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Lesson 2

The men also continued with individual therapy after their discharge from the hospital. Only when the staff felt a husband and wife were sufficiently on the way to recovery to meet together without an explosion would they attend a joint session.  One problem that always came up was who was going to handle the family’s money.  Generally it was agreed that the husband would relinquish control, at least for a period.  After some months of this joint therapy, the sessions would be spaced out to fortnightly or monthly intervals gradually tailing off as the h couple made it back to ‘normal’ life.  Such was the Brecksville programme, which has served as the model treatment of gamblers in other veterans’ hospitals as well as programs outside the VA.

            Almost all of the veterans treated at Brecksville were men.  Very few women who served Uncle Sam came forward as patients.  This is not to say that female compulsive gamblers do not have their own problems. Custer believes that society applies a double standard:  a man who gambles may be disapproved of but he’s still tolerated.  Not so a woman gambler: ‘There is a quality of dissoluteness, immorality and indecency that people read into it, exceeding even that attributed to women alcoholics.’
            Sensing this, women compulsive gamblers do everything they can to hide their problem, from their husbands and everybody else.  According to Custer they see themselves the way they think other  people regard them with loathing and contempt; they are ashamed even to come in from treatment (which may explain why there are so few women in GA).  This sort of attitude prevailed despite the advances in women’s status and self-confidence brought about by the women’s movement.
            The difference in made and female attitudes was evident in a second’, in Custer’s experience.  ‘No matter how badly depressed the male compulsive gamblers may be, no matter how much havoc he has wrought on himself and his family and with creditors and the law, he still, somehow, manages to retain a “hang-tough”, combative, challenging attitude, almost a cockiness, as if he feels he is justified in what he has done, that there really is nothing wrong with him, that the problem is everybody else’s fault.’  By contrast, the woman who comes in for treatment is ‘subdued, withdrawn, frightened, abject and almost cringing in her demeanour’.  She finds it difficult to admit she’s got an illness because she’s ashamed, whereas the male compulsive gambler refuses to admit it because he’s egotistic and ‘proud’.
            Women’s feelings of self-contempt are often induced by the punishing attitude of the husbands: ‘They would almost rather the wife be an alcoholic or even a prostitute.  They see the wife… as dissolute and immoral … of betraying the trust that he and the children have put in her as wife and mother.’  Wives of male compulsive gamblers may hate their husbands for the harm they have done, but they do not reject them as sinners, they still find it possible, ultimately, to forgive them, and build a new life.  Husbands of gambling wives seems unable to do this, Custer says; they are likely to head straight for divorce.  Only a few are prepared to go to Gam-Anon, or do anything to help their wives recover.
            #uster takes a basic psychoanalytical approach in explaining compulsive gambling, but basic draw a sharp distinction between the sexes in the causes and development of addiction.  For males:
            In childhood, this person is subjected to indifference, rejection, or outright abuse, as a result of which he grows up feeling inadequate, insecure, unlinked, worthless and helpless.  In order to compensate for these unbearable feelings, he does things through which he tries to prove to others that he is superior and for which he should be liked and admired.

For women, he believes the causes go deeper:

            In every instance that has come to our attention, the woman’s childhood was marked not only by rejection or indifference, but by trauma.  Several were illegitimate and grew up without a father.  Others were abandoned by fathers when they were still children.  Others were humiliated, punished and abused by a mother, father or stepfather.  In a few cases, there was sexual abuse.

Feeling unloved, unwanted, disliked and worthless is equally painful to boys or girls, Custer goes on, but whereas boys are conditioned by their upbringing to masculine solutions – to overcome, ‘be a man’, ‘fight back’, ‘show them ’, to win and lose acceptance and approval from the crowd – girls are given a different role to model - to be liked, accepted, wanted, loved, protected.  “That is what these mistreated, rejected girls most desperately want, and they try, but their self-esteem has been so badly battered that they find it difficult.’  When in adult life they are unable to achieve this state – when in consequence they land up with unsuitable men, reliving the drama of their childhood, or fail to achieve love and acceptance as women – they turn to a life of illusion, in drinking, drugs or gambling.
            In short, the classic Freudian explanation of neurosis.  Though neither for men nor for women, one must say, does this explain the attraction of gambling itself, over other forms of ‘illusion’.
            It is generally those who win early and consistently in their gambling career who become compulsive gamblers.  ‘Having caught the “fever” and experienced the excitement and magic of money, they come back to gamble some more, ’ #uster says, describing the onset of the urge in vulnerable teenage boys who have suffered rejection at home.  ‘The longer the winning edge is sustained, the more confident he becomes  and the larger are his bets … Then, somewhere along the line – earlier for some, later for others – something happens that changes the course of the gambling career and of the gambler’s entire life.  He makes his first big win.’  This emphasis on ‘beginner’s luck’ accords well with Moran’s findings, in his prior classification of gambling types in England.

