Sexual Perversions

SEXUAL PERVERSIONS. Under P. i. (perversions, paraphilia) is usually meant a deviation from the normal way of sexual gratification, when either there is a one-sided or perverted manifestation of one of the components, or the sexual attraction is directed toward an unusual object. It is not so simple to draw a sharp line between normality and pathology, since in a normal person one can often note various deviations and perversions that may be caused by social and other reasons, for example the inability to have children, fear of contracting venereal diseases, etc. Sexual deviations should be considered pathological only when the sexual interest is completely focused on P. i., which displace and sometimes completely replace the natural sexual act. Speaking physiologically, in the latter case we have an analogy with the state of 'parabiosis' (Vvedensky), when at a certain stage of its development, weak stimuli cause excitation, strong ones cause inhibition. It should be said that the definition given above, theoretically quite acceptable, in practice creates such an expansion of the scope of the concept of P. i. that their boundaries sometimes lose all clarity. Let us give examples of P. i. known under the names of sadism and masochism. These concepts have flowed in a broad stream into everyday life, and many are inclined to call any manifestation of ordinary cruelty sadism. A mother, a teacher who punishes a disobedient child, acquire the nickname sadists; Germans after the Versailles treaty call the French sadists. This expansive interpretation to the point of complete unclearness has unfortunately penetrated scientific literature as well. Thus, Kretschmer in his latest book on genius speaks of 'sublimated' concepts of sadism and masochism, when it is not always possible, as he says, to uncover and prove the sexual nature of these drives. With such a broad and, we add, arbitrary interpretation, Kretschmer finds elements of sadism and masochism in virtues, in the sense of duty, in military discipline and heroic self-sacrifice. By the same paths he reaches theology and philosophy, revolution and legislation: traits of sadism and masochism he sees in Kant's categorical imperative, sadism in Frederick the Great, Robespierre, Nietzsche (speaking of the latter, Kretschmer quotes his famous saying 'when you go to a woman, don't forget the whip'), masochism in ascetic idealism, etc. Such boundless interpretation of P. i. deprives this concept of both theoretical and practical meaning. In other authors, the concept of sadism and masochism is identified with the concepts of sthenic and asthenic, extra- and introverted, cycloid and schizoid (Apfelbach and others.). All this ultimately leads logically to the conclusion that every person is either a sadist or a masochist or both. The roots of this must be sought in the attempt to cover up the class nature of these phenomena with the widely popular Freudian concepts of pansexualism. To clarify the concept of P. i., it is necessary to limit it, strictly conditioning their origin by sexual nature. It must be said that this is far from always so simple to do, since genital functions, as mentioned above, can recede to the background or be completely absent. An example can be kleptomania, appearing during menstrual excitement or the passion for defacing statues, which some authors classify as P. i. Here the sexual nature is not so obvious. The question is further complicated by the fact that even genital impulsive actions cannot always be unequivocally classified as sexual perversions, for example the exposure of genitals before others during the twilight state in epileptics. Pathogenesis of P. i. In sexual pathology, which is engaged in the study of P. i., there are basically two directions: purely biological and purely psychological. Some identify sexual pathology with the pathology of endocrine glands, others reduce sexual pathology to pure psychopathology; however, most authors limit themselves to the external description of the clinical picture of P. i. Both viewpoints do not withstand criticism. Touching upon the question of exo- and endogenesis of P. i., one should say the following. Attempts to explain P. i. only by social or only by biological factors are clearly unsuccessful already for the reason that at this point two planes of research are mixed: a) the question of the historical origin of P. i.; b) the question of how in a given person the mechanisms of one or another type of P. i. are realized, i.e. the question of the clinical variant of P. i. Here different