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Journal of Studies On Alcohol, September, 1963*

Philosophical-Religious Factors In The
Etiology and Treatment Of Alcoholism
HOWARD J. CLINEBELL, Jr., Ph.D. *

References to philosophical and religious factors in the causation of alcoholism have been relatively rare in the literature. The view that such factors exist and are of significance in understanding alcoholism in both its etiological and treatment aspects underlies the present attempt to explore these factors, and leads to a consideration of the ways in which the alcoholic handles his existential anxiety.

Lolli (1) has suggested that the problems of neurotic and existential anxiety are complexly intermingled in the causation of alcoholism. The suggestion that three types of anxiety - neurotic, historical and existential - are involved in alcoholism is one that I offered and elucidated in a preliminary way in another statement (2, pp.61-64,147-149). The purpose of the present essay is to set forth a tentative theoretical structure which may prove to be useful in understanding the role of existential anxiety and its relationship to neurotic anxiety in the alcoholic.

BACKGROUND CONSIDERATIONS

Several types of evidence contributed to my curiosity concerning the broad area of the relationships between alcohol and alcoholism, on the one hand, and such matters as religious strivings, fear of death, loneliness and meaninglessness, on the other. One was a statement by Bill W., co-founder of Alcoholics Anonymous: "Before A.A. we were trying to find God in a bottle."

* Associate Professor of Pastoral Counseling, Southern California School of Theology, Claremont, Calif., and Director, Pastoral Counseling Center, Pasadena, Calif.

Another datum was the familiar paragraph from William James's Guilford lectures: "The sway of alcohol over mankind is unquestionably due to its power to stimulate the mystical faculties of human nature, usually crushed to earth by the cold facts and dry criticisms of the sober hour.. .Not through mere perversity do men run after it.... the drunken consciousness is one bit of mystical consciousness" (3, p. 378).

Abundant material from cultural anthropology, as well as from the history of religions, points to the affinity between alcohol and religion in many cultures. Horton noted that, if one asks a native in a primitive or semiprimitive society why he values alcohol, he will probably say it is because his ancestors found it good or because it was given to his people by the gods. (4, p.l57). Jellinek has described the symbolic aspects of alcoholic beverages and has pointed out that many ancient cultures regarded wine as the "stream of life" (5, p. 150). In the Greek pantheon, Dionysus, god of wine, also was related to the afterlife. An immensely popular deity, he was believed to suffer, die and rise again from the dead (6, p. 125). Goodenough (7) has pointed out that certain jewish gravestones of the Hellenistic period bear carvings of drunken men, apparently serving as meaningful symbols of death-transcending experiences. The use of wine in the Christian tradition-viz, in the sacrament of the Lord's Supper in some Protestant groups and in the Roman Catholic Mass - is another illustration of the link between alcohol and religion. (I am not saying that the link between alcohol and religion is a direct casual factor in producing alcoholism. There is some evidence that the ritual uses of alcohol may actually deter the development of alcoholism in certain cultures (among orthodox Jews for example). The fact that the use of alcohol is often related to religious festivals and practices attests to its value as a religious symbol. The same properties which make it a valuable religious symbol for many people also lend it to use as a substitute for religion by others, including alcoholics.)

Moving from the symbolic and ritual uses of alcohol to its addictive use, the clinical evidence is suggestive. The prominence of the fear of death in the symptomatology of a number of earlystage alcoholics with whom I have counseled has seemed impressive. For example, a single woman in her early forties who was still able to hold a responsible job, but was becoming concerned about her rapidly increasing dependence on alcohol, sought help. Her discussion of her childhood included reference to a persistent fear of being outside under the stars at night. Closer examination of this and subsequent fears disclosed a common underlying theme - an intense fear of dying. Both neurotic and existential elements seemed to be present.

The striving for a kind of pseudo-mystical experience through alcohol has been evident in a number of alcoholics counseled at various stages in their addiction. One man in his early 30's phrased it this way: "When I reached a certain point in a drunk, I felt as though I were on the edge of a beautiful land. I kept drinking to try to find it. I never made it, but I had to keep trying."

