A really beautiful and serious thing

[Guest ASchwartz]

Hi Claire and JP and everyone,

I never heard of "two hatter" either and thank you for the clarification. I also agree that there is no such thing as a stupid question.

I guess you all know that addiction in the medical field is rampant and there are books and articles on this topic. Medical Doctors have all the drugs available to them and so do nurses. However, psychologists, social workers and other health professionals are not immune. Now, there are programs available for doctors and nurses to get help without losing their licenses. I am not sure about psychologists and social workers and other health professionals.

Allan:)

[John Rutledge]

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[Nightwatch]

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[JulianP]

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[Nightwatch]

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[Guest ASchwartz]

Hi JP and Claire,

Inadvertently, and I do believe it is 100% inadvertent, those responses are being interpreted by some of us in a way that is quite similar to being told, "The people who have reported positive benefits of AA are more valid to me than you or others who have had negative experiences" and I am therefore discounting your claims and continuing to refer patients and not include any consideration for possible abuse,...

Excellent post. You "hit the nail on its proverbial head." Speaking for myself ( I cannot speak for Mark but suspect he would agree), I do not invalidate your experiences. I do not even think of them as "claims" because I know they are accurate. I know you read my article about communication and its problems and that is just what I was trying to point out, how, in a debate, it is very easy to feel dimissed and invalidated.

Just to clarify, I do not refer people to AA. In fact, I am retired from active private practice and no longer work for any agencies. Except for this, I am retired. However, it is true that I did suggest AA to a few people over the years. Among those I suggested it to, most refused and a few did not have such good experiences, either. Most of my experience was with AA people who found their way to me. That was when I was in New York City and one person found me on the Internet and then started to suggest me to other AA members. Most came to see me, stayed in psychotherapy and we worked together for years. They have moved on to their full lives and I am retired. By the way, I saw these people at extremely very low fees. That was my choice and no regrets. It worked out well.

Claire, what a great way to put it: Feeling something like the "Elephant Man." Sorry, I never intended for your, JP, JR, Mike or all the others, to feel that way. I am sure Mark would agree.

Could some of you explain, in some detail and without violating anyone's privacy, some specific incidents of the types of abuse you witnessed or suffered at AA? If not, I understand.

Allan

[John Rutledge]

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[JulianP]

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[Nightwatch]

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[JulianP]

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[Mark]

This thread moves too quickly for me to keep up

Julian - your post about misunderstandings was right on, as others have pointed out. Allan and I are not trying to judge or dismiss, but it is easy to see us as judging, dismissive figures, I think, in part because of our professions and the various transferences that go with that.

Claire's image of the Elephant Man is very vivid and painful. It suggests to me the great difficulty - the wounds that have been sustained in the process of "graduation" from AA which those active here in this thread have experienced. In order to break away (after whatever early support's beneficial aspect was done), it was necessary to become very lonely and to go against the prevaling wind. Many people telling you that you were wrong, and only yourself to trust that you were doing right. And - this coming from people who have had reason to not feel confident in trusting their instincts, coming out of a program which makes no bones about its rejection of trusting instincts. So it is a kind of bloody bruising victory that has been achieved, and a lonely one. I get that - or at least that is how I think it must be - not having experienced it directly (in this format - I've had to do my own breaking away in my own life in different circumstances and can relate a little bit).

I see this as a kind of development of identity - an assertion of identity in the face of pressure to not do that. This kind of thing always reminds me of my favorite developmental theorist - Robert Kegan. I recommend that those of you here who are active please read my essay about Kegan's book "the evolving self" - and pay careful attention to the transitions he describes between stages of identity and how the process of emerging from one consciousness into another works - a process of disembedding yourself and becoming more objective about it - and the blowback you get from others around you who can't understand what is happening.

[JulianP]

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[Nightwatch]

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[Mark]

Isn't the point of treatment supposed to be to help people get healthy

That depends on the stage where the person is at re: their problem. Sometimes healthy is defined as "still alive", and other times it is defined as "independent". When someone is in dire trouble, and cannot self-regulate, it is good to put them into an environment where others will help regulate them. Then later on, when external regulation is not as necessary, that same regulation environment may get in the way of progress and maturity if it does not get out of the way.

In my view, AA seems to be best at the former task (of providing external guidance and containment when it is needed), and worst at the latter (getting out of the way when no longer needed).

I feel compelled to say that I had no early support or benefits of treatment or AA.

That's fair, but I know that other people here have reported that it was helpful initially. Individual experiences will vary.

I wasn't sure from your comments whether you are suggesting that the passion some of us have for this issue is somehow pathological.

I do think that there is a level of mild paranoia-esque overgeneralization happening here inasmuch as a number of commenters here have painted Allan and I with a fairly broad brush - representing us as being hostile/dismissive when we are not. It is widely sensed, I believe, that we are looking to judge/condem and we are not. I do think that the level of anger on display here is frequently counterproductive. I do not think that the criticisms are unfounded though or inappropriate (except in as much as they get to be overly repetitious). Edited June 21, 2009 by Mark

[Ray Smith]

Ray, This is ultimately a matter of social skills, I think. You seem unable to recognize when it is time to stop, and that makes it hard for me to like you. I'd like to like you, but listening to you repeat yourself is wearing. Interpret it how you will - I'm fairly sure it will not be flattering, because it does seem that you need me more as something to resist against than as a person who could be a friend - but - it's time to stop at least as far as I'm concerned.

