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Reassessing Anonymity In 12-Step Programs

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Reassessing Anonymity In 12-Step Programs

Mental Health

Reassessing Anonymity In 12-Step Programs

Reassessing Anonymity In 12-Step Programs

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Guests

David Colman, contributing writer, New York Times
Marsha Linehan
, professor of psychology and director of Behavioral Research and Therapy Clinics, University of Washington

Many 12-step programs make a rule of preserving participants' anonymity, but now some are challenging that policy. Opponents say 12-step programs have lost enough of their stigma for participants to be openly involved, while others insist on the value of privacy on the road to recovery.

NEAL CONAN, host: This is TALK OF THE NATION. I'm Neal Conan, in Washington. Alcoholics Anonymous is serious about that second A. Among the policies established right from the start by Bill W., and I quote: "We need always maintain personal anonymity at the level of press, radio and films."

But now some believe the 11th tradition is outmoded and even counterproductive. Fifteen years after AA helped him quit drinking, David Colman revealed his participation in an article in the New York Times, where he argued that most people now accept alcoholism as a disease and not a weakness.

If you've been involved in a 12-step program, tell us: What's the value of anonymity? Give us a call: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, why hysterical laughter isn't hilarious: Grammar Girl on with 101 misused words you'll never confuse again. But first, David Colman joins us from our bureau in New York. He's a contributing writer at the New York Times. Nice to have you with us today.

DAVID COLMAN: Thank you very much. It's nice to be here.

CONAN: Thank you. What's been the reaction since you outed yourself?

COLMAN: Well, I would say that overall, it's been positive. I would say that the - most of the positive reaction would be probably from people who thought it was a very courageous thing, and people who are not in AA. The reaction from people in AA was probably, I would say, tilted to the negative.

CONAN: Tilted to the negative, because it violates tradition, or because they see real purpose in anonymity?

COLMAN: I think both those things. And, you know, and I think that there is purpose in anonymity. There are parts of it that are important. And I talk about that in the story a bit. And - but I think part of it is also that there is, you know, as with any kind of hallowed institutions, there are kind of knee-jerk reactions towards trying to protect, you know, what appear to be core and useful principles.

And, you know, my article was taking a look at how many breaches of anonymity there are now, and how the stigma has lessened so much insofar that, you know, we have movies and books and even CDs about recovery, you know, from pop stars that, you know, that does it make sense, really, for everybody to have to hew to this anonymous line?

CONAN: Have to hew. That's a critical point. You say it should be a choice.

COLMAN: I do think it's a choice, and I would never argue that somebody should be outed in the program without their consent, and they probably - you never - everybody do it - feel whether or not they should do it for themselves.

AA is actually - you know, despite the sort of the outcry about this story from AA people, I mean, one of the central tenets of AA is also that, you know, that there are no rules, that everything is a choice. You know, you take what you like and leave the rest is the, you know, is a common saying there.

And yet it's - what's interesting is, you know, the way that people have come forward to say, you know, no, this is a rule. And it's like, well, you know...

CONAN: It's not the kind of organization where you're going to have your epaulets stripped off and be drummed out of your meeting.

(SOUNDBITE OF LAUGHTER)

COLMAN: No, certainly not.

CONAN: The purpose, as you said, initially was to protect anonymity in a world where being an alcoholic was a terrible stigma. As you say, that's lessened, partly because of our understanding of medicine has advanced, and partly because of the number of people who've gone public.

Nevertheless, that's still a problem for people like - I'm not sure an airline pilot would like it to be known that he's in AA.

COLMAN: Sure. I completely agree with that, and that's why I say it should be a personal choice.

CONAN: And there is also circumstances - some people for example posted pictures from AA meetings on Facebook, inadvertently outing other people.

COLMAN: Yeah. I would never - again, I would never condone that kind of behavior, much less posting pictures on Facebook at all. But that's my preference...

CONAN: Well, that's another issue entirely, and people have gotten into trouble for that sort of thing in any number of cases. But there is also an interesting example that you drew, or interesting comparison you drew in the piece, one of the people you spoke with to say: Wait a minute, this is a little like gay was not so long ago.

