Emotions Anonymous

Emotions Anonymous (EA) is a twelve-step program for recovery from mental and emotional illness. As of 2004 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, replacing the word "alcohol" with "our emotions" in the First Step. Neurotics Anonymous, one of the smaller organizations, is a predecessor of EA, the other, Emotional Health Anonymous (EHA), was created independently. To avoid confusion with the more well known twelve-step program, Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.

History
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 (author of Neurosis and Human Growth), Bill suggested how a Neurotics Anonymous fellowship might work.

In a subsequent letter to Ollie in June of 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., suffered from neurosis. While in AA, he discovered that working the Twelve Steps also helped control the underlying neuroses causing 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 about NAIL, and organized the first meeting from those who responded to it. NAIL grew modestly until a story was written about 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. Attempts to reconcile them were not successful. The Minnesota Intergroup Association separated from NAIL on July 6, 1971, and a few weeks later adopted the name Emotions Anonymous for the Minnesota groups. 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.

Given the changing state of psychology and society at the time, the name change was apropos. 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.

Sometime around 1980 the NAIL groups in the United States either changed their affiliation to EA or became defunct. The NAIL groups in Latin America, however, continued to grow. It has only been since early 2007 that NAIL groups have again began to formally organize in the United States, mostly composed of Spanish-speaking immigrants. EA groups are mostly distributed throughout Europe and English-speaking parts of the world, with some notable exceptions being Brazil, Japan and India. NAIL is also active in Portugal.

Emotional Health Anonymous was created sometime before July 27, 1973. Currently, EHA is only active in the Los Angeles area.

Classifying

 * For more details on this topic, see Self-help groups for mental health: Classifying

Emotions Anonymous, Neurotics Anonymous and Emotional Health Anonymous are all twelve-step programs and self-help groups for mental health. While EA, NAIL, and EHA derive from Alcoholics Anonymous, in research they are often grouped with and compared to Recovery, Inc. and GROW – self-help groups for mental health that do not follow the Twelve Steps and Twelve Traditions of AA.

Grover Boydston believed very strongly that members of twelve-step programs shared the same underlying neuroses caused by self-centeredness, a view also expressed in other twelve-step programs' literature. 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." Sociologist Edward Sagarin compared NAIL's process of building up self-confidence to Albert Ellis' rational-emotive psychotherapy but too fluid to be described by any single philosophical or psychological field.

Purpose
Just as Nicotine Anonymous is for people who have serious problems with nicotine, Emotions Anonymous is for people who have serious problems with their emotions. EA members, however, do not try to become "emotionless." The focus of the program is on learning to manage emotions in healthy ways. 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 in to following anyone's advice. EA members express this in the laconic saying, "No questions, no advice, stick to yourself."

Intellectual disabilities and hospitalization
In 1979 Jim Voytilla of the Ramsey County, Minnesota, Human Services Department created EA groups for mentally retarded substance abusers. 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, several articles have incorrectly described EA as a program specifically for mentally retarded (or in some of the more recent, 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.

Demographics
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 in to 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 her main work. These represented 16% of the members surveyed.
 * Other - Includes students and people who do not fit in to 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. However, other studies of self-help groups for people with serious mental illness found most of the members tend to be unemployed, while other's 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. The difference of 18% may indicate an increasing prevalence of hospitalizations, or it could be due to differences in the methods used to collect information in other studies. Grover's results may have been skewed lower as it was self-selecting survey data.


 * 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.


 * Depression (58%)
 * Anxiety (32%)
 * Fears (23%)
 * Problems in relationships (18%)
 * Psychosomatic pains (14%)
 * Confusion (13%)

 No desire to live (11%)  Inability to cope (9%)  Nervousness (7%)  Loneliness (6%)  Feelings of hopelessness (5%)  Hate (3%) 


 * 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.

Previous treatments
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, but should still give some relevant information on the profile of NAIL, EA, and EHA members.

Psychotherapies

Drugs taken Somatic therapies

Mexico City
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.

Processes

 * 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. This is not unlike when addicts "hit bottom" due to the consequences of substance abuse. The First Step of EA's program, in which members admit powerlessness over their emotions and that their lives have become unmanageable, is an acknowledgment that instead of trying to will away or "white-knuckle" through debilitating emotional states, the emotional suffer will instead try to focus improving their emotional health by changing what is more within their control. 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.

Effectiveness

 * For more details on this topic, see Self-help groups for mental health: Effectiveness

Research on Neurotics Anonymous groups in Mexico has been favorable. In Boydston's survey of NAIL members, when asked if they had received help through the program, 100% of those surveyed said "yes." Grover 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.

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 is 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.

Criticism

 * For more details on this topic, see Self-help groups for mental health: Criticism

Secular Humanist
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) do 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. It is likely they share an ignorance similar to those in the United States who held similar beliefs when X-ray technology was first introduced.

Increasing deviant stigma
Using the terminology of Howard S. Becker, Sargain notes that alcoholics and addicts are considered deviants because they are "so defined." Meaning chronic substance abuse is seen as a deviant, while being sober or "clean" is normal. For addicts and alcoholics, there is no gray area between being sober or clean and drinking, "using" or relapse. For an alcoholic or addict, joining AA or NA immediately reduces their deviant stigma, regardless of whether or not the alcoholic or addict believes it does.

Since, using the same terminology, there is no similar clear cut language to define the deviance of those in non-substance abuse related groups, joining such groups accomplishes the opposite of joining a group like AA or NA. In the act of joining they define themselves as deviant, and take on deviant 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. If stigma is a social force, as viewed by Erving Goffman, it 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. If not also 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.

It is worth noting that 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. Indeed, longterm membership in the AA program 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."

Literature
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 to working the EA program, and It Works If You Work It is a guide book explaining the Twelve Steps.

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.

The NAIL organizations in Brazil and Mexico use translations of the English literature as well as literature written by groups in their area.

Emotional Health Anonymous does not have their own literature, they use Alcoholics Anonymous and the Twelve Steps and Twelve Traditions.

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).