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PubMed1989

Fetishism in a woman.

Fetishism is generally considered to be a perversion occurring only in males. In this paper a clinical illustration of an adult woman with a fetishistic perversion is offered and considered within the context of the classic concept of fetishism originally described by Freud. Similarities and differences between male and female fetishism are discussed, with attention given to the greater complexity of the perversion as it occurs in a woman. The clinical example confirms the existence of fetishism in women and suggests that subtle forms of the perversion may go unnoticed and be more prevalent than previously realized.

Adult↗
PubMed1991

The maternal erotic countertransference.

This paper reviews literature on countertransference erotism and perversion, and offers our conception of the maternal erotic countertransference. We stress that sado-masochistic issues are not only issues of aggression, but represent pre-oedipal erotism as well. The analyst's struggle with these issues may contribute to a perverse misalliance instead of a creative coupling. It is typical of the perverse misalliance that it contains a refusal to participate, with all the attendant disinterest and deadness and lack of creativity usually associated with that condition. We have emphasized two keys to springing the analyst from the deadlocks of such paralysing countertransferences, thereby opening access to the creative use of both maternal erotic transference and countertransference. First, is the analyst's ability to view herself or himself as maternally erotic; and second, is the analyst's ability to experience, contain and make accessible to analysis the patient's potential erotism, including its perverse aspects.

Adult↗
PubMed1989

On a type of heterosexuality, and the fluidity of object relations.

This paper delineates a form of heterosexuality whose underlying psychological structure resembles that of perversions. It is characterized by: idealization of instinctual processes, whereby the ego subordinates the object to the actualization of the instinctual event itself; heightened narcissism in an otherwise neurotic ego organization; multiple intrapsychic uses of the object; a special kind of defensive organization; an experienced victory over the superego and associated elevation of certain aspects of the ego ideal; and a resultant alteration in the nature of close interpersonal relationships. I use clinical vignettes from both male and female patients in psychoanalysis to focus on the phenomena in question. The thinking of Chassequet-Smirgel, Freud, Khan, Rangell, Socarides, and others is used in an attempt to gain an encompassing perspective. It is emphasized that patients demonstrating this form of heterosexuality do not possess a perversion per se, but demonstrate a character neurosis which integrates certain perverse mechanisms into its defensive organization. These mechanisms can be isolated and studied in psychoanalytic treatment, with the potential for illuminating their defensive and mood-regulating functions, and eventual working through and resolution of the intrapsychic conflicts underlying them. Some comments on the implications of this form of sexuality for our contemporary culture are included.

Adult↗
PubMed2004

Hormesis, hotspots and emissions trading.

Instrument choice--the comparison of technology standards, performance standards, taxes and tradable permits--has been a major topic in environmental law and environmental economics. Most analyses assume that emissions and health effects are positively and linearly related. If they are not, this complicates the instrument choice analysis. This article analyses the effects of a nonlinear dose-response function on instrument choice. In particular, it examines the effects of hormesis (high-dose harm but low-dose benefit) on the choice between fixed performance standards and tradable emissions permits. First, the article distinguishes the effects of hormesis from the effects of local emissions. Hormesis is an attribute of the dose-response or exposure-response relationship. Hotspots are an attribute of the emissions-exposure relationship. Some pollutants may be hormetic and cause local emissions-exposure effects; others may be hormetic without causing local emissions-exposure effects. It is only the local exposure effects of emissions that pose a problem for emissions trading. Secondly, the article shows that the conditions under which emissions trading would perform less well or even perversely under hormesis, depend on how stringent a level of protection is set. Only when the regulatory standard is set at the nadir of the hormetic curve would emissions trading be seriously perverse (assuming other restrictive conditions as well), and such a standard is unlikely. Moreover, the benefits of the overall programme may justify the risk of small perverse effects around this nadir. Thirdly, the article argues that hotspots can be of concern for two distinct reasons, harmfulness and fairness. Lastly, the paper argues that the solution to these problems may not be to abandon market-based incentive instruments and their cost-effectiveness gains, but to improve them further by moving from emissions trading and emissions taxes to risk trading and risk taxes. In short, the article argues that hormesis does not pose a general obstacle to emissions trading or emissions taxes, but that in those cases where hormesis does pose such a problem, a shift toward risk trading or risk taxes would be the superior route.

