In a case of Freyer's (Zeitschrift für Medizinalbeamte, third year, No. 8) the occasional connection of exhibitionism with epilepsy is well illustrated by a barber's assistant, aged 35, whose father suffered from chronic alcoholism and was also said to have committed the same kind of offense as his son. The mother and a sister suffered nervously. From ages of 7 to 18 the subject had epileptic convulsions. From 16 to 21 he indulged in normal sexual intercourse. At about that time he had often to pass a playground and at times would urinate there; it happened that the children watched him with curiosity. He noticed that when thus watched sexual excitement was caused, inducing erection and even ejaculation. He gradually found pleasure in this kind of sexual gratification; finally he became indifferent to coitus. His erotic dreams, though still usually about normal coitus, were now sometimes concerned with exhibition before little girls. When overcome by the impulse he could see and hear nothing around him, though he did not lose consciousness. After the act was over he was troubled by his deed. In all other respects he was entirely reasonable. He was imprisoned many times for exhibiting himself to young schoolgirls, sometimes vaunting the beauty of his organs and inviting inspection. On one occasion he underwent mental examination, but was considered to be mentally sound. He was finally held to be a hereditarily tainted individual with neuropathic constitution. The head was abnormally broad, penis small, patellar reflex absent, and there were many signs of neurasthenia. (Krafft-Ebing, Op. cit., pp. 490-492.)
The prevalence of epilepsy among exhibitionists is shown by the observations of Pelanda in Verona. He has recorded six cases of this perversion, all of which eventually reached the asylum and were either epileptics or with epileptic relations. One had a brother who was also an exhibitionist. In some cases the penis was abnormally large, in others abnormally small. Several had very weak sexual impulse; one, at the age of 62, had never effected coitus, and was proud of the fact that he was still a virgin, considering, he would say, the epoch of demoralization in which we live. (Pelanda, "Pornopatici," Archivio di Psichiatria, fasc. ii-iv, 1889.)
In a very typical case of exhibitionism which Garnier has recorded, a certain X., a gentleman engaged in business in Paris, had a predilection for exhibiting himself in churches, more especially in Saint-Roch. He was arrested several times for exposing his sexual organs here before ladies in prayer. In this way he finally ruined his commercial position in Paris and was obliged to establish himself in a small provincial town. Here again he soon exposed himself in a church and was again sent to prison, but on his liberation immediately performed the same act in the same church in what was described as a most imperturbable manner. Compelled to leave the town, he returned to Paris, and in a few weeks' time was again arrested for repeating his old offense in Saint Roch. When examined by Garnier, the information he supplied was vague and incomplete, and he was very embarrassed in the attempt to explain himself. He was unable to say why he chose a church, but he felt that it was to a church that he must go. He had, however, no thought of profanation and no wish to give offense. "Quite the contrary!" he declared. He had the sad and tired air of a man who is dominated by a force stronger than his will. "I know," he added, "what repulsion my conduct must inspire. Why am I made thus? Who will cure me?" (P. Garnier, "Perversions Sexuelles," Comptes Rendus, International Congress of Medicine at Paris in 1900, Section de Psychiatrie, pp. 433-435.)
In some cases, it would appear, the impulse to exhibitionism may be overcome or may pass away. This result is the more likely to come about in those cases in which exhibitionism has been largely conditioned by chronic alcoholism or other influences tending to destroy the inhibiting and restraining action of the higher centers, which may be overcome by hygiene and treatment. In this connection I may bring forward a case which has been communicated to me by a medical correspondent in London. It is that of an actor, of high standing in his profession and extremely intelligent, 49 years of age, married and father of a large family. He is sexually vigorous and of erotic temperament. His general health has always been good, but he is a high-strung, neurotic man, with quick mental reactions. His habits had for a long time been decidedly alcoholic, but two years ago, a small quantity of albumen being found in the urine, he was persuaded to leave off alcohol, and has since been a teetotaller. Though ordinarily very reticent about sexual matters, he began four or five years ago to commit acts of exhibitionism, exposing himself to servants in the house and occasionally to women in the country. This continued after the alcohol had been abandoned and lasted for several years, though the attention of the police was never attracted to the matter, and so far as possible he was quietly supervised by his friends. Nine months after, the acts of exhibitionism ceased, apparently in a spontaneous manner, and there has so far been no relapse.
