Many authors describe adolescence as the convergence of psychological and physical processes. Physiological transformations are subsumed under the term puberty, and puberty refers to the reactivation of childhood sexuality (P. Gutton, 1996). Reaching sexual maturity reawakens incestuous fantasies and the Oedipal complex. Until puberty, the body is a passive carrier of needs and desires; now it turns into an active force and acquires a sexual quality. The sexualized body can now impregnate and be impregnated. In other words, it can carry sexual activity to its end point and is functionally capable of reproduction. This is precisely what makes the body extremely dangerous. This danger is, in fact, the rekindling of a fire that was thought to have died out but was only smoldering. The sexualized body brings the Oedipal conflict, which had fallen into sleep during the latency period, back onto the stage at a different level. The wish to unite with the opposite-sex parent, which had remained at the level of fantasy during the Oedipal phase, is now technically possible. The only factor that can prevent this is the psychic structure inherited from the latency period. However, this structure was formed for a child’s body and is not sufficient to cope with a sexualized body. Therefore, these incestuous fantasies, which cannot be anchored anywhere, and the body as their possible place of realization, can be perceived as dangerous by the adolescent.
Contents
The very process of adolescence itself requires that the psychic structure inherited from childhood become partially invalid. In order for the adolescent to form their own identity, the identifications that enabled entry into latency must be loosened. In adolescence, different defense-based pathological mechanisms are mobilized against the rekindled incestuous fantasies that have once again become technically possible. Obsessions and anxiety disorders are among these. Because the sexualized body is above all a body that has desires and expresses these desires. For an adolescent whose only experience of satisfying these urges has been auto-erotic gratification, this can become extremely distressing. As adolescence approaches and in adolescence, drives settle into the body and the body becomes increasingly difficult to control. The sexualized body not only catches the adolescent unprepared in the face of their own urges for satisfaction, it may also leave them unprepared to decipher and mentally process the sexualized demands of the adult, whose body now targets them sexually. As J. Laplanche points out, the child is both behaviorally and in fantasy in a passive position before the adult. In this period, the adult’s fantasy penetrates the child against the child’s will. With this seductive intrusion by the adult, the child cannot cope with this stimulus; it overwhelms their coping capacities and may create a painful feeling of being violated. Under ordinary conditions this is a normal process, but in some cases disruptions occur. F. Marty states that such disruptions must be evaluated within the framework of the “repression of childhood sexuality” and that, to understand the achievement of genitality, we must again follow the same route.
Puberty is founded on repressed childhood sexuality, and adolescence emerges from this repression. Its opposite—namely the failure of repression—brings “acting-out” into the foreground. Failure of symbolization and the resulting impulse to act in reality reveal that a particular inner scene could not be constructed. Faced with bodily transformations and a new drive energy, the adolescent experiences a sense of external intrusion. Laufer, who views adolescence as a developmental process and assigns a special importance to the body, states that pathology in this period often appears in the form of destructive behaviors directed toward the body. In this period, during which puberty is experienced as traumatic, certain violent acting-out behaviors are attempts to escape from the sense of passivity, that is, from the feeling of being invaded from the outside (Jeammet, 1997). In a sense, the fear of passivity and submission required by the condition of adolescence leads, as C. Balier notes, to a fear of non-existence. Meanwhile, the adolescent is faced with the task of accepting the bodily changes and new drive-laden sensations that are part of puberty, integrating these into their psychic reality, processing positive and negative affective experiences internally, and also making sense of the impact that others have on them. The body, at the center of these adolescent transformations, becomes the spokesperson for these forced changes. In this process, some adolescents experience the changes in their body as a loss of control, as a kind of overflow. The adolescents who are the focus of this study use certain primitive mechanisms to prevent these drive overflows and to keep them under control. In this article, the superficial cuts on the skin, known as scarifications—a masochistic act frequently seen during adolescence—will be examined in relation to masochism.
