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PubMed1992

Sadistic and self-defeating personality disorder criteria in a rural clinic sample.

A sample of 176 outpatients at a mental health clinic in rural southern Georgia were rated for the presence or absence of the DMS-III-R sadistic and self-defeating personality disorder criteria. On the basis of these ratings, 48 patients met the criteria for sadistic (n = 14) and self-defeating (n = 41). Surprisingly, half of the patients who met the sadistic criteria also fulfilled the self-defeating criteria. A factor analysis failed to divide the criteria cleanly into sadistic and self-defeating subsets.

Adult↗
PubMed2000

Sadomasochistic relating: what's sex got to do with it?

The sexuality in sadomasochistic relating is most often viewed as defensive, functioning to erotize the repetition of earlier trauma, as a defense against painful affect, or as masking early, nonerotic needs for recognition and autonomy. However, this emphasis on the nonerotic dimension of so-called sexualized experience leads to symbolic interpretations of sexuality; this "deliteralization of sexuality" requires some embodiment in the concrete and literal, or metaphor is delinked from that which it is derived. Without discounting the validity of such formulations, this paper aims to put the drive (libido) back into formulations of sadomasochistic relations, and discusses the erotic dimension in sadomasochistic relations as an irreducible, hidden structure that both threatens and sustains the destructive attachment. It is suggested that sexuality is a driving force behind sadomasochistic interplay, while aggression may be recruited for defensive, concealing purposes. Through a case illustration, this paper demonstrates how sadomasochistic relating is symbolically penetrating, teasing, withholding, and intensifying in hate-inducing ways, all of which are designed to gratify and simultaneously harden the other. In many cases, sadomasochistic sexuality may be viewed as aggressivized, paradoxically, to maintain safety under the regressive pull of sexual and preoedipal longings.

Defense Mechanisms↗
PubMed2002

"What do I know?": perspectives on what must not be known when change means loss.

Some patients use many ways of not knowing and so not feeling murderous rage at actual and internalized parents they long for and are terrified of losing. They stubbornly resist the liberating psychoanalytic changes that they consciously seek. Hope, promise, and success have come to threaten unbearable loss and catastrophic anxiety. These terrible expectations must become responsibly felt and owned by the patient.

Adult↗
PubMed2002

Psychoanalysis in later life.

After decades of heeding Freud's admonition against taking patients older than fifty years of age into psychoanalytic treatment, psychoanalysts began to treat them and to report encouraging experiences. This essay is another in a series of case reports that confirms and extends the nature of changes possible in the analytic treatment of elderly patients. In order to demonstrate both specific changes and the possibility of satisfactory terminations with patients of advanced age, the author describes his analytic work with a woman who first consulted him when she was sixty-eight years old.

Aged↗
PubMed1975

[Medical opinions on fatal auto-erotic accidents for insurance purposes (author's transl)].

The problematic nature of medico-legal opinions on fatal auto-erotic accidents made for private accident insurance companies is outlined in a survey based on our own records. Taking the "General Insuranc Terms for Accident Insurance" (AUB) into consideration, guidelines for the forming of such opinions are given. One is warned not to form summary opinions. Decisive is the insured's state of conciousness when the accident was triggered. Only in exceptional cases can an insurance covered accident be rejected because of a body injury inflicted by the insured on himself (see article). These actions do not usually result in external injury to the body. Experience proves that "ideal conditions" for forming an opinion are rarely given. Also, the nature of the death situation is such that often the corpse is discovered only days after death. From the outset, forming a medical opinion is beset with varying degrees of difficulty depending upon which category of auto-erotic activities the accident falls into: 1. direct stimulation of the erotic regions, 2. stimulation of sexual centers in the central nervous system, 3. the creation of fear and anguish in the context of masochistic perversion. According the presently valid insurance terms (AUB), cases of auto-erotic electrocution are to be regarded as covered. A disturbance of consciousness--with the exception of such disturbances following the influence of alcohol, medicines or narcotics--cannot be assumed for the moment in which the accident was triggered. At this moment body "integrity" was also intact. Accidents through strangulation, respectively asphyxiation (plastic bags etc.), usually occur during a disturbance of consciousness of the victim. This disturbance is the result of cerebral hypoxia, that is a result of strangulation, respectively external respiratory obstruction. The forming of a medical opinion for insurance purposes on auto-erotic accidents with clearly recognizable masochistic tendency is particularly difficult. A medical decision is only possible when an exact examination and description of the scene of the accident are available. In these instances, mechanical devices rigged by the victim often do not permit with sufficient probability to exclude the possibility of an accident without disturbance of consciousness on the part of the insured.

Asphyxia↗