Otto F Kernberg. Journal of Gay & Lesbian Psychotherapy. Volume 6, Issue 1. 2002.
The scientific study of homosexuality is undoubtedly one of the most fraught examples of the harmful impact of ideology on scholarly inquiry. Indeed, given our still limited knowledge of the relative importance of biological disposition, psychodynamic features, and social and cultural influences in determining homosexuality in humans, it should not surprise us that powerful ideological currents, masked as scientific approaches, complicate our exploration of this field. And, as the cynic may say: “my belief is science, your belief is ideology.” The psychoanalytic exploration of homosexuality cannot escape the powerful social biases affecting this field, as, in fact, no area of psychoanalysis may have escaped such ideological conflict or contamination.
How could it be otherwise, given Freud’s revolutionary discoveries of profound human realities that run counter to cherished conventional beliefs: the importance of infantile sexuality, the influence of unconscious conflicts on conscious functioning, the fundamental influence of destructive and self destructive tendencies in the life of the individual and of society? Throughout its history, psychoanalysis has had to struggle again and again to refind its own revolutionary nature, in the face of the temptation to conform to conventional social pressures to water down its discoveries. Obviously, in the expanding field of clinical and empirical research inspired by psychoanalysis, new findings question old theories, while such findings, in turn, may be interpreted in the light of new theoretical developments, always under the shadow of ideological challenges.
Regarding the psychoanalytic theory of homosexuality, a number of statements may be formulated at this point, reflecting changes in the traditional assumptions of psychoanalytic theory for which there exist generally accepted evidence, and other proposals that are still open to question and even highly controversial. I believe that it is generally accepted by now that homosexuality cannot be considered as part of the perversions-or “paraphilias” as the currently fashionable euphemism in our official classification system of psychiatric conditions calls them. In contrast to the perversions, with their rigid and restricted sexual behavior that becomes an obligatory precondition for sexual excitement and orgasm, homosexuality implies a sexual disposition and set of sexual activities that can be as broad, flexible, and rich as can heterosexual commitment (Friedman, 1988; Friedman and Downey 1993, 1994).
We no longer believe that there exists one homosexuality, but a spectrum of homosexual orientations that reflect different psychodynamics, possibly different etiological factors, and that range clinically from severe psychopathology to health. Whether that polarity of health or “normality” exists is still controversial; more about this later (Socarides, 1978; Chasseguet-Smirgel, 1970, 1986; Stoller, 1968; Tyson, 1994; Morgenthaler, 1980; Isay, 1989; Kernberg, 1992; Kirkpatrick, 1984; Money, 1988). The same spectrum, however, may be described for heterosexuality, although idealized, normative formulations regarding heterosexuality are more readily available (Kernberg, 1995).
Another fact that is probably noncontroversial is that the evidence points to a combination of biological and psychodynamic dispositions to homosexuality, probably with a dominant influence of psychodynamic features in most cases; once again, the same may safely be said about heterosexuality (Friedman, 1988; Kernberg, 1992, 1995). Finally, there are abundant clinical observations indicating that male homosexuality and female homosexuality show significant differences-as do, once more, male and female heterosexuality. So far some basic agreements; now to the controversies.
The first contemporary controversy has to do with the extent to which gender is biologically determined, or socially constructed. I think there is abundant evidence to indicate that gender is biologically determined, in the sense of the anatomical, neurohormonal, and behavioral aspects that derive from the genetic determination of gender. At the same time, gender is also culturally determined, in the sense that the dominant features differentiating masculine and feminine gender role identity are culturally constructed; more about this later.
As for sexual behavior, our present knowledge indicates that it has at least four key components, which complicates the study of homosexuality and bisexuality (Maccoby, 1998; Maccoby and Jacklin, 1974; Kernberg, 1995). First, I am referring here to the intensity of sexual desire, controlled, basically, by the level of testosterone in both genders; but complex psychodynamic dispositions may radically inhibit sexual desire even in the presence of absolutely normal biological functioning.
