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A.A. AT THE CROSSROADS
that America believes less in help-your-fellow than in blame-the-person-who
made you-a-victim, can Alcoholics Anonymous still get its
Andrew Delbanco and Thomas Delbanco
Anonymous turns sixty this year, and while its size and
reach show no signs of waning (there are more than a million
members in the United States and Canada, and eight hundred
thousand more scattered through a hundred and forty other
countries), there is a feeling among A.A. veterans that
the fellowship is at a crossroads. At A.A.'s General Service
Office. in the Interchurch Centre in New York City, an austere
office building at 120th Street and Riverside Drive that
is known in the neighborhood as the God box. One staff member
reflected recently that the Age of the Founders was long
gone - Bill Wilson, the New York stockbroker who led the
movement for more than thirty years, died in 1971, and Bob
Smith, the Ohio surgeon who founded it with him, had died
twenty years earlier - and the Age of the Apostles was now
ending. "There's practically no one alive today who
was there when Bill and Bob met, or in that very first group,"
she said. "Pretty soon, there will be no early timers
Standing like a crewcut cadet among fops, the Interchurch
Centre is set between the ornate spire of Riverside Church,
to the north, and a row of neo-baroque apartment houses,
to the south. A reasonable facsimile of a midtown corporate
fortress, it has revolving doors that spin you into a mopped
marble floor, and a badged guard who eyes you from behind
a security counter. In A.A.'s eleventh floor office - described
by one staff member as "the visible clearing house
of an invisible organization"- close to a hundred people
are at work, filling orders for A.A.'s publications, referring
callers to local groups, disseminating information to the
public and to the medical and counseling professions. "We
are a repository of group experience," he said. "People
write us about a problem they're having in their group -
an unruly member, a question about confidentiality. We share
experience by telling them what's been done in similar situations
in the past. We don't issue directives. We don't hand down
Besides being the nerve centre for the more than fifty thousand
registered A.A. groups in the United States, the General
Service Office is a shrine. Its corridors are hung with
poster-size photographs of the founders, and placards bearing
their sayings; along one wall of an anteroom that leads
into the organization's archive is a locked glass case containing
the various editions of the Big Book - the basic A.A. text,
which has sold thirteen million copies since it was first
published, in 1939. I consider the Big Book an inspired
text, written by Bill under the guidance of the spirit,"
another staff member said. "And I worry that I see
a shrinking in our reading and studying of the Big Book.
People paraphrase it incorrectly. Some do spot reading,
or they don't read it at all."
Some people say that if the Big Book is losing its hold
on new members, it may be because its image of the alcoholic
is hopelessly cornball and exclusively male: he is a travelling
salesman tempted by the hotel bar; he is compared in his
desperation to a "gaunt prospector, belt drawn in over
the last ounce of food;" or, in his drunken oblivion,
to "the farmer who (comes) up out of his cyclone cellar
to find his home ruined," looks around, and remarks
to his wife, "Don't see anything the matter here, Ma.
Ain't it grand the wind stopped blowing?" There is
even a condescending chapter addressed "To Wives."
Today, A.A. is more than a third women, and twenty-five
percent of the membership is under thirty - people for whom
prospectors and storm shelters are defunct metaphors.
Others think the integrity of the fellowship is being threatened
by "people who come in because the courts or rehab
centres send them," in the words of Dr. Marc Galanter,
a New York psychiatrist who has written extensively about
A.A. "Many of these people have to get a meeting card
checked off to show that they're fulfilling the obligations
of, say, their suspended sentence - and though A.A. welcomes
them, this is something that's basically against what makes
the fellowship work. Coming in is supposed to be voluntary
- an act of spiritual surrender, not acquiescence to some
others think that A.A. is becoming a social club where people
show up casually, in order to make deals or dates. "It
used to be that when someone talked about suffering, you
could hear a pin drop," a retired advertising writer
who has been in A.A. for sixteen years said. "But now
people come to the meetings with a bottle of designer water
in hand, and there's more talk about success. It kills the
meeting. People get up to pee, or look for an ashtray."
One member, a carpenter of about forty who lives near a
posh New York suburb, put it this way: "We have actually
become afraid of the still suffering alcoholic. If a drunk
walked into a meeting in my town, people would be agast.
We've become too nice for that." He still attends his
home meeting, he said, but he goes once a month to a meeting
in a man's shelter in a neighbouring town, to get "the
is not only this squeamishness before the hardcore alcoholic
that bothers A.A. veterans, but what they see as a growing
expectation among some members that meetings will amount
to a form of public coddling. Sometimes this expectation
is met ("unconditional love" is how one member
described what she encountered at her first meeting); but
sometimes it is disappointment. When a young woman at a
meeting we attended said in a private- schoolish whine that
she, as a recovering alcoholic, deserved "more space"
than she was getting from her non-drinking friends, a young
man in dreadlocks, looked at her with a mischievous grin
and said, "When I was drinking, I had the same problem
you have now. I had not yet achieved low self- esteem.
