Irving Bieber et al., Homosexuality: A Psychoanalytic Study,
Chapter XII - Conclusions
This study provides convincing support for a fundamental contribution by Rado on the subject of male homosexuality (Sandor Rado, "An Adaptational View of Sexual Behavior", in Psychosexual Development in Health and Disease, ed. Paul Hoch and Joseph Zubin, New York, 1949): A homosexual adaptation is a result of "hidden but incapacitating fears of the opposite sex."
A considerable amount of data supporting Rado's assumption has been presented as evidence that fear of heterosexuality underlies homosexuality, e.g., the frequent fear of disease or injury to the genitals, significantly associated with fear and aversion to female genitalia; the frequency and depth of anxiety accompanying actual or contemplated heterosexual behavior.
We have described the specific types of disturbed parent-child relationships which have promoted fear of heterosexuality (discussed in psychodynamic detail later on) and we have emphasized throughout these chapters the role of parents in the homosexual outcome. The data have also demonstrated that many of the homosexuals in our sample showed evidences of heterosexual interest and desire manifested in dreams, fantasies, and attempts at heterosexual activity.
The capacity to adapt homosexually is, in a sense, a tribute to man's biosocial resources in the face of thwarted heterosexual goal-achievement. Sexual gratification is not renounced; instead, fears and inhibitions associated with heterosexuality are circumvented and sexual responsivity with pleasure and excitement to a member of the same sex develops as a pathologic alternative.
Any adaptation which is basically an accommodation to unrealistic fear is necessarily pathologic; in the adult homosexual continued fear of heterosexuality is inappropriate to his current reality. We differ with other investigators who have taken the position that homosexuality is a kind of variant of "normal" sexual behavior.
Kinsey et al. did not regard homosexuality as pathologic but rather as the expression of an inherent capacity for indiscriminate sexual response. In support of this assumption the authors referred to the high frequency of homosexual experiences in the preadolescence of American males. Thus, an assumption of normalcy is based on the argument of frequency though, in fact, frequency as a phenomenon is not necessarily related to absence of pathology. For example, most people in New York will contract a cold during a given period of time. This expectancy will show a normal probability distribution but respiratory infections are patently pathologic conditions.
Kinsey et al. also stated that the personality disturbances associated with homosexuality derive from the expectation of adverse social reactions. Although most H-patients [in Bieber et al.'s study, homosexual subjects and their relatives are marked H as opposed to non-homosexual "comparison" subjects and their relatives, who are marked C] in our study were apprehensive about being exposed as homosexuals, these were secondary responses to a primary disorder. Further, anxiety about social acceptance would not account for the many significant differences between homosexuals and heterosexuals which were found among the large number of items tapped; in particular, hostility to the H-father, to brothers rather than to sisters, the close relationship with the mother, and so forth. Moreover, some patients had no apparent problems about social acceptance. Without its importance, the emphasis upon fears of censure and rejection as promotive of the personality disorders associated with homosexuality seems to be a quite superficial analysis of this complex disorder.
Ford and Beach (Patterns of Sexual Behavior, New York, 1951), in accord with Kinsey et al., also imply that homosexuality is not pathologic but that "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." The authors compare the sporadic and indiscriminate "homosexual" behavior frequently observed among infrahuman species (though heterosexual behavior is not extinguished in hardly any instances and is reinstated with no apparent change), with human homosexual behavior where cognitive and highly complex patterns are involved and where, at least in our society, fear of heterosexuality is salient. Based on the frequency of homosexual phenomena, the authors state, "The cross cultural and cross-species comparisons presented ... combine to suggest that a biological tendency for inversion of sexual behavior is inherent in most if not all mammals including the human species." Following their logic, one might assume that any frequently occurring sexual aberration may be explained by postulating an inherent tendency. A pathologic formation, i.e., homosexuality, viewed as an inherent tendency points to a confusion between the concept of adaptational potential and that of inborn tendency.
