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Rosenfeld agrees with Melanie Klein's hypothesis that the paranoiac is fixated at the early oral level (paranoid position) and that the paranoiac's homosexuality is secondary and defensive in nature. It is the problem of the relationship of manifest homosexuality to paranoia which is discussed in this paper.
The author uses the clinical material from three patients to make the following deductions: in the first patient homosexual activities were used as a defense against paranoid anxieties and stopped when these anxieties became too great. This patient also suffered from occasional elation which Rosenfeld relates to the homosexuality, indicating that he used his homosexual activity as a means of projecting an unbearable internal depressive or persecutory anxiety situation caused by the greedily incorporated penis or breast.
The second patient was a manifest homosexual male of thirty-eight with conversion symptoms, manic-depressive moods, and paranoid anxiety. Rosenfeld deduces that in this case the homosexuality was partly determined by his attempts to appease external persecutory figures by passive anal intercourse. In addition, his homosexuality was used as a defense against depression. In the transference the depression disappeared after a successful interpretation, which in turn permitted the patient to give up his homosexual activities completely in favor of heterosexuality. The deeper mechanisms included attempts to recapture his lost (or destroyed) mother, his virility and penis, all of which were projected on other men.