,We live in a society in the Western world that teaches us to be all that we can be, to strive for the best in life, to rise above adversity. And while we are also taught to be good citizens, kind and generous, thoughtful and compassionate, it is generally regarded to be a good thing to empower ourselves in order to achieve at least some respectable degree of status in life. How is it, then, that not everyone follows this path always. In fact, it is as though some of us live contrary to these dictates, sabotaging opportunity, and inviting instead, disappointment, misfortune, and pain.
In 1980, the American Psychiatric Association’s task force to revise the Diagnostic and Statistical Manual (DSM), its standard reference guide to help practitioner’s diagnose patients’ problems, was deliberating whether to include a category in its taxonomy of personality disorders referred to as “self-defeating personality disorder (SDPD).” The following criteria were listed in order to make this diagnosis:
In order to assign this diagnosis, the patient must meet at least five of the above criteria. This category, which derived from a more classically-named disorder, “masochism,” was controversial because of its clinical origins associated with a kind of sexual deviance. When the manual was revised again in 1994, even with a new name, the category was dropped altogether largely because of its sexist connotation.
Even though “masochism” hasn’t stood the test of inclusion in psychiatry’s official taxonomy of disorders, it has a richly explored history in the psychoanalytic literature that continues to the present day. For this reason, some such as psychoanalyst, Mark Ruffalo (“Masochistic personality disorder: Time to include in DSM?” Psychology Today, March 23, 2019) question whether psychiatry should reconsider its decision.
Masochism’s Origins in Sexual Deviance
The first modern textbook on sexual deviance (known today as “paraphilias”) was published by a physician, Richard von Krafft-Ebing, in 1886. Krafft-Ebing is the one responsible for introducing sadism and masochism as medical terms that have become part of our everyday language today. The term, “masochism,” was taken, despite the author’s understandable objection, from his name, Leopold von Sacher-Masoch, an Austrian nobleman, who wrote a novel, Venus in Furs, 1870; eventually made into a play by David Ives and, later, an award-winning film in 2013, directed by Roman Polanski) about a man who solicited a relationship with a woman in order to become her sex slave.
The theme of masochism has fascinated many authors since (e.g., The Story of O, Fifty Shades of Gray), served as the study of social scientists such as Tom Weinberg (Studies in Sadomasochism, 1983), and as the source of confessional memoirs and political activism for the LGBTQ community found in the works of Patrick Califia, for example. While masochism as a sexual practice historically has been regarded as a form of deviance, this opinion has not been shared by everyone, including those in the professional community. In his analysis of this sexual practice, social psychologist, Roy Baumeister (Masochism and the Self, 1989) concluded that masochism is a relatively modern phenomenon because it has served to offer an escape for some people burdened by expectations to live up to an identity in a culture that has become highly individualized.
Masochism as both a sexual and personality disorder have often been associated with one another, especially in its early days of study such as by Freud and some of his followers, in an effort to understand how one can seek pleasure through pain. It was then that the sexist association between passivity and self-debasement with the female gender were propounded by the psychoanalytic community. However, today masochism as a personality disorder is not so much understood as a pleasurable phenomenon or as associated with the sexual practice of masochism as much as it is as a function of a failure of ego development and healthy self-efficacy.
Some of the well known quotes of wisdom in our culture are stated in paradoxes. For example, “Not everything that feels good is bad for you.” Another popular aphorism that involves pain, “Whatever doesn’t kill you makes you stronger,” is a paradox accredited to the philosopher, Friedrich Nietzsche. Although it can constitute a part of what masochism entails, suffering, it is implied, isn’t necessarily a bad thing. The ancient Greek stoics, for example, taught forbearance as a means to find greater happiness and peace.
How we construe suffering, however, may be influenced by gender bias, cautions psychologist, Paula Joan Caplan (The Myth of Women’s Masochism, 1993). According to Caplan, what we regard as stoicism in men is often seen, when applied to women, as masochism. Therefore, clarifying the distinction between when suffering is healthy and it isn’t is important. The psychoanalyst, Theodore Reik, offered insight to help identify when suffering is a good thing by observing that when it is consciously experienced and mastered, it can give us wisdom. Conversely, the masochistic personality subconsciously uses suffering to cope with stress, avoid self-assertion, and manipulate others in order to avert the challenges and assumption of responsibility necessary to confront challenges in life.
Suffering as Masochism
In modern times, the first psychoanalyst to write about masochism as a character type was Wilhelm Reich in the early 20th century. According to Reich, masochism represents a subconscious suppression of the expression of pleasure, joy, and self-assertion. The psychoanalyst, Karen Horney, who disagreed with the sexual explanations of the Freudians, explained masochism as a dysfunctional character adaptation to resolve one’s inner conflicts. According to Horney, the masochist suffers from preponderant feelings of helplessness and lack of self-confidence which are used as proximate means to gain power and to meet one’s needs instead, although she also grants the “Dionysian” aspects to masochism that entail a relinquishing of the ego found elsewhere in cross-cultural religious rites and meditation.
In his magnum opus, Masochism and Modern Man (1941), Theodore Reik posited that masochism serves both object-related and narcissistic purposes. With respect to object relations, he claimed that masochists degrade themselves for one aim, to be loved. But it also may serve a narcissistic need as well inasmuch as he also believed that all erotic or romantic love is founded on a basic dissatisfaction with oneself. Masochism in this sense, according to Reik, represents an attempt to escape from oneself in order to identify with a better “self” embodied in a relationship.
Nancy McWilliams, in her book, Psychoanalytic Diagnosis (1994), offers a comprehensive explanation for and description of the origins, dynamics, and treatment of the masochistic personality. As with others in her field, she posits that the masochist is motivated by dependency, insufficient ego development, and the fear of being alone. In cases of the “Battered Woman Syndrome,” for example, the victim would prefer risking their physical safety to being abandoned. She compares the paranoid personality who prefers power over love to the masochist for whom it is the other way around.
The origins of masochism may be found in dysfunctional or abusive relationships with caretakers in childhood. Masochism may also arise when the roles between parents and their children are reversed or when emotional support is provided only when they as children were ill, helpless, or in dire need. When abuse is present in a masochist’s current or early life history, dissociative states such as emotional numbing may occur under circumstances when the reenactment triggers memories of abuse. These dissociative experiences can subsequently elicit masochistic self-inflicted wounds or other behaviors to recover a feeling of being alive.
People who present with masochistic personality disorder or many of its features usually should seek professional help from a qualified mental health clinician. As with many personality disorders, the symptoms by which they are defined are not identifiable to those people who exhibit them. Therefore, they are not likely to be properly addressed except in the hands of a qualified professional.
Masochism may be understood as arising from a state of learned helplessness such that coping strategies associated with it are characteristically passive in nature. When confronted with power, the masochist is inclined to identify with rather than fight against an aggressor. For this reason and because of other, related qualities such as self-sacrificing tendencies, overscrupulosity, dependency in relationships, and a tendency to accept blame, they are often at risk of choosing or being victimized by people who are predatory or exploitative, such as pathological narcissists and cult leaders.
Robert Hamm Ph.D