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  • Between Seduction and Libido: Sigmund Freud’s Masturbation Hypoth eses and the Realignment of His Etiologic Thinking, 1897–1905


In the fall of 1897 Sigmund Freud expressed grave doubts about a theory he had put forth, that the sexual abuse of children was the specific cause of psychoneurosis. In recent years, Freud’s repudiation of this so-called seduction hypothesis has been the source of considerable controversy. 1 Much of the debate has focused on the nature of his motives for abandoning this hypothesis. 2 However, one common assumption is that Freud’s repudiation of this theory was in and of itself—for better or for worse—a foundational shift that led him to fatefully alter the future of psychoanalytic theory. [End Page 638]

Such a historiography can be traced to Freud himself. While he gave various accounts for the emergence of libido theory, the most influential explication was written in 1914. In this account, Freud recalled recognizing that his patients’ tales of seduction were only fantasies, and then, after a period of confusion, fastening on the etiologic import of these same wishful fantasies as manifestations of repressed infantile sexuality. 3 Despite the reservations of some like Ernest Jones, who called this account “dramatic,” the notion that Freud wrested core tenets of libido theory from the very failure of his seduction hypothesis has been central to more-traditional histories of his intellectual development. 4 Furthermore, this historiographic assumption is not limited to traditional historians of psychoanalysis. For instance, revisionists such as Frank Sulloway saw the fall of the seduction hypothesis as opening the way for Freud’s rejection of environmental etiologies and his acceptance and transformation of the Fliessian id. 5

Such a historiography of radical change has been accompanied by significant methodologic problems that make a detailed examination of Freud’s thought during this period challenging. First, Freud’s own accounts at times privilege his experience with patients. However, save for a few fragments, no detailed records of his actual clinical observations during this period exist: they are generally only very indirectly discernible through his correspondence and publications. 6 Second, Freud’s self-analysis occurred during this same period. The self-analysis has been seen by some as the crucial event that caused him to radically break from his former assumptions by revealing aspects of libido theory, though that [End Page 639] interpretation has been seriously questioned by others. 7 For any historian working in this period, adjudicating the relationship between what was revealed to Freud by his own interpretations of his own dreams, and what on the other hand he needed to know a priori so as to interpret his own dreams, is a very complicated matter indeed.

Without denying the possible import of sociopolitical, personal, or undocumented clinical experiences as potential influences on Freud’s etiologic thinking after his development of the seduction hypothesis, I shall focus on the common discourse that ultimately organized all of these concerns—the discourse of Freud’s medical community. And I shall argue that a close examination of extant sources reveals a heretofore-neglected intermediary phase in his theorizing that both situates his post-seduction hypothesis thinking in fin de siècle Viennese medicine, and can be seen as a “missing link” between the differing sets of assumptions: those that guided the seduction hypothesis, and those that organized libido theory. For while Freud may indeed have been confused in this time period, he did not stop generating hypotheses about the etiology of neurosis, and those hypotheses often did not center on childhood seduction or libido. Instead, during this intermediary phase of theorizing, he was chiefly concerned with the causes and ramifications of childhood masturbation. 8

In fact, in a 1906 account of his disenchantment with the seduction hypothesis, Freud referred to the import of masturbation: he recalled recognizing that fantasies of seduction were “attempts at fending off memories of the subject’s own sexual activity (infantile masturbation). When this point had been clarified, the ‘traumatic’ element in the sexual experiences of childhood lost its importance. . . .” 9 As we shall see, this recollection compresses a long and complicated process, for Freud first became interested in masturbation precisely as a traumatic etiologic agent. [End Page 640]

Seduction and Freud’s Theory of a “Specific Cause”

In Studies in Hysteria, though Freud had begun to postulate that the nervous trauma of hysteria was a sexual one, he did not make the case for any specific sexual etiology of hysteria. 10 But that same year, he proposed a specific etiology for both neurasthenia and a new entity he called “Angstneurose.” For Freud, neurasthenia was caused by the somatically depleting practice of adult masturbation, while “Angstneurose” was due to the unreleased sexual tension resulting from adult sexual abstinence, chronic unconsummated sexual excitation, and coitus interruptus. 11

Leopold Löwenfeld (1847–1923), a renowned Munich physician, critiqued Freud’s position—not out of Wilhelmine prudery, but on the basis of etiologic theory. Löwenfeld believed that a neuropathic disposition along with a group of nonspecific environmental causes caused both neurasthenia and hysteria. 12 He rejected Freud’s claim that a specific traumatic sexual etiology resulted in a specific neurosis. 13 Freud quickly replied in print, delineating his theory of a specific cause. 14 He argued that the kind of neurosis a patient developed—what Freud would later refer to as the choice-of-neurosis problem—was “solely determined by the specific aetiological factor arising from sexual life.” 15

By 1 January 1896, in his letters to the Berlin physician Wilhelm Fliess (1858–1928), Freud had become convinced that the specific cause of hysteria came from the sexual seduction of children. 16 All in all, he published three papers that year in which he claimed that hysteria was [End Page 641] based on such sexual stimulation of children. 17 Using the seduction theory, he mapped out his “Neurotica,” an ambitious etiologic model for the development of the psychoneurotic (i.e., obsessional, hysterical, and paranoid) disorders, basing all on sexual seduction during childhood. Such infantile sexual trauma reemerged at puberty due to “deferred action,” creating the need for defense and hence neurosis. 18

In his earliest seduction theories, Freud followed Richard von Krafft-Ebing and others by suggesting that the perpetrators of such abuse were generally nursemaids, older children, and strangers. 19 But two months after his father died, Freud changed his view to his extraordinary theory of paternal seduction, in which the identity of the abuser was the patient’s father. 20 Freud’s interest in sexual seduction as an environmental etiology was not unusual in sexological circles, 21 but his theory of paternal seduction was without precedent. No doubt his turn to this idiosyncratic theory had clinical and biographical roots—but it can also be seen as the logical outgrowth of Freud’s attempts to undercut degenerative hereditarian ideologies. For he realized that if the seducer was not a stranger, but rather uniformly the father, then that family would falsely seem to be degenerative. Paternal seduction, Freud reasoned, created what he called a pattern of “pseudo-heredity” easily mistaken for degenerative inheritance. 22

In the early months of 1897, Freud’s letters to Fliess conveyed an exuberant confidence, as a rush of proposals and extensions of the seduction hypothesis issued from his pen. 23 The first hint of trouble came in a letter of 16 May 1897, when Freud reported the premature termination of one patient, and the likely loss of another. 24 In the same letter, he reported the arrival of a student from Berlin, Felix Gattel (1870–1904). 25 [End Page 642] Over the next three months, under Freud’s guidance, Gattel conducted research intended to test Freud’s hypotheses about the specific sexual causes of “Angstneurose” and neurasthenia. Toward this end, Gattel interviewed one hundred consecutive cases in the Psychiatric Clinic of the Vienna General Hospital, run by Krafft-Ebing.

Gattel’s sexual histories of these hundred patients revealed that childhood sexual experiences—such as masturbation, “sexual games” with other children, and exposure to sexually stimulating situations—were common. More important for Freud, this research seemed to strikingly support his specification of masturbation as the cause for neurasthenia and of sexual abstinence as the cause for “Angstneurose.” 26 But there were also some potentially unsettling findings for Freud. To increase the number of neurasthenics and “Angstneurose” patients, Gattel attempted to eliminate from his cohort any obvious cases of hysteria. 27 Nonetheless, in the end he included four hysterics, which he initially took for neurasthenics, and he also ended up with thirteen mixed cases in which hysteria was present. In that total of seventeen cases containing a hysterical component, Gattel found only two that confirmed a sexual seduction in childhood, and neither was by the father. 28 Freud could easily have discounted the absence of seduction in a hysterical patient’s history, owing to his belief that these memories were repressed; it would have been more complicated for him, on the other hand, to explain why certain hysterical patients both remembered seductions, and remembered their seducers to be people other than their fathers. Furthermore, the fact that Gattel’s sample—which was intended to exclude hysterics—nonetheless ended up with 17 percent of patients’ having a hysterical component has caused Sulloway to argue that this may have led Freud to believe that the general incidence of hysteria was too high to be accounted for by paternal sexual abuse. 29 [End Page 643]

As Gattel’s study was in full swing, Freud complained of intellectual paralysis. 30 He occupied himself with a trip he had planned to Italy in the company of his brother Alexander and Gattel. Upon returning from this Italian sojourn, Freud confided to Fliess the “great secret” that had been dawning for “the last few months.” 31 That secret was that Freud no longer believed in his theory of the neuroses based on the specific etiology of paternal seduction. First, he reported that his treatments based on this theory were failures: his patients fled, his cures were incomplete. Second, he referred to the “realization of the unexpected frequency of hysteria” that would in all cases force him to postulate a pedophilic father. 32 Third, he added that there are no indicators of reality in the unconscious, so that sexual fantasy would alight on the parents, without any real event necessarily having transpired. And finally, he took it as a negative confirmation that even in psychosis or delirium the secret of these childhood abuses did not emerge.

