Transplantation, identity and drug addiction
Author: C, A; Director AMARAL DIAS, T, N, Psychiatrist; VICENTE, M. de , Social Worker; F. CABRITA, A, R. de, Psychologist; MENDONCA
Pages: 21 to 26
Creation Date: 1981/01/01
T, N, Psychiatrist; VICENTE
M. de , Social Worker; F. CABRITA
A, R. de, Psychologist; MENDONCA
Centre for Drug Research and Prophylaxis, Coimbra, Portugal
This report is the follow-up of an earlier work in which the authors set forth some considerations on the psychopathological aspects connected with the transplantation of young Portuguese from the ex-colonies. The group studied was composed of 22 cases of drug addiction admitted to the Centre for Drug Research and Prophylaxis, Coimbra, over a specified period. A qualitative and quantitative change in drug consumption and an increase in delinquent behaviour were considered of particular interest and specifically linked to transplantation. An initial analysis indicated the enormous importance of the conflict of identity which existed in the transplantation situation, which was subsequently explored in more depth. Transplantation put to the test the capacity to adapt and involved profound changes in defensive mechanisms, which under unfavourable social conditions took on a distinctly regressive character. In view of the age group of the cases under study (adolescents), the frustrations resulting from transplantation were thus added to a crisis of maturation which was already regressive in itself. Some clinical examples are provided.
One of the problems in this study has, been to define "transplantation", the word used to refer to the return to Portugal of large numbers of settlers from the African territories which were under Portuguese rule. Although to a certain extent transplantation presents characteristics similar to those of emigration, it is basically different because it arises from a genuine exodus without the voluntary character or, more particularly, the prospects of gain characteristic of conventional migration. However, these differences apart, post-decolonization repatriation is an "atypical" form of emigration and can be included in the category of "psychosocioses", the term used by Z. de Almeida to describe "those psychic disorders directly caused by certain of the social upheavals of our age",
As in conventional emigration, psychopathological analysis reveals phenomena belonging in particular to the area of narcissistic and bereavement pathology, However, in the case of transplantation, which is an abrupt imposed uprooting, the traumatic nature of the separation is intensified and accentuates the feeling of persecution in the face of a depression(bereavement) which for many is unacceptable.
At the family level it is hardly surprising that the processes triggered off should have taken on a clearly dissociative character. Subsequently, and in conjunction with the persecution anxiety which was the expression of the projective manner in which Portuguese society was lived, defence mechanisms assumed more or less manifest forms, always linked, however, to traumatico-pathological bereavement, with a simultaneous tendency towards idealization.
Our study was based on 22 out-patient cases at the Coimbra Centre for Drug Research and prophylaxis over a period of approximately one and a half years.
The sample represented some 10 per cent of the total number of cases (224) at the Centre during that period.
We studied a series of factors, in particular the subject's age upon leaving for the former colonies, the colony where he settled or was born, his age upon return, the age at which he first experimented with soft drugs, the type of drugs used in the country of origin and in Portugal, qualitative and quantitative changes in relation to drugs at the time of transplantation, places where he settled or passed through, occupation and changes in occupation upon repatriation, original psychopathology and subsequent variations, and family type. In relation to the last factor we also attempted to determine whether there was any change upon repatriation, particularly in standard of living and atmosphere within the family, as well as whether there was any family pathology generally (parents living together, separated, deceased, unstable, absent father or disturbed family atmosphere).
Results were as follows:
Fifty per cent of the cases came from Mozambique, 44 per cent from Angola and one case from Guinea;
The average age when "soft" drugs were first used was 13.4 years;
The average age when "hard" drugs were first used was 17.3 years; 1
The average age upon arrival in Portugal was 17.7 years and the average age when subjects came to us for consultation was approximately two years later (19,8 years);
All subjects were using drugs in the countries of origin, the large majority (86 per cent) being occasional consumers of cannabis. Only three cases were already using other types of drugs. Following transplantation the percentages were practically inverted - 77 per cent started injecting drugs whereas 23 per cent continued to use only soft drugs,
1Although the concept of "hard" drugs is today open to question in many respects, we have decided to retain it for the presentation of the present study, including in this category opiates and amphetamines in injectable form, as well as other psycho-stimulants (cocaine) and barbiturates.
There were certain characteristics to be noted in this transition to injecting drugs. Fourteen subjects went from the consumption of liamba (cannabis) and hashish to multi-drug and opiate consumption: four started to consume hallucinogens, in particular LSD, as well as other pharmaceutical products; one became a producer and dealer; three who had previously been using hard drugs started to use them in more varied ways. We also observed that 14 began progressively to step up injections; the three who were already known to be consumers of hard drugs in the former colonies showed a considerable increase in consumption: and five, although they continued to use soft drugs, increased their consumption.
One of the results which we found striking in the study concerned delinquency. Whereas only two were already offenders in the country of origin, 18 (82 per cent of the sample) became so upon their arrival in Portugal.
Taking into account the fact that psychopathological changes are somewhat masked by drug consumption, forms of behaviour and delinquency, a more conventional diagnosis was possible only in four cases, We found three cases of psychosis and one serious case of neurosis.
It should be emphasized that two of the cases of psychosis and the case of neurosis were found in the five cases of soft drugs and the four cases of non delinquence.
We observed a great lack of stability in respect of settlement in Portugal, 68 per cent of these young people and their respective families having already visited more than one area before becoming relatively permanently settled.
In the former colonies, 19 of the subjects had stable occupations; of these 15 were students and four had other occupations, The three others "were unstable in regard to occupation. In Portugal, six continued to study three continued to have stable occupations, seven had casual occupations and six did not have any occupation at any time.
