The Irrationality of Alcoholics Anonymous

Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective.

by GABRIELLE GLASER

J.G. is a lawyer in his early 30s. He’s a fast talker and has the lean, sinewy build of a distance runner. His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. He’s also a worrier—a big one—who for years used alcohol to soothe his anxiety.

J.G. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet. He favored gin and whiskey but drank whatever he thought his parents would miss the least. He discovered beer, too, and loved the earthy, bitter taste on his tongue when he took his first cold sip.

His drinking increased through college and into law school. He could, and occasionally did, pull back, going cold turkey for weeks at a time. But nothing quieted his anxious mind like booze, and when he didn’t drink, he didn’t sleep. After four or six weeks dry, he’d be back at the liquor store.

By the time he was a practicing defense attorney, J.G. (who asked to be identified only by his initials) sometimes drank almost a liter of Jameson in a day. He often started drinking after his first morning court appearance, and he says he would have loved to drink even more, had his schedule allowed it. He defended clients who had been charged with driving while intoxicated, and he bought his own Breathalyzer to avoid landing in court on drunk-driving charges himself.

In the spring of 2012, J.G. decided to seek help. He lived in Minnesota—the Land of 10,000 Rehabs, people there like to say—and he knew what to do: check himself into a facility. He spent a month at a center where the treatment consisted of little more than attending Alcoholics Anonymous meetings. He tried to dedicate himself to the program even though, as an atheist, he was put off by the faith-based approach of the 12 steps, five of which mention God. Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence. He went back to rehab once more and later sought help at an outpatient center. Each time he got sober, he’d spend months white-knuckling his days in court and his nights at home. Evening would fall and his heart would race as he thought ahead to another sleepless night. “So I’d have one drink,” he says, “and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.”

He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.

J.G.’s despair was only heightened by his seeming lack of options. “Every person I spoke with told me there was no other way,” he says.

The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work…

more…

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

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Hermann Hesse on Little Joys, Breaking the Trance of Busyness, and the Most Important Habit for Living with Presence

Illustration by Sydney Smith from Sidewalk Flowers by JonArno Lawson, a wordless ode to living with presence

“The high value put upon every minute of time, the idea of hurry-hurry as the most important objective of living, is unquestionably the most dangerous enemy of joy.”

“Of all ridiculous things the most ridiculous seems to me, to be busy — to be a man who is brisk about his food and his work,” Kierkegaard admonished in 1843 as he contemplated our greatest source of unhappiness. It’s a sobering sentiment against the backdrop of modern life, where the cult of busyness and productivity plays out as the chief drama of our existence — a drama we persistently lament as singular to our time. We reflexively blame on the Internet our corrosive compulsion for doing at the cost of being, forgetting that every technology is a symptom and not, or at least not at first, a cause of our desires and pathologies. Our intentions are the basic infrastructure of our lives, out of which all of our inventions and actions arise. Any real relief from our self-inflicted maladies, therefore, must come not from combatting the symptoms but from inquiring into and rewiring the causes that have tilted the human spirit toward those pathologies — causes as evident to Kierkegaard long ago as to any contemporary person who crumbles into bed at night having completed the day’s lengthy to-do list yet feeling like a thoroughly incomplete human being.

How to heal that aching spirit is what Hermann Hesse (July 2, 1877–August 9, 1962) addresses in a spectacular 1905 essay titled “On Little Joys,” found in My Belief: Essays on Life and Art (public library) — the out-of-print treasure that gave us the beloved writer and Nobel laureate on the three types of readers and why the book will never lose its magic.

More than a century before our present whirlpool of streaming urgencies, Hesse writes:

Great masses of people these days live out their lives in a dull and loveless stupor. Sensitive persons find our inartistic manner of existence oppressive and painful, and they withdraw from sight… I believe what we lack is joy. The ardor that a heightened awareness imparts to life, the conception of life as a happy thing, as a festival… But the high value put upon every minute of time, the idea of hurry-hurry as the most important objective of living, is unquestionably the most dangerous enemy of joy.

Decades before the German philosopher Josef Pieper made his prescient case for liberating leisure and human dignity from the clutch of workaholism, Hesse laments how modern life’s “aggressive haste” — and what a perfect phrase that is — has “done away with what meager leisure we had.” He writes:

Our ways of enjoying ourselves are hardly less irritating and nerve-racking than the pressure of our work. “As much as possible, as fast as possible” is the motto. And so there is more and more entertainment and less and less joy… This morbid pursuit of enjoyment [is] spurred on by constant dissatisfaction and yet perpetually satiated.

Noting that he doesn’t have a silver bullet for the problem, Hesse offers:

I would simply like to reclaim an old and, alas, quite unfashionable private formula: Moderate enjoyment is double enjoyment. And: Do not overlook the little joys!

A century before psychoanalyst Adam Phillips made his compelling case for the art of missing out and the paradoxical value of our unlived lives, Hesse considers what moderation looks like in the face of seemingly unlimited possibilities for what to do with one’s time, and although the options available have changed in the hundred-some years since, the principle still holds with a firm grip:

In certain circles [moderation] requires courage to miss a première. In wider circles it takes courage not to have read a new publication several weeks after its appearance. In the widest circles of all, one is an object of ridicule if one has not read the daily paper. But I know people who feel no regret at exercising this courage.