With the paternal seduction theory in question, Freud now wrote:

I was so far influenced [by this] that I was ready to give up two things: the complete resolution of a neurosis and the certain knowledge of its etiology in childhood. . . . It seems once again arguable that only later experiences give the impetus to fantasies, which [then] hark back to childhood, and with this the factor of a hereditary disposition regains a sphere of influence from which I had made it my task to dislodge it—in the interest of illuminating neurosis. 33

He therefore retreated to the more traditional medical model, in which a hereditary precondition worked in combination with some later cause. But this was not a happy choice for Freud. For if it was not the perverse father creating a pseudo-heredity, but rather degenerative heredity itself, that was the foundation of hysteria, then—by Freud’s own reckoning—limited therapeutic value could be expected from psychological treatments like psychoanalysis. 34

Nonetheless, it was under the continued influence of a disease model in which an earlier condition interacted with a later specific cause that Freud began to rework his theory of the neurosis. And in doing so, he began to lay greater weight on another cause of early sexual over-stimulation. [End Page 644] That other cause was not sexual abuse by others, but childhood self-abuse—that is, masturbation.

Masturbation and Late-Nineteenth-Century European Medicine

By the 1870s, it had become common for medical authors to condemn the terrifying list of illnesses that S. A. D. Tissot, Claude François Lallemand, J. E. D. Esquirol, and others had attached to masturbation in the first half of the nineteenth century. Many medical authorities chastised Tissot in particular, and took pains to discourse on the confusion between cause and effect, post hoc and propter hoc. 35 Nonetheless, almost invariably these same authorities would then go on to list a wide array of urological, gastrointestinal, and nervous disorders that they believed were created by masturbation. In French- and English-language medical discourse after 1870, moral insanity, hysteria, epilepsy, and hypochondria headed the list of nervous illnesses to be feared. 36

During this same period, German-language authors expressed more skepticism about masturbation as an etiology of medical illness. 37 Emil Kraepelin denied the legitimacy of masturbatory insanity, and further declared that masturbation was almost always the effect and not the cause of insanity. 38 Others saw the problems stemming from masturbation [End Page 645] to be essentially iatrogenic, with terrified masturbators becoming hypochondriacal due to the fear drummed into them by the medical profession. 39 Nonetheless, in the German-language medical literature masturbation continued to be an important etiology—being cited by some as a cause of epilepsy, 40 tremor, 41 chorea, 42, and impotence. 43 More commonly, it was thought to cause homosexuality, 44 adult neurasthenia, 45 and hysteria. 46 For instance, in Albert Villaret’s Handwörterbuch der gesamten Medizin, to which Sigmund Freud contributed a number of unsigned psychiatric entries, the anonymous author of the entry on onanism describes it as a cause of, among other disturbances, hysteria and hystero-epilepsy. 47 Furthermore, many pediatricians saw infantile masturbation as the cause of infantile hysteria. 48 In 1886, Freud spent a month at a pediatric clinic in Berlin run by one of the most outspoken proponents of this theory, Adolph Baginsky. 49 [End Page 646]

Thus, in fin de siècle medical discourse, childhood masturbation remained a plausible etiology for numerous nervous illnesses, including infantile and adult hysteria and neurasthenia. But for the theoreticians of such masturbatory etiologies, this question arose: What was the etiology of masturbation? Why, for instance, would a prepubertal child masturbate? Krafft-Ebing spoke for many when he argued—against himself—that such early masturbation was often not acquired at all, but rather resulted from a premature development of the child’s sexuality because of an underlying degenerative constitution. 50 In more environmentally oriented accounts, the initiation of youthful masturbation was linked not to the spontaneous manifestation of an underlying neuropathic constitution, but rather to the sexual overstimulation of the child by a seduction. 51 Iwan Bloch would later warn parents that the best way to prevent early masturbation in their children was to prevent them from being seduced. 52

It was along these interwoven lines—by which either a degeneratively based precocious sexual drive or a sexual seduction created childhood masturbation, and masturbation could reasonably be proposed as an etiology for hysteria—that Freud’s theory of neurosogenesis began to develop in the fall of 1897.

Masturbation and Hysteria

On 27 October 1897, a month after casting doubt on his paternal seduction theory, Freud first began to rethink his general etiologic theory of specific causes: “I am beginning to perceive in the determining factors large, general, framing motives, as I should like to call them, and other motives, fill-ins, which vary according to the individual’s experiences.” 53 Here he seems to shift from the exacting notion of specific causes to a more open-ended proposal in which general causal categories [End Page 647] can be fulfilled with different individual experiences. What were these general factors? In this same letter, Freud presented a theory of hysteria based on a young child’s “sexual experiences” (sexuellen Erlebnissen). 54 Significantly, he now employed general language and did not specify paternal seduction, or any seduction, as the necessary source of these early sexual experiences.

With this October 1897 reconceptualization, Freud rejuvenated an environmental theory of psychoneuroses by broadening his notion from paternal seduction as the specific cause, to some childhood “sexual experiences.” Early nonspecific childhood sexual experiences remained as a “framing” etiology, without the specificity (and epidemiologic unlikelihood) of paternal seduction. Multiple sorts of sexual experiences could account for an overly stimulated sexual foundation in this model.

In the same letter, Freud proposed that the child fated to be a hysteric was removed from such early sexual experiences, and in this state of deprivation, a period of “longing” (Sehnsucht) developed. “Longing,” he wrote,

is the main character trait of hysteria, just as actual anaesthesia (even though only potential) is its main symptom. During this same period of longing fantasies are formed and masturbation is (regularly?) practiced, which then yields to repression. If it does not yield, then no hysteria develops either; the discharge of sexual excitation for the most part removes the possibility of hysteria. It has become clear to me that various compulsive movements represent a substitute for the discontinued movements of masturbation. 55

Two surviving fragments that Freud wrote to himself between 1897 and 1898 present a similar hypothesis. In one, dated “98,” he simply noted: “Contractur Ersatz und Verhinderung der Masturbation”; in the other, he described a hysterical seizure as the substitute for a girl’s clitoral self-stimulation. 56

In 1896, when Freud was still avidly defending his newly born seduction theory, he had anticipated and countered the notion that youthful masturbation led to hysteria: masturbation “must be excluded from my list of the sexual noxae in early childhood which are pathogenic for hysteria,” for masturbation is a “much more frequent consequence of [End Page 648] abuse or seduction than is supposed.” 57 But in the fall of 1897, he shifted the role of masturbation, from an etiologically irrelevant result of seduction to an etiologically significant later element. His new theory of hysteria preserved a foundational, though nonspecific, early sexual stimulation, while adding a later sexual etiology that was quite specific and in part determining: masturbation. The cessation of early sexual stimulation led to later longing, fantasies, and masturbation. As long as this masturbation continued, the discharge of nervous energy prevented a psychoneurosis from developing. Chronic masturbators would become neurasthenic. On the other hand, hysteria emerged if the overstimulated child’s masturbation was repressed.

