Analysis of Histories—Race—Heredity—General Health—First Appearance of Homosexual Impulse—Sexual Precocity and Hyperesthesia—Suggestion and Other Exciting Causes of Inversion—Masturbation—Attitude Toward Women—Erotic Dreams—Methods of Sexual Relationship—Pseudo-sexual Attraction—Physical Sexual Abnormalities—Artistic and Other Aptitudes—Moral Attitude of the Invert.
Before stating briefly my own conclusions as to the nature of sexual inversion, I propose to analyze the facts brought out in the histories which I have been able to study.[[183]]
RACE.—All my cases, 80 in number, are British and American, 20 living in the United States and the rest being British. Ancestry, from the point of view of race, was not made a matter of special investigation. It appears, however, that at least 44 are English or mainly English; at least 10 are Scotch or of Scotch extraction; 2 are Irish and 4 others largely Irish; 4 have German fathers or mothers; another is of German descent on both sides, while 2 others are of remote German extraction; 2 are partly, and 1 entirely, French; 2 have a Portuguese strain, and at least 2 are more or less Jewish. Except the apparently frequent presence of the German element, there is nothing remarkable in this ancestry.
HEREDITY.—It is always difficult to deal securely with the significance of heredity, or even to establish a definite basis of facts. I have by no means escaped this difficulty, for in some cases I have not even had an opportunity of cross-examining the subjects whose histories I have obtained. Still, the facts, so far as they emerge, have some interest. I possess some record of heredity in 62 of my cases. Of these, not less than 24, or in the proportion of nearly 39 per cent., assert that they have reason to believe that other cases of inversion have occurred in their families, and, while in some it is only a strong suspicion, in others there is no doubt whatever. In one case there is reason to suspect inversion on both sides. Usually the inverted relatives have been brothers, sisters, cousins, or uncles. In one case a bisexual son seems to have had a bisexual father.
This hereditary character of inversion (which was denied by Näcke) is a fact of great significance, and, as it occurs in cases with which I am well acquainted, I can have no doubt concerning the existence of the tendency. The influence of suggestion may often be entirely excluded, especially when the persons are of different sex. Both Krafft-Ebing and Moll noted a similar tendency. Von Römer states that in one-third of his cases there was inversion in other members of the family. Hirschfeld also found that there is a relatively high proportion of cases of family inversion.
Twenty-six, so far as can be ascertained, belong to reasonably healthy families; minute investigation would probably reduce the number of these, and it is noteworthy that even in some of the healthy families there was only one child born of the parents' marriage. In 28 cases there is more or less frequency of morbidity or abnormality—eccentricity, alcoholism, neurasthenia, insanity, or nervous disease—on one or both sides, in addition to inversion or apart from it. In some of these cases the inverted offspring is the outcome of the union, of a very healthy with a thoroughly morbid stock; in some others there is a minor degree of abnormality on both sides.
GENERAL HEALTH.—It is possible to speak with more certainty of the health of the individual than of that of his family. Of the 80 cases, 53—or about two-thirds—may be said to enjoy good, and sometimes even very good, health, though occasionally there is some slight qualification to be made. In 22 cases the health is delicate, or at best only fair; in these cases there is sometimes a tendency to consumption, and often marked neurasthenia and a more or less unbalanced temperament. Four cases are morbid to a considerable degree; the remaining case has had insane delusions which required treatment in an asylum. A considerable proportion, included among those as having either good or fair health, may be described as of extremely nervous temperament, and in most cases they so describe themselves; a certain proportion of these combine great physical and, especially, mental energy with this nervousness; all these are doubtless of neurotic temperament.[[184]] Very few can be said to be conspicuously lacking in energy. On the whole, therefore, a large proportion of these inverted individuals are passing through life in an unimpaired state of health, which enables them to do at least their fair share of work in the world; in a considerable proportion of my cases that work is of high intellectual value. Only in 5 cases, it will be seen, or at most 6, can the general health be said to be distinctly bad.
This result may, perhaps, seem surprising. It must, however, be remembered that my cases do not, on the whole, represent the class which alone the physician is usually able to bring forward: i.e., the sexual inverts who are suffering from a more or less severe degree of complete nervous breakdown.
There is no frequent relationship between homosexuality and insanity, and such homosexuality as is found in asylums is mostly of a spurious character. This point was specially emphasized by Näcke (e.g., "Homosexualität und Psychose," Zeitschrift für Psichiatrie, vol. lxviii, No. 3, 1911). He quoted the opinions of various distinguished alienists as to the rarity with which they had met genuine inverts, and recorded his own experiences. He had never met a genuine invert in the asylum throughout his extensive experience, although he was quite willing to admit that there may be unrecognized inverts in asylums, and one patient informed him, after leaving, that he was inverted, and had attracted the attention of the police both before and afterward, though nothing happened in the asylum. Among 1500 patients in the asylum during one year, active pedicatio occurred in about 1 per cent. of cases, these patients being frequently idiots or imbeciles and at the same time masturbators, solitary or mutual. Hirschfeld informed Näcke that, among homosexual persons, hysterical conditions (not usually on hereditary basis) are fairly common, and neurasthenia of high degree decidedly frequent, but though stages of depression are common he had never seen pure melancholia and very seldom mania, but paranoiac delusional ideas frequently, and he agreed with Bryan of Broadmoor that religious delusions are not uncommon. General paralysis occurs, but is comparatively rare, and the same may be said of dementia præcox. On the whole, although Hirschfeld was unable to give precise figures, there was no reason whatever to suppose an abnormal prevalence of insanity. This was Näcke's own view. It is quite true, Näcke concluded, that homosexual actions occur in every form of psychosis, especially in congenital and secondary dements, and at periods of excitement, but we are here more concerned with "pseudo-homosexuality" than with true inversion. Hirschfeld finds that 75 per cent. inverts are of sound heredity; this seems too large a proportion; in any case allowance must be made for differences in method and minuteness of investigation.
I am fairly certain that thorough investigation would very considerably enlarge the proportion of cases with morbid heredity. At the same time this enlargement would be chiefly obtained by bringing minor abnormalities to the front, and it would then have to be shown how far the families of average or normal persons are free from such abnormalities. The question is sometimes asked: What family is free from neuropathic taint? At present it is difficult to answer this question precisely. There is good ground to believe that a fairly large proportion of families are free from such taint. In any case it seems probable that the families to which the inverted belong do not usually present such profound signs of nervous degeneration as we were formerly led to suppose. What we vaguely call "eccentricity" is common among them; insanity is much rarer.