Triumphs of Experience: The Men of the Harvard Grant Study (42 page)

Another half of the men achieved relapse prevention through compulsory supervision or behavior modification. By that I mean the presence of factors independent of willpower that systematically altered the consequences of alcohol abuse. This was often probation, or a painful medical consequence that, as AA members say, “keeps the memory green.”

Two other means of relapse prevention were employed by almost half the men. One was to get involved in an inspirational group (for our sample, usually AA). The second was to find new relationships; sometimes these were love relationships and sometimes opportunities to help needy others. But they were always relationships with people toward whom the alcoholic did not feel guilty for past misdeeds. In their review of the literature on remission from abuse of tobacco, food, opiates, and alcohol, Stall and Biernacki identified these same four factors.
31
The four factors in
Table 9.3
appeared to be the most important keys to relapse prevention; only 30 percent of the men resorted to clinic attendance or hospitalization during their first year of abstinence.

Surprisingly, absence of risk factors for alcohol abuse did not predict successful remission. The skills that get you out of a hole are likely independent of the forces that got you in. The remitted alcoholics abused alcohol for an average of two decades at least, and the severity of their alcoholism and their genetic vulnerability had been if anything greater than that of their nonremitting counterparts. Limited education, which is also a risk factor for alcohol abuse, did not inhibit stable remission. Indeed, the less-educated Inner City men were significantly more likely than their Grant Study counterparts to become
abstinent.
Although the per capita cigarette consumption of the alcoholics was almost twice that of the nonalcoholics, the severity of cigarette abuse among alcoholics was not statistically associated with eventual abstinence.

7. Is recovery through AA the exception or the rule?
For both cohorts, regular AA attendance was strongly associated with sustained abstinence. All four of the factors in
Table 9.3
are embodied in the AA program and in many other incorrectly named “self-help” recovery programs organized along similar lines. I put
self-help
in quotes because AA is as much about self-help as a barn-raising. In both of these community activities, success is at least as much about helping other people as about helping yourself. Four variables were associated with Study men joining AA: severity of alcoholism, Irish ethnicity, absence of maternal neglect, and a warm childhood environment.

Of the nine alcohol-dependent College men who achieved stable abstinence, five (56 percent) attended AA for between 30 and 2,000 meetings. Two other alcohol-dependent College men attended about 50 meetings but relapsed. Of the thirty-nine alcohol-dependent Inner City men with stable abstinence, at least fourteen (36 percent) attended AA for 50 to 2,000 meetings. The Problem Drinking Score assessment of the alcohol-dependent Inner City men with fewer than 30 AA visits was about 9. Men who attended more than 29 AA visits (the mean was 400) had a mean problem drinking score of 12—a very significant difference. One doesn’t usually seek painful hip replacement before one’s arthritis has become quite severe, and “hitting bottom” increases the alcoholic’s willingness to sit on hard church chairs, drink bad coffee, and take “the cotton out of one’s ears and put it in one’s mouth” several times a week. In both cohorts, the men who were stably abstinent attended about twenty times as many AA meetings as the chronically alcoholic (
Table 9.4
).

Table
9.4
Question: How Does AA Work? Answer: AA Works Fine!

Very significant = p<.001; Significant = p<. 01; NS = Not Significant.

THE STORY OF JAMES O’NEILL

The story of James O’Neill illustrates how alcoholism reverses what are commonly thought to be cause and effect; it demonstrates that alcoholism is the horse in life’s troubles, not the cart. O’Neill behaved very badly while drinking, but—however difficult this may be to believe—in 1950, before his alcohol abuse began, he had been assessed by the Study staff as a man of “unqualified” ethical character, and the rather prim director of the Health Services had described him as a “straightforward, decent, honest fellow, should be a good bet in any community.”

James O’Neill did not come to psychiatric attention until 1957, thirteen years after his Harvard graduation, when he was first admitted to a psychiatric ward at aVA hospital. A thirty-six-year-old father of four and former assistant professor of economics, O’Neill described himself as a “failure at his marital and professional responsibilities because of drinking and missing teaching appointments.” His admission note stated, “Present symptoms include excessive drinking, insomnia, guilt and anxiety feeling.” The diagnosis was “behavior disorder, inadequate personality.”

O’Neill
provided the following history, paraphrased from his hospital record. He began drinking and gambling in the summer of 1948, while depressed over a poor performance on his Ph.D. generals. He was drinking during the daytime, and missing teaching appointments. However, he did continue to teach and to keep his family together. He finished his Ph.D. without difficulty, and in 1955 he left his large West Coast school for a research university in the South.

At the time of his admission, O’Neill expressed suspicion and anger toward the important people in his life, all of whom, he alleged, had treated him badly. Otherwise he showed little emotion, and the interviewer commented: “His pattern of drinking, sexual infidelity, gambling and irresponsible borrowing led him to recognize from his reading that it adds up to diagnosis of psychopathic personality, especially since he has experienced no real remorse about it.” It was known that he had given his son some books to sell, and that four books from the university library were among them; he was accused of stealing university property, and fired for moral turpitude. He assured the hospital staff that he did not sell university books knowingly.

The psychiatric record continues:

During all of the time that O’Neill was frequenting bars, contacting bookies and registering in hotels to philander, he always used his own name. It’s interesting that when he was carrying on his nefarious pursuits, he got considerable satisfaction out of it being known that he was a professor. . . . When his mother died in 1949, he felt no remorse [
sic
] at her death. He did not remember the year of his mother’s death. In view of the fact that he dates his extracurricular activities as beginning in 1948, this confusion is probably significant.