regularities, phenomena of 'general' and 'individual' appear. The historical origin of P. i. must be entirely and unconditionally attributed to the basic forces lying outside the personality that construct this socio-economic formation. An example can be the wave of eroticism and the flourishing of P. i. in the era of reaction after the 1905 revolution in tsarist Russia or eroticism and P. i. in modern capitalist countries. It would be a gross mistake to believe, for example, that fetishism of some primitive peoples lies in the biology of one or another personality, of a leader, etc., as Freud wants. The second problem is extremely difficult to finally resolve. When attempting clinical analysis of P. i., one should proceed from the totality and specificity of facts observed in the clinic, namely from the peculiarities of personality development in the biological aspect. This is not only the soil but also the material for the development of P. i. In children (and especially in psychopathic ones), when sexual peculiarities are not yet differentiated, sexual traumas can easily lead to 'associated perversions', i.e. to sexual perversions that become deeply fixed like conditioned or combined reflexes, for example masochism in connection with punishments in childhood, which Rousseau so vividly depicted in his autobiographical 'Confessions'. According to Bekhterev, the development of homosexuality is facilitated by instilling during upbringing such character traits that turn a future man into a woman by habit; such educational conditions were created in former aristocratic families when a child of a sex was born that did not correspond to the desires and expectations of parents. True, usually childhood sexual impressions disappear, are overcome, which means that for this age, if not decisive, then certain significance have endogenous, constitutional factors, such as general psycho-physical lability, increased sexual excitability, tendency to fantasizing, etc. In adults, the above external factors can much more rarely lead to P. i., and then only with sharp general and sexual lability. Here the state of consciousness, the subject's attitude toward sexual life is already decisive; consciousness is the mediating link between the anatomical-physiological peculiarities of the subject and his sexual behavior. We have here a psychopathic or 'intersexual' constitution, schizoid shifts, disintegration of personality in processes leading to dementia (senile, paralytic, more rarely epileptic), changes in personality during epidemic encephalitis, during menopause, etc. What unites all these clinical varieties? According to Freud, the unifying moment is psycho-physical, in particular psycho-sexual infantilism (or primitivism or archaism), i.e. a delay (or regression in case of disintegration) of sexual development at the undifferentiated in sexual respect childhood stage of development. At this stage, polymorphous pre-sexual drives are observed, in particular for example the desire to undress oneself and to examine naked parts of the body, childhood masturbation, etc.; fixation at this stage can explain the appearance of exhibitionism and other sexual perversions, and external factors usually determine the content of P. i. Psycho-sexual primitivism is connected with general and psycho-sexual lability. It is appropriate to note that Kraepelin, otherwise decisely disagreeing with Freud, stands on the same viewpoint and speaks of psycho-sexual infantilism in P. i. Freud points out that among primitive peoples sexual perversions are very common, even ritualized, have a magical tint, and at the same time gives an unsuccessful analogy with early childhood age and so-called civilized peoples. In many cases of P. i., infantile stigmata can be found in the somatic, in the structure of the body, endocrine glands, dysglandular stigmata, etc. Freud's concept attempts to encompass all P. i. in a single system, but in this concept there are all the usual shortcomings of Freudian views: purely biologizing, the break between biological and psychological, a vitalistic understanding of drives; as a premise is taken what requires proof, etc. The origin of P. i. is entirely shifted in the direction of constitution, moreover not real, but theoretically, partly speculatively constructed. In essence P. i. are not so much explained as they themselves serve as the basis for explanation. P. i. are not secondary, they are in Freud's 'primal drives', primal-sexuality, from which normal sexuality is formed. Thus-not perversions, but normal sexuality is the secondary derivative.

