Impressions

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., 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.

[ Psychotic States (A Psychoanalytical Approach), Herbert A. Rosenfeld, International Universities Press, New York, 1966, p. 165. ]

A young man imagines that he is about to be married by the holiest father, even the Pope. He sees himself as being such an attractive young girl that no man can resist him. Having in this way warded off the incestuous possibilities with mother now perhaps mother will love him. Understanding this, I forbade the patient to marry anybody but me, but then continued, 'I want you to be my son.' Almost a year later, when the patient's unconscious homosexuality came up in his analysis, he revealed this episode in the psychosis and remembered what a relief it was to him when, through me, he accepted himself for what he was, a male.
Often female patients pull their hair out or cut their hair off as soon as they have an opportunity to do so. To these patients I denounce their act with fury, announcing that if they become a boy, I will hate them. As a man, I only love daughters. It is to be borne in mind that this does not complete the interpretation required for the girl who has snipped off her hair. I have to relate her act back to the mother in line with my understanding that if the patient is a boy, she will not be competing with her mother for her father, and then perhaps mother will love her.
In both these instances I take a parental role and with considerable feeling deny that I want either the boy to be a girl or the girl to be a boy and instead that what they are is what I want. If they try to be anything different, I'll hate them, not love them.

[ Direct Analysis (Selected Papers), John N. Rosen, M.D., Grune & Stratton, New York, 1953, p. 15. ]

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. ]

G: All the girls that I've had something to do with are going through my mind. They've all given me about the same thing – in different ways, I guess. You know, they give me warmth and peace and quiet. When I'm with a girl I don't think crazy – I don't think I think crazy, and it isn't necessary for me to be crazy. I don't need anything really, just that kind of nearness. I don't want to think that's a bad thing. I don't see how it can be bad.

S: I don't either. Will you ever have to go crazy because you love a woman?

G: I don't think so.

S: I think it's time that you be done with that, huh?

G: Yeah. Being crazy after being with a woman spoiled all the good things. You know when I ... like E, leaving her and vomiting all the way home. All the warmth and good feeling was just spoiled. It really isn't necessary to do that. I wonder why I thought it was necessary.

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 299. ]

G: Why worry about this one little thing? It's not hurting anybody. I'm not hurting anybody with it. And it's not hurting me. It's not a delusion. It's inside of me. This is something I've always known, and I've always felt; and it's there, and it's real, and it's mine; and you can't take it away from me, and neither can anybody else, so you might as well kiss my ass.

S: Does this penis ever show up in your daydreams?

G: How can it show up when it's really there? What are you talking about? You make it sound like it's a dream.

S: Have you ever had sexual daydreams in which you had a penis like a man?

G: No.

S: What's the matter?

G: Nothing.

S: Don't say 'nothing' to me.

G: You're just bugging me, that's all. I've told you all there is to know. [Shouting] I have this. I have it and I use it and I love it and I want it and I intend to keep it, and there's nothing you can do about it. It's mine. It makes me what I am.

[ Splitting (A Case of Female Masculinity), Robert J. Stoller, M.D., Dell Publishing Co., Inc., New York, 1973, p. 15. ]

A deeply schizophrenic woman, twenty-nine years of age at the time when she began psycho-therapy 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 nonhuman arose.

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

     One of the most widely mentioned transference problems is that of dealing with homosexual impulses which may threaten the therapeutic relationship when working with paranoid schizophrenics. Techniques for dealing with disturbing homosexual elements of the transference have varied from the utilization of a female helper (Federn, 34, 35) to the direct energetic discouragement of such tendencies in the patient, forcing him to recognize the dangers in the fulfillment of his homosexual phantasies, and advising him to have heterosexual intercourse (Eidelberg, 28). It seemed advisable in the latter case to transfer the patient's sexual wishes at least in part to a female object in order to lessen the tension aroused by his homosexual trends and hence to make them more analyzable. Some authors have suggested the prospect of recovery in such patients may actually be better when they are treated by women since discussion of their homosexual tendencies is less likely to provoke a panic-like state than when treated by men.

