Considered from a psychoanalytic point of view there is no such thing as an expertise in addiction, but to pay special attention to addiction is important, because it is arguably a paradigmatic expression of the suffering of the modern subject and, moreover, it is a crucial problem for psychoanalysis.
It is important to investigate the effect of the symptom and dual diagnosis from within a psychoanalytic framework for at least the following four reasons:
- Freud’s confrontation with the effect of the symptom is what pushed him into the direction of psychoanalysis, which he developed, failing to incorporate that effect to some extent. Freud in his very early work on cocaine made a very interesting discovery: he realized that cocaine does not affect everyone in the same way (Freud, 1885). There appears to be a variable within the subject which determines what the effect of drugs will be on someone, something which in turn implies that Freud began to locate the cause of any problems with drugs within the subject. In fact, the discovery made him decide that cocaine was not going to be a useful pharmacological instrument and instead he became interested in studying that variable within the subject, that is, he became interested in the constitution of the human psyche.
- Dual diagnosis was Freud’s starting point regarding addiction. Freud’s first diagnostic distinction was between the psychoneuroses (the neuro-psychoses of defence as he called them at the time) and the actual neuroses. He connected the actual neuroses to addiction and subsequently excluded both from his clinic, because he felt that both actual neurosis and addiction do not manifest analysable symptoms. One of the implications of this surely must be that psychoanalysis has a crucial problem.
- Dual diagnosis is a major concern at the moment for psychiatry, psychopathology, and addiction research. The question here is what contribution psychoanalysis can make.
- As we will see, approaching dual diagnosis from a psychoanalytic perspective cannot evade the question of the effect of the symptom or drug. This question goes right to the heart of the suffering of the modern subject.
Psychoanalysis in modern times cannot afford not to question itself regarding its theory and technique because it is a well-known fact that the various addictions are an increasing problem worldwide, which in itself is a strong indication that addiction is related to a changing culture and thus to a change in the response of the human subject to their discontent in civilization. This discontent, and indeed the subject’s response to it, has since Freud always been a concern for psychoanalysis.
Lacan does not refer much to addiction at all. However, at one point in the 1960s he remarks that the legislators of medical practice move medicine “into the direction of jouissance”
(Lacan, 1966, p. 767). He argues that addiction is following the path of medical science and is becoming increasingly dependent on effects we have on the body. Medical legislators, he continues, impose two duties: 1. a controlled use of drugs; and 2. the medical use of jouissance
. These remarks have important implications. He implies that (psychiatric) medicine is becoming increasingly dependent on the effects of drugs and that in turn implies the possibility that an addictive use of drugs, which can be a consequence of this medical dependency, is officially or medically sanctioned and encouraged. It is indeed in this period that tranquilizers
and other drugs began to acquire a newly elevated status in our culture. Therefore it should not surprise us that addiction would become such a pervasive presence in our society a decade or two later.
Concerning the first duty, namely, that the people who determine laws and policies regarding medical practice and research impose a controlled use of drugs, we can say that we can now legitimately rely on drugs as a solution outside ourselves to resolve most human troubles and woes. And indeed, where jouissance and external solutions get out of hand and become a painful experience, we have a solution at hand that falls perfectly within the parameters of aforementioned medical legislation: we have recourse to the kinds of drugs to control this excess of which methadone is a perfect example. The use of methadone is nothing more than a drug solution to a drug problem. Is this not the same as trying to extinguish a fire with petrol?
Concerning the second duty, we can say that jouissance and pleasure have indeed become a duty in our culture. We have to enjoy ourselves, because we have at our disposal and in abundance all the products (such as alcohol and drugs) and gadgets with which to do it. Of course, some of these gadgets and products have existed for a long time. The difference is that previously our enjoyment of them was to some extent curtailed. Now we find ourselves in the opposite situation, which finds its expression in the following credo: “No one needs to be short of anything unless you want to lose out.” In other words, there is nothing that sells more than the promise of total enjoyment and the fear of not being part of that experience.
It can be argued that the push to find solutions outside oneself for one’s problems and discontents, as well as the duty of enjoyment in recent times, fuel the addictification of our society. However, from a psychoanalytic point of view, it is important to state that addiction can never be clinically understood at a general level, that is to say, without knowing how drugs affect people and indeed without knowing why and how these effects relate to other forms of suffering.
