Unmastered Masturbation Conflict
The Role of Masturbation Conflict in the Development of Psychoneurotic Symptoms >>
Baruch Silverman, M.D.<sup>1

1</sup> Mental Hygiene Institute, Montreal

Can Med Assoc J., Mar 1934; 30(3): 287–289.
Read at a meeting of the Montreal Psychiatric Society, November, 1932.

That the anxieties, hypochondriacal complaints, depressive feelings, compulsions and fears which characterize the psychoneurotic patient are caused by a conflict between the instinctive tendencies and inner urges of the individual and the social conventions and ideals which he is brought up to believe in is now accepted by the majority of physicians, who have come to realize that certain mental and social factors in the environment of the individual may be just as harmful to his mental health as are pathological factors in the physical environment to his physical health. Of the mental conflicts that one finds so frequently associated with psychoneurotic symptoms, difficulties in sexual adjustment, and more particularly masturbation problems, appear to play a very important role. The following cases illustrate the manner in which such symptoms may develop.

Case 1
A boy of 14 had been having frequent anxiety attacks for several months. During these attacks he appeared to be very anxious and fearful and did not allow his mother to leave him. He complained of precordial pain and said that his heart was stopping. These attacks came on nearly every night, when he awakened and had a period of typical anxiety which could only be overcome if his mother lay down beside him for the rest of the night. Occasionally he had one of these attacks at school and had to run home, as he was afraid he would die unless he was near his mother. Physically, his condition was entirely negative. The mother who is an extremely sensitive, over-conscientious type of woman, has been very unhappy in her marital life. The father had always been a crank on health matters. The patient, who is the eldest of three children, had always been a rather shy, sensitive boy and had had considerable difficulty in learning to adapt himself to the usual activities of children. The anxiety attacks in this case seemed to be very definitely related to a masturbation problem. Several months before these attacks began he had had a great deal of conflict over this matter, spoke to his father about it, and received the usual admonitions. He was told that if he continued to practice this habit it would undermine his health. His mother finally took him to her physician, who frightened the boy by telling him that masturbation invariably leads to insanity, loss of manhood, and other serious conditions. The boy then determined never to practise this habit again, and shortly after he developed his first anxiety attack.

Case 2
Two months before coming for treatment, a boy of 17 who had always been well-adjusted to his home and school developed numerous ideas of reference and misinterpretations. Ha felt that people on the street were looking at him and passing comments about him. He thought that everybody had turned against him and therefore he decided to stop school and remain at home in order that people might not see him. This boy had been worried over the problem of masturbation for about two years, and had on several occasions made up his mind to stop the habit because he had heard that it would result in his developing a serious illness. He finally decided to see his physician who assumed the same attitude to this problem as did the physician in the previous case. With a great deal of effort this boy was able to overcome this habit, but about a month later he developed the mental symptoms described above.

Case 3
A boy of 18 had had for six months numerous hypochondriacal complaints, globus hystericus, and especially numerous gastric complaints. He had a series of ceremonials which he must go through before he ate or slept. He must do everything, as he says, "the right way." If he picked up a pen or pencil and commenced to write, he was suddenly overcome by a feeling that he did not grasp the pencil firmly enough. He then had to lay it down on the table and pick it up, as he says, "correctly". Only then was he able to carry on with his work. This compulsion to do things the "correct" or "right" way was carried over into a great many of his daily activities. He had been examined physically by a number of physicians but at no time had there been any physical findings. Again in this case the symptoms developed after a severe masturbation conflict, with a final decision to give up this habit entirely.

Case 4
A married woman, of 22, had had for two months feelings of depersonalization. She awakened feeling self-conscious. She did not "feel herself." Her surroundings appeared normal, but she felt very small. Her body felt light. After concentrating on a subject she frequently began to wonder who she was and where she was. This woman, who had been married for 4 years, and had had a child who died at the age of 17 months, had experienced considerable difficulty over the question of contraception. Her husband had religious compunctions on this matter, and this resulted in a good deal of marital conflict which created a state of tension in the patient and made her resort to masturbation with accompanying severe conflict. This went on for about 18 months, when she finally determined to give up the habit, and shortly after developed this rather marked psychoneurotic state.

These cases are rather characteristic of a large number of patients in whom the symptoms appear to be definitely related to a severe masturbation conflict, and the symptoms in some patients develop with dramatic suddenness subsequent to the cessation of this practice.

