The Failure of Separation and Individuation in Adolescence Leading to Addictions

Abstract

As addictive behaviours are prevalent during adolescence, our article attempts to extend the understanding of addictions by assessing changes in aspects of separation-individuation theory and the relation of those to addictions (alcohol, substance use and virtual addictions)—investigating the quality of the relationships of these cases. Our hypothesis is that there is a relationship between failure of the successful separation-individuation stage during the child’s developmental period and addictions later on during adolescence period. Our study is based on empirical data deriving from projective tests, the Rorschach 10 inkblot test, of patients experiencing that type of relationship patterns, their separation from the primordial object and their capacity to mentalize. This empirical study explores the psychological profile of two adolescents with addiction. A sample of two adolescents (16 and 17 years old) whose addictive behaviour had provoked difficulties in their educational and family environment was engaged in psychoanalytic psychotherapy sessions. Two Rorschach’s inkblot tests were administrated in the initial session in order to relate patients to their addictive behaviour and to examine the relation of separation-individuation phases with the ability to mentalize and the addiction patterns of the above persons. Results suggested that there is a correlation between separation-individuation and proneness to addictive behaviour which can imply that adolescents with failure of separation-individuation processes are more likely to develop addictive behaviours due to non-internalized secure objects during childhood and to failure of mentalizing.

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Stavrou, P. (2022) The Failure of Separation and Individuation in Adolescence Leading to Addictions. Psychology, 13, 1314-1334. doi: 10.4236/psych.2022.138085.

1. Introduction

Separation-individuation is a vital organizational process of the human intrapsychic evolution and defines the interpersonal lifecycle of human beings, considering changes in self and object representations (Mahler et al., 1975). Although separation-individuation is seen as a developmental stage during childhood (Mahler et al., 1975), it underpins the renegotiation of family relationships, progressively impacting the ability for independence and autonomy in the context of ongoing relationships both within the family and the wider environment.

In adolescence, the detachment from internalized objects leads to the discovery of new objects in familial surroundings in order to shed parental dependencies. In early childhood, though, during the separation-individuation phase, the child separates from a concrete object, the mother, or the caregiver in general (Blos, 1967). As Blos (1967) states, “this was achieved through the process of internalization that gradually facilitates the child’s growing independence from the mother’s presence, her ministrations, and her emotional supplies as the chief and sole regulators of psychophysiological homeostasis”. The ability for internalization and, therefore, individuation entails an ability to act of one’s own accord and to assume responsibility for one’s own actions, choices and decisions. On the contrary, often struggling in the process of individuation, adolescents are anecdotally known to resort to attributing “the blame” on others, often denigrating and debasing parental figures. The inability to separate from his internal objects except by detachment, rejection, and debasement is already a sign of alienation (Blos, 1967).

The experience of the anxiety produced by separation from close attachment figures is classified as normal and adaptive in early childhood (Bowlby, 1973). However, separation anxiety is presented as a pathological emotional state into later childhood, adolescence and young adulthood and can often be comorbid with anxiety and personality disorders (Milrod et al., 2014). The main feeling, in the beginning, is the difficulty for the child to function in the absence of the mother (Bowlby, 1988), which difficulty can reappear later on and become entrenched under new circumstances.

From a clinical perspective, the use of substances is a way, as addicts admit, to decrease internal anxiety (De Leon et al., 1973; Woody et al., 1975). For this reason, addiction becomes a “solution” that serves many purposes, one of which is the anxiety during adolescence, a period during which the young adult needs to “separate” from his family.

2. First Theory of Separation and Individuation: The Period of Infancy

Individuation defines mostly the adolescence period because it refers to a process “by which a person becomes increasingly differentiated from a past or present relational context” (Karpel, 1976). During this period, the adolescent has a certain mission to set new boundaries for himself and for his environment. Individuation describes a process whereby one forms self-other boundaries and internal representations to reassure independency (Stey et al., 2014). The child is moving gradually away from the dependency on the mother to obtain his own autonomy. The process has been developed by Margaret Mahler as a mental separation of the child from the mother and as an important part of the individual to cultivate a self-concept. Although this process was developed first in order to explain the “psychological birth” of the child during the first years of infancy, it has also been acknowledged during the adolescence and young adult period, as a “second phase”. It goes without saying that issues of self-governance reappeared during puberty (Blos, 1962; Josselson, 1980). Should this separation-individuation fail, certain risks might appear leading to significant concern.

Mahler’s separation and individuation theory was supplementary to Freud’s libido theory (Mahler et al., 1975) and was also influenced by psychoanalytic ideas, such as Winnicott’s theory of the self and Jacobson’s formulations of self and object world. Separation cannot be mentioned without the attachment theory. According to Bowlby’s attachment theory, the child develops internal models as well as models of what one can expect from relationships on the basis of the first relationship with the mother or the caregivers (Bowlby, 1973). Attachment reflects the quality of the affective bond between the child and the mother and it can be either secure or insecure. The continued and secure attachment to the primary object was for Mahler, an essential point to the process of separation-individuation because it organizes the internal world of the subject.

According to Mahler’s theory (Mahler et al., 1975), the child experiences three crucial phases: a non-object phase (autism), a pre-object phase (symbiosis) and an object phase (separation-individuation). This means that there is a slow intrapsychic transformation that leads, firstly, through separation to a world of pure reality, as regards the child’s own deficits and their primary love objects (caregivers/parents) and secondly, as knowledge of his own conquers and characteristics that mark his individuality. This first hypothesized phase describes the child without any object, as a merely physiological human being, with no differentiation between internal and external reality (Mahler & La Perriere, 1965) during the first two months of life.

The next phase, namely the “normal symbiotic state”, was crucial for Mahler’s theory. In this phase, the new-born behaves as though “he and his mother were an omnipotent system—a dual unity within one common boundary” (Mahler et al., 1975). Mahler (1952) started to use the term “symbiosis” from biology, in order to describe the phase of object relationship during infancy (3 months to 1 year), whereby the child acts as a single system with the mother. There is no differentiation between the child and the mother; both self and object are fused in which fusion of the “I” is not yet distinguished from the “not-I”. As the child grows, the separation and individuation process continues, with its peak around the age of eighteen months, when the child develops the capacity to walk which physically separates him from the mother. Gradually, the child separates intra-psychically from the mother, as he introjects the self-object unit into both parts, “I” and “not-I”. The stable presence of the mother is vital, physically and psychically, as Winnicott described in his concept of “a good-enough mother” (Winnicott et al., 1953). The phase of separation-individuation begins at the peak of the symbiotic stage and it consists of two interdependent processes, the individuation and of separation.

