Psychopathia sexualis: With especial reference to contrary sexual instinct
4. Mr. v. H. is also physically ill. He presents signs of slight
5145 words | Chapter 35
anæmia and of neurasthenia spinalis. A rational regulation of his
manner of life and a tonic regimen, and, if possible,
hydro-therapeutic treatment, seem necessary. The suspicion that this
trouble has its origin in early masturbation should be entertained,
and the possibility of the existence of spermatorrhœa, that is of
importance etiologically and therapeutically, lies near. (Personal
case. _Zeitschr. f. Psychiatrie._)
Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on
account of severe spinal irritation and obstinate sleeplessness, in
combating which she had become addicted to morphine and chloral. Her
mother and sister were nervous sufferers, but the rest of the family
were healthy. The trouble dated from a fall on her back in 1872, at
which time the patient was terribly frightened, though, when a girl,
she had been subject to muscular cramps and hysterical symptoms.
Following this shock, a neurasthenic and hysterical neurosis
developed, with predominating spinal irritation and sleeplessness.
Episodically, hysterical paraplegia, lasting as long as eight months,
and hysterical hallucinatory delirium, with convulsive attacks,
occurred. In the course of this, symptoms of morphinism were added. A
stay of some months in the hospital relieved the latter, and
considerably improved the neurasthenic neurosis, in the treatment of
which general faradization exerted a remarkably favorable influence.
Even at the first meeting, the patient produced a remarkable
impression by reason of her attire, features, and conduct. She wore a
gentleman’s hat, her hair closely cut, eye-glasses, a gentleman’s
cravat, a coat-like outer garment of masculine cut that reached well
down over her gown, and boots with high heels. She had coarse,
somewhat masculine features; a harsh, deep voice; and made rather the
impression of a man in female attire than that of a lady, if one but
overlooked the bosom and the decidedly feminine form of the pelvis.
During the long time that she was observed, there were never signs of
erotocism. When questioned concerning her attire, she would only
respond that the style she chose suited her better. Gradually it was
ascertained from her that, even when she was a small girl, she had had
a preference for horses and masculine pursuits, and never any interest
in feminine occupations. Later she developed a particular pleasure in
reading, and prepared herself to be a teacher. Dancing had never
pleased her; it had always seemed silly to her. Too, the _ballet_ had
never interested her. Her greatest pleasure had always been in the
circus. Until her sickness, in 1872, she had neither had inclination
for persons of the opposite nor for those of her own sex. From that
time she had, what was remarkable to herself, a peculiar friendship
for females, particularly for young ladies; and she had a desire, and
satisfied it, to wear hats and coats of masculine style. Since 1869,
besides, she had worn her hair short, and parted it on the side, as
men do. She asserts that she was never sensually excited in the
company of men, but that her friendship and self-sacrifice for
sympathetic ladies was unbounded; while from that time she also
experienced repugnance for gentlemen and their society.
Her relatives report that, before 1872, the patient had a proposal of
marriage, which she refused; and that when she returned from a sojourn
at a watering-place, in 1874, she was sexually changed, and
occasionally showed that she did not regard herself as a female.
Since that time she would associate only with ladies, and has had a
kind of love-relation with one or another, and made remarks which
indicated that she looked upon herself as a man. This predilection for
women was decidedly more than mere friendship, since it expressed
itself in tears, jealousy, etc.
When, in 1874, she was stopping at a watering-place, a young lady, who
took her for a man in disguise, fell in love with her. When this lady
married, later, the patient was for a long time depressed, and spoke
of unfaithfulness. Moreover, since her sickness, her relatives were
struck by her desire for masculine attire, her masculine conduct, and
disinclination for feminine pursuits; while previously, at least
sexually, she had presented nothing unusual.
Further investigations showed that the patient had a love-relation,
which was not purely platonic, with the lady described in Case 118;
and that she wrote her affectionate letters like those of a lover to
his beloved. In 1887 I again saw the patient in a sanitarium, where
she had been placed on account of hystero-epileptic attacks, spinal
irritation, and morphinism. The contrary sexual feeling existed
unchanged, and only by the most careful watching was the patient kept
from improper advances toward her fellow-patients.
Her condition remained quite unchanged until 1889. Then the patient
began to fail, and she died of “exhaustion,” in August, 1889. The
autopsy showed, in the vegetative organs, amyloid degeneration of the
kidneys, fibroma of the uterus, and cyst of the left ovary. The
frontal bone was much thickened, uneven on the inner surface, with
numerous exostoses; dura adherent to vault of cranium. Long diameter
of skull, 175 millimetres; lateral diameter, 148 millimetres; weight
of the œdematous, but not atrophied, brain, 1175 grammes. The meninges
delicate, easily removed. Cortex pale. Convolutions broad, not
numerous, regularly arranged. Nothing abnormal in cerebellum and great
ganglia.
