Since Beard first described neurasthenia, many diverse opinions have been expressed concerning the relationships of sexual irregularities to neurasthenia. Gilles de la Tourette, in his little monograph on neurasthenia, following the traditions of Charcot's school, dismisses the question of any sexual causation without discussion. Binswanger (_Die Pathologie und Therapie der Neurasthenie_), while admitting that nearly all neurasthenic persons acknowledge masturbation at some period, considers it is not an important cause of neurasthenia, only differing from coitus by the fact that the opportunities for it are more frequent, and that the sexual disturbances of neurasthenia are, in the majority of cases, secondary. Rohleder, on the other hand, who takes a very grave view of the importance of masturbation, considers that its most serious results are a question of neurasthenia. Krafft-Ebing has declared his opinion that masturbation is a cause of neurasthenia. Christian, Leyden, Erb, Rosenthal, Beard, Hummel, Hammond, Hermann Cohn, Curschmann, Savill, Herman, Fürbringer, all attach chief importance to neurasthenia as a result of masturbation. Collins and Phillip (_Medical Record_, March 25, 1899), in an analysis of 333 cases of neurasthenia, found that 123 cases were apparently due to overwork or masturbation. Freud concludes that neurasthenia proper can nearly always be traced to excessive masturbation, or to spontaneous pollutions. (E.g., _Sammlung Kleiner Schriften zur Neurosenlehre_, first series, p. 187.) This view is confirmed by Gattel's careful study (_Ueber die Sexuellen Ursachen der Neurasthenie und Angstneurose_, 1898). Gattel investigated 100 consecutive cases of severe functional nervous disorder in Krafft-Ebing's clinic at Vienna, and found that in every case of neurasthenia in a male (28 in all) there was masturbation, while of the 15 women with neurasthenia, only one is recorded as not masturbating, and she practiced _coitus reservatus_. Irrespective of the particular form of the nervous disorder, Gattel found that 18 women out of 42, and 36 men out of 58, acknowledged masturbation. (This shows a slightly larger proportion among the men, but the men were mostly young, while the women were mostly of more mature age.) It must, however, always be remembered that we have no equally careful statistics of masturbation in perfectly healthy persons. We must also remember that we have to distinguish between the _post_ and the _propter_, and that it is quite possible that neurasthenic persons are specially predisposed to masturbation. Bloch is of this opinion, and remarks that a vicious circle may thus be formed.
On the whole, there can be little doubt that neurasthenia is liable to be associated with masturbation carried to an excessive extent. But, while neurasthenia is probably the severest affection that is liable to result from, or accompany, masturbation, we are scarcely yet entitled to accept the conclusion of Gattel that in such cases there is no hereditary neurotic predisposition. We must steer clearly between the opposite errors of those, on the one hand, who assert that heredity is the sole cause of functional nervous disorders, and those, on the other hand, who consider that the incident that may call out the disorder is itself a sole sufficient cause.
In many cases it has seemed to me that masturbation, when practiced in excess, especially if begun before the age of puberty, leads to inaptitude for coitus, as well as to indifference to it, and sometimes to undue sexual irritability, involving premature emission and practical impotence. This is, however, the exception, especially if the practice has not been begun until after puberty. In women I attach considerable importance, as a result of masturbation, to an aversion for normal coitus in later life. In such cases some peripheral irritation or abnormal mental stimulus trains the physical sexual orgasm to respond to an appeal which has nothing whatever to do with the fascination normally exerted by the opposite sex. At puberty, however, the claim of passion and the real charm of sex begin to make themselves felt, but, owing to the physical sexual feelings having been trained into a foreign channel, these new and more normal sex associations remain of a purely ideal and emotional character, without the strong sensual impulses with which under healthy conditions they tend to be more and more associated as puberty passes on into adolescence or mature adult life. I am fairly certain that in many women, often highly intellectual women, the precocious excess in masturbation has been a main cause, not necessarily the sole efficient cause, in producing a divorce in later life between the physical sensuous impulses and the ideal emotions.
