Drug Abuse

Chapter two A gender perspective on female drug-use

2.1 Introduction

The etiology, concomitants and consequences of addiction have been of much interest to scientists. In the past decades there have been several attempts to describe antecedents and consequences of addiction in theoretical models. Perhaps the most important trend is that scientists agree that addiction is a heterogeneous concept in terms of its antecedents and consequences (Hendriks, 1990). But, no matter how heterogeneous these concepts may be, the differences between male and female drug-users have not much been considered. The importance of recognizing the differences has been emphasized in the introduction to this study. Because many problems of women are linked to women's socialization and gender identity it is my aim to initiate a tentative theory of female drug-use from a gender perspective. It is this theory which forms the basis for the questions that will be investigated in the following chapters. In order to develop a conceptual framework, I will first briefly summarize the major models of addiction as background. Subsequently, taking the concept of gender-identity as a starting-point, I will elaborate Kaplan's view on perversion before concluding the chapter by applying her theory to female drug-use.

2.2 Existing models of addiction

In the last decades of the nineteenth century addiction became a medical 'growth area': textbooks started to discuss 'morphia habit', 'morphinism', 'acute and chronic poisoning by opium' and 'withdrawal symptoms' (Berridge & Edwards, 1987). Earlier, until about the middle of the century, doctors had treated opium eating according to the patient's wish (Berridge & Edwards, 1987). They prescribed huge doses of opium without intervening; there are reports of maintenance on a lower dose and sometimes doctors were called to treat disturbing symptoms, though not the opium-eating habit itself.

As Berridge & Edwards (1987) note, 'disease' was generally defined in terms of deviation from the normal. Many doctors recognized that many addictions were iatrogenic in origin. Failures in medical monitoring administration or failures in selfadministration were prime causes of drug addiction.

In the early 1960's, the American metabolism expert Dole was of the opinion that addiction was a metabolic sickness caused by heroine use. According to this theory, methadone could cure the sickness by substituting the substance that heroine had withdrawn from the body. Besides, Dole thought, if enough methadone was administered, the effect of heroine use was undone (Dole & Nyswander 1965, 1980). We are still being confronted with the consequences of this concept even today. The Dutch methadone programmes of the seventies were inspired by the ideas of Dole and the psychiatrist Nyswander (Van de Wijngaart 1989).

However, methadone treatment did not keep its promise; drug-users were not cured and methadone did not block the effects of heroine. As I described earlier, methadone is currently used as a last resort to keep the withdrawal symptoms at bay.

The original metabolic disease concept is revised in the light of new discoveries in medical science (Hendriks, 1990) and interest has shifted towards narcotic receptor occupation (Dole, 1988), the role constitutional factors play in the process of addiction and the chemistry of the brain (Van Ree, 1979, 1987, De Wied, 1977).

From the psychodynamic perspective, drug dependence is not a toxicological manifestation of a drug's destructive action on brain and body, but, as Sandor Rado (1933) suggested, an individual's attempt to cope with serious emotional problems. According to Rado:

(...) not the toxic agent, but the impulse to use it, makes an addict of a given individual.

The drug-user is someone who is unable to cope with frustrations in life, to experience 'painful' tension and who has a low tolerance of pain. In this state of mind, an individual experiences a 'tense depression'. If the individual finds that drugs relieve that tension, then he is sensitized for the pharmacogenic pleasure-effect.

The psychological perspective casts addiction into the light of a learning framework. Drug-use is seen as learned behaviour that is reinforced by stress-reduction (Conger, 1956; Kingham, 1958).

The classical conditioning paradigms refer to the eliciting of stimuli for the response of drug-use. Operant, or instrumental, conditioning refers to the reinforcement of the response (Kanfer & Philips, 1970). As an example of the learning perspective, Miller's (1976) operant conditioning paradigms of alcohol use are presented below. Miller presents the following as eliciting cues of alcohol use: an aggressive boss (social cue), an alcohol advertisement (situational cue), a thought: 'I have

made a mess of my life' as a cognitive cue and withdrawal symptoms as a physiological cue. Excessive alcohol use is the response to these cues. The response is reinforced by positive physiological effects, increased spontaneity and increased assertiveness. The response is also reinforced by diminishment of aversive social, cognitive, physiological and emotional feelings.

This example shows that the learning framework applies social, psychological and physiological antecedents and consequences of behaviour.

Stanton and Peele (1982) viewed addiction from a systems/communication perspective. Their main thesis is that drug-use by a child has a meaning in the family system. As the child prepares to leave the parental home and start work or a career, a crisis between parents develop, because the parents depend on their children for emotional support. The crisis is temporarily resolved when drug-use by the child unites the worrying parents.

