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This book begins on an optimistic note that is contrary to the views of many older analysts: 'There is no question that at the present time we have sufficient evidence … to demonstrate that homosexuality can be cured or at least, in most cases, its symptoms and suffering greatly alleviated by medical psychoanalysis. This
book, a comprehensive and unified medical work, is not only a compendium of the accumulated psychoanalytic knowledge on the problem as well as a presentation of the author's clinical experience and observations but also presents a definite theory as to the origin of homosexuality, the mechanisms involved in its development and the procedures most efficacious for its treatment.'
Socarides insists that the condition is entirely psychogenic, not innate: 'There is no connection between sexual instinct and the choice of sexual object. Such an object choice is learned, acquired behavior; there is no inevitable genetic or hormonal inborn propensity toward the choice of a partner of either the same or opposite sex. The male-female design is taught and … perpetually maintained and only overwhelming fear can disturb or divert it.'
After a comprehensive review of the literature Socarides presents a developmental theory of male and female homosexuality. The male form takes more room throughout the book and is, so to speak, the prototype. The male infant who later develops homosexuality has an overintense affective relationship with his mother, often with conscious incestuous desire, which starts in the separation-individuation phase of earliest infancy, fails to be dissolved, and ends in a severe ambivalence conflict. The infant is terrified by the engulfing possessiveness of the mother as well as by his own oral sadistic drive, the impulse to penetrate and destroy the mother's body, especially the breasts. The attempt to detach himself from the mother leads to identification with her where he remains fixated. This is the 'nuclear' conflict on which t