American Journal of Psychiatry, Vol. 106, 1949
By Bill W.
Alcoholics Anonymous is grateful for this invitation to appear before The American Psychiatric Association. It is a most happy circumstance. Being laymen we have naught but a story to tell, hence the quite personal and unscientific character of this narrative. Whatever their deeper implications the attitudes and events leading to the formation of Alcoholics Anonymous are easy to portray.
Two alcoholics talk across a kitchen table. One is drinking, the other is not. Severe chronics, the threat of commitment hangs over both. The time is November 1934. The active drinker became, years later, the writer of this paper. My sober visitor was an old friend and schoolmate, long catalogued by physicians and family as hopeless. I enjoyed the same rating and well knew it.
My friend had arrived to tell me how he had been released from alcohol. In truth, the quality of his sobriety seemed "different." Having made contact with the Oxford Group, a nondenominational, evangelical movement, my friend had been specially impressed by an alcoholic he had met, a former patient of C. G. Jung. Unsuccessfully treating this individual for a year, Dr. Jung had finally advised him to try religious conversion as his last chance. While disagreeing with many tenets of the Oxford Group, my former schoolmate did, however, ascribe his new sobriety to certain ideas that this alcoholic and other Oxford people had given him. The particular practices my friend had selected for himself were simple:
1. He admitted he was powerless to solve his own problem.
2. He got honest with himself as never before; made an examination of conscience.
3. He made a rigorous confession of his personal defects.
4. He surveyed his distorted relations with people, visiting them to make restitution.
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 sought God’s direction for his life and help to practice these principles at all times.
This sounded pretty naive to me. Nevertheless my friend stuck to the plain tale of what had happened - no evangelizing. He related how practicing these precepts, his drinking had unaccountably stopped. Fear and isolation left and he had received considerable peace of mind. With no hard disciplines nor any great resolves, these attributes began to appear the moment he conformed. His release was a byproduct. Though sober but months, he felt he had a basic answer. Wisely avoiding any argument, he then took leave. The spark that was to become Alcoholics Anonymous had been struck.
What then did happen at the kitchen table? Perhaps this speculation were better left to medicine and religion. I confess I do not know. Possibly conversion will never be fully understood.
Looking outward from such an experience, I can only say with fidelity what seemed to happen. Yet something did happen that instantly changed the current of my life. I haven’t had a drink for over fourteen years. All else will be mere personal opinion—or just fancy.
My friend’s story had generated mixed emotions; I was drawn and revolted by turns. My solitary drinking went on, 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 medicos. Third, that those age-old precepts, when transmitted by him, had struck me with great power. Fourth, that I could not, and would not, go along with any God concept. No conversion nonsense for me. Thus did I ponder. 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 shall not break away.
One morning after my gin a realization welled up. "Who are you," I asked, "to choose how you are going to get well? Beggars are not chooser’s. Suppose 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 didn’t stop them, and you thought conversion could, your pride would fly away. You would soon stand in public squares crying "Amen" among 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. W.D. Silkworth, shook his head. Soon free of sedation and alcohol, I felt horribly depressed. My alcoholic friend turned up. Though glad to see him, I shrank a little. I feared evangelism. Nothing of the sort happened. After small talk, I again asked him about the Oxford Groups. Quietly, sanely enough, he told me, and then departed.
Lying there in conflict, I dropped into a black depression. Momentarily my prideful obstinacy was crushed. I cried out, "Now I’m ready to do anything - anything to receive what my good friend has." Expecting naught, I made this frantic appeal: "If there be a God, will he show himself!" The result was instant, electric, beyond description. The place lit up, blinding white. I knew only ecstasy and seemed on a mountain. A great wind blew, enveloping and permeating me. It was not of air, but of Spirit. Blazing, came the tremendous thought, "You are a free man!" Then ecstasy subsided. Still on the bed I was now in another world of consciousness which was suffused by a Presence. One with the Universe, a great peace stole over me and I thought, "So this is the God of the preachers; this is the Great Reality." But reason returned, my modern education took over. Obviously I had gone crazy. I became terribly frightened.
