In the treatment of sexual perversions and anomalies, always a matter of great difficulty, knowledge of mankind, tact, and the finer understanding of the physician for the psychological peculiarities of each individual case, must play a greater part than any definite method of medical treatment. An exact understanding of the true nature of the sexually abnormal personality is the indispensable preliminary to our exercising a favourable influence upon morbid impulses and practices. Unquestionably, the physician must in the first place treat all actual diseases underlying the sexual abnormalities, by means of the physical and pharmacological therapeutical methods open to us in such abundance. Bodily and mental repose is here often the first need we have to satisfy; and for this purpose a change of environment, climatic cures, and such drugs as bromide and camphor may be very useful. But the principal matter must remain psychical, suggestive treatment. The mere discussion of the matter with the physician, the possibility at length of confiding in one capable of taking a thoroughly objective, calm, comprehensive view of the matter, one who by his profession is instructed in all secrets of the human spiritual and impulsive life, and who is aware of all the bodily necessities—this by itself suffices to restore to these unhappy beings, who are tortured by the evil demon of their unhappy impulse, who are often in a state of spiritual despair and hypochondria, to restore to them an inward confidence and a healing repose. This is the great triumph of medical research in this hitherto tabooed, and yet so enormously important, department, which only crass ignorance or evil-minded hypocrisy could designate as “improper” or “unworthy.” We have passed beyond the fruitless and dangerous method of “moral preaching,” to attain a scientific understanding of sexual anomalies; we have exposed the roots of these anomalies, lying deep in the physical and psychical nature of humanity, and we have recognized their connexion with so many other phenomena of the civilization of our time. When I speak of a “treatment” of the common, widely diffused sexual anomalies, it appears to me that that standpoint is the best which regards them as pure diseases of the will, which have been diffused in all times, but have never been more distinctly manifest, and never have possessed more importance, than they do at the present day, when will, energy, has become the most important weapon in the ever more violent struggle for existence. As Napoleon III. said, it is not to the apathetic man, but to the energetic man, that the future belongs, to the man with the will of iron. But nothing paralyzes the will so much as the dominance of blind and, above all, of abnormal, impulses. Unquestionably they conceal within themselves, when frequently gratified, feelings rather of pain than of pleasure, and become the unconquerable source of hypochondria and self-contempt. The stronger the impulse becomes, the longer the habit has lasted of yielding to that impulse, the greater is the loss of will from which the individual suffers. The first and most important task of the physician is, therefore, to weaken the impulse by means of strengthening the will. He must consistently and methodically educate the will, in order to assist the patient to obtain the victory over his impulse. As Goethe says in his “Epimenides”:
“Noch ist vieles zu erfüllen,
Noch ist manches nicht vorbei:
Doch wir alle, durch den Willen
Sind wir schon von Banden frei.”
[“Much there remains to fulfil,
Many things have yet to be endured:
Still, all of us, by the exercise of will
Can to a large extent free ourselves from our fetters.”]
The best way to attain this is to employ personal influence by means of suggestion. We must recommend frequent conversations on the part of the patient with the physician, which can be powerfully supplemented by epistolary communications on the part of the physician, of which an excellent example will be found in the “Psychotherapeutic Letters” by H. Oppenheim (Berlin, 1906).[670] Hypnosis is also of value, although it does not appear to do any more in these cases than is effected by suggestion in the waking state.[671]
It is not so easy to transform a Hamlet into a man of action. We must impose tasks upon the will, tasks both mental and physical; we must regulate the mode of life; we must give to the individuality special prescriptions adapted to the particular case, and we must call to our assistance, whenever advisable, the friends and associates of our patient. The great enemy of the will, alcohol, must be absolutely prohibited; on the other hand, the taste for finer enjoyment and also for easy sports and pastimes must be stimulated.[672] The vita sexualis needs repose in every case, and, above all, masturbation must be energetically resisted. If we succeed in diminishing the intensity of the impulse, and in increasing the power of the will, we have already done much. In isolated cases, we must also always make the attempt to conduct the libido and its activity very gradually into normal channels, perhaps with the assistance of suggestive ideas in coitu, for which, above all, the assistance of the sexual partner is indispensable. Only an experienced physician can here hit the mark.
[638] The Public Prosecutor Amschl reports in the Archives for Criminal Anthropology, 1904, vol. xvi., p. 173, a gross case of this character, in which a peasant affected with venereal ulcers, having been advised that a cure could only be obtained by intercourse with a pure virgin, had sexual intercourse with his own daughter, and—was cured!!
[639] See 1 Kings i. 1-4.
[640] E. Laurent, “Morbid Love: A Psycho-Pathological Study,” pp. 183, 184 (Leipzig, 1895). Cf. also P. Bernard, “Des Attendants à la Pudeur sur les Petites Filles” (Paris, 1886).
[641] A detailed description of this affair is given in my “Sexual Life in England,” vol. i., pp. 350-381 (Charlottenburg, 1901).