Where Addiction Meets Your Brain

The Neurobiology of Addiction

Addiction and Projective Identification

Self-care and an understanding of projective identification.

Blogging about projective identification is a bit daunting because not everyone agrees about the definition or what projective identification actually means. Like any hypothetical construct, it can mean more or less what you want it to mean, but I would like to use the following definition: “The attempt by the patient/client to directly transfer an emotion to the purported helper/healer or friend or family member.” I like to think of it as an attempt by the addicted person to inject the one who is trying to help with a hypodermic and transfer some of the addict’s painful soul and emotions to that person whether the helper wants it or not. Experienced psychotherapists are able to have you do the injection into a transparent plastic bag rather than their buttock. Family and friends are not able to do this deflection very well, generally. Once the emotion is injected, it has major side effects and can make the helper person sick or emotional if successfully injected. If the vitriol can be contained in the plastic bag, it can be examined and defused or dehydrated or whatever. That’s why they train people to handle such encounters.

In addiction treatment, the overarching projective identification injection is a large dose of anger diluted in shame and guilt. The addicted person says: “I don’t need help. I can do this myself (You and your offers to help are worthless) because I’ve had treatment/help before and it didn’t work (I’m a failure, you are a failure, and this is hopeless anyway.) ““My psycho-pharmacologist in Manhattan told me I should be on benzodiazepines and stimulants, and you are taking me off of them (so you don’t know anything and you are just a therapist/family-member even though you might be right since I’m here in your office/home and not in Manhattan.)” “You’re not doing anything to help me. (I’m afraid. Please reassure me that what you are telling me is going to help and that you are concerned.)”

You get the idea. It is easy to attack someone who is trying to help you or who loves you at his/her most vulnerable places and cast self-doubt on the person who is trying to be there for you. As an addict, you can make helpers fell pretty badly. The helper/ family member thinks: “Maybe I’m not helping despite my good intentions and desire to do the right thing.”

It hurts the helper/family member to sucker-punch them in the stomach and give them the “anger/guilt-injection.” It may feel good temporarily to feel that you are suffering more that they are. ( ”my anger shows you how little you care about me.”

So what to do? This is a blog and not a psychoanalysis session, but at some level it is important to not tee off on people who are trying to help you. There is some entertainment value in recognizing how adept a therapist or family member may be at blocking a punch directed at their soul and life’s work. Sometimes picking a fight with someone who is trying to help you makes you feel better temporally. It shows how much pain you have and how weak the person who is trying to help you out really is. One of my old professors used to say that “if you wrestle with pigs, you get dirty and the pigs enjoy themselves.” I am in no way attempting to say that you, the addicted patient/client are a pig. What I am saying is that projective identification makes you want to pick a fight that is aimed to take a shot at the person who is helping you. The helper who knows to deflect your anger and shame is well trained. But it can be avoided if you have some awareness of this hypothetical construct. It is not that you should not have differences with your therapist or family member. However, you are supposed to be getting help, not starting a brawl.

So you’re scared. Join the club. Having any illness, especially addiction, is a pain and has a lot of grief and shame associated with it. You may want others to feel that pain, but just use your words and say how much it hurts. Attack mode makes it harder and more painful for everyone. When the other person doesn’t understand projective identification, somebody generally gets hurt.

Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.
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