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 gonorrhœa. 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 reëstablishing 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.