Sadism Revisited V. S IO M O P O U L O S , M .D .* I .. ... JE W E T T G O L D S M IT H , M .D .f I %Cag°’ ' Sadism has been for a long time, among psychoanalytic and other writ ers, the subject of extensive theorizing and controversy. This paper takes a fresh look at the many dimensions (sexual, characterological, neurotic, psychotic, neurological) of this old aberration.
The term “sadism,” derived from the notorious French novelist, the Marquis de Sade, is used to describe a variety of behaviors extending from plain nonsexual, physical, or mental cruelty to infliction of pain, or perpe tration of mutilations, or even murder, during, before, or after sexual activ ity of any sort. Generally, most authors have emphasized the presence of aggressive, nonsexual forces in the various manifestations of sadism. Freud (1), seeing an intrinsic connection between sadism and masochism, the de riving of pleasure from being subjected to sexual, physical, or mental abuse, postulated an instinctive tendency toward self-destruction, the so-called “death instinct,” with sadism being a manifestation of it directed not toward the self, but toward others. Freud’s theory of instinctive aggression found support in the last decade in the work of Konrad Lorenz (2), the prominent ethologist, who theorized that all human aggression is associated with a phylogenetically programmed innate instinct—a theory, however, that has been rejected by a great number of psychologists and neuroscientists. Other psychoanalytic writers, such as Theodore Reik, Karen Horney, and Erich Fromm, rejecting the theory of instinctive aggression, maintain nevertheless that the gratification derived from any sort of sadistic activity is to a great extent the satisfaction of aggressiveness. Characteristically, Karen Homey (3) viewed the sadistic person as attempting to enslave, frus trate, exploit, and humiliate another human being. “To be sadistic,” she stated, “means to live aggressively and for the most part destructively through other persons.” Sadistic trends, according to her, may find an ex pression in sexual behavior which is only an expression of a general attitude toward others. Erich Fromm (4) has expressed similar views. The core of * Staff Psychiatrist, Illinois State Psychiatric Institute, 1601 West Taylor St., Chicago, 111. 60612: Assistant Clinical Professor of Psychiatry, University of Illinois, Abraham Lincoln School of Medicine. tDirector, Forensic Program, Illinois State Psychiatric Institute; Associate Pro fessor of Psychiatry, Northwestern University. .....................
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the various types of sadistic behavior—sexual, physical, mental—according to him, is “the passion to have absolute and unrestricted control over a liv ing being.” A tendency to generalize is apparent in all these theories. To assume that the same psychologic forces operate in the person who enjoys verbally humiliating others and the pathetic man who engages in ritualistic spanking before sexual intercourse as well as the psychotic patient who molests and mutilates or kills his victim would be, we think, a gross violation of common sense. In this article we report briefly a few cases of sadistic individuals whom we evaluated at the Forensic Unit of the Illinois State Psychiatric Institute and, aided by similar cases described in the literature, we attempt to point out the clinical and psychopathologic differences of the various types of be havior generally described as sadism. Specifically, going beyond the crude classification of sadism as sexual, physical, and mental, we distinguish the following five clinical categories of sadism: sadism proper, sadism as a neu rotic symptom, sadism associated with an altered state of consciousness, sad ism associated with psychosis, and characterological sadism. Sadism Proper The term “sadism proper” describes cases in which a person derives sexual pleasure from inflicting pain upon or otherwise humiliating another person. The infliction of pain or humiliation takes place in a sexual context which may include sexual intercourse, fellatio, cunnilingus, or any type of sexual encounter. The works of the Marquis de Sade (5) provide numerous ex amples of sadism proper. In “Justice,” for example, we read about the brutal, apparently nonpsychotic tradesman Dubourg who savagely attacks Justine, knocks her to the floor and leaves her with a gleaming red trickle of blood on her face. Then he falls madly on top of her and begins “nozzling her bloody mouth . . . chewing at her neck with fanged teeth,” but he loses his potency before he is able to have sexual intercourse. Jeän-Paul Sartre (6), in his story “Erostratus,” gave a much more re fined description of sadism proper, in which humiliation rather than physical pain is the primary aim of the sadistic hero, an extremely intelligent and ar ticulate person. In the process of planning a pointless, but perfect crime— the shooting of the first five people he sees, as he goes down In the street— he picks up a prostitute and forces her to undress and walk around in front of him, while he sits motionless and fully dressed. At one point he asks her to spread her legs, he looks between them and says, “Look at that!” and be gins to laugh so hard that tears come to his eyes. He asks her to continue walking naked in front of him and do exercises with his cane. Apparently, this gives him extreme sexual pleasure, because he soon ejaculates in his
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pants. Three days later, while he is still planning his crime, he fantasizes that he forces the woman to kneel and “run on all fours,” then he ties her to a pillar and shoots her. At the Illinois State Psychiatric Institute we evaluated an extremely intelli gent, well-educated man, who described himself as having an urge to humiliate women and expressed an almost constant preoccupation with sexual and brutal sadistic fantasies of “smashing” women, whipping them, tearing off their clothes, raping them, and mutilating them. He was arrested and indicted for aggravated kidnapping and deviant sexual assault of a child, charges which he freely admitted. On the day of the arrest incident, he was driving his van when he saw a young girl—it turned out that she was only eleven years old—walking on the sidewalk. He got off the van, approached the girl and hit her on the head with his fists, tied her hands, and under the threat that he would harm her if she did not go along with his wishes he drove her to his apartment, where he submitted her to fellatio and cunnilingus. Although he denied any previous similar incidents, there was a distinct impression that this was not the first time he had carried out this type of activity.
It is apparent, from the examples cited here, that in sadism proper there is a characteristic fusion of sexuai and aggressive drives.
Sadism as a Neurotic Symptom A patient described by Havelock Ellis (7) outlined his sexual aberration in the following way: The actual act of whipping is the source of the fascination. There is abso lutely no desire to humiliate the subject. She must feel pain, but only as an expression of the rigor of the whipping. The infliction of pain itself gives me no pleasure; on the contrary, it is a source of repugnance to me. Apart from this sexual anomaly, I have a great dislike of cruelty. I have only once killed an animal and remember it with regret.
