Читать книгу Psychopathia sexualis: With especial reference to contrary sexual instinct - R. von Krafft-Ebing - Страница 16

Pathology has no easy task, in the single case, when it has to decide whether the impulse to sexual satisfaction has reached a pathological degree. Emminghaus (“Psychopathologie,” p. 225) declares that the immediate re-awakening of desire after satisfaction, with its occupation of the entire attention, and no less the excitation of libido by the sight of persons and things which in themselves should have but an indifferent sexual effect, are decidedly abnormal. In general, sexual instinct and its corresponding needs are in proportion to physical strength and age. Sexual desire rapidly increases after puberty, until it reaches a marked degree; is strongest from the twentieth to the fortieth year, and then slowly decreases. Married life seems to preserve and control the instinct. Sexual intercourse with many persons increases the desire.

Since woman has less sexual need than man, a predominating sexual desire in her arouses a suspicion of its pathological significance; and the more, when this finds expression in desire for adornment, coquetry, or male society, which, passing beyond the limits set by good breeding and manners, becomes quite noticeable.

The constitution, in both sexes, is of the greatest significance. An abnormally strong sexual instinct is frequently accompanied by a neuropathic constitution; and such individuals pass a great part of their lives heavily burdened with the weight of this constitutional anomaly of their sexual life. The power of the sexual impulse in such cases may at times rise to the importance of an organic necessity, and really endanger the freedom of the will. The want of satisfaction of this impulsive desire may, under such conditions, induce a condition allied to actual rutting, or a psychical condition, accompanied by emotions of fear, in which the individual gives up to the impulse, and responsibility becomes doubtful. If the individual does not give up to his powerful impulse, he is in danger, by reason of his enforced abstinence, of ruining his nervous system by inducing a neurasthenia, or seriously increasing such a condition if it be already present. In normally constituted individuals, too, the sexual instinct is an inconstant quantity. Aside from the temporary indifference following satisfaction, and the diminution of sexual desire in long-continued continence after a certain reactionary stage of sexual desire is overcome, the manner of life has a great influence. Those living in large cities, who are constantly reminded of sexual things and incited to sexual enjoyment, certainly have more sexual desire than those living in the country. A dissipated, luxurious, sedentary manner of life, preponderance of animal food, and the consumption of spirits, spices, etc., have a stimulating influence on the sexual life. In woman the sexual inclination is post-menstrually increased. At this time, in neuropathic women, the excitement may reach a pathological degree.

The great libido of consumptives is remarkable. Hofmann tells of a consumptive peasant who satisfied his wife sexually on the evening before his death.

The sexual acts are coitus (eventually rape) and, faute de mieux, masturbation; and, with defective moral sense, pederasty or bestiality. If sexual power is diminished or extinct, with excessive sexual desire, all manner of perversity of sexual acts becomes possible.

Excessive libido may be peripherally or centrally induced. The former manner of origin is the more infrequent. Pruritus and eczema of the genitals may cause it; and likewise certain substances, like cantharides, which powerfully stimulate sexual desire. Not infrequently, in women at the climacteric, sexual excitement occurs, occasioned by pruritus; and also in cases where there is neuropathic taint. Magnan (Annales médico-psychol., 1885, p. 157) reports the case of a lady who was afflicted mornings with attacks of frightful erethismus genitalis, and the case of a man, aged 55, who was tormented at night by unbearable priapism. In each case there was a neurosis.

The central origin of sexual excitement is of frequent occurrence^[39] in persons having neurotic taint or hysteria, and in conditions of psychical exaltation. Here, where the cortex and the psycho-sexual centre are in a condition of hyperæsthesia (abnormal excitability of the imagination, increased ease of association), not only visual and tactile impressions, but also auditory and olfactory sensations, may be sufficient to call up lascivious concepts.

Magnan (op. cit.) reports the case of a young woman who had an increasing sexual desire from puberty, and satisfied it by masturbation. Gradually she grew to become sexually excited at the sight of any man pleasing to her; and, since she was unable to control herself, she would sometimes shut herself up in a room until the storm had passed. At last she gave herself up to men of her choice, that she might get rest from her tormenting desire; but neither coitus nor masturbation brought relief, and she went to an asylum.

