CHAPTER VII.—CONCLUSIONS.

Hirschfeld has discussed these intermediate sexual stages in various works, especially inGeschlechtsübergänge(1905),Die Transvestiten(1910), and ch. xi ofDie Homosexualität. Hermaphroditism (the reality of which has only of late been recognized and is still disputed) and pseudohermaphroditism; in their physical variations are fully dealt with in the great work, richly illustrated,Hermaphroditismus beim Menschen, by F. L. von Neugebauer, of Warsaw. Neugebauer published an earlier and briefer study of the subject in theJahrbuch für sexuelle Zwischenstufenvol. iv, 1902, pp. 1-176, with a bibliography in vol. viii (1906) of the sameJahrbuch, pp. 685-700. Hirschfeld emphasizes the fact that neither hermaphroditism nor eunuchoidism is commonly associated with homosexuality, and that a large proportion of the cases of transvestism, as defined by him, are heterosexual. True inversion seems, however, to be not infrequently found among pseudohermaphrodites; Neugebauer records numerous cases; Magnan has published a case in a girl brought up as a youth (Gazette médical de Paris, March 31, 1911) and Lapointe a case in a man brought up as a girl (Revue de psychiatrie, 1911, p. 219). Such cases may be accounted for by the training and associations involved by the early error in recognition of sex, and perhaps still more by a really organic predisposition to homosexuality, although the sexual psychic characters are not necessarily bound up with the coexistence of corresponding sexual glands. Halban (Archiv für Gynäkologie1903) goes so far as to class the homosexual as "real pseudohermaphrodites," exactly comparable to a man with a female breast or a woman with a beard, and proposes to term homosexuality "pseudohermaphroditus masculinus psychicus." This, however, is an unnecessary and scarcely satisfactory confusion.

To place the group of homosexual phenomena among other intermediate groups on the organic bisexual basis is a convenientclassification. It can scarcely be regarded as a complete explanation. It is probable that we may ultimately find a more fundamental source of these various phenomena in the stimulating and inhibiting play of the internal secretions.[234]Our knowledge of the intimate association between the hormones and sexual phenomena is already sufficient to make such an explanation intelligible; the complex interaction of the glandular internal secretions and their liability to varying disturbance in balance may well suffice to account for the complexity of the phenomena. It would harmonize with what we know of the occasional delayed manifestations of homosexuality, and would not clash with their congenital nature, for we know that a disordered state of the thymus, for instance, may be hereditary, and it is held that status lymphaticus may be either inborn or acquired.[235]Normal sexual characters seem to depend largely upon the due co-ordination of the internal secretions, and it is reasonable to suppose that sexual deviations depend upon their inco-ordination. If a man is a man, and a woman a woman, because (in Blair Bell's phrase) of the totality of their internal secretions, the intermediate stages between the man and the woman must be due to redistribution of those internal secretions.[236]

We know that various internal secretions possess an influential sexual effect. Thus the atrophy of the thymus seems to be connected with sexual development at puberty; the thyroid reinforces the genital glands; adrenal overdevelopment can produce in a female the secondary characteristics of the male, as well as cause precocious development of maleness; etc. "Analteration in the metabolism," as F. H. A. Marshall suggests, "even in comparatively late life, may initiate changes in the direction of the opposite sex." Metabolic chemical processes may thus be found to furnish a key to complex and subtle sexual variations, alike somatic and psychic, although we must still regard such processes as arising on an inborn predisposition.

Whatever its ultimate explanation, sexual inversion may thus fairly be considered a "sport," or variation, one of those organic aberrations which we see throughout living nature, in plants and in animals.

It is not here asserted, as I would carefully point out, that an inverted sexual instinct, or organ for such instinct, is developed in early embryonic life; such a notion is rightly rejected as absurd. What we may reasonably regard as formed at an early stage of development is strictly a predisposition; that is to say, such a modification of the organism that it becomes more adapted than the normal or average organism to experience sexual attraction to the same sex. The sexual invert may thus be roughly compared to the congenital idiot, to the instinctive criminal, to the man of genius, who are all not strictly concordant with the usual biological variation (because this is of a less subtle character), but who become somewhat more intelligible to us if we bear in mind their affinity to variations. Symonds compared inversion to color-blindness; and such a comparison is reasonable. Just as the ordinary color-blind person is congenitally insensitive to those red-green rays which are precisely the most impressive to the normal eye, and gives an extended value to the other colors,—finding that blood is the same color as grass, and a florid complexion blue as the sky,—so the invert fails to see emotional values patent to normal persons, transferring those values to emotional associations which, for the rest of the world, are utterly distinct. Or we may compare inversion to such a phenomenon as color-hearing, in which there is not so much defect as an abnormality of nervous tracks producing new and involuntary combinations. Just as the color-hearer instinctively associates colors with sounds, like the youngJapanese lady who remarked when listening to singing, "That boy's voice is red!" so the invert has his sexual sensations brought into relationship with objects that are normally without sexual appeal.[237]And inversion, like color-hearing is found more commonly in young subjects, tending to become less marked, or to die out, after puberty. Color-hearing, while an abnormal phenomenon, it must be added, cannot be called a diseased condition, and it is probably much less frequently associated with other abnormal or degenerative stigmata than is inversion; there is often a congenital element, shown by the tendency to hereditary transmission, while the associations are developed in very early life, and are too regular to be the simple result of suggestion.[238]

