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"A NOTE ON THE TREATMENT OF SEXUAL INVERSION," in The Alienist and Neurologist, vol. 17 (1896): pp. 257-264.

[p. 257]


Honorary Fellow of the Chicago Academy of Medicine.

In concluding my brief psychological study of sexual inversion, I wish to make a few remarks concerning the general medical aspects of inversion, its prophylaxis and hygiene.

The question of the prevention of homosexuality is a large one, but it 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, as in a very large proportion of cases there is little congenital element, sound social hygiene should render difficult the acquisition of homosexual perversity. What we need first of all is a much greater degree of sincerity concerning the actual facts. The school is undoubtedly the great breeding-place of artificial homosexuality among the general population - at all events in England. Its influence in this respect may have been over estimated, but it is undoubtedly large. It is very unfortunate that school authorities do their best to ignore and conceal the facts. The time is coming, however, when much greater attention to this matter will be insisted on in physicians and others who have the care of boys in large public and other schools. We cannot allow such persons to be mere instruments in the hands of corporations and individuals who are prepared to sacrifice everything to what is called the "school" or "the prosperity of the school," but which has nothing whatever to do with education or with the welfare of the scholar. While much may be done by physical hygiene and other means to prevent the extension of homo-

[p.258] sexuality in schools,* it is impossible, even if it were desirable, absolutely to repress the emotional manifestations of sex in either boys or girls who have reached the age of puberty. The only way to render such manifestations wholesome, as well as to prepare for the relationships of later life, is to ensure the adoption, so far as possible, of the methods of co-education of the sexes. This, however, is not the place to insist on the desirability of co-education.Ý

Turning from the prevention of sexual inversion to its medical treatment, so far as I am entitled to any opinion I strongly advocate discrimination, caution and scepticism.ÝÝ I have little sympathy with those who are prepared to "cure" the invert at any price. Dr. von Schrenck-Notzing, the best known and most successful of these operators, seems to me to serve rather as a warning than as an example. He undertakes even the most pronounced cases of inversion, by courses of treatment lasting more than a year and involving, in at least one case, nearly 150 hypnotic sittings; he prescribes frequent visits to the brothel previous to which the patient takes large doses of alcohol; by prolonged manipulations a prostitute endeavors to excite erection, a process attended with varying results. It appears that in some cases this course of treatment has been attended by a certain sort of success, to which an unlimited good will on the part of the patient, it is needless to say, has largely contributed. The treatment is, however, usually interrupted by continual backsliding to homosexual practices, and sometimes, naturally, the cure involves a venereal disorder. The patient is enabled to marry and to bear children; how the children ...

* In this connection I may refer to the writings of Dr. Clement Dukes, physician to Rugby School, who fully recognizes the risks of school life. There was also an interesting discussion on sexual vice in schools, started by an address by the Rev. J. M. Wilson, headmaster of Clifton College, in the Journal of Education, 1881-2.

Ý Reference may, however, be made to the fact that those persons who have themselves been co-educated with the opposite sex are almost unanimously in favor of such education. See, for instance, "Will the Co-Educated Co-Educate their Children?" (Forum, July, 1894) by Prof. Martha F. Crow, who specially investigated this point. And with regard to the importance of the sexual emotions generally and their training, I may refer to a remarkable book just published by Edward Carpenter, "Love's Coming of Age," Manchester, 1896.

ÝÝ Reference may be made to the wise and comprehensive conclusions of Moll on this matter in his Die Contrare Sexualempfindung.


[p. 259] turn out it is yet too early to say.* Dr. von Schrenck-Notzing may certainly be congratulated on the time, patience and energy which he devotes to his patients. Whether he may be congratulated or the treatment itself, and its results, is less certain. For my own part, I frankly confess that the remedy seems to me worse than the disease. The histories I have recorded in previous articles 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 masturbation per 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.Ý

The sexual invert is specially liable to suffer from a high a degree of neurasthenia, often involving much nervous weakness and irritability, loss of self-control and genital hyperasthesia. This is a condition which may be ameliorated, and it 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 such a prolonged course of 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. Before deciding if is desirable to attempt so radical a change in the sexual impulse, it is necessary to have full knowledge of the patient and his history. If he is still young, and if the ...

