A CASE OF HOMOSEXUALITY AMD CHARACTER DISORDER

A CASE OF HOMOSEXUALITY AMD CHARACTER DISORDER IN A MAN OF 37 TREATED BY L.S.D. AND RESOLVED WITHIN FOUR MONTHS
A. Joyce Martin, M.D., M.R.C.S., L.R.C.P. London, England

Dr. Martin was a pioneer in the technique of psycholytic therapy utilizing LSD and began that work in the early 1950-es. She treated, with remarkable success, on an outpatient basis, all types of patients with severe pathologies and it is truly unfortunate she wrote so little of her work. She was a true humanist, having little time for writing, and died in her sleep one night after having completed her usual twelve hour work day. She died in August, 1969 after a long and successful career as a psychoanalyst.

Introduction

The discovery of the hallucinogenic properties of lysergic acid diethylamide by Hofmann in 1943 led investigators (1,2) to utilize it in the study of psychosis since it was felt LSD produced psychotomimetic effects. Fortunately, it was discovered that LSD could also produce psychedelic (mind-manifesting) effects and that individuals could not only have mystico-religious experiences (3), but that awareness of psychological phenomena from typically inhibited and unavailable levels of consciousness became available (4,5,6). Insights and understandings from these experiences appeared to have significant and positive lasting effects in the lives of these persons. A good deal of significant psychotherapeutic work has been reported utilizing psychodysleptic drugs and the literature contains reports of successful work with a variety of psychopathological conditions, e.g. alcoholism (7) , psychoneurosis (8) , psychopathy (9) and childhood schizophrenia (10).

Two basic psychotherapeutic approaches utilizing psychodysleptic drugs have evolved, the psychedelic and the psycholytic. The differences in these approaches have been delineated in a previous paper (11). Briefly, the goal of the psychedelic experience is the attainment of a new identity based on an experience of universal one-ness through the death of the ego, whereas the psycholytic approach utilizes the altered state of consciousness to do the more traditional psychotherapeutic work of resolution of intra-psychic conflict.

This paper describes the treatment of a 37 year old male with homosexuality and a character disorder who was treated with the psycholytic method (12).

He had received two years of intensive individual and two years of group therapy in the U.S.A. and then had come to England for a course in aversion therapy, but all without success, and he was now in a state of great tension, anxiety, desperation and depression. His history was characterized by an inability to make social relationships, suspicion and mistrust of everyone, and inability to concentrate and succeed in his work, from which he had been discharged for his homosexual practices.

Previous History and Early Development

He was the second son of parents in the U.S.A., his father being a mine worker, but in business later. The patient and his brother, eighteen months older, both went to the local public school, but he did not get on with his brother whom he felt was superior and looked down on him. He was an unhappy, lonely child and did not make much contact with other children, but liked being with his mother and getting as much attention from her as possible. He was told that he was a lusty baby and had enjoyed, the breast feeding tremendously up to four months, when apparently on one occasion he bit the nipple pretty hard and mother got such a shock that her involuntary reaction was to smack him; this made him go into a tantrum so that father was called in and administered a smacking. This was a frightening experience and made him full of rage and hate and guilt, but eventually mother took him back on the breast for another five months. However, he feels that the breast enjoyment was never the same again as he was too frightened to let himself go, that mother also seemed more restrained so that he never regained the full feeling of pleasure and harmony which he had had during the first four months, and when he was weaned he felt orally frustrated.

He grew up a moody, obstinate and unhappy child, unable to make friends and keeping to himself. When he went to school he maintained this attitude, and felt aggressive towards the boys, but not openly; he would throw stones at them from a distance, but could not confront them openly. Quite early, however, he began to have mutual masturbatory activities with one or two small boys and this continued all through his school days up to age 18. He also developed sexual feelings for girls at 15 and 16, but mother would nag him and if she discovered him with a girl she would break it up and humiliate him. This made him feel that sex with girls must be wrong and wicked, and so he returned to his sexual interest in boys.

Initial Treatment

I gave this man a consultation to see if he could communicate and. make rapport with me, and found that he could do this, although he was extremely tense and. rather depressed about his previous failure to respond to treatment, but with a strong motivation towards the L.S.D. treatment. I decided therefore that he was probably suitable for the treatment, and arranged accordingly.

