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.

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

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

Such a differentiation permits a speculative reconstruction of the schizophrenic process which would run as follows. For a variety of reasons – for example, hostility, harshness – the child in the earliest period of life loses confidence in its identity, its worth as a human being of its given sex. Obviously ordinary traumas such as neglect are not sufficient: the hostility or over-demandingness must treat the child like an object with no intrinsic worth of its own. Perhaps the parents unconsciously hate the child's sex or maybe the child senses that to be so despised he must be the wrong sex. Whatever the specific causes may be, one aspect of the general self-disconfirmation the child experiences is to lose (or never gain) confidence in his gender role identity, sometimes feeling like a member of the opposite sex or more often just alien from his own. This lack of gender security tends to influence style of approach to life, especially in the critical adolescent years when the sex roles begin to diverge markedly. Sex-role alienation is manifested primarily in passivity and defective instrumentality among males but is most apparent in the expressive functions among females, taking the form of hostile belligerence and emotional insensitivity when hospitalized. (It remains an open question whether the assertive quality of the behavior observed in female schizophrenics is a secondary by-product of expressive disruption or represents a fundamental divergence from the classical developmental picture of inhibition and social withdrawal in preschizophrenics.) But at the same time, schizophrenics of both sexes are perceived and treated usually by all at home and at school as members of their correct biological sex groups so that they develop more or less normal interests and opinions characteristic of their sex. What is crucial in schizophrenia is a serious disturbance at the primary or identity stage; conflicts at the secondary level of style of approach to life may lead to neuroses and at the tertiary level of interests to social maladjustments. But at any level, sex-role integration appears to be a crucial factor in adjustment.

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

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

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

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

--- R. D. Laing, The Divided Self, Penguin Books, Baltimore, Maryland, 1965, p. 203.

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

--- Karl A. Menninger, Man Against Himself, Harcourt, Brace & World, Inc., New York, 1938, p. 97.

The first step in the process of increasing barrenness of his existence was that the woman lost her love transparency, being a completely different, remote 'foreign' pole of existence; she became 'pale,' a 'mirage,' then she represented 'undigestible food' and finally she dropped entirely out of the frame of his world. When his progressing schizophrenia 'depleted his masculinity,' when most of his own male feelings 'had run out,' he suddenly and for the first time in his life felt driven to 'open himself' to a certain form of homosexual love. He described most vividly how in this homosexual love he succeeded in experiencing at least half of the fullness of existence. He did not have to 'exert' himself very much to attain this semi-fullness, there was little danger of 'losing himself' and of 'running out' into boundlessness in this limited extent and depth. On the contrary, the homosexual love could 'replenish' his existence 'to a whole man.' (Ibid., p. 146)

--- R. D. Laing, The Divided Self, Penguin Books, Baltimore, Maryland, 1965, p. 146.

It is instructive that Schreber was diagnosed in his first illness as suffering from severe hypochondriasis; his second illness commenced as an 'anxiety neurosis' with attacks of panic, then hypochondriacal delusions and suicidal depression; later catatonic excitement alternating with stupor. From then on he might well have been diagnosed variously as suffering from catatonic schizophrenia, paranoid schizophrenia, dementia paranoides, dementia praecox, monomania, chronic mania, involutional melancholia, paranoia paraphrenia, obsessional neurosis, anxiety hysteria, tension state, transvestitism, psychopathy, etc.

--- Daniel Paul Schreber, Memoirs of My Nervous Illness. Translated, Edited, and with Discussion by Drs. Ida Macalpine and Richard A. Hunter. Wm. Dawson & Sons, Ltd. London. 1955, p. 15.

For all students of psychiatry, Schreber, its most famous patient, offers unique insight the mind of a schizophrenic, his thinking, language, behavior, delusions and hallucinations, and into the inner development, course and outcome of the illness ..... Indeed the memoirs may be called the best text on psychiatry written for psychiatrists by a patient. Schreber's psychosis is minutely and expertly described, but its content is – as Dr. Weber explained to the court – fundamentally the same and has the same features as that of other mental patients. Schreber's name is legion. (Ibid. Schreber, p. 25.)

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

--- Freeman, T., Cameron, J.L., and McGhie, A., with preface by Anna Freud, Chronic Schizophrenia, International Universities Press, New York, 1958, p. 67.

