Studies in the Psychology of Sex, Volume 6 Sex in...

If we thus decide to approach it, and if we have reached the conviction—which, in view of all the evidence we can scarcely escape—that, while sexual abstinence in so far as it may be recognized as possible is not incompatible with health, there are yet many adults for whom it is harmful, and a very much larger number for whom when prolonged it is undesirable, we encounter a serious problem. It is a problem which confronts any person, and especially the physician, who may be called upon to give professional advice to his fellows on this matter. If sexual relationships are sometimes desirable for unmarried persons, or for married persons who, for any reason, are debarred from conjugal union, is a physician justified in recommending such sexual relationships to his patient? This is a question that has frequently been debated and decided in opposing senses.

Various distinguished physicians, especially in Germany, have proclaimed the duty of the doctor to recommend sexual intercourse to his patient whenever he considers it desirable. Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative. Nyström (Sexual-Probleme, July, 1908, p. 413) states that it is the physician's duty, in some cases of sexual weakness, when all other methods of treatment have failed, to recommend sexual intercourse as the best remedy. Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate sexual intercourse in some cases, both to men and to women, and has on many occasions argued in this sense (e.g., Darf der Arzt zum Ausserehelichen Geschlechtsverkehr raten? 1904). Marcuse is strongly of opinion that a physician who, allowing himself to be influenced by moral, sociological, or other considerations, neglects to recommend sexual intercourse when he considers it desirable for the patient's health, is unworthy of his profession, and should either give up medicine or send his patients to other doctors. This attitude, though not usually so emphatically stated, seems to be widely accepted.

Lederer goes even further when he states (Monatsschrift für Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3) that it is the physician's duty in the case of a woman who is suffering from her husband's impotence, to advise her to have intercourse with another man, adding that "whether she does so with her husband's consent is no affair of the physician's, for he is not the guardian of morality, but the guardian of health." The physicians who publicly take this attitude are, however, a small minority. In England, so far as I am aware, no physician of eminence has openly proclaimed the duty of the doctor to advise sexual intercourse outside marriage, although, it is scarcely necessary to add, in England, as elsewhere, it happens that doctors, including women doctors, from time to time privately point out to their unmarried and even married patients, that sexual intercourse would probably be beneficial.

The duty of the physician to recommend sexual intercourse has been denied as emphatically as it has been affirmed. Thus Eulenburg (Sexuale Neuropathie, p. 43), would by no means advise extra-conjugal relations to his patient; "such advice is quite outside the physician's competence." It is, of course, denied by those who regard sexual abstinence as always harmless, if not beneficial. But it is also denied by many who consider that, under some circumstances, sexual intercourse would do good.

Moll has especially, and on many occasions, discussed the duty of the physician in relation to the question of advising sexual intercourse outside marriage (e.g., in his comprehensive work, Aerztliche Ethik, 1902; also Zeitschrift für Aerztliche Fortbildung, 1905, Nos. 12-15; Mutterschutz, 1905, Heft 3; Geschlecht und Gesellschaft, vol. ii, Heft 8). At the outset Moll had been disposed to assert the right of the physician to recommend sexual intercourse under some circumstances; "so long as marriage is unduly delayed and sexual intercourse outside marriage exists," he wrote (Die Conträre Sexualempfindung, second edition, p. 287), "so long, I think, we may use such intercourse therapeutically, provided that the rights of no third person (husband or wife) are injured." In all his later writings, however, Moll ranges himself clearly and decisively on the opposite side. He considers that the physician has no right to overlook the possible results of his advice in inflicting venereal disease, or, in the case of a woman, pregnancy, on his patient, and he believes that these serious results are far more likely to happen than is always admitted by those who defend the legitimacy of such advice. Nor will Moll admit that the physician is entitled to overlook the moral aspects of the question. A physician may know that a poor man could obtain many things good for his health by stealing, but he cannot advise him to steal. Moll takes the case of a Catholic priest who is suffering from neurasthenia due to sexual abstinence.

Even although the physician feels certain that the priest may be able to avoid all the risks of disease as well as of publicity, he is not entitled to urge him to sexual intercourse. He has to remember that in thus causing a priest to break his vows of chastity he may induce a mental conflict and a bitter remorse which may lead to the worst results, even on his patient's physical health. Similar results, Moll remarks, may follow such advice when given to a married man or woman, to say nothing of possible divorce proceedings and accompanying evils.

