Psychoanalysis and Religion

It is an infelicitous duty sometimes to warn people about books and their problems, but in this case I do not mind doing so as the publisher in question is one that is notorious for charging some of the most outrageous prices of any academic publisher. In exchange for that, one might hope--indeed, one would rightfully expect--that any book such a publisher produced would be flawlessly edited and smartly presented, but neither is the case with Early Psychoanalytic Religious Writings, eds., H.N. Malony and E.P. Shafranske (Brill, 2021), ix+181pp.

The book is an anthology of excerpts from various first-generation analysts, including Freud, Karl Abraham, Fromm, Sandor Rado, Ernest Jones (whose chapter is sophomoric and supercilious and certainly does not bear reprinting), and Wilhelm Reich. The editors offer an opening and concluding chapter, the latter itself being a reprint of an earlier publication.

Apart from the Oskar Pfister chapter, which reproduces his reply to Freud's The Future of an Illusion, most of the other chapters are such truncated abbreviations of the originals that they offer very little substance. This is certainly true of the excerpts of Fromm and Abraham, inter alia.

The other really vexing and inexcusable problem is that Brill has clearly sacked all its copyeditors, and as a result this book is littered with the most embarrassing sorts of typos, grammatical solecisms, and formatting flaws. Just to give a few examples: in some places, references are made that do not show up in footnotes or the bibliography; in several places periods are missing, so that sentences are smashed together; and in too many places to count, spelling errors abound, including most egregiously on the same page where in at least one instance a name is repeated three times, each of those times in a different spelling! Other howlers could be noted. In short, this is intolerable for a slender book costing nearly $90--and not even containing much original content, either. 

That said, the one redeeming feature here--for those who have not encountered him earlier--is that Pfister is always a delight to read, and his chapter here reminds one of the close relationship he had with Freud and his family for nearly three decades. Pfister, for those who do not know, was a Swiss pastor who not only saw no opposition between Christianity and Freud, but praised the latter as an invaluable critic of the former, saying of Freud that "you fight religion out of religion" and in so doing engage in a "smashing of idols." 

On this latter point, Adam Phillips develops it to such effect in his superlative short collection of essays, On Kissing, Tickling, and Being Bored: Psychoanalytic Essays on the Unexamined Life. And this point is not original to Phillips. Before him, in his Terry lectures at Yale in the 1960s, Paul Ricoeur had already highlighted the anti-idolatry uses of Freud which Christians should embrace and extend to their own tradition.

Oskar is not above twigging his friend Sigmund by noting that Freud's fellow Jew, Jesus of Nazareth, had "practiced psychoanalysis 1900 years before." But Pfister ends by noting that Freud is in fact following Jesus very closely when both of them are "united in a strong faith, the credo of which says: 'The truth will make you free'" (p.148), a quote from John's gospel that Erich Fromm will also use in the same way in his book Beyond the Chains of Illusion: My Encounter with Marx and Freud. 

Working with Violent and Sexually Harmful Children and Adolescents

This book is so new that it bears, on my copy, a copyright date of 2022 even though I have had it in my hands since late August 2021. (One might reflect that perhaps this confusion over dates reflects a rush to get into print a book that, alas, has not been copy-edited very well: I've found several typos and solecisms, which is not a thing one typically expects or encounters in Routledge books.)

In any event, it is a rich collection of articles from numerous clinicians in England associated there with the prestigious Portman and Tavistock clinics: A. Nathanson et al., eds., From Trauma to Harming Others: Therapeutic Work with Delinquent, Violent, and Sexually Harmful Children and Young People (Routledge), xxiii+172pp. In what follows, I simply put together some insights pulled from several (but not all) chapters. I do so in part because about half my current clinical work is with adolescents court-ordered into individual and group psychotherapy for various sexual offenses. This is not work I ever expected to find myself doing at this stage of my life. It was, to be frank, work I was faintly horrified by when I first learned of it. But now that I have been immersed in it for nearly a year, I have come very much to enjoy it in that Winnicottian sense I wrote about here. 

The introduction takes us into some of the theoretical underpinnings of the essays in the collection, and explicitly makes mention of someone whom I was introduced to through reading Adam Phillips: the late American psychiatrist and psychoanalyst Robert Stoller. His book Perversion: the Erotic Form of Hatred gets cited by the editors as a useful text, which I have also found it to be. Stoller has argued--in my view correctly--that often what is sought in sadomasochistic fantasies and enactments as an adolescent or adult is a triumph over childhood traumas. The authors and editors in this new book would also seem to share that view.

