CHRONIC ALCOHOLISM

He is not eating enough; he cannot be bothered to cook and the prolonged effect of alcohol on the stomach has taken his appetite away. He is almost continuously nauseated. Neglect of nutrition may lead to physical illness and this may give the doctor his first opportunity to discover the facts and confront the alcoholic with the diagnosis. Nutritional disorders develop. He has clear-cut physical disease. He is a chronic alcoholic.

He steeps himself in drink. The uninterrupted binges of intoxication, the prolonged periods of continuous drunkenness, may be produced by less and less alcohol, for the body’s tolerance diminishes quite sharply at this time. The alcoholic discovers that he cannot drink anything like the quantity that he formerly consumed. His reduced intake no longer satisfies and, what is more, it makes him disorganized and helpless whereas previously he had prided himself on how much he could take without getting drunk. Alcoholics always realize that this reduction in tolerance indicates a serious physical deterioration. Although his binges are no longer pleasurable he has to give himself up to them. He must have drink and to get it he will go to any lengths. He may start drinking cheap wines, even methylated spirits.

He becomes the victim of terrifying fears. Sometimes these accompany his drinking. Most of the time his thinking is confused. He only knows that not to drink is torture but drinking itself no longer brings relief. He may now seek the help of

Alcoholics Anonymous or go to a doctor for medical advice about alcoholism. He may get this, however, only when he is admitted to hospital with a serious illness, either a physical condition, usually cirrhosis of the liver or peripheral neuritis, or else with a psychiatric complication, delirium tremens, alcoholic epilepsy or a psychosis.

To continue drinking is now impossible; yet to stop is unthinkable. He admits total defeat. His only way out is to find treatment.

Alcoholics, as we have seen, conform to definite types both in personality and in drinking pattern. Similarly there are recognized patterns of behaviour in their wives. Partly these are evolved as responses to the husband’s drinking, but we ought to consider whether they might not have been present in the wife earlier. Do alcoholics, in fact, select certain types of women and are there women who are particularly attracted to alcoholics ? We must remember that at the time of the marriage alcoholism or even excessive drinking may not have developed. The man when he marries may have only the predisposition to alcoholism and the woman who accepts him may be choosing a husband because his personality characteristics appeal to her.

The wife of an alcoholic, much more frequently than chance would account for, is the daughter of an alcoholic. She may be seeking to revive in her marriage the relationship which she had with her father. Because she can see the justness of her friends’ warnings she may be hard put to it to account for her persistence in wanting to marry the man of her choice. She may marry him sensing full well that the marriage is not going to be happy. Her parents’ objections are also no deterrent.

Alcoholics frequently marry women older than themselves. This has been documented by Duchene1, though not found by Amark.8 It may perhaps indicate that the husband seeks maternal responses from his wife; he has created a psychological equivalent of his relationship with his mother. Some men who marry older women are sexually inhibited. They may tolerate, even welcome, being dominated by their wives who are the real authorities in the family. In the case of an alcoholic this domination is frequently benign. His wife may enjoy mothering her husband, even when she has young children to nurture. She loves babies, wants many of them and may happily number her husband among them. Apart from isolated observations like these, our information about wives of alcoholics is derived from questioning them after the alcoholism has developed. An alcoholic’s wife often admits that she was aware that her husband drank a lot at the time she married him, but she will claim that she had not realized the implications of this. She expresses surprise, in retrospect, that she failed to do so. Many women, on the other hand, marry excessive drinkers believing that they will have a reforming influence upon their husbands. They do not realize how beset with conflict the marriage will be. From the wife’s standpoint, her husband will not be dependable; she will have to manage the greater part of the household responsibilities on her own; she cannot rely on him to play his part either in making important decisions, for instance about the children’s education, or in simple day-to-day choices such as planning leisure activities. Very often she will have to go out to work and there may be periods during which he is unemployed and she is the bread-winner. What assistance he renders then takes the form of domestic duties, cooking, cleaning and childminding.

She becomes insensitive to the effect on him of her constantly disparaging and belittling reaction. One wife, genuinely anxious to be helpful to her husband, described in detail his â˜dim-witted behaviour’. She dwelt with careful emphasis on his social clumsiness.

