Biography: "Physician Heal Thyself!"

Dr. Earle M., San Francisco Bay Area, CA.

(p. 393 in 2nd edition, p. 345 in 3rd edition, p. 301 in the 4th edition.)

They Stopped in Time

"Psychiatrist and surgeon, he had lost his way until he realized that God, not he, was the Great Healer."

Earle had his last day of drinking and using drugs on June 15, 1953. An A.A. friend, Harry, took him to his first meeting the following week, the Tuesday Night Mill Valley A.A. group, which met in Wesley Hall at the Methodist Church. There were only five people there, all men: a butcher, a carpenter, a baker, and his friend Harry H, a mechanic/inventor. He loved A.A. from the start, and though he has been critical of the program at times, his devotion has remained constant.

Described in his story heading as a psychiatrist and surgeon, he was qualified in many fields. During his long career, he has been a prominent professor of obstetrics and gynecology, and an outstanding clinician at the University of California at San Francisco. He was a fellow of the American College of Surgeons and of the International College of Surgeons, a diplomat of the American Board of Obstetrics and Gynecology, board-certified psychiatrist, vice-president of the American Association of Marital and Family Therapists, and a lecturer on human sexuality.

He was raised in San Francisco, but was born on August 3, 1911, in Omaha, Nebraska, and lived there until he was ten. His parents were alcoholics. In Omaha they lived on the wrong side of the tracks, and he wore hand-me-down clothes from relatives. He was ashamed of this, and could not begin to accept it until years later. He revealed none of this in his story. Instead he talked about how successful he had been in virtually everything he had done. He said he lost nothing that most alcoholics lose, and described his skid row as the skid row of success.

But in 1989 he wrote an autobiography by the same title, which reveals much more of his story.

During his first year in A.A. he went to New York and met Bill W. They became very close and talked frequently both on the phone and in person. He frequently visited Bill at his home, Stepping Stones. He called Bill one of his sponsors, and said there was hardly a topic they did not discuss in detail. He took a Fifth Step with Bill. And Bill often talked over his depressions with Earle.

In a search for serenity Earle studied and practiced many forms of religion: Hinduism, Buddhism, Taoism, Confucianism, and ancestor worship.

He has long been a strong advocate for the cross-addiction theory, and predicted that over time we would see the evolution of Addictions Anonymous.

When he was sober about ten years, Earle developed resentments against newcomers and began a group in San Francisco for oldtimers. It was called The Forum. He wrote a credo for it designed of ten steps for chemically dependent people. He felt that addiction represents a single disease with many open doors leading to it: alcohol, opiates, amphetamines, cocaine, etc. Most of the Forum members were also devoted A.A. members.

He also established a new kind of A.A. group, which used confrontational techniques. Some A.A. members disliked it intensely, while others seemed to gain a great deal from it.

Many alcoholics make geographic changes when they are drinking. But Earle seems to have made his after achieving sobriety. He has lived in many places, both in this country and abroad, traveled around the world three times, and attended A.A. everywhere he went. He also married several times.

In 1968 he divorced his first wife, Mary, whom he had married in 1940. She once told him she had great respect for him as a doctor, but none as a human being. He admitted that he'd had affairs during the marriage, even after joining A.A. His relationship with their only child, Jane, who was a very successful opera singer, was strained, but he gave her an opportunity to air her feelings in his book. She wrote that when she received the gold medallion at the International Tchaikovsky Voice Competition in Moscow in 1966, a high honor, her father did not attend. Some people told her that it was not easy for him to see her become such a success -- to be so in the public eye. She added that their paths were still separate, but she did not ever totally close a door because he WAS her father.

In the 1960s he was experimenting with encounter and sensitivity awareness groups, which were then in vogue. At one of the encounter marathons he met his second wife, Katie, and within a year they were married and soon moved to Lake Tahoe. They lived separately except for two brief periods, and after a few years were divorced.

