3 The Psychology of the Addict
The Personality of the Addict
A useful definition of the person who becomes dependent on drugs is given by Winick:
The drug addict is a person with certain personality characteristics who happens to have selected this way of coping with his problems for a variety of reasons of which he is usually-unaware. Not the least of these reasons is his access to a social group in which drug use was both practised and valued.1
This accounts neatly for the doctor, the therapeutic and the beatnik addict. But what sort of personality is susceptible; why does one person persevere after a shot while his friend does not? Why does one patient doped with heroin develop a craving while the man in the next bed does not? The key seems to be again in the opiates' power to obliterate worry.
Anxiety is the mental mechanism that forces action to satisfy the basic drives to find food, shelter, a mate. It is the pain that overcomes the sloth of the flesh. It is possible that theft are people who, because of their mental make-up, of their upbringing, or more probably both together, are over-driven; they are never unworried, and their lives are a constant pain to them.
Every unkind word hurts, every difficulty seems insurmountable, every success trifling. Almost all accounts of people who are dependent on drugs stress that they have, continuously, a very bad opinion of themselves and their abilities. The addict never feels the occasional sunburst of self-satisfaction that encourages the rest of us to plug on with life. Most of us cope with anxiety by altering the situation that causes it. A young man, for example, settles his late-adolescent anxiety about his place in life by embarking on a career; a course of action that may produce more immediate worries. But he is stable enough to take a long-term view; set-backs now are played off against long-term successes. But the addict cannot believe that anything which does not make him feel better now will ever make him feel better. Since few situations in life are open to immediate alteration, he prefers, or he is driven, to eliminate anxiety itself. For most of us it is a useful spur; for him a juggernaut. Since whenever a situation becomes painful he uses heroin to eliminate his drive to follow it through, it is not surprising he seldom has a job, or â home, or a wife. Here we have one powerful reason for opiate dependence; it is self-perpetuating in another way, for the more often anxiety is avoided, the less easy it is going to be to face it alone.
The action [of heroin and morphine] on the central nervous system is that the addict feels he has eaten to his heart's content, experienced full sexual satisfaction and eliminated all his anxieties as well. One begins to see that the behaviour of addicts is bound to be utterly different from that of people whose major drive centres round appeasing these basic life factots.2
One might also add that the addict misses the more intense pleasure got from the process of satisfying these drives; he bas to be content merely with the feelings of satiation afterwards.
It is interesting to consider another question. Assuming that these people need something to modify their personalities, 'to take them out of themselves', why do they choose heroin, which is hard to get and brings social disapproval, rather than alcohol which is readily available? The pharmacological part of the answer lies in the diametrically opposite effects of the two drugs. Both deal with anxiety over sexuality and aggression: alcohol, by eliminating inhibition, enables one to act freely; heroin, by removing the drive, makes it unnecessary to act. It is suggested that people tend to use the drug that reinforces their method of handling these drives. In America, and to a lesser extent in Britain, where men are expected to be aggressive and adequately sexed, the majority use alcohol. (It is interesting that in parts of the East, where passivity is preferred, the approved drug is cannabis, another pacifier, and alcohol is held in the same horror as we hold heroin.)3 In the West the minority use heroin to facilitate their naturally passive solution, and it may be that the disapproval this practice causes is aroused by its denial of the basic power source of West= social organization: the self-seeking drive of the male.
Inquiry into the personalities of American addicts tends to confirm this theory. (Unfortunately there has not been any similar study of English addicts.) Chein found that the typical adolescent addict in New York was a pretty, symmetrical, coloured boy; a dandy who would wear a goatee and try to behave like a gentleman. A boy, in short, who had completely opted out of the American Male idea1.4 At the beginning of their inquiry the psychiatrists found themselves almost coming to blows over their descriptions of the boys' personalities. Each addict seemed a different person to each inquirer; they concluded that the addict's make-up was typically fluid and plastic, concealing an inward collection of negative characteristics: inability to have friendly relationships, difficulty with being masculine (probably more important in America than here, where teenagers tend towards outward monosexuality), feelings of futility, depression, being easily frustrated and made anxious and finding these feelings intolerable.
It seemed they often came from homes where the father was non-existent or failed to function, and where the mother was unusually dominant. Another study of mature addicts found more than a third still living with female relatives at the age of thirty — twice as many as one would expect in a prison population which was otherwise comparable.5 Often these addicts' homes would seem to the casual caller to be better furnished and kept than the average. What the visitors could not see was a childhood spent as âne of the furnishings of the home, an object to his parents, rather than a persotl in his own right.
