Alcologia: A “Logical” Paralogia

Early in my training, one of my instructors advised me, “You will never be able to do successful psychotherapy with a schizophrenic unless you understand ‘schizophrenese.’ “He meant that if the paralogia of the schizophrenic is interpreted according to the laws of logic to which we are accustomed, the communication will be missed completely. Yet, in the case of schizophrenia, the patient's verbal productions are often so bizarre, with loose associations, neologisms, predicate identity, gross delusions, etc., that one is quickly put on the alert to be cautious in accepting the patient's verbalizations at their face value.

In treating the alcoholic patient, however, there is much greater danger of being misled by the patient's productions. For here there are no dramatic deviations from ordinary, commonplace conversation. The patient is generally perfectly coherent, often witty and brilliant, is not hallucinating nor delusional, and can put together a rather convincing account which may nevertheless be almost as remote from reality as the psychotic distortions of the schizophrenic. To paraphrase my instructor, I do not believe successful therapy can be done with the alcoholic unless one understands alcologia, a term I have coined to describe the thinking processes of the actively-drinking alcoholic. Whereas it is not true that “only an alcoholic can help an alcoholic,” it probably is true that only one who understands the alcoholic can help him, and this requires a familiarity with the workings of alcologia.

Alcologia consists of three prime ingredients: denial, rationalization, and projection. Whereas these can all be found in normal, neurotic, and psychotic thinking, they are nowhere else so intense and mutually reinforcing, while at the same time appearing superficially congruent with reality, as in the alcoholic. Together they form a virtually impenetrable defensive shield which frustrates and defies all therapeutic efforts. It is not until this shield is somehow tra