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PSYCHIATRIC ANNALS Vol: 5:3, MARCH, 1975

ALCOHOLICS ANONYMOUS AND RELIGION
by Margaret Bean, M.D.

A.A. solves certain knotty problems of working with alcoholics by following a religious rather than a medical model in some particulars. If we consider what A.A. has borrowed from religion and how this operates, it may enrich our understanding of how and why A.A. functions as it does, what it offers, and how it solves some problems and gives rise to others.

"Religion" is such a broad term that it may help for us to isolate a few points and show how these are germane to the problem at hand. Man's religious experience probably developed from a very primitive form whereby magic was used to deal with the "emotional play between hope and fear" and ritual was used to allay anxiety. As the concept of a single God - considerably removed from man yet related to him - developed, the question arose concerning the means whereby the gap could be closed. Three modes, contrasting and interacting, seem to operate in all major religions: the individual's gradual sublimation of his physical nature into his spiritual, his identification with a community that stands in a private relationship to God, and his continuing rejection of acts or qualities perceived as "bad" in favor of those perceived as "good." These various processes give rise to techniques for their accomplishment: worship, ritual, symbol, ceremony, and an ethical system that relates the individual to the community.

We have observed that many of these are used in A.A., and it appears a little puzzling when A.A. states specifically that it is not a religion. Apparently what is meant here is that A.A. does not undertake to determine a member's relationship with God or the structures whereby he achieves this relationship. It is a secular cult that borrows strength from religious experience and may use existing religious structures.

The only aspect of God thought to be important in A.A. is help in staying sober. What it offers is a way of life to help one stop drinking, not to save one's soul or grow into a relationship with God.

But A.A. does incorporate another major aspect of religious thought: the struggle against evil. This is played in modern religious thinking to the point where we may not appreciate the force it has exerted in developing man's religious experience. A.A. is a distinctly Manichean system, with two powerful forces contending for possession of every member's life - alcohol (powerful, beautiful, and evil) and A.A. (powerful, noble, and good). In society, alcohol is regarded as a social good of moderate importance or as a nuisance to be managed by social control. In A.A. it is regarded as an evil of tremendous power. One of the qualities of an A.A. member that sets him apart is the awareness that he and others like him serve as the battleground for epic conflicts waged between elemental forces.

A.A. borrows a number of religious elements to manage this conflict between good and evil. There are historical figures resembling saints and prophets, such as Bill W., who is nearly canonized in A.A. There are ritual roles for leaders and new converts. There is a "bible" and a body of writing that is sometimes read aloud at meetings, like liturgy. The meetings resemble religious services, with prayers, confessions, and a collection. There is a feeling, sometimes explicit, of borrowing strength from conventional religion. Development of religious feeling is considered a safeguard against damaging narcissism, resentment, and self-pity. Each member is specifically instructed to invoke his Higher Power, since he alone cannot exorcise the demon of alcohol. The precise nature of the Higher Power and the person's relationship to it are deliberately not spelled out; the phrase "As we understood Him" occurs twice in the Twelve Steps. This vagueness has presented a problem in some religions in which the main point is man's relationship to God, but it does not cause any difficulty in A.A. because the focus there is not on God but on the struggle between alcohol and the A.A. way of life.

The A.A. system, based on a dualistic world view, has a valuable consequence in the relation between the helper and the helped. A.A. members trying to help an alcoholic achieve sobriety do not experience it as personal failure when the alcoholic relapses. In A.A., when the member drinks it is considered the loss of one battle in the war with the powerful and beautiful satanic force. It is quite comprehensible and does not diminish the intrinsic value of the drinker or the validity of the helping effort. It is a sin against doctrine, not against one's fellow man; the defect is defined as not enough A.A. The forces of good ultimately will triumph over the alcohol, but it is expected to be often a nearly even struggle. This brilliantly sidesteps one weakness of the medical model, in which drinking is seen as disgusting rather than compelling, so the chronicity of recurrent drinking is blamed on the weakness of the drinker and the failure of the helper.

