But cases also occur, in which, with the perverse impulse, there is also sensibility, in a measure, to normal stimuli, and intercourse under normal conditions takes place. In other cases the impotence is not purely psychical, but physical, _i.e._, spinal; for this perversion, like almost all other perversions of the sexual instinct, is developed only on the basis of a psychopathic and, for the most part, hereditarily predisposed individuality; and, as a rule, such individuals give themselves up to excesses, particularly masturbation, to which the difficulty of attaining what their fancy creates, drives them again and again. The number of cases of undoubted masochism thus far observed is very large. Whether masochism occurs associated with normal sexual instincts, or exclusively controls the individual; whether, and to what extent, the individual subject to this perversion strives to realize his peculiar fancies or not; whether he has thus more or less diminished his virility or not,—depends upon the degree of intensity of the perversion in the single case, and upon the strength of the opposing ethical and æsthetic motives, as well as the relative power of the physical and mental organization, of the affected individual. The essential thing, from the psychopathic point of view, and the common element in all these cases, is _the fact that the sexual instinct is directed to ideas of subjugation and abuse by the opposite sex_. What has been said with reference to the impulsive character (indistinctness of motive) of the resulting acts, and with reference to the original (congenital) nature of the perversion in sadism, is also true in masochism. In masochism there is also a gradation of the acts from the most repulsive and monstrous to the silliest, in accordance with the degree of intensity of the perverse instinct, and the power of the remnants of moral and æsthetic motives that oppose it. The ultimate consequences of masochism, however, are opposed by the instinct of self-preservation, and, therefore, murder and serious injury, which may be committed in sadistic excitement, have here, as far as known, no passive equivalent in reality; but the perverse desires of masochistic individuals may, in imagination, attain these extreme consequences (_v. infra_, Case 54). Moreover, the acts to which masochists give themselves up, are performed in some cases in connection with coitus, _i.e._, as preparatory measures; in others, as substitutes for coitus when that is impossible. Here, too, this depends only upon the condition of sexual power, which has been diminished for the most part physically and mentally by the activity of the sexual ideas in the perverse direction, and not upon the nature of the act itself. (_a_) _The Desire for Abuse and Humiliation as a Means of Sexual Satisfaction._—The following detailed autobiography of a masochist, gives an exhaustive description of a typical case of this remarkable perversion:—