SEXUAL ANOMALIES IN THE INSANE AND IN PSYCHOPATHS

When one is familiar with the population of a lunatic asylum, one is struck by a singular phenomenon, from the sexual point of view. A great number of insane women give evidence of intense sexual desire. This desire is manifested in some by incessant masturbation; in others by obscene conversation; in many others, by imaginary love, sometimes sensual, sometimes platonic; often by direct provocation to coitus addressed to the medical officers; but especially by perpetual scenes of jealousy, and often by reciprocal suspicions regarding their sexual life. In fact, a lunatic asylum reveals to us, in the form of repulsive caricatures, all gradations and variations of a more or less degenerate feminine sexual life, coquetry, wearing all kinds of ornaments, jealous anger, erotic excitement, etc.

The sexual excitation of the insane often makes them soil themselves with urine and excrements, and heap insults on persons whom their diseased imagination suspects of sexual assaults or immodest acts toward themselves or others. They have a tendency to believe themselves betrothed or married to kings, emperors, Jesus Christ or God. Pregnancy and childbirth play a large part in their delirium. Some patients imagine themselves pregnant and pretend that they were fecundated secretly. Afterwards they believe that some one has taken away their child while they were asleep.

One of my former patients once accused me of going to her bed at night and fecundating her every week. She also accused me of having hidden the hundreds of children which I was supposed to have procreated with her, and martyred them. Owing to these hallucinations she heard their cries day and night.

Another patient, affected with curable acute mania, was so erotic during her attacks that she made advances toward all the doctors who visited her. Her mind was full of such erotic images that after her cure she was frightened of being pregnant, although she had passed the whole of her time of detention under supervision by female attendants. Women who in their normal state are most modest or sexually cold may be most erotic when they become insane, and may even behave as prostitutes. This is especially observed in periodic hypomania. It is a well-known fact in the female divisions of lunatic asylums, that the doctors are always surrounded by erotic patients, who catch hold of their clothes and pinch them, and try and embrace or scratch them according as they are amorous or jealous, so that they often have trouble in escaping from these signs of violent love or furious jealousy.

On the other hand, in the male divisions of asylums, one is astonished at the indifference and profound sexual apathy of nearly all insane men. Some practice masturbation and others attempt pederasty, but all with a philosophical calmness due to their dementia. Young women may even go among them without any fear of assaults or indecent language. It is only a few of the most violent who are exceptions to this rule.

A young lady doctor, assistant medical officer to the asylum at Zurich, made her visits alone among all the males, even the most violent, without any inconvenience; while, in the female divisions, she was approached by the erotic patients as much as were the male assistants. I mention this fact because some people wrongly imagine that the sexual excitation of insane women is due to the visits of male doctors. These facts are very striking and furnish perhaps the best proof that the feminine sexual appetite is especially situated in the higher brain, while the masculine appetite is situated more in the lower cerebral centers, as we have shown above. Mental alienation is due to irritations of the higher brain, and this explains why in women it lets loose such violent sexual passions and images, and why there is so little of this in men.

The sexual pathological symptoms of the insane are as follows:

(1). Erotomania (satyriasis and nymphomania), or abnormal exaltation of the sexual appetite. This is especially seen in acute mania, in the early stages of general paralysis and senile dementia, also temporarily or permanently in other psychoses. It is manifested by sexual excesses, obscene language or excessive masturbation. All these symptoms disappear after the attack of insanity.

(2). Sexual anæsthesia or hypoæsthesia or even impotence may occur in the later stages of general paralysis and senile dementia. At the commencement of general paralysis there is often violent sexual desire combined with more or less complete impotence. The same thing occurs, as we shall see, in alcoholism.

(3). Subjects affected with systematic delirium of persecution and grandeur (paranoia) sometimes commit atrocious sexual excesses, and often tyrannize and torment in a terrible way the women who are their victims. It is especially in the religious forms of this delirium, combined with fanatic ecstasy, that the most repulsive sexual orgies occur. I have treated a patient with paranoia who, full of pious sayings, regarded himself as a kind of prophet. He made a poor girl and her mother sleep in his room and had connection with them alternately. Finally, he mixed his semen in coffee with the girl's menstrual blood and made her drink the mixture, pretending that this was a religious ceremony intended to produce a strong race. In the end he set fire to the house of these poor women.

