Schizophrenia - The Bearded Lady Disease

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The following quotations on this link can also be found in the book, Schizophrenia - The Bearded Lady Disease.

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We know that the first step towards attaining intellectual mastery of our environment is to discover generalizations, rules and laws which bring order into chaos.

--- Sigmund Freud, Analysis Terminable and Interminable, in The Complete Psychological Works of Sigmund Freud, Volume XXIII (1937-39), THE HOGARTH PRESS and the Institute of Psycho-Analysis. (James Strachey, Translator.) London, 1964, p. 28.

Case A – Patient was a forty-six-year-old divorced man suffering from a psychosis. He had recently broken up with his live-in girlfriend, an event which had triggered his schizophrenic break. He believed he was turning into a woman, and took great pride and pleasure in this fact. During therapy with him it was decided that his male side would be called 'Mars' and his female side 'Venus.' It was pointed out to him that his present psychotic condition was the result of a very severe conflict between his Mars and his Venus. The patient readily agreed with this explanation.
       The thrust of therapy with this patient consisted in the therapist trying to strengthen the patient's Mars while simultaneously allowing his Venus, which had long been deeply repressed, to come out and have her day on stage, so to speak. This she did over a period of several months, while his Mars stood aside and allowed her complete freedom of action and thought.
       On one occasion during this time the therapist mentioned to the patient that he had seen a friend of the patient's drive by with a very pretty blond woman by his side. The patient responded that yes, he knew that, because it was actually the patient himself whom the therapist had seen sitting in the passenger seat of the friend's car. When the therapist countered that on the occasion he was speaking of, it had definitely been a blond female he had seen in the car, the patient replied that yes, he understood that, but the blond was really himself. The therapist then acquiesced to the patient in this matter, seeing that it was futile to differ with him about the identity of the pretty female, as the patient so clearly and emphatically identified himself as being this particular woman.
       At another point during his therapy, the patient brought the therapist a postcard showing a beautiful, voluptuous female lying naked on a bed, with clouds and some angels overhead. The patient told the therapist that the woman shown on the postcard was really himself, as in his psychotic mind this was how he pictured himself at that moment. His Venus was in full bloom at this time.
       Later, as the therapy progressed, the patient's Venus diminished somewhat in power and his Mars began to regain it's rightful place in the patient's psyche.
       Towards the very end of his therapy the patient, in one of his sessions, handed over the above-described postcard to the therapist to keep, stating that it no longer represented what the patient looked like. Shortly after this the patient terminated his therapy.

--- A J.M. Mahoney case study.

Case B – Patient was a thirty-seven-year-old married man suffering from extreme anxiety and incipient paranoia.
       He reported that one evening, after he had gone to bed, he suddenly began remembering the contents of certain perverse, bisexual phantasies which he had masturbated to many years before, an activity he had discontinued upon realizing how 'unhealthy' it was. He had successfully repressed any memory of these events until this very moment.
       Now that he was suddenly confronted again on a conscious level with these long-repressed masturbatory phantasies, he experienced an extraordinary phenomenon. He stated that the very first phantasy he allowed into conscious awareness from its unconscious hiding place caused a transformation in his penis from a state of total flaccidity to full erection and spontaneous orgasmic discharge, all within the space of five seconds or less. When queried about the extremely short time interval between complete penile flaccidity and spontaneous orgasmic discharge, patient answered that the time element may have been even shorter than five seconds, for to him it had seemed like an almost instantaneous happening.
       Greatly astonished by what had taken place, patient said he was able to repeat this phenomenon several more times during the same night, naturally with an increasingly longer time-lag between conscious awareness of a particular phantasy and the ultimate spontaneous orgasm. Patient further reported that he continued this practice nightly for several months until he had exhausted his store of long-repressed phantasies and until these phantasies had lost their power to stir up any more sexual excitement.
       Patient also stated that by the end of this period of phantasy abreaction his anxiety had completely disappeared, along with the incipient paranoia, and that his overall health, both physical and mental, had greatly improved.

--- A J.M. Mahoney case study.

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.

