The Psychology of Alcoholism
15. The Effects of Alcohol on Our
William E. Swegan
Bill Swegan has found that this simple explanation of the basic psychology of alcoholism has given more insight to more struggling alcoholics and opened more eyes than anything else he has ever used in working with newcomers over the past 56 years. Even people with a number of years in the A.A. program often say that this gave them more help than they had ever received before in understanding the underlying nature of their disease and what we have to do at the practical level in order to start getting well.
This chapter is adapted from Chapter 15, "The Effects of Alcohol on Our Emotional Development" in The Psychology of Alcoholism (Hindsfoot/iUniverse 2003, 2011), but the basic material also appeared in many pamphlets which Bill wrote in earlier years. The fundamental ideas go back to 1949, when Bill attended the Yale School of Alcohol Studies and attended Dr. E. M. Jellinek's lectures. It was his friend and supporter Mrs. Marty Mann, the head of the National Committee for Education on Alcoholism (who was also on the faculty of the Yale School) who obtained a scholarship for Bill so that he would be able to attend. While at the Yale School, Bill also became lifelong friends with another of the students there, Searcy Whalen, the man from Dallas who especially displayed his abilities as an alcoholism counselor later on when he became Ebby's sponsor, and kept poor Ebby sober for longer than anyone else had ever accomplished.
Glenn F. Chesnut, Ph.D.
Over the many years I have been writing and lecturing on the problem of alcoholism, my own work has been identified as centering on the emotional aspects of its development. On the basis of what I have learned from observing thousands of alcoholics in recovery over the past half century, I have developed a profile of the alcoholic in which I show the paramount importance of various emotional components in producing compulsive and out-of-control drinking.
I began developing my own philosophy of alcoholism when I attended the Yale School of Alcohol Studies in 1949, and first came in contact with the late Dr. E. M. Jellinek. He was one of the most outstanding alcoholism researchers of his time, and made a number of important contributions to the field. He had originally been trained in the application of the statistical method to biological research, and had an impressive ability to sort through complex data, and spot trends and sequences, and then mathematically prove their statistical validity. One legacy of his work was his development of the Jellinek curve, as it is called, which he drew up by making statistical studies of personal life histories given to him by alcoholics involved in recovery in the Alcoholics Anonymous program. Dr. Jellinek demonstrated that there were clearly defined progressive changes in behavioral patterns as alcoholics continued to drink over months and years, which could be laid out in an easy-to-understand chart. The alcoholic’s problems not only grew worse and worse, they did so in fairly predictable ways, in a sort of stepwise fashion. This Jellinek curve is still used worldwide in classrooms, treatment programs, and in public educational programs.
In addition to his development of this statistical curve, he had also determined through his own research that the depressive effect of alcohol on the barrier separating the conscious from the subconscious played a major role in the progressive development of alcoholism. With his permission, I began using diagrams based on this part of his theories about alcoholism in my own work at Mitchel Air Force Base, and have continued using them to this day. They have proven to be effective and convincing in working with alcoholics who deny that they have any real problem. I have also found that others who work in alcoholism treatment programs have found these diagrams very useful in understanding important aspects of the problem.
I continued to develop my own theories after I arrived at Lackland Air Force Base, where I was appointed as Psychiatric Social Worker in the Department of Psychiatry. My supervisor and mentor there was the late Louis Jolyon West, M.D., an eminent psychiatrist and dear friend, who taught me about many aspects of human behavior and the emotional components of alcoholism. Dr. West eventually became head of the Department of Psychiatry and Director of the Neuropsychiatric Institute at the University of California at Los Angeles, where he used me as a Consultant to their Alcohol and Drug Program. During his lifetime, he was considered one of the most eminent psychiatrists in the United States and received many awards and recognitions.
With the charts based on Dr. Jellinek’s work, ideas drawn from Dr. West’s psychiatric observations, and my own practical experience in running alcoholism treatment programs, I have been able develop speeches and presentations which seem to give most people who attend my talks valuable insights into the underlying nature of this disease. It is an approach which not only works with high success in counseling individual alcoholics, but helps other people involved in alcoholism treatment gain a better grasp of the nature of the problems they are attempting to treat, with again great success when put to practical application.
