February 1945

Dr. POWDERMAKER DISCUSSES THE ROLE OF A PSYCHIATRIST IN ALCOHOLICS ANONYMOUS

There is no need to tell the many of you have heard. There are Even though all this be true, the readers of this journal that the chronic doctors who have considerable A.A. member may well ask the necessity alcoholic presents a difficult problem. understanding, often largely intuitive, of for any association between A.A. and That problem is just as difficult for the the personality and behavior of the psychiatrists. The A.A.s have an psychiatrist to understand and solve as alcoholic, but the reason why he outstanding record of success in helping for anyone else. You may say that it developed this habit rather than some alcoholics stop drinking and keeping ought not to be, since he is presumably other we can’t answer. them dry over periods that now extend an expert in the kinds of behavior that The second point to consider is over approximately a decade a better make people unhappy and sick. He the attitude of the alcoholic when he record, by far, than psychiatry has made should know how to help people to make goes to the psychiatrist. Sometimes he is in this field. Then why do we even a healthy adjustment to life. Many of you not sincere. He kids himself into thinking consider whether psychiatry has any have gone to a psychiatrist or another that he wants to stop drinking but he has place in the life of an A.A.? doctor with just this idea. Then when he no real intention of doing so. Sometimes Well, let us look at that question. failed, as he usually did, you threw up his family makes him go. The All successful A.A.s, as well as your hands, sometimes in sorrow, consequent failure of the psychiatrist psychiatrists who have dealt in any way sometimes in anger, often in resentment gives him an “alibi.” Other alcoholics are but a superficial way with alcoholics, that grew out of your disappointment, sincere when they ask for help – but they recognize that two problems are involved and very often with the feeling, “Well, he expect the doctor to do the curing. The in the care of the alcoholic after he can’t help me, no one can; there is psychiatrist is to perform a miracle, and decides that he is through with drinking nothing to do but keep on drinking.” And lo! the patient is cured. He does not (the 1st step). One involves his then you felt worse when you thought consider that no cure can be effected by personality and the other the life how much liquor could have been bought a psychiatrist, by Alcoholics Anonymous, problems that he has failed to meet. with the money you spent on the or anyone else without his own active The 12 steps are based on a psychiatrist. cooperation without his blood, sweat profound understandingof the alcoholic’s There are two ideas which had and tears, to quote Mr. Churchill. So personality. They take into consideration better be brought up at the start. One: again the failure of the psychiatrist can his compulsion to try to dominate life, his The psychiatrist does not have all of the be used for an “alibi” and often is. refusal to accept help, and then, in answers to human behavior by a long, Actually any psychiatric treatment contradistinction to that, the immaturity long way. For example, there is much that seeks to cure an illness alcoholism inherent in his effort to escape from about the problem of what makes a man or any other must be a joint research problems and responsibility. In drink to excess that we don’t know. Why project carried on by doctor and patient formulating these steps it was recognized should one man drink to excess while with sincerity of purpose, deep interest that the alcoholic uses innumerable another may be a teetotaller but not be and mutual respect for each other and excuses and devices in his attempt to able to stop eating way beyond his for the difficulties of the road they travel gloss over or decry these facts, and they needs? There are several more or less together. help him to face the truth. Feelings of glib answers to these questions that

inferiority, whether recognizedor not, are person you now are, the easier it is for every three or four weeks and lasted two inescapable and sometimes you to manage your life as your adult self or three days. These sprees left him overwhelming. His ability to stay dry would like to. moody and depressed and feeling very depends on his capacity for accepting This is where the psychiatrist guilty, though he would not admit it to his these steps and carrying them out. Each comes in. He is trained not only to listen family. In between, as a rule, he was step successfully achieved adds to his to your present difficulties but to help you somewhat nervous and irritable. hope and confidence and removes some to understand them in the light of your Paul had been the youngest child of his inferiority. past. Occasionally just talking to a and his mother’s favourite. He was But sometimes it is like walking on trained person a few times will give babied and spoiled and protected by her, a tightrope. Feelings of sorrow, guilt, enough perspective and insight into one’s but “Picked on” by his older brothers. failure and desperation rise up and at feelings to help in dealing with them. The Consciously he disliked and looked down times may be so overwhelming as to be psychiatrist helps you solve them by on his mother, who was narrow and unbearable, and a binge becomes showing you that you are trying to meet intolerant and a prominent white inevitable. Or if the urge to escape by them according to habits and ideas ribboner. He admired his father, who did drinking is overcome, the struggle may formed in childhood, which are of no help some drinking, but was not an alcoholic. have been terrific and the suffering in meeting the situation of adult life. Like all alcoholics, Paul never felt at ease acute. Often the feeling of anxiety must – Tensions nerves – come from with people when he was sober. He felt be coped with for a long time. conflicts in the unconscious started in inferior and unable to cope with social You all know what a profound help youth and often set off by some situations. it is to talk out your feelings and happening of the present. To solve them . He was sincere in his desire to experiences with another A.A. member. usually takes longer than a few hours. stop drinking and earnest in his He has been through the same When these unconscious conflicts and acceptance of A.A. principles. He was experiences and he accepts you with the emotions associated with them are able to stay dry for increasingly long understanding and no shadow of blame. brought to light and solved, we can then periods. But some of his nervousness, But there can be further help. You are deal with the problems of the present tension, and feeling of inferiority not only rikeevery other alcoholic but you without being hampered by the dead remained, although they diminished are also unlike every other one. Every weight of old neurotic habits of thinking somewhat as he found that he was able person is unique he is never entirely a and acting. But we can’t solve conflicts to stay away from liquor. , type. The patterns of his behavior as an until we know what they are, and it takes He started working with a adult lie in his experiences in childhood a trained perSon to help bring them to psychiatrist, and while it would take many and adolescence. He has learned by light. pages to give the whole story, certain experience and by the example of those The high points of the story of an important factors, of which he was not around him to meet the particular alcoholic will illustrate this. We will call aware, stand out. His inferiority grew out circumstances of his early life in a certain him Paul Smith an ambitious young of the conflict between his desire to way, or he has reacted against these business man, with high ideals and, continue as the favourite small child, who teachings and examples. The more you when he was sober, a great capacity for could always get his own way, and his understand about yourself and the work. He drank moderately between desire to be as responsible, capable and reason for your developing into the severe drinking spells which occurred self-assured as his brothers were. He

wanted to achieve this independence but not at the cost of giving up his wish to make the world treat him as his mother did. He had periods of hard work and success, but unconsciously he felt that he was giving up too much to make it worthwhile. As long as he unconsciously wanted to be tied to his mother’s apron strings and protected by her, he felt inferior. He finally came to understand the incidents in his childhood and adolescence that showed the origins of his inferiority feelings, and he “got out” the intense and conflicting emotions associated with his relations to his mother, father and brothers. He could then give up his desire to get back the pleasures of a spoiled child, realizing that they were out of date, so to speak, and accept his own more mature ideals without conflict. Some A.A.s find that work in the organization gives them the release and satisfaction that they need. For others, even though they have been able to stop drinking, the way would be made easier by an understanding of the nature of their difficulties. Florence Powdermakee/l M.D.