A p r i l 1965

He was, he claimed, also happy and only the words which count, but the contented, holding down a job, and emotional interactions. However, a planning to take his family on the superficial content analysis would first holiday they had ever all had bring out one point so obvious that together. He was going to an Alco- it must surely deserve attention: holics Anonymous meeting every most of what is said is about drink night of the week, and much of his and drinking. spare time was being spent helping THE PUZZLE OF AA other alcoholics. With what at first appears to be boring reiteration, the meetings drive Any psychiatrist who had in the at the fact that alcoholism is a by Griffith Edwards, M.D. course of psychotherapy produced disease, an allergy, a disorder of such changes would have been metabolism something akin to diapleased with the result. The man’s betes. Drinking story is told after whole ability to function had altered drinking story, and at times the An English psychiatrist finds that AA “continues to grow and to for the better. He could now handle whole meeting seems to lean forpuzzle psychiatrists by breaking all rules o f psychotherapy. ..” relationships with other people and ward with vicarious pleasure as he could deal with situations of frus- some particularly momentous drinktration and conflict which, when we ing spree is described down to the first knew him, he could only re- last bottle and the last blackout. In spond to by drinking. AA, he said, these stories the danger of ‘the first involved in this case and spent was the answer. . . . drink’ is stressed and stressed again, H OSPITALS have their failures, but the outlook for this particular patient seemed so entirely hours talking with the wife and still more hours in trying to get the fam- In England the number of AA members at the present time is difficult to estimate. The movement beand there is a frequently repeated phrase about one drink being too many and one hundred not enough. hopeless that before he was dis- ily rehoused and the man working charged his case was presented at a again. The patient was politely grate- came established soon after the war. An alcoholic, according to the ful but viewed his own problems as In London and the Home Counties doctrine which is reiterated at AA case conference for psychiatric sodistantly as he would have those of over fifty meetings are held each meetings, must accept his alcoholism cial workers as an illustration of the the man in the moon. week. A commercial traveler could as a physical fact, and if he refuses fact that there are alcoholics who simply cannot be helped. Psycho- In his early thirties, the man be fairly sure of being able to con- to accept this fact “and makes an seemed to be heading for the tact AA in any large town or city experiment” he is beckoning ditherapy had been tried but it failed bombed sites and the surgical-spirit from Exeter to Renfrew, in which saster. Such a blunt and unsophistibecause he could not form any usehe put up for the night. A visiting cated emphasis on drinking rather ful relationship with the therapist – drinking schools. He did not turn up again until five years later, when he professor would find active groups than on supposed underlying emohe put on a front of polite uncondropped in at the hospital just to in Oxford and in Cambridge. On tional causes of drinking is in concern. He was given Antabuse, a drug which makes a man nauseated tell us how he was getting on. He holiday, whether in Jersey, Tipper- trast to the approach which the alary or Stornoway, AA is still at coholic is likely to encounter with . if he drinks after taking the tablet had by now been in several hospitals hand.. . . many psychotherapists. Psychotheraand which is often a useful aid in and he had been in prison. For the the early days of sobriety -this last year, however, he had been If an attempt is made to analyze pists can even be found who make man simply palmed the tablets and completely sober, and he had bought the AA meetings, the analysis must the statement that alcoholism has slipped out to the pub. A young himself some very smart clothes as somehow take account of the fact nothing to do with alcohol. student of social work became very an outward sign of inner change. that, as in psychotherapy, it is not It would be wrong to suppose that , I ,..I – . .