All such organic variations are abnormalities. It is important that we should have a clear idea as to what an abnormality is. Many people imagine that what is abnormal is necessarily diseased. That is not the case, unless we give the word disease an inconveniently and illegitimately wide extension. It is both inconvenient and inexact to speak of color-blindness, criminality, and genius as diseases in the same sense as we speak of scarlet fever or tuberculosis or general paralysis as diseases. Every congenital abnormality is doubtless due to a peculiarity in the sperm or oval elements or in their mingling, or to some disturbance in their early development. But the same may doubtless be said of the normal dissimilarities between brothers and sisters. It is quite true that any of these aberrations may be due to antenatal disease, but to call themabnormal does not beg that question. If it is thought that any authority is needed to support this view, we can scarcely find a weightier than that of Virchow, who repeatedly insisted on the right use of the word "anomaly," and who taught that, though an anomaly may constitute a predisposition to disease, the study of anomalies—pathology, as he called it, teratology as we may perhaps prefer to call it—is not the study of disease, which he termed nosology; the study of the abnormal is perfectly distinct from the study of the morbid. Virchow considers that the region of the abnormal is the region of pathology, and that the study of disease must be regarded distinctly as nosology. Whether we adopt this terminology, or whether we consider the study of the abnormal as part of teratology, is a secondary matter, not affecting the right understanding of the term "anomaly" and its due differentiation from the term "disease."

At the Innsbruck meeting of the German Anthropological Society, in 1894, Virchow thus expressed himself: "In old days an anomaly was called πάθος, and in this sense every departure from the norm is for me a pathological event. If we have ascertained such a pathological event, we are further led to investigate whatpathoswas the special cause of it.... This cause may be, for example, an external force, or a chemical substance, or a physical agent, producing in the normal condition of the body a change, an anomaly (πάθος). This can become hereditary under some circumstances, and then become the foundation for certain small hereditary characters which are propagated in a family; in themselves they belong to pathology, even although they produce no injury. For I must remark that pathological does not mean harmful; it does not indicate disease; disease in Greek is νὁσος, and it is nosology that is concerned with disease. The pathological under some circumstances can be advantageous" (Correspondenz-blatt Deutsch Gesellschaft für Anthropologie, 1894). These remarks are of interest when we are attempting to find the wider bearings of such an anomaly as sexual inversion.This same distinction has more recently been emphasized by Professor Aschoff (Deutsche medizinische Wochenschrift, February 3, 1910; of.British Medical Journal, April 9, 1910, p. 892), as against Ribbert and others who would unduly narrow the conception of πάθος. Aschoff points out that, not merely for the sake of precision and uniformity of terminology but of clear thinking, it is desirable that we should retain a distinction in regard to which Galen and the ancientphysicians were very definite. They used πάθος as the wider term involving affection (affectio) in general, not necessarily impairment of vital tissue; when that was involved there was νὁσος, disease. We have to recognize the distinction even if we reject the terminology.

This same distinction has more recently been emphasized by Professor Aschoff (Deutsche medizinische Wochenschrift, February 3, 1910; of.British Medical Journal, April 9, 1910, p. 892), as against Ribbert and others who would unduly narrow the conception of πάθος. Aschoff points out that, not merely for the sake of precision and uniformity of terminology but of clear thinking, it is desirable that we should retain a distinction in regard to which Galen and the ancientphysicians were very definite. They used πάθος as the wider term involving affection (affectio) in general, not necessarily impairment of vital tissue; when that was involved there was νὁσος, disease. We have to recognize the distinction even if we reject the terminology.