COLMAN: Yes. That's very true. And, you know, I'm a gay man, too, and, you know, I'm very out about that. And I've always noticed that there is this sort of strange inconsistency there, that, you know, coming to terms and realizing that, you know, needing to be - you know, develop a certain kind of forthright attitude about being gay is important because otherwise, you do feel like, you know, is this something I'm keeping secret.

And yet at the same time, here I was, I was in this other program that I did feel that I, you know, was supposed to keep secret. And, you know, there is a certain kind of dissonance there that made me think, well, yeah. There is - what is the difference here?

CONAN: And it's another distinction we have to make. There is a public aspect of this, which you say is probably outmoded, or at least for a lot of people it ought to be. There is also an internal anonymity that remains important.

COLMAN: Yeah, I would - I think it is important, because that is really, to me, what the core of the program is about, is about a certain sense of, you know, kind of coming in and being able to sort of take off the backpack of one's self, you know, and sort of say, you know, whoever I am out there, I don't have to be that in here. I can just be, you know, this person.

I don't have to keep up a facade. I can say I - is going on to me, and that that's not going to - that that's going to be treated with a certain amount of courtesy. And that's a wonderful, wonderful thing. So I would - anyway, I - that's what I think.

CONAN: Here's an email we have from Angela in Gadsden, Alabama: I will celebrate 20 years clean and sober this month if I don't get stupid between now and the 26th. My understanding of the tradition of anonymity has deepened and broadened over the past two decades.

Where I once was terrified to let anyone know I was in recovery, now I essentially don't care. I believe the extreme social stigma of having an addiction is a thing of the past, and while those in recovery who choose to be public must take care not to speak as if they represent any viewpoint but their own, I don't think it's detrimental to any 12-step program to have members who live their life in recovery out loud. In fact, it may inspire someone to try our way of life.

And that's an important point, that if people can become public examples, maybe they can inspire other people to get some help.

COLMAN: Yeah. I think that's great, and I think that's basically my attitude, too.

CONAN: Let's see if we can get a caller in on the line, 800-989-8255. Email us: talk@npr.org. What's the value of anonymity if you're in a 12-step program? Kelly's on the line, Kelly with us from Edmond, Oklahoma.

KELLY (Caller): Wonderful, thank you. I think it's important to note the 12th tradition. It states that anonymity is the spiritual foundation of all the traditions, and ever reminding us to place principles before personalities. So it's not so much about the stigma as it is about being one of many.

And whether you're a writer for the New York Times or a pop star or just a janitor from Edmond, Oklahoma, when you're inside the rooms of AA, you're just one of many, a recovering alcoholic. That's my first point.

My second quick point is if somebody was to go public and announce that they're a recovering alcoholic in AA and then they relapse, what kind of image does that give Alcoholics Anonymous?

COLMAN: I'd like to address those questions, because, I mean, they're both things you hear a lot. And his first point I think is true, and I think that's what I was talking about a second ago, about the 12th tradition being this - much more of a central pillar of AA.

The second thing is that, you know, you hear this a lot from people, that, you know, there are these celebrities that come out and - come out of rehab and, you know, whether they say they're in AA or not, you know, the next thing you know, they're back on the cover of the National Enquirer, and that this is something that gives AA a bad name.

And, you know, I'd heard it for 15 years, and I didn't really think too much about it, either. I thought that that was, you know, sound thinking. But in writing this piece, I realized that, you know, that what that argument does is actually make an argument for people to give AA a good name by coming out, if you're somebody who has long-term recovery and who has a fairly - you know, a stable and reliable recovery practice.

You know, if people have - if the public have an idea that AA is about a life of constant relapse, which is something that focus groups have, in fact, established, that that is a public perception, then it seems that, you know, people who do not live that life, who have successfully, you know, licked any - any number of addictions, that, you know, it makes sense for them to come out and say no, no, no, you know, I am 15 years sober. And, you know, this program works, and it's great, and, you know, that's all.

