Prescription for Heterosexuality: Sexual Citizenship in the Cold War Era

By Carolyn Herbst Lewis

In this lively and engaging work, Carolyn Lewis explores how medical practitioners, especially family physicians, situated themselves as the guardians of Americans' sexual well-being during the early years of the Cold War. She argues that many doctors viewed their patients' sexual habits as more than an issue of personal health. They believed that a satisfying sexual relationship between heterosexual couples with very specific attributes and boundaries was the foundation of a successful marriage, a fundamental source of happiness in the American family, and a crucial building block of a secure nation.

Drawing on hundreds of articles and editorials in medical journals as well as other popular and professional literature, Lewis traces how medical professionals defined and reinforced heterosexuality in the mid-twentieth century, giving certain heterosexual desires and acts a veritable stamp of approval while labeling others as unhealthy or deviant. Lewis links their prescriptive treatment to Cold War anxieties about sexual norms, gender roles, and national security. Doctors of the time, Lewis argues, believed that "unhealthy" sexual acts, from same-sex desires to female-dominant acts, could cause personal and marital disaster; in short, says Lewis, they were "un-American."

• Language: English
• Publisher: The University of North Carolina Press
• Release date: Oct 18, 2010
• ISBN: 9780807899540

Carolyn Herbst Lewis

Carolyn Herbst Lewis is assistant professor of history at Grinnell College.

Book preview

Prescription for Heterosexual

Prescription for Heterosexuality

Sexual Citizenship in the Cold War Era

CAROLYN HERBST LEWIS

University of North Carolina Press Chapel Hill

© 2010 The University of North Carolina Press

All rights reserved. Designed by Courtney Leigh Baker and set in Whitman and Myriad Pro by Rebecca Evans. Manufactured in the United States of America. The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources. The University of North Carolina Press has been a member of the Green Press Initiative since 2003.

Library of Congress Cataloging-in-Publication Data

Lewis, Carolyn Herbst.

Prescription for heterosexuality: sexual citizenship in the cold war era / Carolyn Herbst Lewis.

   p.cm. Includes bibliographical references and index.

ISBN 978-0-8078-3425-1 (cloth: alk. paper)

1. Sex—United States—History—20th century. 2. Heterosexuality—United States—History— 20th century. 3. Married people—Sexual behavior—United States—History—20th century. 4. Citizenship—United States—History—20th century. 5. United States—Social conditions— 20th century.I.Title.

HQ18.U5L49 2010 306.76'4097309045—dc22 2010010135

cloth 14 13 12 11 10 5 4 3 2 1

For my father, my husband, and my son

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

Acknowledgments

When a decade passes between the time a project is first imagined and its completion, the author unavoidably owes thanks to a great many people. For their encouragement and guidance at various stages of research and writing, I am incredibly grateful to the following individuals: Leila Rupp, Eileen Boris, Katherine Jellison, Erika Rappaport, Laura Kalman, Sandra Dawson, Patricia Cline Cohen, Jane Sherron De Hart, Laury Oaks, Elizabeth Currans, Jessica Caldwell O'Keefe, Sharon Doetsch-Kidder, Carrie Pitzulo, Michael Osborne, Warren Wood, April Haynes, Elizabeth Stordeur Pryor, David Schuster, and Matthew Sutton. Elaine Tyler May and Miriam Reumann kindly and carefully read the entire manuscript twice. I am extremely appreciative of the advice and guidance they offered.

The research for this project was funded by the Woodrow Wilson Foundation; the Department of History at the University of California, Santa Barbara (UCSB); UCSB History Associates; UCSB Affiliates; the Department of History and the Contemporary History Institute at Ohio University; the UCSB Graduate Division; and the Division of Humanities and Social Sciences at UCSB. A summer grant from the Louisiana State University Council on Research made it possible for me to complete the final revisions to the manuscript.

