Portable AA Big Book

WILLIAM DUNCAN SILKWORTH, MD (1873-1951)

From Mike O., of The Just Do It Big Book Study Group of Alcoholics Anonymous, DeBary, Florida.

Doctor William D. Silkworth, called, "the little doctor who loved drunks", began an indispensable contribution to Alcoholics Anonymous during the early 1930's from his position as medical director of Charles B. Towns Hospital, 293 Central Park West (89th street), New York, N.Y. Towns, founded in 1901, was well known then as a rich man's drying-out place; a rehab for the wealthy, and it served a worldwide clientele. American millionaires, European royalty and oil sheiks from the middle east walked its halls, side by side: brothers in humiliation in bathrobes and slippers.

It was Dr. Silkworth who told Bill Wilson, during the summer of 1933, of the nature of alcoholism: that, in his opinion, the problem had nothing to do with vice or habit or lack of character. It was, he said, an illness with both mental and physical components. Silkworth is quoted widely as calling the illness a combination of "---an obsession of the mind that condemns one to drink and an allergy of the body that condemns one to die" or go mad if one continues to ingest alcohol.

Dr. Silkworth was not the first highly respected authority to write about alcoholism. Solomon, considered the wise man of his era, wrote about it in Proverbs, Chapter 23, and Verses 29 through 35. Solomon's Biblical words seem an accurate description of the alcoholic of today.

Dr. Benjamin Rush, one of the signers of The Declaration of Independence, was the first member of the medical community to write about alcoholism and suggest it might be an illness. In a medical paper he wrote in 1784, Dr. Rush said he thought alcoholism was "-a disease process." He offered no further clinical evidence. So: Dr. Silkworth, it appears, was the first medical person to detail alcoholism, in writing, as an illness.

Silkworth, thus, disagreed with his employer, Charles B. Towns. Towns, who had once claimed to have a "cure" for alcoholism, believed firmly in a physiological, medical model of addiction. But, he denied that alcoholism, per se, was a disease. Silkworth argued that certain individuals were "constitutionally susceptible to sensitization by alcohol" and that drinking sparked an allergic reaction. This, he insisted, made it physically impossible for an alcoholic ever to tolerate alcohol. Moreover, he said, that problem drinkers would have to learn and accept this fact as part of their treatment.

Silkworth played a major role in many of the early recoveries from active alcoholism, particularly those in New York. It's estimated that he treated forty-thousand alcoholics during his career. The introduction to his writings in the book, "Alcoholics Anonymous" says early AA members considered the Brooklyn-born Silkworth no less than a medical saint.

Dr. Silkworth advised Bill Wilson to stop preaching at the drunks he was trying to help by telling them about his powerful spiritual experience. Silkworth urged Wilson to begin, instead, by telling each of the alcoholics that his condition was hopeless, a matter of life-or-death. Only then, Silkworth believed, would the drunks be willing to listen to a story about a spiritual remedy.

Through no fault of the doctor's, there is disagreement about parts of his professional history and about his birth year. In Silkworth's biography in the book, "Dictionary of American Temperance Biography: From Temperance Reform to Alcohol Research, the 1600s to the 1980s," the historian Mark Edward Lender lists Silkworth's date of birth as July 22, 1877. All other sources used in this compilation, which contain a date of birth for Silkworth, including his New York Times obituary, agree that Silkworth's birth year was 1873.

It's agreed, generally, that Silkworth graduated from Princeton University (A.B. 1896) and that he took his M.D. degree from New York University-Bellevue Medical School (1899). But, two principal sources, "Pass It On," published by Alcoholics Anonymous, and, "Not-God," researched and written by the widely respected historian Ernest Kurtz, Ph.D and published by Hazleden, offer differing versions of his career path thereafter.

"Pass It On," (p. 101) reports Silkworth became a specialist in neurology, a domain that sometimes overlaps psychiatry, and entered private practice in the 1920's. It says Silkworth invested his savings in a stock subscription for a new, private hospital. "Pass It On" says Silkworth's investment came with the promise of a staff position when the hospital was built. But, the report says Silkworth lost everything in the stock market collapse of 1929. And,"Pass It On" quotes Bill Wilson as saying that Silkworth, in desperation, went to Towns in 1930 for compensation of about forty dollars a week, plus board.

"Not-God," (p. 22) reports that after he received his medical degree from
NYU, Silkworth began a coveted internship during 1900 at Bellevue Hospital, 462 First Avenue (27th. Street), in Manhattan. It says that in 1924-after completing specialty training as a neuro-psychiatrist- --Silkworth became medical director of Towns. "Not-God" notes that Dr. Silkworth estimated his patients' rate of recovery, until Bill Wilson came along, at "approximately only two percent."

So: "Pass It On" and "Not-God" show a six-year difference in Silkworth's arrival date at Towns.

A third source offers a wider time differential but more information about Silkworth. The respected Journal of Studies on Alcohol, published monthly by The Center of Alcohol Studies at Rutgers University, New Brunswick, New Jersey reports Silkworth arrived at Towns in 1932. An article by Leonard Blumberg, (Professor of Sociology, Temple University, Philadelphia Vol. 38. No. 11, 1977, "The Ideology of a Therapeutic Social Movement: Alcoholics Anonymous") says Dr. Silkworth worked at Towns from 1932 until his death in 1951.

Silkworth's entire career had a psychiatric emphasis. He was a member of the psychiatric staff at the US. Army Hospital in Plattsburgh, New York, for two years (1917-1919) during World War I.

