"Where there is such a marked opposition of opinion truth is not exclusively on one side," remarks Löwenfeld (Sexualleben und Nervenleiden, second edition, p. 40). Sexual abstinence is certainly often injurious to neuropathic persons. (This is now believed by a large number of authorities, and was perhaps first decisively stated by Krafft-Ebing, "Ueber Neurosen durch Abstinenz,"Jahrbuch für Psychiatrie, 1889, p. 1). Löwenfeld finds no special proclivity to neurastheniaamong the Catholic clergy, and when it does occur, there is no reason to suppose a sexual causation. "In healthy and not hereditarily neuropathic men complete abstinence is possible without injury to the nervous system." Injurious effects, he continues, when they appear, seldom occur until between twenty-four and thirty-six years of age, and even then are not usually serious enough to lead to a visit to a doctor, consisting mainly in frequency of nocturnal emissions, pain in testes or rectum, hyperæsthesia in the presence of women or of sexual ideas. If, however, conditions arise which specially stimulate the sexual emotions, neurasthenia may be produced. Löwenfeld agrees with Freud and Gattel that the neurosis of anxiety tends to occur in the abstinent, careful examination showing that the abstinence is a factor in its production in both sexes. It is common among young women married to much older men, often appearing during the first years of marriage. Under special circumstances, therefore, abstinence can be injurious, but on the whole the difficulties due to such abstinence are not severe, and they only exceptionally call forth actual disturbance in the nervous or psychic spheres. Moll takes a similar temperate and discriminating view. He regards sexual abstinence before marriage as the ideal, but points out that we must avoid any doctrinal extremes in preaching sexual abstinence, for such preaching will merely lead to hypocrisy. Intercourse with prostitutes, and the tendency to change a woman like a garment, induce loss of sensitiveness to the spiritual and personal element in woman, while the dangers of sexual abstinence must no more be exaggerated than the dangers of sexual intercourse (Moll,Libido Sexualis, 1898, vol. i, p. 848;id.,Konträre Sexualempfindung, 1899, p. 588). Bloch also (in a chapter on the question of sexual abstinence in hisSexualleben unserer Zeit, 1908) takes a similar standpoint. He advocates abstention during early life and temporary abstention in adult life, such abstention being valuable, not only for the conservation and transformation of energy, but also to emphasize the fact that life contains other matters to strive for beyond the ends of sex. Redlich (Medizinische Klinik, 1908, No. 7) also, in a careful study of the medical aspects of the question, takes an intermediate standpoint in relation to the relative advantages and disadvantages of sexual abstinence. "We may say that sexual abstinence is not a condition which must, under all circumstances and at any price, be avoided, though it is true that for the majority of healthy adult persons regular sexual intercourse is advantageous, and sometimes is even to be recommended."It may be added that from the standpoint of Christian religious morality this same attitude, between the extremes of either party, recognizing the advantages of sexual abstinence, but not insisting that they shall be purchased at any price, has also found representation.Thus, in England, an Anglican clergyman, the Rev. H. Northcote (Christianity and Sex Problems, pp. 58, 60) deals temperately and sympathetically with the difficulties of sexual abstinence, and is by no means convinced that such abstinence is always an unmixed advantage; while in Germany a Catholic priest, Karl Jentsch (Sexualethik, Sexualjustiz, Sexualpolizei, 1900) sets himself to oppose the rigorous and unqualified assertions of Ribbing in favor of sexual abstinence. Jentsch thus expresses what he conceives ought to be the attitude of fathers, of public opinion, of the State and the Church towards the young man in this matter: "Endeavor to be abstinent until marriage. Many succeed in this. If you can succeed, it is good. But, if you cannot succeed, it is unnecessary to cast reproaches on yourself and to regard yourself as a scoundrel or a lost sinner. Provided that you do not abandon yourself to mere enjoyment or wantonness, but are content with what is necessary to restore your peace of mind, self-possession, and cheerful capacity for work, and also that you observe the precautions which physicians or experienced friends impress upon you."
"Where there is such a marked opposition of opinion truth is not exclusively on one side," remarks Löwenfeld (Sexualleben und Nervenleiden, second edition, p. 40). Sexual abstinence is certainly often injurious to neuropathic persons. (This is now believed by a large number of authorities, and was perhaps first decisively stated by Krafft-Ebing, "Ueber Neurosen durch Abstinenz,"Jahrbuch für Psychiatrie, 1889, p. 1). Löwenfeld finds no special proclivity to neurastheniaamong the Catholic clergy, and when it does occur, there is no reason to suppose a sexual causation. "In healthy and not hereditarily neuropathic men complete abstinence is possible without injury to the nervous system." Injurious effects, he continues, when they appear, seldom occur until between twenty-four and thirty-six years of age, and even then are not usually serious enough to lead to a visit to a doctor, consisting mainly in frequency of nocturnal emissions, pain in testes or rectum, hyperæsthesia in the presence of women or of sexual ideas. If, however, conditions arise which specially stimulate the sexual emotions, neurasthenia may be produced. Löwenfeld agrees with Freud and Gattel that the neurosis of anxiety tends to occur in the abstinent, careful examination showing that the abstinence is a factor in its production in both sexes. It is common among young women married to much older men, often appearing during the first years of marriage. Under special circumstances, therefore, abstinence can be injurious, but on the whole the difficulties due to such abstinence are not severe, and they only exceptionally call forth actual disturbance in the nervous or psychic spheres. Moll takes a similar temperate and discriminating view. He regards sexual abstinence before marriage as the ideal, but points out that we must avoid any doctrinal extremes in preaching sexual abstinence, for such preaching will merely lead to hypocrisy. Intercourse with prostitutes, and the tendency to change a woman like a garment, induce loss of sensitiveness to the spiritual and personal element in woman, while the dangers of sexual abstinence must no more be exaggerated than the dangers of sexual intercourse (Moll,Libido Sexualis, 1898, vol. i, p. 848;id.,Konträre Sexualempfindung, 1899, p. 588). Bloch also (in a chapter on the question of sexual abstinence in hisSexualleben unserer Zeit, 1908) takes a similar standpoint. He advocates abstention during early life and temporary abstention in adult life, such abstention being valuable, not only for the conservation and transformation of energy, but also to emphasize the fact that life contains other matters to strive for beyond the ends of sex. Redlich (Medizinische Klinik, 1908, No. 7) also, in a careful study of the medical aspects of the question, takes an intermediate standpoint in relation to the relative advantages and disadvantages of sexual abstinence. "We may say that sexual abstinence is not a condition which must, under all circumstances and at any price, be avoided, though it is true that for the majority of healthy adult persons regular sexual intercourse is advantageous, and sometimes is even to be recommended."