Air Pollutants↗
PubMed2003

The observing ego as voyeur.

A resistance to self-observation and self-reflection is discussed in which there is a perversion of the observing ego. The observing ego has been unconsciously recruited in the service of enacting an unconscious fantasy: the fantasy of being an excited observer of a primal scene who is punished for making forbidden observations. This voyeuristic observing ego is pathologically enmeshed in a love triangle with the patient's seductive superego (i.e. identification with the desired but unfaithful parent) and with the patient's punitive superego (i.e. identification with the rivalrous parent). This unconscious scenario is played out in the clinical situation as the patient unreflectively cycles through phases of denial (i.e. self-seduction) and moral masochism (i.e. self-betrayal). A case study illustrates how humor may be employed to free the observing ego from being enthralled by a perverse superego. Humor may unconsciously enable a rebellious attitude toward the omnipotent sadism of a perversely oppressive superego and thus enable the observing ego to break free from its pathological enmeshment.

Denial, Psychological↗
PubMedDate not supplied

[Social capital, violent deaths, and cancer mortality in Colombia: a population approach].

OBJECTIVE: In Colombia there are evidences that social capital (SC) is associated with greater rates of violent crime ("perverse" SC). This study explores the relation between SC, violent deaths (1973-1996), and the accumulated occurrence of cancer deaths (1990-1996). MATERIAL AND METHODS: An ecologic study with the 33 Colombian departments was carried out. Correlations between violent deaths (inverse proxy of SC), the internal displacement ratio, and the mortality rates by each type of cancer. With robust regressions the effect of violent deaths ("perverse" SC) on the occurrence of mortality cancer were explored, adjusting by economic convergence or polarization (1960-1995), and the internal displacement ratio until 1996. RESULTS: Positive correlations (p < 0.05) between violent deaths ("perverse "CS) and all types of cancer, except breast and lung among men, were observed. In all the cases statistically significant associations were observed, after adjust by departments' economic convergence/polarization and internal displacement. DISCUSSION: This study shows a direct relation between violent deaths on the occurrence of cancer. The findings obtained here suggest an inverted U shape relation between SC and disease occurrence.

Adult↗
PubMed1991

Psychology and psychopathology in women--a psychoanalytic perspective.

Aspects of the normal psychology and psychopathology of women are discussed in relation to adolescence, young womanhood and motherhood. Perversions of motherhood exist, although they are largely denied by a society which idealises being a mother. This denial may be caused by society's inability to see a woman as a complete human being. The aetiology of perversions in women is both psychobiological and social and it is bound up with the politics of power. Perverse motherhood can be seen as the product of the emotional instability and inadequate individuation brought about by a process involving at least three generations.

Female↗
PubMed1986

Identifications, neoneeds and neosexualities.

With regard to perversions, the pertinent question is not which acts and which object-preferences are to be deemed deviant, but when is deviance to be regarded as a simple variation or version of adult sexuality and when is it to be judged symptomatic. This paper proposes that only relationships may aptly be termed perverse. The term neosexualities is chosen to emphasize the innovative and somewhat unreal character of deviant sexual acts and relationships. These are a response to incoherent communications and unconscious problems on the part of parents. The concept of addictive sexuality or neoneeds is also introduced in reference to the compulsivity that invariably accompanies perverse sexuality. Its dynamic and economic aspects are summarized as follows: those who have created a neoreality in terms of sexual acts and objects in the service of libidinal homeostasis, and neoneeds in the service of narcissistic homeostasis, have short-circuited the elaboration of phallic-oedipal castration anxiety and at the same time through disavowing the problems of separateness and of infantile sadism have also circumvented what Klein termed the elaboration of the depressive position. A clinical vignette is given to illustrate the above theoretical propositions.

