The perverse attitude toward reality.

Freud's (1940a) tentative distinction between the defensive maneuvers in neurosis and those in perversion can be extended to good clinical effect. In general, neurotic defenses may be thought of as directed against wishes, whereas perverse defenses are directed against perceived reality. It is suggested that the perverse approach to reality is not limited to frank sexual perversions; it defines a class of operations that involve taking certain liberties with reality. Clinical material is used to demonstrate the perverse attitude and some of its implications for technique. The role of the superego is considered.