Freud’s new two-stage model—in which early nonspecific sexual stimulation, and then later masturbation (when repressed), accounted for hysteria—cohered with fin de siècle medical discourse in that, first, masturbation was a plausible etiology for hysteria, and second, childhood masturbation was seen by many to be caused by prior sexual experiences like seductions. But his new model also incorporated another element that was central to medical debates on masturbation: fantasy. Masturbatory fantasy was becoming, for some, the central pathogenic component of masturbation, for it answered this crucial and vexing question posed by skeptics such as Wilhelm Erb: why was masturbation more damaging than coitus? As Hermann Rohleder replied, the most important difference lay in the intense fantasy that the masturbator generated to satisfy his sexual urges. 58 Similarly, for Albert von Schrenck-Notzing masturbation was distinguished from coitus by its reliance on intense fantasy. 59 He theorized that undifferentiated sexuality in children was molded by an early overstimulating sexual seduction, but a long-lasting pathology was created only if that experience was repeated again and again in masturbatory fantasy. 60 Others such as Albert Moll, while denying that masturbation created homosexuality, nonetheless agreed that masturbation, by fortifying homosexual fantasy, aggravated this condition and hence should be forbidden. 61 [End Page 649]

In his work on neurasthenia, Freud treated masturbation purely as a physiological act; he paid no attention to the psychical world of the masturbator. On the other hand, he had long been interested in the role of fantasy in hysteria. Via his seduction theories, Freud saw fantasies as “set up in front” of real sexual traumas: rather than being etiologic, they were the detritus of real traumatic memories. Fantasies were set up as “protective structures, sublimations of the facts, embellishments of them” whose “accidental origin” was perhaps “masturbation fantasies” providing “self-relief.” 62 Real traumas and their memory created psychic distress and conflict; fantasy and masturbation were the results of these traumas.

But in Freud’s October 1897 letter, fantasy had now taken on more etiologic import. For while fantasy might cover prior overstimulating sexual experiences, fantasies also drove masturbation, which was etiologically crucial. Wishful fantasy was now both the result of prior sexual stimulation, and in part the cause of continued stimulation via masturbation. Hysteria developed only when such fantasies and the attendant masturbation were repressed.

As Freud was contemplating the interaction between childhood sexual experiences and later masturbation in the creation of hysteria, he also began to specify bodily areas of erotogenic excitement in normal men and women. 63 Normally these infantile erotogenic zones—such as the oral and anal zones—were repressed, but if prematurely stimulated they lived on, creating adult sensitivity in these regions and hence perversion. As for the neuroses, Freud noted again “the part played by masturbation in children” destined to become hysterics, and the way hysteria resulted from “the discontinuance of masturbation.” 64

As the tumultuous year of 1897 was coming to a close, Freud vacillated as to the validity of his hypotheses. Suddenly in December—after hearing of a case with paternal sexual abuse—he wrote: “My confidence in paternal etiology has risen greatly.” 65 Nonetheless, in his next letter, ten [End Page 650] days later, the etiologic role of masturbation had returned. He wrote Fliess excitedly:

The insight has dawned on me that masturbation is the one major habit, the “primary addiction.” . . . The role played by this addiction in hysteria is enormous, and it is perhaps there that my major, still outstanding obstacle is to be found, wholly or in part. And here, of course, doubt arises about whether an addiction of this kind is curable, or whether analysis and therapy must come to a halt at this point and content themselves with transforming hysteria into neurasthenia. 66

Here, Freud worried that psychoanalysis could only lift the repression of masturbation in hysteria, and could not effect a cure of masturbation per se. Instead, the hysteric would be turned into a freely masturbating neurasthenic.

So, in the last months of 1897, Freud was entertaining competing models for the etiology of hysteria. His paternal seduction theory had lost much luster, but still had not been finally and completely rejected. He considered whether degenerative heredity might create hysteria, but then he began to articulate a hypothesis that unspecific early sexual experiences led to longing, fanasties, and later masturbation, which when repressed made for hysteria. An undated fragment in Freud’s hand, likely from this period, entitled “Occurrence and Absence of Fantasies” attests to his struggle between these differing models:

I have a case in which I should like to take almost everything as actual memory, i.e., one which thereby differs from all others in their wealth of fantasies. That cannot be due to the cessation of masturb. which is best documented precisely in this case. But perhaps it is because a continuous series of facts to be repressed extends here to the age 12–14y., [whereas] in the others the real experiences break off very soon[,] still within the prehistoric period. 67

Autoerotism and Havelock Ellis

In January 1898, Freud was distressed to find that Felix Gattel’s published account of his study included a long discussion of hysteria, in which any early childhood sexual acts such as masturbation were—following Freud’s own reasoning in 1896—a priori inferred to be the result of prior sexual abuse. Freud felt irked that Gattel had ventured into the realm of [End Page 651] hysteria, and now complained that, in general, “I do not at all agree with his account.” 68

In January and February of that same year, Freud published “Sexuality in the Aetiology of the Neuroses,” a paper that seemed to cover familiar ground. He reiterated the notion that sexual activity in early childhood resulted in the psychoneuroses. 69 He acknowledged the presence of a rudimentary (and normal) childhood sexual life, but crucially noted that childhood sexuality was built to avoid “any great degree of sexual activity during childhood”; therefore, actual early sexual experiences were overwhelming and pathogenic. 70 He notably declined to specify the sorts of childhood sexual experiences he was referring to. And he again presented the masturbatory theory of neurasthenia. Here, perhaps emboldened by Gattel’s data, he argued that there were no cases of neurasthenia without active masturbation. In fact, he argued, diagnoses of neurasthenia without masturbation are incorrect, and probably indicate the underlying presence of hysteria. 71 Hence he suggests that hysteria is marked by the absence/repression of adult masturbation; however, the etiology of hysteria is not made explicit.

Over the ensuing months, Freud struggled to reformulate his “neurotica.” During this period he found thinking about hysteria “torture,” and he considered the writing of his six-hundred-page psychology of dreams to be a pleasant diversion from the problems of the psychoneuroses. 72 At the same time in England, another writer began to wrestle with the relationship between masturbation, fantasy, and hysteria. The British physician Havelock Ellis (1859–1939) was to become one of the most famous sexologists. Before 1898 he had published only the first volume of his grand project, Studies in the Psychology of Sex; in this volume, titled Sexual Inversion, he and John Symonds argued that homosexuality was constitutional. 73

In January 1899, the paths of Ellis and Freud crossed. Freud wrote Fliess:

Something pleasant about which I had meant to write you yesterday was sent to me—from Gibraltar by a Mr. Havelock Ellis, an author who concerns himself with the topic of sex and is obviously a highly intelligent man because [End Page 652] his paper, which appeared in Alienist and Neurologist (October 1898) and deals with the connection between hysteria and sexual life, begins with Plato and ends with Freud; he agrees a great deal with the latter and gives Studies on Hysteria, as well as later papers, their due in a very sensible manner. He even quotes Gattel. At the end he retracts some of his praise. But something remains, and the good impression can no longer be erased. 74

In the article Freud received, “Hysteria in Relation to the Sexual Emotions,” Ellis—impressed by the emphasis placed by Josef Breuer and Freud on the sexual emotions as the site of pathology—concluded that these researchers had held open the door for further research into hysteria as “a transformation of auto-erotism.” 75 This was itself a bold transformation of Breuer and Freud’s work, for in 1895 neither Breuer nor Freud had implied any such relationship between hysteria and a theory of “auto-erotism.” A few months earlier, however, Havelock Ellis had put forth precisely such a theory.

