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Old 04-30-2016, 06:18 PM   #6
Senior Member
Join Date: Aug 2013
Posts: 115
Default Alcoholism and the field of medicine

The following are drugs currently used to treat alcoholism.

This list is strictly for informational purposes:
Declinol, Thiamine by injection, Naltrexone (Revia), Chlordiazepoxide (Librium), Disulfiram (Antabuse)

Twelve Steps & Twelve Traditions
Step 12
Pages 107-109

“Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”

Step One showed us an amazing paradox: We found that we were totally unable to be rid of the alcohol obsession until we first admitted that we were powerless over it.

In Step Two we saw that since we could not restore ourselves to sanity, some Higher Power must necessarily do so if we were to survive.

Consequently, in Step Three we turned our will and our lives over to the care of God as we understood Him. For the time being, we who were atheist or agnostic discovered that our own group, or A.A. as a whole, would suffice as a higher power.

Beginning with Step Four, we commenced to search out the things in ourselves which had brought us to physical, moral, and spiritual bankruptcy. We made a searching and fearless moral inventory.

Looking at Step Five, we decided that an inventory, taken alone, wouldn’t be enough. We knew we would have to quit the deadly business of living alone with our conflicts, and in honesty confide these to God and another human being.

At Step Six, many of us balked—for the practical reason that we did not wish to have all our defects of character removed, because we still loved some of them too much. Yet we knew we had to make a settlement with the fundamental principle of Step Six. So we decided that while we still had some flaws of character that we could not yet relinquish, we ought nevertheless to quit our stubborn, rebellious hanging on to them. We said to ourselves, “This I cannot do today. “

Then, in Step Seven, we humbly asked God to remove our shortcomings such as He could or would under the conditions of the day we asked.

In Step Eight, we continued our house-cleaning, for we saw that we were not only in conflict with ourselves, but also with people and situations in the world in which we lived. We had to begin to make our peace, and so we listed the people we had harmed and became willing to set things right.

We followed this up in Step Nine by making direct amends to those concerned, except when it would injure them or other people.

By this time, at Step Ten, we had begun to get a basis for daily living, and we keenly realized that we would need to continue taking personal inventory, and that when we were in the wrong we ought to admit it promptly.

In Step Eleven we saw that if a Higher Power had restored us to sanity and had enabled us to live with some peace of mind in a sorely troubled world, then such a Higher Power was worth knowing better, by as direct contact as possible. The persistent use of meditation and prayer, we found, did open the channel so that where there had been a trickle, there now was a river which led to sure power and safe guidance from God as we were increasingly better able to understand Him.

So, practicing these Steps, we had a spiritual awakening about which finally there was no question. Looking at those who were only beginning and still doubted themselves, the rest of us were able to see the change setting in.

From great numbers of such experiences, we could predict that the doubter who still claimed that he hadn’t got the “spiritual angle,” and who still considered his well-loved A.A. group the higher power, would presently love God and call Him by name.
Appendix 2 page 567
Big Book
Alcoholics Anonymous

The terms "spiritual experience" and "spiritual awakening" are used many times in this book which, upon careful reading, shows that the personality change sufficient to bring about recovery from alcoholism has manifested itself among us in many different forms.

Yet it is true that our first printing gave many readers the impression that these personality changes, or religious experiences, must be in the nature of sudden and spectacular upheavals. Happily for everyone, this conclusion is erroneous.

In the first few chapters a number of sudden revolutionary changes are described. Though it was not our intention to create such an impression, many alcoholics have nevertheless concluded that in order to recover they must acquire an immediate and overwhelming "God-consciousness" followed at once by a vast change in feeling and outlook.

Among our rapidly growing membership of thousands of alcoholics such transformations, though frequent, are by no means the rule. Most of our experiences are what psychologist William James calls the "educational variety" because they develop slowly over a period of time. Quite often friends of the newcomer are aware of the difference long before he is himself. He finally realizes that he has undergone a profound alteration in his reaction to life; that such a change could hardly have been brought about by himself alone. What often takes place in a few months could seldom have been accomplished by years of self- discipline. With few exceptions our members find they have tapped an unsuspected inner resource which they presently identify with their own conception of a Power greater than themselves.

Most of us think this awareness of a Power greater than ourselves is the essence of spiritual experience. Our more religious members call it "God-consciousness."

