M M Muchnik & E M Raizman. International Journal of Psychotherapy. Volume 4, Issue 2, July 1999.

This paper offers an account of research into 16 cases of clients suffering from severe paranoid difficulties, in which their predicaments are hypothesised in terms of Freud’s original theory of the linkage of the repression of homosexual impulse, and the defence against it of paranoia. This model is supplemented in terms of Fairbairn’s object relations theory of defence against the libidinal object, and Klein’s of a layered defensive process, ultimately aggression defending against the hated need for the mother as first good object, and attacking her as bad object. Both aspects of the hypothesis were found confirmed in a significant proportion of cases, and four substantial illustrations are offered.

A psychoanalytical concept of paranoia began to form in the early works by Sigmund Freud. He described projection as the main protective mechanism in paranoia, carrying outwards the source of displeasure (Freud, 1887). Further on, having analysed the well-known autobiography by Schreber, Freud put forward a theory according to which paranoia appeared as a result of denying homosexual impulses and of a subsequent projection.

Homosexual trends are denied because of their being unacceptable on the conscious level. The feeling ‘I love him’ forbidden for the man, is substituted for the inverse feeling ‘I do not love him, I do hate him’, then, by means of a projection another substitution takes place, ‘It’s not me who hates him, it’s he who hates me’, ‘It’s not me who wants to take possession of him, but he who wants to take possession of me’. In erotomaniacal delusion, the forbidden feeling ‘I love him’, is substituted for ‘I love her’, and then though projecting, for ‘she loves me’.

Psychoanalytical data show that patients suffering of paranoia are struggling against an intensification of their homosexual impulses. This points to a narcissistic choice of the object. This interpretation has got a further development: the persecutor is someone whom the patient loved in the past. Freud supposed that the synthesis of these two positions would necessarily bring to the conclusion that the persecutor had to be of the same sex as the persecuted (Freud, 1915).

Kraft-Ebing, in his time, singled out four stages of an acquired ‘aptitude to one’s own sex’ and the last two of them he defined as ‘a stage of transition to paranoid sexual conversion’ and ‘a stage of paranoid sexual conversion’ (Kraft-Ebing, 1886).

Caprio gives cases of paranoia illustrating the male and female homosexuality. He describes a certain sequence of psychopathological symptoms. Delusive sufferings come out to the foreground, however, later, in the process of psychoanalysis, the patients ‘recollect’ the history of their ‘homosexual formation’.

This confirms Freud’s suggestion that the power of the delusion is conditioned by an element of truth in the history.

Caprio considers obvious that psychosis appears as a result of ‘the sexual guilt’, which was, in turn, caused by homosexuality. Paranoid feelings of ‘persecutions’, or ‘assault from behind’ dominate amongst the people suffering from repression of homosexual impulses (Caprio, 1962).

Examples corresponding to the given psychoanalytical concept of paranoia are quite numerous. One of the most known in the psychiatric literature is ‘the case of the Wagner teacher’, described by Gaupp (1938). His delusion ideas of relations connected with homosexual acts were developing for 12 years and, finally, in 1913 brought him to murdering his wife and four children, and nine inhabitants of the village who ‘had laughed at him’.

Shaken by the story, H. Hesse undertook an attempt investigate the nature of paranoia in his novel Klein and Wagner in 1919, intuitively coming close to the problem of homosexuality. In the novel Klein runs away from his family and commits suicide in order to save from himself and not to kill his wife and children, and the woman he loves. The time of creating the novel coincides with the period of the tragic disintegration of the writer’s family and precedes his undergoing psychoanalysis with Jung in 1921.

‘Homosexual’, concept of paranoia was a constant object of polemics and verification. In a review of experimental studies directed to revealing a connection between paranoia and homosexuality with an intermediate variable in the form of a projection, Blum lists the data of 47% of the group of hospitalized paranoiacs displaying obvious homosexuality. Much data affirm the connection between the paranoia and homosexuality (Blum, 1996).

