Patterns of emotional illness
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Alcoholism Treatment Quarterly
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Addictions as Emotional Illness: The Testimonies of Anonymous Recovery Groups
To cite this article: Paula Helm (2016) Addictions as Emotional Illness: The Testimonies of Anonymous Recovery Groups, Alcoholism Treatment Quarterly, 34:1, 79-91, DOI: 10.1080/07347324.2016.1114314
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Addictions as Emotional Illness: The Testimonies of Anonymous Recovery Groups Paula Helm, PhD
Department of Political Theory, Goethe Universität, Frankfurt, Germany
ABSTRACT Participants in recovery groups from a variety of addictions, following the Alcoholics Anonymous model, identify with each other as suffering from a common “illness of the emotions.” This study analyzes metaphors used to describe the patterns and dynamics of this emotional illness and recovery, derived from the personal writings and testimonials of group partici- pants. Ways in which the participants discover alternate ways to deal with their emotional illness other than manipulating it to an active addiction are also explored.
KEYWORDS Addictions; emotion illness; alcoholics anonymous; recovery groups; personal writings and testimonials; anonymity
Mutual support-groups are one of the most striking phenomena in the field of addictions therapy. Mutual support groups are nonprofessional, self-orga- nized groups that follow the approach of Alcoholics Anonymous (AA). In those groups people who suffer from various kinds of addictions meet to address not only their symptoms of their illness but also the deeper emo- tional roots of their condition. In doing so, they understand addiction not only mentally and physically but experientially. This level of understanding is germane to the process of recovery as it addresses a disease induced and self- imposed emotional isolation that is born out of a fear of facing the pain and suffering associated with one’s disease.
In the recovery groups, participants develop the ability to face themselves and the reality of their destructive behavior seen through the eyes of another with the same condition. Yet, before the group experience, participants fear this pivotal moment. This fear of seeing the reality of their disease in the eyes of another dooms these individuals. Based on this insight, participants of early AA groups developed a new category to describe their alcoholism as an “illness of the emotions” (Alcoholics Anonymous [AA], 1957, p. 239) they called it. Using this category they could identify with each other on a deeper
CONTACT Paula Helm, PhD email@example.com Department of Political Theory, Goethe Universität Frankfurt, Room 3. G 039, Theodor-W-Adorno-Platz 6, 60323 Frankfurt am Main, Germany. The author approved the manuscript and this submission. The author reports no conflicts of interest.
ALCOHOLISM TREATMENT QUARTERLY 2016, VOL. 34, NO. 1, 79–91 http://dx.doi.org/10.1080/07347324.2016.1114314
© 2016 Taylor & Francis Group, LLC
level other than just a behavioral level, finding solace in the commonality of their suffering and breaking through their isolation.
Analyzing groups that understand addiction as an illness of the emotions adds to our understanding of the multidimensional character of addiction. The focus of this article is on emotional illness as an essential component of substance use disorders. Using an ethnographic approach the aim of this study is to capture patterns of emotional illness, identified by studying the groups themselves as well as personal stories, which participants’ author as part of their therapeutic process. In their personal writings they reflect not only on their disease but also on their recovery. An analysis of group rituals and personal stories of the participants identifies not only patterns of emo- tional illness but also of emotional recovery as recounted in group settings.
A 2-year imperial study was undertaken to identify and collate patterns of emotional illness and recovery as recounted in recovery groups. Two primary sources were identified:
(1) Personal testimony archived by recovery groups such as AA, Narcotics Anonymous (NA), Sex Addicts Anonymous, Overeaters Anonymous, and various autobiographic writings that have been published by the groups.
(2) Personal participatory observation by the author in the recovery groups in New York and in Germany.
The sample comprises a heterogeneous mixture of 50 narratives, between 1930 and 2013, including members of different groups, of varying ages, genders, and cultural backgrounds. The sample consists of unpublished narratives, written for the purpose of creating a moral inventory and taken from trademarked texts of 12-Step networks; the source texts were on loan from each group’s World Service Office (WSO). Metaphors used to express and define emotional illness and recovery were collected from members’ autobiographic writings and personal testimonies. The narratives over the years were studied to determine which elements of the narrative structure remained consistent despite cultural and historical changes.