While the above models of addiction have all contributed something to the understanding of drug-use, none of these models sufficiently explains or describes female drug-use. Looking for a theoretical framework to explain this female drug-use, I have turned to feminine psychology, whose basic activity is to question and analyze conscious, unconscious or ignored gender differences in socialization, in gender ideals of femininity and masculinity, in social constructs of identity, in expression of emotions, in social status, in economic power, in standards of mental health and in treatment services. Because the aim of this study is to explain female drug-use, I shall first briefly summarize the psychoanalytical view on female development and then focus on a theory that gives an explanation of female 'deviant' behaviour from a gender perspective.

The theory I have chosen is not a framework that portrays women as innately innocent, powerless victims of a bad, male-oriented society. Nor is it a conceptual framework that diagnoses women's pathologies without considering the social context. I have chosen instead a psychoanalytical conceptual framework that looks at pathology as a strategy, as behaviour within a social context. Because female drug-use concerns women who do "bad or morally wrong" things, displaying defiance at the moral code, I have looked for a theory about women's "bad" behaviour from a gender perspective within a social context. Because drug-use is also a form of dependent behaviour I have sought a theoretical framework that explains dependent behaviour from a gender perspective within a social context.

As I will later show, Kaplan's (1991) psychoanalytical theory about female perversions considers and explains women's "bad" behaviour and dependent behaviour from a gender perspective. Also she bridges the gap between psychoanalysis and the social context in which behaviour takes place.

As an introduction to her theory I shall first describe the concept of gender and the construction of gender-identity. Next I will illustrate the concept of social genderidentity with an example of my own. Subsequently I shall explain Kaplan's gender theory about bad behaviour and dependency. Finally I shall apply this theory to female drug-use.

2.3 Gender identity

One of the recent developments in feminine psychology is the gender theory. Nicolai (1992 a and b), a leading Dutch psychiatrist, has developed a feminist model of women's psychiatric disorders based on gender-identity and the conflicts generated by conflicting notions surrounding it. She differentiates between biological sex, psychological and social-based gender-identity and social-cultural sex roles.

Generally, biological sex is defined when a child is born: 'it is a boy' or 'it is a girl'. At the same time the first step in the psychological development of gender identity is taken.

Between the ages of 18 months and 24 months a child experiences a sense of 'core gender identity' (Stoller, 1977). With 'core gender-identity' is meant the subjective feeling, whether conscious or unconscious, of belonging to one or the other sex (Nicolai, 1992 b).

Social-cultural sex-roles are rules and precepts for stereotypical male or female behaviour. These culturally determined sex-roles change in the course of time. Sex-roles influence many aspects of life: clothes, food, expectations, attitude, speech, language, preferences and leisure activities (Nicolai, 1992 b). Social-cultural precepts and rules strengthen the male or female gender identity (Nicolai, 1992 b).

Several theories have attempted to explain the psychological differences between males and females. One of the most influential theories is psycho-analysis. Although Freud's original statement "anatomy is destiny" (1924) has been swept away by psychoanalytically-oriented feminists, they nevertheless have used the pre-oedipal development and the oedipal dilemma to explain the social construction of male and female gender identity and stereotype sex-roles (Chodorow, 1978; Mahler, 1975, Dinnerstein, 1976). Traditional standards and rules are reproduced in patriarchal society's families, not by nature but by culture. The way French structuralists understand the Oedipus complex, viewed as a metaphor (Lacan, 1966), has influenced feminist theory of gender identity development and the reproduction of social-cultural values and sex-roles.

Structuralists like Lacan (1966) view the Oedipus complex not as a biologically determined phenomenon, but as a metaphor. They emphasize the universal force of the incest taboo and the subject's introduction into patriarchal culture through accepting the 'law of the father'.

By accepting the ban on sleeping with mother and identifying with father's role in society, the little boy enters the civilised world of the grown-ups. According to Lacan (1966), the consequence of acceptation of the law of the father is castration. The supposed symbiotic unity between mother and son is broken. Boys will grow up into men only by giving up their wish to marry their mother and behave like their father. It is clear that the son's introduction to the world of symbols, the world of culture is accompanied by a loss, the loss of his supposed unity with his mother. Never in his live will he ever again experience the same closeness of unity with another person. The annulment of the supposed unity with mother leaves an emptiness which cannot be filled. Man's whole life is filled with the desire to obliterate the emptiness. He will never succeed. In essence, the human being is 'fhomme manque'.

Freud presumed that the pre-oedipal development of boys and girls was identical. There is now considerable evidence to suggest that even in that period, there are differences between male and female children. Stoller (1968) has shown that gender identity is firmly established by about twenty-four months of age.

According to Freud, the Oedipal conflict of the little girl comes into being when she discovers the biological difference between herself and her brother or boyfriend. As a reaction, the little girl's interest in masturbation diminishes. Also, she is very angry with her mother. She holds her mother responsible for her "castration". She holds her mother in contempt. The little girl shifts her attention from her mother towards her father and hopes that he will give her a penis. Subsequently she wishes to get a child from the father as compensation for her wish to get a penis.