Ford and Beach do not distinguish between capacity and tendency. Capacity is a neutral term connoting potentiality whereas tendency implies the probability of action in a specific direction. In our view, the human has a capacity for homosexuality but a tendency toward heterosexuality. The capacity for responsivity to heterosexual excitation is inborn. Courtship behavior and copulatory technique is learned. Homosexuality, on the other hand, is acquired and discovered as a circumventive adaptation for coping with fear of heterosexuality. As we evaluate the maturational processes, a homosexual phase is not an integral part of sexual development. At any age, homosexuality is a symptom of fear and inhibition of heterosexual expression. We do not hold with the now popular thesis that in all adult males there are repressed homosexual wishes. In fact, most adult heterosexual males no longer have the potential for a homosexual adaptation. In the comparison sample one-fourth of the cases revealed no evidence of homosexual propensities -- conscious or unconscious. If we assume that homosexuality is a pathological condition, and our data strongly support this assumption, we would no more expect latent homosexuality to be inevitable among well-integrated heterosexuals than we would expect latent peptic ulcer to be inevitable among all members of a healthy population.
Another approach to the question of homosexuality as behavior within a normal range is found in Hooker's work (see page 17, Chapter I). In this investigation projective techniques were utilized to determine whether homosexuality and homosexual adjustment could be distinguished from that of heterosexuals. It was found that the differences sought between the two populations could not be reliably distinguished. The conclusion was that "homosexuality may be a deviation in sexual pattern which is within the normal range psychologically." Since the tests and adjustment ratings were performed by competent workers and the implication of the findings and conclusions are at marked variance with those -of our own and other studies, we suspect that the tests themselves or the current methods of interpretation and evaluation are inadequate to the task of discriminating between homosexuals and heterosexuals.
Still another type of argument is that homosexuality in certain individuals is related to genetic factors. In Kallman's twin studies, homosexuality among monozygotic twins was investigated (see page 13, Chapter I). Each sibling of forty pairs was found to be homosexual. Kallman placed enormous emphasis on genetic factors; yet, he contradicted his own position by stating that the sexual impulse is easily dislocated by experiential factors. Even assuming a genetic determination, it cannot be strongly operative if sexuality responds so sensitively to nongenetic influences. We propose that the study should have included psychoanalytic treatment for at least some of the pairs studied. Had a shift to heterosexuality occurred in the course of treatment, as it had in one-fourth of the homosexuals in our sample, the reversibility would have cast doubt on the significance of genetic determinants in homosexuality. Though reversibility in itself is not a sufficient argument against the genetic position, there is so much evidence on the side of the nurture hypothesis and so little on the side of the nature hypothesis, that the reliance upon genetic or constitutional determinants to account for the homosexual adaptation is ill founded.
A point of view which has gained some acceptance in psychoanalytic circles is that homosexuality is a defense against schizophrenia; that is to say, if the H-patients had not become homosexual they would have become schizophrenic. Our findings do not support this hypothesis. One-fourth of the homosexual cases were diagnosed as schizophrenic; thus, homosexuality obviously had not defended these homosexuals against schizophrenia. Further, there were no schizophrenic sequelae, among those H-patients who became exclusively heterosexual.
The idea that paranoia is a defense against homosexuality goes back to Freud's early analysis of the Schreber case. According to anecdotal data offered by E. A. Weinstein (United States Public Health Psychiatrist to the Virgin Islands, 1958-1960) homosexual content was absent in the delusional systems during the acute paranoid states of native Virgin Islanders. We propose that schizophrenia and homosexuality represent two distinct types of personality maladaptation which may or may not coexist.
An analysis of the data obtained on the schizophrenic homosexual and comparison cases was made. The analysis was not presented in this volume since it was not central to our study. We did find, however, that with certain item clusters, those patients who were diagnosed as schizophrenic in the H-sample were more like the schizophrenic heterosexuals than like the other nonschizophrenic homosexuals. On other item clusters, however, the schizophrenic homosexuals resembled other H-patients more than they did heterosexual schizophrenics. For example, on item clusters tapping father-son relationships, the schizophrenic patients in both samples were significantly more fearful, more distrustful, and had fewer friendly, accepting, and respectful relationships with significantly more frequently hostile and unsympathetic fathers than was noted among the nonschizophrenic H- and C-patients. But on the Six Developmental Items and on the item tapping aversion to female genitalia, the responses converged according to sexual adaptation, e.g., schizophrenic and nonschizophrenic homosexuals resembled each other more than they did schizophrenic and nonschizophrenic comparison patients whose responses also converged on these items.