Chein's study found that the personality problems of young addicts are just the same as those of the more mature — another blow at the 'pusher corrupting innocence idea. It emerged that three things were necessary to form an addict: (1) a psychological, predisposing inadequacy; (2) a crisis; (3) the timely offer of drugs. The 'crisis' may be nothing in objective terms — perhaps only the problem of asking a girl to dance at a Saturday evening hop — but enough when it faces such a personality caught in throes of adolescence. Narcotic Drug Addiction goes on to say:
Youngsters who experiment with drugs know that what they are doing is both illicit and dangerous, but they have a delinquent attitude towards life. Eighth grade boys with a favourable attitude to the use of ' drugs view life with pessimism, unhappiness and a sense of futility, and they distrust authority.
The chances of a boy's being exposed to drugs depends to a large extent on his being associated with delinquent groups.... The boy who eventually took drugs had no strong incentive to suppress impulse and develop discipline; since the father was absent, or cool, or hostile, the child had relatively little chance to model himself after a male figure; most of the parents had unrealistically low ambitions for their boys, reflecting their own pessimistic attitudes towards life, and they were distrustful of teachers, social workers and other representatives of society.6
With different phrasing, the same assessment sounds like abuse:
Addicted patients are asocial, inadequate, immature and unstable. They are selfish and self-centred without any interest in the welfare of others and are only concerned in their own problems. Their major problem is in the maintenance of the supply of drugs or the immediate gratification of their desire for drugs. They will resort to any means — however unreasonable or dangerous — to satisfy this insistent craving. They have failed to develop normal human relationships and are almost totally without concern for the distress they inflict on their relatives. They lack self-discipline, will-power or ambition, and avoid responsibility. They have a low threshold for pain or any form 'of discomfort and are unable to tolerate criticism or to bear frustration. Their personal relationships tend to become confined to other members of the drug addicts' world and thus they become social outcasts and very lonely people.?
We have to make allowances in transferring the characteristics of American drug users to our own culture, but the pattern seems remarkably basic. This is not to say that one can predict with any certainty who will become dependent on drugs and who will not. The variables of opportunity and event are multiplied by the supreme variable of personality, but one can at least recognize the characteristics of the existing addict as readily here as in America. Here, as an exercise in hindsight, is the story of Stephen North, an eighteen-yearlold who lived in Pimlico.
His mother has a nice rebuilt flat in one of those bleak tenement blocks put up by charitable trusts at the turn of the century. She stood at the door in the dark hallway rubbing her eyes. She wore carpet slippers; she'd been dozing before the convector fire, waiting for her youngest son to come home from school. The winter afternoon light hardly reached through the lace curtain, so the smart black sofa and the woolly carpet glowed red from the heater. She says:
After he left school at fifteen he had trouble with purple hearts and pills. He used to go up these dance cht6s in Soho — they should be blown up if you ask me. He was very unsettled and he didn't want to work; so they sent him on probation to a farm in Kent. He laced that really, and when he came home last spring he seemed much more settled. Well, he even went down to the Labour Exchange and got himself a job with an antique restorer's. He was ever so happy because he's always had artistic leanings. He joined the T.A. then, and he was looking forward to their trip to Germany in the summer.
Then, that weekend. Well, I've lived it over and over in my mind, he came home Friday very cheerful and went out with his girlfriend Annie. And again on Saturday. Only he didn't come home that night. Well, he's done that before, he stays over at her parents' place, 'so I didn't worry. In the morning before eight, there's Jinnie banging at the door. 'He's gone all blue,' she says, so I went round there straightaway. The night before he'd gone off to sleep on the sofa watching tele, so they covered him up and went to bed. In the morning they couldn't wake him, and he didn't look well, but the mother — silly woman — went off to work. Of course I called the ambulance, but he was dead.
They said at the inquest that it was bronchial pneumonia brought on by heroin. They said he'd been an addict for three weeks. Apparently he'd shared a pill with a boy on the estate and gone on from there. It doesn't seem long, dots it? I never thought... It hurty when people
say, 'You should have known.' How could I know'? He didn't do nothing different. I didn't look him over for needle marks in the bath. If they'd got the ambulance straight away, he could have lived. They got the stuff from this Gypsy Curtis who used to hang about Piccadilly Circus selling cheap shots to kids — until he got them hooked. They arrested him the next day, and he died in Brixton the day after. Drowned in his own vomit when they stopped his drugs. He was a putrid character if you please.
Stephen's father? No comment. It's got to the stage where he goes out and gets drunk, and that's that. Stephen used to say, 'Don't you take no notice of him' - he was ever so nice to me. It used to upset him when he was younger, but now he'd got used to it. He was very softhearted; he hated to be called a chicken. He was always having accidents because people dared him to do stupid things. Perhaps that's why he took the tablet. He had his moods too - he'd either be up in the air, or down in the dumps. He was a very nice boy. Everybody said so.
