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 Margherita Antona
Constantine Stephanidis (Eds.)

Universal Access
in Human-Computer
LNCS 11573

Interaction
Multimodality and Assistive Environments
13th International Conference, UAHCI 2019
Held as Part of the 21st HCI International Conference, HCII 2019
Orlando, FL, USA, July 26–31, 2019, Proceedings, Part II
Lecture Notes in Computer Science 11573
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Margherita Antona Constantine Stephanidis (Eds.)
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Universal Access
in Human-Computer
Interaction
Multimodality and Assistive
Environments
13th International Conference, UAHCI 2019
Held as Part of the 21st HCI International Conference, HCII 2019
Orlando, FL, USA, July 26–31, 2019
Proceedings, Part II

123
Editors
Margherita Antona Constantine Stephanidis
Foundation for Research University of Crete
and Technology – Hellas (FORTH) and Foundation for Research
Heraklion, Crete, Greece and Technology – Hellas (FORTH)
Heraklion, Crete, Greece

ISSN 0302-9743 ISSN 1611-3349 (electronic)

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 Foreword

The 21st International Conference on Human-Computer Interaction, HCI International

2019, was held in Orlando, FL, USA, during July 26–31, 2019. The event incorporated
the 18 thematic areas and affiliated conferences listed on the following page.
A total of 5,029 individuals from academia, research institutes, industry, and
governmental agencies from 73 countries submitted contributions, and 1,274 papers
and 209 posters were included in the pre-conference proceedings. These contributions
address the latest research and development efforts and highlight the human aspects of
design and use of computing systems. The contributions thoroughly cover the entire
field of human-computer interaction, addressing major advances in knowledge and
effective use of computers in a variety of application areas. The volumes constituting
the full set of the pre-conference proceedings are listed in the following pages.
This year the HCI International (HCII) conference introduced the new option of
“late-breaking work.” This applies both for papers and posters and the corresponding
volume(s) of the proceedings will be published just after the conference. Full papers
will be included in the HCII 2019 Late-Breaking Work Papers Proceedings volume
of the proceedings to be published in the Springer LNCS series, while poster extended
abstracts will be included as short papers in the HCII 2019 Late-Breaking Work Poster
Extended Abstracts volume to be published in the Springer CCIS series.
I would like to thank the program board chairs and the members of the program
boards of all thematic areas and affiliated conferences for their contribution to the
highest scientific quality and the overall success of the HCI International 2019
conference.
This conference would not have been possible without the continuous and unwa-
vering support and advice of the founder, Conference General Chair Emeritus and
Conference Scientific Advisor Prof. Gavriel Salvendy. For his outstanding efforts,
I would like to express my appreciation to the communications chair and editor of
HCI International News, Dr. Abbas Moallem.

July 2019 Constantine Stephanidis

 HCI International 2019 Thematic Areas
and Affiliated Conferences

Thematic areas:
• HCI 2019: Human-Computer Interaction
• HIMI 2019: Human Interface and the Management of Information
Affiliated conferences:
• EPCE 2019: 16th International Conference on Engineering Psychology and
Cognitive Ergonomics
• UAHCI 2019: 13th International Conference on Universal Access in
Human-Computer Interaction
• VAMR 2019: 11th International Conference on Virtual, Augmented and Mixed
Reality
• CCD 2019: 11th International Conference on Cross-Cultural Design
• SCSM 2019: 11th International Conference on Social Computing and Social Media
• AC 2019: 13th International Conference on Augmented Cognition
• DHM 2019: 10th International Conference on Digital Human Modeling and
Applications in Health, Safety, Ergonomics and Risk Management
• DUXU 2019: 8th International Conference on Design, User Experience, and
Usability
• DAPI 2019: 7th International Conference on Distributed, Ambient and Pervasive
Interactions
• HCIBGO 2019: 6th International Conference on HCI in Business, Government and
Organizations
• LCT 2019: 6th International Conference on Learning and Collaboration
Technologies
• ITAP 2019: 5th International Conference on Human Aspects of IT for the Aged
Population
• HCI-CPT 2019: First International Conference on HCI for Cybersecurity, Privacy
and Trust
• HCI-Games 2019: First International Conference on HCI in Games
• MobiTAS 2019: First International Conference on HCI in Mobility, Transport, and
Automotive Systems
• AIS 2019: First International Conference on Adaptive Instructional Systems
 Pre-conference Proceedings Volumes Full List

1. LNCS 11566, Human-Computer Interaction: Perspectives on Design (Part I),

edited by Masaaki Kurosu
2. LNCS 11567, Human-Computer Interaction: Recognition and Interaction
Technologies (Part II), edited by Masaaki Kurosu
3. LNCS 11568, Human-Computer Interaction: Design Practice in Contemporary
Societies (Part III), edited by Masaaki Kurosu
4. LNCS 11569, Human Interface and the Management of Information: Visual
Information and Knowledge Management (Part I), edited by Sakae Yamamoto and
Hirohiko Mori
5. LNCS 11570, Human Interface and the Management of Information: Information
in Intelligent Systems (Part II), edited by Sakae Yamamoto and Hirohiko Mori
6. LNAI 11571, Engineering Psychology and Cognitive Ergonomics, edited by Don
Harris
7. LNCS 11572, Universal Access in Human-Computer Interaction: Theory, Methods
and Tools (Part I), edited by Margherita Antona and Constantine Stephanidis
8. LNCS 11573, Universal Access in Human-Computer Interaction: Multimodality
and Assistive Environments (Part II), edited by Margherita Antona and Constantine
Stephanidis
9. LNCS 11574, Virtual, Augmented and Mixed Reality: Multimodal Interaction
(Part I), edited by Jessie Y. C. Chen and Gino Fragomeni
10. LNCS 11575, Virtual, Augmented and Mixed Reality: Applications and Case
Studies (Part II), edited by Jessie Y. C. Chen and Gino Fragomeni
11. LNCS 11576, Cross-Cultural Design: Methods, Tools and User Experience
(Part I), edited by P. L. Patrick Rau
12. LNCS 11577, Cross-Cultural Design: Culture and Society (Part II), edited by
P. L. Patrick Rau
13. LNCS 11578, Social Computing and Social Media: Design, Human Behavior and
Analytics (Part I), edited by Gabriele Meiselwitz
14. LNCS 11579, Social Computing and Social Media: Communication and Social
Communities (Part II), edited by Gabriele Meiselwitz
15. LNAI 11580, Augmented Cognition, edited by Dylan D. Schmorrow and Cali M.
Fidopiastis
16. LNCS 11581, Digital Human Modeling and Applications in Health, Safety,
Ergonomics and Risk Management: Human Body and Motion (Part I), edited by
Vincent G. Duffy
x Pre-conference Proceedings Volumes Full List

17. LNCS 11582, Digital Human Modeling and Applications in Health, Safety,
Ergonomics and Risk Management: Healthcare Applications (Part II), edited by
Vincent G. Duffy
18. LNCS 11583, Design, User Experience, and Usability: Design Philosophy and
Theory (Part I), edited by Aaron Marcus and Wentao Wang
19. LNCS 11584, Design, User Experience, and Usability: User Experience in
Advanced Technological Environments (Part II), edited by Aaron Marcus and
Wentao Wang
20. LNCS 11585, Design, User Experience, and Usability: Application Domains
(Part III), edited by Aaron Marcus and Wentao Wang
21. LNCS 11586, Design, User Experience, and Usability: Practice and Case Studies
(Part IV), edited by Aaron Marcus and Wentao Wang
22. LNCS 11587, Distributed, Ambient and Pervasive Interactions, edited by Norbert
Streitz and Shin’ichi Konomi
23. LNCS 11588, HCI in Business, Government and Organizations: eCommerce and
Consumer Behavior (Part I), edited by Fiona Fui-Hoon Nah and Keng Siau
24. LNCS 11589, HCI in Business, Government and Organizations: Information
Systems and Analytics (Part II), edited by Fiona Fui-Hoon Nah and Keng Siau
25. LNCS 11590, Learning and Collaboration Technologies: Designing Learning
Experiences (Part I), edited by Panayiotis Zaphiris and Andri Ioannou
26. LNCS 11591, Learning and Collaboration Technologies: Ubiquitous and Virtual
Environments for Learning and Collaboration (Part II), edited by Panayiotis
Zaphiris and Andri Ioannou
27. LNCS 11592, Human Aspects of IT for the Aged Population: Design for the
Elderly and Technology Acceptance (Part I), edited by Jia Zhou and Gavriel
Salvendy
28. LNCS 11593, Human Aspects of IT for the Aged Population: Social Media, Games
and Assistive Environments (Part II), edited by Jia Zhou and Gavriel Salvendy
29. LNCS 11594, HCI for Cybersecurity, Privacy and Trust, edited by Abbas Moallem
30. LNCS 11595, HCI in Games, edited by Xiaowen Fang
31. LNCS 11596, HCI in Mobility, Transport, and Automotive Systems, edited by
Heidi Krömker
32. LNCS 11597, Adaptive Instructional Systems, edited by Robert Sottilare and
Jessica Schwarz
33. CCIS 1032, HCI International 2019 - Posters (Part I), edited by Constantine
Stephanidis
 Pre-conference Proceedings Volumes Full List xi

34. CCIS 1033, HCI International 2019 - Posters (Part II), edited by Constantine
Stephanidis
35. CCIS 1034, HCI International 2019 - Posters (Part III), edited by Constantine
Stephanidis

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 13th International Conference on Universal Access
in Human-Computer Interaction (UAHCI 2019)

Program Board Chair(s): Margherita Antona

and Constantine Stephanidis, Greece

• Gisela Susanne Bahr, USA • John Magee, USA

• Armando Barreto, USA • Alessandro Marcengo, Italy
• João Barroso, Portugal • Jorge Martín-Gutiérrez, Spain
• Rodrigo Bonacin, Brazil • Troy McDaniel, USA
• Ingo Bosse, Germany • Silvia Mirri, Italy
• Anthony Lewis Brooks, Denmark • Federica Pallavicini, Italy
• Laura Burzagli, Italy • Ana Isabel Bruzzi Bezerra Paraguay,
• Pedro J. S. Cardoso, Portugal Brazil
• Stefan Carmien, UK • Hugo Paredes, Portugal
• Carlos Duarte, Portugal • Enrico Pontelli, USA
• Pier Luigi Emiliani, Italy • João M. F. Rodrigues, Portugal
• Vagner Figueredo de Santana, Brazil • Frode Eika Sandnes, Norway
• Andrina Granic, Croatia • Jaime Sánchez, Chile
• Gian Maria Greco, Spain • Volker Sorge, UK
• Simeon Keates, UK • Hiroki Takada, Japan
• Georgios Kouroupetroglou, Greece • Kevin C. Tseng, Taiwan
• Patrick M. Langdon, UK • Gerhard Weber, Germany
• Barbara Leporini, Italy • Gian Wild, Australia
• I. Scott MacKenzie, Canada • Ed Youngblood, USA

The full list with the Program Board Chairs and the members of the Program Boards of
all thematic areas and affiliated conferences is available online at:

http://www.hci.international/board-members-2019.php
 HCI International 2020
The 22nd International Conference on Human-Computer Interaction, HCI International
2020, will be held jointly with the affiliated conferences in Copenhagen, Denmark, at
the Bella Center Copenhagen, July 19–24, 2020. It will cover a broad spectrum
of themes related to HCI, including theoretical issues, methods, tools, processes, and
case studies in HCI design, as well as novel interaction techniques, interfaces, and
applications. The proceedings will be published by Springer. More information will be
available on the conference website: http://2020.hci.international/.

