The Following is from The New Yorker,
March 20, 1995.
In the thirties, Bob Smith and bill Wilson’s A.A. was the last stop
before the abyss.At some meetings today, they would ‘would be
appalled.”
———————————————————————-
ANNALS OF ADDICTION
A. A. AT THE CROSSROADS
Now that America believes less in
help-your-fellow than in blame-the-person-who-made, you, a, victim,
can
Alcoholics Anonymous still get its message across?
BY ANDREW DELBANCO AND THOMAS DELBANCO
ALCOHOLICS ANONYMOUS turns sixty this year, and while its size and
reach show no sign of waning (there are more than a million members in
the United States and Canada, and eight hundred thousand more scattered
through a hundred and forty other countries), there is a feeling among
A.A. veterans that the fellowship is at a crossroads. At A.A.’s General
Service Office, in the Interchurch Center in New York City, an austere
office building at 120th Street and Riverside Drive that is known in the
neighborhood as the God Box, one staff member reflected recently that the
Age of the Founders was long gone, Bill Wilson, the New York stockbroker
who led the movement for more than thirty years, died in 1971, and Bob
Smith, the Ohio surgeon who founded it with him, had died twenty years
earlier, and the Age of the Apostles was now ending. “There’s practically
no one alive today who was there when Bill and Bob met, or in that very
first group,” she said. “Pretty soon, there will be no early-timers at
all.”
Standing like a crewcut cadet among fops, the Interchurch Center is
set between the ornate spire of Riverside Church, to the north, and a row
of neo-baroque apartment houses, to the south. A reasonable facsimile of
a midtown corporate fortress, it has revolving doors that spin you onto a
mopped marble floor, and a badged guard who eyes you from behind a
security counter. In A.A.’s eleventh floor office, described by one staff
member as “the visible clearing house of an in visible organization”,
close to a hundred people are at work, filling orders of A.A.’s
publications, referring callers to local groups, disseminating
information to the public and to the medical an counseling professions.
“We are a repository of group experience,” he said. “People write us
about a problem they are having in their group, an unruly member, a
question about confidentiality. We share experience by telling them what
been done in similar situations in the past. We don’t issue directives.
We don’t hand down rules.”
Besides being the nerve center for the more than fifty thousand
registered A.A. groups in the United States, the General Service Office
is a shrine. Its corridors are hung with poster-size photographs of the
founders, and placards bearing their sayings; along one long wall of an
anteroom that leads into the organization’s archive is a locked glass
case containing various editions of the Big Book, the basic A.A. text,
which has sold thirteen million copies since it was first published, in
1939. “I consider the Big Book an inspired text, written by Bill under
the guidance of the spirit,” another staff member said. “And I worry that
I see a shrinking in the reading and studying of the Big Book. People
paraphrase it incorrectly. Some do spot reading, or they don’t read it at
all.”
Some members say that if the Big Book is losing its hold on new
members, it may be because its image of the alcoholic is hopelessly
cornball and exclusively male: he is a traveling salesman tempted by the
hotel bar; he is compared in his desperation to a “gaunt prospector, belt
drawn in over the last ounce of food”; or, in his drunken oblivion, to
“the farmer who [comes] up out of his cyclone cellar to find his home
ruined,” looks around, and remarks to his wife, “Don’t see anything the
matter here, Ma. Ain’t it grand the wind stopped blown’?” There is even a
condescending chapter addressed “To Wives.” Today, A.A. is more than a
third women, and twenty per cent of the membership is under thirty,
people for whom prospectors and storm shelters are defunct metaphors.
Others think the integrity of the fellowship is being threatened by
“people who come in because the courts or rehab centers send them,” in
the words of Dr. Marc Galanter, a New York psychiatrist who has written
extensively about A.A. “Many of these people have to get a meeting card
checked off to show that they’re fulfilling the obligations of, say,
their suspended sentence, and though A.A. welcomes them, this is
something that’s basically against what makes the fellowship work. Coming
in is supposed to be voluntary, an act of spiritual surrender, not
acquiescence to some legal requirement.
And others think that A.A. is becoming a social club where people of
leisure show up casually, in order to make deals or dates. “It used to be
that when someone talked about suffering, you could hear a pin drop,” a
retired advertising writer who has been in AA. for sixteen years said.
“But now people come to the meetings with a bottle of designer water in
hand, and there’s more and more talk about success. It kills the meeting.
People get up to pee, or to look for an ashtray.” One member, a carpenter
of about forty who lives near a posh New York suburb, put it this
way:
“We have actually become afraid of the still suffering alcoholic. If a
drunk walked into a meeting in my town, people would be aghast. We’ve
become too nice for that.” He still attends his home meeting, he said,
but he goes once a month to a meeting in a men’s shelter in a neighboring
town, to get “the real thing.”
It is not only this squeamishness before the hard-core alcoholic that
bothers A.A. veterans, but what they see as a growing expectation among
some members that meetings will amount to a form of public coddling.
