Authors: Ernest Kurtz
M. Brunner-Orne and M. T. Orne, “Directive Group-Therapy in the Treatment of Alcoholics,”
Int. Journal of Group Psychotherapy
4: 293-302 (1954) — CAAAL #7060: “Alcoholism cannot be explained solely on the basis of individual psychology; it is also a manifestation of general social maladjustment.”
S. D. Bacon, “Alcohol and Complex Society,” in D. J. Pittman and C. R. Snyder (eds.),
Society, Culture, and Drinking Patterns
(New York: Wiley, 1962),
Chapter 5
, pp. 78-93, which explores alcohol as a means of dealing with the “social complexity in Western civilization.”
10
For discussion of this point,
cf
pp. 34-35 and 59, above.
11
On “three-fold disease,” the first printed use and explanation that I could find was Dr. Clarence P., “The Medical Approach to Alcoholism,” paper presented at the First National and International Meeting of Physicians in Alcoholics Anonymous, held at Cape Vincent, NY, 19-21 August 1949: Conference Record in A.A. archives. The context of its use makes it clear that the physicians present were all familiar with both the term and concept. More obvious, of course, is the concept without the term in
AA: cf
. first “The Doctor’s Opinion;” then, p. 30: alcoholics are “bodily and mentally different;” p. 23: “the problem is first mental;” p. 44 “an illness only a spiritual experience will conquer.” Within the Wilson correspondence,
cf
. especially with Dr. S.J. Minogue, 2 December 1957, 17 January and 6 June 1958; also Wilson to B.W.B., 19 October 1965;
cf
. also “Alcoholism is a Disease,”
AAGV
27:5 (October 1970), 13-15.
The most recent description of a treatment that makes central use of this concept is James R. Milam,
The Emergent Comprehensive Concept of Alcoholism
(Kirkland, WA: Alcoholism Center Associates, 1974).
12
"Alienation” and
“anomie”
as the perceived hallmarks of modernity do not seem to require specific citation. Beyond Marx and Durkheim themselves, I have found useful Shlomo Avineri,
The Social and Political Thought of Karl Marx
(Cambridge: University Press, 1968), “Homo Faber,” pp. 65-95; and the “Introduction” in Anthony Giddens (ed.),
Emile Durkheim: Selected Writings
(Cambridge: University Press, 1972), pp. 12-29. A challenging review and interpretation of research that might suggest some connection between these concepts and the understanding of the word “alcoholic” explored at the conclusion of
Chapter Eight
is M. Clinard (ed.),
Anomie and Deviant Behavior
(New York: Free Press, 1964), see especially the final “Review of the Literature” abstracts.
On the twentieth century as the “Age of Psychology,”
cf
. especially Philip Rieff,
The Triumph of the Therapeutic
(New York: Harper & Row, 1968).
13
The literature that details the damage that alcoholism does to the alcoholic drinker is so vast as utterly to defy citation;
cf
. especially for the most recent thinking the diverse selections in Tarter and Sugerman (eds.) and Kissin and Begleiter (eds.), both previously cited. For a sociological interpretation of the earlier shift in understanding alcoholism, from “moral degradation” to “spiritual disease,”
cf
. Bruce Holley Johnson, as cited in note #3 to
Chapter Eight
, p. 369, above.
14
Silkworth’s contribution has been described on pp. 15-16 and analyzed on pp. 21-22, above.
15
Cf
. note #9 to
Chapter Eight
, p. 371, above, for the Latin quotation and specific citation.
16
Cf
. Wilson’s correspondence with Fred W., partially quoted on p. 178, above, and cited in note #8 to
Chapter Eight
. The Helen C. to whom Wilson is writing in the letter quoted in that note was one person who commented on the dual sense of “spirit.”
17
This response is the main thrust of Wilson’s treatment of Step Two in
12&12
, pp. 25-34. For a more objective treatment of the A.A. program as Higher Power,
cf
the items by Milton Maxwell and Jon Weinberg cited in note #22 to
Chapter Eight
, p. 375, above.
18
A more direct treatment of the problem that Alcoholics Anonymous found in “Absolutes” is offered in
Appendix A
, below.
19
Specific quotations and citations for the ideas described in this paragraph may be found in the Appendix, where they are treated at greater depth.
