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Harry Tiebout: The Collected Writings
This collection of writings by Harry Tiebout, one of the first psychiatrists to describe alcoholism as a disease, are seminal documents in the history, treatment, and understanding of alcoholism.One of the first psychiatrists to describe alcoholism as a disease rather than a moral failing or criminal activity, Harry M. Tiebout was also one of the first to wholeheartedly endorse Alcoholics Anonymous as an effective force in the struggle against compulsive drinking. This volume brings together, for the first time, some of Tiebout's most influential writings. Many of these pieces--from explorations of the therapeutic approach to alcoholism to instructive discussions of the act of surrender so crucial to recovery--are seminal documents in the history, treatment, and understanding of alcoholism. Together, they represent the significant contribution of one man to the countless lives shaken by alcoholism and steadied with the help of Alcoholics Anonymous, psychiatric intervention, and the foresight and commitment of doctors like Harry Tiebout.
- GenresPsychology
148 pages, Kindle Edition
First published September 23, 1999
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Displaying 1 - 5 of 5 reviews
August 21, 2019
Powerful book that gets to the root of the human process of addiction and being stuck in a dysfunctional belief system. While the book explores this primarily through the lens of alcoholism, in my opinion this applies to any and all human self-deception and unconscious drives.
The following are my favorite excerpts:
The Act of Surrender
With respect to the act of surrender, let me emphasize this point: It is an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her unconscious mind becomes involved in a certain set of circumstances. Then the act of surrender can be anticipated with considerable accuracy, as I shall soon show.
Internal Qualities
What are the qualities in a patient’s nature that make him put up such a battle before finally surrendering? …The two qualities that Sillman selected as characteristics – defiant individuality and grandiosity – may very well explain that the alcoholic is typically resistant to the point of being unreasonable and stubborn about seeking help or being able to accept help even when he or she seeks it. Defiant individuality and grandiosity operate in the unconscious layers of the mind, and their influence must be understood if one is to see what probably goes on at a time of surrender.
Defiance
Defiance may be defined as a quality that permits an individual to snap his fingers in the face of reality and live on unperturbed. It has two special values for handling life situations. In the first place, defiance, certainly with alcoholics, is a surprisingly effective tool for managing anxiety or reality, both of which are so often a source of anxiety. If you defy a fact and say it is not so and can succeed in doing so unconsciously, you can drink to the day of your death, forever denying the imminence of that fate. As one patient phrased it, “My defiance was a cloak of armor.” And so it was a most trustworthy shield against the truth and all its pressures.
In the second place, defiance masquerades as a very real and reliable source of inner strength and self-confidence, since it says in essence, “Nothing can happen to me because I can and do defy it.” With people who meet reality on this basis, life is always a battle, with the spoils going to the strong. Much can be said in favor of defiance as a method of meeting life. It is the main resource of the chin-up and unafraid type of adjustment and, as a temporary measure, it helps people over many rough spots.
Grandiosity
Grandiosity, the second quality noted by Sillmann, permeates widely throughout the reactions of the alcoholic. Differing from defiance – which seems almost uniquely structuralized in the psyche of the alcoholic – grandiosity springs from the persisting infantile ego. As in other neurotic states, grandiosity characteristically fills a person with feelings of omnipotence, demands for direct gratification of wishes, and a proneness to interpret frustration as evidence of rejection and lack of love.
Defiance and Grandiosity at work in the Alcoholic
We are now in a position to discuss how these qualities operate in alcoholics. On the one side, the defiance says, “It is not true that I can’t manage drinking.” On the other side, the facts speak loudly and with increasing insistence to the contrary. Again, on the one side, grandiosity claims, “There is nothing I cannot master and control.” And, on the other side, the facts demonstrate unmistakably the opposite. The dilemma of the alcoholic is now obvious: the unconscious mind rejects – through its capacity for defiance and grandiosity – what the conscious mind perceives. Hence, realistically, the individual is frightened by his or her drinking and at the same time is prevented from doing anything about it by the unconscious activity that can and does ignore or override the conscious mind.
External Circumstances
What were the circumstances that made the patient give in and sign that card? [Signing that he is checking himself into a rehab facility] Let me review them for you briefly. He had been drinking for years, and he knew his drinking was getting worse in the eyes of his family and friends. However, he knew that his condition had reached the point where both his wife and his business associates were leaving him and thereby withdrawing their support and protection.