The sensuous impulse having been evolved and perverted before the manifestation of the higher emotion, the two groups of feelings have become divorced for the whole of life. This is a common source of much personal misery and family unhappiness, though at the same time the clash of contending impulses may lead to a high development of moral character. When early masturbation is a factor in producing sexual inversion it usually operates in the manner I have here indicated, the repulsion for normal coitus helping to furnish a soil on which the inverted impulse may develop unimpeded.
This point has not wholly escaped previous observers, though they do not seem to have noted its psychological mechanism. Tissot stated that masturbation causes an aversion to marriage. More recently, Loiman ("Ueber Onanismus beim Weibe," _Therapeutische Monatshefte_, April, 1890) considered that masturbation in women, leading to a perversion of sexual feeling, including inability to find satisfaction in coitus, affects the associated centres. Smith Baker, again ("The Neuropsychical Element in Conjugal Aversion," _Journal of Nervous and Mental Disease_, September, 1892), finds that a "source of marital aversion seems to lie in the fact that substitution of mechanical and iniquitous excitations affords more thorough satisfaction than the mutual legitimate ones do," and gives cases in point. Savill, also, who believes that masturbation is more common in women than is usually supposed, regards dyspareunia, or pain in coition, as one of the signs of the habit.
Masturbation in women thus becomes, as Raymond and Janet point out (_Les Obsessions_, vol. ii, p. 307) a frequent cause of sexual frigidity in marriage. These authors illustrate the train of evils which may thus be set up, by the case of a lady, 26 years of age, a normal woman, of healthy family, who, at the age of 15, was taught by a servant to masturbate. At the age of 18 she married. She loved her husband, but she had no sexual feelings in coitus, and she continued to masturbate, sometimes several times a day, without evil consequences. At 24 she had to go into a hospital for floating kidney, and was so obliged to stop masturbating. She here accidentally learnt of the evil results attributed to the habit. She resolved not to do it again, and she kept her resolution. But while still in hospital she fell wildly in love with a man. To escape from the constant thought of this man, she sought relations with her husband, and at times masturbated, but now it no longer gave her pleasure. She wished to give up sexual things altogether. But that was easier said than done. She became subject to nervous crises, often brought on by the sight of a man, and accompanied by sexual excitement. They disappeared under treatment, and she thereupon became entirely frigid sexually. But, far from being happy, she has lost all energy and interest in life, and it is her sole desire to attain the sexual feelings she has lost. Adler considers that even when masturbation in women becomes an overmastering passion, so far as organic effects are concerned it is usually harmless, its effects being primarily psychic, and he attaches especial significance to it as a cause of sexual anæsthesia in normal coitus, being, perhaps, the most frequent cause of such anæsthesia. He devotes an important chapter to this matter, and brings forward numerous cases in illustration (Adler, _Die Mangelhafte Geschlechtsempfindung des Weibes_, pp. 93-119, also 21-23). Adler considers that the frequency of masturbation in women is largely due to the fact that women experience greater difficulties than men in obtaining sexual satisfaction, and so are impelled by unsatisfying coitus to continue masturbation after marriage. He adds that partly from natural shyness, partly from shame of acknowledging what is commonly accounted a sin, and partly from the fear of seeming disgusting or unworthy of sympathy in the doctor's eyes, women are usually silent on this matter, and very great tact and patience may be necessary before a confession is obtained.
