"On Addiction" - Final Thesis - Master of Arts in Psychoanalysis, 2006, Middlesex University, London, UK.
The Cocaine Papers
Civilizations and its Discontents
3.INTOXICATION AND TOXICOMANIA
4.ADDICTION AND THE ACTUAL NEUROSES
5.CAUSES OF ADDICTION
Freud's ideas on Pain
Cancellation of Pain
Administration of Enjoyment
6.TOXICOMANIA AND THE CLINICAL STRUCTURES
7.THE MARRIAGE WITH THE PHALLUS
Drug addiction is an old phenomenon. The use of toxic substances has been present in every society throughout our history. However, in the last few years it has become a form of social epidemic and a global problem. Different substances have become real “products” which generate a multimillion commerce.
The consequences of drug use (and abuse) have become a field of study. This phenomenon has been studied from different angles
Science (medicine, neurobiology) has put effort into the investigation of the biological conditions which may be responsible for the compulsive behaviour in the use of different drugs. Classifications have been made regarding the toxicity and degree of physical dependence each substance can create. There are investigations which focus on the relationship between drug abuse and underlying genetic factors. (1)
From a social point of view, there have been studies which focus on the environmental factors that might predispose to the use of certain substances: e.g. social background, cultural factors, etc.
The issue of drug abuse also has a very important place in the legal discourse. Drugs belonging to the same classification in terms of their composition or effects might be considered in a very distinctive way should their use be considered illegal in a particular society.
It is clear that there is a multiplicity of discourses dealing with the issue from different points of view. Therefore, it is necessary to redefine our field and deconstruct certain categories in order to arrive at our object of study, a psychoanalytic object of study in the field of addiction and to analyse the positions which present toxicomania as a specific pathology, structure or clinical entity.
These basic elements will provide the framework to attempt an explanation of the phenomenon. Therefore the thesis will be organized in two ways. On the one hand I shall try to outline the characteristics of this phenomenon in psychoanalytic terms paying special attention separately to what belongs to our field from what doesn’t fall under psychoanalytic relevance. On the other I will revise psychoanalytic theorisations on the subject in order to attempt to explain the mechanisms involved in toxicomania.
In the first section "The Category of Addiction” I will present a classical definition of addiction from the medical discourse in order to compare it with a psychoanalytical approach. This will help me to outline the conception of addiction presented in this thesis.
Chapter 2 will be dedicated to review Freud's ideas on addiction. From his early works to “Civilization and its Discontents” (1930). Freud's ideas are extremely important in order to understand the category of the object-drug as well as the process of subjective structuration. In this section I will also introduce Lacan's concept of "jouissance", an invaluable tool to understand the mechanisms involved in toxicomania.
In the next chapter “Intoxication and toxicomania" I will analyse how different authors define toxicomania (or drug abuse) in contraposition to a casual episode of intoxication using drugs. This will help us demarcate my field of investigation.
I will then examine Freud's concept of "Actual Neuroses" (Chapter 4). This concept has been taken up in some contemporary theorisations. I will critically analyse some of these approaches.
Next (Chapter 5) I will present what different authors think of the causes of addiction starting with Freud's ideas on pain. My purpose here is to examine the hypotheses which consider toxicomania as a way of self medication to treat a form of structural pain.
“Toxicomania and the clinical structures” (Chapter 6) will be dedicated to consider the relationship of the matter with the classical nosographic division on clinical structures in psychoanalysis. I will then review Lacan’s references to addiction (chapter 7), this will ultimately allow me to reach my own conclusions in the last chapter as to the phenomenon of toxicomania.
Psychoanalysis can provide the tools to understand this complex phenomenon:
“Only psychoanalysis has been able to bring about the synthesis of the four great models of dynamic psychiatry that are necessary for the rational apprehension of madness and psychical illness. What it did was to borrow psychiatry’s nosographic model, psychotherapy’s model of physical treatment, philosophy, theory of the subject and anthropology conception of culture based on the idea of universality of the human race respectful differences.” (Roudhinesco, 2001)
1. THE CATEGORY OF ADDICTION
One of the main problems when addressing the issue of addiction is the fact that this category is defined within many discourses in different ways. It is present in our common speech, as well as in different fields of study. This can be precisely our first obstacle, as the effect of signification this word has might coagulate its meaning and precipitate a simplistic explanation.
Goodman (1990, p. 1403) defines addiction as “a process whereby a behaviour, that can function both to produce pleasure and to provide escape from internal discomfort, is employed in a pattern characterized by (1) recurrent failure to control the behaviour (powerlessness) and (2) continuation of the behaviour despite significant negative consequences (unmanageability).” (Goodman, 1990, p.1).
This definition shows that the field of addiction is enormous; any object can be taken as an object of an addiction. Addictions can include the abuse of substances but also gambling, addiction to work, addiction to sex, etc. All these behaviours can be described as “compulsive” regarding certain activities and they involve powerlessness and lack of control.
However, in this thesis I will focus on those forms of addictions where a toxic substance is involved. In order to clarify and differentiate from other forms of addiction I will alternatively use the signifier “toxicomania” to refer to the form of addiction which entails the use of a toxic substance.
The main difference between toxicomania and other forms of addiction is the presence of a chemical substance which is introduced into the organism, modifying it and typically providing a feeling of pleasure or “high”. Consequently there is a “real” modification within the body as a result of the act of chemical intoxication.
Despite the fact that psychoanalytic investigation (2) has shown that any substance can ultimately be taken as an object of addiction, my investigations will be centred on substances which have proven in other fields to be “physically addictive” (3), namely substances which produce drug-induced changes in the physical brain.
I’m not suggesting addictive behaviour to be considered as a physical disease, but rather establishing the framework that will facilitate my investigation.
We should also bear in mind that a psychoanalytic approach to the matter should focus on the subject who takes the drugs. The distinction at the level of the object simply aims at differentiating toxicomanias from the other forms of addiction. We should not consider “physical dependence” as the main cause of addiction.
Considering physical dependence to be the cause of addiction has many implications. On the one hand, the cure is thought as a mere “detoxification”, trying to extirpate the toxic substance from the body. On the other, this approach does not take into account the role played by the subject and the functioning of the toxic substance in the psychical economy.