Adult↗
PubMed1990

Child physical and sexual abuse: the roles of sadism and sexuality.

Based on the analytical concepts of narcissism and perversion and clinical material, an hypothesis is presented for the understanding of the mental functioning of the physically and sexually abusive parent. Relating the aggressive instinct to narcissism and the sexual instinct to perversion, two modes of functioning are presented which have some points in common and some diverging but which show the dynamics involved in physical and sexual abuse. Understanding the type of emotional relationship between the parents and the type of their emotional investment in their child allows us to see how the complicity of parents works against the child. This understanding implicitly gives insight into the structuring of the personality of the child-victim, who in turn undergoes the risk of himself becoming a physically and/or sexually abusive parent with his own children.

Child↗
PubMed1987

Incentives for cost-effective physician behavior.

The objective of the National Health Service is to maximise improvements in the health status of patients regardless of their willingness and ability to pay. To achieve this objective it is necessary to identify those procedures which maximise improvements in health or quality adjusted life years (QALYs) and direct scarce resources to those therapies with the best cost-QALY characteristics. Unfortunately in the NHS and elsewhere cost-QALY characteristics are largely unknown and the structure of the health service and its provider remuneration systems are such that objectives are vague, behavior perverse due to the haphazard construction of incentive systems, and health status outcomes often unknown due to the failure to evaluate input-outcome relationships. To reform the NHS, in particular ensure more efficient practice by physicians, existing perverse incentives will have to be replaced by the use of buyer (NHS) power and by budgeting mechanisms which induce economizing behavior. It is not clear which type of incentive mechanism will produce outcomes consistent with NHS goals. To remedy this ignorance experimentation with careful evaluation would seem appropriate.

Cost-Benefit Analysis↗
PubMed2005

Solving the problem of the uninsured.

Reform of the United States health care system is less complicated than at first might appear. The building blocks of an ideal system are already in place. The federal government already generously subsidizes private health insurance and safety net care. What is wrong with the current system is that there are too many perverse incentives. One could reasonably argue that government is doing more harm than good, and that a laissez faire policy is better than what is now in place. Nonetheless, if government is going to be involved in a major way in the health care system, perverse incentives should be replaced with neutral ones. At a minimum, government policy should be neutral between private insurance and the social safety net, never spending more on free care for the uninsured than it spends to encourage the purchase of private insurance. Careful application of this principle would go a long way toward creating an ideal health care system.

Ethics, Clinical↗
PubMed1999

Comparison of sparfloxacin and clarithromycin in the treatment of acute bacterial maxillary sinusitis. Sparfloxacin Multicenter AMS Study Group.

Five hundred four patients were enrolled in a randomized, double-masked, multicenter study comparing the efficacy and tolerability of a 10-day regimen of sparfloxacin with a 14-day regimen of clarithromycin in the treatment of acute maxillary sinusitis. Two hundred fifty-two patients received sparfloxacin as a single 400-mg dose on day 1 and 200 mg once daily for 9 additional days, and 252 patients received clarithromycin 500 mg twice daily for 14 days. In the all-treated population, clinical success was observed at 6 to 10 days after therapy in approximately 82% of the patients in each treatment group. A total of 430 patients met the inclusion criteria for clinical assessment. The success rates in these patients were also comparable, at 83.1% and 83.4% for the sparfloxacin and clarithromycin groups, respectively. Sustained clinical success rates in the all-treated population 3 to 4 weeks after therapy were 71.6% for the sparfloxacin group and 68.6% for the clarithromycin group. All treated patients were included in the tolerability analysis. The frequency of adverse events in the clarithromycin and sparfloxacin groups was 57.9% and 48.4%, respectively. The most frequently noted adverse events were diarrhea, photosensitivity reaction, taste perversion, nausea, and abdominal pain; >96% of adverse events in the sparfloxacin group and 94% of adverse events in the clarithromycin group were of mild or moderate severity. Among adverse events at least possibly related to study drug, photosensitivity reaction was more common in the sparfloxacin group (9.5% vs. 0.4%), whereas taste perversion (8.7% vs. 0.8%) and abdominal pain (3.6% vs. 1.6%) were more common in the clarithromycin group. Thus the sparfloxacin's more convenient regimen was as effective as clarithromycin in the treatment of acute bacterial maxillary sinusitis, and the overall frequency of adverse events with sparfloxacin was comparable to that with clarithromycin.

