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Rosenfeld, H.A. (1960). On Drug Addiction. Int. J. Psycho-Anal., 41:467-475.

(1960). International Journal of Psycho-Analysis, 41:467-475

On Drug Addiction

Herbert A. Rosenfeld

SUMMARY

It is suggested in this paper that drug addiction is closely related to the manic-depressive illness, but not identical with it. The drug addict uses certain manic and depressive mechanisms which are reinforced and consequently altered by the drugs. The drug has both a symbolic meaning which relates to the unconscious phantasies attached to it and the drugging and also a pharmacotoxic effect which increases the omnipotence of the mechanisms used and the omnipotence of the impulses.

The use of the mechanisms of idealization, identification with ideal objects, and denial of persecutory and depressive anxieties is related to a positive or defensive aspect of mania.

The destructive phases in drug addiction are closely allied to the destructive aspect of mania. Drugging often has a depressive meaning also, the drug symbolizing a dead or ill object which the patient feels compelled to incorporate out of guilt. An important part in drug addiction is played by the mechanisms of ego splitting and projection of good and particularly bad parts of the self, mechanisms which are more pronounced than in the manic-depressive states. The bad part of the patient's personality often becomes identified with a drug and during the drugged state is projected into objects in the environment which often leads to severe acting out. Drugging also occurs when the bad self is taken back into the ego. I am suggesting that the weakness of the addict's ego is related to the severity of the process of ego splitting and that the prognosis of the psycho-analytic treatment of a drug addict depends on the extent to which the analysis is able to help the patient to integrate the split-off parts of the self, a process which implies a strengthening of the patient's ego.

Crises of severe drugging may occur when the analysis is making progress and the splitting of the ego diminishes, which leads to aggressive acting out. This reaction may be regarded as a negative therapeutic reaction.

On the surface the oedipal conflict and homosexuality play an important part in the psychopathology of the drug addict, but during analysis it becomes apparent that the overwhelming force of his conflicts can only be understood by examining their basis in the very earliest conflicts and mechanisms of the infant.

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