Katherine
McCarthy, Ph.D.
Journal
of Studies on Alcohol, Vol.45, No.1, 1984
Alcoholics
and those who treat them have been of necessity present oriented. The
day-to-day effort of maintaining or promoting abstinence in living
people leaves little attention for reflection on the history of
treatment. This history can, however, offer much needed perspective
on the problems and limitations of treatments; it permits us to learn
from both the success and failure of earlier work and philosophies.
This
article will outline the history of what is usually called the
"Peabody Method" of recovery from alcoholism. Its best
known practitioner, Richard Peabody, began treating alcoholics
individually in the early 1920s; his followers continued until the
l950s. As with the later Alcoholics Anonymous program, its roots were
in Protestant religious thought rather than in medicine. Its later
practitioners imitated the psychiatric model of professional
practice, but their ideas stemmed from pre-Freudian,
characteristically American Progressive thought.
Peabody’s
book The Common Sense of Drinking, first published in Boston in 1931
was widely read and influenced several medical and lay practitioners.
The basic strategy did not originate with Peabody, however, he
refined and "professionalized" ideas that he had learned in
the Emmanuel Movement from Dr. Elwood Worcester and Courtenay Baylor.
The
Emmanuel Movement began in Boston in 1906 in the Emmanuel (Episcopal)
Church. The movement’s founder, Dr. Elwood Worcester, practiced a
method of healing for assorted forms of "nervousness"
including alcoholism and other addictions. Worcester and his
assistant, Dr. Samuel McComb, operated a free clinic supported by the
church for about 23 years. The movement was widely reported in the
press, and Worcester and McComb became well known for their success
with alcoholics as well as other types of patients.
In
1913, Courtenay Baylor began to work for the Emmanuel church as a
specialist in alcoholism; he was probably the first paid alcoholism
therapist in this country. Originally an insurance agent he had come
to Worcester in 1911 for help with his drinking problem. After a
period of sobriety he retired from the business world to become a
paid "friendly visitor" in the church’s Social Services
Department. He remained at the Church until Worcester’s retirement
in 1929, after which the two practiced together at the Craigie
Foundation of Boston. Worcester died in 1940. In 1945, by now an old
man, Baylor resumed his old job at the Emmanuel Church. By all
accounts he died sober. Baylor described his treatment technique in
the book Remaking a Man (1919) as did Anderson: in his book titled
"The Other Side of the Bottle" (1950).
Baylor’s
most famous patient was Richard Peabody, son of a well known Boston
family, who came to the Emmanuel church for help with his alcoholism
in about 1922. Peabody survived his World War I service unscathed,
but after several years of heavy drinking found that his life was
falling apart. He had lost his share of the family fortune in
shipping at a time when everyone else was becoming rich from the war.
In 1921 his wife (later known as Caresse Crosby) obtained a divorce;
she had become so afraid of him that she would not stay alone with
him and had appealed to her uncle, J.P. Morgan for financial and
moral support. Peabody suffered from acute depression and was
hospitalized more than once.
Despite
his family’s wealth and prestige. Peabody was not prepared for a
career and supporting a family. He had graduated from Groton
preparatory school (where his uncle, Rev. Endicott Peabody, was
headmaster) but never finished Harvard. When he married in 1915, his
wife’s family was already worried about his drinking. Peabody
quickly escaped from family life by signing up for military service
at the Mexican border. Soon after, he left again for the war in
France, having barely seen his two children. Military life was
apparently a preoccupation with the men in his family; Mrs. Crosby
described his parents’ home as having a "family atmosphere of
eau de cologne and tiptoe discipline….The household ticked on a
training schedule." Major and Mrs. Peabody lived a
"militaristic" existence, "a strange, muted life,
uneventful and unjoyful;" everything was highly polished with
"implements of war laid out like precious objets d’art."
According to Mrs. Crosby, Mrs. Peabody spent most of her life in
nightclothes. Peabody was an only child "who had never been
allowed to play or cry, for both these exercises disturbed his
parents," quite a different picture from the "overindulged,
pampered childhood" that Peabody later insisted was the primary
cause of alcoholism.
Peabody
attended the Emmanuel Church’s clinic and weekly health classes in
the winter of 1921-1922 and by 1924 was listed in one of its
publications as a volunteer assistant in the Social Service
Department (Emmanuel Church, Department of Community Services, 1924).
Sometime during the l920s he established his own office on Newbury
Street in Boston. During this period he "effected some
remarkable cures" and became known to some as "Dr.
Peabody"; patients came to him from considerable distances. It
is likely that Baylor referred patients to him from the church, since
there were probably more applicants than Baylor himself could handle.
A few years earlier Baylor had observed in a Church report that
alcoholics were coming for treatment from as far as Santa Barbara,
Denver, Mobile, Washington and Philadelphia, "while New York is
a suburb from which we have many commuters." By 1933, Peabody
was practicing in New York at 24 Gramercy Park.
In
the 1930s Peabody was publishing articles in both the medical and lay
literature on his method: The New England Journal of Medicine (1930),
Mental Hygiene (1930), The American Mercury (1931) and American
Magazine (1931). His book, The Common Sense of Drinking (1931) was
republished in 1935 as an Atlantic Monthly Press book. By the late
1930s, several physicians interested in the new "scientific
approach" to alcoholism were using his technique, including
Norman Jolliffe at Bellevue Hospital in New York, Merrill Moore at
Boston City Hospital and Edward Strecker at the Institute of
Pennsylvania Hospital in Philadelphia. In 1944, the Yale Center of
Alcohol Studies opened the first free clinic exclusively for the
treatment of alcoholism; the Yale plan Clinics in New Haven and
Hartford offered individual and group treatment under the direction
of a Peabody therapist, Raymond G. McCarthy.
Before
his death in 1936, Peabody had trained several, of his sober patients
to become lay therapists like himself, including Samuel Crocker,
James Bellamy, Francis T. Chambers Jr., William W. Wister and Wilson
Mckay. Wister’s experience of treatment with Peabody is described
in detail in a book by Bishop titled The Glass Crutch, with an
epilogue by Wister himself. Strecker and Chambers also published a
book detailing their version of the method.
Peabody
and his coworkers apparently did not share Baylor’s personal
success at remaining sober. A common opinion is that Peabody died
intoxicated, although the evidence is not conclusive. Samuel Crocker,
who had once shared an office with Peabody, told Faye R. that he was
intoxicated at the time of his death. The personal copy of Peabody’s
book belonging to Bill Wilson (one of the founders of A.A.) now in
the A.A. Archives, contains the following inscription; "Dr.
Peabody was as far as is known the first authority to state, "once
an alcoholic, always an alcoholic," and he proved it by
returning to drinking and by dying of alcoholism - proving to us that
the condition is uncurable." This copy was originally owned by
Rosa Burwell of Philadelphia. Some early A.A. members share the
opinion that Peabody died intoxicated. The published sources
contradict each other. Wister quoted Peabody’s second wife to the
effect that he died of pneumonia. The editors of Scribner’s
magazine, which published an article of his posthumously, claimed
that he died of a heart attack. Mrs. Crosby did not say.
Wister’s
authorized biography reports that he became drunk in 1941 after seven
years of sobriety, and although he became sober again, he did not
resume therapeutic work. Faye R., who knew Baylor, Crocker and McKay
also resumed drinking. Faye R. was at different times a patient of
Baylor, Crocker and McKay. She has been abstinent in A.A. for 40
years. Her summary of the Peabody therapists is: "They had many
wonderful ideas but they just didn’t have the magic of A.A."