* See, for instance, Dr. Freiherr von Schrenck-Notzing, Ein Beitrag zur Aetiologie der Contraren Sexualempfindung, Vienna, 1895.

Ý Raffalovich, Uranismite et Unisexualite, 1896, p. 16. He remarks that the congenital invert who has never had relations with women, and whose abnormality, to use Krafft-Ebing's distinction, is a perversion and not a perversity, is much less dangerous and apt to seduce than the more versatile and corrupt person who has known all methods of gratification.


[p. 260] perversion does not appear to be deeply rooted in the organism, it is probable that - provided his own good will is aiding - general hygienic measures together with removal to 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. A brothel, on which Schrenck-Notzing relies, is scarcely a desirable method of treatment from any of view; to say no more, it is not calculated to attract an individual who is already inspired with disgust of women regarded as objects of desire. The assistance of an honest woman would be much better therapeutically, but it can very seldom be right and feasible to obtain the help of one who is likely to be successful. Hypnotic suggestion has undoubtedly proved helpful in many hands.

While it is no doubt a duty to aid those who are anxious for aid to get rid of their abnormality, it is not possible to look upon the results of such aid, even if successful, 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. What usually happens is that the person becomes capable of experiencing both impulses, not a specially satisfactory state of things.

Moreover, it is often not difficult to prematurely persuade an invert that his condition is changed; his health is perhaps improving, and if he experiences some slight attraction to a person of the opposite sex he hastily assumes that a deep and permanent change has occurred. This may be disatrous [sic], 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.*

* I have recently been told, by a distinguished physician who was consulted in case of a congenital invert, highly placed in the English government service, who lately married in the hope of escaping his perversion, and was not even able to consummate the marriage. It is needless to insist on the misery which is created in such cases.


[p. 261] Nor is it possible to view with satisfaction the prospects of inverts begetting or bearing children. Often, no doubt, the children turn out fairly well, but for the most part they bear witness that they belong to a neurotic and failing stock. Sometimes, indeed, 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.

We can seldom, therefore, safely congratulate ourselves on the success of any "cure" of inversion. The success is unlikely to be either permanent or complete, in the case of a decided invert; and in the most successful cases we have simply put into the invert's hands a power of reproduction which it is undesirable he should possess. The satisfactory result is probably obtained when it is possible by direct and indirect methods to reduce the sexual hyperaesthesia which usually exists when the medical treatment of inversion comes into question, and by psychic methods to refine and spiritualize the inverted impulse, so that the invert's natural perversion may not become a cause of acquired perversity in others. The invert is not only the victim of his own abnormal obsession; he is the victim of social hostility. We must seek to distinguish the part in his sufferings due to these two causes. When I review the cases I have brought forward and the mental history of inverts I have known, I am inclined to say that if we can enable an invert to be healthy, self-restrained and self-respecting we have often done better than to convert him into the mere feeble simulacrum of a normal man. An appeal to the paiderastia of the best Greek days, and the dignity, temperance, even chastity, which it involved will sometimes find a ready response in the emotional, enthusiastic nature of the congenital invert. The "manly love" celebrated by Walt Whitman in "Leaves of Grass," although it may be of doubtful value for general use, furnishes a wholesome ideal to the invert who is insensitive to normal heterosexual ideals. It is by some such methods of self-treatment as this that most of the more highly intelligent persons whose histories I have already briefly recorded have ...

[p. 262] at last slowly and instinctively reached a condition of relative health and peace, both physical and moral. This method of self-restraint and self-culture, without self-repression, seems to be the most rational method of dealing with sexual inversion when that condition is really organic and deep-rooted. It is better that a man should be enabled to make the best of his own strong natural instincts, with all their disadvantages, than that he should be unsexed and perverted, crushed into a position which he has no natural aptitude to occupy. What good work in the world the inverted may do is shown by the historical examples of distinguished inverts; and while it is certainly true that these considerations apply chiefly to the finer grained natures, the histories I have brought together suffice to show that such natures constitute a considerable proportion of inverts. The helplessly gross sexual appetite cannot thus be influenced; but that remains true whether the appetite is homosexual or heterosexual, and nothing is gained by enabling it to feed on women as well as on men.

