Jerome Levin offered a theory of addiction based on the work of Heinz Kohut in 1987 which has come to be termed Self-Psychology. While not addressing the notion of spirituality directly, Levin describes personality characteristics of the addictive "self" which AA maintains can only be remedied by reliance on a "Higher Power." Kohut viewed his theory as having an integral relationship with psychoanalytic thought. Kohut's insights were developed while working with individuals diagnosed with narcissistic personality disorders. He viewed these patent's as suffering from a developmental arrest and not from intra-psychic conflict. The consequence of this arrest was that a normal sense of self never developed. "Addiction" in this model, is viewed as a pathological attempt to remedy the narcissistic disturbance. In Levin's words, "alcohol has become the alcoholics sole love object, alcohol here experienced as part of the self."
Narcissism is a pathological form of self-absorption and has nothing to do with a healthy ego. Individuals exhibiting narcissistic traits have an extremely distorted sense of self. They maintain a vigilant guard on the self in an effort to avoid a slip into psychosis (or psychic annihilation). Levin describes the matter in more detail. "Alcoholics have to self-absorbed to make sure they are still alive. There sense of self is so tenuous that they live constantly on the edge of annihilation. Their barely cohesive selves may fragment at any time. Thus, alcoholics suffer from at least four kinds of self-pathology: (1) they are self destructive; (2) they lack certain components of the self that mediate self-care and maintain self-esteem; (3) they are over self involved; and (4) their very sense of being, their self concepts or representations, are fragile and in jeopardy. Since so many observers, from so many points of view, have pointed to an abnormality in alcoholics; relationships to themselves, it seems reasonable to postulate a relationship between alcoholism and narcissism."
Levin views the repair of the self as essential to recovery from addiction. The addict must learn and incorporate new cognitive structures which permit self-development to resume. To this end, he offers various techniques taken from Self-Psychology.
Self-Psychology and the Humanistic Traditions:
Levin maintains that Self-Psychology is a bridge between the psychoanalytic and humanistic traditions. He views Kohut's theory of self-development as more optimistic than that of Freud. In so doing, various parallels are noted between Kohut's theory and that of Carl Rogers. According to Levin, both theories arrive at core formulations. These include the importance of empathic understanding, unconditional acceptance of the patient, the need for "mirroring" of the self by the environment, and the view of a cure as the development of a "cohesive self." (Kohut), or as "self-actualization" (Rogers). Additionally, both Kohut and Rogers emphasize the need to provide the patient with a "growth-prompting environment" while diminishing the role of intra-psychic conflict. Levin summarizes the parallels:
"Rogers views the self as a subset of the totality of the organism's experience; parts of the organism's ongoing processes become conscious through symbolization's, which are experienced as a gestalt, or unity. Kohut views the self as a center of initiative which is experienced as coherent in space and enduring in time. Rogers sees psychopathology as the result of a constriction of the self in which too little of the totality of organismic experience is symbolized and made conscious. Kohut considers most psychopathology to be the result of an insufficient cohesion of the self. Each of these thinkers were trying to do justice to the indisputable datum that man experiences himself as both a coherent whole and disparate assembly of the disjunctive feelings and experiences."
Levin concludes by noting that the propose for existence according to Rogers is self-actualization (in his later years, Rogers expanded the notion of self-actualization to include more spiritual dimension) and that the need to self-actualize is the single force that motivates behavior. This view is contrasted with Kohut's notion of the "tragic man," or un-actualized self. Levin maintains that the chemically dependent individual is an example of both the tragic man and un-actualized self.
The Concept of Self:
Levin begins his review of the "self" by noting its controversial history in psychological theory. He hypothesizes that much of this controversy stems from the literal translation of the word "self." He notes that Psyche, the Greek root from which the words psychology and psychological are derived are often translated as meaning mind, spirit, or soul. The term "self" came to share this ambiguous definition and the concept "self" became synonymous with "soul." Given this association with soul, the idea of self was rejected by the new scientific, experimental psychology of the 19th century.
This rejection of the concept of self as unscientific in psychoanalytic thought prevailed until Kohut began his work in 1971. Psychologists recognized a need for a term which would describe the individuals inner, subjective experiences. Levin points out that the early Freud's attempt to use the notion of an "ego" to denote the self, but the term was never clearly defined. Freud used "ego" as a synonym for "self." However, he later used "ego" as one of the three aspects of the mind. Levin maintained that Freud's use of the term "ego" was inconsistent. At times "ego" was meant to describe the "I" and at other times "ego" was describing an agency of the mind. With Kohut's work, the term "self" again entered scientific discourse to denote the subjective nature of the human experience.
