Studies in the Psychology of Sex Volume Vi Part 10

THE PROBLEM OF s.e.xUAL ABSTINENCE.

The Influence of Tradition-The Theological Conception of l.u.s.t-Tendency of These Influences to Degrade s.e.xual Morality-Their Result in Creating the Problem of s.e.xual Abstinence-The Protests Against s.e.xual Abstinence-s.e.xual Abstinence and Genius-s.e.xual Abstinence in Women-The Advocates of s.e.xual Abstinence-Intermediate Att.i.tude-Unsatisfactory Nature of the Whole Discussion-Criticism of the Conception of s.e.xual Abstinence-s.e.xual Abstinence as Compared to Abstinence from Food-No Complete a.n.a.logy-The Morality of s.e.xual Abstinence Entirely Negative-Is It the Physician's Duty to Advise Extra-Conjugal s.e.xual Intercourse?-Opinions of Those Who Affirm or Deny This Duty-The Conclusion Against Such Advice-The Physician Bound by the Social and Moral Ideas of His Age-The Physician as Reformer-s.e.xual Abstinence and s.e.xual Hygiene-Alcohol-The Influence of Physical and Mental Exercise-The Inadequacy of s.e.xual Hygiene in This Field-The Unreal Nature of the Conception of s.e.xual Abstinence-The Necessity of Replacing It by a More Positive Ideal.

When we look at the matter from a purely abstract or even purely biological point of view, it might seem that in deciding that asceticism and chast.i.ty are of high value for the personal life we have said all that is necessary to say. That, however, is very far from being the case. We soon realize here, as at every point in the practical application of s.e.xual psychology, that it is not sufficient to determine the abstractly right course along biological lines. We have to harmonize our biological demands with social demands. We are ruled not only by natural instincts but by inherited traditions, that in the far past were solidly based on intelligible grounds, and that even still, by the mere fact of their existence, exert a force which we cannot and ought not to ignore.

In discussing the valuation of the s.e.xual impulse we found that we had good ground for making a very high estimate of love. In discussing chast.i.ty and asceticism we found that they also are highly to be valued. And we found that, so far from any contradiction being here involved, love and chast.i.ty are intertwined in all their finest developments, and that there is thus a perfect harmony in apparent opposition. But when we come to consider the matter in detail, in its particular personal applications, we find that a new factor a.s.serts itself. We find that our inherited social and religious traditions exert a pressure, all on one side, which makes it impossible to place the relations of love and chast.i.ty simply on the basis of biology and reason. We are confronted at the outset by our traditions. On the one side these traditions have weighted the word "l.u.s.t"-considered as expressing all the manifestations of the s.e.xual impulse which are outside marriage or which fail to have marriage as their direct and ostentatious end-with deprecatory and sinister meanings. And on the other side these traditions have created the problem of "s.e.xual abstinence," which has nothing to do with either asceticism or chast.i.ty as these have been defined in the previous chapter, but merely with the purely negative pressure on the s.e.xual impulse, exerted, independently of the individual's wishes, by his religious and social environment.

The theological conception of "l.u.s.t," or "libido," as sin, followed logically the early Christian conception of "the flesh," and became inevitable as soon as that conception was firmly established. Not only, indeed, had early Christian ideals a degrading influence on the estimation of s.e.xual desire per se, but they tended to depreciate generally the dignity of the s.e.xual relationship. If a man made s.e.xual advances to a woman outside marriage, and thus brought her within the despised circle of "l.u.s.t," he was injuring her because he was impairing her religious and moral value.[92] The only way he could repair the damage done was by paying her money or by entering into a forced and therefore probably unfortunate marriage with her. That is to say that s.e.xual relationships were, by the ecclesiastical traditions, placed on a pecuniary basis, on the same level as prost.i.tution. By its well-meant intentions to support the theological morality which had developed on an ascetic basis, the Church was thus really undermining even that form of s.e.xual relationship which it sanctified.

Gregory the Great ordered that the seducer of a virgin shall marry her, or, in case of refusal, be severely punished corporally and shut up in a monastery to perform penance. According to other ecclesiastical rules, the seducer of a virgin, though held to no responsibility by the civil forum, was required to marry her, or to find a husband and furnish a dowry for her. Such rules had their good side, and were especially equitable when seduction had been accomplished by deceit. But they largely tended in practice to subordinate all questions of s.e.xual morality to a money question. The reparation to the woman, also, largely became necessary because the ecclesiastical conception of l.u.s.t caused her value to be depreciated by contact with l.u.s.t, and the reparation might be said to const.i.tute a part of penance. Aquinas held that l.u.s.t, in however slight a degree, is a mortal sin, and most of the more influential theologians took a view nearly or quite as rigid. Some, however, held that a certain degree of delectation is possible in these matters without mortal sin, or a.s.serted, for instance, that to feel the touch of a soft and warm hand is not mortal sin so long as no s.e.xual feeling is thereby aroused. Others, however, held that such distinctions are impossible, and that all pleasures of this kind are sinful. Tomas Sanchez endeavored at much length to establish rules for the complicated problems of delectation that thus arose, but he was constrained to admit that no rules are really possible, and that such matters must be left to the judgment of a prudent man. At that point casuistry dissolves and the modern point of view emerges (see, e.g., Lea, History of Auricular Confession, vol. ii, pp. 57, 115, 246, etc.).

Even to-day the influence of the old traditions of the Church still unconsciously survives among us. That is inevitable as regards religious teachers, but it is found also in men of science, even in Protestant countries. The result is that quite contradictory dogmas are found side by side, even in the same writer. On the one hand, the manifestations of the s.e.xual impulse are emphatically condemned as both unnecessary and evil; on the other hand, marriage, which is fundamentally (whatever else it may also be) a manifestation of the s.e.xual impulse, receives equally emphatic approval as the only proper and moral form of living.[93] There can be no reasonable doubt whatever that it is to the surviving and pervading influence of the ancient traditional theological conception of libido that we must largely attribute the sharp difference of opinions among physicians on the question of s.e.xual abstinence and the otherwise unnecessary acrimony with which these opinions have sometimes been stated.

On the one side, we find the emphatic statement that s.e.xual intercourse is necessary and that health cannot be maintained unless the s.e.xual activities are regularly exercised.

