Unless the personality of the alcoholic is taken into account the development of his alcoholism cannot be understood. His addiction is meaningful only in the total context of his-organiza-tion of beliefs, attitudes, dispositions and traits. His alcoholism is an integral aspect of the alcoholic; it is difficult to separate the man from the disease because so much of his energy and his actions are bound up in the addictive drinking and its consequences. Certain people appear predisposed to alcoholism by prior impairment in their personality structure. Such people exploit the gratification and the relief from tension conferred by drinking, because these psychic accompaniments of addictive drinking make their problems in living more tolerable.
People who use alcohol as a substitute gratification are those who are unable to get sufficient reward from ordinary living.
This inability stems from a faulty relationship of the ego to the rest of the self. Different schools of psychology have developed different ways of describing this. The terms and concepts used depend on the model of personality utilized. One of the systems most widely used is the psychoanalytic approach. In this, the growing individual as he passes through youth to maturity is constantly acquiring new patterns of behaviour. The progressive development of personality can be interfered with at any stage during this formative process. If severe interruptions in emotional growth occur, the personality does not evolve uniformly and to its mature form. It is deficient in some aspects and this deficiency reveals itself by a disturbed relation to other people. In psychoanalytic terminology, such a personality is said to have been partially fixated’ at an earlier developmental stage. The stage will correspond to the age at which particular stress had been experienced. Under conditions of subsequent difficulty which resonate with the original stress, the adult individual can regress ‘ and suddenly display, in the context of otherwise mature behaviour, his fixed immature reactions. These regressive actions or attitudes reflect preoccupations retained from much earlier periods in his life, in fact, the behaviour which was appropriate at the point in time when the original interruption took place. These aspects of the self had not shared in the subsequent maturation of the person.
This theory views the person as maturing in irregular steps. He retains residues of encapsulated feelings and impulses which, although usually latent, can suddenly gain an outlet in behaviour when fresh pressures occur. Then occurs an impulsive and inappropriate reaction, often surprising in its irrationality, as a response to the adult’s present crisis. This seemingly incomprehensible behaviour becomes more understandable when regarded as the return of an unmatured childhood reaction pattern.
The socialization process by which all people develop starts in the parental home and extends through schooldays and
adolescence, until in the late twenties maturity is reached. Disturbing experiences or emotional traumas are important because they can interrupt the continuity which makes up the meaningful life history of every person.
Very early experiences which the individual had forgotten can be revived in vivid detail. This has been done experimentally with the aid of hypnosis. The individual retains the impression of far more experiences than those he remembers consciously. Not only events but also the feelings that accompanied them are stored in memory and can be re-activated. The individual relives not just the happenings of past experience but the mood which accompanied the events. During psychotherapy it often happens that a patient recalls a forgotten occurrence, seemingly trivial perhaps, but a highly condensed and potent distillate of the past, which prompts him to remember experiences very significant for his development.
These experiences are aspects of the historical factors which play a part in personality. For the past determines current expectations, and these in turn influence the way in which one presents oneself to others. But current events, situational factors, also have important effects on emotional adjustment. They are the here-and-now experiences which trigger off disorganization of behaviour. A person may only partially comprehend such induced disturbance. It may be only a state of discomfort or anxiety that enters his awareness, and this may be the subjective tension that he seeks to relieve. Drinking may offer that relief.
The course of an individual’s development consists of a sequence of new demands, each stage with its peculiar set of problems. The infant is a helpless being, entirely dependent on others. He progresses to the stage when social demands begin to be made of him. He has to comply in toilet training. Then, as he comes to participate increasingly as a member of the family, he has to master his anger when frustrated and to postpone the gratifications he longs for. He must control his jealous rivalries with brothers and sisters. He can anticipate the
future and even see himself as a potential adult ( when I grow up ‘) with a sexual identification (like my father’). The father is important in giving the boy a male pattern on the basis of which to evolve his own assertiveness; he also acts as a model with which the son can compare his own masculine behaviour in later adulthood.
In psychoanalytic theory, the stage of development at which major fixation occurred determines those infantile traits the adult will continue to manifest in situations which make him anxious. Oral, anal, and genital stages have been differentiated. An oralpersonality has tendencies to be passive, to ding to other people for support ; though he is both demanding and grasping, he makes others his agents. He has failed adequately to master very early infantile impulses: these persist and find symbolic expression in excessive mouth activities and an urge to take things into the self. A relationship between strong oral residues in the personality and the genesis of alcoholism has often been asserted.1
The personality has developmental residues which show in maturity as excessive neatness, suppression of emotion, obstinacy and punctuality.