Rohleder (Vorlesungen über Geschlechtstrieb und Gesamtes Geschlechtsleben der Menschen) adopts a somewhat qualified attitude in this matter. As a general rule he is decidedly against recommending sexual intercourse outside marriage to those who are suffering from partial or temporary abstinence (the only form of abstinence he recognizes), partly on the ground that the evils of abstinence are not serious or permanent, and partly because the patient is fairly certain to exercise his own judgment in the matter. But in some classes of cases he recommends such intercourse, and notably to bisexual persons, on the ground that he is thus preserving his patient from the criminal risks of homosexual practices.

It seems to me that there should be no doubt whatever as to the correct professional attitude of the physician in relation to this question of advice concerning sexual intercourse. The physician is never entitled to advise his patient to adopt sexual intercourse outside marriage nor any method of relief which is commonly regarded as illegitimate. It is said that the physician has nothing to do with considerations of conventional morality. If he considers that champagne would be good for a poor patient he ought to recommend him to take champagne; he is not called upon to consider whether the patient will beg, borrow, or steal the champagne. But, after all, even if that be admitted, it must still be said that the physician knows that the champagne, however obtained, is not likely to be poisonous. When, however, he prescribes sexual intercourse, with the same lofty indifference to practical considerations, he has no such knowledge. In giving such a prescription the physician has in fact not the slightest knowledge of what he may be prescribing. He may be giving his patient a venereal disease; he may be giving the anxieties and responsibilities of an illegitimate child; the prescriber is quite in the dark. He is in the same position as if he had prescribed a quack medicine of which the composition was unknown to him, with the added disadvantage that the medicine may turn out to be far more potently explosive than is the case with the usually innocuous patent medicine.

The utmost that a physician can properly permit himself to do is to put the case impartially before his patient and to present to him all the risks. The solution must be for the patient himself to work out, as best he can, for it involves social and other considerations which, while they are indeed by no means outside the sphere of medicine, are certainly entirely outside the control of the individual private practitioner of medicine.

Moll also is of opinion that this impartial presentation of the case for and against sexual intercourse corresponds to the physician's duty in the matter. It is, indeed, a duty which can scarcely be escaped by the physician in many cases. Moll points out that it can by no means be assimilated, as some have supposed, with the recommendation of sexual intercourse. It is, on the contrary, he remarks, much more analogous to the physician's duty in reference to operations. He puts before the patient the nature of the operation, its advantages and its risks, but he leaves it to the patient's judgment to accept or reject the operation. Lewitt also (Geschlechtliche Enthaltsamkeit und Gesundheitsstörungen, 1905), after discussing the various opinions on this question, comes to the conclusion that the physician, if he thinks that intercourse outside marriage might be beneficial, should explain the difficulties and leave the patient himself to decide.

There is another reason why, having regard to the prevailing moral opinions at all events among the middle classes, a physician should refrain from advising extra-conjugal intercourse: he places himself in a false relation to his social environment. He is recommending a remedy the nature of which he could not publicly avow, and so destroying the public confidence in himself. The only physician who is morally entitled to advise his patients to enter into extra-conjugal relationships is one who openly acknowledges that he is prepared to give such advice. The doctor who is openly working for social reform has perhaps won the moral right to give advice in accordance with the tendency of his public activity, but even then his advice may be very dubiously judicious, and he would be better advised to confine his efforts at social reform to his public activities. The voice of the physician, as Professor Max Flesch of Frankfort observes, is more and more heard in the development and new growth of social institutions; he is a natural leaders in such movements, and proposals for reform properly come from him. "But," as Flesch continues, "publicly to accept the excellence of existing institutions and in the privacy of the consulting-room to give advice which assumes the imperfection of those institutions is illogical and confusing.