The final item of empirical evidence, pointing to a link between alcoholism and religion, is the well-known but only partially explained fact that the most effective program ever devised for treating alcoholics is essentially a spiritual program - A.A. There may be other dimensions to the explanation of this fact that previous studies, largely sociologically and psychologically oriented, have found. Intensive study of A.A. experiences in general and the so-called "spiritual angle" in particular may prove to be productive, especially if undertaken by those whose training bridges the disciplines of the behavioral sciences, on the one hand, and philosophy, comparative religion and theology, on the other. Studies by those within the discipline of the psychology of religion may produce new illumination of the dynamics of this striking social phenomenon.

EXISTENTIAL ANXIETY AND ALCOHOLISM

When ancient man stumbled by accident on the product of fermentation, he must have felt that strange, even miraculous, things were happening to his inner world. When he drank the juice of fruits, grains or honey which had been left in a warm place for a time, his fears and burdens lost their weight. His painful awareness of disease, death and injustice lost its sting. The monotony and drabness of his life were interrupted. He felt lifted out of the horizontal earth-boundness of his daily existence into a temporary experience of the vertical dimension of life. Small wonder that he regarded the substance that could produce these effects as a mysterious gift of the gods.

In a much later period, Thomas Wolfe gives a vivid picture of the way in which alcohol gives some persons a powerful experience of transcending their feelings of weakness and finitude. Intoxicated for the first time, Eugene, in LOOK HOMEWARD, ANGEL (8, p. 525), muses: "In all the earth there was no other like him, no other fitted to be so sublimely and magnificently drunken... Why, when it was possible to buy God in a bottle, and drink him off, and become a God oneself, were not men forever drunken?" The similarity of this statement to that of Bill W. is noteworthy.

Fromm (9, p. 22) holds that the emergence of man from the womb of nature into self-awareness, reason and imagination brought with it the burdens of a sense of estrangement from nature and one's fellows. Nietzsche's insight is relevant at this point: "Under the charm of the Dionysian not only is the union between man and man reaffirmed, but Nature which has become estranged, hostile or subjugated, celebrates once more her reconciliation with her prodigal, man." A part of the charm of alcohol is its ability to impart the Dionysian and thus to restore for a time a sense of unity within oneself, with others and with nature.

It was undoubtedly because of its power to give experiences of the ecstatic and the transcendent that alcohol found such widespread use as a symbol of these elements in religion. Wine, it should be noted, was and is often used in those religious rites and festivals related to the mysteries of man's existence, such as birth, marriage and death. The roots of such practices are deep. That they have survived through the centuries attests to their functional value as meaningful symbols for the participants. It may be that when alcohol loses its associations with the mysteries of life (and the ritual ways of handling them), as it has for many in our culture, it tends to be used in an unrestrained manner.

It is the central thesis of this discussion that one of the significant factors in the etiology of alcoholism is the attempt to satisfy religious needs by a nonreligious means - alcohol. This is to say that the spiritual problems of the alcoholic are not merely derivative from or symptomatic of his underlying personality problems, but constitute genuine problems in their own right. Religious factors cannot be understood adequately when isolated from other factors - sociological, psychological, biochemical - but constitute a significant dimension of a depth understanding of some if not all alcoholism.

For the alcoholic, alcohol is not a symbol of the vertical dimension of life. It is the vertical dimension. The alcoholic substitutes a symbol - the very nature of which is to point beyond itself - for that which is symbolized. Alcohol is not a symbol of his experience of a higher Power; it is his higher Power. Perhaps this is the meaning of the statement, "Before A.A. we were trying to find God in a bottle."

An exploration of the ways in which this operates requires an analysis of the nature of man's religious need. There are at least three aspects of this fundamental need: (1) The need for an experience of the numinous and the transcendent. Ruth Benedict has referred in her anthropological writings to the belief in "wonderful power" which was ubiquitous among the cultures she studied. This need to feel that there is something wonder-full, transcending the mundaneness of life, is what was meant earlier by the "vertical dimension." (2) The need for a sense of meaning, purpose and value in one's existence. Frankl (10) calls this the "will-to-meaning" and sees it as more basic in man than Freud's will-to-pleasure or Adler's will-to-power. (3) The need for a feeling of deep trust and relatedness to life. Maslow uses the phrase "oceanic feeling," in his discussion of the self-actualized person, to describe the experience of being a part of the whole universe.

