Last week’s WAGER presented early psychoanalytic theories of problem gambling that were dominated by a link with masturbation. This week’s WAGER presents a summary of a case study reported by Lindner (1950), the source of the summaries of the theories presented last week, which illustrates how theorists devised the link between problem gambling and masturbation.
The client: A man named Paul.
The treatment plan: Analyze Paul and cure his gambling problem.
At the time of the first meeting with Paul, he is 44 and serving a 3-year sentence in Federal prison for stealing and forgery. Originally, Paul worked as an engineer, but left the profession 17 years ago due to his gambling problems. From that point on, he spent all of his time wagering. He bet on almost anything he could find.
Paul is the eldest of three sons. He describes his mother as a beautiful woman who adored her husband. Paul says that many times he felt like she thought of him and his brothers as chores. His father was a pastor at a local church. Paul describes him as aloof, strict, and frequently physically abusive. Paul expresses that as a child he hated his father and many times wished that his father would die. As a child, Paul had a history of bedwetting and frequent masturbation.
Personal history/history of gambling behavior:
Paul showed no inclination to gamble before he was 25. At this point, he was working as an engineer and was married to a Catholic woman. Because his wife’s faith differed from the family’s his father disinherited him and forbade his mother and brothers to speak of him or communicate with him. He maintained communication with his mother and brothers via mail through a post office box. Paul’s mother visited him and his wife for the first time since their marriage after his father died and the birth of Paul’s daughter. At this point, Paul gambled for the first time. Motivated mainly by boredom, Paul played craps and gambled until 3 in the morning. Shortly thereafter, Paul found himself in a cycle of losing and winning, and increasing disruption to his family life. For a while, his wife would forgive him; he would stop gambling for a day or two, but then would start again. He recognized what his gambling was doing to his family, but couldn’t stop. He eventually left the family and began a long period of doing nothing but gambling.
WHAT DO YOU THINK?
Here is a psychoanalytic interpretation by Robert Lindner from the 1950’s:
Paul wants forgiveness from his father, for whom he had intense negative feelings. As a child, Paul developed bed-wetting to attract his mother away from his father. Additionally, the frequent masturbation had as its unconscious object his mother, and therefore, masturbating was a way to invoke his mother, as well as disobey his father and express his antagonism for him.
Because Paul had so often wished for the demise of his father, his actual death not only fulfilled Paul’s secret childhood desires, but also suggested to Paul that he was omnipotent, since his wish had come true. This caused tremendous guilt for Paul, who then wanted to test if he truly was omnipotent; that is, to see if, indeed, his wishes did kill his father. This explains why gambling was so seductive for Paul. This was a venue in which he could ask the question of whether he could control various outcomes. If he won, then it meant that he did in fact kill his own father with his wishes. If he lost, it was the converse answer, but also provided a release of guilt for him. Had he lost consistently, Paul would have been at peace. However, because chance dictates that there are winning times Paul continued to gamble to lose again after winning episodes so that he could ease his guilt.
This case summary represents an analysis Robert M. Lindner presented in an article he wrote in 1950. When considering the research developments that have occurred in the years since Lindner’s publication, a number of limitations to this analysis emerge. Primarily, more clinicians use objective screening instruments, like the SOGS (Lesieur & Blume, 1987) and DSM-IV (American Psychiatric Association, 1994), to inform the diagnostic process, as opposed to Lindner’s purely subjective interpretation of Paul’s behavior. Also, Lindner’s assessment is likely culturally specific. For example, one could argue that the idea of the human psyche experiencing conflict over masturbation might be particular to contemporary Western culture, and not necessarily present in other cultures. Of course this criticism applies to psychoanalytic interpretations in general. Finally, the developments in the gambling field about psychiatric comorbidity (Black & Moyer, 1998) and theories about the possible genetic (Ibanez et al., 2001) and psychobiological (Elman et al., 1999) components that contribute to addiction make it seem improbable that the root of Paul’s gambling problem lies solely in psychosexual conflict over masturbation.
Although Lindner’s interpretation is limited in a number of ways, reflecting on theoretical explanations for addictive behavior patterns helps us to understand the evolution of the field. In addition, examining past treatment approaches for addiction affords the opportunity to evaluate current treatment methods. One can only guess what Robert Lindner would think of the current treatment methods for addictive behavior patterns.
Comments on this article can be addressed to Debi LaPlante.
American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (Fourth ed.). Washington, D.C.: American Psychiatric Association.
Black, W. B., & Moyer, T. (1998). Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatric Services, 49, 1434-1439.
Elman, I., Breiter, H., Gollub, R., Krause, S., Kantor, H., Baumgartner, W., Gastfriend, D., & Rosen, B. (1999). Depressive symptomatology and cocaine-induced pituitary-adrenal axis activation in individuals with cocaine dependence. Drug & Alcohol Dependence, 56(1), 39-45.
Ibañez, A., Blanco, C., Donahue, E., Lesieur, H. R., de Castro, I. P., Fernandez-Piqueras, J., & Saiz-Ruiz, J. (2001). Psychiatric comorbidity in pathological gamblers seeking treatment. American Journal of Psychiatry, 158(10), 1733-1735.
Lesieur, H., & Blume, S. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 114, 1184-1188.
Lindner, R. M. (1950). The psychodynamics of gambling. Annals of the American Academy of Political and Social Science, 269, 93-107.