(CIPS Series on the Boundaries of Psychoanalysis) Harriet I. Basseches, Paula L. Ellman, Nancy R. Goodman - Battling the Life and Death Forces of Sadomasochism_ Clinical Perspectives-Karnac Books (201
(CIPS Series on the Boundaries of Psychoanalysis) Harriet I. Basseches, Paula L. Ellman, Nancy R. Goodman - Battling the Life and Death Forces of Sadomasochism_ Clinical Perspectives-Karnac Books (201
(CIPS Series on the Boundaries of Psychoanalysis) Harriet I. Basseches, Paula L. Ellman, Nancy R. Goodman - Battling the Life and Death Forces of Sadomasochism_ Clinical Perspectives-Karnac Books (201
FORCES OF SADOMASOCHISM
BATTLING THE LIFE
AND DEATH FORCES
OF SADOMASOCHISM
Clinical Perspectives
Edited by
Harriet I. Basseches, Paula L. Ellman
and Nancy R. Goodman
First published in 2013 by
Karnac Books Ltd
118 Finchley Road
London NW3 5HT
The rights of the contributors to be identified as the authors of this work have
been asserted in accordance with §§ 77 and 78 of the Copyright Design and
Patents Act 1988.
ISBN-13: 978-1-85575-820-9
www.karnacbooks.com
CONTENTS
ACKNOWLEDGEMENTS ix
CHAPTER ONE
Introduction to sadomasochism in the clinical realm 1
Harriet I. Basseches, Paula L. Ellman and Nancy R. Goodman
CHAPTER TWO
Intersecting forces and development of sadomasochism 15
Paula L. Ellman and Nancy R. Goodman
CHAPTER THREE
Sadomasochism in work and play with Diane 29
Paula L. Ellman
v
vi CONTENTS
CHAPTER FOUR
Discussion of the case of Diane 45
Alan Bass
CHAPTER FIVE
Discussion of the case of Diane 63
Jack Novick and Kerry Kelly Novick
CHAPTER SIX
Diane vs. reality: unconscious fantasies at impasse?
discussion of the case of Diane 79
Marianne Robinson
CHAPTER SEVEN
Sailing with Mr. B through waters of “hurting love” 95
Nancy R. Goodman
CHAPTER EIGHT
Discussion of the case of Mr. B 111
James S. Grotstein
CHAPTER NINE
Discussion of the case of Mr. B 123
Margaret Ann Hanly
CHAPTER TEN
Discussion of the case of Mr. B 137
Terrence McBride
CHAPTER ELEVEN
Eating for emptiness, eating to kill:
sadomasochism in a woman with bulimia 157
Andrea Greenman
CONTENTS vii
CHAPTER TWELVE
Discussion of the case of Mariah 179
Steven Ellman
CHAPTER THIRTEEN
Discussion of the case of Mariah 197
Shelley Rockwell
CHAPTER FOURTEEN
Trauma, archaic superego, and sadomasochism: discussion
of the case of Mariah 213
Léon Wurmser
CHAPTER FIFTEEN
The primitive superego of Mr. A: sadistic revenge fantasies,
arousal and then masochistic remorse 229
Richard Reichbart
CHAPTER SIXTEEN
Discussion of the case of Mr. A 247
Sheldon Bach
CHAPTER SEVENTEEN
Discussion of the case of Mr. A 255
Harriet I. Basseches
CHAPTER EIGHTEEN
Sadomasochism and aggression—clinical theory: discussion
of the case of Mr. A 273
Leo Rangell
INDEX 289
ACKNOWL EDGEMENTS
Dear Harriet,
Sorry for this delay.
I am writing these days with great difficulties-age-related—
a pain in the ass.
But wanted this to get to you—so here it is, so far.
That is an amazing duo—our two papers.
Yes, Harriet, the two together are more than interesting; they are
very instructive.
They might appear to come from different patients, yet both are
from the same one.
That’s the way it is, as Walter Cronkite used to say.
Two explorers in the same cluster of caves are digging in caves
side by side which are known and then seen to be connected.
The two are at close but slightly different levels.
The tunnel that finally connected the two was the definitive
interpretation of castration anxiety in both cases, which liberated
the choked-up ego to be able to then rush toward a “cure”.
ACKNOWLEDGEMENTS xi
Love … Leo
ABOUT THE EDITORS AND CONTRIBUTORS
Editors/Contributors
Harriet I. Basseches, Ph.D., ABPP, FIPA, is a training and supervising
analyst in the Contemporary Freudian Society (CFS), formerly the
New York Freudian Society, and the IPA (International Psychoana-
lytical Association), and a member of the CFS Permanent Faculty. She
is a diplomate in psychoanalysis certified by the American Board of
Psychoanalysis in Psychology (ABPsaP). She has held the following
positions: president, the New York Freudian Society; president, the Con-
federation of Independent Psychoanalytic Societies (CIPS); and trustee
of the International Psychoanalytical Association. She has written and
presented in the areas of femininity and female psychology, listening,
enactment, terror, and sadomasochism. She has a private practice in
psychotherapy and psychoanalysis in Washington, DC.
Contributors
Sheldon Bach, Ph.D., FIPA, is adjunct clinical professor of psychol-
ogy at the NYU Postdoctoral Program in Psychoanalysis, and a train-
ing and supervising analyst at the Institute for Psychoanalytic Training
and Research and at the Contemporary Freudian Society. He is the
author of numerous articles and four books: The Language of Perver-
sion and the Language of Love; Getting from Here to There: Analytic Love,
Analytic Process; Narcissistic States and the Therapeutic Process; and The
How-To Book for Students of Psychoanalysis and Psychotherapy. In 2006 he
A B O U T T H E E D I TO R S A N D C O N T R I B U TO R S xv
Jack Novick, Ph.D., FIPA, and Kerry Kelly Novick, FIPA, are child,
adolescent, and adult psychoanalysts on the faculties of numerous psy-
choanalytic institutes around the country. They are both training and
supervising analysts of the International Psychoanalytical Association.
They trained with Anna Freud in London, England, and, in addition to
their clinical work, have been active in teaching, research, professional
organisations, and the community. They joined other colleagues to found
the award-winning non-profit Allen Creek Preschool in Ann Arbor and
the international Alliance for Psychoanalytic Schools. Jack and Kerry
Novick have written extensively since the 1960s, with many articles pub-
lished in major professional journals. They have published four books,
including Fearful Symmetry: The Development and Treatment of Sadomaso-
chism. Several have been translated into Italian, German, and Finnish.
Leo Rangell, M.D., FIPA, (1913–2011) was, from 1995, honorary presi-
dent of the International Psychoanalytical Association. He served twice
as president of both the American Psychoanalytic and the International
Associations and was clinical professor of psychiatry at the University
of California, Los Angeles and San Francisco. He is the author of nearly
500 publications in psychoanalysis and related mental health sciences,
including his most recent highly acclaimed text, The Road to Unity in
Psychoanalytic Theory (2007). In 2011, shortly before his death, he was
awarded the first honorary presidency of the American Psychoanalytic
Association.
Fredric Perlman
xix
xx S E R I E S E D I TO R ’ S P R E FAC E
T
his book examines the forces of sadomasochism in the clinical
domain where transference and countertransference reside.
This is a clinically centred book in which psychoanalysts write
in depth about cases where sadomasochism is present for analysand
and analyst. Four cases present the unfolding analytic exchange where
life and death forces collide. Psychoanalysts from varying schools of
thought provide clinical material and discussions on each case illumi-
nating the complex phenomena that often include lifelong perversions
and painful narcissistic difficulties. Through the four case presenta-
tions and each of their three discussions, psychoanalytic therapists will
find maps for guiding their own work with sadomasochistic processes.
Cases where sadomasochism is prominent abound with dramas con-
taining control and denigration, domination and submission. Often
there is history of overstimulation and under-stimulation from infancy
and childhood.
Since Freud first introduced infantile psychosexual development
and the concepts of component instincts, both passive and active, psy-
choanalysts have been exploring sadomasochism in its various forms
(Freud, 1905). The belief that togetherness must involve pain, creates
a life and death struggle that is imbued with powerful instinctual
1
2 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
A scene
Imagine that there are two people—a man and a woman or even an
analyst and an analysand. In this scene, there might be a third person,
a witness, an observer. The exchange could sound like a fight, a power
struggle over who controls whom, who dominates whom, who wins,
who suffers, and who submits. Or it could seem like the sounds of excit-
ing violent love-making. Pain and denigration are necessary ingredients
of togetherness leading to intense orgiastic sexual contact, then renewal
of separateness. Whatever the subject matter of the exchange, the qual-
ity of the relationship is of one person hurting the other, even each hurt-
ing the other in turn. The third, if present could feel helpless, painfully
overstimulated, anxious, invisible, as if the mutual absorption of the
interacting duo excludes or possibly even annihilates. In their connec-
tion the couple ignore and destroy conventional boundaries. Important
to our understanding of the sadomasochistic transference and coun-
tertransference is the internal representation in each participant. The
observer analyst, the third, may at times become overwhelmed. Or
analytic reflection may manage to remain active. The scene captures
feelings of aliveness and deadness. It is compelling. We have heard the
story many times.
Sadomasochism plays out on the theatrical stage, in literary sagas,
and in the consultation room. Marquis de Sade wrote many scenes
of the erotic form of sadomasochism from his prison cell. The words
“sadism” and “sadist” are derived from his name. Krafft-Ebing (1886)
coined the term “masochism” based on Leopold von Sacher Masoch’s
descriptions of his erotic life in his novella, Venus in Furs (1870).
Recently, in a theatrical adaptation by David Ives (2011), a man and a
I N T R O D U C T I O N TO S A D O M A S O C H I S M I N T H E C L I N I CA L R E A L M 3
Sadomasochism
A life and death struggle is at the core of sadomasochism. The elements
of the erotic sadomasochism, such as humiliation, domination, submis-
sion, merger, intense arousal, and ultimately orgasm, appear as intra-
psychic conflict and in object relations representations. There is layering
in the psychic organisation such that the affects present in this sexual
realm also relate, equivalently, to wishes, fantasies, and compromise
formations. There can be character organisation as well, based on moral
masochism and moral sadism, that is, where the erotic seems muted or
appears nonexistent. Freud first taught us that sadomasochism is found
in each child’s developmental makeup (1905). Other analysts suggest
that sadomasochism only emerges in the face of sexual trauma forced
on a child by an abusing adult. These questions lead psychoanalysts to
explore the mysteries of sadomasochism, trying to identify its sources
and roles. As we discussed sadomasochism in our study group we
often found a sense of “too much”—too much need, too much arousal,
too much humiliation, too much dominance and submission. The mind
searches for a way to manage this “toomuchness” and constructs inter-
nal images of a scene entailing “the battle of life and death forces”.
By life and death struggle, we refer to forces within each individual
and in the relationship that are intent on destruction (death), and at
the same time, preservation (life). We recognise both the preserving
life-saving aspects of these constructions, and the destructive poten-
tial, as we think and write here about sadomasochism in the mind. Life
instincts refer to pleasures and libidinal wishes. Death instincts refer
to destruction, aggression, and repetition. Unconscious fantasy com-
promises from all phases of development and vicissitudes of conflict
and trauma are found in sadomasochism. These forces coalesce around
internal representations of a relationship where someone is hurting
and dominating the other with the correlate of someone being hurt and
dominated—a coupling that can easily reverse. There is a co-existence
of pleasure and pain, and sexual perversity may be present.
In the case material in this book sadomasochism is not only present
but often at the centre of the transference-countertransference dynamics
taking place in the psychoanalytic treatments. Most of these patients
do not overtly enact sexual sadomasochistic scenes. Nevertheless,
all of these patients do have sadomasochistic relationship images in
their psyches—“psychic sadomasochism”—and enact them with oth-
ers including their analysts (Basseches, 1998; Ellman, 1998; Goodman,
6 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
1998). In fact the keeping of the frame for both patient and analyst can
be experienced as a sadomasochistic act. The analyst can be felt as tor-
turing the analysand by inviting the intimacy of the analytic dialogue
while also maintaining the time of the session, beginning and ending,
and expecting payment. Conflicts of aggression and hate, and libido and
love, are arranged in sadomasochistic patterns in which pain in some
form is present. Our patients so yearn for life—to connect, to attach, to
arouse and be aroused—but at the same time wish to destroy us and
themselves. Sadomasochism may be the best effort to find a way to con-
nect to the object, rather than retreat to a narcissistic, isolated world. It
may be the only way to hold together states of terror and inner convic-
tions that all life forces, if detected, will invite both superego retaliation
and re-traumisation from early narcissistic injuries and infant traumata.
This type of attachment is also a way of sustaining distance and brings
fragility to the formation of a therapeutic alliance. An episode of sadis-
tic attack or masochistic suffering so easily can push the analytic couple
apart and require repair for the alliance to reconvene.
As a psychoanalysis deepens, the battle of life and death forces inten-
sifies and repetition compulsions take hold. There is something about
these sadomasochistic repetitions that is most troubling as they often
lead the patient or analyst to withdraw, claiming therapeutic partner-
ship impossible. Freud wrote: “We started out from the great opposi-
tion between the life and death instincts” (1920, p. 53). We see in these
patients that when the instincts are in such battle, the libido is affixed
and the object cathected in a gripping way with the binding force of
active and passive desires to possess and be possessed, to consume and
be consumed, triumph over or submit, and even destroy or be destroyed.
Masochist and sadist are embedded in one another, each yearning for
and fighting against the symbiotic merger. Here the strength of oppos-
ing forces introduces the question of survival of the self, other, and the
analytic process.
ways that one can see overlap and elements of agreement among the
discussions even as they each find unique aspects to explore. It seems
promising for psychoanalysis to think that the diversity of points of
view can also be converging in their clinical understanding. Many note
the way that the relating flips between sadism and masochism, under-
scoring the pairing of the two positions.
All case presenters and commentators find intrapsychic and interper-
sonal object relationships in the sadomasochism of the treatments. Dis-
cussants’ ideas fall into several main categories: (1) their understanding
of sadomasochism in psychic life from a historical/theoretical perspec-
tive and a phenomenological perspective; (2) their creative ideas about
the minds of the patients, moment to moment and in a “big picture”
way, and especially the defensive use and meanings of the behaviors
and interactions; and (3) a range of relevant suggestions about analytic
technique and the working analytic couple. There is an aliveness in
addressing the topic that runs through all the cases and the discussions,
giving renewed vigour to thinking about bearing the unbearable, by
both therapist and patient when sadomasochism is prominent. Here we
capture summaries of the cases and the ideas that the discussants bring
to the material.
Dr. Paula Ellman describes the case of Diane—Sadomasochism in
work and play with Diane (Chapter Three)—bringing forth the agony
of Diane and the intensity of sadomasochism in the transference and
countertransference. As Diane describes the suffering in her soma, her
helplessness and her need and denigration of her analyst, Dr. Ellman
reveals her psychic responses to her patient. The countertransference
pull is to identify masochistically with the devalued object and also
succumb to feeling helpless. As the patient describes sexual contacts of
passion and shame she makes her analyst ashamed of being unable to
enliven her patient’s mind. Tracking the process shows the enactment
of a sadomasochistic pair. The analyst’s reflections of her sadistic and
masochistic felt reactions brings about contact with and understanding
of the internal experience of her patient.
The discussions of Dr. Paula Ellman’s case are written by Alan Bass,
Jack and Kerry Novick, and Marianne Robinson. Bass admires the full
case report as the “best basis for thinking about the integration of theory
and practice.” He uses a dream as his starting place, suggesting that it is
an “atypical moment”. He informs us that the inflicting of pain on the
body is “an unconscious attack on the mother’s body”. Using Freudian
I N T R O D U C T I O N TO S A D O M A S O C H I S M I N T H E C L I N I CA L R E A L M 9
and Kleinian ideas he takes us into the mind, the internal world that
gives some breathing space from the constant psychic beatings taking
place. He thinks of the analyst’s suffering as the needed receptivity to
let the patient “inside” and reminds us of the importance for psycho-
analysts to have tolerance for all forms of sexuality and the place that
pain can have in stimulation and sexual arousal. Interestingly, the other
two discussants also focus on that same dream, each with some unique
kernel of added insight. The Novicks focus on the end of the dream—
“and then I [the patient] walk out”—and suggest that in her own mind
the patient has just committed a “heinous crime”—that of picturing
herself as separating from the mother/analyst, creating “separation
guilt” and thus deserving severe punishment. They characterise sad-
omasochistic relationships as fraught with struggles over power and
defensive omnipotent beliefs and fantasies. What they call the open sys-
tem is attuned to reality, self-regulation, and conflict resolution while
the closed system organises around omnipotence, hostility, aggression,
and self-destruction. They are trying to elaborate what Diane’s “beating
fantasy” is and how it comes into play in her over-training and hurting
of herself. Robinson brings Kleinian ideas to the same element of the
dream, showing how the attempt at a depressive position stance is in
fact only omnipotent repair. “And then I walk out” for her means that
the patient unconsciously believes that “it is possible to leave her ‘bad’
painful parts in her analyst.” She brings ideas of manic defenses (Klein)
and second (armoured) skin (Bick) to her understanding of Diane and
the here and now with the analyst. Life forces are avoided and basic
defenses of splitting and projection are active.
Dr. Nancy Goodman writes about the case of Mr. B—Sailing with
Mr. B through waters of hurting love (Chapter Seven)—where the
choice for the analyst and patient seems to be to exist or not to exist.
Mr. B’s struggle is about autonomy, fantasies of merger, and an uncon-
scious belief in what Goodman calls “hurting love”. Hurting love carries
evidence of the inevitability of overstimulation, oral, anal, and genital,
or understimulation, never being recognised nor responded to. As the
transference and countertransference tensions increase, symbolisation
emerges through dreams and narrative.
The discussants, James Grotstein, Margaret Ann Hanly, and
Terrence McBride write about aspects of the working dyad. Grotstein
speaks to the love-hate affair of sadomasochism and the intersubjec-
tive “group dream” co-constructed by analyst and analysand. He has
10 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
the treatment in terms of both content and process to flesh out the
underlying unconscious fantasy. Rangell sees sadomasochism as rep-
resenting a form of aggression. He sees the suffering as a severe neu-
rotic problem centreing on a fear of homosexuality. This, he explains, is
caused by his identification with the mother, leading to identity confu-
sion and debilitating castration anxiety. He sees the sadomasochistic
fantasies as a defensive testing of the analyst. In de-emphasising the
sadomasochistic fantasies of Reichbart’s patient, he also minimises his
primitiveness and isolation.
In the cases and discussions we find preoedipal and oedipal issues
and their associated unconscious fantasies. The sadomasochistic object
relationship in the service of maintaining the tie to the early mother is
the centre of some discussions. Annihilation fears and survival are men-
tioned, especially in the use of narcissistic defences. Aggression and the
role of the harsh superego, as well as perverse attitudes, receive attention.
Punishment for oedipal wishes and fears of castration, with consequent
regression to anal and oral fixation points, are the foci of others. The role
of the beating fantasy with concomitant aggression and arousal is often
mentioned. Others bring in the trauma of soul blind and soul murder
parental abuse to the intensity of the sadomasochistic phenomena.
Trauma can be sexualised and erotic life can be associated with trauma.
Several discussants put forth the idea that it is ill-advised to make early
transference interpretations, or even clarifications, when working with
the sadomasochism of traumatised and narcissistic individuals. Before
such interpretive work can be helpful, there must be a building up of
analytic trust, and the forming of a working alliance.
Another point of coalescence among discussants is the idea that coun-
tertransference needs to be considered in a nuanced way, to include the
analyst’s conflicts relating to sadomasochism, the affects in response to
the enacted sadomasochism, and the patient’s projections active in the
analyst’s mind. The discussants address how to work with the many
forms of countertransference; for example, the idea that the analyst
must tolerate torture, both active and passive.
There are many instances when sadomasochism presents as though it
were a matter of aggressivised sexuality when in fact the sexualised con-
tent may be in the service of many other motives, particularly defending
against and expressing narcissistic issues. Nevertheless, sexuality plays its
role in sadomasochism, even if muted. We have an awareness of the way
in which sadomasochism functions as the best adaptation the individual
I N T R O D U C T I O N TO S A D O M A S O C H I S M I N T H E C L I N I CA L R E A L M 13
References
Albee, E. (1962). Who’s Afraid of Virginia Wolf? London: Vintage, 2001.
(Premiered at the Broadway Billy Rose Theatre, 13 October 1962.)
Basseches, H. I. (1998). Enactment: What is it and whose is it? S. J. Ellman &
M. Moskowitz (Eds.) Enactment: Toward a New Approach to the Therapeutic
Relationship. New York: Jason Aronson.
Ellman, P. L. (1998). Is enactment a useful concept? In: S. J. Ellman &
M. Moskowitz (Eds.) Enactment: Toward a New Approach to the Therapeutic
Relationship. New York: Jason Aronson.
Freud, S. (1905). Three essays on the theory of sexuality. S.E., 7: 123–246.
London: Hogarth.
Freud, S. (1919). “A child is being beaten”: A contribution to the study of the
origin of sexual perversions. S. E., 17: 175–204. London: Hogarth.
Freud, S. (1920). Beyond the pleasure principle. S. E., 18. London: Hogarth.
Freud, S. (1924). The economic problem of masochism. S. E., 19: 155–172.
London: Hogarth.
Freud, S. (1927). Fetishism. S. E., 21: 147–158. London: Hogarth.
Freud, S. (1937). Analysis terminable and interminable. S. E., 23: 255–270.
London: Hogarth.
Freud, S. (1940). Splitting of the ego in the process of defence. S. E., 23:
271–279. London: Hogarth.
Goodman, N. R. (1998). The fixity of action in character enactments. In:
S. J. Ellman & M. Moskowitz (Eds.) Enactment: Toward a New Approach to
the Therapeutic Relationship. New York: Jason Aronson.
14 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
S
adomasochism in our clinical work arises from intersecting forces
of developmental phase fantasies, conflicts, and traumas. There
is a fixity to the sadomasochistic way of relating that lives in the
patient’s mind and captures the analyst and patient exchange. Perspec-
tives on the developmental position of sadomasochism and the forma-
tive effect of trauma figure into efforts to understand the intractable
hold that sadomasochism has on the analytic dyad. Interacting forces of
narcissism, anality, trauma, and perversion fuel the battle arising from
all stages of development with their accompanying unconscious fanta-
sies and object relations. Narcissistic vulnerabilities related to trauma
and psychic helplessness play a major role in creating fertile ground
for the growth of sadomasochism. Additionally, individuals seek sexual
gratifications through dominance and submission. While the oral and
genital/oedipal stages of development are discernible in sadomaso-
chism, the anal phase of development gives sadomasochism its shape
in the mind and in interactions with others. The centrality of anality is
due to its important organising function in psychic activity. Here we
find unconscious fantasies related to inside and outside, autonomy,
control, submission, and conquest. At this time of development, both
disavowal and perversion contribute to sadomasochism in the arena of
15
16 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
fantasies about spaces within the body and mind, and between self and
other. Differences of all kinds may not be tolerated and sadomasochism
can be used to either manage or obliterate them. We bring a focus on
the anal phase of development followed by discussions of orality and
narcissism, trauma, the oedipal, and lastly, consideration of the place of
disavowal and perversion.
Anality
We find in the clinical material and in the literature that the anal
stage, the time of body mastery and self-other differentiation, is where
sadomasochism organises and then burgeons. Psychoanalysts from
all schools of thought find links to anality in the basic functioning of
sadomasochism (Bach, 1994, 2002; Chasseguet-Smirgel, 1984a, 1991;
Meltzer, 1973, 1992; Novick, J. & Novick, K. K., 1996; Shengold, 1988,
1989; Wurmser, 2007). In their understanding of the historic place of
Freud’s thinking about sadomasochism, La Planche and Pontalis (1973)
state the following:
The genital/oedipal
Oedipal desires highlight the existence of three. Two are entwined with
excitement—with sexual intercourse. One is the onlooker. The primal
20 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
into “psychic sadomasochism”. The analyst must be aware that she too
is holding onto the sadomasochistic relationship as the only viable con-
nection to her patient, and that she too is disavowing the recognition of
difference. Symbolising opens inroads for alternatives to the ultimate
enactment of sadomasochism, the negative therapeutic reaction. In
conclusion, the influences of the oral, anal, and oedipal configurations,
and trauma, each in turn and in combination affect the development of
sadomasochism in the mind with a sense of there being no alternative.
Sadomasochism arises from the intersecting forces of conflict, trauma
and adaptation. The recognition of “psychic sadomasochism” opens the
transference/countertransference arena where meaning can be discov-
ered and movement out of the sadomasochistic hold is possible.
References
Abraham, K. (1923). Contributions to the theory of the anal character. In:
Selected Papers of Karl Abraham. Basic Books: New York, 1927.
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Bach, S. (1994). The Language of Perversion and the Language of Love. Northvale,
NJ: Jason Aronson.
Bass, A. (2000). Difference and Disavowal: The Trauma of Eros. Stanford:
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Coen, S. J. (1988). Sadomasochistic Excitement: character disorder and
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24 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
[I feel for her pain, her profound disappointment in people and her
isolation, but also for my own pain of feeling so inadequate, as if I
am lacking, with little to offer in the psychoanalysis.]
W
hen Diane becomes aware of the presence of the other’s
needs, she believes there is no room for her own. She sees
that I have patients other than her; she hears her mother’s
wish to protect herself from being riddled with regret; she experiences
her girlfriend’s loyalty to her family—and with these moments of feel-
ing left out, Diane is enraged and finds comfort in rejecting the offend-
ing others and remaining alone.
For Diane, any sign of separateness of the other is not tolerable. Diane’s
struggle with herself and in her relationships is rooted in her sadomaso-
chism. “The [sadomasochist’s] hatred is aimed at reality in general and
this is essentially composed of differences … between the appearance
of the need (or wish) and its satisfaction …” (Chasseguet-Smirgel, 1991,
p. 400). Therefore, the need-satisfying object is not well differentiated
from the self. Diane cannot bear experiencing the difference between her
need—what she wants—and its satisfaction. Frustration for her proves
to be unbearable. Her girlfriend, her mother, and I frustrate her wishes
and her sadomasochism floods her inner life and object world.
Diane, a forty-year-old single woman, is a top academic in a prom-
inent educational institution. She was raised in a working class Irish
Catholic family. She is the sixth of seven children (with an oldest brother,
four older sisters, and one younger brother.) Diane’s eldest brother was
most valued by both parents, especially by her father. Her father and
eldest brother were in a mutually idealising relationship that included
alcohol, athletics, and what Diane experienced as a strutting of their
masculinity. Diane remembers her seething hatred at witnessing her
father in his chair watching TV, and with his hand in his pants, scratch-
ing his genitals in an exhibitionistic way.
For Diane, being a woman in the heterosexual world meant being in
relationship to a man where she is denigrated and the man highly val-
ued. Diane’s family’s church culture honoured the male. Diane longed
to be “an altar boy” like her older brother, and bring pride to her parents;
however this was reserved for males. It seemed that being the son was
the only way to bring pride to her parents. On his death-bed, Diane’s
S A D O M A S O C H I S M I N W O R K A N D P L AY W I T H D I A N E 31
father proclaimed how his eldest son surpassed all in his career success,
when in fact there is no doubt that Diane reached a career pinnacle
far beyond anyone else in her family. Even when Diane enjoyed the
dominant phallic position in relationship to her work subordinates, she
felt that her accomplishments went unrecognised by her father. Diane
basked in her sense of being her mother’s favourite, but she was acutely
aware of her place as one of four daughters relied on for household
chores. She felt that her mother tried to provide adequately for her fam-
ily in spite of being overwhelmed with the demands of seven children,
yet she also felt that her mother lavished too much attention on her
father and eldest brother in a way that disgusted her. She remembers
her intolerance for her mother attending to her father’s needs and seem-
ing so easily to accept his crude masturbatory exhibitionism.
