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Abstract

This article maps the entangled (re-)birth of pathological gambling as a medical issue in 1980s West Germany, exploring how self-help group members and ‘psy’ scientists negotiated expertise on excessive gambling behaviour. Taking into account transnational contacts and transfers, it argues that self-help groups played a crucial role in the construction of pathological gambling as an illness. First, the article shows how it was gamblers who – supported by transnational connections and media coverage – were a driving force in the pathologisation of their own behaviour by establishing ‘experiential expertise’ through self-help groups. Second, it demonstrates how professionals reinforced their authority of interpretation over the topic of excessive gambling against the backdrop of the already existing self-help movement by either rejecting or embracing the illness concept prevalent among Gamblers Anonymous. Finally, the article shows how, on the one hand, self-help groups relied on psy-knowledge and its producers, and how, on the other hand, the groups as well as the notion and practice of experiential expertise were integrated into professional therapies, thereby creating a fusion of experiential and scientific expertise into a larger therapeutic health system.

Keywords

addiction expertise Gamblers Anonymous gambling self-help groups

Introduction

In 1983, dubbed ‘Year of the Gambler’ by several psy-scientists at the time (see e.g. Hand and Kaunisto, 1984a: 1), West Germany witnessed a surge in scholarly and media preoccupation with the supposed addictiveness of gambling machines against the backdrop of the rapid growth of the gambling industry in the 1970s. The debate on pathological gambling in West Germany picked up right after slot machines were installed for the very first time in large, state-licensed casinos, which more than doubled in numbers from 13 in 1974 to 27 in 1980 (see Kummer and Kummer, 1986: 112–13), and restrictions were loosened on the number of machines allowed per commercially operated gambling hall, of which there were about 5,000 in 1983 (Deutsche Hauptstelle gegen die Suchtgefahren, 1988: 41). What initially brought the topic to the attention of first the media and then the scientific community was the publication of a psychological dissertation which was quickly picked up by the popular press (see e.g. Hand and Kaunisto, 1984a: 1). It was through media coverage of his thesis that Gerhard Meyer, the young psychologist who kick-started the gambling addiction debate, learned of the existence of several self-help groups at a time when no professional therapy programmes specifically for gamblers existed in Germany (Meyer, 1996: 5). The present article focuses on the role of these self-help groups in the construction of excessive gambling as an illness.

The aim of the article is to show how expertise was established in regard to pathological gambling in 1980s West Germany. Drawing on sociologist Thomasina Borkman’s concept, it argues that self-help group members both claimed and were attributed ‘experiential expertise’ – a new factor which the psy-scientific community had to confront when (re)claiming scientific expertise on the topic of excessive gambling. Writing about self-help groups in the United States (US) in the 1970s, Borkman argued that self-help group members acquired ‘experiential knowledge’, which would turn into ‘experiential expertise’ once collectively applied to a problem (Borkman, 1976: 446–7). Following Gil Eyal’s understanding of expertise as ‘neither … an attribution nor as a substantive skill but as a network’ (Eyal, 2013: 873), this article highlights the role of self-help groups within the emerging network of expertise regarding pathological gambling. The focus lies on the tension between claims of expertise based on subjective experience, on the one hand, and professionalism, on the other. By focusing on an emerging debate and field in 1980s West Germany, the present article looks at expertise ‘in the making’, when ‘alternative devices, actors, concepts, and arrangements are still viable candidates for formulating the problem or addressing it’ (ibid.: 871). As the case of the excessive gambling debate in 1980s West Germany shows, notions and assumptions of ‘objective’ science versus ‘subjective’ experience or of professional versus experiential knowledge were subjected to societal negotiation and historical change (see also Beaumont, Colpus, and Davidson, 2025: 5; Borkman, 1976: 448).

By focusing on the negotiation of expertise on pathological gambling in the case of West Germany, the article considers the role of bottom-up movements in the process of ‘making up people’ (Hacking, 1986) by medicalising deviant behaviour (Conrad and Schneider, 1992). Starting in the 1970s, the self-help movement gained prominence as part of the so-called ‘psycho-boom’, bringing about the diffusion and popularisation of psychological knowledge and therapeutic practices beyond the scientific community (Elberfeld, 2015: 80). The therapeutic sector that slowly emerged not only included established institutions of the healthcare system and welfare state but also the informal networks of the ‘alternative’ milieu, and was played not only by psychiatrists, psychologists, and psychotherapists but also by an increasing number of social workers, counsellors, and self-help groups (Elberfeld, 2019–2020: 146–7). The present article discusses the question of the extent to which self-help groups, as part of this growing therapeutic field, challenged the ‘relation between expert and client … structured by a hierarchy of wisdom’ described by sociologist Nikolas Rose (1991: 96). It will show that the expansion and diversification of the therapeutic field from the 1970s onwards allowed self-help groups to challenge the authority of psy-scientists and establish other social actors as ‘legitimate’ or socially recognised providers of help.

By considering the American origins of the self-help movement and continuing transnational connections, this article accounts for the role of knowledge transfer in constructing gambling as pathological behaviour. Originating in the US, self-help groups for alcoholics in Germany were first founded by the Order of Good Templars in the late 19^th century (Kofahl et al., 2016: 17). Especially from the mid-20^th century onwards, the concept and practice of self-help spread on both sides of the Iron Curtain (see Flora, Raftopoulos, and Pontikes, 2010: 217; Gabrhelík and Miovsky, 2009; Raikhel, 2016: Ch. 5; Söderfeldt, 2020: 60).¹ In West Germany, the Alcoholics Anonymous (AA) model was introduced by American soldiers in the 1950s (Kofahl et al., 2016: 20), and then served as the blueprint for the first German Gamblers Anonymous (GA) group founded in 1982 (see Fröhling, 1996: 8–12).²

