Lucy, Major Tom, Bion and the psychotic vacuum^†

A triptych of clinical cases binds together a new frame for understanding the relationship vacuum that lies at the heart addiction to drugs. Beginning with a case anecdote about an amphetamine user who was troubled with an underlying psychotic condition, and much taken with David Bowie’s song Space Oddity, the case draws attention to the emptiness in which the client's social relations were conducted. Bion's thoughts on the challenge of linking drug addiction and psychosis are refracted in his personal copy of Rosenfeld’s (1965) book Psychotic States, where Bion made copious notes in the margins and coined the term ‘concentration for annihilation’. Some of these notes throw new light on Bion's approach to working with psychotic fixation which he derived from working with clients using drugs as well as those who were suffering psychotic states. Particular attention is given to one of Bion’s clients whose repetition-compulsion appeared to create what we might think of as a ‘psychotic vacuum’. In the final case study the life and death of Lucy Cameron is cause for reflection. Lucy’s poem ‘The Space’ draws attention to the devastating psychotic vacuum created by substance misuse.