Doug Thorburn on Early-Stage Alcohol and Drug Addiction

Bush on the Couch: Inside the Mind of the President, by Justin A. Frank, MD

Dr. Frank’s well written if overly complex book suffers from two fatal flaws and numerous lesser ones. First, he views everything President Bush says or does through his admitted (pseudo)liberal bias. Despotism aside, mixing psychological and political analysis is fatal to an accurate diagnosis of psychological state and alcoholism. One of Frank’s unstated but recurring underlying themes is that those with views differing from his must be psychologically disturbed. This is particularly true of those who would cut government programs aiding the poor and hungry, as if government creates food and other wealth. Frank leaves no room for agreeing to disagree.

Second, in arguing that Bush has never examined the reason for his addictions, he assumes that underlying emotional problems lead to alcoholism. Yet, there is no difference in aggregate levels of such problems in children who later trigger addiction and those who do not. As described in my book, Alcoholism Myths and Realities, this reversal of cause and effect has helped to create one of the grand myths of alcoholism, which has contributed to its stigma. Frank furthers this myth, even if true that the recovering alcoholic must deal with stunted emotional growth and psychological problems resulting from alcoholism.

Among the lesser flaws is the idea that religiosity reinforces a childlike sense of omnipotence and infallibility. It seems to me, a person who is non-supportive of religion in the traditional sense, that religiosity increases humility. Frank uses Freud’s Oedipus Complex, which describes the ambivalence of love and hatred for one’s parents, and Melanie Klein’s model of infant development, which claims that our internal world is shaped by the “chaotic, terrifying terrain into which we are born”and that babies are born with destructive impulses as a result of “fighting their way” out of the womb, in an attempt to explain why George W. Bush is an unstable, sadistic and paranoid megalomaniac. The use of such unprovable hypotheses and extreme language serves only to take the focus off verifiable behaviors that may suggest a return to active alcoholism. Frank frequently attacks Bush’s choice of words, suggesting that, for example, it was inappropriate to use his “nationalistic and religious rhetoric”to “create a tribe of believers deeply invested in his beliefs…”after 9/11 and before the Iraq invasion. He might have said the same of FDR in marshalling public opinion in favor of war after the attack on Pearl Harbor, or of Patrick Henry in inspiring the War for Independence in his “Give me liberty, or give me death!”speech.

The recurring psychobabble is an unverifiable attempt at mind reading. Frank begins integrating psychological and political analysis by claiming that George W., who “craved love and affection from his father,”suffered terribly as a child from his father’s numerous absences. Aside from asking how he knows this, the idea that it would have “profound implications”for W’s psychological health makes one concerned over the terrible effect this must have in the increasing numbers of truly fatherless households. Frank links this apparent psychological abandonment to W’s policies’ “disregard for those less fortunate than him, at home and abroad.”Dr. Frank would no doubt conclude that libertarians, who support policies far more radical than any either Bush I or II has ever proposed, must all have been unloved as children. Perhaps instead, some grasp the idea that policies purporting to help those “less fortunate”almost always suffer from the laws of unintended consequences and serve only to harm the less fortunate. Frank, in asking why George W. tolerates increased arsenic in the public water supply and wants to lift logging restrictions, leaves no room for argument over how much arsenic is safe and how many trees can be felled while keeping a forest healthy or, for that matter, whether government should even own forests. Frank seems to think that anyone disagreeing with his policy prescriptions couldn’t possibly be psychologically healthy.

Why is Bush psychologically unhealthy? Frank engages in some truly fanciful analysis. “Much as Barbara tried unsuccessfully to compensate for her own mother’s unhappiness, George W. couldn’t erase his mother’s pain, which found vivid expression when her hair turned prematurely white in her grief”over the loss of her daughter to leukemia. He wonders “what it was like for [a very young] George to watch his mother’s hair turn white.”Further, “The pattern of reparation by denial is something Bush learned at a crucial moment in his childhood, when his grieving mother decided to put on a brave face so her seven-year-old son wouldn’t have to worry about her.”

Why does Bush support what Frank decries as harmful policies? “A wide array of his domestic policies punish[es] elements of society whose weakness reminds him unconsciously of his own.””Given what we know about the inattentiveness of his parents”who the young [Bush] understood to have rejected him”it’s easy to see how this indifference could have been transposed in his mind into hatred, projecting his unrequited longing onto other targets.””Why does Bush hate us?… His deepest level of contempt is reserved for people who remind him of his parents”and of his own defects.””…Fiscal conservatives have begun to question Bush’s comfort with unprecedented deficit spending. What they fail to recognize is that his need to diminish future progress is an unconscious attack on his own parents…”I’d suggest this is drivel, but the word is hardly adequate in describing such garbage.

