Here are brief notes of a case in which hypnotic suggestion was employed with beneficial results.
Case 17.—X., a boy eleven years of age, was diligent at school. For some time past he had withdrawn from the companionship of all his school-fellows, and his parents had noticed that he was continually in the company of a schoolgirl two years older than himself. He availed himself of every opportunity to play with this girl. When they sat together at table, it was noticed that they endeavoured to secure physical contact by bringing their knees together. In addition, they were often seen kissing one another. It was obvious that the two had a mutual inclination each for the other. If anyone gave the boy a present of money, he shared it with the girl. The two wrote letters to one another, and some of these letters fell into the parents' hands. Thereafter the two were watched, so that this exchange of letters became impossible. At first, the matter was not regarded seriously; on the contrary, the two were teased about it, especially the boy. The latter became very unhappy, and for a time it was believed that the intimacy had been broken off. In reality, the rupture was apparent merely, and was simulated to escape the teasing. In secret, they continued to meet. Whereas regarding the girl few details were at my disposal, I had a good deal of information about the boy. It was astonishing how many excuses he made to deceive his relatives. Sometimes he was supposed to be writing his home-lessons, sometimes to be at a gymnastic lesson or at church, when in reality he was with his girl friend. It had been observed before that the boy occasionally played with his genital organs. Since a complete separation from the girl gave rise in the boy to a state of profound depression, followed by his paying attentions to a somewhat older girl living in his house, his parents now sought my advice. The boy proved to be extremely susceptible to hypnotism and to hypnotic suggestion, and it was remarkable how rapidly a complete change in his demeanour was effected. Since then I have seen the boy occasionally, the last time being when he was about fifteen and a half years of age. There had been no return of the sexual tendencies previously observed. Quite recently, indeed, he had been known to masturbate occasionally; and it was for this reason that he was again brought to consult me. But for four years previously, notwithstanding the fact that he had been very carefully watched, no improper conduct had been detected. Undoubtedly, the recent practice of masturbation would have escaped notice, had not the parents been made very anxious by the earlier experiences. No special treatment was now undertaken, since it appeared that there was nothing more amiss than is observed in average boys of his age; symptoms which in most cases disappear spontaneously, and without treatment.
A short account must also be given here of the method of Breuer and Freud, or the psycho-analytic method. It is true that this method is applicable to adults only, but its aim is to relieve the ill effects of sexual experiences during childhood. I have before pointed out that in Freud's view four neuroses always result from previous sexual experiences; and two of these, hysteria and compulsion-neuroses (Zwangsneurose) are considered by him to depend upon sexual experiences during childhood. Freud, who originally worked out this method in co-operation with Breuer, but subsequently further developed it by himself, assumes that the hysterical symptoms which result from the noxious influences of sexual experiences during childhood, are always permanently allayed if we succeed in making the subject once more actively conscious of them, and enable the emotions thereby again aroused in the mind of the patient to obtain an efficient outlet (sie zum abreagieren zu bringen). If we are able, either with or without the aid of hypnotism, to reawaken the effect which was originally experienced as a result of the sexual trauma, the hysterical symptoms will be permanently relieved. Originally, he endeavoured to reawaken the memory of the sexual trauma by means of the induction of profound hypnosis. Later, however, he was able to do this, without the aid of hypnotism, by conversing with the patient, and by awaking his memory by means of questions. This method, to which formerly Freud gave the name of the cathartic method, but which is now generally known as the psycho-analytic method, has to some extent been further developed by Freud's pupils. Freud's view is that by means of psycho-analysis he is enabled, from the sphere of the unconscious, or rather of the subconscious, to restore to the supra-consciousness the lost sexual experiences of childhood or of later life; and by this means to effect a permanent cure of the most diverse diseases. No detailed criticism of this method of treatment will here be attempted, but my views on the matter will to some extent have become apparent from what has been said in earlier parts of this book. The value of Freud's work appears to me to consist chiefly in this, that he has insisted more definitely than other writers upon the reality of subconscious processes. But I believe that the general sexual etiology which he assumes to exist can from no point of view be regarded as sound, even with the limitation which he later imposed upon his own doctrine, namely, that it is not the sexual experience itself, but the reaction against this experience, which is etiologically significant. Recently, I have several times tried to treat by the psycho-analytic method some of the cases for which that method is supposed to be suitable, and as a result of my experience I have been forced more and more to the conclusion that, notwithstanding all the other advantages of the psycho-analytic method, the importance of the factor of sexual experiences in the causation of disease has been greatly over-estimated by Freud. Moreover, I believe that the cures effected by Freud (as to the permanence of which, in view of the insufficiency of the published materials, no decisive opinion can as yet be given), are explicable in another way. A large proportion of the good results are certainly fully explicable as the results of suggestion. The patient's confidence in his physician, and the fact that the treatment requires much time and patience, are two such powerful factors of suggestion, that provisionally it is necessary to regard it as possible that suggestion explains the whole matter.