The medical discourse has had the biggest impact on the social perception of the phenomenon of addiction. Sylvie Lepoulichet (1990, p.21) suggests that the medical discourse is the most influential in any definition of toxicomania and has also affected some of the psychoanalytical theorisations on the subject.
The notion of pharmaco-dependency has clearly dominated the twentieth century. Addiction is explained as a double dependency, psychical and physiological without any interrogation of the role played by the subject.
In order to establish the foundation to a psychoanalytic investigation on the subject I will review Freud's conceptions on addiction from his early works like "The Cocaine Papers" (1884) to “Civilization and its Discontents" (1930).
2. FREUD'S THEORISATIONS ON ADDICTION
The Cocaine Papers
Freud had the idea that cocaine could be very beneficial for his patients as a local tanaesthetic. “Über Coca” was published in 1884. In this text Freud described the properties of the drug cocaine and explored its effects and therapeutic possibilities. He studied the effects on himself and others.
The properties of the drug included the capacity to increase the person’s ability to work and it allowed people to do without food for long periods of time. He also noticed that taking the drug meant an increase in physical strength.
His investigations led him to believe that human beings had an amount of energy available for work that was somewhat released by cocaine.
A system which has absorbed even an extremely small amount of cocaine is capable, as a result of the reaction of the body to coca, of amassing a greater store of vital energy which can be converted into work than would have been possible without coca. If we take the amount of work as being constant, the body which has absorbed cocaine should be able to manage with a lower metabolism, which in turn means a smaller intake of food (Freud, 1884, p.60)
Eventually, he rejected cocaine as a therapeutic instrument as he discovered that the effect of cocaine was not constant. Different individuals reacted differently to the drug. The effect depended, for instance, on the subject’s mood.
Freud’s investigations revealed that the effects could not be related to the object “cocaine” as its sole cause and this idea could not be explained by his physiological approach.
He finally concluded that cocaine was an “unpredictable object”: General reactions to the drug could not be stated (ibid., p.174) and in some people there was a possibility of a toxic effect.
I suspect that the reason for the irregularity of the cocaine effect lies in the individual variations in excitability and in the variation of the condition of the vasomotor nerves on which cocaine acts. Since little attention has been paid to this factor of individual predisposition, and the degree of excitability generally cannot be known, I consider it advisable to abandon so far as possible subcutaneous injection of cocaine in the treatment of internal and nervous disorders (ibid, p.176)
These arguments put forward have many implications as they can help us to understand Freud’s views on the object-drug. Freud clearly stated that the effects produced by the drug could not be located in the drug itself, but rather individual conditions and predisposition. This introduces a variable which is not taken into account in the medical discourse: the subject and its particularities.
Freud's further theorisations on the matter established a connection between addiction and his conception of sexuality.
In a letter to Flies in 1897 he describes addiction as a substitute to masturbation. “masturbation is the one major habit, the ‘primal addiction,’ and it is only as a substitute and replacement for it that the other addictions -- to alcohol, morphine, tobacco and the like -- come into existence.” (Masson, 1985, p. 287-289)
Freud considered that breaking an addiction involved the same treatment imposed to break the habit of masturbating and that they were both result of the lack of normal sexual intercourse. (Freud, 1898, p.268).
He claimed that masturbation was influential in the development of the neurosis of the subject. However he was not sure of the mechanism of the injurious effects of masturbation (if there were any) (Freud 1912, p 246)
Loose (2002, p.71) proposes that the masturbation issue played a central role in Freud’s thinking. He argues that Freud’s intention when connecting masturbation and addiction was to demonstrate the existence of a fundamental and internal impotence in humans for experimenting pleasure.
Freud didn’t propose a theory of practical solution to the question of addiction, his references to addiction are always connected to another topic but they suggest that the object of an addiction bears a connection with the sexual object.
This exploration of Freud's theories presents another difference from a clinical (medical) approach. Where other theories investigate the properties of the "object-drug" or substance involved, psychoanalysis investigates the connection with a more primitive object, the sexual object.
Freud (1912, p 246) hesitated in considering masturbation as an “actual neurosis”. Some contemporary psychoanalytic approaches share this uncertainty of classification in the field of addiction. We shall see that some authors consider addiction to be an actual neurosis.
J A. Miller’s further investigations on addiction also relate masturbation and addiction. Masturbation seems to bear a resemblance with addiction as both represent a shortcut to satisfaction. Miller (1993) indicates that the jouissance of drug addiction passes neither by the Other nor by phallic jouissance, i.e. avoiding the symbolic framework that mediates the subject's relationship with the object as if the subject could do without the Other to obtain satisfaction.
To fully understand Miller’s statements we need to elaborate on the Lacanian term “jouissance”. In the next section I will outline the most important ideas on Freud's Civilization and its Discontent and introduce Lacan's concept of jouissance
Civilization and its Discontents
The most powerful remarks regarding the use of toxic substances are found in Civilizations and its Discontents (1930) Freud argues that there is a state of dissatisfaction inherent to the state of culture.
He poses the question: What do human beings hope to find in life?
“They strive after happiness; they want to become happy and to remain so. This endeavour has two sides, a positive and a negative aim. It aims, on the one hand, at an absence of pain and unpleasure, and, on the other, at the experiencing of strong feelings of pleasure. In its narrower sense the word ‘happiness’ only relates to the last.” (Freud, 1930, p. 4475)
Freud clearly states that our possibilities of happiness are restricted by our very constitution. We call “happiness” the feeling of satisfaction of needs which have been dammed up to a high degree. We can derive intense enjoyment only from a contrast. If a pleasurable situation is prolonged, “it only produces a feeling of mild contentment” (Ibid. p. 4475)
These remarks have very important implications. From Freud’s conceptualisations we can infer that the state of “complete happiness” is IMPOSSIBLE. This idea may exist as a residue from a primitive state on the structuration of the subject; an undifferentiated state” (1930, p.4468), when the ego and the world were not separate entities.
