“Some perversions, while representing formidable psychopathology, are also tributes to the complexity of the human mind and unconscious ego mechanisms. The patient, a man in his late twenties, reported a periodic desire to be injured by a woman operating an automobile. This wish, present since adolescence, he had by dint of great ingenuity and effort, gratified hundreds of times without serious injury or detection. Satisfaction could be obtained by inhaling exhaust fumes, having a limb run over on a yielding surface to avoid appreciable damage or by being pressed against the wall by a vehicle. Gratification was enhanced if the woman were attractive by conventional standards. Injuries inflicted by men operating automobiles or other types of injury inflicted by women had no meaning. He experienced pleasure from the experience, thus establishing the symptom as a perversion rather than a compulsion. The patient’s sexual, social, and occupational adjustment was good and his intelligence superior. He intellectualized to a considerable extent but could experience and manage strong positive and negative feelings. He was ashamed of his symptom but somewhat proud of its unusual nature. … At least two interlocking themes are necessary for an essentially masochistic gratification. The injury must be inflicted by a woman, probably as a defense against other feelings involving women, and must be inflicted by an automobile, this probably having a specific symbolic meaning.”
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