Discussion

I am grateful to Dr. Padouvas for writing such a detailed, informative account of this unusual and interesting case. I also appreciate Dr. Wright's comprehensive review of the literature on perversions and enlightening discussion.

The patient, Mr. B, has a profusion of perverse fantasies, which pose problems not only for the patient but also for the analyst and the discussant. The patient himself is overwhelmed by the intensity and frequency of his fantasies, leading to anxiety, guilt, and shame. Consequently, he suffers in his ability to produce the film scripts necessary for graduation and to enjoy a harmonious relationship with a woman. From the structural viewpoint, his difficulties may be seen as a weakness in ego functions, especially the capacity to repress intrusive fantasized scenarios and control impulses.

The plethora of the patient's fantasies presents problems for the analyst, also. What should one interpret, in what order should one explicate complex aspects of the material, and what should one emphasize? In particular, it is sometimes difficult to ascertain how the patient's fantasies are manifested in the changeable, multifaceted transference. Another significant problem is presented by the patient's impulsivity and tendency to act out when instinctual pressure reaches a certain height.

In addition, the richness of the material poses a dilemma for the discussant, in terms of what topics to choose. I will focus on two main areas—the patient's fantasies, both conscious and unconscious, and the transference.