"All parts of the body which are developed for a definite use are kept in health, and in the enjoyment of fair growth and of long youth, by the fulfilment of that use, and by their appropriate exercise in the employment to which they are accustomed." In that statement, which occurs in the great Hippocratic treatise "On the Joints," we have the cla.s.sic expression of the doctrine which in ever varying forms has been taught by all those who have protested against s.e.xual abstinence. When we come down to the sixteenth century outbreak of Protestantism we find that Luther's revolt against Catholicism was in part a protest against the teaching of s.e.xual abstinence. "He to whom the gift of continence is not given," he said in his Table Talk, "will not become chaste by fasting and vigils. For my own part I was not excessively tormented [though elsewhere he speaks of the great fires of l.u.s.t by which he had been troubled], but all the same the more I macerated myself the more I burnt." And three hundred years later, Bebel, the would-be nineteenth century Luther of a different Protestantism, took the same att.i.tude towards s.e.xual abstinence, while Hinton the physician and philosopher, living in a land of rigid s.e.xual conventionalism and prudery, and moved by keen sympathy for the sufferings he saw around him, would break into pa.s.sionate sarcasm when confronted by the doctrine of s.e.xual abstinence. "There are innumerable ills-terrible destructions, madness even, the ruin of lives-for which the embrace of man and woman would be a remedy. No one thinks of questioning it. Terrible evils and a remedy in a delight and joy! And man has chosen so to muddle his life that he must say: 'There, that would be a remedy, but I cannot use it. I must be virtuous!'"

If we confine ourselves to modern times and to fairly precise medical statements, we find in Schurig's Spermatologia (1720, pp. 274 et seq.), not only a discussion of the advantages of moderate s.e.xual intercourse in a number of disorders, as witnessed by famous authorities, but also a list of results-including anorexia, insanity, impotence, epilepsy, even death-which were believed to have been due to s.e.xual abstinence. This extreme view of the possible evils of s.e.xual abstinence seems to have been part of the Renaissance traditions of medicine stiffened by a certain opposition between religion and science. It was still rigorously stated by Lallemand early in the nineteenth century. Subsequently, the medical statements of the evil results of s.e.xual abstinence became more temperate and measured, though still often p.r.o.nounced. Thus Gyurkovechky believes that these results may be as serious as those of s.e.xual excess. Krafft-Ebing showed that s.e.xual abstinence could produce a state of general nervous excitement (Jahrbuch fur Psychiatrie, Bd. viii, Heft 1 and 2). Schrenck-Notzing regards s.e.xual abstinence as a cause of extreme s.e.xual hyperaesthesia and of various perversions (in a chapter on s.e.xual abstinence in his Kriminalpsychologische und Psychopathologische Studien, 1902, pp. 174-178). He records in ill.u.s.tration the case of a man of thirty-six who had m.a.s.t.u.r.b.a.t.ed in moderation as a boy, but abandoned the practice entirely, on moral grounds, twenty years ago, and has never had s.e.xual intercourse, feeling proud to enter marriage a chaste man, but now for years has suffered greatly from extreme s.e.xual hyperaesthesia and concentration of thought on s.e.xual subjects, notwithstanding a strong will and the resolve not to m.a.s.t.u.r.b.a.t.e or indulge in illicit intercourse. In another case a vigorous and healthy man, not inverted, and with strong s.e.xual desires, who remained abstinent up to marriage, suffers from psychic impotence, and his wife remains a virgin notwithstanding all her affection and caresses. Ord considered that s.e.xual abstinence might produce many minor evils. "Most of us," he wrote (British Medical Journal, Aug. 2, 1884) "have, no doubt, been consulted by men, chaste in act, who are tormented by s.e.xual excitement. They tell one stories of long-continued local excitement, followed by intense muscular weariness, or by severe aching pain in the back and legs. In some I have had complaints of swelling and stiffness in the legs, and of pains in the joints, particularly in the knees;" he gives the case of a man who suffered after prolonged chast.i.ty from inflammatory conditions of knees and was only cured by marriage. Pearce Gould, it may be added, finds that "excessive ungratified s.e.xual desire" is one of the causes of acute orchitis. Remondino ("Some Observations on Continence as a Factor in Health and Disease," Pacific Medical Journal, Jan., 1900) records the case of a gentleman of nearly seventy who, during the prolonged illness of his wife, suffered from frequent and extreme priapism, causing insomnia. He was very certain that his troubles were not due to his continence, but all treatment failed and there were no spontaneous emissions. At last Remondino advised him to, as he expresses it, "imitate Solomon." He did so, and all the symptoms at once disappeared. This case is of special interest, because the symptoms were not accompanied by any conscious s.e.xual desire. It is no longer generally believed that s.e.xual abstinence tends to produce insanity, and the occasional cases in which prolonged and intense s.e.xual desire in young women is followed by insanity will usually be found to occur on a basis of hereditary degeneration. It is held by many authorities, however, that minor mental troubles, of a more or less vague character, as well as neurasthenia and hysteria, are by no means infrequently due to s.e.xual abstinence. Thus Freud, who has carefully studied angstneurosis, the obsession of anxiety, finds that it is a result of s.e.xual abstinence, and may indeed be considered as a vicarious form of such abstinence (Freud, Sammlung Kleiner Schriften zur Neurosenlehre, 1906, pp. 76 et seq.).

The whole subject of s.e.xual abstinence has been discussed at length by Nystrom, of Stockholm, in Das Geschlechtsleben und seine Gesetze, Ch. III. He concludes that it is desirable that continence should be preserved as long as possible in order to strengthen the physical health and to develop the intelligence and character. The doctrine of permanent s.e.xual abstinence, however, he regards as entirely false, except in the case of a small number of religious or philosophic persons. "Complete abstinence during a long period of years cannot be borne without producing serious results both on the body and the mind.... Certainly, a young man should repress his s.e.xual impulses as long as possible and avoid everything that may artificially act as a s.e.xual stimulant. If, however, he has done so, and still suffers from unsatisfied normal s.e.xual desires, and if he sees no possibility of marriage within a reasonable time, no one should dare to say that he is committing a sin if, with mutual understanding, he enters into s.e.xual relations with a woman friend, or forms temporary s.e.xual relationships, provided, that is, that he takes the honorable precaution of begetting no children, unless his partner is entirely willing to become a mother, and he is prepared to accept all the responsibilities of fatherhood." In an article of later date ("Die Einwirkung der s.e.xuellen Abstinenz auf die Gesundheit," s.e.xual-Probleme, July, 1908) Nystrom vigorously sums up his views. He includes among the results of s.e.xual abstinence orchitis, frequent involuntary seminal emissions, impotence, neurasthenia, depression, and a great variety of nervous disturbances of vaguer character, involving diminished power of work, limited enjoyment of life, sleeplessness, nervousness, and pre-occupation with s.e.xual desires and imaginations. More especially there is heightened s.e.xual irritability with erections, or even seminal emissions on the slightest occasion, as on gazing at an attractive woman or in social intercourse with her, or in the presence of works of art representing naked figures. Nystrom has had the opportunity of investigating and recording ninety cases of persons who have presented these and similar symptoms as the result, he believes, of s.e.xual abstinence. He has published some of these cases (Zeitschrift fur s.e.xualwissenschaft, Oct., 1908), but it may be added that Rohleder ("Die Abstinentia s.e.xualis," ib., Nov., 1908) has criticized these cases, and doubts whether any of them are conclusive. Rohleder believes that the bad results of s.e.xual abstinence are never permanent, and also that no anatomically pathological states (such as orchitis) can be thereby produced. But he considers, nevertheless, that even incomplete and temporary s.e.xual abstinence may produce fairly serious results, and especially neurasthenic disturbances of various kinds, such as nervous irritability, anxiety, depression, disinclination for work; also diurnal emissions, premature e.j.a.c.u.l.a.t.i.o.ns, and even a state approaching satyriasis; and in women hysteria, hystero-epilepsy, and nymphomaniacal manifestations; all these symptoms may, however, he believes, be cured when the abstinence ceases.

