Alcoholics Anonymous: Cult or Cure?
Harper's Magazine, February 1963
by Arthur H. Cain
A useful idea has turned into a religious movement—and a hindrance to
research, psychiatry, and to many alcoholics who need a different kind of
help.
In the beginning "They" created Alcoholics Anonymous. ("They" have not
yet been credited with the creation of the heavens and earth, but, if
present trends continue, they will be.) "They are "W.W." and "Dr.
Bob"--cofounders of a movement which is becoming one of America’s most
fanatical religious cults: "AA"
To be sure, the late Dr. Bob and the very current W.W. did not want to be
deified. They joined forces in 1935 simply to help each other stop
drinking. Today the fellowship they started claims a membership of over
300,000 "arrested" alcoholics in 85 countries. The A.A. idea was based on
psychological and spiritual concepts very similar to those of Frank
Buchman’s then-famous Oxford Group. Conceived in Akron, Ohio, the first
AA. Group was formed in New York City. In A.A.'s first five years no more
than a few hundred people joined.
Then, in 1941, an article about A.A. by Jack Alexander appeared in the
Saturday Evening Post and gave the movement an overnight boost.
Membership leaped to over eight thousand by the end of the year.
A.A.'s basic tenet is that only an alcoholic can help another alcoholic;
that psychiatric and other treatment is usually unsuccessful; but that
alcoholics can, by banding together in a spirit of mutual help and
understanding (and "by turning their lives over to God as they understand
Him"), manage to lead relatively normal lives. Above all, they must face
the fact that they must never again taken even one drink of alcohol.
As long as it restricted itself to informal organization and group
"therapy," A.A. enjoyed--and deserved--universal respect. But a
disquieting change has developed over the past fifteen years. A.A. is now
highly formalized. The meetings, believed to be absolutely necessary, are
ritualistic. And any suggestion to members that The Program is less than
divine revelation evokes an irrational outcry.
I have no personal axe to grind. As a practicing psychologist who
specializes in alcohol problems, I have been active since 1947 in both
therapy and research. I have worked closely with Alcoholics Anonymous. I
have also worked for the National Council on Alcoholism and for the
Christopher D. Smithers Foundation, a charitable organization whose major
interests are alcoholism and cancer.
I am disturbed by the fact that, for many members, A.A. is not as
effective as it once was.
Moreover, I feel that much-needed scientific research is being diverted
to other fields because of A.A.'s omniscient attitude. And I am not alone
in my concern. Frequently in my practice, disillusioned men and women
appeal to me: "Doctor, I’ve tried AA. over and over and I still can’t
stay sober. There must be something else dreadfully wrong with me! What
is it?"
My friends in psychiatry, psychology, and pastoral counseling often ask
me in discreet tones, "What’s happening to AA?" Then, embarrassed at
sounding critical, they add hastily, "It is a wonderful organization."
Dr. E. M. Jellinek, dean of researchers in alcohol studies, pleaded at a
workshop on alcoholism -held at Columbia University in June 1959 that
A.A. leave science alone--so that scientists might get along with the
business of objective research into the problem.
While serving as public-relations counsel to the National Council on
Alcoholism in 1959, I attended A.A. meetings in a dozen major cities.
This personal survey of AA. groups convinced me that there is a widening
breach not only between A.A. and scientists, but also between practicing
A.A.s and other alcoholics.
`What has happened to the excellent program that once helped alcoholics
stop drinking when medicine and psychology failed? Why has A.A. become a
cult that many men and women reverentially call "the greatest movement
since the birth of Christianity"?
" UTILIZE--DON’T ANALYZE"
I attended my first A.A. meeting in 1947 and was enormously impressed by
the sincerity of the members. They were not professional do-gooders. The
speakers seemed genuinely "humble," not piously proud of their humility.
The "A.A. Personality"--identifiable by a studied air of serenity and
steadfast smile (which I have come to think of, uncharitably, as the
"A.A. Smirk")--had not yet come into existence. It is a product of "AA.:
the Cult" as opposed to "A.A.: the Fellowship."
