PASTORAL PSYCHOLOGY, Vol: 21 (No. 202), 1970
ALCOHOLICS ANONYMOUS AS GROUP LOGOTHERAPY
Robert M. Holmes*
"The alcoholics abiding need is for an 'acceptance experience' of such genuineness and certainty that it can move him beyond the stultifying restrictions of social rejection and self-rejection that encumber him."
Man was born to ask why he was born. It is his quest for meaning that makes him human. Many animals seek power, and any animal seeks pleasure, but only man seeks meaning. His preoccupation with this search is neither idle nor pathological, but urgently important if life for man is to rise appreciably above the animal level. The frustration entailed in this pursuit is not a hazard to be avoided or outgrown, but a constant tension that can give life its vitality. The absence of meaning dooms man either to the slow death of neurosis or to the instant death of suicide. Therefore it is to the discovery of meaning (by way of cultivation of responsibility in the present moment) that contemporary psychotherapy would do well to direct greater attention.
This, in broad outline, is the underlying philosophy of the Viennese psychiatrist, Viktor Frankl, and the fundamental orientation of his unique therapeutic approach which he calls "logotherapy." While Frankl is not the first to identify meaning as the principal clue to psychoneurosis and the key to its cure, he remains the one who has framed the problem concisely and emphatically within the psychotherapeutic context and has developed an entire therapeutic technique around it.
* Chaplain and Associate Professor of Christian Thought, Rocky Mountain College, Billings, Montana.
While the directness with which Frankl wrestles with his patients may seem crudely unpermissive to some counselers of a more Rogerian persuasion (some of his writing hints of a kind of "positive thinking with a Ph.D."), he reflects significant insights of such divergent existentialists as Heidegger, Kierkegaard, and Max Scheler, who have emphasized the individuality of each person's unique opportunity and necessity to live life and face death for himself. Frankl, as did Luther, asserts that each man's faith, like each man's death, is his own. His theory, in fact, is not unrelated to Paul Tillich's stress upon the need to recover "the lost dimension of religion" represented by ultimate Questions of meaning.
Interestingly, and quite coincidentally, there is, in our society, no group that provides a better laboratory for logotherapy goals than Alcoholics Anonymous. In. A.A., the quest for the meaning of life does not appear in these words as an explicit aim, but an examination of what actually happens in A.A. reveals that a fundamental concern for meaning is basic to the alcoholic's need and central to A.A.'s therapeutic program. The intent of this article is to show how A.A. functioning quite independently of Frankl or any other psychiatric tradition, and in fact virtually without psychiatrically-oriented or even professionally skilled leadership, operates with the very presuppositions which happen also to be basic to logotherapy. Moreover, if it can be shown that the experience of A.A. is essentially a "group logotherapy experience," certain wider implications can and should be drawn for groups within the church which are designed to meet a broad spectrum of human problems.
It is to Frankl's philosophy rather than to his clinical procedures that A.A. is to be compared. The four basic concepts of Frankl's doctrine of man seem also (though unwittingly, of course) to be fundamental to A.A.'s therapeutic program: 1) dimensional ontology; 2) existential frustration; 3) freedom; and 4) responsibility.
1. Dimensional Ontology
Man must be seem in terms of dimensions rather than layers or compartments, and to be understood fully must be viewed in all these dimensions simultaneously - namely, the psychic, the somatic, and the noetic. Yet it is in the noetic dimension that man's distinctly human nature and his divine potentialities are to be found. This is his "spiritual" nature. The word Frankl uses is geistig rather than geistlich. The latter means "spiritual" with a specifically religious connotation, while the former is translated "noetic" or spiritual without a necessary religious connotation. Frankl's choice of word is made out of respect for the limits of psychotherapy's concern: that is to say, the psychiatrist is not a theologian nor is the doctor's office a church. But ample room is left for the development of specific content with respect to the nature of God and the bearing of theological convictions upon the life of the patient. In any event, an acknowledgment of every individual's dimensional ontology and of the primacy of the noetic dimension as the avenue to his ultimate attainment of wholeness is fundamental in Frankl's anthropology.
Even the most intellectually sophisticated of A.A. members would probably be hard-pressed to articulate the concept of man that underlies A.A. philosophy. Many would, however, be able to testify from experience to the inadequacy of trying to meet the problem of alcoholism from some essentialist point of view that simply seeks to provide a psychiatric analysis of the past or medical "cure" for the present. The alcoholic has a psychological structure and history to be sure, just as he has a set of biological needs and problems. But he also possesses that other dimension too often overlooked if not specifically rejected - namely, the noetic.
