WHY IS AN ALCOHOLIC AN ALCOHOLIC?

by Lida Prypchan

Only by understanding the numerous and complex causes of alcoholism, can the gravity of the problem be appreciated so that therapy may be practiced on an individual level and the disease combated on the social scale.  There are four main causes: DESIRE, TOLERANCE, PERSONALITY, BIOLOGICAL TYPE and HEREDITY:

DESIRE: Firstly we must analyze the hedonic value and the mythical prestige of alcohol: The history humanity shows man’s tendency to seek out pleasure and flee from pain.  This epicurean propensity makes man an easy prey to alcohol, because it has an effect as a tonic and euphoriant, relieves anxiety and frees repressions.  Secondly, certain social prejudices or false beliefs such as the one which attributes medicinal properties to alcohol, or the one which says that it increases a man’s strength and virility.  Thirdly, social pressures.  It is well known that the act of “drinking together” creates solidarity between men.  On the other hand, some drink with their colleagues after work because of peer pressure, so as not to be rejected by the group.  Other pressures come from bombardments of commercials which advertise alcoholic drinks, their cheapness, and the abundance of drinking establishments.  All this great economic power is in the hands of the alcohol magnates, owners of wealthy alcohol manufacturing companies, for whom anti-alcohol campaigns are not profitable.

TOLERANCE: By this is understood the relationship between the concentration of alcohol in the body and the degree of intoxication.  Tolerance varies from one individual to another according to age, sex, hereditary predisposition, food habits, the physical and psychic state and the time of intoxication.  For the alcoholic to seek out drink and to become used to it, he must have a form of tolerance which protects him from major organic disturbances and a form of habituation which makes alcohol a sort of food supplement necessary for the balance of his disturbed metabolism.  This has given rise to the opinion that the metabolic disturbances of alcoholism may in turn condition the alcoholic habit.

PERSONALITY AND BIOLOGICAL TYPE: The “alcoholic personality” has been discussed.  They are individuals who display moral frailty, weak character, lack of social adaptability, sexual disturbances and frequently neurosis.  It must, however, be recognized that often a bad beginning in life, social failure and, particularly, conflicts in the emotional arena can cause a nervous depression which the individual attempts to overcome by “stimulating” himself with alcohol.

With regard to the biotype, it can be said that the pyknic type (with a tendency for obesity and cyclothymic disturbances) tends toward chronic alcoholism, while the long and lean type (schizoid) tends toward delirious alcoholism.

HEREDITY: It was formerly believed that the alcoholic had hereditary defects in his ancestry which were magnified as they passed down the line.  The authors of this theory stated, “Degenerates breed drinkers and drinkers breed degenerates, a vicious cycle maintained by alcohol”.  This degeneration theory is accepted less and less.  It is undeniable, however, that alcoholism is more frequent in the families of alcoholics.

In practice, a greater incidence is observed in persons who have a family history of alcoholism.  In this respect, it would be appropriate to ask whether it is a function of example, early initiation, defective education or genetic factors.

Only one thing amongst all this is certain and that is that alcohol, although socially permissible, is a drug which, like all the others, needs people to campaign for its eradication.

WHICH CAME FIRST: ALCOHOL OR CRIME?

In July 1982, Drs. Román Prypchan and Pedro Téllez Carrasco presented for their professional advancement a detailed study on 150 psychiatric skills entitled: “Problems in the Practice of Psychiatry in Venezuela.  Analysis of some Sample Cases”.  In this work the authors found that alcoholic psychoses constituted 9% of the total sample.  There were 9 cases of pathological inebriation, 2 with alcoholic delusions of jealousy, 1 case of alcoholic hallucinosis and 1 of alcoholic paranoia.  Among the total number of sample cases there were 67 crimes against persons, subdivided into 49 homicides, 1 accessory to homicide, 6 uxoricides, 2 infanticides and 9 cases of injury.  Upon correlation of alcoholic psychoses with crimes against persons it was observed that 10 alcoholic psychoses were responsible for 7 homicides, 2 uxoricides, and 1 case of injury.  Only 2 cases were related to offenses against property and 1 to an offense against morals.  From this it can be deduced that the influence of alcohol was practically insignificant in the offenses against property and morals, whereas in the crimes against persons its influence was most significant.  It was noted, moreover, that the days when the greatest incidence of crime occurred, were on the weekends and holidays (a fact which has not varied since the beginning of the century).

Very interesting data may also be found in the work of other authors reviewed by Téllez and Prypchan.  For example, Rendón Aponte and Arocha Echenagucia, in their work entitled “Homicide and Alcoholic Influence” among 2,220 delinquents in the Penitenciaría General of Venezuela, found that 616 of the 1,467 homicides were committed under the influence of alcohol;  this goes to show that although alcohol is not a causative agent, it does facilitate the onset of crime.  However, the case may be argued to the contrary: that the individual imbibes alcohol in order to work up courage for the crime.  

On the other hand, in the work “Statistical Cause of Four Social Problems in Venezuela” Ricovery López maintains that in 60% of the cases where blood was spilled, the causative agent was the influence of alcohol.  

