looked nor underestimated. We use the word "sexuality" in the same broad sense as the word "love" in the English language. We have also known for a long time that lack of psychic gratification with all its consequences may exist where there is no lack of normal sexual intercourse, and as therapeutists we always remember that only a small proportion of the ungratified sexual strivings whose substitutive gratification in the form of nervous symptoms we are trying to combat, can be done away with through coitus and other sexual acts.
Whoever does not share this conception of psychosexuality has no right to refer to the doctrines of psychoanalysis in which the etiological meaning of sexuality is dealt with. To be sure he has simplified the problem for himself by the exclusive emphasis of the somatic factor of sexuality, but he alone should be responsible for his action.
Still a second and equally serious misunderstanding is obvious from the advice of the physician.
It is true that psychoanalysis specifies that the lack of sexual gratification is the cause of nervous affliction, but does it not say more? Should one leave aside as too complicated the fact that it teaches that nervous symptoms result from a conflict between two forces, a libido (mostly of excessive growth), and an all too strong sexual rejection or repression? Whoever does not forget the second factor, which was not actually assigned to second rank, can never believe that sexual gratification as such is a universally reliable remedy for the complaints of the neurotic. A great many of these persons are incapable of obtaining gratification under the given conditions or under any conditions. If they were capable of it and had they not their inner resistances the force of the impulse would point out the way to gratification, even without the advice of the physician. What then is the use of such advice as the physician ostensibly gave this woman?
Even if it were justified scientifically it would nevertheless be unfeasible for her. If she had no inner resistances against onanism or against an intrigue she would long since, have grasped one of these means. Or does the physician think that a woman of over forty years knows nothing of the possibility of taking a paramour, or does he so greatly overestimate his influence as to believe that without medical approval she could never decide on such a step?