A word may be said as to the connection between sexual inversion and degeneration. In France especially, since the days of Morel, the stigmata of degeneration are much spoken of. Sexual inversion is frequently regarded as one of them:i.e., as an episodic syndrome of a hereditary disease, taking its place beside other psychic stigmata, such as kleptomania and pyromania. Krafft-Ebing long so regarded inversion; it is the view of Magnan, one of the earliest investigators of homosexuality;[239]and it was adopted by Möbius. Strictly speaking, the invert is degenerate; he has fallen away from the genus. So is a color-blind person. But Morel's conception of degenerescence has unfortunately been coarsened and vulgarized.[240]As it now stands, we gain little or no information by being told that a person is a "degenerate." It is only, as Näcke constantly argued, when we find a complexus of well-marked abnormalities that we are fairly justified in asserting that we have to deal with a condition of degeneration. Inversion is sometimes found in such a condition. I have, indeed, already tried to suggest that a condition of diffused minor abnormality may be regarded as a basis of congenital inversion. In other words, inversion is bound up with a modification of the secondary sexual characters. But these anomalies and modifications are not invariable,[241]and are not usually of a serious character; inversion is rare in the profoundly degenerate. It is undesirable to call these modifications"stigmata of degeneration," a term which threatens to disappear from scientific terminology, to become a mere term of literary and journalistic abuse. So much may be said concerning a conception or a phrase of which far too much has been made in popular literature. At the best it remains vague and unfitted for scientific use. It is now widely recognized that we gain little by describing inversion as a degeneration. Näcke, who attached significance to the stigmata of degeneration when numerous, was especially active in pointing out that inverts are not degenerate, and frequently returned to this point. Löwenfeld, Freud, Hirschfeld, Bloch, Rohleder all reject the conception of sexual inversion as a degeneracy.

Moll is still unable to abandon altogether the position that since inversion involves a disharmony between psychic disposition and physical conformation we must regard it as morbid, but he recognizes (like Krafft-Ebing) that it is properly viewed as being on the level of a deformity, that is, an abnormality, comparable to physical hermaphroditism. (A. Moll, "Sexuelle Zwischenstufen,"Zeitschrift für aerztliche Fortbildung, No. 24, 1904.) Näcke repeatedly emphasized the view that inversion is a congenital non-morbid abnormality; thus in the last year of his life he wrote (Zeitschrift für die Gesamte Neurologie und Psychiatrie, vol. xv, Heft 5, 1913): "We must not conceive of homosexuality as a degeneration or a disease, but at most as an abnormality, due to a disturbance of development." Löwenfeld, always a cautious and sagacious clinical observer, agreeing with Näcke and Hirschfeld, regards inversion as certainly an abnormality, but not therefore morbid; it may be associated with disease and degeneration, but is usually simply a variation from the norm, not to be regarded as morbid or degenerate, and not diminishing the value of the individual as a member of society (Löwenfeld,Ueber die sexuelle Konstitution, 1911, p. 166; alsoZeitschrift für Sexualwissenschaft, Feb., 1908, andSexual-Probleme, April, 1908). Aletrino of Amsterdam pushes the view that inversion is a non-morbid abnormality to an undue extreme by asserting that "the uranist is a normal variety of the speciesHomo sapiens" ("Uranisme et Dégénérescence,"Archives d'Anthropologie Criminelle, Aug.-Sept., 1908); inversion may be regarded as (in the correct sense of the word here adopted) a pathological abnormality, but not as an anthropological human variety comparable to the Negro or the Mongolian man. (For further opinions in favor of inversion as an anomaly, see Hirschfeld,Die Homosexualität, p. 388et seq.)

Sexual inversion, therefore, remains a congenital anomaly, to be classed with other congenital abnormalities which have psychic concomitants. At the very least such congenital abnormality usually exists as a predisposition to inversion. It is probable that many persons go through the world with a congenital predisposition to inversion which always remains latent and unroused; in others the instinct is so strong that it forces its own way in spite of all obstacles; in others, again, the predisposition is weaker, and a powerful exciting cause plays the predominant part.

We are thus led to the consideration of the causes that excite the latent predisposition. A great variety of causes has been held to excite to sexual inversion. It is only necessary to mention those which I have found influential. The first to come before us is our school-system, with its segregation of boys and girls apart from each other during the periods of puberty and adolescence. Many inverts have not been to school at all, and many who have been pass through school-life without forming any passionate or sexual relationship; but there remain a large number who date the development of homosexuality from the influences and examples of school-life. The impressions received at the time are not less potent because they are often purely sentimental and without any obvious sensual admixture. Whether they are sufficiently potent to generate permanent inversion alone may be doubtful, but, if it is true that in early life the sexual instincts are less definitely determined than when adolescence is complete, it is conceivable, though unproved, that a very strong impression, acting even on a normal organism, may cause arrest of sexual development on the psychic side.

Another exciting cause of inversion is seduction. By this I mean the initiation of the young boy or girl by some older and more experienced person in whom inversion is already developed, and who is seeking the gratification of the abnormal instinct. This appears to be a not uncommon incident in the early history of sexual inverts. That such seduction—sometimesan abrupt and inconsiderate act of mere sexual gratification—could by itself produce a taste for homosexuality is highly improbable; in individuals not already predisposed it is far more likely to produce disgust, as it did in the case of the youthful Rousseau. "He only can be seduced," as Moll puts it, "who is capable of being seduced." No doubt it frequently happens in these, as so often in more normal "seductions," that the victim has offered a voluntary or involuntary invitation.