Historical sources from within self-help groups founded in the 1980s are limited to a few official brochures, reports written by members, and documents that were kept privately by long-time members.³ Yet, by integrating reports on self-help groups from the media, psy-scientists, and the gambling industry, it is possible to draw a picture of their role in the making of pathological gambling. By bringing together these sources, the article first shows how gamblers were a driving force in the pathologisation of their own behaviour by organising in self-help groups before any other therapy programmes were available, and how they used connections to US-based groups and the West German media to establish experiential expertise and practice self-advocacy. Based on publications in a variety of scientific journals, it then demonstrates how psy-scientists, facing this growing sense of experiential expertise, reinforced their authority of interpretation over the topic of excessive gambling. Finally, the article traces how self-help groups related to scientific knowledge and professionals, discussing whether the idea of experiential expertise was in turn integrated into scientifically sanctioned therapeutic programmes established during the 1980s.

Establishing experiential expertise

This section traces how gamblers in 1980s West Germany claimed and gained agency on their own affliction – by organising in groups that stressed individual responsibility and experiential knowledge, by being publicly visible through media coverage, by advocating in public for the recognition of their problem as an illness, and by soliciting state support. It shows how transnational connections – particularly with the US – shaped the foundation of West German GA groups while the American traditions, rules, and practices were at the same time adapted to local contexts.

The core ideas underpinning the self-help model and the conceptualisation of addiction as a disease were imported from the US and provided the basis for experiential expertise, ‘which refers to competence or skill in handling or resolving a problem through the use of one’s own experience’ (Borkman, 1976: 447). All the foundational texts and traditions that were read out loud during each GA meeting and spread throughout the community had been sent to West Germany by the American branch after German gamblers reached out to them in the early 1980s (Fröhling, 1996: 10).⁴ They translated the materials into German but also adjusted the practices and texts: When they translated the ‘12 steps’ for the first time, for example, the members of the GA group in Hamburg decided to ditch the steps that related to God and only took over 10 steps to follow (ibid.). They therefore focused on the steps towards acknowledging their powerlessness over gambling and committing to personal change through honest self-examination, making amends for past harms, and maintaining ongoing self-awareness. They also committed to living by these principles daily and helping others who suffered from the same addiction. Later on, the other steps – asking members to use prayers and contemplation to establish a connection with and trust in God – were added once again while stressing that everyone should truly understand God however they wanted (ibid.).⁵ Groups also debated whether the US model was actually applicable to Germany since the gambling cultures differed in both countries (‘Verfall bei vollem Bewußtsein’, 1984, 23 April: 87). While the American gambling culture and discourse focused mainly on large casino resorts like the ones in Las Vegas and New Jersey (see McMillen, 1996: 275–81), in West Germany, it was especially the machines with lower stakes in easily accessible gambling halls that self-help group members viewed as problematic (see e.g. Bührmann, 1988: 33; Heimler, 1984, 29 August; ‘Neu: Selbsthilfegruppen gegen Automatenspiel’, 1982).

Although there were differences not only internationally but also within Germany in how people held meetings and which models they followed, the international roots were considered crucial, and international connections even gained importance once GA was established on both the local and national level. When the groups first met in the early 1980s, the focus was very much on establishing and stabilising local communities and on expanding the community to a national level by building on the materials and practices that had been developed in the US. The first national GA meeting in West Germany took place in 1984, but it seems to have been attended by only 20 members (Bellaire, 1987: 153). The national meeting in 1992 was attended by 130 people – some of whom came from Sweden and Canada, a fact that delighted members of the German GA.⁶ As late as 2006, the US-based GA approached the German GA groups for information on their history and development with the aim of showcasing the international dimensions of the GA movement.⁷ Later on, members of the German GA travelled especially to neighbouring countries to celebrate, for example, the 20^th anniversary of the Polish GA (‘Konferenz zum 20-jährigen Bestehen der GA-Polen’, 2014) or the 15^th anniversary of GA in Latvia (‘GA-Lettland', 2015).

What connected all these groups was a sense of self-responsibility based on the conception of excessive gambling as an addiction, ‘which can never be cured, but can be brought to a standstill’ (Anonyme Spieler e. V., 1990: 9), that was transmitted via the foundational texts provided by the groups based in the US.⁸ As Gerda Reith and Fiona Dobbie (2012: 519) have noted, being a ‘pathological gambler’ became ‘core to their sense of who they were’, and addiction, ‘an ontological state of being’. GA members considered their excessive gambling behaviour to be connected to ‘the relentless progression of sick attitudes towards life as a whole’ (Anonyme Spieler e. V., 1990: 9). They conceptualised pathological gambling as something that happened ‘within’ the person, which is why, according to their programme, each individual had to take responsibility and change their own behaviour: ‘Since we have something to do with the fact that we have become what we are, we can also take responsibility for a change of attitude – unconditional surrender is the only thing that can set a process of recovery in motion’ (ibid.). The idea of self-responsibility made the self-help concept attractive to many gamblers in the first place. Self-help group member Michael, for example, found it crucial for gamblers to ‘take the initiative and become active’ and ‘learn to give themselves rules’, since when gambling it seemed as though ‘the machine tells us what to do’ (Heimler, 1984, 29 August: 3).

While the theory of pathological gambling being an incurable addiction embedded in oneself was central for GA, just as AA, it was ‘not a theory-driven’ but ‘a fundamentally pragmatic organisation’ not so much based on ‘a set of beliefs but rather a set of practices’ (Valverde and White-Mair, 1999: 394) that can be characterised as ‘practices of the self’ (see Hofman, 2016: 9). GA was not meant to be ‘a solution’ but to offer a ‘programme of action’ for each individual to reach the central goal of abstinence (Anonyme Spieler e. V., 1990: 9). While GA members believed their affliction to be incurable, they meant to keep their illness at bay using the ‘twelve steps of recovery’ (see Ferentzy, Skinner, and Antze, 2006; May, 2001: 392). Self-help group member Ralf, who published his reflections on 17 years of GA in 2012, concluded that at that point, he still did not understand the true reasons for his excessive gambling behaviour but that understanding was no longer important to him: ‘For me today it is only crucial to know that I can no longer play. Never again’ (P., 2012: 39).