Most emphatically we wish to say that any alcoholic capable of honestly facing his problems in the light of our experience can recover, provided he does not close his mind to all spiritual concepts. He can only be defeated by an attitude of intolerance or belligerent denial.
We find that no one need have difficulty with the spirituality of the program. Willingness, honesty and open mindedness are the essentials of recovery. But these are indispensable.

"There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance --that principle is contempt prior to investigation."

************************************************** ******

From the book: Twelve Steps and Twelve Traditions

Step 12


Now, what about the rest of the Twelfth Step? The wonderful energy it releases and the eager action by which it carries our message to the next suffering alcoholic and which finally translates the Twelve Steps into action upon all our affairs is the payoff, the magnificent reality, of Alcoholics Anonymous. Even the newest of newcomers finds undreamed rewards as he tries to help his brother alcoholic, the one who is even blinder than he. This is indeed the kind of giving that actually demands nothing. He does not expect his brother sufferer to pay him, or even to love him. And then he discovers that by the divine paradox of this kind of giving he has found his own reward, whether his brother has yet received anything or not. His own character may still be gravely defective, but he somehow knows that God has enabled him to make a mighty beginning, and he senses that he stands at the edge of new mysteries, joys, and experiences of which he had never even dreamed.

************************************************** ******

Twelve Steps and Twelve Traditions

Tradition 10

“Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.”

Let us reemphasize that this reluctance to fight one another or anybody else is not counted as some special virtue which makes us feel superior to other people. Nor does it mean that the members of Alcoholics Anonymous, now restored as citizens of the world, are going to back away from their individual responsibilities to act as they see the right upon issues of our time. But when it comes to A.A. as a whole, that’s quite a different matter. In this respect, we do not enter into public controversy, because we know that our Society will perish if it does. We conceive the survival and spread of Alcoholics Anonymous to be something of far greater importance than the weight we could collectively throw back of any other cause. Since recovery from alcoholism is life itself to us, it is imperative that we preserve in full strength our means of survival.

The way that the medical community looked at Alcoholics Anonymous back in 1955 proves for an interesting read. Comments of Dr. Bauer are from the viewpoint of a general physician, while Dr. Tiebout presents a psychiatrist’s perspective. Notice his take on surrender, ego reduction, and surviving the "pink cloud" phase.

It may have been from a convention long ago, but much like the Twelve Steps, the message timeless.

From the book: Alcoholics Anonymous Comes of Age

Chapter 4: Medicine Looks At Alcoholics Anonymous
p. 235-244

Without its friends of medicine, Alcoholics Anonymous might never have been born. It was from the medical profession that we of A.A. learned the physical and emotional nature of our malady. Today thousands of physicians throughout the world are working in closest co-operation with us.
In the following section we introduce two of the medical friends, both of whom freely gave us their warmest endorsements at A.A.’s twentieth anniversary celebration in St. Louis in July, 1955.

Here we reproduce the proceedings of the Twentieth Anniversary Convention’s Medical Panel. The first address was given by Dr. W. W. Bauer of the American Medical Association. This was followed by a paper read by Dr. Harry M. Tiebout, A.A.’s first friend in the profession of psychiatry. Both physicians gave their view of Alcoholics Anonymous and told how the co-operate with us and how A.A. has influenced their own thinking and practice. This session opened with an A.A. member, Dr. Clarence P., in the chair.
A.A. CHAIRMAN DR. CLARENCE P.: To be transplanted from a small town of 9,000 people into an auditorium like this is a little bit overwhelming. And to be presented with the array of talent that we have here this morning is also a little overwhelming.

You have done me a great honor in permitting me to act as your chairman. We will run this pretty much as a medical meeting. We will dispense with all formalities and get down to the business of medicine and A.A.

This morning, first, we have with us the greatest of living A.A.’s who in his humility has refused a doctor of laws degree. It seems to me that this was a great decision. I will only say, thank god he passed this way and that we have known him. There are no words to describe our feeling toward Bill.
BILL: I know you all sense that this is a very significant meeting on a very significant occasion, because it has to do with our relations to the men of medicine. A. A. can be likened to a temple supported by three pillars; one is religion, another is medicine, and the third is our own experience as people who have suffered from alcoholism. Medicine in its broad aspects includes the science of the mind and its effect upon the body, as well as the effect of a physical malady upon the mind. In our two distinguished guests, Dr. Bauer and Dr. Tiebout, we have here people truly expert in each of these departments.

