book reviews  

Mariagrazia Scarnecchia (1999)
Franco Angeli: Beyond the Pillars of Hercules: Drug Addiction Psychoanalytic Psychotherapy.

The volume "Beyond the Pillars of Hercules: Drug Addiction Psychoanalytic Psychotherapy", published by Franco Angeli in the Psychotherapy Series, enrichs the psychoanalytic literature about drug addiction as a matter of fact a branch a little represented.

At once and effectively the title evokes the mood of those ones operate in this field, operators often young and not very experienced, who are to deal with the not well-known sea of hardship and inner suffering of drug addict, to sail the problem of wwhat and how to do, to lay down and hold a safe course that is itself bristling with perils for achievement of a fairly good and constructive therapeutic relation. But it evokes also the necessary equipment to approach safety to walk through these places, reprented by love for knowlwdge, sensibility, capacity to stay in the experience with the other and to elaborate the established relation.

The author recognizes the psychoanalytic model as the methodology able to mix these human qualities so that to make them instruments to explore and sail in this sad and complicated world and she illustrates the characteristics and their complete and available use with the sensibility, the clearness and the competence of one that - acquired a great clinical experience store - has refined her own capacity of elaboration so that to give a further contribution to the theoretical knowlwdges about drug addiction.

The book is formed by a theoretical part illustrating the relations between drug addiction and psychoanalysis, through an exposition inspired to a rigorous scientific methodology, but easy and agreeable to read; the problem if the drug addiction behaviour - like many others pathologies of behaviour - is to be considered symptom or disease and the author's original contribution about a new way to see the drug addiction area.

The second part of the book illustrates the problems of technique through the presentation of clinical cases and with explanatory clearness it deals with questions of great topical interest concerning the psychoterapeutic instructions to give the patients (where and when) and it reserves a large space for the various moments that characterizes it. At this point I'd like to put in evidence in more detailed way the various themes about drug addiction described by the author.

In chapter 1 they are considered - briefly and completely - the aspects of "concreteness" (above all expressed in acting and to pursue states of feelings or to avoid painful of or in body), those aspects that once upon a time were to the edge of the possibility og a psychoanalytic understanding.
Thanks to several authors' contributions (Klein, Bion, Williams) today is possible to see in these aspects of concreteness not only the expression of mental life lack and therefore the product of purgative actions but the functioning procedure expression controlled by original (primitive) emotional problems that mean procedure of communication too; besides a better knoledge of mind, of its developing processes and finctioning procedures characterized by a wavering that is a steady part of individual's life between schizo-paranoiac position and a position of depression (the Bion's double arrow between Ps and D) makes it possible the drug addictor "suffers" more from "will-power" pathology - as can be defined the behaviour superficially - than mental and symbolic difficulty. The knowledge of toxic aspect - refered to the concreteness of drug effect in the body, the actions to find it and the immediate impossibility of a mental and symbolic signification of itself and the understanding of the dependent aspect meaning , all mental side - give the therapist useful instruments to walk through the experience of contact with the drug addiction "space" and to bear the emotions and feelings' state of chaos due to the action of projective identification - sometimes the only way at patient's disposal for communication.

In these phases interpretation and signification again - pertinent and correct in theory - not lead to reduction of splitting, the intensity of mental painful and to more consciousness of patient, but they rather configure as purgative procedures of grief put into motion in the therapist.
The description of what heard in the interview (conversation), the hearing of own contro-transference have an organizing function of ezperience because they reflect and bear the level of concreteness in communication; on the other side, not take down the concrete way to tell oneself and not bear the use of projective identification would produce - such as the author writes - a deep and tearing wound, the same that a long time ago brought the not-understood communication's baby to replace the person and her functions with the thing and its manipulation".
In chapter 2 is illustrated the drug addiction concerning the mental development events, its phases and its developing positions. They are considered Freud and Klein's theories and the following developments, with special regard to Ogden.

In chapter 3 we find the interesting question if drug addiction must be considered as symptom or disease; the examination of theoretical hypothesis supported by reliable scholars of the phenomnon, such as Olivenstein, theory of broken mirrir and Bergeret, who reports the drug addiction behaviour to a very particular attempt to regulate an inner conflict among needs contradictory requirements that isn't possible elaborate mentally … are completely illustrated through clinical implications that the condivision of one theory or another marked.

In chapter 4 the author presents her own reflection about addiction, considering the drug addiction area in an original and creative way from a point of view that privileges rather a "spatial" vision than a structural one, putting the drug addiction behaviour as belonging to a psychic functioning area … crossing longitudinally all the development. This theme is clearly illustrated and with the competence matured during years of clinical experiences; the vertical and multicentral original consideration of the concept of obsession arises from the daily psychotherapic interaction with so complex behaviour that for its understanding and theoretical elaboration requires not only listening capacity in keeping with theoretical model, but the consciousness also of the unavoidable research of "resonance" model through which one can communicate with the patient and understand his communication; all that means a transit moment from being together in a time-space sense to being together in functional sense of couple that is able of transformative interactions. This is a very important passage and - as the author emphasizes - it happens through the consciousness that the "reflection" function is expressed and makes it understood from the patient himself. This patient's becoming active not only symbolizes the eventuality of a manipulation act to bring the therapist "out of the mark", and it's necessary to be always conscious of, but also the way the patient can express his own need to the therapist; the therapist reply gives "shape" of the need expressed, it suggests the establishment of shared communication level and "being together" modality less soaked of "concreteness" levels.
In the second part of the book technical problems are illustrated considering the various moments or relation in keeping with all that written previously.

The necessity to put oneself in an active way concerning listening gives the approaching technique to patient a particular significance, closed and crystallized in a stereotyped that not contemplate as object af attention the person, but the behaviour, at least initially.

The clinical cases description illustrates as to elaborate the basically rhythm that the therapist's mind is brought to listen - at the beginning; the technical suggestions that come are strictly put in the sea of movements with no sense, of speaking without sau anything the psychological listening comes in contact with, the observation of acts and behaviour as another way capable to tell oneself.

At last, very interesting are the problems stricty linked to the psychoterapical "take on" of patient. The attention to send and the spontaneous help request as well as the clearness of conepts that have to protect the relation - in the first place the contract - refer to the need of consciousness and reduction of the ambiguity areas, as far as possible. Such attention engages not only the patient, but both the members of the couple.

Important reflection object are transference movements in the relation; they are considered both from the point of view of contents concerning the particular state of pathology, and from the point of view of relation: "if" and "how" have to be considered and eventually interpreted the transference movement to the patient. In this case too the reference to clinical experience allows understanding the necessity to be in contact and "to feel" the relation's temperature for time choice and intervention way.
The author emphasizes that the matter concerning the transference use in the relation economy (saving) is more technical than theoretical one.

I think it's a way to put first the attention on the most evident aspect for therapist, that is his own "feel" and on the necessary reflection on transformative sense that assumes his intervention rather in time and way than another, and on the consciousness of difficulty to leave the levels of omnipotence, to send back or "to forget the return towards the use of drug", to the place of acceptance of human limit, of history of life and therefore the possibility of an existence in an own space, marked by the flow of time, that characterizes - among other things - the drug addiction real world without a time of experience "in" and "of" relation with the other from oneself.

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last modified: 2001-07-25