It is the physician's business to give advice which is in accordance with the interests of the community as a whole, and those interests require that sexual relationships should be entered into between healthy men and women who are able and willing to accept the results of their union. That should be the physician's rule of conduct. Only so can he become, what to-day he is often proclaimed to be, the leader of the nation."[98] This view is not, as we see, entirely in accord with that which assumes that the physician's duty is solely and entirely to his patient, without regard to the bearing of his advice on social conduct. The patient's interests are primary, but they are not entitled to be placed in antagonism to the interests of society. The advice given by the wise physician must always be in harmony with the social and moral tone of his age. Thus it is that the tendency among the younger generation of physicians to-day to take an active interest in raising that tone and in promoting social reform—a tendency which exists not only in Germany where such interests have long been acute, but also in so conservative a land as England—is full of promise for the future.

The physician is usually content to consider his duty to his patient in relationship to sexual abstinence as sufficiently fulfilled when he attempts to allay sexual hyperæsthesia by medical or hygienic treatment. It can scarcely be claimed, however, that the results of such treatment are usually satisfactory, and sometimes indeed the treatment has a result which is the reverse of that intended. The difficulty generally is that in order to be efficacious the treatment must be carried to an extreme which exhausts or inhibits not only the genital activities alone but the activities of the whole organism, and short of that it may prove a stimulant rather than a sedative. It is difficult and usually impossible to separate out a man's sexual activities and bring influence to bear on these activities alone. Sexual activity is so closely intertwined with the other organic activities, erotic exuberance is so much a flower which is rooted in the whole organism, that the blow which crushes it may strike down the whole man. The bromides are universally recognized as powerful sexual sedatives, but their influence in this respect only makes itself felt when they have dulled all the finest energies of the organism. Physical exercise is universally recommended to sexually hyperæsthetic patients. Yet most people, men and women, find that physical exercise is a positive stimulus to sexual activity.

This is notably so as regards walking, and exuberantly energetic young women who are troubled by the irritant activity of their healthy sexual emotions sometimes spend a large part of their time in the vain attempt to lull their activity by long walks. Physical exercise only proves efficacious in this respect when it is carried to an extent which produces general exhaustion. Then indeed the sexual activity is lulled; but so are all the mental and physical activities. It is undoubtedly true that exercises and games of all sorts for young people of both sexes have a sexually hygienic as well as a generally hygienic influence which is undoubtedly beneficial. They are, on all grounds, to be preferred to prolonged sedentary occupations. But it is idle to suppose that games and exercises will suppress the sexual impulses, for in so far as they favor health, they favor all the impulses that are the result of health. The most that can be expected is that they may tend to restrain the manifestations of sex by dispersing the energy they generate.

There are many physical rules and precautions which are advocated, not without reason, as tending to inhibit or diminish sexual activity. The avoidance of heat and the cultivation of cold is one of the most important of these. Hot climates, a close atmosphere, heavy bed-clothing, hot baths, all tend powerfully to excite the sexual system, for that system is a peripheral sensory organ, and whatever stimulates the skin generally, stimulates the sexual system.[99] Cold, which contracts the skin, also deadens the sexual feelings, a fact which the ascetics of old knew and acted upon. The garments and the posture of the body are not without influence. Constriction or pressure in the neighborhood of the sexual region, even tight corsets, as well as internal pressure, as from a distended bladder, are sources of sexual irritation. Sleeping on the back, which congests the spinal centres, also acts in the same way, as has long been known by those who attend to sexual hygiene; thus it is stated that in the Franciscan order it is prohibited to lie on the back. Food and drink are, further, powerful sexual stimulants. This is true even of the simplest and most wholesome nourishment, but it is more especially true of flesh meat, and, above all, of alcohol in its stronger forms such as spirits, liqueurs, sparkling and heavy wines, and even many English beers. This has always been clearly realized by those who cultivate asceticism, and it is one of the powerful reasons why alcohol should not be given in early youth. As St.

Jerome wrote, when telling Eustochium that she must avoid wine like poison, "wine and youth are the two fires of lust. Why add oil to the flame?"[100] Idleness, again, especially when combined with rich living, promotes sexual activity, as Burton sets forth at length in his Anatomy of Melancholy, and constant occupation, on the other hand, concentrates the wandering activities.

