Presented to the New York City Medical Society on Alcoholism
By Bill W., April 28, 1958
Fourteen years ago, I read a paper before the Medical Society of the State of New York at its annual gathering. For us of Alcoholics Anonymous, that was a history-making event; it marked the first time that any of America’s great medical associations had taken favorable notice of our Fellowship. The physicians of that day did far more than take notice of us; they received us with open arms and allowed our account of AA to be published in their Journal. Reprints of that 1944 paper have since been scattered in tens of thousands of copies throughout the world, convincing physicians everywhere of AA’s worth. What this perceptive and generous act has since meant to countless alcoholics and their families, only God Himself knows.
Keenly appreciative that the members of the New York Medical Society on Alcoholism have in the same generous spirit invited me to be here tonight, it is with a sense of timeless gratitude that I bring you greetings from those 250,000 recovered alcoholics who now comprise cur membership in some 7,000 groups, here and abroad.
Perhaps the better way to understand AA’s methods and results is to have a look at its beginnings, at that time when medicine and religion entered into their benign partnership with us. This partnership is now the foundation of such success as we have since had.
Certainly nobody invented Alcoholics Anonymous. AA is a synthesis of principles and attitudes which came to us from medicine and from religion. We alcoholics have simply streamlined those forces, adapting them to our special use in a society where they can work effectively. Our contribution was but the missing link in a chain of recovery which is now so significant, and of such promise for the future.
Few people know that the first taproot of AA hit paydirt some thirty years ago in a physician’s office. Dr. Carl Jung, that great pioneer in psychiatry, was talking to an alcoholic patient. This, in effect, is what happened :
The patient, a prominent American businessman, had gone the typical alcoholic route. He bad exhausted the possibilities of medicine and psychiatry in the United States and had then come to Dr. Jung as to a court of last resort. Carl Jung had treated him for a year and the patient, whom we shall call Mr. R., felt confident that the hidden springs underneath his compulsion to drink had been discovered and removed. Nevertheless, he found himself intoxicated within a short time after leaving Dr. Jung’s care.
Now he was back, in a state of black despair. He asked Dr. Jung what the score was, and he got it. In substances, Dr. Jung said, "For some time after you came here, I continued to believe that you might be one of those rare cases who could make a recovery. But, I must now frankly admit that I have never seen a single case recover through the psychiatric art where the neurosis is so severe as yours. Medicine has done all that it can for you, and that’s where you stand.
Mr. R.’s depression deepened. He asked: "is there no exception; is this really the end of the line for me?"
"Well," replied the doctor, "There are some exceptions, a very few. Here and there, once in a while, alcoholics have had what are called vital spiritual experiences. They appear to be in the nature of huge emotional displacements and rearrangements. Ideas, emotions and attitudes which were once the guiding forces of these men are suddenly cast to one side, and a completely new set of conceptions and motives begin to dominate them. In fact, I have been trying to produce some such emotional rearrangement within you. With many types of neurotics, the methods which I employ are successful, but I have never been successful with an alcoholic of your description."
"But," protested the patient, "I’m a religious man, and I still have faith." To this Dr. Jung replied, "Ordinary religious faith isn’t enough. What I’m talking about is a transforming experience, a conversion experience, if you like. I can only recommend that you place yourself in the religious atmosphere of your own choice, that you recognize your personal hopelessness, and that you cast yourself upon whatever God you think there is. The lightening of the transforming experience may then strike you. This you must try- it is your only way out." So spoke a great and tumble physician.
For the AA-to- be, this was a ten-strike. Science had pronounced Mr. R. virtually hopeless. Dr. Jung ‘ s words had struck him at great depth, producing an immense deflation of his ego. Deflation at depth is today a cornerstone principle of AA. There in Dr. Jung’s office it was first employed in our behalf.
The patient, Mr. R., chose the Oxford Groups of that day as his religious association and atmosphere. Terribly chastened and almost hopeless, he began to be active with them. To his intense joy and astonishment, the obsession to drink presently left him.
Returning to America, Mr. R. came upon an old school friend of mine, a chronic alcoholic. This friend - whom we shall call Ebby- was about to be committed to a state mental hospital. At this juncture another vital ingredient was added to the AA synthesis. Mr. R., the alcoholic, began talking to Ebby, also an alcoholic and a kindred sufferer. This made for identification at depth, a second cardinal AA principle. Over this bridge of identification, Mr. K. passed Dr. Jung’s verdict of how hopeless, medically and psychiatrically, most alcoholics were. He then introduced Ebby to the Oxford Groups where my friend promptly sobered up.