Embedded in the self-help concept was the idea of every individual being both ‘patient’ and ‘therapist’ (Sutter, 2014: 299) – but, especially in the ‘Anonymous’ movement, only in regard to themselves. The group members claimed not so much a form of ‘lay expertise’ as it was perceived by physicians at the time (Borelli and Bauerdorf, 1990: 15), but highly individualised experiential expertise which could also be called ‘self-expertise’ since it so heavily relied on both notions and practices of the self. Within the groups, it was considered crucial to recognise the singularity of each person: ‘No two lives, no two gamblers, are the same’ (P., 2012: 79). Their stance was that everyone had a ‘right’ to their own personal ‘journey to recovery’ which should not be judged or actively influenced by others (ibid.: 80). In meetings, which was the central practice of GA, everyone was asked to only speak of themselves and listen to others without interruption (Anonyme Spieler e. V., 1990: 23). The speaker could ask for up to three comments which should never contain criticism or advice but should merely shed light on someone else’s subjective experience (ibid.). Within the groups, experiential knowledge was the ‘primary source of truth’ – ‘a truth learned from personal experience with a phenomenon rather than truth acquired by discursive reasoning, observation, or reflection on information provided by others’ (Borkman, 1976: 446).

Although the focus on oneself was considered foundational to the self-help principle, the group setting was considered the indispensable basis for each individual journey to recovery. The groups served as spaces for the exchange of experiences and knowledge related to gambling addiction, and aimed at supporting others and fostering a form of collective experiential expertise. The groups were intended to provide resources – such as information, meeting spaces, shared practices, and a sense of community – to enable each individual to pursue their own path to recovery. According to long-time member Ralf, a GA saying went, ‘that in our meeting rooms … there is a large bowl full of experience and wisdom … I can take from it all that I need for myself and my recovery journey and put my own experiences into the bowl’ (P., 2012: 145). The groups were also prone to dysfunction, though; in practice, the proclaimed right to sharing experiences and a journey towards recovery without interruption or criticism could and would be curtailed at times: self-help group members, for example, complained about being ‘run over by “experts” in the group’ (Bellaire, 1988: 43), and about the lack of commitment of other members leading to the dysfunction and often disintegration of groups (see Claus, 2016).⁹

While the ideal of experiential expertise was inherent to the ‘Anonymous’ movement in general, in the case of gamblers’ self-help groups in 1980s West Germany, it was accompanied by self-advocacy and public visibility. This was a significant difference compared to the original US-based AA groups, which had served as a blueprint in so many ways but ‘refused to engage in political or social change, to lobby for or against legislation, or to participate in the public arena in any way’ (Valverde and White-Mair, 1999: 395). While AA members in the US were required to ‘remain anonymous, particularly in their relation to the media’ (ibid.: 401), GA was highly visible within the media – in West Germany as well as in the US (see Schmidt, 1999: 99–100, 105–6), pointing to a contrast in AA and GA on a transnational level. By presenting self-help groups as a useful source of information, support, and treatment, the media played a crucial role in strengthening the groups’ position within the emerging and contested network of expertise concerning the topic of excessive gambling. In 1990, the Association of Statutory Health Insurance Physicians (Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland) indeed noted the significant contribution of the media to the popularity of the self-help principle (Borelli and Bauerdorf, 1990: 22).¹⁰ Looking at how expertise on pathological gambling in 1980s West Germany was understood and construed, it becomes clear that expertise is relational. If ‘[e]xperts are primarily judged by clients, not necessarily by peers … and they rely on trust by their clients’ (Grundmann, 2017: 27), the media played a crucial role in establishing that trust in the self-help movement. They did not merely report on GA but actively participated in the pathologisation of gambling and the framing of experiential expertise.

Long-time GA member Thomas noted that media interest in the groups and the topic of gambling addiction more generally increased enormously during the 1980s.¹¹ Some journalists were actually directly involved with the groups. Ulla Fröhling, who had worked for the women’s magazine Brigitte for a long time before becoming a freelance journalist and author, contacted a gambler for an article and through this connection became the co-founder of one of the first self-help groups for gamblers in Hamburg in 1982 (Fröhling, 1996: 8–13). Martin Ahrends, who in 1984 successfully applied to leave East Berlin for Hamburg where he then worked at the newspaper DIE ZEIT, not only published on gambling addiction but was a member of various GA groups (Ahrends, 1988: 176). Self-help groups also actively sought out the media to spread the news of newly founded groups and to inform the public about how the groups worked. After the two founders of the GA group in Kassel, for example, informed newspapers about their existence, nine people showed up at the first meeting in 1983 (Heimler, 1984, 29 August: 3). Thomas, a member of the GA group in Lübeck, remembered how much their group grew after the television channel NDR filmed one of their meetings (without showing their faces).¹² The presence of the self-help groups in the media increased their recognition in the public eye – for example, self-help group members now were regularly invited to speak about pathological gambling and how to recover from it at schools.¹³