J.M. Echeverría reports in his study “Alcoholism and Crime”:  “in marginal groups, vagrancy, crude language and drunkenness act together in causing violence.  In these groups there is a marked tendency toward primitivism;  social standards and controls lose their inhibitory effect and lead to crime, for which reason the greatest incidence of community disputes, use of knives, pointless injuries and homicides occurs in these environments during paydays, weekends, Christmas, Carnival, and Holy Week.”

J.M. Mayorca, in an article published in a Caracas newspaper on the issue of advertisements for alcoholic drinks, reported that from 1970 to 1980 the per capita consumption of alcohol in Venezuela had increase from 103.74 to 176.27.  As a consequence the number of suicides also increased from 243 to 285, and homicides from 1,002 to 1,576.

With regard to the question “Which came first, alcohol or crime?” we would have to ascertain not man’s first sin, but his first crime, and whether or not it was unleashed by alcohol.  What is certain is that without actually causing crime, alcohol makes people aggressive and irritable even for a stupid reason.  To confirm this you need only watch a few cowboy movies:  at dusk they congregate in the tavern, at midnight they begin the shoot-out, and by dawn there is not a soul left to tell the tale other than one Manuel Matorrales who was the only male not drinking, because he had gastritis.

THE BOTTLE’S EMPTY, WIVES RUN FOR COVER

There are a few rare cases of people who enjoy long life and excellent health in spite of their alcoholic excesses, while others who drink less decline after just a few months of excess.  Alcoholism depends on the quantities imbibed by a person on a daily basis, subject to certain conditions which are inherent in or acquired by an individual.  It is the permanent psychic anomalies and the neurological and general symptoms which define chronic alcoholism.  Initially the psychic symptoms vary, but as cerebral and general lesions develop, they soon become uniform, developing into alcoholic dementia.  The essence of the alcoholic character resides in emotional fragility, intensity of the emotions, weakness of willpower and absence of inhibitions.  Depending on upbringing, the alcoholic remains amiable in his relations with others, as long as he is not opposed.  If this occurs, with his family, his boss or occasionally his peers, then he can lose control, becoming aggressive and brutal.  During the first years of his alcoholic excesses, because he is pleasant and agreeable, as well as intelligent and not a little hypocritical, he is well-liked, while at home he is a tyrant, an abject creature who plunges his family into misfortune.  Frivolity is typical of the alcoholic: he is moved by external stimuli, his emotions are in constant flux.  His behavior is characterized by inconstancy, nonchalance, amorality, satisfaction of his immediate needs without heed of ethics or the consequences of his actions.  That superficial euphoria is typical of the alcoholic temperament, a certain odd sentimentality or an eternity of abrupt complaints, producing an impression of authenticity when it is merely hypocrisy.

His loss of energy (abulia) is likewise typical.  His intellect declines considerably, terminating in alcoholic dementia.  Mental disturbances occur in the following order, beginning with lack of attention, inability to concentrate, forgetfulness, inability to learn, reduction of the psychic horizon, and in addition to forgetfulness, loss of memory.  Associations are loose and superficial, he is incapable of thought and his judgment is unsound.  The alcoholic mentality is characterized by a search for excuses to stop drinking and for reasons to continue, but whether he is a refined intellectual, wealthy businessman or an illiterate laborer, for some reason he always attempts to justify himself.

The physical symptoms are what finally enable a diagnosis to be made: facial expression, trembling kinetic symptoms, motor symptoms, sensitive symptoms, skin reflexes, nutritional state, alterations in the heart and liver, changes in sleep patterns, sexual disturbances and, if any, convulsions.

An alcoholic has permanently reddish facial features with networks of broken capillaries at the end of his nose and on his cheeks.  Trembling when in need of sustenance is not invariable, nor is it exclusive to alcoholism, but it frequently appears as a regular tremor with minute twitching.

Kinetic symptoms such as a trembling moustache when talking, (for this to be visible, the moustache has to be thin, because if it is thick and aggressive like Magnum’s, not even someone with bionic eyes would be able to see), trembling of the upper eyelid, mioclonic contractions of various muscles and unsteady gait in the more advanced stages.  Motor symptoms are: superior polio encephalitis, hemiplegia or monoplegia following pachymeningitis, or cerebral hemorrhage in cases of serious cerebrovascular accident.  There is also partial paresis or a certain looseness of facial muscles.  Sensitive symptoms are erratic pains or hypesthesia of the lower limbs and cramps in the calves.  In the majority of cases skin reflexes are greatly intensified.  As for general nutrition, there are fat alcoholics (those who drink beer and wine), and thin alcoholics (those who drink spirits), but loss of weight even marasmus, is nearly always evident in severe alcoholism.  Cardiac hypertrophy and fatty degeneration, causing arrhythmia and heart failure, are also evident.  In their digestive systems alcoholics may also suffer initially from gastritis, which later develops into a gastro duodenal ulcer accompanied by vomitus matutinus.  Fatty degeneration occurs in the area of the liver, followed later by cirrhosis then finally failure of the liver.  Among the sleep disturbances, the most frequent is insomnia.  Toward the end of the illness convulsions of the comitial type may occur.  Sexually, the alcoholic has an elevated libido and reduced potency, the latter being responsible for his frequently delayed orgasm or ejaculation and later impotency, an affliction which increases his delusions of jealousy.  I have left delusions of jealousy to the end because these are a very frequent characteristic of chronic alcoholism.  This type of delusion is curious in that while the alcoholic remains insensitive to his wife’s certain infidelities, even condoning them, his fits of jealousy occur when there is the least reason for them.  Such fits occur when he arrives home drunk in the early hours of the morning and roughly accuses his wife of her infidelities, even looking between the sheets for traces of them (or looking for her lover underneath the bed and maybe even, alas, finding him) or in the closet, or for clues on his wife’s face or clothes, some indication in her excuses or in his children’s words or attitudes.  Such a rage of jealousy provokes blows, insults and not infrequently, the violent death of the unfaithful wife and, what is saddest, often without her being unfaithful at all.  This is why, when the bar closes at the hour of dawn and the liquor has all gone, the bottles empty… the wives run for cover.