The dosage I usually start with is 50 -75 gamma according to the size, sex, and nature of the patient, i.e. whether he is used to taking a fair amount of alcohol and drugs. The man had lived in the Far East, and was used to taking alcohol, and he was big in stature, being 6 ft. 2 inches tall and fairly broad. I decided, therefore, not to waste time but to give him a fairly big dose to start with, and gave him 90 gamma, by mouth.

He began to react fairly quickly and after twenty minutes his head felt fuzzy and he lay down on the bed. He then said that he felt an eye was looking at him from behind the mirror on the wall and he felt frightened of it; he then said that I looked like an Indian doctor with a pipe in my mouth. Then he was silent and uncommunicative and when I asked him what he could remember of his early childhood he said he remembered that he was always very interested in his stools. When I questioned him further and asked if he played with them in any way, he thought this was very funny, and roared with laughter. He kept this up for quite a long time and kept saying how funny I was and must be a jolly woman, and he felt quite at ease with me as he thought I was friendly. He was, however, not able to communicate his thoughts and phantasies any further, but always came back to the eye on the wall which he saw throughout the whole of the session, and firmly believed that this was a two-way mirror such as they used in the Intelligence Department, and that someone was spying on him from the other side of the wall, and taking down all his remarks.

Following this session, I asked him to come for a talk to find out what he had gained from the session. He said it had been quite a dramatic experience, and that he was certain someone had been looking at him all the time through the mirror, but he now realized that it was not that sort of mirror and that he had been under a delusion. Apart from that, however, he felt he had not been able to communicate and had gained no insight. I suggested therefore that this might not be the right treatment for him, as it was not suitable for everyone, and perhaps he would do better with abreaction treatments such as sodium amytal and methedrine. He, however, then became very disturbed and could not face the possibility of failure again with the LSD treatment, and said he was sure he could overcome his suspicion and resistance of communication, and respond better to the next treatment if I would, agree to give it to him.

Second LSD Treatment

I agreed to give him a second treatment with a smaller dose, and. this time gave him only 50 gamma, and this just had the effect of relaxing him and allowing him to communicate as much as he could of his memories from early childhood. He actually could not remember much except that he had not been a happy child, always felt frustrated and resentful; that he would be pounced on at any minute for doing something wrong, so that he was always under tension, unable to make friends, and a 'lone wolf.' He then remembered that he had been told about the incident of biting the nipple, and thought that per- haps after that he had been so frightened of showing his aggression that he had suppressed it all, but it had come out in an overt way of mistrust and suspicion, and that he was terrified of it coming out directly. He knew that he had always clung to mother in his childhood, always wanted more from her, and must have had strong erotic sexual feelings for her just as he had had at the breast. All these feelings were repressed except that he remembered that he was in the habit of going to sleep in her bed every night right up to the age of 13, and then moving over to his bed in his brother's room later in the night. He used to wet the bed every night right up to the time he had his first orgasm about 11 years old, and after that the bed-wetting stopped, so that he thought it must have been connected with his desire for mother and also his anger and aggression against her.

He had loosened, up considerably in this session, and gained some insight and I agreed therefore to continue the LSD treatment for him.

Later Sessions

The dosage was now increased to 75 gamma. He went through the strong desire to wet the bed which he knew meant bringing out his aggression against mother and also expressing his sexual feelings, and now he felt he wanted to bring out aggression against me, so that he did allow himself to wet the bed once or twice, and felt pleased that he was not so afraid of his aggression that he could do this consciously and suffer the humiliation consciously, and this helped to release his tension a little.

