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PubMed1997

Masochism revisited: reflections on masochism and its childhood antecedents.

Masochism, originally described as sexual perversion by Sacher von Masoch, was elaborated by Freud to include personality pathology, and further developed by Bieber and others. The DSM-III included sexual perversion and personality pathology as separate diagnoses, but were totally eliminated from the DSM-IV. It is the author's thesis that the masochist's self-abnegating language is diagnostic--a disguised attack expressing fear, hate, and contempt of others.

Adult↗
PubMed1982

The theory of gender identity disorders.

Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes. Transsexualism is closely linked to perversions, and the clinical syndromes may shade from one into another. However, what is kept at the symbolic level in the perversions must be made concrete in transsexualism. In this regard there is a close relation to psychosis. The clinical complaint of the transsexual is a condensation of remarkable proportions. When the transsexual says that he is a girl trapped in a man's body, he sincerely means what he says. As with other symptoms, however, it takes a long time before he begins to say what he means.

Animals↗
PubMed1984

The multiple meanings of masochism in psychoanalytic discourse.

The term masochism was originally used in a narrow, specifically sexual sense (referring to perversions ), but has come to encompass for many analysts an exceedingly broad and variably determined range of clinical phenomena that bear no consistent relation to sexual excitement. In addition, these expanding clinical perspectives have long been entangled with Freud's shifting metapsychological constructions designed to ground masochism in instinctual theory. As a result, the term is used with little consistency and at varied levels of abstraction: loosely descriptive, dynamic, theoretical. It is not always explicit which meaning is intended or what inferences, if any, are meant to be drawn from the term. When used in its broadest sense, masochism may falsely suggest dynamic similarity between diverse phenomena, and is often ambiguous with respect to the presence or absence of underlying erotic or perverse excitement. In the clinical situation, the categorization of material as masochistic may evoke an associated set of genetic, dynamic, or theoretical ideas which may alter the perception, ordering, and interpretation of clinical data. Particularly conducive to this subtle steering process are the enduring influence of the early concept of feminine masochism and the related concept of sadistic and masochistic paired opposite component sexual instincts--a theoretical, physicalistic , linear concept incompatible with the clinical model of overdetermination and multiple function. This paper includes a review of the terminological and conceptual history of masochism, briefly touches on the parallel history of sadism , and offers some provisional definitional solutions.

Anxiety, Castration↗
PubMed1997

Narrative inversion: the biblical heritage of The well of loneliness and Desert of the heart.

The Bible acts as an epistemological anchor for the English Bildungsroman; however, the biblical narratives are themselves in flux, especially with regard to representations of spiritual development gendered feminine. The extent to which one can consider the traveling/travailling mother a spiritually coherent figure who exists independent of male spiritual authority seems only possible insofar as one adopts the position of the perverse reader, who envisions the envelopment of her stories as narrative inversion. To do so is to believe that accounts of female heroism need not narratively depend on those of male heroism. The term narrative inversion in turn allows the perverse reader to recognize a narrative desire that, because it does not conform to but indeed suggests an alternative narrative possibility for the homosocial plot, remains enfolded within the plot. Inhabiting precisely this paradox of narrative inversion are the lesbian heroines who follow in the Bible's wake.

Bible↗
PubMed2000

Hypochondria: a tentative approach.

The author begins his investigation of hypochondria by defining the condition and distinguishing between hypochondriacal symptoms and hypochondriacal crises, the latter being stated to arise when the defensive function of the former fails. After an enumeration of the main psychogenetic elements observed in the psychoanalytic psychotherapy of a sample population of eight patients, he concentrates on the psychodynamic and psychostructural aspects and demonstrates by means of clinical examples how conflicts of separation and dependence give rise to oral-sadistic, anal-sadistic and progressive-perverse defensive structures. Although regressive and progressive psychodynamic processes established between these structures may temporarily stabilise the psychic system to some extent, splits cause them to loom large in a hypochondriacal world full of disintegrative anxiety that is accompanied by an aggressive excitation pervaded with threatening confusion and sexual perversion, where the patient flees into quasi autistic withdrawal and tormenting self-observation. Catastrophic states resulting from earlier traumas are here fused with more mature psychic elements owing to earlier traumas. The author shows how instability in these structures, together with the failure of important ego and superego functions, may lead to a malignant regression and the consequent pathogenic reintrojection of projections. When the psyche is threatened by a dynamic of this kind, hypochondriacal symptoms may ensue as a last-ditch attempt by the patient to defend against psychic decompensation.

