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In an aphoristic statement made early during his career, Freud declared masturbation to be the “primal addiction” (1897, p. 287). In doing so, he hinted at all the essential features of the malady in Zen-like simplicity. These features, of course, are (i) a narcissistic orientation, (ii) turning away from deep object relations, (iii) manipulation of the body, and (iv) replacement of genital sexual pleasure by a regressive pregenital satisfaction.
Freud's ideas were elaborated by subsequent analysts using different vantage points on the human psyche. From the drive theory perspective, addiction was correlated with oral dependency and regression from genital to masturbatory pleasure (Abraham, 1908; Knight, 1937; Fenichel, 1945). From the ego psychology perspective, affect primitivization, the ego's vulnerability to regressive solutions, use of denial, lack of self-governance, and predominance of primitive defenses were implicated (Rado, 1933; Krystal and Raskin, 1970; Mack, 1981). From the object relations viewpoint, a borderline character organization (Kernberg, 1967) and loss of transitional relatedness were regarded as major features. Finally, from the self psychology perspective addiction was seen as a failure of self-regulation (Levin, 1987; Keller, 1992). While not ignoring the role of oedipal factors, almost all authors conclude that the “fundamental wound of the addict's ego” (Simmel, 1948, p. 27) was caused by early, preoedipal damage to the personality. At the same time, they acknowledged the role of social variables and constitutional vulnerabilities, which perhaps explains the fact that not all individuals with preoedipal ego damage develop addiction.
This intrapsychic emphasis while immensely important needs enrichment from the external sociocultural vantage point. After all, addiction occurs in the setting of an anguished and broken heart but also of economic hardship, peer pressure, loneliness, and vulnerability to seductions of advertising, drug traffick