Interior States

by Meghan O'Gieblyn

  As the theater lights come on and people begin filing out of their rows, Barrett and I just sit there, blinking away the brightness, listening to the dwindling voices of the other patrons.

  While the Earth remains.

  As we sit in the emptying theater, I realize what was missing from the film—not the beginning, but the end. After all, believers know that a worldwide catastrophe is, without a doubt, coming. It’s not preached much from the pulpit these days, but my Christian friends and family members often remind me that God will return to destroy the world. The Gospel of Matthew says, “As it was in the days of Noah, so it will be at the coming of the Son of Man.” Of course, many evangelicals believe that by the time the apocalypse hits, the followers of Jesus will have been raptured, taken away to heaven. Like Noah and his family, they will be plucked out of the chaos and allowed to watch from a safe distance as God destroys the Earth: the plants and animals, the mountains and the seas, the rivers and the deserts. All of it consumed by fire. If this is how the world ends—if God has such little regard for his own creation—then why should his followers bother trying to preserve it? The irony is that Ken is building an ark—a symbol of global catastrophe—at a moment when our seawaters are rising and environmental disasters of a biblical scale are becoming a real possibility.

  Outside the Creation Museum, dark rafts of cumulus clouds are amassing, threatening a storm. We get in the car, driving away along a stretch of parched farmland, the fields gone sallow from the recent drought. Barrett flips through some of the museum’s promotional brochures before tossing the glossy pamphlets into the backseat. “I don’t understand why Ken is even bothering to build the Ark. Why does he need to spend all this money and waste all these resources to prove something he already knows is true?”

  “It’s not for him,” I say. “He’s making it for people like us. So we’ll come here skeptical and be converted by the truth.”

  “You think that’ll happen?”

  “To me?”

  “To anyone.”

  I’d like to say no, but I’m not so sure. Ken is fond of ranting against the evils of postmodern relativism, where opinion carries more weight than fact, and all evidence is subject to interpretation. Yet this is precisely the environment that allows pre-Enlightenment thinking like creationism to thrive. If Ken Ham’s worldview is considered a viable product in the marketplace of ideas, it’s because ours is a culture that has lost faith in objective authority—one where opinions are swayed not by the integrity of the argument but by the pyrotechnics of its presentation.

  When I was a kid, the church saw itself in opposition to this sort of relativism—an island amid a sea of shifting truths. And I suppose that in coming to the Creation Museum, the backwater fringe of evangelicalism, I’d expected to find some remnant of this older, near-extinct form of Christianity—one unconcerned with passing fashions, one that was secure in the mysteries of scripture. Instead, I found the church’s latest attempt to bewitch unbelievers with glitzy multimillion-dollar productions. Evangelicals like to claim that theirs is a religion of immutable absolutes, and yet attractions like the Ark Encounter belie the church’s increasing willingness to engage in the kind of market-driven natural selection that increasingly determines “truth” in our culture—call it the survival of the slickest. It’s a worldview that precludes the very possibility of inconvenient truths.

  As we head north, I roll down the windows. The sky has gone black, and the air possesses the damp coolness of the hours that precede a storm. But as we continue our drive home, the sky clears, and night falls, and days pass before the rain finally comes.

  2014, Oxford American

  THE INSANE IDEA

  Last April, the Atlantic published a feature-length takedown of America’s longest-standing mutual aid fellowship. “The False Gospel of Alcoholics Anonymous” was the work of Gabrielle Glaser, who delivered the bad news in dry and dismal statistics. According to modern studies, AA’s success rate is between 5 and 8 percent. Glaser claimed she was surprised by the numbers (“I assumed as a journalist that AA worked”), though the article betrayed a long-standing skepticism. Over the past few years, Glaser has been advancing the message in major news organs that twelve-step programs are bad for everyone, including women (Wall Street Journal), teenagers (New York Times), heroin addicts (The Daily Beast), South Africans (Marie Claire), and doctors (Daily Beast again). But at eight thousand words, the Atlantic article was longer and received far more attention than did her earlier articles. It also offered the most complete formulation of her case. “The problem is that nothing about the 12-step approach draws on modern science,” Glaser wrote, “not the character building, not the tough love, not even the standard 28-day rehab stay.” If alcoholism is truly a disease, why is the default treatment a spiritually oriented support group run by nonprofessionals?

