Chapter 3 Cognitive Behavioral Psychology

The Neo-Freudians then further modified orthodox Freudian doctrine by talking about the importance of issues such as social factors, interpersonal relations, and cultural influences in personality development and in the development of psychological illnesses and disorders. They believed that social relationships were fundamental to the formation and development of personality. So in other words, they tended to reject Freud’s emphasis on sexual problems as the cause of neurosis, and were more apt to regard fundamental human psychological problems as psychosocial rather than psychosexual.

Bill Wilson’s name was linked to that of three of the Neo-Freudians: Adler, Horney, and Jung. His mother, Dr. Emily Griffith Wilson, had studied with Adler in Vienna, and after taking up residence in San Diego, California, lectured on Adlerian psychiatry and maintained a practice as an Adlerian psychoanalyst. In a 1956 letter, Bill W. gave special praise to the writings of another famous Neo-Freudian, Karen Horney. It should further be noted that from 1945 to 1949, Bill was working continuously on his depression with a psychiatrist named Dr. Frances Weeks who was a Jungian, and that the psychiatrist Carl Jung was also usually regarded as one of the Neo-Freudians, even if of a different sort.⁸¹

The kind of A.A. which Jack Alexander was exposed to when he was carrying out his research in the Fall of 1940 for the Saturday Evening Post article that appeared in March of 1941, used this kind of Neo-Freudian approach. Alexander picked up on these ideas and summarized them in his article, which (as we remember) immediately produced an outflowing of eager interest in A.A. all over the United States:

Frequently, the situation is complicated by an off-center home atmosphere in which one parent is unduly cruel, the other overindulgent. Any combination of these factors, plus a divorce or two, tends to produce neurotic children who are poorly equipped emotionally to face the ordinary realities of adult life. In seeking escapes, one may immerse himself in his business, working twelve to fifteen hours a day, or in what he thinks is a pleasant escape in drink. It bolsters his opinion of himself and temporarily wipes away any feeling of social inferiority, which he may have. Light drinking leads to heavy drinking. Friend and family are alienated and employers become disgusted. The drinker smolders with resentment and wallows in self-pity. He indulges in childish rationalizations to justify his drinking: He has been working hard and he deserves to relax; his throat hurts from an old tonsillectomy and a drink would ease the pain; he has a headache; his wife does not understand him; his nerves are jumpy; everybody is against him; and on and on. He unconsciously becomes a chronic excuse-maker for himself.⁸²

Nick Kowalski was a member of one of the two most famous early A.A. prison groups (his story is told in the book The Factory Owner & the Convict). Although brought up Roman Catholic, he was originally taught a Protestant style of A.A. with its heavy emphasis upon human powerlessness and the saving power of free unmerited grace. Like Bill Swegan, Nick was shaped at a profound level by the death of his mother when he was a little boy. In Nick’s case however, an extra dimension was added when one of the people at the orphanage commented right after he arrived on the first day, “Why he’s such a brave little boy, he doesn’t even cry.” The small boy was in fact totally shell-shocked and unable to even begin to comprehend what was happening to him as his father abandoned him and drove away. But little Nick decided, on the basis of the woman’s offhand remark, that praiseworthy behavior meant closing off all your emotions and driving off anyone who ever tried to get close to you, so you could stand there stiffly and pretend to feel nothing. And the diet at the orphanage was so poor, that he developed rickets, and his ribcage was partially sunken in. One of the other children at the orphanage told him (cruelly and ignorantly) that his sunken ribcage was because he was a “queer,” that is, a homosexual, which resulted in little Nick spending years trying never to let any of the other children see him with his shirt off. What developed was social isolationism, just as in Bill Swegan’s case, and a failure to learn how to function in normal society, but with Nick there was also the development of more and more dangerous attempts to “prove his manhood” and show he was a “tough guy” by falling into increasing criminality and violence. Nick ended up getting drunk out of his mind one night, and shooting and killing a stranger in a house of prostitution, for which he received a life sentence at the Indiana state penitentiary.⁸⁴