Subjects affected with partial paranoia often turn the heads of susceptible women by the aid of ascetic religious phraseology, to gratify afterwards their sexual passions. The worst cases are those who are able to hide from the public their delirious ideas, and pass for normal individuals, misunderstood victims, or even saints. I have examined a very orthodox clergyman, highly esteemed by his congregation on account of his ascetic and enthusiastic preaching. In his own home he illtreated his wife, half strangled her, and exacted all kinds of sexual depravity. Unfortunately, the nature of his delirium was not very evident, and he dissimulated so well that the jurists would not admit his irresponsibility, in spite of my medical certificate. His wife was obliged to run away to escape from her martyrdom. The community of property in force in this family completely ruined this unfortunate woman. The husband was not a hypocrite, but simply insane. Volumes could be written on sexual atrocities committed by such people.

I will mention briefly the systematic delirium directed toward pathological love. This is a very common symptom in insane women who combine their amorous sentiments for man with the maddest ideas and hallucinations. An insane woman suddenly discovers that the object of her love is a king or Jesus Christ, and that she is betrothed to him. In her delirium she imagines herself to be queen of the world. In her dreams and hallucinations her king or Christ is in bed with her and she imagines she has connection with him. Still under the influence of hallucinations, she believes herself pregnant and carries an imaginary child for nine months in her womb. She may even imagine that she has given birth to a child, and that the child has been taken away from her by the aid of narcotics, as we have seen above. Although there is an infinite variety in the gradations, the pathological images of the cerebral sexual sphere of insane women always revolve round this eternal theme.

These pathological irradiations of the sexual sphere are associated voluntarily with jealous obsessions and ideas of persecution, which make the subjects furious, and which are confirmed by their paræsthesias and hallucinations. Illusions of memory play a great part in these cases, for the subjects have often never felt what they complain of, and it is then a question of veritable hallucinational memory. We may here observe by the way that, even among healthy people, the sexual passions, like the others, always tend to falsify memory, making things appear in the exclusive sense of the affective state. Once fixed in the memory, such conceptions, the false tendency of which was originally based on passion, gradually assume the subjective character of certainty. Cool-headed people, or those whose affective state directs them to contrary conceptions, then see in such individuals a deliberate intention to misrepresent the facts. This is the reason why people so often hurl mutual insults at each others heads, calling each other liars and calumniators, owing to the affective illusion of memory.

(4). One of the worst of the sexual anomalies in the insane is pathological jealousy, especially in men. Their wives then become martyrs, especially in cases of alcoholism and paranoia. It is not uncommon for assassination to put an end to their torments. Among insane women, jealousy is certainly not less, but they have less legal power and less muscular strength. The most violent jealousy is found in alcoholics.

Jealous delirium renders the subject furious; a word, a look, or some trivial circumstance are enough for him to prove the infidelity of his wife. The latter has to avoid the slightest thing which might arouse jealousy, but all in vain; reserve and even prudery are regarded by the jealous husband as hypocrisy. The unfortunate man watches his wife, night and day, like a watchdog: he threatens and insults her with no reason, and calumniates her in all ways, even in the presence of a third party. He even lays elaborate traps for her. Cases of this kind are legion.

(5). It is necessary to say that the sexual paræsthesias, of which we have spoken, sadism, masochism, fetichism, inversion, etc., often occur in the insane.

(6). The most atrocious sexual crimes are very often the work of idiots or imbeciles, but especially moral idiots, i.e., persons whose idiocy is limited to the moral sense, who are also called simply amoral. This is due to hereditary taint, an innate absence of all sentiments of sympathy, pity and duty. Rape, violation of children, sexual assassination, etc., are usually due to the concomitant action of moral idiocy and violent or perverted sexual passions.