Sometimes this expectation is met (“unconditional love” is how one member
described what she encountered at her first meeting); but sometimes it is
disappointed. When a young woman at a meeting we attended said in a
private schoolish whine that she, as a recovering alcoholic, deserved
“more space” than she was getting from her non-drinking friends, a young
man in dreadlocks looked at her with a mischievous grin and said, ‘When I
was drinking, I had the same problem you have now. I had not yet achieved
low self-esteem.”
The rebuke was a pure expression of “the real thing”, of the Big
Book’s principle that “self-delusion, self-seeking, and self-pity” are
“the root of our troubles,” that we “must be rid of this selfishness. We
must, or it kills us!” But some veterans are troubled that this basic
A.A. insight is invoked less often than it used to be. They worry that
alcoholism, which was once a source of convicting shame in America, is
being turned into an alibi. They mention the recent case of a West-ch
ester man who confessed at an A.A. meeting to a murder committed while he
was on a binge, and then mounted a legal defense based on the claim that
alcohol had led him to confuse his victims with the parents who had
emotionally abused him as a child. And they laugh, though not with real
amusement, about the case of Leonard Tose, the former owner of the
Philadelphia Eagles, who responded to a suit to collect gambling debts
brought by an Atlantic City casino a few years ago by countersuing and
claiming that the casino had allowed him to gamble away his fortune while
he was manifestly drunk. “A.A. is not about excuses,” one longtime member
said. “It’s about obligations. Bill and Bob would b& appalled.”
A.A. came into existence at a time when Americans were introduced to
fear and futility on a scale that had not been previously imagined and
has not been matched since, a time when it was a common experience for a
man to feel prosperous one day and to be reduced to nothing the next.
When A.A. first took form, in the nineteen-thirties, it was not a place
where one came to ventilate anxiety about the enervation of a stressful
life. It was the last stop before the abyss.
For many drinking Americans, Prohibition had been less an obstacle
than a nuisance. (H. L. Mencken reported that he failed only twice during
Prohibition to find a drink, once when he was traveling in Pennsylvania
and did not realize that “seafood” was the local euphemism for beer.)
During “the dry years,” Bill Wilson had made his living as a kind of
mobile industrial-espionage agent, scouting out companies for his
brokerage house by befriending research- and-development men in their
local watering holes, and then stiffening his will with another drink
before attempting to persuade investors of the truth of tips he only half
believed himself By the time of Repeal, in 1933, he bad drunk himself out
of his job.
He and his wife, Lois, who at that time worked as a salesclerk in
Macy’s, joined the ranks of Depression vagabonds, living with her
parents, with friends, or on their own in shabby apartments. Paul Lang,
the archivist in charge of the Wilson family papers at Stepping Stones,
their eventual permanent home, in northern Westchester County (it is now
a historic site, maintained by a foundation established upon Lois’s
death), counts fifty-four different addresses for the couple in the early
nineteen-thirties. These were hellish years, during which three ectopic
pregnancies ended Lois’s hope of bearing children and the pace of Bill’s
drinking grew in proportion to his shame. Bill would dry out periodically
in a clinic on Central Park West called the Towns Hospital, then try to
stay sober until the “small, cold ball of fear … in his stomach would
surge up,” and only a drink could mitigate his terror of its return. He
promised abstinence and was meanwhile hiding his liquor from his wife “as
a squirrel would cherish nuts … in the attic, on beams, underneath the
flooring. . . in the flush box of toilets.” The archive at Stepping
Stones contains Lois’s personal Bible, in which Bill wrote periodic
pledges to stay sober, promises whose ingenuousness is matched by a fear
legible in the handwriting itself, which becomes increasingly spidery as
it moves down the page:
To my beloved wife that has endured so much let this stand as evidence
of my pledge to you that I have finished with drink forever.
Bill
Oct. 20, 1928.
Thanksgiving Day 1928. My strength is renewed a thousandfold in my
love for you.
To tell you once more that I am finished with it. I love you. Jan. 12,
1929.
Finally and for a lifetime. Thank you for your love. Sept. 3,
1930.
As Bill later wrote in the Big Book, he was locked in this cycle of
resolution and relapse by his inveterate tendency to compensate for pain
by finding someone or something to blame:
With the alcoholic.. . this business of resentment is infinitely
grave. We found that it is fatal. For when harboring such feelings we
shut ourselves off from the sunlight of the Spirit. The insanity of
alcohol returns and we drink again. And with us, to drink is to die.
