Chapter Three

As usual, at 8 a.m., I wandered past our nursing station, on the way to my office. The head nurse was already enthroned in her station, and there came from this important person a slightly derisive greeting.

“DOCtor TAber!” she cried. “Guess what the housekeeper killed in the patients' kitchen this morning?”

“A couple of hours, probably,” I suggested.

“A MOUSE!” she shrieked in triumph. “He whacked it with a broom and stomped it!”

“Wow! I guess we better write him up for cruelty to animals.”

“Taber,” she retorted, “This is serious stuff. We can't have mice on the unit. Your gamblers ordered in a pizza last night, and they left crumbs in the kitchen. No wonder we have mice.”

Why were they suddenly my gamblers? They only became our gamblers when a local newspaper or television station wanted to do a story about these curious specimens.

“Let's write a scientific paper,” I said. “Spontaneous generation of mice from pizza crumbs is big news. Might get us a Nobel.”

“Kid around all you want, Taber, but the Chief wants a meeting of all staff and patients in the day room at 3 p.m., to go over the rules for the patient kitchen. You need to be there.”

I stopped briefly in my office and checked the collection of phone slips and messages. Calls from gamblers and their families came in at all hours of the day and night; our gamblers came from all over the United States. A fellow could go on gambling for years, but when he finally decided to call for help he expected instant service from an admiring therapist. He expected us to be there to take the call whether it was Sunday morning or late on Friday night.

So the first step in our patients' treatment was to teach them not to expect miracles, or instant service. At their most desperate hour they had to learn to wait in line, and go about getting help in an organized way. They would learn that no one on the staff thought they were special, wonderful, and different, just because they were finally sick of gambling. There were no emergencies in this business, and if the gambler pulled the “Maybe I should just kill myself” threat, he was promptly referred to his nearest hospital emergency room, with the comment, “We do not admit suicidal people to this unit.” It was a cold but necessary truth.

I locked the office and continued down the hall to our conference room. As I approached, angry voices found their way under and around the heavy steel door that might have served well to stop a fire, but which provided little privacy. In old-style mental hospitals such as ours, the authorities viewed fire safety as more important than privacy. They may have been right.

We would start this new day on the Brecksville Gambling Treatment Program by holding an early morning conference with what are called, in mental health bafflegab, significant others. Years ago we talked about a patient's husband, wife, parent, or child. Significant others is the current dehumanized but politically correct term for just about anybody related to the case at hand.

Gathered in the conference room were the family and friends of Tom, a gambler who had not been invited to the meeting. These people, whose common bond was that they shared a part of their lives with Tom, had been asked to help plan an intervention. The intervention would eventually lead to a confrontation of Tom with the goal of getting him to admit his gambling problem and then enter our treatment program. This morning, the significant others would be getting ready to present a consistent and firm stand together, promising, as an inducement to get Tom to change, their own withdrawal from any further involvement in his life if he did not comply. Such family hardball is a risky, stressful business, and the tension in the room reflected it.

At the time, in planning an intervention, I was following standard procedures for working with addicted people. It was, and still is, not uncommon to use coercion to force a reluctant person into treatment. Today I think there may be better ways, but immediate gratification—getting someone into treatment—was then the rule.

Tom was a chronic gambler who would much rather not face what gambling was doing to his life and to the lives of everyone around him. He was a rascal: charming, talkative, witty, ruthless, lovable, impulsive, flirtatious, unreliable, manipulative, and risk-loving.

In spite of their surface charm and easy social confidence, people like Tom are so caught up in their own needs that they either cannot or will not see the pain they cause others. The guilt and remorse they might feel are overshadowed by the desire for immediate satisfaction of their own impulses. These are the kind of people you love to hate, and hate to love. By hiding their potential for harm under a camouflage of attractive and compelling surface colors, they create in others a conflict of emotions that may surface suddenly in those they encounter.

Controversy surrounds a person like Tom as his friends, using him as a kind of mirror, see first something they admire and next something they fear or despise. How could one personality contain such contrasting and frustrating combinations: charm and guile, intelligence and unreliability, generosity and self-centeredness, potential and poor delivery?

In spite of his absence at today’s gathering—or perhaps because of if—Tom was triggering an emotional storm between his family and closest friends. And we hadn't even begun the meeting! They were comparing notes for the first time, and coming to similar and shocking conclusions. Their memories of scenes and experiences in which Tom had played a central role were evoking once more the old feelings of love, hate, fear, admiration, concern, and hope.

