A Potential Space: Discovering a Place for D.W.

Winnicott in the Psychoanalytic Literature on

Drug Addiction

Karl Southgate

A Dissertation Submitted to the Faculty of

The Chicago School of Professional Psychology

In Partial Fulfillment of the Requirements

For the Degree of Doctor of Psychology

April 9, 2016

i

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ii


A Potential Space: Discovering a Place for D.W. Winnicott in the Psychoanalytic Literature on

Drug Addiction

____________________________________________________________________

A Dissertation Submitted to the Faculty of

The Chicago School of Professional Psychology
In Partial Fulfillment of the Requirements
For the Degree of Doctor of Psychology
_____________________________________________________________________

Karl Southgate

2015

Approved By:

______________________________________________________________

Claude Barbre, M. Div., Ph.D., L.P. Chairperson

Associate Professor, The Chicago School of Professional Psychology

_____________________________________________________________
Jordan Jacobowitz, Ph.D., Member
Associate Professor, The Chicago School of Professional Psychology

iii


Acknowledgments

I would like to thank Dr. Claude Barbre and Dr. Jordan Jacobowitz for teaching me so much

about both the theoretical and clinical dimensions of psychology and for guiding me personally

and professionally over the last five years. It is doubtful that I would be earning this degree were

it not for the love and encouragement of my parents, who have always emphasized the

importance of education.

iv


Dedication

This dissertation is dedicated to the memory of Dr. Alan Paskow, who taught me that truth and

beauty are in the details.

v


Abstract

This dissertation provides readers with a general framework for understanding drug addiction

from a Winnicottian perspective that can help clinicians to better understand and work with

clients who struggle with drug addiction. The underlying purpose of developing such a

framework is not to formulate a “master theory” that is applicable to all cases of addiction or that

claims to encompass all of the myriad facets of addiction—such an endeavor would prove

impossible, reductionistic, and hubristic. Rather, this dissertation uses Winnicott’s theories to

identify and explore emotional, psychological, interpersonal, and developmental components of

addictive processes that are present in some—but not all—cases of addiction. Although

etiological factors play a prominent role in this dissertation, I argue that a Winnicottian approach

can help clinicians to work with clients regardless of how much is known about their pasts and

illustrate that a Winnicottian perspective need not be reductionisitc. I developed this model by

applying the insights gleaned from primary and secondary literature to a case study. More

specifically, I analyze the case utilizing three especially prominent themes in Winnicott’s theory:

being, aggression, and creativity. Doing so enabled me to conclude the following regarding

addiction: From a Winnicottian perspective, an individual’s relationships with drugs of abuse are

both interpersonal and regressive in nature and are founded upon the need to experience the

personal aliveness that accompanies the actualization of one or more developmental potentials.

vi


Table of Contents

Chapter 1: Introduction……………………………………………………………………………1

Introduction………………………………………………………………………………..1

Purpose of this Study……………………………………………………………...………3

Background to the Study…………………………………………………………………..4

Statement of the Problem……………………………………………………………….....8

Scope of this Project…………………………………………………………………........9

Statement of Personal Interest…………………………………………………………...11

Barriers and Issues……………………………………………………………………….14

Winnicott’s Writing Style..………………………………………………………14

Theoretical Ambiguity and Contradictions in Winnicott’s Work…..……………17

Personal Reservations and Criticisms of Winnicott……………..……………….19

Definition of Terms………………………………………………...…………………….21

Summary………………………………………………………………………………....36

Chapter 2: Literature Review………………………………………………………………….…38

Introduction………………………………………………………………………………38

Winnicott and Contemporary Psychoanalytic Perspectives on Addiction………………39

Melanie Klein’s Influence on Winnicott’s Theorizing……………………..……………48

Winnicott’s Statements on Addiction in the Context of Kleinian Literature on

Addiction…………………………………………………………………………...…….58

Literature on Winnicott and Addiction ………………………….………………………66

Addiction as it Relates to Being and Absolute Dependence……………………..67

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Addiction as it Relates to Creativity, Transitional Phenomena, and Relative

Dependence……………………………………………………………………....76

Addiction as it Relates to Aggression……………………………..……………..91

Why Winnicott now in Addiction Studies?...........………………………………………94

Chapter 3: Methodology…………………………………………………………………………97

Purpose………………………………………………………………………………...…97

Proposed Methodology…………………………………………………………………..97

Rationale for Chosen Method………………………………………………………........98

Analysis of Case Study……..……………………………………………………98

Critical Review of the literature……...………………………………………....100

Theoretical Basis for this Approach…………………..……..…………………………104

Summary………………………………………………………………………………..107

Chapter 4: Being and Addiction……………………………………..…………………………109

Introduction……………………………………………………………………………..109

The Case of Roger………………………………...……………………………………111

Being, Dissociation, and Addiction……………………..……………………...114

Trauma, Being, and Addiction……………………………………..…………...135

Summary………………………………………………………………………………..176

Chapter 5: Aggression and Addiction …………………………………………………………..178

Introduction……………………………………………………………………………..178

Addiction, Aggression, and Intrapsychic Surviving and Non-Surviving Objects”….....180

Summary………………………………………………………………………………..228

Chapter 6: Creativity and Addiction……………………………………………………………230

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Introduction……………………………………………………………………………..230

Addiction, Creativity, and Transitional Process……..…….…………………………...231

Summary………………………………………………………………………………..257

Chapter 7: Conclusion…………………………………………………………………………..259

Introduction……………………………………………………………………………..259

Summary of the Findings……………………………………...………………………..259

Limitations……………………………………………………………………………...270

Areas for Further Research…………..…………………………………………………279

Importance of this Study………………………………………………………...…...…281

Conclusion………………………...……………………………………………………286

References………………………………………………………………………….………...…288

iii

 1

Chapter 1: Introduction

Introduction

“I take the first sip of my martini. It feels exactly right, like part of my own physiology. 1”

“I finish the bottle and still do not get that sense of relief I need. It’s like my brain is stubborn
tonight. So I have some bottles of hard cider and these gradually do the trick and I get my soft
feeling.”2

“It burns going down…But then I feel the warmth of it…I feel home, I feel safe.”3

“I have the clarity of mind to know that the reason I am drunk and in a dark bar with a strange
guy is because I am desperate to control something.”4

“I grovel in the dust…I am a pig…a swine…a scoundrel…a beast by nature…a weakling…a

shameless one…[and am made] in the image of the Beast…I drink because I want to suffer!...For
it is not merriment I crave, but tears and sorrow!...I have sought...sorrow and tears, and I found
and savored them.” 5

These words were spoken by memoirist Augusten Burroughs and by the character

Marmelodov in Fyodor Dostoevsky’s Crime and Punishment. These two men both acknowledge

and reflect upon the centrality of alcohol in the shaping of their identities and its powerful role in

their psychological and emotional survival. Their narratives provide readers with a window into

the complexity and tragedy of addiction, revealing drugs of abuse as both salvific and damning.

One cannot deny that the affective valence and the themes underlying the relationships these men

have with alcohol clearly differ from one another. Whereas Burroughs appears to experience

alcohol as a nurturant and enlivening force, Marmelodov portrays alcohol as a font of sorrow.

However, it is clear that despite the cultural, historical, and personal differences between this

1 Burroughs, 2004, p. 15
2 Burroughs, 2004, p. 18
3 Burroughs, 2004, p. 257
4 Burroughs, 2004, p. 259
5 Dostoevsky, 1886, p. 32

impoverished Russian man in the 19th century and this American marketing agent of the 21st

century, each story is laced with the same painful mixture of elation, despair, and confusion. A

close reading of their narratives also reveals that their expectations of alcohol are interpersonal in

nature. Neither man relates to alcohol simply as an inanimate substance. Each sip from a

cocktail glass and every gulp from a grimy cup are infused with powerful relational needs.

The theory of Donald Woods Winnicott represents an invaluable entryway into

understanding the suffering of addicted individuals in a way that places front and center each

person’s idiosyncratic relational histories and patterns. Although masochism appears to be the

most prominent feature of Marmelodov’s relationship with alcohol, it is also apparent that, to

him, vodka represents a force that makes it possible for him to maintain a stable identity over

time. Ego integration is one of the most basic developmental potentials and requires the

presence of a holding other for its actualization. Without the conviction that he is a beast and a

scoundrel, Marmelodov would become overwhelmed by the anxiety that accompanies the

disintegration of identity. For Burroughs, a man who grew up in a chaotic and invalidating

environment, alcohol seems to meet his desperate need to feel nurtured and safe. The holding

embrace of alcohol makes it possible for him to venture out into the night with the ebullience and

vivacity of a child at play. We see that drinking is a way for these individuals to navigate the

vicissitudes of daily life with a sense of meaning and constancy that might otherwise be

impossible. Without addressing the developmental and relational dimensions of addiction,

mental health professionals may be more likely to overestimate the hereditary, biological, and

behavioral components of addiction, a misstep that might foreclose the meaningful exploration

of their clients’ deeply personal suffering.

Purpose of This Study

This dissertation will explore selected themes and concepts that have been overlooked,

underdeveloped, or misunderstood in the existing literature on Donald Woods Winnicott and

addiction. In particular, this project will be directed towards an elucidation of Winnicott’s

concepts of being, aggression, and creativity and a discussion of how these ideas might enrich

our understanding of addiction. Doing so will make it possible to develop a general framework

for understanding addiction from a Winnicottian perspective. In addition, the experiences of

“Roger,” a client from clinical practice, will serve as the primary case material in discussing the

various Winnicottian themes that are salient to clinical work with clients who struggle with

addiction. Readers should emerge not only with a firmer grasp on these Winnicottian themes in

the context of Roger’s experiences as an individual who struggled with drug abuse, but will

come to a better understanding of how these concepts might be used as buoys in navigating the

uncharted territory of addicted clients’ lives as illuminated throughout the therapeutic encounter.

To accomplish the above-stated goal, this dissertation engages a number of central

questions: What has been written on Winnicott and addiction? What are the gaps in the research

literature on Winnicott and addiction? And, most importantly to this dissertation: Why

Winnicott now in regard to addiction studies? By considering these questions and meticulously

analyzing a case study through the lens of Winnicott’s insights, this project endeavors to

demonstrate that any approach towards treating addiction could be bolstered by an integration of

Winnicottian theory and sensibilities, particularly his writings regarding the nature of being,

aggression—both positive and destructive—and the role creativity in a person’s life. His

writings on these topics place front and center the capacity of individuals to engage creatively

with the world, exist with a sense of inner vitality, and to benefit from the fluid interchange

between inner and outer realities and the interaction of self and other. Also, I will draw from my

own experiences as an addict and also from my treatment of addicted clients, acknowledging an

emphasis on the identification of deficits in these capacities, a consideration of environmental

determinants, and the unleashing of creative potential that must become instrumental in the

establishment and maintenance of a meaningful recovery. Although such ideas may be

implicitly embedded in a wide array of other approaches, Winnicott would plead with

psychotherapists treating addicts to prioritize these elements of human experience over “clever

interpretations” or the mechanical, manualized application of certain cognitive-behavioral

interventions.

Background to the Study

Simply put, drug addiction is complex. While impressive in scope, the combined insights

of psychology, psychiatry, medicine, neuroscience, and various other disciplines have not yet

provided a clear and consensually agreed-upon conceptualization of this pervasive individual and

social problem. Doweiko (2012) states, “Addiction [and] dependence…are poorly defined

terms” (p. 15). Should we view addiction as an amalgamation of concrete symptoms? As a

manifestation of regression to orality? As a spiritual malady? These and myriad other

hypotheses have been explored by thinkers who have sought not only to enlarge our

understanding of addiction, but to help us find the most effective way of aiding individuals who

struggle with chemical dependence. An integrative biopsychosocial approach has become more

popular in recent years. An integrative perspective that incorporates the many elements of

addiction seems especially important in psychotherapy because an overemphasis on any

particular dimension risks overlooking crucial elements that need to be addressed.

It has become clear that research on the hereditary elements of addiction cannot be

ignored, especially when discussing alcoholism. For example, viewing addiction as arising

solely from pathological intrapsychic dynamics derived from early experiences would be a

disservice to clients. Studies examined by Zucker (2006) and Ducci and Goldman (2012) have

consistently demonstrated the powerful influence of hereditary factors in the development of

addiction to alcohol and illicit drugs. The medical model view of addiction has grown in

influence alongside the psychodiagnostic identification of substance use disorders. In short, the

Diagnostic Statistical Manual of Mental Disorders, 5th edition (DSM-V) allows clinicians to

determine whether or not their clients meet the criteria for a wide array of substance abuse

disorders.

On the other hand, giving undue emphasis to genetic or diagnostic factors runs the risk of

undervaluing the contributions of past experiences not only to the development of addiction, but

also to the subjective suffering of those who seek psychotherapy. It is here that psychoanalytic

formulations become especially relevant. Since the inception of psychoanalysis, the

understanding of addiction has taken many forms. Theorists over the years have directed their

attention to different aspects of this phenomenon, both in terms of etiology and the psychological

dynamics present in addicted clients. Freud, like most prominent figures in psychoanalysis, did

not devote a great deal of time to studying addiction. Furthermore, he believed that “drug

addicts were not very suitable for analytic treatment because every backsliding or difficulty in

the analysis led to further recourse to the drug” (Ramos, 2003, p. 467). His brief discussions of

drug addiction emphasized the role of libidinal drives and portrayed addiction a successor of and

substitute for masturbation—a stimulant of self-induced pleasure and release of pent up libidinal

energy. In comparison, Khantzian (2003) provided a useful summary of early psychoanalytic

formulations of addiction He noted that early psychoanalytic addictions studies emphasized

themes such as orality (Freud), homosexuality (Abraham), elimination of pain (Rado), and

masochism (Menninger). Khantzian (2003) also wrote about the second wave of addictions

theorists in the 1960s and 70s, who focused more on “structural (ego) factors, developmental

difficulties, and disturbances in self and object relations” (p. 8). Although we will note some of

these earlier perspectives in the literature review, a detailed review of these authors’

contributions clearly lies beyond the purview of this project. However, the fact that these early

theorists chose to incorporate aspects of psychodynamic theory when researching the

phenomenon of drug use makes their work important as a beginning framework in exploring

D.W. Winnicott’s place in addiction studies.

Despite their differences, contemporary psychoanalytic rs tend to agree on two issues: (a)

there has been a surprising paucity of psychoanalytic literature about addiction in recent years

and (b) it is most useful to adopt an integrative approach that integrates various psychoanalytic

perspectives and insights from other fields of study. Ramos (2003) noted that the International

Journal of Psychoanalysis featured only two prominent essays on addiction between 1968 and

2004 (p. 467). However, those who have written on this topic have provided useful

recapitulations of previous literature, developed their own theories, and raised highly important

questions. Khantzian has been especially prolific and has written dozens of papers since 1978.

In addition to introducing the self-medication hypothesis, he has discussed the issues of

psychopharmacological specificity (whether drug users possess particular psychological

dynamics that draw them to particular substances), addictive vulnerability, and the deficits in

self-care and self-regulation common in addicts (Khantzian, 1978, 1987, 2003). Furthermore, he

has explored and sought a resolution to the cause-consequence controversy, asking “whether

psychological or psychiatric dysfunction is a cause or consequence of substance abuse,” a

question that must be addressed if we are to understand and effectively treat addiction

(Khantzian, 1987, p. 521). Ramos (2004), citing the prevalence of polysubstance dependence,

questioned the accuracy of Khantzian’s writings on psychopharmacological specificity. He also

introduced the notion of dependogenic processes: “as one becomes dependent on chemicals, a

process which may be called dependogenic is instilled…[various psychopathological dynamics]

do nothing aside from create vulnerability” (p. 474). He also cited and agreed with Limentani,

who wrote that “‘no [specific] psychopathological pattern arises when investigating chemical

dependency’” (Ramos, 2004, p. 484). In addition, Johnson (1999) provided a useful synopsis and

integration of neurobiological, affect-tolerance, and object/transitional object views of addiction

and highlighted the importance of utilizing the insights of all three in conceptualizing and

treating addiction. Other authors have devoted their time to exploring the phenomenon of

addiction through a particular theoretical lens. Chelton and Bonney (1987), for example,

provided a self-psychological conceptualization of addiction that focused on the role of self

object theory in understanding addiction. Although many theorists have written about how one

might conceptualize and treat addiction from a Winnicottian perspective (Director, 2005; Miller,

2002; Potik, 2007), research in this area has yet to reach its full potential. Subsequently, this

dissertation will address gaps in the psychodynamic literature on addiction and place Winnicott’s

theoretical and therapeutic vision into the ongoing dialog in psychoanalytic addiction studies.

Statement of the Problem

British pediatrician and psychoanalyst D.W. Winnicott has by no means been overlooked

in the literature on addiction. A variety of essays and articles approach the phenomenon of

addiction from a Winnicottian perspective (Eigen, 2011; Livingston, 2006; Luz, 2009).

However, research into this topic yields a surprising dearth of psychoanalytic literature on

addiction that demonstrates the rigorous scholarship Winnicott deserves. Although some authors

give Winnicott a slight nod of acknowledgement with brief references to concepts such as

transitional phenomena, others seem to oversimplify and even misunderstand central

Winnicottian concepts. In fact, addictions literature has almost entirely neglected Winnicott’s

revolutionary theory of aggression. In short, few theorists or clinicians have set out to focus

exclusively and extensively on Winnicottian theory in their writings on drug addiction.

Something is wrong here. Without a doubt, Winnicott has proven to be one of the most

influential theorists and analysts in the history of psychoanalysis—innumerable books, chapters,

and articles have been written about him. The secondary literature on Winnicott has not only

clarified his often-cryptic writing, but has revealed the vast complexity and nuance embedded in

his reflections on being, creativity, and aggression. One needs look no further than Reality and

Fantasy (1978), a collection of 31 essays devoted solely to the exploration of Winnicott’s notion

of transitional phenomena, to see the richness and complexity others have discovered in

Winnicott’s writings on playing and creativity. The contributions of Rose (1978) and Solomon

(1978) have explored the theory of transitional space in complex and fascinating ways. Dozens

of authors have not only illuminated Winnicott’s writings, but have expanded upon his theories.

Some theorists, such as Ogden, have grounded much of their psychoanalytic perspectives in

Winnicottian theory. In his 1985 paper entitled “On Potential Space,” Ogden illuminated and

extended several Winnicottian themes such as the pathology of potential space and the ability to

play, which are especially salient to addiction. There is a similar devotedness in the

investigation of Winnicott’s writings on aggression. Abram (2012) meticulously examined

handwritten notes prepared by Winnicott in order to provide a clearer picture of his often-

confusing writings on the topic of aggression. In “Vital Sparks of Things Unknown,” Goldman

(2012) helps readers to better understand the importance of aggression to the feeling of aliveness.

Despite these contributions, very little literature on addiction capitalizes on Winnicott’s subtle

insights into being, creativity, and aggression—insights that we readily find both in his work and

the secondary literature. This dissertation will address these Winnicottian insights as they relate

to addiction studies.

Scope of This Project

In order to proceed further, it is necessary to delineate what this dissertation will not

address. The multidetermined nature of addiction has been a central theme in recent

psychoanalytic addictions literature (Johnson, 1999; Ramos, 2003). This project will take a

similar approach by assuming that a Winnicottian conceptualization of addiction cannot possibly

capture every dimension of this immensely complex phenomenon. Khantzian’s overarching

perspective will serve as a central organizing principle of the current study. Khantzian (2003)

described his position on addiction:

 10

We all need to strive for (and I ‘plead for’) a ‘measure of marginality’ as we adopt and

advance our perspectives on understanding addictive vulnerability. That is to say, we all

need to try to dwell in the ‘margins…’ between the different paradigmatic domains in

which we operate and seek more ways to integrate those domains even as we focus upon

and emphasize our preferred ones. Ultimately, I have suggested that probably the best we

can do is to milk our perspectives for all they are worth and then to reside, at least for a

while…in the margins of our different way of thinking. The ‘marginal person in each of

us must wait on the rare ‘Renaissance person’ who can ultimately bridge the different

domains and explain how they all come together. This is how we advance our sciences

and our civilization, and it is how we address what ails us as a society. (p. 20)

Simply put, this dissertation will not be a “Renaissance study.” Rather, this project will dwell in

an extremely small margin and its insights will not illuminate, explore, or capture the myriad

elements of conceptualizing and treating addiction. The introductory remarks of this dissertation

provided a backdrop for the exploration of addiction from a Winnicottian perspective by briefly

addressing the genetic components of addiction, the medical model perspective, and influential

psychodynamic models. Going forward, this dissertation will sharpen its focus by primarily

occupying the “margin” of Winnicottian theory.

Just as a strictly Winnicottian discussion of addiction precludes one from delving into

many other various elements of addiction, it will also be impossible to explore every nook and

cranny of the subjective experience of addicts. In fact, to claim that this dissertation will be able

to do so would not only be overly ambitious and hubristic, but would ultimately fail to do justice

to or honor the complex and unique subjective experiences of addicted individuals. No matter

 11

how insightful, illuminating, and seemingly comprehensive a particular theory may be, any

approach anchored in the presumption that one’s perspective can account for the infinitely

nuanced experiences of an addict—much less all addicts—is doomed to failure and will

inevitably objectify and exploit the intensely personal inner worlds of chemically-dependent

individuals. However, limiting ourselves to one theoretical perspective can also be viewed as a

strength. In clinical terms, it is important to have a thorough understanding of whatever

theoretical perspectives guide your conceptualization and treatment of clients. Grounding this

study firmly in Winnicott’s theory will help clinicians interested in psychodynamic approaches

to addiction to obtain a depth of understanding that they would not achieve if this dissertation

spread itself too thin. Many papers about psychodynamic theory and addiction incorporate so

many perspectives in a single paper that readers will likely not emerge with a firm grasp on any

one of the theoretical paradigms.

A particularly obvious limitation of my study lies in the fact that it will only incorporate

the memoir of one individual. This, of course, raises serious doubts about the generalizability of

any potential findings. The task at hand centers more on how Winnicott’s views on being,

aggression, and creativity might enrich the understanding of one individual’s struggle with

addiction. In short, readers will emerge with a clearer picture of Winnicott’s theories on being,

play, and aggression, and about how to utilize his ideas to work effectively with their own

clients.

Statement of Personal Interest

My decision to explore the relationship between Winnicott and addiction did not

originate in my intellectual curiosity about this topic only. I initially intended to explore

 12

addiction from a Kierkegaardian perspective. Having written my undergraduate thesis on The

Sickness unto Death and Crime and Punishment, I was curious to see how I might incorporate

the dialectic of possibility/necessity and Kierkegaard’s notion of despair into how addicts

succumb to their drug(s) of choice. In fact, I knew very little about Winnicott when I first

decided to my dissertation on addiction. My interest in addiction, however, has roots far deeper

than any philosophical or psychological theory. Simply put: my name is Karl, and I am an

alcoholic.

I vividly remember my first encounter with intoxication. At the age of fifteen, I sat in the

bed of a pickup truck on the roof of a parking garage with two friends, enjoying a warm and

breezy summer night in Charleston, South Carolina. I was an energetic, goofy, and ebullient

adolescent who had no problem making friends. These qualities intertwined with insecurity, a

tendency towards depression, and a somewhat anxious and overactive mind. My friends, who

had already completed this rite of passage several months before, offered me an ice cold

Milwaukee’s Best, which we called “the Beast.” I immediately thought of my parents, knowing

they would go absolutely ballistic if they found out. Not surprisingly, this knowledge made that

can of cheap beer all the more alluring. As the drops of condensation slid down the aluminum, I

saw before me a mystery, a symbol of freedom, and a guarantee of acceptance by my classmates.

I smiled, breathed deeply, and gratefully accepted their offer. What a horrible taste! What an

unpleasant feeling as the carbonation rose up in my chest! My first swig proved too

adventurous, and I immediately vomited onto the asphalt. After the third or fourth sip, however,

a magical and effervescent lightness came over me and a grin appeared of its own volition. I was

absolutely “hammered” after three beers (I weighed just over 100 pounds). I floated blissfully

 13

and unrestrained along the cobblestone streets, feeling invulnerable and wise. I awoke the next

morning wanting to drink again as soon as possible.

Six years later, I woke up to a numb tugging situation on my chin as faceless voices

swirled around me. I opened my eyes to see a small gathering of nurses and doctors hovering

above me, speaking in Italian. It was three in the morning and I cried when I called my mother

back in South Carolina: “Mom…I’m in Rome in the hospital. I got mugged and have stitches all

over my face.” I had drunkenly decided it would be a good idea to buy some marijuana in a

rough neighborhood near the Termini and had been beaten over the head, left bleeding

unconscious in the alley. I still wanted to drink. Thus began two years of sobriety. A few

months of the “pink cloud” were followed by eighteen months of battling waves of intense

depression, an ebb and flow that intermingled with times of productivity and loving relationships

with friends and my girlfriend. Two years later, I watched as a beer that had been transformed

into a makeshift pot-smoking apparatus slowly progressed around a circle of people on the floor

of a friend’s living room. My friend, knowing I was in recovery, softly said, “Karl, I don’t want

to lead you down a dark road.” I took the can and inhaled deeply. I woke up the next morning

knowing this would again become a regular fixture in my life. The following two years were

suffused with the grandiosity and spontaneity of being a performing musician and included

losing three jobs, racking up $15,000 in credit card debt, and the worsening of relationships with

my family. I crashed. I started to wake up a little when I found myself anxiously scrounging

through the fibers of my carpet looking for grains of marijuana and after losing my teaching

position following a two-week absence. I did not drink alcohol during this time, but knew that it

would only be a matter of time before my financial situation would make that a necessity.

 14

Seven years later, I sit in the library typing a dissertation during a time that I will

probably look back on as one of the most stable and genuinely fulfilling periods of my life. I

rarely think about drinking or using drugs, although my dreams occasionally wander in that

direction. Studying psychology for the last several years has allowed the following questions to

stir and unfurl in my mind: Why did I drink and use despite all the consequences? Did I choose

to drink and use to such a great extent? What relevant patterns might I find in my psychological

and emotional experiences prior to, during, and after my active years of addiction? Regardless

of genetics, what did I seek and find in drug use, and how might I characterize my relationship to

intoxicating substances? To what extent do my experiences either differ from or resemble those

of other addicts? As a psychologist-in-training, I have developed an interest in working with

individuals who struggle with chemical dependency, and believe that exploring their experiences

in a similar way might aid in the development of meaningful and transformative therapeutic

relationships. Although I can see the potential contributions of cognitive-behavioral, humanistic-

existential, and various psychoanalytic approaches, Winnicott’s theories are especially fertile soil

for responding to these important questions, and for developing my own perspective in

conceptualizing and working with the complex phenomenon of addiction.

Barriers and Issues

Winnicott’s Writing Style

Attempting to develop a Winnicottian perspective on addiction is inherently challenging

for a variety of reasons, such as Winnicott’s writing style, theoretical contradictions, and

ambiguity in his work. Some of Winnicott’s most notable strengths—particularly his open-

endedness and use of paradox—also represent notable drawbacks in his theorizing. However,

 15

people often find themselves drawn to Winnicott because of his writing style, use of paradox,

and his invitation to “play” with the ideas he presents. The combination of playfulness, sincerity,

humility, and ingenuity has made his writings uniquely appealing to countless readers.

In “D.W.W. on D.W.W.,” Winnicott (1967) humbly and humorously stated, “[The

paradox of transitional objects] seems to me to have quite a lot of philosophical importance, only

I don’t happen to be a philosopher” (p. 40). We see his ability to poetically illustrate his

concepts in the following statements from Playing and Reality (1971): (a) “After being—doing

and being done to. But first, being;” and (b) “The searching can come only from desultory

formless functioning” (pp. 64, 85). His wordplay, poeticism, and the unconventional structuring

of his essays do not merely serve the purpose of making his writings more enjoyable. Ogden

(2001) emphasized the “powerful interdependence of language and ideas in Winnicott’s work;”

for instance, he noted that Winnicott’s free-flowing style in describing the infant’s unintegrated

state “allow[s] [the reader] to be carried by the music of the language and ideas … [and to]

experience a floating feeling that accompanies nonlinear thinking” (p. 221). In other words,

Winnicott has an uncanny ability to seamlessly integrate form and function in his writings.

Paradox often lies at the core of Winnicott’s writings. These paradoxes not only help to

illuminate the ineffable dimensions of human existence, but provide readers with the opportunity

to creatively engage with the text and to arrive at their own interpretations. It will become

increasingly clear in this project that his theorizing on creativity and aggression hinge on the use

of paradox. The transitional object—the relationship to which precedes playing—is both created

and found. In the case of destructiveness, the good-enough mother allows herself to be

destroyed, yet she must always survive. In a way, we may benefit from approaching his

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paradoxical ideas in the same way a mother responds to her child’s use of a transitional object:

“The important point is that no decision on this point is expected” (1951, p. 240). In other

words, we often gain the most from Winnicott’s papers when we dwell within the dialectical

tension between opposites such as an object being “found” and “created” or a mother “being

destroyed” while simultaneously “surviving”—without being too concerned with coming to a

precise or final understanding of what Winnicott means. More so than perhaps any analyst

before him, Winnicott encouraged, insisted upon, and delighted in uncertainty. He understood

the risk of dogmatic theorizing, likening its potential effects to those of an intrusive mother.

Introducing the terms “object-mother” and “environment-mother,” Winnicott (1963a) wrote, “I

have no wish to invent names that become stuck and eventually develop a rigidity and an

obstructive quality” (p. 75). Readers of psychoanalytic literature rarely encounter such explicitly

stated caveats.

Yet, the same qualities that make his writing so appealing, effective, and unique

sometimes hinder the reader’s attempts to clearly grasp his concepts or to implement them in

their clinical work. Ogden (2001) wrote, “[Winnicott’s] papers are not well served by a thematic

reading aimed exclusively at gleaning ‘what the paper is about…[and] the writing is

extraordinarily resistant to paraphrase” (p. 213). This, and his proclivity for unsystematic

writing, makes the current task quite challenging. Although it might be tempting to characterize

Winnicott as a perpetually meandering theorist and analyst, he by no means wrote or practiced

without grounding himself in a particular theoretical paradigm. He neither implemented nor

encouraged a willy-nilly approach to therapy in which theoretical perspectives faded into the

background. Zeljko Loparic (2012) emphasized that Winnicott’s effectiveness as an analyst and

 17

r did not stem only from “‘the fruits of chance [or] ‘genial insights of a creative psychoanalyst;’”

he provided the following quote from Winnicott: “‘The only companion I have in exploring the

unknown territory of the new case is the theory that I carry around with me and that has become

part of me and that I do not even have to think about in a deliberate way’” (p. 149). Hence, any r

embarking upon an exploration of Winnicott and addiction faces the challenge of avoiding both

an over-poeticizing and over-concretizing of Winnicott’s ideas. When reading literature about

addiction from other perspectives, whether self-psychological (Chelton & Bonney, 1987) or

cognitive-behavioral (Freeman et al., 2004), one is immediately struck by the exactitude,

cohesion, and confidence in some of these formulations. Concepts particular to those theories

often seem to match up perfectly with various elements of addiction. In comparison, the

difficulty one faces in “applying” Winnicott’s concepts, while also honoring the creative spirit of

his writing, more likely than not plays a role in the paucity of addictions literature utilizing his

insights. Perhaps psychoanalytic thinkers have, for the most part, avoided such a project

precisely because it is, by nature, quite maddening. But this thesis will search for the method in

the madness.

Theoretical Ambiguity and Contradiction in Winnicott’s Work

Many have criticized Winnicott of conceptual ambiguity and theoretical contradictions,

both of which seem to arise in part from his writing style and overall approach to theorizing.

While some of these criticisms encourage further research into Winnicott’s ideas, others have

ascribed his ambiguities and contradictions to intellectual laziness or lack of confidence in his

own theorizing (Gomez, 1997, p. 103-104). We see in numerous cases that even thinkers

influenced by Winnicott have their fair share of critiques. Although Winnicott’s writings on play

 18

and creativity have been applauded by numerous psychoanalytic rs, even those closest to him

have identified problems in his theorizing. For example, Marion Milner (1972-1977) , a close

associate of and inspiration to Winnicott wrote, “Not that I found his way of putting his ideas

about creativity entirely easy: sometimes he seemed to be talking about a way of looking at the

world, sometimes about a way of doing something deliberately, and sometimes about just

enjoying a bodily activity” (p. 171-172). Although she goes on to elaborate upon what she sees a

common thread involving these various manifestations of creativity, the above statement

indicates an awareness of her colleague’s tendency to leave concepts unclear.

Winnicott’s theory of aggression has been criticized perhaps more than any other aspect

of his theorizing. The most famous rejection occurred after a 1968 presentation at the New York

Psychoanalytical Society, when he formally introduced his theory of the non-destructive origin

of aggression. Abram (2012) mentioned that a “culture clash” between the British object

relations perspective and that of American ego psychologists contributed to the immediate

snubbing of Winnicott’s “radical challenge to instinct theory” (p. 305). The extremely negative

response to his paper had a devastating effect on Winnicott, who subsequently considered

abandoning his theory altogether. Although their dismissal arose from incommensurable

theoretical differences, other authors have directed their criticisms at Winnicott’s oftentimes

confusing and inconsistent writings on the topic of aggression. Before attempting to clarify the

progression of Winnicott’s writings on aggression, Phillips (1988) wrote, “as Winnicott initiates

important distinctions he also changes terminology in a confusing way; in the above quotations

aggressive ‘components’ have become ‘impulses’ and ‘instinctual life” has turned into ‘the life

force’” (p. 110). Winnicott’s final published statement on aggression can be found in the 1971

 19

essay entitled, “The Use of an Object.” Abram (1996) points out that this paper, although it

incorporates Winnicott’s most “ingenious” contribution, is especially “opaque” (p. 20). As we

will see, the sometimes impenetrable nature of Winnicott’s concept of aggression makes its

application to addiction very challenging.

The above-mentioned criticisms are important to keep in mind not only for the purposes

of this thesis, but also because the concepts of play and aggression occupy central places in

Winnicott’s theory. It is best to view his contradictions and ambiguity as natural and inevitable

byproducts in the lifelong endeavor of an extremely gifted individual attempting to understand

complex and ultimately inexpressible aspects of human experience. Like Freud, Winnicott’s

ideas evolved over time and contradict themselves in places. One cannot expect such a creative

mind to content itself with static theoretical concepts over a span of 40 years. Furthermore, one

must take into account the difficulty Winnicott faced in attempting to introduce radically

different ideas into the sharply divided political atmosphere of psychoanalysis at that time.

Abram (2012) asserted that only towards the end of his life did Winnicott feel comfortable

writing, “‘I am asking for a kind of revolution in our work. Let us re-examine what we do’”

(p. 312). Unfortunately, this statement was written in informal notes for a 1971 conference in

Vienna that Winnicott was unable to attend—he died just six months before.

Personal Reservations and Criticisms of Winnicott

In addition to the above-mentioned obstacles to completing my project, I have my own

personal reservations about Winnicott’s theories. My hesitancy to endorse some of Winnicott’s

ideas has, to some extent, hindered my exploration of addictive processes from his perspective.

 20

Although I agree with many of his basic theoretical suppositions, I sometimes feel uneasy

when his writing takes on a reductionistic and deterministic character. In “The Theory of the

Parent-Infant Relationship,” Winnicott (1960) wrote the following about fusion, a concept that

will figure prominently in this dissertation`: “without a good enough holding environment [in

infancy] these stages cannot be attained, or once attained cannot be established” (p. 45). Later in

this same essay, he stated, “The mental health of the individual, in the sense of freedom from

psychosis or liability to psychosis (schizophrenia), is laid down by this maternal care” (p. 49).

Such statements seem not only to give undue significance to his concept of the holding

environment, but also seem to deemphasize the influence of genetic determinants. It seems at

times that, for Winnicott, an infant without good-enough caretaking in the earliest months of life

is doomed to a life of stunted emotional development and psychopathology. He augmented the

above assertion regarding schizophrenia in Playing and Reality (1971): “While we recognize the

hereditary factor in schizophrenia…we look with suspicion on any theory of schizophrenia that

divorces the subject from the problems of ordinary living and the universals of individual

development in a given environment” (p. 66). This is, for me, a more palatable assertion

regarding the development of schizophrenia. I feel inclined to view his more deterministic and

reductionist statements as (a) a result of the urgency he felt in emphasizing environmental factors

at a time in which psychoanalytic theory concerned itself almost exclusively with intrapsychic

dynamics and (b) his extensive observations of mothers and infants during his years as a

pediatrician. Given the fact that genetic influences have been established in the etiology of

addiction (especially alcoholism), it has been especially important for me to address this

problematic element of Winnicott’s writing.

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Another difficulty I have encountered in my studies is the question of how much

information regarding childhood experiences is needed in order to understand a patient’s

emotional and psychological difficulties from a Winnicottian perspective. Winnicott adopted a

“deficit model” that highlights the role played by developmental deficits in the genesis and/or

perpetuation of psychopathology. A related issue involves how it is possible to account for an

adult patient’s presenting problem utilizing theories that primarily deal with infancy. In the

chapter entitled “Mirror-role of Mother and Family in Child Development,” there is a notable

discrepancy between the formal explication of theory and its subsequent application to case

vignettes of adult patients. Whereas the first part of the essay focuses exclusively on the infant’s

earliest relationship to the mother, the case vignettes make no reference whatsoever to adult

patients’ early experiences. After first reading this essay, I found myself wondering how

Winnicott was able to interpret his patients’ experiences without much background information

and whether or not it is fair or realistic to so readily equate an adult patient’s problems with those

of a newborn child. I will discuss how I have sought to resolve these questions in the below

section entitled “Theoretical Basis for My Approach.”

Definition of Terms

Before moving forward, I will provide some preliminary definitions of a few terms I will

be using throughout this dissertation. The definitions that follow are not intended to be

comprehensive, nor will I include every important concept to which I will refer. Some terms,

especially those based in Winnicott’s theory, will be fleshed out in chapters 4-6.

Development. It should be kept in mind that, unlike some developmental theorists,

Winnicott did not support the notion of a linear, stage-like progression through the various

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phases of development. Rather, he is more concerned with the types of experience associated

with various phases and the capacities that develop (or fail to develop) in each one. In health, the

child proceeds from “absolute dependence” to “relative dependence” to “towards independence,”

and emerges with the ability to creatively engage with the world in a meaningful, agentic, and

deeply personal way (Winnicott, 1963b, p. 91). During the phase of absolute dependence,

maternal devotion sets up a matrix in which there is no division between mother and child and in

which the mother's ego is, in a sense, the child's ego, or at least provides the shell in which the

infant's nascent psychological structure can form. In “The Theory of the Parent-Infant

Relationship” (1960), Winnicott wrote in his said the following in his characteristically

paradoxical manner wrote, "The infant ego can be said to be weak, but in fact it is strong because

of the ego support of maternal care. Where maternal care fails the weakness of the infant ego

becomes apparent” (p. 55). The crucial aspect here is that the good-enough mother allows her

infant the experience of formlessness, continuity, and “going-on-being.” Furthermore, an infant

with a good enough mother will experience the illusion of omnipotence, for he will believe that

he has actually created the breast that satisfies his spontaneously arising need. The notion of

illusion in Winnicott’s writings can be interpreted in more than one way. We could alternately

view illusion as a reality for the newborn, or as a metaphor Winnicott employs to capture a

particular dimension of the infant’s experience. Winnicott also attributed another crucial

function of illusion, describing it as the very foundation of the capacity to play that is so crucial

to psychological wellbeing throughout the lifespan.

Independence represents the state in which the child has established a clear differentiation

between “me” and “not me,” whereas relative dependence is the era of the “transitional object,”

 23

which serves as a means of cushioning the fall from absolute dependence to awareness of

external reality, vulnerability, and dependency. But how does the infant achieve such a state? In

order to answer this question, one must consider the relationship between what Winnicott terms

“maturational processes” and the “facilitating environment.” Winnicott wrote that the term

“‘maturational process’ refers to the evolution of the ego and of the self” (p. 85). The

maturational processes are inherited potentials characterized by a tendency toward ego

integration. These processes resemble in a way the inherited capacity of babies to walk and talk,

but have more to do with the development of psychological and emotional independence.

Winnicott (1962a) provided his clearest description of integration in “Ego Integration in Child

Development,” where he wrote:

The achievement of integration is the unity. First comes ‘I’ which includes ‘everything

else is not me.’ Then comes ‘I am, I exist, I gather experiences and enrich myself and

have an introjective and projective interaction with the NOT-ME, the actual world of

shared reality.’ Add to this: ‘I am seen or understood to exist by someone;’ and, further,

add to this: ‘I get back (as a face seen in a mirror) the evidence that I have been

recognized as a being. (p. 61)

The end of the above statement brings to our awareness the role of the environment/other.

Although the infant possesses the innate capacity to achieve “unit status” or the feeling of “I

am,” the “facilitating environment makes possible the steady progress of the maturational

processes” (1963b, p. 85). In infancy, it is largely the “good-enough mother” who provides such

an environment by adapting to spontaneously arising needs of her child—a challenging and

complex task that most mothers are able to perform. Winnicott used the term “good-enough”

 24

because he felt that perfect adaptation can actually lead to the inhibition of successful

integration. Throughout Winnicott’s career, he described a wide array of developmental

capacities, the actualization of which depends on the provision of a facilitating environment.

Some particularly important capacities include the capacity to be alone, the capacity for concern,

and the capacity to play. The development of such capacities in childhood and their maintenance

throughout life constitute a central element of mental health.

“Internal” and “External” Reality. As evidenced by the above discussion of ego

integration, the differentiation between “me” and “not-me” implies a distinction between

“internal” and “external” reality. At first glance, it may seem as if Winnicott is posited the

existence of a static external reality that can be understood objectively. Upon closer inspection,

however, his writings at times challenge such a dichotomous view. Although the term “inner

reality…presupposes the existence of an inside and an outside,” the membrane between the two

is permeable, and the constant interactions between inner and outer results in a constant changing

in each (Khan, 1971, p. xii). Winnicott sometimes preferred to replace the terms “outer” or

“external” with “consensual” or “shared;” these latter terms emphasize the co-constructed nature

of reality (both inner and outer) and resonate with the overall theorizing of Winnicott, who

throughout his career criticized traditional psychoanalysis for neglecting the role of the

environment. It is helpful to keep in mind the more recent writings of Rose (1978), who puts

forth a view of “man living within an open system;” Rose described “external reality” as a

“dynamic oscillation between figure and ground” and described the “sense of reality” as “not

[being] formed by an ‘objective’ reality impinging upon the mind, but by the singling out of

specific elements from a totality and electing them to become ‘real’’ (pp. 345, 347). Yet,

 25

Winnicott himself refused to deny some sort of constancy in the “external world” and points to

the “subject’s perception of the object [mother] as an external phenomenon, not as a projective

reality, [and] recognition of it as an entity in its own right” as a crucial element in healthy

development (Winnicott, 1971, p. 89).

Being. Winnicott felt that psychoanalysts of his time had dedicated all of their time to

what he called the “doing” element of the personality. To him, theorists such as Melanie Klein

were preoccupied with identification, projection, and introjection. Such psychological

mechanisms require ego organization and should therefore be seen as more complex

psychological and emotional processes that those that take place during the earliest days of

psychological and emotional life. In concluding the chapter “Creativity and its Origins,”

Winnicott (1971) wrote: “Now I want to say: After being—doing and being done to. But first,

being (p. 85).” Winnicott posited an initial state of unintegration in which there is no

differentiation between mother and child. It is in this state of absolute dependence that simple

being originates. Abram wrote that, for Winnicott, “Being emanates from the notion of a ‘centre

of gravity;” Winnicott associated being with “the central self [that] could be said to be the

inherited potential which is experiencing a continuity of being, and acquiring in its own way and

at its own speed a personal psychic reality and a personal body scheme” (Abram, 1996, p. 58;

Winnicott, 1960, p. 46). The infant’s experience of simple being might be seen as the gradual

growth and emergence of a chick within the psychological shell of absolute dependence.

Without adequate experiences of this kind, the child cannot confidently or with any sense of

vitality “do.” The capacity for this non-reactive and formless type of experiencing continues

throughout life and is analogous to the adult’s ability to retreat into relaxation free from the

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demands of the “outside” world. We may therefore view simple being in adulthood as similar to

the state that many seek to achieve through meditation. However, simple being in adulthood

need not be viewed only as a state that can only be achieved through purposive activity; viewing

simple being exclusively as a “state” implies that it belongs exclusively to “inner” experience, a

conclusion that overlooks the relational foundations that allow for the experience of formlessness

in the first place. One might also consider the “being” and “doing” components of the

personality topographically, as stratifications that belong to the same “earth” of the self, with

simple being representing the earliest and lowermost layers of the individual. In other words,

psychological and emotional wellbeing require that an individual’s day to day decisions and

experiences are generally imbued with the experiential valence of continuity.

Transitional Objects and Phenomena. The concept of the transitional object occupies a

central place in Winnicottian theoretical paradigm and constitutes one of his most famous

contributions. Because one cannot hope to understand Winnicott without grasping this concept

and because of its prominent role in this project, I will provide a summary of the 1951 essay in

which Winnicott first formally introduced this idea, “Transitional Objects and Transitional

Phenomena: A Study of the First Not-Me Possession.” As I have already discussed, the infant

must move from an experience of being at the center of the universe to a mode of experiencing in

which he must negotiate with others. In these early years, the infant must confront the awareness

that his subjectivity is only one of many subjectivities in the world. In order to help the infant

cope with the realization of his dependence and vulnerability, the mother must allow for what

Winnicott termed a “transitional space.” This is an ambiguous space in which the infant

develops the ability to play, think, and explore on his or her own while still feeling protected and

 27

safe. Winnicott (1951) emphasized, however, that although “the mother’s eventual task is

gradually to disillusion the infant…she has no hope of success unless at first she has been able to

give sufficient opportunity for illusion” (p. 95). At this time, the mother also starts to slowly and

gradually frustrate her child's needs and begins to regain her own sense of subjectivity. Mitchell

and Black (1995) said that “it [is] precisely the ambiguity of the transitional realm that root[s]

experience in deep and spontaneous sources within the self and, at the same time, connect[s]

self-expression with a world of other subjectivities” (p. 128). The maintenance of this

transitional phase necessitates a new kind of object—a transitional object.

When some people hear the phrase “transitional object,” they think that such an object

serves as a symbol for the mother’s breast between phases of complete dependence and effective

reality testing. Winnicott argued, however, that “the point of [the transitional object] is not its

symbolic value so much as its actuality. Its not being the breast (or the mother) although real is

important as the fact that it stands for the breast (or mother)” (Winnicott, 1951, p. 92). Winnicott

provided the reader with numerous characteristics of the transitional object that make it so

crucial to the infant. First of all, the transitional object—which, paradoxically, is experienced

neither as an internal object over which the infant has control nor an external object from which

he is separate—allows the infant to retain his illusory sense of omnipotence while relating to a

“not-me” possession. Secondly, the object serves the essential purpose of alleviating unpleasant

experiences of anxiety, depression, and loneliness; this is evidenced by the fact that older

children sometimes return to their transitional objects during times of extreme distress (p. 91).

Thirdly, the transitional object serves as an appropriate object of both love, hate, and destructive

aggression, polarities which the infant is still struggling to reconcile; in the use of the transitional

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object, the infant is learning how to manage sadistic desires—which originally were directed

against a fantasized bad breast—in a world that is not under his complete control (p. 91).

Winnicott mentioned, “the object must never change unless changed by the infant” (p. 91). This

statement points to a fourth function of the transitional object—it helps the child to understand

that there can be constancy in relationships with things that are “not-me.” By ensuring that there

is no “break in continuity in the infant’s experience” with the transitional object, the mother

ensures that she does not “destroy the meaning and value of the object to the infant” (p. 91).

Thus, the transitional object cannot be understood merely as a symbol for the mother’s breast.

Rather, it is an object imbued by the infant with unique meaning and significance. Hence, its

meaning to the child is complex and reflective of the child’s unique idiom. When a child

abandons her transitional object, it is not forgotten, nor are associated feelings repressed—it

simply loses its meaning. The transitional phenomena “have become diffused, have become

spread out over the whole intermediate territory between ‘inner psychic reality’ and the ‘external

world’ as perceived by two persons in common (Winnicott, 1951, p. 91). Indeed, the experience

of transitional space—which Winnicott later referred to as “potential space”—allows for

experiencing our lives with a sense of vitality and meaning.

Creativity. Creativity and transitional phenomena overlap considerably, for both involve

the ways in which an individual experiences, interprets, and negotiates the unending dialogue

between her inner world and shared reality. Simply put, living creatively is equivalent to

psychological health. In Playing and Reality, Winnicott (1971) described creativity as a

“colouring of the whole attitude to external reality” and wrote that “it is creative apperception

more than anything else that makes the individual feel that life is worth living” (p. 65). Creative

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apperception has its origins in the phase of absolute dependence, during which the mother

permits her infant the illusion of omnipotently creating the breast. Allowing for creative

apperception and the use of illusion (not to be confused with “delusion”) facilitates the child’s

ability to live creatively and to “[manipulate] external phenomena in the service of the dream and

[to invest] chosen external phenomena with dream meaning” (p. 51). It sometimes becomes

difficult to disentangle the notions of transitional phenomenon, transitional object experiences,

cultural experience, and playing in Winnicott’s writing. This quote indicates that transitional

phenomena and playing are types of experience. Creativity is something that characterizes each

of these experiences. Jordan Jacobowitz (personal communication, August 29, 2014) offered the

following comment regarding the nature of creativity: “Creativity seems to be the cognitive-

affective process that makes meaning, thus allowing the existence of transitional objects and

play.”

Before proceeding, it may be helpful to briefly discuss the relationship Winnicott posited

between cultural experience and the use of transitional objects. Winnicott (1971) provided a

useful developmental sequence in saying, “There is a direct development from transitional

phenomena to playing, and from playing to shared playing, and from this to cultural experience”

(p. 51). The child’s relinquishment of her transitional object does not mean that she does not

carry with her the psychological and emotional capacities that emerged through her engagement

with her transitional object. Indeed, her ability to tolerate and enjoy the paradoxes of transitional

space enables her to partake in the cultural phenomena, an activity that constitutes a more

complex and increasingly object-related medium in which she explores and becomes enriched by

the communication between the me and not-me worlds in the realm of potential space. The

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common phenomenon of becoming immersed in a novel provides an example of this process.

The characters in the novel can in part be viewed as not-me objects that have been presented to

her by the author, who belongs to the not-me world. Yet, the reader brings her own history and

idiom to the reading experience, imbuing the narrative with her own personal meaning while

sharing Raskolnikov’s despair, journeying through forests with Frodo, or sitting in contemplation

by the river with Siddhartha. The words on the page may not change, but every reader makes

them her own and, in doing so, occupies an enlivening space in which the boundaries between

self and the outside world become blurred. I will deepen this preliminary discussion of creativity

in later chapters.

Aggression. Winnicott’s views on aggression radically differed from the Freudian and

Kleinian perspectives that dominated the psychoanalytic scene. Drawing on Sigmund Freud's

latest model of dual instinct theory, Melanie Klein placed aggression at the center of her theory.

Klein envisioned aggression as an inborn drive (associated with the Death Instinct) that was, by

nature, sadistic and destructive. Winnicott's eventual theory of aggression differed from Klein's

in nearly every way. While he did believe in the innateness of aggression, he characterized it in

a completely different light. First of all, he strongly disagreed with Klein's construal of

aggression as inherently destructive and traced aggression back to its earliest physical

manifestation—the "attack" on the breast during the phase of absolute dependence—in order to

make his point. In essence he noted that a characterization of the infant's aggression as

destructive carries with it an implication that the infant's "aggression is meant;" this is to say that

to ascribe to the infant the ability to "mean" something by his aggression is to "inflict intentions

on the infant of precocious sophistication” (Phillips, 1988, p. 106). Winnicott did not consider

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aggression to be an "instinct" in the traditional sense at all, instead conceiving of it as one of the

"two 'roots' of instinctual life’” (p. 109). “Instinctual life” seems to represent the experience of

propulsion underlying all thoughts, feelings, and behaviors. Winnicott later preferred to

"aggressive and erotic components," as opposed to aggressive and erotic "instincts." This

terminological shift may have been an attempt to distance himself from instinct theorists, who

tended to characterize instincts as physiologically based and more or less divorced from

environmental factors. I interpret this change in phraseology as an attempt to shift readers’

attention away from biologism and reductionism and towards a consideration of “instinctual life”

not as an violent battleground, but as an interaction of broader components of the personality that

are constantly interacting and always influenced by the environment. Winnicott therefore

focused much more on the experience of instinctual life rather than a reductionistic, experience-

distant, and supposedly comprehensive metapsychological explanation of those forces which

underly human activity throughout the lifespan.

In Winnicott’s thinking, aggression and eroticism have quite opposite aims: while the

erotic seeks out merger and union, aggression desires opposition, conflict, and separation. The

infant with insufficient opportunities to experience desire (e.g. an infant whose mother

anticipates and meets his every need or is unable to survive his aggression) also does not have

the chance to find creative and healthy ways to deal with the pain of separation and dependency.

Doing so requires and facilitates the actualization of the child's aggressive potential, which

actually seeks differentiation from the "external" world. It is aggression that enables the

individual to say “I am ME” with confidence and enthusiasm. Thus, we see here the

interrelatedness of aggression and the development of a sense of agency and authorship. A zest

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for life and a bolstered sense of self naturally accompany these feelings of efficacy. Although

the meeting of erotic needs for merger is absolutely essential for healthy development and for the

maintenance of the protective envelope, the inability of the mother to facilitate and survive the

expression of the child's aggressive potential forecloses the possibilities of achieving drive fusion

and living a life unshackled to the protective False Self self-organization 6, at least until the

individual has an experience that provides the necessary experiences absent in childhood. It is an

individual’s inability to “integrate aggressiveness and love” (rather than innate sadistic

tendencies) that results in pathological manifestations of aggression; a particularly common

result of failure of fusion is the disavowal of aggression, which results in the loss of the

“constructive ability to pursue realistic goals” (Summers, 1994, p. 177). Embedded in

Winnicott’s formulations on aggression are concepts such as object usage, survival of the object,

fantasy, the creation of externality, whole object relatedness, cross-identification, the capacity to

love, and the capacity for concern.

