Sexualities and Identities:

It is the fate of collections to be often wildly uneven, and that is true with Sexualities: Contemporary Psychoanalytic Perspectives, eds. Alessandra Lemma and Paul E. Lynch (Routledge, 2015), xiii+244pp. There are two outstanding chapters, and two very good chapters; and then a great deal of other material some readers might find interesting or helpful but I did not. 

I read this book first for general interest, then because I work with adult and adolescent sex offenders ordered by the courts into treatment, and finally because I am working on an essay about the erotic in transferences and counter-transferences. 

I begin with Part III, "Homosexuality" and the first essay in this section by Peter Fonagy and Elizabeth Allision, "A Scientific Theory of Homosexuality." To my mind, this is the most outstanding essay in the book both for the cogency of the writing and for the challenging arguments it offers. The entire chapter--or at least the first half of it--plays something of a trick on the reader who, under that title, is led to expect something the authors very severely put to the question in the chapter's second half. That is, the first part is a brief review of the history of attempts to conjure up a theory of homosexuality (that history has recently been treated more expansively, but not entirely successfully, in a book I discussed here). 

Fonagy, of course, is the founder of the tradition of mentalization-based therapy, about which see here and here. He has also published on possible connections between infantile experiences and attachment, and the development of sexuality. 

With Allison, the burdern of the second half of their co-authored chapter is introduced and encapsulated by the claim that "normal sexual desire is inherently unknowable....Part of the essence of desire is that there is something anti-conceptual, something indefinite and unknowable about it" (p.133). This, in turn leads to one of the other major claims by these authors: "neither homosexuality nor heterosexuality are 'normal' and...neither can be an identity."

I rather imagine that both claims will immediately set some teeth on edge, but both are for me so straighforwardly obvious and true they cease to require additional argumentation. 

These claims are not, of course, entirely original to these two authors. Adam Phillips, for one, has argued something similar about the inherent unknowability about sexual desire and identity, especially in his 1997 book Terrors and Experts, where he has repeatedly noted that "there is nothing like sexuality...for making a mockery of our self-knowledge. In our erotic lives, at least, our preferences do not always accord with our standards." Later in the book he continues by arguing that "from a psychoanalytic point of view, nobody can know about sexuality" in part because "we are never one thing or another, but a miscellany. (For how long in any given day is one homosexual or heterosexual, and can you always tell the difference?)" 

The, uh, desire to have definitions and identities clearly nailed down is, Phillips suggests, an expression of our "wish to be defined [which] is complicit with the wish to be controlled." Additionally, the ham-fisted insistence on clear and sharp definitions runs the very real risk that "too much definition leaves too much out." Too much definition, in other words, undermines mystery and freedom alike. 

This, too, is very similar to what Fonagy and Allison argue: "the essence of desire is its indefiniteness." Indefiniteness means that we can have no legitimating theories of human sexuality, and these authors end their essay by suggesting that such theories in the past have functioned in an anti-mentalizing fashion, shutting down the ability to think about ourselves in ways that take account of our complexity and messiness: "it behooves us to be suspicious of ourselves when our wish for simplicity begins to override out respect for the complexity of subjective experience that our patients engender and bring with them in relation to their experience of their sexuality" (p.135). 

Anyone who has done clinical work for more than a week will immediately realize the profound truth of that last statement. And it shows up in several other essays, as well, including the moving and somewhat melancholic "Intimacy and Shame in Gay Male Sexuality" by Paul E. Lynch: "the beauty of working with patients instead of theories is that they are not so determinedly insistent on conclusions about their own sexuality, and are more often trying to find some way to make sense of themselves, their bodies, their pains and pleasures, and their relationships" (p.146). (Briefly towards the end of his chapter, Lynch suggests that "transgressive sexual behaviors may be an enactment or embodiment of un-represented, un-symbolized, or unformulated early experience," a theme that Adam Phillips has also briefly touched on, and before them both found in the works of Robert Stoller, including Perversion: the Erotic Form of Hatred.)

Earlier in the collection, Mary Target suggests that "fully expressed adult sexuality, regardless of dominant gender identity or orientation, incorporates unconscious bisexuality and bluring of the gender role of self or other." All of these authors, of course, are merely echoing what Freud first postulated in his infamous 1905 Three Essays on the Theory of Sexuality:

Since I have become acquainted with the notion of bisexuality I regarded it as the decisive factor, and witout taking bisexuality into account, I think it would scarcely be possible to arrive at an understanding of the sexual manifestations that are actually to be observed in men and women.

