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Unresolved Issues in the Psychoanalytic Theory of

Homosexuality and Bisexuality
a
Otto F. Kernberg MD
a
Personality Disorders Institute, The New York Presbyterian Hospital-Westchester Division,
b
Joan & Sanford I. Weill Medical College of Cornell University,
c
Columbia University for Psychoanalytic Training and Research,
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To cite this article: Otto F. Kernberg MD (2002): Unresolved Issues in the Psychoanalytic Theory of Homosexuality and
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ARTICLES
Unresolved Issues
Downloaded by [University of Memphis] at 13:56 08 July 2012
in the Psychoanalytic Theory

of Homosexuality and Bisexuality
Otto F. Kernberg, MD
ABSTRACT. Powerful ideological currents, masked as scientific ap-

proaches, complicate the scientific study of homosexuality. Regarding
the psychoanalytic theory of homosexuality, it is generally accepted that
homosexuality cannot be considered as part of the perversions or para-
philias. In contrast to perversions, homosexuality implies a sexual dis-
position and set of sexual activities that can be as broad, flexible, and rich
as can heterosexual commitment. There does not exist one homosexual-
ity, but a spectrum of homosexual orientations that reflect different
psychodynamics, possibly different etiological factors and that range
clinically from severe psychopathology to health. The same spectrum,
however, may be described for heterosexuality, although idealized, nor-
mative formulations regarding heterosexuality are more readily avail-
able. If we assume an unconscious, primitive, universal bisexuality, then
Otto F. Kernberg is Director, Personality Disorders Institute, The New York Pres-
byterian HospitalWestchester Division, Professor of Psychiatry, Joan & Sanford I.
Weill Medical College of Cornell University, and Training and Supervising Analyst,
Columbia University for Psychoanalytic Training and Research.
This paper is an expanded version of a presentation at the panel on Contemporary
Views of Bisexuality in Clinical Work, at the Spring Meeting of the American Psy-
choanalytic Association, Chicago, IL, May 13, 2000.
Journal of Gay & Lesbian Psychotherapy, Vol. 6(1) 2002
2002 by The Haworth Press, Inc. All rights reserved. 9
10 JOURNAL OF GAY & LESBIAN PSYCHOTHERAPY
we may also assume the universal presence of homosexual as well as het-

erosexual tendencies. 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.
The paper goes on to review some dominant psychodynamics that
emerge in the psychoanalysis of homosexual patients, and compares
them with the corresponding psychodynamics of heterosexual patients.
In their clinical work, analysts need to be honestly technically neutral, in
the sense of helping the patient to consolidate his or her own sexual iden-
tity, with the analysts 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 ana-
lyze homosexual patients, analysts whose particular biases might reduce
their technical neutrality by either subtly demeaning or subtly idealizing
homosexual solutions. [Article copies available for a fee from The Haworth
Document Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@
haworthpressinc.com> Website: <http://www.HaworthPress.com> 2002 by
The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Bisexuality, heterosexuality, homosexuality, narcissism,

neurosis, object choice, personality structure, psychoanalysis
The scientific study of homosexuality is undoubtedly one of the most

fraught examples of the harmful impact of ideology on scholarly in-
quiry. Indeed, given our still limited knowledge of the relative impor-
tance 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 psychoan-
alytic 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 Freuds revolutionary discoveries
of profound human realities that run counter to cherished conventional
beliefs: the importance of infantile sexuality, the influence of uncon-
scious conflicts on conscious functioning, the fundamental influence of
Otto F. Kernberg 11
destructive and self destructive tendencies in the life of the individual

and of society? Throughout its history, psychoanalysis has had to strug-
gle 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 ideologi-
cal challenges.
Regarding the psychoanalytic theory of homosexuality, a number of
statements may be formulated at this point, reflecting changes in the tra-