Another exciting cause of inversion, to which little importance is usually attached, but which I find to have some weight, is disappointment in normal love. It happens that a man in whom the homosexual instinct is yet only latent, or at all events held in a state of repression, tries to form a relationship with a woman. This relationship may be ardent on one or both sides, but—often, doubtless, from the latent homosexuality of the lover—it comes to nothing. Such love-disappointments, in a more or less acute form, occur at some time or another to nearly everyone. But in these persons the disappointment with one woman constitutes motive strong enough to disgust the lover with the whole sex and to turn his attention toward his own sex. It is evident that the instinct which can thus be turned round can scarcely be strong, and it seems probable that in some of these cases the episode of normal love simply serves to bring home to the invert the fact that he is not made for normal love. In other cases, it seems,—especially those that are somewhat feeble-minded and unbalanced,—a love-disappointment really does poison the normal instinct, and a more or less impotent love for women becomes an equally impotent love for men. The prevalence of homosexuality among prostitutes may be, to a large extent, explained by a similar and better-founded disgust with normal sexuality.[242]

These three influences, therefore,—example at school, seduction, disappointment in normal love,—all of them drawing the subject away from the opposite sex and concentrating him on his own sex, are exciting causes of inversion; but they require a favorable organic predisposition to act on, while there are a large number of cases in which no exciting cause at all can be found, but in which, from earliest childhood, the subject's interest seems to be turned on his own sex, and continues to be so turned throughout life.

At this point I conclude the analysis of the psychology of sexual inversion as it presents itself to me. I have sought only to bring out the more salient points, neglecting minor points, neglecting also those groups of inverts who may be regarded as of secondary importance. The average invert, moving in ordinary society, is a person of average general health, though very frequently with hereditary relationships that are markedly neurotic. He is usually the subject of a congenital predisposing abnormality, or complexus of minor abnormalities, making it difficult or impossible for him to feel sexual attraction to the opposite sex, and easy to feel sexual attraction to his own sex. This abnormality either appears spontaneously from the first, by development or arrest of development, or it is called into activity by some accidental circumstance.

[225]Seepassim, Jahrbuch für Psychoanalytische Forschungen, Zentralblatt für Psychoanalyse, andInternationale Zeitschrift für Aerztliche Psychoanalyse; also Sadger, "Zur Aetiologie der Konträren Sexualempfindung,"Medizinische Klinik, 1909, No. 2.

[226]For an exposition of this by an able English representative of Freudian doctrines, see Ernest Jones, "The Œdipus Complex As An Explanation of Hamlet's Mystery,"American Journal of Psychology, January, 1910.

[227]The love of relations may be tinctured by all degrees of sexual love, some of which are so faint and vague that they cannot be considered unnatural or abnormal; it is misleading to term them incestuous. The Russian novelist, Artzibascheff, in hisSaninedescribed a brother's affection for his sister as thus touched with a perception of her sexual charm (I refer to the French translation), and the book has consequently been much abused as "incestuous," though the attitude described is very pale and conventional compared to the romantic passion sung in Shelley'sLaon and Cythna, or the tragic exaltation of the same passion in Ford's great play, "'Tis Pity She's a Whore."

[228]Thus Numa Praetorius, a sagacious observer with, a very wide and thorough knowledge of homosexuality, finds himself quite unable to accept the "Œdipus Complex" explanation of inversion (Jahrbuch für sexuelle Zwischenstufen, July, 1914, p. 362).

[229]It cannot be maintained that the frequency of inversion among the near relatives of inverts is a chance coincidence, for it must be remembered that few estimates of the prevalence of inversion yield a higher proportion than 3 per cent.

[230]See also a discussion of the Freudian view by Hirschfeld, who concludes (Die Homosexualität, p. 344) that we can only accept the Freudian mechanism as rare, and in all cases subordinate to organic predisposition.

[231]It has been denied by some (Meynert, Näcke, etc.) that there is any sexualinstinctat all. I may as well, therefore, explain in what sense I use the word. (See also "Analysis of the Sexual Impulse" in vol. iii of theseStudies.) I mean an inherited aptitude the performance of which normally demands for its full satisfaction the presence of a person of the opposite sex. It might be asserted that there is no such thing as an instinct for food, that it is all imitation, etc. In a sense this is true, but the automatic basis remains. A chicken from an incubator needs no hen to teach it to eat. It seems to discover eating and drinking, as it were, by chance, at first eating awkwardly and eating everything, until it learns what will best satisfy its organic mechanism. There is no instinct for food, it may be, but there is an instinct which is only satisfied by food. It is the same with the "sexual instinct." The tentative and omnivorous habits of the newly hatched chicken may be compared to the uncertainty of the sexual instinct at puberty, while the sexual pervert is like a chicken that should carry on into adult age an appetite for worsted and paper. It may be added here that the question of the hereditary nature of the sexual instinct has been exhaustively discussed and decisively affirmed by Moll in hisUntersuchungen über die Libido Sexualis, 1898. Moll attaches importance to the inheritance of the normal aptitudes for sexual reaction in an abnormally weak degree as a factor in the development of sexual perversions.

