PARANOIA
A.
We should be inclined to say that what was characteristically paranoiac about the illness was the fact that the patient, as a means of warding off a homosexual wishful phantasy, reacted precisely with delusions of persecution of this kind.
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 an 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 defence 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. This was certainly not what we had expected. Paranoia is precisely a disorder in which a sexual aetiology is by no means obvious; far from this, the strikingly prominent features in the causation of paranoia, especially among males, are social humiliations and slights. But if we go into the matter only a little more deeply, we shall be able to see that the really operative factor in these social injuries lies in the part played in them by the homosexual components of emotional life. So long as the individual is functioning normally and it is consequently impossible to see into the depths of his mental life, we may doubt whether his emotional relations to his neighbours in society have anything to do with sexuality, either actually or in their genesis. But delusions never fail to uncover these relations and to trace back the social feelings to their roots in a directly sensual erotic wish. So long as he was healthy, Dr. Schreber, too, whose delusions, culminating in a wishful phantasy of an unmistakably homosexual nature, had, by all accounts, shown no signs of homosexuality in the ordinary sense of the word.
[ Notes on a Case of Paranoia, The Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913). Hogarth Press, London, 1958, translated by James Strachey, pp. 59, 60. ]
Freud's discovery that repressed homosexual impulses form the core of paranoia must rank as the greatest contribution anyone has ever made to the field of clinical psychology. The tragedy of Freud's life is that he did not realize that paranoia and schizophrenia are inseparable, and therefore have the same etiological base – repressed homosexual cravings. On page 77 of the above-cited work, he states: "Moreover, it is not at all likely that homosexual impulsions, which are so frequently – perhaps invariably – to be found in paranoia, play an equally important part in the aetiology of that far more comprehensive disorder, dementia praecox." (Eugen Bleuler, in his monumental study of the psychoses, first used the term "schizophrenia" in place of "dementia praecox.")
Freud's inability to see the connection between paranoia and schizophrenia resulted in his not being able to consummate his brilliant libido theory of the neuroses and psychoses. From complete ignorance concerning the cause of mental illness, he brought the world ninety-nine percent of the way to a full understanding of it, then failed to take that final step which would have completed his theory by recognizing that paranoia and schizophrenia are inextricably bound, that what forms the etiology of the one also forms the etiology of the other.
B.
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."
[ Memoirs of My Nervous Illness, by Daniel Paul Schreber. 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. ]
C.
Without going further into all the details of the course of his illness, attention is drawn to the way in which from the early more acute psychosis which influenced all psychic processes and which could be
called hallucinatory insanity, the paranoid form of illness became more and more marked, crystallized out so to speak, into its present picture.
This kind of illness is, as is well known, characterized by the fact that next to a more or less fixed elaborate delusional system, there is complete possession of mental faculties and orientation, formal logic is retained, marked affective reactions are missing, neither intelligence nor memory are particularly affected and the conception and judgment
of indifferent matters, that is to say matters far removed
from the delusional ideas, appear not to be particularly affected, although naturally because of the unity of all psychic events they are not untouched by them.
[ Memoirs of My Nervous Illness, by Daniel Paul Schreber. -- 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, p. 271. ]
D.
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. ]
E.
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. ]