A special constitution, a special clinical form, with which sexual perversions are associated, has not been possible to isolate, and it is hardly likely to be possible. Sexual perversions occur as an isolated symptom, as well as in neurotics and psychopaths (however, particularly often in the sensitive-hysterical type, where infantile stigmata predominate), at the onset of organic feeble-mindedness (especially in senile psychoses). Speaking about the peculiarities of personality, one can only note that the most frequent type is schizothymics. This, on the one hand, is understandable to a certain extent; but, on the other hand, both psychologically and somatically, what is considered schizothymia is often in essence a kind of 'schizoidization' and can be one of the consequences of sexual perversions. In sexual perversions, we often have an early appearance of the sexual drive, which in its physiological nature is very weak, requiring intensified stimuli. In the psychological plane, a great role is played by the feeling of somatic and psychic inferiority and the resulting lack of confidence in one's sexual capabilities. Here we have a complete analogy with the predilection of some women entering the climacteric age for boys (or vice versa), in relation to whom they feel freer. Some indications are given to us by the genetic principle, the ideas of ontogenesis and phylogenesis in their application to sexual perversions. Thus, in the animal world, there are a number of sexual 'anomalies.' We point to the widespread in the animal world sexual coitus 'a tergo.' We recall insects that, by means of masturbatory manipulations, obtain semen from themselves, which they then introduce into the sexual opening of the female; we remember the female spider that kills the male after the sexual act. Nevertheless, there is nothing here of a far-reaching analogy: for the animals in question, these actions are not sexual perversions; they are purposeful acts directed at fertilization, at the continuation of the species. Classification. This question is complicated by the fact that sexual perversions can occur alongside normal sexuality or in isolation, that in the same subject the most diverse, even contradictory perversions can be present, e.g., sadism and masochism in different phases or even simultaneously, that alongside this there are monoperversions. Furthermore, from what has been said above, it is evident that classification according to patho- and psychogenesis, according to psychological structure, according to characterological peculiarities is still impossible. Likewise, classification according to constitutional and clinical-nosological rubrics is not feasible. If, for example, one makes a division into infantile and intersexual, degenerative and organic sexual perversions (including here the feeble-minded), then with each of these forms any perversion can be present. There remains for now only one possibility, although not entirely satisfactory: a descriptive classification. We present this classification here. All sexual perversions can be divided into 4 groups: Group I - when sexual drives are directed toward an unusual living object: toward persons of the same sex (homosexuality), toward children (pedophilia), toward old people (gerontophilia), toward animals (bestiality), toward corpses (necrophilia). Group II - when the drive itself is perverted: the drive to inflict pain on the sexual partner (sadism), to experience pain from him (masochism), sexual attraction to various objects, such as shoes, etc. (fetishism), sexual attraction associated with dressing in clothing of the opposite sex (transvestitism), passion for exposing one's sexual organs (exhibitionism), passion for one's own body (narcissism). As stated above, sexual perversions can be combined in the same subject. The indicated classification concerns sexual anomalies from the point of view of quality. Group III concerns sexual perversions from the point of view of quantitative relationships. These sexual anomalies go in the direction of either hypo- or hyperesthesia. Hypo- or anesthesia occurs relatively rarely, sometimes as a result of improper upbringing (view of the sexual act as a 'sin' etc.), sometimes in connection with endocrine insufficiency, as well as in some psychoses (e.g., in depression, in drug addiction, especially in alcoholism, morphinism, cocaineism). Cases of sexual hyperesthesia are more common, namely in various psychopathies, at the beginning of progressive paralysis, idiocy, in manic and catatonic excitement; in markedly pronounced cases, one speaks of satyriasis in men and nymphomania in women, when the sexual act does not give satisfaction and when the subject, experiencing an irresistible and continuous sexual drive, is