The case of a mother of five children is added, who, in despair about her inordinate sexual impulse, attempted suicide, and then sought an asylum. There her condition improved, but she never trusted herself to leave it.

There are several illustrative cases in men and women in the author’s article, “On Certain Anomalies of Sexual Instinct,” Cases 6 and 7 (Archiv für Psychiatrie, vii, 2); Cases 3 and 5 are given here.

Case 11. On the afternoon of July 7, 1874, Clemens, engineer, being on his way, on business, from Trieste to Vienna, left the train at the town of Bruck, and, passing through the town to the neighboring village of St. Ruprecht, attempted a rape on an old woman, aged 70, whom he found alone in a house. He was seized by the neighbors and arrested by the local police. At his hearing he declared that he had tried to find the pound, in order to satisfy his sexual desire with a bitch. He said that he often suffered with such sexual excitement. He did not deny his act, but excused it as the result of disease. The heat, the motion of the cars, and anxiety about his family, to which he wished to go, had confused him and made him ill. Shame and remorse were not shown. His conduct was open, his mien gay; eyes red and bright, head hot, tongue coated; pulse full, soft, beating over 100; fingers somewhat tremulous. The statements of the accused were precise, but hurried; his glance uncertain, and with an unmistakable expression of lasciviousness. To the medical expert summoned to examine him, he gave the impression of one suffering with disease,—as if he were in the beginning of alcoholic insanity.

C. is forty-five years old, married, father of one child. He does not know what diseases his parents or other members of his family have had. In childhood he was weak and neuropathic. At the age of five his head was injured by a blow with a hoe. A scar one-half cm. broad by one cm. long, situated on the right parietal and frontal bones, dates from that injury. The bone is here somewhat depressed. The overlying skin is united to the bone. Pressure at this point causes pain, which radiates along the lower branch of the trigeminus. This spot is also frequently spontaneously painful. In his youth he had frequent attacks of “fainting”; before puberty, pneumonia, rheumatism, and intestinal catarrh. At the age of seven he experienced a peculiar inclination for men,—i.e., for a certain superior. Whenever he saw this man he had a peculiar feeling in his heart; kissed the ground he walked on. At ten he fell in love with a certain deputy. Later he had an enthusiasm for men, though it was entirely platonic. He began to masturbate at the age of fourteen; first intercourse at seventeen. Then the earlier manifestations of contrary sexual feeling disappeared entirely. At that time he passed through a peculiar acute psychopathic condition, which he described as a kind of clairvoyance. From fifteen, hæmorrhoids, with symptoms of plethora abdominalis. When he had profuse hæmorrhoidal hæmorrhage, which occurred usually every three or four weeks, he was better. At other times he was constantly in a condition of painful sexual excitement, which he satisfied partly by means of onanism and partly by coitus. Every woman he met excited him; even when he was among female relatives he was impelled to make indecent proposals. Sometimes it was possible for him to master his desire; sometimes he was driven to indecent acts. If, after these, he was kicked out-of-doors, it seemed perfectly right to him; for he thought that he needed such correction and support against his powerful impulse, which was a burden to him. No periodicity in this sexual excitement was recognizable.

Until 1861 he committed excesses in venery and was several times infected with gonorrhœa and chancres. In 1861, marriage. He was sexually satisfied, but became a burden to his wife on account of his great sensuality. In 1864 he passed through an attack of mania in the hospital at Fiume, and in the same year he again fell ill, and was taken to the insane asylum at Ybbs, where he remained until 1867. There he suffered with recurrent mania accompanied by great sexual excitement. He says that intestinal catarrh and anxiety were the cause of his illness at that time.

Thereafter he was well, but he suffered much on account of his excessive sexual desire. If he were absent from his wife but a short time, the impulse became so powerful that man or animal was indifferent to him for the satisfaction of his lust. In summer these impulses were much stronger, and were always accompanied by abdominal plethora. Something that he remembered in medical reading, made him think that in his case the ganglionic system was more powerful than the cerebral. In October, 1873, on account of business, he had to leave his wife. From that time until Easter, with the exception of occasional masturbation, there was no sexual indulgence. After that he made use of women and bitches. From the middle of June until July 7, he had no opportunity for sexual indulgence. He felt nervously excited, relaxed, and as if he were going crazy. Of late he had slept badly. A longing for his wife, who lived in Vienna, drove him to leave his business. He obtained leave of absence. The heat and the noise of the train confused him, and he could no longer hold out against his sexual excitement and the pressure of blood in his abdomen. Everything danced before his eyes. He left the car at Bruck, and was absolutely confused, not knowing where he went; and for a moment the thought came to him to throw himself in the water; all was like a mist before his eyes. Then he saw a woman, exposed his genitals, and tried to embrace her. She cried for help, and thus he was arrested.

