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INSTITUTE OF PASTORAL PSYCHOLOGY, 1957

PASTORAL TREATMENT
by John C. Ford, S.J.

Pastoral treatment is only a metaphor. What priests are trying to do and clergymen generally, is to bring men back to God, or bring them closer to God. We don't think of religion as one of the tools of treatment, something that is applied here and applied there, where indicated, in order to cure alcoholism. We think of the religious relationship of the person to God as something utterly transcendent, an invitation from God to love, and an acceptance of the invitation, an acknowledgment of utter dependence on a loving Father.

LIMITATIONS OF THE PRIEST-COUNSELOR

With that prefatory remark, the first thing I would say about a priest-counselor or a clergyman counselor of an alcoholic, is this: We ought to realize our limitations. If it is true that alcoholism is a triple sickness - a sickness of body, mind, and soul - then we cannot handle the whole thing. It is a mistake to take over a case of alcoholism as if "This is now my baby - I'll take care of him. I'll sober him up." I don't believe we should think of it that way. We should think of it as a cooperative effort. We cannot hope to do the whole job ourselves, ordinarily, and so we ought to realize our own limitations.

Now the fact that we do recognize alcoholism as an illness does not deny at all, to my mind, that part of the illness which afflicts the alcoholic is the illness of the soul. If it is a sickness of the body, mind, and soul, the sickness of the soul includes the idea of sin. And I think it is very bad tactics for a priest to say to an alcoholic when he comes to see him, "Well, of course, you are not a sinner, you are a sick man." That is ridiculous! Everybody is a sinner. What we have to offer this alcoholic sinner, like other sinners, is that we are empowered by Christ to forgive his sins. In addition to that, we can provide some very important reassurance. Since we realize that alcoholism is an illness, we can assure this individual that he is not as guilty as he thought he was. You can relieve a great deal of anxiety and mistaken feelings of guilt by assuring a person that he is not as guilty as he thought he was. Alcoholics are very mistaken about the degree of their responsibility. Many people have very primitive ideas about what subjective responsibility is. They have false consciences.

GUILT OF THE ALCOHOLIC

Among alcoholics, I imagine, you have also a great deal of neurotic guilt, a great deal of guilt that is based on unconscious factors and is entirely unreasonable. I do not consider myself an authority on distinguishing that kind of guilt from the real kind. But I do think that, with a certain amount of fundamental orientation, the confessor or counselor can keep his ear cocked for signs of neurotic guilt, and can at least suspect its presence.

This question of guilt in the case of the alcoholic must be handled carefully. If you tell him he is not a sinner and that he is not guilty, he will not believe you; and I don't blame him, because he is a sinner, and he is guilty. It is a question of determining how guilty, and then of helping him see the reasonableness of the sickness concept of alcoholism. We show him that he has a sickness, that he wasn't as responsible as he thought he was, that there are such things as compulsions which diminish or even eliminate sin. Of course the matter is all, finally, in the judgment of Almighty God, not in our judgment. But I do think we can help alcoholics a great deal as long as we stick to our own side of the problem which is real guilt, and offer him the only remedy for real guilt, which is God's forgiveness through the grace of Christ.

Incidentally, if an alcoholic feels guiltier than he should, that doesn't mean that his guilt is neurotic. It may be a guilty feeling based on a mistaken idea of what his responsibility was. You have real objective guilt in the case of a person who commits a sin, knows he did it, and feels correspondingly guilty. That is called real objective guilt. But let's take the case of the alcoholic who does something wrong under the influence of drinking, and, not knowing that he couldn't help doing it, feels guilty about it. That is not neurotic guilt, to my mind. There is a perfectly obvious explanation as to why he feels guilty - he is mistaken as to what his responsibility was. I would call it mistaken guilt, not neurotic guilt. As for neurotic guilt, I prefer to leave it to the psychiatrists to explain just what they mean by it. At least, I do not think that it is my place to try to explain it.

PASTORAL APPROACH

With regard to the pastoral aspect of the care of the alcoholic, bringing him closer to God, or bringing him back to God if he is away from God, can be put under two headings, removing the obstacles to grace, and administering the means of grace to the alcoholic.

First with regard to removing the obstacles to grace. It seems to me that a very large number of alcoholics are afflicted with a very peculiar blindness as to what is wrong with them. They don't understand the nature of their own problem. It is simply fantastic the extent to which they can rationalize the things that happen to them, and give rationalized explanations in order to avoid the conclusion that drinking is the problem. I could entertain you with examples of that kind, and anybody who has dealt with alcoholics knows that it is a fact. That blindness is an obstacle to grace; they do not see themselves as they are; they do not see what the situation obviously requires.