In his research on cocaine, which Freud conducted from 1884 to 1887 and which resulted in a series of papers, he came to the conclusion that cocaine has only an indirect effect on people. Freud (1885, p. 104) was struck by two facts in his findings, namely, that cocaine has an optimum effect when the condition of the subject is poor (depressed mood) and that it has a diminished effect when the condition is “cheerful and efficient” (good mood). This implies that certain psychic conditions such
as “feeling well” have the same effect as cocaine. As I wrote earlier, the decisive factor regarding the effect of cocaine is something in the psyche of the user. That means that, according to Freud, cocaine has an indirect effect via a psychic variable and there is no direct effect on the body. Already then he had come to the conclusion that the cause of addiction is to be sought within the subject—“persons who already in the grip of one demon are so weak in will power, so susceptible, that they would misuse, and indeed have misused, any stimulant held out to them”—(Freud, 1887, p. 173) and not in the drug. In other words, a variable in the subject determines what the effect of drugs will be on someone.
There are obviously generic aspects to the effects of drugs, for example, we all know that heroin, cocaine, hallucinogenics, cannabis, and alcohol each have a particular set of effects. But to believe that all people are affected in the same way by the same drug is a myth that is sustained in order to justify (funded) research that stakes everything onto the object (drug) in order to avoid the complexities of its relationship to subjectivity (the subject). It is my contention that addicts are not addicted to drugs, but are addicted to an effect they get out of drugs: a subject-specific-effect. This is an effect that non-addicts do not get out of drugs. I have attempted to find a mechanism that can contribute to helping to understand how symptoms and drugs affect people differently. I call this mechanism “administration”. I will later explain why I call it that and I will also explain how it can contribute to an understanding of addiction in relation to various forms of human suffering.
At the very end of the first lecture from The Seminar, Book XXI, The Non-Dupes Err/The Names of the Father,
Lacan says the following: “It is necessary to be a dupe, namely to stick to the structure” (Lacan, 1973–1974, lecture from 13/11/73). Before that, he said in the same lecture that the non-dupes are “those that refuse to be captured by the space of the speaking-being” (Ibid.). There are of course several ways of being non-duped. One of the ways is the way of the wayfarer. For those who consider life to be no more than a journey—who consider the period between birth and death to be nothing more than the way towards a promised land—structure will not stick. This kind of life, Lacan suggests, is that of the viator
is a very interesting word in the context of addiction. A viator
is someone who travels; someone who roams the lands. However, there is an old Latin meaning to the word and that is that the viator
is a civil servant of the court: someone who is an administrator to the magistrate of the court, that is to say, someone
who is in the service of someone else. I will return to this within the context of my argument that administration in modernity is less in the service of the Other than it was previously.
In the same context, Lacan says that between birth and death we find structure. However, that is of course only half the story: between life and death we also encounter life in its vital aspect, namely in the form of the jouissance of the living body. This jouissance of the living body becomes, to a greater or lesser extent, entangled with structure during life. The encounter between jouissance and structure will always imply that the subject is duped in terms of jouissance. Another way of avoiding being duped is by overriding the entanglement between jouissance and the body via the toxic route of the body with drugs. In other words, addicts err by not sticking to structure: they skid over it via the use of drugs and alcohol, which turns them (as addicts) into slaves or administrators of jouissance.
I use the following formula for addiction: addiction is a choice for jouissance that is administered independently of the structure that determines the social bond with other people. With this definition I am not implying that the social bond with other people does not play a role in the aetiology and experience of addiction. Rather what I want to emphasize here is the fact that the effect that addicts pursue is something that takes place to a large degree independently of the Other. Consider as a counter-example sex and humour. These are also pleasure-producing activities. For both you need respectively the Other as sexual partner and the Other in the sense of language. The field of language and meaning, as the basis for the social bond with other people, is indeed the field without which humour would not be possible. Humour plays with sense and non-sense and is therefore utterly dependent on language and meaning. Even behavioural and practical jokes can’t escape the fact that they need the interaction between sense and non-sense and therefore the overall framework that determines this, namely, language.
