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.
Everyone’s access to the truth is mediated by fear. Some people’s fear was just severe enough to functionally lock the door. Being constitutionally incapable of honesty is true. It just isn’t permanent.
For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope. – Jeremiah 29:11
We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain – Hebrews 6:19
and hope does not put us to shame, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us. – Romans 5:5
Now faith is the assurance of things hoped for, the conviction of things not seen. – Hebrews 11:1
May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope. – Romans 15:13
Blessed be the God and Father of our Lord Jesus Christ! According to his great mercy, he has caused us to be born again to a living hope through the resurrection of Jesus Christ from the dead – 1 Peter 1:3
Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation – Psalm 42:5
and in his name the Gentiles will hope. – Matthew 12:21
Rejoice in hope, be patient in tribulation, be constant in prayer. – Romans 12:12
So now faith, hope, and love abide, these three; but the greatest of these is love. – 1 Corinthians 13:13
May integrity and uprightness preserve me, for I wait for you. – Psalm 25:21
Be strong, and let your heart take courage, all you who wait for the Lord! – Psalm 31:24
For God alone, O my soul, wait in silence, for my hope is from him. – Psalm 62:5
And now, O Lord, for what do I wait? My hope is in you. – Psalm 39:7
But I will hope continually and will praise you yet more and more. – Psalm 71:14
Hope deferred makes the heart sick, but a desire fulfilled is a tree of life. – Proverbs 13:12
Behold, the eye of the Lord is on those who fear him, on those who hope in his steadfast love – Psalm 33:18
Since we have such a hope, we are very bold – 2 Corinthians 3:12
having a hope in God, which these men themselves accept, that there will be a resurrection of both the just and the unjust. – Acts 24:15
For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope. – Romans 15:4
Where then is my hope? Who will see my hope? – Job 17:15
For in this hope we were saved. Now hope that is seen is not hope. For who hopes for what he sees? – Romans 8:24
And endurance produces character, and character produces hope – Romans 5:4
In hope he believed against hope, that he should become the father of many nations, as he had been told, “So shall your offspring be.” – Romans 4:18
To which our twelve tribes hope to attain, as they earnestly worship night and day. And for this hope I am accused by Jews, O king! – Acts 26:7