Treating the Causes Of Alcoholism – Grapevine Article by Dr. Harry Tiebout November 1963

I liked the article “An AA Doctor’s Prescription,” which appeared in the July issue of the Grapevine. It nicely stressed the importance of stopping the symptom of drinking. The picture showing the roots and fruits of alcoholism is graphic and intelligible. The concept “The treatment of a symptom” is, I am sure, a sound one.

The emphasis on the removal of the symptom can, however, be misleading. It suggests a failure to reach the fundamentals and implies that the symptomatic cure leaves the individual skating on thin ice with the underlying causes of the trouble still lurking in the background ready at any moment to trip up the individual. The charge of superficiality may well be levied against a treatment which thinks only in terms of symptoms.

The truth, however, is that routinely to assume superficiality is also an error. Sometimes, the treatment of a symptom hits into the deeper structures while it takes care of the symptom itself.

The history of medicine is dotted with examples in which the remedy of a symptom provided the cure of the condition. A classic illustration is malaria. The malarial patient had a symptom, a fever. Quinine cured this fever and was in use over the centuries, long before the cause had been determined. The therapy was completely symptomatic yet, as is now known, actually has a scientific basis, namely, that the cause of the illness, the malarial parasite, was killed by the drug.

In other words, treatment, discovered by chance in nature, in a funny sense, reversed the usual sequence. Science says first find the cause and remedy that, thus curing the illness. Instead, the use of quinine treated the symptom of fever with no reference to the cause, which only later was revealed. The charge of superficiality was disproved by the facts uncovered subsequently.

AA is also a therapy discovered by chance. To be sure the original members followed brilliantly the clues with which their own experience had presented them. They learned from experiencing, they followed no book. They found a method, a program; they prescribed it and it worked. The idea of seeking causes was discarded, sometimes noisily and with jeers at those who still tried to be scientific.

Yet AA, like quinine, was designed not only to cure the symptom of drinking but also to tackle and, if possible, eradicate its causes. The AA program helped the individual remain sober, thus removing the symptoms. It also aimed at altering the inner source of discord by its stress on spiritual development, thereby getting at the causes which provoked the symptoms.

The fact is that, as spiritual growth proceeds, the underlying hostile elements are steadily reduced in strength, and thus, in their capacity to cause trouble. Psychiatric therapy, depending upon analytic concepts, had tried to reach and uproot the hidden hostilities which poisoned the psyche, the assumption being that such unearthing would free the individual from their grip and enable him to pursue a more healthy path. Unfortunately, the uncovering method had no way of insuring removal. The individual became acquainted with his hostilities and had no means of getting rid of them.

AA adopted a very different approach. AA found a very basic fact, namely, that spiritual growth is the real antidote for the hostile, negative forces. It learned that these feelings do not have to be uncovered, but that somehow the spiritual elements can neutralize the negative forces, thus freeing the individual from their grip. In that way, the cause of the condition is effectively extirpated. Like quinine, which actually killed the organism, AA through its spiritual emphasis actually may succeed in ridding the individual of harmful attitudes and feelings which had contributed to his difficulties. AA, so to speak, cures without uncovering.

The point of my comment has now been made. AA is not to be considered merely a symptomatic remedy. Through its stress on the spiritual it really digs much deeper. Like quinine, it tackles the original causes. Unfortunately, here the parallel ends. The malarial parasite is specific and can be destroyed. The evils with which the spiritual element must contend are not so readily wiped out. The most one can hope for is progress in the amelioration of the hostilities and growth in the positive forces which insure health.

As a result of this thinking about AA and how its program works, I would like to suggest a companion picture. The tree would have a trunk with roots and branches. The trunk would be labeled the spiritual life and/or sobriety. The roots would have titles like love, warmth, charity, gratitude, friendship, forgiveness, kindliness. The limbs would be covered with leaves or blossoms, and would indicate somehow the overflowing horn of plenty, the abundant life. This, as I see it, is the miracle not only of AA but of all life–the capacity to move from a negative to a positive way of life.

One final point, this time about how the psychiatrist fits into this picture. In my eyes, his is a dual task. He can help to remove blocks, i.e., the hostilities to spiritual growth. Unless he is mindful of both aspects, he is likely to be of little help. He can no more afford to overlook the spiritual than can any member of AA.

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