It would be a sorry day for A.A. if we ever came to think that we had a monopoly on fixing drunks. I think we ought to encourage every research in this area, whether it concerns the mind or the body. As individuals we often ought to associate ourselves with such enterprises.

As excuse-makers and rationalizers, we drunks are champions. It is the business of the to get behind our excuses and to find the deeper causes for our conduct. Though uninstructed in psychiatry, we can, after a little time in A.A., see that our motives have not been what we thought they were and that we have been motivated by forces unknown to us. Therefore we ought to look, with the deepest respect, interest, and profit upon the findings of psychiatry, remembering that up to now the psychiatrists have been far more tolerant of us than we have been of them. So we thank them for the steadfast friendship and support which they have given us in nearly every quarter of the profession. When it comes to the general practitioner or specialist in the chemistry of the body, his findings too ought to be made use of by us as individuals. Of course as a movement we should never presume to intrude on the province of medicine. The practice of medicine is for doctors; the teaching of formal religion is for clergymen. So let us modestly fill our role; let us make our link, the once missing one, strong. And let’s thank God for folks like Dr. Bauer and Dr. Tiebout.

CHAIRMAN: On this morning’s program I have shifted my own responsibilities. I have had the pleasure of meeting Dr. Earle M. from San Francisco. Without ever having met this gentleman before, but having had some previous correspondence with him, I feel as though I had known him for years. I am going to ask him to act as a co-chairman to introduce our next speaker. Let me present Dr. Earle M.

DR. EARLE M.: Fellow members of Alcoholics Anonymous, and distinguished guests: My remarks will be brief. We are indeed fortunate to have with us a man of the caliber that you are about to hear. He is one of the men in an exceedingly high position in the American Medical association; one who carries you and me very close to his heart. We could ask for no better ally than the next speaker to confirm and strengthen the already growing friendship between A.A. and the medical profession. It is a deep pleasure and a great honor to introduce you to my boss—and your and my friend, Dr. W. W. Bauer.

DR. W. W. BAUER: Thank you, doctor, for that gracious introduction. I want to assure you that I am nobody’s boss; I’m just one of the hired hands of the American Medical Association, or perhaps I should say, a perambulating loud-speaker. I think my status in the Association was expressed one day at an annual meeting in Atlantic City, when someone asked me at what hotel I was staying. I mentioned the hotel, and he said, “Oh you’re not staying at such and such a hotel where the heads are; your’ staying with the shoulders.”
As a perambulating loud-speaker, I have faced innumerable audiences. One of my staff told me not so long ago that I had made over a thousand speeches, which is a magnificent tribute to the long-suffering of the American people. Ordinarily I take an audience in my stride, but I had an invitation about a year ago, when the A.M.A. met in San Francisco, to address an open meeting of A.A. in the downtown area of that city, and I admit that I never suffered more trepidation in all my life than I did in anticipation of meeting that audience, because I didn’t see any good reason why I should be standing up there talking to you A.A.’s.

I reminded myself of the young rector in the Episcopal Church to which I belonged. He was consecrated Bishop, which was, of course a great even in the life of a young Episcopal clergyman. After the solemn service of consecration there was a banquet, and the speakers’ table was raised high on a platform so we could all see the new Bishop. He was given some very fine tributes, and when it came to his turn to respond, he said, “I feel like the slightly inebriated gentleman on a bright moonlight night, who walked out onto the middle of a bridge, looked down at the water, saw the moon reflected there, shook his head, and remarked to himself, “How in the hell did I get way up here?”

I don’t feel quite so apprehensive this time because that audience of A.A.’s proved to be just like any other audience; they were very kind and considerate to the speaker; they listened to him with courtesy, and they were even good enough to tell him afterward that they liked him. But the reason why I am much more at home this time is because of what happened to my wife, who accompanied me on the day. After the meeting, we were standing in a group with the people in charge, and with other A.A.’s and, I suppose, guests, and as we were chatting a gentleman joined the group and was introduced around, and when he saw my wife he looked at her and said, “Where have you been? It’s been two years since you attended a meeting.” This was particularly good because my wife is practically a teetotaler.