I then increased the dose to 90 gamma and he went through tremendous passions of rage and hate against mother for all the frustration she had caused him all through his life and particularly at the breast stage, and against father also for supporting her, and he had a strong desire to kill both of them. He was very afraid of these feelings and sometimes felt such tremendous tensions all through his body that he thought he might break out and do something vicious and attack someone. I reassured him that as long as he continued, to express all these feelings to me he would be all right. He could not let the feelings out on me direct, but on all the inanimate objects in my room such as brass ash trays and ornaments, books and magazines, and lampshades. All of these he attacked and destroyed, but then was very conscientious in replacing them and making restitution. This went on for many sessions, and the dose was gradually increased to 150 gamma, and his tensions were lessening, so eventually he worked through this terrible destructive feeling against mother. One day he came for treatment and had his usual dose or a little extra, and then he suddenly said, "I don't know what has happened, I don't feel anger any more, and I don't feel I want to attack or destroy anyone." A long pause, and then he said, "I just feel full of love," and he said 'love' in a perplexed way as though he had never really felt or experienced, it before and was not sure if he ought to be doing so. Then after a few minutes he said again as though he 'could not believe it "I just feel love, and I don't want to destroy." So this was where I knew that he needed some direct support for his feelings, and so I said, "I am coming to sit on the bed with you, but if you don't like it just tell me and I shall understand." So I went and sat on the bed with him, and he immediately grabbed and pulled me tightly towards him and pulled me down onto the bed with him and held me there in a vise, and then he said "Don't move, don't speak, please don't move, just keep very quiet." And so he held me in a vise for what seemed a very long time, probably half an hour, and at intervals he would repeat "Don't move please, don't speak," and so I lay there for a long time. Eventually he relaxed his grip, and then he seemed to be bubbling over with happiness, and eventually burst into song "So nice to see you back where you belong," from the musical play 'Hello Dolly'. Then, after a pause, he said "Where have you been all my life?" And so I was able to point out to him that he must feel he had met me before and had been looking for me all his life and that it was nice to see me back again, and that of course therefore this must be mother whom he was looking for, and I must be standing for mother to him; and now he could, liberate his love again as he had previously for mother at a very early age when he felt fused with her at the breast, and he had just then gone through the same experience of fusion with me as mother as he had originally with his own mother. This experience of fusion was essential to revive his dead and. repressed love for mother after she had appeared to reject him when he had bitten her breast at four months old, but now he had revived the love feeling and was eager and aching to express it fully, and wanted to express it to me. I was able to let him do this, but showed him that these were feelings for mother at an infantile age, and could not therefore bring complete satisfaction for him now sexually, but that he would be able to transfer these feelings to some other woman who would be able to fulfill his sexual love needs completely. He understood this and was able to go out and mix with women more freely, and eventually met one whom he liked very much and started going out with. Eventually they went away for a weekend together, and he made love to her and it was wonderfully successful whereas previously if he had ever attempted making love to women he had been impotent. He was delighted and continued to see this woman every weekend until he told me that he felt he would like to marry her one day but must go home first to try to get a job. He now felt that he had no interest in boys or homosexuality, but wanted to marry and settle down and have a family, and I felt that he had probably integrated sufficiently to be able to do this, and there- fore agreed to him leaving off treatment and going home to look for a job.

Interlude

His home was in the Far East, and he decided to go by way of India where he had previously been a follower of a renowned philosophic teacher there, and so he called in to see him and told him he was cured of homosexuality, but the teacher said, "If you are cured of homosexuality, does that get rid of all your problems?" This comment made the patient think that it was not so necessary to overcome homosexuality and when he returned to his home town where he had many homosexual friends he could not resist the temptation as he thought it was not so important, and he tended to slip back a bit and was not sure if he wanted to marry this girl. So when he wrote to me about it, I advised him to come back and have a few more treatments as he obviously had not worked through all his infantile conflicts although he had matured to a genital sexuality. So he gave up trying to get a job, and returned here for more LSD treatment.

Renewal of Treatment

I now started with a larger dose of 200 gamma, and he did not go through the previous tense aggressive phase, but went immediately into an erotic phase when he had strong sexual feelings and desperately wanted to get an orgasm but could not achieve this, and it was obviously some infantile sexual experience he was going through, probably at the breast.

At the second treatment session, he went through something that he had never experienced before, and that was going through the whole experience of being born, which he felt had been difficult and had caused mother pain, and he felt guilty about this. He also felt resentful because something had gone wrong -- he was born a blue baby, and would not breathe and they had to put him in the warm kitchen oven before he started to breathe and became a normal color. He felt strongly that he had only just made it and very nearly died, and had the feeling that he would prefer to die because he did not want to leave the womb and be born, but some deficiency developed and made him come out. He felt that this deficiency in the womb, perhaps with the placenta, and the unpleasant birth experience, had made him feel insecure, and this caused him to apply himself very strongly to the breast and find comfort and security there.