Obvious analogies to religion roles occur in A.A. The role of the priest is traditionally that of mediator between God and the people. Both the people and the priest's own standard demand that he live a holy life as defined by the goals of the system. His function is to transmit and interpret God to the people, call them back to the ethical life, and perform rituals and acts of sanctification. In A.A. there are priestly or prophetlike figures, the A.A. veterans and sponsors, who are felt to be mediators between the A.A. method and the members. They are under pressure to express in their lives the highest realization of the A.A. ethical system, so it is logical that the leadership emerges from those who have both charismatic qualities and long periods of sobriety without relapse.

Sponsors and veterans serve some priestly function but abjure others. They interpret the A.A. word as embodied in the A.A. writings. They urge members back to the Traditions and Steps. They do not perform sacraments, and they do not decide who is properly related to the group and the doctrine. Confession, absolution, and penance are transacted not between a sinner and a priest but between the member and the group. The sponsors and veterans act collectively and socially only to define the ethical system, and do not in individual cases pass judgment on any member.

I think there are good empirical reasons for this. In A.A. a constant struggle has occured to keep individuals out of power, to protect the structure of the organization against ambition, to ensure an analogue to our current concern for a government of laws and not men. Alcoholics have felt social opprobrium so often that they are acutely sensitive to the danger of giving any member the power to censure another. Guilt is handled not by explicit individual absolution but by implicit collective acceptance of a person's confession. A model that includes punishment by excommunication would be dangerous to A.A., for there is no need to tell an ex-alcoholic that drinking will bring hellish punishment. He knows. For a group of extremely self-destructive people who have primitive and cruel superegos, an organization that controls by attraction and persuasion rather than punishment is a thoughtful way to avoid many problems, and is more effective by virtue of its humaneness.

A.A. shares other external supports and controls with religious systems. One is the use of forgiveness to restore continuity between a transgressor and the social context in which the individual moves towards his ideal. In those religions in which concepts of sin are emphasized, the sinner comes to the absolver; God grants absolution through the priest, and the person usually performs a restorative act. The person's attachment to God and the community is renewed, his relationships are restored, and he is freed from guilt. If we were to consider one aspect of psychotherapy as the freeing from limitations and growth towards an ideal, it would include similar mechanisms of identification of acts of feelings perceived as dysfunctional, giving these up on the therapeutic encounter, reinforcing allegiance to the ideal, and consequent freeing of energy for growth.

In A.A., people confess their past transgressions first to themselves, secondly to another person, and thirdly to a public gathering. This ritual act functions in a complex way to decrease anxiety and improve felt competence. Admitting the behavior may defuse the affect associated with it, assuaging guilt and making stigma more bearable. Confessional speeches are cathartic and deal with social conventions about alcohol by simultaneously confirming, flouting, and working to change them. The needs for punishment and for admiration are both met by the not-very-secret meeting where the speaker degrades himself by public confession and description of his alcoholism before an audience that does not hold him culpable and whose members relish with him the shocking details of his drinking experience.

Many persons are familiar with the confession/penance mechanism only as it functions in the Catholic branch of Christianity, with the requisite participation of a priest. Other modes of religious expression incorporate the same mechanism without a priest; the individual may do it himself or through the action of the community. A closer parallel to the A.A. experience occurs within Fundamentalist Protestant experience. "Typically, after having been crushed by guilt and despair they describe how, within a supportive group, a radical turning point is experienced, in which they deeply feel the acceptance and grace of God, whereupon a rich flow of gratitude and freedom motivated them to reshape their behavior." In A.A. all these elements are present, with hope substituted for grace. The cause of the despair is alcohol, equated with sin, and the behavior to be changed is drinking. These testimonial confessions serve several purposes: they corroborate the ethical system, free the individual of guilt, affirm his status as a member of the community, and provide examples and encouragement in the form of identification figures, role models, and instruction by example in how sobriety was achieved.

Confession in A.A. has a number of psychological functions, such as expressing self-destructiveness in a manner less destructive than drinking, accomplishing universalization of experience so that the person does not feel alone in his badness, providing a frame for making identifications leading to improved object relationships, dramatizing as entertainment, and other complex methods.

