June 1963

erate great degrees of frustration, but through with guilt, hostility, threats this kind of delay and tolerance is of rejection and mutual recriminavirtually foreign to the alcoholic. tions. Let me illustrate. An alcoholic has Upon closer examination, this soan appointment to see his physician ciability, genuine and likeable as it is, for a medical ailment. When he ar- rarely occurs within the context of rives, the doctor is examining another any deeply positive emotional relapatient and is behind in his schedule. tionship, but is superficial in the sense The Alcoholic Personality The alcoholic expostulates with the doctor’s secretary; he had an apthat anyone who comes into contact with the alcoholic will be the recipipointment at 2:30; he hasn’t got all ent of feelings of good fellowship and by Howard T. Blane, Ph.D.* day; he has to be some place else camaraderie. Furthermore, usually shortly; and so on. Or, alternately, present in the alcoholic’s social Assisranr Psychologist, Massachusetts General Hospital, he waits for a few minutes, and then charm is a need to impress others quietly leaves, probably carrying his with his worth, his adventures, his and Research Associate, H a r v a r d Medical S c h o o l resentment with him. accomplishments in life, with well- I n . other words, the alcoholic is worked-out reasons which serve to very apt to interpret ordinary frustra- explain whatever failures he has ex- VERYONE knows about alcohol- tions not in terms of reality but as perienced. E ics; yet we who work in the field, who attempt to obtain precise knowlof equal intensity; the organization of the traits varies from individual to individual. Further, some or all of rejections directed personally toward him. This sort of reaction occurs in A third characteristic of the alcoholic which again presents an apparedge of the alcoholic in the interests these traits are seen in persons who the most mundane situations; being ent paradox, is his feeling of inferiof treatment and of prevention, feel are not alcoholic; indeed, if we ex- waited on in a restaurant, delay of an ority, combined with attitudes of suless certain about what alcoholics are amine ourselves we are apt to see ordered drink, and so on. How such periority. Attitudes of superiority are like. We do know that there are these traits. The difference is that behavior, so often repeated by the readily observable in the alcoholic’s vast differences among individual al- they are transitory, or that they don’t alcoholic, affects his relationships at general behavior. Although the excoholics, and that these differences rule us to the point that they prevent home or ‘on the job is not difficult to pression of these feelings may take depend on a large array of factors, us from doing what we want to do or imagine. many forms, they are most often limsuch as social and cultural back- make us do what we don’t want to A second trait seen in many alco- ited to the following kinds of begrounds, intelligence and education, do, as occurs in the case of the alco- holics is their sociability. They are havior: the stage to which drinking behavior holic. frequently engaging individuals, en- ( 1 ) The alcoholic acts as if he has progressed, and so on. However, Perhaps the most commonly ob- joy the company of convivial groups, assumed that it is his right to get we also know that there are certain served trait among alcoholics is low and can be charming companions. preferential treatment in life, that the personality characteristics, traits, frustration tolerance. When a wish of They have a lively sense of humor satisfaction of his needs and desires consistent patterns of behavior the alcoholic is not gratified imme- and are often good storytellers. This comes before that of others. which occur commonly among alco- diately, the alcoholic tends to react sociability frequently and paradox- (2) He speaks of his importance, holics. with anger, with insistence that his ically coexists in alcoholics who are either his own personal importance These traits are not present in all wish be fulfilled, or with withdrawal unable to maintain permanent, mu- or that which he derives from his asalcoholics, but are common enough from the frustrating situation. Most tually satisfying relationships with sociation with important and influto warrant description. Nor are they of us have the capacity to delay grati- wife, parents, or friends, or whose eritial people; he may dwell on his * B y permission of the author fication as well as the ability to tol- significant relationships are shot past accomplishments and exploits.

