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1991 Sadomasochism, Sexual Excitement, and Perversion. J. Amer. Psychoanal. Assn., 39:333-362 (APA)
Sadomasochism, Sexual Excitement, and Perversion
Otto F. Kernberg, M.D.
ABSTRACT
Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations, and of the very nature of sexual excitement. Sadomasochistic elements are also present in all sexual perversions. Sadomasochism starts out as the potential for erotic masochism in both sexes, and represents a very early capacity to link aggression with the libidinal elements of sexual excitement. Sexual excitement may be considered a basic affect that overcomes primitive splitting of love and hatred. Erotic desire is a more mature form of sexual excitement.
Psychoanalytic exploration makes it possible to uncover the unconscious components of sexual excitement: wishes for symbiotic fusion and for aggressive penetration and intermingling; bisexual identifications; the desire to transgress oedipal prohibitions and the secretiveness of the primal scene, and to violate the boundaries of a teasing and withholding object. The relation between these wishes and the development of erotic idealization processes in both sexes is explored in the context of a critical review of the pertinent psychoanalytic literature.
THE PRINCIPAL THESES OF THIS PAPER are: Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations. It is an essential part of the very nature of sexual excitement. Sexual excitement is a basic affect: it is a fundamental constituent of libido, which I see as a hierarchically supraordinate drive. This idea is in consonance with proposals in my earlier work that consider affects as the "building blocks" of drives (1976, pp. 85?07);
Associate Chairman and Medical Director, The New York Hospital-Cornell Medical Center, Westchester Division; Professor of Psychiatry, Cornell University Medical College; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research.
Presented at the panel on "Sadomasochism in the Perversions," Fall Meeting of the American Psychoanalytic Association, New York, December 17, 1988. Accepted for publication April 27, 1989.
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(1982; in press). Sadomasochism may present as a specific perversion. This perversion is characterized by deriving pleasure from inflicting or receiving pain as an obligatory precondition for achieving sexual gratification and orgasm. This obligatory precondition implies a restriction in the variety, scope, and flexibility of sexual life. The degree of severity of this perversion depends on the degree of ego and superego pathology.
My basic theoretical frame stems from Freud's (1905) description of infantile sexuality. However, I consider the source of the libidinal drive to lie not in the excitation of erogenous zones per se, but in the affect of sexual excitement, which incorporates zonal excitation together with the cognitive aspects of early object relations and other communicative, neurovegetative, and psychomotor substructures of this affect. My view of sexual excitement as a basic affect also incorporates Erikson's elaboration of the theory of infantile sexuality in terms of modes and modalities of object relations implied in the activation of zonal excitation (Erikson, 1963, pp. 72?08).
In earlier work (1986), (1988a), (1989) I stressed the crucial importance of the levels of personality organization梚n other words, of psychic structure梬hen assessing perversions. The difference between perverse fantasies and their symbolic enactment in sexual relations and love, on the one hand, and a consolidated perverse structure, on the other, depends on the nature of ego and superego organization.
The psychodynamic meanings of perverse fantasies and actions lie on a continuum, from normality to psychopathic perversion. The structural characteristics of the different clinical types and degrees of perversion vary greatly, according to whether they are associated with an integrated tripartite structure of normality and neurosis, at the one extreme, a borderline and narcissistic personality structure in the intermediate realm, or with the syndromes of malignant narcissism, antisocial personality structure, and perverse organization in psychosis, at the other extreme. The degree to which the perverse tendencies are transformed into action depends on the predominance
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of aggressive over libidinal components in the individual's instinctual equilibrium and the regressive nature of his personality structure, including the regression and/or disintegration of the superego, the predominance of splitting processes in the ego, the consolidation of a pathological grandiose self, and the weakening and loss of ego boundaries.
Some Illustrative Cases
The following five cases illustrate sadomasochism at various levels of psychopathology, short of actual psychosis. Listed in the order of the severity of the pathology, they should serve to put my discussion in context.
Case 1
The patient, a man in his early twenties, masturbated on the roofs of buildings and threw bricks on women walking on the street below; he reached orgasm at the moment when he either hit a victim or observed the extreme fright of a potential victim. This patient, temporarily hospitalized at the time of his evaluation under court order, presented a sadistic perversion unmitigated by any sense of guilt or any capacity of concern for his victims or for himself. He also evinced a combination of grandiosity, arrogance, and contempt as dominant characterological features. He illustrates the combination of a sexual perversion and a total deterioration or absence of superego functions in the context of a narcissistic personality structure. He was clinically not psychotic, and I formulated the diagnosis of a sadistic perversion in an antisocial personality. Sadistic perversion can also be present as part of psychosis, a further degree of this extreme psychopathology.
Case 2
A man, in his late thirties, was in psychoanalytic treatment because of a long-standing incapacity to commit himself to any
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loving relationship with a woman, sexual promiscuity, and growing dissatisfaction with his sexual life. He was white and had a black mistress, a colleague at work with whom he collaborated in creative projects. She loved him, accepting the limitations of their relationship, which had a sporadic, discontinuous quality stemming from him. Although he had had homosexual experiences in the past, and considered himself "potentially bisexual" as an expression of his sexual freedom and superiority, his current sexual experiences were almost exclusively heterosexual.
