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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.

In any case, the appearance within awareness of the homoerotic interest stirs such violent self-reproach that a dissociation or a vigorous defensive process results. If the self is able to dissociate the abhorrent system, the personality continues thereafter to be in grave danger of [homosexual] panic with succeeding schizophrenia, unless the sexual tensions are being drained off by some collateral procedure such as frequent masturbation or more or less definitely autosexual intercourse with women [or with men in the case of women/jmm]. Moreover, under cover of the dissociation, experience in any case continues to be integrated into the dissociated system, and its partition of energy in the personality to grow.
After the appearance of homosexual cravings, the individual finds himself [herself] much distracted, with reduced "power of concentration" owing to interference with his [her] other interests, and corresponding impairment of efficiency in his [her] routine life. The sexual tendencies, whether still accessible to awareness or existing in complete dissociation from the self-consciousness, tend to integrate interpersonal situations in which the abhorrent behavior might occur, and create relevance and strong (positive or negative) interest in suitable people and their views and behavior in keeping with the tendencies. The opposing tendencies within the self tend to integrate situations and to determine relevance and interest in sexually unattractive people and in personal acts and utterances strongly opposed to homosexual procedures. Both sorts of situations tend to be integrated, with more or less complete blocking of satisfaction to their group of tendencies. The accumulation of sexual or other erotic tension increases the power of the related tendencies and an accidental encounter with a person particularly suited for the sexual behavior generally precipitates an acute disturbance. Not uncommonly this denouement is facilitated by the subject-individual's preternatural naiveté, by which he [she] is led to attempting the integration of an interpersonal situation favorable to the self (that is, favorable to the dissociating system opposed to the erotic strivings) with a person equally conflictful or defensive toward complementary sexual desires. In either case, it is but a matter of time and the flow of events until the victim finds himself [herself] being swept towards an abhorrent consummation. If panic does not supervene, a grave defensive process such as the paranoid state may now appear, or the individual may adopt a course of occasional lapses into the contemned satisfactions, with remorse or increasing desperation thereafter.

--- Harry Stack Sullivan, M.D., Personal Psychopathology / Early Formulations, W.W. Norton & Company. Inc. New York. 1972, 1965 by The William Alanson White Psychiatric Foundation, First Edition, pp. 212-213.

We must recognize that the sexual affections are still the greatest constructive forces of the personality if properly conditioned and adjusted, but also that they may become the most insidiously, irresistibly destructive if perverted or unconditionally repressed. This statement is based upon the study of more than two thousand psychopathic and criminal personalities of many nationalities and intellectual levels.

--- Edward J. Kempf, M.D., Psychopathology, V. Mosby Company, St. Louis, MO. 1920. p. 749.

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

--- Ruth Wilmanns Lidz, M.D., and Theodore Lidz, M.D., Homosexual Tendencies in Mothers of Schizophrenic Women, The Journal of Nervous and Mental Diseases. Vol. 149. No. 2. Williams and Wilkins Co. 1969, p. 232.

After prolonged silences and occasional desultory remarks which I could not put together, the patient, a woman in her middle twenties, suddenly – and for the first time – started to talk about sexual fantasies she had about being a man, about having a penis, and about becoming like me under these circumstances. At the same time, she started to make gestures as if she were bored, gave evidence of some restlessness, and looked repeatedly at her watch. The overall impact of these manifestations was confusing to me.

--- Otto F. Kernberg, M.D., Borderline Conditions and Pathological Narcissism, Jason Aronson, Inc., Northvale, New Jersey and London, 1985, p. 197.

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

--- Harry Stack Sullivan, M.D., Personal Psychopathology / Early Formulations, W.W. Norton & Company, Inc. New York. 1972, 1965 by the William Alanson White Foundation. First Edition, p. 211.

Sex-typed reactions are contrasted in male and female normals and chronic schizophrenics. In general, the schizophrenic shows sex-role alienation on tests which contain a self-image reference (a Role Playing Test, a Body Parts Acceptance Test, and a Figure Acceptance Test). Female schizophrenics tend to react in a more assertive manner like normal males, and male schizophrenics in a more sensitive manner like normal females. In a direct test of assertive vs. yielding story sequences on the TAT, the sex-difference reversal is significant only if housewives are used as normal female controls. The inclination of female schizophrenics toward assertive story sequences is matched by a similar inclination in career women, suggesting this role reversal is not as critical to the schizophrenic condition as the self-image disturbance. In conscious sex-typed interests and attitudes, schizophrenics do not differ from normals. A theory is proposed relating schizophrenia to sex-identity alienation in the early years of life.

--- David C. McClelland and Norman F. Watt -- Journal of Abnormal Psychology. Vol. 73. No. 3. 1968, p. 226. [Please see also Quotations / Comments 267-280 (inclusive) in "Schizophrenia -The Bearded Lady Disease. Vol. One", on this website.]

Paranoia--An historical digression

Paranoia, from Greek meaning wrong of faulty knowledge or reasoning, "antedates Hippocrates" (Cameron, 1944) when "it was most frequently used in a very general sense...as the equivalent of our popular current term insanity". It was resurrected by Vogel in 1772 and further extended by Heinroth in 1818. Its application was then gradually restricted to partial insanity or monomania until Zeihen (1894) and Cramer (1895) "Threw together all the 'primary disorders of reasoning'...including the acute and chronic forms and even all the delirious disorders of no matter what origin" (Meyer, 1928) under that title. Kraepelin "in a fit of indignation against Ziehan" (Meyer, 1917-18) reintroduced "dementia praecox", a term first used by Morel (1860) to call a halt to this paranoification of psychiatry. ... Dementia praecox was formally introduced as a specific disease entity by Kraepelin at the Heidelberg meeting of 1898" (Meyer, 1928). But time moves on and Kraepelin's dementia praecox is now obsolescent. It is being replaced by schizophrenia, the much wider concept introduced by Bleuler (1911), based on understanding of mental processes, rather than the static assessment of presenting symptoms by a multiplication of artificial diagnostic labels. As Meyer (ibid.) so truly says: "The history of dementia praecox is really that of psychiatry as a whole."

--- Dr. jur. Daniel Paul Schreber, Memoirs of My Nervous Illness. Translated, Edited, with Introduction, Notes and Discussion by Ida Macalpine, M.D. and Richard A. Hunter, M.D., M.R.C.P., D.P.M. -- Wm. Dawson & Sons Ltd. London. 1955. pp. 13-4.