Should this type of activity be called sadism? Cases like this are not uncom mon in the literature. We read (8), for example, about a well-educated, sophisticated man, whose sexual practices consisted in beating his girl friend on the buttocks with a whip in a highly ritualistic fashion. He would some times whip himself before the mirror “watching excitedly for the whip marks, just as he did when he could play the scene out with a girl friend,” but he would otherwise be free of any proclivities to cruelty.
One of us has treated a twenty-four-old married man, student of a theo logical seminary, who during foreplay would place his wife on his lap and spank her on the buttocks in a ritualistic way, slightly, not strongly enough to cause her pain. The history revealed that when he was five years old, his father caught him masturbating and spanked him. From then on, the father would frequently ask the patient to pull down his pants to see if the little boy’s penis was erect as a result of
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his masturbatory activity. Apparently, the boy grew up with the unconscious fear that his father actually possessed, his penis and could any time take it away from him. He, however, continued masturbating throughout childhood, adolescence, and married life, sometimes two to three times daily. Masturbation was accom panied by spanking fantasies in which he was alternately either an observer, or the perpetrator, or the victim. Frequently, he would masturbate in front of his wife and ask her to masturbate in front of him. There were accompanying fears of being a homosexual, although he denied any homosexual activities, or fantasies. He decided to become a priest when he saw a movie on the life of Jesus Christ, with whom he apparently identified. He was particularly impressed by the healing powers of Jesus Christ, especially by the scene in the Garden of Gethsemane in which Jesus Christ restores the cut-off ear of the servant. Obviously, this man is suffering from castration fears and anxiety, against which he defends himself by masturbation and the ritual and fantasies of spanking. Spanking does not serve as a source of sexual pleasure for him, although it is part of his sexual foreplay, but, on the contrary, it appears to be a symbolic ritual which frees him from tor menting castration fears. Various authors have stressed the presence of shifting feminine and masculine identifications in cases of this type of “sadism.” Appar ently, in the ritual of spanking, the patient identifies with his punitive father, whereas his wife becomes the helpless child he used to be—in that sense he iden tifies with her, too. Then, he is not any longer the “castrated,” fearful child, but a strong man capable of having intercourse with his wife, whose role switches again from that of a child to that of a woman, while he retains his identification with his father. The defensive, ritualistic, and symbolic nature of this type of “sadism” removes it altogether, in our opinion, from the realm of perversions. Sim ilar reparative rituals have been described by Ovesey (9) in men who be have in a seemingly homosexual manner, although the aim of their behavior is not primarily sexual. For example, Ovesey described a man who, when anxiety-provoking situations arose, would go to the nearest lavatory and give his anus a few strokes with a thermometer, which he carried with him for such contingencies. According to Ovesey, this type of behavior repre sents not a true homosexual behavior, but a pseudohomosexual one, a mag ical attempt to achieve strength through dependency on the phallic instru ment which symbolizes the father’s strength. To place ritualistic “sadism” on the same continuum with sadism proper is, in our opinion, clinically unjustifiable. Sadism Associated with an Altered State of Consciousness The state of consciousness in which the individual feels clearly and sud denly a qualitative shift in his pattern of mental functioning is defined as an altered state of consciousness (10). It may be accompanied by alterations in thinking, disturbed sense of time, loss of self-control, emotional changes
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with an eruption of intense and primitive emotions, changes in body image, perceptual distortions, changes in meaning or significance, feelings of rejuve nation, and a sense of the ineffable (11). Trance, hypnosis, dream, ecstasy (religious, mystical, orgiastic) are common altered states of conscious ness. There is a variety of physiologic and psychologic factors and pharma cologic agents that can trigger an altered state of consciousness. According to Ludwig (11), reduction or increase of exteroceptive stimulation and/or motor activity and/or emotion, increased or decreased alertness, and various somatopsychologic states (dehydration, epilepsy, psychedelic, and other drugs) appear to play a major role in the production of altered states of consciousness. The relationship between ecstasy, a form of altered state of conscious ness, and sexuality has been explored in a study by Laski (12) which in cluded a questionnaire given to a number of people known to have experi enced ecstasy. The questionnaire revealed that art, nature, and sexual love in that order followed by religion were the most frequent triggers of ecstasy. Joseph Popper-Lynkeus, the famous Viennese engineer and philosopher, de scribed a case in which sadistic sexual activity appeared to accompany a typical state of sexual ecstasy. The perpetrator, a well-known scientist, gave a written confession of his crime which was taken nearly verbatim by Lynkeus, a friend of his. Lynkeus describes vividly a typical altered state of consciousness and we will give here brief, but characteristic, excerpts of his description, in translation by Robert Eisler (13), personally known to both Lynkeus and the perpetrator: A man of ripe age . . . was walking on an early summer morning through the countryside. . . . The aromatic smell of the fir-tree resin and the gentle exercise of walking in the fresh air put him in the most pleasant mood, which developed very soon into a highly stimulated sexual excitement. He was en tirely filled with an erotic urge . . . an old woman suddenly stepped forward from among the trees . . . her sudden appearance hit the man like a lightning stroke; his heart beat so violently that he could not speak to the woman . . . he could only ntter a few hoarse sounds, and, without starting any negotiations, grasped the woman around the body, threw her on the grass and himself upon her . . . a peculiar sort of hist awoke in him which appeared to be the natutal continuation and climax of the preceding sensation. “Here,” he thought, “I am quite alone with this person. . . . It must be a prodigious experience to take this life. . . . It would be a thousand pities, not to yield now to the urge of Nature. For it is Nature herself who urges me on to it. . . . He compressed her neck. . . . Finally, she lay there, throttled, a corpse. While the man went on observing her, his previous sensations and urges vanished; after a few mo ments he found it impossible to imagine what he must have been feeling only a few seconds before. . . .