What he enjoyed most with his current mistress was a triangular situation: Having persuaded her to participate in a m閚age ?trois, he would offer her as a sexual partner to a close male friend. His sexual excitement peaked when, while she was having intercourse with his friend in the patient's presence, she would look at him with a loving expression indicating that she was submitting herself to this sexual relationship only because he had asked her to, and with him in mind as her sexual object. Analytic exploration revealed that the meanings of this scene included his unconscious wish to humiliate her as revenge against a hated maternal figure, and the reenactment and magical reversal of his fantasy of being the "excluded third party" of the primal scene: in his fantasy, it was now his friend (= father) who was really the excluded third party. While this was not an exclusive, obligatory, and constant aspect of his sexual behavior, it constituted his most intense and enjoyable way of achieving sexual gratification. This patient presented a narcissistic personality, and, in the transference, a typical "perverse" development (Kernberg, 1985) in the sense of a transformation of everything "good" received into something "bad." He showed a consistent though unconscious effort to utilize the understanding gained from me to demonstrate his independence from me, the futility of psychoanalysis, and the superiority of sadistic enjoyment to any other type of human interaction. At the same time, however, this patient presented good superego functions in all nonsexualized aspects of his daily life, and
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responded positively to psychoanalytic treatment over an extended period of time.
Case 3
This case, reported in another context in an earlier publication (1976, pp. 181?82), is of a woman with severe sexual inhibition, a lifelong incapacity to masturbate because, immediately following any sexual excitement, the face of her mother would flash up in her mind stopping her from further masturbatory activity. Her only erotically exciting behavior was represented by cutting herself in various parts of her body; the excitement was produced by observing blood flowing from these wounds (unconsciously representing an infinite number of tiny vaginas). She developed, in the course of her treatment, the fantasy in the transference that, if I were willing to shoot and kill her, she would feel fully gratified sexually. My killing her would mean that she mattered to me more than anything else in my life, and it would unite us forever in a way in which no other human interaction could. This patient, with a severe personality disorder involving schizoid, masochistic, and obsessive features, functioned on a borderline level of personality organization. She responded very well to psychoanalytic psychotherapy over several years (with an early resolution of her self-mutilating tendency), but her sexual inhibition diminished only very slowly and gradually over the years. This patient illustrates a masochistic sexual organization at a very primitive level, in the context of both lack of activation of ordinary pleasurable features of sexual excitement and an inordinate development of the aggressive components of it. Here, the aggression dominant within sexual excitement was matched with a well-integrated yet extremely sadistic and self-punitive superego.
Case 4
The patient, a man in his middle forties, was impotent with his current girlfriend, a woman he loved deeply but with whom he
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was shy, at times even submissive, although he could be sexually free and fully potent in sadistic involvements with other women if they followed a carefully designed and ritualized protocol. The woman with whom he could be sexually potent had to receive him at the door of the apartment on her knees, suck his penis, then guide him to the bedroom where she undressed, was tied up, and whipped with a careful limitation of the degree of pain or lesions that he inflicted on her. When she appeared to experience only pain and no longer sexual excitement, whipping her lost its attraction for him. He ended his sexual encounter with satisfactory genital intercourse and no potency problems. He had this arrangement with several women over the years, and, apart from this specific scenario, he was concerned and helpful to, though not in love with, these women. This patient presented a sadistic perversion at a neurotic level of personality organization and a personality structure with hysterical and obsessive features. Psychoanalytic exploration revealed that his perverse ritual protected him against underlying castration anxiety, frightening competition with a powerful and dominant father, and an unconscious sense of himself as a little boy who would not be able to gratify the idealized oedipal mother.
Case 5
This is the case of a woman in her early forties with a depressive-masochistic personality structure, in a late stage of her psychoanalytic treatment, during the course of which she was able to resolve an incapacity to achieve orgasm in intercourse with her husband, after many years of marriage. In one session, she developed the fantasy in the transference that she would come to a session, undress totally, and I would be so impressed by her breasts and her genitals that I would become a complete slave to her desire, respond by getting sexually excited and having intercourse with her, and she, in turn, would then be willing to become my slave and leave everything to follow me.
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The only daughter of a dominant, prohibitive mother who was intolerant of any sexual manifestations in her daughter, and of a warm yet distant father who spent time away during extended periods of her childhood, she became immediately aware of the connections between her wish for a sexual relation with me and the rebellion against mother implied in the wish to seduce father away from her. To make me her slave combined the wishes for my full acceptance of her genitals and her sexuality, while punishing me for having preferred other women (her mother), and offering herself in turn for slavery to expiate her guilt. But she also experienced the enactment of the slavery fantasy as an exciting expression of aggression without having to fear its inhibiting effects on her sexual pleasure. To the contrary, she felt that this aggression would heighten the gratification of total intimacy and fusion in the reciprocity of slave and master involvement. Following that session, she was able to ask her husband, for the first time, in the middle of sexual intercourse, to pinch her nipples forcefully, which he did with intense sexual excitement, permitting her, in turn, to scratch his back deeply, so that he bled, and both, for the first time, reached an intense orgasm together.
In analyzing this experience, she expressed the fantasy that her husband was like a hungry, frustrated infant biting mother's breasts, and she, as mother, could gratify his needs while tolerating his aggression, that is, a powerful, understanding, and giving mother. At the same time, she felt, she was also a sexual woman relating to her husband-infant who thus was not a threatening father, and yet taking revenge against father who had abandoned her as well as against her husband himself, who had caused her pain, by causing him in turn to bleed. And she felt that to scratch him while embracing him tightly intensified their fusion and her sense that she could participate in his orgasm while he could participate in hers. The case of this patient, approaching completion of her analysis, illustrates important normal facets of sexual excitement, to be specified further on.
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The Spectrum of Sadomasochism
In summarizing my view of the dynamic and genetic aspects of sadomasochism as a perversion (1989), I pointed out that, in contrast to the traditional relegation of polymorphous perverse features as appropriate merely to sexual foreplay, I consider them a crucial aspect of normal sexuality. These polymorphous perverse features emerge in many unconscious and conscious fantasies regarding sexual intercourse, and in the general erotic and emotional interactions of the sexual couple. Organized perversions at a neurotic level of personality organization do present, in both sexes, the psychodynamics originally proposed by Freud (1905), psychodynamics centering on the fixation at a partial, component drive in defense against full genital sexuality with its oedipal implications, the threat of incest, and castration anxiety.