Case 131. _Gynandry._[117] History: On November 4, 1889, the
step-father of a certain Count Sandor V. complained that the latter
had swindled him out of 800f., under the pretense of requiring a bond
as secretary of a stock company. It was ascertained that Sandor had
entered into matrimonial contracts and escaped from the nuptials in
the spring of 1889; and, more than this, that this ostensible Count
Sandor was no man at all, but a woman in male attire,—Sarolta
(Charlotte), Countess V.
S. was arrested, and, on account of deception and forgery of public
documents, brought to examination. At the first hearing S. confessed
that she was born on Sept. 6, 1866; that she was a female, Catholic,
single, and worked as an authoress under the name of Count Sandor V.
From the autobiography of this man-woman I have gleaned the following
remarkable facts that have been independently confirmed:—
S. comes of an ancient, noble, and highly-respected family of Hungary,
in which there have been eccentricity and family peculiarities. A
sister of the maternal grandmother was hysterical, a somnambulist, and
lay seventeen years in bed, on account of fancied paralysis. A second
great-aunt spent seven years in bed, on account of a fancied fatal
illness, and at the same time gave balls. A third had the whim that a
certain table in her _salon_ was bewitched. If anything were laid on
this table, she would become greatly excited and cry, “Bewitched!
bewitched!” and run with the object into a room which she called the
“Black Chamber,” and the key of which she never let out of her hands.
After the death of this lady, there were found in this chamber a
number of shawls, ornaments, bank-notes, etc. A fourth great-aunt,
during two years, did not leave her room, and neither washed herself
nor combed her hair; then she again made her appearance. All these
ladies were, nevertheless, intellectual, finely educated, and amiable.
S.’s mother was nervous, and could not bear the light of the moon.
From her father’s family it is said she had a trace too much. One line
of the family gave itself up almost entirely to spiritualism. Two
blood-relations on the father’s side shot themselves. The majority of
her male relatives are unusually talented; the females are decidedly
narrow and domestic. S.’s father had a high position, which, however,
on account of his eccentricity and extravagance (he wasted over a
million and a half), he lost.
Among many foolish things that her father encouraged in her was the
fact that he brought her up as a boy, called her Sandor, allowed her
to ride, drive, and hunt, admiring her muscular energy.
On the other hand, this foolish father allowed his second son to go
about in female attire, and had him brought up as a girl. This farce
ceased in his fifteenth year, when the son was sent to a higher
school.
Sarolta-Sandor remained under her father’s influence till her twelfth
year, and then came under the care of her eccentric maternal
grandmother, in Dresden, by whom, when the masculine play became too
obvious, she was placed in an Institute, and made to wear female
attire.
At thirteen she had a love-relation with an English girl, to whom she
represented herself as a boy, and ran away with her.
Sarolta returned to her mother, who, however, could do nothing, and
was compelled to allow her daughter to again become Sandor, wear male
clothes, and, at least once a year, to fall in love with persons of
her own sex.
At the same time, S. received a careful education, and made long
journeys with her father,—of course, always as a young gentleman. She
early became independent, and visited _cafés_, even those of doubtful
character, and, indeed, boasted one day that in a brothel she had had
a girl sitting on each knee. S. was often intoxicated, had a passion
for masculine sports, and was a very skillful fencer.
She felt herself drawn particularly toward actresses, or others of
similar position, and, if possible, toward those who were not very
young. She asserts that she never had any inclination for a young man,
and that she has felt, from year to year, an increasing dislike for
young men.
“I preferred to go into the society of ladies with ugly, ill-favored
men, so that none of them could put me in the shade. If I noticed that
any of the men awakened the sympathies of the ladies, I felt jealous.
I preferred ladies who were bright and pretty; I could not endure them
if they were fat or much inclined toward men. It delighted me if the
passion of a lady was disclosed under a poetic veil. All immodesty in
a woman was disgusting to me. I had an indescribable aversion for
female attire,—indeed, for everything feminine,—but only in as far as
it concerned me; for, on the other hand, I was all enthusiasm for the
beautiful sex.”
During the last ten years S. had lived almost constantly away from her
relatives, in the guise of a man. She had had many _liaisons_ with
ladies, traveled much, spent much, and made debts.