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

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

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

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

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

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

       He became very slovenly, worried about having been subjected to sodomy and his feelings of an enlarging abdomen. He walked so that his abdomen was protruded forcefully, a distinct effort to have a pregnant abdomen.
       He complained frequently that 'this patient in my stomach talks to me all the time and mixes me up. Water or something moves up and down in here. It might be a rupture or something.' He said it took him all over the country and showed him many things and talked 'plainly' to him. He would not talk freely about it because it might get him into trouble. He seemed to believe that the feelings were the result of some form of pregnancy and explained it by 'someone stuck a stick of dynamite in there,' and stuck needles into his 'back.' (Ibid., p. 677)
       He later felt compelled to remove his clothing and without explanation stood about naked. He persisted in fondling certain other patients and became extremely persistent in getting into physical contact with them. He had a particular attachment to another patient who had similar difficulties and frequently hallucinated someone trying to perform sodomy on him. (Ibid., p. 678)

--- Edward J. Kempf, M.D., Psychopathology, C. V. Mosby Co., St. Louis, Missouri, 1920, p. 678.

I recall very vividly four castrated schizophrenics. One of them had cut off his own testicles. Two had their ovaries removed for 'nervous troubles;' i.e., in reality, because of the psychosis. A fourth had an ovariectomy because of an inflammatory process of the internal genitalia. In none of these cases could we detect a beneficial effect on the course of the disease. In two cases, castration was followed by the actual outbreak of the illness, giving rise to the patients' notion that they were no longer 'complete' human beings, thus constituting an integral part of the disease symptoms. Unilateral castration was also of no help in another male case.

--- Edward J. Kempf, M.D., Psychopathology, C. V. Mosby Co., St. Louis, Missouri, 1920, p. 473.

At 17, he joined the marines to get away from his mother, but he was unable ever to shake the sense of perpetual grievance with which she had imbued him, or his anger at a world that stubbornly refused to grant him the recognition she had taught him should be his.
Not surprisingly, the military did not suit him. Cold, sarcastic, withdrawn, he was taunted as 'Ozzie Rabbit' and 'Mrs. Oswald' by his fellow marines, and was court-martialed and found guilty twice, first for shooting himself in the arm with a .22 pistol he was unauthorized to carry and again for pouring a drink over the head of a sergeant who had dared assign him to K.P. duty. He subsequently suffered an apparent breakdown, weeping and firing shots into the night while on guard duty. After that he was called 'bugs.'

--- Gerald Posner, Case Closed - Lee Harvey Oswald and the Assassination of John F. Kennedy, Doubleday, New York, 1994. (The New York Times Book Review, date of review and name of reviewer not noted.)

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

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

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

--- Lawrence S. Kubie, American Handbook of Psychiatry, Vol. III, edited by Gerald Caplan, Basic Books, Inc., New York, 2nd ed., 1974, p. 14.

Our study has helped us refine and extend certain concepts relevant to the etiology of male homosexuality. Certainly, the role of the parents emerged with great clarity in many detailed aspects. Severe psychopathology in the H-parent-child relationship was ubiquitous, and similar psychodynamics, attitudes, and behavioral constellations prevailed throughout most of the families of the homosexuals – which differed significantly from the C-sample. Among the H-patients who lived with a set of natural parents up to adulthood – and this was so for the entire H-sample except for fourteen cases – neither parent had a relationship with the H-son one could reasonably construe as 'normal.' The triangular systems were characterized by disturbed and psychopathic interactions; all H-parents apparently had severe emotional problems. Unconscious mechanisms operating in the selection of mates may bring together this combination of parents. When, through unconscious determinants, or by chance, two such individuals marry, they tend to elicit and reinforce in each other those potentials which increase the likelihood that a homosexual son will result from the union. The homosexual son becomes entrapped in the parental conflict in a role determined by the parents' unresolved problems and transferences.
Each parent had a specific type of relationship with the homosexual son which generally did not occur with other siblings. The H-son emerged as the interactional focal point upon whom the most profound parental psychopathology was concentrated. Hypotheses for the choice of this particular child as 'victim' are offered later in this discussion.

--- Irving Bieber, et al., Homosexuality, A Psychoanalytical Study of Male Homosexuals, Vintage Books, Random House, New York, 1962, p. 310.