My friend Ebby knew well of my plight. I had gone the familiar course. In the summer of 1934 my doctor, William D. Silkworth, had given me up and had pronounced me hopeless. He had been obliged to tell me that I was the victim of a neurotic compulsion to drink that no amount of will power, education or treatment could check. He added that I was also the victim of a bodily derangement which might be in the nature of an allergy - a physical malfunction that virtually guaranteed brain damage, insanity or death. Here again the God of Science-which was then my only god - had well deflated me. I was ready for the message that was soon to come from my alcoholic friend Ebby.
He came to my house one day in November, 1934, and sat across the kitchen table from me while I drank. No thanks, he didn’t want any liquor, he said. Much surprised, I asked what had got into him. Looking straight at me, he said he had "got religion." This was a real crusher, an affront to my scientific training. As politely as possible, I asked what brand of religion he had.
Then he told me of his conversations with Mr. K, and how hopeless alcoholism really was, according to Dr. Carl Jung. Added to Dr. Silkworth’s verdict, this was the worst possible news. I was hard hit. Next Ebby enumerated the principles he had learned from the Oxford Groups. Though he thought these good people sometimes too aggressive, he certainly couldn’t find any fault with most of their basic teachings. After all, these teachings had sobered him up.
In substance, here they are, as my friend applied them to himself in 1934:
1. Ebby admitted that he was powerless to manage his own life.
2. He became honest with himself as never before and made an "examination of conscience."
3. He made a rigorous confession of his personal defects and thus quit living alone with his problems.
4. He surveyed his distorted relations with other people, visiting them to make what amends he could.
5. He resolved to devote himself to helping others in need, without the usual demand for personal prestige or material gain.
6. By meditation he had sought God’s direction for his life and the help to practice these principles of conduct at all times.
This sounded pretty naive to me. Nevertheless, my friend stuck to the plain tale of what had happened. He related how, practicing these simple precepts, his drinking had unaccountably stopped. Fear and isolation had left, and he had received a considerable peace of mind. With no hard disciplines nor any great resolves, these changes began to appear the moment he conformed. His release from alcohol seemed to be a by-product. Though sober but months, he felt sure he had a basic answer. Wisely avoiding arguments, he then took his leave. The spark that was to become Alcoholics Anonymous had been struck. One alcoholic had been talking to another, making a deep identification with me and bringing the principles of recovery within my reach.
At first, my friend’s story generated mixed emotions, I was drawn and revolted by turns. My solitary drinking went on for some weeks, but I could not forget his visit. Several themes coursed in my mind: first, that his evident state of release was strangely and immensely convincing; second, that he had been pronounced hopeless by competent doctors; third, that these age-old precepts, when transmitted by him, struck me with great power; fourth, that I could not, and would not, go along with any God concept, that there would be no conversion nonsense for me. Often trying to divert my thoughts, I found it no use. By cords of understanding, suffering and simple verity, another alcoholic had bound me to him. I could not break away.
One morning after my gin, this realization welled up. "Who are you," I asked, "to choose how you are going to get well? Beggars are not choosers. Supposing medicine said carcinoma was your trouble. You would not turn to Pond’s extract. In abject haste you would beg a doctor to kill those hellish cancer cells. If he couldn’t stop them, and you thought religious conversion might, your pride would fly away. If need be, you would stand in a public square, crying ‘Amen’ along with other victims. What difference then," I reflected, "between you and the cancer victim? His sick body crumbles. Likewise, your personality crumbles, your obsession consigns you to madness or the undertaker. Are you going to try your friends formula - or not?"
Of course, I did try. In December, 1934, I appeared at Towns Hospital, New York. My old friend, Dr. William Silkworth, shook his head. Soon free of sedation and alcohol, I felt horribly depressed. My friend Ebby turned up. Though glad to see him, I shrank a little. I feared evangelism, but nothing of the sort happened. After some small talk, I again asked him for his neat little formula for recovery. Quietly and sanely, without the slightest pressure, he told me. Then he left.
Lying there in conflict, I dropped into the blackest depression I had ever known. Momentarily my prideful depression was crushed. I cried out, "Now I am ready to do anything - anything to receive what my friend Ebby has." Though I certainly didn’t expect anything, I did make this frantic appeal, "If there be a God, will He show Himself!" The result was instant, electric, beyond description. The place seemed to light up, blinding white. I knew only ecstasy and seemed on a mountain. A great wind blew, enveloping and penetrating me. To me, it was not of air, but of Spirit. Blazing, there came the tremendous thought, "You are a free man." Then the ecstasy subsided. Still on the bed, I now found myself in a new world of consciousness which was suffused by a Presence. One with the universe, a great peace stole over me. I thought, "So this is the God of the preachers, this is the Great Reality." But soon my so-called reason returned, my modern education took over. I thought I must be crazy, and I became terribly frightened.
