lnremational Journal of Law and Psychiatry, Vol. 13, 103-l 21,199O Printed m the U.S.A. All rights resewed.

01602527/90 $3.00 + .W CopyrIght 0 1990 Pergamon Press plc

Alcoholism, Freedom, and Moral Responsibility* Warren Lehman**

I. Responsibility and Disease I shall be talking about what coming to accept responsibility is like. By responsibility I mean a preparedness to live, without recrimination, with the consequences of one’s actions. Accepting responsibility is the opposite of feeling victimized, or of trying to blame conditions or other people for our lives. Accepting responsibility is first of all, then, a subjective matter. We might also imagine an objective responsibility. Perhaps a person could have controlled some action or condition but did not believe he could and consequently blamed others. We might say such a person is responsible objectively, though he did not feel or think he was. The law must often impose responsibility on such people. The judge may hope that such a person comes to agree with the legal assessment. Some undoubtedly do, and it probably bodes well if one can. We will want, of course, to suppose that legal responsibility is not arbitrarily imposed, but that it corresponds to psychologically objective responsibility. But for the moment I am concerned not with the law, but with achieving congruence in one’s personal life; a congruence between one’s view of oneself and the facts, that is with coming to accept the responsibility that belongs to one. This is a kind of objective view of the self, but not the third party objectivity of science. It is a radical objectivity that is found through subjectivity. I will be considering how this responsibility-taking comes about in a specific situation: recovery from alcoholism.’ Two recent events make it timely to discuss responsibility in this context: The first is the Supreme Court decision in Traynor v. Turnage. In that case, two veterans had sought an extension of eli-

*Based on a paper delivered in Montreal on June 16, 1988, at the International Congress of Law and Mental Health, and, in revised form, in Tel Aviv on November 16, 1988 at the 2nd International Congress on Drugs and Alcohol. **University of Wisconsin Law School, University of Wisconsin-Madison, Madison, WI 53792. 11would also like to suggest that alcoholism may offer a useful case for developing a psychical topology within the psychoanalytic tradition, that is not subject to the criticism leveled-by Michael Moore in Law and Psychiatry (1984) -at metapsychological accounts of responsibility. Even without my having developed the interrelation between narcissism and alcoholism-implicit in the idea that Alcoholics Anonymous is a selfish program- the framework of a response to Moore can be found in the later pages of this paper. 2nynor v. ll~nuge. Administrator of Veteran’s Affairs, et ol., 108 S.Ct. 1372 (1988). 103

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gibility for GI educational benefits because, they argued, alcoholism had prevented their acting earlier. The VA denied their request. The Court said that it was not obviously medically wrong for the VA to conclude that primary alcoholism, that is alcoholism not the result of prior mental disease, is induced by willful misconduct. Therefore, the VA, in rejecting the extension, was not making a discriminatory interpretation of a statute which allowed extensions to those who had been disabled, but not by intentional misconduct. The court’s decision (which I shall not analyze here) betrayed all of the confusion (which I will be talking about) that surrounds the idea of responsibility in Western thought. For this reason, alcoholism is an appropriate context in which to consider the general question. The second event was the publication, in 1988 of a provocative book, Heavy Drinking, The Myth of AlcoFoIism as a Disease, by Herbert Fingarette.3 Like the earlier Beyond Alcoholism by Dan Beauchamp, Fingarette’s book argues for a radical revision of the public understanding of alcoholism. Beauchamp would have us abandon the concept of alcoholism itself. The very idea focuses attention on the minority who drink disastrously. This, he argues, is not the best policy. He believes we can reduce disastrous drinking more effectively if, rather than trying to cure individual problem drinkers, we discourage drinking generally. This is so because there is no common distinctive feature of those who drink too much. There is, therefore, nothing to change at the individual level; nothing (such as a genetic defect, for instance) to focus research upon; and nothing for public policy to correct, treat, or compensate for. Those who drink too much are merely the far end of a standard deviation, and the far end will be smaller if average consumption can be lowered. Fingarette incorporates Beauchamp’s objection to alcoholism as an idea, but puts a different spin on it. Beauchamp has no suggestion of what, if anything, to do for those now drinking too much, or for the lesser number that would still do so under a national policy of reducing overall consumption. Concern for suffering individuals simply drops from Beauchamp’s consideration. Fingarette, however, while he favors a watered down version of Beauchamp’s social policy, remains concerned with the individual drinker. For Fingarette, the problem with the idea of alcoholism is that it is understood as the name of a disease. He wants to drop the disease concept in order, partly, to revolutionize the way in which the individual is viewed and treated. It is Fingarette’s belief that “heavy drinkers” (the term which he prefers) can often control their drinking by will power and should be encouraged to do so. I take Fingarette’s book as a starting point for my argument about responsibility, both because it is an influential work in need of answering, and because it offers a useful framework against which to build my case. Fingarette’s thesis is that public policy, research, and therapy programs have been misdirected because people believe that alcoholism is a disease. One who has been misled by what Fingarette calls “the classic disease concept” believes that alcoholics have

3H. Fingarette, Heavy Drinking The Myth of Alcoholism as a Disease (1988), [hereafter cited as Heavy Drinking]. 4D. Beauchamp, Beyond Alcoholism -Alcohol and Public Health Policy (1980).