ditional 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 ac-
cepted by now that homosexuality cannot be considered as part of the
perversionsor paraphilias as the currently fashionable euphemism in
our official classification system of psychiatric conditions calls them.1
In contrast to the perversions, with their rigid and restricted sexual be-
havior that becomes an obligatory precondition for sexual excitement
and orgasm, homosexuality implies a sexual disposition and set of sex-
ual 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 spec-
trum of homosexual orientations that reflect different psychodynamics,
possibly different etiological factors, and that range clinically from se-
vere psychopathology to health. Whether that polarity of health or nor-
mality 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 het-
erosexuality, although idealized, normative formulations regarding het-
erosexuality 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 psycho-
dynamic 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 homosexu-
ality and female homosexuality show significant differencesas do,
once more, male and female heterosexuality. So far some basic agree-
ments; 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 deter-
mined, 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 homosexu-
ality and bisexuality (Maccoby, 1998; Maccoby and Jacklin, 1974;

Kernberg, 1995). First, I am referring here to the intensity of sexual de-
sire, 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 identi-
fied 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 gen-
der identity as well.
Third, gender role identity (the enactment of masculine versus femi-
nine roles) is mostly contributed to by social and cultural factors, al-
though, 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 hor-
monal 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 pre-
natally 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 dif-
ferentiating 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 par-
ents do not say anything about masculinity and femininity, except that
they represent identification with paternal and maternal images, respec-
tively.
Otto F. Kernberg 13
In other words, insofar as the characterological constellation con-

tains identifications with both parental images, what may be called mas-
culine 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, biolog-
ical 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 contro-
versies regarding homosexuality, is also the area where our ignorance is

greatest. In contrast to the three other elements determining human sex-
ual behavior, the persisting taboo regarding research on child sexuality
has made this field still unexplored, with the exception of the retrospec-
tive insight into early childhood derived from adult analysis, and the di-
rect 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 objects enactment of gender
role) of the object of sexual (erotic) desire that defines heterosexuality,
homosexuality, and bisexuality. From the viewpoint of psychoanalytic
object relations theoryprobably the most generally agreed upon theo-
retical frame that bridges alternative psychoanalytic theoriesit 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 psychoan-
alytic theory.
Freud postulated a psychological bisexuality, derived from the un-
conscious 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 het-
erosexual and homosexual patients in terms of the unconscious identifi-
cation 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 uncon-
scious identification with both parental figures, emerges as a crucial de-
terminant 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 psycho-
analysis.2 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 de-
scribing 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 bi-
sexual area (Kernberg, 1992). The predisposition, on the basis of ge-
netic 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 seg-
ment 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 be-
tween a culture presenting exclusive male homosexuality on the one
hand, and conventionally suppressed homosexuality within such a cul-
ture, 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 ba-
sic components of sexual behavior, namely, core gender identity, gen-
der role identity, object choice, and intensity of erotic desire. Freuds
Otto F. Kernberg 15
(1905b) original use of the term referred to bisexuality as a basic, origi-

nal bisexual psychic disposition derived from the unconscious identifica-
tion with aspects of parental images of both genders. Freuds 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
assumedand promotedcharacteristics of masculinity and femininity.
So much for the original use of the term bisexuality within the psycho-
analytic literature.
More recently, bisexuality has referred to habitual or extended object
choice of both genders, that is, the coexistence of homosexual and het-
erosexual 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 syn-
drome of identity diffusion and severe character pathology. This may
not be the case in situations such as prisons where previously exclu-
sively 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 clari-
fied, 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 gen-
der 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 bisexu-
ality, 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 psy-
choanalytic 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 nor-
mal 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 homosexu-
ally 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 pres-
sures. In healthier men, there may be suppression of that potential, flexi-
ble area of bisexuality that can be observed in women.
The explanation for the difference in tolerance of homosexual im-
pulses in the context of a heterosexual identity (relevant for the differ-
ence 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 hy-
pothesis, however, has been challenged by several psychoanalytic au-
thors, 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 view-
point of cultural influences, traditional patriarchic cultures have ele-
vated 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 implica-
tion, 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
Otto F. Kernberg 17
the case of women is socially tolerated. In any case, it seems reasonable