Dr. Silkworth came in to hear my trembling account of the phenomenon. He assured me I was not mad; that I had perhaps undergone an experience which might solve my problems. Skeptical man of science he then was; this was most kind and astute. If he had said "hallucination" I might now be dead. To him I shall be eternally grateful.
Good fortune pursued me. Somebody brought a book entitled "Varieties of Religious Experience" and I devoured it. Written by James, the psychologist, it suggests that conversion can have objective reality. Conversion does not alter motivation, and does semi-automatically enable a person to be and do the formerly impossible. Significant it was, that marked conversion experiences come mostly to individuals who know complete defeat in a controlling area. The book certainly showed variety. But bright or dim, cataclysmic or gradual, theological or intellectual in bearing, such conversions did have common denominators, they did change utterly defeated people. And so declared William James. The shoe fitted. I have tried to wear it ever since. For drunks, the obvious answer was deflation at depth and more of it. That seemed plain as a pikestaff. I had been trained as an engineer, so the views of this authoritative psychologist meant everything to me.
Armored now by utter conviction and fortified by my characteristic power drive, I took off to cure alcoholics wholesale. It was twin jet propulsion; difficulties meant nothing. The vast conceit of my project never occurred to me. I pressed my assault for six months; my home was filled with alcoholics. Harangues with scores produced not the slightest result. None of them got it. Disappointingly, 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 endless backslides later on. For I had found that working with alcoholics had a huge bearing on my own sobriety. But why wouldn’t any of my new prospects sober up?
Slowly the bugs came to light. Like a religious crank, I was obsessed with the idea that everybody must have a "spiritual experience" just like mine. I’d forgotten that there were many varieties. So my brother alcoholics just stared incredulously or kidded me about my "hot flash." This had spoiled the potent identification so easy to get with them. I had turned evangelist. Clearly the deal had to be streamlined. What came to me in six minutes might require six months in others. It was to be learned that words are things, that one must be prudent. It was also certain that something ailed the deflationary technique. It definitely lacked wallop. Reasoning that the alcoholics s "hex," or compulsion, must issue from some deep level, it followed that ego deflation must also go deep or else there couldn’t be any fundamental release. Apparently religious practice would not touch the alcoholic until his underlying situation was made ready. Fortunately all the tools were right at hand. You doctors supplied them.
The emphasis was straightway shifted from "sin" to "sickness" - the "fatal malady," alcoholism. We quoted doctors that alcoholism was more lethal than cancer; that it consisted of an obsession of the mind coupled to increasing body sensitivity. These were our Twin Ogres of Madness and Death. We leaned heavily on Dr. Jung’s statement how hopeless the condition could be and then poured that devastating dose into every drunk within range. To modern man science is omnipotent; it is a god. Hence if science would pass a death sentence on the drunk, and we placed that verdict on our alcoholic transmission belt, it might shatter him completely. Perhaps he would then turn to the God of the theologian, there being no place else to go. Whatever the truth in this device, it certainly had practical merit. Immediately our whole atmosphere changed. Things began to look up
Bankrupt at the time, I stumbled into a business venture. It took me to Akron, Ohio, where the deal quickly collapsed leaving me dispirited. Alone, I panicked in fear of getting drunk. This was something new for I realized that I hadn’t thought of drinking since the December 1934 experience. I could now see my peril clearly and thus brush off the usual rationalizations. With relief, I perceived that my new spiritual conditioning really meant something now that the heat was on. But that didn’t stop the compulsive up rush of drinking desire. I needed to talk to another alcoholic, and quickly.
