William Duncan Silkworth
By bob k
The “Roaring Twenties” ended not with a bang, but a whimper, as the stock market crash of 1929 plunged America into the darkness of the Great Depression. Throughout the twenties, and into the thirties, the “noble experiment” of national Prohibition was failing miserably.
The fundamental intention had been to curb drunkenness by outlawing liquor, but the very opposite was being realized. Drinking had achieved a certain “cachet,” as otherwise respectable citizens visited speakeasies, and made bathtub gin at home. “In many circles, it was chic to drink and get drunk and outwit the authorities.” (Getting Better – Inside Alcoholics Anonymous, Nan Robertson, p. 43)
Gangsters amassed huge fortunes on bootlegging and smuggling. It was the heyday of organized crime. The base support for the forces of temperance fell away from beneath them, and in late 1933, the Eighteenth Amendment was repealed.
Drinking was accepted, and again legitimized in American culture. Drunkards were not. “Chronic alcoholism was considered to be a moral weakness, or a sin. Seemingly hopeless alcoholics like Bill Wilson received little understanding and compassion.” (Getting Better, p. 43) The idea of alcoholism as an illness, so ubiquitous in the twenty-first century, had little support in the pre-AA era in spite of being proposed by eminent physicians such as Scotland’s Thomas Trotter, and American Founding Father, Benjamin Rush.
Another significant event occurred towards the end of 1933. The future founder of Alcoholics Anonymous was admitted to a detox center for the well-heeled. “Charles B. Towns Hospital, 293 Central Park West… founded in 1901, was well known then as a rich man’s drying-out place; a rehab for the wealthy, and it served a worldwide clientele. American millionaires, European royalty and oil sheiks from the middle east walked its halls, side by side: brothers in humiliation in bathrobes and slippers.” (The Round Table of AA History by Mike O., Silkworth.net)
The fees would have been well beyond the means of a struggling Lois Wilson and her husband, but the visit was “sponsored” by Leonard Strong, a New York physician married to Bill’s sister, Dorothy. There would be three more “Towns cures” in 1934, and mother Emily was also canvassed to contribute. The chief physician at Towns was William Duncan Silkworth.
Neurology and Psychiatry
Regarding the history of “the little doctor who loved drunks,” there is some disagreement, even as to the year of his birth, which most likely was 1873. It is known that he attended Princeton, achieving an AB degree in 1896. He graduated from NYU – Bellevue Medical School in 1899. During his internship at Bellevue, he discovered a flair for working with drunks.
Called simply a “medical doctor” in the Big Book, “Pass It On” says he “became a specialist in neurology, a domain that sometimes overlaps psychiatry” (p. 101), and that he entered private practice in the 1920s. Ernest Kurtz calls him a “neuro-psychiatrist.”
“Silkworth’s entire career had a psychiatric emphasis. He was a member of the psychiatric staff at the US. Army Hospital in Plattsburgh, New York, for two years (1917-1919) during World War I.” (Mike O., Silkworth.net)
It is most likely that he “served as associate physician at the Neurological Institute of Presbyterian Hospital in Manhattan from 1919 to 1929. He had also been connected with Broad Street Hospital.” (Mike O., Silkworth. net)
His start date at Towns Hospital is inconsistently reported as 1924 (Kurtz), 1930 (Pass It On), or 1932 (various sources). It seems most credible that Silkworth was laid off by Presbyterian after the market crash of 1929, an event which also vaporized his savings, and that he came to Towns in, or after, 1930.
“The pay was pitiful, something like $40. a week and board.” (Pass It On, p. 101) Lois Wilson was making half that as a store clerk.
In the twenty-first century, most people know that alcoholics need to maintain total abstinence to prevail over their drinking problem. Not so, eighty years ago. The ideas that alcoholism was a “disease entity”, and that complete sobriety was necessary, had been proffered much earlier in America by onetime Surgeon General, Benjamin Rush, but such hypotheses gained very little acceptance. ”As far as the temperance movement was concerned, alcoholism was a moral failing, and it vigorously opposed the disease concept of alcoholism.” (Bill W., Francis Hartigan, p. 51) It was not commonly known at the time that the standard advice “Buck up, man, and drink like a gentleman,” was an impossible prescription for a certain element of the population to follow.
