Her promiscuous relations appeared eventually to the patient as having been used to carry out several purposes simultaneously:
They satisfied a need for sensual pleasure and orgasm that had, since her experiences with the woman, become clearer and more urgent.
By cheapening herself as a sexual object, she expressed reproach and criticism of one who had discarded her and made a protest against being so treated.
She reaffirmed her rejection of woman’s role in marriage by caricaturing in her own attitude the personal relations of the heterosexual act.
She found an aspect of the situation, however farcical and insubstantial, by which she could think of herself as mocking the man (his not realizing she knew what he was after).
She tried to ensure her freedom from any need of marrying by getting localized genital pleasures and relief while keeping distinctly withdrawn from truly personal relations.
By changing partners on each occasion, she expressed her freedom from attachment, her disdain for any important relationship in connection with the act. This practice also made it impossible for an attachment to develop and threaten the sort of lonely security she had built up over so many years.
It took her much less time and effort to reach the foregoing conclusions than to realize emotionally that she had, without suspecting it, been very much influenced by a need (not admitted) to find something she had never realized was desirable and necessary until she had sensed a misleading clue to it in her close personal relations with the older woman.
It was more difficult still for her to accept the possibility that anything of this nature might be worth seeking in a man. This possibility did not become acceptable to her so much through its direct examination or continuing reappraisal of what she had experienced with the woman, but chiefly, it seemed, through the relation of present and recent matters, to aims, attitudes, and reactions recognizable in her childhood and, under varying aspects, in the year-by-year pattern of her life. She at first brought out material with little affective reaction to it. Later her feelings about incidents already mentioned were allowed expression.
It was less difficult for her to give up her sexual promiscuity than to alter her attitude toward marriage. Even the possibility that male and female have personality features and resources for erotic relations with each other comparable to the situation anatomically (which she had found so superior to the deviated homosexual experience) was a possibility it took her much time to accept.
The fear, born in her childhood, of losing that freedom which would enable her to escape the fate she saw as inevitable for every housewife, strove long and stubbornly against the recognition of anything that might modify her concepts and her affective reactions to them. These concepts, warning her perpetually from within, had, it seems, blocked many nascent impulses that might have led her years ago into experiences which could not but modify her basic fear. Not by reasoning alone but only by experiencing something directly, something directly between herself and man, was it likely that sufficient modification could occur for her to continue improvement.
From a small and very reluctant beginning, such experiences developed, and with them came changes of attitude extending much deeper than the presence or absence of the symptoms she had once expressed in her behavior.
No attempt has been made to bring out anything very deep or remarkable about this patient. She illustrates, however, several points useful for our purpose. The outlandishly promiscuous and poorly motivated sexual activity that constituted the objective clinical manifestation of her trouble was entirely typical of what we find in the real psychopath. Her conduct in this respect would seem to argue well for that diagnosis. The lack of adequate conscious purpose, of anything resembling irresistible passion or even strong ordinary temptation, to account for such inappropriate and unrewarding behavior seems even more characteristic than the bare deeds.
Important distinctions can be made, however, between this localized expression and the similar but generalized malfunctioning that distorts the psychopath in all his serious performances. Not only was this young lady consistently successful and purposive in her work and in all other social relations, but her emotional attitudes and responses in almost every situation except those centering about sexual aims were normal and adequate. In the erotic situation she not only behaved unwisely and unsuccessfully but also showed evidence of distorted evaluations, of affective confusion, and of serious deficit. In a crude analogy it might be said that her pathology compared with the widespread pathology of the psychopath somewhat as a carbuncle caused by a staphylococcic infection compares to staphylococcic septicemia.
Despite many superficial resemblances to serious and predominant homosexual reactivity and life patterning, she had retained, beneath the surface, biologic and fundamental heterosexual potentiality. Her experiences with the seriously deviated woman awakened or liberated needs and capacities for close, devoted, and understanding human relations. In the framework of this broad awakening, genital impulses were also stimulated, though misdirected. For the patient, it appears that she found in the experience with the older woman expression for much that she had missed long ago in parental relations as well as in friendships and the usual heterosexual gropings of adolescence.
The somewhat clarified and freed genital impulses did not seem to be integrated into the broader pattern of personal arousal in such as way as to constitute real and firmly fixed homosexuality, but rather, they appeared to accompany, in a confusing but additive sense, the other and surrounding affective capacities and urges as all emerged. In a confusion which she could not evaluate, reacting to several important needs or urges, she hit upon the maladapted behavior pattern in which she presented herself.
Her personality as a whole remained sufficiently intact or normally functional for her to give to the physician and to herself an account of earlier experiences and her reactions to them sufficiently valid for plausible explanation of the disordered behavior to emerge. The awareness of important influences shaping the pattern of behavior made available to the patient (as well as to the observer) some understanding of this pattern. On the basis of this, slowly but progressively, helpful modifications were made by the patient in her evaluations and in her adaptation.