At the same time, she carried on literary work, and was a valued
collaborator on two noted journals of the Capital.
Her passion for ladies was very changeable; constancy in love was
entirely wanting.
Only once did such a _liaison_ last three years. It was years before
that S., at Castle G., made the acquaintance of Emma E., who was ten
years older than herself. She fell in love with her, made a
marriage-contract with her, and they lived together, as man and wife,
for three years at the Capital.
A new love, which S. regarded as a fate, caused her to sever her
matrimonial relations with E. The latter would not have it so. Only
with the greatest sacrifice was S. able to purchase her freedom from
E., who, it is reported, still looks upon herself as a divorced wife,
and regards herself as the Countess V.! That S. also had the power to
excite passion in other women is shown by the fact that when she
(before her marriage with E.) had grown tired of a Miss D., after
having spent thousands of guldens on her, she was threatened with
shooting by D. if she should become untrue.
It was in the summer of 1887, while at a watering-place, that S. made
the acquaintance of a distinguished official’s family. Immediately she
fell in love with the daughter, Marie, and her love was returned.
Her mother and cousin tried in vain to break up this affair. During
the winter, the lovers corresponded zealously. In April, 1888, Count
S. paid her a visit, and in May, 1889, attained her wish; in that
Marie—who, in the meantime, had given up a position as teacher—became
her bride in the presence of a friend of her lover, the ceremony being
performed in an arbor, by a false priest, in Hungary. S., with her
friend, forged the marriage-certificate. The pair lived happily, and,
without the interference of the step-father, this false marriage,
probably, would have lasted much longer. It is remarkable that, during
the comparatively long existence of the relation, S. was able to
deceive completely the family of her bride with regard to her true
sex.
S. was a passionate smoker, and in all respects her tastes and
passions were masculine. Her letters and even legal documents reached
her under the address of “Count S.” She often spoke of having to
drill. From remarks of the father-in-law, it seems that S. (and she
afterward confessed it) knew how to imitate a scrotum with
handkerchiefs or gloves stuffed in the trousers. The father-in-law
also, on one occasion, noticed something like an erected member on his
future son-in-law (probably a priapus). She also occasionally remarked
that she was obliged to wear a suspensory bandage while riding. The
fact is, S. wore a bandage around the body, possibly as a means of
retaining a priapus.
Though S. often had herself shaved _pro forma_, the servants in the
hotel where she lived were convinced that she was a woman, because the
chambermaids found traces of menstrual blood on her linen (which S.
explained, however, as hæmorrhoidal); and, on the occasion of a bath
which S. was accustomed to take, they claimed to have convinced
themselves of her real sex by looking through the key-hole.
The family of Marie make it seem probable that she for a long time was
deceived with regard to the true sex of her false bridegroom. The
following passage in a letter from Marie to S., August 26, 1889,
speaks in favor of the incredible simplicity and innocence of this
unfortunate girl: “I don’t like children any more, but if I had a
little Bezerl or Patscherl by my Sandi,—ah, what happiness, Sandi
mine!”
A large number of manuscripts allow conclusions to be drawn concerning
S.’s mental individuality. The chirography possesses the character of
firmness and certainty. The characters are genuinely masculine. The
same peculiarities repeat themselves everywhere in their
contents,—wild, unbridled passion; hatred and resistance to all that
opposes the heart thirsting for love; poetical love, which is not
marred by one ignoble blot; enthusiasm for the beautiful and noble;
appreciation of science and the arts.
Her writings betray a wonderfully wide range of reading in classics of
all languages, in citations from poets and prose writers of all lands.
The evidence of those qualified to judge literary work shows that S.’s
poetical and literary ability is by no means small. The letters and
writings concerning the relation with Marie are psychologically worthy
of notice.
S. speaks of the happiness there was for her when by M.’s side, and
expresses boundless longing to see her beloved, if only for a moment.
After such a happiness, she could have but one wish,—to exchange her
cell for the grave. The bitterest thing was the knowledge that now
Marie, too, hated her. Hot tears, enough to drown herself in, she had
shed over her lost happiness. Whole quires of paper are given up to
the apotheosis of this love, and reminiscences of the time of the
first love and acquaintance.
S. complained of her heart, that would allow no reason to direct it;
she expressed emotions which were such as only could be felt,—not
simulated. Then, again, there were outbreaks of most silly passion,
with the declaration that she could not live without Marie. “Thy dear,
sweet voice; the voice whose tone perchance would raise me from the
dead; that has been for me like the warm breath of Paradise! Thy
presence alone were enough to alleviate my mental and moral anguish.
