Harry Tiebout
Encyclopedia
Harry M. Tiebout M.D. was an American
psychiatrist who promoted the Alcoholics Anonymous
approach to the public, patients and fellow professionals. He served on the Board of Trustees of Alcoholics Anonymous from 1957–1966 and was president of the National Council on Alcoholism from 1951-1953.
in 1917, then went to Johns Hopkins University School of Medicine, where he also completed an internship with a specialization in psychiatry. The psychiatry service at Hopkins was led by Adolph Meyer
, who had an eclectic approach in which Freudian theory was contributory but not dominant. John B. Watson
was also at Hopkins during the time Tiebout was there, conducting research in behaviorism
which would have substantial influence on the field of child development during the 1920s.
, Westchester Division from 1922-24. He then began work in child guidance clinics in New York City, joining the Institute for Child Guidance as staff psychiatrist shortly after it was founded in 1927. The Institute was a well-funded center for training and research, dominated by psychoanalysis and specializing in "exhaustive case histories 75 pages long." During these years Tiebout was also on the staff of Cornell Medical School and the Payne Whitney Psychiatric Clinic
.
In 1935 he became medical director of Blythewood Sanitarium in Greenwich, Connecticut
. Privately owned, Blythewood was situated on a beautiful, rustic 50 acres (202,343 m²) estate once owned by Boss Tweed
. At its peak, it had eight main buildings, eight cottages, a chapel, a building for occupational therapy, and a small golf course. There were no bars on the windows. Artistic and cultural pursuits were encouraged as part of the therapeutic program. Although the sanitarium was primarily for care of the mentally ill, it also provided care for alcoholics.
In 1939, Tiebout received a pre-publication copy of the book, Alcoholics Anonymous. After looking it over, he gave it to one of his patients, Marty Mann
. She had been at Blythewood for over a year but seemed no closer to conquering her alcohol problem than when she arrived, so he considered her a good test of whether the book had value. At first she read the book eagerly, delighted to know for the first time that there was a name (alcoholism) for what ailed her. However, she was soon repelled by the overbearingly religious message and told Tiebout that she could never accept it. Tiebout, according to Mann's biographers Sally and David Brown, quietly encouraged her to keep reading. Eventually taking the book to heart, she had an epiphany during a crisis of resentment and fury and was converted.
Other references, also based on Mann's recollections, portray Tiebout's role a little differently. They describe an ongoing verbal battle lasting several months, in which Tiebout refused to accept Marty's rejection of the book. In the end, Mann did become an active member of AA and within a few years made education about alcoholism, and promotion of alcohol-abuse treatment, her second career. With Tiebout's support, she founded the National Council on Alcoholism
(NCA).
Tiebout also became a friend and supporter of AA founder Bill Wilson, providing personal psychiatric care when Wilson developed depression in the 1940s. It was largely through Tiebout's influence that Bill Wilson was invited to speak at a New York state medical society meeting and then at a meeting of the American Psychiatric Association, and had his talk published in the American Journal of Psychiatry.
Howard J. Clinebell, in a book for clergy on alcoholism counseling, recalled that Tiebout "likened the 'runaway symptom' of alcoholism to the dangerously high fever of pneumonia. The fever is a symptom of the underlying infection, but unless it can be lowered, the person may die of the 'symptom"." Psychiatrists, Tiebout felt, had been ineffectual because they ignored the deadly symptom in an attempt to treat a (theoretical) underlying disease. He credited AA with an ability to target the symptom directly. Tiebout's understanding of the alcoholic mind cannot be entirely separated from his understanding of the 12-step approach, but the primary themes in his writings can be summed up under several points.
Howard Clinebell understood Tiebout to mean that there was, in fact, a pre-alcoholic personality but that "the distinctive factors have not yet been isolated". In a 1947 lecture, Tiebout located the roots of alcoholism in poor parenting, either excessive strictness which caused the child to suffer "perpetual frustration and blocking of his desires and expectations," or over-indulgence. Either way, "Since the alcoholic's sense of self-discipline has not been developed at this point, his natural reaction is to reject all discipline. He now cannot face the realities of his existence. This would indicate that the whole point of treatment is to get the alcoholic to face and accept his limitations and capacities."
