Beating fantasies and daydreams revisited: presentation of a case.
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Clinical material is presented from two patients where hypochondriacal symptoms were seen to be derivatives of unconscious fantasies of being beaten or tortured. The shift along the masochistic axis from these underlying fantasies to the conscious hypochondriacal symptoms is seen as subserving the important defensive purpose of reducing the patients' perception of their conscious guilt feelings.
The study of the legend of Tristan and Iseult in terms of the multiple fantasies it might express adds to our understanding of the psychology of love. In a previous paper (1975), I delineated, via allusion to the Tristan legend, the romantic-erotic conditions sometimes involved in creativity. In this one, I have approached the question of love from the other direction and have tried to delineate the creative-adaptive conditions required for integrating the experiences of loving and being in love. The "High tale of love and death," the Liebestod fantasy realized, is still with us, but the happier ending may be a realistic, viable alternative.
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This paper explores the ontogeny of fear of humiliation, conceived of as an important organizing affect-laden fantasy in certain narcissistic personality disorders. The influence of the pleasure of the parental object in sadistically humiliating is emphasized in the overdetermined genesis of this fear. While, in elaboration of Loewenstein's (1957) and Eidelberg's (1959) contributions, "seduction of the humiliator" is a fundamental defensive process observed in masochistic characters, identification with the humiliator is a sadonarcissistic defense observed in work with certain narcissistic personality disorders. The countertransference potential to enjoy humiliating such analysands, as well as the defensive functions of fear to humiliation, are noted.
The role of therapeutic strategy within psychoanalytic technique is described. An antistrategic bias inherent in certain aspects of the "classical" technique is explored in relation to the historical development of psychoanalysis. Clinical expertise, which includes the making of strategic or tactical choices, is relegated to the "unofficial," due in part to this negative bias impeding the study of technical differences in favor of general agreement about a theory of technique that may differ considerably from actual clinical work. A case is presented that illustrates strategic choices in the management of a severe character resistance in a supervised analysis. Some consequences of a negative bias against therapeutic strategy as it relates to psychoanalytic training is described.
This paper summarizes the major strengths and weaknesses of current psychiatric nosology, and then discusses various forms of masochistic behavior as one illustration of how psychoanalysis can contribute to the continuing evolution of psychiatric nosology. Masochistic behavior is separated into behavior in which there is a predominantly conscious link between pleasure and pain, and behavior in which that link is predominantly unconscious. Both categories are further separated into normal and pathological forms. The current diagnostic category of dysthymic disorder is then discussed, with consideration given to the contribution that psychoanalysis can make toward the clarification and delineation of this heterogeneous diagnostic category.
A case is reported in which a young man for several years experienced his analysis primarily as a source of pain. Each new insight he achieved was an occasion for increased distress rather than liberation. Considerable analytic work elucidating motives for this negative therapeutic reaction produced no change in it. Eventually, it could be determined that the patient's need to suffer within the treatment relationship served a specific form of denial in fantasy that has not, to the author's knowledge, been described elsewhere. The importance of covert libidinal, object-preservative aims in such frustrating and destructive impasses is discussed, as well as the role of countertransference enactment.
Masochistic phenomena in adults are discussed as derivatives of conscious and/or unconscious fantasies. These masochistic fantasies are always associated with conscious and/or unconscious narcissistic and sadistic fantasies. These fantasies, like all fantasies in adults, are conceived of as compromise formations. After a selected review of the literature, analytic data are presented to highlight the clinical advantages of a contemporary elaboration of the structural hypothesis for the understanding of sadomasochistic and sadonarcissistic phenomena.
This paper focuses on the process of working through in psychoanalysis. Reemphasis of the centrality of the empathic listening perspective and discovery of the selfobject transferences made it necessary to reconceptualize various aspects of the analytic process from the perspective of psychoanalytic self psychology. With the help of a clinical vignette, the paper illustrates the manner in which archaic defense organizations and newly developing psychic structures find a compromise solution in a transference symptom. Such symptoms can serve as nodal points in the process of working through; they represent a transitional phase between the old automatic responses to narcissistic injury and an increased capacity to use signal anxiety. The psychopathology that became illuminated in this process can be described phenomenologically as a self-defeating personality disorder.
The author summarizes and develops some of her viewpoints on the perversions (outlined in several of the books and articles she has written). For her all the perversions, whatever their content, develop against an anal sadomasochistic backdrop. Their aim is to destroy reality. Reality, from a psychosexual perspective, may be defined as resulting from the existence of the father separating the mother and the child. This may be formulated in another way: reality is recognition of sexual and generational differences. Or, yet again: mother and father have a procreative sexuality, whereas the child does not. This leads to the idea that the destruction of reality is equivalent to destruction of the paternal universe. Clinical case illustrations are provided, one of which centers on the assassination of an old man who, besides representing a paternal oedipal image, also represents reality itself. This case illustrates in concrete form the murder of the father, and hence of reality, accomplished by the pervert when he eradicates the paternal dimension of psychosexuality by regressing to the anal sadomasochistic dimension.