Battling the Life and Death Forces of Sadomasochism

Clinical Perspectives

Harriet I. Basseches

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367106904
• eBook ISBN:
  9780429911200
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book examines the forces of sadomasochism in the clinical domain where transference and countertransference reside. Psychoanalysts write in depth about cases where sadomasochism is present for both analysand and analyst. Four cases present the unfolding analytic exchange where life and death forces collide. Each case is accompanied by three discussions illuminating the complex phenomena that often include lifelong perversions and painful narcissistic difficulties. Through the case presentations and discussions, psychoanalytic therapists will find maps for guiding their own work with sadomasochistic processes. Treatments where sadomasochism is prominent abound with dramas containing control and denigration, domination, and submission. Often there is a history of over stimulation and under stimulation from infancy and childhood influencing the formation of object relations and unconscious fantasy. Since Freud first introduced the concepts of component instincts and psychosexual development, psychoanalysts have been exploring sadomasochism in its various forms. The belief that togetherness involves tormenting pain creates a sense of life and death struggle that is imbued with powerful instinctual gratification. Unconscious sexualized scenes of both dyadic and triadic forms carry humiliation and conquest.

Chapter One
Introduction to sadomasochism in the clinical realm

Harriet I. Basseches, Paula L. Ellman and Nancy R. Goodman

This 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 illuminating the complex phenomena that often include lifelong perversions and painful narcissistic difficulties. Through the four case presentations 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 containing 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, psychoanalysts 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 gratification. Unconscious sexualised scenes, both dyadic and triadic, carry humiliation and conquest. When these forces are brought to treatment, the analyst’s affective responses to negations and attacks, the countertransferences, provide opportunities to recognise conflicts and repetitions, and to move them into a symbolising process. Rather than embroilment in a negative therapeutic reaction, the treatment process is freed to proceed and deepen. In this chapter, we describe the way our interest in sadomasochism in the mind developed from our clinical work and discussions with each other over many years. We present our evolving thinking about the factors contributing to the dynamics of sadomasochism as they present clinically.

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 exciting 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 quality of the relationship is of one person hurting the other, even each hurting 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 connection the couple ignore and destroy conventional boundaries. Important to our understanding of the sadomasochistic transference and countertransference 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 woman prompt and provoke each other to enact a sadomasochistic way of relating that is both frightening and exciting. The individuals in the couple shift roles continually, recasting themselves, each as dominating, dominated, humiliating, humiliated, master, and slave. They successfully appear to redefine the feminine and the masculine, and imply a triumph over reality, that is, enacting a perversion. Edward Albee (1962), another playwright, powerfully captured the painful and sadomasochistic interaction between George and Martha in Who’s Afraid of Virginia Wolf? The popularity of these plays suggests both the timelessness and appeal of the topic. It is a subject that continues to challenge and perplex psychoanalysts ever since Freud originally chose to write about it. Freud (1905, 1919, 1924, 1927, 1937, 1940). developed his ideas, and many analysts since have reviewed the topic (for example JAPA psychoanalytic panels: 1981, 1984, 1991). Some analysts emphasise the sadistic aspect, others the masochistic, and still others the perverse. The vastness of the psychoanalytic literature as well as the literature of public discourse attest to the compelling nature of the subject. Perhaps its profound linkage to sexuality and aggression, and its pervasiveness in so many aspects of life activities, may help to explain the fascination and universality of this topic.

The fuel for generating this volume: how we arrived here

We have shared our clinical work with one another for over thirty years. As we brought our most despairing cases to each other, we found a trend in the nature of the clinical challenges we were each facing. With certain patients we felt deadened, ineffective, overstimulated, and guilty. These are the patients about whom we prefer not to speak. These are the patients that we are locked in with, believing that the work is at a standstill and not knowing how to free ourselves. With many, we feel anxious or sleepy, dead and invisible. “The analysis seems impossible.” In our study group we came to identify as sadomasochism the hold that these patients were having on us and our analysing capacities. Each of us felt tempted by despair. Were we incompetent, or were our patients unanalysable? Thinking together, we came to realise that there was masochism and sadism at work. We yearned for knowledge. We immersed ourselves in the literature on sadomasochism discovering invaluable ideas about symptoms, dynamics, and efforts at technical strategies. In fact many of the discussants in this book write about sadomasochism, perversion, disavowal, narcissism, and shame. Reading and thinking together provided the grounding for us, anchoring us from feeling swept away.

Transference/countertransference is the playing ground for these sadomasochistic patients’ core issues—their hatred, their need, their contempt, their terrors, their addictive arousal, their degrading and degraded selves. As we started to bring to one another the feelings and fantasies we were secretly harboring in our countertransferences, we found greater access to the transferences of our patients. Our process permitted us to create movement in our analytic work and to make contact with our patients’ minds. Unrecognised sadomasochism often threatens treatment with negative therapeutic reactions. Once we identified our deadness of mind, we found meaning and symbolisation, bringing life back to the analyst’s mind and to the analytic process itself. In other words, centring on the transference and countertransference experience encouraged the battle to continue rather than the treatment be destroyed. We are tremendously grateful for having a place with each other where we are free to expose honestly the workings of our own psyches and our listening capacities (Goodman, Basseches, Ellman, et al., 1993), and discover those of our patients.