Freud’s concept of paranoia was supplemented and modified at different periods of time. In his work On the Origin of the ‘Influencing Machine’ in Schizophrenia, Tausk (1919) made an attempt to prove that the ‘Influencing Machine’, is a projection of one’s own body, particularly that of sexual organs.

The most significant stage of the progress of psychoanalytical concept of the development of psychosis was the creation of the theory of the object relations. The framework of this theory threw a new light on the problem of repressing homosexual trends which made it possible to avoid a schematic determinism and to take into account all the complexity of real clinic phenomena.

According to Fairbairn’s concept, the development of psychosis is correlated with the earliest stages of psychic growth. On the first stage of the infantile dependency, an infant is wholly dependent upon his mother, and its initial attitude to her is not ambivalent. However, the inevitable experience of frustration is leading to a schizoid position, when Ego splits into three parts: central Ego, libidinal Ego and antilibidinal Ego (‘internal saboteur’). Libidinal Ego and antilibidinal Ego are connected with two opposite perceptions of the bosom as an accepted (provocating) object and as a rejected (rejecting) object (Fairbairn, 1941).

According to Fairbairn, schizophrenia and depression are aetiologically connected with disturbances of development at this stage, while neuroses (paranoia included) are connected with disturbances at the second stage, that of transition or of quasi-independence when the child is reaching a partial independence manipulating with accepted and rejected objects which had been created during the period of the schizoid position. And the child might use ‘the paranoid protection’ when an accepted object is conceived as inward and internalized, and a rejected object is conceived as existing outside, externalized. At that, the infant identifies itself with a good object but feels being persecuted by a bad object.

This concept, to some extent, corresponds to Freud’s position: the projection mechanism remains in the foreground with removing a rejected, ‘bad’ object outwards. Objects, the child manipulates with, appear on the first development stage, that of the infantile dependency corresponding to Freud’s oral stage. Fairbairn has revealed a connection between archaic disturbances appearing on the first development stage and disturbances appearing later.

According to M. Klein’s opinion, paranoid trends are being formed during the first months of an infant’s life when it does not distinguish its own Ego from the surrounding world. Its attitude to its mother and her bosom is the basis of the object relations. The bosom delivering pleasure is a ‘good object’ and the frustrating bosom is a ‘bad object’. Such fission of the bosom should protect the psychics of the infant from the confession that loving and hating might be directed to one and the same object. The impulses of anger, directed on to the object are attributed to the object itself. This fact is generating fear of the object and persecution fantasies. Klein describes such experiences in terms of ‘paranoid alert’ and ‘paranoid position’.

Alongside with the fission, the subject uses the projection of his destructive impulses on the bad object which is turned into a persecutor. The paranoid position is the first attempt to cope with the death instinct. Klein thinks that an infant projects self-destruction trends on to the object (Klein, 1932). In accord with the norm the paranoid position should be substituted for a depressive one. The infant is realizing that its love and hatred are directed to one and the same object (Mother) which is the way to realizing its own ambivalence. It is striving to protect its mother against its own hatred, to activate the reparation and to reconstruct the ruined inner object (Klein, 1952). In her analysis, ‘Obsessional neurosis’, dealing with a case of a 6-year-old girl, Klein, describing paranoid experiences of the child, points out the hidden homosexual trends which are being displayed in games and fantasies. However, she thinks that these trends are deposited upon a still deeper and extremely strong feeling of hatred towards Mother, rooted in the child’s early Oedipus complex and oral sadism (Klein, 1932).

Setting forth Klein’s concept, Deleus gives the first object-relations the name of ‘theatre of cruelty’ and describes it with a shocking metaphoric naturalism:

A suckling baby from the very first year of its life is the scene, the actor and the drama itself on the stage of this theatre. The bosom and the whole body of its mother are not only disintegrated into good and bad objects, but they are also aggressively devastated, cut into parts, spilled into crumbles and edible bits.