[ Man Against Himself, Karl A. Menninger, M.D., Harcourt, Brace & World, Inc., New York, 1938, p. 54. ]

     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.

[ Man Against Himself, Karl A. Menninger, M.D., Harcourt, Brace & World, Inc., New York, 1938, p. 97. ]

     Another example of helpful reformulation stems from the experience of one of our associates with a severely disturbed schizophrenic girl. This patient reported to the psychiatrist with whom she had been working over a long period of time: 'I moved up and down and up and down in my bed and was quite upset. I don't know why you told me that I had to wear spikes while doing this.' This patient had been recently moved from the most disturbed ward of the hospital to a less disturbed one. On this occasion she had made the resolution to stop manual masturbation. She was as mixed up about her own sex as most schizophrenics are. The psychiatrist, to whom the patient had previously given information about both these facts, reformulated the patient's statement for her as follows: 'So there was sexual excitement and relief from jumping up and down in your bed. And you were not sure whether or not one had to be a boy ["spikes"] in order to jump around that way. And you do feel that you need the psychiatrist to tell you about it.'

[ Principles of Intensive Psychotherapy, Frieda Fromm-Reichmann, M.D., The University of Chicago Press, Chicago, 1950, p. 95. ]

     The great problem of the pre-schizophrenic person, of course, is that, in keeping with the perpetuation, at an unconscious level, of the undifferentiated mother-infant stage of ego-development, he has not achieved any deep-reaching sexual differentiation of himself and perceived others into either male or female. The struggle to achieve such differentiation is probably one of the internal causes of his conception of all possible human feelings and behavior traits as bearing, like all French nouns, some sexual labels. Such judgements have been fostered in his superego development by parents who were themselves insecure about their sexual identities, and who inculcated in the son the erroneous idea that, for example, gentleness and a love for artistic things are feminine qualities, or in the daughter the notion that assertiveness and practicality are masculine attributes. Such notions, when applied not only to these few human qualities but extended over the whole range of psychological experience, and when applied not to the moderate degree found in the background of the neurotic person but invested with all the weight of actual biological attributes, have much to do with the person's unconscious refusal to relinquish, in adolescence and young adulthood, his or her fantasied infantile omnipotence in exchange for a sexual identity of – in these just described terms – a 'man' or a 'woman.'

[ Collected Papers on Schizophrenia and Related Subjects, Harold F. Searles, M.D., International Universities Press, New York, 1965, p. 437. ]

     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. ]

     According to Redlich (1952) " Most of the ... psychological propositions about schizophrenia ... may be traced back to ... Freud's ingenious discussion of the Schreber case ". Zilboorg (1941) says that " Freud's views on schizophrenia … were based ... on ... the Schreber case ... Later clinical studies corroborated Freud's views that certain aspects of unconscious homosexuality are the determining factor in the development of schizophrenia ". Fenichel (1945) gives a long list of confirmatory publications.

[ Memoirs of My Nervous Illness, by Dr. jur. Daniel Paul Schreber -- Translated, Edited, with Introduction, Notes and Discussion by Drs. Ida Macalpine and Richard A. Hunter -- Wm. Dawson & Sons Ltd., London,1955, p. 11.]

