SOURCE: "Psychiatric Implications of the Kinsey Report," in Sexual Behavior in American Society: An Appraisal of the First Two Kinsey Reports, edited by Jerome Himelhoch and Sylvia Fleis Fava, W. W. Norton & Company, Inc., 1955, pp. 270-93.

This is the report of an investigation of the sexual behavior of nearly 5,300 white American males, between the ages of three and ninety years, from several occupational groups, and from many economic, educational, religious, and social strata from the underworld to the topmost levels of society, from crowded urban and sparsely settled rural areas, and from most national stocks and racial groups except the Negro. Not all of these various sub-groups are represented in sufficiently large numbers to satisfy the exacting statistical standards of the investigators. For this reason their goal is ultimately to secure a record of the sex lives of one hundred thousand human beings. Therefore since this report will be supplemented by later reports both on the male and on the patterns of sexual behavior in the female, it should be looked upon as preliminary and tentative. This is a fact which the popular press has largely overlooked, both in its acclaim and in its criticisms.

The courage, patience, humility, and above all the broad humanity of those who for the last ten years have devoted themselves to this colossal undertaking must command profound respect. It is indicative of their attitude that they have said that they never secured the life history of anyone without ending up with a heightened regard and liking for him. Undoubtedly in this lies the secret of their success in securing the intimate details of the sexual lives of so many people from so many different walks of life. The work has been supported by the National Research Council's Committee for Research in Problems of Sex, by Indiana University, and by grants from the medical division of the Rockefeller Foundation. The result is the most important statistical addition which has ever been made to our information on the incidence in a total population of various patterns of overt sexual behavior; and although several important types of behavior are omitted, the report merits detailed study by everyone who is concerned with human nature.

In addition to its broad general implications, to psychoanalysts the facts which have been assembled will be gratifying as an independent verification of basic psychoanalytic concepts concerning infantile sexuality and the presence of polymorphous sexual impulses in all human beings. Furthermore the variations in sexual mores which occur at different intellectual and cultural levels give valuable information about the development of ego-ideals and of super-ego functions in different strata of our society.

Eye-catching summaries of some of the more startling findings have already appeared in the popular press. Although there is considerable danger that erroneous conclusions may be drawn from these summaries (a danger which will be discussed below), it is to be hoped that there will be repeated presentations of the facts themselves, until they sink deep into the popular mind. Such a summary, however, is not the function of this review. To the technical scientist the details of this study are of such importance that any condensation would do an injustice to the work and would lessen rather than enhance its value. The purpose of this review will be rather to indicate certain attitudes which are implicit in the theoretical approach of the authors which lead them to find erroneous implications in their data, which may in turn mislead the lay reader as well. Precisely because the work itself is continuing, and because the authors will bring out several further reports, it seems to the writer that the most useful function he can perform, and also the highest tribute he can pay to it, is to point out the imperfections of this first report, in the hope that they will be eliminated from those which are still to come.

The chapter on interviewing is a case in point. It can be commended to every young student of psychiatry for its human wisdom and its technical adroitness. Yet it will also be illuminating for its deficiencies: (1) its failure to consider the influence of the various types of transference situation which arise at once in any such intimate interview; (2) its failure to include any guide to the recognition of latent as well as overt trends; (3) the absence of any concern with the varied emotions which must have attended these revelations; and (4) the absence of any preoccupation with either therapeutic or noxious forces which such interviews always set in motion, whether or not the interviewer has any intentions of this kind.

I have already paid tribute to the striking success of the authors in securing sexual histories: yet it would be an over-simplification to think that an ability to win confidences is all that is necessary. Clinical experience shows that the willingness to cooperate can itself be a screen behind which rigid defences may hide. The cultural and personal forces which oppose our facing ourselves or revealing to others the truth about ourselves are very strong: and as a result many who have studied the results of interviews with medical and college students and with nurses as well as with patients, question the validity of data which is derived through the questionnaire type of interview. Some report errors on vital information running as high as 90 per cent. The personality structure of the interviewer and the interviewee and can introduce distortions into this technique of fact gathering. The interviewer's emotional blind-spots may obstruct his vision, and his own emotional needs may lead him to grind axes of which he is unaware: while in the subject all manner of rationalizations, conscious and unconscious guilt feelings, his compensatory needs, and his anxieties influence the data which he gives, no matter how consciously co-operative he may feel. It is for this reason that even in the more dependable non-directive psychiatric interview the information which is obtained at first has to be corrected many times before it can be accepted as factual. The type of interview which is used as the basis for this study must give rise to a fear lest we have here an example of accurate recording of inaccurate data.

With respect to the data itself, there can be no quarrel with the methods of tabulating it. There are, however, various uncertainties concerning its statistical treatment. There seem to be at least three possible sources of error which may tend to exaggerate the statistical summaries with respect to the incidence of deviant patterns:

(a) The inclusion of all early exploratory experiences, as though these were identical in kind with the same behavior when it occurs later in life.

(b) The use of mean deviation and cumulative incidence in drawing conclusions from skew distribution curves.

(c) The neglect of screen memories.

The extent of the errors attributable to these ambiguities is hard to determine with precision; but the nature of each as a potential source of error will be discussed in the course of this review.

