An Anal Substitute for Genital Masturbation in a Case of Paranoid Schizophrenia

There is apparent a close association in the patient's ideation between his gastrointestinal and his sexual functions, and of the latter, masturbation particularly. Pulling out of public hairs while defæcating is an equivalent to masturbation (masturbation=defæcation). This close relationship between anal and genital functioning is confirmed by the patient's fantasy that what he eats causes erections, and that the anal expulsion of intestinal gas leads to rumors that he is masturbating. People know (projection) that he is masturbating even though genital masturbation has long been inhibited. It would seem that here, as in a case recently reported by Kaufman4, food represents the father whom the patient is trying to incorporate. This incorporation is the source of the patient's high moral code. It enables him to feel that he controls his thoughts, but through a return of the repressed it

leads also to sexuality and nocturnal emissions. The food in its course through the intestines is looked upon as a dangerous foreign body, first as a poisonous food, later as the cause of abdominal pains, gas, and cancer of his intestines. When expelled as flatus, it gives rise to rumors that he is masturbating. In this psychotic process the patient has transformed genital impulses into substitutive anal gratifications. The threat (sex) has extended (regression) from his appendix (penis) to his rectum (anus).