Many advocates of s.e.xual abstinence have attached importance to the fact that men of great genius have apparently been completely continent throughout life. This is certainly true (see ante, p. 173). But this fact can scarcely be invoked as an argument in favor of the advantages of s.e.xual abstinence among the ordinary population. J. F. Scott selects Jesus, Newton, Beethoven, and Kant as "men of vigor and mental ac.u.men who have lived chastely as bachelors." It cannot, however, be said that Dr. Scott has been happy in the four figures whom he has been able to select from the whole history of human genius as examples of life-long s.e.xual abstinence. We know little with absolute certainty of Jesus, and even if we reject the diagnosis which Professor Binet-Sangle (in his Folie de Jesus) has built up from a minute study of the Gospels, there are many reasons why we should refrain from emphasizing the example of his s.e.xual abstinence; Newton, apart from his stupendous genius in a special field, was an incomplete and unsatisfactory human being who ultimately reached a condition very like insanity; Beethoven was a thoroughly morbid and diseased man, who led an intensely unhappy existence; Kant, from first to last, was a feeble valetudinarian. It would probably be difficult to find a healthy normal man who would voluntarily accept the life led by any of these four, even as the price of their fame. J. A. G.o.dfrey (Science of s.e.x, pp. 139-147) discusses at length the question whether s.e.xual abstinence is favorable to ordinary intellectual vigor, deciding that it is not, and that we cannot argue from the occasional s.e.xual abstinence of men of genius, who are often abnormally const.i.tuted, and physically below the average, to the normally developed man. s.e.xual abstinence, it may be added, is by no means always a favorable sign, even in men who stand intellectually above the average. "I have not obtained the impression," remarks Freud (s.e.xual-Probleme, March, 1908), "that s.e.xual abstinence is helpful to energetic and independent men of action or original thinkers, to courageous liberators or reformers. The s.e.xual conduct of a man is often symbolic of his whole method of reaction in the world. The man who energetically grasps the object of his s.e.xual desire may be trusted to show a similarly relentless energy in the pursuit of other aims."

Many, though not all, who deny that prolonged s.e.xual abstinence is harmless, include women in this statement. There are some authorities indeed who believe that, whether or not any conscious s.e.xual desire is present, s.e.xual abstinence is less easily tolerated by women than by men.[94]

Cabanis, in his famous and pioneering work, Rapports du Physique et du Moral, said in 1802, that women not only bear s.e.xual excess more easily than men, but s.e.xual privations with more difficulty, and a cautious and experienced observer of to-day, Lowenfeld (s.e.xualleben und Nervenleiden, 1899, p. 53), while not considering that normal women bear s.e.xual abstinence less easily than men, adds that this is not the case with women of neuropathic disposition, who suffer much more from this cause, and either m.a.s.t.u.r.b.a.t.e when s.e.xual intercourse is impossible or fall into hystero-neurasthenic states. Busch stated (Das Geschlechtsleben des Weibes, 1839, vol. i, pp. 69, 71) that not only is the working of the s.e.xual functions in the organism stronger in women than in men, but that the bad results of s.e.xual abstinence are more marked in women. Sir Benjamin Brodie said long ago that the evils of continence to women are perhaps greater than those of incontinence, and to-day Hammer (Die Gesundheitlichen Gefahren der Geschlechtlichen Enthaltsamkeit, 1904) states that, so far as reasons of health are concerned, s.e.xual abstinence is no more to be recommended to women than to men. Nystrom is of the same opinion, though he thinks that women bear s.e.xual abstinence better than men, and has discussed this special question at length in a section of his Geschlechtsleben und seine Gesetze. He agrees with the experienced Erb that a large number of completely chaste women of high character, and possessing distinguished qualities of mind and heart, are more or less disordered through their s.e.xual abstinence; this is specially often the case with women married to impotent men, though it is frequently not until they approach the age of thirty, Nystrom remarks, that women definitely realize their s.e.xual needs.

A great many women who are healthy, chaste, and modest, feel at times such powerful s.e.xual desire that they can scarcely resist the temptation to go into the street and solicit the first man they meet. Not a few such women, often of good breeding, do actually offer themselves to men with whom they may have perhaps only the slightest acquaintance. Routh records such cases (British Gynaecological Journal, Feb., 1887), and most men have met with them at some time. When a woman of high moral character and strong pa.s.sions is subjected for a very long period to the perpetual strain of such s.e.xual craving, especially if combined with love for a definite individual, a chain of evil results, physical and moral, may be set up, and numerous distinguished physicians have recorded such cases, which terminated at once in complete recovery as soon as the pa.s.sion was gratified. Lauvergne long since described a case. A fairly typical case of this kind was reported in detail by Brachet (De l'Hypochondrie, p. 69) and embodied by Griesinger in his cla.s.sic work on "Mental Pathology." It concerned a healthy married lady, twenty-six years old, having three children. A visiting acquaintance completely gained her affections, but she strenuously resisted the seducing influence, and concealed the violent pa.s.sion that he had aroused in her. Various serious symptoms, physical and mental, slowly began to appear, and she developed what seemed to be signs of consumption. Six months' stay in the south of France produced no improvement, either in the bodily or mental symptoms. On returning home she became still worse. Then she again met the object of her pa.s.sion, succ.u.mbed, abandoned her husband and children, and fled with him. Six months later she was scarcely recognizable; beauty, freshness and plumpness had taken the place of emaciation; while the symptoms of consumption and all other troubles had entirely disappeared. A somewhat similar case is recorded by Camill Lederer, of Vienna (Monatsschrift fur Harnkrankheiten und s.e.xuelle Hygiene, 1906, Heft 3). A widow, a few months after her husband's death, began to cough, with symptoms of bronchial catarrh, but no definite signs of lung disease. Treatment and change of climate proved entirely unavailing to effect a cure. Two years later, as no signs of disease had appeared in the lungs, though the symptoms continued, she married again. Within a very few weeks all symptoms had disappeared, and she was entirely fresh and well.

