The Doctor’s Opinion (comparison)

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Rarely have we < RARELY HAVE WE > seen a person fail who has thoroughly directions followed our < path >...
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We 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       

                            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   
as his mind.  It < did > not satisfy us to be told that we    
< 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    
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 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   

     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    
  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       

     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            
  < 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      
  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 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.       
  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        
  <    >.  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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