Exhibitionism is an act which, on the face of it, seems nonsensical and meaningless, and as such, as an inexplicable act of madness, it has frequently been treated both by writers on insanity and on sexual perversion. "These acts are so lacking in common sense and intelligent reflection that no other reason than insanity can be offered for the patient," Ball concluded.[[55]] Moll, also, who defines exhibitionism somewhat too narrowly as a condition in which "the charm of the exhibition lies for the subject in the display itself," not sufficiently taking into consideration the imagined effect on the spectator, concludes that "the psychological basis of exhibitionism is at present by no means cleared up."[[56]]
We may probably best approach exhibitionism by regarding it as fundamentally a symbolic act based on a perversion of courtship. The exhibitionist displays the organ of sex to a feminine witness, and in the shock of modest sexual shame by which she reacts to that spectacle, he finds a gratifying similitude of the normal emotions of coitus.[[57]] He feels that he has effected a psychic defloration.
Exhibitionism is thus analogous, and, indeed, related, to the impulse felt by many persons to perform indecorous acts or tell indecent stories before young and innocent persons of the opposite sex. This is a kind of psychic exhibitionism, the gratification it causes lying exactly, as in physical exhibitionism, in the emotional confusion which it is felt to arouse. The two kinds of exhibitionism may be combined in the same person: Thus, in a case reported by Hoche (p. 97), the exhibitionist an intellectual and highly educated man, with a doctor's degree, also found pleasure in sending indecent poems and pictures to women, whom, however, he made no attempt to seduce; he was content with the thought of the emotions he aroused or believed that he aroused.
It is possible that within this group should come the agent in the following incident which was lately observed by a lady, a friend of my own. An elderly man in an overcoat was seen standing outside a large and well-known draper's shop in the outskirts of London; when able to attract the attention of any of the shop-girls or of any girl in the street he would fling back his coat and reveal that he was wearing over his own clothes a woman's chemise (or possibly bodice) and a woman's drawers; there was no exposure. The only intelligible explanation of this action would seem to be that pleasure was experienced in the mild shock of interested surprise and injured modesty which this vision was imagined to cause to a young girl. It would thus be a comparatively innocent form of psychic defloration.
It is of interest to point out that the sexual symbolism of active flagellation is very closely analogous to this symbolism of exhibitionism. The flagellant approaches a woman with the rod (itself a symbol of the penis and in some countries bearing names which are also applied to that organ) and inflicts on an intimate part of her body the signs of blushing and the spasmodic movements which are associated with sexual excitement, while at the same time she feels, or the flagellant imagines that she feels, the corresponding emotions of delicious shame.[[58]] This is an even closer mimicry of the sexual act than the exhibitionist attains, for the latter fails to secure the consent of the woman nor does he enjoy any intimate contact with her naked body. The difference is connected with the fact that the active flagellant is usually a more virile and normal person than the exhibitionist. In the majority of cases the exhibitionist's sexual impulse is very feeble, and as a rule he is either to some degree a degenerate, or else a person who is suffering from an early stage of general paralysis, dementia, or some other highly enfeebling cause of mental disorganization, such as chronic alcoholism. Sexual feebleness is further indicated by the fact that the individuals selected as witnesses are frequently mere children.
It seems probable that a form of erotic symbolism somewhat similar to exhibitionism is to be found in the rare cases in which sexual gratification is derived from throwing ink, acid or other defiling liquids on women's dresses. Thoinot has recorded a case of this kind (Attentats aux Moeurs, 1898, pp. 484, et seq.). An instructive case has been presented by Moll. In this case a young man of somewhat neuropathic heredity had as a youth of 16 or 17, when romping with his young sister's playfellows, experienced sexual sensations on chancing to see their white underlinen. From that time white underlinen and white dresses became to him a fetich and he was only attracted to women so attired. One day, at the age of 25, when crossing the street in wet weather with a young lady in a white dress, a passing vehicle splashed the dress with mud. This incident caused him strong sexual excitement, and from that time he had the impulse to throw ink, perchloride of iron, etc., on to ladies' white dresses, and sometimes to cut and tear them, sexual excitement and ejaculation taking place every time he effected this. (Moll, "Gutachten über einem Sexual Perversen [Besudelungstrieb]," Zeitschrift für Medizinalbeamte, Heft XIII, 1900). Such a case is of considerable psychological interest. Thoinot considers that in these cases the fleck is a fetich. That is an incorrect account of the matter. In this case the white garments constituted the primary fetich, but that fetich becomes more acutely realized, and at the same time both parties are thrown into an emotional state which to the fetichist becomes a mimicry of coitus, by the act of defilement. We may perhaps connect with this phenomenon the attraction which muddy shoes often exert over the shoe-fetichist, and the curious way in which, as we have seen (p. 18), Restif de la Bretonne associates his love of neatness in women with his attraction to the feet, the part, he remarks, least easy to keep clean.