6. Personality and Social Learning: The Theory of Controlled Drug Use

THE RELATIONSHIPS AMONG PERSONALITY (SET), SOCIAL STRUCTURE (SETTING), and drug initially seem obvious. Everyone knows that psychic states vary greatly, that the environment affects them, and that drugs may make a tremendous impact on them. But these relationships, though easy to grasp in theory, are surprisingly difficult to accept as practical realities. Most of us are accustomed to thinking of drugs in a medical context, where they are used for the treatment of specific conditions. Thus we wrongly assume that the effect of a drug is constant-that it will have the same effect on different patients with the same condition, and moreover that its effects on the same patient will not vary over time. The physician is not eager to dispel this belief because he wishes to maximize the therapeutic effect of the drug he has prescribed.

In spite of this medical aura surrounding drugs, most drug experts have come to accept the importance of set and setting in influencing drug effects. Those who are not experts can perceive the significance of the drug-set-setting combination by examining their own or others' experiences with alcohol. The effects of alcohol vary from person to person and over time: there are happy drinkers, morose drinkers, belligerent drinkers, and flirtatious drinkers. Sometimes alcohol may be a relaxant (the martini after the hard day at the office) and sometimes it may act as a stimulant (the first drink at the party). Often it serves as a mood accelerator, deepening depression or heightening euphoria in accordance with preexisting conditions. At times it releases inhibitions, and at other times those who have already put aside their inhibitions will take a drink or two to provide themselves with a socially acceptable alibi. From the standpoint of pharmacology, alcohol suppresses the action of certain inhibiting centers in the brain and can have no result inconsistent with this action. Yet the range of actual effects in terms of both behavioral change and psychic state is extremely wide. It may be precisely this wide range of possibilities that makes alcohol such a popular drug. Admittedly, these eclectic effects serve my theoretical stance by emphasizing the importance of the interaction of drug, set, and setting.

The Psychological Viewpoint

The investigation of this complex three-way interaction is a comparatively recent phenomenon, even though the existence of psychic disturbances and varying psychic states was recognized long ago. Not until the end of the last century did a technique appear that made possible a systematic theoretical study of personality and personality disturbance: the technique of psychoanalysis developed by Sigmund Freud and his followers. Whatever one may believe about its therapeutic efficacy, this technique permits a thorough study of the individual, tracing the growth of personality structure from the earliest motives and relationships and showing the continuity between early development and later behavior. Freudian studies of individual lives have opened up vistas of perception that have not only influenced every aspect of psychology but have become embedded in the medicine, art, literature, sociology, and even politics of Western culture.

THE IMPACT OF FREUD. Most Westerners of the late twentieth century are aware some would argue hyper-aware--of the intensity and influence of the inner, often unconscious preoccupations. A contemporary writer would not, like Ruskin, discuss in his diary his impotence and sexual dreams as if, like pneumonia, they had been visited upon him. Much more typical of this century was the amused public reaction to President Richard Nixon's parapraxes (slips of the tongue), as when he said in 1960, with his wife at his side, "I can't stand pat," or when he called his colleague and running mate, Henry Cabot Lodge, with whom he had been having disagreements, "my distinguished opponent." Such slips drew guffaws from the audience and made the front page of the New York Times. The twentieth century, indeed, can accurately be characterized as the century of individual psychology, the "I" years (Lasch 1979).

In the light of Freud's impact on Western thinking it is not surprising that the rapid increase of illicit drug use in the 1960s (the so-called drug revolution) evoked not just public condemnation but the question, "Why do they do it?" or "What makes them do it?" And it is understandable that in attempting to answer these questions professionals as well as the public turned first to the deep-seated and usually unconscious personal motivations. Before the drug revolution the theorists and clinicians who studied drug users and abusers had interpreted drug problems as stemming from extensive personality disturbances (the so-called addictive personality) (Zinberg 1975). At that time such users probably made up a far greater percentage of those who became addicted than they do today. The recent shift away from the all-importance of set to a recognition of the significance of both set and setting seems to be part of an ongoing social-historical process that had its beginning during the drug revolution itself. This process was set in motion in the 1960s, when people who were quite different from the earlier drug takers started to use illicit drugs. Weil and I with Nelsen became aware of it in 1968 when we were conducting our controlled experiments with marihuana users. The so-called chronic users in that study, those who had begun smoking marihuana before 1965, were more anxious, more antisocial, and more likely to be dysfunctional-therefore closer in spirit to the handful of musicians, "Bohemians," blacks, and browns who had used marihuana before the drug revolution-than were the naive subjects who were just beginning use in 1968. By the late 1960s, we found, marihuana use was being experienced as a much more normative choice than it had been before 1965. And by the early 1970s the change had become even more evident. The controlled marihuana users described in the present study (exemplified by Michael in chapter z) could not possibly have been driven to drug use by deep-seated and self-destructive unconscious motives.

The situation with heroin is more complicated. Since the 1920s most heroin users have been low-skilled members of the working class, coming from poverty-stricken backgrounds and precarious family situations. Early studies of these users focused on the impact of adverse social conditions on early personality development, thus taking both setting and set into account. It is questionable whether these studies demonstrated that such social conditions were the underlying cause of drug problems; in any case, the immediate object of study was the bitter, deprived personalities that came from such homes. And material from these earlier studies is still being used to show a direct relationship between certain kinds of severe personality disturbances and drug use.

