By Pulkit Sharma September 2011 How a young drug addict turned around her life when provided with a stable, empathetic therapeutic space I still remember being surprised when Ruby (name and some details changed) contacted me for psychoanalysis. Ruby had been a compulsive drug addict for more than four years, with multiple hospitalisations and rehabilitations but nothing had taken her off the drug. At that time, I had a negative opinion about drug addicts and was not comfortable working with them. However, she was motivated and carried hope that even though almost impossible, change was attainable. That hope touched me and persuaded me to give her a try. How it all started She took the drug for the first time at a party thrown by a classmate and was mesmerised by its soothing effects. Never in her life had she felt so calm and relaxed. Thereafter, she started taking it regularly. Very soon, the drug became her top priority. She lost her capacity to control her intake, would do anything to get it, progressively increased the dosage and began neglecting everything including relationships, studies and favorite pastimes. When her parents discovered this, she was hospitalised and treated but once she came out, she had a relapse. Both parents and the treating doctors suspected that she was too weak to give up the drugs she so enjoyed. Initially, I thought so too. In fact, I suspected that she would fail me by sabotaging the treatment. I considered terminating the therapy. However, I pulled myself up short when I recognised that I was beginning to think exactly like her parents did. It made me empathetic to Ruby’s predicament; how vulnerable she was to the possibility that those around her would write her off as no good and abandon her. This did turn out to be the case. Ruby’s parents were highly acclaimed professionals working in a creative industry. Having failed to conceive, they adopted Ruby when she was a few days old. However, they were disappointed that Ruby was not as beautiful, bright or creative as they were. Unconsciously, they distanced themselves from her. While she spent the first few days with her parents, very soon a caretaker was hired and Ruby began spending all her time with her. Though her parents ensured she got care and attention, they distanced themselves from her. She took the drug for the first time at a party and was mesmerised by its soothing effects. Never in her life had she felt so calm and relaxed. Thereafter, she started taking it regularly. Very soon, the drug became her top priority. As we delved into her unconscious mind, the trauma was revealed. There were hardly any memories she could recall of being cuddled, loved, appreciated or guided by her parents. All of us need good and secure relationships to depend upon early in life. Our capacity to be self-reliant depends largely on our network of stable relationships. Failure to get these creates a massive trauma and a lifelong search for something dependable. For some people, drugs fill in this vacuum. Overwhelming emotions Her caretakers changed jobs and there were multiple separations, further injuring her fragile psyche. Without the reliable presence of a soothing caretaker, Ruby never learnt to make sense of her feelings and contain them. All emotions, both positive and negative, were extremely overwhelming and she felt as if she would have a breakdown. The drug fulfilled this need for a soothing caretaker by relaxing her. After several sessions Ruby could understand and put her need into words: “You know doctor, though I’m a grown-up, I still yearn for someone strong to hold me like a baby. I feel I have never been held. I was just passed on from one person to another. My biological parents gave me away to my foster parents and they gave me away to the caretakers. I was always afraid of falling down and breaking into pieces. Whenever I felt like this, the drug would give me solace. No wonder I love it so much.” As she developed increased trust in our work and we understood her challenges, the need to go back to drugs decreased. However, Ruby was extremely sensitive to my absence and would either get enraged or depressed if I was unable to see her on the timings we had fixed. With time we were able to understand each other. Earlier when I was physically away, she found it hard to trust that I cared for her. Somewhere she feared that I may end up behaving like her parents and soon abandon her. Ruby also had a shattered self due to her strong rejection experience in childhood. She experienced intense hatred towards her own self. Self-love is necessary for psychological health. One develops self-love when one experiences being loved. The gleam in the mother’s eye is the first experience that one is special and loveable. Poor Ruby was denied this experience. She candidly admits: “In my dreams, people stare piercingly at me with hatred and sadness in their eyes until I bleed.” Throughout her life, Ruby distanced herself from others as she felt that if she were to get too close, they would find her ugly. Mourning the loss For many sessions she had a secret apprehension that I too found her ugly. It was only when she had traced its source to her parents’ early rejection, that she was willing to let it go. The process was quite difficult because some of the emotions she uncovered were unsettling. The work that we did offered her a reliable and trusting relationship where she could talk about her deepest fears and most negative feelings even if they were in relation to me. Apart from this, she could discover and express her strong unmet need – the need to be loved and admired. She mourned the loss and because it was received empathetically, she felt understood. And the light shines forth This was more than sufficient for her. Gradually, her robust and immaculate self emerged and she became a different person. Ruby subsequently finished her degree in social work and began helping out orphans, whom she felt really close to. She gave up drugs permanently. She married a person in whom she saw the hope of getting her relational needs fulfilled. She still struggled with love and hate towards her parents but was able to accept it as a part of the struggles of her authentic self. In one of our last sessions she reflected: “All I really needed was a reliable relationship where I felt loved, understood, admired and cared for. Now, I feel strong enough to find such a relationship.” I found those words to be very profound and felt that they conveyed the essence of psychoanalytic psychotherapy. We simply provide our clients with a relationship that is missing in their life and this kickstarts the process of growth, development and change. Ruby also taught me the value of trust. It was holding on to our mutual trust that carried us through the treatment. The treatment of drug use requires empathy and understanding. Drugs often serve an important psychological function for the user. Drug users are traumatised by helplessness, painful emotional states, and lack of a reliable relationship. Drugs help them in numbing this pain. It is important to acknowledge and accept these feelings and then encourage the person to develop more constructive ways of dealing with them. Dr. Pulkit Sharma is a psychoanalytical therapist and clinical psychologist at VIMHANS Hospital, Delhi.
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