20
A perception, not related to A.A., that the “addiction to addiction” treated here and in the preceding paragraph is a function of the understanding of modernity may be found in Leslie H. Farber, “Thinking About Will” and “Will and Anxiety” in Farber,
Lying, Despair, Jealousy, Envy, Sex, Suicide, Drugs, and the Good Life
(New York: Basic Books, 1976), pp. 3-34. The relationship between Farber’s thought and A.A.’s insight is most clear in “Our Kindly Family Physician, Chief Crazy Horse,” pp. 106-119,
ibid
.
21
The special need of the alcoholic
to control
is well although largely only indirectly treated in the literature review offered by Helmut Hoffman, “Personality Measurement for the Evaluation and Prediction of Alcoholism,” in Tarter and Sugerman (eds.), pp. 309-358. It is further illuminated by
in eodem
, R. E. Tarter, “Empirical Investigations of Psychological Deficit,” pp. 359-394; and P. E. Nathan and S. A. Lisman, “Behavioral and Motivational Patterns Chronic Alcoholism,” pp. 479-522. The “need to control” is also related to “the narcissistic personality”:
cf
. the citations of Kohut and especially Kernberg in note #34, below; the treatment in the text to which that note offers citation should also clarify my own understanding of one aspect of this connection.
22
On A.A.’s perception of the centrality of denial and the specific denial to which its program is directed,
cf
. above, p. 60.
23
Cf. Al-Anon Faces Alcoholism
(New York: Al-Anon Family Group Headquarters, Inc., 1973), pp. 223-267; also Lois [Wilson],
Lois Remembers
(New York: Al-Anon…, 1979), which was available only in galleys at the time the present book went to press.
24
In recent years, there has developed an emphasis on “early intervention” in the treatment of the alcoholic.
Cf
. especially the writings of Vernon E. Johnson,
e.g., I’ll Quit Tomorrow
(New York: Harper & Row, 1973),
Chapter 5
; but also such authors as David A. Stewart,
Thirst for Freedom
(Center City, MN: Hazelden, 1960),
Chapter 6
; and Roque Fajardo,
Helping Your Alcoholic Before He or She Hits Bottom
(New York: Crown, 1976). All of these approaches make significant use of Alcoholics Anonymous.
25
For the Oxford Group “Four Absolutes,”
cf
. pp. 50-51, above, as well as
Appendix A
, below, pp. 231-247. The quotations are from Wilson to Howard C., 15 November 1960, to be quoted in context in the Appendix.
26
AA
, pp. 60, 58; Wilson to Les V., 25 May 1961 (to be quoted in context in
Appendix A
). For the anti-professionalism and anti-intellectualism of A.A.,
cf
. above pp. 188-191.
27
Wilson to Margarita L., 14 July 1947.
28
Wilson to Marion L., 31 March 1953.
29
Wilson to Jeff K., 1 April 1953.
30
On the “shared honesty of mutual vulnerability openly acknowledged,
cf
. above, pp. 61 and 197 and below, pp. 221-223; on “the only requirement for membership,”
cf
. above, p. 106.
31
The literature on the essence of alcoholism as “dependency” is immense. A sampling of significant observers:
for the evolving consistency of the Freudian understanding:
S. Rado, “Die psychischen Wirkungen der Rauschgifte. Versuch einer psychoanalytischen Theorie der Suchte (The Psychic Effects of Intoxicants. A Psychoanalytic Theory of Addiction),”
Int. Z. Psychoanal
. 12: 540-556 (1926), CAAAL #3594;
E. A. Strecker, “Some Thoughts Concerning the Psychology and Therapy of Alcoholism
“Journal of Nervous and Mental Disease
86: 191-205 (1937);
E. Simmel, “Alcoholism and Addiction,”
Psychoanalytic Quarterly
17: 6-31 (1948); for one interpretation of the history of this idea,
cf
. M. Tremper. “Dependency in Alcoholics: A Sociological View,”
QJSA
33: 186-190 (1972). those who build on this a specific critique of A.A.:
F. T. Chambers, Jr., “Analysis and Comparison of Three Treatment Measures for Alcoholism: Antabuse, the Alcoholics Anonymous Approach, and Psychotherapy,”
British Journal of Addiction
50: 29-41 (1953);
J. Y. Dent in L. Williams, “An Experiment in Group Therapy,”
British Journal of Addiction
54: 109-125 (1958);
R. D. Bonacker, “Alcoholism and Alcoholics Anonymous Viewed Symptomatologically,”
Mental Hygiene
42: 562-566 (1958);
less explicit but of greater popular impact was Jim Bishop,
The Glass Crutch
(New York: Doubleday Doran, 1945), pp. 247 ff.;
those who recognize with some approval the dependence within A.A. as upon a Higher Power:
F. Cohen, “Personality Changes Among Members of Alcoholics Anonymous,”
Mental Hygiene
46: 427-437 (1962);
H. J. Clinebell, Jr., “Philosophical-Religious Factors in the Etiology and Treatment of Alcoholism,”
QJSA
24: 473-488 (1963);
those who criticize A.A. specifically for the religious nature of dependence within it:
E. A. Strecker, “Chronic Alcoholism: A Psychological Survey,”
QJSA 2:
12-17 (1941);
I. Gladston, “The Psychodynamics of the Triad, Alcoholism, Gambling, and Superstition,”
Mental Hygiene
35: 589-598 (1958);
M. Bean, “Alcoholics Anonymous,”
Psychiatric Annals
5: 16-64 (1975), is the most recent and by far the best such treatment, and is especially valuable for its extensive bibliography.
On Wilson’s sensitivity to this as the psychiatric criticism of A.A.,
cf
. Wilson to Oliver J., 13 June 1956: “These psychiatrists have a hell of a lot on the ball. But I sometimes wonder if many know how to pitch it. The parental relation they have with the patient is good to start treatment — but not to continue it. The normal adult relation is a participating one — not a parental one. That’s where we have an advantage in A.A. that they pass up — they are trained in the doctor-patient relation primarily.”
Hoggson,
Alcoholics Anonymous: A Study in Solidarity
, pp. 241 ff., offers indirectly a relatively early (1952) discussion of this perception, with telling citations.
On the modern mind and the Nietzschean will,
cf
. Farber, “Thinking About Will,” as cited in note #20, above, and especially William Barrett,
The Illusion of Technique
(New York: Anchor-Doubleday, 1978), pp. 193-198.
32
On “the alcoholic’s dependence upon the chemical alcoholic as in service to his infantile quest for grandiose omnipotence,”
cf
. especially Rado, Simmel, Bonacker, and Gladston, as cited in note #31, above, for a representative sample.
33
On the psychology of infancy,
cf
. especially the writings of Margaret S. Mahler; most relevant here are
On Human Symbiosis and the Vicissitudes of Individuation
(London: The Hogarth Press and The Institute of Psychoanalysis, 1969), and with Fred Pine and Anni Bergman,
The Psychological Birth of the Human Infant: Symbiosis and Individuation
(New York: Basic Books, 1975) — in both, the first two chapters speak most directly to the point. For an earlier and more challenging interpretation,
cf
. William V. Silverberg,
Childhood Experience and Personal Destiny
(New York: Springer, 1952). Dr. Silverberg found hints of this interpretation in American psychiatric thought before Freud:
cf
. his use of Trigant Burrow’s concept of “oceanic feeling,” pp. 15-16.
34
For this understanding of infant psychology,
cf
. the preceding note, especially Mahler; for one expression of a similar insight into the meaning of the prevalence of addictions,
cf
. David F. Musto,
The American Disease
(New Haven: Yale Univ. Press, 1973).
For a deeper analysis of the implications of such “immaturity,” the recent flurry of literature on “naricissism” is instructive;
cf
. the following:
Heinz Kohut,
The Analysis of the Self
(New York: International Universities Press, 1971), especially the
Chapter 2
discussion of “The Idealizing Transference” and the
Chapter 5
treatment of “Mirror Transference";
Otto Kernberg,
Borderline Conditions and Pathological Narcissism
(New York: Jason Aronson, 1975), especially
Chapters 9
and 10: “Clinical Problems of the Narcissistic Personality” and “Normal and Pathological Narcissism;” also, his thoughts on “Prognosis,” pp. 306 ff., as clarifying the relationship between “immaturity” and “narcissism";
Ernest Becker,
The Denial of Death
(New York, Free Press, 1973),
Chapters 3
,
4
,
7
, 10, and especially II: “What Is the Heroic Individual?”;
Heinz Kohut,
The Restoration of the Self (New
York: International Universities Press, 1977), especially
Chapters 2
and
7
on the need for a “psychology of the self”;
Christopher Lasch, “The Narcissist Society,”
The New York Review of Books
23 (No. 13): 5, 8-13 (30 September 1976), and
The Culture of Narcissism
(New York: W. W. Norton, 1978).