Second, there is core gender identity, reflecting both the subjective sense of being either male or female and the experience of being identified by society as belonging to one or the other gender. Core gender identity begins with sex assignment, although some limited research points to the possibility that biological factors may influence core gender identity as well.
Third, gender role identity (the enactment of masculine versus feminine roles) is mostly contributed to by social and cultural factors, although, to some extent, also by biological factors, particularly the presence or absence of testosterone. Rough and tumble play in boys and (to a lesser degree) maternal-doll play in girls are influenced by hormonal factors (Friedman and Downey, 1993; 1994). In mammals, with the exception of primates, gender coding of differential behaviors of males and females is genetically and hormonally determined, and prenatally fixed. In primates, in contrast, early infant-mother interaction powerfully influences sexual behavior (Money and Ehrhardt, 1972; Bancroft, 1989). The fact that in human beings psychodynamic and psychosocial factors are by far dominant in establishing gender role identity fits with this evolutionary perspective.
As mentioned before, the most important and dominant features differentiating masculine and feminine gender role identity are culturally constructed (Maccoby and Jacklin, 1974; Chodorow, 1978,1994). Yet, from a psychodynamic viewpoint, the crucial aspects of gender role identity that derive from the unconscious identification with both parents do not say anything about masculinity and femininity, except that they represent identification with paternal and maternal images, respectively.
In other words, insofar as the characterological constellation contains identifications with both parental images, what may be called masculine or feminine depends on whether it stems from father or mother, who, in turn, present characteristics that they have taken over through identification from their own parental images and thus may be mixed. Masculinity and femininity, therefore, contain relatively stable, biological and sociocultural elements, and highly variable, psychodynamic- ally determined identification aspects, regarding which the concepts of masculinity and femininity become difficult to determine.
Fourth, object choice: this, the most crucial aspect of all the controversies regarding homosexuality, is also the area where our ignorance is greatest. In contrast to the three other elements determining human sexual behavior, the persisting taboo regarding research on child sexuality has made this field still unexplored, with the exception of the retrospective insight into early childhood derived from adult analysis, and the direct clinical experience of child analysis. Psychoanalysis, in this regard, has a well-deserved central role in the elucidation of this major area of our exploration of homosexuality.
It is the perceived gender (based on the object’s enactment of gender role) of the object of sexual (erotic) desire that defines heterosexuality, homosexuality, and bisexuality. From the viewpoint of psychoanalytic object relations theory-probably the most generally agreed upon theoretical frame that bridges alternative psychoanalytic theories-it seems reasonable to assume that object choice is determined in parallel to the establishment of core gender identity (Kernberg, 1995). In other words, the fixation on an object of erotic desire carries with it, psychologically, a definition of the sexual self in relating to that particular object: here we come to a central, and controversial area of contemporary psychoanalytic theory.
Freud postulated a psychological bisexuality, derived from the unconscious identification with both parental images in the positive and negative oedipal constellation (Freud, 1905b, 1923). This proposal has survived to this day, supported by the clinical experience with both heterosexual and homosexual patients in terms of the unconscious identification with aspects of both parents, with a clear dominance, usually, of the unconscious identification with the parent with whom most severe conflicts existed in the past, regardless of the gender of that parent. In referring to bisexuality, Freud combined what we would now consider the various components of sexual behavior referred to before.
In this connection, an unconscious bisexuality, that is, an unconscious identification with both parental figures, emerges as a crucial determinant of core gender identity as well as gender role identity. In my experience, unconscious identifications with both parental images and aspects of their sexual identity is a universal finding in clinical psychoanalysis. I am fully aware that the experimental studies of Friedman and Downey (1993, 1994) have not been able to confirm this, but there are important methodological questions unresolved in this area, and the corresponding empirical research is only in its beginnings.