The other author they cite, unfamiliar to me, is Ismond Rosen, editor of a collection of articles, published by Oxford UP in its third edition (original: 1979) in 1995 as Sexual Deviation. 

The editors go on to be clear about things that in the popular imagination are often obscure, noting that "only a minority of adolescents who sexually harm others turn into habitual sex offenders" (xiv). This is confirmed in some of the case studies later in the book of adolescents who sexually harmed children not because of an attraction per se to children as such, but because in each case the child represented something the offender hated and sought to strike at to hurt someone else--chiefly a parent. 

The editors in the introduction, and many of the other authors in this collection, acknowledge that what has changed in their work over the years with this population is the Internet and the widespread and rampant access to pornography (and the related problem of other images on social media). 

Mariane Parsons has a brief chapter, "Key Concepts Developed at the Portman Clinic," whose conclusion is simply stated but, in my view, absolutely crucial for this kind of work: "to foster...and enhance the youngster's self-esteem and capacity to be curious about himself it is of vital importance to help him to feel seen by the therapist as a whole person with strengths that can be valued (as well as weaknesses that need help). This offers hope to the patient and is essential for a move towards a healthier future" (p.7). I have written at length elsewhere (in press) about trying to do exactly this and why it is so vital for clinician and patient alike, so I will say no more about that here. (The last chapter in the book, "The History of the Portman Clinic," brings us back to the introduction, but with more particular detail and less clinical material.)

Anne Alvarez, in her chapter "Motiveless Malignity," notes bluntly that clinicians, when working with patients of psychotic and psychopathic tendencies, must "look evil straight in the eye" but then also look at whatever good qualities may be starting to emerge in a patient as well. Sometimes these qualities will be very minimal and must not be overplayed or exaggerated. In some particularly damaged individuals the most we might ever see are "faint beginnings...of trust and faith" which may be remarked upon unsentimentally. Such patients also generally cannot handle symbolic interpretations ("in attacking me you are seeking to strike at your mother") so these must be used with great caution.

Donald Campbell's chapter, "Considering Perversion from a Portman Clinic Perspective," engages with Stoller and other recent clinicians after returning to Freud's 1905 Three Essays on the Theory of Sexuality. Campbell's chapter inspired me to return to that 1905 work also, and find in it some refreshingly blunt and straightforward claims, including that "sadism is the most common and the most significant of all the perversions." 

Campbell agrees with this, and notes that none of us should recoil from this because "all of us in one way or another are neurotic and have entertained perverse fantasies" (22). Much of the rest of the chapter is taken up with case studies and other clinical material. 

Toward the end he offers a welcome note of caution which it seems to me those running CBT-type treatments for sexual offenders might need to take deeper note of: whether in individual or group treatment, authoritarian and "macho" tendencies must be avoided in leaders who must also avoid focusing "exclusively on behavioral change without understanding the individual's internal conflicts and anxieties." Merely focusing on externals overlooks "the abuser's capacity to adopt language, concepts, and whatever is suggested as normative behavior," offering "simulated attitudes and behaviour" and a mere appearance of change (33). 

Graham Music and Heather Wood author the next chapter, which focuses on porn on the 'net. They begin by quoting a 2017 UK study to the effect that 65% of adolescent boys had not just seen porn on-line but "thought such images were realistic." Those who are emotionally fragile may gravitate towards porn and become fixated on it in part because of a pre-existing lack of connection to their own "bodily experiences and desires" (38). Continued use of it may be a defense mechanism against "core complex anxieties." One way to combat this, they aver later in the chapter, may come through developing greater capacity to mentalize, here drawing on Peter Fonagy's well-known work in this regard. 

The authors are commendably straightforward about what is offered by life in comparison to the endless fantasies of porn: compared to those images, reality must seem "very grey and dull" and it requires a perhaps unlovely "acceptance of ambivalence and imperfection" (39). Here I am put in mind of Adam Phillips again and his rather bald assertion that "reality matters because it is the only thing that can satisfy us." 

The ending of this chapter leads into the next, for both talk about porn in Winnicottian terms: as an object over-invested with meaning for some; as an object that attempts to replace human and fleshly contact because of past trauma; as an object to which one relates precisely to escape from the problem of relating to flesh-and-blood human beings. Thus do we come to John Woods' chapter on porn, "Seeing and Being Seen," which draws on Winnicott at length.  