Dr. Silkworth, a medical saint if ever there was one, came in to hear my trembling account of this phenomenon. After questioning me carefully, he assured me that I was not mad, that I had perhaps undergone a psychic experience which might solve my problem. Skeptical man of science though he then was, this was most kind and astute. If he had said, "hallucination," I might now be dead. To him I shall ever be eternally grateful.
Good fortune pursued me. Ebby brought me a book entitled "Varieties of Religious Experiences" and I devoured it. Written by William James, the psychologist, it suggests that the conversion experience can have objective reality. Conversion does alter motivation, and it does semi-automatically enable a person to be and to do the formerly impossible. Significant it was that marked conversion experience came mostly to individuals who knew complete defeat in a controlling area of life. The book certainly showed variety. But whether these experiences were bright or dim, cataclysmic or gradual, theological or intellectual in bearing, such conversions did have a common denominator - they did change utterly defeated people. So declared William James, the father of modern psychology. The shoe fitted, and I have tried to wear it ever since.
For drunks, the obvious answer was deflation at depth, and more of it. That seemed as plain as a pikestaff. I had been trained as an engineer, so the views of this authoritative psychologist meant everything to me. This eminent scientist of the mind had confirmed everything that Dr. Jung had said, and had extensively documented all he claimed. Thus William James firmed up the foundation on which I and many another have stood all these years. I haven’t had a drink of alcohol since 1934.
Armored now by utter conviction, and fortified by my characteristic power drive, I took of f to cure alcoholics wholesale. It was twin-jet propulsion; difficulties meant nothing. The vast conceit of my project never occurred to me. I pressed the assault for six months, and my home was filled with alcoholics. Harangues with scores produced not the slightest results. (Disappointingly, Ebby, my friend of the kitchen table, who was sicker than I realized, took little interest in these other alcoholics. This fact may have caused his backslide later on, though he did make his eventual recovery.) But I had found that working with alcoholics had a huge bearing on my own sobriety. Nevertheless, none of my prospects were getting sober. Why was this?
Slowly, the defects of my approach came to light. Something like a religious crank, I was obsessed with the idea that everybody must have a "spiritual experience" just like mine. I forgot that James had said that there were many varieties of the transforming experience. My brother alcoholics just stared incredulously or joshed me about my "hot flash." Of course this spoiled the potent identification that it was so necessary to establish with them. I had turned evangelist. Clearly the approach had to be altered. What had come to me in six minutes might require six months with others. I had to learn that words were things, that one had to be prudent.
At this juncture - the spring of 1935 — Dr. Silkworth pointed out to me that I had forgotten all about deflation at depth. I had simply turned preacher. Said he, "Why don’t you pour the grim medical facts into these people before you do anything else? Have you forgotten what William James said about ego deflation at depth? Give them the medical business, and give it to them hard. Skip that account of your ‘hot flash.’ Recite your symptoms extensively, so as to get an identification at depth. When you do this, your prospects may become willing to adopt the simple moral precepts you have been trying to teach." Here was a most vital contribution to the synthesis. Once again it had been made by a physician.
The emphasis was straightway shifted from "sin" to sickness - the fatal malady - alcoholism. We quoted several doctors to the effect that alcoholism was often more lethal than cancer; that it consisted of an obsession of the mind coupled to an increasing body sensitivity. These were our twin ogres -: Madness and Death. We leaned heavily on Dr. Jung’s statement of how hopeless the condition could be, and then poured that devastating dose into every drunk within range. To modern man, science is omnipotent - virtually a god. Hence if science passed a death sentence on the drunk, and we placed that fearful verdict on our alcoholic transmission belt, one victim talking to another, it might shatter the listener completely. Then the alcoholic might turn to the God of the theologian, there being no other place to go. Whatever truth there was in this device, it certainly had practical merit. Immediately our whole atmosphere changed. Things began to look up.
A few months later, I was introduced to Dr. Robert S., an Akron surgeon. He was an alcoholic in a bad way. This time there was no preachment from me. I told him of my experience and what I knew about alcoholism. Because we understood and needed each other, there was genuine mutuality for the first time. This marked the end of my preaching attitude. This idea of mutual need added the final ingredient to the synthesis of medicine, religion and the alcoholic’s experience which is now Alcoholics Anonymous.
