A romance with pain: a telephone perversion in a woman?

The patient repeatedly and compulsively made stereotyped telephone calls to her mother and other female protective figures. She had a history of genito-urinary infections and operations consequent to urinary retention. These symptoms were relieved gradually in the course of analysis, in which this was interpreted as a sado-masochistic perversion based on a central fantasy of phallic intrusions on the mother. The fantasy was related to turning passive viewing into active exhibitionism, actively seeking to inflict pain on herself and others in an attempt to overcome early painful medical intrusions, misplaced identification with the father, complementary relationship with the passive, compliant mother, and consequent failed identification with the oedipal mother. In the analysis, she attained a gradual reorganization of adaptive functions which allowed identification with the father through her work, reconciliation with the rivalrous siblings, and enjoyment of her female sexuality in heterosexual intercourse with the use of a fetishistic requirement that the man be uncircumcised. The hypothesis was developed that whether called a symptom or a perversion, the treatment was the same so that it was most useful to think of it as a compromise formation rather than attempting to preserve a distinction largely based on moralistic considerations.