The Psychological Function of Addiction
We have examined some personality characteristics that appear to cause people to become addicts if they get the opportunity; it is also interesting to identify the psychological mechanisms that continue addiction. The important thing is that 'his life adds up to a self-enclosed system where he is able to provide his own pleasure.... He isolates himself beyond the need for human help or satisfaction. He is dependent on no other person:2 His regularly recurring periods of euphoria are balanced by the equally frequent periods of come-down; it seems that the self-punishment of finding drugs as well as incipient withdrawal is as important in the addict's personal universe as the enjoyment of his high.
Scenes of laying in dank, funky, goddam hotel rooms. Sick as a dog.. You know, too weak to care. You know, where literally you do not wash or dress. To go out, you try to stop your heaving long enough to put your clothes on. Forget about combing your hair, washing your face. It's ridiculous. Just put a cap over your head, and hope for the best. And there's moments when you really don't care. `Get me some money, or go to the penitentiary' is the attitude [of the pusher]. You • know, too weak. It's raining. Snowing. Freezing. And it's a Sunday morning, and you look out and there's loads of snow and your shoes got holes in them. All the clothes in the world won't keep you warm. And it's Sunday. And you don't got enough junk.*
Always preferring the short-term gratification to the long-term satisfaction, his continual victory over the withdrawal crisis - which is represented in junkie folklore as an unparalleled catastrophe:
Man, it's hie your skeleton's trying to jump outa your skin,' says a London seventeen-year-old - makes his way of life continually self-justifying. At the same time it disqualifies him, either because he's feeling too ill, or he is too busy looking for drugs, from attempting any other way of life that might lead to deeper satisfaction, but would also expose him to criticism and competition. He takes this course because he has the poorest opinion of himself; he knows he cannot compete on ordinary terms and feels he is doomed to a life of being inferior and despised. Drugs alone offer him a way out of this situation. Nyswander quotes the story of a boy who ran away from school and began a life of crime and addiction because his teacher laughed at his spelling. Drugs give him the satisfactions of the aggressor - over sexual repletion, etc. - while maintaining his passivity:2 Another view:
His conception of himself is that of a fairly worthless creature who can hardly move about in society without a constant barrage of anxiety. [With drugs] he leaves the world of symbolic interaction behind in one fundamental sense: for although he may continue to function as a medical practitioner, a musician, etc., he is no longer dependent on it for his sense of self-value.'
This continual stilling of anxiety with heroin very powerfully conditions him towards heroin use in difficult circumstances. Wilder suggests that this explains how a man can be cured of his addiction, live apparently successfully for fifteen years or so, then his business fails, or his wife leaves him, and he is back on the needle again. Even more ctuiously, one dose in a lapse of this sort will bring on a powerful withdrawal reaction, even when this is pharmacologically impossible. It seems that the whole chemical pattern of drug behaviour is reinforced by framing Jo This has been strikingly confirmed by rat experiments. Wilder found that rats addicted to morphine and then withdrawn showed more withdrawal symptoms if they were kept in surroundings familiar to them during their addiction than if they were moved.14 Another series of experiments showed that rats trained to give themselves injections of morphine when they felt withdrawal symptoms coming on, used more morphine when they got into difficulties and relapsed more easily than rats who were trained to use it simply for pleasure. 15,16.17
Explanations of drug addiction in terms of an inadequate psyche or Pavlovian learning theory follow traditional paths of psychiatry. A more recent suggestionI8 sees addiction in terms of the addict's operation, and explains it as a reaction to an excess of leisure. The point of addiction then is to provide a rigid framework for the addict's life. On heroin, almost every minute of the day is prescribed: the user is either fixing, high, coming down, out boosting to buy more drugs, scoring, fixing again. His life goes in eight-hour cycles, and it is significant that the drug chosen has the shortest cycle period of any available opiate. It is put forward in support of this idea that heroin addicts are often model prisoners, because they welcome the discipline of prison, and that cures using coercion (p.145) are far more successful than those without. In this view the present epidemic of heroin addiction is a reaction of inadequate personalities to a society in which people can eat without working and in which there is nothing people have to do. A working-class Victorian boy, of the personality type that would now become an addict, would not have to use drugs because he would work from dawn to dark. He would have no agonizing decisions to make about what he should do, where he should be.
