Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

I316Casriel, who is medical-psychiatric superintendent of Daytop Village. "For thefirst time, an addict upon entering Daytop sees 100 people who were alsoaddicted but who are living happily and functioning without drugs or the preoccupationwith the thought of drugs."Daytop A'illage has been in existence for 6 months. It is an outgrowth of DaytopLodge, established under a 5-year National Institutes of Mental Health projectto compare the results of several alternative probation arrangements forfelons of the Second Judicial District, New York Supreme Court, and initiallylimited to 25 probationers.,"People live in Daytop in a pleasant, paternalistic, tribelike, family environment,"Dr. Casriel said, paraphrasing his book on Synanon, "So Fair A House."The members think of Daytop neither as a hospital, a prison, nor a halfway house,but as a family-type club or home—a fraternity of people living together andhelping each other to get well * * *. The members are neither patients nor inmates;they are free to leave any time they wish."OXCE BELIEVED THEKE WAS NO HOPEHe said that he himself had once believed there was virtually no hope fordrug addicts "Ten years of contact through community psychiatry with the:problem of drug addiction had left me deeply pessimistic * * *. My observationshad almost brought me to the conclusion that, once addiction was established incertain predisposed but undefined personalitie.s. a basic metabolic change ordeficiency was produced in the a,ddict, manifesting itself in" a craving that onlythe opiate could relieve." .'n.:-. ."That was my position imtil I discovered Synanon 3 years ago," he said, callingDaytop "the amalgamation of the best that was Synanon and the best of theprofessional understanding and knowhow."Citing the relative lack of success of psychiatry in the treatment of characterdisorders, he said that "the question I kept asking myself was, 'Why were nonprofessionalsable to stumble upon a rehabilitation and cure of the drug addict,whereas professionals, as a general rule, were completely unsuccessful?' At lastI feel I've discovered why."After working intensively learning the process of treatment of the drug addictspecifically and the character disorder in general, I was finally able to traceit back and evolve a psychodynamic theory which to me explains why the processworks."The theory, he said, was a modification of the psychocultural views developedby the Columbia School of Adaptational Psychodynamics."A major defect in the adaptational psychodynamic theory," as.serted Dr.Casriel, "was its lack of awareness that there are three major methods of copingwith pain or stress. * * * They accounted for two of these ways by the mechanismsof defense called flight or fight, using the emotions of fear or rage. Whatthey failed to bring into focus is that there is a majoi:, perhaps more primarymechanism in which one avoids danger or pain. * * * it uses neither the emotionsof fear nor rage and may be called isolation or encapsulation. * * * Somepeople withdraw from the pain of awareness, the pain of reality, what theyexperience as the pain of everyday functioning, by withdrawing unto themselves."It was bis observation, he said, "that those people whose primary mechanismof defense is withdrawal are those who fit into the psychiatric classification ofcharacter disorder."Once this "intrapsychic world without tension" has been evolved, he continued,"the individual will overtly or covertly fight anyone who attempts toremove him from his prison-fortress. * * * Once the adaptational mechanism ofisolation is evolved and becomes a primary mechanism, the standard psychoanalytictechniques using introspections and observation are useless. The individualpatient, though he hears, cannot be reached."shbh:,!.must be removedTo treat such patients, Dr. Casriel said, "One must first remove the shell andprevent the individual from acquiring or running into any other kind of shell."Then he must be taught how to grow uj) emotionally, socially, culturally, sexually,vocationally, and educationally.'•!/,!•.