The Doctors Opinion [Page xxiii - xxx]
We of Alcoholics Anonymous believe that the reader will be interested in
the medical estimate of the plan of recovery described in this book.
Convincing testimony must surely come from medical men who have had
experience with the sufferings of our members and have witnessed our
return to health. A well-known doctor, chief physician at a nationally
prominent hospital specializing in alcoholic and drug addiction, gave
Alcoholics Anonymous this letter:
To Whom It May Concern:
I have specialized in the treatment if alcoholism for many years.
In late 1934 I attended a patient who, though he had been a competent
businessman of good earning capacity, was an alcoholic of a type I had
come to regard as hopeless.
In the course of his third treatment he acquired certain ideas concerning
a possible means of recovery. As part of his rehabilitation he commenced
to present his conceptions to other alcoholics, impressing upon them that
they must do likewise with still others. This has become the basis of a
rapidly growing fellowship of these men and their families. This man and
over one hundred others appear to have recovered.
I personally know scores of cases who were of the type with whom other
methods had failed completely. These facts appear to be of extreme
medical importance; because of the extraordinary possibilities of rapid
[page xxiii] growth inherent in this group they may mark a new epoch in
the annals of alcoholism. These men may well have a remedy for thousands
of such situations.
You may rely absolutely on anything they say about themselves.
Very truly yours,
William D. Silkworth, M.D.
The physician who, at our request, gave us this letter, has been kind
enough to enlarge upon his views in another statement which follows. In
this statement he confirms what we who have suffered alcoholic torture
must believe -- that the body of the alcoholic is quite as abnormal as
his mind. It did not satisfy us to be told that we could not control our
drinking just because we were maladjusted to life, that we were in full
flight from reality, or were outright mental defectives. These things
were true to some extent, in fact, to a considerable extent with some of
us. But we are sure that our bodies were sickened as well. In our belief,
any picture of the alcoholic which leaves out this physical factor is
incomplete.
The doctor's theory that we have an allergy to alcohol interests us. As
laymen, our opinion as to its soundness may, of course, mean little. But
as ex-problem drinkers, we can say that his explanation makes good sense.
It explains many things for which we cannot otherwise account. Though we
work out our solutions on the spiritual as well as an altruistic plane,
we favor hospitalization for the alcoholic who is very jittery or
befogged. More often than not, it is imperative that a man's brain be
cleared before he is approached, as he has then a better [page xxiv]
chance of understanding and accepting what we have to offer.
The Doctor writes:
The subject presented in this book seems to me to be of paramount
importance to those afflicted with alcoholic addiction.
I say this after many years' experience as Medical Director of one of the
oldest hospitals in the country treating alcoholic and drug addiction.
There was, therefore, a sense of real satisfaction when I was asked to
contribute a few words on a subject which is covered in such masterly
detail in these pages.
We doctors have realized for a long time that some form of moral
psychology was of urgent importance to alcoholics, but its application
presented difficulties beyond our conception. What with our ultra-modern
standards, our scientific approach to everything, we are perhaps not well
equipped to apply the powers of good that lie outside our synthetic
knowledge. Many years ago one of the leading contributors to this book
came under our care in this hospital and while here he acquired some
ideas which he put into practical application at once.
Later, he requested the privilege of being allowed to tell his story to
other patients here and with some misgiving, we consented. The cases we
have followed through have been most interesting: in fact, many of them
are amazing. The unselfishness of these men as we have come to know them,
the entire absence of profit motive, and their community spirit, is
indeed inspiring to one who has labored long and wearily in this
alcoholic field. They believe in themselves, and still more in the Power
which pulls chronic alcoholics back from the gates of death.
Of course an alcoholic ought to be freed from his physical [page xxv]
craving for liquor, and this often requires a definite hospital
procedure, before psychological measures can be of maximum benefit.
We believe, and so suggested a few years ago, that the action of alcohol
on these chronic alcoholics is a manifestation of an allergy; that the
phenomenon of craving is limited to this class and never occurs in the
average temperate drinker. These allergic types can never safely use
alcohol in any form at all; and once having formed the habit and found
they cannot break it, once having lost their self-confidence, their
reliance upon things human, their problems pile up on them and become
astonishingly difficult to solve.
Frothy emotional appeal seldom suffices. The message which can interest
and hold these alcoholic people must have depth and weight. In nearly all
cases, their ideals must be grounded in a power greater than themselves,
if they are to re-create their lives.
If any fell that as psychiatrists directing a hospital for alcoholics we
appear somewhat sentimental, let them stand with us a while on the firing
line, see the tragedies, the despairing wives, the little children; let
the solving of these problems become a part of their daily work, and even
of their sleeping moments, and the most cynical will not wonder that we
have accepted and encouraged this movement. We feel, after many years if
experience, that we have found nothing which has contributed more to the
rehabilitation of these men than the altruistic movement now growing up
among them.