In high school sexuality was associated with dirt or dirty activity.
Diane wanted to avert exchanges with boys. She hated their pushing up
against her, their out-of-control urges, and her feeling like dirt. Her asso-
ciations to Catholic proscriptions include being “like dirt” by engaging
sexually; she is dirt as “the hole” for the guy, “nothing but a hole for
him”. Diane remembers her mother’s prohibition against masturba-
tion, despite her acceptance of Diane’s father’s exhibitionistic “genital
scratching”. She kept her hands away from her body; her sexual urges
were prohibited. She thought that her vaginal wetness was urine and
“coached” herself to sit on the toilet for a prolonged time to try to empty
her bladder and do away with the wetness.
From early childhood, Diane excelled at athletics and successfully
competed on boys’ teams, often outplaying the boys. She felt intent on
surpassing her older brother, athletically. As a young adolescent she
independently established a rigorous practice schedule to perfect her
tennis. Every afternoon, she hit no fewer than 500 tennis balls on her
own. The results of her extreme effort and talent launched her into pro-
fessional national championships, despite missing the private coaching
that she envied other young athletes receiving. She earned a full athletic
scholarship to a top university. Later, just as with athletics, Diane drove
herself in her career with a rigorous work schedule.
In her late twenties Diane “came out” with her homosexuality.
Neither parent accepted her lesbianism; both treated her with contempt.
Diane remembers her painful aloneness, feeling cast out by her parents.
Soon after, Diane’s father suffered complications from alcoholism and
developed cancer, proving to be fatal.
32 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
was already debilitated by the foot difficulty she had. This additional
problem actually put her on crutches and rendered her truly crippled,
unable to walk.
Currently, Diane is working to fully accept her homosexuality and
resolve the conflict-ridden eroticism she experiences with her female
partner’s penetrating strength and with her own passive receptive
longings. Also, she is attempting to understand better her phallic sadis-
tic strivings. Central to Diane’s analysis is the problem of how pleasure
can be realised while feeling like a denigrated disgusting hole. Diane
describes her painful “submission” to her partner and her arousal in
that pain. She was pained by her concern that it seemed “sadomaso-
chistic”. She loves her partner to “take her”, to be strong and forceful,
yet at the same time detests those masculine reminders. Along with the
challenge of her relationship is her pervasive concern about regaining
her full physical capacity.
Her consideration of her conflicts and limits has been distressingly
challenging of her perfectionism. Her perfectionism for self and
other extends to all areas of her life and is unrelenting. From early
on in the analytic work, she repeatedly called on me to work at my
best, questioned me if I was not speaking, and often doubted if I was
adequately “on my game”. Each time upon entering the consulting
room, she examines me and checks me over for fatigue, distracted-
ness, or any vulnerability that she believes could keep me from giv-
ing her my absolute best. I struggle with my own rage at having my
competence and ethics constantly scrutinised. Diane is brutal in her
assessments of me, always finding me deficient in my efforts. Often
her exasperation with my not providing adequately for her threatens
the treatment as she talks about wanting to find “better remedies”.
She gives me lashings for my substandard performance. She lives out
an unconscious fantasy that threatens to destroy me and her, and our
work together, showing the power of the unconscious sadomasochis-
tic fantasy.
Listening to Diane’s sense of dissatisfaction with me, with her work
subordinates, with her family, friends, and dates, was excruciating.
I will offer some process material between October 2006 and July 2007 as
it proved to be a period of time when elements of sadomasochism came
to the forefront of the analysis. Accompanying the sadomasochism are
expressions of oral themes that are integrally interwoven with her sad-
ism and masochism.
S A D O M A S O C H I S M I N W O R K A N D P L AY W I T H D I A N E 35
At the outset of this period of time, Diane expresses her pain and
what appears as a merger with me, but also expresses concerns with
harming me:
10/6/2006
Dream
patient: I dreamt about you … I am sitting and talking about what
pain I am in. I close my eyes and talk and when I open them
you had moved to another chair because of your back pain.
I ask about it and you say, “Didn’t you see me”? I moved
while you were talking. I say no and am sorry because my
eyes are closed and you’re in great pain and I get up to leave.
I stand up and move next to you. I lift you up because you
are in great pain and help move you back to the other chair
and then I walk out. You are wearing Birkenstocks and M
[girlfriend] wears Birkenstocks.
analyst: You are talking about your pain with your fear that it will
break my back.
patient: I cannot tell people about my pain.
analyst: You must not close your eyes.
patient: I don’t let people know … the old me is always positive,
optimistic.
The patient does not allow herself to be aware of her wants, her desires,
as her eyes are closed and she cannot see me. A mirror to her, I am
rendered crippled in the dream, often the way I can feel in the counter-
transference with her. The sadomasochism in this analysis is excruciat-
ingly painful for me. I struggle to bear both feeling empathically her
chronic pain and also her rage at me for not being enough for her. Her
wish to cripple me, to render me ineffectual, seems similar to the way
she has crippled herself. As Diane experiences her toxicity, its effect on
herself and others, she shifts to her conviction that she is lacking, insuf-
ficient, and ashamed, all of which she expresses in the following dream
one month later.
11/6/2006
patient: I dreamt of you outside, on a sunny day; you had not walked
in yet. I had done something bad, like a little kid, and you
36 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
While Diane expressed her desire to be a little girl with me, she cannot
yet fully own her little girl wishes. She believes she does not measure up
and feels ashamed. She is bad as a defence against her wishes for close-
ness with me. In the transference she is not enough for me nor for her-
self. She shows her yearnings as expressed in not being enough. In the
countertransference, I am put in the place of the disapproving mother
and feel for Diane’s struggle. Diane is self-driving and self-depriving,
specifically around her wanting me in the way that the little girl wants
her mother. The next session further develops her sense of herself as a
fragile toddler as well as the grandiose toddler.
11/9/2006
patient: I am not working my body hard enough. Some days I push to
the end of the day … When I don’t push, I kick myself hard.
I feel so guilty not going to the gym but I am just human …
This is a time when it is not acceptable to be human.
analyst: You have suffered because of your own and others’
humanness.
S A D O M A S O C H I S M I N W O R K A N D P L AY W I T H D I A N E 37
12/7/2006
A further elaboration of her hunger …
patient: Sex is ninety-nine per cent tilted in the direction of oral sex
for me. I think of a cow, like sucking on a nipple … Susan
S A D O M A S O C H I S M I N W O R K A N D P L AY W I T H D I A N E 39
In her hunger she identifies with the male and finds her sexual arousal.
Cunnilingus may involve a fetish for Diane. Could there be a denial
of the “hole” of the vagina, and the search for a “something”? Nev-
ertheless the identification is fraught with conflict. Something about
the intensity of her longings feels like a potential threat to me in the
countertransference. How can I possibly sate her? A few months later
come Diane’s expressions of her fury at masculinity and her compul-
sive drivenness.
2/14/2007
5/2/2007
Dream
patient: I am at an anniversary party. Everyone I know is there. I am
not in a deficient position. Phil walks in—I used to play tennis
with him. When I dated him one summer, it was as if I was not
there; he was rubbing himself, and pushing my head down.
I instead used my hand to touch his penis. In the dream, he
looked for my brothers. I am on skates, and am my old self. At
a second party, there are huge displays of shelves with choco-
late and candy. I can’t figure out what I want. I don’t want to
get sick on sugar. I want to be selective. There is a handsome
guy, but I was not confident, so nothing happened.
analyst: Did he show you interest?
patient: He was a gentleman and waited for me. I tell the truth and
am exposed—a huge botch and so I no longer can walk. And
there is atrophy and joint pain. I was out of the closet with
my shame. Now, I am so far beyond because of my success—
that I leave everyone in shock. So if my Dad starts to pull
any crap, I’ll say what about my life is not good judgment!?
I need to read more about Roosevelt … How does a
man become president in a wheel chair? If he can do it,
I can do it.
I see the chocolate, and can’t figure out what I want, and I
still don’t grab a candy bar. I look at photographs of my par-
ents’ life. There is homogeneity that is dangerous and that
could stuff me into a limited world. I skate back to the candy
bar and am just about to pick something but I don’t take the
candy. There is such shame about being different that I will
succeed by thirty because of my shame.
analyst: You accomplish great things and you did not take the candy
many times.
patient: And I did achieve it; I did all those things, at the same time,
I did not indulge in candy, in desire. I was truly phobic of
something catching me, stopping me if I indulged. I took
some candy but am resentful that I did not take more. I had
to be certain that I was gay before I could go after what I
want.
42 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
to speak to her with force, to pin her down, get her to submit to me,
to my interpretations. While I accept her payments, I become identi-
fied countertransferentially with her rageful projections, and I question
whether I am worthy as an analyst. I observe my worry that what I take
from her could deprive her of what she needs to survive and see that
my countertransference informs me that I am a participant in the sado-
masochistic transference.
Where the structuralisation necessary for differentiation has been
compromised, the sadomasochistic construction is a version of psychic
structure allowing for some differentiation of the self and the other
(Frosch, 1995). Fended off are the infantile longings. The longings to
be loved, “… without the intervening step of a … regression to an anal
sadistic organization, [are] associated with the sense of annihilation”
(Frosch, 1995, p. 444). The challenges for both patient and analyst are
great when the psychoanalysis of sadomasochism calls forth rage at
unmet needs and the threats of annihilation to self and other.
References
Chasseguet-Smirgel, J. (1991). Sado-masochism in the perversions: Some
thoughts on the destruction of reality. Journal of American Psychoanalytical
Association, 39: 399–415.
Frosch, A. (1995). The preconceptual organization of emotion. Journal of
American Psychoanalytical Association, 43: 423–447.
CHAPTER FOUR
F
rom the welter of miseries that is Diane’s treatment I choose an
atypical moment. In the dream of 10/6/2006 Diane is talking
to her analyst about her physical pain. In the dream the analyst
then has severe back pain, and has moved to another chair. Diane says,
“I stand up and move next to you. I lift you up because you’re in great
pain and help move you back to the other chair and then I walk out.
You are wearing Birkenstocks and M [girlfriend] wears Birkenstocks.”
Diane, we know, has terrible foot and leg pains. Birkenstocks are thera-
peutic shoes. The analyst in great pain is wearing therapeutic shoes.
(One wonders what kind of shoes Diane wears to take care of her injured
feet and legs.) Most important, after projecting her pain into the analyst,
Diane not only makes the analyst into her sensible shoe girlfriend, she
cares for the analyst: “I lift you up because you’re in great pain and help
move you back to the other chair”—presumably the analyst’s chair.
My purpose is to explain why I chose this moment as a guiding
thread for a discussion of Ellman’s paper. I hope to show that it says
a great deal about the “life and death forces of sadomasochism”. One
immediately sees both sides in the transference: the “death” side of
projection of Diane’s own pain into the analyst, the “life” side of care
for the analyst, who becomes her girlfriend. How to understand the
45
46 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
gay woman who sexually enjoys penetration and some degree of pain,
and also be the kind of successful, authoritative person she is profes-
sionally. My related, simple guess is that Diane’s sadistic contempt for
others, her “readiness to be dismissive”, is a version of the contempt for
herself sexually. My second-generation Holocaust survivor patient had
similar dynamics. She was deeply ashamed of her arousal by pain. She
started treatment when her long road to professional success placed
her in a position of authority which she wanted to quit, because of the
combination of shame and arousal implicit in a job in which she would
have to “give orders”.
I believe that all these complex dynamics are active in Diane’s case,
but there is more. Let us look at another critical transferential issue,
one in which Diane’s sadism is more than contempt for herself. Ellman
writes:
Above, I said that I think that Ellman’s rage and feelings of being
tortured are not countertransference per se, but rather the inevitable
responses to the affective claims Diane makes on the analyst. How-
ever, I think that there is a possible countertransference problem, in
the usual sense. Some aspects of Diane’s masochism are due to her not
understanding the destructiveness that has been directed against her.
I speculate that she repeats this non-metabolised destructiveness with
Ellman—a destructiveness that “threatens to destroy me and her, and
our work together …” What does one do in a situation that goes beyond
feeling tortured and angry, a situation in which one encounters implac-
able negativity? One can feel persecuted in such a situation. (Kleinians
such as Steiner and Rosenfeld have examined such situations in depth
in their work on sadistic “gangs” of internal objects.) How does one
resist despair, resignation, passivity, which I believe are built into this
kind of clinical situation, and are more difficult to deal with?
54 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
to mastery, which can include cruel actions for their own sake, as in
the example of a child who tears the legs off an insect without any
thought of the insect’s pain. Turning against the self is one of the basic
“vicissitudes” of the drive. When original sadism or cruelty is turned
against the self, the pain it causes can produce sexual excitation. This
is masochism proper. Sexual sadism, in fact, derives from the maso-
chism of non-sexual sadism turned against the self. The sexual sadist is
someone who was originally masochistic, who enjoys being the object
who does to the masochist what the masochist originally did to him or
herself.
There are two important consequences here. The first is the old psy-
choanalytic idea that every sadist can become a masochist, and vice
versa. This is absolutely necessary to Freud’s theory of the component
drives of infantile sexuality, which holds that such drives occur as active
and passive pairs of opposites, such that each can turn into the other.
(Freud gives a similar account of voyeurism and exhibitionism.) The
second consequence has been pointed out by Laplanche (1980). Even
if Freud derives sexual masochism from non-sexual sadism, from the
point of view of sexuality masochism is always primary in his theory.
Laplanche goes further, positing an essentially masochistic nature of
sexuality itself. In this conception, masochism is an irreducible issue.
From Laplanche’s point of view, Diane teaches us something about
sexuality itself.
The next step in Freud on masochism is “‘A Child Is Being Beaten’”.
Here, Freud for the first time provides a complex set of psychodynam-
ics to explain a “perversion”—beating fantasies—rather than simply
seeing it as a fixation to a component drive of infantile sexuality. With-
out going into all the details, Freud finds in beating fantasies Oedipal
wishes, regression to anality, and simultaneous gratification and pun-
ishment (the beating fantasy as a regressive, anal expression of the sex-
ual wish for the father and punishment for that wish). Laplanche (1980)
again finds in this paper evidence that for Freud masochism is always
sexually primary. He says that Freud’s three stage derivation of the beat-
ing fantasy—my father is beating the child who I hate, my father is beat-
ing me, a child is being beaten—replicates the schema of “Instincts and
Their Vicissitudes”: gratification of non-sexual sadism (sibling rivalry),
turning of that sadism against the self (sexual masochism), identifica-
tion with both beater and beaten in masturbatory fantasy. This suggests
a question about Diane: is it possible that one aspect of her self-torture
56 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
in destroying herself and the analyst. To counter this, she would also
have to deal with the pain, the increased tension, of life—the “trauma
of Eros”. Just as our original theory allowed us to hear derivatives of
sexuality in unusual places, the theory I am advocating helps us to hear
derivatives of the life drive in unusual places—here in a brief moment
from the dream of a sadomasochistic patient. This would produce a dif-
ferent interpretive stance. I am not advocating support: “You are kind
to me in the dream, and you make me into your girlfriend who is also
kind to her feet.” Rather, I would approach the issue from the defen-
sive side: “I think it might be very upsetting to you to think about tak-
ing care of me—and yourself, because I contain your pain—and maybe
even more upsetting to think of making me into your girlfriend—who
takes care of her feet.”
My guess is that Diane would reject such an intervention out of hand.
But that would be fine, especially if one hypothesises that her rejection
is motivated by intense anxiety. The same topic comes up again later,
when Diane seems unable to extend to herself the need for rest and food
of a great race horse (Sea Biscuit); I speculate here that Diane also does
not want to acknowledge her need for the analyst’s care. Diane claims
that she concretely needs physical pain relief from the analyst; she seeks
out many alternative treatments. Here I am reminded of a supervised
case, a woman who, like Diane, tortured herself and her analyst with
the analyst’s inadequacy. This patient sought out almost every kind of
alternative treatment imaginable, including having all the fillings in
her teeth changed, and yet never left her analysis. I think one sees an
extreme splitting defence here, splitting against the unconscious knowl-
edge that analytic care is precisely what is needed and desired, and yet
extreme anxiety at the possibility of internalisation of analytic care.
Ellman raises an analogous issue in her concluding remark. Citing
Frosch, she speaks of compromised differentiation between self and
other, and says that “the psychoanalysis of sadomasochism calls forth
rage at unmet needs and the threat of annihilation of self and other.”
I am suggesting a related version of these dynamics: there is not only
rage at unmet needs (what could be clearer in Diane’s case?), but also
intense anxiety about the analytic meeting of these needs, via the
integration of sexuality and self-preservation. The “annihilation” of
self and other, or the entrapment of self and other in vicious cycles of
destructiveness, is due to another form of splitting: the defensive split-
ting of self-preservation and sexuality, the defence against life itself in
D I S C U S S I O N O F T H E CA S E O F D I A N E 59
both content and process aspects. The content aspects are the more
familiar psychodynamic factors, the drives, object relations, fanta-
sies, anxieties, defences, that create sadomasochism. The process
aspects are the less familiar anxiety-filled response to the analyst as
disturber of the peace, such that any integration of sexuality and self-
preservation becomes a threat. This is why we need to be attentive to
any derivatives of such integration, as in Diane’s dream, and even her
passing mention of Sea Biscuit. They are the possibility of successful
treatment.
References
Bach, S. (1994). The Language of Perversion and the Language of Love. Northvale,
NJ: Jason Aronson.
Bass, A. (2000). Difference and Disavowal: The Trauma of Eros. Stanford:
Stanford University Press.
Berliner, B. (1947). On some psychodynamics of masochism. Psychoanalytic
Quarterly, 16: 459–471.
Freud, S. (1905). Three Essays on the Theory of Sexuality. S. E., 7. London:
Hogarth.
Freud, S. (1915). Instincts and their vicissitudes. S. E., 14. London:
Hogarth.
Freud, S. (1919). “A child is being beaten.” S. E., 17. London: Hogarth.
Freud, S. (1920). Beyond the Pleasure Principle. S. E., 18. London: Hogarth.
Freud, S. (1925). The economic problem of masochism. S. E., 19. London:
Hogarth.
Freud, S. (1930). Civilization and Its Discontents. S. E., 21. London: Hogarth.
Freud, S. (1931). Female sexuality. S. E., 21. London: Hogarth.
Frosch, A. (1995). The preconceptual organization of emotion. Journal of
American Psychoanalytic Association, 43: 423–447.
Ghent, E. (1990). Masochism, submission, surrender—masochism as a
perversion of surrender. Contemporary Psychoanalysis, 26: 108–136.
Joseph, B. (1989). Psychic Equilibrium and Psychic Change. London:
Routledge.
Klein, M. (1986). The Selected Melanie Klein (Ed., J. Mitchell). New York: Free
Press.
Laplanche, J. (1980). Life and Death in Psychoanalysis (Trans.,
J. Mehlmann). Baltimore: Johns Hopkins University Press.
Laplanche, J. (1997). Aims of the psychoanalytic process. Journal of European
Psychoanalysis, 5: 69–79.
D I S C U S S I O N O F T H E CA S E O F D I A N E 61
O
ur first response to Dr. Ellman’s vivid and moving account of
her work with “Diane” and her honest portrayal of her own
reactions is to acknowledge that she is not alone. In our years
of working with sadomasochism, we have found, as have others from
Freud on (Freud, 1909, 1940; Meyers, 1988) that the analyses were long
and arduous because of the self-destructive nature of the pathology, its
roots at every level of development, the multiple functions it serves,
and the intense countertransference reactions it evokes. In 1909 Freud
wrote to Jung: “In my practice, I am chiefly concerned with the prob-
lem of repressed sadism in my patients; I regard it as the most frequent
cause of failure of therapy … In general, sadism is becoming more and
more important to me” (cited in Bergmann and Hartman, 1976, p. 33).
Freud remained intrigued by the complexity of sadomasochism and
each major shift in psychoanalytic theory stemmed directly from his
clinical experience with masochistic phenomena. However, by the end
of his career even Freud had to note that “… we are especially inad-
equate” in dealing with masochistic patients (1940 [1938], p. 180).
Analysts are still challenged and fascinated by the complexity and
counter-intuitiveness of sadomasochism. The overarching regulatory
principle is the pleasure principle, so how and why do people do things
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64 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
game’. Each time upon entering the consulting room, she examines me
and checks me over for fatigue, distractedness, or any vulnerability that
she believes could keep me from giving her my absolute best. I strug-
gle with my own rage at having my competence and ethics constantly
scrutinised. Diane is brutal in her assessments of me, always finding
me deficient in my efforts. Often her exasperation with my not provid-
ing adequately for her threatens the treatment as she talks about want-
ing to find ‘better remedies’. She gives me lashings for my substandard
performance. She lives out an unconscious fantasy that threatens to
destroy me and her, and our work together, showing the power of the
unconscious sadomasochistic fantasy.”
The aim of the closed system is to deny the reality of time and
oppose change; such a world, as described by Hegel and Marx (cited in
Rathbone, 2001), consists only and entirely of dominance and submis-
sion. The empathy of the analyst leaves her in danger of being swept
up in the tsunami of the patient’s closed system. Patients do not come
to treatment to have the closed, omnipotent system removed. Just as
Diane did, they come because the omnipotent system is not working as
well as they think it should. They attribute omnipotence to the therapist
and then demand instant results to fix it.
If we engage our empathy too fully with a patient’s pain, victimisa-
tion, and justified rage we will soon become part of the closed system
they operate with. As in the case described, we soon feel like failures, vic-
tims of attack, helpless and filled with rage. We may become even more
masochistic, accepting the patient’s externalisations and feeling like the
denigrated, unappreciated, yet guilty, partner in the sadomasochistic
partnership. Dr. Ellman bravely shares feelings we all have had. She
talks of “ … years of working with Diane, my tortured feelings of failing
her, having nothing to offer her—not being good enough and my anger
at her not appreciating my efforts.” Often in such situations the partners
shift and the analyst can become the sadistic one, subtly pushing patients
to do what they often threaten to do, that is, leave the analyst.
What can analysis offer in these seemingly endless cycles of closed-
system functioning? This is where a two-system model can be helpful.
At the beginning of treatment the two systems model exists mainly in
the mind of the analyst. We do not see omnipotence as a normal phase
of childhood as described by Ferenczi (1913) and posited by many
others. Rather, we see omnipotence as a defence mobilised against
helplessness (trauma) experienced and expected when reality (the
D I S C U S S I O N O F T H E CA S E O F D I A N E 69
parents) fails to meet a child’s basic needs and fails to protect a child
from being overwhelmed by negative affects. It is then actively main-
tained and layers of meaning and adaptation are added throughout
development. To the patient the alternative to the closed, omnipotent
system of self-regulation is helplessness, that is, trauma. The closed
system is not a deficit to be made up or a pathology to be eradicated
but has been a highly effective and cherished means of self-regulation
which includes a powerful magical omnipotent defence against
retraumatisation.
Just as we do not conceptualise normal development as movement
from universal omnipotence to reality, we do not think of the passage
through treatment as a journey from closed- to open-system functioning.
Infants have an innate capacity to perceive and effectively engage with
reality. This is the root of competence and the open system. It coexists
with the potential for creating omnipotent defences from birth to death,
just as we all have the potential to reach for closed-system ways of
being and relating whenever we are threatened with helplessness. What
analysis can and does change is the intensity and automatic recourse to
closed-system modes of self-regulation. This is an economic shift.
The goal of analysis is not to do away with the closed system, but
rather to help the patient realise and experience the value of an open-
system mode of adaptation and self-regulation as a viable alternative.
From the very beginning the analyst has to enter into the borderland
with the patient, but also always keep one foot in the world of reality,
in the open system.
We noted earlier that the successive tasks of the therapeutic alliance,
highlighted in each phase of treatment, represent an open-system alter-
native for both patient and analyst. Here we will use some of the mate-
rial from Dr. Ellman’s case to comment briefly on how an open-system
concept of the therapeutic alliance can help the analyst stay grounded
in reality from the very beginning of treatment, expand the available
techniques, and hopefully move the process forward so the patient
feels more free to choose the life force of “progressive development”
(Freud, A. 1965).
Evaluation
The evaluation phase has hitherto been somewhat neglected, often
dispensed with, and rarely thought about as the crucial foundation
70 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
into that position, and then comes to omnipotently value the role of
striving to accomplish the impossible. The centrality of Diane’s perfec-
tionism in her mental economy indicates that her frantic need to be the
absolute best (and to demand the same of others) rests on an impos-
sible mission to repair her mother. The idea that she tried to meet such
expectations can be floated during the evaluation, as a hypothesis for
both to test. It may give the patient a feeling of being understood for
the first time. This can be a more realistic basis for a therapeutic alliance
than empathy with pain, which is part of Diane’s closed-system effort
toward perfection. Such a different suggestion might also intrigue the
patient and engage her intellect in the quest for understanding. A glim-
mer of a positive response to such a dialogue would give the analyst
hope that this treatment has a future.
Another effect of such exchanges in the early meetings is to demon-
strate to the patient that the analyst is a competent, intelligent person
with something substantive to offer. This is real, in contrast to the trans-
ference role the patient will surely cast the analyst in. This open-system
reality contrast allows the transference to be an experience accessible to
interpretation, rather than a closed-system enactment and delusion that
engulfs both people.
In our paper on love in the therapeutic alliance, we noted “The result
of the transformations of the evaluation phase is a shift from separately
held beliefs to the beginning of shared, reality-based respect and con-
viction about this particular partnership. This joint confidence will be
repeatedly assailed throughout treatment—hence its importance for
the maintenance of the therapist’s conviction in the face of inevitable
undermining from the transference of the patient’s pathology during
treatment. Thus the evaluation can provide the building blocks—in
the form of respect, hope, and a sense of potential partnership—for
the therapist’s ‘objective love’ for the patient, to use Winnicott’s term”
(Novick, J. & Novick, K. K., 2000, p. 197).
Beginning
In the beginning phase the patient’s therapeutic alliance task is to be
with the therapist; the analyst strives to feel with the patient. The ther-
apist intervenes actively when obstacles to being together arise from
within the patient, from the environment, or from the therapist. These
tasks of being with and feeling with will persist throughout treatment,
D I S C U S S I O N O F T H E CA S E O F D I A N E 73
but predominate at the beginning. The model for this attunement is the
early mother-child relationship. Fluctuations in attunement may draw
on and relate to issues of mother-child attachment during infancy and
toddlerhood. The nature of that attachment will be played out in the
therapeutic relationship.
From the start Diane creates a transference relationship of doubt,
mistrust, denigration, and assumption that the analyst is incompetent
and not really there for her. Dr. Ellman experiences this as central to
the case. The analytic content about the incompetence of the analyst
confirms aspects of the history indicated in the evaluation related
to Diane’s position as sixth of seven children with a depressed and
overwhelmed mother, who was too exhausted and depleted to meet
Diane’s needs. In our model sadomasochism springs first from a pain-
ful mother-infant interaction, vividly borne out in Diane’s transfer-
ence. Disruptions and deviations in being with are our first indicators
of resistance to engaging in the therapeutic process and direct our
attention to describing the conditions under which the patient can feel
safe with the therapist.
What appears throughout the case report is that Diane’s sadomaso-
chism is her way of attaching and staying with her analyst at the deep-
est level. As Dr. Ellman notes, “for Diane, any sign of separateness of
the other is not tolerable.” Sadomasochism is a highly effective method
of staying connected and denying separateness.