It is the child’s autonomous movement that takes him both physically and psychologically away from the mother, along with the agonizing fear of losing the mother, which leads him to further internal growth. The outcome of a successful separation-individuation leads to the establishment of a secure sense of identity in the child and the ability to develop non-symbiotic object relationships. This unfolds into the fourth and final phase which is characterized by the “unfolding of complex cognitive functions: verbal communication, fantasy, and reality testing” (Mahler & La Perriere, 1965). This final phase of Mahler’s observation coincides with Erikson’s (1968) concepts of identity and identity crisis during adolescence. Erikson emphasizes that during that period, the subject must be accepted by the community and be placed in the historical time he belongs. Therefore, the identity is a part of the society and the individual recognizes himself also through the communal culture. In summary, the child and the adolescent begin gradually to be undifferentiated through sequential phases toward self-other differentiation. This allows the subject to separate himself from his external mother by internalizing her as a psychic/internal representation (Mahler’s theory). It is only when he leaves the past behind that he can find his individuality and forms his identity in the community (Erikson’s theory).

Overall, the purpose of separation-individuation is the definition of self and object representations, an intrapsychic process depending on the availability of the mother, especially on her emotional availability. This normal process of separation-individuation happens when the child is ready, by its development, to act autonomously (separated) and take pleasure at the same time. Separation-individuation can overall be defined as the developmental process organizing the internal world, which starts with the birth of the infant and continues until the development of the object constancy.

The second individuation theory (Blos, 1962, 1967) suggests that the separation-individuation process does not only apply during early life, but also resurfaces anew during the adolescence period. Blos (1962, 1967) insists on the intrapsychic separation that also Mahler describes in her theory, and not as a literal detachment, as will be discussed in the next sections. Mahler and Blos agree that the challenge of the “separation-individuation process” is the gradual acquisition of the feeling of being separated, with the difference that sexuality and narcissism is the first pages of adolescence.

3. Second Theory of Separation-Individuation: The Period of Adolescence

The task of separation during the separation-individuation process is a challenging one for both parents and adolescents. Adolescents are required to continue certain cultural habits, but also need to build upon their own narcissistic forces and behaviors. The passage from childhood to adolescence is not only due to sexuality, as Freud suggested (1905), but also, because of the transformation of childhood understandings, to adolescent notions through the progression of separation-individuation process. Primary individuation is achieved/com- pleted by the age of three (Mahler et al., 1975). However, this self-other differentiation is re-examined in a second individuation process in adolescence (Blos, 1979).

Blos (1962, 1967) writes that adolescence is a period of a second separation - individuation process which is mainly in the intrapsychic procedure. Adolescence is a crucial period because of continuous internal, external and familial changes, as the young person prepares to “leave home”, establishes his own world and becomes an independent adult. Adolescents undergo an internal transition, as they need to explore their roles, create new relationships outside the entourage and gradually begin to work towards developing a robust identity (Blos, 1979; Erikson, 1968). On this developmental trajectory, individuation equips the young person with the ability to function autonomously free from external pressure and control. The fostering of these changes by the family environment supports a healthy separation whilst maintaining existing relationships. Blos (1962, 1967) foresees the necessarily narcissistic dimension of the link to oedipal objects during adolescence, while Mahler only mentions the dyad child/mother. However, this pre-oedipal dyad benefits Blos in establishing the link between adolescence and regression. According to him (Blos, 1962), even though the adolescent has abandoned the first object of love, she/he regresses later on. By regression, the adolescent goes back to an infantile position. The core is the simple repetition of the first separation-individuation (0 - 3 years old) that can explain the substance use during adolescence as a result of the revival of the primitive relationship with the mother.

On the other hand, interpersonal conflict is a central aspect of adolescence due to the anxiety emanating from separation and a worry around change and loss in the family. Unresolved disagreement may appear and give rise to a range of psychological difficulties. Addiction is one of those presentations whereby a difficulty in negotiating separation from one’s parents leads the adolescent to resort to provocative behaviour and withdrawal from relating to others. As the need for individuation emerges, in order to differentiate himself from his family, the young teenager adopts a substance-using need, which can be a form of many indicators. When an adolescent, due to family pressures that occurred during that period, struggles to achieve independence and separation, substance-using behaviour is embraced and rigid family affiliations can be preserved over the years (Levine, 1985).

4. Separation-Individuation and the Mediating Role of Mentalization

As previously mentioned, the detachment from internal objects necessitates an internal separation during childhood. Maternal separation anxiety can be described as an unpleasant emotional state, linked to the separation experience: it can include expressions of worry, sadness, or guilt (Kins et al., 2013). Developing her theory, Mahler (1972) reemphasised the importance of the mother’s function during the separation-individuation stages. Later on, Mahler, Pine, & Bergman (1975), affirmed that mothers who attach to the infant themselves, discourage independent function. In this way, separation becomes more difficult for both the child and the mother, which can intensify the child’s anxiety. For this reason, the child’s anxiety can be reactivated during the adolescence period, when sexuality comes into the foreground.

The ability for separation requires a confident attachment to the mother. Working through separation and individuation is thought to have effects on personal growth and psychosocial performance. However, if this transition is unsuccessful, individuals can become vulnerable to psychopathology (Blos, 1979; Mahler et al., 1975; Pine, 1979). Conflicts in separation- individuation are central in a range of psychopathological presentations, including borderline and narcissistic personality disorders (Lapsley & Stay, 2010). Pine (1979) distinguishes disorders into higher-order and lower-order ones. Lower-order disturbances, include lack of self-other boundaries and fusion or merging with another. In the higher-order disturbances Pine (1979) includes the incapability to be on one’s own self, the need to exercise control over others as an extension of the self and defects in object constancy.