Phyllis Tyson (1994) has described the combination of a primary vaginal genitality in the little girl and her unconscious identification with paternal and maternal features as the “bedrock” of, respectively, core gender identity and gender role identity. Laplanche (1992), in describing the unconscious selective erotization of the little boy and the little girl in the mother-infant relationship, has provided a contemporary theoretical frame for these developments.
If we assume an unconscious, primitive, universal bisexuality, then we may also assume the universal presence of homosexual as well as heterosexual tendencies. A derivative hypothesis would be that, on the basis of such a universal unconscious bisexuality, psychodynamic as well as biological features might shift object choice into a homosexual or heterosexual direction, or, if such a fixed object choice were not achieved, a bisexual orientation. In practice, we would expect a spectrum, regarding object choice within each gender, extending from exclusive homosexuality to exclusive heterosexuality, with an intermediate bisexual area (Kernberg, 1992). The predisposition, on the basis of genetic and biological determinants, toward one orientation, and/or the reinforcement of such a predisposition by social and cultural pressures might determine the relative strength of fixation in one or another segment of this spectrum. For example, a socially fostered male bisexuality within strict conventional regulations was prominent in ancient Greece, and anthropological observations have suggested a direct relation between a culture presenting exclusive male homosexuality on the one hand, and conventionally suppressed homosexuality within such a culture, on the other (Bancroft, 1989).
Before proceeding to explore the clinical aspects of bisexuality, it may be helpful to clarify the controversy around the definition of the term. Now almost fashionably used in discussions of alternate sexual life styles, the term has become controversial because of the number of confusing uses made of it. Different conditions described as bisexuality reveal a lack of conceptual clarity in relating this concept to the four basic components of sexual behavior, namely, core gender identity, gender role identity, object choice, and intensity of erotic desire. Freud’s (1905b) original use of the term referred to bisexuality as a basic, original bisexual psychic disposition derived from the unconscious identification with aspects of parental images of both genders. Freud’s hypothesis, as mentioned before, seems to me eminently reasonable, and relates to the psychodynamics of all the components of sexual behavior. It points to the impossibility of differentiating masculinity from femininity on a purely psychodynamic basis, in contrast to both the biological definition of gender, on the one hand, and the cultural construct of conventionally assumed-and promoted-characteristics of masculinity and femininity. So much for the original use of the term bisexuality within the psychoanalytic literature.
More recently, bisexuality has referred to habitual or extended object choice of both genders, that is, the coexistence of homosexual and heterosexual object choice (Friedman, 1988). In this regard, bisexuality, in effect, is a behavior that can be observed in typical constellations, and that appears in different contexts in men and women.
In the briefest summary of these differences, I have proposed (1992, 1995) that bisexuality of object choice is characteristic of late onset homosexuality in women, usually in the context of neurotic or normal personality organization. In contrast, the bisexual men I have diagnosti- cally evaluated and/or have treated usually have presented the syndrome of identity diffusion and severe character pathology. This may not be the case in situations such as prisons where previously exclusively heterosexual men may show transitory homosexual behavior.
The confusion regarding the use of the term bisexuality derives from the fact that in the psychoanalytic literature, bisexuality often tends to be referred to interchangeably as the original psychological bisexuality in a Freudian sense, as bisexual object choice, and even as an assumed characteristic of core gender identity. This latter use of the term appears particularly in feminist literature (Layton, 2000). It needs to be clarified, that, from a clinical viewpoint, bisexual behavior in adults never is seen in the absence of a clear core gender identity. In other words, there is no such condition as bisexual core gender identity. Children with gender identity disorder show bisexual characteristics in their gender role behavior, but do have a clear core gender identity, as do the adults with bisexual behavior seen in the clinic. Unconscious psychological bisexuality, we might say, is the common matrix, out of which, presumably by dominant assignment (although we may not as yet discard biological features), emerges core gender identity in the first three years of life (Stoller, 1968). In short, from a clinical viewpoint, bisexuality should only refer to object choice, and be clearly differentiated from the psychoanalytic hypothesis of a basic psychological bisexuality derived from identification with features of both parents.
