Doing Psychoanalysis in ... Rio de Janeiro, Brazil: 

José Alberto Zusman
interviewed by Angela Mauss-Hanke, Munich, Germany

José Alberto, you are a psychoanalyst with a fascinating and important specialism: you are researching and treating addictions. How did your interest for this special field arise and how do you manage to integrate psychoanalysis and treatment of addictions?
For me, both psychiatric and psychoanalytical training always walked side by side; so it was quite natural for me to see commonalities in both fields, and I always looked at them with great interest and curiosity. For years, I dedicated myself to the psychoanalytical study of the psychotic phenomena in very regressed patients, and more recently, due to an increasing demand for treating addicted patients, I felt I had to better understand this intriguing world of addiction as a whole. 

My current interest is to find out whether or not all addictions may have something in common. I started from the assumption that every addict looks for a path to diminish the immense difficulty they have to relate with themselves, as well as with other human beings. All addictions may have in common this same starting difficulty with different outcomes, depending on the method the addict finds to ease their internal pain. Seen from this point of view, the addict’s problem is more of an internal one, to which they turn to an external false solution to deal with it, such as drugs, food, gambling, sex, etc. The addict may not be searching for pleasure as many may think, but for a reliable human connection. At the end of the day, it seems to me that all addicts are very lonely people living in a very painful, emotional, empty world.  

More than 7 million people live in Rio de Janeiro. What sort of addictions are you seeing in your everyday work in this city?
I personally don’t relate addiction only to poverty; instead it is mainly due to internal emotional poverty. In my opinion what draws attention in Brazil, and in Rio de Janeiro as part of it, is its tremendous social inequality and a culture that is seriously compromised by corruption issues. It is in the abandonment of the people, in the absence of clear rules, and in the emptiness of application of just and equal laws for all, that addiction finds its social space. It may be fair to say that addiction may be one of many possible end products of solitude and abandonment from both families and governments. Rich or poor, the addict is a person who was not looked after with concern, love and care. The war against drug addiction has been a complete failure worldwide for not taking into consideration that the real problem of addiction lies inside the person who can’t cope with their internal despair and pain. Addiction doesn’t have to do with the amount of money the person has, but with the amount of love and the good objects a person carries inside. Love and care for themselves, and consequently, for others. As I said above, in my opinion, the most vulnerable people are those that are most abandoned by the government and/or by their families. The bad, toxic objects that live inside of them, resulting from this abandonment, will define their conscious and/or unconscious choices in life.       
In Brazil’s culture, selfishness prevails over collective well-being. Our leaders are the first to give the bad examples. The good news, which brings us some hope, is that we are starting to see important businessmen, politicians and even former-presidents being arrested for crimes they have committed. Brazil seems to no longer be a country where only the poor and the black people go to jail.  The law is either valid for everyone or it is no good for anyone. 
Do poor people / people with not much money have a chance to get outpatient psychoanalytical treatment in Brazil? If yes, how does this work?
Yes, but it’s far from ideal. The majority of Brazil’s population is very poor and badly assisted as a whole. Communities in the rural areas are the most abandoned. In the urban areas you find a better treatment situation. Even so, there is very little done by the psychoanalytical societies, perhaps because many analysts still don’t believe addiction is suitable for psychoanalytically oriented treatment. In the large cities, addiction treatment is offered mainly by universities and by a declining health system network due to the long serious economic and political crisis we have been facing for a long time.  At the Federal University of Rio de Janeiro where I work, there are services for drug addiction, food addiction and digital media addiction. We still haven’t found a way of working together. Addiction treatment requires frequent multi-disciplinary work which is not very common in the psychoanalytical tradition. This may be one of the reasons psychoanalysis, despite its great importance, still has little space in this treatment field. I think that addiction problems rely on profound internal traumas at the beginning of life when the eyes of a child look desperately for the attuned eyes of his care takers. Psychoanalysis - in addition to other types of support - is a fundamental treatment to offer an addict the chance for a new beginning.        

In Europe, the last presidential elections in Brazil were noted with deep concern. Are you already facing changes in your life and work since Jair Bolsonaro became President of Brazil?
Yes. Unfortunately, several places of free assistance are being shut down. But, in my opinion, the endemic damaged culture of abandonment and corruption is the real problem to be faced in Brazil and Jair Bolsonaro himself won’t make much difference. Lula did well at first but ended up being over-idealized and bringing a lot of disappointment. Recent evidence has shown that corruption persisted during his government. Although said, unfortunately the inequality in Brazil has never really been touched. The real change, if it is to happen, will have to come from the Brazilian people. There will be no magical saviour to free Brazil from the historical, long-lasting difficulties that should have been faced a long time ago. Abroad, there is the false impression that we are dealing with a political ideological struggle between left and right, but what we fear the most is to have to put up with a bumbling, unprepared president to lead our country. The fear is to be in a boat without a rudder and the consequences that might have for our future.
Addictions today differ from those thirty years ago - what do you think will be the changes and challenges within the next decades (in your country / South America / on a global scale)?
I am very worried about the future. The fear I have is that the more technologically advanced we get, the lonelier we may become. Addicts show us what this future could turn into. Nowadays you see a considerable number of people of all ages that, instead of interacting and connecting with each other, remain lost in solitude by their addictions. It doesn’t matter if they do it by using drugs or smartphone apps. We have never been so lonely and I am afraid that it may get worse with time. 

What can we as psychoanalysts contribute within the field of addictions even if we’re not specialised?
In my opinion we don’t have to be specialised in the field of addiction proper. In our training we have everything we need to help an addicted person. We have to be strong enough to stand being treated as things and help the addict to stand the pain to be treated as a human person. This process, as in other severe ill presentations, might take time and sometimes may bring disappointing outcomes, but will always be worth trying. As psychoanalysts, I think we are the fundamental professionals to meet this challenge. 

Last but not least: what is missing, what is needed from the IPA and its members to support and spread your important work and those of your colleagues?
To begin with, it is of great importance that psychoanalysts understand their fundamental role in the treatment of addicted people. I think there might be no other mental condition for which psychoanalysis proves to be so useful. It is very important that colleagues present more clinical and/or theoretical papers at our international or regional congresses. For our face-to-face meetings to happen we need some budget because up until now we have had none. If we had enough budget, we could arrange a meeting dedicated to addiction issues at every IPA Congress. We could also constantly keep in touch through the IPA blog to share our difficulties and find, with the help of more experienced colleagues, creative ways to help our addict patients.   

Jose Alberto Zusman, MD
Chair of the IPA Subcommittee on Addiction
Full Member of the Society of Psychoanalysis of Rio de Janeiro (SPRJ)
Doctorate in Psychoanalysis at the Federal University of Rio de Janeiro (UFRJ)


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