The Da Vinci crock

[Verrocchio]

Yet while his sex life was coming to a halt, around 1895, he was also entering a hugely creative period of writing. It was precisely during this period that he developed the concept of sublimation - the transformation of sexual energy into culturally creative acts.

Actually, Freud went a bit further with this idea of sublimation. Not only is sublimation re-direction of impulses from an object (or target) that is sexual to one that is social in character (e.g., masturbation becoming too threatening to a young child, prompting him to horse-back ride), but transformation into a more socially sanctioned form of sadistic aggressive impulses too threatening to self-acceptance is also sublimation. For instance, blocked by external prohibitions or internalized inhibitions (producing conflict/anxiety) the latter impulses may be displaced to interest in Surgery.

The underlying rationale in these assertions was the idea that there was a finite amount of energy contained in the person. This energy that Freud called libido is "cathected" (attached or fixed) on aspects of the internal and external environment. The energy available to the organism may be continuosly transformed, fixed onto different "objects" (Freud meant by "objects" people as well, not just inanimate things). However the total amount of energy is conserved and stable -- Freud's system was thus consistent with the hydraulic models of the 19th-century physics. The Id (Es) was seen as a kind of dynamo, and the total mind (psyche) was viewed as a closed system motivated to maintain equilibrium: Any forces that were built up required discharge. The discharge could be indirect. Instinctual impulses could be displaced from one object to another, for instance, from one's parents to other authority figures or more remotely, from the genitals, e.g., to phallic symbols.

[v i e n n a]

And here it is an article on the connection between Freud's cocaine habit and his homosexual tendencies:

http://www.historyhouse.com/in_history/cocaine

There is a certain interest in the cocaine episode in Freud's life. The explanation lies in that cocaine belongs to the group of prohibited substances today and sensation mongers imagine Freud's association with cocaine might reveal outrageous private secrets! People imagine that the presence of a cocaine episode in Freud's life could be an indication of a drug addicted Freud. On the other hand, the need to demolish great personalities with a decisive influence on Western culture seems to be irresistible. Hence the careful pursuit for biographical details that might prove an active support to this odd need. Freud's relationship with cocaine nevertheless does not satisfy either spicy biographical details mongers or slanderers. The truth is that Freud was a cocaine user indeed. Only that cocaine was not prohibited during his time, but prescribed and used as an euphoric. The harmful side of the substance had not been discovered yet. The fact that famous beverages such Coca-Cola contained coke extract is quite telling! Cocaine addiction and its harmful effects were only discovered later.

You have this poverty-stricken 28-year-old Freud suffering from depression, chronic fatigue, and other neurotic symptoms. "I have been reading about cocaine, the essential constituent of coca leaves, which some Indian tribes chew to enable them to resist privations and hardships," Freud wrote to his fiancée Martha on April 21, 1884. "I am procuring some myself and will try it with cases of heart disease and also of nervous exhaustion..." He used cocaine as a stimulus, something to help him manage his depression, achieve a state of well being, and relax under tense circumstances. Freud even sent some of his precious cocaine to Martha, "to make her strong and give her cheeks a red color." Indeed he pressed it on his friends and colleagues, both for themselves and their patients; he gave it to his sisters. In short, looked at from the vantage point of our present knowledge, he was rapidly becoming a public menace.

Cocaine also had medical advantages for Freud. He started his research in this field concerning the impact of cocaine on medicine, on minor surgery to be more precise. This is what he himself tells us about his endeavor: "In 1884, a side but deep interest" - Freud mentioned in his biography - "made me have the Merck company supply me with an alkaloid quite little known at the time, to study its physiological effects. While engrossed in this research, the opportunity for me then occurred to make a trip to see my fiancée, whom I had not seen for almost 2 years. I then quickly completed my investigation on cocaine and, in the short text I published, I included the notice that other uses of the substance will soon be revealed too. At the same time, I made an insistent recommendation to my friend L. Konigstein, an eye doctor, to check on the extent to which the anesthetic qualities of cocaine might also be used with sore eyes. On my return, I found that it was not him but another friend of mine, Carl Koller (now in New York), who, after hearing me talking about cocaine, had in fact made the decisive experiments on animals' eyes and had presented his findings at the Ophthalmology Congress in Heidelberg. That is why Koller has been rightfully considered as the discoverer of cocaine-based local anesthesia, which has become so important in minor surgery..."

The fact that Freud had so closely missed scientific celebrity with the publication of his findings about cocaine cannot shroud a tragic event he does not mention in his biography. His research of cocaine effects was also due to a personal reason. He hoped cocaine might help his friend von Fleischl-Marxow, who had become a morphine addict, as result of attempts to soothe the pains inflicted on him by an infection. Nevertheless, his friend's cocaine prescriptions proved fatal. "If only it had soothed his pain", Freud would exclaim in 1885. On the contrary, Fleischl-Marxow died a slow, painful death and the alleged remedy had done nothing but increase his suffering. He had become a cocaine addict, in the same way he had been a morphine addict, and ended in using very large quantities thereof.

Cocaine is not to be portrayed as a reinforcer of compulsive behaviour as it is often presented from the perspective of pathology. In contrast, one has to make room for the perspective of the majority of users in which it often appears as one of the hedonistic entities of everyday life. The importance of taking drug related pleasure as a research topic can be illustrated by the serious attempt to understand controlled drug use.