Because all the stories of the sample conform to one specific narrative structure that addresses the taking of a moral inventory of one‘s internal experience, examples from single stories can be quoted to represent an archetype. The authors themselves call the way they structure their narratives
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a “formula” (AA, 2003). This formula was developed in the 1930s when the founders of AA collected participant narratives designed to tease out the typical patterns of emotional reactions to varied stimuli. The following quote from a letter from Bill W. to Bob S. captures this trend and the origins of a narrative “formula”:
It might be a good idea to ask people to write their own stories in their own language and at all the length they want to cover those experiences from childhood up which illustrate the salient points of their character. Probably emphasis should be placed on those qualities and actions which caused them to come into collision with their fellows. The queer state of mind and emotion, the first medical attention required, the various institutions visited; these ought to be brought in. (. . .) There ought to be descriptions of the feelings when he met our crowd, his feeling of hopelessness and the victory over it, his application of principles to his everyday life, including domestic, business and relations the problems which still face him, and his progress with them; these are other possible points. (AA, 1935–1939, Bill W. letter to Bob S., 1938)
The formula extracted from the stories collected during the following months serves as an emotional compass, a compass helping to “make sense of otherwise confusing sequences of experience” (AA, 1935–1939, Bill W. letter to Bob S., 1938).
In this article, quotes taken from an overall sample of 20 unpublished documents and 30 published documents, all following the original for- mula, are used to exemplify the patterns of emotional illness and recovery.
The author also used data for analysis and reference based on ethno- graphic insights gathered during one year of participant observation of mutual support groups in New York and Germany. The author identified herself as a researcher in open meetings conducted by Overeaters Anonymous, Underearners Anonymous, Sex Addicts Anonymous, AA, NA, and Al-Anon Family Groups.
To get insight into the dynamics of emotional illness and recovery process an empirical investigation was conducted, that combined two different approaches:
(1) For analyzing the concepts of emotional illness indicating the different areas of addiction and recovery within the autobiographic writings, a method was applied that works through coding and decoding meta- phors. The method was developed by Lakoff and Johnson (2003). It focuses on how people express subtle emotional processes by project- ing commonly used metaphors on to psychological and emotional
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platforms. As a first step in developing an initial system of categoriza- tion, an open-coding pass was applied on all the text materials of the sample. As a second step, new codes were added whenever a new metaphor arose that did not fit into any of the previously created categories. After classification, all codes were clustered thematically using affinity diagramming.
(2) Turner’s ritual-theory (Turner, 1969, 2000) helps us understand the manner in which mutual support interacts with patterns of emotional illness. The common rituals practiced in the groups were studied following this model. The model concentrates on those ritualized sequences that, despite the different locations, sizes, and topics of the groups, were repeated each and every time. This focus enables us to identify the substantial factors in a group setting that empower people to communicate their emotions and thereby allows mutual identifica- tion at the emotional level.
By combining both approaches, the textual analysis and the ritual study, six major themes of emotional illness and four major themes of emotional recovery were be identified.
The study embraced a subject-centered perspective (Reckwitz, 2003, p. 284). This perspective implies that the participants themselves are understood to be the “experts of their own life” (Thiersch, 2002, p. 124).
Another analytical foundation of this study was one that identified the groups as rites of transition (Van Gennep, 1960/2010). In analyzing the ritualized process of change taking place within the group participants, the Turner model of liminality was used. This model understands liminality as a performativity created space where people (inter)act “beyond the norms and ideals of the social structure” (Turner, 1969, p. 94). Defining the groups as such a space, where people can experience themselves through a paradigm other than that to which they are accustomed, allows nonparticipants to understand how participation in anonymous group rituals positively affects the process of transition from emotional illness to emotional health.
Barthes’ (1982) methodology provides the framework for the critical approach concerning the social factors of the disease of addiction. He advises analyzing pre- and late-modern narrative structures as myths. His approach to history is performative, meaning he understands the subjec- tive perception of reality as determined through a specific representation of the past, which gives meaning and creates cultural currency. This approach serves the purpose of determining how the exchange of
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unconscious, tacit norms influences participants, and how it correlates to broader mythological concepts.