It may be added that from the standpoint of Christian religious morality this same attitude, between the extremes of either party, recognizing the advantages of sexual abstinence, but not insisting that they shall be purchased at any price, has also found representation.Thus, in England, an Anglican clergyman, the Rev. H. Northcote (Christianity and Sex Problems, pp. 58, 60) deals temperately and sympathetically with the difficulties of sexual abstinence, and is by no means convinced that such abstinence is always an unmixed advantage; while in Germany a Catholic priest, Karl Jentsch (Sexualethik, Sexualjustiz, Sexualpolizei, 1900) sets himself to oppose the rigorous and unqualified assertions of Ribbing in favor of sexual abstinence. Jentsch thus expresses what he conceives ought to be the attitude of fathers, of public opinion, of the State and the Church towards the young man in this matter: "Endeavor to be abstinent until marriage. Many succeed in this. If you can succeed, it is good. But, if you cannot succeed, it is unnecessary to cast reproaches on yourself and to regard yourself as a scoundrel or a lost sinner. Provided that you do not abandon yourself to mere enjoyment or wantonness, but are content with what is necessary to restore your peace of mind, self-possession, and cheerful capacity for work, and also that you observe the precautions which physicians or experienced friends impress upon you."
When we thus analyze and investigate the the three main streams of expert opinions in regard to this question of sexual abstinence—the opinions in favor of it, the opinions in opposition to it, and the opinions which take an intermediate course—we can scarcely fail to conclude how unsatisfactory the whole discussion is. The state of "sexual abstinence" is a completely vague and indefinite state. The indefinite and even meaningless character of the expression "sexual abstinence" is shown by the frequency with which those who argue about it assume that it can, may, or even must, involve masturbation. That fact alone largely deprives it of value as morality and altogether as abstinence. At this point, indeed, we reach the most fundamental criticism to which the conception of "sexual abstinence" lies open. Rohleder, an experienced physician and a recognized authority on questions of sexual pathology, has submitted the current views on "sexual abstinence" to a searching criticism in a lengthy and important paper.[95]He denies altogether that strict sexual abstinence exists at all. "Sexual abstinence," he points out, in any strict scenes of the term, must involve abstinence not merely from sexual intercourse but from auto-erotic manifestations, from masturbation,from homosexual acts, from all sexually perverse practices. It must further involve a permanent abstention from indulgence in erotic imaginations and voluptuous reverie. When, however, it is possible thus to render the whole psychic field atabula rasaso far as sexual activity is concerned—and if it fails to be so constantly and consistently there is no strict sexual abstinence—then, Rohleder points out, we have to consider whether we are not in presence of a case of sexual anæsthesia, ofanaphrodisia sexualis. That is a question which is rarely, if ever, faced by those who discuss sexual abstinence. It is, however, an extremely pertinent question, because, as Rohleder insists, if sexual anæsthesia exists the question of sexual abstinence falls to the ground, for we can only "abstain" from actions that are in our power. Complete sexual anæsthesia is, however, so rare a state that it may be practically left out of consideration, and as the sexual impulse, if it exists, must by physiological necessity sometimes become active in some shape—even if only, according to Freud's view, by transformation into some morbid neurotic condition—we reach the conclusion that "sexual abstinence" is strictly impossible. Rohleder has met with a few cases in which there seemed to him no escape from the conclusion that sexual abstinence existed, but in all of these he subsequently found that he was mistaken, usually owing to the practice of masturbation, which he believes to be extremely common and very frequently accompanied by a persistent attempt to deceive the physician concerning its existence. The only kind of "sexual abstinence" that exists is a partial and temporary abstinence. Instead of saying, as some say, "Permanent abstinence is unnatural and cannot exist without physical and mental injury," we ought to say, Rohleder believes, "Permanent abstinence is unnatural and has never existed."
It is impossible not to feel as we contemplate this chaotic mass of opinions, that the whole discussion is revolving round a purely negative idea, and that fundamental fact is responsible for what at first seem to be startling conflicts of statement. If indeed we were to eliminate what is commonly regarded as the religious and moral aspect of the matter—an aspect, be itremembered, which has no bearing on the essential natural facts of the question—we cannot fail to perceive that these ostentatious differences of conviction would be reduced within very narrow and trifling limits.