The analyst’s therapeutic alliance task at the beginning is to feel with
the patient. But what should the analyst be connecting to? What feelings
are useful to empathise with? And what are the sources of the analyst’s
feelings—not everything comes from the patient. Rage at a patient may
be a counter-reaction to being rendered helpless by the patient’s sadistic
attack and not necessarily an internalisation of the patient’s rage. We
think here about the advantages and limitations of empathy.
Empathy demands an act of imagination to put oneself in another’s
shoes and therefore assumes separateness. We see this as an open-
system mental function, in contrast to a closed-system pressure com-
ing from the patient to deny boundaries and separateness, to be as one.
Part of what helps the analyst keep one foot outside the borderland is
to maintain open-system empathy, to feel with the patient in the present
and the past, but maintain the reality of the present.
We notice the occurrence of “developmental images” in our own
minds, generic patterns of interaction that illuminate and suggest
74 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
Middle
For the analyst, even delineating this task conceptually engages with
the separateness of the patient, which the patient combats continually
in a sadomasochistic interaction. When we see the sadomasochism as a
defence against the terror of separateness, the uncertainty of the pleas-
ures of collaboration, and the avoidance of being the agent of one’s own
life in order to maintain the license of justified rage and sadism, we can
open up several lines of inquiry and work. There is also a developmen-
tal transition from passive victimisation in infancy to an active toddler
and childhood construction of an organising set of omnipotent beliefs
and a beating fantasy.
This seems crucial to Diane’s case. Her beating fantasy was probably
enacted in her athletic pursuits. She ignored actual physical pain from
overuse and the signal of pain became the symbol of her omnipotent
triumph over her father and brother and all men. Too much empathy
with this pain can miss the point that, for the sadomasochist, “pain
is the affect which triggers the defense of omnipotence, pain is the
magical means by which all wishes are gratified and pain justifies the
D I S C U S S I O N O F T H E CA S E O F D I A N E 75
well enough, not doing a good job … I WAS NOT enough in therapy.”
We think Diane was right in her dream. She was not being perfection-
istic; rather she was aware that she was not using her full ego capaci-
ties in the work. This is a clear sign that Diane was now experiencing
a middle-phase conflict between closed-system habits and new open-
system possibilities.
In the middle phase, the conflict between open- and closed-system
modes of functioning that has been externalised into the outside world
and played out in the sadomasochistic transference can become increas-
ingly experienced internally. Diane’s third dream expresses the intense
conflict between her actual open-system humanness and her closed-
system pressure toward perfection. She also expresses clearly what to
her still represents her only alternative to closed-system omnipotence,
when she says, “humanness means human limits and errors. I walk
around with the fragility of a toddler, unprotected.” She fears that the
only alternative to her omnipotent sadomasochism is the helplessness
she felt in childhood.
Her treatment is giving her the experience of a different
alternative, in realistic open-system humanness. The battle is joined
in this middle phase of Diane’s analysis. She will never give up her
sadomasochistic solutions. She may, however, with the further work
to come in her treatment, be able to generate and experience the
pleasure and dependability of open-system alternatives for safety,
gratification, and self-regulation. Then she eventually might set aside
her closed-system solutions. Like Mr. M, who started his analysis
beating himself with his fists on the couch, she may be able to say,
as he did near the end of his eleven-year analysis, “It’s my life—
I have only one life and I have to choose. It’s hard to admit that I
was wrong, hard to admit that my pain buys me nothing but aspirin.
But then I never knew that I had a choice, that I could choose to
live a real life, with real pleasure” (Novick, J. & Novick, K. K., 2007
[1996] p. 309).
References
Ferenczi, S. (1913). Stages in the development of the sense of reality. In: First
Contributions to Psychoanalysis (pp. 213–239). New York: Brunner/Mazel,
1980.
Freud, A. (1965). Normality and Pathology in Childhood. Writings 6: 3–273.
New York: International Universities Press.
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Freud, S. (1909). Letter to Jung. In: M. S. Bergmann & F. R. Hartman (Eds.), The
Evolution of Psychoanalytic Technique. New York: Basic Books, 1976.
Freud, S. (1915). Instincts and their vicissitudes. S. E., 14: 117–140. London:
Hogarth.
Freud, S. (1919). “A child is being beaten”. S. E., 17: 175–204. London:
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Freud, S. (1940 [1938]). An Outline of Psychoanalysis. S. E., 23: 141–207.
London: Hogarth.
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of psychical impairment. Alienist and Neurologist, 5: 85–91.
Meyers, H. (1988). A consideration of treatment techniques in relation to the
functions of masochism. In: R. A. Glick & D. I. Meyers (Eds.), Masochism:
Current Psychoanalytic Perspectives (pp. 175–189). Hillsdale, NJ: Analytic
Press.
Novick, J. & Novick, K. K. (1972). Beating fantasies in children. International
Journal of Psycho-analysis, 53: 237–242.
Novick, J. & Novick, K. K. (1991). Some comments on masochism and the
delusion of omnipotence from a developmental perspective. Journal of
American Psychoanalytic Association, 39: 307–331.
Novick, J. & Novick, K. K. (1996a). A developmental perspective on omnip-
otence. Journal of Clinical Psychoanalysis, 5: 124–173.
Novick, J. & Novick, K. K. (1996b). Fearful Symmetry: The Development and
Treatment of Sadomasochism. Northvale, NJ: Jason Aronson.
Novick, J. & Novick, K. K. (1997). Omnipotence, pathology and resistance.
In: C. Ellman (Ed.), Omnipotent Fantasies and the Vulnerable Self (pp. 39–78).
Northvale, NJ: Jason Aronson.
Novick, J. & Novick, K. K. (2000). Love in the therapeutic alliance. Journal of
American Psychoanalytic Association, 48: 189–218.
Novick, J. & Novick, K. K. (2001). Two systems of self-regulation. Journal of
Psychiatric Social Work, 8: 95–122.
Novick, J. & Novick, K. K. (2003). Two systems of self-regulation and the
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Psychoanalytic Inquiry, 24: 232–256.
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Psychoanalysis and Psychotherapy. Maryland: Jason Aronson/Rowman
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Treatment of Sadomasochism. Maryland: Jason Aronson/Rowman and
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78 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
I
am pleased to have this opportunity to discuss Paula Ellman’s
compelling case of sadomasochism as described in her paper.
The initial reading of this paper was a powerful psychosomatic
event for me. I experienced a relentless squeezing out of any potential
psychic space for mindful thinking until it seemed there was nowhere to
go. I dozed off twice and then realised that I felt hopelessly entrapped.
I imagined that being Diane’s psychoanalyst would be similar to
the experience of the brave student in Tian An Min Square facing an
oncoming tank during the 17 September 1989 student uprising against
the current oppressive regime. The determination to meet such destruc-
tiveness, whether concrete or psychic, while also being in contact with
one’s human vulnerability, is a daunting task. However, only in that
state can one come to understand what it is like for Diane to be in the
path of the desperate power of a “regime” whose continued survival is
paramount, regardless of cost. For the Chinese student then, as for the
student of psychoanalysis now (however experienced and skilled), only
faith (Bion, 1970) that transformation is possible would make it bearable
to go on—faith that something will emerge that will impact the relent-
less, destructive repetition. Enduring the knowledge that Dr. Ellman
will live or die as Diane’s psychoanalyst is made possible by the faith
79
80 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
that, whichever the outcome, she will have the ability to survive and
investigate and digest what happened.
Before discussing the clinical material I want to, in broad brush
strokes, outline the theoretical concepts I found myself using during the
reading in order to gain some understanding of Diane’s internal world
and describe how I see her core struggle.
As I free associate to the clinical sessions provided I find myself
focusing on the unconscious fantasies inferred from Diane’s dreams
and associations and their influence on Diane’s internal and external
relationships.
In Kleinian theory unconscious fantasies underlie every mental proc-
ess and accompany all mental activity (Bion, 1962; Hinshelwood, 1989;
Isaacs, 1948; Klein, 1923; Segal, 1991). Unconscious fantasies are the
mental representation of those somatic events in the body that comprise
the instincts, and are physical sensations interpreted as relationships
with objects that cause those sensations. Fantasy is the mental expres-
sion of both libidinal and aggressive impulses and can also be defence
mechanisms against those impulses. Much of the therapeutic activity of
psychoanalysis can be described as an attempt to convert unconscious
fantasy into conscious thought.
Freud (1911) introduced the concept of unconscious fantasy and
fantasising, which he thought of as a phylogenetically inherited capac-
ity of the human mind. Klein adopted his idea of unconscious fantasy
but broadened it considerably because her work with children gave
her extensive experience with the wide-ranging content of children’s
fantasies. She and her successors have emphasised that fantasies inter-
act reciprocally with experience (Segal, 1991) to form the developing
intellectual and emotional characteristics of the individual; fantasies
are considered to be a basic capacity underlying and shaping thought,
dreams, symptoms, and patterns of defence.
I believe the clinical material shows how Diane unconsciously reg-
isters the emergence of important aspects of her object relations. At the
same time, the extent to which this threatens her sadomasochistic psy-
chic retreat (Steiner, 1987) or psychic equilibrium (Joseph, 1992) is seen
in the way the material shows that the destruction of her analyst’s use-
fulness matches the extent of her perceived threat at that moment in the
relationship.
I would summarise Diane’s dilemma as follows. Unconsciously
she wishes for a “cure” that involves a seamless relationship with a
DIANE VS. REALITY 81
mother/analyst who reads her mind and who tends to her every need
before Diane herself becomes aware that there is an outside object on
whom she depends. She wants to be one with her object—a wish rep-
resented orally in her unconscious as an act of gobbling up her object
(“if I am accepted [taken in], I go down the drain”). This leads to variously
expressed fears of being annihilated, going down the drain being one
of those expressions.
On the other hand, and with equal force, Diane strives for a “cure”
that would free her from any reminders of her human vulnerabilities
by moving in the opposite direction and rejecting awareness of any
nurture from an outside object in order to preserve her conviction of
invulnerability. Toward that end she uses the defences (Klein, 1935) of
splitting, projection, idealisation/denigration in an effort to triumph
over psychic reality as well as over the object that put her in touch with
that reality.
Also, and on a more concrete elemental level, Diane desperately tries
to make her body armour stronger by muscular activity (Bick, 1968).
In the process she deadens the senses that register her experience in
order to keep out the unwelcome reality, and she therefore lives a con-
stricted existence of mutilated perceptual capacities with a vicious
vigilance against anything resembling a connection to aliveness. Such
aliveness would bring awareness of dependency, neediness, and inabil-
ity to achieve complete control over her internal and external world,
all of which Diane has avoided with her sadomasochism. Bion (1957)
describes the dilemma when splitting and projection become overac-
tive, resulting in unbearable confusional states:
of her “words” on her analyst makes it clear that she is using speech
as action (Bion, 1970). Her use of words is not symbolic but is instead
connected to an unconscious fantasy that her words concretely hold her
“bad” painful thoughts and feelings and carry them away from herself
and into her analyst. Talking is therefore unconsciously equated with
performing a harmful action, not communicating painful experience.
As a result, Diane feels that her analyst is containing the “badness” that
she has evacuated in an act of splitting. This puts emotional distance
between them (“you had moved to another chair because of your back pain”).
When Diane realises (“when I open them” [her eyes]) she notices that
something has happened which her analyst experienced but that she
herself was blind to (“you say, ‘didn’t you see me?’ I moved while you were
talking”). This is a very disturbing discovery to the part of Diane that
needs to feel in control and insists on knowing everything in order to
maintain a fantasy of being protected from surprising experiences from
within and without.
When Diane realises the damage she has done to her object she is
upset (“I say … [I] am sorry because my eyes are closed”). Her feeling of
being sorry suggests a beginning realisation that her analyst has value
and she has concern for her well-being. This is a depressive anxiety
(Klein, 1935) showing movement toward whole object function and
separateness.
However, Diane’s subsequent action in the dream seems to show
that she is not yet able to deal with the pain of that depressive anxiety
because she now wants to make it all better and completely restore the
analyst to the place she occupied before the assault (“I stand up and move
next to you. I lift you up because you are in great pain and help move you back
to the other chair”). This is omnipotent repair (Klein, 1935) with Diane
in the role of the caretaker of her analyst who is in need. Reparation
would involve dealing with her concern by mourning the damage she
fears her needs have inflicted on to her object and recognising both her
own and her object’s pain with a symbolic gesture of gratitude. Instead
Diane splits and the roles are reversed in an interplay, the dynamics of
which form an ongoing theme in the sessions presented. Having thus
omnipotently restored her object Diane splits (“and then I walk out”),
unconsciously believing it possible to leave her “bad” painful parts in
her analyst.
While exiting, Diane notices that her analyst is wearing Birkenstocks
just like her girlfriend does. I believe this shows that in her state of pro-
jection, boundaries blur between Diane and her objects and confusion
84 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
sets in about who is who and which of them contains what. When Diane
is in pain her objects become undifferentiated receptacles of her projec-
tion. She now relates to her analyst as to her girlfriend which adds to
her sense of being trapped in a world where there is no escape. This
is the inevitable imprisoning effect of splitting and projection because
they distort the object and leave her entrapped in the projections of her
own internal world. She fantasies that she avoids her psychic pain but
the price is imprisoning confusion.
The description of how Diane “repairs” her wounded analyst may
also clarify why she feels herself to be a perennial caretaker of others.
Her modus operandi is to project her pain into her object and then min-
ister to it there. It is possible that she unconsciously finds needy people
who are only too happy to cooperate in that arrangement for a time.
Later in that session Diane says, “I cannot tell people about my pain”. In
so far as she does not use words to talk about her pain, that statement
is accurate. She does however very eloquently communicate her suf-
fering on pre-verbal and non-verbal levels in ways that are powerfully
received by others who tune in to those wavelengths. However, this cre-
ates in Diane the unconscious knowledge that rules have been broken
and that “relationship crimes” have been committed because projection
on this level is unconsciously registered as a destructive assault on the object.
This gives rise to unconscious guilt, as discussed earlier. In that way she
unconsciously continues to replenish evidence for her conscious convic-
tion that she is toxic. Diane feels helpless, useless, and impotent when
she has not already successfully controlled her experience of internal
or external events. When she looks at the world through the lens of
that sense of helplessness she sees an ineffectual analyst in a useless,
unhelpful object world.
Projective identification (Klein, 1946) is unconsciously perceived as a
concrete action that includes two components: one is the projection into
the object of an unbearable experience, the other is the subsequent treat-
ment of that object to induce the projected state of mind. Diane treats
her analyst with the cruel disdain she feels for her own vulnerability. In
the projective process she moves from being the suffering, weak, out-
of-control victim of her own sadism to becoming the sadistic attacker of
her object who now is felt to contain the despised weaknesses.
Within that concrete state of mind, Diane now actually feels herself
to be in the presence of a helpless damaged and useless analyst who
is unable to give her what she feels entitled to receive. Expressing her
DIANE VS. REALITY 85
to banish the image from her mind (“Fuck you (father) … I want to blast
him, but …”).
As additional historic information unfolds in that session it seems
to have been Diane’s sad reality to have had a possessive father who
wanted her achievements to reinforce his inflated importance, in the
process diminishing the appreciation of Diane’s talent. This sadomas-
ochistic part of the father/daughter relationship seems to have been
stirred up in the analyst’s countertransference (“I observed that I have
the desire to want to speak to her with force, to pin her down, and
get her to submit to me and value me”) showing how Diane’s internal
world unfolds in the analytic relationship.
In her determination not to succumb to a dependent relationship and
accept what father had to give, Diane used her talents and accomplish-
ments to become superior (“I hit his world like I did with tennis”). This
gives insight into Diane’s grievance (Steiner, 1996), the hating aspects
of which are now emerging in the analysis, crowding out any access
to loving internal parts (“I don’t have access to any love”). Her efforts to
compensate for deprivation have been motivated by hate and she can
therefore feel neither proud of her achievements nor grateful for what
she has received. The unfortunate outcome is that any pride her father
may have had for her is felt as having been extracted by the force of her
hatred and therefore cannot be warmly received and appreciated.
It seems that on some level Diane feels her crippling symptoms are
deserved paternal punishment for her murderous hatred (“I was not
worthy of a professional coach”). She connects her bodily pain with her
father’s death by referring to her increased symptoms at the time of his
death (“How my muscular stiffness, psoriasis, tendon so tight, joints moving
against each other, are connected with his dying”).
Sadly, in her family Diane was not able to find the opportunity to dif-
ferentiate between the perceived “mediocrity” of being human with its
potential for growth, separateness, and interdependence and the “medi-
ocrity” of a mediocre family whose members may have been unable to
nurture or even recognise her talents and potential.
In the face of the opportunity for a continued partnership that her
analyst offers, Diane fears that if she opens the door to being human she
would be annihilated (“if I am accepting, I’d go down the drain”). Her psy-
chic paralysis is evident and the complexity of her dilemma can be seen
to stem from the different levels of her struggle. As the sixth of seven
children, born after her parents had five children in six years, her reality
DIANE VS. REALITY 89
may have been that, unless she held on by sheer force, no one would
be there for her. This would lead to a conviction that the object would
only be there as a result of her own singular efforts. The other level of
her struggle is in the area of separateness. “Letting go” is felt as a death
of the old way of being without the yet-to-be-established introjected
holding analytic relationship. Until that happens, if it can, Diane lives
in a ruthless world (“you don’t count, you don’t matter. It is the survival of
the fittest”) the tragedy of which Diane is now coming in touch with.
Confronted with such ruthlessness the analyst’s efforts to stay potent
and boundaried become a struggle (“I cringe when I hear her ravenous
hunger and her hatred, and feel that it is only a matter of time before I
too become the object of her rage. I have come to ready myself for her
criticisms of my insufficiencies”). The analyst puts words to the tempta-
tion to harden up and develop her own second skin (Bick, 1968).
The session on 12/7/2006, although short, seems to further elaborate
Diane’s experience of her hunger. It has become enlisted in the service
of her sexuality. In the “down there” position of pleasuring her girl-
friend she is filling the hole in her object, not being “up there” by her
analyst’s nourishing breast filling the hole of her own lack.
Now the analyst also gets blamed for her patient’s hatred of needs
(“you got me there, you can’t pull me back”), showing her paranoid blame
of her object for having put the awareness of a potentially healthy hun-
ger into Diane. With that statement Diane conveys her entitlement to
satisfaction, thereby dismissing any need to feel grateful. Unfortunately
in the process she also destroys the value of what she is given, thus
increasing her hunger and greed (Bion, 1970).
In her session on 2/14/2007 Diane again uses manic defences in her
disdain for her “slacker” supervisee. She is triumphantly dismissive of
her analyst/slacker, (“I do my best work away from you”) apparently with
the unconscious fantasy that she can grow and feed herself without
having to recognise the analytic partnership which she realises she is
destroying inside herself (“I am filling your space and energy with shit”).
Diane is here stating a conscious realisation of how she is treating her
analyst but she may not be aware of the unconscious guilt that accumu-
lates as a result.
In addition Diane seems to indulge in the fantasy that she makes
her analyst a good strong partner solely by the force of her own efforts.
The reality is in fact the reverse; she herself is stronger as a result of her
analyst’s hard work and containment. Her fear that the analyst might
90 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
not be able to bear the force of her emotional presence (a situation she
experienced with her parents) turns into entitlement—“When I get to
the heart of it and throw a temper tantrum, you better be ready. I am not giv-
ing you a free ride. You have to be a good partner. I won’t be compassionate”.
Holding on to that fantasy enables Diane to feel that she is superior to
her analyst. Diane wants to be perfect, that is, without equal.
There is, however, also the reference to Sea Biscuit, a great horse
who “ate a lot of food”. This seems to allow space for her needs and at
that moment Diane’s grandiosity is tempered by realistic ambition
(“even that great horse needed rest and recovery”). After this Diane real-
ises that being more in touch with her reality will confront her with
what to do with her anger from the past (“where will I put the anger of
the past”). Her hatred and entitled anger has powered much of Diane’s
achievements and filled her identity. She will feel empty without it and
has to await a sense of adequacy that facing and bearing reality gives
over time.
In the final session of this paper on 5/2/07, after seven turbulent
months, Diane brings a dream which further widens the analytic field
(“everyone I know is there”). She acknowledges her former tennis part-
ner’s potency/penis (“instead I used my hand to touch his penis”) and
projects her wish to suck on it (“he was rubbing himself, and pushing my
head down”). Now, instead of being tempted by her greed for all the
erotised sweets, she wants to be selective of what she takes in. It seems
Diane is able to differentiate what is nourishing to her growth and what
is not. In that process she meets a handsome/potent part of herself and
in that state of mind she is able to meet her own vulnerability. She is
humbled (“I was not confident … I tell the truth”) in a hopeful whole-object
moment encompassing both her able and humble/truthful parts.
The next sequence is a meaningful emotional confrontation with all
the missed opportunities as a result of her destructiveness (“I tell the
truth and am exposed—a huge botch and so I no longer can walk. And there
is atrophy and joint pain”). If she proceeds, Diane will face the need to
mourn missed opportunities and the destructive effects of her sado-
masochism, some of which cannot be repaired.
In this last session both core parts of Diane’s splitting appear in a
mixture of, on the one hand, awareness of her frailty with recognition of
damage done by her destructiveness, and the old superior sadomaso-
chistic attitude on the other. “I am so far beyond because of my success—
I leave everyone in shock …” are statements of sadistic, manic, superiority
DIANE VS. REALITY 91
Bion makes the point that the “frightful fiend” represents indifferently
the quest for truth or the active defences against it, depending on the
state of mind. He goes on to comment that it may seem improbable
that dread should be associated with analytic progress towards a more
realistic outlook.
When coming to the end of the clinical material, while not know-
ing how Diane’s treatment proceeded, I found something in the session
that gives direction to my conjecture that Diane is plateauing and need-
ing time to consolidate before a possible next phase of turmoil. In her
dream Diane describes that she is “on skates and am my old self”. From
that I infer that she is moving fast and has reconstituted her old ways
of avoiding reality. She says “I skate back to the candy bar and am just
about to pick something but I don’t take the candy”. I believe that the seven
sessions in Dr. Paula Ellman’s paper describe an intense and turbulent
period of Diane’s analysis which shows psychic movement from severe
sadomasochistic internal and external relationships toward space and
capacity to endure the pain and recognition of psychic reality with
potential for incremental amendment of her sadomasochistic entrench-
ment. Whether, and to what extent, Diane will allow herself to become
conscious of that movement is uncertain. I find myself wondering how
92 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
References
Baranger, M. (1993). The mind of the analyst: From listening to interpreta-
tion. International Journal of Psychoanalysis, 74: 15–24.
Bick, E (1968). The experience of the skin in early object relations. Interna-
tional Journal of Psychoanalysis, 49: 484–486.
Bion, W. R. (1957). Differentiation of the psychotic from the non-psychotic
personalities. International Journal of Psychoanalysis, 38: 266–275.
Bion, W. R. (1962). Learning from Experience. London: Tavistock.
Bion, W. R. (1967). Second Thoughts. London: Heinemann.
Bion, W. R. (1970). Attention and Interpretation: A Scientific Approach to Insight
in PsychoAnalysis and Groups. London: Karnac, 1984.
Freud, S. (1911). Formulations on the two principles of mental functioning.
S. E., 12. London: Hogarth.
Hinshelwood, R. D. (1989). A Dictionary of Kleinian Thought. London: Free
Association Books. London.
Isaacs, S. (1948). The nature and function of phantasy. International Journal
of Psychoanalysis, 29: 73–97.
Joseph, B. (1992). Psychic change: Some perspectives. International Journal of
Psychoanalysis, 73: 237–243.
Klein, M. (1923). The development of a child. International Journal of
Psychoanalysis, 4: 419–474.
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive
states. International Journal of Psychoanalysis, 16: 145–174.
Klein, M. (1946). Notes on some schizoid mechanisms. International Journal
of Psychoanalysis, 27: 99–110.
López-Corvo, R. (1999). Self-envy and intrapsychic interpretation. Psycho-
analytic Quarterly, 68: 209–219.
Mitrani, J. L. (1995). Toward an understanding of unmentalized experience.
Psychoanalytic Quarterly, 64: 68–112.
Segal, H. (1991). Dream, Phantasy and Art. London: Routledge.
Steiner, J. (1987). The interplay between pathological organizations and
the paranoid-schizoid and depressive positions. International Journal of
Psychoanalysis, 68: 69–80.
Steiner, J. (1996). Revenge And resentment in the “Oedipus situation”.
International Journal of Psychoanalysis, 77: 433–443.
PART II
CASE PRESENTED
BY NANCY R. GOODMAN AND
DISCUSSIONS
CHAPTER SEVEN
O
“ h no, not again” was a constant and loud refrain ringing in my
inner psychoanalytic ear as I listened to Mr. B and to the coun-
ter feelings in my own psyche. Over his six-year analysis, he
taught me about the way he had evolved, and now used, internal scenes
of what I came to think of as “hurting love”. They took place again and
again, marking their import in his psychic organisation. At times he
was the one being hurt and at times he was bringing hurt to others.
Fear of annihilation/castration ruled his psyche and the terror about
this was avoided and managed with the clarity of an expected sado-
masochistic object relationship. The repetition compulsion was alive in
regard to constant replaying of someone attacking the other resulting in
a sense of psychic death or a state of overwhelming stimulation. Mr. B’s
special way of getting rid of someone was to find fault and to “x” them
out. Both of us suffered often with the sense that a place of disappoint-
ment and detachment would appear again and again. His annihilating
capacity staved off his own terror about being annihilated. In his inner
life a danger signal aroused the desire to get rid of the other as soon as
possible.
After a year of two times a week therapy he started a four times
a week analysis and began to often enact deadness with me as he
95
96 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
fell asleep or was what he called “floating” on the couch. For Mr. B
issues of autonomy and separateness and dangers of body intrusion
coalesced around a regressive use of anal stage organisation in which
dominance and submission, and control and omnipotence, were at play.
Countertransferentially I became familiar with all facets of these meth-
ods of being with someone. We were often involved in fluctuating con-
figurations of “who was going to hurt whom” as “hurting love” was
played out on our analytic stage. I came to appreciate the way in which
a representation of relationship centred on someone causing pain for
the other can function. Similar to the way someone uses a fetish to keep
terror away, Mr. B at times used the “hurting love” scene between us
to disavow the catastrophe signaled by separateness. I am grateful for
Mr. B’s honesty and capacity to discover and his generosity in granting
me permission to write about “sailing with Mr. B”.
truth of this experience, he described how now he often fell asleep with
his head lying on the table after “my lonely dinner”. As a toddler he
received an enema every three days if he was not producing a bowel
movement. Numbers were now very important to Mr. B. He wanted to
optimise time and money by spending very little of each commodity.
He described the many ways he would save money, for example, driv-
ing home to get a coupon if he had forgotten it knowing full well that
the gasoline costs might be greater than the value of the coupon. He
had to go through almost ritualistic machinations to manage a feeling
of being taken advantage of or a sense that his resources were wasted
and misused. Dread about helplessness and the idea of possible misuse
by others was often in his mind.
Another story took place on his eighth birthday and became the pro-
totype for a need to always win negotiations and to never compromise.
He had been clear that he wanted a particular baseball glove with a
signature from a favoured player. His father presented him with a dif-
ferent one and when he protested, his father told him “take it or leave
it”. There was no negotiating. He left it and preferred to have no glove
than to have one he felt he was forced to accept. When I spoke to him
about including this in my write-up, he said: “It was the feeling that I
did not matter that was so awful. Why wouldn’t he care to know why
it mattered to me?”