These charts illustrate the origin and progression of emotional problems, and the way in which alcohol may ultimately be used to alleviate the anxiety and stress associated with both conscious and subconscious problems. We must remember of course, that as mentioned previously, not all individuals who become alcoholics have this sort of emotional component. There are a variety of causative factors which can be at work in producing alcoholic behavior, including genetic, environmental, and experiential factors, and alcoholism can be produced by any one of these factors even though the others are absent.
I have observed alcoholics who suffer only from a physiological addiction, for example. Regular use of alcoholic beverages (including beer or wine) over an extended period of time can create a physical dependence on alcohol in and of itself. These sorts of alcoholics can frequently be identified because there is no gross behavior change displayed in their actions when they are inebriated. Genetics is one of the contributors for most alcoholics. A vast majority of those who eventually become alcoholic have a history of alcoholism in their family, particularly when one investigates not only their parents’ generation but the previous generation as well.
However, one can have alcoholism with no genetic contributor: those who insist that they have no family history of alcoholism cannot use that as a way of defending their obviously out-of-control alcohol abuse as though it were only harmless “social drinking.” A mother who drank during pregnancy, even if she was not an alcoholic, can pass alcohol dependency on to the fetus. This is in addition to the abnormalities produced by the fetal alcohol syndrome and may be present even if that is absent. The kinds of causal factors which can produce alcoholism are many.
Alcoholism is a complex phenomenon. Each alcoholic is unique. There will be a different mix of factors in each individual, so an individualized treatment program has to be devised for each person whom one is attempting to treat. Nevertheless, the emotional component is so often present, that I have found great success over the past half century in making this the centerpiece of my treatment strategy for the vast majority of cases.
If we look at this most typical sort of case, we will discover that the alcoholics’ problems tend to begin appearing in some fashion during their earliest years. In early childhood development, parents have a decided influence on their children. They set the standards for human relationships, and they either provide or fail to provide their children with adequate social skills. The parents’ emotional conflicts or their inability to act as functional parents, will have a dynamic negative influence on their children.
One does not need to have parents with major emotional conflicts or psychological problems per se in order for the children to develop serious personality problems. In spite of the current trend of talking about “dysfunctional families” in the psychological and emotional sense as a central causal factor, problems can just as easily arise from other sorts of issues. In many parts of the United States, for example, children are expected to be able to read and write to some degree prior to school enrollment. Parents who are unwilling or unable to assist their children in this preschool training — who send their children off to school already behind their peers — can create irreversible psychological damage in the child.
School teachers may not be able to reach some of these children in an effective remedial manner, no matter how hard they try. These children’s lifestyles have already been established, and they may refuse to be taught. No amount of external pressure appears to change unmotivated children of this sort, unless they themselves can come to recognize the futility of this kind of negative behavior, and can be encouraged to change their fundamental lifestyle.
The circle in these charts represents the central nervous system or the brain. It is divided into two separate parts, the conscious and the subconscious. The line through the middle, which divides these two sections, represents the inhibitions, that is, the ability to repress negative personality problems which are painful and anxiety laden. Everything which we perceive consciously (see Fig. 1) is not experienced as negative, but for the purpose of exposing the origin of this sort of alcohol problem, only those which are anxiety provoking are listed above the divider line.
Initially in early childhood the problems listed as subconscious (see Fig. 2) were experienced on a conscious level, but the rejection or punishment received was so painful that they were inhibited. When these emotions were forced down into the subconscious in this fashion, alternative behavior patterns emerged to compensate for these traumatic problems. Inhibited negative conflicts cause tension, for example, which in turn produces emotional unrest. The arrows in Figure 2 represent this internal psychological tension. The person then must develop alternative methods for easing this anxiety. In the alcoholic, that beverage is used as a means for coping with problems which produce this sort of anxiety, and as a way to try to deal with the person’s inability to live in an acceptable lifestyle.
