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The application of a holistic psychoanalytic approach, as exemplified by the theories of Horney, to the study of the sexual perversions can offer certain advantages over previous analytic theories, and can contribute much to our understanding of them. The various sexual deviations—compulsive sexuality, hypersexuality, psychosomatic sexual dysfunctions, homosexuality, as well as the more limited perversions—are seen to be determined by neurotic motivations, feelings or attitudes toward others and toward self. This view does not deny the importance of biological sexual needs and drives, but it sees their expression in such pathological sexuality as due to the existence of pathological non-sexual factors. Sexuality is not isolated, compartmentalized or encapsulated from the rest of the personality, but is considered simply as one area of function, along with and of equal importance to the many other areas of interpersonal emotional life. Emphasis is shifted to the neurotic individual rather than to the neurotic sexual activity, and to whether there are more healthy or more compulsive motivations and attitudes underlying the sexual behavior.
The thesis of this paper is that where there is a disturbance of sexual function, there are disturbances in other areas of living; that correlations can be made between fluctuations in the perverse activity and changes in dynamic personality factors; and that these deviations can be treated by long-term psychoanalytic therapy. It is based mainly on a relatively small series of eight clinical cases, in analysis from about one year to eight years, who showed four perversions: exhibitionism, voyeurism, haircutting fetishism and transvestism.
However, with the view that sexual behavior is determined by non-sexual attitudes, sufficient attention may not be paid to certain specific aspects of the perversions which must be otherwise explored and clarified for a more complete understanding. The limitations inherent in this generic view may ac