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SchizophreniaThe Bearded Lady Disease Volume Two
By J. Michael Mahoney
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The Bearded Lady Disease
001 More than thirty years of intensive investigation of these problems permits me to make the general statement that in man every case of emotional neurosis or psychosis is the result of more or less conflict and confusion involving bisexual differentiation.... Dementing schizophrenia is essentially a regression to the cloacal level of hermaphrodism. I am quite sure that it would be easy to demonstrate these factors in any case and often within an hour of investigation.
["Bisexual Factors in Curable Schizophrenia*," Edward J. Kempf, M.D. (*Presented at the Annual Meeting of the American Psychiatric Association, May 18, 1948), Journal of Abnormal and Social Psychology. 1949 Jul Vol 44(3) 414-419. ] (The complete E. J. Kempf article is the final item in the book.)
Dr. Edward J. Kempf was a highly-respected and brilliant psychiatrist and psychoanalyst whose productive years encompassed well over half a century, ending with his death in 1971. Thus, when Dr. Kempf makes the claim that "in man every case of emotional neurosis or psychosis is the result of more or less conflict and confusion involving bisexual differenttiation," the world should sit up and take notice. Unfortunately, not enough notice has been taken of his findings, for today investigators profess to be searching still for the "elusive" cause of functional mental illness, up to and including the dysfunction labeled "schizophrenia."
The purpose of this monograph of 639 quotations from various sources is to prove the validity of this theory of Dr. Edward J. Kempf *, and to set at rest once and for all any questions about the etiology of mental illness.
* Dr. Edward J. Kempf was a Life fellow of the American Psychiatric Association and of the Association for Research in Nervous and Mental Disease; a member of the American Medical Association, the American Psychopathological Association, the American Association for the Advancement of Science, the New York Academy of Sciences, and the American Psychological Association. He was the author of over 30 papers and books, including his famous Psychopathology, published in 1920, and "The Origin and Evolution of Bisexual Differentiation," published in 1947.
Dr. Kempf graduated from medical school at Case Western Reserve University in Cleveland, Ohio, in 1910; interned at the state mental hospital in Cleveland from 1910-11 and at the state mental hospital in Indianapolis, Indiana, from 1911-13. He performed his residency at Phipps Psychiatric Clinic, Johns Hopkins University Hospital, Baltimore, Maryland, from 1913-14. From 1914 to 1920 he was a clinical psychiatrist at St. Elisabeth's Hospital in Washington, D.C.
002 There is evidence of sexual upsurgence and an intense effort at control, repression and denial. There is also much sexual confusion, especially as regards his own sexual identity, which is very poorly established. The patient is extremely defensive, and his defenses for the most part follow an obsessive – compulsive pattern with a definite tendency toward paranoid ideation.
[David and Lisa, Theodore Isaac Rubin, M.D., Ballantine Books, New York City, 1962, p. 141. ]
In this case reported by Dr. Rubin, the patient is obviously suffering from severe bisexual conflict, uncertain whether he is male or female. He is in the throes of what is termed a "homosexual panic," caused by his ego's repression of his effeminate, same-sex, sexual cravings which are threatening to erupt from the unconscious into consciousness, which is the only pathway they can use to gain orgasmic satisfaction and consequent diminution of their drive. The "paranoid ideation" is the direct result of this bisexual conflict.
003 Such fundamental doubts about their sex, though seldom expressly stated in the literature (Bleuler, 1951; Rosen, 1953) we have found an invariable feature of schizophrenia (Macalpine, 1954; Macalpine and Hunter, 1953, 1954a, 1954b, 1955.
[Memoirs of My Nervous Illness, Daniel Paul Schreber, translated by Ida Macalpine and Richard A. Hunter, Wm. Dawson & Sons, Ltd., London, 1955, p. 407.]
In this quotation, Doctors Macalpine and Hunter (a mother-son team) state an extremely important truth: in essence, that all schizophrenics are basically "bearded ladies" – persons who do not know at a deep unconscious level whether they are male or female. They have very strong homosexual feelings, always repressed, which conflict directly with their conscious heterosexual drives, resulting in a blockage of all sexual satisfaction. It is this situation of total sexual frustration which drives them "crazy," i.e., schizophrenic.
004 The primary delusion of a change of sex may appear in patients in various guises, often as the only symptom: complaint of excessive hairiness in women, lack of hairiness in men, symptoms associated with "change of life" in women, even men. Following hysterectomy, complaints about voice being too high or too low, the breasts being too small or too flat, differences between the right and left halves of the body, etc. Examples could be multiplied ad infinitum. Not uncommonly female patients complain that they have a male mind in a female body, and male patients that they have a female mind and request their body be altered accordingly, by surgery or hormones.
[Memoirs of My Nervous Illness, Daniel Paul Schreber, Ibid., p. 405.]
