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Identity disturbances in drug addicts
Drug and Alcohol Dependence, 7 (1981) 105 - 112 0 Elsevier Sequoia S.A., Lausanne - Printed in The Netherlands
IDENTITY
A. VENKOBA
DISTURBANCES
IN DRUG ADDICTS
RAO, P. M. VASUDEVAN
and N. NAMMALVAR
Institute of Psychiatry, Madurai Medical College, and Government Madurai 625 020 (India) (Received
August
105
Rajaji Hospital,
24,198O)
Summary Identity disturbances in a heterogeneous group of drug addicts (n = 30) were studied. Hirvas’ scale of identity, which is based on Erikson’s epigenetic theory of personality development was used. An equal number of normal individuals formed the control group. The identity confusion was studied in three dimensions: intrapersonal, interpersonal, and capacity for objective self-appraisal. Among the addicts a significantly high degree of identity disturbances was found in these three dimensions regarding areas of time perspective, sexual identity, leadership polarisation and ideological polarisation. The possible interrelationship between these disturbances and addictive behaviour is discussed.
Introduction Drug dependence is viewed as an ego-psychological problem by the psychoanalytically orientated theorists. It is the integrative functions of the Ego that determine harmony between one’s emotional needs and external environment. This integration is to a large extent determined by the individual’s current self-concept or his identity. Since the interrelationship between one’s inner psychic needs and social reality plays a major role in determining addictive behaviour a study of the identity disturbances among drug addicts appears relevant. The study was based on Erikson’s theoretical formulations of identity and its development. Erikson defines identity as “one’s ability to maintain inner continuity and sameness”. An individual’s identity at any particular moment is based on two simultaneous observations “the immediate perception of one’s self sameness and continuity in time and the simultaneous perception of the fact that others recognise one’s sameness and continuity” [l] Two components can be distinguished in Ego identity; the individual’s con-
106
cept about himself, namely his personal identity, and the concept other people close to him have of him, i.e. social identity. Integrity of personal identity depends on one’s capacity for objective self-appraisal, whereas social identity rests on one’s capacity to give a clear-cut picture of oneself to others. A comparison of the two gives a picture of the degree of identity integration or diffusion. Erikson adds that formation of the final adult identity is the result of successive stages of psychosocial development and that disturbances in identity are associated with disturbances due to psychosocial crises at the various stages of personality development. The epigenetic theory of Erikson formulates eight stages of development with the psychosocial polarities in each stage (see his Epigenetic Diagram of personality development, Scheme 1). They are Trust versus Mistrust in infancy, Autonomy versus Shame and Doubt in early childhood, Initiative versus Guilt in play age, Industry versus Inferiority in school age, Identity versus Identity Confusion in adolescence, Intimacy versus Isolation in young adult, Generativity versus Stagnation in adulthood, and Integrity versus Despair in mature age. It also shows how adult identity develops from the unipolarity of infancy, through bipolarity of early childhood when the child is able to identify himself apart from the environment; through play identification in play age and work identification in school age. Corresponding to the eight stages of development of personality eight major areas of identity with their polarities can be distinguished. They are Time Perspective versus Time Confusion, Self-certainty versus Self-consciousness, Role Experimentation versus Role Fixation, Apprenticeship versus Work Paralysis, Identity versus Identity Confusion, Sexual Polarization versus Bisexual Confusion, Leader and Followership versus Authority Confusion, and Ideological Commitment versus Confusion of Values. The present study was aimed at finding out the degree of identity disturbances in drug addicts in comparison to normals and to identify the specific areas significantly affected.