It is quite possible that in the fully disordered psychopath similar but far more complicated causative influences exist behind the clinical manifestations. In the real psychopath a gross lack of sincerity and insight seriously impedes all efforts to obtain information essential to interpretation. We must also consider the possibility that the psychopath may be born with a biologic defect that leaves him without the capacity to feel and appreciate the major issues of life or to react to them in a normal and adequate manner.
37. Specific Homosexuality and Other Consistent Sexual Deviations
When the first edition of this book was written it had for many years been customary to use the term sexual psychopath to designate homosexuals, sadists, masochists, and also people specifically inclined towards exhibitionism, voyeurism, fetishism, cross-dressing, and pedophilia. Included at times with these deviations under the concept of sexual psychopathy were also types of abnormal behavior designated as erotomania and sexual immaturity. For many years before and after the initial publication of the Mask of Sanity this custom had authoritative sanction in our nomenclature.
This I believe tended to promote confusion and foster the belief that these, or most of these, sexual disorders, deviations, or anomalies, along with the disorder of the psychopath or antisocial personality, were all types or variations of a unitary basic abnormality. Even now in our latest official nomenclature we find what I, and I believe most other psychiatrists, regard as the real psychopath, included with all the recognized sexual deviations under the general heading personality disorders.
It is true that some sexually aberrant patients show additional pathologic features. Sometimes, but by no means regularly or even frequently, these features include those typical of the
psychopath (true antisocial personality). This relatively rare mixing of features, however, has never seemed to me an adequate reason for identifying the two groups, or even for assuming that they are in fundamental respects closely related.
No one is more ready than I to agree that the real psychopath’s sexuality is abnormal. The schizophrenic, the patient with organic brain disease, the paranoid, and many other types of psychiatric patients also carry out deviated sexual activity, and in those who do not one often finds indications of extremely deviated attitudes about the basic erotic orientations. Yet we would not find it profitable to give up our distinguishing terms for these disorders and merge them as types under a general term that also embraces the sexual disorders. Such a scheme would, no doubt, tend in time to blur our concepts about what we are dealing with.
It impresses me as inaccurate to assume that homosexuals as a class show the general life pattern of gratuitous folly and purposelessness so typical of the psychopath. It seems unlikely that more than a small percentage of homosexuals ever come to the attention of psychiatrists at all. Fewer by far are admitted to psychiatric hospitals.
Whether or not the Kinsey Report167 correctly estimates the proportion of male homosexuals in the nation, it seems obvious that they are far from rare in almost any community. As noted above some deviates of this sort also show the more generalized and even the typical maladjustment seen in the psychopath, but the two groups, neither in medical practice nor in a survey of the community, seem to coincide. There is, indeed, some overlapping, but this is true of most psychiatric conditions.
It would seem remarkable if any physician of experience could not call to mind a great many distinct and overt homosexuals who continue to lead peaceful, productive, and socially useful lives and who cannot, even by the most violent imaginative tour de force, be identified with the psychopath as he is here presented. It could hardly be said that characteristically these deviated people fail to show kindness and consideration for the rights of others, that they are incapable of gratitude, affection, or compassion. Only confusion is promoted by efforts to identify them as a group with the gross pattern of failure and the profound, generalized incompetency of the other life pattern.
In the homosexual group are found people active and persistent in the promotion of painting, music, literature, and other expressions of art of learning, and reliable leaders in civic enterprises. In these endeavors they do not, usually, give evidence of such inconsistency and shallowness as we see in the other disorder.
Among these better adjusted homosexuals are seen successful lawyers, artists, bankers, and scholars, who appear in their nonsexual activities to show persistent purpose and evidence of responsibility. There are also less successful but industrious and peaceful citizens who year after year carry out their duties in humbler occupations and regularly fulfill obligations to dependents.
When we consider people of this sort, and it is not unlikely that they constitute a majority of homosexuals, it is not surprising to see that Greenspan and Campbell long ago made this statement:102
The homosexual is so unlike the psychopath that it is hardly conceivable that the most popular classification places him as a subgroup of the psychopathic personality [They add] However, there are possible two reasons for this error. One, any sexual anomaly, even in the minds of physicians, is unequivocally associated with antisocial behavior and therefore akin to psychopathic personality. Two, an occasional psychopath will admit to homosexual activities, thereby substantiating this impression.
That some homosexuals show persistent and gross maladaptation all through their pattern of living seems less remarkable than that so many avoid what is typical of the psychopath or of the schizophrenic. It seems to me unlikely that the typical homosexual can escape deep frustration in what is perhaps the most fundamental aspect of living. The mockery and scorn deviation of this sort often evokes from society and the almost inevitable efforts at secrecy and pretense to which its victims are usually driven are likely to act as significant distorting forces on the whole personality. Having to suppress, evade, and implicitly deceive so much about something so vital every day of their lives, it is perhaps remarkable that homosexuals can adjust successfully or with dignity in any phase of living.
Another much more complicated factor has also impressed me as contributing to the difficulties of the homosexual’s life. Many of those who discussed their problems with me fully have left me with the conviction that the ideal mate they seek is not another homosexual but a normally oriented person of their own sex. This need would lead to a futile quest for the impossible and bring not only inevitable frustration and repeated disillusionment but also, as can easily be seen, would make for pessimistic and cynical attitudes about love.