It was in the detox hospital in 1934 that Bill first arrived at this
difficult knowledge. The epiphany came as his doctors were putting him
through the usual regimen: sedating him with belladonna and purging him
with castor oil. (Medicine had, and has, made little progress in treating
alcoholism since the eighteenth century, when the pioneer physician
Benjamin Rush treated a man “habitually fond of ardent spirits” by mixing
tartar emetic with his rum.) Left to endure the craving and the cramps in
a room that had been cleared of potential suicide instruments, Bill had
the experience that broke the cycle:
My depression deepened unbearably and finally it seemed to me as
though I were at the bottom of the pit. I still gagged badly on the
notion of a Power greater than myself, but finally, just for the moment,
the last vestige of my proud obstinacy was crushed. All at once I found
myself crying our, “If there is a God, let Him show Himself! I am ready
to do anything, anything! “Suddenly the room lit up with a great white
light. I was caught up into an ecstasy which there are to describe it. It
seemed to me, in the mind’s eye, that I was on a mountain and that a wind
not of air but of spirit was blowing. And then it burst upon me that I
was a free man. Slowly the ecstasy subsided. I lay on the bed, but now
for a time I was in another world, a new world of consciousness. All
about me and through me there was a wonderful feeling of Presence, and I
thought to myself, ‘So this is the God of the preachers!”
Bill left the hospital as a man possessed, roaming New York, in the
words of his biographer, Robert Thomsen, “at all hours, indefatigable and
incorrigible, totally convinced that if he could do it, could find a way
out, [anyone] could do it.” He literally dragged drunks home from the
gutter, inflicting them on his wife, who fed and bunked them in their
Brooklyn home while he pleaded that they consign themselves to “the
Presence.’ Mostly, what the Wilson’s got in return was petty thievery
and, sometimes, vomit on the floor.
In the grip of his new obsession, Bill found himself ridiculed not as
a drunk but as a fit successor to temperance fanatics like Carry Nation.
In the first decade of this century, Carry Nation had toured the country
from saloon to saloon, smashing, as her biographer Robert Lewis Taylor
puts it, “Venetian mirror[s] with brickbats,” ripping “candid and
stimulating prints from the walls,” and, on one notorious occasion,
throwing “a billiard ball at what she mistakenly took to be Satan
lounging behind the bar.” She ended her life, in the words of the
historian Norman Clark, as a carnival freak. . . a sideshow for a series
of county fairs, armed with hatchets and her Bible”, and to many who
watched Bill on the prowl he seemed headed for the same oblivion. Yet
however unavailing these efforts were for his “patients,” they had the
strange effect of somehow keeping him sober himself.
Bill did not come close to a “slip” until the spring of 1935, when he
found himself in an Akron hotel lobby with nothing to do on a weekend
afternoon. A business deal that had brought him to town had fallen
through, and he was drawn by the sociable sounds of the bar.
Retreating to a phone booth as if to a pocket of air in a room fast
filling with smoke, he dialed all the church numbers he could find in the
local directory, and when a clergyman answered he said, not knowing quite
why, that he was a “rum-hound from New York” who needed “to speak now”
with another alcoholic.
He ended up visiting a local surgeon named Bob Smith, who was known
around town as a hopeless boozer; and their encounter was, in effect, the
first A.A. meeting. Dr. Bob never touched another drop for the remaining
fifteen years of his life, going “dry into his casket,” as the poet John
Berryman wrote in his novel “Recovery,” which is about his own A.A.
experience. “Look up his life sometime, there must be stuff”
It took a while for the two men to identify the “stuff” that had saved
them: the therapeutic value for oneself of helping another person stay
sober. “Our talk was a completely mutual thing,” Bill called. “I had quit
preaching. I knew that I needed this alcoholic as much as he needed me.
This was it.” Together, they began to visit patients in detox, telling
their story, and inviting them to give the new talking therapy a try. Let
us talk to you, for our own sakes, they said, in effect, and then talk to
us and we’ll listen. Sometimes they were shooed away like pestering
salesmen. But soon they had a success, with a businessman who was going
through his eighth detoxification in six months, the previous one having
begun with his punching two nurses in the eye. At first, he resisted, and
railed at his wife for revealing his drinking to strangers. When she
coaxed him into seeing them, he braced himself for another sales pitch.
But he relented when he realized that “all the other people he had talked
to me wanted to help me, an my pride prevented me from listening them. .
. but I felt as if I would be a re stinker if I did not listen to a
couple o fellows for a short time, if that would cure them”, and he
became the third member of the new fellowship that called itself “bunch
of nameless alcoholics.”
The principle on which the new group was based was that no one is
responsible for the wreckage of the alcoholic’s life except the alcoholic
himself. No mart what has been done to you, member would be told, you are
responsible f what is done by you. They would refuse to project evil onto
some blamable cause, even though they might speak of alcoholism as (in
the Big Book’s words) an “illness” or “allergy,” and of some people as
alcoholic before they ever touched a drop, as if they were born tinctured
by a poison activated by the first drink.