A large portion of the medical publications used in this project were made available through UCSB's interlibrary loan program. I do not know the names of all the librarians and staff members who tracked down, scanned, and e-mailed articles to me (although I do have quite a few images of your hands and fingers), but I am grateful to each and every one of you for making this project possible. Similarly, the assistance and advice of archivists at several libraries and manuscript collections has been indispensable. This is especially true of the archivists at the Augustus C. Long Health Sciences Library at Columbia University; the Western Historical Manuscript Collection at the University of Missouri, Columbia; and the Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University, Bloomington (IU).

This project also produced several conference papers, and the final version benefited greatly from comments by Carol Groneman, Marilyn Boxer, David Serlin, and the audiences at the Western Association of Women Historians, the Berkshire Conference on the History of Women, the American Historical Association, and the Women's Sexualities conference at iu. The advice I received from scholars at these and other conferences has been invaluable. Thank you especially to Karen Lystra, Carole Srole, Leslie Reagan, and Jessica Weiss. My colleagues in the Department of History and the Women's and Gender Studies Program at Louisiana State University were especially encouraging as I finished the final stages of this book. I am very thankful to have been so warmly welcomed into their fold. Portions of this manuscript initially appeared in the Journal of Women's History; I am grateful to the anonymous reviewers of that article for their feedback. At UNC Press, Sian Hunter, Beth Lassiter, and Jay Mazzocchi have been immensely helpful (and patient) while guiding me through the publication process.

A few individuals need special recognition. For my initial interest in history, I am indebted to my high school teachers, David Bruening and Ken Matuszak. Thank you to Danielle Swiontek for our weekly chats at Mommy and Me Happy Hour, to Renee Geary and Alex Liosatos for our annual retreats, and to Megan Macnaughtan and Aaron Smith for setting up the much-needed and greatly appreciated Sanity Fund. I am also forever grateful to Dr. Susanne Ramos for the safe delivery of my son. Sally Gogol, the Orfalea Family Children's Center at UCSB, the LSU Child Care Center, and various friends enabled me to work with the certainty that my child was in good hands. Most especially, thank you to Sandra Dawson for her friendship, her medical and historical knowledge, her assistance at my son's birth, and her willingness to babysit at any time, day or night. Her husband, Patrick Dawson, also deserves special thanks.

Last, but certainly not least, I must thank my family. My parents, Henry and Frances Herbst, and my sister Kathleen Herbst ofered unwavering enthusiasm as well as financial resources to support my research and writing. My sisters Amy and Sarah Herbst also helped with babysitting and comic relief. My mother-in-law, Eileen Lewis, provided the physical space as well as child care and the emotional support I needed to write at times. My extended family of in-laws, grandparents, aunts, uncles, nieces, nephews, and cousins also were wonderful in their constant interest in my progress. I hope that they are not disappointed.

I'm not sure there are adequate words to thank my spouse, Tony Lewis. He once promised to go wherever this path took me. I am forever grateful to him for never once hesitating in his confidence in me. This project truly was his as much as mine. I am looking forward to returning the favor. Our son, Benton, has no idea what has been going on around him, but he has been a trooper. In five years, he has visited twenty states, driven across the country eight times, and lived in five different homes. Not once has he asked, Are we there yet? I hope someday he reads this book and is horribly embarrassed by—but—proud of—his mom.

Introduction

The January 17, 1966, issue of the Journal of the American Medical Association (JAMA) included a Special Communication from psychiatrist William F. Sheeley, the former head of the American Psychiatric Association's General Practitioner Education Program, a committee devoted to preparing physicians to deal with the psychological problems of their patients in general practice. Sheeley addressed JAMA readers on the topic Sex and the Practicing Physician Since ancient times and before, he began, people have turned to the family physician for help with problems afecting their sex lives. In current times, Sheeley continued, distressed patients regularly consulted their trusted family doctors for help with frigidity, impotence, premarital counseling, and infertility. While these sexual matters were inherently private, laws and customs regarding marriage and divorce attested to the fact that they also concern society at large. This, Sheeley suggested, was important for the physician to keep in mind, for it underscored the importance of sexuality to the overall security of the American public. That basic unit without which few societies can survive—the family—depends upon discipline and control of sexual behavior, he explained. Without such control, the family soon breaks down, and soon thereafter the whole society comes crashing down—like the mighty Roman Empire, which is no more. The family physician, Sheeley insisted, was the person who was properly equipped to stem the tide of this disaster by know[ing] how to anticipate and how to prevent as well as how to treat, sexual dysfunction in his patients. Personal pleasure, family happiness, and national stability were all at stake.¹