Illness Not Sin
Wilson, much later, would write of Silkworth, “From him we learned the nature of our illness: the obsession of the mind that compels us to drink and the allergy of the body that condemns us to go mad or die.” (Alcoholics Anonymous Comes Of Age, p. 13) “For the first time in his life, Bill was hearing about alcoholism not as a lack of willpower, not as a moral defect, but as a legitimate illness.” (Pass It On, p. 102)
“The gentle little man explained (to Lois) that my drinking, once habit, had become an obsession, a true insanity that condemned me to drink against my will.” (AACOA, p. 52) This new information provoked a period of sobriety that Bill reported as two to four months, but Lois remembered as about a month.”
The examples in “More About Alcoholism” reinforce the notion that awareness alone is insufficient. “But the actual or potential alcoholic, with hardly any exception, will be absolutely unable to stop drinking on the basis of self-knowledge. This is a point we wish to emphasize and re-emphasize, to smash home upon our alcoholic readers as it has been revealed to us out of bitter experience.” (AA Big Book, p. 39)
So Bill Wilson had some additional benders, doozies by all accounts, but his drinking would end before Christmas of 1934.
Validating the “Hot Flash”
By the time of Bill Wilson’s fourth confinement at Towns Hospital, he had been approached by Ebby, and been presented with the “I’ve got religion” message. As abhorrent as these ideas were to him, there was no denying that his one-time schoolmate was sober, that “he was on a different footing. His roots grasped a new soil.” (BB, p. 12)
The most extreme desperation opened Bill to what William James would call “the pragmatic theory of truth.” If a religious experience could save him as it had his old friend, it had “utility,” and thus, was worth having.
Cue the bright light, the newfound confidence, and the cool wind a blowin.’ One of the delicious ironies, so entertaining to the cynical, is that in an earlier draught of “Bill’s Story,” the “hot flash” reputedly occurs in Bill’s kitchen, immediately after Ebby’s first visit. The amended version better fits the “as the result of these steps” storyline. It is also a superior timeline in that the original telling has Bill getting drunk several more times AFTER divine salvation! “He drank now as he never had.” (Bill W., Robert Thomsen, p. 196)
At the hospital, he was administered a drug cure concocted by Charles B. Towns, which included hallucinogens. “There is the possibility that his ‘hot flash’ may have been delusions and hallucinations characteristic of momentary alcoholic toxic psychosis.” (The Roots of Alcoholics Anonymous, Bill Pittman, p. 169)
Silkworth’s second great gift to AA, from Bill Wilson’s perspective was that the kindly doctor, a man of science, did not mock his debatable apparition. “’Whatever you’ve got now, you’d better hold onto. It’s so much better that what you had only a couple of hours ago.’ Coming from Silkworth, now a central figure in Bill’s life, this evaluation meant everything.” (Pass It On, pp. 123-124)
Intuitively, Bill Wilson knew that in and of itself, his “awakening” would be insufficient to maintain his sobriety. Wilson’s great insight was in recognizing the value of helping others, the principle which was to turn out to be the very core of AA, and its success.
Four years later, he described his early struggles – “I was not too well at the time, and was plagued with waves of self-pity and resentment. This sometimes nearly drove me back to drink, but I soon found that when all other measures failed, work with another alcoholic would save the day.” (BB, p. 15) And – “Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics.” (BB, p. 89)
Bill’s early evangelism of his newfound solution for a drinking problem was successful only in that it was keeping himself sober.
In the Spring of 1935, Dr. Silkworth stepped up with his third major contribution to what would become AA. “Stop preaching at them… and give them the hard medical facts first…Tell about the hopeless condition, a matter of life or death.” (AACOA, p. 13)
Dr. Bob Smith
Thus, it was a modified approach, directed by Silkworth’s counsel, that got Bob Smith’s attention, where a two and a half year exposure to the Oxford Group’s religious mumbo-jumbo had accomplished nothing for the Akron surgeon.
“Dr. Silkworth’s advice to Bill about talking with, rather that at, his prospects was important to the success of his encounter with Robert Smith… One thing Bob heard from Bill was the notion that alcoholism was not a sin, but an illness. This wasn’t what he was hearing from the Oxford Group.” (Hartigan, p. 82)
“He gave me information about the subject of alcoholism that was undoubtedly helpful. Of far more importance was the fact that he was the first living human with whom I had ever talked, who knew what he was talking about in regard to alcoholism from actual experience. In other words, he talked my language.” (Doctor Bob’s Nightmare, BB, p. 180)
Access to Prospects
Vital to Bill Wilson’s developing method of staying sober was the intensive effort to assist others. In Akron, this had come easily through Smith’s position as a physician with hospital privileges. Back in New York, Bill found some drunks with which to work, but a virtually unlimited supply was provided as Dr. Silkworth risked his professional reputation, in allowing Bill to approach the Towns clientele.