I am not a celebrity who just came out of, you know, Betty Ford an hour ago and I'm, you know, going to leave the studio and go, you know, go to the nearest bar.

CONAN: Kelly, thanks very much for the call.

KELLY: Thank you.

CONAN: Let's see if we can go next to - this is Andy, Andy with us from Roosevelt, Utah.

ANDY (Caller): Hi, Neal. Great to be here on the radio with you, and Mr. Colman, I applaud your efforts of openness. Unfortunately, openness for me - which that's part of the AA meeting where we share our stories, our experience, strength and hope so that we can help others - that openness now is a curse for me.

And I say that sort of mockingly. I am a trained wind technician, working on those big wind turbines. And in a casual lunchtime environment, I mentioned that I'm a recovering alcoholic and recovering addict, and the boss got wind of that and sent me home.

COLMAN: Wow.

ANDY: And unfortunately, it's cost me a career. And right now, I'm doing what I used to do, which is driving a truck. The stigma of this issue about people considering me as an active participant in that old lifestyle, it's very frustrating to have this confrontation where they just throw their pal in the washing machine and get rid of you, you know.

COLMAN: I'm sure.

ANDY: And the struggle for me now is getting a different career, getting a different job. I love those wind turbines. It's a wonderful career. But unfortunately, my big mouth got me sent home, and it's not a very fun place to be.

COLMAN: I'm so sorry. And yeah, I would never argue that the stigma is gone. I would just say that it has lessened, and I felt - I was in a position to take a certain amount of risk and say, you know what? This is - I'm going to come forward. I would never say that it was, you know, right or that everybody should be comfortable doing it, and I'm so sorry that that happened to you. It's a real shame.

ANDY: And, you know, and it is a shame, because my work ethic was never in question, ever. And the simple fact is that these individuals, even the supervisor, didn't have a problem with my background.

CONAN: And some might question, Andy, whether that was entirely legal. I'm not sure, though, that recovering alcoholics are a protected group under the law.

ANDY: I don't think they are. You know, there are so many other groups that are protected, but behavioral stuff like alcoholism, those are not necessarily protected. And that's an unfortunate thing. But it was my choice to come open and share my experience with these gentlemen, not realizing the unintended consequence. And so here I am, driving a truck.

CONAN: Andy, good luck to you. Thanks very much for the call.

ANDY: Thank you very much. Have a great day. Bye.

CONAN: If you have attended a 12-step program, tell us: Why does anonymity matter? 800-989-8255. Email us: talk@npr.org. More with David Colman and your calls in just a moment. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, right after the news.

(SOUNDBITE OF MUSIC)

CONAN: This is TALK OF THE NATION. I'm Neal Conan. Alcoholics Anonymous and similar 12-step programs express one of their core values right there in the name: anonymity. People who suffer from serious mental illness also tend to keep their problems secret, but Marsha Linehan had enough of that. She's director of the Behavioral Research and Therapy Clinics at the University of Washington, creator of a treatment used the world over for severely suicidal people.

What's more, she knows their pain intimately. At the age of 17, she was committed for attacking and mutilating herself, confined to a special seclusion room. She, too, told her story in the pages of the New York Times.

If you've been involved in a 12-step program, tell us, what's the value of anonymity? Give us a call: 800-989-8255. Email: talk@npr.org. You can also join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION.

Our guest is David Colman, a contributing writer for the New York Times. But let's turn to Marsha Linehan, who's with us from the studios of member station KUOW in Seattle. And nice to have you with us today.

MARSHA LINEHAN: Thank you. Nice to be here.

CONAN: And there was - in your piece - it was a piece about you in the New York Times, and it described a situation where some of your patients kept asking you: Are you one of us? Do you feel our pain?

LINEHAN: This is true. Patients did ask that, and - not very often, though, actually. I talked about my life, not because some patient asked me a question about it, but because I believed, at some point in my life, that my research was safe, which was a critical factor that kept me from talking earlier.

CONAN: Because it might have been questioned?

LINEHAN: Questioned or, you know, research is always - can bring about a lot of attacks, but what you want to avoid is ad hominem attacks, in other words, attacks on the research investigator themselves, as opposed to the research itself.