“Male” and “Female” Elements of the Personality. The concept of “male” and “female”

elements of the personality will play an important role in developing an understanding of

addiction in terms of being, aggression, and creativity. Winnicott introduced these terms in

Playing and Reality, and there is significant overlap between these terms and what has already

been said about Winnicott’s writings on being and aggression. Winnicott associated the female

element of the personality with “being,” union, and continuity, whereas he described the male

6 Winnicott characterized the true self as the center of aliveness from which the spontaneous gesture arises and
which, in health, infuses one’s day to day experiences with a sense of realness and authenticity. The false self, on
the other hand, is the “caretaker self” that “is there to defend the true self” by meeting the demands of the not-me
world; when false self activity predominates, one’s life is predominantly reactive and leads to pervasive feelings of
futility and meaninglessness (Abram, 1996, p. 277).

 33

component as involving “doing,” separateness, and the desire for conflict. In discussing the

female element, Winnicott wrote, “The study of the pure distilled uncontaminated female

element leads us to BEING, and this forms the only basis for self-discovery and a sense of

existing” (Winnicott, 1971, p. 82). This clearly resembles Winnicott’s discussion of the simple

continuity experienced by infants during the phase of absolute dependence. Winnicott believed

that psychoanalytic theory had focused too much on the male element of the personality, the

object relating of which presupposes ego integration and underlies the more complex psychic

mechanisms of projection, introjection, and splitting. This was unfortunate because it kept

psychoanalysts from realizing that many emotional and psychological difficulties arise when

there the male element of the personality predominates because the individual’s “doing” does not

have the foundation of “being.” It is important to keep in mind that Winnicott believed that the

male and female elements of the personality exist in both men and women and that he posited an

inherent psychological bisexuality. Abram (1996) highlighted the similarities between

Winnicott’s writings on the male and female elements of the personality and Carl Jung’s

discussion of Eros and Logos: “Eros is attributed to the female and denotes the psychic principle

of relatedness, whereas Logos, attributed to the male, is seen as dynamic and described the

psychic principle of differentiation…Jung asserts that both can coexist in a single individual of

either sex” (p. 65). We will see in the case of Roger that his addiction to opiates can be seen in

part as a strong need to experience the simple being of the female element, a need that arose

from an overidentification with the male element of his personality during childhood and early

adolescence.

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Psychopathology. Not surprisingly, Winnicott developed his views on psychopathology

in the context of maturational processes, emotional development, and creativity; furthermore, he

always takes into consideration the role of the environment in both the development and

maintenance of mental illness. Winnicott (1963c) provided his clearest definition of

psychopathology in terms of emotional maturity and maturational processes in “The Mentally Ill

in Your Caseload,” in which he wrote:

For mental illnesses are not diseases like phthisis, or rheumatic fever…They are patterns

of compromise between success and failure in the state of the individual’s emotional

development. Thus health is emotional maturity, maturity at age; and mental ill-health

always has behind it a hold-up of emotional development. (p. 222)

We see therefore that Winnicott, like many other psychoanalytic theorists, adheres to the notion

of psychopathology as developmental arrest. However, Winnicott described himself from others

in his statements regarding the etiology of mental illness, the role of the environment, and

psychopathology’s relationship to creativity and play. From a Winnicottian perspective,

psychopathology is best characterized as reactive, uncreative, unspontaneous, and immature.

Goldman (2012) stated: “For Winnicott…pathology is, to a large extent, a failure of

imagination” (p. 343). Unimaginative living is both established and perpetuated by an

overreliance on defenses that block the further development of maturational processes and

simultaneously protect the individual from psychological and emotional injury.

Addiction. This project’s operational definition of addiction proceeds directly from the

above discussion of development, internal and external reality, transitional objects, creativity,

play, aggression, and psychopathology. Although the discussion of addiction will not be based

 35

on psychiatric classification, diagnostic approaches do provide a useful perspective in identifying

symptoms common to those suffering with substance use. Despite the immense differences in

the etiology and experience of addiction amongst individuals, some symptoms seem to be

present in most cases. It has become common practice to differentiate what Doweiko (2012)

referred to as “substance use disorders” into various categories such as abuse and dependence

(2012, p. 15). The authors of the DSM-IV asserted that a diagnosis substance dependence

requires the exhibition of symptoms such as (a) “persistent desire or unsuccessful efforts to cut

down or control substance use,” (b) using the substance “in larger amounts or over a longer

period than intended,” and (c) continued use “despite knowledge of having a persistent

physiological or psychological problem that is likely to be caused or exacerbated by” drug use

(American Psychiatric Association, 2013, p. 197). When using the DSM-IV as a diagnostic tool,

a diagnosis of dependence requires the presence of tolerance and/or withdrawal; otherwise, a

diagnosis of substance abuse is made. A precise differentiation between abuse and dependence

will not be necessary in this discussion, but the presence of common symptoms will be explored

from a psychodynamic perspective. This study will move beyond the simple fact that the

symptoms exist by exploring why they are present and how they are experienced. It should also

be noted that the words “substance” and “drug” will be used interchangeably; furthermore,

alcohol will be classified as a drug.

Winnicott (1951) made one of his few explicit statements regarding addiction at the end

of his landmark paper on transitional objects and phenomena: “Addiction can be stated in terms

of regression to the early stage at which the transitional phenomena are unchallenged” (p. 242).

In other words, Winnicott asserted that addiction can at least in part be understood as an attempt

 36

to re-experience—or perhaps to experience for the first time—the generative and vivifying

process that in infancy and early childhood is the foundation for safe and meaningful reciprocity

between me and not-me. Winnicott viewed psychopathology as a “failure of imagination,” or

crisis of imagination. Above, psychopathology was characterized by the relative lack of active,

creative, spontaneous, and emotionally mature living. This dissertation will construe addiction

as a psychopathological phenomenon in which the deficits in these areas have become manifest

in and are maintained by the repetitive, uncontrollable, and self-destructive use of one or more

substances. This conceptualization of addiction involves the experience of psychological and

emotional suffering that derives from continued use. Without denying its hereditary and

biological components, addiction will be understood to some extent as a defensive and self-

protective operation. Although addiction will be viewed as pathological in nature, it will become

clear that it also represents an individual’s attempt to survive psychologically and emotionally in

a threatening world.

Summary

We have now demarcated our area of exploration. It should be clear by now that this

dissertation will prioritize depth over breadth. Just a few minutes of online research will reveal

an abundance of literature on addiction as it pertains to heredity and psychiatric diagnosis.

Furthermore, a great deal of time has been devoted to the consideration of addiction from various

psychodynamic perspectives. This study will be concerned with discovering in what ways we

might enrich our understanding of addiction by viewing it through the eyes of a man whose

interest lay not in systematization or certainty, but in the appreciation of human creativity and the

emotional suffering that results from its absence. To this end, we owe it both to patients and to

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Winnicott himself to plumb the depths of his intricate theories and to determine how his insights

might illuminate the ubiquitous and tragic phenomenon of drug addiction.

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Chapter 2: Literature Review

Introduction

Finding a place for Winnicott in the psychoanalytic literature on addiction requires a

careful exploration of the surrounding landscape. This dissertation will emphasize the

Winnicottian themes of being, creativity, and aggression as they pertain to addiction in particular

in the life example of Roger. The following review of the literature will contextualize these

three themes in terms of their origins in the history of psychoanalysis and in light of their place

in both past and contemporary psychoanalytic investigations of addiction. The first section will

show that deficits in the areas of creativity, being, and aggression may be seen as what the

contemporary theorist Khantzian termed “addictive vulnerabilities,” thus demonstrating the

relevance of Winnicott in the current climate of psychoanalytic addictions studies. The second

section of the literature review will then reveal the immense influence of Melanie Klein on

Winnicott’s theorizing in general, on the development of these three concepts, and on the

relationship between his ideas and the study of addiction. We will also see that many of

Winnicott’s most important contributions have their origins in the rejection of various elements

of Kleinian theory. The stage will then be set for an in depth examination of what has been

written about Winnicott and addiction. This part of the literature review will be broken down

into discussions regarding absolute dependence (the territory of being and primary creativity),

relative dependence (the territory of creativity as it pertains to the negotiation of inner and shared

reality) and the origins and nature of aggression. Although contributors such as Eigen and Eve

Livingston have provided substantive investigations of this field of study, the current body of

literature on Winnicott and addiction fails to capitalize on the richness of Winnicottian theory.

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The final divisions of this chapter will address the following question: Why Winnicott now in

regard to addiction studies? Answering this question will help to clarify the relevance of the

current study and to lead us to consider the ways in which the analysis of case studies provides

an especially fruitful medium for the elaboration of the Winnicottian themes of being,

aggression, and creativity as they pertain to the phenomenon of drug addiction.

Winnicott and Contemporary Psychoanalytic Perspectives on Addiction

The introduction made it clear that there has been a marked paucity of psychoanalytic

literature on addiction in the last 30 years. Despite this state of affairs, a number of pivotal

themes have been introduced in more recent literature that facilitate clinicians’ efforts to

understand the role of psychodynamic factors in the development and maintenance of addiction,

as well as in the recovery process. Equally important is the emphasis contemporary rs have

placed on clarifying the fact that psychoanalytic considerations constitute just one of the many

dimensions that must be considered in conceptualizing and treating addiction. An examination

of the entirety of psychoanalytic contributions over the last several decade lies beyond the

purview of this dissertation. Instead, this section will therefore deal primarily with two concepts

that will be salient throughout this project—Khantzian’s notion of “addictive vulnerability” and

de Paula Ramos’ writings on “dependogenic processes.” These two ideas will permit us to view

developmental deficits in the areas of being, aggression, and creativity not as causal, but as

correlative to other vulnerabilities and processes in the phenomenon of addiction. As we will

see, it is essential to make this clarification before illuminating the historical development of

Winnicott’s theories because the reductionist position that early experiences or particular types

of psychological deficits are either necessary or sufficient in the genesis of addiction must be

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discarded. After summarizing of the contributions of Khantzian and Ramos, this chapter will

provide a preliminary picture of how Winnicottian theory can be understood in light of these

contemporary perspectives.

Khantzian has probably been the most prolific r on psychoanalytic theory and addiction

in the last thirty years. Whether contributing to Neuropsychoanalysis or Psychoanalytic

Dialogues, we find at the center of all his theorizing a consistent emphasis on affects and self-

regulation. He never denies presence or importance of previous explored undercurrents in

addiction such as superego dynamics (the “splitting of the superego” that makes

“conscience…irrelevant” and that renders meaningless “trustworthiness, reliability, and

commitment to others”) “structural deficits,” or “hyposymbolization” (Wurmser, 1977, p. 45;

Khantzian, 2005, p. 613). He did, however, deemphasize these issues and finds more clinical

utility in directing his attention elsewhere. His approach to addiction studies—particularly his

writings on addictive vulnerability—will be instrumental in guiding this dissertation’s integration

of Winnicottian theory and addiction. Indeed, an accurate depiction of addiction from a

Winnicottian viewpoint will necessitate the adoption of the following statements, each of which

are either implicit or explicit throughout Khantzian’s writings: (a) people abuse drugs in part as a

response to suffering, (b) the existence and/or coalescence of difficulties in psychological

capacities such as affective dysregulation or self-care can contribute to the development of

addiction and/or exacerbate suffering during active addiction, (c) the nature of each individual’s

relationship with drugs will almost inevitably intertwine with his or her intrapsychic and

interpersonal dynamics, and (d) a strictly psychodynamic perspective will necessarily omit

various other dimensions of addiction.

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Khantzian introduced the notion of addictive vulnerability long after his original

publications about the self-medication hypothesis (SMH). Addictive vulnerability serves the

purpose of providing a broader context in which to place his previous writings on

psychopharmacological specificity. In his writings on addictive vulnerability, Khantzian (1997)

sought to explore “a basis to explain the essential psychological vulnerabilities that can

malignantly coalesce in an individual to increase the likelihood of a substance use disorder” (p.

233). The integral component of addictive vulnerability lies in addiction’s being a “self-

regulation disorder.” We find in most addicts the presence of disordered self-esteem,

relationships, emotions, and/or self-care (Khantzian, 2003). Addicts struggle to negotiate the

vicissitudes involved in the regulation of self-esteem, interpersonal relationships, emotions, and

self-care in an adaptive and constructive way. The difficulty they have in self-regulation

evidences that addicts are “either arrested or traumatically regressed” in a “normal

developmental line” (Khantzian, 1997, p. 233). Here we can clearly see Khantzian’s adoption of

the psychoanalytically informed deficit model embraced by Winnicott. Khantzian (1997)

provided an example of a “normal developmental line” in his discussion of the “affect deficits”

present in many addicts: “…a normal developmental line for affects in which they are

undifferentiated, somatic, and not verbalized at the outset; later, they differentiate (e.g. feelings

of anxiety and depression can be recognized and distinguished), become desomatized, and are

expressible in words” (p. 233). Khantzian (2003) described “essential factors” and

“contributory” factors. Whereas disordered emotions and self-care are “two of the most basic

and essential factors that coalesce” in the formation of addiction, disordered self-esteem and

relationships are “not sufficient or essential to develop [substance abuse disorders]” (p. 19). The

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drug can serve as both a way to (temporarily) compensate for the deficits in maturation and as a

means of coping with the suffering associated with the inability to successfully regulate these

sectors of their personality. Khantzian’s earlier writings did not provide the broader backdrop of

addictive vulnerability. He focused his attention primarily on the hypothesis that particular

psychological and emotional patterns predisposed an individual to abuse a particular substance.

Underlying this proposition is the idea that an addict’s choice of a particular drug is not random.

Khantzian (1997) claimed that many opiate addicts’ conflicts revolve around the “internally

fragmenting and disorganizing affects of rage and the externally threatening and disruptive

aspects of such affects to interpersonal relations” (p. 232). In his extensive work with heroin

addicts, Khantzian (1997) observed that the majority of his patients sought the tranquilizing

effect of heroin because of its effectiveness in quelling overwhelming and intense feelings of

hostility. Individuals seek alcohol as an “ego solvent;” alcoholics tend to have deeply rooted and

rigid defenses that create feelings of “isolation and emptiness,” and alcohol “create[s] the illusion

of relief because [it] temporarily soften[s] rigid defenses and ameliorate[s] states of isolation and

emptiness that predispose to depression” (Khantzian, 1997, p. 233). The appeal of the SMH lies

in its apparently intuitive truth. Assuming an addict has access to a wide variety of drugs, it

seems likely that he or she would inevitably prefer one to another. Furthermore, one cannot help

but wonder whether or not this “choice” might correlate in some way with one’s underlying

psychological and emotional patterns.

The SMH has been harshly criticized by many in the field of addictions. Some have

pointed out the lack of supporting empirical evidence (Greene et al., 1993; Shinka, et al., 1994)

by administering personality assessments such as the Personality Assessment Inventory (PAI)

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and Minnesota Multiphasic Personality Inventory (MMPI-2). These findings have been

challenged by adherents to Khantzian’s theories. For example, Suh et al. (2008) wrote: “Given

that the SMH involves underlying affects and psychological defenses, and their link to addiction,

the SMH might not have been supported empirically because these studies used assessment tools

that could not validly measure the psychological constructs relevant to the SMH (p. 520). Anne

Lembke (2013) bluntly and unequivocally rejected the SMH on the grounds that Khantzian

endorses a clinical approach that overlooks biological determinants and that erroneously posits a

causal link between psychopathology and addiction. She lamented that Khantzian (2013)

overlooks the biologically based process of reinforcement by “encouraging addicted individuals

to regard symptoms of withdrawal as evidence of an underlying psychiatric condition, which

‘justifies’ their ‘need’ for continued use of substances” (p. 671). I have found in my research a

fundamental problem underlying the negative responses to the SMH and addictive vulnerability:

many authors tend to overlook the open-minded and integrative approach Khantzian adopted in

his writing. Each of the above mentioned criticisms in some way mischaracterizes Khantzian as

reductionistic and close-minded. Such a reading of Khantzian’s writings results in a

communication breakdown between various schools of thought that have much to offer one

another. Furthermore, an outright rejection of Khantzian’s overall approach to addiction may

detract from clinicians’ ability to develop an exploratory approach that honors the complexity

and intensity of their addicted clients’ suffering. For Khantzian (2003), “It is more alliance-

producing…to at least initially explore what the drug does for them…[this] leaves the patient,

often for the first time, feeling more understood” (p. 12). He also encouraged therapists to

examine with clients what their drug of choice did for them before they became chemically

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dependent. Adopting a primarily biological approach to addiction may lead therapists to

overlook the emotional and historical corollaries of their substance use problems.

Ramos (2004) provided extensions and criticisms of Khantzian’s theorizing in “What

Can We Learn from Psychoanalysis and Prospective Studies about Chemically Dependent

Patients?” He continued Khantzian’s line of thought in focusing on psychopathology as a

vulnerability and on the multidetermined nature of addiction. However, he expressed

disapproval of Khantzian’s notion of psychopharmacological specificity (the SMH) and wrote

that Khantzian “seem[s] to be only appending some detail to the well-known theory of

narcissism” and its concomitant problems in successfully emerging from the “fusional

relationship with the mother” (p. 475). Ramos did not claim that narcissistic dynamics are not

found in chemically dependent patients. His criticism lies in his assertion that we do not find the

presence of narcissistic tendencies in all cases of addiction. Furthermore, Ramos (2004) rejected

the notion that any particular psychopathological pattern underlies addiction in writing, “To

assume that, for example, a 50-year-old woman who is addicted to benzodiazepine, an alcoholic

businessman, a teenage ‘crack’ addict and a smoker have the same psychodynamic genesis

seems overly pretentious. (p. 468). This statement implies a rejection of Khantzian’s position

that the psychological vulnerabilities of all addicts can be characterized as failures in self-

regulation. This is not to say, however, that such individuals could not each have developmental

patterns that lend themselves to addictive vulnerability.

Ramos also provided more general criticisms of some psychoanalytic writings on

addiction. Ramos (2004) refuted the counterintuitive notion that all addicts have had inadequate

parenting experiences: “To think that all these people had ‘not good enough’ mothers…seems to

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elude common sense. Perhaps it is preferable to suppose that in a frequent condition such as

alcoholism, for example, one finds all situations represented in other human beings” (p. 473).

His explicit reference to Winnicott’s notion of the “good enough mother” makes the above

statement especially salient for the present investigation. We also find one of his most

substantive critiques in his discussion of psychoanalytic rs’ tendency to overgeneralize from a

select group of patients.

Ramos’ notion of dependogenic processes addresses the limitations of the psychoanalytic

approach while simultaneously creating a space in which to effectively explore the intrapsychic

and interpersonal dynamics found in chemically dependent patients. He also helps clinicians in

negotiating and, to some extent resolving, the “cause-consequence controversy” of whether

psychopathology results from or precedes addiction. He summarized his position in saying,

I prefer to believe that, as one becomes dependent on chemicals, a process which may be

called dependogenic is instilled. Then the issue of gratification without the other, or the

need which is satiated anywhere and at any time, with all its oral and narcissistic

components, arises. For us, primarily therapists, whether this precedes or follows

chemical dependency should not be a paralyzing matter…I am of the opinion that

[narcissism, gratification without object, and omnipotently controlled need] exist, without

being specific, and do nothing else aside from create vulnerability…for a future

installation of a dependogenic process. This process, however, will only begin if the

individual possesses other vulnerabilities. (2004, p. 473-475)

The above statement will serve as a guiding principle throughout this dissertation. I will be

operating within the margins of Winnicottian theory, but it should always be kept in mind that

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the psychological, emotional, developmental, and interpersonal facets I address will constitute

only part of the complex cluster of vulnerabilities underlying our case study of Roger’s

addiction. In dissolving (or at least deemphasizing) the cause-consequence controversy, Ramos

allows therapists to focus on what is truly important in their work: helping patients to grow. Like

many patients, chemically dependent individuals often struggle to face the challenges of daily

life without experiencing feelings of inner deadness, dissolution, or chaos. What separates

addicts from non-addicts is the fact that an addict’s psychopathological patterns are inextricably

linked with their relationship to an intoxicating substance—regardless of whether or not the

underlying psychological dynamics existed before the initiation of abuse. In a series of case

vignettes, Ramos effectively demonstrates that the dependogenics patterns that were present in

his patients’ active addiction resurfaced in times of abstinence, albeit with different

manifestations. Ramos (2004) wrote the following to illustrate this point: “…this is a patient that

came to analysis one year after she had quit using psychoactive substances but who, despite this

abstinence, progressed with her dependogenics pattern (she gained weight, started smoking,

sometimes masturbated compulsively, and in treatment seemed to be by herself)” (p. 478).

Furthermore, he stated that admitting dependence is in and of itself a profound narcissistic

wound and may lead to the deployment of especially maladaptive defenses. He pleaded with

clinicians not to overlook psychological vulnerabilities and warns that failing to address them

could play a part in eventual relapse. He identified difficulties in the “transition from Narcissus

to Oedipus” and the “passage from…dyadic to triadic relationships” as especially prominent in

many (but by no means all) cases of chemically dependent patients (2004, p. 481). As we have

seen, Winnicott’s writings focus a great deal on the spectrum of experiences between

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undifferentiation and unit status. Ramos’ belief in the pervasiveness of such dynamics in

addiction makes his contributions all the more salient to the project at hand.

Whereas Khantzian focused on difficulties of self-regulation as the primary psychological

vulnerability in addicted individuals, this dissertation will consider from a Winnicottian

perspective how deficits in various developmental capacities might predispose an individual to

develop a drug addiction or contribute to his or her suffering during both active addiction and

recovery. Let us consider the capacity for “being.” For Winnicott, inadequate experiences of

continuity of being, unintegration, and formlessness can lead someone to perceive “the world

and its details…as only something to be fitted in with or demanding adaptation,” a state that

“carries with it a sense of futility for the individual and is associated with the idea that nothing

matters and that life is not worth living” (Winnicott, 1971, p. 65). Such an internal state might

lead to any number of psychological and emotional difficulties. In the presence of other

vulnerabilities, might these intrapsychic and interpersonal dynamics facilitate the development of

addiction to a drugs such as heroin or cocaine? Eve Livingston (2004) described the experience

of heroin intoxication as a womb-like state in which one need not worry about the world “out

there” and where the individual has a reassuring sense of omnipotence, calm, and inner vitality.

One cannot help but notice the similarity between this experience and the unintegration

Winnicott associates with absolute dependence. Consideration of this dynamic as a

dependogenic process might help us not only in conceptualizing addiction, but in our work with

patients in recovery. Keeping in mind that our abstinent clients may have lost their primary

means of sensing what Winnicott called “the foundation for the experience of being” may inform

our approach with them (Winnicott, 1971, p. 84). As we will see throughout this dissertation,

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integrating Winnicott’s theories with the contributions of Khantzian and Ramos will allow us to

develop a Winnicottian perspective on addiction that resonates with and adds to contemporary

psychoanalytic addictions literature.

Melanie Klein’s Influence on Winnicott’s Theorizing

Winnicott firmly anchored his early theorizing in the ideas of Melanie Klein. Although

Winnicott had completely rejected many of the central tenets of Kleinian theory by the end of his

life, one can still trace much of his later theorizing back to her original work. After stating his

agreements and disagreements with Klein in his 1962 essay, “A Personal View of the Kleinian

Contribution,” Winnicott wrote: “The main point is that whatever criticism we may want to

make of Klein’s standpoint in her last two decades, we cannot ignore the very great impact her

work has had in England, and will have everywhere, on orthodox psychoanalysis” (p. 177-178).

Winnicott (1935) expressed his indebtedness to her nearly thirty years earlier in stating that

studying Klein “has coincided with a gradual deepening of my appreciation of inner reality” (p.

129). This section will consider the central tenets of Klein’s perspective and their immense

influence on Winnicott’s own theorizing; doing so will allow for a more substantive elaboration

of what Winnicott means by being, aggression, and creativity. By the end of this section, we will

have prepared the way for a discussion of the relationship between Kleinian and Winnicottian

perspectives on addiction.

Before discussing Klein’s influence on Winnicott, it will first be necessary to provide a

concise summary of her theory. Klein always considered herself a Freudian and devised a theory

that was inextricably bound to Freud’s ideas—especially the constitutionality of the life and

death instincts (Eros and Thanatos). The libidinal drive and pleasure principle always played a

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central role in Freud’s theories, and Freud contended that it is the inherent drive for libidinal

gratification that leads the baby to its mother’s breast and which continues to shape human

behavior throughout life. However, he slowly began to realize that much of human behavior

(e.g. masochism and the compulsion to repeat) could not be accounted for by the operation of

libidinal forces alone. His solution centered on the death instinct, which he first introduced in

Beyond the Pleasure Principle (1920). In this work, he described the death instinct as “an

instinct that is an urge inherent in organic life to restore an earlier state of things;” furthermore,

he wrote, “the aim of all life is death” (Freud, 1920, p. 36, 38). Mitchell (1986) described the

death instinct as “a force that [strives] to return the human being back into a state of inertia, of

the inorganic” (p. 14). The only way in which the infant can deal with such a horrific impulse is

by projecting it outward—the child (and many adults) may feel the need to aggressively destroy

objects external world, particularly those that are perceived as threats to survival.

Like Freud, Klein’s entire theory of development and psychological life rests on the

presupposition of constitutional drives. Unlike most of her contemporaries, Klein both accepted

and brought the death instinct to the forefront. Her emphasis on the death instinct becomes

evident in “Notes on Some Schizoid Mechanisms,” where she wrote, “I hold that anxiety arises

from the operation of the death instinct within the organism…the fear of the destructive impulse

seems to attach itself at once to an object” (Klein, 1946, p. 179). Regardless of whether an

individual is healthy, neurotic, borderline, or psychotic, the death instinct always plays a

powerful role in their psychological life. Despite these similarities, we also find in Klein’s work

some significant reformulations of the classical Freudian perspective. Whereas Freud’s writings

greatly privileged the physiological dimensions of drives, Klein introduced both experiential and

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relational elements. Regarding the experiential component of drives, the key difference lies in

Klein’s definition of “instinctual impulses [not as] physiological drives, but hopes, fears, and

wishes experienced in bodily terms” (Gomez, 1997, p. 34). Many have criticized Freud for

deemphasizing the relational dimension of instinctual life. In his theorizing, the baby discovers

the object (breast) accidentally, for it just happens to be the first appropriate object for oral

libidinal satisfaction that the infant discovers. Klein, on the other hand, believed that the baby is

born “with an innate unconscious awareness of the mother” (Klein, 1986, p. 22). This statement

has enormous implications—it means that drives are object-seeking and naturally relational. The

experience of drives also plays an instrumental role in the formation of identity: “[Klein] saw

libidinal and aggressive impulses…as ways of experiencing oneself as ‘good (both loved and

loving) and as ‘bad’ (both hated and destructive)” (Mitchell & Black, 1995, p. 91).

The concepts of the paranoid-schizoid and depressive positions are perhaps the most

influential of Klein’s formulations; not surprisingly, much of the literature on Klein and

addiction emphasizes their role in the phenomenon of addiction. In her introduction to Klein’s

“The Psychogenesis of Manic-Depressive States,” Mitchell (1986) concisely described Klein’s

‘position’ from Freud’s psychosexual stage: “…a position is an always available state, not

something one passes through” (p. 116). Infants are born into a confusing, frustrating, and

terrifying world. Klein “portrayed the infant’s experience as composed of two sharply polarized

states, dramatically contrasting in both conceptual organization and emotional tone” (Mitchell

and Black, 1995, p. 92). To the infant, the breast represents all that is good, nourishing, and

loving. However, the same breast can also deprive the infant and frustrate her needs for

connection and nourishment and is perceived as a punishing and sadistic. In order to cope with

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the chaotic oscillation between feeling loved and starved, the infant in the paranoid-schizoid

position utilizes the primitive defense mechanism of splitting, in which the child relates to the

mother’s breast as two separate part objects—the “good” and “bad” breasts. Splitting, although

engendering paranoid anxiety, creates a state for the child in which “aggression is contained in

the hateful relationship with the bad breast, safely distanced from the loving relationship to the

good breast” and creates an “equanimity” that provides the child with a means of attaining inner

coherence (Mitchell and Black, 1995, p. 94-95). In times of great distress, all individuals have

the potential to revert to paranoid-schizoid dynamics in order to survive psychologically and

emotionally.

The child soon comes to realize that the breast that protects and feeds her is the same

breast that starves and poisons her—this realization marks the advent of the depressive position.

The infant begins to relate to the breast as a whole object and to her mother as much more than a

repository of milk. Mitchell and Black (1995) wrote, “much is gained in the movement from the

experiences of others as split…to the experience of others as whole objects. Paranoid anxiety

diminishes…the necessity for the vigilance of splitting is reduced; the infant experiences herself

as more durable, less in danger of being crushed or contaminated by external or internal forces”

(p. 93). However, the transition to the depressive position in no way implies an absence of

anxiety or psychic conflict. The child now realizes that she has hurt and cannibalized her loving

mother. This implies that she has also destroyed the source of goodness in the world, which not

only diminishes the goodness of the outside world, but causes the child to feel an overwhelming

sense of guilt and regret. Depressive anxiety has now arisen. To cope with these overwhelming

emotions, the child develops reparative fantasies, through which she hopes “to make restitution

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for all the sadistic attacks that [she] has launched onto that object” (Klein, 1935, p. 120). If

successful, the child may be able to salvage the good in the external world and, therefore, within

herself—within herself, because she has introjected the damaged, caring mother and

incorporated it into her own identity. This is no easy task, however, for the child’s destructive

and sadistic impulses have not subsided. Every sadistic projection renews the threat of the good

object’s destruction. The ability to preserve the good object becomes even more difficult when

the child believes herself incapable of such a task and is consumed with “self-reproach,” as well

as “feelings of unworthiness and despair” (Klein, 1935, p. 125). The maintenance of the

depressive position requires that the child “believe[s] that her love is stronger than her hate, that

she can undo the ravages of her destructiveness” (Mitchell & Black, 1995, p. 95).

Winnicott readily admitted Klein’s influence on his thinking and often expressed

appreciation for her advancement of psychoanalytic theory. Despite his gradual departure from

several of her most basic premises, Winnicott never discarded her contributions altogether. We

notice this especially in what continued to be prominent topics and themes over the course of

forty years of writing. His refusal to ignore the earliest psychological processes of infancy

represents perhaps the most obvious commonality with Klein. As a pediatrician, Winnicott was

shocked to discover that so many of his colleagues in the psychoanalytic community paid little

attention to the experiences and psychology of infants. Winnicott (1962b) wrote the following of

his early years in British psychoanalytic circles: “Something was wrong somewhere. When I

came to treat children by psycho-analysis I was able to confirm the origin of psychoneurosis in

the Oedipus complex, and yet I knew that troubles started earlier” (p. 172). He described his first

introduction to Melanie Klein as “an important moment in my life” because she, unlike many of

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their contemporaries, had much to say about “the anxieties that belong to infancy” (1962b, p.

173). He also followed her lead in favoring a less linear model of development by asserting that

adults can (and should be able to) return to even the earliest states of infancy: “…for Winnicott

the healthy integration made possible by a holding environment is always reversible; states of

unintegration can be tolerated and enjoyed” (Phillips, 1988, p. 81). Klein’s depressive

position—with its emphasis on the ability to relate to whole objects, tolerate ambivalence, and

integrate one’s love and hate—play a central role in Winnicott’s theorizing about the phases of

relative dependence and “towards dependence.” Similarly, Klein’s emphasis on unconscious

phantasies of destruction and reparation surfaces in Winnicott’s writings on the capacity for

concern and the use of an object, both of which will be discussed shortly. Essential both to

Winnicott’s theory and to the current study of addiction is Klein’s “understanding of threatened

chaos in inner psychic reality and defences related to this chaos” (Winnicott, 1962b, p. 178).

Indeed, Winnicott’s contributions on the defenses of compliance, dissociation, and manic flight

are based upon the assumption that defensive maneuvers are in large part reactions to a sense of

inner chaos or deadness.

Despite these numerous areas of convergence between Klein and Winnicott, he would

likely make the same criticism of Klein that he leveled at classical psychoanalysis in general:

“…we seldom reach the point at which we can start to describe what life is like apart from illness

or absence of illness. That is to say, we have yet to tackle the question of what life itself is

about” (Winnicott, 1971, p. 98). This quote, taken from a chapter in Playing and Reality entitled

“The Location of Cultural Experience,” embodies the very essence of Winnicott’s theory and

reflects decades of unceasing reflection, clinical work, and meticulous scrutiny of past and

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contemporary psychoanalytic theory. Winnicott concerned himself less with formulating an

airtight metapsychological framework than he did with what enabled individuals to have “the

feeling of real” (Winnicott, 1956, p. 305). The combination of his work with thousands of

children, and his analysis with patients who struggled with feelings of unreality, inauthenticity,

and of being “caught up in…a machine” allowed him to formulate a developmental theory much

at odds with most of his contemporaries, even those who had the greatest impact on his thinking

and practice (Winnicott, 1971, p. 65). The three concepts at the core of this dissertation—being,

aggression, and creativity—grew in large part from his disagreement with Klein on the

psychological state of newborns, the nature of aggression, and the role of the environment in

early development.

Winnicott’s notion of being grew out of his two most fundamental criticisms of Klein:

her neglect of the environmental factor and her assumption that the infant starts life in a state of

integration in which it can clearly differentiate between “me” and “not me.” During a meeting of

the British Psychoanalytic Society, Winnicott famously stated, “There is no such thing as a baby,

only a nursing couple” (Philips, 1988, p. 5). The phase of absolute dependence requires the

mother to provide her newborn with a post-natal psychological womb where the infant is not

aware of his own physical, psychological, and emotional needs, is able to follow his natural

course of development, and has the chance to experience the unfolding of his unique potential.

The mother does this through primary identification with her infant and by anticipating almost

telepathically her child's needs. “Primary maternal preoccupation” sets up a matrix in which

there is no division between mother and child, in which the mother's ego is, in a sense, the child's

ego, or at least provides the shell in which the infant's nascent psychological structure can form

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(Winnicott, 1956). The crucial aspect here is that the good-enough mother allows her infant the

experience of formlessness, continuity, and “going-on-being.” The infant is permitted to

experience a continuity of being, which allows for the gestation and birth of the “central” or

“true” self: “The central self could be said to be the inherited potential which is experiencing a

continuity of being, and acquiring in its own way and at its own speed a personal psychic reality

and a personal body scheme” (Winnicott, 1960, p. 46). Simply put, there is no place for such a

concept in Klein’s theorizing. Klein’s theory rests on the assumption that projective and

introjective mechanisms are highly active from the very start, whereas Winnicott’s ideas on

being presuppose the existence of a state in which there is no “outer” to introject and no “inner”

to project outward. Winnicott’s notion of being is closely linked with his notion of the “female

element” of the personality, a concept that will play an important role in the fourth chapter of this

dissertation.

Winnicott’s theory of being had profound implications for his formulations regarding

anxiety. Because Klein presupposed an initial subject/object distinction in the life of the child—

therefore overlooking the initial state of being—Winnicott felt that Klein fundamentally

misunderstood what constitutes not only the bedrock of psychic life, but the nature of primordial

anxieties themselves. If you will recall, Melanie Klein believed that “anxiety arises from the

operation of the death instinct within the organism [and that] the fear of the destructive impulse

seems to attach itself at once to an object” (Klein, 1946, p. 179). Winnicott disagreed with every

element of this statement. We know that Winnicott wholeheartedly rejected the death instinct.

Moreover, Winnicott (1960) believed that during the stage of absolute dependence, “the word

death has no possible application” and “has no meaning” for the infant (p. 47). Winnicott (1960)

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argued that anxiety during the earliest phase of life “relates to the threat of annihilation” (p. 47).

Annihilation anxiety is intimately bound up with continuity of being, for “the alternative to being

is reacting, and reacting interrupts being and annihilates. Being and annihilation are the two

alternatives” (Winnicott, 1960, p. 47). When an infant’s going-on-being is too often impinged

upon, she begins to develop a reactive stance to life in which her truest core self plays little role.

We find in psychotic individuals the reemergence of these earliest anxieties—“going to pieces,”

“falling forever,” “having no relationship to the body,” and “having no orientation” (Winnicott,

1962a, p. 58). Alford poignantly noted, the threat of annihilation through the disruption of inner

continuity remains throughout life. He asserted that “Trauma has the capacity to destroy even

the most developed sense of the continuity of existence” (Alford, 2013, p. 265) and can “[induce]

madness” because it keeps the individual from “liv[ing] a rich interior life, one not devoted to

responding to external events [and] environmental intrusions” (Alford, 2013, p. 263). We

therefore see that Winnicott’s notion of being has relevance in understanding psychopathology as

well as health.

Winnicott’s writings on creativity during relative dependence (and in cultural experience)

are a direct outgrowth of his formulations regarding being. Not surprisingly, his views regarding

creativity sharply contrast with those of Klein. Ample provision of “formless functioning” is the

prerequisite for the development of creative capacities: “It is only here, in this unintegrated state

of the personality, that that which we describe as creative can appear” (Winnicott, 1971, p. 64).

With a fully charged battery of being based on trust, the child can confidently progress into the

area of transitional experiencing that entails the precarious and exciting negotiation of inner and

outer reality in the phase of relative dependence. Winnicott felt that Klein and most of his

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contemporaries completely missed the mark in their writings on creativity. Melanie Klein placed

creativity within the context of restitution and reparation—concepts which are based in the

original self/other distinction in infancy. In a chapter from Playing and Reality entitled

“Creativity and its Origins,” Winnicott wrote, “Klein’s…work does not reach to the subject of

creativity itself” (1971, p. 70). Winnicott disagreed with Klein for much the same reason he

rejected Freud’s construal of creativity as a manifestation of drive sublimation. In Freudian and

Kleinian theory, creativity has a distinctly defensive flavor, whereas Winnicott viewed it as the

unfurling of an inherited tendency toward integration and self-actualization. In the absence of

excessive anxiety, the child becomes able to spontaneously “[manipulate] external phenomena in

the service of the dream and [invest] chosen external phenomena with dream meaning and

feeling” (p. 51). It is this capacity that imbues one’s experiences with “the feeling of real” and

that is the hallmark of psychological and emotional wellbeing throughout the lifespan.

Having discussed the development of Winnicott’s theories of being and creativity in the

context of Klein, we will conclude this section with a description of Winnicott’s unique

formulation of aggression. The “Definition of Terms” portion of the introduction demonstrated

that Winnicott rejected the way in which Klein construed aggression as inherently sadistic and

aimed at a part object. For Winnicott, an overabundance of sadism belonged to ill-health, not to

a natural stage of development (e.g. Klein’s paranoid-schizoid position). Winnicott associated

original aggression with motility and spontaneity. Rather than viewing aggression as a reaction

to frustration, he believed that it is through motility that “the environment is constantly

discovered and rediscovered” (1950-55, p. 211). In addition to disagreeing with the infliction of

intentionality on the baby’s original destructiveness, Winnicott also faulted Klein for failing to

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discuss the environment’s response to the child’s aggression. It is true that the child causes the

mother a great deal of pain—teething and sleepless nights represent only two of the “injuries”

the child inflicts. The infant does engage in a “continual destruction of the object” through his

“repeated and uninhibited ruthless demand for the environment’s adaptation” (Abram, 2012, p.

320). Winnicott introduced yet another paradox in characterizing the good-enough mother’s

response to the child’s ruthless demands: the mother must allow herself to be destroyed (in the

child’s fantasy), but must also survive the destruction. The mother “survives” by containing the

infant’s aggression and by not falling apart, retaliating, or responding moralistically (Winnicott,

1971). This notion of survival is central to Winnicott’s notion of object usage, a complex

concept that will be explored in detail later. For the purposes of this section, it is sufficient to

note that the mother’s survival (a) facilitates the child’s ability to tolerate ambivalence, (b)

allows the child to appreciate the “autonomy and life” of the mother and to benefit from the

mother’s “contribut[ing]-in,” and (c) enables the child to “live a life in the world of objects” (p.

90). It is when the mother is unable to tolerate the infant’s ruthless demands and when the baby

is made prematurely aware of its having damaged the mother that various forms of pathological

aggression emerge.

Winnicott’s Statements on Addiction in the Context of Kleinian Literature on Addiction

The above section clarified the clear connections between Klein’s theoretical

contributions and various major themes in Winnicott’s work. Despite their many disparities,

Klein and Winnicott place tremendous value on psychic dynamics of infancy, the achievement of

ambivalence, and the influence of the earliest psychological patterns throughout the lifespan.

Not surprisingly, we find similar thematic overlap and dissonance between Kleinian and

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Winnicottian perspectives on addiction. This part of the literature review will begin with an

overview of contributions by Glover and Herbert Rosenfeld, each of whom wrote about

addiction with Klein’s theory in mind. After highlighting the central elements of their essays, we

will see in what ways Winnicott’s brief statements on addiction converge and diverge with their

positions. This review will demonstrate Winnicott’s pithy nineteen-word statement regarding

addiction carries within it the themes of being, creativity, and aggression.

Glover wrote an essay in 1932 that represents the first earnest attempt to incorporate

Kleinian theory into psychoanalytic addictions literature. This article serves as a substantive

reaction to the prevailing views on addiction at the time as elucidated by Rado (1928) and

Simmel (1930). Glover (1932) criticized his contemporaries for (a) overemphasizing the role of

libidinal dynamics, regression, and homosexuality, (b) ignoring or deemphasizing the importance

of sadism, (c) rejecting the possible influence of psychological dynamics predating the Oedipus

complex as traditionally defined, (d) failing to include the fusion of libido and aggression, and

(e) overlooking the inextricable link between paranoid anxieties and addictive phenomena.

Glover’s unique approach and attention to detail allowed him to propose a number of

formulations that merit consideration. We find one the most fascinating—and clinically

relevant—hypotheses in his claim that it is unlikely that addiction, in any case, can be described

as a simple fixation at a particular stage or that it can be easily classified as a close relative of

one of the more studied psychopathological patterns (e.g. psychoneurosis). Glover (1932) wrote

the following regarding a patient who struggled with a debilitating drug addiction: “Here was a

case that showed historically a gradual crescendo of symptoms rising to a paranoid crisis, but

including elements of reaction to every stage of development from primitive oral reaction down

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to infantile genital and adult genital anxiety systems” (p. 312). This statement serves as a

caution to psychoanalytic practitioners who may feel tempted to oversimplify the experiences

and unconscious lives of their addicted patients. Although he sought in this essay to emphasize

the role of early paranoid anxieties in the etiology and maintenance of addiction, he did not deny

the salience of previous contributions. In fact, Glover (1932) wrote, “In supporting these views,

which are in most essentials the views of Melanie Klein, I do not intend to suggest that the

importance of later and more organized infantile systems can be glossed over in drug-addiction”

(p. 307). This points the way towards a view of drug addiction in which various areas and

phases of development may in a sense be seen as superimposed upon one another. Like Klein,

Glover also continually emphasized the role of projective and introjective mechanisms and the

centrality of primitive sadism in addictive processes. Glover (1932) made a “provisional

conclusion” that addiction’s “defensive function is to control sadistic charges” (p. 315).

Although his approach and language may seem archaic, obsolete, and wildly interpretive

to a modern reader, a careful reading of this essay shows that Glover’s insights presage much

later developments in psychoanalytic addictions literature. We will shortly see that Rosenfeld’s

(1960) picture of addiction resembles Glover’s in that it portrays addiction as a chaotic

maelstrom of projective and introjective mechanisms that can change from day to day and

session to session. Furthermore, Glover spent a great deal of time distinguishing between the

experience and psychological dynamics associated with various intoxicating substances; this

portion of his essay resonates with Khantzian’s much later writings on psychopharmacological

specificity. Finally, Glover also focused on shifting intrapsychic dynamics in the various phases

of the addictive process (e.g. intoxication, abstinence, withdrawal). For instance, he noted that

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paranoid dynamics tend to surface most noticeably in periods of abstinence and identified

potentially masochistic elements in withdrawal. His statements in this vein foreshadow the

investigations of Eve Livingston (2006), who also rejected the idea of a single static dynamic

underlying addiction.

Rosenfeld’s oft-cited 1960 essay “On Drug Addiction” also draws deeply from Kleinian

theory. Whereas Glover chose to direct his attention to paranoid dynamics, Rosenfeld (1960)

dedicated the majority of his essay to the commonalities between addiction and manic-

depression. Rosenfeld (1960) wrote:

It is suggested in this paper that drug addiction is closely related to the manic-depressive

illness, but not identical with it. The drug addict uses certain manic and depressive

mechanisms which are reinforced and consequently altered by the drugs. The drug has

both a symbolic meaning which relates to the unconscious phantasies attached to it and

the drugging and also a pharmacotoxic effect which increases the omnipotence of the

mechanisms used and the omnipotence of the impulses. (p. 476)

Throughout this essay, Rosenfeld continually emphasized the ways in which the drug addict uses

various manic mechanisms such as idealization and the denial of depressive and paranoid

anxieties (1960, p. 476). He also follows Klein in his detailed discussion of oedipal themes of

possession, punishment, castration, envy, and the desire for sexual union with the parent of the

opposite sex. His case vignette demonstrates that the symbolism, subjective experiences, and

affects associated with drug use are ever changing for the addict. Through compulsive drug use,

the addict continually sought to avoid the integration of “good” and “bad” within herself or

others. Any achievement of ambivalence is ultimately undermined by the reemergence of

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overwhelming paranoid and/or depressive anxiety or by the inability to tolerate the ebbing and

flowing of aggression. Rosenfeld (1960) described his patient’s experience in the following

way: “Once she had consumed either a great deal of alcohol or stimulating drugs, the destructive

part of her personality became reinforced by the stimulants [and] the positive part of her

personality had no chance to control the situation once the crisis had started” (p. 473). Without

drugs, his patient generally felt unconfident in the effectiveness of her defenses. Rosenfeld’s

discussion, like Glover’s, highlights the fluidity of intrapsychic dynamics in addiction and the

importance of taking one’s time in understanding “the complex nature of this crisis” (1960, p.

476). Indeed, we see in his patient’s life that the role of the drug shifts depending on the

situation. Glover also consistently points out that we should not approach addiction as an

isolated phenomena that can be understood without considering the context of other intrapsychic

processes and day to day occurrences.

Winnicott himself wrote very little regarding addiction. However, the two brief

statements he made on this topic clearly indicate that his views on addiction, like his theories in

general, resonate with and depart from Kleinian perspective in several ways. In the concluding

section of “Transitional Objects and Phenomena,” he wrote: “Addiction can be stated in terms of

regression to the early stage at which the transitional phenomena are unchallenged” (1951, p.

242). It should be noted that Winnicott did not specify what exactly he means by addiction or

what type(s) of addiction to which he is referring. Does Winnicott mean that we should consider

addiction of any sort (e.g. gambling, eating, drugs, or spending) as such a regression? Though

we cannot presume to know what Winnicott considered addiction, a later footnote to this essay

indicates that the phenomenon of drug addiction did occur to him in his reflections on the

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pathology of transitional object experiences. As with so much of Winnicott’s writing, this

description is condensed and open to a wide array of interpretations. A close consideration of

each key word—especially as they relate to the three central themes of this project—will be

necessary for the current project, and we will now carefully examine this statement in the context

of the Kleinian contributions of Glover and Rosenfeld.

Winnicott’s perspective may seem to be totally at odds with a Kleinian view. It lacks any

mention of sadism or primitive oral drives and does not refer to anxieties associated with the

paranoid-schizoid position. However, a closer inspection reveals that many of his priorities were

in line with those of Glover and Rosenfeld. First of all, Winnicott’s decision to focus on the

psychological dynamics of the first years of life mirrors Glover’s approach. By emphasizing

transitional phenomena, Winnicott seems to agree with Glover’s assertion that the etiology and

dynamics of addiction cannot be understood if one adopts a myopic perspective limited to a

consideration of oedipal factors as traditionally conceived. Winnicott may also have agreed with

Rosenfeld’s discussion of his patient’s inability to reconcile the good/loving and bad/destructive

elements of her inner world. Winnicott’s description of the “special qualities” in the child’s

relationship with his or her transitional object address its role in facilitating the management of

aggression and loving: “[The transitional object] must survive instinctual loving, and also hating,

and, if it be a feature, pure aggression” (1951, p. 233). Because Winnicott dealt with addiction in

light of transitional phenomena—which Metcalf and Spitz (1978) described as a neutral zone in

which the child has the opportunity to work out her inner conflicts without much risk—it seems

that Winnicott, like Rosenfeld, would pay special attention to the ways in which drug addicts

struggle to reconcile the loving and hating elements within themselves (Metcalf & Spitz, 1978, p.

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105). Winnicott’s characterization of addiction as regressive in nature also resonates with the

assertions of both Glover and Rosenfeld, who discussed addiction in part as a means to deal with

unresolved paranoid-schizoid anxieties. Although neither Kleinian limits his conceptualization

to the consideration of intrapsychic paranoid-schizoid constellations, the centrality of this

position in the inner world of addicted patients implies an inherent difficulty in maintaining the

ambivalence of the depressive position. Winnicott’s statement also indicates that addiction

involves regression to a phase associated with earlier phases of development.

The amount of dissonance between the two perspectives likely matches or exceeds the

degree of convergence. A consideration of being, aggression, and creativity will help to

demonstrate the marked differences between these two conceptualizations of addiction. Glover

and Rosenfeld’s essays evidence a preoccupation with the operation of projective and

introjective mechanisms in addiction. As we have seen, Klein assumed a primary integration

(unit status) at birth, thus denying a state in characterized by a lack of differentiation between

mother and child. This assertion leaves no place for the oceanic, generative form of being that

undergirds all of Winnicott’s theories and that is necessary for the feeling that one’s experiences

in the realm of transitional space are “unchallenged.” This brings in the role of the environment.

The word “unchallenged” implies that the presence of something “out there” that can

potentiallychallenge the child’s transitional phenomena experience. The postulation of the child

from the start as a factory of introjective and projective processes aimed at equilibrium within a

separate intrapsychic world inherently diminishes the role of environmental provision and the

internalization of a caring, supportive caregiver. Winnicott (1971) consistently rejected the

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inextricable link between meaningful transitional experiencing and the trust that develops during

the phase of absolute dependence.

Glover and Rosenfeld did not discuss creativity or its relative diminution in addiction.

This omission does not of course imply a lack of concern with their patients’ feeling of inner

vitality. Indeed, the consideration of their patients’ frenetic attempts to manage sadism and

paranoid anxieties by means of projective and introjective processes gives us a clear sense of the

profound feeling of powerlessness they sensed in the lives of their addicted clients. Winnicott,

however, would likely have approached the markedly reactive stance of these patients in a very

different way. He might have characterized these individuals’ affective instability and

psychological reactivity as a result of chronic impingement. These patients demonstrate a

rigidity and fragility in their daily lives that Winnicott would associate with deficits in creative

capacity. Perhaps these patients have lost the ability to “[invest] chosen external phenomena

with dream meaning and feeling” and instead have established a pattern of “investing external

phenomena with” nightmare meaning and feeling. This is not to say that Winnicott would ignore

the role of unrestrained sadism or paranoia in addicted individuals. However, he would likely

view these patients’ maladaptive defensive operations in the context of his theory of creativity.

Addressing the fate of aggression in the “regression to the early stage at which the

transitional phenomena are unchallenged” will require some extrapolation. The introduction and

the previous section made clear the sharp contrast between the theories of aggression in the

writings of Winnicott and Klein. Winnicott’s statement in “Transitional Objects and

Phenomena” clearly implies the need to consider being and creativity in a conceptualization of

addiction. The Kleinian essays deal with the centrality of primitive sadism in addictive

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processes. Recall that Glover (1932) made the “provisional conclusion” that that addiction’s

“defensive function is to control sadistic charges” (p. 315). Although Winnicott may have

considered sadism, his ideas on the etiology of such uncontrollable sadism would be qualitatively

different. His statement on addiction indicates that he would probably not consider controlling

sadism as the primary defense in drug addiction. His construal of addiction as a regressive

attempt to have uninterrupted transitional experiences would likely focus on the paucity of

opportunities to experience the “I AM ME” element of primary aggression. His assertion about

addiction does not dismiss the possible role with oedipal forms of aggression (e.g. murder,

castration, etc.), but if he had attempted a thorough exploration of addiction, such themes would

probably not occupy center stage.

Literature on Winnicott and Addiction

Now that we have discussed the historical context and evolution of Winnicott’s general

theory and his views of addiction, we may turn our attention to what has been written regarding

Winnicott and addiction. More specifically, we will explore the writings of various authors on

this topic in terms of being, creativity, and aggression. Because Winnicott places the psychology

of being and creativity in the context of developmental phases, these concepts will be considered

in relation to the stages of absolute and relative dependence. In addition to highlighting some

problematic elements in the existing literature on Winnicott and addiction, the following section

will elucidate the insights of theorists who have provided substantive and conceptually accurate

depictions of his theories as they pertain to drug addiction. It will become apparent that—despite

the positive contributions of rs such as Luz and Eigen—there is a notable lack of academically

rigorous research in the literature regarding Winnicott and addiction.

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Addiction as it Relates to Being and Absolute Dependence

As previously mentioned, many of Winnicott’s contributions grew from his profound

dissatisfaction with the way in which psychoanalysis had overlooked the earliest stage of infancy

prior to the achievement of unit status. The experience of simply being belongs to this state of

unintegration and non-differentiation from the mother and serves as the basis for the ability to

live from one’s “kernel” later in life. Several authors have recognized the intimate connection

between Winnicott’s notion of being and various elements of drug addiction. Various theorists

have chosen to discuss varying dimensions of this deceptively simple concept; while some have

written powerfully and substantively on this matter, others seem to have missed the mark. This

section will review the contributions of (a) Eigen, who emphasized the disruption of being via

traumatically punctured aloneness in his drug-addicted patients, (b) Eve Livingston, who

addressed the mind-psyche-soma relationship during absolute dependence, and (c) Luz, who

discussed the significance of providing addicts with an ego-supportive environment akin to

primary maternal preoccupation so they can experience continuity of being. The section will

conclude with an overview of contributions that seem to oversimplify or misinterpret addiction’s

relationship to Winnicott’s writings on being and absolute dependence.

Eigen (2011) directed his attention to the relationship between addiction and the

experience of genuine aloneness in the phase of absolute dependence. He explicitly stated that

he is only concerned with the unique experience of genuine aloneness, leaving it to others to

discuss the relationship between addiction and the dynamics of later forms of relationships with

caretakers. His general thesis revolves around the necessity for infants (and adults) to have the

experience of aloneness, quiet, and continuity without awareness of the supportive environment

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that allows for such a state of being. This type of aloneness requires a consistent background of

support and the presence of caretakers who do not impinge upon the infant's experiencing of it.

