5:25pm May 7
"Continue to speak
of alcoholism
as an illness,
a fatal malady."
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(BB pg 92)
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Someone once asked Bill Wilson, "How do you justify calling alcoholism an illness, and not a moral responsibility?" (The Disease Concept) To which Bill replied, "Early in A.A.'s history, very natural questions arose among theologians. There was a Mr. Henry Link who had written "The Return to Religion (Macmillan Co., 1937). One day I received a call from him. He stated that he strongly objected to the A.A. position that alcoholism was an illness. This concept, he felt, removed moral responsibility from alcoholics. He had been voicing this complaint about psychiatrists in the American Mercury. And now, he stated, he was about to lambaste A.A. too. Of course, I made haste to point out that we A. A.'s did not use the concept of sickness to absolve our members from moral responsibility. On the contrary, we used the fact of fatal illness to clamp the heaviest kind of moral responsibility on to the sufferer. The further point was made that in his early days of drinking the alcoholic often was no doubt guilty of irresponsibility and gluttony. But once the time of compulsive drinking, veritable lunacy had arrived and he couldn't very well be held accountable for his conduct. He then had a lunacy which condemned him to drink, in spite of all he could do; he had developed a bodily sensitivity to alcohol that guaranteed his final madness and death. When this state of affairs was pointed out to him, he was placed immediately under the heaviest kind of pressure to accept A.A.'s moral and spiritual program of regeneration -namely, our Twelve Steps. Fortunately, Mr. Link was satisfied with this view of the use that we were making of the alcoholic's illness. I am glad to report that nearly all theologians who have since thought about this matter have also agreed with that early position. While it is most obvious that free will in the matter of alcohol has virtually disappeared in most cases, we A.A. 's do point out that plenty of free will is left in other areas, It certainly takes a large amount of willingness, and a great exertion of the will to accept and practice the A.A. program. It is by this very exertion of the will that the alcoholic corresponds with the grace by which his drinking obsession can be expelled." (speaking at the N.C.C.A. documented in 'Blue Book', Vol.12, 1960) 1961 quote by Bill W.: "We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady — a far safer term for us to use." -- The Big Book (which didn’t focus heavily on a specific disease model-- in fact the word disease is only mentioned once in the entire basic text of Alcoholics Anonymous on pg 64) also the publishers of the A.A. Grapevine, often promote a medicalized unitary disease concept. In fact, the disease concept promoted by A.A. co-founder Dr. Bob (a proctologist) was alcoholism as “an illness which only a spiritual experience will conquer,” more a metaphor than a medical mechanism. Bob was noted by his fellow A.A. members as deeply spiritual, given to soul-searching prayer with a alcoholics taking their first steps toward sobriety. For him the importance of the disease concept lay in conveying the hopelessness of terminal illness which only a higher power could touch. As centrally important as Silkworth’s “allergy” and “obsession” ideas were to prove in the continuing understanding that members of Alcoholics Anonymous had of themselves, there is an even deeper significance and contribution tucked away in his “Doctor’s Opinion” letter in the A.A. Big Book, where he also noted that: “We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics. . . .” Therein lie both the problem and the promise of any investigation of Alcoholics Anonymous and the disease concept of alcoholism. For disease in its many names has also long served as metaphor, and “moral psychology” hints of a realm beyond the physical. Our study of Alcoholics Anonymous and the disease concept of alcoholism, then, will necessarily involve more than the obvious, first-level, physical-science aspect of that question. Again, recall that p. 44 “definition” of alcoholism as “an illness which only a spiritual experience will conquer.” A supplementary note on the meaning of disease in early Alcoholics Anonymous, at least to its most medically educated member: In 1938, while preparing the manuscript of the A.A. Big Book, Bill asked Dr. Bob about the accuracy of referring to alcoholism as disease or one of its synonyms. Bob’s reply, scribbled in a large hand on a small sheet of his letterhead, read: “Have to use disease -- sick -- only way to get across hopelessness,” the final word doubly underlined and written in even larger letters (Smith [Akron] to Wilson,15 June 1938). Reading through the Big Book stories that mention Dr. Bob, one finds consistent emphasis on the reminder that an alcoholic cannot safely drink alcohol ever again. (See for example the almost paradigmatic story of Bill D., “Alcoholics Anonymous Number Three,”) A.A.s may be a “day at a time program,” but the admission of powerlessness over alcohol, the surrender to hopelessness, could not be a retractable event, and if the way to get this across was to talk in terms of “disease” or “allergy,” then thus would A.A.s carry their message. Certainly Dr. Bob, who had his own “slip” after his first meeting with Bill, had no doubt about the importance of remembering this facet of his own alcoholism. . . . . ..
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