Within Alcoholics Anonymous (the name was adopted in 1939), some
people speak of its astonishing growth after the Akron meeting as the
expansion of God’s dominion. But there has always been a palpable tension
between what might be called the pietist and the rationalist wings of the
movement; and traces of this division remain in the Twelve Steps, the
list of principles that Bill Wilson drew up as he wrote the Big Book:
- We admitted we were powerless over alcohol, that our lives had
become unmanageable. - Came to believe that a Power greater than ourselves could restore
us to sanity. - Made a decision to turn our will and our lives over to the care of
God as we understood Him. - Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact
nature of our wrongs. - Were entirely ready to have God remove all these defects of
character. - Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to
make amends to them all. - Made direct amends to such people wherever possible, except when to
do so would injure them or others. - Continued to take personal inventory and when we were wrong
promptly admitted it. - Sought through prayer and meditation to improve our conscious
contact with God, as we understood Him, praying only for knowledge of
His will for us and the power to carry that out. - Having had a spiritual awakening as the result of these steps, we
tried to carry this message to alcoholics, and to practice these
principles in all our affairs.
Although some members still speak of these steps as if they were
brought down from Sinai or were revealed, like the Book of Mormon, by a
messenger angel, they are in fact products of contention that is still
discernible in them. Their wording was under debate until just before
release of the Big Book, when the phrase “on our knees” was deleted from
Step 7 and “as we understood Him” was inserted in Steps 3 and 11. Some
regard such concessions as proof of the democratic genius of the
fellowship, of its ability to modulate the idea of a personal deity into
an abstraction that can accommodate all members, including non-Christians
and agnostics. Others worry that God has become so vague a conception
that he has disappeared. Evidently wearied by the prevalence of the term
“self-help,” one member complains, “We’re not a self-help program. If we
were helping ourselves, we’d be in trouble. We are a spirit-help program,
a God-help program.”
God has always been A.A.’s raw nerve, Bill confided in only a few
friends about how “the Presence” had manifested itself to him, lest A.A.
become linked in the public mind with crackpots and ranters. But shortly
after that hospital experience a friend recommended to him William
James’s “The Varieties of Religious Experience.” Bill read the book with
the gratitude one feels toward a respectable witness who confirms that
he, too, has heard the disembodied voice or seen the ghost that has
brought one under suspicion of madness. James (whom Bill came to refer to
as “one of the founders”) seemed to know at first hand the power of
alcohol to make one feel uncontested at the center of the universe, to
turn any party into your fete, any music into your serenade:
Sobriety diminishes, discriminates, and says no; drunkenness expands,
unites, and says yes. It is in fact the great exciter of the Yes function
in man. It brings its votary from the chill periphery of things to the
radiant core.
And when James wrote about the futility of mental effort he seemed to
grasp exactly what Bill had undergone in Towns Hospital:
You know how it is when you try to recollect a forgotten name. Usually
you help the recall by working for it, by mentally running over the
places, persons, and things with which the word was connected. But
sometimes this effort fails: you feel then as if the harder you tried the
less hope there would be, as though the name were jammed, and pressure in
its direction only kept it all the more from rising. And then the
opposite expedient often succeeds. Give up the effort entirely; think of
something altogether different, and in half an hour the lost name comes
sauntering into your mind, as Emerson says, as carelessly as if it had
never been invited. Some hidden process was starred in you by the effort,
which went on after the effort ceased, and made the result come as if it
came spontaneously.
James ratified the value of giving oneself up rather than “pulling
oneself together, an ineffably strange reversal for a man like Bill,
whose life had once been all about seizing opportunities, looking for the
main chance, training, disciplining, driving himself. When Bill read that
“something must give way, a native hardness must break down and liquefy,”
he recognized an account of what had happened to him.
This experience of giving way and breaking down remains the key to
every A.A. meeting, as it was at one we attended on a rainy Saturday
morning in a Boston mental-health center, one of those nineteen-sixties
scored-concrete buildings with all the charm of a highway trestle. On the
steps outside, men slept curled in the rain. Inside, the atmosphere was
festive. A tidy-looking young man (polo shirt, pressed khakis) was
telling a group of about forty men and women how he had stepped, for no
apparent reason, in front of a mirrored column in a subway station.
Walking around it, as if he had been suddenly vouchsafed the ability to
see himself from without, he stared at his own face, yellow and jowly,
really seeing it for the first time. For months, he said, he had been
drinking two bottles of wine every night in between aperitifs and
chasers. In that instant, he knew he would never drink again. But he had
no idea why.
One hears as many metaphors for such an experience as there are
members who speak. One member at the Boston meeting likened it to the
feeling of a runner who gets a second wind, that eerie sensation when
exertion suddenly subsides into limpid ease. Another compared it to what
happens when you learn to ride a bicycle, to that moment when you stop
straining to find your balance and suddenly it’s there. One young man at
a New York meeting described the splitting away of his old self as if he
had been a plank with a fault line running through it until a pressure
came that made the board break.
The later editions of the Big Book play down this expectation of
“sudden and spectacular upheaval,” and report instead that “most of our
experiences are what the psychologist William James calls the
‘educational variety’ because they develop slowly over a period of time.”
