A
wildly imaginative dianoetic rambling concerning the the “basic
text” of Alcoholics Anonymous (viz. the Big Book) (our comments in
red print)
The Doctor's Opinion (pp.
xxvii-xxxii)
“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 [Bill
Wilson] 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 [something
which some of our 'AA entrepreneurs' might care to remember – you
know who you are!], and their community spirit, is
indeed inspiring to one who has laboured 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.
[medical
treatment should remain strictly the province of those qualified to
administer it, and not left to amateur diagnosticians! See our April Fools Quiz,
Q. 4]
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 [“Frothy
emotional appeal”, of course, is a cult speciality. Jumping up and
down and getting all excited whilst chanting 'happy, joyous and free'
and claiming “never to have had a bad day” doesn't quite
constitute a message which has both “depth and weight”]
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, [ie.
probably not a sponsor. See (b) of the “three pertinent ideas”
('Alcoholics Anonymous', Chapter Five, How It Works, p. 60)] 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, [admission
does not in itself constitute acceptance or realisation]
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 [ie.
their restlessness etc derives from failing to satisfy their drink
craving. If one is sober and feeling “restless, irritable and
discontented" this is simply a by-product of normal life; to feel this
way is not evidence of some kind of pathology]
—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 [this
does not imply that these “rules” should be administered by
another – rather that they are adopted and undertaken by the person
concerned].
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 [see
Chapter Five above]. Though the aggregate of
recoveries resulting from psychiatric effort is considerable [see
here],
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, favourably 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 [mere
cognition coupled with will-power is insufficient].
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
[see
Narcissism
with particular reference to its predominance amongst cult types]
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 [now
termed bipolar]
, 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 [ie.
this statement should be regarded as an hypothesis rather than as
accepted fact] 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
haemorrhage 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 [ie.
the initiative remained with him – not with another].
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 [not
a good idea!], and deciding [incorrectly]
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,’’ [see above] 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, M.D.”
(our
emphases)
Coming
next –
Chapter 2 There Is A Solution (as already indicated
Bill's Story will not be included in our discussion)
Cheerio
The
Fellas (Friends of Alcoholics Anonymous)
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