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I am most grateful to the anonymous readers and the editorial team for their helpful comments on earlier versions of this article. Findings were summarised in a poster presented at the conference 'Classifying Sex: Debating DSM-5' held 4-5 July 2013, at the University of Cambridge.
Psychiatric understandings of paedophilia are an outcome of the medicalisation of everyday crime, suggested Thomas Szasz (1920-2012).1Forensic notions of sick desire rely on metaphors applied to crimes, not medical science. Szasz's position is at odds with much of contemporary forensic psychology. Yet, it appears consistent with his critique of sexual nosology at mid-century, where he observes that 'homosexuality is an illness because heterosexuality is the social norm'.2Scattered references to paedophilia in nineteenth-century descriptive psychopathology, discussed below, are indeed very much entangled with coeval debates about how to appreciate widernatürliche Unzucht [unnatural vice] in the new psycho-medical framework of Konträrsexualismus [sexual inversion]. These references foreshadow many comparable twentieth-century debates, for instance, about whether to psychiatricise gay bashing in terms of acute homosexual panic (or Kempf's Disease, coined by Edward John Kempf in 1920), or rape in terms of raptophilia or biastophilic rapism (early 1980s terms by John Money) or sexual assault disorder (included in the first, 1976, DSM-III draft) or paraphilic coercive disorder (considered for inclusion in DSM-III-R in 1985 but voted down the next year).3In these cases, invocation of terms like disease, paraphilia and disorder makes cultural, legal and commercial sense when made to speak either to insanity defence strategies or to evaluations of civil commitment criteria.
Distinctions between criminal and madman have always been central to forensic psychiatry and pre-date 'paedophilia' by more than half a century. A generic 'differential diagnosis' between perversité morale [moral perversity] and perversion maladive [morbid perversion] informed French alienism in the early nineteenth century.4It was explicitly discussed by an author who ventured one of the early psychiatric taxonomies of sexual deviation, marking the subdivision of 'perversion de l'instinct génésique' [perversion of the reproductive instinct] into discrete 'perversions' - including philopédie.5The dichotomy was still critical to the author who would coin the term paedophilia erotica nearly half a century later,...