From: rdh@Veritas.COM (Robert Hartman)
Newsgroups: alt.recovery,talk.politics.drugs
Subject: Disease models (was: Abstinence)
Date: 11 Sep 92 20:30:21 GMT
Followup-To: talk.politics.drugs
Organization: VERITAS Software

In article <1992Sep10.213219.1941@zip.eecs.umich.edu> carnes@quip.eecs.umich.edu (Richard Carnes) writes:

[ Cross-post to t.p.d left in this time; note followups to t.p.d only.
I don't read t.p.d, so if you want to respond from there, please do so
by e-mail.  Please do not reset the followup line.  The politics of all
this is a little bit removed from the charter of a.r.  Thanks.  -r ]

>I agree that AA offers a new way of life and doesn't just tell people
>to stop drinking.  However, I was primarily referring to clinic
>treatment centers that require abstinence.  It is arguable that
>drinking should be allowed in order to facilitate understanding and
>changing the drinking behavior.  It is as if a doctor merely
>prescribed aspirin to suppress the symptoms of a disease without
>treating the pathology.

Ah.  Now that makes more sense to me.

I too have problems with the psychiatric notion that elimination of
symptoms, e.g., "problem drinking," is sufficient--just as I have
problems with the idea that anti-depressants are sufficient to treat
chronic depression.  It would be really convenient if that were true.
But I don't think it is.

Where the psychiatric model breaks down is in recognizing the extent of
systemic emotional and personality disorders where symptoms aren't
readily measurable.  I saw Sybil last night, and the movie ended when
Sybil had gained access to her memories and integrated her sub-
personalities.  But from what I've heard from people in ISA, that is
only half the battle.

It seems to take a long time and a good deal of ongoing support to make
the adjustment after a person stops repressing the memories of
childhood abuse.  Integration, like abstinence, is only the beginning.
To imply that the multiple personality disorder is cured without
dealing with the ensuing post-traumatic stress disorder leaves the
patient high and dry.  So does a residential treatment program that
stops with either abstinence or apparent control over the behavioral
aspect of the disorder.  It's a partial treatment of symptoms only.
The underlying emotional pain still needs to be dealt with.  The
skills needed to live comfortably with, or perhaps outgrow, the
condition, must still be learned.  Otherwise, a person might
just be better off the way they were.

I guess I'm a little miffed that an incomplete conception of the
disease model of alcoholism has been adopted by the psychiatric
establishment as the "official medical" model, and that an incomplete
course of treatment developed from that model is being recommended and
followed.  But let's be clear.  What AA has to say about the disease of
alcoholism is very different from what you've claimed it says.  It
isn't AA who says that abstinence is sufficient.  Not at all.  

If the psychiatric establishment has cherry-picked from AA what fits
within it's narrow proximal cause-and-effect methodology and thrown
away the most important parts of the AA model, then what we have here
is two different models, albeit called by the same name.  I don't think
it would be fair to continue to attribute the latter, ineffective,
"medical" model to AA.

-r