You will hear the symbolic significance of these stories in descrip-
tions of the analytic work, especially in the fantasies and enactments
taking place between Mr. B and me. From the beginning of treatment,
the question of who would control whom or who would force whom
into submission was often an active dynamic. His highly cathected rep-
resentation of a sadomasochistic object relationship would catch each of
us in imagined and enacted active and passive positions. Sometimes I
wanted to absolutely force life into him. Other times, I wanted to merge
into his sleepiness to deny my anxiety of not understanding and to just
find a way to join with him. He produced an agonising deadness in me.
It took time for us together to face the remnants in his mind of the expe-
riences and internal fantasies about having been so often a thing-baby.
A solid belief in destruction and helplessness produced by the narcis-
sistic needs of another was a monument marking a place of “ground
zero” in his psychic organisation. Later in the analysis, I was amazed to
learn about the empathy and attunement which also existed in Mr. B’s
mind. When grandchildren entered his life, I heard about interactions
with babies and toddlers which showed caring and sensitive intimacy.
98 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
He told me stories about being with the babies which brought forth
representations of tender, attentive, and consistent attunement. These
descriptions were valuable in our work as he then realised so fully the
unmet wishes he had and the pain of making them conscious.
analyst: Something about seeing the gap between you brings about
pressure.
mr. b: It brings about more than that. Like something is in my face
that I have no control over.
analyst: Could you tell me more about the gap?
mr. b: It is nothing there, no one is there. It is blackness, nothing
… coming face to face with emptiness, blankness, in fact she
looks blank and I cannot stand it … I don’t know why it is
something that fills me with dread. I don’t want to see it. Yes,
dread. [He is silent for minutes.]
analyst: Is there something difficult about telling me about your
dread, you have become quiet.
mr. b: I started drifting—just a little. I can almost reach for some-
thing [holds arm out with hand reaching] but there is noth-
ing there.
analyst: When you drift you create the nothing that makes you feel
dread, that may be one way to feel in control of what is
frightening.
S A I L I N G W I T H M R . B T H R O U G H WAT E R S O F “ H U R T I N G L OV E ” 105
mr. b: Four days of agony. I took my pills and even they did not
help. I finally got my Doc to order a narcotic. The pain was
all over my head, not just on the left side where it usually is.
I stayed in bed the whole time. I had awful dreams, awful
nightmares. I was lost in tunnels. I was alone. The tunnels
were built into the ground and very dirty. I could look up
and see that overhead there were sort of panels which held
up part of the ceiling of the tunnels, they were made of shiny
metal. But, there did not seem to be enough of them and the
whole thing could collapse and cave in and I would suffo-
cate. I was really scared and did not know what direction to
go in and there were these offshoots where I had not been
and I had to take them to get out but I did not know what
directions to go in and I needed time to figure it out before
everything collapsed.
analyst: I can hear how imminent the danger was.
mr. b: What kind of tunnels are these? They were almost collaps-
ing and there was only this sort of flimsy structure prevent-
ing everything from just falling in, it was not like there was
an actual ceiling, just places here and there where the metal
held things up. I get frightened just telling you.
analyst: You are letting me know how frightened you are at a time
we are planning to stop.
mr. b: That is right, maybe I need to talk some more.
analyst: You were in these tunnels and all alone and have been am-
bivalent about wanting anything from me. I hear your wish-
ing to be on more solid ground and to discover more about
how to make the tunnels safer and stronger before you do
leave. Is it so frightening to need me at this time?
mr. b: It would feel better to take time to figure it out.
analyst: I have been active in trying to respond to your distress in
telling you what I think right away, I wonder how you have
experienced that?
mr. b: My head feels better, no pain. I want to keep meeting for
awhile.
Listening to Mr. B’s nightmare and fear, I felt an urgency to shore things
up and not allow a collapse. We did not take time to hear associations
to the tunnels which sounded so much like a fantasy of the inside of the
S A I L I N G W I T H M R . B T H R O U G H WAT E R S O F “ H U R T I N G L OV E ” 107
anal canal where he felt frantic in wanting more from me. The wishes
and fears collecting around this imagery would develop in the next
phase of our work.
Mr. B was integrating thoughts about himself and his childhood and
acknowledging the wish to use “blacking out”. In another session, he
reports having a sensation of aliveness and connection: “I had a strange
feeling in the waiting room of wanting to reach out and touch some-
one’s coat on the coat rack which I suddenly thought was maybe yours.
It would be so nice to just stroke it. Maybe this is something about wish-
ing to feel your skin. Maybe I will feel sad when I leave … and it will
be soon.”
There were many more dreams symbolising fears and wishes, includ-
ing a dream of a woman who greeted him at the entrance to a museum.
She seemed familiar and took him through the museum. He liked this
woman but did not know who she was. The work was interesting to
me and felt more collaborative—then his announcement: “I am done,
I have no more curiosity and no more interest.” He came to sessions
and said absolutely nothing. He lay down on the couch; after about
five minutes I asked what his quiet might be about? “I have nothing to
say”, he said. After seven minutes I told him that I wondered what he
might be trying to have me feel with his having nothing to say. He said,
“I am done.” I said, “I wonder if we could be curious about your being
done in this way?” He said, “I am not curious and you cannot make
me curious.” Silence. The next sessions were all about his leaving, his
being done, and about a growing desperate feeling in me—a pressure
to say the right thing, a need to come up with something powerful. The
sessions were extremely tense—(the enema in the room, the tunnels—
the cloaca which would collapse under the force of pressure). Someone
would be excitedly evacuated.
I say to him: “I think we are in a crisis. There is no way we can speak
to each other.” He says: “I absolutely agree and feel like just giving in
and waiting until you say I can go; or, I will just walk out. This feels like
S A I L I N G W I T H M R . B T H R O U G H WAT E R S O F “ H U R T I N G L OV E ” 109
a war.” I tell him that I absolutely agree and that he does not have to be
curious just because I am; but, I am curious. I ask: “What is so important
about being in a battle, is it a way to not experience saying goodbye”?
He says: “Aha, I hear another six years coming on, six years to get in
and six years to get out.” We both laugh out loud.
When he returns to silence in sessions, I wonder to him why it is so
important to so often keep the relationship with the analysis and with
me as a place of no feeling.
These questions really make me think and I let him know that. I eventu-
ally tell him that in fact it is a way I think about how to learn about his
mind by attending to ideas and feeling that develop about our relation-
ship and he was probably very attuned to that being important to me.
He also seems to be thinking that if I bring this up it is about doing it
by the book and not about real interest on my part. He remarked that
he knew I liked dreams also and did not know if he was interested in
dreams. “Your interest might also be because you are supposed to pay
attention to dreams” he says to me. I state that I could understand, that
it made sense to me that he would expect me to be another mother who
would use knowledge from books to torture him and make him feel his
authentic experience did not matter, what mattered was what the doc-
tor ordered. As we spoke in this session, it felt like we were listening to
110 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
General comments
I found myself irresistibly drawn into the narrative by the beckoning text
of the author. We are immediately introduced to a tumultuous “love-
hate affair” between two involved but wary “lovers”, except for the fact
that this is not a love-hurting affair in the ordinary understanding of that
idea because it is a “psychoanalytic affair”, not a real life one. It is a psycho-
analytic story by mutual agreement and arrangement between the ana-
lysand and the analyst and by virtue of the fact that the analytic frame
is being rigorously observed. Once the frame and all that it suggests in
terms of self-restraint of impulsive actions are in place, the analysand
as well as the analyst become able to suspend their respective “realis-
tic” impulses (suspend reality in order safely to experience their own
respective freely associative phantasies). It is a pre-arranged dramatic,
seemingly improvisational, and yet paradoxically pre-scripted, dramatic
play taking place in a world that is unconscious to the participants. The
situation is more an intersubjective “group dream” (co-constructed by
analyst and analysand) and their two individual dreams.
When I say a “love-hate (hurting) affair”, I am not necessarily allud-
ing to an erotised transference ↔ countertransference ↔ intersubjective
111
112 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
The analysand, in this case, Mr. B, probably felt tricked, tantalised, and
deceived by the emotions he was compelled to experience in his ana-
lytic regression, including dependency, neediness, passionate desire,
and envy of his analyst. In so doing, he was moving epigenetically from
the position of the passive, shamefully inadequate helpless victim to
the active role in which he in turn sought to tempt and frustrate his
analyst. In other words, he employed the manic defenses (Klein, 1935,
1940) in which he, in unconscious phantasy, reversed the dependency
hierarchy with his analyst and experiencing triumph over, demeaning
contempt for, and control of her and her emotional life.
Now, where do sadism and masochism fit in to “painful love”? Were
Mr. B’s masochism and sadism defensive alternative responses to his
perception of his strict frame-minding and regressive transference-
inducing analyst? Or did his “inherent armory”, that is, his instinctual-
drives, inaugurate his transference behaviour—or both? My tentative
answer at this juncture is that we cannot really know, that is, we can-
not really reconstruct his origins with certainty. We can only know our
experience of the current transference ↔ countertransference evidence
in the here and now.
Let us pursue sadism a step further however. One of the chief com-
ponents of sadism has long been thought of as the enjoyment of being
cruel to an object, the desire to and pleasure in inflicting pain and
suffering in the object. Another component of sadism is the subject’s
pleasure in controlling the object, a tendency which is included in the
Kleinian concept of the manic defence. I believe that sadism may con-
stitute a part-instinctual drive subserving what Bowlby (1969, and per-
sonal communication) calls the “prey-predator instinct”, as in stalking
and hunting prey, an atavistic residue of our animal (creature) pre-
history and geared to be an evolutionary adaptive instrument for our
survival.
Another line of associations now suggests itself in regard to Mr. B’s
analysis and again in the transference ↔ countertransference context.
Winnicott (1969) speaks of the concept of the “subjective object” (p. 91),
the infant’s phantasied perception of the object which (s)he interposes
(projects) into the potential space between him/herself and the object,
thereby distorting her/his image of the real object. One can readily see
that this idea graphically illustrates the phenomenon of the parallax of
transference. Winnicott goes on, however, to say something even more
interesting. He states that the infant seeks to destroy the (subjective)
114 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
object yet hopes that the real object survives. It must be realised that the
infant, like the analysand, is in a state of transference and consequently
cannot distinguish between the self-constructed image of the object and
the real object itself.
Yet there is a deeper layer to “hurting-love”, a layer which is all too
obvious and yet paradoxically mysterious. We all realise that there
can be no love without the occurrence of hate. Put another way, hate
through wanting to hurt the object, helps to define love, as Winnicott
(1945) remind us, but why is this so? The infliction by and the corre-
sponding experience of pain inflicted on an object with whom one is
intimately involved seem to be the emotional certification, a veritable
“branding” by the act of inflicting and of suffering pain in regard to
the other. We are reminded of this by the labour pains mothers have
timelessly suffered for the birth of their beloved infants. This pain con-
stitutes the sacred bonding link between the two and is the hidden
order of the depressive position. The crucifixion of Christ designates
the sacred act whereby the God-appointed scapegoat or Pascal Lamb
willingly suffers for those who cannot tolerate their pain. The Eucharist
designates the ritualisation of inflicting suffering upon the sacred
scapegoat by which act a sacred covenant (in regard to the relationship
to the sacrificial object) emerges, and obligatory guilt becomes etched
into one’s very being (soul). This sacrificial act introduces the birth of
the superego.
Winnicott (1945) grasped the essence of this irony that “hateful love”
poses in the following:
the part of the analysand not be a hidden motive for achieving closeness
for real?
Second conclusion: May the real relationship between the analy-
sand and the analyst be the secret template underlying transference ↔
countertransference and constitute its hidden order—ever to be sought
after but never achieved? To achieve it, including self-disclosure by
the analyst, is sacrilegious to the analytic endeavor. Put another way,
the analysand forever seeks to destroy the transference object (illusion,
phantasy, suspension of disbelief) to achieve possession (“knowing”) of
the real object and yet must always be kept from doing so. The analyst,
on the other hand, is always seeking the analysand’s transference so as
to eradicate it so that (s)he can become more evolved (real) and be able
to experience the realness of the analyst.
Third conclusion: The infliction and experience of suffering unites
the two participant objects by a “branding pain” and an obligatory
guilt that galvanises the intimacy of a relationship between the two and
certifies its sanctity. I believe theology and anthropology (particularly
Shamanism) need to be invoked for further enlightenment on this seem-
ingly obvious yet truly mysterious sacred phenomenon we are dealing
with.
Fourth conclusion: It is important to distinguish between “sex” and
“erotism”, the former being a natural consequence and achievement
of normal libidinal development, and the second being a purloining
or misuse of sexual impulses for defensive reasons and/or perverse
motives (Lichtenberg, 2007). Mr. M., like so many analytic patients, dis-
guises his shameful dependency needs for what pretend to be sexual
needs in order to level the playing field. Dependency connotes a hier-
archic relationship in which the infant or the infantile portion of the
personality feels inferior to or less than the object of their dependency,
the original experience being the breast. Erotic sex, on the other hand,
connotes a prematurely achieved later stage of development in which
the erotised partner and the self are considered to be equal in their ero-
tised enthrallment.
Specific comments
The patient seemed to have better adjusted to the analysis than he had
let on. He moved easily from a twice-weekly psychotherapy to a four
times a week psychoanalysis. One of his first responses after making
116 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
the change was to “enact deadness”, according to the author, and also
to fall asleep. My own “reverie-at-one-remove” was to think of him as
having experienced a deep regression into a womb-like state. I think I
might have understood this as his desire both to become unborn and
also to become reborn with the analyst-as-mother. I felt confirmed in
this speculation a short while later when he told his analyst that he
felt “invisible to others”. I took this remark to suggest the operation of
projective identification, an unconscious phantasy by which he seeks
to become unborn and therefore invisible by disappearing inside the
analyst-mother’s body.
The author comments on how sad and alone he felt. He was divorced
and retired and seemed unable to handle the spaces of unshared time.
He believed his children didn’t need him, a comment that suggested
to me that he was being unconsciously reminded of how needy he
was becoming—and needed to deny by using projective identifica-
tion. We learn from his history that his mother had apparently created
a power struggle with him over his eating. His resultant frustration
must certainly have made his needy dependency feelings shameful or
even humiliating to bear. His feeding trauma became re-enacted in the
transference ↔ countertransference as “painful love” because of pain-
ful need. The trauma resulting from his many childhood experiences
seemed to have activated and confirmed his negativity in regard to his
neediness, and it must have heightened his envy of his needed objects.
It may also have pushed him from feelings of being shamefully power-
less as a helpless infant to that of being a precociously erotic infant or
child, as I alluded to earlier, who, with his discovery of his new erotic
capability, could now equalise the distribution of power with the object
and no longer be the shamefully powerless and vulnerable infant.
thread of the whole analysis. His archaic relationships with his mother
and his father were reported by him as having been painful. Whether
he was the helpless victim of their parental ineptitude, neglect, or
abuse, and/or whether his inherent personality constituted an ongoing
mismatch, the patient, though not necessarily guilty for what had
happened in his infancy and childhood, is nevertheless psychically
responsible for what became activated in his internal world as a con-
sequence of his parents’ impingements and/or neglect of him. He is
unconsciously mandated to repeat these ancient mishaps and their
effects in him in the analysis as a passion play in which he recreates,
re-enacts, and re-dreams his “painful loving”—for the analyst now to
feel the pain that he has felt lifelong. That the analyst must feel his
pain is absolutely necessary, states Bion (1978, and personal commu-
nication). The analyst must feel the patient’s pain so as to achieve the
cure of the pain—as an exorcistic transfer of “demons” (bad objects)
from the patient to the analyst. The analyst must then feel the patient’s
transferred pain instead of the patient and must also vicariously feel the
guilt and regret that the original parents did not or could not reveal
or express. The act is one of vicarious atonement. This healing act is
shamanistic. I term it the “Pieta transference ↔ countertransference”
(Grotstein, 2008a, p. 21).
Conclusion
In the course of an infancy and childhood background characterised by
faulty attachment with injury to his developing self-esteem, this patient
seems to have tightly joined sadism and its twin, masochism, to his
capacity to love. What he is beginning to learn in his analysis is that
true love must always be associated with pain—the pain that inevitably
comes with caring—but it must become “divorced” from its unneces-
sary but persistently persuasive dark side, sadism and masochism.
References
Baranger, M. & Baranger, W. (1961–62). La situation analitico como campo
dinamico. In: Problemas del Campo Analitico. Buenas Aires: Revista
Uruguayo de Psicoanálisis, 4: 3–554.
Bion, W. R. (1976 [2005]). The Tavistock Seminars (Ed., Francesca Bion).
London: Karnac.
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I
n “Sailing with Mr. B”, the author presents a vivid and convincing
narrative of a six-year psychoanalysis with a difficult patient
engaged in a sadomasochistic transference. Mr. B was fifty-seven
when he came for analysis because of a depression with feelings of
“despair and a sense of emptiness”, a depression like one he had suf-
fered after the break-up of his marriage ten years previously. He organ-
ised his life with a full schedule of exercise, social commitments, and
volunteer work in professional organisations. He had no sense that he
could really relate to others, “sure that his married sons and daugh-
ters did not need him and would gladly ignore his existence … He had
to go through almost ritualistic machinations to manage a feeling of
being taken advantage of or a sense that his resources were wasted and
misused.” He would drive home “to get a coupon if he had forgotten
it knowing full well that the gasoline costs might be greater than the
value of the coupon.”
Dr. Goodman builds a complex formulation into the clinical narra-
tive, and she provides clear indications of the nature of the transfor-
mations in the patient’s psychic functioning and life which take place
through the analytic process. Between the formulation and description
of change, the analyst shows how she saw the past coming into the
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124 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
present and tells us what she did and said to further the process and to
create change. In this discussion I will try to make more explicit what
is sometimes implicit in her working formulations and descriptions of
change in Mr. B.
capacities, which had been split off in the service of defence. The analyst
was amazed to hear about a playful empathy and attunement with his
grandchildren which also existed in Mr. B’s mind, “interactions with
babies and toddlers which showed caring and sensitive intimacy”.
Reflecting on the countertransference and helping the patient to own
aggressive impulses was the first step in analysing the revenge wishes
and the traumatically intrusive experiences leading to them. But at first
Mr. B rejected all interpretations concerning his aggressive impulses
towards the women he dated and towards the analyst. During the
second year of the analysis, Mr. B dated thirty women, and it became
clear that he was looking for a woman who would be so perfect that
he would not have any impulse to reject or humiliate her. However,
eventually the analyst and patient were “able to talk about the delight
he took in his harsh devaluations of women”, and in his insinuations
that the analyst’s words could never enliven his inner world. For a long
period he forced a “sadomasochistic coupling” on the analysis: as Mr. B
“withheld a treasure of associations”, the analyst caught sight of her
wish to force him to “give more”, “like the mother giving enemas”. The
acknowledgement in herself of these countertransferential impulses to
intrude aggressively, together with reflection on what this indicated
about the patient’s past experiences, was an important factor in effect-
ing change.
linked to the analyst’s idea that as a baby and little child he felt he was
a “thing” for his mother. Thus he says to his analyst “that he does not
think about her as a real person but as a doctor with knowledge similar
to an instrument”. He sees the analysis as a “business transaction”, and
concludes: “You are like a gasoline station attendant who puts gas in
the car”.
The fantasy of sadistic anal intrusion (the gas hose) seemed linked
to the overstimulating passive experience caused by the mother’s injec-
tion of the enema “instruments” into his rectum; the passive intrusion
experience/fantasy is transformed into the active wishful fantasy of the
analyst viewed as gas station attendant, in a projective identification.
The next part of the discussion will focus on the termination phase,
which gathered and intensified Goodman’s ways of facilitating change
for the patient.
The fantasy structure which had regulated Mr. B’s responses to pain
involved a fear of “sexual difference”, now analysed by Goodman
through reference to implicit castration anxiety: “they all have vaginas
and you keep assassinating them before anything can happen.” Within
this condensed portrayal of a segment of analysis, Goodman’s sponta-
neous interpretation seems to have emerged partially from unconscious
to unconscious communications. A teasing and being teased (Brenman,
1952) dynamic next entered the transference/countertransference with
a more explicit sexual aspect: a “foreplay” was elaborated in the trans-
ference and important functional change was initiated.
During this phase of the analysis, Mr. B not only humiliated the ana-
lyst as powerless to help him, but also tried to erase her, to “x her out”.
130 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
The links between Mr. B’s fear about his wish to annihilate, his self-
punishment, and his states of aloneness and deadness became rep-
resented in the dreams and associations of this period. In one dream
Mr. B is alone and lost in water and on ice. He states: “death can easily
occur, there is no help.” In another dream, he reaches out over a slab of
ice and the German SS are on the other side ready to torture him. He
wakes up in a state of fear from a dream in which he is being tortured,
being burned on his fingers, and he does not feel anything and is glad
to be numb. For the first time, he puts his defensive disavowal of affect
into words, “glad to be numb”, now conscious of and owning the state
he had evacuated and projected into the analyst earlier in the analytic
process.
After analysing Mr. B’s dreams and dread of gaps for months (“com-
ing face to face with emptiness, blankness; in fact she looks blank and
I cannot stand it”), the analyst makes the interpretation linking the
patient’s fear of female genitals, his conflicted sexual desire, his castra-
tion anxiety, and his torture fantasies.
“We have spoken often about your reactions to being face to face
with gaps and how intolerable it is. The thought of separate people
ignites the certainty that someone will be tortured and the gap is the
girl’s genitals, that made the little boy frightened”. Mr. B:. [Laughing
with gusto] “I cannot believe that you say those Freudian things [more
laughter], I guess you are earning your pay.”
Mr. B showed signs that he had a new ability to take in the ana-
lyst’s interpretation of his castration anxiety and unconscious castra-
tion fantasies (Freud, 1915), expressing some relief in his laughter,
but also trying to dismiss the analyst as she brought the fantasy into
consciousness.
132 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
which promotes open possibilities, and … this takes place via the
analyst’s reverie, or time of reverberation. (Birksted-Breen, 2009,
p. 35)
the patient was now hearing her interpretation: “it felt like we were
listening to each other in a different way”. Important transformations
could be seen in his ability to sustain a love relationship, despite his
fears, which had been his reason for entering analysis.
Much discovery of the depths of his mind, and of mine, took place
as he was telling me he was floating or sleepy and we were both
learning to listen to his deep unconscious. While the “oh no, not
D I S C U S S I O N O F T H E CA S E O F M R . B 135
References
Berliner, B. (1958). The role of object relations in moral masochism. Psycho-
analytic Quarterly. 27: 38–56.
Bion, W. R. (1959). Attacks on linking. International Journal of Psycho-Analysis,
40: 308–315.
Bion, W. R. (1962). The psycho-analytic study of thinking. International
Journal of Psycho-Analysis, 43: 306–310.
136 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
A
dramatic narrative unfolds as Dr. Goodman describes the process
of the analysis of Mr. B. A mother-child relationship that was
characterised by pervasive elements of sadomasochism had been
internalised and preserved within Mr. B’s psyche. This became a cen-
tral aspect of his internal object relations world which was revived, and
aggressively defended against, in the transference-countertransference
interaction between Mr. B and Dr. Goodman. The strength of
Dr. Goodman’s presentation lies in her description of both neurotic and
characterologic features, each containing multiple aspects in combina-
tion with one another. This provides ample opportunity for an in-depth
clinical study of the elements of sadomasochism in this case.
Mr. B was feeling desperate when he originally came to see
Dr. Goodman for help. The precipitant was the break-up of a relationship,
which was the latest in a series of break-ups. His complaints of feelings
of sadness, despair, and emptiness, and fears of being invisible to oth-
ers, were symptoms of his profound depression. His condition aroused
deep concern in Dr. Goodman. He had suffered the same depression
after the breakup of his marriage ten years earlier. His reaction marked
the significance of separation and loss in his psychic functioning.
However, it was the sadomasochistic nature of his object relations that
137
138 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
and control, questions of who would hurt whom, who would attack
whom, and who would annihilate whom. Dr. Goodman gives several
examples of the ongoing struggles that ensued between them. One
example describes her susceptibility at times to the regressive pull from
Mr. B of wanting to merge into his sleepiness and the “agonising dead-
ness” that it would produce in her. At other times she wanted to “force
life” into him or had fantasies of “penetrating” him with the excite-
ment that was missing in him. Once the regressive transference deep-
ened, Mr. B’s depressed mood gave way to a state of affective deadness
which rendered him virtually unavailable for emotional contact. On
a manifest level he used withdrawal, disavowal, and frank deprecia-
tion in his recalcitrant resistance to Dr. Goodman’s attempts to engage
him in a meaningful relationship. His devaluation of her, as with all the
women in his life, contained the muted aggression of his “x”-ing out
any relational value. The disdain and disregard that Mr. B expressed
through his depiction of Dr. Goodman as a gasoline attendant, or a
wooden Indian in front of a cigar store, was a depersonalisation of her.
But as he regressed to a more primitive level of development it was the
agonising effect of the deadness itself on Dr. Goodman that revealed
its covert sadistic nature. Despite his devaluation of her, through her
countertransference she was still able to discern, beneath the deadness,
the deeper nature of the regressed world into which Mr. B had reverted.
A need for connectedness to the maternal object/analyst was aroused
in him which represented a paradox of dual function. Entry into analy-
sis provided him with a refuge against the pain and desperation of the
loss of his relationship with his girlfriend, which represented a return to
the loving, nurturing mother/analyst. However, since the transference
was a link to the object of the past, it also meant the entry into the dan-
gerous infantile world of his own sadomasochistic urges and those of
his internal mother/analyst. As a result, he had to control the depth of
the attachment to his new object in order to keep in repression the core
regressive sadomasochistic fantasies and their accompanying intense
affect states. He had to keep Dr. Goodman at a distance “to prevent
recognition of [the] direct connection with the original longed for and
feared object” (Newman, 1999, p. 257).
The genesis of the sadomasochism in Mr. B’s infantile world is sig-
nificant because it reveals its roots and the process of its development.
There are many factors that influence the outcome of early developmen-
tal experience. The meaning of any particular developmental experience
D I S C U S S I O N O F T H E CA S E O F M R . B 143
may result from perceptions of the interaction with the parents based
on the child’s needs and may have little to do with the actual interaction
between parent and child. On the other hand, there are strong indica-
tions of actual early mother-child struggles in Mr. B’s experience with
his mother. Mr. B gave Dr. Goodman examples of his early childhood
experiences, one that was told to him by his aunt, of being “kept in his
highchair until he had eaten what his mother wanted him to eat” and
his memory “as a toddler [being given] an enema every three days if
he was not producing a bowel movement”. His aunt’s witnessing the
highchair event lends some credibility to the reality of his experience.
Meyer (2011) cites Stoller (1975) who “… suggested that [the presence of]
sadomasochism reflect[s] actual cruelty inflicted in childhood” (p. 317).
Dr. Goodman refers to these as “screen scenes”, similar to screen memo-
ries, of his experience of excessive severity of frustration and overstim-
ulating aggression between him and his mother. To allay getting too
caught up in the throes of the transference-countertransference interac-
tion, Dr. Goodman used these screen scenes to anchor herself, presum-
ing that he was conveying to her his experience of representations of his
relationship with his mother.