Material and method Thirty consecutive cases of addicts who attended the Institute of Psychiatry, Madurai Medical College and Government Rajaji Hospital, Madurai, between July 1978 and June 1979 formed the material for the study. The selection criteria included the absence of any primary psychiatric ailment and a duration of addiction of not less than 5 years. An equal number of normals, matched for age, sex and literacy formed the control group. All the probands were males and their ages varied from 20 to 40 years with a mean age of 26.7 at the time of consultation. The mean age at the commencement of their addictive behaviour was 17.4 years, with a range of 13 32 years. The agents involved were cannabis (in 12 individuals), alcohol (6),
Apprenticeship vs. work paralysis
Identity vs. identity confusion
I
II
III
IV
Trust vs. mistrust
Autonomy vs. shame, doubt
Initiative vs. guilt
Industry vs. inferioritv
Mutual recognition vs. autistic isolation
Will to be oneself vs. self-doubt
Anticipation of roles vs. role inhibition
Task identification vs. sense of futilitv
Sexual polarization vs. bisexual confusion
Role experimentation vs. role fixation
V
Self certainity vs. selfconsciousness
Intimacy vs. isolation
Temporal perspective vs. time confusion
from Erikson [ 21)
VI
VII
VIII
Epigenetic diagram of personality development (reproduced
SCHEME 1
Leader and followship vs. authority confusion
Generating vs. stagnation
Ideological commitment vs. confusion of values
Integrity vs. despair
108 TABLE
1
Significance
of differences
between
and normals
in D, , D.J and D, (n = 30)
Controls
Addicts
_
Dl D2 "3
addicts
Mean
S.D.
Mean
S.D.
24.10 34.63 31.00
6.55 8.60 8.55
18.60 27.64 24.25
5.90 9.15 7.60
t
P
3.44 3.10 3.23
0.01 0.01 0.01
cannabis and alcohol together (7), Mandrax, dexedrine and barbiturates in (2) and multiple agents (3). The psychometric tool employed was Hirvas questionnaire for identity. This questionnaire, formulated by Hirvas [ 31 on the basis of the epigenetic theory of Erikson, consists of 80 statements, ten questions covering each of the eight areas of identity with their polarities. Originally the scale was used by Hirvas [ 31 to study identity disturbances in a mentally ill population. Later Kuha [ 41 used it in a study of identity disturbances among tuberculosis patients. The procedure involves administration of the questionnaire to the cohort as well as to the spouse, and a friend or a close relative to obtain the individual’s concept of himself as well as how others close to him view him. Three sets of answers were thus obtained for each subject, indicating the subject’s concept of himself (C,), the subject’s concept of how other people close to him view him (C,), and what a spouse, close relative or friend really thinks of the subject (Ca). The scores in these three sets were compared with each other and the discrepancy was taken as a measure of identity diffusion. Three different dimensions of identity diffusion were arrived at: D, : discrepancy between scores C1 and Cp, i.e. the discrepancy between the subject’s concept of himself and his concept of how others view him. This measures the degree of intrapersonal identity diffusion. D2 : discrepancy between scores Cr and C3, i.e. the discrepancy between the subject’s concept of himself and what a person close to the subject thought of him. This measures interpersonal identity diffusion. Ds : discrepancy between C, and Cs, i.e. the discrepancy between the subject’s concept of how others view him and how others close to him actually do see him. This would indicate the extent of a subject’s lack of awareness of the concept other people have of him.
Results The addicts showed a significantly high degree of identity disturbance in all three dimensions - D1, D2 and Da - compared to the normals (Table 1). Significance was highest in D, , i.e. intrapersonal identity diffusion.
109
Analyses of the degree of diffusion in each of these dimensions in terms of areas are shown in Tables 2 - 4. For D1, which denotes intrapersonal identity, significant differences between the addicts and the control group were found in the areas of time perspective, sexual identity, leader and followership, and ideological commitment and confusion of values (Table 2). No significant differences were found in other areas of identity. For D,, which reflects interpersonal identity diffusion, a significant degree of identity disturbance was seen in the same four areas for Di , namely time perspective, sexual identity, leadership polarisation and ideological confusion (Table 3). Table 4 shows the results for Ds , which indicate that the differences are significantly higher in the four areas as in D, and Da, as well as in the area of self-certainty versus self-consciousness. This reflects the subject’s lack of awareness as to how other people view him with respect to all these five areas.
