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In the past 20 years, the psychology of narcissism has been explored in great depth. A major thrust of psychoanalytic theoretical and clinical effort during this period has been the investigation and clarification of our understanding of the concept of narcissism and the development of techniques for the treatment of pathologic narcissism. Although various explanatory descriptions of both the "normal" development of narcissism as an integral part of the individual personality and its multiple pathological versions continue to differ significantly among varying analytic schools, there is little doubt among psychoanalysts that narcissistic development is a core feature of mental development as a whole and the pathologies of narcissism have been explored in detail. I will, therefore, omit any attempt to recapitulate a detailed description of newer knowledge of narcissism.
A parallel concept, masochism, has only recently begun to receive comparable attention, and it remains the case that masochism is relatively unexplored. I will attempt to focus my comments on enhancing our understanding of masochism. I will continue to maintain my position that masochism and narcissism are developmentally, functionally, and clinically intertwined. I will emphasize that from a psychodynamic perspective, the concept of the narcissistic-masochistic character provides clarity to our understanding of masochism, one of the most puzzling characteristics of human beings. However, diagnostically it is long past time to acknowledge the existence of the masochistic personality disorder. This became clear during a case conference at the N.Y. State Psychiatric Institute when a resident presented a patient whose pathology clearly fit the criteria suggested in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) for Masochistic Personality Disorder,1 but discovered that she was unable to provide this patient with a proper diagnosis because Masochistic Personality Disorder was not included in DSM-IV and none of the personality disorder diagnoses that are provided adequately describe this patient. I suggest that the reasons for that exclusion are sociopolitical rather than psychiatric or psychodynamic.
To sum up my position, masochistic traits develop as an attempt to repair the painful memories of early child experience that are an unavoidable concomitant of narcissistic development. In the course of development, the underlying narcissistic pathology may become less visible as the masochistic defensive responses to narcissistic injury dominate the patient's mental...