The source of these three elements of man's religious need is his existential anxiety. Anxiety in general is the response of the human organism to anything that is perceived as a threat to what one regards as essential to one's welfare or safety. Pathological (neurotic) anxiety arises when contradictory impulses, desires or needs clamor simultaneously for expression or satisfaction. It is the result of inner conflict. It serves the function of keeping material that is unacceptable to the self-image repressed. In contrast, existential anxiety is nonpathological or normal anxiety. It arises from the very nature of human existence. Man is the animal who knows he will die. He is trapped by his rootage in nature. He is subject to its forces of sickness, pain and death, and he lacks what Big Daddy, in Tennessee Williams' Cat on a Hot Tin Roof, calls the "pig's advantage" - viz., ignorance of his mortality. The theme of existential or nonpathological anxiety has been disgussed by thinkers holding to diverse metaphysical presuppositions, including Kierkegaard, Tillich, Fromm, Horney and May. The German philosophical literature refers to this anxiety as Urangst. Erik Erikson calls it the "ego chill." Tillich writes: "Man's essential loneliness and seclusion, his insecurity and feelings of strangeness, his temporality and melancholy are qualities which are felt even apart from their transformation by guilt. They are his heritage of finitude." (11, p. 170)

Existential anxiety results from threats to man's very being. According to Tillich (12) these threats come from three directions: the threat of fate and death, of emptiness and loss of meaning, of guilt and condemnation.

There is no psychological answer to existential anxiety. It cannot be eliminated through psychotherapy. It is existential in that it is inherent in man's very existence as a self-aware being. But its impact on the individual can be either constructive or destructive, a stimulus to creativity or a paralyzing force. Which it is depends on the way it is handled by the individual. Existential anxiety is not the result of the peculiar threats of our period of history, since it is a part of man's "heritage of finitude" in all periods of history. However, as will be discussed subsequently, the particular combination of factors which cause our period of history to be an "age of anxiety" make it more difficult to handle existential anxiety constructively. There are only religious or pseudo-religious ways of handling this kind of anxiety. Pseudo-religious ways eventually fail. The alcoholic employs a pseudo-religious way which, in its failure, produces an increase of both his existential and his neurotic anxiety.

As the alcoholic's illness progresses, he tends increasingly to handle all three aspects of his religious need by means of alcohol. First, his need for a sense of numinous and the transcendent is satisfied partially and temporarily by his experience at certain stages of intoxication. This is the import of the quotations from William James, above, and from the young alcoholic who felt himself to be on the edge of a beautiful land. In her autobiography, a remarkable woman alcoholic, using the pseudonym Elizabeth Burns, writes: "Liquor wasn't a crutch for Liz, it was an exit. A quick flight to a world of her own making... It wasn't that this present world was too much for her; it was that it wasn't enough" (13, p. 127).

The second aspect, the alcoholic's need for a sense of meaning in his life, is also handled by alcohol. In trying to explain the function of alcohol in his life to Big Daddy, his son Brick exclaims: "A drinkin' man's someone who wants to forget that he isn't still young and believing." A paraphrase of this would be: An alcoholic lacks a sense of meaning in his life. He knows he is moving toward the day he will die. Alcohol lets him forget his emptiness and painful awareness of his mortality.

But alcohol for the alcoholic does more than provide the balm of anesthesia. Increasingly it provides a summum bonum to fill the value-vacuum (Frankl) in his inner world. It becomes the value in his bleak inner life. But a vicious cycle is established by this use of alcohol. The relative meaninglessness, which makes alcohol so attractive as a value substitute, is only magnified as other values are squeezed out of his life by alcohol addiction.

