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In a paper on fetishism (1953) I made an effort to organize the clinical picture and life-historical findings of such cases as I had observed, in relation to the development of the body image, since the fetish itself so clearly acts as some kind of stabilizer or reinforcement for the genital functioning of the patient. From this angle, my clinical material indicated rather clearly, I thought, the nature and timing of the special faults in the body image, which were patched up by the use of the fetish in later life. This was a limited presentation, but for me a useful one, since it offered a frame of reference for organizing clinical material, which at the very least is complex and confusing.
The main points of that paper were as follows: The disturbance of the fetishist appearing clinically as an unusually severe castration fear comes essentially from disturbances of pregenitality which render the child structurally unsound and insecure to meet genital-oedipal problems and especially to meet the normal castration threats of this period. In those cases which I saw these threats were already overwhelming, having appeared before the full oedipal development in unusually severe actual traumata of a specifically castrative type—threats not merely by seeing the mother's genital and observing her apparent castration at a time of special masturbatory arousal, as was first postulated by Freud (1927), but much more than this by witnessing or experiencing bloody mutilating attacks in the form of operations (on the self or others), childbirth, abortions, or accidents. These traumatic events, although unknown to the patient early in the analysis, have generally been accessible to validation after they have been brought to consciousness through analytic reconstructions.