It was a magnetic stream; it was a peculiar power your being exercised
over mine, which I cannot quite define; and, therefore, I cling to
that ever-true definition: I love you because I love you. In the night
of sorrow I had but one star,—the star of Marie’s love. That star has
lost its light; now there remains but its shimmer,—the sweet, sad
memory which even lights with its soft ray the deepening night of
death,—a ray of hope.”
This writing ends with the apostrophe: “Gentlemen, you learned in the
law, psychologists and pathologists, do me justice! Love led me to
take the step I took; all my deeds were conditioned by it. God put it
in my heart.
“If He created me so, and not otherwise, am I then guilty; or is it
the eternal, incomprehensible way of fate? I relied on God, that one
day my emancipation would come; for my thought was only love itself,
which is the foundation, the guiding principle, of His teaching and
His kingdom.
“O God, Thou All-pitying, Almighty One! Thou seest my distress; Thou
knowest how I suffer. Incline Thyself to me; extend Thy helping hand
to me, deserted by all the world. Only God is just. How beautifully
does Victor Hugo describe this in his ‘Legendes du Siècle’! How sad do
Mendelssohn’s words sound to me: ‘Nightly in dreams I see thee’!”
Though S. knew that none of her writings reached her lover, she did
not grow tired writing of her pain and delight in love, in page after
page of deification of Marie. And to induce one more pure flood of
tears, on one still, clear summer evening, when the lake was aglow
with the setting sun like molten gold, and the bells of St. Anna and
Maria-Wörth, blending in harmonious melancholy, gave tidings of rest
and peace, she wrote: “For that poor soul, for this poor heart that
beat for thee till the last breath.”
_Personal Examination:_ The first meeting which the experts had with
S. was, in a measure, a time of embarrassment to both sides; for them,
because perhaps S.’s somewhat dazzling and forced masculine carriage
impressed them; for her, because she thought she was to be marked with
the stigma of moral insanity. She had a pleasant and intelligent face,
which, in spite of a certain delicacy of features and diminutiveness
of all its parts, gave a decidedly masculine impression, had it not
been for the absence of a moustache. It was even difficult for the
experts to realize that they were concerned with a woman, despite the
fact of female attire and constant association; while, on the other
hand, intercourse with the man Sandor was much more free, natural, and
apparently correct. The culprit also felt this. She immediately became
more open, more communicative, more free, as soon as she was treated
like a man.
In spite of her inclination for the female sex, which had been present
from her earliest years, she asserts that in her thirteenth year she
first felt a trace of sexual feeling, which expressed itself in
kisses, embraces, and caresses, with sensual pleasure, and this on the
occasion of her elopement with the red-haired English girl from the
Dresden Institute. At that time feminine forms exclusively appeared to
her in dream-pictures, and ever since, in sensual dreams, she has felt
herself in the situation of a man, and occasionally, also, at such
times, experienced ejaculation.
She knows nothing of solitary or mutual onanism. Such a thing seemed
very disgusting to her, and not conducive to manliness. She had, also,
never allowed herself to be touched ad genitalia by others, because it
would have revealed her great secret. The menses began at seventeen,
but were always scanty, and without pain. It was plain to be seen that
S. had a horror of speaking of menstruation; that it was a thing
repugnant to her masculine consciousness and feeling. She recognized
the abnormality of her sexual inclinations, but had no desire to have
them changed, since in this perverse feeling she felt both well and
happy. The idea of sexual intercourse with men disgusted her, and she
also thought it would be impossible.
Her modesty was so great that she would prefer to sleep among men
rather than among women. Thus, when it was necessary for her to answer
the calls of nature or to change her linen, it was necessary for her
to ask her companion in the cell to turn her face to the window, that
she might not see her.
When occasionally S. came in contact with this companion,—a woman from
the lower walks of life,—she experienced a sexual excitement that made
her blush. Indeed, without being asked, S. related that she was
overcome with actual fear when, in her cell, she was compelled to
force herself into the unusual female attire. Her only comfort was,
that she was at least allowed to keep a shirt. Remarkable, and what
also speaks for the significance of olfactory sensations in her vita
sexualis, is her statement that, on the occasions of Marie’s absence,
she had sought those places on which Marie’s head was accustomed to
repose, and smelled of them, in order to experience the delight of
inhaling the odor of her hair. Among women, those who are beautiful,
or voluptuous, or quite young do not particularly interest her. The
physical charms of women she makes subordinate. As by magnetic
attraction, she feels herself drawn to those between twenty-four and
thirty. She found her sexual satisfaction exclusively in corpora
feminæ (never in her own person), in the form of manustupration of the
beloved woman, or cunnilingus. Occasionally she availed herself of a
stocking stuffed with oakum as a _priapus_. These admissions were made
only unwillingly by S., and with apparent shame; just as in her
writings, immodesty or cynicism are never found.
