Sex By Prescription: The Startling Truth about Today’s Sex Therapy

In the book, Sex By Prescription: The Startling Truth about Today’s Sex Therapy (amazon or, philosopher and psychiatrist Thomas Szasz writes about his concern over the medicalization of sex. Originally written in 1980 (and republished in 1990 with a new preface), Szasz voices his incredulousness about so-called sex education, sexual surgery, sex therapy, and sex treatment for sex criminals.

For Szasz, just because sex involves bodily organs does not make physicians or psychiatrists sex experts. He writes:

Every educated person knows that if he wants to learn about good eating, he must consult Craig Claiborne, not his gastroenterologist; that doctors teach people how to abstain from eating and drinking, not how to enjoy these “indulgences.” When it comes to sex, however, such common sense vanishes. Everyone now knows that physicians, especially gynecologists and psychiatrists, are experts on sex. When people want to enjoy copulation or masturbation or some other erotic act, they turn to doctors to advise them. This folly rests on the belief that because physicians are knowledgeable about the physiology and pathology of the genital organs, they are experts on the experiencing and enjoying of the erotic passions as well.

Masturbatory Insanity

When reading Szasz, the reader gets a historical perspective on the topic at hand. Szasz looks at how medicine has embraced fashion trends throughout the ages with disastrous results. He tries to point out how medicine is now making similar mistakes. One of the trends he points to is how masturbation used to be considered a dreaded act that would lead to insanity. Volumes of medical literature were written on the subject of how their profession could help cure the self-abuser with various gruesome surgical techniques. The masturbator was thought to be a dangerous person in need of medical help. Physicians even went so far as to castrate the masturbator, lest he drive himself insane.

I’ve included a few links to historical books on the subject. One of them is from the US National Library of Medicine.

Szasz includes an example of a foolish medical treatment from history:

The following excerpt is from a letter to a colleague written by Luther V. Bell ( 1806–1862 ) on October 9 , 1856. Bell was a prominent American psychiatrist and one of the founders of the Association of Medical Superintendents of American Institutions for the Insane (now the American Psychiatric Association).

I have often been consulted as to tying up the spermatic arteries, the vasadeferentia, and the removal of the testes in forms of insanity connected with spermatorrheoa. I have known it done repeatedly. In one case Dr. castrated a clean gone onanist (masturbator) who subsequently rallied, became an active man, and the doctor told me that he never met him that he did not receive his blessing for the great favor he had conferred upon him.

Thankfully, the creative wit of Mark Twain could see through the ridiculousness of these medical treatments. When fear of masturbatory insanity was high, Twain wrote a satirical piece called, Some Thoughts on the Science of Onanism

In 1879 Twain wrote:

Homer, in the second book of the Iliad says with fine enthusiasm, “Give me masturbation or give me death.” Caesar, in his Commentaries, says, “To the lonely it is company; to the forsaken it is a friend; to the aged and to the impotent it is a benefactor. They that are penniless are yet rich, in that they still have this majestic diversion.” In another place this experienced observer has said, “There are times when I prefer it to sodomy.”

Robinson Crusoe says, “I cannot describe what I owe to this gentle art.” Queen Elizabeth said, “It is the bulwark of virginity.” Cetewayo, the Zulu hero, remarked, “A jerk in the hand is worth two in the bush.” The immortal Franklin has said, “Masturbation is the best policy.”


Szasz says that medicine continues to make the same mistakes today in regards to sex, sex therapy, and sex surgery. For example, he thinks that the current medical preoccupation with transsexualism is ridiculous. He supports the right of a person to transform themselves surgically or otherwise but does not view it as a medical condition. He views it as a performative act. In one of his lectures, Szasz surmises:

If an old person wants to have surgery to look young, we do not say he has a condition called trans-chronologicalism. If a poor person wishes to be rich, we do not say the person has a condition called trans-economicalism. Similarly, a man who wishes to be a woman does not suffer from a condition called trans-sexualism.

Szasz is appalled that we have taken sex therapy so far that so-called sex surrogates (prostitutes) are now paid for by health insurance companies and medicare. He points out the folly of making medical students watch pornography in the name of sex education. At the time of the writing of the book, prosecutors were prosecuting individuals for selling pornography while so-called educators were peddling it to medical schools.


The author maintains that not everything in life can be learned through formal education or through so-called experts. Sex is one of the things that cannot be formally taught. He writes:

The relationship between teaching and learning — as we know only too well from personal experience – is much more loose than we like to pretend. Teaching a subject or skill to someone does not mean that he or she will learn it. In fact, being taught something (especially by compulsion) can be a powerful incentive for not learning it. Conversely, many subjects and skills can be learned without the person having to assume the role of student or subject himself to a formal educational process. Moreover, many things cannot be taught at all, or can be taught only in a very general or rudimentary fashion, the student having to acquire and master the skill for himself. This is true, more or less, for a wide range of human activities – from driving a car to playing chess, from speaking or writing well to keeping a neat home. It is especially true for so – called sexual skills.

Thus, to the question “How should people go about obtaining help for their sexual problems?” My answer is: “The same sorts of ways they go about getting help for their religious problems.” In a theological society, people are expected to seek clerical help. In a therapeutic society, they are expected to seek clinical help. In a free society, they could seek help from whomever they wished.

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