In the therapeutic community, difficulties with separation-individuation are often conceptualized as separation anxiety or difficulty being on one’s own (i.e., dysfunctional dependence). The Diagnostic and Statistical Manual for Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013), lists separation anxiety depression (SAD) as a mental health disorder. SAD is often diagnosed in infancy, early childhood, or adolescence, and symptoms include distress when separated from attachment figures, persistent worrying about loss, and extreme fear of being alone. The separation anxiety is linked to the lost object per se. This means, in psychoanalytic terms, that the image of the mother hasn’t become intrapsychic available for the child, which leads to the inability of the child to bear to lose the object in the real world. Since the constant presence of the object is impossible, the anxiety strikes. When the first, during childhood, separation-individuation has suffered some accidents or fails, then the second separation-individuation, during adolescence will repeat an unhealthy regression.

Another aspect that needs to be considered, as discussing the object experiences, in the psychoanalytic field is the mentalization term. Fonagy (Fonagy, Bateman, & Luyten, 2012) defined mentalization as a form of “mental activity that enables us to perceive and interpret human behaviour in terms of intentional mental states (e.g., needs, desires, feelings, beliefs and goals)”. The three prementalizing modes of thinking influencing the experience of psychic reality are: 1) a teleological mode that refers when the child is experiencing the world without his mental state being represented and can only be expressed in action, 2) a psychic equivalence mode when the distinction between the internal and external reality of the child is poor and 3) a pretend mode when the child is able to separate from the outer reality and maintain an “as if” private reality. By these three modes of thinking, the child is gradually integrating into a mentalizing capacity. In other words, the mentalizing capacity is the ability of a subject to comprehend thoughts and feelings as mental representations of self and others, a capacity acquired during childhood. When a child is able to understand and give meaning to one’s own feelings and behaviours (Fonagy & Target, 1997), the capacity to mentalize is obtained only when a safe and secure environment is engaged (Fonagy & Target, 2006).

It goes without saying that mentalization and imagination are two concepts linked, because mentalization is an attitude where the imagination is used in order for the representation to be symbolized. The ability to mentalize is an ability conquered during the separation-individuation process, which implies in our work the purpose of Rorschach inkblot test, a projective test that illustrates a way to see the internal representation of a subject projected on an inkblot image. When a child is able to bear the absence of the object in the real world, then the object is reliable and representable in the child’s internal world. When a child is able to give meaning and understands his feelings and behaviours and those of others, he is able then to mentalize (Fonagy & Target, 1997). On the other hand, the absence of reflective functioning is related to pathology: Imagination allows to identify a reality that is too intrusive and to construct another one to which the subject will seek success. Imagination is, therefore, the response to the frustration due to the disappearance of the maternal figure, which is essential to individuation.

The importance of the quality of object relations and experiences in the separation-individuation process during infancy for the development of self is widely allied to the capacity to mentalize. All fragments of thoughts are coloured by emotions and feelings. They form the beginnings of mentalization, by associating representations and affects and the child can integrate what happens to him physically as well as psychically. Should the process of mentalization fail, the subject is constantly searching for an object in the external world in order to soften his internal anxiety.

5. Addiction as a “Neoneed” Object

Addictions continue to be a major factor of concern for adolescents. Strikingly, 90% of adult addicts start their drug abuse in adolescence (Sheehan et al., 1988). Along with the influence of peers (Ramirez et al., 2012), one of the most important aspects of adolescent addiction is the trajectory of the process of individuation (Bray et al., 2000). Many researchers suggested that adolescent substance use is a type of risk—seeking behaviour in order to seek autonomy from the family systems (Samuolis et al., 2006). Studies have shown that addictions can be caused by complications encountered during the individuation process during adolescence. One main reason is the emotional fusion and separation/detachment between the adolescent and the parents (Bell et al., 2000; Spotts & Shontz, 1985; Stanton & Todd, 1982; Weidman, 1987). This may be linked with low levels of individuation, which may explain why those adolescents are more likely to differentiate themselves less from friends, be influenced by them and as a result, develop relational problems (Bowen, 1978; Williamson & Bray, 1988). According to Weidman (1987), and to Stanton & Todd (1982), independence, while an individual is in the family process, is called “pseudo-separation” or “pseudo-individuation”. Working through individuation is an arduous and painful task. Addiction is a way of “pseudo-separation” while the adolescent is totally dependent on his familial environment and object.

In the psychoanalytic field, addictive behaviour may offer the illusion not only of independence but also of satisfaction whilst numbing the pain of working through real loss and change. This auto-erotic, as well as auto-aggressive action finds instantly an artificial and illuminative satisfaction which implies that the tension between affect and representation is blocked. The subject, while developing an addictive escape, sets down his libido to an external object gaining immediate satisfaction. The work of Joyce McDougall (1989) states that behind this addictive psychic organization, there is a mother-drug, non-stable or secured interiorized in the infant’s internal world. Consequently, the subject is constantly searching in the external world an object whose role is the role of the intern lost object, a symbolic and an imaginary lack.

During the second period of separation-individuation, in cases when adolescents struggle to develop a healthy detachment (separation) from their family, it is very likely for them to become emotionally enmeshed (Bray et al., 2003). The strength of the bond with the object can lead to a force of alienation, like a “neoneed”, as a form of acting, as the equivalent of defence mechanisms against anxiety-provoking representations. The auto-erotic need for intoxication reveals an auto - aggressive need, towards an addictive object. From this perspective, the links between individuation and substance use, due to the libidinal representations, need to be explored within the family environment and the relation with the object of that environment.

6. Current Study

The aim of the current study was firstly to discuss the relationship between individuation patterns and substance abuse in adolescents with addiction, the type of anxiety associated with unhealthy individuation patterns and also their ability of mentalization. The Rorschach test, based on the analysis and the interpretation of the French School (Verdon & Azoulay, 2019), not only provides the chance to perceive the approach of success or failure to maintain the correlation between external and internal reality, but also the ability to understand better the connection between affect and representation. Since the main question of the test is what might represent, the subject lets his unconscious associative thoughts be revealed. Subjects with addictive behavior might find it difficult to follow the protocol of psychotherapy, the free association of speech. In this context, the projective test cannot be considered other than a relational dynamic and the subject freely addresses emotions and thoughts. Rorschach test combines the dynamics of daydreaming and the ability to represent bodily representations: the surface of contact between an inside and an outside, a subject and an object (Chabert, 2001). Another aspect of the test is the discussion of the defense mechanisms which are grasped on the Rorschach. The defense mechanisms which protect the Ego from driving demand organize the psychic conflict. It is difficult though to classify the defense mechanisms in psychological terms and to observe them because they are likely to vary and be found in several degrees. This paper examines possible Rorschach manifestations of various levels of defensive operations, particularly isolation and splitting, among patients with borderline personality organization. In our case, this empirical study explores the psychological profile of two young addicts who had a volatile view of the other. For confidential reasons, only the protocols and the psychograms of the above adolescents are mentioned below.