The kinds of inhibited conflicts listed on the diagram down below the line, are buried in the subconscious where the individual is no longer in conscious knowledge of their existence, but they will nevertheless still be manifested on the conscious level in a variety of ways. People with subconscious emotional problems feel inadequate, lonely, inferior, self-condemning, and full of self-pity at the conscious level (Fig. 1). And there are other conditions as well which make the person unable to experience good feelings from his or her interpersonal relationships. The entire process produces anxiety and tension which either interferes with or totally precludes normal behavioral responses.
Again I must issue the warning that not all alcoholics drink to try to self-medicate emotional conflicts and problems of this sort. Alcoholism is a complex phenomenon. Many alcoholics do not exhibit a gross behavior change under the influence of alcohol, which may indicate a primarily physiological addiction. Their bodies demand the alcohol because they begin undergoing painful and unpleasant physical symptoms when there is no alcohol in their bloodstreams. It is often difficult to convince people that they are alcoholics when they display little or no behavior changes of the sort we are describing here, that is, the acting out of subconscious emotional conflicts in a destructive or antisocial fashion. Nevertheless the irresistible compulsion to drink, and the negative effects of constant inebriation on their ability to function, means that they too need help in overcoming their alcohol dependency.
One of the most powerful motivations for continuing to act in a certain kind of way arises from the results these behaviors produce. Basically healthy individuals who are looking for positive paybacks will display behavior which is socially and legally appropriate, emotionally rewarding, and within the guidelines of their culture. The successes they achieve by acting that way motivate them to continue this sort of positive behavior. This will set up a positive reinforcing cycle.
When people respond in an opposite way, reacting to their own negative inner drives without being influenced or restricted by cultural demands, they will not receive these positive results, and anxiety will be the byproduct. When they then drink alcohol because of their feelings of anxiety, this will increase the effect of those negative inner drives on their behavior, which will in turn drive them into drinking even more alcohol, and set up a negative reinforcing cycle which will feed on itself and produce ever-growing levels of antisocial behavior.
We are a success-oriented society. Our motive often seems to be to teach people more about how to succeed than how to gain pleasure from life, but this kind of success philosophy can nevertheless be a powerful motivational tool. We eulogize those who are successful, and condemn those who give up and end up in hospitals or jails. Unfortunately, for people who have the kind of negative outlook on life which we see in many alcoholics, there is little chance that the outcome will be positive. Their drinking and their attitudes causes them to be a failure a good deal of the time in achieving meaningful successes in life, and they feel the weight of society’s condemnation quite powerfully.
Most parents encourage their offspring to excel in both physical and mental tasks. As young people go through the maturation process, rewards are allocated to those who accomplish such things as achieving a high grade-point average in their scholastic endeavors, winning parts in plays, earning badges and letters for their achievements, and making the starting team in an athletic program. But some young people end up with little to show for what are in fact only limited efforts on their part to reach most of these goals. As a result, they withdraw psychologically from the process. Eventually they merely exist, and pass most of their time in a totally nonproductive manner.
Achieving some of the accomplishments above requires taking part in group activities. Participation in these provides the individual with a feeling of belonging. Young people who never experienced any positive group relationships within their childhood families enter school with attitudes and behavior patterns already set in such a negative way that there is little likelihood of their responding favorably to group work in the educational setting. One cannot live in any human society without having to function within groups of various sorts. People who developed strong barriers against feeling a part of any group when they were children can continue to be blocked by that from any sort of greatly rewarding life even after they become adults.
We want to feel good. The quality of our interpersonal relationships has a profound impact on our ability to feel good. When we are forced to function within a group, the response of the other group members will determine whether this need to feel good will be met or denied. I had problems this way myself. When I was a child, I was disruptive in school and elsewhere, and sought attention through this disruptive behavior, which naturally caused negative responses. I tried to be a part of the group by creating trouble, or by attempting to do things which I thought would be humorous, and amuse people and make people laugh. When I attempted to win my pilot’s wings in the Air Corps not long after Pearl Harbor, I was expelled from Air Cadet School because of a drunken attempt to dance with a dog at a fancy ball which was held for the cadets. Each time something like this happened, I ended up being isolated from the group. I came to feel that this was my fate, and I bitterly resented those who were well-adjusted and who were regarded as an acceptable part of the group.