Had Tom been present, things would most likely have gone very differently, because he would have used his charm, innocence, and wit to convince all these people that they were making a terrible mistake, that they really didn't understand him, that he really didn't need treatment, and that they should give him one more chance to prove himself.

What a shock it must have been to the group to find that Tom, who earned your trust almost without asking for it, had told the same lies to everybody he knew. Remember how he had said that you were the only one in whom he could really confide? He had told that to me, in fact, just 30 minutes into our first meeting.

Remember how he told you he had never borrowed money from any other friend? Now you find out how many confidants and lenders he really had on the string!

Without guidance this could turn into a lynching that would quickly lose sight of getting Tom to change.

I made my way around the table, shaking hands and trying to get names and relationships attached to faces. Everybody wanted to offer their own information, tell their own story, and ask their own questions. In the lives of each, something was definitely not going according to plan, and Tom was the common denominator. They were all much in need of a friendly ear. So, although we had work to do, I remarked that there seemed to be a need to explore the problem a bit. I warned the group that we would probably need two sessions to do our work. This one would be an orienting session, and the second would be for planning.

Also in the room was Amy, a graduate psychology intern working with me. She and I had done preliminary telephone work with each of the people present, and their common motto had seemed to be, “enough is enough”. So I invited the group members to take a few moments each to tell what they hoped to gain from this coming intervention.

Father was a kindly man with a meticulous haircut, gold glasses, an expensive blue suit, and a well-trimmed mustache. His speech was slow, with an undertone of anger. “I just want my son back,” he said, passionately staring down at the table.

As he continued, Father seemed to be blaming gambling itself for depriving his son out of his wits. Dad reminisced about the good times he and Tom had had together, fishing and going to Little League games. Now they were strangers. This gray and fading man in his 60s saw no evil in his son, and had given him money time after time, always in the simple faith that money was the solution. Dad seemed to be psychologically color-blind, unable to see his son's behavior and emotions as different from those of anyone else’s. He offered the usual false hope: “Let's just get the gambling stopped and the debts paid, then things will be fine again. I'm sure of that.”

Mother was blaming herself and trying to figure out where she had gone wrong, where she had failed her son. Gaunt, in a white flower-print dress, she was pale and tearful. She was clearly wrapped up in her own needs, her own feelings, and her own effort to salvage a little self-esteem. Like many parents, she saw her son as an extension of herself. Whatever he did reflected upon who she was and what she had done. She was unable to voice any personal needs other than a desire to have a son who reflected credit upon the family. She wanted the family to be a family again, and seemed to expect that each member should be willing to pay some unquestioned price to achieve that goal, without asking why.

As she spoke, I wondered to myself about the ultimate purpose of a family. Is it a means to an end—always in transition and always torn by change—or is it the real purpose for individual existence? Is there ever a real and stable balance between service to self and service to family? As usual, the individualist in me won, and I decided that family existed as a springboard for the individual. But that certainly is not how many people see it.

I wondered how much Mother really cared about her son's welfare. Will she be able and willing to let go of her own stuff and begin to understand the problem at a strategic level? Parents, unfortunately, sometimes base their own self-image and self-esteem on the behavior of their children. Some people have children just in the hope that the child will somehow complete their own unfinished personalities. Mother, I guessed, was one of these.

Tom's sister spoke next. Elly just wanted Tom to move out of her small home because by now she was fighting with her husband about supporting Tom, and her children were constantly upset by their parents' anger at their favorite uncle. As I listened to her statement I pondered what has long seemed to be an important observation: Gamblers usually get along better with children—at least for short periods—than with adults. Clearly Tom had the children wrapped around his finger, and they loved him. Children and gamblers seem to have a lot in common. I’m sure Tom felt affection toward them, although he would certainly never accept, or understand, the responsibilities of their parents.

Elly's attitude was so far the most practical, and I began to think that she would be a valuable ally in helping the others adopt a tough love position. She was caught between loyalty to a husband who wanted a normal family life, the needs of her children, and the pressure coming from her parents to help Tom.

The pastor of the family's church wanted Tom to return to the flock, where Tom had once been a choir member and Sunday school teacher.