PERSONALITY THEORIES. The viewpoint that drug use can be explained primarily in terms of personality is based on one or another of the theories of early development elaborated by the followers of Freud. Although, in thinking about very early development, it is extremely difficult to distinguish between genetic predispositions and early postnatal influences, dynamic personality theorists postulate that for a variety of reasons some people, during the process of growing up, find it more difficult than others to deal with certain powerful, primitive impulses. The histories of a few of the compulsive opiate users we interviewed for the present study are typical of what has been called an "addictive personality." These individuals had often been in trouble in grade school because of various problems, some of which appeared to be school phobias.

They had begun to smoke cigarettes heavily before the age of twelve, and they had had consistent and vicious struggles with parents or other family members. Sometimes they had had early obesity problems or had been runaways. They had begun to have trouble with the police in their early teens, when they had also started using alcohol and any other intoxicating substances they could find. They had used these intoxicants to excess, which had led in turn to other troubles indicating lack of control, such as auto accidents, expulsion from school, loss of jobs, or getting into fights. Finally, they had concentrated on one drug, usually heroin but sometimes a barbiturate, and had used it often and compulsively. A few of the compulsive users we interviewed and assigned to a comparison group fitted this general description, as do some of the addicts I have seen in treatment settings.

Users with such histories have led many clinicians and theorists to conclude that drug use is related in an almost one-to-one fashion to the user's disordered personality. By delving into any subject's past, it has been easy for such investigators to obtain a more elaborate history indicating varying degrees of early trauma that might have led to such disorder. One obvious trauma would be the loss of one's mother (through early death, desertion, mental illness, or some form of addiction), or the loss of one's father, or the breakup of the family structure. Though lacking the more overt evidence of early trauma, including physical difficulties, a subject might reveal a deep sense of being unloved or rejected, usually by the mother but at times by various "significant others" (Mead 1934). Such powerful, unfulfilled longings for love, for acceptance as a worthwhile and lovable human being, and for a sense of basic trust in another or in one's self might lead to overwhelming feelings of desolation and rage, over which the individual had been unable to develop reliable internal controls.

Some personality theorists (Knight 1937; Rado 1958; Rosenfeld 1960; Wishnie 1971) have assumed that intoxicants can "help" people with these rending conflicts by providing the surcease from frustration that had not been provided by the absent or unloving mother. These theorists see the users' impulses to take in heroin, alcohol, or other drugs as a translation of those unfulfilled early longings or "needs," to use current parlance. Other theorists (Kaplan & Wieder 1974; Khantzian 1975; Khantzian, Mack & Schatzberg 1974; Krystal & Raskin 1970) have suggested that intoxicants, especially heroin, are used as anodynes to the rage resulting from excessive frustration: if internal controls over these feelings are poor or nonexistent, the drug will act as a tranquilizer. In that case the decision to use drugs is an attempt at self-medication-a misguided effort to adapt to the world and reduce the destructive consequences of one's poorly controlled feelings.

While the earliest psychoanalytic writers on the relation between personality and addiction drew a fairly straightforward picture of unrelieved impulse leading to intoxicant use, later writers have presented a far more complex thesis. In attempting to explain how unrelieved impulse may lead to disorganized and poorly functioning internal psychic structure, a weak self-image, and lack of self-esteem, they have emphasized the process of identification (or lack of it) with reasonable parental figures. Having observed, particularly in the case of alcoholics, that families with significant addicted members breed more addicts, they have theorized that unrelieved desires for acceptance and closeness can be expressed by attempting to be like the desired person, or "object." It is as if unconsciously choosing to be like the person will ensure being liked by that person.

This drama, which is usually played out entirely within the intrapsychic realm, is not recognized by the individual, and consequently the mere suggestion that he is drinking in order to feel close to an alcoholic father he now hates would be anathema to him. Yet most of the direct personality theorists attach great importance to the enormous guilt that arises in the individual, particularly the addict, because of the raw and uncontrolled quality of his impulses. Such theorists view the addict's sense of guilt as the cause of much of his self-destructiveness and difficulty with self-care.

Personality theorists use a variety of forms and terms. Today there is great interest in Heinz Kohut's concept that each person's narcissism develops in a more or less separate line from other aspects of his personality structure. Using Kohut's theory, intoxicant use can be described as a function of the "selfsystem." The sufferer from a narcissistic personality disorder uses an intoxicant in an attempt to avoid directly expressing his desire to merge with a longed-for, idealized self-object, and by this avoidance to keep from reactivating the possibility of a traumatic rejection. Instead, within the self-system, the sufferer is able to function at the high moment of intoxication as if he himself were the object he longs for and idealizes. But when intoxication has receded, that intoxicated aspect of the self has a different function in the self-system; it is more likely to represent the despised, unlovable self. Since this debased conceptualization of self touched off the search for a merger with an idealized self in the first place, it is logical, according to this theory, that the compulsive desire to reexperience intoxication should quickly recur.

