Discussion of Alfred Flarsheim's Article, The Psychological Meaning of the Use of Marijuana and LSD in One Case

Dr. Flarsheim has favored us with an extraordinarily sensitive account of the agony of a young woman driven to the use of hallucinogens by intense fear of the very object contact for which she so desperately longed. He has penetrated to the core affect of sadness that has been the constant phenomenon in the cases of drug dependence I have observed; whether truly depressive or, as in this case, the consequence also of a chronic affect-deprivation syndrome, this tone of sadness and helplessness pervades the psychology of these young people—at least, of those that reach therapy.

This being the case, I am in full agreement with Dr. Flarsheim's views on the technical procedures to be employed with such patients. Specifically, I am, as I apparently failed to make sufficiently clear in the paper to which Dr. Flarsheim refers, opposed to any attempt at prohibition except where it appears that the abuse of drugs makes or threatens to make therapy impossible. This condition apparently did not obtain with this patient, at least for the brief period during which her acute anxiety motivated her for help. That she chose to continue her commitment to drug use after this acute phase has been surmounted is, as Dr. Flarsheim suggests, the right of any patient, and it would be supererogatory for any physician to attempt to impose his judgment upon her. One might, perhaps wonder about the extent to which

alternative possibilities were opened to her in the therapy, but ultimately, of course, the patient is master of his own life.

I wish to make it clear, above all, that I do not equate drug use with “acting out.” Certainly in the patient whose commitment to drug use antedates the beginning of treatment, it is meaningless to consider it primarily as acting out or resistance; still, it may come to have that significance in the course of treatment.

On the other hand, I am not at all sure, as Dr. Flarsheim apparently is, that medical strictures against the use of LSD are of the same order a