Sadomasochism and the defense against recall of painful affect.

Defense against recall of painful affect is proposed as a significant element in the complex entity of neurotic sadomasochism and symptom formation. This formulation requires that the fantasy of reversibility--what happened can be undone--be analyzed in the transference and predict, for the patient, a painful feeling of loss and rage. The structure and tenacity of the powerful resistance to this work has the regressive, anal nature of reversibility which is also seen in the sadomasochistic characteristic of self and object interchangeability. The perceived threat of loss may be understood as related to early object loss, either whole or partial, and is associated with a flawed body image. Because the formative circumstances lie deep within the patient's past, reuniting residual affect, historical event, and early wishes by means of reconstruction is the only means of resolution. But, because it requires the relinquishment of the sustaining illusions of the sadomasochistic structure--omnipotentiality, omnipotence and bisexuality--the process will be experienced by the patient as intensely narcissistically dangerous. Vignettes from the analyses of two women illustrate the thesis and suggest the scope and direction of its clinical application.