       Neither twin was ever interested in girls.
       Both Herbert and Nick held various unskilled jobs as delivery boys until age 22. Herbert then began to behave oddly, staring silently into space, sitting in awkward positions for long periods, neglecting himself, grimacing and laughing to himself; he interpreted passing automobiles as the sound of enemy aircraft.
       On January 8, Herbert was admitted to our hospital and came onto the twin register: 'You feel people are deceiving you. ..... I'd be reading people's thoughts when I concentrate ..... Some people talk backwards and some people you have to get along on top of their talk. [Later] I'm sure an 'interdiscrete society' could help you. Communist aggression mixed with racial intolerance'..... Herbert was committed to long-term care in a mental hospital and was still there after more than 28 years.
       Unknown to us at the time, Nick was admitted to a different hospital on January 5 after running across a plowed field with his arms outstretched as if in prayer. The night of his visit to Herbert, he was found crying and the next day seemed lost in thought and was making clicking sounds with his tongue. After New Year's Day, he amazed his adoptive father with unintelligible talk; he felt that he had special powers but that they left him when a cigarette pack was thrown away; he smashed a porcelain dog – 'The devil was there and it was either him or me'; he saw a mass of flames and heard voices singing 'Hark, the Herald Angels Sing.' He was admitted to a mental hospital the next day in a confused and agitated state. Like his twin, he had been virtually continuously in hospital for over 27 years.

--- Irving I. Gottesman, Schizophrenia Genesis (The Origins of Madness), W. H. Freeman and Company, New York, 1991, p. 122.

A 73-year old Milwaukee woman claimed she became sexually attracted to other women and started having spontaneous orgasms after an electric bingo scoreboard fell on her head. The woman asked for $90,000 from the church where the bingo game took place, but the judge threw out her case because she refused to undergo court-ordered psychological examination. (News story, publication not noted.)

       This condensed report has to do with a young man who, somewhat late in his intensive treatment, which had been instituted because of an acute catatonic episode, awoke from sleep one night in panic about a dream. In this dream he encountered a jungle feline which lived in a 'pit.' He described this beast in all its horrible and terrible characteristics. According to his spontaneous account, this jungle feline was representative of a penis, and the pit represented a vagina. These two lines of associations were jumbled together, so that he said that the jungle feline was himself, it was his penis, it was his mother, and her penis, her vagina, it was full of all the penes in the world, and it sought to devour all of them. He further stated that it was filthy, fecal, putrid, stinking, bloody, and fascinating. In the fury of his revulsion (note the juxtaposition of fascination and revulsion) the patient asserted among other things that he hated his penis; he wanted to cut it off and be free forever from the jungle feline.
       Being translated by the therapist, this impassioned outflow of words conveyed to him the idea that the patient felt that this penis of his, his sexuality, his very being and sanity, were all given to him in the process of birth. Thereby his mother had lost her penis. He saw himself as bound to his mother because his penis, his sexuality, his personality, and his sanity were all on loan from her. He visualized his mother's destructiveness if he were to permit anyone else to share in what he felt belonged to her. In the fury and terror of these associations, he actually perceived the doctor's office as literally filled with these jungle felines. The only solution he could devise to his state of panic was to cut off his penis. Unsaid, but inferred, was the thought that he could then return to his mother and be free both of her mortgage upon him and of her revenge. He could be again in peaceful symbiosis with her. It is worth noting that, although it also was not said, other productions of the patient on other occasions indicated that, having by this desperate self-mutilation freed himself from his mother, the patient would be able to enjoy real relationships, including the sexual, with other persons. For all its concreteness, his expression 'to cut off his penis' does not imply, in his magical thinking, that he will then be without one. However, in a situation such as this, there is a practical danger that the patient may mutilate himself.
       What the therapist said to the patient at this time was stated quietly, firmly, and definitely. It was, 'I do not believe you hate your penis. You like it. You need not cut it off.' This brought this interview to a close. Of course, there was much later reference to this dream as treatment progressed toward the patient's freedom, confidence, and courage to live in the real world.

--- Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia. Chicago: The University of Chicago Press, 1955, p. 209-11.

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

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

During the next session the patient talked about her mother as a murderess from Russia who had killed many people. She herself was also a murderer. She said she was very clever and I was stupid and empty-headed. She stressed again that her mother was a man. I said that she wanted to show me that she now was a man herself and had a penis. She responded very quickly 'Yes, I had one until I was twelve years old and then I had a haemorrhage. Harold shot me and pushed my teeth in.' She immediately asked me whether I was Harold. I said she believed that Harold had taken away her penis and made her ill and she felt now that I was Harold and had taken away her penis and her mind. I also interpreted that she was envious of me and my mind and that was the reason why she wanted to enter my head and wanted to take away my penis. In this session she shouted at me several times that I was mad and prevented me from talking.

--- Herbert A. Rosenfeld, Psychotic States (A Psychoanalytical Approach), International Universities Press, New York, 1966, p. 163.