He tries desperately hard. He wants to be extra nice. He says unusual things, like â˜What a nice hat’ – you know – without realizing sufficiently that what he is saying is unusual. When there is talk about business, he makes remarks which have an air of wisdom but nothing behind them. When people ask him a question about his work or something factual the answer he gives is perfectly futile, even to an outsider. I feel that anyone would know it was a guess. In conversation with me, and particularly when we have other people around, he will make statements about matters of which he knows nothing. They are totally incorrect, and he can’t substantiate them. He tries to, if discussion arises, not really aggressively but he feels he has to assert himself. He makes the mistake of thinking that what matters is asserting himself and not being sure if he is right when he does so.

More than one writer has stressed how capable the alcoholic’s wife is. She can generally manage the household affairs on her own and, to the outsider at least, she seems to have no great need for an adequate husband. Towards her children she feels competent to combine the father’s role with her own. And by assuming this complete parental function she diminishes her husband in his own eyes, underlining his sense of inadequacy.

This view of the wife as a determining or at least an aggravating factor in her husband’s alcoholism comes readily to psychiatrists and social workers whose focus of concern must be with the patient. Because they must mobilize every resource towards improving his condition they are apt to concentrate on those facets of the wife’s behaviour which may be exacerbating his drinking. Some wives feel, when their husbands are receiving treatment, that the psychiatrist is inferring that they are somehow to blame for their husband’s condition. If this suggestion is indeed made to them too directly they are naturally disturbed. If either party merits criticism, the wife considers it is surely the offending husband for the way he has treated her.

The alcoholic makes things very hard for his wife. At the most material level, she is denied the necessary money to manage the house and she knows where it is going. When she protests, he may make promises but matters always get worse.

How could they improve if he is compelled to spend upwards of seven pounds a week on drink ? It costs more than that for half a bottle of whisky a day if you drink at home. In pubs it is more. Try as she may, the wife cannot maintain the home standards she wishes and feels that she justly deserves. Debts mount but her husband appears unconcerned. It is she who meets the tradesman at the door, and when she plans to economize she gets no support from her husband.

Socially too he is no longer dependable. She never knows when he will be home for meals, and if she prepares food it may be wasted. She cannot arrange for them to go out to friends for he may not be willing. She dare not invite friends home for he may not be sober. In short she cannot plan, so no coherent way of life is possible for her. Alcoholics’ wives wait. They wait for their husbands to come home; they wait for an accident; they wait for their husbands to lose their jobs. They wait for the inevitable catastrophe.

The alcoholic’s wife witnesses his intoxicated behaviour, day after day, week after week, with increasing abhorrence. He himself is only partly aware of what he is doing. It is she who sees how appalling some of his actions are. His cigarettes burn holes in the carpet and the bedding. At times he seems blatandy loutish and brutish to her. Mostly she feels that he is incapable of decent behaviour. His behaviour always hurts whether she regards this as intentional on his part or not. She sees him insidiously and progressively destroying all she had come to hope for and expect from life. She may have to endure his violence; by no means all alcoholics are violent when intoxicated, but many knock their wives about. He may be jealous and accuse her of going with other men. She can be severely ill-treated, both physically and mentally.

His sexual approaches may repel her by their unfeeling clumsiness. What has been of emotional importance is now only sordid and loathsome. Fear of becoming pregnant when her husband is in such a state increases her distaste for inter- course, which seems to her to be degrading, merely a satisfying of his transient and ineffective lust.

She misses the companionship, the warmth and understanding which a husband should provide. There is no opportunity for them to talk together, so she cannot convey to him her own thoughts and experiences and needs. Even were she able to, she questions whether he would understand, appreciate and respond. She feels herself increasingly solitary, her life arid from the lack of affection and the impossibility of expressing tenderness towards him.

A wife may lavish this uninvested emotion on the children, swamping them with excessive demands to make good the deficit in her marriage and to provide the affection which she does not get from her husband. Children are not mature enough to meet these emotional pressures and their own development can be harmed by the pressures upon them to do so.

The alcoholic’s wife is bewildered. She is unable to put into perspective what has happened in her life. She ponders whether she has brought it upon herself. She fears at times that she may be responsible for her husband’s drinking. She cannot decide if he is unfeeling, wilful or sick. She does not know if it is more appropriate for her to be angry or protective. She does not know what view to take of the problem or to whom to turn for help. She may continue for a long time, vainly hoping that her husband is just going through a bad patch, that the upset is only temporary, and that by his own efforts he will yet manage to control his drinking.

