“ Hello, my name is John , and I am an alcoholic”
John (aged 46) lives alone in a bedsit in a less than salubrious part of town. He looks in the mirror each morning and thinks to himself …nothing. He just feels numb. Divorced, he does not know where his children are and now isolated as his employer now reckons he can do “without his services”. His previous landlord had given him notice to quit about 3 months ago.
The landlord had stated at that time that John was not quite what he expected, his demeanour and appearance had deteriorated from when he first moved in. John had “Undesired different-ness from what I had anticipated when I first took him in as a tenant”.
John had carried his few belonging to the new place feeling that now as far as anyone else was concerned he was now “reduced from a whole and usual person to a tainted, discounted one”.
John as was drinker. When drunk his alcoholism was out there for all to see, it became a visible discrediting condition. Those around him could see and avoid him. In the mornings before his first drink he carried his alcoholism inside. He used to be able to function at work quite well, his drinking was invisible known only to John (if he thought about it) as a discreditable condition that he was able to pass off.
Throughout his life he had struggled with feelings of self hate and worthlessness. The drink was a friend. However, he knew it was not the friend it once was. He felt different, unwanted, alone. As life got more difficult he could see the stares even when pissed. Being turned down for jobs and housing when his condition became known was increasingly hard to take. Employers and landlords saw him and acted according to the label ‘alcoholic’. His wife eventually had left him unable to take the shame of having a pissed husband turn up at parties making a fool of himself. She had the courtesy of feeling the shame on his behalf.
It was not as if he had visible skin disfigurements or limbs missing, what some have called ‘abominations’ of the body’ this was not why he felt different. After all when sober he had been fairly well presented and in his younger years quite a good looking man. No, the issue now was that others thought of him as weak, unable to control himself, a laughable character, with a character blemish. It was all to do with who he was as a person, it was not his family’s fault and he could not even argue he faced ethnic discrimination living as he did among his own tribe.
His felt socially worthless life was his fault. He was seen as responsible for his drinking. If he could just put the booze down things could be better. However, some had seen him get worse over the years and though there was nothing that could be done, the drinking was progressively worse and possibility incurable. Many friends and work colleges had of course heard about alcoholism and many had drinking habits of their own which may be problematic. However, few had really understood what alcoholism actually was, how it arises, how it affects people beyond seeing the drunk, and of course being drunk was often hard to conceal.
John sat among the group feeling shame for his past behaviour and a little concerned about how this group would judge him. He had enough experience of how other people had treated him recently and so felt apprehensive about the value judgments they would make and actions that this group would take. He was new to AA and had no idea how this worked, he hoped that as the others had been (or still were) drinkers then maybe they would not judge him so?
His last employer, Mark Taylor, had been particularly hard on him. John’s fellow workers had felt however that Mark had some issues of his own which made the relationship between the two even more difficult. Some had even suggested that Mark was a little self obsessed and was difficult to work with. It was felt that he found it difficult to put the needs of others before his own. This only made his attitude towards John even worse. Mark’s narcissistic personality, it was felt, had just made issues worse. Mark’s stigmatization and harsh treatment of John involved dehumanization, threat, aversion and depersonalization into stereotypic caricatures. For Mark, this served to increase his own self esteem, enhanced his control and allowed “anxiety buffering”, through downward-comparison, i.e.comparing himself to John. This process increased his own subjective sense of well-being and therefore boosted his already over inflated sense of self-esteem.
John’s illness experience was being constructed in quite a negative way. His appearance and behaviour singled him out as socially deviant, subject to discrimination, prejudice and stereotyping. His alcoholism was a condition of societal deviance as most people accepted that this was apersonal failing, a sign of moral weakness and lack of control. This was only slightly ameliorated by it being also being seen as a disease. However Johns experience was not that of a patient with an illness that needs medical care, he felt outcast, alone and dirty. It was as if society had two definitions: alcoholism as disease for which John should play the sick role, and alcoholism as deviant behaviour that requires punishment or avoidance.
John thus felt ostracized, devalued, rejected, scorned and shunned. He experiences discrimination, and only thinly disguised insults. He began experience psychological distress expressing suicidal ideation as a result of viewing himself with contempt. The drink paradoxically made that feeling go away. It was both savior and nemesis.
John’s experiences over the past few years had an effect on his behaviour in that he often started to act in ways that others expect of them. In social situations he learned to withdraw as a result of the avoidance behavior of others. This therefore it not only changed his behavior, but it also shaped his emotions and beliefs. Thus his experiences put his social identity into threatening situations, such as low self esteem. He became more aware of the label alcoholic and thus began to act as he though alcoholics were expected to act. He had nothing to lose, people expected it anyway. He knew that he was not being treated the same way as ‘normals’ and knew he would probably be discriminated against.
Alcoholism – a fault with self?
Not everyone is comfortable with the term stigma or its connotations. Critics have argued that stigma focuses too much on the characteristics of the stigmatized, and not enough on the social and structural mechanisms that create discrimination and entrench social oppression. http://stigmaj.org/announcement/view/5
To what extent is alcoholism a personal trouble? To what extent is it a public issue? What social structures are involved in ‘creating’ this as a personal and social problem? What is occurring in the 21st century in certain societies that frames the alcoholic experience in particular ways? What discourses are used to describe alcoholism – biomedical. psychiatric, criminal justice, public health, social? How does each discourse frame the issue? Is there a nursing discourse on alcoholism?
© Benny Goodman 2011