The rebuke was a pure expression of "the real thing"
- of the Big Book's principle that "self-delusion,
self-seeking, and self-pity" are the root of our troubles,
"that we "must be rid of this selfishness. We
must, or it kills us!" But some veterans are troubled
that this basic A.A. insight is invoked less often than
it used to be. They worry that alcoholism, which was once
a source of convicting shame in America, is being turned
into an alibi. They mention the recent case of a Westchester
man who confessed at an A.A. meeting, to a murder committed
while he was on a binge, and then mounted a legal defence
based on the claim that alcohol had led him to confuse his
victims with the parents who had emotionally abused him
as a child. And they laugh - though not with real amusement
- about the case of Leonard Tose, the former owner of the
Philadelphia Eagles, who responded to a suit to collect
gambling debts brought by an Atlantic City casino a few
years ago by countersuing and claiming that the casino had
allowed him to gamble away his fortune while he was manifestly
drunk. "A.A. is not about excuses," one longtime
member said. "It's about obligations. Bill, and Bob
would be appalled."
A.A. came into existence at a time when Americans were introduced
to fear and futility on a scale that had not been previously
imagined and has not been managed since - a time when it
was a common experience for a man to feel prosperous one
day and to be reduced to nothing the next. When A.A. first
took form, in the nineteen-thirties, it was not a place
where one came to ventilate anxiety about the enervation
of a stressful life. It was the last stop before the abyss.
many Americans, Prohibition had been less an obstacle than
a nuisance. (H.L. Mencken reported that he failed only twice
during Prohibition to find a drink - once when he was travelling
in Pennsylvania and did not realize that "seafood"
was the local euphemism for beer.) During the "dry
years," Bill Wilson had made his living as a kind of
mobile industrial espionage agent, scouting out companies
for his brokerage house by befriending research-and-development
men in their local watering holes, and then stiffening his
will with another drink before attempting to persuade investors
of the truth of tips he only half believed himself. By the
time of Repeal, in 1933, he had drunk himself out of his
He and his wife, Lois, who at that time worked as a salesclerk
in Macys’s joined the ranks of the depression vagabonds,
living with her parents, with friends, or on their own in
shabby apartments. Paul Lang, the archivist in charge of
the Wilson family papers at Stepping Stones, their eventual
permanent home, in northern Westchester County (it is now
a historic site, maintained by a foundation established
upon Lois's death), counts fifty-four addresses for the
couple in the early nineteen-thirties. These were hellish
years, during which three ectopic pregnancies ended Lois's
hopes of bearing children and the pace of Bill's drinking
grew in proportion to his shame. Bill would dry out periodically
in a clinic on Central Park West called the Townes Hospital,
then try to stay sober until the "small, cold ball
of fear... in his stomach would surge up," and only
a drink could mitigate his terror of its return. He promised
abstinence and was meanwhile hiding his liquor from his
wife "as a squirrel would cherish nuts...in the attic,
on beams, underneath the flooring...in the flush box of
toilets." The archive at Stepping Stones contains Lois's
personal Bible, in which Bill wrote periodic pledges to
stay sober - promises whose ingenuousness is matched by
a fear legible in the handwriting itself, which becomes
increasingly spidery as it moves down the page:
my beloved wife that has endured so much let this stand
as evidence of my pledge to you that I have finished with
drink forever. Bill October 20, 1928.
Day 1928. My strength is renewed a thousandfold in my
love for you.
tell you once more that I am finished with it. I love
you. Jan. 12, 1929.
and for a lifetime. Thank you for your love.
Sept. 3, 1930.
Bill later wrote in the Big Book, he was locked in a cycle
of resolution and relapse by his inveterate tendency to
compensate for pain by finding someone or something to blame:
the alcoholic...this business of resentment is infinitely
grave. We found that it is fatal. For when harbouring such
feelings we shut ourselves off from the sunlight of the
Spirit. The insanity of alcohol returns and we drink again.
And with us, to drink is to die.
was in the detox hospital in 1934 that Bill first arrived
at this difficult knowledge. The epiphany came as his doctors
were putting him through the usual regimen: sedating him
with belladonna and purging him with castor oil. (Medicine
had - and has - made little progress in treating alcoholism
since the eighteenth century, when the pioneer physician
Benjamin Rush treated a man "habitually fond of ardent
spirits" by mixing tarter emetic with his rum.) Left
to endure the craving and the cramps in a room that had
been cleared of potential suicide instruments, Bill had
the experience that broke the cycle:
depression deepened unbearably and finally it seemed to
me as though I were at the bottom of the pit. I still
gagged badly on the notion of a Power greater than myself,
but finally, just for the moment, the last vestige of
my proud obstinacy was crushed. All at once I found myself
crying out, "If there is a God, let Him show Himself!