Dr. Silkworth also served as associate physician at the Neurological Institute of Presbyterian Hospital in Manhattan from 1919 to 1929. He had also been connected with Broad Street Hospital.

The Blumberg article leaves room for speculation about the circumstances under which Silkworth left the prestigious Presbyterian Hospital in 1929. It concludes that he probably was laid off during a staff reduction following the stock market crash of that same year. The article does not attempt to fill the time vacuum of approximately three years until it says Silkworth went to Towns.

Regardless of his starting date at Towns, Wilson said Silkworth's arrival there was the turning point in the doctor's life. Nearly all sources agree that he worked there approximately nineteen years.

Additionally, Dr. Silkworth was a major influence in persuading the management of Knickerbocker Hospital in upper Manhattan to set aside a small ward, beginning in 1945, for the treatment of alcoholics. Knickerbocker was the first general hospital in New York to do so. (This is significant because many general hospitals at that time would not admit alcoholics as alcoholics. Their doctors had to admit them under false diagnoses.) Dr. Silkworth served six years at Knickerbocker as director of alcoholic treatment, attending an estimated seven thousand alcoholics. Teddy R., a nurse who was an AA member, ran the alcoholism ward. Figures as to costs at Knickerbocker are unconfirmable. But, the fees and other expenses there were much less than at Towns, where patients paid $125.00 for one week of treatment, during the early and mid-1930's. At Knickerbocker, drunks off the street with no financial resources were de-toxified.

William Duncan Silkworth died Thursday morning, March 22, 1951 of heart attack at his home, 45 W. 81st. Street, New York. He and his wife, Marie, had lived in Manhattan during their later years. But, it's known that he commuted for part of the time he worked in New York from a home in Little Silver, New Jersey. Today, there's a train station about one block away from that house, which-as of this writing -- is still standing. But, it's unclear whether the train station was there at the time Silkworth lived in Little Silver.

As noted previously, the book, "Alcoholics Anonymous," reports that early AA members considered Dr. Silkworth a "---medical saint." It was never a secret that his personal relationship with Alcoholics Anonymous was both deep and emotional. He was called, "-the little doctor who loved drunks" because he genuinely cared for and experienced communion with alcoholics. And, they loved him. An in-depth explanation can be found in, "Language of The Heart," (p. 176).

In an article he wrote years later for The Grapevine, Bill Wilson noted that Dr. Silkworth treated some 40,000 alcoholics during his career. Wilson added, "He never tired of drunks and their problems. A frail man, he never complained of fatigue. During most of his career he made only a bare living. He never sought distinction; his work was his reward. In his last years, he ignored a heart condition and died on the job--among us drunks, and with his boots on."
All but one of the AA historians who influenced this writing believe that Dr. Silkworth held positions at both Towns and Knickerbocker Hospitals at the time of his death. But, it should be noted that the respected AA historian and author Mel B., who wrote much of "Pass It On," the official AA biography of Bill Wilson, mentions only Silkworth's affiliation with Knickerbocker Hospital at the time of the doctor's death.

Wilson showed his gratitude to Silkworth in 1950 and '51, when he and some associates tried to raise enough money to allow "Silkie" and Marie, to retire to New Hampshire. The doctor was going to be medical director of the treatment center, Beech Hill Farm, near Dublin, New Hampshire. But, Silkworth died before it could happen. So: Bill, noting Mrs. Silkworth's strained financial circumstances, raised $25,000 for a Silkworth Memorial, to supplement the widow's small income.

Dr. Silkworth's death was announced to the Fellowship in the April 1951 version of the AA Grapevine. And, the article indicates AAs of that time considered Silkworth more than a "medical saint." To those AA's who knew him, William Duncan Silkworth was a hero. The April 1951 Grapevine article notes, "He freely risked his professional reputation to champion an unprecedented spiritual answer to the medical enigma and the human tragedy of alcoholism." Historians point out that he might have been laughed out of the American Medical Association for holding such a view. Obviously, that did not happen.

Wilson, who previously had referred to Dr. Silkworth as "-AA's first and best friend" eulogized Silkworth in the May 1951 Grapevine. And, his affection and sense of personal loss is expressed in a notation on a copy of the appeal for funds (found in the archives of the General Service Conference of A.A.) It says, "Thank Heaven we started this before Silkie went."

The Wilson article, written especially for The Grapevine, concludes with two questions: "Who of us in AA can match this record of Dr. Silkworth's? Who has his measure of fortitude, faith and dedication?" .

SOURCES: The AA publications: "Alcoholics Anonymous", "Pass It On", "The Grapevine" and "Language of The Heart"; the Archives of the AA General Service Office; "Not-God" by Ernest Kurtz; "The Journal of Studies on Alcohol 1977" which contained "The Ideology of a Therapeutic Social Movement: Alcoholics Anonymous." by Leonard Blumberg: published by The Center of Alcohol Studies, Rutgers University); "Dictionary of American Temperance Biography: From Temperance Reform to Alcohol Research, the 1600s to the 1980s" by Mark Edward Lender; "Lois Remembers" by Lois Burnham Wilson; "My Search For Bill W" by Mel B.; Yale University; New York University and private conversations with AA's who knew Dr. Silkworth.

I'm grateful for the above sources. Any errors are my own.

Researched/written for: The Round Table of AA History by Mike O. of The Just Do It Big Book Study Group of Alcoholics Anonymous, DeBary, Florida. Updated/revised: 1999, 2000, and 2001.