Alongside educating the public on the issue of excessive gambling and the self-help principles, a central goal of gamblers’ self-help groups in the 1980s was to influence gambling regulations and the health system. Right after the first few groups were founded in 1982, they started distributing leaflets on gambling addiction in gambling halls (Fröhling, 1996: 9). They described their goal as ‘to give politicians, doctors and the gambling industry a real piece of their mind’ and ‘to tell them what’s going on’.¹⁴ This form of self-advocacy was based on the conviction that ‘the most profound knowledge about gambling addiction could be obtained only from the addicts themselves’ (Fröhling, 1993: 12) since the gamblers were ‘the truly competent people’ when it came to their illness (ibid.: 20). From the outset, the groups publicly demanded recognition of their medical condition, support for the self-help principle, and consequences for gambling businesses – for example, at panel discussions organised by the gambling industry (‘Vorurteile schaffen Mißverständnisse', 1988) or political parties (‘Podiumsdiskussion in Bonn', 1989: 23). In 1983 and 1984, they also spoke at the annual conference of the Association of Addiction Aid Organisations (Deutsche Hauptstelle gegen die Suchtgefahren, DHS), where they defended their conceptualisation of excessive gambling as an illness, but felt ‘brushed off by official addiction experts’.¹⁵

While there is no evidence of direct exchanges with the American branch regarding public advocacy, Alan Collins attributes a comparable influence to the US-based GA: ‘GA was a force that asserted the existence of pathological gambling, construed it in a particular way and thrust it in the face of the professions that claimed an expertise most obviously relevant to the problem: medicine and the psy-sciences’ (Collins, 1996: 91). This suggests that while this form of self-advocacy had not been practiced by the original AA groups, it became a defining feature of GA groups due to broader transnational dynamics – namely, the expansion of the therapeutic field, intensified calls for patient participation, growing public interest in psychological and therapeutic discourse, and an influential mass media complex. Through their highly visible self-advocacy, gamblers in West Germany just like in the US became ‘a force in the construction of their own gambling as pathology’ (ibid.) and therefore played a crucial role in the process of ‘making up people’ (Hacking, 1986). This shows that the process of medicalisation in the late 20^th century was not necessarily characterised by ‘lay people’ drawing on published professional expertise (see Schmidt, 1999: 151), but by ‘lay people’ establishing a different kind of expertise. This led them to not being so much ‘lay people’ – a category that gains meaning only in relation to the professional – but organised, publicly visible experiential experts.

Regaining psy-expertise

This section examines how psy-scientists responded to the rise of gamblers’ self-help groups. While West German psy-scientists engaged with American research in order to (re)claim expertise over the topic of excessive gambling as disease, the discourse in 1980s West Germany took a distinct turn by splitting into two camps: one endorsed the so-called ‘addiction model’ and the illness concept promoted by self-help groups, while the other advocated for a ‘neurosis model’, rejecting, in particular, the notion of abstinence as the path to recovery. As this section will demonstrate, psy-scientists – regardless of which model they followed – were unable to ignore the illness concept already introduced by self-help groups when establishing scientific expertise on the topic.

In the early 1980s, psychiatrists, psychologists, psychotherapists, and social workers in West Germany perceived gamblers’ self-help groups first and foremost as the indication of a deficit in the professional health care system that needed to be addressed and fixed: ‘Self-help groups extend the range of treatment, but they cannot replace the expert system’, wrote Gerhard Meyer (1989: 230), the young psychologist who kick-started the whole gambling debate in Germany and who would spend his entire career focusing on pathological gambling and working closely with self-help groups. One social worker at an addiction counselling centre wrote that ‘gamblers should not be left alone with self-help – indispensable and irreplaceable as it is’, and concluded that ‘[t]he “professionals” are also called upon!’ (Lehmann, 1984: 4). To some professionals, the establishment of experiential expertise validated by the public was even more so viewed ‘as a radical challenge to their authority’ (Borkman, 1976: 453), which now had to be regained by scientifically defining the problem at hand. Speaking at the 1984 conference of the DHS, Iver Hand, a leading behavioural therapist from the Psychiatric and Neurological Clinic of the University of Hamburg, explicitly warned against a ‘surely well-intentioned solidarization of certain journalists or “experts” without therapeutic experience with gamblers’, and questioned the idea that ‘gamblers know best about gamblers and can therefore also help gamblers best’ (Struckmeier, 1984: 16). From his point of view, self-help groups had spread within a ‘therapeutic vacuum’ that now urgently had to be addressed and filled by professionals (Hand and Kaunisto, 1984b: 67).

The founding of increasing numbers of self-help groups, the publication of Gerhard Meyer’s dissertation, and the ensuing media echo in the early 1980s were the key catalysts for the West German academic community to engage with the topic of excessive gambling. Looking back at the debate, Meyer wrote in 1996 that it was the gamblers demanding treatment that ‘decisively drove the acceptance of excessive gambling behaviour as a disorder with pathological value’ (Meyer, 1996: 13). After the publication of his dissertation, articles by Meyer (and subsequently, others) on the topic of excessive gambling were first published in the official journal of the German Society for Addiction Research and Therapy, Suchtgefahren (see Meyer, 1983), which would go on to put out special issues on pathological gambling in 1987 and 1989, and in the general practitioners’ journal Ärztliche Praxis (see Meyer, 1984). The epidemiology, clinical picture, classification, and possible health policy measures were now also discussed in popular science journals such as Psychologie heute (starting with Milkman and Sunderwirth, 1984) or the medical journal for psychiatry and neurology Der Nervenarzt (starting with Kröber, 1985).

