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Sexual Habits





As was emphasized in the preceding chapter, sexual symptoms are
usually the subject of so much worry and disturbance of mind and
become the center of so much unfavorable suggestion, that the only way
to ameliorate the conditions which develop is by securing relaxation
of the attention and diversion of mind. Mental influence is much more
important than any other remedies that we have at our command in these
cases, not only for their relief but for their ultimate cure.

A state of depression of mind similar to that which develops in
patients frightened by seminal emissions is often seen in those who
have for some time indulged in the habit of self-abuse. Rather
frequently a physician, especially if he is known to be interested in
nervous diseases, has to listen to the story of a patient who is sure
that his health is completely undermined and that his future is the
darkest possible, because of this habit in younger days. Usually the
patient is a young man who has been reading some of the literature of
the advertising "specialists" who distribute reading matter which
pictures appalling and almost irretrievable effects from such sexual
habits. The consequence is that the patient is in highly nervous
condition, has lost his appetite, is not sleeping well, is avoiding
society, because he fears that some one may recognize his condition
and its cause, and he is really in a pitiable state. Such patients are
usually sure that little can be done for them. Sometimes they have
already been through the hands of several "specialists," particularly
of the mail-order variety, and the literature provided for them and
the letters written to them have all helped to make them worse and
much more solicitous about themselves.



Unfortunately some of the exaggerated notions with regard to the
effect of these habits that are so widely diffused by the exploiters
of the young have been adopted by moralists with the idea that they
can thus deter youth from certain practices and scare the victims of
such habits out of them. It is extremely doubtful, however, whether
self abuse of itself, unless practiced in very early years or indulged
in to a degree that is possible only in those of unbalanced mind, ever
works anything like the serious harm that is claimed. Certainly
physicians who are most familiar with its results are not ready to
confirm the opinions usually advanced as to the awful harmfulness of
the practice. Personally, I have had a number of patients confess to
me that they had indulged in the habit to some extent for twenty years
and longer and yet had never suffered anything more than passing
physical discomfort. It is unfortunate, then, that the exaggerations
of the quack should by receiving the approval of the well-intentioned
moralists, be emphasized so as to add to the neurotic disturbance of
mind which makes these patients so miserable and for a time may
seriously interfere with their health. Occasionally even suicides are
reported in which the underlying motive seems to have been the dread
on the part of a young man that a sexual habit has so undermined his
health that cure is impossible and that physical and mental
deterioration to a marked degree is inevitable. The opinions of
conservative physicians tend to show that there is no good reason for
thinking that in normal healthy persons such habits ever have the
serious effects thus set forth.

Patients can be assured that whatever evil effects follow the practice
will not remain after it has been given up. There are no serious
enduring sequelae, with one or two exceptions in very special cases,
that perhaps should be noticed. Most men of considerable experience in
the matter are now decidedly of the opinion that self-abuse does not
produce any more serious consequences than the same amount of ordinary
sexual intercourse. It is possible for sexual intercourse indulged in
excessively, as it sometimes is in early marital life, to produce the
same feelings of exhaustion, lack of control over the vasomotor system
and disturbance of the gastro-intestinal tract which are noted in
self-abuse. In both cases the symptoms promptly disappear upon proper
regulation of life. This is a very different opinion from that which
used to be expressed in this matter and it is given only after due
deliberation and consultation of many authorities both in writing and
orally. Its expression, far from taking away one of the best deterrent
motives against the practice, rather forces an appeal to the manliness
of the individual. The motive of fear never accomplishes much, while a
frank statement of the real condition may be greatly helpful.

While the habit of self-abuse as indulged in by the ordinary
individual practically never has the awful consequences that have been
sometimes pictured as resulting from it even long after its cessation,
there is no doubt that it is productive of many physical symptoms
during the time of its indulgence. There is almost sure to be a
discouraging lassitude and a tendency to exhaustion after even
comparatively small efforts. While this is true for ordinary muscular
efforts it is also true for other bodily functions that involve
muscular activity. In recent years we have learned that of the stomach
functions the motor is more important than the chemical. In the bowels
the motor function is extremely important. There are likely to be
disturbances, then, in the gastro-intestinal tract as a consequence of
the muscular condition that develops in those patients. Probably
more important even than the physical, however, are the psychic
results of the habit. The patient feels discouraged and cast down at
his inability to conquer himself and is likely to avoid such exercise
and diversion of mind as would make normal healthy function possible.


