Freud formulated the first major psychotherapeutic technique over 100 years ago. Since then there have been at least 40 modifications of psychoanalysis. However, since the theoretical basis with respect to the psychodynamic and unconscious underpinnings of behavior is very similar, the major focus is on classical psychoanalysis.
Freud's charting of a formerly unknown part of the mind to show the role sex or sexual forces play in unconscious motivation left an impact on twentieth-century thinking that is still being felt.One is hard put to attend the theater, read a modern novel, watch a television program, or listen to everyday conversation without encountering the results of his work. When Freud uncovered the unconscious, man could no longer hide from himself. Whether or not one agrees with Freudian concepts of infantile sexuality, Oedipus complex, transference phenomena, one is nevertheless involved with them. Freud assigned major importance to the instinctive drives of the individual.
He believed that in the course of individual development, failures to channel these drives force them to seek expression in socially and individually unacceptable ways, as for instance substance abuse. When these unpleasant manifestations are repressed, the instinctual energies are expressed as various neurotic substitute behaviors. The mood change, according to Freud, results from a redirection of thought processes in the alcoholic, the alcohol providing the impetus for regression to childhood levels of thinking.The individual thereby achieve gratification from thinking that was uncontrolled by logic. This psychoanalytic theory considers the use of alcohol as an escape from reality. The escape concept has taken hold and is described by many authors, and by the many alcoholics who acknowledge it in a self-incriminating way.
Jellife, (Popham 228) in 1919, developed the escape theory by maintaining that alcohol permits indulgence in the “autoerotic ecstasy of dreaming” instead of facing “tortures which arise from the reality.Parland, (Westerfield ; Lawron 378) in 1957, equated escape in alcoholism with escape in homosexuality. Both kinds of escape, we agree, in women as well as men, stem from desire to flee one's normal sexual role. But we think that emphasis of the escape phenomenon as the major etiological component of alcoholism is an oversimplification. The alcoholic, like all of us, wants to escape from unpleasant reality.
What but escapes are our defenses, our rationalizations? The critical questions are why the choice of alcohol as a means, and why does the escape method cripple the whole personality.As is the case with any inquiring mind, Freud was not satisfied to rest on his formulation and in later years revised his thinking about the alcoholic (Masserman & Yum 36). He equated with alcoholism the model of repressed homosexual traits he had used to describe the development of paranoid symptoms, and these traits illustrated the prime psychological turmoil of the addict. Freud maintained that because of the unconscious homosexual wish (related to strong oral influences of childhood), a man succumbed to the pull of the public house, getting from the company of men the emotional satisfaction he could not get from his wife.
It was Freud's contention that disappointment by women (wives, mothers, lovers) drove men to drink. Whenever the alcoholic's latent homosexual feelings came to the surface, he repressed them by returning to his wife. In turn, he then suspected his wife of sexual activity with those men he unconsciously loved, thereby developing paranoid symptoms. Freud believed that the personality arises through a number of distinct phases.
The individual's pleasure impulses are first focused on sucking (oral phase).One of his first adjustments to society is represented by sphincter control, and he is both socialized and rewarded in the course of this adjustment (anal stage). Then, if he is to reach maturity, he eventually learns, through a series of subphases, to focus his pleasure on a legitimate object of the opposite sex (genital phase). While everyone experiences all these phases to some extent, major crises along the way may cause an individual to regress to and become fixated on a premature phase of development.The parallels between mental illness, alcoholism and drug dependence also extend to another point. Freud and a variety of other students have familiarized contemporary men with the idea that the symptoms of the mentally ill person often represent a solution to his personal problems.
In cases of hysteria, for example, an individual may control his environment with a “paralyzed” hand. The paralysis of the trigger finger of an infantry soldier suffering from “battle fatigue” makes this quite clear. If under hypnosis one suggests that the hand is all right, the individual may regain control over it.But it was often discovered that sometime later a whole new set of hysterical symptoms appeared, worse than the original symptoms. The individual may end up, for example, psychologically blind rather than psychologically crippled. In retrospect, it sometimes seems that the hysterical patient takes the best possible path through the maze of his personal difficulties.
Or again, Freud discovered that when he had eventually uncovered and brought to the surface repressed psychological material, a virtual explosion of aggressive feeling sometimes occurred.In short, when the mentally ill person is deprived of his illness, he may suffer the equivalent of “withdrawal” symptoms. The interrelations between mental illness, alcoholism, and drug addiction are complex. A number of psychiatric syndromes result from alcoholism. The acute alcoholic psychoses include: delirium tremens, hallucinosis, and acute alcoholic intoxication.
