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A contemporary definition of perversion is offered that aims to reveal a form of psychic functioning as a quality of being toward others in the external world, translating to a mode of relating toward internal objects, and/or a mode of relating toward one's body as an object. This quality of being is contrasted with perversion denoting a specific set of behaviors, as in classical conceptualizations. Two schematics illustrate healthy and perverse phenomenological positions (i.e. identifiable within the person's preconscious or conscious perspective and experience). These positions highlight ways in which perverse modes of experiencing can be depicted, by use of internal psychic positions and the extent to which these are integrated, interpenetrate one another or are truncated and foreclosed. In particular, a perverse internal psychic mode is proposed where affective, embodied, and pre-reflective self-experience is split off or dissociated. The case of Laura is offered as an illustration of a perverse mode of being and a perverse relationship to her body. I also suggest that perverse modes of relating towards others (primarily through objectification) is more common in males whereas the objectification of one's body is more common in females.

The terms sadism, masochism, and sadomasochism seem to have become increasingly, if loosely, associated with aggression in psychoanalytic discourse. This is due in part to the fact that Freud's changing ideas generated confusion about the relative contributions of libido and aggression. The author reviews Freud's variable usage and offers a clinical vignette to illustrate the importance of noticing how sadomasochism may maintain a tie to the object by controlling it. The author offers a developmental speculation for the role reversibility typical of sadomasochistic manifestations. He closes with a comment on the role of sadomasochistic aims in adult sexual perversion.

Michel de M'Uzan describes a way to think about identity in which two distinct sources of our sense of identity must be considered. His innovation is the concept of the vital-identital, which he suggests is equally foundational with the sense of identity derived from the early human environment. The term endogenous identity is used to unify under one heading the ideas that de M'Uzan employs to build his concept of vital-identital. The author summarizes de M'Uzan's earlier work, elaborates on his more recent ideas, and illustrates the use of de M'Uzan's ideas with a cultural and a clinical example.

The author reconsiders Freud's "The Sexual Aberrations," the first of his Three Essays on the Theory of Sexuality (1905), in light of contemporary psychoanalytic theory. Are the concepts of sexual aberration and norm still viable? The author argues that they are necessary but insufficient elements in current theory. He then presents a competing model in which sexuality can be reduced to a more elemental level of disturbance and wish, where it is an expression of a nonsexual wish--for example, to possess or control the object to eliminate separateness. The author presents clinical material to demonstrate this alternative model.

(2014). Introduction: “The Sexual Aberrations”—Where Do We Stand Today? The Psychoanalytic Quarterly: Vol. 83, No. 2, pp. 241-247.

The author postulates that challenges related to ending an analysis may reflect the fact that the analysis has never truly begun, in the sense of achieving a true analytic engagement, one that can lead to psychic growth. Patients who are unable to achieve an emotional experience thus highlight the problem of interminability as one of how to begin. The author describes the model of reification of experience and presents aspects of the analysis of a perverse patient, the case of Mr. C, to illustrate the usefulness of this model in understanding how this patient defended against experiencing his emotions and the ensuing transference-countertransference difficulties.

A case is discussed in which the patient's management of aspects of the payment process is seen as a focal point in a perverse defensive structure operating in the treatment. Detailed process material is examined with attention to transference and countertransference components of this defensive process. Recent literature on perverse thought and defense is reviewed in order to understand this case in the context of current thinking, to generate new ideas about the nature of perverse defenses, and to consider the potentially special role that money may play in the operation of such defenses in psychoanalysis.

This paper (1) posits the occurrence of perverse dreams as a type of mental phenomenon in the constellation of perverse processes; (2) considers manifest dreams of frank perversion as a type of perverse dream within the class of perverse dreams as a whole; (3) relates the subtype of perverse dreams without manifest perversions to the occurrence of perverse defenses and the development of a perverse transference; and (4) suggests that consideration to perverse dreams in the psychoanalytic process finds application in identifying and differentiating perverse defenses from neurotic and other characterologic patterns; in identifying and tracing the vicissitudes of difficult perverse transference-countertransference constellations; and in furthering perverse patients' recognition and understanding of particularly troublesome and seemingly intractable issues in their psychic makeup. Clinical material illustrates perverse dreams and their usefulness in the often arduous process of analyzing perverse defenses.

Subtle, nonpsychotic disturbances in thinking may cause significant impairment of intellectual functioning and interfere with a patient's capacity to make use of psychoanalytic treatment. As these come under interpretive scrutiny, the intellectual exchange between patient and analyst may emerge as a theater for the enactment of perverse sexual fantasies. In this paper, the author describes these disturbances in thinking and proposes a model that explains their underlying structure and their link to the associated fantasies. Interpretation and working through of the condensed part-object and whole-object transferences that emerge in the analysis of these forms of thinking may lead to some measure of clinical improvement.