STATES OF AFFINITY

by Lida Pripchan

The attraction, union or closeness between individuals is ruled by circumstance but also by identification and antagonism.

Affinity, either for a similar concept of life, for a shared ideology, for interests in common.  Antagonism, such as that observed between the man and woman who achieve perfect unity by complementing one another.  But individuals of the same sex also can be united by antagonism, an example of which is the relationship between a purely academic individual and a practical one, or between a man who, though wealthy, lacks ideas and one who lacks resources but not ideas.  This introduction leads me to the subject of habits, since antagonism and affinity have a lot to do with them.  So it is easy to see that a drinker can meet another and be friends with him by affinity, but in the end one cannot tell whether the friendship is due to friendship per se or to alcohol; alcohol, money and food make many friends by themselves, but they are friends of circumstance, because when these three factors disappear, so also do the friends.  

The opposite of the preceding case would be the individual factors disappear, so also do the friends.  The opposite of the preceding case would be the individual who recognizes his excessive predilection for drinking and seeks out acquaintances that do not drink.  It can be inferred from these two situations, that the first individual abandons himself without precaution to his appetites, while the second cautiously channels them into other paths.  In this sense one should view youth as a stage which determines the formation of habits, particularly alcoholic ones,  since one unfortunate trait or bad habit is like a pig, which when young, does not make much trouble, but fully grown created havoc everywhere.

During adolescence it is common to allow oneself to be influenced by others (peer pressure), to question, to break with convention, as it is almost impossible to realize that one can be unconventional and very original without doing harm to oneself.  As a result it is a period of great confusion when one does not understand oneself but needs to be accepted by others.  This results in imitation, but not exactly of what is best.  Moreover, to imitate other people’s habits believing them to be one’s own is to live a dangerous lie, because the habits could well become one’s own.  Becoming accustomed to what is inadequate is to fall into a spider’s web, from which it is difficult to extricate oneself later on.  It is also hard to recognize what is going on… Changes occur constantly and with them new ways of focusing life, and although some individuals change more easily than others, there are some who never do, or if they do they don’t appear to , and instead of living through this stage and passing on to the next, they remain stuck in the same one all their lives. 

The question most frequently asked of the alcoholic by the curious is: “Why do you drink?”  I believe that when you ask this question, you expect a confession from a man ruined by adverse circumstances, but what you receive on the contrary is a very pleasant and entertaining answer on how amusing one becomes after a few little drinks.  Let’s examine the best answer, given me two years ago by Mr. C.  He told me: “Look, I’ve been drinking for years now.  I’m a social alcoholic, that’s to say I enjoy the alcoholic habit in company, although I have always been very careful.  But my wife considers me an alcoholic and not exactly anonymous.  Why do I drink?  That’s easy.  For the same reasons that I drink anything; firstly for pleasure, next for pleasure and because it’s a habit, and then for pleasure and because it’s a habit and because you realize that you become married to alcohol which is an acceptable love but not very much respected, but with drink as your companion you can walk down the street with your head held high.  Sure, you’ll find someone who will invent reasons for drinking, like a friend who says he does it because his mother didn’t nurse him (as if mother’s milk had alcohol in it!). 

Someone else says it’s because he’s too shy, another because he’s too forward and alcohol puts a bridle on him (especially when he drinks “Caballito Frenao” ¹), others because they’re in love and don’t know how to appease their passion, others because it’s what the doctor ordered.  As far as I’m concerned, that’s a load of baloney.  You drink for pleasure, for pure enjoyment, because you feel happy and content and alive inside. Anyway, everything has to do with alcohol:  business, politics, art, sports (because they always go on a binge after a championship), even witchcraft is connected with alcohol, you go to a spiritualist session or to Maria Lionza’s mountain², and just see how they put away those big bottles of rum – you’d think they’d called up the Indian Guaicaipuro!  Give me a drink from just half of that bottle and I assure you the First Negro, and all his brothers too ³, would be down in me!  Look, alcohol’s mixed up in everything.  

