MASTURBATION IS THE PRIMAL ADDICTION (Sigmund Freud), -- And if unconditionally repressed, the one from which all other addictions stem (J. M. Mahoney).


Another case of a person, this time a very young man (16) suffering from paranoid schizophrenia and in the grip of a severe homosexual panic, who suddenly runs amok and begins savagely attacking 21 of his schoolmates with two knives, until he is finally subdued.

The name "schizophrenia" was created by Professor Dr. Eugen Bleuler to denote the mental condition formerly known as "dementia praecox" (precocious dementia), this original name emphasizing the fact that the illness often starts during the afflicted person's pubertal years. (In the present case, as has been noted, the young man suffering from paranoid schizophrenia is sixteen-years-old -- and thus in full pubertal "bloom".)

Any severe bisexual conflict / gender confusion at this early stage of life can have devastating and lasting mental health consequences.

[ J. Michael Mahoney, April 14, 2014. ]


Army Specialist Ivan A. Lopez, who had been under psychiatric care at Fort Hood, succumbed to a severe "homosexual panic" attack caused by his long-standing, powerful, and repressed bisexual conflict and gender confusion. This is invariably the precipitating factor in all such cases where men suddenly go berserk -- for no obvious and rational reasons -- lashing out in a psychotic and merciless lethal fury, with no prior warning, targeting some, or all, of those around them -- and then generally suiciding at the end of their deadly rampage. This murderous "breaking bad" phenomenon occurs with a sickening regularity and will continue to do so until its root cause -- severe bisexual conflict and gender confusion -- is widely acknowledged and properly dealt with. (See also the HOMOSEXUAL PANIC / AMOK links on my website.)

[ J. Michael Mahoney, April 7, 2014. ]


The recently-deceased leader of the Westboro Baptist Church, Mr. Fred Phelps, was suffering from paranoid schizophrenia, and it was this disease which caused him to have such a pathological hatred of homosexuals, or "fags", as he so derisively and hatefully called them. In actuality, what he really hated and feared was his very own deeply-repressed homosexual nature, and thus he "projected" these forbidden and terrifying feelings connected with it, in a typically paranoid schizophrenic pattern, out onto the world around him. He was really a severely ill man, deserving of some pity, though he showed none at all for those others he attacked in his hate-filled, psychotic ravings against the entire LGBT community.

[ J. Michael Mahoney, April 4, 2014. ]


Schizophrenia, the "bearded lady" disease, has struck again at Ft. Hood, Texas, leaving -- as it did before and will probably do again sometime -- death and destruction in its wake. Another soldier, suffering from a severe paranoid schizophrenic mental illness, "loses it" and runs amok. (See the link AMOK on this website.) And similar tragedies also occur all-too-frequently in civilian life too, and will continue to occur there -- ad infinitum -- until society starts paying much more serious attention to all the many unstable paranoid schizophrenic personalities in its midst.

[ J. Michael Mahoney, April 4, 2014. ]


Mais, dans des cas pareils, c'est toujours la chose génitale, toujours! toujours! toujours!

[ -- Jean-Martin Charcot, French "neuro-pathologist" (1825-97), commenting on the invariable sexual etiology of the hysterical symptoms afflicting the patients he treated, both male and female, at his famed clinic in Paris. (He was one of Sigmund Freud's early mentors.) ]



     During the next session the patient was at first manically excited and danced around the room. She declared she wanted to marry me, examined my hand, saw my ring, became furious and shouted that she hated me and my wife. Then she became manic again and very superior and said she was now a doctor of medicine and a man. In her manic excitement she had reversed the situation, in an omnipotent way; however, the manic state did not last long. She quickly became aware of her dependence on me, was overwhelmed by fury, and attempted to destroy the furniture in the room. At the same time she shouted that she wanted to break up marriages. (Ibid., p. 164)
     During the next day she at first did not want to look at me. She said, 'I don't love you, I myself am married and I love somebody else, I am Hitler and hate the Jews.' In one moment she said she wanted to break in my face; afterwards she tried to tear her own dress. Later on she said, 'Kill me and rape me; I do not want to live anymore.'
     … During the next few months many fantasies and situations were repeated in the transference. Sometimes she complained that I visited her during the night. These nightly hallucinations often had a sadistic and persecuting character. She sometimes expressed delusions of being split into a masculine and feminine self. She called her masculine part after the musical play 'Annie Get Your Gun.' Her omnipotent manic impulses and fantasies were often related to this masculine self as an expression of her independence and denial of needs. When she was in the feminine role she often said she was full of blood and spiders and attacked her abdomen in order to press all the bad things out. Sometimes she tried to cut off her breasts or to damage them. She said they were full of blood and I should suck the blood out of them. The bad things which she experienced inside herself were, among others, a stolen penis, blood, children and the breasts of her mother, which she felt she had stolen and spoilt in her fantasies. This made it impossible for her to identify with her good mother and to accept her own femininity. As I explained before, the patient was unable in the chronic mute state of the illness to bear a strong sexual transference to me and acted it out. In the acute state it became apparent why her sexual impulses and fantasies were so unbearable: they were accompanied by overwhelmingly strong murderous sadistic fantasies.

[ Psychotic States (A Psychoanalytical Approach), Herbert A. Rosenfeld, International Universities Press, New York, 1966, p. 165. ]



     A young man imagines that he is about to be married by the holiest father, even the Pope. He sees himself as being such an attractive young girl that no man can resist him. Having in this way warded off the incestuous possibilities with mother now perhaps mother will love him. Understanding this, I forbade the patient to marry anybody but me, but then continued, 'I want you to be my son.' Almost a year later, when the patient's unconscious homosexuality came up in his analysis, he revealed this episode in the psychosis and remembered what a relief it was to him when, through me, he accepted himself for what he was, a male.
     Often female patients pull their hair out or cut their hair off as soon as they have an opportunity to do so. To these patients I denounce their act with fury, announcing that if they become a boy, I will hate them. As a man, I only love daughters. It is to be borne in mind that this does not complete the interpretation required for the girl who has snipped off her hair. I have to relate her act back to the mother in line with my understanding that if the patient is a boy, she will not be competing with her mother for her father, and then perhaps mother will love her.
     In both these instances I take a parental role and with considerable feeling deny that I want either the boy to be a girl or the girl to be a boy and instead that what they are is what I want. If they try to be anything different, I'll hate them, not love them.

[ Direct Analysis (Selected Papers), John N. Rosen, M.D., Grune & Stratton, New York, 1953, p. 15. ]



     Moreover, she did not develop the complicated delusions we are used to seeing in schizophrenia, delusions that Schreber exemplifies. Instead, she would explode into a panic state, with confusion, terror, a buzzing, noisy hallucinosis (rather than clear-cut spoken language), poorly formed visual hallucinations such as blood pouring off the walls or black holes appearing in the streets, and an overpowering drive to kill herself. Except for the possibility that she might kill herself, the prognosis of her psychotic episodes was much better than in those of the typical schizophrenic reacting against her homosexuality.
     When my relationship with Mrs. G had become strong enough, after several years of treatment, and when I understood her well enough, I began charging in upon the subject of homosexuality. For the first year or so, when I did this I could count on her becoming psychotic – sometimes right before my eyes, and sometimes after an hour or so, initially it would happen even if homosexuality was only implied, later, each time I stated unequivocally that she was homosexual. To what extent she gradually became 'used' to this subject because of growing insight, or because of growing familiarity with not being destroyed by the thought, I cannot say. It seems to have been a combination of both.15

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 290. ]



G: All the girls that I've had something to do with are going through my mind. They've all given me about the same thing – in different ways, I guess. You know, they give me warmth and peace and quiet. When I'm with a girl I don't think crazy – I don't think I think crazy, and it isn't necessary for me to be crazy. I don't need anything really, just that kind of nearness. I don't want to think that's a bad thing. I don't see how it can be bad.

S: I don't either. Will you ever have to go crazy because you love a woman?

G: I don't think so.

S: I think it's time that you be done with that, huh?

G: Yeah. Being crazy after being with a woman spoiled all the good things. You know when I ... like E, leaving her and vomiting all the way home. All the warmth and good feeling was just spoiled. It really isn't necessary to do that. I wonder why I thought it was necessary.

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 299. ]



G: Why worry about this one little thing? It's not hurting anybody. I'm not hurting anybody with it. And it's not hurting me. It's not a delusion. It's inside of me. This is something I've always known, and I've always felt; and it's there, and it's real, and it's mine; and you can't take it away from me, and neither can anybody else, so you might as well kiss my ass.

S: Does this penis ever show up in your daydreams?

G: How can it show up when it's really there? What are you talking about? You make it sound like it's a dream.

S: Have you ever had sexual daydreams in which you had a penis like a man?

G: No.

S: What's the matter?

G: Nothing.

S: Don't say 'nothing' to me.

G: You're just bugging me, that's all. I've told you all there is to know. [Shouting] I have this. I have it and I use it and I love it and I want it and I intend to keep it, and there's nothing you can do about it. It's mine. It makes me what I am.

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 15. ]



