. By 1950, when the organization began publishing its own journal, General Practice, the Academy boasted 10,000 members, a figure that would triple in the next two decades.²¹ The general practitioner, claimed the editors of New York Medicine, was now the “Backbone of Medicine.”²²

The Birth of Family Medicine

To survive, general practitioners had to do more than stake out their professional territory; they also had to convince the public that the services they offered were worth the time and money. One way that physicians did this was by refocusing their attention on the family unit. The mainstreaming of psychoanalysis and Freudian theories of sexual and emotional development brought new importance to the ability of physicians to see past superficial symptoms in order to identify the deeper disturbances plaguing the individual. Because the family was the heart of psychoanalytic development, medical professionals increasingly considered the factors that shaped family life, and the place of the individual within it, as they diagnosed and treated their patients' conditions. Even practitioners who disagreed with some aspects of Freudian psychoanalysis emphasized the need to consider “the social environment in which the patient is living.”²³

Throughout the 1950s and 1960s, general practitioners increasingly asserted their role as that of specialists in “family medicine” The use of the term “family medicine” as opposed to general practice not only “evoked comfortable images of hearth and home” but also removed the use of the word “general,” which, in the words of historian Jaclyn Duin, “had always seemed to invite the charge of incompetence.” Furthermore, family medicine suggested that the physician would be able to care for each individual patient without “forgetting” that he or she was part of a larger collection of related and emotionally invested people—the family. As professor of psychiatry Kenneth Appel wrote in the New England Journal of Medicine in 1953, unlike the specialists focused on clinical research and practice, the family doctor was able to consider “the needs of the patient himself as a person in his own individual setting” Practitioners of family medicine could offer their patients something that specialists could not: “holistic, comprehensive, and continuing car...

Table of contents

• Cover Page
• Prescription for Heterosexuality
• Copyright Page
• Dedication
• Contents
• Acknowledgments
• Introduction
• Chapter 1 American Physicians and Sexual Defense
• Chapter 2 Femininity, Frigidity, and Female Heterosexual Health
• Chapter 3 Masculinity, Sexual Function, and Male Heterosexual Health
• Chapter 4 The Premarital Pelvic Examination
• Chapter 5 Artificial Insemination and the American Man
• Epilogue
• Notes
• Bibliography
• Index