These considerations therefore lend an added weight to the circumstance that we are in point of fact driven by experience to attribute to homosexual wishful phantasies an intimate (perhaps invariable) relation to this particular form of disease. Distrusting my own experience on the subject, I have during the last few years joined with my friends C. G. Jung of Zurich and Sandor Ferenczi of Budapest in investigating upon this single point a number of cases of paranoid disorder which have come under observation. The patients whose histories provided the material for this enquiry included both men and women, and varied in race, occupation, and social standing. Yet we were astonished to find that in all of these cases a defense against a homosexual wish was clearly recognizable at the very centre of the conflict which underlay the disease, and that it was in an attempt to master an unconsciously reinforced current of homosexuality that they had all of them come to grief.¹
[¹ Further confirmation is afforded by Maeder's analysis of a paranoid patient J.B. (1910). The present paper, I regret to say, was completed before I had an opportunity of reading Maeder's work.]

--- Sigmund Freud, Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides). 1911. The Complete Psychological Works of Sigmund Freud. Vol. XII. The Hogarth Press and the Institute of Psycho-Analysis. London, 1958, p. 59.

If we summarize our impressions of the attitudes of these mothers toward their own parents, we may say that as a group they reported that they loved their fathers or felt that they had some love from them. But, on the whole, the fathers were weak, sometimes brutal, absent, and in one way or another quite inadequate and unreliable. Frequently also there was some feeling that the fathers were either somewhat abnormal heterosexually or were regarded as possibly homosexual. On the other hand, these mothers of schizophrenics nearly uniformly report their respect for their mothers. Almost without exception, they give the impression that they are saying not only that they respect their particular mothers but that through their mothers they have come to idealize motherhood – they believe in the divinity of maternity. This is not an uncommon idea in our culture, but one feels that these women are more desperately devoted to it than are the run of people. The maternal grandmothers of the patients are usually reported to have ruled their homes either directly or, more commonly, through tears and suffering. Mothers of the patients have learned this technique from these grandmothers and with very few exceptions dominate, in one way or another, the family situation, including the husband. Usually they employ the hurt techniques to make others feel guilty; much more rarely they are arbitrarily and angrily in charge. As for the relation to the children, these mothers, in addition to reporting them as model children, also most frequently remark that as little children the patients worshipped their mothers; they frequently comment that they still do.

--- Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia, Chicago: The University of Chicago Press,1955, pp. 112-13.

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 [at the Bearded Lady exhibit]. 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, Lisa and David, New York: Ballantine Books, 1962, p. 128.

"Being born a woman is my awful tragedy. From the moment I was conceived I was doomed to sprout breasts and ovaries rather than penis and scrotum, to have my whole circle of action, thought and feeling rigidly circumscribed." [ ..... ] She accused her mother of being "a walking vampire" who killed her father by "marrying him too old" and "burying him every day since in her heart, mind and words;" "a murderess of maleness," a "killer" as "deadly as a cobra under the shiny green gold hood." [ ..... ] "In my deepest emotions I think of her as an enemy: somebody who 'killed' my father, my first male ally in the world. She is a murderess of maleness ... what a luxury it would be to kill her, to strangle her skinny veined throat ... But I was too nice for murder."

-- Sylvia Plath, U.S. poetess, 1932-63, who succumbed to schizophrenia and later suicided at age 31. (From The Unabridged Journals of Sylvia Plath, 1950-1962. Transcribed from the original manuscript at Smith College, Karen V. Kukil, editor. Anchor Books, New York.)

The mother recalled that as a child the patient was 'fascinated by clothes and loved to dress as a girl. Has always loved costumes and finery.' (p. 130)

..... Developed an interest in automatic writing and felt that he was receiving communications from deceased relatives. An acute disorder of sleep appeared. Became so uncomfortable that he concluded he was suffering an attack of brain fever. Went to visit a relative, previously making a memorandum which he carried with him, as follows: 'I feel under a hypnotic power of someone. And if I should marry, it will be against my will power.' Immediately before this trip he had consulted a physician on the assumption that he had venereal disease. On arriving at the neighboring city he complained that he had a dual personality, that he was hypnotized, and that he was hermaphroditic; 'I know the trouble of the whole matter, it's sex.' He talked much to the physician who was called, of censorship from his father, being married, having attempted Coue's method, and that he was a woman – having been castrated. Great excitement ensued; he became disturbed and combative and much hallucinated. After some weeks of care he was returned to the United States.

On admission to this hospital he was much disturbed and made many attempts to harm himself. There was a great deal of antagonism and pugnacity, this frequently most impulsive. Went nude at times and often refused his meals; had feelings that he was being impersonated by someone outside the hospital. (p. 131)

..... The male nurses scared me. They came into the room about eight o'clock and gave me paraldehyde. It had a revolting taste and odor. I thought it did funny things to me. On one night, I threw up my supper, and then went to sleep. When I woke up, my nostrils were dirty, and I thought they had made me rub my nose in the vomitus. At times, my stomach would seem to swell up specially when I had indigestion. And also when I was shaved, my spine seemed loose, and when I put my head very far back, it seemed as though my spine buckled up. I also thought I was a hermaphrodite. I thought that I was going to become a woman. When my stomach swelled up from indigestion, I thought that I was pregnant. The doctor explained the term hermaphrodite to me in the second nursing home, when I thought I was pregnant. I had the idea afterwards that my penis would drop off. They gave me paraldehyde at night and salts in the morning, and I didn't know what happened at night. The voices never explained what happened at night. There was no desire on my part to become a woman. I did not have a fear of perversion, because I had never slept with a woman. I was over-suppressed. I had the fear that I would be more attracted by the male. I always thought the male figure more beautiful than the female. At the start of my sickness, the only perverted desire I had was a wish to throw my arms around persons whom I developed a fondness for. (p. 135)

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

More than thirty years of intensive investigation of these problems permits me to make the general statement that in man every case of emotional neurosis or psychosis is the result of more or less conflict and confusion involving bisexual differentiation. ...Dementing schizophrenia is essentially a regression to the cloacal level of hermaphrodism.

--- Edward J. Kempf, M.D., Bisexual Factors in Curable Schizophrenia*, *Presented at the Annual Meeting of the American Psychiatric Association, May 18, 1948. -- The Journal of Abnormal and Social Psychology. 1949 Jul Vol 44(3), pp. 414-419.

