By SAMUEL SHEM, Co-author, M.D. D.Phil (Oxon)
Phillip Seymour Hoffman, the brilliant actor, died from a drug overdose. This is a great tragedy. The outpouring of sorrow and tribute has just begun. Online there is a great deal of death about how his death is a lack of willpower. This shows a basic and remarkable misunderstanding of what addiction is. It is not a lack of will, it is a disease. As doctors who have treated many hundreds of alcoholics and addicts, we have come to understand that no amount of willpower can keep an addict or a drunk away from his or her drug of choice. Recovery is not about will-power. It is about venturing out of the isolation of a willful self into a healing connection with other alcoholics or addicts.
Almost eighty years ago two men, Bill Wilson, an alcoholic, and Dr. Bob Smith, “dually” addicted to both alcohol and barbiturates, faced into the lonely hell of addiction, and realized that trying to will yourself through is deadly, and that connection heals. All of the elements of Phillip Hoffman’s tragic journey are in this very first story of finding a treatment for alcoholism: two men on the edge of death, the sudden realization that it was not a “moral failing” but a disease, finding a treatment together, relapsing, and then finding a solid path to sustaining recovery. Sometimes the stories of these successful recoveries of the healing power of connection get buried in our self-valuing society. The public misconceptions of what these two men discovered—Alcoholics Anonymous–is formidable.
The world seeks out heroes—and, less so, heroines. America, from deToqueville, through Emerson’s “self-reliance”, to the thousands of “self-help” volumes, is a nation that highly values “self.” Our mainstream rewards one person or another, not the quality of the connection between them.
In the case of Alcoholics Anonymous, the press and media continually cite Bill Wilson as that hero, the founder of the original 12-step program that has, arguably, done more than any other treatment to heal alcoholics and other substance abusers. Bill always makes the “fame” lists—from Life magazine’s “100 Greatest Americans of the 20th Century” to, in 2010 on the 75th anniversary of the founding of AA, New York Times columnist David Brooks’ entitling his piece “Bill Wilson’s Gospel” and making no mention of Dr. Bob Smith. Biographies of Bill are evergreen and sometimes excellent; there are no comparable biographies of Bob.
“Dr. Bob” was an Akron surgeon who, with “Bill W.”, in one six-hour chance meeting in 1935 in Akron Ohio, created Alcoholics Anonymous. Partly because of our culture’s focus on “the great man,” and the fact that Bill the sophisticated New York stockbroker lived 20 years longer and was a tireless self-promoter (described as “a man who could talk a dog off a meat wagon”) while Bob was a humble and reserved rectal surgeon treating alcoholics in Akron for free, Bill gets almost all the credit, while Bob is a kind of forgotten man. In 1986 when we began researching material for a play about the relationship between the two men, the information on Bob was sparse. Only in Akron, when we met and made friends with Sue Windows, Dr. Bob’s only daughter, did we begin to understand him. Sue and the other locals were delighted that in the play Bob and Bill would be equals.
Bob’s “drunkologue” was every bit as horrific as Bill’s. In his words, “I used pills and booze every day. I woke up in the morning with the jitters, took a sedative to steady my hands for surgery, started drinking again in the afternoon, needing to get drunk to sleep. Sometimes, in the operating room, I’d be high as a kite. Lucky I haven’t killed somebody.” And his eventual recovery was focused on humble “service”; without pay he treated over 5000 alcoholics at St. Thomas Hospital in Akron. As he put it his one his last talks: “Even now I still think I could probably knock off a couple of scotches, but then I say to myself, ‘Better get back on the job, big boy, better go see some of the drunks on the ward.’ Giving of ourselves, our own effort, strength, and time—it takes practice, you know, to learn that spirit of service.”
Yet AA is not about one man “or” the other. The essence of AA is that it is an “and” program—healing arises in the meeting of the two. This “And Factor” is a powerful part of AA. In Bill’s own words, “I realized that no amount of willpower could keep me away from a drink. The only thing that could keep a drunk sober was telling his story to another drunk.” That’s why we entitled the play Bill W. and Dr. Bob. The fellowship, and the healing power, is in that single “and.” They had tried willpower, and it did not work.
When Bill and Bob met that night, each was facing death, trying to find a way to stay alive. We have come to think that the “other drunk” Bill met that night in Akron had to be a doctor. When Dr. Bob hears Bill say that his own physician in New York, William Silkworth, thought “alcoholic allergy” was “a disease”, Bob lights up and says, “A disease? With signs, symptoms, a course and a progression? Implying what? A treatment?” And so Bob recast their shared search for how to stay alive as finding a treatment, and AA was born.
They discovered that, just as in medical illness itself, in addiction there is a danger in isolation and relying on willpower, and there is a healing in mutual connection.
In fact, current medical research suggests that isolation has detrimental effects on the immune system, and connection may stimulate it—and this has relevance for treatments, such as for melanoma and other cancers.
In addition to finding a way to recover, the two men made other discoveries that changed how medicine is practiced today:
By finding that a patient suffering from a particular disease is helped by meeting with another similar sufferer(s), they started what we now take for granted: same-disease support groups (breast cancer, child abuse, war-trauma, etc).