Although few others used such dramatic language, Sheeley was not the only medical author anxious about sex, the family, and national security in the mid-twentieth century. Throughout the 1950s and 1960s, physicians writing in American medical journals expressed their concern over increasing cases of sexual dysfunction and infertility among their patients, a growing acceptance of premarital sexual experimentation, and a rising divorce rate. In their estimation, not only were all of these developments linked, but they also pointed to a broader moral decay that was taking hold in American society. Cold War rhetoric regarding American values and enemies within often worked its way into this discussion. If, as physician H. T. McGuire asserted in a discussion before the Medical Society of Delaware, the family unit is the keystone of the arch of our democracy, then its preservation was of inestimable value.² Sexuality, citizenship, and national stability were all linked, and American physicians had no intention of letting the United States go the way of the Roman Empire.

Medical practitioners in the United States—especially family physicians—thus situated themselves as the guardians of the sexual well-being of Americans in the early decades of the Cold War. Physical and mental health, of course, was paramount. But physicians argued that understanding the link between the body, the mind, and sex was critical to ensuring the overall health of the patient. Sexual dysfunction might suggest that an individual was either physically or mentally unwell. Likewise, proper sexual function indicated that a patient was healthy, that his or her marriage was likely to be successful, and that any children that he or she might have would be reared by happy and well-adjusted parents. Physicians asserted that the performance of healthy heterosexual gender and sexual roles—as evidenced by a satisfying sexual relationship—was crucial to the establishment and maintenance of a stable marriage. As gynecologist and specialist in family issues Nadina Kavinoky had explained to medical students in the early 1940s, ignorance of what constitutes a normal sex pattern has been at the bottom of many unsuccessful marriages.³ In the subsequent decades, physicians sought to remedy this problem. In medical journals and elsewhere, they insisted that educating couples about sexuality would do much to help stabilize many marriages and, by extension, American society as a whole. Presumably, sexually satisfied partners were more likely to stay married, to produce well-adjusted families, and to form the building blocks of a moral and stable national community.

Written during the uncertain times of the early Cold War, the articles, editorials, and letters to the editors of various medical journals demonstrated that physicians worried that unhealthy, maladjusted and even extramarital sexual behavior was just as threatening to American society as were the Soviets and their nuclear bombs. Some physicians even went so far as to assert that changing trends in American sexual behavior were part and parcel of the Communist program to change American sexual mores, [resulting] in a breakdown of the family and collapse of society as a whole, clearing the way for an easy Communist takeover.⁴ Soviet agents presumably had infiltrated the nation's bedrooms, seducing the bodies, as well as the minds, of American citizens.

Physicians were not the only ones who linked sexuality with national security. Events of the spring and summer of 1953 encouraged Americans to make this connection as well. As Senator Joe McCarthy asserted on national television that Communists had infiltrated the U.S. Army, newspapers and magazines throughout the country speculated on the contents of a soon-to-be-released volume on the sexual habits of American women. When Alfred C. Kinsey's Sexual Behavior in the Human Female finally became available in August, it revealed that American citizens, contrary to popular belief, were engaging in a wide variety of nonmarital and nonprocreative sexual activities. That same week, the Soviet Union announced that they had successfully detonated a hydrogen bomb. In the midst of this, at a moment when many Americans were beginning to understand that their world was not as safe and predictable as they had thought, President Dwight D. Eisenhower signed, and the State Department began to enforce, Executive Order 10450. The document expanded the policy of mandated Loyalty Oaths enacted by Eisenhower's predecessor, Harry S Truman. Under the new policy, swearing loyalty to the United States was no longer enough, for, as David Johnson writes, the contents of the order signaled a change in emphasis from issues of political loyalty to broader notions of general characters and suitability⁵ Whether or not they had ever done anything to call their patriotism or loyalty into question, men and women whose mannerisms, hobbies, or associates suggested homosexual tendencies were no longer considered suitable for federal employment. Between 1953 and the early 1970s, thousands of loyal American citizens were either dismissed from their jobs or resigned to avoid an investigation into the most intimate details of their lives.