"Dr. Bob," a very grim case, sobered almost immediately and never took a drink to the time of his death in 1950. He and I soon commenced to work on numbers of alcoholics that we found at the City Hospital. Almost immediately there was a recovery, and then another. The first successful A.A. group had been formed. Returning to New York in the fall of 1935, this time with all the ingredients of recovery, another group soon took shape in this city.
Nevertheless, progress of the Akron and New York Groups was painfully slow for the next few years. Hundreds of cases were tried, but only a few responded. Near the close of 1937, however, forty were sober and we began to be far more sure of ourselves. We saw that we had a formula which might — carried from one alcoholic to the next - eventually produce, chain style, a very large number of recoveries. So came the question: "How can our good news be spread to the millions of alcoholics in America and throughout the world?" One basic answer seemed to be in a literature, detailing our methods. Another need was for widespread publicity which would bring great numbers of cases to us.
By the spring of 1939, our Society had produced a book which was called "Alcoholics Anonymous." In this volume, our methods were carefully described. For the sake of greater clarity and thoroughness, the word-of-mouth program which my friend Ebby had given to me was enlarged into what we now call AA’s "Twelve Suggested Steps for Recovery." This was the backbone of our book • To substantiate AA methods, our book included twenty-eight case histories. We hoped that these stories might fully identify us with readers at a distance, and they certainly have. As we had withdrawn from the Oxford Groups, our Fellowship adopted the name of our book, "Alcoholics Anonymous," as its own. The advent of that volume marked a historical turning—point. In the twenty years since, this basic text has gained a circulation of nearly 400,000 copies. Countless alcoholics have sobered with no other aid than reading this volume and practicing its principles.
Our next need was publicity, and it was forthcoming. Fulton Oursler, the noted editor and writer, printed a piece in "Liberty" magazine about us in 1939. The following year, John D. Rockefeller, Jr., gave AA a dinner which was widely publicized. The next year, 1941, there was a feature article in the "Saturday Evening Post." This story alone brought us thousands of new people. As we gained size, we also gained in effectiveness. The recovery rate went away up. Of all those who really tried AA, 50 per cent made it at once, 25 per cent finally made it; and the rest, if they stayed with us, were definitely improved. That percentage has since held, even with those who first wrote their stories in the original edition of "Alcoholics Anonymous." In fact, 75 per cent of these finally achieved sobriety. Only 25 per cent died or went mad. Most of those still alive have now been sober for an average of twenty years.
In our early days, and since, we have found that great numbers of alcoholics approach us and then turn away - maybe three out of five, today. But we have happily learned that the majority of them later return, provided they are not too psychopathic or too brain—damaged. Once they have learned from the lips of other alcoholics that they are beset by an often fatal malady, their further drinking only turns up the screw. Eventually they are forced back into PA, they must do or die. Sometimes this happens years after the first exposure. The ultimate recovery rate in PA is therefore a lot higher than we at first thought it could be.
Another development of recent years has been a source of much comfort. In our early time, we could only deal with last-gasp cases. Nothing could be done until alcohol nearly wrecked its victim. But nowadays we don’t always have to wait while sufferers plumb these depths. We can now help alcoholics to see where they are headed - before they "hit bottom." In consequence, half of today’ s membership in A.A. is composed of milder cases. Very often, the family, the job, and the victim’s health are relatively unimpaired. Even potential cases are today approaching us, people who have suffered only a little. Here and abroad, too, our Society is making much headway in crossing every barrier of race, creed and circumstance.
Yet we must humbly reflect that Alcoholics Anonymous has so far made only a scratch upon the total problem of alcoholism. Here in the United States, we have helped to sober up scarcely five per cent of the total alcoholic population of 4,500,000.
The reasons are these; We can’t deal with alcoholics who are too psychopathic or brain-damaged; many alcoholics don’t like our methods and they look for an easier or different way; millions still cling to the rationalization that their troubles are wholly due to their personal circumstances and are therefore somebody else’s fault. To get the alcoholic or the potential alcoholic to admit that he is the victim of an often fatal and progressive malady is usually a very difficult matter. This is the big problem that still faces all of us, whether physicians, clergymen, families or friends. However, there is much reason to hope. One of the greatest reasons for hope lies in what you physicians are already doing - and may still do. Perhaps some of you may be asking, "How can we help still more effectively?"
Here we A.A.s can offer nothing authoritative, but we do feel that we can make some helpful suggestions. Consider the family physician. Only a few years ago, a drunk was mostly a nuisance. The physician and the hospital could get him over rough hangovers. A little comfort might be afforded the family, but little else could be done.
