3. Mental treatment, in the sense of combating homo-sexual, and

encouraging hetero-sexual, feelings and impulses. The most important part of the treatment lies in fulfilling the third indication, particularly with reference to onanism. Only in very few cases, where acquired contrary sexual instinct has not progressed far, can the fulfillment of 1 and 2 be sufficient, as the following case, fully reported by the author in the _Irrenfreund_, 1884, No. 1, proves:— Case 132. Count Z., aged 51, of psychopathic mother, was early sent to a military school, and there was taught onanism. He developed well, and had normal sexual feelings, but, as a result of masturbation, he became somewhat neurasthenic in his seventeenth year. He enjoyed intercourse with women, was married at twenty-five, but after a year more became neurasthenic, and absolutely lost his inclination for women. In its place came contrary sexual instinct. Involved in an accusation for high treason, he was sent to prison for two years, and then to Siberia for five years. In these seven years, under the influence of continued masturbation, neurasthenia and contrary sexual instinct constantly increased. With his freedom restored at the age of thirty-five, the patient began to visit all kinds of health-resorts on account of his great neurasthenia; and this has since been his occupation. In all these years his abnormal sexual feeling has not changed in any way. For the most part, he lived away from his wife, whom, it is true, he esteemed for her mental qualities; though he avoided her, as he did every other woman. His contrary sexual feeling is purely platonic. “Friendship,” sweet embraces, and kisses sufficed him. Pollutions, which occasionally occurred, were induced by lascivious dreams which had for subject persons of his own sex. Also, during the day, the most beautiful woman had no charm for him, while simply the sight of handsome men induced erection and ejaculation. Only athletes and male dancers in the circus and _ballet_ interested him. At times of greater excitability, even masculine statues gave him erections. Now and again he resumed his old vice of masturbation. This man of æsthetic culture had a horror of pederasty. He felt, always, that his perverse sexual feeling was something abnormal, without, however, in his apparently much weakened libido and virility, feeling unhappy. The examination gave the usual findings of neurasthenia. Development, manner, and attire presented nothing remarkable. Electrical massage was unusually successful. After a few sittings the patient was mentally and physically much better. After twenty sittings libido was again awakened, not in the same way, but normally, as the patient had felt until his twenty-fifth year. Lascivious dreams were concerned only with women; and one day the patient joyfully gave the information that he had had coitus, and that he had had the same natural feeling in it that he had had twenty-six years before. He then began to live with his wife again, and hoped that he was lastingly freed from neurasthenia and contrary sexual instinct. His hope was fulfilled for the six years during which I was able to keep the patient under observation. As a rule, physical treatment, even though it be re-inforced morally by good advice with reference to the avoidance of masturbation, the repression of homo-sexual feelings and impulses, and the encouragement of hetero-sexual desires, will not prove sufficient, even in cases of acquired contrary sexual instinct. Here a method of mental treatment—hypnotic suggestion—is all that can bring benefit. The following case is interesting; and it is an example of successful auto-suggestion that gives encouragement for the milder forms of the anomaly:— Case 133. _Autobiography of a Psychical Hermaphrodite. Successful Struggle against Homo-sexual Inclinations made by the Patient himself._—“My father once had a stroke, but has recovered save for paralysis of the face. My mother was very anæmic and melancholic. Both suffered severely with hæmorrhoids, and my father ascribed to this trouble the lumbar pain with which he suffered from time to time after his marriage. “I am, if I may so express myself, a passive character. When a child, I indulged in all kinds of fancies, religious as well as others. I suffered with incontinence of urine, and it is said that in sleep I handled my genitals, so that my father fastened my hands to the bed! (I was then a mere child, and had not masturbated.) I was always very shy and embarrassed in social intercourse. When about fourteen or fifteen years old, I was seduced into onanism. The impulse and desire for women, occurring in connection with the awakening sexual feeling, were, in reality, only of a platonic nature; I was also without the