ALEXANDER: Dr

© On Good Authority, Inc. ADDICTIONS A Interview #1: “UNDERSTANDING PERVERSIONS” ARNOLD GOLDBERG, M.D. Interviewed by Barbara Alexander, LCSW, BCD (Edited slightly for readability) ARNOLD GOLDBERG, MD 122 S. Michigan #1305B Chicago, IL. 60603-6107 (312) 922-6796 Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are reading or listening to an interview from CD #1 in our program, ―Addictions A.‖ This program is devoted exclusively to the topic of addictions, and here we cover a range of addictions. More importantly, though, we highlight a variety of models of understanding and treating addictions, ranging from the original Twelve Step model, which is in fact, cognitive behavioral, to systemic family therapy, to developmental, to self-psychology, to traditional psychoanalytic. It is important, I think, which such an intractable foe as addictions, to have an arsenal of approaches available within one‘s own repertoire of thinking, so that you, as counselor or therapist, are better equipped to do battle. We begin in this first CD with return interviews to two popular On Good Authority speakers: first, Dr. Arnold Goldberg discusses his recent book 1 and work on the topic of perversions. We present his interview first because Dr. Goldberg‘s explanation of splitting is so crucial to the understanding of addictions. Then we will hear from Mary Rich, who views gambling from a developmental perspective. Getting addicted patients engaged in therapy is a serious problem and major challenge, not for the thin-skinned. Dr. Rich will explain why so many addicts cannot attach and she shares some innovative suggestions with us. Now to our interviews. Dr. Arnold Goldberg is a Professor of Psychiatry at Rush Medical College in Chicago, and is a training and supervising analyst at the Institute for Psychoanalysis in Chicago. He is well known as one of the leading exponents on self psychology and is the author of many books and articles on the subject. Today we will be discussing his book, The Problem of Perversion, The View from Self Psychology. ALEXANDER: Dr. Goldberg, we are back again talking with you. Our first interview was on self psychology and now we are going to talk about your new book on perversions. Before we really get into the topic of perversions, I want to ask you if you have an opinion as to whether perversions are really addictions, or are they compulsive behaviors? How do you view them? GOLDBERG: I think that it is very important to recognize that addictions should not be thought of as addictions to substances like heroin, cocaine, alcohol, etc, but that there is a wide variety of behaviors that one becomes addicted to. For instance, one can become addicted to therapy. We have many patients who are endless patients, sometimes from one therapist to another, because they are addicted to the process of therapy. So, we have to get a meaning for addiction that goes beyond the overt behavior and see what underlies the nature of addiction to something or someone. 2 ALEXANDER: Is there a physical component -- I mean obviously there is a physical component in perversions, but is there anything that would be physically addicting in perversions, much as there is in the substances? GOLDBERG: That‘s a mystery. I think that the biological substrate to, let's say, sexual perversions is unknown. From the studies that I know about sexual perversions, it's not very clear as to whether one is more prone to one kind of behavior or another kind of behavior. What seems much more significant is that sometimes, one who gets involved in sexual perversions just happens upon a particular kind of activity that seems to work for them: shoe fetishes, some cross- dressers and some exhibitionists, etc, etc. It is not clear at this point that we could give anything like a biological basis. However, it is clear that sexual perversions do give two kinds of physical relief. There is the physical pleasure of these sexual perversions. If one ejaculates or has some kind of orgasm, then that is one component of the perverse activity and there are some investigators who feel that people who have perversions have an exquisite kind of sexual pleasure that is different from the kind of sexual pleasure that homosexuals and heterosexuals normally have— they feel that that there is something special about the sexual pleasure of perversions. I, myself, have never met or seen or treated anyone with that particular emphasis on, ―the pleasure I have is like no other pleasure.‖ I know other investigators like, Otto Kernberg insist that this is true. It may be so, I've never seen that. The second component, other than the physical pleasure of sexuality, and the one that I am the most familiar with, is that the perversion, for the most part, makes a person feel more relieved and relaxed, and usually follows a period of anxiety or depression. So, in that sense, the perversion, like an addiction -- something that they have to do -- is relieving and it makes them feel more comfortable and better. Therefore, it is an answer to some kind of more severe underlying pathology. ALEXANDER: Well, then, Dr. Goldberg, can you give our listeners an outline or an overview on how you conceptualize perversions? 3 GOLDBERG: Yes, I think that the ideas about perversions, for many years, have been based on some kind of psychodynamic formulation, that people with perversions had a particular kind of mother or father or relationship in childhood, etc. I have always felt that this is not a sufficient enough answer to understanding perverse activities since many people with similar dynamics do not have perversions and many people with perversions never seem to have the same dynamics. So, I have always felt that psychodynamics was unsatisfactory and just a partial answer to understanding why people acted with this particular kind of behavior disorder. When we began to study perversions in intensive psychotherapy or in psychoanalysis, we found one other salient characteristic of people who were involved in perverse activity, that is that they had what self- psychologists from Heinz Kohut on have called, ―a vertical split.‖ What this means is that most people who have a perversion, let's say like an exhibitionist perversion, will act on the perversion, and afterwards, often speak about what they did after as if it were another person doing it. They seem to disown or disavow that aspect of themselves that engages in the perverse activity. The split, therefore, is as if another person with different goals, values and ideals is living alongside of this person who otherwise has disdain, contempt and disgust for the perverse activity. The classical upright businessman or executive who periodically goes into a pornographic bookstore or who picks up a young boy to engage in perverse activities and then afterwards, expresses shame and disgust at his behavior represents the classical picture of the vertical split. On the one hand, ―I am a perfectly responsible citizen,‖ on the other hand, ―I do these disgusting horrible things and I feel terrible about them afterwards.‖ ALEXANDER: The question that I have about splitting is this: when the person is engaged in the perverse behavior, what happens to the part of them that feels shame and disgust? GOLDBERG: Well, we often ask the person that in treatment, and they will give various forms of the same answer, which is that the perverse activity dominates the scene. It overwhelms, and the other part of the personality, which we call, ―the reality ego,‖ or ―the reality self‖ is momentarily obliterated, absent, or quiet. That is, indeed, what is so characteristic of addictions: that they dominate the personality, they 4 take over and they run the show. We have many alcoholics who will, after a binge, say that they feel disgusted, ashamed, and convince and resigned to never repeating the activity. That is what is so beautiful about it -- that they can look upon what they have done with the same kind of negative feeling that you could look upon it. ―How could I have done that? I'll never do that again. I feel so ashamed, embarrassed etc.‖ So, that's why we say it's like two persons. This is not like multiple personalities. Here the split is between two individuals who are seeking two different things: the one is the upright citizen; and the other is much more involved – ―I must get involved in this activity.‖ So that was the second salient characteristic of these people: that they had a vertical split and that what they did seemed to be disowned or disdained by them as it occurred, sometimes periodically, sometimes very frequently, often times, quite rarely. There are some people with addictions and perversions who only occasionally get involved in this kind of behavior, and then will look on it like, ―Oh I don't know what was going on and what happened to me.‖ The next feature after the vertical split and after the particular psychodynamics of the individuals that we saw in perversions, and this gets back, I think, to the question of the physical and the biology. The nature of what people with perversions, as opposed to people with substance abuse, do to make themselves feel better has to do with sexualizing. They get involved in some kind of sexual activity. Sexual activity is such a great answer to being upset because these people have learned at an early age that if they do something sexual that will obliterate whatever negative feelings they had. So the sequence goes something like this: something occurs that makes one feel depressed, or anxious, or on the verge of fragmentation (as the self-psychologists talk about: some kind of narcissistic injury leads one to fragment).

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