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base support for the forces of temperance fell away from beneath them, and in late 1933, the Eighteenth Amendment was repealed.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.

Dr Silkworth

Dr. Silworth at age 35 [in approximately1908]

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.

Total Abstinence

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)

“Stop Preaching!”

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.

Medical Endorsement

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.

Human Power

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.

Last Years

Silkworth (New Jersey Home)

Dr. and Mrs. Silkworth at their home in New Jersey.

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.”

Thank God!

Er… I mean… whatevah!!


14 Responses

  1. Christopher G says:

    Thanks, Bob, for all your efforts. I found it very interesting as I have all the attending comments. I look forward to the completed book.

  2. bob k says:

    Well, it’s not that simple. The break from the Oxford Group is significant, BUT the New York drunks had broken away in 1937 – the meetings of alcoholics in Wilson’s Clinton St. home antedated the Cleveland meeting by more than 18 months.

    I do agree that the choice of Dr. Bob’s last drink was somewhat arbitrary as AA’s founding date.

  3. John L. says:

    I find it hard to accept “early AA (even before it had a name)”, just as I find it hard to accept the official position, that AA was founded when Dr. Bob had his last drink. To me, AA never had a real founding moment. If there was one, it was when the first meeting of Alcoholics Anonymous was held in Cleveland, Ohio on 11 May 1939. This was when recovering alcoholics broke free of the Oxford Group. This was when recovering alcoholics began sharing their own “experience, strength, and hope”, rather than religious dogma.

  4. Glenna R. says:

    Thanks Bob for helping us all to sort out this history in a way that is reasonable if maybe, in error. Who knows? It is refreshing to read about AA History that is not written from a sanctimonious and sacred point of view. I believe all writing is personal and our personal experience will get in the way of us as writers or historians. We will all have our biases; to think any other way is naive. I think it’s important to have more views than those that want us to have only, “approved literature”, for our perusal and more seriously, for our meditation i.e. Step 11. Way to go; I look forward to your book.

  5. Hal H. says:

    I’ve often wondered the same thing. It was pointed out to me that “moral” can also mean honest – truthful.

  6. life-j says:

    Bob, thanks.
    And I have always wondered – and it seems to me this has far reaching implications somehow – we take a moral inventory, but why exactly do we do that if we think that alcoholism is not a moral failure?

  7. Adam N. says:

    Of course, religious thinking is uniquely prone to aposteriori re-interpretation. I have often thought that what Bill experienced as a God-given, semi-biblical, white-light, burning-bush message was, in fact, a drug related psychosis, in particular the after-effect or side-effect of the Belladonna and whatever else he was cocktailed with during that particular stay. Of course I get no traction with this sort of blasphemous thinking in my AA meetings, as a rule. But, what do you beautiful godless heathens think about my theory?

  8. bob k says:

    It is very likely that the precise formulae of the various “drug cocktails” used at Towns, have been long destroyed. It seems that some were killed by the cure. Dr. Lambert went to some lengths to distance himself from the proceedings.

    There is some detail, such as it is, in the Charles B. Towns essay on this site.

  9. John M. says:

    Yes, with others, and once again, thank you so much for this history, Bob.

    It’s always so darn fascinating that folks like Dr. Bob will end up saying (or implying) that unless you find God, you will go back out drinking. And yet, as you remind us, God couldn’t get Dr. Bob sober during his Oxford affiliation days. It took a fellow human being, Bill W., to help him with his eventual sobriety.

    “We are doing for ourselves what not even God could do for us” — oops, I guess some folks wouldn’t want me re-writing the Big Book.

  10. bob k says:

    Charles Towns indeed supported Bill, and early AA (even before it had a name). He was a fascinating character. It was said that he “could convince a granite gatepost that it stood in immediate need of life insurance.” Of course, I’m sure you’ll agree that the Towns stories belong in the Towns chapter, which is where they shall be found.

    I’m afraid we have a different view of Ebby. The Ebby piece was done some time ago, and will not be pleasing to Ebby fans. Sorry. To my eyes, he represents the epitome of the “what not to do” position.

  11. Bobby says:

    I’ve read various accounts that suggest Bill Wilson was given a snoot full of belladonna, a hallucinogenic that was also used to relieve stomach distress. I’m wondering if someplace in somebody’s archives those prescriptions still exist. It would be very interesting to see what was floating around in Bills bloodstream that last time at the hospital. Cheers, Bobby.

  12. Thomas B. says:

    Wonderful story again, Bob — thank you . . .

    One little quibble, it was not only Dr.Silkworth who supported Bill’s early work with patient’s at Town’s Hospital – its owner, Charlie Towns, offered a job to Bill in 1937 as a “lay therapist”, which is reported by Francis Hartigan, whom you cite, in his biography about Bill on pp. 98 – 100. Bill was so ecstatic that he rushed home to to a rather lukewarm reception by Lois and a negative reaction by the group of drunks, “the alcoholic squadron”, who gathered every Tuesday night in Bill and Lois’s Clinton Street Brooklyn brownstone. Hartigan relates that one of the group’s newest members, someone “sober only a few months” persuaded Bill that it would not be good for them to create a hierarchy of some members who were paid for helping alcoholics and others who were not. From my reading, this is the first clear-cut instance of the group conscience 2ndTradition at work in what was to become AA. Thank goodness Bill was dissuaded from taking the job – otherwise, AA may never have been around to help all of us achieve sobriety.

    On another note, I’m most pleased that AA Agnostica will publish your book, Key Players in AA History. I’m sure you’ll include a chapter about Ebby. Also that you’ll refer to as far as I know the only book published about Ebby, Ebby, The Man Who Sponsored Bill W. by Mel B.

    I was privileged to do some of the initial research on the book in 1981 with Margaret McPike who with her husband, Mickey, ran the Ballston Spa “Drunk Farm”, where Ebby died sober in 1966. When Margaret died in 1982, I turned my notes and all the material I had to include some photographs Margaret gave me over to Mel B. to finish the project. He did a most credible and worthy job.

    It’s my belief that Ebby along with Bill and Dr. Bob is equally a co-founder of AA and that the three of them represent three broad cohorts of AA members:

    – Dr. Bob represents the more devoutly religious members of AA, perhaps the majority, who believe they are sober solely by the grace of God, specifically Jesus Christ.

    – Bill represents those who perhaps may struggle with belief, but stay sober through an evolving consciousness based on humanist principles inherent in the program –certainly we WAFTs are in this cohort.

    – Ebby represents a third cohort, the significant number of folks who come into AA and chronically relapse. His story offers an excellent example that no matter how often one relapses, there is always hope that one can experience “a daily reprieve” and die sober after achieving some modicum of peace and serenity.

  13. Gabe S says:

    Thanks, Bob. Great chapter.

  14. Pat N. says:

    Thanks again, Bob, for more interesting history of our fellowship and its pappies.

    It’s especially valuable as a reminder that none of us would be sober/alive today if it weren’t for various nondrinkers. Maybe it was an anguished but stubborn spouse, an empathic coworker, a parent or sibling – someone(s) who weren’t alcoholic surely played a role in our resurrections.

    In my case it was a Pentecostal coworker and friend who pulled me out of the snowbank that last, horrible night, and stood by me as I stumbled through those godawful, confused early days. He never judged me nor preached at me, he just loved me. I wish I could say that was true of all my AA peers.

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