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In this book, Wurmser, who practices psychoanalysis in Washington and Baltimore, continues his studies of severe psychopathology. The work is ambitious and impressive, in that it not only encompasses the theory and treatment of masochism, but also takes into account social phenomena of cruelty and suffering and a detailed study of Nietzsche's thinking, as well as a chapter on Thomas Mann. Interspersed in many of the chapters are extensive references to psychoanalytic and world literature, and detailed notes from the analyses of patients whose dominant pathology lies in the various forms of masochism.
Wurmser draws from many conceptual frameworks without ever abandoning the centrality of conflict underlying psychopathology. From his perspective, the chief instigator of conflict is conscience, das Gewissen, to which he refers mostly in nontechnical terms. However, when Wurmser uses technical language, it is evident that for him conscience includes the superego, the ego ideal, and what many would subsume under superego precursors. Conscience is that which inhibits discharge and underlies defenses. At first reading, this can be disconcerting because of the dilution of the term. However, more traditional analysts than Wurmser have also stressed that nonmoral rules of conduct are internalized in the same way as moral precepts.1 No other theorist, however, with the exception of Melanie Klein, on whose work Wurmser does not build, has pushed this recognition to the point where the superego is considered the cause of such a wide array of psychopathology.