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A Lacanian Psychoanalytic Approach to the Treatment of Addictions Cristina Laurita

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A Lacanian Psychoanalytic Approach to the Treatment of Addictions Cristina Laurita Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2010 Working with the Drive: A Lacanian Psychoanalytic Approach to the Treatment of Addictions Cristina Laurita Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Laurita, C. (2010). Working with the Drive: A Lacanian Psychoanalytic Approach to the Treatment of Addictions (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/805 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. WORKING WITH THE DRIVE: A LACANIAN PSYCHOANALYTIC APPROACH TO THE TREATMENT OF ADDICTIONS A Dissertation Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Cristina R. Laurita, M.A. August 2010 Copyright by Cristina R. Laurita 2010 WORKING WITH THE DRIVE: A LACANIAN PSYCHOANALYTIC APPROACH TO THE TREATMENT OF ADDICTIONS By Cristina R. Laurita, M.A. Approved June 18, 2010 APPROVED _______________________________________ Bruce Fink, Ph.D., Director APPROVED _______________________________________ Suzanne Barnard, Ph.D., Reader APPROVED _______________________________________ Colleen Carney, Ph.D., Reader APPROVED _______________________________________ Dan Collins, Ph.D., Reader APPROVED _______________________________________ Christopher M. Duncan, Ph.D., Dean McAnulty College and Graduate School of Liberal Arts iii ABSTRACT WORKING WITH THE DRIVE: A LACANIAN PSYCHOANALYTIC APPROACH TO THE TREATMENT OF ADDICTIONS By Cristina R. Laurita, M.A. August 2010 Dissertation supervised by Bruce Fink This dissertation examines the clinical utility of applying Lacanian psychoanalytic interventions to the treatment of addictions. By combining theoretical exegesis with clinical case studies of psychotherapy with patients who struggled with addictions, this project seeks to: 1) contribute to the improvement of the clinical treatment of addictions; and 2) contribute to the advancement of Lacanian clinical scholarship in the U.S. Although the work of French psychoanalyst Jacques Lacan is well‐known in Europe and South America, Lacanian clinical scholarship in the U.S. is disappointingly sparse. As a result, most American clinicians are not aware of the clinical usefulness of Lacanian theory. This dissertation focuses on how addictions relate to the psychoanalytic concept of the drive, which is closely linked to the repetition iv compulsion and what Lacan refers to as jouissance—a kind of painful enjoyment beyond the pleasure principle. Since addictions involve drive‐related circuits of repetition and Lacanian psychoanalysis aims to facilitate transformations on the level of the drive, this dissertation proposes that Lacanian interventions may be particularly relevant to clinical work with addictions, which are notoriously difficult to treat. This project explores how addictions are highly particular. They manifest themselves and function in very different ways depending on where the individual is situated within the Lacanian diagnostic categories—psychosis, perversion, hysteria or obsessional neurosis—as well as how the individual’s experience of the drive is shaped by the particularity of his or her history and events of development. This dissertation demonstrates how to go beyond surface behavior and transform addictions on the level of the drive. While the techniques and interventions discussed within this project can be used within a wide range of clinical approaches, this project is the first of its kind, in that a Lacanian psychoanalytic approach to the clinical treatment of addictions has not yet been written. v ACKNOWLEDGMENTS The support, encouragement, and assistance of numerous people helped me to write and complete this dissertation. I am particularly grateful to Bruce Fink, who not only directed this project but also had a significant role in my graduate education. He encouraged me to write this project and saw me through to its completion. Over the years, his exemplary clinical supervision and unflagging support have been invaluable. Colleen Carney generously agreed to read my project and offered helpful remarks. She is an inspiring example of what it means to be both an excellent psychoanalyst and a fine human being. Dan Collins gave an estimable commentary on this project and, over the years, has been a fine interlocutor and friend. His generosity is unmatched. Suzanne Barnard kindly joined the dissertation committee and offered useful observations. Last, but by no means least, I would like to thank my patients. Without them, this project would not exist. I can only hope that I have done justice to their stories; nevertheless, the complexity and fullness of their lives exceeds what any theory can represent. For putting their trust in me and allowing me to learn along with them, I am truly grateful. vi TABLE OF CONTENTS Page Abstract…………………………………….