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CHAPTER VI.—THE THEORY OF SEXUAL INVERSION.

What is Sexual Inversion?—Causes of Diverging Views—The Theory of Suggestion Unworkable—Importance of the Congenital Element in Inversion—The Freudian Theory—Embryonic Hermaphroditism as a Key to Inversion—Inversion as a Variation or "Sport"—Comparison with Color-blindness, Color-hearing, and Similar Abnormalities—What is an Abnormality?—Not Necessarily a Disease—Relation of Inversion to Degeneration—Exciting Causes of Inversion—Not Operative in the Absence of Predisposition.

The analysis of these cases leads directly up to a question of the first importance: What is sexual inversion? Is it, as many would have us believe, an abominably acquired vice, to be stamped out by the prison? or is it, as a few assert, a beneficial variety of human emotion which should be tolerated or even fostered? Is it a diseased condition which qualifies its subject for the lunatic asylum? or is it a natural monstrosity, a human "sport," the manifestations of which must be regulated when they become antisocial? There is probably an element of truth in more than one of these views. Very widely divergent views of sexual inversion are largely justified by the position and attitude of the investigator. It is natural that the police-official should find that his cases are largely mere examples of disgusting vice and crime. It is natural that the asylum superintendent should find that we are chiefly dealing with a form of insanity. It is equally natural that the sexual invert himself should find that he and his inverted friends are not so very unlike ordinary persons. We have to recognize the influence of professional and personal bias and the influence of environment.

There have been two main streams of tendency in the views regarding sexual inversion: one seeking to enlarge the sphere of the acquired (represented by Binet,—who, however, recognized predisposition,—Schrenck-Notzing, and recently the Freudians), the other seeking to enlarge the sphere of the congenital (represented by Krafft-Ebing, Moll, Féré, and today by the majority of authorities). There is, as usually happens, truth in both these views. But, inasmuch as those who represent the acquired view often deny any congenital element, we are called upon to discuss the question. The view that sexual inversion is entirely explained by the influence of early association, or of "suggestion," is an attractive one and at first sight it seems to be supported by what we know of erotic fetichism, by which a woman's hair, or foot, or even clothing, becomes the focus of a man's sexual aspirations. But it must be remembered that what we see in erotic fetichism is merely the exaggeration of a normal impulse; every lover is to some extent excited by his mistress's hair, or foot, or clothing. Even here, therefore, there is really what may fairly be regarded as a congenital element; and, moreover, there is reason to believe that the erotic fetichist usually displays the further congenital element of hereditary neurosis. Therefore, the analogy with erotic fetichism does not bring much help to those who argue that inversion is purely acquired. It must also be pointed out that the argument for acquired or suggested inversion logically involves the assertion that normal sexuality is also acquired or suggested. If a man becomes attracted to his own sex simply because the fact or the image of such attraction is brought before him, then we are bound to believe that a man becomes attracted to the opposite sex only because the fact or the image of such attraction is brought before him. Such a theory is unworkable. In nearly every country of the world men associate with men, and women with women; if association and suggestion were the only influential causes, then inversion, instead of being the exception, ought to be the rule throughout the human species, if not, indeed, throughout the whole zoölogical series. We should, moreover, have to admit that the most fundamental human instinct is so constituted as to be equally well adapted for sterility as for that propagation of the race which, as a matter of fact, we find dominant throughout the whole of life. We must, therefore, put aside entirely the notion that the direction of the sexual impulse is merely a suggested phenomenon; such a notion is entirely opposed to observation and experience, and will with difficulty fit into a rational biological scheme.

The Freudians—alike of the orthodox and the heterodox schools—have sometimes contributed, unintentionally or not, to revive the now antiquated conception of homosexuality as an acquired phenomenon, and that by insisting that its mechanism is a purely psychic though unconscious process which may be readjusted to the normal order by psychoanalytic methods. Freud first put forth a comprehensive statement of his view of homosexuality in the original and pregnant little book, Drei Abhandlungen zur Sexualtheorie (1905), and has elsewhere frequently touched on the subject, as have many other psychoanalysts, including Alfred Adler and Stekel, who no longer belong to the orthodox Freudian school. When inverts are psycho-analytically studied, Freud believes, it is found that in early childhood they go through a phase of intense but brief fixation on a woman, usually the mother, or perhaps sister. Then, an internal censure inhibiting this incestuous impulse, they overcome it by identifying themselves with women and taking refuge in Narcissism, the self becoming the sexual object. Finally they look for youthful males resembling themselves, whom they love as their mothers loved them. Their pursuit of men is thus determined by their flight from women. This view has been set forth not only by Freud but by Sadger, Stekel, and many others.^[225] Freud himself, however, is careful to state that this process only represents one type of stunted sexual activity, and that the problem of inversion is complex and diversified.