Later he accepted a job with the U.S. State Department at the University of Saigon Medical School, in Korea. He spent five years there, after which he returned to San Francisco, hoping to rekindle his marriage to Katie.

In September 1975 he moved to Hazard, Kentucky, to work at the Hazard Appalachian Regional Hospital. There he met his third wife, Freda, thirty years younger than he was. Freda came from a truly humble background. She was the daughter of a miner who had died of black lung disease. She and her six brothers were raised in a typical two-room coal miner's house in Hazard. During his relationship with her and her family he was able to put to rest some ghosts concerning his Nebraska background. This wonderful family helped him to re-evaluate his memories of Omaha.

In 1978 his feet began again to itch again. He accepted short-term job in Napal. When he was offered a long-term assignment Freda and his stepsons did not want to leave Kentucky. Disappointed, he returned to Kentucky, and obtained work as a gynecologist in a family planning clinic, and also lectured to medical students on human sexuality at the University of Louisville Medical School. When he moved again, this time to Kirkland, Washington, Freda again refused to leave Kentucky. They were divorced soon after. They remained friendly and talked to one another on the phone about twice a year.

From all his travels, he always seemed to return to the San Francisco Bay Area. In 1980 he accepted a position as medical director of the Institute for Advanced Study of Human Sexuality in San Francisco. There he met his fourth wife, Mickey. She was a Ph.D. candidate at the Institute. He described her as a vibrant, open, honest, direct woman without pretense, non-threatening, sexually on fire, lacking in prejudice, and tolerant about all aspects of life -- including human sexuality. She was already an Al-Anon member when they met, having been married to an alcoholic. She also made contributions in the field of alcoholism and recovery at Merritt Peralta Chemical Dependence Recovery Hospital in Oakland, California. They married and remained together until her death in 2000. His book is dedicated to her.

I talked to Earle on July 27, 2001. He told me he still gets to an A.A. meeting almost every day. His eyesight is not too good, but otherwise he is full of vim and vigor. From his voice, I would have taken him for a man of 40. He missed the A.A. International Convention last year because of Mickey's ill health, but he hopes to attend the one in 2005.

The Four Absolutes

[From a booklet distributed by Cleveland Central Committee of AA, date unknown]

The Four Absolutes

Foreword

“Spelled out as such, the Four Absolutes are not a formal part of our AA philosophy of life. Since this is true, some may claim the Absolutes should be ignored. This premise is approximately as sound as it would be to suggest that the Holy Bible should be scuttled.

The Absolutes were borrowed from the Oxford Group Movement back in the days when our society was in its humble beginning. In those days our founders and their early colleagues were earnestly seeking for any and all sources of help to define and formulate suggestions that might guide us in the pursuit of a useful, happy, and significant sober life.

Because the Absolutes are not specifically repeated in our Steps or Traditions, some of us are inclined to forget them. Yet in many old time groups where the solid spirit of our fellowship is so strongly exemplified, the Absolutes receive frequent mention. Indeed, you often find a set of old placards, carefully preserved, which are trotted out for prominent display each meeting night.

There could be unanimity on the proposition that living our way of life must include not only an awareness of the Absolutes, but a constant striving toward greater achievement in the qualities that they represent. Many who have lost the precious gift of sobriety would ascribe it to carelessness in seeking these objectives. If you will revisit the Twelve Steps with care, you will find the Four Absolutes form a thread, which is discernible in a sober life of quality, every step of the glorious journey.

We walked into this large group of which we had heard so much, but had never attended. From the vestibule we saw a placard on the corner of the far wall reading, "Easy Does IT". We turned left to park our coat. We turned back and there on the other corner of the same wall was a twin placard reading, "First Things First". Then facing to the front of the room, high above the platform we saw in the largest letter of all, "But for the Grace of God". Then as our eyes descended, there directly on the front of the podium was another with four words, "Honesty, Unselfishness, Purity and Love".