Conflict, Psychological↗
PubMed2000

From symbols to flesh: the polymorphous destiny of narration.

The author analyses certain aspects of the narration of a generally taciturn hysterico-phobic obsessional patient as they appear in the transference relationship, pinpointing its phallic mastery and the sadistic impact of the domination over the audience/analyst that underlies this mode of discourse. She examines them in relation to Proust's 'A la recherche du temps perdu', discussing the place of perversion in analytic listening and interpretation. She then outlines some of the key structuralist and formalist views of narration as a form of syntactic structure expanded by the resolution of an enigma via a hero's ordeal, arguing that if syntactic structure exists, it consists neither of affirmation nor of negation but rather of interrogation. The author notes that what makes psychoanalytic theory radically different from other interpretive theories is the co-presence of sexuality and thought: psychoanalysis reinforces the formal description of a signifying act by the unconscious psychosexual conditions of its possibility. She then discusses the poetic narrative of Nerval and also that of Proust, which is dominated by the acting out of perverse fantasy, the resulting polyphony of various psychosexual registers, its philosophical and metaphysical impact and its relevance to the analyst's own interpretive acts when formulating stories within the countertransference relationship.

Countertransference↗
PubMed2001

Freud's letters to Fliess. From seduction to sexual biology, from psychopathology to a clinical anthropology.

The author describes the development of Freud's theory of neurosis from 1892 onwards, starting with his distinction between the actual neuroses and the psychoneuroses and his discovery of a specific, sexual aetiology for both, until which point it remained limited to pathology. The problem of the aetiology of perversion, however, confronted him with a paradox within the theory of seduction: how can an infantile sexual pleasure produce unpleasure when it is remembered at the time of puberty? This problem could not be solved within the framework of the seduction theory because the sexuality of childhood was essential to this theory. For an answer Freud had to turn to biology. He considered that the transformation of an infantile pleasure into unpleasure presupposed an organic repression of non-genital sexual pleasure. This hypothesis of organic repression radically changed the anthropological claim of Freud's theory. As long as he was looking for a specific aetiology of neurosis and perversion, Freud's theory remained restricted to pathology. However, when he introduced infantile sexuality and its organic repression as universal organic processes, the strict distinction between normality and pathology could not be maintained. The author concludes that by turning to sexual biology, Freud transformed psychopathology into a clinical anthropology.

Freudian Theory↗
PubMed2006

On the psychodynamics of collecting.

The urge to collect is a ubiquitous phenomenon which has anthropological, sociobiological and individual psychodynamic roots, but occurs far more frequently among men than women. The author examines the reasons for this gender difference and defines systematic collecting to distinguish it from addictive, obsessive and messy collecting, and from related phenomena such as perversion. The mode of collecting and choice of object are important indicators as to the unconscious psychodynamics of a collector and offer opportunity to describe his structural level. Collecting ranges across a broad spectrum, from an ego-syntonic integrated mode, i.e. sublimation, to a neurotic defence against pre-oedipal or oedipal traumas and conflicts. Alongside this drive-theoretical approach, object and Kleinian theory are also applied to the understanding of collecting. Collecting represents a specific form of object relating and way of handling primary loss trauma, which is different from addiction, compulsion, or perversion. Under certain circumstances collecting can also result in a successful Gestalt or way of life. The paper concludes with a case study showing how collecting develops from a pre-oedipal to a more integrated oedipal mode during the course of the analysis, which is reflected in changes in the transference.

Adult↗
PubMed2006

From acting to communicating: the analysis of a boy with a pathological organization.

The author presents the analysis of an 8 year-old boy prematurely born after a high-risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non-productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school--both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make-believe as well as the intense projective mental functioning.

Acting Out↗
PubMed2003

Psychoanalysis and creative living.