     By the end of four years of work, when she was finally able to move to a ward for undisturbed patients (though still in a locked building), she had become appreciably freer in revealing fond feelings towards me, towards certain of the nurses and some of the other female patients, although not able as yet to divulge any fond memories about, or fond current interest in, her mother. A little less than one year later (at the end of four and three-quarters years of work) my patient, who throughout these years had been manifesting deep confusion as to her sexual identity – she had consistently referred to herself as 'a girl' but had misidentified other persons on innumerable occasions in terms of a projected male-female unconscious image of herself – referred to herself for the first time in all my experience with her as 'a woman.' Intense feelings of dependency, loneliness, and grief were now emerging from her in the hours as she began expressing fond memories of transitory acquaintances with various girls and women in the past both at school and in hospitals. Although still maintaining her letter-writing to the tenaciously-clung-to Dr. Jones, she was now addressing these letters in such a fashion as to make it clear that they were directed as much to me as to him. In a fit of pique at feeling snubbed by Dr. Jones, she expostulated, 'Why, I'd rather be married to a woman!'
     By now (just one month short of five years) we had become so consciously, but as yet very shyly, fond of one another that we could not look at each other during the session without our faces revealing this fondness. I recall that I fantasied now, and continued to fantasy for many months thereafter on innumerable occasions during our highly productive hours together, that I was giving suck to her from my breast. This was a highly pleasurable experience free from either anxiety or guilt.
     She came to express glowingly libidinized memories of various girl friends, expressive of feelings of adoration and sexual desire which were at least as intense as those she had long expressed earlier in our work, with regard to various father figures. These included long-repressed feelings of intense interest in the female breast.

[ Collected Papers on Schizophrenia and Related Subjects, Harold F. Searles, M.D., International Universities Press, New York, 1965, p. 369. ]

     For all students of psychiatry, Schreber, its most famous patient, offers unique insight into 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.

[ Memoirs of My Nervous Illness, Daniel Paul Schreber, translated by Drs. Ida Macalpine and Richard A. Hunter, Wm. Dawson & Sons, Ltd., London, 1955, p. 25. ]

     For example, the female patients often queried their sex in the presence of a male therapist. In an earlier example one patient asked if she was a doctor. She continued: 'Trousers. Each man and woman has trousers on.' Another patient would frequently stand in front of the fire holding a poker in front of her genitals. When asked about this she said she was 'a man standing up.'

[ Chronic Schizophrenia, Freeman, Cameron, McGhie, preface by Anna Freud, International Universities Press, New York, 1958, p. 54. ]

     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.

[ Chronic Schizophrenia, Freeman, Cameron, McGhie, preface by Anna Freud, 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.

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

     The maladaptiveness of the male schizophrenic withdrawal is even more obvious and has been often noted in the literature. For example, Farina, Garmezy, and Barry (1963) report the same differential in marriage rates among male and female schizophrenics noted above and comment that to marry in our culture a man must usually approach, court, and propose to a woman as well as provide a home and financial support for her. Such actions require an assertiveness that male schizophrenics typically lack. However, a woman may marry even though she is sex-role alienated simply because less is required of her. All she has to do is 'go along.' The authors also point out that this explains why among divorced and separated schizophrenics more men than women recovered. The men presumably had to be better sex-adjusted to get married in the first place than the women.

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

     The specificity of the evidence for schizophrenic sex-role alienation suggests the results are not trivial. If it had been found that schizophrenics, whether male or female, simply fail to give normal sex-typed responses, one need only infer that here, as elsewhere, schizophrenics are disorganized. Perhaps they just do not attend to the tests but respond more or less randomly. Such an hypothesis is rendered unlikely by the fact that the schizophrenics give normally sex-typed responses to some tests and not others, and to some items on particular tests and not others.
     For instance, schizophrenic females generally care less than normals about all parts of the body, showing no differential for male and female parts, while male schizophrenics are more sensitive than normal males about female parts. This also demonstrates that sex-role alienation is not simply a matter of one sex reacting always exactly like the opposite sex. That is, the schizophrenic females are not relatively more sensitive about their male than female parts, as the normal males are. It is sex-role alienation, not reversal. Alienation often means reacting like normals of the opposite sex because that is the major or only alternative, but such is not always the case.
     The results taken together suggest that the components of sex-role identity can be arranged in a hierarchy of importance to normal adjustment. At the most basic primary level, at the center of personality structure, lies something that might be labeled gender identity, an unconscious schema representing pride, confidence, and security in one's membership in the male or female sex. Strictly speaking it has little to do with sex-typed actions or roles (which exist on the secondary level of the hierarchy) but with the fundamental experience of one's self as male or female. At this level the schizophrenics show the most disturbance: they make opposite-sex choices in the Role Playing Test, and they do not experience their own bodies the way normal men and women do. The Figure Preference Test results also suggest the same kind of disturbance in self-orientation, but they are harder to interpret and obviously need replication either with the original free response test or with figure choices more definitely representing various male and female body parts. Among the female schizophrenics, 82% either make three or more opposite-sex choices in the Role Playing Test or are insensitive to their bodies (accepting 14 or more of 20 parts) in a very unfeminine way. This contrasts with only 28% of all the normal females who showed one or the other of these deviations. Among the male schizophrenics, 95% show either the same degree of disturbance on the Role Playing Test or are especially sensitive to their female parts, in a non-masculine way (accepts 6 or less out of 8), as contrasted with 35% of the normal males showing one or the other of these gender-alien signs. The instruments were not designed to maximize discrimination of schizophrenics from normals, but even two such simple signs yield very large differences, suggesting that the fundamental problem exists for schizophrenics at this level.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 236-237. ]