There are many other more or less sophisticated variations on these psychoanalytically oriented themes, as well as a variety of behavioral-learning theories, which fall outside the scope of this study. Though their forms of expression differ, the purpose of all these theories is to explain intoxicant problems as principally a function of personality-to trace, as was stated recently, the "developmental stages" as well as those "factors [that were useful] in countering the rage and depression that had to be defended against through drugs and alcohol" (Zaleznik & Schwaber 1976). And although little writing has appeared that specifically utilizes personality theory to explain controlled use, personality theorists would doubtless explain the lack of addiction under the same rubric. For instance, they would see Michael's capacity to control his use of marihuana (chapter z) as having been engendered by a coherent early development and good early relationships with significant others, a condition that would lead to a personality structure well defended against the impulses of desolation and rage and well equipped with internal controls to deal with those impulses if they should get out of hand.

SET-SETTING INTERACTION. As shown in a recent compendium entitled Theories on Drug Abuse (Lettieri, Sayers & Pearson 1980), the complexity of drug use by any individual within a given social milieu is appreciated by more theorists today than it was a few years ago. This move away from thinking almost exclusively in personality terms jibes with my own position that both individual personality structure and social setting must be included in any coherent explanation of the way in which the social learning process makes controlled intoxicant use possible. But how can the interaction of set and setting be explained in psychoanalytic terms? Traditionally, Freudian theorists have been concerned not with the effect of the social setting on the individual but with the impact of the basic, inborn "instinctual drives" and the individual's need to gain control over them in order to achieve a manageable social existence. Freudians have continued to think in terms of these primitive, biologically given drives operating out of a core substratum of the personality that was formed during early development, with emphasis on the management of the aggressive drive (selfpreservation) and the sexual drive (preservation of the race). They have assumed that, because these drives are universal givens transmitted through a family environment and because the personality structures that are developed to control them are relatively immutable, the consideration of social structure has a low priority. They have, of course, seen and explicated in great detail the significance of the child's early years and early relationships, but they have failed to emphasize the continuing significance of the broader physical and social environment.

Yet two of the constructs of psychoanalytic theory-relative ego autonomy (REA) and average expectable environment (AEE)-which have been much used in other contexts, can be very helpful in explaining how social learning produces limited changes in ego structure and functioning. REA, a concept first put forward by Heinz Hartmann (1939), signifies the capacity of the ego to balance and synthesize the inputs from the instincts with those that arise from the press of the environment (Gill & Klein 1964; Rapaport 1958; Zinberg 1975), while AEE refers to the kind of physical and social environment in which REA can be delineated and maintained by the individual (Gill & Klein 1964; Rapaport 1959, 1960).

These two constructs have had an enormous impact on post-Freudian psychoanalytic theory. And although Freud's followers have never parted with the notion of instincts, their interest in the functions of the ego and its capacity to adapt to change in the environment has increased. Edward Bibring (1954), for example, includes the adaptive capacity in his list of six ego functions: perceptual, discharge, executive, mastery of anxiety, sensorial, and adaptive. In addition, other theorists (Rapaport 1958; Zetzel 1949; Zinberg 1975) dealing with the metapsychological level have included the ability to adapt among the following five capacities of the mind: the adaptive, the dynamic, the economic (mental energies, not quantified), the developmental (a genetic developmental sequence), and the structural (the coherent mental structures, or the id, ego, and superego). These five capacities of the mind, including the capacity to adapt to the social environment, are seen as biological givens that are based in the individual and are potentially mutable.

Because no single biological structure-that is, no individual human being-can be considered infinitely adaptive, the individual's capacity to adapt is assumed to function only within a reasonable range of experience. This range is determined after birth by the inputs of the physical and social environment. Of course, individuals with different biological endowments deal with their environmental opportunities differently; they develop different personality structures and adaptive capacities (REA), which function within the range permitted by their particular environment (AEE). For instance, a child growing up in the jungle will have different skills and capacities from a child growing up in the city; while the jungle child is learning about edible wild plants, the city child will be learning not to touch hot stoves. This comparative example is obviously only qualitative; the differences it specifies are not scientifically demonstrable or quantitatively measurable. Like the concepts of AEE and REA, which it is intended to illustrate, it merely suggests the types of differences and limitations that arise for human individuals of different inheritances living in different physical and social environments.

Relative Ego Autonomy

Psychoanalytic theorists who are particularly concerned with ego psychology, most notably David Rapaport, recognize that changes throughout life in not only the physical situation but also the social situation, including social setting and social attitudes, threaten ego autonomy and continually force the ego to reach a new balance or homeostasis.

RAPAPORT's THEORY. Rapaport began his work on ego autonomy by distinguishing the effects of the environment on living and nonliving matter.

Nonliving matter, he wrote, cannot escape the total impact of the environment, and the results of the interaction are invariant and statistically predictable (Rapaport 1.958). This is not true of living matter, however, in spite of the claims of some psychoanalytic theorists that inner forces are strong enough to nullify the effect of the environment and thus make human behavior predictable.

Rapaport developed his argument by referring to the opposing positions of Berkeley and Descartes. In the Berkeleian view, man is totally independent of the environment and totally dependent on inner forces and drives. He need have little concern for the external world since it is "created" by inherent forces. The cartoon psychiatrist who is shown asking someone who has been hit by a car, "How did you cause this to happen to you?" is taking an exaggerated clinical view of this position. Descartes, on the contrary, saw man as a clean slate upon which experience writes. Man is totally dependent upon and thus in harmony with the outside world, and totally independent of, or autonomous from, internal desires. In essence, Cartesians, like some behaviorists, view such drives and the unconscious that supposedly contains them as nonexistent.