--- Theodore Isaac Rubin, M.D., Lisa and David. Ballantine Books. New York. 1962, p. 128. [ Note: This is the Quotation which led to the title of the book: "Schizophrenia -- The Bearded Lady Disease". ]

All through his childhood he had been very fond of playing parts in front of the mirror. Now in front of the mirror he continued to play parts, but in this one special instance he allowed himself to become absorbed into the part he played (to be spontaneous). This he felt was his undoing. The parts he played in front of the mirror were always women's parts. He dressed himself up in his mother's clothes, which had been kept. He rehearsed female parts from the great tragedies. But then he found he could not stop playing the part of a woman. He caught himself compulsively walking like a woman, talking like a woman, even seeing and thinking as a woman might see and think. This was his present position, and this was his explanation for his fantastic getup. For, he said, he found that he was driven to dress up and act in his present manner as the only way to arrest the womanish part that threatened to engulf not only his actions but even his 'own' self as well, and to rob him of his much cherished control and mastery of his being. Why he was driven into playing this role, which he hated and which he knew everyone laughed at, he could not understand. But this 'schizophrenic' role was the only refuge he knew from being entirely engulfed by the woman who was inside him, and always seemed to be coming out of him.

--- R. D. Laing, M.D., The Divided Self. Penguin Books. Baltimore, Maryland. 1965, p. 72.

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 fantasies, 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 make them more analyzable. Some authors have suggested that the prospect of recovery in such patients may actually be better when they are treated by women since discussion of the homosexual tendencies is less likely to provoke a panic-like state than when treated by men.

---- Eugene B. Brody and Frederick C. Redlich, Editors, Psychotherapy With Schizophrenics, International Universities Press, Inc., New York, 1952, p. 54.

Another patient, Dorothea, a fifteen-year-old colored girl, went around lifting her dress and telling everyone she had a penis (which she called a 'dickie'). In the early weeks of therapy her entire conversation was concerned with sexual ideas. One day, she started the meeting this way:

D. 'I know something about you!'

T. 'You know my name?'

D. 'Oh, I know your name, but Barbara [another patient, whom I had seen for diagnostic psychological examination] told me that you had showed her something when she was up there.'

T. 'I showed her a lot of things.'

D. (Giggling) 'She said you showed her what you have between your legs.'

T. 'You mean my 'dickie!' '

D. 'Don't say that' (embarrassed and angry).

T. 'Well, I have one, because I'm a man; you don't have one, because you're a girl. We're different, you and I!'

D. 'I'm a girl, but I'm not your girl friend.'

T. 'Oh! I like you very much!'

D. As she was speaking she moved to another part of the room and lay on her back on the floor. I went and sat on the floor near her. 'You see these things here?' (Giggling.)

T. 'Yes, those are your breasts. Girls have breasts, and you're a girl.' She starts moving her body seductively.

D. 'Do you want to lie on top of me and fuck me?'

T. 'I guess you know very well now that you're a grown-up girl, and you know that I'm different from you.'

D. 'Well don't you want to fuck me?'

T. 'No, I don't want to fuck you, but I'm glad you know that you're a real girl now. You're different from me, I'm a man. You have breasts, and you want to be loved by a man. …..'

--- Austin M. Des Lauriers, Ph.D, The Experience of Reality in Childhood Schizophrenia, International Universities Press, Inc., New York, 1962, p. 88.

        Even as I write this there is a stream of profanities and obscenities pouring out of the little sick girl's mouth – so vile, so foul, the very air is crawling and stinking. Her voice does not have the feminine sound of a girl's voice – it is heavy and throaty. There is a passion, a vitality – a madness in her speech that makes the words she uses seem pitifully inadequate to express her delusions.
        She does not know death is upon her – nor would she care if she did know. Madness is upon her like travail upon a woman with child. It has come. It has claimed her. She can neither avoid it nor satisfy it. It is wasting all the life within her in a prodigal holocaust of raving; is preparing other victims for itself by consuming her here in the presence of all. Death is preferable. Thank God it is coming!
        Even the doctor, who is armed with experience and wisdom – turned and fled from the sight of her – and his eyes held the stark look of human pain in them. He felt the grim helplessness, the painful inadequacy of his profession, which has only been able to provide a long name for her Madness. That was not an adequate armour this morning.

--- Lara Jefferson, These Are My Sisters / A Journal from The Inside of Insanity. Anchor Press / Doubleday. Garden City, New York. 1974, p. 129. [ Note: Before the advent of the powerful new tranquillizing drugs, patients in the so-called "exhaust status" of catatonic schizophrenia would sometimes die as a result of their fulminating madness. ]

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.)