(7). Hypochondria also causes singular results in the sexual sphere. We have already dealt with the masturbation of certain hypochondriacs, which is often wholly or partly imaginary. Others believe they have committed terrible sexual excesses, when nothing of the kind has occurred. I have seen a hypochondriac married and strongly built, who believed his health was ruined because he cohabited with his wife once every two or three months. Other hypochondriacs become impotent simply because they think they are. Others again imagine they are affected with venereal disease, which they have never contracted.

(8). Hysterical men and women have a very peculiar sexuality. Hysteria depends on auto-suggestion or on an exalted and morbid dissociability of psychic activity. A single idea is sufficient in a hysterical subject, to produce the realization of what it represents. The passionate imagination may lead to opinions and actions which are absolutely contradictory. Love and hatred often alternate by transformation. According to the influences to which she is exposed, the same hysterical woman may become a good or evil genius.

In the sexual domain the same extremes are produced in a very striking manner. Inflamed by love, a hysterical woman may exhibit phenomenal eroticism and the most violent sexual excesses, while indifference, disgust, or simply distraction by other ideas will render her absolutely frigid. Cold as ice toward other men, she may have insatiable sexual desire for the man she loves.

The question is often raised whether a woman can love more than once in her life. There is no doubt that many women are so monogamous by instinct that they cannot love more than once; but it is also certain that a hysterical woman is capable of loving several times, and very different persons at different periods of her life. The personality of certain erotic hysterical women is even so dissociable that they can love with all their strength several men at the same time. But the hysterical woman is also capable of hating a man with as much ardor as she formerly loved him; or, on the contrary, of loving the one she formerly hated, according to the suggestion of the moment. The same phenomena occur in hysterical men.

For the same reasons the quality of the sexual sensations and sentiments may vary in a hysterical subject according to the influences it is subjected to, and pass from the normal to the perverted state, or inversely. I have observed a case where a highly cultured hysterical subject, in her early youth, fell in love with another young girl. At this period her sentiments were purely homosexual; her love for the young girl was clearly inverted and accompanied by intense sexual desire, while she was absolutely indifferent to men. Later on, a man fell in love with her, and she yielded to him rather from pity and feminine passiveness than from love. Still later she fell passionately in love with another man, quite as much as she had been with the young girl of her early youth. Her latest love was both exalted and libidinous. Her sexual appetite had thus taken the normal direction under the influence of a hetero-sexual affection.

In hysterical men analogous changes occur less easily, on account of the nature of masculine sexuality which distinguishes more clearly between the mind and the appetite; but these changes are observed sometimes. In woman, the hysterical imagination and dissociation facilitate a polyandrous irradiation of the sexual appetite, which is otherwise rare in the female sex. In this respect the sexuality of hysterical women resembles that of men and differs from that of normal women. Hysterical men, on the other hand, become more feminine, not by their appetite being less polygamous, but by the more dissociated form of their thoughts and sentiments.

(9). A variety of the pathological love of abnormal individuals is imaginary love, not founded on delirious ideas. Certain psychopaths of both sexes are convinced that they love some one, but they suddenly perceive during their betrothal, or even only after marriage, that they are mistaken and that they have never loved the person in question. Such illusions are the cause of numerous broken engagements, divorce and conjugal bitterness.

(10). Amorous tyranny constitutes another variety in the pathology of love. Lovers of this kind constantly tyrannize and torment the object of their passion, by their desires, their observations, their sensitive temper, their contradictions, their exigencies and their jealousy. This atrocious manner of loving is common in both sexes; perhaps more so in women than men.

(11). The love of psychopaths is a subject which has no end. If human society was better acquainted with psychopathology a great deal of conjugal misunderstanding and misery would be avoided.

I have known a woman who would not allow her husband to shut himself in the water-closet, for fear he would take the servant with him! Another became madly jealous if a woman sat opposite her husband and cast the least glance at him; the unfortunate husband not knowing where to look, in the street or in hotels, so as to escape his wife's jealousy. It is still worse when the husband is jealous.

