an incident he found singularly disturbing, though it was a good while before he figured out its meaning. What the man had said was: ‘You know his future, don’t you?’ to which the teacher replied: ‘I don’t think you can be sure about that at the age of seventeen.’
As the party travelled from Paris to Venice, Milan and Montreux, Tom kept up his cheerful letters home, describing mountains, castles and the places where he swam. He never mentioned his fears, though by the time the tour reached the Rhine he was certain he was going crazy. The phobia, as he explained it later, involved the sense that ‘the process of thought was a terrifyingly complex mystery of human life’. Things came to a head in a cathedral in Cologne. He knelt down and began to pray. The rest of the party left. Light was flooding in through the stained glass windows in coloured shafts. Then something miraculous occurred. He had the uncanny sense of being touched by a hand: ‘and at the instant of that touch the phobia was lifted away as lightly as a snowflake though it had weighed on my head like a skull-breaking block of iron’. A religious boy, he was certain he’d experienced the hand of Christ.
For a week he was very happy, and then in Amsterdam the phobia returned. This time, he chased it away almost immediately by composing a poem on the comforts of remembering one is only an individual in a crowd of equally complex beings. The poem itself is barely more than doggerel (‘I hear their laughter and their sighs, / I look into their myriad eyes’), but the experience was pivotal. In Memoirs, he reflected on how important this recognition of being part of a collective was, not just for his own but for any attempt to achieve balance of mind: ‘that recognition of being a member of multiple humanity with its multiple needs, problems and emotions, not a unique creature but one, only one among the multitude of its fellows’.
It was a useful insight. Tom Williams, soon to become Tennessee, would suffer lifelong from moods of terror. Many of the ways he found of medicating and soothing himself were toxic, among them his relationship with alcohol. But discovering that he could dissolve anxiety by looking outward didn’t just save his sanity. It also alerted him to the importance of empathy, that cardinal virtue of the playwright.
I lay awake most of that first night at the Elysée, dreaming in a small window of sleep of a cat with raspberries tangled in its fur. The next morning I had two unprecedented appointments. The first was to visit a psychiatrist and the second was to attend an AA meeting. My cab driver had only just arrived in the city too, and together we muddled out a route to St. Luke’s-Roosevelt Hospital on 10th Avenue and 58th Street. The Addiction Institute was on the ninth floor, down a run of corridors that seemed to spiral inward like a snail’s shell. By the time I was ushered into the director’s office I was thoroughly disorientated. I thought I was deep inside the building and the presence of a window startled me. The books were arranged according to colour, lavender to violet, turquoise to green; a buttress assembled in praise of order.
Back in the day, the Addiction Institute was called the Smithers Alcohol Treatment and Training Center. It’s where John Cheever and Truman Capote went to dry out, though only the former was successful in his labours. At that point, in the spring of 1975, it was located in a brownstone at 56 East 93rd Street. ‘The house is palatial and not at all shabby,’ Cheever wrote in a letter during his voluntary incarceration. ‘The tenants are forty-two drug addicts and clinical alcoholics.’ He shared his room with a con man, a ballet dancer, a sailor and the owner of an unsuccessful German deli, who talked in his sleep, asking all night long: ‘Haff you been taken care of? Haff you been waited on?’ He was intensely miserable (hardly the place for such a distinguished Yankee as a Cheevah) and complained vociferously throughout his twenty-eight-day internment, but it got him sober and in all probability also saved his life.
In order to understand how an intelligent man could end up in such a place, it’s necessary first to know what a shot of Smirnoff or Scotch does to the human body. Alcohol, also known as ethanol, is both an intoxicant and a central nervous depressant, with an immensely complex effect upon the brain. In simple terms, it works by interfering with the activity of neurotransmitters, the chemicals by which the nervous system relays information around the body. Its effects can be divided into two categories. Alcohol activates the pleasure-reward pathways by way of dopamine and serotonin. In psychological terms this effect is known as positive reinforcement, since continuing to ingest the substance leads to pleasure.
But alcohol also works by way of negative reinforcement. In the brain, there are two types of neurotransmitters: inhibitory and excitatory. Inhibitory neurotransmitters depress activity in the central nervous system, while excitatory neurotransmitters stimulate it. When alcohol is ingested, it interacts with the receptor sites of an inhibitory neurotransmitter called gamma-aminobutyric acid or GABA, mimicking its effects. The result is sedative, reducing activity in the brain. In addition, alcohol blocks the receptor sites of an excitatory neurotransmitter: N-methyl-D-aspartate or NMDA (a subset of glutamate, the major excitatory neurotransmitter), preventing its activity. This also causes a reduction in excitation, albeit by a different route.
These sedative effects are what makes alcohol so adept at reducing tension and anxiety. Both positive and negative reinforcement drive alcoholism, but as the addiction progresses it is negative reinforcement that tends to take the larger role. ‘The click’, Brick calls it in Cat on a Hot Tin Roof. ‘This click that I get in my head that makes me peaceful. I got to drink till I get it. It’s just a mechanical thing . . . I just haven’t got the right level of alcohol in my bloodstream yet.’
The realisation that alcohol is capable of alleviating anxiety means that for susceptible individuals it can quickly become the preferred method of managing stress. There’s more than a hint of this in a letter John Cheever wrote about an early experiment with drinking. Intimidated by a social gathering, he discovered alcohol’s powerful knack for obliterating nerves. ‘The next engagement that threatened to arouse my shyness,’ he wrote, ‘I bought a bottle of gin and drank four fingers neat. The company was brilliant, chatty and urbane and so was I.’ In Memoirs, Tennessee Williams takes up the same refrain, noting that after a mezzo-litro of Frascati, ‘you felt as if a new kind of blood had been transfused into your arteries, a blood that swept away all anxiety and all tension for a while, and for a while is the stuff that dreams are made of’.
For a while. The problem is that over time the brain begins to adjust to the presence of alcohol, compensating for its effects on the central nervous system. In particular, it increases the production of excitatory neurotransmitters, so that normal activity can be maintained. This neuroadaptation is what drives addiction, eventually making the drinker require alcohol in order to function at all.
In the current edition of the Diagnostic and Statistical Manual of Mental Disorders (known universally as DSM-IV-TR), alcohol dependence is categorised as a form of substance dependence, which is defined as:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1.Tolerance, as defined by either of the following:
–A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
–Markedly diminished effect with continued use of the same amount of the substance.
2.Withdrawal, as manifested by either of the following:
–The characteristic withdrawal syndrome for the substance.
–The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
3.The substance is often taken in larger amounts or over a longer period than was intended.
4.There