     A deeply schizophrenic woman, twenty-nine years of age at the time when she began psycho-therapy with me, for more than two years showed confusion as to whether she was male or female. This confusion she expressed indirectly, as in the exchange with me which is quoted below. Two words of prefatory explanation: the patient's first name was Nanette, the comments in brackets are mine.
     'An βne is a donkey, isn't it?'
     ['In French, yes'] 'A βne is a donkey in French, yes. It's a game where you're blindfolded and you pin a tail on a donkey. That's my name: β n e (laughing). The 'a' has that – what do you call it, over it? – an inverted V.'
     ['Let's see what an inverted V brings up.'] 'My nose is sort of in the shape of a V. I had a pin that was V-shaped – well, I didn't have it. I didn't have any jewelry. It was Ruth's (Ruth: her younger sister) ... βne – I don't know whether it's masculine or feminine. It doesn't have to be either; it's l-apostrophe.'
     Note her repeatedly associating βne – of which she says, 'I don't know whether it's masculine or feminine' – with herself.
     This confusion about her own sexuality she repeatedly projected onto her environment. She once spoke of a 'statue of a woman in Rock Creek Park,' imitating with upraised arms the posture of the statue, and went on to say that she liked it very much because of it's 'masculine grace.' I replied in surprise, 'It's masculine grace?' She nodded and went on speaking. Also, she described on several occasions, during the first two years of the therapy, an incident when, prior to her hospitalization, she had visited, uninvited, the home of a young man with whom she was having an autistic love affair. Each time she spoke of this, it was evident that she was confused as to whether the person who met her at the door was male or female. She was not sure whether this was the young man himself, or his sister who lived there with him and their father. In one of her accounts of this, she at first said she knew the person was a girl, but she kept referring to the person as 'he,' saying at one point she 'was 60 percent sure' the person was a boy. She described, however, the person as having 'bright red lipstick and lots of powder, and blond hair swept up in back.' This person's name, the patient found upon inquiring, was Janet – very similar to the patient's own name, Nanette; and the patient herself had blond hair. The patient went on to say, giggling tensely, 'He looked like a fashionable sketch,' and then added, 'The other day Dr. ______ [a doctor at the lodge with whom she had, for a long time, an autistic love affair] looked like a fashionable sketch.' This last hinted at her confusion concerning the sex of Dr. ______, a confusion which similarly emerged on various other occasions. All this kind of material from her is suggestive that her confusion about the sexuality of figures in her environment is related to her confusion about her own sexuality.
     It is well known that schizophrenic individuals are frequently confused as to their own maleness or femaleness. … Some of the material suggestive of this point emerged in one hour when she was again describing her experiences of going to the young man's home. She said, 'When it came out of the bedroom it looked just like Fred [the name of the young man] – bright lipstick, a lot of some kind of powder base, and hair done up. It's eyes and nose and mouth were just like Fred's. It was very tall and broad,' she said with a gesture of revulsion. 'I've never seen anything so broad.'
     … I shall not attempt to provide here any detailed material to show further how terrified this young woman was concerning the subjective threat of sexual activity. In the words of her administrator, she was 'crawling with terror' for several months after her admission to the disturbed ward, and in her hours with me she left no doubt that one of her greatest fears was of being raped. She used to plead for, and demand, reassurance that she would not be raped. The psychotherapy eventually brought to light her very strong homosexual desires to rape other persons, and desires on her own part to be raped. She had, as is perhaps by now obvious enough, intensely conflictual desires to be male plus a hatred of and aversion to, maleness.
     In one hour with her I experienced what appears to have been a kind of participation in her own intensely anxiety-laden confusion as to her sexuality. She had come into the hour vividly lipsticked and face-powdered and with a very sexy coiffure, and was lying on the couch with her head propped up and her feet crossed – a posture which impressed me as masculine. I suddenly got a strong conviction that she was a man dressed up as a woman. I kept trying to dismiss the idea as patently absurd, because I knew that the nurses had helped her to change menstrual pads and had given her baths; so I knew it utterly irrational to think that under these circumstances she could have remained on a female ward for many months. But the idea persisted during the remainder of that session, and was accompanied by an eerie feeling which was most uncomfortable. Within the ensuing week, she produced sufficient verbal evidence (some of which I have given above) of her own confusion as to her sexual identity, so as to suggest to me that, as I mentioned in one of my notes during that week, ... my feeling about Nanette as a transvestite probably was not entirely 'imaginary,' i.e. self-produced – probably reflected Nanette's doubt as to her own sex, a doubt reflected in her posture, her mannerisms, and so forth.
     My belief is that I had experienced here, a taste of the eerily uncomfortable feelings which presumably assailed the patient herself in connection with her uncertainty concerning her sexual identity, and that it was partly to relieve just such anxiety as this that her unconscious conception of herself as nonhuman arose.

[ The Non-Human Environment (In Normal Development and in Schizophrenia), Harold F. Searles, M.D., International Universities Press, Inc., New York, 1960, p. 229-232. ]



     One of the most widely mentioned transference problems is that of dealing with homosexual impulses which may threaten the therapeutic relationship when working with paranoid schizophrenics. Techniques for dealing with disturbing homosexual elements of the transference have varied from the utilization of a female helper (Federn, 34, 35) to the direct energetic discouragement of such tendencies in the patient, forcing him to recognize the dangers in the fulfillment of his homosexual phantasies, and advising him to have heterosexual intercourse (Eidelberg, 28). It seemed advisable in the latter case to transfer the patient's sexual wishes at least in part to a female object in order to lessen the tension aroused by his homosexual trends and hence to make them more analyzable. Some authors have suggested the prospect of recovery in such patients may actually be better when they are treated by women since discussion of their homosexual tendencies is less likely to provoke a panic-like state than when treated by men.

[ Man Against Himself, Karl A. Menninger, M.D., Harcourt, Brace & World, Inc., New York, 1938, p. 54. ]



     As one's experience with Mr. Y broadened, it became apparent that his illness represented a struggle against homosexual impulses. In his own story he turned from the peddler, who had wreaths of flowers strung along a stick (probably a symbol of sex to the patient), to the strange girl. His choice of the girl was a flight from homosexual temptation to heterosexual activity. After this incident in which the perverse sexual temptation probably came close to consciousness, he reinforced his defenses by suddenly changing from an easy-going, passive individual whose greatest delight was to putter about the house, to an aggressive, drinking individual, who began to go to houses of prostitution and to fight with his friends. Later, in the sanitarium where he was confined, it was observed that he became disturbed when any attempt was made to substitute men for women nurses in taking care of him. His constant insistence upon his potency was also a defense as was his consistent hatred of anyone whom he called a sissy. This was further corroborated by material brought out in dreams; he dreamed that he was being married, but much to his astonishment he was a woman instead of a man, and a man, a friend of his, holding a long stick, persisted in attempting to thrust it into him.
     In this case, the various elements determining the vivid martyrdom-asceticism picture are clearly visible. The erotic element was explicit; it was of a confused nature involving heterosexual facades for the denial of homosexual urges.

[ Man Against Himself, Karl A. Menninger, M.D., Harcourt, Brace & World, Inc., New York, 1938, p. 97. ]



     Another example of helpful reformulation stems from the experience of one of our associates with a severely disturbed schizophrenic girl. This patient reported to the psychiatrist with whom she had been working over a long period of time: 'I moved up and down and up and down in my bed and was quite upset. I don't know why you told me that I had to wear spikes while doing this.' This patient had been recently moved from the most disturbed ward of the hospital to a less disturbed one. On this occasion she had made the resolution to stop manual masturbation. She was as mixed up about her own sex as most schizophrenics are. The psychiatrist, to whom the patient had previously given information about both these facts, reformulated the patient's statement for her as follows: 'So there was sexual excitement and relief from jumping up and down in your bed. And you were not sure whether or not one had to be a boy ["spikes"] in order to jump around that way. And you do feel that you need the psychiatrist to tell you about it.'

[ Principles of Intensive Psychotherapy, Frieda Fromm-Reichmann, M.D., The University of Chicago Press, Chicago, 1950, p. 95. ]



     The great problem of the pre-schizophrenic person, of course, is that, in keeping with the perpetuation, at an unconscious level, of the undifferentiated mother-infant stage of ego-development, he has not achieved any deep-reaching sexual differentiation of himself and perceived others into either male or female. The struggle to achieve such differentiation is probably one of the internal causes of his conception of all possible human feelings and behavior traits as bearing, like all French nouns, some sexual labels. Such judgements have been fostered in his superego development by parents who were themselves insecure about their sexual identities, and who inculcated in the son the erroneous idea that, for example, gentleness and a love for artistic things are feminine qualities, or in the daughter the notion that assertiveness and practicality are masculine attributes. Such notions, when applied not only to these few human qualities but extended over the whole range of psychological experience, and when applied not to the moderate degree found in the background of the neurotic person but invested with all the weight of actual biological attributes, have much to do with the person's unconscious refusal to relinquish, in adolescence and young adulthood, his or her fantasied infantile omnipotence in exchange for a sexual identity of – in these just described terms – a 'man' or a 'woman.'

[ Collected Papers on Schizophrenia and Related Subjects, Harold F. Searles, M.D., International Universities Press, New York, 1965, p. 437. ]



     Another patient, who passed through a psychosis and panic because of fear of being destroyed and sexually misused, finally recovered and returned to work. A few years later he voluntarily sought admission to St. Eliz. Hospital. He said his genitalia were disappearing and his rectum was changing into a vagina. He was decidedly pleased and lived his belief, devoting his time to erotic fancies about his hermaphrodite nature, not caring to return to society, but probably better pleased with the men on the wards.

[ Psychopathology, Edward J. Kempf, M.D., C.V. Mosby Co., St. Louis, Missouri, 1920, p. 690. ]



     According to Redlich (1952) " Most of the ... psychological propositions about schizophrenia ... may be traced back to ... Freud's ingenious discussion of the Schreber case ". Zilboorg (1941) says that " Freud's views on schizophrenia … were based ... on ... the Schreber case ... Later clinical studies corroborated Freud's views that certain aspects of unconscious homosexuality are the determining factor in the development of schizophrenia ". Fenichel (1945) gives a long list of confirmatory publications.

[ Memoirs of My Nervous Illness, by Dr. jur. Daniel Paul Schreber -- Translated, Edited, with Introduction, Notes and Discussion by Drs. Ida Macalpine and Richard A. Hunter -- Wm. Dawson & Sons Ltd., London,1955, p. 11.]



     By the end of four years of work, when she was finally able to move to a ward for undisturbed patients (though still in a locked building), she had become appreciably freer in revealing fond feelings towards me, towards certain of the nurses and some of the other female patients, although not able as yet to divulge any fond memories about, or fond current interest in, her mother. A little less than one year later (at the end of four and three-quarters years of work) my patient, who throughout these years had been manifesting deep confusion as to her sexual identity – she had consistently referred to herself as 'a girl' but had misidentified other persons on innumerable occasions in terms of a projected male-female unconscious image of herself – referred to herself for the first time in all my experience with her as 'a woman.' Intense feelings of dependency, loneliness, and grief were now emerging from her in the hours as she began expressing fond memories of transitory acquaintances with various girls and women in the past both at school and in hospitals. Although still maintaining her letter-writing to the tenaciously-clung-to Dr. Jones, she was now addressing these letters in such a fashion as to make it clear that they were directed as much to me as to him. In a fit of pique at feeling snubbed by Dr. Jones, she expostulated, 'Why, I'd rather be married to a woman!'
     By now (just one month short of five years) we had become so consciously, but as yet very shyly, fond of one another that we could not look at each other during the session without our faces revealing this fondness. I recall that I fantasied now, and continued to fantasy for many months thereafter on innumerable occasions during our highly productive hours together, that I was giving suck to her from my breast. This was a highly pleasurable experience free from either anxiety or guilt.
     She came to express glowingly libidinized memories of various girl friends, expressive of feelings of adoration and sexual desire which were at least as intense as those she had long expressed earlier in our work, with regard to various father figures. These included long-repressed feelings of intense interest in the female breast.

[ Collected Papers on Schizophrenia and Related Subjects, Harold F. Searles, M.D., International Universities Press, New York, 1965, p. 369. ]



     For all students of psychiatry, Schreber, its most famous patient, offers unique insight into the mind of a schizophrenic, his thinking, language, behavior, delusions and hallucinations, and into the inner development, course and outcome of the illness ... Indeed the memoirs may be called the best text on psychiatry written for psychiatrists by a patient.
     Schreber's psychosis is minutely and expertly described, but its content is – as Dr. Weber explained to the court – fundamentally the same and has the same features as that of other mental patients. Schreber's name is legion.

[ Memoirs of My Nervous Illness, Daniel Paul Schreber, translated by Drs. Ida Macalpine and Richard A. Hunter, Wm. Dawson & Sons, Ltd., London, 1955, p. 25. ]



     For example, the female patients often queried their sex in the presence of a male therapist. In an earlier example one patient asked if she was a doctor. She continued: 'Trousers. Each man and woman has trousers on.' Another patient would frequently stand in front of the fire holding a poker in front of her genitals. When asked about this she said she was 'a man standing up.'