This view may be said to assume a bisexual constitution as normal, and homosexuality arises by the suppression, owing to some accident, of the heterosexual component, and the path through an autoerotic process of Narcissism to homosexuality. On this general Freudian conception of homosexuality numerous variations have been based, and separate features specially emphasized, by individual psychoanalysts. Thus Sadger considers that, beneath the male individual loved by the invert, a female is concealed, and that this fact may be revealed by psychoanalysis which removes the upper layer of the psychic palimpsest; he believes that this disposition of the invert is favored by a frequent mixture of male and female traits in his near relatives; originally, "it is not man whom the homosexual man loves and desires but man and woman together in one form"; the heterosexual element is later suppressed, and then pure inversion is left. Further, developing Freud's view of the importance of anal eroticism (Freud, Sammlung Kleiner Schriften zur Neurosenlehre, vol. ii), Sadger thinks that it is even the rule for a passive invert to have experienced anal eroticism in childhood and been frequently subjected to enemas, which have led to the desire for the anal intromission of the penis. (Medizinische Klinik, 1909, No. 2.) Jekels pushes this doctrine further and declares that all inverts are really passive; the invert is, in his love, he states, both subject and object; he identifies himself with his mother and sees in the object of his love his own youthful person. And what, Jekels asks, is the aim of this mental arrangement? It can scarcely by other, he replies, than in the part of the mother to stimulate the anal region of the object which has now become himself, and to procure the same pleasure which in childhood he experienced when his mother satisfied his anal eroticism. Jekels regards this view as the continuation and concretization of Freud's interpretation; and the main point in homosexuality, even when apparently passive, becomes the craving for anal-erotic satisfaction (L. Jekels, "Einige Bemerkungen zur Trieblehre," Internationale Zeitschrift für Aerztliche Psychoanalyse, Sept., 1913). Most psychoanalysts are cautious in denying a constitutional or congenital basis to inversion, though they leave it in the background. Ferenczi, in an interesting attempt to classify the homosexual (Internationale Zeitschrift für Aerztliche Psychoanalyse, March, 1914), remarks: "Psychoanalytic investigation shows that under the name of homosexuality the most various psychic states are thrown together, on the one hand true constitutional anomalies (inversion, or subject homoeroticism), on the other hand psychoneurotic obsessional conditions (object homoeroticism, or obsessional homoeroticism). The individual of the first kind essentially feels himself a woman who wishes to be loved by a man, while the other represents a neurotic flight from women rather than sympathy to men." The constitutional basis is very definitely accepted by Rudolf Ortvay who points out (Internationale Zeitschrift für Aerztliche Psychoanalyse, Jan., 1914) that the biological doctrine of recessives and dominants in heredity helps to make clear the emergence or suppression of homosexuality on a bisexual disposition. "Infantile events," he adds, "which, according to Freud, decide the sexual relations of adults, can only exert their operation on the foundation of an organic predisposition, infantile impressions being determined by hereditary predisposition." Isador Coriat, on the other hand, while recognizing two forms of inversion, incomplete and complete, boldly asserts that it is never congenital and never transmitted through heredity; it is always "originated through a definite unconscious mechanism" (Coriat, "Homosexuality," New York Medical Journal, March 22, 1913). Adler's view of homosexuality, as of other allied conditions, differs from that of most psychoanalysts by insisting on the presence of an original organic defect which the subject seeks to fortify into a point of strength; he accepts two chief components of inversion: a vagueness as to sexual differences and a process of self-assurance in the form of rebellion and defiance, and even the feminism of the invert may become a method of gaining power (A. Adler, Ueber den Neurösen Charakter, 1912, p. 21).