From the time a child is introduced into the competitive aspect of our society, and throughout the maturational process, there are several constant themes. (1) We must compete and be evaluated. (2) We must experience either acceptance or rejection. (3) We must ultimately confront either success or failure. How well we do is based on our ability to perform under these highly stressful circumstances. I can understand this from my own childhood experiences. I began the process of socialization and maturation by falling into consistently negative responses to these societal demands, so that it is not difficult to see why I failed to negotiate that initial period of my life successfully. Some of the obstacles that I believed blocked me from success, in my own case, were figments of my imagination, but whether these obstacles were real or imagined, they created an unbreakable barrier blocking me from growing up into a stable, mature adult. I did not start growing up myself until I was thirty years old -- I was standing in front of a mirror one summer day in 1948, and I looked at myself, and actually said aloud these simple words, "I am unacceptable to myself."
Societal demands are extremely different now than when I was a teenager, but the basic dynamic has not changed. There still remains the need to feel good about oneself, to function effectively in our competitive society, and to experience love from others. When our inappropriate responses to these external pressures fail to supply these needs, many young people seek alternative routes to temporarily “feeling good.” They attempt to alleviate the anxiety produced by their failure to meet societal demands by various substitute methods, but alcohol can become a major component in this game.
Over the past thirty-five years, increasing numbers of American teenagers have also been tempted to use narcotics and other mind-altering and mood-altering drugs for the same kind of purpose. We have become a drug-oriented society, and although opposed to addiction to these drugs, we provide all the conditions which are conducive to going down that destructive route. Nearly every ache and pain can be treated with a non-prescription drug. This includes drugs which can be taken which we believe will help us to fall asleep, to stay awake, or to block out all sorts of symptomatic physical pain.
People in our society can be, and often are, deluded even at that level. Taking aspirin for a headache will do no good in the long run if a brain tumor is causing the pain, or if what the person really needs is a new pair of eye-glasses. But the belief still persists that if I can figure out the right pill to take, I will automatically start “getting well” and begin to feel good again, with no further effort on my part. So a useless medication can sometimes seem to produce temporary good results, as a sort of psychological illusion. I want so much to believe that it is working, that I delude myself into believing that it is actually working. And so for a certain period of time I can convince myself that I have found the “cure” for what is making me feel so bad.
So adults in our society regularly turn to drugs for all sorts of reasons, and achieve some psychological relief even if these medications are not always all that effective at the purely physical level. Children who observe the attitudinal changes produced in their parents by the use of these drugs, may easily become convinced that they too could overcome any discomfort they were feeling by finding the right type of drug.
Many American teenagers now at least experiment with the effects of narcotics and other drugs, and some become totally addicted to them, nevertheless beverage alcohol is still the number one substance used in this country by young people who are attempting to gain for themselves some sort of chemically-induced attitudinal change. Young people who have difficulty in communicating with their parents, their siblings, their peers, and authority figures, still usually turn to alcohol as the primary mind-altering chemical they use in the attempt to alleviate their painful feelings. In part their choice of alcohol is aided by every type of advertising, in newspapers, magazines, radio, and television, suggesting (without considering the consequences for many) that the use of alcohol will produce socially acceptable benefits in a way that other drugs clearly will not.
I am therefore going to confine myself in this chapter to discussing the effects of alcohol on the central nervous system. I do not want to make this chapter any more complicated than I can help. Figure 3 illustrates the change in behavior and attitude when alcohol is ingested by someone with subconscious emotional conflicts.
The excessive use of alcoholic beverages in our society becomes a trap for the person with emotional problems, as well as for those with a genetic or physical predisposition to becoming addicted to this drug. Alcohol is a socially acceptable beverage in our culture, and most individuals do not intentionally drink compulsively. For vast numbers of people, becoming trapped occurs as a gradual process of falling into greater and greater physical and psychological dependence. However, a small portion of those who drink exhibit extremely negative behavior traits from the onset, as one can see from my own case. Even then, however, the problems progress and the consequences continue to grow worse and worse as the person continues to drink. Those who become trapped in compulsive drinking ultimately become rehabilitated, or descend into a useless life of total alcohol dependence, or die.