. The idea that alcohol problems constituted a disease was not new, but the particular synthesis associated initially with the Yale Center of Alcohol Studies (now at Rutgers) and the National Committee for Education on Alcoholism had unique features not found in earlier theories. The NCEA was one of Marty Mann's projects, and thus influenced by Tiebout. A 1990 Hazelden
pamphlet cites Tiebout, Dr. William Silkworth
and E.M. Jellinek
as formative influences.
Tiebout seems to have been somewhat ambivalent about the disease model, however. In 1955, speaking of the scientific underpinnings of the alcoholism movement in general, he said "I cannot help but feel that the whole field of alcoholism is way out on a limb which any minute will crack and drop us all in a frightful mess." He was consistent in his belief that the acceptance of alcoholism as a disease was essential, but this belief was partially pragmatic. In his experience, chronic alcoholics did not take the steps necessary to recover unless they became conscious of themselves as people with a disease. He emphasized a different aspect of the model in public lectures, however. Family members, friends and employers of alcoholics were encouraged to keep in mind that the condition was an illness and not a moral failing.
" which was Tiebout's essential meaning.
Based on work with 250 alcoholics during his first 10 years at Blythewood, Tiebout developed the following conception of the alcoholic mind:
Using examples from dreams
of patients he had analyzed
, Tiebout presented evidence for the existence of this rigid barrier. As long as the barrier remained, "As long as the self feels protected in a deep unconscious sense, in cannot be and is not disturbed by the warnings of reality, which characteristically roll like water off a duck's back." For the analyst,
In his 1954 article, 'The Ego Factors in Surrender in Alcoholism,' Tiebout began using the term "ego" to describe this concept of a self barricaded by defenses. He related it to Freud's "His Majesty the Baby" and to a similar concept introduced by Sandor Rado in 1933. Rado hypothesized that the elation induced by alcohol produced a reaction in the form of a "tense depression", which then reactivated the childish megalomania
normally outgrown by adulthood. The result was a type of magical thinking in which "the ego secretly compares its current helplessness with its original narcissistic stature . . and aspires to leave its tribulations and regain its old magnitude." Tiebout acknowledged his indebtedness to Rado's conception, while eliminating much of the psychoanalytic complexity of the original. He also felt that Rado was incorrect in advising only the "reduction" of the ego. Tiebout's view was that "reduction" represented a compromise and that there should be no compromise with the ego. The old ego should be eliminated entirely and replaced with a new one through "surrender".
tradition combined with the personal-evangelism techniques developed within the YMCA
movement in the early 20th century. The Oxford Group
had a successful program involving public and private meetings for witness and confession, as well as individual work. Their concept of "surrender" was the traditional Christian one, as a contemporary observer noted:
Conversion
, surrender
, confession
, restitution
and the necessity of evangelizing others were ideas brought from the Oxford Group to Alcoholics Anonymous by members who had found that the intense religious devotion they inspired was the key to a changed life. Tiebout understood the concepts in a more secular way, and approved of them.
Tiebout had found that superficial compliance
in therapy often correlated with lack of real change, and he saw in the AA concept of surrender an antidote to this phenomenon. An act of surrender was the only cure, or practically the only one, to the problem of "compliance", or partial surrender to the psychiatrist's authority and the authority of the reality principle
. Tiebout described true surrender as "an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her unconscious
mind becomes involved in a certain set of circumstances," essentially the circumstances of "hitting bottom".
Conversion, for Tiebout, was a spiritual awakening made possible by the person's recognition of his own egocentricity. The central effect of Alcoholics Anonymous was "to develop in the person a spiritual state which will serve as a direct neutralizing force upon the egocentric elements in the character of the alcoholic." A "vague, groping, skeptical intellectual belief" would not accomplish this but only a true emotional religious feeling, for "unless the individual attains in the course of time a sense of the reality and the nearness of a Greater Power, his egocentric nature will reassert itself with undiminished intensity, and drinking will again enter into the picture."
, and Sarah T. Worn.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
psychiatrist who promoted the Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...
approach to the public, patients and fellow professionals. He served on the Board of Trustees of Alcoholics Anonymous from 1957–1966 and was president of the National Council on Alcoholism from 1951-1953.
