The Return of Masochistic Behavior in the Absence of the therapist*

The confusion in the literature on masochism with its complicated and contradictory formulations has to do in part with the nature of the behavior being studied. Human beings are capable of devising, holding tenaciously to, and involving others in an astonishing variety of pain-inducing, self-defeating, severely self-destructive behaviors. In our work with severely masochistic patients, we become aware that these behaviors have an equally astonishing variety of functions and meanings (Brenman, 1952). Attempts at clarification have been made by suggesting unifying underlying principles and structures. A literature review which, in itself, interestingly reflects changing political climates and theoretical alliances in the history of psychoanalytic theory building is out of the scope of this paper. Let me just suggest that, inadvertently, a false homogeneity has been implied. As clinicians, we are, at times, faced with having to decide to either force a phenomenon into an ill-fitting existing theoretical formulation or to discard a well-worked, elegant theory for an experiential validity. This does little to bind our own anxiety, an anxiety so often aroused when working with patients who engage, at times, in malignant attempts at self-destruction. In response to this dilemma, I began to examine my clinical experiences and those of my colleagues who had worked with so-called severely masochistic patients in long term intensive psychoanalytic treatments. I was interested in trying to see if there are natural groups whose pain producing behaviors have a homogeneity that is more than superficially descriptive. I wondered if there are groups who represent and structure their worlds similarly-who are, in other words, similar dynamically