I am ready to do anything, anything!"
the room lit up with a great white light. I was caught
up into an ecstasy which there are no words to describe.
It seemed to me, in the mind's eye, that I was on a mountain
and that a wind not of air but of spirit was blowing.
And then it burst upon me that I was a free man. Slowly
the ecstasy subsided. I was in another world, a new world
of consciousness. All about me and through me there was
a wonderful feeling of Presence, and I thought to myself,
"So this is the God of the preachers!"
left the hospital as a man possessed, roaming New York,
in the words of his biographer, Robert Thomsen, "at
all hours, indefatigable and incorrigible, totally convinced
that if he could do it, could find a way out, (anyone) could
do it." He literally dragged drunks home from the gutter,
inflicting them on his wife, who fed and bunked them in
their Brooklyn home while he pleaded that they consigned
themselves to "the Presence." Mostly, what the
Wilsons got in return was petty thievery and, sometimes
vomit on the floor.
the grip of his new obsession, Bill found himself ridiculed
not as a drunk but as a fit successor to temperance fanatics
like Carrie Nation. In the first decade of this century,
Carrie Nation had toured the country from saloon to saloon,
smashing - as her biographer Robert Lewis Taylor puts it
- "Venetian mirror (s) with brickbats," ripping
"candid and stimulating prints from the walls,"
and, on one notorious occasion, throwing "a billiard
ball at what she mistakenly took to be Satan lounging behind
the bar." She ended
her life, in the words of the historian Norman Clark, as
"a carnival freak...a sideshow for a series of country
fairs, armed with hatchets and her Bible" - and to
many who watched Bill on the prowl he seemed headed for
the same oblivion. Yet however unavailing there efforts
were for his "patients," they had the strange
effect of somehow keeping him sober himself.
Bill did not come close to a "slip" until the
spring of 1935, when he found himself in an Akron hotel
lobby with nothing to do on a weekend afternoon. A business
deal that had brought him to town had fallen through, and
he was drawn by the sociable sounds of the bar. Retreating
to a phone booth as if to a pocket of air in a room fast
filling with smoke, he dialed all the church numbers he
could find in the local directory, and when a clergyman
answered he said - not knowing quite why - that he was a
"rum hound from New York" who needed "to
speak now" with another alcoholic.
He ended up visiting a local surgeon named Bob Smith, who
was known around town as a hopeless boozer; and their encounter
was, in effect, the first A.A. meeting. Dr. Bob never touched
another drop for the remaining fifteen years of his life,
going "dry into his casket," as the poet John
Berryman wrote in his novel "Recovery," which
is about his own A.A. experience. "Look up his life
sometime, there must be stuff."
It took a while for the two men to identify the "stuff"
that had saved them: the therapeutic value for oneself of
helping another person stay sober, "Our talk was a
completely natural thing," Bill recalled. "I had
quit preaching. I knew that I needed this alcoholic as much
as he needed me. This was it." Together, they began
to visit patients in detox, telling their story, and inviting
them to give the new talking therapy a try. Let us talk
to you for our own sakes, they said, in effect, and then
talk to us and we'll listen. Sometimes they were shooed
away like pestering salesmen. But soon they had a success
- with a businessman who was going through his eight detoxification
in six months, the previous one having begun with his punching
two nurses in the eye. At first he resisted, and railed
at his wife for revealing his drinking to strangers. When
she coaxed him into seeing them, he braced himself for another
sales pitch. But he relented when he realized that "all
the other people that had talked to me wanted to help me,
and my pride prevented me from listening to them…but
I felt as if I would be a real stinker if I did not listen
to a couple of fellows for a short time, if that would cure
them" - and he became the third member of the new fellowship
that called itself a "bunch of nameless alcoholics."
principle on which the new group was based was that no one
is responsible for the wreckage of the alcoholic's life
except the alcoholic himself. No matter what has been done
to you, you are responsible for what is done by you. They
would refuse to project evil on to some blamable cause,
even though they might speak of alcoholism as (in the Big
Books words) an "illness" or "allergy,"
and of some people as alcoholics before they ever touched
a drop, as if they were born tinctured by a poison activated
by the first drink.
Alcoholics Anonymous (the name was adopted in 1939), some
people speak of its astonishing growth after the Akron meetings
as the expansion of God's dominion. But there has always
been a tension between what might be called the pietist
and the rationalist wings of the movement; and traces of
this division remain in the Twelve Steps, the list of principles
that Bill Wilson drew up as he wrote the Big Book:
We admitted we were powerless over alcohol - that our
lives had become unmanageable.
