Homosexuality in English schools has already been briefly referred to in chapter iii. As a precise and interesting picture of the phenomena in French schools, I may mention a story by Albert Nortal, Les Adolescents Passionnés (1913), written immediately after the author left college, though not published until more than twenty-five years later, and clearly based on personal observation and experience. As regards German schools, see, e.g., Moll, Untersuchungen über die Libido Sexualis, p. 449 et seq., and for sexual manifestations in early life generally, the same author's Sexual Life of the Child; also Hirschfeld, Jahrbuch für sexuelle Zwischenstufen, vol. v, 1903, p. 47 et seq., and, for references, Hirschfeld, Die Homosexualität, p. 46 et seq.

While much may be done by physical hygiene and other means to prevent the extension of homosexuality in schools,[[243]] it is impossible, and even undesirable, to repress absolutely the emotional manifestations of sex in either boys or girls who have reached the age of puberty.[[244]] It must always be remembered that profoundly rooted organic impulses cannot be effectually combated by direct methods. Writing of a period two centuries ago, Casanova, in relating his early life as a seminarist trained to the priesthood, describes the precautions taken to prevent the youths entering each other's beds, and points out the folly of such precautions.[[245]] As that master of the human heart remarks, such prohibitions intensify the very evil they are intended to prevent by invoking in its aid the impulse to disobedience natural to every child of Adam and Eve, and the observation has often been repeated by teachers since. We probably have to recognize that a way to render such manifestations wholesome, as well as to prepare for the relationships of later life, is the adoption, so far as possible, of the method of coeducation of the sexes,[[246]]—not, of course, necessarily involving identity of education for both sexes,—since a certain amount of association between the sexes helps to preserve the healthiness of the sexual emotional attitude. Association between the sexes will not, of course, prevent the development of congenital inversion. In this connection it is pointed out by Bethe that it was precisely in Sparta and Lesbos, where homosexuality was most ideally cultivated, that the sexes, so far as we know, associated more freely than in any other Greek State.[[247]]

The question of the treatment of homosexuality must be approached with discrimination, caution, and skepticism. Nowadays we can have but little sympathy with those who, at all costs, are prepared to "cure" the invert. There is no sound method of cure in radical cases.

At one time the seemingly very radical method of castration was advocated and occasionally carried out, as in a case I have recorded in a previous chapter (History XXVI). Like all methods of treatment, it is sometimes believed to have been successful by those who carried it out. Usually, after a short period, it is found to be unsuccessful, and in some cases the condition, especially the mental condition, is rendered worse. It is not difficult to understand why this should be. Sexual inversion, is not a localized genital condition. It is a diffused condition, and firmly imprinted on the whole psychic state. There may be reasons for castration, or the slighter operation of vasectomy, but, although sexual tension may be thereby diminished, no authority now believes that any such operation will affect the actual inversion. Castration of the body in adult age cannot be expected to produce castration of the mind. Moll, Féré, Näcke, Bloch, Rohleder, Hirschfeld, are all either opposed to castration for inversion, or very doubtful as to any beneficial results.

In a case communicated to me by Dr. Shufeldt, an invert had himself castrated at the age of 26 to diminish sexual desire, make himself more like a woman, and to stop growth of beard. "But the only apparent physical effect," he wrote, "was to increase my weight 10 per cent., and render me a semi-invalid for the rest of my life. After two years my sexuality decreased, but that may have been due to satiety or to advancing years. I was also rendered more easily irritated over trifles and more revengeful. Terrible criminal auto-suggestions came into my head, never experienced before." Féré (Revue de Chirurgie, March 10, 1905) published the case of an invert of English origin who had been castrated. The inverted impulse remained unchanged, as well as sexual desire and the aptitude for erection; but neurasthenic symptoms, which had existed before, were aggravated; he felt less capable to resist his impulses, became migratory in his habits of life, and addicted to the use of laudanum. In a case recorded by C. H. Hughes (Alienist and Neurologist, Aug., 1914) the results were less unsatisfactory; in this case the dorsal nerve of the penis was first excised, without any result (see also Alienist and Neurologist, Feb., 1904, p. 70, as regards worse than useless results of cutting the pudic nerve), and a year or so later the testes were removed and the patient gained tranquillity and satisfaction; his homosexual inclinations appeared to go, and he began to show inclination for asexualized women, being specially anxious to meet with a woman whose ovaries had been removed on account of inversion. (Reference may also be made to Näcke, "Die Ersten Kastrationen aus sozialen Grunden auf europäischen Boden," Neurologisches Centralblatt, 1909, No. 5, and E. Wilhelm in Juristisch-psychiatrische Grenzfragen, vol. viii, Heft 6 and 7, 1911.)

