What is the Spiritual Malady? A Deeper Look

A few years ago, in a psychology magazine, I came across this description of a psychopath:

"Negative feelings and emotions, remorse, guilt, shame, shattered self-esteem, self-doubt, even self-loathing; loneliness, alienation, apartness, isolation, depression and feelings of hopelessness, futility and a pervasive sense of meaninglessness of life."

What struck me was that this is also the exact inner experience of an alcoholic, drinking or not, before finding and growing toward a spiritual solution. The only real difference: alcohol never gave the psychopath any relief the way it gives the alcoholic ease and comfort. That's part of why some of them end up committing acts of horrific violence, there's no substance that quiets the noise.

Imagine reading that quote without saying who it describes, then asking the room if anyone doesn't relate. The point: when we rush newcomers past the Steps, this same inner experience keeps running, except the one thing that ever gave them relief from it (alcohol) has been taken away.

The spiritual malady, defined

The disease of alcoholism has three parts: physical, mental, and spiritual. The spiritual part is the deepest, sometimes called untreated alcoholism, whether currently drinking or not. It's caused by self-centred fear.

"Selfishness – self-centeredness! That, we think, is the root of our troubles." — Big Book, p. 62

"When the spiritual malady is overcome, we straighten out mentally and physically." — Big Book, p. 64

That's the whole case for why stopping drinking isn't the same as recovering: if you don't grow spiritually, your inner life gets worse, because the root problem was never addressed.

If any of what follows describes your current experience, the argument goes, you're closer to your next drink than you'd like to be.

Voices from the rooms

The problem drinker vs. the alcoholic

The difference between a problem drinker and an alcoholic is that when the alcohol is taken away from the problem drinker, the problem goes away. But when the alcohol is taken away from the alcoholic, the problem begins.

Once you take alcohol away from an alcoholic, all that's left is the ic (pronounced "ick").

On integrity and the gap between who you want to be and who you are

I wanted to be able to have some integrity but I was not who I wanted to be... One of the things that I had to finally discover was I do not have the power to be what it is I'd like to be. No matter how much I might wish to be that way, I don't have the power. And the conflict that arises as a result of having the grandest intentions but not having the power to live up to those intentions creates more discomfort than I can bear. And so the alcoholic has no choice but when you get into that conflict, ultimately you have to drink... What I want is oblivion. That's where the dis-ease of alcoholism untreated will carry you to. It's not that I don't want to be HERE, it's that I don't want to be here - anywhere else either. So unless I can experience an entire psychic change, there is little hope that I am ever going to recover.

If you can't handle drinking & you can't handle not drinking, then AA's for you. - Clancy I.

On why sobriety alone isn't the ask

To recommend just sobriety is just about impossible for an alcoholic. The reason we drink is because we can't stand living sober. It hurts too much - it's too confusing. When I'm filled with self, there's nothing but suffering. - Don P.

Alcohol-ISM, spelled out

I, Self, Me // I Sponsor Myself // Internal Spiritual Malady (or Maladjustment) // Incredibly Short Memory // InSide Me // I Sabotage Myself.

Drinking as a symptom, not the problem

...my drinking problem was a SYMPTOM, not the PROBLEM. That just startled me that AA told me that drinking was NOT the problem. They said that what we do in AA once we've taken our last drink of alcohol is we use the Twelve Steps... to find a different way to live. A way to live that's sufficiently better than the way we lived before so we don't have to go back to drugs or booze to do something for us that we are unwilling or unable to do for ourselves... If we don't find another way to live, we're going to go back to booze because we don't know how to live without it... There was zest, a vitality, an energy & a sense of humor that I've loved ever since I walked into the doors of AA & it started giving me a sense of hope.

Selfishness, self-centeredness, and needing help you can't provide yourself

"Above everything I must be rid of this selfishness. I must or it kills me." ... If the SELFISHNESS does not go, it'll create a condition within us called the spiritual malady that is so uncomfortable that at some point in time my mind will remember something that will treat that, called alcohol. And I will pick up a drink of alcohol and activate a phenomenon called craving. So this is my problem – my selfishness, my self-centeredness... "God makes that possible and there often seems no way to get rid of SELF without His aid." I have moral and philosophical convictions galore. I cannot live up to them even though I'd like to. Neither can I reduce my self-centeredness much by wishing and trying on my power. I had to have God's help!... Is there anything you've ever been able to do to get rid of your selfishness? No. And that is what I'm going to die from - drunk or sober. Why? Because that isn't how the Universe works... The Universe works along the will of the CREATOR, not along the will of ME. When I am into selfishness and self-centeredness I am going against how the Universe works - and I will always be in turmoil. ALWAYS.