Recovering alcoholics are often able to pinpoint the exact year in their childhoods during which some kind of trauma blocked much of their further emotional growth. We could look for example at the life of Nancy Olson, a recovered alcoholic who became Senator Harold Hughes’ chief aide in charge of alcoholism legislation while the Hughes Act was being passed in 1970. A glance at a photograph taken when Nancy was nine years old, right after her mother and father had separated, shows a little girl with a thousand-yard stare of uncomprehending horror and grief, and a sticker pasted on the photo saying “Tomorrow Will You Know My Name?” Even as a highly competent adult, many years later, when Nancy was placed under certain kinds of stress, she reverted emotionally to behaving like that scared and angry little girl.⁸⁵

Submarine Bill C., when he was twelve years old, almost died as the result of a ruptured spleen received in a fall off a high cliff. As the youngest in a large family, he was already something of a spoiled child, but was now simply given everything he wanted, with never a hint of having to take any other person’s feelings and wishes into account, and grew into an adult who would explode (or seethe) in anger if he did not receive instant perfect gratification. Compounding the problem, when he was sixteen he contracted rheumatic fever and had to spend a year in bed. After being totally bedridden for so long, he was left quite physically weakened at first, and had a classical Adlerian response of an inferiority complex followed by over-compensation. He won a football scholarship to college, went out for Golden Gloves boxing, shot the prize deer in the Pennsylvania woods, and eventually became involved in sordid bar room fights, flirting with the ladies, and other activities of that sort: “playing the tough guy” and continually “trying to prove his manhood.”⁸⁶

If I may give my own interpretation of how I have seen this theory applied in practice, the people in the A.A. group who have already been sober for a long period of time “re-parent” the new arrivals. They serve as good fathers and good mothers, good older brothers and good older sisters, good uncles and aunts, and good grandparents, patiently showing the troubled alcoholic how to behave like an adult. Little children throw childish, out-of-control temper tantrums, while adults know how to express anger and disagreement in ways that make their disputes easier to resolve. Little children demand instant gratification, while adults learn to show patience and look toward delayed gratification. Little children can see only one moral issue at a time, while adults learn how to analyze situations in which several different competing moral claims may be placed on them simultaneously. 1 Corinthians 13 was cited again and again in early A.A. because it stated this so clearly. 1 Cor. 13:4-7 explains what adult love is, as opposed to childish love. For children to act like children is not evil, but after I reach my adult years, continuing to act in a childish and infantile manner is something that needs correcting: “When I was a child, I spoke like a child, I thought like a child, I reasoned like a child; when I became an adult, I gave up childish ways” (1 Cor. 13:11).

Now although many Protestants in early A.A. found it very useful to employ this kind of analysis when working with deeply troubled alcoholics—Kenneth G. Merrill, the devout Episcopalian factory owner in the aforementioned book, The Factory Owner & the Convict, laid out the basic theory in especially clear fashion in an article he wrote called “Drunks Are a Mess”⁸⁷—Roman Catholic thinkers were often made uneasy by parts of this approach.

I remember when I was serving as editor for Ernest Kurtz, the best Catholic philosopher and theologian of A.A.’s second generation—this was when he was writing the second edition⁸⁸ of his famous book on Shame & Guilt—that Kurtz made it clear how uncomfortable it made him to hear people in A.A. use phrases like “we’re as sick as our secrets.” He believed that the attempt to force people to make public their most shameful and humiliating experiences while everyone else gaped and stared, only made the trauma even more horribly unbearable. It was not psychologically healing, in Kurtz’s estimation, but made the person’s guilt and shame far worse and even more deeply crippling.

The Catholic choice: instead of Freudianism, the cognitive behavioral psychology of Dr. Abraham A. Low. Father Dowling and Father Ralph Pfau were likewise not only deeply opposed to classical Freudianism but were also uncomfortable with the later Neo-Freudian approaches that were attracting so many of the A.A.’s who came from Protestant backgrounds.⁸⁹

That was one of the reasons Father Dowling was so appreciative of the twelve step program as practiced by simple laypeople in the ordinary work-a-day rooms of A.A. As he put it, in “moving therapy from the expensive clinical couch to the low-cost coffee bar, from the inexperienced professional to the informed amateur, A.A. has democratized sanity.”⁹⁰ It put moral considerations back on the basis of everyday common sense, and took things out of the hands of over-intellectualized psychiatrists who were all too often deeply hostile to religion and spirituality, and attacked religious beliefs at every turn as superstitious and “neurotic.”