Freud (ibid., p. 4469) states that an adult ego-feeling is the result of a process which starts in a state of total undifferentiation. Primitively a subject and object cannot be distinguished. There are only “sources of excitation” flowing in upon him. These sources of excitation include his body organs, stimuli from the outside world, his mother’s breasts. At this mythic moment this organism has not been bathed in the river of language, this means that the chore of the future personality has not been yet constructed. The idea of an “outside” will appear as a result of the unavoidable sensations of pain and unpleasure. “A tendency arises to separate from the ego everything that can become a source of such unpleasure, to throw it outside and to create a pure pleasure-ego which is confronted by a strange and threatening ‘outside’” (Freud, 1930, p. 4467)
This means that in order to live our human lives we have to pay a price. This price is giving up the total satisfaction of the incestuous relationship.
This very operation is the cause of desire. The primitive object is lost forever. Hence, we will search for substitutes through the path of desire.
What Freud describes as “complete happiness” can be described in Lacanian terminology as “access to jouissance”. By definition access to jouissance is impossible. Prohibition to jouissance in the speakingbeing (4) is the price paid when entering the world of language. Freudian description of a mythical ego which includes the outside world can be thought of in terms of pure jouissance. Pure jouissance until the introduction of the signifier and the passage from a organism-body to an erogenous body.
The signifier creates a lack (a structural lack) and the subject is cut off from a primordial jouissance.
Jouissance must not be confused with “pleasure”, although according to Lacan “pleasure” is a form of jouissance “phallic jouissance”
Phallic jouissance is sexual jouissance, and therefore a possible pleasure. When human beings enter the world of language they have access to this form of regulated jouissance.
This language-regulated form of jouissance functions as a prohibition of the jouissance of incest as a result of the law of symbolic castration.
This form of jouissance is forbidden for the reason that access to this jouissance would be lethal for the subject. Access to the primordial object would mean a total fulfilment of desire and therefore, death.
It is clear that complete happiness is theoretically impossible; in the same way that jouissance is forbidden for the speakingbeing. Human beings do not easily accept this fact and they insist on considering this form of jouissance possible.
According to Freud we’re threatened with suffering from our own ageing body, and also from the external world and its forces of destruction. But the most painful source of suffering comes from our relations to other people (Freud, 1930 p.4475). Sources of pain are an inevitable part of living in civilisation. Freud describes the use of chemical substances as one of the different techniques to avoid pain:
The crudest, but also the most effective among these methods of influence is the chemical one - intoxication. I do not think that anyone completely understands its mechanism, but it is a fact that there are foreign substances which, when present in the blood or tissues, directly cause us pleasurable sensations. (Ibid., p. 4477)
This last quote is fundamental to understand the mechanism of toxicomania as it suggests that there is a difference between the act of intoxication and an addiction to a toxic substance. In addition, it indicates that chemical intoxication can act as a defence against the threatening force of pain. I will return to Freud’s ideas on pain in chapter 5.
3. INTOXICATION AND TOXICOMANIA
It is a fact that different drugs and alcohol have always been used in religion (as part of rituals), medicine, or just as a way of entertainment. However, not everyone who use them become addicted. It is thus necessary to distinguish between normal use and abuse. The distinction does not seem very clear. It is also essential to locate the decisive factors which can transform an isolated behaviour (taking drugs or alcohol in specific circumstances) into toxicomania.
Freud's description of the “habit” using narcotics can lead the way to our first approach to the matter.
‘Habit’ is a mere form of words, without any explanatory value. Not everyone who has occasion to take morphine, cocaine, chloral hydrate, and so on, for a period, acquires in this way an ‘addiction’ to them. Closer enquiry usually shows that these narcotics are meant to serve - directly or indirectly - as a substitute for a lack of sexual satisfaction; and whenever normal sexual life can no longer be re-established, we can count with certainty on the patient’s relapse.” ( Freud 1898, p 467)
In this quote Freud clearly connects addiction with sexuality. Although this differentiation is not entirely clear, we can infer that Freud separates on the one hand “intoxication” and on the other "addiction".
As I explored in the previous chapter, the act of intoxication is one of the ways of dealing with the question of the threatening forces inherent to our state of culture. Addiction in contrast appears as a means of satisfaction when there is a lack of normal sexual life.
In these terms, the difference is connected to what causes the use of drugs, a cause which is present within the subject, and not in the drug itself (morphine, cocaine, chloral hydrate, and so on).
According to Le Poulichet (1990) the difference between toxicomania and the use of drugs is defined by a very distinctive mechanism. She calls “pharmakon operation" the specific mechanism which creates a toxicomania. (1990, p. 51). That is to say, that instead of looking for the causes of what’s socially conceived as “addiction” she conceptualises the conditions which would outline toxicomania under a psychoanalytic framework.
The conditions for this “pharmakon” mechanism to appear are connected to certain particularities in the subject's structuration which result in the subject’s inability to deal with a primitive pain. We'll explore this mechanism in more detail in Chapter 5.
Hector Lopez (2005) makes this distinction between intoxication and toxicomania in terms of the degree to which subjectivity is affected. Hence, intoxication can be described as an isolated episode where subjectivity is not affected. These episodes entail the subject actively choosing the moment, condition, and the type of substance involved. He describes toxicomania, in contrast, as a “state of being”. He considers this to be a “border state of the subject” (estado límite del ser). It cannot be considered as a distinct “structure” in the Freudian diagnostic groups but rather a “permanent state of the subject”. This state defines the subject as such. There is an identification which sweeps away any other trait on the subject. Subjectivity is swept away. (ibid.)
Lopez explains this difference as follows: An isolated episode does not necessarily turn into toxicomania. However, a random encounter with a particular substance could result in a toxicomania. The decisive factor is the subject.
In Rik Loose's words “addiction is a cause and effect. The cause of addiction cannot be known a priori and that this cause can only be articulated by the subject.” (Loose, 2002. p.110) The ultimate cause of the effect is in the subject and it is only this subject that can articulate something about the symptom of addiction.
Rik Loose (ibid. p. 80) also describes symbolically structured forms of addictions. He argues that this form of addiction can be based on identification with someone. These types of addictions appear as a result of an identification with an ideal, i.e. a trait in someone loved or admired.