The mechanism of the genesis of homosexuality put forward by Freud need not be dismissed offhand. Freud has often manifested the insight of genius, and he refrains from molding his conceptions in those inflexible shapes which have sometimes been adopted by the more dogmatic psychoanalysts who have followed him. Nor need we be unduly shocked by the "incestuous" air of the "Œdipus Complex,"^[226] as it is commonly called, which figures as a component of the process. The word "incest," though it has been used by Freud himself, seems scarcely a proper word to apply to the vague and elementary feelings of children, especially when those feelings scarcely pass beyond a stage of non-localized and therefore really presexual feelings (in the ordinary use of the term "sexual") which may be regarded as natural and normal. The Freudian conception is misrepresented and prejudiced by the statement that it involves "incest."^[227] When a child loves its mother with an entire love, that love necessarily involves the germs which in later life become separated and developed into sexual love, but it is inaccurate to term this love of the child "incestuous." It is quite easily conceivable that the psychic mechanism of the establishment of homosexuality has in some cases corresponded to the course described by Freud. It may also be admitted that, as psychoanalysts claim, the pronounced horror feminæ occasionally found in male inverts may plausibly be regarded as the reversal of an early and disappointed feminine attraction. But it is impossible to regard this mechanism as invariable or even frequent. It is quite true, and I have found ample evidence of the fact, that inverts are often very closely attached to their mothers, even to a greater degree, indeed, than is the rule among normal children, and often like to be in constant association with their mothers. But this attraction is quite misunderstood if it is regarded as a peculiarly sexual attraction. Indeed, the whole point of the attraction is that the inverted boy vaguely feels his own feminine disposition and so shuns the uncongenial amusements and society of his own sex for the sympathy and community of tastes which he finds concentrated in his mother. So far from such association being evidence of sexual attraction it might more reasonably be regarded as evidence of its absence; just as the association of boys among themselves, and of girls among themselves, even in co-educational schools, is proof of the prevalence of heterosexual rather than of homosexual feeling. Confirmation of this point of view may be found in the fact—overlooked and sometimes even denied by psychoanalysts—that frequently, even in early childhood and simultaneously with this community of feeling with his mother, the homosexual boy is already experiencing the predominant fascination of the male. He feels it long before the age at which Narcissism is apt to occur, or at which self-consciousness has become sufficiently developed to allow the internal censure on unpermitted emotions to operate, or any flight from them to take place. Moreover, while most authorities have rarely been able to find any clear evidence of the sexual attraction of male inverts in childhood to mother or sister,^[228] an attraction of this kind to father or brother seems less difficult to find, and if found it is incompatible with the typical Freudian process. In my own observation, among the Histories here recorded, there are at least two clear examples of such an attraction in childhood. It must further be said that any theory of the etiology of homosexuality which leaves out of account the hereditary factor in inversion cannot be admitted. The evidence for the frequency of homosexuality among the near relatives of the inverted is now indisputable. I have traced it in a considerable proportion of cases, and in many of these the evidence is unquestionable and altogether independent of the statement of the subject himself, whose opinion may be held to be possibly biased or unreliable.^[229] This hereditary factor seems indeed to be called for by the Freudian theory itself. On that theory we need to know how it is that the subject passes through psychic phases, and reaches an emotional disposition, so unlike that of normal persona. The existence of a definite hereditary tendency in a homosexual direction removes that difficulty. Freud himself recognizes this and clearly asserts congenital psycho-sexual constitution, which must involve predisposition. On a general survey, therefore, it would appear that, on the psychic side, we may accept the reality of unconscious dynamic processes which in particular cases may be of the Freudian or similar type. But while the study of such mechanisms may illuminate the psychology of homosexuality, they leave untouched the fundamental organic factors now accepted by most authorities.^[230]

The rational way of regarding the normal sexual instinct is as an inborn organic impulse, reaching full development about the time of puberty.^[231] During the period of development suggestion and association may come in to play a part in defining the object of the emotion; the soil is now ready, but the variety of seeds likely to thrive in it is limited. That there is a greater indefiniteness in the aim of the sexual impulse at this period we may well believe. This is shown not only by occasional tentative signs of sexual emotion directed toward the same sex in childhood, but by the frequently ideal and unlocalized character of the normal passion even at puberty. But the channel of sexual emotion is not thereby turned into an abnormal path. Whenever this happens we are bound to believe—and we have many grounds for believing—that we are dealing with an organism which from the beginning is abnormal. The same seed of suggestion is sown in various soils; in the many it dies out; in the few it flourishes. The cause can only be a difference in the soil.

If, then, we must postulate a congenital abnormality in order to account satisfactorily for at least a large proportion of sexual inverts, wherein does that abnormality consist? Ulrichs explained the matter by saying that in sexual inverts a male body coexists with a female soul: anima muliebris in corpore virile inclusa. Even writers of scientific eminence, like Magnan and Gley, have adopted this phrase in a modified form, considering that in inversion a female brain is combined with a male body or male glands. This is, however, not an explanation. It merely crystallizes into an epigram the superficial impression of the matter.^[232]

We can probably grasp the nature of the abnormality better if we reflect on the development of the sexes and on the latent organic bisexuality in each sex. At an early stage of development the sexes are indistinguishable, and throughout life the traces of this early community of sex remain. The hen fowl retains in a rudimentary form the spurs which are so large and formidable in her lord, and sometimes she develops a capacity to crow, or puts on male plumage. Among mammals the male possesses useless nipples, which occasionally even develop into breasts, and the female possesses a clitoris, which is merely a rudimentary penis, and may also develop. The sexually inverted person does not usually possess any gross exaggeration of these signs of community with the opposite sex. But, as we have seen, there are a considerable number of more subtle approximations to the opposite sex in inverted persons, both on the physical and the psychic side. Putting the matter in a purely speculative shape, it may be said that at conception the organism is provided with about 50 per cent. of male germs and about 50 per cent. of female germs, and that, as development proceeds, either the male or the female germs assume the upper hand, until in the maturely developed individual only a few aborted germs of the opposite sex are left. In the homosexual, however, and in the bisexual, we may imagine that the process has not proceeded normally, on account of some peculiarity in the number or character of either the original male germs or female germs, or both, the result being that we have a person who is organically twisted into a shape that is more fitted for the exercise of the inverted than of the normal sexual impulse, or else equally fitted for both.^[233]

