The development and organizing function of perversion: The example of transvestism

Abstract

Perversion had been viewed as oedipally determined and in a reciprocal relationship with neurosis. In our widening scope, however, pre-oedipal and traumatic contributions have been increasingly emphasized. While both perspectives represent aspects of clinical reality, the tendency has been to overlook sexual and aggressive drive derivatives, with their related conflicts, object representations, and symbolic enactments, even though they may make significant contributions to the analytic situation. These latter, 'classical' patients have what I consider 'organized' perversions: complex, evolved, neurotic-level, stable psychopathological formations that may be distinguished from borderline or near psychotic syndromes enlisting perverse mechanisms to ward off disorganization. This paper will review Freud's work, briefly consider some recent trends in conceptualizing perversion and perverse mechanisms, characterize organized perversion, and present clinical material to illustrate its evolution, clinical manifestations, and analysis. Transsexualism, overtly similar to transvestism but not functioning as an organized perversion, will serve as a point of contrast.

A metasynthesis of published case studies through Lacan's l‐schema: Transference in perversion

“…At the level of the motives for thoughts, feelings and actions, the perverse patient demonstrates an ability to work analytically and to be open to the interventions of the analyst. Meyer () reports a transvestite patient who felt “reduced” to a girl by having to lie down on the couch and no matter how erotic in fantasy, in real life this was the most infuriating thing he could imagine. The patient reacted by secretly starting to wear panties during consultations.…”

“…In this way, we gathered 11 case studies in total, all with male patients. The studies retained include cases of paedophilia (De Masi, 2007;Houssier et al, 2011), fetishism (Joseph, 1971;Stolorow, 1975;Stolorow and Grand, 1973), homosexuality 4 (Torres, 1987), fetishistic voyeurism (Jimenez, 1993), fetishistic cross-dressing (Baker, 1994), exhibitionism (Vogelgesang, 1999), bisexuality (Carignan, 1999;Purcell, 2006), and transvestitism (Meyer, 2011).…”

“…Following this, we consulted Web of Science with the search terms ‘analysis AND perversion,’ which resulted in 97 hits (search performed in July 2012). We screened all article abstracts for cases of individual psychoanalytic treatment with sexually perverse patients and retained seven eligible cases (Carignan, ; De Masi, ; Joseph, ; Meyer, ; Purcell, ; Stolorow, ; Stolorow and Grand, ; Torres, ). In this way, we gathered 11 case studies in total, all with male patients.…”

Transvestic Disorder, Obsessive Compulsive Disorder, and Bipolar Disorder in an Adolescent Male: Diagnostic Conundrums and Management Difficulties

“…Further understanding of the index case may be arrived at psycho dynamically as described by Jon Meyer. 7 He proposed that perversions may be organized or borderline, that is, nearing a psychotic syndrome. The organized perversions are complex, evolved, neurotic-level pathological formations which are structured akin to a neurosis and are composed of preoccupations, elaborate, and conscious erotic fantasies which are central to sexual arousal and orgasm.…”