Scripting Addiction, Constraining Recovery: Alcoholism and Ideology in Japan

ABSTRACT

Japan’s medical establishment relies heavily on the ideology of Alcoholics Anonymous (A.A.) in treating the nation’s addicts and alcoholics. Japanese individuals diagnosed as ‘alcohol dependent’ and trying to stay sober must embrace and fully incorporate a prescribed recovery ideology into their daily life. A.A. demands acceptance of alcoholism as a lifelong and incurable disease, requires belief in the possibility of a ‘spiritual transformation’, and positions any relapses as the individual’s fault. This organizational system purports to transform individuals into fundamentally new people but runs the risk of casting alcoholics as permanently diseased. It also can shield its methodological framework from criticism. Oftentimes, Japanese alcoholics are cast into a narrow, constraining recovery space without recourse to assert agency over their struggles with addiction. The Japanese A.A. system allows exploration of how prevailing recovery models and views on addiction can exacerbate the suffering of individual addicts through mandated conformity to the dominant views of what constitutes addiction and successful recovery.

Notes

¹ The other group is Danshukai, which translates as the Sobriety Association. With approximately 8,000 members in 2014, the two groups are similar in their membership size (see Yoshimura and Higuchi 2015 for more on the basic organization of both groups). A.A. and Danshukai also share ideological similarities and practices but maintain several fundamental differences, notably family participation and a lack of anonymity in meetings at Danshukai, that make them distinct organizations with a shared mission. This article’s focus is on A.A., but reference to Danshukai is incorporated when relevant.

² Thanks to Nicolas Sternsdorff-Cisterna in the Department of Anthropology at Southern Methodist University for his comments on this section of the paper.

³ Borovoy, The Too-good Wife, 50.

⁴ Higuchi et al., ‘Acceptance of Controlled Drinking’, 447.

⁵ Daidoji, ‘Treating Emotion-related Disorders in Japanese Traditional Medicine’, 74.

⁶ Lock, East Asian Medicine in Urban Japan, 249.

⁷ Raikhel and Garriott, Addiction Trajectories, 9; Nichter et. al, ‘Qualitative Research’, 1935.

⁸ Knight, ‘Review of Addiction Trajectories’, 178.

⁹ As Higuchi et. al (2014) note, the dominance of an abstinence-only A.A. and Danshukai-influenced model is shifting, but it remains the predominant way of treating and diagnosing addiction in Japan.

¹⁰ It should also be noted that the Tokyo-centric approach I take gives an urban bias to the lived experiences surrounding alcoholism in Japan.

¹¹ The Oxford Group was a precursor to and influential force upon A.A. More overtly Christian in focus and practice than A.A., the Oxford Group counted both Bill W. and Dr. Bob as members. See Kurtz’s Not God: A History of Alcoholics Anonymous for more on the Oxford Group.

¹² Cain, ‘Personal Stories’, 211. See also https://www.aa.org/assets/en_US/p-53_theCo-FoundersofAA.pdf for more on the two founders.

¹³ Carr, Scripting Addiction, 12; Tiger, Judging Addicts, 84.

¹⁴ Alcoholics Anonymous, ‘Alcoholics Anonymous 2014 Membership Survey’.

¹⁵ Fingarette, Heavy Drinking, 3; Wiechelt, ‘Alcoholics Anonymous: Warts and All’, 1011.

¹⁶ See https://www.aa.org/assets/en_US/smf-121_en.pdf for a complete list of the Twelve Steps.

¹⁷ Alcoholics Anonymous, Alcoholics Anonymous, 567.

¹⁸ Daidoji, ‘Treating Emotion-related Disorders’, 74.

¹⁹ Campbell and Shaw, ‘Incitements to Discourse’, 709.

²⁰ Valverde, Diseases of the Will, 123, italics in original.

²¹ Ibid.

²² Jordan, An Alcoholic Forever?, 15.

²³ Alcoholics Anonymous, Alcoholics Anonymous, 59, italics in original.

²⁴ See http://www.aa.org/assets/en_US/smf-121_en.pdf for a complete list of the Twelve Steps.