Lynch's claim about un-represented forms of sexual desire and behavior shows up in the last two chapters of this collection, the first written by Avgi Saketopoulou, who has also recently published Sexuality Beyond Consent, which I hope to read over the Christmas break. Her chapter here is entitled "On Sexual Perversions' Capacity to Act as Portal to Psychic States that Have Evaded Representation." 

She grapples with the continued use of the word "perversion," before arguing that we might retain it because it "captures the phenomenology of sexuality that blends anguish and/or pain with pleasure." Those who work clinically, as I do, with patients whose desires have been judged (often by courts, but sometimes by parents or themselves) as perverse and illegal know well this unique, and uniquely difficult, blend of anguish and pain: the desire that is unwanted, that has brought such trouble and left a streak of such devastation, is also a desire not without a certain frisson. Rather than condemn all such desires a priori and totally, we must, if we are to be of any help clinically at all, recognize that in some cases there may be real attempts to grapple with things that were unthinkable to the developing mind. As she puts it, "some sexual perversions...may be understood as proto-attempts towards figuration" (p.214). In the process of trying to figurate such experiences and desires, we must, she concludes, "always be aware" that some things are "eternally inaccessible to us, impossible to bring into knowable experience." Once more those with even modest clinical experience will at once recognize this as true.

Finally, Heather Wood concludes the book with her "Working with Problems of Perversion," and takes a much more practical approach, showing how many and how often perversions function as defensive measures to keep at bay the ever-threatening peril of intimacy and its possible engulfments. Drawing on Glasser's earlier work, Wood argues that "sexual perversions have very little to do with sex...but are about the use of sexualization as a defence to deal with primitive terrors in relationships" (p.224).  Such terrors include an uncertainty about whether the patient's own aggression can be controlled in a relationship or whether it will give rise to sadism and destruction. 

Wood also offers some helpful counsel about working in the transference with such patients, and dealing with counter-transference reactions. Many of us are anxious about sexualized transferences, and perhaps even more sexualized counter-transferences (a topic I'm writing a paper about just now), but she calmly suggests that if we keep in mind her claim above--that sexualization is a defense mechanism like other defenses--it should help us be less anxious about it. We must still, however, examine closely our own reactions as well as the transference to see whether they are about: control? sadism? anxiety? intrusion? seduction? taming a frightening object? fear of abandonment? a defense against destructive urges? a desire for merger which is intolerable and must be defended against? 

In some cases, Wood suggests, after the above forms of sexualization have been worked out, one occasionally might then begin to see less defensive sexual feelings emerge toward the clinician: "it may be important that these feelings are tolerated rather than viewed as defensive if true integration of sexuality and dependency are to occur" (p.228). 

This note has only touched on some of the essays in this rich collection. Anyone interested in sexuality and psychoanalysis will want to have this book on their shelf. 

On Love, Eros, and the Perverse

Introduction:

Recently with my students, I began a discussion about transference and counter-transference in psychotherapy, including erotic transferences and counter-transferences. The class seemed to cleave into two: those who regarded the idea of any sort of erotic feelings arising, in either direction, as "gross"; and those who didn't see what the big deal was. I'm not sure by whose response I am more disconcerted. 

Part of the difficulty turns on the wide variety of meanings attached to the term "erotic." I tried, following the ancients, to expand upon it as something much wider and more vital than the merely sexual or, narrower still, the genital. I brought in Freud's notion of the libidinal and its close links in to the notion of both "life" and "love." This gained traction with the students and also frank relief among them. At last they seemed to find a notion they could relate to: the erotic as something that excites deep and wide interest, even "passion," as people often say today, without necessarily implicating them in some sordid desire for sexual intercourse with whatever/whomever this objet is. 

In talking with them, I was of course drawing on what I've written previously about what I have learned, and am still learning, from Andrea Celenza, especially in her vitally important book Erotic Revelations: Clinical Applications and Perverse Scenarios (Routledge, 2014). I drew on her work with my students in attempting to illustrate the polymorphous ways in which erotic desire can arise in treatment. As Celenza shows, such desire, far from being avoided as it almost universally seems to be today, can in fact be helpful--but it can also lead to disastrous outcomes if not handled well. 