On the psychic side, no doubt, the most frequent and the most characteristic result of persistent and excessive masturbation is a morbid heightening of self-consciousness without any co-ordinated heightening of self-esteem.[340] The man or woman who is kissed by a desirable and desired person of the opposite sex feels a satisfying sense of pride and elation, which must always be absent from the manifestations of auto-erotic activity.[341] This must be so, even apart from the masturbator's consciousness of the general social attitude toward his practices and his dread of detection, for that may also exist as regards normal coitus without any corresponding psychic effects. The masturbator, if his practice is habitual, is thus compelled to cultivate an artificial consciousness of self-esteem, and may show a tendency to mental arrogance. Self-righteousness and religiosity constitute, as it were, a protection against the tendency to remorse. A morbid mental soil is, of course, required for the full development of these characteristics. The habitual male masturbator, it must be remembered, is often a shy and solitary person; individuals of this temperament are especially predisposed to excesses in all the manifestations of auto-erotism, while the yielding to such tendencies increases the reserve and the horror of society, at the same time producing a certain suspicion of others. In some extreme cases there is, no doubt, as Kraepelin believes, some decrease of psychic capacity, an inability to grasp and co-ordinate external impressions, weakness of memory, deadening of emotions, or else the general phenomena of increased irritability, leading on to neurasthenia.
I find good reason to believe that in many cases the psychic influence of masturbation on women is different from its effect on men. As Spitzka observed, although it may sometimes render women self-reproachful and hesitant, it often seems to make them bold. Boys, as we have seen, early assimilate the tradition that self-abuse is "unmanly" and injurious, but girls have seldom any corresponding tradition that it is "unwomanly," and thus, whether or not they are reticent on the matter, before the forum of their own conscience they are often less ashamed of it than men are and less troubled by remorse.
Eulenburg considers that the comparative absence of bad effects from masturbation in girls is largely due to the fact that, unlike boys, they are not terrorized by exaggerated warnings and quack literature concerning the awful results of the practice. Forel, who has also remarked that women are often comparatively little troubled by qualms of conscience after masturbation, denies that this is due to a lower moral tone than men possess (Forel, _Die Sexuelle Frage_, p. 247). In this connection, I may refer to History IV, recorded in the Appendix to the fifth volume of these _Studies_, in which it is stated that of 55 prostitutes of various nationalities, with whom the subject had had relations, 18 spontaneously told him that they were habitual masturbators, while of 26 normal women, 13 made the same confession, unasked. Guttceit, in Russia, after stating that women of good constitution had told him that they masturbated as much as six or ten times a day or night (until they fell asleep, tired), without bad results, adds that, according to his observations, "masturbation, when not excessive, is, on the whole, a quite innocent matter, which exerts little or no permanent effect," and adds that it never, in any case, leads to _hypochondria onanica_ in women, because they have not been taught to expect bad results (_Dreissig Jahre Praxis_, p. 306).
There is, I think, some truth--though the exceptions are doubtless many--in the distinction drawn by W.C. Krauss ("Masturbational Neuroses," _Medical News_, July 13, 1901): "From my experience it [masturbation] seems to have an opposite effect upon the two sexes, dulling the mental and making clumsy the physical exertions of the male, while in the female it quickens and excites the physical and psychical movements. The man is rendered hypoesthetic, the woman hyperesthetic."
In either sex auto-erotic excesses during adolescence in young men and women of intelligence--whatever absence of gross injury there may be--still often produce a certain degree of psychic perversion, and tend to foster false and high-strung ideals of life. Kraepelin refers to the frequency of exalted enthusiasms in masturbators, and I have already quoted Anstie's remarks on the connection between masturbation and premature false work in literature and art. It may be added that excess in masturbation has often occurred in men and women whose work in literature and art cannot be described as premature and false. K.P. Moritz, in early adult life, gave himself up to excess in masturbation, and up to the age of thirty had no relations with women. Lenau is said--though the statement is sometimes denied--to have been a masturbator from early life, the habit profoundly effecting his life and work. Rousseau, in his _Confessions_, admirably describes how his own solitary, timid, and imaginative life found its chief sexual satisfaction in masturbation.[342] Gogol, the great Russian novelist, masturbated to excess, and it has been suggested that the dreamy melancholy thus induced was a factor in his success as a novelist. Goethe, it has been asserted, at one time masturbated to excess; I am not certain on what authority the statement is made, probably on a passage in the seventh book of _Dichtung und Wahrheit_, in which, describing his student-life at Leipzig, and his loss of Aennchen owing to his neglect of her, he tells how he revenged that neglect on his own physical nature by foolish practices from which he thinks he suffered for a considerable period.[343] The great Scandinavian philosopher, Sören Kierkegaard, suffered severely, according to Rasmussen, from excessive masturbation. That, at the present day, eminence in art, literature, and other fields may be combined with the excessive practice of masturbation is a fact of which I have unquestionable evidence.