[232]This view was revived in a modified form by Näcke (Zeitschrift für die gesamte Neurologie und Psychiatrie, vol. xv, Heft 5, 1913), who supposed that there may be an anatomical "homosexual center" in the brain;i.e., a feminine libido-center in the inverted man, and a masculine libido-center in the inverted woman. He expressed a hope that in the future the brains of inverted persons would be more carefully investigated.

[233]I do not present this view as more than a picture which helps us to realize the actual phenomena which we witness in homosexuality, although I may add that so able a teratologist as Dr. J. W. Ballantyne considers that "it seems a very possible theory."

[234]This explanation of homosexuality has already been tentatively put forth. Thus, Iwan Bloch (Sexual Life of Our Time, ch. xix, Appendix) vaguely suggests a new theory of homosexuality as dependent on chemical influences. Hirschfeld also believes (Die Homosexualität, ch. xx) that the study of the internal secretions is the path to the deepest foundations of inversion.

[235]A. E. Garrod, "The Thymus Gland in its Clinical Aspects,"British Medical Journal, Oct. 3, 1914

[236]"The pure female and the pure male are produced by all the internal secretions," Blair Bell, "The Internal Secretions,"British Medical Journal, Nov. 15, 1913.

[237]After this chapter was first published (in theCentralblatt für Nervenheilkunde, February, 1896), Féré also compared congenital inversion to color-blindness and similar anomalies (Féré, "La Descendance d'un Inverti,"Revue Générale de Clinique et Thérapeutique, 1896), while Ribot referred to the analogy with color-hearing (Psychology of the Emotions, part ii, ch. vii).

[238]See,e.g., Flournoy,Des Phenomènes de Synopsie, Geneva, 1893; and for a brief discussion of the general phenomena of synesthesia, E. Parish,Hallucinations and Illusions (Contemporary Science Series), chapter vii; Bleuler, article "Secondary Sensations," in Tuke'sDictionary of Psychological Medicine; and Havelock Ellis,Man and Woman, 5th ed., 1915, pp. 181-4.

[239]Magnan has in recent years reaffirmed this view ("Inversion Sexuelle et Pathologic Mentale,"Revue de Psychothérapie, March, 1914): "The invert is a diseased person, a degenerate."

[240]It is this fact which has caused the Italians to be shy of using the word "degeneration;" thus, Marro, in his great work,I Caratteri del Delinquenti, made a notable attempt to analyze the phenomena lumped together as degenerate into three groups: atypical, atavistic, and morbid.

[241]Hirschfeld and Burchard among 200 inverts found pronounced stigmata of degeneration in only 16 per cent. (Hirschfeld,Die Homosexualität, ch. xx.)

[242]Alcohol has sometimes been considered an important exciting cause of homosexuality, and alcoholism is certainly not uncommon in the heredity of inverts; according to Hirschfeld (Die Homosexualität, p. 386) it is well marked in one of the parents in over 21 per cent, of cases. But it probably has no more influence as an exciting cause in the individual homosexual person than in the individual heterosexual person. From the Freudian standpoint, indeed, Abraham believes (Zeitschrift für Sexualwissenschaft, Heft 8, 1908) that even in normal persons alcohol removes the inhibition from a latent homosexuality, and Juliusburger from the same standpoint (Zentralblatt für Psychoanalyse, Heft 10 and 11, 1912) thinks that the alcoholic tendency is unconsciously aroused by the homosexual impulse in order to reach its own gratification. But we may accept Näcke's conclusions (Allgemeine Zeitschrift für Psychiatrie, vol. lxviii, 1911, p. 852), that (1) alcohol cannot produce homosexuality in persons not predisposed, that (2) it may arouse it in those who are predisposed, that (3) the action of alcohol is the same on the homosexual as the heterosexual, and that (4) alcoholism is not common among inverts.

The Prevention of Homosexuality—The Influence of the School—Coeducation—The Treatment of Sexual Inversion—Castration—Hypnotism—Associational Therapy—Psycho-analysis—Mental and Physical Hygiene—Marriage—The Children of Inverts—The Attitude of Society—The Horror Aroused by Homosexuality—Justinian—TheCode Napoléon—The State of the Law in Europe Today—Germany—England—What Should be our Attitude toward Homosexuality?

