The Group-Fantasy Origins of AIDS

By CASPER G. SCHMIDT
The Journal of Psychohistory, Summer 1984.

Since 1981 a noteworthy epidemic of an acquired immune deficiency syndrome (AIDS) has been described in the larger part of the First World, beginning with the United States of America, but now also found in Western Europe, South and Central Africa, Australia and a scattering of other pockets. It has been described mostly in a few select groups of people at greater risk: homosexual men, IV drug abusers, Haitians and Afticans, children of people in at-risk groups, and a small percentage of people who fit into none of these categories. At the time of the writing of this paper (July, 1984), the total number of US. cases reported to the Centers for Disease Control in Atlanta is in excess of 5,200, of whom approximately 45 per cent have died.

Though small in scope, this epidemic is intensely cathected, as are all group-fantasy rituals. (This is in contrast with Alzheimer's disease, for example, which is unconnected to group-fantasy and kills 120,000 people per year.)

The most popular scientific theory about the etiology of AIDS is a viral hypothesis. According to this theory - which has been taken over by the lay press - AIDS is caused by a novel or mutated virus spread through the exchange of body fluids or through infected needles. A suitable candidate for this viral agent was discovered by French researchers who published their findings in May of 1983. There was very little media attention paid to this since the information was at that time out of sync with the dominant group-fantasy in the US. By the spring of 1984 American researchers announced identification of a similar retrovirus (HTLV-111), with a formal press conference and a great deal of media attention. Immediately after this the consensus of mainstream America was that AIDS had been "solved", with a blood test soon to be available (however uncertain its significance and shaky its interpretation), and with optimistic predictions of a vaccine soon to emerge from the laboratory.

There are, however, not one but two main classes of contagious illness in man: infectious diseases (spread by germs) and contagious forms of psychological disturbances (spread by suggestion). It is often forgotten that the reigning theories of the origins of infectious illness before Pasteur came along were those of humoral causation ("bad humors") and the theory of putrefaction. It took Pasteur years to prove and convince people of the germ theory of infection. Once that explanation became accepted, it became unshakable due to the inertia of the mind. To this day, every single disease entity for which no adequate explanation has been found has been ascribed to a viral origin (from schizophrenia down through autoimmune disorders).

I propose an alternative hypothesis for the etiology of AIDS, based on the second of these two mechanisms of contagion in man. This will posit a psychosocial origin of epidemic AIDS, which will lie on the cusp between immunology, pathology and psychology (the latter including the psychology of both individuals and groups). I will do so in twin papers meant to be read in tandem: this one, which will deal mostly with the group psychology, and a second paper for the medical press. In the medical paper, which is entitled, "The Pathogenesis of Epidemic AIDS", I account for the "biological" end of the disorder. It will trace the physiological effects of the group-psychological factors outlined in this paper on the individual patient, with the resultant epidemic of severe, mostly masked, reactive depression in the at-risk groups, of which the immune deficiency is one facet. It will outline the pathway and the mechanism by which the cellmediated immunity may be suppressed, and will provide an animal model for AIDS, as I discuss below.

HYPOTHESIS

In this paper I would like to present the evidence available to me in support of the hypothesis:
(a) that AIDS is a typical example of epidemic hysteria;
(b) that the epidemic has at its core an unconscious group delusion, which can be called the group-fantasy of scapegoating, according to which the poison feelings of the entire group are injected into containers who are called scapegoats and whose destruction rids the group of these bad feelings and insures its purification of guilt and sinfulless;
(c) that the same fantasy complex underlies this scapegoating ritual as was found for leprosy during the Middle Ages and early Renaissance;
(d) that the proximal and distal causes of the tensions giving rise to the epidemic can be found in the group psychology of the United States and (to a lesser extent, inasmuch as they follow the cultural lead of America) the West since World War II;
(e) that among the more important distal causes are the effects of the following drastic changes in cultural ethos: the development of nuclear arsenals with a potential for obliterating the world, and the changes this has forced in the psychology of warfare; the introduction of birth control and the invention of "recreational sex"; positive changes in the mental health of American women over the last 35 to 40 years, culminating in the women's liberation movement and the proposed Equal Rights Amendment to the US. Constitution; and the "liberation" of various disenfranchised groups such as blacks and homosexuals;
(f) that the proximal cause can be found in a vast, society-wide conservative swing (or neo-popuhst trend) in public opinion since 1977, cumininating in the Reagan years and the Central American conflict;
(g) that the combination of these unconscious group tensions brought about a subtle and sophisticated, but nevertheless sacrificial witch hunt, in which the participants were the Moral Majority and an assortment of other conservative groups (as hunters) and the nation's drug addicts and homosexuals (as hunted);
(h) that both of these subgroups are ardng-out group-sanctioned and group- delegated roles, which acting-out takes place mostly outside of awareness;
(i) that these attacks resulted in an epidemic of depression based mostly on shame;
(j) that the core sign of AIDS, the reclusion of cell-mediated immunity, is one of the typical vegetative signs of a severe depression (the mechanism of which will be the focus of the medical companion piece to this paper);
(k) that the epidemic represents, in the group's unconscious fantasies, an equivalent of war, during which the group keeps carefull count of the sacrifices;
(1) that most of the members of the group (the U.S.A.) are in a regression vis-a-vis this phenomenon, a trance state which is noticeable in a certain suspension of logic in the lay press and in the medical literature;
(m) that there are powerful forces at work to delay the solution of the puzzle posed by this epidemic and to obscure its group-fantasy origins, since the epidemic itself is a wished-for solution to pre-existing conflicts;
(n) and finally that, since the epidemic is psychogenic, the prediction can be made that the group will decide when it should be over (when they have "had enough"), a decision which will be broadcast to the group members through the media, so that after a suitable lag period (based on the time needed for the T-helper lymphocytes to be restored to previous levels of functioning) the epidemic will resolve and the incidence will descend from epidemic to endemic levels.

EPIDEMIC HYSTERIA

The capacity for effective working-through of emotional conflicts within groups is restricted. Bion has shown how groups have great difficulty in performing real work, and how insidious and predominant are those emotional positions which he called basic assumptions (where fantasy solutions hold sway over realistic ones). The commonest pathway for the discharge of dammed-up group tension, historically speaking, is recourse to action. Thus the regular occurrence of human sacrifice, ritual scapegoating, cannibalism, and war throughout history, even though these rituals become more covert the closer one gets to the present. The group actions need not necessarily be destructive, and reparative rituals such as baby booms are also found (usually as a guilt-motivated attempt at replacing those "babies" that had been ritually killed off in fantasy during war).

Opposed to these instances of group action, where the direction of discharge has outward, there is a second avenue of discharge in which the aggression is turned inward. This gives rise to waves of psychological and psychosomatic disturbances, to which the descriptive label of epidemic hysteria has been given. These occur in group members of lower status or in those who do not wield much power (predominantly women, children, laborers, prisoners, and other "powerless" members of the group).

Some solid reviews of the reported cases and the literature have appeared. Since 1943 there has been an upsurge in interest in this topic, after a long hiatus since 1917 during which it virtually disappeared from all medical writing.(1) However, in the mainstream of American psychiatry very little attention has been paid to these phenomena. For example, in the Comprehensive Textbook of Psychiatry by Freedman, Kaplan and Sadock (Second Edition, 1975) - surely the most catholic and eclectic textbook ever devised - I find but one reference to the concept of mass hysteria. Slater and Roth's Clinical Psychiatry (1972) has two, both pertaining to children. (My interpretation is that there may be a strong unconscious resistance to the examination of one's own group participation: since it is both frightening and awesome, and, when known, such awareness interferes with one's ability to act out the group rituals.) To turn now to the phenomenology of epidemic hysteria. The duration of the episodes so far recorded are all relatively short (ranging from a few hours to a few months, only Markush (2) boldly including lengthier ones), The prototypical epidemic is as follows: in a social situation of pronounced stressfulness, in which the members have little or no recourse (schools, factories), a particular stressor is added to the mix; after this a few persons develop vague, non-specific somatic complaints, which go undetected; soon more people become ill; it comes to the attention of the authorities (management and medical), and a rumor spreads, ascribing the outbreak to some toxin in the environment; the group becomes polarized into those who help versus those who fall ill; all stops are pulled out (a typical scene has a panic-stricken school surrounded by fire engines and ambulances with sirens whining, medical epidemiologists taking air and water samples, while school girls are fainting all over) and everything is enveloped in an atmosphere of crisis; the local media spread the news and the rumor, thus precipitating further attacks; an intervention is made (such as closing the school); gradually the number of casualties declines, and the epidemic disappears as mysteriously as it had come.

This can be schematically illustrated (with all the morphological features named in bold print) by a recent outbreak which was extensively and elegantly investigated by Kerckhoff and Back.(3)

The June Bug Epidemic

In Spartanburg, South Carolina, an epidemic occurred in June, 1962 at a large textile plant. There were many sources of strain within the plant: lots of overtime had been put in; many of the workers earned half or more of the income of their respective families; there were strained relationships with supervisors and concerns over work output; in addition, many workers showed role-conflict denial, or a lack of concern that their overtime work kept them from their families (distal causes). June was a particularly busy month, when production was at a peak for the fall line (proximal cause). For about three weeks people had been complaining of bugs and of being bitten, and one week before the epidemic started the plant had been sprayed three times with malathion (the "silent" penumbra of the epidemic). On Friday one person became ill, complaining of severe nausea, and had to be treated by the company physician. Five more got ill on the Tuesday following, fainting and breaking out in hives all over so that some even had to be hospitalized (core syndrome of the epidemic). There was a widespread belief that people were getting ill after being bitten by a poisonous bug, introduced into the plant on cotton from England on that Wednesday (belief in a poison threat). The spread of cases was as shown (Figure 1). On Wednesday the plant was closed down and fumigated. (This was the unconscious epidemic aim, which resolved all tensions related to the work situation through simple avoidance.) Over the next few days the plant opened again, with workers returning in an agitated state. Various experts and authorities were called in (health officials, entomologists, representatives from the plant's insurance and the local exterminating company) and samples of food, bugs and air were taken. More cases occurred on Friday, on Saturday and the next Monday, after which the episode ceased. The time from the onset of the penumbra to the onset of the core syndrome (penumbral lead time) was three weeks, and the duration of the core syndrome itself was 11 days. Two months later, when the researchers investigated the epidemic, 51% of the unaffected expressed a belief in "the bug" as the cause of the disturbance, while 81% of those affected thought so (extent of the belief in the poison threat). In their analysis of the dynamics of the epidemic, the investigators found that 75% of those affected could be predicted by a few variables: (a) strain (the more strain, the more likely persons were to be affected); (b) social influence (if workers knew two or more affected cases, they were more likely to fall ill themselves); and (c) denial (which increased the likelihood of becoming affected in all categories). They found that the psychic contagion (the belief that people were getting ill from the bite of the bug) spread by imitation, by suggestion and by personal contact:

In any such case there are several processes of dissemination going on at the same time, all of which are interrelated but any one or combination of which may become the focus of attention: (1) the spread of a belief in a threat; (2) the spread of the experience of symptoms; (3) the spread of relatively unobtrusive methods of coping with the threat and/or the symptoms; (4) the spread of cases of collapse in the face of the threat and/or the experience of symptoms via seeking medical aid.