For example most cocaine users do not lose control. Apparently some "control mechanisms" exist and they are not restricted to cocaine. This conclusion has been reached by a growing number of drug researchers. A full understanding of control mechanisms is still lacking as well as a a thorough theoretical investigation of this concept itself. But, assuming the validity of such a concept, one of the regulators of drug use might very well be a relative change in drug related pleasure when drug use exceeds certain limits. A cocaine study has showed for instance that when a level of use of 2.5 grams of cocaine per week is exceeded, the number of reported unpleasant negative effects rises steeply. This could very well be one of the explanations of why levels above 2.5 gram per week are so rarely maintained over longer periods in experienced cocaine users, even though many respondents are very well able to financially support such levels of use.

In many psychological and sociological views on drug use both the concepts of drug related pleasure and controlled use are of little or no importance. Heroin and cocaine allegedly cannot be used in a controlled and pleasurable manner because the concepts of control and pleasure conflict with ruling notions. Loss of control and extreme misery is what the use of these drugs will yield. Empirical verification from an epidemiological point of view of such ex cathedra notions is still rare.

If one realizes that much of our knowledge about the use of cocaine has come from studies done by clinicians, one also comes to realize that there is a sampling bias with the data that clinicians use in their generalizations. This problem is similar to the problem one would have if our knowledge about the use of alcohol would be derived solely by the knowledge gathered by clinicians working in alcohol treatment. Alcohol users not seen by these medical professionals of course do exist and are indeed the great majority of the users of alcohol.

[beaubien]

vienna, in a society that's addicted to identifying addictions, some -- "Internet addiction," for instance -- are obvious targets for valid criticism. But identifying drug addiction as a choice? It seems ridiculous, even blasphemous; isn't it scientific fact that drug addiction is an involuntary medical disease? According to the White House Office of National Drug Control Policy, it is: "Chronic, hardcore drug use is a disease, and anyone suffering from a disease needs treatment." Drug addiction is not a disease. Instead, it's a scapegoated behavior that has been incorrectly identified as a physical or mental illness, a victim of bad science and misguided policy. Like homosexuality, masturbation and other behaviors once thought to be physical or mental illnesses -- the idea that drug addiction is an uncontrollable affliction can and should be swiftly discredited.

If addiction is a choice, what is it not? It is not a disease. And it is not involuntary. And it is not a thing that causes people to engage in certain behaviors. The conventional wisdom is that the availability of drugs causes people to use them. That's one of the big arguments that is used to support the war on people=the war on drugs. And the conventional wisdom is also that if you use "addicting drugs," you will not be able to moderate your use of those drugs [or] stop using those drugs. The conventional wisdom is that there is some power in the drug that makes people keep using the drug. Another part of that argument is that once you use the drug, something changes in your body. And that change -- which has never been identified, only hypothesized -- causes you to keep using the drug.

Yet, people use drugs as a way of avoiding and coping with certain existential experiences. They don't want to do what is necessary to change their experience. I'm not saying that's not difficult -- it can be very difficult. For example, Native Americans -- who are the victims of literal and metaphorical genocide -- have major problems they have to contend with; I'm not saying that those are small by any means. But instead of doing what they need to do to change their experience, they may tend to rely on drugs as a way of making themselves feel better so they don't have to cope with those problems. Don't drugs have significant physiological effects on people? Yes, and this is a point that serves as a red herring for people who maintain that drugs are dangerous. There are two ways of looking at this. We can say, "Do drugs have a certain effect on the body?" Of course they do, and the people on my side who go against the grain [admit that]. However, drug use and addiction doesn't have to do with what drugs do to the body, but how drugs get into the body. If you take a drug like cocaine, obviously something changes in your body. Every time you think any thought, your body changes. There's always a physiological change associated with whatever you do. Now the question is, "Does that physiological change make you do what you're doing, or do you choose to do that?" If you have epilepsy, and you have a seizure, of course there's a physical change in your body that makes you go into convulsions. I'm not saying that you have a choice as to whether you convulse or not -- that's clearly not a volitional act. But whether you're going to reach for another cigarette or not is a volitional act; it's not the same thing as an epileptic seizure.

There's lots of evidence that shows that people who have been "addicted" to heroin for a long time give up heroin once their environments change. The act and the behavior of using or consuming a drug -- regardless of what it is -- is a choice, and people engage in those kinds of behaviors for reasons. There isn't some power in the drug or in their physiology that causes them to do it. Because by that reasoning, if people committed crimes while they were on drugs, then we'd have to exculpate them; we'd have to say they weren't responsible for their behavior because they were under the influence of drugs, and that isn't the way the law works. People have always had an investment in scapegoating some group or thing as a way of easing their existential anxiety and as a way of boosting their self-esteem. So to persecute people for using illegal drugs is like persecuting any minority -- blacks, Jews or gays -- because they've been blamed for the problems that the majority experiences. People have always done it; they'll always do it. What's different is that, in the past, people had a clearer sense that they were scapegoating blacks, or scapegoating Jews, or scapegoating homosexuals for their problems. But today, under this charade of science and medicine, we're "not" scapegoating drug users and addictions for our problems -- we're instilling public health. I think that it's human nature to try to find some blame as a way of easing anxiety. If people don't look to religion, then they look to persecute a minority or a substance. Who benefits from persecuting people for being addicts or who benefits from persecuting illegal drug users? I think it's clear: The drug enforcement agents benefit because they earn a living doing that. Politicians benefit because they look like they're getting rid of or getting a control on evil in our society. But I think there's a subtle group that people don't really want to pay attention to -- those who build prisons to house lots of people for consensual crimes. Of course, the others that have a deep ideological and economic investment in the "disease model" of addiction are the treatment providers because they make money treating a mythical disease.

