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Lectures on Violence, Perversion and Delinquency
In this volume contemporary staff describe their thinking and clinical work. Theoretical underpinnings for the understanding of perversion and violence, questions of risk and ethics and the institutional difficulties which emerge in the care of these patients are presented alongside chapters on clinical work, with adults and adolescents, including chapters on paedophilia, the compulsive use of internet pornography and transsexuality. This volume is of relevance to all those working with people with a range of personality disorders and those working with individuals who present with these types of problems in the mental health services and in private practice. The Portman Clinic has been applying a psychoanalytic framework to the understanding and treatment of violent, perverse, criminal and delinquent patients since its foundations in the early 1930's. All Portman Clinic patients have crossed the boundary from fantasy and impulse to action - action which defies legal and moral boundaries but which also breaches the body boundary of the victims.
270 pages, Kindle Edition
First published January 1, 2006
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February 2, 2025
Frankly, the main reason I felt the need to research this book was because of the bizarre inclusion of transsexuality alongside other forms of sexual deviancy. Nonetheless, I still tried to remain open minded despite being lumped in together with other sexual predators, because I find that there is little room for in depth psychoanalytical discussions surrounding this topic nowadays, and am always looking for refreshing new perspectives.
I only managed to find a few excerpts of this book as it is hard to come by, and I was hesitant to go out of my way to buy something that appeared intriguing and very informative at first glance, but quickly proved itself to be rather outdated and way too Freudian in its approach. Way too much is lazily blamed on adverse childhood experiences and traumas, and too many assumptions are made on the patients' behalf that I doubt they would even agree with. Too many conclusions are immediately drawn based on a few personal anecdotes rather than actual research.
I cannot comment on the analysis of the topics of sexual deviancy themselves, as I am no expert, but again I feel like both the approach and conclusions are almost too fantastical in nature.
However, regarding the topic of transsexuality, a subject that I have relentlessly researched most of my life, I am extremely disappointed.
They pinpoint and ask some very important fundamental questions; regarding why we choose to treat psychological problems via surgical intervention? ( I answer this below ) Whether for some, the desire to be the opposite sex is merely a desire for escapism? ( It can be, but not always ) Why patients who afterwards are filled with regret? ( There used to be a strong emphasis on surgical intervention compared to today, because varying levels of dysphoria weren't considered. It was either you were a full transsexual who wanted full sexual reassignment, or were a mere transvestite. You also couldn't change your gender legally without surgery first. This contributed to higher rates of regret post-op as people were pushed to have surgeries to live as their desired gender. Most transsexuals have genital dysphoria, but the risks of surgery sadly still outweigh the benefits. There is also, conveniently, no mention of which types of surgical interventions had lower satisfaction compared to others, as gentital reconstitution is obviously a lot riskier compared to procedures like mastectomies, which have very high levels of satisfaction. )
A lot is glossed over, either because these lectures are extremely outdated, or out of ignorance and lack of expertise.
For example, we had plenty of treatments focused on downplaying transsexual fantasies through conversion therapies in the past, which were psychologically damaging and akin to torture for a lot of these patients, hence why they were outlawed. There is no focus on determining the nature of these fantasies, and how they may neurochemically differ from classical "delusions" such as a anorexia and classic body dysmorphia. They conveniently skim over patients with early onset gender dysphoria, and only list examples of patients with FAR much later onset gender dysphoria. These patients clearly struggle with issues of social identity, not gender/bodily identity and disconnect. I would advise therapists to be aware of transsexuals that have genuine body dysphoria, which is probably biological in nature ( Which observed in various rat and mouse studies where we purposely altered their mating behaviors. There is also a lot of parallel with phantom limb disorders. ) that manifested relatively early, versus misguided cisgender people that bought into the idea that gender transition can give their life new meaning. The former is an expression of visceral, often life damaging body dysphoria that disable the patient from interacting with the world through their body, and prevents them from forging any identity to begin with. The latter is an escapist fantasy, "social dysphoria" if you will, that should be treated with more caution because other factors must be ruled out first before assigning a gender dysphoria diagnosis.
Trans men are almost entirely left out of the conversation, because our behaviors can't be explained by classic Freudian psychology, especially if there is a total lack of any apparent trauma or difficult upbringing present in the patient. The topic, annoyingly, always tries to paint trans women as more fetishistic and deceitful in nature, as if they gain some sense of satisfaction from "forcing others to bend to their fantasy". In reality, transsexuals are well aware that we are asking a lot of other people. There are many who repress their identities in public altogether out of fear and shame, and turn their "fantasies" inward. Others, like myself, grow thick skin and try to learn to live with the painful reality that they will never be viewed as fully human. We are well aware of how grotesque the world thinks we are, and by no means do we derive any masochistic sense of pleasure from "deceiving" others or ourselves. We are very self-aware of our limitations. The entire chapter is a condescending overgeneralization of the unique and painful experiences every transsexual goes through.