Woods begins by commendably acknowledging the "contradictory messages from adult society" that children and adolescents get around sex and porn. On the one hand, we live in a libertarian world where "freedom of expression" is strongly encouraged and the right to sex, to sexual and gender identity, and to explorations of the same are all held up as goods that rights-bearing autonomous citizens have and which must not be impeded by censorious governments or others. But on the other hand, those of us who are working with adolescents and children, especially those court-ordered into treatment, operate with an inescapable and relatively clear moral imperative: certain forms of sexual exploration and expression are totally prohibited by the law, which punishes those who disobey, and our adolescent patients must be brought into compliance with this. 

Woods introduces another element here between competing moral and legal philosophies: the question of development. He believes that "unrestricted access to internet pornography undermines normal development" (56) and can contribute to the problem of voyeurism. On this topic, he draws on Winnicott's erstwhile analysand, the problematic Masud Khan (himself guilty of sexual boundary violations--inter alia--with patients), who notes that the intensity of pornographic arousal may be closely tied to how much of a need for "object relating" it provides. Additionally, the power of voyeurism may come from the fact that one believes one to be able to see anything and everything without consent.

Later in the chapter, Woods returns again to the moral problem of pornography, and is refreshingly candid in asking why "we are turning a blind eye to the very damaging effects of internet pornography in our society" (60) which he says should be regarded as a "Public Health issue" (61). He says clinicians should give support to parents who are fighting to maintain some control over what their children are exposed to, and that "the ideal of free expression and no censorship has to be questioned." Based on my own clinical experience watching how badly distorted some adolescents' views of sex are based on exposure to porn, and how many problems it has created in their life, I am firmly in agreement with Woods in all this.

Ariel Nathanson's chapter "Working with Mental Hackers and Backroom Thinkers" introduces the useful concept of having a mental backroom "as both a hiding place and a control centre" from which to exercise one's wishes for "omnipotence" (67). This chapter could have withstood some further development and elaboration, not least by drawing on what seems to me an obviously relevant body of literature: that of schizoid personality theory from Fairbairn, Guntrip, Winnicott, and most recently Nancy McWilliams. 

She reports confronting one patient with the rather colourful question: "are you making direct in-the-moment contact with me or do you use the sessions as a takeaway service, store my comments, and feed yourself elsewhere?" (76). If progress is made with such patients, then they may come to realize how much of life they are missing out from and thus they may come to leave their backroom, regarding it no longer as a "glorified control centre" but instead a "bleak addict's den" (77). 

In his chapter "Angels and Devils: Sadism and Violence in Children," Graham Music echoes several themes noted earlier about sadomasochism supplying unmet needs, or being a way to triumph over earlier traumas as well as various forms of "anxiety, stress," or "feelings of inadequacy" (86). Sometimes, however, the intensity of sadistic fantasies or enactments is precisely due to the patient having an internal world that is "empty and flat" with much deadening of feeling.

As we move into the later chapters in the book, some of the clinical material becomes darker and we see more severe cases of violent sexual acting out. This leads one of the authors in this section, Tim Baker, to reflect on the connection between aggression and the counter-transference. This becomes especially tricky to manage if one is working with an adolescent offender who was also himself victimized at some point. Baker's chapter on self-harm in adolescents offers some helpful vignettes to those struggling to understand such things as adolescents exposing themselves on-line or in school settings, or in public places, or those who admit to, but never carry out, sexual attacks on siblings. Much of this is discussed under the heading of Winnicott's aphorism that "it is joy to be hidden, but disaster not to be found." 

Patricia Allan's chapter, "Securing the Disaster Zone," offers some useful ways to think about initial contact, early assessment, and decisions for treatment with adolescents. She worked with a badly traumatized 8-year-old boy whose clinical presentation was of very considerable complexity and difficulty.

Ariel Nathanson's chapter closes out the book. She begins by presenting a case of a young man who admitted to using sadomasochistic pornography (of violent cuckolding) to masturbate to as a way of handling fights with and rejection from his girlfriend. He explicitly felt that this was a better way of handling things than giving in to his aggression towards her. The problem with such an approach, Nathanson says (here drawing, as numerous authors before her have, on the work of M. Glasser in the Rosen volume, Sexual Deviation, noted above) is that it rapidly becomes "both perverse and highly addictive" (139).

Nathanson's chapter is an attempt to synthesize "common themes and dynamics" across her many years of work with adolescent and young adult males presenting with sexual difficulties and offenses. Most of them wound up in long-term psychotherapy. All of them presented as "suffering, highly addicted to their destructive activities and feeling at the mercy of those, unable to free themselves, as they would desperately like to do in order to lead a normal life" (140). 