What is striking about sadism and masochism and, in practice, the various combinations of these complementary sexual orientations, is that sadomasochistic elements can be found not only along the entire spectrum from normality to severe psychopathology, but as an essential component of all other perverse elements of sexuality. Thus, in voyeurism, exhibitionism, fetishism, bestiality, homosexuality, transvestism, we clinically always find sadomasochistic elements, and a careful study of the entire literature points to the indissoluble connection between sadomasochism and sexuality in general. Stoller (1985) has pointed to the universal nature of aggression as an aspect of sexual excitement, but has also stated that "when present, it is often a whisper, not a roar, and only a part, not the whole" (p. 42).
Cases of stable perversion and borderline personality organization, in contrast to perversions at a neurotic level of personality organization, typically present the dynamics described by British and French authors (Chasseguet-Smirgel, 1985a), (1986);
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(McDougall, 1978); (Meltzer, 1973), and they show the same condensation of oedipal and preoedipal conflicts under the dominance of preoedipal aggression characteristic of borderline personality organization itself. This condensation includes a regressive primitivization of the oedipal conflict, characterized by extremely primitive and threatening images of both parents, threatening combined father-mother images, and regressive distortions of unconscious perceptions of the functions of the genitals and the primal scene. It is clinically very different from the defensive regression to preoedipal stages of development found in patients with neurotic personality organization. Patients whose polymorphous perverse features are totally inhibited not because of repression, but from lack of activation of early eroticism (that is, some extremely inhibited borderline but not hysterical patients) present the same borderline dynamics. Their sexual inhibitions are the most severe that we encounter in clinical practice.
Sexual perversions in the narcissistic personality structure, particularly in malignant narcissism, show the psychodynamic constellations outlined by Chasseguet-Smirgel (1985a), (1985b), (1986). The full deployment of a regressive "anal universe" described by her overlaps the syndrome of malignant narcissism plus an organized perversion. The primitive destruction in unconscious fantasy of the contents of mother's belly as part of a general intolerance of reality, of the differentiation of sex and ages, and of the acknowledgment of the oedipal father, with a consequent severe disturbance in cognitive processes as well, are typical for the most severe of these cases of perversion in narcissistic personalities.
The cases I have described illustrate an additional aspect of my clinical experience, namely, that, while sadomasochism as an organized perversion (like all organized perversions) is probably more frequent in men (Money, 1988), I have found that sadomasochistic fantasies are probalbly more frequent in women, particularly in their masturbation fantasies.
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The most prevalent psychoanalytic view about this apparent predominance of organized perversion in men links it with a greater intensity of castration anxiety in men. This seems a reasonable hypothesis, and I would suggest the possibility that, in addition, the differences in the sexual development of men and women play a role.
It seems reasonable to assume that the psychosexual disturbances related to early oedipal and preoedipal conflicts are played out more directly in boys' genital sexual life, and more diffusely in vicissitudes of the little girl's emotional involvements, particularly with father. Braunschweig and Fain's (1971) formulations regarding the differential early development of boys and girls, which I shall spell out later on, may be relevant to this issue.
Sadomasochism, I believe, starts out as the potential for erotic masochism梖or sexual excitement with pain梚n both sexes, and constitutes a very early capability to link aggression with the libidinal elements of sexual excitement in an essential way, thus paving the road toward the entire spectrum of sadomasochism at all levels of development and pathology. In light of clinical experience, it seems reasonable to assume that the experience of severe pain may intensify the attachment to the representation of the inflicter of pain, and bring about both a transformation of pain experienced into very early forms of aggression, and varying degrees of erotization of that painful experience and its aggressive elements. It is as if sexuality had, as one of its functions, the neutralization of aggression by incorporating it into the very fabric of sexual excitement. The unconscious identification with the aggressor linked with the erotization of pain facilitates a sexualization of primitive omnipotence, a primitive condensation of love and hatred that may proceed in several directions.
The profound sexual excitement and gratification derived from the expression of sadomasochistic impulses in the context of a sexually gratifying relationship points to the fundamental need to integrate love and hatred while assuring the dominance
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of love. Sexual excitement, in this regard, may be considered a basic affect that permits overcoming primitive splitting of love and hatred, and tolerating ambivalence. Hatred, we might say, is "coopted" by love. As the counterpart of this progressive development, under extremely pathological circumstances, the loving, affectionate aspects of sexual excitement may be recruited by the aggressive elements, leading to perversity, the malignant recruitment of love at the service of aggression, illustrated in Case 2, above.
Clinical Characteristics of Sexual Excitement and Erotic Desire
Let us now examine the characteristics of sexual excitement as we encounter them through psychoanalytic exploration. First, sexual excitement is an affect. It would seem trivial to state this, were it not that sexual excitement is so regularly left out of the studies of affect in the psychoanalytic, neuropsychological, developmental, and physiological literature. It has only been in recent years that psychoanalytic studies of sexual excitement in early development have been carried out, particularly by Stoller (1979), (1985) in this country, and Braunschweig and Fain (1971), (1975) in France. Not surprisingly, we find phenomenological descriptions of sexual excitement in literary essays, poetry, and philosophy; Bataille (1957), Singer (1973), and Scruton (1985) provide detailed descriptions of its psychological, subjective aspects.
Affect can be defined as a subjective experience of a pleasurable or painful nature, with physiological concomitants of that experience (both in characteristic psychomotor manifestations and neurovegetative phenomena), cognitive aspects of that subjective state consistently involving a relationship between self and other under the impact of that experience, and a communicative function conveyed by expressive, particularly facial, movements. Sexual excitement fulfills all these requirements.