Whatever the actual exchange between Mr. B and his mother, there
are indications of force with multiple images of maternal sadism in the
mother-child relationship in his unconscious mind. His state of infantile
dependence on his mother for the satisfaction of his needs put him in
a position of masochistic submission and surrender. Fairbairn (1946)
asserts that the lack of maternal response to the child’s need for love
constitutes trauma. The consequent state of helplessness, frustration,
and rage results in aggression. The Novicks (1995) extend Fairbairn’s
point by considering “the sadomasochistic fantasy as a whole” to be a
derivative of aggression, continuously oscillating between externalising
aggression in the form of a sadistic fantasy directed toward the object,
and turning it against the self when it becomes the masochistic object
of the object’s sadism (p. 25). In addition, despite Fairbairn’s assertion
that aggression is provoked, there is a certain quality of innate aggres-
sion in Mr. B that seemed to contribute to the sadomasochistic interac-
tion between him and his mother. The oral stage infant protesting his
mother’s efforts to make him eat, the rebellious toddler opposing her
control by withholding his bowels, and the latency child rejecting the
baseball glove because it wasn’t the one he wanted, are all signs of an
element of opposition on his part that infers a certain power struggle
144 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
between Mr. B and his parents. This raises the question of a genetic
predisposition on his part. But whether endogenous or provoked by
his mother’s intrusiveness and control, the screen scenes of her sadistic
behaviour toward him (highchair imprisonment/enema impingement)
indicate that his experience was traumatic.
Referring to the phenomenon of oscillation in sadomasochistic
relationships, Fairbairn (1946) notes that masochistic surrender and
sadistic retaliation alternate, depending on the prevailing mode in
the interaction in any given moment (p. 44). Consequent to Mr. B’s
unconscious sadomasochistic object relations structure, the power of
the fantasies created a corresponding interchange between him and his
mother/analyst. The oscillation from masochism to sadism converted
his helpless position into one of “triumph, mastery and revenge”
(Stein, 2005, p. 780), and back again. This pattern was reflected in
Dr. Goodman’s countertransference experience through her own oscil-
lating masochistic and sadistic fantasies between receiving and giving
pain. Mr. B’s oscillation between love and hate, sadism and masochism,
and active and passive modes of interaction reflected the power strug-
gles between them. The dynamic of the sadomasochistic interaction
seemed to stem from frustration, rage, and sadistic provocation and/
or retaliation, each fueling the other. There were elements of both in
each role. It is complicated by the fact that his mother, as well as being
the object of his ruthless destructive attacks, was also the source of
supplies for his need for nurturing, love, and protection. The split in
his sadomasochistic world was the result of his need to keep separate
the dialectical opposites of good and bad self, and good and bad object,
which was necessary for protection against alternating attacks on the
self in the masochistic mode and on the object in the sadistic mode.
Racker’s (1968) exposition of complementary identification with inter-
nal objects, in this case sadism, and concordant identification with
the patient’s self, masochism, is helpful for understanding the oscil-
lation between the two. When Mr. B induced masochistic fantasies in
Dr. Goodman, she was identified with his enduring masochistic self.
When she had sadistic fantasies, she was identified with the internal
maternal object in relation to Mr. B’s victim self. This pattern of oscilla-
tion reflects the internalisation of the infantile sadomasochistic object
relationship as a whole (Novicks’ term, noted above) between Mr. B
and his mother. Fairbairn (1946) suggests that relationships with inter-
nalised bad objects are usually of a sadomasochistic nature, “with a bias
D I S C U S S I O N O F T H E CA S E O F M R . B 145
on the masochistic side” (p. 79, my italics). Regardless of the sadistic side
of his struggle, Mr. B was basically in a masochistic position due to his
helplessness vis-à-vis his mother.
A striking theme in this case is the way in which Mr. B’s tenacious
defensive manoeuvress against the anxiety of his sadomasochistic
strivings were configured and manifested in the transference. Prior
to coming to Dr. Goodman he was already in a regressed state due
to the loss of his relationship. He had unconscious transference feel-
ings from the beginning, despite his denials when Dr. Goodman raised
them. Fairbairn (1951) explains that “the patient is not slow to sense
that the therapeutic endeavour threatens to reproduce the situation
against which his defences are mobilized” (p. 166). He also says that
regression originates from unsatisfactory object relationships during
the oral phase when the child does not feel really loved as a person in
his own right by his mother and that his own love is not valued and
accepted by her. This leaves the child fixated on the mother which is
characterised by extreme dependence, and makes him vulnerable to
the “regressive reactivation of his relations with her” (1941, p. 55). He
refers to the spontaneous return of repressed bad objects as a phenom-
enon of the transference. Further transference regression was prompted
by the transition from psychotherapy to the formal beginning of psy-
choanalysis. Within this deeper state of regression, a powerful uncon-
scious sadomasochistic mother-child relationship was revived. The
feelings of sadness, despair, and emptiness that Mr. B had expressed at
the beginning of treatment seemed to quickly dissolve and give way to
the powerful inner destructive forces within him that had dominated
his infantile object world. These forces threatened to break through the
repressive barrier against them. His symptoms were an indication that
his usual defenses were wearing thin. The weight of his sadomasochis-
tic wishes, fears of the threat of the retaliation or rejection by the object,
the destruction and loss of the object, and/or the annihilation of the
self, required intensified defensive efforts to regulate his anxiety and
to maintain his fragile internal emotional equilibrium. This provoked
intense unconscious anxiety which required him to redouble his repres-
sive efforts against it, draining his mind of its life-giving affects. The
purpose of this deeper level of repression was to maintain the sado-
masochistic fantasies intact, necessary for sustaining the connection
with the maternal object, and to protect himself against awareness of
the longing, the pain, the hatred, and the dread that they contained.
146 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
This massive repression reduced him to the virtual affectless state that
had an alexithymic quality that Dr. Goodman described as a state of
“deadness” in her countertransference. This was in stark contrast to the
sadomasochistic world against which it defended and which was alive
and vibrant.
Referring to the concept of alexithymia in Krystal’s (1988) theory
of affect, the Novicks (1995) say that the sadomasochistic fantasy
defends against the complete withdrawal from the object to a state
some patients have described as “being dead” (p. 69). In McDougall’s
(1984) elaboration of the concept, she defines it in part as “… an
incapacity to be aware of emotions … with the defensive function of
warding off deep-seated anxieties” (1984, pp. 390–391). In her recon-
struction with her patients, she was able to find “… a paradoxical
mother-child relationship in which the mother seems to have been out
of touch with the infant’s emotional needs, yet at the same time has
controlled her baby’s thoughts, feelings, and spontaneous gestures in
a sort of archaic ‘double-bind’ situation” (p. 391). She asserts that these
patients are “… unable to use normal repression [and] must instead
have recourse to mechanisms of splitting and projective identifica-
tion to protect themselves from being overwhelmed by mental pain”
(p. 392). According to Grotstein (1986), repression and splitting and
projective identification are not mutually exclusive. He reflects Fair-
bairn’s view that repression is used as an instrument of splitting and
projective identification. This is a different view of repression from
what McDougall calls “normal” repression. It is a primitive repres-
sion which in Fairbairn’s (1951) view originates in infancy before the
emergence of the oedipal stage (p. 174). This repression is not directed
against impulses but against intolerably bad internalised objects and
the parts of the ego that seek relationships with these internal objects,
as well as the memories and impulses associated with them (Fairbairn,
1944, p. 89). The intensity of these defences must reflect the intensity
of the sadomasochistic fantasies. In order to secure safety against the
multiple threats of these fantasies, Mr. B’s original (oedipal) repres-
sion had to be augmented by these primitive mechanisms, character-
istic of a more regressed state.
The prototype of Mr. B’s relationship with his mother included a
preponderance of projective identification. It was a manifestation of
his regressed primitive state of mind. It pervaded the transference-
countertransference interaction between Mr. B and Dr. Goodman. His
D I S C U S S I O N O F T H E CA S E O F M R . B 147
Up to the time that Mr. B announced his decision to stop his analysis
after five years, not much appeared to have changed. He had begun
to acknowledge some of Dr. Goodman’s interpretations, but his
complacency and recalcitrance seemed fairly static. No wonder she was
shocked by his sudden announcement. The meaning of his involve-
ment with the “short-haired” woman seemed a mystery that remained
to be understood. But despite the precipitousness of his announcement,
his agreement to continue, albeit at a reduced frequency, was a sign
that he was receptive to her influence, in spite of his resistance. As a
result, there were several interesting developments in Mr. B’s psyche.
Foremost, due to “the shock of difference”, was his partial emergence
from the state of primitive regression and the retrieval of some of his
lost affect. His recognition of her “astonishment”, along with perhaps
a retrospective recognition of his earlier “knee-jerk reactions”, opened
him up to an awareness of her as a real person with feelings of her
own, including her reactions to him as a whole person. At the same time
this exemplified their separateness. Not unexpectedly, certain elements
of the sadomasochistic nature of his object relations continued to exert
themselves in the transference-countertransference interaction, but he
was more emotionally present and engaged. The “deadness” was gone!
The primitive level of his repression had lifted. This made Mr. B more
accessible to insight and integration for a period of more collabora-
tive analytic work. The resistance encountered appears to have been a
more expectable amount. The other primitive defences of his previous
state of regression, namely, his depersonalisation of her in the trans-
ference, his dissociation in the deadness of his repression, the splitting
and projective identification as a way of communicating, seem to have
dissolved. Higher level defences emerged in their place, for example a
more developed level of repression, reaction formation, displacement,
and isolation of affect. The residual sadomasochism appeared to be in
somewhat sublimated form. Since one of the functions of projective
identification was to banish his anxiety, it is not surprising that when he
relinquished it, the result was intense anxiety. The question arises about
the meaning of this anxiety. Was it from the preconscious recognition of
his sadomasochistic aggression that he had repressed for so long? Or
was it the emergence of castration anxiety that had been superseded
by the annihilation anxiety of his preoedipal sadomasochism? Presum-
ably Mr. B was able to integrate some of his sadomasochistic fantasies
into his personality to some extent, resulting in their gradual mitigation
150 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
gone unrecognised, the shift in Mr. B’s psyche helped him to begin to
experience the sense of mutuality that was the key to the intimacy that
he both yearned for and feared. Writing about the arduous treatment of
perversions, Eshel (2005) maintains that “… the psychic structure of the
patient is influenced and changes, in the most essential manner, within
the abiding, deep and sustaining connection with the analyst’s psyche
(p. 1093).
Finally, within the termination period, Mr. B’s issue of separation
and loss emerged explicitly, the issue that had brought him into analy-
sis in the beginning. In spite of his protests, his difficulty separating
was pronounced, at first symptomatically (migraines, nightmares, etc.).
Then, there was a beginning acceptance of Dr. Goodman’s interpreta-
tion of his ambivalence about needing her, and his struggle to relate to
her interpretations about his resistance to acknowledging the mean-
ing in his mind of their difference and separateness, as well as of the
significance of the impending separation itself. One of the functions of
his sadomasochism had been to maintain the illusion of no recognition
of difference or separateness; that is, as a link to the early maternal
love object/analyst and as a defence against separation and loss. It was
through the working out and working through of his sadomasochistic
conflicts through his analytic transference relationship with an actual
“good object” that the return of the repressed bad objects could “… be
made to serve a therapeutic aim” (Fairbairn, 1946). As Dr. Goodman
became a whole object with real feelings in Mr. B’s mind, she was trans-
formed from a “wooden Indian in front of a cigar store” to the woman
in the dream who was greeting him at the entrance to a museum, with
all that that portends. Above all, Mr. B’s experience in his relationship
with Dr Goodman provided an alternative experience to the “hurt-
ing love” that he had endured in his relationship with his preoedipal
mother.
It would seem that an indication for the termination of Mr. B’s analy-
sis would be a relative degree of separation from his attachment to his
internal mother and the internalisation of the good analyst/object. The
process of separation from Dr. Goodman would facilitate that.
This case is a tribute to Dr. Goodman’s commitment and endurance.
Thank you to Nancy Goodman for the opportunity to study and dis-
cuss her case, and to the editors of the book for the invitation to be a
discussant of this very fascinating case.
152 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
References
Bolognini, S. (2009). Real wolves and fake wolves: alternating between
repression and splitting in complex clinical cases. Presentation, Los
Angeles Institute and Society for Psychoanalytic Studies, 9 May 2009.
Eshel, O. (2005). Pentheus rather than Oedipus: On perversion, survival
and analytic “presencing”. International Journal of Psycho-analysius, 86:
1071–1097.
Fairbairn, R. (1941). A revised psychopathology of the psychoses and
psychoneuroses. In: Psychoanalytic Studies of the Personality. London:
Routledge & Kegan Paul, 1986.
Fairbairn, R. (1943a). The war neuroses—their nature and significance. In:
Psychoanalytic Studies of the Personality. London: Routledge & Kegan
Paul, 1986.
Fairbairn, R. (1943b). The repression and the return of bad objects. In: Psy-
choanalytic Studies of the Personality. London: Routledge & Kegan Paul,
1986.
Fairbairn, R. (1944). Endopsychic structure considered in terms of object-
relationships. In: Psychoanalytic Studies of the Personality. London:
Routledge & Kegan Paul, 1986.
Fairbairn, R. (1946). Object-relations and dynamic structure. In: Psychoana-
lytic Studies of the Personality. London: Routledge & Kegan Paul, 1986.
Fairbairn, R. (1951). A synopsis of the development of the author’s views
regarding the structure of the personality. In: Psychoanalytic Studies of the
Personality. London: Routledge & Kegan Paul, 1986.
Greenspan, S. I. (1977). The oedipal-pre-oedipal dilemma: a reformula-
tion according to object relations theory. International Review of Psycho-
analysis, 4: 381–391.
Grotstein, J. (1986). Splitting and Projective Identification. Northvale, NJ: Jason
Aronson.
Krystal, H. (1988). Integration and Self-Healing. Hillsdale, NJ: Analytic
Press.
McDougall, J. (1984). The “dis-affected” patient: reflections on affect pathol-
ogy. Psychoanalytic Quarterly, 53: 386–409.
Meyer, J. (2011). The development and organizing function of perversion:
the example of transvestism. International Journal of Psycho-Analysis. 92:
311–332.
Newman, K. (1999). The usable analyst. The Annual of Psychoanalysis, 26:
175–184.
Novick, J. & Novick, K. K. (1995). Fearful Symmetry: The Development
and Treatment of Sadomasochism. Northvale, NJ: Jason Aronson.
D I S C U S S I O N O F T H E CA S E O F M R . B 153
M
ariah entered treatment in mid-life because of concerns about
her bulimia and the impact this was having on her marriage
and family. Daily vomiting since adolescence had eroded her
teeth down to the gum line, threatening her health and shocking her
into seeking help. Troubled by a sense of emotional vacancy in her rela-
tionship with her husband, she was continuously aware of him as a
critical presence, and did not feel free unless she was out of his sight.
Initially, she began twice-weekly psychotherapy. After one year of
treatment, she agreed to move into psychoanalysis, three sessions per
week. At first, she would not agree to the fourth session, but, during
her fourth year of treatment, she assumed a fourth hour. The proc-
ess material I am going to present in this paper took place during this
transitional year as we both began to develop an appreciation for the
virulence of the sadomasochistic dynamic which marked her life and to
enter actively into our relationship. I am grateful to Mariah for giving
me permission to publish this material.
157
158 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
History
Mariah was born in a Latin American country, the only child of parents
who emigrated shortly before the onset of war. Her father was absent
for an extended period of time between her second and third birthday,
travelling for a lucrative import-export business. Starting from when
he returned home, when she was three, Mariah was regularly beaten
by her father. Using his hands or a belt which was sometimes placed
beside her at the table, he would beat her; most often the precipitant to
the beatings was an angry interaction between Mariah and her mother
over her refusal to eat. She felt her mother instigated the beatings and
never attempted to stop or subdue the father. The beatings stopped
when Mariah was around ten, for reasons which remain unclear, but
angry, punitive interactions continued between her and her parents
throughout adolescence.
Mariah experienced her father as a “cipher”, someone who, with no
mind of his own, was doing as her mother wished. Aside from these
beatings, she had little contact with him. He owned his own business and
would come home at the end of the day withdrawn and unavailable.
Mother was a bad-tempered, mean-spirited woman, who, immersed
in her own egocentrism, forced everyone around her to cater to her idi-
osyncratic and unending needs. In the course of their present-day visits,
she often expressed aggressive and critical comments about Mariah’s
clothing, taste, and family members. At the same time, what could also
occur is that the mother might seem bereft and abandoned, expressing
accusatory and self-pitying feelings. She was possessive, wanting all
of her daughter’s attention for herself. For example, Mariah made a
visit to her parents’ home in honour of her mother’s birthday, bring-
ing an expensive gift for the occasion. She spent the entire weekend
with her parents, however made a brief telephone call to say hello to an
acquaintance in a neighbouring town. Later in the day, she discovered
her mother crying and when she inquired about the tears, her father
accused her of not being sensitive to her mother’s feelings by making
the phone call. Couldn’t she spend the entire time with them, for once?
Mariah slept in a crib in her parents’ bedroom until age five. She
remembers often being confined to her crib until very late in the
morning while her parents were asleep, and may have been exposed
to parental intercourse. She describes herself as partially existing in
an imaginary world throughout much of her childhood, engaging in
E AT I N G F O R E M P T I N E S S , E AT I N G TO K I L L 159
Process of treatment
Mariah was a chic woman who devoted much attention to her clothing,
her hair, and her make-up, all of which were expensive and the height
of fashion, yet simultaneously presented herself as sensible, someone
who had her values and priorities straight in life; someone to whom her
friends turned for advice. This created a favourable impression in me
160 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
need to abase herself, or absent herself rather than let me know she was
annoyed with me. What was most helpful in developing and facilitating
an analytic process which sustained and deepened the treatment at this
point were interpretations which repeatedly clarified for her ways in
which she was an active agent in (re-)creating an experience of feeling
persecuted. The sound of my voice, comforting for her in its sameness,
helped to create an environment in which she could hear my comments
as helpful and ultimately friendly, providing useful information to her
about her need to create a context in which she could experience herself
as being criticised and judged by me, as well as by the other significant
individuals in her life.
Slowly and gradually her confusion about the locus of aggression
within the relationship yielded to a greater clarity as she became able
to own her own rageful and attacking impulses. Over the next years,
she began to assess her projections and develop some understanding
that these experiences were most often the product of her own internal-
ised world. She became able to evaluate the reliability of her projections;
while continuing to engage in sadomasochistic enactment, she began
to develop the sense that because of some internal prompting, she was
repeatedly motivated to initiate interactions where she could experience
herself as being beaten, continuously re-enacting her childhood experi-
ence of being beaten by her father, incited by a mother who could not
tolerate her daughter’s needs for age-appropriate separation, differen-
tiation, and individuation. With insight, she realised that beatings were
the only form of love she had received from her father; that to her they
were a sign she was noticed, that he cared. She realised that her ability to
incite him to lose his temper made her feel powerful and special. With-
out the beatings, she feared that there would have been a deep emo-
tional void in her relationship with him. With me too, her sense that she
could experience me as angry with her made her feel that she mattered.
Mariah shifted into taking on the role of the violating aggressor.
Once, she “forgot” her sunglasses, leaving them behind on the couch.
Several minutes later, after the next patient had entered the office, there
was a knock on the door; it was Mariah, interrupting the next patient’s
session to claim her sunglasses. What disturbed me most about the inci-
dent was not only the way in which she violated another patient’s pri-
vacy, but her lack of concern for the other patient and failure to show
remorse. When I raised this incident with her, I felt like the violating
object, piercing through her bland denial.
166 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
(Analyst: Could you say more about that? What comes to mind
about how you want to hurt them?)
First I was going to say I’d want to hurt them, but that’s not it.
I’d want to stab them. Then I thought what a sexual act it is—it’s
sort of penetration. I can’t let the world know what a horrible per-
son I am.
(Analyst: What thoughts do you have about the sexual
connotation?)
The thing that came to mind was when my father hit me,
I thought it was some kind of sexual act. Because I was aroused or
because I enjoyed it which I don’t remember doing at all. I remem-
ber being in pain or mortal fear. Somehow I have confused anger
and striking out with sex and could have seen the sexual act as one
of aggression. Something that somebody does to you out of anger.
Because they want to own you. And they want to get inside you so
they can control you—make you do and say and be exactly what
they want you to be. So if I’m not able to have an orgasm during
sex it is really a decision to protect myself, to not let go. To not give
the other person access to me. To keep up a barrier. Not to let them
take me over … and so being hit actually felt like I was being raped.
I don’t know why I confused the two, but I definitely did.
Although Mariah speaks here of a sexual fantasy, and indeed her anxie-
ties regarding penetration entered fully into her sexual life, the fears of
violation went far deeper. Mariah’s sense of self was so fragile that she
feared she could be annihilated at her very core by her sexual partner’s
entry into her body, and feared that she might destructively attack her
partner as well. I experienced just such an attack when she placed her
handbag “in my space”.
any sense. I have to think of who you are, this person sitting there,
then you represent everything I would hate. A cold impartial, self-
serving individual. I can’t imagine who I am thinking about. Yeah,
then I would want to get even with you. But how could I rape you?
I don’t have the equipment. But somehow it’s the ultimate form of,
I can’t think of the word, not molesting but—violation. That’s the
word. It’s the ultimate violation. It’s like having no control over—
someone taking away the thing that makes you you. And being
totally frustrated. Being totally unable to stop them. Having no say.
Being pinned down and violated. Did my father know what he was
doing to me? No. Didn’t matter what the reality was. It was my
perception that mattered. So how do you heal and recover after
something like that? I guess I just didn’t. I just vowed never to let
anybody in.
Mariah’s decision to wall herself off out of fear of the destructive aspect
of her sadistic impulses also defended against the wishes buried in
her fantasy about penetrating me and served to keep her guilt-ridden
and isolated. As she gained insight into her active role in creating and
maintaining her sadomasochistic position, she became less guarded
and began to think about how she had lived in a false world, warding
off real emotional contact with people. Mariah began to speak about a
deeper level of her emotional experience which involved conflicts over
her sense of connectedness with others, rather than the more aggressive
and paranoid experiences she had been immersed in up to this point.
This shift marked the beginning of her ability to move beyond the sado-
masochistic defence which prevented access to her deeper, vulnerable
core self.
Her psychic space contained an exquisitely vulnerable core, which
she felt she had no adequate means of protecting. Contact with other
human beings left her feeling overwhelmed and threatened her with
a sense of dissolution; she had no secure means of safely and reliably
securing her sense of boundedness as an individual. Her reliance on
binge eating, binge shopping and self-grooming were all methods of
shoring up a very fragile sense of self and her repeated sadomasochistic
enactments ensured that others would never get too close.
The following process material, culled from a series of sessions days
and weeks apart during the fourth year of treatment, illustrates Mariah’s
movement through the threshold of sadomasochistic enactment into a
E AT I N G F O R E M P T I N E S S , E AT I N G TO K I L L 169
deeper level of engagement with her fears of her own consuming sense
of need and anxiety about loss of self and engulfment.
As mentioned earlier, the patient was wont to take frequent vaca-
tions, sometimes leaving and returning several times inside of two
months. Each time she was about to leave, she withdrew from an
emotional engagement with me days before her departure, and when
she returned, she seemed to have lost the emotional thread of our work
and it was as though we had to start anew. She did not voice any feel-
ings about the interruptions in our sessions, and when I asked her, she
denied that she had any feeling about it at all. I felt ignored and dis-
carded, and realised that I, as the transference object, was being spit
out and evacuated from her inner world, similar to the bulimic way she
got rid of her food after a meal. It was easier for Mariah to get rid of me
than to feel the emotions associated with loss of our daily contact. My
countertransference fantasy was that when she left I was moved into
a space where I was enclosed in an impenetrable bubble; it felt lonely,
frozen, and isolated.
Oddly paralleling my countertransference experience, when she
returned she would tell me about a sense of emotional vacancy she
experienced during the time away. Not just a vacation in the sense we
typically understand as a chance for rest, relaxation, and pleasure, her
vacations constituted an experience of “vacating” the transference, and
left her with a sense of internal deadness and emptiness since she had
severed any internal connection with me. Often she would describe a
deep sense of isolation from her husband as well. Despite the fact that
I spoke with Mariah often about the impact of these repeated breaks,
I felt that she never really “heard” me and noted again my annoyance
at being disregarded and the sense that I would have to speak with her
more aggressively in order to “pierce” her resistance.
There came a point when it felt increasingly urgent to “get through”
to Mariah since her frequent breaks were threatening the very viability
and integrity of the treatment. It became difficult, if not impossible, to
establish enough continuity to make the work feel meaningful. I began
to realise that I inhibited myself from effectively raising questions about
her frequent breaks because to do so felt to me like I was pinning her
down, sadistically limiting her autonomy, and even more, inflicting a
beating on her, much as her father had beaten her for her refusal to
eat. My fear of my own aggression led me to avoid confronting her
and served to collude with the real danger that the treatment would be
170 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
I heard the mixture of emotions in her comments, first the pleasure and
sense of accomplishment she felt in freeing herself from an experience
of confinement and intrusion. Yet at the same time I was also aware of
the fact that she had cancelled the first session upon her return, and
wondered to myself how secure the accomplishment was if she felt
unable to protect herself from me, the intrusive analyst, confining her
to show up for her sessions.
E AT I N G F O R E M P T I N E S S , E AT I N G TO K I L L 171
I wondered about the difference in her experience with the driver, yet
her anxiety with me? Did she get rid of me in the absence?
Like I purged myself of you. Here I am, I got along so well without
you. And here you are, you’re gonna be so angry at me for getting
along so well without you. But then if I don’t get along so well, I’ll
still need you. It’s almost as if by being a bad little girl I’m being
just that— a little girl and you’re my mommy and I don’t want you
to hit me.
(Analyst: For leaving me?)
Yeah, for running away from home. And now I’m back with my
tail between my legs. And then I’m not going to be here next week
too.
(Analyst: getting rid of me again?)
Right. So if I do something bad, like go away, I should go away
and not have a good time. But if I go away and have a good time,
172 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
then I have to punish myself for having a good time. I have to pay
for it. This is my contribution.
present, so that we could work with it. At the same time, I anticipated
that she would get angry with me for restricting her freedom.
Clearly our discussion had some impact on her. When she returned the
following week after another break, she said the following:
it, she’s uh—they’re away in a log cabin and she is sitting in his lap
on a rocking chair. I think she fell asleep on him. They must’ve both
fallen asleep. He gets up, and I became so aware of my feelings—
what was he going to do now, because she was laying on him and
he was stuck. What happened was nothing that I was feeling. He
never felt afraid to move her. All of a sudden I realised that I wasn’t
afraid of getting close to somebody, because we had been talking
about intimacy in here—I wasn’t afraid of what I was revealing
about myself—I was afraid I would be putting the other person in a
position they didn’t want to be in. That they’d want to get out—and
they couldn’t. I said to myself—my god—that’s the reason I’m afraid
to get close to somebody, because I’m afraid I would be smothering
them. Because that’s how I would feel, smothered. I would assume
they’d want to get out, and they couldn’t.
I asked her if she understood why these feelings were coming up now.
I don’t know. It was such a strange week. I was away, playing golf,
having fun with family and friends, my husband and we were
E AT I N G F O R E M P T I N E S S , E AT I N G TO K I L L 175
getting along well, and all I could think about was eating. I didn’t
know what was going on.
I’m embarrassed. I feel like a little girl, stupid and vulnerable when
I cry. It amazes me because I didn’t realise, I wasn’t aware until I
came in here how sad I am. I probably wanted to do this all week
and I couldn’t.
(You’re feeling sad? …)
I don’t know what I’m sad about. It’s like a—I feel that I’m
missing out on a lot of love. I can’t give it, and I can’t get it. I seem
to be punishing myself. I can’t stop punishing myself. And I don’t
know what I did wrong. Punished myself for going away in the
middle of my therapy and having a good time and I’m not sup-
posed to.
I felt at this moment she was beginning to move away from her long-
ings, from her consuming need for contact with me and I spoke. I won-
dered if it was really something about the way she held herself back
from me.
I was thinking about that, how this all relates to what’s going on in
here, how maybe I’m afraid to overwhelm you with all my need-
iness, suffocate you and drive you away. If I didn’t hold myself
back, people would run away. You’re just supposed to hold your-
self back, not come on too strong. You don’t let anybody know how
much you like them or need them because they can’t handle it.