Let not the man* who subscribes to a weekly theater series feel that he is losing something if he makes use of it only every other week. I guarantee: he will gain.

Let anyone who is accustomed to looking at a great many pictures in an exhibition try just once, if he is still capable of it, spending an hour or more in front of a single masterpiece and content himself with that for the day. He will be the gainer by it.

Let the omnivorous reader try the same sort of thing. Sometimes he will be annoyed at not being able to join in conversation about some publication; occasionally he will cause smiles. But soon he will know better and do the smiling himself. And let any man who cannot bring himself to use any other kind of restraint try to make a habit of going to bed at ten o’clock at least once a week. He will be amazed at how richly this small sacrifice of time and pleasure will be rewarded…

more…

https://www.brainpickings.org/

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Storyhealing

Imagem relacionada

Untold stories; a country doctor, Ernest Guy Ceriani, going to visit his patients in the 400 miles of remote countryside surrounding Kremmling, Colorado in 1948. Photo by W. Eugene Smith/Magnum

Literature can enthuse medicine, and medicine can inspire literature. They are complementary treatments for being human

Gavin Francis is a doctor and an award-winning writer. His latest book is Adventures in Human Being (2015). He lives and practises medicine in Edinburgh, and writes for The Guardian, The New Republic, The London Review of Books and The New York Review.

Every month or so, I see a patient called Fraser in my primary care clinic, a soldier who was deployed in Afghanistan. Fifteen years after coming home, he is still haunted by flashbacks of burning buildings and sniper fire. He doesn’t work, rarely goes out, sleeps poorly, and to relieve his emotional anguish he sometimes slices at his own forearms. Since leaving the army, he has never had a girlfriend. Fraser was once thickly muscled, but weight has fallen off him: self-neglect has robbed him of strength and self-confidence. Prescription drugs fail to fully quieten the terror that trembles in his mind. Whenever I used to see him in clinic, he’d sit on the edge of his seat, shakily mopping sweat from his forehead and temples. I’d listen to his stories, tweak his medications, and tentatively offer advice.

When Fraser began coming to see me, I was reading Redeployment (2014) by Phil Klay – short stories about US military operations, not in Afghanistan, but in Iraq. No book can substitute for direct experience, but Klay’s stories gave me a way to start talking about what Fraser was going through; when I finished the book, I offered it to him. He found reassurance in what I’d found illuminating; our conversations took new directions as we discussed aspects of the book. His road will be a long one, but I’m convinced those stories have played a part, however modest, in his recovery.

It’s said that literature helps us to explore ways of being human, grants glimpses of lives beyond our own, aids empathy with others, alleviates distress, and widens our circle of awareness. The same could be said of clinical practice in all of its manifestations: nursing to surgery, psychotherapy to physiotherapy. An awareness of literature can aid the practice of medicine, just as clinical experience certainly helps me in the writing of my books. I’ve come to see the two disciplines as having more parallels than differences, and I’d like to argue they share a kind of synergy.

Patients spend more time with a writer than they can ever spend with their physician, and the hours it takes someone to read and reflect on a book can be time well-spent. Redeployment might have eased some of Fraser’s bewilderment and isolation, but by breaking down a boundary of experience it also helped me to understand a little more of what he had been through. There are numberless other books that do the same. William Styron’s Darkness Visible (1990) offers an eloquent testimony of how it feels to suffer severe depression, and I’ve seen it give sufferers a promise and an encouragement that they, like Styron, might find a way back to the light. The list of books I’ve discussed with patients over the years is as plural as the humanity that pours through the clinic: Ray Robinson’s Electricity (2006) when talking about life with severe epilepsy; Annie Dillard’s The Abundance (2016) while exploring the place of wonder in sustaining our lives; Andrew Solomon’s Far from the Tree (2014) on the challenges of caring for a disabled child; Ben Okri’s poem ‘To an English Friend in Africa’ (1992) in a discussion of the trials and rewards of NGO work.

There are parallels between generating and appreciating lasting stories and art, and generating and appreciating healing, therapeutic encounters. Both are helped by adopting the same attitude of open curiosity, of creative engagement, of seeking to empathise with the predicament of the other, of tapping into the wider context of human lives. The doctor, like the writer, works best when she’s alive to the subtlety of individual experience, and is able at the same time to see that individual in his or her social context.

If it’s true that readers make better doctors, and literature helps medicine, it’s worth asking if the relationship is reciprocal – does the practice of medicine have something to offer literature? Certainly, the stories doctors hear take the pulse of a society. Clinicians are often confessors, bound to confidentiality and privy to a community’s secrets in the way that priests once were. More than 300 years ago, Robert Burton in The Anatomy of Melancholy (1621) equated priests with doctors when he said that ‘a good divine either is or ought to be a good physician’; the French novelist Rabelais was both…

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https://aeon.co/essays/medicine-and-literature-two-treatments-of-the-human-condition

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