While the West German debate was influenced by developments in the US, where pathological gambling received increased attention during the same time period, leading, for example, to the establishment of the Journal of Gambling Behavior in 1985 (see Collins, 1996: 69, 74, 83; Schmidt, 1999: 133), German scientists were sceptical about a direct transfer of both research and classifications. The inclusion of pathological gambling in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) by the American Psychiatric Association (APA) in 1980 and later in the International Classification of Diseases (ICD-10) by the World Health Organization (WHO) in 1992 both reflected and increased its relevance within the psy-scientific discourse in the US as well as in West Germany. These classification systems contributed to the international standardisation of diagnoses and had a significant impact on the distribution of healthcare and social insurance benefits in Germany (see Keuck, 2019: 448–50).¹⁶ Psychiatrist Robert Custer, who was the first to treat gamblers in the US in the early 1970s and contributed to the diagnostic criteria established in the DSM-III, was also invited to West Germany multiple times; thus, American research did serve as an important point of reference within the West German discourse on pathological gambling (see e.g. Brengelmann and Waadt, 1985: VII). At the same time, West German psy-scientists were irritated by the very different terminology and illness concept used by American psy-scientists such as Custer, who usually spoke of ‘compulsive gambling’ (Schmidt, 1999: 73), while the German discourse primarily revolved around ‘gambling addiction’. West German psy-scientists emphasised that the insights gained abroad were not readily applicable to the context of the Federal Republic, argued for the necessity of generating practice-based knowledge specifically tailored to the characteristics of the ‘domestic patient population’, and stressed the need to consider the different gambling markets that were very much formed through national and federal legislation (see Bellaire, 1987: 146; Thamm, 1984: 46).¹⁷

The defining feature of the West German psy-scientific discourse and the resulting treatment approaches was their focus on excessive gambling as a form of non-substance-related addiction, whereas the APA (1980: 291–3) and WHO (1992: 364) had at this point categorised excessive gambling as an impulse control disorder. There is a crucial conceptual difference between behavioural addiction and impulse control disorder: While addiction suggests that gamblers are neurologically impaired and unable to resist gambling, rendering their behaviour uncontrollable, impulse control disorder frames gambling as a failure to resist urges due to personality flaws, implying that the behaviour is not uncontrollable but rather uncontrolled (Kaiser, 2022: 96). In West Germany, gamblers were most frequently treated on an outpatient basis by social workers, psychologists, and doctors working at already existing addiction counselling centres run by welfare associations, which so far had been focused on alcohol and drug addiction and now extended and adapted their scope and methods to include pathological gambling (see e.g. Düffort, 1986: 21–3; Weber-Hagedorn, 1991: 17).¹⁸ When defining addiction as less of a physical and more of a psychological dependency, excessive gambling behaviour due to the loss of control and the emotional dependency involved appeared to these psy-scientists to be most adequately described and treated as a non-substance-related addiction (see e.g. Kellermann, 1991; Kellermann and Meyer, 1989: 28–31). This conception validated and scientifically substantiated the disease model that gamblers’ self-help groups were already following.

However, the widespread classification of pathological gambling as an addiction in West Germany – and hence the endorsement of the concept self-help groups relied on – was also heavily criticised, especially by a group of psy-scientists with a background in psychiatry and behaviourism. Unlike in the US, where the use of different terms to describe pathological gambling (such as compulsion, impulse control disorder, and addiction) did not trigger any heated controversies (Collins, 1996: 72), in West Germany, a group of psychiatrists explicitly opposed the so-called ‘addiction model’ and contrasted it with a ‘neurosis model’. They viewed excessive gambling as a ‘neurotic attempt at conflict resolution’ and a learned behaviour whose specific function had to be investigated, rather than as an addiction and thereby an illness in its own right (see Brengelmann and Waadt, 1985: 116; Hand and Kaunisto, 1984a: 5). According to behavioural therapists Iver Hand and Eila Kaunisto, the ‘addiction model’ made gamblers appear as a ‘victim’ of the state and the gambling industry, and thus gave them no ‘opportunity to correct their actions and take responsibility’ (Hand and Kaunisto, 1984a: 1).¹⁹ Proponents of the ‘neurosis model’ deemed it important to block the ‘all too comfortable resort to illness as “fate”’ by opening the way ‘to self-responsible change in behaviour’ (Brengelmann and Waadt, 1985: 36), and proposed to shift attention from the gambling device towards the personality of the gambler. Johannes Brengelmann (1991: 281), head of the Psychology Department at the Max Planck Institute of Psychiatry in Munich, concluded that ‘abnormal gambling always presupposes an abnormal personality whose structure should be analysed instead of inventing a new addiction’. His and many of his colleagues’ criticism was primarily directed at the abstinence requirement that was crucial to the ‘addiction model’ on which self-help groups as well as many clinics and counselling centres relied. Proponents of the ‘neurosis model’ felt that self-help groups did not do much good by promoting the ‘wrong’ diagnosis and path to recovery (see Brengelmann and Waadt, 1985: 105).²⁰

The increasing domination of the ‘addiction model’ within professional therapy was partly due to the fact that gamblers who sought treatment had identified their affliction as an addiction from the outset. Regardless of the psy-scientific controversy on the classification of pathological gambling, the majority of gamblers who showed up at counselling centres and clinics were convinced that they were suffering from an addiction. The case of West Germany shows how gamblers actively identified, articulated, and lent authority to their condition (Reith, 2016: 195), and thereby influenced the psy-scientific reaction towards the issue at hand. While Iver Hand and Eila Kaunisto, who worked according to the ‘neurosis model’, advised to directly confront and reject gamblers’ view of their behaviour as an addiction during their initial interview at the clinic (Hand and Kaunisto, 1984a: 7), other psychotherapists concluded that since being addicted oftentimes became part of the gambler’s identity, this self-diagnosis had to be taken seriously during therapeutic treatment even if the concerned professional thought of pathological gambling as something other than an addiction (Heckmann, 1985: 38). The DHS emphasised that since ‘a large proportion of those affected experience themselves as addicted and expect a corresponding range of counselling and treatment services’, working with the ‘addiction model’ in professional therapy had proven to be most effective (Deutsche Hauptstelle gegen die Suchtgefahren, 1993: 297).²¹ The quickly emerging field of scientific expertise on the topic of pathological gambling therefore was not closed off from but rather shaped by the conceptions prevalent among those affected – either by integrating a critique of their illness concept or by incorporating their beliefs and practices into the professional therapeutic process.