But, whether the release is sudden or slow, public testimony about the
hell in which one lived before deliverance is indispensable for both
speakers and listeners; and the talking therapy has no designated
end.
Like cancer patients in remission, A.A. members think of themselves as
“arrested,” not “cured.” With the possibility of backsliding never far
out of mind, they regard each day of sobriety as an merited gift, and
each A.A. meeting as a holding action, because “each lapse,” as James
wrote, “is like the letting fall of a ball of string which one is
carefully winding up; a single slip undoes more than a great many turns
will wind again.”
As A.A. took form, Bill and Bob had no particular historical model in
mind. They were not bookish men. But it is uncanny how closely their new
fellowship resembled the first American churches that had been “gathered”
three centuries before. The founders of those churches, named Puritans
because of their implacable objections to the rituals of England’s state
church, had instituted in America a practice of public confession, in
which each member of the congregation spoke of his or her enslavement to
sin and of how the bondage had been broken. The Puritans had called these
testimonies “conversion relations” or “professions of faith.” A.A. called
them “drunkalogues.”
In the A.A. view, just as in that of the Puritans, salvation is not
something one can possess by means of a penitential act now and then.
Rather, it is a state of endless striving. The work of salvation, as the
Puritan theologian Jonathan Edwards wrote in the seventeen-forties, must
be, for each person, “not only.., the business of Sabbath days, or
certain extraordinary times, or the business of a month, or a year, or of
seven years… but the business of his life . .. which he perseveres in
through all changes, and under all trials, as long as he lives.” The
convert’s obligation to his fellows is not satisfied by a coin in the
Sunday collection basket. “Faith has to work twenty-four hours a day in
and through us,” as the Big Book puts it, “or we perish.” There is no
evidence that Bill himself ever followed James back to Edwards (in whose
writings James found an “admirably rich and delicate description” of
conversion), but if he had he would have found more than a congenial
spirit. He would have experienced a shock of recognition when he came
upon
Edwards’s list of signs by which the anxious seeker tests the validity
of his or her spiritual experience. Did it come from God, or was it
hallucinatory? Edwards enumerated twelve signs by which one could tell.
They do not match A.A.’s Twelve Steps with the exactness of a stencil,
but they come close. Here is the twelfth sign, which he called the “sign
of signs” and “evidence of evidences” (the Big Book calls the Twelfth
Step “the capstone” and “foundation stone” of all the rest):
Whatever pretenses persons may make to great discoveries, great Love
and joys, they are no further to be regarded, than they have influence on
their practice.
Substantially the same as A. A.’s Twelfth Step, this statement
contains what James called the whole of Edwards’ work. It is “an
elaborate working out of [the] thesis [that] the roots of a man’s virtue
are inaccessible to us,” James wrote. “No appearances whatever are
infallible proofs of grace. Our practice is the only sure evidence, even
to ourselves, that we are genuinely Christians.” If, in other words, two
people claim they are saved, and one sees Jesus’ blood running down the
bedroom wall, while the other sees only the swirls and cracks in the
plaster, this difference between them has not the slightest significance.
The only evidence that one’s inner spiritual condition has changed is
visible evidence of a new responsibility toward others in one’s outward
practice.
James repeated this point again and again, as if to rebuke his Harvard
colleagues, who thought he had gone soft on God. The question of whether
someone s conversion had a supernatural cause or could be explained in
purely psychological terms held no interest for James. (Freud, working
with a dualistic model of the mind, later described such events as an
internal rupture in the psyche through which the unconscious pours into
consciousness.) Like Edwards, James was not interested in causes, only in
results. It matters not a whit if the convert is transformed by God or by
the smile of a child. The only thing that matters is the result of the
experience. “If the fruits for life of the state of conversion are good,”
James wrote, “we ought to idealize and venerate it… if not, we ought to
make short work with it….
When it comes to applying this standard of results to A.A., not much
is known about its aggregate impact on American alcoholics. Most experts
estimate the number of alcoholics in the United States at ten to fifteen
million, and some believe that nearly one in ten adults has attended an
A.A. meeting at some time in his life. In 1968, recognizing that “our
communications to the professional community had very little credibility
because of a lack of objective data,” A.A. began to conduct periodic
surveys of its members in order to assess its own efficacy. In a 1989
survey of almost ten thousand members chosen at random, thirty-five per
cent of the respondents reported less than a year of sobriety, thirty-six
per cent between one and five years, and twenty-nine per cent more than
five years.
