Sunday, August 8, 2010

IDAA - 2010 - Buffalo

I'm attending the International Doctors in Alcoholics Anonymous Meeting in Buffalo USA. I'm thoroughly enjoying the continuing medicine education. In addition I've attended meetings of AA and Al Anon. I just came from the Al Anon banquet where a college student told her story of being in an alcoholic family and moving through Al ATEEN with her parents recovery. She's now in college and says, "my parents are poster children of recovery". She herself was an amazing young woman.

Yesterday I spent more days in AA meetings but today I've attended the Al Anon meetings, enjoying sitting with my friend Hugh. "Double Winners" those like me who've had the disease of alcoholism and been married to an addict or had family members or friends with addiction, have called Al Anon 'finishing school'. I so enjoyed hearing of all my own faults of 'care giving' and 'keeping the peace." People talked of the hidden anger in those who hadn't treated the disease of alcoholism or the untreated al anon consequences and how difficult it was to live with all the smoldering control or chaos that came with surface solutions to deeper problems.

AA and Al Anon have been called 'selfish' programs by members when in deed they're fundamentally selfless. Just as I learned in my first life saving courses we had to remain safe to help those drowning AA and Al Anon teach that we have to put our own recovery first. To this end we take responsibility for our lives and look at the events through the eyes of survivors and not as victims. Al Anons realize that they cling to 'blaming' others and feeling they would know what was 'best' and things would be so good if only everyone else would do what they knew was 'right'. One woman was told by her sponsor that she was 'everyone' else's 'higher power'. It was in a meeting where the Al Anon speaker shared that his spiritually experience had come with the realization that all he could do when faced with a trauma he'd done everything to avoid was 'let it happen'. That was an Al Anon variation on the AA slogan "let go and let God." Years later it turned out that this 'terrible event' was the best thing that could have happened and that cloud had the most amazing silver lining. He went on to paraphrase Kierkegaard saying that he had to learn to 'live life forward' and 'understand life backwards.'

It was so helpful to hear discussions of what the difference was between honest helping and 'enabling' of others. As one Al Anon said, "depriving a person of the consequences of their negative behaviors can really hurt them by denying them the learning that comes with such experience."

At the AA meeting early this morning we'd broken into small groups and discussed the experience of doing a 4th step. The 4th step in AA and Al Anon is where we make a list of our resentments and fear and first identify how these had affected our self esteem, personal and sexual relations and finances. Then we had to imagine that we could ignore the other persons part in the situation and ask ourselves where we'd been selfish, self seeking or frightened. Having been through psychoanalytic therapy for years as part of my psychiatric psychotherapy training I was astonished at the power of this process. In my person life there were Nazis and Jews, Indians and Cowboys, White Hats and Black Hats. Intellectually in therapy I'd accepted it was the work of therapy to find the "Eichman within" but I knew the person who offended me was really a psychopath or a sociopath or had a 'disease'. As Dr. Jay Lifton taught whenever we were threatened we naturally became defensive and of course the "best defense was offense". The meeting was a sharing of all our fears, each doctor discussing how doing the step 4 had brought him in touch with how truly frightened he'd been and how the drugs and alcohol had served to self medicate the profoundly intense anxiety.

Only in AA did I really accept that we were all God's children and even the worst of us had good in him as I was only well aware of my own character flaws and failings. Naturally if one considers that there are a lot more alternatives to relationships that the limitted choices of psychopaths and sociopaths. At the same time Al Anon is teaching me that I can say "No". Having trained as a doctor I've an overriding tendency to be everyone 'care taker'. Over the years I've just got really tired of being everyone's physician, psychiatrist, banker and wife and husband and the friend you could depend on. In our Psychiatrists meeting that was the much the focus of the discussion for the dozen of us. How do we get help for ourselves and take care of ourselves while dealing with the need of patients to have us being the 'idealized parent'. Much of the transformation of psychiatry has been from the psychoanalytic formula of 're-parenting patients' with the attendant unrealistic fantasies that had to be worked through in transference and counter transference to the modern medical team model where the psychiatrist's role is no different than a general medical doctor. One delightful older woman psychiatrist in recovery shared that she only saw patients for 15 minute at a time, prescribed medication and thought nothing of them seeing her or hearing her share her own difficulties at an AA meetings. Another told me she'd had more difficulty meeting other parents in the school. A hospital administrator and psychiatrist shared that he didn't think his disease of alcoholism was any different than having a brain tumor but that alcoholism carried with it the cloak of shame that made everyone collude in secrecy. Even those who were board members admitted to self disclosure in practice but whereas the self disclosure in practice was considered in the context of how it would benefit the patient, in AA meetings the psychiatrist of a leading treatment centre, summed up the consensus of the meeting, "there I'm a patient and what I'm doing is whatever I need to do for my own recovery, I'm not there as a doctor and I'm certainly not there as anybody's psychiatrist." The small town psychiatrist who raised for the meeting had thought at first it was mostly a small town issue but it turned out that even psychiatrists in the largest hospitals of the biggest cities had had issues with this especially with so called "borderlines".

Right now I'm off to hear the medical director of Betty Ford discuss spiritual aspects of the spiritual program of recovery. Last night I spoke with a neurosurgeon and this morning with a leading radiologist. The discussion of body, brain, mind and community and soul are always going on. Meanwhile my friend at the computer in the next table shared he's writing a science fiction novel. He's a leading pharmacologist. Another year he told me about his service in the American military. I miss being with the old General and doctor I'd hung out with last year but have really enjoyed talking with the 68 year old woman doctor who brought her 650 Suzuki on the back of the bus she travels out with. We'd both ridden Harleys to the Portland meeting a couple of years ago.

The fact remains that I like these people. At the very first meeting I realized I'd found a group of doctors who really 'cared'. The scholarship meeting last night where a hundred and forty sum newcomers were supported in coming to their first meeting attested to the care we give for alcoholics in the profession. I felt that care when I first came here thanks to Ray, Graeme and Hank. I felt so alone then, Today I'm a member of an organization of thousands of doctors, mostly those who 'worked hard and played hard'. Over the years I've been a member of the ongoing support we give each other in the confidential online Cyberdocs. Faced with questions from my medical practice, dealing with government or licensing agencies I've phoned and discussed my problems with specialists around the world. I've had email in put from 5 continents when I've been dealing with a problem of my recovery and my practice of medicine. This year I'm joining Cyber Al Anons as increasingly my practice concerns are related to my needing to deal with alcoholics and addicts in my practice and in the positions of power in agencies and organizations that my work takes me.

I'm very thankful to IDAA and the friends I've made and the excellent program of AA and CME that happens August every year. This year the whole history starting with Dr. Pearson in the 40's has been brought out of the archives and laid out in a separate room. I felt proud to be a part of this organization the way I'd felt pride when I first graduated as a doctor. Last night I liked hearing the person beside me say they were feeling more and more like the person they wanted to become.

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