“God solves all problems if you give Him a chance,” suggested the pastor, nodding and staring at me over his glasses. I sensed a rivalry that sometimes seems to enter relationships between mental health workers and the clergy. In a quiet way I was being called out, challenged to some ultimately unprofitable theoretical debate, the sort of argument I had learned to avoid. I nodded and smiled in return, knowing that, although I might phrase it differently, he was correct. We were going to be counting on some higher power, heavenly or earthly, to help us out. Beyond that, my limited theology could not stretch.

As he continued, it became clear that this man of the church actually believed that only the Devil could force a person to behave like Tom the Gambler and that only a divine miracle could save him. We all listened with respect; however, I thought, religion had not been not invented to stop gambling, or any other addiction. I suppose it was invented to offer hope to depressed, hopeless people in an effort to get them through a short and brutal life. But what does an agnostic know? Studies do not show a difference in gambling activity between church members and non-members. Pathological gambling is blind to race, culture, and religion; it is an equal opportunity disorder. There is no scientific evidence that religious activity cures any mental illness.

Bite your tongue, Taber! The house of psychology has a lot of glass in its walls, too.

Tom’s brother Hal wanted Tom to pay back the $10,000 that Hal had raised by taking a second mortgage on his home. The parents, it seems, had begged son Hal to, “Just help out this once and give Tom a second chance.”

A familiar pattern of parental enabling was emerging. Mom and Dad gave Tom advantages he had not earned, and they also protected and sheltered him from the consequences of his gambling, even at the expense of their other children. Thus they enabled him to continue his irresponsibility. It seemed that the more the other kids moved ahead in their own lives, the more they were obliged to help Tom; according to the parents, the worse Tom behaved the more he deserved their help.

Brother Hal had come to the meeting directly from his night-shift job at an automobile assembly plant. He was unshaven, with grease-stained hands, and wearing a tattered jumpsuit. He was about to be laid off, and was facing foreclosure on his home. Well, I told myself, don't expect Mom and Dad to be out begging anyone to help Hal. For some reason the family saw Hal and his sister Elly as strong, competent, and healthy. They would never need handouts. That would be a disgrace.

Curiously, and at the same time, in the eyes of the parents, it would be a disgrace for any of them to refuse to help Tom.

Families! We can sometimes understand what goes on in them, but don't ask for, or expect, logic.

Mr. Heskiss, Tom's boss at the terminal where Tom was a supervisor in the produce yards, just wanted Tom to put in 60 hours of good work each week. When Tom wasn't on the phone to his bookie he was hiding in a shed, listening to the radio to get race and sports news. When Tom actually worked he was the best there was, said Mr. Heskiss. Looking back on his own life of 12-hour work days and the good things hard work had provided for him and his family, Mr. Heskiss offered the opinion that if we could just convince Tom to put his mind completely on his job, things would all turn out well.

The Cleveland produce terminals have always been hotbeds of illegal gambling. Fresh produce is a risky, up-and-down business with grim work hours and harsh conditions. One of Mr. Heskiss’ suggestions was that we should help Tom ration his gambling, and get him to limit it to weekends like normal people. Nothing else was expected to change. Certainly not Tom's job in the produce yard, where gambling flourished, nor his glib personality.

Interesting thought, that a psychologist's job should be to help a client learn how to gamble in moderation. In fact, there are psychologists who believe in doing just that. They try to teach people to drink, smoke, use drugs, eat chocolate, or gamble in moderation. Abstinence, to them, is a form of defeat. Rationing seems to work for some, but I still don't understand what is so important about being able to be just a little bit indulgent. Abstinence, I think, is a more noble and reasonable path than playing Russian roulette with the true addict’s dangerous appetites. Suggestions for moderation and rationing may actually place the life of an addict at serious risk.

An unusual addition to our meeting was Tom's personal physician, whose attendance had been engineered by—who else? Mom and Dad, of course! Doc was tall, thin, and nervous. Apparently he was an old family friend. He acted as if he wanted to be someplace else, but he voiced concern about high blood pressure in his young patient. The doctor seemed to feel that if Tom got into a good physical conditioning program and took his medication regularly, the gambling could then be readily controlled.

