- THE EGO
- IN SURRENDER
M. Tiebout, M.D.
By Two Definitions
to Accept Frustration
Compromise With Ego
the past 15 years, my understanding of the nature of alcoholism
as a disease has been influenced largely by insight into the mechanisms
at work in the Alcoholics Anonymous process. Some years ago I stated
that A.A., to succeed, must induce a surrender on the -part of the
individual I. More recently, I discussed the idea of compliance
acting as a barrier to that real acceptance which a surrender produces.
On this occasion I propose to extend my observations by discussing
(a) what factors in the individual must surrender, and (b) how the
surrender reaction changes the inner psychic picture.
first question, what factors in the individual must surrender received
passing attention in the article on compliance. There, relative
to the difficulty of surrender, I noted that "the presence
of an apparently unconquerable ego became evident. It was this ego
which had to become humble." The first part of the present
communication will be devoted to an elaboration of the nature of
this ego factor.
of the word "ego" involves always the possibility of confusion
of meaning. For a time, therefore, I considered a substitute term.
That idea was set aside because, despite possible misinterpretation,
the word ego is current in everyday language in exactly the sense
in which it will be employed in this discussion. The expression,
"he has an inflated ego," is self-explanatory. It evokes
the picture of a pompous, self-important, strutting individual whose
inferiorities are masked by a surface assurance. Such a person appears
thick-skinned, insensitive, nearly impervious to the existence of
others, a completely self-centered individual who plows unthinkingly
through life, intent on gathering unto himself all the comforts
and satisfactions available. He is generally considered the epitome
of selfishness, and there the matter rests.
popular view of ego, while it may not have scientific foundation,
has one decided value: it possesses a meaning and can convey a concept
which the average person can grasp. This concept of the inflated
ego recognizes the common ancestor of a whole series of traits,
namely, that they are all manifestations of an underlying feeling
state in which personal considerations are first and foremost.
existence of this ego has long been recognized, but a difficulty
in terminology still remains. Part of the difficulty arises from
the use of the word ego, in psychiatric and psychological circles,
to designate those elements of the psyche which are supposed to
rule psychic life. Freud divided mental life into three major subdivisions:
the id, the ego and the superego. The first, he stated, contains
the feeling of life on a deep, instinctual level; the third is occupied
by the conscience, whose function is to put brakes on the impulses
arising within the id. The ego should act as mediator between the
demands of the id and the restraints of the superego, which might
be over-zealous and bigoted. Freud's own research was concerned
mainly with the activities of the id and the superego. The void
he left with respect to the ego is one that his followers are endeavoring
to fill, but as yet with no generally accepted conclusions.
Ego: By Two Definitions
word ego, however has been preempted by the psychiatrists and psychologists,
although they do not always agree among themselves about the meaning
to be attached to it. The resulting confusion is the more lamentable
because almost everyone, layman or scientist, would agree on the
concept of the inflated ego. It would be helpful if other terms
were found for the ego concepts about which there are differing
solution for this dilemma will be to indicate with a capital E the
big Ego, and without a capital to identify the personality aspect
which Freud had in mind when he placed ego between id and superego.3
this disposition of the problem of terminology, it is now possible
to consider the first issue, namely, the Ego factors in the alcoholic
which, through surrender, become humble. The concept of the enlarged
Ego, as noted previously, is available to common observation. Those
who do not recognize it in themselves can always see it in some
member of their family or among friends and acquaintances -- not
to mention patients. Everyone knows egotistical people and has a
perfectly clear idea of what the word means. Besides egotistical,
and the series of words mentioned earlier, adjectives which help
to round out the portrait of the egotistical person are prideful,
arrogant, pushing, dominating, attention seeking, aggressive, opinionated,
headstrong, stubborn, determined and impatient.
these terms are inadequate, however, because they describe only
surface features without conveying any feeling of the inner essence
from which the Ego springs. Unless some appreciation for the source
of the Ego is gained, the dynamic import is lost and the term may
seem merely a form of name calling. It is easy to say someone has
a big Ego without awareness of what is really happening in the deep
layers of that person's mind, without perception of the Ego. Nor
is it a matter of intellect. The need here is to lay hold of the
inner feeling elements upon which the activity of the Ego rests.
