As a brief postscript to my article in Public Square Magazine, I thought I’d tell a little story that illustrates humility coming from a world renowned therapist. Since I complained in that article that sometimes therapists can be narcissistic by seeing every problem as treatable through acting more therapeutically, I thought I’d provide a fascinating historical counterexample.
It’s useful to share this story because, while it may not be apparent to outsiders, therapists and twelve step addiction recovery programs sometimes have a rocky relationship. It isn’t always the case, many therapists recommend (and may even require) attending a twelve step group as a valuable part of their therapeutic recovery process. (I’m one of them, for certain cases at least.) But why do some therapists have a problem with twelve step?
The short answer is: too much God, and not enough graduate degrees. The longer answer is they feel it lacks scientific support, that modern treatment models are superior, and that the free program costs too much money. This last complaint is a bit of a head-scratcher, but we’ll briefly touch on the other two at the end of the piece. Before we do that, let’s tell a fascinating story about Carl Jung and the founding of Alcoholics Anonymous that you may not have heard before.
I read this story in the fine book, The War of the Gods in Addiction by poet and social worker David E. Shoen. I was recommended this book by a friend in recovery who said it was his favorite book about the twelve steps. It also tells the story I never knew before, of the pivotal role Carl Jung played in the founding of Alcoholics Anonymous. (Carl Jung was originally a protégé of Sigmund Freud before they parted ways.)
In the early 1920s, one if his former patients by the name of Rowland Hazard reached out to Jung for help again after a particularly nasty relapse into his alcoholism. Let me let Bill W[ilson], the founder of Alcoholics Anonymous, pick up the tale from there:
First of all, you frankly told him of his hopelessness, so far as any further medical or psychiatric treatment might be concerned. This candid and humble statement of yours was beyond doubt the first foundation stone upon which our Society has since been built…
When he then asked you if there was any other hope, you told him that there might be, provided he could become the subject of a spiritual or religious experience—in short, a genuine conversion. You pointed out how such an experience, if brought about, might remotivate him when nothing else could… [though even then] they were… comparatively rare. You recommended that he place himself in a religious atmosphere and hope for the best.p. 10. (Emphasis added because here we have a humble therapist!)
From there, Rowland affiliated himself with an evangelical group known as the Oxford Group, and got sober. He helped another friend, Ebby T., get sober. Ebby T. in turn ran into an old friend, Bill Wilson, a stock speculator and raging alcoholic. Fast forward to Bill W.’s powerful conversion experience:
…In utter despair, I cried out, “If there be a God, will He show Himself.” There immediately came to me an illumination of enormous impact and dimension… My release from the alcohol obsession was immediate…
In the wake of my spiritual experience, there came a vision of a society of alcoholics, each… transmitting his experience to the next—chain style. If each sufferer were to carry the news of the scientific hopelessness of alcoholism to each new prospect, he might lay the every newcomer wide open to transforming spiritual experience.p. 11-12
That bit about “scientific hopelessness” must also grate on some of my colleagues, because one of the axioms of the religion of scientism is that nothing is outside the realm of study and improvement by the methods of modern science. Bill W. and Jung knew differently. But we can also ask, has anything changed in the intervening hundred years, or is it still “scientifically hopeless”? I’d like to think things are better with science now, but it’s actually quite a complicated question. Comparative outcome research is an extremely difficult research endeavor in mental health for a number of reasons. Two of the big ones are the difficulty of standardizing treatment (how do you ensure each person in the treatment arm gets identical treatment?) and spontaneous remission.
Spontaneous remission refers to the scientifically inconvenient tendency of most people to get better on their own, without any treatment or therapy at all. (This fact also makes some clinicians mad.) For example, one meta analysis claims that up to 53% of incidents of untreated major depression resolve themselves within 12 months. This is about the same as medications through up to 12 weeks (after which they do worse than nothing, on average), and only slightly better than a placebo medication. And talk therapy is only about ten points more effective than spontaneous remission (source).
Addiction recovery outcome research is even harder to standardize and compare, but even for depression all the statistics I quoted in the prior paragraph are hotly disputed.
So while we could delve into the data, the short answer is that it isn’t clear that any treatments are clearly superior to twelve step treatments. As part of my training, I attended several different twelve step meetings, and thoroughly enjoyed every single one of them. I particularly appreciated the hard-won wisdom and frank, no-BS attitude you often heard from the grizzled veterans of addiction.
Living for a time outside of Utah and not being a drinker, I would often have a recovering alcoholic sidle up to me at parties or gatherings and ask me if I was a “friend of Bill.” I was always flattered, but in the interest of honesty, I had to say, “no, but I am a friend of friends of Bill.” I would often end up at the “friend of Bill” table during lunches and company parties, and they were always the best tables to be at.
So while it’s still an open question if there are superior addiction treatment models to the twelve steps, there is another reason I think these modern methods lack power. And it’s something else Bill W. and Carl Jung understood that we too often miss in the behavioral sciences. That is our frequent refusal to admit the existence of objective, personified evil. How often do we hear someone commit an atrocity and we say, “that person is sick.” Carl Jung knew different, as he wrote in his reply to Bill W.:
I am strongly convinced that the evil principle prevailing in this world leads the unrecognized spiritual need into perdition if it is not counteracted either by real religious insight or by the protective wall of human community. An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil, which is called very aptly the Devil. But the use of such words arouses so many mistakes that one can only keep aloof from them as much as possible…
You see, “alcohol” in Latin is spiritus and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is spiritus contra spiritum [“spirit against spirit”]…
“As the hard panteth after the water brooks, so panteth my soul after thee, O God.” (Psalm 42,1)p. 19-20
So while we often hear about Christianity’s “problem of evil,” I happen to think the behavioral sciences “problem of evil” is even more severe, in daily practical effect.
From my perspective, “spontaneous remission” doesn’t do justice to what is happening here. This is probably just me, but I think we could better call it, “the grace of God, combined with hope.” Or as the friendly chant goes at the end of every twelve step meeting I ever attended, “it works if you work it, so work it cause you’re worth it.”