“Perversion is the erotic form of hatred.”
Robert J. Stoller
Photo by Man Ray
Shortly after delivering a seminar on Kohut and self psychology, I found myself sitting alone in a café in Kadıköy. At the neighboring table, two young people were speaking candidly; one was a female medical student describing, with visible distress, the misogynistic, obscene, and ethically alarming attitudes she witnessed among male medical students and interns. She spoke of sexualized joking about female patients and sexual objectification of female students, of a closed male solidarity that protected its own, and of her fear for the future of a healthcare system entrusted to misogynistic individuals so seemingly devoid of empathy. Listening to this conversation immediately after discussing selfobject needs, narcissistic vulnerability, and the development of empathy was deeply unsettling. It was as if the abstract concepts of fragile self-cohesion and failed mirroring were suddenly embodied in the social world before me. This juxtaposition between a theoretical seminar and a spontaneous, unguarded account of lived reality prompted a renewed urgency to think about how failures of the self are not confined to the consulting room, but reverberate through institutions, professions, and bodies, often at the expense of women.
In many patriarchal societies, the dehumanisation of women, particularly within institutions of authority such as medicine cannot be understood solely through moral, legal, or sociological lenses. To ask why such behaviors persist, even among highly educated professionals, requires a psychological inquiry into the formation of the self under patriarchal conditions. I propose that such dehumanisation is rooted in fragile self-structures, chronic failures of selfobject functions, and defensive forms of masculinity that rely on domination and objectification for self-cohesion. Drawing primarily on Kohut’s self psychology and integrating insights from object relations, attachment theory, and social psychology, I argue that misogynistic attitudes and behaviors function as maladaptive attempts at self-regulation. Understanding these dynamics is essential not to excuse ethical violations, but to comprehend their psychological function and to imagine more effective preventative and corrective interventions.
The disturbing sexualized language and obscene joking described in medical training contexts are often misunderstood as expressions of excess libido or moral laxity. Psychoanalytic thought offers a more sobering reading. As Robert Stoller famously observed, “Perversion is the erotic form of hatred.” In the present context, this formulation is not invoked to pathologize sexuality itself, but to illuminate how aggression, humiliation, and disavowed vulnerability may be transformed into sexualized discourse when empathic selfobject functions have failed. When the capacity to experience others as subjects collapses, eroticization can become a vehicle for contempt rather than connection, allowing hostility to be expressed in socially disguised form. From a self psychological perspective, such eroticized degradation serves a regulatory function for fragile selves, stabilizing self-cohesion through domination at the expense of empathy. Seen in this light, the sexualization of women’s bodies, particularly within asymmetrical power settings such as medical training reveals not an overflow of desire, but a defensive organization of the self around aggression and unmet developmental needs.
Fragile Self-Cohesion and Patriarchal Masculinity
From a self psychological perspective, a cohesive self is one that can maintain stable self-esteem, tolerate vulnerability, and recognize others as subjects rather than functions. In contrast, many patriarchal systems cultivate conditional self-worth, particularly in men, where value is tied to achievement, dominance, and emotional invulnerability.
When early selfobject needs, especially mirroring, idealization, and twinship are inconsistently or inadequately met, the developing self remains vulnerable to fragmentation. Such individuals often rely on defensive grandiosity to maintain cohesion. Professional identity, authority, and gendered power then become external selfobjects that prop up an internally unstable self.
In these contexts, masculinity is not experienced as a secure internal state, but as a status that must be constantly proven and defended.
Photo by Man Ray
Failed Selfobject Functions and the Objectification of Women
Kohut emphasized that when others are needed primarily for self-regulation, they are no longer experienced as whole persons. This is central to understanding the dehumanisation of women.
In patriarchal systems, women are frequently recruited into selfobject roles:
- as mirrors of desirability and power,
- as containers for disavowed vulnerability,
- as objects through which dominance can be enacted.
Sexualized talk, obscenity, and humiliation function less as expressions of desire and more as attempts to stabilize a fragile self. Sexuality, stripped of empathy, becomes a regulatory tool rather than a relational experience.
Within medical settings, particularly in fields involving intimate bodily access, this dynamic becomes especially dangerous. Patients’ bodies risk being reduced to sites of projection rather than subjects of care.
Male Solidarity as a Defensive Selfobject System
The strong solidarity observed among men in patriarchal institutions can be understood as a group selfobject, providing mirroring and protection against self-doubt and shame. Loyalty to the group replaces internalized ethics; conscience becomes externalized and regulated by peer norms.
This collective defense system often excludes women, not merely because of sexism, but because women threaten the group’s fragile equilibrium. Women introduce relational complexity, ethical reflection, and the possibility of exposure, each of which risks destabilizing defensive grandiosity.
Photo by Man Ray
Why Women Often Feel Unprotected, even by Other Women
The failure of protection does not rest solely with men. Many women, raised within the same patriarchal selfobject field, have learned that safety depends on adaptation rather than confrontation. Identification with power, lateral competition, and silencing of other women often function as survival strategies rather than expressions of indifference.
From a self psychological viewpoint, these women may lack sufficient internal security to risk dissent. Solidarity requires a degree of self-cohesion that allows one to tolerate disapproval, loss of status, and relational rupture which are conditions many women have historically been denied.
Thus, the absence of protection reflects not moral failure, but collective developmental deprivation.
Integrative Perspective: The Function of Dehumanising Behavior
From an integrative psychotherapy standpoint, all behavior serves a function. The dehumanisation of women by men in patriarchal contexts serves multiple psychological functions:
- Self-regulation: managing shame, anxiety, and fragmentation
- Identity consolidation: affirming masculinity through dominance
- Affect transformation: converting vulnerability into contempt
- Group belonging: securing attachment through shared norms
- Avoidance of mourning: defending against grief for unmet dependency needs
Understanding these functions does not absolve responsibility, but it does clarify why purely moralistic or punitive responses often fail to produce change.
Toward Healthy Masculine Self-Cohesion
Healthy masculine self-cohesion does not require domination or objectification. It emerges when dependency is not shamed, vulnerability is metabolizable, and authority is held without humiliation. Such selves can integrate sexuality with empathy and power with responsibility.
From a self psychological lens, ethics are not imposed from outside, they arise organically when the self no longer needs to defend itself through others.
The dehumanisation of women in patriarchal societies reflects not only cultural ideology, but also widespread failures in the development and support of the self. Fragile selves seek stability through domination; failed selfobject functions distort sexuality and power; unsupported women withdraw protection to survive.
If institutions such as medicine are to become truly ethical, they must address not only conduct, but the inner lives of those who wield authority. Without spaces for reflection, mourning, and relational repair, power will continue to be organized around fragility rather than responsibility. Therefore, understanding these dynamics is a prerequisite for meaningful change!
