Aa history Lovers 2004 moderators Nancy Olson and Glenn F. Chesnut page

origin of alcoholism than the

pansexualism of Freud.

I agree with Dr. Schmalhausen when he says: "The ego is more pervasive as a

human reality than sex. Human natures that harmonize on the ego level can

contrive to put up with sex disharmony; but sex harmony cannot cope with the

problem of disharmony rooted in a maladjustment of egos. The Adlerian theme

runs deeper in human life than the Freudian, though the latter, because of

its dramatic and sensational components, gives the impression of being more

fundamental."

Inasmuch as Dr. Schmalhausen's book, Why We Misbehave, is very far from

being hostile to much that has been written by Freud, this remark is quite

significant. At any rate I have yet to find a case of alcoholism which

seemed to rest on suppressed sexual desires either normal or abnormal,

unless all uncalled-for violence is to be interpreted as Sadism and all

exaggerated friendliness is reduced to terms of homosexuality which does not

seem reasonable to me. Nor does this opinion arise from any prejudice

against Freud in favor of Adler or from any a priori reasoning. As a matter

of fact, it came somewhat as a surprise in my experience that alcoholics

should be so free from sexual disturbances past and present.

As I do not explore the unconscious by psychoanalysis or hypnotism, I cannot

make an unqualified statement that there is not a deepseated relationship

that can be discovered by these methods. It has, however, seemed unnecessary

to go to such lengths to procure satisfactory results.

On the other hand, sex can function as a conscious or semiconscious

stimulation to drink under certain conditions as contrasted with a

fundamental instinctive urge. Men who are self-conscious in the presence of

women find it easier to accomplish their purpose if their timidity is

removed by alcohol (though "satyrs" never allow any blunting of their

sensibilities to interfere with their pleasure).

Furthermore, many men have more of a conscience than they realize. Alcohol

will suppress this inhibiting force during the event and give them an excuse

("I wouldn't have done it if I hadn't been drunk") to dispel remorse after

it is over. Thirdly, the crudities of coarse, inferior women are obliterated

if men of sensibility drink a sufficient amount. Thus for many a bachelor,

unable to find a woman of his own class, the old association of "wine,

women, and song" consciously or unconsciously recommends itself.

For the man who is going to stop drinking, this association must be broken

up. There is no biological urge for drink such as there is for sex, and only

vicious custom has given them a connection. If this break cannot be made,

then 'women' must be avoided until the alcoholic habit has been definitely

overcome. An inebriate's entire life depends on the successful outcome of

the treatment; so it will not do him any harm if he finds he has to do

without women until this has taken place.

In contrast to the sexual theme, them always appears inferiority in some

form or another, often to a marked degree and in most cases fully admitted,

although sometimes a compensatory mechanism is at work, disguised under a

bold front. Alcohol, with the "Dutch courage" that it temporarily supplies,

is a logical antidote for inferiority. Some of the causes of this

inferiority, in addition to the early environment already referred to, are

shocks, humiliations, accidents, failures in athletics and scholarships as

well as in business, disappointments in love, inability to make friends, and

the doing of some act which, even if unknown to the outside world, degrades

the individual in his own eyes. According to Dr. Myerson, "' Dutch courage'

drove from many a man the inferiority and fear that plagued his soul. True,

it drove him into a worse situation, but for a few moments he tasted

something of the life that heroes and the great have. If we can ever find

something that does not degrade as it exalts, all the world will rush to use

it." The italics are mine.

A case might be mentioned of a man becoming a drunkard as a result, so he

thought, of having his heart broken in a love affair. This individual had

always been lacking in self-confidence, but his girl had temporarily given

him the feeling of power that he had abnormally craved. When she terminated

their relationship he collapsed. A short analysis soon showed him that it

was his ego that was broken and not his heart. Sad he was, without question,

but it was humiliation and not sorrow that "drove" him to excessive

drinking.

Just as we speak of a vicious circle of cause and effect which moves faster

and faster as drinking continues, so we can with equal validity refer, in

the case of inebriates, to the cessation of drinking as a benign circle

where confidence and poise follow sobriety, inferiority disappears, and so

sobriety itself is made easier. Self-respect is substituted for degradation.

While the eliminating of drink itself has been the factor in determining

this restored state of mind, still there may be other forces at work which

will determine whether or not the alcoholic is going to be able to complete

satisfactorily his treatment. If he is leading, apart from his drinking, a

life which causes him to lose caste in his own eyes, it is almost certain

that he will conceive of himself as too weak or vicious to give up the drink

habit, though this low opinion of himself may be partly repressed into the

unconscious.