As girls give up their wish to have a penis and exchange the wish for a penis for a child of the father, they grow up and participate in the world of culture. Girls have to give up their phallic wish to become mother's lover, and will have to satisfy themselves with identifying with mother's role in society. The wish to reproduce, the wish to have a child becomes deeply ingrained in her psyche.

More recent theory is based on Stoller's concept of core gender identity, not based on the Oedipal shock, but based on interaction between biological factors, identification with mother, separation from mother and identification with father, plus learning experiences.

New developments in psychoanalytical theory emphasize the experience of 'primary femininity' of little girls, not as a defense against penis-envy, but as a positive feminine development. The relationship with the mother is studied again and re-evaluated (Bergmann, Glover & Mendell, Oliner & Kestenberg in Mendell, 1982; Bernay & Cantor, 1986; Bernstein, 1990; Flax, 1981; Halberstadt- Freud, 1987). These recent developments in psychoanalytical theory refute the idea of the existence of a feminine "core" consisting of three essential traits: narcissism, passivity and masochism (Bernstein, 1983). The current view on female development includes the positive, less conflictual aspects of femininity: an early identification with the mother, designated as primary femininity; a wish for a child beginning much earlier than in the Oedipal phase; an early positive relationship with father and an incorporation of the maternal ego ideal (Bernstein, 1983).

The above model of female development has provided some insight into the construction of female and male gender identity. The model shows the importance of the role of the family as the transmitting agency of cultural norms and values. But it does not say anything about the content of the cultural norms and values defining what is feminine and what is masculine.

In order to gain insight into the so-called social gender identity I shall give an example of current social gender ideals of femininity and masculinity. I found the social gender ideals well-illustrated in the scrapbook of the television serial Beverley Hills. The following is based on this scrapbook.

The meaning of social gender identity

Brenda, one of the female leads, experiences gender identity conflicts. She comes from a provincial town and has just arrived in Beverley Hills. It is not easy for her to adapt. She tries to wear the right clothes and to see the right people, but she experiences an inner conflict, because she does not conform to parental standards and values. In the end, she put all parental and social expectations aside, tries to be herself and... becomes the most popular girl at school, and starts dating Dylan, school's fastest boy.

From the moment that Brenda first starts dating Dylan, she tries to change him, and she succeeds where 'normal' women fail. He starts to show his feelings. Dylan is rich, good-looking and intelligent. He is also a bit of a rebel with an obscure past. He continually has conflicts with his teachers at school. Dylan appears rough from the outside, a real macho. He acts tough, his hobby is, for example, driving his car. With sunglasses on, he sits behind the steering-wheel. He acts as if he is very indifferent. But, as the scrapbook says, when you get to know him better you find that he is a really sensitive boy. Since he met Brenda, he has started to show his feelings. But he still has macho-qualities in the sense that he is mysterious, exciting and dangerous. These qualities have to be seen as opposites of feminine qualities. Brenda, for instance, shows her feelings, talks about her problems, is intimate with her girlfriends and obviously cares about her parents and her brother. She does not act impulsively and does not take risks. She behaves like a proper girl. Dylan is dangerous in the sense that he is tough and does things that other people do not dare, he surfs dangerously and takes risks while driving his car. He remains a mystery, because he does not talk about his problems. He is good-looking, attractive, the opposite of a weak female and therefore exciting.

My interpretation is that, although it seemed that Brenda has solved her gender identity problems by 'just being herself', she did just the opposite and identified with a very traditional female gender ideal. In just being herself, she plays the innocent girl who, by lucky coincidence, becomes the girlfriend of the school's most popular boy. She just plays the role of Cinderella, and the prince on the white horse really comes.

The Beverley Hills television serial encourages identification with the idols by providing things such as posters. T-shirts and a scrapbook to be filled with pictures of Brenda, Kelly, Andrea, Brendon and Dylan. Girls chase after these pictures. It is as if the whole process of social gender identification acts like a drug, they get a high out of it and have "withdrawal" symptoms when the pictures are sold out. At school, their thoughts are filled with the craving of buying pictures after school. They act as if they are obsessed. They spend their money at the drugstore buying a package of pictures. Do they already have the pictures in the package or not? They feel low and very frustrated if a package contains many doubles, although they can exchange the doubles with girlfriends. And yet they crave to buy another package. When they are bored, feel lonely and/or depressed, their spirits lift when they go out to buy a package. They telephone their girlfriends when a new load of packages has arrived at the drugstore.

There is actually no need to get addicted to buying packages. The Beverley Hills album includes an order card and if you fill in the form they send you the missing pictures. But the girls do not get a high out of ordering. So, they go on buying packages and the pile of Beverley Hills pictures in their bedroom grows.