There are, of course, many other psychological influences to which attention must also be directed. One of the most important of these is the avoidance of psychical contagion. A boy who is sexually premature, or in whom some other striking sexual manifestations have occurred, may exercise an extremely harmful influence upon other children. We must endeavour to remove such a boy from the companionship of others, and in this country this often can be effected through the instrumentality of the Law of Guardianship (Fürsorgegesetz). But it will by no means always be easy to find the guilty person. It is extremely common for such an abnormal child to set the tone for the others; and such a child may be making remarkable progress in study, although its sexual and moral level is a very low one. A number of other measures will be inferred from what has been said in the section on etiology. These are social rather than medical problems. We must avoid letting children have the chance of seeing others engaged in sexual intercourse; they must not live in too close and intimate an association with other children; they must not grow up in the society of prostitutes; children who are past infancy should not share a common bed. As regards school-life, it is supposed to be a matter of great importance that there should be separate closets for the two sexes. I am myself doubtful if this last matter is one of much moment.
In any case, we can interfere for the special protection of children who have been exposed to peculiar risks, and have for this reason been led astray sexually. I have seen children who have been taught sexual misconduct, either by a nursemaid or by other children, and have practised such misconduct for a time; but in whom a complete cure has resulted from separation from the seducer. In some cases, of course, it will be necessary to do more than this, and to subject the child to some special treatment; and in rare instances, in which the sphere of the sexual is already markedly developed, it may be necessary that this treatment should be institutional. But such cases are certainly very uncommon. A matter of importance is that the parents or other persons responsible for the care and guidance of the child, should understand the psychical management of children; for example, that they should not fall into the common error of regarding the love-affairs of children as a joke, and that they should not, by this attitude, actually encourage the children in their course of conduct.
One part of sexual education is made up by the question of the purposive sexual enlightenment of children—a matter much discussed at the present day. I have shown, on page 8, that this question is not, as many suppose, a new one. Those who have written on the subject of sexual enlightenment use this term with somewhat various meanings. As regards the extension of the term, it may be applied to either (or both) of two fields, which we may term the objective and the subjective aspects of the sexual life. To the objective side belong the physiological processes by means of which is effected the reproduction of organisms, whether plants, animals, or human beings. In explanation of these it is necessary to describe the reproductive organs, and the processes of conjugation, fertilisation, and fructification, as they have long been customarily taught in the botany class; and the nourishment of the nursing infant from the breast of the mother may also be described. To the subjective side, belong the relationships of the sexual processes to the individual organism, the good and the bad effects of the sexual impulse, &c. In this connexion, reference will be made to the dangers of masturbation, sexual excesses, pregnancy, venereal infection, and so on. By many writers, these two fields are not distinguished each from the other with sufficient clearness. The question, whether children should be taught about the methods of reproduction in plants, animals, and human beings, must not be confused with the question whether they should be taught about masturbation or the venereal diseases. It is possible to teach children that self-abuse is a harmful practice, without giving them any account of the physiological processes of reproduction; and, conversely, these processes may be described, without any special reference to the bearings of the matter on the individual life. Of course, the two fields are interconnected; and some writers suggest that in teaching children and young persons a proper respect for the genital organs, such teaching should be based upon a knowledge of the subsequent function of these organs in the work of reproduction. The individual processes cannot at once be referred to one field or the other; involuntary sexual orgasm, menstruation, the puberal development, inasmuch as they exhibit both a subjective and an objective aspect, belong to both fields. This is also true of the sexual act itself, in connexion with which, moreover, the principal difficulties of sexual enlightenment arise.