[ Chronic Schizophrenia, Freeman, Cameron, McGhie, preface by Anna Freud, International Universities Press, New York, 1958, p. 54. ]



     As already mentioned, Andrew Gray experienced hallucinations of a voice which whispered obscenities in his ear and urged him to masturbate and swear. At other times he experienced visual images, mentioned above, which were again sexual in nature. These experiences were often of a manifestly homosexual type. The genesis of this patient's hallucinations becomes evident when his past history is considered. From his early youth Andrew had participated in a number of incidents with older men involving fellatio and other homosexual stimulation. The beginning of his psychotic breakdown occurred when he was posted by the R.A.F. to a lonely station on the Orkneys where, it can be suggested, the intense pressure of a small closely knit all male culture proved too strong for his basic homosexual conflicts. The voices and visual images the patient now began to experience represented his own homosexual urges which were unacceptable to the ego, and so lost the ego cathexis necessary to identify them as originating within the psyche. The externalization of his own thought processes, concurrent with the break with objective reality, led to the further adjustment which reunited outer reality and the inner processes that had become the psychotic 'reality.' This adjustment took the form of an unknown individual who tormented him with 'a machine' that communicated to him the oral and visual obscenities so repugnant to his own ego. On occasions he would declare his suspicions that the operator of this 'F-ing machine' was an older man who had first persuaded him to indulge in fellatio. His description of the machine itself being like 'an old granny blethering away' has also significance as the patient was reared for the most part by his rather prim grandmother. The reality adjustive function of this delusion became evident when the patient was faced with interpretations which threatened its existence, when his reaction was to refuse further attendance at the groups.

[ Chronic Schizophrenia, Freeman, Cameron, McGhie, preface by Anna Freud, International Universities Press, New York, 1958, p. 67. ]



     Patient B, a married man of German descent, was 40 years of age at the time I became his therapist. He has been admitted to two psychiatric hospitals previously – once for a period of one and a half years, and the second time for a period of six months. His symptomatology during his stay at each of the two previous hospitals had been, as it was when I first saw him, typical of paranoid schizophrenia.
     During the first interviews with me, he allowed silences of no more than a second or two. He kept up an almost incessant stream of conversation, consisting in a melange of references to books he had read, interspersed with comments reflecting self-misidentification, such as, 'Of course I'm Cortez … I died in 1920 as Tolstoy … . I was Esther Williams in [name of a motion picture]'… He apparently considered himself to be, from one moment to another, a limitless number of prominent persons, present and past, including Alexander the Great, Pericles, General Lee, Lincoln, Goethe, Senator Vandenberg, various movie actors and actresses, and so on, and made references to various supernatural powers which he possessed.

[ Collected Papers on Schizophrenia and Related Subjects, Harold F. Searles, M.D., International Universities Press, New York, 1965, p. 80. ]



     The maladaptiveness of the male schizophrenic withdrawal is even more obvious and has been often noted in the literature. For example, Farina, Garmezy, and Barry (1963) report the same differential in marriage rates among male and female schizophrenics noted above and comment that to marry in our culture a man must usually approach, court, and propose to a woman as well as provide a home and financial support for her. Such actions require an assertiveness that male schizophrenics typically lack. However, a woman may marry even though she is sex-role alienated simply because less is required of her. All she has to do is 'go along.' The authors also point out that this explains why among divorced and separated schizophrenics more men than women recovered. The men presumably had to be better sex-adjusted to get married in the first place than the women.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 238. ]



     The specificity of the evidence for schizophrenic sex-role alienation suggests the results are not trivial. If it had been found that schizophrenics, whether male or female, simply fail to give normal sex-typed responses, one need only infer that here, as elsewhere, schizophrenics are disorganized. Perhaps they just do not attend to the tests but respond more or less randomly. Such an hypothesis is rendered unlikely by the fact that the schizophrenics give normally sex-typed responses to some tests and not others, and to some items on particular tests and not others.
     For instance, schizophrenic females generally care less than normals about all parts of the body, showing no differential for male and female parts, while male schizophrenics are more sensitive than normal males about female parts. This also demonstrates that sex-role alienation is not simply a matter of one sex reacting always exactly like the opposite sex. That is, the schizophrenic females are not relatively more sensitive about their male than female parts, as the normal males are. It is sex-role alienation, not reversal. Alienation often means reacting like normals of the opposite sex because that is the major or only alternative, but such is not always the case.
     The results taken together suggest that the components of sex-role identity can be arranged in a hierarchy of importance to normal adjustment. At the most basic primary level, at the center of personality structure, lies something that might be labeled gender identity, an unconscious schema representing pride, confidence, and security in one's membership in the male or female sex. Strictly speaking it has little to do with sex-typed actions or roles (which exist on the secondary level of the hierarchy) but with the fundamental experience of one's self as male or female. At this level the schizophrenics show the most disturbance: they make opposite-sex choices in the Role Playing Test, and they do not experience their own bodies the way normal men and women do. The Figure Preference Test results also suggest the same kind of disturbance in self-orientation, but they are harder to interpret and obviously need replication either with the original free response test or with figure choices more definitely representing various male and female body parts. Among the female schizophrenics, 82% either make three or more opposite-sex choices in the Role Playing Test or are insensitive to their bodies (accepting 14 or more of 20 parts) in a very unfeminine way. This contrasts with only 28% of all the normal females who showed one or the other of these deviations. Among the male schizophrenics, 95% show either the same degree of disturbance on the Role Playing Test or are especially sensitive to their female parts, in a non-masculine way (accepts 6 or less out of 8), as contrasted with 35% of the normal males showing one or the other of these gender-alien signs. The instruments were not designed to maximize discrimination of schizophrenics from normals, but even two such simple signs yield very large differences, suggesting that the fundamental problem exists for schizophrenics at this level.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 236-237. ]



     Normal males clearly show less concern with their bodies than normal females. Nearly three-fourths of the males express satisfaction with about three-fourths of the parts listed, as contrasted with less than one-fifth of the females (x 2 = 10.10, p < .01). Note that both groups of normal women show the same pattern, with the housewives being, if anything, even more concerned about their bodies than the working women. Among schizophrenics there is a decided reversal, females are less concerned, males more so, and the interaction chi-square is highly significant. The result is all the more impressive because it replicates a Sex X Diagnosis interaction found in a similar experiment by Holzberg and Plummer (1964). The reversal shows up markedly for female body parts. Among normals, females care more about them and males less, but among schizophrenics, males care more than females. These parts have to do essentially with the appearance of the body – it's presenting aspects (face, lips, hips, etc.). It is as if female schizophrenics have become insensitive to their appearance (like normal males), and male schizophrenics have become more sensitive to how they look (like normal females).

     Normal males clearly show less concern with their bodies than normal females. Nearly three-fourths of the males express satisfaction with about three-fourths of the parts listed, as contrasted with less than one-fifth of the females (x 2 = 10.10, p < .01). Note that both groups of normal women show the same pattern, with the housewives being, if anything, even more concerned about their bodies than the working women. Among schizophrenics there is a decided reversal, females are less concerned, males more so, and the interaction chi-square is highly significant. The result is all the more impressive because it replicates a Sex X Diagnosis interaction found in a similar experiment by Holzberg and Plummer (1964). The reversal shows up markedly for female body parts. Among normals, females care more about them and males less, but among schizophrenics, males care more than females. These parts have to do essentially with the appearance of the body – it's presenting aspects (face, lips, hips, etc.). It is as if female schizophrenics have become insensitive to their appearance (like normal males), and male schizophrenics have become more sensitive to how they look (like normal females).
     For the male body parts, the interaction is not significant. The female schizophrenics continue to be more satisfied than their normal counterparts, but both groups of males are equally satisfied. However, there is another interesting and significant reversal among the males. Normal males care more about their male (or strength) body parts than their female (or appearance) parts, but the trend is reversed for the male schizophreni(interaction x 2 = 4.33, p < .05). The same reversal does not appear for the females.
     To summarize these findings: schizophrenic males have replaced the normal male concern for masculine body parts with a greater concern for their appearance, like normal females. Schizophrenic females simply show less concern for all parts of their bodies, whether masculine or feminine. By itself, such indifference might be attributable to long hospitalization, but this explanation would not account for the differential results for the schizophrenic males. It seems plausible to conclude that some part of the schizophrenic woman's unconscious self-image is insensitive and more masculine, whereas some part of the schizophrenic man's self-image is sensitive and more feminine. Whether this difference predates their entry to mental hospitals is a question for further research.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 234. ]



     Another case will bring out more of the motives. A thirty-year-old naval officer, married, was brought to the hospital with a history of having mistreated himself and of having contemplated suicide. He was quiet, neat, mildly depressed.
     The history was that his father had been very religious but very difficult to get along with and had deserted the family while the patient was yet small. The mother had been obliged to work very hard to support them. The boy himself had to go to work at an early age but in spite of this obtained a fair education intermittently. He had joined the navy and worked himself up to petty-officer rank. A year before admission he noted that he worried about his work and asked his friends if they noticed that he was not doing so well. He became increasingly depressed.
     Then he began to notice strange noises, thought he heard his shipmates talking about him and accusing him of perverted practices (i.e., of being homosexual). (Individuals with such fears and hallucinations rarely are homosexual overtly, but react with terror to the thought that they might be – just as 'normal' persons do, but in greater degree.) Finally he went to the bathroom and with a safety razor amputated his penis.
     When questioned about it the patient said he has been confused and hadn't known what he was doing. He seemed however, to show little concern or regret. Later he jumped overboard but climbed back aboard the ship on the anchor chain. He admitted, however, that the thought of drowning had always fascinated him.
     The examination showed that he still suffered from auditory hallucinations with voices telling him to do odd things and commenting on what he did. Concerning the charge of homosexuality he was quite perplexed because he had never indulged in it but began his heterosexual life very early. Except for the mutilation his physical condition was excellent and his intelligence above average.
     Later the patient announced that he was 'ready for the supreme sacrifice' (suicide) and wrote a note saying, 'I am a pervert and will pay the penalty.' He became increasingly restless and disturbed and exhibited impulses to fight with patients and attendants.
     ... There is, however, another element which we must not lose sight of. A man who feels guilty about his sex organs because of conscious or unconscious homosexual impulses, accomplishes two purposes when he cuts off his genitals. He punishes himself, but at the same time he converts himself by this deprival into a passive, penisless individual, anatomically comparable with the female. By this anatomical identification, he comes closer to the homosexuality about which he feels guilty than he was before the act. He feels guilty about his homosexual wishes and by castrating himself appears to atone for and relinquish them, but in reality only changes himself so as to be incapable of the active role and even more disposed to the passive role. 35

[ Menninger, K. A., M.D., Man Against Himself, New York. Harcourt, Brace & World, Inc., 1938, pp. 236-237 ]



      As a preliminary exercise in understanding the possibilities in such a situation, a case reported from the literature on mental illness may be considered.
      It is that of a man who has been hospitalized for a long time because of some rather weird ideas. He thinks that certain persecutors, by exerting extraordinary influence upon him, are causing him to be tormented with sexual sensations and feelings which he finds, or professes to find, revolting. The 'influences' by which this is achieved are invisible, and act over long distances. Of main interest here is the kind of experience that could lead to such a disorder, and the kind of person to whom it could happen.
      Important, first of all, is a particular build of personality. The man is described, at the outset, as exaggerated in his self-esteem, confident to the point of arrogance. In the midst of his exalted pretensions and a feeling of contemptuous superiority towards others, he now discovers within himself, not only that he is timid and inadequate in the region of sexual behavior, but that he has a natural disposition toward effeminacy.
      In a society such as ours, in which 'real manhood' is so closely linked with sex virility and masculine courage, such a discovery might well be catastrophic, especially to a person who tends strongly toward vanity. It may easily be believed that the conflict was completely unbearable. Here, where the most exalted ago was confronted with the most degrading and shameful defect, is something approaching the ultimate degree of human internal crisis. The effect of directly facing the facts would be like an explosion in a locked room.
      That such a person should begin to feel himself regarded as an object of contempt is understandable enough; likewise that the onset of his disorder should show the familiar mistaken interpretation of remarks in which he finds the accusation that he is queer and lacking in masculinity.
      In the next phase the idea develops that he has become the object of a plot in which certain evil persons (through motives which need not be detailed) are causing him, or forcing him, to experience the emotions, thoughts and desires of a woman. The extraordinary means by which these influences are exerted, he believes, involve not only supernatural forces, but also electrical action, in which the nerves of his skin are likened to 'tiny radio antennae capable of receiving sensations.'
      While the delusional system here includes some rather strange notions, to be later considered, its meaning is clear enough. Through the belief that others are working these criminal effects upon him, he is able to enjoy otherwise forbidden and shameful erotic sensations and emotions with the excuse that he is a passive and helpless victim. Feminine feelings, homosexual desires, the impulse to masturbate, all now become tolerable since full responsibility can be charged to the persecutors. The delusions are thus, in effect, a denial of ownership. The patient has 'pointed the finger' elsewhere. He has made the paranoid shift.