  The story brought to the surface long-harbored suspicions about the idiosyncrasies of AA: its tent-meeting lexicon, the curious symmetry between the twelve steps and the twelve apostles, the whiff of secrecy and anonymity, the catacombic meeting spaces. During Glaser’s media tour following the article’s publication, news anchors and radio hosts were eager to connect the dots in places where the article had doubtlessly been constrained by fact-checkers. (“Let’s go conspiracy theory just for a moment,” said one radio host.) Glaser played her part by referring to the text Alcoholics Anonymous as AA’s “bible” and by claiming that members were ordered off their psychiatric drugs and forbidden from consulting doctors. When one host asked her to impart some closing words, she spoke as though voicing a public service announcement: “If you are concerned about your drinking, it is really helpful to say to yourself, You can change your drinking yourself. You have agency; you have control over it.”

  When Glaser’s interviewers began citing counterarguments, Glaser responded with science: not, that is, with statistics or data, but literally with the word “science.” “Epiphanies are not science,” she remarked in response to the claim that AA’s religious focus could be helpful. In reply to the observation that AA has worked for a lot of people, she said, “But that’s not science. That’s anecdote.” Then she resorted to anecdote herself: “Hundreds of people have written to me to say that they were ordered off their meds by their sponsor for their mood disorder.” On NPR’s All Things Considered, she dropped her voice and spoke in a breathless, confiding tone: “Someone sent me an email this morning about a younger brother who committed suicide last night with the [AA] Big Book and a glass of scotch next to his bed.”

  All of this might be dismissed as an isolated media event—another story to satisfy our wolfish hunger for seeing respected institutions tarnished by scandal and exposé. But attitudes toward addiction, which Aristotle called one of the “irrational passions,” have long offered a revealing window into cultural assumptions about human behavior. And although Glaser often presented herself as a voice in the wilderness, she is not the only one who has felt compelled to deliver the inconvenient truth about AA. Last year, Dr. Lance Dodes, a retired Harvard psychiatry professor, published The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, which he co-wrote with his son Zachary. More recently, Dr. Markus Heilig, of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), echoed Glaser’s call for more “evidence-based” treatment in The Thirteenth Step: Addiction in the Age of Brain Science. AA has attracted critics since its inception, but these authors constitute something of a new breed, and their work shares a central thesis: while AA maintains a special place in the American imagination, the data is clear that it simply doesn’t work.

  This charge is, it turns out, easy enough to refute; what makes these books worth pausing over is the sensibility that motivates them. Beneath the number crunching and the medical jargon lies the conviction that AA is not just ineffective but incoherent, repellent even. In the end, the most recent skirmish in th
e long quarrel between AA and its “scientific” critics hinges upon a question of human agency: Can the individual really—as Glaser alleges—help herself?

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  Alcoholics Anonymous’s recent critics are united in presuming that science has not yet been harnessed for the treatment of addiction. In fact, scientists have been probing at alcoholism since before the Progressive Era. In 1870 inebriety was officially pronounced a “disease” by the American Association for the Study and Cure of Inebriety, an institution that declared, somewhat prematurely, that alcoholism was “curable in the same sense that other diseases are.” Of course, the “cures” were rarely effective; some were actually dangerous. For nearly a century, hydrotherapy was the leading treatment for alcoholism. Nurses would wrap the detoxifying patient in cold, wet sheets, swaddling him for many hours. If that didn’t work, the drunkard might be subject to an electric light bath, a method used by almost all of the leading hospitals of the world. This technique required locking the patient in a steel box, the inside of which was lined with plate mirrors, dozens of light bulbs, and steam coils to produce a sauna-like atmosphere. Medical authorities believed the light would purge “alcoholic germs” from the patient’s cutaneous tissue. This is to say nothing of prefrontal lobotomy, spinal puncture, colonic irrigation therapy, or the dozens of other addiction treatments carried out over the last century in the name of science.

