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PHYSIOGNOMIC PORTRAITS – THE LONG ROAD OF ADDICTIVE ADOLESCENCE

Autor: Alexandru Trifan
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The depressive roots of addiction in adolescence are discussed in relation with two clinical cases. The picture of narcissism, objectal attachment, oedipal process and a particular form of affective disturbance in adolescence called depressiveness, are described in psychodynamic manner.

François Marty, a remarkable specialist in the field of dismantling the mechanisms that make up the foundation of psychopathology, has advanced the hypothesis according to which alcohol and drug addiction come from their unsuccessful resilience to counteract the depression which they carry inside them. Consuming addictive substances, the youths fight unconsciously against the terror of collapsing while trying to escape what threatens them. However, the threat is inside them, unaltered by exterior intervention except when the respective intervention is psychological not chemical by nature. Therefore, the youths lend themselves to strategies that make them even more dependent. As addiction, especially in adolescents, is a “monster” that makes numerous victims, we shall try to analyse two cases.

1st Case:

I.P.I. was a student in the last grade of secondary school when his mother brought him to the psychiatrist with a significant change in his behaviour. From a diligent and affectionate child he had become troublesome and unrestrained in expressing his emotions. His former attachment to his mother changed into hostility, with conflicting scenes followed by his retreat into his room for days, where he would not allow anyone to enter. He no longer went to school and stopped being concerned about his education future. The research of the family context showed that his father had died after heavy suffering two years before, leaving behind two sons, the patient and his younger brother. Left alone and without sufficient sources of income, their mother decided to marry again triggering her son’s violent blames, being accused of betraying her family.

At the psychiatric examination, the patient was un-cooperative, keeping tenacious silence, avoiding eye contact and adopting a sombre face expression. He refused any intervention on the part of the psychiatrist, whom he reproached the intention of making him a fool. The patient’s ulterior evolution was troublesome. He ran away from home in order to go to monastery and then wanted to study at the Faculty of Theology, but both projects failed. He took a job as a worker in a factory, where the contact with alcoholic peers proved to be fatal, since he also became an alcoholic. An unhappy marriage made him sink into depression and addiction even deeper, and, eventually, he was destroyed by hepatic cirrhosis.

 

2nd Case:
When he was 13 years old, T.V. was first brought to psychiatry with emotional imbalance, moodiness, lack of the initiative and exuberance characteristic for his age. The family context revealed a disorganised family, with his father who had left when the child was very young and, more recently, his mother left him in order to work abroad. The patient remained in his grandmother’s care, whose limited education could not constitute the basis for a solid performance as a tutor. From an excellent student, gradually, he had obtained weaker marks at school. Also in the initial phase, the patient went to a few psychotherapy sessions, which were no longer continued due to his grandmother’s lack of perseverance since she was unable to rear her grandson.

Together with problems of learning, the patient started to miss from school following his association with a group of peers situated at the margin of the school community. At home, under his grandmother’s helpless eyes, the patient surrounded himself with literature and TV programmes centred on extremist characters and events, and the room started to be impregnated with the smell of volatile drugs such as those contained in the solvent for lacquers. The school performance worsened and the violent conflicts with his mother, who, during the short visits at home, was desperately trying to redress him, became more and more noisy and irreconcilable. In his last year of the secondary school, together with the group of outsiders whom he used to frequent, he started to consume agricultural cannabis, which caused a global failure of intellectual and decisional functions and thus he entered into a major affective marasmus of depression with psychotic manifestations.

 

DISCUSSIONS

The adolescent may feel betrayed in his most precious affective investment, namely the maternal one. The drama becomes acute in families where the oedipal process is blocked by the disappearance of one of the parents, and the whole psychic economy of affective attachment is redirected towards the surviving parent. The young person cannot afford another loss after the one suffered by the amputation of oedipal relationship because that would mean to cut the last root that fixes the Ego into the soil out of which it takes its nutriment. If this situation still occurs, the conditions are met for the appearance of an affective state homologous with the adult’s depression. We name it similar and not identical because in adolescents, some criteria are missing or others may replace them. That is why, at this age, the term used adequately would be that of depressiveness, which has a dynamism of its own, but unfortunately, most of the time it may be hopeless.

Addiction appears more frequently than a fracturing of existence, by juvenile suicide, or by sustainable detour of the energies of the Self. In the case of addiction, the recourse to the help of an external object proves the fund of narcissistic fragility, the failure of the negotiations between the Self and the Other, between the narcissistic gratification and the objectal one. The too powerful pulsional tension does not find sufficient internal defences In order to keep away at a distance the embarrassing feelings resulted from the „burns” of the unconsciousness. The subject cannot „walk” without aid. The addiction establishes a short-circuit of satisfaction. There is a lack of ludic space, of transitional objects, of a realm of illusions. Nevertheless, the offer that the drug makes is a surrogate and the manufactured aid of the absence works only in circumstances of total dependency. By the latter, the anxiety is calmed down, the wound is sutured and the haemorrhage of sadness is stopped, but with the price of the impossibility to take the dressing off. The solution of addiction belongs to the class of limit of endurance, where the picture is dominated by identity uncertainty. Addiction tends to maintain the illusion of the permanence of an object, which is no longer there, and which the subject could not interiorize.

The same way as in adult, the detoxification cures are followed by relapses if the depressive abscess is not removed, in adolescents the approach of addiction should start with restructuring meant to compensate the losses that have led to the accumulation of depression.

Summing up the problem succinctly, one may declare that the adolescents face a heightened difficulty in leaving the narcissistic registry of investments in order to enervate the internal conflicts. The prosthetic function of the product does not prevent them from distancing from the object, but neither too far, nor too near, in the end, the dialectics of the dynamic relationship between the narcissistic investment and the objectal one proves to be particularly resistant to any influence. We must point out again this particular economy of the pathologic addiction to the drug, which is always implied in the massive consumption of toxic products such as alcohol and cannabis. What is missing is not the object itself but a Third one, which might allow the transformation of the addiction to the object into an inter-subjective  relationship of autonomy in desire. As it was shown above, addiction tends to maintain the illusion of the permanence of an object that is not there and of a subject, which it could not internalise. In other words, it is a negation of the loss. Addiction indicates in all cases that the psychic process of mourning after the object did not take place. A depression is left, which could not tell the name, which the subject is fighting against and which the addiction is hiding. The trial of separation from the object brings along the risk that the subject feels he/she is in an objectal void. Since nature hates the void, the therapeutic solution is not without risk if it limits itself to the abandon of the abusive consumption. Therefore, the treatment of addiction passes through that of depression, which is sub-adjacent to it. To enable the patient to face depression is the necessary condition to move from need to desire.

 

Bibliography

  1. Marcelli Daniel: Tratat de psihopatologia copilului. Translation. Ed. EFG, 2003.
  2. Marty, François: Dépendance et depréssion à l’adascence \n Revue Roumaine de Psychanalise no. 1/2008.
  3. Mircea, Tiberiu: Tratat de psihopatologie și sănătate mintală a copilului și adolescentului, vol. I, 2004.
  4. Wilmshurst, Linda: Psihologia copilului, Translation. Ed. Polirom, 2001.

 

Correspondence to:
Alexandru Trifan ‘Viaţa Medicală’ Magazine Ion Brezoianu str. no 27, 2nd floor, Bucharest, p.o. 010131