2. Came to believe that a Power greater than ourselves
could restore us to sanity.
3. Made a decision to turn our will and our lives over
to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human
being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became
willing to make amends to them all.
9. Made direct amends to such people wherever possible,
except when to do so would injure them or others.
10. Continued to take personal inventory and when we were
wrong promptly admitted it.
11. 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 that out.
12. 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.
some members still speak of these steps as if they were
brought down from Sinai or were revealed, like the Book
of Mormon, by a messenger angel, they are in fact products
of contention that is still discernible in them. Their wording
was under debate until just before the release of the Big
Book, when the phrase "on our knees" was deleted
from Step 7 and "as we understood Him" was inserted
in Steps 3 and 11. Some regard such concessions as proof
of the democratic genius of the fellowship - of its ability
to modulate the idea of a personal deity into an abstraction
that can accommodate all members, including non-Christians
and agnostics. Others worry that God has become so vague
a conception that he has disappeared. Evidently wearied
of the term "self-help," one member complains,
"We're not a self-help program. If we were helping
ourselves, we'd be in trouble. We are a spirit-help program,
a God- help program."
has always been A.A.'s raw nerve. Bill confided in only
a few friends about how "the Presence" had manifested
itself to him, lest A.A. become linked in the public mind
with crackpots and ranters. But shortly after that hospital
experience a friend recommended to him William James's,
"The Varieties of Religious Experience." Bill
read that book with the gratitude one feels toward a respectable
witness who confirms that he, too, has heard the disembodied
voice or seen the ghost that has brought one under suspicion
of madness. James (whom Bill came to refer to as "one
of the founders") seemed to know at first hand the
power of alcohol to make one feel uncontested at the center
of the universe - to turn any party into your fete, any
music into your serenade: Sobriety diminishes, discriminates,
and says no; drunkenness expands, unites, and says yes.
It is in fact the great exciter of the Yes function in man.
It beings its votary from the chill periphery of things
to the radiant core.
when James wrote about the futility of mental effort he
seemed to grasp exactly what Bill had undergone in Towns
know how it is when you try to recollect a forgotten name.
Usually you help the recall by working for it, by mentally
turning over the places, persons, and things with which
the world was connected. But sometimes this effort fails:
you feel then as if the harder you tried the less hope
there would be, as though the name were jammed, and pressure
in its direction only kept it all the more from rising.
And then the opposite expedient often succeeds. Give up
the effort entirely; think of something altogether different,
and in half an hour the lost name comes sauntering into
your mind, as Emerson says, as careless as if it had never
been invited. Some hidden process was started in you by
the effort, which went on after the effort ceased, and
made the result come as if it came spontaneously.
ratified the value of giving oneself up rather than "pulling
oneself together" - an ineffably strange reversal for
a man like Bill, whose life had once been all about seizing
opportunities, looking for the main chance, training, disciplining,
driving himself. When Bill read that "something must
give way, a native hardness must break down and liquify,"
he recognized an account of what had happened to him.
experience of giving way and breaking down remains the key
to every A.A. meeting, as it was at one we attended on a
rainy Saturday morning in a Boston mental-health center
- one of those nineteen- sixties scored concrete buildings
with all the charm of a highway trestle. On the steps, outside,
men slept curled in the rain. Inside, the atmosphere was
festive. A tidy- looking young man (polo shirt, pressed
khakis) was telling a group of about forty men and women
how he had stepped, for no apparent reason, in front of
a mirrored column in a subway station. Walking around it,
as if he had been suddenly vouchsafed the ability to see
himself from without, he stared at his own face, yellow
and jowly, really seeing it for the first time. For months,
he said, he had been drinking two bottles of wine every
night in between aperitifs and chasers. In that instant,
he knew he would never drink again. But he had no idea why.
hears as many metaphors for such an experience as there
are members who speak. One member at the Boston meeting
likened it to the feeling of a runner who gets a second
wind - that eerie sensation when exertion suddenly subsides
into limpid ease. Another compared it to what happens when
you stop straining to find your balance and suddenly it's
there. One young man at a New York meeting described the
splitting away of his old self as if he had been a plank
with a fault line running through it until a pressure came
that made the board break.
latter editions of the Big Book play down this expectation
of "sudden and spectacular upheaval,” and report
instead that "most of our experiences are what the
psychologist William James called the 'educational variety'
because they develop slowly over a period of time."
