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Am J Psychiatry 1949;105:697-701.
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(1) The character structure of patients with paranoid syndromes varied considerably and indicated that projective phenomena are seen in widely different types of personality organization. In these, there are likewise varying conflicts or constellations of them.(2) Most of the patients in this series came from distrust-provoking backgrounds —unstable, cruel, and punitive, or highly moralistic and demanding, or indulging, pampering ones.(3) The group showed histories of preoccupation with competitive and social strivings, with failure or unsuccessful attempts to maintain ego stature.(4) Crucial precipitating situations were widely prevalent. Failures in love or sex situations were conspicuous.(5) Psychosexual history antedating illness emphasized prevalent guilty attitudes toward sexuality, particularly masturbation.(6) Chief sexual preoccupations during illness were (a) infidelity of mate, (b) being a phantasied love object, (c) victim of heterosexual attack, (d) fear of being considered a pervert, (e) concern of injury to body or sex organs.(7) In many patients, the fear of being or becoming homosexual was an expression of failure, blow to pride, or general distrust of acceptance. These fears did not, of necessity, represent homosexual strivings.(8) In the study of the hostile figures, the majority picked a male for the first hostile figure and even more picked a male figure as the chief persecutor. The hostile figure frequently symbolized a strong, punitive parental figure.(9) The paranoid mechanism cannot be explained solely by homosexual conflict despite the convincing evidence of its pertinence in certain cases. It is so obvious in the cases in which it occurs, that the limits of its application are all the more surprising. One point for the universal application of the relationship of homosexual conflict to paranoid reaction is the inadequacy, and indeed almost absence, of alternative theories. However, if the relationship of homosexuality to the paranoid mechanism is assumed to be invariable, other important considerations will be neglected.

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