Aspects of Internal Self and Object Representations in Disorganized Attachment: Clinical Considerations in the Assessment and Treatment of Chronic and Relapsing Substance Misusers

In clinical theory and practice we rarely find an isomorphic fit between early patterns of attachment and discrete clinical disorders or syndromes. Although a linear equivalence is not implied here the author draws out parallels between early disorganized attachment patterns, the internal world of the substance abuser and the ways in which such psychodynamic processes invariably shape and influence the therapeutic encounter. Exploring further Main and Hesse's (1990) assertion that the essence of disorganized attachment can be summed up as fright without solution, the author develops the idea that active and repeated drug use represents attempts to anaesthetically freeze the self, and in so doing to disable and paralyse internal object imagos that induce feelings of panic, terror and dread. In addition the ingestion of drugs, as other writers on the subject have observed (Rosenfeld, 1965), often provides a type of internal inflation of the fragile self, leading to a sense of omnipotent and omniscient superiority on behalf of the substance abusing patient.