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 o ly 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.