But one remark disturbed me even then. One man arose--a forerunner of the
seer-and-pundit type now prevalent in A.A.--and declared, "There’s an
aggregate of two thousand years of drinking experience in this meeting
room. If we don’t understand alcoholism then nobody does." My own
reaction was that nobody understood alcoholism (no one does now, either)
and it was ludicrous for a group which admittedly had lost control of its
drinking to claim superior knowledge of the subject.
As I began to attend meetings regularly, other aphorisms troubled me. One
favorite cliche appeared to be of special importance and still is:
"Utilize--don’t analyze."
For some members this was fine. They were weary of trying to figure out
how to drink normally; or how to endure sobriety now that it was
achieved; or why they had become alcoholic in the first place. They were
ready to accept blindly anything that would end the agonies of compulsive
drinking.
But for others, such faith was impossible.
Some people simply must analyze--it is their most characteristic
personality trait. Perhaps, during the early, frightening days of their
newly found sobriety they take comfort in letting others think for them.
But as their heads clear and their nerves stop quivering, the need to
comprehend ideas intellectually is reasserted and they find themselves
examining their own behavior with healthy curiosity. As one relapsed
member mournfully described his "slip": "I had been dry for over a year
and, like the window washer, stepped back to appraise my handiwork. I
woke up two weeks later on the Flight Deck [the violent ward at Kings
County Hospital] wondering what had happened."
Relapses occur frequently among such alcoholics trying to stay sober in
A.A. Many A.A. members are unsympathetic to these less fortunate
brothers, whom they regard as "hopeless psychotics" or "nuts who aren’t
‘real’ alcoholics at all." Thus, we see in A.A. two disturbing
tendencies: (1) to define an alcoholic as a person who stays sober in
AA.; and (2) to relegate all other problem drinkers to the limbo of
psychosis.
AAs are fond of quoting such "statistics" as: "Fifty per cent of all
alcoholics coming into AA get sober and remain sober; 25 per cent have
one or two slips, then ‘get the program’ and maintain sobriety; the other
25 per cent are either psychotic or not alcoholic at all."
A question arises: how do A.A. members garner these figures.? Because
A.A. considers itself a deliberately permissive fellowship made up of
autonomous groups which do not keep exact records, no real statistics
exist. Nevertheless, individual members advance these generalizations as
incontrovertible truths.
This kind of misinterpretation has narrowed A.A.'s once flexible
philosophy into exclusive dogma. One undesirable effect is that those
alcoholics who are not able to make A.A. work for them lose all hope;
they fear that nothing is left for them except insanity (Korsakoffs
Syndrome or the dreaded "wet brain") or death. This is not so. Many
alcoholics achieve a sobriety made happy and creative through medical,
psychiatric, psychological, and pastoral techniques. The sometimes-tragic
misunderstanding--that only AA can help--is fostered by A.A.'s growing
rigidity.
If A.A.'s intolerance were confined to its own community, we could "live
and let live," as it exhorts its members to do. But A.A.s are
indefatigable crusaders who greatly influence the national crusade
against alcoholism—a malady which today afflicts five million Americans
and costs taxpayers and industry over a billion dollars annually,
according the National Council on Alcoholism. The Department of Health,
Education, and Welfare has called alcoholism the nation’s fourth most
serious public-health problem, ranking in importance with heart disease,
cancer, and mental illness.
AAs hold key positions in city, state, and private agencies dealing with
alcoholism. Many executive directors of local committees and information
centers are members of AA. This means that public education on alcoholism
is almost entirely in the hands of AAs. Furthermore, nearly all
information about research, treatment, and community action is
disseminated by public-relations directors who adhere to the A.A. party
line. Thus, almost everything we read on alcoholism in newspapers and
magazines is A.A. propaganda.
Zealous members spread this propag- anda, not for personal gain, but to
"flush out" alcoholics and help them share their own dubious serenity. I
have had the unnerving experience of hearing a spontaneous remark made by
an AA speaker in New York on a Monday repeated as gospel in Chicago on
the following Friday. Much worse, I have heard a federal department chief
publicly parrot a "statistic" I knew had been invented by an A.A. the
week before. It is perhaps no coincidence that the A.A. publication is
known as "The Grapevine."