But, whether the release is sudden or slow, public testimony
about the hell in which one lived before deliverance is
indispensable for both speakers and listeners; and the talking
therapy has no designated end.
cancer patients in remission, A.A. members think of themselves
as "arrested," not "cured." With the
possibility of backsliding never far out of mind, they regard
each day of sobriety as an unmerited gift, and each A.A.
meeting as a holding action –because "each lapse,"
as James wrote, "is like the letting fall of a ball
of string which one is care- fully winding up; a single
slip undoes more than a great many turns will
A.A. took form, Bill and Bob had no historical model in
mind. They were not bookish men. But it is uncanny how closely
their new fellowship resembled the first American churches
that had been "gathered" three centuries before.
The founders of those churches, named Puritans because of
their implacable objections to the rituals of England's
state church, had instituted in America a practice of public
confession, in which each member of the congregation spoke
of his or her enslavement to sin and of how the bondage
had been broken. The Puritans had called these testimonies
"conversion relations" or "professions of
faith." A.A. called them drunkalogues."
the A.A. view, just as in that of the Puritans, salvation
is not something one can possess by means of a penitential
act now and then. Rather, it is a state of endless striving.
The work of salvation, as the Puritan theologian Jonathan
Edwards wrote in the seventeen-forties, must be, for each
person, "not only...the business of Sabbath days, or
certain extraordinary times, or the business of a month,
or a year, or of seven years...but the business of his life...
which he perseveres in through all changes, and under all
trials, as long as he lives." The convert's obligation
to his fellows is not satisfied by a coin in the Sunday
collection basket. "Faith has to work twenty-four hours
a day in us and through us," as the Big Book puts it,
"or we perish." There is no evidence that Bill
himself ever followed James back to Edwards (in whose writings
James found an ("admirably rich and delicate description"
of conversion), but if he had he would have found more than
a congenial spirit. He would have experienced a shock of
recognition when he came upon Edward's list of signs by
which the anxious seeker tests the validity of his or her
spiritual experience. Did it come from God, or was it hallucinatory?
Edwards enumerated twelve signs by which one could tell.
They do not match A.A.'s Twelve Steps with the exactness
of a stencil, but they come close. Here is the Twelfth sign,
which he called the "sign of signs" and "evidence
of evidences" (the Big Book calls the Twelfth Step
"the capstone" and "foundation stone"
of all the rest):
pretences persons may make to great discoveries, great
love and joys, they are no further to be regarded, than
they have influence on their practice.
the same as A.A.'s Twelfth Step, this statement contains
what James called the whole of Edwards's work. It is "an
elaborate working out of (the) thesis (that) the roots of
a man's virtue are inaccessible to us," James wrote.
"No appearances whatever are infallible proofs of grace.
Our practice is the only sure evidence, even to ourselves,
that we are genuinely Christians." If, in other words,
two people claim they are saved, and one sees Jesus' blood
running down the bedroom wall, while the other sees only
the swirls and cracks in the plaster, this difference between
them has not the slightest significance. The only evidence
that one's inner spiritual condition has changed is visible
evidence of a new responsibility towards others in one's
repeated this point again and again, as if to rebuke his
Harvard colleagues, who thought he had gone soft on God.
The question of whether someone's conversion had a supernatural
cause or could be explained in purely psychological terms
held no interest for James. (Freud, working with the dualistic
model of the mind, later described such events as an internal
rupture in the psyche through which the unconscious pours
into consciousness.) Like Edwards, James was not interested
in causes - only in results. It matters not a whit if the
convert is transformed by God or by the smile of a child.
The only thing that matters is the result of the experience.
"If the fruits for life of the state of conversion
are good," James wrote, "we ought to idealize
and venerate it... if not, we ought to make short work with
it comes to applying this standard of results to A.A., not
much is known about its aggregate impact on American alcoholics.
Most experts estimate the number of alcoholics in the United
States at ten to fifteen million, and some believe that
nearly one in ten adults has attended an A.A. meeting at
some time in his life. In 1968, recognizing that "our
communications to the professional community had very little
credibility because of a lack of objective data," A.A.
began to conduct periodic surveys of its members in order
to assess its own efficacy. In a 1989 survey of almost ten
thousand members chosen at random, thirty-five percent of
the respondents reported less than a year of sobriety, thirty-six
per cent between one and five years, and twenty-nine per
cent more than five years.
But what such number mean is far from clear. For example,
the survey also revealed that about half of the newcomers
leave A.A. after less than three months, and that "after
the first year... attrition continues, but at a much lower
rate." If you try to adjust the numbers to reflect
these facts, it is still difficult to come up with a true
sobriety (or "salvation") rate. The best the editors
of an exhaustive recent monograph on research on A.A. can
do is conclude that "long term sobriety occurs within
a select minority of those who initially attend A.A."
For certain cancers, this would represent a good outcome.