In a round-table discussion of Kinsey's book which was held at the School of Medicine at Yale University, Professor Frederick D. Sheffield pointed out that while the sampling methods seem adequate for Dr. Kinsey's purpose, his utilization of his statistical data gives the reader an exaggerated impression of the incidence of orgasm, and particularly of those forms of sexual behavior of which the general public most disapproves. This is seen in Kinsey's highlighting of the mean frequency and of the cumulative incidence curve. In statistical analysis it is well known that with skewed distributions, such as are uniformly found by Dr. Kinsey, the mode always will give the smallest value, the median the next, and the mean the highest value. This is because the mean is pulled up by the relatively few individuals who have very high scores. Therefore the mean does not represent accurately the central tendency of the majority of the group. Furthermore, Kinsey's use of cumulative incidence with age may cause many readers to confuse current with past experiences. Thus the cumulative incidence of one homosexual orgasm in a lifetime will be highest for the middle-aged; whereas the great majority of such isolated homosexual experiences actually occur in the pre-adolescent and adolescent periods, where its significance is fundamentally different.

Another important consideration concerns what we call "screen memories." These are late memories which in various ways may fuse with and obscure or distort the memory of earlier events; or dreams and fantasies which are recalled and reported in good faith as though they had really happened. This source of "false positives" is overlooked throughout this report. Because screen memories may be described unaltered in repeated interviews, the unchanged repetition of a story does not, as the authors assume, establish its validity.

The effects of the failure to take into consideration this source of error is evident throughout the book and gives rise to many inconsistencies. For instance, in the last two paragraphs on page 443 the comments on the extreme sensitivity of the three- and four-year-old to subtle hints of adult attitude towards all bodily and sexual matters might well have been written by a psychoanalyst. Yet the following paragraphs on page 444 describe "experiences" of children with a disregard of all the forces which can distort a child's recollections. Here the analyst would be on the watch for screen memories, for fantasies which had acquired the quality of reality, and for dreams which had become confused with actual occurrences. Therefore the analyst would record as psychic facts but not necessarily as historical facts many reports of early "experiences." This is a distinction which the authors do not make. They attribute to human memory a precision which unfortunately it does not possess. They recognize that we can "forget" but not that we can "misremember." It is impossible to guess at the extent of the error which this may introduce into their statistics, but since screen memories come to light in almost every analysis, the error may be not inconsiderable.

Before going any further, I would like to say that none of the criticisms which I will direct at this report will be aimed at the authors. Like their positive achievements in this work, their mistakes are quite obviously the predictable results of the background of training and experience which they brought to it. Every mistake is a result of their lack of experience with the phenomenology and psychology of illness. It would be wholly unfair to criticize the authors for what they could not be expected to know, but it is harder to excuse those who played an advisory role in the planning of the study for their failure to insist that it be a combined operation, in which all that is known from the study of sick individuals would constantly be used in the evaluation and interpretation of the statistical data on large groups. Avowedly I will use my own experience to point out omissions which have led these workers into avoidable error. Surely other specialists, from other allied fields, could make similar criticisms. It is our hope that such frank criticism will lead to a reorganization of the working team so as to avoid a continuation of past errors as this investigation goes forward.

The theoretical preconceptions which I will challenge concern (1) the concept of normality, (2) the significance of conscious and unconscious psychologic forces in the interpretation of all reported variations, and (3) the concept of sexuality. Furthermore I will plead repeatedly that the work of these investigators should be supplemented by an intensive psychiatric and social study of enough individuals to constitute a statistically adequate random sample of each of the various behavior groups which are recognized in this report. The importance of such an intensive study of individuals, to supplement the broad study of large groups, will be discussed in relation to each specific issue as we come to it.

Let us consider first the authors' concept of normality; and why it is incorrect and misleading to assume, as they do, that because something is widespread in human behavior it must therefore be regarded as "normal." In the first place on purely logical grounds this is demonstrably fallacious. In times of epidemic the common cold may afflict more than 50 per cent of the population. This, however, does not make colds normal. Secondly, and of greater importance, is another point: the fact that the normality or abnormality of any act depends, in its ultimate analysis, upon the relative roles of the conscious and unconscious purposes, of the attainable and unattainable goals which are sought through that act. It is this balance that determines whether any act should be regarded as sick or well.

This implies that a heterosexual act may be quite as neurotic as a homosexual act, and that masturbation or homosexual behavior or other deviations may be either normal or neurotic or (and more often) a mixture of both; and that in each case the normality or abnormality depends upon the nature of the purposes served by the act. This differentiating point between normality and neurosis is of practical as well as theoretical importance; and it will be referred to repeatedly in our discussions of heterosexuality and of homosexuality and all sexual deviations.

Obviously the relative overall incidence of neurotic and normal forces in any one form of deviant sexual behavior as compared to any other can be determined only by a study of many individuals who practice such deviation, and the comparison of their whole psychologic adjustment to life with the adjustment of a majority of those who practice either some other deviation or the biologically useful form of sexual activity. Thus every psychiatrist knows that among homosexuals, as among all other deviants as well, are many individuals who have been able to segregate their problems in their "perversions," just as many individuals with frank neuroses are able to segregate their conflicts in their neurotic symptoms, and are enabled thereby to live socially useful and effective lives. This is not true, however, for most sufferers from neurotic difficulties. In most instances such problems infiltrate subtly into every aspect of life, causing great distress and frustration. Therefore we are not misled into calling a neurotic symptom "normal" either because it may be prevalent, or because some of the individuals who have that particular symptom can live effective and productive lives, whether in spite of the neurotic symptoms or even because of them. Before we can evaluate any symptomatic act we must know first its meaning in terms of the purposes it serves for the individual, and then, from the social point of view, what its meaning is for the lives of the majority of those who exhibit it.