Fusing expertises

This section analyses the relationship between gamblers’ self-help groups and the psy-scientific community, showing how both initiated and sought out cooperation while also maintaining their independence. It points to significant transnational shifts both in the self-help movement as well as the psy-scientific community that led self-help groups to become less ‘anti-scientific’ or ‘anti-professional’ while also prompting the therapeutic sector to become more receptive to self-help practices.

As Mariana Valverde and Kimberley White-Mair (1999: 397) have shown in the case of AA, the relationship between self-help groups and medicine was an ambivalent one. The case of GA was similar since by framing excessive gambling as a disease, GA ‘never was independent of previous ideas on addiction’ (Collins, 1996: 91), but at the same time challenged medical and psychological experts by claiming that ultimately the gambler’s subjective experience and individual action were crucial for both diagnosis and treatment. Looking at the US-based GA, Josh Rossol (2001: 334) found that ‘doctors and other medical personnel were identified [by self-help group members] neither as the most legitimate sources of knowledge nor as the group that could provide the best treatment’ and that ‘these roles were instead reserved for GA’. Statements by members of the West German GA support this finding. One member, for example, stressed that he would never have taken advice from a single person such as a therapist but ‘found hope’ with the group of people who ‘claimed to have the same “problem” as me’ (‘Das Weihwasser’, 2009: 10). Long-time member Ralf emphasised that the beauty and strength of the self-help principle lay in the absence of external directives typical of professional therapies: ‘Nobody drew up any therapy plans for me and evaluated them. Nobody forced me to do anything. Nobody judged me in any way. And nobody expected anything from me’ (P., 2012: 144).

Nevertheless, both in the US (see Reith, 2007: 45; Schmidt, 1999: 117–18) and West Germany, gamblers’ self-help groups did use psychological knowledge and findings to underpin their positions and demands, thereby validating professional expertise on excessive gambling behaviour. During one panel discussion, for example, members of self-help groups argued that gambling addiction was a disease by referring to Gerhard Meyer’s dissertation as well as to other scientific reports and positions by the WHO (‘Podiumsdiskussion in Bonn’, 1989: 23). Self-help groups also regularly pointed out the inclusion of pathological gambling in the DSM-III and worked with the diagnostic criteria established there (see Anonyme Spieler e. V., 1990: 13). In at least some groups, the ‘12 steps’, which were considered the guiding principles on the road to recovery, followed the so-called Herrenalb method (Anonyme Spieler e. V., 1990: 22–3) – a method that the psychiatrist and psychotherapist Walther H. Lechler had introduced in the early 1970s for treating alcoholics at the Psychosomatic Clinic Bad Herrenalb after he had become acquainted with the 12-step programme of AA in the US. Psy-scientists were also invited to meetings: While a ‘closed meeting’ was intended for gamblers only, ‘specialist speakers on the subject of gambling addiction’ could be invited to ‘open meetings’ (Anonyme Spieler e. V., 1990: 6; Heimler, 1984, 29 August: 3). GA member Michael’s wife, for example, organised several weekend seminars in the late 1980s, which were accompanied by therapists (Michael, 2020: 12–13). Another self-help group member contacted Walther H. Lechler, whose aforementioned Herrenalb method had already been integrated into GA practice, in order to establish a cooperation.²² Additionally, publications by the German GA frequently included contributions by psy-scientists, such as the psychologist Gerhard Meyer and the psychiatrist Bert Kellermann (see Anonyme Spieler e. V., 1996), whose views on pathological gambling as an addiction were compatible with the groups’ illness concept.²³

Since the involvement of professional expertise was a central concern of gamblers’ self-help groups, in this regard, they resembled West German diagnosis-specific patient associations that established the ‘patient’ as a medical actor in his or her own right by integrating themselves into the existing health system and closely cooperating with doctors (see Söderfeldt, 2020: 76–7, 85–6). But while for patient associations the transfer of medical knowledge to patients and the consolidation of medical expertise played a much more decisive role than the establishment of ‘lay knowledge’, experiential expertise retained the central role in GA groups and was seen to be merely supplemented by professional expertise. These self-help groups thus also fitted into the development of the ‘alternative’ self-help movement that emerged in the aftermath of 1968, and whose initial ‘anti-professional’ attitude changed over time into mutual recognition and appreciation of ‘professionals’ and ‘lay people’ (see Kofahl et al., 2016: 21–2; Sutter, 2014: 296–7; Trojan, Halves, and Wetendorf, 1986: 14–15).

While emancipation from ‘incapacitating expert rule’ was a central motive of the ‘alternative’ movement of the 1970s (Sutter, 2014: 297), gamblers’ self-help groups aimed not so much at the establishment of ‘counter-knowledge’ (see Reichardt, 2024; von Schwerin, 2022) but at the recognition of their knowledge and practices by psy-scientists. The experiential experts’ claims on knowledge called not so much for an alternative science but aimed at making gambling addiction plausible, thereby mobilising psy-scientific recognition and expertise. Even though their knowledge was mainly ‘justified by reference to the subjective experience of its members, not to either scientific logic or factual truths’, they certainly were not as ‘anti-scientific’ as Mariana Valverde and Kimberley White-Mair (1999: 399) have argued for AA. The ‘alleged antiprofessionalism in self-help groups’ should rather be ‘reconceptualized as the substitution of experiential authority for professional authority’ (Borkman, 1976: 452), which left room for cooperation and the possibility of mutual recognition and inclusion of both experiential and scientific expertise. This can be seen when looking at both the West German and US-based GA, which in 1972 founded the National Council on Compulsive Gambling, run and advised by professionals from different fields (Schmidt, 1999: 107). Since one objective of the groups was to medicalise their affliction in the first place, they were apparently more open towards the incorporation of professional expertise than other currents of the ‘Anonymous’ movement.

