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To review a book of this size is a daunting proposition. It is the first textbook on the perversions which collects together all the important researches by psychoanalysts since Freud. The dedication of Socarides to his subject is shown by the massive case material collected over thirty years. That is the time Socarides has spent working psychoanalytically with the perversions—all of them, for not one has been left out. So he speaks not only with great clarity but also with an authority to which he has every right.
So what does be say? He has no truck with those who want to make out that homosexuality is the normal lot for those whose sexual activities are exclusively with the same sex. Even in the case of transsexual persons of either sex he sheds serious doubt on the validity of surgical intervention and shows how the aims of physical changes are much better understood as a defence against recognising the condition as delusional. I make this clear at the start to underline his thoroughgoing psychoanalytic orientation.
Perhaps his most important contribution is how he shows the variety of conditions which are grouped together under the heading of perversion. I refer not only to the long-known variety of them but also to his differentiation of states which can be found if each type is carefully investigated. I suppose this state of affairs has been neglected—I will not say ignored—because of the well—organised stages that can display themselves especially in homosexuals. It is certainly these which have contributed to therapeutic pessimism. Socarides shows no sign of that, though he concedes that a less favourable prognosis must be acknowledged for those perversions which are a symptom of narcissistic or borderline personalities, or when they are found in schizophrenic patients.
His classification of the perversions is therefore especially helpful. It is as follows:
1. Those perversions which are predominantly defences against Oedipal conflicts: reversible regression re