[ This is Mental Illness (How it Feels and What it Means), Vernon W. Grant, PhD, Beacon Press, Boston, 1966, pp. 92-94. ]



      The cross-cultural and cross-species comparisons presented in this chapter combine to suggest that a biological tendency for inversion of sexual behavior is inherent in most if not all mammals including the human species. At the same time we have seen that homosexual behavior is never the predominant type of sexual activity for adults in any society or in any animal species.
      ... The basic mammalian capacity for sexual inversion tends to be obscured in societies like our own which forbid such behavior and classify it as unnatural. Among these peoples social forces that impinge upon the developing personality from earliest childhood tend to inhibit and discourage homosexual arousal and behavior, and to condition the individual exclusively to heterosexual stimuli. Even in societies which severely restrict homosexual tendencies, however, some individuals do exhibit homosexual behavior. In our own society, for example, homosexual behavior is more common than the cultural ideals and rules seem to indicate.

[ Patterns of Sexual Behavior, Clellan S. Ford, PhD and Frank A. Beach, PhD, Harper & Brothers, Publishers, and Paul B. Hoeber, Inc. Medical Books, 1951, pp. 143. ]



      Among the Siwans of Africa, for example, all men and boys engage in anal intercourse. They adopt the feminine role only in strictly sexual situations and males are singled out as peculiar if they do not indulge in these homosexual activities.4 Prominent Siwan men lend their sons to each other, and they talk about their masculine love affairs as openly as they discuss their love of women. Both married and unmarried males are expected to have both homosexual and heterosexual affairs. Among many of the aborigines of Australia this type of coitus is a recognized custom between unmarried men and uninitiated boys. Strehlow writes of the Aranda as follows: ... 'Pederasty is a recognized custom. ... Commonly a man, who is fully initiated but not yet married, takes a boy ten or twelve years old, who lives with him as a wife for several years, until the older man marries. The boy is neither circumsized nor subincised, though he may have ceased to be regarded as a boy and is considered a young man. The boy must belong to the proper marriage class from which the man might take a wife.' (Strehlow, 1915, p. 98)
      Keraki bachelors of New Guinea universally practice sodomy, and in the course of his puberty rites each boy is initiated into anal intercourse by the older males. After his first year of playing the passive role he spends the rest of his bachelorhood sodomizing the newly initiated. This practice is believed by the natives to be necessary for the growing boy. They are convinced that boys can become pregnant as a result of sodomy, and a lime-eating ceremony is performed periodically to prevent such conception. Though fully sanctioned by the males, these initiatory practices are supposed to be kept secret from the women. The Kiwai have a similar custom; sodomy is practiced in connection with initiation to make young men strong.

[ Patterns of Sexual Behavior, Clellan S. Ford, PhD and Frank A. Beach, PhD, Harper & Brothers, Publishers, and Paul B. Hoeber, Inc. Medical Books, 1951, pp. 131-132. ]


It is interesting to note that normal, opposite-sex sexual desires have always, since the early days of Christianity, had names with disapproving connotations attached to them. For example, there are the "Sex [six] L's", as I refer to them: 1. Lascivious. 2. Lewd. 3. Lecherous. 4. Licentious. 5. Lustful. 6. Lubricious. ( And we can also throw in "Wanton" and "Dissolute" as two extra non-Sex L's! )

SO, if not heterosexual, then what?

[ J. Michael Mahoney, Feb. 27, 2014. ]



     At home things really began to deteriorate. I seemed to be tired all the time and I'd sleep for hours without being refreshed by the rest. I became indifferent to Laurie and my sexual appetite vanished; on those rare occasions when we did have intercourse, neither of us was satisfied. I began to doubt my masculinity. There must be something wrong with a man who can't satisfy the woman he loves. Maybe I'm a homosexual. That thought terrified me. On the streets I began to fancy that other men were looking at me. I began to see homosexuals everywhere, and all of them were laughing at me. (A terrible kind of desexualization, a loss of masculine identity, seems often to accompany schizophrenia when it develops in men, and perhaps this accounts for their morbid anxiety over homosexuality.)

[ In Search of Sanity, The Journal of a Schizophrenic, Gregory Stefan, University Books, Inc., New Hyde Park, New York, 1965, p. 19. ]



     As the evening wore on, Tony behaved more and more peculiarly. Despite Bernadette's enthusiasm for the House of Plenty sexuality course, Tony had said next to nothing on the subject, preferring to sit and apparently listen, brooding, But as the conversation turned to more general subjects, he got up and began to prowl the room, almost in parody of a jungle animal. Nobody took much notice; we all assumed that he had been smoking some kind of powerful dope before he got there and was enjoying an interior trip he couldn't share. At one point he went over to Steve, and several times stroked his hair – but it was less a caress than a slap. Later he stalked me, like a cat, and looked in my eyes and said, 'I like you. You know, don't you? You know.'
     I really didn't know, but it's always nice to be told I do, and I nodded at him and he nodded sagely back, and turned away to stalk somebody else. When Tony and Bernadette left, David said, 'Gee, Tony was really strange tonight. Wonder what he's been smoking.' And that's all that was said about it.
     But later in the week I talked to David on the phone and he said things had been very bad with Tony and Bernadette. Apparently the sexuality rap at the House of Plenty had caused Tony to flip utterly. He was manic, as if stoned twenty-four hours a day, never sleeping, always grooving and freaking in this peculiar animalistic way. Little as she cared to, Bernadette took Tony to a straight psychiatrist who said he was schizoid, was in a profound homosexual panic, and ought to be sedated at once. Bernadette would have none of that. She got in touch with Julian Silverman, the Esalen-based shrink who runs the only Laing-oriented Blowout Center in the country, in a wing of Agnews State Hospital near San Jose; Silverman agreed to accept Tony as a voluntary patient. Tony was rarely lucid during discussions leading to his arrival at Agnews, but he was able to agree to admittance and sign the right papers.
     When I next saw Bernadette she was exhausted from dealing with Tony, sleeplessly, for four days, disturbed at what their families would conclude from all this, desperately eager that Tony be able to go through his psychosis quickly and come out, healed, on the other side. And she was fiercely angry with the House of Plenty, even if it had been a rap session only. Obviously, all this auto-erotic, plastic bottle stuff had got to Tony in secret places he didn't know about himself; his response had frightened him into the aforementioned homosexual panic. The House of Plenty people had asked Bernadette to bring Tony back to Oakland. They had seen this response occasionally in the past; perhaps they could help. But Bernadette was having none of that either: 'The bastards should have warned us that the rap was dangerous! It's all their fault.'
     It wasn't, of course, but Bernadette was very tired and distressed, and at that moment I was not about to disagree with her.
     The fault, if you want to call it that, was with the House of Plenty for assuming that everybody attending their basic sexuality seminar was sexually mature. The assumption would have seemed especially justified in Tony's case, on the evidence of his very considerable experience with Esalen and with group encounters of all kinds. But it seemed to us as laymen that the straight shrink's categorization of Tony's state as 'homosexual panic' was correct. The suggestion of sticking a plastic bottle up his ass may have triggered in Tony long suppressed homosexual fantasies. And to have these suggestions delivered – much as Bernadette transmitted them to us – in wholesome, straightforward circumstances, set Tony on a cosmic giggle that we also thought was funny, but threatened with him to last a lifetime.

[ The Bearded Lady, Going On The Commune Trip and Beyond, Richard Atcheson, The John Day Company, New York, 1971, p. 194. ]



     Sullivan's letter to Dorothy Blitzen shows his acceptance of his own lot in life, making it possible for him to deal gracefully with the marital problems of his friends. But earlier – in particular near the end of his years at Sheppard – he had a tragic awareness of his own situation. He had clear evidence from his patients – young males showing acute schizophrenic-like panic – that fear of so-called aberrant sexual cravings in the transition to adolescence was often a prelude to schizophrenic panic; and that early and skilled care within a therapeutic milieu could effect a social recovery, with the patient acquiring an ability to handle sexual needs without interfering drastically with his self-esteem. By then, Sullivan was in the fourth decade of life, and he felt that his pattern of life was already determined; thus his discovery could help others more than it could effect any change in himself. In 1929, he reports on his conclusion from the Sheppard experience: 'In brief, if the general population were to pass through schizophrenic illnesses on their road to adulthood, then it would be the writer's duty, on the basis of his investigation, to urge that sexual experience be provided for all youths in the homosexual phase of personality genesis in order that they might not become hopelessly lost in the welter of dream – thinking and cosmic phantasy making up the mental illness.' His data and certain considerations which he spells out in the same article 'lend pragmatically sufficient justification for the doctrine of a 'normal' homosexual phase in the evolution at least of male personality.' 6
     Thus almost two decades before the first Kinsey report, in 1948, on the sexual behavior of the human male, Sullivan had arrived from his own data at one of the major findings of that report. He had located the lack of experience with a 'normal homo-sexual phase' in his own growing-up years, and hypothesized that this lack had occasioned his own encounter with schizophrenic episodes. Throughout the rest of his life, he had frequent encounters with that painful experience, as late as 1947, he confided in a woman colleague that he had had severe schizophrenic episodes early in life and that he still had them. 7 He told her that he liked to live alone and spend time away from people so that few people would realize that he had such episodes; in particular he was afraid that he would be put into an institution and that someone would 'tamper with his brain.'