While the groups actively sought out doctors and scientists, it was also the professionals that sought contact with the growing self-help movement, thereby recognising self-help groups as important actors within the therapeutic field. At the 90^th German Medical Congress in 1987, the president of the German Medical Association called a ‘cooperation based on trust between the medical profession and self-help groups a crucial task’ that was to be taken seriously (Borelli and Bauerdorf, 1990: 29). Just like Borkman (1990) noted regarding medical self-help groups in the US, contacts between the groups and the professional health system in West Germany became increasingly established. GA groups in northern Germany, for example, started to attend information meetings at clinics four times a year and maintained ‘good contact’ with the addiction counselling centres of the welfare organisation Diakonie (‘Wir stellen uns vor’, 2009). Professionals also adopted knowledge from the self-help movement, thereby creating a network of therapeutic expertise based on mutual recognition, exchange, and cooperation. For example, an addiction counsellor in Berlin developed a guide for gamblers and their relatives in which he integrated a catalogue of questions and statements to indicate problematic gambling behaviour, which was a slightly modified version of the catalogue developed by the Hamburg GA groups (Düffort, 1986: 10).

Self-help groups also became an integral part of most therapy programmes designed for gamblers in both the US (see Schmidt, 1999: 114–16) and West Germany (see e.g. Aktion Glücksspiel, 1992; Schulte-Brandt, 1989: 45–6). Group therapies in general had become popular in the 1970s (see Elberfeld, 2019–2020), creating an openness towards the inclusion of the already existing self-help groups and their practice of meetings into professional therapeutic approaches. The ‘experience of solidarity among addicts’ seemed to counsellor Rainer Düffort a crucial contribution of self-help groups to the therapeutic effort: ‘The affected person sees his “path of suffering” in others’. Newcomers were supposed to take inspiration from ‘old-timers’ who were living proof of the possibility of reaching abstinence, while long-term members were thought to be at a lower risk of relapse due to being confronted with ‘those who are still acutely addicted’ (Düffort, 1986: 21–3). This is why the groups were perceived by many psy-scientists as a valuable addition to professional addiction treatment. At a clinic in the small North Frisian town of Bredstedt, for example, patients who were treated for gambling addiction were regularly driven to the meetings of the nearby Flensburg gamblers’ self-help group (Mazur, 1988: 17). GA member Ulrich, who was hospitalised due to excessive gambling in 1987, recalled that his therapist in the addiction ward regularly invited GA to info meetings at the clinic and made participation in GA meetings a compulsory part of therapy since he himself was ‘an AA who had already been sober for 25 years’ (Ulrich, 2014: 13).²⁴

The integration of the self-help groups’ knowledge and practices was accompanied by a more general shift towards recognising experiential expertise within certain branches of professional therapy, which, in the case of pathological gambling, was relying heavily on communicative and cooperative approaches and self-reports. The experiential dimension became pivotal in diagnosing and treating pathological gambling as an illness because, as an addiction, it was seen as crucially linked to the experience of losing control, which could not simply be observed by a second party but had to be reported by the affected subject him/herself (see Ferentzy and Turner, 2013: 66; Reith, 2004: 291). What can be seen when looking at the fusion of professional and self-therapy in the case of pathological gambling is a more general shift towards recognising that the knowledge and experience of those affected were crucial for identifying and treating their problematic behaviour (see Sutter, 2014: 296), and thereby acknowledging and supporting the idea of experiential knowledge that had been present within self-help groups all along. In 1979, special pedagogue Jörg Fengler noted in the popular scientific journal Psychologie heute that while it was nothing new that people ‘are best able to help themselves with many psychological problems’, what was new was the ‘systematic activation of these self-help skills in psychotherapy’: ‘The therapist is no longer an omniscient and omnipotent controller but only provides assistance’ (Fengler, 1979: 23). Based on such views of the patient–therapist relationship, psychologists and social workers following a person-centred therapeutic approach in working with gamblers stressed that therapy was meant to enable ‘the client to self-questioning, self-knowledge and improved self-acceptance’ (Bensel and Gauls, 2003: 89; Fröhling, 1984: 264–5). The therapist was meant to ‘grasp the inner world and subjective perception of the client’ while ‘[t]he expert regarding these experiences is the client himself’ (Bensel and Gauls, 2003: 90). This supports Borkman’s hypothesis ‘that professional reactions to experiential knowledge in self-help groups will be associated with the degree to which the professional’s model allows input of experiential knowledge’ (Borkman, 1976: 453).

Gamblers’ self-help groups not only gained recognition from large parts of the psy-scientific community but also state-authorised legitimacy, since state support for the self-help movement in general increased in the 1980s, with financial support being made statutory in the 2000s (see Elberfeld 2019–2020: 158; Kofahl et al., 2016: 22–3; Söderfeldt, 2020: 65–6; Sutter, 2014: 301). The self-help contact and information centres (‘Sekis’) that were established as part of these policies also helped to set up new self-help groups for gamblers (see ‘Wie Selbsthilfegruppen’, 1985: 88). By the late 1980s, there were around 60 GA groups as well as other self-help groups that followed different models, such as groups run by the German Caritas Association or the more secular ‘Gamblers Help Gamblers’ groups (Arenz-Greiving, 1989: 112–15).²⁵ Since the systematic financial support of self-help groups by the state was part of a health policy of cost reduction through prevention, a nationwide meeting of self-help groups in 1983 resolved to take a stand against being instrumentalised as ‘cheap labour’ within the healthcare system (Sutter, 2014: 301). This highlights the delicate balance between the desire for recognition and validation and the wish for independence and protection from co-optation by institutional structures that defined self-help groups such as GA during this time period.

