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Every psychoanalyst has met fantasies of a change of sex in women and knows that these fantasies are frequently connected with anxiety and guilt feelings so that they become either repressed or appear as terrible threats rather than as things to be longed for. Girls frequently try to escape from the conflicts between the tendencies, 'I want to be a man' and 'I am afraid of becoming a man' by ideas of introjection: 'If I have a penis within me, or if I become
a penis myself, I do not need to be afraid of the violence of my wishes in that direction any more'.1 This escape occasionally fails, and the girl becomes afraid of her introjection ideas.
Foulkes describes the same material, but interprets it somewhat differently. For him, the introjective idea is not a result of a wish to become a man, but the idea of a change of sex is rather a result of a preceding and threatening introjective fantasy: 'The patients considered themselves possessed by a male principle, a man, or more concretely speaking, a penis inside themselves… The frightening element in the threatening change of sex lay precisely in the fact that these fantasy organs had thus to be revealed, to come out into the open and be set free.'
Four reported case histories are not convincing evidence for such a primary introjective fantasy. The first patient is a paranoid schizophrenic with the delusional idea that a sex changing operation will be performed on her; the second is 'a typical hysteria, for whom the change of sex was a horrible idea'; the third patient was governed by fear of loss of control, which meant a fear of her own aggressive tendencies, and according to Foulkes, was due to the activity of 'a man inside herself, who might get the better of her and break out of her'; the last case was suffering from latent homosexuality, and dreamed that she was chasing a man who turned out to be a woman.