This paper outlines the author's view that certain individuals are “Slaves of Quantity,” condemned to a destiny dominated by the quantity of excitation that cannot be psychically elaborated. The sadistic killer known as M, in the film of the same name by Fritz Lang, and an extreme masochist interviewed by the author, illustrate the features of these perverse disorders, which are also linked to extreme psychosomatic states. The origins of these “slaves of quantity” are related to traumatic factors early in life. Freud's fundamental notions about anxiety and his debate with Rank on birth trauma shed light on a way to more clearly conceptualize the distinction between neurotic and perverse modes of psychic functioning.

Much has changed in clinical practice and theory that bears on the diagnosis and treatment of perversion since Freud's Three Essays on the Theory of Sexuality (1905). Definitions of perversion have been freed from assumptions of a heterosexual normality and from moralistic interpretations. The authors endorse the current emphasis on aggression and early narcissistic problems and include the notion of splitting and sexualized scenarios in their definition of perversion. They present several vignettes of male and female patients to demonstrate the debts owed to Freud's theories and the way in which their thinking differs. They emphasize the understanding of the transference-countertransference picture and the patient's management and control of excitement.

Close examination of Freud's Three Essays on the Theory of Sexuality (1905a) reveals an ambiguity in Freud's language as he simultaneously tries to escape 19th-century psychiatric paradigms concerning sexuality and perversion while also retaining a normative approach to adult sexuality that created new categories of pathology. The result is an ambivalent legacy that has both hampered and helped contemporary clinicians as they deal with a diverse array of presentations of gender and sexual orientation in today's world.

The author's starting point is a psychoanalysis conducted with Emile, a teenager who was unable to form close relationships and was living in a virtual world, planning a school massacre. For him, virtual reality functioned as a bottomless container in which he was no longer a victim of bullying but rather a god. When the boundlessness of cyberspace encounters a "black hole" in the psyche, any fantasies can be put into virtual realization and actions. By recounting his wickedness, violence, destructiveness, and perversion, Emile could start restoring his self boundaries and create his own autobiographical narrative. Unable to sustain the pain of mourning his envelope of invulnerability and omnipotence, however, he prematurely terminated analysis.

Freud's (1940a) tentative distinction between the defensive maneuvers in neurosis and those in perversion can be extended to good clinical effect. In general, neurotic defenses may be thought of as directed against wishes, whereas perverse defenses are directed against perceived reality. It is suggested that the perverse approach to reality is not limited to frank sexual perversions; it defines a class of operations that involve taking certain liberties with reality. Clinical material is used to demonstrate the perverse attitude and some of its implications for technique. The role of the superego is considered.

(1992). An Example of “Character Perversion” In A Woman. The Psychoanalytic Quarterly: Vol. 61, No. 4, pp. 581-589.

The study of a case of voyeuristic perversion and of some previously published cases of simple scopophilia suggests that fear of object loss early in life may be an important factor predisposing one to a propensity for voyeurism. The increased need to maintain visual contact with the object and to incorporate it visually leads to a hypercathexis of the visual function which is at the base of voyeurism. This need later becomes sexualized, while still retaining its pregenital connotations. Although object loss was apparently significant in the case of the patient described in this paper, it is not necessarily a factor in all cases of perverse voyeurism and, when present, may be considered as only one element in its pathogenesis.

The concept of masochism is used in both descriptive and explanatory ways to cover a wide variety of clinical phenomena. Although the concept has been thought to refer to a ubiquitous, fundamental, and paradoxical phenomenon, recent discussions reveal growing uncertainty about the clinical value of the term. The origins of the problem are traced here to Freud's early reliance on concepts borrowed from Krafft-Ebing's sexology. Freud later emphasized structural and object-relations issues. This shift of emphasis was associated with the use of child behavior rather than perversion as the prototype of mental function.

This paper attempts to demonstrate that fetishism as defined by Freud in males also exists among women. Freud described fetishism as a defense against castration anxiety arising from the perception of the female genitals. It is suggested that the main difference between male fetishism and female fetishism is that because of developmental factors involving the phallic phase, for women the fetish represents the penis of the father, not of the mother. Clinical material is presented to support these hypotheses.

The etiological significance of the actually observed primal scene in fetishism and other perversions is discussed. The impact of the primal scene on the pathology of part object relationships, self and object image, and on the development of superego structures in perversion is stressed.