In our theology, actual grace is a special enlightenment of the mind by Almighty God, and an inspiration of the will, as a result of which the person sees himself in a different light from what he did before; or he sees what he ought to do in a different way, and then has that extra strength, that extra push, needed to accomplish it. Theologians speak of actual grace as an illumination of the mind, and an inspiration of the will.

Now I think that we can help to remove some of the obstacles to grace by helping the alcoholics to see himself as he is. We can help him to arrive at the point of self-diagnosis, so that he will see with his own eyes what his problems really is. But how do you do this? I do not think you do it by saying: "look here, old man, you're an alcoholic." I said already, and I think we are agreed on the point, that most alcoholics see red at the word alcoholic. It's a good word to avoid. I think that one way of helping a person to see what his own problem is, is to listen to him. Let him talk. He will talk himself into it if you will listen intelligently, actively, and helpfully.

My experience is that a great many of the alcoholics who come to see me, and come because of a drinking problem, but who are dragged in by the wife, or by some friend, or by the boss, or by another priest, do not believe that alcoholism is their problem at all. One way to start a conversation with them is to find out what they do think the problem is. Obviously there is some problem, or they would not be there. If you can get your visitor to tell you what he thinks the problem is, at least you have something to start talking about. In the course of the conversation very often he finds himself confronted by facts. When he puts the cards on the table, it does turn out that drink has something to do with it, after all. Drinking is in there as a big factor in his problem. He brings this out himself if you win his confidence and let him talk. But I still would avoid using the word "alcoholic." It is better to speak of a drinking problem, once you and your consultant are agreed that drink has something to do with it.

I've also found it useful to employ some of the popular diagnostic aids. Mr. Gardner mentioned one of them yesterday, based on E.M. Jellinek's Phases in the Drinking History of Alcoholics (1946). In its popular form this material can be obtained from the National Council on Alcoholism. There is also the A.A. leaflet, Is A.A. for you? Twelve Questions Only You Can Answer. Another popular leaflet, Who....Me?, which contains the so-called "Forty Questions Test" can be obtained from the Hornell Committee for Education on Alcoholism. This latter item is also contained in The Pastoral counseling of the Alcoholic: a kit for the busy priest, now obtainable from the National Clergy Conference on Alcoholism (NCCA).

The above mentioned diagnostic aids are helpful, I think, in many cases. You can't use them mechanically. There is no rule of thumb. I've seen a man take up one of those tests, and go through it and check off all the things that have happened to him, so that instead of answering "Yes" to five of the questions, he answers "Yes" to ten or fifteen. But after he is all through, he says, "Well, that's interesting, isn't it?" But he didn't believe he was an alcoholic when he started, and he doesn't believe it when he gets through. That is part of the blindness. But these tests have also worked successfully in many cases.

Another means of removing obstacles to grace is to make use of other agencies, especially Alcoholics Anonymous. When a man (or woman) goes to Alcoholics Anonymous he learns alot about himself, and he is often willing to learn things in these circumstances which he isn't willing to learn from us. I'm not talking now about the simple procedure of seeing a drunk in the parlor and telling him: "Well, now the thing for you to do is go to A.A. Good afternoon, goodby, etc." You don't dump people onto A.A. or onto doctors, and psychiatrists, either, for that matter. It is quite an art to refer. That's a study in itself, to learn how to cooperate effectively with A.A., how to find the right sponsor for a person before sending him to A.A. You just don't send him to A.A. by having him look it up in the phone book. You have to find the right person in A.A. to correspond to his particular needs. And you have to follow up later, because A.A. is not going to be specifically aimed at bringing him closer to God, or restoring the religious life of the person. They don't save souls; all they do is wring them out. After that, it's up to us to follow up. And our part of the follow-up is to take care of the spiritual life of that individual.

I'd like to mention here an organization called NCCA - the National Clergy Conference on Alcoholism, which specializes in helping priests to deal professionally with drinking problems that come to their attention. One of the main purposes of the organization is to help priests deal with these cases in their pastoral ministry. This organization runs a pastoral institute in a different diocese every year during Easter week. The proceedings are published annually in The Blue Book, which is available only to priests.

Well, so much for removing the obstacles to grace. A word about administering the means of grace. I'm not going to say much about this aspect, because there isn't any need to enlarge on it. There is no difference here from any other case in which we try to help a sinner get back to God, or help a person who isn't such a great sinner to get closer and closer to God. We make use of prayer, we make use of the sacraments. We encourage people to make retreats where they will receive further instruction and enlightenment in their faith, and further enrichment of their spiritual life. A.A. makes no pretence of taking the place of religion.