Why do I see myself as so strong and everybody else as so weak …
sometimes I feel that everything is changing and nothing’s chang-
ing at the same time. It’s like emotionally I seem to be topsy-turvy
and yet everything in my life continues on the way it always has.
176 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
I said that I didn’t think that that was the case. I thought things were
changing for her, and that one of the reasons this was coming up for
her was that she had experienced me as holding on to her the way her
mother had held her, when I spoke with her about her vacations.
Even as she spoke I was aware of a sense of anxiety, a worry that per-
haps her needs would actually be too much for me. I realised that once
again, I was receiving her projective identification.
F
irst let me thank the editors for allowing me to comment on an
extremely interesting psychoanalytic couple who are finding their
way through a maze of sadomasochistic dynamics. The analyst in
the couple is demonstrating some of the important characteristics of
how to keep an analysis alive and relatively secure. To do this she has
to withstand both internal and externally perceived attacks and she has
been able to survive these attacks.
We enter Mariah’s world most fully during her fourth year of treat-
ment with Dr. Greenman. It is however, instructive to look at the ear-
lier parts of the treatment to see how the analytic couple arrived at the
period most fully described. We know from the history that Mariah
constantly evacuated her mind and body through her use of pills and
her daily bulimia. The evacuation was rarely complete and she had to
rapidly propel ideas from her mind during her analytic sessions.
This view derives from Dr. Greenman’s seeing Mariah as a “high-
speed train, rushing toward one insight after another within the con-
centrated period of our meetings, leaving me with the feeling that I
would have to speak up forcefully in order to get heard. I chose not to
interrupt her, but for the most part simply to listen.” We can easily see
that Dr. Greenman felt full of Mariah’s internal world and that Mariah
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180 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
Analytic trust
Although it is my view that what I am positing is important for all ana-
lytic patients let me focus on two types of patients—narcissistic and bor-
derline. Kohut posited that if the analyst maintained an empathic stance
and “did not interfere by premature transference interpretations” that
some form of either idealising, mirroring, or, in his later parlance, a self-
object transference would form. Kohut in his terms advocates that the
analyst initially provide “forms of mirroring and echoing responses”
(1968, p. 100) so that a form of the mirroring transference will firmly
occur. In my interpretation, Kohut began to enable the analyst to enter
the patient’s world and Bach (1985, 1994, 2006) describes this entry in
a more subtle, nuanced, and utilisable paradigm. Both caution against
184 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
“Borderline” beginnings
Affective interpenetration often is more difficult with patients who need
to destroy the analytic relationship. Each position that in some manner
begins to develop a holding environment, frequently needs to survive
a (borderline) patient’s sense of rage, betrayal, or, in a less dramatic but
perhaps more continuous sense, a patient’s sense of being misunder-
stood. Bion’s (1959, 1962, 1967) ideas about containment are implicitly
present in various forms in both Winnicott’s and Balint’s (1968) for-
mulations about treating the patient who, in Winnicott’s terms, is not
well chosen or is a typical classical psychoanalytic patient (Winnicott,
1960). Paraphrasing Winnicott I would say that surviving, rather than
sidestepping or avoiding the destructive aspects of the analysand, is
a necessary condition for a successful analysis to take place. One has
to survive the patient’s negative affect but in the course of survival it
is crucial to be able to return the affect expressed in a manner that is
detoxified (Bion’s term).
In more ordinary language it is important to survive and talk about,
for example, the patient’s rage without moving away from it or being
excessively retaliative. My assumption is that there is always some
form of enactment (Ellman, 1999) that takes place around negative
and destructive tendencies. With most narcissistic patients this is not a
striking issue in the beginning phases of treatment. However as verti-
cal splitting becomes more prominent in what many analysts would
characterise as borderline experiences, there is a greater chance of con-
tainment being a central facet in the beginning phases of treatment. In
treatments that I am alluding to the ruptures are externalised and fre-
quently enacted and the first rupture that must be endured is one that
threatens to destroy the analytic couple.
More dramatic splitting presents at least two different issues that lead
to difficulties in the analytic situation. Frequently affect is quickly got rid
of in some form of action or in a rapid negation, projection (for me the
correct term is projective identification), or rapid oscillation to another
state or sense of self and other. Here the interpenetration of affect is
even more important, with the analyst not only being able to experience
the affect but gradually to present it to a patient who has already left the
186 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
world projected into the analytic situation. While I have no doubt that
this type of clarification (I wouldn’t call her interventions interpreta-
tions) were helpful I think that Dr. Greenman is closer when she says
that “The sound of my voice, comforting for her in its sameness, helped
to create an environment in which she could hear my comments as
helpful and ultimately friendly.” While it may have stabilised Mariah’s
internal world to understand where things were coming from, it was at
least as helpful to know that they reach another mind where they are
tolerated, contained, and returned with the destructive edge removed
or at least attenuated. In my view this enabled her to become even more
directly aggressive, feeling that she could trust that her aggression
could be tolerated and understood. This enabled the analytic pair to
reach a point described as a “deeper level of engagement with her fears
of her own consuming sense of need and anxiety about loss of self and
engulfment.” It is at this point that two paradoxical feelings occur; the
patient is feeling that she is making progress and doesn’t want to come
to treatment any longer.
Now this type of flight to health (or at least flight to some marginal
improvement) is not unusual in a treatment and one can offer a variety
of explanations for this movement. Here Mariah is actually thinking
of the other and able to tolerate the pain that the other implies in her
object world. She is in a position similar to Fairbairn’s concept of love
made hungry. Her bad love will infiltrate the other and smother them
or worse. This is her conscious feeling and Dr. Greenman’s conscious
countertransference when Dr. Greenman experienced the “continual
flow between us … and could easily understand her need to flee from
an intense feeling of suffocation.” At the end of this report Dr. Greenman
relates that Mariah was able to experience her interventions “as a sign
of caring containment on my part”. So Dr. Greenman has, in my view,
given us a narrative of her being able to get to the point of Mariah being
able to utilise transference interpretations and experience some of her
active fantasies (phantasies) in the transference. Up to this point most
of what has been described has been Mariah’s defensive attempts to
survive with some aspects of a continuous, albeit perverted sense of
self. Dr. Greenman has also survived in this difficult dance to form an
analytic couple.
Here in this moving narrative Dr. Greenman has, in my view, related
the difficulties in the movement towards a utilisable transference state.
This movement might be described in Bionian terms as moving beta
192 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
References
Bach, S. (1985). Narcissistic States and the Therapeutic Process. Northvale, NJ:
Jason Aronson.
Bach, S. (1994). The Language of Perversion and the Language of Love.
Northvale, NJ: Jason Aronson.
Bach, S. (2006). Getting From Here to There: Analytic Love, Analytic Process.
Hillsdale, NJ: The Analytic Press.
Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. New York:
Brunner/Mazel.
194 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
A
n unsettling disjuncture is found in the opening lines of
Dr. Greenman’s eloquent and poignant paper. As the reader
I found myself wanting to smooth over the discrepancies or
ignore them, not quite able to grasp the actual reality of this patient—
thus Dr. Greenman succeeded in recreating for her reader an experience
of this patient’s discordant reality. We learn in the opening lines about
the patient’s (Mariah) “concerns about her bulimia and the impact this
was having on her marriage and family”, which appears as a sensitive,
civilised self-presentation—but in the second sentence we learn that
her vomiting had occurred daily for perhaps more than twenty years
and her teeth have eroded to the gum level, “shocking her into seek-
ing help”. Is it possible to be shocked after all these years of damage
and does concern seem too mild or even an inappropriate word for her
situation? In other words, the patient’s concern seemed unconvincing
to me. In addition, Mariah is “troubled” by the vacancy in her marriage
and because her husband is “continuously … a critical presence, [she]
did not feel free unless she was out of his sight.” In total, a disturbing
picture recounted by a patient who does not seem to feel disturbed, that
is, in contact with what she has described to Dr. G.
197
198 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
General observations
Mariah described to Dr. G that she kept a bag of “sucking candies with
her at all times, so that she could fill her mouth and create a private
space for herself, feeling emotionally detached even while apparently
engaged in working with her partner.” This candy-sucking solution
seemed striking as it allowed her (in fantasy, omnipotent) control over a
“sweet object in her mouth kind of feeling”, thereby dodging the panic
and smallness that relating to a separate object would bring. The sooth-
ing sensations in her mouth might help her titrate the cruelty she felt
was always in the air with her object; thus a concrete/somatic effort
(sucking candy) countered an emotional anxiety. The sucking appears
to have the same function as the bulimia, but on a micro level operating
in the hour between patient and analyst, as if the patient were always
saying to her analyst: I have everything I need right here in my mouth
and I don’t need anything from you, thus projecting into her analyst her
own need and deprivation.
I am interested in picking up how from the beginning Mariah cre-
ated a dual communication with her analyst, that is, I am afraid of
your intrusion or contact with me and to protect myself (i.e., by suck-
ing candy) I egress on you, becoming in the same action both victim
and aggressor. This reminded me of the feelings stirred up by young
children who continue to use a pacifier. When playing with this child
the adult is tempted to pull the “binkie” out of the child’s mouth, as
we are aware that although this sucking may be serving the purpose
of “holding the child together” it is also a block to our relating to him/
her. The child is distracted and garbled, remaining cut off and immune
from us—which stirs our aggression. The action of sucking candy
enacts Mariah’s victimisation by her object; she masochistically protects
200 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
angering and devaluing, her analyst. The patient said, “By not coming
in here, I was out of control.” This seemed exactly right, but this insight
does not stick, cannot be used, as we soon see.
In the last part of the hour the patient released a storm of self-
abnegation, she is a “bad little girl … with my tail between my legs”
whose “mommy” may want to hit her. In the middle of all of this false
“intense feeling” there is the announcement: “I’m not going to be here
next week too.” Mariah had deftly turned her back on the analyst, mak-
ing it clear that the talk or “insight” is empty. It feels to me that the
patient is pushing her analyst into a sadistic response, thus enabling
the patient to continue in the false role of victim to her analyst. Unfor-
tunately the patient’s manoeuvreing covers over more genuine feeling,
involving abuse, abnegation, and hateful fury.
Mariah’s sense of omnipotence and self-delusion is made more clear
in the next day’s session: “If I had some god forbid life-threatening treat-
ment [here she has made a slip and must have intended to say illness]
would I skip treatment every few weeks … I don’t want to believe
there’s anything seriously wrong with me.” Can we take these words
seriously? Mariah has told her analyst that she feels the treatment is
in fact a life-threatening disease. Thinking this through, is it a way of
saying that the analyst is making her ill, that without the analysis she
might be well? I thought she felt in a panic about the analyst’s desire
to be a “big happy family” with her—she feared the analyst’s desire for
her. This projective identification is what Sodre (2004) called disiden-
tification, allowing Mariah to escape and lose contact with her greedy
and devouring wishes. She can indulge these needs and desires alone
at night when she is in control of the object’s ingestion and expulsion,
or safely at the spa where the staff will take charge of her need-desire
problem and the analyst is left behind to pine for her patient. Mariah’s
need to keep herself unintegrated and deeply split is a focus in the anal-
ysis; this attempt at “cure” feels like an illness to the patient—you are
making me worse!
The analyst does confront her patient’s treatment of the analysis as a
“dilettantish adventure” (remember the Cleopatra dream): “whether or
not you attend sessions strikes at the heart of our work together … I am
concerned about your ability to grow and utilise your treatment”. The
patient responds somewhat defensively, but reveals her inner dialogue:
“It’s like a dialogue that goes you’re not interested in me anyway so
I’ll just do what I want. I’ll take care of myself.” Dr. G has just given
D I S C U S S I O N O F T H E CA S E O F M A R I A H 203
Discussion
In standing back I observe that the clinical material has an incestuous
and all-consuming atmosphere with scant sense of the outside: no real live
D I S C U S S I O N O F T H E CA S E O F M A R I A H 205
space apart from their mother, she has “identified with the aggressor”
(A. Freud, 1937). We see in this action with her handbag that Mariah
is “Cleopatra”, a queen surrounded by underlings, or the privileged
guest at a luxury spa. In this seemingly minor gesture she takes over
the analyst’s space and essentially her analyst’s identity. It may feel in
the moment to Mariah that her analyst’s desk belongs to her, is hers to
use however she pleases. This is further developed by Dr. G in another
vignette:
Mariah seemed to feel, even to believe, that this space was hers, and
she owed no apology or concern to her analyst or another patient.
Her handbag and sunglasses are little bits of herself strewn around
whereever she chooses. Again this seemed to be evidence of Mariah’s
introjection of her analyst in a total and concrete way. Whose office is
it? She feels she can come and go as she pleases, it must belong to her.
We see in relation to Dr. G, as with her mother, there is no permissible
separation of identity. Importantly, it is the analyst who is left feeling as
though she had done the violating—Mariah had successfully cut off her
feelings of envy and smallness in relation to her analyst’s possession of
an office, an identity, and a capacity to understand, which the patient
does not control. Instead the analyst feels she is small and powerless
and in the grip of a powerful figure; if she does protest (become strong)
she will injure a fragile innocent child.
Mariah’s fantasy, which I think of as a massive projective identifica-
tion, is also played out in her bathroom ritual. She used the analyst’s
office restroom for as much as fifteen minutes at a time, surely incon-
veniencing both her analyst and other patients. The analyst is left to feel
intruded into and invaded; if she interprets the patient’s mistreatment
she will become the harsh, violating, “slapping” other. Mariah is highly
D I S C U S S I O N O F T H E CA S E O F M A R I A H 207
skilled at inducing her object (i.e., the pharmacist, the security guard,
business partner, husband, and analyst) to slap her, as she herself had
done to a child when at age eighteen she worked in a summer camp.
This must have been a time when her capacity for projective identifica-
tion had broken down and she was at the mercy of her own impulses.
During this period she gained eighteen pounds, frightening her into
bulimic activity.
Theoretical considerations
I would like to suggest that Mariah’s functioning is dominated by her
pathological identificatory processes, involving both directions, that is,
projection and introjection. She is able to insert herself into the other,
taking the object over possessively as well as absorbing her object,
becoming the other through incorporation.
By way of a quick review (following the work of Leslie Sohn (1988)
and Ignes Sodre (2004)) I will highlight some psychoanalytic thinking
(a sampling only) on identification. Sodre wrote:
These ideas are also developed by Leslie Sohn in his paper “Narcissistic
organization, projective identification and the formation of the identifi-
cate” (1988).
Further on he wrote:
Mariah “takes over” Dr. G’s desk, office, the subsequent hour of
another patient, the bathroom—usurping time and space, thereby
revealing her concrete and massive introjection of her analyst: what is
yours is mine, I am now you. We see her omnipotence and grandios-
ity, reflecting her mania. The patient simultaneously projects her weak-
ness, including dependency and envy, into the analyst, succeeding in
getting a hold on her mental functioning. The analyst is pressured to
stop being the analyst (there is already one very confident analyst in
the room!) and to feel like a sadist, or weak, or envious or whatever.
One’s separate identity is momentarily (we hope) lost and we will feel
disturbed, perhaps inhibited in our functioning; the internal work of
righting ourselves and remembering “who is who” is crucial in these
situations. (Sodre, 2004)
Conclusion
Dr. Greenman has provided a beautiful and moving case study of a
patient who is severely narcissistic, but more specifically gripped by
her pathological identifications, what Sohn has called the “identificate”
which is in contrast to those identifications that are more flexible and
integrated within the ego. This reader’s confusion in the opening lines
of the paper reveals a patient deeply at odds with herself. The analyst’s
job, to find out who she is at any given moment and to make contact
with that experience, is daunting. We see—because the victim-victimiser
roles shift so quickly, even imperceptibly at times, and that like the com-
bined parental couple, they often exist at the same time—the analyst
will always be “wrong” (by which I mean caught on one side or the
other of the sadomasochism). Nevertheless it is the following of the
patient’s movements between her identificates which is necessary. It is
only with this kind of work that the patient can begin (her struggle here
with Dr. G) to believe in the possibility of a good object not taken over
by her sadistic and masochistic drives. Mariah appears to be holding
very tight to her earliest objects, to the point that the analytic “cure”
feels to her like its own kind of illness. As analysts we must keep in
mind not only who the patient is at any given moment but who we are
as the object of our patient, which includes our commitment to psy-
choanalysis as a method of growth and development and not one of
illness and destruction.
D I S C U S S I O N O F T H E CA S E O F M A R I A H 211
References
Caper, Robert (1999). A theory of the container. In: A Mind of One’s Own.
Routledge: London and New York.
Freud, A. (1937). The Ego and the Mechanisms of Defence. London:
Hogarth Press and the Institute of Psychoanalysis.
Freud, S. (1917). ‘Mourning and melancholia’. S. E., 14: 237–258.
Freud, S. (1921). ‘Group psychology and the analysis of the ego’. S. E., 18:
65–144.
Joseph, B. (1989). Psychic Equilibrium and Psychic Change: Selected Papers
of Betty Joseph, M. Feldman and E. Bott Spillius (Eds.). London:
Routledge.
Klein, M. (1955). On identification. In: The Writings of Melanie Klein, vol. 3,
Envy and Gratitude and Other Works. London: Hogarth Press (1975).
O’Shaughnessy, E. (1983). Words and working through. International Journal
of Pyscho-analysis, 64: 281–289.
Rosenfeld, H. (1964). On the psychopathology of narcissism: A clinical
approach. In: Psychotic States. London: Karnac, 1965.
Sohn, L. (1988). Narcissistic organization, projective identification, and the
formation of the identificate: In: Melanie Klein Today: Developments in The-
ory and Practice, vol. 1. London and New York: Routledge and Tavistock.
Sodre, I. (2000). Florence and Sigmund’s excellent adventure: (On Oedipus
and us), presented at the English Speaking Conference, London.
Sodre, I. (2004). Who’s who? Pathological identifications. In: E. Hargreaves &
A. Varchevker (Eds.), In Pursuit of Psychic Change: The Betty Joseph Work-
shop. Hove and New York: Brunner-Routledge.
CHAPTER FOURTEEN
T
his very impressive case and treatment study confronts us with
issues that are very frequent in our practice, but not often pre-
sented in such a dramatic and graphic form. There were several
elements in it and questions that struck me especially:
1
One is the massive depersonalisation that affects much of the
experience both of patient and analyst—the pervasive absence of self-
feeling in the perceptions of self and world, as if they said: “I do not
feel this (or anything) to be real although I know it is.” One could talk
about estrangement as a dominant quality of transference and coun-
tertransference. She feels “emotionally detached while apparently
engaged working with her partner” (it is not clear who is meant here
by “partner”), and the analyst notes “the flat quality in our interaction”.
She “began to think about how she had lived in a false world, ward-
ing off real emotional contact with people.” In regard to the frequent
absences and interruptions, “she denied that she had any feeling about
it at all”, but would “tell me about a sense of emotional vacancy”; the
“vacations … left her with a sense of internal deadness and emptiness
213
214 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
since she had severed any internal connection with me. Often she would
describe a deep sense of isolation from her husband as well.” The thera-
pist “felt ignored and discarded”; “when she left I was moved into a
space where I was enclosed in an impenetrable bubble; it felt lonely,
frozen and isolated”—a very good description of depersonalisation in
the countertransference. Dr. Greenman adds: “I felt she never ‘really’
heard me and noted again my annoyance at being disregarded …” and
the urgent need to “pierce” her resistance and “to get through to her”.
Concomitantly with such depersonalisation, goes the sense of dis-
continuity and its factual repetition time and again by the disruptive
“acting out”, similar to what a patient of mine kept complaining about:
“It is a profound discontinuity: that nothing good can be held onto.”
Who is not remembered and perceived as a continuous self forgets
himself and thus his inner continuity—in a poignant image drawn by
Sheldon Bach (2001): “… a person’s specific memories and experiences
are like individual beads that can achieve continuity and gestalt form
only when they are strung together to become a necklace. The string
on which they are assembled is the child’s continuous existence in the
mind of the parent, which provides the continuity on which the beads of
experiences are strung together and become the necklace of a connected
life” (p. 748)—and with that of an identity. Typically, the contents of the
therapy sessions are being forgotten or estranged from one time to the
other: “I don’t remember what we have been talking about last time.”
The same metaphor is used by another patient, in connection with
her emotional distance toward her lover. She relays how she succeeded
for the first time, while reaching a climax, in staying in her sensations
both with him and with herself: “You have to imagine it that way, as
if the feelings were to correspond to pearls, and they had been laying
scattered on the table, each one for itself wonderfully beautiful, but
unconnected, and it was so as if in this experience they were strung
on a thread: suddenly they were joined together” (communicated by
Dr. Heidrun Jaraß, a psychoanalyst in Regensburg, Germany, with
whom I have been working continually and intensively since 1988).
The experience of meaning and of time grows out of a sense of
connectedness of experience, and this in turn grows with the remem-
brance by and of the other in one’s own inner life. Clinical experience
has taught us that there is an intimate relationship between chronic
depersonalisation/derealisation and chronic, unconscious shame (as I
extensively described in The Mask of Shame, 1981). There appears to be
TRAUMA, AR CHAIC SUPER EGO, AND S A DOMA S OC HIS M 215
2
What is the relationship between these two—depersonalisation and
shame—and the sadomasochistic symptomatology? Again, clinical
experience shows that one of the functions of induced suffering, like
cutting, bingeing, or vomiting, can be attempts to pierce the wall of
not-feeling, but are in themselves so circular as to only engender
vastly deepened shame, and hence lead to more depersonalisation.
Dr. Greenman writes, the patient “express[es] shame about her binge-
ing” upon return from her frequent vacations. “Without the beatings
216 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
[by her father], she feared that there would have been a deep emotional
void in her relationship with him. With me too, her sense that she would
experience me as angry with her made her feel that she mattered.” The
therapist speaks about Mariah’s “exquisitely vulnerable core, which
she had no adequate means of protecting.” I think here she speaks
about extreme vulnerability to humiliation and shame. She goes on:
“Contact with other human beings left her feeling overwhelmed and
threatened her with a sense of dissolution; she had no secure means of
safely and reliably securing her sense of boundedness as an individual.
Her reliance on bingeeating, binge shopping and self-grooming were
all methods of shoring up a very fragile sense of self, and her repeated
sadomasochistic enactments ensured that others would never get too
close.”
All this could be put in terms of a self that is very profoundly threat-
ened by shame. She actively brings about various forms of self-abasement
and self-degradation in order not to have to suffer them passively, sud-
denly, and helplessly. The “inner deadness and emptiness”, as well as
the “impenetrable bubble” are thus above all defences against trau-
matic and traumatogenic shame—the former in the form of traumatis-
ing humiliation, the latter as a reaction to trauma more generally. I also
think that the inhibition of the analyst from questioning the patient
about the disruptive breaks or communicating her own anger may have
been an intuitive reaction to her preconscious awareness of how sen-
sitive Mariah was and is to being shamed. Every “penetration” by an
interpretation, especially of the transference, let alone of the counter-
transference, would be experienced as a very dangerous humiliation.
In narcissistically very vulnerable and seriously traumatised patients,
transference interpretations quite generally can be quite ill tolerated.
Fischer and Riedesser stress in their in their standard textbook of psy-
chotraumatology (2003) the required caution with direct transference
interpretations. They tend to stoke the great affective pressure even
more (p. 212):
3
Usually, such severe psychopathology is rooted in massive traumatisa-
tion. Fischer and Riedesser define, trauma “as a vital experience of dis-
crepancy between threatening situational factors and the individual’s
abilities of mastery, a discrepancy that is accompanied by feelings of
helplessness and unprotected exposure and thus effects a lasting shock
in the understanding of self and world” (p. 82); they reject therefore
the term “posttraumatic stress disorder” and replace it with “(basal) psy-
chotraumatic stress syndrome” (pp. 46, 372). Trauma is an ongoing proc-
ess, not simply an external event (p. 46), and they distinguish shock
trauma from cumulative trauma.
There are, of course, many forms of traumatisation, but of special
importance is what we may call “soul blindness” and “soul mur-
der”: “Soul blindness” is a systematic, chronic disregard for the emo-
tional needs and expressions of the child (or, more generally, towards
other people), a peculiar blindness to the individuality and hostility
to the autonomy of the child (or one’s fellow). It shows itself as the
peculiar dehumanisation of the other person, as that what Francis
Brouček (1991) has called “objectification” and postulated as the core
218 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
4
Overriding in Mariah’s consciousness is the archaic superego: an
implacable inner judge that is being either experienced as com-
ing from the outside, or provoked there, in an active re-enactment of
what had been suffered passively, in other words: turning passive into
active, or in Kleinian parlance: by projective identification. “… she
would develop an experience of a very cruel, punitive and unforgiv-
ing other whom she saw both in me and in her husband, leading her to
withdraw from contact or interaction.” So much in her behaviour can
best be understood as a provocation of punishment: “Many transfer-
ence events indicated that she created an experience where she could
see me as hostile, critical, and dangerously violating; judging her for
a variety of self-gratifying behaviours: travelling, shopping, but espe-
cially about her eating … her continuous need to create a relationship
with a sadistically violating object where she could experience herself
as punitively beaten and assaulted, and her need to flee from that”. “…
she was trying to push me away as well as elicit a punitive response
from me. I became the father who beat her … It seemed safer to have
me angry with her than happy with her.” To elicit the figure of the tor-
menting judge on the outside, under her active stage management, was
a powerful defence against suffering it incessantly from within.
How can we understand psychodynamically this archaic, totali-
tarian superego which is ubiquitous after severe and prolonged
traumatisation?
In the severe neuroses (and they are almost coextensive with severe
and chronic traumatisation in childhood), we deal on the one side with
wishes insisting on their absolute fulfillment and equally global affects, in
particular the manifold, overwhelming anxieties, but also rage and shame
and guilt (and others), that involve similar claims for absoluteness. On
the other side, the defensive processes trying to protect the self against
the overpowering dangers from without and within are equally absolute,
equally radical and all-encompassing. And ultimately, the conscience and
the “ideal demands” become the leading representatives of this inner abso-
luteness, and with that we have those fatal vicious circles, the repetitive
patterns (also Wurmser, 1996, 1999, 2000). Inner polarity in its entirety is
then marked by such absoluteness. “Abyss calls the abyss” (Psalm 42.8)!
The just-described archaic equation of traumatogenic affective storms,
sexualisation, and aggression is in turn again very deeply frightening
TRAUMA, AR CHAIC SUPER EGO, AND S A DOMA S OC HIS M 221
5
The feeling of shame in its multi-layeredness and depth is prominent
among the frightening affects induced by trauma. What is this original
link?
One root may indeed be massive shaming as part of the trauma, and
that seems to be a self-evident connection, and certainly easily inferred
222 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
in the way Mariah had been mistreated. But there is far more that we
uncover in our analytic work.
Very commonly it is the shame about the intensity of feelings in general,
the great anxiety to express them, and the anxiety of inner and outer loss
of control. It is so often the premise in the family, supported by cultural
prejudice, that it is a sign of disgraceful weakness and thus of vulner-
ability, to show, or even just to have, strong feelings. This causes a very
strong tendency to be deeply ashamed. The body, especially sexuality,
may be far less strongly shame inducing than this alleged weakness
of having strong feelings: feelings of neediness, of longing, of tender-
ness, of being moved, of being hurt. Many look then for a partner who
is an anti-shame-hero: someone emotionally untouchable, impenetrable,
invulnerable, a disdainful ruler. Looking for the acceptance by such a
figure and merger with him or her would remove the shame of feeling
and wishing too strongly, but it means an almost incorrigible masochis-
tic bondage, and a renewed and deepened sense of disgrace (Wurmser,
1981, 2011).