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

At the head of the list is a middle-aged woman of stern virginal purity. I suppose she is still a virgin, but the sterness has grown and developed into something grim and terrible; and the 'purity' has been replaced by a maniacal obscenity which is revolting.
Now, in the middle years of her life she has left behind both natural modesty and her exalted idea of purity, since madness has claimed her – she has been swept far into unspeakable lewdness. She is so far gone into madness that she fashioned a set of male genitals out of a snuff box. She stands naked before all who may see her and gives voice to her madness by shrieking such foulness the very air around her is crawling and stinking with it. Until others who are mad also, and not easily shocked by such exhibitions, cannot endure the sight of her – who at one time in her life was modest to the point of prudery.

--- Lara Jefferson, These are My Sisters: A Journal from the Inside of Insanity, Anchor Press / Doubleday. Garden City, New York. 1974, p. 42.

At the time I didn't have any answer, not one single alternative to the circus. I guess it was the only gritty, real-life, grossly rapturous thing I could show my children, or safely participate in myself. Now, however, I have an alternative – and as Steve and I looped the loop on the cantilevered coastal highway, we decided that the closest metaphor for our communal experience was the circus. Life at the brink, and the primal ooze – we had had all of that. Including the rankness. And the magic. I think that's what e.e. cummings was getting at when he wrote, 'Damn everything but the circus.' You betcha.
But Corita Kent has already stolen that image for a beautiful volume collecting her collages, so it was opted for. Never mind – we sorted through all the circus images we could think of, until we found one much more apt for us. Bypassing high-wire artists, trapeze artists, lions and tigers and bears, even the Human Bullet, we settled happily on the Bearded Lady. Yin and Yang in one gaudy and astonishing package, the secret, lurking unity in every bipolar self. The androgyne. Our selves. The Devil. God.

--- Richard Atcheson, The Bearded Lady, Going On The Commune Trip and Beyond, The John Day Company, New York, 1971, pp. 139–140.

It is not intended to go into details of the criticisms with which Freud's paper was received in psychiatric circles. But mention should be made of the review by Bleuler (1912), one of Freud's friendliest critics: 'This publication bears the hallmark of an important contribution by the very fact that it provides food for further thought, questioning and research,' though 'difficulties arise by trying to separate Schreber's illness from schizophrenia ..... Paranoid and schizophrenic symptoms not only coexist in one patient, they also seem to merge and indeed appear to be two aspects of the same process.'

--- Daniel Paul Schreber, Memoirs of My Nervous Illness, Translated, Edited, with Discussion, by Drs. Ida Macalpine and Richard A. Hunter. London. Wm. Dawson & Sons, Ltd., 1955, p. 371.

Though simple and hebephrenic schizophrenic reactions become visible during early and middle adolescence, the characteristic reaction is that of an acute catatonic episode. Catatonic reactions are by far the most frequent schizophrenic disorganizations seen during this period and, side by side with the acute conversion reactions, constitute the bulk of emergency psychiatric difficulties during adolescence. Catatonic episodes can develop in a matter of hours and express themselves in great motor inhibition or overactivity, highly overactive and paranoid thought and speech patterns, totally inhibiting panic or desperate grandiosity. Fears centering around homosexuality, sexual inadequacy, or sexual guilt, together with a remarkable concern with philosophic and religious issues of a grandiose nature, almost universally accompany such reactions. Characteristically, catatonic patients have the ambivalent wish to change themselves or feel that they have been transformed into another sex. They wish to change the world immediately, to purify it and bring news to everyone else that has been given them in a revelation. Quite often such wishes are put into action in totally inappropriate and aggressive ways that are disturbing to the people in the patients' environments.

--- Sydney L. Werkman, American Handbook of Psychiatry, Vol. II, edited by Gerald Caplan, Basic Books, Inc., New York, 2nd ed., 1974, p. 230.