During the next session the patient was at first manically excited and danced around the room. She declared she wanted to marry me, examined my hand, saw my ring, became furious and shouted that she hated me and my wife. Then she became manic again and very superior and said she was now a doctor of medicine and a man. In her manic excitement she had reversed the situation, in an omnipotent way; however, the manic state did not last long. She quickly became aware of her dependence on me, was overwhelmed by fury, and attempted to destroy the furniture in the room. At the same time she shouted that she wanted to break up marriages. (Ibid., Rosenfeld, p. 164)

During the next day she at first did not want to look at me. She said, 'I don't love you, I myself am married and I love somebody else, I am Hitler and hate the Jews.' In one moment she said she wanted to break in my face; afterwards she tried to tear her own dress. Later on she said, 'Kill me and rape me; I do not want to live anymore.'
During the next few months many fantasies and situations were repeated in the transference. Sometimes she complained that I visited her during the night. These nightly hallucinations often had a sadistic and persecuting character. She sometimes expressed delusions of being split into a masculine and feminine self. She called her masculine part after the musical play 'Annie Get Your Gun.' Her omnipotent manic impulses and fantasies were often related to this masculine self as an expression of her independence and denial of needs. When she was in the feminine role she often said she was full of blood and spiders and attacked her abdomen in order to press all the bad things out. Sometimes she tried to cut off her breasts or to damage them. She said they were full of blood and I should suck the blood out of them. The bad things which she experienced inside herself were, among others, a stolen penis, blood, children and the breasts of her mother, which she felt she had stolen and spoilt in her fantasies. This made it impossible for her to identify with her good mother and to accept her own femininity. As I explained before, the patient was unable in the chronic mute state of the illness to bear a strong sexual transference to me and acted it out. In the acute state it became apparent why her sexual impulses and fantasies were so unbearable: they were accompanied by overwhelmingly strong murderous sadistic fantasies. (Ibid., Rosenfeld, 165)

Thus a female patient, a spinster in her early fifties, when anxiously depressed, or when she felt she was being 'made into nothing' at work by coercion or undervaluation, would fly into violent rages to master her fears, and scream out: 'I'm not a woman, I'm a man, a man. They cut off my penis and left me with a filthy hole.' It emerged that this 'hole' symbolized her pathological version of the female element, a sense not only of her weakness but of her sense of 'non-being,' of there being nothing there, an emptiness at the heart of her.

--- Harry Guntrip, Schizoid Phenomena, Object-Relations, and the Self, International Universities Press, Inc., New York, 1969, p. 256.

A few weeks after his return to duty, John began to act peculiarly. He stared fixedly at the post nurses and was convinced of their sexual interest in him. At the same time he startled his commanding officer by the question, 'Are you a woman? Are you what you think you are?' Hospitalization followed shortly with a diagnosis of paranoid schizophrenia. Hallucinated voices accused him of weakness, homosexuality, and failure. He attempted to hang himself. His uncertainty regarding the masculine-feminine component of his identity was strikingly indicated by his hearing voices which classified his gender after each of his actions. Because his every movement was followed by the hallucinated comment, 'That's a man' or 'That's a woman,' he felt that his slightest gesture might alter the judgment of his sexual identity. (Ibid., p. 360)

A further gross contradiction of John's assertion of a strong masculine identity was evidenced in his periodic open statements that he wished to be transformed into a woman. He said that women have a better life than men and occupy a position of dominance over everything. Somewhat incoherently he described having attempted between hospitalizations at the Lodge to transform himself by consuming huge quantities of cream and other soft, fattening, and to John, feminizing foods. He had also purchased a large supply of soft pencils with which to 'scratch the muscle fibers to make them female.' The wish to change to a woman was mixed in varying proportions with a fear of such a change. It might be noted parenthetically that in the subsequent course of John's illness the wish gradually predominated over the fear. He seemed progressively to abandon his struggle to achieve a masculine identity patterned after his father and instead to helplessly accept identification with his sick mother. Increasingly his behavior resembles that of his mother in her illness 17 years before, especially in the features of helpless passivity and retreat to bed.

--- Donald L. Burnham, Arthur I. Gladstone, Robert W. Gibson, Schizophrenia and the Need-Fear Dilemma, International Universities Press, Inc., New York, 1969, pp. 360, 363.