On the strength of how much I had learned from that book, I recently bought another of hers: Transference, Love, Being: Essential Essays from the Field (Routledge, 2022). There are riches scattered throughout this collection, one of whose chief virtues is that almost every chapter is 3 or at most 4 pages in length. 

The collection begins by reflecting on the disappearance of the notion of love in psychotherapeutic practice. And that reflection itself begins by referring to Philip Bromberg's work, who really deserves (and will one day achieve) an essay of his own on here. When someone introduced me, last fall, to his essay "Standing in the Spaces," it effected a sea-change in how I conceive of my own mind and the notion of selfhood and psychic change. It also changed for the good how therapy was progressing with one particular long-term case that seemed to be bogged down. 

Since then, I have used excerpts from his essay in a number of classes, and in every case it has stirred up lengthy and fascinating discussion. 

Celenza says that the splits in the self, which Bromberg focuses on, can be helped by reconsidering and reintroducing the notion and practice of love, properly understood, in the therapeutic relationship. 

Disappearing Love and Hidden Sexuality:

Along with the disappearance of any notion of love in contemporary practice, Celenza, in this book and her other one, has pressed the case more relentlessly and compellingly than anyone else I have read about the disappearance of sexuality and the erotic, citing a word-count Fonagy did some years back showing that terms like 'relational' are all over the literature today, but 'sexual' and cognate terms have taken a nose-dive. This leads Celenza to claim that "there is an unmistakable desexualization that pervades psychoanalytic theorizing...., an erasure of the natural erotic and sensual aspects of intersubjectivity" (p.75).

Celenza, later in this chapter, speculates that perhaps this disappearance has someting to do with the fact that, understood classically, "Eros is described as the son of Chaos, the original primeval emptiness of the universe" (p.76). She does not elaborate the point but the suggestion seems to be that therapy is often difficult enough without (one imagines some bedraggled, overworked, underpaid clinician moaning) introducing further potentially destabilizing and presumably difficult elements such as the erotic.

But at what cost do we exclude such things? In later chapters, she returns indirectly to the theme saying that "we must have the full range of affectivity at our disposal" in order for us to "help our patients...experience the excitements and mysteries within themselves" (113). These excitements, she notes a page later, "include allowing sexual desire to be present in our countertransference." The point of doing so, she repeatedly notes throughout the book, is to serve the patient: "the more we can acknowledge what we feel at work with our patients, the better we do." (Her earlier book, Erotic Revelations, has helped me greatly in seeing that such feelings can be stirred up within us in ways that unconsciously and blithely ignore our cultured notions of "gender" and "sexual orientation.") 

The Perverse and Sadomasochistic:

The essays in the final section are the ones I gravitated towards the most for I have for some time been engaged in trying to understand manifestations of what she calls "the perverse," including sadomasochistic fantasies and actions of some patients.

Some interesting work has been attempted here over the years, but there seems to have been gaps in the literature. Robert Stoller's book Perversion: the Erotic Form of Hatred, from the mid 1970s, seems to have been one of the first major works in the area. The topic comes and goes across the decades. There was renewed interest in the late 90s on the "perverse," and I have to say that it was a great surprise to see my first analyst's work in this area cited in Celenza's chapters and notes. (See also this essay by Dr. Louise Carignan, whose winsome necrology is here.) 

Celenza brings much (not all) of this literature together in chapters 30 and 31, which I found the richest in the book. She begins, rightly, by trying to define terms, offering "a contemporary definition of perversion that reveals a form of psychic functioning as a quality of being toward others, toward one's body, or toward internal objects" (p.139). This differs, she says, from past definitions which were almost always entirely behavioral in nature. She continues: "I propose that a perverse internal psychic mode is one where affective embodied and pre-reflective self-experience is split off or dissociated." 

Chapter 31 is perhaps the longest and most helpfully detailed in the book, and continues on these themes. She explicitly reviews the past literature to see what she finds still useful, discarding the rest. She says that any new attempt at defining the perverse must abandon "phallocentric and heteronormative assumptions." 

What does perversion look like in action? She begins by arguing that "persons engaging in perverse scenarios are attempting to imagine a one-person universe" (142). The tracks closely with cases I have seen clinically.

From here she lays out seven "characteristics that define a perverse quality of being." These are:

• Constriction and Constraint
• Repetition
• Objectification
• Sexualization
• Desire to Harm
• Means/End Reversal
• Absence of Symbolization. 