My experience with A.A. goes back to the days when I used to put radio shows on the NBC network every week, and I had the privilege of putting on a show under the guidance and direction of one of your members in the Chicago area. From that time on, I began to understand a little of what A.A. was all about. Of course, a person like me can never understand it fully. I am not a psychiatrist like Dr. Tiebout, so my practical knowledge is only that of a practitioner. I am not a member of A.A., so I do not have the background of experience that you have, and I am quite serious when I say I feel most humble in this position before a group of people like you.
All I can do is to try to express to you the feeling of the medical profession, a feeling which has been growing steadily throughout the life of your organization and which now, I believe, may be said to be fully crystallized—a feeling that A.A. has a very large and important part of such answers as we possess to the problem of alcoholism.

We know of course that the alcoholic is a sick person. That is a very simple phrase. It is today a phrase that is widely and generally accepted, and yet you and I know that it was not so long ago that the alcoholic was regarded as a nuisance, a pest, a person who could snap out of it if he really wanted to. He was regarded as a spoiled brat and as a no-good. Today we know that he is an individual who is sick and we know that he is sick in an area of which our understanding is perhaps the least of any area in medicine, namely, illness of the emotions.

We are in some respects today in the same position with regard to emotional illness that we were fifty years ago with regard to tuberculosis. My memory does not extend quite that far back. I have been out of medical school only thirty-nine years, but from earlier literature I know that the idea persisted in the minds of some people that tuberculosis, an infectious disease which attacks people through no fault of their own, was a disgrace. Families often hid the tubercular person just as they cover up for the alcoholic today. I can remember very well, and so can every doctor on this platform, when we had the same attitude toward cancer. Cancer was regarded as a stigma, as a blight, something to be hidden, because it was reflection upon the family. Today we know that cancer is a misfortune, and we are beginning now to realize that we must adopt the same attitude toward mental and emotional illnesses that we have slowly and painfully adopted toward tuberculosis and cancer. Illness of the emotions is no more something to be ashamed of than is illness of the body. We should no more hesitate to consult a psychiatrist, except for the scarcity of these important specialists, than we should hesitate to consult an orthopedist for a sore foot.

There is so much in attitudes. A movie star of a day gone by, Clara Bow, is credited with the statement that if she said her foot hurt everyone was sympathetic, but if she said, “My feet are killing me!” they laughed. It’s all in the matter of attitude, and we must learn to consult the psychiatrist with the same attitude that we do any other specialist, without a feeling of shame, without a feeling that it is a stigma. There are certain phrases that physicians are compelled to use that we must learn to understand and to accept and to compensate for.

We have to learn in medicine, and the public as a whole is going to have to learn, of the tremendous individual differences among people. Differences in resistance, for example. Some people tire more easily than others. Some people fall victims to infection more easily than others because of differences in their body chemistry. There are marked differences, as you know, in the intelligence of people, and we must also learn to recognize that there are differences in emotional stability. There are some who can “take it” better than others. Being able to take it is generally regarded as a virtue, and so it is; it’s a fine thing if one has it. Courage also is a fine thing, and yet eminent soldiers and military leaders have been asked, “Were you ever afraid in battle?” and the answer, if they were honest, has usually been, “Of course I was always afraid in battle. I’d be a fool not to be afraid in battle. There is danger in battle.

We too must learn that there are battle situations for us, in which we must be afraid, some of us more than others. It is no great credit to me, as an individual, that I am not tempted by alcohol. I have my own temptations. I am tempted by tobacco, I am tempted by food, and there is just as much intemperance in giving way to those temptations as there is in giving way to the temptation which, to some of you and many others, is or has been alcohol.

So we in the medical profession appreciate that we have a partnership with you. We need a partnership with you, as you do with us, to solve this problem of alcoholism. You have arrived by your own separate paths at some of the same solutions that medicine has arrived at in the treatment of alcoholism. We have learned, for example, as you have learned, the value of group therapy in medicine, at least in modern medicine, was expectant mothers’ classes, where a lot of young pregnant women went together and learned all about what was happening to them and why and what to do about it.

Then the idea spread, and a very courageous doctor, who was almost laughed out of the profession, decided that there was no good reason why a man should not learn how to mix a formula and change a diaper. So we had expectant fathers’ classes. And then we found group therapy a very potent factor in the field of mental and emotional health. In some of our mental institutions the device of play-acting is used, in order to allow people to express their latent hostility, if not in a constructive way at least harmlessly.
We have even applied group therapy to one of our other great temptations, the area of food, and it has been seriously suggested that that be organized. I would dislike to see A.A. paraphrased too often, and in regard to lesser issues. But the fact is that overweight people can diet more cheerfully in groups than they can by themselves. I noticed in one of your bulletin items something about a lone member, and I can imagine how much more difficult it must be for lone members than it is for your groups, because the lone members do not have the direct support and sympathy of others who know what their problem is.