Other psychopaths torment the object of their love by the perpetual care they take over imaginary dangers or the slightest indispositions. Others again are affected with hyperæsthesia, and the least noise, the slightest touch, or any sudden sensation, is enough to throw them into excitement and make them a nuisance both to themselves and to their surroundings.

The pathological exaltation of sentiments, which causes the most trifling things to appear as deliberate offenses, and malicious intentions, is still more to be feared. The disproportion between love and sexual appetite also torments many psychopaths, either when a deep love is combined with sexual indifference or disgust at coitus, or even pain (vaginismus, in women, for example); or when an intense sexual appetite is combined with want of love or ferocious egoism (especially in men).

Certain psychopaths appear profoundly amorous but behave like brutes to the object of their love. These are the individuals who are always ready to strangle their sweetheart, to stab or shoot her, if she does not immediately yield to their desires; or else the feeble creatures who threaten to commit suicide if their love is not returned.

Others, tormented by a pathological eroticism are continually annoying young and virtuous girls with their obsessions and their pathological grossness. I have seen a psychopath of this kind write letters and even post cards to a young girl, on which he had drawn pictures of the female genitals, by way of gallantry. In women, hatred and vengeance, aroused by jealousy, are especially blind and tenacious when the chronic passions of psychopathia intervene; this being due to the perseverance natural to the sex. By the aid of their refined intrigues; by their misrepresented statements due to the illusions of a memory distorted by passion, but uttered with a consummate dramatic art, some women may play a truly diabolical role, and even deceive a whole tribunal. When we get to the bottom of the matter, we often find that the primary cause of the evil is a sexual passion embellished and idealized afterwards by all kinds of noble motives, but in reality more or less unconsciously hypocritical. While deceiving others, these psychopathic women also deceive themselves. There are also a number of male psychopaths quite analogous to the above and generally hysterical.

Other morbid symptoms, such as obsessions and pathological impulses, have a certain importance as regards sexual appetite and love. Love or rejection, as well as other sexual images, may become the objects of obsessions, and then cause the subjects much torment, but without harming their surroundings; for the obsessed generally remain passive. Pathological impulse to actions may, on the contrary, become dangerous and lead to violation, whether combined with perversion or not.

(12). We have seen that senile paradoxy often shows itself, as a symptom of senile dementia, by a sexual appetite for children. This is the initial symptom of the complaint, and may lead to the commission of assault. The holy indignation of the public, and often of ignorant judges, against these depraved old men often result in the public contempt or even the imprisonment of poor patients who have hitherto led a blameless life, and who have simply become victims of senile degeneration of the arteries of the brain.

(13). I will mention another case which I have observed, which shows how complex hereditary cerebral pathology may become, and lead in turn to crime, madness and sexual perversion; giving rise to the most tragic scenes of human life, and to the degeneration of families.

The following is another example:

EFFECTS OF NARCOTICS, ESPECIALLY ALCOHOL, ON THE SEXUAL APPETITE

The functional cerebral paralyses produced by narcotics closely resemble in their psychopathological physiognomy the organic paralyses which result from slow atrophy of the cerebral cortex, as in general paralysis—exaltation of sentiment, tremor and slowness of movement up to total paralysis, disorders of orientation in time and space, profound mental dissociation affecting the subconscious automatic actions.

At the same time the individual loses the exact appreciation of his own personality and of the external world; he regards himself as very capable in body and mind while he is becoming more and more powerless; and everything appears rose-colored at the time when he is in a most critical state. He believes himself possessed of great muscular strength when paralysis makes him stagger, and so on.

At the commencement of narcosis the phenomena are somewhat different from what they become later; a certain amount of excitement predominates, as well as the spirit of enterprise and exaltation of the appetites; while later on paralysis, relaxation and somnolence play the principal part.