Mental Disturbances.--It is the custom to say that mental
deterioration almost surely follows the habit. Those familiar with
mental cases often see self-abuse practiced with serious results by
young folks whose mentality is deteriorated. In these cases the
practice was indulged in with great frequency and with direct physical
consequences, such as loss of sleep, of appetite and the like. It is
not the habit, however, that has caused the mental deterioration. The
young patients are going crazy, but not because of self-abuse. Their
habit of self-abuse had originated and become exaggerated because they
were already mentally unbalanced. Their extreme indulgence in it is
especially due to their lack of control over themselves, because they
are not possessed of strong will power with regard to any thing. A
vicious circle is formed and the insane young man gradually deepens
his insanity by hurting his physical condition through over-indulgence
in the habit and all this further lessens his self-control; but were
it not for the original mental weakness the habit would not have been
indulged in to so great an extent.


Effect on Prostate.--There is one phase of the ill effects of
self-abuse that it is well to recall as having the confirmation of men
of large experience and conservative views. There is a definite
impression among specialists in genito-urinary diseases that
enlargement of the prostate in some cases is due to the frequently
repeated irritation and the prolongation of that irritation of the
prostate during the practice of self-abuse. When such men as Bangs and
Keyes are agreed on a subject of this kind, then even though in a
certain number of cases the changes in the prostate leading to its
enlargement are evidently inflammatory, it is well to consider that
the functional over-activity of the gland superinduced by the practice
may lead at least to an enlargement of the glandular elements with the
consequent interference with urination which so frequently comes in
old age.


Physical Factors.--Besides mental elements that predispose to the
formation of sexual habits there are physical factors that are
important in these cases. They must be particularly looked for and
treated carefully if found, or there can be little hope of relief for
the conditions. The most prominent of these is the existence of a long
foreskin, especially if its opening is small, thus leading to the
retention of urine, the deposition of urinary salts with the formation
of preputial concretions or so-called calculi. These are intensely
irritant, cause frequent itching and thus predispose to these sexual
habits. Even where the preputial opening is free and allows egress of
urine without residue, the accumulation of smegma often causes
considerable irritation and if the most scrupulous cleanliness with
cleansing at least once a day is not maintained, irritative conditions
arise, especially in hot weather, that may give occasions for sex
habits.

Under these conditions the habit is sometimes seen in extremely early
years. The youngest case I ever saw occurred in a child not quite
nineteen months old whose mother said that for several months she had
noticed certain curious actions that she could scarcely understand
until finally the truth dawned on her. Then she was morbidly sensitive
about it, sure that the habit was due to a fault of her own and
it was some time before she consulted a physician. This was her fourth
child and, strange as it may seem, it was only at the conception of
this child that she first knew what sexual pleasure was. She feared
that her feeling had been in some way sinful and that as a consequence
of her sin this curious habit had developed in such early years in her
baby boy. As is usually the case in these instances, I found that the
prepuce was very tight indeed, having scarcely more than a pinhole
opening in it. During urination this ballooned and there remained in
the pouch-like process at the end of the penis a certain amount of
residual urine after every urination. From this urinary salts had been
precipitated and had formed scaly concretions which remained in the
preputial pouch and were extremely irritant. As a consequence of this
irritation the baby had been very itchy and it was in the endeavor to
relieve the itching by the natural process of scratching that the
pleasure of the sensations aroused had been discovered and the sexual
habit had been formed.

Not infrequently in young men a condition resembling this to some
degree at least is found and then, of course, the question of its
removal must be taken up at once. It is surprising how often in youths
in their late teens concretions are seen. The constant irritation
makes it practically impossible for the patient to keep his hands from
the parts, and so circumcision is absolutely necessary. Not
infrequently when the preputial condition is not nearly so bad this
operation may also be at least advisable if not necessary. The matter
of cleanliness must be attended to, preferably after getting up in the
morning and not before going to bed at night, for the reaction after
cold water may cause congestion of the organ. After a time the
frequent use of cold water seems to make the parts much less reactive
to irritation of any kind.


Physical Effects.--The super-excitation of nerves consequent upon the
more or less general erethism that is induced, lessens resistive
vitality. Victims of the habit are more liable to colds, to various
infectious diseases, and are subject to fatigue and lassitude, with
incapacity to work to their full power. They lose control over their
vasomotor system to some extent as a result of this systemic erethism.
They blush easily, they perspire easily, there is a tendency in many
of them to flash as if of heat and cold, they become pale under
excitement or anger more than formerly, they are likely to suffer from
cold hands and feet, and the surface of the body is inclined to be
cold and as a consequence patients are tremulous. This represents a
waste of nervous energy and as a consequence sleep may be disturbed
and digestion interfered with.

