Recovery Despite "Grave Emotional or Mental Disorders"

As an individual who has experienced a lifetime of bouts with recurrent depression - one of the "grave mental and emotional disorders" referenced in the "How It Works" chapter of the 'Big Book' of Alcoholics Anonymous - but who has nevertheless attained and sustained long-term sobriety and freedom from alcoholic addiction, it is helpful (indeed necessary) for me to remember the nature of that illness. For this, the "Doctor's Opinion" in the 'Big Book' is the best place to start.

In Doctor Silkworth's statement enlarging upon his views about alcoholism, we are confirmed in "what we who have suffered alcoholic torture must believe - that the body of the alcoholic is quite as abnormal as the mind." Thus, while "the problem of the alcoholic centers in the mind" - as do other, primarily mental illnesses - it is important for me to recognize and remind myself of the strong physical component to alcoholic addiciton.

"It did not satisfy us," we read, "to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete."

If I had never drank alcohol, I wouldn't have become alcoholic, although that latent physical potentiality would still have been there. This does not mean, however, that I would never have suffered from depression. Looking back, with the help of friends, sponsors and therapists, it is clear that at times I treated my depression with the booze and drugs. However, looking at my family tree, it is equally clear that I, along with other family members, suffered from depression - some with additional battles against alcoholism, some without such struggles - irrespective of my alcoholism. Both diseases, I have found, have their biological bases, and their mental expressions are well known.

Thus, just as I seek treatment to guard against, and/ or ameliorate, chronic depression (which is a matter that is strictly between my doctors and myself), I must also remember that my alcoholic addiction requires treatment as well. That is why I continue to work the 12 Steps, attend meetings and try to help others work through the Steps.

Dr. Silkworth (and many doctors since) suggests "that the effect of alcohol on . . . chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve."

Looking back at my sixteen years of alcoholic addiction, three things happened the first time I got drunk, and the same three things happened the last time I got drunk: I lost my natural inhibitions and felt like an integral part of what was happening around me, I wanted more (and still more) of the booze and drugs that were making me feel that way, and I drank way more than I could stomach and eventually passed out. But in the midst of this, sometimes for just the briefest period, I felt elation. These effects were more or less present each time I drank, and accept for the puking out, passing out or, worse, blacking out, I drank for these effects. I craved more and more alcohol, and progressively drank more and more alcohol to attain the desired affect. And when sober, I could not wait to get high and drunk again. Such is the nature of my addiction.

I had one moment of clarity, which looking back I attribute to the grace of God, and that was sufficient to make the tentative first call for help which would lead me out of this alcoholic addiction. I work the 12 Steps to the best of my ability on a daily basis, so that I do not return to active addiction - ever.  I really do not know if I would have a "second chance" at recovery. And, I suspect not.

The added bonus is that working the Steps - living the spiritual way of life I have been taught in A.A. -  also helps me with the continuing threat that depression always poses, although, as mentioned, I do seek outside medical help for that supposedly "outside issue." For a while I attended meetings of Emotions Anonymous (one of A.A.'s many sister groups), where they used the Twelve Steps to deal with emotional and mental issues such as depression. I met people there who were getting great relief through working the Steps in that fellowship.

But, for me, an alcoholic addict in recovery, A.A. will always be home. All around me I see people just like me dealing with the same fears, overwrought desires and their struggles with everyday and once-in-a-lifetime occurrences, and I draw strength from their success, and knowledge from their experience which helps me in my life.

Over the years, I have boiled down the necessity of treating what are, in fact, two separate but related, and primarily mental illnesses (alcoholic addiction and depression) to the following: It is difficult and at times impossible for an unhealthy brain to entertain consistently healthy thought; therefore, I work with my doctor in assuring that my tendency to depression is kept in check. At the same time, it is still all too easy for a healthy brain to have some very unhealthy thoughts; therefore I work the 12 Steps, have a sponsor, and hang with individuals who are both working a program of recovery and have deep aspirations to increase and improve their conscious contact with a Power greater than themselves.

As a result, I have been the beneficiary of some great teachers and garnered invaluable insights into who I am as a person. And irrespective of what life brings to me, I have found (although it may not have seemed so at the time) that I can accept it all good and bad, whether it is the love my children have for me, or the loss of a woman I loved dearly, or any of the ups and downs that have happened in-between. I may not like what life brings, but that is not my call.