As mentioned before, bisexuality looks different in the consulting room in men as compared to women. In the case of women, we do find, indeed, an elective bisexuality, a late onset homosexuality that usually is preceded by an extended heterosexual life style and that may revert to a heterosexual life style. This group includes women who present a normal or neurotic personality organization, are well adjusted in all or most areas of their lives, and usually would not need to come for treatment. This observation dovetails with the greater tolerance that women have of their homosexual impulses, as illustrated by the flexibility of women in engaging in homosexual encounters in the context of group sex, in contrast to the panic of heterosexual man when approached homosexually in such group sex situations (Kernberg, 1995).
In contrast, a transitional zone of bisexuality is not present in men who seek treatment. Their bisexuality usually presents in the context of severe character pathology, with identity diffusion, and most frequently in a narcissistic personality structure. This type of sexuality needs to be differentiated, of course, from men with a clear homosexual identity who have attempted, over many years, to fit into a heterosexual pattern in response to socially and/or psychodynamically determined pressures. In healthier men, there may be suppression of that potential, flexible area of bisexuality that can be observed in women.
The explanation for the difference in tolerance of homosexual impulses in the context of a heterosexual identity (relevant for the difference in bisexual behavior) has both psychodynamic and cultural features. From a psychodynamic viewpoint, it has been proposed that, because men have to abandon a primary identification with mother, their core gender identity is less secure than that of women, who are maintaining their primary identification with mother (Stoller, 1968,1985). This hypothesis, however, has been challenged by several psychoanalytic authors, who propose that mother treats her male and female infant unconsciously in differentiated ways from the beginning of life on; more about this later (Braunschweig and Fain, 1971). From the viewpoint of cultural influences, traditional patriarchic cultures have elevated male homosexuality and female infidelity as the major taboos of the social order, in contrast to matriarchal societies, where father/ daughter incest and male infidelity are the major taboos. The implication, then, would be that it is the social bias against and suppression of male homosexuality that leads to the suppression of bisexual features in men who are not exclusively heterosexual while a bisexual spectrum in the case of women is socially tolerated. In any case, it seems reasonable to propose that, among chronically bisexual men and women, the majority probably have significant character pathology, as indicated by their restricted capacity to commit themselves to one type of object choice, but the “normal” intermediate zone of the total spectrum from homosexuality to heterosexuality is still a theoretical possibility, to be explored.
The proposed combination of biological and psychodynamic determinants of the homosexualities, and of the influence of early developmental features and/or cultural pressures on the differential characteristics of male and female bisexuality, is challenged by the ideologies of both traditional psychoanalysis and homosexual organizations. For the latter, there is great attractiveness in the notion of a biologically determined homosexuality as a normal biological alternative to heterosexual identity, a viewpoint that also corresponds to some culturalist psychoanalytic approaches, such as Morgenthaler’s assumption of normal alternative pathways for sexual identity and object choice (Isay, 1989; Morgenthaler, 1980).
On the other side, a traditional psychoanalytic viewpoint strongly maintained by the French psychoanalytic mainstream postulates that, insofar as the normal resolution of the oedipal complex implies identification with a parent of the same gender both in his or her heterosexual orientation as well as in the disposition to motherhood or fatherhood, a homosexual identity always implies an incapacity to fully identify with that oedipal figure, and indicates a failure in the resolution of the oedipal complex (Chasseguet-Smirgel, 1970, 1986). A corollary of that position is that homosexual object choice always implies a dominance of narcissistic defenses against unresolved oedipal conflicts. Meanwhile, the older psychoanalytic view that included homosexuality with the perversions has mostly been abandoned in the recent literature, although a few adherents of that view remain in the field (Socarides, 1978).
