On the Psychology of the Alcoholic Occupation Delirium

Most sufferers from alcoholic delirium are inaccessible to psychoanalytic self-criticism, and chance has so far denied me cases of the better human material rarely to be found among them.1 The present paper is therefore not a psychoanalysis of the alcoholic occupation delirium; it consists rather of an application of established psychoanalytic principles with a view to gaining an understanding of the clinical picture. The conclusions are based on limited observations, and it would therefore be as well if criticism were restricted to the correctness of those observations and of the approach to the problem.

Clinical psychiatry has hitherto taken a number of detours by which it has evaded the psychological problem of the alcoholic psychoses; it has applied itself to the investigation of the various blood pictures, or demonstrated that there are different frequencies of abuse of alcohol, assuming that different toxic metabolic intermediates account for different alcoholic psychoses. While I do not underrate the value of such investigations, I fail to see that they throw any light on the clinical picture. This approach to the problem opens no path toward understanding the psychology of the alcoholic psychoses and, if one wishes to circumvent the psychological problem, one is left ultimately with no alternative but resorting to 'constitutional factors' for the semblance of an explanation. That, in fact, is the target set in the literature on the subject.