Narcosis acts in a similar way on the genetic sense. It begins by exciting sexual desire, but diminishes the power. As Shakespere says: "Lechery it provokes and unprovokes; it provokes the desire but it takes away the performance." (Macbeth, Act II, Scene iii.) No doubt the narcotics are not all equal in action, and each has its specific peculiarities; but the words of Shakespere express the essential effect of all narcotics on the sexual appetite: First of all excitation of the appetite with the disappearance of moral and intellectual inhibitory representations, and reënforcement of the spirit of enterprise; afterwards, progressive paralysis of sexual power, and finally extinction of the initial appetite itself.

These phenomena are of capital importance in alcoholic narcosis, which plays the principal part in civilized countries. The initial excitation is here very accentuated. If we make a closer examination, however, we find from the first a relaxation of sexual activity and a weakening of all sensory irritations. In coitus, erections are produced more slowly; the voluptuous sensations, it is true, are of great subjective intensity, but they are developed more slowly and there is more difficulty in producing ejaculation. The subsequent relaxation is very great, and a man who is even only slightly intoxicated cannot perform coitus as rapidly, nor repeat it so often, as when he has taken no alcoholic liquor. When the narcosis increases the impotence becomes complete. Owing to the illusion produced by the narcosis, however, a drunken man generally imagines himself to be very capable.

The gross and clumsy form which flirtation assumes under the action of alcohol is only too well known. The gross and persistent obscenity of drunken persons in railway carriages and other places toward women is an example of alcoholic flirtation. (Vide Chapter IV.)

Another peculiarity of the sexual appetite in alcoholic narcosis is its bestiality. The higher irradiations of love are completely paralyzed and sensuality becomes unrestrained, even in men who, when sober, are full of refined sentiments.

The depraving effect of alcohol on the sexual appetite is therefore unlimited. Alcohol does not limit itself to giving free play to a bestial appetite, by paralyzing reason and sentiments of sympathy and duty; it also has a strong tendency to pervert the appetite itself. In a considerable proportion of cases of exhibitionism, inversion, pederosis, sodomy, etc., the development of the perversion is greatly favored, or even directly produced, by the action of alcohol, especially when there is a latent predisposition. I have observed a whole series of perversions in persons whose sexual appetite was normal when they were sober, but became perverted on the slightest intoxication. I am convinced that if more attention was paid to the subject the number of cases in which alcohol increases the perversion, or is even necessary for its development, would be increased.

But what is of much greater importance is the fact that acute and chronic alcoholic intoxication deteriorates the germinal protoplasm of the procreators. I refer the reader to what I have said at the end of Chapter I on blastophthoria. The recent researches of Bezzola seem to prove that the old belief in the bad quality of children conceived during drunkenness is not without foundation. Relying on the Swiss census of 1900, in which there figure nine thousand idiots, and after careful examination of the bulletins concerning them, this author has proved that there are two acute annual maximum periods for the conception of idiots (calculated from nine months before birth): the periods of carnival and vintage, when the people drink most. In the wine-growing districts the maximum conception of idiots at the time of vintage is enormous, while it is almost nil at other periods. Moreover, these two maximum periods come at the time of year when conception is at a minimum among the rest of the population; the maximum of normal conceptions occurring at the beginning of summer.

If these facts are confirmed by further research, we may conclude that even acute alcoholism has a blastophthoric action. We may, therefore, assume that when a germinal cell leaves its gland at the moment when it is impregnated with alcohol, and achieves conjugation, it is unable to return to its normal condition, for want of opportunity to be completely and promptly cleansed by nutrition and the circulation. This explains how it may transmit to the individual which develops from it all kinds of taints and defects.

After what we have said, we can tabulate the destructive effects of the narcotic poisons and alcohol in particular, in the sexual domain, both from the individual and social points of view, as follows:

(1). Irreflective sexual unions, resulting from exaltation of the sexual appetite and temporary paralysis of the sentiments which inhibit such unions in persons who are not under the influence of alcohol. These include the seduction of girls, orgies with prostitutes in brothels, and the procreation of children with low-class women, or under unfavorable conditions.

