A Scientist Speaks Out
DISCLAIMER: Cogniventus.com has neither been approved or endorsed by, and is not affiliated with, Alcoholics Anonymous World Services, Inc. or any service entity of A.A.W.S., Inc. This website’s currently Featured Project, “FINISHING WHAT BILL WILSON STARTED,” is not A.A. Conference-Approved Literature; it is non-fiction commentary submitted here as single-use, not to be used commercially, and cites, for educational purposes, limited sections of the 2nd Edition of Alcoholics Anonymous, 1955, which has been in Public Domain since 1983.
Navigator’s Note: Since the “Doctor’s Opinion” appeared in the 1939 edition of the Big Book, much progress in the understanding of alcoholism appears to have taken place, and between my Sponsor and I, we have witnessed all of that history. But before we congratulate ourselves on our affected compassion or become too entranced with our beautiful images of the effected brain, let us take heed of Arthur C. Clarke’s warning that “information…is not knowledge, that knowledge is not wisdom, and that wisdom is not foresight.”
Since Aristotle weighed in over 2000 years ago, the discussion about what alcoholism is has been in constant flux, with the labels of “disease,” “choice,” and “sin”—recycling relics of the insidious Body-Mind-Spirit conception of Self— jockeying for top position. In trading a moral model for a medical model, it appears that we have just traded one shame for another, and re-stigmatized ourselves in the process. If alcoholism is delusion rather than disease, accident rather than choice, spiritual quest rather than sin, then alcoholism is the drunken canary in the coal mine that is sending humanity a frightening message—and noone seems to be listening.
[2024 UPDATE: Since I first wrote “A Scientist Speaks Out” in 2014, most reputable neuroscientists have had the good sense to back off from calling addiction literally a “brain disease,” but the Addiction Recovery Conglomerate still can’t seem to decide whether addiction is a “Disease” or “Disorder,” (Substance “Use”; Substance “Misuse”; or Substance “Abuse”—pick a noun, any noun!) an “Illness” or an “Injury,” a “Syndrome” or a “Symptom”—or some other equivocating “Condition” that cannot distinguish between cause and effect, or the difference between a Scientific Model and a Medical Model. Fortunately, the rest of humanity now seems to be paying attention to the drunken canary in the coal mine and have talked back with an impressive array of counter-models to describe addiction in a non-medicalized way.
Ironically, we seem to be returning back to the global perspective presented in the landmark 1980 compendium “Theories on Drug Abuse,” where the National Institute on Drug Abuse gave 43(!) prescient explanations of “addiction” grouped as broken Relationship with Others, Society, and Nature. Little today surpasses the breadth of those pioneering times and the excitement over a new vision of human volition that seemed to be emerging. Unfortunately, one could argue convincingly that we have less explanatory and predictive power now than we did four decades ago, having traded an vital, interdisciplinary community of truth-seekers for a self-contained, economic conglomerate of self-appointed experts who have a vested interest in fitting their “evidence-based” “patient outcomes” into the model most likely to fund the Research that will fortify their status as self-appointed experts.
FINISHING WHAT BILL WILSON STARTED
1: You Can’t Go Home Again
2. A Sponsor’s Lament
3. Higher and Lower Powers
4: What Works Poorly
5: What Works Better
6: Relapse or Research?
7: Best by Test!
8: To Alcoholism Professionals
9: The Fellowships Afterward
10: To The Chronically Human
11: A New Vision for a New Generation
The Doctor’s Opinion
WE OF Alcoholics Anonymous believe that the reader will be interested in the medical estimate of the plan of recovery described in this book. Convincing testimony must surely come from medical men who have had experience with the sufferings of our members and have witnessed our return to health. A well-known doctor, chief physician at a nationally prominent hospital specializing in alcoholic and drug addiction, gave Alcoholics Anonymous this letter:
To Whom It May Concern:
I have specialized in the treatment of alcoholism for many years.
In late 1934 I attended a patient who, though he had been a competent businessman of good earning capacity, was an alcoholic of a type I had come to regard as hopeless.
In the course of his third treatment he acquired certain ideas concerning a possible means of recovery. As part of his rehabilitation he commenced to present his conceptions to other alcoholics, impressing upon them that they must do likewise with still others. This has become the basis of a rapidly growing fellowship of these men and their families. This man and over one hundred others appear to have recovered.
I personally know scores of cases who were of the type with whom other methods had failed completely.