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At the Illinois Psychiatric Institute we evaluated a case in which not Na ture, but marijuana, a mild psychedelic drug, triggered an ecstatic sexual ex perience accompanied by sadistic activity.
The perpetrator, a twenty-one-year-old man, and his seventeen-year-old girl friend were smoking marijuana in the basement of his home. Suddenly he be came overwhelmed by sexual excitement of great intensity. He felt, as he graph ically described it, “as if somebody had injected liquefied lust” in him and be came aware of an intense desire to “take” the young body that was sitting next to him. He approached the girl from behind, threw a towel around her neck and tried to choke her. He was not sure whether he wanted to kill her or have sexual intercourse with her. The girl resisted. “Don’t hurt me,” she said and began taking off her clothes, feeling that the aim of the attack was sexual. The recourse to violence on the part of our patient was inexplicable to the young girl since physical intimacy was not absent from their relationship. “If only you had asked me” she said, after the forceful sexual intercourse was over. Following the incident the patient felt extremely guilty and remorseful, unable to understand how he could do such a thing which was totally wrong and for which he deserved punishment. He admitted, however, that when smoking mar ijuana he had fantasies of rape in which the woman would “turn pale, cold, plas tic, like a manikin.” He also admitted a similar incident a few years earlier, again while he was under the influence of marijuana.
Sadistic activity associated with an altered state of consciousness is characterized, as shown by the examples cited above, by paroxysmal sexual and aggressive behavior. Because of the possible involvement of the limbic system in the phenomena of altered states of consciousness as well as in the regulation of sexual and aggressive behavior, sadistic activity accompanying altered states of consciousness might give us clues to, the understanding of sadistic behavior in general. Sadism Associated with Psychosis Incidents of ghastly sexual crimes in which the victim is not only mo lested, but also killed, or mutilated, or even in rare cases eviscerated, may appear from time to time in the daily press. Krafft-Ebing (14) and, among the contemporaries, De River (15) have described numerous cases of this sort. The term sadism or necrophilia is most often used to describe this type of behavior. At the Illinois State Psychiatric Institute we evaluated a man with a history of numerous incarcerations at penal and psychiatric facilities, all associated with acts of violence and sexual deviation (robbery, armed robbery, rape, attempted rape, exhibitionism), variously diagnosed as paranoid schizophrenic, manic-depressive psychotic, and sociopathic personality. Two years after his last psychiatric hos pitalization, he was arrested and indicted on four counts of homicide. He ad-
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omitted freely his crimes which involved, followirig the death of the victims, cunnilingus, mammilingus, and insertion of various objects into their vagina and rectum. On examination, he was obviously psychotic, preoccupied with hallucinations and delusions of persecution. He stated that when he was twenty years old some body from his family, perhaps his mother, put something into his food and “took away his manhood.” Since then he was unable to have an erection. He would have, however, frequent “visions” of naked women who would invite him to make love to them, or whisper in his ears promises of orgies, big parties, where they would continuously drink and gamble and make love. In response to these “visions” and “voices” he would go to various public places (washrooms, parks) waiting for a woman to appear. Then he would attack his victim with a knife, or a rock, or a pipe and, after killing them, he would engage in the activities cited above. One is impressed by the intense sexual content of his hallucinations and the total lack of restraint in acting out aggressively these psychotic experi ences. As in sadism accompanying altered states of consciousness, there is here an unmistakable fusion of sexual and aggressive drives. Characterological Sadism In contrast to sadism proper, in which the infliction of pain or humil iation takes place in a sexual context, in characterological sadism the inflic tion of pain or humiliation is clearly nonsexual. Karen Horney and Erich Fromm gave vivid, penetrating descriptions of this type of sadism. Fromm considers Joseph Stalin the perfect example of mental and physical non sexual sadism. However, psychologic evaluations of the personalities of rulers and political persons in general, based most of the times on insufficient and anecdotal information, may not provide the most reliable examples of the psychologic processes that presumably operate in these persons. Dostoyevsky (16), this master psychologist, has given us a beautiful de scription of the sadistic character in the person of Nikolai Stavrogin, the enigmatic, noble, and beastly hero of The Possessed. To quote from the novel: “Strange rumors soon began to reach. . . . The reports cited savage recklessness, people run down by his horses, and his unspeakably brutal be havior toward a lady of the highest society with whom he had an affair and whom he then insulted publicly . . . he went around insulting people for the sheer joy of it.” There are several incidents in The Possessed which il lustrate Stavrogin’s sadism. When an old gentleman says he would not let anyone lead him by the nose, Stavrogin suddenly catches the gentleman’s nose between his index finger and his thumb and pulls him along. On an other occasion, pretending that he wants to whisper a secret to the governor of the province, he catches his ear between his teeth and bites it quite hard. We consider Nikolai Stavrogin the prototype of characterological sadism.