The differences in psychopathology between the homosexuals and schizophrenics suggest that the time in life when predisposing influences became effective may have occurred earlier among schizophrenics. The nonschizophrenic homosexuals may not have been exposed to as severe pathogenic influences until the appearance of behavior construed by parents as heterosexual; this usually occurs in the early phase of the Oedipus Complex.
Freud's formulations on so-called "narcissistic" love object choice are supported by our findings in the Adolescent Study (Chapter VIII). Reciprocal identifications and love for an exchanged self-image were noted among the adolescents.
Freud postulated that castration anxiety, which he deemed to be a major factor in homosexuality, was strongly reinforced in the male child upon his shocked discovery of the absence of a penis in the female. Our study does not provide data directly bearing upon this hypothesis although our findings permit us to make certain inferences. Fear of and aversion to the female genitalia were reported for approximately three-fourths of the homosexual patients in contrast to only one-third of the heterosexuals. If the assumed anxiety reaction in the young male goes beyond a transitory childhood experience so as to become a determining force in masculine psychosexual development, we could expect a much higher frequency of fear and aversion to female genitalia among heterosexuals. Such was not the case among the heterosexual patient sample. We conclude that the male child's reaction to the observed absence of a penis in the female may be an important determinant of anxiety but only when reinforced by other determinants of anxiety related to sexuality. The significant association between fear and aversion with other items of the questionnaire indicates to us that the aversion is a defense against fear of heterosexuality.
Our findings are replete with evidence of a close mother-son relationship and confirm the observations of Freud and other investigators that "mother fixation" is related to homosexuality. The data also provide convincing evidence of the importance of the Oedipus Complex in the etiology of homosexuality. Our material highlights the parental distortions of this phase of child development, as noted in the overcloseness and seductiveness of the H-mother and the hostility of the H-father.
The data on identification of the homosexual partner with family members support two other of Rado's assumptions: (1) heterosexual impulses may be acted-out in the homosexual act or homosexual relationship; (2) the homosexual adaptation frequently includes attempts to solve problems involving the father.
The identification of the homosexual partner with the mother and sisters, which occurred in some patients of our sample, suggests that heterosexual strivings were being acted-out in these homosexual relationships. On the other hand, the identification of the homosexual partner with a father or brothers who were hated and feared suggests that these patients were making reparative attempts to solve relationship problems originating with the father and/or brothers.
Rado had also stated that two other determinants of homosexual behavior are "temporary expedience" and "a desire for surplus variation." We are in disagreement with these views. We do not base our differences on material derived from our study since our sample was composed of patients who were not "sporadic" homosexuals, and they had well established homosexual pattems - but rather upon psychiatric reports on military personnel during World War II. Lewis and Engel have abstracted the major psychiatric papers. published during the war years; none referred to expedient homosexual behavior despite the deprivation of women for millions of men. Further, a member of the Research Committee who had had the opportunity to observe all homosexuals apprehended for homosexual activity in a particular Theater of Operations did not clinically observe patients with the motivations Rado has proposed. Homosexual behavior was relatively uncommon in the armed forces of Great Britain and the United States. It occurred in individuals with premilitary homosexuality, or occasionally in individuals under the influence of alcohol as might occur in civilian life.
The assumption of "surplus variation" could apply to any aberrant sexual activity. Clinical experience has shown that aberrant behavior is always pathologically motivated. The "doing-it-for-kicks" assumption does not adequately explain aberrant sexuality. We are committed to Rado's own proposition that homosexuality is an adaptation to fear of heterosexuality, and we extend this proposition to account for all homosexual behavior.
