Impressions

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80-71

80.

     The month of November 1895 marks an important time in the history of my life and in particular in my own ideas of the possible shaping of my future. I remember the period distinctly; it coincided with a number of beautiful autumn days when there was a heavy morning mist on the Elbe. During that time the signs of a transformation into a woman became so marked on my body, that I could no longer ignore the imminent goal at which the whole development was aiming. In the immediately preceding nights my male sexual organ might actually have been retracted had I not resolutely set my will against it, still following the stirring of my sense of manly honour, so near completion was the miracle. Soul-voluptuousness had become so strong that I myself received the impression of a female body, first on my arms and hands, later on my legs, bosom, buttocks and other parts of my body. I will discuss details in the next chapter.
     Several days' observations of these events sufficed to change the direction of my will completely. Until then I still considered it possible that, should my life not have fallen victim to one of the innumerable menacing miracles before, it would eventually be necessary for me to end it by suicide; apart from suicide the only possibility appeared to be some other horrible end for me, of a kind unknown among human beings. But now I could see beyond doubt that the Order of the World imperiously demanded my unmanning, whether I personally liked it or not, and that therefore it was common sense that nothing was left to me but reconcile myself to the thought of being transformed into a woman. Nothing of course could be envisaged as a further consequence of unmanning but fertilization by divine rays for the purpose of creating new human beings.

[ Daniel Paul Schreber, Memoirs of My Nervous Illness, WM Dawson & Sons Ltd., London, 1955, pp. 147-148 * Translated, Edited, with Introduction, Notes and Discussion by Ida Macalpine, M.D., and Richard A. Hunter, M.D., M.R.C.P, D.P.M. ]

79.

     On other occasions, the therapist experiences a resolution of the symbiosis, or at least a step in this resolution process, not in this quiet and subjectively inscrutable way, but rather with a sudden sense of OUTRAGE. The very word OUTrage is significant, and the feeling it designates is qualitatively different from annoyance, anger, or even rage. He feels outrage at this or that chronic regressive symptom in the patient, or outrage at the latter's whole regressive symptomatology, and always outrage at the unreasonableness of the demands which the patient has been making upon him these many months or years. He see the enormity of these demands which the patient has been placing, through his illness, upon him and other persons, and sees clearly the folly of acquiescing further in these regressive demands. He is suddenly and vigorously determined to give no more of his long-time dedication, now seen as misplaced dedication, to the gratification of these demands, which he formerly saw as infant needs which it would be unthinkable to brush aside.
     The therapist sees now, by the same token, the full interpersonal offensiveness of the patient's defense mechanisms, whereas he possessed heretofore a high degree of tolerance for such offensiveness in his patient and maintained a devoted effort to see and emphasize with the anxiety, the hurt, the loneliness, and so on, against which the patient has been unconsciously protecting himself through the use of these defense mechanisms. In my work, for example, one paranoid schizophrenic man who chronically manifested intense scorn and sarcasm in his dealings with other persons including myself, for nearly two years I had experienced increasing forbearance towards and sympathy with him as I saw more and more clearly the feelings of hurt, disappointment, and so on which the scorn and sarcasm was serving to maintain under repression. But then with the advent of the resolution-of-symbiosis phase, it forcibly dawned upon me how genuinely obnoxious to me as well as to others he was being with his scorn and sarcasm, the defensive function of these notwithstanding.
     In other words, one now holds the patient highly responsible for his symptoms. One now leaves in his hands the choice as to whether he wants to spend the remainder of his life in a mental hospital, or whether he wants, instead, to become well. In every instance that I can recall from my own experience, I have found occasion to express this newly won attitude to the patient himself, emphasizing that it is all the same to me. These are no mere words, but the expression of a deep and genuine feeling orientation. One cares not, now, how callous this may sound, nor even whether the patient will respond to it with suicide or incurable psychotic disintegration, and one feels and says this while casting one's own professional status, too, into the gamble, not to mention the potential feelings of lasting remorse to which one might be subject in case one's communication had such an irremediably destructive effect upon the patient. Thus, in effect, ones braves the threat of destruction both to the patient and to oneself in taking it into one's hands to declare one's individuality, come what may. [.......]
     Part of this new attitude on the therapist's part is a readiness to let the patient 'stew in his own juice' in contrast to his often having found himself, previously, vicariously expressing the patient's feelings in the symbiosis which then obtained. Likewise, he feels a new freedom to express his own individual thoughts and feelings to the patient as an individual - or, at any rate, as one whose nascent individuality is increasingly in evidence - without being hampered by concerns as to whether he is being inconsistent towards him or is treating the latter unfairly in comparison with his other patients - a not unimportant aspect of the work when one has two or three patients on the same ward.