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The degree of malignancy of this type of sadism varies. As noted by Havelock Ellis, an element of nonsexual sadism, a mild degree of a tendency to relate to others in an aggressive way, is fairly widespread among the gen eral population. Yet, the difference between characterological sadism and the most malignant forms of sexual sadism does not seem to be just one of degree. COMME NT
There are apparent clinical differences among the various types of be havior generally described as “sadism.” In contrast to widespread notions that associate sadism with whipping, flagellation, and similar rituals, com pulsive, ritualistic whipping or spanking is not a genuine sexual perversion. The aim of the ritual here is not to inflict pain and bring about sexual pleasure, but to free the individual of unbearable anxiety. That is neither sadism, nor aggression. It is a pantomime of aggression, a caricature of sadism. It is pseudosadism. Characterological sadism is obviously not related to sex. It is simply a way of relating to others. It emanates from a need for power and control and expresses itself with feelings and acts of hostility, malice, and vengeful ness. We would suspect that most of the sadistic characters are paranoid personalities. Sadism proper, sadism associated with psychosis, and sadism associated with an altered state of consciousness have in common a fusion of aggressive and sexual feelings. This fusion is more apparent in sadistic activity asso ciated with an altered state of consciousness. In this case the individual is seized paroxysmally by forces beyond his control which are both sexual and aggressive in nature. He is totally confused about the aim of his be havior, he is not sure whether he wants to kill or engage in sexual relations with his victim. Recent findings concerning the role of certain areas of the limbic system in the regulation of aggressive and sexual behavior might be useful in elucidating the pathophysiology of this type of sadism. The paroxysmal nature of this type of activity, which combines both sexual and aggressive behavior, is indeed reminiscent of the syndrome, closely related to dysfunction of the limbic system which Mark and Ervin (17) have called episodic dyscontrol syndrome. Prominent features of this syndrome are paroxysmal violent and sexual behavior which, however, are not always present at the same time. It is known, primarily, through the work of Delgado (18), and recently of Mark and Ervin, that electrical stimulation of certain areas of the the limbic system, specifically the amyg daloid complex, may elicit paroxysmal aggressive behavior in animals as well as humans. It is also known, through the works of Olds (19), Mac Lean (20), and Heath (21) that electrical stimulation of some other areas
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of the limbic system, namely the septal region, may elicit paroxysmal sexual behavior. It is conceivable that sadism associated with an altered state of consciousness is the product of simultaneous paroxysmal discharges in the areas of the limbic system that mediate sexual and aggressive behavior. Concerning sadism associated with psychosis, the presence of psychosis is not enough, in our opinion, to explain the gruesome sadistic acts of these patients. The patient here becomes overwhelmed by powerful sexual and aggressive feelings which emerge independently of the psychosis. The psychosis appears to channelize those “blind,” so to speak, feelings into specific objects which become the recipients of the aggressive sexual attack. It is conceivable that in these patients, too, there are, independently of the psychosis, abnormal discharges in the limbic system leading into lustful aggression. That there are no electroencephalographic abnormalities in all of these patients is not surprising in view of the finding by Mark and Ervin that in some patients with dyscontrol syndrome the EEG would become abnormal only during the attack of their aggressive behavior. Sadism proper is a rather elusive entity. It is doubtful whether nonpsychotic persons would engage in the type of sadistic behavior described— more or less as a life style—in the writings of Marquis de Sade. Clinical experience shows that what may be included under “sadism proper” is a tendency to humiliate the other person while engaging in sexual relations. As such, this type of sadism could be seen as a variant, extending into sexual relations, of the characterological sadism described by Karen Homey and Erich Fromm. S UMMAR Y
This paper reviews briefly the literature of sadism and reports and com ments on several cases of sadistic individuals evaluated by the authors. On the basis of their findings the authors distinguish the following five clinical categories of sadism: (1) characterological sadism associated with a need for control over another person; (2) neurotic sadism involving ritualistic, symbolic whipping or spanking whose primary aim is not to inflict pain and derive sexual pleasure, but to free the individual of unbearable anxiety; (3) sadism associated with an altered state of consciousness; (4) sadism associated with psychosis, which are both viewed as products of simultaneous paroxysmal discharges in the areas of the limbic system that mediate sexual and aggressive behavior; and (5) sadism proper, a rather elusive entity, prob ably a variant of characterological sadism extending into sexual relations. R E FE RE NCE S
1. Freud, S. Civilization and Its Discontents. In Standard Edition, Vol. 21. Hogarth Press, London, 1930. 2. Lorenz, K. On Aggression. Harcourt Brace Jovanovich, New York, 1966.
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3. Horney, K. Our Inner Conflicts. In The Collected Works of Karen Homey. Norton, New York, 1937, pp. 192-216. 4. Fromm, E. The Anatomy of Human Destructiveness. Holt, Rinehart & Win ston, New York, 1974. 5. De Sade, M. Justine. In The Encyclopedia of Erotica. Gillette, P. J. and Dicks, R. H., Eds., Award Books, New York, 1959, pp. 222-224. 6. Sartre, J. P. Erostratus. In Intimacy and Other Stories, Alexander, L., Transl. Berkeley, New York, 1958. 7. Ellis, H. Psychology of Sex. Mentor Books, New York, 1975, p. 150. 8. McDougall, J. The Anonymous Spectator. In Contemporary Psychoanalysis, Vol. 10, July 1974. 9. Ovesey, L. Homosexuality and Pseudohomosexuality. Science House, New York, 1969. 10. Tart, C. Introduction. In Altered States of Consciousness, Tart, C., Ed., Wiley, New York, 1969. 11. Ludwig, A. Altered States of Consciousness. In Altered States of Conscious ness, Tart, C., Ed., Wiley, New York, 1969. 12. Laski, M. Ecstasy: A Study of Some Secular and Religious Experiences. Green wood Press, Westport, Conn., 1968. 13. Eisler, R. Sadism and Masochism in Modern Society. In Encyclopedia of Aberrations, Podolsky, E., Ed. Citadel Press, New York, 1965, pp. 478-482. 14. Krafft-Ebing, R. Psychopathia Sexualis, Robinson, V., Transl., Pioneer Pub lications, New York, 1953. 15. De River, J. P. The Sexual Criminal: A Psychoanalytical Study. C. C Thomas, Springfield, 111. 1956. 16. Dostoyevsky, F. The Possessed, MacAndrew, A., Transl., Signet Classics, New York, 1962, p. 42. 17. Mark, V. H. and Ervin, F. R. Violence and the Brain. Harper & Row, New York, 1970. 18. Delgado, J. M. R. Physical Control of the Mind: Toward a Psychocivilized Society. Harper & Row, New York, 1969. 19. Olds, J. Differentiation of Reward Systems in the Brain by Self-Stimulation Techniques. In Electrical Studies on the Unanesthetized Brain, Ramey, S. R. and O’Doherty, S., Eds. Hoeber, New York, 1960. 20. MacLean, P. D. Chemical and Electrical Stimulation of Hippocampus in Un restrained Animals. II. Behavioral Findings. Arch. Neurol. Psychiatry, 78: 128, 1957. 21. Heath, R. G. Pleasure and Brain Activity in Man: Deep and Surface Elec troencephalograms During Orgasm. J. Nerv. Ment. Dis., 154:3, 1972.
