Fetishism: A Case Report

This patient's long-standing perversion first came to light after about a year of treatment for a much more acute disorder. It was not suspected until he reported a dream of women's underwear hanging from a clothes line. The details and complexity of the patient's perverse character structure were gradually and reluctantly revealed during the next five years of treatment, accompanied by intense guilt, depression and anger.

At the age of 21 the patient had graduated from college at the top of his class as an engineer and mathematician to face the strong possibility of serving as an infantryman in the Korean War. His father, a shy little man, had avoided conscription into the Russian army by falsifying his age and leaving the country. The patient hoped to escape military service by employment in a defence plant, but he performed so poorly at this work, which was so tangential to his training and interests, that he feared he would be forced to resign and face the draft. This did happen. The following developments also contributed to his acute illness. A young woman to whom he had recently been introduced by his mother rejected him after he had a few dates and 'fell in love with her'. His mother was now more than ever energetically absorbed in fostering the career of his younger brother, a very talented musician. She became ill and was hospitalized for a vaginal hysterectomy. A transfusion, for which the patient gave his blood, followed surgery.

In these experiences we can see numerous components capable of arousing both separation and castration anxiety. It was during the course of his mother's illness, however, that the patient developed his most acute and disabling symptoms. These included depression and fears that he would never get well and would have to kill himself. These moods sometimes suddenly changed to excited ones during which he was afraid he would do something harmful. He had periodic nausea, vomiting, diarrhoea and constipation. He particula