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It is customary to differentiate sexual excitement梩he diffuse activation of the sexual affect梖rom erotic desire梐 concrete direction of that affect toward a particular object梐nd from love梩he integration of erotic desire with the complex affects implied in a tender, loving relationship. Insofar as erotic desire expresses a highly individualized wish for a sexual relationship with a particular object, it may indeed be differentiated from sexual excitement per se, but not because sexual excitement is objectless. In sexual excitement, similarly to other affects, an object is present, but it is not yet the fully crystallized object of the specific unconscious wish that characterizes erotic desire; it is, rather, a primitive part-object unconsciously reflecting the fusional experiences of symbiosis and merger wishes of early separation-individuation. In its origins, in the first few years of life, sexual excitement is diffuse, and dominantly linked to the object-related implications of the functions of erogenous zones. In contrast, in erotic desire the affect is more elaborated and the specific nature of the object relation is cognitively more differentiated. Erotic desire, in short, is a more mature form of sexual excitement. This may be a minor point, but I wish to stress that, in clinical practice, similarly to what characterizes other affects, we never find sexual excitement without an implied, conscious or unconscious object relation activated in the context of that affect.
This discussion relates to Freud's (1905) description of libido as a drive, originating in the stimulation of the erogenous zones, characterized by a particular aim and an object. In my view, libido originates in primitive affect states, including the peak affect state of elation characterizing the early infant-mother relation and characteristic of symbiotic experience and fantasy. Affectionate, and generally pleasurable, experiences with mother under ordinary, quiescent states are also integrated into libidinal strivings. Sexual excitement is a later and more differentiated affect; it enters as a crucial component of libido as a drive, but the origin of sexual excitement as an affect resides in the integration of multizonal erogenous excitement. Insofar
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as sexual excitement as an affect involves the total field of psychic experience, it is not limited to the stimulation of any particular erogenous zones, but generalizes pleasurable sensations to the entire body.
Sexual excitement also includes the erotic experience of painful stimulation and, at an unconscious level, the activation of unconscious fusion experiences under the sign of peak negative affect states. I believe that the affect of sexual excitement is the core element of libido, and that, while libido originates in pleasurable peak-affect experiences梩he affect of elation in the relation with mother (Kernberg, in press), this elation gradually takes on the characteristics of sexual excitement as a later, more complex affect state.
To highlight that we never find sexual excitement that does not have the implication of a conscious or unconscious object choice, I shall talk about erotic desire as the higher-level affect of which sexual excitement may be considered the precursor. What are the clinical characteristics of erotic desire as uncovered by psychoanalytic exploration?
A first characteristic of erotic desire is a search for pleasure always oriented to another person, an object to be penetrated or invaded or to be penetrated or invaded by. It is a longing for closeness, fusion, and for intermingling that has a quality both of a forceful crossing of a barrier and becoming one with the other person. The concrete sexual fantasies refer to invasion, penetration, or appropriation, and include, at the level of conscious or unconscious fantasy, the relations between bodily protrusions and bodily openings: penis, nipple, tongue, finger, feces on the penetrating or invasive site, and vagina, mouth, anus, on the receptive or encompassing site. The rhythmic stimulation of these bodily zones promises erotic pleasure, but that pleasure loses its gratifying quality when it does not serve the broader function of intermingling with an object. "Container" and "contained" are not to be confused with masculine and feminine, active and passive; we find fantasies of active incorporation and being penetrated passively together with fantasies
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of active penetration and being incorporated passively. Psychological bisexuality in the sense of the identification with both self and object in the specific sexual interaction is universal for men and women. One might say that bisexuality is first of all a function of identification with both participants of a sexual relation, or with all three in the triangulation of sexual experience.
A second characteristic of erotic desire is gratification from identification with the other sex, more precisely, with the sexual excitement and orgasm of the sexual partner, with a condensation of two complementary experiences of fusion. The first element here is the pleasure derived from the desire of the other, the love expressed in the other's response to the sexual desire of the self, and the associated experience of fusion in ecstasy. Together with this is the sense of becoming both sexes at the same time, of overcoming temporarily that ordinarily unbreachable barrier separating the sexes, with a sense of completion and enjoyment of the penetrating and encompassing, penetrated and enclosed aspect of sexual invasion. In this connection, a symbolic displacement of all "penetrating" parts of the anatomy among each other, and of all "encompassing" or "penetrable" openings on the other signal the condensation of eroticism from all zones, a normal regression in sexual excitement to "zonal confusion" (Meltzer, 1973), and the consequent confluence, in each concrete sexual activity or contact, of fantasies and experiences reflecting the entire body surface of both participants. In this identification with the other there is a gratification of the wish for fusion, of homosexual longings, and also of oedipal rivalry in that, by implication, all other relationships disappear in contrast to the unique and fused one of the sexual pair. By the same token, unconsciously identifying with both sexes eliminates the need to envy the other sex. In remaining oneself while becoming the other as well, there is a sense of achievement of intersubjective transcendence.
A third characteristic of erotic desire is a sense of transgression, of overcoming the prohibitions implied in all sexual encounters, a prohibition derived from the oedipal structuring of
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sexual life. This sense of transgression takes many forms. The simplest and most universal is the transgression against conventional morality, the ordinary social constraints that protect the intimacy of body surfaces as well as the intimacy of sexual excitement from public display. Stendhal (1822) pointed out that the very act of undressing repeals social notions of shame and permits lovers to face each other in a shameless way; getting dressed after the sexual encounter is a return to conventional shamefulness. Within the frame of conventional morality (Kernberg, 1987), there is a consistent tendency to suppress or regulate those aspects of sexual encounter most directly related to infantile polymorphous sexual aims; it is these aims, prototypically framed in the sexual perversions, that express most directly sexual excitement and erotic intimacy and the transgression of social conventions.
