It is clinically well known that schizophrenics are very sensitive in the area which may loosely be called 'homosexual.' This sensitiveness, however, amounts principally to fears and preoccupations with the thought that someone else might think the patient homosexual or with efforts to determine in self-defense which persons in the environment may be homosexual. The patients make elaborate efforts to avoid the implication of being homosexual. It is so common for the fear of the patient who goes into panic to include some homosexual content that these panics have even come to be known as 'homosexual.'

[ Psychotherapeutic Intervention in Schizophrenia, Lewis B. Hill, M.D., The University of Chicago Press, Chicago, 1955, p. 61. ]

     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 auto-erotic, 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.

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

     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 homo-sexual 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.'

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

     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.'

[ Psychopathology, Edward J. Kempf, M.D., C.V. Mosby Co., St. Louis, Missouri, 1920, p. 502. ]

     Psychoanalytic observations of schizophrenics subjected to insulin shock therapy provide another opportunity for an understanding of the role of latent homosexuality in the origin of paranoid schizophrenia. In particular, these observations illustrate the important role played by the homosexual disappointment and the homosexual panic. The cathartic discharge provoked by the insulin coma creates a release of repressed libidinal impulses. The ambivalent homosexual attitude becomes split into its two components, with the positive one invested ideally in the transference reaction and thus accessible to analytic interpretations and working through.
     Psychoanalytic investigations have demonstrated the affinity between homosexuality and the schizophrenic break. In certain complex cases of latent homosexuality, the counter-cathexis, built by the ego in order to maintain the dissociation of the psychotic core from the rest of the ego, is so precarious that the psychotic invasion occurs, as it were, spontaneously and periodically.

[ Homosexuality and Psychosis in Perversions, Psychodynamics and Therapy, Gustav Bychowski, M.D., edited by Sandor Lorand, M.D., Random House, Inc., New York, 1956, p. 105. ]

     I have often marveled about the frequency with which psychotic episodes in Latin-Americans begin with a homosexual panic, until I understood that the word maricon (homosexual) is the most derogatory term, used constantly in Spanish-America. Contempt and self-contempt has no parallel or equally meaningful word in Spanish.

[ Johannes M. Meth, M.D., "American Handbook of Psychiatry", Vol. III, Basic Books, Inc., NY, p. 729. ]

     The third form of limited inquiry is one which I have undertaken in the case of some promising patients already suffering incipient schizophrenia or related disorders. The integration of the intimacy situation between patient and physician often cannot proceed in these cases without mediation because of their strong homosexual cravings which may become intolerable leading to panic, occasionally ending in suicide. The principle is to give them protection by way of the three-group, instead of working with the patient alone. The physician distributes his functions between himself and a clinical assistant, striving thereby to effect a distribution of emotional objectivation such that he can always have a positive balance at his disposal to carry the patient forward. The end achieved is a partial socialization of the subject-personality so that he can live for a while comfortably in a suitable special group. Thereafter, a more thorough investigation may be undertaken.

[ Personal Psychopathology (Early Formulations), Harry Stack Sullivan, M.D., W. W. Norton & Company, Inc., New York, 1972, p. 353. ]

     It is clinically well known that schizophrenics are very sensitive in the area which may loosely be called 'homosexual.' This sensitiveness, however, amounts principally to fears and preoccupations with the thought that someone else might think the patient homosexual or with efforts to determine in self-defense which persons in the environment may be homosexual. The patients make elaborate efforts to avoid the implication of being homosexual. It is so common for the fear of the patient who goes into panic to include some homosexual content that these panics have even come to be known as 'homosexual.'

[ Psychotherapeutic Intervention in Schizophrenia, Lewis B. Hill, M.D., The University of Chicago Press, Chicago, 1955, p. 61. ]

     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.

[ Psychopathology, Edward J. Kempf, M.D., C.V. Mosby Co., St. Louis, Missouri, 1920, p. 690. ]

     Moreover, she did not develop the complicated delusions we are used to seeing in schizophrenia, delusions that Schreber exemplifies. Instead, she would explode into a panic state, with confusion, terror, a buzzing, noisy hallucinosis (rather than clear-cut spoken language), poorly formed visual hallucinations such as blood pouring off the walls or black holes appearing in the streets, and an overpowering drive to kill herself. Except for the possibility that she might kill herself, the prognosis of her psychotic episodes was much better than in those of the typical schizophrenic reacting against her homosexuality.
     When my relationship with Mrs. G had become strong enough, after several years of treatment, and when I understood her well enough, I began charging in upon the subject of homosexuality. For the first year or so, when I did this I could count on her becoming psychotic – sometimes right before my eyes, and sometimes after an hour or so, initially it would happen even if homosexuality was only implied, later, each time I stated unequivocally that she was homosexual. To what extent she gradually became 'used' to this subject because of growing insight, or because of growing familiarity with not being destroyed by the thought, I cannot say. It seems to have been a combination of both.15

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 290. ]