Theories which postulate that homosexuality is a coincidental phenomenon in a more comprehensive psychopathologic process are given minimal support by our data. The construct proposed by Ovesey differentiates actual (acted-out) homosexuality from pseudohomosexuality ("latent" or unconscious). Dependency and inhibited assertion are assumed to be the basic psychodynamics underlying pseudohomosexuality so that homosexual preoccupation, fear, panic, and so forth, are viewed merely as symbolic representations of more fundamental pathologic formations. We have found pathologic dependency to be a characteristic of the majority of homosexuals but we have also identified it in most heterosexual patients. According to our formulation, pathologic dependency forms part of the psychodynamic constellation of homosexuality, but, as pointed out in Chapter VII, pathologic, dependency appears as a secondary process. In our view, dependency and inhibited assertiveness are the consequences of psychologic injury and not the causes of it. The patients' symbolization of dependency in homosexual terms does not dispose of homosexuality as a central problem since when such symbolizations occur in dreams, fantasies, and obsessions, a homosexual solution is being contemplated (consciously or unconsciously) and an adaptive shift may be potential at those times.
Our findings support those of Kolb and Johnson in their emphasis upon the parental role in promoting homosexuality; those of Sullivan as to the importance of peer group relationships; those of Thompson in that heterosexuality is biologically more congenial; those of West who asserted that the participation of both parents in the molding of a male homosexual was essential. Lang found an overrepresentation of homosexual siblings in the homosexual sample he studied which is in accord with our data.
Our study has helped us refine and extend certain concepts relevant to the etiology of male homosexuality. Certainly, the role of the parents emerged with great clarity in many detailed aspects. Severe psychopathology in the H-parent-child relationships was ubiquitous, and similar psychodynamics, attitudes, and behavioral constellations prevailed throughout most of the families of the homosexuals - which differed significantly from the C-sample. Among the H-patients who lived with a set of natural parents up to adulthood - and this was so for the entire H-sample except for fourteen cases - neither parent had a relationship with the H-son one could reasonably construe as "normal." The triangular systems were characterized by disturbed and psychopathic interactions; all H-parents apparently had severe emotional problems. Unconscious mechanisms operating in the selection of mates may bring together this combination of parents. When, through unconscious determinants, or by chance, two such individuals marry, they tend to elicit and reinforce in each other those potentials which increase the likelihood that a homosexual son will result from the union. The homosexual son becomes entrapped in the parental conflict in a role determined by the parents' unresolved problems and transferences.
Each parent had a specific type of relationship with the homosexual son which generally did not occur with other siblings. The H-son emerged as the interactional focal point upon whom the most profound parental psychopathology was concentrated. Hypotheses for the choice of this particular child as "victim" are offered later in this discussion.
The father played an essential and determining role in the homosexual outcome of his son. In the majority of instances the father was explicitly detached and hostile. In only a minority of cases was paternal destructiveness effected through indifference or default.
A fatherless child is deprived of the important paternal contribution to normal development; however, only few homosexuals in our sample had been fatherless children. Relative absence of the father, necessitated by occupational demands or unusual exigencies, is not in itself pathogenic. A good father-son relationship and a mother who is an affectionate, admiring wife, provide the son with the basis for a positive image of the father during periods of separation. We have come to the conclusion that a constructive, supportive, warmly related father precludes the possibility of a homosexual son; he acts as a neutralizing, protective agent should the mother make seductive or close-binding attempts.
The foundations of personality and psychopathology are set within the
nuclear family; more specifically, within the triangular system. Parental
attitudes toward a particular child are often well defined by the first
year of life and after the fourth year are well established. Parental attitudes
in most instances undergo little fundamental change so that the child is
exposed to a continuity of relatively unchanging parental influences. When
these influences are pathogenic, they create
and then maintain psychopathology in the child.
