Addiction, Accommodation, and Vulnerability in Psychoanalysis

Circles without a Center

Darren Haber

• Publisher: Routledge
• Year: 2022
• eBook ISBN: 9781000613094
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

This book explores the compulsions and trauma that underlie addiction, using an intersubjective approach in seeking to understand the inspirations and challenges arising from the psychoanalytic treatment of addiction, compulsivity, and related dissociative conditions.

Drawing on insights from his own analytic practice and personal experience, in addition to the work of Stolorow, Brandchaft and Winnicott, among others, Haber considers the complex ways in which addiction becomes woven into a person's life, and analyses how it interacts with other problems such as depression and anxiety, self-fragmentation, and ambivalence about treatment. Haber creatively integrates the work of Camus, Kafka, and Beckett to further contemplate the dilemmas that can arise during the clinical process and, in identifying his own and his patients' vulnerabilities and contradictions, provides an honest, humorous and sometimes painful account of what happens in the consulting room.

With its use of rich clinical material and an accessible and vivid writing style, this book will appeal to all psychoanalysts and psychotherapists working with patients affected by addiction, as well as other professionals seeking new insights into effective strategies for treating this most challenging malady.

Chapter 1

Yearning for Godot

Repetition and Vulnerability in Psychoanalysis

DOI: 10.4324/9781003266358-2

Estragon: I am happy.

Vladimir: We are happy.…

Estragon: What do we do, now that we are happy?

Vladimir: Wait for Godot.

Estragon groans. Silence.

(Beckett, 1954, p. 39)

Lately it seems to me that, within the psychoanalytic process, both patient and analyst find themselves, sooner or later, waiting for Godot.

The patient, especially when new to analysis or analytic therapy, comes with a long-held hope of transcending existential pain and struggle. This hope often, especially with patients struggling with addiction (the majority of my caseload), takes a literal or concretized form. Here a patient awaits a romantic partner or some actual caregiver-figure, possibly including the therapist, to literally transform or ‘rescue’ them from misery, in a way that guarantees ongoing care and attunement, and detours around unspeakable or unnamable (Atwood, 2012) traumatic feeling-states which ‘return one again and again to an [earlier] experience of traumatization … fracturing one’s sense of unitary selfhood’ (Stolorow, 2015, p. 133).

We analysts recognize that such concretized yearnings on the part of the patient, for the reliable circumvention of such overwhelming states, might represent a curative fantasy (Orenstein, 1995)—implying the eventual disillusionment of a patient’s hopes when such fantasy fails to materialize. For some analysts, for reasons I shall explicate, this may lead to a dread or apprehension of ‘failing’ or harming the patient, which in turn may foster repetitions, enactments or ritualizations within the dyad.

We understand, intellectually at least, that if any actual self-expansiveness is to be found, it will likely involve the revisiting of the dreaded, painful affect which a patient has repetitively numbed or averted since an archaic environment demanded it. In fact, the need to repetitively numb such affect is often what fuels addiction in the first place.

It is easy to underestimate the potent persistence of an archaic ‘command’ to maintain the sequestering of trauma-related affect. Such an affective amputation continues to trap the patient in the remains of a structural tie, to caregivers who initially demanded the blunting or segregation of ‘entire zones of [the patient’s] subjectivity’ (Brandchaft, 2010, p. 199). With many if not most of my patients, some form of pathological accommodation is at issue, an underlying adhesion to archaic demands for affective riddance.

Brandchaft often noted how such rigid self-organizations sustain a terror of change, no matter how deeply such change is desired by the patient. An irreconcilable paradox: Godot is wanted or desperately needed, while such need itself must remain ‘offstage’—forbidden, a sign of shameful weakness. This can then lead to a seeking of concretized solutions, bypassing vulnerability.