The genital personality is viewed as resulting from stresses later in development, at about five years of age; a person with emotional encapsulation at this fixation level is unduly preoccupied with sexual thoughts and impulses but at the same time keeps all relationships superficial and has little real capacity for intimacy. He or she tends to attract others sexually while simultaneously having to deny mature erotic needs and to repress sexual impulses. Men with a personality of this type generally have associations with numerous women but they are unable to form a stable and satisfying relationship with any one.
Many alcoholics manifest behaviour characteristic of the oral personality. Without being aware of it they are absorbed in mouth activities, and display passivity and dependency, together with a tendency to place excessive reliance on another person, usually of greater competence. This constellation of dependency features within the adult personality is accentuated when alcohol is taken; but it is also a persistent, hampering element that the alcoholic must contend with when he is not drinking. In a crisis he is apt to respond by adopting a state of helpless dependency. While the oral personality is the most common type found among alcoholics, there are also some who show anal or genital personality residues.
Fixation of development at the oral stage is often attributed to inadequate mothering, for example by a woman who is unable to provide adequate affection for her child. She may deprive her child of affection because she has to expend her emotional energies in another direction, such as going out to work; she may herself suffer from a character disorder or a psychiatric illness; if separation occurs, because of hospitalization, for instance, the child who is too young to grasp the true nature of his terrors may blame her for them and later in life hold her accountable. The relationship with the mother has much to do with the sense of security in later life. The oral personality seeks throughout life to find those maternal comforts which he lacked during infancy when they were so necessary for secure emotional growth.
On the other hand, the mother may pamper and anxiously over-protect the child. Knight1 in studies of North American alcoholics reports that an overly indulgent mother plays a role in stimulating excessive dependency in her child; these patients commonly also had a father who behaved inconsistently, gratifying the child and then as arbitrarily reproving him. The adult from such a parental background has inordinate needs for affection, protection and care, and reacts with rage if not gratified. Some alcoholics seek in marriage a mother substitute, and are likely to marry women older than themselves.
All clinicians who deal with alcoholics have been forcibly struck by the great amount of clear-cut emotional deprivation and trauma they have suffered. Alcoholic patients regularly describe the early death of a parent, parental quarrelling, broken homes, undue parental harshness and sometimes very gross cruelty or neglect. Alcoholics who have lost a parent early in life, or have grown up with parents who were psychologically disturbed or poorly adjusted to each other, show in their adult behaviour the effects of these gross traumas. The disturbing experiences which played a part in the genesis of distorted personality functioning, therefore, are not hard to find. The self-damaging attitudes of some alcoholics are clearly derived from relationships with their parents whose quarrelling between themselves often resulted in strife in the home. Patients are often well aware that the distress they experienced in childhood induced reactions which continue to disturb their adult adjustment.
The scheme of psychological development which we have outlined, with the theory of retention of residues of infantile patterns of behaviour, is of great value in understanding personality structure. The evolution and the current functioning of the alcoholic’s personality help us to understand both the basis on which his alcoholism has developed and his behaviour during the course of drinking. We can now go further and perceive the effect of alcohol itself on personality function.
The three components of a person’s psychological system are his ego (the conscious, realistically-directed, responsible self), his retained feeling residues of the infantile self, and his conscience, derived from the moral values of his parents. These three components must integrate with each other if behaviour is to be both appropriate and effective. Harmonious integration is dependent on the coordinated activity of the brain. But brain function is impaired by alcohol, so that even his precarious integration is lost to the alcoholic when he is drinking excessively.
Psychological concepts, although they clarify our understanding of the behaviour of an alcoholic by defining how the past is transferred to the present and influences a person’s manner of dealing with current situations, cannot explain exactly why one individual and not another becomes an alcoholic. What they permit us to understand is which regressed personality aspects are allowed outward expression in the course of alcoholism, and why particular personalities are more prone than others to become addicted to alcohol.
Many and varied influences combine to generate alcoholism. There is no single cause. No one factor is sufficient by itself. Social, psychological and physical factors have all operated to produce the established alcoholic.