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Intrapsychic dimensions of addiction: the wearing down of help seeking capacities by cruel and tyrannical objects

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  • Rc Internal Medicine
  • Medicine


Research had two aims: firstly, to explore the clinical observation that dependent drug users are often apparently unwilling, or are unable to reflect in any depth on experience, including thinking about mental states in self and other. Secondly, to consider the intrapsychic elements that exist alongside, and which may motivate drug addiction (including heavy and dependent alcohol use). 34 drug users were interviewed using the Adult Attachment Interview, and interviews coded for Reflective Function (RF), an objective measure of the capacity to mentalize. Low RF was identified across the sample. Data from Adult Attachment Interviews also revealed that a climate of violence and/or cruelty, deprivation and a lack of basic care nearly always precede chronic drug or alcohol addiction. I suggest that as a result of this the individuals interviewed had minimised thinking about their own & others’ states of mind. Ten of the sample were then interviewed twice more using a research interview based on the clinical psychotherapeutic interview, which explored internal dynamics and object relational aspects of participants’ narratives. The data obtained revealed the presence of two kinds of internal object relating in a very specific way. A cruel, bullying, depriving object was found to dominate, and to severely restrict access to, a much weaker, though potentially helpful internal object. There was an over-reliance on the dominant bad object which was felt at one time to have saved the addict from unbearable psychic pain, but had then demanded he turn forever away from human help, denying the need for this or indeed any vulnerability or ‘weakness’. Whilst intoxication was initially found both to help the addict sustain this position, and to obliterate psychic pain, ongoing addiction actually cemented the dynamic described, and further inhibited access to helpful, human objects.

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