"A list of my finer qualities" - the maladjusted self (channeling Dr. Silkworth)

A longer, half-satirical self-portrait of the untreated alcoholic condition - drinking or not:

Although I look like a full grown adult, I remain childish, grandiose & gravely emotionally immature. As a going human concern, my natural state is one of growing anxiety, depression & fear, coupled with an intense desire for excitement... Mentally, my thought life is controlled by a hundred forms of fear, self-delusion, self-seeking & self-pity... Socially, I'm a bankrupt idealist & brooding perfectionist who lives defensively & guarded in fear of being found out... I demand the absolute possession & control of everybody & every circumstance that enters my arena of life... My outstanding characteristic is defiance, & rebellion dogs my every step. Now, as a child of God, that is a list of my finer qualities (anybody want a date?). You'll hear this at every meeting you go to, but from newcomers, this is how you hear them: "I don't fit in, I don't belong, I'm not a part of, my God what's wrong with me - I must be different." And the only thing that satisfies that restless, irritable, dissatisfied nature in me is alcohol or drugs.

Straight from the Big Book

Evidence of the malady in the text itself:

They are restless (which is that sense that something's missing), irritable (which means "easily annoyed") and discontented (which means "never satisfied"), unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks. - p. xxvi-xxvii

…plagued by waves of self-pity and resentment. - p. 15

But not so with the alcoholic illness, for with it there goes annihilation of all the things worth while in life. It engulfs all whose lives touch the sufferer's. It brings misunderstanding, fierce resentment, financial insecurity, disgusted friends and employers, warped lives of blameless children, sad wives and parents - anyone can increase the list. - p. 18

We were in a position where life was becoming impossible…go on to the bitter end, blotting out the consciousness of our intolerable situation as best we could. - p. 25

Nervousness, anger, worry, depression, jealousy or the like. - p. 37

We were having trouble with personal relationships, we couldn't control our emotional natures, we were a prey to misery and depression, we couldn't make a living, we had a feeling of uselessness, we were full of fear, we were unhappy, we couldn't seem to be of real help to other people - was not a basic solution of these bedevilment's more important than whether we should see newsreels of lunar flight? - p. 52

Our friend was a minister's son... For years thereafter he was dogged by trouble and frustration. Business failure, insanity, fatal illness, suicide; these calamities in his immediate family embittered and depressed him. Post-war disillusionment, ever more serious alcoholism, impending mental and physical collapse, brought him to the point of self-destruction. - p. 56

The actor metaphor (pages 60–62) - one of the Big Book's most quoted passages:

The first requirement is that we be convinced that any life run on self-will can hardly be a success... Most people try to live by self-propulsion. Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way... What usually happens? The show doesn't come off very well. He begins to think life doesn't treat him right... Is he not really a self-seeker even when trying to be kind?... Selfishness - self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate... So our troubles, we think, are basically of our own making. They arise out of ourselves, and the alcoholic is an extreme example of self-will run riot, though he usually doesn't think so.

Suppose we fall short of the chosen ideal and stumble? Does this mean we are going to get drunk. Some people tell us so. But this is only a half-truth. It depends on us and on our motives. If we are sorry for what we have done, and have the honest desire to let God take us to better things, we believe we will be forgiven and will have learned our lesson. If we are not sorry, and our conduct continues to harm others, we are quite sure to drink. We are not theorizing. These are facts out of our experience. – p. 70

More than most people, the alcoholic leads a double life. He is very much the actor. To the outer world he presents his stage character... Coming to his sense, he is revolted at certain episodes he vaguely remembers... He is under constant fear and tension, that makes for (or leads to) more drinking. – p. 73

The alcoholic is like a tornado roaring his way through the lives of others. Hearts are broken. Sweet relationships are dead. Affections have been uprooted. Selfish and inconsiderate habits have kept the home in turmoil. – p. 82

The less people tolerated us, the more we withdrew from society, from life itself. As we became subjects of King Alcohol, shivering denizens of his mad realm, the chilling vapor that is loneliness settled down... Some of us sought out sordid places, hoping to find understanding companionship and approval. Momentarily we did -- then would come oblivion and the awful awakening to face the hideous Four Horsemen -- Terror, Bewilderment, Frustration, Despair... He cannot picture life without alcohol. Some day he will be unable to imagine life either with alcohol or without it. Then he will know loneliness such as few do. He will be at the jumping-off place. He will wish for the end.