Introjection of these partial objects into the child’s body is accompanied by projecting aggressiveness onto the inner objects and by re-projection these objects onto the mother’s body. (Deleuze, 1969)

The concept of early object relations made not only an essential contribution to the development of the idea of psychosis, but it also complicated the very notion of homosexuality itself. Combinations of homosexual trends with oral and anal ones at different stages of early development will inevitably create premises for the clinical variety of psychotic pictures, connected with homosexual repressions.

The present study was founded on the following hypothesis: the repressed homosexual impulses participate in structurizing delusion disorders; this structure is reflecting certain stages of development, connected with the homosexual fixation; a regression to the earlier phases of development leads to reducing the specific weight of homosexual experiences or of their specific transformations, as well as to changing a psychotic structure. It was supposed that depending on the nature and gravity of psychic frustrations in the structure of psychotic experience, alongside homosexual trends, the significance of early object disorders must be increasing.

The purpose of the investigation was an analysis of experiences of patients, suffering from delusional disorders combined with homosexual trends of different kinds.

The problem included studying the nature of homosexual trends of delusive patients, their interpretation and defining their place among other psychodynamic parameters, and, besides, their correlation with structural and clinic peculiarities of psychotic symptoms. The programme of investigation included patients with delusive disorders combined with sufferings of the homosexual character. All delusive patients admitted in the psychiatric clinic within a month were examined. Sixteen patients of 24 admitted (66.7%) were included in the investigation. These preliminary data point to a high frequency of revealing homosexual problems of delusive patients.

The following phenomena were considered as homosexual sufferings: (1) real homosexual episodes; (2) evident homosexual themes in the contents of delusions or other psychopathological symptoms; (3) homosexual symbols in the contents of delusions; (4) homosexual symbols in dreams or in the data of projective tests (patients’ drawings, TAT, Rorschach’s test); (5) behaviour outside of the delusion interpreted as a reflection of repressed homosexual trends.

The patients with pronounced organic pathology, dementia and affective disorders were excluded from the study. The age of the patients ranged from 20 to 50 years. The average age of the sick persons of the investigated group was 32. Eleven patients had the diagnosis of paranoid schizophrenia, five patients were diagnosed as having delusive disorders of ICD-10.

Delusion syndrome was diagnosed as an isolated disorder in seven patients. Delusion combined with cenestopathies, hallucinations and psychic automatism was found in nine cases.

Homosexual trends were found in the delusion contents in five patients-quite obviously, in eight patients-symbolically. Seven patients displayed repressed homosexual sufferings in the projective tests, in symbolic contents of dreams or in behaviour not connected with the delusion. Thus, homosexual trends were revealed in, at least, two of the areas mentioned above in six persons under investigation.

Nine patients refused, under different pretexts, to undergo the projective tests or gave formal answers.

Oral frustrations were found obvious in the contents of the delusion in one patient, they were found in a symbolic form (as sucking out energy, persecuting by women, poisoning and the like) in five patients, and in the symbolic contents of the behaviour and in the projective tests in nine persons.

The results of the investigation confirmed the initial hypothesis.

Differences of the nature and the depth of psychotic symptoms were connected with the form of manifestations and strength of homosexual trends and with the way they were combined with oral disorders.

Clinical examples illustrating the most typical combinations of all these parameters are given below.

Case 1

Patient B., aged 46, an engineer. He was always egocentric, conflicting, irritable, inclined to litigious reactions. His family came apart soon after the marriage. B. did not want to get busy with household problems which would distract him from his hobby. He lived alone feeling quite comfortable at that. He was an inventor and had many patents for his inventions. He dedicated all his free time to constructing light flying apparatuses, was the leader of an aircraft modelling group. He was greatly respected by the boys of the group.