Of course, it is that very vulnerability which may be the ‘Godot’ we analysts seek, awaiting the emergence of painful or shameful affect, for the sake of empathic inquiry and relational home-building (Stolorow, 2007). How or how long to sustain such inquiry remains an ongoing question, as we hope to cultivate an increased tolerance of a patient’s vulnerability, existential ‘permission’ for fundamental differentiation while ensuring that current analytic ties remain intact. Some patients decide that this is too risky or ‘slow,’ and would rather work with a life-coach, fitness trainer, or psychic reader. Many patients become dismayed at ‘how long this takes,’ in a marketplace glutted with ‘quick fixes.’

Part of the challenge for patients trapped in rigidly accommodative self-organizations, is the struggle to safely exit ‘what has become a closed and noxious system’ (Brandchaft, 1994, p. 63); such an exit is perceived, then and now, as stepping off an existential cliff. Thus, the patient waits for a Godot who guarantees freedom while preserving cohesion and aversion of a feared breakdown (Winnicott, 1974). An analyst’s fear of the latter can lead to the provision of antidotal (Stolorow, Atwood & Orange, 1997) reassurances, affective detours.

Of course, some degree of ‘antidote’ may be necessary, as the challenge with many such patients is that emotionality itself—especially including developmental desires—remains ‘a solitary and unacceptable state, a sign of loathsome defect … that must be eliminated’ (Stolorow & Stolorow, 1987, p. 72). This can mean that—depending on the acuity of a patient’s trauma, and self-protectiveness—a patient’s ‘Godot’ is deemed ready to arrive when and only when an analyst has enabled them to bury ‘verboten’ aspects of selfhood six feet under. Brandchaft (1994), ever prescient, observed that such ‘insidious defensive processes’ ensure that ‘development on the basis of authenticity of experience … is repetitively foreclosed’ (pp. 62–63).

I am beginning to understand how impossibly paradoxical are such developmental yearnings, for patients seeking relief from terrifying affect which has not and cannot even be acknowledged intersubjectively. This in turn only underscores the furtive seeking of concretized or ritualized means of relief, which protect even as they foreclose authentic strivings. (Addictive behaviors, for instance, both fleetingly ‘satisfy’ and exacerbate desires for relational expansiveness.)

Often a patient’s emotionality has been so devalued that its toxicity is beyond question, simply how things are, an ‘absolutized belief’ (Brandchaft, 2010, p. 199), no matter what intellectualized lip service is given to ‘feelings;’ vulnerable or vitalizing self-expression, seeking a more intimate relatedness, remains ‘an inarguable demonstration of … stupidity and willfulness’ (Brandchaft, 1994, p. 63).

Nothing to be done, as Estragon says in Godot.

Often a patient’s hopes for signs of analytic ‘progress,’ guardrails against a terrifying plunge, imply the elimination of the analyst’s own uncertainties and limitations, what Stolorow (2007) calls ‘finitude’—our human imperfections, or being-with-uncertainty, an inability to foreclose a patient’s existential suffering or portkeys perceived as potentially fatal. As we shall see, the latter is no exaggeration, given some patients’ archaically unrecognized trauma. ‘It feels like it will never end,’ some patients say after experiencing retraumatization, as the recurrence of such long-unacknowledged pain appears to attack their very going-on-being (Winnicott, 1965). Uncertainty is itself traumatic for many patients (Brothers, 2008)—and an inevitable aspect of the analytic process.

In the meantime, dyadic glimpses of the very spirit which the analyst hopes to free are precisely what may frighten a patient into self-protective paralysis or retreat. Such self-protections are usually followed, in my experience, by a collapse into shame and self-loathing, as the patient feels he is disappointing a caregiver-figure yet again. Or we might sense implicit or overt demands that analysis ‘get somewhere,’ especially when a patient has been pushed into therapy by a partner or family member demanding ‘progress.’ We may become disappointed in ourselves if we sense we are disappointing the patient in this instance.

The patient might, in other words, begin to resemble Beckett’s Pozzo or Lucky, ‘Godot’s’ master and servant, respectively—helpless or demanding in the extreme—rather than the sibling-in-darkness, or co-dweller within the relational home (Stolorow, 2007) we hope to provide.