However, there is jouissance
that manages to bypass the Other. Addicts predominantly produce non-phallic jouissance
. In this context it might be interesting to mention that Freud made a connection between masturbation and addiction (Freud, 1985, p. 187). Freud argued that masturbation is a shortcut between desire and satisfaction and that as such it is something that allows the subject to bypass the external world (Nunberg & Federn, 1962, pp. 239–240). Thus both masturbation and addiction can produce pleasure for the subject in a manner that is
independent of the Other. However, Freud was not entirely right when he wrote to Fliess that masturbation is the prototype of all other addictions. The masturbator, unlike the addict, is fondly engaged with his phallus; he produces the kind of jouissance
with it that is indeed phallic in nature. Lacan referred to this as “the jouissance
of the idiot” (Lacan, 1998, p. 81). The jouissance
of addiction is not necessarily the jouissance
of the idiot or the masturbator. The masturbator is just hooked to his organ and produces the limit to jouissance
rhythmically with it all the time, whilst the jouissance
pursued by the addict will eventually spell total disaster. That is why masturbation is not really a general problem, unlike addiction.
Having said that Freud was not entirely right, we should add that things have changed in recent times regarding our pursuits of pleasure and comfort. Fabián Naparstek argues that in Freud’s time drug use is one answer among others to our Discontent in Civilization. In fact, Naparstek recognizes three historical moments in the use of drug: in a first period, drug use was not a pathology, or at least it was not considered to be a pathology as such; in a second period, a period that includes Freud’s time, drug use became a solution for dealing with discontent in civilization and it was only considered to be one solution among many others; whilst in the third period one can speak of a “generalized toxico-mania” (Naparstek, 2002, p. 161).
In a certain sense, Freud’s work anticipated this third time. In Jokes and Their Relation to the Unconscious
he implied a connection between speech/language, addiction, and pleasure. He indicated that he prefers jokes to a state of high spirits (Freud, 1905c, p. 127). High spirits is something that happens to the subject, whilst joking is an act that takes place with or within the field of the Other (as we mentioned before). Joking implies other people and takes place within the realm of language. It is a form of diction. To keep things within the realm of language is crucial for the ethics of psychoanalytic practice. Addiction is the opposite from the linguistic act. It uses the toxic route of the body and it can provide pleasure much more effectively and instantaneously. This could lead us to the conclusion that we should be worried and pessimistic about the future of addiction. There are signs that the battle against addiction is already lost. In fact from a psychoanalytic point of view our only hope is to treat the addicted subjects one by one. However, the extraordinary and immediate efficaciousness of drugs allow us to understand that (at least) some addictions function as short-circuit
solutions. Hence, it wouldn’t go too far to say that addiction implies a problematic relationship to the social bond.
The social bond and identity
It is often said that society has a tendency to exclude or reject people who are addicted, especially those with dual diagnosis problems. It seems to me, however, that it would not be very fruitful to make society entirely responsible for addiction and dual diagnosis problems. Addicts also carry responsibility, precisely because they made a choice, and this choice implies a decision at the level of the subject: the addicted subject decided to take a shortcut via the toxic route of the body and, as such, avoid the less immediate, and thus less satisfactory, detour via the social bond.
Therefore the creation and maintenance of a space of transference (a subject–Other space) within society is absolutely essential, not just because addiction is not on the wane but especially because we are increasingly confronted with a culture in which the immediacy of jouissance is forced on us. A dire consequence of this is that there is increasingly less space for dissatisfaction, desire, and the social bond. In other words, more and more we are being dominated by an enjoyment-and-consumption culture in which we should be feeling satisfied (after all haven’t all conditions for satisfaction been met?) but in which the not-feeling-so-good becomes increasingly unbearable.
The philosopher Gilles Lipovetsky (2005) has produced an interesting book on this topic, entitled Hypermodern Times
. He writes that a second modernity has come into being, a period characterized by deregulation and globalization and one which essentially rests on three elements: the market, technocratic efficiency, and the individual (Lipovetsky, 2005, pp. 31–32). It could indeed well be that “this blind modernization and technocratic commodity nihilism is a process that spins around and around in a vacuum, without aim or meaning” (Ibid., p. 34). If that is the case we find here a cultural manifestation of the acephalous aspect of the death-drive. Lipovetsky further argues that pleasure has been turned into a dictatorship, but what really should worry us is the way in which people’s personalities have become fragile (Ibid., p. 55). There is a “weakening of the regulative power of collective institutions” (Ibid.). We are in some sense witnessing the destabilization of an increasingly volatile subject with the rising tide of psychosomatic symptoms,