Since then I have wholeheartedly inscribed the cultivation of femininity on my banner, and I will continue to do so as far as consideration of my environment allows, whatever other people who are ignorant of the supernatural reasons may think of me. I would like to meet the man who, faced with the choice of either becoming a demented human being in male habitus or a spirited woman, would not prefer the latter. Such and only such is the issue for me.

--- Dr. jur. Daniel Paul Schreber, Memoirs of My Nervous Illness. Leipzig, Germany 1903. Translated, Edited, with Introduction, Notes and Discussion by Drs. Ida Macalpine and Richard A. Hunter. Wm. Dawson & Sons, Ltd. London. 1955, p. 149.

In the pre-psychotic phase homosexual tendencies differ from those of the homosexual perversion. The unconscious wish of the pre-psychotic male to be a woman arises not as a defense against the positive oedipus complex but from the constitutional bisexuality of the individual – '… in its deepest nature schizophrenia arises from bisexual conflicts, and this bisexual conflict eventually leads to a state where the heterosexual factor is relinquished.' (Katan, 1954) ... Katan concludes that a part of the personality behaves as if the pre-psychotic phase was still in existence. The non-psychotic part of the personality ('the non-psychotic layer') does not remain constant in size but changes all the time. The extent of the non-psychotic layer is dependent upon the activity of the homosexual conflict. If the homosexual urge is not too powerful the remnants of the ego can function fairly adequately. However, when the homosexual drive increases in intensity, the relative strength of the ego will determine the outcome, i.e. whether or not the subsequent reaction will be in accordance with reality or whether a psychotic symptom will make its appearance. ... The delusion constitutes the psychotic mastery of the conflict (Katan, 1954). Katan interprets hallucinations from a dynamic – energic standpoint. He suggests that the energy of the homosexual urge is withdrawn in the psychotic phase, to avoid the danger arising from it, and used to form a hallucination. This releases the tension caused by the homosexual drive and prevents a complete break with reality. This suggests that 'the 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' (Katan, 1954).

--- Thomas Freeman, John L. Cameron, Andrew McGhie, Chronic Schizophrenia, preface by Anna Freud, International Universities Press, New York, 1958, pp. 37-38.

So manifold were the symptoms he [Daniel Paul Schreber] displayed at one time or another that almost the whole symptomatology of the entire field of psychiatric abnormality is described. Comparison with the items listed in a current textbook on psychiatry (Henderson and Gillespie, 1951) in the chapter on 'Symptomatology' allowed us to tick off nearly all as touched on in the Memoirs. [p. 8] [ ..... ]

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. [p. 15]

--- Dr. jur. Daniel Paul Schreber, Memoirs of My Nervous Illness, Leipzig, Germany 1903. Translated, Edited, with Introduction, Notes and Discussion by Drs. Ida Macalpine and Richard A. Hunter. Wm. Dawson & Sons Ltd. London. 1955. pp. 8, 15.

Freud makes an early reference in his "Three Contributions to the Theory of Sex," in which there is offered the hypothesis that the development of female sexuality contains important variations from that of the male in that the center of interest must shift in the pattern from the clitoris to the vagina -- the clitoris and the penis having similar likeness, the vagina being the typically female organ. Further light is shed from later writings on the "castration complex" and "penis envy" in woman, and the possibility of problems arising in the female as a result of physiological difference receives attention. In brief, the psychic development of woman must undergo an adjustment similar to that in the physiological realm, if she is to attain adulthood.

--- Clara Thompson, M.D., Notes on Female Adolescence, Chapter XIII, pp. 262-3, in Personal Psychopathology / Early Formulations, by Harry Stack Sullivan, M.D. -- W.W. Norton & Company. Inc. New York. 1972, 1965 by the William Alanson White Psychiatric Foundation. First Edition. With Introduction by Helen Swick Perry.

The primary delusion of a change of sex may appear in patients in various guises, often as the only symptom: complaint of excessive hairiness in women, lack of hairiness in men, symptoms associated with "change of life" in women, even men. Following hysterectomy, complaints about voice being too high or too low, the breasts being too small or too flat, differences between the right and left halves of the body, etc. Examples could be multiplied ad infinitum. Not uncommonly female patients complain that they have a male mind in a female body, and male patients that they have a female mind and request their body be altered accordingly, by surgery or hormones. [p. 405.]

[ ..... ]

His basic bisexuality had developed into a true manifest ambisexuality, male and female potentials being equally matched. He was as much both as he was neither. Thus he says 'that I have to imagine myself as man and woman in one person having intercourse with myself.' (S.282) and 'playing the woman's part in sexual embrace with myself' (S.285). These ideas culminated in fantasies of self-impregnation.

In this fundamental doubt Schreber exhibits a common characteristic of schizophrenics. Usually, however, this balanced imbalance of sex has to be deduced from psychotic expression and is not freely accessible. The insight afforded by Schreber on this point gives to his memoirs their unique value. [p. 402.]

--- Dr. jur. Daniel Paul Schreber, Memoirs of My Nervous Illness, Leipzig, Germany 1903. Translated, Edited, with Notes and Discussion by Drs. Ida Macalpine and Richard A. Hunter, Wm. Dawson & Sons Ltd. London. 1955.

She recalled during the analysis that while at the sanatorium she looked over some pictures of priests and thought of herself as being like one of the priests who was effeminate-looking. (This bisexual interest should be compared to the bisexual interests of the previous case.) ... The nurse reported that when she dressed herself after the physical examination she tucked her skirts inside of her drawers like a boy. (Again, the bisexual.)

She had no difficulty in recalling the important features of her illness which were essentially relative to the crucifixion, death of her personality, and the rebirth. (Kemp. p. 575.)

The father and mother situation had to be handled tactfully until she had brought out the details of her psychosis and her life.

The father appeared (hallucinated) in the disguise of elderly women. She said that when he appeared in the reception room, 'He or she said' (laughs), 'It was up to me to make him happy.' He said: 'I hope you can do it, son Harry,' and 'welcome, son Harry.' In the dormitory, 'He, she or it" (laughs) was taken out of the room, and she looked at me and said: 'You will be sorry some day.' ...That her father should call her Harry, was due to the fact that this was her nickname with some playmates when she was a child.

That her father should be associated with women and be spoken of as 'he, she or it...'

The mother's attitude was so subtly ingratiating and yet domineering that she would almost have to be destroyed as a mother if the patient were to free herself from its terrible influence and win her own womanhood and independence. [Likewise for the sons of such mothers. / jmm.]