Why do you think this country is as it is?  Because all political meetings and all important decisions are settled with drinks, of course.  From birth to death alcohol goes with everything: when a baby is born you have to celebrate his first tinkle, when your neighbor dies, as soon as you get through with your sobbing – let the party begin!  Birthdays, baptisms, weddings (you have to be crazy or drunk to get married), silver weddings, golden weddings, copper weddings, Mother’s Day, Student’s Day, Father’s Day, Youth Day, Worker’s Day, the five hundredth anniversary of the town where you were born, Doctor’s Day, Nurse’s Day, Lawyer’s Day, Public Accountant’s Day, Social Worker’s Day, the following day, whatever day you want, the day you name and the one you don’t name too, the three hundred and sixty-five days of the year, and the month and a bit before and after elections.  What are election campaigns all about anyway?  Handing out liquor to the public to send their brains to sleep.  Why is there so much corruption?  Because the politicians steep the public in alcohol, so they can do whatever they want with them.  Forget it, there’s no remedy, society has been alcoholized.  Here’s to your health!”

¹   Literally, “The Bridled Horse”, a popular brand of extremely strong dark rum.

²   Well-known spiritualist rendezvous in Maracay, Venezuela.

³   Mythical spirit figures.

DELIRIUM TREMENS

by Lida Prypchan

Delirium tremens was identified as a clinical syndrome by Sutton (an English doctor) in 1813, but he was unaware of its alcoholic nature.  It was Rayer, in 1819, who gave a new and excellent description of this delirium and insisted upon its alcoholic etiology.

Delirium tremens is the most serious of the complications of chronic alcoholism; although it only develops in chronic drinkers, it is not necessarily a complication of chronic alcoholism, since not all drinkers end up victims to it even though they run the risk of this.  The concurrence of certain somatic factors is first necessary before it presents an appearance.  This is observed exclusively in individuals who present organic lesions resulting from extreme abuse of alcohol over a period of from seven to ten years.  It is characterized by oneiric delirium with typical symptomatology and certain physical symptoms among which the most significant are psychomotor agitation and trembling.

A few decades ago it was only noticed among persons from the lower classes, but for some time since then cases have also been observed in the upper classes, as well as among women, which was formerly the exception other than among prostitutes.

The age at which it occurs is generally between thirty and fifty.

Sudden deprivation of alcohol (abstinence) is very rarely the cause of D.T.

Constitutional predisposition toward alcoholism has been rejected as a significant factor leading to the appearance of D.T. because of the preponderance of people suffering from cyclothymic delirium, which should not be interpreted in the sense that the manic-depressive constitution predisposes one to D.T., if not to alcoholic habits.  Normally it is not usual to find psychopathic or psychotic deficiencies among those suffering from D.T., only that they are individuals of vigorous mental and physical health, whose natural robustness has resisted their alcoholic excesses for years.

D.T. is due to certain metabolic alterations which increase the toxins in the central nervous system, or prevent their destruction.  Some authors focus on hepatic insufficiency as a decisive factor in the production of these toxins; others, on the other hand, refer to renal insufficiency and yet others to cardiac insufficiency.  What is certain is that general pathogenesis cannot be inferred but the almost invariable presence of hepatic lesions speaks in favor of a single pathogenesis of metabolic origin.

Its presence is announced by various premonitory symptoms, the most significant being sleep disorders: short, restless sleep, appearance of terrifying nightmares.  It may also be preceded by one or more epileptiform crises, which can initiate an epileptic fit.  Preceded by these symptoms or appearing completely unannounced, acute alcoholic delirium occurs suddenly in the overwhelming majority of cases.  The clinical pattern is so typical, that it hardly ever presents any difficulties in diagnosis, and is characterized by somatic and psychic symptoms.  The first somatic symptom to come to attention is the excessive trembling during any movement of the limbs, mainly the hands and tongue.  The second is the profuse sweat running down the face.  The third is persistent insomnia, so the individual can rest neither by day nor by night.  Temperature is an essential indicator.  It reaches 39-40°C in two or three days, jumping around then remaining there for several days.  There is a tendency to believe that there is no such thing as apyretic D.T.  The initial fever of 40-41°C indicates acute hyperazotemic alcoholic delirium.

The psychic symptoms are: hallucinations, balance disorders, professional delusions, receptive functions, mental derangement, emotional and behavioral disturbances.

Hallucinations are the most striking symptom of delirium, consisting mainly of highly varied and haphazard visual and tactile (rarely auditory) hallucinations.  The visions are multiple, kaleidoscopic, scenic and microptic, relating to swarms of animals, talking birds, assassins armed with knives, legions of soldiers or dwarfs.  Those who suffer from haptic hallucinations experience hairy, threadlike sensations, water dripping, they feel animals biting or insects stinging, or their whole body itches.  In auditory hallucinations sounds are manifested, but these are more typically rhythmic noises like monotonous singing. By combining hallucinations from the different senses, the subject can see representations of the most diverse scenes: nocturnal processions of witches and dead people singing funeral songs, sounds of bells, a huge fair with puppet shows and fantastic circuses.  They may also experience kinetic sensations, flying off to a witches’ Sabbath, falling over a waterfall or off a tower, or getting out of bed and rising up into space.