This “symbolically structured" form of addiction cannot be considered as toxicomania, but can help us to demarcate the separating line between other approaches and a psychoanalytic view. Firstly, because a psychoanalytic object of study is founded on the sayings of the subject under transference. Hence, the behaviour is secondary. This form of addiction may entail a similar pattern of behaviour, but its underlying mechanisms may be completely different.
A “symbolically structured addiction" is different from toxicomania as it can be considered a psychoanalytic symptom. i.e. a resolution of an underlying conflict via a symbolic compromise. We’ll see that toxicomanias, in contrast do not constitute a symptom in the psychoanalytic sense of the word.
These remarks confirm that when addressing the question of addiction and its possible “causes”, every psychoanalytic approach considers the subject as the most important factor, and not the object-drug. Regardless of the substance (and without despising its real value) it is the position of the subject which really determines the subjective effects of drug use.
4. ADDICTION AND THE ACTUAL NEUROSES
In Chapter 2 I have explored Freud’s conception of addiction and his views on masturbation as the primal form of addiction. A question arises: Why wasn't Freud sure if masturbation should be considered an actual neurosis?
Trying to answer this question will also shed some light over the issue of classification of toxicomanias. Hence it is indispensable to review Freud's concept of actual neurosis in order to see if this concept can be useful in our understanding of toxicomania
At the beginning of his career Freud established two main categories in his clinical field, the actual neuroses and the psychoneuroses.
Both types of neuroses appear as the result of the psychic inability to master an accumulation of sexual excitation. We need to bear in mind that the source of the sexual excitation comes from the body. The concept of “drive” accounts for this.
a concept on the frontier between the mental and the somatic, as the psychical representative of the stimuli originating from the organism and reaching the mind, as a measure of the demand made upon the mind for work in consequence of its connection with the body (Freud, 1915, p. 118)
The distinction between actual neuroses and psychoneuroses can be found in the nature of the excitation. In psychoneuroses the excitation is of a psychological nature which results in a psychological conflict. The psychological conflict is precisely the psychoanalytic definition of “symptom”. With regard to actual neuroses this excitation is of a somatic nature only; Freud calls it a “somatic sexual excitation” (Freud, 1912 p.2562) which is not linked to a psychical representative. In actual neuroses the cause is “actual” (present) i.e. It does not admit to “being traced back historically or symbolically to operative experiences” (ibid. p.2571). In the actual neuroses the mechanisms found in psychoneurotic symptoms (condensation, displacement) do not take place. Freud considered that the “symptoms” of actual neuroses could not be analysed, leaving the field of actual neuroses outside psychoanalytical relevance.
We could speculate that in actual neuroses a process is lacking. What should be transferred from the body to the psychical sphere via a connection with a representative (i.e. a symbolic element) does not take place.
Freud argued that actual neuroses are the expression of a “toxic direct expression” (1925, p.4203). What is toxic comes from within the body and can’t be dealt with via symbolic means.
Ann De Rick (2002) takes up Freud’s ideas on actual neurosis to attempt an explanation for the mechanisms involved in toxicomania. She argues that this inability to deal symbolically with a toxicity from the body results in tension being “changed into anxiety and somatic equivalents of anxiety instead of being psychologically processed.” (De Rick, 2002 p.122). Her hypothesis is that pathologies like substance abuse, self mutilation, psychosomatic phenomena are borderline personality disorders and can be classified under the nosographic label "actual neuroses".
In order to outweigh the real value of this concept, it is important to remember that the three major diagnostic categories in psychoanalysis do not have the purpose of classifying every human subject (according to their pathologies) but they function as a structural organiser.
Following Lacan’s theorisations these structures are determined by the logic of castration. They don’t pre-exist the subject.
Their theoretical value lies precisely in the fact that they explain the complexities of human psychical structure using the minimum amount of elements (5). Hence, we don’t have a multiplicity of clinical entities according to their signs and symptoms as found in the DSM IV.
De Rick's approach seems to confuse psychoanalysis with psychology. Neurosis, Psychosis and Perversion define structures, and not a group of symptomatic signs.
We should not use psychoanalytic diagnostic categories reproducing the model of medicine and psychiatry as if clinicians “knew” about the patient and therefore could put him or her into one or various categories.
Another problem we face when we analyse toxicomania as belonging to what Freud called an actual neurosis is the question of total lack of symbolic activity. “There is no symbolic imaginary processing of the Real in the actual neurotic, the symptoms only exist at the level of the body” (De Rick, 2002 p.128)
Although the source of these “toxic” stimuli is within the body and the means of treatment affects the body directly, we could argue that saying that there is not a psychical correlate and a symbolic inscription (even thought this could be a rudimentary inscription) is imprecise. There is always a symbolic - imaginary processing, somatisation doesn’t happen without a symbolic meaning. To say “somatisation” without symbolic processing is a contradiction in itself.
Hector Lopez (2005) argues that this toxic shortcut via the body cannot be considered either a reflex action nor unmediated behaviour. The effects produced by the toxic substance are absolutely particular and depend on the discursive context. This indicates the existence of symbolic processes and a particular phantasy activity: the value of the drug lies precisely in its symbolic value.
Rik Loose’s position regarding the use of the concept of actual neuroses to describe the mechanisms involved in addiction also has some conceptual contradictions. He argues that considering addiction as an actual neurosis would make it a clinical entity separated from the other clinical structures and their symptoms (2002, p 218). As chemical intoxication is not a symptom in psychoanalytic terms it can therefore not be resolved.
He argues that some chronic addictions have their root in actual neurosis
“The chemical processing of actual neurosis is a fourth form of addiction and it is a form of addiction that has its own relationship vis-à-vis the Other. This relationship modality is characterized by the independent administration of jouissance which functions as the governing or regulating of an unbearable real; a real that threatens to annihilate the subject in actual neuroses.” (ibid, p.220)
These ideas suggest that actual neurosis can be the root of some addictions and/or actual neurosis describes a fourth form of addiction: i.e. it acquires a function in relation to the Other different from the three classical clinical structures. This use of the Freudian concept does not account for a specific mechanism on addiction for psychoanalysis. Moreover, it adds obscurity to the theorisations.
One should pose the question if this reintroduction of the Freudian concept of actual neurosis into contemporary approaches has been useful.
The answer would be that it can be useful to understand the nature of the mechanisms involved in toxicomania, as long as we keep in mind its relationship with the three major categories in psychoanalysis.
