PSYCHOLOGY OF ADDICTION
The common idea that one who is struggling with a drug or alcohol habit
needs sympathy and psychological encouragement is totally at variance with
the facts. No one has ever accomplished anything worth while by holding
the hand of an alcoholic, and any one who is endeavoring to help a case of
this sort will find himself instantly and seriously handicapped if he puts
himself in intimate personal relationship with his patient. Social
intercourse in any degree should be tabooed. The physician should never
take a meal with any of his patients, or visit a theater with them, or
take a drive with them. I have never made a friend of one of my patients,
although among them have been many whom I should be glad to number among
my friends; and no man would go further to help them than I.
Personally, I have never been an excessive alcoholic. It is an interesting
fact that many men endeavoring to deal with people of this class use as a
bait the statement that they themselves have been victims. Their usual
claim is that they first cured themselves, and then took up the work of
curing others. I remember a meeting of social-service workers in Boston
that I was invited to address. I made a statement to this effect in the
course of my talk and greatly offended a previous speaker who had emitted
the usual professional patter concerning his original self-cure. I was
quite willing to compare with him the results of our methods of treatment,
but had no opportunity so to do.
HEREDITARY TENDENCIES TOWARD ADDICTION AN IMPOSSIBILITY
It is absolutely essential that the man who wishes to help another who has
lost control must first accurately understand not only his mental
imperfection, if there is any, but his general psychological state. The
line between sobriety and drunkenness in the man who has once lost control
is almost indistinguishable; it is impossible when talking with him to be
sure whether you are talking with the normal mind or with the alcoholic
mind. Having once made certain that it is the normal mind to which you are
presenting your arguments, your next necessary step is to strip away
every mental reservation. Thousands of men who have honestly desired to
leave off alcohol have been prevented from doing so by their own
secretiveness; it is this mental reservation which has been responsible
for many of the failures of my treatment.
While the absolute inheritance of a craving for alcohol is, in my
experience, a rare thing--so rare as to seem almost negligible, there is
no doubt, on the other hand, that many men and women inherit imperfect
nervous systems. An imperfect nervous system, if it knew the reason for
its own imperfections, might naturally crave alcohol; but inasmuch as such
an imperfect system is not naturally accompanied by this instinctive
knowledge, the theory of hereditary alcoholic craving must be set aside as
untenable. I absolutely deny, therefore, the possibility of such
hereditary tendencies. I know that by so doing I may cause acute mental
discomfort to those who have made of heredity an excuse for their errors
not only to their friends, but in their own minds. The old cloak of
heredity has been worn to tatters and must be discarded. Who among us
cannot follow up the branches of his family-tree and find somewhere upon
one side or the other a person of alcoholic tendencies? In ninety
families out of a hundred any one who looks can find such an excuse for
his own weakness. In thousands of instances physicians have taken
seriously such excuses offered by their patients, but the doctor who
listens to his patient's babble of heredity is sure to be misled, and the
patient who believes this too commonly accepted theory robs himself of his
strongest weapon against alcohol--his own conviction of his personal
responsibility and power for self-help.
ALCOHOLISM AS A DISEASE
We hear much sympathetic talk of the "disease of alcoholism." This is only
in a sense true. It is not a case of helpless chance, for the difficulty
has been manufactured and developed by man himself. The alcoholic,
mentally weakened by the reaction of the stimulant, is of all people most
likely to exhibit that most striking evidence of weakness--a craving for
sympathy rather than for blame. Habitual alcoholics continually plead for
sympathy with mothers, fathers, wives, and friends; and too often they are
granted not only pity, but, what is worse, toleration. The sanatorium
promoters and proprietors of fake cures continually harp on alcoholism as
a disease; and even a few scientists, who should know better, have been
misled into an acceptance of this theory. Doctors should be the first to
knock from under their patients the psychologically harmful props of the
heredity theories.
The first thing a physician must do when dealing with an alcoholic is to
cut every string of excuse which lies between him and his habit. He must
leave nothing of this sort to which the drinker may cling. Sickness,
worry, unhappy circumstances of whatever sort must immediately be
eliminated as excuses for alcoholic indulgence. If they are not, the
patient, although he may gain for a time the mastery over his habit, will
presently be certain to find an excuse in his own mind to justify a return
to it. Then will come a new downfall. There must be no reservations either
in the attitude of the doctor or his patient or in the mental attitude of
the patient toward himself.