The most ready illustrations of the above condition are the sexual

irregularities on the part of married men. Many men, as has been mentioned

before, have more of a sex conscience than they realize. Some, of course,

though they would collapse under the remorse following a petty theft and are

in many other directions anything but conscienceless, have no immorality

conscience at all. On the other hand, there are a great many men who pretend

to this irresponsibility, whereas in reality they are unable to escape the

traditions of their inheritance and bringing up. I have had two cases which

have involved extramarital sexual relationships. In each case I replied

that, as long as it did not lead to drinking directly through emotional

contagion or indirectly through a feeling of guilt which produced

inferiority, it was their own problem to decide. However, these men

voluntarily came to the conclusion that, inasmuch as their wives were doing

all that they could to make the home a happy one, they would make a clean

sweep of their entire irregular life. They found that fundamentally they did

feel conscience-stricken, and that in addition the fear of being caught had

a demoralizing effect upon them.

I have known of other men in this predicament who, because of the difference

of their natures, did not require the adjustment of this factor in their

treatment and cure. But sex is by no means the only cause for an enervating

and demoralized self-ideal, nor is it necessarily the most important one. It

was merely used as a convenient illustration. Any form of behavior which

lowers a man in his own eyes, whether the outside world knows about it or

not, will obviously prevent a vigorous, sustained, and undiverted

concentration on the giving up of the alcoholic habit. Lying furnishes

another excellent illustration of destructive conduct. A man who lies to

those who have a right by nature of their position to know of his affairs is

soon motivated by the feeling that if he is not man enough to tell the truth

to those who are endeavoring to help him he is not man enough to give up

drinking. While he may not consciously formulate this relationship in so

many words, the effects - that is, his actions - soon testify to its

validity. A man quite naturally has feelings of inferiority at the beginning

of his treatment because of the effect that alcohol has had upon him, and so

he should do all in his power to eliminate anything that fosters a lack of

self-respect, whether it appears on the surface to pertain directly to the

question of drinking or not.

"If," writes Professor McDougall in his Outline of Abnormal Psychology, "a

unitary personality is to be achieved, the various sentiments must be

brought into one system within which their impulses must be harmonized, each

duly subordinate to the higher integration of which it becomes a member.

This higher integration is what we call 'character'; it is achieved by the

development of a master sentiment which dominates the whole system of

sentiments, subordinating their impulses to its own…The only sentiment which

can adequately fulfill the function of dominating and harmonizing all other

sentiments is the sentiment of self-regard, taking the form of a

self-conscious devotion to an ideal of character…

"A firm or strong or well-knit character, one that can resist all

disintegrating influences, is one that can face all problems, all critical

alternatives, and can make a decision, can choose one of the alternatives

and give that line of action an assured predominance over all others; and

this capacity depends upon the organization of the sentiments in an ordered

system dominated by a master sentiment; and of all possible master

sentiments the most effective is a sentiment for an ideal of character, an

autonomous self, a reflective self that can control, in the light of reason

and moral principles, all the promptings of other sentiments as well as the

crude urgings of instinct and appetite."

Another factor in the background of alcoholism, which is common to all

neurotics, but which might escape those uninitiated to abnormal psychology,

is the fact that by his conduct the alcoholic is making himself important in

his own eyes. Prevented by his habit from living a constructive life, he is

unconsciously anxious to make a stir in the world, even though this stir is

of a purely destructive nature. Anything is better than oblivion, and so all

the fuss that is made about him, as well as the fact that he is a "serious

problem," is not as distasteful to him as he may imagine. In fact, he often

considers himself a heroic villain or martyr. Those who have had dealings

with drunkards have noticed the phase of self-pity wherein they expatiate at

length about the curse that is laid upon them. They delight in relating how

they are drinking themselves to death; it seems that they cannot help this

unfortunate procedure, since, owing to inheritance or some other bugaboo,

they are in the clutches of a " vice" which is more powerful than they are.

Often this discourse is accompanied by drunken temperance lectures. In a

weepy manner they implore their audience not to follow in their footsteps,

and state with great emphasis that, had they their lives to lead over again,

they would never touch a drop. This is, of course, 100 per cent hocus-pocus,

and nobody realizes it more than the man who has given up the habit "he

couldn't help"' and has learned to satisfy his craving for attention in a

legitimate manner.

