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Clifford Yorke
a
To cite this article: Clifford Yorke (2003) Commentary on Understanding Addictive Vulnerability, Neuropsychoanalysis:
An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 5:1, 42-53, DOI: 10.1080/15294145.2003.10773408
To link to this article: http://dx.doi.org/10.1080/15294145.2003.10773408
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it is doubtful, to say the least, whether these conditions can be properly considered in terms of painful emotions that cry out for control, and the drug
of choice used to this end. But Khantzian is firmly
of the opinion that drugs act in specific ways that
make them especially suited for specific purposes.
Opiates, he avers,
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Drug addiction
Self-damaging bulimia notoriously takes on an addictive form in which the compulsion is hated and
condemned as forcefully as the compliance from
which it is inseparable.4 Its relationship to drug
addiction is of considerable interest. Benedek
(1936) described a woman with a polyphagia who
consumed large quantities of food, alcohol, ether,
aperients, and other medications, though never narcotics. Elsewhere (Yorke, 1970), I suggested that
such a case might provide a bridge between alcoholism and the so-called food addictions. In this connection, it seems worth recalling some comments of
Anna Freud (1965). There, in a brief discussion of
addiction, she referred to a quantitative increase in
otherwise normal tendencies that gave an impression of perverse behaviour (p. 201). She then
turned to children who have an overwhelming
craving for sweets superficially similar to adolescents and adults addicted to alcohol or drugs. Like
adults, the satisfaction of their need acts as an
antidote [to] anxiety, deprivation, frustration, depression, etc., and, just like adults, they will lie and
steal to get hold of what has become a necessity.
She considered, however, that there were important differences between childrens craving for
candy and the addictions of their elders. The craving
for candy is a straight-forward expression of a
component drive rooted in unsatisfied or overstimulated wishes of the oral phase of development,
desires that have grown excessive and by virtue of
quantity dominate libidinal expression (p. 201). As
the child grows up, the sweet eating may be displaced and be reflected in excessive drinking of
water, overeating, gluttony, and perhaps in smoking (p. 202). They are often reflected in the choice
of relationships with those who sustain and give
comfort.
These outcomes in later life do not, for Anna
Freud, have the character of addictions. She considers addictions to be more complex and add to the
4
It is well known that bulimia may follow a period of anorexia
nervosa. An anorexic patient of mine came into treatment when she was
15, with her weight alarmingly low. After some time, she began to wake
up each night at 2:00 a.m. with severe anxiety. When she reported such
an attack, I suggested that she may have been frightened that, in a wish
for a night-feed, she would get up, raid the fridge, and eat everything in
it. The next night, that is exactly what she didshe was then bulimic.
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Clifford Yorke
The profile schema allows the diagnostician to organize information available at the diagnostic stage
into a comprehensive picture of the patient in metapsychological terms5that is, in terms of dynamics,
structure, economics, and genetics. A profile of this
kind can only be provisional, since it is based only
on the information available at the time the assessment is made. A patient who subsequently enters
psychoanalytic treatment will, little by little, reveal
much more information, some of which will no
doubt confirm and enlarge on the initial assessment,
while some of it may cast doubt on some of the
initial conclusions. But, for all its limitations, the
profile is the most efficient instrument we have for
psychoanalytic diagnosis at the stage of assessment.
It has the considerable merit of examining, as
closely as current information allows, the relevant
contributions of a large number of variables, not
only to the presenting clinical picture, but to the
personality in which that picture is embedded.
Many psychoanalysts who are concerned with
the importance of clinical research have overlooked,
in this respect, the strength and value of the profile.
It offers a standardized structure within which available data can be brought together and expressed in
metapsychological terms. And
since this structure is known and reproducible by
psychoanalytically trained clinical research workers anywhere, the Profile can be checked and
rechecked wherever the original data are available.
Furthermore, practiced users of the Profile should
5
Nonpsychoanalytic readers of this Journal should note that
metapsychology simply refers to a psychology that looks beyond consciousness.
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The wanted first child in a respectable upperworking-class family, from the age of 3 or 4
years Sarah was Daddys girl until her puberty.
From that time on she was openly contemptuous
of her father, perhaps on account of incestuous
wishes. The mother was timid, unadventurous,
and of narrow and rigid outlook. At interview
Sarahs dress was untidy, though her hair was
beautifully kept. She talked well enough, if a
little discursively, and her affect was humorous
but unvarying. She was mildly euphoric, giggly,
rather histrionic, and a little flirtatious.
(a) There were clear homosexual tendencies in
her makeup: I went through a lesbian phase
from 11 to 14 . . . imitation lovemaking in bedrooms with a number of girlfriends, each pretending to be a boy and swapping roles. There
was kissing and mutual masturbation between
them. Although she mentioned fantasies of men
in such situations, there was a continuous inclination toward homosexual practice beyond the
age of 14 and, indeed, up to the present time. I
appreciated a womans body. There was a girl at
school I fancied when I was 16. . . . In prison
butch lesbians fancied me, and if a woman had
made advances I just would have gone with her.
This homosexuality was uninfluenced by the
drug taking, and it can therefore be said that she
failed to resolve the re-emergence of the negative oedipal (phallic) phase in adolescence. The
wish for the narcissistic possession of a penis
was evident.
Her close relationships were need-fulfilling and
constant while they lasted. They were chosen on
a narcissistic basis of an altogether unusual degree. She said of her former girl friend: I cant
say much about her except we were the same sort
of person. We were terribly alike; we used to
think the same sort of things were funny. She had
black hair, the same length and color as mine. We
always had it cut and grew it at the same time.
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chant Navy were good and occasioned no anxiety, and he enjoyed eating and drinking with
them. Drugs excited him sexually. He took part
with other drug users in some bizarre activities,
and some wayward sensual pleasures were reinforced by the use of electric shocks.
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