        The origin of the word 'koro' is not clear. It may stem from the Malayan word 'kuru,' shake; the Javanese word 'keruk,' shrink; or according to Yap,153 from the Javanese word for tortoise. The Chinese and Southeast Asians call the glans penis tortoise.
        The Chinese name for the syndrome is 'shook yong.' It has been known in China for centuries. One of their emperors died supposedly of shook yong. The Chinese author Pao described it in 1834. He claimed that it is precipitated by exposure to cold or by the ingestion of cold or raw food. It starts out with abdominal pain, spasms, and cyanosis of the limbs, retraction of the penis and scrotum into the abdomen; then, there is trismus, and finally death. It is a serious emergency. According to Chinese folk medicine, it is related to the middle female meridian which is supposedly governed by the liver – the organ most susceptible to worry, fear, and anger. One of the triggering causes is believed to be excessive intercourse or improper sexual relations.
        The symptoms usually start without warning. The patient, usually between thirty and forty years of age, is suddenly worried that his penis will disappear into his abdomen and that he will die. To prevent this from happening, the patient has to grip his penis firmly; when he becomes tired, his wife, relatives, or friends help him. The Chinese constructed a special wooden clasp for this purpose. At times, fellatio, practiced immediately by the patient's wife, can stop the phobia, otherwise it can last for days, or even weeks. Linton 97 describes a female equivalent of koro in Borneo where the patient is afraid that her breasts are shrinking as well as her labia, which would lead to the disappearance of important female characteristics.
        The Chinese believe that shook yong is caused by an imbalance of yin and yan. The prevalence of the female factor yin must be counteracted by the administration of a drug which increases yan, for example, powdered rhinoceros horn.

--- Johannes M. Meth, American Handbook of Psychiatry, Vol. III, edited by Gerald Caplan, Basic Books, Inc. New York. (2nd Edition) 1974, p. 730.

The more the work of the past year recedes into perspective, the better pleased I am with it. Now for bisexuality! I am sure you are right about it. And I am accustoming myself to the idea of regarding every sexual act as a process in which four persons are involved. We shall have a lot to discuss about that.

--- Sigmund Freud, The Origins of Psychoanalysis (Letters to Wilhelm Fliess, Drafts and Notes: 1887-1902), Basic Books, Inc., New York, 1954, p. 289.

I am not intelligence, but mind. Tolstoy spoke about the mind, Schopenhauer also. I too write about mind. My philosophy is truth and not invention. Nietzsche became insane because he realized at the end of his life that everything he had written was absurd. He became frightened of people and went mad. I will not be frightened if people throw themselves at me. I understand crowds. I can manage them, although I am not a commander. I like family life; I love all children, and I like to play with them. I understand them. I am a child, and I am a father. I am a married man. I love my wife and want to help her in life. I know why men run after girls. I know what a girl is. Man and woman are one; I prefer married people because they know life. Married people make mistakes but they live. I am husband and wife in one. I love my wife. I love my husband. I do not like a husband and wife to be debauched. I am a physical body but not physical love. I am love for mankind. I want the government to allow me to live where I like. My wife is a good woman, so is my child, and they shall not be hurt.

--- Romola Nijinsky, Editor, The Diary of Vaslav Nijinsky, University of California Press, Berkeley, Los Angeles, CA, London, 1971, pp. 155-156.

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 hardworking, 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.

--- Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia, Chicago: The University of Chicago Press. 1955, pp. 134-5.

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.

--- Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia, Chicago: The University of Chicago Press. 1966, p. 106.

His [Schreber's] excitement, which had its origin in the non-psychotic part of the personality, took a different course from that in the pre-psychotic period prior to the psychosis. In the pre-psychotic period the excitement led to genital emissions; a few weeks later, in the psychosis, before a situation leading to excitement could arise, the energy of the homosexual urge was withdrawn and then used to form the hallucination. Thus the hallucination is formed in anticipation of a danger. The energy of the homosexual urge evaporates in forming the hallucination. The hallucination is therefore a discharge phenomenon which serves to prevent the development of danger. Of course, when the homosexual urge acquires energy again, then the danger returns.
..... Through the hallucination the energy of the dangerous urge which would destroy contact with reality is discharged, and this fact leads to the conclusion that the hallucination serves to maintain contact with reality in the non-psychotic layer. This goal of maintaining contact with reality can be achieved only by abandoning it for a short while through the formation of a psychotic symptom (the hallucination). It is like avoiding a major evil by accepting a minor one.

--- Maurits Katan, M.D., The Importance of the Non-Psychotic Part of the Personality in Schizophrenia : The International Journal of Psychoanalysis, No. 35, 1954, p. 126.