CONAN: Right.

LINEHAN: And so I had to keep my research safe because my research was designed to help the very people that I want to help, and I wanted to talk about my life because my life gives hope, but I waited until I felt my work was unassailable.

CONAN: Unassailable. And at that point, you thought it was important to speak out about your past and your struggles - and not just your struggles, but your joy, again, providing that example of saying you can get through this.

LINEHAN: Yes. Exactly.

CONAN: And as you did that, I wonder what's been the response.

LINEHAN: The response in emails - particularly, amazingly to me, from so many colleagues in the field of behavior therapy - has been extraordinarily positive. Many individuals on my faculty, which was probably my biggest worry, also sent me quite positive emails, and family members and patients have sent me emails about two things: one, that they feel hope, and if I can do it, they can do it, which of course was the whole point.

And because my story has a spiritual element to it, also, very surprising to me is the number of people who've written me to say that they, too, have had spiritual experiences but just ignored them, or nobody paid attention to them, or it was viewed as unimportant and that now they could - it validated many people now. That was probably the biggest - single biggest surprise.

CONAN: You thought there would be a lot of skepti-- I should say that there was an experience that you had in prayer that helped you manage your demons, I think, is a fair way to say it.

LINEHAN: No, no. A fair way to say it is transformed me.

CONAN: Transformed you. Okay.

LINEHAN: But my problem with the spiritual experience - I have to say this, because it's so critical - is you can never promise a spiritual experience. But what you can promise is that if you practice, consistently, true, radical acceptance and willingness to have the life that you have, even though it's terrible, it's hell, but you practice acceptance, you'll be transformed ultimately. Everyone will be. And it's true not just in my treatment, but AA, and any real effective treatment forces you to confront the reality of the moment.

CONAN: And we're talking today about the value of anonymity. You said it was important, for many years, to retain that anonymity, to maintain the integrity of your research so it wouldn't be attacked, or you wouldn't be attacked, and the research would stand on its own.

As you look back, what was the value of anonymity to you?

LINEHAN: You know, I believe being public about private parts of your life, when the private parts of your life are stigmatized by the public, should be very strategic, and that it's often a mistake, and many people - particularly people that I treat - are often too public. And so they get rejected before someone gets to know them.

So it can be very valuable in relationships where people already know and value you, to find out things about you that may be stigmatized in our culture. But to tell them a stigmatizing piece of information before they know you usually - not always, but usually backfires.

CONAN: Would you agree with David Colman that the stigma attached to alcoholism that was once so pervasive is a good deal less than it used to be?

LINEHAN: I loved hearing it. I think it's absolutely true. We're way far away from that on severe mental disorders, unless - we live in a culture where if you can't prove that brain abnormality caused it, our only alternative appears to be to be judgmental of the person with a disorder. And so I think alcohol has gotten past a lot of the stigma, obviously not all of it, as you can tell by the caller who got fired.

CONAN: Yeah. It's interesting to me that some degree of the reduction of stigma to alcoholism is the result of its - our understanding of it as a disease, whereas mental disease, always accepted as a disease, is still stigmatized.

LINEHAN: Well, I'm a psychologist. So all human behavior is biological. But that doesn't mean it's all a disease. You know, behavior can be learned. Alcoholism can be learned. Dysfunctional behavior can be learned. Or there can be an absence of learning.

So as a culture, we've sort of gotten into this idea of if you can prove you have a disease, you're a good person. And if you can't prove it's a disease, you're a bad person.

(SOUNDBITE OF LAUGHTER)

LINEHAN: So I'm in favor of getting rid of these kind of judgments and just asking: What's the cause of the problem?

CONAN: David Colman.

COLMAN: Well, first of all, I just want to say how much I enjoyed Dr. Linehan's article and hearing about her philosophy, because I think it is very important. And I think the idea of being able to come forward and sort of say, you know, this is who I am, and this is who - you know, I'm going to accept it, and, you know, I suggest you do the same, I think that's an incredibly empowering experience.

