Anxieties about homosexuality, when subjected to an adaptational analysis, can be broken down into three motivational components sexual, dependency, and power. The sexual component is the only one of these three that seeks sexual gratification as its motivational goal. The anxiety generated in this search is, therefore, a true homosexual anxiety and should be so labeled. Likewise, the associated conflict should be called the homosexual conflict. The dependency and power components, however, as denoted by their names, seek completely different, nonsexual goals, but make use of the genital organs to achieve them. Although the goals appear to be sexual, in reality they are not. For this reason, I have designated these two components as pseudohomosexual. The anxiety incident to their operation constitutes the pseudohomosexual anxiety that is, an anxiety about dependency and power strivings that is misinterpreted by the patient as a true homosexual anxiety. Here the conflict should be called the pseudohomosexual conflict as distinguished from the true homosexual conflict.

A Case Study of Pseudohomosexuality

The patient was in treatment for two years. He was seen four times a week during the first six months, three times a week during the second six months, and twice a week during the second year, for a total of 230 treatment hours. There were three short lapses in his visits of a few weeks each during this two year period. The treatment was conducted in accordance with the adaptational technique of psychoanalytic therapy with the patient lying on the couch.

The patient was a 30 year old married male of medium but athletic build, clean-cut and personable. He was completely masculine in his appearance, manner of dress, gestures, and voice. There was nothing about him that would even remotely suggest the effeminate. He spoke fluently and related easily to the therapist. He was employed at a minimum salary in a trainee capacity as an assistant to a minor executive in a large business organization. His wife also worked in a job that had about equal status and brought in about the same amount of money. They lived modestly and needed both jobs to make ends meet. There were no children. Diagnostically, the patient was a neurotic; the question of a psychosis did not seriously arise.

The patient sought psychotherapy because of a marital problem. For the past two years he had felt a constant, unreasoning resentment of mounting intensity toward his wife, although he readily conceded that her behavior was exemplary and in no way provocative. Together with this resentment he had experienced a loss of sexual interest with a gradual decline m his ability to achieve an erection, whereas previously in his marriage he had been fully potent. He had intercourse only twice in the last six months and then both times he had found it necessary to be drunk in order to carry through. He complained also of chronic anxiety, feelings of depression, and insomnia. He had been falling back on alcohol more and more to relieve his sleeplessness and this he felt had become a serious problem. Hardly a night passed that he did not drink himself to sleep. His emotional withdrawal from his wife had led to a steady deterioration of the marriage and she was about ready to give up. It was primarily at her insistence, in a final effort to save the relationship that he came to the psychiatrist. These were the immediate problems, but behind them were lifelong feelings of inadequacy, inferiority, and lack of confidence.

The patient was an only child, born and raised in a small New England town. His mother, a housewife, was a strange mixture, a domineering but overprotective and affectionate woman, who set exorbitant standards for performance. He had to be the best in everything an impossible task and his childhood was a nightmare of failure, recrimination, and exhortation to do better. The mother was very emotional, and her appeals for improvement were often accompanied by extravagant displays of weeping and wailing. His father was a country doctor who spent little time at home. He rarely showed interest in his son; when he did, it was usually to make an adverse comment. The patient puts it this way: "My father was never around. There was no bond between us. We spoke as strangers. He never believed I could do anything, and when I did do something he regarded it as a happy accident, a pleasant surprise. Father regarded my failures as norms." The patient's childhood otherwise was typical of that of any American boy growing up in a small town. He engaged in the usual school and social activities, but always felt himself inadequate in comparison with other members of his group. He began masturbation in early adolescence and continued into adulthood. He attended college for three years, and during this time had his initial heterosexual experiences. These were sporadic and few in number and usually terminated in a premature ejaculation. At no time was there any history of homosexual relations. The war came, and he left college before graduation to become a fighter pilot in the Air Force. Shortly before leaving this country, he married a girl two years his junior. He was able to stay with his wife for only a few months, but his sexual adjustment during this period was completely satisfactory. Overseas he flew many missions, all in single engine fighter planes, for which he received several decorations for valor in combat. He returned from the war and immediately took a training job with a civilian airline as a pilot of four engine aircraft, a type he had never flown before. He was discharged after a few months because he repeatedly failed the instrument check. He then reentered college for a year, took his degree, and obtained his present job through the intervention of his wife's relatives who exercised influence in the firm. The symptoms for which he came to treatment broke out after his failure with the airline.

The patient opened therapy with a recitation of his failures" during his childhood years. Two of many examples will suffice, since anyone is similar to all the others. In the sixth grade he began to do poorly in arithmetic. His mother, in a characteristic fashion, arranged that he stay after school for special tutelage: "Mother would take me to the instructor and in the presence of both I was very embarrassed and couldn't possibly grasp it, but I acted as though I did. What a dolt I was! He must have thought I was awful dumb!" About the same time his mother insisted he take piano lessons. He rebelled on the grounds his friends would call him a sissy, but as always his mother's will prevailed. Here again he suffered: "I had to learn special pieces to play at the recitals, but knowing I had to play at a public gathering, I couldn't learn them. I never had a time of greater embarrassment. It was just a matter of getting through before dying of fright. I worried for hours before playing, and then I would hack the piece completely." These two episodes are typical, and for several sessions the patient continued in this vein. He recollected an astounding total of childhood incidents, all couched in identical terms of failure. Not once did he mention a single item that he considered a success. After he had disposed of his childhood, he went on to his college years and subjected them to the same treatment. Here his concern was mainly with women and his rivalry for their favor. In his view all the other men were socially graceful, dated only the prettiest girls, and invariably seduced them; he, however, was a boor, got stuck with the crows, and rarely slept with anybody. In the Army, too, he could not act the role he felt he should. He addressed all superior officers as "sir" or by rank, even overseas where informality reigned and where first names were used except for the highest grades. He felt it would have been presumptuous for someone of his low stature to do otherwise.

This deference to authority continued to plague him in his current job. His immediate superior was a petty tyrant who stepped on the patient to inflate his own importance. The patient was full of good ideas, but his boss appropriated all of them and then took the credit. On the other hand, when the boss made an error, it was the patient who was accused to the authorities higher up. The patient had borne this intimidation in silence, too fearful to assert an effective protest. Such a protest would have been completely feasible because of his family connections in the firm and in no way would have put his job in jeopardy. The realization of his weakness deflated him thoroughly: "I know I must stand up and have courage and not let myself be victimized by him or by people like him. Unless I learn to do that, I will never feel like a man" He had no sooner said this than he became apprehensive, fell silent, and began to tremble. Finally, he remarked it was ridiculous, but he felt as though he were in great danger. It was like a combat mission, the moment before approaching the target. That night he had a nightmare.