I was very surprised when I was told I would receive the honor of the Sigmund Freud Award at this luncheon. I am an old man, and it is said about old people that as they get more experience and wisdom with their years, they have more answers. But the truth is, they get asked fewer questions.
To be asked to speak implies that I have answers to your questions, but experience teaches us to be less satisfied with old answers and to ask new questions. When Gertrude Stein was on her deathbed, she was asked, "What is the answer?" She replied, `'What is the question?"
As a psychoanalyst, I have questioned—what should be the attitude or the activity of a therapist toward a patient's sexual orientation? Many years ago, I walked into a psychiatric hospital wearing a black homburg hat. The medical director, a great kidder, said, "Abe, that's a very impressive hat. Do you wear it inside your office to impress your patients?" I replied, "I always wear a hat in the office because I am an orthodox psychoanalyst."
I was kidding about the hat, but not about the orthodoxy. I have always tried to maintain a strictly neutral technique with a patient in psychoanalysis, although I use other methods with patients who are not in analysis.
Over the years I had observed that a psychoanalysis is the best treatment for those patients who are analyzable, so I always wanted to conduct a psychoanalysis when it was indicated.
I had observed, and taught, that homosexual patients often tried to please the analyst by premature attempts to date women. I had usually interpreted this as a transference manifestation which would impede the analytic work. It required transference exploration and interpretation rather than accepting the manifest content and encouraging the patient to carry it out. However, when I began to work with Dr. Socarides in the psychoanalytic study group on sexual aberrations, I heard his opinion that the therapist should strongly encourage any attempt at heterosexuality by a homosexual patient. He had much more experience than I had in treating homosexuality so I had to question my orthodox approach.
The question reappeared from another source. Several years ago I was working on a chapter for a book, edited by Dr. Harvey Schwartz, on psychotherapy with different kinds of patients. I had been asked to write a chapter on the treatment of sexual perversions and homosexuality.
As an aside, when I sent in my chapter entitled "The Treatment of Perversions and Homosexuality," I was told that some associate editors did not like the title. It was politically incorrect, although that was my assigned topic. I tried to change the title to "The Treatment of Sexual Aberrations," but that didn't fly either. Then I tried "The Treatment of the Paraphilias," thinking that they might not know what it meant, but they didn't like it.
Since it happened that the two case examples most fully described were depressed, you can now read the chapter entitled, "Treatment of the Depressed Homosexual Patient," in a book entitled, Psychotherapy in General Psychiatry. I had to accept the title compromise to preserve everything else I said in the chapter. (However, if a homosexual therapist is enticed by the title to read the chapter, he might learn something.)
To get back to the question of encouraging or not encouraging heterosexuality in a homosexual patient, I was discussing with Harvey the technical problem of how to handle the patient's report of dating a woman. He knew my interest in the problem of identification in the treatment of sexual aberrations. He asked, "If you become the father in the transference, doesn't a father in a normal family feel happy about his son's masculinity and always encourage it?"
Harvey's question was one that I should have asked myself. However, there are other considerations. Homosexuality is often a defensive adaptation to preserve phallic power against castration anxiety. A premature push to heterosexuality might interfere with this defense when it is still needed, and might also prematurely close off further analysis. So here is my answer to our question of when to encourage heterosexuality in a homosexual patient. AFTER analysis of the sources of castration anxiety and the defensive functions of the homosexuality, and AFTER the appearance of identification with the therapist-father (or Oedipal strivings toward a female therapist), the therapist should encourage any signs of heterosexuality as they appear in dreams, fantasy or behavior.
Another thing learned over the years is—always listen carefully to your critics, because they will tell you some things that your supporters won't. Homosexual politicians accuse us of harming homosexuals by forcing them into heterosexuality. I doubt that many therapists force them, but if the word premature were placed before the word heterosexuality, they could be correct in some cases.
Another series of interesting questions occurred to me after reading in the July 17, 1955 issue of New Yorker Magazine a review of a book: Vice Versa: Bisexuality and the [Eroticism of Everyday Life. The reviewer was Edmund White, and the author was Marjorie Garber, Professor of English and Director of the Center for Literary and Cultural Studies at Harvard University. The book is about bisexuality as it appears in our culture in literature, films, songs, television programs, and public figures, both in news reports and autobiographies and biographies; and in historical and literary works of the past. It is a large, comprehensive work of about 600 pages. She has many examples of bisexual persons in literature, the arts, theater, film, and entertainment.