The evaluation of the "normality" of sexual deviations rests on a consideration of the same two questions; and such an evaluation can be made only after statistically adequate and representative samples of individuals who manifest each of the various deviations have been studied intensively for comparison with a statistically adequate sample of all other groups in the community. Certainly no such study has ever been reported, either by these authors or by anyone else. Therefore no generalizations are warranted by anybody. The present study does not include any information which illuminates this problem. Not even gross comparative data are presented as to the general life adjustments found among different types of sexual patterns; e.g., through such external manifestations as income levels for the economic group in which the individual was raised, educational level as compared to his background, social productivity, general community achievements, family adjustments, etc. Therefore as far as the material presented in this study goes, the implication that because homosexuality is prevalent we must accept it as "normal," or as a happy and a healthy way of life, is wholly unwarranted.

The same consideration applies to every other deviation which is described. This point is emphasized here, because the popular press has already given wide and uncritical currency to this misinterpretation of Kinsey's data.

For the education both of these workers and their backers and advisers, Ã will develop the contrasting viewpoint. Everywhere throughout the discussion of bisexuality and of homosexuality there is a failure to understand the essential core of the analyst's concern with this whole problem. A few preliminary theoretical discussions and clinical case presentations would have sufficed to lay a basis of agreement for this aspect of their task. They would have learned that the analyst recognizes that the total goal of human sexual activity is never the orgasm alone. This simple biologic aim is overlaid by many subtle goals of which the individual himself is usually unaware.

Some of these are attainable; some are not. Where the majority are attainable, then the end result of sexual activity is an afterglow of peaceful completion and satiation. Where, however, the unconscious goals are unattainable, then whether orgasm has occurred or not there remains a post-coital state of unsated need, and. sometimes of fear, rage, or depression. This may happen with any form of intercourse or of self-stimulation; and no sexual history which omits subjective data on this, gives an adequate basis for estimating the normality of the sexual adjustment. Furthermore there is some reason to believe that in a particularly large proportion of homosexuals the unconscious goals are unattainable, although this is by no means confined to them.

One consequence of this is a fact which Kinsey recognizes, namely, that the homosexual is always on the prowl, and that it is rarely possible for him to establish enduring relationships. He seems always to be seeking something that cannot be achieved in the simple physical experience with anyone, no matter how complete this may be; and this drives him on constantly to new excesses and to new relationships. Comparable unconscious forces contribute to the occurrence of heterosexual promiscuity and compulsive extramarital affairs. Here again statistical frequency is no evidence of social or psychologic normality.

The psychiatrist is far from believing that homosexuality is in and of itself an index of psychopathology (as Kinsey implies on page 660). It is rather that the psychiatrist recognizes that quite apart from social condemnation there is in the life of most homosexuals this haunting search for something unattainable; and while the psychiatrist recognizes something not dissimilar in all human living, including heterosexuality, this futile search seems to characterize the homosexual to a greater extent. Adequate statistics on this basic issue are lacking; but if the analyst's selected experience is in any way characteristic of the whole group, it would indicate that the role of unconscious and unattainable goals is greater in the homosexual than in the heterosexual adjustment.

I hope that in their future investigations and reports, Kinsey and his co-workers will have a more accurate picture than they have at present of the analytic view of this problem; because such mutual understanding would lead to cooperation in further studies of the same material.

As a further complication the analyst would also point out the fact that not infrequently a man who is living as a homosexual has unconscious heterosexual fantasies, as if his homosexual activity were intended to work a magical change on his own body which would make him capable of becoming heterosexual "like everybody else." This is one of the many paradoxical findings which emerge from any intimate study of the homosexual, and which make it impossible to dismiss homosexual activity casually or to accept it as "normal," merely because it is prevalent. Then we would add the parallel observation that homosexual fantasies may underlie heterosexual activity, as for instance when a man in coitus identifies with the woman and lives out a conscious or unconscious fantasy of being the woman. Obviously the latent content of behavior and experience should not be left out of consideration, in any rounded evaluation of the problem. It is important to determine what intrapsychic forces and what external social pressures determine which conscious and unconscious tendencies will achieve overt expression. This will require full data on latent or unconscious sexual orientation, to correlate with statistics on the incidence of overt forms of sexual activity. This again will require a detailed study of many individuals out of each of the various groups.

Of some interest in this connection is the observation which is recorded on page 630, that the incidence of homosexual activities is highest in that group of men who became adolescent at an early age and who showed the highest incidence of early masturbation and early heterosexual contact and indeed of all forms of sexual activity. This would seem to indicate that in youths whose sexual behavior is most free of restraints the pattern of sexual behavior changes frequently and lacks specific meaning; and that in this group homosexual episodes may be quite accidental, and may mean something quite different from the obligatory homosexuality of later life. In such cases the overflow of uncensored genital interests into homosexual activity may not mean that there is any specific homosexual inclination in the psychologic sense.

It is misleading to include the exploratory genital experiences of early adolescence in the over-all statistics on the incidence of homosexuality. At the turning point between puberty and adolescence, to the boy the genitals of girls are more taboo than are the genitals of other little boys. Another little boy "is just like me—there is no harm in looking at him or touching him." Indeed at that age touching himself seems to the child a far greater sin than to touch someone else. In the child's hierarchy of crime to touch a little girl is worst of all; next is to touch oneself; and least sinful and dangerous is to touch another little boy. During adolescence this series gradually is reversed, so that homosexual contacts gradually come under the heaviest taboos. It is only after this shift has occurred that a homosexual contact becomes evidence of an obligatory or dominant homosexual drive. Therefore to include in statistics on the incidence of homosexuality the mutual explorations which little boys make of one another's bodies is as misleading as it would be to include in statistics on the incidence of alcoholism every child who surreptitiously samples his father's bar. It is a further flaw in the report that the data do not make it possible to determine whether there is any statistical correlation between obligatory homosexual needs in adult years and the incidence of homosexual explorations at various earlier ages.