In the early years of my psychiatric practice this frequently recurring feature of the homosexual’s need and quest was vividly illustrated for me by an athletic and successful young man with a fine war record as an infantry officer. With frankness and dignity he discussed numerous and diverse erotic experiences, all with other men. The more he conveyed to me about his reactions, the more it seemed clear that he felt a paradoxical distaste for the available homosexual partners with whom he sought physical satisfaction or relief from tension. It seemed also that he could not, despite his freely admitted homosexuality, wholeheartedly identify himself with the group. In his complexly mixed feelings there seemed to be negative elements not unlike those so often found in the ordinary man’s reactions to those he thinks of as “queers.” At his deeper levels of feeling he seemed to reject other homosexuals from full acceptance, either in the role of erotic partners or as objects of fraternal fellowship.
In sharp contrast to these negative reactions, and ambivalent reactions, toward his fellows, this man expressed pure adoration and unqualified admiration for a young heterosexual male whom he seemed to regard as the ideal, the ultimate, erotic choice. His longing for this unattainable figure seemed completely free from the negative qualities that marred his pleasure with available homosexual partners. In referring to the normally oriented young man who had so powerfully, but unwittingly attracted him, the patient exclaimed, “He was just a typical, clean-cut American boy.” His yearning and his almost ecstatic admiration seemed not only genuine but touched with grief and reverence that brought a lyric note to the ordinarily banal words he seized upon as if in desperate need to convey something complex and specific. With emphasis this man repeated, “He was a perfectly typical young American boy! A clean-cut American boy!”
Indications of a similar choice for the normally oriented and unavailable person of the same sex have often been evident in homosexuals I have since encountered. I have wondered if this specific emotional demand is not far more common among homosexuals than is generally recognized. I have indeed wondered if it might, in some degree, be universal. If so it could account for tragic difficulties in mating.* It is well, however, to avoid sweeping generalizations on the basis of one’s necessarily limited experience.
Some other types of sexual behavior regarded as abnormal have in the past been classified under such terms as erotomania and sexual immaturity. So far as erotomania is concerned, the following points may be made: Most psychopaths known to me have shown little compunction about seeking sexual gratification. They are so frequently found in brothels and with other professional vendors of erotic wares that one might at first glance conclude that they indeed suffer from erotomania.* A closer consideration of the circumstances, however, reveals that the psychopath is not pushed into these situations by an excessively vigorous eroticism but that even the feeblest and most transient impulse will cause him to seek gratification with partners and in environments shunned by a person with ordinary judgment and discretion and taste. It is indeed open to question whether the impulse is more than feeble in the sense of genitalized sexuality, to say nothing of mature sexuality. Sometimes the male psychopath, after carefully setting the stage for seduction, will instead of achieving intercourse, stra
ightway drink himself into the purgatorial Nirvana of maudlin semiconsciousness, leaving his partner to nurse and pamper him. In my experience, the typical psychopath of either sex does not appear to have a sexual drive, normal or perverse, of sufficient vigor to account for the poor judgment shown in what seems rather to be a vague blundering along the roads of folly and frustration toward what is essentially life rejection. There are, of course, persons activated by strong libidinous drive who often commit extremely indiscrete deeds and who sometimes even bring disaster on themselves. These, however, do not impress me as fundamentally similar to the psychopath.
Sexual immaturity can be more aptly used, in my opinion, as a term to describe all psychopaths than to segregate any particular group of them.
Masochism, sadism, bestiality, fetishism, necrophilia, voyeurism, and the terms for various other perversions would seem to imply people who consistently sought definite erotic satisfaction in one or more of these ways and in whom this quest was a major and persistent life aim. Taken in this sense, such characteristics are not particularly common in the psychopaths whom I have studied. Psychopaths, of course, show a carelessness about drifting with virtually any impulse. But they do not regularly give the impression that efforts to attain specific gratification of this sort play an important role in their conduct or could account for their generalized patterns of failure.
In a broader sense it might be said that the apparently willful persistence with which they bring humiliation and emotional suffering upon those who love them, as well as failure and unpleasant circumstances upon themselves, marks all psychopaths as both sadists and masochists. Only in this sense, however, are these impulses common or consistent, and the gratification is probably not the directly erotic sensation enjoyed by perverts who literally whip others or have themselves whipped. I get the impression that a great many of the people who have attracted attention primarily as sadists have many characteristics of the classic psychopath. Certainly they seem to show extreme callousness to the suffering of others. The lives of other famous sadists strongly suggest the influence of deep schizoid disorder. It has been already stated that true psychopaths with serious tendencies to perpetrate violent crimes do exist. The real psychopath who is a real (persistently organized) sadist, of course, ranks as an extremely dangerous person. Like all psychopaths, he is unlikely to be greatly altered by punishment or training or treatment, and he constitutes a grave problem. People of this type are often responsible for perverse and murderous attacks on children frequently noticed in the newspapers.
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