As the alcohol problem progresses, the demand for alcohol increasingly overwhelms the ability to control and abstain. Those in an early stage of alcoholism will usually still have some sense of responsibility, but this progressively erodes away. As the dependency grows, they become more and more preoccupied with the need to procure alcohol to sustain their habit at any cost.
Figure 4 illustrates the emotional picture when alcohol is withdrawn. An even greater emotional instability is created. This emotional state becomes increasingly too painful to tolerate. Now the alcoholic feels the compulsion to drink, not just because of the preexisting subconscious emotional conflicts, but also because of the new anxieties and guilt produced by the last drinking bout, which impose an additional burden of pain. The conscious thought processes have also become even more confused and filled with negative and self-destructive attitudes.
Social drinkers (as opposed to alcoholics) have other interests, and are not continually preoccupied with the thought of drinking or obtaining alcohol to drink. Problem drinkers however increasingly come to have no other interests. They rely on alcohol for social involvement, and to ease stress situations, and then in progressive fashion become dependent on alcohol in order to deal with any kind of life circumstance: weddings, funerals, job promotions or job losses, or in any kind of situation involving responsibilities. For those budding alcoholics who begin young, dealing with the pressures of school and school activities becomes increasingly impossible without drinking.
After alcoholism has progressed to a great enough degree, some individuals are unable to recall events that occurred while drinking. This is called having a “black-out.” This is a definite warning sign that this person has become an alcoholic. However, the reader should be warned, some people are able to progress quite far in the development of the disease without having clear and distinct evidence of black-outs. The apparent absence of black-out drinking does not at all mean that a person has not already become an alcoholic. There are all kinds and degrees of memory loss. There are people who cannot remember their physical surroundings the night before, but whose emotional recall is unaffected. They might remember that they had been very angry the night before, for example, but would not be able to recall the physical situation that made them so angry.
Black-outs may increase the guilt produced by excessive drinking, for those who become apprehensive about their inability to recall their actions while they were in that mental state. Some alcoholics worry incessantly afterwards about where they were, who they offended, whether they borrowed money from anyone, whether they physically attacked anyone, and so on, ad infinitum. Some experts believe that black-outs are a means of escaping the pressures of reality. A strange phenomenon can occur when people in a black-out are suddenly involved in an accident or confronted by the law, and instantly come out of their black-out. It appears that the increase in the flow of adrenaline produces this effect, and returns the mind’s ability to remember.
In the early stages of alcoholism, many do not drink in the morning when they first arise. For them, morning drinking begins only in a later stage of the disease, after the physical suffering from withdrawal has progressed to unacceptable levels. When alcoholics begin drinking in the morning, it is to overcome the emotional discomfort of the hangover, or to satisfy the physical craving of their bodies. This first drink in turn seems to trigger a physical or psychological compulsion to continue drinking for all the rest of that day.
Morning drinking of that sort is a clear indication of an alcoholic pattern of drinking, but one should be very careful here. There are some alcoholics whose disease is quite progressed, who do not drink in the morning, and use this as an excuse to rule out the label of alcohol dependency. These are people who either cannot physically tolerate drinking the next morning at all, or who are willing to bear the physical effects of the withdrawal of the alcohol from their systems, no matter how painful it is. Not drinking before noon, or before five p.m., or some other target time, is not ever “proof” that a person is not an alcoholic. It does not at all indicate that the disease has not already progressed to a truly dangerous point.
Prior to the admission of complete defeat, alcoholics use various methods in the attempt to conceal, deny, or minimize their problem. They usually lie about how much they actually drink when they are asked, and they try to “sneak drinks” when no one is watching.