General Chair
Prof. Constantine Stephanidis
University of Crete and ICS-FORTH
Heraklion, Crete, Greece
E-mail: [email protected]

http://2020.hci.international/
 Contents – Part II

Cognitive and Learning Disabilities

A Collaborative Talking Assistive Technology for People with Autism

Spectrum Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Wajih Abdallah, Frédéric Vella, Nadine Vigouroux,
Adrien Van den Bossche, and Thierry Val

Usability Enhancement and Functional Extension of a Digital Tool

for Rapid Assessment of Risk for Autism Spectrum Disorders in Toddlers
Based on Pilot Test and Interview Data . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Deeksha Adiani, Michael Schmidt, Joshua Wade, Amy R. Swanson,
Amy Weitlauf, Zachary Warren, and Nilanjan Sarkar

Understanding How ADHD Affects Visual Information Processing . . . . . . . . 23

Yahya Alqahtani, Michael McGuire, Joyram Chakraborty,
and Jinjuan Heidi Feng

Attention Assessment: Evaluation of Facial Expressions of Children

with Autism Spectrum Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Bilikis Banire, Dena Al Thani, Mustapha Makki, Marwa Qaraqe,
Kruthika Anand, Olcay Connor, Kamran Khowaja, and Bilal Mansoor

Improving Usability of a Mobile Application for Children with Autism

Spectrum Disorder Using Heuristic Evaluation . . . . . . . . . . . . . . . . . . . . . . 49
Murilo C. Camargo, Tathia C. P. Carvalho, Rodolfo M. Barros,
Vanessa T. O. Barros, and Matheus Santana

Learning About Autism Using VR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Vanessa Camilleri, Alexiei Dingli, and Foaad Haddod

Breaking Down the “Wall of Text” - Software Tool to Address Complex

Assignments for Students with Attention Disorders . . . . . . . . . . . . . . . . . . . 77
Breanna Desrochers, Ella Tuson, Syed Asad R. Rizvi, and John Magee

Feel Autism VR – Adding Tactile Feedback to a VR Experience . . . . . . . . . 87

Foaad Haddod, Alexiei Dingli, and Luca Bondin

Caregivers’ Influence on Smartphone Usage of People with Cognitive

Disabilities: An Explorative Case Study in Germany . . . . . . . . . . . . . . . . . . 98
Vanessa N. Heitplatz, Christian Bühler, and Matthias R. Hastall
xviii Contents – Part II

The PTC and Boston Children’s Hospital Collaborative AR Experience

for Children with Autism Spectrum Disorder . . . . . . . . . . . . . . . . . . . . . . . 116
David Juhlin, Chris Morris, Peter Schmaltz, Howard Shane,
Ralf Schlosser, Amanda O’Brien, Christina Yu, Drew Mancini,
Anna Allen, and Jennifer Abramson

Design of an Intelligent and Immersive System to Facilitate the Social

Interaction Between Caregivers and Young Children with Autism . . . . . . . . . 123
Guangtao Nie, Akshith Ullal, Amy R. Swanson, Amy S. Weitauf,
Zachary E. Warren, and Nilanjan Sarkar

Taking Neuropsychological Test to the Next Level: Commercial Virtual

Reality Video Games for the Assessment of Executive Functions . . . . . . . . . 133
Federica Pallavicini, Alessandro Pepe, and Maria Eleonora Minissi

Evaluation of Handwriting Skills in Children with Learning Difficulties. . . . . 150

Wanjoo Park, Georgios Korres, Samra Tahir, and Mohamad Eid

“Express Your Feelings”: An Interactive Application for Autistic Patients . . . 160

Prabin Sharma, Mala Deep Upadhaya, Amrit Twanabasu,
Joao Barroso, Salik Ram Khanal, and Hugo Paredes

The Design of an Intelligent LEGO Tutoring System for Improving Social

Communication Skills Among Children with Autism Spectrum Disorder . . . . 172
Qiming Sun and Pinata Winoto

An Augmented Reality-Based Word-Learning Mobile Application

for Children with Autism to Support Learning Anywhere and Anytime:
Object Recognition Based on Deep Learning . . . . . . . . . . . . . . . . . . . . . . . 182
Tiffany Y. Tang, Jiasheng Xu, and Pinata Winoto

Design and Evaluation of Mobile Applications for Augmentative

and Alternative Communication in Minimally-verbal Learners
with Severe Autism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Oliver Wendt, Grayson Bishop, and Ashka Thakar

Multimodal Interaction

Principles for Evaluating Usability in Multimodal Games for People

Who Are Blind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Ticianne Darin, Rossana Andrade, and Jaime Sánchez

A Low Resolution Haptic Interface for Interactive Applications . . . . . . . . . . 224

Bijan Fakhri, Shashank Sharma, Bhavica Soni, Abhik Chowdhury,
Troy McDaniel, and Sethuraman Panchanathan
 Contents – Part II xix

A Fitts’ Law Evaluation of Hands-Free and Hands-On Input

on a Laptop Computer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Mehedi Hassan, John Magee, and I. Scott MacKenzie

A Time-Discrete Haptic Feedback System for Use by Persons

with Lower-Limb Prostheses During Gait. . . . . . . . . . . . . . . . . . . . . . . . . . 250
Gabe Kaplan, Troy McDaniel, James Abbas, Ramin Tadayon,
and Sethuraman Panchanathan

Quali-Quantitative Review of the Use of Multimodal Interfaces

for Cognitive Enhancement in People Who Are Blind . . . . . . . . . . . . . . . . . 262
Lana Mesquita and Jaime Sánchez

Statistical Analysis of Novel and Traditional Orientation Estimates

from an IMU-Instrumented Glove . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Nonnarit O-larnnithipong, Neeranut Ratchatanantakit,
Sudarat Tangnimitchok, Francisco R. Ortega, Armando Barreto,
and Malek Adjouadi

Modeling Human Eye Movement Using Adaptive Neuro-Fuzzy

Inference Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Pedro Ponce, Troy McDaniel, Arturo Molina, and Omar Mata

Creating Weather Narratives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312

Arsénio Reis, Margarida Liberato, Hugo Paredes, Paulo Martins,
and João Barroso

RingBoard 2.0 – A Dynamic Virtual Keyboard Using Smart Vision . . . . . . . 323

Taylor Ripke, Eric O’Sullivan, and Tony Morelli

Introducing Pneumatic Actuators in Haptic Training Simulators

and Medical Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Thibault Sénac, Arnaud Lelevé, Richard Moreau, Minh Tu Pham,
Cyril Novales, Laurence Nouaille, and Pierre Vieyres

ANA: A Natural Language System with Multimodal Interaction

for People Who Have Tetraplegia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Maikon Soares, Lana Mesquita, Francisco Oliveira,
and Liliana Rodrigues

An Investigation of Figure Recognition with Electrostatic Tactile Display . . . 363

Hirobumi Tomita, Shotaro Agatsuma, Ruiyun Wang, Shin Takahashi,
Satoshi Saga, and Hiroyuki Kajimoto

A Survey of the Constraints Encountered in Dynamic Vision-Based

Sign Language Hand Gesture Recognition . . . . . . . . . . . . . . . . . . . . . . . . . 373
Ruth Wario and Casam Nyaga
xx Contents – Part II

Assistive Environments

Quantifying Differences Between Child and Adult Motion Based

on Gait Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Aishat Aloba, Annie Luc, Julia Woodward, Yuzhu Dong, Rong Zhang,
Eakta Jain, and Lisa Anthony

Learning User Preferences via Reinforcement Learning with Spatial

Interface Valuing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Miguel Alonso Jr.

Adaptive Status Arrivals Policy (ASAP) Delivering Fresh Information

(Minimise Peak Age) in Real World Scenarios . . . . . . . . . . . . . . . . . . . . . . 419
Basel Barakat, Simeon Keates, Ian Wassell, and Kamran Arshad

A Feasibility Study of Designing a Family-Caregiver-Centred Dementia

Care Handbook. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Ting-Ya Chang and Kevin C. Tseng

Occupational and Nonwork Stressors Among Female Physicians in Taiwan:

A Single Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Kuang-Ting Cheng and Kevin C. Tseng

Classification of Physical Exercise Intensity Based on Facial Expression

Using Deep Neural Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Salik Ram Khanal, Jaime Sampaio, Joao Barroso, and Vitor Filipe

Effect of Differences in the Meal Ingestion Amount

on the Electrogastrogram Using Non-linear Analysis . . . . . . . . . . . . . . . . . . 468
Fumiya Kinoshita, Kazuya Miyanaga, Kosuke Fujita,
and Hideaki Touyama

MilkyWay: A Toolbox for Prototyping Collaborative Mobile-Based

Interaction Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Mandy Korzetz, Romina Kühn, Karl Kegel, Leon Georgi,
Franz-Wilhelm Schumann, and Thomas Schlegel

@HOME: Exploring the Role of Ambient Computing for Older Adults . . . . . 491
Daria Loi

Designing and Evaluating Technology for the Dependent Elderly

in Their Homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
Maria João Monteiro, Isabel Barroso, Vitor Rodrigues, Salviano Soares,
João Barroso, and Arsénio Reis
 Contents – Part II xxi

Applying Universal Design Principles in Emergency Situations:

An Exploratory Analysis on the Need for Change
in Emergency Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Cristina Paupini and George A. Giannoumis

Digital Volunteers in Disaster Response: Accessibility Challenges. . . . . . . . . 523

Jaziar Radianti and Terje Gjøsæter

The Contribution of Social Networks to the Technological Experience

of Elderly Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538
Célia M. Q. Ramos and João M. F. Rodrigues

Automatic Exercise Assistance for the Elderly Using Real-Time

Adaptation to Performance and Affect . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556
Ramin Tadayon, Antonio Vega Ramirez, Swagata Das,
Yusuke Kishishita, Masataka Yamamoto, and Yuichi Kurita

EEG Systems for Educational Neuroscience . . . . . . . . . . . . . . . . . . . . . . . . 575

Angeliki Tsiara, Tassos Anastasios Mikropoulos, and Panagiota Chalki

A Soft Exoskeleton Jacket with Pneumatic Gel Muscles

for Human Motion Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587
Antonio Vega Ramirez and Yuichi Kurita

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605

 Contents – Part I

Universal Access Theory, Methods and Tools

Beyond Usability: Methodologies and Bias – Surveying the Surveys . . . . . . . 3

Troy D. Abel

A.I. Ethics in the City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Marc Böhlen

Empowering Instead of Hindering – Challenges in Participatory

Development of Cognitively Accessible Software . . . . . . . . . . . . . . . . . . . . 28
Susanne Dirks

Inquiring Evaluation Aspects of Universal Design and Natural Interaction

in Socioenactive Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Andressa Cristina dos Santos, Vanessa Regina Margareth Lima Maike,
Yusseli Lizeth Méndez Mendoza, José Valderlei da Silva,
Rodrigo Bonacin, Julio Cesar Dos Reis,
and Maria Cecília Calani Baranauskas

Expectations and Concerns Emerging from Experiences with Assistive

Technology for ALS Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Cornelia Eicher, Jörn Kiselev, Kirsten Brukamp, Diana Kiemel,
Susanne Spittel, André Maier, Ursula Oleimeulen, and Marius Greuèl