MENTAL ATTITUDE A VITAL CONSIDERATION
The possibilities of medical help for the alcoholic have been exhausted
when the patient has been freed from the effect of the stimulant and put
in a physical condition wherein he feels no inclination toward more
alcohol. Great psychological assistance may accompany this definite
medical treatment when the patient's physical craving for alcohol has once
been eliminated if the physician brings him into a mental state which
gives him confidence in his own ability to keep away from stimulants in
the future.
I cannot too strongly emphasize the fact that no cure exists, or ever will
exist, for alcoholism. Its effects may be eliminated, and the victim's
physical condition become so greatly improved that weakness will not make
him yearn for stimulation; but this does not constitute a cure. Nothing
except a man's own mind, whether the treatment extends over six weeks, six
months, or six years, can ever relieve him of the danger of a relapse into
alcoholism. In most cases a definite medical treatment is the intelligent
beginning of help, but no medical treatment, no matter how successful, can
compass that victory which a man must win by means of his own
determination.
THE CHRONIC ALCOHOLIC
The physician still regards such cases only from the point of view of
physical hazard. It is my opinion that in alcoholic cases the physical
hazard is the matter of least importance, and that the world at large has
devoted altogether too much effort to its endeavors to preserve chronic
alcoholics, just as it has devoted far too little effort to rescue the
victims of drugs. It is my opinion that among alcoholics, no matter how
worthy they may have been before they lost control, not more than
twenty-five per cent. of those whose addiction has become chronic are
curable; that is to say, promise any reward whatever for salvage work. The
world must remember that the inflamed brain leads to everything on earth
which is not worth while, and therefore that the man whose brain has for
any considerable period of time been in this condition must have
enormously deteriorated. It must also be remembered that at least one half
of the world's chronic alcoholics have syphilitic histories.
The alcoholic is usually susceptible to the advances of any woman
whatsoever, and as a rule devotes less than the normal attention to his
own wife. To set out to reclaim a chronic alcoholic is, therefore, to set
out to reform a man who has been weakened morally and mentally as well as
physically. In dealing with such people, were the matter left entirely to
me, drastic measures would be taken. It is my belief that the hopeless
inebriate should be unsexed, not because of the danger that, if left
sexually normal, he might transmit his alcoholic tendencies by heredity to
his offspring, but because he is a liability at best, and to leave him
normal adds to his potentiality for waste and evil. Children born of
alcoholic-tainted parentage are not specially likely, I think, to yield to
alcoholic and tobacco tendencies; but they are apt to lack vitality and
mental stamina, so that the probability of their making worthy records is
small. If we go one step beyond syphilis and consider other venereal
diseases, we shall undoubtedly discover that not twenty-five, but ninety,
per cent. of chronic alcoholics, excluding women, have been victims of
gonorrhoea. I am told that modern science is recognizing this disease,
which was once regarded as of slight importance, an inevitable experience
of youth, and something to be accepted and regarded lightly, as an ailment
of nearly as vicious an influence upon the race as is syphilis. Therefore
I have become convinced that the salvage of alcoholic derelicts is of
vastly less importance than prevention at the outset. This principle is
being more and more generally recognized throughout the world; it stands
behind sanitation and all preventive medicine, and it will before long be
recognized in connection with the problem of alcohol. Thus the battle
against alcohol will become, as the battle against tuberculosis has
become, a campaign of education.
It is my belief that every community should have an institution in which
hopeless inebriates may be kept away from their cups and away from sexual
association. There they should be put at useful occupations; full
advantage should be taken of whatever productive capacity alcohol may have
left in them; and they should be maintained in a state as happy as their
capabilities may permit until they mercifully die. Their segregation would
not prevent hereditary drunkenness, for there is, as I have said, no such
thing as an hereditary drunkard, but it would prevent the transmission of
imperfect nervous systems, and depleted intellect and will power.