For most bacterial diseases, it would not. To the theological
father of Puritanism, John Calvin, who wrote in 1536 that
if "the same sermon is addressed to a hundred persons,
twenty receive it with the obedience of faith; the others
despise, or ridicule, or reject, or condemn it," a
"select minority" would seem about right.
was the test of results that clarified for Bill what had
happened to him in Towns Hospital. It gave him a way to
answer those who said he had simply substituted a new addiction
- A.A. - for his old one. When he had been drinking, he
had been "at the gates of insanity," he wrote,
and other people were obliterated by the intensity of his
narcissism. But when, first in Brooklyn and then in Akron,
and then through A.A., his mind had been directed outward,
he was restored to the world of persons. Edwards called
this new engagement with other people "consent to being."
A.A. calls it "Twelve Stepping."
is based on the insight that altruism has selfish value,
in that charity gives hope to the giver: "When the
phone rings at two in the morning," one member told
us, " and it's a member in my group who needs help,
I get up and go. Anything else in my life I will negotiate.
But in A.A. I just do it. It doesn't make any sense to get
up at two on a snowy night. But you do it all the same."
light of the fact that the religious dimension of A.A. has
made many prospective joiners uneasy (newcomers sometimes
have the self-conscious look of stragglers in the pews when
everyone else is taking communion), it is striking how respectfully
A.A. is regarded by even the most secular-minded experts
in the field of addiction. We spoke with one such authority,
Dr. Steven Hyman, who is the director of the Mind, Brain,
Behavior Initiative, at Harvard University, in a squat brick
building at the old Charlestown Navy Yard which used to
be a storehouse for torpedoes but is now a research facility
of the Massachusetts General Hospital, complete with atrium
and cafe. Dr. Hyman, who looks like Pavarotti in fighting
trim, does not initially impress one as likely to have much
tolerance for a movement that began when a patient was seized
in his hospital bed by "the Presence." In this
respect he surprised us.
great A.A. insight was not just that alcoholism is a disease
but that having this disease is not an excuse for anything
- not for missing work, messing up your family, killing
people in automobiles," he began. "In terms of
cause, alcoholism does have genetic causes, cultural causes,
circumstantial causes. But there's nothing deterministic
about its consequences. That's the strange paradox A.A.
understood, and it seems to be more and more difficult for
people to accept."
Dr. Hyman added, "I have no problem with the A.A. method,"
and launched into an explanation of how a spiritual therapy
could relieve a physiological affliction. Rummaging through
the papers on his desk, he came up with an M.R.I. film of
a rat's brain after the animal had been injected with cocaine.
It showed a splatter of bright streaks on a dark background,
like fireworks against the night sky. This picture, he said,
revealed a neurological system that was more complexly developed
in human beings but served basically the same function in
people as rats. He described an experiment done in Canada
in the nineteen-fifties, in which electrodes were affixed
to a succession of sectors of a rat's brain. A lever was
placed within reach of the animal so that it could send
current into itself by depressing the switch. "In some
places, the effect was highly aversive," Dr. Hyman
said. "You can imagine the experience of feeling electrical
sensations in your paws. But when the electrodes were attached
to certain other locations, the rat would press the lever
thousands of times to get more of it - until exhaustion
Now, why do we have such a system - a brain that will light
up when you charge it with electricity or drugs? Because
such things are too important to leave to cognition. If
you left them up to people to calculate, they'd get messed
up. Nature's experience with sexual reproduction would have
been a big failure unless sex were profoundly rewarding.
So we have a neurological system that says, "That was
good, let's do it again.' A few natural substances, including
alcohol, tap into this system in the brain that says, “That
was good, let's do it again, and let's remember exactly
how we did it.” And, since you're bombarded every
day by millions of sensations, the brain is organized in
such a way that certain indispensable experiences, like
sex, have the greatest effective valence, and become objects
Dr. Hyman's name for the process by which this system is
captured by drugs is "adaptation," which is "a
way of making long term changes in the way the brain works,
so that you can remember experience." This kind of
"learning" uses many of the same biological processes
in the brain as in other parts of the body. "Let's
say you want to look like Schwarzenegger, and you went to
a gym and started pumping iron," he said. "Your
arms would really hurt. But eventually you would have an
adaptive response. The genes in the nuclei in your muscle
cells would start making more messenger RNA and then more
protein to build up those muscles, and pretty soon - especially
if you also took anabolic steroids - you would look like
Schwarzenegger. These adaptive responses are helpful like
bulking up, which is essentially a response to injury. Others
are a problem - as when people develop a tolerance for their
asthma medicine. In fact, they not only need stronger doses
but become dependent. If they don't get their asthma medicine,
they have worse asthma attacks.
