CASE I.—A man, 45 years of age, attracted by the allusion to my essay on "Social Perversion" contained in the English translation of Krafft-Ebing's Psychopathia Sexualis, consulted me regarding the possible cure of his condition. This individual was a finely educated, very intelligent man, who was an excellent linguist, had considerable musical ability, and was in the employ of a firm whose business was such as to demand on the part of its employés considerable legal acumen, clerical ability, and knowledge of real-estate transactions. This man stated that at the age of puberty, without any knowledge of perversity of sexual feeling, he was thrown intimately in contact with males of more advanced years, who took various means to excite his sexual passions, the result being that perverted sexual practices were developed, which were continued for a number of years. He thereafter noticed an aversion to women. At the solicitations of his family he finally married, without any very intelligent idea as to what, if anything, might be expected of him in the marital relation. Absolute impotence—indeed, repugnance for association with his wife—was the lamentable sequence. A divorce was in contemplation when, fortunately for all parties concerned, the wife suddenly died. Being a man of more than ordinary intelligence, this individual, prior to seeking my aid, had sought vainly for some remedy for his unfortunate condition. He stated that he believed there was an element of heredity in his case, his father having been a dipsomaniac and one brother having died insane. He nevertheless stated it to be his opinion that, notwithstanding the hereditary taint, he would have been perfectly normal from a sexual standpoint had it not been for acquired impressions at or about the period of puberty. This man presented a typically neurotic type of physique, complained of being intensely nervous, was prematurely gray, of only fair stature, and had an uncontrollable nystagmus, which, he said, had existed for some fifteen years. As might be expected, treatment in this case was of no avail. I began the use of hypnotic suggestion at the hands of an expert professional hypnotist. The patient, being called out of the State, finally gave up treatment, and I have no means of knowing what his present condition is.
CASE II.—A lady patient of mine who happened to be an actress, and consequently a woman of the world, brought to me for an opinion some correspondence which had passed between her younger brother and a man living in another State, with whom he was on quite intimate terms. In one of these letters various flying trips to Chicago for the purpose of meeting the lad, who, by the way, was only 17 years of age, were alluded to. It transpired also, as evidenced by the letters, that on several occasions the young lad had been taken on trips in Pullman cars by his friend, who was a prominent railroad official. The character of the correspondence was such as the average healthy man would address to a woman with whom he was enamored. It seemed that the author of the correspondence had applied to his boy affinity the name Cinderella, and the protestations of passionate affection that were made toward Cinderella certainly would have satisfied the most exacting woman. The young lad subsequently made a confession to me, and I put myself in correspondence with his male friend, with the result that he called upon me and I obtained a full history of the case. The method of indulgence in this case was the usual one of oral masturbation, in which the lad was the passive party. I was unable to obtain any definite data regarding the family history of the elder individual in this case, but understand that there was a taint of insanity in his family. He himself was a robust, fine-looking man, above middle age, who was well educated and very intelligent, as he necessarily must have been, because of the prominent position he held with an important railway company. I will state, as a matter of interest, that the lad in this case, who is now 23 years of age, has recently consulted me for impotentia coëundi, manifesting a frigidity for women, and, from the young man's statements, I am convinced that he is well on the road to confirmed sexual perversion.
An interesting point in this connection is that the young man's sister, the actress already alluded to, has recently had an attack of acute mania.
I have had other unpublished cases that might be of interest, but these two are somewhat classical, and typify to a greater or less degree the majority of other cases. I will, however, mention one other case, occurring in a woman.
CASE III.—A married woman 40 years of age. Has been deserted by her husband because of her perverted sexuality. Neurotic history on both sides of the family, and several cases of insanity on mother's side. In this case affinity for the same sex and perverted desire for the opposite sex existed, a combination by no means infrequent. Hypnotic suggestion tried, but without success. Cause was evidently suggestion and example on the part of another female pervert with whom she associated before her marriage. Marriage was late, at age of 35. In all these cases there was an element of what may be called suggestion, but it was really much more than this; it was probably in each case active seduction by an elder person of a predisposed younger person. It will be observed that in each case there was, at the least, an organic neurotic basis for suggestion and seduction to work on. I cannot regard these cases as entitled to modify our attitude toward suggestion.