He was threatened with the task of managing himself and his condition entirely on his own, so he sought my help and protection to dry him out and thus allow him once more to resume his role of successful defiance and grandiosity. This time, however, I refused to follow my previous role. …When I told him, in essence, that he was not running his case or me anymore, his last prop was thus removed. He had no place to take his defiance and his grandiosity; nor could he become defiant with me: someone who stood for his last bit of hope and who actually had become established as an ultimate resource when he was in difficulty. So he staged a brief inward debate and then signed the card. The act of surrender had occurred.
In short, the patient signed the card, first, when all support was withdrawn; second, when he could not in anger defy those who withdraw their support because he knew they had been patient and long-suffering; and third, when he found himself desperately needing help and had no grandiose ideas left about being able to drink like nonalcoholics. He had neither unconscious defiance nor grandiosity left to fight with. He was licked, and he both knew it and felt it.
The Difference between Submission and Surrender
...In submission, an individual accepts reality consciously but not unconsciously. He accepts as a practical fact that he cannot at that moment conquer reality, but lurking in his unconscious is the feeling, 'There'll come a day' -- which implies no real acceptance and demonstrates conclusively that the struggle is still going on. With submission, which at best is a superficial yielding, tension continues.
When an individual surrenders, the ability to accept reality functions on the unconscious level, and there is no residual of battle, and relaxation ensues with freedom from strain and conflict. In fact, it is perfectly possible to ascertain to what extent the acceptance of reality is on the unconscious level by the degree of relaxation which develops. The greater the relaxation, the greater is the inner acceptance of reality.
We can now be more precise in our definition of an act of surrender. It is to be viewed as a moment when the unconscious forces of defiance and grandiosity actually cease to function effectively. When that happens, the individual is wide open to reality; he or she can listen and learn without conflict and fighting back. He or she is receptive to life, not antagonistic. The person sense a feeling of relatedness and at-oneness that becomes the source of an inner peace and serenity, the possession of which frees the individual from the compulsion to drink. In other words, an act of surrender is an occasion wherein the individual no longer fights life, but accepts it.
Having defined an act of surrender as a moment of accepting reality on the unconscious level, it is now possible to define the emotional state of surrender as a state in which there is a persisting capacity to accept reality.
…He had a typical surrender experience, followed by a typical positive aftermath. But I also saw that the change did not last and that, after several months in which the patient had lived in a state of surrender, he slowly reverted to his former attitudes and ways of feeling. In other words, the surrender reaction did not fix itself into his personality and thus allowed the return of his previous state of mind.
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Another significant emphasis in AA was humility and “hitting bottom,” completely new points of emphasis for me. It was clear that if an individual remained stiff-necked, he would continue to drink. Finally the presence of an apparently unconquerable ego became evident. It was this ego that had to become humble. Then the role of hitting bottom, which means reaching a feeling of personal helplessness, began to be clear. It was this process that produced in the ego an awareness of vulnerability, initiating the positive phase. In hitting bottom the ego becomes tractable and is ready for humility. The conversion experience has started.
…I realized that hitting bottom is ineffectual if not followed by a surrender. Hitting bottom must produce a result, and this result is surrender.
Unless the unconscious has within it the capacity to accept, the conscious mind can only tell itself that it should accept, but by so doing it cannot bring about acceptance in the unconscious, which continues with its own non-accepting and resenting attitudes. The result is a house divided against itself: The conscious mind sees all the reasons for acceptance while the unconscious mind says, “But I won’t accept!” Wholehearted acceptance under such conditions is impossible. Experience has proved that in the alcoholic a halfhearted reaction does not maintain sobriety for very long. The inner doubts all too soon take over. The alcoholic who stays “dry” must be wholehearted. Here we meet a complication. People accept the necessity of being wholehearted about alcoholism but not about everything else. They are determined to maintain their capacity for resistance. They fear the fact that if they become total acceptors they will have no ability whatsoever to resist and will become “pushovers”.
…Four elements are recognized as playing an essential role: hitting bottom, surrender, ego reduction, and maintenance of humility.
The following are my favorite excerpts:
The Act of Surrender
With respect to the act of surrender, let me emphasize this point: It is an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her unconscious mind becomes involved in a certain set of circumstances. Then the act of surrender can be anticipated with considerable accuracy, as I shall soon show.
