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Bergler's essential thesis is that homosexuality in women is determined by a preoedipal conflict. It represents the attempt to deny the maternal rejection and simultaneously allays guilt and anxiety by choosing mother substitutes as love objects. Bergler contends that actual traumatic experiences producing such hatred cannot in and of themselves lead to homosexuality; there must also be a biologic substratum of the 'oral instinctual drive and a personality of the narcissistic-libidinous type'.
Homosexual women present what Bergler calls the 'mechanism of orality', which 'is pathognomonic for all oral neuroses and perversions'. The patients first provoke aggression from the outer world, then react violently to this aggression, and finally indulge in endless self-pity. They have strong masochistic self-destructive tendencies. If this masochism is very strong or if the unconscious guilt cannot be utilized in treatment the prognosis is poor.
The reader is struck by Bergler's pessimism regarding the male of the species: 'In reality men are fighting a desperate rearguard action; more and more they are becoming "appendages" of women'.