  Medication, likewise, is hardly a new proposal for alcoholics. Throughout the nineteenth and early twentieth centuries, newspapers advertised a panoply of commercial tonics: the Fittz Cure, the Bellinger Cure, and the Tiplicuro. The most famous was Dr. Leslie Keeley’s Double Chloride of Gold Cure, a remedy composed of strychnine, cocaine, codeine, and morphine that was given to over half a million alcoholics between 1880 and 1920. Many of these medications were the products of charlatans—country quacks hoping to get rich off the cures—but the drugs recommended by the leading medical institutions offered little improvement over the commercial remedies. The Progressive Era was characterized by a frantic search for an alcoholism “vaccine”—one was made from the blood of horses that had been fed buckets of whiskey—and the twentieth century witnessed faddish experiments in “aversion therapy,” giving alcoholics drugs that would make them violently ill when they drank. Some of these aversion drugs are still on the market today (Antabuse is the most popular), though there is little evidence of their efficacy.

  From the beginning, some alcoholics sought alternative routes to recovery. In his history of addiction treatment in America, Slaying the Dragon, William L. White notes that throughout the nineteenth and early twentieth centuries many alcoholics banded together and offered one another support through a variety of mutual aid societies like the Washingtonian Total Abstinence Society, a fellowship of working-class men founded in the 1840s that held gatherings resembling a contemporary AA meeting. Members signed an abstinence pledge and told the story of their reform from a podium, drawing from the camp-meeting tradition of “experience sharing.” At the height of the movement there were more than 600,000 members throughout the United States; Abraham Lincoln, though a lifelong abstainer, was a vocal supporter of the program.

  Some fellowships, like Dr. Henry A. Reynolds’s clubs, were offshoots of temperance societies for those “addicted to strong drink.” Others grew out of fraternal orders. The Sons of Temperance was formed to address the need for mutual accountability and moral support. As one member put it, “a society was, therefore, needed which should offer a refuge to reformed men and shield them from temptation.” These were far from sparsely populated fringe movements: during the 1850s, the Sons of Temperance boasted 250,000 members, with chapters in every state. Like the Washingtonians, these groups emphasized experience sharing and provided a haven for reformed drinkers within a culture that still stigmatized addiction as a moral vice. Many of the personal testimonies demonstrate a surprisingly contemporary understanding of alcoholism as neither a moral deficiency nor a sign of poor education. In his speeches, Dr. Reynolds would often call attention to his knowledge as a physician, on the one hand, and his inability to control his own drinking, on the other: “I am a graduate of Harvard College, and received a thorough medical education, but I have been drunk four times a day in my office, and if there is any worse hell than I have suffered I don’t want to be there.”

  The popularity of such fellowships was undoubtedly fueled by the fact that professional medical treatments were so unhelpful. But these societies also sought to address addiction in ways that extended beyond the scope of medicine. Many were viewed as part of a “continuum of care.” While medical treatment was naturally isolating, taking patients away from their families, the fellowships provided a community to belong to once the work of the hospitals—detoxification and stabilization—was finished. The goal was to equip the alcoholic with the moral clarity needed to set things right with themselves and their social circles. Some, like the Washingtonians, even maintained a pool of money for the purpose of helping newcomers pay off their debts and court fees.

  Many of these organizations dissolved during Prohibition, and by the 1930s there were few remaining mutual aid societies. Like many wealthy alcoholics of that era, Bill Wilson, AA’s founder, spent much of his adult life receiving the latest and most expensive medical treatments, including hydrotherapy and the famous belladonna cure, an acrid cocktail of prickly ash and the hallucinogen nightshade. It was while taking belladonna at Towns Hospital in Manhattan that Wilson underwent his famous conversion experience. He saw a bright light and felt he was in the presence of God. “Scales of pride and prejudice fell from my eyes,” he recalls in the Big Book. “A new world came into view.”