In medicine, we have learned a great deal about the physical treatment of the alcoholic. We have learned about nutrition and the importance of a fully rounded diet, and vitamins and minerals. We do not regard these as cures for alcoholism, for we don’t believe any more that lack of vitamins is the cause of alcoholism; that’s altogether too simple. But we do know that these things are necessary in the physical treatment and rehabilitation of the alcoholic. We know also that various kinds of drying out and other forms of therapy have failed. They are not enough by themselves. We need something more.

We know also that religious exhortation has failed, as has exhortation from people who have no grasp of the problem, who oversimplify, people in whose view an alcoholic is a person who is perpetually thirsty with a fierce craving for alcohol, people who do not know that a great many alcoholics hate alcohol worse than poison when they are sober, because they know that it is poison.

We have learned the futility of long-term pledges, which are so very, very difficult to keep. All these things you, more than any other group that I know anything about, have taught us. I have a great many friends in A.A. I suspect I have more friends in A.A. than I know anything about, because perhaps some of my friends have not yet told me that they are A.A.’s. I can recall, after some of the broadcasts we made, being stopped on the street in the village where I live near Chicago by people whom I had known for many years, and having them express to me a brief word of thanks for the broadcast. I was astonished at these people, but as time went on I became less and less astonished as I saw the effectiveness of your work, as I saw a man of great talent, a close friend of mine, a man in a creative line which I will not identify because it might possibly identify him, a man who was almost on the verge of genius. I saw alcohol make its insidious inroads upon his career, upon his relationships with his family and children, upon his standing in the community. I saw his wife covering up for him; I saw her describing his frequent illnesses, which we gradually came to know were illnesses, but not the kind she wanted us to believe; I saw him on the verge of losing his job, and I saw him lose his job; and then I saw him surrender. I saw him throw up his hands and quit, saying, “I can’t do it by myself. I’ve got to have help.” And with the spiritual help of his clergyman and A.A., I have seen that man come back to a commanding position in his field, a man who is as sober today, as clear-eyed and bright, as any person in this audience. I’m confident he’s going to stay that way. That is only one of a number that I have seen, and that other doctors have seen too.

So more and more we are beginning to realize that you have in your principles—surrender, humility, looking above for divine guidance, day-by-day sobriety, and above all anonymity—the insurance that nobody is going to get famous as a leader of Alcoholics Anonymous. These principles are all vitally important. You who have seen what alcohol can do in your lives are working together in groups and individually, and you are making a bigger impression on the problem of alcohol than has ever been made before. We need that impression in this world today, a world in which fear dominates.
Alcoholism is an escape—from what? Well, from intolerable situations in your own life, and the whole world is in an intolerable situation today. It is no wonder that alcoholism grows. Not only that, but we are in a social situation where alcoholic temptations are on every hand. I suppose this is the only convention, with perhaps the exception of the strictly religious ones, and not all of them, that is really a dry convention. I don’t know whether you are welcome in convention cities. You certainly don’t do the bar business any good.

People who, when I was a child, would have looked askance at anyone who took a drink are now socially serving cocktails in their homes. Our children are being brought up in a thoroughly alcoholic environment. By billboard, by radio, by television, in advertising of all kinds, the qualities of alcoholic beverages are being extolled. Put those two thing together—a world living under the domination of fear and a world filled with alcohol and with alcoholic suggestion—and you can see how important it is that people realize what alcoholism really is: a deep-seated emotional illness that must be treated according to psychosomatic principles. Psychosomatic of course simply means body and soul. We hear a lot about psychosomatic medicine these days, but let me tell you that any doctor who was worth his salt, from the earliest times to these present days, was practicing psychosomatic medicine.
Sir William Osler said, “It isn’t so important what disease the patient has, as what kind of patient has the disease.” That’s one of the things that you people have realized.

So I come to you here with a great sense of appreciation for your having invited me. I come, as I say, to stand humbly before you and admire your great accomplishments, and to say to you that we in the medical profession are confident that these accomplishments will grow bigger and more significant as time goes on, because you have set your feet upon the upward paths; you have held out, and are holding out, a helping hand to those who need it.