     Normal males clearly show less concern with their bodies than normal females. Nearly three-fourths of the males express satisfaction with about three-fourths of the parts listed, as contrasted with less than one-fifth of the females (x 2 = 10.10, p < .01). Note that both groups of normal women show the same pattern, with the housewives being, if anything, even more concerned about their bodies than the working women. Among schizophrenics there is a decided reversal, females are less concerned, males more so, and the interaction chi-square is highly significant. The result is all the more impressive because it replicates a Sex X Diagnosis interaction found in a similar experiment by Holzberg and Plummer (1964). The reversal shows up markedly for female body parts. Among normals, females care more about them and males less, but among schizophrenics, males care more than females. These parts have to do essentially with the appearance of the body – it's presenting aspects (face, lips, hips, etc.). It is as if female schizophrenics have become insensitive to their appearance (like normal males), and male schizophrenics have become more sensitive to how they look (like normal females).

     Normal males clearly show less concern with their bodies than normal females. Nearly three-fourths of the males express satisfaction with about three-fourths of the parts listed, as contrasted with less than one-fifth of the females (x 2 = 10.10, p < .01). Note that both groups of normal women show the same pattern, with the housewives being, if anything, even more concerned about their bodies than the working women. Among schizophrenics there is a decided reversal, females are less concerned, males more so, and the interaction chi-square is highly significant. The result is all the more impressive because it replicates a Sex X Diagnosis interaction found in a similar experiment by Holzberg and Plummer (1964). The reversal shows up markedly for female body parts. Among normals, females care more about them and males less, but among schizophrenics, males care more than females. These parts have to do essentially with the appearance of the body – it's presenting aspects (face, lips, hips, etc.). It is as if female schizophrenics have become insensitive to their appearance (like normal males), and male schizophrenics have become more sensitive to how they look (like normal females).
     For the male body parts, the interaction is not significant. The female schizophrenics continue to be more satisfied than their normal counterparts, but both groups of males are equally satisfied. However, there is another interesting and significant reversal among the males. Normal males care more about their male (or strength) body parts than their female (or appearance) parts, but the trend is reversed for the male schizophreni(interaction x 2 = 4.33, p < .05). The same reversal does not appear for the females.
     To summarize these findings: schizophrenic males have replaced the normal male concern for masculine body parts with a greater concern for their appearance, like normal females. Schizophrenic females simply show less concern for all parts of their bodies, whether masculine or feminine. By itself, such indifference might be attributable to long hospitalization, but this explanation would not account for the differential results for the schizophrenic males. It seems plausible to conclude that some part of the schizophrenic woman's unconscious self-image is insensitive and more masculine, whereas some part of the schizophrenic man's self-image is sensitive and more feminine. Whether this difference predates their entry to mental hospitals is a question for further research.