6.1. 1st Participant

The present study is based on the psychoanalytic psychotherapy sessions of a 16-year-old male adolescent, here named Theo, who had an addiction to both, marijuana and video games. As the addictive behavior continued for months, his parents sought professional help, acting on the advice of the family doctor. Weekly sessions were recommended over a period of one and a half years. During the first session with his parents, Theo mentioned that he started smoking marijuana with his peers at school, as “everyone was smoking”. His parents mentioned that they began feeling concerned when Theo started going out a lot without notice, and began to sleep over at friends’ homes at night. When his parents asked him why he was spending so much time away from home, Theo replied that they played video games and they “needed to win”. He began the school year with good grades, but in mid-term Theo expressed a lack of interest which led him to school refusal. With regards to his relationship with his parents, Theo said that they are “over-controlling” and “over-protecting” compared to the parents of his peers. He said he found it difficult to hang out with friends, because his parents would not let him, as they would prefer him attaining well at school.

Theo’s Rorschach Test Administration

During the weekly sessions, Theo completed the Rorschach test to assess the level of his internal anxiety, the type of relationship with his parents and his overall emotional well-being. We also focused on the self- and object relationship as demonstrated on the evaluation of Rorschach protocol. During the Rorschach assessment, Theo stayed still, looking at the pictures carefully. He gave his answers promptly, without any distraction. Strikingly, on the last card, Theo stared at it for a prolonged period, offering two different answers. It was the only card (Card IX) at which Theo felt embarrassed and asked if he was holding it in the right direction (See Table 1).

The results of the Rorschach test demonstrated Theo’s difficulty in conveying a full perception of self, his difficulty in concentrating on a task and his low sociability, as the high scores for F (=92.3%) and G (=7) responses indicate. A good indicator to take into account the activity of mentalization and imagination is the Kinaesthetic Human Response. The absence of K on Theo’s protocol showed a poor internal reality and a weak ability for mentalization without any libidinal investment. The A score almost at 47% showed a sense of control over external reality and a way of almost automatic thinking. The devitalized responses (animal content are numerous) allow Theo to avoid the sexualization of the characters. The two anatomic responses (Anat) showed a difficulty in apprehending the human body in its integrity, with more morbid values but not as far as the anxiety of body fragmentation. Human responses were low (=1), and almost all of them were anatomic responses. This shows that Theo had difficulty experiencing and expresses a sense of integrity with regards to his body. The F almost at 93% and F+ at 75% both indicated a very rational way of thinking, a good adaption to reality, a difficulty isolating representation from affect, as well as difficulty adapting to environmental changes. Overall, he had 13 responses which were deemed a very low score. The intellectual inhibition can be understood on the protocol as a defense mechanism because of the low score of total answers and of quality of answers which are infantiles (See Table 2).

Theo’s answers revealed anxiety, especially on card III (“Two people”) and card VIII (“Two tigers”). He could not separate the affect from the representation,

Table 1. Theo’s rorschach protocol.

Table 2. Theo’s rorschach psychogram.

namely his answers were merged which suggests a significant degree of anxiety. Theo’s answers could potentially correspond to the symbiotic phase, when there is a distinction between the internal and external reality, however, the Ego stays detached and the subject finds it difficult to differ from the object. It is also worth- mentioning that Theo’s protocol has no adequate insight or high descriptive ability. Theo’s automatic responses and assumptions showed rigid loyalty to his own perspective (e.g., card V “a mouse”, card VIII “a tiger”). This sentimental rigidity can be liaised to an individuation as we could not find the upheaval of emotional experiences and reactions that are dominant during the adolescent period. His answers could also be characterized as infantile, simplistic, without paying attention to detail, or to colour fact which cannot be related to a developed self-identity or oedipal problematic. In the whole protocol, the reference to the colour is missing, which indicates to us to hypothesize an introversion. His poor imagination demonstrates a reduced mentalization, which Fonagy (1996) highlights a non-secured primary attachment. The transmission of affects from generation to generation has failed, because the infant did not successfully pass by the symbolisation to develop his own feelings. As Erikson (1968) emphasizes, the attachment tasks are intermediary links in the process of development of individuation and of formulation of identity.

Theo seems to isolate the representations from the affect. Due to structured, with poor imagination, answers, our hypothesis is that Theo’s defense mechanism is a priori isolation. As Freud (1936) explains, one defense mechanism is the isolation which is defined by the suppression of the possibility of contact. The subject can remain calm mentioning terrifying moments, but she/he can shift her/his emotions to another event. The subject verbalizes in a conscient detached and avoidant way in order to intellectualize the unconscious representations that might also be traumatic. That means that Theo’s answers even though are emotionless, he can express his emotions otherwise. Although his attitude to life is not apathetic, he chooses to be distant. That can also be explained due to the distinction between internal and external reality, but he still hasn’t been separated from the internal/libidinal objects. The primary objective is there, constantly. Without the dependence on the primary object, the level of the separation anxiety might be very high.

Splitting, as another defence mechanism, is another inability to integrate aggressively and libidinally determinated by self and object images. Mahler and Furer (1968) suggest that splitting is an adaptive pattern of the infantile period, an immaturity of the psychic equipment and later on is used to protect the subject from object representations in order to prevent anxiety. Rorschach manifestations of the splitting mechanism levels usually involve a sequence of answers which include objects that represent alternating polarities. In our case, Theo’s answer on card VI “fish” followed by “the head of the fish” is an illustrative example of splitting. This responsive sequence image shows split images in which the whole image is split and kept apart. Another example is on card X “the inside of a human body”, a fragmented image, the earliest and the most basic form of splitting (Freedman, 1981).

