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Freud, in his classical study of the Schreber case, 3 described paranoid symptoms as a defense against homosexual urges. But it is the experience of the authors that every schizophrenic patient has a paranoid-like delusional system, the only differences being the degree to which the system works and the degree to which the patient is able to communicate his system (see also Rosen 8). This would lead us to believe that homosexual urges and the defenses they engender play a significant part in the pathology of schizophrenic patients.
Such is indeed the case, and one of the major hurdles in the therapy of psychosis is the handling of such homosexual problems. (As Freud pointed out, 4 the handling of these problems represents one of the most difficult obstacles in the analysis of neurotics as well.) A prerequisite for the adequate handling of such problems is an adequate understanding of their source.
The classical view of homosexual impulses is that, although “innate” bisexual factors and oral and anal fixations may be involved, essentially they represent an avoidance of castration anxiety through the choice of a woman with a penis (a man), thus denying the possibility of castration. They also represent an avoidance of competition with the father for the mother (incest), and thus, protection against the father's reprisal.
In our experience such oedipal interpretations produce no noticeable change in schizophrenic patients. Instead, we find that psychotic patients present us with alternative etiological factors. When