From the NARTH Collected Papers, 2003
Presented by Dr. Sander J. Breiner
The subject of homosexuality has been a significant subject of interest and conflict in most cultures throughout history. In the last few years it has been a subject of conflictual interest in the scientific community; especially those fields involved in psychotherapy and counseling.
Dr. Sander J. Breiner
First, we will discuss the concept of phobia. Then, we will discuss a subject related to phobia called paranoia. In exploring the relationship between these two subjects, we hope to get to some further understanding of a complex and difficult subject. This technique is the usual procedure in scientific presentations and discussions. Polemics have no place in such a format. The only acceptable and reasonable procedure is objectivity and kind courtesy to those with other views on these topics. This is to be encouraged, since this is the very essence of scientific inquiry and gaining new knowledge.
1. Phobia is "nearly always, excessive fear of some particular type of object or situation; fear that is persistent and without sound grounds, or without grounds accepted as reasonable by the sufferer." (A Comprehensive Dictionary of Psychological and Psychoanalytic Terms, English 1958)
2. Phobia is "the presence or anticipation of a specific object or situation, exposure to which almost invariably provokes an immediate anxiety response or panic attack even though the subject recognizes that the fear is excessive or unreasonable. The phobic stimulus is avoided or endured with marked distress." (American Psychiatric Glossary, Edgerton and Campbell, 1994)
3. Phobia is "persistent, pathological, unrealistic, and intense fear of an object or situation; the phobic person may realize that the fear is irrational but is, nonetheless, unable to dispel it." (Comprehensive Glossary of Psychiatry and Psychology, Kaplan and Sadock, 1991)
4. Phobia is "an irrational fear of, and avoidance of, a specific object or situation." (The New Language of Psychiatry, Levy, 1982).
5. Phobia is "a morbid fear associated with morbid anxiety." (Psychiatric Dictionary, Campbell, 1981)
6. Phobia is "an unrealistic and disproportionate fear of an object or situation. Characteristically a phobia cannot be reasoned away and is beyond voluntary control; intense anxiety or panic is evoked by the prospect or actuality of exposure to the feared situation which tends to be avoided." (The Encyclopedic Dictionary of Psychology, Harre and Lamb, 1986).
7. Phobia is "a symptom neurosis, characterized by a pathological fear of a particular object or situation, and the consequent attempts to avoid them. The feared situation or object leads to the feeling of fright by providing stimuli to the activation of repressed wishes, usually oedipal, and the defenses against these wishes. Because the source of this fright is unconscious, the attempt (of) avoiding the external situation (moderates) that fear, but it will not cure the phobia."
"Four basic mechanisms appear to be operative in phobia: mobilization of the opposite instinct fusion, projection, displacement, and avoidance. A libidinal wish is warded off by mobilization of an aggressive drive. An unconscious wish is projected to an external object and then displaced to a different (secondary) object, which is then feared and avoided. The primary object relationship will still be maintained in the unconscious; the superego is appeased by the restrictions on freedom by avoidance of the secondary object."
"Phobia is a symptom, neuroses, characterized by a pathological fear of a particular object or situation; and the consequent attitude to avoid them. The feared situation or object leads to the feeling of the fright by providing stimuli to the activation of repressed wishes, usually Oedipal, and the defenses against these wishes. Because the source of this fright is unconscious, the attempt to escape it by avoiding the external situation may allay that fear of the external situation but it will not cure the phobia." (Encyclopedia of Psychoanalysis, Eidelberg, 1968).
8. Phobia in "a psychological symptom characterized by the obligatory avoidance of specific situations or object which, though not objectively dangerous, cause severe anxiety. Literally translated from the Greek, the phobia remains as morbid fear or dread. A prefix is often added to indicate the object, condition, or circumstance dreaded."
"The phobia, like any other psychoneurotic symptom, is a compromise between unacceptable, threatening, sexual and aggressive derivatives and the defending forces of the personality, whose conflict has resulted in signal anxiety. In addition to the invariable basic regressions, specific defense mechanisms determine the form of the neurosis. These are displacement (from one object to another, -- -- --) and projection or externalization. -- -- -- Thus the phobia serves to transform and disguise the unconscious psychological danger."