I have the detailed history of a man of 30, of high ability in a scientific direction, who, except during periods of mental strain, has practiced masturbation nightly (though seldom more than once a night) from early childhood, without any traceable evil results, so far as his general health and energy are concerned. In another case, a schoolteacher, age 30, a hard worker and accomplished musician, has masturbated every night, sometimes more than once a night, ever since he was at school, without, so far as he knows, any bad results; he has never had connection with a woman, and seldom touches wine or tobacco. Curschmann knew a young and able author who, from the age of 11 had masturbated excessively, but who retained physical and mental freshness. It would be very easy to refer to other examples, and I may remark that, as regards the histories recorded in various volumes of these _Studies_, a notable proportion of those in which excessive masturbation is admitted, are of persons of eminent and recognized ability.
It is often possible to trace the precise mechanism of the relationship between auto-erotic excitement and intellectual activity. Brown-Séquard, in old age, considered that to induce a certain amount of sexual excitement, not proceeding to emission, was an aid to mental work. Raymond and Janet knew a man considering himself a poet, who, in order to attain the excitation necessary to compose his ideal verses, would write with one hand while with the other he caressed his penis, though not to the extent of producing ejaculation.[344] We must not believe, however, that this is by any means the method of workers who deserve to be accepted seriously; it would be felt, to say the least, as unworthy. It is indeed a method that would only appeal to a person of feeble or failing mental power. What more usually happens is that the auto-erotic excitement develops, _pari passu_ and spontaneously, with the mental activity and at the climax of the latter the auto-erotic excitement also culminates, almost or even quite spontaneously, in an explosion of detumescence which relieves the mental tension. I am acquainted with such cases in both young men and women of intellectual ability, and they probably occur much more frequently than we usually suspect.
In illustration of the foregoing observations, I may quote the following narrative, written by a man of letters: "From puberty to the age of 30 (when I married), I lived in virgin continence, in accord with my principle. During these years I worked exceedingly hard--chiefly at art (music and poetry). My days being spent earning my livelihood, these art studies fell into my evening time. I noticed that productive power came in periods--periods of irregular length, and which certainly, to a partial extent, could be controlled by the will. Such a period of vital power began usually with a sensation of melancholy, and it quickened my normal revolt against the narrowness of conventional life into a red-hot detestation of the paltriness and pettiness with which so many mortals seem to content themselves. As the mood grew in intensity, this scorn of the lower things mixed with and gave place to a vivid insight into higher truths. The oppression began to give place to a realization of the eternity of the heroic things; the fatuities were seen as mere fashions; love was seen as the true lord of life; the eternal romance was evident in its glory; the naked strength and beauty of men were known despite their clothes. In such mood my work was produced; bitter protest and keen-sighted passion mingled in its building. The arising vitality had certainly deep relation to the periodicity of the sex-force of manhood. At the height of the power of the art-creative mood would come those natural emissions with which Nature calmly disposes of the unused force of the male. Such emissions were natural and healthy, and not exhaustive or hysterical. The process is undoubtedly sane and protective, unless the subject be unhealthy. The period of creative art power extended a little beyond the end of the period of natural seed emission--the art work of this last stage being less vibrant, and of a gentler force. Then followed a time of calm natural rest, which gradually led up to the next sequence of melancholy and power. The periods certainly varied in length of time, controlled somewhat by the force of the mind and the mental will to create; that is to say, I could somewhat delay the natural emission, by which I gained an extension of the period of power."