Numerous distinguished gynaecologists have recorded their belief that s.e.xual excitement is a remedy for various disorders of the s.e.xual system in women, and that abstinence is a cause of such disorders. Matthews Duncan said that s.e.xual excitement is the only remedy for amenorrha; "the only emmenagogue medicine that I know of," he wrote (Medical Times, Feb. 2, 1884), "is not to be found in the Pharmacopia: it is erotic excitement. Of the value of erotic excitement there is no doubt." Anstie, in his work on Neuralgia, refers to the beneficial effect of s.e.xual intercourse on dysmenorrha, remarking that the necessity of the full natural exercise of the s.e.xual function is shown by the great improvement in such cases after marriage, and especially after childbirth. (It may be remarked that not all authorities find dysmenorrha benefited by marriage, and some consider that the disease is often thereby aggravated; see, e.g., Wythe Cook, American Journal Obstetrics, Dec., 1893.) The distinguished gynaecologist, Tilt, at a somewhat earlier date (On Uterine and Ovarian Inflammation, 1862, p. 309), insisted on the evil results of s.e.xual abstinence in producing ovarian irritation, and perhaps subacute ovaritis, remarking that this was specially p.r.o.nounced in young widows, and in prost.i.tutes placed in penitentiaries. Intense desire, he pointed out, determines organic movements resembling those required for the gratification of the desire. These burning desires, which can only be quenched by their legitimate satisfaction, are still further heightened by the erotic influence of thoughts, books, pictures, music, which are often even more s.e.xually stimulating than social intercourse with men, but the excitement thus produced is not relieved by that natural collapse which should follow a state of vital turgescence. After referring to the biological facts which show the effect of psychic influences on the formative powers of the ovario-uterine organs in animals, Tilt continues: "I may fairly infer that similar incitements on the mind of females may have a stimulating effect on the organs of ovulation. I have frequently known menstruation to be irregular, profuse, or abnormal in type during courtship in women in whom nothing similar had previously occurred, and that this protracted the treatment of chronic ovaritis and of uterine inflammation." Bonnifield, of Cincinnati (Medical Standard, Dec., 1896), considers that unsatisfied s.e.xual desire is an important cause of catarrhal endometritis. It is well known that uterine fibroids bear a definite relation to organic s.e.xual activity, and that s.e.xual abstinence, more especially the long-continued deprivation of pregnancy, is a very important cause of the disease. This is well shown by an a.n.a.lysis by A. E. Giles (Lancet, March 2, 1907) of one hundred and fifty cases. As many as fifty-six of these cases, more than a third, were unmarried women, though nearly all were over thirty years of age. Of the ninety-four married women, thirty-four had never been pregnant; of those who had been pregnant, thirty-six had not been so for at least ten years. Thus eighty-four per cent, had either not been pregnant at all, or had had no pregnancy for at least ten years. It is, therefore, evident that deprivation of s.e.xual function, whether or not involving abstinence from s.e.xual intercourse, is an important cause of uterine fibroid tumors. b.a.l.l.s-Headley, of Victoria (Evolution of the Diseases of Women, 1894, and "Etiology of Diseases of Female Genital Organs," Allb.u.t.t and Playfair, System of Gynaecology,) believes that unsatisfied s.e.xual desire is a factor in very many disorders of the s.e.xual organs in women. "My views," he writes in a private letter, "are founded on a really special gynaecological practice of twenty years, during which I have myself taken about seven thousand most careful records. The normal woman is s.e.xually well-formed and her s.e.xual feelings require satisfaction in the direction of the production of the next generation, but under the restrictive and now especially abnormal conditions of civilization some women undergo hereditary atrophy, and the uterus and s.e.xual feelings are feeble; in others of good average local development the feeling is in restraint; in others the feelings, as well as the organs, are strong, and if normal use be withheld evils ensue. Bearing in mind these varieties of congenital development in relation to the respective condition of virginity, or sterile or parous married life, the mode of occurrence and of progress of disease grows on the physician's mind, and there is no more occasion for bewilderment than to the mathematician studying conic sections, when his knowledge has grown from the basis of the science. The problem is suggested: Has a crowd of una.s.sociated diseases fallen as through a sieve on woman, or have these affections almost necessarily ensued from the circ.u.mstances of her unnatural environment?" It may be added that Kisch (s.e.xual Life of Woman), while protesting against any exaggerated estimate of the effects of s.e.xual abstinence, considers that in women it may result, not only in numerous local disorders, but also in nervous disturbance, hysteria, and even insanity, while in neurasthenic women "regulated s.e.xual intercourse has an actively beneficial effect which is often striking."

