Some of what follows is from something I first posted in 2008 at Daniel Goldberg’s Medical Humanities Blog (and cross-posted at Ratio Juris). I have only slightly revised it. The remainder of the material having to do with Alcoholics Anonymous (AA) is new.
The title of this post refers to two books: Theodore Dalrymple’s Romancing Opiates: Pharmacological Lies and The Addiction Bureaucracy (Encounter Books, 2006) and the late Herbert Fingarette’s Heavy Drinking: The Myth of Alcoholism as a Disease (University of California Press, 1988). The second half of the post addresses some features of AA, although, as you will see, Fingarette’s book is germane to both parts.
The Wikipedia entry on Dalrymple introduces our author: “Anthony (A.M.) Daniels (born 1949) is a British writer and retired physician (prison doctor and psychiatrist), who generally uses the pen name Theodore Dalrymple. He has written extensively on culture, art, politics, education and medicine, drawing upon his experience as a doctor and psychiatrist in Zimbabwe and Tanzania, and more recently at a prison and a public hospital in Birmingham, in central England.”
In a brief description of the views that animate his writing, the entry notes that Daniels “contends that the middle class abandonment of traditional cultural and behavioural aspiration has, by example, fostered routine incivility and ignorance among members of the working class. Occasionally accused of being a pessimist and misanthrope, his defenders praise his persistently conservative philosophy, which they describe as being anti-ideological, skeptical, rational, and empiricist.”
I happen to be an unabashed Marxist in political economy (largely along the lines of the ‘analytical Marxists’) while, at the same time, subscribing to many of the democratic values and principles found in the Liberal tradition of political philosophy. Nevertheless, risking inconsistency and contradiction, I feel free to draw upon, say, classical Greek thought, natural law traditions (which need not be religious, hence they can be metaphysical yet secular1), and even anarchist political philosophy if it suits my fancy. And this is in reference only the political and economic parts of my worldview: the broadly philosophical and spiritual parts are principally of Asian provenance. In short, my own worldview is a hodgepodge or motley, in the words of the late Ninian Smart: “Our values and beliefs are more like a collage than a Canaletto. They do not even have consistency of perspective” (Religion and the Western Mind. 1987: 17). While consistency for my lifeworld may be an elusive virtue, I trust coherence is not, especially if one views the parts of the motley as reflective of an intellectual or epistemic and ethical division of labor. All of this by way of accounting for the fact that while Daniels is clearly a consistent conservative, that does not preclude me from finding this particular book persuasive on many counts, a reminder that, at least on what are sometimes confusingly called “cultural matters,” I too, on occasion and some topics, can be conservative, or at least Confucian, wherein in the notion of li involves an ethically formed approach to matters of etiquette, social norms, and perhaps rules generally.2
For some unjustifiable reason, Dalrymple’s book lacks notes of any kind, which is inexcusable, especially with regard to the extensive quoting of others, nor is there a bibliography, and the index is far from complete. As I was digesting the argument it called to mind Herbert Fingarette’s controversial but equally provocative and, by my lights, well-argued book, Heavy Drinking: The Myth of Alcoholism as a Disease (1988). It turns out that Dalrymple/Daniels thought so too, for near the end of the book we learn that “[w]hat Fingarette said of alcoholism can be applied with equal force to opiate addiction,” namely, that “the addict has a problem, but it is not a medical one: he does not know how to live. And on this subject the doctor has nothing, qua doctor, to offer.”
According to Daniels, “The temptation to take opiates, and to continue to take them ... arises from two main sources: first, man’s eternal existential anxieties, to which there is no wholly satisfactory solution, at least for those who are not unselfconsciously religious; and second, the particular predicament in which people find themselves. Modern societies have created, or at least resulted in, a substantial class of persons peculiarly susceptible to what De Quincy calls ‘the pleasures of opium.’” Now it is the second source that Daniels elaborates upon in the following:
“ ... [I]n most western societies [we might ask ourselves, just what is conspicuously ‘modern’ and ‘western’ in such societies!], there is now a class in which tedium vitae is very common, almost normal. This is the class from which the great majority of heroin addicts now comes…. The young of this class are disaffected, and have good reason to be so. They are for the most part poor, though not of course in the absolute sense. On the contrary, they are healthier, better fed, dressed, and sheltered than the great majority of the world’s population, past and present, and dispose of appurtenances whose sophistication would have astonished our forefathers. But they are poor in the context of their own societies (which is what counts psychologically [such ‘relative poverty’ counts in other ways too, as Amartya Sen, and Adam Smith before him, has argued3]) and they are so badly educated (this time in the absolute sense) that any historical or geographical comparison, by means of which they might put their poverty in some kind of perspective, is completely beyond them [They may be poorly educated, formally speaking, but I suspect it is the informal education and upbringing that is more a problem here].
