Perversion

PERVERSION (inversio, perversio). Psychiatric perversions are qualitative disorders of drives in relation to their content and objects. Perversions can be of a psychic (including sexual) and physical nature. Besides sexual perversions, the most well-known are perversions of the drive for food. Idiots, paralytics, and schizophrenics often ingest substances that are not only inedible (sand, stones) but even repulsive (feces, urine, small animals). The suddenly and acutely arising whims of appetite in pregnant women (picae gravidarum) are well known. Hysterical individuals and chlorotics sometimes harbor a passion for consuming paper, chalk, coal, clay, etc. Bernstein described two women who had an irresistible urge to eat earth (geophagy). They looked at it with the same greed with which a chronic alcoholic looks at vodka, and it was necessary to conduct a real course of weaning them from this habit, similar to what is done with drug addicts. Apparently, such states have a somewhat different basis than the corresponding whims of pregnant women and chlorotics: whereas in those cases, a change in metabolism plays a certain role, biologically causing—though perhaps exaggerated—a striving for the introduction of certain chemical components into the organism, in cases similar to those described by Bernstein, it is a matter of the emergence of a drive analogous in its essence to the passion for drug use, based on a pathological habit. The drive for self-preservation undergoes perversion in the tendency toward suicide and self-mutilation observed in many mentally ill patients, as well as in the passion of some psychopaths for inflicting pain upon themselves. Certain bad habits (nail biting, thumb sucking) and such impulsive drives as the passion for vagrancy (poriomania), theft (kleptomania), and arson (pyromania) are also perversions. A single mechanism for perversions of drives cannot be established: even states similar in external manifestations can have a completely different origin in different cases. The most frequent type should be considered the fixation of a drive (apparently on the basis of a conditioned reflex mechanism) to those stimuli that are not appropriate for it in the normal state, but which first caused its satisfaction. This also includes the frequent fixation (or renewal at a later age) of a drive that has already played its physiological role (e.g., thumb sucking in adults). By physical perversion, one most often implies an incorrect position of the viscera.