Crack, the father, psychiatrists and psychoanalysts

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INVITED EDITORIAL

Crack, the father, psychiatrists and psychoanalysts

Sérgio de Paula Ramos

Psychiatrist and psychoanalyst. Coordinator of the Chemical Dependence Unit, Hospital Mãe de Deus, Porto Alegre, RS, Brazil. Member of the Consultative Council, Associação Brasileira de Estudos sobre o Álcool e Outras Drogas (ABEAD - Brazilian Association of Studies on Alcohol and Other Drugs). E-mail: [e-mail].

Over the past 20 years, different researchers have shown an increasing consumption of all drugs of abuse by students in Brazil and in the city of Porto Alegre. In the most recent survey, a tendency of having a female consumption pattern similar to that of men was also evident. Although there are no history series of adults, clinical practice suggests that alcohol consumption remained stable, tobacco use decreased, but consumption of other drugs increased, remarkably stimulants, and we are now living an epidemic of crack. Although its users are usually young individuals, there are reports of cases among children and adults in all economic segments.

This phenomenon is complex and, to understand it, we need to appeal to anthropology, sociology, genetics, psychiatry, and psychology. In this text, I will deal with the contribution psychoanalysis can provide, not only to widen its understanding but also to suggest prevention measures.

By the late 1980's, there was an epidemic of injectable cocaine. Patients were exposed to all known risks to obtain chemical pleasure. As a matter of fact, it was evident at that time that there were two types of pleasure. That created by the pharmacological effect of the drug, but also, when injecting, the pleasure of aspiring one's blood to the syringe chamber and being able to see it. In addition, when these patients managed to withdraw from the drug they constantly reported a feeling of inner emptiness that triggered episodes of craving.

Now I would like to underline two relevant aspects: the pleasure of seeing one's own blood and the almost oceanic feeling of emptiness. What psychoanalysis was able to find out is that, on the one hand, there are different types of chemical dependents and, on the other, there is no universal (or conflictive, if you wish) problem common to everyone. However, these patients that were dependent on injectable drugs had the pleasure of seeing their blood and the feeling of emptiness. To have the first and avoid the second, they would take on all sorts of risks, to the extent of being described in the literature as having risk taking behavior, characterized by the pleasure of exposing their life.

Psychoanalytic clinic has taught us that this subtype of drug-dependent individual has suffered a marked impairment in internalization of their primitive objectives, and the usual scenario are people in symbiosis with their mothers, perceived extremely fragmented, and with the peripheral father figure. As prospective studies are indicating that, in order to understand chemical dependence in adolescence, it is necessary to answer the question "where is the father?" in each case, it seems that the situation is more a result of the paternal function failure in the leverage to terminate the symbiosis. From this perspective, what these patients need is to restore this paternal function.

The current question is whether the type of patient that is using crack is similar to that past user of injectable drugs. They have the severe risk and practice of what I will call "near death to find me alive" in common. In fact, risk behaviors and blood visualization seem to respond to a desideratum that "if I'm not dead then I must be alive." Similarly, "if I see my blood, ditto, ditto."

Such patients often have axis II comorbidity, with cluster B diagnoses, and for them the feeling of being alive is given by non-death.

What I believe is that, without disregarding the contributions of other areas of knowledge, there may be some sense in the hypotheses mentioned above when we realize that, in poor regions, where the current epidemic has began, there is a total concrete absence of the father, and in medium and high classes, toward which the epidemic is spreading, the movement takes place at the expenses of the families where the father figure in usually compromised.

Based on these findings, what can be proposed? Concretely, more presence of the father. As a matter of fact, when the city of New York had it in the figure of Mayor Giuliani, the resulting consumption of drugs and criminality plunged. What about us? Well, we live a special moment after the implementation of the program "Zero Tolerance in Traffic." In 1 month, there was a 63% reduction in deaths! In my life, I had not seen such an epidemiologic impact caused by a law. Based on that, I suggest that we, psychiatrists and psychoanalysts, spread our points of view and favor the reinforcement of the father function at all levels - in the family, school, streets, State, through work in our offices, which we have always done, and in the community. In my opinion, we will be contributing to fighting the current epidemic.

crack

O , o pai e os psiquiatras e psicanalistas

Publication Dates

• Publication in this collection
  06 Jan 2009
• Date of issue
  Aug 2008