psychic retreats into heroin

197 Pages·2017·1.22 MB·English

Running head: PSYCHIC RETREATS INTO HEROIN: INSTITUTIONAL TRAUMA AND LOSS
PSYCHIC RETREATS INTO HEROIN: INSTITUTIONAL TRAUMA AND LOSS
IN THE LIVES OF SUBSTANCE USING MOTHERS

A DISSERTATION

SUMBITTED TO THE FACULTY

OF

THE GRADUATE SCHOOL OF APPLIED AND PROFESSIONAL PSYCHOLOGY

OF RUTGERS

THE STATE UNIVERSITY OF NEW JERSEY

BY

CASSIA LINDSEY MOSDELL

IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE

OF

DOCTOR OF PSYCHOLOGY

NEW BRUNSWICK, NEW JERSEY MAY, 2018

APPROVED: ___________________________
Karen Riggs Skean, Psy.D

___________________________
Seth Warren, Ph.D

DEAN:

___________________________
Francine Conway, Ph.D
PSYCHIC RETREATS INTO HEROIN: INSTITUTIONAL TRAUMA AND LOSS

Copyright 2018 by Cassia Mosdell
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Abstract

This ethnographic study considers the accounts of 12 new mothers in recovery for heroin
addiction. Using structured interviews, it aims to uncover the historical and ideological
contexts of their experiences and seeks to understand how these experiences intersect
with axes of power, oppression, and structural inequality. The study draws upon object
relations, attachment theory, Lacanian analysis, critical theory, theories of liberation
psychology, and a biopsychosocial approach to addiction and harm reduction. It asks: in
what ways do interactions with oppressive systems of race, class and gender impinge
upon substance using mothers? And how do historical and ideological constructions of
motherhood and addiction insidiously insert themselves into the mother-infant dyad? The
study identifies three areas of institutional trauma: exclusion from language, loss and
bereavement, and sociocultural shame. It argues that these combined institutional harms
trigger a psychic retreat into the primordial, preverbal, somatic realm of heroin.
Interviews reveal how institutional systems of control constrict voice, language, and
symbolization, all of which are central to the phenomenology of addiction. They further
r show that many women suffer a profound and enduring loss from child removal, which
increases their risk of future substance use. Analysis of the child welfare system points to
structural problems of race and class bias that lead to excessive child protection
enforcement. Interviews show that substance using mothers experience a unique duality
of shame: the pathogenic shame inherited from their early traumas and a sociocultural
shame specific to social constructions of motherhood and to the phenomenology of
oppression. The study’s findings stress the need to keep mothers and infants together in
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drug treatment, and provide strong support for a harm reduction approaches to addiction
treatment. It concludes that addiction policy should adopt a harm reduction focus,
including the decriminalization of heroin and other drugs, improving access to
medication assisted therapy (MAT), and increasing social welfare spending. Finally, the
study concludes that therapeutic work with substance using mothers calls for a radical
psychoanalysis that bears witness to the trauma of oppression, supports the development
of imagination and resistance, and advances the goals of psychic and social liberation.
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Acknowledgments