Discussion Sense of identity is one of the major functions of Ego and degree of identity integration can be considered as a reliable measure of the degree of psychosocial maturity. As can be seen from the results of the study there is definitely a significant degree of identity disturbance in drug addicts compared to normals (p value significant at 0.05). Significant disturbances were noticed in the spheres of personal identity, interpersonal identity and the capacity for objective self-appraisal, i.e. awareness by the addict of the concept others close to him have of him. Similar findings of disturbed self-concept were reported by Hirvas [ 31 among the mentally ill population and by Kuha [ 41 in his study of tuberculosis patients. In the present study the areas affected significantly are those of time perspective, sexual identity, leadership and authority, and confusion of values. Time diffusion denotes lack of positive future orientation. This negative future orientation implies a lack of selfconfidence and pessimistic outlook towards life in general. The failure to gain mastery over time has been attributed to faulty mothering in the infancy stage and consequent failure to develop basic trust [ 51. Disturbances in sexual identity would indicate the subject’s inability to take up the role of his sex as prescribed by society and culture, which means psychosexual immaturity. Leadership polarisation reflects one’s capacity for assuming responsibility and independence as well as discipline and constructiveness. Ideological polarisation reflects one’s ideological value systems such as political, religious, ethical, etc. It is interesting to note that, except for time perspective, all the areas affected are those which develop fully later in the developmental period, i.e. after adolescence. The general pattern noticed is that the later an area is in the developmental hierarchy the higher the degree of identity diffusion. This finding poses the interesting question of whether the disturbance in Ego
110 TABLE 2 Mean scores in different areas of D1 for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
SD.
Mean
SD.
3.20 2.40 2.66 3.10 3.66 2.71 2.51 3.71
0.71 0.62 1.52 0.90 0.80 0.72 0.63 0.80
2.60 2.10 2.16 2.90 3.13 1.71 1.49 1.81
0.82 0.92 1.01 1.01 1.00 0.64 1.40 0.69
t
P
2.97
1.47 2.30 0.66 2.29 5.56 3.09 3.27
0.01 0.10 0.10 0.10 0.05 0.01 0.01 0.01
t
P
4.20 1.20 2.00 1.31 1.79 3.55 5.06 5.44
0.01 0.01 0.10 0.10 0.10 0.01 0.01 0.01
t
P
3.36 1.50 3.16 1.45 0.75 3.31 3.62 4.54
0.01 0.10 0.01 0.10 0.10 0.01 0.01 0.01
TABLE 3 Mean scores in different areas of D, for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
SD.
Mean
S.D.
4.41 4.10 3.90 2.61 4.50 4.45 4.00 5.39
1.2 2.10 1.50 2.21 2.20 2.31 2.10 2.19
3.17 3.50 3.20 2.40 4.24 3.81 3.20 3.41
1.00 1.80 1.00 1.25 1.30 2.04 1.69 2.80
TABLE 4 Mean scores in different areas of Da for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
S.D.
Mean
S.D.
4.90 3.97
2.24 2.20 2.78 1.86 2.61 2.21 1.95 2.39
3.15 3.23 3.29 2.61 3.46 3.08 2.17 2.90
1.76 1.75 2.00 1.15 1.90 2.00 1.34 1.85
5.25 3.19 3.89 4.87 4.20 5.40
111
identity is the cause or the result of addictive behaviour. In our sample the mean age of the start of addiction was around 17 years, and 88% of the sample started their addictive behaviour between the ages of 13 and 25 years. This is the age when the Ego is faced with the problems of establishing its sexual identity, greater independence, leadership qualities and ideological identity. Psychodynamic theories maintain that addicts handle the conflicting problems of sexuality, dependency needs and aggression by passively avoiding the anxiety generated by these with the help of intoxicating agents. It is possible that adolescents and young adults who are unable to cope with these problems take refuge in addictive drugs. Viewing the problem from another angle, it may be hypothesized that indulgence in addictive behaviour at an early age has disrupted the normal development of an adolescent into a healthy adult resulting in identity disturbances. Observations put forward by Kolansky and Moore [6] based on their studies of adolescent cannabis addicts, are relevant here, especially since 67% of our sample consumed cannabis alone or in combination. According to Kolansky and Moore, physical and mental fatigue, confused thinking, defective judgement, and weakened determination, resulting from cannabis intoxication pose difficulties in establishing personal identity and independence, and in achieving psychosexual maturity and lead on to apathy and goallessness. We find in our sample that there is impairment of positive future orientation as evidenced in time diffusion. Also observed are the inability to take up responsibility, psychosexual immaturity, and lack of ideological integrity. It is conceivable that both these views, namely that it is the identity disturbances which lead to drug taking behaviour or it is the drug taking which has led to disturbed identity, are tenable and there may be interaction and interdependence between the two. Each may affect the other leading to a vicious circle; i.e. drug taking leading to increased identity diffusion which in turn aggravates the drug taking behaviour itself. It is difficult to isolate the effects of one mechanism on the other, and the present study does not help to establish any causal relationship between addiction and identity disturbances. However, the very fact that all the patients studied had been taking drugs over a long period (mean duration of drug taking for the group is 6.8 years) offers evidence for the possible operation of the vicious circle mentioned. The assessment of the areas of Ego malfunction as made in this study, can be of help in the psychotherapeutic approach to the problem of addiction and its secondary prevention. Therapy could be directed towards helping the person develop the capacity to see himself more objectively, thereby gaining more insight into the nature of his problems. This in turn would help establish a more integrated identity, in both personal and social aspects. A better integrated sense of identity fortifies the Ego and strengthens its ability to cope with problems of addiction as well as with many of the psychological factors that originally motivated the drug taking behaviour.
