THE DOCTORS OPINION
We of Alcoholics
Anonymous believe that the reader will be interested in the medical
esti-mate 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
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 cer-tain 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.
know scores of cases who were of the type with whom other methods had
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.
William D. Silkworth,
The physician who, at our request, gave us this let-ter, 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 believethat 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.
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 mans 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:
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 drinksdrinks
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 handand strange as this may seem to those who do
not understandonce 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
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
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
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
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.