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of Studies On Alcohol, September, 1963*
Factors In The
Etiology and Treatment Of Alcoholism
HOWARD J. CLINEBELL, Jr., Ph.D. *
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.
(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.
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.
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).
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.)
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.
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."
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
ANXIETY AND ALCOHOLISM
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
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.
(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.
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
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.
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."
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
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)
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.
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.
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).
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.
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.
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.
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.
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.
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
(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."
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.
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.
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
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.
CONFLICTS and SECONDARY TRUST
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.
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.
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).
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.
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!"
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.
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).
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
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.
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.
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).
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
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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with permission from Alcohol Research Documentation,
Inc., publisher of the Quarterly Journal of Studies
on Alcohol (now the Journal of Studies on Alcohol and