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The most promising approach to the complex phenomenon of epidemic hysteria is from a psychoanalytic point of view, of which Sirois is the foremost and most eloquent proponent.(4) (Trying to understand group dynamics of this kind without the conceptual tools such as "the unconscious" and "group-fantasy" is self-limiting, like trying to understand diabetes without recourse to concepts such as "molecule" and "blood sugar".) Central to his theory and also that of most social psychologists working with such epidemics, is the idea of an unconscious belief shared by many (a group-fantasy). Sirois theorizes that these epidemics represent a contagious type of psychopathology, where the contagion is "a wish whose vector is a fantasy that circulates in a reservoir of susceptible persons".(5) He defines three elements of the epidemic: a prodrome, an epidemic moment (when first cases become manifest), and a rebound (or secondary waves of affliction). For each episode, he says, there is an underlying fantasy which is cathartically worked- through via the epidemic disturbance. An epidemic of hysteria develops (as opposed to other forms of disturbance) due to three factors: (a) the group regression; (b) identification with the index cases; and (c) the unconscious nature of the underlying conflicts or fantasies. "This last aspect is a crucial factor in fostering the manifestation of the conflict through displaced, symbolic or alternate channels."(6) Thus, he argues, the psychosomatic presentation of most epidemics.

The biggest theoretical challenge to the researchers, and the aspect most resistant to explanation or to plausible hypotheses, is the simple fact that perfectly normal and seemingly healthy people get caught up in these epidemics. The disconcerting possibility that this raises is that we are all susceptible. When the psychometricians measure the subjects they find nothing to explain why certain people with a certain make-up get sick and others with identical profiles do not. The tools used to measure them are, however, those designed for picking up individual psychopathology, often of a gross kind. It seems to me that they are measuring the wrong thing. To state it by analogy: if one were to try to determine, in a crowded disco, which people would get up to dance to a certain number, the highest probabilities found would lie on an intersect between the person's drive state (how strong the urge is to dance) and some particular characteristic (what a specific song or partner means to a specific person). Thus, what is sought to be measured here is something inherently evanescent. In an epidemic of hysteria these variables would seem to be (a) the strength of the propensity to get sick in a psychosomatic way (a conversion factor), and (b) the specific contents of the group-fantasies and how well they fit the fantasy structure of the individual (so that the same person would be susceptible to a dancing mania but not susceptible to an epidemic of depression).

In time all of these epidemics come to be organized around - and retrospectively explained by - a core fantasy, which may be called the fantasy of a poison threat. It belongs to the psychology of belief systems, and we have to look to the dynamics of delusions for an explanation. Just as with individuals, the delusions shared by groups are reparative mechanisms: attempts at making sense out of inchoate or incoherent preverbal or affective experiences, or out of a painfull and poorly understood reality. As such they come after the fact, once the disturbance is already well under way. In most instances where the formation of delusions has been studied extensively (see Frosch(7) and Arieti(8), the person experiences a sudden and remarkable sense of relief once the delusion is formed. The confusion subsides.(9) Especially in hypochondriacal and melancholic delusions, the formation of the delusion and its psychosomatic expression permits massive relief from psychotic anxieties. Sperling(10) found that psychosomatic symptoms are solutions for anxieties of psychotic intensity. When conversion symptoms are "released" from their somatic form, they reveal intense and terrifying, and usually psychotic symptoms.(11) And in an epidemic of hysteria the delusion of a poison threat becomes the organizer for tremendous amounts of "poison feelings".

This shared fantasy of a poison threat is found in all cases of epidemic hysteria where there is enough information, and my hypothesis is that it will prove true for all cases if properly studied. These fantasies are culture-specific in contents (based on the theory of disease for each culture), and syntonic with the rest of the cultural beliefs. Underlying these various contents there is a universal radical which remains cross-culturally the same: in all epidemics the bad feelings are ascribed to some contact with poison or a poison threat.

During the twentieth century, since most epidemics take place in schools or factories, and in keeping with the dominant theories of disease, these epidemics are thought to be caused by: Poison gas, mystery gas, anesthetic gas, strange odors, acid or acrid smells, contaminated air, radioactive fall-out, poisonous dyes, fumes and solvents, and to on, in monotonous profusion. And despite extensive toxicological work-ups, no evidence for any of these toxins is ever found. (Suffice it to say that I exclude all cases of genuine poisoning.)

In other times, other fantasy poisons are found. In medieval Spain through Nazi Germany, Jews were believed to poison wells, or were blood poisoners of the group, or the Devil sent his assistants to poison the wells.'(12) In southern Italy people were "bitten" by poisonous tarantulas, thus poisoning their blood for life, a fate which could only be countered by dancing each summer until they dropped from exhaustion, after which they were bled (removal of "poison blood").(13) The dancers in the dancing manias of the Middle Ages believed they were dancing in rivers of blood, so that they had to lift their feet high.(14) In East Africa people caught up in a running mania were trying to escape from imaginary radio-active fallout.(15) During the Salem witch trials the witches were beaten with imaginary whips until the floor of the court was covered with imaginary ("poison") blood.(16) In epidemics of "Dhat syndrome" in India and South East Asia, men's semen became spoiled through their being libertines, and this spoiled semen (fantasy of poison sperm) had to be countered by celibacy and other restrictions on sexual activity.(17) In an epidemic of koro in Thailand, it was thought that the retraction of the genitals was caused by Thai food (noodles and cigarettes) being poisoned by Vietnamese refugees.(18)

A most significant finding is that these epidemics follow the divisions of class, ethnic groups and other cultural differences. (This is one of the major distinguishing features between epidemics of infection and epidemics of hysteria, since the former does not display this "ability" to follow cultural "fatat lines".) Thus, in an epidemic in a Singapore factory, Malay workers were predominantly affected, while those of different ethnic groups who became affected, were few and showed only mild, transient symptoms.(19) In the June Bug epidemic outlined above, the poisonous insect bit only white women working on the morning shift, while other workers on other shifts went unaffected through the same "contaminated" space. Among the Australian aborigines depression tends to occur in clusters rather than in individuals, and when this happens it will, for example, affect all the classificatory brothers of a clan in unison." The line between those affected and those left untouched can therefore be said to follow the cleavage lines of self, self-perception and identity.

Another frequently encountered finding is the fantasy that the poison which caused the epidemic was introduced from outside. It is obvious from analyses of these epidemics that tensions and unresolved conflicts originate from within the group. When these factors, which are psychologically speaking "poisoning the workplace", cannot consciously be identified and reasonably dealt with (due to denial or other defense mechanisms), they are projected outwards. Thus the poison threat is nearly always seen as coming from at least outside of the individual. When more severe regressions occur, the threat is seen as coming from farther away: in the June bug epidemic the culprits were thought to be poisonous insects that had arrived on cloth from England.

Once the epidemic has progressed to the point of consolidation - i.e., once the group delusion about its cause has been formed and disseminated - it thereafter dictates which measures will have to be taken to combat it. This can be called the epidemic aim. Like all things from the unconscious, these measures, though they may seem believable and imperative, are naive and concrete. The most popular solution is to locate the poison - in fantasy - and then to avoid it by dosing down the school or factory, or to build a cordon sanitaire around it (protective isolation), or to expel it to the outside of the group (e.g. by sending people into exile, such as Castro's Mariel evacuation). The core fantasy is always one of poison being contained through the epidemic aim in a person or a place (which may also be a fetish object), and then to avoid direct contact with it, since the poison is thought to spread by touch.

Not all people who come to participate in the epidemic share the epidemic disturbance to the same extent. This is most clearly seen in the 1944 epidemic of the "phantom anesthetist" of Mattoon, Illinois." As shown in Figure 2, two principal beliefs were registered: the one belief was that there was a prowler going around people's back yards; the second was the fantasy of people being put to sleep by a phantom anesthetist squirting gas through people's bedroom windows. This difference is found in most of the epidemics for which enough information is available.

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I propose that these fantasies be separated in principle into a core and a "silent" penumbra (as I indicated above in the synopsis of the June Bug epidemic). The penumbral syndrome is found in those who share in the group disturbance - and thus the group delusion - to a more limited degree than those with the core syndrome. I ascribe this difference to varying degrees of resistance to suggestion that people show within the group situation. In AIDS, this separation into a core and a penumbral syndrome is clear, as can be seen from the graph depicting the incidence of AIDS and of amebiasis (a syndrome of diarrhea caused by an intestinal parasite) in San Francisco. It is my thesis that amebiasis (as also later the lymphadenopathy syndrome, or general swelling of the lymph glands) constitutes the penumbral syndrome (figure 3). 1 take the differential factor to be a quantitative one, with amebiasis resulting from a lesser reduction of the cell-mediated immunity than that required to develop the full AIDS syndrome.

A final point concerning phenomenology. As Johnson was the first to identify, and as can be seen in Figure 2, the typical case of epidemic hysteria occurs in the form of two waves: a wave of suggestibility which is replaced by a wave of countersuggestibility, after which the whole system returns to a baseline condition. During that epidemic back yard noises, which otherwise would have seemed incidental, were ascribed - under the impact of this wave of suggestibility - to prowlers and later to the phantom anesthetist. After this wave had passed, identical noises were passed over as insignificant. The actual epidemic is parallel to the wave of suggestibility, and the wave of countersuggestibility gives rise to an unusually quiet and peaceful period afterwards. Within the wave of suggestibility there is a symmetry, so that the first part of the epidemic to appear (the penumbra) is the last to disappear, which symmetry also holds true for the core syndrome.