How far masturbation in moderately healthy persons living without normal sexual relationships may be considered normal is a difficult question only to be decided with reference to individual cases. As a general rule, when only practiced at rare intervals, and _faute de mieux_, in order to obtain relief for physical oppression and mental obsession, it may be regarded as the often inevitable result of the unnatural circumstances of our civilized social life. When, as often happens in mental degeneracy,--and as in shy and imaginative persons, perhaps of neurotic temperament, may also sometimes become the case,--it is practiced in preference to sexual relationships, it at once becomes abnormal and may possibly lead to a variety of harmful results, mental and physical.[345] It must always be remembered, however, that, while the practice of masturbation may be harmful in its consequences, it is also, in the absence of normal sexual relationships, frequently not without good results. In the medical literature of the last hundred years a number of cases have been incidentally recorded in which the patients found masturbation beneficial, and such cases might certainly have been enormously increased if there had been any open-eyed desire to discover them. My own observations agree with those of Sudduth, who asserts that "masturbation is, in the main, practiced for its sedative effect on the nervous system. The relaxation that follows the act constitutes its real attraction...Both masturbation and sexual intercourse should be classed as typical sedatives."[346] Gall (_Fonctions du Cerveau_, 1825, vol. iii, p. 235) mentioned a woman who was tormented by strong sexual desire, which she satisfied by masturbation ten or twelve times a day; this caused no bad results, and led to the immediate disappearance of a severe pain in the back of the neck, from which she often suffered. Clouston (_Mental Diseases_, 1887, p. 496) quotes as follows from a letter written by a youth of 22: "I am sure I cannot explain myself, nor give account of such conduct. Sometimes I felt so uneasy at my work that I would go to the water-closet to do it, and it seemed to give me ease, and then I would work like a hatter for a whole week, till the sensation overpowered me again. I have been the most filthy scoundrel in existence," etc. Garnier presents the case of a monk, aged 33, living a chaste life, who wrote the following account of his experiences: "For the past three years, at least, I have felt, every two or three weeks, a kind of fatigue in the penis, or, rather, slight shooting pains, increasing during several days, and then I feel a strong desire to expel the semen. When no nocturnal pollution follows, the retention of the semen causes general disturbance, headache, and sleeplessness. I must confess that, occasionally, to free myself from the general and local oppression, I lie on my stomach and obtain ejaculation. I am at once relieved; a weight seems to be lifted from my chest, and sleep returns." This patient consulted Gamier as to whether this artificial relief was not more dangerous than the sufferings it relieved. Gamier advised that if the ordinary _régime_ of a well-ordered monastry, together with anaphrodisiac sedatives, proved inefficacious, the manoeuvre might be continued when necessary (P. Garnier, _Célibat et Célibataires_, 1887, p. 320). H.C. Coe (_American Journal of Obstetrics_, p. 766, July, 1889) gives the case of a married lady who was deeply sensitive of the wrong nature of masturbation, but found in it the only means of relieving the severe ovarian pain, associated with intense sexual excitement, which attended menstruation. During the intermenstrual period the temptation was absent. Turnbull knew a youth who found that masturbation gave great relief to feelings of heaviness and confusion which came on him periodically; and Wigglesworth has frequently seen masturbation after epileptic fits in patients who never masturbated at other times. Moll (_Libido Sexualis_, Bd. I, p. 13) refers to a woman of 28, an artist of nervous and excitable temperament, who could not find sexual satisfaction with her lover, but only when masturbating, which she did once or twice a day, or oftener; without masturbation, she said, she would be in a much more nervous state. A friend tells me of a married lady of 40, separated from her husband on account of incompatibility, who suffered from irregular menstruation; she tried masturbation, and, in her own words, "became normal again;" she had never masturbated previously. I have also been informed of the case of a young unmarried woman, intellectual, athletic, and well developed, who, from the age of seven or eight, has masturbated nearly every night before going to sleep, and would be restless and unable to sleep if she did not.