Freud suggests that in the case of Actual Neurosis psychoanalysis can only help in an indirect way.
an analytic treatment can have an indirect curative effect on ‘actual’ symptoms. It can do so either by enabling the current noxae to be better tolerated, or by enabling the sick person to escape from the current noxae by making a change in his sexual régime. These would be desirable prospects from the point of view of
our therapeutic interest. (1912 p. 2571).
If we consider toxicomania to be a form of actual neurosis then we can speculate that the subject is suffering as a result of the influence of two kinds of noxae.
The first comes form the realm of the body and might be of a more “primitive" or structural nature. We could provisionally add that toxicity arises as a result of a deficit in the symbolic processing.
We will explore in the next chapter the relationship between this structural deficit and the conception of pain.
I would add a second type of noxae which also emanates from the body but, in this case, as a result of biological changes in the nervous system produced by continuous use of certain toxic substances.
In any case, the interest in the concept of Actual Neurosis is only descriptive.
5. CAUSES OF ADDICTION
In the previous sections I have mentioned the most important psychoanalytic approaches to the question of toxicomania in order to differentiate them from a classic approach. From Freud we learn that psychoanalysis locates the “cause” at the level of the subject, and not the substance.
The concept of actual neuroses put forward that toxicomania appears as a reaction to something which happens in the realm of the body The toxic substance is a way to deal with this other “toxicity" which emanates from the body. We can provisionally say that toxicomania is a defence against this toxicity.
I have also suggested that there are specific mechanisms which underlie the phenomenon of toxicomania.
In this chapter I will explore the different views on these mechanisms and examine the possible “causes” of addiction.
In order to shed some light over this matter I will go over the main points in Freud’s conception of pain and its relationship with Lacan’s concept “jouissance”. This will provide the foundations to study the case of toxicomania as a way of dealing with pain, or in Lacanian terms to deal with an unbearable jouissance.
I will also extensively examine Loose’s ideas on toxicomania and his concept of “administration of enjoyment”.
Freud’s ideas on pain
In “Beyond the Pleasure Principle” Freud describes the mechanism of pain. He illustrates it comparing it to a “vesicle of a substance that is susceptible to stimulation” (Freud, 1930, p 3730).
This vesicle has a barrier against stimuli. These stimuli can come from the outside world as well as from within.
“We describe as ‘traumatic’ any excitations from outside which are powerful enough to break through the protective shield. It seems to me that the concept of trauma necessarily implies a connection of this kind with a breach in an otherwise efficacious barrier against stimuli.” (ibid, 3732)
Freud compares these stimuli with the drives and argues that when the psyche is under the influence of pain, all the psychological resources are concentrated on dealing with the part of the body affected and “empty the ego” (Freud, 1926. p 4323). Libido and the ego's interest can't be distinguished. There are many modifications as a result of pain, all libido is withdrawn from the objects and concentrates on the organs which are giving us pain. In Inhibitions, Symptoms and Anxiety (1926) Freud situates another form of pain, the psychological pain. This form of pain arises with the loss of an object. This situation presents the same "cathexis economy" than physical pain but instead of being concentrated on the representation of the injured part of the body, the cathexis of longing is concentrated on the missed or lost object (ibid, p. 4323).
Freud explains that an infant can't distinguish a "temporary" absence from a "loss" so, when he can't see his mother, he behaves as if he would never see her again. (Ibid p. 4322). In other words, the infant does not have the symbolic tools to inscribe this traumatic situation. This explanation seems to suggest that pain appears when the dimension of “absence” has not been introduced.
When the subject enters the world of language he loses his real body as organism. This separation from the real of the body via its symbolic elaboration is also what keeps the subject separated from jouissance. When there is a “hole” in this symbolic barrier, pain appears as an immediate response to the invasion of jouissance and the real of the body.
I will now explore the ideas which present toxicomania as a mechanism to deal with pain.
Cancellation of pain
Some toxic substances have the ability of "cancelling" pain. This is precisely one of its most important effects.
According to Hector Lopez (2003, p 142) the subject of addiction suffers from “something” he can’t escape as it has the same status of a drive. He states that pain is the inability to bind the drive energy to any representation and describes it as the conscious correlate of “jouissance” “What is jouissance in an instance it is pain in the other” (ibid. p 145 my translation)
He explains that this pain is experienced as a result of the breaking down of the defences against jouissance. Hence, the toxic substance becomes necessary to treat the pain.
“Pain and chemical cancellation are complementary terms (…) the addict’s problem is pain, and the mechanism employed as a defence: cancellation” (ibid. p. 149 my translation).
Pain emerges as a result of the impossibility to link the energy of the drive to a representation. Lopez (2005) calls it a “symptom in the real”: The subject does not have the mechanisms to knot jouissance and the signifier to generate a neurotic symptom.
The subject closeness to jouissance is felt as pain. Pain is the breaking through defences and the invasion of the real dimension of jouissance. Intoxication becomes the most effective treatment against this invasion as it creates a “chemical barrier” against anxiety.
Toxicomania is, then, the solution found by the subject in order to defend himself against something unbearable. According to Hector Lopez (2005) the subject is not capable of dealing with privation. He argues that there is a “structural privation” in every subject. if a subject has gone through castration. There is a permanent state of abstinence regarding total satisfaction.
In the addict “abstinence” is the return of a structural abstinence. The use of drugs is the apparent solution. But this solution and satisfaction must be clearly distinguished.
His hypothesis is that on the one hand satisfaction can’t be thought of as something immediate but rather as a metonymic journey and a metaphoric production. We can say that having accepted the impossibility of complete satisfaction with the object, there is still a way to satisfaction. This involves the detour of language and desire, the pleasure of the symbolic
The addict is unable to carry out this task and that is precisely where the substance comes into the scene. The encounter with a toxic substance provides a sensation which may lead him or her to believe that the object of satisfaction is within the reach of his or her hands.
Sylvie le Poulichet (1990) theorises about the specificity of this mechanism. She calls it the “pharmakon operation”.