Frank confuses innate personality type with psychological disorders. His list of W’s “thought disorders”includes “a limited capacity to think in abstract terms”and a “tendency toward concrete thinking.”In pegging Bush as a concrete thinker, Frank denigrates the 75% of the population who score as Sensing types on the Myers-Briggs Type Indicator. Similarly, he attacks Introverts by suggesting that “Bush retreats into solitude and routine…[because he is] unable to trust other people…”

Frank is quite the mind reader. He claims that George W. Bush “turned to alcohol late in his youth, presumably to narcotize anxieties he couldn’t bear to confront….It seems highly likely that the inner demons he tried to manage by drinking still bedevil him today.”No Dr. Frank, Bush used alcohol addictively because his biochemistry allowed him to; alcoholism causes or increases anxiety; and inner demons are borne of alcoholism. Frank continues to explain that Bush “abused alcohol to soothe his anxious soul.”No, he “abused”alcohol because he could and it made him feel god-like, which caused anxiety in moments of clarity when he may have had an inkling of the damage he did while drinking. Frank suggests that Bush’s thinking and behavior may have been “deeply influenced by an alcoholic personality, one that is continually trying…to keep the compulsion to drink under control.”Sorry Dr. Frank, but there is no way to observe someone’s thinking and whether a person is “continually trying to keep the compulsion to drink under control.”

While Frank grasps the idea that active alcoholics are “uninterested in self-knowledge and incapable of introspection”and, therefore to his credit, will not knowingly treat one, he thinks the only proper treatment is AA. He claims Bush “remains in the grip of alcoholic thinking that the program of AA…helps its members to keep at bay.”Since alcoholic thinking is rooted in egomania, anything that helps deflate the ego will decrease such thinking and, more important for those who may be adversely affected by the afflicted person, misbehaviors. Religion, while not the only way to do so, is very effective at deflating the ego. Yet Frank debunks religion as a treatment for alcoholism because, according to him, it serves to replace the endorphin rush, thereby preventing the addict from dealing with his or her underlying pain. Sorry Dr. Frank, but there is no way anyone’s brain, regardless of religion or other belief system, can release endorphins anywhere near the degree that drugs can. Further, religion no more prevents the addict from dealing with pain than does the power of positive thinking. While Frank claims he has “treated alcoholics who are in recovery in AA and alcoholics who are abstaining on their own, and it’s easy to tell the difference,”I’ve known many in AA who are not in recovery and many in sobriety with excellent recovery who never attended AA. And he accuses Bush of rigid thinking. (I will have more on the subject of recovery without AA on the blog and invite your comments on this issue; email me at the link at the bottom.)

As other critics have noted, “it’s hard to ignore the many troubling [alcoholic] elements of his character…including grandiosity, judgmentalism, intolerance, detachment, denial of responsibility, a tendency toward overreaction, and an aversion to introspection.”There are, to be sure, some anecdotes hinting that W. lacks a good program of recovery, including, as Frank reminds us, a Jay Leno interview on the eve of Ws DUI revelation in which he abruptly and inappropriately changed the subject, thereby avoiding a discussion of things he had done of which he was ashamed. On the other hand, any politician proposing that health care be put back into the hands of health consumers is taking anything but a grandiose approach to public policy. Instead, schemes that put our lives in the hands of a government that has repeatedly proven itself inept at everything from disaster relief to delivering mail could arguably be considered grandiose. Perceptive personality types view judgers as overly judgmental; I imagine Frank would so categorize me. Intolerance is anything but an apt term for a sitting President who visited a mosque after 9-11 and commented that “we do not impose any religion; we welcome all religions”at a prayer breakfast shortly after the atrocity. He opposes gay marriage not because, as Evangelicals claim, it is against God’s will, but rather because marriage is an institution so fundamental to society that it simply should not be changed. While we may disagree, his view is not based on intolerance. Kitty Kelley, in her recent book on the Bush dynasty, describes what could be interpreted as the epitome of tolerance at a college reunion hosted by Bush in the White House. Bush told an old classmate, Peter, who had undergone a sex change operation and was now Petra, “Now you’ve come back as yourself.”I have no way of determining whether Bush is detached or has an aversion to introspection because, unlike Frank, I cannot read minds. However, while Bush has been known to deny responsibility, he was quick to point out the federal government’s failures in the Katrina disaster and did not point fingers, even if his choice for FEMA director was based on cronyism.