Marty
Mann described the Peabody Method as being primarily for the
well-educated or the well-to-do, a description that also
characterized patients of Freudian analysis of the time. William
Wister’s family, was as well known in Philadelphia as Peabody’s
was in Boston; Francis Chambers belonged to Philadelphia’s most
exclusive men’s clubs. Faye R. reported that Baylor, Crocker and
McKay were also from well-do-do Boston families.
Few
but the well-to-do could afford Peabody’s fees. Wister was broke
and in debt when he appeared on Peabody’s doorstep in 1934, so the
therapist offered to reduce his fixed fee of $20 per hour to $10.
Peabody told Faye R. that his fee was $10 per session for seven
visits per week; she went to Crocker instead, then newly established
in practice, for $5 per session. According to Faye R., Baylor scorned
such exorbitant rates even when he was himself in difficult financial
straits.
It
appears that the considerable majority of patients of the Peabody
practitioners were men, although Baylor and Peabody occasionally
referred to "men and women" as potential patients.
Peabody’s method, however, was clearly geared to the needs and
interests of men, and Baylor’s was much less so, as will be
described below. The age distribution of Peabody’s .patients is not
known. Peabody once remarked to Faye R., then had known of to do so.
Peabody himself was probably only a year or two older than that when
he stopped drinking. Probably the great majority of the alcoholic
patients of those practitioners were white, since their race was not
mentioned. Worcester did point with pride to the success of his
church’s self-help tuberculosis program with blacks, but did not
refer to them among the clinic patients.
Peabody
made important philosophical changes in and added some psychiatric
terminology to the treatment method although it had as its original
model quite a different conception of the relationships among body,
mind and spirit than those used by Peabody’s contemporaries.
Worcester and McComb based their claims as healers on their
qualifications as clergymen; coincidentally, both had doctorates in
psychology. The later practitioners, however, had serious problems of
establishing professional identification; Peabody and his followers
therefore made serious compromises in their work in the hope -
ultimately unfulfilled -that they could be accepted as
mini-psychiatrists. The Emmanuel Church clergy began their work at a
time when almost no one had heard of Freud, a time when the whole
notion of psychotherapy and "functional" nervous disorders
was still very new and open to various eclectic treatments. Worcester
and McComb were severely criticized by both. physicians and fellow
clergy for daring to invade medical territory, but in 1906 the
medical profession had neither the organization nor the public
acceptance to force them out of the field. By the 1930s, however,
this. had changed considerably. In 1940 Wister was actually
threatened with arrest for practicing medicine without a license. In
trying so hard to imitate the prestigious intellectual ideas of the
l930s, Peabody and his followers essentially gutted their method of
the vital substance that had made Worcester and Baylor so successful
in earlier decades.
In
1935 a new rival to Peabody was quietly being born in Akron, Ohio. By
1942, A.A. had grown enough in size and popular reputation to be a
viable alternative to the Peabody Method in some urban areas. As with
the patients of the earlier method, A.A. was initially composed
primarily of the well-to-do and well educated. Because it was free
and nonprofessional, however, it quickly spread to a much wider
group. Additionally, A.A. in its basic concepts of healing and
suffering, was much more similar to the Emmanuel Movement than to the
professional therapists. Organizationally, it was quite different
from both, but Elwood Worcester would certainly have recognized its
basic beliefs as very harmonious with his own. Faye R. reported that,
near the end of his career, Baylor attended an A.A. meeting and loved
it: he enthusiastically recommended it to her. Bill Wilson and his
wife Lois (later to become the founder of ‘Al-Anon) both read The
Common Sense of Drinking in the early days of his sobriety and were
very interested in it. However, only a few phrases and helpful hints
from it were incorporated into the A.A. program. The Emmanuel Church
like thousands of other American churches -now houses a large A.A.
meeting: it meets on Wednesdays in the old parish house, the same
place where Worcester and McComb gave Wednesday night classes for up
to a thousand "nervous sufferers."
THE
EMMANUEL APPROACH
Worcester
and McComb were not alcoholics. Their therapeutic method was
originally designed to treat the condition then called
"neurasthenia," a term covering an assortment of neurotic
symptoms, psychosomatic problems, phobias, extreme worry, anxiety,
addiction and other problems then considered non-organic. In a follow
up study of clinic patients during part of 1906-1907, Cabot reported
that only 12% were alcoholics. In the Emmanuel Church 1909 Yearbook,
McComb described a cured patient -a young, well educated, "refined"
woman who had been irritable, self-conscious, preoccupied with morbid
thoughts and uninterested in life; "It is mainly, through not
exclusively for sufferers of which this young woman is the type that
our health conference has been inaugurated." The considerable
majority of the nonalcoholic patients were women. Worcester and
McComb reported three rules for accepting alcoholic patients: (1)
They must come voluntarily from their own desire to stop drinking,
not solely because of pressure from others. (2) They must be willing
to accept the goal of total abstinence, for "the attempt to
convert a drunkard into a moderate drinker…..cannot be done once in
a thousand times." (3)
They must be dry during the first interview and pledge to be
abstinent for one week. The brief pledge apparently had some value:
"In the course of many years experience very few patients have
broken this promise."
Worcester
believed that all diseases had physical, mental and spiritual
components - some problems might’ be primarily physical, such as a
broken leg, but the patient’s attitudes could still promote or
retard healing. Many problems were more obviously’ related to a
person’s mental state. A case of deafness, for example, might be
purely organic and should be treated first by a physician, but some
cases were also of psychological origin and could be relieved by
psychotherapy. Many of Worcester’s patients had primarily moral
problems or habits that required a new way of life: addictions,
anxiety, or excessive fear or worry. The realms of the body, mind and
spirit interacted in a delicate balance in each person; an
improvement in one’ area might lead to improvements in another.
Severe pain from an intractable physical ailment could be relieved by
changes in attitude; the physical craving for alcohol or morphine
could be eliminated by a more spiritual way of life. All nervous
sufferers could be helped by redirecting their attention away from
themselves to a life of service to others. Exercise, proper’
breathing and natural sleep would ultimately promote a proper
spiritual balance.
The
concept of the unity of body, mind and spirit that Baylor inherited
from Worcester was probably unique in American thinking of the time.
Worcester acquired his ideas from the German psychologist, Gustav
Fechner, with whom he had studied at the University of Leipzig.
Fechner was renowned for his early work in experimental psychology,
but his lifelong philosophical interest was in developing a true
Geistwissenschaft, or a science that would include both the material
and the spiritual worlds. He believed that the relationships between
these two realms could be understood through mathematical formulas
that would explain both without reducing either to the terms of the
other. ‘Worcester explicated Fechner’s ideas and claimed that he
was unable to disentangle Fechner’s ideas from his own commented:
"The modern temperament finds the union of the mystical and the
scientific difficult to understand. Yet Fechner’s mystical grasp
upon the unity of life and the world lives on, and in each generation
finds a welcome from a few."
Worcester
and McComb were best known for their use of suggestion and
autosuggestion. They employed hypnosis with a small number of
alcoholics to keep them sober long enough to receive treatment, but
in most cases they merely put the patient in a state of relaxation.
