Psychotherapists tend to view homosexuality as a neurosis or as a neurotic symptom (Sadger, 1909, 1921; Klein, 1932; Rado, 1940; Ellis, 1952, 1955; Bieber et al., 1962; Ovesey et al., 1963). In support of this viewpoint, several authors have observed that the frequency of typical neurotic phenomena in homosexual males is much higher than that in a heterosexual male population, and have concluded that homosexuality is one of the neurotic symptoms of their patients (Stekel, 1929; Henry, 1937; Ellis, 1959; Musaph, 1960; Doidge and Holtzman, 1960). However, an alternative interpretation is that such maladaptive patterns develop from the difficult situation of a homosexual male in a heterosexual society and from the general disapproval he encounters. Moreover, the finding of increased prevalence of neurotic symptoms in homosexual males has itself been challenged by Kronfeld (1923) and Hooker (1957), who pointed out that the investigated homosexual males represented a selection of people who sought psychiatric help. Hooker studied non-patient samples from homosexuals' clubs and did not find an abnormally high frequency of neurotic symptoms.

A substantial part of Freud's (1925, orig. 1905; 1926, orig. 1922) theorizing on the causes of male homosexuality was the assumption of a fear of the female genitals, and according to Radó (1969) “fear of the genitals of the opposite sex is the basic dynamic of the individual who wants a sexual relationship with a member of the same sex”. Radó's stress on the phobic component in the causation of male homosexuality is shared by many theorists and practising clinicians.

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