Contribution to the problem of homosexuality and paranoia
THE analysis of Schreber’s autobiography2 and the investigation of paranoiac patients3 established the decisive role of homosexuality, generally warded off with the aid of projection, in the pathogenesis of this psychosis. Since then I have had the opportunity of observing a number of paranoiacs, and in every case without exception I have had no alternative but to interpret the symptoms as the consequences of a destroyed social sublimation of homosexuality. They were all to be regarded as individuals whose development from auto-eroticism to object-love had suffered disturbance, and who had thereupon, as a consequence of narcissistic fixation and subsequent accidental causes, regressed to the homosexual level, but had warded off this perversion, which was intolerable to their consciousness.
Let me now describe one of these cases.
A Suabian peasant4 aged about forty-five, who had always lived a sober life, was brought to me because of his persecution mania. His wife explained to me that he had the fixed idea that every man who approached him was an enemy, wanted to poison him, pointed at him, wanted to ridicule him. If a cock crowed in the yard or a stranger passed him in the street, it all happened because of him.
I asked the man about his relations with his wife. I knew that delusions of jealousy were not confined to alcoholic paranoiacs. Both he and his wife answered unanimously that in that respect everything was in order; they were fond of each other, and had several children; true, since the beginning of his illness the man had refrained from sexual intercourse, but that was because he had ‘other things on his mind’.
I went on to ask whether he took any interest in parish affairs, and, if so, whether there had been any change in this respect since the beginning of his illness. (I know from experience that those who later become paranoiacs, like true homosexuals, show an unusual amount of interest in social affairs and take an active part in them, but partially or completely lose this interest upon the outbreak of paranoia.) His wife answered with a vigorously repeated ‘yes’. Her husband had been a parish councillor and had taken his duties very seriously, but since he had been ill he had taken no more interest in the parish.
At this point the man, who had hitherto listened quietly to all that had been said and had confirmed it, started getting restless, and in response to my questions confessed, after considerable pressure, that he thought I must obviously have been given secret hints by his wife; otherwise he could not see how I could possibly have guessed everything about him so correctly.
I then continued the interview with him alone, in the course of which he eventually admitted that I had been right about his jealousy too; he had not wanted to admit it in his wife’s presence. He secretly suspected his, wife in connexion with every male who came into the house. (In view of the sexual abstinence he had practised for many months, which was not really consistent with his being in love with his wife, I interpreted his jealousy as a projection of his own interest in the male sex.)
I next asked him when and in what circumstances this change in him and his environment had come about, whereupon he told me the following story. Some months previously he had been operated on twice in succession for an anal fistula. The doctor had done the second operation badly, he said, and for some time afterwards he had noticed ‘noises in the chest’ and had had attacks of feeling ‘frightened to death’ several times daily. Simultaneously he felt ‘as if the fistula were suddenly climbing up into his stomach, and that he would be bound to die of it’. He had now got over this fear, but people now wished to declare him mad.
His wife and a friend who accompanied the couple confirmed what the patient said, and in particular made it clear that the delusional ideas had set in only after the paraesthesias and anxiety released by the operation had ceased. Subsequently he had accused the surgeon of having deliberately performed the operation badly.
In view of all that was known to me about the connexion between paranoia and homosexuality, I concluded that his intestinal illness and the resulting necessity for manipulation of his rectum by males (physicians) might have stimulated the patient’s hitherto latent or sublimated homosexual tendencies by the resuscitation of childish memories. In view of the symbolic significance of unsheathed knives, the second operation in particular, which was carried out without an anaesthetic and in which the cutting instrument was introduced deeply into the rectum, seemed well calculated to revive the infantile idea of coitus a tergo.
Without very much beating about the bush, I asked the patient straight out whether in his boyhood he had not done forbidden things with other boys. This question obviously took him aback, and there was a long pause before he answered, and confessed rather shamefacedly that at the age of five or six he had played a remarkable game with another boy of the same age who was now one of his greatest enemies. This boy used to challenge him to play ‘cock and hen’. He accepted, and always played the passive role in the game; he was the ‘hen’. The other boy used to insert either his erect penis or his finger into his rectum; sometimes he would insert a cherry and then remove it with his finger. They had continued with this game until their tenth or eleventh year. Since then, however, he had known that such things were godless and disgusting, and he had never again indulged in them; in fact the idea of them had never again entered his head. He assured me repeatedly that he regarded such shameful actions with contempt.
Now this memory showed that our patient had lingered unusually long and intensely at the stage of homosexual object-choice, and had then energetically suppressed and partially sublimated it. Thus the brutal intervention in his anal erotogenic zone had been well adapted to reawaken the wish to repeat the infantile homosexual play which survived in his unconscious. But in the meantime the sexuality, which in the earlier stage had been childish play, had developed into the impetuous and dangerous drive of a strong, adult, man. No wonder, therefore, that the patient had tried to defend himself against giving abnormal (perverse) outlet to such large quantities of libido and had sought at first to convert them into paraesthesias and anxiety attacks and to project them from the ego into the outer world as delusional ideas. The same unconscious, passive-pederastic fantasy (the ‘anal fistula climbing up into his stomach’) underlay both the delusional ideas and the paraesthesias which had preceded the outbreak of those ideas. It is not improbable that this stage indicated an attempt to deal with the homosexuality by means of paraphrenia,1 i.e. a complete turning away from men and a return to anal autoeroticism; and that the persecution mania broke out only with the ‘return of the repressed’, i.e. with the re-cathexis of the long-sublimated and then completely rejected male love-object. The ‘crowing cock in the yard’ to which the patient attributed a special place in his delusional ideas was identical with the ‘greatest enemy’ to whom he had played the hen in his boyhood.
As I had one conversation only with him, I was unable to confirm my suspicion that the fear of poisoning symbolized in his case, as in so many others, a wish to be made pregnant.
I had no choice but to be very sceptical about the prospect of a cure, but left open the possibility that when the anal fistula had completely healed and the physical conditions thus ceased to be so ‘accommodating’, the delusional ideas might partially or completely cease and that the patient might recover his capacity for sublimation (for intellectualized homosexuality, friendship community sense).
1 German original; Zb. f. Psa. (1911), 1, 557. First English translation.
2 Freud, Collected Papers, Vol. III, pp. 390–472. London: Hogarth Press. 1933.
3 Ferenczi, ‘The Role of Homosexuality in the Pathogenesis of Paranoia’ (1912), in First Contributions, p. 154. London: Hogarth Press. 1952.
4 In the neighbourhood of Budapest there are a few villages inhabited by Germans. These Hungarian Germans are commonly known as ‘Suabians’.
1 Paraphrenia is suggested by Freud as a more suitable term than dementia praecox because it is without the latter’s implications. Incidentally the pathology of the psychosis of paraphrenia is not sufficiently clarified to put out of court an alternative interpretation of the anxiety and the sensory stimulation phenomena as attempts at hysterical conversion.