Early life and education
Harry Tiebout was raised in Brooklyn, New York. He earned his bachelor's degree at Wesleyan UniversityWesleyan University
Wesleyan University is a private liberal arts college founded in 1831 and located in Middletown, Connecticut. According to the Carnegie Foundation for the Advancement of Teaching, Wesleyan is the only Baccalaureate College in the nation that emphasizes undergraduate instruction in the arts and...
in 1917, then went to Johns Hopkins University School of Medicine, where he also completed an internship with a specialization in psychiatry. The psychiatry service at Hopkins was led by Adolph Meyer
Adolph Meyer
Adolph Meyer was a member of the U. S. House of Representatives representing the state of Louisiana. He served nine terms as a Democrat from 1891 until his death in office in 1908.-Biography:...
, who had an eclectic approach in which Freudian theory was contributory but not dominant. John B. Watson
John B. Watson
John Broadus Watson was an American psychologist who established the psychological school of behaviorism. Watson promoted a change in psychology through his address Psychology as the Behaviorist Views it which was given at Columbia University in 1913...
was also at Hopkins during the time Tiebout was there, conducting research in behaviorism
Behaviorism
Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...
which would have substantial influence on the field of child development during the 1920s.
Clinical work
Tiebout was on the staff of New York HospitalNewYork-Presbyterian Hospital
NewYork–Presbyterian Hospital is a prominent university hospital in New York City affiliated with two Ivy League medical schools: Columbia University's College of Physicians and Surgeons and Cornell University's Weill Medical College. It is composed of two distinct medical centers, Columbia...
, Westchester Division from 1922-24. He then began work in child guidance clinics in New York City, joining the Institute for Child Guidance as staff psychiatrist shortly after it was founded in 1927. The Institute was a well-funded center for training and research, dominated by psychoanalysis and specializing in "exhaustive case histories 75 pages long." During these years Tiebout was also on the staff of Cornell Medical School and the Payne Whitney Psychiatric Clinic
Payne Whitney Psychiatric Clinic
At his death in 1927, Payne Whitney bestowed the funds to build and endow the Payne Whitney Psychiatric Clinic on the Upper East Side of Manhattan...
.
In 1935 he became medical director of Blythewood Sanitarium in Greenwich, Connecticut
Greenwich, Connecticut
Greenwich is a town in Fairfield County, Connecticut, United States. As of the 2010 census, the town had a total population of 61,171. It is home to many hedge funds and other financial service companies. Greenwich is the southernmost and westernmost municipality in Connecticut and is 38+ minutes ...
. Privately owned, Blythewood was situated on a beautiful, rustic 50 acres (202,343 m²) estate once owned by Boss Tweed
Boss Tweed
William Magear Tweed – often erroneously referred to as William Marcy Tweed , and widely known as "Boss" Tweed – was an American politician most notable for being the "boss" of Tammany Hall, the Democratic Party political machine that played a major role in the politics of 19th century...
. At its peak, it had eight main buildings, eight cottages, a chapel, a building for occupational therapy, and a small golf course. There were no bars on the windows. Artistic and cultural pursuits were encouraged as part of the therapeutic program. Although the sanitarium was primarily for care of the mentally ill, it also provided care for alcoholics.
In 1939, Tiebout received a pre-publication copy of the book, Alcoholics Anonymous. After looking it over, he gave it to one of his patients, Marty Mann
Marty Mann
Marty Mann was any early female member of Alcoholics Anonymous and author of the chapter "Women Suffer Too" in the second through fourth editions of the Big Book of AA. In part because of her life's work, alcoholism became seen as less a moral issue and more a health issue.It is a common error...
. She had been at Blythewood for over a year but seemed no closer to conquering her alcohol problem than when she arrived, so he considered her a good test of whether the book had value. At first she read the book eagerly, delighted to know for the first time that there was a name (alcoholism) for what ailed her. However, she was soon repelled by the overbearingly religious message and told Tiebout that she could never accept it. Tiebout, according to Mann's biographers Sally and David Brown, quietly encouraged her to keep reading. Eventually taking the book to heart, she had an epiphany during a crisis of resentment and fury and was converted.