We have shown how we got out from under. You say, "Yes, I'm willing. But am I to be consigned to a life where I shall be stupid, boring and glum, like some righteous people I see? I know I must get along without liquor, but how can I? Have you a sufficient substitute?" - p. 151-152

Requiem for an Alkie

A eulogy, proof that the malady kills without a relapse:

We don't have to drink to die of alcoholism. We buried him yesterday. The County Coroner had published the required notices for next of kin and nobody had claimed the body. It was just myself, and his sponsor. Not even a preacher - the county doesn't pay for those.

Not much of send-off, and not the one David had asked for. A cheap coffin, a backhoe digging a hole, and that was it - another old AA gone.

He had been sober over 20 years and in AA over 30, a stern and rigid man who tried to soften his edges and never could. He was a loner, a fringer, an isolated man at the edge of life's good things. He hung in there...and in the end hung himself.

I don't know why; I can't know. I know there had been a diagnosis of senile dementia, and I know that the doctor had added cancer to the list. But, I've seen AA's deal with such things before... I don't know why David decided he couldn't.

It isn't the first time I've been through this in Alcoholics Anonymous. I've known several over the years who just up and walked out life's door one day. Sober, but not happy. Sober, but not at peace. Sober, but they died of alcoholism. Our disease doesn't need us to drink in order to kill us. I wish more folks knew that, and appreciated it.

Alcoholism is the only disease that is entirely capable of fighting back, of taking care of itself, and of emerging in new places and new forms when it isn't properly treated, whether we are drinking or not. That's because of the spiritual malady. Most people think that has something to do with prayer or with God. It doesn't. It has to do with 'our spirit'...that force which animates, motivates and propels us. There are aspects of alcoholism that are mental, psychological and spiritual, which need to be healed with more than just not drinking. That's why there are TWELVE Steps, not just the first one.

As an alcoholic, parts of my spirit are blocked off. It is left unconscious, unrealized. My character, or basic nature, doesn't work right. At its root, it is a fundamental and seemingly irresolvable insecurity...a hole that can't ever be filled. It is an instinct run rampant, a desperate need for acceptance and love that cannot be met... We are obsessed with ourselves, and from this condition of mind...the insanity of feelings gone haywire, we become self-medicators eventually. We discover alcohol or something else...and the stuff quiets the voices, provides the relief we've never been able to find in any other way. It isn't any wonder we drink, or drug, the way we do. And some of us don't develop an addiction...in attempting to meet these crying demands of our blocked spirit, we develop other malformations of behaviour, and suffer in a hundred different ways.

God broke David's obsession to drink. But, I don't think David ever truly understood his disease... His rigidity, coldness, aloofness, isolation and difficulty with other people were a reflection of the pain in his heart...of the disease of alcoholism gone deep inside, still active even though he hadn't had a drink in many years.

Alcoholism didn't need David to drink in order to continue trying to kill him, and in the end...it succeeded. In the end, instead of self abandoned...David abandoned hope...and discovered a bitter end.

Our recovery from alcoholism through the Steps must be a three-fold process. It is not one-dimensional. When we say, in AA, that our solution is like a triangle...recovery, unity, service...we mean it. In working the Steps, I clear a pathway for three purposes...first, to come into a group of human people and away from the fringe of society where I have spent most of my emotional life. Secondly, to awaken spiritually to the parts of our spirit that have been blocked off and left unconscious. And thirdly, discovering "belonging" and continued spiritual growth through service to the people within that group. It is only this entire, threefold process that heals.

Perhaps the 12th Step says it best: "Having had a spiritual awakening as the result of these Steps (recovery), we tried to carry this message to other alcoholics (service) and practice these principles in all our affairs (unity)."

You see, I cannot hold back. I must not continue to suffer that shyness, aloneness, that overwhelming sense of separation in the different aspects of my life. I must get involved in a group of people to practice these principles in all my affairs. Only the total approach is healing. Anything less is little more than driving my disease deep...and if I do that...it will continue to eat away, trying to destroy me.

It destroyed David. This is a memorial to an old AA who gave it his best shot, but there were a lot of old ideas about self that David never fully dealt with by using ALL of the solution AA has to offer.

He is at rest now. But it says somewhere that "no matter how far down the scale we have gone, we will see how our experience can benefit others." David cannot speak to his experience any longer; I am speaking in his memory.

And I think that if David could talk to us today, he'd say "Understand your disease thoroughly, and work the complete program of recovery!"

What About Members With Long-Term Sobriety?

(Excerpted from Akron Intergroup News, December 1998)

The piece makes the case that we watch newcomers closely for good reason, but relapse symptoms are often harder to spot in members with long-term sobriety - because by the time cravings are gone, "call before you pick up" doesn't work the same way. Instead, a slower, quieter shift happens: weeks or months of irrational thinking about life, work, the program, loved ones - until drinking becomes, in a sense, the "natural, instinctive reaction."

