ed. It is in the first class of cases
alone that there is a developed sexual perversion. In the cases of the
second class there is a more or less definite sexual intention, but it is
only just conscious, and the emergence of the impulse is due not to its
strength but to the weakness, temporary or permanent, of the higher
inhibiting centers.

Epileptic cases, with loss of consciousness during the act, can only be
regarded as presenting a pseudo-exhibitionism. They should be excluded
altogether. It is undoubtedly true that many cases of real or apparent
exhibitionism occur in epileptics.[62] We must not, however, too hastily
conclude that because these acts occur in epileptics they are necessarily
unconscious acts. Epilepsy frequently occurs on a basis of hereditary
degeneration, and the exhibitionism may be, and not infrequently is, a
stigma of the degeneracy and not an indication of the occurrence of a
minor epileptic fit. When the act of pseudo-exhibitionism is truly
epileptic, it will usually have no psychic sexual content, and it will
certainly be liable to occur under all sorts of circumstances, when the
patient is alone or in a miscellaneous concourse of people. It will be on
a level with the acts of the highly respectable young woman who, at the
conclusion of an attack of _petit mal_, consisting chiefly of a sudden
desire to pass urine, on one occasion lifted up her clothes and urinated
at a public entertainment, so that it was with difficulty her friends
prevented her from being handed over to the police.[63] Such an act is
automatic, unconscious, and involuntary; the spectators are not even
perceived; it cannot be an act of exhibitionism. Whenever, on the other
hand, the place and the time are evidently chosen deliberately,--a quiet
spot, the presence of only one or two young women or children,--it is
difficult to admit that we are in the presence of a fit of epileptic
unconsciousness, even when the subject is known to be epileptic.

Even, however, when we exclude those epileptic pseudo-exhibitionists who,
from the legal point of view, are clearly irresponsible, it must still be
remembered that in every case of exhibitionism there is a high degree of
either mental abnormality on a neuropathic basis, or else of actual
disease. This is true to a greater extent in exhibitionism than in almost
any other form of sexual perversion. No subject of exhibitionism should be
sent to prison without expert medical examination