Notes on a Case of Drug Addiction1

The case to be described is that of a female drug addict who died towards the end of the fifth year of her analysis, at the age of forty-two, of cerebral hæmorrhage consequent on long-standing hypertension. Her death made me at one time relinquish my intention to present her case. Further consideration, however, convinced me that it provides such excellent clinical material on addiction as to merit description.

It would prove an impossible task to compress such a multi-faceted phenomenon as addiction into the time allotted, and a violation of its complexity to select one single aspect. Therefore, a solution will be attempted, I hope not too unsatisfactorily, by conveying a few clinical features and indicating the salient points of their genesis. Thus anamnesis, clinical history, and the course of analysis will be amalgamated. This unfortunately excludes a unilinear sequence of description and requires the listener's indulgence for a somewhat complex mode of presentation. Dream material, too, will be restricted to relevant aspects.

The patient married at seventeen, and her son was twenty-four when she died. She was a feminine-looking woman, very well-groomed, dressed with conventional taste, except for her peculiar headgear, which varied from a single large feather to just an enormous brim. Although of small stature, her weight at the outset of treatment was no less than 14 stone, this having been constant for the last twenty years. This and other factors, including high blood-pressure, had led her physician, unknown to her, to assess her expectation of life at a few months at most. Her oral anxieties had precluded slimming, since food deprivation greatly increased her craving for morphia. Only during the course of the treatment, when her anxiety was lessened, could she undertake a diet which reduced her weight by over 4 stone. Her blood pressure then fell considerably from the previous systolic figure of around 300. I ought to mention at this point that,