During his eight-month hospital stay, the patient . . . was able to work out a great deal of feelings toward his family, in
particular
toward his mother and also toward his wife. The patient felt quite hostile and anxious about the fact . . . that his parents were always very cold. . . . He harbored many feelings of hostility toward his wife whom he feels does not appreciate the fact that she’s married to such an intelligent college professor. All she wants is to have money and bigger homes.

The discharge diagnosis was “anxiety reaction manifested by feelings of ambivalence about his family, his parents and his work.” The precipitating stress was considered to be “death of the patient’s mother and a long history of drinking and gambling and going into debt.” His predisposition was considered to be “an emotionally unstable personality for the past 20 years.” At one point the VA even called him “schizophrenic.” A diagnosis of alcoholism was never even considered.

But the Grant Study record told a completely different story. In college, James O’Neill had been the embodiment of the Grant Study’s ideals of optimal health and achievement. He was one of the brightest men in the Study, and after three years of observation he received an A in psychological soundness. A child psychiatrist blind to his life after age eighteen was asked to compare his childhood environment with those of his Grant Study peers. She placed it in the top third, and summarized the raw data on his childhood as follows:

O’Neill was born in a difficult delivery. The mother was told not to have more children. His parents were reliable, consistent, obsessive, devoted parents. They were relatively understanding, and their expectations appear to have been more non-verbal than explicit. The father was characterized as easy to meet, the mother was seen as more quiet; no alcoholism
was
reported. Warmth, thoughtfulness and devotion to the home were some of the comments. The subject spoke of going to his father first with any problems, but of being closer to his mother than to his father. His peer relations were reported to have been good, and little or no conflict with his parents was reported.

She went on to predict that O’Neill would develop into “an obsessional, hard-working, non-alcoholic citizen, whose work would be related to law, diplomacy and possibly teaching. He would rely on his intellect and verbal abilities to help in his work. He would probably marry and be relatively straight with his children. He would probably expect high standards from them.”

Other observers summed O’Neill up equally favorably in the years before he turned thirty. The dean’s office ranked his stability as “A” while he was in college; the Study internist described him as “enthusiastic, whimsical, direct, confidant, no grudges or chips, impressed me as an outstanding fellow.” The staff psychiatrist was impressed by his “combination of warmth, vitality and personality,” and also put him in the “A” group. When he was twenty-one, he married his childhood sweetheart, with whom he had been in love since he was sixteen; in 1950, six years after they married, the marriage still seemed solid. When O’Neill was twenty-three, his commanding officer wrote that he gave “superior” attention to duty and was a particularly desirable officer.

From the prospective record it was also possible to record a more accurate picture of O’Neill’s feelings about his mother’s death. The child psychiatrist who assessed the prospective record saw his as among the best mother-child relationships in the Study. His mother’s physician commented that O’Neill had been “devoted and helpful during the illness,” and in 1950, six months after her death, a Study observer
noted
that O’Neill felt her loss deeply. It was only seven years later, on his admission to the VA, that O’Neill reported having no feelings toward his mother and blamed her alleged coldness for his current unhappiness. Over time, alcoholics develop excellent collections of “resentments.”

O’Neill was one of the lostest of the Study’s lost sheep. He had stopped returning questionnaires long before his hospitalization. It was not until 1972 that he finally brought the Study up to date on the progression of his life and his alcoholism. He had begun drinking heavily in 1948 while still in graduate school, and by 1950 he was drinking in the morning. In 1951 O’Neill’s wife’s uncle, an early member of AA, had suggested the possibility of alcoholism. But his wife insisted to the Grant Study, with whom she had maintained connection even while O’Neill did not, that her husband was not abusing alcohol. Furthermore, in 1952, at his first admission, the health services at his university whitewashed his drinking as due to “combat fatigue.” His prospective 1946 military record revealed, however, that O’Neill had experienced no combat in World War II.

In 1972 I interviewed O’Neill, and he filled in some long-standing gaps. We met in his apartment. He was balding and sported a distinguished mustache; his clothes were worn but elegant. He came across as an energetic man who kept a tight rein on his feelings. At first during the interview he had a lot of trouble looking at me and seemed very restless. He chain-smoked, walked back and forth, lay down first on one bed and then on the other. Although he avoided eye contact, there was a serious awareness of me as a person, and I always felt he was talking to me. He behaved like a cross between a diffident professor and a newly released prisoner of war. As he put it to me, “I’m hyper-emotional; I’m a very oversexed guy. The feelings are there, but it’s getting them out that’s hard. The cauldron is always bubbling. In Alcoholics Anonymous, I’m known as Dr. Anti-Serenity.”

He
admitted that he had been chronically intoxicated between 1952 and 1955 while writing his Ph.D. thesis, and that he had regularly sold books from the university library to buy alcohol. By 1954 his wife had begun to complain about his drinking; by 1955 it was campus gossip. But no diagnosis of alcoholism was made during his 1957 VA hospital admission or the subsequent one in 1962. In our 1972 interview, I felt that O’Neill himself still did not understand the cause-and-effect relationship between his drinking and his misery.

In 1970, O’Neill became sober in Alcoholics Anonymous. By our 1972 interview, AA was clearly the most important force in his life, besides his wife. He made frequent reference to it; when I asked him what his dominant mood was, he replied, “Incredulity. . . . I consider myself lucky. Most people in Alcoholics Anonymous do.”

Even after two years of complete sobriety, O’Neill described himself to me as “a classical psychopath, totally incapable of commitment to any man alive.” To me, though, he felt like a lonely but kindly man. I never had the feeling that he was cold or self-absorbed. If anything, he suffered from a hypertrophy of conscience, not a lack thereof. Remember that, although alcohol does not help insomnia, chronic anxiety, or depression, it is the best antidote for guilt that we have.