[ Psychiatrist of America, The Life of Harry Stack Sullivan, Helen Swick Perry, The Belknap Press of Harvard University Press, Cambridge, MA, and London, 1982, p. 337. ]



     She let me just rot in the hospital that first time, she's a fuckin' whore, that's what I told her, that always gets to her. So she put me in the hospital again. She called her boyfriend over and he beat me up because I had disrespect for my mother. You son of a bitch, you try to put me in the hospital, I'll kill you. I tried to call my therapist but he punched me to the floor each time. They tied me down and put me in a straight jacket.
     At the hospital – questions! 'What's the matter?' the psychiatrist wants to know. 'Wars stink. Prostitution stinks. You stink.' 'I think we're gonna have to keep you,' he says. 'No foolin'! This time I had a beautiful woman doctor from Central America, and she really helped me get out ...
     They gave a lot of psychological tests and, you know, I came out masculine. What does that mean? Like on one test they ask: do you want to be married and happy or rich and single? 'Oh, shit! Rich and single,' I said.

[ Women and Madness, Phyllis Chesler, PhD, Doubleday & Company, Inc., Garden City, New York, 1972, p. 232. ]



     Doris: Were you sheltered?
     Shirley: No! Come on, girl. Well, number one, I was very confused and frightened about where I was coming from, actually.
     Doris: What do you mean by 'coming from'?
     Shirley: Well, I thought I was one of the sickest persons in the world. You know, I dreaded even thinking about the term 'lesbian' and I used to cope with the situation by telling myself that I was normal, you understand? And the only thing that would take my normality away would be for me to have an actual gay experience. And I also used to tell myself that you're not gay if you never do it. So I didn't, 'cause I didn't want nothing to tread on my sanity. So I pretended to like boys and dresses and parties and all that bullshit.
     Doris: So you were just fooling yourself?
     Shirley: No, no, I wasn't fooling myself, I was trying to live with myself, and I went out with fellas and I let them fuck me...
     Doris: Well, if you didn't want to be a girl why --
     Shirley: That's what I'm saying. The more they did it, the worse I got, and the more I pretended to act normal, the crazier I got. And I mean I was going out of my mind. When my mother died I just stopped pretending to be something that I wasn't because it ain't done much straightness in the world and it put my mind at ease, you better believe it, and I regained my sanity which was slowly seeping away from me, from trying to be ungay and I am definitely gay.

[ Women and Madness, Phyllis Chesler, PhD, Doubleday & Company, Inc., Garden City, New York, 1972, p. 201. ]



     Lois: One female therapist got scared when I became 'gay.' 'I can't treat homosexuals. There's nothing you can do with them.' She made it sound like terminal cancer ... One male therapist kept insisting I wasn't gay, but he told me it's something I'll outgrow ... He told me I'd end up alone and bitter in the gay scene, and that didn't appeal to me. It still doesn't ... Another woman therapist said, 'But men are so marvelous to sleep with! Lesbianism isn't necessary, it's absurd!'
     In a sense, being psychiatrically hospitalized helped me. I'd hit bottom. Now I could be a lesbian, that's not as bad as a crazy ...

[ Women and Madness, Phyllis Chesler, PhD, Doubleday & Company, Inc., Garden City, New York, 1972, p. 193. ]



     Cheek's (1964) study demonstrated sex-role alienation in schizophrenics in the most theoretically relevant way. She used the Bales' (1950) Interaction Process Analysis coding system for small group behavior in observing discussions that normals and schizophrenics of both sexes had with their parents. Schizophrenic women were more active and schizophrenic men less active than their normal counter-parts. Female schizophrenics exceeded all three other groups in the instrumental conversational categories (giving opinion and explaining – clarification) which are normally male specialties. While she questions whether this may be due to a selection factor in hospitalization which allows overactive males and underactive females to stay in society, the finding adds to the impression that schizophrenic men and women are alienated from their normal sex roles.
     Kagan and Moss (1962) report findings that suggest the etiology of this shift. They found that male children (age 0-3) to whom mothers were hostile tended to grow up to be withdrawn, non-achievement-oriented, and socially anxious (showing the schizoid, non-assertive type of adjustment in males). In contrast, female children to whom mothers were hostile tended to grow up into active, competitive, assertive women (showing an atypical pattern with some components of a schizoid type of adjustment in females). It is conceivable that maternal hostility created sex-identity problems in the children which were solved by opting in part for the opposite sex approach to life.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 227. ]



     The history of castrant sects goes back to very early times. It reached its height in rites connected with the worship of the great mother goddess in ancient Syria during which young celebrants, duly fortified by drugs and roused to religious frenzy stepped forth to the altar and in the presence of all cut off their organs and flung them at the foot of the idol.

[ Sex and the Supernatural, Benjamin Walker, Harper & Row Publishers, New York, Evanston, IL, San Francisco, CA, and London, 1970, p. 84. ]



     Case PD-26 was the only son of an overworked, uneducated mother who suffered from neglect and the need of the simple comforts necessary to make life worth living. He was a typical 'mama's boy,' seriously pampered, effeminate, dainty in his manners, tenor voice, and generally submissive in his make-up.
     He was an ordinary seaman in the navy when a typical homosexual panic developed in which he was obsessed with fears that men plotted to sexually assault him. He had to be tube-fed, and when he resisted, and his arms were forcibly drawn behind him, he had a 'vision of Jesus Christ and the thieves on the cross,' feeling that he was being crucified as one of the thieves. Later, he realized that it was 'imagination.'

[ Psychopathology, Edward J. Kempf, M.D., C.V. Mosby Co., St. Louis, Missouri, 1920, p. 502. ]



     Psychoanalytic observations of schizophrenics subjected to insulin shock therapy provide another opportunity for an understanding of the role of latent homosexuality in the origin of paranoid schizophrenia. In particular, these observations illustrate the important role played by the homosexual disappointment and the homosexual panic. The cathartic discharge provoked by the insulin coma creates a release of repressed libidinal impulses. The ambivalent homosexual attitude becomes split into its two components, with the positive one invested ideally in the transference reaction and thus accessible to analytic interpretations and working through.
     Psychoanalytic investigations have demonstrated the affinity between homosexuality and the schizophrenic break. In certain complex cases of latent homosexuality, the counter-cathexis, built by the ego in order to maintain the dissociation of the psychotic core from the rest of the ego, is so precarious that the psychotic invasion occurs, as it were, spontaneously and periodically.

[ Homosexuality and Psychosis in Perversions, Psychodynamics and Therapy, Gustav Bychowski, M.D., edited by Sandor Lorand, M.D., Random House, Inc., New York, 1956, p. 105. ]



     In each family at least one parent suffered from serious and crippling psychopathology, and in many both were markedly disturbed. Although none of these parents had ever been in a mental hospital, at least 10 of the 16 families contained a parent who was an ambulatory schizophrenic or clearly paranoid, and our diagnostic cut-off point was arbitrary and conservative. Still others were chronic alcoholics, severe obsessives, or so extremely passive-dependent that they were virtually children of their spouses rather than another parent. Many parents constantly required support for their tottering narcissism that could not be gained from the spouse, and they chronically distorted situations to maintain their self-image and the single, narrow way of life that constituted their adjustment. Insecurity and confusion concerning sexual identity, often with fairly obvious homosexual trends, were common, and many of these parents had difficulty in controlling their incestuous impulses, both heterosexual and homosexual.

[ "Schizophrenia, Human Integration, and the Role of the Family," Theodore Lidz and Stephen Fleck, (in The Etiology of Schizophrenia, edited by Don D. Jackson, M.D., Ibid., p. 333). ]



     Simply to indicate the scope of the expansion and reorganization of psychoanalytic theory and psychopathology that appears to be required, we shall briefly consider problems of sexual identity. Whether a person is a male or a female is probably the most important determinant of personality characteristics, and security of gender identity is of critical moment to harmonious personality development. Confusions of sexual identity are basic to most of the perversions, and thereby, if we accept Freud's dicta, contribute to the causation of the neuroses. We have already adequately emphasized the critical role of gender identity confusion in schizophrenia.

[ -- Schizophrenia and the Family -- Theodore Lidz, M.D., Stephen
      Fleck, M.D., and Alice R. Cornelison, M.S.S., International
      Universities Press, Inc., New York, 1965, p. 427. ]



     The problems presented by fathers who are passive adjuncts of their wives, or mothers who assume the prerogatives of fathers, lead to the topic of the importance of the parents' maintenance of gender-linked roles. The parental adherence to appropriate sex-linked roles not only serves as a guide for the achievement of reciprocal role relationships by parents but also plays a major part in guiding the child's development as a male or female. Of all factors entering into formation of personality characteristics, the sex of the child is the most decisive; and security of sexual identity is a cardinal factor in the achievement of a stable ego identity. Probably all schizophrenic patients are seriously confused in their sexual identity. Clear-cut role reversals in parents can obviously distort the child's development as when a parent is overtly homosexual or when they concern the division of major tasks between the parents. However, the inability of a mother to fill an affectional-expressive role, or of a father to provide instrumental leadership for the family also creates difficulties. Either a cold and unyielding mother or a weak and ineffectual father is apt to distort the family structure and a child's development. Failures to maintain gender-linked roles by parents as well as failures of one parent to support the spouse's gender role were very striking in these families – failures ranging from strong homosexual tendencies through assumptions of male roles by mothers and female roles by fathers to absence of effective parental leadership and maternal coldness and aloofness.
     Although the various complications that arise from such deficiencies in parents' adherence to sex-linked roles deserve more discussion, we should note that if a mother is consciously or unconsciously rivalrous with men and denigrating of her husband, a son can readily learn that masculinity will evoke rebuff from her, and fear of engulfment or castration by the mother can outweigh fears of retaliatory castration by the father. The schizophrenic patients' faulty sexual identity, including homosexual tendencies and concerns, are related to the parents' confused gender roles and the resultant imbalances in the family's dynamic structure.

[ -- "Schizophrenia and the Family" -- Theodore Lidz, M.D., Stephen Fleck, M.D., and Alice R. Cornelison, M.S.S., International Universities Press, Inc., New York, 1965, pp. 370-71. ]



     I have often marveled about the frequency with which psychotic episodes in Latin-Americans begin with a homosexual panic, until I understood that the word maricon (homosexual) is the most derogatory term, used constantly in Spanish-America. Contempt and self-contempt has no parallel or equally meaningful word in Spanish.

[ Johannes M. Meth, M.D., "American Handbook of Psychiatry", Vol. III, Basic Books, Inc., NY, p. 729. ]



     What was true of Goethe is true of me. I have two souls. What are they? They are male and female, positive and negative, destructive and inductive, Yang and Yin. And they want to divide in a sort of eternal schizophrenia. Well, let them go. I, quite an ordinary person, have reunited them and I tell them to go where they will. I have a split mind. I was a manic-depressive; let us say for the sake of the argument that I am now a schizophrenic.

