Because Freud saw psychosexual development as a linear progression culminating in full genitality, it was inevitable that the genital character was destined to display virtues lacking in the other stages. As the historian of psychoanalysis Nathan G. Hale has observed, the genital character was held up by many analysts as the “norm of human attainment.” The individual who had conquered all other stages to achieve the primacy of the genital phase was able to blend the most useful features of these earlier stages in a harmony of traits; from the oral stage, Abraham wrote of this ideal type, the genital character had retained “ forward-pushing energy; from the anal stage, endurance and perseverance; from sadistic sources [which Freud traced to both the oral and anal phases] the necessary power to carry on the struggle for existence.”32
Reich, like most analysts, came to assert that establishing genital primacy was the only goal of therapy, but he equated this achievement with orgasm (of which his ex-patient, the impotent waiter, remained deprived). He asserted that genital disturbance was the most important symptom of neurosis. “It is quite striking,” Reich wrote in his essay “On Genitality” (1924), that “amongst the twenty-eight male and fourteen female neurotics I have treated, there was not one who did not manifest symptoms of impotence, frigidity, or sexual abstinence. A survey of several other analysts revealed similar findings.”33 Reich thought a wave of genital excitement in orgasm would rupture the stagnant dams of repression he saw in these patients and shortcut the long, slow process of analysis by leading them more quickly to full genitality.
Reich would encourage, indeed teach, his patients to have regular orgasms. When he instructed one of his patients, an elderly woman suffering from a nervous tic that interfered with her breathing, how to masturbate, Reich wrote that her symptom suddenly subsided. He worked with another young man to dissolve the guilt he felt over masturbation, the cause, Reich thought, of his patient’s headaches, nausea, back pains, and absentmindedness. These symptoms apparently cleared up when he discovered complete gratification in the act. (“Guidance of masturbational practices during treatment,” Reich concluded in a 1922 study of several of the eccentric sexual habits of the Ambulatorium’s patients, is “an essential and active therapeutic tool in the hands of the analyst.”)34
Reich persuaded one woman who was in a sexless marriage to have an affair with a young suitor; he seemed to encourage, or at least condone, others’ sleeping with prostitutes. Reich came increasingly to believe that enabling the patient to achieve orgasm was the measure of successful therapy. The process of analysis had troubled Reich because it had no clearly defined goal, and now he felt he’d found the means to the end of resolving neurosis in the orgasm.
Though there was considerable resistance to this theory from other analysts, Reich’s ideas would later position him at the fore-front of the group of younger psychoanalysts. As the second generation of therapists sought to redefine the relationship between the erotic demands of an increasingly liberated youth and the repressive moral pressures that constrained them, Reich’s theory of the orgasm became the defining metaphor for their sexual revolt.
Inducing orgasm to treat hysteria was an ancient cure that went back to the classical Greeks, who thought that an orgasm might reposition the wandering womb from which hysteria took its name. As the historian Rachel Maines has shown in The Technology of Orgasm, “massage to orgasm of female patients was a staple of medical practice among some (but certainly not all) Western physicians from the time of Hippocrates until the 1920s.”35 The treatment, aimed at relieving congestion of the womb, was not without its moral risks; one turn-of-the-century doctor claimed that the task “should be entrusted to those who have ‘clean hands and a pure heart.’ ”36
In 1878 an electro-mechanical vibrator was used at Paris’s Salpêtrière Hospital to treat female hysterics, which introduced a further degree of clinical distance. That year a male doctor at the institution, Desiré Magloire Bourneville, published a three-volume photographic atlas depicting patients suffering from hysteria and epilepsy that contained photos of women in the throes of mechanically stimulated orgasms. One eighteen-year-old patient referred to as “Th.” in Bourneville’s notes is reported to have cried “Oue! Oue!” as she approached climax, before throwing back her head and rocking her torso violently: “Then her body curves into an arc and holds this position for several seconds,” Bourneville wrote. “One then observes some slight movements of the pelvis . . . she raises herself, lies flat again, utters cries of pleasure, laughs, makes several lubricious movements and sinks down on to the vulva and right hip.”37 During her ecstasy Bourneville made detailed physiological notes from his vantage point as the machine’s operator: “La vulve est humide . . . La secretion vaginale est très abondante.”38 From the 1880s, the vibrator became a widely used tool, an essential piece of equipment in many doctors’ offices and sanatoriums, which gave speed and efficiency to a previously manual process. By the 1920s the device began to appear in the first pornographic films, which discredited it somewhat as a purely medical tool.
Freud would have been aware of Bourneville’s innovations when he interned at the Salpêtrière in 1885, as well as the other vibrating helmets and shaking chairs Charcot used to calm his hysterical patients. At one evening reception he attended at the hospital, Freud heard Charcot excitedly telling a colleague that hysteria always had a genital origin (“C’est toujours la chose génitale, toujours! Toujours! Toujours!”), explaining that all neuroses could be traced back to the “marriage bed” (as in the particular case under discussion, which involved an impotent husband).39 Freud wrote that he was “almost paralyzed with astonishment” at the time, the idea was so shocking, and he soon repressed Charcot’s never-published observation.40
When Freud returned to Vienna and established his private practice, he was reminded of Charcot’s controversial remark when his colleague Rudolf Chrobak referred a hysterical patient to him who was still a virgin despite having been married for eighteen years. Chrobak commented sarcastically, “We know only too well what the only prescription is for such cases, but we can’t prescribe it. It is: ‘Penis normalis. Dosim repetatur!’ ”41 At his clinic Freud employed hydrotherapy, electrotherapy, massage, and the Weir-Mitchell rest cure before abandoning these methods in favor of hypnosis. Rachel Maines wonders whether Freud, who claimed a certain expertise when he distinguished the vaginal from the clitoral orgasm (he considered the latter immature and inferior, to the annoyance of many 1960s feminists), ever operated as a “gynaecological masseur.” In Studies on Hysteria Freud wrote of the case of “Elisabeth von R.,” who had an orgasm when he “pressed or pinched” her legs, supposedly to test her response to pain.42
In a letter dated 1893 to his friend and mentor Wilhelm Fliess, Freud noted that nervous illness was frequently a consequence of an abnormal sex life and speculated about a possible cure for neuroses along free-love lines: “The only alternative would be free sexual intercourse between young men and women. Otherwise the alternatives