Alcoholics Anonymous is hostile to criticism from any source. "All we ask
is to be left alone," they cry. But they do not leave the American public
alone. They influence public-health officials; they write extensively;
they take positions on medical subjects such as diet and drugs
(tranquilizers, sedatives, and stimulants all fall under the rubric of
"goof-balls" to AA), and hold themselves up as final arbiters on any
matter pertaining to alcoholism.
One result of this authoritarianism is that well-meaning laymen organize
committees and -sponsor "research’‘--which leads qualified professionals
to assume that the job of fighting alcoholism is getting done. But it
isn’t—largely because of a basic fallacy in A.A. thinking: that it takes
an alcoholic to understand an alcoholic. The trouble lies in defining the
word "understanding." Scientists agree that alcoholics are more
empathetic to other alcoholics than anyone else; but when they venture
the opinion that trained specialists might be better equipped to conduct
formal treatment and research than untrained alcoholics, they run into a
storm of protest. AAs seem almost afraid that science will come up with a
"cure" (an absolutely taboo word in the A.A. lexicon) and render A.A.
unnecessary.
"What will we do if someone discovers a pill that cures alcoholism? It’s
our dedication that’s keeping us sober and serene!" the executive
-director of an influential agency on alcoholism recently said to me.
Needless to say, this person and most of this agency’s staff are
practicing members of AA. All are dedicated to combating alcoholism. But
just as sobriety is a vocation for many A.A.s, for many agency people it
is a career.
SOBRIETY . . . NOT SLAVERY
Another dangerous aspect of A.A. as a religious cult is the concept of
sobriety as the ultimate goal of life. The very word "sobriety" has taken
on a religious flavor and is uttered with hushed awe, rather than spoken
of as a condition necessary to health and happiness. Practically all
members who have passed the pigeon, or novice, stage speak of the quality
of so-and-so’s sobriety, as if evaluating degrees of spirituality.
Sobriety has, indeed, become the A.A.'s end which justifies any means. I
know men whose wives work and support them so that they may devote their
full time to "A.A. Work." I have talked with these women at Al-Anon
meetings (groups formed especially for the spouses of alcoholics). Most
are not complaining about their lot as A.A. wives; they insist that
anything is better than living with a practicing alcoholic. But other
women confess that eating, sleeping, and talking A.A. twenty-four hours a
day is almost worse than having an alcoholic husband. The masculine point
of view was summed up by a legendary souse at a bar who indignantly
denied that he was an alcoholic. "I’m no blankety-blank alcoholic," he
shouted, "I’m a drunk!" When asked about the difference he retorted,
"Alcoholics have to go to those blankety-blank meetings all the time!"
I have heard husbands of alcoholics complain that A.A. has become a
network of women’s auxiliaries devoted to gossip and the "chanting of
A.A. litanies such as, There but for the Grace of God.. . '; ‘Easy does
it’; and ‘Living one day at a time."’
A.A. dogmatism has prevented many people from seeking a more moderate
solution: sobriety in Alcoholics Anonymous without slavery to it.
And there are still other possibilities such as psychotherapy or pastoral
counseling. But AAs would probably retort, justifiably, that they’ll
stick to what they’ve got until something better comes along. Many
alcoholics who come to A.A. have had unhappy experiences with
psychologists or psychiatrists. Some therapists follow their own party
lines, usually Freudian, too strictly and write off alcoholism as "just a
symptom of some underlying emotional disorder"--implying that once the
disorder is uncovered the problem of alcoholism will automatically be
solved. Too many alcoholics are worsened by this oversimplified approach.
Many others instinctively know better, especially when psychoanalysts
begin probing their Oedipal Situations. However, most psychotherapists
now understand that alcoholism is a complex, distinct illness and must be
treated accordingly.