Taken together, these are usually brought to bear in constructing scenarios and fantasies to manage anxiety, ward off danger, and maintain control. As Stoller put it, sadomasochistic fantasies are usually ones of triumph that at some level are thereby trying to reverse the traumas of the past. They have a dead and deadening, self-reinforcing nature to them; their objects are sexualized to turn threats into pleasure; and there is very little ability to play with them in a symbolic register. She very helpfully elaborates on all these points in some detail, and with clinical material--as she does in nearly every chapter. 

Overall, then, Transference, Love, Being is a rewarding collection and I continue to be grateful for having been led to Celenza's work.

On Sexualized Defenses, Transferences, and Counter-Transferences

Though I can remember almost none of my undergraduate professors at the University of Ottawa from the early 1990s, I have never forgotten Dr Arthur Blank, for both salutary and unsavory reasons. The salutary: I got to write a research paper in his Family Psychology class on what happens to families (such as mine) with a child who is chronically ill and then dies, and it was a profoundly revealing and helpful experience which earned me an A (not a grade I was anywhere near in my psychometrics or neurobiology classes that semester!), and gave me new and more sympathetic insights into what my parents faced and the choices they made to concentrate on my sister in the last six years of her life to the inevitable and unavoidable neglect of me and my younger sisters for most of our late childhood and nearly entire adolescence. 

The unsavory: a few months after class ended, he was in the papers on a regular basis being sued by former patients whom he had sexually abused in his private practice, including a woman who went into therapy with him to deal with having been sexually abused while growing up. He would be struck off the register of psychologists in Ontario and have to pay hundreds of thousands in damages to his ex-patients. I read the newspaper accounts with horror that a man could do such a thing to vulnerable patients. 

This coincided with living with a roommate, whom I knew slightly from my church (which very much encouraged his moving in), who had all kinds of issues with boundaries; we ended up having to ask him to leave. And it also coincided a few months later with my starting analysis and the great pains my analyst took to coax me onto the couch, which I was more than a little frightened of for the vulnerable position it places one in. ("What's she thinking back there watching me? What if she reaches around and touches me before I can see what she's up to and leap out of the way?")

Boundaries, then, have long been prominent in my mind. A few weeks back, I had occasion to read Glen Gabbard, "Lessons to be Learned from the Study of Sexual Boundary Violations" last week (American Journal of Psychotherapy 50, Summer 1996: pp.311-322). I posted insights from that on Twitter. He offers clear and concrete guidelines for avoiding boundary violations based on his work with more than 100 such cases. 

As important as his work in this essay is, he does not reflect on what might be useful in erotic transferences and counter-transferences and how to handle them in a profitable way that does not lead to disastrous outcomes. That crucial task falls to Andrea Celenza, Erotic Revelations: Clinical Applications and Perverse Scenarios (Routledge, 2014), who breaks the ice on these discussions (for me at least). As she notes, much of the clinical literature and likely almost all supervisory contexts avoid the topic because of the understandable fear and even shame such things evoke. 

I was not familiar with her work until Adam Rodriguez on Twitter mentioned how important her work is, and how she should be required reading in training programs. Having taken at least one lesson from her already, and used it in my own supervision, I would agree: she offers insights that begin a long overdue discussion, and we should be introducing that discussion to our students and supervisees. 

What do I mean by that? My take-away from her many insights is that there is a necessary difference between erotic attraction and sexual enactment, and that to feel and discuss the former without shame is not to necessarily risk the latter. Indeed, to put the point more strongly: perhaps the extent to which we feel more free to discuss erotic elements in the transference and counter-transference we may deprive them of the power of secrecy which so often masks and precedes boundary violations. Reading her book has in fact moved me along into feeling more comfortable discussing these things with my own supervisor, who has himself published on problems of sexual boundaries with certain populations, and discusses these with grace and good humour (not unlike Celenza's own supervisor as recounted in an hilarious anecdote on p. 69). 

The other crucial insight she offers is that sexual desire between patient and psychotherapist is always complex and complicated. Though Celenza is not so blunt on this point, I take her to be reminding therapists that if you think your patient really wants to just have sex with you in some straightforward manner, then you are deluded and have indulged in a self-serving and grossly reductionistic attempt to focus on only one thing: your desire. In this monomaniacal pursuit, you not only take your eye off the patient and his or her welfare, but you also fail to recognize that the patient's putative desire for you is highly ambivalent and complicated by many factors, and most certainly does not mean what you want it to. 