How is such a clash of opposing theoretical commitments to be resolved? In my view, the advances in the knowledge of the biological and the psychodynamic contributions to core gender identity, gender role identity, and object choice should gradually clarify the relative importance of biological and psychodynamic features, and facilitate the differentiation of psychodynamic features from sociocultural ones as well. In this connection, the research on children with gender identity disorder has provided evidence of a high correlation of such disorders with severely traumatic experiences, probably present in approximately 68 percent of these cases. A high proportion of male children with gender identity disorder develop a homosexual identity later on: about 70 percent, without treatment (Coates, Friedman, and Wolfe, 1991; Coates, 1992). The majority of adult male homosexuals who come for treatment, however, do not present a history of gender identity disorder, and there is no evidence of a genetic component of gender identity disorder (Green, 1985). At the same time, genetic research points to a definite genetic component in at least a subgroup of male homosexuals; this entire line of research, however, is far from being concluded (Friedman and Downey, 1993, 1994).
From a psychoanalytic perspective, the question of the existence of normal homosexuality as the hypothesis underlying the concept of a spectrum of sexual orientation ranging from the homosexual to the heterosexual with a bisexual intermediate zone may be indirectly evaluated by the study of the psychoanalytic treatment of homosexual patients who do not present significant psychopathology to begin with. Such might be the analysands who seek treatment for training purposes, or out of a belief that their homosexuality per se requires treatment, or in the aftermath of a failed love relationship. If, at the end of such treatment, their homosexuality is unaffected, while they are able to function in a full and satisfactory way in all areas of their life experience, with a rich love life that integrates erotic and tender components, an object relation in depth with their sexual partner, without the manifestations of severe repression or denial of heterosexual impulses, and a capacity for a broad range of relationships in depth with both genders, the notion of homosexuality as an illness by definition would become highly questionable.
In fact, with the acceptance of homosexual candidates in psychoanalytic training in this country and abroad, we do have a way to test this hypothesis. Beyond what just has been described, we may evaluate the capacity of such candidates to identify in depth with the unconscious conflicts of patients of both genders in a sufficiently sublimatory way so as to be able to become psychoanalysts with as few (or as many) “blind spots” as the traditional “well-analyzed” heterosexual candidate. This viewpoint implies a critique of those homosexual psychoanalysts who imply that only a male homosexual analyst may be able to optimally analyze a male homosexual patient (Isay, 1989), a position that also reminds one of the equally problematic assumption that women analysts should analyze women patients, or that preferably women should analyze patients with predominantly pre-oedipal issues, etc.
Let us now review briefly some dominant psychodynamics that emerge in the psychoanalysis of homosexual patients, in comparison with the corresponding psychodynamics of heterosexual patients. I have proposed in earlier work (1992) that the prognosis of male homosexual patients in psychoanalytic treatment depends on the level of severity of their character pathology, a viewpoint that I still maintain. From this perspective, homosexual patients with a neurotic personality organization have excellent prognosis for psychoanalytic treatment. In these cases the psychodynamics originally described by Freud are usually dominant: a predominance of oedipal conflicts, a reinforcement of the negative oedipal complex as a defense against castration anxiety, with a typical split of the paternal image into an idealized one-to which an erotic submission or allegiance protects the patient against the terror of a split-off, sadistic and castrating paternal image, and a profound prohibition against sexual impulses toward the oedipal maternal image. A defensive idealization of anal sexuality as a regression from a predominant genital sexuality complements this constellation.
This dynamic usually overlaps with that of an unconscious identification with a maternal figure, in an unconscious bid for father’s love, an identification powerfully reinforced in cases where a severely rejecting maternal image determines a primitive split of that maternal image. This split involves a persecutory and castrating female image, determining horror of and disgust with the female genitals, and an idealized one with the erotic disposition to mother displaced toward or condensed with the idealized father image. In many of these cases, there emerges a relative weakness of the identification with the parental power of the oedipal paternal image, and a tendency to adopt female gender role characteristics as the counterpart to rejecting male gender role features.