Psychoanalysis is ambivalent about creativity and its own creative potential. On the one hand, psychoanalysis offers enormous resources for elucidating obstacles to creativity, that way of living, making and relating to self and others that is fresh, vital, unpredictable and open to feedback and evolution. On the other hand, when we analysts know too much beforehand about what a work of art really means or the fundamental and singular motives of creativity, then psychoanalysis unconsciously partakes of a perverse scenario in which the work of art serves as merely a means to the author's ends and is psychologically colonized. When psychoanalysis is The Discipline That Knows, then art has nothing new to teach psychoanalysts and our field is impoverished. "Psychoanalysis and Creative Living" attempts to elucidate how psychoanalysis could work through this tension between its creative and perverse possibilities and foster creative living.

Art↗
PubMedDate not supplied

[Contribution to the psychoanalytic theory of exhibitionism].

Exhibitionism can be regarded as a cultural, social and psychological phenomenon. It is given a view of the theories in the literature. Once exhibitionism is a normal human phenomen, otherwise it is pathological, par example also a neurotic symptom. The early psychoanalytic theories describe exhibitionism as a "Psychoneurose" as a result of "Odiopussituation", "Kastrationskomplex" and "Inzestwunsch". Psychodynamically this is not satisfying. With the development of psychoanalytic theory, especially the importance of the pregenital phases, changes the classification of perversions. In this article, exhibitionism-- as a neurotic symptom -- is defined as a "schizoide Perversion" (Riemann), which causes can be find in a preoral, intentional phase. Naturally the treatment must be adapted to it.

Adult↗
PubMed1999

Treatment of a transvestic fetishist with cognitive-behavioral therapy and supportive psychotherapy: case report.

Transvestic fetishism is a paraphilia marked by recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving cross-dressing, in a heterosexual male. There are many explanations of the pathogenesis, but none are conclusive. Different treatments have been applied, but they generally remain obscure and disappointing. Transvestic fetishists rarely seek psychotherapy, because of their dynamic balance between perversion and intrapsychic disintegration. There are few studies, either qualitative or quantitative, associated with transvestic fetishism in Taiwan. This case report describes an adolescent transvestic fetishist who underwent a brief course of psychotherapy in the outpatient department of a psychiatric center in Taipei. After consultation for one year, he still maintained his deviant sexual behavior but also developed more severe moral anxiety. He was then referred for psychotherapy. Cognitive-behavioral and psychodynamic theories associated with transvestic fetishism were reviewed and applied in both understanding and treating this client. Some temporal effectiveness was achieved with combined cognitive-behavioral and dynamic-oriented supportive psychotherapy. After 18 sessions of psychotherapy over more than 4 months, the client was able to stop his perverse behavior and have fewer sexually arousing fantasies. The prognosis of transvestic fetishism is generally supposed to be pessimistic and have a high rate of recurrence. Some propose that adolescents have a better outcome after treatment. This case report reveals the possibility of change for a transvestic fetishist. However, the long-term effects of the brief course of psychotherapy require further evaluation in the future.

Adolescent↗
PubMed2000

[Endocrine disruption agents: environment, health, public policies, and the precautionary principle].

The already substantial body of evidence and growing web of suspicions as to the scale and severity of the cascade effects of endocrine disrupters (related to persistent organic pollutants or POPs) on the health of ecosystems and humans have sparked such concern that in June 1998, representatives of 94 countries meeting in Montreal under the aegis of UNEP signed a draft international agreement to phase out the most harmful POPs. Related to particular persistent organic pollutants--toxic semi-volatile and persistent chemical compounds now found everywhere in the environment, such as BPCs, organochlorine pesticides, dioxins and furans, that build up in the bodies of organisms that consume other contaminated organisms along the food chain--endocrine disrupters are strongly suspected of affecting the health of animals and adversely impacting the health, fertility and even intellectual faculties of humans. For example, very low-level exposure to some POPs is associated with some hormone-dependent cancers, damage to the central and peripheral nervous systems, impaired immune system function, reproductive disorders and developmental disruptions in newborns and infants, who can be affected in utero or through breast-feeding. Considering the extreme complexity of the scientific and socio-economic effects of POP-related endocrine disrupters, there are those who, advocate a wait-and-see approach, claiming that there is not enough formal scientific proof. There are others who use the available evidence to advance the research, press for bans on incriminated substances and look for global, integrated and viable alternatives. And there are other still who, with careless disregard for the Precautionary Principle, are quite prepared to talk about the perverse effects of POPs in order to justify the increased use of artificial means of reproduction or the replacement of chemical pesticides by pest-resistant genetically modified organisms (GMOs), thereby opening the door to "solutions" that are potentially more biologically and ethically dangerous than the problems they purport to remedy. This paper provides an overview of the current understanding of the main sources and suspected effects of POPs on animal life and human health, explores the complexity of the scientific, economic and political issues involved in any international process to do away with the incriminated products, discusses the risks and perverse consequences of some of the proposed alternatives, and stresses the importance, in the light of these risks and consequences, of placing renewed emphasis on public and environmental health approaches based on the Precautionary Principle.