Alcoholics Anonymous. What a cult, a religion! Well, AA should be free to exist just the way any religious group should be free to exist. My concern is that it has become a tool of the state. The state arrests people for drunk driving and orders them into Alcoholics Anonymous. That to me is a violation of the First Amendment, and the separation of church and state. I'm all for people who want to go to AA. I think it's great -- they should be able to go to any group just like they should be able to go any church, synagogue or Islamic temple. What I object to is people are being misled that AA has the truth about addiction, which is absolutely false. It would be like saying that Judaism has the truth about addiction or Christianity does or Catholicism does. What concerns me about what AA teaches is that it goes against scientific research that has focused on the concept known as self-efficacy. That is, if you believe you can do something, you're more likely to try to do it. What AA and similar disease-model groups say is that you can't control your behavior; you can't control your addiction. I think what we should be doing is teaching people that they can control their addiction. It's a choice. And then they're more likely to prove that to be true. And that idea has really been supported by psychological research; the AA idea has not.

People have the right to destroy themselves, as upsetting as that may be. That doesn't mean that private groups -- myself included -- might not try to talk these people into getting some help or talk them out of destroying themselves. But ultimately the choice rests with the individual, and I don't think we are ever justified in a civilized society that values freedom in coercing people into any kind of program, whether it's called treatment or conversation or psychotherapy, against the person's will. I think that people should be held responsible for any harm that they do to anyone else, and I don't think that we should excuse them because they're using drugs. One of the problems we get into here is what constitutes harm? It gets kind of fuzzy. If you engage in a behavior that upsets me, is that harm? You have a right to engage in behaviors of your choice as long as you don't infringe upon my freedom. I think the libertarian dictum that one should be free to do whatever one wants as long as it's not at the expense of someone else is one we should abide by. My right to swing my fist ends precisely at my neighbor's nose; whether I'm using drugs or alcohol is essentially irrelevant. If some family member or friend is self-destructing using drugs, does that cause you harm? It causes you psychological and emotional harm, it's upsetting to you. But is that the same thing as some kind of criminal act? I don't think it is. That's part of the price we have to pay in a free society.

I don't think drugs should be legalized -- I think we should repeal, in total, drug prohibition. "Legalize" connotates government regulation, and I think that people have a right to drugs as property as guaranteed by the constitution. I don't think they should have a right to marijuana, for example, because it qualifies as medicine -- certainly, they should be able to use the drugs for any purposes that they want, whether it's medical or recreational.

[d e f i n a]

Much medical and social science when applied to drugs seem to be unable to describe and explain the phenomenon of drug use without an unusually strong bias. This bias is produced by a cultural dependency on concepts of much larger significance than drug use itself. As a result the object is almost completely blurred from view. One could not help but seeing much of what happened around oneself in the drug arena as "social constructions", realities created by a myriad of relationships between persons who used concepts to understand a reality that would adapt them for their survival within these relationships. And since the inequality of power is one of the structural characteristics of interpersonal (or for that matter, inter-organisational) relationships, much of the so called scientific analysis of drug use would tend to be most instrumental to the survival of the most powerful. Power, of course, is not only connected to wealth or decision making, but also to the construction of morality and ideology.

Science is one of the fundamental instruments of political and ideological conflicts. The determination of which branches and concepts of science will be developed or applied is dependent upon economic and political power. Because power cannot be evenly distributed in a community those in power will develop science according to their interests and taste. One should not look upon this as dishonesty or exploitation per se, but in most cases, as honourable and quite inescapable. The concepts used to attain a detailed understanding of the relation between concepts and power were the "I", the "Ego", and the "individual". The social psychologist for example, would critically investigate many psychological and sociological theories in order to come to grips with the use of social science for the conceptual construction of the "ego" and "the individual". To summarize, in present Western society, dominated as it is by entrepreneurial activity, persons have to very often find their way against or without others. Therefore, generally a person will learn to "experience himself alone, in the centre of things for whom everything else exists outside himself, separated by an invisible wall from him, assuming as self evident that other individuals experience the same". This specific historical construction of the individual, of course, is not the intentional product of some office or ideologue, but a by-product of people in their mutual and socially structured relationships. It goes unnoticed, like breathing. In this way psychiatry, psychology and sociology are tools of a class of people who interpret, influence and try to shape others and society from this dominant perspective on the individual.