It is interesting that Macalpine and Hunter here point out that a great many female schizophrenic patients complain that they have a male mind in a female body and vice versa for male patients. Of course this is also a common complaint among homosexuals and people desiring transexual surgery. Basically, schizophrenia is the negation of homosexuality. The cure for schizophrenia lies in the patient coming to terms with his or her homosexuality, and either remaining at a conscious homosexual level or, through psychotherapy, maturing into heterosexuality.
005 Perversions, alongside the manifestations of normal drives, are much more pronounced in schizophrenics than in neurotics. The homosexual components, especially, play an unsuspectedly large role. But we will not go into further details at this point.
[Dementia Praecox or the Group of Schizophrenias, Eugen Bleuler, International Universities Press, New York, 1950, p. 411.]
Eugen Bleuler, the psychiatrist who first made use of the term "schizophrenia" in the monograph cited here, calls attention to the important role homosexuality plays in that condition. Unfortunately, when he said he would "not go into further details at this point" on the subject, he meant it, and even more unfortunately, he never took up the subject again in any depth. This glaring theoretical omission has had the effect of minimizing to a great degree the profound role homosexual, or bisexual conflict, does play in the etiology of schizophrenia.
006 Other patients are in love with a ward – mate with complete disregard of sex, ugliness, or even repulsiveness. (Ibid., p. 52)
Dr. Bleuler here calls our attention to instances of overt homosexuality among his hospitalized mental patients.
007 His basic bisexuality had developed into a true manifest ambisexuality, male and female potentials being equally matched. He was as much both as he was neither. Thus he says 'that I have to imagine myself as man and woman in one person having intercourse with myself.' (S.282) and 'playing the woman's part in sexual embrace with myself' (S.285). These ideas culminated in fantasies of self-impregnation.
In this fundamental doubt Schreber exhibits a common characteristic of schizophrenics. Usually, however, this balanced imbalance of sex has to be deduced from psychotic expression and is not freely accessible. The insight afforded by Schreber on this point gives to his memoirs their unique value.
[Memoirs of My Nervous Illness, Daniel Paul Schreber, Ibid., p. 402. ]
Here, for the first time in this monograph, we meet Daniel Paul Schreber, considered by many to be psychiatry's most famous patient. He was first brought to the public's attention when Dr. Sigmund Freud wrote a case history dealing with Schreber's psychosis, wherein Freud made the claim that Schreber's illness was caused by repressed homosexual longings. C.G. Jung had given Freud a copy of Schreber's autobiography, Memoirs of My Nervous Illness, and had based his case history on the material in this book.
Schreber's memoirs were first translated into English in 1955 by Doctors Macalpine and Hunter. In commenting on Schreber's illness, Macalpine and Hunter point out the obvious, namely that Schreber's female, or homosexual side, is so powerful it had overwhelmed his male, or heterosexual, side. His memoirs demonstrate this fact irrefutably. He is truly a "bearded lady."
008 Clearly passive homosexual urges, whether conscious or unconscious, should be sharply distinguished from the confusion about their own sex invariably found in schizophrenia. That in the primary fantasy of change of sex or belonging to the opposite sex, homosexuality is likely sooner or later to play a part secondarily, is undisputed. (Ibid., pp. 404-405)
Macalpine and Hunter attempt to separate homosexuality from "the confusion about their own sex invariably found in schizophrenia." Homosexuality plays a primary, not a secondary, role in schizophrenia, as Macalpine and Hunter would lead us to believe.
009 Zilboorg (1941) says that 'Freud's views on schizophrenia, ... were based ... on ... the Schreber case ... Later clinical studies corroborated Freud's views that certain aspects of unconscious homosexuality are the determining factor in the development of schizophrenia.' Fenichel (1945) gives a long list of confirmatory publications. (Ibid., p. 11)
Homosexuality's vital role in the etiology of schizophrenia is confirmed by Fenichel's findings, as well as in the "long list of confirmatory publications." When we speak of "homosexuality" in this regard, we are always referring to unconscious, or repressed, homosexuality, never conscious homosexuality. Basically, it is the repression of strong homosexual cravings which drives people crazy, or "schizophrenic." 8 schizophrenia
010 It is instructive that Schreber was diagnosed in his first illness as suffering from severe hypochondriasis; his second illness commenced as an 'anxiety neurosis' with attacks of panic, then hypochondriacal delusions and suicidal depression; later catatonic excitement alternating with stupor. From then on he might well have been diagnosed variously as suffering from catatonic schizophrenia, paranoid schizophrenia, dementia paranoides, dementia praecox, monomania, chronic mania, involutional melancholia, paranoia paraphrenia, obsessional neurosis, anxiety hysteria, tension state, transvestitism, psychopathy, etc. (Ibid., p. 15)
This quotation confirms what Dr. Edward Kempf said in Quotation 001, namely, that "in man every case of emotional neurosis or psychosis is the result of more or less conflict or confusion involving bisexual differentiation." Daniel Paul Schreber, during the course of his illness, suffered from every named psychiatric syndrome, thereby substantiating Dr. Kempf's hypothesis that not only is bisexual conflict the etiological basis of schizophrenia but of all other emotional disorders as well.
