Failure to Mentalize Self and Masochistic Functioning

Mentalization includes the ability to apprehend and reflect upon one's subjective state, as well as an appreciation of one's agency (Fonagy & Target, 2006 Fonagy, P. and Target, M. 2006. The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20(6): 544–576. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Masochism is a character pattern that is traditionally defined as pleasure in pain or suffering (Million, 1996 Million, T. M. 1996. Disorders of personality: DSM-IV and beyond , 2nd, New York: John Wiley and Sons.  [Google Scholar]). In some cases the etiology of this character pattern may mirror failures on the part of the caregiving surround that contribute to deficits in the ability to mentalize self (Fonagy, Gergely, & Target, 2007 Fonagy, P., Gergely, G. and Target, M. 2007. The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry, 48(3/4): 288–328. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Benjamin, 1988 Benjamin, J. 1988. The bonds of love: Psychoanalysis, feminism, and the problem of domination, New York: Pantheon Books.  [Google Scholar]). When this occurs masochism may be more profitably understood as an inability to register pain, rather than pleasure in pain. A case example demonstrates that when a deficit in mentalization underlies masochistic functioning, treatment may include interventions aimed at helping the patient improve the ability to reflect upon his or her mental state, especially negative affect such as pain and anger, and connect to a sense of agency.