Response by Bernhard Berliner

Dr. Lubin raises the question of why the relationship between depression and moral masochism has not always been recognized. The reason, it seems to me, was that for a long time moral masochism was considered a derivative of a sexual perversion and treated from the viewpoint of the id. The growing interest during recent decades in the ego and in object relations brought the condition into the focus of the ego and of character formation. Wilhelm Reich (1933) was particularly instrumental in this turn.

Looking for the differences between masochism and depression, Dr. Lubin rightly points to the exhibitionistic behavior in moral masochism. His descriptions, including the brief review of his beautiful studies on Van Gogh, are most interesting and convincing. They corroborate my view that moral masochism is a symptom in the frame of the depressive character structure. The symptom shows varying appearances according to when and how much it is needed for defense. The defense is directed against the original conflict between the instinctual need to be loved and the experience of nonlove. I must maintain my basic thesis that depressive suffering has a positive libidinal motivation. This thesis refers not only to the important events in the psychogenesis of the depressive character but also to intrapsychic factors the importance of which I do not underestimate.

Dr. Grinberg finds my consideration of the constitutional factors incomplete. I referred only to the high degree of oral and skin erotisms and to the process of introjection which starts the superego formation. Other constitutional determinants, e.g., biochemical ones, are suspected but not known. The role of the aggressive drives as a constitutional etiological factor in the depressive character is difficult to assess. At first sight the patient's aggressiveness appears to be of low intensity. One feels tempted to speak of a “weak ego.” Possibly we have here a constitutional element, but I am not sure. With the progress