We can therefore come to a definition. Epidemic hysteria is (a) a form of collective mental disorder that takes place in a susceptible population, (b) through the mechanism of a contagion which spreads by suggestion; (c) this susceptibility is defined by the interface between individual character structure (drives) and distal group tensions, (d) and is enhanced by proximal stressors; (e) the contagion can be a wish, a fantasy or a delusion or whatever kind, (f) and gives rise through somatization to somatic or psychosomatic symptoms, (g) the purpose of which is to resolve conflicts through primary process (or unconscious) means, since (h) direct, conscious expression and resolution of conflict is impossible due to group defenses; (i) the spread increases geometrically since the occurrence of the first cases confirms the unconscious fantasy of a poison threat, (j) which is the unconscious encoding of bad feelings projected outwards, (k) in a fantasy complex syntonic with the culture, (1) which comes to be shared by various members of the group to various degrees, giving rise to a core and penumbral syndromes; (m) it is self-limiting, since the epidemic disturbance permits discharge of pent-up tensions (n) and the mobilization of the rest of the group in a reparative role.

It is my interpretation that the gestalt of AIDS, in its epidemic form, fits this definition precisely. According to this interpretation, the viral etiology which is subscribed to by many should be seen as part of the unconscious group delusion of a poison threat. The evidence presented so far supports the view that the virus which has been discovered (LAV / HTLV-111) is probably just another opportunistic infection, and plays, if at all, only a late role in the causal chain of AIDS. As in other epidemics, the poison which "causes" the disorder is assumed to originate from outside the country. At first it was thought that the poison had been brought back to the US. by vacationing homosexuals from Haiti." The final parts of the fantasy - that the virus was spread in Aftica by "itinerant inoculators" and had traveled from there to the US. via Haiti - was definitively formulated by Jacques Leibowitch of France, in a book entitled Un virus etrange venue d'ailleurs (A Strange Virus From Elsewhere, published in April 1984).(24) The route of the poison is clearly shown on this map from Newsweek (Figure 4).

The unconscious social conflict which AIDS is called upon to resolve is twofold: (a) unconscious drug-taking and homosexual fantasies within the general population, brought dangerously close to the surface because of the permissiveness of the 60s and 70s. The bad feelings stirred up by these changes were projected outwards, and into the scapegoats; and (b) guilt over sexual and addictive excesses within the general population as well as within these two subcultures. As we shall see below, when all of America swung to the right and became more righteous and dogmatic (taking a stand against license and permissiveness), a superego position was delegated to the New Right. They delivered a harangue to shame those who represented parts of ourselves (the id) which we now disavowed. This created a wave of reactive depression, caused by repression of the retaliatory fury that the shamed person feels. Three group-fantasies of a poison threat were evolved along the way, which in turn confirmed the delusional thinking and accelerated the epidemic. In fantasy, AIDS was thought to be caused by (a) promiscuity or, in the case of drug addicts, the abuse of drugs (fantasy of moral corruption and decay); (b) viruses contained in blood and blood products (fantasy of poison blood), and (c) viruses contained in bodily fluids, especially sperm (fantasy of poison sperm). These fantasies dictated the epidemic aims: (a) to reduce sexual activity or drug use to the point of abstinence or celibacy (at least in fantasy); (b) to stop the exchange of bodily fluids through the use of condoms, masturbation clubs, "safe sex" and sex rings of "clean" partners; and (c) to avoid the giving or receiving of blood. The core syndrome is the official definition of AIDS by the Centers for Disease Control in Atlanta, while the penumbral syndromes include the epidemic incidence of amebiasis (part of the "Gay Bowel Syndrome"), the lymphadenopathy syndrome and various forms frustes of depression. As I report elsewhere, a joke has come into circulation on every one of these facets of the group psychology.(26) The group trance is at this point heavily upon us, and anyone who proposes that AIDS is not caused by the virus (equivalent, in terms of the June Bug epidemic, to someone saying there was no bug) is viewed as a threat to the group's solidarity.

I have charted in Table I the major features of AIDS and the epidemic of the June Bug, to point up the parallels.

TABLE I: Comparison: AIDS & June Bug Epidemics

The group-fantasies in America contained virtually no mention of the other, officially defined at- risk groups, and there was a reluctance to include them in the official list of risk groups (especially in the case of children, since scape-goating fantasies about children provoke intense guilt). My interpretation it that people in these other risk groups have become involved through a spill-over effect on the basis of unusual suggestibility or because of an unconscious identification with one of the risk groups. Children are a special case. In the medical paper I hypothesize that these children suffer from severe anachtic depression (through deprivation or neglect), and that the pathophysiological mechanism is identical to that in adult patients with AIDS.

The fantasy complex of AIDS (i.e. the triad of promiscuity, poison blood, poison sperm) is not new. It is identical to the one in vogue during the Middle Ages to explain the origins of leprosy. It was generally accepted that leprosy was associated with violent sexual excitement and moral impurity - by the nineteenth century it was common opinion that leprosy was the consequence of lust. During the Middle Ages leprosy was thought to follow from the "filth of lechery", the "impurity of lust"(27) (fantasy of dangerous promiscuity). A second cause for leprosy was "the conception of a child 'in menstrual tyme"' (fantasy of menstrual, i.e. poisonous, blood).(28) A third group of etiological ideas are fantasies of poisonous sperm: John of Gaddesden warns that a man who sleeps with a woman who has previously had intercourse with a leper will contract the disease.(29) Bernard Gordon adds that the man will become leprous only if the woman still retains the seminal fluid of the leper.(30) Copland's translation of Guy of Chauhac advises the diagnostician "to enquyre yf he hath had the company of any lepresse woman. And yf lazar [i.e. a leper] had medled with her afore hym and lately because of the infect mater and the contagious filth that she hadde receyved of hym."(30)

It can be seen that this fantasy complex has not changed, and is encountered intact today, except that in the AIDS epidemic the fantasies have been translated into modern idiom (so that "contagious filth" becomes "semen containing cytomegalovirus or HTLV-III" or, more sophisticated still, "immunosuppressive sperm"). These unconscious fantasies are found not only in the lay press, but they determine the direction of our scientific thinking, so that in scientific magazines usually sceptical clinicians subscribe to them without sufficient proof.

THE MYSTERIOUS LEAP FROM THE MIND TO THE BODY

Against the grain of monoetiological thinking and an unconsciously held Cartesian dualism,(32) I posit that AIDS is a bio-psycho-social disorder. I argue that a sequence of group psychological events in the U.S. has shamed - and mercilessly so - the homosexuals and the drug addicts, giving rise to an epidemic of shame-induced depression. (I examine the dynamics of shame in the next section, and the ways by which it was achieved in later sections.)

Now, depression is not simply a psychological disorder. In fact, it is very much the "iceberg of psychiatric disorders", with just as much if not more going on below the level of consciousness than above. In transcultural psychiatry it has been found that the "psychological form of depression" (sadness, guiltiness and weeping) is not often found outside of the First World.(33) (My thesis, based on deMause's history of childrearing modes,(34) is that the psychological style of the upbringing of the child will determine the clinical picture when they become depressed as adults: the more sophisticated the childrearing becomes, the more the typology of depression will be "psychological".) The most common form of depression encountered elsewhere is that of a masked depression, in which the most obvious signs are the absence of pleasure and the various psychosomatic/somatic components of depression (weight loss, anorexia, lassitude, slowing down of movement, amenorrhea: the so-called "vegetative signs" of depression). In the medical paper I present evidence for the hypothesis that AIDS is a form of masked depression, and that a reduction in the cell-mediated immunity is one of the characteristic vegetative signs of a severe depression.

An animal model for AIDS has eagerly been sought, so far without much success, among infected primates (the so-called Simian AIDS). I think that the answer lies in a different direction and that the guidelines used in looking for an animal model have - incorrectly - been based on the infectious disease model. The closest animal equivalent to depression is that of 'learned helplessness."(35) When rats are exposed to conditions of inescapable shock in the laboratory, they develop learned helplessness, in which they cease to do anything that would alleviate their suffering. They then go on to develop a syndrome of weight loss, stunted growth, anorexia and a lowering of their cell- mediated immunity.(36) These are the same signs and symptoms found in AIDS (allowing for differences between species), and my hypothesis is that this is the valid animal model for AIDS in humans.

THE GROUP PSYCHOLOGY OF SHAME

Shame is one of the two superego affects (the other being guilt) and is the more problematic of the two. Lewis distinguishes between them as follows:(37) shame is the bad feeling you get when you perceive a defect in what you are, whereas guilt arises from the perception that you have done something wrong. Shame is accompanied by strong autonomic arousal, while guilt, being more "cognitive", has a less intense affective tone.

When the defenses against the experience of shame fail, various emergency measures are called into action, of which there are three germane to our purpose: the first is a wish to remove oneself from the painfulness of the observation which brings about the shame (the "Evil Eye" of folklore), and may include wishes to hide, to bury oneself, to withdraw, or ultimately to remove oneself from the group by way of exile or suicide. The second is a strong retaliatory fury which may be directed at the shamer ("to shame the shamer") or at the self. The more sophisticated the group or the individual, the more these vengeful, retaliatory aggressions are aim-inhibited and turned against the self (causing self-destructive actions, from minor accidents to a fury ending in a flamboyant suicide). Where these self-destructive actings-out are inhibited, the rage gets turned against the self and becomes depression. The third is a libidinization of the retaliatory fury with inappropriate sexual excitement. When this is acted upon, the sexual partner becomes in fantasy the object of the destructive rage. This mechanism is one of the root causes of compulsive sexuality, setting up a pathway which is called into service each time the subject feels ashamed.(38)

The reason for the strong reactions provoked by shame is most cogently explained by Piers:"(39) "Behind the feeling of shame stands not the fear of hatred, but the fear of contempt which, on an even deeper level of the unconscious, spells fear of abandonment, the death by emotional starvation." On a social level, within the group dynamics, this becomes the fear of exclusion from the lifeblood of the group, and of ostracism, which is the social death of the organism.

The way in which shame is used in a primitive setting is instructive. It is usually done through the delivery of a harangue (which I propose as the technical term for all shaming procedures). In a small village in Papua-New Guinea, for example, this will be enacted by one person shouting out the harangue at night, and it is listened to by all in absolute silence. The accused individual "will be found sitting inside his house 'with head bowed under the imagined stare of the whole community.'"(40) Response to such a harangue is swift and severe. The shamed person averts his eyes, withdraws, or - in its extreme form goes into hiding or exile.