In explaining the factors that enable the ego to maintain its relative autonomy, Rapaport accepted neither the Berkeleian nor the Cartesian view of man. He reasoned that in order to understand how the ego, whose functions determine and delineate a sense of self, remains relatively autonomous and copes with the demands of the external environment as well as the instinctual drives, one must consider both of these elements and their interactions. On the one hand, the primitive drives provide the ego with the energy to prevent man from becoming a stimulus-response slave. As examples Rapaport referred to the man who did not march in step to an enthralling military band because he was deep in thought, and to Orwell's protagonist in 1984 (1949), who was saved, at least temporarily, from the press of his overwhelming environment by falling in love. On the other hand, the ready availability of a constant stream of stimuli from the environment permits the ego to mediate and moderate these drives by sustaining the primary ego apparatuses-motor capacity, thinking, memory, the perceptual and discharge thresholds, and the capacity for logical communication. Here Rapaport referred to the story of the great king who had been told by his wise men and phrenologist that Moses was cruel, vain, and greedy. Upon finding Moses gentle, wise, and compassionate, the king planned to put his seers to death. Moses demurred, saying, "They saw truly what I am. What they could not see was what I have made of it."

We constantly forget, wrote Rapaport, that what we permit ourselves to perceive of as external reality is an ego function. The soldier, the artist, the dendrologist, and the botanist see the same tree, but each perceives it differently. Moreover, the threshold at which each one discharges his response varies in accordance with his age, personality, ethnicity, social circumstance, and other factors that the ego collates. External reality also nurtures the secondary ego apparatuses, such as competence, cognitive organizations, values, ideals, and a mature conscience, and allows these characteristics to become successfully estranged from the original drive functions. Of all the gross misconceptions about psychoanalytic theory, one of the most egregious is the notion that the sadistic factors that led a little boy, for instance, to tear off a fly's wings propelled him later into a surgical career. In that reductionistic explanation many positive qualities are ignored-his manual dexterity, intellectual capacity, diligence, and regard for the health of others-which had been recognized, nurtured, and rewarded by many significant others, eventually including his patients, and which enabled him to choose a medical career, to complete it successfully, and to use the surgical knife without guilt.

Thus the relationship between the ego's relative autonomy from the id and its relative autonomy from the environment is one of interdependence. To put it another way, the autonomy that Rapaport postulated is always relative, always dependent upon the balance between the inner drives and the outer environment. When these two forces are nearly equally balanced, the ego remains relatively autonomous from both. But if the balance is upset-if the drives take precedence over the stimulus nutriment flowing in from the environment, or if external stimuli overpower the natural instincts-the ego's ability to function is endangered.

When the drives are at peak tension, as in puberty, the ego's autonomy from the id is in jeopardy. Although adolescents try to combat their tendency to subjectivity, seclusiveness, and rebellion by the external reality-related converse of these qualities-intellectualization, efforts at total companionship, and distance from primary objects-it is an unequal and often painful struggle, one that may be played out in part by experimenting with intoxicants. The ego's autonomy from the id can also be disrupted when the balancing input from external reality is minimized. The stimulus-deprivation experiments (Bexton, Heron & Scott 1954; Heron, Bexton & Hebb 1953; Heron, Doone & Scott 1956; Lilly 1956) confirm that when individuals are deprived of the normal, varied stream of external stimuli they become autistic and suffer from magical fantasies, disordered thought sequences, disturbed reality testing, primitive defenses, and poor memory. When the subjects of those experiments were in a state of reduced ego autonomy from the id, they were subjected to such an insistent stream of bizarre instructions, including the order to believe in witchcraft, that their lifelong convictions were shaken. So shaken was their hold on external reality that two weeks after the experiment, when asked about witchcraft, subjects continued to display uncharacteristic doubts about the invalidity of magic. This instructional part of the experiment demonstrated the interaction between the two guarantors of ego autonomy. It showed that when stimuli from the environment were minimized, resulting in a loss of ego autonomy to the id, the ego became an easy prey to the press of the external environment.

REA may also be impaired by conditions that supply frightening forms of stimulus nutriment. In the concentration camps, where external factors maximized the individual's sense of danger and aroused fears and neediness, the primitive drives, instead of acting as guarantors of autonomy from the environment, prompted many to surrender to it. During the stimulus-deprivation experiments, too, the replacement of varied stimuli by streams of official instructions gave those instructions power and engendered belief in their authenticity. It is not surprising that Rapaport used George Orwell's 1984 as a text, for this work describes in clinical detail how the deliberate upsetting of the balance between drives and environmental stimuli can reduce REA and turn individuals into stimulus-response slaves. If human beings are to maintain their sense of identity, their values, ideologies, and orderly thought structures, they need to receive constant environmental support for their existing verbal and memory structures.

Rapaport did not limit his discussion to the ego. He showed that the superego is even more dependent on consistent stimulus nutriment. The socalled convention syndrome-the situation in which respectable men and women who are removed from their usual routines and social relationships behave in an impulsive and uncontrolled manner-illustrates how heavily the rulings of conscience depend on social structure. When the usual constraints are left behind and the individual faces a new, short-term environment, the balance between id and environment is upset and the superego becomes subservient to the id. Thus the sailor in a strange port either must limit his exposure to the new environment or must find acceptable interests to balance his sense of alienation and depression, which might otherwise lead to some form of debauchery.