in other words, is a form of adaptation. Our best current
understanding of alcoholic addiction is that, in response
to bombardment by the chemical ethanol, chronic adaptations
occur in the brain's reward circuitry. There are individual
genetic and developmental and environmental factors that
help determine who will get addicted to alcohol or how soon
- matters we know very little about. But in the context
of individual vulnerability, adaptations will occur in the
circuitry in response to the drug. Once this happens, the
user becomes dependent on it for his world to be O.K. The
brain says, 'That was good, I feel O.K.' If you're an alcoholic,
you simply can't imagine a day without drinking. You need
that hit. Your brain demands it." With almost reverent
intensity, Hyman said, "If you understand addiction,
you understand something very profound about the human brain
- how it hijacks the cortex in the service of the primoral
lizard brain." Hyman went on, "now, to help people
with these molecular changes in their brain, we have to
come up with things that will deliver compensatory pleasure
- a requirement that it's tough to get the medical and scientific
professions to accept. A.A. understood this. In fact, they're
ahead of us. Most pharmacological research is still focussed
on the development of drugs that block pleasure. An example
is Naltrexone, a long-acting blocker of opiate receptors.
If you take it every morning, and shoot up heroin later
in the day, you will not get high. It looked terrific in
the lab. The trouble is that, once it was approved for heroin
users, the compliance rates were about fifteen per cent,
because the addicts said it made them feel lousy. Naltrexone
has just been approved as a drug for decreasing craving
in alcoholism. My prediction is that it won't work because
it doesn't give something back."
Hyman's account of addiction is an impeccably accurate rendition
of the doctrine of original sin as Jonathan Edwards expounded
it. What Hyman called "the reward-circuitry of the
brain" Edwards called the "faculty of the soul...is
inclined to. or disinclined from...sensible objects."
Both regard it as inborn, and yet both insist that people
are fully responsible for how they act on their inclinations.
Edwards thought of this paradox as a war in the soul between
the destructive desires that he called sin or self- love
("self-will run riot" is the Big Book's phrase)
and the productive love that goes outward, asking no reward,
to other people and, through them, to God. Hyman believes
that you can actually see the war in a picture. "I
suspect that if I could compare scans of the brain of an
alcoholic person before and after treatment in a twelve
step program, you would actually see changes. Of course,
the altruistic activity affects the brain as much as a drug
does," he said.
Edwards would have been delighted with this idea. It has
been said, by the historian Perry Miller, that when Edwards
preached he deployed words as an "engine against the
brain" in order to stimulate in his hearers a "taste,"
or "relish," for what he called "divine excellency."
The point was to use words to "let...light into the
soul" by describing vividly the plenitude of nature
or the charitable acts of saintly persons or the selfless
love of Christ, and thereby to entice the imagination away
from its usual focus on worldly glitter. And if Edwards
would have linked Hyman's notion that one might actually
see pictures of this battle within the soul, he would have
loved the metaphoric picture of the lizard brain - of the
reptile within getting hold of the leash.
A.A. understands is that the essence of dealing with alcoholism
is not to blame people for having the disease, yet nevertheless
to demand that they take responsibility for themselves,
"Dr. Hyman said, "That's a hard concept. It is
hard to say to somebody, 'Yes, things are terrible, yes,
getting to your present condition involved what was done
to you, and it even has something to do with the body with
which you were born, but from this day on we have identified
the problem, and you have to be involved in the solution."
Here is Edwards's formula of the same compatibility between
helplessness and responsibility:
order to form their notion of faultiness or blameworthiness,
(people) don't wait till they have decided...what first
determines the will...They don't take any part of their
notion of fault or blame from the resolution of any such
questions. If this were the case...nine hundred and ninety-nine
out of a thousand would live and die without having any
such notion as that of fault ever entering into their
heads, or without so much as once having any conception
that anybody was to be either blamed or commended for
believed that this idea accorded perfectly with common sense.
And Bill Wilson, through his experience in Towns Hospital,
came to the same conclusion - that "what first determines
the will to drink has nothing to do with who bears responsibility
for the consequences of drinking."
For much of American history, there seems to have been a
consensus that this stringent principle should be applied
broadly to the moral life. Among modern Western societies,
America has been the country where human beings were most
exposed to the possibility of advancement, and least protected
from the prospect of decline. It was, in Emerson's phrase,
the culture of "self-reliance," in which a man
was supposed to take his chances and then collect the reward
or pay the price for what he had done or had failed to do.
With the Great Depression, however, this kind of uncompromising
individualism became insupportable. For millions of people
whose best efforts had availed them nothing, the old doctrine
of self-reliance was now experienced as a form of cruelty.
