Illustration · A priest’s desk during the National Clergy Conference on Alcoholism in New York, April 1960, with the conference’s program, a breviary, a rosary and a lit candle. Not drawn from a photograph.

A far safer term

AA’s book called drinking an illness and a malady, and in 1960 a priest asked Bill W. why he never said “disease.”

“…a far safer term for us to use.”

Bill W., answering a priest’s question at the National Clergy Conference on Alcoholism, as the conference’s synopsis of the questions printed it · the conference’s “Blue Book”, 1960

Illness, malady, sickness

When Bill W. wrote AA’s book in 1938, his understanding of the drinking came from Dr. William D. Silkworth, who had told him it was an illness, not a failure of will. (The papers, in The Little Doctor, tells the doctor’s side.) The book that came out in April 1939 calls it an illness, a malady, a sickness. In the chapters Bill wrote, the word “disease” turns up once, and not about drinking: resentment, “How It Works” says, is where “all forms of spiritual disease” begin.

The Journal of the American Medical Association wasn’t persuaded. That October it called the book “in no sense a scientific book.” Bill went on choosing his words. Speaking to the Medical Society of the State of New York in May 1944, he called alcoholism “a complex malady,” and to the psychiatrists in 1949, the “fatal malady.” AA’s new magazine gave its front page to the other word. The Grapevine’s first issue, in June 1944, carried two Yale scientists under the headline “Two Yale Savants Stress Alcoholism as True Disease.”

In April 1960 Bill spoke in New York to the National Clergy Conference on Alcoholism, a yearly meeting on alcoholism for priests. When he finished, a priest the printed record calls Father X. asked whether, in leaving out the word “disease,” he had meant a distinction between disease and sickness. As the conference’s synopsis gives his answer, AAs had never called alcoholism a disease because “technically speaking, it is not a disease entity,” any more than there is one heart disease rather than many heart ailments. AA had not wanted to “get in wrong with the medical profession.” So it had always said illness or malady, “a far safer term for us to use.”

He hadn’t always kept to it himself. A month before, writing in the Grapevine, he remembered Dr. Silkworth telling him and Lois what “the disease of alcoholism” actually is.

Listen A far safer term About 1 minute

In the book

Counting the words

What AA’s book calls the drinking, counted in its first edition and its fourth, then what Bill W. called it over twenty years.

Counted by hand in the text of the first edition (1939) and the fourth (2001), only where the word names the drinking itself. Bill’s words are from his talks and Grapevine essays as printed.

The book’s chapters, 1939

The eleven chapters, pages 10–179 of the first edition

illness9
malady5
sickness3
disease0

Plus one “spiritual disease,” in “How It Works,” about resentment; the fourth edition’s chapters have that one too, and no other. Left out: a family’s “fatal illness,” the “spiritual malady” and “no other human sickness.” Bill wrote at least ten of the chapters; Pass It On says Hank P. may have written “To Employers.”

“Disease,” in the members’ stories

The personal stories at the back of the book

19397
200127

The first edition’s stories, and the fourth edition’s 42, 24 of them new that year. Five uses about something else, such as one woman’s cirrhosis, aren’t counted.

Bill’s words, 1939–1960

1939The Big Book“An illness of this sort—and we have come to believe it an illness—”illness
1944Medical Society of the State of New York“alcoholism is a complex malady”malady
1945The Grapevine, September“a fatal malady over which we are individually powerless”malady
1949American Psychiatric Association, Montrealfrom “sin” to “sickness” – the “fatal malady,” alcoholismmalady
1958The Grapevine, March“the immorality of drinking rather than the disease of alcoholism”disease
1960The Grapevine, Marchwhat “the disease of alcoholism” actually is, as Dr. Silkworth told himdisease
1960The clergy conference, April“an illness or a malady – a far safer term for us to use”illness

Two vocabularies

The chapters Bill wrote never call drinking a disease. The members’ stories do, seven times in 1939 and twenty-seven in 2001, and now and then, so did Bill.

For a closer look

Go deeper

An old objection to calling it an illness, whether Bill ever said “disease,” and the conference and its record.

