Amy: Alhough I’m not an alcoholic, I feel like I understand alcoholism. At the very least, I understand the seductive power of alcohol. Gregory Bateson, the brilliant scientist who studied, among other things,  “feedback loops” in relationships, called alcohol “a shortcut to a more correct state of mind.”

I first developed an affection for Alcoholics Anonymous when I  began working with  Family Doctors in training. We occasionally attended “open” AA meetings, as a way of helping our young docs learn about what’s called the “disease” of alcoholism. I used to love these meetings. I never thought about these meetings as primarily about that alcohol. It was about the trials and tribulations of being human: The ways in which we lie to ourselves, how we protect our fragile pride, the temptation to look for escapes from our stress, the pain of inhabiting relationships where we don’t feel heard, or understood. I greatly admired the courage shown by these folks “in recovery”; the honesty, humility and humor in these rooms is, to me, a model for how to live authentically. I considered it free therapy.

While it’s always tricky to try to understand how someone becomes an alcoholic, I’ve heard many stories in the office from patients “in recovery” to see some patterns. And occasionally I get to see what “pre-alcoholism” looks like. It can tell us a lot about some of the ingredients that go into making an alcoholic. Here’s a glimpse at a case:

The Case: Doug, a rugged-looking, a thirty-two year old “finance” guy,  called me at the urging of his family doctor. He came to see me alone, and at this initial visit he talked about his worries about his marriage. He and Sally had been married two years and she was now talking about trying to get pregnant. Doug expressed to me some real reservations; he said he “wasn’t really happy” in the marriage, and hadn’t been for some time. As he began to reflect openly about his relationship with Sally, he described how he often “went along with the program”, didn’t really talk about what he needed, and tended to bury his feelings. He didn’t express it exactly like this, but that was the gist. One sad and telling part of his commentary was when he described how he “didn’t even enjoy” his own wedding. He mentioned that  everyone said it was “the most awesome” wedding they’d been to–picture perfect–but Doug felt alienated from the whole experience. It sounded like he felt lonely at his own wedding. And the saddest part is that his now-wife knew nothing of his feelings. She didn’t even know he was unhappy in the relationship.

Of course, I asked him to bring Sally in for the next visit. Somewhat reluctantly, he did so. During this visit, I got to know Sally a bit, her view of the relationship, and a bit about her and her background. She worked as a human resource manager, and loved her work, despite finding it stressful.  Sally had some complaints about Doug, especially how he didn’t help enough around the house. And she mentioned his drinking and how he got “wasted”, especially when he watched sports with his buddies. Both Sally and Doug talked about how Doug’s father and brother were “drinkers”, but apparently without major health or relationship repercussions. Sally herself seemed like she operated at a fairly high level of anxiety, of which she appeared unaware. She also didn’t seem to be at all clued-in to the depth of pain her husband experienced. He hid it pretty well, and she didn’t want to see it.

We met for about five sessions, during which time Doug opened up a bit on his unhappiness. He muted the expression of his pain, but I heard it. Sally knew the reason he was now, as she saw it,  “troubling”  her with his complaints, is that he worried about bringing a child into the world at this moment.  While Sally appeared to try to understand Doug, she quickly felt like she was under “investigation”, the villain in the case. I was aware, as the therapist, that I needed to avoid this trap, since I assumed that the problems in the marriage were manufactured by the duet, not just her. So I went out of my way to connect with her, to create an open space where emotional blockages could be explored.

It didn’t work. Well, maybe we could have gotten somewhere, meaning that Sally, perhaps, could have gotten a greater sense of Doug’s pain and how to help. But I had difficulty helping her get past the sense that she was “the problem”. Sally, who had been the golden-child, the fixer in her own family where her father was a somewhat volatile character, maintained a blindness when it came to herself. In the therapy, I also challenged Doug, particularly his tendency to escape into the bottle, and to avoid conflict. But I don’t think Sally really wanted conflict. I think she wanted everything to be smooth, no matter what.

While I was looking forward to helping these basically good folks break through their stuck-ness, Doug called to cancel after the fifth visit. They did not return. I’m pretty sure he felt hopeless about getting Sally to understand him. I myself didn’t feel especially pessimistic: These were young, intelligent people who, I believed, could change in small but significant ways.

This case has stayed with me, probably in part for what I perceived as a premature cutoff. And this couple, and Doug, were in a fair degree of distress. I don’t know if they are still together. (I imagine so.) I don’t know if they went on to have a child. (I’d guess they did. I’ll bet that Doug “went along with the program”). I also imagine that all the ingredients are there for Doug to, eventually, become an alcoholic.

Here’s the partial recipe for Doug’s budding alcoholism:

Bury your feelings. If you must let yourself know how to feel, don’t share it with your family. If they don’t understand, don’t bring it up again. And definitely don’t insist! Respond (inwardly) to other people’s pain as if it’s your own. Believe you are supposed to solve it.  Don’t be a troublemaker. Accept the importance of maintaining a “perfect” facade. Come from a family where alcohol appeared to “solve” may problems.

That’s a partial list. I’m sure our readers could add to that list from their own experience. I’d love to hear your thoughts.

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