Why are creative people more likely to be bisexual than the rest of us? First it could be untrue. The media and biographers tell us only of people in whom we are interested. If Joe Palooka in the next block or in the office downstairs is bisexual, he would not be worth writing about. But even without a formal statistical study, it seems true.
Great writers who tell about the emotions and feelings of the opposite sex as well as their own are probably great because they are aided by more awareness and acceptance of their own bisexuality. The acceptance might make bisexual behavior easier for them. Therapists who have been psychoanalyzed and have become aware of their own bisexuality can better understand the feelings and fantasies of both sexes and can better tolerate any kind of sexual transference. As for entertainers, part of the attraction of the audience is an identification with them, and the pleasure of a projection of forbidden fantasies upon them. The widespread public interest in bisexuality could be a projection of the public's repressed unconscious.
It is also true that the Bohemian life of artists is taken as an entitlement in return for the sharing of their special gifts with us. In fact, some uncreative people live a Bohemian life to claim an unearned privilege. We are more tolerant of non-monogamy as well as bisexuality in artists, and thereby hear more about both. Newspaper gossip columns and supermarket checkout counter scandal sheets are always reporting who is bedding with whom, of either sex.
I was intrigued by the closing paragraph of the reviewer, which is worth a direct quote: He wrote, "And yet I must confess that Garber's multiplication of examples [i.e., of bisexuality] browbeat me into wondering whether I myself might have been bisexual had I lived in another era." Still quoting, "When I was a young man, in the sixties, before the beginning of gay liberation, I was always in therapy trying to go straight. I was in love with three different women over a ten-year period, and even imagined marrying two often. But after the Stonewall Uprising in 1969 [Aside: We might ask if '69 was a fatefully bad year for bisexuals?] Back to the quote: ". . . I revised my thinking entirely: I decided I was completely gay and was only making the women in my life miserable. Following a tendency that Garber rightly criticizes, I denied the authenticity of my earlier heterosexual feelings in the light of my later homosexual identity. After reading Dice Versa, I find myself willing to reinterpret the narrative of my own personal history."
Aside from the subtitle, "Eroticism of Everyday Life", which paralleled Freud's "Psychopathology of Everyday Life," the intimate confession in the closing paragraph of the review induced me to read the book.
Garber makes a good case for the universality of bisexuality. She recalled for me that the dispute which separated those close friends, Freud and Fliess, was over the primal authorship of the idea. Some people speculate that the anxiety over their unconscious attraction to each other was another cause of the split.
Mammals are bisexual in their embryonic development, vestigial anatomy, and hormones. Almost all adults are either male or female. The few exceptions are the pseudo-hermaphrodites. (Stoller has noted that in most cases the personal gender identity of these people corresponds with the assigned sex at birth even if it turned out to be incorrect—rather than the true organ and hormonal identity.) But, although the anatomy and physiology of an individual is either male or female, bisexuality remains in mentation, whether conscious or unconscious, and bisexual behavior is not rare. It is probable that bisexuality is a variant outcome of the Oedipal complex which is almost universally bisexual. The term "bisexual" refers more often to the choice of sexual object rather than to the gender identity of the subject.
People with bisexual conscious thoughts and fantasies or overt behavior usually identify themselves as heterosexual or homosexual. The fact of bisexuality has been disparaged by gay society, and often also by the general culture. Bisexuals trying to act as an identifiable group have often been unwelcome in gay rights demonstrations. Social bias about sexual classification is similar to racial bias.
Under the Nuremberg laws in Germany, even a small fraction of Jewish descent was condemned. In the United States, a small bit of black blood makes the person black. Public figures with Caucasian faces and speech accents are considered to be black if their ancestry is not entirely white. White racists and black racists alike condemn the hybrid, even though hybrids are often a superior biological strain in other species. The gay rights groups have this same bias—they would have us classify anyone who has ever shown same-sex attraction as homosexual, and they have moved the public to this position. What should be our professional opinion?
A few months ago, Ann Landers published a letter from a mother of a teenager who said that her son was upset over fantasies about men. Ann Landers replied that the boy was genetically homosexual and should be helped to accept his condition. I have not seen published the letter I wrote to her explaining the facts clearly and how her advice could do public harm by interfering with diagnostic evaluation and treatment of such cases. Homosexual politicians had convinced her and a large segment of our population that any homosexual behavior OR EVEN FANTASY, at any age, was evidence of a genetic, unchangeable homosexual condition.