He summarized this experience and its outcome in saying, "There is an experiential arc or

rhythm to genuine quiet. It evolves to a point where it completes itself and naturally ebbs,

allowing the next wave of experience to unfold. It is rich, nourishing, peaceful quiet, akin to

quiet immersion...If allowed to play [itself] out, a rhythm of experience grows” (Eigen, 2011,

p. 21). This statement indicates that such aloneness allows for the growth of subjectivity. This

experience serves as the starting point for a psychological and emotional life grounded in its own

rhythm, a life lived from the center of one's self and imbued with a sense of security and safety.

Moreover, having caretakers who perform this vital function helps individuals to develop the

capacity to return to this state of quietude and self-absorption later in life, something essential

later in life when dealing with the complexities and conflicts of interpersonal relationships.

Eigen (2011) believed that addiction often arises from insufficient opportunities for basic

aloneness. Many individuals who struggle with addiction have been "hit by trauma" and have

experienced "traumatized aloneness," something which can "turn beginnings into signs of

trauma” (Eigen, 2011, p. 19). Such individuals fear new beginnings in areas of work, love, and

creativity, for they have deeply embedded expectations that any of these attempts will be met

with trauma. The "dread of trauma hitting involves...dread of death...terrors of psychic

deformation, deterioration, mutilation, and pulverization” (Eigen, 2011, p. 19). The

establishment of such a reactive and threatened approach to life diminishes the capacity to be

with others and with oneself. An individual may withdraw from interpersonal relationships to

recuperate and heal, but finds himself unable to do so. The form of aloneness resulting from

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interpersonal withdrawal has a drastically different character from the free-floating and

nourishing state of going-on-being. It lacks the backdrop of support and the "possibility for

contact with oneself is at risk, pressured, and injured," and addiction can "help one to get through

but thwart fuller unfolding" (Eigen, 2011, p. 19). Substance use presents the individual with the

promise of returning to a state when injury never happened and in which genuine aloneness

becomes possible. Drugs, for a time, give one the sense of an invisible backdrop of safety so

crucial for a rich, rhythmic, and enlivening self-experience. However, addictive drug use seeks

primarily to bypass and disavow the wound's existence and actually prevents healing, something

which requires communication with another person or, in Eigen's view, contact with the spiritual.

An inanimate object can only do so much—no matter how much the drug allows one to feel alive

and safe, it can never provide the caring attentiveness of a good-enough caretaker. The drug is a

substitute for human support and repair, but it cannot possibly perform these functions in the way

another person could. One can extrapolate from Eigen’s statements that the drug cannot gaze

back at the individual who struggles with addiction in the way a mother gazes back at her infant;

the drug cannot "gather [his] bits" together in a way that gives the addict inner certainty and that

reinforces the ability to “maintain integration with confidence” (Winnicott, 1945, p. 150). He

emphasized the fact that, counter to its original promise, the drug actually becomes the medium

for the reenactment of the original trauma. In Eigen's words, the drug "repeats a sense of

damaged perfection, damaged beatitude" and creates a state in which "pain and beatific threads

intermingle, meld, and become indistinguishable” (2011, p. 20). Although Eigen approaches

addiction from a different angle than Solomon, a psychoanalyst whose ideas we will soon

discuss, this statement bears a striking resemblance to Solomon's construal of addiction as a

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masochistic pattern in which the individual engages in both stereotyped and disruptive systems

of behavior.

Whereas Eigen focused on the experience of aloneness, Livingston turned her attention to

the premature development of the intellect and the disruption of the psyche-soma relationship

that belongs to the infant’s experience of being. In her 2006 dissertation entitled, “Between the

Needle and the Damage Done: An Object Relations Perspective on Heroin Addiction,”

Livingston provided a unique perspective into the different dynamics associated with craving,

seeking/acquisition, and ingestion. Whereas many authors talk about addiction as general

phenomena, Livingston set herself apart by analyzing each respective part of the addictive

process. Her discussion of ingestion and the experience of heroin intoxication reveals her keen

insight into their relationship to characteristics of absolute dependence. In “Mind and its

Relation to Psyche-Soma,” Winnicott explained how the development of mental faculties allows

the baby to make sense of and tolerate her mother’s imperfections; mental capacities also

represent in part the child’s initial efforts to grapple with the not-me world on her own. In cases

of inadequate parenting, however, “the thinking of the individual begins to take over and

organize the caring for the psyche-soma, whereas in health it is the function of the environment

to do this” (Winnicott, 1949b, p. 246). This type of mental functioning becomes “an

encumbrance to…the human being’s continuity which constitutes the self” (Winnicott, 1949b, p.

244, 248). A sense of detachment and emptiness results in which one does not feel oneself to be

the owner of one’s experiences. Livingston (2006) wrote that

Heroin represents to the addict an alternative to this mentalizing function; an escape from

it, a reprieve from it, a denunciation of it…it is an attempt at incorporating the mother’s

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soothing function…[it] is a reprieve from the mental world, and as a return to the fetal

maternal holding environment. (p. 63-4)

Like Eigen, Livingston partially characterizes addiction as the unconscious desire to regress to

the undifferentiated and secure state of the newborn, the experience of which they have been

deprived. Livingston (2006) also recognizes the tragic nature of this state of affairs—while such

a state may for a time satisfy the addict’s need for this type of experiencing, the return to the

womb can also be “suffocating” and, ultimately, the addict “is soothed but is also climbing inside

an entrapping, deadening tomb” (p. 64). It should be noted that, although Livingston supplies us

with a great deal of insight into addiction and the dynamics of absolute dependence, her

dissertation provided very little in the way of experiences of actual addicts. This gives her

project an overly abstract and skeletal quality.

Luz provided one of the richest accounts of treating and conceptualizing addiction from

the perspective of being in “Truth as a Way of Developing and Preserving Space for Thinking in

the Minds of the Patient and the Analyst.” Her patient, Vicky, was a drug-addicted adolescent

with borderline personality dynamics. Luz includes several aspects of absolute dependence in

her conceptualization of and analysis with Vicky. After Vicki was hospitalized, Luz described

how the environment provided by her family resembled the state of primary maternal

preoccupation that Winnicott believed allows the mother to almost telepathically anticipate her

infant’s needs (Winnicott, 1956). Luz (2009) wrote, “As it was her first month out of [the]

hospital without drugs, her father, sister, brothers and especially her mother had to be alert to all

Vicky’s movements and gestures, and a schedule of shifts was established to care for her” (p.

301). Luz also draws on Winnicott’s famous insights in his 1958 paper “The Capacity to be

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Alone.” Winnicott (1958) wrote that being comfortable with the “sophisticated aloneness” of

adulthood requires that one has had adequate experience “being alone in the presence of the

mother,” which allows the small child to “[introject] the ego-supportive mother and…[become]

able to be alone without frequent reference to the mother” (p. 30, 32). Vicky completely lacked

the ability to be alone, and used substances and promiscuity to at least temporarily experience the

state of being alone in the presence of another. Just before providing a transcription of a session,

Luz incorporates Winnicott’s writings on the mirror-role of the mother; although mirroring

remains essential throughout childhood, it is especially important in the phase of absolute

dependence. Luz (2009) commented, “The threat of psychotic disintegration was real, and it was

for this reason that Vicky needed so many mirror-gazes where she could see herself and feel

herself to be newly cohesive. Failing this, a return to drugs seemed inevitable” (p. 302). Like

both Eigen and Livingston, Luz seems to view compulsive drug use to make up for a paucity of

experiences of going-on-being.

Director (2005), Potik (2007), and Johnson (1999) also wrote about the potential

connections between addiction and the dynamics associated with absolute dependence.

Although their contributions help to shed some light on the relationship between absolute

dependence and addiction, Director, Potik, and Johnson do not provide us with very substantive

reflections on this topic. This leads either to oversimplification (i.e. not incorporating the

subtleties of Winnicott’s thoughts on this matter) and/or confusing conclusions. Director,

although she provided useful commentary on omnipotence and dissociation in addiction,

dedicated only two short paragraphs to Winnicott and absolute dependence. Director wrote, “it

is fascinating to consider drug use…as a miscarriage of Winnicott’s moment of illusion,

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reverberating throughout time” (2005, p. 579). To be fair, Director did not set out to limit her

discussion to a Winnicottian perspective. However, her article, like many other psychoanalytic

writings on addiction, seems to glaze over the complexities not only of Winnicott, but of other

theorists—she incorporates the contributions of Klein and Bion in a similarly superficial manner.

While one may leave this article with a helpful “zoomed out” picture of addiction, Director

leaves the reader to wonder whether the various perspectives she so seamlessly integrates would

be as compatible if she were to consider the nuances of each one. Just a few pages after

conceptualizing addiction according to Winnicott’s ideas on the illusion of omnipotence, she

concurs with Rosenfeld (1960), who “used Klein’s ideas to propose that drug addiction be seen

as an effort to reinforce the omnipotence of the manic defense, in people whose fragile egos were

not equal to the task of producing the defense wholly on their own” (2005, p. 579). It is of

course true that Winnicott drew heavily from Melanie Klein in his theorizing and that he saw

value in the idea of the manic defense throughout his career (Winnicott, 1939, 1962b). However,

we must keep in mind that Klein’s theories on both the manic position and, more importantly

here, fantasied illusion in infancy were anchored in the presupposition of an original self-other

distinction at birth and in the existence and constitutionality of the death instinct. Winnicott

fiercely opposed each of these assumptions, and his writings on illusion and the manic defense

are to some extent predicated on their rejection. Given the relative incommensurability of

Winnicott and Klein’s construal of the nature and origin of infantile experiences of omnipotence,

how should we approach Director’s implication that addiction’s relationship to omnipotence is

both Kleinian and Winnicottian in nature? Further elaboration on Director’s part might have

succeeded in arguing this point. As it stands, however, Winnicott’s contributions are lost in a

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conceptual melting pot and their potency is diminished. Like Director, Johnson (1999) only

briefly discussed elements of Winnicott’s thoughts on absolute dependence as they pertain to

addiction and therefore fails to establish a meaningful elaboration of Winnicott’s theories in the

context of substance abuse.

Potik (2007) dedicated more time to absolute dependence (although still less than two

pages), but presents a somewhat confused picture of this phase and its “equivalence” to addiction

(p. 313). Potik equated the newborn’s lack of awareness of an external mother with the addict’s

denial of their addiction. Potik (2007) wrote, “Common phrases among drug addicts like ‘I can

stop whenever I want…’ are parallel to the infants’ denial and lack of awareness” (p. 313). It

seems to me that these phenomena may not resemble each other to the extent that Potik claimed

they do. Can an adult’s denial really be equated to a newborn’s lack of awareness of the holding

environment? In “Dependence Towards Independence,” Winnicott (1963b) wrote, “the infant

does not know that the water might have been too hot or cold, but comes to take for granted the

body temperature (p. 86).” The infant here is not denying his dependence, for denial presupposes

the capacity for awareness. An infant in the phase of absolute dependence does not say, “I can

stop relying on my mother whenever I want.” When such an experience becomes possible, the

infant is operating within the world of relative dependence and/or punctured absolute

dependence (i.e. premature awareness of dependence). Moreover, the individual who struggles

with drug addiction—no matter how strong his denial—knows that the “water can be too hot or

too cold,” especially when sober. Later in this section, Potik (2007) wrote, “Constant pursuit

after drugs is a pursuit after constant pleasure, and a will to create a perfect world without

suffering and pain, similar to the primary world of the infant” (p. 313). This statement seems

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more accurate. An addict may seek to re-experience the going-on-being of absolute dependence,

but cannot be said to be in a state of absolute dependence. Yet, either because of overly

condensed writing or actual misunderstanding, Potik makes contradictory statements that prevent

him from presenting a clear elucidation of the connections between addiction and absolute

dependence.

This discussion of the literature on being, absolute dependence, and addiction has

hopefully made clear to the reader the challenging nature of “applying” Winnicottian concepts to

addiction. As Philips (1988) noted, Winnicott largely abandoned the “erudite schematizing” and

“arcane language” common in the psychoanalytic discourse of his contemporaries, preferring to

utilize everyday words like “holding” and “playing” in “idiosyncratic” ways (p. 13). Philips

points out that this element of his writing makes him paradoxically both accessible and opaque.

This state of affairs provides much room for interpretation and makes it difficult to discern

“accurate” discussions of addiction from “inaccurate” ones. It therefore seems that an effective

approach to studying addiction from a Winnicottian perspective requires a careful consideration

of the complex and often confusing nuances underlying his deceptively simple writings. While

we are not in a position to state unequivocally that rs such as Director and Potik are “wrong” in

their assertions regarding absolute dependence and addiction, it is clear that both authors’

contributions would have benefitted from a more rigorous exploration, clarification, and

application of Winnicott’s ideas. The need for painstaking analysis will become even clearer in

the following examination of the literature on addiction in terms of creativity, transitional

phenomena, and relative dependence.

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Addiction as it Relates to Creativity, Transitional Phenomena, and Relative Dependence

The introduction to this dissertation made it clear that, according to Winnicott,

psychopathology can in large part be viewed as the breakdown or impoverishment of an

individual’s capacity for creative engagement with herself and others. We have seen that the

origins of creativity reside in the formless experiencing and original illusions associated with

continuity of being in the phase of absolute dependence. However, the creativity that lies at the

center of cultural experience and which Winnicott referred to as “a colouring of the whole

attitude to external reality” belongs to relative dependence and first becomes manifest in the

child’s use of transitional objects (Winnicott, 1971, p. 65). Many rs have identified deficits in

the ability to maintain a sense of vitality and confidence in the negotiation of inner and shared

reality as key features in the development and maintenance of addiction. The following section

will describe some of the more salient writings on this topic, writings that vary in scope, depth,

accuracy, and clarity. This section will: (a) address terminological and conceptual subtleties in

the use of the term “transitional object,” particularly as it pertains to addiction, (b) illustrate the

problematic elements in various authors’ use of the term “transitional object” in their discussion

of addiction, and (c) review the more useful contributions of Siporin, Luz, and Livingston.

The theme of creativity is ubiquitous in Winnicott’s writings, especially in his later work.

He integrates a wide variety of topics under the conceptual umbrella of creativity—play, fusion,

potential space, transitional objects, transitional phenomena, and cultural experience seamlessly

interweave to form a central pillar of Winnicott’s contributions to psychoanalysis. Of these

various threads, the addictions literature pays special attention to transitional objects. I will soon

discuss why this is the case. A precise analysis of these writings necessitates a brief clarification

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and elucidation of Winnicott’s writings on transitional objects. In reading the following critiques

and commentaries, the reader should keep in mind the following statements written by Winnicott

in his 1951 landmark paper “Transitional Objects and Transitional Phenomena” and in Playing

and Reality. A select assortment of quotations to this point are as follows:

“Addiction can be stated in terms of regression to the early stage at which the transitional

phenomena are unchallenged” (Winnicott, 1951, p. 242).

“There is something to be lost, however, in working backwards from the

psychopathology of fetishism to the transitional phenomena which belong to the

beginnings of experience and which are inherent in healthy emotional development”

(Winnicott, 1951, p. 242).

“[The child’s rabbit] could be described as a comforter, but it never had the true quality

of a transitional object” (Winnicott, 1951, p. 235).

“…I do consider that transitional phenomena are healthy and universal. Moreover if we

extend the use of the word fetish to cover normal phenomena, we shall perhaps be losing

some of the value of the term” (Winnicott, 1951, p. 241).

The above quotes make clear two themes in Winnicott’s theory on transitional object

experiences: (a) the transitional object belongs to health; its “true quality” rests in its being a

facilitator of internal processes required for the later development of the capacity to play and to

live creatively, and (b) pathological relationships with inanimate objects such as drugs or

fetishistic objects in adulthood should not be considered transitional phenomena, for they

facilitate regressive or other unhealthy ways of living. Winnicott also indicated that an accurate

conceptualization of a fetishistic object experience would emphasize its employment of delusion

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rather than illusion (a term Winnicott described as a central element in the use of transitional

objects). In fact, various contemporary scholars have followed this line of thought in the context

of addiction. For example, Frank Summers (personal communication, 2013), a modern day

Winnicott scholar and preeminent psychoanalyst conveyed to me the idea that theorists and

therapists apply the phrase ‘transitional object’ to things as diverse as language and addiction.

He spoke to me about the way in which the term “transitional object” has been used so much that

it is beginning to lose its meaning. He highlighted that a drug is not a transitional object, but an

attempt to have a transitional object experience. He further elaborated in saying that there is

something autistic and regressive about drug addiction, and that these are not qualities of

transitional experience” This perspective parallels Winnicott’s assertion at the end of his 1951

article that addiction should be understood in terms of regression. Ramos (2004) made a similar

point in saying, “…McDougall preferred to relate drugs not to a transitional object, but to a

transitory object, since the latter does not have the characteristic of favoring growth as the other

does” (p. 469).

It is important to note, however, that the nature of transitional objects is somewhat

obfuscated by Winnicott’s writing itself. Winnicott’s above statement regarding the way in

which his patient’s rabbit lacked the “true quality” of a transitional object appeared in a

subsection entitled “Distortion in use of transitional object X” (1951, p. 234). Despite his

assertion that the transitional object belongs necessarily to health, Winnicott occasionally

referred to inanimate objects used by children in problematic ways as “transitional objects.”

How, then, should one use this term, and how can I, given this theoretical conundrum, criticize

authors for equating the addict’s drug to a transitional object? First of all, it is incumbent upon

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those utilizing this term to explore the phenomena of addiction to clearly indicate that the

addictive substance does not have the quality of a “true” transitional object, and that its abuse

does not lead to transitional experiencing. Secondly, Winnicott primarily uses the term as an

indicator of health. When he used the terms “transitional object” and “transitional phenomena,”

particularly in Playing and Reality, he referred primarily to the experience of inner vitality and

creative engagement with the world. Furthermore, when Winnicott described his patient’s rabbit

as a “transitional object,” we must keep in mind that his patient was a child, and not an adult.

When referring to the adult fetish, he made it quite clear that it should not be viewed as a

transitional phenomenon. We find the strongest support for my argument in Winnicott’s 1951

explicit statement on the nature of addiction: “Addiction can be stated in terms of regression to

the early stage at which the transitional phenomena are unchallenged” (p. 242). Transitional

phenomena are, by nature, not regressive. I have not found a single reference to this quotation in

any of my research.

Perhaps some readers would characterize the above discussion as superfluous and overly

preoccupied with semantic issues. It should be emphasized, however, that very little of the

literature on Winnicott and addiction has given such attention to the subtleties of Winnicott’s

theories; an adequate investigation of any phenomenon by any prominent psychoanalytic theorist

requires painstaking analysis and dissection. Otherwise, readers will emerge with superficial,

confused, or erroneous conclusions. This will make it less likely that they will be able to

effectively incorporate what they have read into their own practice. Before discussing the more

substantive and conceptually accurate contributions on transitional objects and addiction, I will

address two flaws that appear in the writings about addiction and transitional objects: (a)

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literature that “cherry picks” this concept without any attempt to address its subtleties and (b)

essayists that seem to equate the addict’s drug with the child’s transitional object.

Rivinus (1992) wrote, “For these young people the psychoactive substances are often

chosen as ‘transitional objects,’ (Winnicott, 1951) that assist them in negotiating separation,

individuation, and a sense of transitional identity” (p. 150). This constitutes the entirety of his

essay’s explicit discussion of Winnicott. Although he emphasizedzes the theme of

“psychological pseudoresolutions” to incomplete developmental processes, he did not attempt to

further incorporate the concept of the transitional object at any other point in his contribution.

This is not to say that Rivinus’ essay does not provide us with helpful insights into the etiology

and dynamics of substance abuse—it does. However, one readily notices that Rivinus did not

dedicate much time to an explication of the relationship between addiction and transitional

objects. His statement might lead some readers to assume that the needle or can of beer serves

the same function as the child’s teddy bear, when this could not be further from the truth.

Furthermore, what does he mean by a “transitional identity?” To my knowledge, Winnicott

never uses this phrase; its inclusion therefore seems inappropriate.

We find similarly cursory discussions of transitional objects in the writings of Jennings

(1991) and Johnson (1999). In her commentary on a case vignette, Jennings (1991) wrote, “As a

transitional object, drugs symbolize the union between the infant and the optimal maternal object

who knows when to minister to the child’s needs. The client’s loss of this symbolic mother

substitute was alarming” (p. 224). Neither before nor after this statement did Jennings refer to or

elaborate upon this topic. Authors who do not attempt to delve beneath the surface of this

deceptively simple concept fail to provide readers with either a deeper understanding of the

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concept of transitional objects or of its connection to addiction. Similarly, Johnson—in an

otherwise illuminating and insightful paper—did not elaborate on the transitional object

dimension of addictions even though he entitles a major section “The Object/Transitional Object

Nature of an Addiction.” Johnson (1999) limits his discussion of Winnicott and addiction to the

following statement: “The object-quality of addictive behavior is central to many theories of

addiction. Winicott’s original formulation of the transitional object (1951) described it as an

addiction” (p. 4). Not surprisingly, authors who do not delve beneath the surface of this concept

also tend to prematurely assert the equivalence of the addict’s drug and the transitional object of

infancy. After briefly mentioning of transitional objects, Johnson immediately referenced Otto

Kernberg’s “object-related dynamics of addiction,” a perspective quite different from

Winnicott’s. Johnson (1999) wrote, “Kernberg…describes several object-related dynamics of

addiction: it may replace a parental imago in depression or an all-good mother in borderline

personality, or may refuel a grandiose self in narcissism” (p. 4). Winnicott did not use the terms

“parental imago” and “grandiose self” in his writings, and to so quickly follow the notion of

transitional objects with references to Kernberg risks the conflation of two very divergent

paradigms in the reader’s mind.

We find in Potik’s article a much more thorough discussion of the relationship between

addiction and transitional objects and phenomena. However, he errs in equating heroin with a

transitional object and by using the term too loosely. After discussing heroin addiction’s

relationship to absolute dependence, Potik proceeded to discuss active addiction, methadone

treatment, psychotherapy, and the treatment setting in terms of transitional phenomena. For

Potik (2007), heroin can be seen as a transitional object in that it “is always available and…never

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fails” and because it helps addicts to survive in times of depression and helplessness (p. 322).

Because many patients “report that they find themselves touching [methadone] bottles (in the

purse or pocket) time and time again when passing by places associated with drug abuse,”

methadone can also serve as a transitional object (Potik, 2007, p. 315). Psychotherapists can

play the role of transitional objects in that they “[represent] a symbol of maternal gratification to

be discarded when no longer needed” (Potik, 2007, p. 317). The problem here should be

obvious: how can all of these be transitional objects? Such an assertion may lead readers to

believe that heroin, methadone, and therapists serve the same function. In other words, the term

“transitional object” seems to lose its meaning when unequivocally applied to so many things.

Miller’s 2002 paper “Heroin Addiction: The Needle as Transitional Object” focuses

squarely on the relationship between addiction and transitional objects and phenomena. We find

in this essay a number of key insights into how we might view addiction from a Winnicottian

perspective. Utilizing her experiences with “Jenifer” allows Miller to effectively illustrate the

ways in which a resentful, shaming, and affectionless mother can set in motion intrapsychic and

interpersonal dynamics that might predispose one to develop addictive behavior. Miller (2002)

relates Jenifer’s drug use to her inability to preserve a “reparative maternal image,” the

“shattering of protective absolutisms,” her difficulty relating to whole objects, and “horrific

object states” (p. 303). She wrote that, for many heroin addicts, “each ‘hit’ (injection) of heroin

[becomes] a reliable externalized way to conjure up the image of themselves as well cared-for

babies armed with the endless safety net of the longed-for maternal caretaking.” Of course, one

may question whether or not addicts actually envision themselves in fantasy as infants with

caring mothers. More importantly, Miller (2002) ultimately described heroin addiction as

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“primitively dysfunctional in its regressive developmental sequences” and wrote, “for the heroin

addict, the concept of transitional object is transformed to pathological process” (p. 7). Unlike

many other contributions, we notice here a careful differentiation between drug addiction and the

developmentally healthy use of inanimate objects in negotiating inner and outer reality. She

relates the heroin addict’s choice of the heroin needle to Freud’s notion of anaclitic object

choice, writing that “such a choice is visibly dependent, passive, and represents an infantile

longing for the ‘primary maternal object’ that never existed” (Miller, 2002, p. 7).

However, Miller’s astute characterization of the addict’s choice of heroin as dependent

and passive would carry more weight if she had altogether avoided asserting the equivalence of

heroin with the transitional object of childhood. Although she more clearly outlines the ways in

which heroin differs from the teddy bear of the healthy child, she, like Potik, utilized the term

“transitional object” to apply to heroin. However accurate her eventual conclusions may be,

Miller’s use of the term “transitional object” is at times confusing: “A number of addicts whom I

have seen…have emphasized that the very act of mainlining is thought of as a transitional object;

the needle itself is equivalent to supplying the mother’s milk and nurturant, rational authority

which has been so lacking in their lives.” This sentence makes it seem as though a transitional

object can be the “equivalent” of the mother’s milk. Although she eventually described heroin as

a distortion of the transitional object experience, Miller’s essay may leave readers confused as to

what she means by “transitional object.” The power of her argument is diminished by the

absence of a fully formulated description of what Winnicott calls the “true quality” of

transitional objects.

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Miller’s depiction of heroin as pathological transformation of transitional object

experiences would be more substantive had she discussed the aspects of transitional object usage

that have more to do with creativity and activity. In paying so much attention to the pathology,

Miller fails to incorporate Winnicott’s thoughts regarding psychological and emotional health in

transitional experiencing. Even in her discussion of “healthy” transitional object usage, she

emphasizedzes the transitional object’s similarity to the mother and its substitutive function. We

find no references to Winnicott’s later writings on the topic of transitional phenomena, which

highlight the creative and agentic dimensions of this key phase of development. In Playing and

Reality, Winnicott (1971) wrote, “the child manipulates external phenomena in the service of the

dream and invests chosen external phenomena with dream meaning and feeling” (p. 51).

Including themes from Winnicott’s later work may have rendered Miller’s arguments more lucid

and compelling. We will now direct our attention to examples more substantive and

conceptually accurate writings on addiction as it pertains to transitional phenomena and

creativity.

In his essay “Transitional Phenomena and Obsessive-Compulsive States,” Solomon

(1978) provided a very useful roadmap of various manifestations of transitional phenomena gone

awry. He touched upon orality, fetishism, masochism, and fixed ideas and traced their roots to

disruptions or deficiencies in early mother-child relationships. Before mentioning addictions, he

began his essay with a concise description of three types of “systems” he observed in child

patients; he later described phenomena such as orality and masochism in terms of what types of

system(s) they represent. After describing the healthy manifestation of the progressive system,

in which “obstacles become challenges rather than threats” and in which transitional objects

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“mediate an approach rather than an escape,” he moved on to discuss (a) the pathological type of

progressive systems, (b) stereotyped systems, and (c) disruptive systems (Solomon, 1978, p.

247). Common to these systems or forms of play is the fact that the “transitional

object…become[s] an end in itself” rather than a means of facilitating the essentially creative

(and exciting) processes of bridging inner and outer, establishing selfhood, and relating to

oneself and others with the feeling of real (Solomon, 1978, p. 247). Each of these three systems

of children’s play serves different self-protective defensive functions. For example, the child

engaged in the pathological form of progressive play fears childhood and its concomitant

attributes of smallness, vulnerability, and powerlessness over the external world. Such children

have a need to grow up prematurely as an attempt to “defeat the threatening world,” and their

play represents “denials of the wish to be little” (Solomon, 1978, p. 248).

Solomon’s brief section on masochistic patterns helps us to see the futility of such frayed

attempts at establishing a feeling of inner safety. The individual struggling with substance use

attempts to follow two divergent paths simultaneously, both of which he hopes will lead to a

sense of cohesion. Sadly, the finish line at the end of each (blissful union and non-traumatic

separateness) is a delusion, for in health the two paths are, in a sense, one. For some drug

addicted clients, the drug promises a sense of womblike union never before experienced (the

stereotyped component of addiction) and also serves as the “bridge to reality,” how one

understands oneself in relationship to the not-me world (the disruptive component). According

to Solomon (1978), “The stereotyped and disruptive pattern suggests that in the face of

uncertainty the subject seeks a quiet maternal substitute, which indeed, is not available. In

seeking mother, he finds inconsistency and turmoil (p. 254).” In seeking union, the addict

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discovers separateness—an exact replication of early experience with not-good-enough

caretaking. The spontaneity of play has no place in the ritualistic preparation and ingestion of

substances, for spontaneity requires a marriage of the elements that addictive processes so

severely split. Many individuals with drug problems have a difficult time tolerating the

ambiguity and tension—the precariousness—that makes a creative approach to life so exciting.

Sheldon Siporin uses his clinical experiences conducting an “Art Group” with drug

addicted clients to illustrate the meaningful relationship between addiction and Winnicott’s

theories of play and the holding environment in his 2010 paper “Addicts to Artists: The ‘Good

Enough Mother’ in the Substance Abuse Clinic.” After identifying both the strengths and

limitations of psycho-educative and behavioral approaches in treating addiction, he approaches

Winnicott and addiction in a different way than many of the rs that have been discussed thus far.

Although he does provide a brief discussion of salient Winnicottian concepts, he grounds his

argument primarily in narratives of clients with whom he worked. Each of the clients he talks

about participated in an experimental “art group” he ran while working at a chemical dependency

clinic. He described the nature of the group and his clinical style as aligned with Winnicott’s

developmental theories and his writings on the psychotherapeutic endeavor. To Siporin (2010),

the group “represented a ‘space’ where patients could be encouraged to ‘play’ with crayons or

paint;” furthermore, he focused not on interpretation, but on the “relational and experiential

components” by “adapt[ing] to patients’ needs…and [providing] an empathic, playful

environment” (p. 325). Unlike behavioral approaches, this group was very open-ended and quite

unstructured. The progress of his clients represented to Siporin (2010) the importance and

effectiveness of allowing for formless experience, adapting to clients’ spontaneously arising

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needs, and creating a “relational area” that Winnicott believed was so crucial to the development

of creative capacities in childhood (p. 325).

The case of “Liora” provides an excellent example of how allowing for and facilitating

creative experiencing can help individuals who struggle with drug addiction. Siporin (2010)

wrote the following to describe Liora’s presenting difficulties and relational problems:

Liora was a 31-year-old Hispanic woman with a history of marijuana dependence and a

DSM-IV diagnosis of bipolar disorder. She reportedly had behavioural issues while in

high school, and an arrest record for assaults triggered by her ‘uncontrollable’ anger.

Both of Liora’s parents were said to be alcoholics and substance abusers. Her history

recorded a conflicting relationship with her mother and negative feelings about men.

Liora herself was a single mother raising five small children. She was reportedly abusive

to her boyfriends, and [was suspected of child abuse]. Liora had successfully completed

the clinic’s outpatient programme. However, she had relapsed, apparently due to

relationship. (p. 326)

Siporin (2010) found that the combination of setting nonverbal limits (e.g., “put[ting] crayons

away while Liora was still working”) and “erring on the side of indulgence” contributed to the

near-absence of aggressive behavior during art group (p. 326). She attributes this result to the

fact that Liora probably felt very safe and secure during sessions—quite a novel experience for

someone with such a chaotic extratherapeutic life. Liora initially resisted playing with clay and

was “uncooperative, complaining that she did not want to touch the ‘disgusting’ and ‘dirty’ clay”

(Siporin, 2010, p. 326). Siporin allowed for such resistance and provided a space in which such

feelings of anger felt safe; however, Siporin often adopted a very playful attitude by waving his

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own clay-covered fingers at her and talking about how fun it was to play with clay. Later, Liora

requested a piece of clay and began to work intensely on making small sculptures. Whenever

Liora criticized her work, Siporin would commend her on the wonderful sculptures she had

made. Liora later began to make pieces of art for her children and asked Siporin for “blank

pictures that she could take home to ‘color when [she felt] stressed” (Siporin, 2010, p. 327).

Siporin did not provide readers with information regarding the eventual outcome of Liora’s

treatment, but felt that Liora’s enthusiasm for art and her use of art in times of distress as signs of

emotional development.

Although Siporin, unlike many other rs, did not provide much in the way of detailed

theoretical analysis of Liora’s treatment, this case demonstrates the potential power of

identifying and reflecting addicted clients’ need for creative experiencing. Siporin noted that the

containment of feelings represented an especially important component of the art group. It has

become clear in this literature review that many individuals who struggle with addiction have

great difficulty regulating their affective states and that their drugs of abuse often serve as a

means of grappling with depression, sadness, and other dysphoric emotions. Keeping in mind

that the capacity for affective regulation is founded upon the provision of a facilitating

environment that meets the infant’s needs while simultaneously fostering confidence in the

negotiation between the me and not-me worlds, we can infer from Siporin’s work with Liora that

the spontaneous and non-purposive manipulation of a not-me object (clay) in the presence of a

trusted other was a healthy alternative to her drug use, which represented an interaction with an

inanimate object that was unspontaneous, stereotyped, isolative, and which foreclosed the

expansion and exploration of potential space. The importance of her use of drawing to “relieve

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stress” at home cannot be overestimated. Here we see an example of what Winnicott would

likely refer to as the internalization of an ego-supportive environment, a process that results in

the child’s sense of agency and confidence in managing the strain of daily life. Winnicott (1971)

stressed that it is only in “desultory formless functioning, or perhaps from rudimentary playing”

that “that which we can describe as creative can appear;” when “reflected back,” engaging in

such an activity “enables [the individual…to postulate the existence of the self” (p. 64). Liora’s

increased capacity to engage in and later to initiate such spontaneous, creative activity therefore

represented a step towards developing the ability to postulate the existence of a self that was

capable of surviving sobriety.

Luz, whose case study aided us in better understanding the relationship between

addiction and absolute dependence, provided us with several insights into how addiction might

be understood in the context of Winnicott’s writings on potential space and play. She spent a

great deal of time describing the unfolding of her relationship with Vicky and beautifully

rejected the ways in which her flexible approach to treating Vicky enabled her to aid Vicky in

developing a creative “space for thinking” (Luz, 2009, p. 291). Luz’s primary focus throughout

her work with Vicky was to “become the object [Vicky] needed” (2009, p. 291). We saw above

that Luz at times occupied the position of the good-enough mother who met each and every one

of Vicky’s spontaneously arising needs and demands. Becoming this type of object made it

possible for Vicky to experience the continuity and security of a newborn, but it also seems that

this same intervention provided the foundation for the gradual development of a space for

thinking, something which has more to do with the phases of relative dependence and towards

independence. It is within in this space for thinking that the capacity for symbolization takes

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form and with which an individual becomes able to engage in play. When Vicky entered

treatment, she had a profound mistrust of others (and the not-me world in general) and had not

developed even a rudimentary sense of inner cohesion or resilience. Some of the primary

contributing factors to these deficits was the pervasiveness of dishonesty in her family system,

the lack of adequate parental concern, and a paucity of validating experiences. Because the

healthy navigation of potential space requires a relatively stable and cohesive self (the

development of which depends upon trust, parental identification, and mirroring) and the sense

of the not-me world as safe, potential space did not become a prominent area of mental life for

Vicky. Luz’s mirroring provided the necessary nurturance for the “structuring of a more

cohesive self,” whereas her capacity to gently and lovingly set boundaries enhanced Vicky’s

sense of the not-me world as somewhat safer (Luz, 2009, p. 302). These environmental

provisions made it possible for potential space—the space in which ambiguity and anxiety can be

safely processed—to become a safe place for Vicky to engage with the not-me world.

How are we to understand Vicky’s addiction in terms of the relative absence of a space

for thinking? Vicky experienced the negotiation of inner and outer in the realm of potential

space as dangerous. Because adults and adolescents experience aliveness primarily in the

potential space, Vicky needed a way to achieve aliveness that did not require her to tolerate the

strain and anxiety associated with the abrogation of omnipotence that is required for the

navigation of potential space. Luz reiterated throughout her paper the immense difficulty Vicky

had tolerating frustration and waiting—both of these experiences were for Vicky reenactments of

traumatic experiences with the not-me world in which she was neglected or abandoned and

carried with them the annihilation anxiety that results from such experiences. Unlike her

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therapist or parents, she experienced drugs as “entirely under her control” (Luz, 2009, p. 297).

The instant gratification of drugs and the sense of omnipotence they provided made it possible to

live within a world devoid of ambiguity and frustration. In this state of being, there was minimal

risk of intrusion from the not-me world and she could have the experiences of aliveness, agency,

and excitement that Winnicott associated with creativity. There was, however, a high price to

pay for relying so heavily on drugs as her primary means of sustenance—she did not get to

experience the enrichment and more nuanced aliveness that belongs to playing within potential

space. Her enjoyment of intoxication fundamentally lacked the mutuality that makes it possible

to engage meaningfully and authentically with the not-me world.

Addiction as it Relates to Aggression

The previous two sections have demonstrated that, although varying in thoroughness and

clarity, the research on the relationship between addiction and Winnicott’s theories of being and

creativity is substantial enough to provide investigators with a foundation for understanding

addiction using these aspects of Winnicottian thought. However, the literature does not appear to

contain any in depth discussions of addiction as it pertains to Winnicott’s unique formulation of

aggression. I was surprised to find the following message after typing “Winnicott” AND

“aggression” AND “addiction” into EBSCOHOST, comprehensive online search engine: “No

results were found.” Augmenting the search to include the word “alcohol” yielded 1,202,639

results. However, the articles and books in the search results dealt with topics far removed from

Winnicott and aggression. Such topics include alcohol use in the military, biomarkers for fetal

alcohol exposure, “Applications of Transgenic and Knockout Mice in Alcohol Research”

(Bowers, 2000), and various addiction rating scales. Conducting this same search in the PEP

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(Psychoanalytic Electronic Publishing) Archive yielded 24 results. Of these, only two papers

(Director, 2002; Johnson 1999) deal with both Winnicott and addiction; Director alone addresses

Winnicott’s theory of aggression as it relates to addiction. In my research outside of these

databases, I have found two other papers that address this topic (Luz, 2009; Potik, 2007). Only

Luz’s paper talks explicitly about Winnicott’s ideas regarding aggression.

I will limit my discussion to the papers by Director and Luz, for they alone address

addiction explicitly in terms of Winnicott’s theory of aggression. Director (2002) speaks about

aggression in terms of survival in the clinical encounter. Director characterizes her patient

“Helena” as someone who had difficulty viewing objects (others) as containing their own

subjectivity. Drug use enabled Helena to maintain a psychological and emotional state in which

she related to objects primarily in subjective terms, a phenomenon that allowed her to experience

the omnipotent control associated with the earliest days of relating to objects. Director believed

that Helena’s drug addiction reinforced intrapsychic and interpersonal dynamics in which the

various components of aggression remained in a regressed state. Director (2002) wrote that

“drug use…is an instrument of omnipotence, giving people the power to dictate the terms of

object relations in their lives” (p. 571). Helena carried this form of object-relating into treatment,

as evidenced by demandingness and overt expressions of hate. Throughout their work together,

Director strove to survive “by maintaining [her] analytic function,” and this helped them to

arrive at a state Director described in the following way: “There we both existed as subjects—I

now as a person, no longer drug, with a life in reality, not merely subject to her fantasized

control” (2002, p. 578). From this discussion, we can extrapolate that individuals who struggle

with addiction will benefit from working with therapists who, much like the good-enough

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mother, are able to contain and survive their hate and destructiveness—a process that facilitates

the transition from object-relating to object-usage.

Luz (2008), like Director, discussed addiction and aggression through the use of a case

vignette and addresses the ways in which the therapeutic relationship can help clients to arrive

develop the capacity to use objects—to desire and benefit from reciprocity in interpersonal

relationships. She emphasizedzes the importance of the therapist’s “survival” of addicted

client’s aggression:

To help Vicky evolve from what Winnicott (1968) calls ‘relating to an object’ to the

ability to ‘use an object’ meant to be moving in the area of transitional phenomena, where

Vicky could ‘destroy me’ in fantasy whenever she acted out and I could ‘survive’ in

reality. Here, to serve means to…maintain the same posture, chiefly non-retaliatory,

regardless of her aggression in relation to our work of comprehension and analysis of her

issues…she was able to evolve from a schizoparanoid functioning to a depressive one,

where the space and capacity for thinking began to flourish and bloom. (p. 303)

This passage highlights the fact that many individuals who are addicted to drugs have not

sufficiently developed the capacity to experience their destructiveness as survivable or to accept

the subjectivity or complexity of others. It is possible that Vicky engaged in dangerous and self-

destructive behavior in order to see if there was something in the external world that would set

boundaries for her in a non-retaliatory manner.

The question must be posed: why has so little been written on addiction and its

relationship to Winnicott’s theory of aggression? First of all, Winnicott wrote much less about

aggression than he did about creativity and continuity. This discrepancy could partially account

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for the paucity of writings on aggression and addiction. Secondly, Winnicott’s theory of

aggression was not nearly as influential on the psychoanalytic community as were his

contributions regarding other areas of psychological and emotional development. However, it is

likely that the opaqueness, vagueness, complexity, and confusing nature of his theory of

aggression has the most to do with its relative absence from psychoanalytic addictions literature.

It is difficult enough to apply his insights to the phenomenon of addiction, for most of his

writings are non-systematic, paradoxical, and open to a variety of interpretations. Each of these

qualities doubly applies to his theory of aggression. It is therefore especially important for this

dissertation to address the relationship between addiction and his theory of aggression,

particularly because it was so revolutionary in the history of psychoanalysis and because it has so

much to offer us in our clinical work with addicted clients.

Why Winnicott Now in Addiction Studies?

The introduction and literature review of this dissertation have accomplished a variety of

tasks. We have outlined the scope of this study, discussed its limitations, and stated our purpose.

The first chapter provided an overview of the current climate of addictions studies as a whole

and noted the ascendancy of biological, psychodiagnostic, and cognitive-behavioral approaches

in understanding addiction. Although we have established the importance of maintaining an

integrative approach in working with addicted individuals, we have reestablished the continued

significance of psychodynamic factors and the need to revitalize this field of inquiry. Chapters

one and two have also familiarized us with the central tenets of Winnicott’s theory, particularly

the themes of being, aggression, and creativity. We have come to understand the historical

context that provided the soil for Winnicott’s theorizing and to appreciate the ways in which his

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acceptance and rejection of various aspects of Kleinian theory facilitated his development as a

psychoanalytic theorist whose insights are relevant to addictions studies. Surveying the existing

literature on Winnicott and addiction has demonstrated that, despite the fruitful contributions of

many authors, there is still much work to be done in this area. However, the question remains:

why Winnicott now? In many ways, the answers to this question are embedded in what has

already been written, but it behooves us to address it in a more explicit manner.

The first answer is academic in nature. In their intellectual pursuits, scholars in every

field inevitably discover terrain that has yet to be explored. Academics must dedicate

themselves to the deepening and expansion of their areas of study—especially in the domain of

clinical psychology, in which scholarly pursuits can lead directly to the alleviation of suffering.

Winnicott’s insights have been utilized to illuminate and enrich areas as diverse as play therapy,

education, and trauma. Although many have implemented his theories in studying addiction, it is

clear that addictions studies have not benefitted from a thorough excavation of his ideas. The

current investigation will not only give Winnicott the attention he deserves in this area, but will

help to rejuvenate the lagging field of psychoanalytic addictions research.

I would also argue that Winnicott’s theories provide an important challenge to clinicians.

The predominant approach towards treating addiction today is without a doubt highly

interventionist in nature. Therapists in training spend hundreds of dollars on textbooks that

promote systematic and manualized methods of treatment for addiction. Winnicott’s theory

forces us to acknowledge that the blind application of scripted interventions might constitute a

form of impingement. Just as Winnicott cautioned against the premature use of interpretation in

psychoanalysis, he would also probably look with suspicion upon an approach that focuses

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primarily on providing the “answers” to addicts at any stage of treatment. There is of course the

debate around whether or not individuals in active addiction or early recovery should pursue

traditional psychotherapy. However, Winnicott’s theory can be applied to any phase of the

addictive process. More than anything, Winnicott’s writings emphasize environmental provision

as the central element not only in child-rearing, but in treatment in general. If we remain

cognizant of the possibility that our clients’ addiction has diminished their capacity to simply be,

we can closely monitor whether or not our therapeutic stance allows them to have the experience

of “formless functioning” in the presence of another. If we consider the atrophying of creativity

as a potential corollary of addiction, we can devote ourselves to creating opportunities that

facilitate the actualization of clients’ creative potential.

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Chapter 3: Methodology

Purpose

The purpose of this dissertation is to contribute to addictions studies by demonstrating the

ways in which D.W. Winnicott’s theories might help us to better understand (a) the etiology and

psychological dynamics of addiction and (b) the subjective experience of those who struggle

with substance use. Although many authors have addressed this topic, few have taken full

advantage of Winnicott’s insights in their attempts to conceptualize addiction from a

psychoanalytic perspective. The Winnicottian notions of being, creativity, and aggression lie at

the center of his theorizing, yet the vast majority of scholars have neglected to give these

concepts ample attention. This project will provide the reader with a clearer and more

substantive grasp of these themes and their potential applications in working with addicted

clients.

Proposed Methodology

This dissertation centers on a critical review of secondary and primary literature in the

context of a case study. The following chapter is divided into sections on being, aggression, and

creativity. I will elucidate the clarifications, emendations, and extensions of Winnicott’s theory

found in each secondary source and simultaneously apply each author’s insights to the life of

“Roger,” a case study loosely based on my work with an opiate-addicted client. The integration

of theory and case study will follow the same sequence in each section: pre-addictive

experiences and defenses, the breakdown of pre-addictive defenses, the establishment and

maintenance of addictive defenses, the breakdown of addictive defenses, and recovery. In the

interest of confidentiality, I have made significant changes to my original client’s demographics,

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personal history, and statements made during therapy sessions; I have also added information to

further conceal the identity of this client. These alterations will not, however, prevent an

accurate assessment of the nature of the conflicts and difficulties underlying the development,

establishment, and breakdown of this client’s addictive defenses.

Rationale for Chosen Method

Analysis of Case Study

One can argue that the most fruitful and informative analyses of Winnicott and addiction

have included detailed case histories. Eigen (2011), Luz (2009), Potik (2007), and Siporin

(2010) each enriched the theoretical dimension of their essays with rich clinical data from their

own psychotherapeutic work with addicted clients. A symbiotic relationship between theory and

the experience of addiction develops from an approach that integrates Winnicottian themes with

the triumph and suffering of those struggling with substance use. The lived experience of

patients breathes life into theory, while Winnicott’s ideas provide a conceptual frame that allows

clinicians to consider these individuals with issues of emotional development, environmental

factors, and human potential in mind. Reviewing Livingston’s contribution showed us that even

a careful and nuanced theoretical study of Winnicott and addiction can be overly abstract and

skeletal in the absence of clinical material. The same is true for research that provides very

limited descriptions of clients’ life stories (e.g. Rivinus, 1992). I considered conducting semi-

structured interviews with volunteers, but this method would not provide me with the amount or

type of information needed to accomplish my objectives. A quantitative approach based on

surveys would also clearly prove inadequate to the task at hand.

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I have chosen to conduct this investigation in the context of my own work with an

addicted for a variety of reasons. This approach makes it possible to develop a Winnicottian

perspective on addiction that incorporates (a) pathogenic historical experiences that “create

vulnerability…for a future instillation of dependogenic processes,” (Ramos, 2004, p. 475), (b)

the ways in which the intrapsychic and interpersonal dynamics set in motion by experiences prior

to drug use can determine to a great extent the defensive functions served by drugs, (c) the ways

in which intrapsychic and interpersonal dynamics shape an individual’s experience of drug

seeking/using, as well as the meanings attributed to these activities, (d) the breakdown of

addictive defenses, and (e) implications for treatment of clients in the recovery process.

My examination of the case of Roger will provide an in-depth account of his chaotic

childhood, opiate addiction, and, to a lesser extent, his early recovery. Examining developmental

precedents will allow for a more substantive dialogue between Roger and Winnicott, who was

first and foremost a developmental theorist. I should point out that I do not presume that not-

good-enough caretaking always leads to drug addiction or that all individuals with problematic

drug use had inadequate early parenting experiences. Furthermore, we cannot ignore the fact

that there are many paths to addiction. Many individuals with drug problems grew up in “good-

enough” environments and had relatively “healthy” pre-addictive personalities. Cultural and

social factors, as well as adult trauma, are in many cases much more influential in the

development of addiction than early experiences of inadequate caretaking. I will raise the

possibility in the concluding chapter that a Winnicottian perspective could help to inform

treatment of addiction regardless of its etiology.

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The purpose of chapters 4-6, however, is to provide an in-depth analysis of a case in

which drug abuse represented to a great extent an attempt to deal with pre-addiction difficulties.

It is not anticipated that there will be a perfect “fit” between the Winnicottian paradigm and

Roger’s lived experiences. However, this study will contend that looking at Roger’s life from a

Winnicottian perspective will provide us with a window into many facets of his childhood,

addiction, and recovery. A Winnicottian approach provides us with an opportunity to investigate

Roger’s private and interpersonal worlds in light of the unceasing and ever-changing movements

of maturational processes—their elaboration, dissolution, stagnation, and growth—that always

influence both behavior and subjective experience, albeit perhaps on an unconscious level.

Successful execution of the proposed method will require a delicate balance between

allowing Roger’s experiences to unfold naturally before us and staying focused on the theoretical

dimension of this project. However, theoretical considerations will undoubtedly be more at the

forefront in this dissertation than they were in my work with Roger. This will almost

undoubtedly lead to some degree of reductionism and/or bias. This inescapable conundrum will

not prevent us from developing a useful perspective on Roger’s experiences or from

demonstrating the relevance of Winnicottian theory in studying addiction.

Critical Review of the Literature

Winnicott looms as a titan in the development of psychoanalytic theory and, arguably,

provided the most radical theoretical revolution since Freud. His rich contributions contain

myriad concepts, all of which he interweaves with subtlety and nuance. As evidenced in the

literature review, a Winnicottian account of addiction that fails to embrace the immense

complexity of his writings may ultimately lead to confusion or oversimplification. It is for this

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reason that a critical review of the literature is necessary for the current project. This study will

not be limited to the intense scrutiny of primary source material. The introduction made it clear

that, despite his ingenuity, Winnicott’s essays are sometimes cryptic, contradictory, and

ambiguous. Fortunately, the current body of psychoanalytic literature abounds with

contributions from authors who have dedicated themselves to the clarification, elaboration, and

extension of Winnicott’s original insights. Very few Winnicottian addictions studies have taken

advantage of the available secondary literature on Winnicott’s theories. The combined analysis

of primary and secondary sources will allow us to explore addiction more thoroughly than much

of the previous research. In the following analysis of Roger’s story, I will explore of

contributions of Goldman, Alford, Abram, and Rose, among others.

In keeping with the conceptual focus of this dissertation, chapters 4, 5, and 6 will include

separate discussions of being, aggression, and creativity, as well as the relevance of these themes

to the study of addiction. These chapters will contain synopses of selected authors’ writings on

the concept under discussion as well as their conceptual innovations, recontextualizations, and

extensions of Winnicott’s views on being, aggression, or creativity. For instance, Abram (2012)

provided us with an in-depth examination and clarification of Winnicott’s views on aggression.

She then moves on to introduce her own notion of the “non-surviving environment,” an idea that

she grounds in Winnicott’s views on object-usage. The inclusion of both the explicatory and

inventive aspects of the papers under discussion will aid us in deepening our appreciation of the

ways in which Winnicott’s distinctive views can enliven the psychoanalytic investigation of

addiction. Papers by Goldman, Alford, Abram, and Rose will be examined in these chapters.

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Several factors complicate the task of these chapters and threaten the accuracy,

comprehensibility, and usefulness of any potential conclusions. Chief among these is the

inherent inseparability of being, aggression, and creativity in Winnicottian theory. One cannot

discuss being without reference to its role in creativity; similarly, an exploration of aggression

without considering its relationship to being will result in only a partial understanding of its role

in psychological development and in the etiology and maintenance of drug addiction. The

problem becomes even more apparent when one considers the fact that most of the secondary

sources include—either directly or indirectly—a discussion of more than one of these three

concepts. Yet, this chapter contains separate sections for being, aggression, and creativity. Two

questions immediately come to the fore. How can we possibly expect this part of the dissertation

to successfully elaborate upon the relationship of these three concepts to addiction if it involves

such an artificial division, and what is the justification for adopting this awkward approach?

I will begin by answering the question of why I have chosen to proceed in this manner. It

is true that these concepts are tightly interwoven and together form a complex portrait of human

development and general psychological functioning. Yet, a failure to understand each

component part on its own ultimately makes comprehension of the whole picture unlikely. Part

of what makes Winnicott so difficult to grasp is the conceptual fluidity present in much of his

writing. The following quote from Playing and Reality (1971) serves as a prime example of this:

The searching can come only from desultory formless functioning, or perhaps from

rudimentary playing, as if in a neutral zone. It is here, in this unintegrated state of the

personality, that that which we can describe as creative can appear. This if reflected

back, but only if reflected back, becomes part of the organized individual personality, and

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eventually this makes the individual to be, to be found; and eventually enables himself or

herself to postulate the existence of the self. (p. 64)

This statement about the way in which the search for the self begins and unfolds involves nearly

every element of Winnicott’s developmental theory. The aspects of his framework either

implied or explicitly addressed include but are not limited to (a) the state of simple being

associated with the earliest days of psychological life, (b) an intimation of later descriptions of

the female element of the personality, (c) the mirror role of the mother, (d) transitional

experiencing, (e) differentiation and the establishment of unit status, (f) the pre-ruth aspect of

aggression that searches for something to “bump up against” and that requires the survival of the

environment so that it might become an integrated part of the personality, and (g) the

sophisticated creativity of adulthood that entails the continuous, precarious balancing of relating

to subjective objects and objects objectively perceived. Considering the statement as a whole

without breaking it down into its various components might provide readers with a “sense” of

what Winnicott is trying to say. A casual reading that that does not illuminate the nature of each

of these themes and their inter-relatedness will not benefit from all that passages such as this

have to offer. Our present approach must resemble that of a literary scholar who, in an effort to

identify and appreciate the myriad subtle meanings and aesthetic components of a poem, can

maintain an appreciation of its overall beauty while scrutinizing every syllable of every line.

Though it may feel unnatural to partition the concepts of being, aggression, and creativity, this

approach will enable us meaningfully relate each of these pivotal elements of Winnicott’s

thought to addiction.