One must simply not take seriously the reasons for the use of drugs that are often mentioned in scientific literature. It's more efficient to look for motives behind the words, and search for these motives in the field of power inequalities. One discovers that the so called "reasons" why people take drugs are convenient conceptual constructions that are fitted to a predetermined, mostly psychopathological model of explanation of drug use and "dependence". However, it might very well have been the emergence of a new class of professional medical men at the end of the last century that helped to socially define illegal (often so called "non-medical") drug use. Professionals related to the maintenance of physical or mental health and the management of pain have throughout history been very powerful people. The tools and concepts of these professionals may change in history. The modern power to mediate between (a large majority of) drugs and the use of drugs is a new and tremendously important instrument. In contemporary Western society drug use is not left to the individual responsibility of the consumer. It is assumed that the consumer is not able to exercise this responsibility. Every consumer of drugs is therefore forced to first consult a "drug broker", which produces in turn an almost total monopoly of the drug broker class. Total prohibition of certain drugs is the focal point of the assumption that drugs should be excluded from the realm of consumer freedom. In this sense the existence of "illegal" or "non medical" drug use is a vital concept for present day legitimizations of medical power. This particular concept has been internalized by all categories of the public, although it has been attacked by theoreticians such as Szasz. And as long as the definition of "illegal drug use" helps medical professionals to retain their power, a large majority of them can be expected to hold to it.

Power also plays a role in the management of minorities. Management of minorities does not only relate to the opportunities of economic exploitation, but also applies to the warding off of fear. If mainstream groups develop fear of minorities for whatever reason, there is a small likelihood that scientists belonging to these mainstream groups will not share these fears. Science can then be used to translate popular and crude verbalisations into an "objective" scientific discourse of warding off policies that legitimate the use of physical force against the feared minorities. One of the most common legitimizations of the use of physical force is the redefinition of drug use as crime or "crime generating". Once this has been accomplished the social institutions that will care for drug users can be defined as the police, prison personnel or, in extreme cases, the army. The redefinition of illegal drug use as pathology is on first view completely different from its redefinition as crime. The difference, however, is mainly in the selection of control institutions. The violence of health institutions towards the users of illegal drugs is often less outspoken than the violence of criminal justice institutions. This is a difference that can be very important for individuals that are subject to this violence. But both medicalization and criminalization are techniques to control defined deviant groups and in this sense they are identical.

For example, it is to be concluded that the conventional combinations of behavior we define as heroin dependence are mainly a product of society's reactions toward a frequent heroin user, not of the effects of heroin itself. We are so conditioned by medicine to think in terms of the pharmacological effects of a substance that drug-use related behaviours are automatically associated with the substance. But the effects of a substance are almost always mediated by the user and the social context in which use takes place. A failure to understand this interaction gives rise to an invalid emphasis on the pharmacological dimension. This distorted emphasis is often connected to narrowly conceived psychiatric models of explanation. Investigation of the concept of addiction itself, as an expression of "central cultural conceptions about motivation and behaviour" would have been a logical extension of this reasoning. Conceptually shifting away from the incorrigible association between frequent use of illegal drugs and pathology, a drug use career with all its secondary social effects can be researched in a completely different way. Once on this road (coupled with the view of the instrumental function of science for drug political status quo) one quickly recognizes "realities" that have been excluded as an object of scientific inquiry. A good example is the pleasure that drugs provide. Drug-related pleasure or other non-negative functions of drug use cannot be easily investigated within a political structure that is committed to the prohibition of drugs as a defense against evil. Imagine a high officer of the Inquisition in the late Middle Ages allowing for the possibility that a large proportion of heretics were "non evil"! This would have been impossible.

Thus, in conclusion it can be observed that the specific ways in which psychology and sociology have looked upon drug use and selected topics for research are often purely instrumental in not endangering the existence of the a priori's of the present "drug problem". On the other hand, both disciplines yield notions that enable us to clarify and identify this instrumentalism. Where an individual scientist will stand might be a matter of chance, but most probably it is a result of his attachment to conventional perspectives and prejudice on drug use or drug dependence. And the chances for developing a non-conventional scientific outlook on illegal drugs become slimmer as financial support for drug research is regulated by drug policy institutions whose aim is to support conventional drug politics. This works also the other way round. No doubt this way to look upon matters of drugs can be very much influenced by the simple circumstance of living somewhere where drug policy is deviant when seen from a global perspective. Finally, let's accept that a neutral view on drugs is highly improbable in a world that translates the drug issue in war metaphors. One has to be convinced that only the abolition of drug prohibition might ultimately create the conditions for a maximum of independent scientific involvement in the issue.

Here's Chomsky's view on the war on drugs:

http://www.chomsky.info/interviews/199804--.htm

[Carmelita]

Greta post, defina! Here it is another intriguing article from Peter Cohen:

The psychological a-priori in scientific discussions of addiction to heroin, as well as addiction to other substances, consists of two separate assumptions:

• that becoming addicted is best described as a psychological process within a particular individual, and that such a description can also serve as the basis for its explanation;
• that addiction is a psychopathological phenomenon within an individual which necessitates change and that the description in psychological terms serves as the basis for a therapeutic intervention.

Logically, 1 and 2 do not go together. But in everyday practice they are inseparable. In this article, which deals mainly with heroin addiction, both are taken as equally important. However, from the addict's point of view and certainly in our own dealings with the so called heroin problem, the idea that every regular heroin user, let alone every addict, is a pathological case is especially important. Several 'theories' are used to label addictions as a pathological aberration. I will indicate four of them, but undoubtedly more could be found in the vast literature on this subject.