After the attempt it suddenly became clear to him what he had done. He openly confessed his crime, which he remembered in all its details, but which seemed to him to be something abnormal. He could not help it. For some days after this, C. suffered with headache and congestions, and was now and then excited and restless, and slept badly. His mental functions are undisturbed, but he is, nevertheless, a congenitally peculiar man, with a character weak and devoid of energy. The facial expression has something lascivious and peculiar about it. He suffers with hæmorrhoids. The genitals present nothing abnormal. The cranium is narrow and retreating at the forehead. Body large and well nourished. With the exception of diarrhœa, there is no disturbance of the vegetative functions.

Case 12. Mrs. E., aged 47. Uncle on father’s side was insane; father was sanguine, and given to excess in venery. Patient’s brother died of an acute cerebral affection. Patient from childhood has been nervous, eccentric, and romantic; and while little more than a child manifested excessive sexual desire, and at ten began sexual indulgence. At nineteen, marriage. Unhappy married life; her husband, who was normal, did not satisfy her, and until recent years she constantly had other friends besides her husband. She was well aware of the immorality of her life, but felt her powerlessness against her insatiable desire, which she sought to keep, at least outwardly, a secret. Later she thought that she had suffered with a “mania for men.” Patient has borne six children. Six years ago she was thrown from a wagon and received a severe cerebral concussion. Following this there was melancholia, with delusions of persecution, which sent her to the asylum. She is approaching the climacterium, and of late the menses have been profuse and too frequent. Since this period she is pleased to note that the previously powerful sexual impulse has declined. Proper behavior. Slight degree of descensus uteri and prolapsus ani.

Hyperæsthesia sexualis may be continuously present with exacerbations, or it may be intermittent or periodic. In the latter case it is a cerebral neurosis per se (vide “Special Pathology”), or an accompanying symptom of a condition of general psychical excitement (mania; episodically in dementia paralytica, dementia senilis, etc.).

Lentz has published a remarkable case of intermittent satyriasis (Bulletin de la société de méd. légale de Belgique, Nr. 21):—

Case 13. For three years the generally respected farmer D., married, aged 35, has manifested states of sexual excitement, with increasing frequency and severity, which, during the past year, have become true paroxysms of satyriasis. It was impossible to discover hereditary or other organic cause. D. was compelled, at times when his sexual excitement was excessive, to perform the sexual act from ten to fifteen times in twenty-four hours, without deriving any feeling of satisfaction. Gradually he developed a condition of general nervous hyper-irritability (éréthisme général) with increased emotional irritability to the extent of pathological outbreaks of anger, and impulse to over-indulgence in alcohol, which induced symptoms of alcoholism. His attacks of satyriasis became so violent that consciousness was interfered with, and the patient raged about in blind impulse to sexual acts. He demanded that his wife give herself to other men or to animals in his presence; that she allow copulation with him, presentibus filiabus, because this would afford him greater enjoyment. Memory for the events at the height of these attacks, in which the extreme irritability even led to outbreaks of maniacal rage, was entirely wanting. D. himself thought that he must have had moments in which he no longer had control of his senses, and without satisfaction from his wife would have been compelled to seize the next best female. After an attack of violent emotion, these attacks of sexual excitement suddenly disappeared entirely.

The two following cases show how powerful, dangerous, and painful sexual hyperæsthesia may become in those afflicted with this anomaly:—

Case 14. Hyperæsthesia Sexualis—Delirium Acutum ex Abstinentia.—On May 29, 1882, F., aged 29, single, shoemaker, was received at the clinic. Father was of passionate temper; mother neuropathic, and had an insane brother. Patient had never been seriously ill previously, and was not a drinker, but had always been sexually very passionate. Five days before, he was taken acutely ill mentally. He made two attempts at rape in broad daylight, before witnesses, and when arrested talked in delirium only of obscene things, and masturbated without stint, and for three days had been raving mad. On admission he presented the picture of a severe acute delirium, with violent motor symptoms of irritation, and fever. Under treatment with ergotin a cure was effected.