The word "pharmakon" in Plato’s texts has an indecidable meaning. (1989, Silverman) Among the contradictory meanings are included: "a drug, a healing remedy or medicine, an enchanted potion or philter, a charm or spell, a poison, a means of producing something, a dye or paint.” Derrida (cited by Silverman, 1989, p. 8) insist that when Plato contextualises this word the multivalence of the word remains in the Greek text.
Le Poulichet (1990, p.53) distinguishes the pharmakon operation from the broader field of substance abuse. The pharmakon can be described as the operation which “gives” a body to the subject. When the pharmakon is not there, the subject feels something missing.
One of the richest metaphors used to describe this operation comes from one of her patients who describe the pharmakon operation as a “phantom limb”. A phantom limb is a frequent consequence of the amputation of an extremity; this limb becomes the source of pain, although in reality is not a part of the body anymore.
This paradox situates the affection in the frontier between the psychical and somatic spheres. The toxic substance has the ability of creating the image of a limb which is not part of the body but hurts. This is an imposition to the subject.
Le Poulichet adds that this phenomenon seems to be related to a form of "hallucination" that takes place when the drug is not there, i.e. in abstinence. (ibid. p.54)
The pharmakon represents the toxic cancellation of pain and it appears as a result of a deficit or “hole” in the symbolic elaboration of the body.
This way of dealing with pain is explained by Rik Loose in terms of the subject's relationship with jouissance. He conceptualises it as “administration of enjoyment". In the next section I will summarize the author's idea of toxicomania and his hypothesis on the subject.
Administration of enjoyment
Rik Loose defines toxicomania as “the search by the subject for an object which can be administrated at will, which would satisfy desire and regulate or keep jouissance at an ideal level.” (Loose, 2002, p. 174)
He introduces the concept of “administration”. This concept functions as a hinge between the clinical structures and addiction and distinguishes between toxicomania and the ordinary use of alcohol and drugs. (ibid, p.135)
Etymologically “administration” comes from the Latin administrare, which means to minister to. A minister is a servant.
He considers this an appropriate signifier as “addiction is the enslavement to enjoyment (jouissance), as well as to language. Addiction is a matter of the subject being caught, as minister or slave, between two masters and it is characterised by the choice of the subject for (going “lock, stock and barrel” for) the One (of jouissance) rather that the Other (Of language)” (ibid. p .136)
This has important implications as it introduces a new element: the subject's responsibility. The author suggests that toxicomania is the response that the subject chooses in order to obtain satisfaction. And at the same time he avoids having to take the detour of language (the symbolic path of desire to a partial satisfaction).
He argues that the desire of the Other is problematic for addicts. Therefore this “administration at will” is a way to avoid the encounter with the desire of the Other. In other words it is a way of satisfaction largely independent of the Other. The encounter with the Other involves a risk, which is precisely what the subject of addiction cannot bear. He is unable to accept that the object cause of desire is irretrievably lost for the subject. (ibid. p. 154)
He describes two forms of toxicomania: A first form which aim at “Other jouissance” beyond pleasure and another form as a “protection against the death drive of the jouissance of the body”. (Loose, 2002. p. 185). The “toxicity” which emanates from “real” unsymbolised parts of the body can become a cause for suffering.
This idea suggests that the process of losing the body as organism has not been entirely successful, and this shows its toxic effects.
In this second case, the toxicity is situated at the level of the subject. Language is not successful in the task of keeping the real body at a distance. He also argues (ibid. p. 189) that the effects of drugs can compensate for the lack of the function of the signifier which is regulating jouissance and “keeping anxiety at bay”. Drugs or alcohol function as barriers against the lethal domain beyond ordinary pleasure.
However, the first form of toxicomania described by the author appears as problematic. When he refers to this “Other jouissance” beyond pleasure we infer he is referring to the intention of the subject to escape the limits imposed by castration. In Lacan the concept of “Other jouissance” is used to describe a form of jouissance beyond the sexual (phallic) form. This characterises the feminine jouissance. However, Rik Loose is not explicit about this.
Rik Loose describes two symbolically determined causes for addiction, which are intertwined. The first cause relates to the structural lack the subject of addiction wants to undo and the second the “unconscious knowledge in the real” as en effect of drugs and alcohol which can “hook” the subject. (Loose, 2002, p. 223).
He argues that the “knowledge in the real” is different to the “real in science”. This is a knowledge which is related to the real of the unconscious of the subject. It has a relation to meaning, as it wants to find an expression of an inexpressible jouissance. That is also why the ultimate cause of the different effects of drugs is found in language (Loose, 2002, p. 224).
Addicts often describe what they experience under the effects of a particular drug as having access to “another level” suggesting that these particular experiences are unique and special, and banned to people who do not use drugs. These experiences may be unique but their effect depends ultimately in the signifier.
“This “knowledge in the real” are precisely the signifiers that have affected the subjects from the very beginning and without their knowledge (…) The earliest encounters between the subject and the signifiers of the other are the utmost importance in the cause-and-effect relationship between drugs and their subject-specific effects”
(Loose, 2002, p. 224)
This is to say that there is an impossiblitity of determining the causes of addiction a priori. The complexity of the issue lies precisely in the fact that toxicomanias are built on the foundations of the particular relationship between each subject's history and the object drug.
Some addicts describe their experiences as a total access to pleasure. There is no such thing as access to total jouissance. By definition this is lost. These experiences described by subjects about an immense pleasure, a “paradise on earth” can be misleading. One could be tempted to think that these experiences could be the cause for the compulsion to repeat them over and over or consider them as a positive experience. But this “jouissance illusion” can be easily explained as determined by discourse.
The cause for this “ultimate pleasure” is the expression of the relief of tension. The precondition is the existence of a stimulus strong enough at the level of the body.
Rik Loose describes toxicomania as a "hinge" with the clinical structures. In the next chapter I will explore the relationship between toxicomania and the clinical structures. This can help us to understand the functioning of toxicomania in the economy of each subject in particular but with the framework of the three clinical structures (Neurosis, Psychosis, and Perversion). Each one establishes a particular relation of the subject to the Other.
6. TOXICOMANIA AND THE CLINICAL STRUCTURES
As mentioned before, different authors in psychoanalysis categorise addiction as a distinctive clinical structure, border pathology or an independent clinical entity. One should ask if the categories of Freudian psychoanalysis are still relevant.