The term “sadism,” derived from the notorious French novelist, the Marquis de Sade, is used to describe a variety of behaviors extending from plain nonsexual, physical, or mental cruelty to infliction of pain, or perpe tration of mutilations, or even murder, during, before, or after sexual activ ity of any sort. Generally, most authors have emphasized the presence of aggressive, nonsexual forces in the various manifestations of sadism. Freud (1), seeing an intrinsic connection between sadism and masochism, the de riving of pleasure from being subjected to sexual, physical, or mental abuse, postulated an instinctive tendency toward self-destruction, the so-called “death instinct,” with sadism being a manifestation of it directed not toward the self, but toward others. Freud’s theory of instinctive aggression found support in the last decade in the work of Konrad Lorenz (2), the prominent ethologist, who theorized that all human aggression is associated with a phylogenetically programmed innate instinct—a theory, however, that has been rejected by a great number of psychologists and neuroscientists. Other psychoanalytic writers, such as Theodore Reik, Karen Horney, and Erich Fromm, rejecting the theory of instinctive aggression, maintain nevertheless that the gratification derived from any sort of sadistic activity is to a great extent the satisfaction of aggressiveness. Characteristically, Karen Homey (3) viewed the sadistic person as attempting to enslave, frus trate, exploit, and humiliate another human being. “To be sadistic,” she stated, “means to live aggressively and for the most part destructively through other persons.” Sadistic trends, according to her, may find an ex pression in sexual behavior which is only an expression of a general attitude toward others. Erich Fromm (4) has expressed similar views. The core of * Staff Psychiatrist, Illinois State Psychiatric Institute, 1601 West Taylor St., Chicago, 111. 60612: Assistant Clinical Professor of Psychiatry, University of Illinois, Abraham Lincoln School of Medicine. tDirector, Forensic Program, Illinois State Psychiatric Institute; Associate Pro fessor of Psychiatry, Northwestern University. .....................
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the various types of sadistic behavior—sexual, physical, mental—according to him, is “the passion to have absolute and unrestricted control over a liv ing being.” A tendency to generalize is apparent in all these theories. To assume that the same psychologic forces operate in the person who enjoys verbally humiliating others and the pathetic man who engages in ritualistic spanking before sexual intercourse as well as the psychotic patient who molests and mutilates or kills his victim would be, we think, a gross violation of common sense. In this article we report briefly a few cases of sadistic individuals whom we evaluated at the Forensic Unit of the Illinois State Psychiatric Institute and, aided by similar cases described in the literature, we attempt to point out the clinical and psychopathologic differences of the various types of be havior generally described as sadism. Specifically, going beyond the crude classification of sadism as sexual, physical, and mental, we distinguish the following five clinical categories of sadism: sadism proper, sadism as a neu rotic symptom, sadism associated with an altered state of consciousness, sad ism associated with psychosis, and characterological sadism. Sadism Proper The term “sadism proper” describes cases in which a person derives sexual pleasure from inflicting pain upon or otherwise humiliating another person. The infliction of pain or humiliation takes place in a sexual context which may include sexual intercourse, fellatio, cunnilingus, or any type of sexual encounter. The works of the Marquis de Sade (5) provide numerous ex amples of sadism proper. In “Justice,” for example, we read about the brutal, apparently nonpsychotic tradesman Dubourg who savagely attacks Justine, knocks her to the floor and leaves her with a gleaming red trickle of blood on her face. Then he falls madly on top of her and begins “nozzling her bloody mouth . . . chewing at her neck with fanged teeth,” but he loses his potency before he is able to have sexual intercourse. Jeän-Paul Sartre (6), in his story “Erostratus,” gave a much more re fined description of sadism proper, in which humiliation rather than physical pain is the primary aim of the sadistic hero, an extremely intelligent and ar ticulate person. In the process of planning a pointless, but perfect crime— the shooting of the first five people he sees, as he goes down In the street— he picks up a prostitute and forces her to undress and walk around in front of him, while he sits motionless and fully dressed. At one point he asks her to spread her legs, he looks between them and says, “Look at that!” and be gins to laugh so hard that tears come to his eyes. He asks her to continue walking naked in front of him and do exercises with his cane. Apparently, this gives him extreme sexual pleasure, because he soon ejaculates in his
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pants. Three days later, while he is still planning his crime, he fantasizes that he forces the woman to kneel and “run on all fours,” then he ties her to a pillar and shoots her. At the Illinois State Psychiatric Institute we evaluated an extremely intelli gent, well-educated man, who described himself as having an urge to humiliate women and expressed an almost constant preoccupation with sexual and brutal sadistic fantasies of “smashing” women, whipping them, tearing off their clothes, raping them, and mutilating them. He was arrested and indicted for aggravated kidnapping and deviant sexual assault of a child, charges which he freely admitted. On the day of the arrest incident, he was driving his van when he saw a young girl—it turned out that she was only eleven years old—walking on the sidewalk. He got off the van, approached the girl and hit her on the head with his fists, tied her hands, and under the threat that he would harm her if she did not go along with his wishes he drove her to his apartment, where he submitted her to fellatio and cunnilingus. Although he denied any previous similar incidents, there was a distinct impression that this was not the first time he had carried out this type of activity.
It is apparent, from the examples cited here, that in sadism proper there is a characteristic fusion of sexuai and aggressive drives.
Sadism as a Neurotic Symptom A patient described by Havelock Ellis (7) outlined his sexual aberration in the following way: The actual act of whipping is the source of the fascination. There is abso lutely no desire to humiliate the subject. She must feel pain, but only as an expression of the rigor of the whipping. The infliction of pain itself gives me no pleasure; on the contrary, it is a source of repugnance to me. Apart from this sexual anomaly, I have a great dislike of cruelty. I have only once killed an animal and remember it with regret.