I've had my own spiritual experiences doing the exact same thing, and I think that, you know, if you don't accept yourself in a - you know, some aspect of yourself, then you are - I can't use a four-letter word, but you're not in good shape.

(SOUNDBITE OF LAUGHTER)

COLMAN: So, you know, I learned to accept myself when I realized that I - there was no question that I was gay, and I did it again when I realized that I was an alcoholic. And I'm sure I'll do it some other times, too - grudgingly, but ultimately very happily. And so I really applaud Dr. Linehan in coming forward on that.

And I do think it's interesting the way - the process by which we kind of identify things as a disease or not a disease is an incredibly murky territory, and I think it's interesting that, you know, alcoholism has been able to kind of pave a route towards public acceptance by calling it a disease, which in some ways does acknowledge that there is some element of severe compulsion to it that does manage to override our free will.

It's interesting, because sometimes I wonder if, you know, calling things a disease is actually a route towards them not being seen as a disease - that is, you know, homosexuality was considered a disease until the early '70s, when the - when it was finally dropped as being seen that way by the - you know, the institutionalized psychiatry world.

And I think that that ultimately actually helped its acceptance, being - perhaps being seen as a disease for a while. And I do think that you see these other things - when you are able to label something something and say this is what I have, this is what I am, this is what I suffer from, and these are its aspects, and I'm a human being just like everybody else, you know, you're sort of forcing people to sort of sit back and say okay. You know, I get. You know, you have this space now, and I won't judge it.

CONAN: Let's get some more callers in on the conversation. Let's turn to Mark, Mark with us from Colorado City.

MARK (Caller): Hi, yes. My name is Mark, and I'm a sex addict. And I've been involved with 12 Step SLAA - Sex and Love Addicts Anonymous - for a long time. Now, even when I go to other - to meetings that are, like, general 12 steps for different kinds of addicts, I don't identify as a sex addict. I just say I'm an addict, because even in there, I feel people move away.

CONAN: So the stigma there, very much alive, you're saying.

MARK: Yes. You know, and I was a substitute teacher. I now work for the government, have a security clearance - though, of course, they know about it. But my understanding of the - was it the 11th Tradition, I have trouble keeping them straight - is it does say at the level of newspapers, magazines, movies. What the individual does is up to them, but to come out - they want people not to come out and maybe present themselves intentionally or unintentionally as spokesmen, you know, speaking for the organization or for the service.

CONAN: It's interesting. We have an email to that point from Teresa(ph) in Hudson, Wisconsin. One of the most beautiful traditions, she wrote, in AA is that by anonymity, many old-timers have established meetings openly use their own last names. This falls within guidelines. AA does not endorse or support any outside entities. I believe the key issue with your speaker is the point of at the level of press, TV or radio. Your guest is using this to achieve his own personal goals, objectives and to feed his ego. We're all equals in AA, Al-Anon and other 12-step programs. We do not endorse his comments, nor is he endorsed as a representative of AA. It's one thing for him to discuss his own personal recovery. That's his decision. It's another whole thing for him to speak specifically of AA or the program. I find his arrogance appalling. He's one of many worldwide and has no authority to speak on anyone's behalf.

MARK: At another level. When I was going through my divorce...

CONAN: Excuse me. I just wanted to give David Colman a chance to respond to that.

COLMAN: OK. Yeah. I mean...

LINEHAN: I'd like to respond to it, also.

(SOUNDBITE OF LAUGHTER)

COLMAN: First of all, I'm not speaking on behalf of anyone. I want to make that perfectly clear. I thought it was clear, but I, you know, I think that if you're - it was my presumption that if you're sort of criticizing this concept, it seems clear that you're not speaking on behalf of anyone. And, you know, I mean, I think anybody who is rocking any boat in the world is going to be accused of arrogance and egotism. And really, actually, I think I'm trying to practice some of the principles of the program, which is to try and make other people aware of this and carry this message.

I think I'm not - I'm not down on AA at all, and this is not an article that was meant to be critical of AA. I was just sort of trying to say, hey, you know, a lot of people don't seem to be observing this anonymity thing. Is it - does it, you know, should we still be hanging on to it?