[ Harold F. Searles, M.D., Collected Papers on Schizophrenia and Related Subjects, International Universities Press, New York, 1965, pp. 544-46. ]

78.

     Without going further into all the details of the course of his [Daniel Paul Schreber's] illness, attention is drawn to the way in which from the early more acute psychosis which influenced all psychic processes and which could be called hallucinatory insanity, the paranoid form of the illness became more and more marked, crystallized out so to speak, into its present picture.
     This kind of illness is, as is well known, characterized by the fact that next to a more or less fixed elaborate delusional system, there is complete possession of mental faculties and orientation, formal logic is retained, marked affective reactions are missing, neither intelligence nor memory are particularly affected and the conception and judgment of indifferent matters, that is to say matters far removed from the delusional ideas, appear not to be particularly affected, although naturally because of the unity of all psychic events they are not untouched by them.
     Thus President Schreber now appears neither confused, nor psychically inhibited, nor markedly affected in his intelligence, apart from the psychomotor symptoms which stand out clearly as pathological to even the casual observer: he is circumspect, his memory excellent, he commands a great deal of knowledge, not only in matters of law but in many other fields, and is able to reproduce it in an orderly manner, he is interested in political, scientific and artistic events, etc., and occupies himself with them continuously (although recently he seems to have been distracted from them a little more again), and little would be noticeable in these directions to an observer not informed of his total state. Nevertheless, the patient is filled with pathological ideas, which are woven into a complete system, more or less fixed, and not amenable to correction by objective evidence and judgment of circumstances as they really are; the latter still less so as hallucinatory and delusory processes continue to be of importance to him and hinder normal evaluation of sensory impressions. As a rule the patient does not mention these pathological ideas or only hints at them, but it is evident how much he is occupied by them, partly from some of his writings (extracts of some are added), partly it is easily seen from his whole bearing.

[ Dr. G. Weber, Superintendent of the Sonnenstein Asylum, in Memoirs of My Nervous Illness, by Daniel Paul Shreber, WM Dawson & Sons Ltd., London, 1955, pp. 271-2 * Translated, Edited, with Introduction, Notes and Discussion by Ida Macalpine, M.D., and Richard A. Hunter, M.D., M.R.C.P., D.P.M. ]

77.

The division of mental diseases into neuroses and psychoses has resulted in new names such as ambulatory or latent schizophrenia, or prepsychosis for the multitude of patients who appear to fall between the two stools.
     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.

[ Memoirs of My Nervous Illness, by Daniel Paul Schreber, WM Dawson & Sons Ltd., London, 1955, p. 15. * Translated, Edited, with Introduction, Notes and Discussion by Ida Macalpine, M.D. and Richard A. Hunter, M.D., M.R.C.P., D.P.M. ]

76.

Hello Michael,

I do find your work fascinating as my boyfriend is suffering 'bearded lady disease'..self diagnosed by (me) after reading your online book.

We had a 6yr gay relationship until earlier this year when he ended the relationship so he could lead a Charlie Sheen 2 1/2 men lifestyle. Basically, he wanted to sleep with lots of women.

7 months later, and he has not slept with any women, but he has had gay sex with me and did like to talk about the sex he would like to have with females.

2 weeks ago he jumped in front of a train (attempted suicide) he is still alive but lost his right wrist. He still loves me and wants to be with me, yet still has sexual desires' for women. I have mentioned your book and may even give him a copy, although he did say he needs sexual counseling. One step forward I guess.

Can you tell me if you have organized therapy training anywhere in Australia, preferably Melbourne?

Regards [name deleted for privacy reasons]

75.