The result section is divided into two parts. The first part is devoted to the five patterns of emotional illness as found in the textual analysis: initial crisis, rationalizing contradictions, metaphors of fight and war, a public and private self, and cycles of selfishness. The second part deals with the narrative of emotional recovery as practiced in the groups and as exemplified in the autobiographic writings of participants. Four patterns are identified: hitting bottom, anonymity, the emotional bottom, capitulation.
Patterns of emotional illness
Initial crisis An initial crisis is a common theme in all of the samples that were analyzed. These crises are described as either personal losses, or collective events such as war, financial crisis. Bill W.’s narrative, in 1939, serves as a constant point of reference for such a crisis:
War fever ran high in the New England town to which we knew, young officers from Plattburg were assigned. [. . .) I was part of life at least and in the midst of excitement I discovered liquor. (. . .) In time we sailed “Over There.” I was very lonely and again I turned to Alcohol. Much moved, I wandered outside. My attention was caught by doggerel on an old tombstone: “Here lies a Hamshire Grenadier who caught his death drinking cold small beer. A good soldier is ne’er forgot hether he dieth by musket or by pot.” Ominous warning—which I failed to heed. (AA, 1939, p. 1)
Bill W. describes how he uses alcohol as a comforter to avoid experiencing the emotional loneliness of his wartime experience and the distress of his subsequent postwar disorientations. Bill uses alcohol to numb his emotional pain and in doing so enters a downward spiral of obsession, compulsion, and addiction. Alcoholics like Bill W. are unable to confront their emotional illness and continue to pursue a pattern of life, seeking temporary relief in alcohol-induced forgetfulness.
Rationalizing contradictions Another theme of contradiction and rationalization emerges from an analysis of the samples. This emotional conflict is again captured in the writings of Bill W. Upon his return from the war he was conflicted by the demands of leadership and of obedience. He uses the myth of the drunken genius to excuse his spirit of rebelliousness. Bill W., writing in 1939, describes his emotional confusion as follows:
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Twenty-two, and already a veteran of foreign wars, I went home at last. (. . .) I took a night law course, and obtained employment (. . .) Potential alcoholic that I was, I nearly failed my law course. Though my drinking was not yet continuous, it already disturbed my wife. I would still her forebodings by telling her that the men of genius always conceived their most majestic construction of philosophical thought when drunk. (AA, 1939, p. 2)
He rationalizes his drinking by using the myth of the drunken genius who can be extremely creative when drunk. His fanciful thinking is again captured in the following quote:
Twenty-two, and already a veteran of foreign wars, I went home at last. I fancied myself a leader, for had not the men of my battery given me a special token of appreciation? My talent for leadership, I imagined, would place me at the head of vast enterprises. The drive for success was on and took me to Wall Street. Many lost money but some became rich—why not I? (AA, 1939, p. 2)
Like Bill W., Susan, a young member of NA finds the roots of her illness in her first life crisis. Her crisis is of a personal nature. It is constructed around the death of her father. However different the natures of Susan and Bills’ crises, the reader finds in both stories the common thread of disorientation:
After my father died, I did not know where to go. I felt lost. Since my father always told me that he was going to meet friends when going to the pub, I started going there too, searching for consolation. (. . .) What I found there was alcohol. The bottle soon became my best and only friend. (Narcotics Anonymous, 1986, p. 7)
Susan didn’t know how to handle becoming an orphan at age 18. Because she had no social network, like NA or AA to direct her in her grief work, she felt helplessly stuck. The resulting reaction was a desperate search for a friend, giving her orientation. She sought solace from her emotional pain in her new friend; that friend was the Friend in the Bottle.
Metaphors of fight and war An analysis of the samples reveals that metaphors of fight and war were used to capture the emotional illness of persons with various addictions. The following quotes, taken from autobiographies of participants with different addictions, genders, and social status, capture one more piece of fight and war.
Jane writes in Overeaters Anonymous (2001), “I had built an armor of fat, protecting me frommy subtle anger against all men. This armor was my prison” (p. 10). Bill writes in AA (1939), “Out of an alloy of drink and speculation I commenced to forge the weapon that one day would turn its flight like a boomerang and all but cut me to ribbons” (p. 2). Bob writes in AA (1939), “At the end I had no more power left to fight.” Susan writes in her personal testimonies, “I realized I treated my addiction like an inner enemy. Today I know I have to welcome this enemy as friend, if I wish to stay abstinent” (Susan N., personal testimonies, collected 2014).