I suppose the attraction of Beverley Hills comes from presenting simple, stereotypical social gender identities that 'solve' gender role conflicts. Girls in Beverley Hills act as girls, they are attractive, show their legs and bosom. The boys admire the feminine girls. The girls admire the masculine boys, who are mysterious, dangerous and macho. Beverley Hills appeals to hurt narcissistic feelings. They transform femininity and masculinity into something magnificent.

Nowadays when narcissistic feelings are hurt, girls are disallowed from doing the things they would like to do, they have to choose the exact sciences, they have to transform their traditional ideas about femininity (filled with thoughts of getting babies and playing with dolls) and develop traditionally male interests. For their part, boys are threatened in their manhood by being pictured in campaigns against sexual violence as potential rapists. It is easy for them to become scared when traditional male sexuality is associated with rape and assault. How beautiful and easy life becomes when they can identify with the glorious manhood of Beverley Hills boys.

The example of Beverley Hills demonstrates the process of socialization through identification with social gender ideals of femininity and masculinity. The following will make clear that conflicting ideas about social gender roles and ideals can cause psychological disturbances.

A gender perspective on psychopathology

Research has shown that women suffer more from psychological complaints than men (SCP, 1992). Mothers with young children especially are at risk of developing psychological and psychosomatic illnesses (Knijn and Verheijen, 1988). These illnesses are expressions of gender identity conflicts (Knijn and Verheijen, 1988). Many mothers with young children are dissatisfied because there is a gap between the ideal of having a career and a paid job and the traditional organisation of motherhood. There is a gap between wish and reality.

More women than men are diagnosed as being depressive (Weissman & Klerman, 1977, Paykel,1991, Nicolai, 1992 b). Women are ten times more as likely to suffer from anorexia nervosa as men (SCP, 1992) and also suffer more from bulimia. Although men commit suicide almost twice as often as women, women are twice as likely to attempt to do the same (SCP, 1992).

These differences between men and women could be explained in several ways. Women might be constitutionally or psychologically predisposed to develop certain psychological complaints. Another explanation is that women live under more difficult social circumstances as men. Thirdly, it could be that women are more likely to be diagnosed as mentally ill as men.

The theoretical explanation that I adopt is the feminist model of psychological problems (Nicolai, 1992 b) that looks at psychological problems within gender perspective. The gender perspective introduces the element of social context in order to explain why women get more depressed, suffer more from eating disorders or try more often to commit suicide than men. The social context is the context of social gender ideals of femininity and masculinity, the reality of gender 'normality' and the inconsistencies between them. The above example of mothers with young children who are at risk of becoming psychologically disturbed is an example of the gap between ideals and reality. According to the feminist model of Nicolai (1992 b), psychopathology could be interpreted as:

-   resistance of, or rebellion against, social gender identity expectancies leading to identification with 'deviant' gender identifications of femininity (the sick woman, the fallen women, the bad woman)

-   a consequence of inconsistencies between biological role, individual gender identity, social gender identity and individual qualities, leading to conflicting ideas of self

-   a consequence of sex-related traumatic events, such as rape, incest, physical abuse or abortion.

Female drug-use, as a kind of psychological disorder, might also be placed in a gender perspective. But before I can do this, I need a more elaborated view on psychopathology and gender pathology. I have therefore looked at a theory that interprets psychopathology as gender pathology.

2.4 A gender perspective on perversions

Kaplan (1991), a leading American psychoanalyst, has made a study of perversion as expression of pathology of gender within the social context of patriarchal society. Her use of the concept of perversion is innovative in that she does not limit perversion to deviant, unusual or bizarre (male) sexual behaviour, as is usual (Freud, 1905). Instead, she extends the concept of perversion to female behaviour that enlists gender stereotypes in a way that deceives the onlooker about the unconscious meanings of the behaviours she or he is observing. Applying perversion in the usual way, meaning unusual or bizarre sexual acts, perversions are almost non-existent among women. Less than one percent of cases cited as sexual perversion have been of females (Kaplan, 1991).

However, with a different understanding of the idea of perversion - perversion not only as expression of pathology of sexuality, but also of gender-pathology - the female perversion is born. In the case of male perversions, the spotlight is put on sexuality, but behind the idol of masculinity lie unconscious, forbidden wishes to be a passive, submissive, denigrated woman, humiliated by a dominating force, the law, or the phallus of the father. Male exhibitionists show their genital, exhibit their power with the purpose of keeping other feelings of inferiority of castration anxiety away. Generally, male perversions are as much pathologies of gender role identity as they are pathologies of sexuality.

Kaplan (1991) considers that most of the characteristics we think of as innately feminine or innately masculine are social gender conventions that have prevailed over long periods of human history. She presumes that social gender stereotypes are reflections of the social and economic structures of westernized industrial societies. Her theory is that conflicts about gender identity, conflicts, for example, between social gender stereotypes and individual desire are expressed in perversions. Kaplan illustrated her theory with the example of madame Bovary who was not satisfied with the role of housewife, mother and wife. Madame Bovary was not able to submit to domesticity. In her rebellion against gender normality, she finds herself within other stereotypes of femininity: the dissatisfied wife, the mad housewife, the seductive housewife, the submissive woman, the commodity-hungry kleptomaniac and the witch-mother. Perversions as pathologies of gender role identity deal with inner conflicts that result from identification with or rebellion against feminine virtues such as passivity, cleanliness, purity, kindness, concern for others and submission.