Mark,

Over the years that I've been reading & posting here, your views on AA appear to have softened, and I've commented on that here and elsewhere. You've gone from thinking there was one extremely angry poster using several names to understanding that there are many people with legitimate gripes, but you still don't seem to have an understanding of what AA can do to people with mental illness.

Your comment on my social skills was tactless, and I got the distinct impression that you were talking down to me.

Like the others that have been posting here, I often don't think I'm being heard. When I am not being heard, I repeat myself and when people still don't hear what I saying, I raise my voice. That has nothing to do with social skills, it has more to do with years of frustration with professionals dismissing what I have to say, or more importantly, dismissing me as some sort of crank. I had to learn to be assertive with people that pushed and prodded me towards ineffective and damaging treatment, and now I do the same for this generation of dually diagnosed people. I hammer out posts filled with facts & figures, stats & studies that go by largely ignored here.

I'm not here to fight you, I've been posting here to try to get you (and now Dr. Schwartz) to examine what you are telling vulnerable people. That's sort of what I do in my job as a Peer Specialist, I act as a bridge between the clients and the professionals, I have a foot in both worlds. The professionals I work with value what I have to say and my ability to reach clients.

Perhaps you still don't understand what I and many others had to go through to find any type of help that was not 12step. Casually mentioning that there are other groups out there doesn't help unless there are meetings in the area. People quit drugs and alcohol only when they find the motivation to quit. Sending people to AA is essentially a crap shoot, helping a person find his or her own motivation is not only statistically best alcohol/drug treatment option available today, it does not have the level of potential harm of 12step programs. Why would anyone send someone with anxiety, depression, or self esteem issues to a fear based program that demands ego deflation?

The AA meetings held outside hospitals and suburbia, the kind of meetings that most people with coexisting mental health and substance abuse disorders are nothing like the the AA you and Dr. Schwartz describe.

I work with clients who are diagnosed with moderate to severe mental illness. The "external guidance" that they get in the rooms is that doctors and mental heal professionals don't know anything about being an alcoholic and that they need to throw their medications away, if they work the program properly and do not drink, they won't need therapy and medication. They are pushed into believing that they are alcoholics or addicts despite not meeting the DSM-IV standards of dependence. Few of my clients do, almost all are either self medicating or attempting to fit in with their limited social circle.

Dr. Schwartz's experience with AA members seeking psychoanalysis sounds like it must have been an upscale meeting, my clients live on Medicare and Medicaid, they cannot afford to seek outside help. And the people Dr. Schwartz describes seeing were part of the small percentage of people who were successful in AA.

The clients I have go to AA and respond to the love-bombing that newcomers experience. ("We'll love you until you can love yourself!") When their mental illness become known though self disclosure or when they become symptomatic, they are shunned by most and become targets for others. Even if dually diagnosed people are warned about predators in the rooms, most do not have the social awareness to differentiate. Most are socially isolated and have never developed the type of skills necessary to navigate dangerous situations. They are easily swayed by those they believe to be friends and by those who represent authority, but when push comes to shove, which will they believe?

You wanted a testimonial?:

One of my former clients was mandated by the court to attend AA. Three or four times a year, the voices would get so bad he would drink in order to pass out. His neighbors would complain about him yelling in night, the police would show up and because he had been drinking every time the police showed up, it was assumed he was an alcoholic. He was a big, scary man in the middle of a psychotic episode, the police were never gentle.

He gravitated towards the other mandated outcasts in the rooms. Because he had a monthly disability check, he was a popular man with the chronic relapsers. He was told he was an alcoholic and believed it, he started really drinking. He stopped showing up regularly for mental health services. It's difficult to compete when a person's "friends" see him all through the week and we were lucky if we could find him for an hour or two.

He met a woman who was also mandated. She had been a prostitute but she never charged him, he thought that proved she loved him, he called her his girlfriend. She quickly introduced him to crack. The two of them would smoke his disability check and she would disappear until he was due for the next one. No drugs or money were found in the room he died in, but the autopsy showed a massive amount of cocaine in his system. He was younger and healthier than me.

Thank goodness that in the real world the mental health field is moving away from the 12step model, to find professionals on a mental health website still unaware of the problems with it is disheartening.

[JulianP]

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[Nightwatch]

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[Guest ASchwartz]

Hi Claire, Ray Smith and JP,

Claire:

I know that I have written that some AA members referred one another to me quite a few years ago. In that situation, they and their sponsors ended up in my office. All of them recognized the fact that they needed psychological help above and beyond what AA could provide.

It has made me wonder if the problem is that the AA chapters vary widely across the nation. I know very well that there are old timers in AA who are extremely conservative, like the very rigid orthodox priests and rabbis found in the various religions. Despite the fact that I have been told that meetings do not vary, my sense is that the sub groups, outside of the meetings, and the various sponsors, vary a great deal. It seems that you and many others were stuck with the very orthodox guys instead of more enlightened and psychological "savvy" people.