During his stay in that hospital, he did not show improvement. He was transferred to the Sheppard and Enoch Pratt Hospital on January 27, last. After discussing his life up to the time of his brother's enlistment, in our initial interview, he was asked if he had missed his brother. He replied: 'Oh ..... He had his friends and went around with girls, too. I had friends, but ..... I could not keep up ..... They were a little ahead of me ..... Well, socially and ..... monetary reasons, too.' Here he referred to a doctor with whom he had had some interviews, saying thereafter 'I slept with my brother 'till the war *** that homosexual feeling H – [the doctor] spoke of. I'd tell him ..... anything, and ..... it seemed I got worse and worse. All our actions and talks were tensions between us, you see. It was on the morning of the eclipse ..... I was relating it to myself ..... and the morning it came, I was wild, I thought I was dying or something. *** I was supposed to be in hell, I guess ..... and they had a language there; I'd hear things ..... I couldn't smoke a cigarette or drink water *** The whole thing was like going through a dream ..... I was two persons; one night, a man and a woman; and the next, two men. *** Called all sorts of damnable things – dog, cocksucker ..... everything that I had ever heard.' Later in the discussion, he volunteered 'Never had inter-course with a woman; never seen a naked woman: have fooled around when I was on the road'; the latter had occasioned two incidents of ejaculatio praecox some short time before his acute episode. He shied at any discussion of the homosexual goal, saying amiably but with tension, 'Don't talk to me about those things, I will get all mixed up again ..... I think I know what ails me ..... my feelings have got swung around.' Inquiry as to what he meant increased his discomfort.

--- Harry Stack Sullivan, M.D., Schizophrenia as a Human Process, W. W. Norton & Company, Inc., New York, 1962, p. 75.

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.

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

       The first clue as to this came in a dream in which she and another person were in a house. The other person seemed to be a part of herself and at the same time seemed to be a man. She was afraid someone would see the man so she jumped into bed and pulled the sheet over her head but then said, as if speaking to the man who was a part of herself, 'What does it matter if they do see you? Why try to conceal it any longer?'
       This dream foreshadowed an increasing realization of the resentment she felt at her own femaleness and the envy she felt toward men. She recognizes (in the dream) that she thinks of herself as part man, part woman – but tries to conceal the 'man' part. In fact, it could be said that her entire life centered about the wish to become a boy like her brothers and the feeling of guilt implicit in the idea of becoming a boy by robbing them of their masculinity. It proved to be the unconscious motive back of her repeated submission to surgeons. One day while in church to which she had gone compulsively as a part of her atonement ritual, it suddenly came to her that perhaps she wanted to suffer like Jesus as she had obviously been doing for a long time, even to the point of having the same pain in her side that Jesus had, for the following reasons: Jesus was a man; hence, by being Jesus, even though one suffers, one can be a man.
       Such an 'irreligious thought,' as she termed it, disturbed her very much, but later she returned to a realization that it was the basis of much of her religious fervor. It explained her wish to believe in miracles, her faithfulness to her devotions, her feeling that some day she would get her reward and that God would answer her prayers. She felt that perhaps if she suffered greatly she might be granted the privilege of becoming a man. This began to appear very clearly in her analysis. She kept complaining that she was getting nowhere. It was not clear what she wanted of the analysis but she evidently expected something wonderful to happen. She expected the analysis to gratify her lifelong quest for masculinity. To this end she assured the analyst of her belief in miracles and implied that she expected a miracle to happen in her analysis. In every way she showed that unconsciously she was taking the position that if the analysis would make her into a man it was worth the suffering it cost her.

--- Karl A. Menninger, M. D., Man Against Himself. New York: Harcourt, Brace & World, Inc. 1938. (pp. 135-36).

       Theresa, a 23-year-old mother of a newborn and a toddler, was the first of the 21 residents to go. She became incoherent at 2 a.m. on a Wednesday. She said she was scared to sleep for fear she wouldn't wake. Two shelter workers listened to her cries. Throughout the night, she talked. At times, her plaints were pitiful. 'I didn't hurt anyone,' she said. 'Why do I feel like this?'
        At one point, she opened a safety pin and began to stick it into her hand. A counselor gently took the pin away.
        By morning, she was calm and more coherent. Counselors decided to escort her to a local hospital. Emergency room attendants checked her physical signs and recommended that she seek psychiatric care. The next day, a psychiatrist prescribed an antidepressant and suggested that she be placed in a psychiatric facility.
        She was allowed to return to the shelter for another night. That evening, as others settled down with their children, Theresa became incoherent again. She talked in a man's voice, then a child's voice, holding her 5-month-old son in her arms.
        The counselors decided that Theresa needed immediate psychiatric help. Twice during the night, they took her to the hospital, where she was given emergency treatment with pamelor, an antidepressant. Doctors there spoke to Theresa but decided she was not in imminent danger and sent her back to Greentree.
        In the morning, Greentree counselors took Theresa to another hospital, where she was admitted to the psychiatric ward.

