Fact-Checking the Doctor's Opinion: The Legend vs. The Record
To me, facts matter. They make our program better.
My home group is a Big Book meeting. Each week we read a chapter from the Big Book, starting in the roman numerals and ending at page 164, except for the last week of the month where we read a story. If you hang out at our meeting long enough, you’ll read through the whole book.
Over nearly 12 years, I’ve read through this book dozens of times.
Last Monday, we read “The Doctor’s Opinion.” If you don’t know, it’s the chapter dedicated to Doctor William Silkworth, the man who treated Bill W. at Towns Hospital. The purpose of the chapter is to tell the sober curious individual that he has a disease, not a moral failing. To underscore the point, Dr. Silkworth states that the nature of the disease is an “allergy” of the mind and body. According to AA legend, Dr. Silkworth initially withheld his name from the Doctor’s Opinion because he was concerned about sanction from the American Medical Association. It wasn’t a mainstream view at the time that alcoholism was a disease. This legend is repeated by Joe and Charlie and their Big Book Study Guides, where the two “shared the history of AA.”
But here’s the problem: In March 1937—two years before the Big Book was published—Dr. Silkworth published his theories under his own name in the Medical Record, a peer-reviewed medical journal. The article, ‘Alcoholism As A Manifestation of Allergy,’ and Reclamation of the Alcoholic presented the same controversial ‘allergy theory’ that appears in the Doctor’s Opinion, just in greater medical detail. His name and credentials were right there: ‘W. D. Silkworth, M.D., Chief of Staff, Charles B. Towns Hospital, New York, N.Y.’
If Silkworth was truly worried about AMA sanctions for his controversial medical theory, why would he have already published it in a medical journal two years earlier?
While the exact dates are unclear, Silkworth appears to have worked at Towns Hospital from around 1932 until his death in 1951.
I bring this up because I’m a stickler for facts, not just legends. I’m not wedded to the idea that the roman numerals through page 164 should remain as is. I believe there should be changes and additions as the facts warrant.
“But Matt! The book works! For nearly 100 years, Alcoholics Anonymous has gotten more people sober than anything else! Don’t fix what ain’t broken!”
If you went to your doctor with the flu and they prescribed the same treatment from 1939, would you feel confident in that care?
I’m not suggesting we delete Dr. Silkworth’s contribution—it was revolutionary for its time. But I’d love to see his work supplemented with an addendum containing current medical understanding of alcoholism.
I’m not going to hold my breath on this one. I know I’m in the minority. Scientific breakthrough is never based on something totally different but on the foundation of what we learned before. These breakthroughs are incremental progress. I’d hate for us to miss something that might make the 12 steps even more effective.
The irony is that Dr. Silkworth himself understood this principle. He built his allergy theory on the work of Professor Bechhold and other scientists who came before him. He would likely appreciate efforts to refine and improve our understanding of alcoholism based on newer research.
I don’t want you to miss the takeaway that Dr. Silkworth leaves us. Alcoholism is a disease. Something happens inside your body that makes you, the alcoholic, susceptible to addiction that doesn’t affect the normal drinker the same way. It’s not a moral failing. You are not a bad person because you can’t stop drinking. You need medical intervention and a recovery program. So don’t be hesitant to find help because you feel it is only reinforcement that you ARE a problem instead of the truth, that you HAVE a problem.
On that, we can agree.