Teaching Empathy in Underserved Audiences Through Game

Based Learning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
John Gialanella and Kimberly Mitchell

From UX to Engagement: Connecting Theory and Practice,

Addressing Ethics and Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Ole Goethe, Kavous Salehzadeh Niksirat, Ilyena Hirskyj-Douglas,
Huatong Sun, Effie L.-C. Law, and Xiangshi Ren

Universal Access: The Challenges Ahead . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Simeon Keates

Achieving Inclusion with Contextualized User-Sensitive Design . . . . . . . . . . 113

Fang Li and Hua Dong

A Disability-Oriented Analysis Procedure for Leisure Rehabilitation

Product Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Ming-Chyuan Lin, Guo-Peng Qui, Xue Hua Zhou, and Jing Chen
xxiv Contents – Part I

Getting Smarter About Data and Access in Smart Cities . . . . . . . . . . . . . . . 146

H. Patricia McKenna

Initiation to Reverse Engineering by Using Activities Based on

Photogrammetry as New Teaching Method in University Technical Studies . . . 159
Dolores Parras-Burgos, Daniel G. Fernández-Pacheco,
Francisco Cavas-Martínez, José Nieto, and Francisco J. F. Cañavate

Disrupting Higher Education: Engaging Design Students in UX Processes

to Enhance Innovation in Higher Education . . . . . . . . . . . . . . . . . . . . . . . . 177
Debra Satterfield, Tom Tredway, and Wesley Woelfel

Novel Approaches to Accessibility

Guideline Definition for the Evaluation of Citizen Experience Using

Urban Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Luis Carlos Aceves Gutiérrez, Jorge Martín-Gutiérrez,
and Marta Sylvia del Rio Guerra

Preliminary Findings from a Study of an Arabic Accessibility

Tool Checker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Mona Alnahari and Joyram Chakraborty

Information Technology Based Usable Ballot Interface Design

for Persons with Visual Impairment in Sri Lanka . . . . . . . . . . . . . . . . . . . . 211
Madhuka De Silva, Thushani Weerasinghe, and Kapila Dias

User Test Logger: An Open Source Browser Plugin for Logging

and Reporting Local User Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Vagner Figueredo de Santana and Felipe Eduardo Ferreira Silva

Research on Wearable Shopping Aid Device for Visually Impaired People. . . 244
Yu-Hsiu Hung, Chia-Hui Feng, Chia-Tzu Lin, and Chung-Jen Chen

Design and Evaluation of a User-Interface for Authoring Sentences

of American Sign Language Animation . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Abhishek Kannekanti, Sedeeq Al-khazraji, and Matt Huenerfauth

Accessibility or Usability of the User Interfaces for Visually Impaired

Users? A Comparative Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Kamran Khowaja, Dena Al-Thani, Aboubakr Aqle, and Bilikis Banire

Reflections on Elements of a Game Design Model Applied to Inclusive

Digital Games. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Patricia da Silva Leite, Ana Paula Retore,
and Leonelo Dell Anhol Almeida
 Contents – Part I xxv

Teaching Video Game Design Accessibility: Toward Effective

Pedagogic Interventions in Accessible Design . . . . . . . . . . . . . . . . . . . . . . . 301
Laura Levy and Maribeth Gandy

An Investigation on Sharing Economy Mobile Service Adoption:

How Perceived Risk, Value, and Price Interact? . . . . . . . . . . . . . . . . . . . . . 312
Shu-Ping Lin and Ya-Hui Chan

The Promotion of Empathy for the Experience of Users with Visual

Impairment in the Game Design Education. . . . . . . . . . . . . . . . . . . . . . . . . 326
Isabel Cristina Siqueira da Silva

Perceivability of Map Information for Disaster Situations for People

with Low Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Siv Tunold, Jaziar Radianti, Terje Gjøsæter, and Weiqin Chen

Multi-faceted Approach to Computer Simplification via Personalization

and Layering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Gregg C. Vanderheiden and J. Bern Jordan

On Online Banking Authentication for All: A Comparison of BankID Login

Efficiency Using Smartphones Versus Code Generators . . . . . . . . . . . . . . . . 365
Ellen Opsahl Vinbæk, Frida Margrethe Borge Pettersen,
Jonas Ege Carlsen, Karl Fremstad, Nikolai Edvinsen,
and Frode Eika Sandnes

Universal Access to Learning and Education

Audiovisual Design for Generative Systems: A Customized

Audiovisual Experiment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Valdecir Becker, Rafael M. Toscano, Helder Bruno A. M. de Souza,
and Edvaldo de Vasconcelos

How to Design an Intervention to Raise Digital Competences:

ALL DIGITAL Week – Dortmund 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Manuela Becker, Alexandra Benner, Katrin Borg, Jan Hüls,
Marina Koch, Annika Kost, Annabelle Korn, Marie-Christin Lueg,
Dominique Osthoff, Bastian Pelka, Carina Rosenberger,
and Helene Sattler

3D Interaction for Computer Science Educational VR Game . . . . . . . . . . . . 408

Santiago Bolivar, Daniel Perez, Armando Carrasquillo,
Adam S. Williams, Naphtali D. Rishe, and Francisco R. Ortega
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xxvi Contents – Part I

A Flexible Assessment Platform for Middle School Supported

on Students Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Pedro J. S. Cardoso, Roberto Lam, Rui Penha Pereira, Nuno Rodrigues,
and Cláudia Herdeiro

A Delphi Study on the Design of Digital Educational Games . . . . . . . . . . . . 433

Panagiota Chalki, Tassos Anastasios Mikropoulos, and Angeliki Tsiara

Visualizing Student Interactions to Support Instructors in Virtual

Learning Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
André Luiz de Brandão Damasceno, Dalai dos Santos Ribeiro,
and Simone Diniz Junqueira Barbosa

A Place to Discover, Imagine, and Change: Smart Learning

with Local Places . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Dalit Levy, Yuval Shafriri, and Yael Alef

A Learning Management System Accessible for Visual, Hearing

and Physical Impairments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Marcos Nascimento, Thiago Oliveira, Nelson Lima, Renato Ramos,
Lidiane Silva, Francisco Oliveira, and Anarosa Brandão

Expressing the Personality of a Humanoid Robot as a Talking Partner

in an Elementary School Classroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Reika Omokawa, Makoto Kobayashi, and Shu Matsuura

Evaluation of User-Interface Designs for Educational Feedback

Software for ASL Students. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Utsav Shah, Matthew Seita, and Matt Huenerfauth

HCI Methods and Practices for Audiovisual Systems and Their

Potential Contribution to Universal Design for Learning:
A Systematic Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Rafael M. Toscano, Helder Bruno A. M. de Souza,
Sandro G. da Silva Filho, Jaqueline D. Noleto, and Valdecir Becker

Virtual and Augmented Reality in Universal Access

Analysis of Biofeedback Through Heartbeat Obtained by Exposure

to Phobia Through Virtual Reality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Edvaldo de Vasconcelos, Amaro Neto, Lillian dos Santos,
and Paula Ribeiro

Using Digital Puppetry to Prepare Physicians to Address Non-suicidal

Self-injury Among Teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Kathleen Ingraham, Charles E. Hughes, Lindsay A. Taliaferro,
Nicholas J. Westers, Lisa Dieker, and Michael Hynes
 Contents – Part I xxvii

Using Virtual Reality to Create an Inclusive Virtual

Drumming Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
Jacob Jewel and Tony Morelli

Visual Issues on Augmented Reality Using Smart Glasses

with 3D Stereoscopic Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
Masaru Miyao, Masumi Takada, and Hiroki Takada

Automation of Box and Block Test in Virtual Reality

and Augmented Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590
Kouki Nagamune and Yujiro Tsuzuki

Exploration of Physiological Signals Using Different Locomotion

Techniques in a VR Adventure Game . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601
Stanislava Rangelova, Simon Flutura, Tobias Huber, Daniel Motus,
and Elisabeth André

Editor of O & M Virtual Environments for the Training of People

with Visual Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
Agebson Rocha Façanha, Windson Viana, and Jaime Sánchez

AR Contents Superimposition on Walls and Persons . . . . . . . . . . . . . . . . . . 628

João M. F. Rodrigues, Ricardo J. M. Veiga, Roman Bajireanu,
Roberto Lam, Pedro J. S. Cardoso, and Paulo Bica

Gaming Background Influence on VR Performance and Comfort:

A Study Using Different Navigation Metaphors . . . . . . . . . . . . . . . . . . . . . 646
Jose L. Soler-Dominguez, Carla De-Juan-Ripoll, Jorge D. Camba,
Manuel Contero, and Mariano Alcañiz

Changes in Eye Movements and Body Sway While Viewing

Stereoscopic Movies Under Controlled Consciousness . . . . . . . . . . . . . . . . . 657
Akihiro Sugiura, Kunihiko Tanaka, and Hiroki Takada

Effects of Low/High-Definition Stereoscopic Video Clips on the

Equilibrium Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669
Masumi Takada, Syota Yamamoto, Masaru Miyao, and Hiroki Takada

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683

Cognitive and Learning Disabilities
 A Collaborative Talking Assistive Technology
for People with Autism Spectrum Disorders

Wajih Abdallah1, Frédéric Vella1, Nadine Vigouroux1(&),

Adrien Van den Bossche2, and Thierry Val2
1
IRIT, UMR CNRS 5505, CNRS Université Paul Sabatier, Toulouse, France
{Wajih.Abdallah,Frederic.Vella,
Nadine.Vigouroux}@irit.fr
2
IRIT, UMR CNRS 5505, Université Jean Jaurès, Toulouse, France
{adrien.vandenbo,thierry.val}@univ-tlse2.fr

Abstract. Autism spectrum disorders (ASD) are characterized by difficulties of

socialization, disorders of verbal communication, restricted and stereotyped
patterns of behaviors. Firstly, the paper reports tools of the user-centered design
(UCD) used as well participants involved in the design of interactive collabo-
rative system for children with ASD. Then, we describe the UCD deployed to
design a vocal communication tool (VCT) between an adult with ASD and his
family caregivers. The analyses of interviews demonstrate a strong need for a
collaborative assistive technology based on voice interaction to avoid the family
caregivers repeating the same sentences to the adult with ASD and, to create a
friendly atmosphere at home. Observations in a real life environment demon-
strate that the VCT is useful and accepted by the adult with ASD and his family.
The work is not complete and issues such as designing a spoken dialogue system
in the smart home need further works. The study of the type of voice synthesis
(human or text-to-speech synthesis) is also an open question.