She puts it more elegantly and less compactly throughout the book, noting, first, that "being multiple selves is the human condition, and being multiple others to our patients is the analytic condition" (p.62). This multiplicity of self-states comes up several times in the book, and puts me in mind of a wonderful essay by Phillip Bromberg, "Standing in the Spaces," that I read recently and profitably. 

She continues in this vein, arguing, second, that "the gender that the analyst is...is not necessarily the only gender the analyst can be in the erotic transference" (ibid). I found this very revealing, opening up a new way of trying to understand same-sex erotic transference which baffled me in one particular case.

So the patient--whether male or female--could be responding erotically to us in a more maternal or masculine, or paternal or feminine role, or mixtures thereof; they could be responding from a younger and more childish part of the self, or (in our counter-transference) we to them from such multiple and entangled and ambiguous self-states of our own. Thus we see that the erotic response of patient to analyst, and therapist to patient, is not at all clear or straightforward, and responding as though it is will always invite disaster. (Celenza notes in an offhand passage something that Gabbard goes into in more detail: sexualized boundary crossings often happen when the therapist is engaged in "defensive efforts to manage our self-neglect" [p.67, with a reference to her 2007 book on the topic].)

Third, she states a little later that "the wish to know the analyst sexually is invariably complicated and usually highly conflicted. And if it is not, it should be, given the inherent power imbalances" in the therapeutic relationship (p.79). This theme of power imbalance is one she threads throughout much of the book, noting that it is inevitable no matter how much some misguided efforts might be made to flatten things and to insist patient and clinician meet on equal terms. We do not, and never will. 

I remember almost nothing else from one of my first supervisors, but he made damn sure to pound into my head one crucial point: We are not and never will be friends with our patients. A fortiori, we are never going to be lovers, either. As Adam Phillips says in one of his many wonderful books, psychoanalysis welcomes exploration of any and all topics no matter how emotionally and erotically laden and we can do this only because we agree never to have sex with each other.

On the question of sexual desires and their conflicts, I think the crucial passage in the entire book is this:

What do our patients want? They say they want our love, or more pointedly, to have sex--but do they really want that? We are many things to our patients simultaneously and equally important: analyst, woman, person, mother, father, sibling, and child....At any one time a plea for love or sex is a plea from within only one of those dimensions....The man may want a kiss, but the child does not. 

From this she follows up even more directly, insisting that "our patients do not really want us to gratify their erotic wishes, despite their vociferous protests to the contrary. But they do not want us to simply maintain our professional role either" (p.68-69). 

How, then, ought we to handle such things if it seems we are caught on the horns of a most serious dilemma? I confess I was gratified to read of her approach, which I stumbled upon myself before I had heard of this book. Celenza notes that if we cannot indulge patient desires, nor shut them down in a brutally "professional" way (for both responses harm patients in different ways), what is needed of us? Patients need us to respond to them as human beings, and so she said that sometimes a response like "I would if I could!" or "In another time or place" are just the sorts of responses "we need to convey to our patients" (p.69). (Quoted in this way, it may sound like Celenza is a bit flippant about such matters, but the force of her cogent book is quite to the contrary: she has clearly thought about such matters in depth and has hard-won wisdom abundantly displayed throughout the book.) 

I do not want to suggest this book is only devoted to these issues. Its other riches include good discussions in ch.1 especially on overly restrictive ideas of gender and on the uses of sexuality as a defense mechanism. Ironically, sexualized defenses and behaviors can often be used to stave off intimacy--a theme she devotes the entire second part of the book to in her focus on sadomasochistic and perverse habits and enactments. 

That final section, on sadomasochism, explicitly draws on a book I have half-finished right now: Robert Stoller's Perversion: The Erotic Form of Hatred. Celenza picks up where Stoller (whose work was published in 1975 but still has valuable insights for me at least in clinical work with sex offenders) leaves off and gives us a nuanced and balanced assessment before concluding that in her view sadomasochistic enactments are problematic insofar as they may be attempts to destroy any "tolerance of dependency, vulnerability, and self-revelation" (p.114) and may participate in "dehumanization of the other" (p.109). She notes that too often sadomasochistic habits may exist as a "closed feedback loop in which repetition and sameness is substituted for creativity and growth" (p.100). She gives an encouraging case study of one such patient who was finally able, after intensive analysis, to move into a much freer and more loving relationship with a woman who became his wife.

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).