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Masochism and the inner mother.

My understanding and treatment of patients with severe masochistic features has evolved and changed radically over the last fifteen years. My work with John and his subsequent life led me to search for new techniques and eventually to the discovery of a different way of understanding and treating these patients. I analyzed John in accord with the classical Freudian formulation of masochism. The paternal transference was central and-while a maternal transference and work with the residues of his experience with his mother were present and partially analyzed-the real power of the inner mother was not touched. It was only when I saw him years later in a near-moribund state that I realized the centrality of what we had not analyzed: the attachment to a punishing inner mother. This led me to conceptualize masochism in a new way. Of central importance in the formation of severe masochism is the relationship between an indifferent, possessive, or rejecting mother and a helpless child in the earliest years, before object constancy. This is a time when the child is unable to differentiate between self and mother. What results is a preverbal conviction that they are ungrateful or "bad" if they think, feel, or behave differently than the mother. This leads to a powerful and rigid attachment to this early mother, internalized as a punishing inner mother. This is the precursor of masochism, not a regression from the Oedipus complex. The child will tolerate physical and mental suffering to remain attached to the needed-even though pain inducing-mother. If the child is not attached, he feels helpless and fears survival. This attachment and fear is internalized and becomes unconscious as development proceeds. Eventually, what is observed in adult patients is a person who is sensitive to others, but unable to be sensitive to him/herself. Awareness of the importance and power of the attachment to the punishing inner mother enables the analyst to hear and perceive masochistic material with a shifted focus. This shifted focus naturally leads to different psychoanalytic treatment techniques throughout the analytic process. Two other cases of masochism are used to illustrate the techniques and course of their analytic processes with this "inner mother" focus. The psychoanalytic understanding of many forms of disturbance has shifted from the oedipal period to the early years in recent years. There is also a corresponding emphasis on the actual experiences with early figures, most prominently the mother. The particular dynamics I have described is part of this general trend.