Similar considerations apply to the significance of sexual relationships with animals. The fact that such contacts are "part of the normal mammalian picture and that such contacts occur in as high a percentage of the population as we have already indicated," as Kinsey points out on page 677, is by no means all that need be said about the problem.

Surely it has a corrective value for Kinsey to challenge any idea that "deviant" or "perverse" sexual behavior is rare, or that any form of sexual activity which is not biologically useful is alien to the nature of the common man; but this does not justify the implication that there are no differences in the relative "normality" of different forms of sexual life, judging normality as we have already indicated in terms of (1) the relative roles of conscious or attainable and of unconscious or unattainable goals; and (2) of the total psychologic make-up and adjustment of the human being.

To emphasize this point it may be well to point to the fact that any experienced psychiatrist and certainly every analyst is aware that many inherently "normal" acts can serve neurotic purposes, as when hard work or handwashing or eating becomes a compulsion. Furthermore all neurotic symptoms, all heterosexual activity, and all perversions can occur in any of a wide variety of psychopathological settings. The patient with a "perversion" may come to a psychiatrist for the treatment not of his sexual pattern but for relief from other symptoms. During the course of any deep exploration of such cases, however, it soon becomes apparent that the neurotic symptoms are closely related to the sexual pattern. This is never, as Dr. Kinsey assumes the psychiatrist to believe, a simple cause-and-effect relationship, but something more intricate. It would represent the psychiatrist's viewpoint more accurately to say that he holds that any obligatory emphasis on any one mode of sexual expression to the exclusion of all others will usually indicate that some underlying neurotic forces are at work; and that the cure of those underlying neurotic forces will automatically and inevitably alter the pattern of sexual expression. Thus the psychiatrist would not consider a woman "normal" even if she is heterosexually and orgastically free, if this can occur only with men she does not love. In fact the analyst cannot accept any form of sexual activity as inherently and inevitably either normal or abnormal. He must always consider the total setting, the play of compulsive and phobic mechanisms, the role of conscious and unconscious guilt and fear, etc. To him the ultimate sign of health is always the degree of psychic freedom from the automatic operation of unconscious mechanisms.

My next major objection concerns Dr. Kinsey's interpretation of the meaning of variations in the amount of sexual activity. About this the analyst will find it impossible to accept the authors' repeated oversimplifications. Thus, as an example, the analyst finds nothing abnormal in eating or in liking to eat a great deal; but when a child is afflicted with an insatiable eating compulsion, which drives the child far beyond his physiologic requirements, the psychiatrist recognizes that a compulsive neurotic mechanism has taken hold of a biologic mechanism and is driving it overtime. He would not leap to the conclusion that such compulsive eating is a true measure of that individual's inherent caloric needs, not even if he continued to be a compulsive eater and to be obese throughout his entire life. The analyst would employ the same reasoning about the quantity of sexual activity. His concern is not with the quantity per se, but with the question of what makes it either great or small. Is it due to a compulsive overdrive or to a phobic inhibition? A man or woman who in spite of full and satisfactory orgasms remains unsatisfied is neurotically ill; just as the child who eats until he vomits is sick. This is not because there is anything either immoral or abnormal in multiple orgasms or in heavy eating; but because in each instance neurotic forces are distorting normal biologic mechanisms.

Because of the neglect of these basic considerations, the weakest section of the report is that which discusses the total sexual outlet. Here the authors make unwarranted deductions concerning the extent to which human beings vary in their inherent constitutional sexual endowments. No psychiatrist would take the position which the authors impute to him, namely that all men and all women are created equal in this respect; but we cannot shut our eyes to the clinical evidence that psychologic forces exercise a profound influence on the quantity of instinctual activity.

For instance, on page 325 the authors point out that those individuals who reach psychologic adolescence late usually delay the start of their sexual activities and maintain a low frequency of sexual activity not only in their early years but throughout the remainder of their lives. This is an important observation; but it does not justify their conclusion: "It is probable that most of these low rating individuals never were capable of higher rates and never could have increased their rates to match those of the more active segments of the population." This of course is an unwarranted assumption. What would these authors say about the patient who under the influence of analysis changes from a faltering rate of sexual intercourse of scarcely once a fortnight or once a month to an active and confident sexual life with intercourse several times a week? This is not an unusual experience in analytic therapy. No psychiatrist would be so rash as to claim on the basis of such experiences that there are no inherent constitutional differences in sexual vigor. But we do not know what percentage of men or women rate low because of constitutional deficiencies, and what percentage because of the inhibiting effects of their conscious and unconscious guilts and fears, or in what percentage both forces are operative. Nor do we know what percentage of those who rate high, do so because of a high constitutional endowment, and what percentage rate high because they are overdriven by compulsive forces which utilize the instinctual endowment for unconscious neurotic purposes.