Kaplan writes that the road to perversion is paved by individual history and childhood traumas. For example, if a woman has been deprived of material goods in her youth, it is possible that she will apply the perverse strategy of kleptomania; on the other hand, if she has been a pure, proper little girl, she might apply the perverse strategy of anorexia.

Kaplan gives several examples of female perversions, for example kleptomania, prostitution, masquerading as a man or as an extremely feminine female, reading romance novels as romantic turn-ons, self-mutilation, the child as salvation, physical abuse of a child and anorexia.

These perversions are considered to be the result of women's socialization in and rebellion against patriarchal society. The perversion is a mental strategy that uses one or another social stereotype of masculinity and femininity in a way that deceives the onlooker about the unconscious meanings of the behaviours she or he is observing" (Kaplan, 1991, p.9).

The main characteristics of perverse strategy are:

-   the appeal of its capacity to provide individual relief from troubling affects and emotions

-   the expression of social gender stereotypes that are reflections of the social and economic structures of society

-   the desperation, the fixity of behaviour, the person has no other choice or would be overwhelmed by anxiety, depression or psychosis

-   defiance of the moral code

-   the necessity of a performance, an enactment

-   it is a central occupation of the person's existence

-   the person feels she is doing something bad and morally wrong

-   the person snatches pleasure from defeat

-   one forbidden impulse is conscious with the purpose of keeping other forbidden impulses unconscious.

Perversions distinguish themselves from normal behaviour in their capacity to provide relief from depression and anxiety. For example: the behaviour of 'eating' is normal behaviour when one is hungry, but that same behaviour can become 'perverse' when eating takes the form of stuffing oneself with food in order to bring relief from feelings of depression and anxiety.

In the past decades the concept of perversion described pathologies of sexuality, mostly pathologies of male sexuality. But there is another dimension to perversion. Perversion also indicates hidden feminine wishes or cross gender wishes. Because we are already acquainted with male perversions, such as fetishism or exhibitionism, we will depart from male perversions in order to gain insight into the functioning of female perversions.

Fetishism as male perversion

Perversions are easily associated with 'kinky' sex or sadomasochism. Male perversions are indeed unusual or bizarre sexual enactments, such as fetishism, transvestism, exhibitionism, voyeurism, sexual masochism, sexual sadism, paedophilia,   zoophilia or necrophilia. Male perversions are as much pathologies of gender role identity as they are pathologies of sexuality. In the perversion, forbidden and shameful feminine wishes are expressed, the wish to be a passive, submissive, denigrated woman, humiliated by a 'phallic' dominator of either sex. Remains of the Oedipal conflict are expressed in perversions.

Kaplan tells a story about a male fetishist who could only masturbate after humiliating a nice woman. This fetishist invites to dinner an unknown woman, whom he has met in a supermarket. At dinner she drinks too much. He prevents her visiting the toilet at the restaurant and takes her out for a walk. When the urge to pee is overwhelming, he books a room in a hotel. When they arrive in the hotel room, he throws her out of the room without her shoes. The shoes he places on the foot of the bed and subsequently he is able to masturbate.

This fetishist has had un unhappy childhood. His mother was addicted to alcohol. In the afternoon she slept and he had to play outside her bedroom. When he cried for his mother, his father told him to play with his mother's shoes. Thus, shoes became fetishes for him and were a kind of transitional object. The shoes represented the love of his mother, her presence and warmth. Once, he went to school with his mother's shoes on. His schoolmates laughed at him and he felt very humiliated.

After he got married, he forced his wife to drink and lose control of herself, soil herself with drink and food. Only when she was drunk could he have intercourse with her. She felt humiliated and stopped drinking. He went out at night in search of nice women whom he could humiliate.

Social gender stereotypes of masculinity and the man's response to his childhood trauma are collaborating in the fetishist perversion. In humiliating women, he humiliates himself.

The strong appeal of perversion, as this case history demonstrates, lies in its capacity to provide relief from troubling affects and emotions. The pervert has no other choice, otherwise he would be overwhelmed by anxiety and depression.

Female perversions

The main difference between male and female perversion is that male perversions enlist sexuality as a way of surviving childhood traumas and that female perversions enlist social gender stereotypes to be relieved of painful feelings and to express hatred against the male-dominated society. Both male and female perversions deal with sexuality and gender pathologies and hidden feminine or masculine wishes.

