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Bak, R.C. (1946). Masochism in Paranoia. Psychoanal Q., 15:285-301.

(1946). Psychoanalytic Quarterly, 15:285-301

Masochism in Paranoia

Robert C. Bak, M.D.

Until the works of Ferenczi (1) and Freud gave us essential insight into paranoia, Kraepelin's point of view dominated. Kraepelin gave the classic description, delineating the symptom complex, and the bulk of the ensuing research attempted to isolate paranoia as a disease entity. With the separation of the paraphrenias from dementia præcox, the sole two remaining clinical forms of sensitive paranoia were the paranoia of jealousy and litigious paranoia. Most investigators held that the psychosis was characterogenic, originating in a specific paranoid constitution, which manifested itself in certain personality traits. The psychosis was supposed to develop under the influence of certain experiences as an exaggeration of the underlying constitution. Among the precipitating experiences were particularly emphasized injuries to the ego, such as slights, frustrated ambitions, injustices.

Freud (2) emerged with his brilliant genetic theory of paranoia, demonstrated by means of Schreber's autobiography. Essentially this theory states that in paranoia the ego sets up defenses against homosexuality, from which there results a regression from sublimated homosexuality to narcissism. The libido is withdrawn from the loved person, the homosexual trend ('I love him') is denied and turned into its opposite ('I hate him'), and the hatred is then projected ('because he persecutes me'). Projection undoes the withdrawal. The subsequent formation of delusions is a work of reconstruction, which carries the libido back to the object, but with a negative prefix. This ingenious theory seemed applicable to the various clinical forms of paranoia.

Clinical psychiatry took over elements of Freud's theory but in an attenuated form.

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