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Joseph, B. (1982). Addiction to Near-Death. Int. J. Psycho-Anal., 63:449-456.

(1982). International Journal of Psycho-Analysis, 63:449-456

Addiction to Near-Death

Betty Joseph

There is a very malignant type of self-destructiveness, which we see in a small group of our patients, and which is, I think, in the nature of an addiction—an addiction to near-death. It dominates these patients' lives; for long periods it dominates the way they bring material to the analysis and the type of relationship they establish with the analyst; it dominates their internal relationships, their so-called thinking, and the way they communicate with themselves. It is not a drive towards a Nirvana type of peace or relief from problems, and it has to be sharply differentiated from this.

The picture that these patients present is, I am sure, a familiar one—in their external lives these patients get more and more absorbed into hoplessness and involved in activities that seem destined to destroy them physically as well as mentally, for example, considerable over-working, almost no sleep, avoiding eating properly or secretly over-eating if the need is to lose weight, drinking more and more and perhaps cutting off from relationships. In other patients this type of addiction is probably less striking in their actual living but equally important in their relationship with the analyst and the analysis. Indeed, in all these patients the place where the pull towards near-death is most obvious is in the transference. As I want to illustrate in this paper, these patients bring material to analysis in a very particular way, for example, they may speak in a way which seems calculated to communicate or create despair and a sense of hopelessness in themselves and in the analyst, although apparently wanting understanding.

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