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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
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 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 100 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 md
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 layman 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
defogged more often than not it is
imperative that a man's brain be cleared
before he is approached as he is 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 was
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 tempered
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 recreate 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've had many men who had for example
worked a period of months on some
problem or a 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 a 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 cauldron 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
willpower
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 md
you