by Leon Wurmser, MD
[Spring 1997; Vol. 24 No. 1]
During my residency time in Switzerland in the 1950s, I was, inspired by the pioneering efforts of Professor Benedetti, working psychotherapeutically with a number of severely ill, hospitalized patients. It struck me how much the affect of shame and shame conflicts played a central role in the psychodynamics of those patients who were either schizophrenic or severely neurotic ("borderline"). These observations were deepened very much during my work at Sheppard Pratt Hospital (1962 - 1965).
The original version of my book on the affect and attitude of shame and its implications in regard to conflicts, ideals, and values, had been written in the mid-sixties, at a time when only a few works on this important topic had appeared: above all the ground-breaking monograph by Piers and Singer, the literary and philosophical analysis by Helen Lynd, and some relevant studies by Erikson. For several reasons I put my own extensive drafts aside for over a decade.
The neglect of this topic hitherto in psychoanalytic exploration
and theory was striking, and in fact, to some extent, it did continue even after the appearance of “The Mask of Shame” in 1981. My own main intention in writing this was the consistent application of the psychoanalytic focus on inner conflict to this affect and attitude: to study shame as the result of inner conflicts,, and in turn to explore the conflicts resulting from the three main forms of shame: the two “negative” forms of shame as anxiety and shame as depressive affect and the third “positive” form, shame as a protective attitude, as a guardian of values and ideals.
Parallel to this I started treating compulsive drug users of all types, both in large scale programs and in individual, psychoanalytically oriented psychotherapy. A number of drug addicts were seen in psychoanalysis proper. Since the beginning of my work with compulsive drug users I had been struck by how helpful it was to understand issues of shame and guilt, of the dilemmas between these two affects and other conflicts of conscience, like loyalty conflicts. Some of the more general insights from the psychodynamic treatment of addicts were the following: The use of drugs is part of complex compromise formations and functions in that way as self-therapy. specifically the drugs block overwhelming affects. They serve in the creation of double reality by aiding the denial both of the traumatic aspects of reality and, more importantly, of the totalitarian aspects of conscience and ideals. They fulfil in complex ways some of the core fantasies, on all levels of gratification, and they serve self-punishment.
I also wrote extensively about drug use functioning as a defense against the superego, as a “flight from conscience.”
During my continued training in psychoanalysis, the influence upon my thinking by Larry Kubie, Jenny Waelder-Hall, Paul Gray, and Joseph Lictenberg was paramount.
In the meantime, my own work went also far beyond the two books I had published in this country: The Hidden Dimension (1978) and The Mark of Shame (1981; both books were recently reissued by Jason Aronson in their Master Work Series). Four major works appeared during the following years in Germany: Flight from Conscience (Flucht vor dera Gewissen), Analysis of Superego and Defense in the Severe Neuroses (1987), Fractured Reality (Die zerbrochene Wirklichkeit), Psychoanalysis as the Study of Conflict and Complementarity (1989), as a third volume the much enlarged and revised German edition of the shame book (1990), and finally, The Riddle of Masochism (Das Ratsel des Masochismus), Psychoanalytic Exploration of the Addiction to Pain and Torment by Conscience (1993). These books emerged from my extensive and regular teaching in Europe. I am in the process right of translating the first of them (Flight from Conscience) into English.
In the course of the years it also became much clearer to what exteant careful superego analysis, and in particular the study of superego transference and superego problems in the countertransference as central technical issues, allow us to see many clinical phenomena in a light quite different from viewing them within the framework of some newer, influential trends of Psychoanalysis. Many conceptualizations of the theory of narcissism in self psychology as well as those of borderline pathology in object relations psychology appear in a radically different perspective, have accordingly to be revised, and used with new proficiency if we use the consistent approach from a vantage point of superego analysis. In other words: neither the theoretical and technical precepts of Kohut nor of Kernberg did justice to the exigencies and observations of the treatment of severly ill patients.
With that, however, the problems of masochism assumed very great interest; and accordingly, my most recent German book, The Riddle of Masochism, has been dedicated to the theoretical and practical aspects of this fascinating topic. The term “masochism" is viewed as purely descriptive; by itself it does not as yet explain anything. The work begins with it, it does not end with it. The phenomena so described are the result of complex inner processes on all developmental strata.
I refer with this descriptive term to the need, usually compulsive, to seek suffering and pain in order to obtain love and respect, and to sabotage one’s chances and success, and have found it useful to differentiate the following four forms:
1) “outer masochism”: the main, relationships with others seem to reflect an incessant search for and clinging to tormenting partners, a need to end up as the victim;
2) “inner or moral masochism": the tormenting is mostly carried by the conscience and directed against the self;
3) "sexual masochism, masochitic perversion”: sexual gratification is bound to symbolic or concrete pain and humiliation;
4) “masochism covered by a sadistic-narcissistic facade”: what appears as outwardly directed cruelty and selfishness has to hide the acting out of a masochistic core fantasy.
These 4 forms are hierarchically arrayed: The core is not found in the perversion which originally gave its name to the entire complex of issues. Rather it seems that the perversion itself, as manifest pattern of behavior, serves as a kind of grandiose defensive structure against the superego problems. The obligatory conditioning of sexual gratification with humiliation and torment can most usefully be understood as a protection against the severity and complexity of moral masochism. Thus, the sexual perversion, in contrast to the defense by sexualization which is quite basic, turns out to be a complex defensive strategy against deeper inner conflicts, among which the superego problems are central. The same holds true for outer masochism: the unconscious, but painfully compulsive and repetitive search for tormenting partners or for situations of anguish and unsolvable conflict in intimate relations is not so much an automatic repetition of older object relations, as it is rather the result of reexternalization of an inner conflict, especially of a tormenting superego pressure.
The independence from administrative and teaching functions made it possible for me to give much more time to the study of various cultures, literature and languages. The inner life of man reflects culture; but to a much greater extent culture reflects the human mind. The deeper the knowledge of the basic cultures - referring mostly, though not exclusively, to the Greek, the Jewish, and the Chinese literatures - the more can the psychological assertions about “human nature” be supported. Many of these endeavors I presented in the book Fractured Reality - Die zerbrochene Wirklichkeit; yet, a lot found a more suitable place in the revised German version of The Mask of Shame: mostly as a separate new chapter studying the issues of shame and guilt in ancient Greek culture, in the Talmud, and in Chinese tradition. Moreover, an appendix was dedicated to a study of superego issues in the philosophy of Confucius and Lao Tse. In Die zerbrachene Wirklichkeit I dealt extensively with some aspects of the works of Dickens, Lagerkvist, Goethe, and the concepts of the “tragic vision of life", in the book on masochism With Ibsen, Nietzsche and Thomas Mann.
I am convinced that psychoanalysis, struggling with the deepest questions of human existence, has as much to contribute to philosophy, as philosophy can give to psychoanalysis. All five books of mine (The Hidden Dimension as well as the four major volumes of the German set) live in the spirit of dialogue between these two disciplines, which deal most centrally with “the nature of man”, two forms of a modern philosophical “anthropology”.
It is the singularity of every person which has influenced me, in all my work. The respect of what is singular both in its presence and in its history is the counterforce to that chronic shaming inherent in “soul blindness" and “soul murder", which we again and again encounter in the severe neuroses whose deep wounds these patients carry within and try to cover.