They have no interests, intellectual or cultural. The consolations of religion are closed to them. As for their family lives, loosely so-called, it is usually of an utterly chaotic nature.... Their sexual relationships are a kaleidoscope of ephemeral couplings, often with abandoned offspring as a result, motivated by an immediate need for sexual release and often complicated by primitive egotistical possessiveness leading to violence and conflict. Their emotional life is intense but shallow, and their interactions with others governed by power rather than any kind of principle. Life is a matter of doing what you can get away with.
Their economic prospects are poor. They are unskilled in countries in which the demand for unskilled labour is limited. [....] Any work that they do will be repetitive and dull; and while a man might once have derived satisfaction from performing a menial task well, from leading a life of modest usefulness to others, this is not an age when such humility is very common.
In large part, this is because people live to a quite unprecedented degree in the virtual world of so-called popular culture. From the very earliest age, their lives are saturated with images of celebrities, whose attainments are often modest but who have been whisked by good fortune into a world of immense and glamorous luxury. This comparison with their own surroundings, squalid if not poor in the literal sense, is not only stark but painful, and is experienced as an open wound into which salt is continually rubbed. It is also experienced as an injustice, for why should people with tastes and accomplishments not so very different from their own lead a life of fairy-tale abundance? The injustice of which they feel themselves to be the victim reduces any lingering inhibitions against causing harm to society, which means in practice individual members of society. Crime ceases to be crime, but is rather restitution or justified revenge. And the fact that the abundance they so desire is itself empty and leads to dissatisfaction and boredom entirely escapes them.
The end result is that, while profoundly dissatisfied with their present lot, they do not have ambitions towards which they might actually work in a constructive fashion, but daydreams, in which every thing is solved at once in a magical way, daydreams from which the emergence into reality is always painful. Any aid to the perpetuation of the state of daydreaming (or reverie, as Coleridge and De Quincy call it) is therefore greatly appreciated.”
Although I might quibble with this or that, I find myself agreeing in the main with Dalrymple/Daniels despite our being at opposite ends of the contemporary political spectrum, importantly, my explanatory causal chain would commence with capitalism, its foremost ideologies as well as its more elusive yet widely diffused cultural ethos.
* * *
Whatever one thinks of Alcoholics Anonymous (AA), it clearly has a skeletal Christian structure (involving, first and foremost, reference to God or a ‘Higher Power’) although it’s officially non-denominational (atheists and agnostics have sometimes formed their own AA groups). Its members often become fervent believers in and missionaries for its methods. It is quite interesting and revealing that “AA sprang from the Oxford Group, a non-denominational, altruistic movement modeled after first-century Christianity. Some members founded the group to help in maintaining sobriety. ‘Grouper’ Ebby Thacher and former drinking buddy approached Wilson saying that he had ‘got religion,’ was sober, and that Wilson could do the same if he set aside objections and instead formed a personal idea of God, ‘another power’ or ‘higher power.’” The Christianity of the Oxford Group—or Buchmanites—was most evident in its revival of the notion of a “public and detailed confession, regarded as the first step toward a sincere conversion....” (of Protestant provenance).4
Whether intentionally or not, AA popularized the “disease” concept of alcoholism, a term that can be understood variously on the order of a biomedical affliction or in more metaphorical terms, with AA members preferring the biomedical interpretation (a conclusion based on anecdotal and other evidence), now depicted as an “addictive disease.” Efforts to assess its effectiveness have been quite difficult if not controversial, yet it appears safe to conclude that AA is “as effective as other abstinence-based support groups.” As Fingarette wrote in Heavy Drinking, “the addict has a problem, but it is not a medical one: he does not know how to live. And on this subject the doctor has nothing, qua doctor, to offer.” But whatever its dispositional commitment to a “disease model” of addictive behavior (discussed at some length in Fingarette’s book), AA does provides its members with an attenuated Christian worldview which addresses some of the “how to live” questions. It is thus not surprising that most of its members reside in North America (although there are members in well over a hundred countries around the world). Intriguingly, the well-known confessional component of AA is entwined with several therapeutic features of AA’s collective self-help group psychological dynamics, including the “instillation of hope, imparting relevant information, group cohesiveness, and catharsis.”