More trust has usually been placed in the psychotherapeutical than the surgical treatment of homosexuality. At one time hypnotic suggestion was carried out very energetically on homosexual subjects. Krafft-Ebing seems to have been the first distinguished advocate of hypnotism for application to the homosexual. Dr. von Schrenck-Notzing displayed special zeal and persistency in this treatment. He undertook to treat even the most pronounced cases of inversion by courses lasting more than a year, and involving, in at least one case, nearly one hundred and fifty hypnotic sittings; he prescribed frequent visits to the brothel, previous to which the patient took large doses of alcohol; by prolonged manipulations a prostitute endeavored to excite erection, a process attended with varying results. It appears that in some cases this course of treatment was attended by a certain sort of success, to which an unlimited good will on the part of the patient, it is needless to say, largely contributed. The treatment was, however, usually interrupted by continual backsliding to homosexual practices, and sometimes, naturally, the cure involved a venereal disorder. The patient was enabled to marry and to beget children.[[248]] It is a method of treatment which seems to have found few imitators. This we need not regret. The histories I have recorded in previous chapters show that it is not uncommon for even a pronounced invert to be able sometimes to effect coitus. It often becomes easy if at the time he fixes his thoughts on images connected with his own sex. But the perversion remains unaffected; the subject is merely (as one of Moll's inverts expressed it) practising masturbation per vaginam. Such treatment is a training in vice, and, as Raffalovich points out, the invert is simply perverted and brought down to the vicious level which necessarily accompanies perversity.[[249]]

There can be no doubt that in slight and superficial cases of homosexuality, suggestion may really exert an influence. We can scarcely expect it to exert such influence when the homosexual tendency is deeply rooted in an organic inborn temperament. In such cases indeed the subject may resist suggestion even when in the hypnotic state. This is pointed out by Moll, a great authority on hypnotism, and with much experience of its application to homosexuality, but never inclined to encourage an exaggerated notion of its efficacy in this field. Forel, who was also an authority on hypnotism, was equally doubtful as to its value in relation to inversion, especially in clearly inborn cases. Krafft-Ebing at the end said little about it, and Näcke (who was himself without faith in this method of treating inversion) stated that he had been informed by the last homosexual case treated by Krafft-Ebing by hypnotism that, in spite of all good-will on the patient's side, the treatment had been quite useless. Féré, also, had no belief in the efficacy of suggestive treatment, nor has Merzbach, nor Rohleder. Numa Praetorius states that the homosexual subjects he is acquainted with, who had been so treated, were not cured, and Hirschfeld remarks that the inverts "cured" by hypnotism were either not cured or not inverted.[[250]]

Moll has shown his doubt as to the wide applicability of suggestive therapeutics in homosexuality by developing in recent years what he terms association-therapy. In nearly all perverse individuals, he points out, there is a bridge,—more or less weak, no doubt,—which leads to the normal sexual life. By developing such links of association with normality, Moll believes, it may be possible to exert a healing influence on the homosexual. Thus a man who is attracted to boys may be brought to love a boyish woman.[[251]] Indications of this kind have long been observed and utilized, though not developed into a systematic method of treatment. In the case of bisexual individuals, or of youthful subjects whose homosexuality is not fully developed, it is probable that this method is beneficial. It is difficult to believe, however, that it possesses any marked influence on pronounced and developed cases of inversion.[[252]]

Somewhat the same aim as Moll's association-therapy, though on the basis of a more elaborate theory, is sought by Freud's psychoanalytic method of treating homosexuality. For the psychoanalytic theory (to which reference was made in the previous chapter) the congenital element of inversion is a rare and usually unimportant factor; the chief part is played by perverse psychic mechanisms. It is the business of psychoanalysis to straighten these out, and from the bisexual constitution, which is regarded as common to every one, to bring into the foreground the heterosexual elements, and so to reconstruct a normal personality, developing new sexual ideals from the patient's own latent and subconscious nature. Sadger has especially occupied himself with the psychoanalytic treatment of homosexuality and claims many successes.[[253]] Sadger admits that there are many limits to the success of this treatment, and that it cannot affect the inborn factors of homosexuality when present. Other psychoanalysts are less sanguine as to the cure of inversion. Stekel appears to have stated that he has never seen a complete cure by psychoanalysis, and Ferenezi is not able to give a good account of the results; especially as regards what he terms obsessional homosexuality, he states that he has never succeeded in effecting a complete cure, although obsessions in general are especially amenable to psychoanalysis.[[254]]

I have met with at least two homosexual persons who had undergone psychoanalytic treatment and found it beneficial. One, however, was bisexual, so that the difficulties in the way of the success—granting it to be real—were not serious. In the other case, the inversion persisted after treatment, exactly the same as before. The benefit he received was due to the fact that he was enabled to understand himself better and to overcome some of his mental difficulties. The treatment, therefore, in his case, was not a method of cure, but of psychic hygiene, of what Hirschfeld would call "adaptation-therapy." There can be no doubt that—even if we put aside all effort at cure and regard an invert's condition as inborn and permanent—a large and important field of treatment here still remains.