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Now that the rationale for this approach has been established, it is possible to address the

question of how to proceed along these lines without overlooking the fact that the inter-

relatedness of being, aggression, and creativity constitutes a broader and unified developmental

paradigm. Most importantly, we must aim to maintain a background awareness of the inherent

inseparability of these concepts. Simply striving to keep this unity in mind while discussing

these topics will help to sustain this precarious balance. However, it will at times be necessary to

reference creativity and aggression when discussing being and to include creativity and being in

the section on aggression. Because creativity itself is in large part a fusion of being and

aggression, relating creativity to addiction will require us to incorporate them when relating

creativity to addiction. It should be noted that doing so will lead to some redundancy or

repetitiousness in chapters 4-6; this, however, is an unavoidable byproduct of the task at hand.

Theoretical Basis for this Approach

The very task of viewing a phenomena as complex as addiction from a particular

theoretical framework inherently entails the threat of reductionism. I believe this to be true both

in the case of psychotherapy and academia. Insights from Winnicott and Summers have aided

me in determining an approach which will help to maintain the precarious balance between the

extremes of reductionism and theoretical timidity.

Psychologists must always exercise caution and strive to prioritize clients’ subjective

experience over their beloved theories. Summers (2013) made an important distinction between

deductivist and heuristic analysts. For deductivists, “the subject’s experience is sought and

recognized in order to see how one can apply the knowledge base of psychoanalysis to the

patient’s symptoms and psychic deficits” (Summers, 2013, p. 5). Summers chided both past and

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contemporary analysts who have been more interested in validating their cherished theories than

in allowing their thoughts and interventions to be guided by the flow of clients’ moment-to-

moment experiencing. Heuristic analysts strive to achieve and maintain this latter stance,

“pursu[ing] psychic depth and open avenues of exploration in accordance with the elaboration of

the patient’s experience” (Summers, 2013, p. 16). Winnicott, whom Summers identified as a

central figure in the development of the heuristic approach, seems to have been acutely aware of

the dangers of imposing theory on clients’ experiences. Especially in his later works, Winnicott

(1971) repeatedly insisted that psychotherapist avoid making interpretations that are “outside of

the ripeness of the material” (p. 51).

However, Winnicott also expressed a somewhat different sentiment throughout his

lifetime. Indeed, he emphasized the necessity of maintaining a theoretical perspective in both

clinical and academic work. He described his theory as his “only companion” in “exploring the

unknown territory of the new case” (Winnicott, 2010, p. 149). A much earlier statement from his

1949a essay “Birth Memories, Birth Trauma, and Anxiety” has helped me to determine how to

utilize his theories in my discussion of addiction. Winnicott sought in this essay to demonstrate

the link between traumatic birth experiences and the development of psychopathology. He listed

various elements analysts must keep in mind when exploring analytic material that involves

themes of psychic residues of traumatic prenatal and postnatal factors. Winnicott (1949a)

introduced these factors in order to demonstrate that “no consideration of the birth trauma can

have value unless a sense of proportion can be maintained” (p. 177). He emphasized that he is

“not claiming that treatments can be done on birth material alone. The analyst must be prepared

to expect whatever type of material turns up, including birth trauma” (Winnicott, 1949a, p. 177).

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The next sentence concisely sums up his approach and also serves as helpful advice for future rs:

“Nevertheless in a discussion of any one subject one should not be afraid temporarily to seem to

over-estimate the importance of the subject under discussion” (Winnicott, 1949a, p. 177). I have

clearly established the need to consider various perspectives in working with addiction.

Following Winnicott’s lead, I will “temporarily overestimate the importance” and prevalence of

Winnicottian themes in conceptualizing addiction throughout this dissertation. Constantly

reminding the reader of considerations beyond the purview of Winnicott’s theories would disrupt

the reading experience and make less clear the relevance of being, creativity, and aggression in

the etiology, maintenance, and experience of addiction.

I must briefly address another difficulty implicit in my task: not only will I be

“overestimat[ing]” the salience of Winnicott’s theories—I will be emphasizing the continual

influence of preoedipal, infantile dynamics in the lives of adults who struggle with addiction. As

I have already discussed, preoedipal themes include the establishment of a “unit self” and the

development of a rudimentary relationship with the m/other. One might ask, “Can’t we assume

that this has already taken place and that these adults clearly demonstrate the capacity to

differentiate self from other? Perhaps considering such factors might make sense in a paper

about psychosis, but not for the individuals under discussion.” Such a statement seems

intuitively correct, and I myself struggle at times to reconcile Winnicott’s theories on infant

development with the experiences of my adult clients. Winnicott (1963a) made the following

statement regarding the relevance of his theories to older children and adults: “Indeed most of

the processes that start up in early infancy are never fully established, and continue to be

strengthened by the growth that continues into later childhood, and indeed in adult life, even in

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old age” (p. 73-4). Winnicott (1971) echoed this sentiment several times in Playing and Reality,

as evidenced by statements such as “It is assumed here that reality-testing is never fully

completed and that no human being is free from the strain of relating inner and outer reality” (p.

13). The “processes that start up in early infancy” include the growth and maintenance of a

meaningful inner world and the ability to maintain cohesion in the face of external events beyond

one’s control.

The overall approach of this dissertation is, by nature, somewhat deductivist. Indeed, one

of the primary aims of the current project involves “see[ing] how one can apply” Winnicottian

theory to Roger’s “symptoms and psychic deficits” (Summers, 2014, p. 5). It is here that we

must make a careful distinction between the role and application of theoretical frameworks in

clinical work and in academic research. In therapy with clients, I have found that it is essential

to make sure that theory does not occupy too central of a place in my mind. This is true both in

terms of what is happening in my mind during sessions and in my interventions. However, I fear

that the complete avoidance of deductivism in research could make it impossible for one to attain

the clarity and depth of theoretical understanding that is one of the foundations for clinical

practice.

Summary

Me: What is it like when you're high?

Roger: All of my nervousness is gone. Anxiety, inhibitions, stress, feelings…

Me: Do you hate yourself when you're high?

Roger: No.

Me: Do you think good things about your self?

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Roger: No. I just don't think—that's the great part.

Just this brief excerpt from a session with my client Roger conveys the power of his relationship

with drugs. This dissertation will consider what might have run through Winnicott’s mind upon

reading this same interchange. By integrating a critical review of the literature with a case study,

the current study will enable us not only to enrich our understanding of Winnicott’s theories, but

to demonstrate the ways in which his insights can assist us in our work with addicted clients. A

Winnicottian perspective alone can never address every dimension of addiction; however,

keeping in mind his notions of being, aggression, and creativity will help to create a space for

meaningful reflection. Having delineated the background, purpose, and method of this project,

we are now ready to begin our formal investigation.

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Chapter 4: Being and Addiction

Introduction

The second chapter of this dissertation entailed an exploration of the current literature on

Winnicott and addiction, the statements Winnicott himself made regarding addiction, and the

relevance of his theory to current psychoanalytic perspectives on problematic drug use. We will

be unable to fully appreciate the potential for Winnicott’s ideas in order to illuminate drug

dependence if we consider only primary source material and the explicit connections others have

made between Winnicott and addiction. The passage of time has provided more recent

psychoanalysts with more nuanced insights into Winnicott’s original theories. While the

clarification of Winnicott’s more difficult or confusing ideas has certainly been a boon to

psychoanalytic thought and practice, the true value of their contributions lies in their ability to

identify and expand upon nascent, underdeveloped, or unappreciated themes in Winnicott’s

corpus. Some of these writers have placed Winnicott’s ideas within the context of more modern

psychoanalytic and philosophical discourse. Furthermore, many of these theorists have

introduced original concepts derived in part from their understanding of primary source material.

The current literature on Winnicott and addiction seems to have almost entirely overlooked the

valuable insights of more recent Winnicottian studies. It will soon become apparent how

profound an impact this omission has on our ability to meaningfully incorporate Winnicottian

theory into the conceptualization and treatment of addiction.

Chapters 1 and 2 made it clear that a discussion of Winnicott and addiction must place

being at its very center. Goldman (2012) and Alford (2011) clarified Winnicott’s writings on

being, which can at times be quite vague. Numerous terms can be placed under the umbrella or

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within the same color spectrum as “being;” these include “going-on-being,” “continuity of

being,” “formless functioning,” “aliveness,” and “the female element.” At times, it seems as if

these concepts are completely synonymous with one another, yet it is clear that this is not the

case. Winnicot does not often provide readers with clear distinctions between these terms, and

we are left a somewhat blurred picture of this dimension of his theory. The situation becomes

even more frustrating when one considers that he formulates these aspects of experience within

the context of infancy and early childhood. Given the more complex nature of adult

psychological processes, students of Winnicott’s work must discern to what extent the “being” of

infants can be compared with the “being” of adults. Recalling the following quote from “The

Capacity for Concern” can provide a starting point for clarifying this state of affairs: “Indeed

most of the processes that start up in early infancy are never fully established, and continue to be

strengthened by the growth that continues into later childhood, and indeed in adult life, even in

old age” (Winnicott, 1963a, p. 73-4). As we will soon see, Goldman and Alford each address

and expand upon this issue in their papers.

These authors also consider the relevance of being to themes that Winnicott addressed

but never fully elaborated. Goldman dedicated the majority of her paper to dissociation and the

ways in which it may be used as a defense against further threats to continuity. Alford provided

a substantive discussion of Winnicott’s thoughts on trauma and described between two forms of

trauma, each of which undermines the capacity to simply be. Most important to the current study

is the fact that their writings on dissociation and trauma serve as starting points for exploring

previously uncharted territory in the application of Winnicottian theory to addiction. In

discussing the relevance of dissociation and trauma to being and addiction, I will provide

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summaries of especially salient points in each of these papers and demonstrate how these

authors’ insights can be applied to the case of Roger.

The Case of Roger

I met with Roger, a 23-year-old male student attending a nearby college, for

approximately 8 months at a community mental health center. His initial concerns were

academic in nature and included difficulty retaining information, sustaining attention, and

passing his classes. He also had difficulty staying motivated over long periods of time, despite

his strong desire to succeed in school. During the initial interview, he disclosed that he was in

recovery from drug addiction (primarily oxycontin) and had not used drugs for almost 2 years.

He had spent time in jail three years earlier due to various drug charges. He indicated that he

consistently felt depressed, anxious, self-loathing, and unmotivated.

Roger grew up in a rural area and had moved to a large city less than one year before

therapy began. His parents divorced at an early age and he characterized their marriage as

unhealthy and tumultuous. Roger had a decidedly negative impression of both parents and of his

formative years in general. He once described his mother as a “fucking mess” and his father as

“totally spaced out.” Roger regularly referred to his mother’s intense anxiety, unpredictability,

and self-absorption—qualities that continue to the present day. Less is known about his father,

who is “in his own world.” Something his parents had in common while growing up was a

consistent disorganization and lack of direction, particularly as it applied to Roger’s upbringing.

At the core of his frustrations regarding his parents’ failures was their inability to provide him

with a structure of any form. Roger sometimes said things like, “They should have just put me

up for adoption if they didn’t want to raise me.” He lamented their complete inability to do what

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“normal” parents do. He wishes he had learned how to live a structured and goal-directed life.

He cites as an example of his parents’ disorganization an instance in which they bought him a

guitar, but failed to follow through on providing him with lessons. He quickly gave up trying to

learn and felt that his mother showed no sincere interest in what he wanted to do with his life.

When Roger would try to tell her about his achievements (e.g. good grades), she would cut him

off and say something to the effect of, “That’s great, Roger. I don’t really have time to chat right

now.” His mother drank frequently and was especially hurtful when intoxicated. Several

sessions into therapy, Roger disclosed that his father had once punched him in the face during an

argument; he responded by urinating in his father’s car.

Roger was an extremely angry child and adolescent. He acted out, treated teachers

disrespectfully, and actively sought out conflict. One of our most fruitful discussions revolved

around the potential origins of his aggression. First of all, he learned from his parents (who were

always arguing) that he must be aggressive in order to communicate himself to others. Secondly,

it represented a way of getting the attention that he did not get at home. He remembers being

extremely angry, irritable, and rebellious. He struggled academically during elementary school,

but his academic problems became much more serious when he started drinking and using drugs

at the age of fifteen. By the age of sixteen, Roger was regularly drinking, smoking marijuana,

and using cocaine. He remembers his first experience of intoxication in great detail—for once,

he felt at peace and was able to interact with others without feeling anxious. He regularly missed

school and performed poorly in classes. At the age of 22, Roger met “Julie,” whom he dated for

a little more than two years. Julie was a drug dealer and introduced him to oxycontin. Roger

quickly developed a serious addiction and using oxycontin intravenously became the center point

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of his life. He and Julie spent every dollar they could scrounge up on heroin, to the point that

they could not afford to buy food or heat their apartment. Crippled with depression, he spent a

great deal of time aimlessly wandering the streets of his small town. He regularly considered

and fantasized about how he would kill himself. Although he tried to kill himself by overdosing,

his attempts were always in vain due to his “ridiculous” tolerance.

Everything changed when he was arrested for drug possession. He spent 11 months in

jail, and recalled this period of time with pain and regret. He moved in with his aunt and, with

her support, he regularly attended 12 step meetings and met for group therapy sessions. His time

was very structured, and was able to abstain entirely from intoxicating substances for one year.

For nearly a year, Roger worked full time at a grocery store; he absolutely hated this job and

strongly desired to find a job more aligned with his interest in business. In order to achieve this

goal, he enrolled in a local college.

In the year or prior to beginning treatment, Roger had had a great deal of difficulty

focusing on school work, establishing and maintaining healthy relationships, sustaining a

positive sense of self, feeling consistently motivated, and feeling comfortable in his own skin.

Several months into therapy, his mother saids something extremely hurtful that made Roger feel

that his attempts to change were futile. Talking about this triggered an influx of painful

memories from early childhood. Roger had the most difficulty talking about how his mother

would often forget to pick him up from school; he would wait for hours on end in the

administrator’s office, not knowing when—or if—she would ever come to get him. This

conversation with Roger stirred within me a complex blend of emotions—anger towards his

mother, sharing Roger’s sadness, and apprehension about how Roger would cope with such a

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devastating psychological and emotional injury. Three days after this session, Roger went to a

friend’s house to drink, and ended up spending 24 hours drinking, smoking crack and marijuana,

and injecting oxycontin. He even tried taking PCP for the first time. He missed several

scheduled sessions and stopped going to class. Roger returned to therapy feeling miserable and

seriously doubting his ability to get back on track, perhaps because of the rekindling of

vulnerability, self-loathing, and despair brought about by his mother’s comments. I was again

flooded with a variety of emotions, most notably self-doubt about how helpful I could be and a

deep concern for Roger’s safety. He then missed four more sessions. Our relationship deepened

over the course of the next several therapy sessions. Although his academic performance

markedly improved and he developed a stronger ability to reflect upon the nature and causes of

his addiction, he still had a great deal of difficulty feeling consistently motivated and emotionally

stable.

Being, Dissociation, and Addiction

In her 2012 paper entitled “Vital Sparks and Things Unknown,” Goldman carefully

traced the threads on the topic of dissociation that run throughout Winnicott’s early, middle, and

late writings. She made the argument that dissociation lies at the very heart of Winnicott’s

theory, despite the fact that he did not make frequent use of the term itself. She identified

dissociation as an essential component of his reflections on absolute dependence, artistic

creation, and trauma. In this section, I will carry her insights further by demonstrating that

dissociative dynamics—particularly as they relate to the various dimensions of being—could

possibly play an important role in our understanding of the etiology of addiction, its

maintenance, and the impact of twelve-step programs and psychotherapy on individuals in

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recovery. Before directly addressing her comments on the complicated nature of this not-so-

complicated psychological activity, it will first be necessary to see what she has to say regarding

the relationship between being, aliveness, and their manifestations throughout development.

Goldman dedicated the first third of her paper to the precarious nature of aliveness. We

find at the center of this discussion her conclusion that, in Winnicott’s framework, being can

essentially be equated with aliveness. Like many Winnicottian scholars, Goldman (2012)

highlighted the following aspects of Winnicott’s writings on being and aliveness: (a) the way in

which “psychological aliveness…originates in an undifferentiated field” and is “never fully

localizable,” (b) the connection between aliveness and the spontaneous gesture associated with

the True Self, (c) the intimate relationship between aliveness and the continuity of being, (d) that

the diminution of psychological aliveness inevitably contributes to feelings of futility and inner

deadness, and (e) Winnicott’s unique formulation of the need for psychological aliveness and the

annihilation anxiety that results from threats to the continuity of being as more primordial than

any consideration of sexual instincts and castration anxiety (p. 332, 334). However, her

conclusion regarding the equivalence of aliveness and being raises the question that must be

answered if we are to make sense of the relationship between being and addiction: to what extent

is the being underlying the experience of aliveness in infancy—the simplest form of being

associated with the time before the establishment of unit status and associated primarily with

relating to subjective objects— equivalent to the being that underlies the aliveness of adulthood?

Though Goldman does not explicitly raise this question, she ultimately provided a satisfying

answer.

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Maintaining a direct equivalence between the continuity of being of infancy and of

adulthood is inaccurate and untenable. Yet, Winnicott’s writings on being and aliveness at times

make it difficult to formulate an alternate stance with confidence. Goldman (2012) succeeded in

differentiating between aliveness across various phases of development with a clarity not often

found in Winnicott’s original works: “Development, for Winnicott, proceeds through the

negotiation of increasingly object-related ways of being alive” (p. 336). She concisely described

the “earliest quality of aliveness” that is associated with “what it means to be alive at a time

before the infant becomes a subject” as being “generated in the context of holding [and] aptly

captured by the rhythmic verb ‘going on being’” (Goldman, 2012, p. 335). This type of being

and aliveness differs qualitatively from that of the relationship to transitional objects, the creative

living of adulthood, and immersion in the artistic process. These other experiences of continuity

each represent “increasingly object-related ways of being alive.” The infant or young child who

both discovers and creates transitional objects is tasked with coming to terms with a “not-me”

world, an activity not required while in a state of undifferentiated and oceanic being facilitated

by the mother’s holding. Similarly, the continuity experienced by an adult creatively engaged in

the daily tasks of life is grounded in a much more complex negotiation than that of early

relationships with transitional objects. Once the differences between the experiential

manifestations of being are understood, one can begin to understand the ways in which they are

related. We get a sense that each form of being is predicated upon the simpler forms associated

with earlier phases of development. The chances of feeling continuity in adulthood are much

lower if one did not have adequate opportunities to experience simple being associated with

earlier phases in development.

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This notion of progression through increasingly complex experiences of continuity brings

us to a question that might be intimately connected with addiction: what happens when the sense

of being in later childhood, adolescence, and adulthood is either lacking or threatened? Goldman

(2012) answered this question in the following statement, in which she quoted a previous article

by F.R. Rodman: “If the child collides with the world rather than find[ing] himself in it…he will

be forced to react by ‘…withdrawal from contact for the re-establishment of the sense of being’”

(p. 335). In other words, individuals who for some reason are unable to experience continuity of

being of the type associated with healthy engagement in age-appropriate developmental tasks

often feel the need to withdraw so they might re-establish—or perhaps experience for the first

time—the type of continuity associated with simpler and less demanding forms of aliveness and

being. This leads us directly to Winnicott’s 1951 statement on the inherently regressive

dimension of addiction: “Addiction can be stated in terms of regression to the early stage at

which the transitional phenomena are unchallenged” (p. 242). I will address the relationship of

addiction to transitional phenomena in a later section. For the purposes of this discussion, I will

put forth the possibility that addiction can also represent an attempt to re-establish the sense of

being associated with the earliest and most basic experience of continuity. As evidenced by the

literature review, this is by no means an original statement. However, placing it in the context of

Goldman’s formulation of the gradual development and sophistication of being throughout the

lifespan gives this oft-discussed dimension of addiction more subtlety than has previously been

incorporated into writings on Winnicott and addiction.

Roger’s experiences of opiate intoxication provide us with a useful demonstration of how

addiction might relate to the re-experiencing of simpler forms of continuity. Goldman (2012)

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brought up an aspect of primary unintegration that does not often receive attention—the

awareness of the structure of time:

In earliest development, Winnicott suggests, if awareness of the structure of time

prematurely pre-empts the experience of his own rhythms, a warp occurs in the

continuity-of-being…‘Continuing to have a self,’ or psychosomatic unity, Winnicott

suggests, is related to one’s capacity to simultaneously hold potentially incompatible

aspects of memory, perception and desire…Memory points to the past, perception to the

present, desire to the future. Any of all of these can be compromised or forfeited in the

processing of experience. (pp. 335-336)

The second half of this quote indicates that maintaining a sense of oneself as an agentic and alive

individual requires an ability to experience continuity despite the vicissitudes inherent in

understanding oneself as a temporal being. This capacity is founded upon prior opportunities to

discover the structure of time according to the spontaneous elaboration of the True Self,

Winnicott’s term for the core of a person’s aliveness and spontaneity. In our work together,

Roger demonstrated with regularity a sense of being adrift in a dark sea of ever shifting

memories and fears, without a lighthouse to guide him to the safe shores of selfhood. This lack

of centeredness in the navigation of past, present, and future arose in part because the meaning of

time had been imposed on him from without. Though we of course cannot know about whether

or not his parents provided him with a “good-enough environment” during infancy, we can

clearly see from looking at his childhood, adolescence, and addiction that he did not demonstrate

a well-developed ability to effectively consolidate and make sense of memories, perceptions, and

desires. Let us imagine the thoughts, emotions, and physical sensations Roger experienced while

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waiting for his mother to pick him up from school. His thoughts might have included, “Where is

my mom? When is she getting back? My other friends’ parents pick them up on time, why can’t

she? Maybe she doesn’t love me. Last time, she didn’t come for three hours and I got so

hungry.” He likely felt a confusing and frightening mixture of anxiety, sadness, fear, and anger.

His physical state was probably tense and agitated, and certainly not at rest.

This imaginative exercise provides us with a window into young Roger’s experience of

the “structure of time” and allows us to explore the nature of his relationship to his memories,

perception, and desires. The psychoanalytic mentality on the ways in which the past continues to

be a powerful force in determining the nature of present experience and in influencing decision-

making resonates with a quote by William Faulkner: “The past is never dead. It’s not even past”

(1951, p. 73). Winnicott’s theories allow us to wonder whether a client’s past is incorporated

into and contributes to aliveness or is experienced as an alien and intrusive presence that

precludes a sense of continuity. In the case of Roger—both in the above example and in his

comments during our session—memories and unconscious residues of his past often operated as

saboteurs that undermined any efforts to establish a sense of continuity in the present. In fact,

we can see that past impingements, which had also been encoded into somatic sensations,

domineered his present to such an extent that it became nearly impossible for him to have “new”

experiences. This amounts to a poisoning of his present perceptions. The impact of past trauma

and reactive present experiences corrupted his relationship to the future as well. Because anxiety

is usually associated with expectations of what lies in store, we can view his anxiety as the

manifestation of a diminished capacity to utilize either conscious or unconscious fantasies about

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his future to achieve a sense of continuity in the present. My work with Roger demonstrated that

he continued to experience time in a similar way throughout adolescence and early adulthood.

Goldman points out that living in such a way will invariably lead to the emergence of primitive

anxieties—the fear of psychological death and of falling forever.

Roger’s description of opiate intoxication demonstrated the relevance of his drug use to

his relationship with the structure of time. Injecting oxycontin resulted in an immediate

disappearance of anxiety, depression, and self-hatred. The sense of being trapped in the self-

perpetuating feedback loop of a traumatic past, chaotic present, and horrifying future

disintegrated. All bodily tension vanished and was replaced by a feeling of being one with his

body. He once told me that the “best part” of being high was the absence of thought. The

coalescence of these aspects of intoxication resembles the type of continuity associated with

absolute dependence. In viewing his opiate use from this perspective, we must be careful not to

ascribe his addiction entirely to the need for experiencing the earliest forms of continuity. At

other times, Roger appeared to have utilized drugs to achieve entirely different purposes. The

purpose of the current discussion is merely to explore the potential connections between his

addiction and desire for the type of continuity associated with infancy. Roger welcomed the

breakdown of the structure of time—such a timeless state offered a reprieve from the

exasperation and deadness that result from the frenetic efforts to maintain a sense of self within

the context of internal and external realities that he did not feel to be his own.

Our exploration cannot end with the conclusion that Roger’s addiction represents a

regressive attempt to re-experience the unintegration of earliest infancy. While such a statement

certainly illuminates a potentially important element of his drug use, it is insufficient if we are to

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take advantage of all that Goldman has to offer. We have thus far dealt with regression primarily

as a state that might be sought by individuals who struggle with addiction. Numerous questions

remain. First of all, limiting ourselves to a discussion of the ways in which addiction might

represent an attempt to re-establish the sense of being associated with infancy does not address

the fate of the aspects of psychological and emotional functioning that had developed over the

years. What “happened” to the psychological contents and dynamics that Roger sought to

escape? What became of those elements of his inner world that represented the exact opposite of

the continuity he so desperately sought? Did they actually disappear at any point in the addictive

process? The insights achieved up to this point also do not tell us much about the recovery

process or how we might improve our work with clients who present with drug problems.

Answering the above questions requires a discussion of dissociation, a defense mechanism that

figures prominently in the search for regressed forms of continuity. A discussion of the

relationship between dissociation and addiction will require a detailed and somewhat lengthy

explanation of what Goldman has to say about the nature of dissociation and its varied

manifestations across the lifespan.

Dissociation in Winnicott’s framework can refer to a variety of different phenomenon.

We see the process of dissociation in the experience of an infant with good-enough

environmental provision. The musician absorbed in composing a new song has become

immersed in a dissociative state. And, as we will soon see, an addict might defensively seek

dissociation in response to inner deadness or chaos. Goldman (2012) provided an excellent

definition of dissociation:

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Understood in its simplest form, dissociation means that two or more mental processes or

contents are not associated or integrated into awareness, memory, or identity. A

sequestered feature of mental life—a form unknown to consciousness—operates almost

autonomously as the mind adaptationally limits its own self-reflective capacity. While

both a natural human capacity as well as a distinct response to trauma, it makes a vast

difference how and in what context dissociation is used. (p. 339)

As with so much of Winnicott’s theorizing, the experiences and dynamics of dissociation in

earliest infancy are in a way the prototype for later dissociative phenomena. We cannot begin to

understand dissociation in later phases of life if we do not have a grasp on the nature of

dissociation during the initial movements of psychosomatic life. Not surprisingly, early

dissociation is intimately bound up with the notion that the infant begins life in a state of

undifferentiation with his mother and has not yet achieved unit status. Dissociation in babies

might be described as an ongoing experiment in selfhood.

Winnicott (1945) described dissociative experiences in infancy: “There are long stretches

of time in a normal infant’s life in which a baby does not mind whether he is in many bits or one

whole being, or whether he lives in his mother’s face or his own body, provided that from time to

time he comes together and feels something” (p. 150). This passage highlights an important

subtlety in Winnicott’s work—when he talks about the centrality of unintegrated experience in

infancy, he does not mean that the child never experiences integration. The infant’s experience

can be more accurately depicted as “pulses of drifting and gelling” (Goldman, 2012, p. 341).

The times in which the child “comes together” or “gels” are dissociated self-states. What makes

these states dissociative? First of all, there is no communication between them; for a time, the

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child does not integrate these disparate experiences into a central identity. In the very beginning,

“there are the quiet and excited states” and the “infant cannot be said to be aware” that “he is the

same” person in these different states (Winnicott, 1945, p. 340). The second dissociative aspect

of these self-states relates the fact that the child for some time has no awareness of the structure

of time. Because a sense of self-constancy develops in the context of memories, perceptions, and

desires, the infant does not experience his self states as related in time. The baby’s sense of

aliveness and simple being relies on the provision of an environment that does not require him to

prematurely integrate disparate self-states or to define himself in the context of the structure of

time.

Winnicott demonstrated throughout his career a great interest in the artistic process and in

the inner lives of artistic individuals. Goldman identified dissociation as a prominent theme in

Winnicott’s formulations regarding the creative arts. Indeed, some of the experiences commonly

associated with artistic creation bear a striking resemblance to the way in which Winnicott

depicts the earliest days of the psychological and emotional life of an infant with a good-enough

mother. An artist immersed in the creative process sometimes loses her sense of time and even

of any hardened sense of self. The “lines” between what constitutes inner and outer reality may

also become more blurred and permeable. According to Goldman (2012), this type of activity

represents a form of dissociation she terms “absorption,” which “is the ability to be so immersed

in a central experience that context loses its frame…it is experienced as being ‘carried away’ or

‘lost’ in a narrowed, concentrated focus of attention that necessarily excludes other contents from

the phenomenal field” (p. 339). The adult engaging in absorption therefore elects to initiate a

temporary alteration in consciousness accompanied by a sense of being quite different from the

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form of being that underlies the healthy day-to-day functioning. Though Goldman did not

explicitly refer to the issue of subjective objects and objects objectively perceived, it can be

extrapolated from her discussion that absorption involves a tilt towards relating more to

subjective objects, something which can also contribute to a more intense feeling of aliveness.

Goldman (2012) described absorption as “a loosening of integrative bonds [that] generates a

tolerable experience of ‘flow’ or ‘creative disorder;” she continued this line of thought in saying,

“A relative freedom from needing to prematurely integrate allows a readiness to create

experiences of greater aliveness” (p. 339). It must be emphasized that, despite their similarities,

artistic absorption should not be equated with the earliest form of dissociation.

Having delineated two forms of dissociation, it now becomes possible to understand with

more clarity what Goldman and other contemporary psychoanalytic theorists have to say about

dissociation as a defensive response to trauma. The healthy individual generally has the capacity

to enter, become energized by, and return from absorptive states—which, in addition to artistic

creation, include “playing, reverie, contemplation…[and] meditative states”—thus establishing

communication between the drifting and gelling experiences of absorption and the more

solidified and integrated sense of self associated with less dissociative, non-absorptive states

(Goldman, 2012, p. 339). This capacity creates a greater sense of agency and meaning in the

daily strain in negotiating “inner” and “outer” realities. As opposed to the conscious, voluntary,

and generative nature of absorptive processes, dissociation as a response to trauma is “liable to

be activated unconsciously as a defense against unmanageable arousal with deadening effect;”

equally important is the fact that such dissociative processes may be “triggered fleetingly or

become hardened into a structured disposition” (Goldman, 2012, p. 339). When dissociation

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becomes a structured disposition, it may be the primary method by which an individual

maintains a sense of continuity of self.

The question remains: what psychological maneuvers are involved when dissociation is

used as a defense mechanism? Goldman (2012) summarizes Donnel Stern’s perspective on this

form of dissociation in describing it as an “active defense” that is “sometimes employed to

prevent well or more fully formed versions of experience from being shaped” and characterizes it

as a means by which one, to use Stern’s words, “‘simply [restricts] the interpretations one makes

of experience’” (Goldman, 2012, p. 343). Stern’s formulation of defensive dissociation as a

restriction of awareness—in conjunction with Goldman’s assertion that an “urge toward life”

undergirds all of Winnicott’s theorizing—allows us to better grasp the reasons why traumatized

individuals may utilize dissociation as a primary means of coping in their day-to-day lives.

Goldman wrote that “the shape the self assumes follows from” the experience of formlessness in

the presence of an affectively engaged other. Individuals who experienced an inordinate amount

of impingement early in life may not experience themselves as having a “shape,” much less one

that was formed on the basis of aliveness, and may be overwhelmed by feelings of

fragmentation. Because such fragmentation arose in part from environmental impingement, the

individual may feel a need to restrict their interpretations of or reflections on “fully formed”

traumatic experiences. The house of the self has been destroyed; the dissociating individual

grasps one piece of rubble and strains to see it as the whole self in order to deny that any damage

ever took place. Unlike the manic defense, which leads to feelings of invincibility and strength,

dissociation more often than not leaves one feeling numb and devoid of aliveness. Goldman

quoted stern, who talks about this topic when discussing the fact that dissociation involves much

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more than cognitive restriction: “[dissociation] needs to be understood…as an unconscious

refusal to allow the possibility that full-bodied meaning be created. It is a strategy designed to

ensure that nothing new, unpredictable, and alive ever happens” (Goldman, 2012, p. 343). The

efficaciousness of dissociation as a defense against feelings of further traumatization has a high

price.

Dissociation and its relationship to being were at the heart of Roger’s recovery and active

addiction. For the sake of clarity, the following discussion will be based on a somewhat

simplified depiction of Roger’s disparate self-states and his futile attempts to achieve a sense of

continuity in the context of profound fragmentation. One of Roger’s most central difficulties lay

in the wide experiential gap between what we called the “high Roger” and the “sober Roger.”

High Roger navigated interpersonal situations with ease; sober Roger was so crippled by

concerns about what to do, what to say, and what others thought about him that he often decided

not to leave home. High Roger felt alive; sober Roger felt dead or dying. High Roger was

resilient and at peace; sober Roger was unimaginably fragile and perpetually in a state of inner

chaos. High Roger felt whole; sober Roger felt shattered and irreparably broken. During our

sessions—during which he was never intoxicated—he was painfully aware of this split. He

acknowledged that much of his anxiety and depression stemmed from an inability to find any

sort of middle ground. He could not break out of the either/or dynamic paradigm that resulted in

part from his difficulty dealing with ambiguity and uncertainty. Roger’s sense of fragmentation

resembled a state of being described by Winnicott (1971): “a state of time-space integration in

which there is one self containing everything instead of dissociated elements that exist in

compartments, or are scattered around and left lying about” (p.67). Could this be accurately

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described as a dissociative state? Does the diminution of the capacity to integrate or to tolerate

ambiguity necessarily result in a dissociative way of living? I will address these questions

regarding his feelings of shattered-ness while sober shortly. When high on oxycontin, and

especially during the early years of his addiction, he was not generally aware any affective or

cognitive dissonance. This lack of awareness dissolved the inner deadness and chaos that

resulted from the constant intrusion of “what [came] unbidden from within,” replacing it with a

sense of inner buoyancy (Goldman, 2012, p. ). It should be kept in mind that the presence of

dissociative processes in his addiction did not mean that there are not other defensive dynamics

in play.

The dissociative nature of his drug abuse becomes especially clear when reflecting upon

his relapse during treatment. Roger and I had made considerable progress in discovering

potential environmental and hereditary determinants of his addiction. Our sessions had also

given him the chance to process his fears and anxiety in the presence of a caring person, a very

rare occurrence in his life. Despite the obvious fragility of his emerging capacities to sit with

painful affects for extended periods of time, he had begun to express—and demonstrate—

resiliency in the face of internal and external pressures. His mother’s vicious comments were

more of a disruption than he could handle. The memories that came “unbidden from within”

terrified him and resulted in an almost complete unraveling of the capacities he had begun to

develop. The intrusion of such a traumatic memory intermingled with and exacerbated the storm

of confusion and anxiety that had slowly begun to diminish. In this sense, the part of himself

that represented weakness and vulnerability changed too rapidly from a relatively “unformulated

experience” to a “distinct object of reflexive consciousness,” one from which he had to distance

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himself in order to avoid the annihilation anxiety it brought to the fore (Goldman, 2012, p. ). At

that moment, I witnessed in Roger a battle between competing methods of achieving aliveness.

Therapy (and recovery in general) represented an opportunity to work towards a more complex

and developmentally appropriate form of continuity and aliveness. Oxycontin represented an

opportunity to slide back into a simpler and regressed form of continuity. Because therapy

entailed an articulation of the threatening unformulated experiences of impingement associated

with his past, it no longer represented a viable or safe way of establishing a sense of continuity.

He was left with only one option—the needle. What was dissociative about his oxycontin abuse?

It is worth repeating Stern’s views on the defensive use of dissociation: “[Dissociation is]

sometimes employed to prevent well or more fully formed versions of experience from being

shaped” and characterize a means by which one “simply [restricts] the interpretations one makes

of experience;” furthermore, dissociation needs to be understood “as an unconscious refusal to

allow the possibility that full-bodied meaning be created [and is] a strategy designed to ensure
7
that nothing new, unpredictable, and alive ever happens” (Goldman, 2012, p. 343).

7 Before proceeding any further, I must bring up a potentially central flaw in adopting a view of addiction rooted
solely in Winnicott’s original theories. The characterization of maladaptive dissociation as a “refusal,” even an
unconscious one, implies a willfulness and defiance reminiscent of Winnicott’s writings on the “antisocial
tendency.” Winnicott puts forth the idea that stealing in childhood and adolescence at times may represent an
attempt to regain a lost object that belongs to the time before a rupturing in the good-enough environment. [citation]
It is an attempt to regain the lost object that has been deprived, and is a sign of hope that the child seeks to find the
lost good object. This is different in regard to privation, where stealing or delinquency does not happen as much as
depression. The notion of addiction as a “refusal” to allow for new experiences necessarily leads us to a
consideration of the nature of choice, free will, and individual responsibility in Winnicott’s theory. One could
certainly argue that Winnicott’s framework fails to take into consideration the role of choice in the maintenance of
psychopathology. Indeed, the bulk of Winnicott’s writings paint a picture of the emotionally disturbed individual as
incapable of making decisions that emanate from the True Self unless he or she is provided with an experience
resembling the environmental provision in early life—and only then can from a facilitating environment that creates
a trust in continuity. Such mutative experiences might include religion and psychoanalysis because they provide
form many people a sense of being held by a trustworthy not-me force. Might such a view of serious emotional
difficulties rest upon an implicit avoidance of questions regarding the active decision-making of disturbed
individuals as beings whose reality is significantly influenced by the choices he or she makes every moment of
every day? We often encounter the “fuck-it” mentality in those struggling with addiction; should we consider this

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Prevention, restriction, refusal, strategy, and predictability—we find each of these

characteristics of dissociation in Roger’s drug abuse. As we have seen, Roger presented with

what Goldman (2012) would call a “built-up dissociative structure,” in the sense that his

predominant presentation was one in which various “mental processes or contents [were] not

associated or integrated into awareness, memory, or identity” (p. 339). We can view his drug use

as an attempt to trade one form of dissociation in for another. He sought to trade the dissociative

dynamics of his adulthood (his inability to integrate his various self-states into a consistent sense

of identity), and the concomitant feelings of deadness and fragmentation that result from such

dissociation, for a dissociative state associated with the earliest days of psychological life. As

has been demonstrated, the experience of being high resembled in many ways the type of

dissociation that a good-enough caretaker allows his or her infant. More specifically, we have

seen that, in states of intoxication, Roger felt safe in the sort non-purposive drifting and gelling

that Winnicott so important in the psychological and emotional life of infants. These

resemblances, however, do not amount to equivalence. Utilizing Stern’s terminology, we can

say the following of the form of dissociation experienced by a child with a good-enough

caretaker: (a) it rests upon the absence of a need to “strategize” in order to survive or feel real

and (b) it is only possible because the child feels safe in her defensive restriction of awareness.

Roger’s strategizing (e.g. securing and purchasing drugs) was aimed at achieving a state where

strategizing was not necessary. Because getting high enabled him to freeze the rapid,

stubborn willfulness as an active choice or as pseudo-choice masquerading as a “true choice” when in fact it is a
“passive” or “reactive” choice that may be rooted in the desperate need to experience a good-enough environment?
Such questions lie at the center of an exploration of the fundamental differences and potential overlap between
object-relations/developmental deficit theories and existential-humanistic perspectives. In the concluding chapter of
this dissertation, I will argue that Winnicott’s failure to pay adequate attention to choice represents a fundamental
shortcoming in his theories and, therefore, in any purely Winnicottian approach to understanding addiction.

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frightening, and unpredictable movements between figure and ground and between various self-

states, it served as a means of restricting awareness in order to achieve a state of formlessness in

which such restriction became unnecessary. This strange pattern of using defensive techniques

in order to be able to relinquish them highlights the ultimate futility of Roger’s quest. The

hopelessness of his attempts becomes even clearer when we consider the fact that—because the

“fall” from being high to sobriety and withdrawal was so traumatic—his search for regressed

dissociation ultimately led to a further rigidifying of the underlying dissociative personality

structure that fueled his desire to regress in the first place.

Now that we have discussed the dynamics and characteristics of dissociation as

elucidated in Goldman’s paper and have applied her foundational insights to addiction, we can

now address the bridging of dissociative gaps as a step on the road to personal growth. Rigid

dissociative gaps manifest in treatment as “spots, gaps, stereotypes, absences, and repetition”

(Goldman, 2012, p. 348). “Repetitions” might be seen as a defense against the unexpected,

novel, and new; “fixity” can represent an attempt to avoid fluidity and ambiguity; “absence”

could, in a way, be a defense against presenting oneself to the other as the self one truly feels

himself or herself to be. Conducting therapy with individuals with predominant dissociative

patterns allows us to witness the interpersonal—not just “intrapsychic” or “private”—dimension

of the client’s dissociation. A patient of Winnicott’s who struggled with an almost complete

dissociation between the male and female elements of his personality once told Winnicott, “you

have spoken to both parts of me” (Winnicott, 1971, p. 74). Because Winnicott was able to

“[locate] the dissociation intersubjectively, the analytic exchange “allowed a channel of

communication to open between…the male and female elements” (Goldman, 2012, p. 352). It

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should not be surprising that Winnicott believed that the provision of a relationship with qualities

of an early good-enough environment facilitated a patient’s capacity to allow for communication

between dissociated parts of the personality without falling apart. After all, the ability to utilize

healthy dissociation—a means of temporarily returning to simple states of being akin to the

earliest forms of dissociation in service of creativity and aliveness—has its foundations in and

continues to be inextricably bound to intersubjective experiences.

What is it about the loosening of dissociative gaps that leads to increased resilience and

the ability to experience an underlying sense of continuity in the moment-to-moment negotiation

of inner and outer? Successful treatment allows for “previously dissociated elements [to

become] symbolized in thought and language” and makes it possible for that which had “been

unsayable in words” to “be contained within the self without loss of continuity of being”

(Goldman, 2012, p. 353). It has been demonstrated throughout this dissertation that personal

aliveness is highly contingent on the degree to which one’s inner world feels integrated. When

an individual lacks a sense of inner cohesion, it becomes more difficult for him to maintain a

sense of continuity and agency, particularly in the face of traumatic or highly stressful events.

Winnicott realized that fusion of and communication between the male and female elements of

his patient’s personality would lead to an enrichment of both his patient’s “doing” and “being.”

Furthermore, Winnicott understood that the establishment of such communication could only be

achieved if he (Winnicott) lived through this difficult and threatening experience with his patient.

These male and female components of psychological and emotional life have much to contribute

to one another and their integration enhances a person’s capacity to live creatively rather than in

a reactive or dissociative way. The enhanced communication between disparate parts of the self

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leads to a “use of imagination [that] allows for what is inside to be felt as having substance and

what is outside as having significance” (p. 351). This element of Goldman’s writing on

dissociation has obvious connections with creativity and will be discussed in the section of this

chapter that addresses creativity.

The relevance of recovery to the breaking down dissociative gaps becomes clear when

we look at in the context of Winnicott’s writings on the dreaming child. Winnicott wrote the

following about dissociation and the difficulty young children have in reconciling their waking

and sleeping selves:

…there is not necessarily an integration between a child asleep and a child awake. This

integration comes in the course of time. Once dreams are remembered and even

conveyed somehow to a third person, the dissociation is broken down a little…It is a

valuable experience whenever a dream is both dreamed and remembered, precisely

because of the breakdown of dissociation that this represents. However complex such a

dissociation may be in child or adult, the fact remains that it can start in the natural

alternation of the sleeping and awake states, dating from birth. (1945, p. 151)

We see here that Winnicott’s belief in the necessity of a “third person” in the breakdown of

dissociation existed in his writings over 20 years before publishing Playing and Reality. One

must ask the question: aren’t there only two people in this situation—the child and adult?

Winnicott viewed the sleeping and awake child as two separate people because the child does

not incorporate these self-states into a consolidated sense of identity. This resembles Winnicott’s

thoughts on the inability of the infant to view herself as the “same person” in quiet and excited

states. Similarly, this passage bears some similarity to the case mentioned above, in which his

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patient was [physically a male yet felt like a female because his mother raised him as one]. The

“breakdown of dissociation” in the infant, child, and adult each represent “valuable experiences”

because it results in an enrichment of inner life, as well as the ability to feel like one’s

experiences are one’s own.

The dissociation of the child’s dreaming and waking selves has perhaps the most bearing

on the growth that often occurs in recovery from active drug addiction. In a way, the

dissociation and lack of communication between intoxicated and sober self-states can be seen as

analogous to the dissociation we see in the waking and dreaming self-states of the child. I have

already described the ways in which Roger truly felt as if “sober Roger” was a completely

different person than “high Roger.” Just as the child often has difficulty remembering his

dreams, sober Roger at times could not recall the events of the night before. When he recalled

his experiences of intoxication, it sometimes felt to him as if he was talking about someone else

altogether. Similarly, he did not bring his “dry experiences” into his experiential awareness

when high. From an outsider’s perspective, it seems obvious that he would benefit from

improving his ability to bring these two states together as an “object of reflexive consciousness,”

for this would allow “previously dissociated elements [to become] symbolized in thought and

language” and would lead to a more cohesive sense of identity (Goldman, 2012, p. 353). This

task was immensely difficult for Roger, particularly because he rarely found himself in the

presence of someone who could help him to take on this challenging task.

Reflecting on Roger’s situation in these terms has enabled me to understand the power of

12-step groups and psychotherapy in a completely different way. When an individual goes to an

Alcoholics Anonymous meeting for the first time, he will immediately find himself surrounded

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by “third persons” to whom he can convey his “sleeping” and “awake” states and with whom he

can share the fragmentation and despair that arises from his inability to reconcile these states.

Goldman wrote that it is, first and foremost, the “affectively safe relationship with an engaged

other” that facilitates the breakdown of dissociation. A good sponsor will be engaged in

meetings with the new member and will provide an environment in which the latter can safely

explore threatening and frightening dimensions of affective life through meaningful dialogue and

walking through the 12 steps. This is most evident in the fourth and fifth steps. The fourth step

encourages members to identify their resentments, fears, and other aspects of themselves that are

difficult to process; the fifth step involves the sharing of these discoveries with another person,

usually the sponsor. Many individuals use drugs and alcohol to avoid having to reflect upon or

sit with painful thoughts and emotions. Such an evasion can play a central role in the

establishment and maintenance of dissociative patterns. When a sponsor provides a safe space

for such an exploration, the individual new to recovery experiences—perhaps for the first time—

an “affectively safe” relationship with another person that allows them to process painful

thoughts and emotions without falling apart. Goldman (2012) provided the following quote from

Bromberg, one which helps to further illuminate the phenomenon of sponsorship: “A patient’s

transition from a dissociative mental structure to an increased affective tolerance for intrapsychic

conflict is a complex process in which realities that have been kept apart by discontinuous states

of consciousness are gradually able to be held within a single transitional state of mind” (p. 351).

With time and practice, an individual in recovery can learn to forge a new sense of identity based

on integration and centeredness rather than reactivity and intrapsychic splintering. In my work

with Roger, he became more and more able to identify his various “discontinuous states of

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consciousness,” to process the affects that arose in our discussions of these states, and to be able

to develop a greater sense of inner cohesion based on the awareness and integration of self-states.

Trauma, Being, and Addiction

Goldman pointed out that although Winnicott did not frequently refer explicitly to

dissociation, it nonetheless has a very strong presence in his formulations. Similarly, Alford

(2013) wrote that Winnicott is “not usually considered a trauma theorist,” but that his writings do

contain a powerful and articulable theory of trauma. Alford’s paper “Winnicott and Trauma,”

which appeared in Psychoanalysis, Culture, and Society, aims to demonstrate the ways in which

Winnicott’s theory can help us to “pay sufficient attention to both the intensely personal nature

of trauma and [its] political dimension” (2013, p. 259). He criticized several writers whom he

sees as privileging the historical and political aspects of trauma over a consideration of

inwardness and unconscious dynamics in the traumatized. According to Alford (2013),

overemphasizing the former perspective leads to a characterization of the traumatized individual

as “a camera” whose memory of traumatic events cannot “be erased or transformed readily into

narrative, as its basic elements are not linguistic symbols, but sensations and iconic images” (p.

261). Alford proposes that Winnicott’s writings depict the victim of trauma as someone whose

sense of life has become meaningless, and that life as personal meaning has come under such an

assault that faith in the stability of the world has been shattered. Yet, Alford (2013) wrote,

“Winnicott’s was always already a social theory of trauma” and by no means overlooks systemic

and historical contributions (p. 264). Unfortunately, many of Alford’s keenest insights lay

beyond the purview of this section, which will deal more with “inwardness” than with political

or macrocosmic perspectives on trauma. After explicating Alford’s elucidation and expansion of

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Winnicott’s theory of trauma, I will explore the ways in which we might utilize his paper to shed

light on aspects of the relationship between being and addiction in terms of true self and false

self dynamics, the mind-psyche-soma relationships, and Winnicott’s model of communication.

It should be noted that the relationship between addiction Winnicott’s theory of communication

has not been pursued in the existing literature on Winnicott and addiction.

I have chosen to include Alford’s paper because he focused squarely on Winnicott’s

notion of being in his illumination of a Winnicottian theory of trauma. Because being plays such

a central role in his paper, it will be important for us to have a clear picture of Alford’s

perspective on this concept. Alford indicated the nature and significance of being in the

following way:

The experience of ‘going-on-being’ is how the meaning of life is frequently characterized

by those who study Winnicott, but that way of putting it could be misleading. For

Winnicott, the first task is not to go anywhere. Not going, but being comes first. To be,

and to be, and to be…without traumatic interruption. Not to feel this experience, not to

have this experience, but to be this experience, is the meaning of life, for it involves the

mind and body as a unity, as though they were one. (2013, p. 265)

Two things immediately stand out in this passage. First of all, Alford emphasizedzes

“meaning”— a point that this dissertation has not placed at the center of our discussion in regard

to what Winnicott means by being. Secondly, we must ask why Alford thinks describing “going-

on-being” as the meaning of life could be misleading. What exactly Alford means by “the

meaning of life” as it pertains to being and to other aspects of psychological and emotional life

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will become clearer as this section progresses. Suffice to say, Alford posits that being and

meaning are closely related, and perhaps even synonymous.

Alford’s caveat about using the phrase “going-on-being” as a means of describing

personal meaning draws upon a chapter from Playing and Reality entitled “Creativity and its

Origins.” It is in that chapter that we find Winnicott’s most extensive discussion about the male

and female elements of the personality. Alford did not explicitly refer to this part of Winnicott’s

final book, but he clearly has it in mind. In fact, Alford’s style of writing here resembles that of

Winnicott, (1971), who wrote, “After being—doing and being done to. But first, being” (p. 85).

Whereas Winnicott (here at least) characterizes “doing” as the opposite of being, Alford

discussed “going” as the opposite of being. The word “going” implies directionality, movement,

and implies a destination. Later, when talking about why “being discovered” by another is so

“disastrous,” Alford wrote that many people are “forced out of hiding with no retreat…while

having no self to return to” (2013, p. 266). Individuals for whom this is true feel as if they must

move in response to forces they perceive as intrusive or threatening; such emotional and

psychological movement away from the kernel of the self is a movement toward a pattern of

excessive doing that lacks the substrate of simple being. This part of Alford’s discussion bears a

resemblance to Goldman’s discussion of how not-good-enough caretaking can result in

expectations of premature integration. Though Alford likely did not disagree with the usefulness

of the phrase “going-on-being” in discussing the development or maintenance of a rich inner

world, his discussion of trauma requires the reader to understand that simple being—not going or

doing—is the bedrock of living life with a sense of personal meaning.

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Now that I have noted the ways in which Alford’s description of being emphasizes

meaning and the absence of going, I will discuss his views on being in the context of what I have

already saids about the ways in which being changes throughout the lifespan. Unlike many other

writers, Alford—because he directed his attention to traumas experienced by adults and by entire

demographics—did not spend much time talking about infancy or early childhood, and this is

true when he talks about being. In the above section on dissociation, I discussed the ways in

which the nature of experiencing aliveness changes throughout the lifespan, citing the following

quote from Goldman (2012): “Development, for Winnicott, proceeds through the negotiation of

increasingly object-related ways of being alive” (p. 336). This must be kept in mind if we are to

fully grasp Alford’s paper and apply his ideas to addiction. Alford focused a great deal on the

impact trauma has on individuals who have achieved expected levels of integration and who

have been afforded ample opportunity to live meaningfully. For instance, he talks about the

ways in which PTSD can undermine the security that individuals have derived from

“relationships that support [them] in a woven web of flesh and love and expectations met over

and over again” (2013, p. 266). Whereas many authors—even those who write about adults—

spend a great deal of time on explicating Winnicott’s model of early development, Alford’s

application of Winnicott’s writings to trauma has more to do with the sense of being that

accompanies highly complex modes of object-relating. This distinction will also be important in

the application of Alford’s ideas to the case of Roger—an individual who did not have

“relationships that support[ed] [him] in a woven web of flesh and love,” but who nonetheless

was exposed to trauma throughout his life.

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Before addressing possible connections between addiction and Alford’s ideas about

trauma, it will first be necessary to clarify what exactly Alford and Winnicott mean by “trauma.”

In accordance with his emphasis on being, Alford frames trauma in terms of its relationship to

continuity and meaning. He wrote that trauma can be accurately characterized as an event (or

series of events) that can “[induce] madness” and that has the “capacity to destroy even the most

developed sense of the continuity of existence” and which “induces madness” (2013, p. 265). He

referred to Winnicott’s definition of madness as “a break-up of whatever may exist at the time of

a personal continuity of existence” (Winnicott, 1967, p. 97). Such events include rape, mass

murder, or debilitating physical illness. Accompanying this “break-up” of continuity are a

profound sense of vulnerability, a shattering of one’s faith in the stability of the world, and a

deterioration of aliveness (Alford, 2013, p. 267). The above statements regard the alteration in

psychological and emotional states upon experiencing trauma, but we must keep in mind that, for

Winnicott, an individual’s defensive reactions to impingement are often more important to

consider than the impingements themselves, for it is these reactions that may eventually manifest

in psychopathological symptoms. Winnicott provided a clear illustration of this in the following

quote: “A trauma is that against which an individual has no organised defense so that a

confusional state supervenes, followed perhaps by a re-organisation of defences, defences of a

more primitive kind than those which were good enough before the occurrence of the trauma”

(Winnicott, 1970, p. 259). Alford contends that individuals who have been traumatized tend to

utilize defenses aimed at “self-holding.” For instance, Alford (2013) wrote, “The deeply

traumatized person generally learns to use the mind to hold himself or herself” (p. 265).