In a fairly decent research article (as such things go) on psychological concepts and therapeutic factors in AA aimed at those involved in different forms of therapy and counseling,5 one of the therapeutic modalities discussed is Alfred Adler’s (somewhat misleadingly titled) “individual psychology” model of psychotherapy. Mention is made AA members putting faith in something beyond themselves, acknowledging that some members will not be comfortable with “God-talk”: “For those who have had their struggles with organized religion [Is that redundant? Is not religion by definition more or less ‘organized’?] or concepts of God, it might be suggested that ‘God’ means [or can be replaced by] ‘good orderly direction,’ or ‘group of drunks’ [communal fellowship, if you will]. If a newly sober member has no interest in God, or the concept of one [in other words, they are agnostic or atheistic], it may be suggested to simply make the group their Higher Power.” From a psychoanalytic group psychology (be it Freudian or Kleinian) perspective, that does not seem a healthy alternative, even if communal fellowship or simply a sense of community among members is a valuable desideratum (as it was with Adler).
It has been said that today AA does not require a belief in God or even a “higher power”: “The only requirement for membership is a desire to stop drinking.” While welcome or inviting as stated, it is questionable outside groups whose members are avowedly agnostics or atheists, for while it may not be a de jure requirement, it seems by most accounts to be a de facto requirement. And so one thing I found (thus far) troubling or simply puzzling was an example used by our authors to illustrate the putative fact that religious faith or spiritual belief is not necessary for membership:
“On numerous occasions, one of the three authors has participated in the Mustard Seed AA Meeting in Chicago, where newcomers are given a note card with a mustard seed taped to it and advised it only takes that much faith to begin. In accordance with AA’s anonymity, the specific author is not identified.”
This is a somewhat disingenuous ritual or practice that hardly seems innocent or innocuous with respect to religion, in particular, Christianity! Surely our authors have heard of the “mustard seed parable” in the Gospels (often paired with ‘the leaven’ parable) of the New Testament:
- In the Gospel of Matthew [Matthew 13:31–32]: “The Kingdom of Heaven is like a grain of mustard seed, which a man took, and sowed in his field; which indeed is smaller than all seeds but when it is grown, it is greater than the herbs and becomes a tree, so that the birds of the air come and lodge in its branches.”
- In the Gospel of Mark [Mark 4:30–32]: “It’s like a grain of mustard seed, which, when it is sown in the earth, though it is less than all the seeds that are on the earth, yet when it is sown, grows up, and becomes greater than all the herbs, and puts out great branches, so that the birds of the sky can lodge under its shadow.”
- In the Gospel of Luke [Luke 13:18–19]: “It is like a grain of mustard seed, which a man took, and put in his own garden. It grew and became a large tree, and the birds of the sky lodged in its branches.”
Cf. the Gospel of Thomas (also known as the Coptic Gospel of Thomas) an extra-canonical “sayings” gospel, which is the most pellucid with regard to meaning (Thomas 20): “The followers said to Jesus, ‘Tell us what heaven’s kingdom is like.’ He said to them, ‘It is like a mustard seed, it is the smallest of all seeds, but when it falls on prepared soil, it produces a large plant and becomes a shelter for birds of heaven.’”
Hermeneutically, theologically, and doctrinally speaking, the authenticity of this parable “is not in question,” writes Ann Wierzbicka in What Did Jesus Mean? (Oxford University Press, 2001). Alongside the parable of the leaven, “nobody doubts that both these short and rather cryptic parables originated with Jesus. Furthermore, nobody doubts that they occupy an important place in Jesus’ teaching and that in fact they contain ‘one of the central elements of the preaching of Jesus.’”
The parable of the mustard seed contains a number of thematic images and metaphors: “the hiddenness of the seed (proverbially the smallest of all seeds); the inevitability of its growing (once planted); the consequent certainty of the outcome; the mysteriousness of this growth and its lack of dependence on human effort[!]; the amazing transformation of a tiny seed into large shrub; the shift from something hidden and imperceptible to something visible, tangible, and indeed spectacular.”