On January 5, 1888, second admission, in a state of violent mania. On January 4, he had become morose, irritable, whining, and sleepless; and then, after vain assaults on women, had manifested symptoms of increasing angry excitement.

On January 6, progress of the condition to severe acute delirium (great disturbance of consciousness, jactation, grinding of the teeth, grimacing, and other motor symptoms of irritation; temperature as high as 40.7° C.); impulsive masturbation. Recovery was complete by January 11, under energetic treatment with ergotin.

After his recovery the patient gives an interesting account of the cause of his illness. Always very passionate sexually; first coitus at the age of sixteen. Continence caused headache, great psychical irritability, lassitude, great loss of pleasure in work, and sleeplessness. Since he had few opportunities in the country to satisfy his desire, he had recourse to masturbation. It was necessary for him to masturbate once or twice daily. No coitus in two months. Increasing sexual excitement; could think of nothing save means for the gratification of his impulse. Masturbation was not sufficient to banish the constantly increasing torment ex abstinentia. During the last four days violent impulse to coitus; increasing sleeplessness and irritability. There was only a summary recollection of the height of the illness. Patient recovered in December. A very respectable man; he considers his inordinate desire decidedly pathological, and is anxious about his future.

Case 15. On July 11, 1884, R., aged 33, servant, was admitted suffering with paranoia persecutoria and neurasthenia sexualis. Mother was neuropathic; father died of spinal disease. From childhood he had an intense sexual desire, of which he became conscious as early as his sixth year. From this age, masturbation; from fifteenth year, faute de mieux, pederasty; occasionally, sodomitic indulgences. Later, abusus coitus in marriage cum uxore. Now and then even perverse impulse to commit cunnilingus and to administer cantharides to his wife, because her libido did not equal his own. His wife died after a short period of married life. Patient’s circumstances became straightened, and he had no means to indulge himself sexually. Then masturbation again; employment of lingua canis to induce ejaculation. At times, priapism and conditions approaching satyriasis. He was then driven to masturbate, in order not to become stuporous. Beneficial diminution of the libido nimia, with the gradually predominating sexual neurasthenia and hypochondria.

The following case, valuable for an understanding of many Messalinas, some of whom are historically celebrated, is a classical example of pure hyperæsthesia sexualis, which I take from Trelat’s “Folie lucide”:—

Case 16. Mrs. V. has suffered with a passion for men since her earliest youth. Of good family, well bred, of pleasant disposition, exceedingly modest, she was, as a little girl, a terror to her family, because she could scarcely be alone with a person of the opposite sex, no matter whether it was with child or man of any age, without exposing herself immediately and demanding satisfaction for her sexual passion, even going so far as to lay hold of him. An attempt was made to cure her by marriage. She loved her husband passionately, but even with him she could not keep from demanding coitus of every one with whom she could be alone, no matter whether it was servant, laborer, or school-boy.

Nothing could cure her of this impulse. Even when she became a grandmother, she was still a Messalina. One day she locked a twelve-year-old boy in her room and tried to seduce him. The boy defended himself and escaped. She was severely punished by his brother. All was in vain. She was put in a cloister. There she was an example of morality, and gave not the slightest cause for blame. Immediately after her return the scandal began again. The family banished her, and set aside money to support her. She earned by her own hand-work enough to buy herself lovers. Any one seeing this neatly dressed matron, of good manners and amiable disposition, would never suspect how recklessly passionate she still was at the age of sixty-five. On January 7, 1854, her family, in despair at new scandals, placed her in an asylum. She lived there until May, 1858, when she died of apoplexia cerebri, in her seventy-third year. Her conduct in the asylum was exemplary. Left to herself, and under favorable conditions, her sexual impulses manifested themselves shortly before her death. With the exception of this, during an observation of four years by physicians of the asylum, she never showed a sign of mental abnormality.