Tales from the Therapist's Couch: 'Who are the perverts now? And who says so?'

The use of words to communicate our inner worlds is always a double-edged tool. In therapy, in the consulting room, people struggle to find a language with which to articulate and share their private, often previously unspoken experience. Wrestling to make verbal sense of what feels nonsensical is one way, a very good way, of taking control of our worlds. Psychologically, it's what Adam did when he named the beasts in the garden of Eden. Once defined they were mastered, known and so less fearful.

The problem is that the nature of the beast is always more than the definition. Our stories need to be continually revised to keep the truth of the experience alive. This is as true of the myths first created about psychoanalysis by Freud as it is of the personal histories reconstructed every day in consulting rooms. Hysteria, the Oedipus complex, narcissism, transference, the ego and the id... much of Freud's language needs a regular revision. The new wine simply doesn't mature in the old bottles.

One concept developed by Freud which has become something of a dinosaur is his use of the word perversion. In the early days of psychoanalysis, a perversion was any deviation from the "normal" sexual act, with "normal" being defined as genital intercourse with someone of the opposite sex. So homosexuality was tarred with the same brush as paedophilia, necrophilia, bestiality, fetishism, transvestism, voyeurism, exhibitionism and sadomasochism.

Thankfully, few theorists are still tethered to Freud's male homophobic interpretation. And yet therapeutic use of the term "perversion" to describe everyday clinical issues is far from extinct. Glancing through recent publications, it looks as if it is, in fact, enjoying something of a comeback. So what acts are nowadays being defined as perverse? And by whom?

Read any newspaper and it is tragically clear that paedophilia, sexually motivated murder, rape and bestiality are still with us. But for most therapists, these are rarely confessed to. More likely to be heard about in the 50-minute hour are voyeurism, exhibitionism, pornography, sadomasochism, prostitution or fetishism. Whatever someone's sexual orientation, any of these, if performed by a man, would be interpreted as a perversion by most analytic theory. There may be less homophobia in analytic thought today, but the world of perversion still belongs exclusively to the world of men. If you don't have a penis, the argument goes, you can't be sexually perverse.

Until fairly recently, that is. One reason for the surge in clinical references to perversion is a loosening of its definition to include the world of women. The underlying cause of male acts of perversion has always been explained as the need for control and mastery in order to compensate for deep-seated feelings of sexual insecurity, which in turn are caused by arrested psychosexual development. Men who use perversions to find sexual gratification invariably admit to difficulties in relating sexually to other adults as equals. To compensate, they choose an object (person or thing) they can use to release sexual tension within a totally unthreatening – because totally controlling – way. The sadism and violence of some perversions is an expression of the impotent rage behind this need. Therefore all perversions, from benign to tragically malign, involve the use of some object to serve their needs. The possibility of a sexual relationship that includes equality, love and concern is thus sabotaged.

So where do the female maladies fit in? Many therapists are arguing that the same pattern – of using and abusing another to relieve oneself of self-hatred and sexual insecurity – is exactly what women do when they turn to anorexic, bulimic and self-harming behaviours. Only the object they attack is, of course, themselves. The issue now is a much broader one of why someone of either sex feels deeply impotent and insecure about their sexuality, and is driven to distorted ways of achieving relief from tension.

If this definition of perversion is here to stay, Freud's earlier description has been well and truly revised. It now has nothing to do with one's sexual orientation or method of intercourse, but everything to do with how we use and abuse power in our everyday relationships with others and ourselves, and the degree of love and concern, as opposed to control and mastery, that we show in our sex life. This is a far cry from Freud's language. For many it is also perhaps a little uncomfortably closer to home.

elizabeth.meakins@blueyonder.co.uk

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the clinical material above refers to specific individual cases