121 Chapters
Medium 9781855756403

CHAPTER FIVE: The fiend that sleeps but does not die: Toward a psychoanalytic treatment of the addictions

Karnac Books ePub

The fiend that sleeps but does not
die: Toward a psychoanalytic treatment
of the addictions

Stephen M. Sonnenberg

In this essay the author describes his views on the psychoanalytic treatment of the addictions. He describes addiction as a serious mental disorder, which is appropriately included as a topic in this conference. Next, he conveys the scope of this major public health problem, and discusses the reasons why psychoanalysis has made so small a contribution to its understanding. This essay discusses addiction in high functioning analytic patients, and offers a definition of what constitutes high functioning individuals. Case examples from thirty years ago, and from the present, illustrate how today, with more advanced knowledge, more successful analytic treatment of addiction is possible. The author describes modifications in standard analytic technique which are helpful, and which result in analysands who remain abstinent indefinitely.

At first blush one might wonder whether the treatment of the addictions belongs in this conference where we are exploring such difficult clinical situations as the treatment of schizophrenia, borderline personality disorder, and suicidality. I contend that it very much fits, because addicted analysands often behave in suicidal ways, in some cases might well qualify diagnostically as schizophrenics or borderlines, and in general fundamentally challenge the treating psychoanalyst to work effectively.

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Medium 9781780491745

CHAPTER EIGHT: Social conscience

Williams, Paul Karnac Books ePub

Seventeen unnoticed final grammar school report damning Carragher washed hands of him the sooner he leave the better agreed. No French class since absurd “The Sixth Form” decision gliding thorn-back ray spotted him in a corridor one morning unassuming shambles a brief word?

“So, what are you going to do when you leave?” “Dunno, sir.”

Bus conducting came to mind didn’t mention it or the “milk round” banks businesses army selling themselves to “potential undergraduates” steered clear didn’t say he thought it a fair for posh kids.

“There is a possibility, if you are interested,” he continued, “that you could work as an assistant teacher of English in a ‘petit séminaire’ school in Coutançes, Northern France—Normandy. I have a colleague there, M. Bernard Aubert, who is looking for someone to help teach English to younger children, seven or eight years of age, from the autumn. Do you think you might be interested in doing something like this?”

“OK,” replied his mouth.

“All right,” Mr McMorine continued. “I’ll look into it and keep you informed.”

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Medium 9781855752740

3: The unconscious and psychosis: some considerations on the psychoanalytic theory of psychosis

Paul Williams Karnac Books ePub


The author contends that the various psychoanalytic theories and techniques employ different models of the unconscious, each relating to a different unconscious reality describable in terms of specific mental functions. He reviews in particular the Freudian dynamic unconscious, based on repression; the Kleinian unconscious, which adds the notions of unconscious fantasy and splitting of the object; Bion’s conception of the unconscious as a mental function of which the subject is unaware but which can formulate thoughts and metabolise emotions; and the neuroscientific view of the unconscious as coinciding with that of which one is unaware and not with the Freudian repressed. The author thus distinguishes between the dynamic and the emotional unconscious and between ‘unconscious’ and ‘unaware’, and notes the role of distortion of the ‘unaware’ perceptions involved in the analytic relationship in the impasse situation. He is particularly concerned to show that, whereas neurosis involves the dynamic unconscious, psychosis alters the emotional unconscious, the entity underlying the sense of identity and the ‘unaware’ consciousness of existence. In psychosis the emotional unconscious is blinded, so that the patient is conscious but lacks awareness. The dynamic unconscious is also affected. After presenting two case histories, the author draws attention to the need for further clinical and theoretical research in this field.

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Medium 9781780491745


Williams, Paul Karnac Books ePub

Eternities earlier than grammar school drowned by the ritual of primary school wandering grey streets respite in The Woods the lug of tired frame through rusted gates slumped under words rotas that buried him. The Woods seemed to change even before animal killers chased him out for good their acceptance indifference on long wet days when he hurt himself went numb with cold wet prickling bitingly icy stinging itching spoiling what would happen if things got worse.

Primary school should have been better than the grey box wasn’t. Stuck from the start why people were there they him filed into a classroom why do they do this walking into a room together?


“Where d’ya get that pencil?”
“Wanna come to my house afta?”
“Have y’seen my satchel?”
“We’ve gorra a new cat.”

Why these words? How did they know when to talk stop talking know what to say next? Silence desk lids open— how? All this all day every day no hope of work exhausted by noon fending off a thousand orienting disorienting events once twice caught sight of why they were there a shaft of dust sunlight painted a stripe across the room everyone settled at desks ready to begin he a part of them convulsed ribs knifed passed out stone still awake out cold stabbed dying flesh pounded dust dust to dust crushing machinery oblivious to the fact the job long since complete donkey work rampant parasite contraption evaded by dissolving melting if this fails become an alien. Might the crusher pause malfunction detect a misshapen boulder? Never. Flesh blood nerve endings no longer exposed anxiety pain renewed convulsions all efforts futile uncaring risks to avoid crusher force useless. Ebbed away to the extent that he no longer had a foothold on the planet not distress a catastrophe as these far reaches lie within moments of extinction numb blind to the emergency all emergencies long since taken care of coma gave way to naked terror body dismembered floating shrivelled parts feet first legs then arms torso finally face head what was left of his mind thrashing snatching chasing after extremities in the time left before the rest disappears lost for good. Anyone shot into the void at these speeds enough to rip limb from limb who lives to tell the tale spends life in mortal panic unaware that the only thing of importance is to remain unaware of the irruption that killed them.

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Medium 9781855752160

8. Escalating Violence

Williams, Arthur Hyatt Karnac Books ePub

Anyone who stands at the edge of a sandy cove will have noticed how the power and fury of a stormy sea expends itself as the broken wave runs up the sloping sand and then gendy runs back down the beach, leaving a smooth expanse of sea-washed shore. This is what happens in ordinary circumstances with the ebb and flow of the tidal cycle. Under some conditions, however, forces such as cyclones, storms acting upon the sea, eardiquakes, or other volcanic actions stir the depths. They infuse a more inexorable menace into the situation, so that instead of losing power and slowly flowing back into the matrix of origin, each successive wave, more powerful than its predecessor, escalates the violence, sometimes to the destructive crescendo of a tidal wave.

Violence is an essential part of each one of us and, like the sea, it can run a benign course or it can escalate to a dangerous and destructive crescendo. An example of nondestructive violence is a man I saw who fainted and fell into fairly deep water. I was on the point of jumping in to save him when my colleague, a man so slow and gende in ordinary life that we liked to call him “the sleeping clergyman,” was in the water before me. His organized se-quence of violence ended with successful artificial respiration and the relatively quick recovery of the man. When things were calm, I mentioned that his rapid, life-saving, violent action seemed to contradict his everyday behavior. My colleague replied, “It had to be done. I don’t expend energy unnecessarily.”

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