Dr Tiebout in AA Comes of Age.

Harry Tiebout’s first paper on alcoholism, “Therapeutic Mechanism of Alcoholics Anonymous,” appears as appendix E:b i(page 311) in Bill W’s history of AA, “Alcoholics Anonymous Comes of Age”


This paper, originally published in 1944 in a  psychiatric journal 2, presents Dr Tiebout’s view of AA’s program as therapy, just 5 years after he first read the multilith version of the Big Book’s first edition.

Tiebout is much more forthright in his description of AA’s dependence on a higher power:

“Granting then the more or less constant presence of these [narcissistic, egocentric]  character traits, it is easy to see how the person possessing them has difficulty in accepting God and religion. Religion by its demand that the individual acknowledge the presence of a God challenges the very nature of the alcoholic. But, on the other hand, and this point is basic to my paper, if the alcoholic can truly accept the presence of a Power greater than himself, he, by that very step, modifies at least temporarily and possibly permanently his deepest inner structure and when he does so without resentment or struggle, then he is no longer typically alcoholic. And the strange thing is that if the alcoholic can sustain that inner feeling of acceptance, he can and will remain sober for the rest of his life. To his friends and family, he has gotten religion! To psychiatrists, he has gotten a form of self-hypnosis or what you will. Regardless of what has occurred inside the alcoholic, he can now stay dry. Such is the Alcoholics Anonymous contention, and I believe it is based upon facts.”

Dr Tiebout gives us the case of Bill W. (“Mr X”) to illustrate a sudden and deep spiritual experience. He also describes a patient who had an experience of the educational variety.

The paper makes clear that Dr. Tiebout had, as far as a non-sufferer can, a full understanding of how AA works as a spiritual program. The paper also contains the earliest message I can find from Dr. Tiebout to his colleagues regarding alcoholism:

“The lesson for psychiatrists is clear, it seems to me. Although we admittedly deal with emotional problems, we, as a group which tends to be intellectual, distrust emotions too much. We are self-conscious and a little ashamed, when we are forced to use them, and always apologetic with our confreres if we suspect they have reason to think our methods are too emotional. In the meantime, others, less bound by tradition, go ahead to get results denied to us. It is highly imperative for us as presumably open-minded scientists to view wisely and long the effects of others in our field of work. We may be wearing bigger blinders than we know.”

This remark perfectly frames Dr Tiebout’s later writings to members of his profession. I highly recommend reading this article for anyone trying to understand those writings.

Here’s a password protected link to the full text of the paper. The password is “tiebout”. Please don’t make copies of the content of that page so that you and I can both stay within the bounds of copyright law.

“AA Comes of Age” is available from AAWS in print and in electronic editions on Amazon, iBooks and B&N Nook. Your favorite meeting or Central Office are likely to have copies too. Plus, there’s always your local library.

Tiebout HM. Appendix E:b. In: Alcoholics Anonymous Comes of Age – a Brief History of AA. Alcoholics Anonymous World Services; 1957:311.
TIEBOUT HM. THERAPEUTIC MECHANISMS OF ALCOHOLICS ANONYMOUS. AJP. 1944;100(4):468-473. doi: 10.1176/ajp.100.4.468

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