This problem has much more than academic interest. It is important both as a scientific fact and in relation to our sexual mores. We should not be misled into thinking that our mores are wrong when they fail to meet the needs of those compulsion neuroses which manifest themselves through exaggerated and insatiable sexual activity, any more than we should be misled into thinking that our culture is excellent where it is dictated by neurotic phobias and neurotic guilt. Therefore, it is a matter of importance for human society to determine the range of actual physiologic variation around which the compulsive and phobic mechanisms operate. It does not clarify this point to assume, as this report tends to—not constantly but recurrently, that most of the variations which are encountered arise from physiologic differences,¹ when any experienced psychiatrist knows what tremendous variations in sexual activity can be manifested in any one individual under the influence of depressions and elations, hate and fear, compulsions and phobias, whether these be conscious or unconscious. Here again is where detailed investigation of individuals becomes an absolute necessity.

Even the age at which adolescence occurs is in itself not free from the influence of psychologic factors. Critical endocrinologists describe young women in whom the onset of menstruation is delayed until their neurotic difficulties are relieved, and obese little girls and boys whose sexual maturation is delayed by their compulsive overeating of fatty foods. Many of these would correspond to the type described on page 326; yet with the relief of their psychologic difficulties these youngsters change their food habits, slim down, and pass through a swift maturation, with rapid development of all secondary sexual characteristics. These clinical experiences must be kept in mind as correctives to some of the deductions which Kinsey draws from his statistics. They indicate again how valuable it would be for endocrinologists, internists, taxonomists, and psychiatrists to make a combined study of psychologic and physiologic variants in the processes of pubescence.

The next major blind spot in this study is towards psychiatrists and all clinical and psychologic considerations. Perhaps because these workers are experienced primarily in the biologic rather than the clinical sciences, as they approach this clinical field they attribute to the psychiatrist a degree of naivete which may once have been true of all of us, and which undoubtedly is still true for some of us, but which certainly is not true of the advancing frontiers of modern dynamic psychiatry. Without being unduly defensive, it seems fair to ask that the formal technical presentation of such a work as this should be in terms of the mature forefront of psychiatric thinking and not in terms of that part of the psychiatric column which lags in the rear. Nor, for that matter, are well-trained psychiatric social workers as naive in their theoretical concepts as these authors seem to feel.

I would repeat that my concern is not to defend psychiatrists or social workers; but to eliminate misunderstandings between disciplines which should work together. Many of Kinsey's criticisms are valid with respect to part of the psychiatric profession. They trouble me, however, when they are expressed as part of the authors' general attitude toward psychologic forces which should be given fuller consideration in the interpretation of their data.

At times it almost seems as though the authors are trying to caricature the psychiatrist by attributing to him ideas which are patently absurd;² as, for instance, when they refer to some hypothetical "older psychiatrist" (p. 374) who is supposed to have claimed that for the female to assume the dominant position in coitus will always lead to nervous disturbances and to divorce. It is difficult to believe that any psychiatrist who is representative of the profession holds such an opinion. It would of course be quite legitimate for a psychiatrist to argue that any rigid and obligatory ritual with respect to the position during coitus could indicate a neurotic maladjustment which would inevitably be linked to other neurotic troubles. This quite different interpretation of the same phenomenon is not considered by these authors.

This underestimation of psychologic considerations crops up repeatedly.

On page 523 the fact that adolescents may masturbate without conscious fantasy (or for a year or so before conscious fantasies are permitted to appear), is taken as a measure of the relative role "of the physical and the psychic in the sex life of the human animal." Here as usual the authors fail to appreciate the importance of the role of conscious and unconscious fear and guilt. It takes courage and at least some degree of freedom from incest taboos before a child can allow himself to indulge in conscious sexual fantasy, especially in association with masturbation. To the child the erotic fantasy often seems to be more sinful than the act. Many a child will have sexual fantasies without masturbation on one occasion, and will masturbate without fantasy on another. It may be some years before he will have the courage to synchronize the two, thereby defying the parental image which is embodied in his own conscience. There are important Psychopathologic differences between the child in whom the act is more taboo than the fantasy, and the child in whom the fantasy is more taboo than the act. Without knowledge of the relative roles of act and fantasy, we have only one part of the picture of a child's psychosexual development, and not necessarily the more important part.

Again on page 580 is an example of a failure to include adequate consideration of psychologic forces in the interpretation of their data. Here it concerns premature ejaculations. The authors impute to clinical observers the notion that intense, vigorous, and rapid erotic responses are abnormal. This is patently absurd. Uncontrollability would be significant, however; and particularly if the uncontrollability is associated not with intensity of feeling or sensation but with its absence; and if the rapidity of orgasm has its roots either in profound hostility to women, or in such anxiety that the man has to have his orgasm in a hurry in order to get away as quickly as possible. Here again, the nature of the forces which determine the speed of ejaculation must be determined; and if evidence on this point is lacking one is in no position to judge the nature of the act. Whether there is anything comparable to this in the speedy ejaculation which is sometimes observed in lower animals is something that we have as yet no way of determining. Certainly, however, it is a misinterpretation of the psychiatric viewpoint to say, as the authors do here, that the clinician feels that a man should always be able to control his orgasm until the woman has come to orgasm, no matter how pathologically slow she may be. Such an attitude would be a masochistic distortion of control, which would in its own right invite investigation as to its neurotic determinants.

The chapters on extramarital intercourse and prostitution are marred by the same defects as those on homosexuality and total sexual outlet. They present useful statistical data, but lack adequate psychologic consideration. Here it is particularly important that the activity should be understood in terms both of the conscious and the unconscious goals and their subtle interweaving. It is not the fact of extramarital intercourse but the conscious and unconscious "why" of it which determines whether it is healthy or neurotic. Every analyst knows that monogamous fidelity can sometimes be the result of free, healthy, conscious choice, and at other times an escape from profound neurotic guilt and fear. Similarly extramarital sexual activity can be normally and freely determined, or it can be the product of blind, unconscious hostilities, of unconscious, repetitive needs to test out one's potency, or of unconscious homosexuality. Its prevalence is surely an important fact to establish, but warrants no deductions as to either its individual or social "normality." The authors seem to be oblivious to such considerations.