A second study was completed to investigate the relationship of individuation with substance abuse and anxiety in adolescence. This case highlights the separation-individuation process, which is emphasized in the results of the projective tests provided.

6.2. 2nd Participant

Michael, aged 17 years old, started psychoanalytic psychotherapy sessions after being referred by his school psychologist due to his aggressive behavior at school. Michael began to act in an offensive and aggressive way toward his peers following his parents’ divorce. A year before that, he had already begun drinking alcohol to a concerning degree. A few months after the divorce of his parents, Michael began using cannabis, whilst he also spent a lot of his time on video games. As a consequence, his grades dropped at school. His teachers were concerned when Michael began bullying his peers while he could be missing school for days. Michael’s mother, who he lived with, was not aware of his non- attendance at school; however she had also begun to notice that her son was becoming verbally violent towards her. As the addictive behavior continued for months, Michael’s mother was advised by the school counsellor to seek help. Weekly sessions were recommended for a period of one year. During the first session with his parents, Michael mentioned that he felt angry with his mother for not seeing his father as often as before his parents’ divorce. He began drinking beer with his friends at parties, and he shared that later he began to enjoy smoking cannabis and drinking beer. Michael mentioned that he wanted to drop out of school, as professional life did not matter to him. He did not have any plans for the future, but he mentioned that he could perhaps make money by playing games online. With regards to his relationship with his mother, he did not care for it and he would have preferred to live with his father. He also expressed that his mother had been “absent”.

Michael’s Rorschach Test Administration

Michael completed the projective test of Rorschach during our first session. Although he appeared as a rebellious adolescent, he engaged well with the process of the assessment. We focused on the self- and object relationship as demonstrated in the evaluation of the Rorschach protocol.

Michael’s protocol consisted of 11 answers overall which may be seen as a sign of his intellectual inhibition and imagination. At the beginning of the test, Michael was impatient and moved the cards in all directions to find the “right answer”. As he could not find an answer on card V, he seemed relieved that there was no “right” answer and he was able to continue more focused and engaged in the task. We can see an effort in his answers to give a sense of a movement, however, they remained restricted and without express much imagination. When Michael looked at the last card, he gave the answer with a smile on his face. He had seemed nervous all along, and was relieved to know we had completed the task. Both very high scores of F (81.81%) and G (=7) indicated Michael’s low sociability and his difficulty in producing an imaginary scenario with the protagonists of the test. These two scores also show the absence of flexibility and knowledge of the external world. The mere two kan answers (Card VIII and card X) in Michael’s test results showed a struggle to offer a perception of movement and integrity. The presence of kan responses implies the existence of a minimum imaginary potential, but is so minimized that Michael’s responses were overall poor. His internal reality manifested itself, but on a limited and rudimentary level as it became evident in the two movements of “fighting” (Card VIII) and “trying to be together” (Card X). A psychoanalytic interpretation of those answers would have been what he is trying to fight? And then to be together with? It is clear that the symbiotic relationship with the object is represented in both answers, as Michael is trying to fight not to be together with the object, but he fails afterwards.

Michael’s response on card VIII, “two tigers that are fighting”, revealed his primitive conflict towards the object which one may say had already become relived in his refusal to produce an answer for card V. Michael seemed to have made an attempt to control his conflict on the last card, by naming the two animal figures together, separating the image into two, and giving an answer for the whole card. Even though his anxiety is high, he managed to separate his libidinality into two figures.

There were more animal-answers (A = 6) than human-answers (H = 4), however the difference was insignificant. This might also indicate an effort on Michael’s side to avoid automatic responses and assumptions. However, he remained rigid and inhibited throughout the test and there was a little meaningful reliving of emotional states and thoughts. There was no re-enactment in terms of self-identity and the oedipal problematic. His poor imagination and expression reveals, in this protocol too, that the subject is incapable of comprehending his inner state, to be able to distinguish material reality from psychic one, because of the lack of a good quality of mentalization. By all odds, Michael’s protocol shows a subject with an insecure attachment to a non-stable figure in his environment.

Michael’s protocol is also another example of an isolation mechanism of defence. Jeammet writes (1989) that in order to think, it is needed to isolate first, separate and then select the experiences. An effective mentalization must not isolate affects and representations. Michael isolates first his answers, in order to choose the right one, the one that is more suitable to be heard. His answers appear very infantile and not suitable for his age. He regresses, and sees himself as a child. More specifically, for example, on card X (“Two fishes that are trying to be together”), there is not any sexual identification, not even an impulsion, as the answer “fishes” means. The use of formal characteristics is particularly high, given the number of responses, and is confirmed by the enlarged F% on the one hand and by a very strong desire to minimize the emotional influence on the other.

Regarding the splitting mechanism on Michael’s protocol, card II (“two twins” followed by “two babies separated”) demonstrates a fragmentation of the image and suggests an inability to integrate contrasting affects to a single image. This image, seen firstly as a whole, but then perceived unified, is a splitting context. The violation of the conceptual integrity of ideas and objects is a characteristic of a Rorschach’s borderline psychic organization (See Table 3 and Table 4).

Table 3. Michael’s rorschach protocol.

Table 4. Michael’s rorschach psychogram.

Overall, Michael’s protocol may also be considered as indicative of an unhealthy individuation process; mainly due to Michael’s tremendous difficulty being separated from the object and developing the symbolic function.

7. Discussion

By comparing the Rorschach two protocols, both individuals with addictive behaviour gave similar answers. Both their protocols indicate limited imagination, poor mentalization and difficulty in the area of expressing emotions, with a tendency to rather control them. Most important, their anxiety appeared linked to a fixation towards the object. In this way, the object seemed to remain experienced as unseparated and undifferentiated rather than linked to the self. Furthermore, both protocols have been characterised by the mechanism of inhibition and poor imagination, which are essential characteristics of borderline personality. The adolescents are constantly struggling against any associative commitment. An increased vigilance is marked during the Rorschach tests, by reinforcing their defenses of mechanism, by inhibitions and by conformity of their responses.