[ Wisdom, Madness and Folly (The Philosophy of A Lunatic), John Custance, Pellegrini & Cudahy, New York, 1952, p. 135. ]



     We shall attempt to characterize the nature of this 'self' by statements made not only by this 'self' directly but also by statements that appear to originate in other systems. There are not a great many of these statements, at least by the 'self' in person as it were. During her years in hospital, many of them probably had become run together to result in constantly reiterated short telegraphic statements containing a great wealth of implications.
     As we saw above, she said she had the Tree of Life inside her. The apples of this tree were her breasts. She had ten nipples (her fingers). She had 'all the bones of a brigade of the Highland Light Infantry.' She had everything she could think of. Anything she wanted, she had and she had not, immediately, at the one time. Reality did not cast its shadow or its light over any wish or fear. Every wish met with instantaneous phantom fulfillment and every dread likewise instantaneously came to pass in a phantom way. Thus she could be anyone, anywhere, any time. 'I'm Rita Hayworth, I'm Joan Blondell, I'm a royal queen. My royal name is Julianne.' 'She's self-sufficient,' she told me. 'She's the self-possessed.' But this self-possession was double-edged. It had also its dark side. She was a girl 'possessed' by the phantom of her own being. Herself had no freedom, autonomy, or power in the real world. Since she was anyone she cared to mention, she was no one. 'I'm thousands. I'm an in divide you all. I'm a no un' (i.e. a nun: a noun: no one single person). Being a nun had very many meanings. One of them was contrasted with being a bride. She usually regarded me as her brother and called herself my bride or the bride of 'leally lovely lifey life.' Of course since life and me were sometimes identical for her, she was terrified of Life, or me. Life (me) would mash her to pulp, burn her heart with a red-hot iron, cut off her legs, hands, tongue, breasts. Life was conceived in the most violent and fiercely destructive terms imaginable. It was not some quality about me, or something I had (e.g. a phallus = a red-hot iron). It was what I was. I was life. Notwithstanding having the Tree of Life inside her, she generally felt that she was the Destroyer of Life. It was understandable, therefore, that she was terrified that life would destroy her. Life was usually depicted by a male or phallic symbol, but what she seemed to wish for was not simply to be a male herself but to have a heavy armamentarium of the sexual equipment of both sexes, all the bones of a brigade of the Highland Light Infantry and ten nipples, etc.

     She was born under a black sun.
     She's the occidental sun.

     The ancient and very sinister image of the black sun arose quite independently of any reading. Julie had left school at fourteen, had read very little, and was not particularly clever. It was extremely unlikely that she would have come across any reference to it, but we shall forgo discussion of the origin of the symbol and restrict ourselves to seeing her language as an expression of the way she experienced being-in-the-world.
     She always insisted that her mother had never wanted her, and had crushed her out in some monstrous way rather than give birth to her normally. Her mother had 'wanted and not wanted' a son. She was 'an accidental sun,' i.e. an accidental son whom her mother out of hate had turned into a girl. The rays of the black sun scorched and shrivelled her. Under the black sun she existed as a dead thing.

[ R. D. Laing, M.D., "The Divided Self", PenguinBooks, Baltimore, Md, 1965, p. 203 - 205. ]



     I had been seeing this man, a typical transvestite, for about a year. He would not consider himself a patient but rather a research subject, though I was aware that his occasional visits were motivated by more than his willingness to assist in the research. As different from most transvestites, he had a clear though mild paranoid quality, which put him into closer contact with some of his psychodynamics than is seen in the typical transvestite. Sometime before his first visit, he had gotten from some reading the idea that transvestism and homosexuality were connected. To determine if this was true for himself, over a period of several months he talked with homosexuals, visited 'gay' bars, and read increasingly about homosexuality. (I take this to be evidence of homosexual desires, still forbidden but nonetheless moving toward conscious gratification.) Along with this interest, he coerced his wife into sexual games in which homosexual qualities were increasingly manifest. This was accompanied by a crescendo of anxiety, irritability, suspiciousness, depressive fits, and hyperactivity, culminating in a paranoid psychosis precipitated by his having his wife, dressed like a prostitute, attach to herself an artificial penis he had made, with which she then performed anal intercourse upon him. Following this dreadful, and finally quite conscious, gratification of his homosexual desires, he became suicidal and homicidal. As we talked throughout the several hours of this emergency, he vividly expressed his opinion, derived possibly in part from his readings, but mainly from his own psychotic thoughts, that his transvestism had been an attempt to keep himself from sensing his homosexual desires. As he absorbed what he was saying, he became calmer. He also stopped his transvestism. Since that moment, a year ago, he has not practiced it again.
     A psychodynamic remission. He now has insight, the product of his psychosis and the cause of his remission. Where formerly a potential psychosis was held in check by the complex character structure we have called transvestism, the psychosis is now contained by insight ... But is that the answer? Is there proof this is so? Would a recurrence of the psychosis prove the theory wrong?
     The patient now says that he no longer has any desire to dress. He has given away the clothes, make-up, wigs, transvestite magazines and books, and the clothes catalogues. When he sees a woman wearing articles of clothes the sight of which (clothes) would formerly have excited him, he feels no lust (nor disgust either). His wife corroborates this, although, since she cannot climb into his mind and know all he thinks, she still fears it may start up again. (To what extent do her fears that he may again indulge press him toward doing just that?)

[ Robert J. Stoller, M.D., "Sex and Gender", Jason Aronson, New York, 1968, 1974, p. 244. ]



     Perhaps the most frequent and highly charged dilemma encountered among psychotics is between gender identities, i.e., whether to become or remain a man or woman.
     A woman patient's childhood had been marked by total rejection by her parents, who openly preferred her brother. As a result, she struggled throughout her life among conflicting unconscious drives to possess her brother, to kill him, to supplant him in her father's love by becoming a big blond boy like her brother; yet, she never totally abandoned all feminine goals or identifications. She struggled over whether to grow older or younger, whether to be boy or girl, or both. With each birthday, this struggle became sharper, and she became more depressed.
     She was still able to function when she unconsciously sought a solution to her unresolved conflict through a surrogate relationship, namely, through marriage to a man who had been her brother's best friend. In addition, her new husband's father was a close friend of her own father; and prior to the marriage, he had always shown the patient far more affection than had her own father. But immediately after the marriage, the new father-figure turned away from her. With this repetition of her childhood pain and loss, she became bewildered and unhappy. Her husband's complete recovery from a dangerous illness came soon afterwards, and turned out to be a psychological catastrophe for her, by reactivating her buried death-wishes toward her brother and her need to replace him.
     Thereupon, from having been freely active, she became anxiety-ridden and severely agoraphobic, so that she could hardly bring herself to move more than a few blocks from her home. With the passing years, and further deterioration of the marriage, she superimposed on this terror an equally violent claustrophobia. At this point, she was trapped between two terrors, so that she sometimes stood on the threshold of her home for hours, equally terrified to go in or go out, to be among people or to be alone, to move or to remain motionless. Here, then, was a juxtaposition of irreconcilable drives and irreconcilable defenses. This brought on the imminent threat of full-blown psychotic disorganization, which, fortunately, led her into intensive treatment just in time to save her.

[ Lawrence S. Kubie, M.D., in the "American Handbook of Psychiatry", Vol. III, edited by Gerald Caplan, Basic Books, Inc., New York, 2nd Edition, 1974, p. 14. ]



     It is clinically well known that schizophrenics are very sensitive in the area which may loosely be called 'homosexual.' This sensitiveness, however, amounts principally to fears and preoccupations with the thought that someone else might think the patient homosexual or with efforts to determine in self-defense which persons in the environment may be homosexual. The patients make elaborate efforts to avoid the implication of being homosexual. It is so common for the fear of the patient who goes into panic to include some homosexual content that these panics have even come to be known as 'homosexual.'

[ Psychotherapeutic Intervention in Schizophrenia, Lewis B. Hill, M.D., The University of Chicago Press, Chicago, 1955, p. 61. ]



     It would seem that the schizophrenic patient is often of the third generation of abnormal persons of whom we can gain some information. The preceding two generations of mothers appear to have been obsessive, schizoid women who did not adjust well to men. There is some evidence that they were, in a sense, immature and that within the obsessive character structure could be found hysterical difficulties. It is to be noted, also, that there are two preceding generations of men who are not masters, or equals, in their own marriages and homes, or psychosexually very successful, and who are often described as immature, alcoholic, and passive, or hard-working, self-centered, and detached from the family. We do not know what sort of mothers and fathers these fathers of schizophrenics may have had, but it could be presumed that the fact that they let themselves be married to mothers of schizophrenics implies something concerning their own mothers.
     Loosely, the pattern which emerges is that of two generations of female ancestors who were aggressive, even if in a weak-mannered and tearful way, and two generations of male ancestors who were effeminate, even if the effeminacy was disguised by obsessive or psychopathic tendencies. It might be expected, or at least we would not be surprised to find, that the child of such ancestry would have difficulties centering around the problems of active aggressiveness and passive submissiveness. If the child is unstable in its balance of activity and passivity, the likelihood is that, under the guidance of the sort of mother who gets herself called 'schizophrenogenic,' the passive behavior will emerge as the overt character of the child, whereas the active behavior will be noted only in the form of negativism, of stubbornness, of retentiveness, and so forth.

[ "Psychotherapeutic Intervention in Schizophrenia", Lewis B. Hill, M.D., University of Chicago Press, Chicago, pp.112-113, ]



     During his professional career this young man went out with his colleagues and, because he did not want them to think him queer, occasionally had intercourse with a party girl. After a few years, the firm for which he worked decided to raise two of its employees to junior partnership. The patient was perhaps the brightest of the five candidates, but he was not chosen. He complained about this and was told that he did not have the personality for executive work. He could stay on as a worker doing technical detail. In the next few months he became aware that strange things went on in the office. One day six men came out of the boss's office carrying a coffin. The patient looked into it and saw the boss smoking a cigar. Several men, including those who had been promoted, began to sneer at him and to call him 'queer.' They drank together, and he saw one of them kiss another on the stairway in broad daylight. The coffin appeared again and again. The patient appealed to his sister, who recognized his condition. In his anxious tension and near-panic he made some effort to embrace her. She was not certain whether he was trying to seduce her or to kill her. On the way to the hospital the patient spent a night with his uncle, sleeping in the same bed with him. He slept very deeply, as if drugged. In the morning he saw a spot of blood on the outside of the seat of his pajamas. It meant to him that his uncle had had anal relations with him.

[ "Psychotherapeutic Intervention in Schizophrenia", Lewis B. Hill, M.D., University of Chicago Press, Chicago, 1955, p.168. ]



     As many authors have described, quite often the pre-schizophrenic child has also some indecision as to what his sex is going to be ... In children who tend to become schizophrenic in adult life, the uncertainty about sexuality is of a different nature. It concerns the sex and gender identity. Some of these children do not know what their sex is going to be. Although they know that they are boys or girls, they are not sure that they will maintain their sex throughout their lives. Boys may lose a penis. Girls may grow one. Although even normal children or children who later develop less serious psychiatric conditions occasionally have these thoughts, in the pre-schizophrenic they assume the form of serious and disturbing doubt. In many cases the doubts are related to the fact that children somehow connect a sense of hostility coming from others with their belonging to a given sex. If they were girls instead of boys, or boys instead of girls, they think their parents would be more pleased with them. If the most disturbing parent is of the opposite sex, the child would like to be of the same sex as this parent, so that he could resist him or her better.