The same kind of vicious cycle operates in the third area of his religious need satisfaction - the satisfaction of the need for experiences of trust and relatedness. The alcoholic who reads John Donne's familiar words, "No man is an island," may sneer, "Oh, yeah?" - for he feels exactly that: a lonely island, a clod cut off from the mainland of humanity. He feels like Camus' Stranger, as though wandering in a foreign land where he does not know the language and has no possibility of learning it. Through alcohol he experiences a temporary but highly valued experience of unity. This includes the unity of psychological and physiological satisfactions achieved by regression to the oral level of infancy, to which Lolli refers (14). At earlier stages of intoxication it also includes feelings of closeness to other people. But when the magic moments pass, the alcoholic discovers that the gulf is wider and the 'isolation deeper than before. Yet he is trapped, since alcohol is the only way he knows to overcome his cut-offness even for a brief time.

As a chemical pseudo religion for the alcoholic, alcohol is a Janus-faced god. Eventually it shows its hidden face - the face of a devil, so far as the alcoholic's trust in it is concerned. It may be that it is when alcohol loses its pseudo-religious power - its power to bring unity, meaning and transcendence - that the alcoholic "hits bottom." He can no longer overcome his neurotic or his existential anxieties by its use. His god has betrayed him and his ego is exposed to the full chill of ultimate anxiety.

It is pertinent to ask why the alcoholic turns to alcohol in the attempt to handle his existential anxiety. We live in a period of history when it is not easy to find genuinely religious answers. Contemporary religion in the West has lost much of the sense of the numinous and the transcendent. To use Ruth Benedict's two categories for describing religions, the Apollonian has taken over, the Dionysian has been squeezed out. In Jungian terms, the masculine (reason, ethics, logic, controls) has become dominant; the feminine (feeling, giving, mothering, accepting) has been repressed. Many contemporary religious expressions are pale and anemic, lacking in the ecstatic, the mystical, the numinous. When religion loses its spine-tingling quality, alcohol is substituted by many. The prayer of St. Augustine, "Oh, that Thou wouldst enter into my heart and inebriate it... has wishful overtones for modern man.

The contemporary crisis in values makes it difficult for many persons to find a philosophy of life that is so vital it bleeds when cut. Community consensus has been a casualty of rapid social change, urbanization and high population mobility. It is not an easy time for the individual to find what Fromm (9, p. 21) calls "a frame of orientation and an object of devotion." The breakdown of a strong sense of community is another aspect of our times which makes it difficult to find relatedness. In his review of Peter Viereck's book, The Unadjusted Man; A new Hero For Americans, Geoffery Brunn writes:' "Ours is an orphan age, severed from its historic past by the transforming impact of dynamic technology. Today every individual in the 'lonely crowd' is haunted by a sense of desolation and incommunicable singularity." Our much bewailed conformity is a symptom of the breakdown of community - the uprooting of those relationships of mutual trust within which existential anxiety can be handled constructively and self-esteem can flower.

Tillich (12, p. 62) summarizes the impact of these general characteristics of our times, so far as existential anxiety is concerned; "The anxiety which, in its different forms, is potentially present in every individual, becomes general if the accustomed structures of meaning, power, belief and order disintegrate. These structures, as long as they are in force, keep anxiety bounded within a protective system of courage by participation....In periods of great change, these methods no longer work."

The general factors described above obviously affect all of us, including the alcoholic and those who would help him. But the alcoholic appears to be particularly devastated by the impact of his existential anxiety and two factors seem to account for this. On the one hand, his existential terror of nonbeing is complicated by a heavy burden of neurotic fear of death resulting from psychological damage during the oral period. On the other hand, because of his exaggerated dependency - autonomy conflict, he is unable to avail himself of the experiences in adolescence and young adulthood which would help him handle his anxiety constructively. An examination of these two factors is in order at this point.

The psychoanalytic view of alcoholism points in the direction of a basic disturbance of the mother-infant relationship in the first year of life. Because of some inadequacy in the quality of this relationship, the prealcoholic did not develop what Erik Erikson has called "basic trust." He did not experience the world as trustworthy. Basic trust constitutes the foundation for all subsequent relationships of trust, including trust in God. The extreme narcissism of drinking alcoholics has been noted by many students of the subject. This is directly related to the lack of basic trust. The person who regresses to narcissism when his self-esteem is threatened, as the alcoholic does, is one who sustained a psychological injury during that period when narcissism was normal, the first year. Because of this injury, the person continues into adulthood yearning for the "undifferentiated pleasure of body and mind" (1, p. 99) which were in short supply during the nursing period. From the threat to his very existence which is present in the deprivation of adequate love-sucking-security-warmth, the individual develops terrible fears of dying mixed with intense rage feelings toward the object perceived as depriving. It is noteworthy that many adult alcoholics respond as though the entire world of relationships were a bad brest, a depriving mother. Such alcoholics form impossible demanding dependencies and then feel angry and rejected when their grandiose demands are not met.