Since the retaliatory ftiry and feelings of revenge can for the most part not be vented towards the group, it is turned inwards or inhibited, giving rise to various self-destructive acts. In a benign form (such as in veumayiyi(41)) the shamed person shames the shamer with an extravagant gift. In a more malignant form, the person becomes suicidal: Malinowski gives examples of people committing "flamboyant suicide" by jumping from palm trees after being shamed for transgressing a dan taboo.(42)

A particular form of shame is that which is felt for others who have been shamed and with whom one has identifications, especially in field-dependent subjects. The prototype of this reaction and its resolution is found in an account by Sack.(43) In former times it seems that when a woman had been shamed only her death could remove the shame. I interpret this as a pathway by which already- existing matricidal impulses can be discharged through a fantasy of "killing the shamed". This is confirmed by the fact that it was usually the woman's own son who led the killing party. It is my contention that this mechanism of 'killing the shamed" in one of the most powerful, though deeply repressed, dynamics of the AIDS epidemic: that which is enacted in real murder in the tribal culture, becomes a more sublimated but nevertheless equally venomous outpouring of death wishes towards drug addicts and homosexuals. It is as if the shame of the offenders' misconduct were acutely felt by the rest of the group, so that only their elimination can remove the painful effects of the shame. These identifications are based on an unconscious resonance between the shamed ones and the rest of the group.

The epidemic of AIDS is an awesome demonstration of the power and destructiveness of so much concentrated shame. Moveover, in a particularly lethal combination, the harangue which was delivered by the New Right induced in homosexuals and drug addicts both guilt and shame. They were in effect told that they were bad (should feel shame for being homosexual or addicted), and that they had done wrong (were guilty of promiscuity and drug abuse). Since there was no effective action through which to get rid of the retaliatory rage, it was all turned in against themselves, causing a wave of shame- and guilt induced depression in those who were most susceptible to the disapproval of the group (on the basis of individual psychological make-up). There have been reports of three people comn-titting suicide after being diagnosed with AIDS in Sweden,(44) but none in the US.

DISTAL CAUSES

Group tensions can build up and be discharged over surprisingly long intervals. If we look at the statistics for the incidence of suicide in the US. during the twentieth century and compare that with the statistics for venereal disease, an interesting pattern emerges (Figures 5 & 6). Both of these reach a peak around a major war - peaks of suicide preceding and the peaks in venereal disease coinciding with or following the war - and an abnormally high plateau is reached by the curve for venereal disease during the mid-70s. From a group-psychological standpoint, we can make the interpretation that we are passing through the psychological equivalent of World War III, or that we are at its foothills. This can also be inferred from the apparent inverse relationship between world war and the incidence of epidemic hysteria, noted by Sirois.(45) The factor preventing a world war seems to me to be the invention of the nuclear bomb, since the powerful destructive force at man's disposal is far more than will ever be necessary for purposes of war. The enormous surplus of destructive power that may not be used (since total annihilation would exceed the sacrificial quota of war) has led to an enormous curbing of fantasies of phallic aggressiveness. Everyone was made aware of these terrible atomic powers through the scare drills of the early 50s, which brought home to everyone how precarious our control over our group aggressions really is. (Interestingly enough, the age group most affected by AIDS, aged 30 - 39, were exposed to these drills during their early school years.) The nuclear freeze movement should be interpreted as a huge obsessive defense (reaction formation) against the use of these weapons.

The destructive forces at our disposal have forced a total reorganization of our thinking, since there is no longer the possibility of a winnable war between the superpowers. We resort to fantasies, as in the case of World War 11 which is currently being touted, somewhat nostalgically, as "The Good War."(47) The pattern of warfare for both superpowers - China is ignored as a superpower for purposes of fantasy, since one has only two parents - has become one of war-by-proxy or displacement wars. Thus, Korea, Vietnam, and Central America for the U.S., and uprisings in the Eastern Bloc countries and Afghanistan for the US.S.R. This curb on phallic-aggressive acting-out by the US. had led to widespread fears of being effeminate or impotent (fantasy: "We can't screw them, therefore we must be women.") As can be seen from the cartoons from the early part of the Reagan years (Figures 7 & 8), most of our phallic potency was injected into the Russians, who took on a frighteningly and humiliatingly masculine aspect, while America felt relatively impotent. These are, I think, the roots for the great need for "a winnable war" (between the superpowers) which is so apparent at this time. This curb on phallic-assertiveness created a feeling of gender dysphoria, which was then injected into the nations's homosexuals in fantasy. ("It's not we who feel weak and impotent, it's them.") This weakness and impotence "of America" was painfully conscious for all during the Carter years, and part of Reagan's mandate was to turn this around. After the invasion of Grenada the 'balance of potency" was completely reversed (Figure 9), so that we felt proud again, or as the phrase went, 'America [was] standing tall again."

That these painful feelings of emasculation were intolerable to us, and that something drastic had to be done, was shown, and the solution implied by Alexander Haig's statement about the Falklands War (the "dress rehearsal" for the invasion of Grenada). He said: "Britain's action may have marked a turning point in a long and dangerous night of Western passivity",(48) after the thought of the Argentinian junta that "a Western democracy was too soft, too decadent to defend itself". After the Grenada invasion America exulted: "Thank God, we finally have a real man in the White House", and "U.S. soldier's boot prints in Grenada's sod have done more than the MX will do to make US. power credible."(49)(50)

But in the unconscious group-fantasies there were several other causes of gender dysphoria that rose in a swelling tide through the 60s and 70s, cresting in the 80s. And all of these feelings had to be contained by the homosexuals.

The invention of birth control methods far beyond anything previously available made possible an explosion of "recreational sex" (as opposed to an ideal of purely functional sex) and 1957 remains a watershed in the moral history of the world. The "sexual revolution", as it came to be known, created an enormous change in American family life, though this change was more dangerous in fantasy than in reality. The most distressing single factor was an overt sexual desire and a demand for orgasmic satisfaction on the part of women. That this was a threat can be seen in statements such as the following: "the incidence of male homosexuality has increased enormously perhaps a hundred times - with the introduction of oral contraceptives."(51) In addition, such pleasurable sexuality - and so much of it - produced a massive build-up of guilt, which became more obvious as the 70s wore on, and they helped propel superego forces to center stage. Since the assumption of this anti- pleasure position, there has developed a sinister preoccupation in America with so-called "sexual compulsives" (i.e. those into whom we have projected our own sexual desires in fantasy), who are currently being "treated" in AA-type group sessions. It was into containers such as these that we poured both our own sexual wishes and to whom the punishment could then be applied. These groups have become, almost literally, whipping boys, as alternatively guilt and shame is induced. (A valuable critique of this method of "treatment" has been written by Stein(52) and Wedin,(53) for alcoholics and sexual compulsives respectively.) The homosexuals were chosen to be the model for "sexual compulsives" since their legendary sexual activity generated scorn, fear, and envy in the larger group. (During the years 1983-84 we also saw an increase in the TV coverage of the use of such groups, and on national television members of such groups were shown being humiliated and made to feel guilty - instead of having their intrapsychic conflicts solved.) The sexual revolution and the freeing up of heterosexual conduct was parallel to that in the homosexual community, but it was the latter that was chosen to represent those impulses we wished to disavow and punish. Indirect evidence for this comes from anecdotal reports that one of the major topics of conversation at meetings of scientists around AIDS is the sexual habits of the homosexuals.

The last and the most important of the distal causes of the epidemic, adding further unresolved tensions to the unconscious fire, is the effect of women's liberation on the group psychology of America. Srole and Fischer,(54) in a fascinating study of the longterm trends in mental health in women in the US., present persuasive evidence that something changed in the past 35 to 75 years. There was a distinct difference between the mental health of men and women when the Midtown Manhattan study was done in 1954, at which time women were more compromised than men. When a re-study was done in 1974 this difference had disappeared so that women were on par with men on all measures of mental health. My interpretation is that the childrearing practices vis-a-vis girls improved decade by decade, giving rise to healthier and happier mothers in a positive feedback loop. It was this increase in psychological well-being, I posit (as per psychic primacy), that created a new generation of women with less passivity, less depression, more self-esteem - all of which gave rise to the women's movement.

The way these changes translated themselves into society at large can be read from the lifestyle changes in the US. since the 60s: women became more independent; there was an increase in the divorce and then the re-marriage rates (which signified that women were now less afraid of searching for better partners); women tended to become more assertive (demanding orgasm, and more often starting their own businesses); and entered the workforce in droves (with confident predictions that the pay gap will "narrow perceptibly" during the 80s). The effects were electrifying, similar to the earlier response to the suffragette movement. At that time suffrage was seen as dangerous "because it threatened the existence of separate spheres. If women voted, they will abandon the home and womanly virtues. The differences between the sexes would be obscured: men would lose their manhood and women would begin to act like men."(56) The response to the women's movement in unconscious fantasy was just as strong and fearful. The title page of an article in the Ladies Homejournal captures it neatly: next to a hand holding up a little flag that says, "Help!" stands the title, "'The Hurting Husband", followed by "As more women try to change the scope of their marriages, more men suffer from 'liberation shock"."(56)

In Dominus: A Woman Looks at Men's Lives (1978), author Gittelson(57) traces the effect of the "new woman" on the consciousness (read: group-fantasy) of men. These quotations convey the tone: 'the so-called feminist revolution has transformed the consciousness of American men more dramatically, more decisively - and perhaps more dangerously - than the consciousness of women."(58) And, "...the second storm of female liberation within this century was rising all around them."(59) Men "...yearned openly ... for the return of the 'unreconstructed female'."(60) She shows persuasively how the quest for orgasm, the changes in gender role definition, the new honesty about their feelings by dissatisfied housewives, and the solidarity of women turned male-female relationships upside-down. 'A nation of little Wilburs ... cringed under Big Mama's broomstick, accepting the reprimand to their entire sex. 'It's the pussy-whipping of America.'"(61) This was one of the regressive positions men repaired to: passive-masochistic attachment to phallic mother. There were others: a flight into bisexuality ("the American flirtation with bisexuality expanded into a coast- to-coast affair "(62) ); a flight intohomosexuality, and its opposite, a flight into machismo. The men's movement consisted of a network of support groups across America. Anyone with a precarious sexual identity was massively threatened. Unacceptable sexual impulses that had been managed through control based on repression rather than by a more flexible control based on mastery, could not take the changes in sway, and started crumbling.