society of ladies. When about eighteen, I attempted to satisfy my sexual desire in the natural way, more in obedience to a feeling of curiosity than from inner longing. Since that time, without having experienced any real inclination for women, as often as possible I have satisfied my desire by means of sexual intercourse. “Soon after puberty I became very anæmic, and appeared much older than I really was. Then came melancholic and peculiar ideas. It was a delight to me to fancy myself humiliated in the extreme. It may be of interest to add that, at that time, I was troubled with religious doubts, and only later found the courage to rise above religions. I fell in love with young men. At first I opposed these ideas; later they became so powerful that I became a genuine urning. Women seemed to me to be human beings of the second class. I was in a state of despair. My sickened soul was filled with tædium vitæ and thoughts inimical to humanity. One day I read: ‘What will it come to?’ And ere I knew it, I was a socialist; but an ideal one. Life again had value for me, for I had an ideal,—the joyous struggle for the social elevation of the proletariat. This caused a powerful revolution in me. As in my best years (from the age of sixteen to seventeen), I took interest in art, particularly in dramatic art. I am, at the present time, writing a play and a story, and I am occupied with the grandest thoughts. I read a remark of Schlegel’s concerning Sophocles, who was indebted to his physical exercise for his energy and creative power, and to music for his artistic proportions. In another place I read: ‘The dramatist must, above all things, be mentally intact.’ This depressed me; for my contrary sexual feelings could not arise in a perfectly normal mind. “I thought of having myself treated hypnotically; but shame held me back. Then I said to myself that I was a weakling, indeed, to have so little confidence in myself, and began in earnest to combat my abnormal desires. At the same time, I struggled against my nervousness by leading the proper kind of a life. I rowed, fenced, and was much in the open air; and I was delighted when, at last, I awoke and seemed to be an entirely different man. When I thought of the time from my twentieth to my twenty-sixth year, it seemed to me that, during those years, a strange and depressive being had been dwelling within me. “I was astonished that the handsomest rider or the trimmest waiter excited in me almost no interest; even the muscular masons had no effect on me. I was disgusted when I thought that, at one time, such men had seemed handsome to me. My self-respect increased; I am good-natured, but my character is entirely active. Since my twentieth year my appearance has steadily improved. My appearance now corresponds perfectly with my years. There were recurrences of my abnormal inclinations, to be sure; but I struggled against them energetically. I satisfy my libido only by means of natural intercourse, and I hope that, by continuing to lead a proper life, my pleasure in natural coitus will increase.” As a rule, only suggestion coming from a second person, and that by means of hypnosis, promises any success. In such cases, the object of post-hypnotic suggestion is to remove the impulse to masturbation and homo-sexual feelings and impulses, and to encourage hetero-sexual feelings with a sense of virility. A prerequisite is, of course, the possibility to induce hypnosis of sufficient intensity. It is, unfortunately, in these very cases of neurasthenia that this is impossible, since they are often excited, embarrassed, and in no condition to concentrate their thoughts. Thus, in a case reported by me in the _International. Centralblatt für die Physiologie und Pathologie der Harn- und Sexualorgane_, Bd. i, Heft 2, p. 58, it was impossible for me to induce hypnosis, though the patient desired it, and did everything to make it successful. By reason of the great benefit that can be given to such unfortunates, and with Ladame’s case in view (_v. infra_), in the future, in all such cases, everything should be done to bring about hypnosis,—the only means of salvation. The result, in the three following cases, was satisfactory:— Case 134. _Contrary Sexual Instinct Acquired through Masturbation._—Mr. X., merchant, aged 29. Father’s parents healthy. Nothing nervous in father’s family. Father was an irritable, peevish old man. One brother of the father was a man-about-town, and died unmarried. Mother died in third confinement, when the patient was six years old; she had a deep, rough, masculine voice, and coarse appearance. Of the children, one brother is irritable, “melancholic,” and indifferent to women. When a child patient had scarlet fever with delirium. Until his fourteenth year he was