THE DOCTOR'S OPINION
1. In R.A.'s Multilith Big Book, on page 1a, you will find "The Doctor's Opinion."
2. Notice that the title is "The Doctor's Opinion." It does not state that this letter contains facts about alcoholism by a doctor. It is the doctor's opinion. It says:
"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. . ."
3. This well-known doctor was Dr. Silkworth. The reason the doctor gave Bill Wilson this letter was because Bill had been a patient of his. He was the chief physician at Towns Hospital. He had seen that the program worked for Bill Wilson. This convinced him that it would work for others. So he became a strong advocate of the program.
4. That is why Dr. Silkworth wrote the following letter endorsing the pioneers' program. He later added a further endorsement of the program for the front of the Big Book. First, we will read the letter. In it Dr. Silkworth says:
"To Whom It May Concern:
"I have specialized in the treatment of alcoholism for many years.
"About four years ago 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 thirty of these cases who were of the type with whom other methods had failed completely."
5. Notice that the last line says, "cases who were of the type with whom other methods had failed completely." The people he is talking about were persons who had tried other methods and which had failed completely, absolutely, and totally. These were people who were utterly unable to stop drinking. They were powerless.
6. Being powerless is the basic premise of the program. Someone who has the ability to control his or her behaviors and problems would not need a program designed for someone who is powerless.
7. Simply put, if you tell someone to stop drinking or drugging or gambling, etc., and they can stop just because you told them to, they are not powerless.
8. Also, notice that Dr. Silkworth's letter says that Bill recovered during his third trip to the hospital. He had been there twice before.
9. People sometimes question the treatment Bill received during that third stay in the hospital. They want to know whether his treatment included sedatives or medications that could have caused Bill to hallucinate.
10. The answer is that Bill's third treatment was no different from the first two. It was the same treatment that had been given to the hundreds, or thousands, of people who had also been patients at that hospital up to then. Bill was the only one who reported a spiritual experience, and this only happened after he worked the program with Ebby.
11. Immediately after his spiritual experience, as part of his rehabilitation, Bill commenced to present his ideas to other alcoholics. As part of this process, Bill impressed upon them that they must "do likewise with still others."
12. We think it is important to note that Dr. Silkworth doesn't recount any of the other principles that became part of the program. The only one he describes is working with others. This became the Twelfth Step.
13. Dr. Silkworth says that he personally knew "thirty of these cases." This means that he must have been familiar with the entire program. Yet, in his letter he only mentions one part of the recovery program.
14. Thus, we can surmise that Dr. Silkworth apparently thought that carrying the message of recovery to others was the most important aspect of the program. He felt it was more important than admitting powerlessness, believing God can restore sanity, surrendering one's life and will to Him, or doing an inventory.
15. The pioneers believed that someone should start talking with others even before they had completed their stay in the hospital. They did not require someone to fully understand the program, or even to be sober before they should start helping others. The pioneers expected someone to start talking to others as quickly as possible.
16. Working with others is an important part of the recovery process. Working with others is essential to becoming recovered. It is vital to maintaining recovery.
17. Ebby first met with Bill around Thanksgiving. This is in Bill's story, which is the next chapter in the Big Book we are going to read. However, we are going to share some of his story now.
18. Bill's talk with Ebby intrigued him, so Bill went on to do more investigating. Eventually, and we'll read about it later, Bill went to an Oxford Group meeting and, on the way there, he got drunk—so drunk that they almost didn't let him in.
19. Ebby was at the meeting. He intervened and allowed Bill to enter. During the meeting, there was a time for people to get up and make their surrender. Each, in turn, would turn their life and will over to God. Bill was drunk and got up to go to the front of the room.
20. Ebby tried to grab his coattail to pull him back down. But Bill made it up to the front of the room and made his surrender anyway. Then, after the meeting, he went upstairs with Ebby who sobered him up.
21. On the way home, Bill got on the subway and realized something was different. He had just walked past all the bars he had gone into on his way to the meeting. He hadn't stopped at any of them.
22. Of course Bill, being compulsive and not actually working the program, soon decided that maybe suddenly stopping all together wasn't a good idea. He thought that maybe he should taper off instead. Of course, he tapered back on.
23. However, Bill's experience, his momentary freedom from his obsession, convinced him that the program would work for him. That's why he went to the hospital. He thought that, if he was in the hospital and couldn't drink, then he could go through the process with no distractions.
24. Of course, Bill, being an alcoholic, got drunk on the way to the hospital. However, once Bill was in the hospital, Ebby did talk to him again. He took Bill through the spiritual program we now call the Twelve Steps.
25. As we'll read later, going through this process resulted in Bill having his famous wind on the mountain top spiritual experience. Bill never got drunk again.
26. While Bill sobered up during his stay in the hospital, this wasn't due to his being in the hospital. Bill recovered only after going through the program with Ebby. We know this because the treatment Bill received during his third hospital stay was no different from the treatment he received on his previous two visits.