It is important, therefore, to consider these cases as really needing
medical care. For their treatment the most important consideration is
prophylaxis, not alone of the habit itself, but of each of the acts.
Prophylaxis of the habit is an ethical question that we can scarcely
do justice to here. Prophylaxis of the acts requires consideration of
the physical and moral factors that predispose to their commission.
While the habit may have secured such deep control that the patient
almost despairs of relief from it, when care is taken to remove
physical and moral predispositions the conquest of the habit becomes
comparatively easy. Over and over again I have seen cases that have
lasted for years in which the patients were surprised at the ease with
which they were able to drop the habit just as soon as they took
the measures necessary to prevent predisposing conditions.


Breaking the Habit.--Once physical factors predisposing to it are
removed, the habit is not so hard to break as it would seem to be from
the suggestions to that effect made in sensational literature. It is
neither so deleterious in its physical effects nor so deteriorating as
regards character as is usually stated. Anyone with a reasonable
amount of firmness can break it off if he really resolves to. Over and
over again I have seen patients quite surprised at the ease with which
they were able to avoid the practice for weeks once they made up their
minds in the matter. Indeed this is one of the unfortunate features in
completely conquering the habit. It is comparatively so easy to break
it off when the mind is made up that there comes the feeling that now
it must be absolutely facile to keep away from it. This is, however,
never true. Relapses are extremely easy. If the patient allows himself
to read vicious books, or suggestive literature of any kind, or
permits himself an indulgence in the reading of several columns of the
account of a sex murder trial, or goes to see a sex problem play with
its suggestions, or exposes himself to sexually exciting conditions of
any kind, he will be almost sure to lapse into the old habit.

Relapses are almost inevitable. But it is easier to break the habit
the second time than it was the first and it becomes increasingly easy
if the patient keeps up the effort of regulating his life so as to
avoid the occasions of the habit. Relapses are quite as sure to occur
as with regard to alcoholism if occasions for the taking of liquor are
not sedulously avoided. The patient always seems to need a
confidant--someone to whom he can go for help and who assures him of
the ability that he has to overcome himself if he only will. The
practice of confession in the Roman Catholic Church makes it
comparatively easy for serious people of that faith to overcome the
habit. The physician must be taken into confidence in the same way and
for a time, at least once a week, the patient may have to be perfectly
frank with regard to his condition in order to have the help afforded
by such confidences. The physician can often, particularly at the
beginning, make the physical conditions such as to help in the
breaking of the habit. Bromides taken to the extent of a dram or more
a day are almost a specific for superirritability of the nervous
system, and if taken for two or three weeks the patient will usually
have little or no difficulty in overcoming the habit. They are not of
much avail after this time unless the patient's character has been
aroused to determined helpfulness in the matter.

In obstinate cases it may be necessary to have a patient come every
day, or at least every second day, for some time and give an account
of how he has succeeded in resisting his habit in the interval. At
least he must be asked to report whenever there is a lapse. It is
surprising how much the anticipation of having to tell someone else of
a drop back into the habit means in helping the patient eventually to
overcome it. Very slight motives serve to cause relapses, but almost
any external personal aid, if pursued with confidence, will avail
effectually to break it. I talk from an experience of many cases and
know how much can be accomplished even though patients insist that
they have tried all the resources of their will power and of prayer
without avail. They have really not tried, they have not willed in
reality; sometimes they have reached a point where they cannot
will without the moral support of another personality. This can be
readily supplied to them by a firm, sympathetic physician whom they
respect. It will take time to overcome the tendency to relapse
whenever the will is relapsed, but the habit itself can be broken
without much difficulty in a few days.

Certain times are particularly dangerous for relapses into the habit.
These are just before going to sleep at night and before getting out
of bed in the morning. At these times the mind must be occupied or
else the patient will almost surely find his habit recurring. Often
the habit of reading in bed, properly supported by pillows and with
abundant light at an angle that makes reading easy, seems to be good
for these patients, because they may read until their eyelids get
heavy, then pull the chain of their light to extinguish it and turn
over to sleep. In the morning prompt rising after waking is important.
Bed clothes that are too heavy and too great warmth of clothing
predispose to sexual excitation and must be avoided. The room should
be cool rather than warm and the mattress rather hard.

The more tired the patient is the less liability will there be to
difficulty in these matters. But air is even more important than
exercise in giving the tiredness which superinduces deep sleep. A
lessening of the normal amount of oxygen seems to relax the inhibitory
power of the higher centers over the sexual centers in the cord.
People who are drowned, those who are hanged, and those whose supply
of oxygen is shut off by the inhalation of the heavier gases are
likely to have involuntary seminal emissions. These are probably
consequent upon the shutting off of the air.