Only when these elements become clear can the fundamental basis
of the Ego also be clarified.
is convenient, for the exposition of this inner functioning, to
reverse the usual sequence and to present a conclusion in advance
of the evidence on which it is based. This is, briefly, that the
Ego is made up of the persisting elements, in the adult psyche,
of the original nature of the child.
aspects of the infant's psyche may be usefully examined. There are
three factors which should receive mention. The first is, as Freud
observed in his priceless phrase "His Majesty the Baby,"
that the infant is born ruler of all he surveys. He comes from the
Nirvana of the womb, where he is usually the sole occupant, and
he clings to that omnipotence with an innocence, yet determination,
which baffles parent after parent. The second, stemming directly
from the monarch within, is that the infant tolerates frustration
poorly and lets the world know it readily. The third significant
aspect of the child's original psyche is its tendency to do everything
in a hurry. Observe youngsters on the beach: they run rather than
walk. Observe them coming on a visit: the younger ones tear from
the car while their elder siblings adopt a more leisurely pace.
The three-year-olds, and more so the twos, cannot engage in play
requiring long periods of concentration. Whatever they are doing
must be done quickly. As the same children age, they gradually become
able to stick to one activity for longer times.
at the start of life the psyche (1) assumes its own omnipotence,
(2) cannot accept frustrations and (3) functions at a tempo allegretto
with a good deal of staccato and vivace thrown in.
the question is, "If the infantile psyche persists into adult
life, how will its presence be manifested?"
general, when infantile traits continue into adulthood, the person
is spoken of as immature, a label often applied with little comprehension
of the reason for its accuracy. It is necessary to link these three
traits from the original psyche with immaturity and, at the same
time, show how they affect the adult psyche. If this is done, not
only will the correctness of the appellation "immature"
be apparent but, moreover, a feeling for the nature of the unconscious
underpinnings of the Ego will have been created.
steps can aid in recognizing the relationship between immaturity
and a continuance of the infantile elements. The first is, by an
act of imagination, to set these original traits into an adult unconscious.
The validity of this procedure is founded upon modern knowledge
of the nature of the forces operating in the unconscious of people
of mature age. The second step is to estimate the effect that the
prolongation of these infantile qualities will have upon the adult
attempt should not strain the imagination severely. Take, for instance,
the third of the qualities common to the original psychic state,
namely, the tendency to act hurriedly. If that tendency prevails
in the unconscious, what must the result be? The individual will
certainly do everything in a hurry. He will think fast, talk fast
and live fast, or he will spend an inordinate amount of time and
energy holding his fast-driving proclivities in check.
the net result will be an oscillation between periods of speeding
ahead followed by periods during which the direction of the force
is reversed, the brakes (superego) being applied in equally vigorous
fashion. The parallel of this in the behavior of the alcoholic will
not be lost on those who have had experience with this class of
us take the same trait of doing everything in a hurry and apply
it to the word "immature." Few will deny that jumping
at conclusions, doing things as speedily as possible, give evidence
of immaturity. It is youth that drives fast, thinks fast, feels
fast, moves fast, acts hastily in most situations. There can be
little question that one of the hallmarks of the immature is the
proneness to be under inner pressure for accomplishment. Big plans,
big schemes, big hopes abound, unfortunately not matched by an ability
to produce. But the effect upon the adult of the persisting infantile
quality to do everything in less than sufficient time can now be
seen in a clearer light. The adult trait is surely a survival from
the original psyche of the infant.
two other surviving qualities of the infantile psyche similarly
contribute to the picture of immaturity and also, indirectly, help
to clarify the nature of the Ego with a capital E. The first of
these, the feeling of omnipotence, when carried over into adult
life, affects the individual in ways easily anticipated. Omnipotence
is, of course, associated with royalty, if not divinity. The unconscious
result of the persistence of this trait is that its bearer harbors
a belief of his own special role and in his own exceptional rights.
