You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This paper is based on ten personally observed male patients, seven of whom were partially analysed, and on the observation of thirty male patients cared for by colleagues. In all cases personality symptoms and weak psychotic symptoms of a paranoid and schizoid nature were found. The typical childhood situation was that of a mother who over-indulged the child and fostered excessive ambitions, and of a cold, imperious and inconsistent father. Both parents did much unconsciously to maintain a passive attitude and develop ambivalence. Oral passivity became exaggerated at puberty when jealousy of men's potency and fear of identification with a bad, seducing mother became apparent. Alcohol is used to produce recurrent psychotic regressions of both libido and aggression to get forbidden pleasure and to release repressed hostility in phantasy and reality. Occasionally the psychosis becomes more or less permanent. Details of the masochistic and sadistic phantasies in several severe cases are given.
Necessary modifications of technique are discussed. Several anamnestic interviews with wise questioning are needed at the beginning in order to decide in what situation treatment will be possible. Some can be treated in private with a hospital in the background, whereas others need to be treated continually in hospital. Some social contact with the patient may be necessary and continued suggestions of harmless alternatives to alcohol may help. Understanding of the early tender, indulgent aspects of the transference situation is essential. Later in the treatment psycho-analytic technique without modifications can be pursued.
A tentative classification of the severe types is attempted and the grounds for needing to aim at complete abstinence with certain patients is discussed.