5. PSYCHOANALYSIS

In the foregoing I have had occasion to refer to psychoanalysis. Owing to

the profound influence that Freud and his followers have had on abnormal

psychology and the justified interest that the public has taken in the

popularization of his works, the relationship between this most important

study of the human mind and alcoholism should be made clear. When the large

number of inebriates seeking help is contrasted with the relatively small

amount of space that the psychoanalysts have devoted in their works to this

phase of abnormal psychology, the thought occurs that possibly

psychoanalytic procedure in this direction has not been as productive as it

has been with hysteria, anxiety, and obsessional neuroses. In Dr. William

Healy's recent publication, The Structure and Meaning of Psychoanalysis,

which Dr. Wittels of Vienna has referred to as a "'Bible of Psychoanalysis,"

less than two pages out of 480 are devoted to alcoholism.

Nevertheless, since psychoanalysis has done more than anything else to

illuminate for me the abnormal processes of the human mind, this form of

treatment at the hands of an expert is most sincerely recommended when

stringent methods seem necessary. I do not question the fact that the

fundamental motivating cause of alcoholism may often be a conflict buried in

the unconscious, but experience has shown others besides myself that methods

more or less similar to those set forth in this book are in general adequate

for cure without more intricate psychoanalytical investigation.

Of course I do not mean in the least to imply that exploration is neglected.

The patient, as I have described, is encouraged to talk at length on every

conceivable topic that interests him from his earliest childhood to the

present time, and past as well as present problems are given special

attention from the point of view of "confession" or catharsis. This, to many

psychiatrists who are by no means inimical to psychoanalysis, constitutes

sufficient analysis. Let me here refer to The Human Mind.

"One very useful method," (of treating nervous disorders) says Dr.

Menninger, "is a combination of expression (analysis) and suppression

(persuasion). Sometimes it is called reeducation. It amounts to this. The

physician learns as much as he can about his patient, in all the ways he

can, but chiefly by as much mental catharsis and as much environmental

investigation as possible. These he puts together, consults his knowledge of

the principles of mental functioning and mental disease, and his experience

with other cases; and on this basis he gives advice, adjuration,

enlightenment, encouragement."

III

FIRST STEPS

1. SURRENDER

THE first essential requirement for successful treatment is the sincere

desire to be helped on the part of the alcoholic himself. Nothing

constructive has ever been accomplished or ever will be with men who are

dragged or pushed toward curative measures by friends or relatives. In fact,

sometimes actual harm is done by such a procedure. A man will often reject

premature persuasion, and, once having rejected it, may maintain his

attitude for all time. He should be informed that professional assistance is

available and then left

undisturbed to seek it on his own initiative.

I can well understand from the point of view of the family that "premature"

may hardly seem a suitable word to apply to a person who has been drinking

to excess for many months and possibly years--, but in spite of this fact, I

repeat, he should be given the idea as a suggestion and then left alone to

think it over. Nothing may ever come of it, to be sure, but on the other

hand he may be much more concerned with the matter than appears on the

surface. No action may result until some particularly depressing series of

events has brought vividly home to him the futility of trying to continue

drinking and the apparent impossibility of giving it up unaided. If he

should have a friend who has been successfully treated and in whom he has

confidence some pressure may be applied by this friend, but even here tact

and suggestion should be relied on more than persuasion or exhortation.

Alcoholics are apt to be extremely stubborn people; in fact, it might be

said with much truth that the therapeutic problem consists in redirecting

this stubbornness from destructive to constructive ends.

One man, who now no longer drinks anything, when first informed by an

ex-alcoholic that there was a systematic method for treating inebriety, did

nothing about it for a year, although it had long been obvious to even his

most dissipated friends that he simply could not withstand alcohol. Matters

naturally went from bad to worse, but this seemed to be necessary in order

to convince him that his habit had definitely gotten the upper hand. When at

last he awoke to his condition, he allowed his friend to bring him in for an

interview. Before very long he was a successful case himself, though both he

and the friend who introduced him had looked upon the situation as hopeless

before the treatment. However, he did want to stop, or, to use his own

phraseology, he "wanted to want to stop," which is all that can be desired

in the uninitiated.

