What is "The Doctor's Opinion," and who wrote it?
In short:
- "The Doctor's Opinion" is the section at the front of the Big Book, before Chapter 1 (pp. xxv–xxxii). It gives a physician's view of the alcoholic and of A.A.'s way of recovery.
- It was written by Dr. William D. Silkworth, who signs both his letter and his longer statement (pp. xxvi, xxxii). Short connecting paragraphs between them are written by A.A. members themselves (pp. xxv–xxvii).
- Silkworth was a New York specialist in alcoholism who had greatly helped Bill W. (p. xvi). The Preface says the section has been kept just as he wrote it in 1939 (p. xi).
- His main points: the alcoholic's body reacts abnormally to alcohol (his "allergy" theory), the result is a craving the normal drinker never has, the only relief he knows is not drinking at all, and real recovery takes "an entire psychic change" (p. xxix).
Who wrote which part
The section has three voices: 1. A.A. members open it, introducing "the medical estimate of the plan of recovery described in this book" from a doctor "chief physician at a nationally prominent hospital specializing in alcoholic and drug addiction" (p. xxv). The text doesn't name the hospital. 2. Dr. Silkworth's letter "To Whom It May Concern" (pp. xxv–xxvi) is signed William D. Silkworth, M.D. 3. A.A. members then comment on his views (pp. xxvi–xxvii), and his longer statement follows (pp. xxvii–xxxii), signed again at the end (p. xxxii).
Who he was, from the book itself: the Foreword to the Second Edition (1955) calls him "a New York specialist in alcoholism" who had greatly helped Bill W. and from whom Bill "had learned the grave nature of alcoholism" (p. xvi). The Preface calls him "our Society's great medical benefactor" and says his section "has been kept intact, just as it was originally written in 1939" (p. xi). A.A. Comes of Age (1957) adds that he was "then Physician-in-Chief of the Charles B. Towns Hospital in New York," and that he was with Bill in that hospital in December 1934 (Comes of Age, p. 13).
The letter's patient of "late 1934" (p. xxv) and the "leading contributors to this book" who came under his care (p. xxvii) are not named in the section. Comes of Age identifies Silkworth as the doctor who treated Bill (Comes of Age, p. 13).
What the doctor says
In his letter (pp. xxv–xxvi): a hopeless patient picked up ideas about recovery and began passing them on to other alcoholics, telling them to do the same, and "This man and over one hundred others appear to have recovered" (p. xxv). The results seemed to him of "extreme medical importance" (p. xxv).
In his longer statement (pp. xxvii–xxxii): - The body. He suggests that alcohol acts on these drinkers as "a manifestation of an allergy" and that "the phenomenon of craving is limited to this class and never occurs in the average temperate drinker" (p. xxviii). He offers this as a theory, one he says he had "suggested a few years ago" (p. xxviii). - The mind. "Men and women drink essentially because they like the effect produced by alcohol" (p. xxviii). Without a drink they are "restless, irritable and discontented" (p. xxviii). After each spree comes remorse and a firm resolution, and "This is repeated over and over" (p. xxix). - The way out. "The only relief we have to suggest is entire abstinence" (p. xxx). But not drinking takes more than knowledge or willpower: "unless this person can experience an entire psychic change there is very little hope of his recovery" (p. xxix). - What medicine can't do. Doctors, he admits, "have made little impression upon the problem as a whole" (p. xxix). "One feels that something more than human power is needed to produce the essential psychic change" (p. xxix). - Why he backs A.A. He praises the members' unselfishness and "the entire absence of profit motive" (p. xxvii) and says he has found nothing that has done more for these men "than the altruistic movement now growing up among them" (p. xxviii). He closes with two case histories (pp. xxxi–xxxii) and a line every reader of the Big Book knows: the alcoholic who reads it, "though perhaps he came to scoff, he may remain to pray" (p. xxxii).
What A.A.'s own paragraphs say
The members agree with the doctor that "the body of the alcoholic is quite as abnormal as his mind" (p. xxvi), and they take care over what they claim: "As laymen, our opinion as to its soundness may, of course, mean little" (p. xxvi). They also say they "favor hospitalization for the alcoholic who is very jittery or befogged," so that his mind is clear before he is approached (p. xxvi).
Read it yourself
- "The Doctor's Opinion," pp. xxv–xxxii, free from A.A.: https://www.aa.org/sites/default/files/2021-11/en_bigbook_foreworddoctorsopinion.pdf
- Preface, p. xi: https://www.aa.org/sites/default/files/2021-11/en_bigbook_preface.pdf
- A.A. Comes of Age is sold by A.A. World Services: https://onlineliterature.aa.org
- Related: What does the Big Book mean by alcoholism as an illness?
Sources
| Source | Pages | Date |
|---|---|---|
| Alcoholics Anonymous, "The Doctor's Opinion" | xxv–xxxii | 1939 |
| Alcoholics Anonymous, Foreword to Second Edition | xvi | 1955 |
| Alcoholics Anonymous, Preface | xi | fourth edition, 2001 |
| A.A. Comes of Age (Bill W.) | 13 (page from the book's own index) | 1957 |
Recovery Starts is independent and not affiliated with Alcoholics Anonymous. Quotations are brief and cited; the Big Book and A.A. Comes of Age are © A.A. World Services, Inc.
These pages answer questions about A.A. from A.A.'s own published literature, read in full, with every quote checked word for word against the page it cites. Recovery Starts is independent and not affiliated with Alcoholics Anonymous. What we read, and when each source was written.