An outstanding psychiatrist, psychoanalyst and MD, Edmund Bergler wrote 25 books on psychology and 273 articles in leading professional journals. His books cover topics such as child development, neurosis, midlife crises, marriage difficulties, gambling, self-destructive behavior, and homosexuality. Bergler was rightfully recognized as an expert of his time in terms of homosexuality. The following are excerpts from his work.

Recent books and productions have attempted to portray homosexuals as unhappy victims who deserve sympathy. The appeal to the lacrimal glands is unreasonable: homosexuals can always resort to psychiatric help and be cured if they want to. But public ignorance is so widespread on this issue, and the manipulation of homosexuals by public opinion about themselves is so effective that even intelligent people who were definitely born yesterday did not fall for them.

Recent psychiatric experience and research has unequivocally proven that the supposedly irreversible fate of homosexuals (sometimes even attributed to non-existent biological and hormonal conditions) is actually a therapeutically altered unit of neurosis. The therapeutic pessimism of the past is gradually disappearing: today psychotherapy of a psychodynamic direction can cure homosexuality.

By cure, I mean:
1. a complete lack of interest in their gender;
2. normal sexual pleasure;
3. characterological change.

Over thirty years of practice, I successfully completed the treatment of a hundred homosexuals (thirty other cases were interrupted either by me or by the patient's departure), and advised about five hundred. Based on the experience gained in this way, I make a positive statement that homosexuality has an excellent prognosis for psychiatric treatment of the psychoanalytic approach from one to two years, at least three sessions a week, provided that the patient really wants to change. The fact that a favorable outcome is not based on any personal variables is confirmed by the fact that a significant number of colleagues achieved similar results.

Can we cure every homosexual? - Not. Certain prerequisites are necessary, and most importantly, the desire of a homosexual to change. Prerequisites for success:

1. internal guilt that can be therapeutically used;
2. voluntary treatment;
3. not too many self-destructive trends;
4. therapeutic preference for homosexual reality of homosexual fantasies;
5. lack of real experience of complete mental dependence on the mother;
6. lack of persistent reasons to maintain homosexuality as an aggressive weapon against a hated family;
7. lack of an “authoritative” statement about incurability;
   
8. experience and knowledge of the analyst.

1. Guilt

We know that guilty feelings are present without exception for all homosexuals, although in many cases it is not noticeable and, more importantly, even being in a latent state cannot be used analytically. The question arises: where is it usually deposited? The answer to the banality is simple: it, as a rule, is deposited in social ostracism, in the real danger of coming into conflict with society, with the law, with blackmailers. Absorption in the desire for punishment is sufficient for them in most cases. Such people do not want to get out of their vicious circle and therefore do not seek treatment.
Gay's internal guilt is especially difficult. On the one hand, despite the almost complete lack of conscious guilt, a homosexual man who came to me because of other neurotic symptoms was cured of his homosexuality. On the other hand, despite the fact that it looked like an immense sense of guilt in one patient, there was little to help him. He did not advance beyond premature ejaculation with a woman. Therefore, it must be recognized that we do not yet fully understand the practical assessment of the possibility of using this sense of guilt among homosexuals. The bloated guilt often turns out to be a mirage unconsciously supported by the patient in order to prove his inner conscience: “I do not enjoy it; I suffer". Therefore, before making a forecast, in doubtful cases, a trial period in the 2 – 3 month will be appropriate.

2. Voluntary treatment

Homosexuals sometimes come for treatment for the sake of their loved ones, parents or relatives, but the strength of such sensual aspirations is rarely enough for success. In my experience, it seems that for homosexuals there is no such thing as a beloved parent or relative, that these patients are filled with wild unconscious hatred of the latter, hatred comparable only to the wild self-destructive tendency. I am of the opinion that the willingness to start treatment is an indispensable condition. Naturally, you can try to mobilize guilt for a kind of trial treatment, but I am increasingly avoiding this attempt as futile.