to propose that, among chronically bisexual men and women, the ma-
jority 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 determi-
nants 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 tra-

ditional 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 iden-
tity, a viewpoint that also corresponds to some culturalist psychoanalytic
approaches, such as Morgenthalers 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 identifi-
cation 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 oedi-
pal complex (Chasseguet-Smirgel, 1970, 1986). A corollary of that po-
sition 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, al-
though a few adherents of that view remain in the field (Socarides,
1978).
How is such a clash of opposing theoretical commitments to be re-
solved? 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 im-
portance 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 gen-

der 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 treat-
ment, 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 en-
tire 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 het-
erosexual with a bisexual intermediate zone may be indirectly evalu-
ated 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 treat-
ment, 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 re-
lation 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 ques-
tionable.
In fact, with the acceptance of homosexual candidates in psychoana-
lytic 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 an-
alyze a male homosexual patient (Isay, 1989), a position that also re-
minds one of the equally problematic assumption that women analysts
should analyze women patients, or that preferably women should ana-
lyze 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
Otto F. Kernberg 19
with the corresponding psychodynamics of heterosexual patients. I

have proposed in earlier work (1992) that the prognosis of male homo-
sexual patients in psychoanalytic treatment depends on the level of se-
verity 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 usu-
ally 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 oneto which
an erotic submission or allegiance protects the patient against the terror

of a split-off, sadistic and castrating paternal image, and a profound pro-
hibition against sexual impulses toward the oedipal maternal image. A
defensive idealization of anal sexuality as a regression from a predomi-
nant genital sexuality complements this constellation.
This dynamic usually overlaps with that of an unconscious identifi-
cation with a maternal figure, in an unconscious bid for fathers 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, deter-
mining 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 ideo-
logical 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 iden-
tity 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 psycho-
dynamics of borderline personality organization alone. In contrast, ho-
mosexual patients who present a predominantly oral orientation toward
the idealized father, with severe and pervasive conflicts of hostility to-
ward the preoedipal mother, constitute a specific syndrome of male ho-
mosexuality 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 cor-
responding clinging nature of chaotic love relations of heterosexual

borderline patients.
A third, and quite characteristic constellation, is that of male homo-
sexuality in a narcissistic personality structure, with a defensive ideal-
ization of the homosexual relationship as the counterpart to an aggressive
devaluation of women, and an alternation between exploitative tenden-
cies toward a mirror image erotic partner, on the one hand, and the in-
capacity 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 ap-
pear to be more stable and adaptive than that of the borderline homosex-
ual patient with an unconscious identification with a dependent, clinging
infant relating to a maternalized father image. In this latter case, a cha-
otic 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 con-
trasts 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 syn-
drome that again presents practically the same dynamic characteristics
as heterosexual malignant narcissism. Male antisocial personality dis-
orders of the aggressive typethe homosexual serial killerscorrespond
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.
Otto F. Kernberg 21
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 distor-
tions because of a superimposed, culturally determined homophobia?
Or, to the contrary, should we accept the theoretical assumption of a pri-
mary 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 infants 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 girls
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 sex-
ual 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 lit-
tle 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 mothers unconscious homophobic
defense, and leading secondarily to the various psychodynamic constel-
lations 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 re-
action to the development of penis envy, which normally would deter-
mine the disappointed turning away of the little girl from mother to
father, the positive oedipal relationship might be disrupted by the trans-
fer of that disappointment to father, in a situation where the pathological
intensity of penis envy would determine an unconscious identification
with fathers penis, the devaluation of masculinity, and the develop-

ment 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, submis-
sive erotic idealization of mother might serve both to eliminate oedipal
guilt and to avoid the competition with the envied father.
The implication of Freuds and Abrahams view was that penis envy
occupied a fundamental etiological role both in the shift of the little
girls love from mother to father, and in the failure of this shift deter-
mined 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 re-
gressive 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
conflictsparticularly aggressiononto the relationship with father, bring-
ing 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 mater-
nal 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 girls erotic interest to father in an unconscious
identification with mother, the identification with mothers desire.
When this process is disrupted by excessively severe aggressive inter-
actions 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 frus-
trating and unavailable father.
Obviously there are many individually differentiated psychodynamics
that can only be roughly encompassed by such general statements.
Otto F. Kernberg 23
However, as Poluda (2000) stresses, all the described dynamic constel-