Endocrine System Diseases↗
PubMed1991

[Viewpoint apropos transgenerational aspects of child abuse].

The fact that child abuse recurs from generation to generation, raises many questions. The psychoanalytical approach tries to figure out the position of the victimized child. Usually, he is considered either as the narcissistic image of the abuser or as the partner of a perverse situation. To analyse how transgenerational coalitions work within the family to reproduce violence, the systemic approach focuses on concepts like loyalty and perverse triangulation.

Adolescent↗
PubMed1991

[Marginal and bone marrow pools of neutrophil granulocytes in patients with lung cancer].

Marginal and bone marrow pools of neutrophil leucocytes were studied in 194 patients with lung cancer, stage III-IV. Reactions of neutrophil marginal pools (adrenaline test) were characterized by the development of neutrophil leucocytosis (NL) in the peripheral blood of 64.5% of cases (typical reaction), or by NL absence in 35.5% (perversed reaction). The prednisolone test conducted for evaluation of bone-marrow pool of neutrophils has revealed perversed leucocytic reaction in 39.6% of patients. Unstable marginal pool and decreased bone marrow neutrophil reserve were recorded in the course of polychemotherapy. Changes in the prednisolone test indices precede the development of neutropenia in the peripheral blood.

Adult↗
PubMedDate not supplied

[The concept of masochism].

The terms masochism and masochistic behaviour are clinically used for acceptations extending well beyond the relatively well-defined limits of sexual perversion. If it is indeed rather unusual to see a masochist pervert identified as such among psychiatric hospital or ambulatory patients, yet you very often find in a medical record the term masochist applied to a patient without there being any question of his sexual habits. This enlargement of the concept masochism has its roots in the works of Freud who introduces, next to the masochist perversion, notions of feminine and moral masochism. The aim of this paper is to re-situate in the light of psycho-analytic theory, the specificity of the various masochistic formulas in order to render them their semiologistic value, more particularly in connection with the therapeutic indications involved.

Female↗
PubMed1987

Fetishism revisited.

Following a brief review of the psychoanalytic literature on perversions, a case of fetishism is presented. The patient was a man who could only have an erection while wearing an apron. Nevertheless, it did not help him to reach an orgasm. He could only achieve this while having certain anxiety dreams that produced nocturnal pollutions. It is suggested that whatever the pregenital determinants of this perversion are, fetishism makes special reference to problems related to the phallic position (a concept suggested as an alternative to the notion of a developmental genetic phallic phase). References are made to the families of perverts and, specifically, to the function of the father.

Adult↗
PubMed1979

Psychosexuality and the representational world.

The sensual experiences, fantasies and enactments that occur in the course of normal development are seen as psychic organizers which contribute vitally to the structuralization of the representational world. In the sexual perversions which occur in structurally deficient, developmentally arrested individuals, this function of early psychosexual experiences has been retained and is regressively relied upon in order to restore or sustain the cohesion and stability of crumbling, fragmenting or disintegrating self and object representations. Analytic exploration of the details of perverse fantasies and acts, their origins and functions, reveals the particular ways in which they compensate for specific structural weaknesses in patients' representational worlds. Some clinical illustrations and therapeutic implications of these formulations are briefly presented.

Fantasy↗