It is important to remark that the evil results of s.e.xual abstinence in women, in the opinion of many of those who insist upon their importance, are by no means merely due to unsatisfied s.e.xual desire. They may be p.r.o.nounced even when the woman herself has not the slightest consciousness of s.e.xual needs. This was clearly pointed out forty years ago by the sagacious Anstie (op. cit.) In women, especially, he remarks, "a certain restless hyperactivity of mind, and perhaps of body also, seems to be the expression of Nature's unconscious resentment of the neglect of s.e.xual functions." Such women, he adds, have kept themselves free from masturbation "at the expense of a perpetual and almost fierce activity of mind and muscle." Anstie had found that some of the worst cases of the form of nervosity and neurasthenia which he termed "spinal irritation," often accompanied by irritable stomach and anaemia, get well on marriage. "There can be no question," he continues, "that a very large proportion of these cases in single women (who form by far the greater number of subjects of spinal irritation) are due to this conscious or unconscious irritation kept up by an unsatisfied s.e.xual want. It is certain that very many young persons (women more especially) are tormented by the irritability of the s.e.xual organs without having the least consciousness of s.e.xual desire, and present the sad spectacle of a vie manquee without ever knowing the true source of the misery which incapacitates them for all the active duties of life. It is a singular fact that in occasional instances one may even see two sisters, inheriting the same kind of nervous organization, both tormented with the symptoms of spinal irritation and both probably suffering from repressed s.e.xual functions, but of whom one shall be pure-minded and entirely unconscious of the real source of her troubles, while the other is a victim to conscious and fruitless s.e.xual irritation." In this matter Anstie may be regarded as a forerunner of Freud, who has developed with great subtlety and a.n.a.lytic power the doctrine of the transformation of repressed s.e.xual instinct in women into morbid forms. He considers that the nervosity of to-day is largely due to the injurious action on the s.e.xual life of that repression of natural instincts on which our civilization is built up. (Perhaps the clearest brief statement of Freud's views on the matter is to be found in a very suggestive article, "Die 'Kulturelle' s.e.xualmoral und die Moderne Nervositat," in s.e.xual-Probleme, March, 1908, reprinted in the second series of Freud's Sammlung Kleiner Schriften zur Neurosenlehre, 1909). We possess the apt.i.tude, he says, of sublimating and transforming our s.e.xual activities into other activities of a psychically related character, but non-s.e.xual. This process cannot, however, be carried out to an unlimited extent any more than can the conversion of heat into mechanical work in our machines. A certain amount of direct s.e.xual satisfaction is for most organizations indispensable, and the renunciation of this individually varying amount is punished by manifestations which we are compelled to regard as morbid. The process of sublimation, under the influence of civilization, leads both to s.e.xual perversions and to psycho-neuroses. These two conditions are closely related, as Freud views the process of their development; they stand to each other as positive and negative, s.e.xual perversions being the positive pole and psycho-neuroses the negative. It often happens, he remarks, that a brother may be s.e.xually perverse, while his sister, with a weaker s.e.xual temperament, is a neurotic whose symptoms are a transformation of her brother's perversion; while in many families the men are immoral, the women pure and refined but highly nervous. In the case of women who have no defect of s.e.xual impulse there is yet the same pressure of civilized morality pushing them into neurotic states. It is a terribly serious injustice, Freud remarks, that the civilized standard of s.e.xual life is the same for all persons, because though some, by their organization, may easily accept it, for others it involves the most difficult psychic sacrifices. The unmarried girl, who has become nervously weak, cannot be advised to seek relief in marriage, for she must be strong in order to "bear" marriage, while we urge a man on no account to marry a girl who is not strong. The married woman who has experienced the deceptions of marriage has usually no way of relief left but by abandoning her virtue. "The more strenuously she has been educated, and the more completely she has been subjected to the demands of civilization, the more she fears this way of escape, and in the conflict between her desires and her sense of duty, she also seeks refuge-in neurosis. Nothing protects her virtue so surely as disease." Taking a still wider view of the influence of the narrow "civilized" conception of s.e.xual morality on women, Freud finds that it is not limited to the production of neurotic conditions; it affects the whole intellectual apt.i.tude of women. Their education denies them any occupation with s.e.xual problems, although such problems are so full of interest to them, for it inculcates the ancient prejudice that any curiosity in such matters is unwomanly and a proof of wicked inclinations. They are thus terrified from thinking, and knowledge is deprived of worth. The prohibition to think extends, automatically and inevitably, far beyond the s.e.xual sphere. "I do not believe," Freud concludes, "that there is any opposition between intellectual work and s.e.xual activity such as was supposed by Mobius. I am of opinion that the unquestionable fact of the intellectual inferiority of so many women is due to the inhibition of thought imposed upon them for the purpose of s.e.xual repression."

It is only of recent years that this problem has been realized and faced, though solitary thinkers, like Hinton, have been keenly conscious of its existence; for "sorrowing virtue," as Mrs. Ella Wheeler Wilc.o.x puts it, "is more ashamed of its woes than unhappy sin, because the world has tears for the latter and only ridicule for the former." "It is an almost cynical trait of our age," h.e.l.lpach wrote a few years ago, "that it is constantly discussing the theme of prost.i.tution, of police control, of the age of consent, of the 'white slavery,' and pa.s.ses over the moral struggle of woman's soul without an attempt to answer her burning questions."

On the other hand we find medical writers not only a.s.serting with much moral fervor that s.e.xual intercourse outside marriage is always and altogether unnecessary, but declaring, moreover, the harmlessness or even the advantages of s.e.xual abstinence.

Ribbing, the Swedish professor, in his Hygiene s.e.xuelle, advocates s.e.xual abstinence outside marriage, and a.s.serts its harmlessness. Gilles de la Tourette, Fere, and Augagneur in France agree. In Germany Furbringer (Senator and Kaminer, Health and Disease in Relation to Marriage, vol. i, p. 228) a.s.serts that continence is possible and necessary, though admitting that it may, however, mean serious mischief in exceptional cases. Eulenburg (s.e.xuale Neuropathie, p. 14) doubts whether anyone, who otherwise lived a reasonable life, ever became ill, or more precisely neurasthenic, through s.e.xual abstinence. Hegar, replying to the arguments of Bebel in his well-known book on women, denies that s.e.xual abstinence can ever produce satyriasis or nymphomania. Nacke, who has frequently discussed the problem of s.e.xual abstinence (e.g., Archiv fur Kriminal-Anthropologie, 1903, Heft 1, and s.e.xual-Probleme, June, 1908), maintains that s.e.xual abstinence can, at most, produce rare and slight unfavorable results, and that it is no more likely to produce insanity, even in predisposed individuals, than are the opposite extremes of s.e.xual excess and masturbation. He adds that, so far as his own observations are concerned, the patients in asylums suffer scarcely at all from their compulsory s.e.xual abstinence.

It is in England, however, that the virtues of s.e.xual abstinence have been most loudly and emphatically proclaimed, sometimes indeed with considerable lack of cautious qualification. Acton, in his Reproductive Organs, sets forth the traditional English view, as well as Beale in his Morality and the Moral Question. A more distinguished representative of the same view was Paget, who, in his lecture on "s.e.xual Hypochondriasis," coupled s.e.xual intercourse with "theft or lying." Sir William Gowers (Syphilis and the Nervous System, 1892, p. 126) also proclaims the advantages of "unbroken chast.i.ty," more especially as a method of avoiding syphilis. He is not hopeful, however, even as regards his own remedy, for he adds: "We can trace small ground for hope that the disease will thus be materially reduced." He would still, however, preach chast.i.ty to the individual, and he does so with all the ascetic ardor of a mediaeval monk. "With all the force that any knowledge I possess, and any authority I have, can give, I a.s.sert that no man ever yet was in the slightest degree or way the worse for continence or better for incontinence. From the latter all are worse morally; a clear majority are worse physically; and in no small number the result is, and ever will be, utter physical shipwreck on one of the many rocks, sharp, jagged-edged, which beset the way, or on one of the many beds of festering slime which no care can possibly avoid." In America the same view widely prevails, and Dr. J. F. Scott, in his s.e.xual-Instinct (second edition, 1908, Ch. III), argues very vigorously and at great length in favor of s.e.xual abstinence. He will not even admit that there are two sides to the question, though if that were the case, the length and the energy of his arguments would be unnecessary.