A. Addiction is pathological because addictive behaviour reflects a developmental disorder.

Within psychoanalysis this vision is paramount. Addictions are either based on an oral fixation1 or on an anal one, or even on both. In this reasoning the actual addiction is a regression which has to be dealt with by removing the regression. This idea has remained almost undisputed within psychoanalysis even though it has long been known that addiction is extremely hard to 'cure' by psycho analytical methods.

B. Addiction is pathological "because it is characterized by an abnormally high intensity of craving for satisfaction and by a strikingly low susceptibility for modification of the need for that satisfaction."

This way of describing addiction makes quantity rather than quality the basis of the pathology. One might remark here, that this type of description could easily encompass many behaviours which we do not normally consider pathological (for example, ambition, sex or the need for company).

C. Addiction is pathological because of the function it fulfils within some pathological syndrome.

For instance Kuiper says that not only affective problems, but also other illnesses can lead to addiction. Thus for Kuiper emotional inhibitions can provide the motivation underlying addiction to disinhibitors like alcohol or stimulants; depression or dysphoria can give rise to addiction to alcohol or opiates; anxiety can lead to addiction to alcohol, opiates or hypnotics; and tension, depersonalization and derealization can result in addiction to substances that counteract these affects. Chronic depersonalization and emotional emptiness give rise to chronic use of cannabis. Here the addiction is functional within a pathology, and thereby becomes pathological itself. It is a secondary pathology.7

Authors like Mijolla and Shentoub fall into this category. For them addiction is a symptom of the impossibility of enacting satisfactory object relations. The addictive substance replaces the human object, and the relation to the substance replaces a relation to the human object.

D. Although the following theory of the pathology of addiction is similar to that given by Mijolla and Shentoub, I present it separately because of its rigour. For Kohut, some cases of addiction occur because people do not have sufficient psychological structure "to soothe themselves or to go to sleep". Later he states, in a generalizing context, that "the addict craves the drug because the drug seems to be capable of curing the central defect in his self". This looks like pathology in extremis. Kohut's view could also have been considered under the first heading, in which addiction is seen as a developmental disorder.

This short and certainly incomplete excursion through the theories which define addiction as pathological behaviour on the basis of a psychological understanding of the phenomenon, leaves us with a strong sense of disquiet. If we are to believe the quoted authors, there is a lot wrong with addicted people.

[Carmelita]

But strangely enough, authors can be found who describe addiction as pathological without linking it to specific qualitative or quantitative characteristics. I should mention Van Dijk, who concludes with regard to alcohol addiction, that "for the person who gets addicted there is no indication whatsoever of specific personality characteristics". The American investigator Craig has enriched the literature with a thorough review of all empirical studies of personality characteristics of heroin dependents. He concludes that there is pathology, but not a specific one, and that particular personality characteristics of heroin dependents cannot be found. We might be tempted to react to all this with a very modern conclusion. In the current climate, with its preference for multi-causality, multi-functionality and even for multi-disciplinary research we have to accept that different psychological theories may apply when analysing or treating a case of addiction. I do not support this conclusion, because it leaves veiled the a-priori I mentioned at the beginning of this article.

At this point I would like to turn for a moment to a completely different so-called problem area, homosexuality. In the Netherlands, e.g., people have almost completely passed out a period when they considered homosexuality to be a mental disorder, a psychopathological state. A great variety of theories and scientists were preoccupied during this period with the 'problem' of homosexuality, without ever being able to reach a more or less homogeneous view of its causes or its treatment. But nevertheless, homosexuality was by common consent seen as a pathological disorder, either moral or mental, and mostly as both. This point of view has changed considerably. In fact, as homosexuality has reached a level of social acceptance and integration, so the matter has been dropped. As a result, its earlier problematic content -- translated into a scientific problem -- has petered out. During certain periods psychologists and psychiatrists seem to make observations and design theories about assumed pathological phenomena, in which they probably do little more than provide scientific rationalisations for social conventions. What is the plausibility of the hypothesis that our present theorizing in relation to addiction (in particular heroin addiction) takes as point of departure the a-priori which we have seen in the case of homosexuality? "Impossible," -- a therapist will remark -- "in my own work I have seen addicts who are as mad as a hatter. I really cannot see such people as constructions of my phantasies nor myself as promulgating invisible social prejudices. These people cry for help. So I need adequate psychological theory on which to base my therapies".