The variety of determinants, divided between forms and kinesthesias, as well as the variety of contents suggest a certain richness of mentalization. However, the failure of a good quality of mentalization in the case of our adolescents is as obvious due to the fact that the level of verbalization is low. The colors on the cards, even perceived, are avoided and are uninterpreted. In consequence, thereof, in the field of addictions, severe impairments of mentalization can be noticed, because of the insecure separation-individuation. This can also be due to the paucity of the number of defensive operations available, associated with a rigid recourse most often to one of them slightly prevalent in the protocol which then aims to prevent progressive or regressive movements. The mechanism of isolation is predominant in both our cases, can be traced to the poverty of imagination, the separation anxiety and the neutralization and leads to the conclusion that the massive inhibition expresses the affect and the high level of anxiety. As described above (Richelle et al., 2017), the mechanism of isolation is marked on the Rorschach test by an increase in F% and F+ % (Theo’s F is 92.3% and F+ 75% and Michael’s F is 81.81% and F+ is 138%), a decrease in sensory reactivity, a perceptual and interpretative decoupage (Dd, Dbl, Ad, Hd).

Taken together, the splitting mechanism of both tests suggests that our adolescents have a fluctuant point of view of others and of themselves. However, both adolescents imply that the splitting organization is a fundamental of positively toned representations. Their Rorschach test show a reflective feeling of aloneness, separation and failure of individuation. As seen, their whole projection of image and of others is gradually a separated image. The battle to keep a whole image is apparent, but failed in the end.

The purpose of our study was to demonstrate that adolescents with addictions are more likely to develop unhealthy individuation patterns because of the failure or accidents that happened during the first separation-individuation. The reactivation of the individuation process, mediated by identity-formation and the resolution of the Oedipal problematic, is a core developmental task in adolescence. Data from the projective tests protocols of the above participants indicate deficits in those areas, which would suggest that the individuation process was hindered.

The inability to integrate the aspects of the separation-individuation process of experience can lead to psychopathology (Mahler, Pine, & Bergman, 1975). As discussed in the above protocols, in our cases, the ineffectiveness in integrating frustrating and enjoyable aspects of experience with another person, especially with the mother, led to an unstable sense of self and to an insecure relationship with the object. The danger of regression means a non-separation of the child/mother dyad with the internal psychic/internal representation of the mother and this suggests a connection to the failure of the resolution of the Oedipus complex.

Blos (1962), as mentioned above, goes even further mentioning that the adolescence hides a narcissism behind. This may also be due to the sexuality, the essence that distinguishes the adolescent from the child. Failure of the second separation-individuation could be due to possible rejection from the family during childhood. It is not only about a physical absence, but lived experiences by the child and internalized as such. The adolescents, in our cases, try to move forward by adopting pseudo-adult behavior and characteristics in order to conquer their own subjectification in a quest for the symbolic father only by regressing to a childhood and primitive behavior. The results showed that the two subjects had a volatile view of the others and themselves. The Rorschach test also showed a reflexive sense of detachment, failure of individuality and of construction of identity. The complete projection of their image and of that others was a progressively detached image. The battle to preserve a complete image is visible, but failed in the end.

These “cumpulsive acts in the border between psyche and soma”, as Joyce Mc Dougall mentions, serve as a wall against differentiation and identity and rise to mop up the anxiety of emptiness and separation. The anxiety of separation can here be translated as the anxieties of separation experienced as a loss of self due to the fact that the maternal object is included in a narcissistic experience. The setback of separation of the object is that the loss is impossible because of the fundamental narcissistic function. The addiction to any object shows a dependence caused by non existance of self-sufficiency.

Overall, the addiction can be explained here as a merciless quest for an object to consume. It reflects an appetite without investment, a daily battle to try to maintain an internal balance and an oscillation between the need for an object and narcissistic safeguarding. Not only the lack of answers in total (for Theo 13 answers and for Michael 11 answers) is an indicator of addictive behavior, but also the fixed unemotional and cold answers (“two humans”, “two babies” etc.) are repetitively found in addictive patients’ protocols (Smaniotto & Lighezzolo-Alnot, 2010), as opposed to the dynamic of expressive answers.

Any therapeutic relationship, especially a psychoanalytic psychotherapy, elevates the hidden regressive desires for total dependence on an object adorned with the qualities of the ideal object, exclusively available and holder of a totally co-planting magical power which would realize a state of indifferentiation. These characteristics have also been raised on the Rorschach protocols as seen above. For both case studies, the object is constantly unseparated and there are no renunciations of perception and pleasure of the primary object in reality, but regression on the dependence on the primary object.

There have been many psychological studies examining psychological factors in addictions. Many of them have focused on a specific addiction, such as drug abuse, alcohol or the use of smartphones. The purpose of our study was to focus on intrinsic factors impacting on one’s proneness to develop addictions, and more specifically on the links between the individuation process and its failure. Our study is limited due to the small number of protocols provided. It could be extended and elaborated with more samples. Further investigation is needed in order to value the findings within a larger sample. Furthermore, future research can examine the type of therapy that these individuals might benefit from.

8. Conclusion

The first developmental challenges occur in early childhood according to Mahler, establishing that one needs to be separated from primary love objects (i.e., separation) in order to acquire unique individuality (i.e., individuation). According to Blos, the second phase of separation-individuation is “reborn” during adolescence. During both developmental phases, the child progressively bears the separateness from the mother. Meanwhile, the child tries to maintain contact with their primary love objects. Overall, separation-individuation is the purpose of a multifaceted dialectical interaction between independence and connection (Allen et al., 1994; Grotevant & Cooper, 1986). The aptitude for separation, therefore, has the power of a true psychic organizer.

Adolescent individuation has been characterised by the reproduction of the structural emotional changes that are rooted in internal childhood objects. It reflects not only a process, but also an achievement that constitutes an internal module. It also signifies all the ego changes of the adolescent detachment from infantile objects (Blos, 1967). Without a successful disengagement from the infantile objects during separation-individuation, the adolescent sees the world either as “precluded, hindered, or remains restricted to simple replication and substitution” (Blos, 1967). Without “true engagement with the other”, there is no “the result” or “test of firm self-delineation” (Erikson, 1968). The importance of the quality of object experiences during infancy is emphasised as they reappear during adolescence. Failure to acquire a secure detachment from the primary object, adolescents are going to face an inability to mentalize. The inability to separate is linked with the inability to acquire rich imagination, and the incapacity to comprehend, recognize and give meaning to their emotions and those of others. As discussed, the Rorschach projective test, demonstrates the sterile vocabulary and imagination due to unsuccessful mentalization. Since mentalization assumes that the subject is capable of linking the affects to sharable representations in a conscious and continuous way, in order for the object to be whole and continent, our adolescents find external addictive objects in order to gain the unaccomplished containment. The external reality seems to be used more as a substitute for the void of the internal object than as a support for the imaginary activities.