In my experience, cardiovascular problems afflict about 30 percent of all chronic gamblers. It was unusual that Tom was getting medical attention since a gambler usually takes good health for granted and ignores problems until it’s too late. If the parents weren't running the show and looking out for his health, Tom would have been just like the rest of my advanced pathological gamblers, physically old beyond his years. As it was, Tom was 30 pounds overweight and smoked far too much.

We consistently see the solution to gambling problems from the perspective of our own experience! Here was a physician making suggestions that would no doubt be good for the health of anyone, gambler or not. I thought, however, that such a prescription would be futile as far as gambling was concerned. Little did I realize at the time that this physician, Dr. Fringe, would enter my life again in the future, long after Tom’s case had gone into the records.

 Get religion, ration your gambling, attend to your job, exercise regularly, eat a good diet, fix the family, take your pills—great advice, coming from all directions. But of course, none of it would stop the gambling, even if Tom accepted it.

Although I often talked with physicians on the phone, it was quite unusual for one to take time away from his office and get personally involved. Unfortunately, Dr. Fringe seemed uninterested in what the others were saying. He seemed confidant that he had a bottom-line answer, and offered his opinion that simple will power was lacking here. “Tom,” he said, “really ought to put his mind on acting like a responsible adult, and just leave gambling alone.” Nice bromides—true in concept, of course—but useless to someone suffering from pathological gambling.

And, although I could not agree more strongly with the doctor’s theories nor refute the minister's opinions, neither gentleman was specific about just how to achieve their respective goals. No prayer or ritual could guarantee God's intervention. No pill or shot could infuse the required will power into Tom's blood. Until the cure arrived, whether it was spiritual or physical, several lives lay in ruins. We were going to have to get started on our own cure, using ourselves as tools.

Like the mother, both the physician and the clergyman were unable to express any selfish, personal goals for this intervention. They saw the meeting simply as an opportunity to offer advice and solutions, not as a chance to explore their own feelings about gambling, about gamblers, or about Tom in particular.

Two of Tom's close friends from college were there, and I suspected they were spies for Tom, for he alone had suggested their names.

Olie and Reggie offered the same idea: “Help Tom moderate and control his gambling. We don't want him to turn into a dull, ordinary person. He's a great guy and we don't want to change that.”

Fortunately for our cause, both of the college friends finally admitted that Tom owed them substantial sums of money; they could be recruited to the goal of eliminating Tom's gambling completely only if that were the best way of getting their money back.

“Just stop the gambling and don't change another thing,” Olie said.

“He's a great guy and we don't want to change that,” Reggie agreed.

This seems to be a common wish for people involved with problem gamblers. Gamblers themselves usually voice this desire early in treatment. To me it was nonsense, but it seems to make a great deal of sense to some.

Sorry, folks. For pathological gambling to be treated, a host of things have to change, and the changes must come from within. In fact, you may not like the person very much after a year or two of successful treatment, and after some time in Gamblers Anonymous. Like it or not, if treatment works, the patient will be a very different person.

Later I would find better words with which to teach that information.

But now we were hearing from the girlfriend, the fiancée Gilda! She was slim, freckled, and blue-eyed. Her blond hair was braided and wrapped around her head like some Norwegian princess. She was a beautiful girl, but not very friendly to the others. She reinforced the mother's idea that somehow the parents had failed to love Tom enough, and she implied that once she and Tom were safely married, her love would correct any slight flaws in Tom's character. He would give up gambling for the love of Gilda!

“Good luck, Sweetheart,” I muttered to myself.

Love, indeed, is a powerful force. But love, like religion, wasn't designed to cure mental disorders. Love exists to help our species survive; such is my Darwinian guess. Besides, greater love hath no gambler than his love of the chase. Beautiful as Gilda was, she had taken on Lady Luck as a competitor, and that lady, to a gambler, is far more bewitching than Gilda could ever be, even in her finest negligee.

Sadly, most of the goals of the people at today’s meeting were either unrealistic or premature. Tom was going to be pretty much Tom even if he did stop gambling, and although these people had endured so much at his hands, not one of us could guarantee either a perfect Tom or a trouble-free life, even under the best of circumstances.