Although officials did not assume that homosexuals were by default Communists, they did believe that homosexuality made a person weak in terms of national security. Medical professionals encouraged this view. As physician John Campbell asserted in a 1951 JAMA article that predated the revised federal policy, while homosexuals could be patriotic, loyal citizens they also had been blackmailed and browbeaten, under threat of having their defect revealed. For this reason, he concluded, they should not be allowed to hold positions involving great security risks⁶ Removing the stigmas against homosexuality never seemed to be an option. At this time, the dominant view of gays and lesbians was not that they were sinful or immoral (although there were many who thought that they were). Instead, homosexuality was viewed by the general public as being somewhere between a vice and an illness, comparable to alcoholism or drug addiction.⁷ Homosexuals were perverts, and the threat they posed could be contained only by excluding them. Because of their sexual desires, then, gays and lesbians were discriminated against and persecuted—virtually erased from the postwar vision of American life and relegated to the status of second-class citizens.

Heterosexual Americans, by contrast, not only retained their full citizenship status but also became emblematic of what it meant to be an American. The American home, populated by a heterosexual couple and their children, became, symbolically and literally, a fortress against the anxieties provoked by the Cold War. Federal, state, and local authorities encouraged Americans to prepare for Soviet attack by building private fallout shelters in their backyards, stockpiling household and emergency supplies, and reviewing duck-and-cover strategies with their children. Moreover, the middle-class, suburban home became the primary symbol of the American way of life. The family-centered consumerism of the Affluent Society promised to alleviate much of the apprehension elicited by Cold War tensions. Just as the United States embarked upon a foreign policy to contain the Communist threat abroad, Americans also committed themselves to a policy of domestic containment as well. Contain panic through consumer comforts and defense preparations. Contain dissent through an emphasis on conformity and maintaining the status quo. Contain brewing shifts in gender roles and sexual morality by making marriage and family life patriotic duties. The American home was the institution that promised to make this work.⁸

Underlying this domestic containment was a commitment to what scholars have labeled heteronormativity—the notion that the gender and sexual performances of heterosexuality constitute the only legitimate expression of self, desire, and identity. Moreover, the institutionalization of heter0norma-tivity ensures that heterosexuality and its corresponding gender expectations form the basis of the social, political, and economic order. In recent decades, scholars have begun to interrogate the creation, enforcement, and subversion of heteronormativity in the United States.⁹ The following chapters establish how the American medical profession contributed to the development of the gender and sexual constructs of the mid-twentieth century. Medical professionals used the cultural authority of science to make gender a product of sexual performance. By rooting gender identity in concepts of physical, psychological, and emotional health, physicians made it difficult to challenge these naturalized visions of gender and sexuality, particularly as they became linked to citizenship and national identity.

The definition of sexual health asserted by the American medical profession shaped how and why heteronormativity was enforced by various social and civic authorities during the 1950s and 1960s. The medical establishment championed a specific vision of heterosexuality that relied upon carefully delineated patterns of physical and emotional development as well as sexual behaviors. As the following chapters demonstrate, it was not enough for an individual to identify as heterosexual. How he or she performed heterosexu-ality—in his or her daily life as well as in the bedroom—mattered. Medical authorities sought to go far beyond containing what they considered to be inappropriate sexual desires or behaviors; they also sought to ensure that their patients were practicing the sexual and gender roles that would encourage their individual health, the success of their marriages, and the stability of their communities. As one physician explained, When the sex life is associated with marriage, children, and everything that responsible parenting implies, this not only stabilizes the family but society as well.¹⁰ In an era in which science had unprecedented cultural authority, medical practitioners, particularly those who specialized in the emerging field of family medicine, were in a unique position to define the parameters of sexual health for all American citizens.