Father Dowling and Father Pfau were not totally hostile, however, to all varieties of psychology and psychotherapy. Both of them were strong supporters of the approach taken by Chicago psychiatrist Dr. Abraham A. Low (1891-1954), the original founder of the kind of cognitive-behavioral therapy which (in the 1950’s and 60’s) was further developed by Albert Ellis and Aaron T. Beck. In 1937 Dr. Low started a program to teach his system, which he called Recovery Inc., which quickly spread across the United States and Canada, particularly after the Saturday Evening Post published an article describing their recovery groups in December 6, 1952. Low publicized his ideas in two important bodies of work, which came out in 1943 and 1950 respectively.⁹¹ In 2007, Recovery Inc. changed its name to Recovery International, and in 2009 became Abraham Low Self-Help Systems, and is still active today, with over six hundred groups meeting in the U.S. and several other countries. The program can give enormous help to patients who are dealing with a wide range of different psychological problems, including phobias, general anxiety and panic attacks, depression, obsessive-compulsive disorder, and bi-polar disorder. It can even help in anger management and make it easier for patients to manage schizophrenic symptoms.

The question we must ask here though, is why were Dowling and Pfau so attracted to Abraham Low’s method, but so deeply repelled by Freudian psychiatry of any kind? As Father Dowling saw it, Low preserved the Catholic insistence on the vital role of human free will in human moral and spiritual development. As he put it in a speech to the N.C.C.A. in 1953:

Fr. Ralph Pfau likewise recommended Recovery, Inc., several times in his autobiography,⁹⁶ and told how he went to their group meetings in Louisville in addition to his participation in A.A. One of the modern experts on the Recovery program is Ernest Kurtz’s wife, Linda Farris Kurtz, DPA, who is now Professor Emeritus at Eastern Michigan University’s School of Social Work, and who also highly praises the group.⁹⁷

Abraham Low’s system is designed help people deal with a large number of psychological problems, including phobias, anxiety, panic attacks, depression, feelings of low self-worth, outbursts of uncontrollable anger, obsessive compulsive disorder, social anxiety, crippling shyness, psychologically induced tremors or dizziness, suicidal thoughts, and certain types of sleep problems. It can also help people manage their symptoms when they are being treated for attention deficit disorder, bipolar disorder, borderline personality disorder, schizoaffective disorder, and schizophrenia.

A triggering event will cause us to fall into either a “fearful temper” or an “angry temper.” In either case, the feeling is produced by a certain kind of judgment that our minds have made about the triggering situation. A fearful temper arises from the belief that we have done something wrong, which gives rise to feelings of fearfulness, shame and inadequacy. An angry temper is produced by the belief that we have been wronged, which produces feelings such as indignation and impatience.

If we respond to this initial flash of temper by using more and more “temperamental lingo” in our internal self-dialogue, the incapacitating and/or destructive emotions will grow greater and greater. Temperamental lingo includes using overly judgmental language about right and wrong (“good people always do such-and-such,” “I am a totally and absolutely bad person,” etc.), and the use of defeatist and fatalistic language to describe our symptoms: “intolerable,” “unbearable,” “uncontrollable,” “irresistible,” and so on.

Abraham Low’s Recovery, Inc. program stresses the power of human free will. It rejects the psychoanalytical idea of the subconscious, and argues that any therapeutic system which teaches that human behavior is determined by unconscious motives, instincts, and drives will of necessity be self-defeating. Human beings have the power to analyze what they are feeling and what is going on in their lives, and then working out rational ways to deal with those problems, and acting upon their carefully considered conclusions. We do not have to accept every thought that arises, nor do we have to act on every impulse that springs up. And even more important, we can use our free will to devise training programs where we replace the old destructive thoughts and feelings which used to pop up automatically in our minds with a new set of habitual responses built up out of self-affirming inner thoughts and positive external behaviors.

Group members are trained to respond to unsetting situations by going through a four-part process of analysis. (1) This begins with a brief statement of the situation: for example, the clerk at a store helped someone else before taking my order, even though I had been there first; I had to ride up ten floors in an elevator even though I suffer from extreme claustrophobia; I did not know the answer to the first question on the exam, and immediately fell into such a panic that I could not even remember the answers to problems which I would otherwise have been able to work easily.