But what such numbers mean is fat from clear. For example, the survey
also revealed that about half of newcomers leave A.A. after less than
three months, and that “after the first year… attrition continues, but
at a much slower rate.” If you try to adjust the numbers to reflect these
facts, it is still difficult to come up with a true sobriety (or
“salvation”) rate. The best the editors of an exhaustive recent monograph
on research on .A.A. can do is conclude that “long-term sobriety occurs
within a select minority of those who initially attend A.A.” For certain
cancers this would represent a good outcome For most bacterial diseases,
it would not To the theological father of Puritanism John Calvin, who
wrote in 1536 that “the same sermon is addressed to a hundred persons,
twenty receive it with the obedience of faith; the others despise, or
ridicule, or reject, or condemn it,” a “select minority” would seem about
right.
It was the test of results that clarified for Bill what had happened
to him in Towns Hospital. It gave him a way to answer those who said he
had simply substituted a new addiction, A.A., for his old one When he had
been drinking, he had been “at the gates of insanity,” he wrote, and
other people were obliterated by the intensity of his narcissism. But
when, first in Brooklyn and then in Akron, and then through AA., his mind
had been directed outward, he was restored to the world persons. Edwards
called this new engage ment with other people “consent to being.” A.A.
calls it “Twelve-Stepping.”
Twelve-Stepping is based on the in sight that altruism has selfish
value, in the charity gives hope to the giver: “When the phone rings at
two in the morning,” one member told us, “and it’s a member in my group
who needs help, I get up and go. Anything else in my life I will
negotiate. But in A.A. I just do it. It doesn’t make any sense to get up
at two on a snowy night. But you do it all the same.”
In light of the fact that the religious dimension of A.A. has made
many prospective joiners uneasy (newcomers sometimes have the
self-conscious look of stragglers in the pews when everyone else is
taking communion), it is striking how respectfully A.A. is regarded by
even the most secular-minded experts in the field of addiction. We spoke
with one such authority, Dr. Steven Hyman, who is the director of the
Mind, Brain, Behavior Initiative, at Harvard University, in a squat brick
building at the old Charlestown Navy Yard which used to be a storehouse
for torpedoes but is now a research facility of the Massachusetts General
Hospital, complete with atrium and cafe. Dr. Hyman, who looks like
Pavarotti in fighting trim, does not initially impress one as likely to
have much tolerance for a movement that began when a patient was seized
in his hospital bed by “the Presence.” In this respect, he surprised
us.
“The great A.A. insight was not just that alcoholism is a disease but
that having this disease is not an excuse for anything, not for missing
work, messing up your family, killing people in automobiles,” he began.
“In terms of cause, alcoholism does have genetic causes, cultural causes,
circumstantial causes. But there’s nothing deterministic about its
consequences. That’s the strange paradox A.A. understood, and it seems to
be more and more difficult for people to accept.
Dr. Hyman added, “I have no problem with the A.A. method,” and
launched into an explanation of how a spiritual therapy could relieve a
physiological affliction. Rummaging through the papers on his desk, he
came up with an M.R.I. film of a rat’s brain after the animal had been
injected with cocaine. It showed a splatter of bright streaks on a dark
background, like fireworks against the night sky. This picture, he said,
revealed a neurological system that was more complexly developed in human
beings but served basically the same function in people as in rats. He
described an experiment done in Canada in the nineteen-fifties, in which
electrodes were affixed to a succession of sectors of a rat’s brain. A
lever was placed within reach of the animal so that it could send current
into itself by depressing the switch. “In some places, the effect was
highly aversive,” Dr. Hyman said. ‘You can imagine the experience of
feeling electrical sensations in your paws. But when the electrodes were
attached to certain other locations, the rat would press the lever
thousands of times to get more of it, until exhaustion supervened.
“Now, why do we have such a system-a brain that will light up when you
charge it with electricity or drugs? Because some things are too
important to leave to cognition. If you left them up to people to
calculate, they’d get messed up. Nature’s experience with sexual
reproduction would have been a big failure unless sex were profoundly
rewarding. So we have a neurological system that says, That was good,
let’s do it again.’ A few natural substances, including alcohol, tap into
this system in the brain that says, ‘That was good, lets do it again, and
let’s remember exactly how we did it.’ And, since you’re bombarded every
day by millions of sensations, the brain is organized in such a way that
certain indispensable experiences, like sex, have the greatest affective
valence, and become objects of desire.”
Dr. Hyman’s name for the process by which this system is captured by
drugs is “adaptation,” which is “a way of making long-term changes in the
way the brain works, so that you can remember experience.” This kind of
“learning” uses many of the same biological processes in the brain as in
other parts of the body. “Let’s say you wanted to look like
Schwarze-negger, and you went to the gym and started pumping iron,” he
said. “Your arms would really hurt. But eventually you would have an
adaptive response. The genes in the nuclei in your muscle cells would
start making more messenger RNA and then more protein to build up those
muscles, and pretty soon, especially if you also took anabolic steroids,
you would look like Schwarzenegger. These adaptive responses are
universal. Some are helpful, like hulking up, which is essentially a
response to injury. Others are a problem-as when people develop a
tolerance for their asthma medicine. In fact, they not only need stronger
doses but become dependent. If they don’t get their asthma medicine, they
have worse asthma attacks.