We cannot strictly coordinate the impulse of reproduction with the impulse of nutrition. There are very important differences between them, more especially the fundamental difference that while the satisfaction of the one impulse is absolutely necessary both to the life of the individual and of the race, the satisfaction of the other is absolutely necessary only to the life of the race. But when we reduce this question to one of "sexual abstinence" we are obviously placing it on the same basis as that of abstinence from food, that is to say at the very opposite pole to which we place it when (as in the previous chapter) we consider it from the point of view of asceticism and chastity. It thus comes about that on this negative basis there really is an interesting analogy between nutritive abstinence, though necessarily only maintained incompletely and for a short time, and sexual abstinence, maintained more completely and for a longer time. A patient of Janet's seems to bring out clearly this resemblance. Nadia, whom Janet was able to study during five years, was a young woman of twenty-seven, healthy and intelligent, not suffering from hysteria nor from anorexia, for she had a normal appetite. But she had an idea; she was anxious to be slim and to attain this end she cut down her meals to the smallest size, merely a little soup and a few eggs. She suffered much from the abstinence she thus imposed on herself, and was always hungry, though sometimes her hunger was masked by the inevitable stomach trouble caused by so long a persistence in thisrégime. At times, indeed, she had been so hungry that she had devoured greedily whatever she could lay her hands on, and not infrequently she could not resist the temptation to eat a few biscuits in secret. Such actions caused her horrible remorse, but, all the same, she would be guilty of them again. She realized the great efforts demanded by her way of life, and indeed looked upon herself as a heroine for resisting so long. "Sometimes," she told Janet, "I passed whole hours in thinking about food, I was sohungry. I swallowed my saliva, I bit my handkerchief, I rolled on the ground, I wanted to eat so badly. I searched books for descriptions of meals and feasts, I tried to deceive my hunger by imagining that I too was enjoying all these good things. I was really famished, and in spite of a few weaknesses for biscuits I know that I showed much courage."[96]Nadia's motive idea, that she wished to be slim, corresponds to the abstinent man's idea that he wishes to be "moral," and only differs from it by having the advantage of being somewhat more positive and personal, for the idea of the person who wishes to avoid sexual indulgence because it is "not right" is often not merely negative but impersonal and imposed by the social and religious environment. Nadia's occasional outbursts of reckless greediness correspond to the sudden impulses to resort to prostitution, and her secret weaknesses for biscuits, followed by keen remorse, to lapses into the habit of masturbation. Her fits of struggling and rolling on the ground are precisely like the outbursts of futile desire which occasionally occur to young abstinent men and women in health and strength. The absorption in thoughts about meals and in literary descriptions of meals is clearly analogous to the abstinent man's absorption in wanton thoughts and erotic books. Finally, Nadia's conviction that she is a heroine corresponds exactly to the attitude of self-righteousness which often marks the sexually abstinent.
If we turn to Freud's penetrating and suggestive study of the problem of sexual abstinence in relation to "civilized" sexual morality, we find that, though he makes no reference to the analogy with abstinence from food, his words would for the most part have an equal application to both cases. "The task of subduing so powerful an instinct as the sexual impulse, otherwise than by giving it satisfaction," he writes, "is one which may employ the whole strength of a man. Subjugation through sublimation, by guiding the sexual forces into higher civilizational paths, may succeed with a minority, and even with these only for a time, least easily during the years of ardent youthful energy.Most others become neurotic or otherwise come to grief. Experience shows that the majority of people constituting our society are constitutionally unequal to the task of abstinence. We say, indeed, that the struggle with this powerful impulse and the emphasis the struggle involves on the ethical and æsthetic forces in the soul's life 'steels' the character, and for a few favorably organized natures this is true; it must also be acknowledged that the differentiation of individual character so marked in our time only becomes possible through sexual limitations. But in by far the majority of cases the struggle with sensuality uses up the available energy of character, and this at the very time when the young man needs all his strength in order to win his place in the world."[97]
When we have put the problem on this negative basis of abstinence it is difficult to see how we can dispute the justice of Freud's conclusions. They hold good equally for abstinence from food and abstinence from sexual love. When we have placed the problem on a more positive basis, and are able to invoke the more active and fruitful motives of asceticism and chastity this unfortunate fight against a natural impulse is abolished. If chastity is an ideal of the harmonious play of all the organic impulses of the soul and body, if asceticism, properly understood, is the athletic striving for a worthy object which causes, for the time, an indifference to the gratification of sexual impulses, we are on wholesome and natural ground, and there is no waste of energy in fruitless striving for a negative end, whether imposed artificially from without, as it usually is, or voluntarily chosen by the individual himself.
For there is really no complete analogy between sexual desire and hunger, between abstinence from sexual relations and abstinence from food. When we put them both on the basis of abstinence we put them on a basis which covers the impulse for food but only half covers the impulse for sexual love. We confer no pleasure and no service on our food when we eat it. But the half of sexual love, perhaps the most important and ennobling half, lies in what we give and not in what we take. To reduce this question to the low level of abstinence, is not only to centre it in a merely negative denial but to make it a solely self-regarding question. Instead of asking: How can I bring joy and strength to another? we only ask: How can I preserve my empty virtue?
Therefore it is that from whatever aspect we consider the question,—whether in view of the flagrant contradiction between the authorities who have discussed this question, or of the illegitimate mingling here of moral and physiological considerations, or of the merely negative and indeed unnatural character of the "virtue" thus set up, or of the failure involved to grasp the ennoblingly altruistic and mutual side of sexual love,—from whatever aspect we approach the problem of "sexual abstinence" we ought only to agree to do so under protest.
If we thus decide to approach it, and if we have reached the conviction—which, in view of all the evidence we can scarcely escape—that, while sexual abstinence in so far as it may be recognized as possible is not incompatible with health, there are yet many adults for whom it is harmful, and a very much larger number for whom when prolonged it is undesirable, we encounter a serious problem. It is a problem which confronts any person, and especially the physician, who may be called upon to give professional advice to his fellows on this matter. If sexual relationships are sometimes desirable for unmarried persons, or for married persons who, for any reason, are debarred from conjugal union, is a physician justified in recommending such sexual relationships to his patient? This is a question that has frequently been debated and decided in opposing senses.