Father saw the problem as caused by gambling itself. Mother saw it as the result of parental failure. Sister Elly saw it as a problem of finding a suitable environment and a good living situation for her brother. The pastor saw the gambling as a result of a spiritual crisis and a lack of religious faith. The physician saw a need for more will power (but was unable to write a prescription to be filled at the local drug store). The boss thought we could solve the problem by banning radios and telephones from the loading docks and by rationing Tom's action. Friends Olie and Reggie started out wanting moderation and self-control, but ended up feeling like Tom needed their moral support and a more drastic personality change; perhaps they were the most realistic of all. And Gilda thought that pathological gambling was the result of a deficiency of love from a good woman, a commodity she was quite prepared to supply abundantly, if uncritically.

I happened to glance at my intern Amy, and she returned my glimpse with just a trace of a grin on her face. Like me, she appreciated the basic insanity of the world. We had heard all these misguided formulae for failure many times before.

Fortunately, to achieve a common front, total agreement was not required. It was not my job just now to change anyone's opinion or interpretation of things, only to get them to act firmly together in getting Tom into treatment. It is not so important that people agree on why a gambler should stop gambling; they only need to agree that he should. And I was always ready to make referrals if any one of these significant others wanted to get help in changing their own views of the world. But they hadn't come to me for therapy, so none would be offered.

When they had completed their individual statements, we talked at a very general level. Each person was, to some degree, able to see himself or herself as representative of a larger group of people affected by another's gambling.

Quite accidentally, we tapped a special source of information in the physician who turned out to be a student of philosophy and history. He mentioned that gambling problems had been recognized in ancient Hindu literature, and that some of the early Greek and Roman physicians had discussed the obsession to gamble. At that moment, I had a peculiar feeling that Dr. Fringe and I would meet again.

Now that a small measure of detachment and objectivity had been achieved and first angry passions spent, I brought them back to themselves again.

“Just for a moment now, let's look at ourselves,” I said. “Look what gambling has done to you, and none of you even gamble. Can you see how Tom's gambling has affected your feelings, thoughts, and actions? Do you really want to go on letting a gambler control your feelings and your life?”

Immediately there were five or six people talking and muttering all at once. Their eyes were temporarily away from Tom, and they were being asked again to focus on their own needs. They were uncomfortable with this. Now we were beginning to suggest possible changes in them when they had come in a good faith effort to change someone else.

However painful and vexing their own present problems might be, I wanted them to realize that others had faced the same issues—with varying degrees of success—many times before. And I wanted them to realize that Tom wasn't special or different from the thousands of problem gamblers who populate history. Most of all, I wanted them to get ready to make some drastic changes in how they dealt with Tom.

Our time was up. We scheduled a second meeting for a few days later. I then suggested, “Today happens to be my day to lecture our patients at 1 p.m. I'll be talking about the history and effects of gambling, so if any of you want to drop in you're certainly welcome. There’ll be about 30 of our alcoholism patients there, along with the six gamblers we have in treatment now. It might give you a better feel for our program.”

At my suggestion, the doctor, the minister, and the college friends agreed not to attend our second session, when the others would have to draw a line in the sand, so to speak.

After more discussion, the family became willing to gamble on detachment. They agreed eventually, and with many reservations, that if Tom did not accept the help available they’d detach their lives from his. What a difficult and scary thing this is for parents, sisters, lovers, and even employers, to decide to just let go of a problem like this! The family was so sure it was indispensable. It seemed an admission of personal powerlessness to acknowledge that Tom might be able to make important changes without them, with only the help of strangers and other gamblers like himself. But, they realized that their only real tools were self-interest and self-protection. Without these, they were no match for Tom. The record was clear on this.

This group was done for the day, but Tom's story goes on. Gilda later got a bit of special help from some of the wives in the local Gam-Anon group, a self-help group for the families of gamblers. They told her what it was like to be married to a pathological gambler. In time she became willing to put her marriage plans on hold until Tom finished treatment, until he proved that he sincerely wanted to stop gambling and would then do something about it!

The people who cared about Tom eventually did their jobs by explaining their limits to him in clear, firm language. He would ultimately enter treatment, where he began to look at himself and his behavior. Tom embarked on a long-term program of personal growth, and he owes a very great debt to all those people who had the caring and courage to be honest with him. He will not soon forget that rainy Friday afternoon one week later when, thinking he was coming for a private therapy session, he walked into our conference room and was confronted by a determined, well-prepared group of significant others. He rammed against a psychological stone wall of tough love through which he could find no openings. Nor could he soften their resolve, or find a way around it.