Atheist Book Book Study: The Doctor’s Opinion
My first sponsor in A.A. knew that not drinking and going to meetings was about all that I could handle, so that’s what I did. I didn’t drink and I went to meetings. A lot of meetings! Eventually I decided that I should try working the steps, so I found a sponsor who suggested we read the Big Book and go through the steps together. When we got to “The Doctor’s Opinion”, I was told to read it every day for thirty days. I was further instructed that if I ever missed a day then I would need to start the 30 day count all over again.
I can’t tell you how many times I had to start that thirty day count all over, but the end result is that I read this passage from the Big Book more than any other. As an aside I should say that I would never require someone to do that. I don’t believe in heavy handed authoritative sponsors. I guess I had one at one time, but not since. The sponsorship thing in A.A. can sometimes get a bit weird. I have often heard intelligent, mature people act like they are blithering idiots if not for their drill sergeant sponsor keeping them in line. But I digress…
The doctor who is opining in this piece is William D. Silkworth who was the director of Towns Hospital in New York during the 1930’s. This is the hospital where Bill W was separated from alcohol for the last time.
Acquired Certain Ideas
Dr. Silkworth begins his opinion in a letter to Alcoholics Anonymous in which he describes the treatment and recovery of one of A.A.’s founders, Bill W., who the doctor had previously declared as hopeless. However, during Bill’s third visit to Towns Hospital, Silkworth writes that his patient had “acquired certain ideas concerning a possible means of recovery”.
Before going any further, let’s take a look at what these ideas were and how they were acquired. Events had to line up exactly so, or A.A. as we know it may never have come to fruition.
During Bill’s second treatment, he met with Dr. Silkworth who presented him with the hard facts of alcoholism. The doctor explained that Bill had an illness that caused him to become physically allergic to alcohol, and a mind that was obsessed with drinking. He said that as soon as Bill ingested as much as one drink, the craving for alcohol would make it impossible for him to drink with any degree of control. As Ernest Kurtz puts it in Not God: A History of Alcoholics Anonymous, “allergy, obsession, compulsion”.
Silkworth informed Bill’s wife Lois to either “lock him up, watch him go insane or let him die” (Kurtz). Bill heard this as well, and knew the doctor was right, but he was certain that with this knowledge of his condition, he would not drink again. A few weeks later on Armistice Day, he drank again and set in motion his last alcoholic binge. A binge that was interrupted by an old friend, Ebby T.
Ebby was about to be committed to a mental institution until members of the evangelical Oxford Group secured his release. At the Oxford Group Ebby learned the principles that helped him find sobriety; moral inventory, confessing personal defects, making restitution and having faith in one’s personal conception of “God”. It was with this message and new found sobriety that Ebby visited Bill.
These principles from the Oxford Group are the “certain ideas” Bill acquired and presented to other patients at Towns Hospital. Silkworth writes that he had witnessed scores of alcoholics get better from this approach, and he thought this would be important to the field of medicine.
Body as Abnormal as the Mind
In a second statement Dr. Silkworth elaborates on the disease concept of alcoholism. In the “Doctor’s Opinion” alcoholism is described as both a mental and physical condition, and any description that leaves out the physical factor is incomplete.
Anyone who has any experience at all with alcoholics understands that there is a definite physical component. I have personally witnessed people coming off of alcohol who had to be strapped to their beds because they were so jittery, I’ve seen them go through DTs, and seizures, and I have known far too many who have died. There is no doubt in my mind that this is both a mental and physical disease. In A.A. you will often hear that it is also a spiritual disease, but to me that’s nonsense and totally unnecessary.
Speaking of unnecessary nonsense, let’s examine this line, “though we work out our solution on the spiritual as well as the altruistic plane, we favor hospitalization for the alcoholic who is very jittery or befogged”. Imagine an A.A. without what I believe is supernatural nonsense. As John Lennon would say, “it’s easy if you try”. All they had to do is remove the word spiritual, “though we work out our solution on an altruistic plane…”, and it works perfectly. You will notice time and again that the spiritual language in the Big Book is for the most part totally superfluous and if you removed it, the program actually makes more sense for everyone regardless of whether or not they believe in a god. However it is definitely true that often times an alcoholic needs medical attention. Alcohol withdrawl can actually kill a person.
If A.A. works at all, it’s not in my opinion because of a god who bestows sobriety on the deserving few, it is rather the human connection, one alcoholic talking to another. I would sum it up with the word “love”, but it’s more than that. There is a support network in A.A. that is incredible. People really do help each other and ask nothing in return. This is the altruistic movement that Dr. Silkworth witnessed at Towns Hospital in the 1930’s.
I never heard of moral psychology until I read the “Doctor’s Opinion”, early on I rationalized that this must be what’s really taking place in A.A. People must be receiving psychological benefit from these steps. They may believe that a god is doing it, but actually it’s all psychological.
These were thoughts kept in my own mind, I would never have felt comfortable sharing them openly in a meeting. Especially in those early days when so many people were giving me the advice to “pray about it” and “turn it over”. Maybe it’s because of where I am in my sobriety, but I don’t hear this as much anymore. Maybe the newcomer still hears it.
At any rate, it turns out that moral psychology is a real thing. It started with Plato who believed that to “know the good is to do the good”. This is what Dr. Silkworth wrote that the medical profession realized was necessary to help alcoholics, but they just didn’t know how to apply it.
Silkworth then goes into a description of Bill W. telling his story and passing on the Oxford Group principles to other alcoholic patients. The Doctor was encouraged by the results. Perhaps, this is the moral psychology that the doctor had difficulty applying. Was the trick to build a community of alcoholics who would live by “spiritual principles”?
Doctor Silkworth continues with another description of the allergy, obsession and compulsion of alcoholism. He describes it in words that I have unwittingly committed to memory, and it’s as good a description as I have ever heard.
“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”.
The doctor goes on to say that this is repeated over and over again, and there is no hope unless the alcoholic can experience an “entire psychic change”. This phrase gave me hope as a newcomer because it sounded scientific. I didn’t have to rely on a belief in a god that I’ve never been able to pull off very well anyway. In my mind this meant that I needed to change profoundly, but the change was to be psychological in nature, not spiritual.
He goes on to describe the various types of alcoholics; the psychopaths, the type unwilling to admit he or she can’t drink, the manic depressive, and the type who is entirely normal in all aspects with the exception of the physical reaction to alcohol. All of these types writes Silkworth have one common symptom, they cannot start drinking without triggering the phenomenon of craving. He relates experiences of patients who found recovery by following the plan outlined in the book Alcoholics Anonymous.
He concludes with the totally unnecessary comment that an “alcoholic should read this book and though he came to scoff, he may remain to pray”. Again, this is the frustrating nature of A.A., everything seems sensible until right at the end they throw in something about prayer or god. It’s reminiscent of my first meeting. Everything seemed practical and sensible and I felt that I truly belonged, until the meeting ended with us all holding hands and praying.
As an atheistic alcoholic, I still find the “Doctor’s Opinion” worthwhile. I like the historical background, the description of the alcoholic, the moral psychology and psychic change. I just have to discard the supernatural god, prayer and spirituality.