"Virtually any sexual and aggressive drive derivatives are unconsciously experienced as dangerous and may be the occasion for the formation of a phobia. The symptom is therefore seen in connection with a wide range of psychopathologic states, from the mildest to the most severe." (Psychoanalytic Terms and Concepts, Moore and Fine, 1990).
9. Phobia is an "unrealistic fear of specific objects, locations, or situations, which are avoided with great effort. If confronted with the object of their avoidance, phobic patients develop anxiety in a degree proportionate to the fear they harbor."
"The nature of phobia is a persistent avoidance behavior and is secondary to irrational fears of a specific object, activity, or situation. -- -- -- phobia are unreasonable and unwarranted fears given the actual dangerousness of the object, activity, or situation avoided." (Comprehensive Textbook of Psychiatry, Kaplan, 1985).
10. The "four basic mechanisms that appear to be operating in phobia are; the mobilization of the opposite emotional fusion, projection, displacement, and ambivalence. A libidinal wish which is warded off by mobilization of an aggressive drive. An unconscious wish is projected to an external object and then displaced to a different (secondary) object, which is then feared and avoided." ("The Psychoanalytic Theory of Neurosis," Fenichel, 1945)
11. "Neurotic character traits (including phobia character traits) are ego-syntonic, unlike neurotic symptoms." ("Phobia, and Anxiety, And Depression", Greenson, 1959)
1. "Separation-individuation concepts and (general) development have effect on gender identity conflicts, which predispose to feelings of vulnerability and primary femininity and masculinity -- that may be even more basic than the derivatives of homosexual conflict. Studies seem to confirm that homosexual conflicts are prevalent in paranoid schizophrenia, -- --". (Psychoanalytic Terms and Concepts, Moore and Fine, 1996).
2. Though there have been many modifications of Freud's original conception of paranoia (Freud 1923), his basic conceptions related to the denial and projection has held to be true. In addition, his analysis of the Schreber case (Freud 1911) led him to conclude that the core conflict in Schreber's paranoia was a homosexual wish -- fantasy of loving a man. The paranoia represented the contradiction of Schreber as a man loving a man. Unconsciously, Schreber moved to the delusion that, "It is not I love the man; it is the man who loves me. I do not love him, I hate him. Because of this he hates me, and persecutes me." The fear of passivity will, depending upon the quality of ego organization, determine the symptom organization of homophobia.
Clinical observation has shown homosexual conflicts (gender conflicts) in the majority of male patients who demonstrate homophobia, paranoid-like ideation, suspicion, and distrust. This is on a continuum from a mild neurosis with anxiety about homosexuality to a severe paranoid psychotic position. The latter most extreme position will have homosexuality as a conflict to focus on (perhaps); but is not the major fear that drives the delusional system. It appears to be due to the fear of loss of one's intactness (dissolution of self), a threat to one's very existence (aphanisis).
Currently in the psychoanalytic literature there are extensive discussions regarding the topic of homosexuality. In particular, there are expressions by some therapists of possible blocking of exploring homosexuality, where homosexuality is seen by some as a reasonable or not pathological human reaction of adults. The not exploring of this issue of the "reasonableness/normality of homosexuality" by the mainline of psychoanalysts has been considered as a conscious and unconscious avoidance. The writers who have been discussing this issue have been calling this "internalized anti-homosexual attitudes" which they have shorthanded to "internalized homophobia." (Maylon, 1982).
Though it was recognized by one author (Friedman, 2002) as not originating as a psychoanalytic conception, he and others writing positively about the normality of homosexuality, have insisted on referring to this phenomenon as "homophobia." This tendency by any analytical author to take a concept which has one definition and applying it to a related or other concept tends to "muddy the waters," contribute to confusion, and even obfuscate the issue. This well may be what is taking place today in the psychoanalytic literature and discussions on the subject of homosexuality and homophobia.