Judging from my own observations among both sexes, I should say that in normal persons, well past the age of puberty, and otherwise leading a chaste life, masturbation would be little practiced except for the physical and mental relief it brings. Many vigorous and healthy unmarried women or married women apart from their husbands, living a life of sexual abstinence, have asserted emphatically that only by sexually exciting themselves, at intervals, could they escape from a condition of nervous oppression and sexual obsession which they felt to be a state of hysteria. In most cases this happens about the menstrual period, and, whether accomplished as a purely physical act--in the same way as they would soothe a baby to sleep by rocking it or patting it--or by the co-operation of voluptuous mental imagery, the practice is not cultivated for its own sake during the rest of the month.
In illustration of the foregoing statements I will here record a few typical observations of experiences with regard to masturbation. The cases selected are all women, and are all in a fairly normal, and, for the most part, excellent, state of health; some of them, however, belong to somewhat neurotic families, and these are persons of unusual mental ability and intelligence.
OBSERVATION I.--Unmarried, aged 38. She is very vigorous and healthy, of a strongly passionate nature, but never masturbated until a few years ago, when she was made love to by a man who used to kiss her, etc. Although she did not respond to these advances, she was thrown into a state of restless sexual excitement; on one occasion, when in bed in this restless state, she accidentally found, on passing her hand over her body, that, by playing with "a round thing" [clitoris] a pleasurable feeling was produced. She found herself greatly relieved and quieted by these manipulations, though there remained a feeling of tiredness afterward. She has sometimes masturbated six times in a night, especially before and after the menstrual period, until she was unable to produce the orgasm or any feeling of pleasure.
OBSERVATION II.--Unmarried, aged 45, of rather nervous temperament. She has for many years been accustomed, usually about a week before the appearance of the menses, to obtain sexual relief by kicking out her legs when lying down. In this way, she says, she obtains complete satisfaction. She never touches herself. On the following day she frequently has pains over the lower part of the abdomen, such pains being apparently muscular and due to the exertion.
OBSERVATION III.--Aged 29, recently married, belonging to a neurotic and morbid family, herself healthy, and living usually in the country; vivacious, passionate, enthusiastic, intellectual, and taking a prominent part in philanthropic schemes and municipal affairs; at the same time, fond of society, and very attractive to men. For many years she had been accustomed to excite herself, though she felt it was not good for her. The habit was merely practiced _faute de mieux_. "I used to sit on the edge of the bed sometimes," she said, "and it came over me so strongly that I simply couldn't resist it. I felt that I should go mad, and I thought it was better to touch myself than be insane...I used to press my clitoris in...It made me very tired afterward--not like being with my husband." The confession was made from a conviction of the importance of the subject, and with the hope that some way might be found out of the difficulties which so often beset women.
OBSERVATION IV.--Unmarried, aged 27; possesses much force of character and high intelligence; is actively engaged in a professional career. As a child of seven or eight she began to experience what she describes as lightning-like sensations, "mere, vague, uneasy feelings or momentary twitches, which took place alike in the vulva or the vagina or the uterus, not amounting to an orgasm and nothing like it." These sensations, it should be added, have continued into adult life. "I always experience them just before menstruation, and afterward for a few days, and, occasionally, though it seems to me not so often, during the period itself. I may have the sensation four or five times during the day; it is not dependent at all upon external impressions, or my own thoughts, and is sometimes absent for days together. It is just one flash, as if you would snap your fingers, and it is over."
As a child, she was, of course, quite unconscious that there was anything sexual in these sensations. They were then usually associated with various imaginary scenes. The one usually indulged in was that a black bear was waiting for her up in a tree, and that she was slowly raised up toward the bear by means of ropes and then lowered again, and raised, feeling afraid of being caught by the bear, and yet having a morbid desire to be caught. In after years she realized that there was a physical sexual cause underlying these imaginations, and that what she liked was a feeling of resistance to the bear giving rise to the physical sensation.