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Authors: Ernest Kurtz

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The present study is not bound by that Tradition, but entering the controversial discussion over alcoholism as disease would be at least as unhelpful to its purpose as public controversy over the question would be to A.A.’s mission. For one thing, Jellinek’s acute observation is, if anything, even truer today. Two decades of continuing, sophisticated medical research and psychological investigation have revealed complexities rather than produced any agreed-upon understanding. Further, neither disease as entity nor “dis-ease” as concept furnishes the most helpful category for the task of historical analysis at hand. Rather, one clear intuition arises from the historical narration and contextual analysis that have been presented: especially as religious in its inspiration, the Alcoholics Anonymous understanding of alcoholism begs for exploration within the insight that disease can also be metaphor.
3

Finding in understandings of disease either a conscious or an unconscious metaphor is not a new idea. The concept is an ancient one, and also one intriguingly revived in twentieth-century cultural analysis.
4

In antiquity, the Bible portrayed leprosy as a metaphor for sin. The disease of leprosy — a noisome rotting of the flesh — aroused disgust in others, and their horror was accentuated because the malady was thought to be highly contagious. Thus lepers were segregated from the society of the healthy. The image, then, both reminded that sin was a disgusting evil and reinforced awareness of its social nature: even sin that was apparently merely personal threatened others and therefore alienated from society as well as from God. Finally and most strikingly, the power to cure leprosy — like the power to forgive sin — was seen as a divine attribute.
5

The nineteenth and especially the twentieth centuries have witnessed a rebirth of the use of disease as metaphor, albeit the figure has become subtler and more extended. At the beginning of the twentieth century, and specifically in America, the Progressive Era found its disease-metaphor in the “white death” of tuberculosis. A self-consciously expanding economy feared stiflings from within, as critical thinkers worried over the implications of monopolistic enterprise and ever denser city slums. Although usually unconsciously and sometimes even erroneously used, the image of tuberculosis helped some Progressive reformers to face up to the apparent paradox in the new economy: it seemed to produce vigor and beauty even as it sapped both enterprise and the city by smothering their essence from within. The plaint pathetically described by Robert Hunter — “Breath, breath, give me breath” — symbolized the cry of the small entrepreneur even more poignantly than it recorded the dying words of a young man in a New York tenement.
6

More recently, the self-consciously post-modern era so aware of the perils of untrammeled growth has discovered its disease-metaphor in the malignancy of cancer. It is still too early to grasp all the ramifications of cancer as metaphor. Two of the image’s socially relevant insights would seem to concern the dangers of uncontrolled growth and the fear that fatal contamination can be induced by the minutely accidental — by unintended and even unknown by-products. But such metaphorical wisdom comes at a terrible cost, a price paid by the actual victims of the actual disease, for metaphor too easily veils a process by which fear of the disease becomes loathing of the diseased. Susan Sontag has well analyzed and brilliantly protested this process and price for victims of cancer. Significantly, one hint that alcoholism and cancer may be related —
as metaphors
— stems from the awareness that alcoholism as metaphor imposed a similar stigma. As even less conscious metaphor, it may further have exacted an even greater price.
7

Before exploring the relationship between the metaphors of cancer and alcoholism, and what it might tell moderns about modernity, an essential
caveat
must be stated and even flourished. As the examples of leprosy, tuberculosis, and cancer so vividly attest, to posit any specific illness as an age’s disease-metaphor in absolutely no way denies the objective reality of the disease so used. An important and significant point about disease-metaphors, indeed, arises precisely because they are most often drawn from and rooted in a society’s uncomprehending terror in the face of its direst malady. The sad irony is that the metaphor, especially as unconscious, serves to deepen the incomprehension and to increase the terror even as it illuminates the culture. The actual victims of the actual disease used as metaphor thus become their culture’s double losers — victims of both the disease and the metaphor. Leprosy, tuberculosis, and cancer are “real” diseases; the use in what follows of alcoholism as disease-metaphor intends neither to deny nor to affirm the objective reality of alcoholism as a disease. The analysis to follow derives from two plain facts: “alcoholism is a disease” has become a generally accepted cliché in the America of the second half of the twentieth century, and that first fact is generally attributed to the impact upon the culture of Alcoholics Anonymous.
8