“Addiction, in other words, is a form of adaptation. Our best current
understanding of alcoholic addiction is that, in response to bombardment
by the chemical ethanol, chronic adaptations occur in the brain’s reward
circuitry. There are individual genetic and developmental and
environmental factors that help deter-
mine who will get addicted to alcohol or how soon, matters we know
very little about. But, in the context of individual vulnerability,
adaptations will occur in the circuitry in response to the drug. Once
this happens, the user becomes dependent on it for his world to be O.K.
The brain says, ‘That was good, I feel O.K.’ If you’re an alcoholic, you
simply can’t imagine a day without drinking. You need that hit. Your
brain demands it.” With almost reverent intensity, Hyman said, “If you
understand addiction, you understand something very profound about the
human brain, how it hijacks the cortex in the service of the primordial
lizard brain.
Hyman went on, “Now, to help people with these molecular changes in
their brain, we have to come up with things that will deliver
compensatory pleasure, a requirement that it’s tough to get the medical
and scientific professions to accept. A.A. understood this. In fact,
they’re still ahead of us. Most pharmacological research is still
focussed on the development of drugs that block pleasure. An example is
naltrexone, a long-acting blocker of opiate receptors. If you take it
every morning, and shoot up heroin later in the day, you will not get
high. It looked terrific in the lab. The trouble is that, once it was
approved for heroin users, the compliance rates were about fifteen per
cent, because the addicts said it made them feel lousy. Naltrexone has
just been approved as a drug for decreasing craving in alcoholism. My
prediction is that it won’t work, because it doesn’t give something
back.”
Hyman’s account of addiction is an impeccably accurate rendition of
the doctrine of original sin as Jonathan Edwards expounded it. What Hyman
calls “the reward-circuitry of the brain” Edwards called the “faculty by
which the soul.. . is inclined to.. . or disinclined from… sensible
objects.” Both regard it as inborn, and yet both insist that people are
fully responsible for how they act on its inclinations. Edwards thought
of this paradox as a war in the soul between the destructive desires that
he called sin or self-love (“self-will run riot” is the Big Book’s
phrase) and the productive love that goes outward, asking no reward, to
other people and, through them, to God. Hyman believes that you can
actually see the war in a picture. “I suspect that if I could compare
scans of the brain of an alcoholic person before and after treatment in a
twelve-step program, you would see clear changes. Of course, the
altruistic activity affects the brain as much as a drug does,” he
said.
Edwards would have been delighted with this idea. It has been said, by
the historian Perry Miller, that when Edwards preached he deployed words
as an “engine against the brain” in order to stimulate in his hearers a
“taste,” or “relish,” for what he called “divine excellency.” The point
was to use words to “let… light into the soul” by describing vividly
the plenitude of nature or the charitable acts of saintly persons or the
selfless love of Christ, and thereby to entice the imagination away from
its usual focus on worldly glitter. And if Edwards would have liked
Hyman’s notion that one might actually see pictures of this battle within
the soul, he would have loved the metaphoric picture of the lizard brain,
of the reptile within getting hold of the leash.
“What A.A. understands is that the essence of dealing with alcoholism
is not to blame people for having the disease, yet nevertheless to demand
that they take responsibility for themselves,” Dr. Hyman said. “That’s a
hard concept. It is hard to say to somebody, Yes, things are terrible,
yes, getting to your present condition involved what was done to you, and
it even has something to do with the body with which you were born, but
from this day on we have identified the problem, and you have to be
involved in the solution.'” Here is Edwards’s formula-non of the same
compatibility between helplessness and responsibility:
In order to form their notion of faultiness or blameworthiness,
[people] don’t wait till they have decided .. . what first determines the
will…. They don’t take any part of their no-ton of fault or blame from
the resolution of any such questions. If this were the case . . . nine
hundred and ninety-nine out of a thousand would live and die without
having any such no-don as that of fault ever entering into their heads,
or without so much as once having any conception that anybody was to be
either blamed or commended for anything. Edwards believed that this idea
accorded perfectly with common sense. And Bill Wilson, through his
experience in Towns Hospital, came to the same conclusion, that “what
first determines the will” to drink has nothing to do with the question
of who bears responsibility for the consequences of drinking.
For much of American history, there seems to have been a consensus
that this stringent principle should be applied broadly to the moral
life. Among modern Western societies, America has been the country where
human beings were most exposed to the possibility of advancement, and
least protected from the prospect of decline. It was, in Emerson’s
phrase, the culture of “self-reliance,” in which a man was supposed to
take his chances and then collect the reward or pay the price for what he
had done or had failed to do.