Later Associations and Dreams

Following this experience of birth, he had several dreams about sand and cement to support structures that were breaking down, and that he got hold of wiring to help support it, but all to no avail. His associations to this were that the placenta was not functioning properly, that he must bring new arteries to supply it, and because of this he was not getting enough oxygen and was born blue. He also continued to have the association that the placenta was very warm and comfortable and had usually supplied all his needs very well, and he had received pleasure from it. He suddenly thought to the pleasure he had in homosexual relationships where he made his partner be the passive one and supply all his needs, which he felt was very narcissistic but very pleasant, and must be like he felt in the womb as part of mother, and he was also identifying with mother by giving the breast in the form of the penis into his partner's mouth, and never vice versa. Regarding these placenta associations, Professor Lietaert Peereolte in his book on Pre-Natal Dynamics (13) mentions the importance of the placenta in development.

He had several dreams of this nature, and then they changed to another type of dream which brought out very clearly murderous rage and jealousy towards his brother and his father in relation to his mother, and he had never been aware of this before but now realized that he could not bear any competition for mother but wanted to possess her completely for himself. He then reverted to the compulsive eating he had had as a child, and now it returned in full strength, and he was powerless to resist it and became very embarrassed about it. Gradually, however, he was able to realize more and more that he had always felt uncertain and insecure about mother since the breast biting incident, and so had to hang on to her more tenaciously and possessively than the average child, and could not bear any interference or competition. This had made it very difficult for him to relate to girls and women as he always expected too much of them and mistrusted them. He now, however, was happy to recognize that the girl he was going with and wanted, to marry was completely for him and thought him wonderful and he felt therefore completely secure with her and no jealousy arose in relation to any other man, and he felt that if there was any competition with another man at any time over her, he would be able to stand up to him and tackle him confidently, and not be terrified of his aggression as with his brother and father.

Later Activities

He now found, that he wanted to express himself more in various activities which might partly be sublimating his aggression, and also giving him pleasure. So he took up Squash enthusiastically, also golf and. badminton and swimming. He also increased his social activities and now enjoyed, meeting people and communicating with them which he had not been able to do before. He was not working because he was not allowed to get a job in this country, but felt he could now tackle one with confidence when he got home. He had lost all interest in homosexual activities, and had grown extremely fond of his girl friend, so that now he decided he would propose to her, which he did, and she accepted with delight. They got married three weeks later, and now she is expecting a baby, and he is delighted and taking as much interest in it as her, and finding where he can get the new oxygen apparatus which makes birth easier and improves the health of the baby. He has put in for several jobs and hopes to get one soon. After one and one half years following termination of treatment, the patient was doing well, was happy in the marriage and was not experiencing any sexual problems.

Discussion

The success of this treatment was due to the LSD plus the transference relationship that developed, which was of an infantile love-hate nature, and after liberating excessive hate, the love relationship was cemented by the direct physical approach with the therapist, which caused the original fusion with mother to be relived as a sort of mystical experience as it was at the early breast phase. This allowed the patient to make conscious and express all his previously repressed physical love feelings for mother, and not be afraid of them or feel they were wrong, but was able to develop them to an adult level, and then transfer them to someone else who eventually became his wife. Without this direct approach the transference relationship would, have taken much longer to resolve and would not have been so effective. This man was a confirmed homosexual since eight years of age, and had now become a social outcast since he had lost his job on account of it. As Freud (14) points out, homosexuality can be caused by an arrest in the emotional development of the child, and this patient was certainly an example of this, having been severely arrested at an oral level, and later identifying with mother. The severity of the early emotional arrest was shown at the first 1ST) session when be became almost psychotic and showed such strong paranoid features, which through the transference situation cleared up fairly quickly. The violent early hostility was also eventually resolved in the same way, through staying with the patient throughout the session of six hours, being patient and understanding, and then finally giving the dynamic physical love support at the right moment to restore the early love-fusion relationship with mother. Without this restoration the frustration feeling would have continued much longer.

Conclusion

An account has been given of a case of homosexuality and character disorder in a man of 37, treated by psycholytic therapy plus a direct approach and resolved within four months with the establishment of a happy heterosexual married relationship, with a family on the way.

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