s regards both sexes,
though he admits that masturbation may cause some degree of psychopathic
deterioration. Even in this respect, however, he points out that "when
practiced in moderation it is not injurious in the certain and
exceptionless way in which it is believed to be in many circles. It is the
people whose nervous systems are already injured who masturbate most
easily and practice it more immoderately than others"; the chief source of
its evil is self-reproach and the struggle with the impulse.[326]
Kahlbaum, it is true, under the influence of the older tradition, when he
erected katatonia into a separate disorder (not always accepted in later
times), regarded prolonged and excessive masturbation as a chief cause,
but I am not aware that he ever asserted that it was a sole and sufficient
cause in a healthy organism. Kiernan, one of the earliest writers on
katatonia, was careful to point out that masturbation was probably as much
effect as cause of the morbid nervous condition.[327] Maudsley (in _Body
and Mind_) recognized masturbation as a special exciting cause of a
characteristic form of insanity; but he cautiously added: "Nevertheless, I
think that self-abuse seldom, if ever, produces it without the
co-operation of the insane neurosis."[328] Schuele also recognized a
specific masturbatory insanity, but the general tendency to reject any
such nosological form is becoming marked; Krafft-Ebing long since rejected
it and Naecke decidedly opposes it. Kraepelin states that excessive
masturbation can only occur in a dangerous degree in predisposed
subjects; so, also, Forel and Loewenfeld, as at an earlier period,
Trousseau.[329] It is true that Marro, in his admirable and detailed study
of the normal and abnormal aspects of puberty, accepts a form of
masturbatory insanity; but the only illustrative case he brings forward is
a young man possessing various stigmata of degeneracy and the son of an
alcoholic father; such a case tells us nothing regarding the results of
simple masturbation.[330] Even Spitzka, who maintained several years ago
the traditional views as to the terrible results of masturbation, and
recognized a special "insanity of masturbation," stated his conclusions
with a caution that undermined his position: "Self-abuse," he concluded,
"to become a sole cause of insanity, must be begun early and carried very
far. In persons of sound antecedents it rarely, under these circumstances,
suffices to produce an