CONAN: Marsha Linehan?

LINEHAN: You know, this is why it's hard to come out to say much, because you get accused of being egotistical, self-centered, all these other things, which on the blogs, I've been - that's been said about me, also. And one of the main reasons I never - one of the other reasons, I really had no personal desire...

(SOUNDBITE OF LAUGHTER)

LINEHAN: ...to talk about my life. And if I hadn't thought it was cowardly to keep it private, I wouldn't have talked about it. But the reason was is the fear of being egotistical, self-centered or wanting to make myself looked like something that I'm not. But I - so I think we have to be correctly careful not to assume motivation on the part of other people, if we're not in their minds to actually see their motivation...

CONAN: We're talking with...

LINEHAN: ...and...

CONAN: Oh, I'm sorry. We're talking with Marsha Linehan, who's a professor of psychology at the University of Washington, and with David Colman, a contributing writer for The New York Times, about the value of anonymity in 12-step programs. And you're listening to TALK OF THE NATION, from NPR News. And I'm sorry, Marsha Linehan. I didn't mean to cut you off.

LINEHAN: It's OK, because I'd mostly finished...

CONAN: OK.

LINEHAN: ...except to - I think that, you know, we need enough people talking, because alcohol has become less stigmatized - if you're in recovery, of course...

(SOUNDBITE OF LAUGHTER)

LINEHAN: ...and depression has, because all the famous people who get on TV now who say they were depressed. And many of these disorders will get destigmatized if people who recover talk. And as someone else pointed out to me once, they said, you noticed that almost everybody who talks about having had a disorder now is old and can't be hurt anymore...

(SOUNDBITE OF LAUGHTER)

LINEHAN: ...by coming out. And that's definitely true of me.

CONAN: Let's see if we get another caller in. This is Jean, Jean with us from Waltham in Massachusetts.

JEAN (Caller): Yes. Hi. How are you?

CONAN: I'm good. Thanks.

JEAN: Excellent. My feeling is, and what I was bringing up is that the highest office any of us can achieve in AA is servant. We don't have any bosses. There is nobody who runs the show for us. And that's what makes it work because, you know, our primary purpose is that still-suffering alcoholic out there. And we need to know how we need to handle it, and handling it amongst ourselves. There are different kinds of anonymity that I hear being spoken about: personal, group and organizational. And from a personal level, it's just that. It's a personal decision. That's fine. But I would not want someone to make the decision for me. And, you know, that's my perspective.

CONAN: And organizationally, David Colman, another principle cited is that of principle, not personality.

COLMAN: Yeah. That's true. And that's in the 12th Tradition, which I was talking about earlier, and which a lot of people seem to think I don't care about, which - although I did talk about it in the article. And I do think it's a very important, and I think it's one of the most wonderful aspects of AA, because it creates an anonymous atmosphere for anybody to go in there and not be judged, essentially - you know, hopefully, that is. And I think that that 12th Tradition is a wonderful thing. I would never suggest it be altered. I do think it is one of the best things about AA. And, you know, I wish people could understand that and see that I did include that in the story. But I constantly am criticized for not - for leaving it out.

CONAN: Well, David Colman, thank you very much for your time today. Jean, thanks very much for the call.

JEAN: Oh, terrific. Thank you for your time.

CONAN: David Colman, a contributing writer for The New York Times, where his article "Challenging the Second 'A' in AA" ran on May 6th. You can find a link to that on our website, npr.org. Click on TALK OF THE NATION. He joined us from our bureau in New York. Our thanks also to Marsha Linehan, director of the Behavioral Research and Therapy Clinics at the University of Washington and a professor of psychology. There's a link on our website to The New York Times article that ran on June 23rd, where she wrote about her struggles with mental illness.

Go to npr.org. Click on TALK OF THE NATION. Thanks very much. And when we come back, we'll be talking with Grammar Girl about the distinction between explicit and implicit and, well, 99 other words. Stay with us. It's the TALK OF THE NATION, from NPR News.

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