Keywords: User-centered design
Assistive technology

Autism spectrum disorders

1 Introduction

The term “autism” was introduced by the Swiss psychiatrist Bleuler in 1911 to des-
ignate people who are schizophrenic folded on themselves, disconnected from reality
and excluded from all social life [1].
Autism spectrum disorders are characterized by a triad of impairments [2]: diffi-
culties of socialization, disorders of verbal communication, restricted and stereotyped
patterns of behaviors and interests. Firstly, people with ASD suffer from qualitative
alterations of social interactions. These disorders are not a lack of interest or willing-
ness on the part of the family to help the person with autistic disorder, but a problem of
social skill that prevents him interacting with them. Most people with autism also suffer
from communication disorders and these difficulties appear in very different ways.
People with autism also exhibit stereotyped and repetitive behaviors. This autism
characteristic intervenes differently according to the age or the cognitive abilities of

© Springer Nature Switzerland AG 2019

M. Antona and C. Stephanidis (Eds.): HCII 2019, LNCS 11573, pp. 3–12, 2019.
https://doi.org/10.1007/978-3-030-23563-5_1
4 W. Abdallah et al.

people. In this regard, stereotyped body movements or stereo-typical use of objects are
more frequently observed.
There are a lot of assistive technologies (AT) devices for children and adults with
autism. Putnam et al. [3] have reported on results to elucidate information about
software and technology use according domain (education, communication, social
skills, therapeutic, entertainment and scheduling) were 31 applications out of 45 are
dedicated to the education domain and designed for the personal computer. They also
suggested considering sensory integration issues by allowing users to set colors and
sounds as design consideration. This study shows that there are few assistive devices to
help the family caregivers to help them for activities of daily living. To fill these gaps,
we have designed a collaborative voice communication tool (VCT) between an adult
with ASD and his or her family by implementing a user-centered design method.
In this paper, we first present the user-centered design tools to design assistive
system for people with ASD. Next, the needs and the use context extracted from
interviews of family caregivers will be reported as well as the different versions of the
prototype. Then lessons from real use observation of VCT will be discussed. Finally,
perspectives of this study will be described.

2 The User-Centered Design Implemented for ASD

According to ISO 9241-210 [4], the user-centered design is defined as follows

“Human-centred design is an approach to interactive systems development that aims to
make systems usable and useful by focusing on the users, their needs and requirements,
and by applying human factors/ergonomics, and usability knowledge and techniques”.
The purpose of the UCD is to respond to better to user needs, is an iterative process
as shown in Fig. 1.

Fig. 1. Diagram of the user-centered design cycle according to ISO 13407 [5].
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 “Just the same do we find it at the time of the Italian renascence and at the
time of the Hohenstaufen dynasty—a complete confusion of sexual relationships.
The eighteenth century, also, notwithstanding all the justified jeremiads of
Rousseau regarding the widespread unnaturalness of the time, and
notwithstanding all the sorrows of the young Werther, was distinguished by the
production of an incredible abundance of men of genius; and in contemporary
France, the country which was most severely affected by this moral decay, there
flourished the generation to which such men as Mirabeau and Napoleon belonged
—men whose unparalleled vitality influences us to this moment.”

Finally, I must refer to two leading authors of recent years, Eli

Metchnikoff and Georg Hirth, whose writings exhibit a remarkable
similarity in respect of general philosophical foundation. Both have
energetically opposed the unfounded fantasies of degeneration
(there exists also a justified campaign against the continuously
effective causes of degeneration in the form of alcohol, syphilis,
etc.), and both have advocated a belief in life and in the life-force.
In his work “The Nature of Man” (English translation by Chalmers
Mitchell; Heinemann, 1903), Metchnikoff advances an “optimistic
philosophy,” in opposition to the pessimistic degenerative theory of
our time, of which latter P. J. Möbius may be regarded as the chief
advocate, and he proves how the imperfections and “disharmonies”
of the human organism may give place to a further development and
perfectibility of human nature, and this precisely in connexion
with culture and civilization. It is now that humanity first
begins really to live.[468] Mankind has not degenerated in
consequence of civilization, but has, on the contrary, by means of
civilization, first attained the possibility of establishing “physiological
old age” and “physiological death.” Our device is not backwards,
but forwards! The pessimists cry out: “Existence has no meaning!
For what purpose do we live, and for what purpose do we die?” This
dreadful “for what purpose” with which Friedrich von Hellwald
concludes his history of civilization, disturbs day by day emotional
minds. Metchnikoff proves that this problem is connected with the
existence of the disharmonies of human nature. But evolution
continues to transform these disharmonies into harmonies
(“orthobiosis”). Thus the aim of human existence lies in “the
completion of the entire physiological cycle of life with a normal old
age, so that, with the cessation of the instinct to live, and with the
appearance of the instinct for natural death, the cycle comes to an
end.” This is, to a certain extent, the scientific formulation of the
“superman” of Nietzsche, who based upon quite similar
considerations his opposition to the hypothesis of degeneration, and
who, out of the disharmonies, imperfections, and pains of life, also
created the conviction of a progressive evolution, and thus, like
Metchnikoff, thoroughly affirmed life. Metchnikoff’s ideal human
being of the future is realizable, but only by means of the principles
of science and intelligent culture.
Similar views to those of Metchnikoff are advanced by Georg Hirth.
He, above all, has introduced into science the most felicitous
conception of “hereditary enfranchisement.”[469] Thus to the
pessimistic degeneration theories and the psychical paralysis evoked
by the idea of “hereditary taint” (we now hear the expression from
every mouth), Hirth opposes a word of power, a word expressing
“an energetic opposing stream of tendency.” Thus the incontestable
fact finds simple expression, that
“The requirements of all individuals through millions of generations constitute
an inalienable, progressively influential common possession of the
whole of humanity, an impulsive force based upon natural law, which
marches victoriously forward over the sins and failures of individuals.... That is to
say, that in our entire organism, so long as it continues to live, in addition to the
disturbing influences which we have inherited or have acquired by our own faults,
there exists also a mass of old and new constructive influences, which work
towards the restitution of the former condition.... Enfranchisement by
means of primevally old, healthy, and strong reproductive cells is stronger than the
quite recent tainting by means of weakly and diseased germs. If it were not so,
the entire human race would long since have passed away, for there can hardly
exist a single family tree at the foot of which there are not somewhere worms
gnawing.”

I cannot here examine more closely the extremely interesting

foundation of this view, which rightly places in the foreground the
capacity for self-regeneration, for the removal of morbid vital
stimuli, and their replacement by new and healthy vital stimuli, and
which notably limits the extension of hereditary “tainting.” The
conclusion which Hirth draws from this view is identical with that of
Metchnikoff—namely, that our life remains capable of upward
progress, a view which Hirth everywhere happily employs in his
battle “with the forces of obscurity and degeneration.”
The theory of degeneration finds a thorough scientific refutation
also in the admirable work by Dr. William Hirsch, “Genius and
Degeneration: a Psychological Study” (Berlin and Leipzig, 1904). At
the end of the book (p. 340) the writer says:
“In view of the investigations I have made, we are necessarily led to the
conclusion that the authors mentioned have by no means adduced proof of a
general degeneration of the civilized nations. Humanity need not be alarmed with
regard to the alleged ‘black plague of degeneration,’ and the world need be as
little concerned by these fables of the ‘twilight of the nations’ as by Herr Falb’s
prophecies of the approaching destruction of our planet.”

It cannot be denied that the wide diffusion of the deleterious

means of sensual gratification (alcohol, tobacco, etc.), the increase
in the number of large towns, and the rapid growth in their
population, by means of which prostitution and the spread of
venereal diseases are especially favoured, constitute important
etiological factors for the degeneration of the race. Still, the wide
diffusion of public hygiene, which is more and more brought under
the notice of the individual, affords here an effective counterpoise.
“Enfranchisement” in Hirth’s sense is here clearly manifested.
After we have seen that the “degeneration” of our time, to the
medical idea of which we shall return to speak more exactly in the
next chapter, is not greater now than it was in earlier epochs, and
that sexual anomalies have always existed, let us return to consider
this point, to the anthropological view of psychopathia sexualis.
In my “Etiology of Psychopathia Sexualis” I have collected the
general human phenomena of the sexual impulse in primitive and
civilized states—that is, the everywhere recurring fundamental
lineaments and phenomena of the vita sexualis peculiar to the genus
homo as such.
 As the principal result of this inquiry, the following propositions
appear to me to be established:
Degeneration cannot be employed, as von Krafft-Ebing
has employed it in his “Psychopathia Sexualis,” as a
heuristic principle in the investigation, recognition, and
judgment of sexual aberrations and perversions.
At the most, degeneration is no more than a favouring factor of
the diffusion of sexual abnormalities, an influence which increases
the frequency of their appearance.
On the contrary, the ultimate cause of all sexual
perversions, aberrations, abnormalities, and irrationalities,
is the need for variety in sexual relationships peculiar to the
genus homo, which is to be regarded as a physiological
phenomenon, and the increase of which to the degree of a
sexual irritable hunger is competent to produce the most
severe sexual perversions.
In contrast with this, “degeneration” or diseases play only a
subordinate part, and can be invoked for the explanation of only a
small number of sexual aberrations—at most for those which come
to the notice of physicians on account of pathological conditions or
in foro. In fact, the majority of cases of sexual perversions which
come the way of the physicians in clinical or forensic relationships
are pathological, but these constitute only a minority of all cases.
The large majority of cases do not come within the scope of
degeneration.[470]
Freud, in his “Three Essays on the Sexual Theory,” recognizes the
justice of my view, and on p. 80 he writes:
“Physicians who have first studied perversions in well-marked examples and
peculiar conditions are naturally inclined to regard them as signs of disease or as
stigmata of degeneration, just as in the case of sexual inversion. Daily experience
has shown that the majority of these transgressions—at any rate, the less marked
of them—constitute a seldom lacking constituent of the sexual life of healthy
persons. In favourable conditions the normal individual may exhibit such a
perversion for a considerable length of time in the place of his normal
sexual activity; or the perversion may take its place beside the normal
sexual activity. Probably there is no healthy person in whom there does
not exist, at some time or other, some kind of supplement to his normal
sexual activity, to which we should be justified in giving the name of
‘perversity.’”[471]