(2). Increase of venereal disease. I have made statistics which show that about 75 per cent. of venereal disease is contracted by men under the influence of alcohol, chiefly by persons who are slightly intoxicated and rendered enterprising thereby.

(3). All kinds of misfortunes and catastrophes, such as illegitimate pregnancies, despair, suicide, etc., resulting from irreflective sexual unions and venereal disease.

(4). The production of the majority of sexual crimes also resulting from the exasperation of eroticism combined with irreflection and general motor impulsiveness. Jealousy here plays a great part. The most important statistics (for example, those of Baer, in Germany), prove that from 50 to 75 per cent. of criminal assaults are committed under the influence of alcohol. Indecent exposure, etc., is due to alcohol in 75 or 80 per cent.

(5). Exaltation and sometimes development of sexual perversion.

(6). Creation of hereditary alcoholic blastophthoria, either as the result of a single drinking bout, or from habitual drunkenness. The offspring tainted with alcoholic blastophthoria suffer from various bodily and physical anomalies, among which are dwarfism, rickets, a predisposition to tuberculosis and epilepsy, moral idiocy and idiocy in general, a disposition to crime and mental diseases, sexual perversions, loss of suckling in women, and many other misfortunes.

(7). The delirium of jealousy is a specific symptom of chronic alcoholism. Its effects are terrible and lead to all kinds of sorts of infamies, assaults and even assassination.

(8). Alcohol is also the almost indispensable vehicle of prostitution and proxenetism, which could not be maintained without it, at any rate in their present disgusting and brutal form.

(9). The coarseness and vulgarity of alcoholic eroticism produce in public places, as well as in private, an importunate and obscene form of flirtation, which is brutally and cynically opposed to all sentiments of propriety and modesty.

The above statements refer chiefly to men. Among women, alcoholism is less common, at least in continental Europe; in England, however, drunken women are often seen in the streets. Among prostitutes, however, alcoholism is almost universal. Proxenetism makes use of alcohol to compromise and seduce girls and thus lead them to prostitution. When they have once fallen they often drink to forget the horror of their situation.

The action of alcohol on the feminine sexual appetite is very peculiar. The appetite is generally exalted, while the power is not affected, owing to the passive role of woman in coitus. At first, paralysis of the psychic inhibitions and their higher irradiations (love, duty, modesty, etc.) by alcohol deprives the woman of nearly all power of resistance against the sexual desire of the man. It results from this that an intoxicated woman becomes the easy prey of a man whose sexual appetite is excited. The following case is instructive from this point of view:

I have mentioned this case to show that, even in women, sexual excess does not necessarily destroy the character, the sentiments of modesty, nor the will. It all depends on their cause. If there is congenital weakness of character, the evil is irreparable; but if it is only due to external forces which can be eliminated in time, its effect may often be permanently suppressed. Some female inebriates are sexually cold and repulse men; but others are erotic and even nymphomaniacs.

Whosoever has the welfare of humanity at heart, and takes the trouble to reflect on the ravages caused by alcohol in human society, should have the courage to make a slight effort and renounce all alcoholic drink—say for six months at first, as an experiment—in order to combat the social alcoholic misery by force of example, instead of empty phrases. He will then discover, like all abstainers, that the usage of alcohol (including wine, cider and beer) however small the quantity consumed, only serves to maintain a habit which is vicious and disastrous to society, by giving the contagious example of so-called moderation, to which a great number of persons cannot restrict themselves. He will then abstain for the rest of his days, and it will become more and more incomprehensible to him how humanity has been led, first by the spirit of imitation, later by the conservation of prejudices, to develop, maintain and defend such a social abuse by the aid of a legion of sophisms.

SEXUAL ANOMALIES AND PERVERSIONS BY SUGGESTION AND AUTO-SUGGESTION

The role of the phenomena of suggestion in sexual life is much greater than is generally supposed. I shall return to this subject in a special chapter, but I may state here that there is a category of sexual perversions and anomalies of all kinds which are not hereditary but acquired, and which Krafft-Ebing, although he cites striking examples, wrongly attributes to the effect of sexual excess and depravity, or which he compares to ordinary psychopathia, while in reality they are only the direct effect of strong suggestion or auto-suggestion.