Among medical authorities who have discussed the question of s.e.xual abstinence at length it is not, indeed, usually possible to find such unqualified opinions in its favor as those I have quoted. There can be no doubt, however, that a large proportion of physicians, not excluding prominent and distinguished authorities, when casually confronted with the question whether s.e.xual abstinence is harmless, will at once adopt the obvious path of least resistance and reply: Yes. In only a few cases will they even make any qualification of this affirmative answer. This tendency is very well ill.u.s.trated by an inquiry made by Dr. Ludwig Jacobsohn, of St. Petersburgh ("Die s.e.xuelle Enthaltsamkeit im Lichte der Medizin," St. Petersburger Medicinische Wochenschrift, March 17, 1907). He wrote to over two hundred distinguished Russian and German professors of physiology, neurology, psychiatry, etc., asking them if they regarded s.e.xual abstinence as harmless. The majority returned no answer; eleven Russian and twenty-eight Germans replied, but four of them merely said that "they had no personal experience," etc.; there thus remained thirty-five. Of these E. Pfluger, of Bonn, was skeptical of the advantage of any propaganda of abstinence: "if all the authorities in the world declared the harmlessness of abstinence that would have no influence on youth. Forces are here in play that break through all obstacles." The harmlessness of abstinence was affirmed by Krapelin, Cramer, Gartner, Tuczek, Schottelius, Gaffky, Finkler, Selenew, La.s.sar, Seifert, Gruber; the last, however, added that he knew very few abstinent young men, and himself only considered abstinence good before full development, and intercourse not dangerous in moderation even before then. Brieger knew cases of abstinence without harmful results, but himself thought that no general opinion could be given. Jurgensen said that abstinence in itself is not harmful, but that in some cases intercourse exerts a more beneficial influence. Hoffmann said that abstinence is harmless, adding that though it certainly leads to masturbation, that is better than gonorrha, to say nothing of syphilis, and is easily kept within bounds. Strumpell replied that s.e.xual abstinence is harmless, and indirectly useful as preserving from the risk of venereal disease, but that s.e.xual intercourse, being normal, is always more desirable. Hensen said that abstinence is not to be unconditionally approved. Rumpf replied that abstinence was not harmful for most before the age of thirty, but after that age there was a tendency to mental obsessions, and marriage should take place at twenty-five. Leyden also considered abstinence harmless until towards thirty, when it leads to psychic anomalies, especially states of anxiety, and a certain affectation. Hein replied that abstinence is harmless for most, but in some leads to hysterical manifestations and indirectly to bad results from masturbation, while for the normal man abstinence cannot be directly beneficial, since intercourse is natural. Grutzner thought that abstinence is almost never harmful. Nescheda said it is harmless in itself, but harmful in so far as it leads to unnatural modes of gratification. Neisser believes that more prolonged abstinence than is now usual would be beneficial, but admitted the s.e.xual excitations of our civilization; he added that of course he saw no harm for healthy men in intercourse. Hoche replied that abstinence is quite harmless in normal persons, but not always so in abnormal persons. Weber thought it had a useful influence in increasing will-power. Tarnowsky said it is good in early manhood, but likely to be unfavorable after twenty-five. Orlow replied that, especially in youth, it is harmless, and a man should be as chaste as his wife. Popow said that abstinence is good at all ages and preserves the energy. Blumenau said that in adult age abstinence is neither normal nor beneficial, and generally leads to masturbation, though not generally to nervous disorders; but that even masturbation is better than syphilis. Tschiriew saw no harm in abstinence up to thirty, and thought s.e.xual weakness more likely to follow excess than abstinence. Tschish regarded abstinence as beneficial rather than harmful up to twenty-five or twenty-eight, but thought it difficult to decide after that age when nervous alterations seem to be caused. Darkschewitcz regarded abstinence as harmless up to twenty-five. Frankel said it was harmless for most, but that for a considerable proportion of people intercourse is a necessity. Erb's opinion is regarded by Jacobsohn as standing alone; he placed the age below which abstinence is harmless at twenty; after that age he regarded it as injurious to health, seriously impeding work and capacity, while in neurotic persons it leads to still more serious results. Jacobsohn concludes that the general opinion of those answering the inquiry may thus be expressed: "Youth should be abstinent. Abstinence can in no way injure them; on the contrary, it is beneficial. If our young people will remain abstinent and avoid extra-conjugal intercourse they will maintain a high ideal of love and preserve themselves from venereal diseases."

The harmlessness of s.e.xual abstinence was likewise affirmed in America in a resolution pa.s.sed by the American Medical a.s.sociation in 1906. The proposition thus formally accepted was thus worded: "Continence is not incompatible with health." It ought to be generally realized that abstract propositions of this kind are worthless, because they mean nothing. Every sane person, when confronted by the demand to boldly affirm or deny the proposition, "Continence is not incompatible with health," is bound to affirm it. He might firmly believe that continence is incompatible with the health of most people, and that prolonged continence is incompatible with anyone's health, and yet, if he is to be honest in the use of language, it would be impossible for him to deny the vague and abstract proposition that "Continence is not incompatible with health." Such propositions are therefore not only without value, but actually misleading.

It is obvious that the more extreme and unqualified opinions in favor of s.e.xual abstinence are based not on medical, but on what the writers regard as moral considerations. Moreover, as the same writers are usually equally emphatic in regard to the advantages of s.e.xual intercourse in marriage, it is clear that they have committed themselves to a contradiction. The same act, as Nacke rightly points out, cannot become good or bad according as it is performed in or out of marriage. There is no magic efficacy in a few words p.r.o.nounced by a priest or a government official.

Remondino (loc. cit.) remarks that the authorities who have committed themselves to declarations in favor of the unconditional advantages of s.e.xual abstinence tend to fall into three errors: (1) they generalize unduly, instead of considering each case individually, on its own merits; (2) they fail to realize that human nature is influenced by highly mixed and complex motives and cannot be a.s.sumed to be amenable only to motives of abstract morality; (3) they ignore the great army of masturbators and s.e.xual perverts who make no complaint of s.e.xual suffering, but by maintaining a rigid s.e.xual abstinence, so far as normal relationships are concerned, gradually drift into currents whence there is no return.

Between those who unconditionally affirm or deny the harmlessness of s.e.xual abstinence we find an intermediate party of authorities whose opinions are more qualified. Many of those who occupy this more guarded position are men whose opinions carry much weight, and it is probable that with them rather than with the more extreme advocates on either side the greater measure of reason lies. So complex a question as this cannot be adequately investigated merely in the abstract, and settled by an unqualified negative or affirmative. It is a matter in which every case requires its own special and personal consideration.

