Meetings of the New York Psychoanalytic Society

February 13, 1951. SOME PHYSIOLOGICAL ASPECTS OF MASTURBATION. Sydney G. Margolin, M.D.

The concept of autoerotism requires redefinition, re-examination as a neurophysiological reflex mechanism in which no object, other than an immediate reaction to a stimulus, provides a means of instinctual discharge. Autoerotism of this order should be differentiated from masturbation. The spectrum of masturbatory activity ranges from a totally involuntary somatic reaction with a minimum of psychic participation (autoerotism) to one with a minimum of somatic participation and a maximum of psychological activity. A somatic point of view is thus added to the genetic, dynamic, topologic, economic, and structural points of view. Observations of surgical patients throw light on the psychosomatic dynamics and genetics of masturbation. Case material is presented to illustrate how surgical intervention brings about a shift in libido from one position to another, new varieties of sensation being exploited in masturbatory fashion. Patients have been observed to invest surgical apertures (ileostomy) with displacements of oral, anal, or genital strivings. Such erotization is influenced by the helplessness of the patient, his dependency upon the ministrations of another individual in the care and management of the incontinent new 'organ', and by its continuous localized excitation. This permits its investment with deeply repressed, infantile, passive dependent wishes, accompanied by characterological changes. The libidinal investment of such openings remains larval and pregenital and, unlike oral, anal excretory, and genital apertures, appears to undergo no progressive changes in terms of instinctual aims and objects. The exclusion of the genitals that accompanies the new 'psychosexual investment' is not accomplished in the service of defense against guilt at recognizing the sexual significance of the new opening. Genitals are excluded as a consequence of regression to pregenital