--- Chris Spolar (staff writer), No Home and Not Much Hope, The Washington Post National Weekly Edition, March 27 - April 2, 1989, p. 6.

        Then, his mind stole his future. Over the course of several years, he began having delusions. Doctors would later diagnose him as schizophrenic. He lost interest in his high school teaching job and quit. He became paranoid and argumentative.
       His parents took him in, but he no longer trusted them. He claimed they had stolen him from his true parents: Marilyn Monroe and Jack Lemmon.
       Because he refused to see a psychiatrist, mental health officials said they could do nothing for him.
       [ Name deleted], 42, is now on medication and living in a group home. As he describes it: 'One day I was minding my own business and the police hassled me and turned me over to a mental hospital.'
       [Name deleted] had been walking by an elementary school in Vallejo. His mother says police picked him up because he was wearing a dress. He agreed to be treated for his mental illness, because, he says, he was afraid to fight the system.
       Meanwhile, his parents deposited a Social Security check in his bank account each month and struggled to keep track of him through bank statements that showed which automatic bank teller machines he used.
       'When we didn't hear from him for a while,' his mother said, 'we were afraid he had ..... you know ..... that he was dead.'
       Then he would call to ask for money. One day, his parents arranged to meet him in Oakland. His mother remembers noticing from a distance, with a touch of hope, that his beard was gone. When he got closer, 'I burst into tears,' she said.
       Her son was wearing a flower-print dress, high heels, lipstick, makeup and jewelry.
       'Jim,' his mother said.
       'Jamie, please,' her son corrected.
       He doesn't seem to remember that.
       Sometimes, when he hadn't called for a while, they looked for him, often finding him at a Berkeley BART station, shouting at passersby. 'I'm politically outspoken,' he admitted with a shy smile.
       Now, he spends most days watching television. Sometimes he goes for walks. His parents pick him up Friday afternoons for weekends at home.

--- Tony Bizjak (staff writer), A Son's Tragic Slide, San Francisco Chronicle, March 15, 1989, p. B6.

        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

--- Karl A. Menninger, M.D., Man Against Himself. New York: Harcourt, Brace & World, Inc. 1938. (pp. 236-37).

Most schizophrenics have a homosexual bent or conflict. This was fully confirmed by the histories and psychological tests of our two groups of patients: 27 of the 30 in each group revealed homosexual tendencies. But there was a sharp contrast in expression of the tendency. In the 27 Irish patients the homosexuality was latent but repressed, whereas 20 of the 27 Italians had become overt homosexuals. The underlying factors in both cases are clear. The Italians had rejected a male role out of hostility to their overbearing fathers and elder brothers. Italian men, no less than Irish men, take pride in masculinity; indeed, they are, if anything, more masculine in behavior. But they are also readier to act on sexual impulses, and when they lose their sense of sexual identification in schizophrenic illness, they do not shrink from overt homosexual behavior. Irish men, on the other hand, flee from their identity as males through fear of the mother rather than hostility to the father. All of our Irish schizophrenic patients were either pallidly asexual or latently homosexual. Most of them avoided females. Their homosexuality was repressed because sexuality in general is inhibited in the Irish culture. But it emerged in their fantasies. Indeed, some misidentified themselves as women: one patient had the delusion that the front of his body was covered by an 'apron which bled periodically.'

--- Marvin K. Opler, Schizophrenia and Culture, (publication not recorded), August 1957, p. 120.

'Mary Frances! Mrs. Quinette!' shouted a patient through the glass, pulling his T-shirt higher up his chest and rubbing his belly.
        'Mr. Whitman, don't.'
        'They found the baby in my stomach, on the X ray.'
        'Mr. Whitman,' repeated the nurse, who was also this patient's advocate or case manager, 'don't yell through the glass. Knock on the–'
        'They took an X ray and saw the baby with a snake in it. That proves I'm a woman,' and with that the volatile Mr. Whitman disappeared around the corner and into the men's room. (Ibid., p. 110)

--- Susan Baur, The Dinosaur Man (Tales of Madness and Enchantment from the Back Ward). Harper Collins Publishers, New York, 1991, p. 110.