Shortly I was introduced to Dr. Robert S., a surgeon. He was an alcoholic in a bad way. This time there was no preachment from me. I told him my experience and what I thought I knew about alcoholism. Needing him as much as he did me, there was a genuine mutuality for the first time and, as we now say in A.A., he soon "clicked" never to drink again. That was June 1935. We began to spend long hours on drunks at a local hospital. One of them is sober yet, no relapse. Though nameless, the first A.A. Group had actually started. Dr. S. has since hospitalized some 4,000 cases at Akron. The bulk have recovered. All this too without a cent of monetary return to him. Thus he became co-founder of Alcoholics Anonymous. As I left Akron in September 1935 three alcoholics were staying sober. Arrived at New York, I set to work and another A.A. group took shape. But nothing was very sure; we still flew blind.
It was soon necessary to retire from the Oxford Group. The good people there had disapproved us. For our purpose, the Oxford Group atmosphere wasn’t entirely right. Their demands for absolute moral rectitude encouraged guilt and rebellion. Either will get alcoholics drunk, and did. As nonalcoholic evangelists, they couldn’t understand that. Good friends these, we owed them much. From them we had learned what, and what not, to do.
Then commenced a 3 year season of trial and error eventuating in our textbook, "Alcoholics Anonymous," published in 1939. That book, now backbone of our A.A. society, opens with a typical story of drinking and recovery. Next comes a chapter of hope, entitled "There Is A Solution." In A.A. vernacular two chapters describe alcoholism and the alcoholic, their object being of course to first identify and then deflate. A chapter is devoted to softening up the agnostic. This leads to the "Twelve Steps" of present-day Alcoholics Anonymous. The heart of our therapy, and a practical way of life, these "Steps" are little but an amplified and streamlined version of the principles enumerated by my friend of the kitchen table.
The balance of the text is mostly devoted to practical application of these "Twelve Steps," and to reducing the inner resistance’s of the reader. Working with other alcoholics is very heavily emphasized. Chapters are devoted to wives, family relations, and employers. The final chapter pictures the new society and begs the recovered alcoholic to form a group himself. This ideology is then shored up by 30 case histories, or rather stories, written by A.A. members. These complete the identification and stir hope. The 400 pages of "Alcoholics Anonymous ‘‘ contain no theory; they narrate experience only.
When the book appeared in April 1939, we had about 100 members. One third of these had impressive sobriety records. The movement had spread to Cleveland and drifted toward Chicago and Detroit. In the East it inclined to Philadelphia and Washington. There was an extraordinary event at Cleveland. The Plain Dealer published strong pieces about us backed by editorials. A barrage of telephone calls descended on 20 A.A. members, mostly new people. A.A. book in hand, they took on all comers. New members worked with the still newer. Two years later, Cleveland had garnered by this chain reaction hundreds of new members. The batting average was excellent. It was our first evidence that we might digest huge numbers rapidly.
Then came great national publicity. The Saturday Evening Post piece (March 1941) shot thousands of frantic inquiries into our tiny New York office. This gave us lists of alcoholics in hundreds of cities. Business men traveling out of established A.A. centers used these names to start new groups. By sending literature and writing often, A.A. groups sprung up by mail. With no personal contact whatever, this was astounding. Clergy and medical men began to give their approval. I wish to say that Dr. Harry Tiebout, chairman of our discussion today, was the first psychiatrist ever to observe and befriend us. Alcoholics Anonymous mushroomed. The pioneering had ended. We were on the U.S. map.
As of 1949 our quantity results are these. The 14-year-old society of Alcoholics Anonymous has 80,000 members in about 3,000 groups. We have entered into 30 foreign countries and U.S. possessions; translations are going forward. By occupation we are an accurate cross section of America. By religious affiliation we are about 40% Catholic; nominal and active Protestants, also many former agnostics, and a sprinkling of Jews comprise the remainder. Ten to 15% are women. Some Negroes are recovering without undue difficulty. Top medical and religious endorsements are almost universal. A.A. membership is pyramiding, chain style, at the rate of about 30% a year. During 1949, we expect 20,000 permanent recoveries, at least. Half of these will be medium or mild cases (average age about 36) a fairly recent development.