unable to control himself. Group IV includes sexual paradoxia, which is understood as the presence of a sexual drive at an unusual age: early childhood or advanced old age. Individual types of sexual perversions Group I. 1. Homosexuality (see) is distinguished as male and female. The first - so-called pederastry (from the Greek pais - boy and erastes - lover) (syn. uranism) consists in introducing the penis into the anus of an adult man or boy. The active pederast is called a pedicator, the passive one - a cineade or a pathicus. Female homosexuality is called lesbian love. This name is based on the fact that in ancient times on the island of Lesbos, allegedly, cohabitation of the same sex was practiced. Synonyms are: sapphism (from the name of the ancient Greek erotic poetess Sappho, who lived on the island of Lesbos and preached same-sex love among women), tribadism (from the Greek tribein - to rub). A woman suffering from homosexuality is called an urning. According to the object of attraction in connection with age, there is a distinction: for men - ephebophilia - attraction to boys, androphilia - attraction to adult men; for women - corophilia - attraction to immature girls, parthenophilia - to mature girls, gynephilia - to mature women, and gerontophilia - to old women. 2. Pedophilia - sexual desire for children, most often of both sexes. In this perversion, the environment plays a very large, if not decisive, role. Most pedophiles are teachers; sometimes it is sufficient to change one's profession to get rid of pedophilia. It is curious that in some during the holidays pedophilia disappears. Elements of sadism are sometimes mixed with pedophilia. As with all sexual perversions, alcohol here can be a provoking factor. From the constitutional side, one must emphasize a certain lack of confidence in sexual matters, which forces one to seek a specifically inadequate subject. Here there is an analogy with the sexual drive described above in some climacteric women. Pedophilia can also arise in various forms of feeble-mindedness, e.g., in senile dementia, especially in the twilight state, as well as in old people. 3. Gerontophilia - sexual attraction to old people - a rather rare perversion, mainly in psychopaths. 4. Bestiality, or sodomy, zoophilia - sexual attraction to animals. Zoophilia (syn.: zooeroticism, zooerasty) is a sexual perversion only in cases when sexual intercourse with animals displaces, replaces the natural sexual drive. It occurs in feeble-minded epileptics, in psychopaths with increased sexual excitability. It should be noted that many cases when a person uses animals for sexual intercourse cannot be classified as zoophilia. Such are, for example, cases when it is not about sexual attraction, but about the desire to have a warm living object for sexual intercourse, whether it is an animal, a child, or an adult - such cases are often found in the feeble-minded; or cases when, from a superstitious belief that sodomy frees from sexual diseases, one enters into sexual intercourse with animals. Zoosadism is understood as zoophilia that is combined with sadistic tendencies, when sexual satisfaction is achieved by killing the animal. 5. Necrophilia see below. Group II. 1. Sadism - a term proposed by Kraft-Ebing in honor of the French writer Marquis de Sade, who in a number of novels described this kind of sexual perversion. Sade was in prison and in a psychiatric hospital. Under sadism Kraft-Ebing understood a peculiar perversion of sexual life, which is expressed in an irresistible urge to inflict pain, actively to torture, to subordinate the sexual partner, and this state is accompanied by a feeling of voluptuousness. According to Kraft-Ebing, sadism is pathologically exaggerated manifestations of love in men, masochism in women. In reality, here there is a qualitative difference, and the sexual means turns into an end in itself. Havelock Ellis sees in sadism an analogy to the love struggle in the animal world and an exaggeration of 'sexual manifestations' inherent in the normal person (embracing, pinching etc. during the sexual act). In any case, the similarity between male sexual aggressiveness and sadistic manifestations is greatly exaggerated. Besides cruelty, for sadism is characteristic the satisfaction derived from the helplessness of the sexual partner, which does not occur in normal sexual intercourse. The cruelty of sadism as a sexual end in itself (since the sexual act may not take place) speaks with all definiteness of the pathological nature of this sexual perversion. The manifestation of sadism without participation in the sexual act is called symbolic sadism (e.g., the sadism of an educator); the sexual nature of this perversion may not reach the consciousness of the subject.

