The Doctors Opinion from the “Big Book” of Alcoholics Anonymous (AA)

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
business man 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 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 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 worth while 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 City. 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.