We analysts are thus ourselves waiting: for signs of our own effectiveness, confirmation that patients understand, or recognize, in some part at least, our care or concern for them.

We may also be waiting for signs of enlivening relatedness, the fleeting appearance or exploration of developmental strivings, for emotionality to become valued rather than loathed; for opportunities to employ ‘spontaneous disciplined engagement’ (Lichtenberg, 1999)—for some clues, so help us, that all this effort is ‘getting somewhere.’ Repetition can be wearying, such as a patient’s epically-embedded ritualizations or self-protections, or other manifestations of an ‘exacerbated [transference] dilemma,’ which puts the analyst in the grip ‘of a requirement to provide the patient with an unbroken … experience uncontaminated by painful repetitions of past childhood traumata’ (Stolorow, 1993, p. 33), forestalling analytic traction.

Examples of such ‘grips’ include, in my case, a patient’s seeking a ‘prescription’ of how to stop ‘wanting’ to drink or use drugs (often to please an impatient other); determining whether or not he has a frightful disease based on somaticized symptoms; or how to exit an abusive relationship in a way that ensures the other will not collapse. In such cases, a patient often becomes frustrated or deflated if I cannot detect or articulate their feelings from afar, conceptually perceived, that I am ‘forcing’ them to dwell in pain rather than analyze or surgically remove such affect for the sake of ‘curing’ or cleansing them, finally, of overwhelming, obtrusive, or even contemptible emotion.

Here too I may sense I am ‘failing’ the patient in my inability to provide an assuredly safe prescription, as if my own analytic orientation, or fallible subjectivity (Orange, 2006) is shamefully at issue, that if I come up short or offer something ‘deficient,’ the patient may become endangered, or exit—as they sometimes do.

Estragon: Use your intelligence, can’t you?

Vladimir uses his intelligence.

Vladimir: I remain in the dark.

(p. 12)

Such situations—the Godot situation generally, with these specific variations—can be especially problematic for those of us who survived a ‘gifted child’ (Miller, 1997) upbringing, resulting in a fraught intersubjective resonance (Stolorow & Atwood, 2016) when vulnerability becomes perceived, by patient and/or analyst, as dangerously or contemptuously risky. An eerie déjà vu ensues, as I once again appear required to provide an asymmetrically ‘perfect’ responsiveness—lest I become a kind of ‘anti-Godot’ to a person I hope to help. In my own childhood, not knowing or having answers to ‘obvious’ questions asked by agitated or angry caregivers—in an attempt to prove that the feelings I was expressing were ‘immature’ or ‘irrational’—marked me as inadequate, a longstanding killer-organizing principle (Stolorow, 1999) of my own.

Atwood (2015) describes this ‘gifted child’ scenario as being a ‘traumatic condition’ called ‘the situation of the lost childhood,’ which ‘has developed early in the lives of almost every psychotherapist I have known,’ especially those of us who treat acutely disordered or dissociated patients. In such histories, whenever the child or ‘little psychotherapist’ dares to pursue vitalizing self-expression, ‘the parental response may be, “Why are you killing me?”’ (all quotes, p. 150).

Atwood describes how such a child becomes beholden to the needs of parents for whom differentiation produces ‘reactions of great distress … sometimes rage’ (p. 15...

Table of contents

• Cover
• Endorsements
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Credits List
• Introduction
• 1. Yearning for Godot: Repetition and Vulnerability in Psychoanalysis
• 2. The Doorknob Dilemma
• 3. Intimate Strangers: Albert Camus and Absurdity in Psychoanalysis
• 4. Lost in Reflection: Winnicottian Mirroring and Invisibility in Early Caregiving
• 5. Accommodating Brandchaft: Theory and Transference in Analytic Training
• 6. A Comedy of Terrors: Franz Kafka and a Vexing Case of Porn Addiction
• 7. Simulated Selfhood, Authentic Dialogue: An Intersubjective-Systems Look at Treating Addiction
• 8. Reflections in the Fog: Transferential Challenges and COVID-19
• Index