Everyone knows the possible consequences of "addictive" behaviour (addiction: dependence, a harmful habit, habituation), that is, of dependence on pleasure; to some degree it is familiar to us all. In this article we look at addiction from a different angle. The use of drugs (alcohol and the rest), their abuse and, finally, dependence on them is a problem not only for the addicted person but also for those close to them.
Drug addiction and other forms of dependence
Addiction has two "faces":
- it is a compulsive need that overpowers a person's will,
- it is a survival strategy.
A leaning towards addictive behaviour should also be understood as a reaction to inner emptiness, to a lack of stability, to hopelessness or to psychological trauma.
Addiction as a survival strategy means that, by using legal or illegal drugs, some people can ward off emotional states they cannot allow themselves and try to compensate for feelings of inferiority. Tormenting biographical experiences and psychological traumas are, as it were, "frozen", so that a person becomes able to bear unconscious and conscious affects, memories and uncontrollable, tormenting impulses.
In this way drug addiction has become not a way of life but a survival strategy, a mechanism for coping with suffering, and, in the sense of a compromise, it can be regarded as a symptom that serves stabilisation.
Introduction
Symptoms, in the sense of signs of illness, are often regarded in Western medicine and psychology as "deficiency phenomena" or "defects". An aching tooth, for instance, points to a defect in the substance. Pain can be read as a warning signal that leads to medical action meant to protect the diseased tooth from further damage.
The symptom of pain points to an impending danger to a person's physical and psychological integrity and thus provides the necessary precondition for the unconscious and conscious actions that secure adaptation for survival, whether the triggers are inner or outer. In this context pain is a necessary and meaningful (if unpleasant) sensory perception.
In the definition of pain given by the IASP (International Association for the Study of Pain), the phenomenon is described as follows (Göbel 1988): "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage ..."
This shows that symptoms (here, pain), as sensory and emotional experiences, can be manifestations of physical and psychological processes. Sensory-emotional perception conveys impending damage, irritation or possibly even a psychodynamic conflict.
On the sense of symptoms
As early as his "Introductory Lectures on Psycho-Analysis", Sigmund Freud describes, in the chapter "The Sense of Symptoms", that
the symptom has a sense and is connected with the patient's experience.
Freud gives several examples and develops these ideas in other chapters in connection with dreams or parapraxes (the theory of parapraxes), which he likewise calls "neurotic symptoms". He refers to Pierre Janet and Josef Breuer, who as early as the end of the 19th century suspected that symptoms have a sense and are connected with inner conflicts (Freud 1992/1917). Alfred Adler, the founder of individual psychology, postulated, after his "Study of Organ Inferiority" published in 1907, that
congenital anomalies of constitution are to be understood not only as signs of degeneration but (...) lead to compensatory activity and increased performance. This compensating mental effort often takes other, new paths in order to meet the strain of life (...) and thus fulfils the task of covering the felt deficiency (...) in the most remarkable way.
In neurosis Adler sees an auxiliary construction whose final goal is to attain superiority, so as to balance out feelings of inferiority by compensating and drawing up a corresponding life plan (Adler 2001/1930). This rests on the assumption that human behaviour is goal-directed. Rudolf Dreikurs, too, holds, in Alfred Adler's spirit, that "nervous disorders" arise where they indicate that "you are faced with tasks you do not like. The symptoms, whether slight or intense, represent a kind of safeguard" (Dreikurs 2005/1933).
Symptoms are thus compensatory compromise formations of inner psychological dynamics, there to make mental tension bearable. The symptom is at the same time the expression of an attempt at a solution. It mirrors the conflict and, with it, a possible attempt to resolve it.
Beyond psychoanalysis, the idea that symptoms have a sense is found in other sources as well. Daniel Hell, for instance, writes in one of his books ("What Sense Does Depression Make?") about the bond-strengthening component of depression. Hell explains that a couple's relationship is stabilised by the negative feedback that comes with depression. The depressive way of communicating leads to a "build-up of the relationship dynamic that makes it harder to dissolve the mutual bonds" (Hell 2002).
Freud writes that "the symptom has a sense and is connected with the patient's experience", and thereby underlines the subjectivity of that experience. The symptom can thus show itself as an individual adaptation to the biographical, personal experience of the ill person. Oleksy was able to demonstrate that patients with borderline personality disorder use self-harming acts constructively (often unconsciously), acts that exist alongside destructive components (Oleksy 2007). Sachsse (2002) examined interviews with patients in order to show that many borderline patients are able to improve and stabilise their emotional state through acts such as cutting, scratching or burning. Some even reported that these acts put a distance between them and suicide.