The conception of the latent bisexuality of all males and females cannot fail to be fairly obvious to intelligent observers of the human body. It emerges at an early period in the history of philosophic thought, and from the first was occasionally used for the explanation of homosexuality. Plato's myth in the Banquet and the hermaphroditic statues of antiquity show how acute minds, working ahead of science, exercised themselves with these problems. (For a fully illustrated study of the ancient conception of hermaphroditism in sculpture see L. S. A. M. von Römer, "Ueber die Androgynische Idee des Lebens," Jahrbuch für sexuelle Zwischenstufen, vol. v, 1903, pp. 711-939.) Parmenides, following Alcmaeon, the philosophic physician who discovered that the brain is the central organ of intellect, remarks Gomperz (Greek Thinkers, Eng. tr., vol. i, p. 183), used the idea of variation in the proportion of male and female generative elements to account for idiosyncrasies of sexual character. After an immense interval Hössli, the inverted Swiss man-milliner, in his Eros (1838) put forth the Greek view anew. Schopenhauer, again from the philosophical side, recognized the bisexuality of the human individual (see Juliusburger, Allgemeine Zeitschrift für Psychiatrie, 1912, p. 630), and Ulrichs, from 1862 onward, adopted a similar doctrine, on a Platonic basis, to explain the "Uranian" constitution. After this the idea began to be more precisely developed from the scientific side, though not at first with reference to homosexuality, and more especially by the great pioneers of the doctrine of Evolution. Darwin emphasized the significance of the facts on this point, as later Weismann, while Haeckel, who was one of the earliest Darwinians, has in recent years clearly recognized the bearing on the interpretation of homosexuality of the fact that the ancestors of the vertebrates were hermaphrodites, as vertebrates themselves still are in their embryonic disposition (Haeckel, in Jahrbuch für sexuelle Zwischenstufen, April, 1913, pp. 262-3, 287). This view had, however, been set forth at an earlier date by individual physicians, notably in America by Kiernan (American Lancet, 1884, and Medical Standard, November and December, 1888), and Lydston (Philadelphia Medical and Surgical Reporter, September, 1889, and Addresses and Essays, 1892).

In 1893, in his L'Inversion Sexuelle, Chevalier, a pupil of Lacassagne—who had already applied the term "hermaphrodisme moral" to this anomaly—explained congenital homosexuality by the idea of latent bisexuality. Dr. G. de Letamendi, Dean of the Faculty of Medicine of Madrid, in a paper read before the International Medical Congress at Rome in 1894, set forth a principle of panhermaphroditism—a hermaphroditic bipolarity—which involved the existence of latent female germs in the male, latent male germs in the female, which latent germs may strive for, and sometimes obtain, the mastery. In February, 1896, the first version of the present chapter, setting forth the conception of inversion as a psychic and somatic development on the basis of a latent bisexuality, was published in the Centralblatt für Nervenheilkunde und Psychiatrie. Kurella (ib., May, 1890) adopted a somewhat similar view, even arguing that the invert is a transitional form between the complete man or woman and the hermaphrodite. In Germany a patient of Krafft-Ebing had worked out the same idea, connecting inversion with fetal bisexuality (eighth edition Psychopathia Sexualis, p. 227). Krafft-Ebing himself at first simply asserted that, whether congenital or acquired, there must be Belastung; inversion is a "degenerate phenomenon," a functional sign of degeneration (Krafft-Ebing, "Zur Erklärung der conträren Sexualempfindung," Jahrbuch für Psychiatrie, 1894). In the later editions of Psychopathia Sexualis, however (1896 and onward and notably in Jahrbuch für sexuelle Zwischenstufen, vol. iii, 1901), he went farther, adopting the explanation on the lines of original bisexuality (English translation of tenth edition, pp. 336-7). In much the same language as I have used he argued that there has been a struggle in the centers, homosexuality resulting when the center antagonistic to that represented by the sexual gland conquers, and psycho-sexual hermaphroditism resulting when both centers are too weak to obtain victory, in either case such disturbance not being a psychic degeneration or disease, but simply an anomaly comparable to a malformation and quite consonant with psychic health. This is the view now widely accepted by investigators of sexual inversion. (Much material bearing on the history of this conception has been brought together by Hirschfeld, in Die Homosexualität, ch. xix, and previously in "Vom Wesen der Liebe," Jahrbuch für sexuelle Zwischenstufen, vol. viii, 1906, pp. 111-133.)