[ "Sex-Role Alienation in Schizophrenia," David C. McClelland and Norman F. Watt, Journal of Abnormal Psychology, Vol. 73, No. 3, 1968, p. 234. ]

     Another case will bring out more of the motives. A thirty-year-old naval officer, married, was brought to the hospital with a history of having mistreated himself and of having contemplated suicide. He was quiet, neat, mildly depressed.
     The history was that his father had been very religious but very difficult to get along with and had deserted the family while the patient was yet small. The mother had been obliged to work very hard to support them. The boy himself had to go to work at an early age but in spite of this obtained a fair education intermittently. He had joined the navy and worked himself up to petty-officer rank. A year before admission he noted that he worried about his work and asked his friends if they noticed that he was not doing so well. He became increasingly depressed.
     Then he began to notice strange noises, thought he heard his shipmates talking about him and accusing him of perverted practices (i.e., of being homosexual). (Individuals with such fears and hallucinations rarely are homosexual overtly, but react with terror to the thought that they might be – just as 'normal' persons do, but in greater degree.) Finally he went to the bathroom and with a safety razor amputated his penis.
     When questioned about it the patient said he has been confused and hadn't known what he was doing. He seemed however, to show little concern or regret. Later he jumped overboard but climbed back aboard the ship on the anchor chain. He admitted, however, that the thought of drowning had always fascinated him.
     The examination showed that he still suffered from auditory hallucinations with voices telling him to do odd things and commenting on what he did. Concerning the charge of homosexuality he was quite perplexed because he had never indulged in it but began his heterosexual life very early. Except for the mutilation his physical condition was excellent and his intelligence above average.
     Later the patient announced that he was 'ready for the supreme sacrifice' (suicide) and wrote a note saying, 'I am a pervert and will pay the penalty.' He became increasingly restless and disturbed and exhibited impulses to fight with patients and attendants.
     ... There is, however, another element which we must not lose sight of. A man who feels guilty about his sex organs because of conscious or unconscious homosexual impulses, accomplishes two purposes when he cuts off his genitals. He punishes himself, but at the same time he converts himself by this deprival into a passive, penisless individual, anatomically comparable with the female. By this anatomical identification, he comes closer to the homosexuality about which he feels guilty than he was before the act. He feels guilty about his homosexual wishes and by castrating himself appears to atone for and relinquish them, but in reality only changes himself so as to be incapable of the active role and even more disposed to the passive role. 35

[ Menninger, K. A., M.D., Man Against Himself, New York. Harcourt, Brace & World, Inc., 1938, pp. 236-237 ]

      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 described, 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.

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

      The cross-cultural and cross-species comparisons presented in this chapter combine to suggest that a biological tendency for inversion of sexual behavior is inherent in most if not all mammals including the human species. At the same time we have seen that homosexual behavior is never the predominant type of sexual activity for adults in any society or in any animal species.
      ... The basic mammalian capacity for sexual inversion tends to be obscured in societies like our own which forbid such behavior and classify it as unnatural. Among these peoples social forces that impinge upon the developing personality from earliest childhood tend to inhibit and discourage homosexual arousal and behavior, and to condition the individual exclusively to heterosexual stimuli. Even in societies which severely restrict homosexual tendencies, however, some individuals do exhibit homosexual behavior. In our own society, for example, homosexual behavior is more common than the cultural ideals and rules seem to indicate.

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

      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 circumsized 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.

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

     At home things really began to deteriorate. I seemed to be tired all the time and I'd sleep for hours without being refreshed by the rest. I became indifferent to Laurie and my sexual appetite vanished; on those rare occasions when we did have intercourse, neither of us was satisfied. I began to doubt my masculinity. There must be something wrong with a man who can't satisfy the woman he loves. Maybe I'm a homosexual. That thought terrified me. On the streets I began to fancy that other men were looking at me. I began to see homosexuals everywhere, and all of them were laughing at me. (A terrible kind of desexualization, a loss of masculine identity, seems often to accompany schizophrenia when it develops in men, and perhaps this accounts for their morbid anxiety over homosexuality.)

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

     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. ]

186.