These facts appear to be of extreme medical importance; because of the extraordinary possibilities of rapid
Public Domain
“We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.” from “The Doctor’s Opinion” in Alcoholics Anonymous, 1939
A SCIENTIST SPEAKS OUT
We, of THE NEW FOUNDERS OF ALCOHOLICS ANONYMOUS, know that the reader will benefit from a scientific evaluation of the “medical estimate of the plan of recovery” given in on “The Doctor’s Opinion” in the Big Book. In the Scientist’s own words:
“Why a Scientist’s opinion instead of a Doctor’s? As of this writing, the “brain disease” model of alcoholism holds ascendancy within the community of treatment professionals, and it has for several years. Whether some other version of the disease model supplants the current one by the time this goes to press is of no concern. What characterizes proselytizers of the disease model—past, present, and future—is their need to claim authority for their position, and for that they turn to Science. The errant mantra “Science has proven that alcoholism is a disease” has become an unfortunate discussion stopper for those who do not understand what Science really is or what Science really does. It is to the misguided use of science as support for the disease model that a Scientist can, and should, speak out.
“But do not take as authoritative anything I say. An undergraduate degree in Biology and a graduate degree in Chemistry does not make me a Scientist. Twenty-five years of professional experience at solving scientific problems do not make me a Scientist. I am a Scientist because my heart and my mind burn with the Francis Bacon’s divine fire to resolve and separate natural phenomenon—to understand the difference between what is real and what is appearance. And I bring that same sense of exploratory optimism to a personal life that
© 2005, 2012, 2022 Michael V. Cossette
The Doctor’s Opinion
growth inherent in this group they may mark a new epoch in the annals of alcoholism. These men may well have a remedy for thousands of such situations.
You may rely absolutely on anything they say about themselves.
Very truly yours,
William D. Silkworth, M.D.
The physician who, at our request, gave us this letter, has been kind enough to enlarge upon his views in another statement which follows. In this statement he confirms what we who have suffered alcoholic torture must believe-that the body of the alcoholic is quite as abnormal as his mind. It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete.
The doctor’s theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.
Though we work out our solution on the spiritual as well as an altruistic plane, we favor hospitalization for the alcoholic who is very jittery or befogged. More often than not, it is imperative that a man’s brain be cleared before he is approached, as he has then a better
Public Domain
A Scientist Speaks Out
“includes a bells-and-whistles, white-light, shout-it-from-the rooftops, instantaneous and permanent removal of a constant impulse to drink that plagued my early adulthood.
“Any Scientist looking at the medical model of addiction must also be willing to look at its existential dimension, without which no picture of addiction is complete. The same insatiable thirst to ask questions, to look for causes, to propose solutions, and to test those solutions in the laboratory, must persist when that laboratory is daily life.
“When we move away from popular literature and turn to the Scientists who study Addiction our critical work gets even tougher. As an experimentalist who has read peer-reviewed technical journals for a living for over 25 years, I look at published work in my own field with tremendous skepticism—particularly review sections that summarize current theory and practice. Most Scientists I know have the same attitude. The very best journal articles will contain experiments that cannot be repeated exactly, and the data often does not support the claim of the paper. Closely checking a paper’s references often reveals misquotations and misrepresentations. And occasionally we find two articles in the same issue of a journal that essentially contradicts the other’s findings.
“If you carefully read the battery of peer-reviewed research papers on Addiction, you will invariably find that the methodology does not consider all the subjective factors of human experience, that most the physical studies have been done on animals other than humans (for obvious ethical reasons), and that the real answers are still unknown.
© 2005, 2012, 2022 Michael V. Cossette
The Doctor’s Opinion
chance of understanding and accepting what we have to offer.
The doctor writes:
The subject presented in this book seems to me to be of paramount importance to those afflicted with alcoholic addiction.
I say this after many years’ experience as Medical Director of one of the oldest hospitals in the country treating alcoholic and drug addiction.
There was, therefore, a sense of real satisfaction when I was asked to contribute a few words on a subject which is covered in such masterly detail in these pages.
We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.
Many years ago one of the leading contributors to this book came under our care in this hospital and while here he acquired some ideas which he put into practical application at once.
Later, he requested the privilege of being allowed to tell his story to other patients here and with some misgiving, we consented. The cases we have followed through have been most interesting; in fact, many of them are amazing. The unselfishness of these men as we have come to know them, the entire absence of profit motive, and their community spirit, is indeed inspiring to one who has labored long and wearily in this alcoholic field. They believe in themselves, and still more in the Power which pulls chronic alcoholics back from the gates of death.