[A] We should be inclined to say that what was characteristically paranoiac about the illness was the fact that the patient, as a means of warding off a homosexual wishful phantasy, reacted precisely with delusions of persecution of this kind.
     These considerations therefore lend and added weight to the circumstance that we are in point of fact driven by experience to attribute to homosexual wishful phanatasies an intimate (perhaps an invariable) relation to this particular form of disease. Distrusting my own experience on the subject, I have during the last few years joined with my friends C. G. Jung of Zurich and Sandor Ferenczi of Budapest in investigating upon this single point a number of cases of paranoid disorder which have come under observation. The patients whose histories provided the material for this enquiry included both men and women, and varied in race, occupation, and social standing. Yet we were astonished to find that in all of these cases a defense against a homosexual wish was clearly recognizable at the very centre of the conflict which underlay the disease and that it was in an attempt to master an unconsciously reinforced current of homosexuality that they had all of them come to grief [1]. This was certainly not what we had expected. Paranoia is precisely a disorder in which a sexual etiology is by no means obvious; far from this, the strikingly prominent features in the causation of paranoia, especially among males, are social humiliations and slights. But if we go into the matter only a little more deeply, we shall be able to see that the really operative factor in these social injuries lies in the part played in them by the homosexual components of emotional life. So long as the individual is functioning normally and it is consequently impossible to see into the depths of his mental life, we may doubt whether his emotional relations to his neighbors in society have anything to do with sexuality, either actually or in their genesis. But delusions never fail to uncover these relations and to trace back the social feelings to their roots in a directly sensual erotic wish. So long as he was healthy, Dr. Schreber, too, whose delusions, culminating in a wishful phantasy of an unmistakably homosexual nature, had, by all accounts, shown no signs of homosexuality in the ordinary sense of the word.
[1] Further confirmation is afforded by Maeder's analysis of a paranoid patient J.B. (1910). The present paper, I regret to say, was completed before I had an opportunity of reading Maeder's work.

[ Notes on a Case of Paranoia, in The Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913), London, The Hogarth Press and the Institute of Psycho-Analysis, 1958, pp. 59-60. ]

[B] Since then I have wholeheartedly inscribed the cultivation of femininity on my banner, and I will continue to do so as far as consideration of my environment allows, whatever other people who are ignorant of the supernatural reasons may think of me. I would like to meet the man who, faced with the choice of either becoming a demented human being in male habitus or a spirited woman, would not prefer the latter. Such and only such, is the issue for me.

[ Daniel Paul Schreber, Memoirs of My Nervous Illness, WM. Dawson & Sons Ltd., London, 1955, p. 149. ]

[C] And if tormented and in anguish man is mute, God granted me to tell me of what I suffer.

[ Johann Wolfgang von Goethe, 1749-1832: The above words from a poem by Goethe were used by Daniel Paul Schreber as the epigraph for his Memoirs of My Nervous Illness. ]

74.

[A] It would seem that the schizophrenic patient is often of the third generation of abnormal persons of whom we can gain some information. The preceding two generations of mothers appear to have been obsessive, schizoid women who did not adjust well to men. There is some evidence that they were, in a sense, immature and that within the obsessive character structure could be found hysterical difficulties.
     It is to be noted, also, that there are two preceding generations of men who are not masters, or equals, in their own marriages and homes, or psychosexually very successful, and who are often described as immature, alcoholic, and passive, or hard-working, self-centered, and detached from the family. We do not know what sort of mothers and fathers these fathers of schizophrenics may have had, but it could be presumed that the fact that they let themselves be married to mothers of schizophrenics implies something concerning their own mothers.
     Loosely, the pattern which emerges is that of two generations of female ancestors who were aggressive, even if in a weak-mannered and tearful way, and two generations of male ancestors who were effeminate, even if the effeminacy was disguised by obsessive or psychopathic tendencies.

[ Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia, University of Chicago Press, Chicago, 1955, pp. 134-135. ]

[B] We must recognize that the sexual affections are still the greatest constructive forces of the personality if properly conditioned and adjusted, but also that they may become the most insidiously, irresistibly destructive if perverted or unconditionally repressed.

[ Edward J. Kempf, M.D., Psychopathology, C. V. Mosby Company, St. Louis, MO, 1920. ]

[C] The mother's attitude was so subtly ingratiating and yet domineering that she would almost have to be destroyed as a mother if the patient were to free herself from its terrible influence and win her own womanhood and independence. [Likewise for a son - his own manhood and independence/jmm]

[ Edward J. Kempf, M.D., Psychopathology, C. V. Mosby Company, St. Louis, 1920. ]