Kohut's Theory of the Self:
Throughout his career, Kohut worked with individuals diagnosed with narcissistic personality disorders. Levin explains, "These patients were neither psychotic, out of contact with reality, nor neurotic, suffering from conflict between repressed desires and conscience. They seemed to lack a firm sense of self, yet they had the ability to enter into a stable relationship with the analyst. Psychotic patients are rarely able to do this. However, Kohut's patients did not react to him as neurotic patients typically do. Instead, they formed what Kohut first called the 'Narcissistic' and later called the self-object transference's; that is, they related to their analysts as if the analyst were parts of them. Kohut classifies these relationships as either 'mirror transference's,' in which the patients treated their analysts as if they were an extension of themselves, or 'idealizing transference's,' in which the patients acted as if they were part of the analyst, whom they perceived as omnipotent."
In working with these individuals Kohut proposed a developmental model for the evolution of the self. From lowest to highest. These stages consisted of a self in a state of fragmentation, to an archaic (primitive) self, to a cohesive, and finally mature self. Kohut concluded that the narcissistic patients he was treating were fixated at the developmental level of the archaic self. He hypothesized that this fixation resulted when primary care providers failed at empathic relating (mirroring) early in life.
Self Psychology and Addiction:
Levin notes that Kohut wrote a great deal about chemical dependency. Addiction, according to Kohut is a desperate and futile attempt by the addict to repair the self's developmental deficits. Treating the narcissistic self is essential to recovery from addiction. Levin explains the plight of the active addict. "Certainly not all alcoholics suffer from the narcissistic personality disorders; however, narcissistic disturbances are extremely common in alcoholics. Their self-cohesion is tenuous and easily threatened, subjecting them to panic and anxiety. They tend to relate to others, including counselors and therapists, along the lines described by Kohut in his discussion of narcissistic transference. They are subject to 'empty' depression because they lack what Kohut called 'psychic structure,' internal resources for maintaining self-esteem. Finally, they often resist giving up alcohol not so much because they want to drink as because they experience the inability to drink safely as an intolerable defect. We Can thus understand much of alcoholic behavior and denial as a defense against narcissistic decomposition-the fragmentation of the self, which would mean psychic annihilation."
Levin is careful to point out that archaic narcissism is characteristic of the active alcoholic (pathological narcissism) and not necessarily characteristic of the pre-alcoholic personality. He therefore, refers to pathological narcissism as a regression or fixation to the stage of archaic self. This stage of self-development is characterized by by a cohesive but insecure self. It is constantly threatened by a fear of regression to full psychosis (fragmentation). Behavioral manifestation of the archaic self includes arrogance, isolation, unrealistic goals, feelings of entitlement, the need for omnipotent control, poor differentiation of self and object, and deficits in the self regulation capacities of the self.
Kohut's theory of self-development views the grandiose self as the result of merging with (not differentiating from) a mother who used the child to gratify her own narcissistic needs. Because existence itself is dependent on the mother, (Kohut's self-object), the relationship between self and self-object is characterized by primitive, panic level anxiety created by the threat of self dissolution. This dynamic results in the need for omnipotent control of the self-object. Therefore, any significant lack of empathic nurturing on the part of the self-object (mother) results in the archaic self's needs going unmet and is experienced as an injury to the self. This injury is reacted to as with "narcissistic rage." Levin points out that narcissistic rage is understood in psychodynamic terms as a psycho-sexual regression to oral dependence.
Levin views addiction as a substitute self-object which meets the subconscious dependency needs of the addict. He explained, "Although this deep need for fusion with a self-object may be repressed from consciousness or dealt with by reaction formation so that it is not readily apparent in the form of excessive interpersonal dependence, the alcoholic has nevertheless found the 'perfect' self-object with which to meet his need-the bottle. At the same time, that dependency needs, or the need for self-objects, is being denied/repressed, it is being met through the pathological use of alcohol, which is simultaneously experienced as the perfect self-object and as a magic fluid (milk). Further, since the internalization of self-soothing, stimulus augmentation, and self-esteem regulation which are originally performed by the self-objects, have failed or are at least deficient in pathological narcissism, the pathologically narcissistic individuals may openly seek fulfillment of these needs in their interpersonal relations or they may deeply repress them, or, as is more typical, they may be in intense conflict over meeting these needs, which are, in the very nature of the case, always present. However, open dependency is not acceptable in adult males and is increasingly unacceptable in adult females in our society. Hence, conflict must ensue. Thus, dependency conflict is a necessary correlate of pathological narcissism."
Through the bodies of physiological response to addictive drugs, the addict is able to regulate several other functions of the self that he/she otherwise is unable to perform due to fixation/regression to the archaic narcissistic level. Via the use of drugs, addicted individuals are able to temporarily regulate their affect. Additionally, painful or other unacceptable sensations, drives, and emotions are anaesthetised through the use of chemicals. Finally, because the use of many drugs is socially acceptable (at least within certain subcultures) it is not considered dependent behavior. Therefore, individuals regressed/fixated at the pathological narcissistic stage can use drugs to perform self-functions which they otherwise would be incapable of without appearing dependent.
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