" ARRESTED" OR "RECOVERED"
But AAs veer to the other extreme. They assert vehemently that there’s
nothing wrong with alcoholics except alcohol, and all the alcoholic has
to do is to stay away from that first drink. (There is a standard gag in
A.A. about the alcoholic who always orders two drinks and only drinks the
second one.) The facts are: (1) the alcoholic obviously wouldn’t be an
alcoholic if it weren’t for alcohol (what would he be?) and he certainly
must abstain from it if he is to get well; but (2) he undoubtedly is
suffering from some sort of psychological disorder: emotional, mental, or
social. Unfortunately, "psychology" is a synonym for "psychosis" to most
A.A.s. When a recent Ph.D. dissertation on alcoholism was published in
popular book form (Sever Sinners, by Arthur King, Harcourt, Brace and
World, 1961), A.A.s immediately took the author to task for suggesting
that alcoholics could be placed in categories of psychopathology like any
other victims of a behavior disorder: the manic-depressive or
compulsive-obsessive cases, for example, complicated by uncontrolled
drinking. What was the big idea of saying alcoholics were a bunch of
nuts, A.A.s demanded. Yet, they insist that "alcoholism is a disease."
The President of the National Council of Alcoholism, an exceptional
executive with a scientific mind, goes further, calling alcoholism a
respectable disease. It can happen to anyone, he implies, and should not
have social or moral stigma attached to it. I couldn’t agree more
heartily.
But AAs prefer to regard alcoholism as a purely physical disease:
organic, glandular, metabolic, dietary--anything but mental. The only
time this dread word is used is in an AA. definition of alcoholism: "A
physical allergy, coupled with a mental compulsion."
According to the American Medical Association (Journal of the American
Medical Association, May 25, 1957), "alcoholism can be classified into
(1) primary alcoholism, which includes (a) those patients who from the
very first drink of an alcoholic beverage are unable to control their
desire for it and (b) those who through use over a great many years have
developed an inability to take a drink or leave it alone and have become
like group (a); and (2) secondary alcoholism, which includes those who
use alcohol for its sedative action as a means of escape from reality
and, in particular, from their personal problems. . . . This secondary
group comprises by far the majority of patients suffering from
alcoholism; however, most alcoholic patients prefer to be in the primary
group." (Emphasis mine.)
By refusing to take into account problems of mental confusion, emotional
immaturity, and social maladjustment, A.A.s are seriously hindering not
only their own recovery, but scientific research as well.
If AAs are to be rescued from fanaticism, they must thoroughly understand
two crucial words--"arrested" and "recovered." These are terms used to
describe alcoholics who do not drink any more. Most members of A.A. fall
into the former category; that is, they have arrested the development of
their disease and have learned to live with it. To these men and women,
alcoholism is something real in itself, like an incurable cancer. "Once
an alcoholic, always an alcoholic" is one of A.A.'s most holy doctrines.
They mean that once a person has lost control of his drinking he will
never again be able to drink normally, even to the extent of one glass of
beer. He must work regularly at the business of not taking that first
drink.
This means he must practice A.A. in all his affairs; attend meetings
without fail; do "Twelfth Step Work" (the analogy between A.A.'s "Twelve
Steps" and the Ten Commandments is unmistakable); and proselyte other
alcoholics into Alcoholics Anonymous. If he doesn’t live AA., he’s sunk.
He gets drunk again sooner or later and--alcoholism being in the dogma of
AA. A progressive disease--he’ll be worse off than ever.
It is true, of course, that the drinking alcoholic becomes worse and
worse in his drinking behavior. But what A.A. does is to superimpose this
concept on the behavior of the non-drinking alcoholic. According to A.A.,
the disease itself progresses. This is erroneous thinking. An alcoholic
who relapses after a period of abstinence may very well get sicker than
ever, but because he has aged, not because his alcoholism has
"progressed."
The term "recovered" means something different: it implies that the
patient’s alcoholism is no longer a problem. He may not be able to drink
normally again, although some investigators such as D. L. Davies, Dean of
the Institute of Psychiatry at the Maudsley Hospital, London, believe
there are many such cases. This hospital’s work has been conscientiously
reported by the Quarterly Journal of Studies on Alcohol (at the Rutgers
Center of Alcohol Studies; "Normal Drinking in Recovered Alcohol
Addicts"’ March 1962). Here is an excellent example of -the true
scientific method, for the Quarterly Journal reports both fact and
theory. It is not surprising that Dr. Davies’ article has been either
ignored by A.A., or brushed off with typical illogic: "Well, if these
people drink normally, then they couldn’t have been alcoholics in the
first place." No AAs I queried had actually read the piece, though all
were firm in their denunciation of it. I have heard A.A.s say that the
report was immoral on the grounds that they might be tempted to drink
again after hearing of it. Scientific truth was of no consequence.