……………………………………………iv Acknowledgments……………………………………………………………………..vi Chapter 1…………………………………………………………………………………1 Introduction to the Problem………………………………………………...………..1 Lacanian Clinical Studies…………………………………………………………….5 A Call for Lacanian Clinical Literature on Specific Clinical Problems……...…..7 Addiction as a Major Problem in the U.S….………………………….……….……9 Lacanian Clinical Work and Addictions…………………………………..………13 What Lacanian Literature on Addiction is Already Extant and What are its Limitations (Why Do We Need More)?............................................. 14 Introduction to the Method………………...………………………………………..22 Overview of the Chapters……………………...…………………………………….25 Chapter 2……………………………………………………………………….……….35 The Drive……………………………………………………………………………….35 Chapter 3………………………………………………………………………………..74 Addiction and Obsessional Neurosis………………………………………………74 Buck’s Addictions: As Oedipal as it Gets…………………………………………74 Introduction…………………………………………………………………………..74 vii On Obsessional Neurosis……………………………………………………………75 Case History: Buck…………………………………………………………………..79 Clinical background. ………………………………………………………………79 Overview of Buck’s addictions. …………………………………………………..80 Highlights of Buck’s history. ……………………………………………………..86 Gender relations, gender trouble. ………………………………………………...90 “Gaping holes” and the role of emptiness: Orality and the drive. …………...96 “Piles and piles of shit”: Anality and the drive. ……………………………...102 The end of therapy: How Buck ultimately “went.” …………………………..108 Chapter 4………………………………………………………………………………112 Addiction and Obsessional Neurosis…………………………………………..…112 The Color of Emptiness: Re‐enacting the Paternal Metaphor—From Darkness to Light—In an Attempt to Transform “Mamajuana” into Ordinary Marijuana…………………………………………………………………112 Introduction………………………………………………………………………….112 The Drive’s “Color of Emptiness”…………………………………………………113 Case History: Phil………………………………………………………………….114 Clinical background. ……………………………………………………………..114 On beginning the treatment. …………………………………………………….116 From demand to desire. ………………………………………………………….117 viii A jouissance crisis. ……………………………………………………………….120 Intervening between the real and the symbolic. ………………………………122 “Mamajuana” and the fundamental fantasy. …………………………………130 Dark. ……………………………………………………………………………….135 Between darkness and light: Re‐enacting the paternal metaphor. …………137 The light of sublimation. ………………………………………………………...143 A modification of jouissance: From “mamajuana” to ordinary marijuana. 146 Chapter 5………………………………………………………………………………151 Addiction and Perversion…………………………………………………………...151 A Thief is Being Beaten……………………………………………………………..151 Introduction………………………………………………………………………….151 On Perversion………………………………………………………………………..151 Case History: Gary ………………………………………………………………...155 Clinical background. ……………………………………………………………..155 Overview of Gary’s addictions. ………………………………………………...156 Family history. ........................................................................................................158 Course of treatment and results. ………………………………………………..161 Chapter 6………………………………………………………………………………169 Addiction and Psychosis……………………………………………………………169 Psychosis and the Drive………………………………………………………….….169 ix Introduction………………………………………………………………………….169 The Mirror Stage and Psychosis…………………………………………………...169 The Paternal Function and the Other’s Demand in Psychosis…………………176 A Fundamental Hole…………………………………………………………….…..183 Psychosis, the Body, and the Drive………………………………………………..193 Chapter 7………………………………………………………………………………199 Addiction and Psychosis……………………………………………………………199 A (W)hole Feeling: Filling in and Creating Holes to Modify the Drive……..199 Introduction………………………………………………………………………….199 Case History: Nadia………………………………………………………………..203 Clinical background. ……………………………………………………………..203 Family History.........................................................................................................207 No place. ………………………………………………………………………….207 “La unidad” without Dad. ……………………………………………………..209 A primal scene. …………………………………………………………………..213 Relationships………………………………………………………………………214 One attempt at building a fragile imaginary: “I’ll never allow myself to get like that.” ………………………………………………………………..214 A man who raped her……………………………………………………………217 Overview of Presenting Issues…………………………………………………...222 x Holes, cuts, and the body. ………………………………………………………222
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