Why should this patient have become masculine ('son Harry') during her stuporous state? Christ and the young priest had marked effeminate traits, as do many crucified heroes: and males who go through the crucifixion, complain of being effeminate and even of losing all masculine attributes. The renunciation of all competitive sexual interests in order that the rival parent shall dominate, may perhaps be compensated for by the development of a complete sexual cycle within the self. The female, developing masculine traits, and the male, developing female traits, are protected, like Buddha, from the more virile members of their sex who would dominate them. This conjecture is based upon observations of the completely autoerotic who are physically of one sex and fancifully develop the attributes of the other sex, thereby perfecting the autoerotic cycle. Some of our autoerotic patients complain of being male at one time and female at others.

--- Edward J. Kempf, M.D., Psychopathology. C. V. Mosby Co., St. Louis, Missouri. 1920. pp. 575, 7.

[2] No student of human behavior, no matter what his point of view, can, for one moment, afford to lose sight of the fact that all men and women are bisexual in their anatomical construction and in their affective cravings, and that all the segments contribute to the affections and wishes of the personality. (Kempf. Ibid., p. 14.)

[3] A brilliant, paranoid army surgeon amputated his penis to prevent young women, whom he hallucinated, from using him for sexual purposes. The erotic segments continued to exercise a pathological effect upon the personality even though partly destroyed. He now begs to have his testicles excised for the same purpose. [All this as a defense against his homosexual cravings and his unconscious wish to become a woman. / jmm] -- (Kempf. Ibid., p. 70.)

[4] During the convalescence [from her third labor], following a sudden conflict with her mother, she passed into a psychosis in which she became crucified as a hermaphrodite Christ -- becoming both male and female in that she believed she was masculine sometimes and feminine others. (Kempf. Ibid., p. 103.)

[5] The patient insisted that he had 'feminine' qualities, but, spontaneously, with undue earnestness and repeated efforts, he tried to establish that he was not 'effeminate.' No homosexual relations had ever occurred, and no perversions.
He dreamed of a knight in beautiful armor who appeared before an audience, and a penetrating light was thrown upon his pelvis which revealed the genitalia of a female. He recognized himself as this knight. This was a reaction to the light of psycho-analysis. He also dreamed of a man singing to an appreciative audience. The man had a baritone voice, but it changed to contralto and then to soprano. The hair became long, although his mustache remained; the breast was a man's but the manners were a woman's. The singer showed embarrassment, then distress, and, finally broke down in tears. The audience sympathized with him. The patient awakened 'in strong agitation' and recognized the singer as himself. At one time he had a pleasing baritone voice. He never shaved his mustache in order not to look effeminate. [This man had become homicidal before being admitted to St. Elizabeth's Hospital.] -- (Kempf. Ibid., p. 281.)

[6] She repeatedly protruded her tongue, covered with foaming saliva, during the conversation and, in reply to my questions, she explained that this meant 'passion.'... From the time of her admission she had complained of being afraid of an 'old, grey-haired woman,' described her as naked, trying to get into her bed to perform sexual acts on her 'with her mouth.' For this reason she was afraid of the women when they entered her room and attacked them. ... The patient's anxiety about her perverse eroticism was unquestionable. She was terrified and begged to be saved from insanity. (Kempf. Ibid., p. 341.)

[7] She rubbed and plucked her skin like the autoerotic patient, but denied masturbation. During the erotic period I observed her to rub her finger and, unmistakably, make the masturbatory movement of the male, without apparently being aware of it. (Kempf. Ibid., p. 363.)

[8] He said: 'I would rather die than become a cocksucker.' ... Either attempts at suicide, or, as he expressed himself before discharge, 'I'd rather go crazy before I'd become a cocksucker.' ... The fear of the shrinking penis becoming invaginated into the abdomen was apparently due to an uncontrollable effeminate attachment to his companion. (Kempf. Ibid., p. 498.)

[9] Case PD-26 was the only son of an overworked, uneducated mother who suffered from neglect and the need of the simple comforts necessary to make life worth living. He was a typical 'mama's boy,' seriously pampered, effeminate, dainty in his manners, tenor voice, and generally submissive in his make-up.
He was an ordinary seaman in the navy when a typical homosexual panic developed in which he was obsessed with fears that men plotted to sexually assault him. He had to be tube-fed, and when he resisted, and his arms were forcibly drawn behind him, he had a 'vision of Jesus Christ and the thieves on the cross,' feeling that he was being crucified as one of the thieves. Later he realized that it was 'imagination.' (Kempf. Ibid., p. 502.)

[ 10 ] She complained almost constantly about the two balls of hair in her throat, frequently palpable and enlarged submaxillary glands, which, she said, was one of the balls, and wanted to have her throat cut or an operation performed to remove it ..... she said she couldn't control herself and felt compelled to scream her denunciations of God, and wanted to know why she shouted: 'If I had it I would bite it off.' (Kempf. Ibid., p. 376.)

[11] Another woman, who had rubbed all the hair from her scalp so that she was perfectly bald, occupied a bed in the same ward. The patient forced herself into this woman's bed calling her a 'man,' and it was with difficulty that she was removed. Then she began an unusually unbridled, vicious attack upon her own genitals, masturbating without restraint and regardless of all the women on the ward; stuffing pieces of cloth, and other things, into her vagina. (Kempf. Ibid., p. 373.)

[12] Case MD-9 is an unmarried woman of sixty, who has for three years been trying to dominate her environment by claiming to be 'The Lord,' 'God Almighty,' 'The King,' 'The President,' 'Secretary of the Navy,' and so on. She proclaims that she is the maker of a cannon that shoots 6,000 cannon balls which will destroy everything and shoot into the uterus of her physician, who is a 'she devil.' She threatens to cut off anyone's head who comes near her, damns everybody, and does it with such vicious emphasis that she makes one feel decidedly like leaving her alone.
With hair flowing, gown often exhibitionistically adjusted, exophthalmic stare, stern masculine countenance, mannish voice, and hypertrichosis, she makes a formidable impression.
At about thirty-five she had a serious depression, lasting 17 months, following the death of her sister.
At fifty, she had a manic attack, lasting a year.
At fifty-four, she had a similar psychosis which lasted about 8 months. (Kempf. Ibid., p. 407.)

