BINGEING ON SOBRIETY: WHITE HOLES, BLACK HOLES AND TIME'S ARROW IN THE INTRA-PSYCHIC WORLDS OF ADDICTED AND SUBSTANCE ABUSING PATIENTS

摘要

Every psychotherapist working in the challenging field of the addictions is familiar with patients who yo-yo between extended periods of abstinence from substances, or other compulsive and non-substance-based addictive behaviours, and who then lapse or relapse to compressed periods of excessive substance misuse, the so-called binge episode. In this paper we reverse the lens of theoretical focus somewhat, from its more traditional position within the clinical field of addiction. We suggest that periods of abstinence from substance misuse, or other compulsive behaviours, may also represent a type of binge-like behaviour which satisfies, for a time, core needs though which may also invariably be non-sustainable if the underlying psychodynamic processes underscoring such repetitive abstinence binges are not explored and translated, in work with the patient. Linkage will also be made between poles of experience that addicted and substance abusing patients evince, which are here termed black holes (Sweet, 2012) and white holes (Miller, personal communication, 2015). These proposed intra-psychic structures are, it is asserted, intimately related to the ability, or not, of the individual to bear psychological pain and distress, tolerate separation from objects at both an inter-personal and intra-psychic level and to delay gratification of instinctually grounded desires and wishes. The authors reference Hopper's (1995) previous description of both black holes and white holes in the addictions, and Glasser's (1979) conception of the black hole in relation to perversion and his description of the 'core complex', drawing out both similarities and differences in the viewpoints presented. Key ideas in the paper are illuminated and contextualized through the presentation of a number of illustrative clinical examples.