In the next ten minutes as we sat unnoticed in the last row waiting for the meeting to start, many thoughts tumbled through a mind that was really startled by this first face to face meeting with the four Absolutes for a very long time.

We started to grade ourselves fearlessly on our own progress toward these Absolutes through long years of sobriety. The score was a pitiful, lonely little score. We thought of a fine lead recently heard in which a patient humble brother had told his story, and had mentioned his overwhelming sense of gratitude as an important ingredient of his fifteen years of sobriety.

And in listing things for which he was so grateful, he mentioned how comfortable it was to be completely honest. Certainly he meant nothing prideful. He simply meant that he told his wife and friends the truth as best he could, had no fishy stories to reconcile, was honest with money and material things, etc.

This was a truly grateful, humble fellow. Certainly he did not resemble the man pictured in the cartoon, speaking to a large audience, pounding on the table and with a jutting chin proclaiming in a loud voice that he had more humility than anyone there and could prove it.

But just think of "complete honesty". Is it not the eternal search for the truth which is endless, and in which none achieve perfection?

What do the four Absolutes mean to most of us? Words are like tools. Like any other tools they get rusty and corroded when not used. More importantly, we must familiarize ourselves with the tools, understand them, and ever improve our skill in their use. Else the end product, if any, is pathetically poor.

We thought of a dear friend in the fellowship, prone like other alcoholics to move quickly from one hobby or interest to another, without really doing much with any of them. (Does that sound like someone you know?) Once this friend decided that working with his hands would solve some problems—quiet his nerves—and perhaps help him to achieve serenity and balance. So he reviewed an impressive collection of tool catalogues with friends already addicted to the woodworking hobby.

He bought a large expensive collection of tools, and a lot of equipment. He hired a carpenter to build a shop in his basement, install the equipment, and make custom-built racks to house the tools. But in the end not one shaving and not one tiny bit of sawdust graced its floor. The idle tools serve just as will to keep our friend occupied while he doesn't go to meetings, do Twelfth Step work or engage in other happy activity in AA.

How many of you will be completely honest and admit that you have put the four Absolutes in the attic, a little rusty from non-use perhaps, but none the worse for wear? Give or take a little, how many of us who still maintain the workshop for the Absolutes, will admit that not too many shavings or much sawdust from our activity have ever graced its floor? Or even assuming that the activity has persisted, how many will admit that the end product did not win a prize for its quality?

Such lack of quality can only mean lack of objectives or lack of all-out effort toward such objectives. We must recognize the Absolutes as guideposts to the finest and highest objectives to mortal man. But recognition is not enough. We must use the tools.

Honesty

We must ask ourselves, over and over, "Is it true or is it false?" For honesty is the eternal search for truth. It is by far the most difficult of the four Absolutes, for anyone, but especially for us in this fellowship. The problem drinker develops genuine artistry in deceit. Too many (and we plead guilty) simply turn over a new leaf and relax. That is wrong. The real virtue in honesty lies in the persistent dedicated striving for it. There is no relaxed twilight zone, it's either full speed ahead constantly or it's not honesty we seek. And the unrelenting pursuit of truth will set you free, even if you don't quite catch up to it. We need not choose or pursue falsity. All we need is to relax our pursuit of truth, and falsity will find us.

The search for truth is the noblest expression of the soul. Let a human throw the engines of his soul into the doing or making of something good, and the instinct of workmanship alone will take care of his honesty. The noblest pleasure we can have is to find a great new truth and discard old prejudice. When not actively sought, truth seldom comes to light, but falsehood does. Truth is life and falsity is spiritual death. It's an everlasting, unrelenting instinct for truth that counts. Honesty is not a policy. It has to be a constant conscious state of mind.