[D] I am indebted to Dr. Will Elgin, of the Sheppard and Enoch Pratt Hospital, for another repeated observation which, because it is characteristic, needs reporting. For many years Dr. Elgin, in the process of admitting patients, observed the enactment of a scene which assumed diagnostic significance. His office arrangement permitted relatives a choice of three seats, one opposite his desk, one at the end of it quite near him, and one several feet away. He observed that when the mother and father of the patient appeared together to arrange admission, there occurred something of significance. If mother sat in one of the two chairs at his desk, and father sat off in a corner, it usually followed that mother took over the discussion, did the talking, made the arrangements, and even read the fine print on the contract. Father, meanwhile, looked unhappy and was silent save for an occasional abortive effort to modify certain of the mother's statememts. When this was the course of the admission interview, he came to know that the odds were that the patient [male or female/jmm] would be schizophrenic. There is an interesting addendum. In a later interview father, appearing alone, was often very aggressive in his criticism and his demands and accusations. However, it could often be demonstrated that his belligerence was that of a very unwilling agent of his wife.

[ Lewis B. Hill, M.D., Psychotherapeutic Intervention in Schizophrenia, University of Chicago Press, 1955, pp. 106-107. ]

[E] Sexual identity guarantees our psychic unity.

[ Julia Kristeva, Psycho-Analyst ]

[F] I had to pay heavily for this bit of good luck. People did not want to believe my facts and thought my theories unsavory. Resistance was unrelenting.

[ Sigmund Freud ]

73.

[A] In any case, the appearance within awareness of the homoerotic interest stirs such violent self-reproach that a dissociation or a vigorous defensive process results. If the self is able to dissociate the abhorrent system, the personality continues to be in grave danger of panic with succeeding schizophrenia, unless the sexual tensions are being drained off by some collateral procedure such as frequent masturbation or more or less definitely auto-sexual intercourse with women [with men in the case of females/jmm]. Moreover, under cover of the dissociation, experience in any case continues to be integrated into the dissociated system and its partition in the personality to grow.

[ Harry Stack Sullivan, M.D., Personal Psychopathology, W. W. Norton & Company, New York, 1972, 1965, p. 212. ]

[B] Among those who prove incapable of achieving the biologically ordained heterosexual goal are a great many to whom the mother has continued to be of excessive significance, overshadowing or coloring strongly all pretensions of other women. This handicap is perhaps most vividly illustrated in the case of the woman who has married for spite a man whom she soon comes to loathe, yet with whom the peculiarities of her personality, or economic factors, or other cause, force her to live. When a son is born of such a union, he is generally sacrificed to the mother's unsatisfied erotic tendencies, and he becomes tied to her by the sort of intimacy so remarkably symbolized by Von Stuck in his painting, Die Sphinx. Whether he comes finally to rebel, hates her, and goes through life destroying as much as he can of that which arouses the mother stereotype, or instead goes on being her child-lover, the result is most unfortunate as to his growth in personality. It is almost certain that he will not proceed in erotic development past interest in his own sex.

[ Harry Stack Sullivan, M.D., ibid, p. 169. ]

[C] Sexual asceticism was the greatest good, and both organized and informal opportunities for its achievement were provided. Once one had turned from the lure of the flesh, one could live quietly in a considerable measure of sanctified intimacy with a group of kindred souls. Or one could take to a dignified paranoid state and go about a slow "psychical castration." If schizophrenic phenomena appeared, this did not necessarily disable one: quite a few opportunities for utilizing this eccentricity were provided in the business of evangelism. Moreover, one might, if needs be, found an eccentric religion and often secure the necessary disciples.

[ Harry Stack Sullivan, M.D., ibid, p. 225. ]

[D] ...in them [schizophrenics] the early childhood tie to the parent has never been outgrown.

[ Harry Stack Sullivan, M.D., Personal Psychopathology, ibid, p. 262. ]

[E] These sudden reintegrations of tendencies opposed to homosexual activity in turn set up the situation of homosexual cravings, with consequences similar to those above indicated. That the outcome in these individuals who have had earlier experience is somewhat less ominous than is the case in its absence is not only theoretically to be expected, but actually the case in the paranoid developments.