Such a person finds it well-nigh impossible to function happily
ordinary level. Obsessed with divine afflatus, the thought of operating
in the lowly and humble areas of life is most distressing to him.
The very idea that such a place is all one is capable of occupying
is in itself a blow to the Ego, which reacts with a sense of inferiority
at its failure to fill a more distinguished position. Moreover,
any success becomes merely Ego fodder, boosting the individual's
rating of himself to increasingly unrealistic proportions as the
king side eagerly drinks in this evidence of special worth.
ability to administer the affairs of state, both large and small,
is taken for granted. The belief that he is a natural executive
placed in the wrong job merely confirms his conviction that, at
best, he is the victim of lack of appreciation, and at worst, of
sabotage by jealous people who set up roadblocks to his progress.
The world is inhabited by selfish people, intent only on their own
genesis of all this is beyond his perception. To tell him that his
reactions spring from the demands of an inner unsatisfied king is
to invite incredulity and disbelief, so far from the conscious mind
are any such thoughts or feelings. People who openly continue to
cling to their claims of divine prerogative usually end up in a
world especially constructed for their care. In others, the omnipotence
pressures are rather better buried. The individual may admit that,
in many ways, he acts like a spoiled brat, but he is scarcely conscious
of the extent of the tendency, nor how deeply rooted it may be.
He, like most people, resolutely avoids a careful look because the
recognition of any such inner attitudes is highly disturbing. The
unconscious credence in one's special prerogatives savors too much
of straight selfishness to be anything but unpleasant to contemplate.
so, for the most part, people remain happily ignorant of the unconscious'
drives which push them around. They may wonder why they tend to
boil inside and wish they could free themselves from a constant
sense of uneasiness and unsettlement. They may recognize that they
seem jittery and easily excited and' long for the time when they
can meet life more calmly and maturely; they may hate their tendency
to become rattled. But their insight into the origin of all this
is next to nothing, if not a complete blank. The king lies deep
below the surface, far out of sight.
Inability to Accept Frustration
last trait carried over from infancy is the inability to accept
frustration. In an obvious sense, this inability is another aspect
of the king within, since one of the prerogatives of royalty is
to proceed without interruption. For the king to wait is an affront
to the royal rank, a slap at his majesty. The ramifications of this
inability to endure frustration are so widespread, and the significance
of much that occurs in the behavior of the alcoholic is so far-reaching,
that it seems advisable to discuss this trait under a separate heading.
already indicated, on the surface the inability of the king to accept
frustration is absolutely logical. The wish of the king is the law
of the land, and especially in the land of infancy. Any frustration
is clearly a direct threat to the status of his majesty, whose whole
being is challenged by the untoward interruption.
more significant is another aspect of this inner imperiousness.
Behind it lies the assumption that the individual should not be
stopped. Again, this is logical if one considers how an absolute
monarch operates. He simply does not expect to be stopped; as he
wills, so will he do. This trait, persisting in the unconscious,
furnishes a constant pressure driving the individual forward. It
says, in essence, "I am unstoppable!"
unconscious which cannot be stopped views life entirely from the
angle of whether or not a stopping is likely, imminent, or not at
all in the picture. When a stopping is likely, there is worry and
perhaps depression. When it seems imminent, there is anxiety bordering
on panic, and when the threat is removed, there is relief and gaiety.
Health is equated with a feeling of buoyancy and smooth sailing
ahead, a sense of "I feel wonderful!" Sickness, contrariwise,
means lacking vim, vigor and vitality, and is burdened with a sense
of "I'm not getting anywhere." The need to "get somewhere"
to "be on the go," and the consequent suffering from eternal
restlessness, is still another direct effect of an inner inability
to be stopped or, expressed otherwise, to accept the fact that one
is limited. The king not only cannot accept the normal frustrations
of life but, because of his inordinate driving ahead, is constantly
creating unnecessary roadblocks by virtue of his own insistence
on barging ahead, thus causing added trouble for himself.
course, on some occasions, the king gets stopped, and stopped totally.