Of course an alcoholic ought to be freed from his physical
Public Domain
A Scientist Speaks Out
“I am not saying that there is deliberate deception or bad Science being done. The Scientific mind understands that all explanations are provisional—a perspective missing from the pundits who think that beginning a sentence with “Scientific Research proves…” turns them into Moses descending from the mountaintop. In Science no explanation is ever finally “proved” in the sense that we normally use that word, but instead proposed after gathering as much empirical evidence as possible about the phenomenon under investigation, and then ruling out all other explanations that do not fit the facts. If someone comes up with another explanation that accounts for the same set of facts, then that new explanation is just as valid until someone devises an experiment that can distinguish between the two.
“And relapse after an extended period of Twelve Step sobriety—an event the Big Book was, of course, unable to address—just may be the unintended recovery experiment that provides answers to what is often overlooked in the primary disease community but described in the basic text of Alcoholics Anonymous (without any real understanding): the curious natural phenomenon known as the “mental blank spot.” In pointing to the factual presence of a new group of alcoholics whose alcoholism actually worsens when they follow the directions of the Addiction-Recovery Community, the authors of “FINISHING WHAT BILL WILSON STARTED” have finally provided us with a way to resolve and separate the natural phenomenon of addiction and recovery from it—to distinguish between what really works, and what only appears to work.
“Currently, Addiction-Recovery in both the Treatment Profession and the AA Fellowship mistakenly focuses on “craving” as the psycho-physical culprit: an uncontrollable urge to drink described and detailed by the Treatment Profession as a long causal chain, the biochemical mechanism; and mythologized in the AA Fellowship as “Powerlessness.” For the purposes of the Treatment Profession, alcoholism starts with some DNA and ends with that first drink. For our purposes, there is one very simple way to disarm the primary disease model without even discussing the contradictory evidence. Grant the entire unproven package right up to the reported craving to drink: a gene that specifically encodes for the Addiction, the supporting body
© 2019 Michael V. Cossette
The Doctor’s Opinion
craving for liquor, and this often requires a definite hospital procedure, before psychological measures can be of maximum benefit.
We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.
Frothy emotional appeal seldom suffices. The message which can interest and hold these alcoholic people must have depth and weight. In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to re-create their lives.
If any feel that as psychiatrists directing a hospital for alcoholics we appear somewhat sentimental, let them stand with us a while on the firing line, see the tragedies, the despairing wives, the little children; let the solving of these problems become a part of their daily work, and even of their sleeping moments, and the most cynical will not wonder that we have accepted and encouraged this movement. We feel, after many years of experience, that we have found nothing which has contributed more to the rehabilitation of these men than the altruistic movement now growing up among them.
Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience
Public Domain
A Scientist Speaks Out
“chemistry, and the state-of-the-art Neural Imaging that displays the offending brain in living color. Grant the proponents of the primary disease theory everything they ask for and then propose a simple question:
How do you prove that an urge is “uncontrollable”?
“Show us how you get from the urge to drink to the liquor store! Do we just accept the alcoholic’s word that they are driven against their will, or do they just believe they cannot resist? Can we just infer a mental state from a behavior or a PET scan? If you are going to rob me of humanity by turning me into a reflexive animal that can no longer make choices, then you had better bring an understanding of human nature so profound and so convincing as to leave no room for argument—and no such understanding exists in the mainstream Addiction-Recovery movement.
“The general weakness of the craving brain corollary of the primary disease argument became even more obvious to me when I turned my inquiry around: after a few disappointing decades of reviewing published mechanistic information touted as proof of how craving operates in rodent and monkey brains, I could not find one equally detailed Scientific Explanation of the Spontaneous Recovery of a human brain from Addiction. When an alcoholic immediately stops drinking, what has reversed the uncontrollable urge? Either the brain-based mechanism for craving is still in effect when an alcoholic immediately stops drinking—suggesting that it is not causative, or it is not in effect—which demands an explanation for how it was overridden, or where it is hiding. A true scientist driven by the spirit of exploration always pays close attention to disconfirming evidence. And The New Founders of Alcoholics Anonymous have discovered many anomalies within Addiction-Recovery that demand an explanation; and their cogent formulation in this proposed sequel to the Big Book of the First Founders of Alcoholics Anonymous demands serious attention...End of UNRESTRICTED ACCESS
RESTRICTED ACCESS or CONFIDENTIAL Text may be Available on Request
© 2005, 2012, 2022 Michael V. Cossette
The Doctor’s Opinion
Public Domain
A Scientist Speaks Out
© 2005, 2012, 2022 Michael V. Cossette
The Doctor’s Opinion
Public Domain
A Scientist Speaks Out
© 2005, 2012, 2022 Michael V. Cossette