In a previous column Dr. Mooney and I looked at the link between genetics and the disease of alcoholism and the neuropharmacology that leads to the compulsion to drink. We saw that once there is the onset of the disease that certain neuro-chemical sequences occur in the brain each time alcohol is introduced into the system setting up a cycle that will require the continued presence of alcohol in the system. This compulsion to drink is usually linked with the drinker’s denial that he or she has any problem. To the addicted and non-addicted person alike this denial of a problem is one of the most frustrating, least understood aspects of the disease.
This article will try to help us better understand this concept which is referred to as denial. First we must clear up some confusion; often people think that denial is a form of mental illness. Non-addicted people suggest this because it seems “crazy” for the alcoholic to deny that he has a problem when his or her drinking is causing his family to break up, or creating financial problems or causing his law practice to decline. Denial is not a type of mental illness, but the fact that people may think it is reflects the imprecision of the term. The word denial implies that there is some conscious process going on, when there is not. A more accurate term would be self-deception. Let’s look at what happens.
An alcoholic has a biochemical compulsion to drink. When you have a compulsion to drink the natural response is to drink. If you drink compulsively you get drunk or reach a functional state of intoxication. After you get drunk the natural thing that happens is you get in trouble from your drinking. This is the basic progression of alcoholism. Two incompatible behaviors are created: first the physiological need to drink and second the irresponsible behaviors that come with the altered mental and emotional state of intoxication.
The self-deception is the process by which the psyche seeks to reconcile these two conflicting outcomes: a) the physical need to drink; and b) the negative physical behaviors that come with intoxication. In other words the mid-brain, the site of the altered neurochemistry of addiction tells the body I have to have this chemical and yet when it is ingested the drinker engages in conduct governed by his intoxication that is at odds with his or her own values. These two conflicting internal messages create a pressing need in the psyche for reconciliation, to bring about an inter-psychic truce so that the person can drink and not have severe mental anguish.
So how does the mind do this? It does this by developing a pattern of rationalizations, of self-deception that go something like this: I don’t mind being a little irresponsible, I have spent too much of my life being uptight; or I don’t mind if my children don’t have a sober father at home, they need a few challenges so they will be able to face the real world; or I don’t mind drinking up the money I would use to send my kids to college because they will be a lot better off if they have to work for an education; or my spouse really isn’t the sort of person I thought he/she was when we married, so my infidelity is really not inappropriate. In other words there is a slow erosion of the person’s ordinary value system so that the person never has to look at his or her alcohol use in a negative way. The trouble created by alcohol use isn’t seen as trouble. It is seen as problems that others cause. Lawyers are particularly good at this self-deceptive thinking because they are trained to believe that every situation has two sides.
A few people will not be drawn into self-deceptive thinking, these will see the consequences of their drinking and decide to stop drinking. Often this group will be made up of strong willed people like lawyers often are. They will go cold turkey, try to stay sober without any treatment. What happens here is that the river of compulsion continues to flow and the lake eventually over runs the dam of the will and breaks. This is the pattern of the remorseful drinker who quits and then binges. This pattern continues over and over again unless the drinker chooses AA or treatment.
For some the pressure on the value system of the psyche is such that in order to reconcile the compulsion to drink and the negative behavior caused by it the mind creates a delusional system of thinking. This is a further extension of the type of self-deception described earlier. Examples: I know that I have a drinking problem but I read in the newspaper that if I drink then my cholesterol would be better. Or, my doctor told me to take one or two stiff drinks after work and all I am doing is following my doctors instructions, as to what is a good way for me to handle my stress (despite the fact that I have just gotten my third DWI and my wife left me a year ago).
Sometimes this sort of self-deceptive or delusional thinking can become a self fulfilling prophecy. For example: Yes, I’m nervous and shaky and the only thing that makes me feel better is another drink.
Denial then is a way the alcoholic can justify drinking over and over again in spite of the self destructive problems caused by it. Denial is a defense mechanism that allows the neurobiological compulsion to be released. This same defense mechanisms is seen with other diseases. Dr. Mooney recalls, “I had a patient diagnosed with cancer. She had pain in her back related to the cancer and an abnormal chest X-ray that showed that the cancer had spread. We talked about the problem and had a biopsy done. In our conversation it was like she said well I know that you are fresh out of medical school and you wouldn’t know how to read one of those biopsies and I’ve been working in my kitchen all week and sweeping with my broom and that has left me with back pain. And I’ve had a cold lately and that is the spot you see on my lungs. Her denial system took every piece of information that was used to confirm her diagnosis and used the same information to say that she had no malignancy.”
This is the same thing that an alcoholic does, but in the case of the alcoholic there is not just fear of a fatal disease that drives the self-deception, but also a physical compulsion to drink. This is why it is so hard for people to understand the chemically addicted person, because his or her behavior often looks crazy or anti-social. Actually their behavior reflects the operation of ordinary defense mechanisms attempting to allow them to survive, and it makes logical sense in the state of compulsion existence they are in.
From, The North Carolina State Bar Journal, Vol. 1, No. 1, Fall 1996
Tags: alcoholism, denial, self-deception Posted by