1991 Sadomasochism, Sexual Excitement, and Perversion. J. Amer. Psychoanal. Assn., 39:333-362 (APA)
Sadomasochism, Sexual Excitement, and Perversion
Otto F. Kernberg, M.D.
ABSTRACT
Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations, and of the very nature of sexual excitement. Sadomasochistic elements are also present in all sexual perversions. Sadomasochism starts out as the potential for erotic masochism in both sexes, and represents a very early capacity to link aggression with the libidinal elements of sexual excitement. Sexual excitement may be considered a basic affect that overcomes primitive splitting of love and hatred. Erotic desire is a more mature form of sexual excitement.
Psychoanalytic exploration makes it possible to uncover the unconscious components of sexual excitement: wishes for symbiotic fusion and for aggressive penetration and intermingling; bisexual identifications; the desire to transgress oedipal prohibitions and the secretiveness of the primal scene, and to violate the boundaries of a teasing and withholding object. The relation between these wishes and the development of erotic idealization processes in both sexes is explored in the context of a critical review of the pertinent psychoanalytic literature.
THE PRINCIPAL THESES OF THIS PAPER are: Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations. It is an essential part of the very nature of sexual excitement. Sexual excitement is a basic affect: it is a fundamental constituent of libido, which I see as a hierarchically supraordinate drive. This idea is in consonance with proposals in my earlier work that consider affects as the "building blocks" of drives (1976, pp. 85?07);
Associate Chairman and Medical Director, The New York Hospital-Cornell Medical Center, Westchester Division; Professor of Psychiatry, Cornell University Medical College; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research.
Presented at the panel on "Sadomasochism in the Perversions," Fall Meeting of the American Psychoanalytic Association, New York, December 17, 1988. Accepted for publication April 27, 1989.
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(1982; in press). Sadomasochism may present as a specific perversion. This perversion is characterized by deriving pleasure from inflicting or receiving pain as an obligatory precondition for achieving sexual gratification and orgasm. This obligatory precondition implies a restriction in the variety, scope, and flexibility of sexual life. The degree of severity of this perversion depends on the degree of ego and superego pathology.
My basic theoretical frame stems from Freud's (1905) description of infantile sexuality. However, I consider the source of the libidinal drive to lie not in the excitation of erogenous zones per se, but in the affect of sexual excitement, which incorporates zonal excitation together with the cognitive aspects of early object relations and other communicative, neurovegetative, and psychomotor substructures of this affect. My view of sexual excitement as a basic affect also incorporates Erikson's elaboration of the theory of infantile sexuality in terms of modes and modalities of object relations implied in the activation of zonal excitation (Erikson, 1963, pp. 72?08).
In earlier work (1986), (1988a), (1989) I stressed the crucial importance of the levels of personality organization梚n other words, of psychic structure梬hen assessing perversions. The difference between perverse fantasies and their symbolic enactment in sexual relations and love, on the one hand, and a consolidated perverse structure, on the other, depends on the nature of ego and superego organization.
The psychodynamic meanings of perverse fantasies and actions lie on a continuum, from normality to psychopathic perversion. The structural characteristics of the different clinical types and degrees of perversion vary greatly, according to whether they are associated with an integrated tripartite structure of normality and neurosis, at the one extreme, a borderline and narcissistic personality structure in the intermediate realm, or with the syndromes of malignant narcissism, antisocial personality structure, and perverse organization in psychosis, at the other extreme. The degree to which the perverse tendencies are transformed into action depends on the predominance
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of aggressive over libidinal components in the individual's instinctual equilibrium and the regressive nature of his personality structure, including the regression and/or disintegration of the superego, the predominance of splitting processes in the ego, the consolidation of a pathological grandiose self, and the weakening and loss of ego boundaries.
Some Illustrative Cases
The following five cases illustrate sadomasochism at various levels of psychopathology, short of actual psychosis. Listed in the order of the severity of the pathology, they should serve to put my discussion in context.
Case 1
The patient, a man in his early twenties, masturbated on the roofs of buildings and threw bricks on women walking on the street below; he reached orgasm at the moment when he either hit a victim or observed the extreme fright of a potential victim. This patient, temporarily hospitalized at the time of his evaluation under court order, presented a sadistic perversion unmitigated by any sense of guilt or any capacity of concern for his victims or for himself. He also evinced a combination of grandiosity, arrogance, and contempt as dominant characterological features. He illustrates the combination of a sexual perversion and a total deterioration or absence of superego functions in the context of a narcissistic personality structure. He was clinically not psychotic, and I formulated the diagnosis of a sadistic perversion in an antisocial personality. Sadistic perversion can also be present as part of psychosis, a further degree of this extreme psychopathology.
Case 2
A man, in his late thirties, was in psychoanalytic treatment because of a long-standing incapacity to commit himself to any
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loving relationship with a woman, sexual promiscuity, and growing dissatisfaction with his sexual life. He was white and had a black mistress, a colleague at work with whom he collaborated in creative projects. She loved him, accepting the limitations of their relationship, which had a sporadic, discontinuous quality stemming from him. Although he had had homosexual experiences in the past, and considered himself "potentially bisexual" as an expression of his sexual freedom and superiority, his current sexual experiences were almost exclusively heterosexual.
