The Trip to Echo Spring (4 page)

The brain switch wasn't a concept I'd come across before. It was initially proposed about fifteen years earlier by Alan Leshner, then director of the National Institute on Drug Abuse. He suggested that neurobiological changes took place around the nucleus accumbens, the part of the mesolimbic system that deals with pleasure and reward, where addiction takes hold most strongly. These neural pathways, Dr. Levounis explained, ‘don't only signify for pleasure and pain; they also signify for salience. Essentially, they tell us what is important and what is not. So instead of having all kinds of things that are pleasurable and rewarding and salient in your life, all these things start becoming less and less important and the one that remains is primarily the drug of abuse. It's alcohol.'

The permanence of this hijack is due primarily to the geography of the pleasure-reward pathways, their anatomical position within the nutshell of the human skull. He mapped it out for me with his hands, showing
how the mesolimbic system is sandwiched between the hippocampus, which is the memory centre of the brain, and the limbic system, which is its emotional core. It made sense to me. Memory and emotion. How else do we make decisions, except by cognition, by the pure application of reason? But that region of the brain, the frontal lobes, is far away, anatomically speaking, and imperfectly connected, especially in the young. Little wonder that alcoholism was once characterised as a failure of will. The frontal lobes weigh right and wrong, apportion risk; the limbic system is all greed and appetite and impulse, with the hippocampus adding the siren's whisper:
how sweet it was, remember?

I shifted in my seat. I could see
The Line of Beauty
on the shelf in front of me, filed among the blue books. There were pigeons outside. The city was hammering against the window, insistent as a drill. Dr Levounis was talking now about the long-term picture: how the pleasure-reward pathways stay hijacked even in sobriety, so that although the alcoholic might stop drinking they remain vulnerable to addiction. For how long, I asked, and he replied: ‘Although a lot of people manage to beat the illness, the risk of using stays with you for a long, long time, if not for the rest of your life.'

We turned then to a discussion of treatment. Dr Levounis outlined the two basic options for recovery: the abstinence-based model and the harm-reduction model. In the abstinence-based model (the version favoured by Alcoholics Anonymous), the alcoholic stops drinking entirely, concentrating on the maintenance of sobriety. In the harm-reduction model, on the other hand, the focus is on improving the conditions of one's life and not necessarily on stopping drinking. He thought, pragmatically, that both were efficacious, depending on the individual's circumstance and needs.

There was a lot to think about in this conversation, but it was the big beast that stayed with me when I went down into the street. What would Tennessee Williams have made of it, the idea that addiction has its own momentum, its own articulated presence within the skull? I'm not sure he would have been surprised. He had a gut sense of how people are driven by irrational cravings. I thought of poor Blanche DuBois, sneaking shots of whiskey in her sister's house in New Orleans; of Brick Pollitt, hobbling back and forth to Echo Spring, saying to his dying father, ‘it's hard for me to understand how anybody could care if he lived or died or was dying or cared about anything but whether or not there was liquor left in the bottle'. Williams might not have known where the frontal lobes were located (although he probably did, being a dedicated hypochondriac whose sister's lobotomy left him with a lifelong terror of psychiatric care), but he certainly understood how a human being can navigate without the use of reason. I'm not sure
Cat on a Hot Tin Roof
is about much else besides irrational compulsions – alcohol, money, sex – and how they can unshape a life.

The AA meeting was on the Upper West Side at 6 p.m. I slept a while at the hotel and then cut across Central Park, eating a hot dog on the way. The trees were maybe a fortnight away from coming into leaf and as I walked I saw a red cardinal in a bush beside the path. Nothing except changes in climate and language communicate so thoroughly a sense of travel as the difference in birdlife. A week later, on the way to Key West, I'd see vultures circling above Miami, ospreys in the Everglades, an ibis picking its way through a tropical graveyard. Another
week on and thousands of miles north, on the outskirts of Port Angeles, I'd watch bald eagles fishing in a river and clouds of violet swallows swarming above a gorge. But the red cardinal was the first purely American bird of my trip and it heartened me. Whatever happens, happens here, in the populated earth. I was grateful for the science lesson, but I didn't want to divorce the neural drama of alcoholism from the world, the quick and grubby world in which it takes place.

No chance of that at AA. I sat at the back, with an old-timer, Andi, who'd offered to show me around. People were drifting in, clutching coffees, in baseball caps and suits. It seemed at first glance almost comically New York, right down to the couple in the front row who looked like rock stars, one in enormous sunglasses and leather shorts, the other swaddled in a floor-length fur coat.

There was a sign on the wall that displayed the Twelve Steps, next to one that read ‘No spitting. No eating food on shared computers.' The combination would no doubt have amused John Cheever, who struggled for a long time with the democracy of these dingy rooms, though in his last years he softened in his loathing of AA, becoming vocally grateful for its role in his sobriety. I read through them, step by step, for the hundredth time.

1.
We admitted we were powerless over alcohol – that our lives had become unmanageable.

2.
Came to believe that a Power greater than ourselves could restore us to sanity.

3.
Made a decision to turn our will and our lives over to the care of God as we understood Him.

4.
Made a searching and fearless moral inventory of ourselves.

5.
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6.
Were entirely ready to have God remove all these defects of character.

7.
Humbly asked Him to remove our shortcomings.

8.
Made a list of all persons we had harmed, and became willing to make amends to them all.

9.
Made direct amends to such people wherever possible, except when to do so would injure them or others.

10.
Continued to take personal inventory and when we were wrong promptly admitted it.

11.
Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12.
Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

No one knows for sure how AA works. It was from the very beginning a gamble, a shot in the dark. It was established in the 1930s by a doctor and a failed stockbroker, Dr. Bob and Bill W., both of whom suffered from alcoholism themselves. Among its central tenets are the beliefs that recovery depends upon a spiritual awakening, and that alcoholics can help one another by sharing their experiences: a kind of bearing witness that proved from the outset astonishingly powerful. As a statement by AA World Services puts it: ‘Together, we can do what none of us could accomplish alone. We can serve as a source of personal experience and be an ongoing support system for recovering alcoholics.'

I'd come to an open meeting. We all joined hands in the little room to singsong our way through the Serenity Prayer.
God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.
I had a flash of that tiresomely English reluctance to join in, the suspicion of group identities.

The speaker was a man in his forties, with fine dark hair and a beautiful, ravaged face. He spoke in a meandering, elegant way. Alcohol was the family disease. His father pushed him to succeed. He was gay, attempted suicide as an adolescent and at a late stage in his drinking stopped going out entirely, barricading himself in his apartment with crates of red wine. He used to suffer from blackouts and as he explained this period of vanishing from society he used another of those images that lodged itself painfully in my mind. He said: ‘It was like my life was a piece of cloth that I had shredded down to lace and then I tore the connections away until there was nothing left.' Eventually he checked into a recovery programme and after that he stayed sober, even when – and here, for just a minute, he looked exhausted – his partner killed himself. No alcoholic ever dies in vain, he said then, because their story might be the one thing that catalyses someone else's recovery.

After he'd finished speaking, which might have been half an hour, the group gave their responses. Each person began by saying their first name, the nature of their addiction and the length of their sobriety, with the rest chanting back in unison, ‘Hi Angela, Hi Joseph . . .' At first it seemed theatrical. There was evidently a clique at the front, and their responses
were annoying a man beside me. ‘Oh GROSS,' he kept saying. ‘Oh fuckin' love, love, love.'

I had some sympathy for him, but the next stage made me change my mind entirely. People were asked to put up their hands if they were celebrating a sobriety birthday that month. Some hadn't touched alcohol for years; some for decades. An Indian man stood up and said: ‘I can't believe my son is eighteen this week and that he's never seen me or my wife drunk.' It hadn't really dawned on me before how much of a fellowship AA is, or how powerfully it depends on people wishing to pass on the help and friendship that's been offered to them. By the time the closing prayer began I was close to tears. ‘Right?' Andi said, nudging me, and I nodded back. Right.

We said goodbye at the kerb and I walked to the subway alone. I'd forgotten my coat but it didn't matter. The air was almost warm and the moon was very high in the sky, bright as a nickel, ripe as a peach. On the corner I passed a little girl of eight or so roller-skating outside an apartment building. She was hanging on to the hands of a Puerto Rican woman I assumed must be her nanny and whirling in circles, calling out in an imperious voice: ‘Again! Again! I'll just do one more!' One more. It must at some time or other have been the rallying cry of every man and woman in that meeting. As I turned down towards the Elysée I could still hear her shouting ‘Seven! Eight! Ten!' as she completed each triumphant, greedy circuit.

I'd made these two small pilgrimages as a way of immersing myself in the subject of alcoholism (an approach, now I came to think about it, not dissimilar to John Cheever's preferred method of swimming in cold water: leap in, preferably buck naked, no namby pamby fiddling about on the side). What hadn't occurred to me, foolishly, was that
spending a day listening to people talk about drinking might trigger corresponding memories of my own.

My room at the hotel was very plush. The Italian influences of the lobby had given way to a French chateau (later, when I went down to breakfast, I found an English country house library, complete with hunting prints and a piano). There was a painting of smugglers huddled around a bonfire above my bed, and I slumped beneath it and tried to order my thoughts. I had ducks on the brain. I knew why, too. When my mother's partner was in treatment she sent me a card. She must have been somewhere between Step Eight, which requires one to make ‘a list of all persons we had harmed, and became willing to make amends to them', and Step Nine, which is to make ‘direct amends to such people wherever possible, except when to do so would injure them or others'.

What I remembered, lying on the overstuffed bed, was sitting by the bookshelves in my mother's study, reading a card with a duck on it. It wasn't a cartoon. It was a serious, sporting drawing of a mallard or pintail, its feathers marked with immaculate gradations of colour. I remembered the duck and I remembered that both sides of the card were filled with small dense writing in black ballpoint pen, but I had no idea now, beyond the vaguest sense of an apology, what it actually said.