On to The Act of Surrender

I really enjoyed our first session tonight. I hope you did too.

Tonight, we read “The Role of Psychiatry in the Treatment of Alcoholism” 1 .

In that paper, Tiebout tells his fellow psychiatrists there are two reasons why the profession has failed to have success with alcoholics. First, he says psychiatrists tend to be discouraged by alcoholics because they are often difficult patients that don’t respond to conventional treatment. The second and most important reason psychiatrists fail is that they treat alcoholism as the symptom of underlying mental disorder, rather than a disease in itself. He offers evidence for the disease nature of alcoholism in the fact that alcoholic patients can never drink again normally, no matter how much deep analysis they undergo. He points to the success of Alcoholics Anonymous in addressing drinking as the problem, rather than a symptom. Tiebout is looking primarily at steps one through three and AA’s success in getting drunks to “put the plug in the jug.” He notes that the rest of the steps deal with maintaining sobriety, but he’s looking at stopping drinking as an outstanding clinical success that conventional psychiatry has been unable to achieve.

Next up is “The Act of Surrender in the Therapeutic Process with Special Reference to Alcoholism”2 on page 13.

In this paper, Tiebout is going to look at surrender from a psychiatric point of view. He wants to understand what we in AA see as a spiritual transformation in psychological terms. He especially wants to understand what causes an individual to resist the act of surrender. He identifies “defiant individualism” and “grandiosity” as two personality traits in alcoholics that stand in the way of progress. He says they flow from the “persisting infantile ego.” Tiebout offers a definition of surrender ” … as a moment when the unconscious forces of defiance and grandiosity actually cease to function effectively.” To surrender, an alcoholic must accept reality at both a conscious and unconscious level. Tiebout introduces the idea of compliance which he defines as what happens when the alcoholic accepts reality consciously but not unconsciously. (Hint: it doesn’t work out well.)

The rest of the paper consists of Tiebout’s attempts to relate his insight about surrender to practical aspects of psychotherapy.

“The Role of Psychiatry” was 7 pages long. “The Act of Surrender”  is 16 pages long. There’s a lot of meat on the bones here as well. We will probably take at least two meetings to finish it.

Looking forward to next week!

TIEBOUT H. The role of psychiatry in the field of alcoholism; with comment on the concept of alcoholism as symptom and as disease. Q J Stud Alcohol. 1951;12(1):52-57. [PubMed]
TIEBOUT H. The act of surrender in the therapeutic process with special reference to alcoholism. Q J Stud Alcohol. 1949;10(1):48-58. [PubMed]

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