In “Autoerotism: A Psychological Study,” Ellis defined autoerotism as the “phenomena of spontaneous sexual emotion generated in the absence of an external stimulus proceeding, directly or indirectly, from another person.” 76 Hence, autoerotism was a category that explicitly excluded heterosexuality or homosexuality, as well as fetishism; instead, in Ellis’s view, it encompassed masturbatory activity and was closely related to daytime reverie—that is, fantasy. “Daydreams,” he wrote, have “. . . never been counted of sufficient interest for scientific inquisition; it is really a process of considerable importance and occupies a large part of the autoerotic field.” 77 For Ellis, autoerotic fantasy and masturbation were normal and, in moderation, were not physically pernicious. Still, too much masturbation led to a morbid heightening of “Narcissus-like” self-absorption and the development of dangerous, artificial fantasies, especially in adolescents. Hysterics differed from others only insofar as their autoerotic lives made for conflict. 78 [End Page 653]

Ellis later republished this essay in his Studies in the Psychology of Sex, subsuming both 1898 essays under the title “Auto-erotism: A Study of the Spontaneous Manifestations of the Sexual Impulse.” 79 In November 1900 Freud reported having read the German translation of this volume 80 —but there is reason to suspect that he read a reprint of Ellis’s article on “Autoerotism” before 1900. After he received Ellis’s first reprint, which so provocatively tied Breuer and Freud’s work on hysteria to “autoerotism,” Ellis and Freud struck up a correspondence. The earliest of these letters have been lost, but in the Columbia University Freud Collection there exists, among a number of other reprints from Ellis, an annotated reprint of the article on autoerotism. Though the problems of attribution in this archive are difficult, this article—I submit—was annotated by Sigmund Freud sometime between January and 9 December 1899. 81

Freud’s first encounters with Ellis’s work on autoerotism, fantasy, and hysteria are of historical interest. For in the very same letter in which he reported receiving and reading Ellis’s article on sexual emotions and hysteria (in which Ellis proposed autoerotism as the bedrock of hysteria), Freud reported a breakthrough that would be critical to the development of his theory. In that letter, he wrote of a new clarity in his thinking, which he attributed to his self-analysis. 82 He had come to three new [End Page 654] postulates. First, he wrote: “fantasies are the products of later periods and are projected back from what was then the present into earliest childhood”; second, “To the question ‘What happened in earliest childhood?’, the answer is ‘Nothing, but the germ of a sexual impulse existed’”; and third, he announced: “I have grasped the meaning of a new psychic element which I conceive to be of general significance and a preliminary stage of symptoms (even before fantasy).” 83 That stage before fantasies, the stage that later fantasies were projected back onto, the stage of earliest childhood where, normally, the germ of a sexual impulse existed, all this would soon be encompassed by a new stage of development that Freud called—following Ellis—“autoerotic.” 84

Auto- and Alloerotic Illness: Freud’s 1899 Etiologic Hypothesis and the Dora Case

After this contact with Ellis, Freud’s inquiry into the relationship between masturbation and fantasy as elements in psychopathology continued. 85 Then, on 9 December 1899, in an important letter to Fliess, Freud put forth a new theory of neurosogenesis that crystallized his prior hypotheses of the last two years into a two-stage epigenetic theory for psychoneurosis:

The problem confronting me is that of the “choice of neurosis.” When does a person become hysterical instead of paranoid? In my first crude attempt, made at a time when I was still trying to take the citadel by force, I thought it depended on the age at which the sexual trauma occurred—the person’s age at the time of the experience. That I gave up long ago; but then I was left without a clue until a few days ago, when I saw a connection with the sexual theory. 86

He went on: “The lowest of the sexual strata is autoerotism, which dispenses with any psychosexual aim and seeks only locally gratifying sensations.” 87 “Autoerotism” for Freud denoted a normal stage of self-directed [End Page 655] childhood self-stimulation; a pathological return to this stage, he wrote, resulted in paranoia. 88 Autoerotism was followed by a second stage, “alloerotism (homo- or heteroerotism),” but the prior stage remained as foundational and “continues to exist as an undercurrent. . . . Hysteria (and its variant, obsessional neurosis) is alloerotic, since its main path is identification with the loved one.” 89

Here, for the first time, Freud employed Ellis’s term, autoerotism, but he had also clearly in part redefined this term. Medical discourse on masturbation had long been plagued by problems of definition and terminology. In 1875 H. Fournier listed twelve synonyms referring to sexual self-stimulation. 90 Rohleder and others grumbled about the poor definition of masturbation, especially among the French. 91 Much of the confusion stemmed from the seemingly synonymous concept of onanism, which, by its biblical definition, referred not only to solitary acts of masturbation, but also to nonprocreative dyadic sexual acts—such as oral sex between heterosexual partners, as well as all homosexual sex. 92

Upon publicly introducing the term autoerotic to readers of his Three Essays on the Theory of Sexuality in 1905, Freud would credit Ellis’s introduction of this “happily chosen term” denoting self-directed sexual activity, but he would also complain that Ellis marred his concept by attempting to include all of hysteria and all of masturbation under the realm of the autoerotic. 93 For Freud, the autoerotic stage was more simply characterized by Ellis’s core definition—that is, it was a stage of self-directed sexual arousal. Other sorts of “onanistic” activity were not necessarily autoerotic; rather, such masturbation could be object-directed sexuality, either in action, such as mutual masturbation, or in fantasy.

Freud’s 1899 letter also makes it clear that, unlike Ellis, he did not account for hysteria by a transformation of autoerotism. In Freud’s 1899 synthesis, hysteria resulted from both an undercurrent of autoerotic pathology and unspecified alloerotic pathology. But a central question remains unaddressed in this formulation: What was the cause of pathology in each stage? Were causes again specific, or were more general categories employed? Was Freud still employing trauma theory and repressed stimulation in a reflex-arc model of the mind? If so, did that [End Page 656] stimulation emerge from experiences like seduction or masturbation, or had Freud by 1900 already come to the belief that the sexual constitution, libido, was responsible?

The clarification of such historical questions can best be found in the very next case history that Freud wrote, his Fragment of an Analysis of a Case of Hysteria. 94 In the fall of 1900, a woman named Ida Bauer came to him for treatment. In January 1901, when this young woman had left her psychoanalysis, Freud concluded that the case history of her hysteria would be perfect for extending his theory of dreams into the realm of psychopathology, as he had not yet been ready to do earlier in his Interpretation of Dreams (1900). By analyzing this young hysteric’s dreams, he promised to expose the unconscious etiology of her hysteria. To do so, of course, meant that he had, in the end, to propose an etiology for hysteria—something he had not done in print since his 1896 papers arguing for the seduction theory.

Before examining this case, its complicated publication history must be addressed. 95 Freud wrote up this case immediately after Ida Bauer left treatment in the first weeks of 1901, but he did not publish it until 1905, at which point the text had clearly been revised in places. Hence the dating of different passages is a complicated task. However, it is evident that he did not rework his basic etiologic understanding of Dora’s hysteria to tally with his 1905 libido theory, for its structure is based in trauma theory and the specific trauma of masturbation. 96 [End Page 657]

In brief, the case history is that of an eighteen-year-old Viennese girl, Ida Bauer—“Dora”—who had been sexually approached by a certain Herr K. when she was only fourteen, and then again when she was sixteen. To the girl’s dismay, when she complained about these spurned advances to her father, he agreed with her would-be seducer that her tale was not of an actual seduction, but of a meaningless sexual fantasy.