Approaches to masochism in the literature are quite diverse. Sándor Rado argues that at the root of masochism lies the automatic internalization of yielding and submission to the parental threat of punishment that precedes forbidden pleasurable experiences. The desire to reach forbidden pleasures brings on guilt, and guilt in turn generates the wish to self-punish. Rado calls this “pain-addicted behavior” and claims it appears in all situations where the pleasure function is impaired. Some authors define masochism as an “id phenomenon” derived from sexual and aggressive drives, while others describe it as a superego phenomenon. Masochism is also considered an expression of the wish to be punished and of guilt for forbidden desires. In the face of a cruel superego, it is described as a position of self-sacrifice. Freud divided masochism into three forms: erotogenic, feminine, and moral. Erotogenic masochism is based on sexual excitation, whereas feminine masochism is described as an expression and behavioral pattern of the feminine nature (Freud, 1919). Moral masochism is defined by Freud as unconscious guilt. This unconscious guilt in moral masochism can be understood as the need to be punished by an authority figure such as the parents.
Psychoanalytic evaluations show a theoretical parallel between masochism and narcissism. While narcissism is defined as the libidinal cathexis of self-representation, masochism is described as the aggressive cathexis. In addition, many authors have noted that intense masochistic acts often coexist with severe narcissistic pathologies. The roots of masochistic acts in the psychoanalytic literature are linked to deprivations, traumas, and developmental arrests in the pre-Oedipal period. Such an etiology suggests a similar cause–effect relationship as in narcissism. Masochism, in terms of both its function and structure, is not a phenomenon that can be explained or studied in a one-dimensional manner. Some self-destructive masochistic behaviors serve to punish Oedipal wishes, whereas in other pathology groups they possess a narcissistic function defending against the disintegration and fragmentation of self-representation. Moreover, masochistic acts in adolescence and adulthood serve different functions. Masochistic acts in adolescence can be described as tools that, by turning to pain, aim to control the dissolution of the ego and threats to identity, and to help the fragile self regain an active role and the capacity to act in its environment. This situation, which P. Denis calls “the satisfaction of taking hold,” represents the rescue of the self from narcissistic collapse through the power of control, enabling it to move again and to avoid being shattered. In adolescence, masochistic acts, masochistic relationships, and suffering protect boundaries and control the object.
At the same time, masochistic acts, which calm and soothe adolescents, contain a dimension of pleasure felt after pain. The calming and soothing quality of the cutting act, together with its pleasurable and painful aspects, brings to mind the question Freud raised: might masochism be operating against the pleasure principle? Although human beings generally tend to avoid all forms of pain, one might think that in masochism pain itself is pleasurable, and that pleasure is actively sought in pain. If the primary goals of mental processes governed by the pleasure principle are to avoid unpleasure and states of no-pleasure, then masochism becomes incomprehensible. If pain and unpleasure are not merely stimuli to be avoided but become ends in themselves, the pleasure principle is paralyzed. This would be equivalent to the pleasure principle—which is of great importance for our mental life—being anesthetized and rendered inoperative. In this case, masochism appears far more dangerous to the ego than its opposite, sadism. For the pleasure principle is not only the guardian of our mental life but also of life itself (S. Freud, 1920). The mental apparatus strives to reduce to zero, or at least to a minimum, the quantities of stimulation directed toward it. This is expressed in the Nirvana principle as the tendency of the death drive, and the pleasure principle is, hypothetically, identical with the Nirvana principle. The Nirvana principle becomes, in living beings, the pleasure principle through a transformation made possible by libido, that is, the life drive. The reality principle, as a modification of the pleasure principle, expresses the demands of libido under the influence of external reality. These three principles do not exclude each other, and none can completely suspend the others. Even though conflicts between them are inevitable, as each has its own distinct goals, they generally tolerate one another. For one, the aim is to reduce the quantitative load of stimulation, while for another, the qualitative characteristics of stimulation are paramount. All three serve the same ultimate purpose through their different yet interconnected tasks: to protect the integrity of the psychic apparatus and ensure its continuity. When we consider masochistic acts in this framework, the cutting behavior can be seen as a sign that the cooperation among these three principles has broken down, their coordination cannot be achieved, and their functions cannot be fulfilled. In such a situation, the search for pleasure and the regulation of its quantitative and qualitative aspects becomes dependent on external intervention. The function of the pleasure principle seems to have been deactivated because the individual seeks pleasure through self-mutilative behavior. Thus the quest for pleasure is externalized. When confronted with a problem, the individual does not produce or experience the emotional response that should be given internally, but instead resorts to action.
