Psychoanalysis has changed as western cultural values, beliefs, and identities have evolved, and in ways that Freud's original work could never have envisioned. During its period of dogmatism, psychoanalytic theory and practice tried to shield itself from these changes, creating to some the appearance of a religious order which had hermetically sealed itself off from the rest of the world. This was certainly true of psychoanalytic theories of homosexuality, which were cast in the scientific and cultural beliefs of another era. To the contemporary reader, these theories were detached not only from modern biological and sexological research, but also from the contemporary, subjective experiences of gay men and lesbians.
As psychoanalysis prepares to enter its second century, analysts of this generation are paying increasing attention to data from extra-analytic sources. This process includes integrating clinical, psychoanalytic data with newer findings and theories in other research areas, such as the neurosciences or evolutionary psychology. Other psychoanalytic theorists, with interests and training in the humanities, are taking the field in altogether different directions. Their work, informed by gender and cultural studies, has chosen to focus on the personal and cultural meanings of what goes on in psychoanalytic treatment. Narrative psychoanalysis addresses what homosexuality has meant to psychoanalysts in the past, and how the field has adapted to changing cultural meanings of same-sex relationships.

Freud's Psychoanalytic Unconscious: Meanings As Causes

Freud was trained as a physician and neurologist an in an era when neurology was a young but rapidly-expanding field. In fact, before he became a psychoanalyst, he wrote several papers about staining techniques for nervous tissue, a legitimate scientific endeavor of his time. His postgraduate medical training eventually led him to Paris, where he studied Charcot's hypnotic treatments for hysterical patients. Freud was, in fact, in the forefront of medical practice in the late nineteenth century, and he conducted his own, later clinical research and treatment of patients within the framework of the medical model.
Freud and an early medical colleague, Josef Breuer, introduced the pre-psychoanalytic "cathartic method." Its theoretical presupposition was based upon an analogy with the physical purging of blocked bowels for therapeutic purposes. They hypothesized that hysterics could be "purged" of the traumatic, usually sexual memories presumed to have caused their symptoms. In their model, what might be thought of as a metaphorical "psychological catharsis" occurred when a physician created the conditions in which a patient could talk about forgotten memories. This allowed psychic energies to be "discharged" and it was this presumed discharge that led to the disappearance of the patient's symptoms.
In their joint publication, Studies on Hysteria, Breuer and Freud, offered a novel linkage between the cause of an illness and the meaning of an illness in their claim that "hysterics suffer mainly from reminiscences" (1893, p. 7). As Freud went on to develop his later psychoanalytic model of treatment, he came to regard hysterical symptoms as physical complaints which resulted from unconscious conflicts, that is to say psychological struggles which were completely out of a patient's awareness. Freud would argue, for example, that a hysterical patient with a paralyzed hand might have an underlying, unconscious wish to sexually touch someone. This wish was at odds with the patient's moral prohibitions against sexuality, which were also out of consciousness. Unable to resolve the conflict in the conscious mind, "I want to touch but I should not," the psychological struggle is unconsciously transferred into the body, where it is enacted as a hysterical paralysis. Psychoanalytic treatment, through a process of free association and analytic interpretations, might allow the meaning of this unconscious conflict to enter consciousness. A conflict becomes conscious when the patient discovers the sexual wish as well as its prohibition. The need to resolve psychic conflict by moving it into the body disappears, and so should the symptom. In other words, the patient's hand should be able to move normally again. Here, the meaning of the symptom to the patient ("I am sexually conflicted") is regarded as the cause of the symptom ("I cannot move my hand because I am sexually conflicted"). The psychoanalytic search to make conscious a symptom's meaning is equivalent to the search for the symptom's cause.
Using analogous reasoning, Freud hypothesized that the origins of conditions other than hysteria could be explained in psychological terms as well: Schizophrenia, depression, bipolar disorder (manic-depression), obsessions, and compulsions, to name a few. All had an unconscious psychological meaning leading to symptoms. Again, the pivotal contention of Freud's psychoanalytic theory was that physical symptoms (or behaviors) had meanings and if a patient and therapist could uncover that meaning, symptoms could either go away or be alleviated.