With this understanding in mind, we decided to write a clinical book, a book focused on what happens in the consultation room. We decided on a format in which the case could become known to the reader, a complete case write-up with clear delineation of the contours of the experience. A full clinical case presentation allows more in-depth access to the mind of the analyst, the mind of the patient, and the unfolding analytic process. Not only are we offering a clinical volume, but one which gathers together a collection of four clinical cases into one compendium—a window into the duet of two psyches in four different dyads. Each case remains close to the experience of sadomasochism between the analyst and analysand. This format brings about an enlivening dialogue honouring the way psychic communication unfolds in the dyad of treatment. Each case has the attention of three discussants. We asked all discussants to stay close to the experience as written by the analysts who held the stories of sadomasochism. Our instructions were: “This is not supervision—this is an opportunity to associate freely and comment, to show the best of psychoanalytic dialogue.” Engaging our psychoanalytic community through discussions expands understanding of the sadomasochistic paradigm: traumas, desires and their conflicts, aggression and hatred, perversions and fragilities of narcissistic vulnerabilities.

Sadomasochism

A life and death struggle is at the core of sadomasochism. The elements of the erotic sadomasochism, such as humiliation, domination, submission, 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 internal 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 potential, 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 compromises 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 others including their analysts (Basseches, 1998; Ellman, 1998; Goodman, 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 torturing 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 connect 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 convictions 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 sadistic 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 intensifies 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 partnership impossible. Freud wrote: “We started out from the great opposition 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 opposing forces introduces the question of survival of the self, other, and the analytic process.

The clinical presence of sadomasochism in the mind: introduction of cases

All of the cases in this book reveal the dynamics of sadomasochism that exist in the patient’s mind, the analyst’s mind, and the analytic interchange. The activity of sadomasochism is present in differing degrees across the cases. Yet, each one is a living example of “psychic sadomasochism” in which the patient draws in the analyst to become a controlling or submitting presence. When sadomasochism enters the transference-countertransference in this way, despair arises, often making analyst and analysand doubt the viability of treatment. There are moments of being overwhelmed, doubtful, and attacking of the treatment process. Alternatively there may be an illusion of merger involving a saviour fantasy. The reader, too, is likely to feel the pull for submission, dominance, and destruction as the life and death battleground is vividly portrayed. These analysts and commentators have written with a willingness to know and experience the scripts of sadomasochism. The overall intent of the cases and discussions is to underscore the mysteries of sadomasochism, bringing them into view in a compelling way. Readers will be better able to acknowledge sadomasochism in their patients, in themselves, and in the material and enactments taking place in their treatments.

The discussions provide reflective space where analysts of differing theoretical backgrounds bring understanding to what is transpiring in the analyses. Although there are certainly common themes amongst their presentations, each describes his or her ideas of what brought these patients to their troubles. They find sources for the clinical presentation of sadomasochism in the history of trauma and narcissistic issues. Also ideas about self-cohesion, and defenses against anxieties of preoedipal and oedipal conflicts figure prominently. The felt desire to understand, to help maintain life forces over death forces, is present in each commentary. The treatments presented, and the informative discussions, bring articulation to this often mysterious destructive constellation.

We acknowledge the value of bringing to light these heart-wrenching psychic realities, thereby loosening the hold of sadomasochism and freeing the individuals who have been bound by it. Remarkably, patients and analysts begin to symbolise and dream, and renew their alive analysing instrument.

Commentary on the cases and discussions

The writers of the cases and the discussants come from a variety of orientations to psychoanalytic knowledge. They focus on the presence of sadomasochism in the ongoing clinical realm as it emerges and grips the analytic process. A reader might be somewhat surprised by the 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, underscoring the pairing of the two positions.

All case presenters and commentators find intrapsychic and interpersonal object relationships in the sadomasochism of the treatments. Discussants’ ideas fall into several main categories: (1) their understanding of sadomasochism in psychic life from a historical/theoretical perspective 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 Freudia...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE EDITORS AND CONTRIBUTORS
• SERIES EDITOR’S PREFACE
• CHAPTER ONE Introduction to sadomasochism in the clinical realm
• CHAPTER TWO Intersecting forces and development of sadomasochism
• PART I: CASE PRESENTED BY PAULA L. ELLMAN AND DISCUSSIONS
• PART II: CASE PRESENTED BY NANCY R. GOODMAN AND DISCUSSIONS
• PART III: CASE PRESENTED BY ANDREA GREENMAN AND DISCUSSIONS
• PART IV: CASE PRESENTED BY RICHARD REICHBART AND DISCUSSIONS
• INDEX