Illness, arrest, sometimes the rules and regulations of life, will
halt him. Then he marks time, complies if need be, waiting for the
return of freedom, which he celebrates in the time-honored fashion
if he is an alcoholic: he gets drunk, initiating a phase when there
is no stopping him.
immaturity of such a person is readily evident. He is impatient
of delay, can never let matters evolve; he must have a blueprint
to follow outlining clearly a path through the jungle of life. The
wisdom of the ages is merely shackling tradition which should make
way for the freshness, the insouciance of youth. The value of staying
where one is, and working out one's destiny in the here and now,
is not suspected. The 24-hour principle would be confining for one
whose inner life brooks no confinement. The unstoppable person seeks
life, fun, adventure, excitement, and discovers he is on a perpetual
whirligig which carries him continuously ahead but, of course, in
a circle. The unstoppable person has not time for growth. He must
always, inwardly, feel immature.
then, is how the carry-over of infantile traits affects the adult
so encumbered. He is possessed by an inner king who not only must
do things in a hurry, but has no capacity for taking frustration
in stride. He seeks a life which will not stop him and finds himself
in a ceaseless rat race.
this is part and parcel of the big Ego. The individual has no choice.
He cannot select one characteristic and hang on to that, shedding
other more obviously undesirable traits. It is all or nothing. For
example, the driving person usually has plenty of energy, sparkle,
vivacity. He stands out as a most attractive human being. Clinging
to that quality, however, merely insures the continuance of excessive
drive and Ego, with all the pains attendant upon a life based on
those qualities. The sacrifice of the Ego elements must be total,
or they will soon regain their ascendancy.
Learning To Live
who view the prospect of life without abundant drive as unutterably
dull and boring should examine the life of members of Alcoholics
Anonymous who have truly adopted the A.A. program. They will see
people who have been stopped -- and who, therefore, do not have
to go anywhere -- but people who are learning, for the first time
in their lives, to live. They are neither dull nor wishy-washy.
Quite the contrary, they are alive and interested in the realities
about them. They see things in the large,are tolerant, open-minded,
not close-minded bulling ahead. They are receptive to the wonders
in the world about them, including the presence of a Deity who makes
all this possible. They are the ones who are really living. The
attainment of such a way of life is no mean accomplishment.
to this discussion, the conclusion was offered that the Ego was
a residual of the initial feeling life of the infant. It should
be evident that the immaturity characteristically found in the make-up
of the alcoholic is a persistence of the original state of the child.
In connection with the description of the manifestations which denote
a large and active Ego, it should be recalled that the presence
in the unconscious of such Ego forces may be quite out of reach
of conscious observation. Only through the acting and feeling of
the individual can their existence be suspected.
the answer to the first question raised herein, namely, what part
of the alcoholic must surrender, is obvious: it is the Ego element.
without Ego is no new conception. Two thousand years ago, Christ
preached the necessity of losing one's life in order to find it
again. He did not say Ego, but that was what he had in mind. The
analysts of our time recognize the same truth; they talk also about
ego reduction. Freud saw therapy as a running battle between the
original narcissism of the infant (his term for Ego) and the therapist
whose task it was to reduce that original state to more manageable
proportions. Since Freud could not conceive of life without some
measure of Ego, he never resolved the riddle of how contentment
is achieved; for him, man to the end was doomed to strife and unhappiness,
his dearest desires sure to be frustrated by an unfriendly world.
his studies on the addictions, Rado3 more explicitly asserts that
the Ego must be reduced. He first portrays the Ego as follows: "Once
it was a baby, radiant with self-esteem, full of belief in the omnipotence
of its wishes, of its thoughts, gestures and words." Then,
on the process of Ego-reduction: "But the child's megalomania
melted away under the inexorable pressure of experience. Its sense
of its own sovereignty had to make room for a more modest self evaluation.