If the alcoholic is really to be understood as a person he must be viewed in all of his dimensions. Many an alcoholic has a long history of futile attempts to deal with his drinking problem independently. In this sense, A.A. is profoundly existential in its approach in that its focus is upon a person with a drinking problem, the alcoholic as he "exists." There is no primary interest in the etiology of alcoholism generally or in an analysis of its customary symptoms, but only in the experience of the alcoholic. The extent to which the A.A. program encourages the alcoholic to become aware of his total existence is daring in its depth and often painful in its intensity. The original fellowship of A.A. was founded on the insight that one's drinking problem could not be separated from the total combination of his relationship to others, his attitude toward self, and his response to life. Herein lies the importance of steps four and ten of the Twelve Steps of A.A:
4.... made a searching and fearless moral inventory of ourselves.
10.... continued to take personal inventory and when we were wrong promptly admitted it.
Through the genius born of experience rather than religious training, A.A. has discovered that the alcoholic must not be dealt with as a bundle of symptoms or a pawn of drives, but as an existing person who must be met as a total self and must come to see himself in this way. With the help of Frankl, we might say that A.A. majors in the "existential act," which is that of "emerging oneself spiritually above one's own psychophysical condition."
The success of A.A. like that of logotherapy, is dependent upon the noetic dimension. Though both programs refuse to spell out God's nature in any specific terms, the reality of God and of the spiritual nature of man are basic assumptions of both. They concern themselves with the healing of the soul, leaving the saving of the soul to religion. But A.A. is unapologetic about the theocentrism of its program. Six of its twelve steps make specific reference to God. Repeatedly, in the handbook of A.A. the word "God" is followed by the modifying phrase, "as we understood him;" yet while 'A.A. does not press for an "objective" conceptualization of God, it speaks of its program as a "spiritual awakening."
2. EXISTENTIAL FRUSTRATION
Frankl's vast clinical experience and the frequency with which the psychotherapeutic needs of his patients seem to have been preceded by metaphysical needs, have led him to formulate the concepts of "existential frustration" and "existential vacuum." The former refers to the frustration of one's will to meaning, and "existential vacuum" refers to that condition of emptiness that exists when all meaning seems lost or undiscovered. In contrast to psychoanalysis' hasty translation of this concern for meaning into mere "instinct determinism," and the individual psychology's diagnosis of "inferiority complex," Frankl maintains that existentil frustration. far from being pathological, is the most human of phenomena.
While the etiology of alcoholism could hardly be reduced simply to existential frustration, the crucial role that it plays should not be too hard to see. For example, many psychologists and sociologists today speak of boredom as one of the factors in our nation's growing alcohol problem. They see a nation of people who are unequipped to use their increasing leisure time healthfully. Frankl speaks of existential vacuums becoming manifest in the condition of boredom, which, he says, demonstrates that even when all apparent needs are satisfied there is still a fundamental need that is not met which is not described on the psychic or somatic level.
He speaks of "victims of 'Sunday neuroses"' who "get drunk in order to flee from their spiritual horror of emptiness." Boredom, in the deepest sense, means not just lack of something to do, but lack of any real sense of purpose or meaning. The use of alcohol is one of the most prevalent escapes from this intolerable state. This would seem to explain why alcoholics are often rich, popular, highly skilled, and sometimes extremely gifted people. What possessions or abilities one has are always secondary to the meaning he finds in these endowments. If meaning is lost, no amount of evidence of well-being will provide a satisfying life. The slow death of alcoholism is selected as the only apparent alternative to suicide (though obviously, suicide is often chosen as the easier course). If the alcoholic is to be helped, then, it will not be by making him see the dangers of his drinking or by increasing his already intolerable sense of guilt for his gross misuse of life, but by meeting him at the point of his sense of meaninglessness - his existential vacuum.
While not using any of the technical terminology, this is precisely what A.A. does. It achieves it in two ways: first by providing an acceptance experience in which the alcoholic's worth as a person is reaffirmed, irrespective of his alcoholism, and second, by providing him with a sense of purpose that arises not in spite of his alcoholism but out of the very fact of it!
The affirmation of personal worth. To Frankl this is crucial to all good therapy. In his encounters with patients he makes frequent reference to the value of the contributions the patient has made in his past life and of his potential for the future. His stress upon the supreme importance of "attitudinal values" is aimed at helping the patient achieve, or retrieve, a sense of personal integrity and importance by seeing the unique opportunities that are his and his alone. If one can create little, thus possessing few "creative values," and even if one's sphere of experience is limited, thus providing little in the way of "experiential values," each patient has a unique and almost limitless field of "attitudinal values" which arise out of the manner in which he faces and deals with his particular existential situation.
The alcoholic's abiding need is for an "acceptance experience" of such genuineness and certainty that it can move him beyond the stultifying restrictions of social rejection and self-rejection that encumbers him. Accordingly, the most fundamental characteristic of the atmosphere of A.A. is that of maximum acceptance. It provides a context where the individual is a person again in his own right. Frankl would maintain that this provision for a sense of personal worth is essential in genuine therapy.
The discovery of purpose. Frankl is of the personal persuasion that no life is meant to be purposeless and that every life can find purpose, no matter what its history. The older citizen or the terminal patient can choose to look upon death as a fitting climax to a meaningful life, or his response to the fact of death can itself become an event of ultimate meaning - perhaps the highest meaning a mortal life can achieve.