In important ways, sibling relationships and parent-sibling relationships also contribute to personality formation and to psychodynamic mechanisms operant in interpersonal affairs. Siblings may "tip the scales" one way or the other; they do not set the tenuous balance. However, a good sibling relationship - in particular, one with an older male sibling - may to some extent compensate for a poor one with the parents; it may even reinforce a heterosexual adaptation in a child who might otherwise have become homosexual. A rivalrous, disturbed sibling relationship, or sibling behavior outside the family which is traumatic to the child even when not directed at him, may be the "final straw" to precipitate homosexuality. But again, it is the parents who determine the family atmosphere and the relationships that transpire within the family setting. Other events are relatively of secondary importance.
We believe that sexual development (and its vicissitudes) is a cornerstone in homosexual adaptation. We do not regard homosexuality as a nonspecific manifestation of a generalized personality disorder. Therefore we shall outline a formulation of sexual development relevant to male homosexuality.
The first manifestations of sexuality occur as an integral part of the total growth process. Intricate and complex attitudes, behavior patterns and interpersonal relationships have already evolved before significant sexual development begins. All that has preceded sexual organization plays some part in determining its course. Conversely, the sexual process will itself condition the totality of pre-existing personality attributes, interpersonal relationships, and behavior patterns.
The initial stage of heterosexual responsivity occurs between the third and sixth years of life. Differentiated reactions toward males and females are observable at this period. These reactive differences are determined by a beginning capacity to respond to sexual stimuli from heterosexual objects in the environment - parents and siblings included. The young male child not only develops the capacity to respond sexually to females but he becomes capable of exciting such responses in females, including his mother. Bieber (Irving Bieber, "Olfaction in Sexual Development and Adult Sexual Organization", in Am. J. Psychother. 13:851-859, 1959) has advanced the hypothesis that olfaction plays an important part in the initial organization of the capacity for heterosexual responsivity and differentiation; the male takes on the odor characteristic of males sometime between the third and fifth year of life. Sexual responsivity in the young male stimulates a wish to be physically close to females and, as culturally patterned, to kiss, hug, and so forth. Rivalrous feelings toward males, particularly toward the father, generally accompany the developing capacity for heterosexual responsivity. The sexual response to the mother and rivalrous feelings to the father constitute the fundamentals of the Oedipus Complex.
Sexual reactions to the mother constitute one manifestation of the male child's developing capacity for heterosexual responses. The profound relationship established with the mother during infancy and into the pre-Oedipal years becomes integrated with the emerging heterosexual responsivity toward the mother as the most prominent and accessible female in the immediate environment. The nature of the child's sexual response in no way differs from that felt toward any comparably accessible female though the singular attachment of son to mother includes the earlier infantile dependence upon her which begins to articulate with his developing heterosexual interests. It is at this point that the incest taboo is first communicated from parent to child. Because of anxiety connected with incest, the mother will suppress her son's heterosexual responses to her. Sexual repression in concert with filial rivalry toward the father results in the son's repression of incestuous wishes.
Parental responses to the child's emerging heterosexuality are not ordinarily emphasized in a discussion of the Oedipus Complex, yet these responses are crucial in determining the fate of the Oedipus Complex. Developmental processes in children, sexual and other, form part of a reverberating stimulus-response system with the parents. Every maturational phase of development in the child stimulates responses in the parents which, in turn, condition the original stimuli and fundamentally determine the nature of development of that specific maturational phase. We refer to the interactional response patterns involved in bowel training, walking, talking, early masturbation, and so forth.
A mother who is pleased by her son's masculinity and is comfortably related to his sexual curiosity and heterosexual responsiveness to her and other females, encourages and reinforces a masculine identification. A father who is warmly related to his son, who supports assertiveness and effectiveness, and who is not sexually competitive, provides the reality testing necessary for the resolution of the son's irrational sexual competitiveness. This type of parental behavior fosters heterosexual development which in adult life is characterized by the ability to sustain a gratifying love relationship. Parents who are capable of sexually constructive attitudes to a child usually are individuals who are capable of a love relationship with each other and provide a stable and affectionate atmosphere in the home. In the context of sexual development, a positive parental relationship provides no basis in reality for expectations of exclusive possession of the mother. Where the marital relationship is unsatisfactory, the parents may make attempts to fulfill frustrated romantic wishes through a child. In the case of the mother the child chosen for this role is usually a son. Thus, in part, she fulfills the son's unconscious incestuous wishes and she intensifies his rivalry with and fear of the father. She alienates son from father who, in turn, becomes hostile to both wife and son.