I am no psychiatrist, but I have confidence in saying this to you as I have said to thousands of patients, that the thing we need most of all in this world today is tranquility of mind. Various names have been given to it. Some books about it have been very popular. Some call it the power of positive thinking, some call it peace of mind, some call it peace of soul, but I’m inclined to go along with Billy Graham and call it peace with God. Those are the things we need. And an organization like yours, in a world that seems to have gone materialistically mad, gives us courage to believe that there is still hope, that there is still idealism, and that we are going to win out over many, many of our problems, one of the most serious of which is alcoholism.

CHAIRMAN: I am a Jack-of-all-trades and master of none, namely, a general practitioner, so I am a member of the American Academy of General Practice, which has its headquarters here in St. Louis. (I had to get that plug in!)

A.A. in its early days was nurtured by three outstanding doctors. You have heard Bill mention Dr. Silkworth. We all know our friend Dr. Harry Tiebout, and I would like at this time to mention our own B. Kirby Collier of New York State, who was instrumental in getting Bill W. to address the American Psychiatric Association, at which time he gave that very fine paper, “Medicine Looks at Alcoholics Anonymous,” which was a milestone in medical history. So at this time I would like to pay a special tribute to G. Kirby Collier, who left us a year or so ago. Dr. Silkworth, Dr. Tiebout, and Dr. Collier were great workers for A.A. in its formative years, and we cannot say too much for any of these three men.

The next speaker in my opinion is a great physician. First he is a doctor of medicine, and then he has pursued that special branch of medicine called psychiatry. He has written many inspiring articles, the most recent one of which I would call to your attention, “The Ego Factors in the Surrender of Alcoholism.” We had some reprints of this piece that we passed around to members of our groups in Rochester. We think it is one of the finest things that has been written in recent years. Of course, all of us alcoholics are endowed with this ego which Dr. Tiebout so effectively describes.
It gives me great pleasure to introduce to you Bill’s friend of long standing, a great friend of A.A., a fine physician, scientist, and research man, Dr. Harry Tiebout of Greenwich, Connecticut.

DR. HARRY M. TIEBOUT: Under ordinary circumstances, I should thank the man who introduced me for his very nice remarks, but for years I’ve been teaching the need for ego reduction, and I’m not sure that my ego got sufficiently reduced by the introduction.

When the invitation came to speak before this group I immediately said, “Yes, I want to go.” For many years, as you all know, I have been associated with A.A., and all the experiences that I had had came flashing through my mind, so there was so much to say that I didn’t know quite where to begin. With your permission, I’m going to use a manuscript, so that the points I want to make will not be forgotten.

At an A.A. meeting the speaker as a rule identifies himself as an alcoholic and then proceeds to tell his story, sprinkling wisdom or humor, or both, as he goes along. I shall also tell my story, although I am less sure of matching either the wit or the wisdom of the A.A. speakers.

I joined A.A. by proxy in 1939 when a patient of mine became a member of the New York group. Well do I remember my first meeting. It was tense with excitement. A.A. was going on the air for the first time. One of the members, trying to rehabilitate himself, had talked with Gabriel Heatter, who, on hearing his story, suggested that he, the A.A. man, appear on the program “We The People.” This was the night of his appearance, and it was far too thrilling and special for settling down to a regular meeting. The actual even was a bit of a letdown. The man from A.A. spoke briefly of his experiences—and it was over. A.A. however, had taken a step toward making itself known, not a very big step, to be sure; but one of the many which finally led to its present position on the national and international scene.

Later I attended other meetings, more orthodox in character, and as I did, I developed the conviction that this group had hit upon a method which solved the problem of excessive drinking. In a sense, it was an answer to my prayers. After years of butting my head against the problem of treating the alcoholic, I could now begin to hope.
In that respect my first two or three years of contact with A.A. were the most exciting in my whole professional life. A.A. was then in its miracle phase. Everything that happened seemed strange and wonderful. Hopeless drunks were being lifted out of the gutter. Individuals who had sought every known means of help without success were responding to this new approach. To be close to any such group, even by proxy, was electrifying.

In addition, from a professional point of view, a whole new avenue of treatment for the problems of alcohol had opened up. Somewhere in the A.A. experience was the key to sobriety. Here was the first authentic clue after many years of fruitless effort. The possibilities ahead were most intriguing. Perhaps I could learn how A.A. worked and thus learn something about how people stopped drinking. Yes, I shared in the general excitement of those days. I could see some daylight ahead.

