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PubMed2006

Playing patient, playing doctor: Munchausen syndrome, clinical S/M, and ruptures of medical power.

This article deploys sadomasochism as a framework for understanding medical practice on an institutional level. By examining the case of the factitious illness Munchausen syndrome, this article analyzes the operations of power in the doctor-patient relationship through the trope of role-playing. Because Munchausen syndrome causes a disruption to the dyadic relationship between physicians and patients, a lens of sadomasochism highlights dynamics of power in medical practice that are often obscured in everyday practice. Specifically, this article illustrates how classification and diagnosis are concrete manifestations of the mobilization of medical power.

Antisocial Personality Disorder↗
PubMed1981

The paradox of persisting self-punitive behavior.

The paradox presented by the "masochist" who persists in behaviors that are followed contingently be seemingly aversive consequences is analyzed. Prototypical data from infra-human experiments are evaluated for their bearing on two theories of self-punitive actions, one based on traditional stimulus-response principles, the other on cognitive assumptions. Although the label "self-punitive" is widely used, a question remains as to whether animals that react so as to bring about so-called noxious outcomes are properly to be described as "punishing themselves." In an attempt to resolve this question, two major conceptions of punishment are evaluated as they apply to self-punitive studies. Neither conception is deemed adequate because of a lack of criteria for determining which events are aversive. A search for criteria of aversiveness eventuates in a completely relativistic view in which noxiousness and attractiveness are judged to be relational rather than absolute properties of events.

Animals↗
PubMed1989

Validity of criteria for DSM-III self-defeating personality disorder.

Criteria for self-defeating personality disorder were examined using a standard measure in 148 psychiatric outpatients. The best individual criterion was self-defeating B (taken advantage of by others). Self-defeating A (sacrifices needs for others) and K (being hurt is sexually arousing) were of little value. Although some dependent, histronic, and avoidant criteria were also related to self-defeating personality disorder, the disorders appeared fairly clearly separate. There did appear to be more overlap (although not identity) with borderline personality disorder. It appears possible that in some circumstances self-defeating personality disorder might be diagnosed using two criteria.

Adult↗
PubMed2001

(Serious) sadomasochism: a protected right of privacy?

Several adult male members of a sadomasochistic sex club were arrested for violating a U.K. statute passed in 1861--The Offences Against the Person Act. The sex acts spanned a 10-year period and were videotaped. They involved manipulation of the genitalia with hot wax, sand paper, fish hooks, and needles. The sexual interactions were consensual. This analysis tracks the case from trial, to the Court of Appeal, to the House of Lords, and on to the European Court of Human Rights. It examines whether or not these sexual behaviors should be protected under a right to privacy. It contrasts state concerns of bodily harm, albeit consented to, in sex with those incurred in sport.

Boxing↗
PubMed2002

Investigating the underlying structure in sadomasochistically oriented behavior.

This study explores the extent to which 29 individual sexual behaviors, previously identified in L. Alison, P. Santtila, N. K. Sandnabba, and N. Nordling (2001), as each being associated with 1 of 4 different broad themes of sadomasochistically oriented behavior, represent different scales of intensity within each theme. The themes were as follows: hypermasculinity, administration and receipt of pain, physical restriction, and humiliation. For example, we wanted to establish whether skinbranding is a more intense expression of pain than spanking; whether faceslapping is a more intense expression of humilitation than flagellation, and so on. One hundred and eighty-four participants (22 women and 162 men) who were members of two sadomasochistically oriented clubs gave information concerning which of the 29 sexual behaviors they had participated in during the preceding 12 months. A multivariate analysis (POSAC; Shye, 1994) supported the existence of cumulative scales in each of the 4 themes, suggesting that the order in which people engage in different sadomasochistic behaviors is not random and that specific, less intense behaviors generally precede more intense behaviors.

Adult↗
PubMed2003

Two systems of self-regulation and the differential application of psychoanalytic technique.

Out of our work over the years on child development, clinical technique, and sadomasochism, we have begun to formulate a model of development that describes two possible ways of responding to feelings of helplessness in the face of the challenges of internal and external experience. Any psychoanalytic model has implications for how we think about technique and can be tested on the basis of its utility in generating technical ideas and enhancing our therapeutic repertoire. At this juncture in the history of our field, it is crucial for us to demonstrate that psychoanalytic techniques are effective in helping people enter treatment, change, and finish in a way that consolidates their gains. In this paper we explore the utility of our two-systems model for expanding the discourse about psychoanalytic technique.

Female↗
PubMed1997

Etiology of the masochistic and narcissistic personality.

It is the premise of this article, that at least in some instances, narcissistic and masochistic characters may develop from different role assignments in the same family (i.e., families with narcissistic dynamics). It is hypothesized that the child who later becomes narcissistic becomes assigned the role of the good child, remains merged with the mother, and becomes her ego-ideal. In contrast, the mother projects the egodystonic aspects of herself onto the child who becomes scapegoated, more willful, and defiant and eventually masochistic. The author has observed among her patients that some variables that seem to have contributed to the particular role assignment of a given child in the family are birth order, temperament, gender, resemblance to grandparents or significant objects in parents' life, and/or innate talents, gifts, and differences. It is suggested that the presence of narcissistic dynamics in the families of both masochistic and narcissistic characters may account for the similarities between the two character structures previously noted in the literature. It is obviously a limitation of this article that conclusions about family members (i.e., mothers and siblings) are based on reports of patients during long-term psychoanalytic treatment rather than direct observation. It is thus recommended that future research efforts attempt to verify these hypotheses through longitudinal family studies.

Birth Order↗
PubMed1992

Nonmonotonic relation of autogynephilia and heterosexual attraction.

In this study I investigated the relation between normal heterosexual attraction and autogynephilia (a man's propensity to be sexually aroused by the thought or image of himself as a woman). The subjects were 427 adult male outpatients who reported histories of dressing in women's garments, of feeling like women, or both. The data were questionnaire measures of autogynephilia, heterosexual interest, and other psychosexual variables. As predicted, the highest levels of autogynephilia were observed at intermediate rather than high levels of heterosexual interest; that is, the function relating these variables took the form of an inverted U. This finding supports the hypothesis that autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it.

Adolescent↗