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Masochism and pathological gambling

That all pathological gamblers have an "unconscious wish to lose," an idea first expressed by Freud and Bergler, is neither true nor useful; wrong as well, however, are the reasons for neglecting masochism in relation to gambling. There is a small but clinically significant subgroup of pathological gamblers who are masochistic. I present clinical vignettes and a more extended treatment account to illustrate its importance. Masochism has been a confusing concept. As used here it refers to the deliberate seeking of pain, loss, suffering, or humiliation. There may be pleasure in pain, or an obligatory combining of pleasure and pain. A sense of power and control may be achieved through suffering. The case material illustrates clinically useful types (sexual masochism, masochistic personality disorder, moral masochism, relational masochism) as well as some common masochistic dynamics encountered in the treatment of pathological gamblers. These masochistic patterns are often identifiable during the initial evaluation. Distinguishing features may include a reversal of normal attitudes about winning and losing, the absence of an early winning phase, sometimes a memorable early loss. Gamblers may sabotage opportunities for success or create unnecessary obstacles for themselves. Losing may be more comfortable than winning or may be overtly sexualized.

Psychoanalysis as the patient: high in feeling, low in energy

This paper examines the increasingly important role that affect is assuming in psychoanalytic research and practice. This rise in the centrality of affect has been at the expense of an independent role for motivation and a dismissal of any energy concept. Difficulties with this affect-first approach are identified and an alternative offered that accords motivation an independent role and accommodates a useful energy concept. Research on esophageal atresia, addiction, and infant suckling are cited in support of this position.

On reminiscences

Recently, psychoanalysts have focused on narrative truth and hermeneutics with diminished attention to the role of remembering in symptom formation and treatment. This shift has tended to remove us from prior status as a motivational and cognitive science with potential for causal inferences. At the same time, psychiatry and cognitive science have moved toward a vigorous study of reminiscences and their role in pathology. Arguments for a revival of Freud's position on the central role of memory are cited. A case example is offered to show that Freud and his psychoanalytic progeny have never taken a simplistic view of archeological truth, but were among the original group to bring to light the distorting effect of mind on remembering, and actually led the way for other scientific approaches.

Preoedipal factors in "Little Hans"

In this article, the text of "Little Hans" has been reexamined in reference to the existence of negative oedipal and preoedipal factors in the development, meanings, and resolution of Hans's phobia. The cumulative effect of the frequent administration of enemas, sleeping in the parental bedroom, exposure to the bloody birth of a sibling, a generally absent father and a seductive, threatening mother would be expected to interfere significantly with the process of separation-individuation. Evidence suggesting that Hans had problems in this area is discussed. In addition to reflecting the displaced fear of Hans's oedipal rival, his horse phobia may also represent his dread of a castrating preoedipal mother and his fear of a castrating vagina. The treatment, by clarifying many of Hans's misconceptions and by allowing Hans to develop a closer, more solid relationship with his father, assisted Hans in more completely negotiating the phallic-dyadic phase of development and helped him to move more completely into the oedipal phase proper.