His disease started at the age of 40. During sexual intercourse the patient felt as if his energy ‘was sucked’, out of him at the moment of the orgasm. Feeling devastated and exhausted, he came to the conclusion that his health was injured. Soon after that he felt torturing burning and pressure in the rectum and anus. He consulted surgeons and proctologists and had to undergo all kinds of observation. No pathology was found.

Nevertheless the patient was convinced of being seriously ill and demanded to be given different courses of treatment. He gained his purpose of being operated on. The treatment gave a temporary effect. Symptoms were soon renewing. And every time, the patient considered the doctors treating him last, to be the cause of his sufferings. He made complaints many times and demanded law-suits. He lost faith in medicine and began to fight with the disease himself. He succeeded in getting a private study in the office so that nobody could disturb him while massaging the area of the anus and rectum with the help of a pencil at a strictly defined time. The patient had wad overalls sewn which he was putting on over his business suit when going out even on the hottest days to prevent cooling and ‘blowing through’ his anus and perineum. During one of his current acute conditions his doctors recommended that he should consult psychiatrists. The state of the sickness improved quickly, unpleasant feelings disappeared against the background of neuroleptical therapy given to him. The patient was excitedly telling about ‘some indefinitely pleasant feeling in the pelvis minor’ instead of pains. He expressed thanks to the doctor psychiatrist, the man, adding that none of the surgeons could have helped him that well.

However, very soon B. ‘guessed’, that this doctor had been experimenting on him which resulted in his losing his sexual energy. He began pursuing the doctor, was planning a murder, tried to attack him and came out with antipsychiatric slogans.

Homosexual impulses of this patient are distinctly seen in the contents of his hypochondriac delusion. He is preoccupied with the area of his anus and is trying to make others manipulate in this area. Disorders of perception, bodily sensations are symbolizing a passive homosexual act. Homosexual impulses are also revealed in projections which define his relations with other people, in transference and in the difficulties connected with the choice of heterosexual partners. Homosexual inclinations are at first satisfied in the positive transference to the doctor and physiological, cenestopathological feelings connected with it. Then they acquire paranoid symptoms and the doctor is accused of the damage. The patient thinks of himself as the persecutor and the avenger.

Homosexual impulses are not displayed openly-they are encoded, symbolized due to the inner censorship. Direct statements of homosexual character, fears and ideas of relations having to do with the homosexual theme are not to be seen in the psychosis structure. Oral sensations in the psychosis are presented rudimentarily (as ‘sucking out energy’ by a woman-partner during a sexual act). Homosexual passiveness is symbolically demonstrated in the hypochondriac psychosis and is combined with an emphasized independence and autonomous way of life. The feeling of ‘anal threat’, incarnated in the hypochondriac delusion, is step by step added with ideas of being persecuted and experimented on. And as a result, the chronic polythematic systematized delusion of paranoid structure with hypochondriac, persecutory and querulant plots and with the position of ‘the persecuted persecutor’ is being formed. For many years of his psychosis the patient’s delusive ideas preserve a relative likelihood, they are rather coherent and consistent. There are neither absurd, impossible nor fantastic statements in them. Speech incoherence and behaviour disorganization are not observed. Disorders of perception in the form of bodily sensation could be observed only at the peak of the psychosis and were entirely connected with the basic delusive sufferings. Outside the delusive idea, the behaviour of the patient remained regulated and adequate, he went on functioning quite successfully and was preserving his social status. Such a condition corresponds to the criteria of a delusion disorder and does not give reasons for diagnosing schizophrenia.

The following case illustrates the analogous combination of clinic and psychodynamic characteristics. The case is of importance because it has given much information on projective tests to confirm the interpretation of the clinic data.

Case 2

Patient N., aged 44, a chauffeur, not married, has got no heterosexual relationships, recollects only two cases of platonic love stories. The duration of the illness is 8 years, there have been eight hospitalizations.