A similar or allied view is now constantly met with in writers of scientific authority who are only incidentally concerned with the study of sexual inversion. Thus Halban ("Die Entstehung des Geschlechtscharaktere," Archiv für Gynäkologie, 1903) regards hermaphroditism, which he would extend to the psychic sphere, as a state in which a double sexual impulse determines the course of fetal and later development. Shattock and Seligmann ("True Hermaphroditism in the Domestic Fowl, with Remarks on Allopterotism," Transactions of Pathological Society of London, vol. lvii, part i, 1906), pointing out that mere atrophy of the ovary cannot account for the appearance in the hen bird of male characters which are not retrogressive but progressive, argues that such birds are really bisexual or hermaphrodite, either by the single "ovary" being really bisexual, as was the case with a fowl they examined, or that the sexual glands are paired, one being male and the other female, or else that there is misplaced male tissue in a neighboring viscus like the adrenal or kidney, the male elements asserting themselves when the female elements degenerate. "Hermaphroditism," they conclude, "far from being a phenomenon altogether abnormal amongst the higher vertebrates, should be viewed rather as a reversion to the primitive ancestral phase in which bisexualism was the normal disposition.... True hermaphroditism in man being established, the question arises whether lesser grades do not occur.... Remote evidence of bisexuality in the human subject may, perhaps, be afforded by the psychical phenomenon of sexual perversion and inversion." Similarly in a case of unilateral secondary male character in an otherwise female pheasant, C. J. Bond has more recently shown (Section of Zoölogy, Birmingham Meeting of British Medical Association, British Medical Journal, Sept. 20, 1913) that an ovi-testis was present, with degenerating ovarian tissue and developing testicular tissue, and such islands of actively growing male tissue can frequently be found, he states, in the degenerating ovaries of female birds which have put forth male plumage. Sir John Bland-Sutton, referring to the fact that the external conformation of the body affords no positive certainty as to the nature of the internal sexual glands, adds (British Medical Journal, Oct. 30, 1909): "It is a fair presumption that some examples of sexual frigidity and sex perversion may be explained by the possibility that the individuals concerned may possess sexual glands opposite in character to those indicated by the external configuration of their bodies." Looking at the matter more broadly and fundamentally in its normal aspects, Heape declares (Proceedings of the Cambridge Philosophical Society, vol. xiv, part ii, 1907) that "there is no such thing as a pure male or female animal, but that all contain a dominant and recessive sex, except those hermaphrodites in which both sexes are equally represented.... There seems to me ample evidence for the conclusion that there is no such thing as a pure male or female." F. H. A. Marshall, again, in his standard manual, The Physiology of Reproduction (1910, p. 655 et seq.), is inclined to accept the same view. "If it be true," he remarks, "that all individuals are potentially bisexual and that changed circumstances, leading to a changed metabolism, may, in exceptional circumstances, even in adult life, cause the development of the recessive characters, it would seem extremely probable that the dominance of one set of sexual characters over the other may be determined in some cases at an early stage of development in response to a stimulus which may be either internal or external." So also Berry Hart ("Atypical Male and Female Sex-Ensemble," a paper read before Edinburgh Obstetrical Society, British Medical Journal, June 20, 1914, p. 1355) regards the normal male or female as embodying a maximum of the potent organs of his or her own sex with a minimum of non-potent organs of the other sex, with secondary sex traits congruent. Any increase in the minimum gives a diminished maximum and non-congruence of the secondary characters.

We thus see that the ancient medico-philosophic conception of organic bisexuality put forth by the Greeks as the key to the explanation of sexual inversion, after sinking out of sight for two thousand years, was revived early in the nineteenth century by two amateur philosophers who were themselves inverted (Hössli, Ulrichs), as well as by a genuine philosopher who was not inverted (Schopenhauer). Then the conception of latent bisexuality, independently of homosexuality, was developed from the purely scientific side (by Darwin and evolutionists generally). In the next stage this conception was adopted by the psychiatric and other scientific authorities on homosexuality (Krafft-Ebing and the majority of other students). Finally, embryologists, physiologists of sex and biologists generally, not only accept the conception of bisexuality, but admit that it probably helps to account for homosexuality. In this way the idea may be said to have passed into current thought. We cannot assert that it constitutes an adequate explanation of homosexuality, but it enables us in some degree to understand what for many is a mysterious riddle, and it furnishes a useful basis for the classification not only of homosexuality, but of the other mixed or intermediate sexual anomalies in the same group. The chief of these intermediate sexual anomalies are: (1) physical hermaphroditism in its various stages; (2) gynandromorphism, or eunuchoidism, in which men possess characters resembling those of males who have been early castrated and women possess similarly masculine characters; (3) sexo-esthetic inversion, or Eonism (Hirschfeld's transvestism or cross-dressing), in which, outside the specifically sexual emotions, men possess the tastes of women and women those of men.

Hirschfeld has discussed these intermediate sexual stages in various works, especially in Geschlechtsübergänge (1905), Die Transvestiten (1910), and ch. xi of Die Homosexualität. Hermaphroditism (the reality of which has only of late been recognized and is still disputed) and pseudohermaphroditism; in their physical variations are fully dealt with in the great work, richly illustrated, Hermaphroditismus beim Menschen, by F. L. von Neugebauer, of Warsaw. Neugebauer published an earlier and briefer study of the subject in the Jahrbuch für sexuelle Zwischenstufen vol. iv, 1902, pp. 1-176, with a bibliography in vol. viii (1906) of the same Jahrbuch, pp. 685-700. Hirschfeld emphasizes the fact that neither hermaphroditism nor eunuchoidism is commonly associated with homosexuality, and that a large proportion of the cases of transvestism, as defined by him, are heterosexual. True inversion seems, however, to be not infrequently found among pseudohermaphrodites; Neugebauer records numerous cases; Magnan has published a case in a girl brought up as a youth (Gazette médical de Paris, March 31, 1911) and Lapointe a case in a man brought up as a girl (Revue de psychiatrie, 1911, p. 219). Such cases may be accounted for by the training and associations involved by the early error in recognition of sex, and perhaps still more by a really organic predisposition to homosexuality, although the sexual psychic characters are not necessarily bound up with the coexistence of corresponding sexual glands. Halban (Archiv für Gynäkologie 1903) goes so far as to class the homosexual as "real pseudohermaphrodites," exactly comparable to a man with a female breast or a woman with a beard, and proposes to term homosexuality "pseudohermaphroditus masculinus psychicus." This, however, is an unnecessary and scarcely satisfactory confusion.