Accuracy is close to being the twin brother of honesty, but inaccuracy and exaggeration are at least "kissing cousins" of dishonesty. We may bring ourselves to believe almost anything by rationalization, (another of our fine arts), and so it's well to begin and end our inquiry with the question, "Is it true?" Any man who loves to search for truth is precious to any fellowship or society. Any intended violation of honesty stabs the health of not only the doer thus the whole fellowship. On the other hand if we are honest to the limit of our ability, the basic appetite for truth in others, which may be dormant but not dead, will rise majestically to join us. Like sobriety, it's the power of example that does the job.

It is much simpler to appear honest, than to be honest. We must strive to be in reality what we appear to be. It is easier to be honest with others than with ourselves. Our searching self- inventories help because the man who knows himself is at least on the doorstep of honesty. When we try to enhance our stature in the eyes of others, dishonesty is there in the shadows. When falsehood even creeps in, we are getting back on the merry-go-round because falsehoods not only disagree with truth, they quarrel with each other. Remember?

It is one thing to devoutly wish the truth may be on your side, and it is quite another to wish sincerely to be on the side of truth. Honesty would seem to be the toughest of our four absolutes and at the same time, the most exciting challenge. Our sobriety is a gift, but honesty is a grace that we must earn and constantly fight to protect and enlarge. "Is it true or false?" Let us make that a ceaseless question that we try to answer with all the sober strength and intelligence we have.

Unselfishness

At first blush, unselfishness would seem to be the simplest of all to understand, define and accomplish. But we have a long road to travel because ours was a real mastery of the exact opposite during our drinking days.

A little careful thought will show that unselfishness in its finest sense, the kind for which we must strive in our way of life is not easy to reach or describe in detail. In the final analysis, it must gain for us the selflessness, which is our spiritual cornerstone, the real significance of our anonymity.

Proceeding with the question method of digesting the absolute, we suggest you ask yourself over and over again in judging what you are about to do, say think or decide, "How will this affect the other fellow?"

Our unselfishness must include not merely that we do for others, but that which we do for ourselves. I once heard an old-timer say that this was a 100% selfish program in one respect, namely that we had to maintain our own sobriety and its quality before we could possibly help others in a maximum degree. Yet we know that we must give of ourselves to others in order to maintain our own sobriety, in a spirit of complete selflessness with no thought of reward. How do we put these two things together?

Well, for one thing, it points up that we shall gain in direct proportion to the real help we give others. How many of us make hospital calls simply because we think that we need to do it to stay sober? Those who think only of their own need and who reflect little on the question of doing the fellows at the hospital some genuine good are missing the boat. We know, for we used to make hospital calls in much the same way that we took vitamin pills.

Then one day in our early sobriety, we were asked to call on a female patient. There weren't enough gals to go around in those days and the men were called in to help. Never will we forget the anxiety on the way to that nursing home. And after nearly two hours of earnest talk we left one of the noblest women we will ever meet, worried about whether we had helped, or hurt, or perhaps had accomplished nothing at all. Some of her questions stayed with us. We thought of better answers later on, and returned to see her several times.

We are helped on our long journey to unselfishness by our great mission of understanding that sometimes seems as precious as the gift of sobriety itself. But the quality cannot be confined alone to that which we do for others. We must be unselfish even in our pursuits of self-preservation. Not the least of our aid to others comes from the examples of our own lives.

Is there any protection against that first drink which equals our thought of what it may do to others, those whose unselfish love guided us in the beginning, and those whom we in turn guided later on? We are again reminded of the later verse of an anonymous poem:

"I must remember as I go, through sober days, both high and low, what I must always seem to be for him who always follows me."

Love

We often learn more by questions, than by answers. Did you ever hear a question that caused you to think for days or even weeks? The questions, which have no easy answer, are often the key to the truth. However, in this series on the four Absolutes, we are concerned with the questions we should be asking ourselves over and over again in life. The integrity of our answers to these questions will determine the quality of our life, may even determine the continuance of our sobriety.