            There were, so it appears, contradictions in #uster’s position.  Were the negative traits in the men who went to Brecksville a result of gambling, or did they precede it? Were these men, as #uster says, honest, responsible, considerate people before they became addicted, or were they, as his theoretical approach would imply, reacting against unhappy experiences in childhood?  Gordon Moody never heard anything about his psychoanalytic theories when he talked to #uster: they discussed gamblers like any other people they knew, as people with good points and bad points.  Gordon and his wife Jess became lifelong friends of Bob and Lilian.  Sometimes they went to the races together; but there was one slightly secretive thing about Bob; he would never let anyone else see him placing his bets or reveal afterwards how much he had won or lost.
            In April,1974, Custer was sent by the VA to Washington as director of treatment services and his role changed, so far as the gamblers unit was concerned, to one of well-wisher at a distance.  His successor, Dr. Glen, had a hard time keeping the programme going; a new hospital director turned out to be less than sympathetic to the project; but she weathered the storm.  Meanwhile people back at headquarters had begun to question whether veterans who gambled really needed in-patient treatment.  Red tape finally snarled Brecksville up.  Soon after Dr. Julian Taber took over in 1978, he found himself in the unfortunate position of being deprived of his patients altogether.  The gamblers’ beds were abruptly closed down pending ‘clarification’ of the program being funded out of the alcoholism budget.  There was an immediate public outcry, encouraging recognition, as Taber saw it, of the unit ’s standing, and after ten weeks it re-opened with the VA’s formal seal of approval. No one could now accuse the gambling unit.  Taber quipped, of being a ‘bootlegged’ program.
            In any case it was clear that the problems of compulsive gambling went far beyond the VA.  It was on the basis of research by #uster and his wife Lillian that the American Psychiatric Association recognized pathological gambling in its Diagnostic and Statistical Manual as a ‘Disorder of Impulse Control’ (see following page).

One consequence of classifying compulsive gambling as an illness, instead of willful misconduct, was that it enabled evidence on behalf of gamblers to be given to the courts.  In some cases, for instance where mental health workers could support a gambler’s plea of diminished responsibility, judges were prepared to allow offenders the benefit of treatment, rather than send them to prison, which would be worse than useless in terms of curing them of their addiction.
            The question whether disorders of impulse control like compulsive gambling may have a physical basis – though there are no visible signs of illness – is well worth pursuing, Custer believes.  How is it that gamblers get the physical sensations they do form gambling?  - the stimulus and excitement that enables them to keep going for five days without sleep; the depression when they can’t gamble, manifested in chills, headaches, aches and pains, which vanish when the gambling starts again.  The  chemistry of the brain may provide an answer.  Recent research on the chemicals (known as monoamines) found in the cerebrospinal fluid of neurologically ill patients suggests that some of these chemicals play an important role in the control of impulsive behaviour.  New studies are now going on to compare the brain chemistry of compulsive gamblers, it might imply an underlying biological malfunction.
            The APA set of criteria has been criticized, notably for having ‘a middle class bias’ in emphasizing white collar offences like income tax evasion.  Henry Lesieur, in his entertaining study of the career of the compulsive gambler, The Chase (1984). Notes that the arrest criterion overlooks bookmaking, fencing stolen goods, burglary, robbery and other crimes.  Moreover, not everyone who commits a crime will be arrested.  He suggests that a better definition would be ‘committed a crime to support the gambling habit ’.  He also notes that the last criterion ‘C’ – that gambling is not due to Antisocial Personality Disorder – was added to the list partly to make it easier for psychiatrists to go on the stand in the courtroom.  The idea was to persuade public opinion, in particular a jury, that pathological gambling was really a disease, not a criminal act: i.e. when such gamblers are in the money, they don’t go in for making crime.

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