Freud's Nonconflictual Theory of Homosexuality

One exception in Freud's conflictual model of human behavior was his theory of so-called perversions in general, and of homosexuality in particular. Freud believed that human beings were intrinsically bisexual and that homosexual feelings were normal. When sublimated, homoerotic feelings formed the basis of same-sex friendships and everyday camaraderie, leading Freud to conclude that a certain degree of homosexuality was necessary if one was to become a normal heterosexual. Furthermore, he did not think of homosexuality as a symptom of illness. Instead, as the homosexual instinct was presumed to be biologically intrinsic, those who actively expressed their homosexual impulses were simply expressing them in an unconflicted way. Because homosexuality did not result from conflict, it was not an illness, at least not in the psychoanalytic sense of the word. If homosexuality, as part of human nature had no conflictual meaning, psychoanalytic interpretation could not make it go away. This reasoning formed the basis of Freud's pessimism about finding a way to change gay men or lesbians into heterosexuals:
Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness; we consider it to be a variation of the sexual function, produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest men among them (Plato, Michelangelo, Leonardo da Vinci, etc.)...[Can I] abolish homosexuality and make normal heterosexuality take its place [?] The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible (Freud, 1935, pp. 423-424).
Freud never devoted a major psychoanalytic work to his theories of homosexuality. However, he addressed the subject over a twenty-year span and consequently his theories of homosexuality are complex, and often contradictory. For example, he did believe that childhood homosexuality was a passing phase to be outgrown on the road to adult (hetero)sexuality. Although he believed homosexuality was intrinsic and did not have a "cause," in the usual psychoanalytic sense, he nevertheless hypothesized one "cause" for the instinct's persistence into adulthood: homosexuality was caused by a boy being too close to his mother in childhood.

Mama's Boys

Do mothers cause homosexuality? Many psychoanalysts seem to believe so, although their unproven theories have no scientific validity. They simply draw upon cultural stereotypes about the meaning of homosexuality. The "mama's boy" is a case in point. That boys being too close to their mothers "causes" gender nonconformity is a rather common belief in the general population. Psychoanalysts, however, reporting on what their patients told them, attempted to elevate these cultural beliefs into pseudoscientific facts. Bieber et al. (1962), for example, conducted a study of gay men in psychoanalysis and claimed to have discovered homosexuality's "causes" through the analytic deciphering of their patients' narratives:
The majority of H-parents [that is parents of homosexual patients] in our study had poor marital relationships. Almost half the H-mothers were dominant wives who minimized their husbands. The large majority of H-mothers had a close-binding-intimate relationship with the H-son. In most cases, this son had been his mother's favorite.....In about two-thirds of the cases, the mother openly preferred her H-son to her husband, and allied with son against the husband. In about half the cases, the patient was the mother's confidant [p. 313].
In conducting this study, the Bieber group treated the information obtained from their patients' narratives as incontrovertible facts regarding the causes of homosexuality. They claimed that among their patients, the undermining of the father's authority by the boy's mother was a contributory factor in causing male homosexuality. They found "the best interparental relationships," meaning those least likely to produce homosexuality, in the families of their heterosexual patients where "father dominates but does not minimize mother" (p. 158).
In their evocation of the stereotype of the mama's boy, the Bieber study lent the ponderous weight of medical authority to a cultural belief that a father should be the undisputed head of his family. Foucault (1978) might have argued that such conservative conclusions often serve social purposes which have little to do with medicine, science or sexuality. In fact, psychoanalysts of that earlier era were often champions of the traditional nuclear family. Yet laudable as taking such a moral position might have been, it had nothing to do with science. In fact, there is not much research evidence confirming the Bieber theory from non-psychoanalytic sources. For example, a much larger study of 979 gay and lesbian individuals who were not in psychoanalytic treatment found no correlation between family dynamics in childhood and future homosexuality in adulthood (Bell, Weinberg and Hammersmith, 1981).
What the Bieber group did was use the language of science to uphold and reinforce deeply held cultural beliefs about the meanings of homosexuality. This may seem patently obvious, since one does not have to be psychoanalyst to believe that a boy who is too close to his mother runs the risk of undermining his future masculinity. Undoubtedly, many of the male homosexual patients treated in the Bieber study thought of themselves as mama's boys. After all, a belief in the supposed demasculinizing effects of mother is a cross-cultural one, although the solutions to the problem may vary from culture to culture. One tribe of Papua New Guinea also worries about boys being too close to their mothers. Unlike the Bieber group, the Sambia offer a homosexual solution to the problem of developing a masculine identity:
Seven-to-ten year old Sambia boys are taken from their mothers when first initiated into the male cult, and thereafter experience the most powerful and seductive homosexual fellatio activities. For some ten to fifteen years, they engage in these practices on a daily basis, first as fellator, and then as fellated. Elders teach that semen is absolutely vital: it should be consumed daily since the creation of biological maleness and the maintenance of masculinity depend on it. Hence, from middle childhood until puberty, boys should perform fellatio on other youths. Near puberty the same initiates become dominant youths. Ritual helps remake their social and erotic identity, the bachelors becoming the fellated partners for a new crop of ritual novices. And at the same time, youths and boys must alike must absolutely avoid women, on pain of punishment....This dual pattern--prescribed homosexual activities and avoidance of women--persists until marriage (Herdt, 1994, pp. 2-3).

