April 1966

sometimes wrong quantities of them, nonalcoholic. The superior attitude . I “

A plea for one world that only abet or worsen the alco- which says, “I’ve got all the answers in alcoholism treatment holic’s problem. and I am holier than thou” affects But ignorance exists on the part many a Twelfth Step worker as well of many others. It confounds the as many a physician, spouse, court alcoholic’s spouse for a long while, or well-meaning friend. It consists often until she finds her way to Al- of such advice as: “You must Anon. It confuses the early alco- use willpower.” “You mustn’t be holic who, sensing that something is weak.” “Snap out of it.” “You gotta wrong with him, wanders about have guts.” The omnipotent twelfthhopelessly like a tuberculosis victim stepper says, “Do it my way.” Our Mutual Sins of the Middle Ages who, spitting We doctors practice omnipotence blood, did not know what was when we believe that a magic medi- By HARRY K. ELKINS, M.D. wrong or what to do. cine or rigid forms of psychotherapy The second error is that of fear. alone will do the trick. When our Fear about alcoholism confounds all omnipotence fails to bring about the Dr. Elkins, a psychiatrist, is Director o f the Santa Clara County of us, those who should be in a po- desired results, we become angry Alcoholic Rehabilitation Clinic in Sun JosP, California. This article sition to help, as well as the alco- and say the alcoholic won’t cooperis condensed from a talk he gave ot the Hospital and Institutions holic himself. ate. The omnipotent doctor ends up Committee Section of the meeting in Sun Jose last March. The physician often acts out of talking only to himself. fear of offending both the alcoholic As for omnipotence .on the part and his spouse, as though alcohol- of the alcoholic, I need not dwell on ism were a dirty word. The doctor that. It deludes the alcoholic while hesitates to name it and talk about drinking and it sneaks up on him it. The employer fires the alcoholic when abstinent. For this he needs HERE are, seven deadly sins – for other reasons without attempting the continued reminder and support Tword or errors, if you prefer that which keep our two worlds case where a bartender may be more learned than a doctor or a judge. to talk openly about the real prob- of AA. lem. The wife hides it from herself, The fourth error is that of resentapart. I mean the world of the non- It is a sad fact that the diagnosis family and friends. All out of fear. ment, anger. It is committed on both alcoholic professionals engaged in of alcoholism escapes many a physi- The alcoholic must come to face sides of the fence. Usually, after treating alcoholics, and the world of cian. Even when he is confronted his alcoholism; it need not be feared omnipotence falls flat on its face, alcoholics sober in AA who are en- with all the signs and symptoms of if it can be understood. The ability the physician is apt to become disgaged in carrying the messagc of alcoholism, the unknowing physi- to speak without fear, to speak with illusioned, then resentful and angry. sobriety to still active alcoholics. cian, along with many others, may understanding and directness, is This feeling may easily spread to his The first deadly sin (excuse me, offer the statement: “You’re no most necessary in order to cut attitude about all alcoholics. Since error) is that of ignorance. Many more an alcoholic than I am” or through the facade of the man still he doesn’t understand them and persons who should be in a posi- “Why don’t you taper off with a drinking. You who do Twelfth Step they have not responded to his omtion to know the rudiments of alco- little beer?” work know this very well. nipotent methods he concludes that holism just don’t. They are ignorant Ignorance, then, is perhaps our The third error is that of omnipo- they are not worth helping or that -not ignorant persons, but ignor- first and gravest error. It allows tence which is practiced a great deal they cannot be helped. His resentant about the problem. Here is a some of us to offer medications, and by all of us, both alcoholic and ment may be openly expressed.

The spouse, the employer, the does treat alcoholics and treats existence of this power, and no al- to our purposes all that we now law itself, having gone through all them quite successfully, regularly coholic is safe without it. The wor- know to be effective: the proper the steps of ignorance, fear and om- admits his alcoholics under the di- ship of no pill, no machine, no handling of early alcoholics, whether nipotence, may take on an attitude agnosis of singultus, i.e., hiccough. special technique of intellectualized it be at home, in the doctor’s office, of open anger and resentment. The It is the only way he can get them a psychology will do us any good in on the job, in jail, in our hospitals bitter-end point is reached when bed in certain hospitals. the absence of this belief. In what I and institutions. More teaching divorce occurs not only between the The alcoholic who has not ac- call idolatry we take to worshiping about alcoholism in medical schools alcoholic and his spouse but be- complished ‘true sobriety practices something other than a Higher and to the public at large. Provision tween the alcoholic and his entire this form of dishonesty also. So long Power. We take to worshiping a of more and better facilities in hosworld. as he cons himself into giving only special system of treatment or, in pitals. More sobering-up stations, I need not mention the extent to lip service to the principles of AA the case of the’ alcoholic, worship- outpatient clinics and communitywhich resentment and anger bog he deludes himself. ing the bottle. sponsored halfway houses. In all down the alcoholic’s life. Along The sixth error I call idolatry. It In idolatry, both physician and these areas we commit the error of with omnipotence it is perhaps the may exist in those who are in a alcoholic are left in a chasm of indolence. chief problem with which he has to position to help the alcoholic as defeat. There can no longer be the world contend. well as the alcoholic himself. Idola- The seventh and final error is of the nonalcoholic and, opposed to The fifth error is that of dishon- try is nothing more than losing that of indolence. It is committed it, the world of the alcoholic. We esty. The doctor commits this error touch with a power greater than by society as a whole. In our indo- need one world if we are to be efwhenever he sidesteps the issue of ourselves. By whatever name we lence we fail to do more than we are fective together in , helping alcoalcoholism and calls it something may want to designate this power, already doing about alcoholism. We holics. else. Hospitals practice it insofar as either as God, nature, the forces of are not doing enough to dispel ig- I think now that I have given my they may admit alcoholics under the universe, love or as a philoso- norance. We are not doing enough list of our mutual sins, it would be some diagnosis other than alcohol- phy of life, no one can hope to help to dispel fear. to the point to go back a bit and ism. One of my medical friends who the alcoholic who does not feel the We are not doing enough to bend review my own experience.