Should this type of activity be called sadism? Cases like this are not uncom mon in the literature. We read (8), for example, about a well-educated, sophisticated man, whose sexual practices consisted in beating his girl friend on the buttocks with a whip in a highly ritualistic fashion. He would some times whip himself before the mirror “watching excitedly for the whip marks, just as he did when he could play the scene out with a girl friend,” but he would otherwise be free of any proclivities to cruelty.
One of us has treated a twenty-four-old married man, student of a theo logical seminary, who during foreplay would place his wife on his lap and spank her on the buttocks in a ritualistic way, slightly, not strongly enough to cause her pain. The history revealed that when he was five years old, his father caught him masturbating and spanked him. From then on, the father would frequently ask the patient to pull down his pants to see if the little boy’s penis was erect as a result of
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his masturbatory activity. Apparently, the boy grew up with the unconscious fear that his father actually possessed, his penis and could any time take it away from him. He, however, continued masturbating throughout childhood, adolescence, and married life, sometimes two to three times daily. Masturbation was accom panied by spanking fantasies in which he was alternately either an observer, or the perpetrator, or the victim. Frequently, he would masturbate in front of his wife and ask her to masturbate in front of him. There were accompanying fears of being a homosexual, although he denied any homosexual activities, or fantasies. He decided to become a priest when he saw a movie on the life of Jesus Christ, with whom he apparently identified. He was particularly impressed by the healing powers of Jesus Christ, especially by the scene in the Garden of Gethsemane in which Jesus Christ restores the cut-off ear of the servant. Obviously, this man is suffering from castration fears and anxiety, against which he defends himself by masturbation and the ritual and fantasies of spanking. Spanking does not serve as a source of sexual pleasure for him, although it is part of his sexual foreplay, but, on the contrary, it appears to be a symbolic ritual which frees him from tor menting castration fears. Various authors have stressed the presence of shifting feminine and masculine identifications in cases of this type of “sadism.” Appar ently, in the ritual of spanking, the patient identifies with his punitive father, whereas his wife becomes the helpless child he used to be—in that sense he iden tifies with her, too. Then, he is not any longer the “castrated,” fearful child, but a strong man capable of having intercourse with his wife, whose role switches again from that of a child to that of a woman, while he retains his identification with his father. The defensive, ritualistic, and symbolic nature of this type of “sadism” removes it altogether, in our opinion, from the realm of perversions. Sim ilar reparative rituals have been described by Ovesey (9) in men who be have in a seemingly homosexual manner, although the aim of their behavior is not primarily sexual. For example, Ovesey described a man who, when anxiety-provoking situations arose, would go to the nearest lavatory and give his anus a few strokes with a thermometer, which he carried with him for such contingencies. According to Ovesey, this type of behavior repre sents not a true homosexual behavior, but a pseudohomosexual one, a mag ical attempt to achieve strength through dependency on the phallic instru ment which symbolizes the father’s strength. To place ritualistic “sadism” on the same continuum with sadism proper is, in our opinion, clinically unjustifiable. Sadism Associated with an Altered State of Consciousness The state of consciousness in which the individual feels clearly and sud denly a qualitative shift in his pattern of mental functioning is defined as an altered state of consciousness (10). It may be accompanied by alterations in thinking, disturbed sense of time, loss of self-control, emotional changes
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with an eruption of intense and primitive emotions, changes in body image, perceptual distortions, changes in meaning or significance, feelings of rejuve nation, and a sense of the ineffable (11). Trance, hypnosis, dream, ecstasy (religious, mystical, orgiastic) are common altered states of conscious ness. There is a variety of physiologic and psychologic factors and pharma cologic agents that can trigger an altered state of consciousness. According to Ludwig (11), reduction or increase of exteroceptive stimulation and/or motor activity and/or emotion, increased or decreased alertness, and various somatopsychologic states (dehydration, epilepsy, psychedelic, and other drugs) appear to play a major role in the production of altered states of consciousness. The relationship between ecstasy, a form of altered state of conscious ness, and sexuality has been explored in a study by Laski (12) which in cluded a questionnaire given to a number of people known to have experi enced ecstasy. The questionnaire revealed that art, nature, and sexual love in that order followed by religion were the most frequent triggers of ecstasy. Joseph Popper-Lynkeus, the famous Viennese engineer and philosopher, de scribed a case in which sadistic sexual activity appeared to accompany a typical state of sexual ecstasy. The perpetrator, a well-known scientist, gave a written confession of his crime which was taken nearly verbatim by Lynkeus, a friend of his. Lynkeus describes vividly a typical altered state of consciousness and we will give here brief, but characteristic, excerpts of his description, in translation by Robert Eisler (13), personally known to both Lynkeus and the perpetrator: A man of ripe age . . . was walking on an early summer morning through the countryside. . . . The aromatic smell of the fir-tree resin and the gentle exercise of walking in the fresh air put him in the most pleasant mood, which developed very soon into a highly stimulated sexual excitement. He was en tirely filled with an erotic urge . . . an old woman suddenly stepped forward from among the trees . . . her sudden appearance hit the man like a lightning stroke; his heart beat so violently that he could not speak to the woman . . . he could only ntter a few hoarse sounds, and, without starting any negotiations, grasped the woman around the body, threw her on the grass and himself upon her . . . a peculiar sort of hist awoke in him which appeared to be the natutal continuation and climax of the preceding sensation. “Here,” he thought, “I am quite alone with this person. . . . It must be a prodigious experience to take this life. . . . It would be a thousand pities, not to yield now to the urge of Nature. For it is Nature herself who urges me on to it. . . . He compressed her neck. . . . Finally, she lay there, throttled, a corpse. While the man went on observing her, his previous sensations and urges vanished; after a few mo ments he found it impossible to imagine what he must have been feeling only a few seconds before. . . .
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At the Illinois Psychiatric Institute we evaluated a case in which not Na ture, but marijuana, a mild psychedelic drug, triggered an ecstatic sexual ex perience accompanied by sadistic activity.