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Traumatized individuals, in marshaling their mental faculties to manage the pain of trauma, often

do so at the cost of inner vitality.

Each of the “specific” defenses Alford discussed in this paper (e.g. restriction of affect,

hypervigilance, and overreliance on the mind) has its roots in a dramatic imbalance between

false self and true self functioning. Up to this point, this dissertation has dealt very little with the

notion of the true self, or the core of one’s aliveness, which is one of the most important and

influential concepts in Winnicott’s theory. A satisfactory Winnicottian theory of addiction must

incorporate the concepts of true and false selves because an imbalance in their interactions often

lies at the center of the type of reactive, un-creative functioning so commonly found in

individuals who struggle with drug use.

Alford provided a concise description of true and false self dynamics:

With the term true self, Winnicott referred not to a psychic structure, but to a vital

psychosomatic center, bound up with a feeling of bodily aliveness, and experienced by

self and others most immediately in the spontaneous gesture. Adam Phillips (1989)

argues that the true, or core, self has no content of its own, becoming a sort of ‘negative

theology’–- all the false self is not (p. 97). The false self is that part of the person that

devotes its attention, time, and energy adapting itself to others’ (originally mother’s)

moods and expectation. The false self is reactive, compliant, and lacking in spontaneity.

The false self exists to protect the true self from being known and exploited by others.

Not ontological centers of being, the terms true self and false self refer to sources of

vitality in living (making no distinction between psychic and somatic sources), the way in

which these sources may be corrupted, and how we try to protect them. (2013, p. 264)

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This passage clarifies several aspects of this part of Winnicott’s theory, in that (a) the true self is

not homuncular in nature and is therefore not the equivalent to the ego as described by Freud and

Klein; (b) aspects of the false self in its natural form is absolutely necessary to healthy

functioning and is not “bad,” similar to Jung’s notion of “persona” or the mask we learn to

present to the world; and (c) the true self is inextricably bound to and is the source of aliveness,

spontaneity, and personal meaning. Furthermore, the false and true selves are both “sources of

vitality” in life. This last point raises the question of how something that is by nature “reactive,

compliant, and lacking in spontaneity” can be a source of vitality. Alford emphasizedzes that

one cannot experience aliveness without the healthy operation of the false self because the false

self serves as a sort of protective shield that keeps others from discovering or exploiting the core

self, which must remain inviolate if one is to live an agentic and meaningful life. As

Shakespeare noted, one must not “wear one’s heart on one’s sleeve/where birds will peck at it.”

Alford’s musings on this topic resonate with Christopher Bollas’ statement that, “[it is not

possible to just be a true self; the goal of true self is to be able to elaborate itself through object

relations].”

Alford characterizes trauma as an assault on these sources of vitality—an attack that

results in the overactivity of the false self, and an atrophying of the true self that creates a

frightening emergence of vulnerability, twinned with a heightened sense of one’s immense

dependency on his or her environment. From Alford’s perspective, it can be difficult to

recognize to what extent the continued nurturance and elaboration of personal meaning depends

on forces beyond our control, much less to remember that whatever sense of authenticity we do

have has its origins in a state of complete dependency on the other: “It is worthwhile, but

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difficult, to recognize our dependence on a being and a force, mother, who was beyond both our

control and our knowledge…when we needed her the most. Equally difficult to recognize is that

in certain key respects this dependence never ends; it just changes its locus—from mother to

world” (2013, p. 267). Trauma can set into motion a terrifying experiential reverberation: my

world is broken, I am broken, my world is unsafe, I am unsafe. Keeping in mind the

interdependence of self and other/world allows us to see with more clarity why a psychologically

and emotionally mature individual might respond to trauma by mobilizing the forces of his or her

false self. Because trauma destroys one’s sense of “unit status,” the traumatized individual may

again find himself in the position of an infant in an impinging environment—a position where he

or she must live reactively in order to salvage the bit of “me-ness” that remains. Unfortunately,

such reactivity from Winnicott’s perspective amounts to annihilation of the self. Though the

traumatized individual may “have” or “feel” experiences, the conspicuous absence of her true

self from the scenes significantly diminishes her capacity to “be” an experience.

Discussing trauma in terms of the true self and false self provides a helpful general model

of how the traumatized may adopt a reactive stance toward life that drains them of inner vitality

or stability; however, we must turn to other aspects of Winnicott’s theory if we are to understand

the types of defenses available to traumatized individuals looking for ways to survive. Alford

draws attention to two common modes of coping: changes in the nature of one’s communication

and the dissociation between mind and psyche-soma. Both of these strategies could be described

as forms of self-holding; these two defenses also represent more specific manifestations of

excessive false-self activity. As mentioned above, Winnicott wrote that trauma often results in

the need to reconfigure one’s defensive repertoire in such a way that more primitive defenses

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replace the mature defenses that had been effective prior to the occurrence of the traumatic event.

To illustrate this point, let us take the example of an individual who has experienced a sexual

assault. Although this individual may have had mature and developmentally appropriate

defenses prior to the attack, she may have to utilize more primitive defenses such as dissociation

or splitting to cope with and make sense of the trauma. This leads to the question of what these

more mature defenses actually are and why they are no longer available to the traumatized

individual. As we will see in the last section of this chapter, developmentally appropriate

defenses as individuals grow older have more and more to do with a creative negotiation of

inner/outer and self/other authored by an individual with a sense of inner vitality and agency. A

person with these defenses at her disposal will have a resilience that enables her to respond to

impingements without falling apart. The ability to utilize defenses of this type is predicated upon

an abundance of inner resources upon which she can draw in times of stress. Because trauma

can drain even the most mature individual of these resources, she may no longer be able to use

adaptive defenses to protect herself from external and internal threats to her core self.

Alford clearly believed that using the mind for purposes of self-holding is one of the most

common defensive responses to trauma. Shortly after discussing the impact of trauma on true

and false self dynamics, he wrote, “The deeply traumatized person generally learns to use the

mind to hold himself or herself. The result is a split between psyche and soma, and hence the

loss of a certain feeling of vitality” (2013, p. 265). Though Alford did not spend much time

discussing the developmental aspects of form of self-holding, the current discussion requires a

brief statement of Winnicott’s position. Winnicott (1949b) provided readers with a profound

insight into the development of mental capacities. After the initial weeks of primary maternal

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preoccupation, the mother will gradually begin to fail her infant; these failures are both

inevitable and essential. Winnicott (1949b) wrote, “The ordinary mother is good enough. If she

is good enough the infant becomes able to allow for her deficiencies by mental activity…The

mental activity of the infant turns a good-enough environment into a perfect environment…What

releases the mother from her need to be near-perfect is the infant’s understanding” (p. 245).

Thus, we see that the infant’s mental faculties allow the baby to tolerate and make sense of her

mother’s imperfections; also, mental capacities also represent in part the child’s initial efforts to

grapple with external reality on her own. In cases of inadequate parenting, however, “the

thinking of the individual begins to take over and organize the caring for the psyche-soma,

whereas in health it is the function of the environment to do this” (Winnicott, 1949b, p. 246). In

the beginning, there is only psyche-soma; “soma” is the body, whereas the psyche represents

“the imaginative elaboration of somatic parts, feelings, and functions, that is of physical

aliveness (p. 244).” The infant with good-enough mothering develops a sense of embodiedness,

of residing in her soma. When the mind is forced to take over the function of the environment,

the psyche is “seduced” away from the soma by the mind and the mind then becomes a “thing in

itself.” This type of mental functioning becomes “an encumbrance to…the human being’s

continuity which, in turn constitutes the self [my italics]” (Winnicott, 1949b, p. 244, 248). A

sense of detachment and emptiness results in which one does not feel oneself to be the owner of

one’s experiences.

Winnicott indicated that the development of overreliance on mental capacities can and

does emerge from excessive, traumatic environmental impingements. In discussing this form of

self-holding, Alford pays special attention to the ways in which an individual’s soma and mind-

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psyche can, in a sense, become strangers to one another, a phenomenon which results in the loss

of capacity to feel centered, grounded, and alive. Alford (2013) wrote that “This is no small

matter, for it is the unity of psyche and soma that was, as we have seen, the key to the meaning

of life for Winnicott” (p. 265). We will soon see that the dissociation between soma and mind-

psyche manifests itself across the development, maintenance, and breakdown of addictive

defenses.

Having detailed Alford’s perspective on the connections between trauma and simple

being, true and false self dynamics, and the relationship between mind-psyche-soma, we are now

able to apply his insights on these topics to Roger’s drug addiction. The following analysis will

demonstrate that his decisions and difficulties throughout his life were entwined with an ongoing

procession of ever-changing defensive patterns aimed in part at establishing contact with and/or

protecting the buried and polluted source of simple being within him. This section will address

the nature of trauma in Roger’s life, trauma’s impact on his experience of himself and others, and

the types of defenses he utilized at different periods. His life will be broken down into (a) the

dynamics in his childhood and early adolescence and (b) the establishment and nature of

addictive defenses. Following from our discussion of Alford’s paper, these stages of his life will

be considered in terms of true self/false self and mind-psyche-soma. Alford concerns himself

primarily with defenses that could he characterized as “self-holding” in nature. Although Roger

relied heavily on such defenses in childhood and early adolescence, his addiction can be seen in

part as a manifestation of his growing lack of confidence in his ability to hold himself. This is

not to say that he abandoned the use of self-holding defenses; rather, self-holding defenses

became less effective and were gradually supplemented, often replaced by defenses that grew out

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of an increasing need to feel held, to become once again part of the nursing couple, and to relieve

himself of the burden of having to hold himself. Generally speaking, his addictive defenses,

insofar as they relate to simple being, emerged from a greater regressive pull towards the earliest

phases of psychological life.

If you will recall, it is an imbalance in true and false self functioning that undergirds all

of the other defenses that have been addressed in this section. It could even be said that mind-

psyche-soma dynamics and communicative patterns represent manifestations of the interactions

between the true and false selves in the individual. Understanding addiction in terms of the

development and characteristics of Roger’s mental life will therefore require us to develop a

basic grasp of this more general substratum of his personality. Answering the following question

will provide an entryway into an understanding of his true and false self dynamics in early life:

What was the most dominant characteristic of his way of interacting with his world during

childhood and adolescence? His approach toward life could be described as reactive and

outwardly directed, centered on responding to his environment. Furthermore, the reactive nature

of his being can be attributed to having experienced “the shattered self” and having a sense of the

world as “fundamentally unstable, fragile beyond words” (Alford, 2013, p. 267). In other words,

his sense of self and ways of thinking, feeling, and behaving developed in the context of having

experienced trauma and were maintained by the continued need to insulate himself from the

impact of further trauma.

Although the portion of Alford’s paper that we are using in this section deals a great deal

with sudden trauma, we can still utilize his insights in a case of cumulative distress such as we

find in Roger’s life—a case in which we cannot identify a specific event that represents the

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original or primary trauma. The rejection or neglect of (or punishment for the expression of) the

spontaneous gesture emanating from the true self represents a central criterion of what defines a

traumatic event. It will therefore suffice to identify a particular experience in Roger’s past in

which he experienced such a response to the reaching out of his true self. Roger’s desire to play

guitar in elementary school could be characterized as a spontaneous gesture from the creative

center of his being. Initially, his parents responded in a “good-enough” manner—they bought

him a guitar. This represented an instance in which the spontaneity of the true self “joined up

with the world’s events” thus giving Roger the sense that the energies of his true self could be

elaborated through and supported by his relationships with others (Winnicott, 1960b, p. 146).

Imagine Roger’s distress when his parents failed to follow through by never getting around to

arrange guitar lessons; imagine the pain he felt every time he saw his unplayed guitar in the

corner of his room collecting dust. His guitar was a symbol and constant reminder of what was

bound to happen whenever he made the attempt to integrate his true self in his experiences with

others. Winnicott would most likely cite this as a “breaking of faith…the destruction of the

purity of individual experience by [an]…unpredictable intrusion of actual fact” (Winnicott,

1960b, pp. 146-147). The “actual facts” in this example were the erraticism of Roger’s parents

and their disregard for his true self needs.

The accumulation of experiences such as these contributed to Roger’s inability to

establish a stable or adaptive relationship between the operations of his true and false selves. It

appears that Roger’s behaviors became increasingly dedicated to the protection—rather than

elaboration—of his true self, and this necessitated a hypervigilance on the part of the false self,

the lifelong defender of one’s true self or core of aliveness. Whereas many writers discuss the

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ascendancy of the false self in terms of compliance to the demands of the environments, it should

not be forgotten that compliance represents only one form of reactivity, which is a broader mode

of psychological and emotional functioning. In other words, the false self can adopt any number

of means of protecting the true self from further trauma, and it is likely that the chosen method of

false self activity is not random and does not develop in a vacuum. If the true self is eradicated,

then psychic death follows, and the false self will employ any means to safeguard the existence

of this core of being—even to bury it, as Harry Guntrip noted, “on cold storage” (Gomez, 1997).

A closer analysis of Roger’s situation indicates that his primary means of insulating his true self

from further injury—rebellion, aggression, and assertion of his independence—developed in the

context of a home environment filled with fighting and chaos. His constant anger and hostility

towards others might have actually been a means of preventing intimacy or closeness with

others. Paradoxically, it could also have represented an example of the “antisocial tendency,”

serving as a means of compelling others to recognize his behavior as a cry for help and

nurturance (Winnicott, 1956). I will return to the topic of his aggression in the next section of

this chapter. Suffice it to say, his behavior resembled that of a wounded animal snapping at

anyone and anything that came too close.

The inextricability of Roger’s true/false self dynamics and the dynamics of his mind-

psyche-soma becomes clear when one realizes that both involve the movement of the locus of

psychoemotional activity from the “inside” to the “outside.” Before discussing the character of

Roger’s mind-psyche-soma functioning during childhood and early adolescence, I must first

point out a few aspects of Winnicott’s contributions that have not yet been fully elucidated thus

far. According to Winnicott, the psyche begins as an “imaginative elaboration of…physical

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aliveness” (Winnicott, 1949b, p. 244). As an imaginative elaboration of somatic experiences, the

psyche does not originate as a self-reflexive or abstracting component of the individual’s life.

Rather, it represents a deeply personal activity in which the infant’s primary psychological

creativity becomes embedded in and associated with the physical sensations that represent her

earliest form of self-experience. The psyche-soma is the primordial source of I-ness and the

wellspring of personal meaning. Just days after birth, “an interrelation of the psyche with the

soma” will begin to take place; in other words, the child has begun the process of identifying his

imaginative self as separate from—yet still anchored in—her “live body” (Winnicott, 1949b, p.

244). In healthy development, the mind (cognitive capacities and self-reflexivity) has its roots in

the subtle interplay between the psyche and body (soma), a rootedness made possible by

caretakers’ “keep[ing] the world of the infant as simple as possible” by “insulat[ing] [the] baby

from coincidences and other phenomenon that must be beyond the infant’s ability to

comprehend” (pp. 245-246). The mind should therefore be felt by the child as her own, as a

natural extension of her psyche-soma, as a manifestation of her I-ness. When environmental

deficiencies overtax the adaptive capacities of mental functioning, the psyche (the imaginative

self) is seduced away from the soma and becomes an unwilling participant in the creation of the

“mind-object” (Livingston, 2006). This development results in a “false-localization” of the self

in cognitive functioning, which is now sensed as a thing in itself and is divorced from the soma

and lacking in personal meaning (Winnicott, 1949b, p. 244). Livingston points out that because

the mind-object formed in reaction to environmental impingements, mental life may itself be felt

as intrusive or alien, despite the fact that it serves as the child’s first line of defense against injury

to the true self—an organization that include both psyche and body as the core of aliveness. At

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this point, one might raise the following objection: Winnicott focusedes his attention on infancy

in his 1949 essay—how can you justify applying his insights here to a child or adult?” Winnicott

provided the answer to this question in this very same paper: “…whatever applies to very early

stages also applies to some extent to all stages, even to the stage that we call adult maturity” (pp.

244-245).

Roger was forced far too early to rely on his mental capacities for psychological survival,

estranged from resources that were far from fully developed. His caretakers’ erraticism forced

him time and again to make sense of his experiences on his own—what we have termed “self-

holding.” In comparison, the development of thinking can be an exciting step for the child, for it

builds up a sense of agency and individuality. For Roger, however, thinking took a decidedly

reactive quality and was divorced from the kernel of his self. It may be helpful to remind

ourselves that Alford, in his initial comments on simple being, implicitly relates his view of

trauma and simple being to Winnicott’s writings on the male and female elements of the

personality. Alford emphasized that trauma robs an individual’s experience of “being” and

forces her into a pattern of relentless “going.” “Thinking” can be seen as a specific form of

“going” belonging to the developmental line of intellectual and cognitive capacities. The healthy

development of cognitive functioning necessitates an ongoing communication with and

rootedness in simple being—which precedes cognitive functioning. This prevents intellectual

functioning from becoming totally submersed in and characterized by a freneticism stemming

from the compulsive, reactive, and involuntary search for premature integration, a need arising

from an excess of intrusive environmental factors. Because Roger was unable to have adequate

experiences of relaxed, enriching unintegration, he was forced out of being and into a pattern of

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going on thinking, with a polarized tendency of going/thinking, ways of living that, while they

certainly served an adaptive purpose in his early life, exacerbated the dissociation between soma

and mind-psyche, leading him further and further away from the atrophying source of being

within him. Thus, we can view his eventual mind-psyche-soma relationships as an example of

what Winnicott terms “lop-sided bisexuality,” for it evidenced excessive identification with the

male component of existence (Winnicott, 1971, p. 83).

The lop-sided bisexuality of Roger’s cognitive functioning—largely a result of

cumulative trauma—is captured by the following statement by Roger concerning his early

teenage years: “I was…angry all the time, and I had crazy social anxiety.” This section has

somewhat artificially separated cognitive/somatic and affective processes; Roger here reminds us

that they are ultimately inseparable. His pervasive anxiety and anger (affects) were characterized

by and experienced as mental overactivity and unpleasant physiological excitation. His own

thoughts and physiological sensations felt intrusive and even alien. His anger was partially

expressed through “angry thoughts” such as “I hate my mom,” and “fuck that teacher,” as well as

the actions resulting from those thoughts (arguing with her mother and rebelling against her

teacher); these thoughts were accompanied by intense physiological arousal. His anxiety was

partially expressed through “anxious thoughts” such as “Everyone must think I’m a loser” and

“I’m going to say something stupid and they’re going to make fun of me,” as well as the actions

resulting from those thoughts (primarily withdrawal); these thoughts were also accompanied by

intense physiological arousal. The ubiquity of these thoughts, affects, and physiological

sensations evidenced the existence of a pervasive outward-directedness underlying Roger’s

relationship to self and others. Again, we should not forget Alford’s characterization of such

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activity as serving a defensive function best described as “self-holding” in nature. In health,

intellectual activity stems from, is integrated with, and enriches a core self in which psyche and

soma are one. From Alford’s perspective (2013), the fact that Roger’s intellectual life served a

protective—rather than elaborative—purpose led to a “loss of the meaning of life” (p. 266).

Roger’s misery becomes understandable when viewed as a manifestation of a deep sense of his

life as devoid of personal meaning. It is, however, important to draw a distinction between the

case of Roger and the types of people Alford referred to in his paper. Alford (2013) concerns

himself primarily with adults who have had ample experiences of living life with personal

meaning, whose “expectations [have been] met over and over again,” and have had the

opportunity to experience the world as stable (p. 266). As a child and adolescent who did not

have these advantages, Roger’s use of self-holding had a somewhat different nature, for he did

not have much of an actualized self to hold. As a result, his use of the mind to hold the soma

represented the protection of a fragile seedling.

Therapist: What is it like when you're high?

Roger: All of my nervousness is gone. Anxiety, inhibitions, stress, feelings…

Therapist: Do you hate yourself when you're high?

Roger: No.

Therapist: Do you think good things about yourself?

Roger: No. I just don't think—that's the great part.

This exchange with Roger highlights the centrality of mind-psyche-soma dynamics in the

establishment of his addictive defenses. The establishment of an overactive mind served a self-

protective function for Roger, in that it took over the caretaking role his mother failed to provide.

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The defense of excessive mental activity allowed for psychological survival early in life.

However, this defensive engine was overworked, for it had been running at full power for years

on end; overheated and rattling, it finally gave way and started to break down. It ceased to serve

its purpose, leaving Roger vulnerable and defenseless against the tortuous vicissitudes and

terrifying ambiguity of everyday life, and he was no longer able to make sense of his

experiences. Roger also at times mentioned the exhaustion that accompanied the constant use of

self-holding defenses. Simply put, Roger gave up. He gave up on his ability to respond

adequately to his environment without falling apart and he lost faith in the possibility that

stability in either the inner or outer world could ever result from the continued use of self-

holding defenses. One can argue that oxycontin promised Roger a return to a psychological

amniotic sac. Just as the mind “seduced” the psyche away from the soma, oxycontin guaranteed

a reintegration with the soma, a sense of embodiedness and of being the owner of his

experiences. In this sense, the use of oxycontin differs from the self-holding via mental

functioning because it is directed not primarily towards the protection of the soma/true self, but

is an activity that sought submersion in true self experiencing by attempting to restrict awareness

or diminish the effect of traumatic environmental impingements and that aims to relinquish the

use of the deadening defensive structures that were constructed to deal with impingement. The

unconscious fantasy underlying Roger’s addictive defenses was one of floating and swimming in

personal meaning in the absence of interruption. In terms of the male and female elements of the

personality, using oxycontin represented an attempt to achieve identification with the female

element and to dissociate from the male element. Doing this required him to feel held by a

tangible object in the external world.

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What did Roger hope to achieve by entering the oceanic and generative experiences of

intoxication? He had spent so much time apart from the experience of unintegration and

formlessness that its allure must have been palpable, its promise of sanctuary irresistible, and its

nurturing capacity salvific for his dehydrated, fractured, and atrophied self-experience. Eve

Livingston (2004) described the experience of heroin intoxication in the following way:

[It] essentially vaporizes feelings of physical and emotional discomfort, displeasure, fear,

anxiety, and longing. The skin may experience a warm, flushed sensation, the limbs may

relax and feel heavy...After the…initial experiences of injected heroin—those often

described an erotic, orgasmic rush and exhilarating inhibition—there is a transition to a

sense of serene calmness, self-assurance, then drowsiness. (p. 11)

We see here a remarkably womb-like state in which one need not worry about the world “out

there” and where the individual has a reassuring sense of omnipotence, calm, and inner vitality.

Winnicott wrote that continued reliance on the mind-object might eventually make “without-

mind” the desired state—a state of pure soma-psyche integration. Clearly, this contrasts

drastically with Roger’s lifelong feelings of powerlessness, chaos, and inner deadness.

In addition to the disturbance in the relationship between mind, psyche, and soma, it is

also possible that victims of trauma will have to fundamentally alter their ways of

communicating with themselves and with others in to protect what remains of their inner

aliveness. Not surprisingly, Alford deals with the aspects of Winnicott’s theory of

communication that have to do with being and continuity. In comparison, Winnicott (1963d)

described the individual as an isolate who should be afforded the right not to communicate with

others—including psychoanalysts. The notion of the core self as essentially isolated represents

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yet another paradox in Winnicott’s theory, as we have seen time and again the emphasis he

places on the inherently relational foundation of emotional development from the earliest days of

psychological life. Although his descriptions of the true self—a term more or less synonymous

with “core self”—in “Ego Distortion in Terms of True and False Self” (1960) imply the private

nature of the true self, Winnicott did not explicitly frame this concept in terms of

communication, nor did he mention its relationship to communication with self and others.

However, as with his writings on the true self in the 1960 publication, his discussion of the core

self in his essay on communication clearly links the core self with the experience of continuity

and being in infancy and throughout life. The principles underlying Winnicott’s model of

communication had theretofore not been formally developed or even introduced in either the

psychoanalytic literature or his previous writings. This fact might help to explain the somewhat

obtuse nature of the system he proposes. As with all maturational processes in Winnicott’s

theory, the development of healthy communication entails a delicate balance between

environmental provision and intrapsychic (but not necessarily structural) dynamics.

At the heart of Winnicott’s theory of communication and the section of Alford’s paper

that deals with communication and trauma is the idea of an isolated core self that never

communicates with the “external” world. Winnicott formulates the notion of an incommunicado

element of the personality and communication in general in the context of the infant’s journey

from relating to subjective objects, to objects objectively perceived. Alford (2013) differentiates

these two types of objects:

Subjective objects are those things we believe exist for us, mirroring our needs and

wishes, conforming perfectly to our view of the world. At first we see the mother this

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way. Subjective objects confirm our sense of being alive. Objective objects are things

that exist external to us, without reference to us and our needs and view of reality. They

exist in their own right, irrelevant to our subjectivity. They are “not-me-objects,”

objectively real, but they do not necessarily feel real and alive to us…We invest…the

objective object…with something of the subjective object and thus bring it to life,

without reducing the objective to the subjective, which would be madness. (p. 269-70)

The isolated core of the individual—the development and protection of which contributes to the

establishment and maintenance of psychological and emotional health—is founded upon the

possibility of uninterrupted communication with subjective objects, a form of communication

intimately bound up with continuity and simple being. When an individual has access to his or

her absolutely private self, he or she has a choice in whether to communicate with objective

objects or to engage in silent communication with him or herself. With a safe base to which one

can return, one can venture with more confidence and liveliness toward the two forms of healthy

communication with the shared world: “communication that is explicit, indirect, and pleasurable,

and…[an] intermediate form of communication that slides out of playing into cultural experience

of every kind” (Winnicott, 1963d, p. 188). Winnicott described silent communication with

subjective objects and explicit, indirect communication with objective objects (primarily through

language) as extremes. Creative communication with the shared world emanates from the

resource of aliveness in the protected and nurtured incommunicado self and represents a “most

valuable compromise” between these extremes and is available for “many, but not all” people

(Winnicott, 1963d, p. 192).

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It seems appropriate to address a particular valence of explicit, indirect communication

with objective objects. There are times in which the individual must communicate with

objective objects that pose potential threats to the core self and in which a person is required

to temporarily and dramatically shift the locus of communication away from the feeling of real,

and subsequently toward a more frustrating, numbing, and outward-directed reactive

communication—and to do so without falling apart or losing the sense of realness altogether.

Healthy and adaptive recuperation from sustained communication of this sort—that is, an

exaggerated false self communication—requires the individual to have the capacity and desire to

engage in a temporary splitting of the personality that corresponds to the splitting found in

pathological patterns of communicating and not communicating. This split involves engaging in

an acute dissociation between communicating with objective and subjective objects in order to

“refuel” and to immerse oneself in the feeling of real without feeling pressured to translate one’s

private language into shared language. Winnicott described this as “a not-communicating that is

active” and emphasized it belongs both to health and to “cases of slighter illness;” in the latter,

this form of not-communicating shows itself as “clinical withdrawal” (Winnicott, 1963d, p. 184).

This splitting remains adaptive insofar as it does not become a rigidified pattern and as long as

long as it does not become the only means by which one can protect and contact the sacred,

incommunicado element of the personality.

Because we are considering addiction in large part as a form of pathology, we must turn

our attention to the forms of communicating and not-communicating that Winnicott attributed to

immature psychological and emotional functioning. We can glean from the above discussion

that a pattern of communicating with objective objects that is rooted in false self activity, and is

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one that lacks the feeling of real often predominates in individuals who struggle with emotional

and psychological difficulties. Whereas many people, when they are exhausted by an experience

of communication with objective objects that draws minimally from a true self initiative, are able

to engage in an active not-communication that “belongs to health and comes from choice”

(Abram,1996 p. 83), others with early impingement histories are often left with two options: (a)

to give up and to live in a world that is felt as “only something to be fitted in with or demanding

adaptation,” thus dwelling in a state that “carries with it a sense of futility and is associated with

the idea that nothing matters and that life is not worth living;” (Winnicott, 1971, p. 65) or (b) to

retreat to a reactive form of not-communicating that is limited to a silent communication with

subjective objects that are “scarcely influenced by an objectively perceived world” (Winnicott,

1963d, p. 183). This bifurcated pattern of communicating and not-communicating in an adult

resembles the split in object-relating Winnicott associates with the infant who has not been

provided with a facilitating environment. Reactive not-communicating, present in many

environmentally-deprived infants and adults with significant pathology, can play an important

role in the maintenance of drug addiction. Winnicott (1963d, p. 183) asked the following of his

readers in his discussion of reactive not-communicating: “Clinically do we not see this in the

autistic rocking movements, for instance; and in the abstract picture that is a cul-de-sac

communication, and that has no general validity?” I will discuss the notion of cul-de-sac

communication (which is closely related to simple being) in more detail in the study of Roger’s

addiction.

Having elucidated Winnicott’s model of communicating and not-communicating, we are

now able to return with more insight to Alford’s comments regarding trauma and the continuity

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of being. In summary, a healthy individual has access to three modes of communication—silent

communication, explicit and indirect communication with objective objects, and creative

communication within the intermediate area—and will be capable of simple not-communicating

(i.e. resting, absorption into being) and, when necessary, active non-communication. Individuals

with psychological and emotional difficulties will suffer from a relative inability to enjoy either

indirect and explicit communication or creative communication with the “not-me” world because

communication with objective objects will be largely associated with futility and deadness; they

also have difficulty simply resting, and must resort to a reactive, cul-de-sac form of not-

communicating if they are to experience the feeling of real. We are now faced with two

important questions: what might lead an individual to rely on pathological forms of

communicating and not-communicating? What can be done to help such individuals to break

free from such problematic patterns? I will here address the first of these questions, for they are

pertinent to addiction triggers.

Alford introduced communication and its relationship to continuity of being in a section

of his paper entitled “Trauma as Penetration of the Core Self;” this aligns with the fact that

Winnicott placed this very form of trauma at the center of his 1963 paper on communication.

Alford (2013) wrote that, although people of course have a need to communicate and become

intimate with others, their “greatest fear is that of being found, of having no place to be alone,

undisturbed, to just be;” being found “is tantamount to being a social self forced to react to the

acts of others…[to be] forced out of hiding with no retreat…while having no self to return to”

(p. 266). We have seen over and over in Winnicott’s theory the disastrous results that pervasive

reactivity can have on an individual’s emotional, social, and psychological experiences. When

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an individual feels his or her most private self has been discovered, the capacity to meaningfully

interact with the “not-me” world is diminished. Witnessing the suffering induced by traumatic

impingement upon the core self in his patients evoked powerful emotions with Winnicott, and he

wrote about this topic with uncharacteristically strong language:

I would say that the traumatic experiences that lead to the organization of primitive

defences belong to the threat to the isolated core, the threat of its being found, altered,

communicated with…Rape, and being eaten by cannibals, these are mere bagatelles as

compared with the violation of the self’s core, the alteration of the self’s central elements

by communication seeping through the defences. For me this would be the sin against

the self. (1963d, p. 187)

Winnicott again reaffirms that a traumatic experience is one that leads to the development of and

reliance on primitive defenses. The above discussion on mind-psyche-soma dynamics revealed

that trauma can result in a dissociation characterized by the development of the mind-psyche as a

separate entity divorced from the soma; we now see that a pattern of pathological communicating

and not-communicating represents another means by which the traumatized individual deals with

the threat to the core self. Indeed, the greater the threat and the more hopeless an individual

feels, the more primitive the defenses that must be used to protect oneself. The sense of

violation and futility may become so great that it becomes necessary to utilize the very same

forms of communicating and not communicating adopted by a newborn who is confronted with a

profoundly inadequate caretaking environment. Whereas a “mildly” traumatized person might

evidence a somewhat regressed mode of communicating, the severely traumatized patient at

times, in order to retain at least a semblance of simple being, relies on communicative strategies

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reminiscent of the infantile split in which there is no integration between communication with

the presenting object and the subjective object. Alford (2013) would likely describe the extreme

need to retreat to an reactive, autistic communicating with subjective objects (i.e. reactive, cul-

desac non-communicating) as approaching the “madness of excessive subjectivity [in which one

is] lost so deeply in self that [he] can never be found” (p. 266).

It is now possible to analyze Roger’s drug addiction in terms of Winnicott’s theory of

communication. As with the above interpretation of Roger’s addiction in terms of mind-psyche-

soma dynamics, the following discussion will be broken down into analyses of his

childhood/early adolescence and the establishment of addictive defenses. Developing an

understanding of his communicative patterns in childhood and early adolescence will necessitate

a consideration of (a) manifestations of his communicative style, (b) his most prominent mode(s)

of communication, (c) environmental determinants in the formation of his preferred means of

communicating, and (d) the repercussions (both dynamic and experiential) of his overreliance on

unhealthy modes of communication. In order to ascertain the nature of his addictive defenses, it

will be necessary to (a) explore the experiential and dynamic dimensions of the hoped-for

destination of his flight from the ineffective communicative strategies of early adolescence,

(b) highlight the primary motivations for such a flight, and (c) complete a “differential

diagnosis” aimed at ascertaining the most prominent mode(s) of communicating and not

communicating that were actually in operation during his periods of intoxication.

The affective tone of Roger’s interactions with others ranged from venomous hatred to

fearful anxiety. Acting out at home, rebelliousness toward authorities, scrutinizing his every

word in order to avoid sounding “stupid,” and his chameleonic ability to blend in—these were all

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typical interactions throughout Roger’s early years. The diversity of emotional valences in these

interactions might lead one to believe that they must be manifestations of different modes of

communication. What could urinating in his father’s car possibly have in common with wearily

mimicking the behavior of his peers? Closer examination reveals that each of these examples is

likely a demonstration of a particular type of communicating—explicit/indirect and

unpleasurable communication with objects objectively perceived that have not been adequately

infused with his own subjectivity. Utilizing Alford’s language, we could describe Roger’s

perception of both his belligerent father and peers in the same way—both “exist[ed] external to

[him], without reference to [him] and [his] needs and view of reality” (2013, p. 269). In each of

these cases, Roger operated with a lack of confidence in his ability to establish a living, breathing

relationship with another individual. Retaliation took the place of reciprocity; disguises took the

place of authenticity. Retaliation and disguises, despite their differences, are both reactions to

external threats.

Before addressing the experiential and dynamic impact that this rigid communicative

pattern had on Roger, it will first be necessary to briefly mention some of the possible

environmental determinants that led to such a restriction. Let us imagine ourselves as Roger at

home during elementary and middle school: Hands shaking, I wipe tears from my eyes and blood

from my lip. I hear my father’s uneven footsteps on the stairs. Another punishment for God

knows what—The door slams open, and my mother screams at me, telling me to put my ‘stupid

drawing book’ away. I just wanted to be by myself and doodle—It’s two in the morning. They’re

still at each other’s throats. Only occasionally do I hear intelligible words—“You stupid bitch,”

“A fucking failure,” “You don’t even love me.” Fear, apprehension, pain, shock, confusion, and

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shame—these represent just a few of the emotions that must have constantly stirred in Roger

over the years. When intensely evoked by others, each of these feelings requires a response at

that moment, a reaction aimed at preventing the exacerbation or continuance of the feeling. This

is so because the primordial anxieties of falling forever and falling apart constituted the

unconscious meaning of these conscious feeling states; it is the exposure and rape of the

incommunicado core of the self that threaten the actualization of horrifying psychological and

emotional fragmentation and chaos.

Because of his early non-facilitating environment, Roger had to adopt a self-holding

means of communication that would enable him to avoid the affects associated with the threat of

complete annihilation. Like the precocious construction of the mind-object, the rigidifying of his

communicative approach shielded his innermost source of vitality and selfhood from further

corruption. We now see that retaliation and concealment—in addition to both being

manifestations of unsatisfying communication with objects objectively perceived—arose from

the conspicuous absence of the true self from the interpersonal and intrapersonal communicative

dimensions of his life. How do we know this to be the case? We need look no further than the

impression Roger reported of his communication during childhood and early adolescence—he

felt exasperated and deadened by his constant need to lash out and to hide. The following quote

by Winnicott (1963d) provides an approximation of the true/false self dynamics underlying both

his retaliation, concealment, and social anxiety: “…such communication as occurs from the false

self does not feel real; it is not a true communication because it does not involve the core of the

self, that which could be called a true self” (p. 184). His hostility towards others in positions of

authority can be understood as false self activity if one adopts the broader interpretation of it as a

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reactivity underlying communication. His anger towards authority bears some resemblance to

the infant whose “mother’s adaptations to [his] hallucinations and spontaneous impulses is

deficient;” such an infant possesses a “general irritability” that is a manifestation of “the protest

against being forced into a false existence” (Winnicott, 1960b, p. 146). His compliance with the

expectations of his peer group line up more closely with the more specific and common

interpretation of false self activity as compliance.

There was a high price for Roger’s reliance overreliance on false self communication.

Dynamically speaking, we notice immediately that healthier forms of communicating and not-

communicating were not available to him. Perhaps the most devastating deprivation was the

profound lack of and disconnection from vivifying subjective objects. The basis for the capacity

to communicate with subjective objects is founded upon the mother’s ability to “put herself in

the infant’s place” during the times in which the infant perceives his environment as unreliable

and (e.g. mentalization). This capacity is also predicated upon the mother’s allowing her infant

the experience of going-on-being that, while it “scarcely deserves the epithet communication,” is

as close as the infant comes to communicating with the mother during periods of rest (Winnicott,

1963d, p. 183). It is through the repetition of these accommodations that the child builds up a

store of subjective objects. The inability of Roger’s parents to provide either of these conditions

precluded him from being able to regularly communicate silently with subjective objects either

in childhood or early adolescence. Every other form of healthy communication—and even the

communicating and not-communicating associated with slight mental illness—was unavailable

to him due to the paucity of contact with and relative absence of vivifying subjective objects. He

could not seek solace in the active non-communication seen in clinical withdrawal, nor could he

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even achieve the feeling of real that comes along with pathological reactive non-communication.

Mutually enlivening communication with others was clearly unavailable to him for similar

reasons. Yet, we should not underestimate the value of this restriction of communicative paths—

without it, he would have simply fallen apart.

Drug addiction is commonly thought of an escape from something. Viewing addiction in

terms of Winnicott’s theory of communication illuminates this element of drug addiction, but

also draws our attention to a consideration of that towards which individuals with drug problems

might be escaping. Keeping in mind the central paradox in Winnicott’s 1963 paper provides a

useful foundation for this part of the current discussion: “Here is a picture of a child establishing

a private self that is not communicating, and at the same time wanting to communicate and to be

found. It is a sophisticated game of hide-and-seek in which it is a joy to be hidden but a disaster

not to be found” (p. 186). When reading Winnicott’s ideas on the “private self,” one gets the

sense of the incommunicado element or the isolated core as a space. It is helpful to think of it as

a child’s bedroom. Just outside this room are the hallways that lead to the rooms of the child’s

parents and siblings, to the stairs down to the living room and kitchen. These are all places that

require the child to engage in more complicated modes of communication. When engaging with

these other people (objects objectively perceived), the youth carries with him either conscious

memories or unconscious residues of building his private, non-communicating world—a world

constructed by engaging silently in activities such as building forts, playing dress up, and

performing for audiences of stuffed animals. The uninterrupted establishment and continued

maintenance of the incommunicado self makes it possible for the child to experience the “joy” of

being hidden. How does the isolated core of the self remain hidden while still being found? In a

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good-enough environment, parents knock on their child’s door to ask for permission to enter this

sacred space, a space that should not be entered without the child’s approval. Similarly, the child

might hear her parents’ footsteps creaking on the floor outside, knowing that they know she

needs to be alone but also knowing that they recognize and are excited about her agentic creation

of her own identity.

At the moment before his first use of intoxicating substances, Roger had never been

found. It could also be argued that he had never been hidden in the way Winnicott means in this

passage—a hiddenness that cannot be achieved by the child of a “mother who does not allow the

child her secret” (Winnicott, 1963d, p. 186). Perhaps most importantly, Roger had not

established or built up a private self in which he could hide, in which secrets could be nourished

or securely held. This does not mean that he completely lacked an isolated core. Rather, this

core was a weak and flickering flame always facing the threat of extinguishment by the powerful

winds in the “outer” world. By the end of his non-using days, Roger began to experience an

“alterations of the self’s central elements by communications seeping through [his] defences”

(Winnicott, 1963d, p. 187). As was the case with his mind-psyche-soma dynamics, Roger’s

defensive machinery broke down. He finally felt that the threats to his core from objects

objectively perceived had begun to pierce his armor, his heart just inches from being pierced.

The feared defilement of his insulated—not necessarily isolated—core was at hand and he had

no way of combating the inexorable march of impingement.

In his exasperation and desperation, he flung himself back toward the core of his being in

an attempt to submerge himself in whatever remained of the unadulterated and generative oasis

at the center of his being. Roger hoped to rediscover—or create for the first time—a sacred

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place that remained unpopulated by objects objectively perceived. He often discovered such a

place during opiate intoxication. In this place, the frightening voices of his parents, which had

been such a jarring force both consciously and unconsciously, faded away and were replaced

with peaceful silence. The anxiety-inducing otherness of peers diminished, and he no longer had

to experience the unpleasant affective states that accompanied the sense of rejection and

alienation so common in his social interactions. In this sense, we can see that his desired state

bore a strong resemblance to the earliest and simplest forms of object relating. Winnicott wrote

that, “In so far as the object is subjective, so far is it unnecessary for communication with it to be

explicit” (1963d, p. 182). In the above discussion on Roger’s mind-psyche-soma dynamics, we

established that the mind develops in large part as a response to environmental demands. Just as

cognitive capacities emerge from and help the infant to adjust to the abrogation of omnipotence

brought about by inevitable environmental frustration, so is there a “change in the purpose and in

the means of communication as the object changes over from being subjective to being

objectively perceived, in so far as the child gradually leaves the area of omnipotence as a living

experience” (Winnicott, 1963d, p. 182). Roger relied too heavily on the use of strained, explicit,

and unpleasurable communication with objects objectively perceived—objects that he was

unable to infuse with true self energy. When he was high, others objects (people) in his life lost

the quality of objectivity. Individuals around whom he felt anxious and fearful when sober

became friends or faded into the background, therefore becoming unthreatening. This amounted

to a reversal of the process of maturation in which objects “change over” from being subjectively

perceived to objectively perceived—when Roger was intoxicated, the objects in his world

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changed over from being objectively perceived to being subjectively perceived. In a sense, this

this process can be seen in part as a regression to omnipotent control.

Eve Livingston’s description of the experience of heroin (opiate) intoxication (2004)

provides further evidence for this regressive element of Roger’s drug addiction: “[Heroin]

essentially vaporizes feelings of physical and emotional discomfort, displeasure, fear, anxiety,

and longing” (p. 11). For Roger, each of these emotions was associated with the need to limit his

communicative style to explicit and unpleasurable communication with objects objectively

perceived. Because the physiological and emotional experience of oxycontin intoxication so

resembles that of an infant with a good-enough mother in the phase of absolute dependence, it

must have in some way represented to him “the foundation for the experience of being”

(Winnicott, 1971, p. 84).” In a sense, Roger had never been and had therefore never truly

engaged in the earliest and most foundational type of communication. Oxycontin represented to

Roger the prospect of a new beginning, an erasure of past trauma, and a chance to plant the seeds

for self-actualization and a creative approach to life—in short, rebirth. This represented a

relinquishment of self-holding defenses and the establishment of the belief in oxycontin as a

holding force.

However, we should not be satisfied by concluding this investigation with a statement

such as, “Through drug use, Roger escaped the strain of having to relate to objective objects and

to reach a state in which he felt held by oxycontin, thus becoming able to communicate only with

subjective objects and to seek an establishment the feeling of real.” Though it may be true that

Roger’s destination was one in which there was no need to acknowledge or react to objects

objectively perceived, this quality can be attributed to more than one type of communication—an

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adult’s silent communication with subjective objects, the communication of an infant in the

earliest phases of development who has not yet achieved unit status, an adult engaging in active

not-communicating, and an adult engaging in reactive not-communicating. Furthermore, we

cannot be sure that Roger actually reached his intended destination. Did drug use result in

psychoemotional rebirth in the way that Winnicott believed was possible through

psychoanalysis? Developing a clear picture of the establishment of addictive defenses as they

relate to Winnicott’s theory of communication requires a sort of “differential diagnosis” aimed at

identifying with more clarity the type of communicating or not-communicating opiate

intoxication actually represented.

Roger did not reach his destination. Where, then, did he arrive? Let us consider the

range of possible states at which he may have arrived through oxycontin intoxication. By

looking at the context in which communication with subjective objects is conducted, we can

confidently “rule out” the possibility that intoxication was a form of healthy, silent

communication with subjective objects. In health, silent communication with subjective objects

represents only one way of establishing the feeling of real and is carried out with the implicit

understanding that it will only be temporary. The healthy individual is enriched by more

complex forms of communicating and does not view communication with subjective objects as a

sufficient means of sustaining a sense of meaning. For Roger, however, communication with

subjective objects was salvific, while other modes of communicating were perceived as

threatening. This leaves us with the two other forms of communicating with subjective objects

in Winnicott’s theory of communication: active not-communing and reactive not-

communicating. The former occurs when communication becomes overly “linked with some

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degree of false or compliant object relating” and it “periodically take[s] over to restore balance”

(Winnicott, 1963d, p. 185). As with healthy communication with subjective objects, we find that

active non-communication (associated with slight illness) takes place with the implicit

understanding that it will only be temporary. Especially important here is that active not-

communicating is a choice made by an individual with generally sufficient means to

communicate with objective objects without being overwhelmed. Roger’s communication with

subjective objects does not appear to arise from a choice grounded in a general sense of agency.

It seems that his communication with subjective objects during periods of intoxication can most

accurately be described as reactive not-communicating or cul-de-sac communication. Nearly

every “criteria” of this mode of not-communicating resonates with Roger’s experiences of

intoxication: (a) it alone “carries all the sense of real,” (b) it is “[futile] from the observer’s point

of view,” (c) it is “scarcely influenced by an objectively perceived world,” and (d) it is a reactive

choice. Having established the nature of Roger’s addictive defenses in terms of true and false

self dynamics, the mind-psyche-soma relationship, and communication, it is now possible to

address the breakdown of his addictive defenses in the context of these three domains of

psychological, emotional, and interpersonal functioning.

Eventually, it became apparent that Roger’s addictive defenses simply stopped working.

Physiological and psychological withdrawal, imprisonment, and attempted suicides—each of

these clearly indicates that his regressive attempts to reconnect with and immerse himself in

simple being via the discovery of a new “holder” collapsed just as his self-holding defenses had

in early adolescence. Before proceeding with the analysis of the breakdown of addictive

defenses in terms of mind-psyche-soma dynamics and communication, I must reiterate and

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elaborate upon a caveat I have mentioned several times in this chapter. This chapter has

oversimplified the process and experience of addiction for the purposes of conceptual clarity. It

is almost certainly not the case that the changes in Roger’s defensive patterns were as linear as

has been implied here. We should also remind ourselves that periods of intoxication were

temporary and did not always constitute the majority of his day-to-day life. Similarly, it must be

kept in mind that the predominance of holding/life-seeking defenses did not result in a total

relinquishment of the self-holding defenses that dominated in childhood and early adolescence.

He did not succeed in entirely dismantling his mind-object through the use of addictive defenses;

in fact, he probably did not desire to get rid of it altogether. Despite the emphasis this chapter

has so far placed on simple being, it is tempting to view the function of drugs exclusively in

terms of continuity. The next two chapters will make it clear that drugs can fulfill a variety of

purposes that have more to do with aggression and creativity; furthermore, as Ramos (2004)

noted, any attempt to identify the mechanism behind a client’s drug abuse is both futile and

clinically unhelpful.

Having detailed the limitations of the current approach, it is now possible to, as

Khantzian recommends, to “dwell in the margins” in order to reap the potential benefits of

exploring this small nook of addiction studies. A passage from Playing and Reality provides an

excellent overture to achieving an understanding of the breakdown of addictive defenses in the

context of trauma, simple being, mind-psyche-soma dynamics, and communication. Winnicott

wrote:

Hamlet is mainly about the awful dilemma that Hamlet found himself in, and there was

no solution for him because of the dissociation that was taking place as a defense

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mechanism. It would be rewarding to hear an actor play Hamlet with this in mind. This

actor would have a special way of delivering the first line of the famous soliloquy: ‘To

be, or not to be…” He would say, as if trying to get to the bottom of something that

cannot be fathomed, “To be, …or…” and then he would pause, because in fact the

character Hamlet did not know the alternative. At last he would come in with the rather

banal alternative: “…or not to be”; and then he would be well away on a journey that can

lead nowhere. ‘Whether ‘tis nobler in the mind to suffer/ The slings and arrows of

outrageous fortune,/ Or to take arms against a sea of troubles,/ And by opposing them end

them?’ Here Hamlet has gone over into the sado-masochistic alternative, and he has left

aside the theme he started with. The rest of the play is a long working-out of the

statement of a problem. I mean: Hamlet is depicted at this stage as searching for an

alternative to the idea, ‘To be.’ He was searching for a way to state the dissociation that

had taken place in his personality between his male and female elements, elements which

had up to the time of the death of his father served together in harmony, being but aspects

of his richly endowed person. (Winnicott, 1971, p. 83)

Winnicott portrays Hamlet, therefore, as a man who did not know how to be. Like Roger, he

proceeded with a sigh and lived reactively to the threats and dangers of the outside world—both

Hamlet and Roger lived in a world where the only options were to hurt or to be hurt without the

option of simply living life. We can see Roger’s path to heroin as a “journey that [could] lead

nowhere.” Simply put, heroin provided him with a somewhere. Tragically, Roger discovered

over the course of heavy drug use that this somewhere was an illusion, and that he had continued

to tread a road to nowhere. Hamlet’s desperate journey ended in suicide; unable to rediscover

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and commune with the female element of living, he threw up his hands and ended his life which

was, in some ways, not a life at all. Roger’s drug use provided him with a glimpse of vitality and

continuity, but ended with him strung out and shivering in an unheated apartment, comforted

only by thoughts of death.

We have characterized the development of self-holding defenses, their relinquishment,

and the establishment of addictive defenses as a flight from inner (prenatal life) to outer (the

precocious establishment of false self dynamics), followed by an almost involuntary whiplash

back to inner (regressed unintegration). It has also become clear that both self-holding defenses

and regressive defenses were effective insofar as they prevented annihilation anxiety from

causing psychosis and collapse. The problem lied in the fact that the oblivion achieved through

intoxication did not eliminate the myriad impinging forces and objects in the “external” world

that necessitated retreat in the first place. Equally important is the fact that the reactive

submersion in illusory true self experiences in no way equipped him to develop the capacity to

achieve the balance between inner and outer required for resilience and psychological health.

Whether utilizing self-holding defenses in non-intoxicated states or regressive defenses to

achieve intoxication, he was never able to break free from the either/or paradigm that resulted in

the perceived mutual exclusivity between being and doing and between reactivity and primary

psychic creativity. In fact, one could argue that regressive retreats eventually made the not-me

world even more threatening.

Cul-de-sac communication and the dismantling of the mind-object both allowed Roger to

withdraw into and float in the generative waters of simple being. However, these methods of

achieving aliveness came at a price—each necessitated the disavowal of external realities and

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diminished his capacity to cope with outer pressures when not intoxicated. The more time he

spent intoxicated, the less capable he became in times of sobriety to use the self-holding defenses

that, no matter how maladaptive or ineffective, still represented a means of dealing with

environmental impingements. If you will recall, the establishment of the mind-object and of

rigid communicative patterns had, in childhood and early adolescence, served the purpose of

warding off distressing affective states that arose unbidden from within. The upswelling of

painful emotions during periods of sobriety became more intense and unmanageable the more he

came to rely on drugs for their diminution. Furthermore, threats to the core self became even

more terrifying because Roger had actually experienced the bliss and nourishment of

uninterrupted psyche-soma integration and unrestricted communication with subjective objects.

Having these experiences provided him with a conviction that experiences of meaningfulness

and realness were in fact possible—thus, there was more at stake in his battle with the outside

world.

Central to the breakdown of addictive defenses was the unconscious realization that the

drug lied. The drug broke its promise, and the addictive process represented a reenactment of

earlier traumatic experiences. As a child, he had expected and needed his parents to protect him

and to nourish his inner development; he hoped that drugs would faithfully fulfill this same task.

In his relationship with oxycontin, he was held…and then dropped. The oscillations between

being and doing became violent and jarring. The sense of self that he had built up through

intoxication revealed itself as incapable of sustaining him, and its artificiality became more and

more apparent. The physiological symptoms of opiate withdrawal established the sense of his

body as an alien and intrusive force. The frightening otherness of objects objectively perceived

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intensified, and his attempts to strip them of their otherness became more and more difficult.

Eventually, the holding power of oxycontin essentially vanished. The elements of the “dry

world” from which he sought to escape gradually began to bleed into his drugged states. Even

after injecting “ridiculous amounts” of oxycontin, he could still not banish feelings of

depression, anxiety, vulnerability, and inadequacy from his awareness. He was left with an inner

world that not only lacked vitality, but that was littered with dead and dying subjective objects

that had been created and communicated with through drug use.

Why suicide? Roger’s despair was deeper and more intense than ever before when drugs

stopped working. He seems to have resigned himself to annihilation. Committing suicide was a

way for him to die on his own terms rather than passively suffer collapse at the hands of forces

outside of his control. Perhaps the most complex and tragic element of Roger’s story was his

repeated but failed attempts to overdose on heroin. His tolerance was “fucking crazy” and made

it virtually impossible to die. Heroin had initially promised a secure holding environment, but

gradually became associated with the “tantalizing” mother, in that after brief periods of respite,

Roger would reawaken unequipped to face the harsh realities of the “real world.” Oxycontin had

initially represented an unconscious attempt at rebirth, at starting over. Having given up on the

possibility of returning to the womb or of living amongst others, Roger reached out to death and

nothingness, the ultimate clean slate.

Our understanding of recovery from addiction can also be enriched by viewing addiction

as a response to trauma that results in the adoption of imbalanced true/false self activity and

regressed modes of mind/psyche/soma dynamics, and communicative patterns aimed at

achieving a sense of continuity. We can now grasp more fully the extreme fragility of

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individuals early in recovery. Many individuals begin recovery lacking psychological equipment

with which to deal with environmental stressors. Clinicians should keep this in mind when

working with individuals struggling with substance abuse. Alford (2013) reminds us that

“victims of trauma bring deep unconscious material to the surface” and that “memory is overlaid

with more recent experiences” (p. 264). When an individual new to recovery experiences some

form of traumatic impingement (either minor or significant), it is likely that their response to this

trauma will be significantly impacted both by the residues of previous trauma and the rekindling

of unconscious annihilation anxiety. This will impel them to resort to familiar ways of coping

with impingements. In the case of Roger, we can view his mother’s vicious comments as a fresh

trauma. Whereas many clients may have the resources to survive such an impingement without

collapsing, this experience immediately brought into Roger’s awareness repressed memories of

previous maltreatment and vulnerability. It should therefore not be surprising that he employed

the same types of defenses he had in the past, even though he knew on some level that doing so

was ultimately futile.