Addiction as a symptom, and the drug as an attempt at self-healing
Early traumatic experiences in particular, in the first and therefore formative years of life, can later lead to severe mental disorders. So-called early interpersonal traumas – such as physical violence against children or sexual violence, and inadequate, deficient care on the part of the parents – have been identified in the literature as risk factors for substance abuse in adolescence and adulthood (Kaplan et al. 1999). This can lead to disturbances of interpersonal relationships, to problems with self-esteem and identity, as well as to dysfunctional coping strategies and, finally, to disorders of affect regulation (Schäfer et al. 2006). According to Schäfer, the extent of psychiatric comorbidity in patients with an addiction is striking. It is most pronounced in patients with post-traumatic stress disorder, borderline personality disorder, anxiety disorders and depression.
In his contribution "Psychoanalysis of Addiction", Gerhard describes how substance abuse and dependence can be symptoms of a deep infantile conflict (Gerhard 2003). Following inner compulsions, substances have to be taken in. Because of low self-esteem and the habitual effects, the person concerned loses control over their drug use more and more.
According to object-psychological models, alcohol-dependent people and many drug-dependent people develop an (auto)destructive process in which the "malignant introjected early object" is to be poisoned and destroyed. People with mental disorders are trying to cope with their emotional pain.
This "self-healing character" of addictive behaviour can also be found in ego-psychological models, according to which structurally weakened parts of the ego are to be compensated for by the effect of drugs (Rost 1987). Many drug-dependent people are so much at the mercy of their emotions that relatively undifferentiated affects and perceptions have to be numbed (blotted out). Reducing the intensity of impulses and tension has a stabilising effect in times of crisis and protects against emotional overload. In this connection Gerhard speaks of the development of a "pseudo-identity" and of the loss of contact with reality. The compensation and the protection against unmanageable emotional experiences and memories, sensible as they were at first, also reach their limit. The rise out of traumatising and oppressive humiliation, the temporary sense of being alive and the grandiose fantasies (Kohut 1976) produced by the effect of the drugs collapse sooner or later.
Turning away from traumatising experiences often creates an inner emptiness, a feeling that one's own existence is meaningless and a lack of any prospect. The person feels that they are, that they are alive, only through the "obtaining, the consuming and the effect" of drugs.
Scheidt (1976) says: "Drug users strive to dissolve the false self in intoxication (...) in order finally (...) to reach the true self."
In the case of traumatic experience, addictive behaviour can be a saving way of life, a survival mechanism or a coping strategy, and it can be seen as symptom formation that serves stabilisation. Nevertheless, for clients as well as for the therapists treating them, the search for the true self becomes possible precisely because addiction is no longer seen as a disorder but simply as a temporary form of coping. New, healthier alternatives can come into view if addiction is understood as a "meaningful" reaction to psychological damage and therefore no longer stands at the centre of therapeutic interest.
References
Adler, A. (2001/1930): The Practice and Theory of Individual Psychology
Dreikurs, R. (2005/1933): Fundamentals of Adlerian Psychology.
Freud, S. (1992/1917): Introductory Lectures on Psycho-Analysis.
Gerhard, H. (2003): Zwischen Lebensstil und Sucht. Drogengebrauch und Persönlichkeitsentwicklung in der Spätmoderne.
Göbel, H. (1988): Zur Komplexität einer umfassenden Definition des Phänomens Schmerz. Der Schmerz: Vol. 2: 89-93.
Kaplan (1999): Child and adolescent abuse and neglect research: a review of the past 10 years. Part I: Physical and emotional abuse and neglect. Psychiatry 38, 1214-1122
Kohut, H. (1976): Foreword to J. v. Scheidt: Der falsche Weg zum Selbst. Drogenkarriere als gescheiterter Selbstheilungsversuch.
Gerhard, H. (2003): Zwischen Lebensstil und Sucht. Drogengebrauch und Persönlichkeitsentwicklung in der Spätmoderne.
Oleksy, P. (2007): "Sinn im Unsinn. Konstruktive Aspekte selbstschädigenden Verhaltens bei Borderline-Patienten". Diploma thesis at the Faculty of Education, Leopold Franzens University of Innsbruck
Sachsse, U. (2002): Selbstverletzendes Verhalten. Psychodynamische Psychotherapie. Trauma, Dissoziation und ihre Behandlung.
Schäfer, I.; Krausz, M. (2006): Trauma und Sucht. Konzepte - Diagnostik - Behandlung.
Scheidt, J. v. (1976): Der falsche Weg zum Selbst. Drogenkarriere als gescheiterter Selbstheilungsversuch.
© Natallia Nechai