Mental exercise, like physical exercise, has sometimes been advocated as a method of calming sexual excitement, but it seems to be equally equivocal in its action. If it is profoundly interesting and exciting it may stir up rather than lull the sexual emotions. If it arouses little interest it is unable to exert any kind of influence. This is true even of mathematical occupations which have been advocated by various authorities, including Broussais, as aids to sexual hygiene.[101] "I have tried mechanical mental work," a lady writes, "such as solving arithmetical or algebraic problems, but it does no good; in fact it seems only to increase the excitement." "I studied and especially turned my attention to mathematics," a clergyman writes, "with a view to check my sexual tendencies. To a certain extent I was successful. But at the approach of an old friend, a voice or a touch, these tendencies came back again with renewed strength. I found mathematics, however, the best thing on the whole to take off my attention from women, better than religious exercises which I tried when younger (twenty-two to thirty)." At the best, however, such devices are of merely temporary efficacy.

It is easier to avoid arousing the sexual impulses than to impose silence on them by hygienic measures when once they are aroused. It is, therefore, in childhood and youth that all these measures may be most reasonably observed in order to avoid any premature sexual excitement. In one group of stolidly normal children influences that might be expected to act sexually pass away unperceived. At the other extreme, another group of children are so neurotically and precociously sensitive that no precautions will preserve them from such influences. But between these groups there is another, probably much the largest, who resist slight sexual suggestions but may succumb to stronger or longer influences, and on these the cares of sexual hygiene may profitably be bestowed.[102]

After puberty, when the spontaneous and inner voice of sex may at any moment suddenly make itself heard, all hygienic precautions are liable to be flung to the winds, and even the youth or maiden most anxious to retain the ideals of chastity can often do little but wait till the storm has passed. It sometimes happens that a prolonged period of sexual storm and stress occurs soon after puberty, and then dies away although there has been little or no sexual gratification, to be succeeded by a period of comparative calm. It must be remembered that in many, and perhaps most, individuals, men and women, the sexual appetite, unlike hunger or thirst, can after a prolonged struggle, be reduced to a more or less quiescent state which, far from injuring, may even benefit the physical and psychic vigor generally. This may happen whether or not sexual gratification has been obtained. If there has never been any such gratification, the struggle is less severe and sooner over, unless the individual is of highly erotic temperament. If there has been gratification, if the mind is filled not merely with desires but with joyous experience to which the body also has grown accustomed, then the struggle is longer and more painfully absorbing. The succeeding relief, however, if it comes, is sometimes more complete and is more likely to be associated with a state of psychic health. For the fundamental experiences of life, under normal conditions, bring not only intellectual sanity, but emotional pacification.

In these combats there are, however, no permanent conquests. For a very large number of people, indeed, though there may be emotional changes and fluctuations dependent on a variety of circumstances, there can scarcely be said to be any conquest at all. They are either always yielding to the impulses that assail them, or always resisting those impulses, in the first case with remorse, in the second with dissatisfaction. In either case much of their lives, at the time when life is most vigorous, is wasted. With women, if they happen to be of strong passions and reckless impulses to abandonment, the results may be highly enervating, if not disastrous to the general psychic life. It is to this cause, indeed, that some have been inclined to attribute the frequent mediocrity of women's work in artistic and intellectual fields. Women of intellectual force are frequently if not generally women of strong passions, and if they resist the tendency to merge themselves in the duties of maternity their lives are often wasted in emotional conflict and their psychic natures impoverished.[103]

The extent to which sexual abstinence and the struggles it involves may hamper and absorb the individual throughout life is well illustrated in the following case. A lady, vigorous, robust, and generally healthy, of great intelligence and high character, has reached middle life without marrying, or ever having sexual relationships. She was an only child, and when between three and four years of age, a playmate some six years older, initiated her into the habit of playing with her sexual parts. She was, however, at this age quite devoid of sexual feelings, and the habit dropped naturally, without any bad effects, as soon as she left the neighborhood of this girl a year or so later. Her health was good and even brilliant, and she developed vigorously at puberty. At the age of sixteen, however, a mental shock caused menstruation to diminish in amount during some years, and simultaneously with this diminution persistent sexual excitement appeared spontaneously, for the first time. She regarded such feelings as abnormal and unhealthy, and exerted all her powers of self-control in resisting them. But will power had no effect in diminishing the feelings. There was constant and imperious excitement, with the sense of vibration, tension, pressure, dilatation and tickling, accompanied, it may be, by some ovarian congestion, for she felt that on the left side there was a network of sexual nerves, and retroversion of the uterus was detected some years later.

