Editorial Comment 5/12/20: The Janus-faces of enablement

It’s not so true that the COVID-19 pandemic confinement orders create more free time, as that they oblige even more time than usual, in front of a computer.  So it has been that I find myself off on tangents of exploration, seeking the trails of topics and people, night after night.  

I had shamefully allowed myself to fall out of touch with a friend and mentor of over three decades, T. K. Schultz, MD, “Terry”, who with Allan Graham, Richard Ries, and Bonnie Wilford had edited two editions of The Principles of Addiction Medicine.  A regular at ASAM conferences until recent years, he seemed to have disappeared.  His friend and colleague Allan clarified why this was so, and put through a gentle call to Joanne, Terry’s wife, to confirm.  He died some months later.  [https://www.dignitymemorial.com/obituaries/aurora-co/terry-schultz-8898064]

…By 1986, after a year of abstinence and having returned to emergency medicine, I attended one of several conferences that Terry hosted in Hawaii, the Pacific Institute for Chemical Dependence.  We met, I was gradually befriended by him, and after a time was encouraged to work for him.  This required that I return to active Naval service to fill an existing but vacant billet, in the Tri-services Alcoholism Recovery Facility (TRISARF) that he had founded at Tripler Army Medical Center, Hawai`i. 

I yearned for the job.  And I carefully explained the many obstacles to this, why it could not possibly happen, that officers with a history such as mine were never resurrected.  It was a fantasy; and only his complete imperviousness to my perfectly rational objections compelled my persistence.

So it was that, in 1988, I was uniformed and working as TRISARF Medical Director, with little more to commend me than a medical degree and a personal clinical trial in the clinical and social consequences of alcohol addiction.  Clinical, social, and financial consequences. When Terry stopped in to tell me yet another (or yet again) one of his store of insufferably juvenile jokes – jokes which, probably in the telling, were always strangely very funny -  he learned of my indebtedness, the sort of shaming debt  that is a hallmark of the disease.  And having no reason to trust my future solvency or reliability, he immediately offered to cover my debt.

It was a loan that I didn’t accept, an offer that ultimately proved unnecessary beyond its moral value:  Terry strongly and effectively showed faith in my capacities beyond my own faith, and that saw me through.  Terry knew alcoholism, he knew physicians and soldiers and airmen and sailors and Marines; and he recognized that sometimes the doctor has to get into the trench with the patient, and incur a risk.  This account is pretty pedestrian, it is the kind of story that we not uncommonly hear in this field and which may represent a trespass into the realm of enablement.   But as I read through the citation below, relating to Dr. Leigh Sundem’s memorial fund, it suggests that there are both pejorative and honorable uses of the term, “enablement.”

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM