Appendix — The Treatment of Sexual Perversions
In the treatment of sexual perversions and anomalies, always a matter of great difficulty, knowledge of mankind, tact, and the finer understanding of the physician for the psychological peculiarities of each individual case, must play a greater part than any definite method of medical treatment. An exact understanding of the true nature of the sexually abnormal personality is the indispensable preliminary to our exercising a favourable influence upon morbid impulses and practices. Unquestionably, the physician must in the first place treat all actual diseases underlying the sexual abnormalities, by means of the physical and pharmacological therapeutical methods open to us in such abundance. Bodily and mental repose is here often the first need we have to satisfy; and for this purpose a change of environment, climatic cures, and such drugs as bromide and camphor may be very useful. But the principal matter must remain psychical, suggestive treatment. The mere discussion of the matter with the physician, the possibility at length of confiding in one capable of taking a thoroughly objective, calm, comprehensive view of the matter, one who by his profession is instructed in all secrets of the human spiritual and impulsive life, and who is aware of all the bodily necessities—this by itself suffices to restore to these unhappy beings, who are tortured by the evil demon of their unhappy impulse, who are often in a state of spiritual despair and hypochondria, to restore to them an inward confidence and a healing repose. This is the great triumph of medical research in this hitherto tabooed, and yet so enormously important, department, which only crass ignorance or evil-minded hypocrisy could designate as “improper” or “unworthy.” We have passed beyond the fruitless and dangerous method of “moral preaching,” to attain a scientific understanding of sexual anomalies; we have exposed the roots of these anomalies, lying deep in the physical and psychical nature of humanity, and we have recognized their connexion with so many other phenomena of the civilization of our time. When I speak of a “treatment” of the common, widely diffused sexual anomalies, it appears to me that that standpoint is the best which regards them as pure diseases of the will, which have been diffused in all times, but have never been more distinctly manifest, and never have possessed more importance, than they do at the present day, when will, energy, has become the most important weapon in the ever more violent struggle for existence. As Napoleon III. said, it is not to the apathetic man, but to the energetic man, that the future belongs, to the man with the will of iron. But nothing paralyzes the will so much as the dominance of blind and, above all, of abnormal, impulses. Unquestionably they conceal within themselves, when frequently gratified, feelings rather of pain than of pleasure, and become the unconquerable source of hypochondria and self-contempt. The stronger the impulse becomes, the longer the habit has lasted of yielding to that impulse, the greater is the loss of will from which the individual suffers. The first and most important task of the physician is, therefore, to weaken the impulse by means of strengthening the will. He must consistently and methodically educate the will, in order to assist the patient to obtain the victory over his impulse. As Goethe says in his “Epimenides”:
“Noch ist vieles zu erfüllen,
Noch ist manches nicht vorbei:
Doch wir alle, durch den Willen
Sind wir schon von Banden frei.”
[“Much there remains to fulfil,
Many things have yet to be endured:
Still, all of us, by the exercise of will
Can to a large extent free ourselves from our fetters.”]
The best way to attain this is to employ personal influence by means of suggestion. We must recommend frequent conversations on the part of the patient with the physician, which can be powerfully supplemented by epistolary communications on the part of the physician, of which an excellent example will be found in the “Psychotherapeutic Letters” by H. Oppenheim (Berlin, 1906).670 Hypnosis is also of value, although it does not appear to do any more in these cases than is effected by suggestion in the waking state.671
It is not so easy to transform a Hamlet into a man of action. We must impose tasks upon the will, tasks both mental and physical; we must regulate the mode of life; we must give to the individuality special prescriptions adapted to the particular case, and we must call to our assistance, whenever advisable, the friends and associates of our patient. The great enemy of the will, alcohol, must be absolutely prohibited; on the other hand, the taste for finer enjoyment and also for easy sports and pastimes must be stimulated.672 The vita sexualis needs repose in every case, and, above all, masturbation must be energetically resisted. If we succeed in diminishing the intensity of the impulse, and in increasing the power of the will, we have already done much. In isolated cases, we must also always make the attempt to conduct the libido and its activity very gradually into normal channels, perhaps with the assistance of suggestive ideas in coitu, for which, above all, the assistance of the sexual partner is indispensable. Only an experienced physician can here hit the mark.
Notes
638 The Public Prosecutor Amschl reports in the Archives for Criminal Anthropology, 1904, vol. xvi., p. 173, a gross case of this character, in which a peasant affected with venereal ulcers, having been advised that a cure could only be obtained by intercourse with a pure virgin, had sexual intercourse with his own daughter, and—was cured!!
639 See 1 Kings i. 1-4.
640 E. Laurent, “Morbid Love: A Psycho-Pathological Study,” pp. 183, 184 (Leipzig, 1895). Cf. also P. Bernard, “Des Attendants à la Pudeur sur les Petites Filles” (Paris, 1886).
641 A detailed description of this affair is given in my “Sexual Life in England,” vol. i., pp. 350-381 (Charlottenburg, 1901).
642 Compare in this connexion more especially the apt remarks of J. P. Frank, “System of a Medical Polity,” vol. vi., pp. 94, 95 (Frankenthal, 1792).
643 Cf. Sollier’s remarks on this subject in Von Schrenck-Notzing’s “Die Suggestions-Therapie,” p. 7.
644 Regarding child prostitution in Berlin, numerous details are to be found in the work, “Child Prostitution in Berlin: Unvarnished Revelations and Moral Pictures by an Initiate” (Leipzig, 1895).
645 G. Schmoller, “Elements of General Political Economy,” vol. i., p. 233 (Leipzig, 1901).
646 Such relations can become actual, even at the present day, as we learn from the case reported by the Public Prosecutor, Dr. Kersten, in the Archives for Criminal Anthropology (1904, vol. xvi., p. 330), of a Moor, sixty-five years of age, who, in intercourse with his step-daughter, procreated a daughter, and later with this daughter of his own, when she was thirteen years of age, had sexual intercourse!
647 G. Mirabeau, “Erotika Biblion,” p. 91 (Brussels, 1868).
648 German authors use the word Sodomie to denote sexual relationships between human beings and animals. Mr. Havelock Ellis informs me (in a private letter) “the German use of ‘sodomy’ to include ‘bestiality’ is quite ancient, and no doubt had a theological origin. I imagine the confusion was made with the idea of throwing on to ‘bestiality’ the same reprobation as the Bible metes out to ‘sodomy.’” There is, of course, no mention of bestiality in connexion with the destruction of Sodom. The sin for which the city was destroyed was the desire for carnal knowledge of the two angels in the house of Lot (Gen. xix. 5). The signification of the various terms used to denote unnatural intercourse is thus defined by Mann, in his work on “Forensic Medicine”: Sodomy means unnatural sexual intercourse between two human beings, usually of the male sex.... Tribadism, the gratification of the sexual instinct between two human beings of the female sex.... Pederastia is that form of sodomy in which the passive rôle is played by a boy, the active agent being man or boy. Bestiality means sexual intercourse between mankind and the lower animals. Generally speaking, in this translation the terms mentioned are used as above defined. If there is any variation from that use, the context will manifest it. In any case, Sodomy has never been employed in the translation as an equivalent of the German Sodomie, the latter term having been invariably rendered by Bestiality.—Translator.
649 Iwan Bloch, “A Remarkable Case of Sexual Perversion (Zoophilia),” published in Medizinische Klinik, 1906, No. 2.
650 Of the recent literature on this subject I may refer to G. Dubois-Dessaulle, “Étude sur la Bestialité au Point de Vue Historique, Médical, et Juridique” (Paris, 1905); F. Reichert, “The Significance of Sexual Psychopathy in Human Beings, in Relation to Veterinary Practice,” Inaugural Dissertation (Bern and Munich, 1902); Franz Hora, “A Case of Unnatural Fornication with a Goose,” published in the Tierärztliches Zentralblatt, 1903, No. 13, p. 197; R. Froehner, “Sadistic Injuries to Animals,” published in the Deutsche Tierärztliche Wochenschrift, No. 1, 1903, p. 153; same author in Der Preussische Kreistierarzt, vol. i., pp. 487-491 (Berlin, 1904); Grundmann, “A Case of Bestiality and Sadism,” published in the Deutsche Tierärztliche Wochenschrift, 1905, No 45. A very painstaking and critical study of unnatural fornication with animals is published by Haberda in the Vierteljahrsschrift für Gerichtliche Medizin, 1907, vol. xxxiii., supplementary number. It deals with 162 medico-legal cases. Among these, two only concern girls of sixteen and twenty-nine years of age respectively, persons who have had improper relations with dogs. Most of the male offenders were persons whose occupations brought them much into contact with domestic animals; about half of them were under twenty years of age. The animals concerned were cattle, goats, horses, dogs, pigs, sheep, and hens. In the majority of cases there were fornicatory acts—acts analogous to sexual intercourse—less commonly other sexual contacts. The girl of sixteen was caught in the act of intercourse with a dog. The majority of male offenders made use of female animals. In two cases young men allowed dogs to have intercourse with them per anum, the dogs having been trained to do this, and in both of them were found lacerations of the anus and rectum. Only in a few of the 172 cases of bestiality was there any reason to doubt the mental integrity of the person concerned. In those cases there was senile dementia, epilepsy, or alcoholism. The principal causes for the practice of bestiality were enhanced opportunities, the lack of possibility in the country for conjugal or extra-conjugal normal sexual intercourse, or, finally, superstition (belief in the possibility of curing of venereal disease by intercourse with animals).
651 Regarding the ethnology of bestiality, consult my “Etiology of Psychopathia Sexualis,” vol. ii., pp. 272-276.
652 Cf. F. S. Krauss, “Bestial Aberrations,” published in “Anthropophyteia,” vol. iii., pp. 265-322.
653 Iwan Bloch, “The Origin of Syphilis,” part i., p. 22 (Jena, 1901).
654 The following authentic case, which occurred in the year 1902, appears to be unique. A man compelled his wife, who was amiable but somewhat weak-minded, to have intercourse with a male pointer, which he himself prepared for the act, and in course of time he made the animal complete coitus with his wife five or six times whilst he looked on (“A Horrible Case,” published in the Archives for Criminal Anthropology, vol. xiii., pp. 320, 321). A case of bestiality with a rabbit is reported by Boëteau (“Un Cas de Bestialité,” published in France Médicale, 1891, vol. xxxviii., p. 593). Regarding passive bestiality with dogs, cf. A. Montalti, “La pederastia tra il cane a l’ uomo,” published in Sperimentale, 1887, vol. lx., p. 285; Delastre et Linas, “Sodomie Bestiale” (Societe de Médecine Lègale, 1873-74, vol. cxi., p. 165); Brouardel, “Pédérastie d’un Chien à l’Homme,” (published in the Semaine Médicale, 1887, vol. vii., p. 318); Féré, “Note sur un Cas de Bestialité chez la Femme” (published in Archives de Neurologie, 1903, p. 90).
655 The belief in vampires is in part dependent upon necrophilia. In Southern Slavonic countries the corpses of young women and girls were sometimes found which had been disinterred. The necrophilist had misused them sexually, and had then cut off the breasts and torn out the intestines (F. S. Krauss, “Anthropophyteia,” vol. ii., p. 391). In the fifth decade of the nineteenth century the notorious necrophilist Sergeant Bertrand performed similar acts.
656 Reported by A. Eulenburg, “Sadism and Masochism,” p. 56. Another case of necrophilia, with subsequent mutilation, occurred during the night of December 21-22, 1901, in the mortuary at Weiher, on the corpse of the wife of a day-labourer. The offender, who was arrested, had, on account of intense sexual hyperæsthesia, committed other sexual offences, among them bestiality (cf. “A Case of Necrophilia,” published in the Archives of Criminal Anthropology, 104, vol. xvi., pp. 289-303).