In the case of the infant who experienced the outside world as untrustworthy, his only feeling of safety was that which he could create in his inner world. Because he was actually so weak and dependent on others, he had to fantasy himself as very strong. Freud used the phrase "His Majesty the Baby" in this connection. In order to find even the illusion of safety, the baby retreats into a world where he is his own love object. His narcissism is an attempt to protect himself from the fear of death which is ever present.

The deeper the alcoholic regresses in an individual binge and in the progression of his illness, the more complete the narcissistic focus of his love energy becomes. But this very regression to the infantile defense of narcissism exposes him to the terrifying giants and demons of the infant-level inner world. The overwhelming "nameless" fears of advanced alcoholism can be understood in this framework of thought. The intense fear of dying and devouring rages toward the depriving object are revived in the alcoholic. Only added alcohol-induced grandiosity can even begin to hold them in check. Spiraling waves of feelings of omnipotence are out desperate attempts to cope magically with the fear-giants and cannibalistic rages of the infantile world (which is also the world of psychosis). Thus his existential anxiety is compounded and made unmanageable by his oral-level neurotic fear of death.

DEPENDENCY CONFLICTS and SECONDARY TRUST

The second reason why the alcoholic is peculiarly exposed to this existential anxiety is that his extreme dependency-autonomy conflict prevents him from forming healthy dependency relationships. McCord and McCord, on the evidence from a longitudinal study of alcoholism, based on data from the Cambridge-Somerville delinquency prevention project, conclude: "The major force which seemed to lead a person under heavy stress to express his anxiety in alcoholism was the erratic frustration of his dependency desires." (16, p. 152). The original project, beginning in 1935, included 650 boys, both "normal" and "predelinquent." By the time of the analysis of the data, about 25 years later, 10 per cent of the subjects had become alcoholics. But a lower percentage of those who experienced overt rejection by their mothers eventually became alcoholics than of those whose mothers were alternately loving and rejecting. One third of the latter group had become alcoholics in their 30's. As Pavlov and others have demonstrated, the erratic, alternate frustration and satisfaction of a need enhances the strength of that need. McCord and McCord reason that the prealcoholic is involved in an endless quest to satisfy powerful dependency needs which, in our culture, are unacceptable to males. Alcohol is highly functional in the psychic economy of such a person because simultaneously it can give him feelings of dependence and allow him to maintain his image of rugged virility by "drinking like a man." It is when, through the effects of prolonged excessive drinking, the self-image of the independent he-man breaks down, that alcoholism develops.

McCord and McCord divided the boys in their study into Protestant-Catholic groups and the parents of each of these into strong-weak religious interest. They found that approximately equal percentages of Protestant and Catholic boys eventually became alcoholics, that the strength of the father's religion had no relevance, and that the same applied to the strength of religious interest by the Protestant mothers. In the case of the Catholic subjects, however, only 4 per cent of those whose mothers' religion was rated "strong" became alcoholics, whereas 21 per cent of those whose mothers' religion was rated "weak" became addicted. The investigators believe that this outcome is related to what sociologists have called the "Protestant ethic," which has become the heart of middleclass values for most Americans of all faiths. This ethic is characterized by an emphasis on success achieved through masculine independence, competition and self-reliance. These values tend to increase the prealcoholic's rejection of his own dependent side. Those strongly influenced by Catholicism with its emphasis on feminine symbols, dependency and being a part of a supernatural organism, have a channel for satisfying their dependency needs at the same time that they assert their independence through masculine success in their work.