The only area where I can agree is the idea that group therapy can help both a lot of transsexuals and misguided cisgender people. That they can help dissipate any false fantasies on what transition truly entails. It is important for us to share both the good and the bad side of such a difficult journey, and there is indeed a severe lack of this now that we have a very blindly affirmative approach to all of this.
I only managed to find a few excerpts of this book as it is hard to come by, and I was hesitant to go out of my way to buy something that appeared intriguing and very informative at first glance, but quickly proved itself to be rather outdated and way too Freudian in its approach. Way too much is lazily blamed on adverse childhood experiences and traumas, and too many assumptions are made on the patients' behalf that I doubt they would even agree with. Too many conclusions are immediately drawn based on a few personal anecdotes rather than actual research.
I cannot comment on the analysis of the topics of sexual deviancy themselves, as I am no expert, but again I feel like both the approach and conclusions are almost too fantastical in nature.
However, regarding the topic of transsexuality, a subject that I have relentlessly researched most of my life, I am extremely disappointed.
They pinpoint and ask some very important fundamental questions; regarding why we choose to treat psychological problems via surgical intervention? ( I answer this below ) Whether for some, the desire to be the opposite sex is merely a desire for escapism? ( It can be, but not always ) Why patients who afterwards are filled with regret? ( There used to be a strong emphasis on surgical intervention compared to today, because varying levels of dysphoria weren't considered. It was either you were a full transsexual who wanted full sexual reassignment, or were a mere transvestite. You also couldn't change your gender legally without surgery first. This contributed to higher rates of regret post-op as people were pushed to have surgeries to live as their desired gender. Most transsexuals have genital dysphoria, but the risks of surgery sadly still outweigh the benefits. There is also, conveniently, no mention of which types of surgical interventions had lower satisfaction compared to others, as gentital reconstitution is obviously a lot riskier compared to procedures like mastectomies, which have very high levels of satisfaction. )
A lot is glossed over, either because these lectures are extremely outdated, or out of ignorance and lack of expertise.
For example, we had plenty of treatments focused on downplaying transsexual fantasies through conversion therapies in the past, which were psychologically damaging and akin to torture for a lot of these patients, hence why they were outlawed. There is no focus on determining the nature of these fantasies, and how they may neurochemically differ from classical "delusions" such as a anorexia and classic body dysmorphia. They conveniently skim over patients with early onset gender dysphoria, and only list examples of patients with FAR much later onset gender dysphoria. These patients clearly struggle with issues of social identity, not gender/bodily identity and disconnect. I would advise therapists to be aware of transsexuals that have genuine body dysphoria, which is probably biological in nature ( Which observed in various rat and mouse studies where we purposely altered their mating behaviors. There is also a lot of parallel with phantom limb disorders. ) that manifested relatively early, versus misguided cisgender people that bought into the idea that gender transition can give their life new meaning. The former is an expression of visceral, often life damaging body dysphoria that disable the patient from interacting with the world through their body, and prevents them from forging any identity to begin with. The latter is an escapist fantasy, "social dysphoria" if you will, that should be treated with more caution because other factors must be ruled out first before assigning a gender dysphoria diagnosis.
Trans men are almost entirely left out of the conversation, because our behaviors can't be explained by classic Freudian psychology, especially if there is a total lack of any apparent trauma or difficult upbringing present in the patient. The topic, annoyingly, always tries to paint trans women as more fetishistic and deceitful in nature, as if they gain some sense of satisfaction from "forcing others to bend to their fantasy". In reality, transsexuals are well aware that we are asking a lot of other people. There are many who repress their identities in public altogether out of fear and shame, and turn their "fantasies" inward. Others, like myself, grow thick skin and try to learn to live with the painful reality that they will never be viewed as fully human. We are well aware of how grotesque the world thinks we are, and by no means do we derive any masochistic sense of pleasure from "deceiving" others or ourselves. We are very self-aware of our limitations. The entire chapter is a condescending overgeneralization of the unique and painful experiences every transsexual goes through.
The only area where I can agree is the idea that group therapy can help both a lot of transsexuals and misguided cisgender people. That they can help dissipate any false fantasies on what transition truly entails. It is important for us to share both the good and the bad side of such a difficult journey, and there is indeed a severe lack of this now that we have a very blindly affirmative approach to all of this.
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