THE HEROIN ADDICT. An understanding of REA with its dependence upon the balancing inputs of id and environment sheds a good deal of light on the mental state and behavior of the heroin addict. Obviously the addict has lost or been cut off from many sources of stimulus nutriment. He is alienated from his family and. friends, or if such relationships still exist they center on acrimonious pleadings that he give up drugs. Moreover, his inputs from the larger society, which regards him as a deviant, give him an entirely negative view of himself. His only other environmental input consists of the limited litany of his drug-using group: "Have you copped? When? Where? Was it good? What do I need to cop? What if I can't? Who got busted? Will I get busted?" The addict, in short, resides in a relatively stimulus-deprived environment. His dependence on whatever is left of the environment is further heightened by his need to continue coherent relationships with the few remaining external objects. He suffers constantly from doubts about his ability to maintain such relationships, and he readily accepts society's condemnation. This holding to what remains of the external environment maximizes the ego's autonomy from the id, but it does so at the cost of impairing the ego's autonomy from the environment by minimizing the input of those affective and ideational signals that usually regulate judgment and decision.

Thus the addict is caught on the horns of an environmental dilemma. His dependence on environmental support is increased by his need to cop, but his access to that support is curtailed by the deviant label society has pinned on him. At the same time, the addict's drive structures, derived from his primitive instincts, are kept at peak tension by his desire for gratification from the drug, as well as by his deep fear of the result of being unable to get it, the withdrawal syndrome. He is at the mercy of primitive impulses and of an overwhelming sense of neediness that invades or, rather, blocks out the capacity to perceive and integrate "objective" reality. Filled with doubts, he gullibly responds to those in the external environment who offer schemes that promise magical succor, and he continues to seek the drug that will provide relief.

When REA is upset, the ego tends to seek a new homeostasis. In the case of the drug addict, the new balance is likely to be relatively inflexible and to have a slow rate of change. This balance is established under very unfavorable conditions. At the same time that the input from both the id and the environment is insufficient or distorted, the drive structures are making variable but insistent demands for drug gratification, and the ego is struggling, as the clinical evidence from our subjects has shown, to retain whatever level of ego functioning is still left to it.

This internal struggle is the principal reason for the rigidity therapists have found in their work with addicts, both in and out of methadone clinics. The addict's new homeostasis of ego functioning cannot easily absorb fresh stimulus nutriment, not even an input so neutral and sustaining as that of a reasonable therapeutic relationship. In fact, the therapeutic relationship is particularly difficult for the addict to tolerate because it is intended to be at variance with the addict's usual relationships and to make his reliance on selective perception, quick repression, projection, and denial more difficult. All of these intrapsychic defenses are used by the addict to avoid coming in contact with perceptions, affects, and ideas at variance with his acceptance of himself as an addict and with the internal state he has derived from that acceptance. This is in distinct contrast to the psychological state of controlled users. Yet, as long as addicts continue to be classified as deviants, they will find it extremely hard to see themselves in any other light. And as long as their relationships with theexternal world continue to supply only restricted stimulus nutriment, they will probably continue to block most affective environmental inputs that are not oriented toward drug gratification and their accepted view of themselves.

The psychological state (set) of the addict, which resembles that of the subjects of the stimulus-deprivation experiments, is reminiscent of the regressive state described in the discussion of REA. In this state-the result of the ego's inability to maintain its relative autonomy from either the id or the external environment-the barriers between the ego processes and the id processes become fluid. Images, ideas, and fantasies based on primary-process thinking (according to Freud, thinking from the instinctual depths of the mind) rise to consciousness; and interest in magic, belief in animism, generalized unfounded suspiciousness, and acceptance of extremely childish rhetoric become regressively active in ego functioning. As the individual is forced to rely more and more on primitive defenses, his sense of voluntariness and his inner control over his actions tend to disappear.

The addict often seems to be vaguely aware of his own primitive responses, but he cannot bring them into consciousness long enough to question them: not only does his ego struggle to retain its existing capacity to function, no matter how unsatisfactorily, but his primitive feelings usually seem so real that he is unable to transform them into secondary-process thinking. His primary-process responses are not unlike those of the LSD user of the 1960s, particularly the user whose trip experience had little in common with his previous social and psychological experiences. By the 1970s, however, the changing social setting-the appearance of well-defined social groups that were knowledgeable about tripping-enabled the user to respond in a secondary-process way (Zinberg 1974).

Rapaport's writings on REA, which make it clear that the impact of the social setting on ego development is an ongoing process, tend to support my view that continued personality development and social setting are interdependent. Just as REA rests on a relatively stable but continually shifting balance between internal forces (which change at different life stages) and an external environment (which is constantly in the process of change), so the relationship between personality and social setting involves a relatively stable but continually shifting balance. Changes in that balance often result in changed social attitudes toward particular patterns of behavior. Thus behavior patterns that were once perceived as deviant and as the source of disruptive emotional conflicts may gradually become socially acceptable and even normative.

Average Expectable Environment

Rapaport's explication of Hartmann's concept of REA depended upon and included the equally important construct of AEE: the idea that a consistent, regular relationship between the individual and his social environment guarantees him a coherent series of mental functions free from domination by primitive impulses. This construct makes it possible for psychoanalytic theory to take account of the role of social change-the changing attitudes and behaviors of the social setting-in the development of that subtle complex of self-awareness that is variously called a mature ego, an identity, the self, a sense of selfactualization.