A good question to ask ourselves on love might be, "Is it ugly or is it beautiful?" We are experts on ugliness. We have really been there. We are not experts on beauty but we have tasted a little, and we are hungry for more. Love is beauty. Coming from the depths of fear, physical agony, mental torture and spiritual starvation, we feel completely unloved, impregnated with self-pity, poisoned by resentment, and devoured by a prideful ego, which with alcohol has brought complete blindness. We receive understanding and love from strangers and we make progress as we in turn give it to new strangers. It's as simple as that. Fortunately for us love is inspiring from the very beginning, even in kindergarten, which is where many of us still are.

The old song tells us that love is a many-splendored thing. In giving it we receive it. But the joy of receiving can never match the real thrill of giving. Consider that the non-alcoholic seldom experiences this great mission of love, which is ours and you have a new reason for gratitude. Few are privileged to save lives. Fewer have the rich experience of being God's helper in the gift of a second life. Love is a poor man's beginning toward God. We reach our twelfth step when we give love to the new man who is poor today, as we were poor yesterday. A man too proud to know he is poor has turned away from God with or without alcohol. We have been there too. But if he has a drinking problem, we can show him the way through love, understanding and our own experience.

When we live for our own sobriety, we again become beggars in spiritual rags, blind once again with the dust of pride and self. Soon we shall be starving with the hunger of devouring ourselves, perhaps even lose sobriety, Love is "giving of yourself" and unless we do, our progress will be lost. Each one owes the gift of this second life of sobriety to every other human being he meets in the ceaseless presence of God, and especially to other alcoholics who still suffer. Not to give of himself brings the desolation of a new poverty to the sober alcoholic.

When we offer love, we offer our life; are we prepared to give it? When another offers us love, he offers his life; have we the grace to receive it? When love is offered, God is there; have we received Him. The will to love is God's will; have we taken the Third Step? Ask yourself, "Is this ugly or is it beautiful?" If it's truly beautiful then it is the way of love, it is the way of A.A., and it is the will of God, as we understand Him.

Purity

Purity is simple to understand. Purity is flawless quality. Gerard Groot in his famous fourteenth century book of meditation, has an essay entitled, "Of Pure Mind and Simple Intention", in which he says, "By two wings a man is lifted up from things earthly, namely by Simplicity and Purity. Simplicity doth tend towards God; Purity doth apprehend and taste Him."

Purity is a quality of both the mind and the heart, or perhaps we should say the soul of a man. As far as the mind is concerned, it is a simple case of answering the question, "Is right, or is it wrong?" That should be easy for us. There is no twilight zone between right and wrong. Even in our drinking days we knew the difference. With most of us, knowing the difference was the cause or part of the cause of our drinking. We did not want to face the reality of doing wrong. It isn't in the realm of the mental aspects of purity that our problem lays. We can all answer the question quoted above to the best of our ability and get the correct answer.

It's in the realm of the heart and spirit that we face difficulty. We know which is right, but do we have the dedicated will to do it? Just as a real desire to stop drinking must exist to make our way of life effective for us, so we must have a determined desire to do that which we know is right, if we are to achieve any measurable degree of purity. It has been well said that intelligence is discipline. In other words knowledge means little until it goes into action. We knew we should not take the first drink, remember? Until we translate our knowledge into the action of our own lives, the value of it is non-existent. We are not intelligent under such circumstances. So it is with the decency of our lives. We know what is right, but unless we do it, the knowledge is a haunting vacuum.

In discussing unselfishness we mentioned that it includes more than just doing for others. We repeat that it includes all that we do, since much of our help to others comes through our own example. Nowhere is this truer than in the decency and rightness of our life. Were we to contemplate the peace and contentment that a pure conscience would bring to us, and the joy and help that it would bring to others, we would be more determined about our spiritual progress. If our surrender under the Third Step has not been absolute, perhaps we should give the Eleventh Step more attention. If you have turned your will and your life over to God, as you understand Him, purity will come to you in due course because God is Good. Let us not just tend toward God, let us taste of him.