This dissertation has taken a long time to write, and consequently, the list of
people who deserve my thanks is also a long one. I wanted also to make visible all of the
many people who have helped me along the way. Central to the topic of my dissertation
is the conviction that it takes an entire community to raise a child, to pursue an education,
to create a home and to make it through life.
Thank you first and foremost to the women involved in this study. Your strength
and resilience inspired me, moved me, and changed me. To me, your strength was never
about your sobriety, your abstinence or your recovery. Your strength was your humanity
and your love, in the face of so much adversity. Thank you for sharing your stories with
me. I will carry them with me. I will continue to speak out against our current child
welfare system and to champion fair and humane drug policy.
I would like to thank Karen Haboush, who died unexpectedly on the morning of
July 27th. You were my rock in the program. Part of the reason I came to GSAPP was
because of your interest in merging psychoanalytic practice and school psychology – a
rare thing to find and something that is still sorely needed in our schools. Thank you for
all of your kindness and support. You gave me the courage to pursue psychoanalysis in a
sea of behaviorism, and you supported me to write this dissertation. I will never forget
your gentle, soothing presence and your kind, kind heart. I miss you.
Karen Skean, thank you for your unwavering support over the years. Not only
have I benefited so much from your knowledge of psychoanalysis and attachment theory,
but I have also learned so much from your style of interacting, your empathic disposition
and your personality. I draw upon it clinically, and in my life. Thank you for always
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providing the space for me to be curious, to explore new ideas and to challenge and
question the status quo. I have really felt your presence throughout my time at GSAPP,
and it provided a veritable holding environment for my growth and learning. Thank you
also to Seth Warren. You are a huge inspiration and I have learned so much from your
well of psychoanalytic knowledge, from your refreshing irreverence for the medical
model, from your commitment to social justice and from the ways in which you respond
with humanity and compassion to human suffering. You joined my committee at a critical
moment and I cannot thank you enough for your support. Thank you for understanding
my vision, my political leanings and for making space for me to put my passions and my
ideas into writing.
I’d also like to thank the rest of GSAPP’s staff and faculty. Each of you played a
special role in getting me through the program. Anne Gregory, thank you for periodically
checking in with me and encouraging me along the way. Your work continues to be a
huge inspiration to me and it was immensely helpful to have somebody looking out for
me.
Thank you to Sylvia Krieger without whom I would have never made it through.
You were my ray of sunshine at GSAPP. You sat with me through some very difficult
times in my life and your unwavering support has meant the world to me. You are a rare
individual – someone who loves and cares so generously. Thank you from the bottom of
my heart.
I want to thank my friends who all played a crucial role in getting me through this
process. Getting though graduate school and writing a dissertation as a single parent is no
small feat but I have always known that I am not to credit for the strength that it took. I
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had an army of support who helped me with child care, with emergency pick-ups and
drop offs at school, and with lots of moral support and encouragement. Kathleen, Sara,
you have been my support over the last seven years and I am forever grateful for our
friendship and our shared experiences of single parenthood. I am very grateful to my
emotional support team including Katarina, Lindsey, Roberta, Bahar, Diana, Piera,
Marina, Ty and Fumiko, as well as my oldest and dearest friends Sejal, Sheila, Camille,
Amy, Elspeth, Lisa and Rodman.
I want to give special thanks to Rodman for the many hours of long conversations
that we had about race, critical theory, Racecraft, and the meaning of life, during the
process of writing this dissertation and dating back almost 20 years. You have no idea
how much you have influenced my thinking and I hope that I can continue to learn from
you for years to come. Thank you for your friendship, which means the world to me.
Maria, thank you for your friendship, which I cherish. Thank you for radicalizing
me early on in my life and for always being a phone call away when I need to lament
capitalism and trust that someone will respond with complete understanding. The world
is blessed to have an advocate like you and I remain inspired and empowered by our
many adventures from taking on charter schools, to advocating for the blind, to pushing
back against the racism and classism of the child welfare system. Thank you also for your
love and support. You have been there for me through so much, since I was only 19 years
old. You are family. Elora, thank you for inspiring me every day with your kind-
heartedness, your fighting spirit, and your refusal to accept injustice. You are a shining
star and I love you chuchie- luchie.
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Matt, I cannot even put into words all of the love and support that I felt from you
throughout this process. Thank you for your unflinching support and putting up with the
months (years?) of work that this project took. Thank you for spending hours upon hours
trying to understand Lacan with me and for integrating words like ‘mentalize’ and
‘dysregulated’ into your everyday parlance. I always feel heard and seen by you. I never
cease to be amazed by your generosity and your compassion. You are a true
humanitarian, feminist and a kind, ethical human being. Thank you from the bottom of
my heart.
My deepest thanks to Karen chan. Karen, you have been a light in my life the last
couple of years and are a constant source of emotional support, understanding, and joy.
We are true kindred spirits. Our long train rides and deep, reflective and inspiring
conversations grew me as a person and as a psychologist. You are a dear dear friend and I
am looking forward to many more years of friendship and to our private practice with
“analytic scarves.”
My deepest thanks also to Jeff, friend and co-parent. You have been supportive
from day one. Thank you for helping me to raise the best little boy in the world and thank
you for believing in me and always encouraging me. You have informed much of my
thinking over the years. I am always inspired by your compassion for others and the way
in which you treat everyone, people from all walks of life, with so much dignity and
respect. You are a very special person and the world is a brighter and better place because
you are in it. I could not have done this without you.
Thank you from the bottom of my heart to my parents. You have been a loving
source of support throughout my entire life, and especially throughout this process.
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Thank you for being there for Finn, for arriving early in the morning to care for him
every day of my year-long internship, and for your emotional support to get through the
ups and downs of graduate school. This dissertation was inspired by the values that you
instilled in me early on. Not only did you teach me compassion and care, but you also
taught me to question our economic and political system and to speak out against
injustice. Words cannot capture how grateful I am for all of your love and support.
In the end, this project is for my son, Finn. Finn, you inspire me each and every
day to make the world a better place and to be a better person. Without you, I could have
never understood some of the ideas I was writing about. I could never have understood
fully what it meant to love a child. Every day, I learn so much from you – about love and
kindness and empathy. Your warm, bright personality is so full of creativity, imagination
and love. I know that writing this took many, many, hours and that you looked forward to
it coming to an end. Thank you for your patience and for the many hugs along the way.
Thank you for being the special person that you are. I love you so much. This dissertation
is about building a life for us and about making the world a better place for you, and for
parents and children everywhere.

“Mom, this is me writing my dissertation.”
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TABLE OF CONTENTS

ABSTRACT ...........................................................................................................................ii

ACKNOWLEDGMENTS .....................................................................................................iv

CHAPTER I: Introduction: Rethinking Ideologies of Motherhood and Addiction ...............1

CHAPTER II: Methodology ..................................................................................................10

Type and Design of Study ..........................................................................................10
Participants .................................................................................................................11
Materials ....................................................................................................................11
Procedures ..................................................................................................................13
Data Analysis .............................................................................................................14
Ethical Considerations ...............................................................................................18
CHAPTER III: Exclusion from Language .............................................................................20
Voice and silence in feminist theory ..........................................................................27
Lacan, the Symbolic and the Jouissance of heroin ....................................................32
Language and self-regulation .....................................................................................41
Unsymbolized affect and the body ............................................................................45
Mentalization and transitional spaces ........................................................................49
CHAPTER IV: Loss ..............................................................................................................53
Institutional trauma and its sequelae ..........................................................................62
The termination of parental rights ..............................................................................70
Community-level impacts ..........................................................................................77
The illusion of safety: child removal outcomes .........................................................83
Directions for child welfare .......................................................................................89