The course, symptomatology and duration of each episode of acute alcoholic delirium cannot be described diagrammatically because of its severity and the variety of forms which it takes.  The length varies from two to eight days; some cases may be fatal, but generally the attack ends with a long dream after an intense display of the above symptoms.  During its course, relapses may occur, or it could go into a sub-acute state, or continue into residual delirium.  Recovery is usually swift, but once the delirium has occurred, a certain predisposition toward recurrence remains.  When the delirium is over, the symptoms of chronic alcoholism continue.

DRUNK WITH LOVE

by Lida Prypchan

When a normal individual (normal being the term for average, not a value judgment) gets drunk, he displays a statistically average form of behavior, called normal or simple inebriety.  This is characterized by a change in mood (which becomes expansive or, less frequently, depressed), behavior, attention, and in motor function.  It has three phases.  The first shows a pattern of hypomania: the individual is euphoric, abnormally talkative, care free, mentally agile, and intellectually hyper productive, but this is accompanied by a decrease in self control, as well as in attention and vigilance, which, together with the release of his inhibitions causes him to speak tactlessly.  In a second stage there is incoherence of speech, the faculty for self-criticism decreases or disappears completely, motor coordination is impaired (difficulty in articulation, unsteady gait and clumsy gesticulation), swings in mood increase: he is easily offended, flies into rages, sings, and displays general sensory hypoesthesia.  In the third phase the subject collapses, vomits, his breathing becomes labored, his breath smells of acetone, his reflexes diminish, his body feels anesthetized and he may become incontinent.  After sleeping for several hours he wakes up quite normal, unless ingestion was excessive, in which case he passes from a coma to complete collapse – or a better life.  Preceding these phases is the pre-clinical phase, where alcoholemia reaches 0.80 gr/l.  In this phase the individual does not display symptoms, but if tested psychometrically, alteration in sensory function and decrease in sensory motor activity can be observed.

The difference between simple and complicated inebriety is in the intensity of the latter, namely a quantitative difference, since complicated inebriety presents the symptoms of simple inebriety but in a more exaggerated form.

Biochemically, the pre-clinical state is considered to occur between 0.5 to 1 gr/l of alcohol; inebriety at 1 gr/l; between 1 and 1.5 gr/l signs of intoxication are evident; between 1.5 and 2 gr/l there is a state of intoxication; above 2 gr/l intoxication is deep, the lethal dose between 4 and 5 gr/l.

Pathological intoxication, as differentiated from the simple and complicated forms, is displayed in individuals whose constitution is so predisposed, suffice to say that it is typical among neuropaths, hysterics, schizophrenics, epileptics and psychopaths.  It can also, however, be caused by abuse of alcohol (in chronic alcoholism), by cranioencephalitic traumatism, severe cerebral illness, syphilis etc.  There are six main characteristics of pathological intoxication:  1) the insignificant amount of alcohol which is necessary to unleash it; 2) the almost immediate surrender of oneself to the  consumption of alcohol;  3) its duration, either very short or very long (up to 24 hours); 4) extreme violence, which is why homicidal assaults, pyromania, rapes, exhibitionism and pederasty are frequent; 5) almost entire lace of recollection afterwards of what has happened) tendency for relapses.

Pathological intoxication can be classified into three types: excitomotory, hallucinatory, and delirious.  In the excitomotor type, the individual is possessed for several hours by an uncontainable fury, he brushes everything aside, strikes out in any direction, gesticulates threateningly, and displays great anguish on his face with bulging eyes and fixed stare.

In the hallucinatory form, the subject lives his visual or auditory hallucinations, confusing them with reality, as is the case in delusions of flagrant infidelity, of massacres, threatening gangs, with the possibility of impulsive homicidal reactions.  The third form is the delirious form.  Here confabulation preponderates, with four main themes: self-accusation, megalomania, jealousy and persecution. In delirious self-accusation, the drunkard goes to the police station to denounce himself for a crime which is currently in the headlines. In these cases it is necessary to guard the individual from suicidal impulses. In megalomania the drunk presents himself at the presidential mansion, demanding entry because he is the President.  When the theme of his delirium is jealousy, the victim can see and hear his wife’s lovers.  In these cases the person to be protected is the wife, since he may kill her (and since all this can happen so quickly, it would be advisable for the wife to have a scooter around the house too).  When the delirium is persecutory, the individual seeks protection desperately from the police, since he feels threatened by a gang of crooks that wants to trash him, and he may in his panic have defensive and aggressive reactions.