Having now completed the psychological analysis of the sexual invert, so far as I have been able to study him, it only remains to speak briefly of the attitude of society and the law. First, however, a few words as to the medical and hygienic aspects of inversion. The preliminary question of the prevention of homosexuality is in too vague a position at present to be profitably discussed. So far as the really congenital invert is concerned, prevention can have but small influence; but sound social hygiene should render difficult the acquisition of homosexual perversity, or what has been termed pseudo-homosexuality. It is the school which is naturally the chief theater of immature and temporary homosexual manifestations, partly because school life largely coincides with the period during which the sexual impulse frequently tends to be undifferentiated, and partly because in the traditions of large and old schools an artificial homosexuality is often deeply rooted.

Homosexuality in English schools has already been briefly referred to in chapter iii. As a precise and interesting picture of the phenomena in French schools, I may mention a story by Albert Nortal,Les Adolescents Passionnés(1913), written immediately after the author left college, though not published until more than twenty-five years later, and clearly based on personal observation and experience. As regards German schools, see,e.g., Moll,Untersuchungen über die Libido Sexualis, p. 449et seq., and for sexual manifestations in early life generally, the same author'sSexual Life of the Child; also Hirschfeld,Jahrbuch für sexuelle Zwischenstufen, vol. v, 1903, p. 47et seq., and, for references, Hirschfeld,Die Homosexualität, p. 46et seq.

While much may be done by physical hygiene and other means to prevent the extension of homosexuality in schools,[243]it is impossible, and even undesirable, to repress absolutely the emotional manifestations of sex in either boys or girls who have reached the age of puberty.[244]It must always be remembered that profoundly rooted organic impulses cannot be effectually combated by direct methods. Writing of a period two centuries ago, Casanova, in relating his early life as a seminarist trained to the priesthood, describes the precautions taken to prevent the youths entering each other's beds, and points out the folly of such precautions.[245]As that master of the human heart remarks, such prohibitions intensify the very evil they are intended to prevent by invoking in its aid the impulse to disobedience natural to every child of Adam and Eve, and the observation has often been repeated by teachers since. We probably have to recognize that a way to render such manifestations wholesome, as well as to prepare for the relationships of later life, is the adoption, so far as possible, of the method of coeducation of the sexes,[246]—not, of course, necessarily involving identity of education for both sexes,—since a certain amount of association between the sexeshelps to preserve the healthiness of the sexual emotional attitude. Association between the sexes will not, of course, prevent the development of congenital inversion. In this connection it is pointed out by Bethe that it was precisely in Sparta and Lesbos, where homosexuality was most ideally cultivated, that the sexes, so far as we know, associated more freely than in any other Greek State.[247]

The question of the treatment of homosexuality must be approached with discrimination, caution, and skepticism. Nowadays we can have but little sympathy with those who, at all costs, are prepared to "cure" the invert. There is no sound method of cure in radical cases.

At one time the seemingly very radical method of castration was advocated and occasionally carried out, as in a case I have recorded in a previous chapter (History XXVI). Like all methods of treatment, it is sometimes believed to have been successful by those who carried it out. Usually, after a short period, it is found to be unsuccessful, and in some cases the condition, especially the mental condition, is rendered worse. It is not difficult to understand why this should be. Sexual inversion, is not a localized genital condition. It is a diffused condition, and firmly imprinted on the whole psychic state. There may be reasons for castration, or the slighter operation of vasectomy, but, although sexual tension may be thereby diminished, no authority now believes that any such operation will affect the actual inversion. Castration of the body in adult age cannot be expected to produce castration of the mind. Moll, Féré, Näcke, Bloch, Rohleder, Hirschfeld, are all either opposed to castration for inversion, or very doubtful as to any beneficial results.

In a case communicated to me by Dr. Shufeldt, an invert had himself castrated at the age of 26 to diminish sexual desire, make himself more like a woman, and to stop growth of beard. "But the only apparent physical effect," he wrote, "was to increase my weight10 per cent., and render me a semi-invalid for the rest of my life. After two years my sexuality decreased, but that may have been due to satiety or to advancing years. I was also rendered more easily irritated over trifles and more revengeful. Terrible criminal auto-suggestions came into my head, never experienced before." Féré (Revue de Chirurgie, March 10, 1905) published the case of an invert of English origin who had been castrated. The inverted impulse remained unchanged, as well as sexual desire and the aptitude for erection; but neurasthenic symptoms, which had existed before, were aggravated; he felt less capable to resist his impulses, became migratory in his habits of life, and addicted to the use of laudanum. In a case recorded by C. H. Hughes (Alienist and Neurologist, Aug., 1914) the results were less unsatisfactory; in this case the dorsal nerve of the penis was first excised, without any result (see alsoAlienist and Neurologist, Feb., 1904, p. 70, as regards worse than useless results of cutting the pudic nerve), and a year or so later the testes were removed and the patient gained tranquillity and satisfaction; his homosexual inclinations appeared to go, and he began to show inclination for asexualized women, being specially anxious to meet with a woman whose ovaries had been removed on account of inversion. (Reference may also be made to Näcke, "Die Ersten Kastrationen aus sozialen Grunden auf europäischen Boden,"Neurologisches Centralblatt, 1909, No. 5, and E. Wilhelm inJuristisch-psychiatrische Grenzfragen, vol. viii, Heft 6 and 7, 1911.)