To place the group of homosexual phenomena among other intermediate groups on the organic bisexual basis is a convenient classification. It can scarcely be regarded as a complete explanation. It is probable that we may ultimately find a more fundamental source of these various phenomena in the stimulating and inhibiting play of the internal secretions.^[234] Our knowledge of the intimate association between the hormones and sexual phenomena is already sufficient to make such an explanation intelligible; the complex interaction of the glandular internal secretions and their liability to varying disturbance in balance may well suffice to account for the complexity of the phenomena. It would harmonize with what we know of the occasional delayed manifestations of homosexuality, and would not clash with their congenital nature, for we know that a disordered state of the thymus, for instance, may be hereditary, and it is held that status lymphaticus may be either inborn or acquired.^[235] Normal sexual characters seem to depend largely upon the due co-ordination of the internal secretions, and it is reasonable to suppose that sexual deviations depend upon their inco-ordination. If a man is a man, and a woman a woman, because (in Blair Bell's phrase) of the totality of their internal secretions, the intermediate stages between the man and the woman must be due to redistribution of those internal secretions.^[236]

We know that various internal secretions possess an influential sexual effect. Thus the atrophy of the thymus seems to be connected with sexual development at puberty; the thyroid reinforces the genital glands; adrenal overdevelopment can produce in a female the secondary characteristics of the male, as well as cause precocious development of maleness; etc. "An alteration in the metabolism," as F. H. A. Marshall suggests, "even in comparatively late life, may initiate changes in the direction of the opposite sex." Metabolic chemical processes may thus be found to furnish a key to complex and subtle sexual variations, alike somatic and psychic, although we must still regard such processes as arising on an inborn predisposition.

Whatever its ultimate explanation, sexual inversion may thus fairly be considered a "sport," or variation, one of those organic aberrations which we see throughout living nature, in plants and in animals.

It is not here asserted, as I would carefully point out, that an inverted sexual instinct, or organ for such instinct, is developed in early embryonic life; such a notion is rightly rejected as absurd. What we may reasonably regard as formed at an early stage of development is strictly a predisposition; that is to say, such a modification of the organism that it becomes more adapted than the normal or average organism to experience sexual attraction to the same sex. The sexual invert may thus be roughly compared to the congenital idiot, to the instinctive criminal, to the man of genius, who are all not strictly concordant with the usual biological variation (because this is of a less subtle character), but who become somewhat more intelligible to us if we bear in mind their affinity to variations. Symonds compared inversion to color-blindness; and such a comparison is reasonable. Just as the ordinary color-blind person is congenitally insensitive to those red-green rays which are precisely the most impressive to the normal eye, and gives an extended value to the other colors,—finding that blood is the same color as grass, and a florid complexion blue as the sky,—so the invert fails to see emotional values patent to normal persons, transferring those values to emotional associations which, for the rest of the world, are utterly distinct. Or we may compare inversion to such a phenomenon as color-hearing, in which there is not so much defect as an abnormality of nervous tracks producing new and involuntary combinations. Just as the color-hearer instinctively associates colors with sounds, like the young Japanese lady who remarked when listening to singing, "That boy's voice is red!" so the invert has his sexual sensations brought into relationship with objects that are normally without sexual appeal.^[237] And inversion, like color-hearing is found more commonly in young subjects, tending to become less marked, or to die out, after puberty. Color-hearing, while an abnormal phenomenon, it must be added, cannot be called a diseased condition, and it is probably much less frequently associated with other abnormal or degenerative stigmata than is inversion; there is often a congenital element, shown by the tendency to hereditary transmission, while the associations are developed in very early life, and are too regular to be the simple result of suggestion.^[238]

