Emotions Anonymous (EA) is a twelve-step program for recovery from mental and emotional illness. As of 2004[update] there were approximately 1,100 EA groups active in the United States. EA is the largest of three organizations that have adapted the Twelve Steps of Alcoholics Anonymous (AA) to create a program for people suffering from mental and emotional illness. Neurotics Anonymous is a predecessor of EA. Emotional Health Anonymous (EHA), was created independently. To avoid confusion with Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.
- 1 History
- 2 Misconceptions
- 3 Demographics
- 4 Processes
- 5 Effectiveness
- 6 Criticism
- 7 Literature
- 8 See also
- 9 References
- 10 External links
The conception of Neurotics Anonymous began with Alcoholics Anonymous co-founder Bill W. After achieving sobriety Bill continued to suffer from neurosis, specifically depression. In letters to other AA members he wrote about his personal experience with neurosis, its prevalence in AA, and how he and others learned to cope with it. Bill expressed that as he learned to let go of his dependence on people and situations for emotional security and replaced that dependence with "showing outgoing love as best as he could," his depression began to subside. In correspondence with another AA member about neurosis and psychoanalyst Karen Horney Bill suggested how a Neurotics Anonymous fellowship might operate.
You interest me very much when you talk of Karen Horney. I have the highest admiration of her. That gal's insights have been most helpful to me. Also for the benefit of screwballs like ourselves, it may be that someday we shall devise some common denominator of psychiatry — of course, throwing away their much abused terminology — common denominators which neurotics could use on each other. The idea would be to extend the moral inventory of AA to a deeper level, making it an inventory of psychic damages, reliving in conversation episodes, etc. I suppose someday a Neurotics Anonymous will be formed and will actually do all this.
— Bill W., Letter to Ollie in California, January 4, 1956.
In a subsequent letter to Ollie in June 1956, Bill suggested the inventory of psychic damages include inferiority, shame, guilt and anger. He added that the effectiveness of the inventory would come from reliving the experiences and sharing them with other people.
Neurotics Anonymous was created eight years later, February 3, 1964 in Washington, D.C. by Grover Boydston (August 16, 1924 - December 17, 1996). Grover was an AA member, recovering alcoholic, psychologist, and Ed.M. Grover had attempted suicide five times before the age of 21 and, like Bill W., was neurotic. Grover believed members of twelve-step programs shared the same underlying neuroses caused by self-centeredness, a view expressed in other twelve-step programs. Grover went as far as to say, "All of us are, indeed, brothers, and the variations in detail are no more than if one of us likes chocolate ice cream, and the other likes vanilla."
While in AA, Grover discovered working the Twelve Steps helped remove the neuroses underlying his alcoholism. As an experiment Grover instructed a woman who suffered from neurosis, but not alcoholism, to work the Twelve Steps. He discovered that they aided her recovery from neurosis as well. He wrote Alcoholics Anonymous World Services for permission to use their Twelve Steps with the word "alcohol" in the First Step replaced with "our emotions." Permission was granted. Grover placed an ad in a Washington, D.C. newspaper for Neurotics Anonymous, and organized the first meeting from those who responded to it. NAIL grew modestly until an article was published on it in Parade magazine. The Associated Press and United Press International republished the story, and NAIL groups began forming internationally.
Marion Flesch (July 24, 1911 - October 10, 2004) is responsible for starting what would become Emotions Anonymous. Marion was a graduate of St. Cloud State Teachers College (now St. Cloud State University) and at various times worked as a teacher, secretary, clerk, accountant, bookkeeper and office manager. Later in life she became a certified chemical dependency counselor through the University of Minnesota and started work on a master's degree, but stopped at age 80 due to health concerns. Marion originally went to Al-Anon meetings at the advice of a friend to help deal with panic attacks. After she learned of NAIL, she started the first such meeting in Minnesota. It was held April 13, 1966, at the Merriam Park Community Center in St. Paul, Minnesota. NAIL grew quickly in Minnesota, and by Fall of 1966 there were thirty active groups in the state.
Differences developed between the Minnesota groups and the central offices of NAIL. The Minnesota Intergroup Association separated from NAIL on July 6, 1971, after unsuccessful attempts to reconcile differences with NAIL and later adopted the name Emotions Anonymous. They wrote to Alcoholics Anonymous World Services for permission to use the Twelve Steps and Twelve Traditions. Permissions was granted. Emotions Anonymous officially filed Articles of Incorporation on July 22, 1971.