(2) I note any feelings which I then experienced: for example, angry thoughts, fearful thoughts, a wave of pure despair, wanting to scream, wanting to cry, mental confusion, or what have you. Also physical symptoms: things like sweaty palms, trembling hands, pounding heart, a knot in my stomach, clenched teeth, feeling myself growing red in the face, or what have you. The object here is to be as objective and analytical as possible, to help defuse and lower the emotional level.

(3) Spotting means analyzing my thoughts and feelings so as to identify the places where I am violating the principles of the Recovery, Inc. program in ways which will increase my anger and fear. Reframing means changing the way I have been viewing the situation and my role in it.

(4) I then remind myself of how I would have mishandled this situation before I began working the Recovery, Inc. program, and what a catastrophe I would have made out of things, as a way of giving myself positive reinforcement for my new behavioral pattern.

This kind of extremely rationalistic approach fit much better with typical Jesuit modes of thought, than psychological approaches which talked too much about the unconscious or fell too heavily into rejecting all human self-will. St. Ignatius, for example, had taught the Jesuits how to practice discernment when they had to make difficult decisions: the Ignatian method of discernment was a systematic analysis of the person’s own thoughts and feelings which had many similarities to Dr. Abraham Low’s methodology.

Ever since the sixteenth century Reformation, Catholic theologians had feared that Protestant theologians had too great a tendency to let people just sit around until they spontaneously felt like they would enjoy changing. Catholic theologians believed that ordinary human beings needed direction from people who were more knowledgeable, and that sometimes they needed to be told to buck up their will power and make themselves do things which would help them grow spiritually, even if this meant deliberately doing things which involved pain and suffering. The idea of engaging in strenuous psychological exercises through the Recovery, Inc. program, in order to train our wills to be stronger and in better control, was something that Catholic theologians could find extremely attractive.

And in the history of Christian spirituality, we need to remember, the word asceticism originally came from the ancient desert monks, who took the pagan Greek word askêsis (which referred to the kind of hard, sweaty, difficult physical training which athletes underwent) and turned it into a term referring to the kind of rigorous and often painful spiritual training which the monks underwent as they prayed and meditated for hours without cease in the heat of the Egyptian desert.

And to make my own comment, we also need to remember that there is no reason to make an either-or issue out of the differences between cognitive behavioral therapy and the Neo-Freudian psychosocial analysis of childhood development. A.A. members who developed low self esteem and a continually self-sabotaging inferiority complex as children, can be helped enormously by simple behavioral techniques such as drawing up a list of their good attributes and reading these over every morning. Likewise, making a gratitude list and reading it every morning can help to recondition and reframe people’s minds when their habitually negative self-talk drives them into chronic depression.

Even if the person’s problems arose out of specific childhood traumas, many of the best old-time A.A. sponsors would tell their sponsees to “perform the right motion until you feel the right emotion,” or similar advice. This was the standard behaviorist observation that when people acted in a certain way over and over, they would eventually begin to feel the emotions that went with those actions. Submarine Bill, one of the A.A. old-timers from my part of the U.S., was told by his sponsor to perform a good deed every day for one of his brothers-in-law—the person whom he hated and resented more than any other person in the world—until he learned to love that man. Bill found that after enough weeks of doing this, he could spend time with the brother-in-law without being driven into out-of-control anger and attacks. Bill at first despised and looked down upon the other A.A. members, so his sponsor made him stand by the front door and greet every person who entered, shaking that person’s hand, looking the other person in the eye, and greeting the person by name. After enough weeks of that, Bill’s mind had been reframed and his emotions had been reconditioned, so that he was actually feeling cheery and welcoming when he shook the person’s hand, and he found himself slowly coming to genuinely like the other people at the meeting.

Given the important role that early Catholic members played in getting A.A. to employ cognitive behavioral methods as a regular part of the A.A. toolbox, they did an enormous service to the movement.