Patient was rather poorly adjusted in her early years, was said to be extroverted in her activities. She made her own living from an early age but changed jobs frequently, usually getting into difficulty with her employers and later becoming heavily addicted to alcohol. Her first actual psychosis occurred at the age of 50 and she had four hospitalizations in rather rapid succession with what were called manic attacks of comparatively short duration and always discharged as recovered with the exception of the last or present admission at the age of 65. On this admission the patient was very threatening and destructive, showing irritability and resistiveness with noisy shouting and scolding. She attempted to bite the nurses and other patients at times. The content of her speech was very religious and she heard voices of the dead. She later took up some work and became comparatively quiet although she could still hear voices at times. She thought she could talk with living people who were located at a great distance. Once she produced a coat hanger, one end of which was wrapped with a bandage until it was phallus shaped. The end was tipped with blood. This she declared came out of her own body. She said she was going to thrust it into the abdomen of the female physician in charge. (Ibid. Lewis, p. 241)

At the age of 28 after a series of quarrels with her husband she attempted suicide by cutting her throat. At the time she was admitted to the hospital she was excited, sang and talked under pressure, and was generally difficult to manage. She was partly out of touch with things, spoke meaningless phrases, was manneristic and irritable and had hallucinations principally of devils and bogies. She remarked, 'Someone has tried to gas me – put croton oil in my cabbage and rose water in my tea.' Her trouble began when 'bull-dike' (neologism) 'smashed a devil into me in a lunch room. Ever since then bull-dikes have been bothering me. They would first love me up and then when I did not love them they would bite me inside. I felt shocks like needles in my arms.' Patient was boisterous, vulgar, obscene and abusive most of the time. She expressed a flash of insight when she remarked 'I am crazier than the others in the hospital and want to teach them more about crazy things.' She would urinate on the floor and make designs out of the puddle. She also made homosexual assaults on the other patients and nurses as she was erotic and sadistic most of the time and claimed she could recognize passive homosexuality at a glance and thus knew whom to assault.

--- Nolan D. C. Lewis, M.D., Research in Dementia Praecox, Northern Masonic Jurisdiction of the Scottish Rite, 1936, pp. 241, 244.

Perhaps I should digress from the subject of obsessional doubts and mention another element of the larger picture – namely, what we see in the way of real, abiding uncertainties in people. These can be awfully harassing things – sometimes, I think, about as painful mental states as one can chronically have. But they are never expressed in frank doubts and so on. In a typical instance of this, it only gradually occurs to you that a particular patient must be eternally wondering whether he is 'a boy or a girl' – where, in the masculinity-femininity distribution, he really belongs. Or perhaps his uncertainty is – as we often hear in classic theory – 'Can I be loved? Can anybody love me? Am I not essentially unlovable?' But in such an instance, you hear no rattling off of doubts of the typical harassing, obsessional kind. The patient cannot confront these things clearly, even though he is always preoccupied with them. You fall over the thing in all sorts of subtle, indirect attempts which the patient is making at investigating his problem – and the characteristic of all these attempts is that the approach does not present the problem so clearly that the poor bird has to be aware of what is bothering him. He can't stand it, and yet he can't drop it because it has become involved in the whole structure of the future. Until this is settled, there is no peace, there is no happiness; there is always doubt – real doubt – and there is uncertainty, insecurity, sometimes suspicion, and always caution about what people mean and what their actions mean, and so on. Let us say that in treating one of those people, you finally, as a result of good luck and plenty of alertness, close in on a really probable hypothesis of what lots of little details refer to, and you say, for instance, 'Look, are you unclear as to whether you are mostly a man or a woman?' The patient is likely to look at you as if at last somebody had opened the gates of paradise for a moment, and to say, 'Yes, I think I have always been worried about that.'

--- Harry Stack Sullivan, M.D., Clinical Studies in Psychiatry, W. W. Norton & Company, Inc., New York, 1956, p. 252.