112
Acknowledgements Thanks are due to Dr. (Mrs.) S. Parvathi Devi, Dean, Madurai Medical College and Government Rajaji Hospital, Madurai, and to Dr. S. Gnanadesikan, Director of Medical Education, Madras, for their permission and encouragement .
References E. H. Erikson, Identity and Life Cycle: Psychological Issues, International University Press, New York, 1959. E. H. Erikson, Identity, Norton, New York, 1960. J. Hirvas, Identity and mental1 illness, Trans. Westermarck Sot., 12 (1966). S. Kuha, Identity disturbances in patients with pulmonary tuberculosis. Psychiatr. Fenn., (1973) 229 - 239. E. H. Erikson, Childhood and Society, Norton, New York, 1950. H. Kolansky and W. T. Moore, Toxic effects of chronic marihuana use. J. Am. Med. Assoc., 222 (1972) 35 - 41.
IDENTITY
A. VENKOBA
DISTURBANCES
IN DRUG ADDICTS
RAO, P. M. VASUDEVAN
and N. NAMMALVAR
Institute of Psychiatry, Madurai Medical College, and Government Madurai 625 020 (India) (Received
August
105
Rajaji Hospital,
24,198O)
Summary Identity disturbances in a heterogeneous group of drug addicts (n = 30) were studied. Hirvas’ scale of identity, which is based on Erikson’s epigenetic theory of personality development was used. An equal number of normal individuals formed the control group. The identity confusion was studied in three dimensions: intrapersonal, interpersonal, and capacity for objective self-appraisal. Among the addicts a significantly high degree of identity disturbances was found in these three dimensions regarding areas of time perspective, sexual identity, leadership polarisation and ideological polarisation. The possible interrelationship between these disturbances and addictive behaviour is discussed.