Other references, also based on Mann's recollections, portray Tiebout's role a little differently. They describe an ongoing verbal battle lasting several months, in which Tiebout refused to accept Marty's rejection of the book. In the end, Mann did become an active member of AA and within a few years made education about alcoholism, and promotion of alcohol-abuse treatment, her second career. With Tiebout's support, she founded the National Council on Alcoholism
National Council on Alcoholism and Drug Dependence
The National Council on Alcoholism and Drug Dependence was founded in 1944 by the first female member of Alcoholics Anonymous , Marty Mann . It has a nationwide network of 95 affiliates around the United States...
(NCA).
Tiebout also became a friend and supporter of AA founder Bill Wilson, providing personal psychiatric care when Wilson developed depression in the 1940s. It was largely through Tiebout's influence that Bill Wilson was invited to speak at a New York state medical society meeting and then at a meeting of the American Psychiatric Association, and had his talk published in the American Journal of Psychiatry.
Alcoholism: Approach to the patient
Tiebout had many years of training and experience in the management of alcohol problems before his first exposure to Alcoholics Anonymous. However, his earliest detailed article concerning alcoholism was published in 1944, 5 years into his relationship with AA, and is primarily a description of AA itself. Over the next 10 years he published a number of articles outlining his theories about alcoholism, the psychodynamic causes of the disorder and his reasons for endorsing AA as the definitive solution.Howard J. Clinebell, in a book for clergy on alcoholism counseling, recalled that Tiebout "likened the 'runaway symptom' of alcoholism to the dangerously high fever of pneumonia. The fever is a symptom of the underlying infection, but unless it can be lowered, the person may die of the 'symptom"." Psychiatrists, Tiebout felt, had been ineffectual because they ignored the deadly symptom in an attempt to treat a (theoretical) underlying disease. He credited AA with an ability to target the symptom directly. Tiebout's understanding of the alcoholic mind cannot be entirely separated from his understanding of the 12-step approach, but the primary themes in his writings can be summed up under several points.
The alcoholic personality
In one of his early papers Tiebout discounted the idea, common among psychoanalytically-inclined doctors, that there was a classic type of pre-alcoholic personality. In his view all of the personality characteristics associated with early alcoholism were manifestations of the tension state accompanying intermittent alcohol binges. These features included:- An unconscious need or drive to dominate
- A prevailing negative, hostile feeling-tone
- A capacity for ecstatic peaks
- A sense of loneliness and isolation
- Feelings of inferiority and superiority which exist simultaneously in the individual
- A striving for perfection
Howard Clinebell understood Tiebout to mean that there was, in fact, a pre-alcoholic personality but that "the distinctive factors have not yet been isolated". In a 1947 lecture, Tiebout located the roots of alcoholism in poor parenting, either excessive strictness which caused the child to suffer "perpetual frustration and blocking of his desires and expectations," or over-indulgence. Either way, "Since the alcoholic's sense of self-discipline has not been developed at this point, his natural reaction is to reject all discipline. He now cannot face the realities of his existence. This would indicate that the whole point of treatment is to get the alcoholic to face and accept his limitations and capacities."
The disease model
The concept of alcoholism which dominated treatment approaches in the second half of the 20th century, and is still influential today, defined alcoholism as a diseaseDisease Theory of Alcoholism
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. The existence of alcoholism as a disease is accepted by some within the medical and scientific communities, although critics...
. The idea that alcohol problems constituted a disease was not new, but the particular synthesis associated initially with the Yale Center of Alcohol Studies (now at Rutgers) and the National Committee for Education on Alcoholism had unique features not found in earlier theories. The NCEA was one of Marty Mann's projects, and thus influenced by Tiebout. A 1990 Hazelden
Hazelden
The Hazelden Foundation is a non-profit organization based in Center City, Minnesota. Hazelden has alcohol and drug treatment facilities in Minnesota ; Newberg, Oregon; Chicago, Illinois; Naples, Florida and New York City, New York...
pamphlet cites Tiebout, Dr. William Silkworth
William Duncan Silkworth
William Duncan Silkworth, M.D., was an American medical doctor and specialist in the treatment of alcoholism. He was Director of the Charles B...
and E.M. Jellinek
E. Morton Jellinek
Elvin Morton "Bunky" Jellinek , E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism researcher. He was born in New York City and died at the desk of his study at Stanford University on 22 October 1963. He was fluent in nine languages and could...
as formative influences.