This difficulty is exemplified in Volume XXX of the Annual of Psychoanalysis ("Rethinking Psychoanalysis and the Homosexualities"). In this book of 22 chapters, many aspects of homosexuality are explored. However, because of the conception of "internalized homophobia" that seems to flavor the entire volume, there is little that indicates homosexuality as being anything other than normal.
Since "internalized homophobia" is not a correct psychological term, this places much of the discussion on less than solid ground. "Internalized homophobia" is not homophobia. The differences between diagnostic/therapeutic approaches to homosexuality are in the realm of different therapeutic responses. Therefore, just as there are differences in various analytic approaches (e.g., Kleinan), so there are therapeutic differences in the approach to the homosexual.
The editor of the book Homophobia: How We All Pay the Price (1992), Warren J. Blumenfeld ("writer and gay activist") has organized its 17 chapters so that the concepts of homophobia, anti- homosexuality, social and religious prejudice, and treating homosexuality as a complex symptom, are all treated as being part of the same expression of irrational anti-homosexuality and homophobia.
He (Blumenfeld) refers to four types of homophobia:
1. Personal homophobia "a personal belief system (a prejudice) that sexual minorities either deserve to be pitied as unfortunate beings who are powerless to control their desires or should be hated; that they are psychologically disturbed, genetically defective, unfortunate misfits, that their existence contradicts the laws" of nature, that they are spiritually immoral, infected pariahs, disgusting - to put it quite simply, that they are generally inferior to heterosexuals.
2. Institutional homophobia "refers to the ways in which governments, businesses, and educational, religious, and professional organizations systematically discriminate on the basis of sexual orientation or identity."
3. Interpersonal homophobia occurs "when a personal bias or prejudice affects relations among individuals, transforming prejudice into its active component - discrimination."
4. Cultural homophobia occurs when "the social norms or codes of behavior that, although not expressly written into law or policy, nonetheless work within a society to legitimize oppression."
The comments in response to the Annual of Psychoanalysis (XXX) are even more applicable to the Blumenfeld book. There is no personal, internal, institutional, or cultural homophobia. The terms do not exist in the recognized scientific literature, as described earlier. There is only one homophobia, which has been properly defined. It is somewhat similar to what occurred 100 years ago when a diagnosis was made of Ague. That label referred to any kind of ache or pain; from the mildest inconsequential ache to a severe debilitating condition. There was little understanding of the various normal and abnormal entities that could exist under that rubric. In a similar fashion, Blumenfeld and others are doing the same with the term homophobia. Their purpose may be sincere and in some contexts useful. However, the approach is unscientific and not useful in the diagnostic/therapeutic sphere. It can even be used by some individuals in an anti-therapeutic manner.
Calling all responses to homosexuality other than it "is a normal sexual variation" as homophobic is anti-scientific and decidedly anti-therapeutic. Even in the Textbook of Homosexuality & Mental Health (Cabaj, 1996) published and sponsored by the American Psychiatric Association, the position is taken that homosexuality is a normal variation of human sexuality and not a mental illness.
There is no doubt that homophobia exists. There is also no doubt that there are rationalized and irrational anti-homosexual attitudes. However, it would be very valuable for society in general, and therapists in particular, to have a clear picture of homophobia separated from all the other topics that have been lumped under that rubric. With this in mind, let us examine the topic of homophobia, as would be correctly defined and limited as a true phobic reaction
Discussion (Part I)
Minor amounts of anxiety or discomfort in dealing with homosexuality is like any other anxiety response. The individual knows there is no reality to their discomfort and responds generally within normal social limits. They are aware of their discomfort and recognize that they can rationalize that response, or they will deal with it in a therapeutic relationship.
The preceding describes individuals who have anxiety and conflicts who are able to test reality and respond in a relatively reasonable fashion. This is typical of neurotic conflicts. Like all the neuroses, it is amenable to resolution through analytic therapy. The basis for the symptom of anxiety about homosexuality may be due to many different factors and conflicts from early in that individual's life. There usually is no absolute direct link to homosexuality per se; but rather it can come from one of many different early conflictual areas.