011 For all students of psychiatry, Schreber, its most famous patient, offers unique insight into the mind of a schizophrenic, his thinking, language, behavior, delusions and hallucinations, and into the inner development, course and outcome of the illness ... Indeed the memoirs may be called the best text on psychiatry written for psychiatrists by a patient. Schreber's psychosis is minutely and expertly described, but its content is – as Dr. Weber explained to the court – fundamentally the same and has the same features as that of other mental patients. Schreber's name is legion. (Ibid., p. 25)
Schreber's name is legion, in that every mentally ill man suffers from the same bisexual conflict as did Schreber. Furthermore, bisexual conflict forms the etiological basis of mental illness in all females as well.
012 M. Bleuler (1953) in a personal communication stated that E. Bleuler would have agreed that 'schizophrenics are almost invariably, if not indeed invariably, in doubt about the sex to which they belong.' (Ibid., p. 25)
Manfred Bleuler, son of Dr. Eugen Bleuler, here confirms the fact that his father had found sexual confusion to be a prominent, if not invariable factor, in the disease he had named "schizophrenia." Unfortunately, Dr. Bleuler had not emphasized this point sufficiently in his monumental textbook on the subject.
013 In the pre-psychotic phase homosexual tendencies differ from those of the homosexual perversion. The unconscious wish of the pre-psychotic male to be a woman arises not as a defense against the positive oedipus complex but from the constitutional bisexuality of the individual – '... in its deepest nature schizophrenia arises from bisexual conflicts, and this bisexual conflict eventually leads to a state where the heterosexual factor is relinquished.' (Katan, 1954) ... Katan concludes that a part of the personality behaves as if the pre-psychotic phase was still in existence. The non-psychotic part of the personality ('the non-psychotic layer') does not remain constant in size but changes all the time. The extent of the non-psychotic layer is dependent upon the activity of the homosexual conflict. If the homosexual urge is not too powerful the remnants of the ego can function fairly adequately. However, when the homosexual drive increases in intensity, the relative strength of the ego will determine the outcome, i.e. whether or not the subsequent reaction will be in accordance with reality or whether a psychotic symptom will make its appearance. ... The delusion constitutes the psychotic mastery of the conflict (Katan, 1954). Katan interprets hallucinations from a dynamic – energic standpoint. He suggests that the energy of the homosexual urge is withdrawn in the psychotic phase, to avoid the danger arising from it, and used to form a hallucination. This releases the tension caused by the homosexual drive and prevents a complete break with reality. This suggests that 'the goal of maintaining contact with reality can be achieved only by abandoning it for a short while through the formation of a psychotic symptom (the hallucination). It is like avoiding a major evil by accepting a minor one' (Katan, 1954).
[Chronic Schizophrenia, Thomas Freeman, John L. Cameron, Andrew McGhie, preface by Anna Freud, International Universities Press, New York, NY, 1958, pp. 37-38.]
Dr. Maurits Katan agrees with Dr. Edward J. Kempf that "... in its deepest nature schizophrenia arises from bisexual conflicts" and adds that "this bisexual conflict eventually leads to a state where the heterosexual factor is relinquished."
Dr. Katan is the only investigator I am aware of who has unearthed the mechanism of delusion and hallucination formation in schizophrenia. He explains that the energy which fuels these symptoms arises from the homosexual libido which is blocked from normal orgasmic genital discharge by the repressive ego. This homosexual libido consequently "converts" itself into the energy force which fuels the delusions and hallucinations of the disease, thus achieving its energic discharge in a roundabout way, in the manner in which all conversion hysteria symptoms are formed.
014 One of the most widely mentioned transference problems is that of dealing with homosexual impulses which may threaten the therapeutic relationship when working with paranoid schizophrenics. Techniques for dealing with disturbing homosexual elements of the transference have varied from the utilization of a female helper (Federn, 34, 35) to the direct energetic discouragement of such tendencies in the patient, forcing him to recognize the dangers in the fulfillment of his homosexual fantasies, and advising him to have heterosexual intercourse (Eidelberg, 28). It seemed advisable in the latter case to transfer the patient's sexual wishes at least in part to a female object in order to lessen the tension aroused by his homosexual trends and hence make them more analyzable. Some authors have suggested that the prospect of recovery in such patients may actually be better when they are treated by women since discussion of the homosexual tendencies is less likely to provoke a panic-like state than when treated by men.
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