Vocabulary for the July 9th Meeting.

We are at the top pf page 26, at the heading that reads “Differing Acts of Surrender.” Tiebout uses a couple of terms in a technical way that might bear some explanation.

Catharsis

A good dictionary will tell you that this word comes from a greek word that means purification, cleansing or purging. Catharsis generally means revealing hidden emotions in a way that removes them as problems. You can have catharsis in art or in many other contexts. Tiebout’s use of the word is probably closer to the technical meaning given to it by Freudian psychoanalysis. A paragraph from the Wikipedia page for catharsis sums that up nicely:

The term catharsis has also been adopted by modern psychotherapy, particularly Freudian psychoanalysis, to describe the act of expressing, or more accurately, experiencing the deep emotions often associated with events in the individual’s past which had originally been repressed or ignored, and had never been adequately addressed or experienced.

Transference

This word describes the situation where we transfer out emotions from one person. place or thing to another. For example, maybe I deal with my (male) boss as if he had the attitudes my father had. My emotions about my father transfer to my boss. In psychotherapy, transference describes a patient placing feelings of love, anger or fear onto the therapist. Often that shows up as romantic or erotic feelings, but a whole slew of emotions including anger can show up. Transference can be seen as valuable to therapy as a way in to a patient’s unconscious feelings.

 

Set Aside Prayer

From Suzanne:

Using my tweaked version of the Set-Aside prayer helps me when I am learning new information that I experience as overwhelming.

“God, please enable me to set-aside everything I think I know for an open mind and a new experience. Help me see the truth and direct my thinking.”

That prayer has helped me a lot in so many situations.

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”

1 

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.

1.
Tiebout HM. Appendix E:b. In: Alcoholics Anonymous Comes of Age – a Brief History of AA. Alcoholics Anonymous World Services; 1957:311.
2.
TIEBOUT HM. THERAPEUTIC MECHANISMS OF ALCOHOLICS ANONYMOUS. AJP. 1944;100(4):468-473. doi: 10.1176/ajp.100.4.468

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!

1.
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]
2.
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]

New Book Study on 6/4/2017, 6:00PM PDT

We are planning to start another pass through the Tiebout Papers beginning on Sunday, June 4th, 2017 at 6:00 PM Pacific Daylight Time. If you would like to participate in the study, please contact me by leaving a comment here or sending me some email at  egbokalaka@gmail.com.

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.

Finishing Up Ego Factors

We are going to continue our reading of “The Ego Factors in Surrender in Alcoholism.” We are at the last section of the paper on page 57 or 58 (as far as my Kindle can tell) under the heading “No Compromise with Ego.” This section offers up a couple of case studies and concludes and summarizes the ideas he has  developed so far. Tiebout says that the point of the paper is that “it is the Ego that is the archenemy of sobriety, and it is the Ego that must be disposed of if the individual is to attain a new way of life.”

We’ll probably get through this final section and have time to start the next paper “Alcoholics Anonymous: An Experiment of Nature.” This is a transcript of a talk Tiebout gave to the New York Medical Society in October 1959. He’s urging his colleagues not to ignore the AA experience (or “clinical data”) just because it’s non-scientific. He offers up the history of two of his patients, the first being Marty Mann and the second being a woman who summarizes how she felt before and after hitting bottom and surrendering.  He goes on to identify four concepts that pertain to recovery from alcoholism. These are hitting bottom, humility, surrender and ego reduction. We have seen these before, but Tiebout restates his case in an interesting way. We may get through to his treatment of the first concept, hitting bottom, on or about page 69.

Vocabulary

phenomenon–a fact or situation that is observed to exist or happen, especially one whose cause or explanation is in question.
“AA is a phenomenon of nature”

You also see this word in the There Is Solution on page 27, where Doctor Jung, talking about “vital spiritual experiences” says “To me these occurrences are phenomena.” meaning “stuff that happens that I can’t fully explain.”

psychodynamics–how the parts of the mind work together.
“Man, your psychodynamics are scaring me!”

We’ve seen this one before but I thought I’d mention it here. Theories of the mind that break personality into different parts (for example id, ego and superego) usually come with an explanation of how the parts work together. That explanation part is psychodynamics. Tiebout has been talking about how the alcoholic ego works to prevent surrender. That’s psychodynamics too.

Continuing Ego Factors

We are continuing our reading of “The Ego Factors in Surrender in Alcoholism.”  To preserve some context, we’re going to back up a bit to the paragraph on page 51.

So far, Tiebout has defined “Ego” and sketched out some important traits in the “infantile ego” of the alcoholic. These “ego factors” are

  1.  Omnipotence,  the feeling of having power over everything I survey
  2. Inability to accept frustration
  3. A tendency to speed through life.

Next, he’s concerned with how this immature ego expresses itself in the adult alcoholic. At our starting point, he’s setting the stage for this understanding.

There is so much coming up in this reading. It bears repeating that this paper is the most significant one in the collection.

Vocabulary

Remember that Tiebout is using lowercase “ego” when he’s talking about the psychiatric definition in which ego is regarded as a good thing and capital “E” Ego when he means the infantile ego that has all the traits we are discussing.  For me, this is important when he talks about not compromising with Ego.

Here are some vocabulary words in the order they are encountered in our reading. If I’ve missed something, let me know in the comments or on the call.

Omnipotence – “All Powerful.” The feeling that everything around me is mine to command. This trait is associated with gods and kings.

Afflatus – Inspiration from God.

Prerogative – privilege due to royalty or some other group. Synonyms: right, privilege, advantage, due.

Imperiousness – assuming power or authority without justification.

Whirligig – a toy that spins around, for example, a top or a pinwheel. Hectic, unpredictable.

Narcissism – extreme selfishness, with a grandiose view of one’s own talents and a craving for admiration.

Megalomania – obsession with my own power

 

Ego

We are about to start the paper “The Ego Factors in Surrender in Alcoholism.” This is one of the most important papers in the collection.

Right up front, Tiebout faces a difficulty with the word “ego.” There is a common definition of ego that he wants to use:

ego
noun
1: egotism; conceit;self-importance: Her ego becomes more unbearable each day.

But he knows his colleagues won’t think of that definition. They’ll think of Sigmund Freud’s model of the human psyche in which ego has a technical definition not at all like the one Tiebout wants to use. Just remember that he’s using the word in its ordinary sense. He’s going to talk about the immature ego of an alcoholic. That probably means what you think it means.

Optional background.

Freudian psychology ruled the roost in 1953 America when this paper was written. According to Freud, the ego was one part of the human psyche, along with the id and the superego. The ego was actually the part that kept the balance between the other two, so it was considered healthy when working properly. You can find nice short outline of Freud’s model of the psyche here.

There are many competing and/or cooperating models of the structure of the psyche out there today. Freud’s original ideas aren’t so much in fashion, but they have had an enormous impact on the development of the field. Here’s a short article on that topic.

The Act of Surrender Part 2

The Act of Surrender in the Therapeutic Process. Page 21.
We are scheduled to discuss this reading on March 5, 2017.

We learned that we had to fully concede to our innermost selves that we were alcoholics 1

Tiebout has identified defiance and grandiosity as factors that stand in the way of the 1st step surrender to reality. He said these factors exist in the unconscious mind of the alcoholic. To surrender, an alcoholic must accept reality at both a conscious and unconscious level. He’s now going to look at compliance which he defines as what happens when the alcoholic accepts reality consciously but not unconsciously. Hint: it doesn’t work out well.

The meeting from 2/26 is now available on the recordings page.

1.
More About Alcoholism. In: Alcoholics Anonymous Big Book. A.A. World Services Inc.; 2002:30.