Men have cried out to me in sincere and
despairing appeal: "Doctor, I cannot go on like this! I have everything to
live for! I must stop, but I cannot! You must help me!"
Faced with this problem, if a doctor is honest with
himself, he must sometimes feel his own inadequacy. Although he gives all that
is in him it often is not enough. One feels that something more than human
power is needed to produce the essential psychic change. Though the aggregate
of recoveries resulting from psychiatric effort is considerable, we physicians
must admit we have made little impression upon the problem as a whole. Many
types do not respond to the ordinary psychological approach.
I do not hold with those who believe that alcoholism us
entirely a problem of mental control. I have had many men who had, for example,
worked a period of months on some problem or business deal which was to be
settled on a certain date, favorably to them. They took a drink a day or so
prior to the date, and then the phenomenon of craving at once became so
paramount to all other interests so that the important appointment was not met.
These men were not drinking to escape; they were drinking to overcome a craving
beyond their mental control.
There are many situations which arise out of the
phenomenon of craving which cause men to make the supreme sacrifice rather than
continue to fight.
The classification of alcoholics seems most difficult,
and in much detail is outside the scope of this book. There are, of course, the
psychopaths who are emotionally unstable. We are all familiar with this type.
They are always "going on the wagon for keeps." They are over
remorseful and make many resolutions, but never a decision.
There is the type of man who is unwilling to admit that
he cannot take a drink. He plans various ways of drinking. He changes his brand
or his environment. There is the type who always believes that after being
entirely free from alcohol for a period of time, he can take a drink without
danger. There is the manic depressive type, who is s, perhaps the least
understood by his friends, and about whom a whole chapter could be
written.
There are types entirely normal in every aspect except in
the effect alcohol has on them. They are often able, intelligent, friendly
people.
All these, and many more, have one symptom in common:
They cannot start drinking without developing the phenomenon of craving. This
phenomenon, as we have suggested, may be the manifestation of an allergy which
differentiates these people and sets them apart as a distinct entity. It has
never been, by any treatment with which we are familiar, permanently
eradicated. The only relief we have to suggest is entire abstinence.
This immediately precipitates us into a seething caldron
of debate. Much has been written pro and con, but among physicians, the general
opinion seems to be that most chronic alcoholics are doomed.
What is the solution? Perhaps I can best answer this by
relating one of my experiences.
About one year prior to this experience a man was brought
in to be treated for chronic alcoholism. He had but partially recovered from a
gastric hemorrhage and seemed to be a case of pathological mental
deterioration. He had lost everything worthwhile in life and was only living,
one might say, to drink. He frankly admitted and believed that for him there
was no hope. Following the elimination of alcohol, there was found to be no
permanent brain injury. He accepted the plan outlined in this book. One year
later he called to see me, and I experienced a very strange sensation. I knew
the man by name, and partly recognized his features, but there all resemblance
ended. From a trembling, despairing, nervous wreak, had emerged a man brimming
over with self reliance and contentment. I talked with him for some time, but
was not able to bring myself to feel that I had known him before. To me he was
a stranger, and so he left me. A long time has passed with no return to
alcohol.
When I need a mental uplift, I often think of another
case brought in by a physician prominent in New York. The patient had made his
own diagnosis, and deciding his situation hopeless, had hidden in a deserted
barn determined to die. He was rescued by a searching party, and, in desperate
condition, brought to me. Following his physical rehabilitation, he had a talk
with me in which he frankly stated he thought the treatment a waste of effort,
unless I could assure him, which no one ever had, that in the future he would
have the "will power" to resist the impulse to drink.
His alcoholic problem was so complex, and his depression
so great, that we felt his only hope would be through what we then called
"moral psychology" and we doubted if even that would have any
effect.
However, He did become "sold" on the ideas
contained in this book. He has not had a drink for a great many years. I see
him now and then and he is as fine a specimen of manhood as one could wish to
meet.
I earnestly advise every alcoholic to read this book
through, and though perhaps he came to scoff, he may remain to pray.
William D. Silkworth, M.D.