By 1974 the Diagnostic and Statistical Manual of Mental Disorders, at the time in second edition (DSM-II), was undergoing revision. The framework developed for the third edition (DSM-III) was no longer based on psychoanalytic principles such as neurosis. The connotation of neurosis in common language also began to change. "Neurosis" was being used, increasingly, in a facetious or pejorative sense, rather than a diagnostic sense. These combined factors could make it difficult to take an organization known as Neurotics Anonymous seriously. In current NAIL literature, there is not a scientific definition ascribed to neurosis. As used in the NAIL program, a neurotic is defined as any person who accepts that he or she has emotional problems.
Although EA outgrew NAIL in the United States, NAIL in Latin America continued to grow. It has only been since early 2007 that NAIL groups have again begun to formally organize in the United States, composed largely of Spanish-speaking members. EA groups are mostly distributed throughout Europe and English-speaking parts of the world, with some notable exceptions being Brazil, Japan and India. Outside of the Americas, NAIL is only active in Portugal.
EA is not intended to be a replacement for psychotherapy, psychiatric medication, or any kind of professional mental health treatment. People may find EA useful when psychiatric treatment is not available to them, when they have resistance to psychiatric treatment, or as a complement to such treatment. EA does not attempt to coerce members into following anyone's advice. EA members express this in the saying, "No questions, no advice, stick to yourself."
Intellectual disabilities and hospitalization
Jim Voytilla of the Ramsey County, Minnesota, Human Services Department created EA groups for intellectually disabled substance abusers in 1979 Voytilla noted when this particular demographic of substance abusers attended AA meetings in the surrounding community, they felt uncomfortable and made others attending the meetings uncomfortable. Voytilla's EA meetings were created to avoid these problems, and address the illnesses of his clients other than substance abuse. Since then, four articles have narrowly defined EA as a program specifically for mentally retarded or intellectually disabled substance abusers. In a similar way, EA has also been incorrectly described as an organization either specifically or primarily for those who have been discharged from psychiatric hospitals.
While EA does not discriminate against any demographic—all that is needed to join EA is a desire to become emotionally well—EA is not, and never has been, a program specifically for people of any particular background or treatment history. It is not uncommon, however, for former patients in psychiatric hospitals to seek help in EA after being discharged.
Grover Boydston conducted the first demographic study of Neurotics Anonymous in 1974. Much of what he found has been reproduced in subsequent demographic studies of Emotions Anonymous and similar groups. Such studies are rare and samples sizes are usually small as any group following the Twelve Traditions is required to protect the anonymity of their members. While researching such groups is still ethically possible, it is more difficult given this constraint.
- Age: Boydston's study found the average age of NAIL members surveyed to be 43.02 years. A study six years later of self-help groups for people with serious mental illness, found the average age to be 35.3 years.
- Attendance and Tenure: Of the NAIL members surveyed Boydston found they attended, on average, six meetings per month and had spent an average of 2.37 years in NAIL. The meaningfulness of the latter statistic is mitigated as NAIL only existed for approximately ten years at the time of the survey.
- Employment and socioeconomic status: Boydston categorized the occupations of NAIL members into four categories.
- Professionals - Includes people who practice a profession that is so considered by scientific, academic, business, and other people. It includes physicians, lawyers, engineers, nurses, college and university instructors. These represented 38% of the members surveyed.
- Clerical persons - Includes people who perform office work or sales work according to the classification of "clerical." These represented 32% of the members surveyed.
- Homemakers - A person who takes care of a home as his or her main work. These represented 16% of the members surveyed.
- Other - Includes students and people who do not fit into the three previous categories. These represented 32% of the members surveyed.
- According to Boydston's results at least 70% of NAIL members were employed. This is similar to a specific study of EA that found most of the members were middle class. Other studies of self-help groups for people with serious mental illness found most of the members tend to be unemployed, while others found members to be predominately working class.
- Ethnicity: Boydston's study, and all similar studies in the literature have found that the majority of members in NAIL, EA, and other self-help groups for people with serious mental illness are white.