Adolescents are more prone to find “home” in substance use or objects and become addictive in order to develop an illusion of independence and a sense of merging again with the primary object. The first attempt to be separated from the primary object and then to adopt the identification through individuation by mediating mentalization is unsuccessful, which fact drives the subject to repeat this process during adolescence, with the difference that this time he needs to choose an external object. The addiction can be explained as dependence to the external reality of the external object through the mechanism of defense that is the isolation, which intervenes to separate the representation from its emotional charge.

Internalized object relations and defensive functioning have been central fields in studies of borderline personality psychic organizations. The generalization of the results is limited by the number of participants in this study. However, our study aims at concluding the clinical sessions of the two addict subjects using the Rorschach test. Future researches might be conducted using a larger number of participants in order to generalize our findings. Our empirical study is limited and needs to be broadened with compared results of adolescents without addictions. Suggested therapy is Mentalized-Based Therapy (Fonagy, & Target, 2006) which aims to increase the capacity to mentalize in order to improve the regulation of the affect and the interpersonal relations of borderline patients.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Allen, J. P., Hauser, S. T., Eickholt, C., Bell, K. L., & O’Connor, T. G. (1994). Autonomy and Relatedness in Family Interactions as Predictors of Expressions of Negative Adolescent Affect. Journal of Research on Adolescence, 4, 535-552.
https://doi.org/10.1207/s15327795jra0404_6
[2] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Publishing Incorporated.
https://www.psychiatry.org/psychiatrists/practice/dsm
https://doi.org/10.1176/appi.books.9780890425596
[3] Bell, N. J., Forthun, L. F., & Sun, S. W. (2000). Attachment, Adolescent Competencies, and Substance Use: Developmental Considerations in the Study of Risk Behaviors. Substance Use & Misuse, 35, 1177-1206. https://doi.org/10.3109/10826080009147478
[4] Blos, P. (1962). On Adolescence: A Psychoanalytic Interpretation. The Free Press.
https://www.worldcat.org/title/on-adolescence-a-psychoanalytic-interpretation/oclc/1175425
[5] Blos, P. (1967). The Second Individuation Process of Adolescence. The Psychoanalytic Study of the Child, 22, 162-186. https://doi.org/10.1080/00797308.1967.11822595
[6] Blos, P. (1979). The Adolescent Passage. International Universities Press.
https://archive.org/details/adolescentpassag00blos_0
[7] Bowen, M. (1978). Family Therapy in Clinical Practice. Aronson.
[8] Bowlby, J. (1973). Attachment and Loss: Volume II: Separation, Anxiety and Anger. In Attachment and Loss: Volume II: Separation, Anxiety and Anger (pp. 1-429). The Hogarth Press and the Institute of Psycho-Analysis.
[9] Bowlby, J. (1988). A Secure Base. Parent-Child Attachment and Healthy Human Development. Basic Books.
[10] Bray, J. H., Adams, G. J., Getz, J. G., & McQueen, A. (2003). Individuation, Peers, and Adolescent Alcohol Use: A Latent Growth Analysis. Journal of Consulting and Clinical Psychology, 71, 553-564. https://doi.org/10.1037/0022-006X.71.3.553
[11] Bray, J. H., Getz, J. G., & Baer, P. E. (2000). Adolescent Individuation and Alcohol Use in Multi-Ethnic Youth. Journal of Studies on Alcohol, 61, 588-597.
https://doi.org/10.15288/jsa.2000.61.588
[12] Chabert, C. (2001). Psychoanalysis in the Service of Projective Psychology. Psychologie Clinique et Projective, 7, 55-69. https://doi.org/10.3917/pcp.007.0055
[13] De Leon, G., Skodal, A., & Rosentham, L. (1973). Phoenix House: Changes in Psychopathological Signs of Resident Drug Addicts. Archives of General Psychiatry, 28, 131-135.
https://doi.org/10.1001/archpsyc.1973.01750310103017
[14] Erikson, E. H. (1968). Identity, Youth, and Crisis. Norton.
[15] Fonagy, P. (1996). The Significance of the Development of Metacognitive Control over Mental Representations in Parenting and Infant Development. Journal of Clinical Psychoanalysis, 5, 67-86.
[16] Fonagy, P., & Target, M. (1997). Attachment and Reflective Function: Their Role in Self-Organization. Development and Psychopathology, 9, 679-700.
https://doi.org/10.1017/S0954579497001399
[17] Fonagy, P., & Target, M. (2006). The Mentalization-Focused Approach to Self Pathology. Journal of Personality Disorders, 20, 544-576.
https://doi.org/10.1521/pedi.2006.20.6.544
[18] Fonagy, P., Bateman, A. W., & Luyten, P. (2012). Introduction and Overview. In A. W. Bateman, & P. Fonagy (Eds.), Handbook of Mentalizing in Mental Health Practice (pp. 3-42). American Psychiatric Publishing, Inc.
https://psycnet.apa.org/record/2011-19854-001
[19] Freedman, N. (1981). Varieties of Splitting. In S. Tuttman, C. Kaye, & M. Zimmerman (Eds.), Object and Self. International Universities Press.
[20] Freud, S. (1936). Inhibitions, Symptoms and Anxiety. The Psychoanalytic Quarterly, 5, 1-28. https://doi.org/10.1080/21674086.1936.11925270
[21] Grotevant, H. D., & Cooper, C. R. (1986). Individuation in Family Relationships. Human Development, 29, 82-100. https://doi.org/10.1159/000273025