27. Therefore, it had to be Ebby's taking Bill through the steps that produced his recovery. This was the only thing that changed. It just happened that Bill was in the hospital when Ebby took him through the program.
28. Continuing back in R.A.'s Multilith, on page 1a, at the bottom of the doctor's note, it says:
"These facts appear to be of extreme medical importance; because of the extraordinary possibilities of rapid growth inherent in this group they 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, (Signed) - - - - - 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 anyone who has suffered alcoholic torture must believe—that the body of the alcoholic is quite as abnormal as his mind. It does not satisfy us to be told that we cannot 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."
29. Today scientists tell us that there is a genetic marker that is fairly consistent in compulsive personalities. So there certainly is something physically different about people with various compulsive problems and behaviors. Now, this next passage is interesting because it's often misunderstood.
30. Continuing on page 1a, with the bottom paragraph, it says:
"The doctor's theory that we have a kind of allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-alcoholics, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account."
31. In the current Big Book they changed "kind of allergy" to "an allergy."
32. We wish they had not changed that wording. This is because in his biography, "Pass It On," on page 388, in the third paragraph, Bill maintains that Dr. Silkworth "knew the condition was not strictly an allergy; he simply used the word for want of a more specific one."
33. Continuing in the bottom paragraph on page 388, it says, "Dr. Silkworth's 'allergy,' said Bill, was the tendency of alcoholics to have some disturbance in their blood chemistry, often hypoglycemia—low blood sugar..."
34. In other words, Bill Wilson says that Dr. Silkworth was actually talking about hypoglycemia, not the kind of allergy that someone has when they eat a strawberry and break out in a rash.
35. Dr. Silkworth was trying to describe the physical component of our spiritual malady. He was trying to explain how drinking would cause someone's blood sugar to crash. This would cause craving, which someone would then try to fix by self-medicating. They would do this by taking another drink.
36. Today, we know that there are other factors involved, primarily serotonin. When somebody drinks, or does drugs, or bungee jumps, gambles, over eats, etc., the body produces extra serotonin. This causes someone to feel better, especially if they are starting off slightly depressed or even deeply depressed.
37. However, there is a problem with self-medicating. While this can produce more serotonin, and a momentary feeling of wellbeing, the serotonin increase does not last. The body absorbs it and the person crashes. They feel worse than before.
38. Because they are powerless to control this process, they will repeat this cycle over and over again. They will continue trying to find that momentary feeling of wellbeing.
39. One of R.A.'s members shares:
"I am hypoglycemic. I also have other allergies. I feel that my body reacts crazy to even the smallest amount of sugar. I have tried to not have flour and sugar. I know a lot about blood sugar, hypoglycemia, and other related things.
"In R.A.'s Multilith Big Book, on page 17, it says that someone will be, '...absolutely unable to stop drinking on the basis of self-knowledge.' I am definitely an example of this because all my knowledge does not consistently effect or change my behavior."
40. This member is powerless. That is why she needs the program. Fully working all Twelve Steps is how she will develop a relationship with a loving Creator who will do for her what she can't do for herself. She will be restored to sanity. By God's grace, she will begin to make sane, appropriate choices.
41. Someone who is powerless, never gets the power back. Working the program does not give them back the power. God does not give them back the power. However, when someone works all Twelve Steps, God will do for them what they can't do for themselves.
42. Continuing on page 2a, with the top paragraph, it says:
"Though we work out our solution on the spiritual 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."
43. Bill wrote that the pioneers "favor hospitalization" because they wanted Dr. Silkworth to endorse the program. Remember, Dr. Silkworth was the chief physician at Towns Hospital.
44. However, as the program grew, the pioneers found that hospitalization was not required for most people to recover. Some who were in bad shape may still need to go to rehab, or be hospitalized. Once there, they should work all Twelve Steps by following the pioneers "clear-cut directions" from the Big Book.
45. One of our members shares:
"If someone has overdosed, or is unconscious, 911 should be called, so they can be taken to an Emergency Room for treatment. They may need to go to a facility that has a detox unit. Without quick treatment, someone can suffer brain damage, or die."
46. In R.A.'s Multilith Big Book, on page 2a, The Doctor's Opinion continues by saying:
"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.
"About four 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 perhaps 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."
47. Please remember that this was written in 1939. The pioneers later found that hospitalization wasn't required in most cases.
48. Continuing on page 2a, with the next two paragraphs, it says:
"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."
49. Notice that, once again, Dr. Silkworth is saying that someone needs to find God. They need to find a power greater than themselves who will solve their problems, and "recreate their lives." He is not offering any other solution.
50. On page 2a, starting with the bottom paragraph, the doctor continues by saying:
"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 community 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."
51. Dr. Silkworth is saying that there is very little hope of someone recovering unless they "can experience an entire psychic change."
52. In the next paragraph on page 3a, the doctor continues by saying:
"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."
53. Please note that the "psychic change" is just another name for the spiritual experience or spiritual awakening. The "few simple rules" are, of course, the Twelve Steps.
54. Continuing on page 3a, in the next two paragraphs, the doctor says:
"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 perhaps 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."