With the patient seated in a comfortable chair in a dim and quiet
room, the therapist would give directions for systematically relaxing
each limb and slowing down racing thoughts. Baylor would ask the
patient to imagine that he was sailing in a small boat toward an
island, at first quickly, then more slowly until the person ended up
lying comfortably on a sunny shore.
Worcester
believed that a person’s subconscious mind was more amenable to
outside influence while he was in this relaxed condition. He could
then suggest to an alcoholic, for example, that the desire to drink
would soon pass, that he would soon sleep better and that he could
begin to make progress in his life. Worcester believed that in this
way powerful healing forces of the subconscious mind( a term that he
intentionally retained after Freud’s "unconscious" became
popular) could be brought into play to support a person’s conscious
desire to recover. Worcester saw the subconscious mind as an
essentially positive force: it was the source of enormous strength,
creativity, inherited memory and communication with the spiritual
realm. It was, in short, the spirit of the soul. Consistent with his
view of the unity of the soul and body, he saw the subconscious as
the regulator of elementary physical processes, including the
heartbeat, circulation, respiration and time keeping; thus positive
suggestions directed to it could affect physical health.
For
Worcester, the, redirection of attention was a very basic element of
therapy. Nervous sufferers and alcoholics became morbidly preoccupied
with their destructive habits and sufferings; the therapeutic effort
was to redirect that attention toward higher goals - the development
of a spiritual life and service to others. Misdirected attention,
produced often by physical pain or bad habits, caused much avoidable’
suffering; "A large part of the sorrow, ‘failure, sickness and
discouragement of’ life comes from this one source, the
anticipation of evil. If we could disregard all pain and misfortune
but the actual, we should deliver ourselves from about eight—tenths
of the sorrow of this life." (This is the same principle as
A.A.’s injunction "don’t project" - or assume a future
possibility to be present fact.)
Attention
could be redirected at first by a therapist through suggestion while
the patient was in the relaxed stated but the patient must be taught
to practice autosuggestion until new mental habits were learned. The
latter technique made the healing power of the subconscious available
in daily life; it consisted of "holding a given thought in’
the mental focus, to the exclusion of all other thoughts." The
patient learned autosuggestion and other techniques (proper
breathing, hints on obtaining restful sleep, etc.) not only in
individual treatment sessions but in the Wednesday night classes in
which the clergy and others lectured on such topics as habit, anger,
worry and fear.
The
theological basis of Worcester’s belief in redirected attention
rested on the Biblical "resist not evil" which he
interpreted to mean that constructive psychological change could be
promoted more effectively by building up a person’s strengths than
by directly attacking the problem or bad habit itself. For example,
Baylor reported successfully treating a woman with a phobia about
open spaces by engaging her in a deep conversation about her work
while walking with her, for the first time in many years, through
Boston Public Gardens. He had already done the ground work, however,
with many sessions of relaxation and suggestion and by gradually
weaning her away from sleeping medications.
The
Emmanuel clinic used prayer as an essential vehicle for acquiring the
power of attention, just as some holistic healing strategies today
often employ meditation for related purposes. Worcester’s theory
went well beyond that of simple meditation, however; for him, the
therapeutic dynamic was that "surrender implied in sincere
prayer is always followed by the consciousness of peace and inner
freedom." The mechanism here, as with attention, is paradoxical:
"Only by surrender to the All Holy and All Powerful are, the
potentialities of the self realized." What follows is a process
of conversion; "Whereas the sinful tendency about which (the
patient) was in the main concerned is robbed of its attractive
quality and the thought of it finds no entrance to his imagination."
New sources of energy from the subconscious are thereby tapped. These
paradoxes had long been familiar to religious thinkers, but they were
not described in the psychiatric literature until the 1940s with
Tiebout’s analyses of the therapeutic mechanisms of A.A.
Worcester
also saw the benefit of group support and the service that afflicted
could render each other, an idea that A.A. developed to a much
greater extent years later. The Emmanuel Movement prescribed not only
individual therapy, lectures and reading, but provided social hours
after the weekly classes at which the patients were expected to talk
to each other their growth and progress. Following the principle of
redirected attention, however they were not supposed to dwell on
their ailments. The Church also ran a well staffed Social Service
Department that provided "friendly visitors" to call on
patients and provide moral support, assist in finding jobs and
occasional financial help. Some staff members, such as Baylor, were
paid former patients: others were volunteers.
The
"guiding principle" of the Social Service Department,
according to the Emmanuel Church 1909 Yearbook, was to turn the
thoughts of each sufferer from himself to others. In all troubles of
mental origin, one of the most successful curative agencies has been
to get one person to help another suffering from exactly from his own
trouble. How can we ask another to make efforts which we will not
make ourselves? In this way moral strength is passed on from one to
another."
An
important off-shoot of this arrangement was ‘the Church sponsored
club for alcoholics. Founded in 1910 by’ a nonalcoholic
parishioner, Ernest Jacoby, the club held meetings in the church
basement on Saturdays and its space was used for socializing on most
other nights. Nonalcoholic’s also attended and the club’s
relationship to alcoholism was disguised’ in Church reports, but
the evidence is that its purpose was to help newly abstinent patients
reinforce each other’s abstinence. Its motto was "A club for
men to help themselves by helping others." There were no
membership fees. The only requirement for membership was "an
expressed desire to lead an honorable life and a willingness to aid
other men less fortunate." Worcester’ added one other
requirement; "They should not come to the Church drunk." A
follow-up committee sought out those who failed to appear for
meetings. A system resembling A.A. sponsorship was created, called
"special brothers," in which each member was expected to
look out for another. Saturday night meetings included food,
entertainment and lectures on topics of current interest. "The
broadest religious tolerance was observed, and many faiths were
represented." In the 1910 Church report, 20 persons were listed
by name as officers and members of the club. No women’s names were
included.
By
1912, the club announced that it had "already accomplished
results beyond our farthest hopes." The club had grown, and most
of its original members were still attending. It was arranging for a
better system of record keeping and was soliciting contributions for
a new clubhouse; one was reported from a little girl who gave a
benefit fair. The club moved out of the’ Church in about 1914;
nothing is known of it after that time except for Greene’s report
that it maintained good relations with the Emmanuel Church, which
continued to send it new members.
The
ideas of self-help and mutual support as alcoholism treatment were
not original to the Emmanuel Movement. The best known historical
antecedent was the Washingtonian Movement of the 1840s, a large group
of abstinent alcoholics and nonalcoholic temperance advocates who
achieved brief but spectacular success at "reforming"
drunkards. Some recent authors have noted that other temperance
groups in the following decades also employed the group-support
principle. According to Levine, "In the latter half of the 19th
century the Sons of Temperance, the Good Templars, and a host of
smaller fraternal groups, functioned in much the same manner that
A.A. does today. They provided addicts who joined their organizations
with encouragement, friendship and a social life free from alcohol.
They went to inebriates in time of need, and in some cases offered
financial support as well." It is difficult to determine at this
distance whether the founders of the Jacoby Club were familiar with
the earlier organizational forms. The major difference in the
Emmanuel Church work was that it rejected temperance preaching as a
means to attract or help alcoholics.
Although
Worcester was himself a supporter of the idea of temperance, he had
an approach to the problem of the moral status of alcoholism
different’ from that of his temperance predecessors or scientific
successors. Worcester had no doubt that alcoholism was both a disease
and a moral problem. Addiction involved habit, for him clearly a
moral category, yet he unhesitatingly ranked alcoholism along with
tuberculosis, cancer and syphilis as the four major diseases of his
time. To Worcester, the question of will was irrelevant to alcoholism
and neurasthenia; both were diseases of the whole person in body,
mind and spirit, not merely problems of the faculty of will.