Various distinguished physicians, especially in Germany, have proclaimed the duty of the doctor to recommend sexual intercourse to his patient whenever he considers it desirable. Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative. Nyström (Sexual-Probleme, July, 1908, p. 413) states that it is the physician's duty, in some cases of sexual weakness, when all other methods of treatment have failed, to recommend sexual intercourse as the best remedy. Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate sexual intercourse in some cases, both to men and to women, and has on many occasions argued in this sense (e.g.,Darf der Arzt zum Ausserehelichen Geschlechtsverkehr raten?1904). Marcuse is strongly of opinion that a physician who, allowing himself to be influenced by moral, sociological, or other considerations, neglects to recommend sexual intercourse when he considers it desirable for the patient's health, is unworthy of his profession, and should either give up medicine or send his patients to other doctors. This attitude, though not usually so emphatically stated, seems to be widely accepted. Lederer goes even further when he states (Monatsschrift für Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3) that it is the physician's duty in the case of a woman who is suffering from her husband's impotence, to advise her to have intercourse with another man, adding that "whether she does so with her husband's consent is no affair of the physician's, for he is not the guardian of morality, but the guardian of health." The physicians who publicly take this attitude are, however, a small minority. In England, so far as I am aware, no physician of eminence has openly proclaimed the duty of the doctor to advise sexual intercourse outside marriage, although, it is scarcely necessary to add, in England, as elsewhere, it happens that doctors, including women doctors, from time to time privately point out to their unmarried and even married patients, that sexual intercourse would probably be beneficial.The duty of the physician to recommend sexual intercourse has been denied as emphatically as it has been affirmed. Thus Eulenburg (Sexuale Neuropathie, p. 43), would by no means advise extra-conjugal relations to his patient; "such advice is quite outside the physician's competence." It is, of course, denied by those who regard sexual abstinence as always harmless, if not beneficial. But it is also denied by many who consider that, under some circumstances, sexual intercourse would do good.Moll has especially, and on many occasions, discussed the duty of the physician in relation to the question of advising sexual intercourse outside marriage (e.g., in his comprehensive work,Aerztliche Ethik, 1902; alsoZeitschrift für Aerztliche Fortbildung, 1905, Nos. 12-15;Mutterschutz, 1905, Heft 3;Geschlecht und Gesellschaft, vol. ii, Heft 8). At the outset Moll had been disposed to assert the right of the physician to recommend sexual intercourse under some circumstances; "so long as marriage is unduly delayed and sexual intercourse outside marriage exists," he wrote (Die Conträre Sexualempfindung, second edition, p. 287), "so long, I think, we may use such intercourse therapeutically, provided that the rights of no third person (husband or wife) are injured." In all his later writings, however, Moll ranges himself clearly and decisively on the opposite side. He considers that the physician has no right to overlook the possible results of his advice in inflicting venereal disease, or, in the case of a woman, pregnancy, on his patient, and he believes that these serious results are far more likely to happen than is always admitted by those who defend the legitimacy of such advice. Nor will Moll admit that the physician is entitled to overlook the moral aspects of the question. A physician may know that a poor man could obtain many things good for his health by stealing, but he cannot advise him to steal. Moll takes the case of a Catholic priest who is suffering from neurasthenia due to sexual abstinence. Even although the physician feels certain that the priest may be able to avoid all the risks of disease as well as of publicity, he is not entitled to urge him to sexual intercourse. He has to remember that in thus causing a priest to break his vows of chastity he may induce a mental conflict and a bitter remorse which may lead to the worst results, even on his patient's physical health. Similar results, Moll remarks, may follow such advice when given to a married man or woman, to say nothing of possible divorce proceedings and accompanying evils.Rohleder (Vorlesungen über Geschlechtstrieb und Gesamtes Geschlechtsleben der Menschen) adopts a somewhat qualified attitude in this matter. As a general rule he is decidedly against recommending sexual intercourse outside marriage to those who are suffering from partial or temporary abstinence (the only form of abstinence he recognizes), partly on the ground that the evils of abstinence are not serious or permanent, and partly because the patient is fairly certain to exercise his own judgment in the matter. But in some classes of cases he recommends such intercourse, and notably to bisexual persons, on the ground that he is thus preserving his patient from the criminal risks of homosexual practices.
Various distinguished physicians, especially in Germany, have proclaimed the duty of the doctor to recommend sexual intercourse to his patient whenever he considers it desirable. Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative. Nyström (Sexual-Probleme, July, 1908, p. 413) states that it is the physician's duty, in some cases of sexual weakness, when all other methods of treatment have failed, to recommend sexual intercourse as the best remedy. Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate sexual intercourse in some cases, both to men and to women, and has on many occasions argued in this sense (e.g.,Darf der Arzt zum Ausserehelichen Geschlechtsverkehr raten?1904). Marcuse is strongly of opinion that a physician who, allowing himself to be influenced by moral, sociological, or other considerations, neglects to recommend sexual intercourse when he considers it desirable for the patient's health, is unworthy of his profession, and should either give up medicine or send his patients to other doctors. This attitude, though not usually so emphatically stated, seems to be widely accepted. Lederer goes even further when he states (Monatsschrift für Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3) that it is the physician's duty in the case of a woman who is suffering from her husband's impotence, to advise her to have intercourse with another man, adding that "whether she does so with her husband's consent is no affair of the physician's, for he is not the guardian of morality, but the guardian of health." The physicians who publicly take this attitude are, however, a small minority. In England, so far as I am aware, no physician of eminence has openly proclaimed the duty of the doctor to advise sexual intercourse outside marriage, although, it is scarcely necessary to add, in England, as elsewhere, it happens that doctors, including women doctors, from time to time privately point out to their unmarried and even married patients, that sexual intercourse would probably be beneficial.
The duty of the physician to recommend sexual intercourse has been denied as emphatically as it has been affirmed. Thus Eulenburg (Sexuale Neuropathie, p. 43), would by no means advise extra-conjugal relations to his patient; "such advice is quite outside the physician's competence." It is, of course, denied by those who regard sexual abstinence as always harmless, if not beneficial. But it is also denied by many who consider that, under some circumstances, sexual intercourse would do good.
Moll has especially, and on many occasions, discussed the duty of the physician in relation to the question of advising sexual intercourse outside marriage (e.g., in his comprehensive work,Aerztliche Ethik, 1902; alsoZeitschrift für Aerztliche Fortbildung, 1905, Nos. 12-15;Mutterschutz, 1905, Heft 3;Geschlecht und Gesellschaft, vol. ii, Heft 8). At the outset Moll had been disposed to assert the right of the physician to recommend sexual intercourse under some circumstances; "so long as marriage is unduly delayed and sexual intercourse outside marriage exists," he wrote (Die Conträre Sexualempfindung, second edition, p. 287), "so long, I think, we may use such intercourse therapeutically, provided that the rights of no third person (husband or wife) are injured." In all his later writings, however, Moll ranges himself clearly and decisively on the opposite side. He considers that the physician has no right to overlook the possible results of his advice in inflicting venereal disease, or, in the case of a woman, pregnancy, on his patient, and he believes that these serious results are far more likely to happen than is always admitted by those who defend the legitimacy of such advice. Nor will Moll admit that the physician is entitled to overlook the moral aspects of the question. A physician may know that a poor man could obtain many things good for his health by stealing, but he cannot advise him to steal. Moll takes the case of a Catholic priest who is suffering from neurasthenia due to sexual abstinence. Even although the physician feels certain that the priest may be able to avoid all the risks of disease as well as of publicity, he is not entitled to urge him to sexual intercourse. He has to remember that in thus causing a priest to break his vows of chastity he may induce a mental conflict and a bitter remorse which may lead to the worst results, even on his patient's physical health. Similar results, Moll remarks, may follow such advice when given to a married man or woman, to say nothing of possible divorce proceedings and accompanying evils.