²⁵ Danshukai is, of cours,e the obvious alternative that, while I would argue is ideologically similar to A.A. in many ways, has purged any mention of Christianity from its ideological governing structures. However, Danshukai also relies on acceptance of a power greater than oneself and surrender to that power, itself something that is very much reliant on a particular view and interpretation of spirituality and its transformative power.

²⁶ Pagano et al., ‘The 10-Year Course of Alcoholics Anonymous Participation’, 7; Thatcher, ‘Negotiating the tension’, 403.

²⁷ Officially titled Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism (1939), it is A.A.’s primary text and serves as a guide to working the Twelve Steps and outlining the experiences of founding members.

²⁸ The phrase she used was omae, otokoyarō. It should be noted that this is an informal and idiomatic expression often associated with the Kansai region of western Japan that conveys an immediate bluntness and strong disapproval of Gen’s sobriety.

²⁹ Christensen, Japan, Alcoholism, and Masculinity, 52.

³⁰ Allison, Nightwork, 45; Borovoy, The Too-good Wife, 43.

³¹ Lock, East Asian Medicine in Urban Japan, 248.

³² Room, ‘Stigma, Social Inequality and Alcohol and Drug Use’, 145.

³³ Chenhall and Oka, ‘The Way of Abstinence’, 109.

³⁴ Alcoholics Anonymous, Alcoholics Anonymous, 59.

³⁵ Garcia, The Pastoral Clinic, 17–18.

³⁶ Kitanaka, Depression in Japan, 18.

³⁷ Ibid.

³⁸ Chenhall and Oka, ‘The Way of Abstinence’, 109.

³⁹ Christensen, ‘The Program is Perfect’; Wiechelt, ‘Alcoholics Anonymous: Warts and All’, 1012.

⁴⁰ Sussman et Al., ‘First Things First’, 1.

⁴¹ Kaskutas, ‘Alcoholics Anonymous Effectiveness’, 146.

⁴² See https://www.aa.org/assets/en_US/smf-121_en.pdf for a complete list of the Twelve Steps. Emphasis in the original.

⁴³ Bevacqua and Hoffman, ‘William James’s “Sick-Minded Soul” and the A.A. Recovery Paradigm’, 440. The authors insightfully point out that A.A. grew narrower in its ideological focus by excluding other treatment paradigms that reflected the ‘variability of human personality’.

⁴⁴ Lock, East Asian Medicine in Urban Japan, 249.

⁴⁵ Nakamura, A Disability of the Soul, 3–4; Totsuka, ‘The History of Japanese Psychiatry’, 193.

⁴⁶ Borovoy, The Too-good Wife, 56–57; Christensen, Japan, Alcoholism, and Masculinity, 52–53.

⁴⁷ Campbell, Discovering Addiction, 1.

⁴⁸ Ando et. Al., ‘Review of Mental-health-related Stigma in Japan’, 472.

⁴⁹ Lock, East Asian Medicine in Urban Japan, 25.

⁵⁰ Valverde, Diseases of the Will, 44.

⁵¹ Vrecko, ‘Folk Neurology’, 303.

⁵² I have also mentioned Danshukai’s presence in Japan and areas of noteworthy similarity and difference between the organizations. My focus here, however, has been A.A. and its ideological impact on Japanese alcoholics. While Danshukai is a distinct organization deserving of appropriate attention and focus, the struggles between group ideological demands and the pressures surrounding how alcoholism and addiction are broadly perceived in Japan are an issue both groups struggle to address.

⁵³ Substantial differences exist between A.A. and Danshukai, notably in the latter’s lack of anonymity and its encouragement of family participation at meetings. However, like A.A., Danshukai relies on the disease model to define addiction and structure recovery by emphasizing belief in something beyond oneself and alcoholism as a lifelong, chronic condition from which total recovery is impossible. My contention is that these are far more substantive and consequential similarities than any differences in organizational and meeting structure.

⁵⁴ Raikhel and Garriott, Addiction Trajectories, 18.