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the diagram is labeled disengagement to reflect the fact that ego contraction implies a reduction ot personal contact with the environment; the weak or threatened ego retains its integrity by limiting its figural relation with the ground of the surrounding world. The right side of the diagram is labeled engagement to reflect the fact that ego expansion implies an increase in the person's sense of dominance or control over both the self and the environment; the figural ego swells, providing increased belief in one's personal power and importance.

To the right of the vertical coordinate is a dimension that runs from ecstasy (which arises from achieving a near-transcendent state through one's own efforts), to peace or serenity (which stems from the passive disengagement of ego concerns)'. Next is a dimension that runs from striving (which is oriented more toward conventional than spiritual achievement), to passivity and relaxation, or loss of interest in the normal activities of life.

Just below the horizontal coordinate on the right a dimension runs from paranoia, or projection of unconscious impulses outward, to emergence of the unconscious or the flooding of awareness with impulses of a psychic nature; some psychoanalysts might call this the "return of the repressed." Finally, a dimension runs from violence, which usually consists of attacks on others but may have self-destructive consequences as well, to sacrifice, which means opening up (disintegrating) the ego to the acceptance of psychic reality. As used here, the term violence does not mean controlled violence, of the sort used by professional athletes or policemen, but an explosive, unthinking rage in which all sense of identity is lost.

As indicated, the ego states induced by chronic, heavy abuse of stimulants, narcotics, depressants, and psychedelic drugs fall into distinctive sectors of figure 1. The placements of different drugs are indicated by broken lines on the diagram. These reflect our current judgments regarding the states these substances produce in individuals committed to chronic heavy use of each substance. For example, the placement of cocaine shows that, while it may produce paranoia, it does not typically precipitate the violence that is often associated with amphetamine or barbiturates. Also, although it shares features in common with amphetamine, users report that cocaine produces a state of ecstasy that is apparently unique.

Narcotics induce ego contraction, disengagement, or serenity. However, especially in very large chronic doses, they may awaken terrifying phantasmagoric images (such as those that affected Thomas DeQuincey and Samuel Taylor Coleridge), which indicates that unmanageable unconscious material has broken loose and is emerging into awareness.

Barbiturates may produce some positive effects, like relaxation, but with heavy use, the dark side effects of violence, self-destructiveness, and loss of self-identity outweigh the pleasant ones. lndeed, heavy barbiturate use seems to yield more socially and personally destructive acts than any other form of drug abuse.

We have not studied alcohol abusers but feel that the ego state produced by alcohol is similar to that produced by barbiturates, though at a less intense level. We also believe that people who take psychedelic drugs regularly may do so in an attempt to achieve something akin to spiritual enlightenment. However, psychedelic drugs are unpredictable.

and there is always the danger of a bad trip, the emergence of chaotic material from the psyche into consciousness.

We have not studied long-term polydrug abusers, but it appears that attainment of a specific ego state may be irrelevant for these individuals. They seem to be willing to enter any drug-induced ego state, so long as it differs in strong or noticeable ways from the ego state which exists during abstinence. These individuals may well be more disturbed and have fewer personal resources than any other group depicted in figure 1.


The various groups of drug users we studied have each gravitated to substances that induce temporary states that help them cope with specific disturbances in ego/psyche relationships. Because of adverse developmental conditions, these individuals are unwilling or unable to pursue a normal course of individuation. They seek shortcuts, a pseudointegration by means of counterfeit ego states produced by pharmacological agents.

Amphetamine abusers have failed to develop the tender, compassionate sides of themselves and view women as terrifying creatures who threaten to render them impotent. With the aid of amphetamine, these men attempt to live a precarious but hypermasculine existence. Cocaine abusers have similar traits but are somewhat more resourceful and better integrated; they fight for what they want and regard normal dependency as defeat. They are subject to crises of alienation and feelings of emptiness and despair. Cocaine provides them a powerful, though counterfeit, substitute for the warmth and nurturance they need.

Narcotics abusers are poorly defended against the environment and their own psychic lives; they use drugs to help shrink their egos so that they can maintain limited personal integrity in the face of internal and external forces they cannot control. They seek serenity and an ally which will provide temporary relief from anxieties and help them function in a limited but more integrated way.

Barbiturate abusers are neglected individuals who believe they have received little love, attention, or respect in life. Drugs provide these men temporary release and escape from identities which mark them as perpetual failures in their own eyes.

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The following discussion is restricted to the psychodynamic study of "compulsive drug use," the latter being defined as any form of substance abuse where there is substantial subjective psychological need to resort to or to continue using mind-altering substances in disregard of possible noxious consequences that such use socially, legally, somatically, or psychologically entails. lt is a relative, not an absolute concept, a "more or less," not an "either/or." What is experienced as "freedom of choice" versus "irresistible intense necessity" is arrayed in a "complemental series" (Freud 1926). As a rule, such use is based on severe inner conflicts, developmental disturbances, and serious family pathology, unless it is used to cope with the effects of "minimal brain damage.11


Drug use is preeminently a pharmacologically reinforced denial—an attempt to get rid of the feeling import of more or less extensive portions of undesirable inner and outer reality. lt is a defense making the emotional significance of a perception of the outer or inner reality unconscious, inoperative, irrelevant. The broader such blocked-out emotional significance becomes, the more the personality is drained of vitality, of identity, of inner richness.

