Direct Treatment of a Symptom

This paper was included in a medical journal published in 1973, so Tiebout is again talking to his colleagues. For me, this is one of the most difficult papers in the collection, not because it’s complicated or obscure, but because a lot of it goes against what what I believe about the 12 step program.

Tiebout says that the AA program was “designed to get the individual to stop drinking, and really nothing else.” He gives a nod toward inventory and spiritual growth, but he says that “they had nothing to do with causation.” Tiebout sees AA as an “adjunct to therapy” that is useful to get the patient to put the plug in the jug and keep it there.

Tiebout’s use of the word “causes” is pivotal in finding where the disconnect with AA is. Psychiatrists then and now look at the experiences that people have, particularly during childhood, as one set of causes for psychiatric illness. Today there’s also more emphasis on genetic factors. For the scientist, roughly speaking, that’s all there is.

AA’s premise is that the problem of alcoholism is spiritual in nature. We take inventory to understand our part in the anger and fear we hold around people, places and things. That looks like therapy on the surface but it’s really the beginning of moral reeducation and character amendment. It’s part of a journey to rebuild sufferers’ lives and characters so they can have a spiritual experience. So we think we are amending the cause of alcoholism: the spiritual malady.

Psychiatry doesn’t see alcoholism as a spiritual malady. For Tiebout, the inventory and character building have a different purpose: to keep the alcoholic from drinking again. He has told us what stands in the way of that: the infantile ego that must be reduced. He understands that AA tries to keep that ego reduction in place but he believes that’s a direct treatment of the symptom of drinking. The real causes, the reasons why the ego is as large as it is and why the patient drinks, stem from childhood development and genetic predisposition.  Those are in the province of psychiatry and of science.

Of course, life events are fodder for the 4th step in AA, so practically speaking, therapy can help AA and vice versa. I’m a fan of psychiatric therapy. I think it can be immensely useful and helpful to anyone with an ego as large as mine. But I’m not looking to psychiatry to further my spiritual growth.  I’d be delighted to hear your thoughts on this subject.