Psychopathia sexualis: With especial reference to contrary sexual instinct / A medico-legal study

by R. von Krafft-Ebing

In the course of time the following conditions have become accessory: A prostitute’s shoe that is elegant and chic; starched petticoats, and black hose, if possible. Nothing else in woman interests him. He is absolutely indifferent to the naked foot. Women have not the slightest mental charm for him. He had never had masochistic desires, in the sense of being trod upon. In the course of years his fetichism had gained such power that when he saw a lady on the street, of a certain appearance and with certain shoes, he was so intensely excited that he had to masturbate. Slight pressure on the penis sufficed to induce ejaculation, in his state of severe neurasthenia. Shoes displayed in shops, and, of late, even advertisements of shoes, sufficed to excite him intensely. In states of intense libido he made use of onanism, if shoes were not at his immediate command. The patient quite early recognized the pain and danger of his condition, and, even when he was free from neurasthenic ailments, he was morally very much depressed. He sought help of various physicians. Cold-water cures and hypnotism were unsuccessful. The most celebrated physicians advised him to marry, and assured him that, as soon as he once really loved a girl, he would be free from his fetichism. The patient had no confidence in his future, but he followed the advice of the physicians. He was cruelly disappointed in the hope which the authority of the physicians had aroused in him, though he led to the altar a lady distinguished by both mental and physical charms. The wedding-night was terrible; he felt like a criminal, and did not approach his wife. The next day he saw a prostitute with the required chic. He was weak enough to have intercourse with her in his way. Then he bought a pair of elegant ladies’ boots, and hid them in bed, and, by touching them, while in marital embrace, after a few days, he was able to perform his marital duty. He ejaculated tardily, for he had to force himself to coitus; and, after a few weeks, this artifice failed, because his imagination failed. He felt unspeakably miserable, and would have preferred to make an end of himself. He could no longer satisfy his wife, who was sensual, and much excited by their previous intercourse; and he saw her suffering severely, both mentally and morally. He could not, and would not, disclose his secret. He experienced disgust in marital intercourse; he felt afraid of his wife, and feared the coming of night and being alone with her. He could no longer induce erection.

He again made attempts with prostitutes, and satisfied himself by touching their shoes. Then the puella had to touch his penis, when he would have ejaculation; but, if this did not take place, he would attempt coitus with the lewd woman; without success, however, for ejaculation would occur immediately. In absolute despair, the patient comes for consultation. He deeply regretted that, against his inner conviction, he had followed the unfortunate advice of the physicians, and made a virtuous wife unhappy, having deeply injured her, both mentally and morally. Could he answer God for continuing such a marriage? Even if he were to discover himself to his wife, and she were to do everything for him, it would not help him; for the familiar perfume of the demi-monde was also necessary.

Aside from his mental pain, this unfortunate man presented no remarkable symptoms. Genitals perfectly normal. Prostate somewhat enlarged. He complained that he was so under the domination of his boot-ideas that he would even blush when boots were talked about. His whole imagination was given up to such ideas. When he was on his estate, he often suddenly had to go a distance of ten miles to the city, to satisfy his fetichism with shoe-stores or with puellis.

This pitiable man could not bring himself to take treatment; for his faith in physicians had been greatly shaken. An attempt to ascertain whether hypnosis and a removal of the fetichistic association by this means, were possible, increased the mental excitement of the unfortunate man, who was exclusively controlled by the thought that he had made his wife unhappy.

Case 88. X., aged 24, from a badly-tainted family (mother’s brother and grandfather insane, one sister epileptic, another sister subject to migraine, parents of excitable temperament). During dentition he had had convulsions. At the age of seven he was taught to masturbate by a servant-girl. X. first experienced pleasure in these manipulations when this girl occasionally stroked his penis with her foot with her shoe on. Thus, in the predisposed boy, an association was established, as a result of which, from that time on, merely the sight of women’s shoes, and, finally, merely the idea of them, sufficed to induce sexual excitement and erection. He now masturbated while looking at women’s shoes, or while calling them up in imagination. At school the teacher’s shoes excited him intensely, and in general he was affected by shoes that were partly concealed by female garments. One day he could not keep from grasping the teacher’s shoes,—an act that caused him great sexual excitement. In spite of punishment he could not keep from performing this act repeatedly. Finally, it was recognized that there must be an abnormal motive in play, and he was sent to a male teacher. He then reveled in the memory of shoe-scenes with his former school-mistress, and thus had erections, orgasm, and, after his fourteenth year, ejaculation. At the same time, he masturbated while thinking of a woman’s shoe. One day the thought came to him to increase his pleasure by using such a shoe for masturbation. Thereafter he frequently took shoes secretly, and used them for that purpose.

Nothing else in a woman could excite him; the thought of coitus filled him with horror. Men did not interest him in any way. At the age of eighteen he opened a general store, and, among other things handled ladies’ shoes. He was excited sexually by fitting shoes for his female patrons, or by manipulating shoes that they had worn. One day, while doing this, he had an epileptic attack, and, soon after, another, while practicing onanism in his customary way. Then he recognized, for the first time, the injury to health caused by his sexual practices. He tried to overcome his onanism, sold no more shoes, and strove to free himself from the abnormal association between women’s shoes and the sexual function. Then frequent pollutions, with erotic dreams about shoes, occurred, and the epileptic attacks continued. Though devoid of the slightest feeling for the female sex, he determined on marriage, which seemed to him to be the only remedy.

He married a pretty young lady. In spite of lively erections when he thought of his wife’s shoes, in attempts at cohabitation he was absolutely impotent; for his distaste for coitus, and for close intercourse in general, was far more powerful than the influence of the shoe-idea, which induced sexual excitement. On account of his impotence, the patient applied to Dr. Hammond, who treated his epilepsy with bromides, and advised him to hang a shoe up over his bed, and look at it fixedly during coitus, at the same time imagining his wife to be a shoe. The patient became free from epileptic attacks, and potent so that he could have coitus about once a week. Too, his sexual excitation by women’s shoes grew less and less. (Hammond, “Sexual Impotence.”)

Following these two cases of shoe-fetichism, which apparently depend merely upon accidental association, and are not favored by any inner relation between the things themselves, is given the very strange case of a fetichist who was excited sexually only by the idea of a night-cap on the head of an ugly old woman; also a case arising apparently from merely accidental association:—

Case 89. L., aged 37, clerk, from tainted family, had his first erection at five years, when he saw his bed-fellow—an aged relative—put on a night-cap. The same thing occurred later, when he saw an old servant put on her night-cap. Later, simply the idea of an old, ugly woman’s head, covered with a night-cap, was sufficient to cause an erection. Simply the sight of a cap, or of a naked woman or man, made no impression, but the mere touch of a night-cap induced erection, and sometimes even ejaculation. L. was not a masturbator, and had never been sexually active until his thirty-second year, when he married a young girl with whom he had fallen in love. On his marriage-night he remained cold until, from necessity, he brought to his aid the memory-picture of an ugly woman’s head with a night-cap. Coitus was immediately successful. Thereafter it was always necessary for him to use this means. Since childhood he had been subject to occasional attacks of depression, with tendency to suicide, and now and then to frightful hallucinations at night. When looking out of windows, he became dizzy and anxious. He was a perverse, peculiar, and easily embarrassed man, of bad mental constitution. (Charcot and Magnan, Arch. de neurol., 1882, No. 12.)

In this very peculiar case, the simultaneous coincidence of the first sexual excitation and an absolutely heterogeneous impression seems to have determined the association.