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Slips
and Human Nature
by
William Duncan Silkworth, M.D.
The mystery of slips is not so deep as
it may appear. While it does seem odd that an alcoholic,
who has restored himself to a dignified place among his
fellowmen and continues dry for years, should suddenly throw
all his happiness overboard and find himself again in mortal
peril of drowning in liquor, often the reason is simple.
People are inclined to say, "there
is something peculiar about alcoholics. They seem to be
well, yet at any moment they may turn back to their old
ways. You can never be sure."
This is largely twaddle. The alcoholic
is a sick person. Under the technique of Alcoholics Anonymous
he gets well - that is to say, his disease is arrested.
There is nothing unpredictable about him any more than there
is anything weird about a person who has arrested diabetes.
Let's get it clear, once and for all,
that alcoholics are human beings. Then we can safeguard
ourselves intelligently against most slips.
In both professional and lay circles,
there is a tendency to label everything that an alcoholic
may do as "alcoholic behavior." The truth is,
it is simple human nature.
It is very wrong to consider any of the
personality traits observed in liquor addicts as peculiar
to the alcoholic. Emotional and mental quirks are classified
as symptoms of alcoholism merely because alcoholics have
them, yet those same quirks can be found among non-alcoholics
too. Actually they are symptoms of mankind!
Of course, the alcoholic himself tends
to think of himself as different, somebody special, with
unique tendencies and reactions. Many psychiatrists, doctors,
and therapists carry the same idea to extremes in their
analyses and treatment of alcoholics.
Sometimes they make a complicated mystery
of a condition which is found in all human beings, whether
they drink whiskey or buttermilk.
To be sure, alcoholism, like every other
disease, does manifest itself in some unique ways. It does
have a number of baffling peculiarities which differ from
those of all other diseases.
At the same time, any of the symptoms and much of the behavior
of alcoholism are closely paralleled and even duplicated
in other diseases.
The slip is a relapse! It is a relapse
that occurs after the alcoholic has stopped drinking and
started on the A.A. program of recovery. Slips usually occur
in the early states of the alcoholic's A.A. indoctrination,
before he has had time to learn enough of the A.A.
techniques and A.A. philosophy to give him a solid footing.
But slips may also occur after an alcoholic has been a member
of A.A. for many months or even several years, and it is
in this kind, above all, that often finds a marked similarity
between the alcoholic's behavior and that of "normal"
victims of other diseases.
No one is startled by the fact that relapses
are not uncommon among arrested tubercular patients. But
here is a startling fact - the cause is often the same as
the cause which leads to slips for the alcoholic.
It happens this way: When a tubercular
patient recovers sufficiently to be released from the sanitarium,
the doctor gives him careful instructions for the way he
is to live when he gets home. He must drink plenty of milk.
He must refrain from smoking. He must obey other stringent
rules.
For the first several months, perhaps
for several years, the patient follows directions. But as
his strength increases and he feels fully recovered, he
becomes slack. There may come the night when he decides
he can stay up until ten o'clock. When he does this, nothing
untoward happens. Soon he is disregarding the directions
given him when he left the sanitarium. Eventually he has
a relapse.
The same tragedy can be found in cardiac
cases. After the heart attack, the patient is put on a strict
rests schedule. Frightened, he naturally follows directions
obediently for a long time. He, too, goes to bed early,
avoids exercise such as walking upstairs, quits smoking,
and leads a Spartan life. Eventually, though there comes
a day, after he has been feeling good for months or several
years, when he feels he has regained his strength, and has
also recovered from his fright. If the elevator is out of
repair one day, he walks up the three flights of stairs.
Or he decides to go to a party - or do just a little smoking
- or take a cocktail or two. If no serious aftereffects
follow the first departure from the rigorous schedule prescribed,
he may try it again, until he suffers a relapse.
In both cardiac and tubercular cases,
the acts which led to the relapses were preceded by wrong
thinking. The patient in each case rationalized himself
out of a sense of his own perilous reality. He deliberately
turned away from his knowledge of the fact that he had been
the victim of a serious disease. He grew overconfident.
He decided he didn't have to follow directions.
Now that is precisely what happens with
the alcoholic - the arrested alcoholic, or the alcoholic
in A.A. who has a slip. Obviously, he decides to take a
drink again some time before he actually takes it. He starts
thinking wrong before he actually embarks on the course
that leads to a slip.
There is no reason to charge the slip
to alcoholic behavior or a second heart attack to cardiac
behavior. The alcoholic slip is not a symptom of a psychotic
condition. There's nothing screwy about it at all. The patient simply
didn't follow directions.
For the alcoholic, A.A. offers the directions.
A vital factor, or ingredient of the preventive, especially
for the alcoholic, is sustained emotion. The alcoholic who
learns some of the techniques or the mechanics of A.A. but misses
the philosophy or the spirit may get tired off following
directions - not because he is alcoholic, but because he
is human. Rules and regulations irk almost anyone, because
they are restraining, prohibitive, negative. The philosophy
of A.A. however, is positive and provides ample sustained
emotion - a sustained desire to follow directions voluntarily.
In any event, the psychology of the alcoholic
is not as different as some people try to make it. The disease
has certain physical differences, yes, and the alcoholic
has problems peculiar to him, perhaps, in that he has been put
on the defensive and consequently has developed frustrations.
But in many instances, there is no more reason to be talking
about "the alcoholic mind" than there is to try
to describe something called "the cardiac mind"
or the "TB mind."
I think we'll help the alcoholic more
if we can first recognize that he is primarily a human being
- afflicted with human nature.
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