The structures in psychoanalysis are organized around the “castration complex” and the response of the subject against this complex. The response outlines neurosis, perversion or psychosis.
Hector Lopez situates toxicomania as a specific mechanism but he distinguishes this mechanism from foreclosure, repression or disavowal. “Cancellation of pain as a specific mechanism of toxicomania refers to a particular clinical structure where the “addictive complex” is a symptomatic effect” (Lopez p152)
The specific mechanism involved can coexist with one of the three others and therefore does not constitute a different structure. This mechanism can be distinguished from repression as this constitutes a symbolic barrier against the threatening of the real. (Lopez, 2005) This barrier is fragile, but means that the subject has “accepted” the original lack. Chemical intoxication reinforces this symbolic barrier. Le Poulichet (1990, p. 121) describes this form or toxicomania as a “supplement” because it adds a precarious stability to the ego when the symptom is not efficient against the threat of something unbearable. Symptom is characterized by subjective division. In this form of toxicomania, the ego's consistency is reinforced, so the subject can imagine as "being one", i.e. having a unified ego. (Lopez 2005)
In this form of toxicomania there is an addictive assembly which is used as a method to attain a “narcissistic prosthesis” (Le Poulichet, 1990 p.134). These subjects do not suffer the threat of the Other’s invasion (the case of Psychoses) but the threat of castration.
Perversion is characterized by the fact that the subject replaces the lack with an object, retaining a particular jouissance related to a specific object. The object “drug” does not have a fetish value, the addict seeks for the effect produced by the drug and not the object itself, which is interchangeable. It is a “product to be consumed”. (Lopez, 2003, p.153). In Perversion, the subject “knows” about jouissance.
Toxicomania can have a very different meaning in psychosis where it can act as a “substitute” (Le Poulichet, 1990. p. 121) for the insufficiency of the Name-of-the-Father.
Here, the subject's existence is at risk. Toxicomania aims at controlling the body. The absence of the symbolic Other leaves open the constant threat of a jouissance which is not mediated by signifiers.
Le Poulichet claims that not all the cases which present with toxicomania as a "substitute" necessarily mean psychosis. There could be a certain failure in the paternal function where the drug plays the role of remedying a partial opening to jouissance.
When they do mean psychosis, these forms of toxicomanias respond to the insufficiency of the signifier of the Name-of-the-father. Structurally, the body has not been entirely lost. The dimension of “absence” is unknown, so toxicomanias (or the pharmakon operation as the author calls them) organise a circuit with the intention of blocking the invasion of this omnipresent Other.
7. THE MARRIAGE WITH THE PHALLUS
Lacan did not elaborate a theory on addiction. His references to the topic where always in the context of the elaboration of the main psychoanalytic concepts and not a specific theorisation of toxicomania. The most important reference of Lacan to the matter can be found in a text from 1975 “journée d’etude des Cartels de l’Ecole freudienne. Séance de Closure”
In this text he analyses the relationship between anxiety and castration. Castration is the operation which can liberate the subject from anxiety. He poses the question “what is anxiety?” (Lacan, 1975 p. 1623)
He refers to Freud’s famous clinical case “little Hans” and defines anxiety as localised in a point of evolution when the child “realises he’s married to his prick” (5) (ibid, p 1623 my translation).
He starts perceiving sensations from his “little willie” (petit-pipí) and that makes him realise that “…there is nothing better to act as (faire) phallus, which is obviously a complication (…)”(6)
This complication is Hans’ phobia. Hans will have to go through all the paths and comply with the necessary symbolic transformation of this “willy-phallus” to become a part of the symbolic world. This symbolic world in which the “sexual law” allows the real penis to be symbolysed as an instrument (the phallus). (Lopez, 2002, p.92)
The girl also has the same complication, although she’s more fortunate (heureuse). It will take some time to realize that she doesn’t have the little willie, therefore her anxiety is in reference the one afflicted for this reason. (7)
One of the ways of dealing with this affliction is the use of drugs
“Everything which permits the escape from this marriage (to the phallus) is clearly very welcome, that is the reason for the success of drugs, for instance; there is no other definitions for drugs than this one: it is what permits to break the marriage to the little willie “
( Lacan, cited by Loose, 2002, p.221) (8)
This marriage with the phallus refers to the illusion of believing that the phallus doesn’t constitute an obstacle to the sexual relationship. Lacan is also suggesting that the subject does not accept the limits imposed by the phallus as a regulator of jouissance.
In this context we can speculate that Lacan is referring to a mechanism which aims at escaping castration. In other words, to configure a response to the structural lack inaugurated by castration.
The issue of drug addiction is a very complex phenomenon and many discourses try to define it. There seem to be an explanation of the phenomenon in every discourse. These explanations appear as a result of the demand of a “cause” of addiction. We should bear in mind that it is not pertinent to psychoanalysis to answer that demand, but to try to understand the matter with our available tools.
I tried to deconstruct this category in order to arrive at a psychoanalytic object of study, and to impose my own limits, as the field of addiction is enormous. I've centred my research in drugs which could cause changes in the physical brain if used for a long period of time. However, for psychoanalysis the importance of the qualities of the object-drug are secondary; the real issue is located at the level of the subject and the relationship that he establishes with that specific object.
I've explored different authors from the psychoanalytic literature to demonstrate that intoxication and toxicomania (addiction to drugs) should be clearly distinguished. Not everyone who uses drugs as a recreational use becomes addicted to them. The decisive factor is the subject. An addiction develops under certain subjective conditions.
Toxicomania appears as a self-medication to treat something which emanates from the realm of the body. Freud's ideas on pain showed that there is a psychical pain which takes up the model of the physical pain, and that occurs when the subject does not have the symbolic tools to deal with traumatic stimuli. In Lacanian terminology, it is to deal with an unbearable jouissance.
This inability to manage jouissance via symbolic processing causes the use of drugs to configure a non-symptomatic way to attain certain stability. i.e. toxicomania does not constitute a symptom in the psychoanalytic sense of the word.
One of the ways to describe the mechanism of toxicomania is the Freudian conception of actual neuroses. The description is valid, but the use of the concept in contemporary literature is problematic in relation to the existing nosographic division or clinical structures.