According to Levine, "In 19th and 20th century versions,
addiction is seen as a sort of disease of the will, an inability to
prevent oneself from drinking." For temperance advocates, this
meant that moral exhortation addressed to the will would be
sufficient to keep a person from drinking. Other historians have
described the remedy for alcoholism espoused by the late
nineteenth-century Reform Clubs and the Woman’s Christian
Temperance Union as "gospel temperance" -a moral suasionist
attempt to spark a spiritual rebirth in alcoholics and to get them to
keep a pledge of total abstinence. The task as the Union Signal put
it, was analogous to "Peter preaching to the gentiles."
This same view characterized the mission approach of the Salvation
Army and other turn-of-the-century mission efforts.
By
comparison, Worcester’s approach ‘was more modern in totally
rejecting moral suasion, as a healing strategy. Worcester believed
that sermons were for normal people: "Something more than
exhortation, argument, or persuasion is’ necessary.... They may
provoke opposition on the patient’s part or they may even be
dangerous." Something more was needed because more than one
aspect of the personality was involved; like A.A., Worcester felt
that the individual’s entire life was affected and that an appeal
solely to the strengthening of the will would thus be inadequate. He
saw evil as a more basic, pervasive condition in’ the individual’s
life than did most of his contemporaries, such as the mind—cure
practitioners and those with various scientific approaches, including
the most recent. For Worcester, recovery must come from surrender to
both an external force (as in conversion) and to the, healing
capacities within the subconscious.
According
to Clinebell, one secret of the Emmanuel Movement’s success lay in
this effort to reduce an alcoholic’s guilt rather than to increase
it as did the other strategies of the time: "Emmanuel therapy
apparently was frequently able to convey this experience. When guilt
is reduced, the energies previously employed in the guilt and
self-punishment process, are freed and made available for therapeutic
Ends. The alcoholic’s inferiority is reduced... by (his) becoming
aware of his ‘higher and diviner self’ which is his real self."
Like others of the Progressive Era, Worcester had great faith that
the human race was improving and that an enlightened science could
help reduce human suffering. He did not believe that his method was,
antagonistic to medicine or that it was a "mind-cure"; on
the contrary, he believed his method to be more scientific than that
of contemporary physicians who could understand only the body,
without any theoretical comprehension of the importance of mind and
soul. He believed that clergy and physicians working’ together
could accomplish far more than either alone. Worcester and McComb
firmly believed in the essential goodness of human nature, even of
the unconscious mind; for them the ideal life was a balance of
natural inner forces, not a constant struggle with instincts and
impulses. For Worcester, feeling in itself was never a problem; even
painful emotions such as fear had their useful functions. Kurtz
(Not-God, A History of Alcoholics Anonymous) noted that Bill Wilson
also had a basic acceptance of human instincts, which for him only
became a problem when alcohol, permitted them to "run riot."
In
defense of the reality of his patients’ nervous sufferings,
Worcester ‘once stated that he would rather break both thighs than
undergo the pain that some of them experienced. Worcester and McComb
never hesitated to speak of fear, faith, hope and the spirit; Peabody
would not even mention the word "suffering." His book was,
of course, an offer of hope and help to alcoholics, but Peabody could
not bring himself to name the feelings.
Worcester
was writing primarily for and working for women, although he never
publicly acknowledged this. In 1908, he earned the equivalent of a
year’s salary writing five enormously successful articles —
including one oh alcoholism in women-for the Ladies Home Journal.
Peabody was writing self-consciously for men. His examples of
schools, clubs and recreational activities were exclusively those of
upper-class men. He worried about the "manly complex" that
might drive a man back to drink; he urged his readers to remember
that "it is the manly thing to do to give up drinking because
the weakling cannot do it." His ambivalence about
stereotypically female feelings and expressiveness runs through his
work and accounts for many of the ways in which his methods diverged
from those of Worcester and Baylor.
Courtenay
Baylor
Courtenay
Baylor must have been a, remarkable man. Constance Worcester and Faye
R. spoke of him with great personal affection, even many years later.
Peabody dedicated his book to him; Anderson described him: "He
had a ‘soothing7 beautiful voice that lulled you but at the same
time gave ‘you confidence. It was a voice you could, trust."
On
Baylor’s effectiveness, he commented: "If I had been one of
those skeptics, who say it is not the therapy but .the therapist that
gets results, he would have been a shining example; for he was one of
the most illuminating and persuasive personalities I have ever met.
However, the results of his work for four decades of practice and the
success of the people whom he had trained give solid proof that in
this case the value lay in the therapy as well as the man."
Baylor did not confine his work to alcoholism; his book (Remaking a
Man) was intended to help various types of nervous sufferers,
including the shell-shock victims with whom he began working in 1917.
Baylor
did not see alcoholics as being fundamentally different from other
people. Every person who drinks, however moderately, "has a
‘true alcoholic neurosis’ to the extent that he drinks,"
since he makes up excuses for drinking and will not stop without a
struggle. Like Worcester, he was willing to blame alcohol for
alcoholism rather than finding the fault in the individual’s early
history. He believed that all neurosis took the form of alternating
periods of rationalization and excuses. Therefore, the treatment for
alcoholism was not significantly different from the treatment for
other forms of nervous suffering.
Baylor
fully accepted the Emmanuel Church’s model of social service and
mutual helpfulness for his own work; he did not foster professional
distance between himself and his patients. According to Constance
Worcester, he did not discuss the fact that he was an alcoholic with
outsiders, but, unlike Peabody, he was direct about this with his
patients. He required mutual confidentiality as a condition of his
work: "Before we get through, I shall have to reveal as much
about myself as you do about yourself." He insisted that the
patient take increasing responsibility for the work. At the beginning
of treatment the patient was informed that: "You will act in a
double capacity: you are to be patient and physician at the same
time." The patient and instructor "are to study out
together certain fundamental psychological laws, the knowledge of
which will enable them to get to the bottom of that trouble."
Baylor’s goal with a patient was "to so help him to help
himself that his reconstruction will be permanent." Faye R.
reported that his methods were much less formal than those of Crocker
and McKay.
According
to Baylor, all neuroses, including alcoholism, resulted from mental
and physical "tenseness." He believed that "the taking
of the tabooed drink was ‘the physical expression of a certain
temporary but recurrent mental condition which appeared to be a
combination of wrong impulses and a wholly false, though plausible,
philosophy. The cause of this mental state was a condition of the
brain "akin to physical tension" during which it "never
senses things as they really are." For example, the person
believes that his troubles are entirely the fault of other people or
circumstances, and does not realize the extent to which his own
depression, fear or irritability color his perceptions and may
actually change the attitude of others toward him. This leads to more
practical problems and to greater tenseness, which will be expressed
in further drinking or neurotic behavior: "literally a circle of
wrong impulses and false philosophy — each a cause and a result of
the other."
The
solution, therefore, was first to promote physical and mental
relaxation, and then to examine in a calm frame of mind those "false,
though plausible" attitudes. Ultimately, the patient should
learn permanent relaxation by practicing the techniques that he has
learned. Anderson described this state as "a combination of
‘suppleness, vitality, strength and force -a certain definite
intentional, elasticity." Baylor called it peace of mind and
stated: "Peace of mind will do wonders."
