GO TO THE PATIENT NOT THE BOOK

GO TO THE PATIENT NOT THE BOOK
Abraham J. Twerski, M.D.
Medical Director,
Gateway Rehabilitation Center

In 1527, Paracelsus assembled his medical students at the University of Basel, gathered the authoritative medical textbooks, and threw them into a huge bonfire. "You wish to learn medicine? Go see your patients," he said.

Whereas one cannot totally dismiss the written word, there is truth in Paracelsus' directive. Furthermore, advances in modern medicine occur at so rapid a pace that most texts are partially obsolete by the time they are published.

The continuing relevance of the Big Book to today's alcoholic is precisely due to the fact that it does not seek to treat nor teach by its contents. Rather, it is a description of a program that is effective, and provides testimonials of people whom the program has helped. In other words, this is a book that says, "Go to the patients, both the suffering and the recovering. They will help you, not a book; not even this book."

From the vantage point of a psychiatrist with 20 years of experience and involvement with 32,000 patients afflicted by alcohol and/or chemical dependence, I have found this to be true. The Big Book works because it advocates the program, and it is the program that works. Searching for the secret of A.A.'s effectiveness is akin to saying, "it works in practice, but how does it hold up in theory." The famous 5th chapter is appropriately titled "How It Works," not "Why It Works."

The Big Book approaches alcoholism phenomenologically, and thus remains valid, genetic and neurophysiologic findings not withstanding. The quasirational insanity of alcoholic thinking described in the personal accounts is as applicable today as a half-century ago, as are the endless manipulations with which the modern alcoholic can identify.

Many psychiatrists and psychologists consider all cases of alcoholism to be symptomatic of an underlying disorder. The Big Book seems to consider all alcoholism as primary. Given the consensus in the field that the ratio of primary to secondary alcoholism is 4:1, the Big Book's approach has greater likelihood of success in an unselected population.

The effectiveness of the 12-step program in other addictions, especially narcotics, gambling, and food, indicates that the Big Book's value extends far beyond ethanol. This is because the 12-steps are a protocol for personality, for growth, and for self-realization, a process of value to even the non-alcoholic or non-addicted individual. Thus, even if science will someday discover a physiologic solution to the destructive effects of alcohol, the personality enhancing value of the Big Book will continue.

Within the firm guidelines of its 12 traditions, Alcoholics Anonymous has evolved and adapted to cultural changes. Nor does the Big Book advocate a rigidity that would stultify recovery. The Big Book and A.A. remain as effective today as the day they came into being, and are likely to remain unfettered by the continuing passage of time.