The majority of H-parents in our study had poor marital relationships. Almost half the H-mothers were dominant wives who minimized their husbands. The large majority of H-mothers had a close-binding intimate relationship with the H-son. In most cases, this son had been his mother's favorite though in a few instances an underlying CBI ["close-binding-intimate"] relationship had been concealed by a screen of maternal minimization and superficial rejection. Most H-mothers, were explicitly seductive, and even where they were not, the closeness of the bond with the son appeared to be in itself sexually provocative. In about two-thirds of the cases, the mother openly preferred her H-son to her husband and allied with son against the husband. In about half the cases, the patient was the mother's confidant.
These data point to maternal attempts to fulfill frustrated marital gratifications with the homosexual son. A "romantic" attachment, short of actual physical contact (specifically, genital contact), was often acted-out.
We assume that the unusually close mother-son relationship and the maternal seductiveness explicit in over half the cases had the effect of over-stimulating the sons sexually. We further assume that, over-stimulation promoted sexual activity rather than sexual patterns characterized by total inhibition as seen in apparent asexuality or impotence. The combination of sexual over-stimulation and intense guilt and anxiety about heterosexual behavior promote precocious and compulsive sexual activity, as was noted among H-patients. In these assumptions we found that homosexuals as a group began their sexual activity earlier than did the heterosexuals; the H-patients were more active sexually in preadolescence than were C-patients. The pre-occupation with sexuality and sexual organs frequently observed among homosexuals appears to emerge out of an intensity of sexual urges pounding against extensive impairment of heterosexual functioning. Sexual over-stimulation together with heterosexual impairment, promotes compulsive homosexual activity. Reparative mechanisms, usually unconscious and irrational, operate to restore heterosexuality. A reparative mechanism noted among the H-patients included the selection of homosexual lovers who were quite masculine - the "large penis" type. Such a maneuver involves an attempt to identify with a powerful male through symbolic incorporation usually expressed in oral sexual practices. Not infrequently the homosexual lover is perceived as a potent rival or as the most likely threat to heterosexual goals. The reparative aim is to divert the partner's interest from women, thus symbolically "castrating" him in the homosexual act - an irrational and magical attempt to achieve heterosexuality by eliminating an obstructive, threatening rival.
Earlier, we pointed out that one son was chosen for a particular role. Certain kinds of parental psychopathology are acted-out with this son and eventuate in his becoming homosexual. We propose that the mother chooses a son whom she unconsciously identifies with her father or with a brother who has great emotional value to her - usually he is an older brother. Such an identification may be made on the basis of physical traits or other cues to which the mother reacts transferentially but which, in a fundamental sense, evolve from her wish to possess a male like her father, or both. Since the H-son is the instrument which the mother uses to act-out her own anxiety-laden incestuous wishes, she is especially alert to any sexual behavior her son may express to her. Lest his behavior expose her own feelings, she suppresses all such manifestations in her son who soon learns that any act which includes an element of sexuality and virile masculinity is unwelcome to her. If her anxiety is severe enough, she attempts to demasculinize her son and will even encourage effeminate attitudes.
Most H-mothers were possessive of their sons. Because they apparently could not tolerate a romantic relationship with their own husbands, they appeared to be insecure about their ability to maintain ties with a male perceived as "valuable"; as compensation, they clung tenaciously to the H-son. In general, demasculinization by the mother serves to insure her son's continued presence; his extinguished heterosexuality then protects her against abandonment for another woman. Demasculinizing maternal behavior may also occur in those women who have been rejected by their own mothers who had preferred a male sibling. Such H-mothers have a need to dominate and control males and to hinder their effectiveness in an irrational attempt to deter further deprivation of feminine love - a female homosexual dynamic. Again, psychoanalytic experience with this type of woman leads us to hypothesize that many such mothers are burdened by deep-going homosexual problems.
