In the consulting room the young psychiatrist is introduced to Mick the alcoholic, who has been making death threats to various people in his drunken, paranoid rages. A consultant tells Mick that any threats of violence he makes will be reported. The young psychiatrist notes the tactic. “This is to remind him that he is a moral agent, that there are consequences,” even although the police can’t actually do anything until actual violence has occurred. The Mental Health Act does not permit action to be taken for addiction — for the phenomenology of an illness — only actions (details?). Mick, however, has a different take. “This is my character,” he says. “I am an alcholic, and I threaten people. That’s who I am. It’s your job to deal with me.” He would rather live with his paranoias, rages, screaming demons of panic and poverty than do anything. But he does think somebody else should do something.
Let’s call Mick “Alcoholic Two,” because he represents the middle of our three characters. He believes he has been consigned to addiction by his “character.” There is convenience in his biological determinism, as well as, probably, some truth. He feels he doesn’t have to take responsibility for himself. There is a missing moral agency. There may even be neuro-wiring at work (details?), weakening the decision-making capacity.
Later, Alcoholic One comes into the room. He is the bottom of the ladder of addictive disorders. He barely needs a name, because the psychiatrist feels he barely exists as an individual. He lives in filth and drink, is not quite homeless, but is basically a tramp, and looks like one, covered in his own shit. He is locked up, cleaned up, and detoxed (under what powers?). When he comes back to the psychiatrist, there isn’t even the attempt at self-justification, or a need to shift responsibility. He ignores questions, reacts with grunting, animal resentment to any suggestions. The horror of his life is meaningless to him. Despite being sober and clean, he only wants a drink. And this is what he will get. Until he is back, literally, in the shit again.
Leonard is Alcoholic Three. He is a talented writer, powerful intellect and dedicated family man. At least, he is now. For 20 years he was a drug addict and alcholic. Now he takes only coffee and roll-ups. For many years he was in various kinds of psychoanalysis. The Freudians blamed his mother. Indeed, he did have a dreadful family life. While his mother was dying, he still blamed her. Then she died, and he wondered if maybe children can fuck up their parents, as well as the other way round. He ended up sacking all his analysts. Looking back, he now recalls several sessions with one ridiculous old Freudian. Leonard would come in, strung out on heroin, coke, booze, whatever. And they would talk about his mother. The Freudian didn’t care that there was a crazed elephant mind-bending intoxication in the room. He thought it came down to the mother-son relationship. In the end, Leonard came to believe that he was, like Mick, an addictive personality. It was what his parents gave him, but in the form of genetic make-up rather than family background. But, unlike Mick, having accepted that, he decided never to have another drink or fix again. Now, the raging agression has gone; Leonard turns out to be affectionate and attached to his children. Of course, the difference here may be that he had more to aspire to than Mick, that drugs stopped him developing as a writer and a man. And that he had a wife who helped enforce the AA meetings, and life on the wagon.
What are the differences between alcoholics 1 to 3? Not social circumstances alone, surely? Otherwise, all drinkers with Mick’s background would be alcoholics. All three seem to have “addictive personalities.” Perhaps the difference is one of degree in terms of character, multiplied by certain life-factors.
But whatever the equation, it doesn’t help Mick’s psychiatrist. Here is a drunk who refuses to deal with the misery he causes, to himself and to others. He is not, yet, a criminal. How do you “diagnose” him? How do you treat him? How do you deal with him?