This may be a partial explanation for the wide divergence of views and experiences with regard to AA. Even outside of the particular chapter that sort of connected itself to me, there were other people, from very different chapters, who found me because they were seeking psychotherapy. One of them was a thirty year veteran of AA.

My point is that, again, this may explain some of our divergent views. I certainly appreciate and am even angered by the fact that some "Jerk" in AA attempted to discourage psychotherapy. Ridiculous.

Ray Smith and JP:

Sorry, but I do not see psychotherapists moving away from AA or from 12 step programs. I also cannot imagine any Competent psychotherapists dismissing patient complaints about AA or complaints about anything. In fact, I would advise anyone who sees a therapist who discounts their complaints about anything to go and find a new therapist.

Sorry, Ray, but I did not do psychoanalysis with the AA people I have discussed. I charge and received amazingly low fees, I really mean a few dollars because they were down and out and it was all they could afford. These were people who had, during their addiction, become homeless, some had been in prison for a long time, etc. No, these were not "wealthy people" they just wanted to put their lives together again. Perhaps it is New York City, where people are more knowledgeable about psychotherapy than elsewhere. I have lived all across this nation of ours and I believe i am right about that.

So, sorry Ray, no, this was not psychoanalysis, not even remotely. It was supportive psychodynamic therapy and they got a lot out of it.

JP, no one is telling to give up "your story." At the end of your last post you wrote "That is my story and I'm sticking to it." Fine, no one is asking you not to and neither Mark nor myself seem to be able to make any of you undestand that we are NOT dismissing your complaints, observations or experiences. However, this goes both ways: Whether it is Ray, Claire, JP, JR or anyone else, stop trying to minimze, reduce and ridicule my very real experiences and observations. I do not mind dialogue but I am muchly bothered by the defensiveness.

Allan

Edited June 22, 2009 by ASchwartz

[JulianP]

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[xenophon]

Well, if there is to be any progress in the matter of substance abuse treatment, there must be movement away from 12 step. I realize that inertia is a problem. But, someone has to get moving. Otherwise, we will continue to get more of the same.

"If you are satisfied with the results you have been getting, keep doing what you have been doing."

Under present day conditions, I cannot, with honor, recommend what passes for substance abuse 'treatment'. I must, as a matter of calculated risk, counsel do it yourself. I am not a luddite.

I do not expect substantive change in the present day conditions of substance abuse 'treatment'. Perhaps, one day, it may. But, I doubt that I will live to see any improvement. That is my view of it.

[Nightwatch]

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[Ray Smith]

Whether it is Ray, Claire, JP, JR or anyone else, stop trying to minimze, reduce and ridicule my very real experiences and observations. I do not mind dialogue but I am muchly bothered by the defensiveness.

Allan

Don't you think we feel the same way? I have been shouted down, ridiculed, deserted by family, and suffered many threats of physical violence for questioning AA since 1983. And I do mean questioning, I wasn't a hard line, AA critical person until a few years ago.

Now I'm involved with several 'alternative' recovery and AA-critical email groups, totaling thousands of members. A person wanting to join one today said, "I am sick of having my self-esteem trampled on by AA." That after 16 years of on and off attendance.

But anecdotal evidence proves little for either side, they are testimonials and not necessarily representative of a typical experience.

Over 60% of new AA members arrive under some sort of mandate, 95% of all new members leave within the first year. What does that say about a program that claims to be founded on "attraction rather than promotion"? The system as it now stands is cranking out a vast number of disgruntled ex-members for every member it manages to keep.

I, too, know people who swear that AA has kept them sober, but when you look at the numbers, the dropout rate, the relapses, the mortality rate, at what point do you question? You can't judge a flawed program by its handful of successes. People deserve better than being told they have a life long disease that they are powerless over. Instead of praying to God to remove the symptoms of their disease one fearful day at a time, they should be encouraged and motivated to make healthier choices. And that is happening in the mental health field more and more each day.

When a treatment method fails scientific scrutiny, new treatment methods need to be explored, evidence-based methods.

[xenophon]

I just think that it is unfortunate that people get caught up in all that. AA is full of drama, defeatism, one downmanship, etc etc. The AA that I saw was a can't do attitude, velied death threats, condescension and arrogance.

No thank you. I am better off doing it myself. And, I was. I did do it myself and I am proud that I had the strength, courage and determination to remake my life after a lot of adversity. It is no fun for everyone you cared about die. And, to have your wife die at 630 am on a sunday morning, and to be the only witness. And, AA tried to tell me what I could not do? ha.

Thanks -- but no thanks aa.

It is far past time to do better. I am 63 -- I am sure that I will not live to see any improvement.

[John Rutledge]

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[xenophon]

As someone who solved the problem on his own, I do not matter. If I can do it on my own, I did not really have a problem. So, this is from someone who cannot be taken seriously -- substance abuse treatment is a disaster. And, I doubt very many people actually care.

I, for one, think that all that is unfortunate. But, I do not matter.