The importance of what has been carefully explained concerning the use of disease as metaphor, the peril as well as the promise of this mode of analysis, derives from the intuition that the uses of alcoholism and of cancer as disease-metaphors are connected. Each reveals modern concerns over the very meaning of modernity. The disease-metaphor of alcoholism, however, precedes that of cancer in both historical and logical sequence. Alcoholism-as-metaphor deals with the subjective consciousness of moderns, while cancer-as-metaphor discloses the objective implications of modernity. The metaphor of alcoholism lays bare modernity’s internal process; that of cancer laments its external results.

Understanding alcoholism as a metaphor for the subjective condition of modernity illuminates the modern era’s discomfort and therefore dis-ease when confronted by an apparent paradox of the human condition — the
meaning
of human as limited but frustrated by this limitation. By applying the insights gleaned in Chapter Eight to the historical context glimpsed in Chapter Seven, what follows attempts to penetrate this veiled metaphor. It explores the subjective sense of “being modern” by applying to this modern sensibility the classic Evangelical Pietist intuition conveyed within Alcoholics Anonymous. This ancient insight suggests that humankind exists in a state of being that is essentially limited, and that transcendence of this limitation requires first acceptance of it, then the embrace of salvation from it as coming only from outside the individual self.
9

The analytic insight that finds in alcoholism a metaphor suggests that three facets of the Alcoholics Anonymous understanding of alcoholism merit special study: alcoholism as threefold disease, as obsessive-compulsive addiction, and as distorted dependency. Further, because this insight proposes alcoholism as specifically the disease-metaphor for the
subjective condition
of modernity, the exploration of each of these three aspects of A.A.’s understanding begins with a reminder that Alcoholics Anonymous itself never treats directly of
alcoholism
, but rather directs its attention to the
alcoholic
— the subject of the disease.
10

Although the phrase appears nowhere so succinctly in A.A. literature, immersion in that literature makes it clear that an understanding common among members of Alcoholics Anonymous and often detailed at A. A. meetings infuses the very heart of their program: “alcoholism is a threefold disease — physical, mental, and spiritual.” The clear message is that there is a unity in human life, ill or healthy. The parts of the human experience are so interconnected that to suffer disturbance in one is to suffer dislocation in all; and in recovery, all must be attended to if any is to be healed.
11

The most common diagnosis of the source of modern malaise describes that cause as “alienation” and
anomie
— the feeling of separation and the despairing loneliness of a deeply sensed isolation which, because there are no norms, denies the very possibility of meaning. Critics of modernity have also called attention to its monstrosity, its characteristic of disproportionate growth. The vision of society as organic especially points up such discrepancies as those between “haves” and “have-nots;” and modern individuals seem divided into the distinct categories of those who think but can’t feel, those who feel but don’t think, and those who act and so have time for neither thinking nor feeling. All these situations cause pain, as the recognition of the twentieth century as “The Age of Psychology” — and especially of psychotherapy — testifies.
12

In presenting alcoholism as threefold disease, Alcoholics Anonymous both speaks to this modern pain and sharpens these critiques of the modern situation. The pinch of alienation, A.A. suggests, comes less from man’s separation from the product of his labor than from modernity’s claim and attempt to separate three aspects of human life and experience that are in reality essentially conjoined — the physical, the mental, and the spiritual. The A.A. insight insists first that body, mind, and spirit are so intimately related within each individual that what affects one influences the others. The headache that impedes concentration is not merely physical, nor can the guilt that issues in such a headache be deemed merely spiritual. The thinking that denies guilt into repression, or that expresses its brilliance in devising rationalizations that will inevitably lead to more such hangover mornings, is also “sick.”

