Emil G--,--, aet. 23, showed formerly
high mental attainments, and at the age of twenty-one became an advocate.
His figure was bent, the body lean, the muscles soft, the skin colorless,
the countenance void of expression, the eyes dull and turned towards the
ground; the voice weak, behavior timid, and the lower extremities in
constant motion. Although he spoke little and awkwardly yet he made
the following clear statement in writing regarding his condition:--
After the patient had been addicted to onanism
from his twelfth year, there appeared at the age of nineteen a change in
his character. At first there was a gradual mental loathing at everything,
a profound general ennui. Hitherto he had seen only the bright side of
life, but now everything was viewed from the dark side, and soon
the idea of suicide entered his mind. In a year after this the idea left
him, and he then considered himself the object of scorn by others. He thought
that everybody laughed at his appearance and his manners, and he several
times heard, as well in the streets as in the house amongst his relations
and friends, reproaches directed at him. At last he believed that all the
world insulted him, if any one coughed, sneezed, laughed, put his hand
to his mouth, or a pocket-handkerchief before his face, it made on him
the most painful impression--sometimes angry emotions, sometimes deep depression
and an involuntary flow of tears. He was indifferent to everything, and
always engrossed with his ideas; he sought solitude, and society was painful
to him. He owned that he may have had hallucinations, but felt convinced
that his ideas were not without foundation: that his countenance was somewhat
strange; that persons could rest in it his fears, and the thoughts which
tormented him. He now experienced a weight in his head, a sort of pressure
on the brain; he was weak, passionless, sleepy and dull. Every movement
fatigued him, and yet he had the constant desire to change his position.
He felt that he had become old; for the last few months his depression
had been increasing; for the past five years nothing had made on him a
cheerful impression, everything had oppressed and annoyed him; he was anxious,
bashful, perplexed, incapable of acting or speaking: "The Spirit of life
has withdrawn itself from me. For the past nine months the patient had
completely renounced the practice of onanism, and yet his condition became
worse every day. He had inveterate constipation; complete absence of erections
and sexual desires; about one to two pollutions in a month. The urine always
contained a copious flocculent sediment, like a thick decoction of barley,
and decomposed rapidly. After each stool, a viscid fluid, like thick gum,
appeared at the orifice of the urethra. The urine was voided .frequently;
there was irritability of the seminal ducts, testicles, and particularly
of the urethral mucous membrane, and redness of the urethral orifice [Griesinger,
1882, 167].
What treatment
would you expect to be prescribed?
Masturbation and Insanity
Emil G (p. 167) Cauterization of the neck of the bladder and
prostatic part of the urethra was resorted to. This was
followed by a gradual improvement, which was furthered by continuous
tepid baths. Complete recovery and
reestablishment of sexual function resulted.
Now the insanity which begins at this period [pubescence],
and has its origin in the cause indicated [masturbation] presents ceertain
characteristic features, which enable us for the most part to distinguish
it from insanity otherwise caused. It is a very disagreeable form of mental
disease, and it is not often that those who have to do with it fail to
recognise it. The miserable sinner whose mind suffers by reason of self-abusebecomes
offensively egotistic; he gets more and more closely wrapped up in his
own narrow and morbid feelings, and les and less sensible of the claims
of others upon him and of his duties towards them; he is full of self-feeling
and self-conceit; insensible to the feelings of others; his moral nature
is blunted or lost. His mental energy is sapped, and though he has extravagant
pretensions, and often speaks of great projects engendered of his conceit,
he never enters seriously into any occupation nor works systematically
at the accomplishment of any object, but spends all his time in indolent
and solitary self-brooding, and is not wearied of going on day after day
in the same purposeless and idle life. Hypochondriacally occupied with
his health, his sensations, his feelings, he imagines that his relatives
are hostile to him because they do not take the interest in him which he
does in himself, or make the estimate of him which he makes of himself.
His won family are especially hostile to him, because they are distressed
by his indolence and pretension, and try to instigate him to do something.
if they speak of the impossibility of always maintaining him in complete
idleness, they are unfeeling and do not understand him. His manner is shy,
nervous and suspicious, his dress often untidy, or slovenly; there is a
want of manliness of appearance as of manliness of feeling. The pupils
are often dilated, the breath bad, the face sallow, and the body somewhat
emaciated. When we are consulted about a cace presenting these generral
features, we may hardly feel justified in signing a certificate of insanity,
but we have little doube to the nature of the mental degeneration which
is beginning [Maudsley,
1868, 153-4]