People who habitually have to im- to his credit and be a person of con- wide range of behaviors. Thus, the press others (sod thus themselves) feeling and fantasies of superiority siderable success but, nevertheless, in part at least as a defense against alcoholic is fearful of trying to obwith their own berth frequently suf- pervasive feelings of worthlessness, tain a job that is within his abilities perceiving his feelings of worthlessfer from doubt8 as to their ability of low self-esteem, accompany his ness. We also suspect, however, that and for which his past expefience or adequacy. qlcoholics eventually every thought or action. well equips him, especially if he feels bring up violent feelings of hatred some of his feelings of superiority Recently one of our psychiatrists stem from a more basic source in his the job to be a worthy one. This is toward themselpeS, and speak con- was seeing an alcoholic patient in one reason why alcoholics are often vincingly of their lack of worth, of personality structure. the emergency ward. The patient in- Fourthly, most alcoholics are fear- found working in menial jobs, for intheir inadequacb. sisted that the doctor call him”Bum,” These are not the isolated or spe- ful individuals. The fearfulness be- stance as dishwashers, kitchen and was obviously perturbed when hind his attempts to impress others helpers, or janitors, even though cific feelings of the sort that we have the doctor naturally refused and con- is frequently all too readily evident. they may be reasonably well eduwhen we are anr\oyed at ourselves for tinued to address him as “Mister.” -What is the alcoholic afraid of? cated and have training in jobs which being unable to q0 specific task. When questioned, the patient elab- Experience in therapy with alco- are higher in the occupational scale. On the Contrary, when the alcoholic orated convincingly, and with feeI- holics shows that their fears and anx- The alcoholic is also fearful of enis unable to accamplish even the most ing, on why he ought to be called ieties can be numerous, and highly tering into relationships in which he commonplace eoa], this for him is “Bum” and did not deserve to be individual with respect to the per- feels demands may be made upon just a confirmalion of what he has called “Mister.” son’s unique life experiences and him involving responsibility and muknown all al~ng-~hat he feels just The alcoholic most of the time, of background. For our purposes, the tuality, and by mutuality I mean replain no good through and through. course, tries to avoid feelings of low primary thing to take note of is that spect for the other person, as well as And further, this feeling can occur self-esteem, and part of this avoid- the alcoholic is afraid of anything trust in his respect for you. despite the most blatant evidence to ance technique is to impress not only the contrary. ‘We alcoholic may have that poses a challenge to him and to This anxiety places the’ profesothers but himself with his own his abilities. sional person in a most awkward poall sorts of sub8tantial achievements worth. In other words, we see his This over-all formulation covers a sition with regard to reaching the al-

coholic. To be treated with respect is frightening to him, and he will most “To be treated with respect is frightening. . . 99 often react with either defensive anger or attempts to run from the relationship. To be treatcd with disrespect, with derision, open hostility, or he get into a situation which he feels face behavior, be described as de- avoided. They see themselves as a moralizing attitude is what the alco- is a test, he is most apt to take the pendent, clinical and therapeutic ex- quite capable of taking care of themholic expects, for it confirms him in view that he has failed and will re- perience teaches us that dependent selves, usually deny any problems inhis view that the world is hostile, spond with depression or increased needs are nearly always of central volving drinking, and pride themnonunderstanding, and not to be drinking behavior. importance in the alcoholic’s person- selves on their masculine, physical trusted. The alcoholic often impresses one ality make-up. prowess. The statement “He can It is this self-created conception as an expert at garnering failure, and One group of patients, who quite drink like a man” is among their of the world that the alcoholic uses as one who is equally expert in ra- openly seek to be taken care of and highest forms of praise. That they do as a major reason for his continued tionalizing failure as due to unavoid- to be given to, we infer to have strong seek gratification of dependent needs, drinking behavior. If he is able to able external circumstances, such as dependent needs for which they seek however,. is apparent, though such accept the respect of others, this is his being victimized by a hostile en- direct gratification. Alcoholics in expressions are indirect. The bonalready an excellent sign of potential . vironment. When he suffers a setback this group expect and actively try to homie of the tavern, the sometimes recovery, and is a first step to discon- in reality or merely in his own mind’s get others and the environment to maudlin avowals of friendship, and tinuing drinking. The alcoholic seems eye, he is frustrated and responds meet their needs. They show a indeed the dependency on alcohol itaware of this, and while some part of accordingly. marked lack of initiative, will do little self are examples of this. himself would like not to be alco- I want to emphasize again that the on their own, and appear to function We infer that this type of alcoholic holic, another and nearly always failures or defeats that the alcoholic most adequately under the firm and has intense dependent needs, the stronger part is tremendously fearful feels he has suffered consist from our close guidance of those around them. direct satisfaction of which is exof not being an alcoholic. For these point of view of the minor irritations, They are often drifters who develop tremely unacceptable and frightenreasons the alcoholic shies violently the petty annoyances that beset us relationships with a dominant man or ing to him. The basic fear seems to away from any potentially mutually daily. However, they do assume mn- woman who will protect and take be that directly dependent behavior respectful relationship. jor proportions in the alcoholic’s care of them. makes him look like a little boy, like Another aspect of the alcoholic’s mind, and he reacts as we might to a A second extreme group of pa- a “sissy.” In other words, he fears fearfulness has to do with testing major blow in life. One can only tients includes alcoholics who are that expressed dependency will drashimself and his capabilities. He won’t guess what a burden life must be to quite the opposite to the above. Re- tically alter his tenuous image of shut up and he is afraid to put up. the alcoholic, and what a Kafka-like lationships that involve any open ex- himself, will destroy his identity as He is well able to tell others of his nightmare he exists in. The writings pression of dependent behavior are a man. capacities, but this is bravado in the of someone like Edgar Allan Poe, service of warding off feelings of in- himself an alcoholic and drug addict, adequacy and helplessness. When it become understandable in these comes to the point of doing things terms. which he feels will in a reality and The fifth personality variable comaction setting test his statements, the monly seen among alcoholics inalcoholic becomes quite fearful, and volves dependency and its various exunder these conditions will more pressions. While many alcoholics likely than not resort to flight. Should would not, on the basis of their sur-