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no capacity whatsoever to refuse a second drink; that they are incapable of participating in their own recovery; and that they are not responsible for their drinking. According to the author, those who assert that alcoholism is a disease convey to the afflicted not simply a loose notion of illness, but the content of the classic concept and, therefore, two unfortunate ideas: (i) that they can do nothing to control the problem in their own lives (it is as a disease inaccessible to the will, so why bother to try); and (ii) that they are not responsible for drinking or its consequences (so they should be pitied rather than told to shape up). In two words, the impression conveyed, he says, is one of hopelessness and irresponsibility. The concerned public is similarly misled, he believes, and therefore does not consider potentially useful social policies such as the one Beauchamp recommends; the public may think alcoholics constitute a determinate group of defective people; and programs aimed at people generally - discouraging everyone’s drinking- will not reach the abusers, but will burden those who are not sick. Disease or Illness In making his case about how alcoholics should be treated in a world in which alcoholism is not seen as a disease, Fingarette evidences no awareness of Michael Moore’s careful remarks on the difference in ordinary usage between the word disease and the word illness. We usually speak of disease while believing that there are discrete diseases, that these are identifiable by characteristic symptom clusters, and that each disease is referable to a specific pattern of physical causation. Disease usually means, therefore, something grounded in physical conditions. The word illness as we use it has no such necessary relation to discrete physical causation. And in the case of mental illness, what is normally meant is only unintelligible behavior, with no claim about causation.s Fingarette discusses only disease, and in a manner unwaveringly consistent with Moore’s usage. He never considers the possibility that alcoholism may be in Moore’s sense an illness and that other participants in the discussion may be using disease loosely to mean something like Moore’s illness idea. The boundary between the two words is, of course, only a tendency in usage. People may speak loosely or metaphorically of mental disease, without intending to imply physical causation; and often those people we say are ill are, in fact, suffering a physical disease. It is important, in the light of Fingarette’s concern about responsibility, if one saying alcoholism is a disease means only that it is something like Moore’s illness. Moreover, Moore believes that an illness may properly be treated as exculpatory, even absent physical causation.6 If Moore is right, then proving that alcoholism is not in the doctor’s sense a disease, does not resolve the question Fingarette is concerned with. Fingarette is trying to do for alcoholics what Thomas Szasz has tried for mental illness: he wants to avoid importing determinism, hence irresponsibility, into the law. He proposes to do this by denying that there is a disease SMoore, supra note 1, 186-89. 6Id. at 243-45.

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because the exculpatory implications of disease seem to know no bounds. Michael Moore sought a middle ground between those who say, in effect, that no one is really responsible for anything (we are all a little crazy) and those who say in effect that we are responsible for everything (The Szasz-Fingarette school). After Moore (and Fingarette wrote after Moore), it is too late to be arguing this proposition. If there is no satisfactory theoretical resolution to the conflict between free will and determinism,’ there are arguable practical answers to the question of assigning legal responsibility in such cases. I shall not be pursuing this side of the argument, though I am generally persuaded of Moore’s conclusion. I shall be arguing, rather, that even if alcoholism is either disease or illness, it does not follow that alcoholics are not responsible. People may be responsible for having, or acting out of, a disease. The trouble is, however, that the U.S. Supreme Court and the general public read books like Fingarette’s, not cautious tomes like Moore’s. Fingarette’s view that alcoholics are responsible, was relied upon in the plurality opinion in the Traynor decision, where it supported the VA’s conclusion that primary alcoholism is willfully induced. The reservations that might be inferred from Moore’s work on mental illness had no place in the decision. Civilization

and Its Discontents

No doubt there are those, like Fingarette, who, whenever they see disease conjoined with alcoholism, conjure up all the half-truths and untruths embodied in that “classical disease concept.” Surely, it is worth disabusing them, but three points need to be made. First, it is not Alcoholics Anonymous that is misled in these ways, or most anyone else in the treatment field. Second, Fingarette’s effort to clear up such misunderstanding, as exists, causes more harm than good. Finally, the way Fingarette goes wrong exposes an incoherence in common Western ideas concerning freedom, self, knowledge, and action.” The surprising twist in all of this, is that the misunderstandings about responsibility that Fingarette’s work betrays, often cause those who share them to drink and take drugs. People drink and drug themselves because their lives are painful. They are hurt because they try to live their lives according to ideas of self regulation that are derived from Western theory, but that do not fit our nature as human beings. For the resulting pain, alcohol is a sovereign remedy. So, the concepts that fail as a framework for understanding alcoholism are the same that guide so many to that life of psychic misery which fosters alcoholism, drug abuse, teenage suicide, compulsive overeating; all the destructive disorders of the modern self.9

sThe very one bothering Lloyd Weinreb, supm note 7. sThe havoc wreaked by alcohol or drug use can itself become part of the background that addicts use those chemicals to escape. Perhaps this is a reason, along with growing tolerance, why consumption tends always to increase. It seems possible in principle, however, that one might become physically addicted to alcohol without any prior psychic discomfort. In that event, it would be the alcohol alone that made one’s life intolerable. If there are people with such a history, it would seem they should be able to withdraw from

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The implicit theory here will be seen as a variation on the familiar one from Civilization and its Discontents. lo The symptomology is the same. I suggest, however, that the discontent is not an inevitable correlate of civilization, but is eased or exacerbated at different periods in history.” Freud, himself, is one of those exacerbating this problem in the modern world. In his essay, On Narcissism,12 Freud wrote: The charm of the child lies to a great extent in his narcissism, his selfcontentment and inaccessibility, just as does the charm of certain animals which seem not to concern themselves about us, such as cats and large beasts of prey. Indeed, even great criminals and humorists, as they are represented in literature, compel our interest by the narcissistic consistency with which they manage to keep away from their ego anything that would diminish it. It is as if we envied them for maintaining a blissful state of mind-an unassailable libidinal position which we ourselves have since abandoned. Briefly, it is our loss as adults, of the simplicity and coherence common to us as children, that constitutes the characteristic misery widespread in the modern West. In identifying the self-love and self-possession of children with Narcissus, infatuated with his own reflection; in describing efforts to recapture that state as regressive; and in describing as childish the love of parents for their young who have not yet lost it; Freud aligns himself with the forces in the culture that encourage the misery he, in many ways, described so insightfully. Freud’s position, on both discontent and narcissism, aligns itself with his commitment to the ego as the proper organizing center of the adult human being. It is the ego that in maturing Westerners displaces the narcissistic agency of children, criminals and humorists. And this is the Western theory of selfregulation, against which so many are in a kind of inverted, self-destructive revolt. It is Freud’s commitment to ego and against the unconscious (to which the narcissistic agency is privy) that grounds Jacques Lacan’s critique. Disease, AA, and Bias Professor Fingarette, failing to see the inherent difficulties in understanding the phenomenon of self-regulation, wants to place a major share of the blame for confusion about disease and responsibility in the matter of alcoholism upon Alcoholics Anonymous. He wrongly assumes that when AA speaks of alcoholaddictions without the long run support of a program such as AA’s. In denying physical causes, Fingarette seems to be telling us, however, that such an etiology is unlikely. I am not persuaded; and were there those so afflicted, they would seem candidates for the kind of treatment we will see Fingarette recommending. Fingarette’s standard heavy drinker, then, is neither mentally nor physically dependent on alcohol, but is an habitual drinker who doesn’t recognize it as a problem, or doesn’t know the self-disciplinary techniques that might relieve him. toFreud, Civilizution and ifs Discontents (J. Strachey, trans. 1961). ItSee, e.g. Lehman, “Justice and the War of Reasons,” I Can. 1 of L. 14Jurisprudence 127 (1988), arguing that psychic resolution is more difficult at different times in history. t2Freud, On Narcissism: An Introduction, 14 Standard Edition 73 (1961).