[13] Often at night, he pounded on the door and called for help. He would usually be in a panic because of his terrifying sensory hallucinations, such as having holes pounded into his abdomen, drawing sensations at his heart and umbilicus, and pounding electricity into his head. Sometimes he tied a handkerchief about his head because of head pains, and another time he pasted a piece of paper over his abdomen and asked for treatment for a hole there.
The voices talked of making a 'hermaphrodite' out of him. (Kempf. Ibid., p. 501.)

[14] He impulsively attacked other patients, and, one time, while lying sullen and brooding on a couch, and a physician bent over him to ask how he felt, he struck the physician in the face, shattering his glasses. He would give no explanation for this act. It looked 'impulsive,' but later he explained that he thought homosexual insinuations were meant by the question of 'how he felt.'
. .... About the fifth month, his work had to be stopped because he began openly to accuse different men of making sexual advances to him. ….. At this time he was very erotic and one morning he indignantly demanded the protection of his physician, and with great bitterness, he insisted that while asleep some men had forced him to submit to an oral sexual assault. Despite the most earnest persuasions, he could not be made to doubt the reality of this vivid dream experience. Fear of sexual assault by men continued almost nightly for the next two months. During this time, he slept very little and used many precautions to protect himself from the assaults. He barricaded the door of his room with all the furniture available, and kept chewed paper in his mouth, which, he thought, would catch the semen and prove that he had been mistreated while asleep. Unfortunately, one morning, he found a hair in the paper, and this firmly convinced him that his hallucinations were realities. Conversations or questions had 'double meanings.' One night, the attendant legitimately asked him if he wished to have a sheet. The patient interpreted this to mean something 'to spit in,' and promptly assaulted the attendant. He was sure he heard the attendant say he had chancres in his throat. (Kempf. Ibid., pp. 521,2.)

[15] That he will be able to maintain a biologically satisfactory heterosexual adjustment is very unlikely, and his homosexual cravings being intolerable, a latent sustained chronic dissociation of the personality with consequent deterioration, because of the future hallucinatory gratification of his homosexual needs, will probably be the ultimate course of his biological career. (Kempf. Ibid., p. 500.)

[16]   All night long he remained in his room (9th floor) in a panic expecting the Masons to rush into his room. He prepared the window so that he could jump if the door was opened. (His behavior suggests an explanation for some impulsive leaps from windows by panic-stricken travelers in hotels.)
        He was then sent to a sanatorium and the physicians, he said, put 'poison,' 'spue' (semen) into his food and wanted him to marry an immoral woman. The physician, he fancied, tried to hypnotize him and promised to release him if he would perform fellatio. He eloped from the sanatorium in a panic and was committed to St. Eliz. Hospital. (The cause of the panic and delusions must be seen in the patient himself – in his uncontrollable homosexual cravings.) ..... He finally confided that he was controlled by a stronger will which masturbated him and forced him to submit to oral perversions. ..... He described Dr. – as trying to make him submit to a sexual assault and in it he made a significant error; 'Then I begged him not to let me. I mean not to make me do it. He kept me from eating and tried to weaken my will.' (The oral erotic act often has the significance of a religious act, a crucifixion of the rival son to the virile father ..... Homosexual perverts sometimes speak of their oral-erotic submission as a crucifixion. Biologically, this is quite true.)
        For a year or more previous to this analysis, he had complained of being masturbated and orally seduced by hypnotic powers, etc., and spit continuously in any direction and on anything. His face was chapped and raw from the constant application of a towel over his mouth to keep out 'something.' He used great quantities of toothpaste to keep his mouth clean and would not explain to us why he persisted in these prophylactic measures.
        He had an occasional tic, jerking his head back as if something sharp were being thrust into him, but would never discuss this, usually only muttered and cursed to himself when it occurred. (Kempf. Ibid., p. 541.)

[17] Case CD-5 was an uneducated Russian immigrant who was sent to St. Eliz. Hospital after having excised one of his testicles. He said it did not stop masturbating, but his behavior otherwise showed unmistakable religious fanaticism and the desire to be crucified. He tried to raise a beard like Christ, and his prayers and uplifted eyes, ecstatic crucifixion countenance, his tears and impulsive giggles, revealing pleasure at the physician's approach on the ward, showed, as he persisted in attempts to bow and kiss the physician's hand, not only his appreciation, but also an intense desire to subject himself to the physician's domination. The homosexual eroticism of this was suspected at first, but later it became confirmed when we had to watch him continually to prevent him from getting into homosexual embraces with other erotic men. (Kempf. Ibid., p. 600.)

[18]   A severe panic about having circumcised, eaten and killed her infant continued about three weeks. She was sad and cried as if her baby were really dead. (The identification is made here of the entire baby with the baby's penis which actually was circumcised. Later the identification of the penis as a baby came out frankly and the feeling that she had eaten her baby became recognizable as an erotic wish fulfillment.)
        When I asked, 'Why do you think you ate your baby?,' she gave me to understand that she did not 'hate' her baby. The burdensome baby was disposed of in her dreams and hallucinations in the form of abortions.
        She thought she threw her infant down a shaft and burned it to death.
        When she was in bed she would lie half exposed and as a man approached she made little movements to uncover herself. (To submit herself) and yet looked at him in great fear. ..... She still had erotic dreams and would have to awaken to keep from masturbating. Her social interests were decidedly homosexual. She delighted in dancing with certain women, dreamed of being in continuous tubs with them and being tempted to masturbate by them.
        She began to quarrel with the other patients, and derived special delight out of 'cussing.' She used profanity liberally for almost everything, and was very much like a tomboy in her vulgarity and heedlessness. ..... ‘I remember when I was lying with my head on my nurse's knee I determined not to commit masturbation, but I would have anything for happiness, so I let my imagination go and it got bigger and worse all the time.' (Ibid., p. 642)
        She wrote several letters filled with vulgar sexual phrases, references to feces and her love for the nurse. ..... She was fond of resting her back against the electric light switch and turning on the light. Sometimes she assumed the female sexual position on the floor and then assumed the male sexual position and initiated coitus: she usually left her slippers in the office when she started to leave. ..... Since her return to the hospital she will not wear clothing, but tears her dresses, wraps them around her body like a blanket, sits on the floor for hours with her head buried in her arms and her knees pulled up to her chest – a very common dementia praecox position in which such patients freely play with their pelvic orifices. (Kempf. Ibid., p. 657.)

[19]   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.'
        . .... 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. (Kempf. Ibid., pp. 677,8.)