Baylor
believed that his failures resulted from his inability to gain a
patient’s attention; some remnant of spiritual capacity must be
present in order for him to break the "vicious circle of
neurasthenia" - or the patients endless brooding attention to
his troubles. "I fail to get this attention either because the
patient has an innate lack of desire to change his life and ideas and
no spiritual element out of which to build such a desire, or because
he has an actual mental defect, or because his illness is so
deep-seated and his spiritual side so buried that the stimulus
dynamic enough to reach and arouse him or the time and personal
attention necessary to get through to him have been lacking."
Baylor’s
strategy was to supply the person with a "new point of
attention, a’ new philosophy of life, and a new courage with which
to face life." The complex interaction of ‘body, mind and
spirit can be seen here: "attention" was for Worcester and
Baylor both a spiritual and a mental concept, with both cause and
effect in the physical realm. To attend to good rather than to resist
evil, and also to develop a new sense that life is worthwhile would
not only promote spiritual growth but actually keep some patients
alive.
One
way to redirect a patient’s attention was to provide a new time
focus. The new interest and new point of view should be "so big
and so different that they occupy the present moment fully and make
all of life seem worthwhile." One strategy that he used for
adjusting the ,patient’s time sense to a normal pace was to speed
up or slow down his own thinking during a therapeutic session to
match that of the patient; he would then take the lead in adjusting
the speed of the patient’s thoughts to a more normal level.
Baylor
made no direct reference to the "subconscious" but it is
clear that he regarded it as a vital spiritual force in redirecting a
patient’s attention. Interviews with patients were "one
hundred per cent suggestion, direct or indirect." There is
nothing "weird" or "uncanny" about this, he
explained; it is as natural as the fact that a salesman’s
cheerfulness has a positive effect on a customer. (Those who believe
that the theory of suggestion is dead might take another look at
modern advertising.) The reeducational work itself, however, is
logical and rational; it proceeds through discussion of the patient’s
past to "analysis and explanation and definite instruction."
Baylor described the results to be anticipated by the patient as the
awakening of a new part of the mind or spirit: "Because you have
recognized a new function, or another sense perhaps, you will have a
hope that you can handle life instead of having life handle you."
Success with the method would lead to new confidence, efficiency and
happiness; but happiness,he believed, could not be directly sought.
Applying
Worcester’s principle of "resist not evil," Baylor did
not address phobias directly but worked to eliminate the background
reasons for fears in general; otherwise the phobia might recur in
altered form. Relaxation would make an alcoholic able to cope with
"tense" periods of his life before they actually leads him
to a drink. (The actual practice of A.A. meetings resembles this
"resist not evil" principle, without using that language;
the bulk. of a recovering alcoholic’s effort is to establish a
foundation of "sober thinking" rather to confront the
alcohol itself directly. A.A. teaches its members to avoid the
recurring periods of "alcoholic thinking" or "dry
drunks" that resemble Baylor’s "tenseness."
After
a few years of’ experience, Baylor began to realize that a longer
course of treatment was necessary for alcoholics than what Worcester
had provided. Worcester had seen most alcoholics several times a week
for a few weeks or months. A newspaper ("Preacher-Healer tells
of his cures") reported the case of a woman addicted to alcohol,
chloral and morphine who had been "cured" by Worcester in
seven visits. There was a form of follow-up, however; she was
thereafter required to write him a letter whenever she felt like
taking a drink or a drug. Baylor did not mention follow-up to
treatment, although Faye R. reported that he and the Peabody
therapists were always willingly available by telephone.
In
the Annual Report of the "Men’s Department" Emmanuel
Church 1916 Yearbook), Baylor announced: "We have come to feel
that it is unwise to attempt to accomplish the work in a few
interviews, and an agreement is made with those who come that they
will abide by our instructions for a year, This means that they see
us frequently at first. Periods between visits are then lengthened, a
course of rea4ing is taken up and various exercises are carried
through." A typical interview lasted a half-hour. He described
the long-term difficulties as follows:
"Getting
the man to stop drinking is only the first step in a very long march.
All the negative traits induced by alcohol must be eliminated and the
positive traits put in their places. Irritability, self-pity, fear,
worry, criticism of friends, bitter hatred of enemies, lack of
concentration, lack, of initiative and action, all these must be
worked out of the character. The entire mental process must be
changed, a new sense must be grown, one that can recognize the soul;
when this is accomplished we have the man himself cured from
alcoholism."
According
to some sources, Baylor was "more worldly" than ‘Worcester
and paid more attention to practical problems, including the effects
of alcohol on the family. Worcester had enlisted the cooperation of
the family in. accepting the goal of sobriety for both the patient
and themselves. Baylor went much further in discussing the specific
problems that family members developed as a result of living with an
alcoholic in the practical, mental and spiritual areas. Much of
Baylor’s time was spent working with relatives; he recognized the
difficulty that they experienced in accepting an alcoholic who had
changed greatly by becoming sober. He compared the difficulty of this
task to a "delicate surgical operation." He also worked
directly with employers to try to change negative attitudes. Faye R.
reported that he later developed a considerable practice in divorce
counseling. His Social Services Department of ten provided material
assistance to families of alcoholics, whether or not the alcoholic
was in treatment.
Baylor
did not consider himself a scientist. He felt that his work was "more
than a science; it is also an art." In the introduction to
Remaking a Man, he apologized for the lack of technical terminology.
Peabody, however, took quite a different tack. In the introduction to
his book he explained that he had simplified his "somewhat
technical vocabulary" so that the average layman can read it
without reference to a dictionary." Neither man had a college
degree. Each brought vital experience to the problem of alcoholism,
but they chose to use it in quite different ways.
Baylor
had none of Peabody’s professional pretensions, yet his claim to
competence was broader: he believed that he could understand and
influence not only the mind, but the body and spirit as well. The
originators of the Emmanuel Method did not consider their work to be
subordinate to that of medical professionals; the Rector of Emmanuel
Church initially hired physicians to do routine diagnostic work, then
took over the task of healing when they had failed.
We
know somewhat more about Worcester and Baylor’s therapeutic
success. In 1908, Dr. Richard C. Cabot of the Harvard Medical School
published a report on the outcome of 178 cases of all types,
including alcoholism, seen by Worcester and McComb in a six-month
period of 1907. Of 22 alcoholics, 11 were listed as "much
improved" or "slightly improved"; seven had unknown
outcomes. These rather vague terms do not reflect the fact that
Worcester, during the early months of this period, was using a
technique that he later reported to Peabody was a total failure -
trying to teach his patients to "drink like gentlemen."
Exactly when his approach changed is not clear.
Clinebell
concluded: "It’ seems possible that the Emmanuel Movement
enjoyed a relatively high degree of success in providing at least
temporary sobriety," based on, Worcester’s long-term
reputation and his own statements. Baylor reported in 1919 that, of
about 100 cases that he had seen personally in the previously seven
years, about two-thirds had been successful. His annual reports from
1913 to 1916 also refer to significant numbers of "successful
cases" each year. We do not know how long the patients of either
Worcester or Baylor were able to maintain their abstinence, but
Worcester referred to several who had "stood like rocks in their
place for years."