The most commonly-believed accusation is the purported “tendency toward overreaction,”of which Iraq is frequently cited as proof. Bush was outlining his views on foreign intervention in speeches as early as late 1999 in discussing, as the Wall Street Journal recently pointed out, “the need to combat new threats posed by the intersection of weapons of mass destruction and ‘car bombers and plutonium merchants and cyber terrorists and drug cartels and unbalanced dictators.'”It took months of debate before invading Iraq, and only after repeated warnings. The accusations against Bush in regards to Iraq and the idea that he “knew”Saddam didn’t have WMD are reminiscent of Republicans declaring that FDR “lied us into war”with the Nazis and Japanese. How easily the media forgets Al Gore’s assertion in 2002 that “we know that he has stored secret supplies of biological and chemical weapons…”and Hillary Clinton’s claim a few weeks later, “In the four years since the inspectors left, intelligence reports show that Saddam Hussein has worked to rebuild his chemical and biological weapons stock, his missile delivery capability, and his nuclear program. He has also given aid, comfort, and sanctuary to terrorists, including al Qaeda members…”Most people seem to have conveniently forgotten that John Kerry, John Edwards and Hillary Clinton all voted for the Iraq resolution. If megalomania drove Bush to invent adversaries so that he could destroy them as Frank posits, what drives others to rewrite history? And what could make Frank state as if absolute fact that Bush invented the adversary? As one reviewer wrote, “try inventing 9-11, try inventing the Taliban, try inventing the countless beheadings of innocent people in Iraq”and the one million killed in his invasion of Iran.

If Bush can be accused of anything, it is a steadfastness that can work against him. He can be slow to admit he is wrong and to change his approach. In this, Frank is correct in pointing to Bush’s rigidity, but for the wrong reason: he cites Bush’s “reliance on daily routines,”pointing out “a healthy person is able to alter his routine; a rigid one cannot.”Yet, he complains that “he managed to spend 42 percent of his first seven months as president away from the White House,”largely at his ranch in Crawford, Texas, implying he is not working while at the ranch. One might be skeptical that rigid people take repeated vacations, whether or not working ones. Frank suggests the “rigid routine”goes with rigid thought processes, an “obsessive way in which he holds on to ideas and plans after they have been discredited….”Frank, again, inserts his own self-righteous views.

Frank finally points out some behavioral symptoms of alcoholism and the reactions of close persons. His discussion of the drinker’s unpredictability and those nearby “walking on eggshells”is excellent (all of it on page 45). He is right in being more concerned when treating an alcoholic who does not attend AA than one who does. He is also correct in being concerned over Bush’s inability to speak, his repetition of key words and phrases and the idea that if he relapses, he will do everything possible to hide it. Frank explains that there is significantly impaired memory in heavy drinkers and in former heavy drinkers, but fails to mention that such impairment dissipates over time, especially after as many years of sobriety as Bush has had. The possibility of some other brain dysfunction such as pre-senile dementia is largely ignored. While Frank rightly points out that the public has a right to know about cognitive function in the President, I’d go further in opening up the medical records of politicians and other government employees in regards to psychotropic drug use and their aftereffects. The most important indication that there may be a problem is found 191 pages into the book, where he mentions the August 2003 physical that reported on the removal of a number of spider angiomas from his nose”capillary bursts most common to pregnancy and chronic alcoholism.

According to Frank, Bush replaced alcohol with religion. He explains that “Bush now numbs himself through exercise, prayer, and sleep.” He argues that obsessive behavior drove Bush to alcoholism, again reversing cause and effect. While obsessive behavior can pre-exist alcoholism, many non-alcoholics are obsessive. While it has nothing to do with causation, it is exacerbated by active addiction. Some might suggest that Christianity was adopted in an effort to deflate his ego and as a tool for recovery, but Frank sees only obsession. While some might see exercise as a means to keep physically fit, Frank sees obsession. Talk about rigid and, at the same time, conflicted. Frank says, “…when he stopped drinking Bush discovered that spirituality could serve as something like his own personal opiate, offering him the means to calm himself in the absence of liquid spirits.”He debunks the idea of spirituality serving to keep the addict off the booze because religion is “…a system of endorphin-mobilizing ideas”and “when we numb our pain…we sometimes avoid resolving it.”He is not only reversing cause and effect, but also suggesting that religion prevents us from dealing with pain.

Frank admits that the American Medical Association has proclaimed that his methods of analyzing someone without ever meeting that person are not only impossible, but also unethical and unprofessional. If there is active alcoholism, there is no need for psychoanalysis; we know that alcoholism causes egomania and abusive behaviors. However, most of Frank’s analysis rests on behaviors that are rooted in political beliefs with which Frank disagrees, rendering a diagnosis of active alcoholism impossible. If W. falls apart before 2008, the cause will be active alcoholism. Frank diverts our attention from the real issue and sheds more light on himself than on Bush.