This includes coprolalia and coprography, verbal and written sadism, a passion for hurling abuse, writing abusive and pornographic anonymous letters, composing pornographic literature, etc. They often use the telephone for verbal abuse, unleashing it on telephone operators. The basis of sadism can be uncovered in a number of cases of arson (pyromania), theft (kleptomania), in a tendency to cause pollution, in a need to cut the clothing of persons of the opposite sex, etc. In the case of love for statues (pygmalionism), it goes as far as damaging works of art, pouring ink on them, etc. Among sadistic manifestations, the tendency to flogging (in the literal sense of the word) or active flagellation is of practical interest, with the partner often being flogged until bleeding; most often this serves as preparation for sexual intercourse, less often as a substitute for it; in the latter case, sexual satisfaction is derived from the moment of humiliating the partner. Sometimes flagellation, associated with refined tortures, is hidden under various forms of cult symbols. Kraft-Ebing singled out a special group of such sadistic manifestations in relation to children, which is also noted in sadistically predisposed teachers. Oppenheim proposed the term 'misopedia' (hatred of children) for sadistic manifestations of mothers who beat their children (most often not their own, but from another marriage), experiencing sexual excitement in the process. Even more cruel manifestations of sadism must include the passion for strangulation identified by Roleder, when the subject strangles their sexual partner, as well as the passion for stabbing (so-called stabbers), for which they try to choose attractive young women, inflict several superficial wounds on them, and the sight of blood alone provides sexual satisfaction. Finally, this also includes lust murder, before or after sexual intercourse, and often the victim is mutilated and cut into pieces, the sexual organs are cut out, the blood of the victim is drunk (bloodthirstiness in the direct sense of the word), and parts of the killed body are eaten (anthropophagy). A variety of this P. I. is so-called vampirism, a passion for defiling corpses; in this respect, the French lieutenant Bertrand acquired a sad notoriety (hence the term-Bertrandism). Here there are all shades: necrophilia, when satisfaction is derived from the sight of a corpse without touching it—in the case described by Kronfeld, the subject paid prostitutes to pretend to be dead, which caused excitement; imaginary defilement of a corpse—sexual excitement during the funeral ceremony; necrosadism—defilement, disfigurement of the corpse; finally necrophagy—eating parts of the corpse, most often the sexual organs. Sadism also includes the sexual passion to torment and kill animals. Sometimes sadistic manifestations require an intermediary, e.g., a sadist forces his wife to kill animals. Touching upon the question of constitutional peculiarities, one can basically note 2 groups: the sthenic, impulsive (here belong psychopaths, erotically-explosive types, epileptoids) and the group of asthenic, timid, insecure individuals. From a legal point of view, sadism is of great interest, as it is often associated with great dangers to others.

2. Masochism—a term proposed by Kraft-Ebing after the name of the Austrian writer Sacher-Masoch, who described this P. I. in a number of his novels and, as it turned out later, suffered from this perversion himself (M. Hirschfeld proposed to call this perversion metatropism). By masochism Kraft-Ebing understood a peculiar perversion of sexual life, which is expressed in an irresistible desire to experience pain, to submit oneself to violence, to undergo humiliation, and this state is accompanied by a feeling of voluptuousness. Masochism may only accompany normal sexual life, but it can completely displace normal sexual intercourse, and masochists lose the ability to normal sexual life. Kraft-Ebing in male masochism sees an exaggeration of female psychological, sexual characteristics, notes the presence of feminine traits in many masochists. Speaking of the connection between the feeling of pain and pleasure, united in the sensations of a masochist, one can point out that the highest degree of voluptuousness is connected for a normal woman with pain, 'with the moment of losing virginity,' that is why a number of authors say that certain traits of masochism are inherent in women by nature. Physical pain itself is not, as is commonly thought, the central symptom of masochism; that is why replacing this term with the term algolagnia, which was proposed by Schrenk-Notzing, would be incorrect, and this name did not catch on. In fact, in masochism there are 2 groups of psychological phenomena: masochism in the narrow sense of the word, limited to sexually erotic content and manifestation, and masochism in the broader sense of the word, when it comes to a general peculiar neuropathic attitude towards life, to the feeling of obedience, submission, close to suggestibility. This kind of masochism is not always connected with sexual actions, is often limited to fantasizing, dreaming, etc. This is the so-called 'ideal masochism' of Kraft-Ebing. In connection with this, the manifestations of masochism are extremely diverse, ending with purely ideological forms. Thus, in Western European literature, cases are described where masochists took positions as servants, when 'high-ranking' persons went to the 'lower levels,' became lackeys, performed the blackest work. Sometimes masochism has a purely verbal character, voluptuousness is achieved due to the fact that a woman is showered with unworthy abusive words. Usually the common type of masochism is the one where the subject of the PERVERSIONS