SOCIAL CHANGE AND PERSONALITY DEVELOPMENT. Although much of the writing of psychoanalytic theorists seems to imply that the early social environment alone constitutes the AEE, it is apparent that changes in the environment continue to affect ego development throughout life, and further that the kind of environment experienced by the infant may change from one generation to the next, if not from one decade to the next. Take, for example, the subject of breast feeding. One decade, breast feeding is out of fashion; thc next, it is in fashion. And whether it is out or in makes a marked difference to the child in his earliest relationship with his environment.

Up to now the study of the influence of social change on personality development has not demanded full attention because the investigation of the way in which individuals master their early primitive drives and longings has in itself been sufficiently preoccupying. And the view that environmental change does not contribute to the process of essential personality development contains some seeds of truth. Personality has only a few basic building blocks, which include only a few fundamental affects (feelings); and the essential structure, whether based on genetic predispositions, early experience, or early introjections (internalizations of significant others)-and it is impossible to . differentiate these-is laid down very early. Therefore, social change has a greater impact on what happens after the basic structure of personality has been established than on the original formation of that structure. The building blocks are in place; the cornerstone cannot be moved. But considerable rearrangement of the secondary structure is possible, on both a short-term (consciousness change) basis and a long-term (personality modification) basis. Each person, as a result of his genetic predispositions, early development, and social circumstances, has available a limited range of ego functions that can become relatively autonomous. But the social setting determines exactly which of these perceptions, discharges, and capacities are most likely to achieve REA. The active process of social learning will affect different personality structures differently, but there will always be a balance between the inner drives and the outer environment.

It is also true that the opportunities offered by the environment for the expression of individual psychological states in certain forms of behavior may change in ways that affect the emerging personality fundamentally and irrevocably. For example, social attitudes toward sex changed so rapidly in the United States after the Second World War that a period of even a decade or two made an appreciable difference in individual sexual behavior. For the sake of illustration, consider the hypothetical cases of three sexually inhibited twentyyear-old women, the first living in the 1950s, the second in the 1970s, and the third in the 1960s. (The contrasts presented in this illustration are sharpened by not following chronological order.)

The woman of the 1950s experienced psychological conflicts about sex but remained aloof from sexual experience until custom forced her into a predictable marriage and a sharply defined sexual role. The similarly inhibited twentyyear-old of the 1970s behaved very differently, entering into a variety of sexual experiences before marriage, because as an adolescent she had internalized a more permissive set of social mores. that permitted some relaxation of her superego. In spite of underlying inhibitions and doubts, she was pushed by peer pressure, technological "advances," and the changing value system into a more direct expression of sexuality. Finally, the twenty-year-old woman of the 1960s behaved differently from both her counterparts. During her adolescence she had experienced far greater anxiety about pregnancy than the girl of the 1970s: the Pill had not yet been accepted, and she had not received much information about sexual activity and homosexuality from the media. She therefore felt threatened by the new social attitudes, and although she experimented with premarital sex, she experienced psychological conflicts akin to those of the woman of the 1950s.

The different forms of sexual behavior manifested by these three women can best be explained in environmental terms. Viewed psychologically, all three were conflicted about sexuality, but each woman's behavior reflected the mores of her time. The social inputs of each decade delineated the AEE and brought about the ego development that enabled each woman to adapt to the new situation.

TECHNOLOGICAL AND SOCIAL-PSYCHOLOGICAL CHANGE. Social-psychological change is often touched off by technological change-for the women of the 1960s and 1970s by the development of the Pill. Technological change occurs obviously and relatively rapidly and is therefore quickly transmitted through the process of social learning. By contrast, social-psychological change takes place slowly and is more subtle, but it is no less critical to personality development. Two of the best examples of technological change and its socialpsychological consequences come from the area of drug use.

The development of drug technology has had two major effects on drug use in America. First, technological advances, which have resulted in a proliferation of new, powerful drugs and the rediscovery of older ones, have vastly increased the number and availability of psychotropic substances. Some of these are concentrates, produced by extracting the active ingredients from natural drugs: heroin, for example, was derived long ago from opium. Others are synthetics, such as LSD, which are powerful substances but have no previous history of use. Several observers, notably Andrew T. Weil (1972) and James V. DeLong (1974), have stressed the importance of this first effect of new drug technology.

But the second effect is much more significant. Although it is not generally recognized, the fact is that the rise of interest in the consciousness-changing illicit drugs was preceded by a rise of interest in the consciousness-changing licit drugs. Until the 1950s, medical practitioners had few psychoactive substances, and those they did have, such as the barbiturates and the amphetamines, had only very general depressant or stimulant effects. Before the late 1950s, literally tons of phenobarbital were prescribed each year in the hope that this drug would reduce the edge of anxiety for some individuals. Then, quite suddenly, the phenothiazines, the tricyclics, the monoaminooxidase inhibitors, the benzodiazepines, and other new drugs appeared. Each of these new classes of antipsychotic, antidepressant, or antianxiety medications spawned numerous variants and combinations intended to achieve specific psychoactive changes for many types of people. It would not be going too far to say that the entire community mental-health movement and the press for deinstitutionalization of the enormous state hospital systems could not exist were it not for the phenothiazines.