Rohleder (Vorlesungen über Geschlechtstrieb und Gesamtes Geschlechtsleben der Menschen) adopts a somewhat qualified attitude in this matter. As a general rule he is decidedly against recommending sexual intercourse outside marriage to those who are suffering from partial or temporary abstinence (the only form of abstinence he recognizes), partly on the ground that the evils of abstinence are not serious or permanent, and partly because the patient is fairly certain to exercise his own judgment in the matter. But in some classes of cases he recommends such intercourse, and notably to bisexual persons, on the ground that he is thus preserving his patient from the criminal risks of homosexual practices.
It seems to me that there should be no doubt whatever as to the correct professional attitude of the physician in relation to this question of advice concerning sexual intercourse. The physician is never entitled to advise his patient to adopt sexualintercourse outside marriage nor any method of relief which is commonly regarded as illegitimate. It is said that the physician has nothing to do with considerations of conventional morality. If he considers that champagne would be good for a poor patient he ought to recommend him to take champagne; he is not called upon to consider whether the patient will beg, borrow, or steal the champagne. But, after all, even if that be admitted, it must still be said that the physician knows that the champagne, however obtained, is not likely to be poisonous. When, however, he prescribes sexual intercourse, with the same lofty indifference to practical considerations, he has no such knowledge. In giving such a prescription the physician has in fact not the slightest knowledge of what he may be prescribing. He may be giving his patient a venereal disease; he may be giving the anxieties and responsibilities of an illegitimate child; the prescriber is quite in the dark. He is in the same position as if he had prescribed a quack medicine of which the composition was unknown to him, with the added disadvantage that the medicine may turn out to be far more potently explosive than is the case with the usually innocuous patent medicine. The utmost that a physician can properly permit himself to do is to put the case impartially before his patient and to present to him all the risks. The solution must be for the patient himself to work out, as best he can, for it involves social and other considerations which, while they are indeed by no means outside the sphere of medicine, are certainly entirely outside the control of the individual private practitioner of medicine.
Moll also is of opinion that this impartial presentation of the case for and against sexual intercourse corresponds to the physician's duty in the matter. It is, indeed, a duty which can scarcely be escaped by the physician in many cases. Moll points out that it can by no means be assimilated, as some have supposed, with the recommendation of sexual intercourse. It is, on the contrary, he remarks, much more analogous to the physician's duty in reference to operations. He puts before the patient the nature of the operation, its advantages and its risks, but he leaves it to the patient's judgment to accept or reject the operation. Lewitt also (Geschlechtliche Enthaltsamkeit und Gesundheitsstörungen, 1905), after discussing the various opinions on thisquestion, comes to the conclusion that the physician, if he thinks that intercourse outside marriage might be beneficial, should explain the difficulties and leave the patient himself to decide.
Moll also is of opinion that this impartial presentation of the case for and against sexual intercourse corresponds to the physician's duty in the matter. It is, indeed, a duty which can scarcely be escaped by the physician in many cases. Moll points out that it can by no means be assimilated, as some have supposed, with the recommendation of sexual intercourse. It is, on the contrary, he remarks, much more analogous to the physician's duty in reference to operations. He puts before the patient the nature of the operation, its advantages and its risks, but he leaves it to the patient's judgment to accept or reject the operation. Lewitt also (Geschlechtliche Enthaltsamkeit und Gesundheitsstörungen, 1905), after discussing the various opinions on thisquestion, comes to the conclusion that the physician, if he thinks that intercourse outside marriage might be beneficial, should explain the difficulties and leave the patient himself to decide.
There is another reason why, having regard to the prevailing moral opinions at all events among the middle classes, a physician should refrain from advising extra-conjugal intercourse: he places himself in a false relation to his social environment. He is recommending a remedy the nature of which he could not publicly avow, and so destroying the public confidence in himself. The only physician who is morally entitled to advise his patients to enter into extra-conjugal relationships is one who openly acknowledges that he is prepared to give such advice. The doctor who is openly working for social reform has perhaps won the moral right to give advice in accordance with the tendency of his public activity, but even then his advice may be very dubiously judicious, and he would be better advised to confine his efforts at social reform to his public activities. The voice of the physician, as Professor Max Flesch of Frankfort observes, is more and more heard in the development and new growth of social institutions; he is a natural leaders in such movements, and proposals for reform properly come from him. "But," as Flesch continues, "publicly to accept the excellence of existing institutions and in the privacy of the consulting-room to give advice which assumes the imperfection of those institutions is illogical and confusing. It is the physician's business to give advice which is in accordance with the interests of the community as a whole, and those interests require that sexual relationships should be entered into between healthy men and women who are able and willing to accept the results of their union. That should be the physician's rule of conduct. Only so can he become, what to-day he is often proclaimed to be, the leader of the nation."[98]This view is not, as we see, entirely in accord with that which assumes that the physician's duty is solely and entirely to his patient, without regard to the bearing of his advice on social conduct. The patient's interests are primary, but they are not entitled to beplaced in antagonism to the interests of society. The advice given by the wise physician must always be in harmony with the social and moral tone of his age. Thus it is that the tendency among the younger generation of physicians to-day to take an active interest in raising that tone and in promoting social reform—a tendency which exists not only in Germany where such interests have long been acute, but also in so conservative a land as England—is full of promise for the future.