What he enjoyed most with his current mistress was a triangular situation: Having persuaded her to participate in a m閚age ?trois, he would offer her as a sexual partner to a close male friend. His sexual excitement peaked when, while she was having intercourse with his friend in the patient's presence, she would look at him with a loving expression indicating that she was submitting herself to this sexual relationship only because he had asked her to, and with him in mind as her sexual object. Analytic exploration revealed that the meanings of this scene included his unconscious wish to humiliate her as revenge against a hated maternal figure, and the reenactment and magical reversal of his fantasy of being the "excluded third party" of the primal scene: in his fantasy, it was now his friend (= father) who was really the excluded third party. While this was not an exclusive, obligatory, and constant aspect of his sexual behavior, it constituted his most intense and enjoyable way of achieving sexual gratification. This patient presented a narcissistic personality, and, in the transference, a typical "perverse" development (Kernberg, 1985) in the sense of a transformation of everything "good" received into something "bad." He showed a consistent though unconscious effort to utilize the understanding gained from me to demonstrate his independence from me, the futility of psychoanalysis, and the superiority of sadistic enjoyment to any other type of human interaction. At the same time, however, this patient presented good superego functions in all nonsexualized aspects of his daily life, and
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responded positively to psychoanalytic treatment over an extended period of time.
Case 3
This case, reported in another context in an earlier publication (1976, pp. 181?82), is of a woman with severe sexual inhibition, a lifelong incapacity to masturbate because, immediately following any sexual excitement, the face of her mother would flash up in her mind stopping her from further masturbatory activity. Her only erotically exciting behavior was represented by cutting herself in various parts of her body; the excitement was produced by observing blood flowing from these wounds (unconsciously representing an infinite number of tiny vaginas). She developed, in the course of her treatment, the fantasy in the transference that, if I were willing to shoot and kill her, she would feel fully gratified sexually. My killing her would mean that she mattered to me more than anything else in my life, and it would unite us forever in a way in which no other human interaction could. This patient, with a severe personality disorder involving schizoid, masochistic, and obsessive features, functioned on a borderline level of personality organization. She responded very well to psychoanalytic psychotherapy over several years (with an early resolution of her self-mutilating tendency), but her sexual inhibition diminished only very slowly and gradually over the years. This patient illustrates a masochistic sexual organization at a very primitive level, in the context of both lack of activation of ordinary pleasurable features of sexual excitement and an inordinate development of the aggressive components of it. Here, the aggression dominant within sexual excitement was matched with a well-integrated yet extremely sadistic and self-punitive superego.
Case 4
The patient, a man in his middle forties, was impotent with his current girlfriend, a woman he loved deeply but with whom he
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was shy, at times even submissive, although he could be sexually free and fully potent in sadistic involvements with other women if they followed a carefully designed and ritualized protocol. The woman with whom he could be sexually potent had to receive him at the door of the apartment on her knees, suck his penis, then guide him to the bedroom where she undressed, was tied up, and whipped with a careful limitation of the degree of pain or lesions that he inflicted on her. When she appeared to experience only pain and no longer sexual excitement, whipping her lost its attraction for him. He ended his sexual encounter with satisfactory genital intercourse and no potency problems. He had this arrangement with several women over the years, and, apart from this specific scenario, he was concerned and helpful to, though not in love with, these women. This patient presented a sadistic perversion at a neurotic level of personality organization and a personality structure with hysterical and obsessive features. Psychoanalytic exploration revealed that his perverse ritual protected him against underlying castration anxiety, frightening competition with a powerful and dominant father, and an unconscious sense of himself as a little boy who would not be able to gratify the idealized oedipal mother.
Case 5
This is the case of a woman in her early forties with a depressive-masochistic personality structure, in a late stage of her psychoanalytic treatment, during the course of which she was able to resolve an incapacity to achieve orgasm in intercourse with her husband, after many years of marriage. In one session, she developed the fantasy in the transference that she would come to a session, undress totally, and I would be so impressed by her breasts and her genitals that I would become a complete slave to her desire, respond by getting sexually excited and having intercourse with her, and she, in turn, would then be willing to become my slave and leave everything to follow me.
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The only daughter of a dominant, prohibitive mother who was intolerant of any sexual manifestations in her daughter, and of a warm yet distant father who spent time away during extended periods of her childhood, she became immediately aware of the connections between her wish for a sexual relation with me and the rebellion against mother implied in the wish to seduce father away from her. To make me her slave combined the wishes for my full acceptance of her genitals and her sexuality, while punishing me for having preferred other women (her mother), and offering herself in turn for slavery to expiate her guilt. But she also experienced the enactment of the slavery fantasy as an exciting expression of aggression without having to fear its inhibiting effects on her sexual pleasure. To the contrary, she felt that this aggression would heighten the gratification of total intimacy and fusion in the reciprocity of slave and master involvement. Following that session, she was able to ask her husband, for the first time, in the middle of sexual intercourse, to pinch her nipples forcefully, which he did with intense sexual excitement, permitting her, in turn, to scratch his back deeply, so that he bled, and both, for the first time, reached an intense orgasm together.
In analyzing this experience, she expressed the fantasy that her husband was like a hungry, frustrated infant biting mother's breasts, and she, as mother, could gratify his needs while tolerating his aggression, that is, a powerful, understanding, and giving mother. At the same time, she felt, she was also a sexual woman relating to her husband-infant who thus was not a threatening father, and yet taking revenge against father who had abandoned her as well as against her husband himself, who had caused her pain, by causing him in turn to bleed. And she felt that to scratch him while embracing him tightly intensified their fusion and her sense that she could participate in his orgasm while he could participate in hers. The case of this patient, approaching completion of her analysis, illustrates important normal facets of sexual excitement, to be specified further on.
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The Spectrum of Sadomasochism
In summarizing my view of the dynamic and genetic aspects of sadomasochism as a perversion (1989), I pointed out that, in contrast to the traditional relegation of polymorphous perverse features as appropriate merely to sexual foreplay, I consider them a crucial aspect of normal sexuality. These polymorphous perverse features emerge in many unconscious and conscious fantasies regarding sexual intercourse, and in the general erotic and emotional interactions of the sexual couple. Organized perversions at a neurotic level of personality organization do present, in both sexes, the psychodynamics originally proposed by Freud (1905), psychodynamics centering on the fixation at a partial, component drive in defense against full genital sexuality with its oedipal implications, the threat of incest, and castration anxiety.