[ Harry Stack Sullivan, M.D., ibid, p. 214. ]

[F] In the case, however, of another boy, one for example who has been seriously warped by the continued or augmented importance of a more or less primitive attachment to his mother, and who therefore is not susceptible to any marked heterosexual drives because of attachment to the mother - with rationalizations generally contributed by her in the shape, perhaps, of advice to keep away from "bad girls," examples of misfortune resulting from dealings with crafty females, and the like - the outcome is quite otherwise. [Likewise in the case of a daughter/jmm]

[ Harry Stack Sullivan, M.D., ibid, p. 199. ]

[G] From my material, in which negative instances are conspicuously absent, I am forced to the conclusion that schizophrenic illnesses in the male [or female/jmm] are intimately related as a sequel to unfortunate prolongation of the attachment of the son [or daughter/jmm] and the mother. That schizophrenic disorders are but one of the possible outcomes of the persisting immature attitudes subtending the mother and son [or daughter/jmm] relationship must be evident. The failure of growth of heterosexual interests, with persistence of autoerotic or homosexual interests in adolescence, is the general formula. The factors that determine a schizophrenic outcome may be clarified by a discussion on the one hand of the situations to which I shall refer as homosexual cravings and acute masturbation conflict - often immediate precursors of grave psychosis - and of the various homo-erotic and auto-erotic procedures, on the other. [See further, New Quotation/Comment # 757 - this website/jmm.]

[ Harry Stack Sullivan, M.D., ibid, p. 211. ]

72.

[A] How fatal it has been that all the women have ruled the men right out of their masculinity, independence, courage, will and at last, brains even.

[ Walker Evans, photographer (and homosexual), reflecting on a visit to a reunion of his mother's relatives, in the biography Walker Evans, by James R. Mellow. ]

[B] An auto-erotically motivated bisexuality might then be said to be universal among the young of these several species and certainly, as by Stekel, to characterize civilized man.

[ Harry Stack Sullivan, M.D., Personal Psychopathology, W. W. Norton & Company, Inc., New York, 1972, 1965, p. 235. ]

[C] The weaker the ego, the more likely it is that the lust will be experienced as a function not of the self but of the introject - as something alienly lustful and further contradictory of the person's own sexual identity, such that the boy may sense a lustful female within him, or the girl, a lustful male.

[ Harold F. Searles, M.D., Collected Papers on Schizophrenia and Related Subjects, International Universities Press, New York, 1965, p. 435. ]

[D] It may be that he [or she] apprehends the hostility of the woman [or man] and finds himself [herself] utterly impotent.

[ Harry Stack Sullivan, M.D., Personal Psychopathology, W. W. Norton & Company, Inc. New York, 1972, 1965, p. 192. ]

[E] In schizophrenia, on the other hand, attempts to solve the bisexual problem and still remain in contact with reality fail. Therefore, in its deepest nature, schizophrenia arises from a bisexual conflict, and this conflict eventually leads to a state where the heterosexual factor is relinquished.

[ The Importance of the Non-Psychotic Part of the Personality in Schizophrenia, Maurits Katan, M.D., International Journal of Psycho-Analysis, No. 35, p. 121. ]

[F] 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.

[ Edward J. Kempf, M.D., Bisexual Factors in Curable Schizophrenia, (presented at the annual meeting of the American Psychiatric Association, May 18, 1948), Journal of Abnormal and Social Psychology, Vol. 44, 1949. ]

71.

     These observations illuminate one meaning of the futility of the dependence-independence struggle of the schizophrenic [male or female]. It is his belief, based upon his observations, that if he should improve and become well in the normal sense, his mother would become psychotic. He is aware that, so long as he stays in the hospital and is treated as an infant, mother is somehow secure in that he does not belong to someone else or really get away from her. Were he to become fantastically well, as required in fantasies and expectations, he is aware he would actually be a paranoid psychotic himself. It seems that these patients prefer to carry the illness, which, as they see it, legitimately emanates from, and, were they to drop it, would return to their mothers.
      There is much more which could be learned about the mothers of schizophrenic patients, and it is good to note that currently a great deal more attention is being paid them than has heretofore been granted. It has been assumed that they were practically inaccessible to treatment - first, because they would not recognize that they were sick, and, second, because they defended themselves against this recognition in order not to suspect that the child's illness had something to do with his experience of them. However, I have known of a few mothers of very sick schizophrenic patients who have, for some reason, submitted themselves to prolonged, intensive psychotherapy. They have in the course of that therapy eventually become able to consider their own psychotic potentialities and, as it were, to lift the burden of carrying these from their children. In these instances patients who otherwise could not have been expected to improve made striking improvement and workable extrahospital adjustments. It does not seem likely that any large number of the mothers of schizophrenics will do this.

[ Psychotherapeutic Intervention in Schizophrenia, Lewis B. Hill, M.D., The University of Chicago Press (Chicago and London), 1955, 1973, pp. 127-128. ]