A second important factor in the genesis of sexual anomalies is

the ease with which the sexual impulse is affected by
external influences, the associative inclusion of manifold
external stimuli in sexual perception itself, the “synæsthetic
stimuli,” as I myself have called them, in the amatory life of
mankind. In this way gradually all the relations of art, religion,
fashion, etc., to sexuality have developed, and they offer, in
conjunction with the sensory impressions and the psychical and
physical imaginative associations which accompany the sexual act,
an incredibly rich material for the manifold realizations of the sexual
need for variation.
The need for variety in sexual relationships, in conjunction with
the sexual “demand for stimulation” (Hoche),[472] plays a great part,
especially in the occurrence of sexual perversions in adult persons
and at a more advanced age of life. The effect of external
influences is most clearly noticeable in childhood, when it is
experienced most deeply and in a most enduring manner, and when
it can become permanently associated with sexual perception (Binet
and von Schrenck-Notzing).
Alexander von Humboldt, in his “Cosmos” (vol. ii., Introduction),
drew attention to the well-known experience that “sensual
impressions and apparently chance occurrences are, in the
case of youthful emotional individuals, often capable of
determining the entire course of a human life.” Freud draws
attention to the psychological fact that impressions of childhood,
which have apparently been forgotten, may, notwithstanding, have
left the most profound marks upon our psychical life, and may have
determined our entire subsequent development. The impressions of
childhood are often incorporated fate. For this reason, for example,
the children of criminals become criminals themselves, not because
they are “born” criminals, but because, as children, they grow up in
the atmosphere of crime, and the impressions they here receive
become firmly and deeply rooted in their natures. Hence the
campaign against crime must in the first place take into
consideration the education of the children of criminals!
From the need for variety in sexual relationships, and from the
effect of external influences, we deduce the possibility and the
actual frequency of the acquirement and the artificial
production of sexual perversions and perversities; and these, in
proportion to the intensity of the sexual impulse (very variable in
strength in different individuals, according to the ease with which it
is excited), will appear now earlier, now later, will be now transient
and now enduring.
The third important etiological factor in the origination of sexual
perversions is the frequent repetition of the same sexual
aberration. There can be no doubt whatever that the normal human
being can become accustomed to the most diverse sexual
aberrations, so that these become perversions, which appear in
healthy human beings just as they do in the diseased.
Fourthly, suggestion and imitation play an extremely
important r?e in the vita sexualis alike of primitive and of civilized
nations, in accordance with which certain aberrations in the sexual
sphere become diffused with great rapidity, and make their
appearance as customs, fashions, and psychical epidemics. Those
who everywhere trace perversities from morbid rudiments
underestimate the powerful influence which example and
seduction exercise in the human sexual life. This is especially
noticeable to-day in those sexual perversions which have become
national customs. The most celebrated example is that of
Hellenic pæderasty, reputedly introduced from Crete, but
probably in the first place originated by a few genuinely
homosexual individuals, who in their own interest transmitted
artificially by suggestion their peculiar tendencies to a few
heterosexual individuals, until at last the love of boys became a
national custom which every heterosexual man adopted. The
momentous part which modern prostitution, and more especially
brothels, plays in the suggestion of perversions has already been
mentioned. It is a matter to which we shall frequently have occasion
to return. Schrank alludes (“Prostitution in Vienna,” vol. i., p. 285) to
a prostitute who enjoyed a “European reputation” as an artist in
sexual perversities of every kind, and who enjoyed the nickname of
“the Ever-Virgin,” because she allowed men every possible kind of
enjoyment except that of regular normal intercourse (which she
avoided for fear of becoming impregnated).
Fifthly, the difference between man and woman in the essence,
the kind, and the intensity, of sexual perception (sexual activity in
man, sexual passivity in woman) constitutes a rich source of sexual
aberrations, most of which belong to the provinces of masochism
and sadism.
Sixthly, and lastly, in otherwise healthy individuals there
occur at a very early age, and probably in consequence of
congenital conditions, changes in the direction and the aim of
sexual perception, variations from the type of differentiated
heterosexual love. Genuine homosexuality is the principal
phenomenon to be considered under this head. It occurs in perfectly
healthy individuals quite independently of degeneration and of
civilization; and it is diffused throughout the whole world.
From all these facts may be deduced the untenability of a purely
clinical and pathological conception of sexual aberrations and
perversions. We must now accept the point of view that, although
numerous morbid degenerate and psychopathic individuals exhibit
sexual anomalies, yet these identical anomalies and aberrations are
extraordinarily common in healthy persons.
Ethnological research, for more exact details of which I may refer
to my own work already mentioned, and to the pioneer works of
Ploss-Bartels,[473] Mantegazza,[474] Friedrich S. Krauss,[475] and
Havelock Ellis,[476] has adduced stringent proof that sexual
aberrations and perversions are ubiquitous, diffused throughout
the entire world, just as much among primitive races as among
civilized nations, that on the psycho-physical side they are
“elementary ideas” in Bastian’s sense, that they recur everywhere in
a qualitatively identical manner as a result of similar conditions. As it
is with prostitution, so it is also with sexual perversions—a tendency
to sexual aberration is deeply rooted in human nature. It is a
primitive, purely anthropological phenomenon, which is not
strengthened by civilization, but, on the contrary, is mitigated
thereby. Charles Darwin rightly points out that the hatred of sexual
immorality and of sexual aberrations is a “modern virtue,”
appertaining exclusively to “civilized life,” and entirely foreign to the
nature of primitive man. Primitive man revelled in wild indecency (as
Wilhelm Roscher also proves), in sexual perversions, and
libertinism.[477] The sexual aberrations of civilized mankind are for
the most part imitations of the examples given by primitive
peoples.
Thus, the well-known “stimulating rings” of European rubber
manufacturers (cf. Weissenberg, in the “Transactions of the
Anthropological Society of Berlin,” 1893, p. 135) correspond to the
“stimulating stones” of the Battaks (Staudinger, op. cit., 1891, p.
351), to the “penis stones” of the savage Orang Sinnoi in Malacca
(Vaughan Stevens in the Zeitschrift für Ethnologie, 1896, pp. 181,
182), the “ampallang” of the Sunda Islands (see Miklucho-Maclay in
the “Transactions of the Anthropological Society of Berlin,” 1876, pp.
22-28). The “renifleurs” and “gamahucheurs” of the Parisian brothels
and houses of accommodation find their typical analogues in the
urine fetichists and cunnilingi of the Island of Ponape, in the
Carolines (cf. Ploss-Bartels), who are, in truth, far removed from the
fin-de-siècle life. And what a perverse imagination have the women
of this same island! According to Otto Finsch (Zeitschrift für
Ethnologie, 1880, p. 316), the men of this island have all only one
testicle, because in boys at the age of seven or eight years the left
testicle is removed by a piece of sharpened bamboo. This is said to
make the men more desirable to the women! Among the Masai,
for similar reasons, circumcision is effected in such a manner that a
portion of the prepuce is left behind to form a kind of firm button of
skin. “This mode of circumcision is greatly prized by the women.
Among the black races, indeed, everything turns round the question
of sensual enjoyment” (“Medical Notes from Central Africa,” by M. C.,
published in the Deutsche Medizinische Presse, 1902, No. 14, p.
116). And how can our roués compete with the Tauni islanders of
the South Seas? These select certain women, who are not allowed to
marry, but are reserved as simple “objects of sensual pleasure,” and
with these every kind of sexual artifice is practised (Dempwolf,
“Medical Notes on the Tauni Islanders,” published in the Zeitschrift
für Ethnologie, 1902, p. 335).
Thus between primitive and civilized races in these respects there
are no important differences; and according to recent researches we
find the same may be said with regard to civilized nations, that there
is no difference between town and country.[478] I quote here the
account given by an experienced author sixty years ago:
“People usually believe that in the country morals are much better than in the
towns, but this belief is quite erroneous. Brothels and professional prostitutes
naturally cannot exist in the country, but nearly every peasant-girl in the country is
equivalent to a secret prostitute. It is incredible what sexual excesses go on
between the masculine and feminine inhabitants of the villages. Every barn, every
shed, every haystack, every copse, bears witness to this. Especially
disadvantageous to morals is it when in the heat of summer persons of different
sexes work side by side, half undressed, in remote fields for the whole day, and lie
down to rest side by side.”[479]

We may here allude to a fact that we shall have to discuss later—

that young men, after the conclusion of their term of military
service, carry back with them to the country the knowledge of
sexual excesses and perversities which they have acquired in the
town, and thus diffuse these tendencies more and more widely.
Since sexual anomalies constitute a phenomenon generally
characteristic of humanity, race and nationality, as such, have less
to do with the matter than is commonly imagined. The Mongol and
the Malay are not less voluptuous than the Semites, or than many
Aryan races. Among the Semites, the Arabs and the Turks are pre-
eminently sexually perverse nations. They seek sexual gratification
indifferently in the female harem and in the boys’ brothel (see
numerous descriptions of travellers on the moral customs of Turkey,
the Levant, Cairo, Morocco, the Arabian Soudan, the Arabs in Africa,
etc.). Among the Aryan races the Aryans of India must be considered
pre-eminent as refined practitioners of psychopathia sexualis, which
they have reduced to a system. In addition to recognizing forty-
eight figuræ Veneris (different postures in sexual intercourse), they
practise every possible variety of sexual perversion; and they have in
various textbooks[480] a systematic introduction to sexual immorality.
Here there is manifestly no trace of morbid conditions, of
degeneration, or of psychopathia; it is simply a matter of popular
manners and customs. Sexual perversion among the Greeks and the
Romans, two other Aryan nations, is too well known to need detailed
description. In modern Europe the French were at one time believed
to lead the way in sexual artifices. For a long time this has ceased to
be true, and, in fact, never was true. They do, indeed, excel, if one
may use the expression, all other nations in the outward technique
and in the elegance of their sexual excesses. To them from very
early times there has been ascribed a certain preference for the
skatological element in the sexual life; but according to the recent
researches of Friedrich S. Krauss regarding the Slavs, published in
his “Anthropophyteia,” this alleged pre-eminence is extremely
doubtful. That among the Slavs sexual perversions of every kind
have an extraordinarily wide diffusion has been shown by this
investigator by the collection of an enormous mass of material. It is
also very generally known that the English from early days have
exhibited a marked tendency to sadistic practices, and especially to
flagellation. I will return later to this remarkable phenomenon. The
French accuse the Germans of an especial tendency to
homosexuality (le vice Allemand), but there are no sufficient grounds
for this accusation. In psychopathia sexualis, the Germans are as
cosmopolitan as they are in other respects.
With regard to the age of the individual in relation to sexual
perversions, the frequency of these is greater after puberty than
before,[481] and the frequency increases with advancing years. The
time at which the imagination unfolds its greatest activity, the
commencement of manhood, is extremely favourable to the
origination of sexual aberrations, and to their becoming habitual
practices; and, again, the age at which the sexual powers begin to
decline, and when for their incitation new stimuli are needed, is one
at which abnormal varieties of sexual gratification frequently
originate.[482]
Which sex is more inclined to abnormalities of the sexual impulse,
the male or the female?
 The primitively more powerful sexual impulsive life of man in
association with his greater use of alcohol makes him distinctly more
inclined to follow sexual bypaths than woman, whose sexuality at
first develops very gradually, and experiences, in consequence of
motherhood, powerful inhibitions to the development of any sexual
anomalies. On the other hand, the much more difficult
development of voluptuous sensations in women, by means of
normal coitus, is not rarely the cause of a tendency to perverse
varieties of sexual intercourse. They often seduce man in this
direction, and excel him in the discovery of sexual artifices. Among
primitive races, where the relationships are clearest, this is still easily
recognizable, whereas by civilization the matter is often obscured. All
the artificial deformities of the male genital organs amongst savages,
which give the man much more trouble than pleasure, but which, on
the other hand, increase the voluptuous enjoyment of the woman
during the sexual act, cannot otherwise be explained except on the
ground of an original demand on the part of women. To this
category belong incisions in the glans penis, and the implanting of
small stones in the wounds until the skin has a warty appearance
(Java); perforation of the penis to enable rods beset with bristles,
feathers, rods with balls (the well-known “ampallang” of the Dyaks
of Borneo), bodkins, rings, bell-shaped apparatus, to be inserted
through these perforations; the wrapping up of the penis in strips of
fur with the hair outwards, or enveloping it in a leaden cylinder, etc.
The feminine imagination has proved inexhaustible in this direction.
Miklucho-Maclay, the great authority on the sexual psychology of the
savage races of the Malay Archipelago and the South Sea Islands,
declares it to be extremely probable that all these customs and
all these apparatus were invented by or for women. The
women reject all men who do not possess these stimulating
apparatus on the penis. Finsch and Kubary confirm this, and state
that in most cases it is the frigidity of the women which makes them
desire such means of artificial stimulation. Among civilized races,
also, abundant material can be collected with regard to sexual
perversities among women, as has recently been done by Paul de
Régla in “Les Perversités de la Femme” (Paris, 1904), and by René
Schwaeblé in “Les Détraquées de Paris” (Paris, 1904).
The following case shows that European women sometimes
demand artificial changes in the male genital organs, in order to
increase their voluptuous sensations. Some years ago a man, fifty
years of age, was admitted into the syphilis wards of the Laibacher
Hospital. The discharge from the penis was, however, found to be
due merely to balanitis. On examination the greatly enlarged penis
was found to be perforated by rod-shaped objects, and an incision
through the skin showed that these were pins and hairpins. The pins
were about two inches long, with brass heads the size of a
peppercorn, and they were at least ten in number. One of the pins
was run partly into the testicle. After the foreign objects had been
removed, the man informed us that his mistress had stuck these in,
in order that she might experience more ardent sensations. The pins
were all subcutaneous; several of them ran right round the penis.
Social differences in respect of the frequency of sexual
perversions do not exist. Sexual perversions are just as widely
diffused among the lower classes as among the upper. A. Ferguson,
Havelock Ellis, Tarnowsky, and J. A. Symonds are all in agreement
regarding this fact, which, indeed, in view of the anthropological
conception of psychopathia sexualis, does not require additional
explanation.
Finally, we come to the last and most important point—to the
question of the relation of culture and civilization to psychopathia
sexualis. Even though psychopathia sexualis is in its essence
independent of culture, is a general human phenomenon, still we
cannot fail to recognize that civilization has exercised a certain
influence upon the external mode of manifestation, and also upon
the inner psychical configuration of sexual aberrations. Especially as
regards the latter—the psychical relationships—the perversity of the
civilized man is more complicated than that of primitive man,
although in essence the two are identical.
The modern civilized man is in respect of his sexuality a peculiar
dual being. The sexuality within him leads a kind of independent
existence, notwithstanding its intimate relationship to the whole of
the rest of his spiritual life. There are moments in which, even in
men of lofty spiritual nature, pure sexuality becomes separated from
love, and manifests itself in its utterly elementary nature beyond
good and evil. I expressed earlier the idea that this frequent
phenomenon reminded me of the “monomania” of the older
alienists. “Il y a en nous deux êtres, l’être moral et la bête: l’être
moral sait ce que mérite l’amour véritable, la bête aspire à la fange
où on la pousse,” we find in a French erotic work (“Impressions
d’une Fille” par Léna de Mauregard, vol. i., pp. 57, 68; Paris, 1900).
No other human impulsive manifestation is so ill adapted as
sexuality to the coercion and conventionality which civilization
necessarily entails. Carl Hauptmann, in an interesting socio-
psychological study, “Unsere Wirklichkeit” (“Our Reality”; Munich,
1902), has described very impressively this frightful conventionality,
especially characteristic of our own time, which so painfully
represses the “reality” of love, suppresses everything primitive in it,
banishes it into the darkness of its own interior, and only allows the
conventionally sanctioned forms of sexual love to subsist. This
coercion, this outward pressure, develops a volcano of elementary
sexuality, which usually slumbers, but may suddenly break out in
eruption, and give free vent to excesses of the wildest nature.
Dingelstedt in his poem “Ein Roman,” has excellently described this
condition:
 “Wenn du die Leidenschaft willst kennen lernen,
Musst du dich nur nicht aus der Welt entfernen.
Such’ sie nicht auf in friedlicher Idylle,
In strohgedeckter und begnügter Stille...
Da suche sie in festlich vollem Saale
Bei Spiel und Tanz, an feierlichem Mahle,
Dort, eingeschnürt in Form und Zwang und Sitte,
Thront sie wie Banquos Geist in ihrer Mitte.”