What is striking about sadism and masochism and, in practice, the various combinations of these complementary sexual orientations, is that sadomasochistic elements can be found not only along the entire spectrum from normality to severe psychopathology, but as an essential component of all other perverse elements of sexuality. Thus, in voyeurism, exhibitionism, fetishism, bestiality, homosexuality, transvestism, we clinically always find sadomasochistic elements, and a careful study of the entire literature points to the indissoluble connection between sadomasochism and sexuality in general. Stoller (1985) has pointed to the universal nature of aggression as an aspect of sexual excitement, but has also stated that "when present, it is often a whisper, not a roar, and only a part, not the whole" (p. 42).
Cases of stable perversion and borderline personality organization, in contrast to perversions at a neurotic level of personality organization, typically present the dynamics described by British and French authors (Chasseguet-Smirgel, 1985a), (1986);
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(McDougall, 1978); (Meltzer, 1973), and they show the same condensation of oedipal and preoedipal conflicts under the dominance of preoedipal aggression characteristic of borderline personality organization itself. This condensation includes a regressive primitivization of the oedipal conflict, characterized by extremely primitive and threatening images of both parents, threatening combined father-mother images, and regressive distortions of unconscious perceptions of the functions of the genitals and the primal scene. It is clinically very different from the defensive regression to preoedipal stages of development found in patients with neurotic personality organization. Patients whose polymorphous perverse features are totally inhibited not because of repression, but from lack of activation of early eroticism (that is, some extremely inhibited borderline but not hysterical patients) present the same borderline dynamics. Their sexual inhibitions are the most severe that we encounter in clinical practice.
Sexual perversions in the narcissistic personality structure, particularly in malignant narcissism, show the psychodynamic constellations outlined by Chasseguet-Smirgel (1985a), (1985b), (1986). The full deployment of a regressive "anal universe" described by her overlaps the syndrome of malignant narcissism plus an organized perversion. The primitive destruction in unconscious fantasy of the contents of mother's belly as part of a general intolerance of reality, of the differentiation of sex and ages, and of the acknowledgment of the oedipal father, with a consequent severe disturbance in cognitive processes as well, are typical for the most severe of these cases of perversion in narcissistic personalities.
The cases I have described illustrate an additional aspect of my clinical experience, namely, that, while sadomasochism as an organized perversion (like all organized perversions) is probably more frequent in men (Money, 1988), I have found that sadomasochistic fantasies are probalbly more frequent in women, particularly in their masturbation fantasies.
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The most prevalent psychoanalytic view about this apparent predominance of organized perversion in men links it with a greater intensity of castration anxiety in men. This seems a reasonable hypothesis, and I would suggest the possibility that, in addition, the differences in the sexual development of men and women play a role.
It seems reasonable to assume that the psychosexual disturbances related to early oedipal and preoedipal conflicts are played out more directly in boys' genital sexual life, and more diffusely in vicissitudes of the little girl's emotional involvements, particularly with father. Braunschweig and Fain's (1971) formulations regarding the differential early development of boys and girls, which I shall spell out later on, may be relevant to this issue.
Sadomasochism, I believe, starts out as the potential for erotic masochism梖or sexual excitement with pain梚n both sexes, and constitutes a very early capability to link aggression with the libidinal elements of sexual excitement in an essential way, thus paving the road toward the entire spectrum of sadomasochism at all levels of development and pathology. In light of clinical experience, it seems reasonable to assume that the experience of severe pain may intensify the attachment to the representation of the inflicter of pain, and bring about both a transformation of pain experienced into very early forms of aggression, and varying degrees of erotization of that painful experience and its aggressive elements. It is as if sexuality had, as one of its functions, the neutralization of aggression by incorporating it into the very fabric of sexual excitement. The unconscious identification with the aggressor linked with the erotization of pain facilitates a sexualization of primitive omnipotence, a primitive condensation of love and hatred that may proceed in several directions.
The profound sexual excitement and gratification derived from the expression of sadomasochistic impulses in the context of a sexually gratifying relationship points to the fundamental need to integrate love and hatred while assuring the dominance
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of love. Sexual excitement, in this regard, may be considered a basic affect that permits overcoming primitive splitting of love and hatred, and tolerating ambivalence. Hatred, we might say, is "coopted" by love. As the counterpart of this progressive development, under extremely pathological circumstances, the loving, affectionate aspects of sexual excitement may be recruited by the aggressive elements, leading to perversity, the malignant recruitment of love at the service of aggression, illustrated in Case 2, above.
Clinical Characteristics of Sexual Excitement and Erotic Desire
Let us now examine the characteristics of sexual excitement as we encounter them through psychoanalytic exploration. First, sexual excitement is an affect. It would seem trivial to state this, were it not that sexual excitement is so regularly left out of the studies of affect in the psychoanalytic, neuropsychological, developmental, and physiological literature. It has only been in recent years that psychoanalytic studies of sexual excitement in early development have been carried out, particularly by Stoller (1979), (1985) in this country, and Braunschweig and Fain (1971), (1975) in France. Not surprisingly, we find phenomenological descriptions of sexual excitement in literary essays, poetry, and philosophy; Bataille (1957), Singer (1973), and Scruton (1985) provide detailed descriptions of its psychological, subjective aspects.
Affect can be defined as a subjective experience of a pleasurable or painful nature, with physiological concomitants of that experience (both in characteristic psychomotor manifestations and neurovegetative phenomena), cognitive aspects of that subjective state consistently involving a relationship between self and other under the impact of that experience, and a communicative function conveyed by expressive, particularly facial, movements. Sexual excitement fulfills all these requirements.