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In these examples, one can see different approaches that capture the interior struggle of persons dealing with the emotional illness of their con- dition. The following questions emerge: Who is fighting against whom here and how to help the struggling individuals deal with the conflict?
A public and a private self The narratives reveal that persons with addictions deal with two competing notions of self: a public self and a private self. The emotional illness of the addiction finds full expression in the private self. Various substances and beha- viors are used to numb the sense of pain that is experienced by the private self.
At the same time, the person seeks to maintain an idealized public self. To maintain some sense of balance between the competing selves, the person who is drug dependent uses destructive rationalizations, denial, and isolation to deal with a bipolar self. The private and public images drift further and further apart as the addiction progresses, producing feelings of constant emotional isolation and alienation. Helen, an Overeaters Anonymous mem- ber, describes this feeling of the two separate selves as follows:
Taking a look at my resume, my life looks just as perfection claims. But secretly I always thought to myself: If they knew what price I pay (. . .) if they knew the secret – that I can only manage to keep my perfect appearance because I puke as soon as I get home (. . .) nobody would trust me anymore. (. . .) I was haunted by the fear that if anybody would discover my secret, nobody would trust me anymore. Everybody would hate me. I honestly thought that way. And I believed what I thought. (. . .) When I started attending Meetings I made the experience of sharing my worst fears and secrets and being acknowledged with them. Today I’m so grateful because I feel that my private and my public self slowly melt together to be one again. (Helen S., personal testimonies, collected 2014)
This narrative illustrates the struggle between the two selves: the public and the private selves. Helen received social acknowledgment for the perfect self she displayed in public. Helen’s hidden self, the suffering self, remains a source of deep emotional distress that she treats with her addictive behavior. In recovery she discovers an ability to bring her two selves together in a context of healing that is promoted through her group participation.
Cycles of selfishness The participants also recount patterns and cycles of selfishness. These beha- viors are closely related expressions of an emotional illness, such as self- isolation and inner conflicts of self, which characterize various forms of addiction. This inward focus is described as “self-centeredness and self- pity” and again “as the root of all problems” (AA, 1939, p. 62). This internal obsession is offset by an outward, exaggerated expression of competitiveness and of self-importance. Mel T., as a woman member of Underearners Anonymous, captures this emotional turmoil as she writes:
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I used to be a know-it-all. I was arrogant because I’m insecure. I feel superior to my family and to all black people (. . .) and I hate white people. So I act like I’m better than I believe myself to be. There is a lot of compulsive need to prove (. . .) as the only smart black kid at grammar school. I used to walk into a room and feel like the entirety of the black people were depending on me to get it right. I think people are out there to get me, that people are patronizing me because I’m black and poor and uncultured. I created an attitude of opportunity and enjoyment that manifest in the appearance of my clothes, my office, my teeth, my hair. (. . .) But when I ran into situations that showed my ignorance and small living to the world, I hide. I get scared and intimidated. I hide and bite. (. . .) I create an attitude of poverty and paucity. (. . .) I even have run from opportunities in the past. I ignore my inner gifts and strength. (. . .) A lot of that is dissipating now due to writing in the Steps teaching me to take an honest look at myself. (Mel T., personal testi- monies, collected 2014)
Mel T. in this narrative captures another expression of the two competing selves that are encountered in addictive states. Neither self is an authentic one, and the conflict between the two produce profound alienation and isolation, expression of her interior emotional illness, her ability to take “an honest look at myself” at the beginning of her recovery.
Narratives of emotional recovery
An analysis of the narratives also reveals metaphors and rituals that illustrate the dynamics associated with recovery. These experiences called “emotional recovery” are closely related to the pattern of emotional illness described in the previous section.
Hitting bottom Many emotional crises characterize the narratives of the group participants in this study (AA, 2003). “Hitting bottom” differs from the previous crisis that, though in themselves are painful and devastating, do not confront the denial of the addictive condition or open the pathway to recovery. Rainer, a German addicted to alcohol, captures the essence of truly “hitting bottom” in distinguishing the various “bottoms” he has experienced in the course of his illness:
My name is Rainer and I’m an alcoholic. I pray to my higher power that the crisis I recently went through will be my bottom. I’ve often believed I’d hit it, but, so far, I was doomed to be proved wrong each time. Today I write down my life-story, a story that I was always afraid to face. I sit down to write, carrying the hope that writing about my last bottom will help to make it be my last one. (Anonyme Alkoholiker, 2009, p. 256)
There are many narratives, which replicate Rainer’s experience, when analyzing these studies. They recount the desperate struggles of persons with addictions to break the destructive patterns of their addictive behaviors
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and to escape from their profound emotional illness, characterized by power- lessness, hopelessness, self-hatred, and desperation.
