Medicine: Alcoholics’ Ego

The patient, a middle-aged businessman, faced the sanatorium psychiatrist defiantly. His wife was leaving him and his business partner was quitting. In the last, taut stage of a prodigious binge, the patient announced importantly that he had come to “dry out” again.

The psychiatrist said quietly: “Not this time. You will sign yourself in for 30 days or go somewhere else.”

The patient glared and clapped his hat on his head. Then defiance oozed out of him. He picked up a pen and signed himself in.

To the psychiatrist, Dr. Harry M, Tiebout, that surrender was as dramatic as a profession of religious faith. Dr. Tiebout believes that it was, essentially, a kind of spiritual awakening. Soon afterward, the patient joined Alcoholics Anonymous and quit drinking for good. He said to the psychiatrist some time later: “You did something to me when you made me sign that card. I knew you meant business. I made up my mind I wasn’t going to run my own case any longer. . . . [Then] I felt calmer and quieter inside and have ever since.”

Surrender. Tweedy, genial Dr. Harry Tiebout (pronounced teebo) is physician-in-charge of the Blythewood sanatorium in Greenwich, Conn. He is also a lecturer at Yale’s School of Alcohol Studies and an admirer of Alcoholics Anonymous. Like many another psychiatrist, he had long wondered what mysterious power enables A.A. to reform alcoholics when psychiatry fails. He has decided that the secret of A.A.’s success is the alcoholics’ surrender to a higher power. And Dr. Tiebout has figured out a psychiatrist’s explanation for it.

Like other types of mental patients, alcoholics are generally self-centered and defiant. During drinking bouts especially, they develop expansive egos and large ideas, are given to a well-recognized disease known as “telephonitis,” i.e., an irresistible itch to make long-distance phone calls, particularly to their psychiatrists (one well-heeled alcoholic of Tiebout’s acquaintance runs up phone bills of $400 a month).

Admission. Tiebout thinks that for such characters, standard psychotherapy —building up the patient’s ego and self-confidence—is sadly misplaced. He is convinced that an alcoholic who stubbornly tries to defeat the habit all by himself is sure to fail. A.A.’s major discovery, says the psychiatrist, is that the first essential step is the alcoholic’s admission that alone he is helpless against alcohol.

When the alcoholic quits trying to “run his own life,” his tension, his feeling of hostility toward his fellow men and his sense of isolation disappear; he feels a vast relief and “release of power.” Said a Tiebout patient after joining A.A.: “Now I am not unhappy about being unhappy. Before, I used to plan; now I can think without planning.”

Says Tiebout, a religious man but no churchgoer: “Surrender means cessation of fight . . . logically to be followed by internal peace and quiet. Loss of self is basic. And when the individual surrenders his ego, God automatically steps in.”