ABSTRACT
Rob Hale, a psychiatrist as well as a psychoanalyst, describes thirteen years as a consultant to staff at a drug dependency unit. The unit he describes is a prescribing one, and methadone is prescribed to heroin addicts. The clinic walks a tightrope between an unrealistic expectation that patients will become clean and a more realistic awareness that for many of their patients this will not be the outcome. Some patients use the clinic in a corrupt way, buying and selling their methadone scripts.
This chapter describes some of the difficult emotions engendered by the work: frustration, hopelessness, and despair. This is similar to that described by Susannah Rose in her chapter (chapter nine) on working on an eating disorders unit. Rose describes the pain of seeing attractive, intelligent young people who have reduced themselves to skin and bone.
Hale uses Glasser’s theory of the core complex to understand the addict’s terror of relationships. He suggests that there is a parallel between the perverse person’s need of his perversion and the addict’s need of his drug. If perversion fails as a defence, the individual 200 may resort to violence—suicide or murder—to protect himself from psychic disintegration. In an earlier chapter ( chapter six ), Hale took us into the mind of a murderer.
What does the drug dependency unit have to offer the patients instead of their drugs? The answer is that it needs to offer what Hale offers the unit—emotional containment, in the sense described by Bion. This theory describes how mothers help babies cope with overwhelming feelings. These feelings are projected into the mother, who processes them in her own mind and returns them to the baby in a more digestible form. For containment to take place, the mother or worker needs to be disturbed or unsettled by what is experienced, but then to be able to process this disturbance. Hale only visited for an hour a week, but the workers started to pick up psychoanalytic ideas. These ideas have a containing function, making the experiences of the patients meaningful to the workers.