In conclusion, while there is nothing unsettling, be it religiously, spiritually, or psychologically speaking about this parable from the viewpoint of a Christian worldview or lifeworld, it decidedly is not a perspicuous illustration of AA’s refusal to require belief in God or a faith in a Higher Power sans the influence or presence of Christian faith or sentiment! In fact, the note card with the mustard seed attached to it would seem to be part of preparing the soil for planting the seed, and thus the Christian hopes that follow therefrom! If a prospective or new member asks a veteran, why a mustard seed? Or what is the meaning of this mustard seed note? It hardly seems possible that any forthcoming explanation will be bereft of some sort of Christian take on things along the lines of our introduction to the parable above.
I end on a personal note: my few encounters with AA members have not been encouraging (I’ll spare you the details), and my best friend from high school attended meetings for some time but eventually relapsed. But my experiences are idiosyncratic and anecdotal. If lives have been saved and members have found some relief from what ails them through AA, I can hardly begrudge them, for they have found something that “works,” at least in salient respects, for them. For a more objective assessment, see the conclusion to the above article on the history of AA’s work with alcohol addiction, one that credits AA with “revolutioniz[ing] humanity’s understanding and perspective on addition,” noting the “millions of individuals who have benefitted from the therapeutic elements in the support group model of counseling theory.” Finally, “AA has both relied upon, and established, numerous and powerful therapeutic factors that have exceeded its inception … [and whatever the origins of these therapeutic factors], “the contributions of the AA model on the sobriety and mental health of its members cannot be underestimated.”
Notes
1. Here are three contemporary examples of secular Natural Law theorizing that remain unavoidably metaphysical: The first is from Larry May in the context of his larger moral and legal treatment of international criminal law (especially jus cogens norms) and the “crimes against humanity” in particular. May proffers a “morally minimalist” conception of natural law that is beholden to H.L.A. Hart’s belief in what Hart called “a minimum content of natural law” as well as Thomas Hobbes’s moral and political philosophy in his book, Crimes Against Humanity: A Normative Account (Cambridge University Press, 2005 [see the index entry on ‘natural law’]). By way of making his brief argument eminently plausible, please see the discussion of same in S.A. (Sharon) Lloyd’s brilliant analysis, Morality in the Philosophy of Thomas Hobbes: Cases in the Law of Nature (Cambridge University Press, 2009). Second, May has essentially turned this into a book-length argument in Limiting Leviathan: Hobbes on Law and International Affairs (Oxford University Press, 2013). Finally, see the essay, “The Open Texture of Natural Law,” by Raghavan Iyer from his book, Parapolitics: Toward the City of Man (Oxford University Press, 1979): 50-60.
2. Please see the entry on “li” in my study guide for Confucianism. The term can embrace notions of ritual, rites, etiquette, customs, conventions, social norms, and propriety. Culturally and psychologically, involving both formal and informal methods of education in a society, li has everything to do with what the philosopher and writer Iris Murdoch once characterized as the “proper directing of our modes of attention.”
3. Please see Amartya Sen’s discussion of “relative poverty” in the chapter, “Conceptualizing and Measuring Poverty,” in David B. Grusky and Ravi Kanbur, eds. Poverty and Inequality (Stanford University Press, 2006): 30-46.
4. Stanley W. Jackson, Care of the Psyche: A History of Psychological Healing (Yale University Press, 1999): 144. Jackson devotes an entire chapter in his book to doctrines and practices of “Confession and Confiding.”
5. David A. Stone, John A. Contch, and Joshua D. Francis, “Therapeutic Factors and Psychological Concepts in Alcoholics Anonymous,” Journal of Counselor Practice 8(2): 120-135, 2017.
Recommended Reading (additional relevant titles are found in the three bibliographies below)
- Carr, E. Summerson. Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety (Princeton University Press, 2011).
- Elster, Jon. Strong Feelings: Emotion, Addiction, and Human Behavior (MIT Press, 1999).
- Elster, Jon. Ulysses Unbound: Studies in Rationality, Precommitment, and Constraints (Cambridge University Press, 2000).
- Elster, Jon, ed. Addiction: Entries and Exits (Russell Sage Foundation, 1999).
- Elster, Jon and Ole-Jørgen Skog, eds. Getting Hooked: Rationality and Addiction (Cambridge University Press, 1999).
- Heyman, Gene M. Addiction: A Disorder of Choice (Harvard University Press, 2009).
- Poland, Jeffrey and George Graham, eds. Addiction and Responsibility (MIT Press, 2011).
- Radoilska, Lubomira. Addiction and Weakness of Will (Oxford University Press, 2013).
Relevant Bibliographies