Or they attempt to deal with their alcoholism in ways that never work and never can. Perhaps they begin to realize to a certain degree that alcohol is beginning to interfere in their lives, or that they have developed an unhealthy dependence on alcohol. So they may exclaim, “I’m off the hard stuff, only beer from now on.” One of the great American myths is that beer is the beverage of moderation, so alcoholics switch from hard liquor to beer in order to convince others that they really have no alcohol problem. Beer as beverage of moderation is a fairy tale, because it is just as intoxicating as any other beverage containing alcohol. It takes a greater volume of beer because of its lower alcohol content, and a slightly longer time to become inebriated because of its slower absorption rate. But one can produce all the alcoholic symptoms on beer alone, as many people have found to their dismay. It does not slow or reverse the progression of the disease in the slightest.
The same warning applies to wine. The progression of the disease will continue the same way as it would while consuming any alcohol-containing beverage. One need only glance at a wino lying in the gutter, clutching a bottle of wine in a brown paper bag, to dispel the myth that one can stop the progress of alcoholism by switching from hard liquor to wine.
I recently saw a program on television in which the old claim was again being raised that drinking slight amounts of alcohol (wine was being recommended in this case) can help people avoid heart attacks. I immediately cringed to think of what this advice could do to undermine someone who was drinking excessively, and who also had a weak heart, but was trying to quit. The television presentation also ignored the fact that any slight statistical gain achieved in avoiding heart attacks by moderate alcohol ingestion would be more than offset by the greater statistical chance of dying of cancer (and many other diseases) instead, for consuming even small amounts of alcohol affects those statistics negatively. Those are so many more effective methods of coping with heart problems, which are not risks to those who are already on the edge of becoming alcoholics, such as eating healthier food or walking for exercise. But bending your elbow every day is not what is meant by “taking regular exercise.”
And alcoholics use many other tactics to try to talk themselves into believing that some kind of “controlled” drinking would be possible for them, whether it is the type of beverage, or the amount drunk, or the time of day that they take their first drink. The Rand Report that came out in the mid 1970’s suggested that some alcoholics, with proper therapy, could return to social drinking with no ill effects (see William L. White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, 293-295; and Nancy Olson, With a Lot of Help from Our Friends, ch. 27, “The Controlled Drinking Controversy.”) That particular claim has continued to emerge occasionally from time to time. The actual statistics in each instance -- when serious controls were applied, truly objective long term follow-up methods were used, and all of the eventual effects were included as part of the data -- never bore out any of these assertions, but the claims continue to appear periodically, for they appeal to a certain kind of wishful thinking.
In all my own years of working with alcoholics, I have never known of even one person who was able to accomplish the feat of returning to normal social drinking successfully. The ones whom I know who tried it, returned to the same dysfunctional lifestyle and began exhibiting the same kinds of destructive behaviors that they had shown when they drank previously. Alcoholics do not drink for social reasons in the first place, they drink to escape the pains of reality. That is why the majority of alcoholics, once solidly established in recovery, find that they would not want to drink again at all even if some technique were developed which would allow them to do so without returning to their old compulsive excess -- they simply do not desire even a small amount of that kind of sensation or mental state any more.
These comments are based mainly upon observations I have made of alcoholics who were still in denial. But there are some alcoholics who only rarely attempt to minimize the amount they are actually drinking, and who regularly admit, and sometimes even brag, about their excessive drinking. Alcoholics of this sort make little or no attempt to deny that. What they do instead is to recite the problems they are having, and complain about the circumstances which they insist are causing them to drink. It is always the fault of other people and circumstances, and they rarely acknowledge that it was their drinking itself which was causing most of the problems in the first place. They turn to self-pity in order to eliminate self-blame for their alcoholic behavior. So alcoholics of this sort have their own strategies for evading facing the full truth.
The important thing to note is that in one way or another, alcoholics who have not yet acknowledged their defeat use alibis, lies, and concealment tactics to attempt to hide their excessive drinking or make excuses for it. And they cannot learn how to deal with their problem until they first admit that it exists.