Having thus considered the general significance of sexual enlightenment, we have next to ask what are the grounds on which such enlightenment is thought to be desirable. These will have become partly apparent from what has been said regarding the importance of the sexual life of the child; but this does not exhaust the matter, for the sexual enlightenment of the child may also comprise instruction concerning the entire subsequent development of the sexual life. The reasons for sexual enlightenment may be classified under various heads; the chief of these are reasons of health, of social life, of law, morality, education, and the intellectual development.
To consider first the matter of intellectual development, we have here to think, not so much of a limitation of the intellectual growth in consequence of the sexual thoughts of the child, as of the fact that instruction in the nature of sexual processes, at least as far as the objective field is concerned, promotes the general culture. The degree to which even adults are ignorant about such matters, is hardly credible. There are persons who believe that every egg laid by a hen will develop into a chicken if incubated by the mother, or if kept for the proper time in an artificial incubator; there are persons who do not know what the hard roe and soft roe of fishes are, who do not understand the nature of the spawning process, and are, in fact, quite uninstructed concerning the process of reproduction in fishes. I have conversed with adults who did not know wherein a wether differs from a ram, or a bullock from a bull; and who were even ignorant, as regards great groups of the animal kingdom, whether they reproduced their kind by means of eggs or living young. But on such matters as these, every cultured person should be sufficiently informed, and should not be capable of being shamed by the superior knowledge of an uneducated child from the country. On one occasion, I even saw a married woman, actually twenty-eight years of age, who had been examined by a gynecologist, and for whom the latter had recommended the operative division of the hymen; but the lady confused this operation with oöphorectomy, and it was by no means an easy matter to make her understand the difference between the two. It will readily be understood that every grown man and woman ought ultimately to be fully informed concerning all such matters. In part, such instruction will take place at school, and more especially in the case of processes in the vegetable and lower animal world; these things will be explained in connexion with instruction in natural history and biology. But information about the human reproductive organs cannot be given in the school, unless to children of a considerable age; for these matters, direct personal instruction at home is more suitable.
Apart from the demands of general culture there are other reasons why sexual enlightenment is desirable. These chiefly concern the subjective aspects of the sexual life, whilst the objective processes serve principally for preparatory instruction.
First of all, grounds of health have to be considered. It may be desirable to enlighten the child regarding the dangers of masturbation, those of ordinary illegitimate sexual intercourse, and those of sexual excesses. No detailed discussion of these points is here necessary, since they have been dealt with before at considerable length, especially on p. [180] et seq. Here I will merely point out that this aspect of enlightenment affects the entire future of the child and the family it will one day have. The first consideration here is the danger of venereal infection, and it is this danger, in close association with the other prophylactic efforts of our time, which has given rise to the recent movement in favour of sexual enlightenment. In this connexion the dangers may be explained that threaten the male from gonorrhoeal infection, not only in his own person, but also in the persons of his future wife and children. The wife may be infected by the husband, and the visual powers of the new-born child may also be endangered. Ophthalmia of the new-born, which often leads to blindness, commonly depends upon conjunctival infection received during the act of parturition. Syphilis was referred to on p. [192]. Here it may be added that still-births and abortion and miscarriage may result from syphilitic infection either of the mother or of the embryo. Or the child may be born alive, but suffering from syphilitic infection. Even when no actual infection of the offspring results, syphilis favours the occurrence of a general degeneration of the progeny. If we desire to safeguard human beings against such dangers as these, we shall feel it necessary to enlighten them before it is too late; and in view of the fact that from a single act of intercourse infection may result by which the health may be permanently injured, such enlightenment is no less necessary for girls than for boys.