In Purity as in Honesty the virtue lies in our striving. And like seeking the truth, giving our all in its constant pursuit, will make us free even though we may never quite catch up to it. Such pursuit is a thrilling and challenging journey. The journey is just as important as the destination, however slow it may seem. As Goethe says, "In living as in knowing be intent upon the purest way."

The Absolutes - A Summary

Our consideration of the absolutes individually leads to a few conclusions. The Twelve Steps represent our philosophy. The Absolutes represent our objectives in self-help, and the means to attain them. Honesty, being the ceaseless search for truth, is our most difficult and yet most challenging objective. It is a long road for anyone, but a longer road for us to find the truth. Purity is easy to determine. We know what is right and wrong. Our problem here is the unrelenting desire to do that which is right. Unselfishness is the stream in which our sober life must flow, the boulevard down which we march triumphantly by the grace of God, ever alert against being sidetracked into a dark obscure alley along the way. Our unselfishness must penetrate our whole life, not just our deeds for others, for the greatest gift we bestow on others is the example of our own life as a whole. Love is the medium, the blood of the good life, which circulates and keeps alive its worth and beauty. It is not only our circulatory system within us, but it is our medium of communication to others.

The real virtue is in our striving for these Absolutes. It is a never-ending journey, and our joy and happiness must come each step of the way, not at the end because it is endless. Cicero said, "if you pursue good with labor, the labor passes and the good remains, but if you court evil through pleasure, the pleasure passes and the evil remains." Our life is a diary in which we mean to write one story, and usually write quite another. It is when we compare the two that we have our humblest hour. But let's compare through our self-inventory and make today a new day. Men, who know themselves, have at least ceased to be fools. Remember if you follow the Golden Rule, it's always your move too. To love what is true and right and not to do it is in reality not to love it, and we are trying to face reality, remember? The art of living in truth and right is the finest of fine arts, and like any fine art, must be learned slowly and practiced with incessant care.

We must approach this objective of the Absolutes humbly. We pray for these things and sometimes forget that these virtues must be earned. The gates of wisdom and truth are closed to those wise in their conceit, but ever open to the humble and the teachable. To discover what is true and to practice what is good are the two highest aims in life. If we would be humble, we should not stoop, but rather we should stand to our fullest height, close to our Higher Power that shows us what the smallness of our greatness is.

Remember our four questions: "Is it true or false?", "Is it right or wrong?", "How will this affect the other fellow?", and "Is it ugly or beautiful?" Answering these queries every day with absolute integrity, and following the dictates of those answers one day at a time, will surely lead us well on our journey toward absorbing and applying the Absolutes.”

Note: the Four Absolutes are indeed not included in AA philosophy either formally or informally. For why see here: “What did A.A. learn from the Oxford Group and why did they leave them?”

Interview: A Doctor Speaks

George E. Vaillant, M.D., joined AA's General Service Board as a Class A (nonalcoholic) trustee in 1998. He is professor of psychiatry, Harvard Medical School, director of the Study of Adult Development, Harvard University Health Services, and director of research in the Division of Psychiatry, Brigham and Women's Hospital. The author of The Natural History of Alcoholism Revisited, a comprehensive study of alcoholism, George lectures widely on alcoholism and addiction and is one of the foremost researchers in the field.

This article appeared originally on the AA Grapevine Magazine on May, 2001, Vol. 57, No. 12. Available on: http://www.aagrapevine.org. Reprinted with permission.

Grapevine: In an article about alcoholism in Harvard Magazine, you were quoted as saying that 50 percent of the people brought into emergency rooms with fractures are there as a result of alcohol, but that blood-alcohol levels are never checked. It made me curious about the way medical professionals view alcoholism today. Can you tell us something about that?