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ism as a disease, it holds to all of the implications that “the classic disease idea” has for him. But AA’s claim is quite circumspect, and it isn’t the one that Fingarette is refuting. In the Society’s basic text, one disease theory-that alcoholism is an allergy-is offered in a prefatory letter by Dr. William Silkworth, who had run a sanitarium in which Bill Wilson, AA’s co-founder, had been treated.13 Speaking for AA, the writer, presumably Wilson, says, “The doctor’s opinion . . . interests us . . . It explains that for which we cannot otherwise account.“14 But learning that he had a disease with an arguably physical base oddly did not, for Wilson, imply a medical cure. The idea did comfort him, however.15 It seemed to relieve him of some burden, as it has thousands of alcoholics since. I shall be considering later, what the comforting might have amounted to, but it was not, surprisingly, relief from responsibility. Nor did Dr. Silkworth conclude that Wilson’s allergy should be treated by anti-histamines. He spoke, rather, of “moral psychology.” This is not an idea congruent with alcoholism being a disease, in the sense Fingarette wants to deny. I am reminded of what seemed a mystery at the time, that when I was in an alcoholic treatment center we began the day meditating in the hospital chapel. Can we imagine a condition of disordered thinking (an illness), yet with a physical ground (so in that sense a disease), yet not cured by addressing that physical ground, but by speaking to a mental condition that potentiates it? That seems to be about AA’s idea. Fingarette’s attitude toward AA goes beyond his misunderstanding or disagreement with what the disease idea means to AA. He seems to see himself fighting a lonely battle against evils being perpetrated by the recovering alcoholics in AA.16 Fingarette is not alone in his antipathy. It is dismaying the way AA has become the common object of a kind of intellectual know-nothingism. I do not mean such as the conclusion of P. J. O’Rourke’s Wall Street Journal review of Jay McInerney’s novel, Story ofMy Life: Allison [the heroine] comes to a tragic end. She’s sent to an expensive drug rehab clinic. The tragedy isn’t hers, of course. She’ll be fine. She’ll come out of therapy just as ignorant, irresponsible and useless, but healthy. The tragedy is ours. We’ll have to listen to her babble about the virtues of AA and interactive psychoanalysis for the rest of her life. l7 Undoubtedly, we deserve chiding when we forget that a convert’s zeal gets boring. A wonderful parody of AA in a Barney Miller T.V. show segment a few years ago made the same point. What bothers me is the biased misinformation spread abroad by apparently responsible authorities. Take D.S. Sutherland, a Professor of Experimental 13Alcoholics

Anonymous

(3rd. ed. 1976) xxvi.

Wd. at xxiv. IsId. at 7. l6Who he suggests note 3, at 24.

are not above intimidating

those with whom they disagree,

17Bookshelf: Story ofMy Life, The Wall Street Journal,

(September

see Heavy Drinking,

16, 1988) p. 14, ~01.1.

supra

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Psychology, reviewing in the Times Literary Supplement five recent books on alcoholism. One of the five, called Constructive Drinking, he says is consistently humorous; it reads “like a parody of sociology. . . .” Sutherland is, nonetheless, willing to rely upon this book for the assertion that “in the power they have over their members [AA resembles] sects like the Moonies or the Scientologists.“ls Sutherland, like Beauchamp before him, characterizes AA as a secret organization, apparently because its members seek a modicum of privacy in coming to terms with their disease. One could as well say an HMO is a secret organization. In all this work, there is no serious effort to explore what AA readily makes available: Its literature and many of its meetings are open, so that anyone honestly interested could explore whether AA has anything to teach about alcoholism or its cure .I9 None of these academic inquirers does that, despite the fact that all grudgingly admit that AA seems to have a higher rate of success than any other therapy. AA has not countered these attacks, apparently treating itself as barred by its own Traditions from responding. Tradition Ten says: “Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.” Though this might be thought not an outside issue, it is clear that the organization has assiduously, and wisely I think, avoided taking an official stand even on matters intimately concerned with alcoholism. The view I express here is mine alone. It has not been cleared with anyone. No one in an official capacity in AA knows of its existence. I do not think that Tradition Ten requires that those who know something of AA, even from the inside, ought not give thought to its work and meaning, or discuss it in academic settings. That is what has not been done in discussions of alcoholism, and what I will in fact try to do. Bias and Enlightenment Both Fingarette’s blindness to the difficulties in Western personality theory and his prejudice against AA appear in this book as if they were artifacts of a commitment to a unified vision of knowledge, the self, and human action that is becoming each day more manifestly untenable.*O According to that vision, anything that counts as knowledge must be understandable categorically; the self is a conscious mind subsisting in a body and truly human action consists in the categorical mind imposing, through will, its ideas of what to do. This vision is crumbling. Categorical knowledge cannot mirror the world (Rortyzl); the tsWhen to Say When, Times Literary Supplement, (August 12-18, 1988) at 880-81. t9An example of the potential for this kind of undertaking is E. Herman, The Twelve-Step Program: Cure or Cover? Utne Reader (No. 30, NovJDec. 1988, reprinted from Out/Look: National Lesbian and Gay Quarterly (Summer 1988). Ms. Herman writes, “I have never been a member of a fielve-Step program. To research this article, 1 attended a lot of meetings and talked to many people.” She does not come away from that enterprise an unqualified supporter, but a responsible critic, concerned with what she sees as a turning by those in Twelve-Step programs from the political activism she favors. ZeFingarette’s other works suggest, however, that he is not narrowly committed to the Enlightenment model 1 will be discussing, but in Heavy Drinking, he presents himself as if he were. His books include, among others: The Self in Transformation (1963), On Responsibility (1967), and Confucius: The Secular as Sacred

(1972). *lR. Rorty, Philosophy and the Mirror of Nature 12-13 (1979).

