Dependence

The term "dependence" is part of contemporary language; it is frequently used in the field of psycho-pathology but more for descriptive convenience than to specify a precise relational modality concerning the subjection of a subject to an object. Sigmund Freud used the term infrequently but made reference to it in his discussion of the pleasure principle: "It will be rightly objected that an organization which was a slave to the pleasure principle and neglected the reality of the external world could not maintain itself alive for the shortest time, so that it could not have come into existence at all. The employment of a fiction like this is, however, justified when one considers that the infant—provided one includes with it the care it receives from its mother—does almost realize a psychical system of this kind" (1911b). Serge Lebovici (1991) remarked that the human being's original state of dependence is a fundamental postulate of Freudian theory; it is the baby's Hilflosigkeit, or helplessness (détresse or désaide in French).

As Michael Balint (1968) remarked, the notion of "oral dependence" appeared in the work of Otto Fenichel in 1945. Fenichel describes oral character traits, especially a disguised dependent need, created by reaction-formation, manifest in attitudes and behaviors of independence and rebellion. Franz Alexander used this idea to describe ulcerous subjects who indicate their condition by the conflict between the desire to maintain a state of infantile dependence and the affirmation of independence of the adult ego.

Melanie Klein showed no interest in the concept, but her students Paula Heimann and Joan Riviere, in Developments in Psychoanalysis, refer to the infant's total dependence on the mother at the beginning of life. The concept becomes central in the thought of Donald Winnicott (1963), who emphasizes that the baby, who is dependent on the care of those around him, is subject to a "dual dependency," which will become simple dependency as soon as he or she becomes aware of it.

This is part of a normal process for every human being, so that not every state of dependence later found to exist can be reduced to it. Yet this inaugural kernel, which is characterized by a sense of powerlessness (as well as the narcissistic omnipotence associated with it), is the basis of subsequently-observed states of mental dependence and defects in the separation-individuation process. Adolescence especially is a period of reactualization and the heightened revival of feelings of dependence and infantile helplessness. Philippe Jeammet (1989), who considers dependence to be characteristic of this period, has developed the concept within a metapsychological perspective that cannot be easily summarized. According to this conception, the adolescent shows himself to be clinically dependent whenever he feels that his object needs threaten his autonomy and narcissistic equilibrium.

Some authors have examined dependence in the treatment of borderline states, following Winnicott, who emphasized the danger of underestimating the transference dependence in this type of case as part of the counter-transference risks of his interpretation. He, like Balint, cautions against an overly systematic interpretation of transference dependence, introducing the risk of reinforcing the dependence—especially oral dependence—of the patient on the analyst, and the latter's omnipotence. Otto Kernberg, working with narcissistic patients, describes their inability to depend on the analyst from the beginning of therapy, which can be compared to the fear of "giving in to dependence" described by Masud Khan.

In contemporary psychiatric clinics there has been a recategorization and clinical reassessment of dependence. The term is no longer only applied to drug addiction, alcohol or tobacco dependence, and so on, but tends to define a biological-psychological-behavioral syndrome that is very broad and includes those states as well as pharmacodependence. The concept of "addiction," which is very similar to that of dependence, is an indication of this broadening. Thus the pathological behaviors in which an act of incorporation (often but not exclusively through use of a toxic object) allows the subject to relieve the internal tension by short-circuiting a threatening mental condition are grouped under the term "addiction." These include alcoholic and drug-related behavior, bulimia (and anorexia), as well as addictions that do not involve the ingestion of a product (games of chance, shopping sprees, sexual addiction), and even relational dependence.

BÉNÉDICTE BONNET-VIDON

See also: Addiction; Helplessness. Bibliography

• Freud, Sigmund. (1911b). Formulations on the two principles of mental functioning. SE, 12, 218-226.