Willaim Duncan Silkworth and Bill Wilson

WDS, based on over forty years of clinical practice with alcoholics, was convinced that alcoholism was a physical illness not a psychiatric disorder, nor a moral issue.  He believed that alcoholism had not been studied properly by the medical community because of the stigmatization of alcoholics.  He further believed that the underlying pathology was some type of allergy to alcohol that developed, over a variable time course of drinking, into a physical change in the alcoholic that was accompanied by common symptomatology:  obsession, compulsion, craving, loss of control over consumption, “sprees,” and the inability to have “just one drink.”  When not drinking the alcoholic experienced a peculiar dysphoria, famously “restless, irritable, and dicontented” that could be relieved by drinking.  Unfortunately, this illness at that time (1934) was hopeless with only a 2% rate of successful treatment.  There was no effective, systematic treatment.  WDS was convinced that some “essential psychic change” was necessary to produce successful abstinence but did not have the “moral psychological” techniques available to produce such a change in the alcoholic.  WDS was, in addition, an astute and compassionate clinician who seemed able to provide positive unconditional regard and thoughtful intervention for these unlovely patients.

Under the influence of WDS description of alcoholism as an illness, but a hopeless illness with only incarceration, commitment or death as outcomes, Bill Wilson connected with Edwin Throckmorton Thacher aka Ebby, an old friend and alcoholic who had achieved recovery through Oxford Group participation.  Bill spent several weeks with Ebby and Oxford Group members and had a subtle “spiritual experience” at the Calvary Mission run by the Oxford Groupers.  This experience resonated for Bill, but he drank again and ended up back in Towns Hospital.  In Towns for the last time in December of 1934, in a deep depression, he had his famous and dramatic spiritual experience.  WDS’ insightful clinical intervention supporting Bill’s sanity and encouraging Bill to “hold onto” the experience that he believed freed him from his alcoholism is an historic clinical intervention.

Bill over several years, with the continued support of WDS, combined three things: what he learned from the Oxford Groups, one systematic approach to producing a spiritual experience; what he had learned reading William James’ Varieties of Religious Experience, a comprehensive discussion among other things spiritual, of the many systematic approaches to producing spiritual experiences; and what C. G. Jung contributed to Roland H. “Spiritus contra spiritum.”  He combined these things with what he and his recovering colleagues had learned by practical clinical work with alcoholics under WDS’ supervision into the Twelve Steps.  Notably WDS in supervisory mode, told Bill to stop “preaching” and emphasize the hopelessness of the illness, what the ex-alcoholics themselves had experienced, their stories, and then this might open the “prospect” to the introduction of the spiritual solution.  

One can imagine this early time as a period of research and development out of which the resulting method developed and was then published in Alcoholics Anonymous in 1939.  It is critical to note that during this period that rather than creating a for-profit franchise Bill and his colleagues produced a not-for-profit, very eclectic approach to the “solution” and the treatment of alcoholism.  The general approached was “fine-tuned” by WDS and nurse Teddy at Towns and then Knickerbocker Hospital and simultaneously Dr. Robert Smith and nurse Sister Ignatia in Akron.  Forever after the response to the question of “What the A.A.’s ‘angle’ was?” would be the response “Were here to help ourselves by trying to help you and there is no cost or obligation.”