The Enigma of Dr. Vaillant - George and Me

George Vaillant and the mystery of people's outgrowing alcoholism

Posted May 25, 2011

George Vaillant and I have been antagonists for four decades or so, since I reviewed his "The Natural History of Alcoholism" in 1983, which I found was "intellectually dishonest -- Vaillant systematically created summaries that disputed his own data, while citing cases selectively to try to support what he perceived to be the safe positions to take."  As Wikipedia describes it:

Perhaps the sharpest critic of Vaillant’s work was controlled drinking proponent Stanton Peele. In a 1983 review in The New York Times, Peele wrote that "The results of this research do not provide ready support for the disease theory of alcoholism. ... [For example, Vaillant] finds strong evidence in the inner city group for sociocultural causality in alcoholism."[78] In his book Diseasing of America Peele claimed that "Vaillant emphatically endorses the disease model... He sees alcoholism as a primary disease... However, Vaillant's claims are not supported by his own data."

George Vaillant is a brilliant psychiatrist and professor at Harvard, where for the last 30 years he has been director (now co-director) of the Laboratory of Adult Development.  George has spent his career examining the courses of people's lives (called longitudinal or prospective -- following people into their futures -- research).  Since he has been studying these for so long, George knows as much as anyone about the vagaries of existence.  Indeed, he was drawn into the field when he found files of two men who ceased being schizophrenic (which is now known to be more typical than previously thought).  The kinds of cases that appeal to George are of "classic psychological overachievers" (my term) -- by which I mean people whose early experiences would not have predicted the good lives they led, and late bloomers -- people like one of his subjects who had a troubled life and only in his seniority found contentment and social acceptance, including marriage.

There are sad cases in George's research, but more frequently there are the stories of how people overcame adversity -- which was far from uncommon -- to lead contented and productive lives.  I was fascinated by George's first book, Adaptation to Life (1977), and his even earlier work with naroctics addicts at the public health hospital in Lexington, KY.  George examines the types of defenses people put to use in handling the varieties of human experience -- some for better, some for worse.  George's unique approach comprises an optimistic, applied psychoanalysis, as described in a profile in The Atlantic

Most psychology preoccupies itself with mapping the heavens of health in sharp contrast to the underworld of illness. "Social anxiety disorder" is distinguished from shyness. Depression is defined as errors in cognition. Vaillant's work, in contrast, creates a refreshing conversation about health and illness as weather patterns in a common space. "Much of what is labeled mental illness," Vaillant writes, "simply reflects our ‘unwise' deployment of defense mechanisms. If we use defenses well, we are deemed mentally healthy, conscientious, funny, creative, and altruistic. If we use them badly, the psychiatrist diagnoses us ill, our neighbors label us unpleasant, and society brands us immoral."

So I was shocked when I was confronted with George's second volume, The Natural History of Alcoholism (1982), which I reviewed for the New York Time Book Review.  The title of the book describes George's fundamental point of view: mental disorders, including alcoholism, have life histories -- they ebb and they flow with what life brings people and how they deal with it:

Again and again, Vaillant has returned to his major preoccupations. One is alcoholism, which he found is probably the horse, and not the cart, of pathology. "People often say, ‘That poor man. His wife left him and he's taken to drink,'" Vaillant says. "But when you look closely, you see that he's begun to drink, and that has helped drive his wife away." The horrors of drink so preoccupied Vaillant that he devoted a stand-alone study to it: The Natural History of Alcoholism.

But that wasn't how George approached alcoholism in his book, where he declared it irrefutably a disease.  And my review -- "Disease or Defense" -- pointed out this contradiction.  George, I was told (up to that time I hadn't met him) didn't like my review, in which I reported about George's own hospital 12-step-based treatment program,

that 95 percent of the patients treated at his clinic, where A.A. attendance was compulsory, relapsed following treatment. After two and eight years, they showed no greater progress than comparable groups of untreated alcoholics. In acknowledging this, Dr. Vaillant confronts the dilemma of how to justify his faith in the efficacy of therapy. His resolution is to encourage the therapist not to interfere with the natural healing process. 

Moreover, George found, most of his subjects overcame alcoholism without joining AA.  But he didn't handle that finding fairly, as I noted in my review:

The Natural History of Alcoholism contains less case description than Adaptation to Life. But the cases that Dr. Vaillant does include work against the results of his data analysis. The cases belie the complexity of his research by emphasizing with monotonous regularity the need for an alcoholic to acknowledge he has an uncontrollable disease and to seek redemptive treatment for it.

I concluded:

In alcoholism research, where one side regularly parades a new study and the other then vilifies it, Dr. Vaillant's work can be cited approvingly by both. This is due in part to his admirable balance, fairness and honesty and in part to his willingness to accept contradiction and to defy his own research findings.

After his book appeared, George joined the national board of Alcoholics Anonymous, where he served many years.  In his book on alcoholism, George had emphasized the role of spirituality in recovery, which was his natural contact point with AA.  But in his 2002 book, Aging Well, in which he unsurprisingly found that psychological and social variables better predicted late-life well-being than medical ones, George (never one to be hobgoblinned by consistency, but still capable of glaring honesty) noted, "I was backing the wrong hypothesis.  Neither spirituality nor religiosity appeared [to be] associated with successful aging."  Since then, however (in 2008), George has published Spiritual Evolution: A Scientific Defense of Faith.

George and I met in exotic contexts over the years.  One time, Dr. Nancy Snyderman (a physician who is now NBC's medical editor, but who was then with CBS) brought us together for virtually a whole day to film us debating the disease theory (our segment was never shown in the final version of her special).  We met again in the Swiss Alps at a conference on natural recovery from alcoholism, when we cross-country skied together.

Then, in 2006, we were both presented with lifetime achievement awards at an international conference in Vancouver.  George's presentation involved brain diagrams showing where the urge for faith is located.  When no one spoke after his talk, I asked what he thought of harm reduction, and he said he wouldn't answer me. Leaving the conference, I jumped in a cab to catch a plane to Victoria, on Vancouver Island.  As the driver turned around to look at me, George suddenly appeared -- it was his cab, he said, he had been inside retrieving his brief case. (Obviously, there IS a God, and he or she has a wicked sense of humor.)  I suggested we ride to the airport together and Geroge -- ever gracious -- agreed.  On the way there I said, "George, I always followed your suggestion in the Time article about your book, where you were shown sharing wine with your children at dinner."  George looked at me with a wry smile: "You've always been so obedient, Stanton."

Stanton Peele has been empowering people around addiction since writing, with Archie Brodsky, Love and Addiction in 1975. He has developed the on-line Life Process Program. His new book (written with Ilse Thompson) is Recover! Stop Thinking Like an Addict with The PERFECT Program. You can follow Stanton on Twitter and Facebook.

The ever-smiling George Vaillant