THE CHRISTIAN CENTURY, Vol. 66: 1264-1266, October 26, 1949
SIN OR SICKNESS?
by J. Maurice Trimmer
A superior court judge in California recently ruled that a woman convicted of gambling was not a criminal by intent. She was, he said, suffering from some form of "psychomotor disorder." The judge accordingly issued instructions that she be given a medical examination. The specialist to whom her case was referred gave her two "electro-encephalogram" treatments, which in nontechnical language means electric shocks to the brain. He declared that the treatments should restore her sense of responsibility and cure her of the gambling fever.
The judgement of the court in this case reflects a pronounced trend. Human perversity is held to be a medical rather than a moral problem. The conception that a person who is guilty of wrongdoing is sick rather than sinful raises a number of pertinent questions: If certain forms of misbehavior are sickness rather than sin, why does the same diagnosis not apply to other misdeeds? By what criteria are judges to determine whether the rational individual who does wrong is willfully perverse or woefully pathological? If addiction to gambling is caused by a psychomotor disorder, why are not addictions to murder, adultery, stealing, lying, and other pernicious practices also attributable to the same ailment? Or does each represent a different but equally amoral reflex?
When Jesus answered the Pharisees who criticized him for associating with sinners, "They that are whole have no need of a physician, but they that are sick," what did he mean? In my opinion he meant to imply, not that sin is a form of sickness, but that sin produces a form of sickness. There is a radical difference between these two propositions. Certainly he did not intend to teach that all moral weakness, or even the worst type of it, is to be included in the category of illness over which the doer has no control. Just as the physician must go among those who are sick in order to heal them, so should the physician of souls go among those who are "sick" as a result of sinning to accomplish their conversion and redemption.
But there is a disposition in certain quarters to push the analogy much farther than Christ intended it to be carried. So we hear that those who violate recognized patterns and principles of behavior should have diagnosis rather than denunciation, treatment rather than punishment, cure rather than conversion. To insist that it is as irrational to stigmatize a person for gross offenses against right and decency as to stigmatize a patient for developing tuberculosis or cancer is pure sentimentalism.
Some schools of thought classify alcohol addiction as a medical rather than a moral problem and attribute it to sickness rather than to sin. Adherents of this attitude say in substance: Excessive indulgence in intoxicants is a symptom rather than a source of basic disorders in personality. The moralistic doctrine that the chronic alcoholic is a sinner and a criminal is medieval and unscientific. Those who are uncontrollably seduced by alcohol cannot be held responsible for the misfortunes they inflict upon themselves, their families and society. The trouble is not in the bottle but in the individual. Or it resides in certain structural ills of society, such as slums, broken homes, unemployment, maladjustments in jobs, racial conflicts, international tensions and war. This position not only removes all stigma from problem drinking but it has the highly convenient virtue of also completely absolving the liquor traffic from all blame for the manifold evils produced by its operations.
When Borden P. Browne was professor of philosophy at Boston University, a perplexed student asked him at the close of one of his classes, "Professor, did you say it was thus, or so?" Answered the philosopher: "My young friend, the longer you live in this strange world, the more things you will find in it of which you cannot truly say either-or, but must learn to say both-and." That wise observation, with its implied warning against being confused and deceived by false dilemmas, is certainly applicable to the subject under consideration. It suggests that the following is a realistic analysis of the situation.
MORAL AND MEDICAL
First, addiction to alcohol is both a medical and a moral problem. Neither the moral nor the medical approach is a sufficient solution in itself. Certainly the mere detention of drunks until they sober up is deplorably inadequate treatment of their condition. To confine problem drinkers in county jails, reformatories or houses of correction until the effects of intoxication have worn off, without any constructive effort to accomplish their permanent rehabilitation, is a medieval practice. Such cases should be under the care, not only of the police authorities, but of the public health authorities as well. Unquestionably many of them should be sent to hospitals rather than to jails. A number of states, including Wisconsin, New Hampshire, Connecticut, New Jersey, Massachusettes and Virginia, have inaugurated enlightened programs for the treatment of compulsive drinkers. In general they substitute the hospital for the jail and place a major emphasis on medical rehabilitation.