This study considers how the medical profession envisioned sexual health in the decades following World War II. Building on the work of scholars such as Margot Canaday and David Johnson, who have exposed the formal and informal policies that enforced the link between sexuality and citizenship status in the twentieth-century United States, the chapters that follow explore the medical profession's contribution to the Cold War definitions of sexual citizenship.¹¹ In short, American physicians gave sexual citizenship a biological and medical foundation, thereby giving credence to the policies aimed at excluding and persecuting homosexual Americans. Medical professionals insisted that gender identity—as demonstrated in appearance, mannerisms, and behavior— was integral to the performance of healthy hetero-sexuality and that healthy heterosexuality was essential to overall physical and mental well-being. Most important, American physicians believed that how a couple performed heterosexuality in their marriage bed would demonstrate and reinforce their gender identities. In the pages of their profession's journals, physicians asserted that guiding their patients into healthy and satisfying sexual practices would strengthen individual families, creating the building blocks of a durable American society that was capable of resisting Communist infiltration and renewing itself in the wake of nuclear disaster. In this sense, the definition of healthy heterosexuality crafted by the medical profession served as the first step in securing the nation against the Cold War threat. It also aimed to contain the homosexual threat by attempting to reproduce a primarily heterosexual citizenry.

The 1950s and 1960s were, to a certain extent, both the height and the last gasp of medical authority over sexuality. The sexual revolutions of the ensuing decades would question the boundaries of normality that had been so heavily maintained during the postwar era. While every generation seems to worry about shifting values and morality, there seems to have been something especially potent about the anxieties of the early Cold War. Although the consensus that framed Cold War culture was neither absolute nor unwavering, it did dominate the social, political, and sexual landscape throughout the 1950s and well into the 1960s. Moreover, evidence that the realities of daily life were falling increasingly short of national ideals encouraged a conservative revival among various cultural and political authorities. This is the era that produced the John Birch Society, Young Americans for Freedom, and the National Review.¹² For the American medical profession, this translated into an ideological entrenchment that denied any validity to nonmarital or nonheterosexual sexual practices. The rising rates of premarital intercourse, teen pregnancy, and divorce, as well as reports of the increasing visibility of homosexuality, were threats that needed to be contained, not evidence that the time had come for change. If homosexuality was the greatest threat to American life, then heterosexuality became the greatest symbol of its security. This was no less visible in the pages of American medical journals than it was in the films produced in Hollywood or the policies devised in Washington, D.C.

The following chapters explore the convergence of this valorization of heterosexuality, the fear of invisible enemies within, and the awesome authority of the medical profession over the private lives of American citizens. The themes of formulating professional identity and claiming scientific authority over public life recur throughout this study, as the materials used to illuminate this history are the primary means by which physicians solidified their professional identities and staked out their professional terrain: medical societies and the journals that they published. JAMA was and continues to be the most widely circulated medical journal, with American Medical Association (AMA) membership and subscriptions exceeding 200,000 in 1965. By comparison, the New England Journal of Medicine (NEJM), also a prestigious volume, only boasted 100,000 subscriptions by the end of the 1960s— a figure that had quadrupled since the end of the Second World War. But even as more and more physicians were reading JAMA and regional journals such as NEJM, the Wisconsin State Medical Journal, and Michigan Medicine, the number of publications and organizations devoted to a particular specialty increased spectacularly in the postwar decades. In 1950, for example, both the American Academy of General Practice and the American Society for Reproductive Medicine began publishing journals (General Practice and Fertility and Sterility, respectively). As the specialized, suburban-based, private practitioners who comprised the organizational base of the AMA began to identify with their specialty first and the broader practice of medicine second, they began to depend on specialty journals just as much as, or perhaps even more so than, JAMA for the latest information in their particular fields.¹³

