BOOK NOTICES 773

will find it here. He speaks with conviction and justifies his inde-
pendence in order to evolve a “new psychoanalysis.” IVhatever hap-
pened in psychoanalysis before o r outside Kohut’s work can only be
considered as long as it supports the primacy of self psychology. One
would have hoped that this volume would instead have invited an
open interchange and dialogue among psychoanalysts.

Peter B. Neubauer, h1.D.

New York City

ALIENATION I N PERVERSIONS. By M . Masud R. Khan. New York: In-

ternational Universities Press, 1979, 246 pp., $22.50.

This is a collection of essays previously published between 1962 and

1976. hl. h4asud R. Khan’s valuable contributions to a psychoanalytic
theory of perversion and to the psychoanalytic treatment of perverts
are to be found primarily in four of these articles. Chapters 5 and 6
were (for the most part) published in the ZnternatiotialJournal of Psycho-
Ana1jsi.s in 1965 and 1969. Chapters 2 and 4 were harder to come by.
All four have received insufficient attention in the psychoanalytic
literature. Throughout this volume, but especially in his later writings,
Khan’s overemphasis on the positive, reparative, humanistic aspects
of perverse enactments approaches idealization of the human poten-
tial for good, growth, and change. I suspect this has put off many
psychoanalysts from appreciating what is useful here for a current
assessment, theoretical as well as clinical, of perversions within struc-
tural theory.
From these four essays can be culled a reasonably well-integrated
and plausible theory of perversion formation. Genetically, maternal
deprivation or impingement is focused, according to Khan, on. the
mother’s depression during the patient’s early childhood. This is de-
fended against by the mother’s obsessional techniques and denial.
Khan has here elaborated some of IVinnicott’s earlier ideas. A collusive
defensive constellation is enacted between mother and child to protect
the mother from awareness of her pathology and from the intense
rage in both mother and child. Early bodily intimacies-which in some
cases, with seductive mothers, have been excessive (together with ex-
cessive neglect of the child and his own developmental needs)-are
idealized and amplified in masturbatory reverie states. T h e child “li-
bidinizes” the body, including the genitals, in response to deficiency
in maternal care. hlasturbatory reveries aim to preserve and idealize
774 BOOK SECTION

the good aspects of the mother-child relationship apart from the

child’s rage at her. Khan postulates that a part of the self is kept
separate from the mother, does not surrender to her o r to her moods,
and is validated in the masturbatory reveries. Fears of passive ma-
sochistic surrender to others as well as to one’s own driven needs and
feelings are abated by these masturbatory reverie states-a kind of
mental masturbation, in which intellect dominates passion and need.
This is a clear and useful genetic formulation. What I would criticize
h&e is the failure to examine the role of sexuality in the evolving
mother-child relationship and to explore why a sexual mode (per-
version) is chosen to gratify and defend against conflicts we so often
encounter in more severe character pathology.
Similarly, Khan’s discussion of the dynamic and adaptive aspects
of perversion largely omits consideration of how sexual feelings, fan-
tasies, and experiences function. Nevertheless, I must acknowledge
Khan’s contribution to our understanding of perverse behavior.
Khan, more than any other contemporary psychoanalyst, has at-
tempted to move us away from our reflexive bias against the acting-
out behavior of the pervert. What Khan has done here for our attitude
toward perverts is similar to what a number of modern authors have
done for our difficulties in maintaining an analytic attitude toward
narcissistic personality disorders and certain other needy, driven
preoedipal character types.
Khan is at his best as a writer when he portrays the pervert’s
talent and skill at engaging another person to enact his perverse scen-
ario. He beautifully renders the pervert’s fear of fully surrendering
himself to another person, as well as to his own driven needs and
feelings. This leads the pervert to maintain control and distance in
the relation to the partner, by whom and with whom he can never
allow himself to be satisfied. I recommend reading Khan’s convincing
explanation of the multiple functions served by perverse enactments.
H e is concerned with a theory of imperative action. Khan focuses this
mainly on the need for concrete validation of internal fantasy images
and the need for defense and repair of immobilizing depression. He
struggles to understand the pervert’s simultaneous fear and intense
need of others, as well as of his own internal states, as he explains the
pervert’s relationship to his partner. Khan emphasizes the positive
potential, in that the-partner is another separate human being, no
matter how much the pervert is projectively identified with him and
regards him as his own subjective creation.
Khan believes he has solved the dilemma between subjective and
interpersonal by use of IVinnicott’s concept of transitional objects and
 BOOK NOTICES 775