This process, first described by Freud, may be designated the reduction
in size of the original ego; it is a painful procedure and one that
is possibly never completely carried out."
No Compromise With Ego
Freud, Rado thinks only in terms of reduction; the need for the
complete elimination of Ego is a stand which they cannot bring themselves
to assume. Hence they unwittingly advocate the retention of some
infantile traits, with no clear awareness that trading with the
devil, the Ego, no matter how carefully safeguarded,' merely keeps
him alive and likely at any occasion to erupt full force into action.
There can be no successful compromise with Ego, a fact not sufficiently
appreciated by many, if not most, therapists.
the dilemma encountered in ego-reduction would be best resolved
by recognizing that the old Ego must go and a new one take its place.
Then no issue would arise about how much of the earliest elements
may be retained. The answer, theoretically, is none. Actually the
total banishment of the initial state is difficult to achieve. Man
can only grow in the direction of its complete elimination. Its
final expulsion is a goal which we can only hope.
second question raised here is, "How does the surrender reaction
change the inner psychic picture?" This question is based on
a presupposition, namely that surrender is an emotional step in
which the Ego, at least for the time being, acknowledges that it
is no longer supreme. This acknowledgment is valueless if limited
to consciousness; it must be accompanied by similar feelings in
the unconscious. For the alcoholic, surrender is marked by the admission
of being powerless over alcohol. His sobriety has that quality of
peace and tranquility which makes for a lasting quiet within only
if the surrender is effective in the unconscious and permanent as
effects of surrender upon the psyche are extremely logical: The
traits listed as~ characteristic of the Ego influence are canceled
out. The opposite of king is the commoner. Appropriately, Alcoholics
Anonymous stresses humility. The opposite of impatience is the ability
to take things in stride, to make an inner reality of the slogan,
"Easy does it." The opposite of drive is staying in one
position where one can be
open-minded, receptive and responsive.
picture of the non-Ego type of person might be amplified in many
directions but to do so would serve no immediate purpose. To have
discussed the effect of the Ego upon behavior, and to have pointed
out what may happen when the Ego is at least temporarily knocked
out of action, is sufficient to, make the point of this communication:
It is the Ego which is the arch-enemy of sobriety, and it is the
Ego which must be disposed of if the individual is to attain a now
way of life
to this point, no clinical material has been submitted to confirm
the ideas presented. Their validity will be apparent to many therapists.
One brief citation from clinical experience will be offered, however,
in the hope that it may serve as a concrete illustration of these
patient, a man in his late 30's, had a long history of alcoholism
with 7 years of futile attempts to recover through Alcoholics Anonymous,
interspersed with countless admissions to "drying out"
places. Then, for reasons not totally clear, he decided to take
a drastic step. He determined to enter a sanitorium and place himself
in the hands of a psychiatrist, a hitherto unheard of venom. We
planned to arrange for a limited stay at a sanitarium where he could
have regular interviews with me.
the outset, he was undeniably in earnest, although it was only after
the first interview that he really let go and could talk freely
about himself and the things that were going on inside him. After
the usual preliminaries, the first interview started with a discussion
of feelings and how they operate. The patient was questioned about
the word Ego as used at A.A. meetings. He confessed his ignorance
of its true meaning and listened with interest to brief remarks
on how it works. Before long, he was locating in himself some of
the Ego forces which hitherto he had been vigorously denying because
they savored too much of vanity and selfishness with that recognition,
the patient made a revealing remark. He said, in all sincerity,
"My goodness, I never knew that. You don't do your thinking
up here (pointing to his head), you think down here where you feel"
placing his hands on his stomach. He was learning that his feelings
had a "mind" of their own and that unless he heeded what
they were saying, he could easily get into trouble. He was facing
the actuality of his Ego as a feeling element in his life, a step
he was able to take because he was no longer going at full steam
ahead. His decision to place himself under care, a surrender of
a sort, had quieted him and made him receptive, able to observe
what was going on in himself. It was the beginning of a real inventory.