Tiebout seems to have been somewhat ambivalent about the disease model, however. In 1955, speaking of the scientific underpinnings of the alcoholism movement in general, he said "I cannot help but feel that the whole field of alcoholism is way out on a limb which any minute will crack and drop us all in a frightful mess." He was consistent in his belief that the acceptance of alcoholism as a disease was essential, but this belief was partially pragmatic. In his experience, chronic alcoholics did not take the steps necessary to recover unless they became conscious of themselves as people with a disease. He emphasized a different aspect of the model in public lectures, however. Family members, friends and employers of alcoholics were encouraged to keep in mind that the condition was an illness and not a moral failing.
Role of the ego
In a 1954 article Tiebout introduced a definition of the term "ego" which was to become important in his later writings, particularly those for AA audiences. Although his use of the term was new, the concept behind it had been developed by Tiebout during the early 1940s. In these early articles he was addressing a professional readership, and use of the term might have created confusion between the psychoanalytic meaning of ego and the colloquial "egoEgo (spirituality)
In spirituality, and especially nondual, mystical and eastern meditative traditions, individual existence is often described as a kind of illusion. This "sense of doership" or sense of individual existence is that part which believes it is the human being, and believes it must fight for itself in...
" which was Tiebout's essential meaning.
Based on work with 250 alcoholics during his first 10 years at Blythewood, Tiebout developed the following conception of the alcoholic mind:
- In the normal individual there is a tendency to create some privacy for his inner life, for his motivations, reflections and emotions, so that they are not completely accessible to the environment. Normally this attempt interferes only slightly with the freedom of movement of outgoing and incoming stimuli and impulses. The boundary which the normal individual sets up between himself and the environment may be called a floating or diffuse boundary. In incipient alcoholism, however, it appears that the boundary is drawn somewhat tighter than is usual, and that with each stage of further development of the alcoholism more and more gaps are closed until the alcoholic seems to have erected what may be called a barrier which permits only a minimum of interplay between the inner self and the environment.
Using examples from dreams
Dream interpretation
Dream interpretation is the process of assigning meaning to dreams. In many ancient societies, such as those of Egypt and Greece, dreaming was considered a supernatural communication or a means of divine intervention, whose message could be unravelled by people with certain powers...
of patients he had analyzed
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
, Tiebout presented evidence for the existence of this rigid barrier. As long as the barrier remained, "As long as the self feels protected in a deep unconscious sense, in cannot be and is not disturbed by the warnings of reality, which characteristically roll like water off a duck's back." For the analyst,
- Tactics are governed not only by strategy; they are also guided by three basic principles in technique. These are, briefly, that the patient must suffer or feel anxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
about himself and his condition; second, that it is the impersonal pressures of reality which activate suffering; and third, that it is the first and most immediate task of the psychiatrist to overcome the patient's refusal, unwillingness or inability to sense or feel these pressures of reality.
In his 1954 article, 'The Ego Factors in Surrender in Alcoholism,' Tiebout began using the term "ego" to describe this concept of a self barricaded by defenses. He related it to Freud's "His Majesty the Baby" and to a similar concept introduced by Sandor Rado in 1933. Rado hypothesized that the elation induced by alcohol produced a reaction in the form of a "tense depression", which then reactivated the childish megalomania
Megalomania
Megalomania is a psycho-pathological condition characterized by delusional fantasies of power, relevance, or omnipotence. 'Megalomania is characterized by an inflated sense of self-esteem and overestimation by persons of their powers and beliefs'...
normally outgrown by adulthood. The result was a type of magical thinking in which "the ego secretly compares its current helplessness with its original narcissistic stature . . and aspires to leave its tribulations and regain its old magnitude." Tiebout acknowledged his indebtedness to Rado's conception, while eliminating much of the psychoanalytic complexity of the original. He also felt that Rado was incorrect in advising only the "reduction" of the ego. Tiebout's view was that "reduction" represented a compromise and that there should be no compromise with the ego. The old ego should be eliminated entirely and replaced with a new one through "surrender".
