Comparing “The Doctor’s Opinion” to the original manuscript for our Basic Text
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THE DOCTOR'S OPINIONWe of < 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 nation- ally 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. About four years ago < In late 1934 > I attended a patient who, though he had been a competent businessman of good earning capa- city, 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. thirty these 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,
(Signed) - - - - - - -
< 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
anyone has
< we > who < have > suffered alcoholic torture must be-
lieve – that the body of the alcoholic is quite as abnormal
does
as his mind. It < did > not satisfy us to be told that we
cannot
< could not > control our drinking just because we were mal-
adjusted 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.
a kind of
The doctor's theory that we have < an > allergy
to alcohol interests us. As laymen, our opinion as to its
ex-
soundness may, of course, mean little. But as < ex-problem >
alcoholics
< drinkers >, we can say that his explanation makes good
sense. It explains many things for which we cannot other-
wise 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 be-
fore 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 con-
ception. What with our ultra-modern standards, our scien-
tific approach to everything, we are perhaps not well
equipped to apply the powers of good that lie outside our
synthetic knowledge.
About four
< 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
perhaps
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 trage-
dies, 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 encou-
raged this movement. We feel, after many years of experi-
ence, that we have found nothing which has contributed
more to the rehabilitation of these men than the
community
< 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, sud-
denly 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
perhaps
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
condition
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 over-
come a craving beyond their mental control.
There are many situations which arise out of the phe-
nomenon 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.
constitutional
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.
Then there are those who are never properly adjusted
< >
to life, who are the so-called neurotics. The prognosis
< >
of this type is unfavorable.
< >
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 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 phenome-
non of craving. This phenomenon, as we have suggested,
may be the manifestation of an allergy which differenti-
ates 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
an experience of two years ago
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 con-
tentment. I talked with him for some time, but was not
able to bring myself to feel that I had known him before.
More than
To me he was a stranger, and so he left me. < A >
three years have now
< 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, < was > brought to
me. Following his physical rehabilitation, he had a talk
with me in which he frankly stated he thought the treat-
ment 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 depres-
sion 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
more than three
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 re-
main to pray.
< William D. Silkworth, M.D. >
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