The physician is usually content to consider his duty to his patient in relationship to sexual abstinence as sufficiently fulfilled when he attempts to allay sexual hyperæsthesia by medical or hygienic treatment. It can scarcely be claimed, however, that the results of such treatment are usually satisfactory, and sometimes indeed the treatment has a result which is the reverse of that intended. The difficulty generally is that in order to be efficacious the treatment must be carried to an extreme which exhausts or inhibits not only the genital activities alone but the activities of the whole organism, and short of that it may prove a stimulant rather than a sedative. It is difficult and usually impossible to separate out a man's sexual activities and bring influence to bear on these activities alone. Sexual activity is so closely intertwined with the other organic activities, erotic exuberance is so much a flower which is rooted in the whole organism, that the blow which crushes it may strike down the whole man. The bromides are universally recognized as powerful sexual sedatives, but their influence in this respect only makes itself felt when they have dulled all the finest energies of the organism. Physical exercise is universally recommended to sexually hyperæsthetic patients. Yet most people, men and women, find that physical exercise is a positive stimulus to sexual activity. This is notably so as regards walking, and exuberantly energetic young women who are troubled by the irritant activity of their healthy sexual emotions sometimes spend a large part of their time in the vain attempt to lull their activity by long walks. Physical exercise only proves efficacious in this respect when it is carried to an extent which produces general exhaustion. Then indeed the sexual activity is lulled; but so are all the mental andphysical activities. It is undoubtedly true that exercises and games of all sorts for young people of both sexes have a sexually hygienic as well as a generally hygienic influence which is undoubtedly beneficial. They are, on all grounds, to be preferred to prolonged sedentary occupations. But it is idle to suppose that games and exercises will suppress the sexual impulses, for in so far as they favor health, they favor all the impulses that are the result of health. The most that can be expected is that they may tend to restrain the manifestations of sex by dispersing the energy they generate.
There are many physical rules and precautions which are advocated, not without reason, as tending to inhibit or diminish sexual activity. The avoidance of heat and the cultivation of cold is one of the most important of these. Hot climates, a close atmosphere, heavy bed-clothing, hot baths, all tend powerfully to excite the sexual system, for that system is a peripheral sensory organ, and whatever stimulates the skin generally, stimulates the sexual system.[99]Cold, which contracts the skin, also deadens the sexual feelings, a fact which the ascetics of old knew and acted upon. The garments and the posture of the body are not without influence. Constriction or pressure in the neighborhood of the sexual region, even tight corsets, as well as internal pressure, as from a distended bladder, are sources of sexual irritation. Sleeping on the back, which congests the spinal centres, also acts in the same way, as has long been known by those who attend to sexual hygiene; thus it is stated that in the Franciscan order it is prohibited to lie on the back. Food and drink are, further, powerful sexual stimulants. This is true even of the simplest and most wholesome nourishment, but it is more especially true of flesh meat, and, above all, of alcohol in its stronger forms such as spirits, liqueurs, sparkling and heavy wines, and even many English beers. This has always been clearly realized by those who cultivate asceticism, and it is one of the powerful reasons why alcohol should not be given in early youth. As St. Jerome wrote, when telling Eustochium that she must avoid wine like poison, "wine and youth are thetwo fires of lust. Why add oil to the flame?"[100]Idleness, again, especially when combined with rich living, promotes sexual activity, as Burton sets forth at length in hisAnatomy of Melancholy, and constant occupation, on the other hand, concentrates the wandering activities.
Mental exercise, like physical exercise, has sometimes been advocated as a method of calming sexual excitement, but it seems to be equally equivocal in its action. If it is profoundly interesting and exciting it may stir up rather than lull the sexual emotions. If it arouses little interest it is unable to exert any kind of influence. This is true even of mathematical occupations which have been advocated by various authorities, including Broussais, as aids to sexual hygiene.[101]"I have tried mechanical mental work," a lady writes, "such as solving arithmetical or algebraic problems, but it does no good; in fact it seems only to increase the excitement." "I studied and especially turned my attention to mathematics," a clergyman writes, "with a view to check my sexual tendencies. To a certain extent I was successful. But at the approach of an old friend, a voice or a touch, these tendencies came back again with renewed strength. I found mathematics, however, the best thing on the whole to take off my attention from women, better than religious exercises which I tried when younger (twenty-two to thirty)." At the best, however, such devices are of merely temporary efficacy.
It is easier to avoid arousing the sexual impulses than to impose silence on them by hygienic measures when once they arearoused. It is, therefore, in childhood and youth that all these measures may be most reasonably observed in order to avoid any premature sexual excitement. In one group of stolidly normal children influences that might be expected to act sexually pass away unperceived. At the other extreme, another group of children are so neurotically and precociously sensitive that no precautions will preserve them from such influences. But between these groups there is another, probably much the largest, who resist slight sexual suggestions but may succumb to stronger or longer influences, and on these the cares of sexual hygiene may profitably be bestowed.[102]
After puberty, when the spontaneous and inner voice of sex may at any moment suddenly make itself heard, all hygienic precautions are liable to be flung to the winds, and even the youth or maiden most anxious to retain the ideals of chastity can often do little but wait till the storm has passed. It sometimes happens that a prolonged period of sexual storm and stress occurs soon after puberty, and then dies away although there has been little or no sexual gratification, to be succeeded by a period of comparative calm. It must be remembered that in many, and perhaps most, individuals, men and women, the sexual appetite, unlike hunger or thirst, can after a prolonged struggle, be reduced to a more or less quiescent state which, far from injuring, may even benefit the physical and psychic vigor generally. This may happen whether or not sexual gratification has been obtained. If there has never been any such gratification, the struggle is less severe and sooner over, unless the individual is of highly erotictemperament. If there has been gratification, if the mind is filled not merely with desires but with joyous experience to which the body also has grown accustomed, then the struggle is longer and more painfully absorbing. The succeeding relief, however, if it comes, is sometimes more complete and is more likely to be associated with a state of psychic health. For the fundamental experiences of life, under normal conditions, bring not only intellectual sanity, but emotional pacification. A conquest of the sexual appetites which has never at any period involved a gratification of these appetites seldom produces results that commend themselves as rich and beautiful.