In those cases in which the Protestant ethic dominated the home, the prealcoholic probably experienced great difficulty in finding satisfying dependency relationships in the church or in a neaningful relationship to a higher Power. McCord and McCord found that, for the most part, the alcoholics were raised by parents who were nominally religious but lacking in a deep commitment to their faith. They conclude: "Raised in such an environment, it is unlikely that the prealcoholic would place much reliance on the church. Thus, one major outlet of his conflict-submergence in a strong religious faith-would be denied to him. Unlike the strongly religious person, the prealcoholic would tend to withdraw from the comforts of the church; he could not express his dependent longings by seeking direction from God, the priest, the minister or the elders. He could not find, in the church, the sure direction and guidance that he lacked in his early life" (16, p. 155).

One might say that the prealcoholic's early problem with his mother prevented him from finding the experience of trust in "mother church." The same could be said for the other social institutions in which trust-full relationships are available for adolescents and adults in our culture. The person who is not a prealcoholic and who carries major deficiencies in the area of basic trust from his early life can find periodic reaffirmation of trust in religion. Erikson, in a discussion of "the sense of inner identity," states: "We must ask ourselves what the social institutions are which support the individual in the basic conflicts...and which give him continuing collective reassurance when his personal development may have left a residue of insecurity. There can be no question but that it is organized religion which by way of ritual methods offers man a periodic collective restitution of basic trust which in adults ripens to a continuation of faith and realism" (17, p. 353). This second chance at experience of trust is apparently relatively unavailable to the prealcoholic.

People shape their personal religion in terms of their inner needs. The alcoholic provides a vivid illustration of this general principle. His religious life tends to reflect his narcissism and his dependence-autonomy conflict. He often expects God to take care of him in infantile, magical ways. He tries to use God as an overprotective grandmother whose main function is to extricate him from alcoholic scrapes scot free. He makes impossible demands, expects a special set of rules-of-the-game, and then feels rejected when God does not "come through" according to his demands. His religion both reflects and enhances his narcissistic self-worship and his dependency conflict. Rather than allaying anxiety it increases it because it operates in the same manner as his neurosis. The underlying meaning of much alcoholic atheism seems to be, "All right, if you won't take care of me like a child, I'll show you, I'll destroy you by the magic of thought-by not believing in you at all!"

Blocked from finding normal dependency and trust-producing relationships, the alcoholic is left at the mercy of his neurotic and his existential anxieties. Between these two forms of anxiety there is a reciprocal relationship. As Tillich points out, a high degree of neurotic anxiety renders one hypersensitive to the threat of non-being (12, p. 67) and, conversely, "those who are empty of meaning are easy victims of neurotic anxiety" (p. 151). As he puts it, neurotic anxiety may be seen as a way of avoiding non-being by avoiding being (or defending oneself against the fear of death by not being fully alive). As we have seen, the alcoholic's extreme dependency conflict makes him unable to form trustful relationships. He is too concerned with hiding his dependency, too angry with frustrating dependency objects. The effect is circular: the more he is cut off from trustful relationships, the more his dependency cravings spiral, and with them his anger at depriving parent-symbols. The angrier he feels, the more cut off he must be to protect himself from expected retaliation. This spiraling mingles with the spiraling impact of existential anxiety in the advancing stages of the illness.

SURRENDER AND THERAPY

The key to understanding the psychodynamics of recovery, how some alcoholics escape from the self-perpetuating mechanism, is the concept of "surrender" which Tiebout has explored extensively (18, 19, 20).

The phenomenon which he describes has been observed by various workers in the clinical encounter. Using Tiebout's important contributions as a foundation, an alternative approach to understanding the nature of surrender will be set forth. The alcoholic "hits bottom"-i.e. his pseudo-religious solution no longer functions effectively and, at a deeper level, his narcissistic defenses no longer protect him from his fear of death and meaninglessness. The surrender experience, which may occur at this point, has two essentials: First, the unconscious renunciation of the disintegrating defense of infantile narcissism, which he gives up in order to avoid the overwhelming infantile anxieties to which this regression exposes him. Second, in hopelessness, the alcoholic makes a desperate leap. One alcoholic gave this description of the experience: "It's a leap of fear. You leap the chasm blindly, not knowing what's on the other side. Fear is pushing you and hope is pulling you." Another put it aptly when he described his experience as "letting go of my I-ism." He went on to describe the change in his distorted view of the world of relationships. During his thinking, his world had been peopled by depriving mother-figures. Having taken the leap toward trust, he discovered in A.A. that trustworthy relationships were available, that he could distribute his dependency within the group, and that he could participate in the give as well as the take of relationships. For him, as for many alcoholics, this was a striking new experience. In effect he broke the vicious cycle of spiraling isolation and anger, "rejoined the human race," and thus acquired new and more effective ways of handling his anxiety.