With the Great Depression, however, this kind of uncompromising
individualism became insupportable. For millions of people whose best
efforts had availed them nothing, the old doctrine of self-reliance was
now experienced as a form of cruelty. At that moment, when the exigencies
of the exposed life were judged to be intolerable, and the old stress on
individual responsibility had come to seem our of balance with valid
claims for individual rights, a profound change took place in America. It
was a fusion of the old doctrine of the accountable self with a new kind
of public responsibility for the fate of individuals. At the level of
politic and public life, this new synthesis came be known as the New
Deal. Under rha rubric, the government, mainly through programs that
would, today be called “workfare,” undertook to provide work
opportunities for those whom the private economy had abandoned. At the
grassroot level, the most important and enduring expression of this same
self-help idea of the founding of A.A.
A.A. was a “church” in which right were kept in steady balance with
responsibilities through the mechanisms off expression and requisite
community set vice. As such, it kept unflinchingly to Edwardsian
principle of what the theol gian Reinhold Niebuhr called, in 193
“responsibility despite inevitability,” a at the same time committed
itself to pr oviding the unconditional help that suffering human beings
have a right expect from others. In this sense, A. was both a religious
revival with roots an earlier America and a spontaneous depression of the
kind of balanced liberalism that emerged in the Roosevelt years.
But the paradoxically symmetrical idea that lies at the heart of A.A.,
that helplessness is a fact of human life, yet, at the same time, no one
should be spared responsibility for his actions, has proved extremely
difficult to sustain. The relation between rights and responsibilities
within American liberalism seems to many people to have been thrown out
of balance. In response to this apparent distortion, certain liberal
institutions (welfare) and ideas (affirmative action) have been charged
with misattributing suffering to circumstance rather than to the
responsible self. Such an approach to the alleviation of human suffering,
its critics say, misleads people into thinking that the world owes them
redress, and leaves them in a state of perpetual expectation for a
reparation that will never come.
As part of the feeding frenzy on the corpse of liberalism which now
passes for political debate, this critique is often a pretext for
mean-spirited attacks on “freeloaders”, people who are deemed unworthy
beneficiaries of a misguided paternalism. Yet even some defenders of
liberalism agree that, at least in such conspicuous areas as criminal
law, regulated speech, and normative sexual behavior, American society
has moved too far toward rights and away from responsibilities. Some of
the more spectacular “don’t blame me” defendants who have entertained and
disgusted Americans in recent years, Lorena Bobbitt, the Menendez
brothers, seem to represent a moral decadence in which a once dignified
liberalism has been reduced to the claim that maimers and murderers are
entitled to sympathy and exoneration if only they can show that they were
victims, too. ‘The architecture of [their] self-defense plea,” as
Elizabeth Hardwick has put it, is most often organized around the claim
of having suffered sexual abuse, “as pertinent to the therapist,” she
says, “as a kidney to the urologist.” These are people who claim, in
contrast to Edwards, that “what determines the will” not only means
something but means everything.
It is not surprising that, as this exculpatory idea of the coerced
will grows rampant in American life, the balance within A.A. between
rights and responsibilities has also shifted. “It’s getting harder all
the time just to find a volunteer for setting up the coffeepot before the
meeting, or scrubbing it out after,” one member told us. “The idea of
helping others in order to help yourself is in trouble.” And some
members, pointing to circumstantial factors, remark that the practice of
Twelve-Stepping is on the decline. “In the days of Bill and Bob, everyone
knew a drunk whom you could seek our and Twelve-Step in what used to be
your favorite bar,” one member said. “But today they’re hidden away in
rehab centers and dealt with in a medical setting. The expectation that
every A.A. member will seek out someone to help seems to be fading.”
There are members who believe that the fellowship actually has begun
to break apart into schisms. On the one side, there are the proliferating
victim groups (“Shoplifters Anonymous, Tight-Shoes Anonymous,
Edsel-Owners Anonymous” was the list offered by Marc Galanter), a sort of
endless Oprah Winfrey show that claims the A.A. Twelve Step method as its
inspiration, but in which the real meaning of the Twelfth Step is lost
amid an incessant whine about the injured self. “There’s been an influx
of doubletalk from these groups,” one veteran remarked. “I’ve heard about
an A.A. meeting in New Jersey where the old-timers have taken to yelling
out ‘Tough shit, don’t drink!’ whenever the whiners get started.”
On the other side, there is a rival group, called Rational Recovery,
which began in 1986 and publishes a guide entitled “The Small Book,” in
which the addict is promised “sobriety.., without depending on other
people or Higher Powers to help you our.” This dilute version of the A.A.
original seems, to A.A. true believers, a vestigial church, where members
make no real commitment to helping others, yet refuse to face the
irremediable loneliness of helping only themselves.
How A.A. will respond to these challenges remains an open, and for
many members an urgent, question. It is a fellowship based on the
proposition that human beings can overcome their existential fear only by
recognizing their responsibility for themselves and their obligations to
others. To contemplate the history and the destiny of this idea in a
culture that seems to be losing its grasp of it is to understand what
Bill Wilson meant when he wrote that “bottles were only a symbol” of the
endless human struggle against self-deception