Third, shame is caused by the experience that one has not been per-
ceived as a person with the right for one’s own feelings and will. The
“soul blindness” of the other evokes the feeling of great worthlessness;
the contempt by the other expressed by disregard for one’s own inner
life is matched by self-contempt (certainly quite prevalent in Mariah’s
case). Analysis itself may be shaming and thus inadvertently repeat the
traumatogenic shame. There are many ways of doing this: sometimes it
may be the silence to a question, sometimes a sarcastic comment, often
direct drive interpretations, and, what I see particularly in my super-
visions in Europe, the unempathic, forced relating of every aspect to
transference (see above). All this can be felt to be “soul blind”. Incom-
prehension and tactlessness are experienced as a renewed deep insult
and shaming.
Fourth, typically in severe traumatisation in childhood and as
already described, sexualisation is deployed as an attempt to regulate
affects. Both the flooding with affects and the very archaic defense by
sexualisation lead to an overwhelming feeling of shame. On an addi-
tional frontline of defence, aggressive wishes, impulses, and fantasies
are thrown in as means to re-establish control; they should stop the fur-
ther tumble in that regressive spiral.
Fifth, every kind of excitement turns, as affect regression, into over-
excitement and overstimulation, and this inevitably leads to a crash, to
TRAUMA, AR CHAIC SUPER EGO, AND S A DOMA S OC HIS M 223
6
Reading Mariah’s history I was wondering about its transgenerational
aspects. There are vague references to the background: “emigrated
shortly before the onset of war”. Had they emigrated from Europe to
Latin America in order to escape from the Holocaust? Or from Latin
America to the US before some war there? In the former and likelier
case, it seems to me inescapable to assume that the family’s traumatisa-
tion by persecution, mortal threat, terror, and extermination would be
of enormous, albeit strongly denied, presence behind the phenomena
described in the study of case and treatment. If my conjecture is correct,
the entire case study needs to be understood in that light: this would
be the cardinal psychodynamic fact around which the entire psychody-
namics revolve. Not to mention that this would be a grave omission,
and not to deal with it as a central issue would express pervasive denial
(Grubrich-Simitis, 2008).
224 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
7
Finally, especially in the treatment with so severely and chronically
traumatised patients as Mariah, particularly if my surmise of the con-
nection with the Holocaust is borne out, we may have to resort to a
framework different from the one that is solely based on the theory of
technique, and hence on the “analysis of transference”. It is a difference
of the philosophical vantage point.
As psychoanalysts we usually go out from the a priori assumption
that inner life can best be understood by seeing all the inner processes
as incessantly standing in conflict with each other and continually also
complementing each other in spite of their contradictions. Without this
philosophical presupposition, psychoanalysis would be unthinkable. It
is being used and is useful in every moment of our work.
But it is not the only one. There is a second a priori presupposition:
that all these insights are only truly mutative if they occur in the matrix
of an emotionally intimate relationship, a deep trustful togetherness
that far transcends intellectual insight. Here Buber’s philosophy of
dialogue appears to be particularly helpful. In no way should it sup-
plant the understanding by conflict, it should only complement it. In
other words, the intrapsychic and the interpersonal or relational way
of understanding are dialectically bound to each other. One without
the other does not do justice to the complexity of our work. The more
severe traumatisation there is as background, the more important is the
real relationship in treatment (Grubrich-Simitis, 2007, 2008). This is, of
course, particularly true in families of the survivors of the Holocaust
and of other genocides.
This is an inescapable conclusion from work that is as difficult and
demanding as that so skillfully carried out and so well described by
Dr. Greenman and others who work with survivors.
References
Bach, S. (2001). On being forgotten and forgetting oneself. Psychoanalytic
Quarterly, 70: 739–756.
Breuer, J. & Freud, S. (1893–1895). Studies on Hysteria. S. E., 2: 1–251.
Brontë, C. (1847, in 1994). Jane Eyre. In: The Brontës. Three Great Novels.
Oxford: Oxford University Press.
Brouč ek, F. J. (1991). Shame and the Self. New York: Guilford.
Buber, M. (1947). Dialogisches Leben. Zürich: Gregor Müller Verlag.
(W. Kaufman (Trans). I and Thou, pp. 77–79).
Fischer, G. & Riedesser, P. (2003). Lehrbuch der Psychotraumatologie (3rd,
revised edition). München: Reinhardt.
Fraiberg, S. (1982). Pathological defenses in infancy. Psychoanalytic Quarterly,
51: 612–635.
Grubrich-Simitis, I. (2007). Trauma oder Trieb—Trieb und Trauma:
Wiederbetrachtet. Psyche, 61: 637–656.
Grubrich-Simitis, I. (2008). Realitätsprüfung an Stelle von Deutung. Psyche,
62: 1091–1121.
Kilborne, B. (2002). Disappearing Persons: Shame and Appearance. Albany:
State University of New York Press.
Krystal, H. (1988). Integration and Self-healing: Affect, Trauma, Alexithymia.
Hillsdale, NJ: Analytic Press.
Krystal, H. (1998). Desomatization and the consequences of infantile
trauma. Psychoanalytic Inquiry, 17(2): 126–50.
Novick, J. & Novick, K. K. (1996a). Fearful Symmetry: The Development and
Treatment of Sadomasochism. Northvale, NJ: Aronson.
Novick, J. & Novick, K. K. (1996b). A developmental perspective on
omnipotence. Journal of Clinical Psychoanalysis, 5: 131–75.
226 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
I
t is hard to remember the feeling I had treating Mr. A fifteen years
ago or to convey the texture of those early sessions. Mr. A could be
tedious in the extreme and so consistently repetitive as to lead me
to often roll my eyes as he lay on the couch. In fact, the beginnings of
sessions for years were more or less the same with his stating in almost
the exact same words how he did not want to be in treatment, how
I was out to hurt him, how he could not possibly say anything new,
how he wanted to leave. At the beginning of his treatment, the sessions
would only be different after an obligatory forty minutes of this dia-
tribe. Over years, the obligatory time was gradually reduced to half
an hour, to fifteen minutes, to ten minutes, until eventually fourteen
years into treatment, it would be only a sentence or two about how
he was still not comfortable coming to see me. At the same time for
years of early treatment, he was anxiety-provoking, frequently threat-
ening suicide at the end of sessions (which at one early point led him
to arrange a noose for himself in the basement of his parent’s home,
a basement to which he often retreated to stare for hours at the fish in
the large fish tank which he tended there) and often begging me, plead-
ing with me, to ”let him go”, to just give up on him. I think I benefited
from a certain naïveté: he was an early psychoanalytic case and I was
229
230 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
overjoyed to have anyone on the couch. And despite what often struck
more experienced psychoanalysts as something approaching psychosis
about him (I was told by one analyst to whom I presented the case as
a candidate that he was a “very sick” man and told repeatedly that he
would make a poor control case), I found myself plodding along with
him day after day, year after year, tedium after tedium, only to find
years later somewhat to my own surprise that this marginal individual,
this self-made outcast had fashioned a life for himself, married, become
a loving if conflicted father to two children, and gained some under-
standing of his emotions and his fears.
But things were hardly promising at the beginning. Mr. A, twenty-six
years old, appeared in speech and affect tighter than a drum. He was
hunched, his face expressionless, and he gave off the impression of not
wanting to notice anyone or to be noticed. When he sat on a waiting
room chair, staring downward, he seemed as if sitting on a New York
subway train the kind of person to whom one might instinctively give
a wide berth. He exuded suspicion of others, everything in his face and
body saying, “Stay away from me. Don’t talk to me.” Indeed, for ten
years Mr. A reported that he feared coming to the waiting room and
preferred to enter just a moment before the session from his car in the
parking lot. He avoided eye contact with anyone he met in the street
and certainly with other patients. For that matter, he also did not let
register obvious things in his environment. It took him fifteen years
to realise that there was a large watercolour of tiger lilies on the far
wall of my consulting room, beyond where I sat, one of the first things
one might ordinarily see on entering. It was useless information to
him: each time he entered he looked sideways at me and made his way
to the couch.
For that matter, there was not much information that Mr. A could
impart about himself because he did not remember his early childhood
at all. His memories seemed to begin around adolescence and they were
traumatic. It was almost as if at the symbolic moment of his Bar-Mitzvah,
Mr. A had decided to leave civilised society rather than journey into
responsible manhood; and that was the way he thought of his devel-
opment. When adolescence came, right after the Bar-Mitzvah, Mr. A,
who described himself as having until then friends who were “normal”
(although in fact he never spoke of them), changed his friends, becom-
ing involved with a sadistic boy whom he idolised and whose ways he
tended to follow. The reasons for the change no one knew but it became
THE PRIMITIVE SUPEREGO OF MR. A 231
clear that one of them was that Mr. A believed that as an adolescent his
breasts had become enlarged, making him look feminine which then
became symbolic for him of the fact that normal kids would not have
anything to do with him. From that moment, he avoided taking off his
shirt, refused to go swimming in his family’s pool, gave up swimming
entirely although he enjoyed it, and changed his friends. For six years
in treatment he continued to believe that he had enlarged breasts; and
only after fourteen years was he able to remark to me, “What was I
thinking when I thought I had breasts?”
Another reason for the change after his Bar-Mitzvah was that Mr. A
felt he could not view the world in what he considered a “normal” way,
meaning loving or accepting. Instead, he believed the world was cruel
and terrifying and that in ways unknown even to his family, he himself
was warped. For that matter, he took distinct sadistic pleasure in his
own and the world’s harshness. The “normal” ways of the world—any
view that the world was at all beneficent—were disdained for being as
fatuous as cotton candy.
Before I proceed further in this history, however, I do not wish to
give the impression that Mr. A told me details of his history directly. On
the contrary, he told me things in dribs and drabs over many months
and many years. For years Mr. A would omit telling me of an event
from his past that he knew was crucial, because he was embarrassed
or felt that what he had done was terrible. Then when he had reached
some internal point when he felt that it might be safe to tell me about
the event, he would say that he had something important to tell me but
could not. After often months of this, he would tell me a portion of the
event but leave out a crucial part, something I might extract if the story
he told was clearly incomplete, and at other times, something of which
I remained entirely unaware for additional months or years. This ten-
dency to withhold with its teasing quality was not just a defence: it was
a sadistic aggression, designed—albeit sometimes unconsciously—to
mislead and frustrate me.
There were many events to which this process applied, almost all
sexual in nature. Mr. A eventually told me that his adolescence was all
but haunted (my words not his) by his mother’s seductiveness toward
him. When he began treatment, he described his mother with reverence
and awe as the strong parent who had established her own business.
He thought of his father in contrast as weak and spoke of him with
disdain. By the time of his adolescence, his parents’ roles at home had
232 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
apparently changed from his childhood: his mother who formerly had
done the housework now did very little. His father, whose work hours
were less demanding, did all the cooking. Typically, when Mr. A was
an adolescent, his mother came to the dinner table in her underwear.
The table was glass, and Mr. A would become obsessed at looking at
her crotch; his interest in her was particularly aggravated when at the
end of the meal, she pushed her chair back and relaxed with a cigarette,
crossing her legs. In the evening, Mr. A would also go to his mother’s
bedroom, where she would lie in her underwear, and he would sit on
the bed while she helped him with his homework. His mother had
been an elementary school teacher, but this process of help from her
was fraught with mixed feelings by Mr. A. He could not take his eyes
off of her, always wondering how much of herself she would expose;
and he believed in part that she wanted him to look at her. (As it was,
Mr. A had great difficulty in school; he appears to have some degree
of dyslexia—so that his mother helped him by actually doing much of
the work. How much of this learning disability was created and not
just aggravated by knowledge itself becoming sexualised as a conse-
quence of his mother’s efforts was never entirely clear. Suffice it to say,
however, that by the end of treatment, Mr. A was able to learn without
hindrance; his job performance and his responsibility for the welfare
of others at his job were dependent upon this improved reading and
understanding.)
When his parents were out of the house, Mr. A would enter their
bedroom, remove his mother’s frilly underwear and put on her panties.
He found this tremendously exciting and would masturbate. Some-
times he would take his mother’s underwear and dispose of it because
he was afraid his ejaculate on it would be discovered. Other times, he
would just return the underwear to the drawer. He was somewhat con-
vinced that his mother was aware of his activity because, after all, her
underwear disappeared from time to time.
Often after dinner and his having been helped with his homework,
his parents would retire to their bedroom from which a strong odour
then emanated, making it obvious that they were smoking marijuana.
This whole procedure infuriated Mr. A: he felt he had been allowed to
be aroused by his mother only to have her then go into the bedroom
with his father behind a closed door. At one point, Mr. A discovered that
there was a marijuana plant growing in the backyard. Indeed, Mr. A
as an adolescent began to indulge himself heavily in pot to the extent
THE PRIMITIVE SUPEREGO OF MR. A 233
brought him to this dentist so that he ended up returning over and over.
At one point, Mr. A had an emission which frightened him. As a young
adult now, Mr. A had related experiences with his barber. He was terri-
fied of going to this barber apparently because he found himself becom-
ing aroused. He insisted on having his hair straightened from its curly
state which he thought was ugly (his mother’s hair was straight) and
he parted it down the middle. The barber to whom he had been going
for years was a man, also anti-Semitic, to whom he pretended he was
not Jewish. In addition, he pretended to the barber that he was mar-
ried when he was still single so that the barber would not mistake him
for a homosexual. Making an appointment with the barber and actu-
ally going were fraught with anxiety, because he feared that the barber,
like the dentist from his childhood, would sexually seduce him. Mr. A
would procrastinate over and over and worry obsessively about it.
In fact, any new activity for Mr. A was fraught with anxiety; and
he often found himself gagging when he contemplated doing some-
thing new. More particularly, any sense that he was motivated by
aggressive or sexual desires that he found unacceptable (sometimes as
a consequence of some observation I might make to him) resulted in
his beginning to gag uncontrollably. In addition, such pleasure whether
anticipated or experienced, often resulted in Mr. A subsequently com-
ing down with a severe migraine. Although Mr. A evinced the desire
to have a relationship with a woman, the only sexual relationship he
could recall at the beginning of treatment involved one with his cousin,
of whom he was very fond. They had sex in his grandparents’ home in
Florida when he was an adolescent which appears to have been inter-
rupted but not discovered by his grandfather. This experience served
Mr. A, who was very much in love with her, to come out of himself,
despite his discomfort with the incestuous wishes which he associated
with his love for her.
Despite his evident confusion about his body, his fear of sexuality,
and his sadomasochistic desires, Mr. A yearned most of all to have a
fulfilling relationship with a woman and to get married, and he all
but begged me to help him make this possible. Of course, the eventual
process of dating was as anxiety-filled as anything else. The thought
of a woman’s vagina filled Mr. A with disgust; he would gag at the
mention of it. He could not bear to look at a woman’s vagina, indeed
refrained from doing so when he was first married for fear he would
gag. For that matter, he had tremendous difficulty kissing a woman or
THE PRIMITIVE SUPEREGO OF MR. A 235
parent, all in the service of a fantasy that he would displace the man
and be a better husband to the wife (as he believed on some level he
had done with his mother). As a consequence of his projecting his sex-
ual wishes, his competitiveness, and his animosity onto new people he
might meet, he became so anxious that he often avoided stepping out
of the house entirely or, if he did so, he could not take part in the social
give-and-take necessary to establish new relationships. In this regard,
it should be mentioned that Mr. A had little nuance in establishing a
relationship: he often completely mistook somebody’s kidding of him
as open hostility, often missing entirely the import of what was said,
while at the same time managing in his own attempts at joking to say
tremendously aggressive things without realising it. Lastly, it should
be mentioned that Mr. A committed the most striking malapropisms
without any awareness of doing so and often in the service of trying
to say something in the vernacular—a marked contrast to a certain for-
mality and stiltedness of his speech in general. In a way, I could observe
Mr. A careen like a man frightened of his internal urges over which he
has limited control (not unlike an uptight drunk), one moment saying
the most aggressive things unintentionally, the next being unusually
formal, in effect viewing every encounter with another human being
whether stranger, friend, or loved one as a mine field.
does so. His wish is for revenge, and that is what is exciting—to make
his mother suffer for humiliating him. Or another time, he thinks about
getting revenge on his mother, telling me—very late in the treatment—of
the vibrator that he discovered in her bedroom as a teenager. He would
like it to be a hair curler, to get her in her vagina with his “too hot” penis
and scar her—prevent her from ever having sex with his father: “Burn
her. Brand her.” He has the image of having her cry out in pain, and then
he has the same fantasy about doing that to me.
Then, a month later, after a number of sessions in which he realises I
am a “nice man”, and I am not becoming aroused at his fantasies, which
angers him, he struggles with thoughts about his masochistic child-
hood friend Ralph. He has thoughts of sucking Ralph’s penis. He was
attracted to him. He wants me to be a “mean mother fucker” like Ralph.
Then he himself wants to be “evil and a loser, the best loser there is.” He
now has the fantasy that he will become aroused, naked, and handcuff
me to my chair. He will rub his penis against my chest and ejaculate on
me. I will worry about his putting his penis into my mouth and I will
wonder “What’s going on here.” In the next session, he elaborates fur-
ther: he will cut off my testicles and penis and eat them like franks and
beans, and I will be seated at the table with him, with my penis cut off,
wondering what he is doing. He laughs about this.
Too quickly, in many of these sessions, the tables would turn and
his sadism would transform to equally cruel self-punitive masochism,
which would preclude working through his feelings. At other and later
times, Mr. A would be genuinely upset and wish to understand why he
became aroused at such awful ideation. Two things became clear as time
went on—he needed to have his penis in effect acknowledged and his
manhood accepted (because he was so castrated psychologically by his
parents) and he was very reluctant to give up the excitement of his sado-
masochistic arousal (despite his hatred of it). He literally lived for those
arousing moments. It was very important for me in the transference to
acknowledge his manhood while not endorsing his sadomasochism.
Some process
Here is an example from a session twelve years into treatment which
indicates how primitive Mr. A’s wishes remained and how punitive his
superego, in this case as he tried to negotiate having a male friend, actu-
ally a paternal uncle. Despite the fact that this uncle and his wife had
THE PRIMITIVE SUPEREGO OF MR. A 239
lived around the corner from Mr. A as he grew up as a child, his parents
had never visited them nor invited them into their home. Now, many
years later, Mr. A was making an effort to befriend this uncle who had,
with his wife, made some overtures toward him. This was fraught with
difficulty for Mr. A because he sensed that his parents (particularly his
mother) would disapprove; and the difficulty was aggravated by the
fact that the uncle and his wife seemed to accept Mr. A’s children much
more readily than his own parents, and in fact seemed easier to be with
generally. Thus, Mr. A felt very guilty that he liked his uncle. When his
uncle suggested they go fishing together (one of the few activities that
Mr. A had once done with his father but which his father no longer
pursued) Mr. A’s trepidation about accepting became major. This was
aggravated, unbeknownst to me, by the fact that his uncle had told him
he would teach him how to fly-fish, which Mr. A had always wanted
to do.
He began one session by continuing to talk about how afraid he was
to go with his uncle and to enjoy it, because he would give himself a
terrible migraine if this happened—just as he was afraid to go out with
male friends in general for this reason. He then fantasised that his uncle
would rape him and force him to have anal sex; and then he fantasised
that I would do the same thing to him, that it would hurt because my
penis was so big. I wondered to him about his need to think of anal sex
only as so painful or of my penis as so big. He then fantasised that I
would hold his penis, at which point he reported feeling nauseous. He
said that he would ejaculate and his ejaculate would go so far up that it
would hit the picture on the wall above his head, and that as a result I
would be compelled to throw him out. He then fantasised that he would
force me to have anal sex. At this point, he became accusatory towards
me and said that this was not helping him, why was I letting him go
on like this. He threatened to kill himself by leaving the session and
walking in front of a car. Or he would simply cancel his trip with his
uncle. He will have to cancel it because he now envisions that when his
uncle takes him fly-fishing, his uncle will touch his hand to teach him
how to cast and will stand behind him. He contends that I will throw
him out. I ask him, “Why?” He is convinced he has done something to
offend me. He is convinced that I want to hurt him. I state that this is his
fantasy: “Why would I be offended?” I say that he hasn’t done anything
to hurt me; it is all a wish, a fantasy. He is convinced that if he ejaculates
here, I will throw him out. I ask, “Why?”
240 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
As I indicated before, this was hardly the first time that he had
articulated sadomasochistic thoughts and then become anxious about
doing so. Thus, when he continues to say that, if not now, at some time
I will surely have had enough of him and will get rid of him, I tell him
that it is clear that he would prefer not to work this through so that he
doesn’t have these thoughts. He would prefer for the thoughts to remain
with him all the time and prevent him from making male friends, and
sustain his view of himself as a victim. (I had made these interpretations
before, but perhaps never all of a piece, and not when the immediate
possibility of a friendship—after all, he tended to avoid friendships—
was so compelling.) When he comes in the next week, he says that he
was surprised because he looked at himself in the mirror and realised
that he does not have such a bad body. “What was I thinking when I
thought that I have breasts?” he says. He then talks about his uncle at
some length and has fantasies that if he embraced him, he would get
aroused. I make an interpretation that underlying his fantasies seems
to be his wish that people notice his erection, and that he wants me to
admire his erection. His need for this is a consequence, I say, of the fact
that his mother denied that he had a penis, when she appeared to him
in undress, as did his father. He wants me to acknowledge that he has
one. He is silent. Tears stream down his face. After a while he is able to
speak: he says that he wishes that he had had a father like me.
Six months later, his mother died precipitously from cancer. It was
an awful death, aggravated by the fact that his mother was angry and
hysterical throughout and to the end denied she was dying. But her
death had the curious positive effect, after his initial shock and mourn-
ing, of releasing Mr. A from his internal sense that his mother was all-
powerful. At the same time, his mother’s passing also led to another
disappointment: Mr. A had fantasied that, with his mother gone, he and
his father might share their loss together and that his father might draw
closer to him, but his father remained as distant as before. Thus Mr. A
felt more dependent upon me than ever. At one point, he became very
angry at me because I was to be gone for two sessions on a brief break.
He said it was not fair for me to leave and then went on:
A month later, when I confronted him about his fantasy that he would
come to see me forever, he said:
Countertransference
Mr. A’s very graphic sadistic ideation and wishes expressed during the
treatment toward me rarely—as far as I could discern then and even
in retrospect—had a pronounced emotional effect on me, although he
was usually convinced I was disgusted and appalled by them and that
I must hate him for them. I believe I was less affected than he imag-
ined for a number of reasons. For one, although in his interpersonal
dealings, he could be emotionally cruel, he never acted sadistically in
a physical way (despite his experiences with animals when he was a
teenager). In fact, much of my work involved helping him to distin-
guish between sadistic wish and action—he might wish with sexual
THE PRIMITIVE SUPEREGO OF MR. A 243
time and devaluing my attempt to help him (remember I did not know
that ultimately the outcome would be positive) and, at other times, to
find—despite myself—that I vengefully responded by barely staying
awake or in some instances actually nodding off, although recovering
in a few moments without (apparently) being detected.
To return to my being “stalwart” in the face of Mr. A’s sadism and
primitiveness, such stalwartness came at a price. Feeling compelled to
be an unadorned and matter-of-fact symbol of reality for Mr. A when
he indulged in his exaggerated sadistic reactions—with their hysterical
tinge—I experienced the need to be stalwart as a confinement and a
burden. I found that Mr. A responded best to matter-of-fact, almost con-
crete, ways of saying things, without nuance. When I intervened in this
manner I spoke to that part of him that reacted as a child who needed to
know that the world was not as dangerous a place as he feared, and for
whom nuance would confuse rather than comfort. For example, it was
much more useful to say in a concrete way, to Mr. A, that he brought his
mother into the room (or into his relationship with his wife) than to talk
about the nature of his internal processes more abstractly. Rarely could I
relax into the type of allusions or speculative thinking that might touch
my work with another patient. For much of the treatment, there seemed
to be no room for poetry or grace or embellishment in what I said. In
part, this was because some of the references (given Mr. A’s inability to
educate himself) would have been obscure to him and then would have
distracted from the import of what I said, but also because he seemed to
require and respond to unadorned directness. Perhaps the only excep-
tion to this was that Mr. A could respond and incorporate a remark
by me in which I was cuttingly facetious about some manner in which
he was withholding or cruel to others, such as when he procrastinated
repeatedly on getting his wife a birthday present she had requested (one
of her few open requests), and I remarked when he persisted in a clearly
transparent excuse, “Nice guy.” (This brought not a defensiveness on
his part but laughter followed by somewhat penitent acknowledgment
of his motivation to hurt by withholding.)
Another reason for the direct and matter of fact approach was that,
although Mr. A’s imagined sadistic scenarios were not in danger of
taking place, he too often acted emotionally cruel toward his loved
ones—his children and his wife and then, in turn, himself. Often he
was in danger of emotionally sadistic or un-thoughtful parenting (and
he would actively plead to me for help with it when he recognised it),
THE PRIMITIVE SUPEREGO OF MR. A 245
Conclusion
This was a remarkably successful psychoanalysis despite the initial
seemingly grim prognosis of others. The final healthy turning point
came when Mr. A was able to seek out a job where he had true responsi-
bility. For years, he had a position, of which he was initially very proud
because it had a “scam” quality to it, in a major company where the
employees constantly billed clients for hundreds of hours in which they
did nothing. It did have one virtue: it permitted him to come to see me
during the day, because no one at the company cared that he was una-
vailable. Gradually, it came as a revelation to him that his very work was
destroying him with its boringness and encouragement of deceit. In a
sense, his superego—so rigid in some ways, so lax in others—became
gradually modulated and continuous in both directions.
Near the end of treatment he also spontaneously remarked that he
could not believe how much he constantly feared that I was going to
seduce him the way the dentist had, and that he realised now it was all
in his mind—that in fact he had wanted to seduce me.
As to my role in his life, and the extent to which I was compelled
to make suggestions to fill the deficits he had, I certainly was like a
parental figure for him. Not infrequently he said, as therapy drew to
a close, that I had saved his life. He often fantasised at that time that
he would bump into me when he was out with his children and his
wife, so that I could see them. It was as if I had been the father he did
not have and the grandparent his children never had. Still, five years
after the end of his treatment, I have on four occasions received phone
calls on my answering machine very early in the morning, when he is
in his car on the way to work. He lets me know that he is doing well
and thanks me. In the last one, he called to tell me that his daughter
had just had a Bat-Mitzvah. He was so overwhelmed with gratitude
toward me—remember too that his reaction to his own Bar-Mitzvah
had marked his turning away from health in his own adolescent devel-
opment—that he kept on repeating into the phone, “Thank you, Thank
you, Thank you.”
CHAPTER SIXTEEN
I
want to thank Dr. Reichbart for allowing me to discuss
this interesting case, for being so open with us about his
countertransference thoughts and feelings, and above all for stick-
ing with this very challenging patient for so very many years. As I read
this case with its remarkable and moving outcome, I kept feeling that
there was a great deal in it from which all of us could learn.
Most obviously there seemed to be a lesson in humility, for
Dr. Reichbart was at the beginning of his career and, although he rightly
turned to more experienced analysts for help, he was told that the patient
was very sick or quasi-psychotic, which may have been correct, and that
he would make a poor control case, which was certainly wrong. For I
think that Dr. Reichbart might well admit that the many years he spent
with Mr. A have been both enormously instructive and rewarding for
both of them. How this came about makes a fascinating story.