The discussion of sublimation (pp. 205 to 213 and elsewhere) brings to light several other fallacies in the authors' approach. In the first place a significant bias is revealed, which leads the authors to overlook completely both the existence and the effects of compulsive sexual overdrives, although they acknowledge eagerly the role of neurotic inhibitions in lessening the total amount of sexual outlet. They seem to take the position that while many people limit themselves to less sexual activity than they are capable of, no overactivity should ever be looked upon as in excess of physiologic needs. This bias influences the authors' reasoning in many matters, including the problem of sublimation. Furthermore, in this connection they concern themselves exclusively with the popular misuses of the concept, accepting these as though they were accurate. Indeed nowhere do they give any indication that they themselves understand its precise scientific meaning.

Thus it is obvious that the individuals who suffer from neurotic sexual inhibitions tend to rationalize these on pseudo-moralistic grounds. Similarly others who suffer from compulsive sexual overdrive often attempt to control their compulsions by will power alone. Such efforts can be no more effective than are any efforts to control compulsions by mere self-control. In each case these efforts and rationalizations are often miscalled "sublimation," which has nothing to do with either of these neurotic phenomena. Analysts, on the other hand, are quite aware of the fact that the concept of sublimation is not entirely clear. Its accurate differentiation from symptomformation is uncertain. Therefore, the best that one can say for Kinsey's contribution to the clarification of this problem is that it may stimulate the analyst to clarify his own concepts and terms in this area. In the meantime, no matter how sceptical Kinsey and his co-workers may be about the basic value of the concept, no biologist will find it possible to dispense with it entirely. If biochemical forces are the source of our psychologic activities, then it is self-evident that these biological energies are translated into forms of behavior which are as many and as varied as is human conduct. This is the essence of the concept of sublimation; and the biologist who rejects this is rejecting the biochemical origins of human psychologic processes. Perhaps it will help the authors to clarify their thinking about sublimation in their future work, if they will keep this fact in mind, plus the further fact that sublimation is a name for a process which applies to all basic instinctual energies but not to their phobic or compulsive derivatives.

A similar failure to understand the psychiatric point of view is evident in many other places. For instance, the authors make much of the fact that auto-eroticism is severely condemned at lower cultural levels (p. 375). This certainly is no news to the psychiatrist. More than thirty years ago William Healy in Mental Conflicts and Misconduct pointed out the fact that among juvenile delinquents who were arrested for stealing were many who had been taught at the same time, and often by the same older boy, both to masturbate and to steal. When stirred by erotic impulses these lads would often steal rather than masturbate, because a genital "crime" usually seems far more serious to the child than does the social crime.

This brings up the next important obscurity in the theoretical concepts of these authors. The social crime in such a case carries much of the psychic "energy" of the pubescent sexual need. This raises an important question concerning concepts and terminology. Under such circumstances should the stealing be called a sexual outlet, since it discharges some part of the sexual need? Surely in such a study as this we ought to be clear how we are going to use this word. Should we name a wind by the direction from which it comes or towards which it blows? Which is more useful in dealing with human behavior? This is a question which these authors neither ask nor answer.

On page 498 the same semantic problem is raised concerning the meaning of the word "sexual." For instance, in the discussion of masturbation the authors state that "rubbing or scratching one's body, even one's genitalia, is not masturbation when it serves some other function than that of effecting erotic arousal. Throughout this volume the word has not been applied to anything except deliberate self-stimulation." Since all human activities serve both conscious and unconscious purposes, and since without careful investigation of the individual it is impossible to determine the balance between the two, it should be clear that we cannot draw so hard and fast a line. For instance, genital activity which culminates in orgasm can serve many purposes in addition to simple erotic needs; just as we may eat for many reasons other than the biologic need for food. The complexity of human behavior is such that no instinctual activity serves only its primitive biologic purpose. Therefore it is never easy to make so simple a distinction between sexual and nonsexual data.

This lack of conceptual and terminological clarity about the meaning of the word "sexual" leads the authors into many inconsistencies. They brush aside the analytic emphasis on the sexual nature of many apparently nonsexual activities in children; and then give evidence which conclusively supports the analytic position. For instance, on page 162 they speak of certain types of genital play as "purely exploratory, animated by curiosity, and as devoid of erotic content as boxing, or wrestling, or other non-sexual physical contacts." Later on the same page, when giving a list of the sources of erotic responses among pre-adolescents and younger adolescent boys, boxing and wrestling were specifically mentioned. Their difficulty seems to arise (1) from a failure to recognize the diffusion and overlap of instinctual impulses on the psychologic level, (2) from their failure to recognize the multiple symbolic significance of many such activities, and (3) from their lack of any awareness of how frequently aggressive activities can be used as a mask for subtly disguised erotic impulses, and vice versa. It is unfortunate that these authors who are so superb in their ability to divorce themselves from prejudiced condemnation of all frankly sexual activities are not equally free of bias in their evaluation of the latent sexual significance of many seemingly nonsexual actions.

