Surrender and Psychiatry

Surrender and Psychiatry

Harry M. Tiebout M.D. was an American psychiatrist who promoted the Alcoholics Anonymous approach to the public, patients and fellow professionals. He was president of the National Council on Alcoholism from 1951-1953.

In 1939, Tiebout received a pre-publication copy of the book, Alcoholics Anonymous. After looking it over, he gave it to one of his patients, Marty Mann. She had been in treatment for over a year but seemed no closer to conquering her alcohol problem than when she arrived, so he considered her a good test of whether the book had value. At first she read the book eagerly, delighted to know for the first time that there was a name (alcoholism) for what ailed her. However, she was soon repelled by what she saw as the overbearingly religious message and told Tiebout that she could never accept it. Tiebout, according to Mann's biographers Sally and David Brown, quietly encouraged her to keep reading. Eventually taking the book to heart, she had an epiphany during a crisis of resentment and fury and was converted.

Other references, also based on Mann's recollections, portray Tiebout's role a little differently. They describe an ongoing verbal battle lasting several months, in which Tiebout refused to accept Marty's rejection of the book. In the end, Mann did become an active member of AA and within a few years made education about alcoholism, and promotion of alcohol-abuse treatment, her second career. With Tiebout's support, she founded the National Council on Alcoholism (NCA).

Tiebout also became a friend and supporter of AA founder Bill Wilson, providing personal psychiatric care when Wilson developed depression in the 1940s. It was largely through Tiebout's influence that Bill Wilson was invited to speak at a New York state medical society meeting and then at a meeting of the American Psychiatric Association, and had his talk published in the American Journal of Psychiatry.

Howard J. Clinebell, in a book for clergy on alcoholism counseling, recalled that Tiebout "likened the 'runaway symptom' of alcoholism to the dangerously high fever of pneumonia. The fever is a symptom of the underlying infection, but unless it can be lowered, the person may die of the 'symptom"." Psychiatrists, Tiebout felt, had been ineffectual because they ignored the deadly symptom in an attempt to treat a (theoretical) underlying disease. He credited AA with an ability to target the symptom directly.

Tiebout described the alcoholic personality as:

-An unconscious need or drive to dominate
-A prevailing negative, hostile feeling-tone
-A capacity for ecstatic peaks
-A sense of loneliness and isolation
-Feelings of inferiority and superiority which exist simultaneously in the individual
-A striving for perfection

He said "Since the alcoholic's sense of self-discipline has not been developed at this point, his natural reaction is to reject all discipline. He now cannot face the realities of his existence. This would indicate that the whole point of treatment is to get the alcoholic to face and accept his limitations and capacities."

Tiebout was consistent in his belief that the acceptance of alcoholism as a disease was essential, but this belief was partially practical. In his experience, chronic alcoholics did not take the steps necessary to recover unless they became conscious of themselves as people with a disease.

Tiebout's view was that the old ego should be eliminated entirely and replaced with a new one through "surrender". Conversion, surrender, confession, restitution and the necessity of helping others were ideas brought from the Oxford Group to Alcoholics Anonymous by members who had found that the intense spiritual devotion they inspired was the key to a changed life. Tiebout understood the concepts in a more secular way, and approved of them.

Tiebout had found that superficial compliance in therapy often correlated with lack of real change, and he saw in the AA concept of surrender an antidote to this phenomenon. An act of surrender was the only cure, or practically the only one, to the problem of "compliance", or partial surrender to the psychiatrist's authority and the authority of the reality principle. Tiebout described true surrender as "an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her unconscious mind becomes involved in a certain set of circumstances," essentially the circumstances of "hitting bottom".

Conversion, for Tiebout, was a spiritual awakening made possible by the person's recognition of his own egocentricity. The central effect of Alcoholics Anonymous was "to develop in the person a spiritual state which will serve as a direct neutralizing force upon the egocentric elements in the character of the alcoholic." A "vague, groping, skeptical intellectual belief" would not accomplish this but only a true emotional spiritual feeling, for "unless the individual attains in the course of time a sense of the reality and the nearness of a Greater Power, his egocentric nature will reassert itself with undiminished intensity, and drinking will again enter into the picture."

(With a lot of thanks to Wikipedia references)