55. In other words, Dr. Silkworth is saying that, if doctors are honest with themselves, they have to admit their "own inadequacy." They have to admit that they don't have the ability to produce "the essential psychic change," the spiritual awakening.
56. Dr. Silkworth goes on to describe the results of "psychiatric effort." He says that "little impression upon the problem as a whole" had been made because many people did "not respond to ordinary psychological approach[es.]"
57. In R.A.'s Multilith Big Book on page 3a, Dr. Silkworth continues by saying:
"I do not hold with those who believe that alcoholism is entirely a mental condition. 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."
58. In other words, Dr. Silkworth is saying that these men were powerless over "a craving beyond their mental control."
59. In the next two paragraphs, Dr. Silkworth continues by saying:
"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 constitutional 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."
60. Dr. Silkworth describes how many people swear they are not going to drink again. They promise that they are "going on the wagon for keeps." However, they have not demonstrated their decision to turn their life and their will over to the care of God by working all Twelve Steps. Therefore, they do drink again.
61. You might have heard this little riddle before. There are three frogs sitting on a log. One of them decides to jump off. How many frogs are left sitting on the log?
62. Most people answer two. However, the right answer is three.
63. This is because when someone makes a decision to do something, it doesn't mean that they have actually followed through and done it.
64. When someone makes a Third Step decision, the way they need to demonstrate that decision, is by following through with working the rest of the Twelve Steps, including intensive work with others.
65. Remember, in order for someone to fully recover, they need to fully work all Twelve Steps. They need to do this by following the pioneers' "clear-cut directions" from the Big Book. It is unreasonable for someone to expect all of the results that the program promises before they have fully worked all of the Twelve Steps.
66. The next paragraph, at the bottom of page 3a, was deleted and not included in the current Big Book. It says:
"Then there are those who are never properly adjusted to life, who are the so-called neurotics. The prognosis of this type is unfavorable."
67. We can't be certain as to why they deleted this paragraph. However, a pretty good guess would be that they took it out because they found that neurotics could recover, if they did work the Twelve Steps.
68. In R.A.'s Multilith Big Book on page 4a, in the first paragraph, Dr. Silkworth says:
"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."
69. We want to put what the Doctor is saying in this paragraph into other contexts. For example, let's think about what this says regarding food.
70. People with an eating disorder often try to solve their problem by changing what they eat. They try to eat low fat food, or they try to switch to diet drinks, etc. However, they are just treating their symptom, not solving the real cause of their problem, the spiritual malady.
71. Continuing in the next two paragraphs, Dr. Silkworth says:
"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, 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."
72. Unfortunately, many people stop reading at the end of this paragraph. This leads them to think that the doctor and the pioneers are endorsing abstinence as a valid concept. However, if that is true, why did the doctor write the next paragraph?
73. In R.A.'s Multilith Big Book on page 4a, in the next paragraph, Dr. Silkworth says:
"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."
74. So, if the doctor is actually making the suggestion to be entirely abstinent, and if this is a valid suggestion, why are alcoholics doomed?
75. We believe that physicians thought the alcoholics are doomed because they knew that an alcoholic could never follow the suggestion to be abstinent. So they clearly thought that abstinence was not a valid option.
76. In the next sentence Dr. Silkworth continues by going on to rhetorically ask:
"What is the solution?"
77. Dr. Silkworth is asking that, since abstinence isn't the solution, what is the alternative, "What is the solution?"
78. In R.A.'s Multilith Big Book on page 4a, starting with the next sentence, Dr. Silkworth continues by saying:
"Perhaps I can best answer this by relating an experience of two years ago.
"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. More than three years have now passed with no return to alcohol."
79. If this dramatic recovery happened for someone who was in a condition of "pathological mental deterioration," why can't everyone recover? The answer is that everyone can recover, if they fully work all Twelve Steps.
80. In R.A.'s Multilith Big Book on page 4a, starting with the next paragraph, Dr. Silkworth continues by saying:
"When I need a mental uplift, I often think of another case brought in by a physician prominent in New York City. 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 more than three 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."
81. These two passages are extremely powerful. They should help lessen, but not necessarily remove, any doubts you might still have about whether or not Recoveries Anonymous can work for you. This is especially true since it is unlikely that you are in anywhere near the condition that these two people were in.
82. However, don't leave out the most important part. Remember, it takes the entire program to produce the entire recovery.
83. The original Twelfth Step says, "Having had a spiritual experience as the result of this course of action, we tried to carry this message to others, especially alcoholics, and to practice these principles in all our affairs."
84. The current Twelfth Step says, "Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs."
85. The pioneers changed "as the result of this course of action," to "as the result of these steps." The important word in both versions is "result."
86. We get this "psychic change" we just read about, which is the same as the spiritual experience, or spiritual awakening, as the "result" of working all Twelve Steps..
87. We need to do this by thoroughly following all of the pioneers' "clear-cut directions" as they are written in the Big Book.
Please use R.A.'s Questions and Answers Forum to ask any questions or make any comments about any of this.