- Hospitalization: Boydston's study of NAIL members found that 42% percent had been hospitalized for psychiatric reasons. More recent studies have shown that in self-help groups for serious mental illness approximately 60% (55%-75%) of members had been hospitalized for psychiatric reasons.
- Marital Status: In Boydston's study of NAIL members he found 25% were single, 48% were currently married, 22% were divorced and 5% were widowed. This finding has not been replicated in studies of similar groups where it was found most members had never been married.
- Religion: Boydston's survey included not only religious affiliation, but also included a measure of religiosity. Of the NAIL members surveyed he found 24% identified as Catholic, 47% identified as Protestant, 9% identified as Jewish, and 19% did not consider themselves religious. Additionally, only 19% of members identified themselves as "very religious," 42% identified themselves as moderately religious, and 39% identified themselves as "not very religious."
- Specific disorders (neuroses): Boydston's survey contained an open-ended question asking about the "main complaints" NAIL members came to the program with. He summarized them in a list of twelve. Listed below are his results, in order from the highest to lowest percentage of members reporting them. Members often presented with more than one complaint.
- Sex: Boydston's study of NAIL members found approximately 36% were male, and 64% were female. This ratio, of two (or more) females for every male, has been reproduced in all other studies of self-help groups for persons with serious mental illness, as well as specific studies of EA groups.
The tables below are the percentages of members who received the listed treatments before joining NAIL. The data is taken from Boydston's 1974 study of NAIL members. The treatments mentioned in this table represent those that were available in 1974 and earlier.
In 1988 the World Health Organization estimated that 89 percent of Mexico City's population was in a crisis they described as "psychological and very severely emotional." It is estimated that 15% of the workforce in Mexico City are alcoholics. In Mexico City, alcoholism is ten times more prevalent in men than in women (the disparity increases in rural areas) and AA groups are consequently predominately male. The Mexican government funds a hot line staffed by volunteers from NAIL to counsel people in crisis by phone.
Neurotics Anonymous (Neuróticos Anónimos) groups in Mexico, like the groups in the United States, are predominately female. The connotation of the word "neurotic," however, is different; anyone who openly expresses anger is considered neurotic. For example, a wife who frequently scolds her husband or children is neurotic and can be treated in NAIL. While men can be neurotic it is considered to be mostly a female affliction, usually developed in response to male alcoholic behavior. Al-Anon groups in Mexico City are also predominately female, but many women attend NAIL to deal with their husband's alcoholism.
A study of Neurotics Anonymous members in the Xochimilco borough of the Mexican Federal District found members presented with a heterogeneous composition of problems and disorders (including depression, suicidal ideation, obsessions, anxiety, sexual problems and somatic disorders). Most members were between 20 to 40 years old (73%) and were predominately female (87%); coinciding with established social roles in the culture that men are alcoholics and women suffer from depression and other emotional problems. All members in the sample had average or below average levels of income. While members worked on average 2.5 hours per day and 87% were satisfied with the amount of time spent working per day (as it allowed them more time to participate in the group) 87% were also dissatisfied with their economic security.
- For more details on this topic, see Self-help groups for mental health: Group processes and Twelve-step program: Process
Emotions Anonymous views mental and emotional illness as chronic and progressive, like addiction. EA members find they "hit bottom" when the consequences of their mental and emotional illness cause complete despair. Twelve-step groups symbolically represent human structure in three dimensions: physical, mental, and spiritual. The illnesses the groups deal with are understood to manifest themselves in each dimension. The First Step in each twelve-step group states what members have been unable to control with their willpower. In some cases the emphasis is on the experience in the physical dimension; in AA the First Step suggests admitting powerlessness over alcohol, in Overeaters Anonymous (OA) it is powerlessness over food. In other groups the First Step emphasizes the experience in the mental dimension; in NA the First Step suggests admitting powerlessness over addiction, in EA (as well as NAIL and EHA), it is powerlessness over emotions. EA, NAIL and EHA focus on deviant moods and emotions, not just a craving for mood alteration. The subjective experience of powerlessness over one's emotions can generate multiple kinds of behavioral disorders, or it can be a cause of mental suffering with no consistent behavioral manifestation (such as affective disorders).
In the Third Step members surrender their will to a Higher Power, this should not be understood as encouraging passiveness, rather its purpose is to increase acceptance of reality. The process of working the Twelve Steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action; this is known as a spiritual awakening, or religious experience.