"Where there is such a marked opposition of opinion truth is not exclusively on one side," remarks Lowenfeld (s.e.xualleben und Nervenleiden, second edition, p. 40). s.e.xual abstinence is certainly often injurious to neuropathic persons. (This is now believed by a large number of authorities, and was perhaps first decisively stated by Krafft-Ebing, "Ueber Neurosen durch Abstinenz," Jahrbuch fur Psychiatrie, 1889, p. 1). Lowenfeld finds no special proclivity to neurasthenia among the Catholic clergy, and when it does occur, there is no reason to suppose a s.e.xual causation. "In healthy and not hereditarily neuropathic men complete abstinence is possible without injury to the nervous system." Injurious effects, he continues, when they appear, seldom occur until between twenty-four and thirty-six years of age, and even then are not usually serious enough to lead to a visit to a doctor, consisting mainly in frequency of nocturnal emissions, pain in testes or r.e.c.t.u.m, hyperaesthesia in the presence of women or of s.e.xual ideas. If, however, conditions arise which specially stimulate the s.e.xual emotions, neurasthenia may be produced. Lowenfeld agrees with Freud and Gattel that the neurosis of anxiety tends to occur in the abstinent, careful examination showing that the abstinence is a factor in its production in both s.e.xes. It is common among young women married to much older men, often appearing during the first years of marriage. Under special circ.u.mstances, therefore, abstinence can be injurious, but on the whole the difficulties due to such abstinence are not severe, and they only exceptionally call forth actual disturbance in the nervous or psychic spheres. Moll takes a similar temperate and discriminating view. He regards s.e.xual abstinence before marriage as the ideal, but points out that we must avoid any doctrinal extremes in preaching s.e.xual abstinence, for such preaching will merely lead to hypocrisy. Intercourse with prost.i.tutes, and the tendency to change a woman like a garment, induce loss of sensitiveness to the spiritual and personal element in woman, while the dangers of s.e.xual abstinence must no more be exaggerated than the dangers of s.e.xual intercourse (Moll, Libido s.e.xualis, 1898, vol. i, p. 848; id., Kontrare s.e.xualempfindung, 1899, p. 588). Bloch also (in a chapter on the question of s.e.xual abstinence in his s.e.xualleben unserer Zeit, 1908) takes a similar standpoint. He advocates abstention during early life and temporary abstention in adult life, such abstention being valuable, not only for the conservation and transformation of energy, but also to emphasize the fact that life contains other matters to strive for beyond the ends of s.e.x. Redlich (Medizinische Klinik, 1908, No. 7) also, in a careful study of the medical aspects of the question, takes an intermediate standpoint in relation to the relative advantages and disadvantages of s.e.xual abstinence. "We may say that s.e.xual abstinence is not a condition which must, under all circ.u.mstances and at any price, be avoided, though it is true that for the majority of healthy adult persons regular s.e.xual intercourse is advantageous, and sometimes is even to be recommended."

It may be added that from the standpoint of Christian religious morality this same att.i.tude, between the extremes of either party, recognizing the advantages of s.e.xual abstinence, but not insisting that they shall be purchased at any price, has also found representation. Thus, in England, an Anglican clergyman, the Rev. H. Northcote (Christianity and s.e.x Problems, pp. 58, 60) deals temperately and sympathetically with the difficulties of s.e.xual abstinence, and is by no means convinced that such abstinence is always an unmixed advantage; while in Germany a Catholic priest, Karl Jentsch (s.e.xualethik, s.e.xualjustiz, s.e.xualpolizei, 1900) sets himself to oppose the rigorous and unqualified a.s.sertions of Ribbing in favor of s.e.xual abstinence. Jentsch thus expresses what he conceives ought to be the att.i.tude of fathers, of public opinion, of the State and the Church towards the young man in this matter: "Endeavor to be abstinent until marriage. Many succeed in this. If you can succeed, it is good. But, if you cannot succeed, it is unnecessary to cast reproaches on yourself and to regard yourself as a scoundrel or a lost sinner. Provided that you do not abandon yourself to mere enjoyment or wantonness, but are content with what is necessary to restore your peace of mind, self-possession, and cheerful capacity for work, and also that you observe the precautions which physicians or experienced friends impress upon you."

When we thus a.n.a.lyze and investigate the the three main streams of expert opinions in regard to this question of s.e.xual abstinence-the opinions in favor of it, the opinions in opposition to it, and the opinions which take an intermediate course-we can scarcely fail to conclude how unsatisfactory the whole discussion is. The state of "s.e.xual abstinence" is a completely vague and indefinite state. The indefinite and even meaningless character of the expression "s.e.xual abstinence" is shown by the frequency with which those who argue about it a.s.sume that it can, may, or even must, involve masturbation. That fact alone largely deprives it of value as morality and altogether as abstinence. At this point, indeed, we reach the most fundamental criticism to which the conception of "s.e.xual abstinence" lies open. Rohleder, an experienced physician and a recognized authority on questions of s.e.xual pathology, has submitted the current views on "s.e.xual abstinence" to a searching criticism in a lengthy and important paper.[95] He denies altogether that strict s.e.xual abstinence exists at all. "s.e.xual abstinence," he points out, in any strict scenes of the term, must involve abstinence not merely from s.e.xual intercourse but from auto-erotic manifestations, from masturbation, from h.o.m.os.e.xual acts, from all s.e.xually perverse practices. It must further involve a permanent abstention from indulgence in erotic imaginations and voluptuous reverie. When, however, it is possible thus to render the whole psychic field a tabula rasa so far as s.e.xual activity is concerned-and if it fails to be so constantly and consistently there is no strict s.e.xual abstinence-then, Rohleder points out, we have to consider whether we are not in presence of a case of s.e.xual anaesthesia, of anaphrodisia s.e.xualis. That is a question which is rarely, if ever, faced by those who discuss s.e.xual abstinence. It is, however, an extremely pertinent question, because, as Rohleder insists, if s.e.xual anaesthesia exists the question of s.e.xual abstinence falls to the ground, for we can only "abstain" from actions that are in our power. Complete s.e.xual anaesthesia is, however, so rare a state that it may be practically left out of consideration, and as the s.e.xual impulse, if it exists, must by physiological necessity sometimes become active in some shape-even if only, according to Freud's view, by transformation into some morbid neurotic condition-we reach the conclusion that "s.e.xual abstinence" is strictly impossible. Rohleder has met with a few cases in which there seemed to him no escape from the conclusion that s.e.xual abstinence existed, but in all of these he subsequently found that he was mistaken, usually owing to the practice of masturbation, which he believes to be extremely common and very frequently accompanied by a persistent attempt to deceive the physician concerning its existence. The only kind of "s.e.xual abstinence" that exists is a partial and temporary abstinence. Instead of saying, as some say, "Permanent abstinence is unnatural and cannot exist without physical and mental injury," we ought to say, Rohleder believes, "Permanent abstinence is unnatural and has never existed."

It is impossible not to feel as we contemplate this chaotic ma.s.s of opinions, that the whole discussion is revolving round a purely negative idea, and that fundamental fact is responsible for what at first seem to be startling conflicts of statement. If indeed we were to eliminate what is commonly regarded as the religious and moral aspect of the matter-an aspect, be it remembered, which has no bearing on the essential natural facts of the question-we cannot fail to perceive that these ostentatious differences of conviction would be reduced within very narrow and trifling limits.