The question can be raised, to what extent all of these conflicts may obscure a primary dominance of the negative Oedipus complex, that is, a primary love to father that transfers the earliest loving relationship from mother into a non-conflictual homosexual object choice (Isay, 1989; Morgenthaler, 1980). Here, I believe, it is fair to state that ideological biases and theoretical preconceptions may tilt the balance of the analytic conviction regarding how much is primary homoeroticism, and how much is conflictual, defensive reactivation of the negative oedipal conflict under the impact of castration anxiety.
Male homosexual patients with a borderline personality organization show the typical condensation of oedipal and pre-oedipal conflicts that characterizes the entire borderline field. It could be argued that gender identity disturbance is a natural consequence of the syndrome of identity diffusion. The majority of children with gender identity disorders, however, do not present borderline personality organization, in spite of the fact that severe trauma is such a crucial etiological factor in those cases. Therefore, the dominant homosexual orientation in patients with gender identity disorder should not be ascribed to the general psychodynamics of borderline personality organization alone. In contrast, homosexual patients who present a predominantly oral orientation toward the idealized father, with severe and pervasive conflicts of hostility toward the preoedipal mother, constitute a specific syndrome of male homosexuality linked to borderline personality organization. Here the childlike, dependent, clinging relationship to the male partner, in the context of general emotional immaturity and lability, replicates the corresponding clinging nature of chaotic love relations of heterosexual borderline patients.
A third, and quite characteristic constellation, is that of male homosexuality in a narcissistic personality structure, with a defensive idealization of the homosexual relationship as the counterpart to an aggressive devaluation of women, and an alternation between exploitative tendencies toward a “mirror image” erotic partner, on the one hand, and the incapacity for any stable erotic engagement as part of a general incapacity for any object relation in depth, on the other. Paradoxically, the surface relationship of such narcissistic homosexual men with women may appear to be more stable and adaptive than that of the borderline homosexual patient with an unconscious identification with a dependent, clinging infant relating to a maternalized father image. In this latter case, a chaotic relationship to women, with frail desexualized idealization, on the one hand, and aggressive devaluation of women, on the other, may go hand in hand with a caricaturized identification with female gender role features that hides a profound aggression toward women. This overall chaos in male homosexual borderline patients’ object relations contrasts with the apparent stability of the narcissistic type. The prognosis for the treatment of this spectrum of characterological constellations is quite similar to that for the corresponding heterosexual patients, and the dynamics overlap to a large extent.
The most severe category of male homosexuality is the combination of male homosexuality and a syndrome of malignant narcissism, a syndrome that again presents practically the same dynamic characteristics as heterosexual malignant narcissism. Male antisocial personality disorders of the aggressive type-the homosexual serial killers-correspond equally to the clinical characteristics and “null” prognosis for treatment of the heterosexual antisocial personalities who are serial killers. In short, it is the severity of the personality pathology that determines the prognosis.
From a theoretical viewpoint, the main issue involved in all these psychodynamic features of male homosexuality, as underlined by Isay (1989), is the question of the existence of a primary love for father. Is there an original, “negative” Oedipus complex that only secondarily is complicated by castration anxiety, and that leads to pathological distortions because of a superimposed, culturally determined homophobia? Or, to the contrary, should we accept the theoretical assumption of a primary positive oedipal complex evoked in the unconscious seduction of the male baby by mother as part of the maternal “general seduction” as a universal process, as proposed by Laplanche (1992)?
Turning to female homosexuality, the most important question raised by those who postulate a primary homosexual orientation in the little girl is the same “general seduction” theory that is involved in the mother-infant relationship and the eroticization of the infant’s body in both genders. According to the contributions of Braunschweig and Fain (1971), such unconscious eroticization by mother operates fully in the case of the relationship between mother and infant boy, and is restricted in the case of the relationship of mother with her infant girl. In the latter case, mother unconsciously avoids the stimulation of the little girl’s genitals, and treats her as a narcissistic replica of herself, in contrast to her relationship to her little boy, whom she treats as an alternative sexual object that unconsciously represents her own father.