USE OF THE PLEDGE

I want to say a word about the pledge, because it is a religious means which has been used in connection with alcoholism, and questions about it are asked so often.

Here is a wrong idea about the pledge: "Alcoholics need it, and other people do not." If anything is true, it is just the opposite of that. It isn't particularly good or effective for alcoholics, but it is often good and effective for other people, this pledge of total abstinence. In other words, I am distinguishing between the pledge as a measure of rehabilitation and recovery for alcoholics, and the pledge as a means of prevention of excess, and of alcoholism. As a rehabilitative measure, especially when used by itself, is not very effective for alcoholics. I do not think it is a good idea to give the pledge to alcoholics as a rule. Occasionally, I have used it by giving the pledge for a very short period of time to a person who is well motivated religiously. But I always explain that the pledge of itself does not oblige under pain of sin. I don't want the violation of the pledge to be hanging over the alcoholic's neck like the sword of Damocles with a new threat of mortal sin, which will not keep him from drinking but only increase his guilt. No, I make it clear that this is a religious resolution, a sacred resolution made for religious, supernatural motives, but it is not a vow, and it should not bind under pain of sin. I believe that is the way the pledge is usually administered nowadays, when it is administered.

Do occasionally I've used it with an alcoholic for a very short period of time, perhaps a week, or two weeks, or five weeks. I remember one case where it was very effective. The man sobered up when he took the pledge. He stopped drinking and we were able to talk sense to him. He wasn't entirely sensible when he took it, but he kept it, and then we were able to talk sense to him. We got him into A.A. That was in 1947 and he hasn't had a drink since. So I don't want to exclude the pledge; but I do think the more serious the alcoholism is, the farther advanced it is, the less likely that the pledge alone will be of any avail. As a rule I would discourage its use as a means of rehabilitating alcoholics.

But the prevention of excessive drinking and of alcoholism is another matter. I do not believe that the pledge has been very effective, for instance among the Pioneers in Ireland, and in the Catholic Total Abstinence Union of America, and in other total abstinence organizations, as a preventive of alcoholic excess. Total abstinence is the surest preventive there is. I think that a vigorous and popular total abstinence movement would be a most valuable part of a preventive program, although I am a little uncertain just how such a program cant be made popular and effective at the present time. Consequently it is very important to institute popular education as to the true meaning of the word moderation, and the exercise of the virtue of Christian sobriety through the practice of true moderation. That also is an essential part of a program of prevention.

DISTINCTION BETWEEN PREVENTION AND RECOVERY

Prevention and recovery are to different fields. It is not likely that the people who are engaged in preventive work are going to get along too well with people who are engaged in recovery work. Their mentality is too different. Besides, you are working with two entirely different groups of people. When you are helping alcoholics to recovery they are generally older people, who have been through the mill. Many are somewhat defeated and even cynical. They are sick. When you are dealing with the problem of prevention your clients and prospects are healthy young people who are enthusiastic and idealistic. You can propose very high and generous ideals to them and get results. The success of the Pioneers among young people in Ireland is an example. But do not be misled by the fact that total abstinence is the only means of recovery for the alcoholic and is therefore the aim of every recovery program. It is a different kind of total abstinence - a total abstinence which is mandatory if the man is to survive as a normal human being. The total abstinence of a preventive program is altogether different. It is a work of supererogation, chosen freely out of generous devotion to Christ, not out of desperate necessity. We should not try to handle recovery techniques and preventive techniques in one confused program where the persons involved have nothing in common but the word alcohol. They are oil and water and will not mix.

MISTAKEN APPROACHES

Another mistake We, as clerical counselors, sometimes make in dealing with an alcoholic is this. We insist too much on will power. I might say that the medical profession occasionally makes the same mistake. We say: "Use your will power. Get in there and fight." Or, "Just make up your mind and you won't drink any more." Or the doctor says: "Well, now I've got you sober, it's your job to stay sober. Its up to you. Use your will power."

The reason why I am against that kind of advice is that it doesn't work. Alcoholics are sick and tired of hearing it. It is bad tactics to keep telling them to use their will power when they resent the very sound of that phrase.

Furthermore, it is misleading. The vast majority of alcoholics do not stay sober unaided. They need continuing help with their problem if they are going to persevere. They can get this kind of help in A.A. It is very misleading to let them think they are going to succeed on will power alone. They may need continuing medical help. Some will profit from continuing psychiatric help. Most will need continuing spiritual help.

