The sexual interests and activities of Khan's patient were exclusively centered in the foreskins of beautiful youths. He had himself been circumsized at birth. The fetish had complex derivations but especially related to longing for oral union with the mother, who had both seduced and rejected him beginning in early childhood. From a later level of development the foreskin symbolized the mother, the glans symbolized the father, and the foreskin enclosing the glans symbolized the mother and the father happily united. This contrasted with reality as the father and mother had quarreled and divorced. Narrow focus on the foreskin also served as a defense against fear of total surrender and collapse relating to early experiences with the mother. In Hartmann's idiom, the fetishism in this case, as well as in general, could be postulated as a pathological substitute for secondary autonomy. In a ten-year follow-up, the patient was found to be 'doing good work in an atmosphere of social belongingness', but it is not stated whether he achieved heterosexuality.