[“If you wish to learn to know passion,

You must, above all, not remove yourself from the world.
Do not look for it in a peaceful idyll,
In padded and satisfied quietude....
Look for it in the full festal hall,
At the game and the dance, at the brilliant banquet;
There, entrapped amid form, and coercion, and custom,
Enthroned, like Banquo’s ghost, it sits amid the throng.”]

Similarly, Charles Albert[483] remarks:

“If love nowadays so often manifests itself in the form of aberration or passion,
this is almost always to be explained by the hindrances of every kind which have
been opposed to it. No other feeling is so hindered, opposed, detested, and
loaded with material and moral fetters. We know how education makes a
beginning in this way, declaring that love is something forbidden, and how the
hardness of economic life continues the process. Hardly has a young man or a
young girl gone out into life, hardly have they begun to feel their way into society,
but they encounter a thousand difficulties which are opposed to their living out
their life from a sexual point of view. How would it be possible that, in the limits of
such a society, love could become anything else but a fixed idea of the individual,
and how could it fail to give rise to continuous restlessness? Nature does not allow
herself to be inhibited by our artificial social arrangements. The need for love
within us remains active; it cries out in unsatisfied desire; and when no answer is
forthcoming, beyond the echo of its own pain, it takes a perverse form. The love
which is prevented from obtaining complete satisfaction and repose is to many an
intensely painful torment.... The over-rich imagination and the unsatisfied longing
give rise to the most horrible and abnormal forms of love. Above all, in a society
which will make no room for love, the love-passion must give rise to the greatest
devastation. The impulse to love which is repressed by the organization of society
does not only fight violently for air—the inevitable consequence of any pressure—
but it discovers also all those artifices and corruptions which are supposed to
make the enjoyment of love more intense. Conscious of being despised by society,
it endeavours to regain by violence what is wanting to it in sensuality.”

The struggle for reality in love, for the elementary and the
primitive, manifests itself in the search for the greatest possible
contrast to the conventional, to the commonly sanctioned mode of
sexual activity. Love cries out for “nature,” and comes thereby to the
“unnatural,” to the coarsest, commonest dissipation. This
connexion has been already explained (pp. 322-325). Certain
temporary phenomena exhibit also this fact—for example, the
remarkable preference for the most brutal, the coarsest, the
commonest dances, mere limb dislocations, such as the cancan, the
croquette (machicha), the cake-walk, and other wild negro dances,
which rejoice the modern public more than the most beautiful and
gracious spiritual ballet. It was only when the above-described
connexion became clear to me that I was able to understand the
remarkable alluring power of these dances, which had hitherto been
incomprehensible to me.
An additional factor which favours the origination of sexual
perversions is the unrest always connected with the advance of
civilization, the haste and hurry, the more severe struggle for
existence, the rapid and frequent change of new impressions. Fifty
years ago the celebrated alienist Guislain exclaimed:
“What is it with which our thoughts are filled? Plans, novelties, reforms. What is
it that we Europeans are striving for? Movement, excitement. What do we obtain?
Stimulation, illusion, deception.”[484]

There is no longer any time for quiet, enduring love, for an inward
profundity of feeling, for the culture of the heart. The struggle for
life and the intellectual contest of our time leaves the possibility only
for transient sensations; the shorter they are, the more violent, the
more intense must they be, in order to replace the failing grande
passion of former times. Love becomes a mere sensation, which in
a brief moment must contain within itself an entire world. Modern
youth eagerly desires such experience of a whole world by means
of love. The everlasting feeling of our classic period had been
transformed, more especially among our leading spirits, into a
passionate yearning to reflect within themselves truly the spirit of
the time, to live through in themselves all the unrest, all the joy, all
the sorrow, of modern civilization.
From this there results a peculiar, more spiritual configuration of
modern perversity, a distinctive spiritualization of psychopathia
sexualis, a true wandering journey, an “Odyssey” of the spirit,
throughout the wide province of sexual excesses. Without doubt the
French have gone furthest in this direction, and the names of
Baudelaire, Barbey d’Aurevilly, Verlaine, Hannon, Haraucourt, Jean
Larocque, and Guy de Maupassant, indicate nearly as many peculiar
spiritual refinements and enrichments of the purely sensual life.
We have no longer to deal with the pure love of reflection, as in
the case of Kierkegaard and Grillparzer, and in the writings of young
Germany, where, indeed, reflection predominates, but which still
more extends to the direction of higher love. Contrasted with this
is the simple lust of the senses, by means of which new psychical
influences are to be obtained. Voluptuousness becomes a cerebral
phenomenon, ethereal. In this way the most remarkable, unheard-
of, sensory associations appear in the province of sexuality—true fin-
de-siècle products which are, above all, specifically modern, and
could not possibly exist in former times. For it is always the same
play of emotion, the same effects, the same terminal results:
ordinary voluptuousness. The dream of Hermann Bahr, of “non-
sexual voluptuousness,” and the replacement of the animal impulse
by means of finer organs, is only a dream. The elemental sexual
impulse resists every attempt at dismemberment and sublimation. It
returns always unaltered, always the same. It is vain to expect new
manifestations of this impulse. Such efforts end either in bodily and
mental impotence, or else in sexual perversities. In these
relationships the imagination of civilized man is unable to create
novelties in the essence; it can do so only as regards the objective
manifestations. This is confirmed by the increase of purely ideal
sexual perversities in connexion with certain spiritual tendencies of
our time. Martial d’Estoc, in his book, “Paris Eros” (Paris, 1903), has
given a clear description of these peculiar spiritual modifications of
sexual aberrations. (It is interesting to note that Schopenhauer
remarks, in his “Neue Paralipomena,” pp. 234 and 235: “The caprices
arising from the sexual impulse resemble a will-o’-the-wisp. They
deceive us most effectively; but if we follow them, they lead us into
the marsh and disappear.”)