She is religious, has a lively interest in all that is noble and
beautiful,—men excepted,—and is very sensitive to the opinion others
may entertain of her morality.
She deeply regrets that in her passion she made Marie unhappy, and
regards her sexual feelings as perverse, and such a love of one woman
for another, among normal individuals, as morally reprehensible. She
has great literary talent and an extraordinary memory. Her only
weakness is her great frivolity and her incapability to manage money
and property reasonably. But she is conscious of this weakness, and
does not care to talk about it.
She is 153 centimetres tall, of delicate skeleton, thin, but
remarkably muscular on the breast and thighs. Her gait in female
attire is awkward. Her movements are powerful, not unpleasing, though
they are somewhat masculine, and lacking in grace. She greets one with
a firm pressure of the hand. Her whole carriage is decided, firm, and
somewhat self-conscious. Her glance is intelligent; mien somewhat
diffident. Feet and hands remarkably small, having remained in an
infantile stage of development. Extensor surfaces of the extremities
remarkably well covered with hair, while there is not the slightest
trace of beard, in spite of all shaving experiments. The hips do not
correspond in any way with those of a female. Waist is wanting. The
pelvis is so slim, and so little prominent, that a line drawn from the
axilla to the corresponding knee is straight,—not curved inward by a
waist, or outward by the pelvis. The skull is slightly oxycephalic,
and in all its measurements falls below the average of the female
skull by at least one centimetre.
The circumference of the head is 52 centimetres; the occipital
half-circumference, 24 centimetres; the line from ear to ear, over the
vertex, 23 centimetres; the anterior half-circumference, 28.5
centimetres; the line from glabella to occiput, 30 centimetres; the
ear-chin line, 26.5 centimetres; long diameter, 17 centimetres;
greatest lateral diameter, 13 centimetres; diameter at auditory meati,
12 centimetres; zygomatic diameter, 11.2 centimetres. The upper jaw
projects strikingly, its alveolar process projecting beyond the under
jaw about 0.5 centimetre. The position of the teeth is not fully
normal; the right upper canine has not developed. Mouth remarkably
small. Ears prominent; lobes not differentiated, passing over into the
skin of the cheek. Hard palate narrow and high; voice rough and deep;
mammæ fairly developed, soft, and without secretion. Mons veneris
covered with thick, dark hair. Genitals completely feminine, without
trace of hermaphroditic appearance, but at the stage of development of
those of a ten-year-old girl. The labia majora touch each other almost
completely; labia minora have a cock’s-comb-like form, and project
under the labia majora. The clitoris is small, and very sensitive.
Frenulum delicate; perineum very narrow; introitus vaginæ narrow;
mucous membrane normal. Hymen wanting (probably congenitally);
likewise, the carunculæ myrtiformes. Vagina so narrow that the
insertion of a membrum virile would be impossible, and it is also very
sensitive; certainly coitus had not taken place. Uterus is felt,
through the rectum, to be about the size of a walnut, immovable, and
retroflected.
The pelvis appears generally narrowed (dwarf-pelvis), and of decidedly
masculine type. The distance between anterior superior spines is 22.5
centimetres (instead of 26.3 centimetres). Distance between the crests
of the ilii, 26.5 centimetres (instead of 29.3 centimetres); between
the trochanters, 27.7 centimetres (31); the external conjugate
diameter, 17.2 centimetres (19 to 20); therefore, presumably, the
internal conjugate would be 7.7 centimetres (10.8). On account of
narrowness of the pelvis, the direction of the thighs is not
convergent, as in a woman, but straight.
The opinion given showed that in S. there was a congenitally abnormal
inversion of the sexual instinct, which, indeed, expressed itself,
anthropologically, in anomalies of development of the body, depending
upon great hereditary taint; further, that the criminal acts of S. had
their foundation in her abnormal and irresistible sexuality.
S.’s characteristic expressions—“God put love in my heart. If He
created me so, and not otherwise, am I, then, guilty; or is it the
eternal, incomprehensible way of fate?”—are really justified.