  During the early months of his sobriety, Wilson often returned to Towns Hospital and asked to speak to the patients. It was there that he realized his urge to drink subsided when he was talking to other suffering alcoholics. “It was not just a case of trying to help alcoholics,” he wrote years later. “If my own sobriety were to be maintained, I had to find another alcoholic to work with.” As he began to sober up fellow patients, they too followed his method of working with other alcoholics. By 1939 there were a hundred men and women involved in this informal fellowship, and Bill began to devise a program of recovery based on the principle of “one alcoholic working with another.”

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  Alcoholics Anonymous is notoriously difficult to evaluate scientifically. Several observational studies have been quite favorable to the program—finding, for instance, that the longer people attend twelve-step meetings, the more likely they are to achieve long-term sobriety, or that engagement in meetings, as opposed to mere attendance, can be correlated with sobriety. But for many, such studies are innately compromised by the fact that their members self-select. In The Sober Truth, Lance Dodes dismisses the observational studies wholesale. The kinds of people who go to AA—moreover, the ones who stick around—are those who find it useful. What about everyone else? To really understand the effectiveness of AA, Dodes suggests, we must consider everyone who walks into the rooms, including those reluctant attendees who skulk into the back rows of speaker meetings, nod off during the Serenity Prayer, and never return. AA’s literature claims that those who fail to fully participate in the twelve steps tend to relapse, but for Dodes such warnings are little more than community propaganda, a way of blaming the participant when the program fails them. “Imagine if similar claims were made in defense of an ineffective antibiotic,” he writes.

  As the comparison makes clear, Dodes conceives of AA as a “treatment” for alcoholism, a term that assumes patient passivity and is at odds with how members often describe the program—as a spiritual discipline that requires its participants to engage in a series of actions and rituals. Yet it is the discussion of attendance versus participation that lays the groundwork for Dodes’s conclusion about AA’s inefficacy. Citing data from the NIAAA that cl
aims up to 31 percent of people who go to AA stick around for a year or more, Dodes then modifies those numbers to reflect attendance rather than involvement. If we include all the people who have attended at least one AA meeting but failed to get “actively involved”—according to one study, that number is around 79 percent—the success rate becomes significantly smaller. And because the NIAAA data does not specify how many of those attendees remained sober during their year of engagement, Dodes decides to dock the number an additional several percentage points for good measure. It is this gerrymandered set of data that leads Dodes to the conclusion that “roughly 5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than one year.”

  AA’s low success rate compels Dodes to look for alternative treatment paths, and The Sober Truth is ultimately an argument for his specialized brand of “psychodynamic” therapy, which is built on the proposition that the addictive impulse can be traced back to a single source: the desire to reverse a sense of “overwhelming helplessness.” According to this theory, AA’s poor statistical showing should come as no surprise, given that the program reinforces the addict’s sense of helplessness as opposed to combating it. The process of making amends, for instance, involves needless self-flagellation. Equally disturbing is the notion that addicts must rely on a higher power to stay sober, even if the step is interpreted, as it often is by AA’s more secular members, as making the group itself into the higher power. “The problem persists,” he writes. “Why can’t this ultimate power lie within the addict?”

  Glaser, who cites Dodes’s research several times in her Atlantic article, asks the same question in her book-length treatment of the subject, Her Best-Kept Secret: Why Women Drink—and How They Can Regain Control. The book, which bills itself as a clarion call for “evidence-based” addiction treatment, insists that the twelve steps—such as admitting “powerlessness” and submitting one’s will to a higher power—are particularly damaging to AA’s female members. Glaser tells the stories of several affluent suburban women who summon the courage to attend a meeting only to discover that it’s a massive downer. They don’t like that abstinence is nonnegotiable. They are horrified by the prospect of uttering the words “I’m an alcoholic.” They balk at the terms “powerlessness” and “surrender.” In her Atlantic article Glaser tells the story of Jean, a floral designer whose physician recommends she try AA: