January 1975

The Story of uAnnabelle treat the underlying cause. This treatment would then lead to disby Abraham J. Twereki, MD appearance of the symptom. In those –

Clinicul director, Department of Psychiatry, cases where depression or severe characterized by a determination that St. Fruncis General Hospital, Pittsburgh, Pa. anxiety underlay the problem drink- she would never drink again and, ing, the use of antidepressants or with equal regularity, was soon foltranquilizing medication was said to lowed by relapse into drinking. be of help. Needless to say, her behavior Then came Annabelle, and 1 am brought about eventual alienation willing to believe that it was by de- from all of her family, who were sign of Providence that she came burdened by the strain of her dewhen she did. I feel this so strongly mands and wearied of repeated calls because I have never been able to to participate in futile rescue efforts. elucidate any reason why she sought She knew nothing of the where- Gateway Treatment Center. Aliquippa. Pa. a psychiatric interview at that time. abbuts of her former husband, and She was sixty-one years old then, heard only a vague rumor as to the NNABELLE DIED last week. A few nize and treat alcoholic neuritis, A people will remember her, and pancreatitis, hepatitis, and delirium probably a granite marker will bear tremens; but as far as treating the and had been sober for four years. 1 learned from her that at twentyfour years of age she was already location of her one child. At age fifty-seven, Annabelle did a rather strange thing. She contacted her epitaph. But some ten miles disease of alcoholism itself, I had heavily involved in drinking. Several an attorney friend, who had extrifrom the Greater Pittsburgh Airport, learned worse than nothing at all. years later, she recognized that she cated her from the results of many there stands a huge monument to In medical school, there were no lec- could not fulfill her obligations to minor infractions, and asked him to Annabelle. It is not only an inipres- tures whatever on alcoholism. Dur- her husband and their infant son, petition the court for her commitsive, four-story, 150-bed-capacity ing my clinical years, the attitude and she did not contest his divorce ment to a state hospital as an inebrimodern edifice, but a living memo- toward the occasional patient hos- action. Following termination of the ate. The attorney at first did not rial – an active and growing reha- pitalized for intoxication was that he marriage, she became completely ab- believe that she would carry through bilitation center for persons suffering could be “dried out” and sent back sorbed in drinking, and this persist- with this idea, but her persistence from habituation to alcohol or seda- to the inevitable relapse. ed for the next thirty years. convinced him of the sincerity of her tive drugs. In psychiatric training, I had b e From Annabelle’s appearance at determination. She remained in the I first met Annabelle many years gun to learn that treating alcoholics age sixty-one, it was evident that she hospital for the full year, and upon ago, when I was a fledgling resident was quite futile, because successful must have been an extremely attrac- her release became involved with a in psychiatric training and she came psychotherapy was dependent on a tive and charming woman in her group of people in Alcoholics Anonto the clinic requesting an interview high degree of motivation, and vir- youth. She related how she had ymous, many of whom she had with a psychiatrist. Having complet- tually no alcoholic was motivated been wined and dined in deluxe known from her long drinking caed four years in an excellent medical for help, as the frequent relapses fashion. As the years went on, with reer. At the time she came for her school. a year of internship in ‘ a seemed to indicate. Furthermore, I time and alcohol taking their toll, first psychiatric interview, she had general hospital, and one year of was led to believe, problem drinking her habits deteriorated, and she maintained her sobriety for over four psychiatric residency, I “knew” then was generally the result of some un- spent many a night in a flophouse. years with AA. what unfortunately too many physi- derlying emotional disturbance, and She accumulated a record of ap- This was the first occasion wherecians still believe today. since it was a symptom, the appro- proximately fifty hospitalizations for in I learned something about this I had been taught how to recog- priate approach was to seek out and detoxification, each of which was unusual group of people. As far as

realization that a residential treat- been drinking, but that this was an ment facility, to provide intensive acute reaction to her illness. treatment following detoxification, She then asked me to pray with I had been concerned, AA was of being the first general hospital in was an absolute necessity for our her, and knowing Annabelle as 1 something that was always being the country to admit persoris for community. Again with the support did, I knew that none of the formal confused with the AAA, with the detoxification under a diagnosis of and encouragement of people in the liturgy would suffice. I took her unfortunate consequence that a per- alcoholism. I became more closely AA program, the impossible task of hand in mine and said, “Dear Lord, son with a stalled motor might find involved with AA members who opening a multimillion-dollar facil- You have helped Annabelle survive himself being given black coffee and would hold weekly meetings at the ity without one cent of Federal mon- her drinking and two major operahclped into a cold shower. In retro- hospital, and who would come in to ey was accomplished. tions. All we ask for now is that if spect, I can hardly fault my educa- see patients upon request. I began Many times, the administrator of You have anything left for her to tors for my ignorance, since they to understand the principles and the facility indicated that there was accomplish, You allow her the health could not impart to me something modus operandi of AA, and a mu- no possible way of meeting the next to do so. If her work is all done, of which they themselves had no tual trust developed between me and payroll, only to be advised that we she really doesn’t mind leaving.” knowledge. But I was fascinated by a number of AA members. could not expect anything of our Characteristically, Annabelle re- Annabelle’s accounts of this group All this time, I was still searching patients that we did not expect from marked. “That’s exactly what I of persons who were somehow man- in Annabelle for that elusive factor ourselves; if we taught them to live wanted to say.” I assurcd Annabcllc aging to recover from a condition responsible for her making a mo- “one day at a time,” we must do the that anyone who could lick alcoholthat I believed was untreatable, and mentous decision at age fifty-seven, same. We therefore refused to panic ism could lick cancer with both were doing so without the benefit of which totally changed her life. By about the payroll crisis until the hands tied behind her back. any therapist or medication. I was this time, she was employed and actual date arrived. Somehow (al- Annabelle didlick cancer, although further intrigued by their willingness financially self-sufficient, but had not though nobody is quite certain ex- her body became quite frail. She to respond, any time of day or night, attempted to recontact her family, actly how), each crisis was survived. returned to her job at a switchboard, to a call for help from some total except for an exchange of greetings As the years went on, Annabelle and remained active until the last. stranger. on Christmas. Her sobriety, then, suffered some physical setbacks, re- using energies which came from Appointments with Annabelle con- was not motivated by the desire to quiring removal of the major portion some source unknown to medical tinued on a regular, weekly basis. I reestablish family ties. She had made of her stomach and removal of one science. The end came fairly swiftly, am not sure what she derived from an interesting return to religion, in kidney. About three years ago, with a stroke, which did not allow them, but I was getting an invalu- that she would tithe regularly, al- when she made a routine visit to the her to suffer unnecessarily. . able and incomparable education, as though she never participated in office, I noticed a small lump on The elusive factor has essentially she described the myriad machina- formal church services. Somewhere her neck. A surgeon found i.t to be remained elusive. Only one conclutions which may be found in people along the way, I realized that she malignant. She was hospitalized for sion is left: Within every human with problem drinking. When I left had become quite devout, but had a radiation therapy, and had a very being. there lies a nucleus of dignity the residency, she requested that I very personal God, to whom she was unusual reaction following the first and self-respect, which, no matter continue to see her as a private unable to relate within the walls of several treatments: She became ex- how deeply buried and concealed, patient. I was all too happy to further any building specifically designed for tremely confused and was halluci- nevertheless retains its essence. At my knowledge of alcoholism, and that purpose. nating. This lasted for only one day. some point, the person may become the relationship continued. My ever-increasing involvement On the following day, she asked me, aware that he (or she) need not and Shortly after this, I became direc- with persons admitted to the hospital “Do~tor,where in the world did I dare not be less than what he can tor of psychiatry of a large general because of drinking problems (ap- get a bottle? I just don’t recall drink- be. At .that point, the miracle of hospital, which has the distinction proximately 800 a year) led to the ing.” I assured her that she had not sobriety can occur.