Home > International Dictionary of Psychoanalysis > Alcoholism

Alcoholism is not a psychoanalytic concept. The most rigorous definition, following from the basic notion of dependence, is the one provided by Pierre Fouquet: "An alcoholic is any man or woman who has lost the ability to do without alcohol." The word "alcoholism" was introduced by the Swedish physician Magnus Huss (1849) and mentioned in France by M. Gabriel (1866) in his medical dissertation. It appears in Freud's writings prior to 1900 in association with hysteria and hypnosis, as a form of "subjection," a "morbid habit," falling somewhere "between the organic affections and the disorders of the imagination." Principal occurrences of the word appear in letters to Wilhelm Fliess (especially that of December 22, 1897), in the attached manuscript (Draft H., 1895), and especially in the key text "Sexuality in the Aetiology of the Neuroses" (1898a). "Habit," Freud writes, "is a mere form of words, without any explanatory value" and "success will only be an apparent one, so long as the physician contents himself with withdrawing the narcotic substance from his patients, without troubling about the source from which their imperative need for it springs" (p. 276).

It was initially believed (Sigmund Freud, Karl Abraham, Sándor Ferenczi) that alcohol does not create symptoms but only promotes them, removing inhibitions, and destroying sublimation. The theory of alcohol addiction (1905d) is summarized in terms of its predominance among men beginning with the onset of puberty; its relationship to sexuality, and latent homosexuality, already identified as narcissistic and specular by Viktor Tausk (1913) and Lou Andreas-Salomé (1912); oral fixation, and autoerotic behavior. Emphasis later focused on the nature of the defensive process, an immediately effective means, but one that is too accessible, which is why it is so dangerous (1930a [1929]). The economic approach to affects was emphasized next—concepts of alexithymia (McDougall, 1978), instinctual discharge by the body ("resomatization of affects"), and acting out ("dispersion," "destruction of affects," "acts-symptoms"), depending on the author—all at the expense of psychic elaboration.

Alcohol plays the role of a unique substitute object and a trap, creating a pseudo-reality; the hallucinations associated with delirium tremens cease with the administration of alcohol. The narcissistic problematic (withdrawal) in fact harbors an autoerotic component and gives rise to defenses, barriers, or narcissistic prostheses, such as an overinvestment in work, children, "friends," etc., and alcohol. The mechanism of splitting into non-alcoholic (common, neurotic) and alcoholic sectors of the ego has denial as its corollary, but it is a denial that does not involve the perception of an external reality (difference of the sexes, castration) but rather the internal perception of the body itself. There exist silent zones, "matrices of painful, deadly territories that threaten the unity of the ego" (Mijolla and Shentoub, 1973). These are the parts of the body that lie outside symbolization and outside language, as described by Jean Clavreul (1959). For Paul Schilder and Walter Bromberg (1933), alcoholism is accompanied by a regression from castration that leads to bodily fragmentation. The alcoholic short circuit leaves no room for the establishment of loss, the source of desire, but rather establishes an ensemble of needs and repetitive acts that are without meaning. An analogy can be made with pathological games. Shame or opprobrium are distinguished from guilt. The superego of an alcoholic is demanding but "soluble in alcohol" (Simmel, 1930). There is no strong image with which the subject identifies, but identification can occur with someone hated, which can lead to "self-hatred." The indulgent and demanding mother who creates insecurity is the object of reverse fantasies (idealization).

The symbolism of alcohol is that of vital fluids (blood, "the blood of the vine," sperm, milk) or destructive humors (urine, feces), of the breast and the penis, good and/or bad. This symbolism is present in all the myths associated with alcohol, from Dionysus to the Eucharist.

The situation in terms of a psychoanalytic classification is still the subject of controversy. It is a narcissistic disorder, closer to manic-depression and paranoia than to neurosis, psychosis, or perversion. Its issues fall within the framework of addiction.

Intolerance to alcohol can be interpreted as a reaction formation to the excitations that alcohol promotes, or to the frequently negative attitudes toward alcoholics, sometimes as extreme as hatred (Winnicott, D. W., 1947), or even to the most primitive issues of the alcoholic that are awakened in the therapist. From the standpoint of treatment, it is a matter of detoxification or social prohibition (1927c)—"Not all men abandon this toxic supplement with the same facility" (1905c), "the only effective remedy is the resolution that draws its strength from a powerful current of the libido"—as opposed to involvement of the superego (1966b [1932]). The effectiveness of temperance movements appear to be associated with libidinal investments "torn from alcohol" and given expression in exhibitionism, or homosexual and narcissistic masochism.

There is a double risk of using the term "alcoholism": the risk of turning it into a closed and homogenized entity, or of breaking apart the clinical concept, reductively assimilating it to various diagnostic classifications (neurosis, psychosis, perversion—fetishism, for example—paranoia, manic-depression, psychopathy, etc.). To compound the problem, concepts such as homosexuality, orality, "disappointment," and "libidinal viscosity," risk serving as facile or even completely inappropriate explanations.

Freud himself often superimposed the phenomenology of drunkenness and the psychopathology of alcohol addiction, and even considered the relation of the alcoholic to his poison as nonconflictual, "the purest harmony," and "an example of a happy marriage" (1912d, p. 188). Blind spots with respect to his own relationship to toxic substances (cocaine, tobacco) led him outside the field of psychoanalysis when he postulated a "toxological theory" in psycho-pathology, which he did not abandon until the Outline of Psychoanalysis (Descombey, 1994).

There are a number of concepts related to alcoholism: addiction, alcoholic intoxication, alcoholic delirium and jealousy, delirium tremens (Viktor Tausk's delirium of action or occupation), alcohol-associated epilepsy. And it can be asked, as Freud asked about psychosis, if the terms "denial" and "repression" have the same meaning with respect to alcoholism as they do for the psychopathology of the neuroses. The same question could also be asked about the familiar use of the concepts of desire and pleasure when it comes to a clinical practice that is situated "beyond the pleasure principle" or within the register of need.

Post-Freudian authors who have done substantive work on alcoholism include James Glover (1938) and the Kleinians Herbert Rosenfeld (1964) (paranoidschizoid and depressive positions), Sándor Radó (1933) (pharamacothymia, initial anxiety depression, pharmacogenic orgasm, addiction crisis), and Michael Balint (1977) (basic fault). There has also been renewed interest in the subject in the work of the French psychoanalysts Jean Clavreul (1959), Alain de Mijolla and Salem A. Shentoub (1973); the Lacanians François Perrier (1975), Charles Melman (1976), A. Rigaud (1976), M. Lasselin (1979), and F. Gondolo-Calais (1980); as well as Jacques Ascher (1978), Joyce McDougall (1989), M. Monjauze (1991), and Jean-Paul Descombey (1985-1994).

JEAN-PAUL DESCOMBEY

See also: Addiction; Dependence; Dipsomania; Indications and contraindications for psychoanalysis for an adult.