light-hearted and social, but, after that, quiet, solitary, and “melancholic.” The first trace of sexual feeling appeared in his tenth or eleventh year, and at that time he learned masturbation from other boys, and practiced mutual onanism with them. At the age of thirteen or fourteen, ejaculation for the first time. Patient has felt no evil results of onanism until the last three months. In school he learned easily, but was troubled with headaches. After the age of twenty, pollutions, in spite of daily practice of onanism. With pollutions, “procreative” dreams, as man and wife might perform the act, occurred. In his seventeenth year he was seduced into mutual onanism by a man having a love for men. He found satisfaction in this, inasmuch as he was always very passionate sexually. It was a long time before the patient again sought new opportunities for intercourse with males. He did it simply to rid himself of semen. He felt no friendship or love for the person with whom he had intercourse. He felt satisfaction only when he played the passive _rôle_,—when manustupration was practiced on him. When the act was once completed, he had no respect for the individual. If it happened that, later, he came to respect the man, then he ceased to indulge in the act with him. Later it became indifferent to him whether he masturbated or had masturbation practiced on him. When he himself practiced onanism, he always thought of pleasing men practicing onanism on him during the act. He preferred a hard, rough hand. The patient thought that, had he not been led astray, he would have arrived at a natural mode of satisfaction of his sexual desires. He never felt love for his own sex, though he had pleased himself with the thought of loving men. At first he had had sensual inclinations toward the opposite sex. He had taken pleasure in dancing, and he had been pleased with women, but he had taken more pleasure in the figure than the face. Too, he had had erections at the sight of women that pleased him. He had never attempted coitus, for fear of infection; whether he was potent or not with women, he did not know. He thought he could be so no longer, because his feeling for women had grown cold, especially during late years. While previously, in his sensual dreams, he had had ideas of both men and women, of late years he had dreamed only of approaches to men; he could not remember that he had dreamed, in late years, of sensual relations with a woman. At the theatre, as well as in the circus and _ballet_, the feminine figure had always interested him. In museums masculine and feminine statues had affected him equally. Patient is a great smoker, a beer-drinker, loves male society, and is a gymnast and skater. Anything dandified was repugnant to him, and he had never felt any desire to please men; he would even have preferred to please women. He now felt his position to be painful, because onanism had obtained the upper hand. Masturbation, that had previously been practiced without evil effects, now began to disclose its bad results. Since July, 1889, he had suffered with neuralgia of the testicles. The pain occurred particularly at night; and at night there was also trembling (increased reflex excitability). Sleep was not refreshing, and he would wake up with pain in the testicles. He was inclined, now, to indulge more frequently in onanism. He was afraid of the consequences of the habit. He hoped that his sexual life might still be turned into normal channels. Now, he thought of the future; he had a relation with a girl, who was attractive to him, and the thought to possess her as a wife was pleasing. For five days he had abstained from onanism, but he could scarcely believe that he would be able, with his own strength, to overcome the habit. Of late he had been very much depressed, having lost all desire for work, and become tired of life. Patient is tall, powerful, well nourished, and has a thick growth of beard. Skull and skeleton normal. Knee-jerks very prompt; deep reflexes in upper extremities much increased. Pupils dilated, equal, and act promptly. Carotids of equal calibre; hyperæsthesia urethræ; cords and testicles not sensitive; genitals normal. The patient was calmed, and given hope for the future, provided that he give up onanism and attempt to transfer his sexual desires from persons of his own sex to females. Hip-baths (24° to 20° R.); ext. secal. conut. aquos., 0.5; antipyrin, 1.0 (_pro die_); pot. brom., 4.0 (evenings), were ordered. December 13th. To-day the patient came, in a disturbed condition of mind, complaining that, unaided, he was unable to resist the impulse to masturbate, and he asked for help. A trial of hypnosis induced a condition of deep lethargy in the patient. He was given the following suggestions:—