This article is not entitled “Drunk with Love” by chance, since as I was writing it I found similarities between the stages of falling in love and the phases of drunkenness.  In a love affair the conscience recedes into the background, resembling a pattern of hypomania: the individual is euphoric, abnormally talkative, carefree, mentally agile (unless revealing severe mental retardation), intellectually hyper-productive (works and thinks better), but at the same time self-control is reduced (saying inappropriate things like “if I ever stop loving you I will give you an income for life”), attention and vigilance diminish (he doesn’t notice that his future mother-in-law is intolerable and will make life impossible for him).  In a second stage after marriage, two things can happen: either compatibility or mutual tolerance prevail in the relationship or, what happens in the majority of cases, incompatibility.  If the latter occurs, one observes verbal incoherence, decreased or zero facility for self-criticism in both persons, impaired motor coordination (stammering, prolonged silences, staggering gait upon arriving home at dawn and clumsy gesticulation during explanations), and increased swings in mood (morning irritability and evening irascibility) interspersed with periods of reconciliation which again suggest a pattern of hypomania.

MALE AND FEMALE ALCOHOLISM

by Lida Prypchan

When a woman gets drunk, she tends to hide herself away, to be ashamed of herself.  A man on the other hand, for social reasons, boasts about it.  The alcoholic female drinks alone, the male tends more to meet up with friends and only to become captive to the addiction when it reaches its more advanced stage.  Women more often recognize their sickness, while men deny it, even as they fall down drunk with a drink in their hand.  The disasters caused by alcoholism in the family acquire a much more serious aspect when it is the mother who drinks, because the maternal figure in the family unit is more important than the paternal figure, in fact indispensable.

Certainly much more is expected of a woman on both family and social planes.  More is expected because she can give more, due to her ability to mature and bear great responsibility.  Although it is claimed that the male sex is the stronger, the facts show that men are weaker in character and have more difficulty in maturing and bearing moral responsibilities (the ones which have nothing to do with generating income or following courses of study).  That is why everything is made easy for him and why he is forgiven for his philandering (sexual promiscuity), drunkenness and lack of attachment to the family (he is always at work, on a trip, playing dominoes or with his lover).  So little is demanded of a man on the family level; he is considered a successful father just because he brings money home, even though he never talks to his children – who are like aliens to him.

A woman is a woman, and for that simple reason her errors, either as mother, wife, daughter, or employee, are not forgiven.  With today’s lamentable change in women, who are imitating the errors they so criticized in men, more alcohol is being consumed by them daily, which translates into an increase in the figures for female alcoholism.  

I will now present the case histories of two alcoholics: a man and a woman.  Each was given a blank sheet of paper with the following questions: How long have you been drinking?  With whom do you drink?  Why do you drink?  What have been the consequences of your addiction?

Here are their replies:

Case No.1 – 59 year old woman, foreigner, widow, housewife, 4 children.

“I could not say precisely why I drink.  It was mainly to go along with my husband.  Over the past nine years, because of his death, drinking has become a habit.  For the past five years I have been drinking more than normal: from addiction, lack of sleep too – when I drink before going to bed it’s easy to get to sleep.  My marriage was better than most.  I have been particularly prone to depression since my husband died.  Inevitably, my past is always present – I survived the war and lost all my family in it.  Alcohol makes me forget all these thoughts.  I have mixed tranquilizers and other drugs with alcohol and they bring about an incredible sensation of peace, although the next day I am sure to say I will never drink again.  But it is inevitable…after a while I have to start drinking.  When my children became aware of my addiction, they removed every drop of alcohol from my home.  It was worse because I even drank “eau de cologne”.  I can see the consequences clearly now: to be precise, the inability to do without alcohol, mental collapse and the feeling of being a slave to it… when I have it, I can’t stop drinking it…what else can I say?”

Case No. 2 – 44 year old man, died a few months ago of a hemorrhage due to rupture of esophageal varices, Venezuelan, divorced after 8 months of marriage.  Occupation:  businessman (bar owner).

“I began to drink when I was young, in a group.  I come from a large family where they drink a lot.  Two of my brothers are alcoholics and so was my father.  I come from a part of the country where the only pastimes other than chasing women are drinking aguardiente and betting on the cocks.  Anyway, this problem I have now began when I bought a bar where I was working.  There are regular customers who invite you or almost force you to drink with them. I had a good marriage relationship.  It was because of the death of a brother I was close to that I began to drink more frequently: at least, I got dead drunk three or four times a week and my wife, instead of being sympathetic, treated me badly and wouldn’t cook for me and worse, she refused to have sex with me – which made me so mad that I would hit her.  Then we had money problems and she wanted a divorce, which I gave her right away, but when I got drunk, which was every day then, I went to her house and yelled at her because it annoyed me that while I had to work, she lived off what I earned and when I began to have problems, instead of being by my side she threw me out.  All women are the same: they use you as long as they can… then they make out that they are martyrs.  You can see the results of this:  I am forty-four years old and look like seventy,  I’ve lost a lot of weight  because when I was drinking I lost my appetite, and when I get up I vomit a lot and have meager, foul-smelling bowel movements.  My marriage didn’t fail because of alcohol, but because my wife was a mean, dull creature, incapable of understanding me.