For adolescents who resort to masochistic acts, obtaining narcissistic gratification or narcissistic mirroring is not the primary goal. This distinguishes them from other masochistic acts in which the aim is to be mirrored by the other, to secure approval and appreciation by sacrificing oneself for the other. These belong to a different developmental phase of self. In the adolescents discussed in this study, masochistic acts serve the purpose of preserving structural integrity. This is especially true for repetitive superficial cuts. Studies on the quality and patterns of cuts have shown that repetitive, shallow cuts often serve to discharge inner affect. Deeper cuts may symbolically represent reuniting and merging with others (Pa, 1969). A common element in explanations based on affect regulation theory, attachment theory, theories of boundaries and object relations, and drive theory is the effort to preserve the structure and guard against fragmentation and disintegration.
In the clinical setting, these individuals are examined under various diagnostic categories: borderline personality disorder, conduct disorder (oppositional defiant behavior), antisocial personality disorder, intermittent explosive disorder, and so on. In projective tests, we see the specific acting-out tendencies and processing deficits reflected in their Rorschach responses. Catherine Marta’s work with self-harming adolescents illustrates how closely clinical interviews and projective test data can be linked. In a study of adolescents aged 14–17, in which she examined only superficial cutting as a masochistic attitude, Marta concluded that masochistic behaviors inherently carried “a request for help.” The psychic functioning of these adolescents is close to borderline pathology. Yet analysis of the protocols showed that they could be neurotic, narcissistic (as severe as borderline), or decompensated psychotic. In their psychic functioning, pubertal conflicts, anxieties regarding sexual identity, and the fear of losing the love object emerged from time to time. Although the adolescents in the study showed various patterns of psychic functioning, an underlying issue common to them all was a problem with limits. As mentioned earlier, the meaning or function of masochism varies according to the person’s pathological condition, psychic organization, and developmental period. In the adolescent referred to as H. in this study, masochism has a narcissistic function in defending against the disintegration and dissolution of self-representation. In the case of H., whose self-representation is on the verge of losing its distinctness and boundaries—becoming blurred and dissolving—there is a quest for masochistic experiences of acute pain in order to feel real and alive (and not dead). Her words are striking in explaining the situation she experiences: “Normally I can’t cry. I can only manage it when I cut. Cutting makes me start to cry. Scratching my arm is like pinching someone half-asleep to wake them up—it’s to wake and rouse them. I cut to wake myself up.”
Case History
H. is a 14-year-old girl and an only child. Her mother works as a hairdresser, and her father, due to severe alcohol use, is unemployed. H.’s parents divorced when she was seven. She was admitted to the hospital after a suicide attempt by taking medication. H. describes the reason for her attempt as “not to think and not to feel,” stating that she did not actually intend to die. Another reason she gives for her suicide attempt is as follows: “I had not cut myself for about 15 days; everything I was fighting against had piled up. A few months earlier I also tried to kill myself with antipyretics, but nothing happened.” H. reports that her father drinks heavily and applies physical violence to her and that this violence has intensified recently. Of the 20 adolescents in a study at the University of Kansas who were hospitalized for self-harm that they could not control, it was found that they had not experienced a stable attachment process in childhood. At least 16 of them had been exposed to physical abuse, and some had lost one of their parents. In addition to physical abuse, some had experienced sexual abuse within their families. These adolescents experience intense feelings of guilt, isolation from society, and abandonment. They feel far more helpless than their peers. The physical, sexual, and psychological trauma they have endured affects them so deeply that, under the emotional and affective weight of these traumas, they lose control. We may liken this to a dizzy person desperately struggling to hold onto something. A dizzy person feels the need to grab anything nearby so as not to collapse. Similarly, adolescents exposed to such abuse, in their efforts not to collapse, resist their loss of control by harming themselves.
H. engages in behaviors such as punching herself, slapping herself, and scratching herself. Isolation becomes an extremely oppressive state for her. In addition, she begins to think that she has no place in the world and experiences her blood and her body’s bleeding as the only reality. The statement “Seeing blood calms me” may represent the moment when the psyche, in the face of a dissociative break, clings to reality. If dissociation is a moment of disruption, self-harm may be the action that prevents a complete break from reality and reconnects the individual to it. What I describe here may sound strange, but for individuals whose internal harmony and inner balance are impaired, and who have failed to establish adequate adaptation, these are their real experiences of life.