SELF-CONFIDENCE NECESSARY
Involved in helping these cases, my investigations have shown me that when
once it is determined on reasonable evidence that a man is curable, the
first effort should be devoted to reestablishing his confidence in
himself. He should be "given a new mind" upon the subject of drink and
general self-indulgence. It does little good to free a man from alcohol if
his mental state is so poor that he will celebrate this boon by again
making himself a voluntary victim of the habit. It is for this reason that
I have found the least hopeful work in reclamation to be that which is
conducted among the idle rich. The alcoholic idle poor are virtually
hopeless; the alcoholic idle rich are absolutely hopeless. To the reform
of the drunkard mental and physical occupation and some sense of moral
responsibility are imperative. It is because of these things that I have
deliberately and persistently refused to use the word "cure" in connection
with my treatment. A man cannot be cured of alcoholism. He can be given
medical aid which will restore his self-control.
The ordinary methods in vogue for the reclamation of alcoholics are
pitifully futile. The greatest mistake of all is that workers never finish
with those whom they are endeavoring to help. One must finish with the
alcoholic promptly and conclusively. I have found that alcoholics taking
treatment at my hospital must understand that I do not wish to hear from
them after they have left my care; that I do not wish to know if they have
yielded to new madnesses and relapsed into alcoholism. It is specially
important for an alcoholic to learn that at a certain point society will
have had enough of him. Fathers must break with alcoholic sons and
daughters, mothers must break with alcoholic children, wives and husbands
must be freed from alcoholic mates, charitable institutions must be rid of
alcoholic derelicts. Society itself must be rid of this waste material,
after it has ascertained that their cases are hopeless and has provided
comfortable sequestration for them.
THE DRUNKARD WHO CAN BE SAVED
Now let us turn to the vast army of people who are worth while, but who,
nevertheless, have, through mistakes common to our society, become victims
of the alcoholic habit. It would almost seem that the incurables among
alcoholics have received more consideration from the kindly minded, and
even from the scientifically inclined, than have the curables. The curable
among alcoholics are intense and pitiable sufferers. They have never had
real help. They have been penalized. The poor among them have been
colonized in harmful state institutions by the public authorities; the
rich among them have been placed in equally harmful private institutions
by their relatives and friends. The alcoholic who is punished by
incarceration in a cell is harmed, not helped, by it; the man who, on the
mythical chance of reform is shunted off to a state establishment, or who
is sent by prosperous friends to board at some expensive sanatorium,
stands to lose, not gain, by his experience. These methods merely beg the
question. They recognize the drunkard as a liability and put him out of
sight; they do nothing toward his real regeneration. The inebriates' farm
is based on the same utter misconception as the fashionable sanatorium to
which the rich man's son may be committed. An intelligent handling of this
subject would close or entirely reform ninety-nine per cent. of the public
institutions devoted to the care of inebriates, and would depopulate one
half of the sanatoriums between the Atlantic and the Pacific. To put a
poor man to sober up on a farm where the State will pay his board and
expect him not to become an active menace to society as soon as the period
of his sequestration comes to an end is no more foolish than to put the
rich man's son into a private institution where he will be petted,
coddled, and retained at the highest rates as long as possible, and from
which he will be eventually permitted to return to his old haunts freed
from the immediate physical discomforts of his past alcoholism and
therefore provided with a fresh capacity for strong drink and rejuvenated
powers for evil-doing. Placing a drunken young man in a sanatorium where
some one will pay his board while he lives in utter idleness is certain
not to correct, but to complete, the evil work which has been started in
him; and thus in many cases the very means adopted by friends and parents
for the benefit of those they love are likely to increase rather than to
decrease their ultimate tendency toward dissipation.
Nothing can be much more pitiful than the spectacle of a youngster led
into an alcoholic addiction through the influence of older men. I am by no
means accepting the theory of hereditary drunkenness when I say that many
young drunkards are only faithfully following their fathers' footsteps,
and cannot be justly blamed for their error. Too often it is true that
they literally find themselves unable to catch up with their fathers in
alcoholic exploits, because their constitutions, depleted by vicious
parental habits, prove too weak to stand the pace.
Even where boys are not unfortunately influenced by vicious examples
offered by their parents, there are circumstances of our modern life that
are likely to work havoc with the rising generation. The youth who up to
his twenty-first birthday has been permitted to "have his own way" is not
likely to have formed the habit of traveling in a very good way; nor will
he be likely to change it for a better one when it is proved to him and to
his friends and to society that it is bad; for habits form early.
Association with thousands of those who have gone wrong has proved many
social facts to me, one of which I mention here despite its apparent
irrelevance. The boy who has never known the value of money, on whom the
responsibilities of life have never been impressed, is as seriously
uneducated as he would be if lack of common schooling had left him
illiterate.