It is always useful to review an article’s bibliography and references to get a deeper understanding of the psychoanalytic concepts and theoretical framework in it.
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Heiman, M. (1951). International Journal of Psychoanalysis. XXX, 1949: Remarks on the Relation of Male Homosexuality to Paranoia, Paranoid Anxiety and Narcissism. Herbert Rosenfeld. Pp. 36–47.. Psychoanal Q., 20:321-322.
Psychoanalytic Electronic Publishing: International Journal of Psychoanalysis. XXX, 1949: Remarks on the Relation of Male Homosexuality to Paranoia, Paranoid Anxiety and Narcissism. Herbert Rosenfeld. Pp. 36–47.
Rosenfeld agrees with Melanie Klein's hypothesis that the paranoiac is fixated at the early oral level (paranoid position) and that the paranoiac's homosexuality is secondary and defensive in nature. It is the problem of the relationship of manifest homosexuality to paranoia which is discussed in this paper.
The author uses the clinical material from three patients to make the following deductions: in the first patient homosexual activities were used as a defense against paranoid anxieties and stopped when these anxieties became too great. This patient also suffered from occasional elation which Rosenfeld relates to the homosexuality, indicating that he used his homosexual activity as a means of projecting an unbearable internal depressive or persecutory anxiety situation caused by the greedily incorporated penis or breast.
The second patient was a manifest homosexual male of thirty-eight with conversionsymptoms, manic-depressive moods, and paranoid anxiety. Rosenfeld deduces that in this case the homosexuality was partly determined by his attempts to appease external persecutory figures by passive anal intercourse. In addition, his homosexuality was used as a defense against depression. In the transference the depression disappeared after a successful interpretation, which in turn permitted the patient to give up his homosexual activities completely in favor of heterosexuality. The deeper mechanisms included attempts to recapture his lost (or destroyed) mother, his virility and penis, all of which were projected on other men.
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The third patient was a man with paranoid character traits and strong latent homosexual wishes. After two and one half years of analysis, he developed pleurisy and while hospitalized he became acutely psychotic with suicidal depression and a hypochondriacal kind of paranoia. Rosenfeld declares that through this case he learned (eight years ago) that latent homosexuality may cover up latent paranoia. He mentions the Wolf-man as another well-known case of a neurosis with underlying psychosis. Interestingly enough, this patient returned for treatment after several years despite (or because of) his claim that his analyst had crippled him. He improved quickly and Rosenfeld deduced the presence of a mechanism similar to that in case two.
Lastly, the author uses the third patient to point out the relation between homosexuality and narcissism: a projection takes place of a part of the patient, usually his penis, onto another man to whom there is then a narcissistic attraction. Rosenfeld thinks this projective mechanism can be traced back to the early oral-sadistic impulse of forcing one's self into another person. He brings further clinical data to support this view, held by Melanie Klein and named by her 'the paranoid position'. The fixation at this early level may be responsible for the frequent combination of paranoia and homosexuality.
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Heiman, M. (1951). International Journal of Psychoanalysis. XXX, 1949. Psychoanal. Q., 20:321-322