The antidote offered: trust between members, and the willingness to confront a struggling friend with compassion, in true 12th Step spirit. Below is the full checklist of relapse symptoms to watch for - in yourself or someone close to you:

1. Exhaustion - Allowing oneself to become overly tired; usually associated with work addiction as an excuse for not facing personal frustrations.
2. Dishonesty - Begins with a pattern of little lies; escalates to self-delusion and making excuses for not doing what's called for.
3. Impatience - I want what I want NOW. Others aren't doing what I think they should or living the way I know is right.
4. Argumentative - No point is too small or insignificant not to be debated to the point of anger and submission.
5. Depression - All unreasonable, unaccountable despair should be exposed and discussed, not repressed: what is the "exact nature" of those feelings?
6. Frustration - Controlled anger/resentment when things don't go according to our plans. Lack of acceptance. See #3.
7. Self-pity - Feeling victimized, put-upon, used, unappreciated: convinced we are being singled out for bad luck.
8. Cockiness - Got it made. Know all there is to know. Can go anywhere, including frequent visits just to hang out at bars, carry-outs, boozy parties.
9. Complacency - Like #8, no longer sees value of daily program, meetings, contact with other alcoholics (especially sponsor!); feels healthy, on top of the world, things are going well. Heck, may even be cured!
10. Expecting too much of others - Why can't they read my mind? I've changed, what's holding them up? If they'd just do what I know is best for them? Leads to feeling misunderstood, unappreciated. See #6.
11. Letting up on disciplines - Allowing established habits of recovery — meditation, prayer, spiritual reading, AA contact, daily inventory, meetings — to slip out of our routines; allowing recovery to get boring and no longer stimulating for growth. Why bother?!
12. Using mood-altering chemicals - May have a valid medical reason, but misused to help avoid the real problems of impending alcoholic relapse.
13. Wanting too much - Setting unrealistic goals; not providing for short-term successes; placing too much value on material success, not enough on spiritual growth.
14. Forgetting gratitude - Because of several listed above, may lose sight of the abundant blessings in our everyday lives: too focused on #13.
15. "It can't happen to me." - Feeling immune; forgetting what we know about the disease of alcoholism and its progressive nature.
16. Omnipotence - A combination of several attitudes listed above; leads to ignoring danger signs, disregarding warnings and advice from fellow members.

Practical advice embedded here: treat this as a short-form 4th and 5th Step process - go through the list honestly, and if you see yourself (or a friend) in several of these right now, that's the signal to talk about it openly rather than push it down.

The Insanity — from My Name Is Bill W.

A scene from the 1989 Hallmark Hall of Fame film, starring James Woods as Bill Wilson. Bill has just come down from another drunk. Lois comes home, hangs up her coat, and asks:

"Does it have anything to do with me...your drinking?"

"No, it's not you. It's me."

"Why? Why do you do it to yourself?"

"I've been standing here all afternoon asking myself the same question. I look out the window and I watch all the normal people walking by. It's funny, I don't think I've ever felt really normal all my life, I mean like other people. I feel different somehow, like I don't really measure up. Ever since I can remember, I've had this feeling, deep down in my gut...scared. I see people laughing, at ease with each other. I'm on the outside looking in, afraid that I won't be accepted. And then overseas, I found that a drink...a few drinks...makes me feel comfortable, like I always want to feel. It gives me courage...to be with people, do things...to dream. The money, the success, the respect...it was all good for a while, but it never seems enough. I always want doubles of everything to make me feel alive, worthwhile inside. And then, it all began to slip away. I feel cheated, angry, always so full of fear...so I drink. More. And it makes it OK for a while. I convince myself that things will turn around, tomorrow, soon. That I'll make it all up to you. But it only gets worse. I...I keep promising you, others, myself...'That's it, no more, going on the wagon. THAT'S IT!' And I think I mean it. But the guilt and the depression...I can't look in the mirror, or at you...especially at you. I've stopped believing in everything, people, God, myself. I know it sounds insane, Lois, but in spite of all this, what I want right now more than anything else...is another drink."

Pulling it together

Every piece here - the clinical quote, the AA shares, the Big Book passages, the eulogy, the checklist, the movie scene - is making the same argument from a different angle: alcohol is not the disease, it's the coping mechanism for one. The disease itself is a blocked-off spirit, driven by self-centered fear, that produces the same restless, isolated, hopeless inner state whether or not a person is drinking. Sobriety removes the coping mechanism. Only the full three-fold process - recovery, unity, service - actually treats the underlying condition. Skip that, at any stage of sobriety, and the malady is still fully capable of doing damage - sometimes fatal damage - on its own.