Neurotics Anonymous developed the Test of Mental and Emotional Health as a tool to help members evaluate their progress. It is a fifty question test, with each answer rated on a three level Likert scale. Possible scores range from zero to one hundred. Higher scores are thought to indicate better mental and emotional health.
In Boydston's survey of NAIL members, when asked if they had received help through the program, 100% of those surveyed said "yes." Boydston claimed NAIL had similar results to AA in terms of recovery — 50% with a desire to stop drinking do so, 25% recover after one or more relapses, but most of the other 25% never successfully recover.
- For more details on this topic, see Self-help groups for mental health: Criticism
Free Inquiry, a publication affiliating itself with secular humanism, criticized Alcoholics Anonymous and Neurotics Anonymous organizations operating in Mexico as having questionable therapeutic methods based on supernatural intervention. Further, stating such groups practice deception, foster ignorance, and promote blatantly false beliefs. The journal claimed the methods used create a kind of mental control that almost completely destroys individual freedom and integrity.
NAIL members in Comalapa (a municipality in Nicaragua) believe X-ray images (radiografías) can serve as a moral diagnostic revealing information about the intent and mores of those being examined. There is, however, no evidence that they are deliberately attempting to mislead other members. Americans had similar misunderstandings of X-ray technology when it was first introduced in the United States.
Increasing deviant stigma
Sociologist Edward Sagarin noted that alcoholics and addicts are considered deviants because their behavior is socially labeled as deviant. Meaning chronic substance abuse is seen as a deviant, while being sober or "clean" is normal. For an alcoholic or addict, joining groups such as AA or NA immediately reduces their deviant stigma, regardless of whether or not the alcoholic or addict believes it does.
There is no similar clear cut language to label the deviance of those EA, EHA or NAIL, in the act of joining these groups members label themselves as deviant, and take on stigma by identifying as one of those in the group afflicted with the problems of the other members. Initially joining the group may prove to be more ego damaging than ego reinforcing, regardless of whether or not the group helps them overcome their problems. Therefore social stigma would attract alcoholics and addicts to groups like AA and NA. It would, however, become a barrier preventing people from joining groups such as EA.
In contrast, those with severe mental illness may have acquired stigma through professional labels and diagnoses as well as through other behaviors associated with their mental illness defined as deviant. This stigma may not be as easily understood as alcoholism or addiction because the behavior is more varied and can not be explained by substance use.
The objective of NA and AA is not just to help their members stop abusing drugs and alcohol. It is acknowledged in these programs that addiction is more systemic than a "bad habit" and is fundamentally caused by self-centeredness. Long term membership in the AA has been found to reform pathological narcissism, and those who are sober but retain characteristics of personality disorders associated with addiction are known in AA as "dry drunks."
Emotions Anonymous publishes three books approved for use in the organization. Emotions Anonymous is the primary book, the Today book contains 366 daily meditation readings related the EA program, and It Works If You Work It discusses EA's tools and guidelines in detail.
- Emotions Anonymous (1996). Emotions Anonymous (Revised ed.). St. Paul, Minnesota: Emotions Anonymous International Services. ISBN 0-9607356-5-8. OCLC 49768287.
- Emotions Anonymous (1987). Todays. St. Paul, Minnesota: Emotions Anonymous. ISBN 0-9607356-2-3. OCLC 19232484.
- Emotions Anonymous (2003). It Works If You Work It. St. Paul, Minnesota: Emotions Anonymous. ISBN 0-9607356-9-0. OCLC 54625984.
From 1965 to 1980 Neurotics Anonymous published a mimeographed quarterly periodical, the Journal of Mental Health (ISSN 0022-2658). This should not be confused with the newer journal of the same name that began publishing in 1992 (ISSN 1360-0567). Early in the development of NAIL they used Alcoholics Anonymous (the so-called Big Book) and the Twelve Steps and Twelve Traditions, the two fundamental books of the Alcoholics Anonymous program. While reading out loud at meetings, members changed instances of the word "alcoholic" to "neurotic." Passages in the book referring specifically to drinking were ignored. Eventually, NAIL began creating books from articles published in the Journal of Mental Health. There were three such books published in English.