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mind/body dualism cannot hold (Ryle,22 Ungerz3); we use words because of their suggestive rather than definitional relevance (Wittgensteinz4); and the self of radical individualist theory is incoherent or non- existent (Derrida,*j Rortyz6). Fingarette’s uninformed critique of AA looks as if it manifests the defensiveness of those still committed to the crumbling Enlightenment vision.27 He poses science against the hermeneutic “irrationality” of AA. In fact, the disease idea, the radicalized ideal Fingarette properly wants to reject, is not the property of AA, but of the medical community and of social theory. It is people discomfited by talk of moral psychology; people who want to banish subjectivity in favor of a straight medical model; people who see sufferers as victims, who prefer the idea of alcoholism as a physical disease, and who associate it with lack of responsibility. In a word, while it is science on which Fingarette relies in his attack on the disease concept, it is another manifestation of that science which promotes it. One would think, therefore, that Fingarette would be pleased that the nation’s treatment programs are largely staffed by recovering alcoholics. They temper the medical community’s effort to apply the medical model, rejecting, for instance, its self-satisfaction with mere chemical detoxification. But he is not happy about this, either. Fingarette takes his allies where he may: he sympathizes with the lamentations of physicians over the recalcitrance of the recovering alcoholics who are the foot soldiers in the treatment field.28 (These recovering alcoholics are destined to be no more than that, and rightly, Fingarette implies, because they lack degrees and believe anecdotal evidence is worthy.29) But if alcoholism is not a disease, why is Fingarette trying to protect the power of the physicians? He knows perfectly well that they play but a marginal role in any treatment program .30 Fingarette may think that physicians will be more amenable than recovering alcoholics to the controlled drinking regimen he favors. He is probably right. Physicians could try to use his work to recapture the field. Unfortunately, if he succeeds in forming that alliance, it will be the alcoholics who suffer. II. AA’s Self-understanding

The consequence of Fingarette’s bias that shall interest us here is that he refuses to take AA’s self-understanding seriously. He treats AA as a self-help

2%. Ryle, The Concept ofMind 11-24 (1949). *3R. Unger, Knowledge and Politics 29-62 (1974). *4L. Wittgenstein, Philosophicallnvestigations 54-55 (2d ed., G. Anscombe, trans., 1958). *sSee, e.g., J. Derrida, The Post Card: From Socrates to Freud and Beyond (A. Bass, trans., 1987); J. Derrida, Toking Chances: Derrida, Psychoanalysis, and Literature (J. Smith & W. Kerrigan, eds., 1984). *sR. Rorty, The Contingency ofSe/fiood, London Review of Books at 11 (8 May 1986). *‘But see supra note 13. *gHeavy Drinking, supra note 3, at 23-24. *90n the worthiness of empathic and introspective inquiry that he calls the essence of psychoanalysis, see Heinz Kohut, The Restoration ofthe Self(1977). at 298-312. 3OHeavyDrinking, supra note 3, 75.

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group that engages in “a modest form of elective brain-washing . . . ” He says what AA does “is rather like what critics of sects would call ideological reeducation.“31 The thing is that, any suggestion of non-categorical or sub-conscious knowing, such as AA deals in, is disdained by the Enlightenment’s academic rear guard.32 Nevertheless, Fingarette has allied himself with this view in this book, regardless of what he may say elsewhere. The fact is that our freedom of choice as alcoholics, and hence our responsibility, are central presumptions of the program of Alcoholics Anonymous. The difficult question, really, is where the disease idea fits into the program. To understand how in AA freedom and responsibility fit with the disease concept, we have to do what Fingarette did not do. We have to take AA’s self-understanding seriously. AA offers a specific mental discipline, akin to psychiatry’s talking cure, so far as both assume the mind to be an independent force that can be worked upon in mental ways. AA’s discipline is intended to achieve a specific thing: it claims to know how to relieve the mind or spirit of its dependence upon alcohol. The way to do that, it says, is to follow a program of twelve steps that have a certain sequential logic. In its own view, therefore, its success is not to be dismissed as the result of some non-respectable social voodoo. In light of its success in treating alcoholics, that claim is worth considering. The first thing to understand about AA’s view is that it sees alcoholism quite differently than does Fingarette: it is aimed at an end that Fingarette does not pursue. Therefore its cure is different; it does something quite other than what is achieved by the kind of treatment Fingarette promotes, as I can testify. The Desire to Drink I went through a program in 1977 that used all of the techniques Fingarette recommends as if they were surprising novelties. Through role playing, I practiced saying no when offered a drink. It was explained to me that drinking was a way of life, around which I centered all my activities, that it took up much of my time, and that in abandoning it I would find great stretches in my days with apparently nothing to do. I was introduced to pleasant alternative activities: volleyball, miniature golf, and classical music. There was an effort made to situate me personally in a world in which it would be easier not to drink. The long-suffering dean of the Law School came down to the hospital for conferences, as did my less patient wife and children, most of whom were themselves alcoholic. Some of this was undoubtedly useful. But it did not get at the most important thing. It did not get at the desire to drink. It is the peculiar intensity of the desire some people have for alcohol that suggests turning to medicine for explanations. In a word, alcoholism is first recognized as, in Moore’s terms, an illness. It seems hardly possible that some3IHeavy Drinking, supra note 3, 87-90. 32This is another example of a matter I discuss in Justice and the War of Reasons, supra note 11: the conflict in the modern world between the Enlightenment and its critics. I argue there that this conflict also shows up, for instance, in the feminist movement; the humanist/fundamentalist conflict in the U.S: and in the Critical Legal Studies movement.