In these combats there are, however, no permanent conquests. For a very large number of people, indeed, though there may be emotional changes and fluctuations dependent on a variety of circumstances, there can scarcely be said to be any conquest at all. They are either always yielding to the impulses that assail them, or always resisting those impulses, in the first case with remorse, in the second with dissatisfaction. In either case much of their lives, at the time when life is most vigorous, is wasted. With women, if they happen to be of strong passions and reckless impulses to abandonment, the results may be highly enervating, if not disastrous to the general psychic life. It is to this cause, indeed, that some have been inclined to attribute the frequent mediocrity of women's work in artistic and intellectual fields. Women of intellectual force are frequently if not generally women of strong passions, and if they resist the tendency to merge themselves in the duties of maternity their lives are often wasted in emotional conflict and their psychic natures impoverished.[103]
The extent to which sexual abstinence and the struggles it involves may hamper and absorb the individual throughout life is well illustrated in the following case. A lady, vigorous, robust, and generally healthy, of great intelligence and high character, has reached middle life without marrying, or ever having sexual relationships. She was an only child, and when between three and four years of age, a playmate some six years older, initiated her into the habit of playing with her sexual parts. She was, however, at this age quite devoid of sexual feelings, and the habit dropped naturally, without any bad effects, as soon as she left the neighborhood of this girl a year or so later. Her health was good and even brilliant, and she developed vigorously at puberty. At the age of sixteen, however, a mental shock caused menstruation to diminish in amount during some years, and simultaneously with this diminution persistent sexual excitement appeared spontaneously, for the first time. She regarded such feelings as abnormal and unhealthy, and exerted all her powers of self-control in resisting them. But will power had no effect in diminishing the feelings. There was constant and imperious excitement, with the sense of vibration, tension, pressure, dilatation and tickling, accompanied, it may be, by some ovarian congestion, for she felt that on the left side there was a network of sexual nerves, and retroversion of the uterus was detected some years later. Her life was strenuous with many duties, but no occupation could be pursued without this undercurrent of sexual hyperæsthesia involving perpetual self-control. This continued more or less acutely for many years, when menstruation suddenly stopped altogether, much before the usual period of the climacteric. At the same time the sexual excitement ceased, and she became calm, peaceful, and happy. Diminished menstruation was associated with sexual excitement, but abundant menstruation and its complete absence were both accompanied by the relief of excitement. This lasted for two years. Then, for the treatment of a trifling degree of anæmia, she was subjected to a long, and, in her case, injudicious course of hypodermic injections of strychnia. From that time, five years ago, up to the present, there has been constant sexual excitement, and she has always to be on guard lest she should be overtaken by a sexual spasm. Her torture is increased by the fact that her traditions make it impossible for her (except under very exceptional circumstances) to allude to the cause of her sufferings. "A woman is handicapped," she writes. "She may never speak to anyone on such a subject. She must live her tragedy alone, smiling as much as she can under the strain of her terrible burden." To add to her trouble, two years ago, she felt impelled to resort to masturbation, and has done so about once a month since; this not only brings no real relief, and leaves irritability, wakefulness, and dark marks under the eyes, but is a cause of remorse to her, for she regards masturbation asentirely abnormal and unnatural. She has tried to gain benefit, not merely by the usual methods of physical hygiene, but by suggestion, Christian Science, etc., but all in vain. "I may say," she writes, "that it is the most passionate desire of my heart to be freed from this bondage, that I may relax the terrible years-long tension of resistance, and be happy in my own way. If I had this affliction once a month, once a week, even twice a week, to stand against it would be child's play. I should scorn to resort to unnatural means, however moderately. But self-control itself has its revenges, and I sometimes feel as if it is no longer to be borne."
The extent to which sexual abstinence and the struggles it involves may hamper and absorb the individual throughout life is well illustrated in the following case. A lady, vigorous, robust, and generally healthy, of great intelligence and high character, has reached middle life without marrying, or ever having sexual relationships. She was an only child, and when between three and four years of age, a playmate some six years older, initiated her into the habit of playing with her sexual parts. She was, however, at this age quite devoid of sexual feelings, and the habit dropped naturally, without any bad effects, as soon as she left the neighborhood of this girl a year or so later. Her health was good and even brilliant, and she developed vigorously at puberty. At the age of sixteen, however, a mental shock caused menstruation to diminish in amount during some years, and simultaneously with this diminution persistent sexual excitement appeared spontaneously, for the first time. She regarded such feelings as abnormal and unhealthy, and exerted all her powers of self-control in resisting them. But will power had no effect in diminishing the feelings. There was constant and imperious excitement, with the sense of vibration, tension, pressure, dilatation and tickling, accompanied, it may be, by some ovarian congestion, for she felt that on the left side there was a network of sexual nerves, and retroversion of the uterus was detected some years later. Her life was strenuous with many duties, but no occupation could be pursued without this undercurrent of sexual hyperæsthesia involving perpetual self-control. This continued more or less acutely for many years, when menstruation suddenly stopped altogether, much before the usual period of the climacteric. At the same time the sexual excitement ceased, and she became calm, peaceful, and happy. Diminished menstruation was associated with sexual excitement, but abundant menstruation and its complete absence were both accompanied by the relief of excitement. This lasted for two years. Then, for the treatment of a trifling degree of anæmia, she was subjected to a long, and, in her case, injudicious course of hypodermic injections of strychnia. From that time, five years ago, up to the present, there has been constant sexual excitement, and she has always to be on guard lest she should be overtaken by a sexual spasm. Her torture is increased by the fact that her traditions make it impossible for her (except under very exceptional circumstances) to allude to the cause of her sufferings. "A woman is handicapped," she writes. "She may never speak to anyone on such a subject. She must live her tragedy alone, smiling as much as she can under the strain of her terrible burden." To add to her trouble, two years ago, she felt impelled to resort to masturbation, and has done so about once a month since; this not only brings no real relief, and leaves irritability, wakefulness, and dark marks under the eyes, but is a cause of remorse to her, for she regards masturbation asentirely abnormal and unnatural. She has tried to gain benefit, not merely by the usual methods of physical hygiene, but by suggestion, Christian Science, etc., but all in vain. "I may say," she writes, "that it is the most passionate desire of my heart to be freed from this bondage, that I may relax the terrible years-long tension of resistance, and be happy in my own way. If I had this affliction once a month, once a week, even twice a week, to stand against it would be child's play. I should scorn to resort to unnatural means, however moderately. But self-control itself has its revenges, and I sometimes feel as if it is no longer to be borne."