Scrupulosity is a self-tormenting tendency among some religious people in which they feel pathological guilt over their own behavior in minor or trivial situations which they have convinced themselves involve serious moral issues or a blasphemous mistake in the performance of a religious ritual. St. Ignatius Loyola once spoke of accidentally stepping on two straws which had fallen to the ground in the form of a cross, and suddenly feeling that he had committed a grave sin. Martin Luther in similar fashion said that on one occasion he accidentally left out the word enim (“for”) in one passage while saying mass, and suddenly was overwhelmed with the feeling that he had committed a sin as grave as divorcing a spouse or murdering a parent. (It is ironic that Loyola and Luther, although on opposite sides of the sixteenth-century Protestant Reformation, were two of the most famous sufferers from scrupulosity in the history of the disorder—both the Spiritual Exercises and the Lutheran interpretation of the gospel message in the Apostle Paul’s letter to the Romans were attempts to devise methods of treating and healing scrupulosity.)

In addition to his Montserrat Circle for Catholics suffering from scrupulosity, Dowling also set up two additional self-help groups (meeting at The Queen’s Work) for people who suffered from nervous disorders. It was a bustling place: people belonging to these two groups were continually coming and going from Fr. Ed’s office, or holding long consultations with him over the telephone. Ernest Kurtz believes that this may have been an early version of what was later known as Neurotics Anonymous or Emotions Anonymous.⁹⁹

Group therapy: God working through the group. A.A. members in particular, Dowling stated on one occasion, “know the wonders that can come from amateur group psychotherapy based on the human will aided by God’s help.”¹⁰⁰ The twelve steps, he discovered, provided one of the best disciplines ever seen for turning a small group therapy session into a context in which the grace of God and the power of the divine Spirit could operate in and through the members of the group. It was not just alcoholism that could be healed in that fashion, nor was it just addictive behaviors, but an incredibly wide range of human moral and relationship problems.

Combining A.A. with Recovery Inc., Cana, and a 1950’s movement called Divorcées Anonymous. When Fr. Dowling discovered Alcoholics Anonymous at the end of 1940, he quickly became convinced of the special power of the twelve steps as a spiritual tool. In the following years he liked to incorporate insights and teaching techniques from A.A. into his work with other groups. He sometimes put together interesting combinations of group therapies, as we see in the letter he wrote Bill and Lois Wilson at Christmas time 1953:
The Recovery Inc. people borrow strength from the 12 Steps …. Last month we experimented with a Cana Conference, confined to couples from A.A., Recovery Inc., Divorcees Anonymous, and Cana.

They discussed in small groups, three and four couples each and then processed to new groupings. The case presented involved money, in-laws, jealousy, sex. Then asked the question, “What could A.A. contribute to this situation?” What would Recovery? What would Cana? What would Divorcees Anonymous?¹⁰¹

Father Ed was also a man of that era, just like Samuel Starr, and some of his words about marriage counseling seem quite dated today. He argued, for example, that America needed “an ‘internship in housework’ for society debutantes and college girls,” displaying an attitude toward male and female marital roles that would enrage one of today’s feminists. But when he “urged married couples to write each other love notes to make up for the lag in conversation,” although this might at first sound to some modern men and women like a piece of sentimentality from a 1950’s American television show, in fact, getting family members to explicitly tell other family members that they love them, and say it — really meaning it — on a regular basis, can play a vital role in healing all sorts of dysfunctional family relationships.¹⁰³ How many men and women in twelve-step programs for example, never heard their fathers, or their mothers, telling them that they loved them, but instead received only harsh words, put-downs, and constant denigration?

Why did Divorcées Anonymous come into being at that time, in 1949? People in the United States had been alarmed by the sudden sharp peak in the divorce rate that occurred right after the Second World War, even though the divorce rate went back down quickly. There had been nothing like that before in all of U.S. history. This 1946-47 outbreak was almost as high (even though not nearly as long-lasting) as a second peak which began its rise in the later 1960s and 1970s and continued through the 1980s before it began turning back down slightly.

It is to Fr. Dowling’s credit that, instead of reacting to the crisis that had broken out within the U.S. marriage system by preaching condemnatory sermons denouncing men and women who got divorced and threatening them with hellfire—and instead of trying vainly to bring down the divorce rate by conducting political campaigns against the legalization of divorce (or against birth control or against other women’s rights, as some conservatives in the U.S. and Europe were doing at that time)—he devoted his energies to trying to lend his help to the best available marital therapy group which a Catholic priest of that period could endorse.