The perpetrator, a twenty-one-year-old man, and his seventeen-year-old girl friend were smoking marijuana in the basement of his home. Suddenly he be came overwhelmed by sexual excitement of great intensity. He felt, as he graph ically described it, “as if somebody had injected liquefied lust” in him and be came aware of an intense desire to “take” the young body that was sitting next to him. He approached the girl from behind, threw a towel around her neck and tried to choke her. He was not sure whether he wanted to kill her or have sexual intercourse with her. The girl resisted. “Don’t hurt me,” she said and began taking off her clothes, feeling that the aim of the attack was sexual. The recourse to violence on the part of our patient was inexplicable to the young girl since physical intimacy was not absent from their relationship. “If only you had asked me” she said, after the forceful sexual intercourse was over. Following the incident the patient felt extremely guilty and remorseful, unable to understand how he could do such a thing which was totally wrong and for which he deserved punishment. He admitted, however, that when smoking mar ijuana he had fantasies of rape in which the woman would “turn pale, cold, plas tic, like a manikin.” He also admitted a similar incident a few years earlier, again while he was under the influence of marijuana.
Sadistic activity associated with an altered state of consciousness is characterized, as shown by the examples cited above, by paroxysmal sexual and aggressive behavior. Because of the possible involvement of the limbic system in the phenomena of altered states of consciousness as well as in the regulation of sexual and aggressive behavior, sadistic activity accompanying altered states of consciousness might give us clues to, the understanding of sadistic behavior in general. Sadism Associated with Psychosis Incidents of ghastly sexual crimes in which the victim is not only mo lested, but also killed, or mutilated, or even in rare cases eviscerated, may appear from time to time in the daily press. Krafft-Ebing (14) and, among the contemporaries, De River (15) have described numerous cases of this sort. The term sadism or necrophilia is most often used to describe this type of behavior. At the Illinois State Psychiatric Institute we evaluated a man with a history of numerous incarcerations at penal and psychiatric facilities, all associated with acts of violence and sexual deviation (robbery, armed robbery, rape, attempted rape, exhibitionism), variously diagnosed as paranoid schizophrenic, manic-depressive psychotic, and sociopathic personality. Two years after his last psychiatric hos pitalization, he was arrested and indicted on four counts of homicide. He ad-
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omitted freely his crimes which involved, followirig the death of the victims, cunnilingus, mammilingus, and insertion of various objects into their vagina and rectum. On examination, he was obviously psychotic, preoccupied with hallucinations and delusions of persecution. He stated that when he was twenty years old some body from his family, perhaps his mother, put something into his food and “took away his manhood.” Since then he was unable to have an erection. He would have, however, frequent “visions” of naked women who would invite him to make love to them, or whisper in his ears promises of orgies, big parties, where they would continuously drink and gamble and make love. In response to these “visions” and “voices” he would go to various public places (washrooms, parks) waiting for a woman to appear. Then he would attack his victim with a knife, or a rock, or a pipe and, after killing them, he would engage in the activities cited above. One is impressed by the intense sexual content of his hallucinations and the total lack of restraint in acting out aggressively these psychotic experi ences. As in sadism accompanying altered states of consciousness, there is here an unmistakable fusion of sexual and aggressive drives. Characterological Sadism In contrast to sadism proper, in which the infliction of pain or humil iation takes place in a sexual context, in characterological sadism the inflic tion of pain or humiliation is clearly nonsexual. Karen Horney and Erich Fromm gave vivid, penetrating descriptions of this type of sadism. Fromm considers Joseph Stalin the perfect example of mental and physical non sexual sadism. However, psychologic evaluations of the personalities of rulers and political persons in general, based most of the times on insufficient and anecdotal information, may not provide the most reliable examples of the psychologic processes that presumably operate in these persons. Dostoyevsky (16), this master psychologist, has given us a beautiful de scription of the sadistic character in the person of Nikolai Stavrogin, the enigmatic, noble, and beastly hero of The Possessed. To quote from the novel: “Strange rumors soon began to reach. . . . The reports cited savage recklessness, people run down by his horses, and his unspeakably brutal be havior toward a lady of the highest society with whom he had an affair and whom he then insulted publicly . . . he went around insulting people for the sheer joy of it.” There are several incidents in The Possessed which il lustrate Stavrogin’s sadism. When an old gentleman says he would not let anyone lead him by the nose, Stavrogin suddenly catches the gentleman’s nose between his index finger and his thumb and pulls him along. On an other occasion, pretending that he wants to whisper a secret to the governor of the province, he catches his ear between his teeth and bites it quite hard. We consider Nikolai Stavrogin the prototype of characterological sadism.