Introduction Drug dependence is viewed as an ego-psychological problem by the psychoanalytically orientated theorists. It is the integrative functions of the Ego that determine harmony between one’s emotional needs and external environment. This integration is to a large extent determined by the individual’s current self-concept or his identity. Since the interrelationship between one’s inner psychic needs and social reality plays a major role in determining addictive behaviour a study of the identity disturbances among drug addicts appears relevant. The study was based on Erikson’s theoretical formulations of identity and its development. Erikson defines identity as “one’s ability to maintain inner continuity and sameness”. An individual’s identity at any particular moment is based on two simultaneous observations “the immediate perception of one’s self sameness and continuity in time and the simultaneous perception of the fact that others recognise one’s sameness and continuity” [l] Two components can be distinguished in Ego identity; the individual’s con-
106
cept about himself, namely his personal identity, and the concept other people close to him have of him, i.e. social identity. Integrity of personal identity depends on one’s capacity for objective self-appraisal, whereas social identity rests on one’s capacity to give a clear-cut picture of oneself to others. A comparison of the two gives a picture of the degree of identity integration or diffusion. Erikson adds that formation of the final adult identity is the result of successive stages of psychosocial development and that disturbances in identity are associated with disturbances due to psychosocial crises at the various stages of personality development. The epigenetic theory of Erikson formulates eight stages of development with the psychosocial polarities in each stage (see his Epigenetic Diagram of personality development, Scheme 1). They are Trust versus Mistrust in infancy, Autonomy versus Shame and Doubt in early childhood, Initiative versus Guilt in play age, Industry versus Inferiority in school age, Identity versus Identity Confusion in adolescence, Intimacy versus Isolation in young adult, Generativity versus Stagnation in adulthood, and Integrity versus Despair in mature age. It also shows how adult identity develops from the unipolarity of infancy, through bipolarity of early childhood when the child is able to identify himself apart from the environment; through play identification in play age and work identification in school age. Corresponding to the eight stages of development of personality eight major areas of identity with their polarities can be distinguished. They are Time Perspective versus Time Confusion, Self-certainty versus Self-consciousness, Role Experimentation versus Role Fixation, Apprenticeship versus Work Paralysis, Identity versus Identity Confusion, Sexual Polarization versus Bisexual Confusion, Leader and Followership versus Authority Confusion, and Ideological Commitment versus Confusion of Values. The present study was aimed at finding out the degree of identity disturbances in drug addicts in comparison to normals and to identify the specific areas significantly affected.
Material and method Thirty consecutive cases of addicts who attended the Institute of Psychiatry, Madurai Medical College and Government Rajaji Hospital, Madurai, between July 1978 and June 1979 formed the material for the study. The selection criteria included the absence of any primary psychiatric ailment and a duration of addiction of not less than 5 years. An equal number of normals, matched for age, sex and literacy formed the control group. All the probands were males and their ages varied from 20 to 40 years with a mean age of 26.7 at the time of consultation. The mean age at the commencement of their addictive behaviour was 17.4 years, with a range of 13 32 years. The agents involved were cannabis (in 12 individuals), alcohol (6),
Apprenticeship vs. work paralysis
Identity vs. identity confusion
I
II
III
IV
Trust vs. mistrust
Autonomy vs. shame, doubt
Initiative vs. guilt
Industry vs. inferioritv
Mutual recognition vs. autistic isolation
Will to be oneself vs. self-doubt
Anticipation of roles vs. role inhibition
Task identification vs. sense of futilitv
Sexual polarization vs. bisexual confusion
Role experimentation vs. role fixation
V
Self certainity vs. selfconsciousness
Intimacy vs. isolation
Temporal perspective vs. time confusion
from Erikson [ 21)
VI
VII
VIII
Epigenetic diagram of personality development (reproduced
SCHEME 1
Leader and followship vs. authority confusion
Generating vs. stagnation
Ideological commitment vs. confusion of values
Integrity vs. despair
108 TABLE
1
Significance
of differences
between
and normals
in D, , D.J and D, (n = 30)
Controls
Addicts
_
Dl D2 "3
addicts
Mean
S.D.
Mean
S.D.
24.10 34.63 31.00
6.55 8.60 8.55
18.60 27.64 24.25
5.90 9.15 7.60
t
P
3.44 3.10 3.23
0.01 0.01 0.01
cannabis and alcohol together (7), Mandrax, dexedrine and barbiturates in (2) and multiple agents (3). The psychometric tool employed was Hirvas questionnaire for identity. This questionnaire, formulated by Hirvas [ 31 on the basis of the epigenetic theory of Erikson, consists of 80 statements, ten questions covering each of the eight areas of identity with their polarities. Originally the scale was used by Hirvas [ 31 to study identity disturbances in a mentally ill population. Later Kuha [ 41 used it in a study of identity disturbances among tuberculosis patients. The procedure involves administration of the questionnaire to the cohort as well as to the spouse, and a friend or a close relative to obtain the individual’s concept of himself as well as how others close to him view him. Three sets of answers were thus obtained for each subject, indicating the subject’s concept of himself (C,), the subject’s concept of how other people close to him view him (C,), and what a spouse, close relative or friend really thinks of the subject (Ca). The scores in these three sets were compared with each other and the discrepancy was taken as a measure of identity diffusion. Three different dimensions of identity diffusion were arrived at: D, : discrepancy between scores C1 and Cp, i.e. the discrepancy between the subject’s concept of himself and his concept of how others view him. This measures the degree of intrapersonal identity diffusion. D2 : discrepancy between scores Cr and C3, i.e. the discrepancy between the subject’s concept of himself and what a person close to the subject thought of him. This measures interpersonal identity diffusion. Ds : discrepancy between C, and Cs, i.e. the discrepancy between the subject’s concept of how others view him and how others close to him actually do see him. This would indicate the extent of a subject’s lack of awareness of the concept other people have of him.