The expression "recovered alcoholic" means that the patient no longer has
to treat himself or take treatment from others at least twice a week for
the rest of his life. He accepts life without alcohol; he makes certain
adjustments within himself and in his attitude toward society; and he
gets back into the mainstream of life. He might devote part of his time
to helping alcoholics or others—probably he does--but because he can and
wants to, not as a device to keep himself sober.
TRY A.A. FIRST, BUT…
There are many such recovered alcoholics, both in and out of Alcoholics
Anonymous. These men and women have learned one thing: neither A.A. nor
psychotherapy, nor any other treatment is more than a bridge between
alcoholism and real recovery. Good bridges, perhaps. I still believe that
A.A. provides the best possible way, at present, for most alcoholics to
get sober and start a new life without alcohol. Others need some form of
psychotherapy and/or pastoral counseling--perhaps in conjunction with
A.A. These disciplines are especially helpful to people who cannot,
without professional guidance, sincerely practice certain of A.A.'s
Twelve Steps, such as Step Four--"Make a Searching and Fearless Inventory
of Ourselves"; or Step Ten--"Continue to Take Personal Inventory and When
We Are Wrong Promptly Admit It"; or those Steps that refer to "a Power
greater than ourselves."
Alcoholics Anonymous is not a sustain- ing Way of Life. Sobriety can
never be a satisfactory ultimate goal; it is, after all, merely the
absence of intoxication. It is what one does with one’s sobriety that is
important. AA. is a man-made means for attaining this sobriety.
Alcoholics Anonymous should not be a cult for the retardation of the
"arrested" alcoholic. I do not suggest for a moment that a single A.A.
quit the fellowship. On the contrary, I strongly urge sticking with it.
To anyone who is having trouble with alcohol I say: try A.A. first; it’s
the answer for most people.
But to those who insist upon serving A.A. as if it were a holy and
apostolic church, I say, Beware. Observe those members who seem genuinely
serene. Talk with those who have been in A.A. a long time and who really
practice "live and let live." Though A.A. is an important part of their
lives, it is an adjunct, not the whole. They have crossed the bridge from
arrested alcoholism to true recovery.
And if even then they cannot stay sober and happy, they should not
despair. There are other ways, other bridges--physicians and
psychiatrists, psychologists and pastoral counselors, who are capable and
anxious to help them. Some specialize in helping alcoholics who have
conscientiously tried A.A. and failed. Most agree that there’s no such
person as a hopeless alcoholic.
A.A. as a group must recognize its real function: to serve as a bridge
from the hospital or the jail to the church--or to a sustaining personal
belief that life is worthwhile. It must not pose as a spiritual movement
that provides everything the alcoholic needs to fulfill his destiny. It
must not teach its young (as it does in Alateen, its Sunday School for
the children of alcoholics) such catechisms as: "We will always be
grateful to Alateen for giving us a way of life and a wonderful healthy
program to live by and enjoy." It must realize that "the actual coffee
pot Anne used to make the first A.A. coffee (shown in "Alcoholics
Anonymous Come of Age," Harper 1957, a commentary on the A.A. bible,
Alcoholics Anonymous, Works Publishing Company, 1946) is not the Holy
Grail. The cake and coffee served after meetings are just refreshments,
not the body and blood of Jesus Christ.
Only then will Alcoholics Anonymous "come of age." Then, perhaps, more of
its members will become "recovered" instead of "arrested" alcoholics.
Science may then be stimulated to further research. And those alcoholics
who are unable to make A.A. work for them may look elsewhere and find
their serenity, too.
Arthur H. Cain, who has a Ph.D. from Columbia and is a graduate of Yale
(now Rutgers) School of Alcohol Studies, is the author of Young People
and Drinking, to be published by John Day. A licensed psychologist
practicing in New York City, Dr. Cain recently made a research tour of
the world studying drinking customs and sexual habits.
Source: Harper’s Magazine, February 1963
Contact:
The Legacy Group of Alcoholics Anonymous © 2005