The story begins with Dr. Reichbart taking on a patient whom he
finds tedious, boring, and consistently repetitive, so much so as to often
lead him to roll his eyes as the patient lay on the couch. The patient
would arrive just moments before the session began because he was
terrified of sitting in the waiting room. He would then spend most of
the session repeating how he did not want to be in treatment, how the
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248 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
analyst was out to hurt him, how he could not possibly say anything
new, and how he wanted to leave. At the end of the session he would
frequently threaten suicide, or plead with the analyst to just give up on
him, to “let him go”, as if he were enthralled or enslaved.
Now if you type “boredom in the countertransference” into the PEP-
Web search engine, dozens of articles on the subject will appear. For the
most part they all seem to agree that boredom in the countertransfer-
ence is a sign that the analyst is defending himself in some way against
something important that is going on between him and the patient. This
is not necessarily a bad thing; sometimes momentary self-defence is the
only way to stay alive or to not give up at certain times in a very difficult
treatment. And of course it is perfectly comprehensible that fifteen or
twenty years ago Dr. Reichbart would have been unclear about how to
proceed, because it is hard to believe that any beginning analyst would
have known how to treat patients like this one without the help of a
supervisor who had had long experience treating psychotic, borderline,
or other challenging patients in psychoanalysis. It is a great credit to
Dr. Reichbart’s strength, natural instincts, psychoanalytic talent, and
downright doggedness that he nonetheless persisted with this case for
so many years only to find, as he so touchingly puts it, that to his own
surprise this marginal individual, this self-made outcast, had fashioned
a life for himself, married, become a loving if conflicted father to two
children, and gained some understanding of his emotions and his fears.
So how now, with the ease and great advantage of hindsight, might we
try to understand what was going on?
I believe that, in general, because his clinical and theoretical training
had presumably been with “neurotic” patients, it was rather difficult
for Dr. Reichbart, as it is for most of us, to really grasp and comprehend
the extremely primitive level of pathology at which Mr. A was operat-
ing. Two small examples:
Again, Dr. Reichbart wonders at Mr. A’s need for concrete, matter-of-fact
responses and his inability to deal with poetry, grace, or embellishment.
This again is a common symptom at this level of pathology and impli-
cates his relative lack of reflective self-awareness that might allow him
to get outside of his own subjectivity (Bach, 1994, 2006) and the relative
absence of a transitional area (Winnicott, 1953) in which poetry, allusion,
speculation, and uncertainty can co-exist with concrete reality. These
deficits of course limit his ability to have enduring relationships, and
also undermine his ability to play, whether with partners and children
or in the analysis. The ability to play, as we have learned from Winnicott
(1971), is essential not only to engage in an authentic analysis but also
to live an authentic life. But at every step of the way we can recognise
and empathise with the patient’s persistent but not totally successful
efforts to create or to provide himself with the “normal” transitional
attachments that were lacking, as when he masturbates in his mother’s
underwear while she is gone (Kohut, 1971), or when he becomes tre-
mendously attached to his dog.
So we have, at the beginning, a patient in a state of extreme anxiety,
with a fragmented sense of self and a constant fear of being attacked
and annihilated. He barely manages to get to the sessions at all and,
while in session, he constantly repeats the same stereotyped words and
phrases as if to reassure himself and to reassert: I AM, I AM HERE,
I EXIST, you cannot hurt me, you mean nothing to me, it’s just ME, ME, ME.
To this Dr. Reichbart responds with boredom, as if he were being left out
of the picture and psychologically annihilated, which is exactly what
is actually happening; but it is only the patient’s pre-emptive counter-
attack to his own terrible fears of annihilation, and his repetition in the
transference of what had been done to him. As a child and adolescent
the patient was not recognised by his mother as a separate person with
his own needs and identity; this left him feeling not only castrated, as
Dr. Reichbart notes, but also with a confused identity (breasts) and a
deep feeling that he was not really human. It is one of Dr. Reichbart’s
many accomplishments that in the course of this treatment Mr. A began
to feel more like a human being who could once more rejoin his cohort
and become part of the mainstream of life.
250 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
“No matter what I do to you, you will never be able to leave me,
and we can live in this timeless world where you participate in my
omnipotence!”
References
Bach, S. (1991). On sadomasochistic object relations. In: G. Fogel & W. Myers
(Eds.), Perversions and Near-Perversions in Clinical Practice (pp. 75–92)New
Haven: Yale University Press.
Bach, S. (1994). The Language of Perversion and the Language of Love. Northvale,
NJ: Aronson.
Bach, S. (2002). Sadomasochism in clinical practice and everyday life. Journal
of Clinical Psychoanalysis, 11: 225–235.
Bach, S. (2006). Getting from Here to There: Analytic Love, Analytic Process.
Hillsdale, NJ: Analytic Press.
Bach, S. & Schwartz, L. (1972). A dream of the Marquis de Sade. Journal of
the American Psychoanalytic Association, 20: 451–475.
Ellman, S. (2007). Analytic trust and transference love; healing ruptures and
facilitating repair. Psychoanalytic Inquiry, 27: 246–263.
Gergely, G. (2000). Reapproaching Mahler: New perspectives on normal
autism, symbiosis, splitting and libidinal object constancy from cognitive
developmental theory. Journal of the American Psychoanaytic. Association.,
48: 1197–1228.
Lacan, J. (2002). [1949]. The mirror stage as formative of the I function as
revealed in psychoanalytic experience. In: Ecrits (pp. 75–81), Trans. Bruce
Fink. New York: Norton.
Kohut, H. (1971). The Analysis of the Self. Chicago, IL: University of Chicago
Press.
Winnicott, D. W. (1953). Transitional objects and transitional phenomena—
a study of the first not-me possession. International Journal of Psycho-
Analysis, 34: 89–97.
Winnicott, D. W. (1958). The capacity to be alone. International Journal of
Psycho-Analysis, 39: 416–420.
Winnicott, D. W. (1971). Playing and Reality. London: Tavistock Publications.
CHAPTER SEVENTEEN
M
“ r. A could be tedious in the extreme and so consistently
repetitive as to lead me to often roll my eyes as he lay on
the couch.” These words, used by the analyst to convey the
early sessions with the patient, caught my attention immediately, alert-
ing me to the possibility of sadomasochism. I am appreciative of having
the opportunity to comment on Dr. Reichbart’s case. It is a beautifully
written description of a long and successful psychoanalysis with a very
difficult patient. There is much to learn from this psychoanalysis, which
would offer the consideration of many aspects of psychoanalysis in the
clinical setting. As the sadomasochistic fantasy life, the sadomasochism
as revealed in the treatment in the transference-countertransference
interaction, and the sadomasochism in the patient’s behavioural life,
all come alive, these elements help to shed light on the way they seem
to intertwine with certain seminal environmental and developmental
points in the life story of the patient. To tease out the sadomasochism,
existentially, might lose the precious interconnections with these other
aspects of the situation. In describing the treatment, Dr. Reichbart
emphasises the slow emergence of both historical recollections and fan-
tasy life, bringing to mind both the natural flow of an analysis and also
the possibility of withholding by the patient. The fantasy life is almost
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256 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
see as a call for help on his part that seems to be ignored by the parents.
To the extent that Mr. A does experience the capacity to be “like” the
parents, he picks something not only destructive but blurring of ego
capacities already compromised.
I would like to add a paradoxical oedipal influence. I say, paradoxical,
in that the negative oedipal seems redolent with shame and disgust for
his father and himself. At the same time, Mr. A is jealous of the father’s
privilege in the primal bedroom, a suggestion of his positive oedipal.
He is also described as believing his mother prefers him to his weak
father. He appears mixed up over whether he is his mother’s lover and
the oedipal victor, or her look-alike as a “castrated” male, or her infant
to replace the sister as the baby getting “all the attention” and needing
to be taught even the most basic of things. Parallel to Mr. A’s own confu-
sion, there is an implication that the mother, in switching roles with the
father, is having her own identity crisis, driving a fantasy that she might
replace the father, male, for which she might feel the need to “possess”
her son’s penis as her part object and her belonging. She cannot make
up her own mind whether she wants to be the dominating seductress
or the forever maternal nurturer to her “infant” son. Her availability to
be the parent attending the son’s athletic activities perhaps presages her
wish for usurpation of her son’s maleness for herself.
Sadomasochism
Now to turn specifically to the sadomasochism. The psychoanalytic
definition of sadomasochism is somewhat illusive, as the term is often
used to encompass a variety of meanings (See Chapters One and Two
of this volume). For this discussion, I would include a conception of
sadomasochism that is fairly broad. By sadomasochism I will be refer-
ring to behavioural action or fantasy that captures a sense of pleasure
in hurting someone else (i.e., sadism) or in being hurt by someone
else (i.e., masochism); the sexual or the aggressive component may be
unconscious or conscious. In this case, however, I want to suggest, first,
the possibility of an autoerotic form or meaning of the sadomasochis-
tic ideation and action. Though played out with others, the sadomaso-
chism might actually be thought of as an expression of a power struggle
within Mr. A himself over his feeling of helplessness to resolve the major
issues that had been triggered in him. It would be as if the sadistic side
and the masochistic side represented an active and a passive alternative
262 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
even though not enacted, is a terrifying one for the patient and in his
mind a “real” possibility because of his difficulties in reality testing, his
lack of clarity over what is internal and what is external; his inability to
distinguish between wishes and action; and his blurring of sexual dif-
ferences, as well as the past and the present.
Transference
For Mr. A, the analyst seems to represent a combination of projections.
First and foremost, the analyst is Mr. A’s important object—for fifteen
years. He is carried in Mr. A’s mind well beyond the duration of the
treatment signaling object permanence and object constancy—and grat-
itude. This is the glue that makes Mr. A attach and stay attached, even
though at times he has such profound negative feelings. For much of
the time, it is a sadomasochistic object relation. But it is a sadomaso-
chistic relationship with a difference—the object, the analyst, does not
fully engage in the relationship at the same sadomasochistic level as the
patient. It is comparable, in a way, with the parent of the two-year-old or
the parent of the adolescent who sidesteps the toddler’s or adolescent’s
bid to get into a power struggle, always looking for solutions that are
not confrontations; the parent who has patience to wait and help the
struggling young person come to his own more successful solutions, no
matter what the parent may be feeling inside.
The patient had what amounted to a ritual that he would state at
each session: how much he did not want to be in treatment, how the
analyst was out to hurt him, how he could not possibly say anything
new, and how he wanted to leave. Strikingly, he needed to repeat this
“mantra” for less and less of the session time as the years rolled on. It
reminds me of the way a pre-adolescent might not want to “jinx” his
luck when he has something good; or, of the idea, “[the patient] doth
protest too much.” At the same time, even as we know that the uncon-
scious knows no “no”, we are also aware that the patient was articulat-
ing, in this ritualised form, his obsessional masochistic attachment to
his objects. He was rationalising why he could not proceed any less
cautiously—that is, because of these dangers, these fears: his negativity
would cause him to bolt and lose his analyst, but also his fear of being
hurt making vulnerability to his analyst worrisome, and further his
having to hold onto a belief that the analyst could not have good will
toward him. Thus, he continually had to overcome his conviction that
D I S C U S S I O N O F T H E CA S E O F M R . A 267
he dare not say anything “new”. One might think of this as setting up
the line in the sand for a power struggle over the contents in his mind.
Apparently, the answer that he got to his challenge—that the analyst
would wait, would listen with interest, would wait some more, and,
most importantly, mostly would pay attention—were different enough
or valuable enough for him to stick around and continue the process.
So he came to understand that he could put his poop in the pot at his
own body’s rhythm. Mr. A was also testing the analyst, to see if the
analyst would be able to tolerate Mr. A’s separation anxiety. This could
have been in identification with his mother’s hysterical reactions to the
father’s absences that might have led him to believe that it was unbear-
able for him to be separate from his mother. At the end of early ses-
sions, the patient would repeat a threat of suicide, even to the point
of describing setting up a noose in the basement of his parent’s home
where he would routinely go. (I note again, an interest in something
squeezing the neck—this time his own.) He apparently acknowledged
deriving pleasure from this negativity about himself and the cruelty
of the world. One wonders how the analyst would tolerate such per-
versity so triumphantly avowed. This masochistic provocation, again,
could be considered a test of the resolve of the analyst.
Another interesting point: the analyst noted that the patient only
noticed a large watercolour of tiger lilies on the far wall of his office
after coming for fifteen years. He would look “sideways” at the analyst.
Could such a furtive look at the analyst and lack of attention to his
environment have reflected his thinking that his analyst (and his pos-
sessions) were “off limits”? I see this as indicative of his inhibition or
his feeling of prohibition from “looking”, an issue that seems to touch
on his feelings of wish and fear to exhibit his own genitals and to look
at those of his analyst.
Mr. A certainly saw his analyst as a superego incarnate who would
be disgusted with him and disapproving of him, but also who might
be a corrupter of conscience as well: exhorting against the analyst for
tolerating his telling of his disturbing fantasies. Those two aspects—
conscience and corrupter of propriety—seem to transferentially sug-
gest Mr. A’s complicated feelings toward his mother. Then, there were
feelings toward the analyst that suggest a paternal transference in the
form of the various homosexual (with himself as the “feminine” part-
ner with the enlarged breasts) and sadomasochistic references to what
he would “do” to the analyst and what the analyst would “do” to him.
268 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
The incidents described with the barber and with the Uncle who liked
him and wanted to take him fly-fishing (fishing in the fly?), seem, in
the displacements, evidence of his fears of his homosexual attraction
to the analyst. With the barber, it seems, more blatantly, fear of his
homosexual strivings. But, with the uncle in particular, it seems as if
Mr. A is reaching for an identification—a mentor who can teach him
how to be a man—and an aunt who accepts his manliness, perhaps in
contrast to his conviction that his mother can only find him acceptable
if he stays attached to her and to no one else, in a masochistic pseudo-
oedipal way. This conviction seems matched by his own wish to possess
his mother—in a regressed sadomasochistic translation of an oedipal
striving—to brand her; to hurt her and prevent her from ever having
sex with the father; to have her cry out in pain. Similar to the fantasy
about strangling the woman by the neck, this could equal a child’s lis-
tening at the primal scene door, hearing moaning while the parents are
behind the closed door and interpreting the moaning as the woman
being hurt and in pain.
This fantasy relating to his mother gets transferred on to the analyst—
what he will do to the analyst reflects perhaps another iteration in his
shifting identifications. He is now not identifying with the female, but
treating the analyst as the masochistic female to his sadistic male self.
He notices that his analyst is not aroused by his fantasy. He “realises”
that the analyst is “a nice man and [is] not becoming aroused at his
fantasies, which angers him.” This fantasy, as riddled with sadomaso-
chism as it sounds, could have been equal to his attempted overture
to love-making to the analyst. That might explain why he would be
angry at the analyst for not being aroused, even while the analyst’s
not becoming aroused protects the patient, something neither parent
seemed to do.
Countertransference
The analyst’s countertransference appears to show a split in the ana-
lyst’s emotional stance to the patient, perhaps a little bit like the split
that Sterba (1934) long ago spoke of as a desirable split between the
observing and the experiencing ego. In this case, however, it seems more
like levels of observing ego and levels of experiencing ego. Returning
to my opening sentence to this discussion, I quoted Dr. Reichbart’s
phrasing that he often rolled his eyes, in particular while listening to
D I S C U S S I O N O F T H E CA S E O F M R . A 269
the patient’s objects stand in for the patient’s self. Thus, in embracing
a need to protect the masochistic objects of the patient and rejecting
the patient’s sadism, the analyst can inadvertently, but understandably,
become allied with the masochistic part of the patient. If one consid-
ers the close relationship between external real objects and the inter-
nal objects in the patient’s mind, the analyst can be thought of, in such
moments, as identifying with the masochistic victim object inside the
patient.
This phenomenon, as well as other factors, including the inevitable
wish on the part of the analyst to protect a patient from harm to him-
self or others, may lead to a kind of countertransference different from
one primarily of a sadomasochistic tenor being dominant in the analytic
couple. It might be thought of as a kind of protective parental model, on
the order of a corrective emotional experience in Bibring’s (1954) posi-
tive use of the term that abjures the sadomasochistic.
Dr. Reichbart describes many internal issues that sustained him and
permitted him to tolerate the power of the sadistic-masochistic pull. One
was his joy at having the analytic case; thus, perhaps, the benefits out-
weighed the pain. It appears that Dr. Reichbart liked the patient, which
provided an important balance to the situation. Another, as Dr. Reichbart
described in discussing his transference to the patient, was a parallel to
his own personal life experience. Dr. Reichbart empathised in a very
intimate way with what he understood Mr. A had to endure based on
Dr. Reichbart’s experience with his own theatrical mother. Because of
this, Dr. Reichbart considered that he was able to function toward the
patient with the “stalwartness” that he had been able to exhibit with
his own mother. Still another reason that Dr. Reichbart gives is that the
sadism and masochism current to the treatment was not physical, so
that the analyst could think about it for the most part as the workings in
the mind rather than the patient’s life.
Finally, although there were many years of work, the analyst may
have been able to sustain his own liveliness and interest because, in fact,
the patient did change. Ultimately, Dr. Reichbart was able to say to the
patient, and the patient was able to hear, that “underlying his fantasies
seems to be his wish that people notice his erection, and that he wants
me to admire his erection. This need for this is a consequence, I say, of
the fact that his mother denied that he had a penis, when she appeared
to him in undress, as did his father.” It is with the patient’s recogni-
tion of this interpretation that the healing that needed to happen to the
D I S C U S S I O N O F T H E CA S E O F M R . A 271
patient’s sense of his male body image was contained, putting him on
the road to recovery. No longer had he to be locked into the prison of
believing that the only relationship he could have with another was a
freakish sadomasochistic one. What a fine analytic outcome!
Summary
The drumbeat of this patient’s sadomasochistic fantasy life must have
been very absorbing, picturing violent, sexualised relations with his
inner objects and making it difficult for him to attend to the outer world
of reality. Up to the time of his treatment, this self-absorption may have
functioned as a perverse (and perhaps addictive) adaptation. Yet, begin-
ning with Dr. Reichbart, and seeing him day after day and year after
year, may have been an effective invitation to work together to allow
his mind to broaden his fantasies and inner life, and to include space for
a more balanced view of himself and his objects. It seems as if he was
able to rebuild and rebalance his identifications and consequently his
relations to his objects to let the power of the earlier, sadomasochistic
orientation recede into the background of his thinking.
I have followed the sadomasochistic coloration of Mr. A’s thinking
and object relations through attention to the transference, countertrans-
ference, and the process of the analysis. We owe a debt to Dr. Reichbart
for his generosity in sharing this material that highlights sadomaso-
chism so prominently.
References
Bibring, E. (1954). Psychoanalysis and the dynamic psychotherapies. Jour-
nal of the American Psychoanalytic Association, 2: 745–770.
Blos, P. (1962). On Adolescence. New York: The Free Press.
Freud, S. (1905). Three Essays on The Theory of Sexuality. S. E., 7: 125–243.
London: Hogarth.
Freud, S. (1919). ‘A child is being beaten’: A Contribution to the Study of the
Origin of Sexual Perversion. S. E., 17: 175–204.
Greenacre, P. (1953). Fetishism and body image. Psychoanalytic Study of the
Child, 8: 79–98.
Greenacre, P. (1969). The fetish and the transitional object. Psychoanalytic
Study of the Child, 24: pp. 144–164.
Kohut, H. (1971). The Analysis of the Self. A Systematic Approach to
the Psychoanalytic Treatment of Narcissistic Personality Disorders.
272 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
273
274 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
Phenomenology
To focus first on the chosen topics, the data and clinical observations
that one can consider coming under the aegis of sadism and masochism
are themselves actually obscure and indistinct. It is difficult to defini-
tively pin down observed data either at their periphery, to establish a
border to other contiguous phenomena, or within their own psychic
interior, to define a specific cluster of behaviour as coming under these
two related concepts.
The same applies to the supporting, underlying theme of aggres-
sion in the body of psychoanalytic theory. The origins of this half of
Freud’s instinct theory, the variations it can assume during the course
of any clinical material, and its general vicissitudes throughout life do
not make for easy categorisation. The obscurity and fuzziness of the
several possibilities, and the obstacles to arriving at a common scientific
consensus have generally resulted in some kind of temporary bypass-
ing of the problem by the average psychoanalyst, utilising in each case
a formula that each feels serves him best.
Aggression is not synonymous with sadism, nor the opposite in
masochism. The element of cruelty must be added—in one case the
intent to hurt; in the other, to suffer or be hurt, to be treated unfairly.
An action being aggressive, or forcefully executed, is not sufficient to
be sadistic.
If this volume is an attempt, or possibly a hope, to improve on this
less-than-settled scientific problem, we authors of its separate chapters
have bitten off some difficult assignments. Each is stimulated to survey
his life experience as a psychoanalytic clinician to see if any advance
can be made in what have become the ongoing conceptualisations of
this aspect of human life.
To do this in my own case, to see what I have been using as a work-
ing hypothesis in my psychoanalytic understanding of sadistic and
masochistic behaviour, and whether this view can stand up to closer
S A D O M A S O C H I S M A N D AG G R E S S I O N — C L I N I CA L T H E O RY 275
genitalia, a dip into secret transvestitism. One could have elicited sexual
psychopathology wherever he explored.
Any attitudes or other clinical material looking sadistic or maso-
chistic, however dramatically expressed, were a side issue, not the cen-
tre, intellectual, not affective, empty boasting rather than substantial
thoughts. The patient was grateful when these were not made too much
of, and his real unconscious conflicts addressed. Recognition of this ena-
bled the analyst to maintain the analytic attitude throughout, despite
his being “bored to death”. It was being met by this non-judgmental
response on the part of the analyst time after time that enabled the
patient to develop the trust that led to the series of exposures of the
underlying conflicts, and ultimately the drastic positive changes that
ensued.
For the analyst, his analytic role came from various sources. Besides
his analytic goals and the gradual learning that came from this and
other cases, and from training, there was the less-than-defensible real-
ity of his needing the case and the patient. It was not the analyst’s coun-
tertransference that kept the boring analysis going so tenaciously and
so long but at least partly his being “overjoyed” at the early analytic
case and having a patient on the couch. Analytic candidates, as well
as many analysts at various times, know this well. But to be complete
without too much rationalisation, this did not harm the patient but did
him a service, motivating him, and the analyst, to “hang in there” to a
good ending.
But perhaps the main reason neither the analyst nor patient “gave
up” at the boring repetitiveness of the early hours are stated near the
end of the paper. Both knew, or felt, that the threats and whining and
desperation expressed by the patient were quite empty gestures, rooted
in fantasy life, far from any danger of reaching the border to the external
world. The patient was well-defended against outer discharge. “I will
do this and that to you, cut off your testicles and penis and eat them”,
etc., was nowhere near action. Such outbursts in fact sounded more like
adolescent boasting than real threats. Both parties could relax.
Complications introduced by countertransference (i.e., in my
understanding coming from the analyst’s own unresolved past) were
far from primary in the material reported, in spite of the analyst’s few
relevant references about his own mother which fortified his “stalwart”
approach. His recognised boredom and discomfort were more related to
the patient’s manner of presenting and to the appropriate exasperation
S A D O M A S O C H I S M A N D AG G R E S S I O N — C L I N I CA L T H E O RY 279
it produced after years of the same. What was slow in coming seems
to have been the recognition of the unconscious psychopathological
process, and the centrality of castration anxiety at the centre of his
psychosexual development. This appeared from many directions,
including his affectionate thinking of the analyst as “a dinosaur with
a long tail”.
When the interpretation of castration anxiety finally does come—not
far from the end of the paper—it comes with a bang, and has a marked
effect. Hearing that “he wished the analyst would acknowledge that he
has a penis, which the behaviour of his mother toward him worked to
deny”, he becomes silent, tears streaming down his cheeks. He wishes
he had a father like the analyst. The interpretation, not quite on tar-
get but somewhat inexact (Glover, 1955) was effective nevertheless.
In today’s climate, this moment of insight is actually one of the most
touching understandings of castration anxiety I have heard in recent
years (Rangell, 1991).
No doubt this interpretative event played a strong part in propelling
the analysis toward its favourable end, enabling the patient to complete
his object-choice that led to his marriage and fatherhood. This is also,
incidentally, a brief commentary on unconscious object-choice in hetero
and homosexuality, a subject of great conflict and disagreement in the
modern sexual sphere. This patient demonstrated a bisexual disposi-
tion, was becoming uni-sexed as a compromise for strong conflictful
reasons, gained some mastery over this basic conflict by the analysis,
and was eventually able to exercise a satisfying and durable ego choice
by the autonomous ego as a result of the security achieved.
Actually, political correctness aside, one would say that this patient’s
heterosexual choice, his natural aim during his developmental progres-
sion, was being pressured and compromised by his neurotic life, push-
ing him toward identification with his mother. The result was a surge
of impulses as well as an accompanying fear (up to panic), of assuming
an ego-dystonic feminine identity, which produced his chronic anxi-
ety, which pressed him to reconsider his direction, from which path he
came to make the heterosexual object-choice that characterised the rest
of his life-span thus far, with a normal amount of contentment and psy-
chic peace.
The word “natural” needs to be expanded, or it can today be the
cause of much passion and conflict. The above statement was about a
psychic situation occurring decades ago—and might not be the same
280 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
Theory
The overall conclusion about the relevance of the clinical case presented
for the study of the subject of this book is that it demonstrates not the
syndrome to be explored but one with which it is commonly confused.
It is of course clinically valuable to be able to recognise and distinguish
pseudo-sadistic behaviour from contiguous states. Each calls for differ-
ent approaches in an analysis.
Actually, the entire symptom constellation of the patient we have
been attending derives from the twists of psychopathological devel-
opment described rather than from any excessive presence or use of
aggression in his psychic makeup, in spite of his complaints of internal
suffering and his mode of resorting to aggressive but empty threats.
Nevertheless, since aggression is characteristically the base from
which sadomasochism is executed when present, the theory to be
understood behind the symptomatology—which is the central subject
of this book—is still the theory of aggression and how this is utilised
by the unconscious ego to bring about the compromise formations that
constitute this symptom complex.
To begin therefore to fathom the theory or science behind two such
opposite but joined clinical phenomena as sadism and masochism,
I will turn as an opener to the subject from which both can be thought
to derive: the theory of aggression, as this has occupied psychoanalytic
theoreticians. Considering the fairly universal concurrence of analysts
that both sadism and masochism are related to the course and direc-
tion of aggression in their developmental histories, it would be a quite
rational move to examine closely the theory of aggression itself, to see
whether this exploration would lead to agreement from the opposite
direction: that is, starting from the original role of aggression and exam-
ining this element through its applied clinical phases and vicissitudes
on its way to many different presenting syndromes.
Freud’s theory of aggression did not become a part of his epoch-
making new formulations until some two decades after his thinking
was first introduced to the public at the end of the last century with The
Interpretation of Dreams (Freud, 1900). This part of the general theory,
moreover, was never assimilated in an equally global way as was the
revolutionary sexual instinct, nor has it ever achieved the same intensity
of interest, degree of reception, nor the clarity of its theoretical role as
did the sexual half of Freud’s instinct theory (in spite of the early huge
rejection of Freud’s sexual theories).
282 BAT T L I N G T H E L I F E A N D D E AT H F O R C E S O F S A D O M A S O C H I S M
References
Bond, B. (2011). Ex-mistress testifies. Los Angeles Times, 29 April.
Brenner, C. (1999). Reflections on psychoanalysis. Paper delivered to The
New York Psychoanalytic Society, 13 June.
Chowchilla. In: Kidnap memories won’t be buried, Los Angeles Times,
4 April 2011.
Darwin, C. (1859). The Origin of Species. Oxford: Oxford University Press.
Fenichel, O. (1945). The Psychoanalytic Theory of Neurosis. New York:
Norton.
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289
290 INDEX