Masturbation per se is a normal phase of sexual life and the practice of this habit, if it is not associated with severe conflict, does not produce any ill effects. In fact, the majority of writers on this subject suggest that the practice is a universal one and that its reputed harmful effects have been very grossly exaggerated. K. B. Davis [1], in a study of certain autoerotic practices in 1,000 married women and a somewhat larger number of unmarried women, finds that 60 per cent practised masturbation. Peck and Well [2], in a study of 250 college men, report that 77 per cent admitted this practice. Nearly all writers agree that the so-called effects or sequelae of masturbation are practically negative. Where, however, there is mental conflict associated with this habit there appear to be more definite effects. Such conflict usually exists in those individuals whose normal sexual curiosity in childhood has been severely repressed because of unwise management on the part of parents, who resort to all sorts of punishments and even castration threats for any such evidence in their children. Those patients who have marked mental conflict associated with masturbation are individuals who have developed a very strict conscience and unusually high ideals, especially where sexual matters are concerned, and this creates a state of tension and conflict which must be resolved in some fashion. The crude, anaesthetic, unromantic individual suffers very little from masturbation conflict. It is usually the sensitive, shy, introverted adolescent who experiences such conflict which frequently leads to the development of symptoms. Since in the practice of this habit the individual resorts to a good deal of phantasy, he develops a tendency to resort to imaginary solutions of any problems with which he has to cope, rather than face the real facts of the external world. Emotional disappointment coming from the outside world to such persons results more readily in neurotic disturbances.

Another factor that leads to the development of psychoneurotic symptoms in these patients is that the masturbator usually has a strong sense of guilt, with an evident need for punishment for the indulgence in this habit. Karpman [3] says that many neurotic symptoms are the punishments anticipated by the unconscious. Anxiety and fear paralyses the patient physically and mentally. This fear and the appearance of symptoms assure the patient that the criminal act, i.e., giving vent to instinctive cravings, will not be committed. The following case illustrates this mechanism.

Case 5
For two years a girl of 21 had had numerous hypochondriacal complaints for which no physical cause could be found. Mental examination revealed that she had a great deal of conflict over the problem of masturbation with which she had been concerned for many years. When she was 7 years old she lived through a very trying experience in which a soldier attacked her. This experience she gradually forgot, but throughout childhood she seemed to have a strong feeling or guilt and marked self-consciousness whenever anything pertaining to sex was mentioned. At the age of 10 she began to practise masturbation and continued this habit until about 2 years ago. During this interval she made repeated attempts to stop the practice because she had strong feelings of guilt and began to feel that people might find out about her. She finally determined to stop the habit entirely and her symptoms developed shortly after. The feeling of guilt that pervaded her whole life made itself manifest in many ways especially in the past two years. She had a strong desire to be punished and frequently resorted to a variety of measures which resulted in her receiving some punishment. She frequently would come late to work in order that she might be scolded by her employer, and it was only when she was severely reprimanded or punished in some other way that she felt relieved of the general state of irritability which was associated with her hypochondriacal complaints. She constantly felt that people were too good to her, that they treated her too well, and seemed to long for criticism and punishment.

Where severe conflict associated with masturbation is followed by a complete cessation of the habit it seems that a situation is created in which symptoms can develop more readily. Wechsler [4] says that anxiety may arise in a person who gives up masturbation because of moral compunctions or fear of hurting himself physically. He says that he has seen such instances following the cessation of masturbation after a confessional or on being deterred from the practice by reading pseudo-scientific literature or receiving foolish advice from a physician or teacher. The suddenness with which psychoneurotic symptoms develop following the cessation of masturbation can be understood when one takes into consideration that where such an energy outlet as masturbation is suddenly completely blocked, especially in an individual who has no adequate substitute satisfactions, such as opportunities for discharge of energy through physical, social or intellectual activities, a state of tension is created which may readily develop into symptoms. The following case illustrates such a situation.

Case 6
A young man of 21 developed marked restlessness and insomnia every night for several weeks. He became extremely restless, making convulsive movements with his arms and legs. These became so marked that he had to be tied down to the bed every night for about an hour until the attack subsided. During each of these attacks he was fully conscious, knew what he was doing, spoke to those who were near him, and said that he did not know what made him act in that fashion. After each attack he was able to sleep for the rest of the night and was perfectly well until the following night. Physically, his condition was entirely negative. For several years this patient had had rather excessive sex experiences, which he had carried on continuously to such a marked degree that, on the advice of a physician, he finally determined not to indulge at all. Shortly after he developed the above symptoms which were a definite sexual equivalent.

Summary

Careful study of a large number of such patients leads one to conclude as follows.

       1.    Masturbation, per se, does no definite harm and does not result in psychoneurotic or psychotic symptoms, excepting where it is very excessive.
       2.    Only when this habit is present in shy, sensitive, introverted individuals, and is accompanied by conflict do such symptoms develop. Conflict is usually the result of attitudes to sex which the adult carries with him from childhood, and these are based on repressive measures, castration threats, and other punishments for sex curiosity in childhood.
       3.    The use of phantasy in masturbation strengthens the tendency to avoid reality in any difficult situation, and therefore leads more readily to the development of symptoms.
       4.    The sense of guilt accompanying this practice results in the conception of a need for punishment and the symptoms often act as the punishment.
       5.    Where there is complete cessation of the habit following conflict a critical situation is created which may very easily result in the development of psychoneurotic symptoms.

References
   1. Davis, K. B., Mental Hygiene J., 1924, 8: 668; 1925, 9: 28.
   2. Peck, M. W. and Wells, P. L., Mental Hygiene J.. 1923, 7: 697.    
   3. Karpman, B., Arch. Neurol. & Psychiatry, 1931, 26: 1261.
   4. Wechsler, I. S., The Neuroses, Saunders, Phila., 1929, p. 130.

>>