Self-Help and the Chicago Connection

By Christopher G. Fichtner, M.D.; Thomas H. Jobe, M.D.; and James T. Barter, M.D.

Chicago Medicine

The self-help movement, American in origin, has expanded exponentially to become an international phenomenon. However, few may know the important role Chicago psychiatrist and neurologist Abraham A. Low, M.D. (1891-1954), played in the history of the self-help movement when he founded Recovery Inc. Alcoholics Anonymous (AA) the earliest self-help group was founded in 1935 by a physician and stockbroker, both heavy drinkers. Their relationship and cooperation was born out of the need for mutual support. AA has become a prototypic self-help organization. It has developed a structured 12-step program that relies on healing through selfawareness and peer counseling.

In 1937, Recovery Inc. was founded by Dr. Low to provide mental health aftercare for psychiatric patients, many of whom had received treatment at the Psychiatric Institute of the Illinois Research and Education Hospitals. Recovery soon became an independent organization. As more members joined and formed new groups, Recovery expanded throughout the Chicago area. It subsequently grew to a national, and now international, organization with more than 800 chapters.

Dr. Low, born in Poland in 1891, attended school in Germany and received his medical training at the University of Vienna. He arrived in the United States in 1921 and practiced general medicine, first in New York City and later, in 1923, in Chicago. In 1925, he was appointed instructor in neurology at the University of Illinois Medical School. Subsequently, he became associate professor of psychiatry as well as acting director of the University of Illinois Psychiatric Institute. He remained on the faculty of the University of Illinois until his death in 1954.

Developed principles

Dr. Low, who believed that psychiatric patients could take an active role in maintaining their mental health through control of their responses to recurrent symptoms, was a pioneer in developing the basic principles of self-help.

In addition, his ideas contained much that anticipated later developments in group, cognitive, and behavioral therapies. The characteristics outlined by Dr. Low for Recovery Inc. provided a model for successful support-group intervention in psychiatry. Among the characteristics of self-help groups discovered by Dr. Low were: the necessity of personal participation, importance of faceto- face personal interactions, need to define a purpose with agreed-upon actions directed toward that end, opposition to some entrenched and orthodox practices, and use of a reference group for individual members that provides a point of connection and identification with others.

Where there's a will. . .

The focus of Recovery was the prevention of relapse into mental illness through control of the behavioral expression of psychiatric symptomatology. Mental Health Through Will Training lays out the basic tenets of Dr. Low's Recovery model of self-help. Dr. Low's clinical approach focused on reducing the symptoms of anxiety, panic, and depression that complicate the long-term course of major psychiatric disorders (e.g., schizophrenia, manic-depressive illness, and psychotic depression). Also, ongoing self-esteem issues were of major concern. Decreased self-esteem was related to the stigma of mental illness that Dr. Low believed could be overcome by patients and their families through the Recovery method.

Dr. Low believed and taught that in the face of increasing anxiety, patients were prone to use alarmist and defeatist language with fatalistic implications. These features were understood by Dr. Low as components of a danger signal, which he summarized as the symptomatic idiom. Dr. Low believed the patient had the will, which could be trained to accept or reject the suggestions of the symptomatic idiom. The implications of the symptomatic idiom were impending physicalmental collapse and resignation to permanent handicap.

Dr. Low's interest in developing a theory of the will places him among many of the historic psychologists, though the concept of the will has been given relatively little attention in modern psychiatry by both biological and psychoanalytic theorists.

Spotting technique

Although the authority of the physician is a central tenet of Recovery, the self-help program was developed to function independently of the physician-patient relationship. Dr. Low developed a technique called spotting, whereby a patient could look for signs of defeatist thinking among other group members and bring them to the attention of the group for help. Within the meetings, a highly structured panel interview occurred. Individual patients would present their case vignettes and testimonials, always following a prescribed formula designed to illustrate Recovery principles. These examples would begin with a description of the problem and how it escalated to become a source of acute anxiety or crisis for the patient. The 'spotting' of the problem was described, and the Recovery principles were applied. In conclusion, a summary statement comparing the current reaction to the problem with previous reactions prior to receiving Recovery training was offered.

Adjunctive therapy

Studies have shown that self-help organizations and aftercare support groups are an important source of adjunctive therapy in many psychiatric, addictive, and medical problems. They may also offer great support to individuals with specific non-medical issues of concern. Though some research has been done on Recovery, Inc., and other self-help groups, the long term effectiveness of self-help has not been established.

Physicians need to increase effective cooperation between self-help groups and the medical profession. Perhaps one approach may be to define the role of medical professionals within such groups, especially from the group members' standpoint.

Abraham A. Low, M.D., a pioneering Chicago physician, was a truly interdisciplinary figure, with academic interests and scholarly contributions in such diverse areas as clinical neurology and psychiatry, neuropathology, electroconvulsive therapy, and group therapy. His writings in connection with Recovery Inc. also reflect a linguistic and philosophical sophistication that equipped him to address difficult issues requiring analysis from multiple perspectives. His work deserves reexamination because of its potential contribution to the reformulation of biopsychosocial issues central to many areas of medicine, including psychiatry.

This article is published with permission from Chicago Medical Society.

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