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The Act of Surrender in the Therapeutic Process. Page 13. ¹

The terms “spiritual experience” and “spiritual awakening” are used many times in this book which, upon careful reading, shows that the personality change sufficient to bring about recovery from alcoholism has manifested itself among us in many different forms. ²

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 block the act of surrender. He says they flow from the “persisting infantile ego.” We are going to get a first look at what he later calls the “ego factors” that block the surrender he recognizes is essential to recovery. We call it the beginning of a spiritual experience that allows an alcoholic to proceed with the steps. Tiebout sees it as essential before therapy can commence.

This site exists to support a study of  “Harry Tiebout: The Collected Writings.” If you don’t have the book, check out the Obtaining the Book page.

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 practise. 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 1944 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. His viewpoint is invaluable in understanding the mental nature of the disease of alcoholism.

He 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. He says so in a talk he gave at the 1955 International Convention. (Tiebout starts around 3:15.)

Tiebout also 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 realisation that drinking had to stop  – “Admitted we were powerless over alcohol,” and proceeded from there. Drying out made the rest of AA’s program possible.

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 an alcoholic who is suffering from active drinking. It’s part of the “medical sledgehammer” that can help an alcoholic to hit bottom.

What I take away from Tiebout:

1. Alcoholism is a disease of the mind.
2. I have an stubborn, large and immature ego.
3. I have to smash that ego in order to get on with AA. (Surrender)
4. My resistance is unconscious. I can smile and agree while secretly holding out.
5. The ego has astonishing recuperative powers. I need a practise that continuously keeps it in check.

There’s a lot more in those pages. Let’s get on with the reading!