The message of this insight is that the self is complex, and that in order to live comfortably with self as well as with others, both self and others must be accepted as complex. The
total
experience of
each
human being comprises at least these three dimensions: physical, mental, and spiritual. These are evidently related to each other, and as evidently bespeak also a larger relatedness. If one is to live a fully human life among human others, as well as if one is to live with oneself as fully human, there must be sensitivity to each of these three components in both self and others. In the absence of such sensitivity, alienation occurs — a felt-separation the pangs of which are both two-sided and twofold as they mutually reinforce each other. This destructive mutuality arises because feeling divided within oneself both results in and is intensified by feeling separated from others, while at the same time the felt-separation from others both reinforces and is furthered by deliberate dissection of the self. Feeling “messed up” leads to distance from others, as others’ distance encourages “feeling messed up.”

That which would attempt to heal such alienation clearly must speak also to this destructive reciprocity, for false separation within the self and destructive separation between selves are mutually related. Just as “a sound mind” and “a sound body” — according to the ancient adage — promote each other’s soundness, the healthy self both helps and is helped by healthy others. Because Alcoholics Anonymous offers itself to the recovering alcoholic as
both
fellowship and program, it suggests by this very understanding of itself that these twin aspects of human experience can beget a twofoldness of mutualities that are healingly related. As program, A.A. teaches that the physical, mental, and spiritual components of each alcoholic’s individual life are mutually connected. To injure one is to harm the others, and to treat one healthfully is to promote the well-being of all three and so of the whole organism. But A.A. is also fellowship, and as such it teaches that it is with others rather than as individual that one treats self healthfully. Thus the mutuality among alcoholics within the A.A. fellowship reinforces the threefold recovery of each alcoholic, and the ongoing recovery of each alcoholic in turn promotes healthy mutuality within the fellowship.

Few can ignore that the drinking alcoholic destroys himself physically and impairs his mental faculties. Many have also stressed moral degradation, but one effect of the Alcoholics Anonymous understanding of the alcoholic has been to shift this last emphasis to “the spiritual.” The heart of the alcoholic malady, A.A. teaches, is
spiritual disease
. It is the spiritual in the trilogy of “physical, mental, and spiritual” that wastes first in the progression into alcoholism and is restored last in recovery from it. The spiritual is the key to the A.A. program, as befits the understanding of a phenomenon in the history of religious ideas. The spiritual also provides the linchpin of Alcoholics Anonymous as fellowship, as exploration of the implications inherent in A.A.’s understanding of alcoholism as obsessive-compulsive addiction and as distorted dependency will clarify.
13

A.A.’s presentation of alcoholism as “obsession-compulsion” reflects its borrowing from Dr. Silkworth’s diagnosis of Bill Wilson. This understanding describes more than explains the alcoholic’s insatiable quest for
more
and unrelenting pursuit of
again
. Bill, like countless alcoholics before him, described to the doctor his fixation of being able to “think of nothing else,” and how he was driven to seek to recapture again that glowing feeling of warmth that his early drinking had brought. At least until he had first heard Ebby’s message, that fixation (obsession) and that drive (compulsion) had been the story of Wilson’s adult life. The psychiatrist’s main contribution here was to give A.A.’s co-founder labels for an experience that every true alcoholic knew all too well but rarely was able to describe so succinctly.
14

The other alcoholics to whom Wilson carried Siikworth’s diagnosis as a way of introducing Ebby’s message identified readily with it. Bill’s description of obsession-compulsion hit home, and so it helped these early adherents of Alcoholics Anonymous to admit hopelessness and thus to make the surrender that sobriety within A.A. required. Because “it worked,” they in their turn described rather than attempted to explain when they later approached their own “pigeons,” and it is in this way that the first message of Alcoholics Anonymous has been consistently carried. Founded in experience, A.A. has little use for philosophizing. Yet there are philosophical and even theological ideas contained in A.A.’s portrayal of obsession-compulsion, and those who would understand at depth its message of not-God-ness might well explore them.

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