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This paper will attempt to summarize ideas concerning the nature of perversions, especially emphasizing the genetic and dynamic aspects. The multiplicity of the forms and the varied intensities in which perversions appear may be confusing in efforts to understand their essential character. Drawing on a fairly wide range of clinical pictures from those cases which seem but slightly deviant from the normal to those extreme forms of perversion which may startle by their bizarre characteristics, the attention of the investigator must first focus on relatively pronounced cases in which perverse development is clear and definite.
I shall refer first to fetishism, which next to homosexuality is seen more frequently in patients under treatment than the other more florid perversions. Patients rarely seek treatment because of it, however, and, as Freud (1927) remarked, many patients regard their practice as abnormal but not as a symptom. It is uncovered—or rather, comes under scrutiny—in the course of working with other disturbances. In a review of the literature (1953) I found that in only one case was fetishism reported as a presenting symptom (Romm, 1949), and then it was due to the rebellion of the wife, who was obliged to participate in the fetishistic ritual which drove the patient to treatment.
While the careful study of a very few cases is of the utmost importance and furnishes the best foundation for clinical psychoanalytic