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DESPITE PUTATIVE SHIFTS IN THE TYPES OF PATHOLOGY PRESENTED to the modern psychoanalyst, our caseloads are in fact very similar to Freud's, since he too grappled with masochistic phenomena of varying intensity and pervasiveness in his daily work. The male cases cited in his paper on beating fantasies (1919) "included a fairly large number of persons who would have to be described as true masochists" (p. 196) and there are references to suicide in all of Freud's published cases except Little Hans (Litman, 1970); (Novick, 1984). The difficulties in conceptualization and technical handling of masochism led Freud to repeated revisions of his formulations and ultimately to fundamental changes in psychoanalytic metapsychology.
Since Freud a vast literature has accumulated around the theoretical and clinical problems of masochism. Good summaries of the classical view are provided by Fenichel (1945), Loewenstein (1957), Bieber (1966), and Ferber (1975). Maleson (1984) says that masochism has acquired a "confusing array of meanings," with "little consistency or precision in its current usage" (p. 325). For