Neofreudians Redefine Homosexuality as an Illness

For psychoanalysts, simply referring to gay men as mama's boy was insufficient to the task. To create the appearance of science demands a technical language and neofreudians, like Freud, chose the language of medicine and illness. As previously mentioned, Freud himself did not think homosexuality was an illness and he was pessimistic about changing the sexual orientation of adult patients. But neofreudians took a different position and considered "homosexuality to be a pathologic biosocial, psychosexual adaptation consequent to pervasive fears surrounding the expression of heterosexual impulses. In our view, every homosexual is, in reality, a 'latent' heterosexual" (Bieber, et al, 1962, p. 220). In search of a technical language for their theory, neofreudians went back to Freud's first conflict model. They maintained that homosexuality did not derive from an intrinsic bisexuality, whose existence they denied, but that same-sex attractions, like hysterical symptoms, had their roots in neurotic conflict. Eventually, it was the work of Charles Socarides which set the neofreudian standard for psychoanalytic attempts to reframe homosexuality as a product of conflict, and therefore amenable to psychoanalytic interpretation, treatment, and "cure:"
The perverted action [i.e., a homosexual act], like the neurotic symptom, results from the conflict between the ego and the id and represents a compromise formation which at the same time must be acceptable to the demands of the superego...the instinctual gratification takes place in disguised form while its real content remains unconscious (Socarides, 1968, pp. 35-36).
Given that Freud was unsuccessful in analogizing his theory of psychic conflict as a determining cause of other major disorders, it seems puzzling that neofreudians chose to emulate this model. One possible explanation, however, is that these theories of homosexuality were advanced during a period when the field of psychoanalysis had become extremely dogmatic and did not hold itself to the standard of scientifically verifying its theories from extra-analytic sources.
Neofreudian claims notwithstanding, no one has conclusively "proven" that homosexuality arises from an unconscious, intrapsychic conflict. In fact, unconscious, intrapsychic conflicts, based upon concepts like "ego," "id," and "superego," are metaphorical abstractions removed from clinical data. Psychoanalysts would have to first prove the existence of an ego, id and superego, which they have never done, before reaching the conclusion that conflicts between them lead to homosexuality. What neofreudians did instead was to construct a psychoanalytically meaningful case for their particular vision of human nature and the presumed goals of human sexuality. Theirs was a vision which idealized heterosexuality and denigrated less conventional sexual practices. They took the culture's disapproval of homosexual behavior and metaphorically likened it to the medical concept of illness.

Does Psychoanalysis Address Causes or Meanings?