Excommunication is the state in which a person, once in a positive relationship with a dogma or ethical life, is removed from it. It may be either an official action or a felt state. Alcoholics in A..A. who have had a lapse see themselves in a disturbed relationship with their ethical and social frame, and they know the ritual, symbolic, and social acts whereby they can restore the relationship. In A.A. a slip does not result in formal action of excommunication, though in an organization where the requirement for membership is a desire to stop drinking, continuing to drink brings members status into question. Relapse triggers not official condemnation but, rather, heavy caring pressure to restore the person's attachment to the community.

Another religious aspect of A.A. is Twelfth Step work: "Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs."

This is the correlate of evangelization and conversion of nonbelievers. Many observers have pointed out the importance of Twelfth Step work in A.A. It maintains the group, provides members with status, reinforces aversion to drinking, safeguards against idealization of drinking, and acts as a therapy for the helper. It functions as an ego defense in which the alcoholic can safely act out rescue fantasies and master conflict by projective identification and fullfillment of his own wish to be rescued, and it is a means of assuming a prestigious role as a missionary healer.

From the point of view of the organization's continuance, Twelfth Step work is adaptive. If there were no mechanism for recruitment of new members, A.A. would shrink and all the processes that rely on large numbers, wide geographic spread, numerous role models, and the doctrine that "nothing works but A.A." and "A.A. always works" would grind to a halt. It is psychologically vital to permit development of individual defenses: first reaction formation, counterphobia, and undoing and, as the person matures, sublimination and altruism.

The Twelfth Step worker in A.A. is the analogue of the missionary and healer in religion. He spreads the good news, achieves conversion of the uninitiated, ministers to the distressed and needy, and serves as an ethical model for the community and living proof of the efficacy of the system. His existence shows not only that the struggle against alcohol can be won but also that it can result in a meaningful and satisfying life. Twelfth Step activity bolsters his self-esteem, secures his defenses, and, by symbolic reminder of the wreckage of life and devastation of personality that can be wrought by alcohol, heightens his motivation to stay sober.

For many in A.A. it seems to work. One disadvantage of the limitation of the ethical system to the relation with alcohol is that missionary or priestly status seems to be the only way maturity can be conceived of in A.A. The person who gives up drinking and achieves mature functioning must express this by the A.A. formula, or he will have no role in A.A. The same thing often occurs in religious systems that see maturity only in terms of involvement in their system. I think there are many people who recover from alcoholism in A.A. and find they no longer need so much reaction formation and focus on the fearfulness of alcohol. They have internalized their defenses (at least partially) and have other important commitments and sources of meaning in their lives. A.A. does not provide very well for these people. It does not encourage their achievements elsewhere, and finds the fact that they can stay sober outside A.A. threatening. Such people are never mentioned to newcomers.

This leads to a basic difficulty that A.A. shares with religion: the question of authority and autonomy. Many religions have experienced the problem that arises when the individual internalizes the system and can function autonomously, no longer needing the community to maintain his proper relation to God.

In A.A. there are people in whom the same maturation has taken place. They no longer need the world view that divides all experience into evil and good, nor do they need the external supports, controls, and community reaction formation. A.A. rejects this possibility, and in doing so betrays its limited respect for man's capacity to change. A.A.'s fundamental strength, the dependence that works so well to facilitate the early establishment of sobriety, becomes a weakness or constraint for someone in the later stages of recovery. The same problem occurs for our patients who wish to maintain affiliation with a religious system that conflicts with their growth in personal maturity.

It may well be that the patient for whom A.A. was useful, aiding him to mourn alcohol and reinvest in controlled sobriety, must come to the point where he has to mourn A.A. and reinvest in further life goals. These are problems for which no solution exists. Professionals outside A.A. can at least be aware of them; if they find themselves working with a mature, recovering alcoholic, they can encourage him to understand what is happening and develop according to his own strengths and capabilities. We need not accept A.A.'s dictum that such capacities are limited.

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