George Vaillant: What happens in emergency rooms is actually much more dramatic than that. Probably 50 percent of all the people brought into emergency rooms had blood-alcohol levels over .25 - which is enough to make any nondependent person comatose, not just prone to accidents. And even though this is a clear biochemical fact staring doctors in the face, no referral is made - nothing is done about it - because when it comes to treating alcoholism, the medical profession feels so helpless, so without hope. And for a doctor, feeling powerless is reason enough to put his head in the sand.

Grapevine: Why do you think that feeling persists?

George Vaillant: You have to remember that very few doctors have ever seen a recovered alcoholic. If you're recovered, you don't have any reason to tell your doctor you're an alcoholic. And if you're not recovered, you go back to see him a hundred times, so you're forever etched in his memory. Consequently, doctors overcount the failures and have no knowledge of the successes. They don't understand that 40 percent of all recovery has probably occurred through Alcoholics Anonymous.

Grapevine: What could be done to change that?

George Vaillant: The two simplest ways that I know are both within the power of the Fellowship. One is to take your doctor to open meetings so he or she can see for themselves these well-dressed people in nice suits who look like anybody else and have been in recovery for years. It was terribly important for me to get inside of open meetings and see sober alcoholics for myself because they're terribly inspiring.

The second is to twelfth-step your doctor - not to teach him about alcohol or Alcoholics Anonymous, but to give him a list of names that motivated patients could call. Doctors aren't experienced enough in their practices to find recovering alcoholics, so recovering alcoholics must either say "I will talk with patients," or give doctors referrals. What medical professionals need is a list of referral sources, clearly typed, and some success using those referrals, so they have hope rather than hopelessness.

Grapevine: How did you, a nonalcoholic, get to know AA?

George Vaillant: I was working for an alcohol clinic where it was a condition of employment. I had to go to a meeting a month. In addition, half the staff were recovering alcoholics, and they were the first people whom I'd met at Harvard in ten years who knew anything about the disease.

Grapevine: Is there any movement afoot to establish that kind of requirement for medical students today?

George Vaillant: For the last ten years, medical students in many medical schools have been required to go to one or two AA meetings, due in large part to the activity of AA's CPC (Cooperation with the Professional Community) committee. But the problem is that in your first two meetings, there's so much going on that you don't always get the feeling of, "My God, these people are recovering." It's more about learning what a terrible disease alcoholism is and not about realizing that the people in the meeting are the same people you see in your emergency room with the fractures.

What people are only slowly learning is that you can teach medical students anything that's noble and good about people and they get it right on the exam. But where medical students learn how to be doctors is on the hospital wards and in the emergency rooms, where they're working with residents. And interns, for very good reasons, hate active alcoholics with a passion. Therefore, the educational program has to begin again after residency. And that really is something patients can do for their doctors - not by teaching them about AA, but by telling their stories and offering whatever suits them of the Twelve Steps. And, as I said, by giving them a number to call when the roof is falling in.

Grapevine: You said about 40 percent of the people who remain abstinent do it through AA. What about the other 60 percent? Could we in AA be more open, more supportive of these?

George Vaillant: Yes. You know, if you're batting 400, it's all right to miss a few. I think the fact that AA knows the answer to an extremely complicated problem is probably all right.

But it doesn't hurt at the level of GSO for AA to have humility and understand that 60 percent do it without AA. It's also true that most of those 60 percent do it with the AA toolbox: their spirituality doesn't come from AA; their support group doesn't come from AA; and what I call "substitute dependency" doesn't come from AA. But they still use the same ingredients that AA uses.

And I don't think there's anything that the other 60 percent are doing that AA needs to learn from, except: "If it ain't broke, don't fix it." If you meet someone who has stayed sober for more than three years and they're pleased and boasting that they did it without AA, thank your Higher Power for another recovery. You know, there's "little" sobriety, being dry, and there's sobriety with a big S, which includes humility and not thinking that you're the center of the earth. So if someone is doing something without your help, good enough.

Grapevine: What have you discovered about AA since becoming a trustee? Or as you put it, what if anything has made you say, "Aha!"

