THE DOCTOR'S OPINION
· · ·
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 of 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 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
exproblem 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 solution 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 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 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 feel 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 of
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 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 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 than 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.
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 be a case of pathological mental deterioration. He
had 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.
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.