Internal Qualities
What are the qualities in a patient’s nature that make him put up such a battle before finally surrendering? …The two qualities that Sillman selected as characteristics – defiant individuality and grandiosity – may very well explain that the alcoholic is typically resistant to the point of being unreasonable and stubborn about seeking help or being able to accept help even when he or she seeks it. Defiant individuality and grandiosity operate in the unconscious layers of the mind, and their influence must be understood if one is to see what probably goes on at a time of surrender.
Defiance
Defiance may be defined as a quality that permits an individual to snap his fingers in the face of reality and live on unperturbed. It has two special values for handling life situations. In the first place, defiance, certainly with alcoholics, is a surprisingly effective tool for managing anxiety or reality, both of which are so often a source of anxiety. If you defy a fact and say it is not so and can succeed in doing so unconsciously, you can drink to the day of your death, forever denying the imminence of that fate. As one patient phrased it, “My defiance was a cloak of armor.” And so it was a most trustworthy shield against the truth and all its pressures.
In the second place, defiance masquerades as a very real and reliable source of inner strength and self-confidence, since it says in essence, “Nothing can happen to me because I can and do defy it.” With people who meet reality on this basis, life is always a battle, with the spoils going to the strong. Much can be said in favor of defiance as a method of meeting life. It is the main resource of the chin-up and unafraid type of adjustment and, as a temporary measure, it helps people over many rough spots.
Grandiosity
Grandiosity, the second quality noted by Sillmann, permeates widely throughout the reactions of the alcoholic. Differing from defiance – which seems almost uniquely structuralized in the psyche of the alcoholic – grandiosity springs from the persisting infantile ego. As in other neurotic states, grandiosity characteristically fills a person with feelings of omnipotence, demands for direct gratification of wishes, and a proneness to interpret frustration as evidence of rejection and lack of love.
Defiance and Grandiosity at work in the Alcoholic
We are now in a position to discuss how these qualities operate in alcoholics. On the one side, the defiance says, “It is not true that I can’t manage drinking.” On the other side, the facts speak loudly and with increasing insistence to the contrary. Again, on the one side, grandiosity claims, “There is nothing I cannot master and control.” And, on the other side, the facts demonstrate unmistakably the opposite. The dilemma of the alcoholic is now obvious: the unconscious mind rejects – through its capacity for defiance and grandiosity – what the conscious mind perceives. Hence, realistically, the individual is frightened by his or her drinking and at the same time is prevented from doing anything about it by the unconscious activity that can and does ignore or override the conscious mind.
External Circumstances
What were the circumstances that made the patient give in and sign that card? [Signing that he is checking himself into a rehab facility] Let me review them for you briefly. He had been drinking for years, and he knew his drinking was getting worse in the eyes of his family and friends. However, he knew that his condition had reached the point where both his wife and his business associates were leaving him and thereby withdrawing their support and protection.
He was threatened with the task of managing himself and his condition entirely on his own, so he sought my help and protection to dry him out and thus allow him once more to resume his role of successful defiance and grandiosity. This time, however, I refused to follow my previous role. …When I told him, in essence, that he was not running his case or me anymore, his last prop was thus removed. He had no place to take his defiance and his grandiosity; nor could he become defiant with me: someone who stood for his last bit of hope and who actually had become established as an ultimate resource when he was in difficulty. So he staged a brief inward debate and then signed the card. The act of surrender had occurred.
In short, the patient signed the card, first, when all support was withdrawn; second, when he could not in anger defy those who withdraw their support because he knew they had been patient and long-suffering; and third, when he found himself desperately needing help and had no grandiose ideas left about being able to drink like nonalcoholics. He had neither unconscious defiance nor grandiosity left to fight with. He was licked, and he both knew it and felt it.
The Difference between Submission and Surrender
...In submission, an individual accepts reality consciously but not unconsciously. He accepts as a practical fact that he cannot at that moment conquer reality, but lurking in his unconscious is the feeling, 'There'll come a day' -- which implies no real acceptance and demonstrates conclusively that the struggle is still going on. With submission, which at best is a superficial yielding, tension continues.