APPENDIX
SEXUAL PERVERSIONS DUE TO DISEASE
It is the immortal service of Casper and von Krafft-Ebing to have
insisted energetically upon the fact that numerous individuals
whose vita sexualis is abnormal are persons suffering from disease.
This is their monumentum ære perennius in the history of medicine
and of civilization. Purely medical, anatomical, physical, and
psychiatric investigations show beyond question that there are many
persons whose abnormal sexual life is pathologically based.
I shall not here discuss the peculiar borderland state between
health and disease, the existence of which can be established in
many sexually perverse individuals; I shall not refer to the
“abnormalities,” the “psychopathic deficiencies,” the “unbalanced,”
etc.; nor shall I discuss the question of the significance of the
stigmata of degeneration, because these will be adequately dealt
with in connexion with the forensic consideration of punishable
sexual perversions.
Here we shall speak only of actual and easily determined diseases
which possess a causal importance in the origination and activity of
sexual perversions. The great majority of these are, naturally,
mental disorders.
Von Krafft-Ebing, to whom we owe the most important
observations regarding the pathological etiology of sexual
perversions, enumerates the following conditions: Psychical
developmental inhibitions (idiocy and imbecility), acquired weak-
mindedness (after mental disorders, apoplexy, injuries to the head,
syphilis, in consequence of general paralysis), epilepsy, periodical
insanity, mania, melancholia, hysteria, paranoia.
Among these, epilepsy possesses the greatest importance.[485] It
comes into play much more frequently as a causal morbid
influence in the case of sexually perverse actions and offences than
has hitherto been believed. The psychiatrist Arndt maintains that
wherever an abnormal sexual life exists, we must always consider
the possibility of epileptic influence. Lombroso assumes that all
premature and peculiar instances of satyriasis are instances of larval
epilepsy. He gives several examples in support of this view, and also
a case of Macdonald’s which illustrates the connexion between
epilepsy and sexual perversity.[486] Especially in the so-called
epileptic “confusional states” do we meet with sexually perverse
actions; exhibitionism and other manifestations of sexual activity
coram publico are frequently referable to epileptic disease. Similar
impulsive sexual activities and similar confusional states are seen
after injuries to the head and in alcoholic intoxication, also
after severe exhaustion. Many cases of “periodic psychopathia
sexualis” are due to epilepsy.
Senile dementia and paralytic dementia (general paralysis of
the insane), also severe forms of neurasthenia and hysteria,
often change the sexual life in a morbid direction, and favour the
origin of sexual perversions.
It is a fact of great interest that Tarnowsky and Freud attribute to
syphilis an important rôle in the pathogenesis of sexual anomalies.
In 50 % of his sexual pathological cases Freud found that the
abnormal sexual constitution was to be regarded as the last
manifestation of a syphilitic inheritance (Freud, op. cit., p. 74).
Tarnowsky observed that congenital syphilitics, and also persons
whose parents had been syphilitic, but who themselves had never
exhibited any definite symptoms of the disease, were apt later to
show manifestations of a perverse sexual sensibility (Tarnowsky, op.
cit., pp. 34 and 35). Obviously this is to be explained by the
deleterious influence upon the nervous system (perhaps by
means of toxins?) which syphilis is also supposed to exert in
the causation of tabes dorsalis and general paralysis of the
insane. When investigating the clinical history of cases of sexual
perversion, it appears that previous syphilis is a fact to which some
importance should be attached.[487]
From syphilis we pass to consider direct physical abnormalities
and morbid changes in the genital organs as causes of sexual
anomalies. In women prolapsus uteri sometimes leads to perverse
gratification of the sexual impulse—for example, by pædication;[488]
in men, shortness of the frænum preputii plays a similar part,[489]
also phimosis. Wollenmann reports the case of a young man
suffering from phimosis, who, at the first attempt at coitus,
experienced severe pain, and since that time had an antipathy to
normal sexual intercourse. He passed under the influence of a
seducer to the practice of mutual masturbation. Only after operative
treatment of the phimosis did his inclination towards the male sex
pass away, and the sexual perversion then completely
disappeared.[490]
[456] Hermann Joseph Löwenstein, “De Mentis Aberrationibus ex Partium
Sexualium Conditione Abnormi Oriundis” (Bonn, 1823).
[457] Joseph Häussler, “The Relations of the Sexual System to the
Psyche” (Würzburg, 1826).
[458] Heinrich Kaan, “Psychopathia Sexualis” (Leipzig, 1844).
[459] R. von Krafft-Ebing, “Psychopathia Sexualis” (Stuttgart, 1882).
[460] We must not omit to mention the fact that a little earlier the French
physician Moreau de Tours published a comprehensive work upon
psychopathia sexualis, entitled “Des Aberrations du Sens
Génésique” (Paris, 1880).
[461] S. Freud, “Three Essays in Contribution to the Sexual Theory,” p.
70.
[462] Cf. the interesting remarks of G. H. C. Lippert, “Mankind in a State
of Nature,” p. 1 et seq. (Elberfeld, 1818).
[463] Christian Muff, “What is Civilization?” pp. 30, 31 (Halle, 1880).
[464] G. L. N. Delvincourt, “De la Mucite Génito-Sexuelle,” p. 64 (Paris,
1834). Apt remarks on the alleged degeneration of the French are
to be found also in the work of P. Näcko, “The Alleged Degeneration
 of the Latin Races, more Especially of the French,” published in
Archives for Racial and Social Biology, 1906, vol. iii.
[465] As, for example, Immermann, in his work “Epigonen,” published at
the same period (1836), assumes. In the mouth of the physician he
puts the following words: “The physician has a great task to
perform in the present day. Diseases, especially nervous troubles, to
which for a number of years the human race has been especially
disposed, are a modern product.” Cf. Leopold Hirschberg, “Medical
Matters as dealt with in General Literature: the Judgment of a
Member of the Laity regarding Nervousness in the Year 1876,”
published in Medizinische Wochenschrift, 1906, No. 41, p 428.
Seventy years ago the German people was “nervous”; thirty-four
years before Sedan, thirty years after Jena! Therefore neither Jena
nor Sedan can be connected with the nervous “degeneration.” The
authors of the eighteenth century (!) made similar complaints of the
nervousness of their time, upon which Cullen and Brown founded
their medical theories.
[466] J. Pohl-Pincus, “The Diseases of the Human Hair, and the Care of
the Hair,” third edition, p. 57 (Leipzig, 1885).
[467] Carl Bleibtreu, “Paradoxes the Conventional Lies,” sixth edition, pp.
1, 2 (Berlin, 1888).
[468] See “Nature and Man,” E. Ray Lankester’s Romanes Lecture, 1905.
—Translator.
[469] G. Hirth, “Hereditary Enfranchisement,” published in “Ways to
Freedom,” pp. 106-127 (Munich, 1903).
[470] Näcke’s thesis is in agreement with this, that “all sexual abnormal
practices in an asylum are for the most part much more rare
than the laity, or even many physicians, imagine.” Cf. P. Näcke,
“Some Psychologically Obscure Cases of Sexual Aberrations in the
Asylum,” published in the Annual for Sexual Intermediate Stages,
vol. v., p. 196 (Leipzig, 1903). See also, by the same author,
“Problemi nel Campo delle Psicopatie Sessuali,” in Archivio delle
Psicopatie Sessuali, 1896; “Sexual Perversities in the Asylum,” in the
Wiener klinische Rundschau, 1899, Nos. 27-30.
[471] S. Freud, op. cit., pp. 19, 20.
[472] A. Hoche, “The Problem of the Forensic Condemnation of Sexual
Transgressions,” published in the Neurologisches Centralblatt, 1896,
p. 58.
[473] Ploss-Bartels, “Das Weib in der Natur- und Volkerkunde,” eighth
edition, 2 vols. (Leipzig, 1906).
[474] Mantegazza, “Anthropological and Historical Studies on the Sexual
Relationship of Mankind.”
[475] F. S. Krauss, “Morals and Customs relating to Sexual Reproduction
among the Southern Slavs,” published in “Kryptadia,” vols. vi.-viii.
(Paris, 1899-1902); and in the larger work, “Anthropophyteia”
(Leipzig, 1904-1906).
[476] In all his works.
[477] Cf. Charles Darwin, “The Descent of Man, and Selection in Relation
to Sex,” vol. i., p. 182 (2 vols., London, 1898).
[478] Cf. the inquiry of C. Wagner, containing extremely valuable material,
“The Sexual and Moral Relationships of the Protestant Agricultural
Population of the German Empire” (3 vols., Leipzig, 1897, 1898).
[479] “Prostitution in Berlin and its Victims,” p. 27 (Berlin, 1846).
[480] Cf. the detailed bibliography of these works in my “Contributions to
the Etiology of Psychopathia Sexualis,” vol. i., pp. 29, 30.
[481] Typical sexual perversions have, however, been observed even in
children, and it is this fact which has chiefly given rise to the
doctrine of the “congenital” character of sexual perversions.
[482] Cf. the remarks of the Marquis de Sade regarding the abnormal
sexuality of elderly men, in my “New Research Concerning the
Marquis de Sade,” pp. 421, 422 (Berlin, 1904).
[483] C. Albert, “Free Love,” p. 148.
[484] Joseph Guislain, “Clinical Lectures on Mental Diseases,” p. 229
(Berlin, 1854).
[485] Kowalewski, “Perversions of Sexual Sensibility in Epileptics,”
published in the Jahrbücher für Psychiatrie, 1887, vol. vii., No. 3.
[486] C. Lombroso, “Recent Advances in the Study of Criminology,” pp.
197-200 (Gera, 1899).—Tarnowsky has even described a form of
“epileptic pæderasty” (cf. B. Tarnowsky, “Morbid Phenomena of
Sexual Sensibility,” pp. 8, 51; Berlin, 1886).
[487] E. Laurent (“Morbid Love,” pp. 43-45; Leipzig, 1895) regards
tubercular inheritance as an important etiological factor of sexual
anomalies, for these occur more frequently in blonde, weakly
individuals, than in brunettes (?).
[488] Bacon, “The Effect of Developmental Anomalies and Disorders of
the Female Reproductive Organs upon the Sexual Impulse,”
published in the American Journal of Dermatology, 1899, vol. iii.,
No. 2.
[489] M. Féré, “Sexual Hyperæsthesia in Association with Shortness of the
Frænum Preputii,” published in the Monatshefte für praktische
Dermatologie, 1896, vol. xxiii., p. 45.
[490] A. G. Wollenmann, “Phimosis as a Cause of Perversion of Sexual
Sensibility,” published in Der ärztliche Praktiker, 1895, No. 23.
Matthaes has shown that morbid changes of the genital sphere or
its vicinity are apt to give rise to offences against morality (“The
Statistics of Offences against Morality,” published in the Archiv für
Kriminalanthropologie, 1903, vol. xii., p. 319).
 CHAPTER XVIII
MISOGYNY

“Thou priestess of the most flowery life, how is it possible

that such things should draw near to thee—one of those pale
phantoms, one of those general maxims, which philosophers
and moralists have invented in their despair of the human
race?”—G. Jung.

CONTENTS OF CHAPTER XVIII

Non-identity of misogyny with homosexuality — History of misogyny — Misogyny
among the Greeks — Christian misogyny the true source of the modern
contempt for women — Characteristics of modern misogyny — De Sade and
his modern disciples (Schopenhauer, Strindberg, Weininger) — Scientific
misogyny (Möbius, Schurtz, B. Friedländer, E. von Mayer) — Distinctions
between the individual varieties — Counteracting tendencies — Beginnings of
a new amatory life of the sexes — A common share in life — Freedom with,
not without, woman.

CHAPTER XVIII
Before proceeding to the consideration of homosexuality I propose
to give a brief account of contemporary misogyny, in order to avoid
confusing these two distinct phenomena under one head, and also
to avoid making the male homosexuals, who are often erroneously
regarded as “woman-haters,” responsible for the momentarily
prevalent spiritual epidemic of hatred of women. This would be a
gross injustice, because, in the first place, this movement has in no
way proceeded from the homosexual, but rather from heterosexual
individuals, such as Schopenhauer, Strindberg, etc.; and because, in
the second place, the homosexual as such are not misogynists at all,
and it is only a minority of them who shout in chorus to the
misogynist tirades of Strindberg and Weininger.
The misogynists form to-day a kind of “fourth sex,”[491] to belong
to which appears to be the fashion, or rather has once more
become the fashion, for misogyny is an old story. There have always
been times in which men have cried out: “Woman, what have I to do
with you? I belong to the century”;[492] times in which woman was
renounced as a soulless being, and the world of men became
intoxicated with itself, and was proud of its “splendid isolation.”
Of less importance is it that the Chinese since ancient times have
denied to woman a soul, and therewith a justification for
existence,[493] than that among the most highly developed civilized
races of antiquity such men as Hesiod, Simonides,[494] and, above
all, Euripides, were all fierce misogynists. In the “Ion,” the
“Hippolytus,” the “Hecuba,” and the “Cyclops” we find the most
incisive attacks on the female sex. The most celebrated passage is
that in the “Hippolytus” (verses 602-637, 650-655):
“Wherefore, O Jove, beneath the solar beams
That evil, woman, didst thou cause to dwell?
For if it was thy will the human race
Should multiply, this ought not by such means
To be effected; better in thy fane
Each votary, on presenting brass or steel,
Or massive ingots of resplendent gold,
Proportioned to his offering, might from thee
Obtain a race of sons, and under roofs
Which genuine freedom visits, unannoyed
By women, live.”[495]
 In this passage we have the entire quintessence of modern
misogyny. But Euripides betrays to us also the real motive of
misogyny. In a fragment of his we read “the most invincible of all
things is a woman”! Hinc illæ lacrimæ! It is only the men who are
not a match for woman, who do not allow woman as a free
personality to influence them, who are so little sure of
themselves that they are afraid of suffering at the hands of woman
damage, limitation, or even annihilation of their own individuality.
These only are the true misogynists.
It is indisputable that this Hellenic misogyny was closely
connected with the love of boys as a popular custom. To this we
shall return when we come to describe Greek pæderasty.
Among the Romans woman occupied a far higher position than
among the Greeks—a fact which the institution of the vestal virgins
alone suffices to prove. Among the Germans, also, woman was
regarded as worthy of all honour.
The true source of modern misogyny is Christianity—the
Christian doctrine of the fundamentally sinful, evil, devilish nature of
woman. A Strindberg, a Weininger, even a Benedikt Friedländer,
notwithstanding his hatred of priests—all are the last offshoots of a
movement against the being and the value of woman—a movement
which has persisted throughout the Christian period of the history of
the world.
“If I were asked,” says Finck,[496] “to name the most influential, refining
element of modern civilization, I should answer: ‘Woman, beauty, love, and
marriage’! If I were asked, however, to name the most inward and peculiar
essence of the early middle ages, my answer would be: ‘Deadly hostility to
everything feminine, to beauty, to love, and to marriage.’”

