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To summarize: the function of moral masochism may best be comprehended when considered in a unified and holistic sense. Case material has demonstrated how moral masochism arises as the result of a complex interaction between drive, defence, and ego-adaptive functions, not simply as the expression of an id drive, or the product of defence mechanisms, or the result of superego tyranny alone. The variegated and often confusing clinical picture is due to the constant shifting of these forces. For example, at various times the masochist (as in the case of Margaret) may be trapped in a morass of self-punishment, on other occasions swept along by the fury of his aggression. At other moments he may be quietly beseeching love or experiencing intense abandonment anxiety. Still at other times, through the use of ego-adaptive functions in combination with the gratification of vital needs and through the skilful interplay of defence mechanisms he may give the impression of being in harmony with himself and even capable of giving to others without an obvious demand for payment in return.
Stages of compensation, decompensation, and failure should be considered essential elements of the condition.