Results The addicts showed a significantly high degree of identity disturbance in all three dimensions - D1, D2 and Da - compared to the normals (Table 1). Significance was highest in D, , i.e. intrapersonal identity diffusion.
109
Analyses of the degree of diffusion in each of these dimensions in terms of areas are shown in Tables 2 - 4. For D1, which denotes intrapersonal identity, significant differences between the addicts and the control group were found in the areas of time perspective, sexual identity, leader and followership, and ideological commitment and confusion of values (Table 2). No significant differences were found in other areas of identity. For D,, which reflects interpersonal identity diffusion, a significant degree of identity disturbance was seen in the same four areas for Di , namely time perspective, sexual identity, leadership polarisation and ideological confusion (Table 3). Table 4 shows the results for Ds , which indicate that the differences are significantly higher in the four areas as in D, and Da, as well as in the area of self-certainty versus self-consciousness. This reflects the subject’s lack of awareness as to how other people view him with respect to all these five areas.
Discussion Sense of identity is one of the major functions of Ego and degree of identity integration can be considered as a reliable measure of the degree of psychosocial maturity. As can be seen from the results of the study there is definitely a significant degree of identity disturbance in drug addicts compared to normals (p value significant at 0.05). Significant disturbances were noticed in the spheres of personal identity, interpersonal identity and the capacity for objective self-appraisal, i.e. awareness by the addict of the concept others close to him have of him. Similar findings of disturbed self-concept were reported by Hirvas [ 31 among the mentally ill population and by Kuha [ 41 in his study of tuberculosis patients. In the present study the areas affected significantly are those of time perspective, sexual identity, leadership and authority, and confusion of values. Time diffusion denotes lack of positive future orientation. This negative future orientation implies a lack of selfconfidence and pessimistic outlook towards life in general. The failure to gain mastery over time has been attributed to faulty mothering in the infancy stage and consequent failure to develop basic trust [ 51. Disturbances in sexual identity would indicate the subject’s inability to take up the role of his sex as prescribed by society and culture, which means psychosexual immaturity. Leadership polarisation reflects one’s capacity for assuming responsibility and independence as well as discipline and constructiveness. Ideological polarisation reflects one’s ideological value systems such as political, religious, ethical, etc. It is interesting to note that, except for time perspective, all the areas affected are those which develop fully later in the developmental period, i.e. after adolescence. The general pattern noticed is that the later an area is in the developmental hierarchy the higher the degree of identity diffusion. This finding poses the interesting question of whether the disturbance in Ego
110 TABLE 2 Mean scores in different areas of D1 for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
SD.
Mean
SD.
3.20 2.40 2.66 3.10 3.66 2.71 2.51 3.71
0.71 0.62 1.52 0.90 0.80 0.72 0.63 0.80
2.60 2.10 2.16 2.90 3.13 1.71 1.49 1.81
0.82 0.92 1.01 1.01 1.00 0.64 1.40 0.69
t
P
2.97
1.47 2.30 0.66 2.29 5.56 3.09 3.27
0.01 0.10 0.10 0.10 0.05 0.01 0.01 0.01
t
P
4.20 1.20 2.00 1.31 1.79 3.55 5.06 5.44
0.01 0.01 0.10 0.10 0.10 0.01 0.01 0.01
t
P
3.36 1.50 3.16 1.45 0.75 3.31 3.62 4.54
0.01 0.10 0.01 0.10 0.10 0.01 0.01 0.01
TABLE 3 Mean scores in different areas of D, for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
SD.
Mean
S.D.