In
the early years of the Emmanuel Movement there was almost no interest
within the medical profession in "‘spirit", or feeling as
healing resources. The great majority of psychiatrists and
neurologists were concerned exclusively With somatic explanations for
mental and emotional problems; they believed that all such problems
would ultimately be explained by reference to "lesions" of
the nervous system. As Grob has noted, late-nineteenth--century and
early-twentieth-century psychiatrists, "having rejected as
subjective and unscientific such affective sentiments as humanity,
love and compassion....found their own supposedly objective and
scientific approach to be barren."
Part
of the great, influence of Freud on American thinking was of course
his recognition of the role of feelings in various types of
illnesses, both psychosomatic and purely psychological ones. For
Freud, feelings and their conflicts were usually problematic and the
cause of endless human difficulties. For Worcester, however, the
awakening of new spiritual feeling was essential to the cure of many
troubles; positive feelings in themselves constituted a cure.. Freud,
and his followers also cultivated a dry and austere language, quite
the apposite of the sentimentality of the clergy. By the post-World
War I years, the kind of language of feeling that Worcester and
McComb had used seemed insufficiently "professional" for
physicians; in fact, it was rarely used as a form of public statement
outside the churches.
The
differences in the two approaches to alcoholism were summed up by
Freud himself in comments he made to a reporter when visiting this
country in 1909. When asked his opinion of the fact that Worcester
and others "claimed to have cured hundreds of cases of
alcoholism and its consequences by hypnotism, Freud replied, "The
suggestive .technique does not concern itself with the origin,
extent, and significance of the symptoms of the disease, but simply
applied a plaster-suggestion-which it expects to be strong enough to
prevent the expression of the diseased idea. The analytical therapy
on the contrary. . . concerns itself with the origin and progress of
the symptoms of the disease." (Hale, Freud and the Americans:
The Beginning of Psychoanalysis in the United’ States. 1971)
According to Hale, "he implied that hypnotism also was a morally
doubtful kind of trickery that resembled ‘the dances of pills of
feather-decorated, painted medicine men.’ He criticized the clergy
and others who practiced without medical degrees: "When I think
that there are many physicians who have been studying methods of
psychotherapy for decades and, who yet practice it only with the
greatest caution, this undertaking of a few men without medical, or
with a very superficial medical training, seems to me at the very
least of questionable good." He implied that such people might
affect the reputation of his own method: "I can easily
understand that this combination of church and psychotherapy appeals
to the public; for the public has always had a certain weakness for
everything that savors of mysteries and the mysterious, and these it
probably suspects behind psychotherapy, which, in reality has
nothing, absolutely nothing, mysterious about it." Hale
concluded: "Admitting that he knew little about the Emmanuel
Movement, he promptly condemned it."
Granted
that the question was somewhat inaccurate (Worcester rarely used
hypnotism), Freud’s response still shows not only his ignorance of
addiction but his lack of interest in the actual relief of suffering.
Rieff (Freud: The Mind of the Moralist) noted: "Clearly no one
so unsentimental as Freud can be accused of loving humanity, at least
not in the ways encouraged by our religions and their political
derivatives,....He was interested in problems, not patients, in the
mechanisms of civilization not in programs of mental health.
As
Hale described it, "Freud at once constructed a counter-image
that became in turn an important psychoanalytic stereotype-
psychoanalysis was austere and difficult, requiring extraordinary
expertise but promising radical cure."
Richard
Peabody
Such
was the narrow model of professional practice available to Peabody as
a therapist of the 1920s. He did not attempt to imitate the
particular techniques of a psychiatrist, but he systematically
eliminated from his terminology and concepts anything that hinted of
the church and "feather-decorated, painted medicine men."
The acknowledgments in his book include Baylor and six physicians,
but he did not mention the Emmanuel Church. Like the psychoanalysts,
Peabody kept an extreme professional distance from his patients;
Wister reported that all he had ever learned about Peabody personally
was that "Peabody had learned much in Boston from, two noted
psychiatrists and that he had married twice." Wister also noted
that he spoke objectively, as though he were discussing the proper
treatment for a broken leg and that he never discussed the moral
aspects of alcoholism."
Since
Peabody had no credentials and chose not to use his own experience as
the basis for his claim to be a teacher, he was in a difficult
position to justify his fees. The nearly total lack of interest of
the medical profession in working with alcoholics should have given
him a wide field in which to work, but the only formal reason he
could give patients for coming to him for treatment was that it might
speed up recovery. He quoted a patient approvingly: "I went to
Peabody on the same theory that I would have gone to an instructor of
mathematics had I found it necessary to learn calculus. Probably I
could learn calculus by myself out of books, but it would take me a
great deal longer than if I went to a competent teacher."
Peabody
promised in his book to avoid "moralizing"; his was
strictly a "scientific approach." By 1931, moralizing about
alcohol was certainly out of favor, within his social class at least.
The excesses of some of the Prohibition advocates and the
difficulties of enforcing Prohibition had embarrassed most advocates
of such laws into silence. It was becoming fashionable now to blame
the drinker, not the social institution of drinking, for alcoholism.
Peabody wrote an article on "Why Prohibition Has Failed,"
in which he claimed, in effect, that drinking is a normal human
activity (for men, at least) and should not be tampered with by mere
moralizers.
Peabody
went a step beyond the anti-Prohibition logic. It was one thing to
claim that ordinary drinkers should not have to feel guilty for their
indulgence, yet quite another to imply that alcoholics themselves
have ho problem with guilt or shame about their addiction. Nowhere
did Peabody recognize the fact that alcoholics do feel much guilt and
remorse about the trouble that they have caused themselves and
others. Peabody provided no mechanism by which forgiveness and
acceptance could be attained, either in a religious sense or through
a group of similarly afflicted individuals.
The
men of the Jacoby Club bonded together "to lead a more honorable
life," but Peabody did not use even such indirect references to
guilt or self-esteem. Since neither morality nor feeling was an
acceptable topic of discussion for Peabody, the only justification he
could give for the effort to become sober was, in effect,
"efficiency." A man must be impressed with the fact that he
is, undergoing treatment for his own personal good and because he
believes it to be the expedient thing to do."
The
major practical drawback to excessive drinking cited specifically’
by Peabody was its "supreme stupidity." His explanation was
designed to appeal to the patient’s respect for ‘his own
masculinity: "Just as all normal boys are anxious not to be
considered incompetent in athletics, so to be thought stupid is the
last thing that a full-grown man with any pretense to normality
wishes. Even in prisons drunkards are held in low repute by criminals
because they are where they are as a result of inferior intelligence
rather than a distorted moral point of view."
It
seems curious now that Peabody did not attempt to resolve the
moralizing problem by calling alcoholism a disease or an illness. The
disease concept was certainly, available to him-the Emmanuel Movement
had used it freely, and it had been current in some circles of
temperance workers and physicians since the late nineteenth century.
Diseases, however, are ordinarily understood to have some connection
with the body and Peabody’s basic philosophical orientation seemed
derived from the mind-cure movement, including Christian Science,
which essentially denied the significance of the body and was
interested only in the mind as a means for controlling an
individual’s life. Many of Peabody’s therapeutic suggestions
resemble a secularized version of the writings on mind-cure and
self-help dating from the 1890s. His work was thus a strange amalgam
of these ideas and the quite different philosophical and
psychological ideas of Worcester and McComb.