As further example of this, we would point to the fact mentioned on page 164, that the pre-adolescent boy reacts without discrimination to a wide array of varied emotional situations, whether these seem to be sexual or nonsexual in nature; whereas his sexual response becomes more specific as the years go on. Here Kinsey's own observations give evidence of the early diffuseness of the sources of erotic arousal, and demonstrates the validity of certain fundamental psychoanalytic concepts. This makes all the more perplexing the statement on page 180 that his data "give no support to the Freudian concept of a pre-genital stage of generalized erotic response that precedes more specific genital activity." Here again is a problem which should be explored in detail. What happens to the boys in whom the sexual response does not become more discriminating? In what percentage is this true? What kinds of boys are these? What is the mechanism by which the more sharp discrimination is gradually established? Questions such as these could be answered only by detailed psychiatric and social studies of an adequate statistical sample of various types of individuals. Only out of such studies can come an increase in our knowledge of the genesis of sexual deviations, and of their correlation with normal and pathologic psychology.

There are many other important questions which can be answered only by intensive studies of individuals taken as samples of their various groups. For instance, it would be important to know how often there is an inverse relationship between the early occurrence of nocturnal emissions and early masturbation or early intercourse. In other words, do those individuals who early in life have a sexual outlet through masturbation or through intercourse therefore not need nocturnal emissions? And do those who are too inhibited to masturbate or to have intercourse have nocturnal emissions, simply because this is the only outlet which their unconscious guilts and fears can tolerate? Or do the two go hand in hand? The answer to this has many consequences. If there is such a negative correlation then early intercourse need not necessarily mean a higher charge of sexual energy (i.e., a more highly endowed sexual apparatus) as Kinsey assumes; but may mean merely a less powerful restraint by conscious and/or unconscious guilt and fear. In this connection it is of interest that the breakdown of the data by social and educational and economic levels offers a hint that where intercourse occurs early nocturnal emissions are more rare than where masturbation is the chief early outlet. If this is true, then masturbation would appear to be a less effective "protection" against nocturnal emission than is intercourse; which would indicate that the same psychologic forces which make a youth choose masturbation rather than intercourse leave him in the grip of a considerable conflict, with the result that some part of his sexual need can achieve expression only during sleep, when his psychologic defenses are down.

Because of these various deficiencies the discussion of each of nine different forms of sexual expression which is presented in Part III (Chapters 14 to 22) is the least satisfactory section of the book; precisely because the conscious and unconscious forces which determine the choice of sexual aim and object are never adequately considered. This does not mean that the chapters are devoid of factual material which is of value and interest. But the treatment of the material and the implied deductions as a whole are far less valuable than elsewhere in the book.

We must also point out certain important omissions; such as attitudes towards intercourse during menstruation, attitudes towards genital size, actual data on genital size (both male and female), attitudes towards the size of breasts (both male and female), attitudes towards erection of the nipples, the influence of early or late circumcision, etc.

Similarly there is a great deal of social data which is needed if we are to evaluate the phenomena which have been statistically recorded by Kinsey. We would like to know what is the ordinal position of the subject of the inquiry in his own family, whether he is the oldest, or the youngest, or in between, whether he is an only child; whether he has sisters, and whether these are older or younger; whether he was brought up in a matriarchal or patriarchal family; whether there had been early separation from father or mother; whether the initial experiences were through any process of seduction, etc. In pointing out such omissions, it is only fair to say that some of these data may already be in the possession of the investigators and may appear in later volumes. It is known that this is true about certain anatomical facts. Nevertheless, it is perhaps unfortunate that more of it has not been incorporated into this report where it is relevant.

The attention of psychiatrists will be drawn to the challenge on page 576 to the usually held ideas about vaginal orgasm, a matter which will surely be discussed more fully in the forthcoming reports on female sexuality.

In spite of all these defects, the data on sexual behavior at different social levels will be of great value to everyone who is concerned with the organization of our educational and disciplinary institutions. Especially interesting is the evidence that there has been little significant change in patterns of sexual behavior over the course of at least one generation, in spite of vigorous educational influences, both deliberate and accidental. A more detailed study of the subtle processes by which to such an extraordinary degree sexual patterns are stabilized in various occupational and cultural groups would add greatly to the scientific value of this section.

In addition to the psychologic studies of individual representatives of the various types and patterns of sexual behavior, certain neurophysiologic studies should also be made. It is extraordinary that we have no information on the existence of variations in the innervation of the sacral segments of individuals who manifest different types of overt sexual responsiveness. Thus it would be illuminating to know what differences there may be in the distribution of axonal reflexes throughout the perineum, in the degree of referral of prostatic stimulation to perianal or penile areas, in the precision with which sensations are localized in those areas, in the extent to which sharply defined epicritic or diffuse protopathic sensations dominate. If there is a significant degree of individual variation, such variations could contribute to the choice of patterns of sexual behavior. It is to be hoped that in forthcoming studies of the sexual patterns of women, such physiologic investigations will not be omitted. It would certainly be significant to know whether among women there are differences in vaginal sensitivity and in the supply and distribution of sensory end-organs within the vagina, which might contribute to variations in degree of responsiveness to vaginal stimulation.

Such studies will require a high degree of critique if they are to rule out the influence of psychogenic anesthesia and of conditioning. For instance, if in the sensory examination of an experienced anal pederast, anal and perianal stimulation caused specially intense penile sensations, it would not be safe to jump to the conclusion that this was evidence that there were special reflex pathways. Such a sensory link might equally well depend upon the conditioning effects of that man's experiences in passive anal intercourse. Therefore, although it is important to collect information on constitutional anatomic variations in the distribution of sensory nerves, since such variations might play a role in determining deviations in sexual behavior, nevertheless the interpretation of such neuroanatomic and neurophysiologic findings will have to be made with great care.

