About "The Doctor's Opinion"

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The Doctor's Opinion begins on p.xxiii of the Big Book Alcoholics Anonymous. The doctor in question was Dr. Silkworth who suprised many readers by writing: "...true alcoholism is a manifestation of an allergy." (p. xxvi)

I have heard addiction experts—even some belonging to AA— who minimize or totally ignore Dr. Silkworth's use of the word "allergy". Some physicians hint that Dr. Silkworth made a misdiagnosis based on inferior medical knowledge. Others suggest that he was employing some sort of metaphor. (A "metaphor" is the application of a word or phrase which is not literally applicable. Example: "Laziness is a CANCER spreading through society.") I studied the history of the medical term "allergy" and I believe that today's skeptics misunderstand Dr. Silkworth's use of the word.

Did the Doctor make a misdiagnosis?  That is very unlikely. When he made the statement, Dr. Silkworth had already treated over 5,000 patients for various levels of alcohol abuse. He described only the most severe cases as suffering from an "allergy". Perhaps our difficulty in understanding him arises from OUR current use of the word. Most people now think of an "allergy" as some sort of histamine reaction (i.e., hay fever, pet allergies, poison ivy, bee allergies). The word "allergy" had a different meaning in Dr. Silkworth's time. The medical term was created in 1906 by an Austrian doctor (http://en.wikipedia.org/wiki/Clemens_von_Pirquet) who noticed that some patients safely tolerated a vaccine for a while, but they later experienced a dangerously different reaction to later doses of the same vaccine. That Austrian doctor published his findings and by the 1930s, his meaning of "allergy" was widely known among physicians of Dr. Silkworth's era. Our current notions of sneezy, watery-eyed allergic reactions came from the anti-histamine drug advertising.

Did the Doctor use the word "allergy" as a metaphor? This metaphor idea seemed very possible to me at first. Now, I seriously doubt it. Dr. Silkworth was giving his opinion as a physician, not as a poet or creative writer. A physician has no reason to employ a precise medical term like "allergy" unless he is describing that exact condition. A doctor would confuse his readers if he wrote, "Alcoholism is a cancer" (or any other bona fide medical diagnosis). The chance of being misinterpreted would be too great. An educated person like a physician could easily think of clearer examples if he were striving to find a metaphor. My conclusion is that he was speaking literally.

I believe Doctor Silkworth used the term "allergy" according to the  medical definition in use at the time. I am not a doctor but it appears to me that Dr. Silkworth was describing those drinkers who drank safely at first, but who eventually experienced a dangerously different reaction. He wasn't referring to itching or sneezing. He was describing people who drank at 20 years old with no serious physical problems but who experienced inexplicably different reactions later. Many respectable citizens were almost dead of horrifying and seemingly incurable alcoholism by middle-age. Same substance; different reaction. In 1939 (when the Big Book was written) the correct diagnosis for that reaction was an "allergy".

I personally am convinced that the "allergy" diagnosis in the Doctor's Opinion of the Big Book is rooted in solid science, not in metaphor or outdated medicine. Regardless, I am grateful for the pioneering work performed by Dr. Silkworth and countless others in the early days of Twelve Step recovery.

God bless you and keep you,



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