The narrative of Eileen, across American woman with addictions captures her desperate struggle to escapes from the horrors of her addictions to alcohol and medications:
I knew nothing about Delirium Tremens but I’d scream at the telephone that I’d split wide open. I knew that alcohol and I had to part. I knew I couldn’t live with it anymore. And yet, how was I to live without it? I didn’t know. After pills and alcohol I became work addicted.(. . .) I sat for a week, a body in a chair, a mind of in the air. I thought the two would never get together. I went to my doctor again. I said: “I can’t find a middle way in life. Its either all work or I drink.” He said: “Why don’t you try the groups?” (AA, 2003, p. 298)
Finding “the groups,” an AA group, proves to be the turning point in Eileen’s recovery. She finds an alternative to her destructive behaviors and emotional suffering by “hitting bottom” and by finding a recovery group where she can share her suffering in the context of understanding and acceptance.
Eddy T., one of the earliest members of AA, recalls his desperate cries of struggling with alcoholism prior to the foundation of AA, when incarceration or closed psychiatric wards were the only options available (Lobdell, 2007, p. 10). Eddie T., like Helen at a much later date would find his salvation in AA groups after he, too, had experienced “hitting bottom.”
Anonymity Anonymity, since the inception of AA in 1935, has been one of the most cherished and effective elements of the recovery process from addictions and, in the context of this study, from the emotional agony of the illness. The founders of AA and its earliest members embodied the “attitude of anonymity” (Desmond T as quoted in AA, 2010) by creating a space where group participants can freely share their most overwhelmingly emotional and physical agony (AA, 1939, p. 9) The group setting creates a liminal space, a space where Turner (1969) describes as a “space beyond the everyday life social structures.” Within this safe space, group participants are empowered by a revered ritual that enables them to reveal their hidden wounded selves with others who are experiencing like suffering. A perfor- mative potential is created where the group members can share their stories, by identifying themselves by their first names only unencumbered by the pretense surrounding their inflated egos and their public selves that they have created as part of their addictive behavior. The group settings if free of social stigmatization (Goffman, 1963) and isolation and alienation are breached in a setting where anonymity equates with equality and
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acceptance. The power of anonymity is captured in the testimonies of an early group member in Akron, Ohio.
Everybody who knew me said I was a hopeless drunk. But when I ended up in hospital I believe every member of the Akron Group did come to see me. They impressed me terrifically, not so much because of the stories they told me, but because they would take the time to come and talk to me without knowing who I was. They didn’t need to know me, they simply believed in my potential to change. (AAA, 2003, p. 244)
Emotional bottom Another emotional bottom emerges as group participants reveal more freely by the safe liminal space afforded by the group leadings. Discarded and empowered by anonymity, persons who are recovering see themselves reflected in the stories of others. One narrator recounts she discovered an understanding of her illness through the story of another: “Yes, that’s me, I’m like that too, and if he says he is ill, then I am ill, too” (AA, 1957, p. 69).
Helen, a member of Overeaters Anonymous, identifies the two bottoms that she encounters in the course of her recovery.
I was raised to be no ghetto child, to hold my head up and not act like or be mistaken as an American black, but my story has all the classical embarrassments of being an American black. Ghetto parents, theft, denial, neglect, violence, ignorance, sexual abuse. (. . .) The process I’m going through right now in this program is the act of rooting out the distress, the clearing and cleaning of my system. However, right now, as I get to the bottom of my distress, I believe I have gotten to the bottom of the bottom within myself. I’ve allowed myself to see and feel it. (. . .) I’m embarrassed by my upbringing and the only way to cleanse and purge it is to write about it. The laxatives didn’t do it. I got nice and thin, but it never erased what happened. Nothing will erase what happened. I just have to live with it all now. (Helen S., personal testimonies, collected 2014)
Capitulation The narratives analyzed in this study constantly report that capitulation (surrender) is a metaphor used to describe the ability to choose another path resulting from “hitting bottom.” As a polar opposite of the fight/war metaphors identified by participants as a component of their emotional illness, capitulation implies surrender, or radical deconstructions of one’s former attitudes and self-image. The process of capitulation (surrender) is debilitated by group rituals especially those that describe “hitting bottom” in the dynamics of the death and rebirth experience (Turner, 2000; Van Gennep, 1960/2010). Anniversaries of sobriety in AA and other mutual help groups are celebrated as birthdays.
