The Rôle of Homosexuality in the Genesis of Paranoid Conditions

Freud, in 1895, was the first to call attention to the role of homosexuality in paranoia. His writing at this time consisted of the psychoanalysis of a few cases of paranoia. His first work defining his views of sexuality was given to the psychiatric world in his “Studies in Hysteria.”1 During the following eighteen years, however, his own views underwent many changes and modifications. His first conception of the role of sexuality, in abnormal conditions, was expressed in regard to the place of sexuality in the etiology of the psychoneuroses.2 Later his writings have dealt with its role in the etiology of the psychoses. His many observations among the different psychoses led to his final statement that homosexuality held a very important position as an etiological factor in paranoia. His close observations finally led him to believe that the basis of all paranoid conditions was an existing homosexuality, and to explain the symptoms to be observed in these conditions as resulting from attempts to repress such homosexual ideas. His explanation of these mechanisms is given in his recent publication “Psychoanalytic Remarks on an Autobiographically Described Case of Paranoia.”3

In this psychoanalysis of the well-known case of Dr. Jur. David Paul Schreber, as autobiographically described, Freud is able to trace all symptoms to homosexual impulses, which the ego, finding incompatible with itself, attempted to repress. His explanation of these mechanisms is presented in compact form by Payne4 in a recent article in the psychoanalytic review. They are as follows, in brief resume: The struggle with the homosexual impulse leads to a substitution for the unbearable