Central to every story, she says, is a theme of descending into a dark world. For many, this is a comforting and familiar world, a world where they can feel alive, where they feel their "real self" may be discovered, where their "real attachment" and "first love" abide (140). Such a world elides the problem of abandonment. It creates and welcomes plenty of bad objects which become perversely salvific.

Nathanson talks of how all her patients come sooner or later to a moment of realizing how and when their "fuck-it" button functions in life--that rapid moment of transition from one self-state to another which has previously been so rapid for them and so out of control that they find themselves back in addictive behaviors before they realize it, let alone attempt to control them or resist them. As one increasingly recognizes the dynamics of this process, she reports that patients notice things slowing down. The fuck-it button might still get pressed, but this time with a little more room for noticing, and perhaps very briefly tolerating, the anxieties that precede it.  

As this increases, patients realize how much they have ritualized, via negative behaviors, unintegrated anxieties, memories, feelings. Over time much of this can actually decrease: enactments may still happen, but with less intensity and frequency, and with greater realization and control: this is what she calls "emerging potency" (148). One patient noted "how not enacting sexually made him feel more potent, creative, and able to use his aggression to assert himself at work." 

Central to success in this work is an increasing "integration between the physiological and psychological, often reconfiguring the relationship between their bodies and their minds after many years of addiction and abuse" (149). 

In her conclusion, Nathanson affirms a practice that is central to the program I work in with adolescent sexual offenders: not just building a general relationship with each patient, but having each patient narrate in close and concrete and unsparing details the nature of their enactments and abuse. These are then "looked at carefully, under a microscope." 

Each of my patients struggles to do this, but it is key to all future progress. Such enactments, she says--echoing, of course, Bion--constitute "attacks on linking." The moment when the fuck-it button is identified is the beginning of the end of attacks on linking, the beginning of the restoration, in fact, of the capacity to see, and gradually to accept and tolerate, linking (between, that is, maladaptive behavior in the present along with anxieties and feelings from a traumatic past, which are now noticed and increasingly tolerated before being changed). 

Finally, Nathanson notes that responses to enactments are often much more effectively delivered by group therapy than individual. In the latter, responses from the therapist to enactments can seem authoritarian and punitive, shutting down the process of exploration and reinforcing the very habits of flight one is working to heal. A group, by contrast, offers different ways of exploring these enactments that eventually lead to their extinguishment (or at least very dramatically reduced number and nature).

In sum, then, From Trauma to Harming Others is a rich compendium of clinical experience that all those of us working with adolescents and young men struggling with sexual addictions and crimes can profit from with gratitude. 

In Praise of Nancy McWilliams: On Psychodynamic Therapy

I forget when I first stumbled upon Nancy McWilliams, but it was some time ago. I had started with W.R.D. Fairbairn's pioneering work on the schizoid personality, and then read Melanie Klein and Harry Guntrip on the same phenomenon.

It was, however, only when I came to McWilliams that I found an essay on the topic that is the clearest and most compelling treatment of them all. Not unrelated to this post, McWilliams in that essay quotes Harold Davis to the effect that “'psychoanalysis is a profession by schizoids for schizoids'.”

On the strength of that essay, and also very much respecting Jonathan Shedler, who regularly extolls McWilliams work on Twitter, I put her Psychoanalytic Psychotherapy: A Practitioner's Guide on my reading list, and have now had a chance to go through it very carefully. It is excellent, especially for those with little background in psychoanalysis. 

I appreciate her openness in the preface where she recognizes that there is a legitimate diversity of treatments, but that psychodynamic approaches are often neglected when it comes to studies of their efficacy. From here she notes that her approach in writing this book will be to emphasize what may be applied "to all clients," and not just those who have signed up for psychodynamic therapy. I take her to mean that psychodynamic theory is applicable and useful in understanding patients even if a given therapist operates predominantly from a tradition of CBT or DBT (etc.). 

In this she puts me in mind of the great philosopher Alasdair MacIntyre whose early work in the philosophy of science and the development of theoretical traditions--and the clashes between them--rightly reminds us that one mark of a stronger tradition is its capacity to more fully and helpfully account in a better way for the gaps in, or problems raised by, its rivals. 