The new assertiveness in women kindled fears of impotence in men, and homosexual fears were exacerbated. Male bonding, a mounting "gay tide" and flirtations with homosexual experimentation were the regressive positions to which men retreated under the impact of this gender crisis. "Homosexuality is on the rise in today's society. And with the Women's Liberation Movement, more and more men are feeling threatened by women and choosing homosexual rather than heterosexual relationships."(61) These fears were the ones injected into the homosexuals, even though that solution in itself in turn generated other fears. The "state of pain between men and women" (as Gittelson's book cover puts it) resulted in fantasies of complete gender role reversal, with films about househusbands, about cross-dressing (Victor/Victoria, Tootsie and so on), a film about a pregnant man (The Rabbit Test, which is an example of the couvade syndrome) and by the early 80s there arose a preoccupation with androgynous rock stars.

Parallel to these changes in sexual morality came a greater acceptance of the use of various "recreational drugs" (marijuana, amyl nitrite, cocaine) as well as addictive drugs (narcotics). Folk heroes, like Timothy Leary, advocated hallucinogens and much of America went off, so to speak, on a huge cloud until and even beyond the anti-drug backlash of the mid-70s. The group solution to this problem was similar to that used for the gender dysphoria. In both cases containers had to be found who could contain all these pleasurable, but eminently punishable, wishes.

PROXIMAL CAUSES

A clue to the psychological transformation affecting America during the later 70s comes from what we know about a group trance.(64) Most extensively studied around hypnosis, the most germane quality of a trance is its self-limiting nature. Each person seems to be suggestible up to a point: once suggestions are made that conflict with the basic structure of the personality, the subject becomes increasingly agitated and ultimately wakes up out of the trance or, paradoxically, falls asleep. Multiplied by millions and spread out over 10 years, this seems to be a fair description of what happened to America in the late 70s. It was as if everyone had become involved in a pleasurable picnic since the 60s, and all of a sudden everyone simultaneously started waking up from the trance, shamefacedly scrambling for their clothes and hurrying home. This was the conservative clampdown.

By using several key indicators, it is possible to locate this change in unconsciously held attitudes more or less precisely. This is done by considering:
(a) retrospective assessments - "Future historians of the movement, in fact, may set the years of the sexual revolt at roughly 1965 to 1975."(65)
(b) Slips of the tongue, such as Robert Gallo's making the slip in 1984 that the epidemic of AIDS had started 9 years before."
(c) The beginning of the clampdown on hardline drug abuse with the creation in 1975 of CENTAC 1 (a central tactical unit of the Drug Enforcement Administration) and 18 similar units since then.(67)
(d) A sudden swing in contributions of funds to political campaigns by large corporations - for example, a certain corporation that used to give 93% of its contributions to liberal causes in 1976 started giving only 17% to liberal causes in 1978, and this formed a trend.(68)
(e) The beginning of the clampdown on sexuality, which showed itself first through the backlash against "runaway gay liberation", spearheaded by the Anita Bryant campaign in Dade county, Florida in early 1977. This was followed by a series of 'Anita Bryant Laws" in various states, the formation of Moral Majority, Inc., in 1978, Religious Roundtable in 1979, the phenomenal direct-mail missives on behalf of conservative causes by Richard Viguerie, and the apotheosis of conservatism with the election of Ronald Reagan in 1980.
(f) In the heterosexual sphere the equivalent was the concern over herpes, which was, as Time magazine put it, "Today's Scarlet Letter"." All of these changes ushered in a period of sadistic super- ego control and a turn away from pleasure. On the issue of "Sex in the '80s", we were informed by Time that "The Revolution Is Over",(70) and by Newsweek that "AIDS may mean the party is over."(71)

In terms of group process, such a period of clampdown (of which Prohibition and McCarthyism are earlier examples) consists of two components: a phase of internal sacrifice followed by a phase of external sacrifice. The latter usually takes the form of a war, and at this time the stage has been set for that in Central America.(72) Psychologically speaking, the phase of internal sacrifice is the result of a more advanced mode of group functioning, one which implies impulse control and the ability to delay gratification (and by not immediately going out and making war - such as is the norm for headhunters). It attempts to deal with certain group tensions by internal means rather than fighting them abroad or in others via projection. The phase of internal sacrifice started around 1975, intensifying by 1977, and was made into a formal doctrine in 1981 with the introduction of Reaganomics. (For an analysis of how this was done, see deMause's book, Reagan's America.(73)) The central tenet was one of the withdrawal of things that were seen as "too good": the withdrawal of permissiveness and the "end of the sexual revolution" in the sexual sphere; the withdrawal of food and services from women and children (from which emerged the guilty preoccupation with "hunger in America" during 1983; the withdrawal of permission for abortion; the withdrawal of permission for the use of drugs, culminating in Nancy Reagan's 'War on Drugs" in the 80s; and a proliferation of bad feelings towards homosexuals, who had come to represent all the gender dysphoria that had accumulated over the previous two decades.

This conservative swing, as with all group-fantasy phenomena, affected the entire group, and all of America became more sober and conservative as the 80s wore on. In Berkeley, hotbed of protest in the 60s, students were now putting up posters of Reagan and saying, "I can definitely see us going to war."(74) Among homosexuals "the greatest growth of gay political activity is among Republican suburbanites."(75) In the psychological sphere there has been, all of a sudden, a spate of anti- Freudian or antishrink books.(76) In television the half-hour sitcom made, during the 1983-84 season, its "worst showing in 30 years; not a single sitcom that ran all season was ranked among the top ten" as contrasted with the 1974-75 season, when 7 did.(77) Action programs like "The A- Team" and others responded to our new warlike mood and did well.

In the accompanying graph (Figure 10) I have indicated the relationship between this conservative swing and the incidence of AIDS, as it relates to real and perceived threats against homosexuals. It is possible to draw up similar graphs for drug abuse and the turn of popular opinion against that. (As in the rest of the paper I will concentrate on the group dynamics as it pertains to the homosexuals, and refer to the others only briefly and in passing.) It must be kept in mind that these constitute conscious factors, which, in their appearance, were preceded by an "incubation period", as the unconscious impulses slowly percolated through to consciousness.

Above the line I depict the incidence of AIDS for the U.S. as a whole, and that of amebiasis for San Francisco. Below the line are listed those incidents that seemed to attain symbolic significance (based on attention paid to them in the homosexual periodicals and on psychohistorical interpretation). (For example, the Briggs-sponsored Proposition 6 - which would have barred homosexuals from teaching in public schools - was defeated in a referendum; yet, since it was concrete evidence of the strength of the clampdown, it is included.) As can be seen, the incidence of amebiasis begins to rise to epidemic levels immediately after the postulated swing in unconscious attitude, and that of AIDS starts to climb about 2 to 4 years after the clampdown became "official" through the campaign of Anita Bryant. (In the medical paper I advance the hypothesis that this lag period depends on the turnaround time for the development of T-helper cells.) The formal introduction of Reaganomics in 1981 coincides with the first clinical descriptions of AIDS, thus confirming the unconscious group-fantasies, and setting up the positive feedback system that has propelled the epidemic forward ever since.

HISTORY OF AN EPIDEMIC

I. Line-up for the dash

Groups, in Slater's celebrated phrase, have a "peculiar, crablike locomotion", by which he meant that they move slowly and strangely, and often obliquely to or away from the point. Nowhere is this more apparent than in the behavior of the three subgroups of the US. who came to participate in the origins of the AIDS epidemic. I would like to examine, in turn, the major outlines of what happened to the "gay rights movement" after 1973-74, and the contribution by the homosexuals to the "war of morality" that was to follow; the rise and the move to center stage of the New Right, especially the contribution that the formation of the Moral Majority and the anti-gay rights movement made to the group-fantasy origins of AIDS; and finally, I will take a look at the largest subgroup of Americans, the so-called "silent majority" and what part they played in this clash of ideologies.

The first of the three groups, the homosexuals, essentially turned their aggression inward (by somatizing tensions) and played the role of the masochistic partner in the scapegoating ritual which was to follow. This position was dictated by an "internalized homophobia" (a total misnomer for "identifications with their aggressors and those who wished them to disappear"), and is similar to that taken by all martyred scapegoats through the ages. The second group, the New Right, played the role of sadist in this scapegoating battle, slinging death threats in the direction of the homosexuals with an absence of empathy and full of righteousness. The third group, the silent majority of Americans, at first took little notice. Everyone was swinging to the right, and by 1981 Goldwater could say, "It's a wonderful feeling to be a conservative these days", since such a position had the full support of the group-fantasy. Around Reagan's election they started playing up the role of the New Right, for example, by television and media coverage exceeding the extent to which the general public subscribed to their notions. A Gallup poll taken in 1980 on this issue (the definition of a group-fantasy issue in America) showed that less than 50 percent of Americans knew about the Moral Majority, that only 23 percent saw themselves as belonging to the "New Christian Right" and only 8 percent approved of the goals of the Moral Majority.(78) This behavior by mainstream America towards the New Right is typical for behavior shown towards delegate groups: these groups quietly practise their own, usually somewhat fanatical, group-fantasies in the wings until they are needed by the majority. They are then called to center stage, and quietly nudged (like an adolescent in a family) into acting out some of the conflicted needs of the group, after which they are "discarded".

II. Anlagen for Heroic Suicide

I do not review here the history of the "gay rights movement", and refer the reader elsewhere for excellent overviews.(79) Suffice it to say that a wave of excited self-revelation and selfdiscovery, followed by a "new boldness", spread through the homosexual community from 1969 onwards (after a group of homosexuals attacked police who were raiding the Stonewall bar in New York City). By 1973-74 two rather profound changes were to take place in the official standing of homosexuality in America. The psychiatrists (father imagoes onto whom homosexuals have traditionally displaced their rage and hatred, a position that has since been reserved for "Freudian analysts") reversed themselves as a group in 1973 and declared that homosexuality per se was no longer considered to be a psychiatric disorder. In 1974 the American Psychological Association followed suit. Throughout the early 70s many states were re-writing their criminal codes, and by 1976 about half of the United States had revoked their sodomy statutes. On this issue, there was hearty criticism from conservatives such as Reagan, who said in 1976, "I would have vetoed it. You can make immorality legal but you cannot make it moral."(80) During 1976 the pace of anti-discrimination laws being passed slowed down to a considerable extent.