3. Not too many self-destructive trends

Undoubtedly, the disfavor of society, as well as the methods of concealment and self-defense that every homosexual is forced to resort to, contain an element of self-punishment that absorbs part of an unconscious sense of guilt arising from other sources. However, it is amazing how large the proportion of psychopathic personalities among homosexuals is. In simple terms, many homosexuals bear the stigma of insecurity. In psychoanalysis, this insecurity is considered part of the oral nature of homosexuals. These people always create and provoke situations in which they feel unfairly disadvantaged. This sense of injustice, which is experienced and perpetuated through their own behavior, gives them the inner right to be constantly pseudo-aggressive and hostile to their environment, and to feel sorry for themselves masochistically. It is this vindictive tendency that the non-psychological, but observant outside world calls homosexuals “unreliable” and ingratitude. Naturally, at different social levels, this tendency manifests itself in different ways. Nevertheless, it is amazing how large the proportion of homosexuals is among scammers, pseudologists, counterfeiters, offenders of all kinds, drug dealers, gamblers, spies, pimps, brothel owners, etc. The “oral mechanism” of the development of homosexuality is fundamentally masochistic, although it certainly has a very wide facade of aggression. To what extent this self-destructive tendency is accessible therapeutically depends, undoubtedly, on its quantity, which is not currently established. Estimating the number of other neurotic investments of the patient allows you to quickly navigate. In other words: how much does the patient harm himself in other ways? These “impossible and smug people,” as the mother of one of my patients described her son and his friends, are often worthless as patients.

4. Therapeutic preference for homosexual reality of homosexual fantasies

Sometimes it happens that young people who are homosexually attracted begin analytic treatment at the very time when they have already decided to switch from fantasy to action, but still have not found the courage to do it. Thus, analysis becomes an external alibi for them. Alibi is that the patient reassures himself that he is in the process of treatment, giving him the opportunity to recover, and everything that is happening at this time is a transitional phase. Thus, this type of patient abuses the analysis in order to realize his perversion своё. Naturally, the context is more complex. The beginning of homosexual practices during the analysis represents an unconscious element of contemptuous pseudo-aggression against the analyst, whom the patient reproaches in the process of transferring the hatred conflict to hostility to homosexuals and treating them like animals based on moral considerations. Any attempt to show these patients that we see them not as animals, but as sick people, is blocked by mistrust. Thus, the analyst is subjected to a test, which can become very unpleasant, as the family will accuse him that the patient has become a practicing homosexual because of him. If the analyst shows the slightest internal resistance or disappointment when the patient accepts active homosexual relationships, treatment should generally be considered hopeless. The analyst will only provide the patient with the desired opportunity to “teach him a lesson”.
A patient of this type came to me for the treatment of kleptomania, but was also homosexual. He constantly arranged a polemic against me, claiming that internally I saw him as a criminal, although I always told him that I simply looked at him as a patient. Once he brought me a book as a gift and told me exactly where he stole it. He obviously counted on an emotional outburst on my part that would make me vulnerable. I thanked him for the book and suggested analyzing the purpose of his aggressive gift. It was possible to convince the patient that at least this the book must be returned to its owner. Trials run by a homosexual who begins an open relationship during analysis can last six months and is therefore more difficult to tolerate than the kleptomaniac case. This places a heavy burden on the analyst, which not everyone is able to bear. Experience teaches that it is easier if the patient has already entered into a relationship before starting treatment. This purely pragmatic conclusion is not affected by the age of the patient or the duration of his homosexual practice. In other words, even if people have been engaged in homosexuality for many years, under the first three conditions, they are easier to change than patients who first enter into a relationship during the analysis.

¹ Here the psychiatric use of the word “perversion” must be differentiated from the popular one; the latter includes moral connotations, while psychiatric perversion means infantile sex occurring in an adult, leading to orgasm. In short - a disease.

5. Lack of real experience complete mental
mother dependent

I mean cases when the mother was the only teacher. For example, an early divorce of parents or a completely indifferent father. Such a situation may be subject to masochistic abuse, and in the case of homosexuality, this is not encouraging.

6. Lack of persistent reasons to maintain homosexuality as an aggressive weapon against a hated family

There is a difference between whether pseudo-aggression against the family (manifested in homosexuality) belongs to the “historical past” or is used as a weapon.