The important element in the treatment is to make the patient feel
that, if he really wants to, he can conquer in this matter. The old
motives of fear, and especially fear of physical consequences, were
quite unworthy, and inasmuch as they had any effect rather produced a
deterioration of character than a strengthening of it. The patient
must understand that if he is a man he can overcome it. Religious
motives will help much. I do not know that I have ever seen a case
where religious motives were not the most important element in the
cure, but that may be due to the conditions in which I have been
placed. I have seen a number of these cases in men and women because
clergymen have sent them to me in order that they might be helped in
the work of reform, and while there are many relapses and some had
apparently given up the effort in despair of their power to overcome
themselves, nine out of every ten of those who have seriously faced
the problem have succeeded in overcoming themselves, and as a result
have a better knowledge of their own characters and more respect for
themselves. They are better men in every way than if their improvement
had come about through selfish fear of physical consequences.


After Cure.--After the habit of self-abuse has been conquered the
seminal vesicles will have a tendency to evacuate themselves rather
more frequently than before and as a consequence they will nag at
certain sexual nerve endings. They are used to having their contents
emptied and distention is followed by rather ready evacuation. During
the course of this evacuation sexual thoughts are awakened in dreams
and this may lead to dream states in which there seem to be lapses
into the old habit. This constitutes a serious difficulty in getting
rid of the habit entirely in young and vigorous men. They may even
become disheartened by it. It should be explained to them that they
must let contrary habits form gradually and permit nature to
accommodate herself to the new state of affairs. The bromides are a
useful adjunct for body and mind.


Supposed After-effects.--At times a patient suffering from some
exhausting or serious disease, consumption, heart disease or the
various forms of Bright's disease, will be discouraged by remembrance
of the fact that in earlier years he allowed himself for some time to
fall into the habit of self-abuse. If he has read, and very few men
have not, some of the literature issued by the advertising
"specialists" and has heard the unfortunately exaggerated ideas
commonly entertained with regard to the influence on health of this
habit, he will become more or less disheartened by the idea that he
thus undermined his constitution and that one reason why he is not
able to react better against his affection is that he seriously
diminished his resistive vitality. This idea must, of course, be
overcome or it will act as a constant source of unfavorable
suggestion, lessening appetite, tending to disturb sleep, banishing
peace of mind to some extent and thus inhibiting the patient from
releasing such stores of vital energy for his recovery as would surely
be in his power under favorable conditions.


Female Habits.--The habit is more rare in women than in men, but when
it occurs is a little harder to break. In men it usually develops in
youth, but oftenest in women who are past thirty-five and unmarried.
In these cases it is much harder for the patient to regain
self-control, because the class of women patients who acquire such a
habit have less character, as a rule, than the men who fall into the
same condition. In all sex matters, once passion is aroused or habit
formed, the woman is likely to lose control of herself more than is
the man. Even in women, however, it is not only possible, but under
favorable circumstances, quite easy to secure a break in the habit,
though relapses are more frequent than in men. Certain occupations
seem particularly to favor the development of the habit. These are
mainly sedentary occupations that can be followed without the
necessity for such attention as to prevent the mind from wandering off
into thoughts that may prove provocative of sexual sensation.
Dressmakers seem particularly likely to suffer from the affection, and
those who run sewing-machines are predisposed by the movements
involved in their occupation to the development or, at least, to the
persistence of the habit.

For women even more than men religion and the motives it supplies are
the most efficient factors for the ultimate cure of the habit. In
general, the greater difficulty of overcoming it in them is due in no
small degree to the fact that they live indoors much more than men,
often have sedentary occupations, and are more frequently alone. These
afford opportunities for introspection and for the harboring of
thoughts that lead to relapses into the habit. Besides, women are more
prone to read novels and stories relating to sex problems and the
details of sex murder trials and the like which constitute
ever-recurring sources of mental erethism. If their habits can be
modified, especially if they can be made to realize the necessity for
being out in the air as much as possible, and for keeping their
windows open at night, as well as for thorough cleanliness--for every
gynecologist notes the necessity for this and how frequently it
happens that neglect of it leads to irritability of the external
organs that is of itself a serious factor--then it would be no more
difficult for women to overcome the habit and get beyond the relapses
than it is for men. Sometimes we have to overcome a morbid dread
of touching themselves even for cleansing purposes which allows the
accumulation of irritant material and predisposes to relapse.