SUMMARY

If this report by Dr. Kinsey and his co-workers does no more than present us with incontrovertible statistics concerning the incidence of manifest infantile sexuality and of manifest adult polymorphous sexual tendencies, it will be a major contribution to our understanding of human development and of human culture. Psychiatry and psychology will always be in their debt for this. Nevertheless, two of the basic implications of their report must be rejected. One is that the overt manifestations of sexual patterns are all that we need to know about human sexuality. The other unacceptable implication is that where any behavior pattern is widespread among human beings, it is superfluous to attempt to explain it. The physiologist does not feel that he does not have to explain the mechanism of the heart beat merely because everybody's heart beats. Nor does the epidemiologist dismiss the problem of the common cold merely because everybody catches cold. Universality is not synonymous with normality; and our obligation to explain every variety of sexual activity, whether heterosexual, homosexual, or anything else, is not lessened in any way by the fact that every form of sexual behavior is widespread.

Nevertheless I want to restate my conviction that this report is a significant contribution and that in balance it will undoubtedly do more good than harm in spite of its errors and its exaggerations. Thus, almost all of the statistics on the incidence of various patterns of sexual behavior are probably somewhat excessive, because of errors in sampling, errors in interviewing, and errors in the treatment of the statistics. Furthermore the important role of chronic compulsive inflation of instinctual needs and of their phobic inhibition is scarcely recognized. This oversight is particularly serious in the case of compulsive sexual athleticism, because in the report one finds the implication that we should remake our culture and our laws to conform to "high scores," as though such compulsive exaggerations of sexual need constituted the ideal for all men. This is just as misleading as are the pseudo-moralistic restrictions which are placed on our sexual mores by unrecognized phobic inhibitions. My fear is that the overstatement of Kinsey's case will lessen the effectiveness of the report in freeing our sexual mores and our laws from the domination of neurotic anxiety and neurotic guilt.

Freud related the universality of deviant sexual trends to the development of the neurosis, indicating that it is neither the latent nor the overt trend which in itself produces the neurosis, but rather the conflict between these trends and the intrapsychic forces which oppose them. I believe that it would help to bring into harmony the observations of the biologist and of the psychoanalyst if we could agree that it is never the deviant drive as such which is abnormal, but (1) the conflict which arises around it and (2) the compulsive and obligatory quality which may attach itself to the drive. Thus an obsessional furor can manifest itself in heterosexual activity just as readily as in masturbation or in homosexuality or in any other deviant form of sexual conduct. It is this obsessional furor plus the phobic exclusion of alternative outlets which is the mark of abnormality, rather than the specific pattern of sexual behavior itself.

The failure of Kinsey and his co-authors to give full and consistent consideration to the powerful psychologic forces which influence the objects, the aims, and the quantity of sexual activity is a source of errors in many conclusions which they draw from their data. It would add immensely to the value of all of the observations made by Dr. Kinsey and his co-workers if we could know more about the physiologic and psychologic setting of the various forms of sexual behavior whose incidence they have determined. To this end it would be essential to make intensive individual physiologic, anatomic, psychiatric, and social studies of individuals who would constitute a statistically adequate random sample of each form of sexual behavior. This would give us vital additional information as to their general life adjustments and the ways in which they handle instinctual processes other than sex, particularly those having to do with food and fluid intake, with excretion, with exercise, and with sleep. The addition of such information as this would be of great importance for our understanding of human nature in general and of sexual nature in particular.

I hope that I have succeeded in making several points clear:

(1) We need a detailed study of enough individuals to constitute a statistically adequate sample of each of the many subgroups which are here described.

(2) Dr. Kinsey and his co-workers were wise not to allow themselves to characterize any individual as good or bad, as sick or well, as neurotic, psychotic, or psychopathic. Certainly from the point of view of establishing their contacts and gathering their material this was essential.

(3) On the other hand, from a social and scientific viewpoint the work must not stop at the gathering of this raw material. Not for the purpose of pigeonholing individuals, but in order to learn more about the significance in human life of all variations in patterns of sexual behavior, representative individuals should be studied in great detail so that we may learn more about their personality make-up and general life adjustment. We must know what variations there are in each sexual pattern and what different kinds of people manifest the same or different types of sexual deviations, so as to establish what correlations there may be between such deviations and all other aspects of human nature.

(4) For this purpose it will be essential to bring to this work a mature understanding of fundamental principles of dynamic psychopathology, both conscious and unconscious, latent and overt. This will require the cooperative effort of teams of psychoanalysts, clinical psychologists, neurophysiologists, endocrinologists, cultural anthropologists, and psychiatric social workers, as well as biologic taxonomists. That such a study will present formidable difficulties is evident; but that it is essential is equally true.

NOTES

¹ The authors point out certain quantitative differences in total sexual activity among three educational levels. This indicates that the authors realize the importance of psychologic forces; but they do not always seem to keep this point clearly in mind.

² The only reference to the important problem of incestuous drives, whether overt or latent, is a statement on page 558. This is so fantastically untrue that I almost hesitate to quote it. However, it reads, "There are some psychoanalysts who contend that they never had a patient who has not had incestuous relations." There has never been and never will be any psychoanalyst who has made such a statement; it would be in the interest of scientific progress if the authors will correct this. We expect such distortions from occasional biased and irresponsible ignoramuses, but not from responsible fellow-scientists.