My imperative is to stay awake spiritually, to accept life as it is served to me, and to learn to accept it as it is, rather than plucking up false courage and unwisely battling things that are far beyond my ability to influence or control. My life remains unmanageable, and I accept that. Thank God, it is under better management than I could ever provide!

Grave Mental and Emotional Disorders: 'The AA Member, Medications & Other Drugs''

In the "How It Works" excerpt that is read to open so many A.A. meetings, we face the fact that many of us may "suffer from grave emotional and mental disorders, but many of (us) do recover if (we) have the capacity to be honest." As one who has suffered from such disorders, in sobriety, I am grateful that those words are there. And it is not surprising that they are there, considering that we know that "the main problem of the alcoholic centers in his mind." [Alcoholics Anonymous, page 23.]

I am also grateful that I have learned, and been shown in A.A., that an additional mental illness - in my instance depression - is no impediment to recovery if it is addressed realistically and soberly.

In fact, the doctors who I have seen to treat this additional "outside" problems have, in some instances, helped me to gain some of the greatest insights into my 'self' - which is, after all, the root cause of my alcoholism and addiction, as well as my depression. 

Indeed, I have been blessed to have a plentitude of what Bill called the "loving advisors" who helped steer him through his alcoholic addiction, as well as his own battles with chronic and lasting depression.

"Had I not been blessed with wise and loving advisers," Bill writes in the August 1961 Grapevine, "I might have cracked up long ago. A doctor once saved me from death by alcoholism because he obliged me to face up to the deadliness of that malady. Another doctor, a psychiatrist, later on helped me save my sanity because he led me to ferret out some of my deep-lying defects. From a clergyman I acquired the truthful principles by which we A.A.'s now try to live."

"But these precious friends did far more than supply me with professional skills. I learned that I could go to them with any problem whatsoever. Their wisdom and their integrity were mine for the asking."

"Many of my dearest A.A. friends have stood with me in exactly this same relation. Oftentimes they could help where others could not, simply because they were A.A.'s."

["As Bill Sees It," page 303.]

Rather than morosely seeing depression as a debilitating character defect, I have come to see it as a readily treatable condition - much like alcoholism - rather than as a moral feeling. Unlike alcoholism, however, my depression requires that I take medication on a daily basis. Like meditation and prayer - which, not uncoincidentally, are also very helpful in dealing with depression - the medication that I take is, for me, a necessity and not a crutch.

Having had the chance to share my experience in dealing with one of the "grave mental and emotional disorders" which others in the program also struggle with, I have found that reading and understanding our pamphlet on "The AA Member - Medications & Other Drugs" is invaluable.  I am not a doctor, and as just another 'alky' (albeit with a concurrent illness), I would not dream of sharing my "medical expertise" with an  alcoholic who is a fellow member of Alcoholics Anonymous.

Fortunately, the "Other Medications" pamphlet contains a report from a group of physicians in A.A. that the General Service Conference approved, presumably, for use in just such instances. At the beginning of the pamphlet it states the following:

"The experience of some A.A. members reveals that drug misuse can threaten the achievement and maintenance of sobriety."

"Yet some A.A. members must take prescribed medication in order to treat certain serious medical problems."

"Experience has shown that this problem can be minimized if the following suggestions are carefully heeded:

1. Remember that as a recovering alcoholic your automatic response will be to turn to chemical relief for uncomfortable feelings and to take more than the usual, prescribed amount. Look for nonchemical solutions for the aches and discomforts of everyday living.
2. Remember that the best safeguard against drug-related relapse is an active participation in the A.A. program of recovery.
3. No A.A. Member Plays Doctor.
4. Be completely honest with yourself and your physician regarding use of medication.
5. If in doubt, consult a physician with demonstrated experience in the treatment of alcoholism.
6. Be frank about your alcoholism with any physician or dentist you consult. Such confidence will be respected and is most helpful to the doctor.
7. Inform the physician at once if you experience side effects from prescribed drugs.
8. Consider consulting another doctor if a personal physician refuses or fails to recognize the peculiar susceptibility of alcoholics to sedatives, tranquilizers, and stimulants.
9. Give your doctor copies of this pamphlet.

"Because of the difficulties that many alcoholics have with drugs," the pamphlet continues (at page 13), "some members have taken the position that no one in A.A. should take any medication. While this position has undoubtedly prevented relapses for some, it has meant disaster for others."

"A.A. members and many of their physicians," it further continues, "have described situations in which depressed patients have been told by A.A.s to throw away the pills, only to have depression return with all its difficulties, sometimes resulting in suicide."