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one who is sound could behave so self-destructively. The problem with the classic medical model -turning observed illness into technical disease - is that none of the chemical or biological theories so far tested seem able to account for more than a minority of cases. Because no biomedical account satisfies him, Fingarette seems always at the verge of telling us that alcoholics have been willfully drinking themselves to death, because drinking is really something they can choose by will power not to do. He cannot deny that: “There is . . . a phenomenon involving the strong inclination to drink to excess.“33Heavy drinkers, he says, choose “to engage, again and again, in drinking conduct that to most of us seems irrational, imprudent, harmful, and disruptive.“34 But, despite that admission, “the strong inclination to drink to excess” disappears from the analysis once he has shown that there is, so far, no demonstrated universal physical explanation for it. It disappears just when one would most want it attended to; when he talks about treatment. Nothing in Fingarette’s recommended treatment regimen directly addresses what is for AA the central issue: that seemingly irresistible desire to drink. Choosing to drink, he asks us to believe, is no different from choosing to be a professor35-as if there were a similar strong inclination to profess to excess, to engage, again and again, in professing conduct that is irrational, imprudent, harmful and disruptive. Fingarette dismisses even those medical hypotheses that may be partially explanatory, on the ground that they are less than universal.36 His official position, however, is that there is not one alcoholism, but many. Nevertheless, he does not consider the possibility-plausible in light of his account-that at least some alcoholisms are true diseases, for instance, those that are genetically grounded. But it would be a red herring to pursue that argument here. As we have seen, following Moore, the disease/illness distinction does not resolve the question of responsibility. Still one as yet unproven medical theory, worthy of remark because it supports Dr. Silkworth’s allergy theory mentioned earlier, has a great deal of plausibility. It is argued by some that alcohol when it metabolizes produces morphine-like substances. Either some of us are more excited by them than others, the theory says, or in some, more of those substances are produced. Clancy, a popular AA speaker (that’s his first name) makes that point by saying that for us a sip of alcohol “goes KAA-BOOOM,” while for other people it fizzes gently. Fingarette says of this theory, that any such metabolic by-product, because it would stay in the body only a few hours, could not account for one resuming drinking after a long period of abstinence.-” This is the medical model, with a not uncharacteristic mechanical vengeance. There are many kinds of pleasures that keep drawing us back after the immediate stimulant has been withdrawn from the system. Fingarette ignores this point

33Heavy Wd., at 35Id., at 36Id,, at 37Id., at

Drinking, supra note 3, at 44. 45. 102. 54, 56, and 57-58. 55-6.

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because it means that the attraction of alcohol may be mediated by mental, rather than chemical, events. While he pays some attention to psychological accounts of alcoholic etiology, they are not for him matters of disease.3* But, if I am right that alcohol is (especially for some genetically predisposed people) a sovereign remedy, for a kind of psychological pain so serious that it often leads to suicide; it is hardly surprising that we should be overwhelmingly attracted to it, even when it is not present in our systems, so long as we know no less dangerous road to relief. The point is, as Clancy says, that if alcohol is your problem, you are not an alcoholic. Fingarette thinks alcohol must be the cause of alcoholism, and, if it is not, there is no disease. Alcoholism is a disease named after what appears to be its remedy.3v Fingarette appears to believe that by showing that no physical cause of alcoholism exists, he has also shown that the desire for drink is no different than the desire to profess. From that position, Fingarette can feel free to promote his theory that if controlling one’s drinking is hard, then stopping completely is necessarily harder. It is not. (Most people in AA are horrified by the reports that surface every six months or so, which say alcoholics can, after all, return to social drinking. We have seen too many people try it and die. And it seems to me that there is a fatal flaw in Fingarette’s argument. If people who drink too much cannot face abstinence, then there is, after all, a serious and oppressive desire to drink.) AA offers a way of life in which “an enormous effort”40 at control is unnecessary. The thing about AA is that under its tutelage the unexplainable desire to drink equally unexplainably disappears. This happens because AA redirects the alcoholic’s attention. Controlled drinking focuses, as Fingarette does, upon alcohol. AA focuses upon the psychological difficulty that underlies the drinking. The Steps The first of the recommended steps invites an interpretation of the circumstances under which one initially comes to AA. It says, “We admitted we were powerless over alcohol, that our lives had become unmanageable.” It makes explicit that we would not have done so unless we had been unable, by the kinds of technique Fingarette recommends, to control our drinking. Most of us had tried control but had eventually gone back to our old drinking patterns. We found ourselves not only powerless to control the desire to drink, but also unable to control the disorder in our lives. The crazy soap opera parody, Mary Hartman, Mary Hartman was being broadcast during the last years of my drinking. It was what my family was like. My wife and daughter, also alcoholics, had each made suicide attempts. My students were petitioning that I not be allowed to teach required courses. A son was claiming he was being robbed on his newspaper route, but he was actually using the money to buy drugs. A

Wd., at 61-63. 391want to thank metabolism theory.

Patricia

Andrews

for pointing

aHeavy Drinking, supra note 3, at 19.

out Fingarette’s

missing

of the point about

the morphine

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psychiatrist had put me on Valium to deal with free-floating anxiety and a growing phobia about driving. I had thrown my wife out because of her drinking and, after she stopped, moved out because of mine. I had high blood pressure and lived in constant fear of a heart attack such as had killed my father. But I would collapse in anxiety if I heard mention of the subject. I was constantly angry. I had broken down doors and thrown dinner plates through the window when a kid had spilled his milk on the dining table. I took four martinis and a couple of Valium to recover from a typical faculty meeting. I felt driven and overwhelmed by life. Nothing that I could think to do seemed able to make things better, except to drink. Alcohol I thought, was my medicine.4’ This is the vision implied by the words I was invited to say, that I am powerless over alcohol, that my life is unmanageable. I was not demonstrating a commitment to the classic disease concept of alcoholism. And I was not brainwashed by AA. One might think, however, that I did mean to claim irresponsibility. Yet AA goes on to tell me to be responsible. The major part of the Twelve Steps is concerned with responsibility: first with recognizing and then confessing the wrongs we did while drinking (Steps Four and Five), then with trying to put ourselves in a position in which the habits that hurt ourselves and others can change (Steps Six and Seven), and, finally, with making a list of the people we have harmed and making amends to them (Steps Eight and Nine). Step Ten tells us to keep up such practices everyday and Twelve tells us to use our new found competence to help others. Eight of the twelve lead us step by step into real, practical responsibility taking. Six of the steps, however, do deal with things that seem inconsistent with responsibility taking, ideas like powerlessness and turning one’s will over to God. Is AA just a grab bag of inconsistent ideas? Fingarette thinks ~0.~~I think not. I think, rather, that the apparent inconsistency of the AA program confronts us with the conundrum of moral responsibility that I told you about. Do we have to be in control of our lives in order for responsibility to be appropriate? The character of the conflict can be represented by the views of Aristotle and John Calvin. Aristotle’s is the view most of us would find congenial.