Conclusion

By claiming that their subjective knowledge and skills were essential in diagnosing and treating their illness; reaching out to the media, politicians, gambling industry representatives, and scientists; and attending panel discussions and visiting schools, West German gamblers’ self-help groups questioned ‘the hierarchy of wisdom’ between ‘expert and client’ (Rose, 1991: 96). By fusing ‘expert’ and ‘client’ into one and by relying on the self and subjective experience as the basis of knowledge and behavioural change, these groups developed a form of experiential expertise. In their demand for public, political, and scientific recognition of their illness, they did not, however, reject science or psychology in principle but rather demanded co-determination in the making of a psycho-pathological phenomenon. The negotiation of pathological gambling was shaped less by a binary opposition between professionals and ‘lay people’ than by the evolution of a new field and network of expertise including experiential and scientific experts.

The growing public attention to self-help groups and a young psychologist’s doctoral research on the topic of gambling addiction combined with its inclusion in the DSM-III sparked an intensive debate within the West German psy-scientific community on the issue of how to classify and treat excessive gambling. This debate shows how the demand for specific forms of psychological knowledge and therapeutic treatment reflects the social conjuncture of values, fears, and perceptions of crisis (see Tändler and Jensen, 2012: 20–1). It was the pressure generated by the media and those affected, against the backdrop of a growing legalised gambling market and the international recognition of excessive gambling as a medical issue, that made the scientific examination of the topic of gambling addiction necessary in the first place. Although the scientific community was quick to (re)gain authority of interpretation over the topic by conducting scientific research and introducing professional treatment, the concepts of pathological gambling that self-help groups had established remained a crucial point of reference. Their conception of pathological gambling determined the direction scientific research would take in the years to follow and influenced how the scientifically sanctioned therapeutic programmes specifically designed for gamblers looked like.

When looking at the process of ‘making up people’ (Hacking, 1986), we must therefore take into account the role of bottom-up movements such as self-help groups. Certainly, the medicalisation of excessive gambling can be viewed as only ‘one small example of how the psy sciences produce new means of governing populations’ (Collins, 1996: 71). The case examined in this article, however, demonstrates how patients – in this case, gamblers – were a driving force in the pathologisation of their own behaviour. Nikolas Rose (1991: 90–1) described psychology as a ‘generous’ discipline, arguing that its power lies not in ‘exclusiveness and monopolization’ but in its openness and capacity to ‘infuse the practices of other social actors such as doctors, social workers, managers, nurses, even accountants’. As this article showed, psychological knowledge also infused the practices of ‘lay people’ – and allowed them to define themselves as patients in the first place. Indeed, self-help group members made themselves into ‘psychological objects’ rather than waiting for ‘the psychologist’s intervention’ without which, according to social psychologist Kurt Danziger (1993: 24), ‘these categories of people would not exist’. When talking about medicalisation, it is therefore crucial to look at how the psychological object came into being and what role those affected played. In the case of pathological gambling, they certainly did actively influence the making of an illness.

The making of pathological gambling in West Germany took place at a moment in time when the scope and set-up of the scientific community changed, making space for new actors, concepts, and therapeutic approaches. This led to experiential expertise establishing itself as a politically and professionally sanctioned part of the expanding therapeutic field. While the decline in moral arguments against gambling, the liberalisation of gambling markets, and changes in the psy-scientific conception of addiction were crucial for the medicalisation of gambling in the late 20^th century (see Collins, 1996), the role of gamblers within an expanding therapeutic field was equally important. By looking at the making of pathological gambling in 1980s West Germany, we are able to see the increasing fusion of the experiential expert and the scientific expert into a larger therapeutic health system.

The emergence of pathological gambling as a diagnosis was closely tied to transnational knowledge transfers between West Germany and the US – both within the self-help movement and among psy-scientific communities. These exchanges fostered parallel developments, such as the use of similar texts and practices in GA meetings and the psycho-medical codification of excessive gambling as a form of illness. A particularly notable similarity between West German and US-based GA lies in their public visibility and advocacy, which marked a departure from the more discreet model established by AA. Whereas AA found it crucial to distance itself from the earlier temperance movement and therefore actively refused to participate in public debates (Valverde and White-Mair, 1999: 395–6), GA’s primary concern lay in securing recognition both for excessive gambling as an affliction and for their diagnosis-specific self-help practices. From the 1980s onwards, the increasing institutional integration of self-help into therapeutic infrastructures marked a decisive transnational shift on both sides of the Atlantic. At the same time, the adaptation of circulating knowledge to local contexts led to important differences: in West Germany, for instance, religious elements were integrated into GA groups only with delay, and psy-scientific debates about whether excessive gambling could be classified as an addiction were particularly heated. The outlined convergences and divergences could provide promising starting points for further comparative inquiry into self-help groups and their conceptions of illness, self, and knowledge within changing networks of expertise.

Footnotes

Acknowledgements

I want to thank Martin Herrnstadt, Fritz Kusch, Fabienne Müller, Laura Nys, Avner Ofrath, and Cornelius Torp as well as the two anonymous reviewers and the editors of the special issue for their thoughtful comments and feedback on earlier versions of this article.

ORCID iD

Sophia Gröschel

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), project no. 526389960.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Notes

Author biography

Sophia Gröschel is a doctoral candidate and Teaching Associate at the University of Bremen, Germany. She studied history at the Freie Universität Berlin and the University of Limerick. Her doctoral thesis explores the history of gambling as a history of emotions drawing on the example of West Germany, 1945–2020.

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Negotiating scientific and experiential expertise: Pathological gambling in the making in 1980s West Germany

Abstract

Keywords

Introduction

Establishing experiential expertise

Regaining psy-expertise

Fusing expertises

Conclusion

Footnotes

Acknowledgements

ORCID iD

Funding

Declaration of conflicting interests

Notes

Author biography

References