- Neurotics Anonymous (1968). Neurotics Anonymous. Washington, D.C.: Neurotics Anonymous International Liaison, Inc.
- Neurotics Anonymous (1970). The Laws of Mental and Emotional Illness. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTOFYS. LCCN 76102220. OCLC 104842.
- Neurotics Anonymous (1978). The Etiology of Mental and Emotional Illness and Health. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTON22. LCCN 76040759. OCLC 4500175.
Tools and guidelines for recovery
All twelve-step programs use the Twelve Steps and Twelve Traditions, but most have their own specialized tools and guidelines emphasizing the focus of their program. EA developed the "Twelve Helpful Concepts," and "What EA Is...and Is Not." EA's also uses a modified version of Al-Anon's "Just for Todays," as well as a slightly modified version of AA's Twelve Promises. The EA "Just For Todays" were adapted by a twelve-step organization for female victims of domestic violence with substance abuse histories, Wisdom of Women (WOW).
- List of twelve-step groups
- Recovery International (formerly Recovery, Inc.)
- Self-help groups for mental health
- Recovery model
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- Boydston, Grover (1974). A history and status report of Neurotics Anonymous, an organization offering self-help for the mentally and emotionally disturbed (Ed.M thesis). Miami, Florida: Barry University. OCLC 14126024.
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- Results from EA's Search Engine for Meetings
- Neuróticos Anónimos (2007-06-20). "Neuróticos Anónimos – Portugal" (in Portuguese). Archived from the original on 2009-02-15. Retrieved 2007-06-20.
- Earliest result in a Google News Archive Search as of 2007-05-28
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- Emotions Anonymous (2003). It Works If You Work It. Emotions Anonymous. pp. 7–10. ISBN 0-9607356-9-0. OCLC 54625984. Chapter includes guidelines What EA Is...and Is Not.
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Degenhardt, Louisa (June 2000). "Interventions for people with alcohol use disorders and an intellectual disability". Journal of Intellectual & Developmental Disability 25 (2): 135–146. doi:10.1080/13269780050033553.
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- Emotions Anonymous (1996). "Chapter 1. An Invitation". Emotions Anonymous (Revised ed.). St. Paul, Minnesota: Emotions Anonymous International Services. pp. 1–6. ISBN 0-9607356-5-8. OCLC 49768287.
- Hughes, Kathleen; Ashby, Chris; (March 1996). "Essential components of the short-term psychiatric unit". Perspectives in psychiatric care 32 (1): 20–25. doi:10.1111/j.1744-6163.1996.tb00495.x. ISSN 0031-5990. PMID 8868849.
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- Neurotics Anonymous (1978). The Etiology of Mental and Emotional Illness and Health. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTON22. LCCN 76040759. OCLC 4500175.
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- Alcoholics Anonymous (1976-06-01). Alcoholics Anonymous. Alcoholics Anonymous World Services. ISBN 0-916856-59-3. OCLC 32014950.
- Alcoholics Anonymous (2002-02-10). Twelve Steps and Twelve Traditions. Hazelden. ISBN 0-916856-01-1. OCLC 13572433.
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- Emotions Anonymous (1996). "Part III. Tools for Recovery". Emotions Anonymous (Revised ed.). St. Paul, Minnesota: Emotions Anonymous International Services. pp. 231–240. ISBN 0-9607356-5-8. OCLC 49768287. Chapter includes the Helpful Concepts, Twelve Promises and Just For Todays.
- Al-Anon. "Al-Anon/Alateen Family Groups of Connecticut - Literature - Just for Today". Al-Anon/Alateen. Retrieved 2007-07-10.
- Fearday, Frederick L.; Cape, Anita L. (2004). "A voice for traumatized women: inclusion and mutual support". Psychiatric rehabilitation journal 27 (3): 258–265. doi:10.2975/27.2004.258.265. PMID 14982333.
- Emotions Anonymous International
- Emotions Anonymous in Germany
- Emotions Anonymous in Japan
- Works by or about Emotions Anonymous in libraries (WorldCat catalog)
- Neurotics Anonymous in the United States
- Neurotics Anonymous in Argentina
- Neurotics Anonymous in Brazil
- Neurotics Anonymous in Mexico
- Neurotics Anonymous in Portugal
- Works by or about Neurotics Anonymous in libraries (WorldCat catalog)