[ "Interpretation of Schizophrenia", by Silvano Arieti, M.D., Basic Books, Inc., New York, 2nd Edition, 1974, p 92. ]



     I am indebted to Dr. Will Elgin, of the Sheppard and Enoch Pratt Hospital, for another repeated observation which, because it is characteristic, needs reporting. For many years Dr. Elgin, in the process of admitting patients, observed the enactment of a scene which assumed diagnostic significance. His office arrangement permitted relatives a choice of three seats, one opposite his desk, one at the end of it quite near him, and one several feet away. He observed that when the mother and father of the patient appeared together to arrange admission, there occurred something of significance. If mother sat in one of the two chairs at his desk, and father sat off in a corner, it usually followed that mother took over the discussion, did the talking, made the arrangements, and even read the fine print on the contract. Father, meanwhile, looked unhappy and was silent save for an occasional abortive effort to modify certain of the mother's statements. When this was the course of the admission interview, he came to know that the odds were that the patient would be schizophrenic. There is an interesting addendum. In a later interview father, appearing alone, was often very aggressive in his criticism and his demands and accusations. However, it could often be demonstrated that his belligerence was that of a very unwilling agent of his wife.

[ Psychotherapeutic Intervention in Schizophrenia, Lewis B. Hill, M.D., Ibid., p. 106. ]



     Kvarnes: Unless you are really doing it in some way you can make use of. Anybody can find fault with his own sexuality and particularly if he has low self-esteem. There's another dimension to that. I'm not sure Sullivan ever spent enough time developing it, but certainly one of his core ideas was the huge problem in the schizophrenic of gender identity and the terminology and the concepts weren't developed very well at that point. It is a problem with all kinds of people but particularly with schizophrenics because they've got it backwards much of the time and the homosexual framework for that is not adequate. It's just simply a scary kind of business where you act out something, but deeper down there is an identification on the part of the male schizophrenic with the female person and that is what they have such an enormous problem dealing with. Then when they get to puberty they may come apart trying to deal with pubescent sexuality, partly because they now have to assume a masculine role and masculine identity that they are not prepared for. And either he mentioned that in this seminar or I read about it someplace else, but it is something we might keep in mind, particularly with this patient, because he's got a father who is a success but not a very capable model for a kid; he's got a mother he's much closer to but she's crazy. So here's this guy trying to mold himself with these two unusable models. I think that may get somewhat clearer as we go on. As I reflect on it, it certainly seems to be what the problem was for the guy, although I didn't know it at the time, didn't see it that clearly.

[ A Harry Stack Sullivan Case Seminar, Treatment of a Young Male Schizophrenic, Robert G. Kvarnes, M.D., Editor, Gloria H. Parloff, Assistant Editor, W. W. Norton & Company, Inc., New York, 1976, p. 90.]



     The third form of limited inquiry is one which I have undertaken in the case of some promising patients already suffering incipient schizophrenia or related disorders. The integration of the intimacy situation between patient and physician often cannot proceed in these cases without mediation because of their strong homosexual cravings which may become intolerable leading to panic, occasionally ending in suicide. The principle is to give them protection by way of the three-group, instead of working with the patient alone. The physician distributes his functions between himself and a clinical assistant, striving thereby to effect a distribution of emotional objectivation such that he can always have a positive balance at his disposal to carry the patient forward. The end achieved is a partial socialization of the subject-personality so that he can live for a while comfortably in a suitable special group. Thereafter, a more thorough investigation may be undertaken.

[ Personal Psychopathology (Early Formulations), Harry Stack Sullivan, M.D., W. W. Norton & Company, Inc., New York, 1972, p. 353. ]



     In Paris itself the University did not fail to make known, with great ceremony, the outcome of the trial in which it had played a predominant role. The Journal d'un Bourgeois de Paris, written by a university man and therefore conveying university feeling exactly, has a long account of how '... on the day of Saint-Martin-le-Bouillant (July 4th) a general procession was made to Saint-Martin-des-Champs and a brother of the Order of Saint Dominic, who was an Inquisitor and a Master of Theology, preached a sermon. In this he included a version of Joan the Maid's whole life; she had claimed to be the daughter of very poor folk; she had adopted man's attire when she was only fourteen and her father and mother would willingly have killed her then had they been able to do it without wounding their own conscience; and that was why she left them, accompanied by the hellish Enemy. Thereafter her life was one of fire and blood and the murder of Christians until she was burned at the stake.'
     The Journal records, before this, and in all the detail which the writer had been able to obtain, a life and trial of Joan in much the same spirit, adding an account of her execution which no doubt conveys more or less what was known in Paris and echoes the version put about by the university: 'When she saw that her punishment was certain she cried for mercy and orally abjured. Her clothes were taken from her and she was attired as a woman, but no sooner did she find herself in this attire than she fell again into error and asked for her man's clothes. She was therefore soon condemned to death by all the judges, and bound to a stake on the scaffold of plaster (cement) on which the fire was built. She perished soon, and her dress was all burned away, then the fire was drawn a little back that the people should not doubt. The people saw her stark naked with all the secrets which a woman can and should have. When this sight had lasted long enough, the executioner replaced great fire under that poor carrion which was soon charred and the bones reduced to ashes. Many people said there and elsewhere that she was a martyr and that she had sacrificed herself for her true prince. Others said that this was not so and that he who had so long protected her had done her ill. Thus spake the people, but whether she had done well or ill, she was burned that day.'

[ "Joan of Arc, by Herself and Her Witnesses", Regine Pernoud, Stein & Day, NY, 1969, p. 238. ]



743 – In regard to the management of patients we found in St. Eliz. Hospital that confused males who are fearful of their inability to control their cravings to submit themselves to homosexual seductions are partly relieved by being attended or supervised by a female. The more maternal she is in her personal attributes the more successful her influence. The narcissistic or homosexual type of female nurse is of little value in such cases. The patient apparently does not feel confidence in her presence because he cannot trust her sympathy. ... Similarly, the female patient who is in a panic because of fear of homo-sexual assault will attack (defensive) female physicians and nurses when they approach her, but will show signs of relief when attended by a male physician.

[ Psychopathology, Edward J. Kempf, M.D., p. 743. ]



     Doris: Were you sheltered?
     Shirley: No! Come on, girl. Well, number one, I was very confused and frightened about where I was coming from, actually.
     Doris: What do you mean by 'coming from'?
     Shirley: Well, I thought I was one of the sickest persons in the world. You know, I dreaded even thinking about the term 'lesbian' and I used to cope with the situation by telling myself that I was normal, you understand? And the only thing that would take my normality away would be for me to have an actual gay experience. And I also used to tell myself that you're not gay if you never do it. So I didn't, 'cause I didn't want nothing to tread on my sanity. So I pretended to like boys and dresses and parties and all that bullshit.
     Doris: So you were just fooling yourself?
     Shirley: No, no, I wasn't fooling myself, I was trying to live with myself, and I went out with fellas and I let them fuck me. …
     Doris: Well, if you didn't want to be a girl why?
     Shirley: That's what I'm saying. The more they did it, the worse I got, and the more I pretended to act normal, the crazier I got. And I mean I was going out of my mind. When my mother died I just stopped pretending to be something that I wasn't because it ain't done much straightness in the world and it put my mind at ease, you better believe it, and I regained my sanity which was slowly seeping away from me, from trying to be ungay and I am definitely gay.

[ "Women and Madness", Phyllis Chesler, Ph.D, Doubleday & Company, Garden City, NY,1974, p. 201. ]



     Lois: One female therapist got scared when I became 'gay.' 'I can't treat homosexuals. There's nothing you can do with them.' She made it sound like terminal cancer ... One male therapist kept insisting I wasn't gay, but he told me it's something I'll outgrow ... He told me I'd end up alone and bitter in the gay scene, and that didn't appeal to me. It still doesn't ... Another woman therapist said, 'But men are so marvelous to sleep with! Lesbianism isn't necessary, it's absurd!'
     In a sense, being psychiatrically hospitalized helped me. I'd hit bottom. Now I could be a lesbian, that's not as bad as a crazy ...

[ "Women and Madness", Phyllis Chesler, Ph.D., Doubleday & Compnay, Inc., Garden City, NY, 1972, p. 193. ]



     I spoke to twenty-four women who had been psychiatrically hospitalized at some time between 1950 and 1970. Twelve women clearly reported exhibiting opposite-sex traits such as anger, cursing, aggressiveness, sexual love of women, increased sexuality in general, and a refusal to perform domestic and emotional compassionate services. Four of these women also experienced 'visions.'

[ Women and Madness, Phyllis Chesler, PhD, Doubleday & Company, Inc., Garden City, New York, 1972, p. 164. ]


     'Schreber's basic bisexuality had developed into a true manifest ambisexuality, male and female potentials being equally matched. Thus he developed fantasies of self-impregnation while he was acting the part of the woman having intercourse with himself.'
     This penetrating reanalysis of Schreber's material reminds us of elements described in some former detailed observations of schizophrenia, in particular the classic publications of Nunberg.
     The role of ambisexuality, with its far-reaching consequences in the clinical picture of advanced schizophrenia, has been evident for a long time. From a clinical point of view, one should bear in mind that Schreber not only went through periods of deep paranoid aggression and extensive elaboration but also long periods of catatonia. We know especially, from detailed observations of catatonic attacks and catatonic stupor, that phantasies of self-pro-creation frequently play an important part.
     It is also generally recognized that confusion about one's own sexual identity is a frequent and important part of schizophrenic symptomology. It may occur at a relatively early stage of the illness and, at times, may be detected by psychological testing prior to becoming manifest clinically. In my opinion, this symptom reflects a significant change in the patient's ego and may be described as a struggle of the feminine and masculine identification or, in other words, generally speaking, of the paternal versus the maternal introject.

     [ Homosexuality and Psychosis in Perversions, Psychodynamics and Therapy, Gustav Bychowski, M.D., edited by Sandor Lorand, M.D., Random House, Inc., New York, 1956, p. 98. ]


     From my material, in which negative instances are conspicuously absent, I am forced to the conclusion that schizophrenic illnesses in the male are intimately related as a sequel to unfortunate prolongation of the attachment of the son and the mother. That schizophrenic disorders are but one of the possible outcomes of persisting immature attitudes subtending the mother and son relationship must be evident. The failure of growth of heterosexual interests, with persistence of autoerotic or homosexual interests in adolescence, is the general formula. The factors that determine a schizophrenic outcome may be clarified by a discussion on the one hand of the situations to which I shall refer as homosexual cravings and acute masturbation conflict - often immediate precursors of grave psychosis - and of the various homoerotic and autoerotic procedures, on the other.

[ Harry Stack Sullivan, M.D., "Personal Psychopathology / Early formulations", W. W. Norton & Company Inc., New York, 1972, 1965, p. 211. ]



     In all three cases, the mother's relationship to the daughter who became schizophrenic contained an erotic quality, including sensuous physical intimacies. None of the mothers had been able to provide good nurturant care to the patient as a child but, at the same time, did not establish clear boundaries between herself and the child. The vacillations between disinterested aloofness and inappropriate physical intimacies that continued into adolescence or even adult life perplexed these patients. The mothers confused their daughters' needs with their own, transferred their anxieties to their daughters, and seemed to need the daughter's dependence upon them. Still, they gained little pleasure or gratification from a daughter but related by being concerned – and conveyed concerns that undermined the daughter's self-esteem and autonomy.
     Studies have indicated that the homosexual concerns and tendencies of schizophrenic patients, as well as their incestuous strivings and fears, reflect the incestuous or homosexual proclivities of a parent and, concomitantly, the failure of parents to maintain their own gender-linked roles and the essential boundaries between the two generations in the nuclear family (3). The child's development becomes confused when identification with the parent of the same sex does not promote formation of a proper gender identity that is fundamental to the achievement of a stable and coherent ego identity. The de-erotization of the child-parent relationship is one of the cardinal functions of the family.