AA gives no attention at all to prob- – as opposed to the manifest con- AA. One of the reasons it has bur- the assumption that group therapists lems other than the immediate prob- tent of any AA discussion – is that geoned into an international organi- are the prerequisite of group theralem of alcohol. Part of the time at alcohol and alcoholism are each only zation seems to be that the right py. The training of the group theraa meeting may be spent in discus- mentioned once while God is men- balance has been struck between pist has given him awarenesses and sing ‘thinking.’ There is a phrase of tioned five times. . . . A recurrent central control and group autonomy. skills which are used by him to admonition which is sometimes problem arises in interpreting the None of this provides the whole direct and interpret the processes of heard to the effect that “it’s not your Twelve Steps in such a way as to explanation of how a man who has group interaction. Yet AA has no drinking but your stinking thinking,” make AA acceptable to the alcoholic failed completely to benefit from trained person to control its interand it is held in AA that there are who is not theistic, and arguments everything which psychiatry could actions, and all the mistakes which faulty attitudes which can be iden- go on around the “as we under- provide, should come back five years the trained therapist would wish the tified as ‘alcoholic thinking.’ For in- stood Him” clause which seems to later sober and wearing a new suit group to avoid, the AA group prestance, the alcoholic is seen as a embrace even denying His existence. and saying, “I don’t let things get on sumably goes straight ahead and man who has a tendency to put the Sometimes. however. an alcoholic my nerves the way they used to do.” makes. All the uncontrolled and deblame on others. He is always look- who at first sees in AA only a meth- AA eschews psychiatric jargon, and vious manifestations of projected ing for excuses. He is someone who od of keeping dry, will later “go on yet some effort at interpretation in aggression and projected anxiety is always in a hurry, trying to do to get the spiritual side.” terms of group dynamics seems presumably leap like lightning about too much too soon, a fault which is The Twelve Traditions lay down necessary for complete understand- the room. corrected by the AA teaching that a simple framework for organiza- ing, although not for its functioning. The absence of a leader tempts the you keep sober ‘just for today.’ tion and administration. Central The most immediately apparent psychiatrist to try to detect sub- The individual is invited t o search control is to be k e ~ tto a minimum. fact about the dynamics of AA is stitute and symbolic leaders. AA himself for a number of wrong- Groups are to avbid the entangle- that the AA group is a group with- itself can be conceived of as an headed stereotypes of reaction-pat- ments of’big funds, and AA is to be out a leader. Group therapy, which abstract good object. One could tern.. . . self-supporting. Members are to like AA has burgeoned since the erect a number of other hypotheses: A feature of AA’s Twelve Steps speak for themselves and not for war, has as its uncodified first step that God is the group’s symbolic

leader, that the chairman plays the AA member has even been known introverted natures who find AA energy and ubiquity, and second as role of therapist, that Bob S. and to try to stop a divorce by going meetings disconcerting, and who a puzzle of extreme theoretical in- Bill W. have in some ways taken on round to give a solicitor a lecture on feel more able to work out their terest. Therapy without therapists, symbolic stature, but the fact re- the disease concept of alcoholism. problems with an individual doctor. sponsors manifesting unashamed inmains that AA works through un- The sponsor is not held back by any AA in London cooperates very volvement, groups demanding redirected group processes. The of the qualms about involvement successfully with the medical pro- pression, emphasis on the symptom absence of a therapist may in part be which might inhibit the well-trained fession and the experienced AA rather than the disease – and all responsible for the strength of group social worker. But even in AA the sponsor will not infrequently per- this producing therapeutic successes cohesion : there is no f ather-pro- older hands will caution against suade an alcoholic to seek psychi- sometimes of startling brilliance. If tector to hold the group together and over-involvement and will insist that atric help. In some mental hospitals we could understand AA we should, for this reason if the group is to sur- no one can be helped until that per- regular AA meetings are held. in the process, come to understand vive (and it badly wants to) anx- son really wants help. AA thus has a double importance: a great deal about human interieties must be very quickly dealt AA is not simply a crutch which first as a therapeutic organization of action. ‘ with. The absence of a therapist offers the abnormal personality seems also sometimes to result in mere support in contrast to psychoanxieties being repressed rather than therapeutic processes which actually resolved: there are taboo subjects, correct the abnormality, although such as homosexuality. there are indeed occasional cases Another interesting aspect of AA where AA does no more than supdynamics is that interaction is not port a man in a chronic state of limited to the meeting. In conven- neurotic maladjustment. Alas, psytional group therapy the therapist chiatry can often do no better. Sohopes to work through a network briety itself, however achieved, can of transferences, counter-transfer- sometimes allow a spontaneous maences and verbal interactions, he turation of personality, but AA hopes very much to avoid acting-out. seems often to exert a specific and Aggression must be at a verbal level positive psychotherapeutic effect by rather than an exchange of blows offering a man what is at first the and sympathy must be verbal rather experience of an accepting group. than a loan of money. His patients Experience of the group later breaks gather in his room, and he will prob- down into a network of individual ably feel that the therapeutic process relationships which may often be the will work best if they go their ways first warm and meaningful relationuntil the next meeting. ships the alcoholic has been able to In AA the state of affairs is very experience. AA is seldom able to different. A well-established mem- help the drifting, rootless man who ber will accept responsibility as has very livited powers to form responsor for the newly joined mem- lationship of any sort: the skid-row $ ber. He will go round to the new alcoholic as poor a candidate for member’s house, and spend hours AA as he is for psychotherapy. talking to him over cups of tea. An There are also people with rather