A more serious form of anti-homosexual response is seen in the individual who hates, fears, and/or is disgusted by homosexuality. This is most usually seen in males responding to male homosexuality. (Please note that many male anti-homosexuals are sexually stimulated by pornography of female homosexuality). These individuals obviously have impaired judgment, and are much more frightened than the first group of individuals with minor anti-homosexual feelings. Their impaired judgment tends to put them in the large group of borderline ego organization. Here, the individual is dealing with insecurity about his own intactness as an individual with significant elements of impaired self-esteem. They are not psychotic. They are found as members of that the large segment of our population that has a borderline ego organization. Therefore, since it comprises such a large and varied portion of the population, I prefer to call it a borderland group of ego organization. Those closer to the psychotic fringe feel more vulnerable and act more defensively. The group that approaches the psychotic is that part of the population that is closer to true homophobia.
The next group is basically comprised of psychotic characters. They may or may not have a frank psychosis, but they all have disturbed, irrational reasoning. At least in one significant area they have a very primitive ego, or some ego disorganization. In other words, in some area they have significant difficulty in testing reality. Those individuals who express such hatred of homosexuals are likely to be true homophobics.
One author who had his training in theology (Doupe, 1992) insightfully observed that a Canadian psychologist said that the greatest hostility is found in those who are very fearful, and that "the world is seen as an unsafe place in that society," and they are at risk. This approaches an understanding of the connection to paranoia.
There are two facets to the true homophobic. One is when there is such a fear of homosexuality or homosexuals that they will withdraw in fear and panic from any situation that would resemble for them any such contact. The other facet is the rabidly hating anti-homosexual who will hurt or even murder someone they believe presents a homosexual threat to them. This could be anyone who may or may not be homosexual. This could also be any homosexual who makes no attempt at any advance or closeness to this type of homophobic person.
The simplest explanation of the complicated dynamics of the paranoid homophobic is a fear of their own homosexuality. For example, they will consciously or unconsciously feel an attraction to another male. This evokes anxiety, so they project their feelings to the other man. They now say this individual is attracted to them. They take their defense one step further by saying, "I don't like this man who is attracted to me. I hate him." They deny that the hatred originates within themselves and take it a step further with, "this man hates me, and wishes to do me harm in some fashion. Now, I am justified in hating him for his hating me." He anticipates some injury coming from this other individual; and to protect himself now feels completely justified in attacking this "enemy."
The dynamics we see in the psychotic, paranoid homophobic in its gross qualities, we often can find in a subtler and milder form in individuals with negative responses to homosexuality. However, they are psychologically (ego strength) much healthier. The underlying dynamic is related to concepts of oneself. For the male patient who fears homosexuality, it can be due to the poor identification with a benign male figure in the first seven years of their life. It may cause them to feel less manly because in a childlike fashion they are still seeking that important male model to love and with whom they wish to identify.
Another dynamic can be an unresolved identification conflict with mother, which conflict is experienced as difficulty in normal male gender relationships with men and women. Thus, any need or emotion that leads to passivity and/or dependency can feel threatening. Therefore, any homosexual (particularly another male) can be perceived as a threat ("it could be me").
A more serious problem occurs when the only way he can see himself as being intact is when he is being "strong," which is usually expressed by various forms of hostility. Passivity of any kind is felt as a dissolution of oneself. That is such a threat, that they will do anything to protect themselves. Their defensive reactions are perceived as a life saving. Thus, the irrational fear and hatred of homosexuals is expressed by a true homophobia. But all fear of homosexuals will not necessarily be expressed as homophobia because this form of phobic expression can be found in any paranoid type of delusion.
