Commentary on “Understanding Addictive Vulnerability”

The target paper

I read Professor Khantzian's target paper with some disappointment, and I was unhappy when I was asked to be a discussant.

His observations cover a great deal of ground but do not, to my mind, make an appropriate basis for an exchange of views between psychoanalysts and neuroscientists on the vexing question of addiction. Indeed, his “psychodynamic perspective” seems to minimize some crucial psychoanalytic concepts. Unconscious mental functioning receives scant, if any, attention, outside the following sentence:

Contemporary psychodynamic theory in application to SUDs paralleled developments in modern psychoanalytic thinking by laying less emphasis on drives and unconscious conflicts, but placing greater emphasis on appreciating the importance of affects, on the development of ego and self structures, and on the quality of and capacity for relationships and connection to others.

“Less emphasis” could well be read as “little emphasis” without doing any disservice to the general purport of the text. (SUDS—“substance-use disorders”—seems the preferred term to drug addiction nowadays, but seems to me insufficiently explicit.)

The point about affects calls for immediate comment. Freud's views on affects have been effectively and cogently discussed in this Journal by Solms and Nersessian (1999); also, the point that, without a concept of drives, there is no psychoanalytic concept of either thought or affect has been emphasized by others, including the writer (Yorke, 1999a, 1999b). For Freud, a drive can only be known through its mental representatives, of which the quantitative aspects are perceived as affects (the qualitative ones are thoughts). In psychoanalytic thinking there can be no affects without drives, about which Khantzian borders on the dismissive. And what is meant by “self structures”? If Khantzian means self-representations, these are conceived, psychoanalytically, as complex mental organizations, conscious and uncon