As a member who has come all-too-close to suicide in sobriety let me be brutally honest with you. If an A.A. member gives such advice to another member, he or she is self-centeredly playing with that person's life. If the advice is given to you - even by your sponsor - ignore it and talk to your doctor about it. If you hear another person giving such advice, intervene. You may save that person's life.

Remember, as the pamphlet stresses in capitals: No A.A. Member Plays Doctor!

But also remember that, thank God, there are many "wise and loving advisers" we can turn to - inside and outside the program for help with any of the difficulties we may face in life. We are "no longer alone," nor need we be.

From "Grave Mental and Emotional Disorders" to "Emotional Sobriety"

One of Bill W.'s most self-revelatory writings, a letter he wrote to a close friend who also suffered from bouts of depression, was published in the January 1958 issue of the Grapevine under the title "Emotional Sobriety: The Next Frontier." It's also published at page 236 in "The Language of the Heart," and is essential reading if you or anyone you know suffers, as I have done, from what Winston Churchill called "the black dog" of periodic depression.

In it, Bill notes that "many oldsters who have put our 'booze cure' to severe but successful tests still find that they often lack emotional sobriety. Perhaps," he suggests, "they will be the spearhead for the next major development in AA - the development of much more real maturity and balance (which is to say humility) in our relations with ourselves, with our fellows, and with God."

He continues:

"Those adolescent urges that so many of us have for top approval, perfect security, and perfect romance - urges quite appropriate to age seventeen - prove to be an impossible way of life when we are at age forty-seven or fifty-seven."

"Since AA began, I've taken immense wallops in all these areas because of my failure to grow up, emotionally and spiritually. God, how painful it is to keep demanding the impossible, and how very painful to discover, finally, that all along we have had the cart before the horse! Then comes the final agony of seeing how awfully wrong we have been, but still finding ourselves unable to get off the emotional merry-go-round."

"How to translate a right mental conviction into a right emotional result, and so into easy, happy, and good living - well, that's not only the neurotic's problem, it's the problem of life itself for all of us who have got to the point of real willingness to hew to the right principles in all our affairs."

"My basic flaw," Bill confesses, "had always been dependence - almost absoulute dependence - on people or circumstances to supply me with prestige, security and the like. Failing to get these things according to my perfectionist dreams and specifications, I had fought for them. And when defeat came, so did my depression."

Our stories, "before and after," we repeatedly hear in the "How It Works" reading, makes clear the idea that "we were alcoholic and could not manage our own lives." I have found that my dependence on being able to manage my life so that I received what I thought I needed as far as security, love and social standing with my fellows turned out, as it did for Bill, to end in crushing disappointments and the very real, grave and life-threatening onset of depression. However, when I have truly surrendered the management of life to the source that already controls it - surrendered life to life itself - I have found that my dependencies and my depression recede, and that I have those precious commodities I need to sustain me, the experience of a loving God-consciousness and the serenity of emotional sobriety.

This is not to say that the alcoholic addict who suffers or suspects he or she may suffer from depression should not see a medical professional. Quite the contrary. AA has "no opinion" on that issue, as is noted in "The A.A, Member and Other Medications," pamphlet. However, it must also be noted that our experience (as set out in the pamphlet) is that if a person requires medication and is not taking that medication, this may prevent him or her from having the spiritual awakening that is necessary to arrest his or her active addiction.

That being said, Bill notes that he found the beginning of a solution to his grave emotional problem with depression in realizing he could not be both dependent on others and reliant upon God to meet his true needs:

"Plainly," he observes, "I could not avail myself of God's love until I was able to offer it back to him by loving others as he would have me. And I couldn't possibly do that so long as I was victimized by false dependencies."

"For my dependency meant demand - a demand for the possession and control of the people and the conditions surrounding me."

In my instance, the problem and the results were the same. With the aid of appropriate medication (carefully prescribed and monitored by my doctor), and the admixture of the "self-examination, meditation and prayer," that was similarly recommended to me, I can truly let go of my dependency for people to conform with my ideas of how life should be 'managed,' and accede to the way that God manages life - all of life - and always has.

Of course, as it is recognized, I first had to be honest and willing to face the reality of how I had I subtly tried to manage life myself. This was the honesty and humility I needed to cope with depresssion - a "grave mental and emotional disorder" which can be overcome if I manifest my God-given capacity to be honest with myself.