Discussion (Part II)
Dr. Charles Socarides is a leading authority on understanding the symptoms and problems of homosexuality. Among his many important observations of this complex issue is the clinical observation he finds in homosexual patients where there is "severe conscious and unconscious paranoid tendencies" without clinical psychosis. Thus, the stresses that are reasonable for a therapist to assume in their homosexual patients is a tendency towards paranoid ideation; no matter how much they may struggle against it. This is an important point to understand in dealing with issues related to the treatment of homosexuals. (Socarides 1968)
In exploring any symptoms or behavioral expression, it is important to take a multifaceted approach. This should include in the valuation of ego functioning particularly looking at the level of libidinal fixation or regression, as well as a stage of maturation fixation or aggression in general development of the ego. The processes by which this symptom or behavioral expression developed is vital in understanding of the issue. Finally, in annihilating the ego structure of an individual we need to know how the ego is functioning in other areas, particularly in its object relations. (Socarides, The Homosexualities, 1990)
Therefore, the homosexual inclination or behavior can be an expression of oedipal and or pre-oedipal material. It can be an unconscious conflict resolution from the earliest aspects of the ego development to a higher-level of ego organization.
The pre-oedipal dynamics in that form of homosexual conflict resolution tends to move closer to the projective defensive and paranoid expression.
The incomplete resolution of conflicts that is expressed by even the higher levels of ego organized homosexuality can be seen in the marked frequency of instability and they homosexual "marriages". These commitments, they do not the last more than two years; and even in that. There are frequent "adulterous" relationships. This clearly indicates how it is almost a certainty that homosexual behavior and is an attempt to resolve and unconscious conflict prior to five years of age.
The earlier in ego development where there are fixations due to unresolved conflicts, the closer that individual is to experiences of narcissistic injury. This can be experienced and expressed as narcissistic rage (in gross or more subtle form) to a therapist; or anyone who takes a therapeutic response to homosexuality. It can even take the director against anyone who responds to homosexuality as a problem and not a normal way of functioning.
Is obvious that the higher the level of ego organization (oedipal) the better the prognosis is resolution of the underlying conflict. However, like in all therapeutic (analytic) relationships, the motivation of the patient to understand and resolve their internal conflicts is the most important element for a successful outcome. Anything that counters such a motivation is not only counterproductive but actually has a constructive inhibitory quality. Therefore, it is incumbent on all reasonable people to support those individuals with homosexual symptomatology to work towards a solution of that problem. It is the opposite of helpful to attempt to treat such symptomatology as normal; thereby reducing the individual's motivation for help.
A difficulty occurs when reasonable people wish to protect homosexuals from legal and illegal abuse gather under the umbrella of various like-minded organizations. What often results is a collection of individuals with more serious ego defects (early/primitive points of fixation, incomplete maturation) under the same umbrella organization. The result can be destructive or at least injurious to society and individuals. It can be a significant contributory factor to the many negative responses to the usual family structure (heterosexual marriage and children). The so-called "freedom of choice" has become an invitation for increased sexual promiscuity, and a result in the increase of sexually transmitted disease.
One of the important dynamic constructions is the sadomasochistic conflict. For example, the passive homosexual with masochistic inclinations will give up a power or maturational position for the sake of love; while those with a more sadistic defensive construction may take a more paranoid type of response and give up love for what they feel is power (hostility) Since there is a known connection between homosexuality and paranoia, we can see some elements of this in some of the group's hostility to those who see homosexuality as a social/psychological problem. This can be dangerous or society and counterproductive in any scientific group or discourse.
An interesting clinical point is seen in the not surprising finding of the tendency of the distrustful-to-paranoid individual to experience and express hostility related to those who don't agree with them, as if they are the victims. We have seen this in the politically active homosexual groups in social, political, and scientific organizations. Not surprisingly, there is even a tendency to express their homosexual position in grandiose terms.
Currently, there is a great deal of literature circulating in the nation schools that has been prepared by homosexual teachers. This material tells children that they have "legitimate sexual alternatives." This may not create homosexuals, but it certainly will contribute to any sense of insecurity and gender role doubts that are normal in children. Instead of contributing to their freedom to think and feel and explore their world, it can significantly contribute to their anxiety and confusion. Teenagers commonly experience homosexual feelings and even a homosexual experience. This usually leads to a normal heterosexual development. The preceding literature of "legitimate sexual alternatives" can only add to their doubts and security and depression. I and others agree that it will increase the tendency toward suicide.