Summary

Addressing the relationship between being and addiction permitted us to incorporate into

the study of addiction just one half, or one component, of what Winnicott termed “instinctual

life,” a phrase I have interpreted to mean the experience of propulsion underlying all thoughts,

feelings, and behaviors. That discussion allowed us to develop a wider view of addiction that

considers the ways in which drug use might represent a method of fleeing from the perpetual

state of the inner strain and deadness that results from the incapacity to experience aliveness in

more complicated forms of object relating. We also discovered that, in terms of being, addiction

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can represent more than just an escape from overwhelming inner and outer stressors. It became

clear that drug abuse can be seen in some cases as an essentially regressive attempt to “restart”

developmentally, to re-experience or experience for the first time earlier and simpler forms of

being, and to supply oneself with the psychological, emotional, and somatic fuel provided by the

generativity of less demanding and more oceanic modes of being. To accomplish such a goal, it

becomes necessary for some individuals to relinquish reactive and self-protective defenses in the

realms of dissociation, true/false self dynamics, the relationship between mind/psyche/soma, and

communication. Although the dismantling of such defenses and the diminishment of the reliance

on them was temporarily “effective” in the case of Roger, addictive defenses eventually broke

down; this led to the reemergence of the primordial anxieties that led to drug abuse in the first

place. He was left with three options: to continue this “journey to nowhere,” to commit suicide,

or to begin the process of recovery.

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Chapter 5: Aggression and Addiction

Introduction

However interesting or instructive the discoveries made in the previous chapter may be,

developing a more thorough model will require us to consider the potential relationships between

addiction and the second root of instinctual life—aggression. The development of an

individual’s aggressive potentials occurs alongside and is inextricable from the development of

her capacity to imbue experiences with a sense of continuity. A disruption of being will also

impede the healthy trajectory of aggression; excessive impingement will stunt and distort the

growth of both continuity and aggression. As previously indicated, the separation between being

and aggression necessitated by the current study is an artificial one. Winnicott’s notion of the

primitive love impulse—which posits the admixture of destructiveness and the urge for union in

the earliest motivational force of infancy—provides the clearest evidence for the essential unity

of the erotic and aggressive roots of instinctual life (Abram, 2006). It is important to keep in

mind, however, that eroticism and aggression, in an experiential sense, are in a sense separate

during infancy. Prior to the establishment of unit status, the infant lives dissociatively and

experiences himself as wholly different across what Winnicott (1951) called “quiet and excited

states” (p. 151). Quiet states can be understood as those states in which the infant is guided by

erotic desires for merger and continuity and relates to the environment mother; excited states are

those states in which the infant is guided by aggressive “crude instinct-tension” and relates to the

object-mother (Winnicott, 1963a, p. 76). Achieving the capacity for concern and whole-object

relatedness requires a “new fusion” between aggression and eroticism (Winnicott, 1963a, p. 76).

Particularly important for chapter 6 is that this new fusion is also a prerequisite for the ability to

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live creatively (Winnicott, 1971). Thus, an understanding of the ways in which addiction relates

to being and creativity requires an elucidation of how the disruption of aggressive processes can

contribute to the development of addictive defenses.

The integration of secondary literature is perhaps more essential in elaborating

aggression’s relationship to addiction than in any other part of this dissertation. Winnicott’s

theory of aggression, despite its ingenuity, is for the most part confusing, complicated, and

dense. As he moved further away from classical psychoanalytic formulations of aggression, he

regularly changed his terminology without necessarily explaining the justification or implications

of doing so. His final published statement on aggression, a chapter in Playing and Reality (1971)

entitled “The Use of an Object and Relating through Identifications,” involves the simultaneous

use of new phrases (e.g. “placing the object”) and inclusion of more traditional terminology (e.g.

“unconscious destruction”); this can make it difficult to distinguish where he maintains

allegiance to previous conceptions of aggression and where he departs from them. This is not to

say that a careful reading this paper will not lead one to appreciate the uniqueness or importance

of his theoretical innovations. However, he did not clearly delineate the many layers of the

theory of object usage, nor does he provide a complete, cohesive elucidation of what he means

by aggression. It was of course not in Winnicott’s nature to present systematized theories, but

any attempt to apply his theory of aggression to drug addiction utilizing only his original papers

would likely be muddled and inaccurate. This section will explore the relationship between

aggression and addiction using Abram’s 2012 paper “DWW’s Notes for the Vienna Congress

1971: A Consideration of Winnicott’s Theory of Aggression and an Interpretation of the Clinical

Implications.” Abram will be our guide to the discussion about aggression and addiction.

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Addiction, Aggression, and “Intrapsychic Surviving and Non-Surviving Objects”

Abram provided the clearest and most thorough explication of Winnicott’s theories of

aggression and object usage I have yet to discover. In addition to tracing Winnicott’s evolving

views on aggression from 1942’s “The Observations of Infants in a Set Situation” to Playing and

Reality (1971), she utilized handwritten notes made by Winnicott just weeks before his death.

Abram (2012) feels that “the notes of this unwritten paper stand as Winnicott’s ‘last word’ on

‘the use of an object’ theory and offer a consolidatory advance to his final theoretical

conclusions on the psychoanalytic concept of aggression” (p. 312). She succeeded in clarifying

Winnicott’s theory of object usage and other central elements of his theory related to aggression.

She then introduced the notion of intrapsychic surviving and non-surviving objects, which she

contrasts with Klein’s concept of “good” and “bad” objects. This section will use both her

clarifications and extensions of Winnicott’s theories of aggression and object usage in order to

provide a coherent account of how we can understand addiction through the lens of this

particularly difficult area of Winnicott’s theory. It will be seen that analyzing Abram’s paper

permits the development of a four-part model of Winnicottian aggression. Integrating this new

model with Abram’s three-part description of Winnicott’s “environment” provides an exciting

opportunity to more clearly examine the ongoing exchange between aggressive development and

environmental factors. As with the above sections on being and addiction, the following

discussion will assess Roger’s psychodynamic patterns prior to addiction, in the establishment

and maintenance of addictive defenses, during the breakdown of addictive defenses, and in

recovery. In analyzing each of these phases, it will be necessary to examine the state of the four

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dimensions of aggression, the qualities of the environment, and the dynamic interplay between

surviving and non-surviving objects.

Given that the capacity to use objects represents the outcome of healthy aggressive

development, it may be helpful to clarify what exactly is meant by object usage before delving

into the complex processes that make it possible. Abram’s article makes it clear that mutuality

must be given a central role in our understanding of object usage, both in terms of its initial

development and its continued growth throughout the lifespan. It is this emphasis on mutuality

and reciprocity that distinguishes Winnicott’s object usage from a phrase like “whole object

relatedness,” which is often discussed more in terms of intrapsychic dynamics—the subject’s

capacity to achieve and tolerate ambivalence by perceiving and incorporating both the good and

bad aspects of both himself and others—rather than the continual interpsychic interchanges that

allow the subject to make valuable contributions to others and in which the “object…contributes-

in to the subject, according to its own properties” (Winnicott, 1971, p. 90). That the object must

be viewed as having “its own properties” apart from the subject points to the fact that mutuality

presupposes the subject’s maintenance of a non-traumatic sense of separateness from the object.

In other words, the achievement of object usage implies the “discernment of the Other” and the

capacity to view the other “as separate and ‘not just a bundle of projections’” (Abram, 2012, pp.

325, 327). In other words, “the use of an object symbolizes the union of two now separate

things” (Winnicott, 1971, p. 108). The use of objects is accompanied by a sense of aliveness and

confidence in interpersonal relationships. What might object usage look like? An individual

capable of object usage will demonstrate both an interest in and the capacity to “contribute-in”

and will have a sense of feeling enriched by what the environment “contributes-in” to his inner

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psychic reality. Furthermore, object usage results in a comfort in one’s own skin and the ability

to take pleasure in one’s own separateness.

Now that we understand the basic characteristics of object usage, we can assess—

descriptively, not dynamically—the extent to which Roger exhibited the capacity to use objects

in childhood and early adolescence. Abram made it clear that the capacity to use objects and the

manifestations of aggression change form over the course of the lifespan; however, the there are

three interrelated qualities that underlie object usage at every stage of development: mutuality,

the capacity to integrate the good and bad within oneself and others, and a non-traumatic,

enriching sense of separateness. In short, Roger did not consistently meet any of these three

“criteria” in his life before his drug use began. As indicated above, mutuality involves a sense

that one can meaningfully contribute-in in her relationships and that one is being meaningfully

contributed-into by the environment. This was clearly not the case in Roger’s childhood. Roger

did not feel as if his parents contributed-into his inner world; rather, his interactions with them

generally left him feeling either depleted or damaged. One could view his hard work in

elementary school as an attempt to contribute to his parents’ lives, in that it would help them to

feel like good parents. We have much more evidence of Roger’s doubts that he could offer his

parents anything they would have appreciated and of his eventual desire to retaliate against his

parents for their inadequate caretaking. Roger also did not possess a strong ability to tolerate

ambivalence in his relationship to either himself or others. For example, Roger was generally

unable to view his teachers as having the capacity to be supportive or caring; he tended to

characterize them simply as persecutors who sought to control him. Others, particularly those in

positions of authority, tended to be viewed as all-bad; Roger also had a great deal of difficulty in

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recognizing and integrating the good and bad within himself, and also struggled to reconcile his

feelings of love and hate. Finally, Roger oscillated between feeling painfully alienated from

others and from feeling trapped in the affective maelstrom in his home environment.

It is of course insufficient to provide a purely descriptive picture of this deficit in Roger’s

early emotional development, and a number of questions must be addressed: If Roger did not

achieve the capacity to use objects—the end product of healthy aggressive development—then in

what form did the aggressive component of his instinctual life take, and down what paths did it

proceed? What factors contributed to distortions in his aggressive growth? And, particularly

important in understanding the development of addictive defenses, how did Roger experience

such distortions? Answering these questions necessitates (a) the elucidation of Abram’s four-

part model of aggression, (b) an explanation of her three-part conceptualization of the

environment, (c) a summary of her clarification of “Winnicott’s famous sequence,” and (d) an

explication of her notion of intrapsychic surviving and non-surviving intrapsychic objects. I will

refer to Roger’s experiences in early childhood and adolescence in discussing each of these

subjects.

The above description of object usage, the final product of aggressive development,

makes it possible to redirect our attention to the earliest form of aggression with a greater sense

of perspective. It may seem odd at first glance that the ultimate outcome of healthy aggressive

development in Winnicott’s theory does not seem to address the intentional destructiveness and

sadism that belong to aggression in other psychoanalytic perspectives. Most significantly, there

is no mention of sublimation, a central indication of the healthy handling of aggression in

Freudian, Kleinian, and ego-psychological paradigms. This omission grows from a

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fundamentally different view of what constitutes original aggression, a view that can be clarified

by breaking it down into its four constituent parts, all of which are related and to a degree

inseparable:

1. The inherently relational nature of original aggression

2. Destructiveness as a “ruthless, uninhibited demand for the environment’s adaptation”

(Abram, 2012, p. 320 )

3. Aggression as a “symptom of being alive” (Winnicott, )

4. Aggression as a desire for separation and its role in the creation of externality

The first of these–the inherently relational nature of original aggression—is a dramatic

departure from Freud and Klein, who construed aggression as essentially separate from

environmental factors. Abram (2012) noted that Winnicott’s later writings tend to use the term

“destructiveness” instead of “aggression” because the former was a “way of qualifying the

meaning of early aggression…that it is object related” (p. 304). Mitchell and Greenberg (1983)

capture this element of original aggression in characterizing aggression in Winnicott’s theory as

a “non-belligerent desire for engagement” (p. 206). Regarding destructiveness, the second part

of this model, we must keep in mind that Winnicott never denied the damage done by the infant

to the mother. In fact, he provided several reasons “why a mother hates her baby” in his

landmark paper “Hate in the Countertransference” (1947): “The baby is an interference with her

private life…[the baby] is ruthless, treats her as scum, an unpaid servant, a slave...[the baby] is

suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt” (p.

201). Yet, the infant’s aggression cannot be characterized as intentional or directed, for he has

not yet developed unit status. Winnicott urges us to make the important distinction between

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“wish” and “need;” the child’s ruthlessness arises from a need for adaptation rather than a wish

to harm his mother. Winnicott had begun characterizing aggression as a symptom of aliveness as

early as 19xx. He saw evidence of this in prenatal motility and in the infant’s fascination with

his own physical movement. The fourth and final characteristic of aggression as a desire for

separation is closely tied to the desire for engagement, for one cannot truly engage with objects

until they are sensed as separate from oneself. In contradistinction to many theorists that came

before him, Winnicott felt that it was aggression that created externality, and that it did not exist

originally as either a projection outward of the death instinct or as a response to frustration from

the external world.

Because aggression cannot be viewed apart from environmental factors, it will be

necessary to address Abram’s clarifications of what is meant by the “environment” in

Winnicott’s theory before we are able to assess Roger’s aggressive development during

childhood and early adolescence. Reading Abram’s paper reminds us that, from Winnicott’s

point of view, the environment is not something that is “out there.” It is easy to forget that,

despite Winnicott’s recurrent use of dichotomous language (e.g. subject/object, inner/outer), he

advocated for a view of reality as co-constructed and that he emphasized the ways in which the

dynamic interplay between self and other continually reconstitutes the nature and perception of

shared reality. This aspect of his theory is especially salient in his writings on the earliest stages

of development, in which the distinction between inner and outer is essentially non-existent for

the child. Perhaps the most important clarification offered by Abram is her statement that the

environment, rather than being external, is a “psychic environment” (Abram, 2012, p. 304). This

aspect of Winnicott’s perspective underlies several of his most important terminological

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contributions to the psychoanalytic study of infancy. By directing his readers’ attention to

“holding” (rather than just “handling,” which is constituted of basic maternal activities such as

feeding and clothing) and to the “environment mother” (rather than just the “object mother”),

Winnicott encouraged us to envision the environment as a psychic field in which a matrix of

relatedness gradually develops in the mother-infant dyad through the child’s internalization of

repeated experiences of mutuality. The experience of mutuality requires presence of certain

qualities in the mother’s psychic life, for the unconscious communication of the contents of the

mother’s psyche constitutes a significant part of the environment for the child still in the process

of developing his own inner reality. Chief among these is “how the m/other feels in relation to

her infant” (Abram, 2012, p. 304). The mother must want to fulfill her responsibilities as a

mother. The capacity to not only endure, but to enjoy such experiences rests upon a more

general state of primary maternal preoccupation, which allows the mother to temporarily

surrender her subjectivity; this is not just a state of mind possessed by the mother, but constitutes

part of the environmental setup.

These properties of aggression and the environment do not disappear once unit status has

been achieved, although they manifest differently over the course of the lifespan. If you will

recall, Goldman (2012) enabled us to understand the way in which the need to experience

continuity continues throughout life, despite the fact that we are never truly capable of re-

experiencing the simplest forms of being present in infancy: “Development, for Winnicott,

proceeds through the negotiation of increasingly object-related ways of being alive” (p. 336).

This insight can be usefully applied to aggression as well, particularly because it constitutes the

“other half” of aliveness. The need for engagement, the need for “something to bump up

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against,” the need for the environment’s adaptation, the need to sense oneself as unique and

separate from others—these needs continue to drive human behavior and undergird emotional

life regardless of an individual’s age. There is also an underlying valence shared by good-

enough environments for the infant and for the adolescent. Although the phenomenon of

primary maternal preoccupation belongs only to the mother-infant relationship, a good enough

m/other will still possess the capacity for intense identification with her adolescent that enables

her to understand and anticipate his unique needs. Just as the mother of the newborn should be

able to sense her child’s dilemma during the phase of absolute dependence, the parent of the

teenager should be able to recognize the unique adolescent quandaries faced by her growing

child. We will soon see that these qualities in the mother of the older child are necessary for

continued healthy aggressive development.

We are now able to descriptively assess the quality of Roger’s aggressive development as

well as the general properties of the environment that in part determined the paths along which

his aggressive processes travelled. I use the phrase “descriptively” because I will here utilize the

four-part model of aggression above in order to identify “signs” of unhealthy aggressive

development and will draw from the three-part model of the environment to highlight elements

of his childhood and early adolescent environment that may have contributed to distortions in

aggressive development. A dynamic assessment of his early patterns of aggression must

incorporate object usage and Abram’s writings on intrapsychic surviving and non-surviving

objects.

Let us begin with the element of aggression that has to do with a feeling of active and

exciting aliveness. The above discussion on continuity focused a great deal on Roger’s anxiety

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as reflecting in part insufficient experiences of going-on-being, and thus of the quality of

aliveness associated with the female, union-seeking element of his personality. Yet, Roger also

struggled with depression throughout his childhood and especially during adolescence. Roger

experienced depression as a draining and enervating phenomenon, and we can see this

psychological and emotional dulling as a reflection of inadequate opportunities to experience the

invigoration that arises from healthy aggressive development. This type of aliveness relates to

the inherently relational nature of aggression and its craving for the establishment of a non-

traumatic externality, for it develops force and meaning through mutuality between oneself as an

active agent and a “not-me” world that both challenges and enriches. Indeed, Winnicott viewed

depression as “an affective disorder which emerges as a result of the lack of opportunity to

contribute in” (Abram, 1996, p. 139). Roger’s parents did not facilitate in him the sense that his

efforts to “add” to the parent-child relationship would be appreciated or even acknowledged. We

might also view his depression as a result of his relationship to the fourth component of

aggression—the demand for the environment’s adaptation. For Winnicott, “it is paramount that

the baby is not made aware of what he is doing” (e.g. hurting the mother during painful

breastfeeding) because this enables the infant to “get on with the tasks involved in being out of

the womb” (Abram, 2012, p. 320). Winnicott echoes this sentiment in his writings on adolescent

development: “…the point about adolescence is its immaturity and the fact of not being

responsible. This [is] its most sacred element…We cannot expect the adolescent to be aware of

his or her immaturity” (Winnicott, 1971, p. 147). The healthy elaboration of aggression in

infancy and adolescence necessitates that the child not be made overly aware of the damage or

distress he is causing caretakers. Roger developed an ambivalent relationship to his own desires,

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needs, and demands on his environment because they were so often met with rejection, the

instillation of guilt, and the feeling that they were inherently destructive. His parents’ responses

to the various elements of his aggression—denying his need for mutual engagement and

responding inadequately to his needs for adaptation—evidence a lack of the preoccupation and

identification required for the establishment of a nourishing psychic environment.

The above clarification and application of what Winnicott means by aggression and the

environment have paved the way for an incorporation of object usage into the analysis of drug

addiction in terms of aggression. Playing and Reality includes one of Winnicott’s most famous

passages, one that outlines the development of object usage. Abram provided a “dissection” of

this sequence and breaks it down into its five component parts:

1. Subject relates to object.

2. Object is in process of being found instead of placed by the subject in the world.

3. Subject destroys object.

4. Object survives destruction.

5. Subject can use object. (Abram, 2012, pp. 319-320)

The first step has been covered at length in this dissertation. It has to do with the state of

absolute dependence in which the infant is unaware of the differentiation between himself and

the mother, is ruthless in his demands, and should not be made aware of his impact on caretakers.

The period in which “the object is in [the] process of being found instead of placed by the subject

in the world” relates to the infant’s gradual awareness of the object’s separateness. Abram

(2012) points out three important subtleties of this process, namely that it is the regular meeting

of the child’s needs that contributes to its being experienced as separate, that the experience of its

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otherness is unconscious, and that the “process of finding out and moving towards more

conscious awareness has to be given space and time” (p. 320). In other words, the consistency of

the mother’s ministrations both reinforces the child’s subjective omnipotence and, paradoxically,

is simultaneously experienced (unconsciously) as a constant variable that operates outside of the

area of omnipotence. The object/caretaker has not yet been “placed” in the outside world in an

experiential sense (for it is not yet accurate to speak of an “outside world”), but is in the process

of being “found” according to the deeply felt and unified psyche-soma activity of the child.

Indeed, at the beginning there is “no duality in the biological/instinctual demand, because at the

beginning it is a movement concerning being alive and has no intention other than to relate, i.e.

to feel the extent of the boundary and to find the objects for needs to be met” (Abram, 2012, p.

321). The child seeks and, in a good enough environment, the child finds something. The nature

of this “something” (the object) changes over time—from being experienced as something part

of the self to something “out there.” The key point here is that this changing-over of the object’s

location must occur in a way that is in sync with the child’s movements and expectations. As we

will see shortly in talking about the survival of the object, this process does not occur simply as a

consequence of “optimal frustration” of the child’s physiological needs, but through the

continued reliability and safety of the psychic environment.

Winnicott usage of the terms “destruction” and “survival” can be somewhat confusing at

times; Abram’s paper provides a concise interpretation of these terms without oversimplifying

them. While it is true that the term destruction, unlike aggression, carries with it implications of

inherent object-relatedness, it is still tempting to assign to it a quality of intentionality, as if the

infant has an inborn desire or wish to carry out destruction. Abram (2012) steers us away from

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this faulty reasoning in saying, “The repeated and uninhibited ruthless demand for the

environment’s adaptation amounts to a continual destruction of the object. The ongoing

destruction is not intentional but rather a necessary process of ‘discovering’ the externality of the

object” (p. 320). It is true that destroying the object in this way “feels good” to the infant—his

biting, demandingness, and screaming are all accompanied by feelings of psychosomatic vitality.

Despite these characteristics of destructive aggression, these activities are not grounded in a need

to inflict injury. However, the infant cannot achieve health if he cannot move beyond such

primordial forms of aggressive expression or if the energy underlying them is squelched.

The fate early aggression depends to a large extent on the survival of the object.

Although Winnicott’s writings convey in detail what he means by “survival,” Abram clarified his

position in a way not found in his original writings: “The mother’s sustained capacity to tolerate

the baby’s endless demands because of her state of primary maternal preoccupation offers the

infant a sense of continuity and reliability. Survival involves primary identification, ego

protections, processing, and crucially, non-retaliation” (p. 320). Survival is thus made possible

by and is in a way equivalent to the qualities and capacities of the good-enough mother’s

psychical relationship to her child’s own psychosomatic experiences and needs.

Keeping in mind the child’s communication to the surviving mother will help to remind

us of what Roger missed out on because of his parents’ non-survival: “The subject says to the

object: ‘I destroyed you,’ and the object is there to receive the communication. From now on the

subject says: ‘Hullo object!’ ‘I destroyed you.’ ‘I love you.’ ‘You have value for me because of

your survival of my destruction of you’” (Winnicott, 1971, p. 90). Another imaginary

communication of the child echoes this sentiment: “‘You survive what I do to you as I come to

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recognise you as not-me’” (Winnicott, 1968, p. 103). These statements highlight the ways in

which the child experiences survival. The mother’s continual tolerance of her child’s

destructiveness, as well as her mirroring and encouragement of the other components of his

aggression (e.g. the need for engagement and the expression of aliveness) are initially

consciously experienced as gratification within the area of omnipotence and unconsciously as

belonging to some vague and nascent not-me world, but gradually transform into something

more concrete against which the child can bump, with which he can meaningfully communicate,

and that he can trust. This is an exciting process for the child, who “begins to believe in external

reality” and whose “spontaneity…has been joined up with the world’s events” (Winnicott,

1960b, p. 146). At the same time, the mother’s survival constitutes a gentle challenge to the

infant’s omnipotence and to the essentially projective (although not in the Kleinian sense) basis

of his earliest mode of object-relating. The child’s capacity to sustain a non-traumatic sense of

separateness is founded upon the internalization of the experience of mutuality, of the ego-

supportive environment that sustained him during the phase of absolute dependence. The

distinction between the internalization of an environmental experience as opposed to the

internalization of object is at the heart of what differentiates Winnicott from Klein. The

establishment of an “internalized ‘ego-supportive environment’” that takes place in the gradual

emergence of a not-me world is what enables the “subject…to distinguish between their

projections and the integrity of the m/other” (Abram, 2012, p. 321). Without this development,

the infant will not attain the capacity to use objects.

Non-survival can take many forms, each of which interferes with how the child

experiences his own aggression and colors the creation and interpretation of externality. Before

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moving on to a discussion of intrapsychic surviving and non-surviving objects, I will here briefly

mention the modes of non-survival evident in Roger’s childhood and early adolescence: the

paucity of both conscious and unconscious identification, falling apart, and retaliation. Good

enough caretaking at all stages of development requires that caretakers have the capacity and

desire to identify and to empathize with the central predicaments of each developmental phase.

Roger’s history abounds with examples of deficient identification on the part of his parents.

Their inability to provide him with a sense of organization during his childhood evidences their

failure to acknowledge the fact that children in elementary school “are becoming more aware of

themselves as individuals” and are typically very concerned about being able to do things

successfully on their own, but that they still need an organizing force at home to help them

resolve what Erik Erikson called the crisis between industry and inferiority. Roger did not

develop feelings of mastery or self-efficacy during this fragile age, and therefore did not

experience the healthy elaboration of the component of aggression that has to do with agency.

His aggressive development was also stunted in the area of the need for environmental

adaptation to his dependency needs, and this stemmed in part from his parents’ tendency to fall

apart under the pressure of his developmentally appropriate demands. Roger’s parents regularly

blamed their fights on him; this is just one instance of the way in which Roger came to

experience his needs as dangerous and painfully unfulfillable. When Roger looked at his mother,

he saw a broken mirror held by a crazed woman—a mirror that reflected back to him a

kaleidoscopic and fractured picture of himself, a mirror that he himself felt he had shattered

through the expression of his needs.

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As noted by Abram, non-retaliation represents perhaps the most central feature of

survival, and Winnicott gave it a very prominent place in his final formulations on aggression

and object usage. The manifestation of non-retaliation on the part of parents takes different

forms throughout the child’s development, and we can see that Roger’s parents were unable to

adopt a non-retaliatory stance in both his childhood and adolescence. During grade school,

Roger on occasion initiated fistfights with classmates, which was in and of itself a manifestation

of pathological, split off aggression that will be addressed shortly. Roger’s parents

unquestioningly took the side of his teachers whenever there had been a conflict at school

without trying to understand the situation from his point of view. He would return home from

parent-teacher conferences and face further punishment. He was often demeaned for being “a

baby” when he threw tantrums, a form of retaliation that left Roger feeling humiliated and

misunderstood.

In his discussions of adolescence, Winnicott (1971) felt it crucial to differentiate

“confrontation” from retaliation. He uses the word confrontation “to mean that a grown-up

person stands up and claims the right to have a personal point of view” and wrote, “confrontation

belongs to containment that is non-retaliatory, without vindictiveness, but having its own

strength” (Winnicott, 1971, pp. 147, 150). Though the adolescent may balk at her parents’

confrontation, the confrontation—which is “personal” and grounded in love—provides for the

teenager an experience reminiscent of the infant whose enriching acceptance of and relationship

with the surviving mother nonetheless requires an at-times distressing abrogation of

omnipotence. The adolescent’s “greatest asset” is “the freedom to have ideas and to act on

impulse;” the “most sacred element” of adolescence “is its immaturity and the fact of not being

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responsible” (Winnicott, 1971, pp. 150, 147). Paradoxically, a confrontation that is personal and

consistent in nature, rather than constricting the “strivings” of adolescence actually serves to

“[give them] reality” (Winnicott, 1971, p. 150). By responding to Roger’s impulsivity and rage

through physical violence, Roger’s father (a) demonstrated a lack of interest in what lay behind

Roger’s rage, (b) held Roger wholly accountable for his (Roger’s) actions when in fact the

causes for such actions developed in the context of inadequate parenting, (c) failed to establish a

boundary that could have led to constructive communication between Roger and a father with

“his own personal point of view,” and (d) reinforced in Roger the sense that his (Roger’s)

aggression was not survivable. It should be kept in mind that the rebelliousness demonstrated by

Roger was qualitatively different from the rebelliousness of the adolescent with a history of

good-enough parenting, a rebelliousness “that belongs to the freedom [parents have given their]

child by bringing him or her up in such a way that he or she exists in his or her own right”

(Winnicott, 1971, p. 145). The development of such healthy rebelliousness would have required

the growth and predominance of an intrapsychic surviving object, a concept to which I will now

turn.

Abram based her concept of the internalized (or intrapsychic) surviving object on

Winnicott’s writings about the child’s internalization of an ego-supportive environment. The

internalized surviving object is an inherently relational object that derives from the child’s

continual experiences of mutuality with the object and repeated experiences of the object’s

survival—the intrapsychic surviving object grows not from the internalization of a gratifying

object, but from the internalization of an experience of and with a surviving object. We should

keep in mind that, due to the lack of differentiation in the earliest time of life, the mother’s ego is

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the child’s ego, and that the mother’s experience is therefore part of the infant’s experience: “the

newborn…[internalizes] the experience of the object mother [and environment mother] having

survived his excited states” (Abram, 2012, p. 322). The good-enough mother’s experience of her

own survival is suffused with love and joy, and her child experiences these feelings as his own.

Simultaneously, the infant is also unconsciously aware of the object; the object’s survival

therefore instills within the infant the feeling that his aggression is survivable and valued. As the

baby gradually develops a sense of personal identity and places the object “outside,” the earlier

experiences of and with the surviving mother are consolidated into an intrapsychic object.

Through this process, “the mother becomes an integrated part of the fabric of the baby’s internal

world whose [sense of] self emerges through her ego-coverage and her inter-psychic unconscious

identifications” (Abram, 2012, p. 322). The mother’s resilience becomes the baby’s resilience,

and the mother’s toleration and facilitation of her infant’s aggression becomes the baby’s

capacity to have faith in the survivability and value of his own needs for engagement, separation,

and environmental adaptation. Abram made it very clear that children and adolescents still have

a strong need for the object’s survival and for the ongoing nourishment of the intrapsychic

surviving object, even though the object’s survival is qualitatively different at each

developmental stage. Moreover, the individual does not develop a “whole surviving object”

until the end of adolescence; for Abram(2012), the whole surviving object “is the result of a

developmental process that is ongoing from before the beginning of birth, throughout childhood

and [that] reaches a particular peak of growth at the onset of adulthood” (p. 323). The building

up and ongoing growth of an internalized surviving object represents a crucial foundation for the

individual’s capacity live with confidence, agency, and creativity.

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The non-surviving internalized (or intrapsychic) object, not surprisingly, develops in the

context of a relationship with a non-surviving object in early life. Like its counterpart, the non-

surviving intrapsychic object relates primarily to aggressive development, is inherently

relational, and cannot be understood without considering environmental, interpsychic, and

interpersonal factors. The primary differences between these two objects lies in the type of the

environment that the child internalizes over time, their impact on the infant’s primary affective

states, and their influence on the infant’s overall sense of self. Whereas the child with a good-

enough caretaker gradually internalizes the stability and cohesion of an environment grounded in

a mutual relational matrix, the less fortunate child inherits the unpredictability and fragmentation

of an environment devoid of meaningful, enriching engagement. Abram (2012)posits that “terror

is at the root of a non-surviving object,” characterizing this terror as a residue of the “unthinkable

anxiety” and “primitive agony” that resulted from earlier deficiencies in ego coverage (p. 322).

The child in a consistently non-surviving environment has “catalogued the culmination of non-

survivals of the object that carries the history of a lack of reception and reflection from the

object;” because “the benign/destructive/creative impulse becomes thwarted…the infant has no

other option than to withdraw or attack the self” (Abram, 2012, p. 323). Given that the fortunate

infant internalizes the mother’s own experiences of survival, we can infer that the child who

develops within a non-surviving environment internalizes his mother’s experience of her own

non-survival. Emotions experienced by the non-surviving mother can range from depression to

anxiety and from anger to resignation. Abram (2012) believed that the child with an inordinately

powerful intrapsychic non-surviving object is prone to depression, feelings of psychic deadness,

and problematic relationships to his own desires (p. 324-325). She described the impact of a

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non-surviving environment on the child’s self-experience in saying, “consolidation of a non-

surviving object…impoverishes and depletes the sense of self” (Abram, 2012, p. 323). We must

keep in mind that, according to Abram (2012), every individual has within them a surviving

object: “Everyone alive will have introjected a good enough experience, however brief, that will

give birth to a surviving object” (p. 324). It is the proportion between experiences with surviving

and non-surviving environments that determines the extent to which one’s inner world governed

by surviving or non-surviving objects. The assessment of an individual case therefore involves

considering the prominence of the role played by each type of object on the intrapsychic stage. It

is also necessary to consider the ongoing interactions between surviving and non-surviving

objects over the course of the lifespan:

I want to emphasize that in the sequence from object relating to object usage, a

continuous dynamic process gradually builds up in the psyche and, at each stage of

development, the surviving and non-surviving objects contain particular configurations of

memories at each phase along a developmental line…These multilayered configurations

are sets of dynamic object relationships related to a continuous relationship to time and

space; repression and the unconscious. (Abram, 2012, p. 325)

This aspect of Abram’s paper will be especially important in considering the establishment,

maintenance, and breakdown of Roger’s addictive defenses. We have established that Roger’s

parents consistently failed to survive his aggression and that their non-survival contributed to

problems in his aggressive development. It has also been established that he exhibited several

symptoms associated with distortions in various dimensions of aggression—depression, intense

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hostility towards others, difficulty establishing or maintaining meaningful relationships, and

anxiety.

Now that Abram’s concept of internalized surviving and non-surviving objects has been

elucidated, we can now make a more dynamic interpretation of these difficulties. I will begin by

analyzing his depression in terms of Abram’s insights. She wrote the following regarding

dramatic imbalances in the force exerted by surviving and non-surviving objects within an

individual’s inner world: “The cumulative effect of the environment means that the non-

surviving object begins to grow and is liable to dominate the internal picture of the analysand. It

overwhelms the internal world (i.e. eclipses the undeveloped surviving object)” (2012, p. 324).

Roger remembers being depressed as early as elementary school, an indication that something

was likely amiss in the development of his intrapsychic surviving and non-surviving objects. If

you will recall, Winnicott viewed depression in part as an affective disorder founded on the

paucity of opportunities for the child to contribute-in in his interactions with caretakers. Roger

struggled to make close friends in grade school and watched sadly as his classmates formed

mutually joyous friendships. His parents did not allow him to contribute-into their lives and

rarely noticed his attempts to do so; Roger carried his resignation regarding his own capacity to

contribute into his relationships with other students. This element of his early interpersonal

interactions can be partially attributed to the dominance of his intrapsychic non-surviving object.

Roger’s depression, in addition to pervading his interpersonal life, was intimately bound up self-

loathing and feelings of deflation. The last of these relates to the aspect of aggression that has to

do with aliveness and correlates with Abram’s assertion that an overly powerful internalized

non-surviving object can result in psychic deadness.

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What about his self-hatred? I mentioned above that Roger learned to associate his needs

for engagement and adaptation with punishment in the form of both non-responsiveness and

outright chastisement. If you will recall, the child internalizes the attitudes and emotions of the

non-surviving caretaker. Roger’s parents, in their non-survival, viewed him as a hindrance and,

both willfully and inadvertently, punished him for his aggression. Is it any surprise that Roger

transformed their punitiveness into self-directed chastisement? Abram (2012) wrote that the

infant with chronic exposure to a non-surviving environment “has no other option than to

withdraw or attack the self” (p. 323). Eventually, Roger communicated with himself in a manner

similar to the explicit and implicit communications he had received from his parents—“You’re

worthless, you’re weak, and your needs are unimportant.”

Identifying the accumulation of rejection and dismissiveness accompanying Roger’s

parents’ non-survival as an origin of his self-hatred and self-flagellation allows us to deepen our

understanding of his depression by highlighting a significant parallel between Abram’s notion of

the intrapsychic non-surviving object and Klein’s “bad object.” In Klein’s framework, the bad

internal object derives from the projection outward of the death instinct and the subsequent

internalization of the bad external object that had been created by the original projection. The

preponderance of bad objects in the infant’s intrapsychic life intensifies annihilation anxiety, for

the child comes once again to sense the presence of internal persecutors whose aim is his

destruction. Although the origins of a powerful intrapsychic non-surviving object have nothing

whatsoever to do with the death instinct, we see in the case of Roger that the anxiety produced

by the dominance of the non-surviving object leads—as with the predominance of bad internal

objects—leads to the feeling that “malevolence [was] located [inside]” himself (Gomez, 1997, p.

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93). Klein hypothesized that the infant embarks upon a complex projective and introjective

process to ensure that his intrapsychic world is not overpopulated with bad objects; we will soon

see that Roger’s intense hostility and rebelliousness can at least partially be viewed as an attempt

to rid himself of the persecutory aspects of his intrapsychic non-surviving object. It should be

kept in mind, however, that this threat posed does not involve the return to an inorganic state, as

is the case in Klein’s theory. Rather, the self-castigating component of Roger’s depression

should be seen as an inner source of impingement upon his core self, thus threatening the

emergence of the primitive anxieties of falling apart and falling forever.

Roger’s hostility towards and contempt of others, like his depression, can also be seen as

arising from distortions in his aggressive development. Although hostility and rebelliousness are

certainly common in adolescence, we should keep in mind that Roger’s overt aggression

originally manifested in elementary school and was more intense than most other adolescents by

the time he reached middle school. Abram (2012) provided a useful framework for

distinguishing a Winnicottian perspective on forms of maladaptive aggression from that of

earlier theorists: “Winnicott’s ‘use of an object’ theory in my view suggests that pathological

sadism, masochism, contempt, envy, jealousy, and perversion arise as a result of reactions to

cumulative non-survivals of the object” (p. 326). In essence we can argue that Roger’s enmity

towards others and his initiation of fights with peers can be viewed in large part as his primary

defense against the depression caused by the dominance of his intrapsychic non-surviving object,

the building up of which was primarily caused by cumulative non-survivals of the object.

We have seen that Roger’s depression impacted each of the four components of

aggression: it was constituted by resignation regarding the environment’s capacity to adapt to his

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dependency needs, profound doubts about the possibility of establishing mutually enriching

relationships, feelings of psychic deadness, and immense difficulty in perceiving himself as an

agentic individual in his interactions with the “not-me” world. His adoption of a contemptuous

and hostile attitude served to alleviate the suffering that accompanied each of these facets of his

depression. Before proceeding further, it should be emphasized that Roger did not simply

progress in a linear fashion from depression to anger—he constantly vacillated between these

two states throughout his childhood and early adolescence. The most apparent change effected

by anger was its instillation of a sense of aliveness. Rageful outbursts provided Roger with a

physiological and mental arousal not accessible to him in states of depression, and thus offered a

means of tapping into the dimension of aggression that Winnicott called “a symptom of being

alive,” although this aliveness was of course qualitatively different from that which accompanies

health. The sense of himself as an agentic being represented an important corollary of the

vitality made possible through anger. Regardless of whether or not he won a fight or succeeded

in getting his way in an argument with a teacher, fighting and arguing allowed him to take an

active stance in his interactions with others. As a very young child, he had so frequently been

placed in a passive position that the allure of self-assertion, no matter the consequences, must

have been irresistible.

Closely related to this transformation from passivity to activity was the fact that anger

made it possible for him to banish from awareness the vulnerability associated with unmet

dependency needs. In the earliest phases of his life, his ruthless demands for environmental

adaptation were not intentionally destructive and were initially integrated with the other positive

features of early aggression. His depression reflected a resigned withdrawal from rejecting

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objects and an underlying conviction that his needs could not be met; however, this represented

only one possible response to the continual frustration of his needs. The other option entailed a

splitting off of the destructive component of aggression (i.e. the demand for adaptation) from

other domains of aggressive life (especially that of the desire for mutuality) and its

transformation into intentional destructiveness. Having given up on the capacity of the

environment to fulfill his needs, and seeking to escape the painful vulnerability of depression, he

said to the world: “I demand that you listen to me, and I will hurt you if you do not do as I say!”

Although his physical violence towards classmates and his vicious verbal attacks on others could

not accurately be described as sadistic, he certainly derived some form of pleasure from

imposing his will on others by hurting and demeaning them. As we can see, this pleasure likely

arose from the intoxicating power of being the aggressor after so many experiences of being the

victim of others’ meanness and abuse.

The final defensive function of Roger’s anger centered on the diminution of the suffering

caused by his self-hatred, an impinging force within his intrapsychic world that threatened the

emergence of primitive anxieties. The ways in which Roger dealt with his self-loathing indicate

that he was operating within a paradigm reminiscent of what Klein termed the paranoid-schizoid

position, the primary defenses of which are splitting and projection. Although Winnicott

disagreed with Klein’s assertion that the infant begins life in a paranoid-schizoid state, he wrote

that “we nevertheless cannot ignore the fact that we meet, in a vitally important way, the two

mechanisms [of] talion dread [and] splitting of the object into ‘good’ and ‘bad’” (Winnicott,

1962b, p. 177). The latter of these two mechanisms was readily apparent in Roger’s early life:

he almost invariably ascribed to teachers and many classmates an inherent “badness.” More

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specifically, he adopted a perspective in which others were viewed unequivocally as agents of

persecution. It may seem at first glance that splitting external objects in this way would do little

to improve Roger’s situation—how could generalizing his perceptions of his parents to others

possibly help him to avoid the depression that was caused by persecution from the “outside”

world in the first place?

Further examination reveals that there were several psycho-emotional “benefits” of

establishing such a perspective. The first advantage has to do with the fact that the mechanism

projection intermingled with and made possible the splitting process. By projecting his “inner

persecutor” onto others, he diminished the force and presence of the “bad” and self-destructive

component of the non-surviving object in his inner world. His evacuation of this aspect of

himself can be seen as a sort of intrapsychic detoxification. Indeed, this aspect of Roger’s

intrapsychic functioning strongly resembles what Gomez (1997) said about paranoid-schizoid

dynamics: “it is somewhat less dangerous to feel that malevolence is located outside oneself” (p.

93). Projecting his inner persecutor and adopting a view that did not acknowledge the internality

of others also served the purpose of decreasing the frequency and intensity of Roger’s painful

introspection on his neediness, vulnerabilities, and defects. The more Roger directed his enmity

outwards, the less psychological and emotional energy he had to engage in self-flagellation.

Thirdly, projection and splitting allowed Roger to deny the value of mutuality and, therefore, to

banish from awareness the pain that resulted from the paucity of mutual relationships in his life.

The final advantage to adopting a perspective in which others were seen primarily as persecutors

is addressed by Winnicott in a chapter from Playing and Reality entitled “Contemporary

Concepts of Adolescent Development”: “Logic holds no sway once the delicious simplification

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of a persecutory position has been achieved” (1971, p. 148). We know from previous sections in

this dissertation that chronic impingement interferes with the child’s ability to achieve

personalization, integration, and realization. Deficits in these maturational processes increase the

chance that the child will be overwhelmed by chaos, disorganization, and uncertainty. By

achieving this “delicious simplification,” Roger was able to view himself as a stable entity over

time relating to an external reality that was also stable—to maintain a sense of self and identify.

It should be noted that Roger’s anger did little to develop his capacity for object usage, for it

indicated that he had not yet developed the capacity “to discern the other as separate and ‘not just

a bundle of projections’” (Abram, 2012, p. 327).

Now that we have established the etiology and nature of Roger’s primary psychological

states and defensive patterns in childhood and early adolescence, we can utilize Abram’s

clarifications and extensions of Winnicott’s theory of aggression to illuminate the establishment,

maintenance, and breakdown of addictive defenses. This analysis will show that the relationship

between aggression and addiction resembles the relationship between being and addiction. The

following statements are equally true regarding addiction as it relates to being and aggression:

the need for addictive defenses arose upon the breakdown of the defenses of childhood and early

adolescence; his addiction was essentially regressive in nature; his drug use was an attempt to

“hit the reset button” on his psychological and emotional development, and the expectations he

had of drugs were interpersonal in nature. As has been the case thus far in this section, I will

emphasize the four-part model of aggression, Abram’s clarifications on “the environment,”

object usage, and intrapsychic surviving/non-surviving objects.

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The above discussion elaborated upon the “benefits” of Roger’s hostile stance toward the

not-me world; however, there was a high cost to using the defenses involved in maintaining such

a perspective. Most broadly, his rancorous attitude did little to nourish his fledgling intrapsychic

surviving object. Abram said the following regarding the ongoing dynamic between surviving

and non-surviving objects: “the surviving and non-surviving objects contain particular

configurations of memories at each phase along a developmental line…these multilayered

configurations are sets of dynamic object relationships related to a continuous relationship to

time and space; repression and the unconscious” (Abram, 2012, p. 325). In other words, at any

given time, an individual’s relationship to his own inner world, to others, and to the passage of

time itself can be viewed in terms of the ways in which intrapsychic surviving and non-surviving

objects have been shaped through the accumulation of memory residues. Given that Roger’s

primary home environment remained a non-surviving one and that he continually perceived his

school and social environments as retaliatory (i.e. non-surviving), it can be said with confidence

that his non-surviving object grew stronger and stronger over the years and that the “sets of

dynamic object relationships” that constituted his non-surviving object more or less dictated his

sense of himself and others. Meanwhile, his surviving object remained underdeveloped and

longed for enrichment through experiences of environmental survival. Whereas the healthy

adolescent is in the process of developing a “whole surviving object” founded upon “ongoing

interpersonal/interpsychic relationships…feeding the surviving object,” (323). Roger’s early

adolescence was characterized by ongoing interpersonal/interpsychic relationships that starved

his surviving object (Abram, 2012, p. 323). It will soon become clear that his drug use, in part,

can be construed as an attempt to build up and strengthen his surviving object.

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The most central reason behind the breakdown of Roger’s pre-addictive defenses

concerns the illusory nature of the benefits they provided. At one point during treatment, Roger

mentioned that he started using drugs in part because he was “tired of being angry all of the

time.” I feel that the wearisomeness of his anger can be attributed in part to the illusory nature of

the aliveness it offered. This is to say that his vitality and autonomy did not feel real. The

invigoration that accompanied conflict did not emanate from either his true self or his surviving

object, but was rather a derivative of the reactivity generated by the chronic non-survival of his

environment. Indeed, the hypervigilance and constant search for conflict that accompanied his

anger can be viewed in much the same way as the overactivity of his mind-object in the above

discussion on being. His need to stay angry represented an overidentification with the male

element of his personality and indicated that he had been forced to adopt a means of living based

primarily on “doing and being done to” in the absence of continuity. At some point, Roger just

gave up. This way of interacting with others (and himself) became too exhausting, and the

hyper-aroused state it generated inevitably dissipated, leaving Roger in a state of deflation and

depression.

Therapy led Roger and I to explore the possibility that his defensive hostility may have

created a second illusion: that he no longer needed others. This illusion operated on both a

conscious and unconscious level. Thoughts such as “I don’t need anyone else to get by”

occurred to his conscious mind, while the reactive desire for and belief in his separateness was

an unconscious force that propelled him to distance himself from others and, as we have seen,

was made possible by projection, splitting, and the feelings of autonomy and agency fostered by

seeking out conflict. However, he could only maintain this denial of dependency needs for so

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long, for doing so required immense effort on his part and was inevitably followed by attacks on

the self, longings for friendship, and the painful reemergence of vulnerability. Similarly, the

diminution of inwardness facilitated by projection and the denial of others’ internality could only

be sustained for so long and were succeeded by intense and uncontrollable introspection and

submersion in the negative feelings generated by the dominance of his internalized non-surviving

object. Complicating matters was the fact that the mechanisms of splitting and projection

actually made the meeting of his dependency needs and the establishment of mutually enriching

relationships and the experience of object usage less likely. While his hostile interactions with

and aggressive behavior alienated others from him, his singular focus on the “badness” of those

with whom he interacted prevented him from discovering the “goodness” in others who may

have actually cared for him or been able to provide him with support or nurturance.

The final illusion created by Roger’s pre-addictive defenses involved the sense of

interpersonal/intrapsychic stability and the feeling that his inner world was safe. The above

discussion demonstrated that the adoption of a persecutory position allowed him to develop a

generally reliable model of self-other interactions: “Everyone else is out to get me, but I’m more

than capable of facing the threats they pose.” Roger encountered two difficulties in his attempts

to maintain this schema. The first involved the way in which this schema and its concomitant

defenses created a not-me world that became overwhelmingly frightening. The more he

projected his inner persecutor—an aspect of his intrapsychic object-relating founded upon the

original non-survival of his environment—the scarier the not-me world actually became. We see

here that the projection of the self-destructive aspect of his non-surviving object rebounded and

posed a serious danger to his sense of aliveness. While it was true that his attacks on perceived

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persecutors at times gave him a sense of agency, he was forever infusing the not-me world with

more and more projections; the intrapsychic surviving object that would have enabled him to

withstand threats from the outside world rarely received nourishment from the not-me world.

We should not forget that, from an observer’s point of view, his “external” environment (that

which existed outside of his projections) to a great extent remained threatening and rarely

survived either the split-off, intentional, and destructive component of his aggression and

continued to be misattuned to the silenced and less apparent aspects of his aggression that had to

do with the desire for mutuality and genuine aliveness. This state of affairs led to what can be

considered the second major difficulty Roger encountered in his over-reliance on a limited

defensive repertoire—it became increasingly difficult for him to maintain a view of himself as an

agentic being capable of defeating his persecutors, especially because he regularly returned to a

depressed state in which he again became his own source of persecution. The resulting scenario

was one in which the tragic hero shrank back as the villain grew ever stronger. For example, in

periods of depression, Roger found himself unable to survive emotionally when he felt rejected

by them. The “cool kids” got cooler and Roger felt “lame” and increasingly insecure.

Winnicott’s model of psychological and emotional development was essentially a deficit

model, so any interpretation of Roger’s addiction as it pertains to aggression must be viewed in

this context. As such, the development of addictive defenses can most generally be conceived of

as a regressive attempt to make up for deficits in his aggressive development and to undo or

force out of awareness the damage done by a non-surviving environment. In her dissection of

Winnicott’s sequence, Abram (2012) wrote that, in the stage called “subject relates to object,”

the “environment mother must protect” the infant from becoming aware of the demands he is

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placing on her “so that [the baby] can get on with the tasks involved in being out of the womb”

(p. 320). This statement can be generalized to apply to all phases of development, for it contains

within it the most fundamental principle in Winnicott’s theory: there are “tasks” associated with

every stage of development that rely upon environmental provision for their completion.

Although good-enough environmental provision is particularly crucial during infancy, when the

child has not yet achieved unit status, inadequate caretaking can thwart the maturing individual’s

tendency towards growth at any age. The nature, complexity, and tasks of aggressive

development differ qualitatively at various ages, and the successful resolution of a particular

phase’s task rests to a great extent on the degree to which the child or adolescent has mastered

the undertakings of earlier stages.

As a teenager, Roger was faced with the dilemmas associated with adolescence in

general—coming to terms with the fact that “growing up is an inherently aggressive act,”

“gradually accept[ing] responsibility for all that is happening in the world of personal fantasy,”

and developing the “capacity to discover in the self the balance of the good and the bad, the hate

and destruction that go with live, within the self”—but had not yet met the simpler, less-object

related milestones of infant and childhood aggressive development (Winnicott, 1971, p. 148).

Roger’s task was therefore especially daunting, for he had to endure the vicissitudes of

adolescent aggressive development without the tools required to do so. As his pre-addictive

defenses became less effective in protecting his core self and more maladaptive in his

interpersonal relationships, he desperately needed to find a way to cope with the strains of

adolescence without falling apart. He needed something that would enable him to survive the

strains of adolescence and, as we have seen, doing so requires the presence of a strong

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intrapsychic surviving object. Unfortunately, the development of an intrapsychic surviving

object can only take place in the context of a surviving environment and, as we know, Roger did

not experience his home, school, or social environments as capable of surviving his aggression.

This leads us to the one of the primary functions drugs served for Roger: the creation of

an environment through an attempted regression to the earliest phases of development. This

element of his drug addiction was particularly apparent in his cravings for oxycontin and his

subjective experiences of opiate intoxication. I will here be focusing primarily on his private

intrapsychic relationship to oxycontin without reference to his polysubstance abuse,

interpersonal relationships with friends and sexual partners, or his interactions with authority

figures. Addressing these aspects of his life will require us to illustrate the relationship of his

drug use to later tasks in aggressive development; these topics will be discussed shortly. The

above examination of being and addiction demonstrated the centrality of oceanic sensations

during opiate intoxication and indicated that understanding Roger’s addiction from a

Winnicottian perspective requires a consideration of regression to the psycho-emotional world of

infancy. In the context of aggression, his need for regular retreats to formlessness can best be

understood by emphasizing Abram’s clarification of the destructive component of aggression,

her characterization of the surviving environment, and her description of the ways in which the

surviving environment responds to the child’s ruthless need for adaptation.

What demands did Roger place on oxycontin, and what did he expect to result from its

“ministrations?” The most primordial demand in infancy is not for milk, but the demand that

maturational processes are allowed to develop—to get on with becoming and being “me.” In the

earliest phases of life, this requires the presence of an environment capable of surviving the

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destructive component of the baby’s aggression. We must be careful not to equate Roger with an

infant, even one who, through excessive impingement, has become prematurely aware of his

separateness. Having achieved unit status (in terms of consciously being aware of himself as a

individual differentiated from the not-me world), Roger was of course on some level aware of

the separateness of the syringe and the fact that it had the capacity to fulfill his needs. The key

point here is that oxycontin promised to return him to a state in which he could forget that he had

had such desperate demands for adaptation in the first place or that the satisfaction of his needs

required the assistance of a not-me object. Both the establishment and breakdown of his pre-

addictive defenses (in terms of aggression) arose in part from the lack of a developed

intrapsychic surviving object, the frailty of which resulted partially from the absence of an

environment that could survive his ruthless need for accommodation. His desire to experience a

state of formlessness associated with the phases of object-relating and object-finding can

therefore be seen as a manifestation of his need to live in the sort of environment that facilitates

the establishment and nourishment of an internalized surviving object.