It can scarcely be said that the attitude of society is favorable to the invert's attainment of a fairly sane well balanced attitude. This is, indeed, one of the great difficulties in his way that causes him to waver between extremes of melancholia and egotistic exaltation. This is well brought out in a vigorous document by a very able writer, which I may here publish:

"In this case the strength of sin is the law. No passion, however natural, which is scouted, despised, tabooed, banned, punished, relegated to holes and corners, execrated as abominable and unmentionable, can be expected to show its good side to the world. The sense of sin and crime and danger, the humiliation and repression and distress to which the unfortunate Pariahs of abnormal sexuality are daily and hourly exposed - and nobody but such a Pariah can comprehend what these are - inevitably deteriorate the best and noblest element in their emotion. It has been, I may truly say, the greatest sorrow of my life to watch the gradual dwindling and decay of emotions which started so purely and ideally, as well as passionately, for persons of my own sex in boyhood, to watch within myself, I repeat, the slow corrosion and corruption of a sentiment which might have ...

[p. 263] been raised, under happier conditions, to such spiritual heights of love and devotion, as chivalry is fabled to have reached - and at the same time to have been continually tormented by desires which no efforts would annihilate, which never slumbered except during weeks of life-threatening illness, and which, instead of improving in quality with age, have tended to become coarser and more contented with a trivial satisfaction. Give abnormal love the same chance as normal love, subject it to the wholesome control of public opinion, allow it to enjoy self-respect, draw it from dark places into the light of day, strike off its chains and make it free - and I am confident that it will develop analogous virtues, chequered of course by analogous vices, to those with which we are familiar in the mutual love of male and female. The slave has of necessity a slavish soul. The only way to elevate is to emancipate him. There is nothing more degrading to humanity in sexual acts performed between a man and a man than in similar acts performed between a man and a woman. In a certain sense all sex has an element which stirs repulsion in our finer nature. The high gods have

'Strewed one marriage bed with tears and fire,
'For extreme loathing and supreme desire.'
"Nor would it be easy to maintain that the English curate begetting his fourteenth baby on the body of a worn-out wife is a more elevating object of mental contemplation than Harmodius in the embraces of his friend Aristogiton - that a young man sleeping with a prostitute picked up in the Haymarket is cleaner than his brother sleeping with a soldier picked up in the Park."

That is a statement of the matter as it appears to the most fortunate and the most successful of these pariahs. The case of most is far worse. While many become brutalized by this antagonism, the abject prey of their perverted instincts. The passage just quoted, however, by no means expresses the feelings of all inverts. It may be well here to quote Mr. Raffalovich who writes with a full knowledge of his subject:

"I do not believe that inverts are so much to be pitied as Kraft-Ebing thinks; if they are superior inverts they only suffer what superior men always suffer; the struggle between conscience, desire, prudence and the world is not worse for the superior invert than for the superior heterosexual man.

[p. 264] Their inversion has never prevented the great inverts from being themselves, and doing their work in the world. Do you think that Plato, Walt Whitman, Michael Angelo, the great Conde, Winkelmann, and the legion of others had the right or the wish to complain of their homosexuality? * * * As to ordinary and abject inverts, they do not think themselves more to be pitied than men who are drunkards by taste or by habit."*

It is necessary to give full weight to these aspects of the matter in coming to any decision regarding the treatment of any particular case of inversion. The physician's task, rightly considered, is not that of merely enabling an invert to commit masturbation per vaginam. His task is more difficult and more complex, and can only be determined by a full consideration of each case, as it arises. Before sexual practices can wisely be changed, sexual ideals must be changed. To attempt to force an invert into connection with a woman before making the feminine ideal desirable to him should be considered a gross and discreditable failure of psychological insight.

* Uranisme, p. 91.