What is centrally denied in compulsive drug users are affects of a potentially overwhelming nature. ln short, drugs are used to forestall or soothe affective storms or nagging dysphoric moods.

This presupposes not solely a proneness for this particular archaic defense, but also an inclination for what has been described as affect regression (Krystal 1974)—the global, undifferentiated nature of emotions that can often only scantily be put into words and other symbolic forms (hyposymbolization), but is instead partly converted into somatic sensations. (Many drug addicts are today's version of conversion hysterics!) Anxiety of an overwhelming nature and the emotional feelings of pain, injury, woundedness, and vulnerability appear to be a feature common to all types of compulsive drug use. The choice of drugs shows some fairly typical correlations with otherwise unmanageable affects— narcotics and hypnotics are deployed against rage, shame, jealousy, .and particularly the anxiety related to these feelings; stimulants against depression and weakness; psychedelics against boredom and disillusionment; alcohol against guilt, loneliness, and related anxiety. This means we immediately recognize the following layering: (1) drug use, (2) affective storms or chronic dysphoria representing such unpleasant affects, (3) underlying pathology of a hysterical or obsessive-compulsive, of a phobic or depressive, or occasionally of a psychotic or organic nature. Symptom and character neuroses usually coexist.

Where such broad chunks of reality are sapped of their lifeblood, so to speak—due to widespread denial—we find something very characteristic of many drug users—depersonalization and the impression of a "false self"—of a double personality, split into a docile, submissive, conforming self, and one of violent rebellion and deep hurt.


Addictions and phobias parallel each other in structure, though with inverted valence. While the addict compulsively seeks an external object to serve as protector mainly against vague anxiety of unknown meaning, the phobic compulsively avoids an external object to serve as representative for vague anxiety of unknown meaning. Even more specifically, we find in the history of most addicts phobic systems as antecedents of their current problem. More and more l see, at least in most addicts, a phobic core as the infantile neurosis underlying the later pathology, typically the fears (and wishes) around being closed in, captured, entrapped by structures, limitations, commitments, physical and emotional closeness and bonds. This concrete or metaphorical claustrophobia is seen, as primary phobia, very close to the original experience of traumatic anxiety, the strangling feeling of being closed in and confined. The limits given by one's conscience and outer societal limitations and watched over by the so important guardian feelings of guilt and shame are foremost examples of claustra that must be broken or eluded.

Where there are phobias, there are protective fantasies—fantasies of personal protective figures or of impersonal protective systems, specifically counterpoised to these threats. This search for a protector against the phobic object and the anxiety situation almost inevitably leads to a compelling dependency on such a counterphobic factor—a love partner, a fetish, a drug, a system of actions, the analyst. Most typically, drug addiction is fulfilling a protective fantasy defending against the phobic core. Protective objects and protective systems show "return of the repressed." Many of the frightening features are covertly present in the protector. Paradoxically, the claustrophobic seeks the shelter that turns into a new claustrum; he or she will find this in the transference to the therapist as well.

Similarly these protectors are highly (narcissistically) overvalued. They are expected to be all-powerful, all-absolving, all-giving, yet also feared to be all-destructive, all-condemning, all-depriving.


Many compulsive drug users were severely traumatized as children. Child abuse is, in the simplest and strongest terms, one of the most important etiologic factors for later drug abuse. A child cruelly beaten or exposed to severe, often homicidal violence in the immediate surrounding, a child involved in sexual actions of adults, a child subjected to relentless intrusions or endlessly deceived and mystified has a number of other defenses at its disposal to deal with the abysmal sense of helplessness (besides denial).

The helplessness reflected by the state of primary phobia (claustrophobia) especially and the pain of repeated feelings of having been uncontrollably overwhelmed, traumatized, are defended against by a thick crust of narcissism. Grandiosity and haughty arrogance, more or less extensive and deep withdrawal of feelings from the painful environment and, hence, coldness and ruthlessness are typical features of such a narcissistic defense. lt is often papered over by a superficial amiability, friendly compliance, and flirtatious charm—the hallmarks of the "sociopath."

Even more broadly, one can recognize the consistent use of the defense of turning passive into active. Just as the patient suffers and fears disappointment as a main theme of life, he or she does everything possible first to enlist help, but then to turn the tables and to prove the therapist helpless and defeated. Very closely related to this is the pervasive use of defense by externalization. lt is a counterpart to denial, just as projection is to repression. ln it "the whole internal battle ground is changed into an external one" (A. Freud 1965). lt is the defensive effort to resort to external action in order to support the denial of inner conflict; the latter is changed back into an external conflict; for example, ridicule, rejection, and punishment are provoked by, not just suspected from, the outside world. Limit-setting is invited and demanded but then endlessly fought against. lts aim is to take magical, omnipotent control over the uncontrollable, frightening. Such action for action's (and, implicitly, punishment's) sake is reflected not merely in excessive drug taking, but in gambling, racing, motorcycle jumping, lying, cheating, and violence.


lt is part of the archaic defenses, the affect regression, and the traumatized ego core that there is a remarkable discontinuity of the sense of self. Patients often are or resemble "split" or "multiple" personalities. What is characteristic is the sudden total flipflop, a global lability with no mediation and no perspective. lt is the unreliability that is so infuriating for others, so humiliating for themselves.

This is not a defense, but an "ego defect," a functional disparity that affects not solely the ego, but no less the superego. ldeals and loyalties are suddenly replaced by more primitive commitments and pursuits of grand designs.

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