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June 1960

Paranoid State—Theory and Therapy

Author Affiliations

Washington, D.C.

AMA Arch Gen Psychiatry. 1960;2(6):679-693. doi:10.1001/archpsyc.1960.03590120087010

The dynamics of paranoia and the paranoid state were inextricably involved with sexual pathology through Freud’s brilliant recognition of the relationship of paranoia and repressed homosexual drives. He said:

We shall therefore, I think, raise no further objections to the hypothesis that the exciting cause of the illness of Schreber was the appearance in him of a feminine, that is, passive, homosexual, wishful phantasy which took as its object the figure of his doctor (Fleschig).1

While his formulation was fruitful in understanding many aspects of the delusional formation, it was of limited value in helping us to comprehend the dynamics of the paranoid process or its refractory nature in therapy. Recent investigations of homosexuality, both latent and overt, and other studies in paranoia and paranoid states (Rado, Robbins, Ovesey, Sullivan, Salzman, and others)4-10 have thrown new light on this malignant disorder. I do not intend

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