Her life was strenuous with many duties, but no occupation could be pursued without this undercurrent of sexual hyperæsthesia involving perpetual self-control. This continued more or less acutely for many years, when menstruation suddenly stopped altogether, much before the usual period of the climacteric. At the same time the sexual excitement ceased, and she became calm, peaceful, and happy. Diminished menstruation was associated with sexual excitement, but abundant menstruation and its complete absence were both accompanied by the relief of excitement. This lasted for two years. Then, for the treatment of a trifling degree of anæmia, she was subjected to a long, and, in her case, injudicious course of hypodermic injections of strychnia. From that time, five years ago, up to the present, there has been constant sexual excitement, and she has always to be on guard lest she should be overtaken by a sexual spasm. Her torture is increased by the fact that her traditions make it impossible for her (except under very exceptional circumstances) to allude to the cause of her sufferings. "A woman is handicapped," she writes. "She may never speak to anyone on such a subject. She must live her tragedy alone, smiling as much as she can under the strain of her terrible burden."

To add to her trouble, two years ago, she felt impelled to resort to masturbation, and has done so about once a month since; this not only brings no real relief, and leaves irritability, wakefulness, and dark marks under the eyes, but is a cause of remorse to her, for she regards masturbation as entirely abnormal and unnatural. She has tried to gain benefit, not merely by the usual methods of physical hygiene, but by suggestion, Christian Science, etc., but all in vain. "I may say," she writes, "that it is the most passionate desire of my heart to be freed from this bondage, that I may relax the terrible years-long tension of resistance, and be happy in my own way. If I had this affliction once a month, once a week, even twice a week, to stand against it would be child's play. I should scorn to resort to unnatural means, however moderately. But self-control itself has its revenges, and I sometimes feel as if it is no longer to be borne."

Thus while it is an immense benefit in physical and psychic development if the eruption of the disturbing sexual emotions can be delayed until puberty or adolescence, and while it is a very great advantage, after that eruption has occurred, to be able to gain control of these emotions, to crush altogether the sexual nature would be a barren, if not, indeed, a perilous victory, bringing with it no satisfaction. "If I had only had three weeks' happiness," said a woman, "I would not quarrel with Fate, but to have one's whole life so absolutely empty is horrible." If such vacuous self-restraint may, by courtesy, be termed a virtue, it is but a negative virtue. The persons who achieve it, as the result of congenitally feeble sexual aptitudes, merely (as Gyurkovechky, Fürbringer, and Löwenfeld have all alike remarked) made a virtue of their weakness. Many others, whose instincts were less weak, when they disdainfully put to flight the desires of sex in early life, have found that in later life that foe returns in tenfold force and perhaps in unnatural shapes.[104]

The conception of "sexual abstinence" is, we see, an entirely false and artificial conception. It is not only ill-adjusted to the hygienic facts of the case but it fails even to invoke any genuinely moral motive, for it is exclusively self-regarding and self-centred. It only becomes genuinely moral, and truly inspiring, when we transform it into the altruistic virtue of self-sacrifice. When we have done so we see that the element of abstinence in it ceases to be essential, "Self-sacrifice," writes the author of a thoughtful book on the sexual life, "is acknowledged to be the basis of virtue; the noblest instances of self-sacrifice are those dictated by sexual affection. Sympathy is the secret of altruism; nowhere is sympathy more real and complete than in love. Courage, both moral and physical, the love of truth and honor, the spirit of enterprise, and the admiration of moral worth, are all inspired by love as by nothing else in human nature. Celibacy denies itself that inspiration or restricts its influence, according to the measure of its denial of sexual intimacy. Thus the deliberate adoption of a consistently celibate life implies the narrowing down of emotional and moral experience to a degree which is, from the broad scientific standpoint, unjustified by any of the advantages piously supposed to accrue from it."[105]

In a sane natural order all the impulses are centred in the fulfilment of needs and not in their denial. Moreover, in this special matter of sex, it is inevitable that the needs of others, and not merely the needs of the individual himself, should determine action. It is more especially the needs of the female which are the determining factor; for those needs are more various, complex and elusive, and in his attentiveness to their gratification the male finds a source of endless erotic satisfaction. It might be thought that the introduction of an altruistic motive here is merely the claim of theoretical morality insisting that there shall be a firm curb on animal instinct. But, as we have again and again seen throughout the long course of these Studies, it is not so. The animal instinct itself makes this demand. It is a biological law that rules throughout the zoölogical world and has involved the universality of courtship. In man it is only modified because in man sexual needs are not entirely concentrated in reproduction, but more or less penetrate the whole of life.