More trust has usually been placed in the psychotherapeutical than the surgical treatment of homosexuality. At one time hypnotic suggestion was carried out very energetically on homosexual subjects. Krafft-Ebing seems to have been the first distinguished advocate of hypnotism for application to the homosexual. Dr. von Schrenck-Notzing displayed special zeal and persistency in this treatment. He undertook to treat even the most pronounced cases of inversion by courses lasting more than a year, and involving, in at least one case, nearly one hundred and fifty hypnotic sittings; he prescribed frequent visits to the brothel, previous to which the patient took large doses of alcohol; by prolonged manipulations a prostitute endeavored to excite erection, a process attended with varying results. It appears that in some cases this course of treatment was attended by a certain sort of success, to which an unlimited good will on the part of the patient, it is needless to say, largelycontributed. The treatment was, however, usually interrupted by continual backsliding to homosexual practices, and sometimes, naturally, the cure involved a venereal disorder. The patient was enabled to marry and to beget children.[248]It is a method of treatment which seems to have found few imitators. This we need not regret. The histories I have recorded in previous chapters show that it is not uncommon for even a pronounced invert to be able sometimes to effect coitus. It often becomes easy if at the time he fixes his thoughts on images connected with his own sex. But the perversion remains unaffected; the subject is merely (as one of Moll's inverts expressed it) practising masturbationper vaginam. Such treatment is a training in vice, and, as Raffalovich points out, the invert is simply perverted and brought down to the vicious level which necessarily accompanies perversity.[249]

There can be no doubt that in slight and superficial cases of homosexuality, suggestion may really exert an influence. We can scarcely expect it to exert such influence when the homosexual tendency is deeply rooted in an organic inborn temperament. In such cases indeed the subject may resist suggestion even when in the hypnotic state. This is pointed out by Moll, a great authority on hypnotism, and with much experience of its application to homosexuality, but never inclined to encourage an exaggerated notion of its efficacy in this field. Forel, who was also an authority on hypnotism, was equally doubtful as to its value in relation to inversion, especially in clearly inborn cases. Krafft-Ebing at the end said little about it, and Näcke (who was himself without faith in this method of treating inversion) stated that he had been informed by thelast homosexual case treated by Krafft-Ebing by hypnotism that, in spite of all good-will on the patient's side, the treatment had been quite useless. Féré, also, had no belief in the efficacy of suggestive treatment, nor has Merzbach, nor Rohleder. Numa Praetorius states that the homosexual subjects he is acquainted with, who had been so treated, were not cured, and Hirschfeld remarks that the inverts "cured" by hypnotism were either not cured or not inverted.[250]

Moll has shown his doubt as to the wide applicability of suggestive therapeutics in homosexuality by developing in recent years what he terms association-therapy. In nearly all perverse individuals, he points out, there is a bridge,—more or less weak, no doubt,—which leads to the normal sexual life. By developing such links of association with normality, Moll believes, it may be possible to exert a healing influence on the homosexual. Thus a man who is attracted to boys may be brought to love a boyish woman.[251]Indications of this kind have long been observed and utilized, though not developed into a systematic method of treatment. In the case of bisexual individuals, or of youthful subjects whose homosexuality is not fully developed, it is probable that this method is beneficial. It is difficult to believe, however, that it possesses any marked influence on pronounced and developed cases of inversion.[252]

Somewhat the same aim as Moll's association-therapy, though on the basis of a more elaborate theory, is sought by Freud's psychoanalytic method of treating homosexuality. For the psychoanalytic theory (to which reference was made in the previous chapter) the congenital element of inversion is a rare and usually unimportant factor; the chief part is played by perverse psychic mechanisms. It is the business of psychoanalysisto straighten these out, and from the bisexual constitution, which is regarded as common to every one, to bring into the foreground the heterosexual elements, and so to reconstruct a normal personality, developing new sexual ideals from the patient's own latent and subconscious nature. Sadger has especially occupied himself with the psychoanalytic treatment of homosexuality and claims many successes.[253]Sadger admits that there are many limits to the success of this treatment, and that it cannot affect the inborn factors of homosexuality when present. Other psychoanalysts are less sanguine as to the cure of inversion. Stekel appears to have stated that he has never seen a complete cure by psychoanalysis, and Ferenezi is not able to give a good account of the results; especially as regards what he terms obsessional homosexuality, he states that he has never succeeded in effecting a complete cure, although obsessions in general are especially amenable to psychoanalysis.[254]

