[Note 3]: For the difficulties entailed in the attempt to ascertain the proportional number of inverts compare the work of M. Hirschfeld in the Jahrbuch für sexuelle Zwischenstufen, 1904. Cf. also Brill, The Conception of Homosexuality, Journal of the A.M.A., August 2, 1913.
[Note 4]: Such a striving against the compulsion to inversion favors cures by suggestion of psychoanalysis.
[Note 5]: Many have justly emphasized the fact that the autobiographic statements of inverts, as to the time of the appearance of their tendency to inversion, are untrustworthy as they may have repressed from memory any evidences of heterosexual feelings.
Psychoanalysis has confirmed this suspicion in all cases of inversion accessible, and has decidedly changed their anamnesis by filling up the infantile amnesias.
[Note 6]: With what reserve the diagnosis of degeneration should be made and what slight practical significance can be attributed to it can be gathered from the discussions of Moebius (Ueber Entartung; Grenzfragen des Nerven- und Seelenlebens, No. III, 1900). He says: "If we review the wide sphere of degeneration upon which we have here turned some light we can conclude without further ado that it is really of little value to diagnose degeneration."
[Note 7]: We must agree with the spokesman of "Uranism" that some of the most prominent men known have been inverts and perhaps absolute inverts.
[Note 8]: In the conception of inversion the pathological features have been Separated from the anthropological. For this credit is due to I. Bloch (Beiträge zur Ätiologie der Psychopathia Sexualis, 2 Teile, 1902-3), who has also brought into prominence the existence of inversion in the old civilized nations.
[Note 9]: Compare the last detailed discussion of somatic hermaphroditism (Taruffi, Hermaphroditismus und Zeugungsunfähigkeit, German edit. by R. Teuscher, 1903), and the works of Neugebauer in many volumes of the Jahrbuch für sexuelle Zwischenstufen.
[Note 10]: J. Halban, "Die Entstehung der Geschlechtscharaktere," Arch. für Gynäkologie, Bd. 70, 1903. See also there the literature on the subject.
[Note 11]: According to a report in Vol. 6 of the Jahrbuch f. sexuelle Zwischenstufen, E. Gley is supposed to have been the first to mention bisexuality as an explanation of inversion. He published a paper (Les Abérrations de l'instinct Sexuel) in the Revue Philosophique as early as January, 1884. It is moreover noteworthy that the majority of authors who trace the inversion to bisexuality assume this factor not only for the inverts but also for those who have developed normally, and justly interpret the inversion as a result of a disturbance in development. Among these authors are Chevalier (Inversion Sexuelle, 1893), and v. Krafft-Ebing ("Zur Erklärung der konträren Sexualempfindung," Jahrbücher f. Psychiatrie u. Nervenheilkunde, XIII), who states that there are a number of observations "from which at least the virtual and continued existence of this second center (of the underlying sex) results." A Dr. Arduin (Die Frauenfrage und die sexuellen Zwischenstufen, 2d vol. of the Jahrbuch f. sexuelle Zwischenstufen, 1900) states that "in every man there exist male and female elements." See also the same Jahrbuch, Bd. I, 1899 ("Die objektive Diagnose der Homosexualitat," by M. Hirschfeld, pp. 8-9). In the determination of sex, as far as heterosexual persons are [concerned], some are disproportionately more strongly developed than others. G. Herman is firm in his belief "that in every woman there are male, and in every man there are female germs and qualities" (Genesis, das Gesetz der Zeugung, 9 Bd., Libido und Manie, 1903). As recently as 1906 W. Fliess (Der Ablauf des Lebens) has claimed ownership of the idea of bisexuality (in the sense of double sex). Psychoanalytic investigation very strongly opposes the attempt to separate homosexuals from other persons as a group of a special nature. By also studying sexual excitations other than the manifestly open ones it discovers that all men are capable of homosexual object selection and actually accomplish this in the unconscious. Indeed the attachments of libidinous feelings to persons of the same sex play no small rôle as factors in normal psychic life, and as causative factors of disease they play a greater rôle than those belonging to the opposite sex. According to psychoanalysis, it rather seems that it is the independence of the object, selection of the sex of the object, the same free disposal over male and female objects, as observed in childhood, in primitive states and in prehistoric times, which forms the origin from which the normal as well as the inversion types developed, following restrictions in this or that direction. In the psychoanalytic sense the exclusive sexual interest of the man for the woman is also a problem requiring an explanation, and is not something that is self-evident and explainable on the basis of chemical attraction. The determination as to the definite sexual behavior does not occur until after puberty and is the result of a series of as yet not observable factors, some of which are of a constitutional, while some are of an accidental nature. Certainly some of these factors can turn out to be so enormous that by their character they influence the result. In general, however, the multiplicity of the determining factors is reflected by the manifoldness of the outcomes in the manifest sexual behavior of the person. In the inversion types it can be ascertained that they are altogether controlled by an archaic constitution and by primitive psychic mechanisms. The importance of the narcissistic object selection and the clinging to the erotic significance of the anal zone seem to be their most essential characteristics. But one gains nothing by separating the most extreme inversion types from the others on the basis of such constitutional peculiarities. What is found in the latter as seemingly an adequate determinant can also be demonstrated only in lesser force in the constitution of transitional types and in manifestly normal persons. The differences in the results may be of a qualitative nature, but analysis shows that the differences in the determinants are only quantitative. As a remarkable factor among the accidental influences of the object selection, we found the sexual rejection or the early sexual intimidation, and our attention was also called to the fact that the existence of both parents plays an important rôle in the child's life. The disappearance of a strong father in childhood not infrequently favors the inversion. Finally, one might demand that the inversion of the sexual object should notionally be strictly separated from the mixing of the sex characteristics in the subject. A certain amount of independence is unmistakable also in this relation.