Among the many reports of the negative responses to heterosexuality by some homosexual organizations are the following: Quicksilver Times in 1970 reported a homosexual workshop in a Philadelphia convention that included in one of their demands called the abolition of the nuclear family because it perpetuates the false categories of homosexuality and heterosexuality. At the same meeting, another group said that, "the nuclear family is a microcosm of the fascist state, where the women and children are owned by, and their face determined by, the needs of man, and a man's world." (Socarides, A Freedom Too Far, 1995).
Socarides has also indicated that for the obligatory homosexual, there is often a fear of engulfment by the mother which is connected to a fear, like aphanisis and a searching for their lost masculinity. (Socarides, 1995)
Another expert (Meissner, 1990) in diagnosing and treating homosexuals looked at the dynamics discussed where he described two clinical types of overt homosexuals: Namely the feminine identifying homosexual and the masculine identifying homosexual. The feminine identifiers tend to avoid seeing themselves as masculine and preferred to see themselves as weak and passive in their social interactions, especially in avoiding competitive interactions with other men. Their strong passive need produces a fear of maternal envelopment which is protected against by a deep attachment to a very masculine male object.
The homosexuals with a strong masculine identification will often try to reject (deny) their homosexual inclinations. Power plays a very important role in their efforts to maintain their masculine identity often by dominating a weaker partner. These "hyper masculine" homosexuals tend to be more aggressive and violent in sexually related activity, and they often demonstrate paranoid characteristics (Ovesey and Person, 1973)
The connection between the masochistic character and paranoid thinking has been extensively discussed. One therapist (Nydes 1963) saw the masochistic individual avoiding a power position for the sake of being loved; while the paranoid character avoids love so he can be in a power position. Thus, many analysts and therapists since Freud conceded a connection between paranoia and homosexuality. That connection is common and often clinically observed. There is a difference of opinion among that group of therapists whether it is invariable or usual.
"What has not been generally agreed upon (but is certainly true)* are the concepts that,  masochism defends against a frightening sadism,  the masochist (particularly the pain needing type) is at best borderline in ego functioning,  masochism is not just an expression of pre-oedipal needs but is a defensive function, (as is true for all perversions)  all masochists are depressed, (as is true for all self depreciatory or self injurious conditions)  and infantile pre-genital sadism underlies all masochism. (Breiner, 1994)
Another view of the conflictual dynamics in homosexuality is that feminine and masculine wishes are in conflict with each other and defend against each other. When they give rise to very uncomfortable internal affects the result is an upset quality that feels like a "psychic chaos." A well known analytic author states that, "in analytic practice with adult patients there is such an oscillation (which can be seen) very clearly in many male homosexuals." (Brenner, 1982)
What is the value in understanding the topic of homophobia in exploring the connection between homosexuality and paranoid ideation? Consider again the violent homophobic. Their irrational hostility would fit in with a paranoid dynamic construction. The milder less destructive homophobic is also likely to contain some elements of paranoid ideation. In addition, those individuals who would attack in any way the benign position of a therapist trying to help homosexuals by calling them homophobic are likely expressing projection and likely some dynamics similar to the paranoid position. Therefore, the greater our understanding of true homophobia helps the therapist to a better diagnostic/therapeutic position. This is obviously better in all ways for the patient.
Homophobia is a unique form of a phobic reaction. Like any true phobia, when an individual is forced to face the phobic object or situation, panic can occur. This panic reaction will produce a fight or flight response. If the symptom is a milder form of negative response, it is not a phobia. Not liking spiders is not the same as being terrified of them (arachnophobia). Not liking homosexuality or homosexuals or being uncomfortable with them is not homophobia. Homophobia, like any phobia is a significant symptom. In some instances it can be considered dangerous--such as in the paranoid psychotic. Fortunately, this latter form is not that common.
"There are presently numbers of homosexuals who feel that their sexuality is ego-syntonic. For them, treatment for their sexuality is virtually impossible; and some respond to the recommendation that they seek treatment as a grossly insensitive subjection. That they have become some of the most vocal and strident critics of psychoanalysis is largely the result of their changing conception of their sexuality." *** "... another aspect of this problem is that psychoanalytic knowledge, like the basic knowledge in other scientific disciplines, does not - and cannot - receive its validation from majority views or opinions. Nor is its knowledge limited (relative) to specific historical or cultural settings. (Levine, 1979).