411 have been fortunate in not having had to drink since I walked in the doors of AA. I do understand, however, something about what it is like to go back to an abandoned addiction, because more than once I returned to smoking after, in one case, three years of abstinence. I can still picture the beginning of one of those slips. I know right where 1 was when it happened, though it was nearly fifteen years ago. I was sitting in the couch in my living room, an ashtray and a pack of cigarettes on an end table next to me, the room lit by a single lamp. It was late at night, after bar closing time. My wife, with whom my relations were then very much strained, was in bed and asleep. I put, eventually, six lit cigarettes in my mouth simultaneously, so that I could fill my lungs with that poison all the faster, and then I opened up my fly and masturbated. Within days, 1 was back to smoking three packs of cigarettes a day. That rapid return to the old pattern is what AA means to convey by the idea that we do not recover from alcoholism; rather, we have a daily reprieve. It is lying there in wait for us. It may not be that the first drink will have irreversible consequences, but any first drink may set us off again and we may not get back afterwards. We have all seen that happen to people we know. Nothing about professing has ever brought me to such a pass. @‘AA’s teachings were derived from an amalgam of ideas that fit together only loosely. There are appeals to the alcoholics willpower as well as emphasis on his helplessness.” See Heavy Drinking, supra note 3, at 18.

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III. Aristotle and Calvin Aristotle did not see human action as covered by law-like regulation that appears to deny freedom. Making a choice was for Aristotle just what it seems to any ordinary introspective observer: a mental event undetermined by prior conditions. That doesn’t mean that Aristotle saw every action as free. His understanding is quite close to the law’s The law recognizes that freedom, and hence responsibility, may be qualified, for instance, by misunderstanding or duress. Aristotle also taught that fortune plays a part in our lives, perhaps through godly intervention. He doesn’t want to believe, however, that fortune determines whether we are virtuous and happy. He says, therefore, that it would be surprising if the most important thing in the world, happiness, were a gift of God, hence humanly fortuitous. He says that happiness is accessible to us by our own activity. And since for him happiness is consequent upon an active life of virtue, he agrees with Fingarette that virtue is also something we can choose. Aristotle recognized, however, that people - and alcoholics might have served him as an example-sometimes seem unable to choose virtue. Aristotle says we get into such a desperate position by freely elected earlier choices that have become habitual. Fingarette would agree, and there is a truth here, but also a major difficulty. The way we acquire virtue, Aristotle says, is by imitation. Performing the externals, however, he says does not constitute virtue. We aren’t really virtuous unless we enjoy being so. There is an interior component, the psychological posture in which our virtuous acts cause us to be happy-rather than, say, selfrighteous or resentful. The externals of virtue can be imitated without the internal state being achieved. Two children encouraged to practice virtuous acts may respond quite differently, one becoming genuinely virtuous, the other merely manipulative and pious. Aristotle can’t tell us what makes the difference. But if we don’t know that, the key to virtue is still missing. It is a real mystery, what puts a person over the threshold, so that he is willing to try the disciplines of virtue or sobriety. We alcoholics tend to view our reprieve as miraculous, because honest introspection discovers nothing we have done that would account for it. That mystery of how the sick become well also surfaces in the writings of St. Paul, particularly in Romans and Galatians. Paul’s radical critique of the law is an attack upon those who think, with Aristotle and Fingarette, that they can choose to escape the sickened will that falls into persistent self-destruction, that we can force our way into heaven or sobriety, virtue or health by following a body of rules. John Calvin carried these Christian reservations to Aristotelianism to a logical, if dismaying, conclusion. How can it be right to dole out rewards and punishments in an afterlife if whether we are saved or not is just something visited upon us? Calvin boldly asserts that it is not ours to justify; it is simply a fact: salvation is a free gift, and those not saved but punished are guilty and deserve it. That is hard to take. Yet is not Calvin simply forcing us to face what Aristotle brushed aside, that we do not seem to choose to get well, that it is a

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mystery why some do and others do not, and that it is futile to quibble over the justice of reality? But that is still not entirely satisfying. Countering the vision of a chain of cause and effect from which we cannot escape is the fact that, often at least, we feel free. Are we to deny the existence of the world, or of ourselves, or of freedom, or of alcoholism because our intellectual constructs seem to disconfirm them? Or are we to believe in what is there in front of us? On the other hand, though, and seeming to confirm the pessimism shared by Calvin and modern science, is the fact that the most important things -including that imperious desire to drink -seem beyond our power to control. Is it possible that the contradiction the intellect sees is not a contradiction psychologically, or that the appearance of uncontrollability is a delusion? Or is there a way in which we both have control and lack it? Agamemnon’s

Apology

Let me call your attention to a discussion in E. R. Dodd’s book, The Greeks apology to Achilles in the Iliad. As Homer tells it, it is a case in which responsibility was accepted for an act done in a dissociative state, one the Greeks thought of as a form of divine possession: and the Irrational. He spoke of Agamemnon’s

Let us start from that experience of divine temptation or infatuation to compensate himself for the loss of his own mistress by robbing Achilles of his. “Not I,” he declared afterwards, “not I was the cause of this act, but Zeus and my portion and the Erinys who walks in darkness: they it was who in the assembly put wild ate in my understanding, on that day when I arbitrarily took Achilles’ prize from him. So what could I do? Deity will always have its way.” By impatient modern readers these words of Agamemnon have sometimes been dismissed as a weak excuse or evasion of responsibility. But not, I think, by those who read carefully. An evasion of responsibility in the juridical sense the words certainly are not; for at the end of his speech Agamemnon offers compensation precisely on this ground- “But since I was blinded by ate and Zeus took away my understanding, I am willing to make my peace and give abundant compensation.” Had he acted of his own volition, he could not so easily admit himself in the wrong; as it is, he will pay for his acts. Juridically, his position would be the same in either case; for early Greek justice cared nothing for intent -it was the act that mattered. Nor was he dishonestly inventing a moral alibi; for the victim of his actions takes the same view of it a he does. “Father Zeus, great indeed are the atai thou givest to men. Else the son of Atreus would never have persisted in rousing the thumos in my chest, nor obstinately taken the girl against my will.” You may think that Achilles is here politely accepting a fiction, in order to save the High King’s face? But no: for already in Book 1, when Achilles is explaining the situation to Thetis, he speaks of Agamemnon’s behavior as his ate; and in Book 9 he exclaims, “let the son of Atreus go to his doom and not disturb (ate) which led Agamemnon