While from the point of view of society, as from that of Nature, the end and object of the sexual impulse is procreation, and nothing beyond procreation, that is by no means true for the individual, whose main object it must be to fulfil himself harmoniously with that due regard for others which the art of living demands. Even if sexual relationships had no connection with procreation whatever—as some Central Australian tribes believe—they would still be justifiable, and are, indeed, an indispensable aid to the best moral development of the individual, for it is only in so intimate a relationship as that of sex that the finest graces and aptitudes of life have full scope. Even the saints cannot forego the sexual side of life. The best and most accomplished saints from Jerome to Tolstoy—even the exquisite Francis of Assisi—had stored up in their past all the experiences that go to the complete realization of life, and if it were not so they would have been the less saints.

The element of positive virtue thus only enters when the control of the sexual impulse has passed beyond the stage of rigid and sterile abstinence and has become not merely a deliberate refusal of what is evil in sex, but a deliberate acceptance of what is good. It is only at that moment that such control becomes a real part of the great art of living. For the art of living, like any other art, is not compatible with rigidity, but lies in the weaving of a perpetual harmony between refusing and accepting, between giving and taking.[106]

The future, it is clear, belongs ultimately to those who are slowly building up sounder traditions into the structure of life. The "problem of sexual abstinence" will more and more sink into insignificance. There remain the great solid fact of love, the great solid fact of chastity. Those are eternal. Between them there is nothing but harmony. The development of one involves the development of the other.

It has been necessary to treat seriously this problem of "sexual abstinence" because we have behind us the traditions of two thousand years based on certain ideals of sexual law and sexual license, together with the long effort to build up practices more or less conditioned by those ideals. We cannot immediately escape from these traditions even when we question their validity for ourselves. We have not only to recognize their existence, but also to accept the fact that for some time to come they must still to a considerable extent control the thoughts and even in some degree the actions of existing communities.

It is undoubtedly deplorable. It involves the introduction of an artificiality into a real natural order. Love is real and positive; chastity is real and positive. But sexual abstinence is unreal and negative, in the strict sense perhaps impossible. The underlying feelings of all those who have emphasized its importance is that a physiological process can be good or bad according as it is or is not carried out under certain arbitrary external conditions, which render it licit or illicit. An act of sexual intercourse under the name of "marriage" is beneficial; the very same act, under the name of "incontinence," is pernicious. No physiological process, and still less any spiritual process, can bear such restriction. It is as much as to say that a meal becomes good or bad, digestible or indigestible, according as a grace is or is not pronounced before the eating of it.

It is deplorable because, such a conception being essentially unreal, an element of unreality is thus introduced into a matter of the gravest concern alike to the individual and to society. Artificial disputes have been introduced where no matter of real dispute need exist. A contest has been carried on marked by all the ferocity which marks contests about metaphysical or pseudo-metaphysical differences having no concrete basis in the actual world. As will happen in such cases, there has, after all, been no real difference between the disputants because the point they quarreled over was unreal. In truth each side was right and each side was wrong.

It is necessary, we see, that the balance should be held even. An absolute license is bad; an absolute abstinence—even though some by nature or circumstances are urgently called to adopt it—is also bad. They are both alike away from the gracious equilibrium of Nature. And the force, we see, which naturally holds this balance even is the biological fact that the act of sexual union is the satisfaction of the erotic needs, not of one person, but of two persons.

This view was an ambiguous improvement on the view, universally prevalent, as Westermarck has shown, among primitive peoples, that the sexual act involves indignity to a woman or depreciation of her only in so far as she is the property of another person who is the really injured party.