The other welcome note in the preface is that McWilliams is not going to be a zealous crusader insisting that everyone must slavishly imitate her methods, or those of psychoanalysis more generally. Instead she speaks of the "need for therapists to honour their own individuality in the arrangements they make" (xiii). The preface ends by McWilliams recognizing her own debts to various figures, including Theodor Reik (he of the "third ear") and especially Frieda Fromm-Reichmann, whom I wrote about appreciatively and at length here. 

Later on she returns to this theme, insisting in several places that one should "integrate one's individuality into the role of therapist" (p.52) and that therapists are most successful when they "relax and let their unique personalities become their therapeutic instrument" (53). As she notes later, "when it goes well, psychoanalytic therapy feels to both parties like a conversation from the heart, not the head" (66).

The patient seeing you being genuine and open, and speaking from the heart, can find all this therapeutic. But we must, of course, do more than that--if a bit of warm listening and sincere opening up were all that a patient needed, then they would simply turn to a good friend or family member, not a psychotherapist. The uniqueness of the role is that we must also challenge patients to grow. 

Throughout the book one has the sense of serenity in McWilliams: she is not someone who defensively feels she must be a fierce advocate for or against any particular approach, or to challenge patients in an obnoxious fashion. In this, as I have remarked elsewhere, she stands firmly in Freud's line who, pace the myths talked about him, emerges in his correspondence and in Paul Roazen's original and invaluable scholarship, as very "liberal" in encouraging all sorts of methods of healing, not just psychoanalysis. 

In her discussion on the "American Medicalization of Psychoanalysis," McWilliams, in fact, emerges as a critic of the tradition she is defending and its "cult-like atmosphere," its often ideological and hidebound ways that have, perhaps more than anything else, contributed to the vastly diminished standing psychoanalysis has in this country. 

By contrast, she notes that contemporary psychoanalysis in this country, to the extent it remains viable and healthy, tends, rightly, to eschew tendencies towards "purity" of both theory and method, being comfortably eclectic in some ways ("I remain skeptical of orthodoxies, especially technical ones" [p.23]). 

In her first chapter she draws close to something I am working on in my next book: the increased openness towards spirituality in psychoanalysis today, and psychology generally. Here she references the work of Bion in particular, whom I discussed a bit here. 

What, if anything, distinguishes a psychoanalytic approach from any other? McWilliams begins by noting that there must be a "curiosity and awe" for the unconscious, and an awareness that most of our behavior, thoughts, and feelings are not in fact consciously determined. This requires of the therapist a willingness regularly to have what one thought one knew about the patient disconfirmed and disturbed. If, she suggests, one is attempting to practice some version of Freud's "evenly hovering attention," then this might not be so difficult for in that state one has not fixated on any one thing, least of all some notion of causation which might blind us to other factors in play. 

In her second chapter, McWilliams quotes Christopher Bollas from his first (and to my mind still his best) book, The Shadow of the Object: Psychoanalysis of the Unthought Known: "in order to find the patient, we must look for him within ourselves." 

She rounds out this chapter with a brief discussion on the role of faith--in the process, in ourselves, and in our patients--though there is no mention here of the extensive writings on the topic by Nina Coltart, who, to my mind, has covered this topic perhaps more forcefully than anyone else I know of. 

Chapter 3, "The Therapist's Preparation," begins by noting that we are going to make mistakes, and need to be okay with that. What happens after the mistake is often more crucial than the mistake itself. Will this lead to an enactment, or rupture, and if so, how is that handled? 

In her fourth chapter, McWilliams discusses the well-known findings about the centrality of the therapeutic or working alliance to the success (or failure) of all therapies. The patient cannot be expected early on to know to check in about this, so the therapist needs to make a regular point of asking  "How are you feeling about working with me?" or "Are you finding yourself comfortable talking with me?" (p.82). 

I have, so far, only once been scared by a patient, but I managed to wrestle control over my fear by, as it were, "channeling" the spirit of D.W. Winnicott (whom I last wrote about here), about whom it was often said that he refused to be afraid of his patients. I thought fear would be something you'd just have to get used to, if it came to that, but McWilliams addresses fear and threats of various sorts in several places in the book, and she helpfully reminds us that "the therapist's sense of safety is as important as the patient's" (80). 

Later on in a related vein she will note that protecting therapist and patient alike is also part of the reason for the frame, and one should never deviate from it lightly. If, she says, you ever feel uneasy about any request that seems to veer towards a boundary violation, trust your gut and err on the side of being conservative. Boundaries and frames, moreover, are crucial in managing the huge power differential that exists in therapy, of which we must ever be mindful. 

