Dipsomania (International Dictionary of Psychoanalysis)
The term "dipsomania" was used in clinical psychiatry. It is not a psychoanalytic term but was used on occasion by Sigmund Freud and other psychoanalysts. The classic definition of "dipsomania" is that of Valentin Magnan (1893): Preceded by a vague feeling of malaise and a burning sensation in the throat, dipsomania is a sudden need to drink that is irresistible, despite a short and intense struggle. The crisis lasts from one day to two weeks and consists of a rapid and massive ingestion of alcohol or whatever other strong, excitatory liquid happens to be at hand, whether or not it is fit for consumption. It involves solitary alcohol abuse, with loss of all other interests. These crises recur at indeterminate intervals, separated by periods when the subject is generally sober and may even manifest repugnance for alcohol and intense remorse over his or her conduct. These recurring attacks may be associated with wandering tendencies (dromomania) or suicidal impulses. Although "dipsomania" means compulsive thirst, the use of the term is reserved for the compulsive intake of alcoholic beverages.
The term was introduced by Dr. C. W. Hufeland in 1819 in his preface to Trunksucht (Dipsomania), a study of the phenomenon by C. von Bruhl-Cramer. Even as early as 1817 the Italian physician Salvatori had identified a "furor to drink." All of these authors contrast dipsomania and chronic alcoholism.
Freud alluded to dipsomania in his correspondence with Wilhelm Fliess (Freud to Fliess, January 11, 1897, and "Draft K") and in his "Further Remarks on the Neuro-Psychoses of Defence" (1896b). He saw dipsomania as a secondary symptom of a defense against an obsessive thought that forms when the compulsion is displaced from that thought onto the motor impulses directed against the thought. In more exact terms, the compulsion, emanating from the ego, is mobilized against the affects linked to the obsession, as a measure of protection against and desensitization to suffering induced by these affects and as a means of obtaining pleasure. This need for alcohol is a substitute for an associated repressed sexual activity of an autoerotic kind, namely masturbation, which Freud, in a letter to Fliess dated December 22, 1897, calls "the one major habit, the 'primal addiction' " (1950a [1887-1902], p. 272). The drunken stupor represents both a desensitization of the ego to painful affects and the pleasure of active mastery of experiences of passivity. Motor acts (drinking, whether or not associated with dromomania) are central to the obsession.
In a letter of January 11, 1897, Freud cited the case of "a man of genius" who "had attacks of the severest dipsomania from his fiftieth year onwards" and who was "a pervert and consequently healthy" until that point (1950a [1887-1902], p. 240). The man's crises were heralded by catarrh, hoarseness, and diarrhea ("the oral sexual system"), all of which represented bodily "reproduction of his own passive experiences" and brought together desensitization, repetition, and mastery. Freud compared this substitution of compulsive drinking for the sexual instinct to the substitution that culminates in the passion for gambling. In this letter to Fliess, Freud outlined an intergenerational psychopathology. During the same period he published, in succession, "Heredity and the aetiology of the neuroses" (1896a) and "Sexuality in the aetiology of the neuroses" (1898a).
There is little elaboration of this notion in Freud's subsequent writings. However, in considering epileptic fits and pathological gambling as they relate to (auto-erotic) sexuality and death in "Dostoevsky and Parricide" (1928b), Freud provided, without designating them as such, insights into the alcoholic's crises: "He never rested until he had lost everything" (p. 191). "The irresistible nature of the temptation, the solemn resolutions, which are nevertheless invariably broken, never to do it again, the stupefying pleasure and the bad conscience which tells the subject that he is ruining himself (committing suicide)ll these elements remain unaltered in the process of substitution" (p. 193).
In this essay Freud proposes the hypothesis of an abnormal mechanism of discharge of the instincts, posited organically, that operates both in histolytic or toxic brain disease and in cases of inadequate control over the psychic economy when energy levels reach a certain threshold. This mechanism is closely related to the sexual processes, understood as "fundamentally of toxic origin" (p. 180), and enables the ego to "get rid by somatic means of amounts of excitation which it cannot deal with psychically" (p. 181). The meaning and intentionality of such crises (drunkenness, coma, or deep sleep) are well known: Such "deathlike" (p. 182) states express an identification with a dead person, in either reality or fantasy, the latter being more significant (boys, in their fantasies, usually wish for the death of the father). The dipsomania crisis, preceded by an aura of supreme happiness, liberation, and triumph, has a punitive value: the subject is dead, like the person the subject wished dead. This is similar to the situation of the brothers of the primitive horde and relates to totemic ritual.
In the view of Otto Juliusburger (1913), dipsomaniacs who seek out the company of "lower-class" drunks in this way demonstrate their subjection to sadomasochistic instincts. Edward Glover (1932) compared dipsomania to an obsessive ceremonial (less obvious in solitary drinkers) and saw it as an "artificial" manic-depressive syndrome (with more direct sadism and a less severe oral fixation). Similarly, Otto Fenichel (1945) saw a link between pathologically impulsive characters and "the ego's morbid syntonic impulses," expressed on the economic and dynamic levels as manic-depressive disorders characterized by alternating acts and remorse. These impulses are seen as (futile) attempts to master old experiences through repetition and active dramatization, to master guilt, depression, and anxiety. John W. Higgins (1953) and William J. Browne (1965) emphasize the passage from thought to motor action, a return to the mother, an incorporation of the mother's breast, and denial of passivity. For Charles Melman (1976), aversion therapies that seek to create new boundaries are actually aggravating factors in dipsomania. In an observation based on just two interviews, Jean-Paul Descombey (1992) relates the case of a young dipsomaniac who engages in a repetitive ritual of a "tournament of grand dukes" with his various brothers and sisters, begun from when he discovered the body of his dead mother; autoerotism and the death instinct are condensed in the subject's comment "I must finish myself off."
The notions of somalcoholosis (P. Fouquet, 1955) and alcoholism (Edmund Jellinek) are synonymous with dipsomania. Alcoholepsy, or alcoholic seizures (P. Fouquet, 1970) is a critical episode in a chronic alcoholic; associated forms of dromo-dipsomania have been described. Bulimic behaviors, which are comparable to dipsomania, are sometimes associated with it. Alimentary orgasm (Sándor Radó, 1933), which has a euphoric pharmacogenic effect, is provoked by the ego, which thus rediscovers its broadest narcissistic dimension.
The relative dearth of studies of dipsomania is explained by the fact that dipsomaniacs are often approached only in single interviews in hospital emergency rooms, where they tend to end up; there is rarely any follow-up. Nevertheless, as a particular form of alcohol abuse, dipsomania is of interest in that it involves a kind of epitome and condensation of various aspects of alcoholism: a compulsion for repetition; a short-circuiting of psychical working through by acting out an undeclared depressive state; the problematic interplay of desensitization and attempted mastery; and autoerotism and self-destructive, potentially lethal actions. There are two possible dangers here: overdistinguishing dipsomania from other forms of alcoholism and, alternatively, failing to perceive its specificity. The same is true for transitory alcohol abuse and drunkenness in "normal" subjects, which are insufficient in and of themselves to account for alcohol addiction, whether or not dipsomania is present. A dynamic approach must go beyond organicist views, which attempt to link dipsomania to manic-depressive psychosis or epilepsy, and take into account the connections suggested in clinical practice. Finally, Freud, in "Dostoevsky and parricide" (1928b), though he does not explicitly cite alcoholism (from which Dostoyevski himself was not immune), nevertheless proposes a toxicity-based theory of sexuality and the neuropsychoses (Descombey, 1994).
See also: Addiction; Alcoholism.
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