Sickness and sin

In the same talk Bill took up an old objection from theologians. Early in AA’s history, he said, a Mr. Link, author of a popular book called The Return to Religion, had objected to AA’s position that alcoholism was an illness, because he felt it took away the alcoholic’s moral responsibility. AA had never used it that way, Bill said: “we used the fact of fatal illness to clamp the heaviest kind of moral responsibility on to the sufferer.”

The question was live in the Church that spring. In March 1960, Father Ed Dowling wrote to Sister Ignatia that Cardinal James McIntyre of Los Angeles objected to AA’s idea that alcoholism is a disease. (Backing away from hell, in Some Bum from St. Louis, tells it.)

Did Bill say “disease”?

Not in his papers to doctors in 1944 and 1949. AA’s biography of Bill, Pass It On (1984), says that in his 1944 talk to the Medical Society of the State of New York “he referred to alcoholism as a disease.” The talk as the society’s journal printed it that August says “illness” and “a complex malady,” and not “disease.”

In the Grapevine he used it: in March 1958, writing about education on alcoholism, and again in March 1960, a month before the clergy conference. The same 1958 essay said the American Medical Association had “officially declared alcoholism to be a chronic illness.”

The historian Ernest Kurtz read the 1960 answer as hesitancy, not denial: Bill was “hardly denying an understanding that includes a medico/physiological element in alcoholism.” AA, Kurtz argued, “neither originated nor promulgated” the idea that alcoholism is a disease. Yale’s scientists and Marty M.’s committee pressed it (Something useful, in People Like You), and AA’s members spread it.

The conference and its record

Father Ralph Pfau, believed to be the first Catholic priest in AA, founded the National Clergy Conference on Alcoholism in 1948. Its talks were printed each year in a volume called the “Blue Book.” The twelfth conference met in New York from April 19 to 21, 1960, AA’s archives newsletter Markings says. Bill spoke one morning, and the question about “disease” came after his talk.

The question period was printed as a synopsis, so its words may not be exactly the ones spoken. His answer is usually quoted secondhand, and the tellings differ. Kurtz’s paper of 2002 puts it in 1961, at a “National Catholic Clergy Conference,” and has Bill say “Therefore we always called it an illness.” The conference’s synopsis, as transcribed, has “Hence we have always called it.” This page quotes the synopsis.

Sources

Alcoholics Anonymous. Works Publishing, 1939 (first edition): the eleven chapters and the personal stories. Fourth edition, AA World Services, 2001: the chapters and the personal stories.
Bill W., talk and answers to questions, Twelfth National Clergy Conference on Alcoholism, New York, April 1960, printed in the conference’s “Blue Book,” vol. 12 (1960), pp. 179–210, with “Question Period: A Synopsis,” as transcribed at silkworth.net.
Markings, May–June 2004, “The Clergy and Alcoholics Anonymous” (aa.org).
Bill W., “Basic Concepts of Alcoholics Anonymous,” New York State Journal of Medicine, August 1944, as transcribed at silkworth.net.
Bill W., “The Society of Alcoholics Anonymous,” American Journal of Psychiatry, 1949, read to the American Psychiatric Association in Montreal, May 1949, as transcribed at silkworth.net.
The Language of the Heart. AA Grapevine, 1988. Bill W., “‘Rules’ Dangerous but Unity Vital” (September 1945), “On the Alcoholism Front” (March 1958) and “After Twenty-Five Years” (March 1960), first printed in the AA Grapevine.
Pass It On. AA World Services, 1984. On the 1944 talk, and on who wrote “To Employers.”
Markings, September–October 2005, “A.A. and Medicine Forge a Durable Relationship” (aa.org), quoting the Journal of the American Medical Association, October 14, 1939.
AA Grapevine, June 1944, page 1.
Ernest Kurtz, “Alcoholics Anonymous and the Disease Concept of Alcoholism,” Alcoholism Treatment Quarterly 20, no. 3/4 (2002), pp. 5–39, from the author’s manuscript at prestongroup.org.
Nancy O., “Biography of Fr. Ralph Pfau,” silkworth.net.
Box 4-5-9, October–November 2001, on the fourth edition (aa.org).
aa.org, “What is alcoholism?”, and Is A.A. for You? (P-3).