Worcester
had begun his clinic work partly in response to the apparent healing
successes of Christian Science. He viewed their theology and that of
New Thought as shallow and materialistic, however, and little
resemblance existed between his tripartite view of the person and the
idea in mind-cure that pure thought can be used to eliminate disease
and to produce increased efficiency and business success. Christian
Science denied the reality of bodily suffering altogether and of
course had no use for the medical profession. Mary Baker Eddy did not
believe in the existence of the unconscious, and other mind-cure
writers "far from teaching an open-door policy toward the
subconscious. . . taught absolute denomination over it."
According
to Meyer ( The Positive Thinkers. .Religion as Pop Psychology from
Mary Baker Eddy to Oral Roberts ) the central tenet of mind—cure
was that "God was Mind....The crucial aim in this
characterization was that it should guarantee a self-enclosed and
coherent existence....Mind was above all the realm in which people
might feel that life came finally under control." Christian
Science, and later mind-cure expressed no interest in human service
(a fact commented on quite sarcastically by both Mark Twain and
Elwood Worcester), which might account for Peabody’s lack of
interest in it.
Peabody
continued to use several important ideas he had learned from Baylor:
surrender, relaxation, suggestion and catharsis. His development and
reformulation of some of these -particularly surrender and,
suggestion- was much more specific to and useful for an alcoholic’s
particular situation than the formulations of Worcester and Baylor.
Peabody
was very clear about the new priorities for a reordered life: "The
first step to sobriety is surrender to the fact that the alcoholic
cannot drink again without bringing disastrous results" and
"this surrender is the absolute starting point. The conviction
of its supreme importance is an absolute necessity. With surrender,
halfway measures are of no avail." This was undoubtedly the
source of Bill Wilson’ s better known phrase: "Half measures
avail us nothing." Peabody noted that an "intellectual
surrender by no means settles the question," but he did not
discuss the emotional aspect of such surrender. He did detail some of
the obstacles to it, included "distorted ‘pride" and the
conviction that drinking is "smart" or "manly."
The
patient, must also have a conviction that he needs help. Peabody
sometimes made a prospective patient convince him of the fact that he
was truly an alcoholic. He would not accept a patient unless "he
can say that he would like to be shown how to reconstruct his mental.
processes so that in due time he will no longer want to drink."
Peabody
used the same relaxation technique employed by Worcester and Baylor,
although he was somewhat defensive about it: "I appreciate that
this relaxation-suggestion phase of the treatment may sound like
hocus-pocus to those who have never tried it." He justified
relaxation in part on the grounds of efficiency - on the grounds that
a person could accomplish more work in a day with less effort if the
exercise were done daily. They could also be used as mental training
to avoid "displays of temper, baseless apprehensions, shyness,
and other unpleasant moods, not by trying to support them, but by
finding out why they exist and anticipating occasions which might
create them." The regular practice of relaxation would prevent
the "accumulation of emotional tension." He devoted only
one page to the physical aspects of the treatment, including
exercise.
Suggestion
had wider uses, Peabody defined its most useful form for alcoholics
as "driving home platitudes as if they were profundities over
and over again." ( It is very likely not a coincidence that this
is the basic organizational principle of A.A. meetings ) The
therapist supplied these suggestions during relaxation sessions and
the patient was to repeat them nightly at bedtime. Peabody also
assigned readings and the daily copying out of simple statements that
he supplied one at a time as the patient was ready.
Like
his predecessors, Peabody appreciated the significance of catharsis,
although none of the three used that term. They all provided an
opportunity for a patient to discuss his drinking history and earlier
life experiences. Peabody saw this as a more formal task of analysis
(in a somewhat Freudian sense) than did the’ others; it was not
merely an emotional purging for the patient, but an opportunity for
the therapist to point out the causes of the individual’s drinking.
Peabody’s ideas about the causes of alcoholism will be discussed
further below.
Unlike
Worcester and Baylor, Peabody did not regard the unconscious as
necessarily helpful. It was the repository of excuses, denial and:
other obstacles to permanent abstinence, as well as the ever
dangerous emotions it was the mental scrap heap to which the desire
to drink must ultimately be relegated. The unconscious also needed to
be "taught," and the method of teaching it was through
thought control. "The most important element in the work (is)
the control and direction of the thoughts toward the ultimate logical
goal." All negative thoughts must be stopped and positive ones
substituted; "When at length the mind is diverted, the
unconscious, which is supposed to retain all memories, must be left
with a true picture of the whole situation and the individual’s
intellectual attitude toward it."
The
most distinctive aspect of Peabody’s method was his plan for time
control. He described it: Before going to bed the patient should
write down on a piece of paper the different hours of the following
day, beginning with the time of arising. Then, so far as can be
determined beforehand, he should fill in these hours with what he
plans to do. Throughout the day notations should be made if
exceptions have occurred in the original plans, and it should be
indicated whether these exceptions have been due to legitimate or
rationalized excuses.... Small as well as larger activities that are
taken up should not be dropped until completed unless they are in a
sense unknown quantities, entered upon for the purposes of
investigation only. Several pages of instructions follow. Peabody
emphasized that the spirit in which the time plan is followed was
more important than accuracy. Its functions were to (1) give the,
patient something concrete to do to change his condition, (2) provide
the patient with "training in executing his own commands"
and (3) prevent idleness. Regarding this last point he quoted Stekel:
"Earthly happiness….. is primarily dependent upon our
relationship to time." Following this regimen might well have
helped the patient to develop a new sense of responsibility, since he
had to be accountable to his therapist for his actions every day.
Peabody, however, did not discuss responsibility.
Faye
R. recalled that her therapists told her to break down the schedule
into 30-minute units. Marty Mann reported that one Peabody patient
whom she knew carried time cards with him in his shirt pocket so that
he would never be far from his schedule.
In
his discussions of time and impulse control, Peabody appeared less
like the psychiatrist and more like the industrial engineer
perfecting his efficiency and productivity. He is also the military
officer planning in advance so that his troops would not mutiny while
he slept. He compared the time exercises to "close order drill";
discipline, not character, was his security. "In battle it has
been proved over and over again that large hordes of individually
brave but untrained men can accomplish little when opposed by a
smaller but disciplined military group -so with the alcoholic and his
temptation. He cannot expect consistently to conquer his enemy in
every drawing room and country—club porch if he has made no advance
preparation."
Peabody
apparently expected the self to remain deeply divided; balance of any
sort must have seemed unattainable to him because he recommended that
constant vigilance be exercised against endlessly threatening,
feelings. Wister reported that Peabody had told him: "I want you
to begin thinking of yourself as two selves. There’s your
intellectual self and your emotional self. This intellectual self is
a good self, the logical self. Its your best self...Now there’s the
other self, the emotional self. It’s always there and it is right
that it should always be there. But it is the side that wants to
drink....But thought control will shrink it down so that it becomes
much smaller than the good ‘self. You must reconcile both selves.
But you must permit the intellectual side to dominate."
Peabody,
the factory manager, again noted: "Every phase of this therapy
is governed by a time element. You will eventually learn to master
your emotions and you will sit, intellectually, in the driver’s
seat. For a time, however, you will have to direct your mental
processes by hand . Later they will operate automatically."
(This statement is exactly the opposite of A.A.s recommendation: "Get
out of the driver’s seat.") Nowhere did Peabody speak of
patients acquiring new feelings, desires or interests Other than
"hobbies"- his limited aim was that they be free of one
destructive desire. Alcoholics must "train their minds so that
they no longer wish to drink." Clearly, Peabody "resisted
evil" as strongly as he could.