[20]   This was only intelligible from what followed in the sense that he was resisting his feminine cravings to marry a man. ..… He always slept in a bed with his back to the wall, and watched the men so that they could not secretly perform sodomy upon him while he slept. He had a characteristic walk. Passing along through the ward for several steps, then turning to look down close behind him, as if sensory disturbances made him feel that someone was approaching him. Such back and anal sensations persisted more or less vividly for about ten months, as his behavior indicated.
        One day he approached me asking if I was a detective and adding, 'I am carved from here to here.' (passing his hand from anus to scrotum.) ..... During most of this period, frank sodomistic interests and fancies occupied his entire time. He could not be interested in anything.
        Whenever I met him on the ward he would come up to me, grinning and shaking his head oddly, to say that he was not sure that anyone had performed sodomy on him, but that he would watch out for them. (Kempf. Ibid., p. 681.)

[21]   (Case HD-16) – He was sent to St. Eliz. Hospital because of his unfitness to remain in the Soldier's Home. He says: 'I represented the Spirit of American Service, the Navy Service and the Department of Justice, through a method of transfiguration, the purity of the Church represented in it.' (Grand compensation).
        On the wards he often shouted 'get out of my stomach,' and rubbed his left hand on the right side of his abdomen. When asked about the trouble, he said it was a 'composition' put in by magnetism through a transfiguration, and a 'divorced woman, a whore, is trying to get inside.'
        He said he had been bothered considerably more than usual the past ten months or year. He earnestly asked the physicians to feel his abdomen and note the movements in it. Sometimes he insists that there is something 'alive' in his 'stomach'.
        When the remark was passed that ten months was a long time to carry anything there, he looked decidedly pleased and smiled effusively. When asked how he acquired it, he threw back his head and looked upward and smiled knowingly (as if it came from God).
        He will not frankly state today that he is pregnant, but he is pleased by such fancies, and characteristically rubs his abdomen. While making this note he suddenly denounced in vigorous language the 'divorced whore' who is trying to get into his abdomen. (Kempf. Ibid., p. 691.)

[22] The factor of this man's anal eroticism and its capacity to take his senses away, make him unconscious, will be referred to in the chapter on the anal erotic group and their convulsions and stupors. (Kempf. Ibid., p. 533.)

[23] The crucifixion cravings soon dominated everything, and he had to be isolated because he persisted in removing his clothing and being crucified. ... From about the fourth week to about the thirty-fifth week, except for a brief interval, his personality was markedly dissociated, and he seemed unable to prevent himself from submitting to the hallucinations. ... but he later abandoned himself to the affective wave that swept the ego under. ... During this catatonic period he used manneristic expressions and symbols, and entertained classical crucifixion fancies. He also informed the nurse that he had given birth to a child, and actually simulated labor pains. Then followed the birth of many children. When, during this apparently profound stupor, he protested that his nurse was killing his child, he spoke the nurse's correct name. ... He said his body was destroyed, bones broken, he died, was female and male in one, had all the thoughts of the world to care for, etc. (Kempf. Ibid., p. 562.)

[24] Another patient, who passed through a psychosis and panic because of fear of being destroyed and sexually misused, finally recovered and returned to work. A few years later he voluntarily sought admission to St. Eliz. Hospital. He said his genitalia were disappearing and his rectum was changing into a vagina. He was decidedly pleased and lived his belief, devoting his time to erotic fancies about his hermaphrodite nature, not caring to return to society, but probably better pleased with the men on the wards. (Kempf. Ibid., p. 690.)

[25] Fig. 69 – Masculine compensation in a woman. Following the mother's interference with her mating she developed a psychosis in which she solved her unhappiness by becoming male, the priest of an elaborate new religion and philosophy. Her attitude is that of aggressive homosexuality. She made the costume. (Kempf. Ibid., p. 701.)

[26] On the other hand, the individuals, who finally yield to their perverse erotic cravings and resign themselves to live at the level of non-resistance to it, may be found on the wards by the hundreds as so-called chronic dementia praecox types. A study of these people shows that they are preoccupied with an incessant stream of lurid, weird polymorphous perverse sexual thoughts and sensations, and a most grotesque, primitive estimation of their place in the social herd. Their slovenly appearance and characteristically relaxed, slouchly carriage reveal the marked indifference of the erotic affect to social esteem ... (Kempf. Ibid., p. 706.)

The effect of his father's influence, not to mention his mother's reclusiveness, on his four siblings was even more powerful. His brother Amos became a preacher, and later a professor at the Yale Divinity School, after suffering a nervous breakdown in 1934. Despite such setbacks, Amos and his youngest sister, Janet, at least raised families. His two other sisters, like Thornton [a homosexual / jmm.] remained unmarried throughout their lifetimes, Isabel choosing to remain near her parents in New Haven. (She also chose that city to be near Thornton, whom she worshiped throughout her life, and tried to emulate as a novelist.) His older sister, Charlotte, a poet with unconsummated lesbian tendencies, had a serious schizophrenic meltdown and spent years in mental institutions undergoing therapy, shock treatments, and, finally, a lobotomy, like the sister of Tennessee Williams.

--- Robert Brustein, A Prince of the Palefaces, in his review of the book, "Thornton Wilder: A Life", by Penelope Niven. The New York Review of Books. New York. Nov. 22, 2012, p. 12.

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

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

Oh, play ball. Bash with Teddy. Roll on the floor. Shout loud. Scream and be wild. Hit with my hands, kick with my feet. Be a boy, all trousers and roughness. Never in those days did I wear a skirt. Within a few weeks of first getting up, all the jewellry and make-up was shed. My feet were always bare and my hair was long. There were a few rare quiet moments, as when I would carefully wrap Teddy in a yellow counterpane Joan had given me. Then I would sit, on the floor, rocking myself and Teddy. Sometimes Joe had visitors. 'Wait here, I'll be back.' Times passes. What is the matter? Where am I? Oh God, God where's Joe? What have I done? Oh why did I run downstairs, rushing up to Joe? Oh God, why do I 'go against'? Groan and rock. Bang my head on the wall. Curl up. Lay down. I can't move. I'm stuck with 'it.' There's a noise. Is it? Can it be? Really? The noise gets nearer. God. God. 'What's that there?' My legs stretch. 'Well, if it isn't Mary Barnes.'

--- Mary Barnes and Joseph Berke, Two Accounts of a Journey Through Madness, Harcourt Brace Jovanovich, Inc., New York, 1971, p. 122.

