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Krystal, H. (1978). Self Representation and the Capacity for Self Care. Ann. Psychoanal., 6:209-246.

(1978). Annual of Psychoanalysis, 6:209-246

Self Representation and the Capacity for Self Care

Henry Krystal, M.D.

I. Substance Abuse and Psychoanalytic Theory

Some of the early analysts, especially Abraham (1908, 1924), Simmel (1930, 1948), and Rado (1926, 1933) contributed significant insight into the psychodynamics of alcoholism and drug addiction, and in the process enriched psychoanalysis. As pessimism shrouded over the prospects of individual analytic therapy for these patients, we lost interest in them, and thereby we lost the opportunity to learn from working with them. Symptomatic of this impoverishment of our studies is the absence of a course on problems of alcohol or other drug dependence from the curriculum of all psychoanalytic institutes affiliated with the American Psychoanalytic Association (Handler, 1977). The Board on Professional Standards of the American Psychoanalytic Association does not require or recommend any instruction in the area of the addictions.

Yet I have found this to be a rewarding area to study. Impressed with the vagueness and lack of differentiation of affective states, particularly depression and anxiety in withdrawal states, I pursued a study of affective disturbances in alcoholism and drug dependence (Krystal, 1962). I found an affective disturbance in drug-dependent individuals consisting of affect dedifferentiation, deverbalization, and resomatization (Krystal and Raskin, 1970). These patients showed a severe disturbance in affective forms and function.

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