At that moment - when the exigencies of the exposed life
were judged to be intolerable, and the old stress on individual
responsibility had come to seem out of balance with valid
claims for individual rights - a profound change took place
in America. It was a fusion of the old doctrine of the accountable
self with a new kind of public responsibility for the fate
of individuals. At the level of politics and public life,
this new synthesis came to be known as the New Deal. Under
that rubic, the government, mainly through programs that
would today be called "workfare," undertook to
provide work opportunities for those whom the private economy
had abandoned. At the grassroots level, the most important
and enduring expression of this self-help idea was the founding
A.A. was a "church" in which the rights were kept
in steady balance with responsibilities through the mechanisms
of free expression and requisite community service. As such,
it kept unflinchingly to the Edwardsian principle of what
the theologian Reinhold Niebuhr called in 1939, "responsibility
despite inevitability," and at the same time committed
itself to providing the unconditional help that all suffering
human beings have a right to expect from others. In this
sense, A.A. was both a religious revival with roots in an
earlier America and a spontaneous expression of the kind
of balanced liberalism that emerged in the Roosevelt years.
But in the paradoxically symmetrical idea that lies at the
heart of A.A. - that helplessness is a fact of human life,
yet, at the same time, no one should be spared responsibility
for his actions - has proved extremely difficult to sustain.
The relation between rights and responsibilities within
American liberalism seems to many people to have been thrown
out of balance. In response to this apparent distortion,
certain liberal institutions (welfare) and ideas (affirmative
action) have been charged with misattributing suffering
to circumstance rather than to responsible self. Such an
approach to the alleviation of human suffering, its critics
say, misleads people into thinking that the world owes them
redress, and leaves them in a state of perpetual expectation
for a reparation that will never come.
part of the feeding frenzy on the corpse of Liberalism which
now passes for political debate, this critique is often
a pretext for mean-spirited attacks on "freeloaders"
- people who are deemed unworthy beneficiaries of a misguided
paternalism. Yet even some defenders of liberalism agree
that, at least in such conspicuous areas as criminal law,
regulated speech, and normative sexual behaviour, American
society has moved too far towards rights and away from responsibilities.
Some of the more spectacular "don't blame me"
defendants who have entertained and disgusted Americans
in recent years - Lorena Bobbit, the Menendez brothers -
seemed to represent a moral decadence in which a once dignified
liberalism has been reduced to the claim that maimers and
murderers are entitled to sympathy and exoneration if only
they can show that they were victims, too. "The architecture
of (their) self-defense plea," as Elizabeth Hardwick
has put it, is most often organized around the claim of
having suffered sexual abuse - " as pertinent to the
therapist," she says,: as a kidney to the urologist."
These are people who claim, in contrast to Edwards, that
"what determines the will" not only means something
but means everything.
It is not surprising that, as this exculpatory idea of the
coerced will grows rampant in American life, the balance
within A.A. between rights and responsibilities has also
shifted. "It's getting harder all the time just to
find a volunteer for setting up the coffeepot before the
meeting, or scrubbing it out after," one member told
us. "The idea of helping others in order to help yourself
is in trouble." And some members, pointing to circumstantial
factors, remark that the practice of Twelve Stepping is
on the decline. "In the days of Bill and Bob, everyone
knew a drunk whom you could seek out and Twelve Step in
what used to be your favourite bar," one member said.
"But today they're hidden away in rehab centers and
dealt with in a medical setting. The expectation that every
A.A. member will seek out someone to help seems to be fading."
are members who believe that the fellowship actually has
begun to break apart into schisms. On one side, there are
the proliferating victims groups ("Shoplifters Anonymous,
Tight-Shoes Anonymous, Edsel-Owners Anonymous" was
the list offered by Marc Galanter), a sort of endless Oprah
Winfrey show that claims the A.A. Twelve Step method as
its inspiration, but in which the real meaning of the Twelfth
Step is lost amid an incessant whine about the injured self.
"There's been an influx of double talk from these groups,"
one veteran remarked. "I've heard about an A.A. meeting
in New Jersey where the old-timers have taken to yelling
out “Tough shit, don't drink!” when the whiners
On the other side there is a rival group called Rational
Recovery, which began in 1986 and publishes a guide entitled
"The Small Book," in which the addict is promised
"sobriety...without depending on other people or Higher
Powers to help you out." This diluted version of the
original seems of A.A. true believers, a vestigial church,
where members make no real commitment to helping others,
yet refuse to face the irremediable loneliness of helping
A.A. will respond to these challenges remains an open -
and for many members an urgent -question. It is a fellowship
based on the proposition that human beings can overcome
their existential fear only by recognizing their responsibility
for themselves and their obligations to others. To contemplate
the history and the destiny of this idea in a culture that
seems to be losing its grasp of what Bill Wilson meant when
he wrote that "bottles were only a symbol" of
the endless human struggle against self-deception.
The New Yorker, March 20, 1995)