The patient has no complaints, but thinks that he is spied on, reports of unpleasant sensations in the area of his back and ‘voices’, appearing against his will bearing indecent abusing thoughts. In the course of examination N.’s behaviour is passive, he needs stimulating. He is trying to fulfil all tasks, but cannot manage a single test demanding self-depending work. Returning empty blanks of questionnaires he explains that nothing comes to his mind.

The patient states that he did not love his mother in his childhood. He describes her as a cruel and irritable woman (‘I love my mother, but we are enemies’). His relations with his father, according to his statement, were close and warm. He gladly recollects his father taking him, as a boy, to his work and allowing him to steer the wheel in his car and even drive it.

The disease started with appearing ideas of the patient ‘being persecuted’ by his chief. The patient worked as a chauffeur and mechanic at that time. This is associated with fixed recollections of his childhood, when his closeness to his father was displayed by the latter letting his son be ‘chauffeur’ in his car.

Situations ‘in the car’ were among significant associations for many other of our paranoid patients (Klein dreams of a car in Hesse’s story too).

The chief ‘was persecuting’ the patient ‘because of jealousy’. Once the chief’s wife looked at N. in a special way. ‘Everybody noticed this’. ‘I love him’ (father person) is shifting to ‘I love her’ (chief’s wife), then, by way of projection to ‘She loves me’. The chief’s persecution is manifested as his concern for the patient’s health. The chief provides him with accommodation in a sanatorium (‘so that he could not see his wife’) and sends a doctor to him. Thus, the persecution is masked as a loving father’s concern. The patient’s ‘illness’ is accompanied by specific pains in the bottom of his back in combination with unpleasant odours. He complains of his hands smelling of excrement (a complex of sufferings, connected with actualizing anal erotic fantasies).

The patient has changed several places of work as a result of ‘being persecuted’ by the chief. And everywhere he meets hostility. N. becomes an invalid when he returns to the triangle of his relations with the parents.

There were ‘voices’, demanding that he should kill his nephews. He undertook attempts at suicide to avoid this. He inflicted on himself a great number of knife wounds and made an attempt to shoot himself with his father’s shot-gun. He was afraid of being poisoned.

For 3 years past the patient’s condition became stabilized. He lived at his father’s, received a disability allowance, was engaged in agricultural work; sometimes he visited the chess amateurs’ club and played football. The present acute condition, according to the patient’s opinion, is caused by his father’s decision to get married after his mother’s death, which happened 3 years ago. The patient’s reaction to this fact was quite negative and he forbade his father to meet ‘her’ at their house. His desire to stay with his father, that had been finally realized, was now endangered, which in its turn actualized his childish trauma and provoked the exacerbation.

The findings of the projective tests confirm the interpretation of the case history. What can be marked out at examining the patient with TAT methods is the constant use of two plots, which may be expressed as: ‘husband and wife are quarreling’ and ‘a lonely sick person’.

A series of pictures are commented with stereotype phrases: ‘Husband and wife have quarrelled, wife is persuading her husband, to stay with her’; ‘Something has happened, there is some talk: man, wife, mistress, but he will stay with his wife’ etc.

These associations correspond to the plot of the first paranoid attack (relations between the chief and his wife) still preserving its actuality and to the childish unexpressed desire of the parents’ divorce.

Another row: ‘A sick person comes to the graveyard. He is praying to the God to forgive him. He is ill’; ‘A man has opened the window, he is in the dark, then the light comes, he is in a bad mood, he wants to throw himself out, he has bad thoughts, something bad has happened to him. He is alone in the dark’; ‘A man is taken ill. A wise man is doing something to make his health return. An immovable illness’ (let us remember the chief taking care of the patient’s health); ‘It’s a mental patient, he is climbing the rope, he has undressed himself. He will change his mind. He might be hearing voices. That’s you who might be thinking this way. He is looking something out, he is spying on his friends. Maybe somebody will bring him a bottle of wine, no, nobody will be bring him the bottle’.