She spends a lot of her energy covering up for him. She dissembles to his employers about his lateness, his absences or his early departures from work. She parries neighbours’ puzzled inquiries or unwanted expressions of sympathy. She attempts, with less success than she knows, to conceal from her children the slights to which she is subjected and the quarrels which ensue. Her parents begin urging her to take a strong line with him, even to leave him, and she is in conflict between

her filial and her wifely loyalties. Even if she feels wholeheartedly that she ought to take her husband’s side, she knows that she may later have to depend on her parents should the situation worsen.

The wife tries what have been called â˜home remedies’,1 the vain devices aimed at removing available liquor. Bottles are searched for, emptied down the sink, hidden; attempts are made to control the money, to persuade shops not to allow credit. Decisions are made, promises extracted, ultimatums delivered. The wife persists in the hopeless sequence of pleading, argument, hostility, hatred because she does not grasp yet that, much as her husband would wish to stop drinking, only with specialized outside assistance will he be able to give up alcohol. In the meantime, the family may live through quarrels, terror, physical assault and neighbourhood disgrace. The wife may be unable to tolerate more distress, or she may decide that for the sake of the children she has to leave her husband.

If she can only come to understand that what besets her husband is illness, a new way of dealing with her total problem opens to her. She can cease to hold her husband responsible for what he is doing to her and her natural affection and sympathies for him need no longer be withheld. She is not out of the wood by this realization.

A patient’s wife was telling the doctor about his behaviour when drinking, alternately talking to the doctor and rounding on her husband who was present:

Once he starts drinking nothing you say makes sense to him. There’s an imbecilic look on his face. You’re just not in the same world at all. It’s a completely different person! He talks rubbish. Everything makes him quarrelsome. You get the failings of everybody thrown at you all the time. I don’t think you even remember what happens, or all the things you say. An objectionable, horrible person, completely different. Such a horrible creature. It’s a terrible

Jekyll and Hyde thing. It’s as,if he takes a blackout or a brainstorm. It’s not that he’s drunk: all sense seems to go completely out.

It’s difficult to move him from one room to another. You try to make him go into the bedroom, to get him out of sight. He fights you. You try to stop him from damaging himself when swaying too violently. You can’t reason with him – I’m told I’m completely useless, quite hopeless, I’m told I can’t face life as it really is. I find bottles about the room and tell him. He says, â˜There were no bottles in the room.’ He tells me he has stopped, and I find one bottle in the bed and one under the car seat. Then he drinks champagne to celebrate finishing with drink for all time. You really have to live with it to know what it’s like. My goodness, I can sympathize with any wife who goes through this. Now I’ve got to think of the boys – my one son is disgusted with his father; the other won’t go near him.

When the wife stopped speaking her husband glared at her and said quietly: â˜What you really want to see happen is that I should be locked up.’ His wife did not deny the hostility she had been driven to feel. She said helplessly, â˜If I stopped seeing it as an illness that would be hopeless. If I thought he could help it, that would be the end.’

The wife who has learnt to regard her husband’s alcoholism as an illness can go on to orient her own life with greater assurance even should her husband continue to drink. As far as her feelings are concerned she may still oscillate between sympathy and anger. But she no longer has to feel ineffectual, overwhelmed by the problem. She can now approach the resources in society that can provide help. Professional people are becoming increasingly enlightened about the problem of alcoholism, and the misguided attitudes of previous times are giving way to better counsels today. So the doctor, the minister, the lawyer, the social worker need not nowadays limit their advice to moralizing. The doctor can advise a suitable course of action and inform the wife what treatment will be available. She may be recommended to adopt a certain approach if her husband is cooperative, but if he is not she can still be helped to decide what to do. There are few doctors today who will tell the wife that her alcoholic husband is worthless, urging her to leave him. Ministers can offer practical advice to suit the particular need in addition to the prayer and faith which they have always advocated. Social workers no longer dispense readymade drastic advice or solutions, but investigate with the wife the special circumstances of her case. Should she want to stay with her husband, this will be appreciated by members of these helping professions. If she is determined to leave him, they will not criticize. If she cannot make up her mind they will not make the decision for her but will assist her in weighing up the merits of each course. A decision on her part to separate may not be the drastic undoing of her husband that she fears. The fact of a wife’s leaving may make an alcoholic more prepared to go for treatment. An excess of care by a supportive wife, especially if the dependent relationship shields the alcoholic from what would otherwise be the realities of his addiction, may actually militate against his acceptance of medical treatment.