My future in this regard was now clear. I would try to discover what made A.A. tick. In this quest for understanding I would never have gotten beyond first base if it had not been for Bill and many of the early members. A study of the Twelve Step helped a little, but of far greater importance were the many insights already possessed by Bill and the others into the process through which A.A. brought about its results.

I heard of the need to hit bottom, of the necessity for accepting a higher Power, of the indispensability of humility. These were ideas which had never crossed my professional horizon and certainly had never influenced my nonprofessional thinking or attitudes. Revolutionary as they were, they nevertheless made sense, and I found myself embarked on a tour of discovery.

I began to recognize more clearly what hitting bottom really implied, and I began to do what I could to induce the experience in others, always wondering what was happening inside the individual as he went through the crisis of hitting the bottom.

Finally, fortune smiled on me again, this time from another patient. For some time she had been under my new brand of psychotherapy, designed to promote hitting bottom. For reasons completely unknown, she experienced a mild but typical conversion which brought her into a positive state of mind. Led by the newly found spiritual elements, she started attending various churches in town. One Monday morning she entered my office, her eyes ablaze, and at once commenced talking. “ I know what happened to me! I heard it in church yesterday. I surrendered.” With that word “surrender” she handed me my first real awareness of what happens during the period of hitting bottom.

The individual alcoholic was always fighting an admission of being licked, of admitting that he was powerless. If and when he surrendered, he quit fighting, admitted he was licked, and accepted the fact that he was powerless and needed help. If he did not surrender, a thousand crises could hit him and nothing constructive would happen. The need to induce surrender became a new therapeutic goal. The miracle of A.A. was now a little clear, though the reason was still obscure why the program and the fellowship of A.A. could induce a surrender which could in turn lead to a period of no drinking.

As might be expected, I enjoyed a thrill of my own. I was getting in on what was happening, all of it an enjoyable experience. Still questing eagerly, I shifted my therapeutic attack. The job now was to induce surrender. But I ran into a whole nest of resistances to that idea. Totally new territory had to be explored. As I continued my tour it became ever more apparent that in everyone’s psyche ther existed an unconquerable ego which bitterly opposed any thought of defeat. Until that ego was somehow reduced or rendered ineffective no likelihood of surrender could be anticipated. The shift in emphasis in hitting bottom to surrender, to ego reduction, occurred during the first five or six years of my initial contact with A.A.

I well remember the first A.A. meeting to which I spoke on the subject of ego reduction. A.A., still very much in its infancy, was celebrating a third or fourth anniversary of one of the groups. The speaker immediately preceding me told in detail of the efforts of his local group, which consisted of two men, to get him to dry up and become its third member. After several months of vain efforts on their part, and repeated nose dives on his, the speaker went on to say, “Finally I go cut down to size, and I’ve been sober ever since.” When my turn came to speak I used the phrase, “cut down to size,” as a text around which to weave my remarks. Before long, out of the corner of my eye, I was conscious of a disconcerting stare. It was coming from the previous speaker. Looking a little more directly I could see his eyes fixed on me in wonder. It was perfectly clear that he was utterly amazed that he had said anything that would make sense to a psychiatrist. The look of incredulity never left his face during my entire talk. The incident had one value in my eyes. It showed that two people, one approaching the matter clinically, and the other relying on his own intuitively experienced report of what had happened to him, both came up with exactly the same observation: the need for ego reduction.

During the past decade my own endeavors have centered primarily upon this problem of ego reduction. How far I have been able to explore the territory is not at all certain. I have made, however, a little progress, and in the minutes remaining I shall try, first, to acquaint you with some of my findings, and second, to relate them to the A.A. scene as I see it.

As I have already stated, the fact of hitting bottom to produce a surrender which cut the ego to size was evident fairly soon. In time two additional facts manifested themselves. The first was that a reduced ego has marvelous recuperative powers. The second was that surrender is an essential disciplinary function and experience.
The first is merely repeating a fact known to you all. It is common knowledge that a return of the full-fledged ego can happen at any time. Years of sobriety are no insurance against it resurgence. No A.A., regardless of his veteran status, can ever relax his guard against the encroachments of a reviving ego. Recently one A.A., writing to another, reported that he was suffering, he feared, from “halo-tosis,” a reference to the smugness and self-complacency which so easily can creep into the individual with years of sobriety behind him.