MASTURBATION.—Moreau believed that masturbation was a cause of sexual inversion, and Krafft-Ebing looked upon it as leading to all sorts of sexual perversions; the same opinion was currently repeated by many writers. It is not now accepted. Moll emphatically rejected the idea that masturbation can be the cause of inversion; Näcke repeatedly denies that masturbation, any more than seduction, can ever produce true inversion; Hirschfeld attaches to it no etiological significance. Many years ago I gave special attention to this point and reached a similar conclusion. That masturbation, especially at an early age, may sometimes enfeeble the sexual activities, and aid the manifestations of inversion, I certainly believe. But beyond this there is little in the history of my male cases to indicate masturbation as a cause of inversion. It is true that 44 out of 51 admit that they have practised masturbation,—at all events, occasionally, or at some period in their lives,—and it is possible that this proportion is larger than that found among normal people. Even if so, however, it is not difficult to account for, bearing in mind the fact that the homosexual person has not the same opportunities as has the heterosexual person to gratify his instincts, and that masturbation may sometimes legitimately appear to him as the lesser of two evils.[[191]] Not only has masturbation been practised at no period in at least 7 of the cases (for concerning several I have no information), but in several others it was never practised until long after the homosexual instinct had appeared, in 1 case not till the age of 40, and then only occasionally. In at least 8 it was only practised at puberty; in at least 8, however, it began before the age of puberty; at least 9 left off before about the age of 20. Unfortunately, as yet, we have little definite evidence as to the prevalence and extent of masturbation among normal individuals.
Among the women masturbation is found in at least 5 cases out of 7. In 1 case there was no masturbation until comparatively late in life, and then only at rare intervals and under exceptional circumstances. In another case, some years after the homosexual attraction had been experienced, it was practised, though not in excess, from the age of puberty for about four years, and then abandoned; during these years the physical sexual feelings were more imperative than they were afterward felt to be. In 2 cases masturbation was learned spontaneously soon after puberty, and in 1 of these practised in excess before the manifestations of inversion became definite. In all cases the subjects are emphatic in asserting that this practice neither led to, nor was caused by, the homosexual attraction, which they regard as a much higher feeling, and it must be added that the occasional practice of masturbation is very far from rare among fairly normal women.[[192]]
While this is so, I am certainly inclined to believe that an early and excessive indulgence in masturbation, though not an adequate cause, is a favoring condition for the development of inversion, and that this is especially so in women. The sexual precocity indicated by early and excessive masturbation doubtless sometimes reveals an organism already predisposed to homosexuality. But, apart from this, when masturbation arises spontaneously at an early age on a purely physical basis it seems to tend to produce a divorce between the physical and the psychic aspects of sexual love. The sexual manifestations are all diverted into this physical direction, and the child is ignorant that such phenomena are normally allied to love; then, when a more spiritual attraction appears with adolescent development, this divorce is perpetuated. Instead of the physical and psychic feelings appearing together when the age for sexual attraction comes, the physical feelings are prematurely twisted from their natural end, and it becomes abnormally easy for a person of the same sex to step in and take the place rightfully belonging to a person of the opposite sex. This has certainly seemed to me the course of events in some cases I have observed.
ATTITUDE TOWARD THE OPPOSITE SEX.—In 17 cases (of whom 5 are married and others purposing to marry) there is sexual attraction to both sexes, a condition formerly called psycho-sexual hermaphroditism, but now more usually bisexuality. In such cases, although there is pleasure and satisfaction in relationships with both sexes, there is usually a greater degree of satisfaction in connection with one sex. Most of the bisexual prefer their own sex. It is curiously rare to find a person, whether man or woman, who by choice exercises relationships with both sexes and prefers the opposite sex. This would seem to indicate that the bisexual may really be inverts.
In any case bisexuality merges imperceptibly into simple inversion. In at least 16 of 52 cases of simple inversion in men there has been connection with women, in some instances only once or twice, in others during several years, but it was always with an effort, or from a sense of duty and anxiety to be normal; they never experienced any real pleasure in the act, or sense of satisfaction after it. Four of these cases are married, but martial relationships usually ceased after a few years. At least four others were attracted to women when younger, but are not now; another once felt sexually attracted to a boyish woman, but never made any attempt to obtain any relationships with her; 3 or 4 others, again, have tried to have connection with women, but failed. The largest proportion of my cases have never had any sexual intimacy with the opposite sex,[[193]] and some of these experience what, in the case of the male invert, is sometimes called horror feminæ. But, while woman as an object of sexual desire is in such cases disgusting to them, and it is usually difficult for a genuine invert to have connection with a woman except by setting up images of his own sex, for the most part inverts are capable of genuine friendships, irrespective of sex.