Our imagined therapist is right. Some addicts show incontestable pathology. I want to ask two questions here. How often does this occur? Or, in other words, how representative are heavily disturbed people (psychotic or prepsychotic) of the total population of drug dependents? Can we find a theory, maybe even for psychotic drug users but certainly for the mass of drug users or misusers, which does not explain drug use or misuse primarily in terms of psychopathological processes? For an answer to the first question I will refer not only to empirical research, but also to practical experience. Years ago the local government of Amsterdam was considering the enabling of the Health Authority to maintain a small group of addicts on prescriptions of morphine. For the members of this group a completely new word was coined: EPD. This stands for Extra Problematic Drug-user. In an unpublished report by the Health Authority the size of this group was estimated to be 120 people. An EPD is characterized by severe psychiatric disorder with concurrent physical and social neglect. We may assume that the other heroin dependents in Amsterdam (about 8000) do not belong to the EPD-group. This assumption is consistent with what is generally accepted in the literature about (the range of) the proportion of heavily disturbed people among drug dependents. But let us for a moment broaden our concept of pathological dependence to include all people we call junkies. They are the more conspicuous of heroin users, and in Amsterdam they were estimated to number 1200. Junkies are defined by their full time involvement in obtaining their prefered drug and if this is not available in finding a substitute. Not all of them look badly neglected, not least because many shoplifters, chequeforgers, and in particular prostitutes, cannot afford this.

For an answer to the second question: Norman Zinberg, an American analyst and psychiatrist tries to show how we construct the pathological and individual psychic source of junkie behaviour. He is not soft in his description of junkies who "look a lot alike: they are usually thin, their clothing shabby and their person somewhat unkempt. Initial conversations reveal their almost total preoccupation with heroin or its replacements and the life-style that surrounds its compulsive use". Furthermore they demonstrate a clear negative identity, they naively believe in all kinds of magical processes, they are paranoic and their deterioration of super-ego functions is dramatic. If something goes wrong, others are guilty. They cannot reason logically and their memory is bad. This is not minimal. But still Zinberg does not stop. He adds that their "everyday psychological state seems compatible with a diagnosis of borderline schizophrenia or worse". According to Zinberg, it follows that for a psychologist or a psychiatrist it is very attractive to use all these observations to construct psychological explanations of drug dependence. That is, explanations in which drug dependence is seen as being grounded in psychic characteristics which are evidently pathological and -- this is essential -- which were already present in the pre-morbid person before he got drug dependent.

But Zinberg is not convinced. He asks what evidence we have that the personality state in which these drug dependents present themselves to us, has anything to do with the psychic structure of the person before the onset of his drug dependency. According to him no such evidence is available and he finds it unacceptable to 'explain' the mental characteristics of heroin dependents by means of postulated unsolved mental problems which predated the addiction. This is a type of explanations he calls "retrospective falsification". Let us go back to Craig now. He concludes his review on the literature about personality characteristics of heroin dependents with many research recommendations. Craig's conclusion, that "it is impossible to ascertain if traits found in heroin addicts, predated addiction or were the result of it" brings him to recommend longitudinal studies that will answer this question. Elsewhere he states that "we are in desperate need for longitudinal studies concerning changes in personality over time". Craig does not move away from the psychological a-priori, although I consider the massive lack of evidence for a psychological explanation of heroin dependence the most essential part of his findings. Stanley Einstein has worded his doubts about the psychological a-priori in the following way: "What are the implications of relating to a dynamic living person -- a drug user -- from the theoretical perspective of a closed system stereotype?" In addition he states that we see the drug user as somebody who "differs significantly from us and others in our life space in a negative sense", a view he calls the theoretical dehumanization of the drug user. One could justly interpret these words as a combined criticism on both the psychological a-priori and the social conventions behind it. But in this case the argument is not elaborated.

[Carmelita]

Social determinants of addict behavior

When we agree with Zinberg and Craig, and accept that at least we make a highly unfounded judgement on the pathological content of something within an individual that makes him into a drug addict, how then can we explain the modes of behaviour we so often see in heroin dependent people. And if it were true that the strikingly uniform ways in which junkies appear to us are not to be connected to a set of definite personality traits, do we have to leave the realm of psychology altogether in our search for explanations? To deal with these questions I would like to return to Zinberg and in addition introduce some criminological notions as expressed by Leuw. Zinberg's response to the problem he himself helped to create is worded in both psychoanalytic and sociological terms. His opinion is that the social situation in which heroin users find themselves after a period of regular use creates a condition which he defines as stimulus-deprivation.

Because of severe disapproval and in many cases rejection by parents, wider family and long standing social contacts, heroin addicts increasingly lose essential sources of stimuli. It is precisely these stimuli which enable a person to maintain a measure of continuity and structure as a person. Referring to Rapaport, Zinberg assumes that the relative ego autonomy in relation to the Id and the environment is harmed or disturbed by this deprivation of social stimuli. Out of that condition emerges the process of 'junkieization' of heroin users. Junkie behaviour is not seen as arising from pathological traits within a pre-morbid person but from strong environmental forces which exclude people from standard forms of social relations by labeling them as extremely deviant or even dangerous. This might be compared to banishment to a public Siberia. Few could remain "normal" under such circumstances. I could even add here that a high degree of "normality" has to be assumed in order to account for sensitivity to stimulus deprivation. Zinberg's reasoning does not leave the domain of psychology at all, but it does end the primacy of psychological theory when trying to explain junkie behaviour.

And now Leuw. He published a clear and outstanding analysis of the social construction of the so-called heroin problem, but it is outside the scope of this article to summarize it adequately. I will draw only on a few details that supplement Zinberg's view. Leuw adopts much of the criminological theory of stigmatization, in which a distinction is made between primary and secondary deviance. In the case of heroin use primary deviance consists of consuming a substance that is socially seen as devilishly dangerous. Although it is quite possible to use heroin inconspicuously in a perfectly integrated life style, primary deviance almost always develops into a secondary one. For a host of reasons primary deviance creates repressive or rejective social reactions. The expulsion of the heroin user and his concurrent social retreat instigates the process of secondary deviance. In this process deviance becomes the "all defining characteristic of somebody", "for himself as well as for his surroundings". Also for Leuw it is social rejection that not only diminishes the range of adaptive behaviour but also seems to be a strong determinant of its content.