In summary, there are three basic kinds of causal factors which can produce alcoholism, either by themselves or in combination. The most prevalent contributing factor is the genetic background of the victim. Alcoholism as physical addiction can be produced simply by drinking too much alcohol too regularly over too long a period of time. But for most people I have treated over the past half century, the use of alcohol in an attempt to medicate the stress of dealing with reality was what led to the excessive dependence, and serious internal emotional problems and failure in adequate socialization were responsible for the majority of the pain and distress.
The goal of treatment is not only the removal of the irresistible compulsion to drink, but also teaching alcoholics how to feel good. That is what human beings desire more than almost anything else, and that is what the kind of treatment I am describing in this book can produce. If you the reader are an alcoholic who is locked in enormous misery and pain, do please hear me when I tell you that there is an answer. You can be freed from that, and can learn how to feel good about yourself again. This is the most priceless gift anyone could ever be given.
The A.A. program was an attempt to produce a balanced synthesis between psychology and spirituality, but there was sometimes tension in early A.A. between those who put more stress on the spiritual aspects of the program and those who put more emphasis on the psychological side. What makes Bill Swegan's writings important is that he describes better than anyone else the kind of psychological principles used by the latter group, those who interpreted the twelve steps in predominantly psychological terms. This chapter is must reading for anyone who would want to understand early A.A. All the good old-timers who have read it say that Bill accurately describes what those early A.A. people believed, and that this short piece is a real classic.
Bill was a psychiatric social worker at Lackland, with no training in theology or religious studies, but he was certainly not an atheist or agnostic, and in fact he continually makes it clear that any newcomers who are totally hostile to God are going to have to get past that if they expect to get healthy again. The real issue they are struggling with is in fact hardly ever theological -- that is just a blind to cover the real problem -- because what is almost invariably going on is a deep anger and resentment towards a parent, or the religious teachers whom they were subjected to when they were children, or authority figures in general. Or sometimes it can be a control neurosis where they are thrown into a panic at the thought of any situation where they themselves are not totally in control, or something of that sort. Getting them to look at the real this-worldly problem instead of haranguing against God is the first step towards psychological health.
The kind of psychology which most influences Bill Swegan is what is called Neo-Freudianism. This was a group of psychiatrists who started off as orthodox Freudians, but then began to realize that the over-emphasis on Freudian Oedipal complexes and penis envy and things of that sort was not useful for explaining why most people had psychological problems, nor was it helpful in curing their problems. We remember what Dr. Bob said in his last public speech, where he warned that the kind of psychiatry which focused on over-drawn theories about "Freudian complexes" was not useful in working with alcoholics. As we see from the old Akron reading list for A.A. beginners, Dr. Bob and the Akron A.A. people instead recommended reading works like the book by the Yale-trained psychologist Ernest M. Ligon, Psychology of Christian Personality, which combined Neo-Freudian psychiatric principles with a positive attitude toward religion and spirituality.
The Neo-Freudians modified orthodox Freudian doctrine by talking about the importance of other issues such as social factors, interpersonal relations, and cultural influences in personality development and in the development of psychological illnesses and disorders. They believed that social relationships were fundamental to the formation and development of personality. So in other words, they tended to reject Freud's emphasis on sexual problems as the cause of neurosis, and were more apt to regard fundamental human psychological problems as psychosocial rather than psychosexual. The works of the Neo-Freudians Alfred Adler (1870-1937) and Karen Horney (1885-1952) are especially important for understanding Bill Swegan's psychological approach.
Bill was also later on strongly affected by the writings of the psychologist Abraham Maslow (1908-1970). After Maslow became chair of the psychology department at Brandeis University in 1951, he began developing his theory of self-actualization as the goal of the best and most satisfying kind of life. What he called self-actualization had many things in common with Karen Horney's idea of self-realization. Although Bill does not use either technical term, this kind of idea is at the heart of much of the kind of therapy which he used with so much success with struggling alcoholics.
Approaches like this fit much better with the understanding within A.A. that alcoholics had great problems dealing with other human beings, and that one of the main purposes of the fourth through eighth steps was discovering our own role in producing all these areas of resentment and fear towards other people, and healing our relationships with these other people so that we could become fully functioning members of society once again.
Glenn F. Chesnut, Ph.D.