THERE ARE ALCOHOLICS AND THEN THERE ARE ALCOHOLICS

by Lida Prypchan

“All we know of happiness is the word itself.  Our oldest companion is new wine.  Caress with your eyes and clasp in your fingers the only good thing that never fails: the living amphora of the blood of the grapevine.”                 (Omar Khayyam, Rubaiyat)

Unquestionably there are alcoholics and then there are alcoholics; they are rich and perfumed, poor and slovenly, ill-humored and aggressive, sweet and affectionate, weeping or silent, brilliant or dull, shrewd or perverse, refined or tasteless.  Those were not the parameters, however, which Fouquet and Jellinek selected to define their classifications of the main types of alcoholism.  The classification I am presenting here is an adaptation of the one established by Jellinek in which he elaborated upon certain aspects of Fouquet’s classification.

A.    The drinker with a dependence on alcohol: This is the individual with a psychological dependence, who finds relief from some emotional tension or some physical discomfort, or who simply claims to have courage to face “soberly” the burdens of everyday life.  He ingests large quantities of alcohol but does not lose control and is able to abstain.  Withdrawal symptoms are rare, unless consumption is interrupted abruptly, such as being hospitalized for injury or sickness (frequently cirrhosis of the liver or polyneuritis).

B.    The alcoholic who drinks wine:  This individual is able to control the quantity of drink which he imbibes at a certain moment and seldom needs to drink to the point of severe intoxication, but he is unable to abstain for one single day.  If he does, he experiences strong cravings and almost immediately displays withdrawal symptoms, which within a few days lead to delirium tremens.  He thus displays both physical and psychological dependence.  Few of these types consider themselves alcoholics, but the truth is that they are in a constant state of slight intoxication.  It is for this reason that this is a public health problem in wine-consuming countries such as France and Italy.

C.    The compulsive drinker: This is the individual who, once he has taken the first swig, drinks until his stock of money or alcohol runs dry, or until loss of consciousness or an accident ends the session.  This loss of control is accompanied by increasing tolerance, psychological then physical dependence, violent cravings, and withdrawal symptoms in the event of deprivation.  It is frequently observed in Canada, the United States, Australia and Nordic countries.

D.    The symptomatic alcoholic: In this, individual alcoholism is secondary to some psychiatric disorder, such as neurosis (phobias, in particular), psychosis (depression or schizophrenia), or some organic lesion (such as the initial changes accompanying a brain tumor).  It is particularly common in males who in time develop a physical dependence and addiction.

E.    The occasional drinker: This is the person who alternates brief periods in which he drinks pathological quantities, with long periods during which he is able to drink reasonably or to abstain altogether.  The weekend drunk belongs to this group.  This is the predominant form of alcoholism in Venezuela: those timeworn machos that, if they don’t go out for a spin and end up smashing into a wall, spend from Friday to Sunday boasting about their conquests.

F.    The dipsomaniac:    This one only drinks during brief crises (for hours or days) without anything else mattering to him; he generally hides away and ingests anything he can find in his path, drinking even eau de cologne, perfume or ethylated spirits, reaching a severe state of alcoholic intoxication which produces a comatose condition from which he emerges repentant and rejecting alcohol.  He abstains for long periods but as the years pass he develops an alcoholic neurosis.  Dipsomania is more common among women.

G.    The chronic alcoholic: This is the final fate of excessive drinkers, whatever form their alcoholism takes.  The chronic alcoholic displays psychological and physical changes, the latter being due not only to the unfortunate effect of alcohol on the various organs and systems, but also to inadequate nutritional habits and hydroelectrolitic disturbances.  This individual suffers constant diarrhea and nausea which aggravate his malnutrition even more.  This condition is frequently complicated by polyneuritis or cirrhosis of the liver followed shortly after by liver failure.  At this stage he feels drunk even after drinking small quantities, because his tolerance has decreased.  His economic situation deteriorates because he is incapable of work; he is rejected by his family and society and ends up in hospital for some physical complication or psychiatric disturbance such as delirium tremens, alcoholic hallucinosis, epilepsy or paranoid psychosis.

So, as a toast to the future of alcoholism in Venezuela, shall we serve another drink?

ALCOHOLIC HALLUCINOSIS

by Lida Prypchan

Very rare in its pure form, alcoholic hallucinosis, also known as hallucinatory paranoia and chronic alcoholic delirium, characteristically exhibits auditory hallucinations which generate delusions of persecution, while retaining clarity of the senses without impairment.  It differs from delirium tremens in the predominance of auditory and tactile hallucinations and clarity of consciousness; in that the prolonged abuse of alcohol as displayed among younger drinkers is not inevitable; in that it is not characteristic of those who drink spirits, hence its frequency among women, and in the lack of serious organic changes.  Some authors concur that delirium tremens and alcoholic hallucinosis are pathogenically identical.  Kraepelin concedes that the onset of delirium tremens is caused by sudden inundation of the brain by alcoholic metatoxins, whereas if there are fewer of them, they attack only the auditory centers, causing sounds of voices and slight obnubilation, a pathogenic explanation for the intensity of the delirium and the mildness of the hallucinosis.  The observations of Wolfer, Sberger and Bleuler tend to attach great importance to the schizophrenic tendency of the constitution, which is set in motion by the metabolic changes produced by alcohol.  This hypothesis has been supported in the cases of hallucinosis where the final development is clearly schizophrenic.  In hallucinosis the somatic and neurological symptoms of chronic alcoholism are imperceptible or not particularly pronounced, whereas sleep is always insufficient and never peaceful.