The sexual pervert attempts to subordinate himself to a woman, playing a passive role with her, and the sexual act is accompanied by beatings which she inflicts upon him; these beatings are administered with a whip, a stick, cuts are made, sometimes serious injuries are inflicted. Particularly disgusting are the masochistic manifestations when they reduce to the need to be soiled by the secretions of the sexual partner (so-called passive polluism), the need to smell and even drink the partner's urine (urolagnia), eat their feces (coprolagnia), suck mucus from the vagina, lick saliva, mucus from the nose, etc. To denote such perversions of the olfactory and gustatory senses, Eilenburg proposed the name picacism. However, in these manifestations there are often sadistic elements—it is a matter of the desire to force a woman to endure all these abominations. An admixture of sadism is also present in so-called triolism (syn. pluralism), which consists in that the masochist forces his partner to have sexual intercourse with another man in his presence, whom he considers a happy rival and in this experiences sexual pleasure (close to triolism are the so-called voyeurs and reniflQurs or epongeurs of French authors—peeping and smelling during another's sexual act) [syn. mixoscopia of Kraft-Ebing (from Greek mi-xis-sexual intercourse and skeptein-to observe), when sexual arousal is caused by observing the sexual act of others]. Under servilism and pajism is understood the attraction to be a servant, a page. Under passiophilia is understood homosexual masochism. As objects for masochistic manifestations for the purpose of increasing the degree of self-abasement, prostitutes, physical freaks, etc. are often chosen. Masochism must be distinguished from flagellantism (khlystovstvo), which has elements of masochism, sexual self-abasement, but which in its pure form is a means to increase sexual potency. Flagellants usually make themselves beaten on the buttocks. In the fusion of erotic ardor and 'religious ecstasy' ('dying of the flesh' during this procedure), flagellants experience the highest pleasure. Clearly expressed forms of masochism in women are almost never encountered. It is appropriate here to mention the abnormal attraction in some women to surgical operations as an expression of masochism. By aggravation and simulation, patients achieve surgical intervention. Thus, in the case of Yel. Karchikyan, the patient underwent 11 operations in 7 years, including appendectomy, cholecystectomy, laparatomy, gastroenterostomy, thyroidectomy (for a small goiter). The patient with enthusiasm said that she wished to give her life into the hands of the surgeon. It is possible that such cases sometimes go unnoticed by the surgeon. A number of authors (for example Magnus-Hirschfeld) is inclined to single out a special sexual constitution in masochism. Hoffman tries to justify this constitution genotypically: due to the inconsistency of valencies in both parents, a perversion occurs in the sexual nature, and male traits appear in women and vice versa. These perversions are such that they do not reach the degree of homosexuality. However, Hoffman himself is sufficiently cautious to indicate that it is not always possible to uncover such a constitution. The type of sensitive psychopath predominates. Treatment-suggestive. 3. Fetishism (syn.: partialism, idolism, symbolism)—a term proposed by Binet and denoting passion for individual parts of the sexual partner, physical or mental peculiarities of his, causing sexual excitement, usually with complete indifference to the personality of the partner as a whole. The roots of fetishism are also present in so-called physiological love, when individual traits of the partner acquire a special, dominant significance. Fetishism becomes an end in itself, displaces the sexual act, serves for sexual satisfaction by masturbation, touching the fetish gives greater sexual satisfaction than the sexual act; the more difficult it is to obtain the object of one's fetishism, the more satisfaction the fetishist experiences. As objects of fetishism, footwear is encountered particularly often as a symbol of 'masochistic' subordination (since in fetishism there are usually also elements of masochism). Kraft-Ebing cites a case where a fetishist