The surrender to the fact that alcohol can no longer be indulged in without

bringing disastrous results is of such importance that it requires extremely

thoughtful consideration. This surrender is an absolute starting point as

far as the conscious mind is concerned. Experience has shown, however, that

an intellectual surrender by no means settles the question, because there

are unconscious motivations working in opposition which the patient must be

made aware of and upon which he must devote considerable reflection in order

that a distorted pride may be expelled from the deepest recesses of the

mind. The alcoholic, in company with all other drinkers, started his habit

with the idea of being smart or manly as one of the main impulses. Although

this idea is supposed to pass away with the coming of maturity, in reality

it does not do so. It still lingers in the unconscious as a sort of credo

and accounts for much of the driving force which operates against a graceful

surrender to the inevitable.

In some cases it is fully conscious, and the individual frankly admits that

he hates to say "no forever," for reasons which are hard for him to explain

because they seem to be apart from an actual desire to drink. When he is

confronted with the 'manly" or "freshman" complex, as I often call it, a

certain illumination is shed on the question, though often it takes a little

analysis and "planation for the idea to become a conviction. If he will face

this problem and bring to bear on it the counter idea (which is, of course,

only too obvious) that it is the manly thing to give up drinking because

weaklings cannot do it, he will accomplish a great deal in the correcting of

a very deep-seated obstruction to the cure. It is driving home platitudes as

if they were profundities over and over again that actually unifies the

emotional system with the intellect so that the latter has complete and

permanent domination.

Another reason for not wanting to surrender is that the patient visualizes

such a step in the light of an irrevocable pledge which he might some day

want to retract. The sooner he takes this "'pledge" by himself, the better

off he will be, but he is not asked to do so, and a little reflection should

show him that as long as he remains in a civilized community there is

nothing to prevent a retraction if he really wants to make it.

A third way of expressing this will-not-to-surrender is in terms of bogus

freedom. The alcoholic wishes to feel "free" to do as he likes; he does not

want to bow to the will of his family, his friends, the prohibitionists, or

his own better self. This demand for free self-expression may be logical for

the man who has drink under control. He may be justified in resenting the

interference of those who wish by legislation to interfere with customs

which are as old as civilization. But the drunkard should realize that he is

in search of a larger freedom which rises far above the influence of

man-made law. He has become a slave to something which can in the long run

only be used by those who remain masters of it. In reality he has not known

what freedom was since he first tried to limit his drinking and found

himself unable to do so. The only freedom he can enjoy is that derived from

an abstinence which gives him assurance and self-respect in his own eyes.

When he knows each day what he has done, what he wants to do, and when he

feels within himself the power to do it, then and then only can he

understand the true meaning of the word "freedom," as well as the absolute

bondage that he was in when he tried to express himself "freely" by drinking

all the alcohol that he could lay his hands on.

These various theories for not surrendering are often supported by actions

clearly showing unconscious motivation: such, for instance, as persistent

attendance at very wet parties (though the patient was "absolutely sure of

himself" before he went to them), quarrels with relatives and friends

inducing self-pity, the distortion of theories designed for the elimination

of drinking so that they come to permit of light drinking once in a while.

This unconscious resistance against surrendering - that is, being cured is

nowhere better demonstrated than by avoiding work and being late for or

breaking appointments, apparently always with the best of reasons. There is

a telling paragraph in Dr. Sigmund Freud's Introduction to Psychoanalysis:

"If you were to come in contact with neurotics as a physician, you will soon

cease to expect that those who complain most woefully of their illness are

the ones who will oppose its therapy with the least resistance or who will

welcome any help. On the contrary, you will readily understand that

everything contributing to the advantage derived from the disease will

strengthen the resistance to the suppression and heighten the difficulty of

the therapy. We must also add another and later advantage to the gain of

illness which is born with the symptom. If a psychic organization, such as

this illness, has persisted for a long time, it finally behaves as an

independent unit, it expresses something like self-preservation, attains a

kind of modus vivendi between itself and other parts of psychic life, even

those that are fundamentally hostile to it."'

Of course a man cannot be expected to agree to do something until he knows

of what it consists. Therefore one who has not been entirely convinced that

he needs or wants help might be interested in a preliminary interview so

that he can have first-hand information that may be of use to him some day,

or that might entertain him as pure theory.

The attitude taken with such an individual is simply to answer his questions

as fully as possible, discussing drink from any angle that he may wish. The

accounts of changes in the lives of others more or less similarly situated

may catch his attention and it may be possible thus inadvertently to

"convert" him as to the advisability of seeking a cure. He is definitely