For the student of Freud’s emerging theory, the Bauer family tale—with its accusations of attempted sexual seduction, and dismissals based on the claim of fantasy—recapitulates Freud’s own struggles with the etiology of hysteria. But now, without hesitation, he presented his new position on this matter. 97 When Herr K. sexually approached Dora, she was overwhelmed not by sexual excitement but by disgust; hence, for Freud, the girl at this point was already “entirely and completely hysterical.” 98 Rather than viewing this as the etiologic trauma, Freud argued: “If, therefore, the trauma theory is not to be abandoned, we must go back to her childhood and look about there for any influences or impressions which might have had an effect analogous to that of a trauma.” 99

So Freud indicated that this case would be conceptualized within trauma theory, not the vicissitudes of some infantile sexual drive. What would this early trauma be? No longer sexual seduction, for Freud reported that he had concluded that such accusations of seduction were often screens for the patient’s own masturbatory activity. 100 Similarly, he concluded that Dora’s fantasies of having sex “per os” with her father were screens for her earliest masturbatory activity, namely her childhood history of sucking her thumb. Dora’s history of being a thumb sucker was, Freud reported, common among his hysterical patients. By traumatically overstimulating this germ of her autoerotic sexuality, Dora allowed it to aberrantly develop into a perversely thriving erotic region. Then, crucially, when the girl was four or five she was broken of this habit by her parents. 101 [End Page 658]

Dora’s hysteria was not primarily due to her autoerotic pathology of sucking her thumb, however; according to Freud’s December 1899 model, that alone would have resulted in paranoia. Rather, this undercurrent of autoerotic overexcitement was compounded by a second stage of neurosogenesis—one that Freud, as promised, would discern from his patient’s dreams. Dora’s first dream contained, by Freud’s reckoning, an accusation of seduction that was a veiled self-accusation of genital masturbation. 102 Following his 27 October 1897 construction, he concluded that the childhood thumb sucker, having been broken of this habit, was left in an overly aroused state of longing. Three years later, the now-older girl experienced the earliest stirrings of object-related sexuality, fantasizing about having sex with her beloved father. Dora’s loving fantasies toward her parents were unlike the typical child’s, for along with these fantasies she genitally masturbated. Her Oedipal love was marked by a reinforcement, due to the appearance of “true genital sensations, either spontaneously or as a result of seduction or masturbation.” 103 At the age of eight she suddenly stopped masturbating, repressing her conscious masturbatory fantasies, and hence became hysterical.

While many commentators have retrospectively read into this case the presence of a pathogenic Oedipus complex, Freud is quite clear on this account: Dora did not become ill because of Oedipal love. 104 Rather, his 1900 model of psychopathogenesis required an additional traumatizing factor to pathologically reinforce or fixate Dora’s unconscious and all-too-human Oedipal love. As Freud stated, his reasoning in this case was built around the preservation of trauma theory. And the trauma, as he also made explicit, was not seduction; rather, the trauma here was oral and genital masturbation. 105

When Freud told Dora that she had become hysterical due to the repression of her masturbation, she denied the charge. 106 But in a symbolic enactment of the repressed perverse action, she began to play with a small reticule—opening it, sticking her finger in it, then shutting it. 107 Freud took this as indirect confirmation of his interpretation. Then, after elucidating all the pathogenic consequences of Dora’s masturbation, in [End Page 659] the account of this case published in 1905 he posed the larger question with regard to the etiology of hysteria: “Is Dora’s case to be regarded as aetiologically typical? does it represent the only type of causation? . . . I am sure that I am taking the right course in postponing my answer to such questions until a considerable number of other cases have been similarly analyzed and published.” 108 The once-zealous theoretician of specific causes now cautiously suggested: “Let it suffice if we can reach the conviction that in this case the occurrence of masturbation in childhood is established, and that its occurrence cannot be an accidental element nor an immaterial one in the conformation of the clinical picture.” 109


Histories of Sigmund Freud’s early etiologic thinking have commonly argued for a theoretical leap from his earlier seduction theories to his libido theory. I have attempted to show that Freud’s masturbation hypotheses can be seen as the “missing link” between these theories. For Freud, the gradual shift from an emphasis on the specific cause of sexual seduction to the vicissitudes of masturbation was in part a convenient move from one commonly regarded source of traumatic sexual stimulation to another. Like seduction, masturbation as an etiology allowed him to temporarily preserve trauma as the basis of psychoneuroses. Masturbation easily fit into Freud’s modified Charcotian thinking in which a specific sexual trauma caused hysteria. Further, his reflex-arc model of the mind demanded stimulation and repression for the creation of pathology: sexual self-stimulation, like sexual seduction, was commonly thought to be a route to such stimulation.

While these concerns from the seduction theory remained with Freud during this transitional period, his turn to masturbation as an etiology brought with it differences that would prove to be transforming. The seduction theory was a radically environmentalist trauma theory; Freud’s consideration of masturbation, on the other hand, altered Freud’s emphasis from the accidents of external trauma to a more complicated interaction between nascent immature childhood sexual biology, trauma, and inner wishing and fantasy. While contemplating the role of masturbation in neurosis, Freud for the first time began to postulate a normal role for erotogenic zones that children self-stimulated, and a normal autoerotic stage—essential elements of his later libido theory. At the [End Page 660] same time, he could maintain trauma theory, insofar as he envisioned pathogenesis as the traumatic stimulation of such immature childhood sexuality. But as wishful fantasy took on the power to drive masturbation, inner psychical life became essential to neurosogenesis. With masturbation as the focus, pathogenesis was not simply due to an accidental trauma, but increasingly was poised between the inner and outer, between psyche and soma.

After contemplating potential masturbation hypotheses for two years, Freud encountered Havelock Ellis’s work, in which hysteria was thought to be due to a transformation of “autoerotism.” Eleven months later Freud proposed a new theory of psychoneurosis based on autoerotism, and a later stage of object-directed alloerotism. This etiologic framework, I have argued, organized his etiologic thinking in his next published case history, the Dora case. This young hysteric’s fantasies of seduction were seen as screens for her own masturbatory activity, and it was that excess oral and genital self-stimulation—not abuse by others, or simple Oedipal love for her father—that created her hysteria.

Hence, as Freud moved away from the seduction hypothesis in the fall of 1897, the ensuing period of transition—which has been characterized in histories of his development as one of confusion—was significantly organized by his thinking on masturbation. It was within the ambiguous concept of “masturbation” that Freud’s theory of neurosogenesis began to shift away from a trauma-based theory, toward one based on self- and object-related sexuality and the power of inner wish and fantasy.

Sometime between 1901 and 1905, Freud’s understanding of masturbation shifted along these lines. In 1903, he reassured his patient Albert Hirst that his masturbation was not harming him. 110 In 1905, when Freud’s Three Essays on the Theory of Sexuality appeared, the autoerotic stage had changed from a fragile state of immature sexuality that might be traumatized by stimulation, into a normal set of spontaneous, erotogenic-zone-based, partial drives that manifested themselves normally in masturbatory actions. 111 Such normal infantile masturbation was now only pathological if it continued into latency. Furthermore, Freud proposed that this early object-less autoerotic stage was replaced at puberty by a stage of genitally organized object-directed sexuality. 112 In all of this, elements of Freud’s masturbatory hypotheses had taken pride of place in his new theory. But masturbation as a traumatic etiology of hysteria and neurosis had apparently disappeared. Masturbation had shifted from a [End Page 661] cause to an effect, from an etiologic agent to a marker of childhood psychosexuality.

Or so it would seem. For Freud’s belief in masturbation as a pathogenic agent would not die so easily. After 1900, medical opinion increasingly rejected the notion that masturbation was harmful. In a 1912 discussion of the Vienna Psychoanalytic Society psychoanalysts such as Wilhelm Stekel argued that the condemnation of masturbation was a senseless prejudice. Surprisingly, Freud thoroughly rejected this claim, arguing that masturbation caused organic and psychic damage. 113 The role of masturbation as an etiology would fade from psychoanalysis, but Sigmund Freud, it seems, held onto his beliefs about the pathogenic nature of this sexual act—beliefs shared by many of his fin de siècle medical colleagues, and beliefs that had once been crucial to his theory building.

George J. Makari

George J. Makari is Assistant Professor of Psychiatry and Director of the History of Psychiatry Section at Cornell University Medical College, Box 171, 525 East 68th Street, New York, New York 10021 (e-mail:; he is also on the faculty at the Center for Psychoanalytic Training and Research at Columbia University. He has published numerous articles on the origins of psychoanalysis, with a special focus on the development of the concept of transference.


* I would like to acknowledge support received from a fund established in the New York Community Trust by DeWitt-Wallace. I would also like to acknowledge the helpful comments of Nathan G. Hale, Robert Michels, and the anonymous reviewers of the Bulletin. Segments of this paper have been presented at the European Association for the History of Psychiatry, 13 September 1996; and the Cheiron XXIX Proceedings, 19 June 1997.

1. See, for instance, Jeffrey M. Masson, The Assault on Truth: Freud’s Suppression of the Seduction Theory (New York: Farrar, Straus and Giroux, 1984); Jean G. Schimek, “Fact and Fantasy in the Seduction Theory: A Historical Review,” J. Amer. Psychoanal. Assoc., 1987, 35: 937–66; Hans Israëls and Morton Schatzman, “The Seduction Theory,” Hist. Psychiatry, 1993, 4: 23–59.