Now the situation is different. Nearly every city and hamlet in this country has an A.A. group. Yet all too often, the alcoholic will not try A.A. This is just where the family physician can so often step in. He is the one usually called upon when real trouble starts to loon. After getting the victim sobered up and the family quieted down, he can frankly tell the alcoholic what ails him. He can do the same thing for his patients that Carl Jung did for "Mr. R." and that Dr. Silkworth did for me. This is to make it clear to the reluctant drunk that he has contacted a progressive and often fatal malady, that he can’t get well by himself, that he needs lots of help. Since a great deal is known today about the emotional and metabolic deficiencies of the alcoholic, family physicians can document their presentation in a far more convincing manner than could our early pioneer doctors.
It is very gratifying to know that today the subject of alcoholism is being taught in many of our medical schools. In any case, the facts about alcoholism are easy to obtain. Organizations like the National Council on Alcoholism, the Yale School of Alcoholic Studies, plus innumerable state rehabilitation and clinical efforts, are ready sources of helpful knowledge. So armed, the family physician can - as we say in A.A. "soften" up the drunk so that he will be willing to take a look at our Fellowship. Or if he balks at A.A., he may be directed to a clinic, a psychiatrist, or to an understanding pastor. At this stage, the main thing is that he recognize his illness and that he start to do something about it.
If the family physician’s job is carefully done, the results are almost immediate. If the first attempt doesn’t work, the chances are better than even that persistent and successive approaches will bring results. These simple procedures do not rob the family physician of much time, nor will they be necessarily hard on the patient’s pocketbook. A concerted effort of this sort by family physicians everywhere could not fail to achieve immense results. In fact, the effect of the family physician’s work of this sort has already been great. And for this, I would like to set on our record the very special thanks of AA to them.
Now we come to the specialist, usually the psychiatrist. I’m glad to say that psychiatrists in great numbers are referring alcoholics to A.A., even psychiatrists who more or less specialize on alcoholics. Their understanding of alcoholics is now great. Their patience and their tolerance of us, and of AA, has been monumental.
In 1949, for example, the American Psychiatric Association allowed me to read a paper on AA before a section of its Annual Meeting. As these doctors specialize in emotional disorders - and alcoholism is certainly one of them -this act of theirs has always seemed to me a wonderful example of fine humility and generosity. The reprints of even that one paper have had a vast effect, world-wide. I’m sure that we A.A.s have never been sufficiently appreciative of all of this. It used to be the fashion among some of us in A.A. to decry psychiatry, even medical aid of any description, save that barely needed for sobering up. We pointed to the failures of psychiatry and of religion. We were apt to thump our chests and exclaim, "Look at us. We can do it, but they can’t." It is therefore with great relief that I can report this to be a vanishing attitude. Thoughtful AA members everywhere realize that psychiatrists and physicians helped to bring our Society into being in the first place and have held up our hands ever since.
We also realize that the discoveries of the psychiatrists and the biochemists have vast implications for us alcoholics. Indeed, these discoveries are today far more than implications. Your President and other pioneers in and outside your Society have been achieving notable results for a long time, many of their patients having made good recoveries without any A.A. at all. It should here be noted that some of the recovery methods employed outside A.A. are quite in contradiction to AA principles and practice. Nevertheless, we of AA ought to applaud the fact that certain of these efforts are meeting with increasing success.
We know, too, that psychiatry can often release the big neurotic overhang from which many of us suffer after A.A. has sobered us. We know that psychiatrists have sent us innumerable alcoholics who would have never otherwise approached AA, and many clinics have done likewise. We clearly see that by pooling our resources we can do together what could never be accomplished in separation; or in short-sighted criticism and in competition.
Therefore I would like to make a pledge to the whole medical fraternity that AA will always stand ready to cooperate, that A.A. will never trespass upon medicine, that our members who feel the call will increasingly help in those great enterprises of education, rehabilitation and research which are now going forward with such promise.
So menacing is the growing spectacle of alcoholism that nothing short of the total resources of society can hope to vanquish or much lessen the strength of our very dangerous adversary, John Barleycorn. The subtlety and power of the alcoholic’s malady is revealed on every page of mankind’s history - and never so starkly and so destructive as in this century.
When our combined understanding and knowledge have been fully massed and applied, we of AA know that we shall find our friends of medicine in the very front rank - just where so many of you are already standing today.
When such an array of benign and cooperative action is in full readiness, it can, and will surely be, a great tomorrow for that vast host of men who suffer from alcoholism, and from all its dark and baleful consequences.