Drive Theory in Diagnosis and Treatment*

In thinking about severe emotinal illness, modern analysts have come to view the solutions patients use to deal with their emotional conflicts to be variations on patterns of turning destructive impulses inward. It helps if we view these solutions as organized mental activity in which the flow of energy can be understood as a method for mastering tension. Using object language to think about the regressed patient is usually an error. Pleasure-pain, tension reduction, overstimulation are terms which better fit the longings and rage with which the narcissistic patient is struggling. Drive theory provides us with the picture of conflict as an insufficient quantity of libido in the system to cope with the amount of tension.

It is clear in a reading of the psychoanalytic literature that despite our experience of treatment with the regressed aspects of a patient, thinking in drive theory terms is difficult for the analyst. When writing, we tend to convert phenomenological experience into self-object representations. When the feeling in the room with a patient is of vast spaces, we describe it as aloneness or emptiness. This is understandable since no psyche stood still at the periods we are capturing. Layers of pre-object and object experience are added to the surviving psyche. But the period of life experienced in psychosis returns to a pre-object state, and for the most part, a pre self-object merged state. Much of the experience recaptured in sessions dates to a dawning awareness of being and a responsiveness to that awareness of existence.