was outraged by an exhibition of ladies' footwear, considering such exhibitions immoral. Further, objects of fetishism are handkerchiefs, underwear, silk, fur. The fetish serves as individual parts of the body, hands, feet, eyes, ears, especially braids, which fetishists, overcoming all obstacles, sometimes cut on the street, hide, and the process of cutting itself gives them sexual satisfaction. It is interesting to note that deformity can also serve as an object of fetishism, for example, baldness, strabismus, lameness, etc. Of individual types of fetishism, the following should be mentioned: phalloctenism—cult of the male penis, one of the most common types of fetishism in antiquity, preserved to this day among some primitive peoples. Dendrophilia—perverse attraction to trees. To a certain extent, this also includes such perversions of the normal sexual act as annilinguus and annilinctio (from anus-anus and lingua-tongue), causing sexual excitement by the irritation of the man's mouth of the woman's anus; cunnilinguus and cunnilinctio (minette)—irritation of the man's tongue of the woman's genitals; fellatorism (fellatio, pennilinctio)—irritation of the woman's tongue of the man's penis; digitatio—obtaining satisfaction by irritation of the partner's genitals with the help of a finger. In individual cases, fetishism is combined with sadism, sometimes fetishists try to soil the object of their attraction. Magnus Hirschfeld also relates to fetishism the phenomena of negative attitude towards individual objects belonging to the sexual partner, this so-called 'sexual aversion'. Fetishism is found among both men and women. Many theories exist to explain fetishism, but none of them can be considered satisfactory. The theory that is usually attributed to Freud consists in that in early youth, at the first awakening of sexual life, events may occur which are then consolidated by association. This theory was put forward by Binet, and from 1892 by Kraft-Ebing, i.e., a year before the appearance of Freud's teaching. Havelock Ellis described a patient who first experienced sexual feeling when he fell and a woman accidentally stepped on his stomach with her feet. Since then, the shoe became the object of his fetishism. In contrast to other sexual perversions, hypnosis gives a good effect here. 4. Transvestite—a sexual attraction associated with dressing in clothes of the opposite sex. In half of the cases, transvestism is connected with homosexuality and is one of the manifestations of general sexual perversion. In the other half of cases, it is observed with quite normal sexual attraction, and some cases can be classified as obsessive manifestations. 5. Exhibitionism was first described by Lasègue and denotes passion for exposure in the presence of the opposite sex and children of their sexual organs, which often completely displaces or replaces the sexual act; sometimes self-exposure ends with masturbation. In individual cases, the matter is limited to abusive cries, without exposure of the sexual parts. In rarer cases, exposure concerns the back parts or the entire body. Exposure occurs on the street, in the theater, church, etc., and many exhibitionists experience an irresistible need to return to the same place, realizing the increased danger of such behavior. Many have the conviction that the act of exhibitionism arouses sexual interest in those before whom self-exposure is committed. Women suffer from exhibitionism extremely rarely. A variety of exhibitionism is frottage (frottage, from frotter-to rub)—the desire to satisfy sexual attraction by rubbing an exposed or covered penis against a woman's body, dress. Exhibitionist acts are of an obsessive, irresistible nature, often arise suddenly, as a result of which they more often than in other P.I. lead to conflicts with the law. In rarer cases, these acts are prepared in advance, and some subjects have special pants facilitating rapid exposure of the sexual parts. In completely healthy people, exhibitionism is almost never encountered, except in persons with sharply weakened sexual excitability; 'symptomatic' exhibitionism is encountered in idiocy, paralytic and senile dementia, epilepsy (for a long time exhibitionism was considered an epileptic equivalent), more rarely in schizophrenia. 'Essential' exhibitionism is characteristic of psychopaths, especially with traits of infantilism with symptoms of general developmental delay, while in the symptomatic form, elements of mental disintegration predominate. According to Lepine, exhibitionists are usually timid, helpless people in the presence of women, who have long practiced masturbation; by the way, Kraepelin considers exhibitionism one of the types of masturbation. The etiology and pathogenesis of exhibitionism are attempted to be uncovered by the Freudian school. Like narcissism, it considers exhibitionism in the light of human sexual development as a normal stage of childhood sexuality, expressing the need to show and inspect the body (so-called Schau- und Zeigetrieb).