Surrender and conversion
The hallmark of Tiebout's work was his ability to explain 12 step ideas in psychoanalytic terms. The primary source for the steps was a religious movement popularized by Frank Buchman, with elements of the Higher Life movementHigher Life movement
The Higher Life movement was a movement devoted to Christian holiness in England. Its name comes from a book by William Boardman, entitled The Higher Christian Life, which was published in 1858...
tradition combined with the personal-evangelism techniques developed within the YMCA
YMCA
The Young Men's Christian Association is a worldwide organization of more than 45 million members from 125 national federations affiliated through the World Alliance of YMCAs...
movement in the early 20th century. The Oxford Group
Oxford Group
The Oxford Group was a Christian movement that had a following in Europe, China, Africa, Australia, Scandinavia and America in the 1920s and 30s. It was initiated by an American Lutheran pastor, Frank Buchman, who was of Swiss descent...
had a successful program involving public and private meetings for witness and confession, as well as individual work. Their concept of "surrender" was the traditional Christian one, as a contemporary observer noted:
- Surrender means the complete surrender of the will to Christ. They make no claim that this is easy. It may mean an entire change in one's whole life plan. It has meant just that for many of the Groupers. But it is necessary. So long as there are reserved areas in a man's life, they assert, he cannot expect to enter into a wholly satisfying experience of God.
Conversion
Religious conversion
Religious conversion is the adoption of a new religion that differs from the convert's previous religion. Changing from one denomination to another within the same religion is usually described as reaffiliation rather than conversion.People convert to a different religion for various reasons,...
, surrender
Surrender (spirituality and psychology)
To surrender in spirituality and religion means that a believer completely gives up his own will and subjects his thoughts, ideas, and deeds to the will and teachings of a higher power. It may also be contrasted with Submission...
, confession
Confession
This article is for the religious practice of confessing one's sins.Confession is the acknowledgment of sin or wrongs...
, restitution
Restitution (theology)
Restitution in moral theology signifies an act of commutative justice by which exact reparation as far as possible is made for an injury that has been done to another....
and the necessity of evangelizing others were ideas brought from the Oxford Group to Alcoholics Anonymous by members who had found that the intense religious devotion they inspired was the key to a changed life. Tiebout understood the concepts in a more secular way, and approved of them.
Tiebout had found that superficial compliance
Compliance (medicine)
In medicine, compliance describes the degree to which a patient correctly follows medical advice...
in therapy often correlated with lack of real change, and he saw in the AA concept of surrender an antidote to this phenomenon. An act of surrender was the only cure, or practically the only one, to the problem of "compliance", or partial surrender to the psychiatrist's authority and the authority of the reality principle
Reality principle
In Freudian psychology, the reality principle is the psychoanalytic concept describing circumstantial reality compelling a man or a woman to defer instant gratification...
. Tiebout described true surrender as "an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her unconscious
Subconscious
The term subconscious is used in many different contexts and has no single or precise definition. This greatly limits its significance as a definition-bearing concept, and in consequence the word tends to be avoided in academic and scientific settings....
mind becomes involved in a certain set of circumstances," essentially the circumstances of "hitting bottom".
Conversion, for Tiebout, was a spiritual awakening made possible by the person's recognition of his own egocentricity. The central effect of Alcoholics Anonymous was "to develop in the person a spiritual state which will serve as a direct neutralizing force upon the egocentric elements in the character of the alcoholic." A "vague, groping, skeptical intellectual belief" would not accomplish this but only a true emotional religious feeling, for "unless the individual attains in the course of time a sense of the reality and the nearness of a Greater Power, his egocentric nature will reassert itself with undiminished intensity, and drinking will again enter into the picture."
Later life
Tiebout retired as medical director of Blythewood in 1950. The sanitarium was gradually changing into a long-term care facility for the elderly, with fewer psychiatric patients. He continued to see patients privately and kept up an active speaking schedule, as well as serving on the boards of various alcohol-related organizations. He died in Greenwich in 1966 of cardiac causes. He was the husband of the former Ethel Mills and father of Harry Tiebout, Jr., a philosophy professor; Charles TieboutCharles Tiebout
Charles Mills Tiebout was an economist and geographer most known for his development of the Tiebout model, which suggested that there were actually non-political solutions to the free rider problem in local governance. Graduated Wesleyan University in 1950, received PhD in economics in University...
, and Sarah T. Worn.