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Every psychotherapist working in the challenging field of the addictions is familiar with patients who yo-yo between extended periods of abstinence from substances, or other compulsive and non-substance-based addictive behaviours, and who then lapse or relapse to compressed periods of excessive substance misuse, the so-called binge episode. In this paper we reverse the lens of theoretical focus somewhat, from its more traditional position within the clinical field of addiction. We suggest that periods of abstinence from substance misuse, or other compulsive behaviours, may also represent a type of binge-like behaviour which satisfies, for a time, core needs though which may also invariably be non-sustainable if the underlying psychodynamic processes underscoring such repetitive abstinence binges are not explored and translated, in work with the patient. Linkage will also be made between poles of experience that addicted and substance abusing patients evince, which are here termed black holes (Sweet, 2012) and white holes (Miller, personal communication, 2015). These proposed intra-psychic structures are, it is asserted, intimately related to the ability, or not, of the individual to bear psychological pain and distress, tolerate separation from objects at both an inter-personal and intra-psychic level and to delay gratification of instinctually grounded desires and wishes. The authors reference Hopper's (1995) previous description of both black holes and white holes in the addictions, and Glasser's (1979) conception of the black hole in relation to perversion and his description of the ‘core complex’, drawing out both similarities and differences in the viewpoints presented. Key ideas in the paper are illuminated and contextualized through the presentation of a number of illustrative clinical examples.

Psychoanalytic psychotherapists increasingly find themselves treating patients who present with problems of compulsive sexual behaviour or sexual perversions. Drawing from clinical examples and theoretical perspectives, the author delineates six key themes which encapsulate her own learning when commencing work with perverse patients. The first is the heterogeneity of this group of patients, both in terms of symptoms and presentation, but also in terms of the depth and developmental implications of the pathology. Further themes are the patient's fear of the object and the inability to bear separation. The author explores the significance of negative countertransference which may be experienced in relation to perverse patients, as well as the risks of being drawn into exhibitionistic or voyeuristic dynamics. Finally, the nature of the superego in perverse patients and the impact of this on the transference are discussed drawing on O'Shaughnessy's notion of the abnormal superego.

This paper describes how the radical concept of maternal perversion first presented by Estela Welldon (1988) informs the psychotherapeutic assessment and treatment of female inpatients within forensic services and of women in the community who commit acts of violence. It presents a model of the psychology of female violence that the author describes as ‘crimes against the body’. The paper offers clinical evidence for Welldon's model of female perversion in forensic settings and provides an extended clinical illustration of psychotherapeutic work, when the therapist was pregnant, with a woman who killed her child.

This paper highlights three important combined subjects in Estela Welldon's theory: perversion and depression, perversion and anxiety and perversion and motherhood. The underlying argument is that annihilation anxiety is central for the pervert and not castration anxiety. This annihilation anxiety goes back to a particular relationship between mother and child, which explains at the same time the ever-present threat of depression.

In our practice as psychoanalysts we frequently meet the perverse, and this may incorporate a range of pathologies. For example, borderline or psychotic structures are often associated with a sexualized and perverse use of the body. We discuss in the following clinical case study how sadistic sexual fantasies mingled with primal scene representation gave rise to persecutory anxieties, and how this blocked progress towards a resolution of the oedipal stage. It was at the point of intense psychic pain with a consequent fear of psychotic breakdown that the patient sought psychoanalytic help. We conclude that psychoanalytic treatment in such cases is likely to involve a deep regression, and that communication between the patient and the psychoanalyst will rely primarily upon a sharing of feelings and emotions.

Biological diversity is presented as a model of psychic diversity. Perversity, the general form of perversion which pervades, to some extent, the psyches of us all, is not presented as a diversity of lifestyle, as political correctness might have it. It is presented as a psychopathology causing suffering and needing help. The reprehension of perversity is suggested, through the work of Bion, as itself an aspect of perversity. The difficulties of analysing perversity through the general condition of narcissism is addressed emotionally through the universality of some measure of narcissism and theoretically through the work of Bion on ‘without-ness’, frustration and the disappointment of constant conjunction, and through Meltzer’s distinction between polymorphous and perverse and through his concept of aesthetic conflict.

I shall start with some thoughts about perversion as a psychopathological entity. It is about the absence of a capacity to obtain sexual genital fulfilment within an intimate, loving relationship with another adult person. Instead, the individual suffering from a perversion feels taken over by compulsive behaviour (often inexplicable and bizarre to them and others) that provides temporary relief from unbearable and increasing sexualized anxiety. The notion of temporary relief is important, given that a feature of a perverse act is that it has to be repeated, yet it is never the hoped-for solution to intolerable psychic pain. Instead it could be thought of as an evacuation and a communication; or a repetition of early, unprocessed traumatic experiences no longer available to conscious thought.

The author explores the clinical problem of narcissism by discussing a patient who was seen privately for once-weekly therapy for a period of two years. The emphasis is on trying to understand the nature of this pathology and the difficulties it presents to the therapist, especially in the transference and countertransference. The clinical material is examined in the light of theoretical concepts relating mainly to pathological organizations of the personality and perversion. The viability of working once weekly with such patients within a psychoanalytic framework is also considered.

SUMMARY. The recent psychodynamic literature on homosexuality is reviewed and a negative view is shown to remain prevalent. It is suggested that this may be the result of prejudice as opposed to simple error or to justified belief. In order to support this suggestion a theory of the origins and operation of prejudice is outlined. Next it is shown to be a consequence of this theory that prejudice should be especially likely in the domain of sexuality. Then an understanding of the psychic mechanisms which maintain prejudice is applied to a close reading of three papers concerned with homosexuality, which are shown to retain the marks of prejudice despite their compassionate and thoughtful stance. The way in which the logical distortions which mark prejudice are discernible in all three papers and operate to perpetuate some prejudices about AIDS, HIV infection, homosexuality and perversion is also shown. The prevalence of prejudices about homosexuality is noted to be especially great amongst psychodynamic therapists. It is argued that some reasons for this lie in the nature of psychoanalytic theory particularly in the way that homosexuality challenges some choices implicit within psychoanalytic theory. The parallels between this situation and that of the prejudiced individual are noted and suggestions are made for steps that might reduce prejudice in this area. Finally it is argued that the ill effects of prejudice on theory in this area are detrimental to psychoanalysis as well as to homosexuals. Prejudice and its effects are argued to be major barriers to the construction of good theory about homosexuality and, more optimistically, the work of some analysts who have questioned the prevailing attitude to homosexuality is reviewed.

SUMMARY. Utilising detailed clinical material from two analytic cases, this paper delineates a search to understand a difficult clinical situation in which the analyst's capacity to think and to analyse during the analytic hour are experienced as being paralysed by virulent, primarily unconscious, sadistic attacks on the part of the patient. The intensity of the counter-transference experience involving such attacks on the analyst's capacity to think left her feeling that the descriptive explanations of the mental processes involved (i.e. ‘perversion of communication’and‘projective identification’) fell short of helping to provide the understanding needed to overcome the analytic impasse. Investigation of Bion's concept of emotional knowing did provide understanding sufficient to resolve the analyst's experience of paralysis and thus overcome the threat to the analytic process.

Violence can be understood as the exercise of physical force so as to inflict injury on or damage to persons or property. In another sense it denotes the perversion of meaning. I indicate here connections between the two senses of violence in both social and individual spheres. I propose that the perversion of meaning is a condition underlying the use of physical violence.