Harry Tiebout was a psychiatrist who had worked for years with alcoholics when he was first exposed to AA in 1939. He was astonished at how effective the AA program was in getting alcoholics to stop drinking. He started to make a close study of AA’s method and tried, with success, to apply it to his own therapeutic practice. Tiebout developed some ideas about why AA works for alcoholics. He expanded on those ideas in papers published in medical journals and talks given to professional medical societies over a period of at least 20 years. (The earliest paper in this collection was published in 1949 and the last in 1965.)
He decided that the alcoholics he was trying to treat were driven by an unconquerable infantile ego. He noticed that the infantile ego was in the subconscious, and resistant to the application of conscious reasoning. He recognized that this ego needed to be smashed and that a surrender (to reality, at least) had to occur in order to allow therapy to proceed. He insightfully described the ego characteristics of many alcoholics. For me, his viewpoint is invaluable in understanding the mental nature of the disease of alcoholism.
Tiebout usually refrains from discussing spiritual matters in these essays, probably because his intended audience were scientifically minded and as a group, dismissive of spiritual explanations of phenomena. In his later writings, Tiebout acknowledges the “spiritual angle” of AA as essential in maintaining sobriety, especially when he was speaking to AAs rather than his colleagues. He’s not being duplicitous; his approaches to both audiences is consistent, but he emphasizes different aspects of the problem depending on who he is talking to.
One thing that I found difficult to understand coming from a 12 step perspective was that Tiebout focusses on putting the plug in the jug rather than looking for underlying mental illnesses or neuroses. Again, his audience makes it clear why he does this. Psychiatrists of the day were ignoring the drinking and focussing on what they were trained to do: to identify and bring to light the unconscious motivations that drove the patients misbehavior with alcohol. AA started out with a realization that alcoholism itself, the “allergy of the body and obsession of the mind” had to be treated before moving on to a deep examination of “causes and conditions.” Drying out made the rest of AA’s program possible and Tiebout was impressed by AA’s ability to do that.
So you can look at Tiebout as focussing on step 1. But he also addresses the second half of that step after the dash “- that our lives had become unmanageable.” His insight into the psychological makeup of many alcoholics is important information for someone trying to help an alcoholic who is suffering from active drinking, or to someone with years of sobriety who may be dealing with the effects of ego in their own lives and spiritual practice.
This is a book about ego, so it’s a little ironic that I should include some lines about me. I want to be transparent about where I’m coming from so you can better judge the opinions I present. First, as a member of Alcoholics Anonymous, I approach recovery as a spiritual process. Tiebout is a psychiatrist looking at unconscious processes to understand how to treat alcoholism. These are two different approaches to the same problem that have two related but different purposes in mind. AA is looking at spiritual growth as a way of life that has, as one of its benefits, the maintenance of sobriety. Tiebout is looking at the factors in the alcoholic’s mind that may block him or her from surrendering to reality. thus allowing therapy to begin. These approaches are not incompatible but I find it useful to keep the differences in mind.
Second I hold no academic degrees in Psychology or a related field. Though I’ve had an amateur’s interest in Psychology for many years, my opinions on the subject are unschooled. I may or may not miss some finer points, or even be confused by larger ideas. As a student, and as a person practicing a 12 step program, I try to do my best and remain open to different ideas and better information. I tend to learn a lot each time I go through this material, from individuals and group interactions.
What I take away from Tiebout:
- Alcoholism is a disease of the mind.
- I have an stubborn, large and immature ego.
- I have to smash that ego in order to get on with AA. (Surrender)
- My resistance is unconscious. I can smile and agree while secretly holding out.
- The ego has astonishing recuperative powers. I need a practice that continuously keeps it in check.
There’s a lot more in those pages. Let’s get on with the reading!