In order to gain insight in the dynamic process of female perversion I would like to take two of Kaplan's female perversions as example, 'kleptomania' and the 'Horigkeit script'. I have chosen these two specific perversions because their dynamic background is strikingly comparable to female hard drug-use.

Kleptomania

In the perversion of 'kleptomania', the dynamic of the process of perversion - social gender stereotypes are enlisted as strategies to escape from painful feelings that are a result from childhood traumas - is very obvious. Stolen goods are used to compensate for all kind of infantile deprivations. The theft is also an expression of hatred and contempt toward the male-oriented society.

Women's gender role types them both as primary consumers and as deprived of economic power. Women's status in the economic order is marginal. Kleptomania is the woman's response to deprivation of power.

I will illustrate kleptomania with the clinical story of Sharon, a former patient of mine.

Sharon's kleptomania

Some years ago a probation officer referred Sharon, a middle-aged woman of foreign origin, to a mental health setting. Formerly, Sharon came to trial because she had stolen goods from a supermarket. Instead of punishment she was referred for treatment. Sharon had experienced childhood trauma, she was beaten by her mother. When she was sixteen, she was forced to marry. Her husband abused her physically. Sometimes she escaped and went with her children to a crisis centre, a so-called 'Blijf van mijn Lijf home. In her own Hindustani culture women were not allowed to divorce their husbands. If a wife divorced her husband, she brought shame on herself and her family. Sharon's family always persuaded her to return to her husband. Once, because her husband threatened her with a knife, she jumped out of the window and she was so seriously injured that she was admitted to a hospital. Revalidation took almost a year. After more than ten years of physical abuse, she divorced her husband.

When Sharon's children were young, she had no money. When they came out of school, she would go to a shop in her neighbourhood and steal pieces of candy. After her divorce, Sharon got state benefit and could buy what she needed. Nevertheless, whenever she entered a supermarket, her state of consciousness altered and, in a trance, she quite openly stole goods like coffee and tea. It was only afterwards, when she was caught, that she awoke and felt sick.

In her case, kleptomania could be interpreted as a result of her wish to spare her children the childhood trauma of deprivation. In her eyes, a mother without sweets or cookies for her children is a bad mother. Sharon's kleptomania could also be seen as an expression of (self) hatred. Sharon feels angry and depressed because she has not seen her mother for twenty years. She feels hatred for her culture, because it allowed her husband to abuse her and deprive her of all luxuries.

In the light of the conceptual framework of female perversions, Sharon's kleptomania has the function of expressing hatred against society and providing relief from painful feelings such as anxiety and depression. It appeared that when Sharon stopped being a kleptomaniac she became overwhelmed by depression and wanted to kill herself. Only her children kept her alive.

The Horigkeit script

Another gender identity conflict is expressed in submissiveness. Submissiveness, or 'Horigkeit' is defined as extreme dependency on a man.

Kaplan (1991) illustrates submissiveness with the story of an educated woman who is a brilliant speaker. She is constantly being invited to give speeches. Before giving a speech, she is very nervous, but she speaks well and the audience generally reacts very enthusiastically. Afterwards, some strange things happen. She mingles among the audience in search of an older, fatherly man. When she meets this person, she asks him humbly if he thinks she was any good. He reassures her, she performed very well tonight. She prolongs her sweet-talking, and at the end of the evening he accompanies her to her hotel room. She acts as if she is nothing without him. Sexual union with this man's phallus reaffirms her feminine self. She has done something forbidden and has to punish herself. The next morning, she feels ashamed and betrayed, because she has made an exhibition of herself and has humiliated herself.

Another example which illustrates this perversion was featured recently in a Dutch paper. The widow of a famous Dutch writer gave an interview. The interviewer describes the widow as a woman in her forties who does not look grown up. According to the interviewer, this is commonly seen in women living with older men: they retain the image of being 'daddy's little girl'. The widow met her husband when she was 23 years old and he was 47. He had twice been married. Until his death, she assisted him in everything. She gave up her own interests, because what he was doing was more interesting and she had few ambitions of her own.

After his death, while putting his work into the archives, she often has the feeling that she has become her own husband. She gave up her own life, she sacrificed herself and as a reward she now lives in permanent union with her husband's fame.

Why is the behaviour of these women perverse? The first woman acts as if making a speech was bad, morally wrong and forbidden. As if she has stolen goods or power [the phallus] belonging to someone else. The strongest appeal of her perversion is its capacity to provide her with relief from anxiety. If she does not sleep with a fatherly man, she has a sleepless night filled with anxiety and fits of coughing.

The second woman avoids feelings of anxiety and depression by assuming the identity of another person. She says: "I was constantly searching for my identity as a person of my own, until suddenly, I did not need it any more." By giving up her maiden name, she felt strong.

James (1980) observes that because Westernized industrial culture has placed so high a value on "proper" sex role identification, many people have become addicted to the acting out of social role-stereotyped behaviour in order to prove their normality and consequently their acceptability. The Horigkeit script is just like a script to be acted out consisting of pure, innocent self-defeating femininity.