The difference between Zinberg and Leuw lies in the greater psychological detail which Zinberg uses, but for both it is neither the substance heroin nor the assumed psychological disorder within individuals that explain junkie-behaviour. For both, the explanation has to be found in a complex interaction between a person and several levels of the environment. A completed process of junkieization results in a heroin user who lives at the margIn of society, driven there by his friends, his parents, the police, social assistance or whatever. The heroin-using culture is the only environment where he is allowed to function. "The moral rejection and the (legal) repression did not only ban him from 'normal' society, they also convicted him to live in a psychologically very destructive milieu". In summary, we have seen that psychology or psychiatry offer a great many explanations of addiction. The supply is so large that almost any part of human development, of emotions and the pathology thereof can be causily connected to the emergence of addiction. Little wonder that empirical research cannot support an assumption that specific personality traits can be made to explain heroin addiction any more than was the case with alcohol addiction.

We may quietly consider it plausible that in a great many cases of addiction, psychology by itself lacks the competence to explain them. Denial of this involves a psychological apriori. The means by which this apriori is usually maintained was given the name of "retrospective falsification" by Zinberg. Of course psychology must play a role in a theory of addiction and addict behaviour, and so must psychopathology. But neither can play more than an auxiliary role within the broader social scientific theory of the addictions.

[Carmelita]

What conclusions should psychiatrists and psychologists draw from these arguments? Both groups of professionals are functional in preserving some of the important social factors that together cause the extreme rejection of heroin dependence. It is not that these professionals create this reality or the dependents by their strong labeling actions. This would be a naive and even nonsensical view because the social factors that uphold the rejection of heroin use are many. The view that regular heroin use or heroin dependence is pathological is one of these factors and may have the function of creating an ideological foundation of quasi-scientific status. However, even without this foundation social rejection would occur, probably because it has very important societal functions. How can we fit their observations into a broader social scientific view of addict behaviour? Those who see substance dependence solely as a developmental disorder cannot be very useful for such a theory. But those who look upon addiction as a quantitative aberration are already closer to a contribution. One might reason that the 'abnormality' of the intensity which is hypothesized in the craving for drugs does not necessarily have a disruptive function in the social development of a person. This is valid even for heroin dependency under present conditions of severe illegality. The intensity in itself could be without social (and thus personal) consequences if the drug user could keep his use secret, or contain the secrecy within a circle of trustees and if the user were able to prevent his conscience from fulfilling the role of an external rejecting agent.

But for many heroin users these preconditions do not exist. The financial burden of obtaining the illegal substance gives them away, and the consequences of being socially known as a user of forbidden substance take their inevitable toll. Subsequently, the pharmaceutical and subcultural consequences of substance use become dominant in such a way that substance dependence as a normal adaptation is hidden from view. In Mulder's words, this dominance becomes the "abnormal intensity" of the need for satisfaction. An additional problem is that current social judgement of heroin use are in part shared by most heroin users themselves, belonging as they do to the same dominant value system. The pain associated with this self-rejection adds to the intensity which, according to Mulder, is abnormal. This might explain the higher than average suicide rate found amongst heroin users, as was the case with homosexuals at the height of their persecution. This way of reasoning can also be applied to the evaluation of the psychological theory which looks upon addiction as a defense against very intense affects or the lack of them. Depression, depersonalization, great fury, apathy, emptiness: as adaptations to the many stages of a career into a social outcast they are not so strange. One could even empathize with them. This is also valid for the reported feeling of not being a person or in Kohut's words, a lack of psychic structure or self. I do not want to be misunderstood to be holding the view that these affects or states always develop after the onset of forbidden substance use. We should be fully aware, however, that what we call "pathological" emotions can have principally different etiologies. When we find them in heroin dependent people, the incidence of these emotional states alone is insufficient to locate their etiology in mental processes dating from before the consequences of illegal heroin use became operational.

The observations of these affect-theoreticians have remained useful. However, the theoretical framework in which they can find a place has changed. Where we should seek the explanation of addict behaviour is not the individual in which some pathological process has taken place, but in a polymorphic social interaction between a rejecting environment and a person who happens to like an illegal substance very much. For normal people it is this interaction which is pathogenic and which gives rise to the heroin addiction problem as we know it now. What I am saying, in essence is that the run-of-the-mill junkie has some characteristics which could be described as pathological, but which are better described as enforced emotional adaptations of normal persons. Extraordinary psychic pathology does exist in some heroin dependent people, but to use this picture as a generalization for all heroin users or addicts is very bad science. However, this way of reasoning does not explain why some people get addicted and some do not. This is indeed a challenge created by rejecting the psychological a priori.

