Dr. William Silkworth (1873 – 1951) was the Medical Director at the Towns Hospital and treated Bill W and other early members of AA. He was the first 20th century physician to advocate that alcoholism is an illness, rather than a vice or moral failing. He, probably more than anyone else, is responsible for Step 1 of the 12 Steps (The Origins of the 12 Steps). He also wrote “The Doctor’s Opinion” in Alcoholics Anonymous. This article was first published in 1947 in the AA Grapevine.
Doctor Calls “Slip” More Normal Than Alcoholic
By Dr. William Silkworth
THE mystery of slips is not so deep as may appear. While it does seem odd that an alcoholic who has restored himself to a dignified place among his fellow-men, and continued 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 very simple.
People are inclined to say: “There is something peculiar about alcoholics. They may 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 techniques 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 just like other human beings – then we can safeguard ourselves intelligently against most of the slips.
Both in professional and lay circles, there is a tendency to label everything that an alcoholic may do as “alcoholic behavior.” The truth is, it is simply human nature!
It is very wrong to consider many 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 nonalcoholics, too. Actually they are symptoms of mankind!
Of course, the alcoholic himself tends to think of himself as different; someone 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.
The patient must have full knowledge of his condition, keep in mind the facts of his case and the nature of his disease and follow directions.
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 all other diseases. At the same time, many of the symptoms and much of the behavior of alcoholism are closely paralleled and even duplicated in other diseases.
The alcoholic “slip,” as it is known in Alcoholics Anonymous, furnishes a perfect example of how human nature can be mistaken for alcoholic behavior.
The “slip” is a relapse! It is a relapse that occurs after the alcoholic has stopped drinking and started on the AA program of recovery. “Slips” usually occur in the early stages of the alcoholic’s AA indoctrination, before he has had time to learn enough of the AA technique and AA philosophy to give him solid footing. But “slips” may also occur after an alcoholic has been a member of AA for many months, or even several years, and it is in this kind, above all, that one finds a marked similarity between the alcoholic’s behavior and “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 directions for the way he is to live when he gets home. He must be in bed every night by, say, 8 o’clock. 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 10 p.m. When he does this, nothing untoward happens. The next day he still feels good. He does it again. 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 rest schedule. Frightened, he naturally follows directions obediently for a long time. He, too, goes to bed early, avoids exercise such as walking up stairs, 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 after-effects follow the first departure from the rigorous schedule prescribed he may try it again, until he suffers a relapse.
In both cardiac and the 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 this knowledge of the fact 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 AA – who has a “slip.” Obviously he decides again to take a drink sometime before he actually takes it. He starts thinking wrong before he actually embarks on the course that leads to a “slip.”
There is no more reason to charge the “slip” to alcoholic behavior than there is to lay a tubercular relapse to tubercular 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.
And that’s human nature! It’s life! It’s happening all the time, not merely among alcoholics but among all kinds of people.
The preventative is plain. The patient must have full knowledge of his condition, keep in mind the facts of his case and the nature of his disease and follow directions.
For the alcoholic, AA offers the directions. A vital factor, or ingredient, of the preventative, especially for the alcoholic, is sustained emotion. The alcoholic who learns some of the technique or the mechanics of AA but misses the philosophy or the spirit may get tired of 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 AA, 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 nervous 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 t.b. 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!
Copyright © The AA Grapevine Inc. January 1947. Reprinted with permission.