Of alcoholics who stay with us and really try, 50% get sober at once and stay that way, 25% do so after some relapses and the remainder usually show improvement. But many problem drinkers do quit A.A. after a brief contact, maybe three or four out of five. Some are too psychopathic or damaged. But the majority have powerful rationalizations yet to be broken down. Exactly this does happen providing they get what A.A. calls a "good exposure," on first contact. Alcohol then builds such a hot fire that they are finally driven back to us, often years later. They tell us that they had to return; it was A.A, or else. They had learned about alcoholism from alcoholics; they were hit harder than they had known. Such cases leave us the agreeable impression that half our original exposures will eventually return, most of them to recover. So we just indoctrinate the newcomer. We never evangelize; Barleycorn will look after that. The clergy declare we have capitalized the Devil. These claims are considerable but we think them conservative. The ultimate recovery rate will certainly be larger than once supposed.
Such is a glimpse of our origin, central therapeutic idea, and quantity result. The qualitative result is assuredly too large a subject for this paper.
Alcoholics Anonymous is not a religious organization; there is no dogma. The one theological proposition is a "Power greater than one’s self." Even this concept is forced on no one. The newcomer merely immerses himself in our society and tries the program as best he can. Left alone, he will surely report the gradual onset of a transforming experience, call it what he may. Observers once thought A.A. could appeal only to the religiously susceptible. Yet our membership includes a former member of the American Atheist Society and about 20,000 others almost as tough. The dying can become remarkably open minded. Of course we speak little of conversion nowadays because so many people really dread being God-bitten. But conversion, as broadly described by James, does seem to be our basic process; all other devices are but the foundation. When one alcoholic works with another, he but consolidates and sustains that essential experience.
The forces of anarchy, democracy, and dictatorship play impressive roles in the structure and containment of our society; Barleycorn the Tyrant Dictator is quite impersonal. But Hitler never did have a Gestapo half so effective. When the anarchy of the alcoholic faces his tyrant, that alcoholic must become a social animal or perish. Perforce, our society has settled for the purest kind of democracy. Naturally, the explosive potential of our rather neurotic fellowship is enormous. As elsewhere, it gathers closely around those eternal provocateurs: power, money and sex. Throughout A.A. these subterranean volcano’s erupt at least a thousand times daily; explosions we now view with some humor, considerable magnanimity, and little fear at all. We think them valuable object lessons for development. Our deep kinship, the urgency of our mission, the need to abate our neurosis for contented survival; all these , together with love for God and man, have contained us in surprising unity. There seems safety in numbers. Enough sand bags muffle any amount of dynamite. We think we are a pretty secure, happy family. Drop by any A.A. meeting for a look.
But, there isn’t the slightest evidence that violent neurosis, drunkenness, or lunacy is to be the destiny of Alcoholics Anonymous. Such dark forecasts have not materialized.
Many an alcoholic is now sent to A.A. by his own psychiatrist. Relieved of his drinking, he returns to the doctor a far easier subject. Practically every alcoholic’s wife has become, to a degree, his possessive mother. Most alcoholic women, if they still have a husband, live with a baffled father. This sometimes spells trouble aplenty. We A.A.’s certainly ought to know! So, gentlemen, here is a big problem right up your alley.
Now to conclude: We of A.A. try to be aware that we may never touch but a segment of the total alcohol problem. We try to remember that our growing success may prove a heady wine; that our own resources will always be limited. So then, will you men and women of medicine be our partners; physicians wielding well your invisible scalpels; workers all, in our common cause? We like to think Alcoholics Anonymous a middle ground between medicine and religion, the missing catalyst of a new synthesis. This to the end that the millions who still suffer may presently issue from their darkness into the light of day!
I am sure that none, attending this great Hall of Medicine will feel it untoward if I leave the last word to our silent partner, Religion:
God grant us the serenity to accept the things we cannot change, courage to change the things we can, and wisdom to know the difference.
* Read at the 105th Annual Meeting of the American Psychiatric Association, Montreal, Quebec, May 23-27, 1949