657 These æsthetic motives were predominant in the cases of statue-love reported from antiquity.
658 Cf. L. Fiaux “Les Maisons de Tolérance,” pp. 176, 177 (Paris, 1892). Moreover, the well-known tableaux vivants of the variety theatre can be regarded as a lesser form of such pygmalionistic spectacles.
659 Ch. Lasègue, “Les Exhibitionistes,” published in L’Union Médicale, 1877, No. 50.
660 Cf. A. Hoche, “Elements of a General Forensic Psycho-Pathology,” published in the “Handbook of Forensic Psychiatry,” p. 502 (Berlin, 1901).
661 G. Burgl, “Exhibitionists before the Law-Courts,” published in the Zeitschrift für Psychiatrie, 1903, vol. lx., Nos. 1, 2, pp. 119-144.
662 Regarding this custom of obscene gestures, which is extremely remarkable from the point of view of the history of civilization, see the second volume, now in course of preparation, of my work on “The Origin of Syphilis.”
663 Von Schrenck-Notzing, “Crimino-Psychological and Psycho-Pathological Studies,” pp. 50-57 (Leipzig, 1902).
664 Not to be confused with the “essayeurs,” a speciality of the brothels of Paris. These are male individuals who are hired by the owner of the brothel, in order, in the presence of clients, to carry out indecent manipulations in association with the prostitutes, and thus to induce sexual excitement in the guests, and stimulate them to fornication (cf. L. Fiaux, “Lee Maisons de Tolérance,” p. 177).
665 Regarding secret sexual clubs, see also my “Sexual Life in England,” vol. i., pp. 400-415.
666 Cf. L. Taxil, “La Corruption Fin de Siècle,” p. 226 (Paris, 1904).
667 S. Freud, “Three Contributions to the Sexual Theory,” pp. 40-42.
668 L. Lewin, the article “Opium,” in Eulenburg’s “Realenzyklopädie der Heilkunde,” vol. xvii., p. 629 (Vienna, 1898).
669 The following interesting reports, given by A. Wernichs (“Geographico-Medical Studies,” pp. 48-50), elucidate very exactly the nature of the sexual fantasies of the opium-smoker, which have the character of an indeterminate and by no means coercive sexual desire: “It is not necessary to proceed to gratification; one is almost disinclined to bring the series of beautiful pictures to an end in this way. All the joyful sexual experiences follow one another in a peculiar and fanciful admixture. Alluring forms appear in the most stimulating postures. Often one does not seem to take part in the matter oneself. Beautiful women whom one has seen in any part of the world, at the theatre, etc., move before one’s eyes, in the most beloved games of our youth. Everything that memory and the half-dream brings us is naked, shining, delicate, luxurious—and for us alone; for me these groupings, these fountains with bathing forms, these gestures, these embraces.” It is, therefore, not simply by chance that the majority of Chinese brothels have arrangements for opium-smokers, and that, contrariwise, many opium-dens provide opportunities for sexual enjoyment. Indeed, prostitutes are said to prefer opium-smokers, precisely because the latter, as long as the effect of the opium persists, do not come to an end of their enjoyment.
[These sexual fantasies of the opium-smoker probably occur only in the initial stages of indulgence in the drug. The confirmed opium-smoker, like the man habituated to the hypodermic injection of morphine, is probably, with rare exceptions, completely impotent. Sexual appetite and power return, however, when the habit is cured.—Translator.]
670 I refer more especially to the last letter, one directed to an onanist (pp. 42-44), as instructive in this connexion.
671 Cf. also Alfred Fuchs, “Therapeutics of the Abnormal Sexual Life in Men” (Stuttgart, 1899).
672 In such cases music, more especially the more emotional music of Wagner, must be employed only with great care.
Supplementary Note.—With regard to offences against morality, see the comprehensive work by Mittermaier, “Crimes and Offences against Morality” (Berlin, 1906) (gives a comparative description of the legislation of various countries). See also J. Werthauer, “Offences against Morality in Large Towns” (Berlin, 1907).