Meanwhile homosexuals all over America were coming out of the closet (from Air Force Sergeants to professional football players), swept along in the euphoria of their new-found assertiveness and the acceptance which they read in the recognition by the two major psychological blocs: "Come out, come out...... they exulted, "gay people are not invisible anymore...."(81) It is my impression that many people who came out were ill-prepared for what was to follow once they were to meet prejudice face-to-face, since few had sufficiently worked-through the issues of shame and guilt involved. More important, many people in mainstream America were just as ill-prepared for it, as became clear in retrospect. The sense of freedom (from external constraints) was heady, and a large sector of the homosexual community were "living in a very fast trajectory indeed, at a high velocity fueled by late nights and early mornings, of dancing for hours without a break, of taking drugs and having sex with a lot of very handsome, strong, powerful, wonderful men."(82) In clinical experience, sudden freedom before a person has adequately been prepared is rarely tolerated well, since there is not always sufficient ego structure to cope with it. Fall-back positions then include: rigid self-control through denial of too much pleasure or, as a regressive position, submission to external controls. Before this liberation into mania, external controls had been built into the system, so that excesses of lifestyle as were later described were rare, and self-limiting.

On the heels of the sexual revolution followed an epidemic of venereal disease, with an incidence that shot sky-high during the 60s and remained high throughout the 70s. In the mid-70s the term "gay bowel syndrome" was coined for the plethora of illnesses encountered by proctologists. Significantly, as I had alluded to about the penumbral syndrome of AIDS, the incidence of amebiasis abruptly took off in 1975, with a dramatic increase over the previous year. Since no overt change in sexual habits took place in 1974 (such as a sudden introduction of anilingus), we have to look for alternative explanations. I posit that a sudden change took place in the unconscious group-fantasies of the homosexuals at that moment, a covert event which was translated into psychosomatic symptoms and augured in the coming epidemic. "How long, [they] began to wonder, could this marvelous pleasure last?"(82) My supposition is that a build-up of guilt had taken place, based on the new lifestyle, and that it showed itself in this way at first. An additional due can be read from an advertisement that ran in The Advocate (the most important homosexual newspaper at that time), for about 2 years on and off, starting in 1975. It was an ad for the GSF (Gay Social Forum), and ran as its eye-catcher the line, "The Only Happy Homosexual Is A Dead One."(83) This was carefully rationalized as a statement by the "enemy", and went on to speak of "a lifetime of suicide". I interpret this as the first sign of the massive buildup of unconscious guilt over such sexual abandon, a particularly difficult demon to placate and one which was to demand many sacrifices in times ahead.

A recent example of the same submissive, sacrificial attitude is found in an advertisement for the Metropolitan Community Church (which is a congregation of homosexuals).(84) The MCC is one of the favorite targets of Jerry Falwell, and the ad quotes him as preaching on the "Old Time Gospel Hour": "Thank God this vile and satanic system will one day be utterly annihilated and there will be a celebration in heaven." The MCC's response to this is a gentle: "No Jerry, that's not what the Metropolitan Community Church is like because: We are a caring, loving group of people. We have created a 60-minute television documentary to confront those kind of lies...." This is an attitude identical to that of Jews trying to convince Nazis that they were in fact quite patriotic and German, and equally futile. (For an analysis of the group dynamics of the masochistic partner in a sado- masochistic ritual on the historical stage, I refer the reader to Stein.)(85) Clinically and historically one finds that this type of meekness invites further sadistic onslaught, so that the system becomes self-perpetuating.

Whatever death wishes the homosexuals may have been unconsciously entertaining towards themselves in 1975, they were just that: wishes. Soon, however, as they were continuing to be projected into the "enemy out there", they found an object to stick to, which escalated the seriousness. As long as one perceived threats where there are none, all is vaguely well. When someone responds to that perceived threat and starts to really threaten you, it sets up a process of resonance, making one's greatest fear become very real and inducing dread. This is, I think, what happened around the time of that crucial switch in the mid-70s. By July 1976 the United Federation of Teachers went on record against gay rights.(85) By early 1977 the homosexual press started reporting that students on campuses were wearing T-shirts saying: "Bury a Fairy" or "Do the world a favor - Shoot a Faggot."(87) The process of liberalization, though slowed down, continued. Dade county, Florida had passed a gay rights ordinance in February - the first major city in the previous year. There had been active campaigning by the homosexuals since the previous November, and it was the first victory by a "gay political machine" of its kind. And here, in the spring of 1977, the stage was set for the dampdown-to-come.

The New Right Shows Its Fist

Enter Anita Bryant, an unhappy singer who identifies herself with "Deborah in the Bible whom God chose in a period of spiritual depravity when male leaders weren't what they should be...... "(88) Her marriage of many years' standing unhappy, unfulfilling and on the brink of divorce, she feels herself drawn to lead the counterrevolution. She leads the attack on gay rights, and founds at first "Save Our children (From Homosexuals), Inc." and later "Anita Bryant Ministries". The popularity of this cause is evident in the more than $2 million contributed by 400,000 people within the first 10 months.(89) In her book, The Anita Bryant Story - subtitled: The Survival of our Nation's Families and the Threat of Militant Homosexuality - she outlines the major issues: "The women's liberation programs ... have weakened family ties ... single men are the chief source of crime and social disruption ... marriage is essential to male socialization...."(90) The gay rights movement is an "escape from sexual responsibilities and its display a threat to millions of young men who have precarious masculine identities."(91) That all of this would lead to a sacrificial ritual in which people would actually have to die, is clear from statements such as: "they were sacrificially committing themselves to whatever was necessary to save our children" (my emphasis)(93) and "I'm not out with a Bible in one hand and a sword in the other" (negation).(94) She correctly foresaw that "a repeal [of the gay rights ordinance] would send a tidal wave of repression an across the country."(95) She quoted a Dr. Lindsell: "if he [the homosexual] does not repent, he is doomed...."(96) A commingling of her personal and the group's fears are revealed in: "...as the more liberal life-styles come into the open, divorce rates soar, leaving the debris of human tragedy behind to suffer. The debris? Our children."(97)

As the campaign heated up in Dade county, homosexuals realized exactly what was going on, and became appropriately scared. Their most outstanding response to this threat, however, was also the most self-destructive: they started wearing little pink triangles, like those that had been issued to homosexuals under the Third Reich, saying, in effect, "We are your willing sacrificial victims."(98) Bumper stickers in Dade county started to sport overt death wishes: "KILL A QUEER FOR CHRIST."(99)

When the vote was tallied, victory was in the hands of Bryant and the New Right. She flashed a "dazzling smile of triumph. The 'normal majority' have said, 'Enough! Enough! Enough!'"(100) It was obvious to Sergeant Leonard Matlovitch (a former Vietnam War Hero who had deliberately provoked a discharge from the Air Force in 1975 by informing his superior officer that he was gay) that a wave of repression was indeed going to follow, as well as the sacrificial events that Bryant had prophetically foretold. He warned that "Stormy times are ahead. I fear repression. Some gays are going to have to be prepared to make sacrifices - even die." (my emphasis).(101)

Those were the first pieces of the puzzle: the delivery of the harangue was underway. In contrast to the simple recitation in the quiet of the Papuan night, this harangue was to be delivered in a stream of bitter fragments scattered across all the media and the mail for the next few years.(102) The picture that emerges from the examples of direct-mail solicitations I have seen shows a distorted, overblown image of a militant, marching cadre of homosexuals and America about to be engulfed by Sodom and Gomorrah. Against this "fearsome foe" the New Right mobilized all their forces. In his "Declaration of War",(103) Falwell writes that "the Old Time Gospel Hour hereby declares war against the evils threatening America during the 1980s ... this shall be a Holy War, not a war with guns and bullets ... lead an army of Christian soldiers into the war against evil" (Figure 11). The Evils to be fought against are abortion, the murder of innocent babies, and homosexuality as the cause of the deterioration of home and family. He vows in another letter to "continue to expose the sin of homosexuality... I believe that the massive homosexual revolution is always a symptom of a nation coming under the judgment of God.... The homosexuals are on the march in this Country."(104) Behind the fear of homosexuals was a conspiracy: "the drive for homosexual rights ... [is] just a fraction of a master plan to destroy everything that is good and moral here in America", said another.(105)

It is impossible to estimate the numbers of letters and appeals such as these that went out in the US. mail: the Moral Majority Report goes out to 840,000 homes per month, and there is no way of estimating the volume of mail sent out by Richard Viguerie's direct-mail empire.(106) That the Moral Majority knew that they were engaged in a witch hunt ("Holy War") was evident from statements made at training seminars such as, "We're here to learn how to burn witches and everything else the press says we're about."(107) Sentiments were expressed blatantly: "I know what you and I feel about these queers, these fairies. We wish we could get in our cars and run them down while they march...."(108) Another: "I agree with capital punishment and I believe that homosexuality ... could be coupled with murder and other sins.... It would be the government that sits upon this land who will be executing the homosexuals."(109) And: "The cure to cancer is not to ignore it - remove it."

Then there were "the recent efforts of the so-called 'American Party for Manhood' to bring back capital punishment for homosexuals."(110) Death wishes were also issued by the church: "I was told by a sincere Christian counselor that it would be 'better' to 'repent and die', even if I had to kill myself, than to go on living and relating to others as a homosexual."(111) These are quotes from a radio preacher: "Sodom and Gomorrah were turned into ashes as an example of how God feels about being gay..... and "God dropped an atomic bomb on Sodom and Gomorrah because they were perverts!"(112) Some said, "A very good case can be made out that the homosexual is the modern equivalent of the leper" and that "the children of Israel were commanded by God to stone to death homosexuals (Lev. 20:13), a severe treatment intended to keep them from becoming contagious."(113) Here we are on the threshold of the poison fantasies of the epidemic proper. Anita Bryant was intuitively homing in on another of the core fantasies (though at this time still with an admixture of cannibalism) when she said that God does not like homosexuals because "the male homosexual eats another man's sperm. Sperm is the most concentrated form of blood. The homosexual is eating life."(114)

Put together succinctly, this whole catalogue of threats delivered into the public arena (starting with Bryant's campaign materials which contained a paper entitled, "Why Certain Sexual Deviations Are Punishable By Death") points to one end, which is "Death to the Homosexuals." And this was indeed the message they picked up. Full-page advertisements such as the one depicted here (Figure 12) have been run since the AIDS epidemic started.(115) it shows how the death threats and the clampdown have been internalized: gone was the gallows humor of "The only happy homosexual is a dead one."

A similar harangue was delivered to the drug addicts of the US. with, as is my thesis, identical results. In Figure 13 1 have collated newspaper headlines from the past 4 years. Not surprisingly there has been an epidemic of heroin-related deaths in the Washington, D.C. area for the past 4 years, with a death rate higher than any previously reported in the literature.(116) These harangues, with their severe public shaming of these two groups for irrational reasons, were the factors that intensified whatever change had taken place in 1975, and were thus the direct precipitants of the AIDS epidemic.