By realizing that alcoholism is a disease with three elements—physical, psychological, and spiritual, and had to be treated in all three arenas—they discovered the “holistic movement”, currently labeled the “bio-psycho-social” model that is now at the heart of modern medicine. All in 1935, eight decades ago.
And what about God? At the time that the two of them met, neither one had much faith in a traditional religious God. As Bob says: “I was forced to attend church four times a week. I vowed when I was free I would never darken the door of a church again—a vow I’ve kept, religiously, for forty odd years.” Bill, too, had more or less given up on God. Both men had pragmatic reasons: they had tried prayer to God, and it didn’t work to keep them sober. The key to their vision about “God” came from a man named Ebby Thatcher, an old friend of Bill’s who said, “You don’t have to believe in God, you just have to admit that you’re not God. Use what you do believe in, whatever it is.”
The essence of this is twofold. If an alcoholic cannot himself stay sober, then asking for help from someone or something outside that “self” is, pragmatically, necessary. One term that is used is “a Higher Power,” or “a Power greater than myself”—whatever form that takes for each person. Second, there is often confusion in the difference between a “religious” program and a “spiritual” program. It is clear from both of these men’s lives that AA is not “religious,” but “spiritual.” Bill’s transformation in Towne’s Hospital three months before he chanced to meet Bob has been described by many writers as a “conversion experience,” a spiritual experience described by William James, a philosopher that both Bill and Bob read. The 12 Steps of AA are heavily influenced by a non-theistic spirituality, Buddhism—in tune with “non-self”, “non-attachment”, “letting go”, which both men, to different extents, embraced. The phrase written into the 12 Steps by Bill and Bob is, “God, as we understood him.” (italics from 12 Steps). Including the word “God” was a way of compromising with various factions at the time, the late 1930’s, a very different era from ours.
Our pundits and columnists will continue to tout the lone hero who prescribes—and sometimes proscribes—to millions. But the healing, not just of the millions of recovering alcoholics and addicts in `12 Step programs, but the hope for healing of the world, lies beyond the hero. The adversarial stance of “I”/”You”, “Either”/”Or”, dominates American culture, from what we drink or drug or eat, to whom we see as enemies. The promise is in shifting from the individual’s will to the quality of the relationship, to that “And”, to a fellowship of mutual healing.
The suffering in AA is centered on “alcohol,” but that particular story is relevant to any human suffering. If we isolate ourselves, and try to will ourselves to walk through our suffering alone, we will suffer more, and we will spread more suffering around. If we try to walk through suffering with others—at best, others with similar sufferings—we will suffer less, spread less suffering around, and walk out of it, perhaps, with a bit more compassion, and even gratitude, and service to others.
Phillip Seymour Hoffman did his best to find this path, and for decades of marvelous sober work did walk it to the limit of his spirit, but then, tipped over by prescribed pain-killers, he relapsed, and died alone. To frame this as a lack of willpower is to diminish not only him, but all those who are in recovery.
Samuel Shem, author of The House of God, and Janet Surrey are the authors of the Off Broadway play Bill W. and Dr. Bob, currently at the Soho Playhouse. (see attached resumes)
SAMUEL SHEM, Co-author, M.D. D.Phil (Oxon)
Samuel Shem, pen-name of Stephen Bergman, is a doctor, novelist, playwright and activist. A Rhodes scholar, he was on the faculty of Harvard Medical School for three decades. Shem has been described in the press as “Easily the finest and most important writer ever to focus on the lives of doctors and the world of medicine”, and “He brings mercy to the practice of medicine.” The Lancet called THE HOUSE OF GOD: ”One of the two most significant medical novels of the 20th century”. Its sequel, MOUNT MISERY, reviewed as “another medical classic,” is about training to be a psychiatrist; FINE is about a psychoanalyst.
His 2008 novel, THE SPIRIT OF THE PLACE, about a primary care doctor in a small town, was reviewed as ”The perfect bookend to THE HOUSE OF GOD”. It won the “National Best Book Award 2008 in General Fiction and Literature” from USA Book News, and the “Independent Publishers National Book Award in Literary Fiction 2009.”
As a playwright, with his wife Janet Surrey he wrote the Off Broadway hit play BILL W. AND DR. BOB, about the founding of Alcoholics Anonymous, which won the “Performing Arts Award of the National Council on Alcoholism 2007”, and is being produced all over the country. He was playwright-in-residence at the Boston Shakespeare Company; and has had many other plays produced, including “The Shem Plays” Off Off Broadway, which were published in THE BEST SHORT PLAYS anthologies. Bill W. and Dr. Bob is now in its 7th month of a run (175 performances) at the Soho Playhouse, Off Broadway.
With Janet Surrey he has also published the nonfiction book: WE HAVE TO TALK: HEALING DIALOGUES BETWEEN WOMEN AND MEN, winner of the Boston Interfaith Council’s Paradigm Shift Award, 1999.