In terms of the experiences it allowed Roger to have, oxycontin proved very effective in

in the creation of what Roger experienced as a surviving environment. Roger’s desire for

gratification from oxycontin rapidly transformed into a voracious appetite. The intensity of his

demands for satisfaction, as with the infant, was most intense during “excited states”—when he

was sober, agitated, and needing a good feed to reestablish a sense of inner calm. His demands

arose at all times of the day and night, much like the infant who cries out to her mother

throughout the day. For a time, oxycontin always met his demands. His experience of its

reliability and consistency must have been borne some resemblance to that of the infant whose

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m/other maintains a state of primary maternal preoccupation—something that is not just an

attitude on the part of the m/other, but a component of the total environmental setup. Oxycontin

did much more than simply meet his needs—it never retaliated, it did not stir within Roger the

sense that his ruthlessness could possibly cause harm, and it did not instill in him the sense that

his dependency needs were futile or unimportant.

The seeking and achievement of the oceanic state achieved through opiate intoxication

also had an impact on Roger’s relationship with the other three components of aggression—

aliveness, the non-traumatic sense of separateness, and mutuality. The effect of oxycontin on

Roger’s psychosomatic vitality was perhaps the most readily apparent of these changes. Roger

described the instantaneous effect of oxycontin as “powerful” and “orgasmic.” In the early days

of his drug use, he felt invigorated and restored whenever he used oxycontin. Accompanying

this physiological vivification was a concomitant increase in the spontaneity of his thoughts and

behaviors. This spontaneity was bolstered by the strong influence oxycontin had on his sense of

himself as an agentic being in control of his life. Roger reported that he sometimes “felt like

God” when intoxicated and that he felt invincible. This represented a welcome contrast to the

fear, shame, emptiness, and self-loathing that so predominated his psycho-emotional world

during his childhood and early adolescence. His seamless ebbing and flowing between

experiences of undifferentiation and more cohesive self-states reminds one of the following

quote from “Primitive Emotional Development” (1945): “There are long stretches of time in a

normal infant’s life in which a baby does not mind whether he is in many bits or one whole

being, or whether he lives in his mother’s face or his own body, provided that from time to time

he comes together and feels something” (Winnicott, p. 150). The “coming together” that took

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place during periods of intoxication happened on his own terms and arose organically from a

state of psychosomatic unity, thus lending his every thought and action a quality of authenticity

and centeredness. Finally, his periods of coming together felt safe and fostered a belief in the

safety of his inner world.

Identifying the influence of oxycontin on the aspect of aggression that has to do with

mutuality and relatedness is somewhat more difficult. It behooves us to keep in mind that

Roger’s expectations of oxycontin were interpersonal in nature. In this sense, Roger did interact

with oxycontin as if it were actually a person. It may help, in the style of Winnicott, to

imaginatively depict Roger’s unconscious (and perhaps to a degree conscious) communication

with oxycontin:

Roger: I am hurting.

Drug: Let me soothe you.

Roger: I am happy.

Drug: I will help you stay that way.

Roger: I am scared.

Drug: I will help you feel brave.

Roger: Who am I?

Drug: You are you.

While it is true that this depiction contradicts to some extent the above statements regarding the

capacity of opiates to diminish Roger’s awareness of his needs and separateness, it should be

remembered that the reliability of a surviving environment leads the infant to develop an

unconscious sense of the m/other as a separate object. Moreover, as has been established,

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Roger—as an adolescent and adult—knew that the drug was a not-me object, particularly in

times of sobriety. His relationship with opiates therefore resembled the infant’s earliest

experiences of mutuality, and permitted him to feel at times that there was a separate force that

contributed-in and with which he could communicate. The repetition of these interactions served

as a foundation upon which he could develop both a qualitatively different understanding of his

capacity to engage with another being and a renewed belief in the value and safety of

relationships.

Limiting our discussion of Roger’s drug addiction in terms of regression to the earliest

phases of aggressive development through the seeking and use of oxycontin would preclude us

from addressing several other important aspects his life, most notably changes in his

interpersonal life and in his ability to reconcile the “good” and “bad” elements in his inner world.

In other words, the above description of the dynamics involved in his retreats to formlessness

provided an assessment of the simplest forms of aggressive development, but we must now turn

to a consideration of the more complex and object-related modes of aggression in order to have a

more comprehensive understanding of the relationship between aggression and addiction. The

interactions with oxycontin that have been described thus far led to the creation of a psychic

environment, a matrix in which Roger’s ego boundaries became more diffuse and permeable.

This facilitated an osmotic influx of the enriching nutrients that belong to experiences of

survival, which in turn were unconsciously felt to nurture and fertilize an intrapsychic surviving

object. Thus equipped, he could venture outward into interpersonal relationships with the

resilience and more positive sense of self that results from the existence of a strong internalized

surviving object. Though we should be careful not to posit an overly simplified or causal

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relationship between his regressive, regenerative experiences with oxycontin and the alterations

in his engagements with the not-me world, it is undeniable that his retreats to formlessness

fundamentally transformed the his capacity to engage in more complicated forms of object-

relating without falling apart.

One of the most powerful changes brought about by Roger’s drug use was quite simple: he

did have friends. Seeking and using drugs enabled him to discover a community of other

individuals with whom he had something in common. Roger experienced a veritable sea change

in his interpersonal world in a period of months, and this had a tremendous impact on nearly

every other dimension of his life. Rather than treading water in a maelstrom of contempt, fear,

alienation, and hopelessness, Roger now spent his time laughing and sharing with others,

experiencing consistent trust and supportiveness for the first time in his life. His new friends

noticed when he felt sad or frustrated and offered support; they commiserated and agreed with

him when he railed at authority figures. Equally important was Roger’s initiation into the world

of sex. Prior to using drugs, Roger had never been physically intimate with another person.

Indeed, the establishment of a social network and development of his sexuality ranked among the

greatest benefits of drug use for Roger.

It should not be surprising that these newly forged relationships entailed dramatic changes in

the various components of his aggressive life. The most notable transformation took place in the

development of and interactions between the aspects of aggression having to do with mutuality

and separateness. If you will recall, Roger’s difficulties in childhood revolved around

underlying convictions that he was fundamentally incapable of contributing-in and that others

had no desire to contribute-into him; such beliefs and the constant lack of mutuality led to

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symptoms of depression and to uncontrollable self-castigation. His defenses against

depression—particularly projective processes and the refusal to consider the internality of

others—eventually led to exhaustion, affective instability, depletion, and the renewed threat of

annihilation anxiety. By the time he began using drugs, Roger had a profound lack of confidence

in himself as an individual capable of maintaining inner cohesion and agency in the context of

interpersonal relationships. The undeveloped nature of his aggressive dynamics precluded him

from experiencing the various benefits that arise naturally from object usage, which we have

defined in part as a capacity to tolerate and embrace the ambiguity of reciprocity. The

community he discovered through drug use provided a safe context in which Roger excitedly

experimented with the enlivening interplay of separateness and mutuality.

However, his enhanced sense of himself as a relational being cannot be ascribed only to

the discovery of new social circles through drug seeking and using—indeed, one would think

that being exposed to so many new relationships would have actually caused him a great deal of

anxiety. To account for his desire for and confidence in reciprocity, we must turn to Roger’s

polysubstance use and the physiological, psychological, and emotional effects of the non-opiate

drugs he used. Oxycontin can be usefully viewed as providing a private and safe place that was

always available and that re-energized him to go out and to engage in more object-related tasks

and activities of aggressive development. Cocaine, however, served a primarily social function

and did so by acting upon his relationship to himself and to others in a unique way. Ingesting

cocaine immediately bolstered his sense of himself as a resilient and agentic entity, making him

feel “on top of the world” and “invincible.” In addition, Roger gladly traded the all too familiar

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lassitude of depression and the exhausting hypervigilance of anxiety for the powerful

physiological and cognitive stimulation of cocaine.

This of course relates to the component of aggression having to do with aliveness, but

also proves highly relevant to Roger’s newfound experiences of non-traumatic, enlivening

separateness and fulfilling interpersonal relationships. Having experienced a simultaneous

diminution of self-loathing and establishment of invulnerability, the need to defensively perceive

others as threats to his self essentially disappeared in his interactions with friends. Cocaine

created within him a core of psychic, emotional, and somatic energy that radiated outward and

impelled him to share what he perceived as his authentic self with others rather than scrambling

to erect ever-crumbling defensive walls to protect his true self. What need had he to shy away

from others when he had so much to offer? Humor, sex appeal, and charisma—he felt himself to

have each of these qualities and was eager to share himself with others. He also became more

open to allowing for the possibility of positive attributes in others and grew to perceive them as

unique individuals from whom he could learn and with whom he simply enjoy life. His use of

other drugs, particularly hallucinogens and alcohol, also facilitated the experiential integration of

separateness and mutuality that led to the benefits Winnicott associated with the object usage of

adolescence. In addition to being fueled by the aliveness generated by drug use, the interplay of

separateness and mutuality was bolstered by and intertwined with a growing belief in the

capacity of his environment (i.e. social network) to tolerate his needs for adaptation. As we

know, health in adolescence and early adulthood requires the ability to effectively handle and

elaborate the four components of aggressive life, and Roger’s polysubstance use made such a

task seem achievable.

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Over time, however, the efficacy of drug use in creating experiences that resemble those

associated with healthy aggressive development diminished, and Roger once again suffered the

breakdown of previously effective self-protective defenses. The drugs lied and only created the

illusion of mutuality, aliveness, agency, and the survivability of his demands for adaptation.

There were two primary reasons behind the breakdown of his addictive defenses in terms of

aggression. First of all, Roger’s needs and expectations of drugs were interpersonal in nature.

His relationship with drugs inherently lacked vital qualities of human relationships and therefore

failed to foster the types of inner growth that can only take place with another person. The

second central contributing factor to the eventual ineffectiveness of Roger’s addictive defenses

has to do with Abram’s theory of how intrapsychic surviving and non-surviving objects develop

and interact. Abram reiterated throughout her paper the fact that the building up of an

internalized surviving object occurs gradually. Roger did in fact have experiences of himself and

others that were reminiscent of individuals with resilient intrapsychic surviving objects, but the

suddenness of their occurrence betrayed their artificiality and therefore the absence of a well-

established intrapsychic surviving object. The breakdown of addictive defenses represented a

reenactment of previous traumas and led to the reemergence of primitive anxieties.

In discussing the disintegration of addictive defenses or the ultimately maladaptive nature

of Roger’s addiction, we should not overlook the value that drug use had for Roger or wholly

dismiss its potentially positive impact. It was in large part because of using drugs that Roger was

first able to experience friendship, rudimentary feelings of love, and deeply felt agency. The fact

that Roger’s friendships may have been rooted in and dependent on substance abuse does not

invalidate their meaningfulness or their contributions to his personal development. Drugs really

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did help Roger to identify actual positive qualities within himself and others. Roger

demonstrated throughout treatment that he possessed a great sense of humor and a strong

intellect. Using drugs simply unlocked the safe in which Roger had been keeping these un-

mirrored—and therefore unrealized—personal characteristics and created a psycho-emotional

state in which he could elaborate and express these strengths in his communication with both

himself and others. In treatment, it became very important for us to explore the experiences of

these positive components of his personality he had during his active addiction and to determine

ways in which he could recover and reintegrate these parts of himself without reverting to drug

use. Some of the friends Roger made during his years of addiction continued to be supportive

and affirmative; Roger would have never made these friends had it not been for drug abuse.

Drug use played a central role in the development of Roger’s identity; to describe his addiction

merely as a pathological defensive repertoire or to characterize his experiences of aliveness as

completely artificial would constitute a grave and dehumanizing oversight.

There are three manifestations of the breakdown of addictive defenses that most clearly

relate to Winnicott’s theory of aggression: (a) withdrawal, (b) increased tolerance, and

(c) heightened strain in interpersonal relationships. One might argue that because the

phenomena of withdrawal and tolerance are the result of biological processes, attempting to

frame them in terms of unconscious, intrapsychic dynamics or developmental theory will

inevitably lead to contrived and unfounded speculations divorced from reality. It is not my

attempt to deny the biological dimension of withdrawal and tolerance—that would be absurd.

However, Roger did not consciously experience the activity of neurotransmitters, and a strictly

medical explanation of his late addiction does not take into account the what, why, and how of

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the meaning Roger attributed to the nausea, weakness, physiological arousal, tension, and

excruciating pain that arose from the operation of such biological mechanisms. From a

Winnicottian perspective, a thorough and clinically useful account of Roger’s final period of

active addiction must take into consideration the ways in which his unique personal history, the

sophistication of his maturational processes, and his predominant intrapsychic/interpersonal

dynamics interacted to suffuse his subjective experiences with idiosyncratic unconscious and

conscious meanings.

Roger’s increased tolerance represented one of the most immediate signs of oxycontin’s

decreased efficacy as a viable defense for Roger. In terms of aggression, it relates most clearly

to aliveness and to Roger’s relationship to and perceptions of his own dependency needs.

Oxycontin for quite some time responded immediately to Roger’s spontaneously arising desires

for adaptation and comforting. It has been demonstrated that the effects of oxycontin facilitated

the achievement of a state in which Roger became less aware of his vulnerabilities, which in turn

fostered psycho-somatic-emotional vitality. His heightened tolerance for opiates, though of

course a product of physiological processes, resulted in a qualitative shift in his awareness of and

in the experiential valence of his needs for palliative ministrations. As his retreats to

formlessness became less and less restorative, it became increasingly clear that the seed of

aliveness did not reside within him, but in an outside source that had become increasingly distant

and unresponsive. It has been reiterated throughout this dissertation that hyperawareness of

dependency, both in children and adults, in conjunction with unmet needs often leads to the

reemergence of primitive anxieties and a resultant hyper-reactivity that obliterates any trace of

spontaneity. His incapacity to achieve aliveness on his own shows that the development of this

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component of his aggression had not been as significant as it may have seemed before.

Depression began to reassert itself as a prominent feature in his psychological and emotional life.

Once again, he desperately fended off the various manifestations of depression—self-castigation,

deflation, and hopelessness—even during times of intoxication. If you will recall, depression

often results from an overly predominant intrapsychic non-surviving object and the relative

absence of an internalized surviving object from the psychic scene. The reemergence of

depression therefore suggests the possibility that, despite Roger’s having had plentiful

experiences of the sort that arise from possessing an internalized surviving object, his addiction

had rather set up within him an illusory surviving object that, rather than permanently

diminishing the power of a non-surviving object, had actually only succeeded in temporarily

silencing its haunting voice.

Roger’s increasingly intense withdrawals also fundamentally changed the ways in which

he experienced the aggressive dimensions of his psychological and emotional life. Though

withdrawal was certainly related to the component of aggression that has to do with aliveness, it

was most intimately bound up with the destructive element of aggression and, more specifically,

with the extent to which Roger felt his needs for environmental adaptation to be acceptable and

survivable. I believe that Roger unconsciously, and perhaps consciously, experienced

withdrawal symptoms as punishment for and rejection of his relentless dependency needs. This

of course represents the exact opposite of survival. His withdrawal symptoms may therefore

have represented a reenactment of earlier traumatic relationships with caretakers who had failed

to respond appropriately to his bids for adaptation. This state of affairs may have been even

more painful than his childhood trauma, as it had been preceded by a period of trust, reliability,

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and safety. “You’re pathetic and weak. There’s nothing that can save you, no force that can

hold you.” Such was the nature of the communications he received from oxycontin and in his

communication with himself. It should not come as a surprise, therefore, that he again came to

feel ashamed of his needs and to do everything in his power to banish them from awareness.

Such efforts included using dangerous amounts of oxycontin, increasing his cocaine intake, and

promiscuity. These efforts eventually became ineffective, and he gradually became more

preoccupied with suicidal thoughts. As was the case with increased tolerance, his withdrawals

also show that the imbalance between intrapsychic surviving and non-surviving objects had not

changed as much as it had seemed.

The third and final indication of his addictive defenses’ diminished efficacy centered on

the increasingly strained nature of his interpersonal relationships. The aspects of aggressive life

involving separateness and mutuality are particularly salient in considering the social dimension

of his life toward the end of his active addiction. The question of to what extent Roger was

capable of object usage also comes to the forefront. In his relationship with Julie, arguments and

vicious verbal attacks came to replace intimacy and love. His interactions with friends became

less spontaneous, and he grew less sure of their supportiveness and of his desirability as worthy

of friendship. Julie became a “bitch;” he grew to perceive many of his friends as “assholes” or

“downers;” he often viewed himself as a “loser.” Such blanket statements regarding others and

the concomitant refusal to acknowledge their internality are clearly reminiscent of the defensive

approach to relationships he had adopted during his childhood and early adolescence. Roger

became increasingly aware of the extent to which camaraderie with his friends and acquaintances

relied on a steady supply of drugs and continuous intoxication. When sober or in withdrawal,

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Roger came to realize the conditionality of his friendships and even discovered that some of his

friends were not friends at all, but rather “moochers” who only spent time with him when he had

drugs. This contractuality obviously differed from the mutually enriching and spontaneous

nature of his interpersonal life during the earlier phases of his addiction. The enmity he felt

towards Julie and others in his life can be seen in part as a reaction to feeling betrayed by those

whom he felt had genuinely cared for him. Dynamically speaking, one could say that Roger’s

initial idealized perceptions of his friends indicated that his relationships—like his demonization

of others prior to drug use—derived in part from the difficulty he had “to discern the other as

separate and ‘not just a bundle of projections’” (Abram, 2012, p. 327). Others became appealing

and attractive to him partially because he had, through drug use, developed goodness in his inner

world that was capable of being projected outward. In other words, his impressions of those with

whom he spent time may have been quite unrealistic at times because they were unduly

influenced by the automatic attribution of positive qualities to members of his newfound social

network, attributions that served to diminish the sense of the outside world as threatening. This

form of object relating had a somewhat narcissistic tinge, for it was based on Roger’s

relationship to his own projections rather than a thoughtful consideration of the separateness and

internality of others. This is not to say that Roger’s interactions with others were completely

delusional, nonreciprocal, or that they did not evidence a degree of object usage. Rather,

Roger’s discovered that there was indeed an artificial and illusory quality to what he had

previously believed to be mature and mutually beneficial relationships.

Two other central factors contributed to the untenable nature of addictive defenses and to

the inevitability of the trauma experienced by Roger because of his increased tolerance, during

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withdrawal, and through dissolution of interpersonal harmony. Abram (2012) emphasized

throughout her paper that the intrapsychic surviving object develops only through “ongoing

interpersonal/interpsychic relationships…feeding the intrapsychic in the internal world” (p. 323).

She also highlighteds that the building up of an intrapsychic surviving object must be

incremental and that it takes time to happen. These statements are true regarding formation of

the initial surviving object in infancy, the development of a whole surviving object throughout

adolescence, and the personal growth that takes place during the analytic encounter. The process

of aggressive development is a complex one—attaining the capacity to integrate the four

components of aggression both in one’s sense of self and in one’s interactions with others does

not take place overnight. The infant does not develop agency, aliveness, comfort in mutuality, or

confidence in the survivability of his needs for adaptation through a single ministration of the

m/other. Furthermore, the infant requires the continual input of another subjectivity throughout

every stage of aggressive development.

Roger’s interactions with drugs decisively lacked the essential qualities of mutuality and

gradualness that must be present in any relationship that fosters the maturation of an internalized

surviving object. Simply put, a needle does not possess subjectivity. The surviving environment

is itself constituted by the m/other’s capacity for nearly complete preoccupation and intense

identification. Because the drug, as an inanimate object, could not perform either of these

functions, any conscious or unconscious belief that drugs were capable of carrying out the tasks

of a subjective object was therefore a fantasy, regardless of how impactful the drug’s effect on

Roger’s experience of aggressive life may have been. Within seconds of injecting oxycontin,

ecstasy supplanted misery, courage replaced fear, and calm superseded chaos. Although the

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good enough m/other’s ministrations of course relieve dysphoric states, no single ministration of

another person could possibly effect these changes to such a degree when the individual in need

is as deprived and underdeveloped as Roger. Pouring a bucket of water on a withering plant in

arid soil will not significantly facilitate growth of the root structure; similarly, the deluge of

vivifying psychoemotional experiences could not possibly have provided the nutrients necessary

for the fertilization and growth of a resilient internalized surviving object. The processes of

tolerance and withdrawal were so traumatic in part because they demonstrated to Roger that he

was once again alone without an object that could survive and reflect the various components of

his aggressive life.

Having detailed the establishment and breakdown of addictive defenses, we can now turn

to a brief discussion of recovery and treatment as they pertain to Winnicott’s theory of

aggression. I will here focus on two forms of interventions especially common for individuals in

recovery: twelve-step programs and psychotherapy. The connections between twelve step

programs and aggression from a Winnicottian perspective are quite apparent, and it will not be

necessary to debate the merits of twelve step programs or to incorporate the notion of a “higher

power” that is so central to twelve step programs, but that frequently deters new members from

fully engaging in “working the steps.” Although the founders of Alcoholics Anonymous

obviously did not incorporate Winnicott’s ideas in developing the twelve step model of recovery,

their efforts yielded a program the structure of which seems to inherently address the four

components of aggressive development. A preliminary sketch of these linkages will suffice.

Sponsors take on the burden of surviving new members’ needs for adaptation; like the good

enough m/other, a good enough sponsor will be on call at all times of the day or night when the

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sponsee feels overwhelmed, alone, or frightened. Answering the phone and refusing to give up

on or retaliate against their sponsees therefore represent examples of survival. Developing the

capacity for mutuality and for non-traumatic separateness also seem to be implicit in the goals of

twelve step programs. Members of twelve step groups engage in difficult self-reflection, through

a thorough analysis of their shortcomings, resentments, and fears. The centrality of introspection

and inwardness in twelve step programs evidences a belief that true growth can only result when

an individual is capable of and wiling to analyze their place in the world of others and to delimit

the boundaries between themselves and those who have hurt them and who they have hurt. Yet,

such straining and at times frightening work always takes place in the context of others who

stand ready not only to provide emotional support, but to contribute-in as well. By standing at

the podium and telling her story, the newcomer has a chance to contribute-in to the lives of

others, thus making a step towards overcoming the sense of worthlessness that so often

contribute to depression. Through engaging in the various components of twelve step programs,

members often develop a newfound sense of aliveness that enables them to move forward

without the need to revert to drug use.

Winnicott’s theory of aggression can also shed light on the process of psychotherapy with

individuals in recovery. This is clearly a vast subject and one that will be discussed as an area

for further research in the concluding chapter of this dissertation. It has been established that the

development of a solidified intrapsychic surviving or non-surviving object requires consistent

experiences of environmental survival or non-survival over an extended period of time. This fact

provides support for the use of long-term psychotherapy with individuals who struggle with drug

addiction. Abram wrote,

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Clinical examples throughout the literature illustrate how the analytic setting offers an

opportunity for an undeveloped surviving object to grow through the specialized analytic

treatment within the transference-countertransference. It is the analyst’s psychic survival

that potentially facilitates the subject’s (stunted) surviving object to grow which in turn,

strengthens and facilitates the development of the [sense of] self. (2012, p. 325)

Many people require immediate behavioral or medical interventions when they begin the

recovery process. However, from a Winnicottian perspective, short-term and/or strictly

cognitive-behavioral interventions would probably not provide clients with adequate

opportunities to experience survival and, therefore, to build up their own intrapsychic surviving

environment. It should be kept in mind that long-term therapy with individuals in recovery need

not be based on achieving what is traditionally called “insight.” The key ingredients in long-

term treatment of addiction would be reliability, mirroring, allowing for non-purposive

experiences, and communication regarding the relationship between therapist and client.

Summary

Analyzing Roger’s journey through the lens of Winnicott’s writings on aggression has

brought to the fore a variety of issues that have arguably not received enough attention in either

psychoanalytic or general literature on addiction. The above discussion yielded a

multidimensional perspective that integrates developmental processes, environmental factors,

interpersonal patterns, intrapsychic dynamics, and biological mechanisms. We discovered how

the four components of aggressive life—aliveness, separateness, mutuality, and the demand for

environmental adaptation—manifested themselves before, throughout, and after active addiction,

and how drugs can serve as a means of making up for deficits in their development. More

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specifically, we saw that a primary appeal of drugs is their apparent capacity to facilitate positive

experiences of both simple and increasingly object-related modes of aggressive life. The

opportunity to have such experiences can create a the sense of possessing a powerful internalized

surviving object that, for a time, is felt to predominate in an individual’s inner world and which

allows for more meaningful interactions with others. It became apparent, however, that the lack

of true mutuality in the user’s relationship to drugs, combined with the inevitable increase of

tolerance and onset of withdrawal symptoms, can result in reenactments of earlier traumatic

experiences and can create overwhelming feelings of alienation, helplessness, and despair.

These findings point to fundamental shared characteristics between the ways in which can be

understood in the context of Winnicott’s theories of being and aggression. Although the

development of aggressive life is of course quite different from what Winnicott at time called

“erotic instincts,” we can say with confidence that, for Roger, the primary function of drugs

involved the creation of an environment that facilitated the unfolding of inherited tendencies that

had not been sufficiently actualized during his formative years. In the case of both being and

aggression, it became clear that there is an essentially regressive quality to drug addiction, but

that drug addiction must also be viewed as a manifestation of Roger’s desire for a personal

renaissance.

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Chapter 6: Creativity and Addiction

Introduction

Creativity has been at the center of everything that has thus far been stated regarding

being, aggression, and addiction. Though the above two sections rarely referred explicitly to

creativity, it is the notion of creativity that unites being and aggression and that makes a

discussion of their inherent relatedness possible. We have been introduced to a variety of

dichotomies embedded in Winnicott’s theories of development, and his insights into the concept

of creativity—particularly those found in Playing and Reality—provide the basis for

understanding that mental health requires the capacity to negotiate these polarities without falling

apart or losing the feeling of real. The dichotomies that have been addressed up to this point

include, but are not limited to the following: relating to subjective objects and objects objectively

perceived; separation and union; the male and female elements of the personality; being and

doing; unintegration and integration; and fantasy and reality. Moreover, there is a broader and

more complex between being and aggression that involves the subtle interplay of these sub-

dichotomies. With the exception of his descriptions of the primary psychic creativity during

infancy, which he associated with subjective omnipotence and unintegration prior to the

achievement of unit status, Winnicott depicted creativity primarily as the cognitive-affective

process that allows one to dwell within a space of dialectical tension and to both tolerate and feel

enriched by the navigation between the myriad polarities of psychological, emotional, and

emotional life.

This section will analyze Roger’s drug addiction in the context of Winnicott’s theory of

creativity. Doing so will raise a number of questions. To what extent was Roger’s drug abuse a

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creative or non-creative act? Can drugs of abuse be accurately described as transitional objects?

How can we expand upon Winnicott’s 1951 statement on drug addiction? In answering these

and other questions, I will focus especially on three characteristics of the creative act: deliberate-

ness, confidence, and the capacity to tolerate and benefit from the inherent precariousness

involved in dwelling in potential space. The structure of this discussion will follow a similar

format to the above explorations of being and aggression, in that it will break down Roger’s

psychological and interpersonal dynamics into the phases of pre-addiction, the establishment and

breakdown of addictive defenses, and recovery. This section, however, will differ in several

ways from the chapters 4 and 5. First of all, I will not be focusing so exclusively or in so much

detail on one or two secondary sources. Winnicott’s original writings will be more central here,

and I will integrate the insights of other authors, particularly Rose, when doing so is especially

helpful in clarifying Winnicott’s insights. Secondly, the following analysis will not spend so

much time on Roger’s life prior to the establishment of addictive defenses, nor will it so

thoroughly detail the breakdown of pre-addictive defenses. Doing so would result in excessive

redundancy, particularly because the events and processes that lead to a stunting of creative

processes in early life so closely resemble those that thwart development in the areas of being

and aggression during an individual’s formative years.

Addiction, Creativity, and Transitional Process

Exploring the ways in which addiction can be understood in the context of Winnicott’s

writings on creativity will require a basic understanding of what he called “potential space.”

Asking whether or not an action or thought process is creative is in part a way of attempting to

clarify the extent to which it takes place in potential space. Winnicott (1971) described potential

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space, or play space, as “the…space between the subjective object and the object objectively

perceived, between me-extensions and the not-me” (p. 100). Potential space represents a “third

area” (Winnicott, 1971, p. 101) apart from inner psychic reality and the external world, and can

be viewed as “an area of mental life” that exists “between the individual and the environment”

(Winnicott, 1971, p. 100). Potential space is the area in which symbol formation takes place and

in which the individual experiments with samples from the external world and imbues them with

personal meaning. Winnicott described potential space as “the place where we live,” as the place

where adults are when “we are listening to a Beethoven symphony…[or] playing tennis,” where

children are “when sitting on the floor playing with toys under the aegis of the mother,” and

where teenagers are when “participating in a pop session” (105). Potential space exists to at least

some degree in the mental life of almost all individuals. What differentiates one person from

another is the expansiveness of potential space as an area of mental activity and the complexity,

emotional valence, and variability of experiences in potential space. Given that potential space

has its roots in early engagement with transitional objects, it should not be surprising that the

negotiation of separation and union and of self and other constitute the most central dialectics in

this intermediate area of experiencing. Winnicott (1971) famously wrote that “in any cultural

field it is not possible to be original except on the basis of tradition,” and cited this paradox as

“one more example, and a very exciting one, of the interplay between separateness and union”

(p. 99). He restated this paradox in describing potential space as “the separation that is not a

separation but a form of union” (Winnicott, 1971, p. 98). These statements highlight the ongoing

interchange of self and other representations that takes place in the creative use of potential

space.

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We must now ask ourselves an important question: what term is most appropriate to

describe the type of mental activity that takes place in potential space? Transitional phenomena?

Transitional experiences? For the remainder of this section, I will use the phrase “transitional

process,” which Rose coined in his 1978 paper entitled “The Creativity of Everyday Life.” He

defined transitional process as that process in which an individual “samples the pluralism of

reality, withdraws and readvances, attempting to abstract coherent configurations composed of

both self and nonself elements” (Rose, 1978, p. 354). Rose described transitional processes as

being at the heart of “man’s human task,” which he described as:

Journeying in the transitional area between degrees of narcissistic fusion and

separateness, making use of universal themes around birth and death, bodily forms and

fusions; creating the unique form of his own identity to become what he is in a world

from which he abstracts what will constitute, for him, his reality. (1978, p. 347)

Rose characterized transitional process as the psychological, emotional, cognitive, and relational

process that remains once the original transitional object—the medium through which the infant

initially grapples with the tension between separation and union—has been relinquished due to

its no longer being necessary for the child to maintain a relatively stable sense of self in the

context of her experiences with otherness. Rose (1978) reiterated throughout this paper that “the

transitional process in its developed form as the creative imagination remains an essential

instrument of adaptation” that, “in contrast to repression and denial…[it] offer[s] new

perspectives from which to explore and enhance rather than circumscribe the appreciation of

reality” (p. 354). His depiction of transitional process is quite complex, and involves a detailed

analysis of each of transitional process’ constituent elements, which include “the active process

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of perception,” “the temporary suspension of the boundaries between self and object

representation,” “the two-way traffic between rhythmic body imagery and outer forms,” “the

sufferance of illusion,” and “the further mixing, testing, and abstracting to form bridges made of

inner and outer elements” (p. 353). Considering the myriad subtleties of this concepts would

lead us too far astray, and we must be content with a more generalized understanding of what

Rose means when he talks about transitional process.

Rose’s concept of transitional process aids the current investigation in several ways. First

of all, it ensures that we do not overly value developmental and causal factors in evaluating the

ways in which people navigate potential space. Winnicott places so much emphasis on early

environmental determinants of mental health and illness that readers can easily lose sight of the

ways in which his theory can contribute to understanding clients’ difficulties in the context of

their present experiences. Assessing the here-and-now dynamics of patients prevents clinicians

from becoming overly dependent on obtaining detailed personal histories and decreases the risk

of giving etiological factors too much attention during the therapeutic hour and in

conceptualization. Rose also provided an epistemological “update,” for he succeeded in

translating Winnicott’s perspective into the social-constructivist paradigm that has become

predominant in more recent psychoanalytic theory. Finally, the notion of transitional process

enables us to avoid becoming lost in Winnicott’s own ambiguous terminology. The benefits of

incorporating Rose’s insights will become clearer when we discuss Roger’s addiction in terms of

transitional process.

It should be noted my approach to the issue of creativity and the use of the term

transitional process differs from Rose’s in significant ways. First of all, Rose (1978) cautions

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against adopting an overly clinical or diagnostic perspective in evaluating transitional process,

which for him is the foundation for the “creativity of everyday life” (p. 352). He frowns upon

the use of terms such as regression in describing the psychological and emotional life of

individuals, whereas a Winnicottian perspective requires the use of a developmental framework

in which regression must be considered a viable theoretical construct. Despite this discrepancy,

it is clear that Rose views transitional process as healthier than other less adaptive methods of

coping with the inherent and universal conflicts of separation and union, as evidenced by the

above statement contrasting transitional process with defenses such as repression and denial.

Secondly, Rose does not explicitly integrate the term potential space into his elucidation of what

constitutes transitional process. However, the various activities he described as central to

transitional process serve similar functions to the creative exploration of potential space

Winnicott discusses in Playing and Reality. The third discrepancy is terminological in nature.

Because this section draws heavily from Winnicott’s writings on creativity, I will refer to the

transitional process as a negotiation of the dialectic between “inner psychic reality” and the

“external world.” Although Winnicott at times used phrases that imply a belief in the fluid and

relational nature of what might be called objective reality (e.g. the “repudiated” world), he quite

clearly avoided relativism and posits the existence of an external, observable, and constant

reality. For instance, Winnicott wrote that “actual, or external reality…has its own

dimensions…can be studied objectively, and which, however much in may seem to vary

according to the state of the individual who is observing it, does in fact remain constant”

(Winnicott, 1971, p. 41). This differs from Rose, who rejected such ideas and criticized

Winnicott’s concept of “good enough mothering” as a “grossly simplifying assumption” that

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views external reality as “a steady background for the projection of mental figures” rather than a

“dynamic oscillation between figure and ground” (Rose, 1998, p. 347). Despite his more modern

epistemological paradigm, however, Rose relies on phrases such as “inner and outer elements”

and “the appreciation of reality” to elucidate his theory of transitional process. His blanket

criticisms of what he perceives as Winnicott’s obsolete epistemological assumptions could

emerge from either an oversimplification of Winnicott’s perspective or from the possibility that

their views may be closer than they seem. It is beyond the purview of this project to establish the

nature of reality. Given these considerations, it certainly possible that my use of the phrase

transitional process constitutes a bastardization of Rose’s original term. Although Rose would

possibly object to my use of his terminology in the current project, I have not yet found a better

phrase to describe the universal mental activity so central to Winnicott’s theory. Therefore, for

the purposes of clarity, I will use the term transitional process to refer to the general and

universal process of navigating potential space.

Winnicott posited an intimate relationship between creativity and play, and understanding

play will allow us to better comprehend what constitutes a creative act or thought process of an

individual who has attained at least a rudimentary sense of unit status. Winnicott (1971) made

the link between creativity and play especially clear when he wrote that “creative living” is

“manifested in play” (p. 100). This statement reveals the central difference and connection

between play and creativity. Creativity—along with being and aggression—is one of the three

primary constituents of aliveness in psychological and emotional life, and psychological health

throughout life rests upon the expression of creativity throughout increasingly object-related

developmental tasks. Play, on the other hand, is a manifestation of creativity that occurs through

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the healthy and enriching negotiation of potential space, and belongs originally to the period

after early transitional object usage. Although Winnicott wrote that play expands into the field

of cultural experience, a manifestation of creativity that is even more object-related and belongs

to a later stage of life, cultural experience can still be accurately described as a form of play. In

other words, play is the sin qua non of healthy transitional process. We can therefore discern the

relative presence or absence of creativity in an individual’s daily life by determining the extent to

which the qualities of play are present in his or her ongoing activities in potential space.

Winnicott speaks at length in Playing and Reality about what constitutes play and

creativity in play, and I will use some of his insights from this work to lay the foundation for

analyzing Roger’s addiction in the context of Winnicott’s theory of creativity. Confidence in the

navigation of separation and union is one of the most central features of playful transitional

process. Winnicott regularly referred to the inherent precariousness of play: “Play is always

liable to become frightening…The precariousness of play belongs to the fact that it is always on

the theoretical line between the subjective and that which is objectively perceived” (Winnicott,

1971, p. 50). Maintaining confidence in this inherently precarious mental activity requires “the

presence of responsible persons” who are attuned to the needs of the playing child (Winnicott,

1971, p. 50). Yet, the confidence that exists in play extends far beyond the issue of whether or

not precariousness feels threatening. Someone capable of engaging in play has developed a

confidence in the non-threatening nature of the not-me world, the inherent value in exploring the

separate properties of not-me objects they encounter (e.g. the color palette of a painting or the

internality of others), and in their own ability to influence the world of not-me objects and

phenomena. When someone cannot sustain confidence, transitional processing can become

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overwhelming and anxiety-inducing. Rose speaks to this point in saying, “The burgeoning of

information and the proliferation of possibilities of all kinds, unsecured from guiding values,

may threaten the adult, too, with traumatic overstimulation or hound him into defensive

insensibility” (Rose, 1978, p. 354). Such “defensive insensibility” increases the likelihood that

the individual’s stance will shift from one of creativity to reactivity. This brings us to a second

crucial element of playful transitional processing—deliberateness. The individual engaging in

playful transitional process has the sense that his movements are his own and that his choices

emanate from his true self. Winnicott most clearly stated the relationship between deliberateness

and play when he said, “Playing is doing” (Winnicott, 1971, p. 41). The deliberateness of play is

evidence that the spontaneous gesture of the true self continues to find expression in transitional

processing. The deliberateness of play grows not only from operation of the true self, but from

the suffusion of thoughts and actions with the whole of the individual’s personality: “It is in

playing and only in playing that the individual child or adult is able to be creative and to use the

whole personality, and it is only in being creative that the individual discovers the self”

(Winnicott, 1971, p. 54). The presence of extreme dissociation in an individual’s psycho-

emotional life would therefore make it difficult for his daily life to be grounded in adaptive

transitional processes.

Play is also non-climactic and variable in nature. Winnicott criticized previous

psychoanalysts for limiting their discussions of play-activity to its apparent instinctual

components and, therefore, climax. After disagreeing with the close linkage others had made

between playing and masturbation and asserting that “playing needs to be studied as a subject on

its own,” he bluntly stated that “in the psychoanalytic literature [there is a] lack of a useful

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statement on the subject of play” (Winnicott, 1971, p. 39). Indeed, Winnicott believed that play

ceases to be play when instinctual forces or preoccupation with climax and conclusion have an

undue emphasis in the psychological and emotional world of the child. This is not to say that

various forms of playful transitional processing are not goal oriented or intense. A student

focusing intently on his dissertation must meet deadlines and has specific goals in mind, but in

positive circumstances his mental activities are concerned more with the process rather than the

final product. Winnicott (1971) highlighted the potential for immense pleasure in play and spoke

of the “tremendous intensity of these non-climactic experiences that are called playing” (p. 98).

Variability represents another quality that helps to differentiate play from the mental activity of

an individual with significant deficits in the capacity to engage in transitional processing. In

distinguishing between play and other types of activities, Winnicott (1971) wrote “phenomena of

the play area have infinite variability, contrasting with the relative sterotypy of phenomena that

relate either to personal body functioning or to environmental actuality” (p. 98). The issue of

whether or not a particular activity is stereotyped or variable in nature will become an important

consideration in our analysis of Roger’s drug addiction.

Confidence, deliberateness, variability, and the lack of preoccupation with climax are

present in myriad forms of transitional process. Yet, there is an even more fundamental

characteristic that unites all forms of creativity, from the earliest moments of life to old age. For

Winnicott, creativity is “a colouring of the whole attitude to external reality” and is an approach

to life that is founded upon “creative apperception” (Winnicott, 1971, p. 65). Creativity—and its

manifestation in play—holds such a central place in Winnicott’s theory that it constitutes the

primary measure of psychological and wellbeing: “In some way or other, our theory includes a

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belief that living creatively is a healthy state, and that compliance is a sick basis of life”

(Winnicott, 1971, p. 65). Winnicott’s notion of creative play does not apply only to the playing

of children or to experiences of easygoing enjoyment. For instance, he posited a close

relationship between the play of childhood and the adult’s capacity for concentration. He also

described love between two people as another phenomenon that is founded in the negotiation of

potential space. It is the active and creative investment of external phenomenon with personal

meaning that unites these various forms of transitional process.

The previous sections in this chapter highlighted the pervasively reactive nature of

Roger’s approach to life during his childhood and early adolescence; because reactivity

constitutes the opposite of creativity, we can say with confidence that Roger’s experiences in

potential space cannot be characterized as playful in nature. Rather than reexamining the

multitude of self-protective and reactive defense mechanisms Roger utilized during this time

(e.g. splitting, dissociation, and projection), I will examine one of the central reasons behind his

relative incapacity to engage in creative transitional processes: the impact of inadequate

environmental provision on the development of potential space as an area of mental life. The

initiation of transitional object usage—the precursor for play—arises from the baby’s “need to

shake free and achieve autonomy,” which involves the setting up of a space that represents a

“separation that is not a separation but a form of union” (Winnicott, 1971, p. 98). Getting started

in the process of navigating this new space requires belief in the reliability of the environment,

which is of course founded upon experiences of a reliable environment and of caretakers’

reliability. Winnicott (1971) wrote that “the potential space happens only in relation to a feeling

of confidence on the part of the baby, that is, confidence related to the dependability of the

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mother-figure or environmental elements, confidence being the evidence of dependability that is

being introjected” (p. 100). Needless to say, Roger’s parents were generally unreliable during

both his earliest and later efforts to experiment with otherness. If you will recall from the above

elucidation of Abram’s insights, the “environment” in Winnicott’s framework is a psychic

environment; therefore, the unreliability of Roger’s caretakers was eventually introjected as his

own unreliability, and he developed a sense of himself as incapable of negotiating potential

space. Winnicott could not seem to emphasize enough the role of personal experiences enough

when talking about the formation of potential space: “The special feature of this place where

play and cultural experience have a position is that it depends on its existence on living

experiences, not on inherited tendencies;” in the case of the baby who has not received sensitive

management, “the potential space…has no significance” (1971, p. 108). This statement serves as

a reminder that potential space is just that—a potential space that does not necessarily come into

being as a prominent area of mental life for all individuals.

Winnicott highlighteds two possible outcomes that can arise when the child has not had

sufficient opportunity to build up the capacity for engaging in transitional process, and we find

evidence of each in Roger’s adoption of a hostile approach to the not-me world during his

formative years. The first of these relates to the concept of the false self that was so central in

conceptualizing addiction in terms of both being and aggressive development: “In unfavourable

circumstances the creative use of objects is missing or relatively uncertain. I have described

elsewhere…the way in which the defence of the compliant false self appears, with the hiding of

the true self that has the potential for creative use of objects” (Winnicott, 1971, p. 102). In the

above discussion of aggression, I highlighted that Roger’s anger helped him to achieve a sense of

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aliveness, agency, and inner safety. I also characterized his anger as an attempt to deny

vulnerability and to protect his core self from further injury. Yet, we can also see his reactive

hostility as a manifestation of his having developed a perspective “in which the world and its

details” had become “recognized but only as something to be fitted in with or demanding

adaptation” (Winnicott, 1971, p. 65). Such an approach to the not-me world, though it may have

protected his true self, also precluded its elaboration through the creative use of objects and,

therefore, led to feelings of futility and inauthenticity. Winnicott (1971) also spoke of an

“alternative danger,” which occurs when “potential space may become filled with what is

injected into it from someone other than the baby (p. 102). It seems that whatever is in this space

that comes from someone else is persecutory material, and the baby has no means of rejecting it”

(Winnicott, 1971, p. 102). This statement helps us to identify another reason why Roger had

difficulty dwelling comfortably within potential space. Given that his earliest experiences with

the not-me world centered on his interactions with his parents, it is likely that potential space had

become for him a dangerous terrain populated by objects derived from and associated with his

parents’ coldness and cruelty. His anger can in part be seen as an attempt to prevent prolonged

experiences in potential space, for residing in this intermediate area requires the capacity to

tolerate its inherent ambiguity. Through fighting and screaming, he brought the battle to the not-

me world, resulting in what Ogden (1985) may have described as psychopathology that results

from the “failure to create or maintain the dialectical process” inherent in the navigation of

potential space (p. 129)

I will adopt a somewhat different approach in analyzing Roger’s addiction in the context

of Winnicott’s writings on creativity. The above sections on being and aggression were based on

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an analysis of the progression from the establishment to the breakdown of addictive defenses.

The following discussion, rather than centering on the chronological development of Roger’s

addiction, will derive its structure from an analysis of his drug use in terms of the concepts that

have thus far been elucidated. Four questions will frame this examination: Was Roger’s drug use

itself playful? Did his drug use engender the initiation and experience of healthy transitional

process in his interactions with the not-me world? Were drugs transitional objects for Roger?

How can we make sense of Roger’s addiction in terms of Winnicott’s 1951 statement on

addiction? Answering each of the questions will require us to consider both earlier and later

phases of Roger’s active addiction. This section will reiterate that Roger’s addiction was by no

means devoid of “positive” attributes. However, when looked at as a total phenomenon, Roger’s

addiction from a Winnicottian perspective must ultimately be viewed at as a “mental illness” that

“has behind it a hold-up of emotional development” rooted in an underdeveloped capacity to

engage creatively with the not-me world (Winnicott, 1963c, p. 222). Several examples of this

will be provided shortly.

Winnicott regularly referenced adult interactions with inanimate objects as a potential

medium of creative living and of enriching experiences in potential space. Let us begin with a

consideration of whether or not Roger’s relationship with drugs and drug paraphernalia

represented an example of transitional process. In other words, were Roger’s interactions with

drugs playful? The four primary characteristics of play mentioned above are a particularly useful

entryway into answering this important question. In short, Roger’s drug use, when viewed as a

complete phenomenon, essentially lacked the qualities of healthy transitional process. The most

apparent evidence of this lies in the fact that Roger’s drug use was aimed almost entirely at

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climax. Imagine Roger sitting across from the table on which his needle and tourniquet rested

and contrast this with the image of a guitarist looking at his instrument on the other side of the

room. This hypothetical musician, although of course not representative of all artists, likely

approaches his guitar expecting to spend half an hour or so experimenting with new chord

progressions or practicing previously learned material; doing so will may lead to an intense

experience of enjoyment and will he might finish playing with a feeling of relaxation or

fulfillment. Roger was never interested in such a relatively open-ended engagement with

oxycontin—he always wanted to get as high as possible as quickly as possible. He even

compared intoxication with orgasm, a direct contradiction to Winnicott’s characterization of play

as fundamentally unconcerned with climax.

Roger’s drug use similarly lacked the qualities of variability, deliberateness, and

confidence. The eventual compulsivity of Roger’s drug seeking and using represents the exact

opposite of variability—his interactions with substances and paraphernalia were the same every

time. Let us again examine the differences between Roger and the guitarist. It is unlikely that

the musician will always start with the same riff or amplifier settings, and he will probably not

expect to experience the same feelings and sensations each time he picks up his guitar. Roger,

on the other hand, resembled an automaton as he mechanically moved through the motions of

drug use. The stereotypy of drug administration reminds us of what Solomon had to say

regarding stereotyped play in children: “Stereotyped activity is a device for attaining tranquility

or certainty from turbulence and uncertainty” (Solomon, 1978, p. 254). This leads us directly

into the deliberateness of play. Though Roger of course made the decision to buy drugs, tie the

tourniquet around his vein, and inject oxycontin, this decision was essentially reactive in nature.

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His choice to use arose not from a spontaneous expression of his true self based on trust in his

ability to negotiate potential space, but from terror and instinctive flight. We are therefore again

confronted with the paradoxical situation in which his choice was not truly a choice. A

consideration of this paradox allows us to assess the extent to which his drug use can be

characterized as arising from and being accompanied by a feeling of confidence. Though Roger

may have felt confident in his use of drugs during the early phases of his addiction, this

dissertation has made it clear that his drug use, on an unconscious level, arose from insecurity

from the very beginning. The above discussion of withdrawal and increased tolerance

demonstrated that his later drug use was pervaded by feelings of desperation and helplessness

We must now broach the topic of whether or not his drug use resulted in genuine transitional

process through intoxication and through its impact on his interactions with objects in the not-me

world. This question cannot be answered with the same degree of certainty as the question of

whether or not his interactions with drugs and drug paraphernalia can be characterized as an

example of creative engagement with an inanimate object. In addressing this subject, I will

consider many of the aspects of his addiction I discussed in the above section on aggression—his

experiences of oxycontin intoxication, polysubstance abuse, interpersonal interactions, and his

overall sense of self during his years of active addiction. It will become clear that Roger’s

interactions with drugs certainly led to experiences accompanied by the various characteristics of

play and that he reaped many benefits associated with engaging in transitional process.

However, his later drug clearly lacked the qualities of transitional process, and his addiction and

betrayed a certain artificiality in the apparent creativity of his drug use.

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Roger’s sense of self in his interactions with the not-world and the qualities of his

relationships with others during Roger’s earlier years of addiction—when the drugs “worked”—

represent the areas of his life in which characteristics of playful transitional process were most

apparent. Once rudimentary unit status has been achieved and in the absence of extreme

psychosis, interpersonal relationships and the shaping of self-perception through interactions

with others inherently involve at least some extent of activity in potential space. In other words,

there will always be a not-me quality to other people and an intermingling of “me-ness” with the

externality of others. The initiation of Roger’s drug use effected an immediate and qualitative

shift in the nature of his experiences in potential space. I described a number of changes in

Roger’s interpersonal life in the above section on aggression—the establishment of a social

group through drug use, belief in his capacity to contribute-in to the lives of others, faith in his

friends’ ability to contribute-in to him, and a sense of resilience in communicating with people.

These changes reflected the expansion of potential space as an area in Roger’s mental life, a

space that now had personal significance for him. No longer was Roger forced into the extremes

of extroversion (outwardly directed hostility) or introversion (the painful introspection of

depression). His use of a variety of substances, each with its own psychological and emotional

benefits, increased his capacity to experiment in the intermediate area. His drug use made it

easier for his experience in potential space to acquire the quality of transitional process, which

Rose (1978) believed “samples the pluralism of reality, withdraws and re-advances, [and

attempts] to abstract coherent configurations composed of both self and non-self elements”

(p.354). His experience in potential space obtained each of the qualities we have come to

associate with creative negotiation of potential space. He felt confident in his interactions with

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others and more regularly felt a sense of deliberateness in his everyday life. Moreover, his daily

experiences of himself and with others became more varied and exciting. Perhaps most

significantly, he became able to experience, perhaps for the first time, what it felt like to

approach life in a creative way.

However, we know that Roger’s addictive defenses broke down. The ineffectiveness of

drugs manifested most clearly in withdrawal symptoms and increased tolerance, which I have

characterized as physiological phenomena infused with personal meaning and accompanied by

his diminished experiences of continuity, agency, and mutuality. These physiological events

also coincided with immense changes in the degree to which he could sustain what appeared to

be a creative approach to life. Confidence was replaced by insecurity and fear; a gradual

awareness of the stereotypy of his life replaced his perception of his experiences as variable and

exciting; the dawning consciousness of his desperate need for drug-induced climax supplanted

his capacity to simply enjoy life; deliberateness was stripped of him as he began to feel like the

victim of his own bodily processes. Of course, the increased strain in his interpersonal

relationships also had implications for his capacity to engage in playful transitional process. It

became increasingly difficult for him to tolerate, much less enjoy, the ambiguity of potential

space. His increasing dependence on the use of splitting, projection, and self-flagellation

evidenced a reemergence of reactivity as his primary stance in life and served to foreclose

enriching or meaningful experiences in potential space.

Given the drastic shifts in the nature of his experiences in potential space over the course of

his active addiction, how are we to understand his addiction in terms of creativity and transitional

process? It seems inaccurate to completely dismiss the possibility that his drug addiction made it

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possible for him to become enriched through creative engagement within potential space or to

conclude that drug use did not at all facilitate the actualization of his creative potential. Yet, it

seem equally incorrect to characterize his drug addiction as an adaptive, healthy transitional

process. The following statements by Winnicott and Marin will help us to make sense of this

dilemma:

Play is immensely exciting…The thing about playing is always the interplay of personal

psychic reality and the control of actual objects. This is the precariousness of magic

itself, magic that arises in intimacy, in a relationship that is found to be reliable.

(Winnicott, 1971, p. 47)

[Adolescents use drugs to] provide for themselves what we deny them: a confrontation

with some kind of power within an unfamiliar landscape involving sensation and risk. It

is there, I suppose, that they hope to find, by some hurried magic, a new way of seeing, a

new relation to things, to discard one identity and assume another. (Marin, 1974, p. 45)

We can see from his life that Roger certainly experienced “magic.” He found “a new way of

seeing,” “a new relation to things,” and was able to assume another identity. He loved being one

of the “bad kids” and reveled in the inherent riskiness of doing drugs. Yet, unlike the magic of

which Winnicott spoke, Roger’s magic lacked the backdrop of intimacy, trust, and safety upon

which genuine transitional process is founded. As the drugs became less effective and as his

relationships with others fell apart, the precariousness of the interplay between inner psychic

reality and the external world became too much, and he was forced to leave the playground of

potential space.

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Our understanding of drug addiction in terms of transitional process, however valuable,

has not addressed a question that has concerned so many who have written about addiction from

a Winnicottian perspective: are drugs of abuse transitional objects? The following exploration

will establish that drugs of abuse cannot be accurately characterized as transitional objects. A

close examination of Winnicott’s terminology and a careful application of his ideas on

transitional objects to the phenomenon of addiction reveals two primary reasons behind this

assertion. First of all, Winnicott’s final statements on creativity and play, in conjunction with

Rose’s definition of transitional objects on creativity and play, indicate that transitional objects

are unique to infancy and early childhood. Secondly, even if we were to allow for the possibility

that drugs of abuse could be considered transitional objects (i.e., if we disregarded the first

argument), there are fundamental differences underlying the underlying psychological process

and emotional experiences of transitional objects and drugs. This clarification will allow us to

develop a clearer idea of what Winnicott meant in his 1951 statement on addiction.

