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Savitt, R.A. (1963). Psychoanalytic Studies on Addiction: Ego Structure in Narcotic Addiction. Psychoanal Q., 32:43-57.
(1963). Psychoanalytic Quarterly, 32:43-57
Psychoanalytic Studies on Addiction: Ego Structure in Narcotic Addiction
Robert A. Savitt, M.D.
In the psychopathology of the addictive process the most malignant form is addiction to narcotics. Object relationships are on an archaic level and the addict is unable to experience love and gratification through the usual channels of incorporation and introjection. Tension and depression become unbearable and in the process of regression the ego is overwhelmed by the threat of disintegration. Like the neonate, the addict has no ability to bind tension. Because of the inability to tolerate delay, he seeks an emergency measure which bypasses the oral route of incorporation in favor of a more primitive one, the intravenous channel.
He injects a tension-relieving opiate which immediately restores the integrity of the ego. But what is restored is merely the relatively fixated archaic infantile ego by which the addict survives from one drug feeding to another, with indolence, semistupor, or sleep between feeding. The vicious cycle repeats itself whenever the drug hunger appears. With the rapid repair of the distintegrating infantile ego, perception is diminished or obliterated and the process of denial is served. The question is raised: Does the injection symbolically represent an attempt to re-establish a total fusion with the mother as well as a union with her breast?
When we speak of the archaic ego in the addict, we do not set a limit on the concept of its extent or potentiality for maturation. We do not yet know how far the psychotherapeutic process will provoke ego maturation in the addict. In the cases
described the ego of the criminal addict was the most archaic. The one who went on to recovery had the more mature ego to start with and, of the four, he alone was capable of developing a classical transference neurosis during psychoanalytic treatment.
Pertinent questions arise. Why do not other patients with apparently similar hunger needs develop narcotic addiction? Why do so many resort to alcohol, to barbiturates, to food, and still others to hypersexuality as a way of dealing with tension? Is there a recognizable additional factor? The mother-child relationship appears to be crucial, but this is equally true in many other psychiatric syndromes. Attention is called to the first patient mentioned in this paper. For several years he went through the gamut of varied addictions before he became a confirmed opiate user. Of the four addicts, he seems to have been the most deprived during his infancy. He did not have the advantage of object constancy and a consistent relationship with his mother was not effected until he was four.
While the core of the addictive process exists in all of us in such benign forms as cravings for food, tobacco, candy, or coffee, the vicissitudes of early ego development and later ego maturation which facilitate fixation and encourage regression appear to play a dominant role in predisposing an individual to the development of the crippling, morbid craving.
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