Five years ago I attended my first me. The AA speakers had played There are those who feel that AA understand why anyone, not an al- AA convention. I was quite new to their role as devil’s advocates and coholic himself, could possibly be is the one and only method of atalcoholism at that time. I then be- by so doing had jarred me into takinterested in the problem of alco- taining abstinence and sobriety. It lieved that the alcoholic could ing another look, which was good holism, want to help, and have is similar to believing there is only change if you just listened to his for me. something useful to offer. They per- one true church for alcoholics. This unconscious long enough and could I saw that instead of one world, petrate the myth that “you have to is not entirely true. Many different understand him properly. I felt that vitally concerned and working cobe an alcoholic to help an alco- kinds of people become alcoholics personal interest, understanding and operatively on the problem of alcoholic.” To these few extremes, to and there are many different pospsychiatric interpretations were suf- holism, we have two worlds: the reactionaries, I would say, “Come sible answers. Each person must ficient. I didn’t understand the alco- world of the (sober) alcoholic and out of it. As you come forward to find the answer which fits him, in holic’s unstoppability, the fact that the world of the nonalcoholic. A accept and understand and help his own way. he already understood his uncon- high brick wall sometimes seems to educate the nonalcoholic world, you But lest these remarks be dis-. scious better than I could ever know separate us, and I am not quite sure will help erase the boundaries that astrously misconstrued, let me add it, the need for a crisis in his life, how it got there. There are errors divide our two worlds.” that “other ways” are not in comand the constant reminder necessary on both sides of this wall, but let me The respect which AA holds in petition with AA, that AA is far to keep his ego down to human size. now be a devil’s advocate, in the the nonalcoholic world need not be and ahead, in my opinion, the most I certainly didn’t understand AA. pages of AA’s magazine, and say emphasized here. This respect is readily workable way that I know At that AA convention I found how I see this operating in some AA immense. You need not and should of. And I must certainly add that myself very much alone. I was a members. I am speaking of those not feel sensitive or apologetic any AA has never hurt anyone (alstranger who could not understand few but particular members of AA more than you need feel angry though there are a few practicing the language being spoken. Even who sometimes give the impression about the nonalcoholic’s difficulty alcoholics who would like to blame the few doctors I met at the conven- of being so isolationist, so fright- in understanding alcoholism. 1 sus- their drinking on AA which they tion, good AA members, didn’t ened about maintaining their sobri- pect that most nonalcoholics are “once tried”). Most important of seem to speak my language, or per- ety, and still so angry with the rest not as much “against” the alcoholic all. I hope no one now safely in AA haps I didn’t speak theirs. To add of the world that I would call them as puzzled and troubled by him. I slips into the fallacy that he can hurt to my loneliness I heard AA the reactionaries of AA. ( I know suggest that AAs help these non- “go it alone” or that he now dare speaker after speaker get up on the full well that these also exist on the alcoholics to get unpuzzled and un- try some other ephemeral way of podium and rib the hell out of the other side of the wall, among non- troubled. achieving sobriety without AA. doctors who had tried to treat them. alcoholics.) I remember one young lady who There are probably many reawith a flip of her cigarette an- sons why some few abstinent alconounced, “So I went to this doctor holics feel the need to keep hostile and he tried this, and I went to that fires going to maintain two worlds doctor and he tried that, and then in alcoholism. Some have had exthere was the psychiatrist who kept perience in the hands of nonalcome five years on the couch. But I holic helpers which they feel were kept on drinking!” harmful to them. Others, in the I was uncomfortable and a little course of their Twelfth Step work angry. are irked by the mismanagement of Only on the way home did I see fledgling AAs by professional perthat this was a good experience for sons. I suspect many others cannot