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dysfunctions. He is certain the condition can be inherited: “We can certainly with some justification make heredity responsible for the origin of the pathological condition of the patient.”⁷² On a variety of fronts, Westphal promotes and underscores the physical origins of same-sex desire.

      The physical and psychological symptoms of sexual inversion include feminine characteristics in his male patients and masculine characteristics in his female patients. Emphasizing the importance of gender inversion, Westphal cites Ulrichs frequently, repeatedly stressing that the male invert has female characteristics and vice versa. His first patient, the woman “N,” speaks the language of inversion precisely: “I feel completely like a man and would like to be a man.”⁷³ His second patient, “Ha …,” adopts the clothes and indeed the entire habitus of a woman. Westphal claims to have noted “Ha …”’s feminine comportment as soon as he saw him knitting in the hospital waiting room.⁷⁴

      More so than Ulrichs and Kertbeny, Westphal is consistent in exploring the possibilities of gender symmetry inherent in the notion of inversion. Ulrichs and Kertbeny repeatedly neglect to include women in their examples, despite acknowledging the existence of women who are sexually attracted to women. Westphal however starts out with a woman and devotes a considerable amount of time to women’s sexual inversion.

      Westphal’s essay is an assertion of power, part of a tradition of medical claims to expertise in sexual matters. Significantly, he denies the layperson the ability to determine gender in both cases. He cautions that “N” does not seem unfeminine; about “Ha …” he is only willing to concede that “one can perhaps find something feminine” in his facial features.⁷⁵ Several decades later, Näcke continues in the tradition of insisting that certain types of expertise are required to determine who is truly gender transgressive: “this requires a specially schooled eye, such as the scholar of inversion, the homosexual himself, the artist, the tailor, and so forth have, but that others—for instance myself—do not.”⁷⁶

      Westphal’s claim to medical power makes counter-assertions of power by his patients all the more interesting, particularly in the case of the woman “N.” Middle-class, she assisted her sister who ran a girls’ boarding school in the country. Having been conscious of her desires for the female sex since her childhood, she regularly indulged in them when she was between eighteen and twenty-three. Since then she had only been able to masturbate. She declares that “female occupations were always distasteful to me; I would like to have a masculine occupation, and have therefore always been interested in mechanical engineering, for instance.”⁷⁷ Besides the compelling tragedy that this woman’s desire to be a mechanical engineer is pathologized stands the noteworthy fact that her voice manages to cut through the medical language. Westphal has the honesty to report that she does not consider herself insane: “She declared that she herself wanted to go to a hospital, but was however surprised that she had been brought to an insane asylum, as she was not mentally ill.”⁷⁸ “N” and Westphal are some of the first players in what Gayle Rubin calls the “intensely collaborative enterprise between the doctors and the perverts.”⁷⁹

      While “N” is a middle-class woman working in an educational establishment, Westphal’s second patient comes from a socially more disadvantaged background. Westphal calls him “Ha …,” although he himself claims to be “U.B.” An effeminate cross-dresser, he goes to jail multiple times, for stealing women’s underwear and garments and for “fraudulently” posing as a lady, receiving sentences ranging from two months to five years. “Ha…” claims to have resisted all sexual advances from men,⁸⁰ confirming Foucault’s observation that Westphal’s invert is characterized “less by a type of sexual relations than by a certain quality of sexual sensibility, a certain manner of inverting the masculine and the feminine in oneself.”⁸¹

      Many enigmas surround Westphal’s account of “Ha….” The exact details of the arrests and the prison record are confusing and contradictory. Why bother to distinguish between his assumed name “U.B.” and his “real” name of “Ha …,” if both names were changed in order to maintain confidentiality? How serious is the assertion that “Ha …” never had sex with his gentlemen admirers? When “Ha …” claims he would “earn money” at the train station, where he frequently found a “lover,” it sounds like he was in the practice of offering sex for money. Perhaps “Ha …” defined sex such that he could offer physical gratification to his lovers while believing he was resisting their sexual advances. When he boasts that he “earned a great deal of money” while making “demands on gentlemen,” it sounds like he might have been demanding payment after putting the men in a sexually compromising position.⁸² Blackmail was certainly frequently on the minds of the urnings, inverts, and homosexuals of nineteenth-century Europe. This is not to deny Foucault’s point that, even if sexual activities took place, they were apparently always done in order to support a kind of gender inversion, specifically what “Ha …” calls his passion “for those damnable women’s clothes, which have always been my undoing.”⁸³

      Westphal’s case is clearly different from that of Ulrichs and Kertbeny. While Ulrichs relies at times on medical evidence to make his points and Kertbeny claims medical expertise in order to legitimate his position, only Westphal consistently and thoroughly pathologizes same-sex desire. Working within a medical context, he makes no extensive demands on the political situation, although he was against the criminalization of those whose acts were the result of a medical condition like “sexual inversion.” Whereas Ulrichs and Kertbeny present a relatively positive picture of the urning and the homosexual, Westphal’s invert is quite clearly sick. Westphal believes the inversion is probably a symptom of a deeper problem, noting for instance the migraines of “N” and the myriad problems “Ha …” has. Admittedly, Westphal cites passages from Ulrichs in which Ulrichs insists the love of urnings is of the highest and most noble order, but he does so in order to refute the claim. He believes this love is pathological to its core.

      Westphal’s writings achieved a more widespread readership than either Ulrichs’s or Kertbeny’s essays. The Journal of Mental Science printed a review of the essay in 1871, using the term “inverted sexual proclivity” as a translation for conträre Sexualempfindung. Havelock Ellis became the first to use the term “sexual inversion” in English in his essay on same-sex desire of 1897. Quickly, “invert” and “inversion” came to be used as frequently as “homosexual” and “homosexuality.”

      The widespread availability of Westphal’s writings has led to an overemphasis of the medical tradition in histories of sexuality, at the expense of activists such as Ulrichs or Kertbeny. Strikingly, Foucault does not discuss either Ulrichs or Kertbeny in his Histoire de la sexualité, while granting Westphal paternity to the very concept of homosexuality. It could well be that Foucault was unaware of Kertbeny’s work or unable to access it, but Westphal quotes Ulrichs extensively in his article. The absence of a direct reference to Ulrichs suggests that something larger than ignorance is at work in Foucault’s writing. Writing his introduction to the history of sexuality originally in the 1970s, Foucault has little interest in a romantic representation of nineteenth-century heroes of sexual emancipation. Despite his allusion to “the constitution of a discourse ‘in reverse,’” in which “homosexuality began to speak of itself, demanding its legitimate and ‘natural’ rights, often in the same vocabulary, using the same categories by which it was medically disqualified,”⁸⁴ an important part of Foucault’s work puts into question the validity of many claims of sexual emancipation and liberation. He is much more interested in the ways in which sexual categories are produced by and play into forces and powers that are much larger than any individual physician like Westphal or lawyer like Ulrichs or homme de lettres like Kertbeny. Instead, he focuses on the medical institutions that create modern homosexuality.

      Because of Foucault’s emphasis on the power of institutions, relatively little attention was paid in the immediate wake of his work to the acts of resistance apparent in the case studies of the patients.⁸⁵ As Rubin has argued, however, there was “a complicated tango of communication and publication” between “the medically credentialed sexologists, the stigmatized homosexual intellectuals, and the mostly

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