Affect and Psychosis

After Jorge Garcia Badaracco's few words of introduction, Wilhelm Burian presented the first paper, ‘Drug addiction and affect’.

Wilhelm Burian's main proposition was that drug addiction represents an attempt to deal with painful affects in the absence of a helpful internalised maternal object—and that drug—taking could even be seen as a disastrously misfiring attempt at self—medication. He discussed Freud's concept of ‘protective shield’, but surmised that the impulses the individual has difficulty with were internal impulses, such as painful affects that the patient is not able to handle. In the absence of a satisfactory internalised object able to integrate feelings and affects, the individual may take recourse to action, and to violent action, in order to achieve a degree of, albeit costly and temporary, psychic integration.

Later, Badaracco pointed out that the notion of violent behaviour representing an attempt at integration is relevant also in the context of psychotic mental functioning, but in his paper Burian concentrated on addiction. He made clear that these patients are not usually psychotic, even though from a psychodynamic point of view they are unable to develop from the paranoid—schizoid position, with its fears and fantasies of omnipotence and annihilation: ‘the drug—addict's actual basic disorder is a fragmentation of the ego on several dimensions— his ability to recognise and make use of the various functions of the self is very much impaired and he regards these functions (introjects) as foreign objects’. The drug represents an ambivalently cathected maternal object that the patient cannot give up. Drug—taking can become a means of regressing to an ideal state of fusion, and at the same time it can also be a way of protecting oneself against disintegration. Burian explained that psychoanalysis is suitable only for some addicts, and the setting is crucial—he quoted Balint's invitation to ‘avoid creating an atmosphere that causes the patient to with