But alcoholic addiction is also a moral problem and should continue to be regarded as such. Addiction indicates that there are basic defects not only in the constitution but also in the character of the addict. To insist that drunkenness is not a disgrace but a disease, and therefore to sentimentalize it and attempt to remove all reproach from it, is just as unscientific as going to the opposite extreme and declaring the drunk to be a criminal and a sinner who deserves only condemnation and punishment. Arbitrarily to remove the stigma from alcoholic excesses while continuing to keep it on numerous other practices which are legally and morally opprobrious would not only be gross inconsistency but rank injustice as well. Drunkenness is both a disease and a disgrace. It deserves to receive both treatment and punishment. The problem drinker requires reformation of his character as well as the rehabilitation of his condition.
SCIENCE AND SPIRIT
Second, the solution of problem drinking demands both the scientific and spiritual approaches. Excessive indulgence in intoxicants is both a source of sickness and a symptom of it. The correct classification of the chronic alcoholic is a "sin-sick-soul." Making due allowance for different categories of problem drinkers, and acknowledging that no single type of treatment will be effective in every case, it nevertheless remains profoundly true that the most effective cures are obtained when the influences of religion are combined with the techniques of medicine.
That amazingly successful organization, Alcoholics Anonymous, recognizes this principle and utilizes it with highly benefical results. For that reason the processes of rehabilitation it employs are generally considered to be medically sound by physicians and religiously wholesome by clergymen. The organization refers a large number of its cases to medical practioners, especially in the initial stages of treatment. But it also invokes the assistance of the dynamic forces of religion to accomplish the permanent cure. It proceeds on the assumption that in alcoholic excesses there is a reciprocal relation between sin and sickness in cause and effect. Consider the "Twelve Steps" outlined in the book, Alcoholics Anonymous:
1. We admitted that we were powerless over alcohol - that our lives had become unmanageable.
2. We came to believe that a Power greater than ourselves could restore us to sanity.
3. We made a decision to turn our will and our lives over to the care of God as we understood Him.
4. We made a searching and fearless moral inventory of ourselves.
5. We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. We were entirely ready to have God remove all these defects of character.
7. We humbly asked Him to remove our shortcomings.
8. We made a list of all persons we had harmed, and became willing to make amends to them all.
9. We made direct amends to such people wherever possible, except when to do so would injure them or others.
10. We continued to take personal inventory and when we were wrong promptly admitted it. 11. We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of his will for us and the power to carry it out.
12. Having had a spiritual experience as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Note that the steps, which are the basis of A.A.'s remarkable success, are predominantly, definitely and deeply moral and spiritual. They are based on the conviction that the alcoholic is suffering from both sin and sickness, and more from the former than the latter. They prove that the Christian approach to his problem is of fundamental value, and that an experience equivalent to religious conversion is vitally essential to his permanent cure.
Third, both the problem drinker and the beverage alcohol business are to blame for the devastating consequences of excessive indulgence. The contention of the liquor interests that the ultimate source of the disorder lies in the individual rather than in the bottle is specious and false. The argument that the enterprises which promote and profit from the sale of intoxicants must be absolved of all blame because many people can indulge moderately without apparent harmful effects, is a flagrant fallacy. Certain groups which have rendered distinguished service by their clinical study of the medical and psychological aspects of compulsive drinking may not be excused for their disposition to exonerate the liquor business from major responsibility for the problem. Anybody who discourages militant opposition to the liquor traffic shares in responsibility for the lives it is helping to wreck. Certainly an essential approach to the satisfactory solution of the alcohol problem is a constant crusade to reduce, and ultimately to abolish, the manufacture, sale and consumption of alcoholic beverages. In addition, a persistent campaign to promote total abstinence should be waged.
It is far more sensible to put a fence around a dangerous cliff and so to prevent disastrous accidents than merely to place an ambulance in the valley to transport victims to the hospital. There are people who have become so enthusiastic about the ambulance as a solution of problem drinking that they have lost all interest in the fence. In principle both are essential, because many people who drink moderately for a while graduate into excessive drinking suddenly, or by a series of progressions, with no diagnostic signs discernible to doctors to mark the tragic transition. As long as such individuals have access to intoxicants their plight will be precarious. In their cases an ounce of prevention is worth many pounds of cure. A brotherly and compassionate spirit toward the compulsive drinker and a sincere concern for his moral and medical rehabilitation are entirely compatible with an unrelenting hatred of the liquor traffic and a steadfast effort to combat it, reduce it and abolish it. Those who are committed to the practice of abstinence and the principle of abolition should refuse to be impaled on the horns of the false dilemma of sin or sickness in connection with the alcohol problem.