Is it any surprise, then, that in a society made aware of the existence of* many substances that might change consciousness for the better, some individuals have begun to take a new look at all sorts of drugs, both licit and illicit? Recently I appeared on a panel with a prominent psychopharmacologist who was describing the successful treatment of a complex case of mixed paranoia, depression, and anxiety. The doctor explained that by carefully titrating a mixture of a phenothiazine, a tricyclic, and a benzodiazepine, he had been able to help the patient significantly. In reply I said that I had just returned from Washington where I had heard young men in important political positions describing their daily lives: long hours of hard, intense work followed by a round of official cocktail parties. They said they enjoyed the tension-relaxing drinks; and the parties, attended by Congressmen, Congressional aides, political appointees, and other Washington-based power brokers, gave them an opportunity to do business. Later in the evening, in order to cut through the alcohol effect and get back to work, they found a little sniff of white powder just the ticket. Then, when they finally reached home exhausted, they relaxed by puffing on a thin cigarette filled with brown material, called a joint. "Was this careful titration of illicit drugs," I asked the panel members, "very different, except in the degree of emotional difficulty, from the medication regimen described by the psychopharmacologist?"

THE IMPACT OF SOCIAL LEARNING. For individuals with certain kinds of personality structure, such as those who are apprehensive about controls or those who are morally opposed to anything illicit, the presence in the AEE of licit consciousness-changing drugs has not weighed heavily enough to change the perception of drug-using behavior. For others with a different personality structure this social input has made a difference. It is clear, for example, that in the case of those who chose to use or not to use marihuana after its use became widespread, the nonusers were no longer necessarily the good guys, although plenty of decent, reliable, interesting, and adventurous youngsters decided that marihuana was not for them. And, conversely, those who chose to use were no longer necessarily the bad guys, although plenty of pleasure-seeking, anxiety-avoiding, passive youngsters decided to use.

The impact of social learning is not confined to behavior. It also affects internal perception and the capacity to activate internal controls. Our recent interviews with marihuana users revealed that naive subjects no longer need to try marihuana several times before they experience a high-a phenomenon characteristic of the 1960s, observed by Weil, Zinberg & Nelsen (1968) and others (Becker 1953; Goode 1972; Kaplan 1970). Nowadays, as a result of accumulated knowledge about the effects of marihuana use, even first-time users are prepared to experience the high and therefore many have done so.

The recent history of LSD use also exemplifies the impact of social learning. Howard S. Becker's prediction (1967), made at the beginning of the drug revolution, to the effect that after the intoxication induced by psychedelics had become more familiar and the users knew what to expect, their fears would be minimized and their reactions would be less severe and less frequent, proved to be correct (see chapter 1). Becker did not underestimate the extent of the changed consciousness state produced by LSD; he knew the drug to be many, many times more powerful than marihuana. But he was also aware of the power of the social learning process to socialize users to the experience. Verification of Becker's point was offered by my phenomenological study of the "high state" (Zinberg 1974). I discovered something that had not been so obvious to Becker and others: that when an individual experienced the psychoactive effects of LSD, he would select explanatory constructs out of the range of cognitive and emotional percepts available to him, and his responses would follow the available able explanations of his situation. In effect, the boundaries of his AEE, which were determined in part by the social learning process, also determined the drug response to a great extent.

It may be that society is facing not only the powerful impacts of widespread drug use on individual behavior and internal capacity but also a striking change in the influence of social learning itself. Technological change, or more precisely the growth of knowledge, is one of the most important elements affecting the AEE. And philosophers of science point out that the rate of growth of knowledge has increased exponentially, as judged by rates of publication, patents, and other measurements. Before 1945, it took over 100 years for the sum of knowledge to double; then, amazingly, it doubled between 1945 and 1960 and again between 1960 and 1970. What is more, as of the early 1980s, the totality of human knowledge is expected to double every twelve years.

This rapid change means, for one thing, that parents have a different AEE from their children. Parents born in the 1920s or 1930s often find computers and their accessories strange and forbidding. They must restrain themselves from fulfilling a wish to "bend, spindle, or mutilate." By contrast, people born in the 1960s or later regard the computer, whether pocket, desk-top, or any other model, as just one more familiar article that they have learned about and used in school.

The splendid works of Thomas Hardy describe a society in which most learning took place vertically from one generation to the next. In Hardy's Wessex, children learned from their parents about work, relationships, and customs, and they followed the family pattern. Leaving one's village was a major step. When Jude left home to live in far-off Oxfordshire, he broke away from the family pattern, and his life broke up in consequence (Hardy 1895). In such a society, social learning hardly went on outside the family or the close social group.

Today much learning and perhaps most social learning is horizontal, that is, intragenerational. The peer group is mainly responsible for spreading information about work, relationships, and customs. Certainly most information about drug use, including particularly sanctions and rituals, is being transferred through peer groups, although the specific informational content may vary enormously from one group to another. It seems likely that this growing familiarity will permit future generations to make distinctions among drugs and forms of use that are not being made today by either parents or policymakers. It is also possible that social learning relating to drug use will in the future be transmitted within the family, as is the case with alcohol use now, and that the role of the peer group will be less important. A change in that direction seems to be taking place already in relation to certain illicit drugs, in particular marihuana.