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The degree of malignancy of this type of sadism varies. As noted by Havelock Ellis, an element of nonsexual sadism, a mild degree of a tendency to relate to others in an aggressive way, is fairly widespread among the gen eral population. Yet, the difference between characterological sadism and the most malignant forms of sexual sadism does not seem to be just one of degree. COMME NT
There are apparent clinical differences among the various types of be havior generally described as “sadism.” In contrast to widespread notions that associate sadism with whipping, flagellation, and similar rituals, com pulsive, ritualistic whipping or spanking is not a genuine sexual perversion. The aim of the ritual here is not to inflict pain and bring about sexual pleasure, but to free the individual of unbearable anxiety. That is neither sadism, nor aggression. It is a pantomime of aggression, a caricature of sadism. It is pseudosadism. Characterological sadism is obviously not related to sex. It is simply a way of relating to others. It emanates from a need for power and control and expresses itself with feelings and acts of hostility, malice, and vengeful ness. We would suspect that most of the sadistic characters are paranoid personalities. Sadism proper, sadism associated with psychosis, and sadism associated with an altered state of consciousness have in common a fusion of aggressive and sexual feelings. This fusion is more apparent in sadistic activity asso ciated with an altered state of consciousness. In this case the individual is seized paroxysmally by forces beyond his control which are both sexual and aggressive in nature. He is totally confused about the aim of his be havior, he is not sure whether he wants to kill or engage in sexual relations with his victim. Recent findings concerning the role of certain areas of the limbic system in the regulation of aggressive and sexual behavior might be useful in elucidating the pathophysiology of this type of sadism. The paroxysmal nature of this type of activity, which combines both sexual and aggressive behavior, is indeed reminiscent of the syndrome, closely related to dysfunction of the limbic system which Mark and Ervin (17) have called episodic dyscontrol syndrome. Prominent features of this syndrome are paroxysmal violent and sexual behavior which, however, are not always present at the same time. It is known, primarily, through the work of Delgado (18), and recently of Mark and Ervin, that electrical stimulation of certain areas of the the limbic system, specifically the amyg daloid complex, may elicit paroxysmal aggressive behavior in animals as well as humans. It is also known, through the works of Olds (19), Mac Lean (20), and Heath (21) that electrical stimulation of some other areas
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of the limbic system, namely the septal region, may elicit paroxysmal sexual behavior. It is conceivable that sadism associated with an altered state of consciousness is the product of simultaneous paroxysmal discharges in the areas of the limbic system that mediate sexual and aggressive behavior. Concerning sadism associated with psychosis, the presence of psychosis is not enough, in our opinion, to explain the gruesome sadistic acts of these patients. The patient here becomes overwhelmed by powerful sexual and aggressive feelings which emerge independently of the psychosis. The psychosis appears to channelize those “blind,” so to speak, feelings into specific objects which become the recipients of the aggressive sexual attack. It is conceivable that in these patients, too, there are, independently of the psychosis, abnormal discharges in the limbic system leading into lustful aggression. That there are no electroencephalographic abnormalities in all of these patients is not surprising in view of the finding by Mark and Ervin that in some patients with dyscontrol syndrome the EEG would become abnormal only during the attack of their aggressive behavior. Sadism proper is a rather elusive entity. It is doubtful whether nonpsychotic persons would engage in the type of sadistic behavior described— more or less as a life style—in the writings of Marquis de Sade. Clinical experience shows that what may be included under “sadism proper” is a tendency to humiliate the other person while engaging in sexual relations. As such, this type of sadism could be seen as a variant, extending into sexual relations, of the characterological sadism described by Karen Homey and Erich Fromm. S UMMAR Y
This paper reviews briefly the literature of sadism and reports and com ments on several cases of sadistic individuals evaluated by the authors. On the basis of their findings the authors distinguish the following five clinical categories of sadism: (1) characterological sadism associated with a need for control over another person; (2) neurotic sadism involving ritualistic, symbolic whipping or spanking whose primary aim is not to inflict pain and derive sexual pleasure, but to free the individual of unbearable anxiety; (3) sadism associated with an altered state of consciousness; (4) sadism associated with psychosis, which are both viewed as products of simultaneous paroxysmal discharges in the areas of the limbic system that mediate sexual and aggressive behavior; and (5) sadism proper, a rather elusive entity, prob ably a variant of characterological sadism extending into sexual relations. R E FE RE NCE S
1. Freud, S. Civilization and Its Discontents. In Standard Edition, Vol. 21. Hogarth Press, London, 1930. 2. Lorenz, K. On Aggression. Harcourt Brace Jovanovich, New York, 1966.
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3. Horney, K. Our Inner Conflicts. In The Collected Works of Karen Homey. Norton, New York, 1937, pp. 192-216. 4. Fromm, E. The Anatomy of Human Destructiveness. Holt, Rinehart & Win ston, New York, 1974. 5. De Sade, M. Justine. In The Encyclopedia of Erotica. Gillette, P. J. and Dicks, R. H., Eds., Award Books, New York, 1959, pp. 222-224. 6. Sartre, J. P. Erostratus. In Intimacy and Other Stories, Alexander, L., Transl. Berkeley, New York, 1958. 7. Ellis, H. Psychology of Sex. Mentor Books, New York, 1975, p. 150. 8. McDougall, J. The Anonymous Spectator. In Contemporary Psychoanalysis, Vol. 10, July 1974. 9. Ovesey, L. Homosexuality and Pseudohomosexuality. Science House, New York, 1969. 10. Tart, C. Introduction. In Altered States of Consciousness, Tart, C., Ed., Wiley, New York, 1969. 11. Ludwig, A. Altered States of Consciousness. In Altered States of Conscious ness, Tart, C., Ed., Wiley, New York, 1969. 12. Laski, M. Ecstasy: A Study of Some Secular and Religious Experiences. Green wood Press, Westport, Conn., 1968. 13. Eisler, R. Sadism and Masochism in Modern Society. In Encyclopedia of Aberrations, Podolsky, E., Ed. Citadel Press, New York, 1965, pp. 478-482. 14. Krafft-Ebing, R. Psychopathia Sexualis, Robinson, V., Transl., Pioneer Pub lications, New York, 1953. 15. De River, J. P. The Sexual Criminal: A Psychoanalytical Study. C. C Thomas, Springfield, 111. 1956. 16. Dostoyevsky, F. The Possessed, MacAndrew, A., Transl., Signet Classics, New York, 1962, p. 42. 17. Mark, V. H. and Ervin, F. R. Violence and the Brain. Harper & Row, New York, 1970. 18. Delgado, J. M. R. Physical Control of the Mind: Toward a Psychocivilized Society. Harper & Row, New York, 1969. 19. Olds, J. Differentiation of Reward Systems in the Brain by Self-Stimulation Techniques. In Electrical Studies on the Unanesthetized Brain, Ramey, S. R. and O’Doherty, S., Eds. Hoeber, New York, 1960. 20. MacLean, P. D. Chemical and Electrical Stimulation of Hippocampus in Un restrained Animals. II. Behavioral Findings. Arch. Neurol. Psychiatry, 78: 128, 1957. 21. Heath, R. G. Pleasure and Brain Activity in Man: Deep and Surface Elec troencephalograms During Orgasm. J. Nerv. Ment. Dis., 154:3, 1972.