It is self-evident that a man who enters into a poor marriage, and then remains in it, has serious problems. The father who is detached, hostile, and rejecting to his son in most instances is in an unsatisfactory marriage, as our data have shown. Hence, such men have a double-pronged psychopathologic interpersonal involvement - with the wife on the one hand, and with the H-son on the other. These fathers, not unlike their wives, are unable to maintain a love relationship with a spouse. Some such men attempt to fulfill those emotional goals by acting-out with a daughter as their wives are acting-out with a son. These fathers tend to be unusually hostile to men perceived as sexual rivals. Rejected by their wives in favor of the H-son (many of whom were openly preferred and more highly esteemed), the already existing competitive attitudes the fathers had toward males were intensified with the H-sons. Thus paternal competitive attitudes are expressed in overt hostility and rejection or in indifference. As for the son, he accurately interprets his father's behavior as sexually competitive. Fear of attack from the father coupled with the wish for his love is indeed a potent combination; it disturbs the son's own developing masculine sexuality which, he senses, is offensive to the father. Paternal preference for a daughter with expressions of love for her, which the son witnesses and envies, fosters in him the wish to be a woman; further, it interferes with a masculine identification and a heterosexual adaptation.
Much of the data of this study document the importance of father in his son's sexual outcome. The role-fulfilling father shares supportive, organizing, and orienting behaviors with the mother. Where a father has been devaluated by a wife's contempt while the son has been elevated to a position of preference, and where the father's potentially supportive role is undermined, a highly unrealistic and anxiety-laden grandiosity is promoted in the son. To be treated as superior to the father deprives the child of having the paternal leadership he craves and the support he requires.
In the father's specific contribution to his son's psychosexual development, the father should be a male model with whom the son can identify in forming masculine patterns in a specific cultural milieu. An affectionate father through his warmth and support provides a reality denial for any retaliatory expectations the son may have for harboring sexually competitive attitudes. The father who promotes an identification with him will ordinarily intercede between his son and a wife who may be CBI, thus protecting the boy from demasculinization. Such a father does not default his paternal role out of submissiveness to his wife. Our data record only one such supportive, affectionate H-father - he was a stepfather who came upon the scene when the patient was already ten years old. This patient became exclusively heterosexual in psychoanalytic treatment.
The father who is underprotective or who singles out one or several sons for the expression of hostile attitudes and behavior is usually acting-out a transference problem, generally based on difficulties had with his own father and/or a male sibling. Such a father tends to derogate his H-son and to show contempt at his failures in peer groups.
By the time the H-son has reached the preadolescent period, he has suffered a diffuse personality disorder. Maternal over-anxiety about health and injury, restriction of activities normative for the son's age and potential, interference with assertive behavior, demasculinizing attitudes, and interference with sexuality - interpenetrating with paternal rejection, hostility, and lack of support - produce an excessively fearful child, pathologically dependent upon his mother and beset by feelings of inadequacy, impotence, and self-contempt. He is reluctant to participate in boyhood activities thought to be potentially physically injurious - usually grossly overestimated. His peer group responds with humiliating name-calling and often with physical attack which timidity tends to invite among children. His fear and shame of self, made worse by the derisive reactions of other boys, only drives him further away. Thus, he is deprived of important empathic interactions which peer groups provide. The "esprit de corps" of boyhood gang-life is missed. Having no neighborhood gang to which to belong only accentuates the feeling of difference and alienation. More than half our H-sample were for the most part, isolates in preadolescence and adolescence, and about one-third played predominantly with girls.
