4inquiries (4inquiries) wrote in psychoanalysts,

Leys on Drug Therapy

From “Splinting the Mind: William Sargant and Cartharsis in World War II” in Trauma: A Genealogy (2000):

In Trauma: A Genealogy Ruth Leys tells us about “the British psychoanalyst, Victor Horsley, who in the 1930s had invented ‘narcoanalysis’ by substituting barbiturate abreaction for hypnotic catharsis in certain cases of neurosis” (192). Horsley “was the first to combine a chemical approach with the psychodynamic concepts of conflict, repression, and amnesia” (198).

Horsley emphasized the classical goals of integrating alienated psychic material (overstimulating memories) as opposed to releasing overstimulation with strong emotional expression. Leys emphasizes that it is not clear that this opposition holds up. However, the opposition was important for Horsley’s drug therapy technique, particularly in determining dosages, “Horsley presented the distinction between the drug-analytic method and narcoanalysis proper as in part a question of drug dosage” (199). Light dosages (narcoanalysis proper) best allow a patient to acknowledge overstimulating memories and conflicts, but heavy dosages (drug-analytic) best allow a patient to express or externalize overstimulation; it is not clear what the agent of the cure is, except that the poisonous overstimulation must be touched upon once more for a curative effect. In this sense we can agree with Leys strong suspicion that there is no real difference between the drug-analytic method and narcoanalysis proper; at best we might say that they are two different ways of doing the same hair-of-the-dog therapy.

Leys shows us that Horsley’s opposition between two kinds of drug therapy functioned to preserve the authority of psychoanalysis, though we also learn that dissident analysts used the opposition between the two kinds of drug therapy in order to distance themselves from psychoanalysis. On this point Leys introduces William Sargant, who drew from Horsley. Though Sargant opposed the Freudian emphasis on psychodynamics, Sargant “rediscovered the method of cathartic abreaction that Breuer and Freud had first introduced in the 1890s to treat hysteria and that during World War I had been revived by William Brown and others to treat the shell-shocked patient” (192). Sargant’s experience with treating trauma with drugs led him to the very technique that Horsley rejected, the drug-analytic technique of shocking the patient with drugs to encourage psychological stability through abreaction. At first, “when Sargant encountered psychiatric casualties from Dunkirk he recognized in their symptoms the same clinical features of the traumatic neuroses whose prototype was the railway neurosis and that had already been described as shell shock in World War I” (191). Leys relates the specific aesthetics of trauma with which Sargant worked; traumatized soldiers were “hysterically mute, hands shaking, and with a nervous paralysis of the bladder,” or might have “gross bodily tremors, total paralysis of the right hand, and an almost complete loss of recent memory” (191). In general Leys offers us “the characteristic signs of shell shock - mutism, loss of sight or hearing, spasmodic convulsions or trembling of the limbs, anesthesia, exhaustion, sleeplessness, depression, and terrifying, repetitive nightmares” (84). Sargant tried injecting “the barbiturate drug, sodium amytal” and when symptoms were alleviated, Sargant “gave injections of the same drug to other hysterical cases, and again they worked” (191).

Why did the drugs work? Some soldiers suddenly had access to memories while others suddenly were able to express their strong feelings - were these agents or effects in the stabilization of the patient? What part of the drug treatment cured people? Perhaps the truth of trauma for the patient is formative of the curative aspect, because only biographical details make a patient’s specific placements of numbness intelligible, and “barbiturates did not always work” (201). However, “Sargant claimed that if the reliving of an actual incident did not bring about relief, invented situations could be successfully employed to cure the patient,” and fictions could even bring more success than the truth for Sargant - “Sargant claimed that the abreaction of false memories might be more effective than the abreaction of real memories in achieving therapeutic success” (202, 203). This leads Leys to offer us characterizations of Sargant such as “Sargant’s anti-Freudian, physiological approach to trauma,” but Freud acknowledges the effectiveness of Sargant’s kind of approach (208). In “Constructions in Analysis” Freud tells us, “Often enough it [the analyst’s construction] fails to lead the patient to recall what has been repressed. In lieu of that, through the correct conduct of the analysis, we succeed in firmly convincing him of the truth of the construction, and therapeutically this achieves the same result as regaining a memory,” so we cannot dismiss Sargant as simply anti-Freudian or entirely physiological (85). At times Leys, too, acknowledges that “Sargant’s conceptualization of abreaction was ambiguous through and through,” not clearly in opposition to psychoanalysis (196).

Leys cuts through the confusion surrounding narco-abreactive cures by showing that in every case of successful abreactive therapy, “shock was cured by shock” (209). Again we are seeing the hair-of-the-dog therapy, since people in shock are treated with shock to positive effect. The association between drug therapy and electro-shock therapy reoccurs through the history of psychoanalysis for both advocates and critics of psychoanalysis, and even “Sargant compared his abreactive methods to the electrical or faradic treatments used in World War I” (210). Shock through electricity and shock through drugs can even be compounded to better effect, since “one of the main practitioners of the faradic method in Brain, L.R. Yealland... even recommended anesthetizing the patient in order to make the authoritative suggestions more effective” (210). Again you either need to remember the trauma to cure it or otherwise reach the same emotional intensity/modality as the trauma. So on one hand mental collapse is the problem, but on the other hand Sargant “repeatedly stressed the importance of that mental collapse, pointing out the frequency of its occurrence in the work of others who had used abreaction, such as Brown in World War I” (210-211). It is as if Sargant understands that mental collapse is the means of cure and drugs/analysis are only means to a curative mental collapse, since “Sargant constantly stated the need to try different drugs or combinations of drugs in order to achieve the desired result, as well as the necessity of tailoring the therapeutic approach to the individual case” (217). Leys attempts wittily to disregard these therapeutic successes because they did not permit soldiers to return to the war without symptoms returning, “Cure by means of emotional discharge? Cure by means of military discharge would be closer to the truth” (219). Yet military discharge alone was not able to cure soldiers, since some discharged soldiers had come back with lasting shell-shock symptoms. Some kind of breakdown is needed to stabilize people who have had a breakdown. So when Sargant’s opponents thought it best to “disparage Sargant’s use of false scenarios to stimulate abreaction, suggesting that he might well have exposed his patients to retraumatization,” it is precisely exposure to retraumatization that cures trauma (227).

Leys gives us a hint of the direction of narco-abreaction therapy after Horsley and Sargant set up an impossible opposition for future therapists to inherit. In the 1940s “Roy Grinker’s and John Spiegel’s psychoanalytically oriented abreaction method... used barbiturates to obtain very emotional reenactments of the traumatic scene” (195). In an unprecedented violation of the analyst’s supposed neutrality, though, Grinker’s and Spiegel’s “narcosynthesis” held that “the therapist must himself enter into the hypnotic performance, imitating various roles in order to help the narcotized patient reexperience the traumatic event in its original intensity” (195). Again we have remained with the Freudian principle that reexperiencing a trauma is a cure for trauma, but now the therapist can be personal for the sake of psycho-dramatic therapy. Grinker and Spiegel described the results of a drug-induced collapse with the words, “The stuporous became alert, the mute can talk, the deaf can hear, the paralyzed can move, and the terror-stricken psychotics become well organized individuals” (quoted on 211). Because of this success with drug-induced psycho-drama, the personalization of the analyst will become a consistent theme in narco-abreaction therapy.
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