The court granted pardon. The “countess in male attire,” as she was
called in the newspapers, returned to her home, and again gave herself
out as Count Sandor. Her only distress is her lost happiness with her
beloved Marie.
A married woman, in Brandon, Wisconsin, whose case is reported by Dr.
Kiernan (_The Medical Standard_, 1888, November and December), was
more fortunate. She eloped, in 1883, with a young girl, married her,
and lived with her as husband undisturbed.
An interesting “historical” example of androgyny is a case reported by
Spitzka (_Chicago Medical Review_, August 20, 1881). It was that of
Lord Cornbury, Governor of New York, who lived in the reign of Queen
Anne. He was apparently affected with moral insanity; was terribly
licentious, and, in spite of his high position, could not keep himself
from going about in the streets in female attire, coquetting with all
the allurements of a prostitute.
In a picture of him that has been preserved, his narrow brow,
asymmetrical face, feminine features, and sensual mouth at once
attract attention. It is certain that he never actually regarded
himself as a woman.
* * * * *
Moreover, in individuals afflicted with contrary sexual instinct, in
themselves, the perverse sexual feeling and inclination may be
complicated with other perverse manifestations. Thus here, with
reference to the activity of the instinct, there may be acts quite
analogous to acts indulged in by individuals in perverse satisfaction of
the instinct, but who, at the same time, have a natural inclination
toward persons of the opposite sex.
Owing to the circumstance that abnormally increased sexuality is almost
a regular accompaniment of contrary sexual feeling, acts of lustful
cruelty in the satisfaction of libido are easily possible. A remarkable
example of this is the case of Zastrow (Casper-Liman, 7. Auflage, Bd. i,
p. 190; ii, p. 487), who bit one of his victims (a boy), tore his
prepuce, slit the anus, and strangled the child.
Z. came of a psychopathic grandfather and melancholic mother. His
brother indulged in abnormal sexual pleasures, and committed suicide.
Z. was a congenital urning, and in habitus and occupation masculine.
There was phimosis. Mentally, he was a weak, perverse, unsocial man.
He had horror feminæ, and, in his dreams, he felt himself like a woman
toward a man. He was painfully conscious of his want of normal sexual
feeling and his perverse instinct, and sought satisfaction in mutual
onanism, with frequent desire for pederasty.
Similar sadistic feelings of this kind, in those afflicted with contrary
sexual instinct, are found in some of the foregoing histories (comp.
Cases 107 and 108 of this edition, and Case 96 of the sixth edition).
But masochism also occurs (comp. Case 43, sixth edition; Cases 111 and
114 of this edition; and Case 3, in the first edition of “Neue
Forschungen”).
As examples of perverse sexual satisfaction dependent on contrary
sexual instinct, may be mentioned the Greek, who, as Athenäus reports,
was in love with a statue of Cupid, and defiled it, in the temple of
Delphi; and besides the monstrous cases reported by Tardieu
(“Attentats,” p. 272), the terrible one reported by Lombroso (“L’uomo
delinquente,” p. 200), of a certain Artusio, who wounded a boy in the
abdomen, and abused him sexually _by means of the incisions_.
Cases 86, 110, and 111, also, show that fetichism may also occur with
contrary sexual instinct.
DIAGNOSIS, PROGNOSIS, AND THERAPY OF CONTRARY SEXUAL INSTINCT.
While up to this time contrary sexual instinct has had but an
anthropological, clinical, and forensic interest for science, now, as a
result of the latest investigations, there is some thought of therapy in
this incurable condition, which so heavily burdens its victims,
socially, morally, and mentally.
A preparatory step for the application of therapeutic measures is the
exact differentiation of the acquired from the congenital cases; and
among the latter, again, the assignment of the concrete case to its
proper position in the categories that have been established
empirically.
The diagnostic differentiation of the acquired from the congenital
condition is made without difficulty in the early stages of the anomaly.
If sexual inversion has already taken place, then the history of the
development of the case will throw light upon it.
The important decision, prognostically, as to whether the contrary
sexual instinct is congenital or acquired, can only be made in such
cases by means of the most minute details of the history.
The establishment of the fact that contrary sexual instinct existed
before indulgence in masturbation is of great importance with reference
to deciding whether the anomaly is congenital or not. In this, however,
a difficulty arises, owing to the possibility of imperfect localization
of past events (illusions of memory).
For the presumption of acquired contrary sexual instinct, it is
important to prove the existence of hetero-sexual instinct before the
beginning of solitary or mutual onanism.
In general, the acquired cases are characterized in that:—
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