BEYOND EPIDEMIC AIMS

The cure for an epidemic of hysteria is extremely simple. Once identified as such, all one has to do is to publicly announce it to be an epidemic of "mass hysteria", after which the epidemic resolves itself in a very short space of time. In an outbreak of psychosomatic symptoms due to a suspected poison gas at an elementary school in Dade County, Florida (in1976)(117), it was possible for Nitzkin to effectively terminate the epidemic within a time span of 2 hours and 10 minutes after it was started. The rumor that a gas leak was causing girls to faint (fantasy of poison gas) had started and spread within one hour, by which time most major news media from South Florida had arrived on the scene. By announcing that the disturbance was a mass hysteria and that there were no toxic causes, all further attacks were prevented and the school returned to its usual functioning. During the Koro epidemic in Singapore in 1967 a delusion of poisoned pork (based on recent vaccinations of pigs for swine fever) caused 469 persons over a period of 10 days to seek help in great panic that their genitals were retracting into their bodies.

"After public announcements by the Singapore Medical Association and the Ministry of Health were given wide exposure on television and in the newspapers stating that koro was a result of fear, not a physical disease with fatalities, and that meat from inoculated pigs was completely harmless to human beings, there was an immediate decline in the incidence of koro. Several days after these public announcements there were only a few cases reported, and within a month koro was not being reported in Singapore at all."(118)

There are two mechanisms by which this resolution may be brought about: (a) the old analytic dictum of "making the unconscious conscious", whereby the unconscious fantasies are robbed of their powerful sway over the conscious mind; and (b) the person who takes control and makes the announcement serves to reassure the affected cases that rationality and sanity will prevail. The officials act as containers for the anxieties of the group.

Nitzkin (as did Kerckhoff)(119) outlines how the medical response to such an epidemic is a powerful and determining factor in its outcome. In a similar epidemic of koro in Thailand, the medical authorities did not take the same calm, reassuring stance as they did in Singapore - with the result that the epidemic dragged on for (unnecessary) months.(120) To respond in a way that confirms the group delusion - to pull out all the medical stops with blood tests and hospitalizations, and the general "epidemic hoopla" of heightened emotions and excited poison hunters - is to perpetuate the epidemic. (This in no way precludes consideration of toxic causes when appropriate.) In fact, Nitzkin reports:

in several of these outbreaks, the diagnosis was strongly suspected early in the outbreak but not acted upon because the investigators apparently believed that such a diagnosis could not be announced or acted upon until all other diagnoses had been "completely ruled out".(121)

This means that epidemic hysteria, in those few cases where it is at all considered, usually remains an exclusion diagnosis rather than a positive gestalt that can be identified on its own criteria (bias against psychological diagnoses). Apart from a lack of knowledge about this entity (quite prevalent since so few of the textbooks carry the information and it is not included in the current diagnostic manual of American psychiatry, the DSM-III), another factor obscures the picture. It seems to me that the crucial, inhibiting factor is the extent to which the medical examiner comes to share the belief in the poison threat. If the medical professionals cannot disentangle themselves from this belief, they will be powerless to terminate the epidemic, and it will have to wind down on its own.

If AIDS is indeed found to be an epidemic of depression with psychogenically reduced cell- mediated immunity, it follows from my argument that a simple announcement to this effect will have the desired therapeutic result. However, all therapeutic efforts so far have been applied to short epidemics (2 hours and 10 minutes in Dade County, and 10 days in Singapore). The time needed for a resolution ought therefore to be proportionately longer, and about 2 to 4 years (the turnaround time for the development of the T-helper cells and enough time to slough off the belief in poison sperm and blood) ought to be a minimum. This time period may be shortened by psychotherapy, adjunctive therapies and a rational stance from officials in whom the public places faith.

My sense, however, is that an announcement that any particular epidemic is an example of epidemic hysteria will be met with resistance among those who subscribe to the group delusion, and for whom the epidemic is a golden solution to unconscious conflicts. The larger the number of people subscribing to the delusion, the stronger I would expect the resistance to be to such an announcement (magnification effect of the group). Since it would also give rise to power struggles among people over whose beliefs are stronger or more accurate, such an announcement will have to come from someone held in very high esteem for having impeccable scientific credibility In the AIDS epidemic, with the entire Western world sharing a belief that AIDS is caused by promiscuity and two fluids containing a virus, one should expect a truly monumental outpouring of hatred and resistance to such an announcement.

So strongly can a fantasy press upon the minds of scientists and laymen alike that evidence is frequently misinterpreted in order to fit in with more comfortable notions, or, as was pathetically and poignantly done in the case of a phantom epidemic of gonorrhea in a primary school, the wished-for evidence can even be hallucinated.(122) Viruses have been found in patients with AIDS and related conditions in 1983-84. 1 remain skeptical about their role in the etiology of AIDS, since their discovery generated immoderate enthusiasm and was felt to vindicate all the fantasies of poison sperm, poison blood and dangerous promiscuity. And because a reasonable hypothesis with sufficient explanatory power to account for virtually all of the known facts of the epidemic can be formulated without invoking them.

At this point the only attempts at cure from the lay public have been along the line of the "epidemic aims" (such as reducing sexual activity and numbers of sexual partners, and the widespread apotropaic ritual of "safe sex"). As with other epidemics which have a psychological component, there is a certain blindness to many aspects of the epidemic in one's midst, due to the group trance. I suspect it will be found, as with epidemics of heroin abuse, "that a community's awareness ... often comes only after the epidemic has peaked and is already on the decline."(123) Once the peak has been passed (i.e. when the unconscious driving forces are on the decline) it becomes easier to wake up out of the trance. One can only hope, for the sake of the 2,500 people in the United States living with a diagnosis of AIDS, and the 90-odd who are newly diagnosed each week, that we wake up from the trance, and soon. *

REFERENCES

I would like to thank Lloyd deMause and David Reisel, without whose support and inspiration this essay would not have been possible.

1. Major recent reviews are: Francois Sirois, "Epidemic Hysteria", Acta Psychiatrica Scandinavica, 1974; Suppi. 252, 1-45. R.F,. Markush, "Mental Epidemics: A Review of the Old to Prepare for the New", Public Health @ws, 1973; 2: 353-442. George Mora, 'An Historical and Sociopsychiatric Appraisal of Tarantism and its Importance in the Tradition of Psychotherapy of Mental Disorders", Bulletin of the History OfMedicine, 1962; 36: 13-44. One book has been devoted in its entirely to the subject: Mass Psychogenic Illness: A Social Psychological Analysis, edited by Michael J. Colfigan, James W Pennebaker & Lawrence R. Murphy (Hillside, NJ: Lawrence Erlbaum, 1982).

2. Markush, loc. cit., P. 396, 404.

3. Alan C. Kerckhoff & Kurt W Back, The June Bug. A Study of Hysterical Contagion (New York: Appleton-Century-Crofts, 1968). The same epidemic was also reported in: Francis P. Champion et al., "Mass Hysteria Associated with Insect Bites-, J. So. Carolina Mcd. Assn., 1963; 59:351-53.

4. Francois Sirois, 'Perspectives on Epidemic Hysteria" in CoUigan et al., op. cit., pp. 217-236.

5. Sirois, ibid., P. 231.

6. Sirois, ibid., P. 232.

7. John Frosch, The Psychotic Process (New York: International Universities Press, 1983), pp. 417-418, 140-149.

8. Silvano Arieti, "Introductory Notes on the Psychoanalytic 'Merapy of Schizophrenics", in Psychotherapy of the Psychoses, ed. A. Burton (New York: Basic Books, 1961).

9. H. Rosenfeld, "Note on the psychopathology of confusional states in chronic schizophrenia", Int. J. Psycho-Anal., 1950; 31:132-137.

10. Mehtta Sperling, Psychosomatic Disorders in Childhood (New York: Jason Aronson, 1978).

11. Elizabeth B. Weller & Ronald A. Weller, "Case Report of Conversion Symptom Associated with Major Depressive Disorder in a Child", Am. J. Psychiatry, 1983; 140: 1079-1080.

12. Norman Cohn, Warrant for Genocide (New York: Harper & Row, 1966), pp. 32, 186-7, 204 and especially 261-263.

13. Jean Fogo Russell, "Tarantism", Medical History, 1979; 23: 404-425, P. 408.

14. Jean Fogo Russell, "Dancing Mania", in Festschriftfor Kenneth Fitzpatrick Russell (Melbourne: Queensberry Hill Press, 1978), p. 8.

15. B.H. Kagwa, "The problem of mass hysteria in Fast Africa", East Affican Med. J., 1964; 41: 560-566.

16. Lyle Koehler, A Searchfor Power.- The "Weaker Sex' in Se-venteenth-Century New EnglatO (Urbana: University of Illinois Press, 1980), P. 391, quoted from: Robert Cales, More Wondffs of the Invisible World (London: 1700), p. 355.

17. James W Edwards, "Semen Anxiety in South Asian Cultures: Cultural and Transcultural Significance", Med. Anthropol., 1983; 7: 51-67.

18. W jilek & L. jdek-AaH, 'A Koro Epidemic in 'Mafland", Transcultural Psychiatr. Res., 1977; 15: 57-58.

19. WH. Phoon, "Outbreaks of Mass Hysteria at Workplaces in Singapore: some Patterns and Modes of Presentation", in Colfigan a al., opcit., P. 24. Similarly dramatic is the cleavage in the Thai koro epidemic where, though they form 10 percent of the population, not one case was reported among the Chinese: Sangun Suwanlert & Donald Coates, "Epidemic koro in Thailand - Clinical and Social Aspects", Transcult. Psychiatr. Res, 1978; 16: 64-66.

20. Harry D. Eastwefl, "Psychological Disorders Among the Australian Aboriginals", in Extraordinary Disorders of Human Behavior, ed. Claude T.H. Friedmann & Robert A. Faguet (New York: Plenum, 1982), P. 237.

21. Donald W Johnson, "The 'Phantom Anesthetist' of Mattoon: A Field Study of Mass Hysteria", J Abnorm. Soc, Psychol., 1943; 40: 175-186,

22. The Lancet, 1983; 8: 51.

23. The Washington Post, March 17, 1983, P. A8. This was at first known as the "voodoo connection". Daily News, February 28, 1983, P. 33.

24. The Advocate, March 20, 1984, P. 21.

25. Newsweek, May 7, 1994, p. 101.

26. Casper G. Schmidt, 'AIDS jokes; or, Schadenfteude Around an Epidemic", Maledicta, 1984; 8: in press.

27. Saul Nathaniel Brody The Disease of the Soul: Leprosy in Medieval Literature (Ithaca: Cornell University Press, 1974), pp. 138-9.

