Heart of Addiction
Displacement
Lance Dodes
Lance Dodes, M.D. is a Training and
Supervising Analyst with the Boston
Psychoanalytic Society and Institute and
assistant clinical professor of psychiatry at
Harvard Medical School.
He has been the Director of the substance
abuse treatment unit of Harvard’s McLean
Hospital, Director of the Alcoholism Treatment
Unit at Spaulding Rehabilitation Hospital (now
part of Massachusetts General Hospital) and
Director of the Boston Center for Problem
Gambling.
He annually chairs the discussion group The
Patient witih Addiction in Psychotherapy and
Psychoanalysis at the fall meeting of the
American Psychoanalytic Association.
Dodes in the news...
Reversing Helplessness:
Factor 1
Take an action that we know will make us feel better
It’s an understanding approach
Making the unconscious / conscious and then doing
something about it
I make sense of my behavior
Addiction
Virtually every addictive act is preceded by a feeling of
helplessness or powerlessness.
Addictive behavior functions to repair this underlying feeling
of helplessness.
It is able to do this because taking the addictive action (or
even deciding to take this action) creates a sense of being
empowered, or regaining control-over one’s emotional
experience and one’s life.
Vignettes: Regaining Control
Vignettes (cont.)
Paradox
Addictive behavior behavior is out of control, but addiction
serves a deeper purpose of regaining control - at least
internally
But off course - you eventually create more out of
controlness
Dodes believes that helplessness is common, but
everyone experiences it a bit differently, it affects us
differently, and the circumstances that makes become
helplessness and the dynamics behind them are
psychodynamically unique.
Explaining the Drive Behind Addiction:
Factor 2
Helplessness leads to a
feeling of anger / rage
These feelings come in
subsidiary forms
Identify what things make
us feel intolerably
helplessness
Root these out, have
them expressed
Displacement: 3rd Factor
Addiction results from a redirection of energy to a
substitute or displaced action because another more
direct, action is not considered permissible.
Key is to find that displacement - what is being
displaced?
When actions are taken directly to deal with
helplessness, there is no addiction.
The Man Who Had No Time
Intro:
Frequented Tony’s Bar most days
Recent Visit to Doc shook him up - You’re drinking every
day again -
Given Dodes #
Ted did not drink for two days afterwards - but returned to
drinking for two days afterwards.
Ted Meets with Dodes
Ted - been to a lot of treatment “I Know that I am an
alcoholic”
Comes down to will power / stick with the program
don’t drink
Lost 12 year marriage as a result of drinking
(painful)
Lost job as an financial advisor
Arrested for DUI’s
Considered suicide on a few occasions
Ted Meets With Dodes:
Psychodynamic History
Still drinking when sessions began (wasn’t causing crisis)
Only child (father computer programmer mother was research
assistant / medical lab)
Ted done well in school (straight A’s elementary through highschool and in sports (football team)
Pushed himself to achieve “I had to accomplish things...Uphold
something for the family”
Impressive achievement in college gave him wide selection to
schools
Went to a college that fit his Dad’s standards - doing the right
thing
Began to drink there “heavily” for the first time
Ted and Dodes (cont.)
College was when alcohol really started to interfere... In a
way, the problem was really time”... If I’d taken even a
quarter of the time I spent drinking to do the studying I
should have done (shaking head in disgust)... And after
College, just drank more”.
Taking about marriage, fights, spoiled special occasions,
failed career as a financial advisor, accounts he’d let
slide...
He kept returning to the time he had lost. “If only I could
have that time back”
Psychodynamic Insights
Instead of talking about time lost to drinking, Dodes began to learn that
Ted regretted other kinds of “time” losses
There’s never enough time to do things- things I really want to do...Never
time for myself, time to do stuff that’s really mine
•
Insight 1) Realization that Ted was not in control of his own life.
Insight 2) Further sessions revealed just how burdened Ted had become (i.e.,
taking work home)
•
•
Insight 3) Pressure coming from the inside “I always should be doing more”
•
Insight 4) Work hard as an “adult” and “be good” pattern lived out as a child
A Core Insight
Pressure to perform at work = VALIDATION
•
Getting caught in head
•
Takes on new project >>> Feel stressed at work
•
“When I am going to have my time”
•
I started slapping around papers - then said
“F - IT”
Drinking Displaced Anger and Made Up For Freedom
TED IN A NUTSHELL
Choice to drink gave him control over his
past feelings of helplessness
Ted started to feel better about his
helplessness the “moment” he decided he
was going to drink
His rage drove the behavior... Dodes
states... “Qualities of rage at helplessness
- an intense, narrowed focus, a loss of
usual judgement, and a temporary
blindness to consequences - are precisely
the characteristics that describe
addiction...
Summing Up
Displacement
•
Addictive behavior at its core has an element of emotional health
•
We all fight against helplessness - it is psychologically essential -
•
Suffering with an addiction then, does not make you
psychologically sicker or less mature than people with a wide
variety of other problems
•
We can learn to use addictive drive as a signal that something
emotionally wants to be heard, felt, and metabolized
For Thursday
Read Staying in the Action PDF and
Chapter 17 Relaspe Prevention for Alcohol
and Drug Problems