As we start again our journey through the Big Book, it may be good to be reminded why the decision was made to begin the Big Book with the ’Doctor’s Opinion’. The explanation below relates why Bill came to believe it essential that this ‘new idea’ of alcoholism as an incurable, fatal, progressive disease be established upfront by a doctor specializing in the treatment of alcoholism. Another key new idea in the Doctor’s Opinion is how any alcohol can trigger the disease reemergence in its progressive state and thus abstinence from alcohol is essential to keep the disease in remission.
Lack of Power: Our Dilemma
As Bill W. prepared to travel to Akron after repeated failures to sober anyone up through the Oxford Group in New York, Dr. Silkworth reminded him of William James’ observation that “truly transforming spiritual experiences are nearly always founded on calamity and collapse.” He urged him to “stop preaching at them, and give them the hard medical facts first. This may soften them up at depth so that they will be willing to do anything to get well. Then they may accept those spiritual ideas of yours, and even a Higher Power.”
Bill W. Meets Dr. Bob
The “hard medical facts” were the then novel concept that alcoholism is a disease, or, as we say nowadays, an addiction. We suffer from a mental state that compels us to drink, and from a physical condition that makes us crave for more and renders us helpless to stop. The disease is progressive. It can only get worse. There is no cure for it. We can never drink safely. Up to that point, Bill had been giving the “spiritual angle” first, setting forth the treatment before presenting a full diagnosis of the illness. He would stress the need for a spiritual experience such as he had had, leading to a relationship with God, as the solution to the alcoholic problem. Predictably, he had been coming up against the fierce resistance of the average alcoholic to anything that smells of religion.
Of course, what Dr. Silkworth was telling Bill was to apply the lesson of his own experience. Hadn’t he resisted Ebby’s “I got religion” approach at that kitchen table in Brooklyn Heights? Hadn’t his epiphany at Towns Hospital been founded on his own “calamity and collapse?” Dr. Silkworth wasn’t saying to forget the spiritual and to stick just to the physiological and psychological facts of the illness. The idea was to address the underlying cause of the alcoholic’s resistance. This was his self-centered pride, or, in the language of psychology, his bloated ego. More than just “using psychology” in a tactical sense, Dr. Silkworth’s counsel had a fundamentally spiritual objective: to chip away at the wall of denial erected by pride.
The first step was to “deflate” the alcoholic, apt image for lowering his pride and humbling him. He had to be shown objectively speaking, in the medical or “scientific” view, his was a hopeless case. Only then would he be open to a spiritual solution he might otherwise reject instinctively. For this to be accomplished, the alcoholic’s circumstances had to be sufficiently desperate. Under such conditions, being confronted with the fatal nature of his disease had the effect of sucking any remaining air out of the alcoholic’s “prideful balloon.” Any vestige of the illusion that he could handle things on his own would be gone. He would be forced down to a hard landing, hit bottom, and admit defeat. When he met Dr. Bob, Bill W. followed Dr. Silkworth’s advice, and the rest is history. We follow on their footsteps. Defeat, despair, and collapse force us to surrender and admit what we would not willingly admit, that we are powerless over alcohol and that our lives have become unmanageable.