There is no frequent relationship between homosexuality and insanity, and such homosexuality as is found in asylums is mostly of a spurious character.  This point was specially emphasized by Naecke (e.g., “Homosexualitaet und Psychose,” Zeitschrift fuer Psichiatrie, vol. lxviii, No. 3, 1911).  He quoted the opinions of various distinguished alienists as to the rarity with which they had met genuine inverts, and recorded his own experiences.  He had never met a genuine invert in the asylum throughout his extensive experience, although he was quite willing to admit that there may be unrecognized inverts in asylums, and one patient informed him, after leaving, that he was inverted, and had attracted the attention of the police both before and afterward, though nothing happened in the asylum.  Among 1500 patients in the asylum during one year, active pedicatio occurred in about 1 per cent. of cases, these patients being frequently idiots or imbeciles and at the same time masturbators, solitary or mutual.  Hirschfeld informed Naecke that, among homosexual persons, hysterical conditions (not usually on hereditary basis) are fairly common, and neurasthenia of high degree decidedly frequent, but though stages of depression are common he had never seen pure melancholia and very seldom mania, but paranoiac delusional ideas frequently, and he agreed with Bryan of Broadmoor that religious delusions are not uncommon.  General paralysis occurs, but is comparatively rare, and the same may be said of dementia praecox.  On the whole, although Hirschfeld was unable to give precise figures, there was no reason whatever to suppose an abnormal prevalence of insanity.  This was Naecke’s own view.  It is quite true, Naecke concluded, that homosexual actions occur in every form of psychosis, especially in congenital and secondary dements, and at periods of excitement, but we are here more concerned with “pseudo-homosexuality” than with true inversion.  Hirschfeld finds that 75 per cent. inverts are of sound heredity; this seems too large a proportion; in any case allowance must be made for differences in method and minuteness of investigation.

I am fairly certain that thorough investigation would very considerably enlarge the proportion of cases with morbid heredity.  At the same time this enlargement would be chiefly obtained by bringing minor abnormalities to the front, and it would then have to be shown how far the families of average or normal persons are free from such abnormalities.  The question is sometimes asked:  What family is free from neuropathic taint?  At present it is difficult to answer this question precisely.  There is good ground to believe that a fairly large proportion of families are free from such taint.  In any case it seems probable that the families to which the inverted belong do not usually present such profound signs of nervous degeneration as we were formerly led to suppose.  What we vaguely call “eccentricity” is common among them; insanity is much rarer.