Marriages of alcoholics are often interrupted by separations and many end in divorce. Either the alcoholic or the spouse may initiate the separation but it is usually the latter because the alcoholic has much more to lose than to gain by leaving home. If we are considering male alcoholics it is generally late in the progress of the condition that they quit the home and often it is the wife who brings this about, not the alcoholic. Sometimes the wife leaves, taking the children with her and retreating to her mother’s house or to another member of the family. She does it because she can no longer stick the drunken behaviour at home and the humiliation of never being able to go out or to have friends call; she does it to protect her children from the repugnant sight of their father and, last but not least, she does it to exert pressure on him to stop drinking or to go for treatment. These separations may not last long; the wife yields to his pleas for her return and his protestations that he will reform. When next he relapses it will be less of a struggle for her to leave. So there are often a number of separations. By themselves these do not necessarily indicate that the marriage will end. It is considerably more likely to do so when the husband has lost his job or has been physically violent to his family. Then his wife often concludes that the marriage is hopeless and makes a decision never to return. Whether or not such a final separation is taken to the divorce courts depends on many extraneous factors.

It is much less common for a wife to leave an alcoholic husband than for a husband to leave an alcoholic wife. Women alcoholics have less stable marriages than do male alcoholics. Fox1 suggests three reasons for this: that drinking by men is more socially acceptable, that women have mothering impulses which they can extend to their drinking husbands, and that in harsh economic terms wives are financially dependent on husbands. To these we would add a fourth: women alcoholic patients have in the main more disturbed personalities than their male counterparts.

When the wife remains with her husband she may none the less harbour intensely painful feelings of resentment and anger towards him. She is sometimes not fully aware of this hostility. Though she does not voice it direcdy she can use others in the family to give expression to it.

An alcoholic gave up drink when treated, and after leaving hospital returned to work and regularly attended the weekly out-patient psychotherapeutic group in which he was exploring his inter-personal problems.

His wife’s father, who lived in the house with them, was an irritation to the patient. The old man would rarely leave the house: he was involved in all the family discussions, recalling how difficult the alcoholic had been, the hardships his daughter had suffered, the disadvantages inflicted on the children, and so on. When the patient had a temporary lapse he was ashamed and dejected. To his wife’s reproaches were added the old man’s portentous predictions of imminent disaster: everything was hopeless, all was now lost. The alcoholic drank more, grabbed sleeping pills from the medicine cupboard and swallowed a large number in the presence of his wife and father-in-law. He sat down and gradually got drowsy. As he became unconscious, the father urged: â˜Leave him’. It was only when the 12-year-old son returned home that the mother was persuaded to call the doctor, who then summoned an ambulance to convey the by now unconscious man to hospital.

There are marriages in which the wife of the alcoholic herself becomes ill. Sometimes this happens when the husband stops drinking, the first symptoms appearing when he assumes increasing family responsibility. When this occurs it is a serious added strain to the husband, often jeopardizing his recovery. Fortunately it is not common.

Another alcoholic had recovered satisfactorily with treatment and resumed his part in his family’s affairs. An unmarried daughter had become pregnant, and when the time came for her delivery she was living in a distant city with a married sister. The recovered patient wanted to go with his wife on the visit she had planned to support her daughter through this difficult time. He intended to urge his daughter to end her association with the man responsible for the pregnancy.

He succeeded in conveying his point of view, but his wife became involved in a quarrel with the married daughter whose house it was. As a result, she was told to leave. Thereupon she lost her memory, and for months afterwards was disabled by a psychological disorder of fluctuating severity, in which she was unable to recall how many children she had, and how old they were; at times she was even uncertain whether she was married or not.

Notwithstanding the great stresses imposed, a great number of wives stay with their husbands through painful years of disappointment, debt and humiliation; they assist them

energetically to obtain treatment, seek advice themselves to understand how they might have contributed to their husbands’ difficulty, and are profoundly happy with the contentment and order which results when their husbands’ drinking stops.

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