Eva Poluda, in a recent, comprehensive review of the psychodynamics of female homosexuality (2000), has stressed the primary, unconscious, homophobic attitude of mother as a determinant of the turning of the little girl from mother to father. Poluda, in reviewing the psychoanalytic contributions to the psychodynamics of female sexuality proposed by Freud (1905a, 1920), Chasseguet-Smirgel (1970), McDougall (1964, 1986), Halenta (1993), Siegel (1988), and Kestenberg (1986, 1993), concludes that a primary, “negative” Oedipus complex is a universal disposition in women, inhibited by mother’s unconscious homophobic defense, and leading secondarily to the various psychodynamic constellations described by the authors she quotes.
Freud (1920) described a case of female homosexuality as reflecting the predominance of the negative oedipal complex as a defense against the repressed positive one. Abraham (1920) had suggested that, in a reaction to the development of penis envy, which normally would determine the disappointed turning away of the little girl from mother to father, the positive oedipal relationship might be disrupted by the transfer of that disappointment to father, in a situation where the pathological intensity of penis envy would determine an unconscious identification with father’s penis, the devaluation of masculinity, and the development of a masculine, “revenge type” of female homosexuality. In other cases, Abraham had proposed, in a disappointed turning away from a rejecting father, or in an effort to deny penis envy, a regressive, submissive erotic idealization of mother might serve both to eliminate oedipal guilt and to avoid the competition with the envied father.
The implication of Freud’s and Abraham’s view was that penis envy occupied a fundamental etiological role both in the shift of the little girl’s love from mother to father, and in the failure of this shift determined by either excessive preoedipal conflicts reinforcing penis envy, or excessive unconscious guilt regarding the positive oedipal complex. Melanie Klein (1945), in her fundamental critique of the primary nature of penis envy, pointed to the unconscious envy of the other gender as a universal characteristic of both genders. She also stressed the tendency to escape from severe, preoedipal conflicts dominated by aggression into a premature oedipalization, that, because of the transfer of preoedipal aggression onto the oedipal object, might fail in turn, and lead to a regressive split of the preoedipal object into an idealized and a persecutory image.
Melanie Klein proposed that, in the case of the little girl, the primary, preoedipal conflicts with mother may determine the transfer of such conflicts-particularly aggression-onto the relationship with father, bringing about excessive penis envy and rejection of the feminine position, with a defensive splitting of a maternal image into a persecutory and an idealized one, and a sexual orientation toward such an idealized maternal image.
Joyce McDougall (1964, 1986), in consonance with Chasseguet-Smirgel and Braunschweig and Fain, focuses on the primary vaginal genitality of the little girl, and its inhibition under the influence of the selective rejection of the erotic relationship with her little daughter on the part of the preoedipal mother. While implicitly acknowledging a primary homoerotic tendency of the little girl, McDougall stresses the normal shift of the little girl’s erotic interest to father in an unconscious identification with mother, the identification with mother’s desire. When this process is disrupted by excessively severe aggressive interactions with mother, it leads to the split of the maternal image into an idealized and a persecutory one, a defensive erotic submission to the idealized mother representation, and a rejection of the erotically frustrating and unavailable father.
Obviously there are many individually differentiated psychodynamics that can only be roughly encompassed by such general statements.
However, as Poluda (2000) stresses, all the described dynamic constellations of female sexuality have in common the assumption of a primary homoerotic relation of the little girl to mother, that appears to be clearer than the corresponding assertion of a primary homoerotic relation of the little boy to father, and may provide part of the explanation of the differential characteristics of female and male homosexuality and bisexuality. In any case, from a clinical viewpoint, we do find both some parallel developments and some differences of female and male homosexuality.