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me, for Zeus, the counselor took away his understanding.” It is Achilles’ view of the matter as much as Agamemnon’s; and in the famous words which introduce the story of the Wrath-“The plan of Zeus was fulfilled”- we have a strong hint that it was the poet’s view.43 Dodds would not have to work so hard to make his point if we did not automatically accept Aristotle’s view and reject Calvin’s. It seems self-evidently incoherent, simultaneously to believe and to behave as Agamemnon did. And yet when Dodds says that if Agamemnon had acted on his own volition he would have found it harder to take responsibility, it has the ring of truth. How could that be? That is our problem. A Model of the Psyche

I am going to offer a model of the psyche that would account for such a strange possibility. What I want to say is quite simple: The psyche has two parts or modes of operation.” For our purposes here, I shall call them mode a and mode b.45 When my head is working in what I am calling mode a I haven’t any consciousness of myself. Myself disappears. I am completely and literally absorbed in what I am doing. This might happen when I am writing a letter to a friend, or playing the piano, or concentrating on a difficult pool shot. Awareness of myself and conscious reasoning belong to life in mode b, as when I am asking myself what I should do next or wondering what someone will think of me. I think if you reflect a moment you will recognize from your own experience the difference between these two ways of being. Each mode works in a different way and has different attributes. Happiness and the experience of freedom belong to mode a, the unconsciously operating one, because they are felt rather than thought. When mode a is committed to a course of action (whether or not it is one we have also consciously thought about), we feel free, happy, and accept responsibility. When it is not (when the mind and will of b try to impose on a), we feel oppressed.&

43E. R. Dodds, The Greeks and the Irrational 2-3 (1951). MPerhaps a third, as well, but we can defer that question to another occasion. 4sSimilar divisions in the self are suggested by many writers. Besides the obvious psychoanalytic candidates, I mention Plato and Aristotle. Modern philosophy sees the self as fragmented, “a problematically yoked-together bundle of partly autonomous systems.” D. C. Dennett, Why Everyone is a Novelist, London Times Literary Supplement, September 16-22, 1988, 1016, 1028. Modern philosophy has a pre-commitment to the incoherence of the self, hence is uninterested in seeing what can be made of those systems. We can also mention that strange, but compelling work, The Origin of Consciousness in the Breakdown of the Bicameral Mind (1976), by Julian Jaynes. Recently, I have been reading Heinz Kohut, a psychoanalyst offering a nonFreudian two-part mental structure in The Restorafion of the Self (1977). And then there is the whole scientific and popular literature surrounding the so-called split brain, cases where one brain hemisphere is injured or where the corpus callosum has been severed. 1 do not think that the effort to make something of all the evidence and theory should be abandoned. Indeed, I think it a fruitful study and intend to pursue it with the goal of sorting out more and less plausible notions of the character and meaning of the divisions of the psyche. This is but a part of that enterprise. See also infra. note 46. 461 can describe the character and activity of the two modes only in a very rough way. None of the words one might at first choose is wholly satisfactory. For instance, it is not a matter simply of conscious/unconscious. Some of what goes on in b is unconscious. See S. Freud, Dissection of the Psychical Personality, New

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Particularly among Western men, the conscious reasoning of mode b commonly overrides and ignores mode a. 47 Because the self-aware ego in b, men seem to have a firmer sense of the boundaries of self than do women, whose sense of self has been called more diffuse, which is a way of saying women are more responsive to others. Mode b has a rhetoric, warranted by the tradition of Enlightenment, for overriding mode a- a rhetoric it also sometimes uses to disparage women. For instance, mode b can dismiss the movements of mode a as mere feeling, because mode a, being relatively inarticulate, usually presents its conclusions simply as inclinations to act. Maturity is self denial pursued under the guidance of ego and superego, tenderness towards one’s feelings infantile or regressive. 48Feeling, mode b tells us; belongs to body and not mind; the body is what we share with other animals, and is therefore not a fully human element in action taking; the action taking appropriate to rational beings is only that which arises out of conceptual self-awareness, which b calls mind. Mode a I suppose to be primary and continuously at work. That is, when we are in mode b the activity of mode a does not stop. The activity of mode b, however, is secondary and discontinuous. (The distinction roughly corresponds, I suppose, to Freud’s between primary and secondary processes.49) Lucien LevyBruhl’s work on tribal society describes people who live primarily in the a mode.jO They are indifferent to what seems to us as unacceptable intellectual confusion. They don’t like the categorical thinking that is the crowning achieveIntroductory Lectures on Psychoanalysis 57 (J. Strachey, trans.,

Norton Edition 1965). Moreover, mode a seems capable of presenting itself in categorical thought, even to resolve difficult analytical problems, but does not do so analytically. It is the seat of the capacity to translate its experience into language. (Professor Lewis R. (Lash) LaRue does his best to keep me honest on this matter.) But for all the difficulty of characterization, I am persuaded that there is a functional separation. I can say some other things about the a mode, which elsewhere I have called the arbiter. See W. Lehman, “How We Make Decisions” 71 (Institute for Legal Studies Occasional Paper, Ser. 1, No. 5 1986)). The arbiter was the description of mode a used to account for a series of facts: first, introspection seems unable to uncover the experience of making a decision, and the conscious mind seems unable to create a categorical model by which it happens; second, decision making has an affective or intentional element that categorical thought does not seem direct!y to create; and, third-an implication really of the first -general rules are not able to specify with certainty any particular. The last means that the arbiter or the b mode cannot fully account for a judge’s decision making. It was to understand judicial decision making that I initially took up this inquiry. See Lehman, “How To Interpret a Difficult Statute”, 1979 Wis.L.Rev. 489; Lehman, “Rules in Law”, 72 Ge0.L.J. 1571 (1984); W. Lehman, “How We make Decisions”, supra. What was needed was a capacity that somehow incorporated intentionality, an ability to respond to particulars, and an ability to translate between general and particular. And, 1 add, to do these things in the present, intending thereby to incorporate Bergson’s critique of Kant’s conceptual understanding of time. See H. Bergson, Zme and Freewill: An Essay on the Immediate Data of Consciousness (F. L. Pogson, trans., 1910). The capacity I called the arbiter is the site at which the apparent dualism of mind and body is transcended. 47See Carol Gilligan, In A Different Voice (1982); see also Lawerence Kohlberg, The Philosophy of Moral Development: The Nature and Validity of Moral Stages 338-61 (vol. 2, 1981). 4sEven the proponents of narcissism argue that a “progressive” reconciliation of the superego (which is narcissism’s internal critic) with the ego ideal (which embodies the narcissistic self conception) can only be achieved through hard work and postponing gratification. A reconciliation that he calls “regressive” is sometimes sought through “fusion with powers greater than the self.” F. Alford, Narcissism: Socrates, the

Frankfort School and Psychoanalytic Theory 60. (1988). @See S. Freud, The Unconscious, The Essentials of Psychoanalysis 159-60 (J. Strachey, trans., SOL. Levy-Bruhl, How Natives Think (L. Clare, trans., 1985).