Sexual Perversion.--Sexual perversions are sometimes considered as
different from sexual neuroses, but such they really are. They are
oftener due to habit than to anything deeper. Much has been said about
the unfortunate natural inclination of some people to indulge in
sexual perversion, but such talk partakes of the nature of similar
remarks with regard to habits of other kinds. The alcohol habit, for
instance, is formed by many men as the result of their environment and
a weakness of character, with lack of resolution to support themselves
in self-denial when they are tempted to drink. In recent years it has
been only too often the custom to excuse or to justify many of these
cases. There are a few persons in whom, owing to weakness of
character, alcoholism is more or less inevitable if occasions for
indulgence occur. And in the same way there has been much maudlin
sentimentality wasted on sexual perverts, as if most of these men
could not avoid the actions that the rest of humanity abominates.
There are, perhaps, a few individuals who because of a failure on the
part of nature to define sex in them properly--as if she had not quite
made up her mind which sex they should belong to--are more to be
pitied than held to account for their delinquencies in this matter.
Compared to the whole number of sexual perverts, however, these are
very few. Under the protection of the pity awakened for these, a large
number of others find quasi-justification for their acts.

Anyone who knows much about these patients realizes that their story
is, as a rule, very different from what it would be if they were
inevitably impelled to the commission of the acts in question. Many of
them had the greatest abhorrence for it at the beginning, were
attracted to it out of curiosity and morbid sexualism, because they
had allowed themselves to think and read and dream about sex matters
overmuch. They are usually idle people who do not take life seriously
and who have an inordinate curiosity about sex subjects. At the
beginning the commission of the perverted sexual act was associated
with an intensely deterrent rather than an attractive feeling, but
gradually this was overcome and a contrary habit has been formed. It
is difficult to break this habit and to get away from the morbid
sexual ideas that have been allowed to develop and grow strong in
connection with it.

This opinion is somewhat different from that held by many men who are
recognized as authorities on this subject and who find many excuses in
the nature of their patients for these perversions. If it is recalled,
however, that whenever wealth has brought luxury to a people and
luxury has brought over-refinement, such sex perversions have been
particularly noted, it will be realized that not nature, but the ways
of men are responsible for their development. Whenever men pay much
attention to their bodies, exercise for the sake of their muscles,
bathe not for cleanliness but for luxury, sex perversions become
common in history. The story of Greek love is well known.
Corresponding conditions developed at Rome under similar
circumstances. According to good authorities, the English universities
became tainted with it a generation ago. Our athletic clubs in this
country have rightly or wrongly fallen under suspicion in this matter,
though the tendency to exaggeration with regard to such things, and
popular credulity in such matters must be recalled. Some
confirmatory evidence undoubtedly there was. Sexual perversions then
would seem to be due in most cases to definite conditions and our
knowledge suggests readily what should be the prophylaxis.

In the course of some studies with Professor Magnan at L'Asile Ste
Anne in Paris I saw a number of these curious cases of sexual
divagations, exhibitionism, sex perversions and similar conditions.
Some of his cases were clearly curious examples of natural tendency,
at least, to mental hermaphroditism. Occasionally men of normal
development otherwise have a woman's waist and woman's torso above the
waist, and many womanly coquettish ways that point to this curious
mixture of sexes. Occasionally women are lacking in all the sex
characteristics of the upper portion of the body, have no breasts and
have the hirsute characteristics of men on the face and even on the
chest. In such cases one may be tempted to let one's pity override
one's better judgment and feel that resistance to the temptations to
indulge in perverted sexual feelings may be so difficult for these
people as to be almost impossible. Even in such cases, however, under
Magnan's gentle tutelage, under his faithful care and sympathy, men
and women lost most of the tendency to commit unnatural acts and
certainly found it easier to live normal lives than before.

For the majority of these sexual perverts, however, it is as with
regard to drug addictions, alcoholism, and obesity, just a question of
willing not to indulge in certain appetites that serves to help them.
There is no doubt that it is a difficult matter to break a habit that
has become a second nature, and it is almost impossible that it should
be accomplished without a number of relapses. If the patient really
wishes to correct the evil habit, however, this is perfectly possible.

The talk of a third sex with homo-sexual inclinations is quite beside
the mark. Certain of this class have a weakness of intellect and of
will that is at the root of their trouble, but not a few of them pride
themselves on their intellect and will power in most other things and
must not be permitted to deceive themselves as to their weakness and
its significance. It is not nature but self that is at fault and the
disease can be completely eradicated.





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Previous: Sexual Neuroses



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