The assumption that one has all the answers, and the contrary, that one needs to know no answers, but just to follow A.A., are two indicators of trouble. In both cases open-mindedness is notably absent. Perhaps the commonest manifestation of the return of ego is witnessed in the individual who falls from his pink cloud, a state of mind familiar to you all. The blissful pink cloud state is a logical aftermath of surrender. The ego, which is full of striving, just quits, and the individual senses peace and quiet within. The result is an enormous feeling of release, and the person flies right up to his pink cloud and thinks he has found heaven on earth. Everyone knows he is doomed for a fall. But it is perhaps not equally clear that it is the ego slowly making its comeback which forces the descent from the pink cloud into the arena of life, where, with the help of A.A., he can learn how to become a sober person and not an angel. I could go on with many more examples familiar to you all, to show you the danger of ever assuming that the ego is dead and buried. Its capacity for rebirth is utterly astounding and must never be forgotten.

My second finding, that surrender is a disciplinary experience, requires explanation. In recent articles I have shown that the ego, basically, must be forging continuously ahead, and that it operates on the unconscious assumption that it, the ego, should never be stopped. It takes for granted that it is right to go ahead. It has no expectation of ever being stopped and hence no capacity to adjust to that eventuality. Stopping says in effect, “No, you cannot continue,” which is the essence of disciplinary control. The individual who cannot take a stopping is fundamentally an undisciplined person. The function of surrender in A.A. is now clear. It produces that stopping by causing individuals to say, “I quit. I give up my headstrong ways. I’ve learned my lesson.” Very often for the first time in that individual’s adult career he has encountered the necessary discipline which halts him in his headlong pace. And this happens because we can surrender and truly feel, “Thy will, not mine, be done.” When that is true we have become in fact obedient servants of God. The spiritual point, at that moment, is a reality. We have become members of the human race.
I have now presented the two points I wished to make, namely, first, the ego is revivable, and second, surrender is a disciplinary experience. I next wish to discuss their significance to A.A. as I see it.

Primarily, they say quite simply that A.A. can never be just a miracle. The single act of surrender can produce sobriety by it stopping effect upon the ego. Unfortunately, that ego will return unless the individual learns to accept a disciplined way of life, which means that a tendency for ego comeback is permanently checked. This is not new to A.A. member; they have learned that a single surrender is not enough. Under the wise leadership of the founding fathers, the need for continued endeavor to maintain that miracle has been steadily stressed. The Twelve Steps, repeated inventories, not just one, and the Twelfth Step itself, a routine reminder that one must work at deserving sobriety, are all essential. Moreover, it is referred to as Twelfth Step work, which is exactly what it is. But this time the miracle is for the other fellow.

The Traditions are also part of a non-miracle aspect of A.A. they represent, as Bill has said, the meanings and the lessons of experience. They serve as guides for the inexperienced. They check the ways of the innocent and the unwary. They bring the individual down to earth and present him with the facts of reality. They say, “Pay heed to the teachings of experience or you will court disaster.” It is not without reason that we talk with a sober voice of experience. My stress on the non-miracle elements of A.A. has a purpose. When I first made my acquaintance with A.A., I rode the pink cloud with most of its members. I, too, went through a period of disillusionment and, fortunately for me, I came out with a faith far stronger than anything a pink cloud can supply.

Mind you, I’m not selling miracles short. They do loosen up the individual. I know however, now, the truth of the Biblical saying, “By their fruits ye shall know them.” Only through hard toil and labor can lasting results be obtained. As a consequence of the need for hard work to supplement any miracle, my interest in the non-miracle features is strong.

I can accept more truly the necessity of organization and of structure to curb as well as to guide. I believe there must be meetings like this one to provide the sense of belonging to a big working organization, of which each individual is but a part. And I I believe that any group or individual who fails to participate in the enterprise of the organization is rendering himself and his group a disservice by not submitting to the disciplinary values inherent in those activities. He may be keeping himself free of entanglements but he is also keeping the ego unstopped. His chances of remaining sober are not of a high order. He is really going it alone and may be needing another miracle, which may not come off the next time.

In closing, let me reaffirm my proxy membership in A.A. I have been in on its glowing start and I have shared in its growing pains. And now I have reached the state of deep conviction in the soundness of the A.A. process, including its miracle aspects. I have tried to convey to you some of my observations on the nature of that process. I hope they will help in making the A.A. experience not just a miracle but a way of life which is filled with eternal value. A.A. has, I can assure you, done just that for me. Thank you.
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