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This study identifies “emotional illness” as an expression of various forms of addiction. Patterns of emotional suffering have been identified from an analysis through the writings and personal testimonies of participants in mutual help groups, representing the earliest experiences of the AA groups and subsequent groups modeled after the AA experience. Six integrated expressions of emotional illness are described in the Results section together with four corresponding patterns of recovery. In this Discussion section, important elements of emotional illness and of early recovery are identified.
Ongoing crises of an emotional nature emerge as a constant feature in the narratives, between 1935 and 2013, and is embraced by this study. Persons experiencing addictions are enabled to deal with such crises without a supportive network or principles that restore some sense of inner peace. Unable to address an ongoing state of emotional turmoil, persons with addictions become dependent on addictive substances or like behaviors in an effort to medicate their emotional suffering. This condition is further aggravated by isolation and alienation and by desperate efforts to rationalize the conflict between the contradictory sources of self-destructive behavior and the desire to address the cause of this profound inner conflict. Two selves develop as a result of this conflict, the public self that would maintain some semblance of normalcy and the inner self that is racked by guilt, remorse, and a host of other negative emotions. A cycle of self-centeredness and selfishness designed to conceal the inner self from the addictive person and others emerges. These factors allied with the other negative forces create a downward spiral of self-destruction.
The crises multiply and culminate in a major crisis that is described by the studies participants as “hitting bottom.” This experience becomes an indis- pensable product of recovery, when it is shared in the context of a recovery group. Otherwise it is yet another devastating loss and emotional crisis in the continuing downward spiral of self-destruction that characterizes an addiction.
The textual and self-testimony analysis embodied in this study confirms that group participants clearly identify “emotional illness” as an essential component of their addiction. This finding is not a novel one, but it does emphasize the need to maintain a consistent focus on the emotional dimen- sions of addiction and in the concomitant process of recovery that addresses the emotional illness.
The other contribution of this study is found in its identification of some essential qualities of the processes of change and early recovery as captured from the narratives of the participants. “Hitting bottom” has a decisive emotional element that serves as an agent of ongoing change and
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transformation when shared in a group setting. A group ritual, influenced by the disarming power of anonymity, creates a safe liminal space for the group members. The context of trust and honesty, facilitating capitulation (surrender), by telling ones stories in a symbolic and real way has the power of “performative magic” as described by Audehm (2001).
A dramaturgy is at work in the group dynamics as illness and recovery are described in one’s life story in terms of spiraling down, hitting bottom, which results in confirmative change experienced at the emotional and spiritual levels. As the process of rebirth is a constant feature of the narratives study in which the old self, with its selfish, self-centered ego is abandoned, and a renewed, caring and connected self is embraced. “Self-sacrifice,” in AA terminology, is at work in this process (AA, 1957, p. 91).
Metaphors and rituals are used in this study to further amplify our under- standing of the dynamics of change experienced by participants in mutual self-help groups. Emotional illness is identified as an essential element of addiction, and corresponding elements of recovery are also explored. Concentrating on and inspecting the narratives of the participants allows the participants to tell their stories in their own voices as they share the emotional devastation of their illness and the day-to-day hope embodied in their recoveries. This tradition of story-telling is central to the healing process embodied in AA and other like self-help groups (Kurtz, 1991). This tradition, now 80 years old, has been respectfully employed in this study.
The author specifically acknowledges the editorial report of Marsha Elizabeth Thompson in preparing this article.
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- Theoretical basis
- Patterns of emotional illness
- Initial crisis
- Rationalizing contradictions
- Metaphors of fight and war
- A public and a private self
- Cycles of selfishness
- Narratives of emotional recovery
- Hitting bottom
- Emotional bottom
- Patterns of emotional illness