phenomena. He states, for example, that perversion is “auto-erotism

A deux . . . an engineered re-enactment of masturbatory practices
between two persons” (p. 24). Although this is a seductive formulation,
it is not accurate o r consistent with Khan’s dual attention tosubjective
states as well as self-and-other interactions. What needs to be specified
are the relations between perverse practices with others and one’soivn
masturbatory fantasies and practices, together with the qualities of
involvement between self and other and the needs served thereby.
Brody’s recent critique of the concepts of transitional object and phe-
nomena can be usefully applied to Khan’s reduction of perverse prac-
tices to such infantile phenomena, which d o not involve another
person. Similarly, Bak‘s criticism that adult fetishism should not be
reduced to the infant’s use of transitional, intermediary, or prosthetic
objects is relevant. Thus, Khan’s description of his male homosexual
patient is marred by connecting adult ritualistic behavior (the fetish)
with childhood reverie states, which are called “fetishistic” reveries.
I have some trouble with Khan’s use of sexual drive. Although
he generally refers to defensive sexualization, at times he posits that
there is great danger to the pervert from instinctual excitement. This
may be the case, but Khan is not at all convincing. What comes across
more are dangers of greed and envy, which he acknowledges, and
which he does not regard as purely instinctual excitement. Some of
this is explained by the manic defense involved in exploitation of
instinctual arousal. Perhaps the problem here is that Khan is not clear
about his view of how sexual drive is used by the ego for defense and
adaptation.
T h e reader should be aware-and this has been a problem since
Freud tried to derive a theory of perversion from the perverse fan-
tasies of neurotic patients-that the two reported cases of homosex-
uality, male and female, began such behavior only during analysis.
Some caution must be maintained concerning the general applicability
of such material to homosexual perverts. This limitation is particularly
unfortunate for the paper on female homosexuality, because so little
has been published about this by contemporary psychoanalysts.
Khan was the first psychoanalytic author to suggest that the writ-
ings of certain well-known perverse authors might have some relation
to the needs served by their perverse practices. T h e last chapter of
this book, on pornography, is therefore particularly disappointing.
Although Khan uses the concept o€ the reader as accomplice to the
author, rather than inquiring into the possible defensive and adaptive
functions of such writing for the author or reader, he presents a
polemic against pornography. T h e marquis de Sade and Jean Genet
776 BOOK SECTION

are reduced to writers of pornography in a tirade (originally published

in the Tiines Literary Supplement) against dehumanization, which is un-
characteristic of Khan’s more thoughtful and complex work.

Stanley J. Coen, M.D.

New York City

HOMOSEXUAL BEHAVIOR: A hfoDERN REAPPRAISAL. Edited by Judd

Martnor. New York: Basic Books, 1980, xv + 416 pp., $27.50.

This survey “modern reappraisal” takes as its aim an extensive

overview, not an intensive study; as its object, homosexual behavior,
not inner meanings and roots. Unfortunately, the panorama is
clouded by an intrusive attitude of opposition to classical psychoa-
nalysis, its theories and its “anecdotes” (i.e., single case studies). Many
of the biological, social, and clinical views presented are informed by
the editor’s principle that labeling behavior as a disorder o r a perv-
ersion defines normality in terms of social convention and therefore
is destructive to both individuals and society. For the moment, let us
set aside the unquestionable concerns for protection of civil rights
-remaining cognizant that any scientific study which tailors obser-
vations to the bias of politics will betray the ultimate social goal as
surely here as in Marxist agriculture.
Psychoanalytic understanding has distinguished perversion from
deviation, with the former defined in terms of the development of
object choice and drive discharge, the latter in terms of popularity or
statistical acceptability. Regrettably, the familiarity of several of the
authors with the classical theory they abuse seems to have stopped at
the level of the first instinct theory developed around Freud’s Three
Essay on the Theory of Sexuality in 1905; consequently, the three-quar-
ters of a century of arduous development through analytic investi-
gation, work by such people as Sachs, Loewenstein, Bychowski, Bak,
and Greenacre, is not integrated into conceptualizations. Questions
of body image and of narcissism are passed by, the role of aggression
is neglected, and the supraordinacy of the adaptive point of view is
posited as if it were both new and simply interpersonal in scope. A
low point of polemic is reached whenone author quotes Freud, using
a partial citation to suggest misleadingly that Freud’s view was the
direct opposite of that stated in the source paragraph (see p. 318).
Homosexual and heterosexual object choice are generally felt