The hero with whom the patient identifies himself appears in each of these associations: he is a sick person, with suicidal fantasies, suffering an ‘immovable’ illness; somebody, a man, taking care of him, the hero himself is also spying on men-the persecuted becomes the persecutor).

The blank card is of particular interest. The patient meets no difficulties with it, his reaction is immediate-’this is a football match, I would like to have a look at it’. An empty blank list to which the patient could project anything he likes is for him the world without women, it is a masculine game. Since ancient times in Greece men’s athletic competitions have been associated with homosexual relations which were even encouraged at certain periods of history.

Thus, the results of the projective tests bring about the following conclusion: the idea of the quarrelling pair is the embodiment of the small boy’s fantasies of replacing his mother by his father’s side (the negative Oedipus complex), of his dreaming of their possible divorce. Then these fantasies were included into the delusion plot (of the chief and his wife) and, finally, has resulted in the exacerbation at the present moment.

The patient identifies himself with a lonely sick person. His passivity in the given context may be looked upon not only as the manifestation of a disturbance of will. Its symbolic meaning is the striving for a passive feminine position which finally he occupied in the family after his mother’s death and which was endangered at present.

It should be noted that behind his homosexual trends there can be found certain disorders of his early childish object relations. We could remind one of this interpretations of TAT: ‘It’s a mental patient, he is climbing the rope, he has undressed himself. He will change his mind. He might be hearing voices. That’s you who might be thinking this way. He is looking something out, he is spying on his friends. Maybe somebody will bring him a bottle of wine, no, nobody will bring him the bottle’.

A direct connection between the idea of persecution and oral dependence can be seen here. It’s necessary to point out that two brothers of our patient are alcoholics, both were married, one of them was subjected to a forced treatment. The patient says this brother was their mother’s favourite. The patient is sure his mother did not love him, he felt lonely and insignificant in his family. So, it can be supposed that all three sons were dependent on their mother in a symbiotic, infantile manner. However, on splitting their Egos, both of his brothers acquired a stronger libidinal Ego (the attracting and accepting object), while our patient has got a stronger antilibidinal Ego, ‘the internal saboteur’ (the rejected and rejecting object).

Predominated hatred of the oral phase has defined the form of Oedipus complex, the inclination to reject women. This delusive striving to murder his nephews is reflecting his children destructive fantasies directed towards the brothers and his tending to annihilate what can be looked upon as the symbol of their successive connection with an accepting object (whose symbol is the children).

Some attention should be paid to the patient’s joke of the voices he hears being the fruit of imagination of the woman psychologist. The voices can be looked upon as the result of internalizing the ‘bad’ object. The idea of voices ‘inside the heads’ is one of the differential diagnostic criteria of schizophrenia. From the psychoanalytical point of view the voice inside might be a result of the oral incorporation or absorption: the voices the patient hears are his mother’s thoughts that he had sucked in.

Patients with psychoses of an organic or hysterical nature practically never hear voices of such a kind from ‘inside’. A more mature psychics of the subject can help him distinguish his own Ego from the outer world. He feels the Ego-borders quite distinctly which makes projecting more safe and quiet. A bad object, bad voices are in the outer world, and one can protect oneself against this world by escaping from or refusing food, by directing complaints to higher instances and so on. All the horror of the experiences of a schizophrenic is in his being unprotected against the ‘bad’ object.

Fairbairn’s metaphoric expression of the ‘internal saboteur’ is acquiring a special meaning in paranoid schizophrenia: the bosom not only absorbs the patient (which is the projection of his own striving to devastate) but it also destroys him from inside. Homosexual experiences of the patient (as well as in the first case) are obvious, but they are presented in the structure of psychosis symbolically. His actions and utterances have got no direct homosexual contents. Homosexual experiences can be found in the structure of a delusion plot connected with infantile homosexual and Oedipal fantasies, in bodily sensations and olfactory disorders, in the absence of heterosexual contacts.