George Vaillant: I'd never seen the General Service Manual before, and to me as a nonalcoholic, it is a great piece of world literature, like the American Constitution. It is a great contribution to human thought.

I've also learned something about spirituality. Every time there is a board weekend, I arrive thinking, "Oh my God, this is another weekend I'm not with my family." Then I spend the next two days bathed in love and acceptance that is not from my being anyone special. So I've learned another definition of spirituality: we are each like the beautiful wave that's about to crash on the beach, saying, "This is it. This is forever." Then a voice from behind says, "Don't worry, son. You're not a wave; you're part of the ocean."

Grapevine: There is still a great deal of debate about the role of addicts in AA. What are your views on that?

George Vaillant:This is a terribly important question. AAs should focus on alcoholism. They're right. They've got enough to do, and there are enough alcoholics to go around in the world that they should never fear for their primary purpose.

But because there are a lot of people with mixed addictions, it's important for individual groups that can tolerate them to be tolerant and inclusive. There are some groups that welcome white, middle-aged Protestant males. And that's okay; they should be there, even though the rest of AA may regard them as hopeless dinosaurs and politically incorrect. And there are other groups that tolerate people who spend a little bit too much time talking about their $5-million cocaine habit and not enough time talking about alcoholism. And that's the wave of the future. There are increasingly fewer alcoholics. So some groups are going to have to change.

Grapevine: What are some of the other challenges that AA faces?

George Vaillant: I think there are two, really. One is to come to some meaningful terms with the individuals who are frightened that AA is a religion. This will involve some work and growth in AA to incorporate its diversity without losing its traditions. This is in keeping with the question of keeping the first 164 pages that Bill W. wrote in the Big Book and at the same time including contemporary stories about things some groups might be horrified by.

The second challenge (and this may be more important to me as a class A trustee) is to convey to the world what an extraordinary organization Alcoholics Anonymous is - not only in its ability to cure alcoholism but in its ability to conceptualize the fact that we're all one planet.

Just as an example, groups that are supposed to know about human beings and to be peaceful - the Christian church, the psychoanalytic movement, and the peace movement - are constantly splintering and fighting with each other. And somehow for sixty years, AA has kept two million very diverse individuals, who in their past lives were often a lot less peaceful than the Christians, the psychoanalysts, and the advocates of peace, working together for a common good.

I'm not sure that's a challenge to the Fellowship, or necessary to keep people sober. It's simply to me a challenge that people appreciate the depth of this message, which is expressed more in the Twelve Traditions and Twelve Concepts that in the Twelve Steps.

Grapevine: When you spoke of religious skeptics or of those fearful that AA might have a religious agenda, were you thinking of professionals in the field of alcoholism, or alcoholics themselves?

George Vaillant: Oh, both. Alcoholics, because of the shame, are enormously sensitive to exclusion. So to say, "If you want what we have, you have to believe in a Higher Power; you have to be spiritual, or you have to fake it till you make it" is enormously threatening to some people. They're still at a point of self-absorption; the idea of depending on a power greater than themselves is something they're going to have to learn. Think of it this way: there are a lot of things parents believe, like the value of working hard and completing an education, that make no sense to an eighteen-year-old. And for some alcoholics, spirituality is like one of those things that you learn when you get older. AA has to constantly remind itself that it needs to meet people where they are and that it can only make loving suggestions.

Bill W. spells out very clearly that Alcoholics Anonymous is not a religion. And he makes it clear that there should be nothing about AA that excludes anyone who's a suffering alcoholic. But how you get people who've grown up in one tradition to understand how the world looks to people who've grown up in another takes ongoing discussion. Universality is very hard to achieve. And AA, in its effort of world unity, is constantly having to evolve. It's not a question of changing. It's a process of growth.

Copyright 2001, AA Grapevine Magazine, Inc., All Rights Reserved

The Fundamentals - In Retrospect