2. On this debate, see Rachel Blass and Bennet Simon, “Freud on His Own Mistake(s): The Role of Seduction in the Etiology of Neurosis,” Psychiatry & Human., 1992, 12: 160–83; idem, “The Value of the Historical Perspective to Contemporary Psychoanalysis: Freud’s ‘Seduction Hypothesis’,” Internat. J. Psychoanal., 1994, 75: 677–94.

3. Sigmund Freud, “On the History of the Psychoanalytic Movement” (1914), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, ed. James Strachey, 24 vols. (London: Hogarth Press, 1953–74), 14: 17 (henceforth Standard Edition).

4. Ernest Jones, The Life and Work of Sigmund Freud (New York: Basic Books, 1953), 1: 267. See also James Strachey, “Editor’s Note,” in Standard Edition, 7: 125–29, especially p. 128; Ernst Kris, “Introduction,” in Sigmund Freud, The Origins of Psychoanalysis: Letters, Drafts and Notes to Wilhelm Fliess 1887–1902 (New York: Basic Books, 1954), pp. 33–34; Max Schur, Freud: Living and Dying (New York: International University Press, 1972), p. 114; Peter Gay, Freud: A Life for Our Time (New York: Norton, 1988), pp. 95–96.

5. Frank Sulloway, Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend (New York: Basic Books, 1979), p. 207.

6. While case records exist for Freud’s earlier cases, both in published form—see Albrecht Hirschmüller, Freuds Begegnung mit der Psychiatrie von der Hirnmythologie zur Neurosenlehre (Tübingen: Editions Diskord, 1991)—and in the Freud Archives, to my knowledge there are no available detailed case notes in his hand that chronicle clinical treatment during the years 1897 to 1905. Freud’s fragmentary notes to himself at times refer to clinical encounters; these notes are housed in the Sigmund Freud Collection at the Library of Congress.

7. See, for instance, Didier Anzieu, Freud’s Self-Analysis, trans. P. Graham (Madison, Conn.; International Universities Press, 1986); and, for a less sympathetic account of this analysis, Sulloway, Freud (n. 5), pp. 18–19, 207–10.

8. Those writing on Freud’s work have almost universally failed to take note of this period. A notable exception is Frank Sulloway, who, while not elaborating, stated: “What is also not appreciated about Freud is how integral his medical views on masturbation were to his overall theory of the neuroses. After his abandonment of the seduction theory in 1897, his theory of the neuroses became, in significant part, a theory about infantile sexual masturbation” (Freud [n. 5], p. 185).

9. Sigmund Freud, “My Views on the Part Played by Sexuality in the Aetiology of the Neuroses” (1906), in Standard Edition, 7: 271–79, quotation on p. 274.

10. Josef Breuer and Sigmund Freud, Studies in Hysteria (1895), Standard Edition, vol. 2.

11. Sigmund Freud, “On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description ‘Anxiety Neurosis’” (1895), Standard Edition, 3: 90–115.

12. Leopold Löwenfeld, Pathologie und Therapie der Neurasthenie und Hysterie (Wiesbaden: J. F. Bergmann, 1894).

13. Leopold Löwenfeld, “Über die Verknüpfung neurasthenischer und hysterischer Symptome in Anfallsform nebst Bemerkungen über die Freudsche Angstneurose,” Münchener medizinische Wochenschrift, 1895, 42: 282–85.

14. Sigmund Freud, “A Reply to Criticisms of My Paper on Anxiety Neurosis” (1895), Standard Edition, 3: 123–39. Freud argued that neurosis was essentially the result of (1) a precondition; (2) a specific cause; (3) concurrent causes; and (4) a precipitating cause. Concurrent causes and a precipitating cause were nonspecific and neither necessary nor formative. A precondition was generally necessary, but not sufficient. The specific cause was necessary, and only it determined the form of neurosis that developed.

15. Ibid., p. 139.

16. The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887–1904, ed. and trans. Jeffrey M. Masson (Cambridge: Harvard University Press, 1985), pp. 158–69 (hereafter Freud-Fliess Letters).

17. Sigmund Freud, “Heredity and the Aetiology of the Neuroses” (1896), Standard Edition, 3: 141–56; idem, “Further Remarks on the Neuropsychoses of Defence” (1896), ibid., pp. 157–85; idem, “The Aetiology of Hysteria” (1896), ibid., pp. 187–221.

18. “Further Remarks” (n. 17), pp. 162–85.

19. Freud, “Aetiology of Hysteria” (n. 17), pp. 208–9.

20. Freud-Fliess Letters, p. 212.

21. See George J. Makari, “Toward Defining the Freudian Unconscious: Seduction, Sexology, and the Negative of Perversion, 1896–1905,” Hist. Psychiatry, 1997, 8: 459–85.

22. Freud, “Aetiology of Hysteria” (n. 17), p. 209. Also see Freud-Fliess Letters, pp. 210, 212.

23. Freud-Fliess Letters, pp. 221–23.

24. Ibid., pp. 243–44.

25. On Gattel, see Michael Schröter and Ludger M. Hermanns, “Felix Gattel (1870–1904): Freud’s First Pupil. Part I,” Internat. Rev. Psychoanal., 1992, 19: 91–104; idem, “Nachträge zu ‘Felix Gattell: Der erste Freud Schüler,’” Luzifer-Amor: Zeitschrift zur Geschichte der Psychoanalyse, 1994, 7: 17–29. Also see Sulloway, Freud (n. 5), pp. 513–15.

26. Felix Gattel, Ueber die sexuellen Ursachen der Neurasthenie und Angstneurose (Berlin: August Hirschwald, 1898), pp. 47–48. Of thirty patients with “pure” cases of neurasthenia, all were found to have histories of masturbation. Of the nine mixed cases of neurasthenia and either hysteria or “Angstneurose,” all but one had a history of masturbation. Of forty-four patients with “Angstneurose,” twelve gave histories of abstinence, while another twenty-four practiced some form of coitus interruptus.

27. Gattel also argued that he could not attempt to ferret out the specific etiology of hysteria because detecting that etiology from early childhood would not be possible in a short interview, but would require psychoanalysis: ibid., p. 11.

28. Ibid., p. 25.

29. Sulloway, Freud (n. 5), pp. 513–15. Sulloway’s speculation is interesting, but it should be noted that Freud could have discounted the incidence of hysteria in Gattel’s sample for the simple reason that this was a sample of psychiatric patients, not a random sample of the normal population. Furthermore, we have no information on how many hysterics Gattel turned away to get his cohort of one hundred “nonhysterics.”

30. Freud-Fliess Letters, pp. 253–54.

31. Ibid., p. 264.

32. Ibid., pp. 264–65, quotation on p. 264.

33. Ibid., p. 265.

34. Freud, “Reply” (n. 14), p. 138.

35. See, for example, H. Fournier, De l’onanisme: Causes, dangers et inconvénients pour les individus, la famille et la société; Remèdes (Paris: J. B. Baillière, 1875), p. 8; J. Christian, “Onanisme,” in Dictionnaire encyclopédique des sciences médicales, ed. Amédée Dechambre, 100 vols. (Paris: Masson and Asselin, 1869–89), 15: 359–85, see especially p. 361.

36. Fournier, De l’onanisme (n. 35), pp. 59–105; Th. Pouillet, Essai médico-philosophique sur les formes, les causes, les signes, les conséquences et le traitement de l’onanisme chez la femme (Paris: Adrien Delahaye, 1876); Charles Mauriac, “Onanisme et excès vénériens,” in Nouveau dictionnaire de médecine et de chirurgie pratiques, ed. Dr. Jaccoud (Paris: J. B. Baillière, 1879), pp. 494–539; Th. Pouillet, Psychopathie sexuelle. I. De l’onanisme chez la femme, 7th ed. (Paris: Vigot Frères, 1897); Henry Maudsley, The Pathology of the Mind (New York: Appleton, 1880); William A. Hammond, A Treatise on Insanity in Its Medical Relations (New York: Appleton, 1883), p. 667; W. R. Gowers, Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms, and Treatment (New York: William Wood, 1885), p. 25.