Alcoholism is like death in that it is an inescapable fact. He cannot look hopefully to the day when he will not be an alcoholic. He can only confront this fact, accept it, and decide how he is going to deal with it. A.A. suggests that the most significant meaning his life may ever achieve can arise directly out of the fact of his alcoholism. When an alcoholic testifies to his own experience he discovers that it is of value to others. Thus the culminating step of the program asks him to be on call at virtually any hour and to be willing to travel any distance to be at the side of an alcoholic who has taken the initiative to call for help. The realization that as an alcoholic there are functions he can perform better than anyone else (even a psychiatrist or a pastor) provides the ultimate satisfaction of his existential frustration. There is a famous declaration of Nietzsche which Frankl is fond of paraphrasing: "He who has a 'why' to live endures almost every 'how'."
Frankl is unequivocal in his rejection of any anthropology which sees man as the victim of some kind of determinism. Man is free to make choices, free to respond, free to take a position, free to say "yes" or "no" to life. He is free even if he does not yet understand the ultimate meaning of things. He is free even if he pretends not to be free.
The alcoholic, whose history has been marked by alternate encounters with sympathy and rejection, comes into Alcoholics Anonymous, where he finds neither. The judgement under which he has lived - that he is a "hopeless drunk" - is contradicted by A.A.'s affirmation that although he is indeed a drunk he is not the least hopeless.
The entire program of A.A. is predicated on the assumption that the individual, no matter how depressing his past, is free to choose - to accept or reject a positive future - step by step, one day, one hour at a time. To make the admission called for in the "first step" (one's powerlessness over alcohol) is to make a decision of the greatest importance. It launches the alcoholic on a program that enables him to accept his situation and to use his freedom creatively within the limits of that situation. He is free to acknowledge that he is not free to drink, and he is free to abide by the self-imposed restriction of abstinence. Step Three states: "We made a decision to turn our will and our lives over to the care of God as we understood Him." Indeed, in a larger sense, each of the Twelve Steps is accepted only by personal decision. Frankl would applaud this insistence upon the recognition of each man's freedom.
Freedom and responsibility imply each other. According to Frankl, in the same way that authentic therapy frees the patient from much that has encumbered him, it must educate him to a sense of responsibility. Though a man may not be responsible for everything that happens to him, he is inevitably responsible for what he does about what happens to him. He may not be responsible. for his symptoms, but he is responsible for his attitude toward his symptoms. Though there may be a limit to the extent to which he can alter his existential situation, nevertheless he is under obligation to realize values and discover meaning in his life, no matter what the circumstances.
The phrase "education to responsibility" would appear to be a particularily apt description of the A.A. program. The education begins at the point where the alcoholic first dials A.A.'s number, or attends his first closed meeting. To be sure, alcoholism is always the result of a complex of factors which spread the total responsibility for the condition far beyond the alcoholic himself. But it is of no help to the alcoholic to dwell on this fact. Recovery comes rather by way of the difficult but releasing process of self-acceptance, the vital core of which is acceptance of personal responsibility.
Each of the Twelve Steps presupposes the alcoholic's capacity to respond. This responseability includes the acceptance of one's condition, the confession of one's willful wrongdoing and tendencies to evade responsibility, and a sense of obligation to apply one's own experience to the needs of others. The focus, therefore, is upon responding creatively in the present moment in such a way that meaning is discovered not apart from or in spite of the circumstances of life, but out of their very warp and woof.
5. SOME IMPLICATIONS FOR THE CHURCH
If Frankl's anthropology is correct, then. the patient who enters his clinic, the alcoholic, who comes through A.A., and the parishioner in the average church are not essentially (or better, existentially!) different. The fact bears profound implications for lay groups in the local church.
It is to Frankl's philosophy rather than to his clinical procedures that A.A. is to be compared and to which the local church might profitably direct its attention. Clinically, Frankl employs techniques which the church is neither called upon nor equipped to use. But "group logotherapy" in the church, undertaken in the manner of A.A.'s rejuvenated Oxford Movement, could pay large spiritual dividends. A.A. dramatizes the possibilities of implementing the logotherapy philosophy in concrete "growth group" situations under relatively unskilled but devoted leadership.
Who could predict the results of such a group in the church, called to discuss their own failures, their own "existential vacuum?" What personal discoveries might be made in the discipline of "telling one's own story" from the standpoint of one's search for meaning in the unavoidable facts of his life? What theological insights or what receptivity to new revelation might result from a reexamination of the Fourth Gospel in the light of Frankl's focus on Logos as "meaning?" With a logotherapeutic orientation, executed in the pattern of the informal quasi-class meeting structure of A.A., and informed by the New Testament, the church could become a laboratory in which the average parishioner could forge ahead with new freedom and vitality in his essential quest for life, liberty, and the pursuit of meaning.