The Letter, Issue 20, Autumn 2000, Pages 117 - 129
PSYCHOSIS, TOXICOMANIA AND THE HOMELESS'
Dirk Bryssinck
Formulation of the Problem: A New Diagnosis?
The psychiatric landscape has undergone a lot of changes in the last couple of years. This constant evolution shouldn't surprise us, considering its youthful existence and bearing in mind that psychiatry always follows in the wake of an ongoing society. Hysteria is commonly known to adapt itself to the prevailing discourse, but that psychoses should also be appearing in a new attire is a relatively new feature. Since Nietzsche's creed that God is dead one has rarely come across the 'traditional' psychotic delusions, such as the religious delusion of redemption. In the footsteps of literary forerunners like Burroughs, Huxley and Leary, psychotics have discovered drugs, - drugs which we consider as one of the current symptoms of discomfort in our post-modern culture.
This new climate is now also tangible in the psychosis department of the psychiatric hospital where I have been working for twelve years, and which has recently become an explosive mix of questionably psychotic individuals with a serious problem of addiction. Since the success (or perhaps the failure) of the DSM-III this has been known as comorbidity or dual diagnosis: psychosis/toxicomania. Whether it is a so- called drug psychosis, a toxic psychosis or a genuine underlying psychotic structure which remained hidden, is difficult to discern, precisely because the drug-use functioned for a time as an anchoring point or suppletion - and the social environment was a supportive factor - or perhaps the drug- use was even the enticing factor. An additional problem is the rise of the new synthetic drugs with a base of fentanyl. Since their chemical structures are difficult to determine and their effects difficult to anticipate the symptomatology becomes more complex when compared with
established products such as cocaine and heroin, which have more clearly delineated effects.