Medical journals enabled even physicians long finished with their formal schooling and well established in their practices to, in the words of historian Rosemary Stevens, rediscover their own values¹⁴ The AMA in 1966 happily noted that in California, a court identified attractive journals as setting standards for practitioners to adopt in their practices.¹⁵ In 1973 scholars Diana Scully and Pauline Bart called this process professional socialization. ¹⁶ The materials published in medical journals served two functions. First, they provided readers with information about advances in medical science and technology; and second, they presented a clear exposition of the profession's stance on various matters, including everything from medical ethics and civil defense preparations to definitions of normative sexuality. Indeed, the professional socialization that occurred in American medical journals in the 1950s and 1960s reinforced the hegemonic gender and sexual norms of the era. In the pages of the nation's medical journals, physicians positioned themselves as models of virtue, decorum, and citizenship for their patients and their communities. The material in medical journals provided examples of how physicians might relay information on sexual health to their patients in the most efficient and effective manner. What physicians wrote to one another in articles, editorials, conference proceedings, and letters created an intellectual and ideological framework that shaped how physicians imagined their role as health-care providers, how they cared for their patients, and, in this case, how they defined normative sexuality for all American citizens.

Because the medical journals represented such an important feature of professional identity and medical knowledge, the material published by American medical societies in the volumes of professional journals comprises the primary source base for this study. The hundreds of materials cited from medical journals in this volume were gathered in several stages, including page-by-page examinations of some journals and the use of the print and online indices of others. The Index Medicus, a yearly comprehensive index of the publications in all professional medical journals, provided citations for the years 1945 to 1960, and numerous searches in the National Library of Medicine's online database, PubMed, yielded materials from roughly 1955 forward. By utilizing manual searches, the Index Medicus, and the digital archive of PubMed, I was able to check the accuracy of my searches. Although I have no doubt that there are articles that I overlooked, I feel confident that the hundreds of articles employed here represent a complete view of the profession in the 1950s and 1960s.

The articles, letters, and editorials used in this study come from a wide array of publications that includes not only big names such as JAMA or Fertility and Sterility but also journals that had a more limited readership—particularly regional publications, such as the Florida State Journal of Medicine or New York Medicine, and the publications of specific groups, such as the Journal of the American Medical Woman's Association. Many authors published only once; some authors published nearly identical articles in multiple venues; still others wrote widely in their fields and published in specialized, regional, national, and international journals. Most important, these authors cited each other. Their footnotes form a veritable web of professional engagement that illustrates the intellectual community and ideological cohesion of the American medical profession.

These intellectual and ideological strands reached beyond the American medical profession and into the general public. The definitions of healthy heterosexual behavior and identity crafted within the medical community thus reached a popular, nonmedical audience as well. Many articles on sex in marriage, artificial insemination, or the premarital consultation were either written by physicians or cited physicians as a source. Consequently, they reinforced the status of medical professionals as authorities on the subjects of gender and sexuality, and they lent the authority of science to the messages themselves. Articles in such publications as Readers' Digest, Ladies' Home Journal, Look, Good Housekeeping, Playboy, Newsweek, Science Digest, and Modern Bride provided an interesting comparison to the articles from the professional journals. They also offered a means of uncovering the messages that physicians actually communicated to their patients regarding gender and sexuality. Many of the popular press articles were structured as a sample dialogue between physician and patient, alerting readers as to what to expect in terms of questions asked, answers given, and the appropriate parameters of the doctor-patient relationship. In some sense, they represent a dialogue between an absent physician and an invisible body of patients.

This imagined doctor-patient dialogue also exists in the large numbers of marriage and sex guides produced for a popular audience in the mid-twentieth century. Physicians writing articles on marriage guidance or sexual counseling often provided a list of published resources that their readers could use themselves and other doctors could pass on to their patients. Whenever possible, I located copies of these pamphlets, guides, and other materials. I also read book-length manuals written by the same physicians publishing in the medical journals. All of these volumes targeted patients, not physicians, as their readers, thus simultaneously challenging and reinforcing physicians' authority over their patients' sexual and marital relationships.

Unfortunately, the big mystery that remains is what physicians said to their actual patients, and what patients thought about what their doctors told them. Uncovering records of doctor-patient conversations