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The author discusses the genesis of masochism and supports his views with detailed excerpts from the analysis of an extreme case of masochistic character formation. He criticizes adversely Freud's later theories with regard to the Death Instinct, the Repetition Compulsion and Primary Masochism, and upholds and elaborates the old theory that masochism is sadism turned inwards. He holds that the conflict which is fundamental to masochism is one between the libido and the patient's environment (the 'patriarchal civilization' of Western Europe). It is not between two essentially opposed internal forces, such as Eros and the Death Instinct. He regards this as of importance both for the theoretical understanding of masochism and for the therapeutic treatment of cases. He criticizes also Alexander's views on the 'need for punishment'.
Reich enumerates the four chief traits which characterize the masochist, namely: (1) the sense of suffering; (2) the tendency to self-abasement and self-injury; (3) the passion for tormenting others as well as the self; (4) the tendency to awkward, ungainly behaviour. He works out the contributions of constitutional predisposition and fixations with regard to each of them.
Skin erotism is a factor of great importance. The painful experiences, such as flogging, which the patient phantasies or actually experiences, have this in common, that they lead to a warming of the skin as well as to pain. One of the foundations of masochism is a feeling of disappointment in love, which was originally a feeling of loss of contact with the warm skin of the love object. The masochist's demands for love are exceptionally great and perhaps unfulfillable, and possibly a physiological basis for this is to be found in some peculiarity of the vasomotor nervous system which controls the dilatation and contraction of the peripheral blood vessels.
The pains to which the masochist subjects himself in reality or phantasy also signify punishment, but are not desi