Toxicomanias are characterised by a casual encounter with the substance which makes the subject believe that the object of satisfaction is within the reach of his hand. In this sense the object-drug is connected with the primitive, sexual object.
Thus, the use of drugs becomes the most adequate response to deal with this pain which emanates from the body. The particular conditions for this to happen are singular and have to do with the story or that subject. At the next moment, this solution doesn’t work anymore and at the same time there have been changes in the “real” of the body which adds intensity to this dimension of pain.
There are not enough particularities to consider toxicomania as a specific pathology, structure or clinical entity, we’re dealing with the subject and the way he has organised a response to the question of a structural pain or lack. There is an inability to do this via a symbolic symptom.
There is a lack of symbolic processing and a shortcut to a form of pleasure, a sort of paradise which lasts for a short period of time. We could add that whilst this is the case we’re not dealing with a real “problem”.
We should also keep in mind that the real problem is not defined by the dangers that the use of drugs has to the physical health. Although that can be true to a certain extent, this is not the field of psychoanalysis. Psychoanalysis operates with the subject and it is a “practice” of the subject, it doesn’t operate on social identities. We should keep in mind that the graveness of the compulsive behaviour is defined by the degree of lack of subjectivity and inertia.
The field of toxicomania does not constitute a clinical structure, it is a paradoxical self-preserving mechanism as it outlines a temporary or chronic response to the issue of lack.
The particularities of structuration of the subject of addiction should be read bearing in mind the Freudian clinical structures: Psychoses, Neuroses and Perversion. In addition to this, a clear diagnosis can give us the tools to direct the cure. A subject can be related to a substance in multiple ways, therefore it is impossible to make a generalisation and consider it as an independent clinical structure. The state of addiction can have very different roles in a Psychosis, Neurosis or Perversion. We must bear in mind that we are dealing with subjects, not with addicts.
The treatment of toxicomania via psychoanalytic therapy can be efficient, but it is necessary to install in the subject who suffers from a form of toxicomania, the need of discourse. In order to start putting the situation into words, to configure another option to the "solution" found in the use of drugs.
It is an obstacle to consider addiction as a specific clinical entity or a particular pathology in the field of psychoanalysis. The evidence of the diagnostic signs can make clinicians forget about the particularities of the case by case.
Drugs are not the real toxic substance. What is toxic is the dimension of pain which invades the subject: an unbearable jouissance.
Most psychoanalytical theorisations give account of an insufficiency of language to keep the real of the body at a distance. They argue that there is a failure of deficit in the process of structuration of the subject. But they do not specify why toxicomania would be the “chosen” response to deal with this problem.
If that’s the case, toxicomanias do not constitute any particular pathology, but rather a specific response to the general issue of jouissance and castration. The effects of drugs compensate for the lack of function of the signifier regulating jouissance.
Considered as a form of structural pain, or insufficiency of the symbolic function, toxicity is always located at the level of the body. And substance abuse would only be a form of self-medication to deal with it.
1 There are various examples of these investigations one of them is Molecular Basis of Long-Term Plasticity Underlying Addiction by Eric J. Nestller. Nature review, February 2001. Volume 2 Macmillan Magazines Ltd. New York.
2 See Naspartek “el agua tóxica de Mario” (Mario’s toxic water) in “Sexuación y semblantes . ¿mujeres anoréxicas , hombres toxicomanos?” (2002) Ed. Plural. Bolivia. p. 20. This is the case of a patient who was addicted to water. A substance extremely poisonous for him in large quantities.
3 See Lyvers, Michael Drug Addiction as a Physical Disease: The Role of Physical Dependence and Other Chronic Drug-Induced Neurophysiological Changes in Compulsive Drug Self-Administration in “Experimental and Clinical Psychopharmacology” (1998) American Psychological Association, Inc., Vol. 6, No. 1, 107 - 125 available online:
4 The symbolic is a complex function which is present in every human activity. This function distinguishes humans from the animal world. Lacan uses the neologism “parletres” (speakingbeings) to make this clear. When the human being is born, he or she enters a world of language. This world of language preexist the subject, and it’s full of desires, expectations, plans for this baby. In other words, this discourse expresses demand and desire towards the newborn. Lacan calls this the “Other” and it is the “treasure of the signifiers”.
The signifier is the basic element of the symbolic world and it is responsible for the regulation of all the social bonds and the sexual difference. The signifier allows to “read” psychoanalytic symptoms.
5 The logic of structuralism and Lacan's attempt to introduce Psychoanalysis into the field of science can be found in Jean-Claude Milner's book, La obra Clara: Lacan, la ciencia, la filosofía. Chapter: El doctrinal de la ciencia. (1995) Buenos Aires Ed. Manantial
6 S’aperçoit qu’il est marrié avec sa queue.
7 il n’y a rien pour mieux faire phallus
8 This is the complete fragment in French: Vous me pardonnerez d’appeler ça comme ça, c’est ce qu’on appelle généralement pénis ou pine, et qu’on gonfle en s’apercevant qu’il n’y a rien pour mieux faire phallus, ce qui est évidemment une
complication, une complication liée au fait du noeud, à l’ex-sistence, c’est le cas de le dire, du noeud. Mais s’il y a tout de même quelque chose qui est fait dans les Cinq Psychanalyses pour nous montrer le rapport de l’angoisse avec la découverte du petit-pipi, appelons ça
comme ça aussi, c’est tout de même clair, il est certain que c’est tout à fait concevable que pour la petite fille, comme on dit, ça s’étale plus, c’est pour ça qu’elle est plus heureuse ; ça s’étale parce qu’il faut qu’elle mette un certain temps pour s’apercevoir que le petit-pipi, elle n’en a pas ; ça lui fout de l’angoisse aussi, mais c’est quand même une angoisse par référence, par référence à celui qui en est affligé ; je dis « affligé », c’est parce que j’ai parlé de mariage que je parle de ça ; tout ce qui permet d’échapper à ce mariage est évidemment le bienvenu, d’où le succès de la drogue, par exemple ; il n’y a aucune autre définition de la drogue que celle-ci : c’est ce qui permet de rompre le mariage avec le petit-pipi
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