The literature review acknowledged the ambiguity in Winnicott’s use of the term

transitional object and attributed some of the vagueness and inaccuracy of other authors in their

writings on addiction to Winnicott’s at times confusing writing. Abram strengthened her

assertions regarding Winnicott’s sometimes bewildering theory of aggression by using his last

statements on the subject. The fact that I will be referring to some of Winnicott’s final

statements on creativity, play, and transitional objects similarly supports my argument that drugs

of abuse should not be described as transitional objects. Winnicott (1971) made it clear in

Playing and Reality that transitional phenomena and objects are unique to infancy and early

adolescence, as evidenced by the following sequence: “There is a direct development from

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transitional phenomena to playing, and from playing to shared playing, and from this to cultural

experiences” (p. 51). This reminds us of the description of Winnicott’s theory provided by

Goldman, which has become so central to this study, namely that Goldman’s description of

Winnicott’s theory: “Development, for Winnicott, proceeds through the negotiation of

increasingly object-related ways of being alive” (2012 p. 336). We can conclude from

Winnicott’s sequence that he felt transitional phenomena—which obviously involved the use of

transitional objects—represent the earliest form of achieving aliveness through the negotiation of

potential space, and that the use of transitional objects actually helps to establish potential space

as an area of mental life. Rose’s definition of transitional objects substantiates this claim. He

defines a transitional object as “a temporary construction to aid the infant in the early stages of

development of the sense of reality and identity and in separation from the mother” (1978, p.

351). The key words and phrases here are temporary and early stages. Transitional objects are

utilized to assist with the initial and earliest experiences of separation from the mother, and

facilitate the new person’s experimentation with areas of mental life in addition to subjective

omnipotence. If my assertion is correct, and I think it is, then it would be inaccurate to

characterize oxycontin or alcohol as Roger’s transitional objects.

It is incumbent upon us to note a statement from Playing and Reality that seems to

contradict what I am trying to say on this topic of transitional objects. Winnicott (1971) wrote,

“We experience life in the area of transitional phenomena, in the exciting interweave of

subjectivity and objective observation, and in an area that is intermediate between the inner

reality of the individual and the shared reality of the world that is external to individuals” (p. 64).

It is clear that this statement could be interpreted in more than one way. Winnicott, just thirteen

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pages after laying out the above sequence of increasingly object-related manifestations of

creativity, uses the term “transitional phenomena” in the context of adult life. Such

contradictions can be somewhat maddening, particularly when trying to usefully apply his theory

in clinical practice. A possible way to reconcile this statement with my argument thus far is to

point out that he here referred to “the area of transitional phenomena” rather than to “transitional

phenomena.” We might interpret this to mean that he at times feels comfortable equating

“potential space” and “the area of transitional phenomena,” (just as he interchangeably uses the

phrases “potential space,” “the third area of experience,” and the “intermediate area”), but that he

did not as readily equate “transitional phenomena” (which appear to be unique to infancy and

early childhood) with “play” or with something like what Rose later referred to as “transitional

process.”

Some may disagree with this argument and criticize me for outright inaccuracy or at least

for engaging in excessive nitpicking. Despite my interest in analyzing the minutiae of

psychoanalytic terminology, it is certainly possible that some readers may feel that this thesis has

led them down a tedious, unnecessary, contradictory, and ultimately futile line of exploration. I

will therefore temporarily set aside this dimension of my argument and allow for the possibility

that adults can have transitional objects and that drugs of abuse should be considered as

transitional objects. Once this line of thought is permitted, it is easy to see why so many have

equated drugs with transitional objects. Let us take Roger’s use of oxycontin as an example.

There are immediately a variety of apparent similarities between the role of oxycontin in Roger’s

life and the function of transitional objects. Roger “assumed rights over” oxycontin, he in a

sense “affectionately cuddled [and] excitedly loved” it, it “[gave] warmth,” it allowed him to

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experience the vitality and confidence that the transitional object engenders in infants and young

children (Winnicott, 1951, p. 233). Furthermore, it clearly helped him to assuage the negative

emotions associated with the painful sense of separateness and alienation and enabled him to

engage with the not-me world in an agentic way. With these resemblances in mind, how could

we possibly conclude that Roger did not use oxycontin as a transitional object?

To respond to this question we can again turn to Winnicott’s original writings and Rose’s

clarifications to challenge the assertion that drugs of abuse are transitional objects. Despite the

apparent similarities, drugs lack several essential qualities that Winnicott attributed to

transitional objects. First of all, Winnicott believed that the “fate” of the transitional object is “to

be gradually allowed to be decathected” and asserted that the transitional object is “not forgotten

and not mourned” (Winnicott, 1971, p. 5). These phenomena clearly did not occur in Roger’s

drug use. Rose (1978) wrote that the transitional object is “a bridge between the familiar and

disturbingly unfamiliar that facilitates acceptance of the new” (p. 351). However, Roger’s

eventual breakdown and the dissolution of his interpersonal relationships makes one wonder to

what extent he had truly accepted “the new.” Furthermore, we found in the above discussion of

aggression that Roger’s object relating to the “new” had a narcissistic tinge, for he was to some

extent relating to his own projections rather than truly acknowledging the internality of others.

Had he truly accepted and internalized the new, he would have been able to be clean without

reverting to the primitive mechanisms of splitting and denial. Perhaps the most central

difference between transitional objects and drugs of abuse is the degree to which the use of each

arises from a creative or reactive stance. The use of a transitional object comes from a place of

centeredness and agency, for it is a manifestation of true self activity. Drug use may have

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provided Roger with experiences reminiscent of true self activity, but his use of the drug itself

originated in profound anxiety and reactivity. Finally, Winnicott wrote that “when a child is

playing the physical excitement of instinctual involvement becomes evident…the playing stops,

or is at any rate spoiled” (Winnicott, 1971, p. 39). I would argue that when anxiety predominates

in the origination of the use of an inanimate object or “spoils” its use, the object ceases to be and

cannot be considered a transitional object. This could indicate that the drug might start out as a

transitional object and transition into something else. Although I believe there is enough

evidence to counter this claim, it has more credence than the assertion that the drug of abuse

serves as a transitional object throughout the course of active addiction.

We are now ready to consider Winnicott’s 1951 statement about addiction: “Addiction

can be stated in terms of regression to the early stage at which the transitional phenomena are

unchallenged” (p. 242). The brevity of this statement makes it difficult to know what exactly

Winnicott meant, and some speculation is necessary to make sense of his viewpoint. I believe

that the discussion of addiction, transitional process, play, and transitional objects has provided

sufficient grounds for such conjecture. We have established that, for Winnicott, “transitional

phenomena” belong to infancy and early childhood. It seems that Winnicott felt that increasing a

patient’s capacity to play at times necessitated regression, and that such regression would

provide the patient with experiences that resemble the early stage during which transitional

phenomena are unchallenged. This indicates that Winnicott believed experiential regression to

the earliest and least object-related stages of experiencing and negotiating potential space was

indeed possible, though I have doubts that he would claim the therapist could represent a

transitional object, since he on several occasions limits the use of this term to the psychological

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and emotional life of infants. He would, however, likely characterize the analytic process as

having the potential to allow for a generative and transformative regression. This thesis has

interpreted Winnicott’s statement on addiction as indicating that compulsive drug use represents

an attempt to reach back to the phase in which transitional phenomena are unchallenged, but one

that is doomed from the start because the individual’s relationship to the drug fundamentally

lacks so many qualities that make successful therapy mutative.

The above insights into addiction and its relationship to transitional process and

transitional objects make it possible to formulate a formal statement on addiction in the context

of Winnicott’s theory of creativity. This statement must have two parts, for we have analyzed

addiction in terms of both transitional process and transitional objects/phenomena. On the one

hand, addiction can be viewed as an attempt to engage in more vivifying and enriching

transitional process. Regression need not be considered a central component in analyzing

addiction from the perspective of transitional process. The second dimension of addiction relates

more closely to Winnicott’s original formulation, and is based on the attempt to regress to the

early stage during which the infant is just beginning to come to terms with the conflict between

separateness and union through the use of transitional objects. In other words, drug use can be

viewed in part as an attempt to have a transitional object experience in which transitional

phenomena are unchallenged.

I will now briefly comment on how we might use the above insights on creativity and

addiction to understand Roger’s intrapsychic and interpersonal dynamics during recovery and

treatment. Despite drugs’ decreased efficacy in helping Roger to tolerate the vicissitudes of

separation and union and their diminished capacity to infuse his daily life with the various

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qualities of creativity, he still drew some modicum of comfort by convincing himself on

occasion that he could reach a state of bliss and vitality through drug use. Oxycontin only

“worked” for a few minutes before feelings of guilt and despair set in; yet, this brief communion

with creative experiencing, along with euphoric recall, provided enough solace that drugs—

regardless of how much pain they had caused him or the extent to which they unconsciously

represented a reenactment of previous trauma—still served a palliative and restorative function.

When Roger stopped using drugs, he lost his primary means of contacting the creative forces

within him. With this resource gone, navigating potential space while maintaining ego integrity

and aliveness became extremely difficult and felt impossible. His increased reliance on the

defenses so predominant in his childhood and early adolescence evidenced a return to the

collapse potential space and the avoidance of the terror involved in tolerating ambiguity. Such

defenses were often successful in staving off primitive anxieties, but precluded him from

engaging in playful transitional process.

Various passages from Winnicott’s from Playing and Reality played an important role in

my work with Roger, and suggest future work with addiction issues. I found the following

statement particularly salient in conceptualizing his addiction and in developing my therapeutic

stance:

This give us our indication for therapeutic procedure—to afford opportunity for formless

experience, and for creative impulses, motor and sensory, which are the stuff of playing.

And on the basis of playing is built the whole of man’s experiential existence. No longer

are we either introvert or extrovert. We experience life in the area of transitional

phenomena, in the exciting interweave of subjectivity and objective observation, and in

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an area that is the intermediate between the inner reality of the individual and the shared

reality of the world that is external to individuals (1971, p. 64).

Winnicott wrote this in the context of what he called “the search for the self,” a process

intimately related with both simple and complex manifestations of creativity. In my work with

Roger, I strived to allow for experiences of formlessness (i.e. in which he felt little need to

“make sense of nonsense”) in a safe environment and in a relationship with someone who

“reflected back” his spontaneous gestures. I mentioned that he experienced a collapse of

potential space upon relinquishing drugs. It was my hope that allowing him to meander without

an expectation of resolution would begin the process of reestablishing his confidence in the

expansion of and experiences within potential space. This does not mean that I aimed to effect

an extreme regression; this may not have been therapeutically indicated and would not have been

possible considering the treatment setting. Rather, I sought to facilitate the emergence of a

transitional process that was based not on reactivity, fear, and mistrust, but on creativity,

confidence, and trust. I treated Roger like and adult; despite his difficulties interacting with the

not-me world with a sense of vitality and agency, he still demonstrated the capacity to relate to

me as an individual in my own right. Thus, in addition to supporting and mirroring him, I

sometimes challenged him to examine the ways in which his relational conflicts might derive in

part from his resistance to seeing or acknowledging the internality of others. We explored the

nature of his defenses and the potential genetic determinants of his addiction. We also laughed

and sighed together, and gradually became more comfortable with periods of silent reflection.

It is my hope that he emerged from treatment with a greater sense of confidence and

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deliberateness in his daily life. In other words, I hope treatment allowed him to begin to develop

a more creative approach to life.

Summary

Chapters 4-6 incorporated some of Winnicott’s most important contributions to

psychoanalysis in the context of drug addiction. We have seen that exploring the three

overarching themes of this dissertation—being, aggression, and creativity—have required us to

consider many other concepts as well. It became apparent that using secondary sources

significantly contributes to a clear and thorough understanding of Winnicottian theory. Utilizing

Goldman’s insights enabled us to more clearly consider the ways in which dissociation lies at the

center of Winnicott’s writings on being and at the heart of addictive processes. Alford’s paper

demonstrated how trauma can interfere with an individual’s experience of continuity. A

thorough analysis of the relationship between trauma and addiction required the incorporation of

many other concepts such as true and false self, communication, and mind-psyche-soma

dynamics. In terms of addiction, we came to see that trauma and its immense impact on Roger’s

psychological and emotional functioning constituted a primary addictive vulnerability. Abram

clarified Winnicott’s theory of aggression and introduced us to the concept of intrapsychic

surviving and non-surviving objects. Her extensions and elaborations on this especially difficult

component of Winnicottian thought made it possible to identify the central components of

aggressive life—aliveness, destructiveness, mutuality, and separateness—and to examine the

subtle ways in which environmental factors can both foster and inhibit the development of

aggressive life. It became evident that Roger’s drug use served in part to make up for deficits in

his aggressive development. Finally, integrating Rose’s notion of transitional process into the

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study of creativity helped our investigation of addiction because, for doing so helped us to

differentiate between manifestations of creative living across the lifespan and to identify

confidence, deliberateness, variability, and the appreciation of process rather than the need for

climax as the central ingredients of experiences in potential space.

It is now possible to make a statement that summarizes all of the above findings on

addiction’s relationship to being, aggression, and creativity: From a Winnicottian perspective,

some individuals’ relationships with drugs of abuse can be seen as both interpersonal and

regressive and nature, and as founded upon the need to experience the personal aliveness that

accompanies the actualization of one or more developmental potentials.

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Chapter 7: Conclusion

Introduction

It is my hope that readers now have a better grasp of Winnicott’s writings on being,

aggression, and creativity and appreciate the ways in which these concepts can be used to enrich

the understanding and treatment of addiction. However, reaching a satisfactory conclusion to

this study will require me to address several issues that have not yet been explored. I will begin

with a summary of my findings; this will aid in reflecting upon what we have learned and in

developing a clearer picture of the model I have developed.

As with any research, this project has its share of limitations. Identifying and elucidating

the ramifications of these limitations will enable us to understand not only the pitfalls of

adopting a strictly Winnicottian perspective, but will allow us to see what aspects of Roger’s

addiction—and therefore of addiction in general—have not been incorporated into my research.

Demonstrating the limitations of this project will make it possible for us to identify areas of

further research. I will also highlight the ways in which my dissertation represents a significant

contribution to the field of addiction studies, particularly in the areas of addictions literature and

clinical practice.

Summary of the Findings

If we are to emerge from this dissertation with a comprehensive and coherent

Winnicottian model of addiction, we must first look back and reflect on everything that has been

written thus far. This section will highlight the most important insights and summarize the

findings from each chapter. Completing these tasks will accomplish much more than providing

readers with a concise statement on the model that has been developed, for it will also serve as a

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reminder of the context in which this study was undertaken and of the reasons why I decided to

conduct this research in the first place. This summary will (a) reiterate the major points of the

introduction, particularly the ways in which it provided a context and purpose of this dissertation,

(b) summarize the findings of the literature review, (c) restate the rationale behind my

methodology, and (d) provide concise descriptions of the major findings in the sections on

addiction as it pertains to being, aggression, and creativity.

Chapter 1 served a number of purposes, and I will now highlight its conclusions and

primary areas of focus. One of the most important tasks of the introduction centered on the need

to adopt a holistic and multidimensional view of addiction. I demonstrated both the strengths

and the salience of a variety of perspectives in the study and treatment of addiction, emphasizing

that neuropsychological, hereditary, cognitive-affective, psychodynamic, and relational factors

must each be considered as contributing to the etiology and formation of addiction and should

not be ruled out as potential topics in treatment. However, I also pointed out that the

predominance of the medical model and of cognitive-behavioral approaches to treatment has led

to a problematic de-emphasis on the role of early environmental experiences, unconscious life,

and other less quantifiable features in both the conceptualization and treatment of addiction. I

indicated that psychoanalytic perspectives provide a particularly useful means of inquiry into

these components of drug addiction. I made the argument that Winnicott’s theories on being,

aggression, and creativity represent especially promising entryways into this realm of

investigation, for his writings place front and center the capacity of individuals to engage

creatively with the world, exist with a sense of inner vitality, and to benefit from the fluid

interchange between inner/outer and self/other. I stated my belief that an emphasis on the

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identification of deficits in these capacities, a consideration of environmental determinants, and

the unleashing of creative potential can be instrumental in the establishment and maintenance of

a meaningful recovery. The need to develop a Winnicottian model of addiction became even

clearer when I intimated what the literature review would prove beyond a doubt—that the current

literature on Winnicott and addiction fails to provide a coherent paradigm and does not capitalize

on the subtleties and depth of this important psychoanalytic figure’s contributions. Finally, I

justified an exclusive focus on Winnicott by grounding my study in Khantzian’s belief that

addictions research is most effectively conducted when authors write “within the margins” of

their specialty as long as they do not lose sight of the bigger picture.

The literature review sought out to accomplish several goals and was successful in

providing the background, rationale, and delimitations of the analysis in Chapters 4-6. Chapter 2

began with a preliminary investigation of how Winnicott’s perspective might relate to more

recent psychoanalytic theories of addiction. I focused on Khantzian’s “self-medication

hypothesis” and his writings on addictive vulnerability; I also discussed Ramos’ concept of

dependogenic processes. I concluded that a Winnicottian approach to addiction resonates with

Khantzian’s hypotheses because the latter conceptualizes addiction from a developmental deficit

model and emphasizedzes the role of the unconscious in the development of addiction.

Khantzian dealt primarily with problems in self-regulation; I decided that a successful

application of Winnicott’s theory to addiction would require a consideration of other

maturational processes. Ramos’ paper proved not only to resonate with Winnicott in several

ways, but also supplied insights that would serve as guiding principles for this investigation.

Like Winnicott, Ramos focused a great deal on the spectrum of experiences between

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undifferentiation and differentiation, thus indicating that Winnicott’s theories could very well

find a place in more contemporary psychoanalytic perspectives on addiction. Even more

valuable was Ramos dissolution of the cause-consequence dilemma in addiction studies. This

paved the way for me develop a model of addiction the use of which did not depend on knowing

whether or not an individual’s underlying pathological dynamics existed before they developed

drug problems.

The next section of chapter 2 dealt primarily with Klein’s influence on Winnicott’s

thinking and analyzed the ways in which an exploration of the key similarities and differences

between these psychoanalysts can lead us to better grasp both Winnicott’s theory and how it can

be applied to addiction. I emphasized that it is difficult to understand Winnicott without being

familiar with Klein’s perspective. Winnicott drew heavily from Klein’s theorizing, as evidenced

by his interest in the psychological life of infants, his less linear model of development

(compared to Freud), and his various writings on the capacity of individuals to reconcile love and

hate in their intrapsychic and interpersonal worlds. However, he strongly disagreed with her on

several topics. He felt that Klein grossly underestimated the role of environmental factors, that

she was wrong in her assertion that newborns begin life with a sense of themselves as subjects

separate from an external reality, and that Klein erred in her characterization of early aggression

as intentional and sadistic. I demonstrated the ways in which Winnicott’s views on being,

aggression, and creativity can be traced directly back to his departures from these aspects of

Klein’s theory. The chapter then turned to a consideration of Winnicott’s original statement on

addiction and examined it in the context of Glover and Rosenfeld, two theorists who wrote about

addiction from a Kleinian perspective. Not surprisingly, we found similar thematic overlap and

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dissonance between Kleinian and Winnicottian views on addiction. Whereas Glover and

Rosenfeld focused on the role of sadism and oedipal themes, Winnicott’s construal of addiction

as a regression to the early phase in which transitional phenomena are unchallenged indicate that

he felt addiction had more to do with reactivity, the loss of continuity, and the inability to engage

creatively with the not-me world. Clarifying Winnicott’s views on being, creativity, and

aggression, as well as closely examining his brief comments on addiction made it possible to

move on to the next task at hand: investigating what has already been written on Winnicott and

addiction.

Because Winnicott placed the psychology of being, creativity, and aggression in the

context of developmental phases, I decided to consider what had be written on these concepts in

the addictions literature in relation to the stages of absolute dependence and relative dependence.

In addition to highlighting some problematic elements in the existing literature on Winnicott and

addiction, I elucidated the insights of theorists who have provided substantive and conceptually

accurate depictions of his theory as it pertains to drug addiction. I referred to contributions by

Eigen, Livingston, and Luz as examples of exemplary research on being and addiction. These

authors, respectively, emphasized the role of traumatically punctured aloneness in addiction, the

disturbances individuals with drug problems experience in the area of mind-psyche-soma

dynamics, and the significance of providing individuals in recovery with an ego-supportive

environment akin to primary maternal preoccupation. Authors such as Potik, Director, and

Johnson also discussed addiction as it relates to absolute dependence, but I found their

contributions to be lacking in depth, vague, or inaccurate. The section on relative dependence

provided an important foundation for the discussion of creativity in chapter 4 by demonstrating

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the delicacy with which we must proceed when using phrases such as “transitional object” or

“transitional phenomena” in approaching the topic of addiction. Some authors (Jennings,

Johnson, Rivinus) went astray in their conceptualization by failing to sufficiently elaborate the

relationship they posited between transitional objects and drugs of abuse. Potik and Miller

provided more thorough discussions of the connections between addiction and transitional

objects and phenomena, but erred in equating heroin with a transitional object and by using the

term too loosely. I concluded this portion of the literature with a summary of what I found to be

very useful applications of Winnicott’s writings on this topic to addiction. The final section of

the literature reviewed what has been written about the relationship between addiction and

Winnicott’s theory of aggression. It became very apparent that there is a surprising lack of

literature on this topic, and I emphasized the importance of pursuing this subject further.

Chapter 3 provided readers with a description of and rationale for the methodology I

chose to use to conduct a thorough investigation of addiction through the lens of Winnicott’s

writings on being, aggression, and creativity. It was determined that the methodology must be

twofold in nature. Chapter 2 concluded that the current literature on Winnicott and addiction, for

the most part, lacks depth and does not evidence the rigorous scholarship Winnicott deserves. I

also highlighted that no one who had written on Winnicott and addiction had utilized the rich

body of secondary literature that exists on Winnicott and other topics of social and clinical

interests. I established that a critical review of the literature and the application of secondary

sources on Winnicott would provide a particularly effective means of gaining a more

comprehensive understanding of addiction from a Winnicottian perspective. Chapter 3 also

made it clear that the most successful Winnicottian studies of addiction included detailed case

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studies. Without a case study, I reasoned, any examination would ultimately be both skeletal and

clinically unuseful. Following the lead of writers such as Luz and Eigen, I decided to use my

previous experiences with a client (“Roger”) as a context for exploration.

Chapter 4-7 centered on utilizing secondary sources on being, aggression, and creativity

to understand Roger’s addiction and to develop a Winnicottian model of addiction. I began with

a summary of Roger’s early childhood, adolescence, active addiction, and recovery. The

investigation of being first focused on Goldman’s insights to the case of Roger. Her 2012 paper

“Vital Sparks and Things Unknown” focused primarily on aliveness and dissociation, both of

which lie at the heart of Winnicott’s writing on continuity and simple being. Her approach

aligns with that of Alford, in that she also paid attention to the impact of trauma on the capacity

for infants, children, and adults to maintain an underlying sense of continuity in their lives. After

analyzing the various types of dissociation (both healthy and unhealthy) across the lifespan, I

determined that Roger’s addiction could be seen as an inherently dissociative process,

emphasizing the wide experiential gap and breakdown in communication between self states. I

pointed out that this became especially clear in his treatment and relapses, when the lack of

integration between “high Roger” and “sober Roger” came to the fore. I expanded upon the

dissociative nature of his addiction by showing that he utilized substances to restrict his need to

reflect upon his vulnerability. Paradoxically, he utilized this form of dissociation in part to

achieve dissociation of another sort—the dissociation belonging to the infant who has not yet

achieved unit status and who does not feel the need to integrate. This state is accompanied by

the simplest, most generative form of simple being. However, the following quote represents

Goldman’s most significant contribution to this dissertation: “Development, for Winnicott,

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proceeds through the negotiation of increasingly object related ways of being alive” (2012, p.

336). This insight played a central role in the later discussion of aggression and creativity.

The second half of chapter 4 explicated and applied the various insights from Alford’s

paper “Winnicott and Trauma” (2014). Although Alford placed special emphasis on trauma, he

provided us with very concise statements on a variety of important Winnicottian principles: what

Winnicott meant by being, the nature of the true and false selves, mind-psyche-soma dynamics,

and Winnicott’s at times confusing theory of communication. He reiterated and expanded upon

Winnicott’s assertion that trauma is something that disrupts one’s continuity of being and forces

the individual to rely on primitive and/or self-holding defenses. Alford also facilitated our

capacity to apply Winnicott’s writings on these concepts in the context of adulthood. I built

upon Alford’s ideas to develop the idea that, in Winnicott’s theory, true and false self dynamics

represent one of the most basic substrata of psychological and emotional life and that other

defenses (e.g. hypervigilance and intellectualization) can be viewed as more specific

manifestations of an overly active false self. I also asserted that compliance represents just one

possible form of false self activity and claimed that any overly reactive mode of being can be

seen as evidence of the predominance of the false self in psychological, emotional, and

interpersonal functioning. I stated that Roger started using drugs in part because he could no

longer sustain the deadening, reactive defenses that had helped to protect him from annihilation

anxiety during his childhood and early adolescence. His parents’ lack of attunement forced him

to prematurely construct a mind object, which although it allowed him to function without

collapsing, resulted in a distancing from his core self; this was manifested through mental

overactivity, hypervigilance, and having to make sense of things on his own. His defenses in the

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realm of communication also evidenced a form of reactivity, in that he was forced to engage too

frequently in communication with objects objectively perceived, a form of communication that

was not infused with the energy that accompanies communication with subjective objects. I

showed that his drug use, particularly his abuse of oxycontin, can be seen in part as an attempt to

reimmerse himself in true self experiencing—to dismantle his mind object and to reestablish

contact and communication with subjective objects. These attempts proved to be futile. His

addiction represented not an adaptive form of communication with subjective objects that is

found in artistic absorption, but a reactive “cul-de-sac” communication in which only subjective

objects carried the feeling of real.

Chapter 5 turned its attention to the ways in which we might understand Roger’s

addiction using Winnicott’s theory of aggression. I decided to use a 2012 paper by Abram in

which she provided an invaluable clarification of Winnicottian aggression as well as an

introduction of new concepts. Drawing from Abram’s work enabled me to not only to outline

the ways in which aggressive development proceeds from infancy through adulthood, but to

identify the four central features of aggression: aliveness, separateness, mutuality, and the

demand for environmental adaptation. This four part model of aggression made it possible for us

to more clearly track the quality of Roger’s aggressive life during childhood, adolescence, active

addiction, and recovery by evaluating the extent to which these components of aggression were

meaningfully elaborated in his relationship to himself and with others. Abram’s notion of

intrapsychic surviving and non-surviving objects also played a crucial role in analyzing Roger’s

addiction. Abram posited that these are internal objects that derive from the internalization of an

environment (not an object) that survives and facilitates the child’s aggression. Whereas a strong

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surviving object fosters feelings of vitality and self-efficacy, the predominance of a non-

surviving object often results in depression and psychic deadness.

Using Abram’s clarifications and theoretical constructs helped us to develop a more

complex and comprehensive model of addiction. The section on being focused primarily on

Roger’s oxycontin use and emphasized the ways in which his addiction represented an attempt to

regress to the earliest phases of psychological life. While still addressing this aspect of

addiction, exploring aggression facilitated the examination of Roger’s drug use in the context of

more object-related areas of his life, thus capitalizing upon the above-mentioned quote by

Goldman. We paid particular attention to the role drug use played in his social relationships with

peers and became able to examine with more clarity the phenomena of polysubstance abuse,

withdrawal, and tolerance. We saw that a primary appeal of drugs for Roger was their apparent

capacity to facilitate positive experiences of both simple and increasingly object-related modes

of aggressive life. The opportunity to have such experiences created the sense of possessing a

powerful internalized surviving object that, for a time, was felt to predominate in his inner world

and which allowed for more meaningful interactions with others. It became apparent, however,

that the lack of true mutuality in his relationship with drugs, combined with the inevitable

increase of tolerance and onset of withdrawal symptoms, resulted in reenactments of earlier

traumatic experiences created overwhelming feelings of alienation, helplessness, and despair.

Chapter 6 examined Roger’s addiction through the lens of Winnicott’s theory of

creativity. This section differed somewhat from the preceding discussions; while secondary

sources played a significant role in the section on creativity, chapter 6 more heavily on

Winnicott’s original writings, especially Playing and Reality. The close examination of

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Winnicott’s final book made it possible to identify the four primary features of creativity and

play: confidence, deliberateness, variability, and the lack of preoccupation with climax. This

four-part model of creativity served as a set of criteria by which we evaluated the relative

presence or absence of creativity from the psychological, emotional, and interpersonal scene

throughout Roger’s life. Rose’s notion of transitional process helped to create a clearer picture

of the form of navigating potential space that belongs to adolescence and adulthood and to see he

ways in which it differs from the type of experiences in potential space that Winnicott associated

with infancy and early childhood. Rose’s paper also provided a very clear definition of the term

“transitional object” that, to me, aligns with Winnicott’s latest writings on creativity and play.

Using Rose’s formulation made it possible to articulate a more accurate and precise

understanding of the relationship between addiction and this important Winnicottian concept.

This section also built upon the previous discussion of addiction in the context of object-related,

present-centered aliveness and in terms of regression to the earliest phases of development. The

analysis of creativity and addiction concluded with a reconsideration of Winnicott’s original

statement on addiction.

We made several important conclusions regarding Roger’s addiction and creativity. First

of all, it was established that Roger’s relationship with drugs cannot be seen as an example of

engagement with an inanimate object that facilitates healthy and creative transitional process. I

next asked the question of whether or not Roger’s drug use facilitated transitional process in his

interactions with both himself and others. It became clear that his drug use did in fact for some

time generate experiences with the qualities of creativity. Yet, the breakdown of his addictive

defenses and his misery during withdrawal revealed the somewhat illusory nature of those

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experiences. I concluded that drugs of abuse cannot be characterized as transitional objects for

two reasons. The first is terminological in nature. Winnicott’s late writings on creativity and

Rose’s interpretation of transitional objects indicate that the term should only be applied to the

objects used by infants and children in their initial efforts to manage the strain of reconciling

union and separation. My second reason centered on the fact that Roger’s interactions with

drugs lacked the relational, non-reactive, and adaptive features of transitional objects.

Furthermore, unlike transitional objects, the drug’s loss was mourned and it was not gradually

decathected. I then reevaluated Winnicott’s original statement on addiction and asserted that

Roger’s addiction can be viewed in part as an attempt to reach back to the phase in which

transitional phenomena are unchallenged, but one that was doomed from the start because his

relationship to drugs lacked so many qualities Winnicott associated with creativity. I concluded

that drug addiction must also be seen simultaneously as an attempt to engage in more vivifying

and engaging transitional process, a term which refers to more complex and object-related forms

of negotiating inner and outer reality in the area of mental life Winnicott called potential space.

The research, reflection, and effort I put into writing the chapters 1-6 allowed me to

formulate a statement that encompassed the entirety of my findings: From a Winnicottian

perspective, some individuals’ relationships with drugs of abuse can be seen as both

interpersonal and regressive and nature, and as founded upon the need to experience the

personal aliveness that accompanies the actualization of one or more developmental potentials.

Limitations

Regardless of how thorough and useful the model we have developed may be, there are

several limitations that must be discussed if we are to usefully apply what has been learned. I

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will here address two primary types of limitations: inherent weaknesses in developing a strictly

Winnicottian approach to addiction and limitations in the methodology and conclusions of this

dissertation.

I have used the words “mother,” “m/other,” “environment,” and “developmental”

hundreds of times in this dissertation. This highlights a potentially serious flaw in adopting a

strictly Winnicottian approach in conceptualizing and treating addiction. The following

statement by Alford, although made in the context of trauma theory, clearly articulates my

concerns: “Winnicott was preternaturally sensitive to the failures of the holding environment”

(Alford, 2014, p. 273). Like so many other psychoanalysts before and after him, Winnicott’s

strong attachment to his theory ultimately led to a restricted view of psychological and emotional

life. It is difficult to determine to what extent his oversights resulted from willful exclusion,

unconscious influences, or the “blinders” created by strong adherence to any perspective.

Regardless, the absence of many important concepts and phenomena that would challenge his

views is readily apparent. This has significant implications for the current study, for a failure to

consider this weakness in Winnicott’s theory would preclude us from developing a more

comprehensive and multidimensional view of addiction. Adopting a strictly Winnicottian

approach to addiction entails several dangers: (a) the risk of over-pathologizing addiction, (b) a

problematic de-emphasis on choice in addictive phenomena, and (c) the possibility of

overlooking the role of the “darker” side of human nature in the phenomenon of drug addiction.

There is no escaping that, from a Winnicottian perspective, addiction must be viewed as a

pathological in nature. Even if we adopt Rose’s disinclination towards using phrases such as

“regression,” “narcissistic fusion,” and “depressive anxiety,”—all of which he feels have

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“pejorative connotations”—(Rose, 1978, p. 352) in the discussion of transitional process and

addiction, we are still left with a model in which distinctions must be drawn between “health”

and terms like “illness” or “maladaptive.” I have tried to emphasize the need to adopt a view of

addiction that views drug abuse as more than a repertoire of pathological defenses and that

honors the personal meaning derived from addiction. Furthermore, Winnicott did make

statements that seem to indicate some hesitancy in adopting a clinical approach rooted in a

dichotomy between illness and health:

I suggest that the time has come for psychoanalytic theory to pay tribute to this third

area, that of cultural experience which is a derivative of play. Psychotics insist on our

knowing about it, and it is of great importance in our assessment of the lives rather than

the health of human beings. (Winnicott, 1971, p. 102)

“In any description of psychiatric illness there is overlapping. People do not group

themselves nicely into illness groupings. It is this that makes psychiatry so difficult for

physicians and surgeons to understand. They say: ‘You have the disease and we have (or

will have in a year or two) the cure. No psychiatric label exactly meets the case, and least

of all the label ‘normal’ or ‘healthy.’ (Winnicott, 1971, p. 140)

Yet, even these passages reflect Winnicott’s essential adherence to a model in which certain

states of psychological functioning can be viewed as healthier than others. The latter quote does

not deny the utility or importance of psychiatric labels, whereas the former merely suggests

another way of viewing clinical practice rather than finding any inherent fault in distinguishing

between health and illness. It is not my intent to discount the value in such an approach; indeed,

my views in many ways align with the characterization of drug addiction as a phenomenon often

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indicative of emotional immaturity or maladaptive intrapsychic and interpersonal patterns. Yet,

over-reliance on or unquestioned belief in a classificatory model based on preconceived notions

of what constitutes mental illness poses an inherent danger in clinical work, namely the

possibility of privileging one’s own preconceived notions over the exploration of a client’s

unique lived experiences. I have deliberately refrained from using the word “addict” to describe

an individual struggling with drug abuse, for it ultimately defines the patient primarily in terms

of his “presenting problem.” I would encourage readers who find value in the Winnicottian

model of addiction I have developed to keep this inherent limitation of Winnicott’s theory in

mind in their clinical work.

The above analysis yielded a complex portrait of Roger’s addiction as a phenomena

inextricably linked with nearly every facet of his social, emotional, psychological, and somatic

functioning. Even the most thorough examination, however, will be unable to address every

dimension of the subject at hand, particularly if the paradigm through which the researcher

conducts his work precludes him from or does not lend itself to the investigating central

questions. Some readers may have emerged from reading this case study with the sense that

Roger had little choice in the matter of his addiction, either in its early or later phases. I would

be the first to agree with this sentiment. Winnicott’s at times myopic focus on environmental

deficiencies results in a portrait of man as a being whose destiny is shaped almost entirely by the

extent to which his environment—familial, social, or cultural—has responded to and facilitated

the unfolding of maturational processes. While it is true that Winnicott discussed the inherent

capacity for choice and agency, the development of the ability to maintain unit status and make

one’s own decisions with confidence, he did not pay enough attention to more philosophical

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issues such as free will or existential assertions regarding the ways in which man is defined by

his choices. The above case study does in large part characterize Roger as someone whose

decisions are guided primarily by unconscious psychological and interpersonal patterns shaped

by his early experiences, as an individual on a treadmill with little say in his destination. I find

that any consideration of addiction must to some extent incorporate issues of powerful

unconscious forces and causality. Yet, if a therapist’s perspective fails to consider the possibility

that individuals might be able to shape their fate through choice no matter how traumatic their

experiences, then the therapist is liable to conceive of his or her patient as a passive agent who

requires the intervention of a caring, motherly figure to cease problematic drug use.

Despite my passion for and resonance with Winnicottian ideas, I periodically sense in

myself an irksome frustration that it difficult to articulate. It often arises more as an intuitive, gut

reaction than as a careful intellectual consideration, and manifests itself in the vague feeling that

something is missing. I often feel that Winnicott’s perspective is too gentle, too reassuring, and

too hopeful. Alford’s following statement captures my reservations perfectly:

In the end, we will all be lost to the void, and the traumas that many of us experience

along the way (albeit of vastly varying magnitudes) all point in this direction, all remind

of this reality. At some level of the psyche there is only one interpretation of the final act

of this play, and about this reality Winnicott would comfort us with teddy bears and

blankies….Nietzsche reminded us that Greek tragedy makes it possible to live with

knowledge of the void. With Winnicott one has the sense that it is better not to talk about

such things. (2014, p. 273)

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Alford also wrote that Winnicott was “preternaturally sensitive to the failures of the holding

environment,” and it seems to me that his preoccupation with environmental factors leads him to

overlook entire dimensions of human life and entails a pervasive denial of darkness within the

human psyche (Alford, 2012, p. 273).

In discussing the potential value of Freud’s death instinct, Gomez (1997) wrote, “[the

death instinct] may…enable us to go beyond a sentimental view of humanity in which its most

sinister traits are explained away” (p. 18). It would seem that Winnicott would have us believe

that sadism, sociopathy, and avarice owe their existence almost entirely to environmental

deficiency. Is it not possible that the intentional destruction of others represents a ubiquitous,

natural, and appealing method of self-preservation? Do we not see evidence of this in the

genocidal foundation of the United States? Even if one chooses to deny that this destruction of

an entire people is the manifestation of the deflection of the death instinct on a broad scale, we

cannot deny that our survival as a fledgling nation was predicated on the reducing of millions to

an inorganic state. The ubiquity of this method of nation building over human history and the

overwhelming tendency of cultures to exploit and impoverish the weak forces us to strongly

consider the possibility that such amorality and sadism are inherent in the psychic constitution of

man.

Winnicott’s pervasive disavowal of the “dark side” of human nature becomes all the

more noticeable when one considers the degree to which other psychoanalytic theorists have

incorporated sadism, evil, and self-destructiveness into their frameworks. One need not agree

with the viewpoints of these writers, but the fact that so many important psychoanalysts—not to

mention philosophers—have found such issues essential in any consideration of human nature

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should make us at least somewhat hesitant to wholeheartedly accept Winnicott’s perspective.

Let us look to a few examplar ideas from the work of Sigmund Freud and Carl Jung to get a

sense of what Winnicott’s theory fails to include:

And now turn your attention from the individual case to the great war devastating

Europe. Think of the amount of brutality, the cruelty, and the lies allowed to spread over

the civilized world. Do you really believe that a handful of conscienceless egoists and

corruptionists could have succeeded in setting free all these evil spirits, if the millions of

followers did not share in the guilt? Do you dare under these circumstances to break a

lance for the absence of evil from the psychic constitution of mankind? (Freud, 1912, p.

119)

Samuels (1986) provided the following quote by Jung when defining the shadow:

Everyone carries a shadow, and the less it is embodied in the individual’s conscious life,

the blacker and denser it is…If it is repressed and isolated from consciousness, it never

gets corrected, and is liable to burst forth in moments of unawareness. At all counts, it

forms an unconscious snag, thwarting our most well-meant intentions (CW, 11, para.

131). (p. 138)

Despite their personal and theoretical differences, Freud and Jung both highlighted the presence

of innate and collective forces in humankind that exist ab ibnitio and remains part of everyone’s

psychic constitution irrespective of environmental factors. Concepts such as the death instinct

and the shadow provide us with a framework in which we can more substantively incorporate the

“dark side” of mankind into our conceptualization of and work with clients. To say it bluntly,

there is no place in Winnicott’s theory for such ideas. It is beyond the purview of the current

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study to develop a perspective on addiction that incorporates the darker side of human nature.

Yet, given the naturally self-defeating nature of addiction and the damage it can inflict on others,

it seems that a consideration of concepts such as the death instinct, repetition compulsion, and

the shadow could potentially lead to a richer and more comprehensive theory of addiction. It is

also possible that neglecting to consider the darker elements of humanity could adversely impact

our work with addicted clients. For instance, the notion of repetition compulsion could help us

to develop insights into the self-sabotaging nature of compulsive drug use that we could not

attain if we were to adopt a strictly Winnicottian approach.

In addition to the problems present in Winnicott’s theory, there are limitations in both the

methodology and scope of this dissertation that must be pointed out if we are to usefully apply its

contributions in clinical work. One of the most significant shortcomings of chapters 4-6 were

their inability to represent more than one “type” of drug addiction. In other words, Roger can be

seen in large part as an individual who sought out addiction to deal with problems that existed

prior to addiction. For instance, I emphasized throughout the case study the ways in which

Roger used drugs in order to relinquish the self-protective, but ultimately deadening defenses he

had utilized in childhood and early adolescence to cope with chronic exposure to a non-

facilitating environment. There are many clients whose drug abuse arises in large part from their

inability to find other ways to deal with difficult past experiences, but by no means do all cases

of addiction result from the predominance of psychopathology prior to the initiation of drug use.

What of individuals who wander into addiction through cultural, social, or peer influences?

What about people who had “healthy” personalities before becoming addicted to drugs? The

sheer variety of potential contributing factors in the development of addiction precludes us from

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assigning typicality to any one instance of addiction. Thus, the case of Roger should not be seen

as representative of addiction as a phenomena, nor can we say with certainty that particular

elements of his addiction are universal. I will not attempt to deny the importance of such

considerations. However, I do not think they should render useless or even unhelpful the model

of addiction I have derived from examining Roger’s life. Regardless of how or why a person

develops drug problems, I feel that evaluating the extent to which an individual can engage

creatively with the world or the degree to which someone experiences continuity in their daily

lives can help us to both understand and treat addiction.

This project has dedicated very little time to a consideration of the roles played by factors

of diversity and culture in the etiology, maintenance, or nature of addiction. There is no question

that the exclusion of these variables threatens the generalizability and applicability of the model I

have developed. What if Roger had been a black male from a low socioeconomic background?

What if Roger had been a gay male raised in a devoutly Christian family? Neither the literature

review nor the case study provided us with information regarding the ways in which a

Winnicottian framework can aid in understanding the ways in which the myriad dimensions of

diversity (e.g. sexual orientation, ethnicity, age, race, educational level, religion, socioeconomic

status, and the presence or absence of physical disabilities) might impact our work with

individuals who struggle with drug abuse. Even the case study did not incorporate important

issues such as growing up in a rural environment or being a white American. These limitations

exist in part because I chose to emphasize the elements of psychological and emotional life on

which Winnicott himself focused. Yet, I do think that Winnicott’s perspective lends itself to an

incorporation of social and cultural factors. Although he did not often deal directly with the

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influence of diversity factors on development, I feel his attunement to the role of environmental

factors would make it possible to address the influence racism, classism, or heteronormativity

might have on the development and experience of addiction.

Areas for Further Research

The analysis of this project’s shortcomings has been significant in helping me to

determine which fields of study still require more exploration. I have also identified topics that I

referred to with some regularity during chapters 4-6 that I hope will be adopted by other scholars

and clinicians as subjects for their own investigations.

The above description of this study’s limitations demonstrated that the limited

consideration of diversity and culture constitutes perhaps the most significant shortcoming of my

dissertation. There are several ways in which these important factors could be incorporated into

a Winnicottian perspective of addiction. Given the fact that Winnicott placed so much emphasis

on the role of environmental factors, it should not be surprising that a great deal has been written

on Winnicott and social issues such as racism. Just as I utilized secondary sources on Winnicott

that dealt with topics unrelated to addiction, other researchers might refer to literature on

Winnicott and culture in order to elucidate a Winnicottian theory of addiction that incorporates

the areas of study I have not explored in the current study. One example of such a text is Farhad

Dalal’s Race, Colour, and the Process of Racialization: New Perspectives from Group Analysis,

Psychoanalysis, and Sociology. Dalal (2002) wrote that, in Winnicott’s framework, “Anxiety

and aggression are reframed as aspects of relational processes rather than internal energies” and

proceeds to relate this to group formation and racism (p. 181). Alford’s “Winnicott and

Trauma,” the paper I utilized in the section on being and addiction, also contains poignant

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commentary on how we might understand the impact of discrimination and marginalization can

adversely impact the capacity to sustain a sense of continuity in daily life. Future investigators

could potentially utilize insights such as these to add enrich the Winnicottian perspective of

addiction that has been developed in this dissertation.

Other researchers could also explore the similarities and differences between the

Winnicottian view I have developed and the contributions from other schools of thought. The

introduction and literature review provided a preliminary picture of how a Winnicottian

perspective on addiction could potentially be integrated with and differentiated from other

approaches. I highlighted potential connections between a Winnicottian paradigm and more

recent psychoanalytic contributions, Kleinian theories of addiction, medical models of drug

abuse, and cognitive-behavioral frameworks. These discussions, particularly the last two, were

by no means exhaustive and left out many nuances of these various viewpoints. Through

analyzing Roger’s addiction, I was able to formulate a comprehensive model of addiction

through the lens of Winnicottian theory. I believe that incorporating the conclusions I have

drawn regarding being, aggression, and creativity with psychoanalytic, cognitive-behavioral, and

humanistic-existential theories of addiction could foster conversations that would deepen our

understanding of addiction.

Further exploration of the relationship between Winnicott, recovery, and treatment would

also contribute to a more fully developed perspective. Chapters 4-6 focused primarily on

Roger’s formative years and on the establishment, maintenance, and breakdown of addictive

defenses. Although I discussed Roger’s experiences during recovery at the end of each chapter, I

did not do so with the thoroughness with which I examined his life before and during active

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addiction. I dedicated some of each section to my work with Roger and drew many connections

between Winnicott’s theory and its implications for treatment. Yet, I believe there is much more

that can be said on this topic. Several questions come to mind in reflecting upon the various

avenues for further research. How could a therapist incorporate this model in the earliest phases

of treatment? To what extent is achieving insight important in implementing this approach?

How could one use this perspective in working with individuals who patients who also struggle

with symptoms associated with other diagnoses (e.g. personality disorders, bi-polar disorder)?

Would this approach to treatment be useful in working with patients who have cognitive deficits?

In what ways could therapists integrate a Winnicottian approach with more behavioral

approaches? Addressing these and other questions would contribute both to a richer

understanding of addiction and increased efficacy in working with clients from a psychodynamic

perspective.

Importance of this Study

Having summarized the findings and limitations of this study, it is possible to discuss its

significance. My dissertation represents a valuable contribution to addictions literature and

provides a model that can aid clinicians in their work with individuals who struggle with

addiction.

This project has a great deal to offer scholars and practitioners who want to enhance their

capacity to understand addiction from a psychoanalytic perspective. This is particularly true for

those interested in or influenced by Winnicott’s work. In chapter 1, I placed Winnicottian ideas

in the context of contemporary psychoanalytic addiction theories and provided an overview of

existing literature on Winnicott and addiction. The literature review summarized several

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substantive and enlightening papers that focused on the ways in which various elements of

Winnicott’s theory can be usefully applied to the study of drug abuse. I owe a great deal to

writers such as Eigen and Eve Livingston, whose insights fueled my curiosity and impelled me to

develop my own formulations on this topic. The writings of Luz and Siporin also provided me

with a foundation upon which I could begin my exploration. However, it became clear over the

course of chapter 2 that careful, in-depth applications of Winnicott’s theory to addiction are to

some extent the exception rather than the rule. We found that some authors restricted their

incorporation of Winnicottian theory to one or two paragraphs or only briefly referred to famous

phrases such as “transitional object” or “good enough mother.” Other writers dealt more

extensively with Winnicottian themes, but I found their conclusions to be vague, superficial,

and/or inaccurate. I demonstrated that Winnicottian literature on addiction consisted of a handful

of successful papers and many more articles that merely pay lip service to or misrepresent this

important psychoanalytic figure.

This dissertation represents a significant advancement in the task of understanding

addiction from a Winnicottian perspective for several reasons. Very few who have written about

Winnicott and addiction have provided anything resembling an overview of what had previously

been written on this topic. This is part of what contributes to the piecemeal nature of the current

body of work about Winnicott and addiction—each paper stands on its own as an isolated

contribution. The literature review served as the first comprehensive presentation of the

literature dealing with Winnicottian views of addiction. This paper can therefore serve as a basis

for reference for writers who wish to further explore this subject, something that heretofore has

not been available. Chapter 2 also prepared the way to understand a Winnicottian theory of

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addiction in the context of both older and contemporary psychoanalytic addictions literature.

This makes it possible for us to compare and contrast this project’s conclusions with more recent

concepts such dependogenic processes.

The contribution of chapters 4-6 was fivefold in nature. First of all, the isolation of

being, aggression, and creativity as guiding principles made it possible to formulate a more

organized and structured model of addiction. Starting out with these three broad concepts also

facilitated the analysis of addiction in terms of various “smaller” concepts such as mind-psyche-

soma dynamics and dissociation. The use of secondary sources in these chapters will benefit

future scholars in at least three ways. First of all, each of the authors I referred to helped in some

way to clarify Winnicott’s terminology and his theory in general. This should make it easer for

others to apply Winnicott’s theory to addiction with a higher degree of confidence. Secondly,

the papers discussed in chapter 4 made it possible for us to achieve a depth and level of detail

unprecedented in previous writings on Winnicott and addiction. The four part model of

aggression derived from Abram’s paper and the careful distinctions facilitated by Rose’s essay

represent the clearest examples of this. Through the application of their ideas, we were able to

move beyond the surface level analysis of Winnicott’s theory so common in the current body of

literature. The incorporation of secondary sources also enriched the Winnicottian paradigm

through the introduction of novel concepts such as transitional process and intrapsychic non-

surviving objects. Finally, grounding chapter 4 in a detailed case study made it possible to

understand the ways in which Winnicottian theory can be understood in the context of lived

experiences.

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This dissertation also contributes to addictions literature in general. Much of the current

research on addiction conceptualizes drug abuse from various behavioral perspectives.

Penberthy et. al. (2011) wrote that cognitive approaches to addiction “Focus on thought

processes, recognizing that emotions and behaviors are best addressed by considering the faulty

thought processes that precede such feelings and acts” (p. 730). I hope I have made it clear that

there is much more to drug addiction than cognitive processes. It is not so much that the

cognitive behavioral model is “wrong.” I doubt Winnicott would claim that problematic thought

processes do not play an important role in addiction. However, cognitive behavioral approaches

often paint a picture of addiction as a failure in computation rather than a deeply personal

relationship with a substance that can lead not just to “faulty thought processes” but to the

impoverishment of an individual’s inner world. Authors who write from a cognitive behavioral

perspective do not deny the pervasive impact of addiction on almost every dimension of a

person’s life. Yet, one does get a sense that their extreme emphasis on cognitions and on

concrete causal connections between thoughts, feelings, and behavior might preclude them from

considering a multitude of other factors. The in depth exploration of Winnicott’s theory in

chapters 4-6 raised a wide variety of questions that would likely never be raised by clinicians

who conceptualize from a primarily cognitive-behavioral paradigm. The addition of my

dissertation to the existing body of addictions literature will hopefully encourage professionals

with cognitive-behavioral backgrounds to consider other avenues of exploration.

The findings of this dissertation also have many implications for psychotherapy with

clients who struggle with addiction. I will again turn your attention to the ubiquity of behavioral

interventions in order to demonstrate the relevance of my dissertation to clinical work. At this

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point in time, the landscape for addiction treatment is dominated by “evidence-based

treatments.” Cognitive-behavioral approaches are usually considered the treatment of choice,

particularly with individuals who are new to recovery. I have personally utilized behavioral

interventions (e.g. “homework” and progressive muscle relaxation) with clients who struggle

with addiction, and in no way want to dismiss them as unhelpful. In fact, I feel that they are

often essential to successfully working with addicted clients. The current study, however, should

make us question the automatic and unquestioned application of structured interventions from

the onset of treatment. From a Winnicottian perspective, the most obvious drawback of

behavioral interventions is the possibility that such an overtly directive approach might be

experienced by the patient as impingement. I would encourage clinicians to keep the core

themes of this dissertation in mind from the very first meeting with a client. To what extent does

your client have the feeling of real, and how has this been affected by drug cessation? What

purposes did their drugs of abuse serve in the early phases of their addiction, and what made

drug use necessary? How might you characterize your client’s capacity to engage in mutually

enriching relationships, to feel himself to be the author of his own experiences, to be alone, and

to endure the stresses of everyday life without collapsing? An assessment of clients from this

vantage point might very well lead you to conclude that behavioral interventions would actually

be the most efficacious and appropriate approach. I believe that the model I have provided

would be especially useful in working with clients in recovery who have managed to maintain

sobriety, but who still struggle with the desire to use and with the variety of psychological,

emotional, somatic, and interpersonal difficulties that accompany the cessation of drug use. This

does not mean that it would be necessary to limit therapy to the exploration of traumatic

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experiences, or that an analysis of their early lives would even need to be a focus of treatment.

Rather, the insights obtained in this project could help clinicians to constantly monitor the degree

to which the therapeutic environment is one that facilitates the unfolding and elaboration of the

clients’ maturational processes.

Conclusion

Just a perfect day

You made me forget myself
I thought I was someone else
Someone good…8

Although Lou Reed’s 1972 song “Perfect Day” seems like a love song to a lover, it is

often interpreted as a love song to heroin. If seen in this way, Reed’s lyrics highlight a

dimension of drug use that can be easily overlooked if one adopts an approach to addiction that

is too heavily influenced by cognitive-behavioral or medical paradigms. We of course do not

want to ignore the potential role of hereditary or physiological factors in the etiology and

maintenance of addiction, but it is incumbent upon mental health professionals to consider the

deeply personal meaning drugs can have for people and to keep in mind that many individuals

have relationships with drugs that have qualities of interpersonal experience. Winnicott’s theory,

more than most, facilitates the illumination of these aspects of drug use. Regardless of Reed’s

actual intentions in writing these lyrics, some individuals who struggle with heroin addiction feel

as if this song encompasses the very essence of their lived experiences with addiction. Reed’s

song indicates that heroin took him to a place in which he felt alive, safe, confident, and held. It

allowed him to assume a new identity and to start life anew through the experience of womblike

8 Reed, L. (1972). Perfect day. [Recorded by Lou Reed]. On Transformer [Compact disc].

BMG Entertainment International UK & Ireland.

 287

security, yet also made it possible for him to engage more meaningfully with the outside world.

The peaceful and sublime melody is eventually interrupted by violins mourning in a minor key, a

juxtaposition that, from a Winnicottian perspective, represents the tragic illusion inherent in drug

addiction.

 288

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