The main psychic symptoms are the auditory hallucinations, or voices, of one or more invisible people who talk about the subject in the third person, referring to his habits and practices and uttering true or false accusations.  In very advanced cases the subject participates in the dialogue himself.  Some of the voices speak in his favor and others against him, although in the beginning they are not too clear, more a sort of murmur.  Frequently tactile hallucinations follow next, such as being pinched or nipped.  Then come visual hallucinations in which the individual sees a person in the darkness or behind the door.  When hallucinations of coenesthesia, smell and taste occur, schizophrenia must be considered.  The hallucinations are accompanied by delusions, concerning guilt over alcoholic abuse and real or imaginary errors.

The voices present delusions of persecution, plans for escape, always senseless and passing uncriticized by the victim.  The tremendous anxiety caused by harassment from these presumed persecutors induces the victims to commit acts of self-abuse.

Clarity of their senses is preserved almost intact, although hallucinatory experiences mingle with actual perceptions.  Orientation is perfect and behavior correct, to the point of not attracting the attention of colleagues at work.  Concentration and attention appear normal, and they can carry on a lucid conversation, although from time to time they withdraw from it to attend to their voices.  Memory remains intact, proof of which is that they often relate minute details of their hallucinatory experiences and the events in their lives without tending to lie.  The predominant emotion ruling their behavior is anxiety.  Duration of alcoholic hallucinosis is somewhat longer than that of delirium tremens, between a week and three months, abstinence being indispensable for a cure.

Lastly I will dedicate a short space in commenting on a movie which impressed me both with the theme and the harshness of its portrayal.  I am referring to “Ironweed”, with Jack Nicholson and Meryl Streep, who won an Oscar for best actress instead of Cher, since Ms. Streep managed a rather difficult role which not just any actress could have done.  It is about the life of a couple of alcoholic vagrants who are reduced to poverty by their addiction.  She is a singer, successful in radio, whose downfall is caused by the temporary relief and euphoria produced by alcohol.  She ends up as a vagrant who, so as not to die of cold or be devoured by the hungry denizens of the streets, takes refuge in a man’s car, the price of this sojourn being to have sex with him.  He was apparently married with children and in one of his drunken bouts returns home and accidentally causes the death of his youngest daughter and on other occasions gets involved in some disturbance or strike, causing the accidental deaths of still more people.  What is certain is that because of his alcoholic excesses he has visual hallucinations which consist in seeing all these people whom he has harmed and who ask him questions, watch and deride him.  One guesses, we are not actually shown, that both of the couple end up committing suicide.

AMONG ALCOHOLICS AND PSYCHOPATHS

by Lida Prypchan

“Since you do not know what tomorrow will bring, try to be happy today.  Take a pitcher of wine, sit in the moonlight and drink it, reflecting that maybe tomorrow will be better.”  (Omar Khayyam, Rubaiyat)

There are two dominant psychological types of alcoholic.  There is the sensitive type, who feels inferior and insufficient and has difficulty with interpersonal contact, who is timid and although in great need of affection and friendship, lacks the ability to obtain them.  People like this find that alcohol gives them self-confidence – makes them euphoric, but leaves them depressed – because as long as they are floating in alcohol their troubles vanish, but when they come to the dregs they return to reality.  The other type is the antithesis of the former, but becomes just as much of an alcoholic though by different means and for other reasons.  The extrovert is genial and talkative, very sociable, likeable and active, always euphoric and eventually experiencing a certain decline in inhibitions and self-criticism.  He begins by becoming a habitual excessive drinker convinced that “it doesn’t hurt me” because of his particular blindness towards his own weakness of character.  Given his low tolerance for unpleasant experiences and for failures (which are frequent because of his inability to make long-term plans and his propensity for “living in the present moment”), he usually first becomes a habitual drinker, then an alcoholic.  Although these two types appear opposites, they share characteristics such as immaturity, insecurity, dependency and intolerance of frustration.

Their environment, physical predisposition, and heredity (the predisposition to establish a habit easily is inherited) interact in the problem.  The increase in female alcoholism is alarming.  It is more varied and bears more of a social stigma, frequently originating in some neurosis or depression.

The common trait of all personalities which are predisposed to alcoholism is a lack of harmony and balance between the instinctive emotional and volitional psychic strata.  This is also a trait of psychopaths, for a number of them are alcoholics.  The alcoholic conduct of psychopaths is often related to socio-cultural factors.  In under-developed countries inebriation is infrequent, except in the case of periodical celebrations of an orgiastic nature, reminiscent of the Bacchanalia celebrated in Greece in honor of the god Bacchus.

The consequences of alcoholism are very serious: repercussions at home and at work which can lead to family break-up and real social dislocation; a considerable higher mortality rate due to visceral complications, depressions, suicides and accidents, psychic complications and crime (blows and injuries, child abuse, rapes, homicides).

What is evident is that both alcoholism and psychopathy are moral problems, social fossils.  Both display a desperate search for pleasure and an inability to allow life to proceed with its natural rhythms and changes.