Failure in the peer group, and anxieties about a masculine, heterosexual presentation of self, pave the way for the prehomosexual's initiation into the less threatening atmosphere of homosexual society, its values, and way of life. As a group, homosexuals constitute a kind of subculture with unique institutions, value systems, and communication techniques in idiom, dress, and gestures. The tendency to gravitate to large cities may also be extended to residence in particular locales and to "hangouts." Often there is a sense of identification with a minority group which has been discriminated against. Homosexual society, however, in which membership is attained through individual psychopathology, is neither "healthy" nor happy. Life within this society tends to reinforce, fixate, and add new disturbing elements to the entrenched psychopathology of its members. Although the emotional need of humans to socialize with other humans keeps many homosexuals within groups, some find the life style incompatible with other held values so that in some cases they come to prefer relative isolation.
Some homosexuals tend to seek out a single relationship, hoping to gratify all emotional needs within a one-to-one exclusive relationship. Such twosomes are usually based on unrealistic expectations, often accompanied by inordinate demands; in most instances, these pairs are caught up in a turbulent, abrasive attachment. These liaisons are characterized by initial excitement which may include exaltation and confidence in the discovery of a great love which soon alternates with anxiety, rage, and depression as magical expectations are inevitably frustrated. Gratification of magical wishes is symbolically sought in homosexual activity which is intense in the early phase of a new "affair." These relationships are generally disrupted after a period of several months to a year or so; they are generally sought anew with another partner and the cycle starts again. The depressions accompanying the dissolution of a homosexual bond and the despondency brought about by developing insight into the futility of such relationships are often precipitating circumstances motivating the undertaking of psychiatric or psychoanalytic therapy. Chronic underlying depressive states, a frequent characteristic of homosexuals, are often masked by a fa*ade of gaiety.
A detailed study of the etiology of homosexuality in the atypical cases must await a special study of larger numbers of these sub-groups than was available in the present investigation. In several instances, mothers were detached and hostile and several were detached and indifferent. Some fathers were not detached and a few were overprotective. Some homosexuals were not excessively fearful and some did not flinch from fighting; some even sought fights. Though they differed from the majority of H-patients in these aspects, they still had in common with the others highly pathologic relationships with parents and had come to fear a sustained heterosexual love relationship.
In about one-fourth of the comparison patients, evidence of severe homosexual problems was noted. None, however, had actually participated in homosexual activity in adolescence or adult life. We infer that a fragmentary homosexual adaptation had been organized and that the possibility of a homosexual shift had been considered on either a conscious or unconscious level at some time. Since a homosexual integration takes place only where there is severe anxiety regarding heterosexuality, some of these heterosexual patients were apparently tempted to escape from their fears by a flight into homosexuality. This kind of alternative to anxiety usually produces added and even more intense anxiety, since the renunciation of heterosexuality represents a serious loss to perceived self-interest; it is, in a sense, a type of castration. Secondarily, the homosexual solution is socially unacceptable and confronts the individual with unforeseen pitfalls in a new way of life. Certain heterosexuals are thus caught between the anxiety experienced in a sexual bond with a woman, and the panic and fear associated with homosexuality. We view such individuals as potentially homosexual Only those men who have such problems are considered by us to be "latent" homosexuals, but since the concept of homosexual latency is one that assumes a universal tendency present in all men, we prefer to discard the term entirely and refer to homosexual problems in those patients among whom such difficulties can be identified.
The therapeutic results of our study provide reason for an optimistic outlook. Many homosexuals became exclusively heterosexual in psychoanalytic treatment. Although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change.
We assume that heterosexuality is the biologic norm and that unless interfered with all individuals are heterosexual. Homosexuals do not bypass heterosexual developmental phases and all remain potentially heterosexual.
Our findings are optimistic guideposts not only for homosexuals but for the psychoanalysts who treat them. We are firmly convinced that psychoanalysts may well orient themselves to a heterosexual objective in treating homosexual patients rather than "adjust" even the more recalcitrant patient to a homosexual destiny. A conviction based on scientific fact that a heterosexual goal is achievable helps both patient and psychoanalyst to take in stride the inevitable setbacks during psychoanalysis.
We have learned a great deal about male homosexuality, yet we are under no illusion that this is a final statement on the subject. We hope that our work will stimulate other investigators to find answers to the many questions still unanswered.