Through these auspices, Hank P. and Fitz M. were the earliest converts to the nascent movement. A couple of years later, Towns client, Jim B. would become a somewhat recalcitrant, but notable recruit.
Financing the Book Project
Bill Wilson and Hank Parkhurst developed some spectacular visions for expansion of their new methods of “curing” drunks. Dreams of Rockefeller millions danced in their heads, and yet the two sales dynamos were having enormous difficulty in raising the funds necessary to support the writing and publication of the book.
Again William Silkworth had a hand in overcoming this obstacle. That Charles B. Towns supplied $2,500, later increased to $4,000, was undoubtedly due in part to the urging of his chief physician.
As a salesman, Bill Wilson understood the value of “third party testimonials.” In spite of some undeniable successes, that a pack of drunks would seek to publish a book at such an early stage was at best ambitious, and possibly laughable.
An endorsement, at the very opening of their text, from “a well known doctor, chief physician at a nationally prominent hospital specializing in alcoholic and drug addiction.” (BB, 1st Edition, p. 1) contributed some desperately needed credibility.
The brevity of the initial letter provided is suggestive of a man who was both humble and diffident, antithetical to so many of his patients.
In the modern world, the good doctor’s use of the term “allergy” is under attack, as is the notion of alcoholism as a disease. In both cases, these are rather technical debates. We are given perspective in the wise words of Bill White – “Science is unlikely to destroy the popularity of the disease concept, but a better metaphor could.” (Slaying The Dragon, Second Edition, William L. White, p. 512)
Similarly, “allergy” when seen as an abnormal reaction, has explanatory value, even if alcoholism differs from other allergies in a strict diligence of science.
When one listens to psychiatrist, Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health since May 2003, one very much hears twenty-first century talk of alcoholism and addiction that is consistent with the speculations of Dr. Silkworth, many decades earlier. Modern brain imaging has proven that alcoholics are physically different from their peers. What Silkworth saw as a “mental obsession” is confirmed, as are its physical causes.
It has been variously estimated that “the little doctor who loved drunks” consulted with from 40,000 to 50,000 alcoholics. By his own modest admission, before AA, he saw his success rate as about two percent. This speaks to the insidiousness of alcoholism, and of the need for some sort of ongoing therapy, beyond the rehabilitation possible in a month, or a week.
For the starry-eyed fundamentalist there is an additional problem of accounting for the 400, 600, or 800 people who were successfully treated, with mere human power. The stock answer, of course, is that they weren’t “real” alcoholics, and thus without any qualm, they tarnish the legacy of a selfless man, one of our most substantial contributors.
William D. Silkworth remained a friend of AA, and he took joy in watching alcoholics helping each other at a rate his most diligent efforts had been unable to match. “Dr. Silkworth was a major influence in persuading the management of Knickerbocker Hospital in upper Manhattan to set aside a small ward, beginning in 1945, for the treatment of alcoholics. Knickerbocker was the first general hospital in New York to do so. (This is significant because many general hospitals at that time would not admit alcoholics as alcoholics. Their doctors had to admit them under false diagnoses.)… At Knickerbocker, drunks off the street with no financial resources were de-toxified.” (Mike O., Silkworth. net)
In 1950 and ‘51, Bill Wilson and some associates were raising funds so that “Silkie” and wife, Marie, could retire in New Hampshire, but, on March 22, 1951, AA’s “medical saint” died before that could happen. His most famous patient rounded up $25,000 to assist the widow through her remaining years.
“Silkworth had explained the mechanisms of the lock that held the alcoholic in prison.” (Thomsen, p. 204)
William Silkworth was at the forefront of those who effected a reversal in the prevalent view of alcoholism in America, and the world. We may argue the esoterica of “disease,” “disease entity,” “illness” and the like, but the views of alcoholism as a “moral failing,” a “willpower issue,” or a “sin”, are all but gone among the informed. Modern science continues to hammer nails into the “moral failing” coffin.
Only the religious ultra-right still talks of “sin.”
Er… I mean… whatevah!!
A paperback version of Key Players in AA History is available at Amazon USA.