I wanted all my mother's attention and to be looked after as a baby and I wanted to be a boy and have all my brother had that I didn't have. The moment they said, 'Well, he's a boy,' I would have the most terrible anger, and when my body got fat and it got periods and breasts I hated all that. I wouldn't wear a brassiere and I demanded to know why didn't boys have 'it,' periods. ... I looked at other girls and wondered if they got 'it' – periods. I didn't ask them. Then I realized what it was all about, girls 'not being well,' being excused swimming or gym. I was more angry than ever and frightened of my sex. I felt so ashamed. I wanted to be a boy. I had no idea of how a boy might like me because I was a girl. (Ibid., p. 29)

In the spring of '66 my bearing and behavior could be very deceptive to strangers. As I felt, so I appeared. Sulky, excitable, shouting, screaming. My speech always muddled, unclear, when hurried, went from a sheer jumble of running words, into mere sounds. My pronunciation was queer. I was going back to my real girl self through my pretence layers of girl on boy. (Ibid., p. 143)

At this time too she was of a lively temperament, but still self-willed. She had already chosen the motto: aut Caesar aut nihil! 5 [Literally, 'Either Caesar or nothing!' – translated.]
Up to her sixteenth year her games were boyish. She preferred to wear trousers. From her babyhood Ellen West had been a thumb-sucker; at sixteen she suddenly gave that up, along with her boyish games, at the onset of an infatuation which lasted two years. In a poem written in her seventeenth year, however, she still expressed the ardent desire to be a boy, for then she would be a soldier, fear no foe, and die joyously, sword in hand.

--- Ludwig Binswanger, The Case of Ellen West / An Anthropological-Clinical Study, in Existence, edited by Rollo May, Ernest Angel and Henri F. Ellenberger, Simon & Schuster, New York, 1958, p. 239.

On the third day of being home she is as if transformed. At breakfast she eats butter and sugar, at noon she eats so much that – for the first time in thirteen years! – she is satisfied by her food and gets really full. At afternoon coffee she eats chocolate creams and Easter eggs. She takes a walk with her husband, reads poems by Rilke, Storm, Goethe, and Tennyson, is amused by the first chapter of Mark Twain's 'Christian Science,' is in a positively festive mood, and all heaviness seems to have fallen away from her. She writes letters, the last one a letter to the fellow patient here to whom she had become so attached. In the evening she takes a lethal dose of poison, and on the following morning she is dead. 'She looked as she had never looked in life – calm and happy and peaceful.' (Ibid., p. 267)

But this is awkward. Rosa was speaking in Italian. Virginia did not understand Italian but she could recognize it. And knowing that Rosa was an Italian helped. The girl spoke brilliantly and she used magnificent gestures. She raised a fist and beat her chest. Almost at once you caught on that she was imitating Mussolini.
The two white-capped waitresses didn't reach the speaker right away. They scurried around their steam wagon and ran into each other. One of them knocked a stack of plates from the cart and they stopped to pick them up. The plates did not break. They were metal. They made a frightful clatter and Rosa had to raise her voice. Rosa was not simply imitating Mussolini, for the time being she was Mussolini. Everyone was much impressed and they frowned at the waitresses. The Nose, the aristocrat who dined at Virginia's right, tapped impatiently on the table and said, 'Quiet, you fools.'
When the waitresses reached the speaker they did not apologize for their rudeness. Great strapping women that they were, they laid hands on the delicate Rosa and took her from the dining room so rapidly that you were not certain if they carried her or walked her.

--- Mary Jane Ward, The Snake Pit, The New American Library, 1946, p. 36.

Now Cauchon, as an advocate experienced in dealing with the law, knew that, according to the rules of the Inquisition courts, none but those who, having recanted their heresy, had relapsed, could be condemned to suffer death by burning. And having succeeded in making the wearing of man's clothes (it is certain, from the evidence given by Jean Massieu, that the wearing of such clothes was expressly mentioned in the cédule) the symbol of Joan's failure to submit to the Church, he might be fairly sure that she would, without much delay, show herself to have relapsed by retaining her male attire. Events were soon to prove him right.

--- Regone Pernoud, Joan of Arc, by Herself and Her Witnesses, Stein and Day, New York, 1969, p. 218.

       ... Sunday, May 27th, Cauchon learned that Joan had resumed male attire. On the following day he went to the prison, accompanied by the vice-Inquisitor and several assessors. The following is from the official record:
       'The Monday following, 28 of the month of May, on the day following Holy Trinity, we, judges aforesaid, went to the place of Joan's prison to see her state and disposition. Were present the lords and Masters Nicolas de Venderes, Thomas de Courcelles, Brother Isambart de la Pierre, Guillaume Haiton, Jacques Camus, Nicolas Bertin, Julien Floquet and John Gray.'
       'Joan was dressed in a man's clothes, to wit tunic, hood and gippon (a short robe worn by men) and other man's clothes, attire which on our order she had formerly left off and had taken women's clothes: therefore did we question her to know when and for what cause she had again put on man's attire.'
       Joan: I not long since resumed man's attire and left off woman's attire.
       Question: Why have you assumed this male attire and who made you take it?
       Joan: I have taken it of my own will. I have taken it because it is more licit and fitting to have man's clothes since I am with men than to have woman's clothes. I have resumed it because what had been promised me has not been observed, to wit that I should go to mass and should receive the Body of Christ and should be taken out of irons.
       Pierre Cauchon: Have you not made abjuration and promised especially not to resume man's clothes?
       Joan: I would rather die than remain in irons; but if it be permitted me to go to mass and I be taken out of irons and that I be put in a pleasant (gracieuse) prison, and that I have women, I will be good and will do what the Church wishes. (The item 'have women' is down in the French Minute but not in the official text of the proceedings.)
       Cauchon: Since that Thursday, have you heard the voices of Saints Catherine and Margaret?
       Joan: Yes.
       Cauchon: What did they tell you?
       Joan: God has sent to me by Saints Catherine and Margaret great pity for the mighty betrayal to which I consented in making abjuration and revocation to save my life, and that I was damning myself to save my life.
       (Here the clerk has noted in the margin, responsio mortifera [mortal (fatal) answer]. Ibid, p. 220.)