If a sense of safety on the part of the patient exists, and boundaries are in good working order, then the patient may begin to experience his capacity to express hostility and contempt toward the therapist without fear of retaliation. Handling this requires a deft touch so that you do not masochistically collude in diminishing yourself on the one hand, nor in reacting defensively and perhaps vindictively on the other. 

The topic of hate returns late in the book, when she notes that a therapist might well need to encourage a patient not merely to express that feeling, but even feel encouraged to enjoy it. 

Handling other requests also requires a deft touch. A bit earlier, in her section "The Art of Saying No" (p.126), she has some very useful advice which I had no sooner read then within a day or two had occasion to put it into practice, finding success on both occasions (to my considerable relief!). She refers to those sometimes awkward conversations one must have with patients, often over fees, or no-show policies, or other limits. Rather than give them a lecture on how such limits or policies are really in the patient's best interest, she finds it much easier to elicit co-operation if she presents those as helping to fulfill her needs. 

I did this with a patient who had sustained a serious injury and then not showed up to two appointments in a row. I could legitimately tell this person that I was worried they might have been hospitalized with worsening injuries and I was worried about them. This prompted a phone call the following week when another (different but serious) reason kept my patient from making the appointment. I think both of us felt relief that this was handled now openly and simply via this expedient manner. 

Chapter six ends with some welcome reflections on the nature of psychoanalytic love. Here, as earlier, she has returned to Freud's famous observation in a letter to Jung that psychoanalytic cures are, in the end, ones of love. This, she insists rightly, is not an infantilizing form of love but one of serious respect that takes account of all qualities, positive and negative, in the patient. It is not cheap sentimentality, and certainly never exploitative. 

Chapter 10 offers some brief comments on sexuality, noting "how sexually diverse people are," and learning this can often be a very freeing part of good psychoanalytic therapy: "the appreciation of sexual diversity and the capacity to own one's unique sexuality without apology are frequent 'nonspecific' outcomes" (pp.254-55). 

The final chapters of the book offer an array of more practical tips to therapeutic practice, with welcome comments on malpractice hearings and ethical violations, and how to handle them. The very last chapter is focused entirely on self-care, one form of which she advocates that I also greatly love doing: writing. Here she quotes Michael Eigen that "psychoanalysis is a writing cure, not only a talking cure. Writing helps organize experience of sessions, but it also helps discover and create this experience." 

In the end, McWilliams has a lovely answer as to why many of us might be, at least in part, motivated to do this work: "our patients heal us as we heal them" (p.281). 

Sadomasochism in Everyday Life

During the fall of 2018 I was on sabbatical and set aside plans to finish my book on Freud, and instead wrote what became Everything Hidden Shall Be Revealed: Ridding the Church of Abuses of Sex and Power, published the following year. 

Freud still featured in that unexpected book in important ways. I made the case for why Freud's theory of moral masochism was very helpful in explaining some of the continued cringe-making deference, indeed submission and subservience, to the "Holy Father" and pope of Rome and to all others bearing the title "Father" in the Catholic Church. Such submission is not a small factor in seeking to understand how and why this crisis of sexual abuse has gone on for so long and been so widespread across every continent on earth. 

Freud's 1924 essay "The Economic Problem of Masochism" was very helpful here, along with his other, better known works. That essay is available in this very rich collection: Essential Papers on Masochism. 

Since reading that book, and writing my own, I have had on my list of things to return to and investigate in more depth the topic of sadomasochism. Part of this is driven by clinical work with sexual offenders. 

But part of this is also driven by trying to understand certain dynamics within contemporary America, including contemporary American Christianity in its reactionary and "conservative" guises where the levels of cruelty have been revealed in the past few years in ways I still find astonishing both in number and degree. I am far from finished thinking through all these issues so I will say no more about them here.

Instead the purpose of this note is to draw your attention to a book I just finished this week which is very much worth your time if you are interested in these issues whether to understand your own life, or the life of your patients, or of parts of our culture, or perhaps all three. 

Before doing so, however, let me draw your attention very briefly to two other works I have found useful, and then a longer note about a third book in particular. 

The first book is one that R.A. Glick and D.I Meyers edited: Masochism: Current Psychoanalytic Perspectives, which was first published in 1988 and has a number of useful and insightful chapters by such well-known figures as Otto Kernberg and Roy Schafer. 

The second book is also an edited collection: The Clinical Problem of Masochism, eds. D. Holtzman and N. Kulish (Jason Aronson/Rowman & Littlefield, 2012). This work contains chapters again by Kernberg, alongside others such as Glen Gabbard, Stanley Coen, Harold Blum, and others. 