This case is characterized by a closer connection between homosexual repressions and disturbances of the early object relations. The persecutory delusion based on homosexual impulses has a chronic, systematized nature. The plot of the delusion is remaining within the story of relations with the authorities, its seeming reality is preserved, the patient’s behaviour is also remaining stable and ordered for many years; though this stability and order are quite formal.

Disorders of self-identification connected with the oral and symbiotical experience are leading to a deep frustration of functioning in social, professional and sexual spheres. It is resulting in the appearance of symptoms reflecting the fundamental failure in the ‘Ego’ structure and the Ego-borders. ‘Somebody else’s thoughts’ in the patient’s head make him obey the alien will. Auto-aggressive absurd behaviour is placing the patient experiences beyond the limits of ‘psychologically acceptable and comprehensible’ and is adding to them a shade of mannerism and is drawing them together with disorders of the schizophrenic rank.

But this schizophrenic colouring is rather delicate in both cases described above, and we are inclined to refer them to one pole of the continuum. Now we are going to come down to cases which should be referred, in our opinion, to the opposite pole.

Case 3

Patient K., aged 22, a student. His elder brother and sister suffer from schizophrenia. He was taken ill all of a sudden: waking up in the morning he felt ‘a lumbago fit’ in the area of his anus and guessed that while he had been sleeping that night he had been raped by his father. He insists that his real father could not have done anything like that, but ‘the father of the dream had done that’ and ‘the dream became the reality’. Now everybody knows that he has been violated and is laughing at him, that is why he avoids contact; he has undertaken several suicidal attempts.

In this case repressed homosexual fantasies broke into the dream and, simultaneously, ‘became the reality’ of the delusion experience. The unconscious was not satisfied with realizing its impulses in a dream but found the way to incorporate into the psychosis.

This case differs from the former two as the reflection of the patient’s homosexual experiences in the delusive plot does not bear a symbolic character. While the bodily sensations in the above-mentioned cases were interpreted by the patients hypochondrically, in the given example they are directly pointing out his passive homosexual role to him. It should be noted that not only homosexual impulses, but also Oedipal sufferings subjected to a still deeper repressing, have been realized in the form of the delusion. The delusion comes forward here not as a symbolic expression of homosexual repression and protection from it, but as ‘submergence of the consciousness’ with unconscious impulses.

This is accompanied by losing ‘the sense of reality’ and borders between the dream and the real world, between real figures and images of fantasies, by opening his inner world to other people. It is possible to single out an expressed schizophrenic colouring of psychotic symptoms, which is confirmed by a deepening autism and disturbances of social functioning and auto-aggression.

The following example illustrates still deeper disorders.

Case 4

Patient C, aged 18. He insists on being influenced by an artificial satellite which is taking off his brain some information and putting in it the new one. The satellite doesn’t allow the patient to see or walk. He was taken ill 5 years ago when he began hearing a man’s voice in his head and feeling hypnotized. He felt his heart contract and widen while his soul was filled with sorrow or joy. ‘They made’ the patient do an absurd action: he attacked his relative in order to suck his penis.

He felt he was changing into another person. He guessed that ‘people around him were all false’, that ‘something was of a particular meaning’: other patients were uttering sounds of sucking, they were wrinkling their foreheads and noses, implying by this that they were despising him for his having sucked the penis. He hears condemnation and inside his heads he hears the God’s voice. He thinks his mother despises him too. During subsequent hospitalizations his aggression towards his mother was becoming more expressed. He was wicked. During an examination he beat unmercifully an assistant nurse. He drove his mother out of his room, refused food and smoked too much. He insisted on his father’s having incited his mother against him. He felt that his mother was issuing a poisonous smell which darkened the light for him and made him feel sick. He chopped off his toes ‘because his mother was poisoning him with some gas’.