[Carmelita]

Subculture

In their essay on possible causal relationships between psychopathological processes and non-medical drug use, Schuster, Renault, and Blaine argue that there is no reason to assume that the use of opiates cannot be normal human behaviour. Their problem is to explain why in our cultures it is seen as abnormal. They suggest that social factors transform opiate use into an exception, and they recommend research to clarify these factors and their operation. One could ask, agreeing with Schuster et al. how it is possible that the social factors of which they speak are in a great many cases, mitigated or neutralized. Fortunately "becoming deviant" is a research topic in criminology. Matza even looks into the concept of pathology in this context. The concept of subculture is of central importance here. In his study "Drug use and Subculture" Cohen shows how subcultural influences ease the emergence of behaviour which is looked upon as deviant or even criminal by others outside the subculture. The drug scene provides participants with a different selfconcept, different ideology, ways of defensive communication, warning systems against invasions of the subcultural sphere, rituals, forms of magic and last but not least, with attractive new personal relations. Clearly the emergence of subcultures explains much concerning why some people get addicted and others not. Matters like proximity are vital here, and possibly chance plays some role. More important, the emergence of subcultures is not arbitrary. Subcultures are specific reactions to broad social developments that sensitize either one -or an other social substratum into creating them or being attracted to them.

At the present moment opiate use is clearly bound up with specific youth subcultures, in contrast to the opiate use of some 60 years ago when it was called the illness of the better classes. The similarity in primary deviance between such completely different groups is in itself a very interesting theme. But the challenge of explaining why some people get addicted and others not, although all belong to the same social strata, may not be completely met by the concepts of deviance and subculture. It is worthwhile focussing research on this problem, without falling back upon the psychological a-priori. The habit of psychologists and psychiatrists of connecting use and misuse of drugs primarily to psychopathological processes in individuals helps to maintain the present heroin problem. This may be sad, but the consistent failure of the greater part of therapeutic work with drug addicts and the history of our drug policy allow no other conclusion. The real help that these professional groups could give to heroin dependents is to cease every intervention that confirms the drug addict in his role of social outcast and failure. Therapists have to make a conceptual and ideological 'volte face' by accepting the drug dependency of a person.

This actually implies their leaving the field of the drug-issue altogether but for the time being this is not very likely. But as long as they are involved in drug problems, they should help addicts to function in spite of social rejection, by supplying drugs in a pure form, and by encouraging the emergence of better regulated ways to consume them. The goal is not abstinence, but amelioration of the social position of the drug addict as much as possible. A consequence of this might be that a body of generally accepted rules emerges for dealing with opiates, as is already the case regarding the way we deal with alcohol. According to Hunt and Zinberg, these rules play an essential part in the (self) regulation of drug use. Maybe it will eventually be possible to make a contribution towards changing the relationship between users and non users of opiates so that the pathogenic interaction between these two groups becomes less oppressive, and thereby less risky for both. I strongly oppose the use of psychotherapy in the bulk of drug dependence cases, even if the addict himself asks for it because of his addiction. For, is psychotherapy here not the quasi-scientific treatment of the suffering from social prejudice, a prejudice the addict himself has not been able to escape, alas?

[I Do (But I Dont)]

das Geviert, innocent as Leonardo's vulture phantasy is, I bet the poor man would have never ever written it, had he known a paranoid individual like Sigmund Freud would make such a big deal out of it!!!

Have you read his paper on Michelangelo's Moses? THEN you'd be right to say Freud is unbelievable!



He completed his paper, "The Moses of Michelangelo," on New Year's Day, 1914; he had been thinking about it for at least 13 years, struggling with it, talking to his colleagues about it. His thoughts reached a pitch of intensity in 1912 and 1913. But once the paper was completed, he still did not want to publish it. Jones, Ferenczi, Abraham, Rank, and Sachs were dismayed. Freud told them he had more doubts about its conclusions than usual; he worried that it might seem amateurish. The paper meant something more to him than other papers had. Finally, he gave in to his friends' good advice, but he still insisted that it be published anonymously! Why? "It is only a joke," he wrote Jones, "but perhaps not a bad one." To Abraham, he also wrote, "It is only a joke." Not for 10 years would Freud publicly admit authorship. 19 years after its completion, he wrote Edoardo Weiss: "My feeling for this piece of work is rather like that towards a love-child. For 3 lonely September weeks in 1913 I stood every day in the church in front of the statue, studied it, measured it, sketched it, until I captured the understanding for it which I ventured to express in the essay only anonymously. Only much later did I legitimatize this non-analytical child."

Every day by himself before a piece of marble for 3 weeks? Love-child? This after 11 years of regular visits to the object of his fascination? And then he was unwilling to put his name to the paper. Freud had had similar uncharacteristic reactions to "Totem and Taboo" and later would to "Moses and Monotheism," two other works he was inclined to publish anonymously. "The Moses of Michelangelo" was more than a demonstration of the application of the psychoanalytic way of thinking, more than a scholarly exercise.  It was a work of art itself, thus a personal statement. But was Freud being self-deprecatory and trivializing when he called it a joke? In "Jokes and Their Relation to the Unconscious," Freud found similarities between jokes and works of art. What about the "love-child" comment? It appears that child was the product of breaking the rules which purport to separate science from art, rules which would dictate conformity and submission to authority rather than revolution, and rules which call only for conventional solutions to oedipal dilemmas.