In acute alcoholic psychosis, the drinker, after consuming only a small amount of alcohol, may develop total amnesia to events that follow and often carry out automatic behavior that may be violent and dangerous.Chronic alcoholic deterioration is manifest as a gradual deterioration of the moral and ethical senses and values of the patient. Korsakoff's psychosis results in extreme memory defects. Chronic alcoholic psychosis of a paranoid type and alcoholic schizophrenia appear when persons seem normal while not drinking, but manifest paranoid and schizophrenic symptoms while drinking.
Wernicke's syndrome consists primarily of a clouding of consciousness and possible appearance of a stuporous or somnambulant state. Other psychopathologies from alcohol also may occur.Among the mental complications that occur after the use of drugs are: the psychoses, paranoia, and anxiety reactions as so intoxication; and by a self-destructive attitude in dealing with relationships and life situations. Alcoholism is the result of: a disturbance and deprivation in early infantile relations accompanied by related alterations in basic physiochemical responsiveness; the identification by the alcoholic with significant figures who deal with life problems through the excessive use of alcohol; and a socio-cultural milieu that causes ambivalence, conflict, and guilt in the use of alcohol.Contemporary and later analysts utilized this Freudian formulation and elaborated upon it.
For example, Karl Abraham (Conger 296) considered the alcoholic as severely frustrated by his mother early in life and hence forced to turn to his father for solace. This resulted in over identification with his father and the development of homosexual tendencies. Since alcohol consumption is related to increased sexual excitement, Abraham formulated a popular equation: drinking prowess is the equivalent of sexual prowess. To this day a man who does not drink is viewed by many with suspicion and distrust.
Abraham further pointed out that alcohol may substitute for sex, and he likened this substitution to certain sexual perversions such as voyeurism and fetishism. In perversions, stimuli that normally are a part of the foreplay of sex become its major gratification; there is fixation at this preliminary sexual stage. For example, viewing the desired sexual object is but a means of forepleasure leading to culmination in sexual union. For the voyeur, however, complete satisfaction is achieved merely by the looking. Abraham believed the sexual development of the alcoholic was fixated in forepleasure (oral stimulation).
Alcohol thus becomes the means of effortless gratification whereby the alcoholic exchanges women for wine. Although latent homosexuality and confusion in sexual identity may play a significant role in the evolution of problems associated with substance abuse, they do not offer sufficient impetus for the development of so devastating a condition. Much of the psychopathology of alcoholism may be tied to factors commonly seen in the patient with homosexual problems, but these are not only insufficient to be the sole etiological agent for alcoholism; they are often misinterpreted.Since the fixation at the oral stage is so early in psychosexual development, the alcoholic has never achieved a genital level of differentiation and is so desirous of receiving love, he does not differentiate the sex of the provider.
Another important psychoanalytic component of alcoholism often advanced is the self-destructive drive of alcoholics. Menninger (Ullman 602) in his best seller Man Against Himself raised this much-disputed point. It was his contention that generally alcoholics unconsciously have a powerful desire to destroy themselves.Addiction is one means of expressing this unconscious urge which is the result of the child's feeling betrayed by his parents. The frustration arising from the betrayal results in an intense rage toward his parents which in turn causes interpersonal conflict.
He wishes to destroy his parents yet he fears losing them. Later in life, alcohol becomes a means of achieving both gratification and revenge against the parents. The feeling of hostility toward parents creates a desire for punishment to alleviate guilt. Therefore, Menninger viewed alcohol addiction as a form of slow suicide used to avert a greater self-destruction.
The concept of self-destructive urges in alcoholism has recently been challenged by McCord (Shoben 1956) and his group in their longitudinal studies of pre-alcoholics and non-alcoholics. They expected to find, if the self-destructive etiological concept was correct, a higher incidence of suicidal trends in the pre-alcoholic than in the non-alcoholic. This was not borne out in their study. Irrespective of these findings about suicide, our experience with alcoholics has revealed that most of their relations, endeavors, and goals have been self-destructive.The continuous, unbroken thread always runs in the direction of the alcoholic's unconsciously doing himself harm. Hence, it is not the alcohol wedded specifically to suicidal attempts or thoughts which emphasize the alcoholic's self-destructive drives, but rather the total life pattern of aggression and hostility directed inward.