I will now investigate whether it might be possible to understand female drug-use as a female perversion.

2.5 Drug-use as a female perversion

Kaplan (1991) does not consider female drug-use as a female perversion. However, in my view it is indeed quite possible to see female drug-use as a pathology of gender, as a perversion. This becomes particulary when one looks at the similarities of female addiction and female perversion. I will consider these similarities in detail.

One characteristic of female perversion is the appeal of its capacity to provide individual relief from troubling affects and emotions. Drug-use, like a perversion, produces a kick, rush or flash that enables a woman to anaesthetize her feelings and to reduce tension.

Another characteristic of female perversion is that the perversion itself is the expression of social gender stereotypes that are reflections of the social and economic structures of society. This is also the case with the female drug-user. The female druguser is rebelling against gender 'normality' and finds herself identifying with another stereotype of social gender: the fallen woman.

A third characteristic of female perversion is the desperation, the fixity of behaviour. The person has no other choice, otherwise she would be overwhelmed by anxiety, depression or psychosis. This is also true of the female drug-user. She cannot give up drugs, because she would then not only feel withdrawal symptoms, but also be overwhelmed by the pain of childhood traumas. The female drug-user is aware of a compulsion or urge to perform the addicted behaviour.

The fourth characteristic of female perversion is the defiance of the moral code. A female drug-user flouts the moral code by acting out her role of the 'fallen woman'. The fifth characteristic of the female perversion is the necessity of a performance, an enactment. The female drug-user sometimes masquerades as a 'fallen woman', she plays the role of societal outcast as a stage performance. Behind the acting-out lie hidden feelings of vulnerability, of longing for a symbiotic union with mother, of longing to be taken care of. Her mother almost never lived up to society's images of the good mother. By acting out the bad woman-script she is able to take her enraged revenge on society and at the same time, by taking drugs, she provides herself with a perfect mother and a perfect lover.

The sixth characteristic of perversion considers perversion to be a central occupation of the person's existence. There is a strong resemblance here with addiction. Addiction includes 'an overwhelming involvement with drugs' (Alexander, 1990). Life revolves around addiction, addiction is the fuel of one's life, nothing is more important than obtaining drugs (Van Bilsen, 1992). Careful research and planning of the addictive behaviour takes place, a female drug-user devotes continuous attention to having a supply of enough drugs.

The seventh characteristic of perversion is that the person feels she is doing something bad and morally wrong. The female drug-user also feels that what she is doing is outlawed and morally wrong.

The eighth characteristic is that the person snatches pleasure from defeat. This is also typical of drug-use. It is a defeat when, after a period of abstention, a female druguser relapses and uses drugs again. But she also snatches pleasure from this defeat.

The last characteristic of perversion is that one forbidden impulse is conscious with the purpose of keeping other forbidden impulses unconscious. The female drug-user is generally aware of the forbidden impulse of wanting to take revenge on society by acting out the bad-woman script. She is also aware that she is physical dependent on drugs. She knows that increased tolerance with regard to the effects of the addictive behaviour forces her to take an ever-increasing dose in order to provide the same effect. She also knows that she is in need of continual drug-use if she is to avoid withdrawal symptoms. But she is unaware that she is not only acting out the bad-woman script, but also acting out the "Horigkeit script". Just like the so-called Horigkeit script, a drugusing woman has become extremely dependent. If she uses hard drugs, a woman is doubly dependent. Not only is she dependent on a man because of money, but also on a drug.

Considering the general characteristics of female perversion, drug-use also might well be seen as such. The kind of perversion female drug-use resembles most is the Horigkeit script and kleptomania.

Just as in drug-use, kleptomania is about using material goods to compensate for childhood deprivations. And if we compare female drug-use to the Horigkeit script it is striking that in both instances there is a question of extreme dependency, either on a man or on a drug. Identification with male power provides an escape from serious, primary femininity-threatening, masculine wishes. The 'Horigkeit script' expresses the conflict between woman's primary role as wife and mother and her exclusion from public and social power. The submissive script hides enormous feelings of anger, frustration, anxiety and depression, precisely as is the case with female drug-use.

The following case-history illustrates the gender identity conflicts and the extreme dependency of one female drug-user who was admitted at the VKC.

Kelly's drug-use

Kelly, a woman in her thirties, was admitted to a drugs clinic because she was in crisis after her five year-old daughter had been put into foster care. She hyperventilates and is depressed. In the clinic she relates how, as a child, she was a tomboy, climbed trees, played only with boys and loved meccano. Her relationship with her mother was perfect. As she describes her mother, tears well in her eyes. Her mother appears to be a very submissive woman. Her mother spent her life in the service of her husband and children. Kelly's father was a rough man, a garage owner, who beat Kelly up because she did not comply with his rules and did not behave submissively. Because of her misbehaviour, Kelly was placed in foster-care when she was four years old. Although in foster-care, she was still allowed to visit her parents.