The book I want to focus on now has been published for nearly a quarter-century now, so some of its cultural references are a bit dated, but the overall discussion and analysis stands up very well indeed to the passage of time. The book is by a clinical psychologist and psychoanalyst in New York, John Munder Ross, and was published in 1997 by Simon & Schuster as The Sadomasochism of Everyday Life: Why We Hurt Ourselves--and Others--and How to Stop.

The sub-title and the fact of being brought out by a commercial publisher both suggest a certain "self-helpish" nature to the book, but the author, to his credit, largely steers clear of that. As author he's more a sober clinician than a gushing guru bidding for a spot on Oprah, and we can be thankful for that. At the same time, however, he manages to write as a clinician in a way that makes abundant use of examples from modern culture and describes them in ways those with little clinical or psychoanalytic background could easily grasp. 

Before diving into Ross, I went back to Freud's Three Essays on the Theory of Sexuality, and he does not equivocate in there when he argues that "the tendency to cause pain to the sexual object and its opposite, [is] the most frequent and most significant of all the perversions." And a little further on in this section he notes reassuringly that "sadism can be readily demonstrable in the normal individual" not least by looking at the forms of its "displacement" through aggression. And masochism, too, is equally widely to be found: "Masochism is nothing but a continuation of sadism directed against one's own person." (These views, of course, would be modified by some of Freud's later works, including the essay mentioned above, but the general point still stands in my view.) 

This is clearly where Ross picks up, too, as when, on the first page, he claims that "Scratch the most normal surface and you will find a little fundamental erotic sadomasochism in just about everybody" (p.11). Before we all run furiously to issue disavowals of this, note that Ross uses terms in the same way as Freud: "erotic," like "libidinal," is not the same thing as "sexual" and does not necessarily entail "genital activity." The former terms are used much more diffusely, and Ross gives examples that reassure us of this: the scab we were fascinated with picking as a child, or the neck-craning we do as adults at the scene of a motor wreck on the highway. Pain and suffering, both our own and that of others, often elicits a certain frisson in us, a soupçon of Schadenfreude if you will, however much admitting so is uncomfortable to us. But admitting so does not thereby entail copping to all of us having bondage dungeons in our basements! Ross's title here is important: everyday life. Dungeons are still a little outré for most of us!

Ross then brings to our attention people who, knowing what they are doing, and knowing the need to change, still engage in self-sabotage. In dramatic and large terms we know such people as, e.g., alcoholics who have lost jobs, children, marriages, even housing. But in smaller and more everyday terms, whom does he not describe? Which of us has not done this a little bit ourselves, and probably as recently as, oh, this week? Self-sabotage seems very much to be an everyday and a universal phenomenon. (It could have been something as banal as skipping on your workout this morning even though you know you need it after scarfing that entire bag of chips last night watching that old horror flick that always gives you nightmares and leaves you feeling anxious and fatigued the next day.)

Work with a patient once brought me back to Freud's little-known 1916 essay "Those Wrecked by Success" as a means of helping to understand how and why it is a person in the prime of life, who has achieved very widespread success and recognition, would descend into a fit of self-destruction. Ross also avers to this essay, which deserves more attention than it seems to have gotten.

Since the pandemic started, and more recently as it appeared to be winding down, how many stories have we been bombarded with about workers not returning? Restaurants are notoriously desperate for staff, truck-haulage companies as well, daycare institutions across the country, and just this morning a local story about 70 unfilled positions in the Indiana State Police after a rash of retirements and resignations. Everyone rightly focuses on the low wages in many of these occupations but in these and many (most?) other occupations, how much attention have we given to the power structures and their abuses? If, writing in 1997, Ross could claim this, it is surely a fortiori applicable today: "Nowhere in daily life is sadomasochism more constantly in evidence than in the institutions that constitute the workplace" (p.44). He expands on this a little later, noting that "surreptitious sadomasochism is to be found everywhere in the life of ordinary individuals and the institutions that organize their social lives" (p.47). 

Overt sadists are rare; so too masochists. Ross draws our attention to how often such phenomena are masked and only manifest clinically in compromise formations, therapeutic enactments, and of course the transference. For some particularly recondite sadomasochistic dynamics, I would follow Nina Coltart's lead and pay attention to whatever images, nicknames, or reveries thrown up in the counter-transference.

