Substance Abuse as Symptom: A Psychoanalytic Critique of Treatment Approaches and the Cultural Beliefs That Sustain Them

271 Pages·1991·9.27 MB·English

by  Louis S. Berger

Substance Abuse
as
Symptom
________
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Substance Abuse
as
Symptom
____
A Psychoanalytic
Critique of
Treatment
Approaches
and the Cultural
Beliefs that
Sustain Them
Louis S. Berger
(cid:1)

THE ANALYTIC PRESS
1991 Hillsdale, NJ London
Copyrighted Material
Copyright © 1991 by The Analytic Press, Inc.
All rights reserved. No part of this book may be reproduced in any
form, by photostat, microform, retrieval system, or any other means
without prior written permission of the copyright holder.
Published by The Analytic Press, Inc.
365 Broadway, Hillsdale, NJ
Library of Congress Cataloging-in-Publication Data
Berger, Louis S.
Substance abuse as symptom : a psychoanalytic critique of
treatment approaches and the cultural beliefs that sustain them I
Louis S. Berger.
p. em.
Includes bibliographical references and index.
ISBN 0-88163-102-7
I. Substance abuse-Treatment. 2. Psychoanalysis. 3. Narcotic
addicts-Psychology. I. Title.
[DNLM: I. Cultural Characteristics. 2. Models, Biological.
3. Psychoanalysis. 4. Psychoanalytic Therapy. 5. Substance Abuse­
-psychology. WM 270 B496s]
RC564.B474 1991
616.86-dc20
DLC
for Library of Congress 91-4571
CIP
Printed in United States of America
10 9 8 7 6 543 2
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Listen to the discussion between any two philosophers one of
whom upholds determinism, and the other liberty: it is always
the determinist who seems to be in the right. He may be a be­
ginner and his adversary a seasoned philosopher. He can lead
his cause nonchalantly, while the other sweats blood for his. It
will always be said of him that he is simple, clear and right. He
is easily and naturally so, having only to collect thought ready to
hand and phrases ready-made: science, language, common
sense, the whole of intelligence is at his disposal. Criticism of an
intuitive philosophy is so easy and so certain to be well received
that it will always tempt the beginner. Regret may come later­
unless, of course, there is a native lack of comprehension and,
out of spite, personal resentment toward everything that is not
reducible to the letter, toward all that is properly spirit. That
can happen, for philosophy too has its Scribes and its Pharisees.
Henri Bergson, The Creative Mind
Upon meeting a friend in the corridor, Wittgenstein is alleged
to have said: 'Tell me, why do people always say it was natural
for men to assume that the sun went round the earth rather
than that the earth was rotating?' The friend responded, 'Well,
obviously, because it just looks as if the sun is going round the
earth.' To which Wittgenstein replied, 'Well, what would it have
looked like if it had looked as if the earth was rotating?'
Michael Lockwood, Mind, Brain and the Quantum
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Acknowledgments
I am most grateful to the staff of The Analytic Press for their extensive and
significant help. Drs. Paul Stepansky and John Kerr edited the book.
Unfailingly, they gave close readings to the various versions of the manu­
script, responding with thoughtful, even provocative critiques, sugges­
tions and comments. Dr. Stepansky, especially, played a central role in tile
project. He was always accessible and generous with his time and was in
on the work from its sketchy beginnings. I doubt that there would have
been a book had it not been for his many-faceted contributions. My thanks
to Eleanor Starke Kobrin, Managing Editor, who carefully and effectively
shepherded the manuscript through the production stages, and to my
copy-editor, Dr. Carol Lucas.
vii
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Contents
Part I

One I Introduction: Psychoanalysis and Compulsive Drug Use 3

Two I The Medical Model and Its Implications 9

Three I Criticisms of the Medical Model 25

Four I Viewing Society from a Psychoanalytic Perspective
53
Five I Cultural Psychopathology and the Medical Model 81

Part II

Six I Optimal Interventions 105

Seven I Substance Abuse: Psychopathology, Therapies

and Therapists 115

Eight I Good-Enough Therapy and Good-Enough Therapists 143

Nine I Good-Enough and Not-Good-Enough Patients 187

Notes 209

References 229

Index 253

ix

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