By using the turn homophobic in a nonspecific and general manner it loses its impact and diagnostic importance. It is most unwise to give up a useful diagnostic tool. It is even more unwise to take a clinical issue and make it a social and/ or political football.
Clinical Case: Mr. J.
Mr. J. in his early forties entered his third psychotherapeutic experience. He was in therapy for two years in his early twenties on a once a week basis and in his early thirties on three times a week analytic psychotherapy for three years. He began formal psychoanalysis with me for a period of 10 years
After eight years of marriage his parents were able to conceive Mr. J. He was the only child until five years of age. His mother was a grade school teacher and his father was a day manager of a large factory. From birth on, his mother treated him in a seductive and episodically castrating and cold manner. She repeatedly his genitals, being concerned about undescended testis. She made him to take naps with her in the same bed until his puberty. Both were in their underwear. He had strict orders not to move while in bed with her as this would disturb her nap.
He was not permitted to be angry with her or anyone, or openly disagree. She usually was cold to her husband rejecting any affectionate advances from him; and she would episodically withdraw and go to bed for part or all of a day. The only time he could count on his mother's affection is when he was taken on shopping trips. When she would try on clothes in the woman's dressing room, he was required to stay in there with her. The father was not able to intervene or he chose not to "upset" his wife. His father also treated himself as intellectually inferior to his more educated wife.
Until the age of seven this boy's only playmates were girls in the area. He didn't participate with boys from school and none lived on his street; nor did his parents arrange for him to play with these boys after school.
From age eight to 13 he had three or four close boyfriends, though he never participated in sports as his friends and others boys did. At age 13 his boyfriends stopped associating with him. They were interested in girls and he "wasn't like them." He dates all of his life's difficulties from that point on. He has never felt to be a man; he has always felt he is a boy, not a man, and defective somehow.
He was a brilliant student in school, college, and graduate school. He became successful in a major heavy industry as a creator and published writer. Despite his many accomplishments and appreciation by all who know him, he hates himself because he is different from everyone else and not a man. His appearance, however, is quite masculine.
He finds women's bodies objectionable though up to six years of age he had interest and curiosity in the genitals of his female playmates. His main interest secretively is male genitals, and how men get to be men. He will go to pornographic movie houses and watch other men masturbate. He will rent a motel room and watch homosexual male activity. An abortive attempt at homosexual experience he found anxiety-provoking and not appealing. He does not believe he is heterosexual, but he believes he is some kind of homosexual.
He has been plagued with suicidal thoughts and wishes for years. He feels he is unable to love. In all the years of analytic work, he has been unable to directly express positive feelings about the analyst or anyone else, except his mother. Both parents died prior to his beginning analysis. He has been able to express tantrum like rages in some analytic sessions. He also was afraid to terminate analysis as it is the only non-work situation that gives him a sense of stability. He believes he will commit suicide when he is forced to retire.
This man has a significant depression problem. He is not psychotic. He doesn't need medication. In fact, he rejects any suggestion (by me or other physicians) of taking any psychoactive medication. There is significant underlying anxiety. There is a significant gender sexual role identity problem. There is a significant sadomasochistic organization with passive form of passive aggressive minor symptoms and major fantasies.
The homosexual elements of this case are expressions of the underlying psychopathology. He wishes to be heterosexual like other men but doesn't know how. He wants the analyst to cure him, and make him into a "whole man." He blames and attacks analysts and all therapists for not succeeding in this; and almost gloats in our "therapeutic inadequacy."