When an individual surrenders, the ability to accept reality functions on the unconscious level, and there is no residual of battle, and relaxation ensues with freedom from strain and conflict. In fact, it is perfectly possible to ascertain to what extent the acceptance of reality is on the unconscious level by the degree of relaxation which develops. The greater the relaxation, the greater is the inner acceptance of reality.
We can now be more precise in our definition of an act of surrender. It is to be viewed as a moment when the unconscious forces of defiance and grandiosity actually cease to function effectively. When that happens, the individual is wide open to reality; he or she can listen and learn without conflict and fighting back. He or she is receptive to life, not antagonistic. The person sense a feeling of relatedness and at-oneness that becomes the source of an inner peace and serenity, the possession of which frees the individual from the compulsion to drink. In other words, an act of surrender is an occasion wherein the individual no longer fights life, but accepts it.
Having defined an act of surrender as a moment of accepting reality on the unconscious level, it is now possible to define the emotional state of surrender as a state in which there is a persisting capacity to accept reality.
…He had a typical surrender experience, followed by a typical positive aftermath. But I also saw that the change did not last and that, after several months in which the patient had lived in a state of surrender, he slowly reverted to his former attitudes and ways of feeling. In other words, the surrender reaction did not fix itself into his personality and thus allowed the return of his previous state of mind.
-------------------------------------------------------------------------------
Another significant emphasis in AA was humility and “hitting bottom,” completely new points of emphasis for me. It was clear that if an individual remained stiff-necked, he would continue to drink. Finally the presence of an apparently unconquerable ego became evident. It was this ego that had to become humble. Then the role of hitting bottom, which means reaching a feeling of personal helplessness, began to be clear. It was this process that produced in the ego an awareness of vulnerability, initiating the positive phase. In hitting bottom the ego becomes tractable and is ready for humility. The conversion experience has started.
…I realized that hitting bottom is ineffectual if not followed by a surrender. Hitting bottom must produce a result, and this result is surrender.
Unless the unconscious has within it the capacity to accept, the conscious mind can only tell itself that it should accept, but by so doing it cannot bring about acceptance in the unconscious, which continues with its own non-accepting and resenting attitudes. The result is a house divided against itself: The conscious mind sees all the reasons for acceptance while the unconscious mind says, “But I won’t accept!” Wholehearted acceptance under such conditions is impossible. Experience has proved that in the alcoholic a halfhearted reaction does not maintain sobriety for very long. The inner doubts all too soon take over. The alcoholic who stays “dry” must be wholehearted. Here we meet a complication. People accept the necessity of being wholehearted about alcoholism but not about everything else. They are determined to maintain their capacity for resistance. They fear the fact that if they become total acceptors they will have no ability whatsoever to resist and will become “pushovers”.
…Four elements are recognized as playing an essential role: hitting bottom, surrender, ego reduction, and maintenance of humility.
December 16, 2020
This is an interesting and enlightening book, both historically and for a deeper working knowledge of the process of breaking free from addiction. Among the highlights for me are the discussion of the difference between surrender and compliance and the delineation of the psychology of "hitting bottom," surrender, and ego reduction. Now that I know what "ego" means in context, I can finally stop bitching about 12-Step programs misusing the term. My only problems with Tiebout's work is his insistence that AA does not deal with causes of alcoholism (it's right there in Steps 4-9) and his mainstream religious take on spirituality. (He does bring up Zen, though, so I should give him credit. A worthy rescue from the days before psychiatrists were glorified pill dispensers.
March 13, 2017
I found it interesting that he is one of the early psychologist that backed AA. Here are my takeaways:
Need surrender and enthusiasm.
Compliance won't work as lacks enthusiasm.
Surrender deals directly with permanently replacing the old ego and it's activity. It goes much deeper than acceptance.
Ego Reduction:
1. The need to hit bottom.
2. The need to be humble.
3. The need to surrender.
4. The need for primary ego to be reduced.
Need surrender and enthusiasm.
Compliance won't work as lacks enthusiasm.
Surrender deals directly with permanently replacing the old ego and it's activity. It goes much deeper than acceptance.
Ego Reduction:
1. The need to hit bottom.
2. The need to be humble.
3. The need to surrender.
4. The need for primary ego to be reduced.
August 26, 2008
Very technical, but good.
March 14, 2012
A fascinating look at the characteristics that shape the alcoholic. If you want to understand the mind of the alcoholic then this is a book you want to include in your library.
Displaying 1 - 5 of 5 reviews