37. For example, in a medical compendium, E. Hitzig rejected masturbation as a cause for cerebellar atrophy; Hermann Nothnagel discounted masturbation’s import with regard to epilepsy; and Albert Eulenburg argued against the etiologic relevance of masturbation in progressive muscular atrophy: E. Hitzig, “Hypertrophy and Atrophy of the Brain,” trans. H. Swanzy et al., in Cyclopaedia of the Practice of Medicine, 21 vols., ed. Hugo Wilhelm von Ziemssen, American ed. Albert H. Buck (New York: William Wood and Co., 1874–81), 12: 846–48; Hermann Nothnagel, “Epilepsy and Eclampsia,” trans. J. Haven Emerson, in ibid., 14: 203; Albert Eulenburg, “Vaso-motor and Trophic Neuroses,” trans. David F. Lincoln, in ibid., 14: 113–14.

38. Emil Kraepelin, Psychiatrie: Ein Lehrbuch für Studierende und Aerzte, 5th ed. (Leipzig: Johann Ambrosius Barth, 1896), p. 51.

39. Felix von Niemeyer, A Textbook of Practical Medicine: With Particular Reference to Physiology and Pathological Anatomy, trans. G. H. Humphreys and Charles Hachley (New York: Appleton, 1874), 2: 98–100.

40. Moritz Rosenthal, A Clinical Treatise on the Diseases of the Nervous System, trans. L. Putzel, 2 vols. (New York: William Wood, 1879), 2: 70.

41. Eulenburg, “Vaso-motor and Trophic Neuroses” (n. 37), 14: 386; Rosenthal, Clinical Treatise (n. 40), 2: 108.

42. Hugo Wilhelm von Ziemssen, “Chorea,” trans. David F. Lincoln, in Cyclopaedia (n. 37), 14: 423.

43. Rosenthal, Clinical Treatise (n. 40), 2: 157.

44. Richard von Krafft-Ebing, Psychopathia Sexualis mit Besonderer Berücksichtigung Der Conträren Sexualempfindung: Eine Klinisch-Forensische Studie, 7th ed. (Stuttgart: Ferdinand Enke, 1892), pp. 191–93.

45. Wilhelm Erb, “Diseases of the Spinal Cord and Medulla Oblongata,” in Cyclopaedia of the Practice of Medicine, ed. H. von Ziemssen, trans. H. Swanzy et al., 21 vols. (New York: William Wood, 1874–81), 13: 371; Richard von Krafft-Ebing, Psychopathia Sexualis: Eine klinisch-forensische Studie (Stuttgart: Ferdinand Enke, 1886); Ernst Adolph Gustav Gottfried Strümpell, A Textbook of Medicine for Students and Practitioners, trans. H. Vickery and P. Knapp (New York: Appleton, 1887), pp. 570–71, 767; Löwenfeld, Pathologie und Therapie (n. 12), pp. 68–69; Hermann Rohleder, Die Masturbation: Eine Monographie für Ärzte und Pädagogen (Berlin: H. Kornfeld, 1899), p. 163.

46. Niemeyer, Textbook of Practical Medicine (n. 39), pp. 100–101; Rosenthal, Clinical Treatise (n. 40), 2: 44; Strümpell, Textbook of Medicine (n. 45), p. 757; Löwenfeld, Pathologie und Therapie (n. 12), pp. 68–69.

47. “Onanie,” in Handwörterbuch der gesamten Medizin, ed. Albert Villaret (Stuttgart: Ferdinand Enke, 1891), 2: 431.

48. See K. Codell Carter, “Infantile Hysteria and Infantile Sexuality in Late Nineteenth-Century German-Language Medical Literature,” Med. Hist., 1983, 27: 186–96.

49. See Adolph Baginsky, Handbuch der Schulhygiene zum Gebrauche für Ärtze, Sanitätsbeamte, Lehrer, Schulvorstände und Techniker (Berlin: Denicke, 1877). On Baginsky and Freud, see Carlo Bonomi, “Why Have We Ignored Freud the Pediatrician? The Relevance of Freud’s Pediatric Training for the Origins of Psychoanalysis,” in One Hundred Years of Psychoanalysis: Contributions to the History of Psychoanalysis, ed. André Haynal and Ernst Falzeder (Geneva: Cahiers Psychiatriques Genevois et Institutions Universitaires de Psychiatrie de Genève, 1994), pp. 55–99.

50. Krafft-Ebing, Psychopathia Sexualis (n. 44), p. 187.

51. Mauriac, “Onanisme” (n. 36), p. 518; George Beard, Sexual Neurasthenia (Nervous Exhaustion): Its Hygiene, Causes, Symptoms, and Treatment (New York: E. B. Treat, 1884), p. 120; Albert von Schrenck-Notzing, Therapeutic Suggestion in Psychopathia Sexualis: (Pathological Manifestations of the Sexual Sense), with Especial Reference to Contrary Sexual Instinct [1892], trans. C. G. Chaddock (Philadelphia: F. A. Davis, 1895), pp. 150–53.

52. Iwan Bloch, The Sexual Life of Our Time, In Its Relations to Modern Civilization, trans. M. Eden Paul (London: Rebman, 1908), pp. 427, 634.

53. Freud-Fliess Letters, p. 274.

54. Ibid. For the German, see Sigmund Freud, Briefe An Wilhelm Fliess, 1887–1904 (Frankfurt am Main: S. Fischer, 1986), p. 296. In this letter Freud seems to hold on to his notion of a “pseudo-heredity,” by claiming that these early sexual experiences and later longing form a degenerative character (degenerative Charakter).

55. Freud-Fliess Letters, pp. 274–75; Freud, Briefe (n. 54), p. 296.

56. The Sigmund Freud Collection, Library of Congress, Washington, D.C., Series B-28; © 1997 A. W. Freud et al., by permission of Mark Paterson and Associates.

57. Freud, “Further Remarks” (n. 17), p. 165.

58. Rohleder, Die Masturbation (n. 45), pp. 35, 170–71. The competing argument as to what distinguished masturbation from coitus was that masturbation, unlike coitus, could be easily engaged in excessively: see, for instance, Kraepelin, Psychiatrie (n. 38), pp. 50–51; Erb, “Diseases of the Spinal Cord” (n. 45), 13: 149.

59. Schrenck-Notzing, Therapeutic Suggestion (n. 51), pp. 15–16.

60. Ibid., pp. 152–53.

61. Albert Moll, Perversions of the Sex Instinct: A Study of Sexual Inversion Based on Clinical Data and Official Documents [1891], trans. Maurice Popkin (Newark: Julian Press, 1931), pp. 156–57.

62. Freud-Fliess Letters, p. 239; also see pp. 242, 247, 248, 250, 251.

63. Ibid., p. 279.

64. Ibid., p. 280. Masson’s translation of this sentence is misleading. Freud wrote: “Daher etwa die Anästhesie der Frauen, die Rolle der Masturbation bei den zur Hysterie bestimmten Kindern und das Aufhören der Masturbation, wenn eine Hysterie daraus wird” (Freud, Briefe [n. 54], p. 304); hence he wrote not of children “predisposed” to hysteria, as Masson has it (which would imply a hereditarian disposition), but rather of children “destined” or “fated” to become hysterics. Furthermore, the last phrase indicates that the hysteria resulted from the cessation of masturbation, something that is hard to garner from Masson’s text.

65. Freud-Fliess Letters, p. 286.

66. Ibid., p. 287.

67. As cited in Ilse Grubrich-Simitis, Back to Freud’s Texts: Making Silent Documents Speak, trans. Phillip Slotkin (New Haven: Yale University Press, 1996), p. 99; © 1997 A. W. Freud et al., reproduced by permission of Mark Paterson and Associates.

68. Freud-Fliess Letters, p. 297. See Gattel, Ueber die sexuellen Ursachen (n. 26), pp. 7, 57–58.

69. Sigmund Freud, “Sexuality in the Aetiology of the Neuroses” (1898), Standard Edition, 3: 259–85, see especially pp. 280–81.