It
is difficult to imagine that efficiency, expediency and time
management could provide sufficient inspiration to transform active
alcoholism into a lifetime of sobriety. It was a far cry from
Worcester’s promise of reawakened spiritual powers or Baylor’s
hope for "recognition of the soul;" A life of mere
efficiency and the systematic suppression of feelings, organized in
hours or half-hours, certainly resembles Crosby’s description of
the atmosphere in which Peabody grew up: a "strange muted life,
uneventful and unjoyful". and a "tiptoe discipline (which)
ticked on a train-like schedule." Such an arrangement might
achieve freedom from alcohol, but it is much less clear what that
freedom was for.
For
Peabody, indulgence of feeling and lack of discipline were the
causes, of alcoholism. He discounted heredity as causative, claiming
instead that improper family circumstances lead to a "nervous
condition," which "in turn induces alcoholism." He
described his typical patient as a first or only son, suffering from
a fear of maternal domination: he was "pampered and
overprotected" as a child and drank to resolve his conflicts
about achieving manhood. The patient "had unconsciously to
choose between becoming a timid mother’s darling, completely
surrendering his own personality, or putting up an exaggerated
opposition. Of the two he unquestionably chose the wiser course."
The typical mother ‘was "domineering and prudish" and the
typical father was shy, with periods of despondency. Ultimately, the
parents were responsible for the child’s alcoholism. "The
resulting character, is the fault of the parents, though in the use
of the word "fault" we do not wish to conjure up an ethical
concept so much as one of ignorance and lack of self-control."
Later
writers on this topic were not as delicate about the use of the
"ethical concept." Much of Bishop’s fictionalized
biography of Wister is an essay on his mother’s faults, on how she
caused and encouraged his alcoholism. Strecker and Chambers were much
more pointed in their insistence that mothers be blamed for the sins
of their sons. Peabody did not single out mothers in particular. In a
series of writings employing Peabody’s ideas, Strecker and
Chambers’s denunciation of women and their insistence that men
control women became increasingly shrill. In the book Their Mother’s
Sons, the psychiatrist Strecker reached new depths in denouncing
mothers for virtually every faulty male act of the World War II era,
much like Philip Wylie’s better known Generation of Vipers. None of
these writers informed us what the cause of alcoholism in women might
be.
Although
Peabody’s method was widely practiced for about two decades, little
is known of its overall therapeutic success, and an accurate guess is
impossible at this date. Marty Mann concluded that Peabody and his
therapists "accomplished a heroic work during the 1930’s, when
little else was being done for alcoholics" and that the method
"was effective with a considerable number"’ of patients.
It is known that a few remained abstinent and professionally active
in the field of alcoholism. Others who failed at the Peabody method
were known to have joined A.A. in its early years, but it is
impossible to determine how many remained quietly sober without
joining A.A. or professional groups. The fact that several of the
Peabody method’s major practitioners - apparently including the
founder - were not able to maintain their sobriety, however, does not
bode well for other patients with whom contact was lost.
Conclusions
The
major significance of Peabody’s work was probably not its long term
therapeutic success but the hope that it gave, both to the
researchers in the early scientific study.’ of alcoholism and to
early A.A. members, that alcoholism was a treatable condition and a
worthy topic for further research and investigation. In their review
of the treatment literature, Bowman and Jellinek concluded, "In
this country, Peabody has probably exerted more influence than anyone
else on the psychotherapy of alcohol addiction," The writings of
Peabody and of Strecker and Chambers reached a far wider audience
than Baylor’s book ever had. By the 1930s, the Emmanuel Movement
had almost been forgotten. Even if the physicians and other
professionals of the late l930s and early 1940s had known of
Worcester and Baylor’s work, they undoubtedly would have rejected
it as too religious for their own use. A.A. methods could not be used
directly by professional therapists, since these methods depended on
a group of recovering alcoholics. The tone and style of Peabody’s
writing was undoubtedly far more agreeable to professional
practitioners by the end of Prohibition. The Peabody model was
actively used in the Yale Plan Clinics, which employed both
individual therapy and the class method of teaching similar to what
Worcester had originally used. These class sessions were published
verbatim in several issues of the Quarterly Journal of Studies on
Alcohol and were very likely influential in the practice of other
early clinics.
The
difference between Worcester’s and Peabody’s work is in part
accounted for by the spirit of the times when they developed their
work. Elwood Worcester was 50 years old when World War I began;
Richard Peabody was 20. Although Worcester incorporated some
psychoanalytic concepts in his later work, he never altered his
conviction that human nature was basically good and that the
"subconscious" was a useful ally of consciousness. For
Peabody, who had fought at Chateau-Thierry, those assumptions had
become untenable. More congenial to his generation were the ideas of
Freud, for whom the mind was an endless battleground of life and
death instincts that could be kept in check only by the eternally
vigilant forces of’ civilization. Peabody’s understanding of
human life was thus more modern than Worcester’s. For the younger
man, life was an endless struggle, not so much between conscious and
unconscious forces, but between sober reason on the one hand and
feeling (equated with intoxication) on the other. A tone of postwar
despair and depression permeated his work. Writing in 1919, Baylor
used relatively little of Worcester’s inspirational religious
language, although he retained his basically spiritual view of the
recovery process. Writing in 1930, Peabody had abandoned the
spiritual language and concepts altogether.
Curiously,
the postwar pessimism did not similarly affect Bill Wilson, who was
Peabody’s close contemporary and who also fought in World War I.
Wilson’s writings retained the language of another
turn-of-the-century Protestant source, the Oxford Groups, through
which he had initially stopped drinking. Many people, including new
A.A. members and professionals, have reacted to his language in
Alcoholics Anonymous, the primary A.A. sourcebook, as anachronistic
and overly sentimental. It is essentially the same kind of style that
was popular in Worcester’s time, with the same indomitable optimism
and confidence in the efficacy of spiritual ideas. It contrasts
sharply with today’s professional therapeutic language.
It
is hard for us now to accept Worcester’s optimism about the human
race or his conviction that our inner impulses are always beneficent
ones. There are still no more than a few of us, as Murphy (Historical
Introduction to ‘Modern Psychology) noted, who can understand his
vision of the, unity of the mystical and material worlds; our culture
has trained us for so long to keep them rigidly separated. Worcester
also could not give us an explanation of suffering. Like A.A., he had
only a theory of progress and improvement not a theory of evil.
It
is probably unfortunate from the long-term point of view of treatment
that the "scientific" interest in alcoholism that developed
in the 1930s could find professionally acceptable only the rather
limited approach of Peabody. The International Bibliography of
Studies on Alcohol (Keller) does not even list the writings of
Worcester and Baylor. Apparently, its definition of "science"
was not broad enough even to include, the Emmanuel Movement, at least
in the English speaking world. Perhaps, if we had adopted the broader
concept of a Geistwissenschaft as Worcester — and perhaps also
Freud - understood it, we would not be embroiled in such continuing
problems with understanding the proper scope of the terms "science"
and "disease."
Indirectly,
one can conclude that the Emmanuel approach probably deserved its
reputation for greater therapeutic success, since it used several of
the major strategies that were later proved successful in related
form by A.A. From the point of view of recovery, far more has’ been
accomplished in the past 50 years by those who appreciated
Worcester’s paradox - that the unmanageability of life may be
turned around by relaxing, control, not by ever more frenzied efforts
to regain it.