       When I first saw this patient, she was an 18-year-old girl who had been referred to the Gender Identity Research Clinic as a schizophrenic; she had been in treatment at two other clinics for the previous two years. She had gradually become psychotic, starting at age 14, when she was told by a gynecologist that she 'might be a boy.' She had been brought for that physical examination because her breasts had not started to develop and her periods had not yet begun. Though she was concerned about this, she had no question about her proper sex. She was then examined gynecologically and found to be neuter.* The physician who did the examination talked with her and her mother, making every attempt to be honest, yet tactful. As many enlightened physicians do, he subscribed to the thesis that this information would not be disturbing, and that, with proper explanations, no psychological damage would result. So the child and her mother were told that she had no functioning ovaries and therefore no periods or completed secondary sex characteristics, but especially that her chromatin staining showed a male pattern and that her chromosomes were XO. To the patient, despite all accompanying explanations, this meant that she was genetically, and therefore in the most biological sense, no longer a female but a freak, with both male and female qualities. From the day of that pronouncement, she began ruminating on whether she was a female or a male; this rumination and her unsuccessful attempts to reestablish a fixed gender identity led to her gradually thinking and reacting in a more and more bizarre manner – the psychosis.
       As soon as she was first brought for psychiatric treatment at age 16, after two years of developing bizarreness, she was diagnosed as schizophrenic; two years later she was still considered psychotic*. Her first therapist described her as follows:
       'Frequently her manner and behavior seem bizarre. Often she appears disheveled in dress and hairdo. Her problems are rather clearly expressed through body language and verbalizations. She has often verbalized her suspiciousness of me. In the early interviews, her arms were frequently held back of her, constantly swinging of legs, looking away to the side, and sneaking glances at the worker. As she talked, she would giggle, laugh loudly, cry, pound on the desk or put her head down. There was great vacillation in moods, that seemed either manic or depressed. Her voice would vary from an inaudible whisper to a loud shout.'
       She was referred to me because she was still psychotic and because I was interested in seeing intersex patients.
       The following quotations are taken from several different periods in the first months of her treatment with me. They exemplify the kind of material that was reported by the other clinics and suggest the moderate psychosis (with hysterical features of hopeful prognostic significance) that was present for the four years from the time she was told of her sexual abnormality until the psychosis died away some months after being in treatment in the Gender Identity Research Clinic.
       'As soon as they found out about my condition, I should have been left to die. I am no good to society. I am abnormal. I am different. That is what has always been done since time immemorial. No one can reach me. Not even you. I have to kill myself because society didn't. I am trash of the earth. Not fit to live. The population is cluttered with people like me. Only the tall and the handsome shall live. Little puny people like me shall die. I am God. Did you know I am God? I told you I would have delusions of grandeur. And since I am God I shall kill you. You don't deserve to live either, since you are helping me. I will contaminate you with my disease. Keep away from me. Don't touch me. Don't hurt me. Don't let me go! Don't kill me – save me ..... I am a destructive God. Only I can destroy anything I don't like. I have power over everyone in the world.'
       As she began feeling better, she described some of her feelings of confused gender identity:
       'I had fears of being male. I was acting like a little girl partly because of this and partly because I felt I just wouldn't prove to be a female if I acted like one, and I was terrified of having to face that. One day I had a very vivid picture of my pelvis as being all female like I was told it was, but I thought of one place where I would possibly have a male organ and it seemed quite logical to me, because that was the place I was missing the female one and I didn't know for sure. I finally got up enough courage to ask the doctor. She told me I had nothing but fibers there. She told me I was an it, only I didn't have to look [like] or be one because of my medication. She also told me it was possible that if anything had been there, the other chromosomes – it possibly might have been the Y one. All this was terribly hard to take and digest and I guess I still haven't digested it.....
       'I don't want to be a girl. I wish I were a boy. I like being a girl sometimes when men pay attention to me, but I feel I would be more wanted by my parents. My breasts aren't real. Only my vagina is, because it was there before. That is what I meant by my sex feelings originate in only one place like a man's instead of two like a woman's. My breasts were given to me for a time. Who knows when they will be taken away? That is my fear. My terrible fear. Not to be like a woman. ..... I must learn appropriate ways to show emotion. It just builds up in me and then I have to escape. All of a sudden I feel very womanly. From way inside of me at the center and at the core. The externals don't matter to me ..... I feel like my personality is unique, like no other girl's. No man can touch me. He will never know my inner self, my personality, because I don't have one. It is too odd. He won't understand.'
       Following some months of treatment aimed at her finding her sense of femaleness again, and that she truly was a young woman, the psychosis disappeared. What has lingered, but with diminishing intensity, are ruminations about whether a particular thought or act is masculine or feminine. (For example: 'You will never know what it is like to pass a restroom marked 'Boys' and wonder if you should go into that one instead of the women's. It's terrible. I was always afraid I would make this mistake sometime and go in the wrong one.' 'Where do I fit in? If I go to school and work, does it mean I am not a woman? If I am forward at the dances does it mean I am not a woman, or do I have to wait to be asked?') While there was a special intensity in her voice when she discussed such problems, the content is not very different from what we hear in some of our anatomically normal patients.

--- Robert J. Stoller, M.D., Jason Aronson, Sex and Gender, New York, 2nd ed., 1974, pp. 24-28.