Only by taking into consideration this all-encompassing self-destructiveness that pervades every facet of the alcoholic's personality can one understand the total intensity of this etiological factor.Many theorists have elaborated on Freud's original oral concept, and oral fixation has also been incriminated as the sole cause of alcoholism. For example, Knight (Richter), was of the opinion that the predominance of oral craving is especially significant in the alcoholic. He attributes the oral fixation to specific early family experiences: an indulgent mother and an inconsistent father he sees as the most common family configuration. A child overly indulged by a permissive mother, according to Knight, cannot learn self-control and reacts with intense rage to every frustration.
This capacity for rage is fed by an inconsistent father who unpredictably gratifies at one time and denies at another. In such a family the attitudes of the mother and father tend to reinforce one another. This pattern of dependence, rejection, and intense desire for indulgence is built into the personality, associated with deep feelings of inferiority and guilt. During puberty, there is an intensification of envy of masculine prowess as exemplified by the father, and drinking becomes regarded as “manly.
” The child begins to drink, and his drinking in time becomes anti-social with concomitant defiance of parental wishes.This pathological behavior develops out of an unresolved adolescent revolt. The pharmacological effects of alcohol reinforce irresponsible behavior, and ultimately others are forced to take care of the imbiber in his passive, drunken stupor. If Knight's contentions concerning the typical family producing alcoholics are correct, then we must prepare for an invasion of alcoholics in unbelievable numbers. In mid-twentieth-century America (and, we suspect, in other affluent societies as well), mothers are primarily directed toward overindulging the needs of their children.With the commuting father in and out of the home like a surreptitious lover, his influence and attitude are limited and inconsistent.
Fortunately such parental influences appear not to be a major contributing factor in alcoholism. Tiebout (Williams 452) incriminated the unconscious need to dominate as a strong motivating force of the alcoholic. Along with this need are found hostile attitudes, feelings of loneliness and isolation, and ambivalent perceptions of inferiority and superiority.With these deprived and conflicting feelings the alcoholic, according to Tiebout, strives for perfection and craves “ecstatic peaks. The striving for perfection we feel is an important concept, as it may be the means by which the alcoholic assures himself of certain and continuous failure.
The Adlerian school of “individual psychology” evolved their own concept of the substance abuse. They attributed addiction to a desire of the individual to remove powerful feelings of inferiority while escaping responsibilities. To Adler, (Dollard ; Miller 1950) feelings of inferiority were the root of all alcoholic problems. Inferiority might be overtly expressed or be hidden behind the screen of superiority.Marked shyness, a preference for isolation, impatience, irritability, anxiety, depression, hypersensitivity, and sexual insufficiency may herald the onset of an addiction.
“Boastfulness, malicious criminal tendency, a longing for power,” Adler maintained might be the symptoms of addiction when the superiority complex was the adaptive mechanism employed. He contended that alcoholism is the result of childhood pampering. Overindulgence and excessive coddling result in the individual's inability to face up to the frustrations of adult reality, and this in turn leads to inferiority feelings.The alcoholic then attempts to counter the demands of society by the use of alcohol. It is not difficult to see that the traits Adler listed are quite universal and in no way specific to alcoholism.
An elaboration of the Adlerian view by Schilder (Wexberg 227) attributes alcoholism to a perpetual state of insecurity from earliest childhood. This insecurity is related to parental associations. The child, in Schilder's formulation, has been pushed deeper and deeper into an insecure abyss by ridicule, by passivity, by threat, by corporal punishment, and by degradation.Although the threats originally came from one or both parents, the child learns to expect them, and soon sees the community as threatening him in a similar way. Social tension and insecurity are thereby heightened. In adult life, alcohol dissolves this painful situation, generating feelings of social acceptability and security while the individual is intoxicated.
With the disappearance of that mood, the original feelings return with increased vigor and demand renewed drinking. Schilder felt that the alcoholic suffers deeply from his social insufficiency.He is unable to establish a close relationship with other human beings and is aware of it. He claims and expects special favors, appreciation, and love. Schilder says the love the alcoholic feels for his own body and intellect he hungers for from others.
The constant social tension developed from this desire is only relieved through alcohol, which permits him the feelings of being lovable and loved. The Schilder psychoanalytic theory concerning social insecurity does not answer why all socially insecure people who drink do not become addictive drinkers.
