This article analyzes the first edition of Freud’s (1905b) “Three Essays on the Theory of Sexuality” and more particularly the status of the perversions as it appears in that book, demonstrating how this seminal text contains a radical critique of a “psychiatric style of reasoning” (Davidson, 2001a) that turns the perversions into a separate identity fundamentally different from other ‹identities›. Freud’s insights are then confronted with the Lacanian idea of a “perverse structure.” It is argued that Lacan’s theories on perversion remain deeply influenced by the French psychiatric tradition on the topic (Dupré, 1925) and that they imply a return to the “psychiatric style of reasoning” that Freud tried to overcome. Finally, I formulate some suggestions with regard to a re-thinking of sexuality in psychoanalytic metapsychology.