4.41 4.10 3.90 2.61 4.50 4.45 4.00 5.39
1.2 2.10 1.50 2.21 2.20 2.31 2.10 2.19
3.17 3.50 3.20 2.40 4.24 3.81 3.20 3.41
1.00 1.80 1.00 1.25 1.30 2.04 1.69 2.80
TABLE 4 Mean scores in different areas of Da for addicts and controls Areas
Time diffusion Role Self-certainty Achievement Identity Sexual Leadership Ideological
Addicts
Controls
Mean
S.D.
Mean
S.D.
4.90 3.97
2.24 2.20 2.78 1.86 2.61 2.21 1.95 2.39
3.15 3.23 3.29 2.61 3.46 3.08 2.17 2.90
1.76 1.75 2.00 1.15 1.90 2.00 1.34 1.85
5.25 3.19 3.89 4.87 4.20 5.40
111
identity is the cause or the result of addictive behaviour. In our sample the mean age of the start of addiction was around 17 years, and 88% of the sample started their addictive behaviour between the ages of 13 and 25 years. This is the age when the Ego is faced with the problems of establishing its sexual identity, greater independence, leadership qualities and ideological identity. Psychodynamic theories maintain that addicts handle the conflicting problems of sexuality, dependency needs and aggression by passively avoiding the anxiety generated by these with the help of intoxicating agents. It is possible that adolescents and young adults who are unable to cope with these problems take refuge in addictive drugs. Viewing the problem from another angle, it may be hypothesized that indulgence in addictive behaviour at an early age has disrupted the normal development of an adolescent into a healthy adult resulting in identity disturbances. Observations put forward by Kolansky and Moore [6] based on their studies of adolescent cannabis addicts, are relevant here, especially since 67% of our sample consumed cannabis alone or in combination. According to Kolansky and Moore, physical and mental fatigue, confused thinking, defective judgement, and weakened determination, resulting from cannabis intoxication pose difficulties in establishing personal identity and independence, and in achieving psychosexual maturity and lead on to apathy and goallessness. We find in our sample that there is impairment of positive future orientation as evidenced in time diffusion. Also observed are the inability to take up responsibility, psychosexual immaturity, and lack of ideological integrity. It is conceivable that both these views, namely that it is the identity disturbances which lead to drug taking behaviour or it is the drug taking which has led to disturbed identity, are tenable and there may be interaction and interdependence between the two. Each may affect the other leading to a vicious circle; i.e. drug taking leading to increased identity diffusion which in turn aggravates the drug taking behaviour itself. It is difficult to isolate the effects of one mechanism on the other, and the present study does not help to establish any causal relationship between addiction and identity disturbances. However, the very fact that all the patients studied had been taking drugs over a long period (mean duration of drug taking for the group is 6.8 years) offers evidence for the possible operation of the vicious circle mentioned. The assessment of the areas of Ego malfunction as made in this study, can be of help in the psychotherapeutic approach to the problem of addiction and its secondary prevention. Therapy could be directed towards helping the person develop the capacity to see himself more objectively, thereby gaining more insight into the nature of his problems. This in turn would help establish a more integrated identity, in both personal and social aspects. A better integrated sense of identity fortifies the Ego and strengthens its ability to cope with problems of addiction as well as with many of the psychological factors that originally motivated the drug taking behaviour.
112
Acknowledgements Thanks are due to Dr. (Mrs.) S. Parvathi Devi, Dean, Madurai Medical College and Government Rajaji Hospital, Madurai, and to Dr. S. Gnanadesikan, Director of Medical Education, Madras, for their permission and encouragement .
References E. H. Erikson, Identity and Life Cycle: Psychological Issues, International University Press, New York, 1959. E. H. Erikson, Identity, Norton, New York, 1960. J. Hirvas, Identity and mental1 illness, Trans. Westermarck Sot., 12 (1966). S. Kuha, Identity disturbances in patients with pulmonary tuberculosis. Psychiatr. Fenn., (1973) 229 - 239. E. H. Erikson, Childhood and Society, Norton, New York, 1950. H. Kolansky and W. T. Moore, Toxic effects of chronic marihuana use. J. Am. Med. Assoc., 222 (1972) 35 - 41.