next insight he uncovered was even more startling. He had been requested
routinely to report any dreams he would have. Much to his surprise,
they appeared regularly during the period of contact. In his fifth
dream, the patient found himself locked up in an institution because
of his drinking. The interpretation offered, based upon relevant
materials, was that the patient equated any kind of stopping with
being locked up; that his real difficulty lay in the fact that he
could not tolerate being stopped, and abstaining was merely another
stopping he could not take. The patient's reaction to the interpretation
was most significant. He remained silent for some little time; then
he began to talk, saying, "I tell you, Doc, it was like this.
I'd get drunk, maybe stay on it 2 or 3 days, then I'd go into one
of those drying out places where I'd stay 5 or 6 days and I'd be
all over wanting a drink. Then I'd come out and stay sober, maybe
a week, 'maybe a month, but pretty soon the thought would come into
my mind, I want to drink! Maybe I'd go into a tavern and maybe not,
but sooner or later I'd go and I'd order a drink, but I wouldn't
drink it right off. I'd put it on the bar and I'd look at it and
I'd think and then I'd look and think: King for a day!" The
connection between Ego and his own conduct had become explicit,
as well as the relationship between not being stopped and Ego. He
saw clearly that when he took that drink, he was the boss once more.
Any previous reduction of Ego had been only temporary.
treatment, the problem is to make that reduction permanent. Therapy
is centered on the ways and means, first, of bringing the Ego to
earth, and second, keeping it there. The discussion of this methodology
would be out of place here, but it is relevant to emphasize one
point, namely the astonishing capacity of the Ego to pass out of
the picture and then reenter it, blithe and intact. A patient's
dream neatly depicted this quality. This patient dreamt that he
was on the twelfth floor balcony of a New York hotel. He threw a
rubber ball to the pavement below and saw it rebound to the level
of the balcony. Much to his amazement, the ball again dropped and
again rebounded to the same height. This continued for an indefinite
period and, as he was watching, a clock in a neighboring church
spire struck nine. Like the cat with nine lives, the Ego has a marvelous
capacity to scramble back to safety -- a little ruffled, perhaps,
but soon operating with all its former aplomb, convinced once more
that now it, the Ego, can master all events and push on ahead.
capacity of the Ego to bypass experience is astounding and would
be humorous were it not so tragic in its consequences. Cutting the
individual down to size and making the results last is a task never
completely accomplished. The possibility of a return of his Ego
must be faced by every alcoholic. If it does return, he may refrain
from drinking, but he will surely go on a "dry drunk,"
with all the old feelings and attitudes once more asserting themselves
and making sobriety a shambles of discontent and restlessness. Not
until the ego is decisively retired can peace and quiet again prevail.
As one sees this struggle in process, the need for the helping hand
of a Deity becomes clearer. Mere man alone all too often seems powerless
to stay the force of his Ego. He needs assistance and needs it urgently.
the process of surrender which the alcoholic necessarily undergoes
before his alcoholism can be arrested, the part of the personality
which must surrender is the inflated Ego. This aspect of personality
was identified as immature traits carried over from infancy into
adulthood, specifically, a feeling of omnipotence, inability to
tolerate frustration, and excessive drive, exhibited in the need
to do all things precipitously. The manner in which surrender affects
the Ego was discussed and illustrated briefly from clinical experience.
The object of therapy is to permanently replace the old Ego and
Tiebout, H.M. "The Act of Surrender in the Therapeutic Process."
With special reference to alcoholism. Quart. J. Stud. Aic. 10: 48-58,
H.M. "Surrender Versus Compliance in Therapy". With special
reference to alcoholism. Quart. J. Stud. Aic. 14: 58-68,1953.
S. "The Psychoanalysis of Pharmachothymia (drug addiction).
The clinical picture." Psychoanal. Quart. 2: 1-23, 1933.