Thanks to "endocrine" reasons, some people experience a delay at this stage of childhood development. Thus, exhibitionism is considered an innate defect, and the reason for the manifestation of exhibitionism at a later age is not explained here in any case. Kraepelin notes that in 70% of cases there is a hereditary predisposition. According to Stegelin, among 70 exhibitionists there were: 31 psychopaths, 21 intellectually deficient (imbeciles, morons), 10 schizophrenics, 2 epileptics, 2 alcoholics; among psychopaths, a hereditary predisposition was noted in 74% (mainly psychopathy, alcoholism, sexual anomalies). Marriage does not contribute to the eradication of exhibitionism, and punishment naturally does not lead to the desired goal either. According to Stegelin, among those punished, the recurrence of exhibitionism was 73%, while among those not punished it was only 20%. The best results are currently achieved through psychotherapy, although the results are generally not very encouraging. 6. Narcissism (see). Instead of narcissism, Havelock Ellis proposed the term autoeroticism, and Roleder-auto-monosexuality. The diagnosis of sexual perversion, except for those difficult cases mentioned above, is not particularly difficult to make. It is very advisable to use the content of dreams in persons suffering from S.P., as they are often reluctant to give anamnestic information regarding these anomalies. The content of dreams is mostly related to perversions. In cases where apparent improvement is not accompanied by a change in dream content, one must be cautious regarding the prognosis. The prognosis was considered poor until recently. Recovery was achieved only in some cases, and mainly in those where bisexual tendencies exist, where normal sexual impulses coexist with perversions. However, the question of therapy is still far from resolved, so prevention is in the forefront: proper sexual education, co-education, etc. It should be kept in mind that alcoholism sharply contributes to the development of S.P. Attempts at treatment by transplantation of sex and other endocrine glands have so far not produced encouraging results. Along with preventive and social health measures, the main treatment should be psychotherapy, in particular hypnosis and suggestion, which give satisfactory results not only where S.P. is associated with psychogenic layers (e.g., depression related to exaggerated ideas about the harm of masturbation), but also in purely endogenously conditioned perversions. Here, greater therapeutic persistence is necessary, and it is especially necessary to decisively convince the patient that S.P. is not "innate," "hereditarily conditioned," and therefore "incurable." Moll proposes the so-called "associative therapy," which consists of suppressing perverse associations and cultivating normally directed impulses through proper direction of reading, creating the right environment, etc. This therapy is based on the fact that in all perversions, a bridge to normal sexual impulses can still be found. In a number of cases, it is important to reduce heightened sexual excitability by using work and hydrotherapy, physical exercise. Advice to marry does not in itself have a therapeutic effect. From a forensic psychiatric point of view, S.P. is of considerable interest. The feeling of one's own inadequacy, "lowness," and the resulting alienation lead to conflicts and various life collisions. And most importantly, the S.P. themselves often violate the generally accepted norms of social behavior. In capitalist countries (and before the revolution in our country as well), these violations are prosecuted by special "laws of morality." Besides the fact that these laws, which are partially directed against biologically conditioned deviations, are absurd in themselves, they do not give real results. On the contrary, they are extremely harmful to the psyche. To this day, in advanced capitalist countries, the struggle to abolish these hypocritical institutions is far from over. Thus, in Germany, Magnus Hirschfeld is particularly passionately, but so far unsuccessfully, fighting for the repeal of the law against homosexuality. Soviet legislation does not know a crime directed against morality in general. Our legislation, based on the principle of protecting society, provides for punishment only in cases of S.P. when the object of sexual interest becomes minors or juveniles. This is Art. 151, 152 of the Criminal Code of the RSFSR. The Soviet assessment of persons suffering from S.P. sharply differs from that in capitalist countries. Taking into account the pathological nature of S.P., society cannot blame the carriers of these peculiarities for them. This thereby destroys the wall that is erected between these individuals and society, a wall that often leads them to suicide attempts, depression, etc. By emphasizing the origins of these sexual anomalies, Soviet medicine, through a number of preventive and health measures, creates the necessary conditions for life conflicts in these patients to proceed as painlessly as possible and for their alienation to dissolve in a healthy collective.