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
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 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.