In Paris itself the University did not fail to make known, with great ceremony, the outcome of the trial in which it had played a predominant role. The Journal d'un Bourgeois de Paris, written by a university man and therefore conveying university feeling exactly, has a long account of how. '... on the day of Saint-Martin-le-Bouillant (July 4th) a general procession was made to Saint-Martin-des-Champs and a brother of the Order of Saint Dominic, who was an Inquisitor and a Master of Theology, preached a sermon. In this he included a version of Joan the Maid's whole life; she had claimed to be the daughter of very poor folk; she had adopted man's attire when she was only fourteen and her father and mother would willingly have killed her then had they been able to do it without wounding their own conscience; and that was why she left them, accompanied by the hellish Enemy. Thereafter her life was one of fire and blood and the murder of Christians until she was burned at the stake.'
The Journal records, before this, and in all the detail which the writer had been able to obtain, a life and trial of Joan in much the same spirit, adding an account of her execution which no doubt conveys more or less what was known in Paris and echoes the version put about by the university: 'When she saw that her punishment was certain she cried for mercy and orally abjured. Her clothes were taken from her and she was attired as a woman, but no sooner did she find herself in this attire than she fell again into error and asked for her man's clothes. She was therefore soon condemned to death by all the judges, and bound to a stake on the scaffold of plaster (cement) on which the fire was built. She perished soon, and her dress was all burned away, then the fire was drawn a little back that the people should not doubt. The people saw her stark naked with all the secrets which a woman can and should have. When this sight had lasted long enough, the executioner replaced great fire under that poor carrion which was soon charred and the bones reduced to ashes. Many people said there and elsewhere that she was a martyr and that she had sacrificed herself for her true prince. Others said that this was not so and that he who had so long protected her had done her ill. Thus spake the people, but whether she had done well or ill, she was burned that day.' (Ibid., p. 238)

Patients laugh and posture when they see through the doctor who says he will help but really won't or can't. Posturing, for a girl, is seductive, but it's also an effort to distract the doctor away from all her pelvic functions. The patients try to divert and distract him. They try to please the doctor but also confuse him so he won't go into anything important. When you find people who will really help, you don't need to distract them. You can act in a normal way. I can sense if the doctor not only wants to help but also can and will help. [The patient stressed this.]
(What kind of help did you need?) Well, one thing was getting down to my need to be a boy. The very first interview you said something about a prick. I was terrified but it really was a great relief, even though I felt like an old rag in a gun closet. Most of my doctors had avoided it with me. You showed that you felt it was a problem that had to be cleared up. You knew I was terrified, but I knew you would go down to the depth with me. All my other doctors sat on the edge and fished. They waited for me to say things. That's not fair. You went right ahead. You were willing to get in with me. [M.L. Hayward and J. E. Taylor]

--- Bert Kaplan, Editor, The Inner Word of Mental Illness (A Series of First-Person Accounts of What It Was Like), Harper and Row, New York, Evanston, IL and London, 1964, p. 327.

The reference to a 'prick,' in the second paragraph, relates to the fact that Joan had always carried a knitting needle with her to the early interviews. The therapist made the suggestion, 'Perhaps you feel safer if you have something to prick with.' As discussed in an earlier paper, this type of clarification gives the patient the enormous encouragement of realizing that the doctor can understand and accept his problems. Joan also points out the futility of 'fishing'; that is, asking questions.
Her comparison of herself to a rag in a gun closet seems a particularly vivid example of the intense overvaluation of the phallus that is seen as a major problem in many girls suffering from schizophrenia. (Ibid., p. 327)

The toy penguin mentioned in the text is related to an extraordinary episode which occurred at the time of Joan's first visit home, after the clearing of the overt psychosis. In spite of the fact that Joan was a tall, handsome young woman of 19, her father brought this doll as a present and insisted she carry it on the trip home. From this episode one can see the father's overwhelming unconscious need to convert her from a growing woman to a male child. (Ibid., p. 328)

I needed to be controlled and know what you wanted me to be. Then I'd be sure you would want me. With my parents I couldn't be a boy and they never made it clear what else they wanted me to be except that. So I tried to die by being catatonic. You should never have let me wear slacks. You even said I looked nice in them. I was sure you loved me like that and would be like my parents.
I would go into these violent rages at you, early in treatment, because of a sense of desperate frustration. I longed for you to take care of me and love me, but I was sure I wasn't lovable as a girl, and I knew I couldn't really become a boy. I felt sure you would soon realize I wasn't a boy and then you would go away. You seemed ready to feed me but then you never would. (Ibid., p. 333)

Joan's outstanding problem throughout treatment was a feeling that she could be more lovable as a boy. Apparently this idea had its roots in her earliest relationship with her mother.
Treatment had to prove to her that she was a girl and could be loved as a girl; starting with her existence only as a wish in the therapist's mind. Eventually, as described in Section XXV, she could test the therapist out more and more completely; thereby convincing herself that as a girl she did have power to please and attract people. Sechehaye describes this growth of self-esteem very well. (Ibid., p. 334)

The majority of schizophrenics are struggling with three conflicting drives. Part of these drives wants to be a boy, part wants to be a girl, and part a baby. As Joan has pointed out, the simultaneous presence of all these drives leads to immense confusion. (Ibid., p. 335)

When a girl doesn't want to walk, it's because she doesn't want to realize that there is nothing swinging between her legs. She would like to be paralyzed from the waist down. If her legs are dead, then her genitals are dead too. She won't have to think of them again. I hated to walk. I could feel my thighs rubbing and that made me remember my genitals. I hated you for making me walk. (Ibid., p. 340)

Hindsight shows that in this case the therapy of the period of overt psychosis fell into three principal phases. At the start, Joan presented chiefly the picture of catatonic withdrawal or of belligerent masculine identification, so that the work of therapy centered around efforts to help her control her aggression and overcome her fear of being hurt again if she established a human relationship. The therapist had to be tested at length until he proved he was dependable and would always strive to do what was necessary for her welfare.
       Once Joan was sure she could depend on the therapist, she began a process of replacing the deprivations of the original oral period through a new mother-infant experience. This she describes as the really vital relationship which enabled her to feel like a girl. She could only be a girl if she started with a mother who could love her as a girl.
       The third phase, or period of growth, went on slowly and almost imperceptibly. Joan was free of overt psychosis by the time she began to use the therapist, less as a mother and more as a good father who could convince her of her ability to be attractive and successful as a woman.
       She entered reality solidly, when she could again see the therapist as a doctor and the relationship became more co-operative and adult. (Ibid., p. 344)