70. Ibid., pp. 280–81.

71. Ibid., p. 270.

72. Freud-Fliess Letters, p. 314. Also see p. 324.

73. Havelock Ellis and John Addington Symonds, Studies in the Psychology of Sex. Vol. 1: Sexual Inversion (London: Wilson & MacMillan, 1897).

74. Freud-Fliess Letters, pp. 338–39. Lewis and Landis list a copy of this 1898 reprint in the holdings that were purchased by Columbia University: Nolan D. C. Lewis and Carney Landis, “Freud’s Library,” Psychoanal. Rev., 1957, 44: 327–54, #256—but this reprint (along with 163 other items listed by Lewis and Landis) is apparently lost.

75. Havelock Ellis, “Hysteria in Relation to the Sexual Emotions,” Alien. & Neurol., 1898, 19: 614. In the same paper, Ellis seemed ready to discount Freud’s theory of a specific sexual etiology of hysteria, but in a footnote he admitted that “the recent investigation of Gattel . . . has furnished striking evidence of the importance of the sexual factor in severe functional neurosis” (p. 614).

76. Havelock Ellis, “Auto-erotism: A Psychological Study,” Alien. & Neurol., 1898, 19: 260.

77. Ibid., pp. 273–74.

78. Ibid., pp. 279–80.

79. Havelock Ellis, Studies in the Psychology of Sex: The Evolution of Modesty, the Phenomena of Sexual Periodicity, Auto-eroticism (Philadelphia: F. A. Davis, 1900), pp. 110–204.

80. Freud-Fliess Letters, p. 428. Freud reported reading Ellis’s new volume at the same time that he was treating Ida Bauer (“Dora”), whose hysteria, as we shall see, he linked to autoerotism.

81. The article in question is annotated in one of Freud’s characteristic manners: see Sander L. Gilman et al., Reading Freud’s Reading (New York: New York University Press, 1994). More importantly, the actual annotations point to Freud, for, in contrast to numerous small annotations, one bold, prominent, blue “X” was flourished in the margin next to Ellis’s one explicit reference to Sigmund Freud. If these are Freud’s annotations, it is not unreasonable to think that they were made before he read Ellis’s book in November 1900—for if he had already read the first volume of Ellis’s Studies in the Psychology of Sex, why would he then read the older autoerotism article and annotate it? After all, this same article was reproduced and expanded upon in the book. Rather, it seems likely that Freud read this reprint sometime between January 1899 and 9 December 1899, when he first put forth a theory explicitly named “autoerotism.”

On questions of attribution in the Columbia Freud Archive, see David Bakan, “The Authenticity of the Freud Memorial Collection,” J. Hist. Behav. Sci., 1975, 11: 365–67; Hans Lobner, “Some Additional Remarks on Freud’s Library,” Sigmund Freud House Bull., 1975, 1: 18–29; “Dr. Anna Freud on Visit to P and S, Recalls Past of Her Father’s Books,” P & S News, 1978, 23: 4.

82. Freud-Fliess Letters, p. 338. It should be noted here that Freud attributed these breakthroughs to his self-analysis; and without denying that as a possible other source of his understanding, I would here side with Malcolm MacMillan, who argues that it is dubious that Freud could have won such knowledge only from the analysis of his own dreams. Instead, MacMillan argues that “theoretical requirements” led to Freud’s “sudden realisation” of autoerotic impulses (Malcolm Macmillan, Freud Evaluated: The Completed Arc [Amsterdam: North-Holland, 1991], pp. 286–87). I have attempted to delineate those theoretical considerations, and thereby to show that Freud’s movement to the autoerotic was not so “sudden” when seen in the context of his almost-two-year engagement with masturbation as an etiologic agent.

83. Freud-Fliess Letters, p. 338.

84. Ibid., p. 390.

85. For example, see ibid., pp. 342, 345, 380.

86. Ibid., p. 390.

87. Ibid.

88. Ibid.

89. Ibid.

90. Fournier, De l’onanisme (n. 35), p. 11.

91. Rohleder, Die Masturbation (n. 45), p. 20.

92. See, for instance, Mauriac, “Onanisme” (n. 36), pp. 496–98. On this issue, see Vern Bullough and Martha Voght, “Homosexuality and Its Confusion with the ‘Secret Sin’ in Pre-Freudian America,” J. Hist. Med., 1973, 28: 143–55.

93. Sigmund Freud, Three Essays on the Theory of Sexuality (1905), in Standard Edition, 7: 123–254, see especially p. 181.

94. Sigmund Freud, Fragment of an Analysis of a Case of Hysteria (1905), in Standard Edition, 7: 1–122. The literature on the Dora case is vast, but relatively little of it is devoted to historical contextualization. The obvious exception is Hannah S. Decker, Freud, Dora, and Vienna, 1900 (New York: Free Press, 1991). For a review of recent publications on this case, see Jerry Jennings, “The Revival of ‘Dora’: Advances in Psychoanalytic Theory Technique,” J. Amer. Psychoanal. Assoc., 1986, 34: 607–35. For an internal examination of the case, see Rachel Blass, “Did Dora Have an Oedipus Complex?” Psychoanal. Stud. Child, 1992, 47: 159–87.

95. On the issues surrounding the delayed publication of this case, see Decker, Freud, Dora, and Vienna (n. 94), pp. 146–49. I have assumed that the reported dialogue between Freud and Dora and the basic etiologic formulations stemming from that dialogue were written in 1901. I have attempted to make no such assumptions about the assertions and interpretations that are not specifically tied to interchanges reported in the text. Furthermore, I cannot account for the possibility that deletions may have substantially altered the context of events. As Swales has pointed out, a mystery in this regard is the relative unimportance of bisexuality as an etiologic element in the published case: Peter J. Swales, “Freud, Fliess, and Fratricide: The Role of Fliess in Freud’s Conception of Paranoia,” in Sigmund Freud: Critical Assessments, ed. Laurence Spurling (London: Routledge, 1989), p. 320.

96. For a more detailed reading of this case, see George J. Makari, “Dora’s Hysteria and the Maturation of Sigmund Freud’s Theory of Transference,” J. Amer. Psychoanal. Assoc., 1997, 45: 1061–96.

97. Freud, Fragment (n. 94), pp. 26–27.

98. Ibid., p. 28.

99. Ibid., p. 27

100. In this reasoning, Freud was preceded by Henry Maudsley (1835–1918), who argued that insanity caused by self-abuse was frequently heralded by delusions of sexual seduction, and that “patients of this class are apt to make unfounded charges of attempts upon their virtue” (Maudsley, Pathology of the Mind [n. 36], pp. 459–61, quotation on p. 461).

101. Freud, Fragment (n. 94), p. 51. Thumb sucking had been associated in medical discourse with both masturbation and infantile hysteria: see Carter, “Infantile Hysteria” (n. 48), pp. 186–96; Jonathan Gillis, “Bad Habits and Pernicious Results: Thumb Sucking and the Discipline of Late-Nineteenth-Century Paediatrics,” Med. Hist., 1996, 40: 55–73.

102. Freud, Fragment (n. 94), pp. 78–80.

103. Ibid., p. 57.

104. This point has been made by Blass, “Did Dora Have an Oedipus Complex?” (n. 94).

105. In a footnote Freud added that such pathogenic reinforcement of Oedipal love could hypothetically come in three ways: from the spontaneous early appearance of genital sensations, “or as a result of seduction or masturbation” (Freud, Fragment [n. 94], p. 57).

106. Ibid., p. 76.

107. Ibid., pp. 77–78.

108. Ibid., p. 81.

109. Ibid., p. 82.

110. David Lynn, “Freud’s Psychoanalysis of Albert Hirst,” Bull. Hist. Med., 1997, 71: 74.

111. Freud, Three Essays (n. 93), pp. 173–94.

112. Ibid.

113. Sigmund Freud, “Contributions to a Discussion on Masturbation” (1912), Standard Edition, 12: 239–54.

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