When she was seventeen, she dropped out of school, out of foster-care, became addicted to drugs, used drugs intravenously and, at the age of 29, had a child. She did not know who the father was. After the child, a girl, was born, Kelly cared for it for a year and a half, after which Kelly's mother took over till the child was five years old. Then, the little girl was placed in foster-care, which meant for Kelly that she did not easily have access to her daughter.

When asked about her wishes for the future, Kelly said she had none. She no longer wished to be alive. Nothing interested her any more, not even drugs. She just wanted to visit her mother and daughter once before she died. She did visit her mother and daughter. A month later, she died in the general hospital from a brain haemorrhage

In the end, the perverse strategy had lost its meaning, Kelly died of loss, loss of her mother and loss of her daughter. Kelly had rebelled against woman's submissive role in society, she would never submit herself to the wishes of a man. She would be independent. She earned her own money from prostitution; she used drugs with the purpose of keeping responsibility and masculine wishes away. For her, it was impossible to manage a life on her own, not in the service of another person. Initially, she had experienced pleasure in tomboy activities, but had been beaten up because of it. Now, she kept away from her father, hated him and could not identify with him.

In spite of her rebellion against female gender identity, the only thing worth living for was her child. She rejected her own masculine wishes and, while identifying with her mother, she became a totally dependent woman. When she lost her daughter, she lost all interest, both in life and in drugs.

This case-history shows the characteristics of female perversion. Kelly's life was devoted to rebellion against gender 'normality'. As a child, she was a tomboy and could not identify with her submissive, but nevertheless perfect mother. She made a saint out of her mother. Nor could she identify with her father, because he rejected her and beat her because of her tomboyish behaviour.

Through her inability to identify with a stereotype gender ideal of femininity, because she resisted submissiveness, she found herself within another stereotype of femininity, that of the fallen woman. As a fallen women she is, like her mother, an extremely dependent woman, dependent on drugs, dependent on prostitution. The self-sacrifice of her mother and her own apparently selfish behaviour are two sides of the same coin, a coin that holds no advantages for either of these two women.

2.6 Summary

In this chapter I have tried to develop a gender-perspective on female drug-use. I began by looking at existing models of drug-use, the physiological-medical view, the psychoanalytical view, the learning theory model and the model of family therapy. These models explained the drug-use of the drug-user but not of the female drug-user. As I showed in the introduction, there are considerable differences between male drugusers and female drug-users. In order to explain the differences between male and female drug-users I explored the theory of gender identity, the innate feeling of belonging to one or the other sex. This innate sense of being male or female is definitively established before a child is 24 months old (Stoller, 1968). Gender-identity is a result of a combination of biological, psychological and cultural influences. Because female development is extensively influenced by social gender ideals of femininity and masculinity, I illustrated social gender ideals with an example from a popular television serial, Beverley Hills. At one and the same time this example of social gender identity demonstrates both the gender identity problems experienced by young people and how they solve them.

As Kaplan (1991) demonstrates, female perversions, by enlisting social gender stereotypes, function as strategies for solving gender identity pathology. Kaplan illustrates her theory that gender pathology causes perversions with the example of Madame Bovary, a woman who resisted gender 'normality' and as a consequence identified with other, more or less deviant, social gender stereotypes of femininity. In Kaplan's view, female perversions enlist social gender stereotypes as a way of surviving and compensating childhood traumas. She gives several examples of childhoodtraumas, including parental neglection, childhood cruelty, sexual abuse and physical abuse.

I selected two female perversions from Kaplan's study, 'Kleptomania' and the 'Horigkeit script'. I presumed that both perversions are in some way similar to druguse. Just as drug-use is forbidden, so it is forbidden to steal. Society views a woman that steals or uses drugs as a bad woman. So both women, the woman who steals and the woman who uses drugs, act out a deviant gender role, a 'bad-woman script'. The so-called 'Horigkeit script' refers to extreme dependency on a man. A female drug-user is not only dependent on a man, but also on drugs. She is not able to make her own choices, but is a victim of her own dependency.

Although Kaplan did not refer to female drug-use as a female perversion, I thought it would be worthwhile to examine whether or not her theory could be applied to female drug-use, because it would then be possible to generate a gender-perspective on addiction.

In order to study whether female drug-use could be seen as a female perversion, I compared Kaplan's characteristics of female perversions to female drug-use and found that female drug-use could indeed be understood within Kaplan's terms.

One consequence of viewing female drug-use as a female perversion is that it now becomes important to investigate the role of childhood traumas and the psychological strategies that women enlist to survive these traumas. This in-depth investigation of the background of female drug-users will take place after a global sketch of the psychosocial characteristics of the female drug-user who is admitted at the VKC, including her drug-use, her involvement in prostitution, and her crisis.

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