I place in this category the cases where a man, whose sexuality has hitherto been normal, suddenly becomes pathological as the result of some circumstance which produces on him a profound impression. For instance, the sexual appetite of an individual may be strongly excited, in a brothel or elsewhere, by an erotic woman whose feet or shoes are especially elegant. The sight of this well-fitted foot exalts his sexual desire to a high degree. From this moment feminine shoes, by subjective association, exercise on him an irresistible erotic power, which dominates everything else and transforms him into a fetichist; the female body no longer elicits his appetite, the latter having become the slave of the image of shoes only. (Shoe fetichism.)

Sexual inversion may also be acquired by suggestion, when a normal man becomes excited by acts of masturbation or pederasty, or simply by some psychic image with a strongly suggestive action. He may thus lose his normal sexual appetite for women and become homosexual.

These phenomena occur especially in individuals whose suggestibility is pathological or hysterical, or even simply exaggerated. But these individuals are numerous, and this fact gives us the explanation of a large proportion of acquired sexual anomalies, at the same time indicating the means of curing them. In such cases, it is not a question of moral depravity, nor necessarily of a latent hereditary predisposition, but simply of a single sudden suggestive action, sometimes repeated.

Among other cases, I may mention that of a well-educated man of very refined sentiments, deeply in love with his wife, but very suggestible, who became suddenly impotent and homosexual as the result of a simple idea-image which became fixed in his mind and subjected it by suggestion. His strong character enabled him to resist intercourse with males, but he fell into despair and became very unhappy. I am convinced that a careful study would reveal an increasing number of cases of psychopathia acquired by suggestion or auto-suggestion.

Cases of this kind may be spontaneously cured. Treatment by suggestion is indicated and may act directly or indirectly. Everything which is of a functional psychic nature may occur by suggestion, or be, on the contrary, eradicated by suggestion. The important point is to emphasize the fact that whenever a man, hitherto normal, is affected, without apparent cause, with a more or less sudden sexual anomaly, and which is consequently not the effect of long habit, suggestion or auto-suggestion should be borne in mind.

These two conceptions can, moreover, be hardly distinguished, for the things which cause suggestion are usually the sensory perceptions of sight, smell, touch and hearing, associated with certain situations, or with an intense affective state which fixes them in the brain. Sometimes it is a question of simple imaginative ideas. The cases where a hypnotizer intentionally suggests sexual perversion probably exist only in theory. We are, therefore, concerned with fortuitous suggestions, acting through persons, situations, objects or ideas, which excite the mind by the impression they produce on the sentiments and the sexual appetite.

SEXUAL PERVERSIONS DUE TO HABIT

Without being congenital and without depending on a special predisposition, all the perversions of the sexual appetite that we have just described may be acquired, by means of the artificial and continued excitation of a sexual appetite which seeks satisfaction in change and unusual situations: Moreover, perverse satisfaction of the sexual appetite is often resorted to—onanism, pederasty or oral coitus—either to avoid conception, or with the idea of escaping venereal disease, or in the case of onanism, to avoid publicity, trouble or expense. As we have seen above alcohol favors the development of sexual perversions.

It is evident that a commerce in women systematically tolerated by the state, as is the proxenetism of regulated prostitution, employs all means imaginable to attract and excite its clients. In this way prostitution becomes the high-school for all the refinements of sexual perversion. It not only offers special objects required by individuals tainted by heredity with various perversions, but it artificially develops perverse habits in the normal man. The manipulations of sadism or masochism are even utilized to revive a sexual appetite weakened by abuse. Individuals who have become impotent often try to excite themselves by observing the coitus of others. In fact a leaven of corruption and ignominy ferments on the dunghill of venal and artificial excitation of the sexual appetite.