Anyone working with this man in a therapeutic endeavor would be accused by some writers of being homophobic. Anyone working with this not atypical male with homosexual expressions should be considered, if anything, homophilic
When a fellow human being is in distress it is normal to try and aid them. If it is a medical problem, it is reasonable for a physician to treat such a hurting individual. If it is a psychological problem, a psychotherapist would respond in a similar fashion. If a homosexual male or female is uncomfortable with that position and wishes to seek help, it is incumbent on any therapist to help them deal with their psychological problem. Particularly is this the case if the patient feels their problem is their being homosexual. To respond to their distress as abnormal (homophobic) is anti-analytic, and grossly insensitive to a patient's problems. In this situation neither the patient nor the therapist can even be remotely considered homophobic. Quite the opposite. Since the patient likes himself but is in conflict and wants to help himself, and the therapist is in a positive relationship with the patient, we should even consider these two individuals in the therapeutic relationship to be homophilic.
The Annual of Psychoanalysis: Rethinking Psychoanalysis and the Homosexualities, Eds. Winer, J., W. Anderson, et al, Vol. XXX, The Analytic Press, 2002, p.71.
Blumenfeld, W. Ed, Homophobia: How We All Pay The Price, Beacon Press, 1992, pp. 196-8.
Breiner, S., Leopold Von Sacher-Masoch, Journal American Academy of Psychoanalysis, 22 (4) p. 655, 1994.
Brenner, C., The Mind in Conflict, International Univ. Press, 1982, pp 100-1
Campbell, R., Psychiatric Dictionary (5th edition) Oxford Univ. Press, 1981, p. 467.
Doupe, G.E., True to Our Tradition, in Homophobia, Ed., Blumenfeld, 1992, pp. 107-8.
Edgerton, J., R. Campbell, Eds., American Psychiatric Glossary (7th edition) American Psychiatric Press, 1994, p. 102.
Eidelberg, L. Ed, Encyclopedia of Psychoanalysis, The Free Press, 1968, pp 309-10.
English, H., A. English, Eds., A Comprehensive Dictionary of Psychological & Psychoanalytic Terms, David McKay Co, 1958, p. 388.
Fenichel, O., The Psychoanalysis Theory of Neurosis, Norton, 1945, p 180.
Freud, S., The Case of Schreber, Hogarth Press, 1911, p 47.
The Ego and the Id, Hogarth Press, 1923, p 43.
Friedman, R.C., "Homosexuality," in The Annual of Psychoanalysis, Winer, Ed, 2002, pp 69-77.
Greenson, R., "Phobia and Anxiety, and Depression," Journal of American Psychoanalytic Assoc., 1959, p. 7.
Harre', R., R. Lamb, Eds., The Encyclopedic Dictionary of Psychology, MIT Press, 1981, p. 472.
Kaplan, H., B. Sadock, Eds. Comprehensive Textbook of Psychiatry (5th Ed), Williams & Wilkins, 1985, pp 458, 973.
Ibid - Comprehensive Glossary of Psychiatry & Psychology, Williams & Wilkins, 1991, pp 141-2.
Levine, E., "Sexual Deviance," Psychoanalysis and Society: On Sexuality, Eds., Karasu, T. &C. Socarides, International Universities Press, 1979 p. 342.
Levy, R., The New Language of Psychiatry: Learning & Using DSM-III, Little, Brown & Co, 1982, p. 115.
Malyon, A.K., "Psychotherapeutic Implications of Internalized Homophobia in Gay Men," Journal of Homosexuality, Vol. 7, 1982, pp. 59-69.
Meissner, W., Paranoid Process & Homosexuality, The Homosexualities, Socarides, Ed., 1990, IUP Press, pp. 81, 82, 88, 91, 92.
Moore, B., B. Fine, Eds, "Psychoanalytic Terms & Concepts," American Psycho-analytic Association & Yale Univ. Press, 1990, pp 144-5.
Nydes, J. (1963), "The Paranoid-Masochistic Character," Psychoanalytic Review, pp. 215-25.
Ovesey, L., E. Person, "Gender Identity and Sexual Psychopathology In Men: A Psychodynamic Analysis of Homosexuality, Transsexualism and Trans-version," J. Am. Academy of Psychoanalysis, 1973, pp. 53-72.
Socarides, C., The Overt Homosexual, Grune & Stratton, 1968. P73.
Ibid - Homosexuality: A Freedom Too Far, 1995, pp. 125-6.