Changing Constitution

Constitutionally Incapable

In Alcoholics Anonymous (AA), the phrase “constitutionally incapable” uses the physical and psychological definition of “constitution” to describe a person’s deep-seated, baseline nature.

What it Means in AA Context

  • Deeply Engrained Nature: It refers to an individual’s fundamental psychological makeup, temperament, and character structure.
  • Not a Moral Flaw: The text explicitly notes these individuals are “not at fault,” meaning it is viewed as an inherent trait or an extreme defensive structure rather than a conscious choice to lie.
  • Inability to Self-Examine: In this context, the physical/mental makeup is so blocked by severe denial, delusion, or ego defenses that the person cannot accurately see the truth about their own life.
  • The Barrier to Recovery: Because the AA program relies entirely on a baseline of “rigorous honesty” to work, a physical or mental makeup that cannot practice self-honesty makes recovery statistically “less than average.”

The Modern Psychological Equivalent

While written in 1939 using the language of that era, modern recovery groups and psychologists often translate this “constitutional” makeup into contemporary terms:

  • Severe Personality Disorders: Conditions like antisocial or narcissistic personality structures where pathological lying or extreme denial is a core defense mechanism.
  • Anosognosia: A neurological condition where a person is genuinely unaware of their own mental health condition or illness.
  • Terminal Denial: A state of mind where the ego protects itself by completely blocking out reality, making the person literally unable to see their own truth.

Grave Mental And Emotional Disorders

1. In Modern Medical Terms

While the Big Book uses 1930s language, today the community and medical professionals map “grave disorders” to conditions like:

  • Severe Mood Disorders: Major depressive disorder, clinical depression, or treatment-resistant anxiety.
  • Bipolar Disorder: Extreme shifts in mood, energy, and activity levels.
  • Personality Disorders: Conditions like Borderline Personality Disorder (BPD) or Antisocial Personality Disorder.
  • Psychotic Disorders: Schizophrenia or other conditions causing a detachment from reality.
  • Complex Trauma & PTSD: Deep emotional wounds, often from childhood, that severely impair emotional regulation.

2. In Historical AA Context

Bill Wilson himself suffered from grave, clinical depression that plagued him for decades, even during long-term sobriety. The early members also encountered people with “wet brain” (Wernicke-Korsakoff syndrome), severe paranoia, and deep emotional instability caused by years of heavy drinking or underlying trauma.

Why the Big Book Includes This Distinction

The inclusion of this sentence on page 58 serves an intentional, dual purpose:

  • An Message of Hope: The text emphasizes that “many of them do recover if they have the capacity to be honest.” It explicitly states that having a psychiatric illness or severe emotional damage does not disqualify you from getting sober.
  • Honesty is the Sole Qualifier: It draws a sharp line between a mental illness and a lack of honesty. A person can be deeply depressed, traumatized, or suffering from bipolar disorder, but if they can tell the truth about their drinking and their life, the 12 Steps can still work for them.
  • Destigmatizing Mental Health: It was a revolutionary statement for 1939. It separated moral failure or psychological weakness from the medical reality of mental illness, offering a place in AA to those whom society had entirely written off.