When they came to the Centre this situation had changed. Five of the six who had been studying had abandoned their studies and the other was doing his military service. Two of the three who had remained in stable occupations had been imprisoned for delinquency, The remaining 13 were unemployed or were in casual employment. In other words, of the 22 cases only one had retained a stable occupation, and of the 19 who had been working or studying in the country of origin, only one had remained in this category.
Family analysis presented several problems, particularly when an attempt was made to systematize the type of family relationship. We can, however, affirm a pathology of parental loss (parents separated or deceased) in 27 per cent of the cases. A more thorough analysis indicates that in 68 per cent of the cases there was a clear lack of stability on the part of one or even both parents (alcoholism, marked psychiatric disturbances etc,). Moreover, taking into consideration the type of relationship within the family, we observed that in 77 percent of the cases family relationships had already deteriorated in part prior to the subject's return to Portugal, although the latter further contributed to this deterioration. One factor which we consider to be extremely important is what we have termed the pathology of the absent father, which can take on different forms (deceased, separated, travelling, rarely at home, very busy). This type of pathology was found in 82 per cent of the cases.
Families returned to Portugal as one unit (family and young person) in 50 per cent of the cases. An essentially economic deterioration in the standard of living was noted in all cases.
Finally, in this connection, the occurrence of family separation at the time of repatriation should be noted. In 78 per cent of the cases the children were living apart from their parents in institutions or foster homes, or spent most of their time wandering about.
The above-mentioned changes in respect of drug consumption and delinquency seem to be specifically linked to the phenomenon of transplantation.
Clearly, the cases studied are those of young people either in the middle of or trying to find a way out of the crisis of adolescence, who have drug habits and who are not only suffering from "acculturation" but are also experiencing difficulties in maturing. The problems of adolescence and drug addiction and the particular form which the latter takes on as a result of the interference of the social phenomenon of transplantation must naturally be considered.
Adolescence is a phase characterized by change at the level of object investment - in other words, a sense of bereavement resulting from the loss of the child's world and a selection of new objects - and by an accompanying narcissistic regression triggered off by the questioning of earlier phases of development.
Seen from another angle, adolescence is a period of intense psychic and social interaction. For Erikson, this period ends only when the young person subordinates childhood identifications to new identifications, which impose a particularly delicate task upon the individual and society. Adolescence is also a waiting period prior to the acquisition of a complete adult identity, a period which is considered by Erikson to be a psycho-social "moratorium" during which the young adult may find a "niche" in society by freely experimenting with his role. This moratorium is characterized by a specific attitude on the part of adults known as selective tolerance. Every society in every culture institutionalizes a certain "moratorium" for the majority of its young people,
In addition to its epidemic characteristics, modern drug addiction is a problem which is inseparable from the "problem of youth", Drug addiction encompasses the whole pathology and psychopathology of adolescence, The young person encounters drugs at a time when the phenomena of regression and change are at their most marked. Moreover, not only do drugs encourage regression but regression is of their essence, i.e. the procurement of immediate pleasure without conflict, In this way drugs put off indefinitely resolution of the crisis and the psycho-social "moratorium" founders, revealing at the same time an inability to find an adult identity.
How can transplantation have the effect of initiating significant changes in drug consumption and delinquency?
We have already referred to transplantation as a social phenomenon having deep psychological implications and involving a historical and cultural rupture. During childhood, according to Erikson, identifications are first accumulated creating a hierarchy of expectations for later verification. Secondly, the young person must be recognized by those who surround him. These two factors are thus supports in forming an identity, which can be seriously disturbed if a historico-cultural change intervenes, as has been the case here.
Going back to the young people in our study, a number of conditions combined to promote the acquisition of a negative identity: an interruption in the process of identification: existing problems in relation to a somewhat disturbed family life; a more or less open rejection on the part of the receiving society; an emotional, historical and socio-cultural break with the country of origin.
The concept of a negative identity is clarified by the clinical material set out below, In the cases presented, as in most of our sample, delinquency and dependence on drugs only began after arrival in Portugal.
A., 19 years old, arrived from Angola at the age of 15, in the middle of an adolescent crisis which was complicated by traumatic factors. He told us, "Everything I had has been left behind in Angola. I like the black people". He told us that already when he was a child he had run off to the "Muceque"(black area), where he felt at ease. He found love and understanding there in maternal forms of substitution, He said this explicitly: "I felt good there . . I took liamba(cannabis), but I felt good, Deep down I feel I am black. ,Here I don't feel good, even with the drug. . . . When I came here there were only whites, There could be no love, only hate."
C.,19 years old, returned three years ago from Mozambique where he had settled at the age of four. For him, "Here in Portugal people are different, everything is very divided . . . there are classes; .some people think they are the cat's whiskers, and others kowtow to them. It wasn't like that in Mozambique. Here the land is old and nothing comes out of it any more. There it was warm, here everything is cold, the only thing that's warm is heroin."
E.,22 years old, from Mozambique, speaks in a pejorative way about the Portuguese--the "Portos"--and accuses them of being mistrustful and selfish. "There's a price for everything here, so I give them good lessons--take this, and you too, and I give them drugs, or money, whatever I have." But he goes on to say, "Like that I became somebody straight away, Everybody knew me and came to see me,"
Almost all of them expressed the desire to leave Portugal - for a tropical country, for example - and one of them has already done so and returned to Angola,
In each case a defensive idealization is predominant, linked to a persecution anxiety resulting from the loss of the idealized object (the mother country).
In addition, whatever the clinical case, it is an extreme, almost caricatured form of transplantation which has pushed these young people towards a deviant "moratorium" and a consequent negative identity. This seems to result, as Erikson says, from a vindictive choice which represents a desperate attempt to recover power over the self in a situation where the elements of positive identity cancel each other out.
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