Garber gives a review of the experimental work which has reported evidence of genetic homosexuality, along with the scientific fallacies and failure of confirmation of those studies. Even the respected journal Science has published a paper with such a flawed methodology that it would not have been given a second reading if it were on any other topic.
I have asked mammalian curators at the Philadelphia Zoo whether they have ever observed or read papers on the occurrence of obligatory homosexual preference in primates or any other mammalian species. The answer is that occasional homosexual behavior is seen in all species, but not in adults when the other sex is present. If homosexuality is genetic, why only in home sapiens?
The general biological rule is that the higher the development of mental faculties in a phylum, class, genus or species, the more behavior is determined experientially rather than genetically. The genetic behavior of ants and birds seems miraculous to us humans, who have to depend on experience and thought. Garber quoted Gore Vidal, "There are no homosexuals, there is homosexual behavior."
The question which the book posed for me is: If we are all bisexual as infants, why are there heterosexuals and homosexuals? Freud, in "Three Contributions to a Theory of Sexuality," wrote that infants are polymorphous perverse. We can confirm this by the observation that an infant will do anything pleasurable with anybody. Although some innate activity differences, with much overlap, between male and female infants, has been reported, the response to physical pleasurable stimulation in either sex does not depend on the sex of the stimulator.
What changes this bisexual behavior to heterosexual or homosexual behavior in most people? If we knew more about "why heterosexual?" we might learn more about "why homosexual?" The heterosexual outcome seems to be due to an infancy that enhances a healthy narcissism and individuation, thus beginning the gender identification which is fortified during the Oedipal period and by the hormonal surge and bodily changes of adolescence. But in all heterosexuals there remains the possibility of bisexual fantasy with varying degrees of conflict or behavior. Studies have shown that sixty percent of male heterosexuals have fantasies of threesomes, and pornographic film makers who cater to male heterosexuals know the arousal value of portraying lesbian sex.
Social ideals and group superego are probably very important in allowing only heterosexual expression, but male gender identification and phallic narcissism are the most important components of healthy narcissism in males. It is narcissistically painful for most men to doubt their heterosexuality. It is in the interest of protecting their narcissism that most men must be only heterosexual and need to constantly repress bisexual or homosexual fantasies, and cannot countenance homosexual acts by themselves or others.
In special situations, such as in prisons, homosexual rape is committed by heterosexual men as a proof of their phallic power over other men and it thereby supports their narcissism rather than injures it. The need to preserve phallic narcissism is also important—although it takes a different direction—in many men with homosexual behavior.
Thus, masculine narcissism accounts for rigid male heterosexuality, homophobia and the gay rights movement. An example of extreme homophobia is the severely narcissistically injured person, with some psychotic genetic determinants, whose bisexual or homosexual fantasy can precipitate a paranoid psychosis. Psychoanalysts see many patients with less narcissistic difficulty who have not solved the bisexual conflict, either consciously or unconsciously.
Now to "why homosexual?" when we know that there is bisexual predisposition, but no homosexual predisposition. We all know the identity problem engendered by the enveloping mother and the absent father. And we know about the Oedipal conflict and castration anxiety. But what had become of his bisexual predisposition? First of all, I think that homosexuals are mislabeled; they are, like all of us, bisexuals—but many of whom have pathologically repressed the desire for the opposite sexual object. Their psychopathology may have early roots in identifying with the opposite-sex parent, or they might have a more neurotic structure of phobia for the genitalia of the opposite sex. There is a varying degree of both experiential factors in most cases.
The treatment, then, is of the identification problem and the early aggression problem (of the borderline) and the resolution of the Oedipal complex (as in the phobic psychoneurotic). And, since we all know that it is easier to treat neurotics than to treat borderlines, we can expect that many people with homosexual behavior will not have therapeutic outcomes as favorable as others. An obligatory homosexual can be considered a bisexual who has a phobia for the female genitalia. Therefore, as in the treatment of the phobic object or situation in the interest of furthering the analysis, one might eventually have to encourage the person with a phobic avoidance of female genitalia to do the same. So, since we have returned in a circular manner to answering the question of when to encourage heterosexual behavior, it is almost time to stop.
As for the question, "When should a 'homosexual' be treated?" All bisexuals need treatment when they are depressed or in conflict no matter what their choice of sexual object.