lations 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 differ-
ential characteristics of female and male homosexuality and bisexual-
ity. 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 cou-
ples, probably replicating important differences in male and female sex-

uality 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 pre-
dominate, 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 Abra-
ham, 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 homo-
sexuality with a borderline personality organization. Here we find in-
tense 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 narcissis-
tic personalities with heterosexual orientation.
As mentioned before, in contrast to these relatively fixed or perma-
nent types of female homosexuality, the late onset female homosexual-
ity 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 bi-
sexual spectrum that has been hypothesized from the theoretical per-
spective 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 help-
ing the patient to consolidate his or her own sexual identity, with the an-
alysts total acceptance of that potential freedom of the patient, and an
ongoing, self-reflective awareness of the high risk of ideological con-
tamination of the clinical approach in this particular area. This is a task
for both heterosexual and homosexual analysts who analyze homosex-
ual 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 re-
ferred to should be more than sufficient to consider that an analysis of a
homosexual patient has been completed, not different from the expecta-
tions that we have of the analysis of a heterosexual patient. The counter-
transference 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 analysts
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; eas-
ier 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 psychoana-
lyst, not be demanded also of the psychoanalyst who analyzes the pa-
tient 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.
Otto F. Kernberg 25
NOTES
1. Editors Note: American Psychiatric Association (1994), Diagnostic and Statisti-
cal Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric
Press.
2. Editors Note: Within psychoanalysis, the rejection of a theory of universal bisex-
uality, first put forward by Sandor Rado (1940A critical examination of the concept of
bisexuality. Psychosomatic Medicine, 2:459-467. Reprinted in Sexual Inversion: The
Multiple Roots of Homosexuality, ed. J. Marmor. New York: Basic Books, 1965,
pp. 175-189.), would later inform the psychodynamic theories which pathologized ho-
mosexuality as a phobic avoidance of the other sex.
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in the Psychoanalytic Theory

ABSTRACT. Powerful ideological currents, masked as scientific ap-

we may also assume the universal presence of homosexual as well as het-

KEYWORDS. Bisexuality, heterosexuality, homosexuality, narcissism,

The scientific study of homosexuality is undoubtedly one of the most

destructive and self destructive tendencies in the life of the individual

statements may be formulated at this point, reflecting changes in the tra-

The first contemporary controversy has to do with the extent to

ality and bisexuality (Maccoby, 1998; Maccoby and Jacklin, 1974;

In other words, insofar as the characterological constellation con-

versies regarding homosexuality, is also the area where our ignorance is

terminant of core gender identity as well as gender role identity. In my

(1905b) original use of the term referred to bisexuality as a basic, origi-

choanalytic hypothesis of a basic psychological bisexuality derived

of their homosexual impulses, as illustrated by the flexibility of women

the case of women is socially tolerated. In any case, it seems reasonable

male and female bisexuality, is challenged by the ideologies of both tra-

68 percent of these cases. A high proportion of male children with gen-

From a psychoanalytic perspective, the question of the existence of

with the corresponding psychodynamics of heterosexual patients. I

an erotic submission or allegiance protects the patient against the terror

responding clinging nature of chaotic love relations of heterosexual

From a theoretical viewpoint, the main issue involved in all these

Turning to female homosexuality, the most important question raised

with fathers penis, the devaluation of masculinity, and the develop-

or excessive unconscious guilt regarding the positive oedipal complex.

However, as Poluda (2000) stresses, all the described dynamic constel-

ples, probably replicating important differences in male and female sex-

away of the children from home, establish a homosexual relationship,

contrary, it seems reasonable to state that there is general agreement that

Friedman, R. C. (1988), Male Homosexuality: A Contemporary Psychoanalytic Per-

Farrar, Straus and Giroux.

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