Particularly significant, so far as the present discussion is concerned, he learned in A.A. an effective way of handling his existetial anxiety. This happened gradually through the so-called "spiritual angle." During the narcissim of active alcoholism, he had become his own mother, his own god. The essence of surrender is to stop playing god, or rather, to let go of the need to play god. The A.A. program helps the alcoholic curb his tendency to retreat to infantile, magical religion. It accomplishes this by suggesting to him that he line up his life with reality rather than expect reality to adapt itself to him. This is the significance of the 11th Step of the A.A. program: "...praying only for knowledge of His will for us and the power to carry it out." This, like the other aspects of the A.A. "spiritual angle," assists the alcoholic in building an approach to a higher Power that is the exact opposite of his typical approach during his drinking days. The alcoholic develops humility and he begins to grow in his ability to trust. His spiritual growth occurs, as such growth nearly always does, in a group committed to spiritual values. The A.A. group thus gives the individual another opportunity to establish a trustful relationship with a higher Power. Like a good family, the group symbolizes, incarnates and communicates the acceptance of the higher Power. As his relationship with the higher Power grows, it reinforces his ability to trust people and to become a giving person. By staying in a dependent relationship with the higher Power, he is helped to retain his humility and to resist the temptation to return to narcissistic self-idolatry and to drinking.

Yet the surrendered alcoholic must continue to exercise vigilance to avoid losing his humility. The underlying problem of infantile narcissism is not resolved but instead is walled off in the experience of surrender. When deep-seated anxieties are aroused by threats to his self-esteem or by failure to grow spiritually, the old temptation to regress to his primitive defense and curse still remains. This accounts for the necessity which most A.A. members feel to "work the program" continually, even though their sobriety has been stabilized for years.

As relationships of trust are established - with others and with a higher Power - existential anxiety becomes, in Kierkegaard's word, a "school." The alcoholic is able to face and integrate his existential anxiety within his self-system. Tillich holds that it is only as existential anxiety is confronted and taken into self-affirmation of the person that it enriches rather than diminishes life. In his classic work, The Concept of Dread, Kierkegaard pointed out that in the very experience of facing anxiety an individual is educated to inner certitude or faith. This gives him the "courage to renounce anxiety without any anxiety, which only faith is capable of - not that it annihilates anxiety, but remaining ever young, it is continually developing itself out of the death throes of anxiety" (21, p. 104).

The alcoholic in whom this has occured has, as one of them put it, learned to "die living rather than live dying." Existential anxiety has become a life-enhancing force which has been responded to in such a way as to produce inner resources which aid rather than hinder the handling of neurotic anxiety.

SUMMARY

A tentative, theoretical structure is set forth as an approach to understanding the role of existential anxiety and its relationship to neurotic anxiety in the alcoholic. Certain evidence which suggests a dynamic interrelationship between alcohol and alcoholism, on the one hand, and religion, on the other, is reviewed. The thesis is presented and examined that one of the significant factors in the etiology of alcoholism is the vain attempt of the person to satisfy deep religious needs by means of alcohol. Psychoanalytic, sociological and philosophical views are presented and interrelated as they seem to contribute to an understanding of why the alcoholic tends to use alcohol in this way and thus mishandles his existential anxiety. The role of religious factors in recovery from alcoholism is discussed with particular emphasis on the conception of surrender.

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*Posted with permission from Alcohol Research Documentation, Inc., publisher of the Quarterly Journal of Studies on Alcohol (now the Journal of Studies on Alcohol and Drugs [www.jsad.com])

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