The weaker the internal harmony, the more the individual will try various ways—sometimes the most unexpected, surprising maneuvers—to cling to reality in order to maintain adaptation. For at one time, the instruments that ensured internal harmony and balance were damaged. Adolescence is a distressing period even for those young people who are best at regulating affect. Adolescents who have been sexually and physically abused experience additional distress in their bodies on top of the distress normally felt in this phase. Moreover, adolescence means the sexual maturation of the body in spite of the individual. In other words, adolescence is an invasion. It is an invasion of both body and psyche. For adolescents who have already experienced intrusion and abuse of the body in the past, this period of adolescence brings “trauma upon trauma.”
In particular, the self-cutting behaviors seen in female adolescents have been interpreted by some psychoanalysts as an attempt to identify with the mother’s menstrual bleeding. In contrast to menstrual bleeding, cutting and self-harm allow the adolescent to control the flow of blood and stop it at will. These are symbolic interpretations and unconscious formulations. Whether or not this is the case, such adolescents, using primitive or more developed methods, are trying to keep themselves under control in terms of affect regulation and drive control, and they are engaged in a struggle for psychic survival.
H. states that the moment she sees her own blood, she feels calmer. Another reason she cuts herself is that “it helps me cry.” She says she cuts whenever she reaches a point where she cannot cry. She also expresses that she feels oppressed when she is alone and feels that she has no place in the world. She feels as if everything is collapsing around her. When asked why she scratches her arm, she answers: “It’s like pinching someone who is half-asleep to wake them up. I scratch to wake myself up.”
H.’s cutting can be interpreted as an effort to repair a structural breakdown that she appears unable to tolerate. Symbolically, the self-inflicted wound represents both destruction and an attempt at repair. Cutting externalizes and gives form to an unbearable inner pain. For H., whose sense of self is fragile and fragmented, this act becomes a tool to restore continuity of being. The act also reduces dissociation by bringing intense focus back to the body. Although this method is destructive, it functions as a primitive attempt at self-regulation.
During projective testing, H.’s production suggests that her internal world is dominated by fragmentation, instability, and persecutory anxiety. The boundaries between fantasy and reality are permeable. Affective regulation is insufficient, and instinctual overflow becomes overwhelming. Cutting behavior appears to operate as a crude stabilizing mechanism against psychic collapse.
TAT Evaluation:
In H.’s Thematic Apperception Test responses, themes of abandonment, helplessness, and being harmed repeatedly appear. The presence of persecutory figures and feelings of being trapped are prominent. The narratives suggest that H. experiences herself as weak and vulnerable, struggling to protect herself against overwhelming internal and external pressures. Her stories attempt to resolve conflict through passive endurance rather than active mastery.
Rorschach Evaluation:
H.’s Rorschach protocol reveals diffuse and unstable boundaries between self and other, weak reality-testing, and difficulty integrating affect. Her responses show a tendency toward concrete thinking and bodily preoccupations. Aggressive impulses appear unmodulated. The predominance of movement responses (M) suggests reliance on fantasy, while the quality of these responses indicates a fragile and poorly differentiated self-representation. Disorganization is frequent, and form quality is often poor. These findings are consistent with borderline-level functioning.
H.’s masochistic behaviors, particularly cutting, are understood as attempts to preserve structural integrity in the face of disintegration anxiety. Rather than seeking approval or recognition from others, as in classical relational masochism, H.’s behavior appears driven by a desperate effort to feel real and alive, to avoid psychic collapse, and to regulate intolerable affective states.
In this sense, cutting becomes an act through which the adolescent tries to exert control over bodily sensations and psychic experience. The bleeding wound serves as the point where internal and external realities momentarily reconcile, allowing the adolescent to experience herself as whole, cohesive, and in control. Although destructive, the act temporarily relieves unbearable tension and restores a sense of agency.
The clinical understanding of H.’s case indicates that psychotherapeutic work should focus on helping her develop alternative means of affect regulation, strengthening ego capacities, and establishing a stable sense of being. It is essential to create a therapeutic environment that provides emotional containment, fosters the development of symbolic functioning, and supports the gradual internalization of safer relational patterns.
Adolescents like H. need spaces where their experiences can be understood and mentalized. When cutting serves as the only means of expressing or regulating overwhelming internal states, therapy becomes the place where meaning can be restored and where the adolescent can begin to experience herself not as fragmented or invaded, but as coherent, valued, and capable of forming stable connections.