Acute Disease↗
PubMedDate not supplied

Comparison of the efficacy and safety of 2% dorzolamide and 0.5% betaxolol in the treatment of elevated intraocular pressure. Dorzolamide Comparison Study Group.

A multicenter, parallel-design, randomized, double-masked study was conducted to compare the efficacy and safety of 2% dorzolamide with those of 0.5% betaxolol in the treatment of elevated intraocular pressure (i.o.p). A total of 311 adults with ocular hypertension or open-angle glaucoma were randomly allocated to receive either 2% dorzolamide administered topically TID or 0.5% betaxolol administered topically BID plus placebo administered topically QD for 12 weeks. After the washout of previous ocular hypotensive drugs, patients with IOP > or = 23 mm Hg in at least one eye at 10 AM or 4 PM on study day 1 were randomly allocated to receive one of the study treatments. Throughout the study, IOP was measured 2 and 8 hours after instillation of study medication for the morning peak effect (hour 2) and afternoon trough effect (hour 8). After 12 weeks of therapy, the mean change in IOP was not significantly different between the dorzolamide and betaxolol treatment groups at hour 8 (-3.6 mm Hg in both groups) or hour 2 (-5.4 vs -5.3 mm Hg, respectively). The differences between treatments (and 95% CIs associated with these differences) in mean IOP changes from baseline were 0.02 mm Hg (-0.870 to 0.901) for hour 8 and -0.14 mm Hg (-0.959 to 0.685) for hour 2. The ocular adverse experience (AE) most frequently reported by patients was ocular burning and/or stinging, and the most frequently reported nonocular AEs were taste perversion, upper respiratory infection, and headache. Only the incidence of taste perversion was significantly different between treatment groups (14.6% for the dorzolamide group and 0.0% for the betaxolol group). Two percent of patients in each treatment group discontinued the study due to AEs. This study confirmed the similar IOP-lowering effect of 2% dorzolamide and 0.5% betaxolol. Both treatments were generally well tolerated, and their safety profiles were similar.

Adrenergic beta-Antagonists↗
PubMed2002

[Confrontation of children and adolescents with pornography].

The author describes the influence of pornography on children, focusing on pornographical material on the web. Most children escape almost uninjured from visualization of pornography. However some are either traumatized, or precipitated in a strict perversion. The consequences on adolescents are similar, though more complex. The hypersexualization of teenagers may become complicated by addiction (so called internet addiction disorder: IAD), isolation, and perversion. Recommendations for the parents are presented.

Adolescent↗
PubMed2001

Live attenuated HIV vaccines: predicting the tradeoff between efficacy and safety.