Thus while it is an immense benefit in physical and psychic development if the eruption of the disturbing sexual emotions can be delayed until puberty or adolescence, and while it is a very great advantage, after that eruption has occurred, to be able to gain control of these emotions, to crush altogether the sexual nature would be a barren, if not, indeed, a perilous victory, bringing with it no satisfaction. "If I had only had three weeks' happiness," said a woman, "I would not quarrel with Fate, but to have one's whole life so absolutely empty is horrible." If such vacuous self-restraint may, by courtesy, be termed a virtue, it is but a negative virtue. The persons who achieve it, as the result of congenitally feeble sexual aptitudes, merely (as Gyurkovechky, Fürbringer, and Löwenfeld have all alike remarked) made a virtue of their weakness. Many others, whose instincts were less weak, when they disdainfully put to flight the desires of sex in early life, have found that in later life that foe returns in tenfold force and perhaps in unnatural shapes.[104]
The conception of "sexual abstinence" is, we see, an entirely false and artificial conception. It is not only ill-adjusted to the hygienic facts of the case but it fails even to invoke any genuinely moral motive, for it is exclusively self-regarding and self-centred. It only becomes genuinely moral, and truly inspiring, when we transform it into the altruistic virtue of self-sacrifice. When we have done so we see that the element of abstinence in it ceases to be essential, "Self-sacrifice," writes the author of a thoughtful book on the sexual life, "is acknowledged to be the basis of virtue; the noblest instances of self-sacrifice are those dictated by sexual affection. Sympathy is the secret of altruism; nowhere is sympathy more real and complete than in love. Courage, both moral and physical, the love of truth and honor, the spirit of enterprise, and the admiration of moral worth, are all inspired by love as by nothing else in human nature. Celibacy denies itself that inspiration or restricts its influence, according to the measure of its denial of sexual intimacy. Thus the deliberate adoption of a consistently celibate life implies the narrowing down of emotional and moral experience to a degree which is, from the broad scientific standpoint, unjustified by any of the advantages piously supposed to accrue from it."[105]
In a sane natural order all the impulses are centred in the fulfilment of needs and not in their denial. Moreover, in this special matter of sex, it is inevitable that the needs of others, and not merely the needs of the individual himself, should determine action. It is more especially the needs of the female which are the determining factor; for those needs are more various, complex and elusive, and in his attentiveness to their gratification the male finds a source of endless erotic satisfaction. It might be thought that the introduction of an altruistic motive here is merely the claim of theoretical morality insisting that there shall be a firm curb on animal instinct. But, as we have again and again seen throughout the long course of theseStudies, it is not so. The animal instinct itself makes this demand. It is abiological law that rules throughout the zoölogical world and has involved the universality of courtship. In man it is only modified because in man sexual needs are not entirely concentrated in reproduction, but more or less penetrate the whole of life.
While from the point of view of society, as from that of Nature, the end and object of the sexual impulse is procreation, and nothing beyond procreation, that is by no means true for the individual, whose main object it must be to fulfil himself harmoniously with that due regard for others which the art of living demands. Even if sexual relationships had no connection with procreation whatever—as some Central Australian tribes believe—they would still be justifiable, and are, indeed, an indispensable aid to the best moral development of the individual, for it is only in so intimate a relationship as that of sex that the finest graces and aptitudes of life have full scope. Even the saints cannot forego the sexual side of life. The best and most accomplished saints from Jerome to Tolstoy—even the exquisite Francis of Assisi—had stored up in their past all the experiences that go to the complete realization of life, and if it were not so they would have been the less saints.
The element of positive virtue thus only enters when the control of the sexual impulse has passed beyond the stage of rigid and sterile abstinence and has become not merely a deliberate refusal of what is evil in sex, but a deliberate acceptance of what is good. It is only at that moment that such control becomes a real part of the great art of living. For the art of living, like any other art, is not compatible with rigidity, but lies in the weaving of a perpetual harmony between refusing and accepting, between giving and taking.[106]
The future, it is clear, belongs ultimately to those who are slowly building up sounder traditions into the structure of life. The "problem of sexual abstinence" will more and more sink into insignificance. There remain the great solid fact of love, the great solid fact of chastity. Those are eternal. Between themthere is nothing but harmony. The development of one involves the development of the other.
It has been necessary to treat seriously this problem of "sexual abstinence" because we have behind us the traditions of two thousand years based on certain ideals of sexual law and sexual license, together with the long effort to build up practices more or less conditioned by those ideals. We cannot immediately escape from these traditions even when we question their validity for ourselves. We have not only to recognize their existence, but also to accept the fact that for some time to come they must still to a considerable extent control the thoughts and even in some degree the actions of existing communities.
It is undoubtedly deplorable. It involves the introduction of an artificiality into a real natural order. Love is real and positive; chastity is real and positive. But sexual abstinence is unreal and negative, in the strict sense perhaps impossible. The underlying feelings of all those who have emphasized its importance is that a physiological process can be good or bad according as it is or is not carried out under certain arbitrary external conditions, which render it licit or illicit. An act of sexual intercourse under the name of "marriage" is beneficial; the very same act, under the name of "incontinence," is pernicious. No physiological process, and still less any spiritual process, can bear such restriction. It is as much as to say that a meal becomes good or bad, digestible or indigestible, according as a grace is or is not pronounced before the eating of it.
It is deplorable because, such a conception being essentially unreal, an element of unreality is thus introduced into a matter of the gravest concern alike to the individual and to society. Artificial disputes have been introduced where no matter of real dispute need exist. A contest has been carried on marked by all the ferocity which marks contests about metaphysical or pseudo-metaphysical differences having no concrete basis in the actual world. As will happen in such cases, there has, after all, been no real difference between the disputants because the point they quarreled over was unreal. In truth each side was right and each side was wrong.