All such organic variations are abnormalities. It is important that we should have a clear idea as to what an abnormality is. Many people imagine that what is abnormal is necessarily diseased. That is not the case, unless we give the word disease an inconveniently and illegitimately wide extension. It is both inconvenient and inexact to speak of color-blindness, criminality, and genius as diseases in the same sense as we speak of scarlet fever or tuberculosis or general paralysis as diseases. Every congenital abnormality is doubtless due to a peculiarity in the sperm or oval elements or in their mingling, or to some disturbance in their early development. But the same may doubtless be said of the normal dissimilarities between brothers and sisters. It is quite true that any of these aberrations may be due to antenatal disease, but to call them abnormal does not beg that question. If it is thought that any authority is needed to support this view, we can scarcely find a weightier than that of Virchow, who repeatedly insisted on the right use of the word "anomaly," and who taught that, though an anomaly may constitute a predisposition to disease, the study of anomalies—pathology, as he called it, teratology as we may perhaps prefer to call it—is not the study of disease, which he termed nosology; the study of the abnormal is perfectly distinct from the study of the morbid. Virchow considers that the region of the abnormal is the region of pathology, and that the study of disease must be regarded distinctly as nosology. Whether we adopt this terminology, or whether we consider the study of the abnormal as part of teratology, is a secondary matter, not affecting the right understanding of the term "anomaly" and its due differentiation from the term "disease."

At the Innsbruck meeting of the German Anthropological Society, in 1894, Virchow thus expressed himself: "In old days an anomaly was called πάθος, and in this sense every departure from the norm is for me a pathological event. If we have ascertained such a pathological event, we are further led to investigate what pathos was the special cause of it.... This cause may be, for example, an external force, or a chemical substance, or a physical agent, producing in the normal condition of the body a change, an anomaly (πάθος). This can become hereditary under some circumstances, and then become the foundation for certain small hereditary characters which are propagated in a family; in themselves they belong to pathology, even although they produce no injury. For I must remark that pathological does not mean harmful; it does not indicate disease; disease in Greek is νὁσος, and it is nosology that is concerned with disease. The pathological under some circumstances can be advantageous" (Correspondenz-blatt Deutsch Gesellschaft für Anthropologie, 1894). These remarks are of interest when we are attempting to find the wider bearings of such an anomaly as sexual inversion.

This same distinction has more recently been emphasized by Professor Aschoff (Deutsche medizinische Wochenschrift, February 3, 1910; of. British Medical Journal, April 9, 1910, p. 892), as against Ribbert and others who would unduly narrow the conception of πάθος. Aschoff points out that, not merely for the sake of precision and uniformity of terminology but of clear thinking, it is desirable that we should retain a distinction in regard to which Galen and the ancient physicians were very definite. They used πάθος as the wider term involving affection (affectio) in general, not necessarily impairment of vital tissue; when that was involved there was νὁσος, disease. We have to recognize the distinction even if we reject the terminology.

A word may be said as to the connection between sexual inversion and degeneration. In France especially, since the days of Morel, the stigmata of degeneration are much spoken of. Sexual inversion is frequently regarded as one of them: i.e., as an episodic syndrome of a hereditary disease, taking its place beside other psychic stigmata, such as kleptomania and pyromania. Krafft-Ebing long so regarded inversion; it is the view of Magnan, one of the earliest investigators of homosexuality;^[239] and it was adopted by Möbius. Strictly speaking, the invert is degenerate; he has fallen away from the genus. So is a color-blind person. But Morel's conception of degenerescence has unfortunately been coarsened and vulgarized.^[240] As it now stands, we gain little or no information by being told that a person is a "degenerate." It is only, as Näcke constantly argued, when we find a complexus of well-marked abnormalities that we are fairly justified in asserting that we have to deal with a condition of degeneration. Inversion is sometimes found in such a condition. I have, indeed, already tried to suggest that a condition of diffused minor abnormality may be regarded as a basis of congenital inversion. In other words, inversion is bound up with a modification of the secondary sexual characters. But these anomalies and modifications are not invariable,^[241] and are not usually of a serious character; inversion is rare in the profoundly degenerate. It is undesirable to call these modifications "stigmata of degeneration," a term which threatens to disappear from scientific terminology, to become a mere term of literary and journalistic abuse. So much may be said concerning a conception or a phrase of which far too much has been made in popular literature. At the best it remains vague and unfitted for scientific use. It is now widely recognized that we gain little by describing inversion as a degeneration. Näcke, who attached significance to the stigmata of degeneration when numerous, was especially active in pointing out that inverts are not degenerate, and frequently returned to this point. Löwenfeld, Freud, Hirschfeld, Bloch, Rohleder all reject the conception of sexual inversion as a degeneracy.