The apostles of Mammon and Bacchus, the former by interest, the latter by the aid of a narcosis which paralyzes the higher sentiments and reflection, work in concert to maintain this foul swamp. The same individuals very commonly combine the two apostleships and become themselves the victims of their false gods, after sacrificing hundreds of their fellows.

To make matters more clear I will recapitulate as follows:

(1). We often meet with pederasty without a trace of inversion of the sexual appetite. It is also practiced on women by the psychopathic male. But the normal man hardly ever prefers it to normal coitus.

(2). Compensatory masturbation is very common and ceases with the opportunity for normal coitus.

(3). Sodomy is also often compensatory.

(4). It is the same with assaults on children, which seldom depend on a hereditary disposition.

(5). Lesbian love, a form of degeneracy, artificial excitation of the clitoris by the tongue or otherwise, may have quite a different origin than from sexual inversion or other perversions.

All these things take place chiefly in brothels or with prostitutes, in barracks, boarding-schools, convents, and other isolated places where men and women live alone and separated from the other sex.

Sadism, masochism, fetichism and exhibitionism are much more rarely the result of habits, because their object and the images with which they are associated do not offer compensation for the normal excitation of the sexual appetite, or only do so insufficiently.

I am here obliged to contradict Krafft-Ebing, who regards exhibitionism as the effect of the impotence of certain individuals depraved by excesses, or as the unconscious act of certain epileptics. No doubt the two conditions which he mentions may present themselves, but the exhibitionists I have observed have all been psychopaths whose perversion was primordial and hereditary, with the exception of some females in whom perversion originated in suggestion or alcoholism, which had at any rate aroused the disposition.

Lesbian love merits special mention. Owing to the clitoris being more or less concealed, women are often not satisfied by coitus, especially when the ejaculation of the male takes place too quickly. Consequently a number of normal women prefer to procure an orgasm by means of lesbian love (cunnilingus.) There are clubs of female perverts, many of whom are not homosexual by heredity.

Although they differ from hereditary perversions, acquired perversions are connected with the former by a series of latent hereditary dispositions, more or less marked, and often difficult to distinguish in particular cases, especially when suggestion is blended with them.

Among the entirely hereditary and congenital sexual perversions, many occur in individuals who are well conducted and often possessed of delicate and altruistic sentiments. This point is not sufficiently recognized. Such persons are nearly always more or less neurotic in other respects. They are disheartened by their perversion and are so much ashamed of it that they often prefer to carry their secret to the grave rather than confide it to their doctor.

Others sometimes confess to a doctor, and the life of a martyr, who is always contemplating suicide, is revealed to him. Individuals of feeble, cynical, egoistic or abnormal natures, whose number is legion in the corrupt centers of modern civilization, yield to their perversion and often come before the tribunals, or else become objects of public contempt. As it is this class which generally become known, it is assumed by too hasty generalization that sexual perverts are necessarily cynical, vicious or weak-minded individuals; but this induction is false. It is unfortunately impossible to estimate the number of sexual perversions dissimulated by a large number of pessimists of both sexes, generally celibate and usually males.

I do not pretend that, when sexual perversion is neither hereditary nor favored by a latent hereditary predisposition, nor developed or fixed by alcoholism, it is usually possible to cure it by suggestion. This often acts even in cases where alcohol has aroused a hereditary taint. The incorrigible recidivists among the sexual perverts are, I am convinced, either hereditary or strongly predisposed, or degenerated by alcoholism. The original will power of the pervert is also of great importance. Weak-willed perverts always tend to relapse.

The social sanitation of sexual intercourse would certainly reduce to a minimum the compensatory perversions of normal persons who abstain from alcohol. The prohibition of alcoholic drink would definitely eliminate not only the perversions directly due to alcohol, but gradually also those due to alcoholic blastophthoria in the descendants. Other hereditary perversions, not of alcoholic origin, can only be definitely eliminated by healthy selection.

Perversions acquired by suggestion or auto-suggestion should be combated by suppression of the depraved examples which cause them, as well as by treatment by suggestion. It is needless to say that sexual perverts should always abstain from alcoholic drinks.