The first generation of illicit drug users is always regarded as deviant. They have strong personal motives for seeking out such a drug as marihuana, and they use it with great anxiety. Gradually, as the deviant activity catches on (as marihuana use did in the mid-1960s), knowledge increases, misconceptions are corrected, and the users become more confident and tend to stop thinking of themselves as deviants.

The second generation of users tries the illicit drug not primarily because it wants to rebel against the straight society (the larger social setting) but out of curiosity or because they are interested in its effects. When the second generation supports the arguments of the first generation and opposes the cultural stereotypes about marihuana use and users, it is more likely to be heard: there are more of them; they are more diverse in background; and their motives, which seem less personal and less antagonistic to the reigning culture, are more acceptable to society.

By this time even the straight society has moved away from its formerly rigid position toward marihuana and has become mainly confused. Such confusion encourages others in the larger social setting who are not primarily motivated by either drug hunger or social rebellion to experiment with the drug. Their reports have an even greater effect on the larger society; and in addition, the new diversity of the using population makes it possible to develop various using styles that work better and cause less trouble.

NEGATIVE EFFECTS OF NEW TECHNOLOGY. Although advances in drug technology have enormously increased the availability and use of both licit and illicit substances, they have at the same time inhibited the development of rituals and sanctions like those that accompany the social use of many natural drugs. Before the American Indians use peyote, they all take part in the ritual of preparing the drug. This ritual puts them into the right frame of mind for use, gives them a knowledge of the drug, and emphasizes the quality of use, thus providing social learning and social control of the drug. But when, as in our culture, drug preparation is transferred to the technical expert or manufacturer, the natural social method of control is lost. The first-time user can be suddenly confronted with a substance that he does not understand and for which rituals, sanctions, and other social controls have not been developed or disseminated.

In addition to providing society with new,' more powerful drugs that lack built-in social controls, technology has supplied the means of publicizing the worst effects of these new drugs. In the 1960s, at the beginning of the drug revolution, the reading and viewing public suddenly learned from widely disseminated media reports, principally on television, about the disastrous results of a psychedelic trip. The discovery of this new experience, experimentation by a few individuals who had a variety of reactions, and further experimentation by others were all kaleidoscoped into a few searing media presentations. These presentations gave the impression, accepted by most of the public, that such disastrous effects were the normal response to psychedelic drug use. Those whose personal experiences or observations had shown them otherwise were forced into a sharply opposing position, as has often happened in the field of illicit drugs. Neither of these responses allowed room either for reasonable social learning about the range of responses to the drug and how best to cope with them or for the development of social sanctions and rituals that might prevent many of the dysfunctional reactions.

Drug Use, Personality, and Society

Most proponents of Freudian instinct theory do not deny that technological change brings about social change, but they do question the view that social change contributes to continued personality development. They say instead that the two dominant drives, sex and aggression, are aroused in all individuals and that society works out ways for those impulses to achieve a degree of discharge under acceptable circumstances. For example, when an individual uses alcohol to remove his inhibitions, society accepts his flirtatiousness and his argumentativeness within limits that are subtly but differently defined by various ethnic groups and social classes. But why do such Freudian theorists not apply the same reasoning to the individual who uses marihuana in a controlled way in order to focus attention on a particular event or to reduce the boundary between himself and his sensations? Both the alcohol user and the marihuana user feel caught between sensations that pull in various directions, and they find reassurance in the capacity to focus for a time on a socially acceptable discharge or a derivative discharge of a primitive impulse. In both cases, the ego's usual relative autonomy from the id is maintained by its traditional guarantor of such stability, the external environment, which determines the acceptability of each form of discharge.

Unlike those, including Andrew Weil, who believe that the search for intoxication and consciousness change is instinctual, I see these interests as an integral function of the ego, part of its capacity to develop and change thresholds for discharge and to limit perceptual capacities. The ego has the potential to achieve discharge of primitive affects and fantasies in various ways, including that of consciousness change. Thus in this and many other societies the use of intoxicants is closely linked with impulse discharge. The group ceremonies and other elaborate social mechanisms developed by primitive societies not only define these discharges as acceptable but also control them, often claiming religious exemption for them. Those South American Indian societies that have used psychedelic drugs on special occasions have managed to control their use in this fashion. It is interesting to note, however, that such societies have not been able to cope with a new, technologically advanced intoxicant--distilled alcohol.

No society can hold back technological and social change. New substances, along with ideas about their use, are continually being introduced, and it takes time for society to find out which of them affect personality development and personal relationships. Not only the drug and the personal needs of the user but also the subtleties of history and social circumstances must be taken into account. No one has understood this more clearly than Griffith Edwards, director of the intoxicant research center at the Maudsley Hospital in England. He once remarked, in pointing out the fallacy of trying to separate the specific incident of drug taking from its social matrix, "One could not hope to understand the English country gentleman's fox-hunting simply by exploring his attitude toward the fox" (Edwards 1974).

The view that intoxicant use depends only on the drug or on a disturbed personality may seem attractive to those who accept the moral condemnation that society has visited upon illicit drug use. But for experts to use psychoanalytic theory to further such a view would be to belittle their own clinical and theoretical aims as well as the capacity of that powerful theory to incorporate social structural variables and the social learning process.