We cannot strictly coordinate the impulse of reproduction with the impulse of nutrition. There are very important differences between them, more especially the fundamental difference that while the satisfaction of the one impulse is absolutely necessary both to the life of the individual and of the race, the satisfaction of the other is absolutely necessary only to the life of the race. But when we reduce this question to one of "s.e.xual abstinence" we are obviously placing it on the same basis as that of abstinence from food, that is to say at the very opposite pole to which we place it when (as in the previous chapter) we consider it from the point of view of asceticism and chast.i.ty. It thus comes about that on this negative basis there really is an interesting a.n.a.logy between nutritive abstinence, though necessarily only maintained incompletely and for a short time, and s.e.xual abstinence, maintained more completely and for a longer time. A patient of Janet's seems to bring out clearly this resemblance. Nadia, whom Janet was able to study during five years, was a young woman of twenty-seven, healthy and intelligent, not suffering from hysteria nor from anorexia, for she had a normal appet.i.te. But she had an idea; she was anxious to be slim and to attain this end she cut down her meals to the smallest size, merely a little soup and a few eggs. She suffered much from the abstinence she thus imposed on herself, and was always hungry, though sometimes her hunger was masked by the inevitable stomach trouble caused by so long a persistence in this regime. At times, indeed, she had been so hungry that she had devoured greedily whatever she could lay her hands on, and not infrequently she could not resist the temptation to eat a few biscuits in secret. Such actions caused her horrible remorse, but, all the same, she would be guilty of them again. She realized the great efforts demanded by her way of life, and indeed looked upon herself as a heroine for resisting so long. "Sometimes," she told Janet, "I pa.s.sed whole hours in thinking about food, I was so hungry. I swallowed my saliva, I bit my handkerchief, I rolled on the ground, I wanted to eat so badly. I searched books for descriptions of meals and feasts, I tried to deceive my hunger by imagining that I too was enjoying all these good things. I was really famished, and in spite of a few weaknesses for biscuits I know that I showed much courage."[96] Nadia's motive idea, that she wished to be slim, corresponds to the abstinent man's idea that he wishes to be "moral," and only differs from it by having the advantage of being somewhat more positive and personal, for the idea of the person who wishes to avoid s.e.xual indulgence because it is "not right" is often not merely negative but impersonal and imposed by the social and religious environment. Nadia's occasional outbursts of reckless greediness correspond to the sudden impulses to resort to prost.i.tution, and her secret weaknesses for biscuits, followed by keen remorse, to lapses into the habit of masturbation. Her fits of struggling and rolling on the ground are precisely like the outbursts of futile desire which occasionally occur to young abstinent men and women in health and strength. The absorption in thoughts about meals and in literary descriptions of meals is clearly a.n.a.logous to the abstinent man's absorption in wanton thoughts and erotic books. Finally, Nadia's conviction that she is a heroine corresponds exactly to the att.i.tude of self-righteousness which often marks the s.e.xually abstinent.

If we turn to Freud's penetrating and suggestive study of the problem of s.e.xual abstinence in relation to "civilized" s.e.xual morality, we find that, though he makes no reference to the a.n.a.logy with abstinence from food, his words would for the most part have an equal application to both cases. "The task of subduing so powerful an instinct as the s.e.xual impulse, otherwise than by giving it satisfaction," he writes, "is one which may employ the whole strength of a man. Subjugation through sublimation, by guiding the s.e.xual forces into higher civilizational paths, may succeed with a minority, and even with these only for a time, least easily during the years of ardent youthful energy. Most others become neurotic or otherwise come to grief. Experience shows that the majority of people const.i.tuting our society are const.i.tutionally unequal to the task of abstinence. We say, indeed, that the struggle with this powerful impulse and the emphasis the struggle involves on the ethical and aesthetic forces in the soul's life 'steels' the character, and for a few favorably organized natures this is true; it must also be acknowledged that the differentiation of individual character so marked in our time only becomes possible through s.e.xual limitations. But in by far the majority of cases the struggle with sensuality uses up the available energy of character, and this at the very time when the young man needs all his strength in order to win his place in the world."[97]

When we have put the problem on this negative basis of abstinence it is difficult to see how we can dispute the justice of Freud's conclusions. They hold good equally for abstinence from food and abstinence from s.e.xual love. When we have placed the problem on a more positive basis, and are able to invoke the more active and fruitful motives of asceticism and chast.i.ty this unfortunate fight against a natural impulse is abolished. If chast.i.ty is an ideal of the harmonious play of all the organic impulses of the soul and body, if asceticism, properly understood, is the athletic striving for a worthy object which causes, for the time, an indifference to the gratification of s.e.xual impulses, we are on wholesome and natural ground, and there is no waste of energy in fruitless striving for a negative end, whether imposed artificially from without, as it usually is, or voluntarily chosen by the individual himself.

For there is really no complete a.n.a.logy between s.e.xual desire and hunger, between abstinence from s.e.xual relations and abstinence from food. When we put them both on the basis of abstinence we put them on a basis which covers the impulse for food but only half covers the impulse for s.e.xual love. We confer no pleasure and no service on our food when we eat it. But the half of s.e.xual love, perhaps the most important and enn.o.bling half, lies in what we give and not in what we take. To reduce this question to the low level of abstinence, is not only to centre it in a merely negative denial but to make it a solely self-regarding question. Instead of asking: How can I bring joy and strength to another? we only ask: How can I preserve my empty virtue?

Therefore it is that from whatever aspect we consider the question,-whether in view of the flagrant contradiction between the authorities who have discussed this question, or of the illegitimate mingling here of moral and physiological considerations, or of the merely negative and indeed unnatural character of the "virtue" thus set up, or of the failure involved to grasp the enn.o.blingly altruistic and mutual side of s.e.xual love,-from whatever aspect we approach the problem of "s.e.xual abstinence" we ought only to agree to do so under protest.

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 s.e.xual 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 s.e.xual 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 s.e.xual 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 s.e.xual intercourse to his patient whenever he considers it desirable. Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative. Nystrom (s.e.xual-Probleme, July, 1908, p. 413) states that it is the physician's duty, in some cases of s.e.xual weakness, when all other methods of treatment have failed, to recommend s.e.xual intercourse as the best remedy. Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate s.e.xual 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 s.e.xual 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 att.i.tude, though not usually so emphatically stated, seems to be widely accepted. Lederer goes even further when he states (Monatsschrift fur Harnkrankheiten und s.e.xuelle 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 att.i.tude 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 s.e.xual 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 s.e.xual intercourse would probably be beneficial.

The duty of the physician to recommend s.e.xual