1986).

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ment of the b mode.51 It is clear, therefore, that the b mode developed in history, and especially strongly in Western history. If we are constructed in the way I have suggested, it would explain why we may more readily accept responsibility for what we have done out of mode a, even when it is experiencing an emotional storm, than for what we do in mode b, even though it may seem fully thought out, self-conscious, and controlled. The problem is that taking actions out of mode b, in disregard of a, leaves mode a dissatisfied. If we do this consistently, we can become so painfully unhappy that we want to die.52 Most alcoholics want to die. If we do not make overt suicide attempts, the desire not to suffer a life run in that way produces continuous diffuse anxiety, or else anger and depression, for both of which alcohol is long an effective palliative. Consuming it is also an acting out of the unconfessed desire to die. While it relieves the pain, it produces, in unconsciousness, a simulacrum of the end sought, and hastens it by the damage it does to the body. An action dictated by b without obtaining a’s concurrence might not have proven distasteful to ~1,had it been consulted. We can make ourselves miserable doing things we would be content to do, had we invited 4’s exploration of them.53 Aristotle is right about the interior component of the life of virtue and that form alone is inadequate. The metaphor of modes encourages using computer analogies. The computer I write at has two kinds of memory. It shifts back and fourth between them without my knowing about it. That shift is described as user transparent. In the normal case, movement between the two modes of our self-government is also transparent. That transparency allows us to believe that there is a single, unproblematic self, located in consciousness. In our ordinary lives, the way in which mode a makes use of the conscious and categorical material from mode b cannot be seen. We think that our decisions are made in mode b because we often have been consciously thinking before we make them. The transition is transparent. It is only when we really try to catch up with them, try to find the events in which thoughts are digested into decisions, that the disjuncture comes to light and it is evident that something quieter, that we cannot readily see, has to be at work. The difficulty with the unproblematic conscious self is a subject of the most abstruse but fashionable post-modern thinking, such as that of RortyS4 DerridaSs and Dennett.56 Sartre’s notion of bad faith is another intimation of that difficulty; we understand in consciousness one motivation that is belied by

stFreud sounds as if he had read Levy-Bruhl when he says that: “The logical laws of thought do not apply in the Id, and this is true above all of the law of contradiction.” S. Freud, supra note 46, 73. szThis phenomenon is, 1 think, the same that Freud calls repression. See S. Freud, Repression, supra note 49 at 523ff. However, it is obvious that my account would differ in at least one significant respect, that the energy seeking to express itself does not come from such as Freud’s unmindful Id, but from an independently intelligent deciding capacity. Wee Lehman, supra note 11. Wee Rorty, supru note either 21 or 26? Wee Derrida, supru note 25. Wee Dennett, supru note 45.

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another, deeper one that troubles us vaguely, but which we do not allow to surface.” One of the hardest things in the world is to get out of a life dominated by b and return to one in which a is dominant and we, therefore, are happy. The problem is that the b mode, which is where we think and where we live when we are trying to exercise control, does not understand the a mode and cannot by its own methods get us into it. It tries by conscious thought, will, and action to do that which can only be done unconsciously, and which therefore depends upon faith in that inaccessible force. The only thing b can do is get out of the way. But it is threatening to consider venturing to the edge of the known world, and in the understanding of the b mode, beyond its horizons there is only a void, or, worse yet, sea serpents. I can return now to the matter of calling alcoholism a disease. What doing so does is relieve me of the otherwise unassuagable guilt I had for being unable, as step one says, to control- by the methods of mode b-my drinking or the life world around me. It is the a mode, out beyond the horizon of conscious control, that drinks away its sorrow at being ignored, and that is willing in its misery to pull the whole structure down in intimate Goetterdammerung. In Alcoholics Anonymous, I begin to recognize the impossibility of the life that I had accepted as my lot and duty. When I say that I have a disease, or that I am an alcoholic, I am admitting my human limitations. I admit that the kind of being I am is actually determined by a, though I had been persuaded that it is possible and better to live only in b. But if I, in mode b, admit my powerlessness, what am I to do to get well? Step 2 says that I came to believe that a power greater than myself could restore me to sanity. That power greater than myself, I say unto you, is mode a.ss AA allows me to think of its god in such terms. In fact, however, I prefer the traditional language. To speak in computer language is to pretend that there is no history to understanding the self in this way. But that is what religion is really about, pace Marx and Freud. I now understand how it happens that god is within, that I can love him and be loved by him, that he knows what is best for me, that I find freedom in obedience to him, why it is children that get into the kingdom of heaven, why it is by faith that I am saved, rather than works, and why I need to love myself before I can love others. And when I have encompassed Step 2, I must go on to Step 3, in which I actually turn my will and my life over to my higher power, mode a within me, and allow myself to act upon the inclinations I discover within, rather than upon the errant directives of my imperial consciousness. And when I do that, I become one integrated being, whole and entire, with no force at work in me that is pushing me away from the voice of my god, my self, my higher, inner power. And then I do not need to drink. And whatever I do is without regret. I am quite willing to take responsibility for it. I did it, whatever the result. No one else.

575. P. Sartre, Being and Norhingness 47-70 (H. Barnes, trans., 1956). ss“The superego is the Bible,” Grunberger says, “but narcissism is God Almighty.” Alford, supra note 48. at 55, quoting B. Grunberger, Narcissism: Psychoanalytic Essays, at 104.

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That is the discipline that AA teaches me. It is not an easy one, but not impossible either. There are now over a million people who follow it. There may be other kinds of alcohol problems that can be solved by the kind of less drastic measures that Fingarette recommends. I do not know. What I do know is that there are many of my kind, and that about us Fingarette is wrong and his recommendations destructive.