[ "Homosexual Tendencies in Mothers of Schizophrenic Women," Ruth Wilmanns Lidz, M.D. and Theodore Lidz, M.D., The Journal of Nervous and Mental Diseases, Vol. 149, No. 2, Williams and Wilkins Co., p. 232. ]



During the period of multiple therapy, in one session he gazed at the other therapist and myself and began talking, 'They take the upper halves of the bodies of two men and attach them to the lower halves of the bodies of two women …..', convincing both the other therapist and myself, independently, that this was how he was perceiving us – not as really human beings but as the strange kind of, as it were, manufactured combinations which he had described. This fit in with his own manner of walking, which was a grotesque, disharmonious combination of exaggeratedly feminine hip-swinging and mincing gait, plus a carriage of his arms, chest, and shoulders which caused one of my colleagues, seeing him for the first time emerging from my office, to take me aside and ask in astonishment, 'What was that?' I replied, in some amusement, 'What did it look like?' He replied, 'It looked like somebody trying to walk like a gorilla.' (Ibid., p. 361)

      This is a classic case of the "bearded lady" syndrome in schizophrenia. It could not be more apparent. In the circus the Bearded Lady is usually split down the middle, the left side one sex, the right side the other. In this case the patient had made the split across the middle, the top half male, the bottom half female. That is the picture the patient has of himself, half male, half female – both sides competing against each other and neither one able to gain ascendancy.

[ Please refer to Quotation 096 in "Schizophrenia: The Bearded Lady Disease", by J. Michael Mahoney, on this website. ]



He was eleven and went to a freak show. He saw a boy who was supposed to be turning into an elephant but that didn't bother him. Then he saw a man who put needles through his skin, and he didn't like that at all. At another platform he saw a dwarfed, hunchbacked man billed as 'the human frog,' and he felt terribly sorry for him. Then he came to Alan-Adele – half man, half woman. He looked, fascinated – one side bearded, the other side smooth-shaved; flat-chested and full-breasted; long hair, short hair. Then he made the error; he thought of himself. He became terrified and ran out of the show shaking and sweating. He still felt odd when he thought about it. But he couldn't talk about the memory to anybody ..... not yet.

[ Lisa and David, Theodore Isaac Rubin. (Ibid., p. 128), and Quotation 058 in "Schizophrenia: The Bearded Lady Disease", by J. Michael Mahoney. ]

      David has unlocked the secret of schizophrenia, thanks to his visit to the "Bearded Lady" in the freak show. In seeing himself in this figure, he can now come to grips with the severe bisexual conflict which forms the basis of his mental illness.


      The period of his second hospitalization lasted from November 1883, when he was admitted to the Leipzig clinic, until his discharge at his own request (following his successful lawsuit against his tutelage) from the State Asylum Sonnenstein in Pirna (near Dresden) on 20 December 1902. The extant medical bulletins describe his initial condition as follows:

      At first more hypochondriacal complaints, that he suffers from a "softening of the brain, will soon die," etc., at the same time mixed with delusions of persecution, that "he has now been made happily insane." Also hallucinations now and then, which gave him quite a fright … He thinks he is dead and has begun to rot, that he is no longer in a condition "fit for burial"; that he is "plague-stricken," probably as a result of olfactory hallucinations; that his penis was twisted off by means of a "nerve probe"; he thinks he is a woman, but also often claims he must repulse energetically, "the homosexual love of certain persons." All of these things tormented him greatly so that he wished for death; he tried to drown himself in the bathtub and for many weeks demanded daily "the glass of cyanide destined for him." The auditory and visual hallucinations sometimes became so strong that he spent hours at a time in a chair or in bed completely inaccessible, squinting his eyes. The delusions of his senses apparently were of ever-changing content, referring in the more recent period of his stay at the Leipzig clinic to his belief that he was being tortured to death in a ghastly manner. He then lost himself more and more in a mystic-religious dimension, maintaining that God spoke openly to him, that vampires and devils make game of him. He said he wanted to convert to the Roman Catholic Church in order to avoid being persecuted. He then saw apparitions, heard sacred music and, finally, apparently thought he was in another world. At least he considered everything around him to be spirits, taking his environment to be a world of illusions … At that time [Dr.] Flechsig considered him dangerous to himself and to others.

[ "Memoirs of My Nervous Illness", by Dr. jur. Daniel Paul Schreber, Translated and edited by Drs. Ida Macalpine and Richard A. Hunter, with a new introduction by Samuel M. Weber. Harvard University Press / Cambridge, Massachusetts / London, England 1988, p. xxi. ]


"If I had a gun I would blow your fucking head off."

The above threat was communicated over the phone to this writer by a 39-year-old woman suffering from paranoid schizophrenia, and whom he had known since she was a teenager. At this time she was in a half-way house for mentally ill and drug-addicted patients.

The most shocking thing about this violent threat was that it was the first time she had ever displayed any open hostility towards him in all the years they had known each other, and thus it had come totally "out of the blue", with no prior warning or any follow-up. Before there was any chance to thoroughly discuss this threat with her, she had succumbed -- several weeks later -- from a drug overdose. It was never determined for certain if it was a suicide or an accidental overdose.

She, of course, as is always the case in such tragedies, had a very severe "bearded lady" conflict and the direct cause of her schizophrenia -- with its resultant added symptoms of drug and alcohol addiction.

Once when she was younger and had come to his office for a visit, she was wearing masculine-looking pants and a man's jacket with prominent shoulder padding, and when he went to give her a welcoming hug she had turned completely sideways, so that it was like hugging the sharp edge of a knife. He knew then that eventually she would either have to "come out" as a lesbian or else sink into schizophrenia, if she continued to repress her powerful, opposite-sex tendencies and feelings.

Unfortunately she chose this latter course, being extremely intolerant of accepting any conscious awareness of her predominantly homosexual, opposite-sex nature. Or, as Sigmund Freud would have explained it, she had a very severe, puritanical, intolerant and punishing super-ego -- or conscience.

On one occasion she had remarked to him that someone with whom she was in a bitter dispute, "had" her "by the cojones" -- the Spanish word for "testicles". When he pointed out this obvious "Freudian slip" to her, she was silent.

Her strongest emotional connections were always with other "girlfriends". She did marry, but the marriage ended several years later in a contentious divorce.

She had a mother who, in this particular case, lacked normal maternal instincts, and who had once taunted her when she had threatened to commit suicide, with the words "You wouldn't have the guts to do it."

She had a brother who was homosexual and also a drug addict, and who had often switched gender roles with her in their play together when they were children.

Although she had never known her biological father, she was fortunate enough in her later life to have a very supportive stepfather. But by then it was too late to repair the long-term emotional damage life had thrust upon her.

This is a very sad story, as are all the stories wherein schizophrenia, the "bearded lady" disease, has claimed another innocent victim -- or victims.


Great to hear from you again, [Deleted]. I am very sorry to learn about your brother's psychological troubles. The best thing for him to do is find a good psychologist or psycho-analyst (Freudian-trained, if possible) he is comfortable with and then just start talking about what is on his mind (or in his unconscious). This is known as the "talking cure" and can be a very long and difficult process, but it is the only way for him to gain the needed insight about his "bearded lady" bisexual conflict and gender confusion, to effect a "cure".

You could also suggest that he look at my website or read my book on schizophrenia.

Please keep in touch and let me know how things are going.

Very best, Mike

----- Original Message -----

From: [Deleted]
To: J. Michael Mahoney
Sent: Saturday, August 24, 2013 3:35
Subject: schizophrenia

Thank you Mike. I've been reading as you suggested and looking at the information on your website. Schizophrenia is a fascinating subject and the evidence put forward in your research has been quite a revelation to me. I have a brother who was diagnosed as schizophrenic many years ago. He is now [deleted] years old. Everything you've said fits with what I know about his bisexual conflict and repression. You also say that psychotherapy is the only effective treatment for schizophrenia. Now I'm wondering if you can give me any information about where I could seek help for my brother. He is currently living in [Deleted] but is going to be relocated nearer family living in [Deleted]. I would be grateful for any advice you can give me.

Best Regards, [Deleted]


      While in Iraq, where he downloaded 700,000 secret government files that he sent to WikiLeaks, Private Manning responded with angry outbursts when he was chastised over minor misconduct, went "catatonic" [ schizophrenic ] at times while talking, e-mailed a photograph of himself dressed as a woman to a supervisor, and was found in the fetal position with a knife, witnesses said. [ ....... ]
      Prosecutors pushed back, suggesting that the understaffed intelligence unit was doing the best it could with what it had. And Mr. Adkins, noting that psychologists never pronounced Private Manning unfit for duty, said he had hoped to help the young soldier get through the deployment so that he could be honorably discharged. [ ....... ]
      Even before the unit deployed to Iraq, Mr. Adkins had referred Private Manning for a mental health screening because he had angrily responded after being criticized for missing a formation.
      And in December 2009 -- a month before he started sending files to WikiLeaks -- Private Manning shoved a chair and shouted when he was chided for losing a key. Soon after, as he was being counseled for being tardy, he flipped over a table, dumping two computers to the floor, and was put in a headlock by another soldier until he calmed down, several witnesses testified. [ ....... ]
      In April 2010, Mr. Adkins wrote another memo to behavioral psychologists, noting his "instability was a constant source of concern" and that it included "frequent catatonic [ schizophrenic ] periods," like when he stopped talking and went blank in the midst of a briefing. [ ....... ]
      That e-mail was titled "My Problem." In it, Private Manning told Mr. Adkins that he had been struggling with something "for a long time" that was "haunting me more and more as I get older." Attached to the e-mail was a picture of him wearing a blond wig and makeup.
      Then, in early May, Mr. Adkins was called to the classified information facility because Private Manning was in the "fetal position" in a storage room, "clutching his head as if he was in pain." At his feet was a knife, and he had carved the words "I WANT" in a chair. [ ....... ]
      But later that same shift, Private Manning punched another soldier in the face. When a higher-ranking officer, Capt. Tanya Gaab, who also testified on Tuesday, found out about the incident, she banned him from coming into the information facility again. Weeks later he would be arrested.

[ "Manning Played Vital Role in Iraq Despite Erratic Behavior, Supervisor Says", by Charlie Savage, The New York Times, August 14, 2013, p. A14. ]


      Mr. Manning [ Pfc. Bradley ] has reacted stoically to the conditions of his imprisonment, much of it in solitary confinement, although others, including his legal team and Amnesty International, have loudly protested his treatment. In one of his chats with Mr. Lamo [ Adrian ], he contemplated a life behind bars, which could be especially difficult for him because of his struggles with his gender identity.
      "I wouldn't mind going to prison for the rest of my life," he wrote to Mr. Lamo, "or being executed so much, if it wasn't for the possibility of having pictures of me plastered all over the world as a boy."

[ "Loner Sought a Refuge, and Chose the Army", By John M. Broder and Ginger Thompson, The New York Times, Wednesday, July 31, 2013, Front-page / page A13. ]


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