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It is customary to differentiate sexual excitement梩he diffuse activation of the sexual affect梖rom erotic desire梐 concrete direction of that affect toward a particular object梐nd from love梩he integration of erotic desire with the complex affects implied in a tender, loving relationship. Insofar as erotic desire expresses a highly individualized wish for a sexual relationship with a particular object, it may indeed be differentiated from sexual excitement per se, but not because sexual excitement is objectless. In sexual excitement, similarly to other affects, an object is present, but it is not yet the fully crystallized object of the specific unconscious wish that characterizes erotic desire; it is, rather, a primitive part-object unconsciously reflecting the fusional experiences of symbiosis and merger wishes of early separation-individuation. In its origins, in the first few years of life, sexual excitement is diffuse, and dominantly linked to the object-related implications of the functions of erogenous zones. In contrast, in erotic desire the affect is more elaborated and the specific nature of the object relation is cognitively more differentiated. Erotic desire, in short, is a more mature form of sexual excitement. This may be a minor point, but I wish to stress that, in clinical practice, similarly to what characterizes other affects, we never find sexual excitement without an implied, conscious or unconscious object relation activated in the context of that affect.
This discussion relates to Freud's (1905) description of libido as a drive, originating in the stimulation of the erogenous zones, characterized by a particular aim and an object. In my view, libido originates in primitive affect states, including the peak affect state of elation characterizing the early infant-mother relation and characteristic of symbiotic experience and fantasy. Affectionate, and generally pleasurable, experiences with mother under ordinary, quiescent states are also integrated into libidinal strivings. Sexual excitement is a later and more differentiated affect; it enters as a crucial component of libido as a drive, but the origin of sexual excitement as an affect resides in the integration of multizonal erogenous excitement. Insofar
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as sexual excitement as an affect involves the total field of psychic experience, it is not limited to the stimulation of any particular erogenous zones, but generalizes pleasurable sensations to the entire body.
Sexual excitement also includes the erotic experience of painful stimulation and, at an unconscious level, the activation of unconscious fusion experiences under the sign of peak negative affect states. I believe that the affect of sexual excitement is the core element of libido, and that, while libido originates in pleasurable peak-affect experiences梩he affect of elation in the relation with mother (Kernberg, in press), this elation gradually takes on the characteristics of sexual excitement as a later, more complex affect state.
To highlight that we never find sexual excitement that does not have the implication of a conscious or unconscious object choice, I shall talk about erotic desire as the higher-level affect of which sexual excitement may be considered the precursor. What are the clinical characteristics of erotic desire as uncovered by psychoanalytic exploration?
A first characteristic of erotic desire is a search for pleasure always oriented to another person, an object to be penetrated or invaded or to be penetrated or invaded by. It is a longing for closeness, fusion, and for intermingling that has a quality both of a forceful crossing of a barrier and becoming one with the other person. The concrete sexual fantasies refer to invasion, penetration, or appropriation, and include, at the level of conscious or unconscious fantasy, the relations between bodily protrusions and bodily openings: penis, nipple, tongue, finger, feces on the penetrating or invasive site, and vagina, mouth, anus, on the receptive or encompassing site. The rhythmic stimulation of these bodily zones promises erotic pleasure, but that pleasure loses its gratifying quality when it does not serve the broader function of intermingling with an object. "Container" and "contained" are not to be confused with masculine and feminine, active and passive; we find fantasies of active incorporation and being penetrated passively together with fantasies
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of active penetration and being incorporated passively. Psychological bisexuality in the sense of the identification with both self and object in the specific sexual interaction is universal for men and women. One might say that bisexuality is first of all a function of identification with both participants of a sexual relation, or with all three in the triangulation of sexual experience.
A second characteristic of erotic desire is gratification from identification with the other sex, more precisely, with the sexual excitement and orgasm of the sexual partner, with a condensation of two complementary experiences of fusion. The first element here is the pleasure derived from the desire of the other, the love expressed in the other's response to the sexual desire of the self, and the associated experience of fusion in ecstasy. Together with this is the sense of becoming both sexes at the same time, of overcoming temporarily that ordinarily unbreachable barrier separating the sexes, with a sense of completion and enjoyment of the penetrating and encompassing, penetrated and enclosed aspect of sexual invasion. In this connection, a symbolic displacement of all "penetrating" parts of the anatomy among each other, and of all "encompassing" or "penetrable" openings on the other signal the condensation of eroticism from all zones, a normal regression in sexual excitement to "zonal confusion" (Meltzer, 1973), and the consequent confluence, in each concrete sexual activity or contact, of fantasies and experiences reflecting the entire body surface of both participants. In this identification with the other there is a gratification of the wish for fusion, of homosexual longings, and also of oedipal rivalry in that, by implication, all other relationships disappear in contrast to the unique and fused one of the sexual pair. By the same token, unconsciously identifying with both sexes eliminates the need to envy the other sex. In remaining oneself while becoming the other as well, there is a sense of achievement of intersubjective transcendence.
A third characteristic of erotic desire is a sense of transgression, of overcoming the prohibitions implied in all sexual encounters, a prohibition derived from the oedipal structuring of
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sexual life. This sense of transgression takes many forms. The simplest and most universal is the transgression against conventional morality, the ordinary social constraints that protect the intimacy of body surfaces as well as the intimacy of sexual excitement from public display. Stendhal (1822) pointed out that the very act of undressing repeals social notions of shame and permits lovers to face each other in a shameless way; getting dressed after the sexual encounter is a return to conventional shamefulness. Within the frame of conventional morality (Kernberg, 1987), there is a consistent tendency to suppress or regulate those aspects of sexual encounter most directly related to infantile polymorphous sexual aims; it is these aims, prototypically framed in the sexual perversions, that express most directly sexual excitement and erotic intimacy and the transgression of social conventions.