[22] Jeammet, P. (1989). Les assisesnarcissiques de la symbolisation. Revue française de psychanalyse, 53, 1763-1774.
[23] Josselson, R. (1980). Ego Development in Adolescence. In J. Adelson (Ed.), Handbook of Adolescent Psychology (pp. 188-210). Wiley.
https://www.worldcat.org/title/handbook-of-adolescent-psychology/oclc/5496180
[24] Karpel, M. (1976). Individuation: From Fusion to Dialogue. Family Process, 15, 65-82.
https://doi.org/10.1111/j.1545-5300.1976.00065.x
[25] Kins, E., Beyers, W., & Soenens, B. (2013). When the Separation-Individuation Process Goes Awry: Distinguishing between Dysfunctional Dependence and Dysfunctional Independence. International Journal of Behavioral Development, 37, 1-12.
https://doi.org/10.1177/0165025412454027
[26] Lapsley, D. K., & Stey, P. (2010). Separation-Individuation. In The Corsini Encyclopedia of Psychology. John Wiley & Sons, Inc..
https://doi.org/10.1002/9780470479216.corpsy0847
[27] Levine, B. L. (1985). Adolescent Substance Abuse: Toward an Integration of Family Systems and Individual Adaptation Theories. American Journal of Family Therapy, 13, 3-16. https://doi.org/10.1080/01926188508250217
[28] Mahler, M. S. (1952). On Child Psychosis and Schizophrenia: Autistic and Symbiotic Infantile Psychoses. The Psychoanalytic Study of the Child, 7, 286-305.
https://doi.org/10.1080/00797308.1952.11823164
[29] Mahler, M. S. (1972). On the First Three Subphases of the Separation-Individuation Process. International Journal of Psycho-Analysis, 53, 333-338.
[30] Mahler, M. S., & Furer, M. (1968). On Human Symbiosis and the Vicissitudes of Individuation: I. Infantile Psychosis. International Universities Press.
[31] Mahler, M. S., & La Perriere, K. (1965). Mother-Child Interaction during Separation-Individuation. The Psychoanalytic Quarterly, 34, 483-498.
https://doi.org/10.1080/21674086.1965.11926361
[32] Mahler, M. S., Pine, F., & Bergman, A. (1975). The Psychological Birth of the Human Infant. Symbiosis and Individuation. Basic Books.
[33] McDougall, J. (1989). Theaters of the Body: A Psychoanalytic Approach to Psychosomatic Illness. WW Norton & Co. https://psycnet.apa.org/record/1989-98359-000
[34] Milrod, B., Markowitz, J. C., Gerber, A. J., Cyranowski, J., Altemus, M., Shapiro, T. et al. (2014). Childhood Separation Anxiety and the Pathogenesis and Treatment of Adult Anxiety. American Journal of Psychiatry, 171, 34-43.
https://doi.org/10.1176/appi.ajp.2013.13060781
[35] Pine, F. (1979). On the Pathology of the Separation Individuation Process as Manifested in Later Clinical Work: An Attempt at Delineation. International Journal of Psycho-Analysis, 60, 225-241. https://pubmed.ncbi.nlm.nih.gov/553060/
[36] Ramirez, R., Hinman, A., Sterling, S., Weisner, C., & Campbell, C. (2012). Peer Influences on Adolescent Alcohol and Other Drug Use Outcomes. Journal of Nursing Scholarship, 44, 36-44. https://doi.org/10.1111/j.1547-5069.2011.01437.x
[37] Richelle, J., Debroux, P., De Noose, L., Malempré, M., & Migeal, C. (2017). Manuel du test de Rorschach. De Boeck Supérieur. https://doi.org/10.3917/dbu.riche.2017.03
[38] Samuolis, J., Hogue, A., Dauber, S., & Liddle, H. A. (2006). Autonomy and Relatedness in Inner-City Families of Substance Abusing Adolescents. Journal of Child & Adolescent Substance Abuse, 15, 53-86. https://doi.org/10.1300/J029v15n02_04
[39] Sheehan, M., Oppenheimer, E., & Taylor, C. (1988). Who Comes for Treatment: Drug Misusers at Three London Agencies. British Journal of Addiction, 83, 311-320.
https://doi.org/10.1111/j.1360-0443.1988.tb00473.x
[40] Smaniotto, B., & Lighezzolo-Alnot, J. (2010). The Object Relation in Alcoholism: Comparative Projective Study of Chronic and Intermittent Alcoholism. Bulletin de Psychologie, 506, 99-108. https://doi.org/10.3917/bupsy.506.0099
[41] Spotts, J. V., & Shontz, F. C. (1985). A Theory of Adolescent Substance Abuse. Advances in Alcohol & Substance Abuse, 4, 117-138. https://doi.org/10.1300/J251v04n03_06
[42] Stanton, M. D., & Todd, T. C. (Eds.) (1982). Family Therapy of Drug Abuse and Addiction. Guilford Press.
https://www.guilford.com/books/Family-Therapy-of-Drug-Abuse-and-Addiction/Stanton-Todd-Associates/9780898620375
[43] Stey, P. C., Hill, P. L., & Lapsley, D. (2014). Factor Structure and Psychometric Properties of a Brief Measure of Dysfunctional Individuation. Assessment, 21, 452-462.
https://doi.org/10.1177/1073191113517261
[44] Verdon, B., & Azoulay, C. (2019). Psychoanalysis and Projective Methods in Personality Assessment: The French School. Hogrefe Verlag. https://doi.org/10.1027/00557-000
[45] Weidman, A. (1987). Substance-Abusing Adolescents in Family Therapy. International Journal of Family Psychiatry, 8, 211-229.
[46] Williamson, D. S., & Bray, J. H. (1988). Family Development and Change across Generations: An Intergenerational Perspective. In C. J. Falicov (Ed.), Family Transitions: Continuity and Change over the Life Cycle (pp. 357-384). Guilford Press.
[47] Winnicott, D. W., Objects, T., & Phenomena, T. (1953). A Study of the First Not-Me Possession. The International Journal of Psycho-Analysis, 34, 89-97.
[48] Woody, G. E., O’Brien, C. P., & Rickels, K. (1975). Depression and Anxiety in Heroin Addicts: A Placebo-Controlled Study of Doxepin in Combination with Methadone. The American Journal of Psychiatry, 132, 447-450.
https://doi.org/10.1176/ajp.132.4.447

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