Much of sadomasochism, he says later in the book, must be seen as "obeying two basic principles of mental functioning: 'overdetermination' and 'multiple function.' In other words, it has many causes and, once it is in place, serves many ends" (p.160). Some of these manifestations and causes--and here Ross avers to the famous "third ear" of Reik--have to be listened and watched for in particular ways. 

Sadism and masochism may once have played a useful role in the child's development (Ross is familiar with the work of Klein and Winnicott in particular, and cites them later in the book), but he recognizes how "maladaptive" (96) such things usually become later in life. One manifestation in adulthood may be the lack of self-love: "Sadomasochists...lack the basic self-self with which to withstand the fact of their own repugnant but naturally ordained desires" (102). 

The reference here to self-love indicates that Ross is also familiar with, and occasionally quotes from, Heinz Kohut. I have not read as much Kohut as I feel I should, but Charles Strozier's biography is lovely and a worthy introduction to Kohut's life. (I suppose I should confess a bias here in that Strozier has been kind and helpful to me on a number of occasions in sending me drafts of stuff he was working on, and reviewing an article I was working on. It was through Strozier, moreover, that I was introduced to the enormously valuable work of Vamik Volkan.)

When I was on my fellowship at the Chicago Psychoanalytic Institute in 2018-2019, we did devote a day to Kohut and our teacher was very helpful in breaking down some of the recondite terminology and opaque jargon that Kohut seems to have unhelpfully delighted in. 

In addition to Kohut and the others, Ross also rightly draws on the work of Robert Stoller, to whom I was first introduced a few years back by the great Adam Phillips, from whom I have learned so much. Stoller's book Perversion: the Erotic Form of Hatred is one of the most insightful things I have read in this whole area. For Stoller many manifestations of masochism and sadism are "reparative" attempts by the adult self to turn childhood traumas into triumphs. 

Later in the book, Ross returns to Freud's views on moral masochism, and claims that "since neurosis is inevitable and universal, so, too, is moral masochism" (p.152). Here Ross links this back to one of Freud's last works, Civilization and its Discontents, suggesting that in some ways the price of civilized order is that we all must tolerate a certain degree of moral masochism. 

Moral masochism preoccupies the last two chapters of Ross' book. Chapter 9 ("Sadomasochism in the Treatment Setting: the Cure") argues that "the universality of moral masochism makes almost every course of treatment harder and longer than might otherwise be the case" (p. 185). Here, of course, our attention is drawn to negative therapeutic reactions, retrenchment, and so-called resistance. Here we are confronted, in some patients, with a high enough level of masochistic guilt that they keep themselves from betting better. (As Winnicott famously observed, "health is ever so much more difficult to deal with than disease.")

The therapeutic challenges are many, and Ross does not shy away from discussing them. He notes that people who punish themselves and are unable to allow themselves to get better do so because such reactions have many "internal and external masters" whose job is always to seek to maintain "the social status quo" (187). Thus for some, they really do prefer to remain in "an oppressive but contained and secure" environment of their own making--however painful it is to them and others. 

For the therapist inclined here, when faced with such patients, to resort to moral exhortation to grow past their masochistic masters, Ross rightly cautions us in no uncertain terms that 

The very act of offering advice runs counter to the ingenuity of psychoanalytic method [that]...is devised to draw out & then call into question the omniscience & omnipotence attributed to the practitioner by the patient & to analyze the sources of these illusions (191).

In saying this, Ross is echoing and in fact anticipating Adam Phillips, not least in the latter's recent book The Cure for Psychoanalysis (but see also his Terrors and Experts). 

What then, can the clinician, tempted to despair, actually do? Ross offers two things worth considering. The first has very strong echoes of Winnicott: "What is most significant for the resolution of masochistic conflicts...is the psychoanalyst's growing emphasis on the patient's capacity to be alone and to tolerate tension and uncertainty" (192). In increasing such an emphasis, the therapist has to find ways of gently but firmly thwarting the patient's desire for a panacea, for a clear-cut "fix" to all their problems. 

An additional way forward is here suggested by Ross: "in order to be free or independent, one must mourn one's past, refrain from taking the path of least resistance, and constantly act to impose one's will on oneself" (193). In saying this, Ross is rightly pointing out that the work rests on the patient. Here he reminds me of that constant refrain supervisors have given down through the ages: do not work harder than your patient. Ross makes this explicit thus when addressing the reader directly at the very end of his book The Sadomasochism of Everyday Life: Why We Hurt Ourselves -- and Others -- and How to Stop: "the responsibility for making changes is your own, and in a sense nobody changes anybody else's mind or heart" (220).