It is not easy to diagnose a long-standing heroin habit without chemical analysis of the urine, or provoking a withdrawal. Apart from the need to inject the drug, there may be no outward signs of dependence at all if the dose is nicely calculated to the addict's tolerance. He then behaves perfectly normally, though if one could compare him to his unaddicted self, he would show less nervous tension. Before addiction in itself was recognized, or became politically and morally unacceptable, opium was used at the end of the last century to calm vicious criminals without fogging their minds.I1 The real objection to long-term use of opiates is that the need for them becomes, to the addict, a primary one replacing the needs for sex or food, whose satisfaction serves no useful social purpose.
Wilder describes a most interesting if rather cold-blooded, experiment in which an ex-addict was allowed to re-addict himself in the certainty that at a given time his supply of drugs would be cut off. The candidate was under psychiatric observation during the experiment, and himself chose the size and frequency of his doses entirely as he wished. The man selected had had a spectacular career as a speedboat driver during Prohibition. At the age of twenty-two he would drive his boat all night, get home in the early morning, sleep three or four hours and then smoke a pipe of opium. He would go out to a meal, then spend long afternoons and evenings smoking his pipe with a few friends.
He thought withdrawal from morphine unpleasant, but no deterrent, and readily agreed to the experiment. Normally he was rather guarded towards the hospital staff, but after his readdiction had started he showed more hostility, and was full of stories of the guards being unfair to the other patients. By the end of five months he had raised his dose to nearly twelve shots of two grains a day, or a total of twenty-four grains (still a long way from the highest known dose of seventy-five grains). As the experiment proceeded, he welcomed his increased tolerance and craving, 'It's nice to be hooked, because when you're not it's like a good friend's gone away'; it meant that he could enjoy the thrill of injection more often: `A steak tastes good at any time,/ but even better if you're hungry.' He would work two hours a day at filing, and spent the rest of his time lying on his bed, listening to the radio, dozing, and saying he wouldn't get hooked. A month before his supplies were stopped he was warned, and offered advice on tapering off and transferring to methadone. This he did for three weeks, but two days before the end he pushed his dose right back lip again and suffered a spectacular withdrawal.
Although he had felt guilty during the experiment because he was becoming hooked again against his will, and because he was enjoying the luxury of opiates when his fellow prisoners could not, he felt all this had been expiated by his withdrawal. Although he had consumed the junkie's equivalent of a fortune of drugs, with very little outcome, since his projected analysis under morphine was largely abortive, he still demanded payment in opiates for help in further experiments. He obviously felt that withdrawal had discharged his debts; he owed no one any favours over that transaction. Wilder suggests that this need and ability to pay off one's guilt internally suggests why addicts so often choose heroin, the drug that hooks the hardest and from which one falls the furthest, although morphine, meperidine and methadone all produce euphoria. To the addict, the withdrawal or its threat is necessary counterbalance to- the high; thus, in spite of his disesteem which prescribes guilt for every satisfaction, he is able to have his pleasure and live free of pain.12
Analysis of the addict personality generally takes the form of enumerating externally apparent characteristics. There is little attempt to understand why he behaves as he does, partly perhaps because such a projection into such a different way of behaviour is difficult even for a trained psychiatrist, partly perhaps because if we understand we can hardly condemn. The closer we get to the centre of the problem, the closer we come to the dilemma of drug use: do people use drugs, or do drugs use people? We like to say that the first is true; we act as if the second were. At the centre of the addict is the answer; perhaps for our peace of mind, it is better not to inquire too closely.
The typical young addict described in several American accounts sounds very much like the young schizophrenic, whose predicament Laing analyses so brilliantly in The Divided Selj:13 Both were 'good' babies, have strong but equivocal relationships with their mothers, are often apparently well looked after, but in reality were brought up as things rather than people. The schizophrenic never developed a sense of confidence in his own inner reality because no one ever 'saw' him as a valuable human being. He tries to deal with his unsureness of his own reality by constructing an unreal personality front behind which the solitary self cowers, omnipotent in a vacuum. He manipulates the false personality to fit his surroundings, in a desperate attempt to avoid the frictions and anxieties of being a rounded whole in a 'hostile world. (This recalls the plasticity of Chein's young addicts.) In the end the defences of his mind break down and the world invades the hollow at his centre; he becomes overtly schizophrenic. It is not impossible that opiates, by knocking out the anxiety which forces these manoeuvres, save the addict from schizophrenia and tide him over the years of internal dissociation. It is even possible that the incipient psychotic who chooses drugs is in a better position than one who tries to cope alone, for there is strong evidence (see p. 154) that heroin addiction is a phase of life from which the addict slowly matures. Although it is often, and probably quite correctly, said that drug use never improves the addict's immediate social adaptation or efficiency, this leaves out of account the slow and irretrievable personality collapse he might suffer if his drugs did not put his problems on ice until he matures from under them.