28 Ibid., P. 55.

29 Ibid., p. 54.

30. Ibid., P. 54.

31. Ibid., P. 54.

32. Kurt W Back, "Epidemiology versus Cartesian Dualism", Soc. Sci. & Med., 1971; 5: 461- 468.

33. J. Angst, "Masked Depression viewed from the cross-cultural standpoint", in Masked Depression, ed. P. Kielholz (Bem: Hans Huber Publishers, 1973, pp. 269-274.

34. Lloyd demause, "The Evolution of Childhood", in Foundations of Psychohistory (New York: Creative Roots, 1982), pp. 1-83.

35. S.F. Maier & M.E. P. Seligman, "Learned Helplessness: Iheory and F-vidence",J. Exp. Psychol., 1976; 105: 3-46.

36. Steven F Maier, "Learned Helplessness, Depression, Analgesia, and Endogenous Opiates", Psychopharm. Bull., 1983; 19: 531-536.

37. Helen Block Lewis, Shame and Guilt in Neurosis (New York: International Universities Press, 1971), pp. 83-91.

38. Ibid., P. 275, pp. 311-316.

39. G. Piers & M. B. Singer, Shame and Guilt: A Psychoanalytic and a Cultural Study (New York: Norton, 1953), P. 29.

40. A.L. Epstein, The Experience ofshame in Melanesia (Royal Anthropological Institute of Great Britain and Ireland: Occasional Paper No. 40, 1984) (Atlantic Highlands, NJ. Humanities Press, distributors), P. 12.

41. Ibid., p. 13.

42. Bronislav Mahnowski, Crime and Custom in Savage Society (London: Routledge & Kegan Paul, 1926).

43. P. Sack, "'Me range of traditional Tolai remedies", in Contention and Dispute: Aspects of Law and Social Control in Melanesia, ed. A.L. Epstein (Canberra: A.N.U. Press, 1974), P. 83.

44. Goran Bratt-Venhalsan, Handout for Workshop I, Information Ex- change: AIDS Conference of International Gay Association, Amsterdam, Jan. 20-22, 1984.

45. Sirois, "Epidemic Hysteria", loc. cit., P. 25.

46. Figure 5: Samuel L. Maxwell, Jr., "Suicide by firearms", N. EngL J. Med., 1984; 310: 46-47. Figure 6: Compound graph derived from data contained in: M.A. Conant, et al., "Changing Patterns of Sexually Transmitted Diseases over the Past 15 Years", in AIDS: the Epidemic of Kaposi's Sarcoma and Opportunistic Infections, ed. Alvin E. Friedman-Kien & Linda Laubenstein (New York: Masson, 1984), pp. 263-278.

47. The Atlantic, July 1984, cover. 48. Time, April 9, 1984, P. 61.

49. The Observer, October 30, 1983, p. 11.

50. George Will, Newsweek, November 7, 1983, P. 142.

51. Witham Fitch, Christian Perspectives on Sex and Marriage (Grand Rapids, Midi.: Herdmans, 1971), p. 133.

52. Howard F. Stein, "Ethanol and its Discontents: Paradoxes of Inebriation and Sobriety in American Culture", J. Psychoanal. Anthropol., 1982; 5: 355-377.

53. William R. Wedin, "No 'Cure' for Anonymous Sex", New York Native, April 9-22, 1984, pp. 21, 36. Also: "'Sexual Compulsion' - or, What's in a Name?: An Analysis of Anonymous Sexual Activity and Its Labelline', paper presented at the First International Lesbian and Gay Health Conference, New York, June 16, 1984.

54. Leo Srole with Anita Kassen Fischer, "The Midtown Manhattan Longitudinal Study vs. 'The Mental Paradise Lost' doctrine", Arch Gen. Psychiatry, 1980; 37: 209, 221. See also a corroborative study by the Wellesley College Center for Research on Women, showing that depression in women (ages 35-55) has declined dramatically: U.S. News & World Report, March 19, 1984, P. 47.

55. Paula Baker, "The Domestication of Politics: Women and American Political Society, 1780- 1920", Am. Hist. Rev, 1984; 89: 620-647, P. 638.

56. Ladies' Homejournal, January 1981, P. 32.

57. Natalie Gittelson, Dominus: A Woman Looks at Men's Lives (New York: Harcourt, Brace, jovanovich, 1978).

58, Ibid., P. 4.

59. Ibid., P. I 0.

60 Ibid., P. 12.

61. Ibid., P. 2 1.

62. Ibid., p. 25.

63. Paul D. Meier, Christian Child-Rearing and Personality Development (Grand Rapids, Mich.: Baker Book House, 1977), P. 52.

64. See deMause, Foundations, pp. 188-192.

65. Time, April 9, 1984, P. 76.

66. New York Native, June 4-17, 1984, p. 15. The incident occurred on April 23, 1984.

67. U.S. News & World Report, October 31, 1977, P. 64.

68. Perry Deane Young, God's Bullies: Native Reflections on Preachers and Politics (New York: Holt, Rinehart & Winston, 1982), P. 92.

69. Time, August 2, 1982, cover.

70. Time, April 9, 1984, cover.

71. Newsweek, August 8, 1983, p. 30.

72. See: Casper G. Sdimidt, "'Me Use of the Gallup Poll as a Ps torical Tool", J. Psychohist., 1982; 10: 141-162.

73. Lloyd demause, Reagan's America (New York: Creative Roots, 1984) pp. 51-67.

74. Daily News, July 20, 1984, P. 37.

75. New York Native, June 18-july 1, 1984, P. 27.

76. Village Voice, Voice Literary Supplement, June 1984, p. 16.

77. Time, June 4, 1994, p. 76.

78. Young, op. cit., P. 270.

79. Dennis Altman, The Homosexualization of America (Boston: Beacon Press, 1982); John D'Emiho, Sexual Politics, Sexual Communities: The Making of a Homosexual Minority in the United States, 1940-70 (Chicago: U of Chicago Press, 1983).

8o. The Advocate, August 11, 1976, P. 11.

81. The Advocate, May 7, 1975, P. 9.

82. Nathan Fain, 'AIDS in the United States, Challenge and Response", European AIDS Conference, IGA, Amsterdam, January 20-22, 1984.

83. The Advocate, February 26, 1975, P. 17.

84. The Advocate, August 7, 1984, p. 25.

85. Howard F. Stein, "Judaism and the Group-Fantasy of Martyrdom: The Psychodynamic Paradox of Survival nvough Persecution", J. Psychohist., 1978; 6: 151-210.

86. The Advocate, July 28, 1976, P. 21.

87. The Advocate, March 23, 1977, P. 9.

88 Ladies' Home journal, December 1980, P. 66.

89. Ibid., p. 63.

90. Anita Bryant, The Anita Bryant Story: The Survival of the Nation's Families and the Threat of Militant Homosexuality (Old Tappan, NJ.: Fleming H. Revell Co., 1977), P. 53-54.

91. Ibid., P. 55.

92. Ibid., p. 55.

93. Ibid., P. 59.

94. Ibid., P. 9 i.

95. Ibid., P. 89.

96. Ibid., p. I 1 1.

97. Ibid., P. I 1 6.

98. Time, June 20, 1977, p. 59.

99. Time, June 13, 1977, p. 20,

100. Time, June 20, 1977, P. 59.

10l. Ibid.

102. A note on countertransference: I attempt to convey here an inkling of the tone of these events and the unspoken quiet horror that I imagine the recipients of these utterances must have felt. I felt myself pulled in three simultaneous directions as I was synthesising this section: identifications with all three groups of participants. At times it was hard for me to refrain from responding with revulsion and disgust at the cruelty of the New Right, just as I had to keep myself from sneering at the pathetic helplessness of the homosexuals, and just as I had to withhold myself from enjoying - with mainstream America - this moral slugfest as one would enjoy the gore in a Roman arena. I kept an even - though often unsteady - keel by remembering that all of these groups were desperately fighting for the integrity of their selves and their mental balance, and that they seemed only capable of doing so by viciously exploiting and abusing each other or themselves in their struggle for love.

103. Perry Deane Young, op. cit., P. 308.

104. Ibid., P. 22 1.

105. Fundraising letter for Christian Voice, n.d., signed by Robert G. Grant, cited in Alan Crawford, Thunder on the Right: the "New right" and the Politics of Resentment (New York: Pantheon, 1980), P. 146.

106. Young, opcit., P. 223.

107. Ibid., P. 221.

108. Ibid., P. 78.

l09. Ibid., P. 77.

110. Letha Scanzoni & Virginia Ramey MoUenkott, Is the Homosexual My Neighbor?: Another Christian View (New York: Harper & Row, 1978), P. 3.

ill. Cited in Scanzoni, op. cit., P. 7, from "Torture, Homosexuality, and the Cry for Hope', The Other Side, 1977; 13: 6.

112. Scanzoni, op. cit., P. 31.

113. Ibid., P. 3 2.

114. Time, June 13, 1977, P. 20.

115. New York Native, April 25-May 8, 1983, p, 8.

116. Anon., "Heroin-Related Deaths - District of Columbia, 1980-1982-, J.A.M.A., 1983; 250: 463-464.

117. Joel L. Nitzkin, "Epidemic Transient Situational Disturbance in an Elementary School", J. FlMda Med. Assoc., 1976; 63: 357-359.

118. Robert T Rubin, "Koro (Shook Yang): A Culture-Bound Psychogenic Syndrome", in Friedmann & Faguet, op. cit., pp. 164-165.

119. Alan C. Kerckhoff, "A Social Psychological View of Mass Psychogenic Illness", in Cothgan et al., op. cit., P. 204.

120. Sangun Suwardert & Donald Coates, op. cit. (Ref. 19), P. 66. See also, for the tremendous pressure brought to bear on the physician to subscribe to the group delusion, James A. Knight, 'Meodore 1. Friedman & Julie Suhanti, "Epidemic Hysteria: A Field Study, Am. J. Publ. Health, 1965: 55: 858-865, especially p.859.

121. NiLzkin, loc. cit., P. 359, and his references 4, 5, 7, 8, 13, and 16.

122. Judith S. Mausner & Horace M. Gezon, "Report on a Phantom Epidemic of Gonorrhea", Am. J. EpidemioL, 1967; 85: 320-331.

123. Patrick H. Hughes et al., "The natural history of a heroin epideniic", Am. J. Publ, Health, 1972; 62: 995-1001.