Moll is still unable to abandon altogether the position that since inversion involves a disharmony between psychic disposition and physical conformation we must regard it as morbid, but he recognizes (like Krafft-Ebing) that it is properly viewed as being on the level of a deformity, that is, an abnormality, comparable to physical hermaphroditism. (A. Moll, "Sexuelle Zwischenstufen," Zeitschrift für aerztliche Fortbildung, No. 24, 1904.) Näcke repeatedly emphasized the view that inversion is a congenital non-morbid abnormality; thus in the last year of his life he wrote (Zeitschrift für die Gesamte Neurologie und Psychiatrie, vol. xv, Heft 5, 1913): "We must not conceive of homosexuality as a degeneration or a disease, but at most as an abnormality, due to a disturbance of development." Löwenfeld, always a cautious and sagacious clinical observer, agreeing with Näcke and Hirschfeld, regards inversion as certainly an abnormality, but not therefore morbid; it may be associated with disease and degeneration, but is usually simply a variation from the norm, not to be regarded as morbid or degenerate, and not diminishing the value of the individual as a member of society (Löwenfeld, Ueber die sexuelle Konstitution, 1911, p. 166; also Zeitschrift für Sexualwissenschaft, Feb., 1908, and Sexual-Probleme, April, 1908). Aletrino of Amsterdam pushes the view that inversion is a non-morbid abnormality to an undue extreme by asserting that "the uranist is a normal variety of the species Homo sapiens" ("Uranisme et Dégénérescence," Archives d'Anthropologie Criminelle, Aug.-Sept., 1908); inversion may be regarded as (in the correct sense of the word here adopted) a pathological abnormality, but not as an anthropological human variety comparable to the Negro or the Mongolian man. (For further opinions in favor of inversion as an anomaly, see Hirschfeld, Die Homosexualität, p. 388 et seq.)

Sexual inversion, therefore, remains a congenital anomaly, to be classed with other congenital abnormalities which have psychic concomitants. At the very least such congenital abnormality usually exists as a predisposition to inversion. It is probable that many persons go through the world with a congenital predisposition to inversion which always remains latent and unroused; in others the instinct is so strong that it forces its own way in spite of all obstacles; in others, again, the predisposition is weaker, and a powerful exciting cause plays the predominant part.

We are thus led to the consideration of the causes that excite the latent predisposition. A great variety of causes has been held to excite to sexual inversion. It is only necessary to mention those which I have found influential. The first to come before us is our school-system, with its segregation of boys and girls apart from each other during the periods of puberty and adolescence. Many inverts have not been to school at all, and many who have been pass through school-life without forming any passionate or sexual relationship; but there remain a large number who date the development of homosexuality from the influences and examples of school-life. The impressions received at the time are not less potent because they are often purely sentimental and without any obvious sensual admixture. Whether they are sufficiently potent to generate permanent inversion alone may be doubtful, but, if it is true that in early life the sexual instincts are less definitely determined than when adolescence is complete, it is conceivable, though unproved, that a very strong impression, acting even on a normal organism, may cause arrest of sexual development on the psychic side.

Another exciting cause of inversion is seduction. By this I mean the initiation of the young boy or girl by some older and more experienced person in whom inversion is already developed, and who is seeking the gratification of the abnormal instinct. This appears to be a not uncommon incident in the early history of sexual inverts. That such seduction—sometimes an abrupt and inconsiderate act of mere sexual gratification—could by itself produce a taste for homosexuality is highly improbable; in individuals not already predisposed it is far more likely to produce disgust, as it did in the case of the youthful Rousseau. "He only can be seduced," as Moll puts it, "who is capable of being seduced." No doubt it frequently happens in these, as so often in more normal "seductions," that the victim has offered a voluntary or involuntary invitation.

Another exciting cause of inversion, to which little importance is usually attached, but which I find to have some weight, is disappointment in normal love. It happens that a man in whom the homosexual instinct is yet only latent, or at all events held in a state of repression, tries to form a relationship with a woman. This relationship may be ardent on one or both sides, but—often, doubtless, from the latent homosexuality of the lover—it comes to nothing. Such love-disappointments, in a more or less acute form, occur at some time or another to nearly everyone. But in these persons the disappointment with one woman constitutes motive strong enough to disgust the lover with the whole sex and to turn his attention toward his own sex. It is evident that the instinct which can thus be turned round can scarcely be strong, and it seems probable that in some of these cases the episode of normal love simply serves to bring home to the invert the fact that he is not made for normal love. In other cases, it seems,—especially those that are somewhat feeble-minded and unbalanced,—a love-disappointment really does poison the normal instinct, and a more or less impotent love for women becomes an equally impotent love for men. The prevalence of homosexuality among prostitutes may be, to a large extent, explained by a similar and better-founded disgust with normal sexuality.^[242]

These three influences, therefore,—example at school, seduction, disappointment in normal love,—all of them drawing the subject away from the opposite sex and concentrating him on his own sex, are exciting causes of inversion; but they require a favorable organic predisposition to act on, while there are a large number of cases in which no exciting cause at all can be found, but in which, from earliest childhood, the subject's interest seems to be turned on his own sex, and continues to be so turned throughout life.

At this point I conclude the analysis of the psychology of sexual inversion as it presents itself to me. I have sought only to bring out the more salient points, neglecting minor points, neglecting also those groups of inverts who may be regarded as of secondary importance. The average invert, moving in ordinary society, is a person of average general health, though very frequently with hereditary relationships that are markedly neurotic. He is usually the subject of a congenital predisposing abnormality, or complexus of minor abnormalities, making it difficult or impossible for him to feel sexual attraction to the opposite sex, and easy to feel sexual attraction to his own sex. This abnormality either appears spontaneously from the first, by development or arrest of development, or it is called into activity by some accidental circumstance.

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