The utility of live attenuated vaccines for controlling HIV epidemics is being debated. Live attenuated HIV vaccines (LAHVs) could be extremely effective in protecting against infection with wild-type strains, but may not be completely safe as the attenuated strain could cause AIDS in some vaccinated individuals. We present a theoretical framework for evaluating the consequences of the tradeoff between vaccine efficacy (in terms of preventing new infections with wild-type strains) and safety (in terms of vaccine-induced AIDS deaths). We use our framework to predict, for Zimbabwe and Thailand, the epidemiological impact of 1,000 different (specified by efficacy and safety characteristics) LAHVs. We predict that paradoxically: (i) in Zimbabwe (where transmission is high) LAHVs would significantly decrease the AIDS death rate, but (ii) in Thailand (where transmission is low) exactly the same vaccines (in terms of efficacy and safety characteristics) would increase the AIDS death rate. Our results imply that a threshold transmission rate exists that determines whether any given LAHV has a beneficial or a detrimental impact. We also determine the vaccine perversity point, which is defined in terms of the fraction of vaccinated individuals who progress to AIDS as a result of the vaccine strain. Vaccination with any LAHV that causes more than 5% of vaccinated individuals to progress to AIDS in 25 years would, even 50 years later, lead to perversity (i.e., increase the annual AIDS death rate) in Thailand; these same vaccines would lead to decreases in the annual AIDS death rate in Zimbabwe.

AIDS Vaccines↗
PubMed1976

The sexually exploited child.

Sexual exploitation of children (under 14 years of age) is a common occurrence, although actual numbers are unknown. There are three major forms of sexual abuse: (1) incest, ie, sexual activity between consanguineous family members; (2) sexual assault, such as rape or molestation by adults not related to the child; and (3) habitual sexual exploitation for purposes of financial reward or perverse sexual satisfaction. Brother-sister incest has the highest incidence in the middle and upper socioeconomic levels and is probably the least damaging, psychologically, to sexual adjustment later in life. Father-daughter incest is more common in the lower socioeconomic levels and is thought to produce major disorders in the psychosexual area. Sexual assault of children, if handled supportively and with understanding by the surrounding adults, including parents, physicians, teachers, law enforcement officers, and others, can result in minimal sequelae; however, often the situation is handled with emotional reactions ranging from disgust to hysteria which result in the child's being victimized and traumatized unnecessarily. These latter situations lead to sexual acting-out in adolescence, promiscuity, perversions, or frigidity in adult sexual life. Teachers, physicians, and child welfare workers need to be attuned to the possibility to sexual abuse in the children they serve.

Adaptation, Psychological↗
PubMed1976

Social reintegration of sexual delinquents by a combination of psychotherapy and anti-androgen treatment.

The high frequency of recidivism with convicted sexual perverts is mainly due to the compulsive character of perversion. The classical methods of treatment are seldom satisfactory: Surgery provokes ethical objections, psychopharmaca and oestrogens lead to disagreeable side effects, psychotherapy of any kind is unlikely to be efficacious because of the unfavourable atmosphere the nature of perversion causes it to take place in. However, the climate of both psychoanalytical treatment and suggestive and directive psychotherapy can be enhanced by a combination with an anti-androgen treatment, which eliminates the patient's fear of conviction by inhibiting his sexual urge. Two cases illustrate this combined method. On the basis of a positive disposition, which arises from the improved climate, sublimation of the sex drive and the achievement of a feeling of social responsibility is aimed at. The advantages of the combined therapy are then discussed in comparison with the existing treatments. It is concluded that this combined treatment, next to social guidance and an attempt at solving the fundamental problem of loneliness, can promote the social reintegration of the convicted sexual pervert.

Adult↗
PubMed1974

Skin lipids: their biochemical uniqueness.

Two key words characterize the uniqueness of skin lipids: complexity and perversity. Each suggests a function. Complexity manifests itself in the large number and variety of both saturated and unsaturated fatty chains synthesized by human skin. Functionally, this allows each individual to have a distinct odor or chemical fingerprint. Perversity manifests itself when one compares the lipids synthesized by skin with those synthesized by internal tissues. For example, skin makes odd instead of only even chains, branched instead of only straight chains, free instead of only esterified acids, places double bonds in unusual positions in the fatty chains, extends chains to extreme lengths, and accumulates intermediates in the synthesis of a biologically valuable compound such as cholesterol. Functionally, these products may pose metabolic problems to potential pathogens and thus contribute to the survival of only compatible microorganisms.

Chemical Phenomena↗