At the cusp of the millennium, psychoanalysts have become increasingly intrigued by questions regarding the nature of the inquiry in which they are engaging. Is psychoanalysis a science or a hermeneutic discipline? Does it deal with retrievable historical facts or does it concern itself with the understanding or deciphering of meanings? Spence (1982), among others, has suggested that psychoanalysts and their patients generate narratives in their work together that are narrative constructions, rather than reconstructions of historical data. In other words, an analyst and patient generate a story that is meaningful to the two of them rather than discovering an objective history based on recollections of actual events. Analysts, swayed by their own theories and personal belief systems, can influence the shape of these narratives by asking leading questions and by directing their attention to certain patient responses. Patients in turn are adept at learning the clinical theory, attitudes, and language of their therapists. Together, the "successful" analysis leads to a shared narrative in which both the patient and the psychoanalyst can believe.
The history of psychoanalytic attitudes toward homosexual patients seems to substantiate this perspective. Rather than discovering the "causes" of homosexuality, the two participants in the psychoanalytic setting are engaged in a dialogue about the shared meanings of same-sex attractions and behaviors. The psychoanalytic views of Bieber, and Socarides prevailed when American culture vigorously disapproved of homosexuality from the 1940s through the 1960s. In those years, treatment began with the therapist and patient sharing the belief that homosexuality was a problem to be overcome, with both of them motivated to answer the question of how the patient got off the track toward normal heterosexuality. When social attitudes toward (homo)sexuality became more tolerant in the late 1960s, new psychoanalytic attitudes emerged as well. Rejecting the neofreudian theory of conflict, contemporary analysts maintained that homosexuality per se could not be attributed to conflictual factors and, harking back to an earlier era, they again regarded homoerotic feelings and behaviors as an expression of normal human sexuality.
If no scientific research to date has discovered the cause of homosexuality, or of heterosexuality for that matter, can two people sitting in a room who are essentially just talking to each other discover what causes homosexuality? Rather than seeing the analytic enterprise as a search for homosexuality's causes, contemporary psychoanalysts would maintain that a patient's (or therapist's) theory of homosexuality is both a personal and culturally constructed narrative about the meaning of homosexuality (Domenici and Lesser, 1995; Magee and Miller, 1997; Drescher, 1998). A patient who tells an analyst he thinks homosexuality is an illness that needs to be changed to heterosexuality does so in a social context. Such beliefs are shaped by years of cultural conditioning, interacting with the individual, psychological profile of the patient. The patient who believes his homosexuality is an illness is telling the analyst that he (the patient) thinks of himself "bad" and is asking the analyst, in the cultural role of healing priest, to make him "good."
In what is increasingly beginning to look like a postmodern psychoanalysis, the meanings of one's beliefs are treated as the significant communications of treatment. It can no longer be assumed that causes necessary lie in the meanings, at least not in the hysterical sense first laid out by Freud. As a result, the focus of treatment among contemporary psychoanalysts has moved away from Freud's favored motif of the "detective story." Treatment does not necessarily entail answering the question of what caused the patient to act in such and such a way. Instead, it can be regarded as a form of editing and literary criticism in which the personal, familial, and cultural sources of the patient's arguments and theories about him or herself are deconstructed, and then given back to the patient for consideration. This narrative approach to psychoanalytic treatment inevitably moves the field away from discourse on etiological theories. Narratives, after all, need to be convincing but they do not have to be proven. An awareness of this psychoanalytic limitation does raise the interesting question of what is therapeutic about good story-telling? Perhaps psychoanalysts will arrive at some conclusions about that particular subject in the next millennium.

References

Bell, A., Weinberg, M. & Hammersmith S. (1981), Sexual Preference: Its Development in Men and Women. Bloomington, IN: Indiana University Press.
Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., & Bieber T. (1962), Homosexuality: A Breuer, J. & Freud, S (1895), Studies on hysteria. Standard Edition 2. London: Hogarth Press, 1955.
Domenici, T. & Lesser, R., eds. (1995) Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.
Drescher, J. (1998) Psychoanalytic Therapy and The Gay Man. Hillsdale, NJ: The Analytic Press.
Foucault, M. (1978), The History of Sexuality, Volume I, An Introduction. Originally published as Histoire de la sexualité 1: La volonté de savoir (Paris: Gallimard). New York: Vintage, 1980.
Freud, S. (1900), The interpretation of dreams. Standard Edition, 4 and 5. London: Hogarth Press, 1953.
Freud, S. (1935), Anonymous (Letter to an American mother). In The Letters of Sigmund Freud, ed. E. Freud, 1960. New York: Basic Books, pp. 423-424.
Herdt, G. (1994), Guardians of the Flutes: Idioms of Masculinity. Chicago, IL: University of Chicago Press.
Magee, M. & Miller, D. (1997), Lesbian Lives: Psychoanalytic Narratives Old and New. Hillsdale, NJ: The Analytic Press.
Socarides, C. (1968), The Overt Homosexual. New York: Grune & Stratton.
Spence, D. (1982), Narrative Truth and Historical Truth: Meaning and Interpretation in Psychoanalysis. New York: Norton.