Men and women drink essentially because they like the effect produced by
alcohol. The sensation is so elusive that, while they admit it is
injurious, they cannot after a time differentiate the true from the
false. To them, their alcoholic life seems the only normal one. They are
restless, irritable and discontented, unless they can again experience
[page xxvi] the sense of ease and comfort which comes at once by taking a
few drinks -- drinks which they see others taking with impunity. After
they have succumbed to the desire again, as so many do, and the
phenomenon of craving develops, they pass through the well-known stages
of a spree, emerging remorseful, with a firm resolution not to drink
again. This is repeated over and over, and unless this person can
experience an entire psychic change there is very little hope of his
recovery.
On the other hand -- and strange as this may seem to those who do not
understand -- once a psychic change has occurred, the very same person
who seemed doomed, who had so many problems he despaired of ever solving
them, suddenly finds himself easily able to control his desire for
alcohol, the only effort necessary being that required to follow a few
simple rules.
Men have cried out to me in sincere and despairing appeal: "Doctor, I
cannot go on like this! I have everything to live for! I must stop, but I
cannot! You must help me!"
Faced with this problem, if a doctor is honest with himself, he must
sometimes feel his own inadequacy. Although he gives all that is in him,
it often is not enough. One feels that something more than human power is
needed to produce the essential psychic change. Though the aggregate of
recoveries resulting from psychiatric effort is considerable, we
physicians must admit we have made little impression upon the problem as
a whole. Many types do not respond to the ordinary psychological approach.
I do not hold with those who believe that alcoholism is entirely a
problem of mental control. I have had many men who had, for example,
worked a period of months on some problem or business deal which was to
be settled on a certain date, favorably to them. They took a drink a day
or so prior to the date, and then the phenomenon of craving at once
became paramount to all other interests so that the [page xxvii]
important appointment was not met. These men were not drinking to escape;
they were drinking to overcome a craving beyond their mental control.
There are many situations which arise out of the phenomenon of craving
which cause men to make the supreme sacrifice rather then continue to
fight.
The classification of alcoholics seems most difficult, and in much detail
is outside the scope of this book. There are, of course, the psychopaths
who are emotionally unstable. We are all familiar with this type. They
are always "going on the wagon for keeps." They are over- remorseful and
make many resolutions, but never a decision.
There is the type of man who is unwilling to admit that he cannot take a
drink. He plans various ways of drinking. He changes his brand or his
environment. There is the type who always believes that after being
entirely free from alcohol for a period of time he can take a drink
without danger. There is the manic- depressive type, who is, perhaps, the
least understood by his friends, and about whom a whole chapter could be
written.
Then there are types entirely normal in every respect except in the
effect alcohol has upon them. They are often able, intelligent, friendly
people.
All these, and many others, have one symptom in common: they cannot start
drinking without developing the phenomenon of craving. This phenomenon,
as we have suggested, may be the manifestation of an allergy which
differentiates these people, and sets them apart as a distinct entity. It
has never been, by any treatment with which we are familiar, permanently
eradicated. The only relief we have to suggest is entire abstinence.
This immediately precipitates us into a seething caldron of debate. Much
has been written pro and con, but among physicians, the general opinion
seems to be that most chronic alcoholics are doomed. [page xxviii] What
is the solution? Perhaps I can best answer this by relating one of my
experiences.
About one year prior to this experience a man was brought in to be
treated for chronic alcoholism. He had but partially recovered from a
gastric hemorrhage and seemed to a case of pathological mental
deterioration. He has lost everything worthwhile in life and was only
living, one might say, to drink. He frankly admitted and believed that
for him there was no hope. Following the elimination of alcohol, there
was found to be no permanent brain injury. He accepted the plan outlined
in this book. One year later he called to see me, and I experienced a
very strange sensation. I knew the man by name, and partly recognized his
features, but there all resemblance ended. From a trembling, despairing,
nervous wreck, had emerged a man brimming over with self-reliance and
contentment. I talked with him for some time, but was not able to bring
myself to feel that I had known him before. To me he was a stranger, and
so he left me. A long time has passed with no return to alcohol.
When I need a mental uplift, I often think of another case brought in by
a physician prominent in New York. The patient had made his own diagnosis
and deciding his situation hopeless, had hidden in a deserted barn
determined to die. He was rescued by a searching party, and, in desperate
condition, brought to me. Following his physical rehabilitation, he had a
talk with me in which he frankly stated he thought the treatment a waste
of effort, unless I could assure him, which no one ever had, that in the
future he would have the "will power" to resist the impulse to drink.
His alcoholic problem was so complex and his depression so great, that we
felt his only hope would be through what we then called "moral
psychology", and we doubted if even that would have any effect. [page
xxix] However, he did become "sold" on the ideas contained in this book.
He has not had a drink for a great many years. I see him now and then and
he is as fine a specimen of manhood as one could wish to meet.
I earnestly advise every alcoholic to read this book through, and though
perhaps he came to scoff, he may remain to pray.
William D. Silkworth, M.D [page xxx]
Contact:
The Legacy Group of Alcoholics Anonymous © 2005