He turned the TV-set to the wall and switched it on very loudly because he was sure that somebody had installed cameras in the house. He declared that they had spoken about him in the TV and radio programs that half of the country had voted for him, and that he had calculated the system of leading the country out of crisis. He was becoming particularly wicked while threatening that he would murder his parents and complaining that ‘darkness and delusion were penetrating his head’ and ‘an old wicked woman was sitting on his lap and getting into his bosom’.

The development of the psychic disease of this patient is accompanied by blending up homosexual and oral experiences. The starting point of the psychosis is connected with the influence of a man and with oral homosexual intercourse. This oral component has immediately become dominant (‘other patients are uttering sounds of sucking’). The bosom and the penis, anal and oral fantasy are blended together, his father is convicting him with God’s voice from inside, his mother is poisoning him with awful smells from outside, the disgusting sucking is pursuing him, his bodily sufferings are becoming so unbearable that they result in self-damaging. And the final hallucination (a crone in the lap of the child trying to get into his bosom) is the symbol of the oral projection and interjection.

It is necessary to note two essential moments. There are not only ideas of homosexual contents in the structure of psychotic sufferings, but also direct actions realizing homosexual impulses (the voice of a man, ‘forcing’ the patient to attack his relative points to the repression and projection). There is also interpenetration of homosexual, anal and oral fantasies, mentioned above. And oral problems and experiences pointing to the breach of the early object relations come out to the foreground plan. The structure of the psychosis is fragmental and not systematized, the delusion ideas are extremely absurd, pretentious, fantastic and changeable at that.

An extended syndrome of psychic automatisms, experiences of influence, massive disorders of perception of pseudohallucinatory character point to the affectedness of the deep ‘Ego’ structures accompanied by estranging bodily and psychic functions, full disorder of the identification up to the idea of metamorphosis, paralogism of utterings, paradoxality, absurdity and impulsivity of actions.

The analysed cases illustrate the regularities characteristic of the whole group of patients included in the investigation. In the course of this investigation, the formalization of a number psychodynamic and clinical parameters was carried out. Among the characteristic taken into consideration were listed the following: systematization of the delusion, absurdity, mannerism, irreality or ‘plausibility’ of the delusion plot, the presence of symptoms of the ‘first rank’, orderliness or disorganization of behaviour, emotional disorder and formal disorders of thinking.

The data received confirm the initial hypothesis. The presence of homosexual repressing in patients suffering from delusive disorders is not a casual finding but appears to characterize more than half of hospitalized delusion patients chosen randomly for the investigation.

The character of unconscious homosexual sufferings is closely connected with the delusion plot shaping and the patient’s behaviour.

The patients, whose delusive disorders were stable, systematized, ‘plausible’ and whose behaviour beyond the plot of the delusion was quite ordered, have got the following psychodynamic characteristics:

• The unconscious displayed in dreams and fantasies, in the behaviour or psychotic disorders had predominantly anal and homosexual contents.
• Anal and homosexual impulses were revealed only as symbols. Homosexual contents were never directly expressed either in words or in actions, even at the peak of the psychosis.

This fact can be interpreted as evidence of deep and efficient ousting. As for the chronic delusive disorder (to which criteria the described conditions are corresponding), it is the defence mechanism protecting the consciousness against unacceptable impulses.

When such features as instability, absurdity, mannerism, symptoms of behavioural and emotional disorganization, symptoms of estranging and ‘Ego’ disorders (psychic automatisms, ideas of influence and control) are increasing and developing in the structure of psychosis, then other psychodynamic characteristics come to the foreground:

• Sufferings, connected with disorders of the early object relations are dominating in the structure of unconscious which is interpretable.
• Homosexual and anal impulses inseparably connected with oral ones are being directly expressed in the structure of psychosis through the contents of the delusion, verbal hallucinations or as impulsive actions of the homosexual nature.

Thus, the psychodynamic characteristics of schizophrenic psychosis make it differ from psychosis of another nature; and the schizophrenic psychosis does not carry out the defence function of symbolizing unconscious impulses, homosexual included.