I have met with at least two homosexual persons who had undergone psychoanalytic treatment and found it beneficial. One, however, was bisexual, so that the difficulties in the way of the success—granting it to be real—were not serious. In the other case, the inversion persisted after treatment, exactly the same as before. The benefit he received was due to the fact that he was enabled to understand himself better and to overcome some of his mental difficulties. The treatment, therefore, in his case, was not a method of cure, but of psychic hygiene, of what Hirschfeld would call "adaptation-therapy." There can be no doubt that—even if we put aside all effort at cure and regard an invert's condition as inborn and permanent—a large and important field of treatment here still remains.

As we have seen in the two previous chapters, sexual inversion cannot be regarded as essentially an insane or psychopathic state.[255]But it is frequently associated with nervous conditions which may be greatly benefited by hygiene and treatment, without any attempt at all to overcome a homosexual attitude which may be too deeply rooted to be changed. The invert is specially liable to suffer from a high degree of neurasthenia, often involving much nervous weakness and irritability, loss of self-control, and genital hyperesthesia.[256]Hirschfeld finds that over 67 per cent. inverts suffer from nervous troubles, and among the cases dealt with in the presentStudy(as shown in chapter v) slight nervous functional disturbances are very common. These are conditions which may be ameliorated, and they may be treated in much the same way as if no inversion existed, by physical and mental tonics; or, if necessary, sedatives; by regulated gymnastics and out-of-door exercises; and by occupations which employ, without overexerting, the mind. Very great and permanent benefit may be obtained by a prolonged course of such mental and physical hygiene; the associated neurasthenic conditions may be largely removed, with the morbid fears, suspicions, and irritabilities that are usually part of neurasthenia, and the invert may be brought into a fairly wholesome and tonic condition of self-control.

The inversion is not thus removed. But if the patient is still young, and if the perversion does not appear to be deeply rooted in the organism, it is probable that—provided his owngood-will is aiding—general hygienic measures, together with removal to a favorable environment, may gradually lead to the development of the normal sexual impulse. If it fails to do so, it becomes necessary to exercise great caution in recommending stronger methods. Purely "Platonic association with the other sex," Moll points out, "leads to better results than any prescribed attempt at coitus." For even when such attempt is successful, it is not usually possible to regard the results with much satisfaction. Not only is the acquisition of the normal instinct by an invert very much on a level with the acquisition of a vice, but probably it seldom succeeds in eradicating the original inverted instinct.[257]What usually happens is that the person becomes capable of experiencing both impulses,—not a specially satisfactory state of things. It may be disastrous, especially if it leads to marriage, as it may do in an inverted man or still more easily in an inverted woman. The apparent change does not turn out to be deep, and the invert's position is more unfortunate than his original position, both for himself and for his wife.[258]

It may be observed in the Histories brought forward in chapter iii that the position of married inverts (we must, of course, put aside the bisexual) is usually more distressing than that of the unmarried. Among my cases 14 per cent. are married. Hirschfeld finds that 16 per cent. of inverts are married and 50 per cent. are impotent; he is unable to find a single cure of homosexuality, and seldom any improvement, due to marriage; nearly always the impulse remains unaffected. The invert's happiness is, however, often affected for the worse, and not least by the feeling that he is depriving his wife of happiness. An invert, who had left his country through fear of arrest and married a rich woman who was in love with him, said to Hirschfeld: "Five years' imprisonment would not have been worse than one year of marriage."[259]In a marriage of this kind the homosexual partner and the normal partner—however ignorant of sexual matters—are both conscious, often with equal pain, that, even in the presence of affection and esteem and the best will in the world, there is something lacking. The instinctive and emotional element, which is the essence of sexual love and springs from the central core of organic personality, cannot voluntarily be created or even assumed.[260]

For the sake of the possible offspring, also, marriage is to be avoided. It is sometimes entirely for the sake of children that the invert desires to marry. But it must be pointed out that homosexuality is undoubtedly in many cases inherited. Often, it is true, the children turn out fairly well, but, in many cases, they bear witness that they belong to a neurotic and failing stock;[261]Hirschfeld goes so far as to say that it is always so, and concludes that from the eugenic standpoint the marriage of a homosexual person is always very risky. In a large number of cases such marriages prove sterile. The tendency to sexual inversion in eccentric and neurotic families seems merely to be nature's merciful method of winding up a concern which, from her point of view, has ceased to be profitable.

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