The history of medieval misogyny was described by J. Michelet in

his book “The Witch.” Since woman and the contact with woman
were regarded as radically evil, it followed that in theory and
practice asceticism was the ideal; celibacy was only the natural
consequence of this hatred of woman; so also were the later witch
trials the natural consequence. Therefore to this medieval misogyny,
in contrast with modern misogyny, which represents only a weak
imitation, we cannot deny a certain justification. The misogyny of
the middle ages was earnestly meant; but it has become to-day
mere phrase-making, dilettante imitation, and ostentation. In
contrast with the utterances of the modern misogynist, the coarse
abuse of women by such a writer as Abraham a Santa Clara has a
refreshing and amusing character.[497]
Modern misogyny is certainly an inheritance of Christian doctrine,
and a tradition handed down from much earlier times, but still it has
its own characteristic peculiarities. Misogyny is, however, now much
more an affair of satiety or disillusion than of belief or
conviction; whereas in the days of medieval Christianity belief and
conviction were the effective causal factors of misogyny. In addition,
among our neo-misogynists we have the factor of the spiritual
pride of a man who, from the standpoint of academic theoretical
culture (which to men of this kind appears the highest summit of
existence), looks down upon women, whom he regards as mentally
insignificant, while he sympathizes with her “physiological weak-
mindedness.” He smiles on her with pity, and completely overlooks
the profound life of emotion and feeling characteristic of every true
woman, which forms a counterpoise to any amount of purely
theoretical knowledge—quite apart from the fact that women of
intellectual cultivation are by no means rare.
If, in fact, we regard the lives of those who have reduced modern
misogyny to a system, we shall be able to detect the above-
mentioned causes in their personal experiences and impressions.
The first important modern advocate of misogyny, the Marquis de
Sade, lived an extremely unhappy married life, was deceived also in
a love relationship, and nourished his hatred of women by a
dissolute life and a consequent state of satiety.
And as regards Schopenhauer, who does not recall his unhappy
relations with his mother? For he who has really loved his mother,
he who has experienced the unutterable tenderness and self-
sacrifice of maternal love, can never become a genuine,
thoroughgoing woman-hater. But the mutual relationship of
Schopenhauer and his mother was rather hatred than love. Beyond
question, also, his infection with syphilis, to which I was the first to
draw attention, played a part in his subsequent hatred of women.
Strindberg, in his “Confessions of a Fool,” has himself offered us
the proof of the causal connexion between his misogyny and his
personal experiences and disillusions; and in Weininger’s book we
can read only too clearly that he had had no good fortune with
women, or had had disagreeable experiences in his relations with
them.
De Sade, who, perhaps, was not unknown to Schopenhauer,[498]
was the first advocate of consistent misogyny on principle. It is an
interesting fact, to which I have alluded in an earlier work (“Recent
Researches regarding the Marquis de Sade,” p. 433), that de Sade’s
and Schopenhauer’s opinions on the physical characteristics of
women are to some extent verbally identical. While Schopenhauer,
in his essay “On Women” (“Works,” ed. Grisebach, vol. v., p. 654),
speaks of the “stunted, narrow-shouldered, wide-hipped and short-
legged sex,” which only a masculine intellect when clouded by
sexual desire could possibly call “beautiful,” we find in the
“Juliette” (vol. iii., pp. 187, 188) of the Marquis de Sade the following
very similar remarks on the feminine body: “Take the clothes off one
of these idols of yours! Is it these two short and crooked legs which
have turned your head like this?” This physical hatefulness of
women corresponds to the mental hatefulness of which de Sade
gives a similar repellent picture (“Juliette,” vol iii., pp. 188, 189). In
all his works we find the same fanatical hatred of women.
Sarmiento, in “Aline et Valcour” (vol. ii., p. 115), would like to
annihilate all women, and calls that man happy who has learned to
renounce completely intercourse with this “debased, false, and
noxious sex.”
Quite in the spirit of de Sade, to whom the misogynists of the
Second Empire referred as an authority, Schopenhauer, in the
previously quoted essay “On Women,” Strindberg, in the
“Confessions of a Fool,” and Weininger, in “Sex and Character,”
preached contempt for the feminine nature;[499] and this seed has
fallen upon fruitful soil in modern youth. Every young blockhead
inflates himself with his “masculine pride,” and feels himself to be
the “knight of the spirit” in relation to the inferior sex; every
disillusioned and satiated debauchee cultivates (as a rule, indeed,
transiently) the fashion of misogyny, which strengthens his
sentiment of self-esteem. If we wish to speak at all of “physiological
weak-mindedness,” let us apply the term to this disagreeable type of
men. As Georg Hirth truly remarks (“Ways to Freedom,” p. 281),
such masculine arrogance is merely a variety of “mental defect.”
Unfortunately, this misogyny has intruded itself also into science.
The work of P. J. Möbius,[500] notwithstanding the esteem I feel for
the valuable services of the celebrated neurologist in other
departments, can only be termed an aberration, a lapsus calami.[501]
But he does not stand alone. The admirable work of Heinrich
Schurtz, also, upon “Age Classes and Associations of Men” (Berlin,
1902), is permeated by this misogynist aura; not less so is the
equally stimulating work, “The Vital Laws of Civilization” (Halle,
1904), by Eduard von Mayer. This book, in association with the
equally thoughtful and compendious work “The Renascence of Eros
Uranios” (Berlin, 1904), by Benedikt Friedländer, and in conjunction
with the efforts of Adolf Brand, the editor of the homosexual
newspaper Der Eigene, and Edwin Bab (cf. this writer’s “The
Woman’s Movement and the Love of Friends”; Berlin, 1904), to
found a special homosexual group demanding the “emancipation
of men,” have been the principal causes of the belief that the male
homosexuals are the true “repudiators of woman,” and that from
them has proceeded the increasing diffusion of modern misogyny. I
repeat that this connexion is true only for the above-named group;
that, on the contrary, genuine misogyny has been taught us by the
world’s typically heterosexual men, such as Schopenhauer and
Strindberg. Benedikt Friedländer and Eduard von Mayer preached,
above all, a “masculine civilization,” a deepening of the spiritual
relationships between men; whereas Strindberg and Schopenhauer,
and even Weininger, really leave us in uncertainty as to what they
imagine is to take woman’s place. All five agree in this, that the
“intercourse” of man with woman is to be limited as much as
possible; but only the two first-named openly and freely advocate
homosexual relationships, or at least a “physiological friendship” (B.
Friedländer), between men. Schopenhauer, Strindberg, and
Weininger did not venture to deduce these consequences. Yet this is
the necessary consequence of misogyny based on principle.
To the heterosexual men—and such men form an enormous
majority—the noble, ideal, asexual friendship of man for man
appears in quite another light from that in which it appears to the
misogynist, to whom it is to serve to replace sexual love, whereas
for heterosexual men friendship for other men is a valuable treasure
additional to the love of woman.
Is there, then, any reason for this contempt and hatred for
woman? Do not the signs increase on all hands to show us that new
relationships are forming between the sexes, that a number of new
points of contact of the spiritual nature are making their appearance
—in a word, that an entirely new, nobler, most promising
amatory life is developing? I will not fall into the contrary error to
misogyny and inscribe a dithyramb of praise to feminine nature, as
Wedde, Daumer, Quensel, Groddeck, and others, have done; but I
merely indicate the signs of the times when I say that woman also
is awakening! Woman is awakening to the entirely new existence
of a free personality, conscious of her rights and of her duties.
Woman, also, will have her share in the content and in the tasks of
life; she will not enslave us, as the misogynists clamour, for she
wishes to see free men by her side. What would become of woman
if men became slaves? How could slaves give love?
Life has to-day become a difficult task both for man and for
woman. Man and woman alike must endeavour to perform that task
with confidence in their respective powers; but each, also, must
have confidence in the powers of the other—a confidence which
becomes palpable in the form of love or friendship, so that those
who feel it have their own powers strengthened.
Not “Free from woman” is the watchword of the future, but “Free
with woman.”
[491] V. Hoffmann, in a bad novel, “Das vierte Geschlecht” (Berlin, 1902),
gives this name to the non-homosexual misogynists.
[492] Karl Gutzkow, “Säkularbilder,” vol. i., p. 55 (Frankfurt, 1846).
[493] In the Shi-king we find the following characterization of woman:

“Enough for her to avoid evil,

For what can a woman do that is good?”

Indian literature is also full of such ideas. Cf. H. Schurtz,

“Altersklassen und Männerbunde” (Age Classes and Associations of
Men), p. 52.
[494] Simonides considered that women were derived from various
animals. W. Schubert (“From the Berlin Collection of Papyri,”
published in the Vossische Zeitung, No. 23, January 15, 1907)
reproduces long fragments of a Greek anthology which collates
praise and blame of woman in the original words of the poets.
[495] I quote from “The Plays of Euripides in English,” in two volumes,
vol. ii., p. 136 (Everyman’s Library, Dent, London).—Translator.
[496] H. T. Finck, “Romantic Love and Personal Beauty,” vol. i., pp. 186,
187 (Breslau, 1894).
[497] Equally amusing is the misogynist “Alphabet de l’Imperfection et
Malice des Femmes,” by Jacques Olivier (Rouen, 1646), in which all
the bad qualities of woman, observed down to the year 1646, are
described with effective care and completeness.
[498] We know that Schopenhauer was a lover of erotic writings; a fuller
account of this matter will be found in Grisebach’s “Conversations
and Soliloquies of Schopenhauer.”
[499] That Nietzsche is wrongly accredited with misogyny is convincingly
proved by Helene Stocker (“Nietzsches Frauenfeindschaft,”
published in Zukunft, 1903; reprinted in “Love and Women,” pp. 65-
74; Minden, 1906).
[500] P. J. Möbius, “The Physiological Weak-mindedness of Woman,”
fourth edition (Halle, 1902). Näcke terms the recently deceased
Möbius the “German Lombroso,” in order by this term to indicate,
on the one hand, the man’s indubitable genius, and on the other
hand the superficiality and purely hypothetical character of his
scientific deductions.
[501] The grounds for this opinion were given in the fifth chapter.