Still more fundamentally, alcoholics suffer from a compulsion to drink. I am still using this word compulsion as a moralist would use it. Compulsions do not operate with mechanical, predictable necessity. They operate with more or less frequency and more or less force. Only at times are they utterly compelling and completely uncontrollable. But a person who suffers from a compulsion either cannot help doing what he is doing, or at least his freedom not to do it is seriously impaired. In the case of alcoholics there are indefinite degrees of compulsion. It is weaker in some, stronger in others. In many it operates only after they have started drinking. In others there is often a compulsive factor in the first drink. But anyone who acts through compulsion has no will power, or has greatly impaired will power with regard to the object of the compulsion, while the compulsion is actually operating. It is the very nature of an alcoholic's compulsion that it interferes seriously with his will power, and can even destroy it, where drink is concerned. When you tell him to use his will power in order to stop drinking and stay sober, you are telling him to use the very thing he hasn't got or at least the very thing that's pathologically impaired.

You cannot attack compulsion head on. You have to circumvent it. It can be circumvented by natural means and by supernatural means. The alcoholic can use his will power to take these means. There is a mysterious interplay between free will and divine grace. The surrender to grace and the psychological surrender to the realities of the situation seem curiously intermingled.

I think one of the reasons A.A. is so successful with so many alcoholics is that they use various practical, psychological techniques to help the alcoholic to circumvent that compulsion to drink, to head it off, to get around it, to substitute ahead of time other thoughts and interests that will take up his mind and attention and exclude the obsessive urge to drink, or prevent that insidious, fascinated way of thinking about a drink from getting a real hold on his mind. A.A. newcomers, whether they realize it or not, are being given some practical amateur mental hygiene. They are being taught how to live with their resentments, how to keep from nourishing anger, how to get rid of it without drinking. And this takes place in an atmosphere of sympathetic, almost affectionate, acceptance, surrounded by successful examples of people who have done it. For an alcoholic, getting rid of resentments is an essential means of circumventing the compulsion to drink.

SPIRITUAL CONSIDERATIONS

As for the supernatural means of circumventing compulsion, it is part of our theology that actual grace can and does change our thinking. Almighty God, by a special intervention of a supernatural kind, can help us and will help us, if we ask Him, to have the right thoughts and to exclude the wrong thoughts. When we receive the sacraments we receive along with the sacramental grace a claim on God for the special actual grace that we need.

There is an interior struggle going on within all of us. In the alcoholic it has assumed pathological proportions. But it is a kind of struggle which is vividly illustrated in a passage St. Paul wrote to the Romans in which he describes the conflict that was going on within his own soul. He says:

"The law, as we know, is something spiritual. I am a thing of flesh and blood, sold into slavery of sin. My own actions bewilder me; what I do is not what I wish to do, but something which I hate .... Praiseworthy intentions are always ready to hand, but I cannot find my way to the performance of them; it is not the good my will prefers, but the evil my will disapproves that I find myself doing .... Inwardly, I applaud God's disposition, but I observe another disposition in my lower self, which raises war against the disposition of my conscience, and so I am handed over as a captive to that disposition toward sin which my lower self contains. Pitiable creature that I am, who is to set me free from a nature thus doomed to death? Nothing else than the grace of God, through Jesus Christ Our Lord." (Romans 7:14-24)

We never know, in our own lives or in the lives of others, just how much of what is happening is due to divine grace and just how much is due to the effort of the will. That is the eternal mystery of the interplay between divine grace and human free will.

Perhaps I can illustrate this point by an example. I talked with an alcoholic years ago who told me that he had stopped drinking several years before. This occurred some years before A.A. had been established, though he was now in A.A. This is how it happened. He came home from work one day, a little the worse for wear, went into the dining room and heard his wife and little girl, who was 12 years old, out in the kitchen. The daughter was crying, and the mother asked her why she was crying. She said: "The kids say daddy is a drunk." He told me that when he heard those words they went through his heart. He never took another drink. Now the A.A.'s might say that at that point he hit bottom, psychologically. Maybe that was a natural experience. Perhaps psychology can explain why he suddenly saw himself in a completely different light, and never took another drink. But I am inclined to think that divine grace had something to do with it.

We talk about external graces in theology. God makes use of external events to touch our hearts and move us to the good. I just don't know where grace leaves off and nature begins. And so I think we can profit by following the advice of a great saint who said that we ought to pray as if the whole thing depended on God, and then work and act as if the whole thing depended on ourselves.

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