Another theme is sexuality. One of the primary elements of Freudian psychology is sexuality, and sexuality plays a primary role in the madness of Arkham Asylum. Amadeus Arkham's psychological conflict is wrapped up in his mother, and in Freudian psychology the relationship between the mother and son is deeply connected to sexuality. Arkham's guilt over his mother's death takes on a sexual aspect. He takes on her role after her death, mentally changing genders much as the clown fish changes gender. This is one reason why Arkham wears his mother's wedding dress.