7. Lack of “authoritative” statement about incurability

I would like to explain what I mean by example. A few years ago I had a homosexual patient. It was an unfavorable incident, because he did not have a sincere desire to get rid of perversion. He allowed his elderly friend (who was a major industrialist) to shower with presents and, thus, was on the way to male prostitution. The patient was completely inaccessible, and his resistance intensified when he told his rich patron that he was in the process of treatment, about which he was still very prudently silent. This man did something discouragingly insightful: instead of just trying to dissuade the patient from continuing treatment and putting pressure on him with threats, etc. - what usually happens - he told him that he was wasting time, because the highest psychoanalytic authority told him that homosexuality was incurable. He admitted that 25 years earlier, he himself was undergoing treatment with a very reputable psychoanalyst who a few months later completed work with him, saying that he was now reconciled with his homosexuality and that more could not be achieved. I don’t know if the old man’s story was true or false, but he gave the young man so many details about his treatment that the latter was actually convinced that the old man was telling the truth. In any case, I could not convince the patient that continued treatment would make any sense.
I believe that it would be better if authoritative pessimistic judgments were excluded. The fact remains: some of our colleagues consider homosexuality to be incurable, while others consider it to be curable. There is no reason to hide it from an incredulous patient. But there is also no reason to interfere with optimists in their work: if we are mistaken, our mistake will entail heavy retribution. Therefore, I declare that analysts should exercise caution in such matters and, above all, they must keep the pessimism of their former department to themselves as a personal statement.

8. Analyst experience and knowledge

As you can see, I bring the analyst’s special knowledge last, which, therefore, are relatively insignificant. Not wanting to be cynical, I have to say that when I read the medical history of homosexual patients published in our journals and see how different types of homosexuality are distinguished, I get the same impression as if the scientists described the different forms adopted by desert sand under the influence of the wind, forgetting that in the end they deal only with sand. The forms accepted by the sand can be very diverse, but if someone wants to know the chemical composition of the sand, he will not become wiser if, instead of the sand formula, he will supply sober sincerity with many descriptive forms of sand. Each analyst has deep prejudices in favor of his own experience, gained as a result of many bitter disappointments. Based on my clinical experience, the pre-oedipal attachment to the mother and the breast complex are the psychic center in male homosexuality, and that it, like the Oedipus complex, is secondary to these patients. On the other hand, there is no reason to doubt the good practices of other colleagues, although, in my opinion, they simply relate to the surface layers.
We must also be extremely clear about what we call success in the treatment of homosexuality. I reject as an analysis goal the opportunist idea of ​​reconciling the homosexual with his perversion, as with something given from God. I also reject any attempts to sound analytic success, when a homosexual becomes occasionally able to commit coitus purely out of a sense of duty, completely without interest and retaining attraction to his sex. In my opinion, we are dealing with striking failures in both cases. As already mentioned, by success I mean: a complete lack of sexual interest in one's sex, normal sexual enjoyment and a change in character.
I am the last one to say that this is possible in every case. On the contrary, this is only possible with a very specific and limited group of homosexuals. I already mentioned the trap of therapy: many patients never go beyond premature ejaculation with women. The most difficult thing is to change the orally envious masochistic personality of these patients, which can survive the disappearance of the perversion itself. The bad reputation of our therapy among homosexuals is due not only to analytical skepticism and the misuse of the analytical tool. To these we must add indiscriminate acceptance for treatment of homosexuals with a poor prognosis (as it turns out later). Such patients become eloquent propagandists against us, spreading the false assertion that analytical psychiatry cannot help homosexuals. The danger can be eliminated by selecting suitable cases. I believe that the prerequisites that I have listed can help in this selection.

You should also be aware of the pseudo success observed in a small minority of cases. We are talking about the temporary disappearance of symptoms, when the analyst directly or indirectly touches the real motives of the patient, and he, due to an unconscious fear of losing his general mental structure, temporarily stops the symptoms. In other cases, a defensive reaction may dictate an escape (the homosexual patient suddenly interrupts treatment). The patient sacrifices the symptom, but this is always done in order to prevent the analysis of deeper unconscious tendencies with libidinal content. Freud called this defense mechanism "the flight to health."
There are two differences between pseudo-success, and genuine, hard-won process. First, pseudo-success represents a dramatic transformation overnight; genuine successes are always characterized by long periods of obvious progress and obvious regression, as well as indecision and hesitation. Secondly, there is no obvious connection between the processing of the material and the disappearance of the symptoms, and this is completely understandable, since the very purpose of sacrifice is to protect the layers that would otherwise be destroyed by the analysis of the symptom. Unfortunately, there is full confidence in relapse with such pseudo-success.

Sources: Edmund Bergler MD
The Basic Neurosis: Oral Regression and Psychic Masochism
Homosexuality: Disease or Way of Life?

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E. Bergler - Homosexuality: A Disease or Lifestyle?