Big Book Step Study 1.1 : The Doctor’s Opinion

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 one
hundred 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, M.D.

Alcoholics Anonymous p. xxv-xxvi

The next section from Bill can be largely skipped as it’s mostly paraphrasing the second letter from Dr. Silkworth.

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 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 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 man’s 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:

Alcoholics Anonymous p. xxvi-xxvii

Silkworth’s Second Letter

The second letter covers a couple of things, but the main topic is Silkworth sharing an unpopular opinion. At the time of writing, in the 1930’s alcoholism was thought of exclusively as a failure of will-power and discipline. This view still exists to varying degrees today. The Doctor’s Opinion is that there is something different about the body of the alcoholic compared to that of the non-alcoholic that causes them to react differently to alcohol.

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.

It is tough not to admire Dr. Silkworth’s readiness to admit the lack of success his field has been able to produce. In fact, it seems as if he is writing off science itself and its practitioners as a whole.

While I personally think that science has progressed to a place of usefulness in the treatment of addiction, it would be difficult to disagree with the Doctor in his own time.

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.

While not a medical professional, it is important to note the Doctor’s recommendation of at least medical supervision for detox.

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.

Here it is! This is “The Doctor’s Opinion!” Dr. Silkworth states that there is something different about the body of alcoholic.

He uses the term “allergy.” This confused me for a long time. My dad had seasonal allergies, and I knew what that looked like. There were kids with bee and peanut allergies in school, and I knew what that looked like. But as Joe & Charlie say, “How in the hell can I be allergic to alcohol? I’m drinking a quart a day.”

One of the big things I learned about myself in recovery is that I think I know the definitions of a lot more words than actually do, and I could stand to use a dictionary a bit more often. The definition of allergy that I found is “an abnormal reaction to the introduction of a substance to the body.”

Silkworth was at the cutting edge of his time with his opinion. He was observing craving for the first time and trying to medically categorize it. Thinking about it like that, his use of the word allergy makes perfect sense. Pollen gets into my Dad’s sinuses, he sneezes and gets congested. Bee kid gets stung by a bee, he swells up. I drink, I crave more. That craving is a reaction to the substance, alcohol, being introduced to my body. And it is abnormal. Normal people don’t feel that craving. I could never understand pouring a shot for someone and them saying they were “all set.”

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.

Frothy emotional appeal: my mom telling me I’m ruining my life, significant other’s leaving me, losing friends, etc. These things mattered, but not enough to get me to change my behavior.

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.

“Men and women drink essentially because they like the effect produced by alcohol.” And here I was thinking that the reasons I drank were complicated, nuanced, and special. Just like I thought I was. Turns out I drink because it makes me feel good. The real question is, “why do I need to feel better?”