To begin, female homosexual couples tend to be more stable and less tolerant of promiscuous sexual behavior than male homosexual couples, probably replicating important differences in male and female sexuality that override the difference between homosexual and heterosexual orientation (Kirkpatrick, Smith, and Roy, 1981; Bell and Weinberg, 1978, 1981).
Female homosexuality may present within the context of a neurotic personality organization, where relatively clear oedipal dynamics predominate, together with a relatively clear differentiation of maternal and paternal images, unconscious guilt over positive oedipal longings, a regressive idealization of the oedipal mother condensed with preoedipal longings toward her, and a predominant female gender role identity. This constellation differs from the unconscious identification with male gender roles characteristics of the “revenge” type described by Abraham, where intense penis envy and resentment against men reflects a condensation of severe aggressive conflicts with both the oedipal father and the preoedipal mother.
The presence of female homosexuality in the context of borderline personality organization has similar or parallel features to male homosexuality with a borderline personality organization. Here we find intense ambivalence toward the love object, with rather chaotic splitting of both male and female images into idealized and persecutory ones complementing the homosexual object choice. Homosexual women with a narcissistic personality also present parallel characteristics to those of homosexuality in narcissistic males, with a surface idealization of female bonding, devaluation of men, and the problems in developing a relationship in depth that correspond to similar problems of narcissistic personalities with heterosexual orientation.
As mentioned before, in contrast to these relatively fixed or permanent types of female homosexuality, the late onset female homosexuality occurs in women who have had a dominant, basically non-conflictual heterosexual orientation during significant parts of their life, and who, usually after loss of a spouse through death or divorce, or the moving away of the children from home, establish a homosexual relationship, often in the context of a supportive homosexually oriented community. These cases constitute what corresponds to the theoretically normal bisexual spectrum that has been hypothesized from the theoretical perspective outlined before.
Now we come to the final controversy in this field, namely, what is to be expected from the treatment of homosexual and bisexual patients? It is probably not controversial to state that older psychoanalytic concepts implying that the optimal treatment of homosexual patients should transform them into heterosexual persons has been abandoned. To the contrary, it seems reasonable to state that there is general agreement that the analyst needs to be honestly technically neutral, in the sense of helping the patient to consolidate his or her own sexual identity, with the analyst’s total acceptance of that potential freedom of the patient, and an ongoing, self-reflective awareness of the high risk of ideological contamination of the clinical approach in this particular area. This is a task for both heterosexual and homosexual analysts who analyze homosexual patients, analysts whose particular biases might reduce their technical neutrality by either subtly demeaning or subtly idealizing homosexual solutions.
From a clinical viewpoint, the criteria of normality previously referred to should be more than sufficient to consider that an analysis of a homosexual patient has been completed, not different from the expectations that we have of the analysis of a heterosexual patient. The countertransference complications in treating homosexual patients of the same or opposite gender of the psychoanalyst constitute particular challenges in the treatment that need to be carefully explored in the analyst’s self-analysis. I have referred to the influence of the relationship of the gender of the psychoanalyst with the gender of the patient in earlier work (Kernberg, 2000), and want to limit myself here to simply stating that this requires a comfortable relationship of the heterosexual analyst with his or her homosexual tendencies, and a comfortable relationship of the homosexual analyst with his or her heterosexual tendencies; easier said than done, but an indispensable part of analytic work. After all, the heterosexual analyst analyzing a heterosexual patient of the other gender must be able, at certain points, to identify himself or herself with the erotic aspirations and fears, the excitement and terror of that patient; there is no reason why this task, ordinarily demanded of the psychoanalyst, not be demanded also of the psychoanalyst who analyzes the patient whose object choice is homosexual. At the end, it helps when an ideologically non-militant psychoanalyst is available to a patient whose militancy is open to analytic exploration.