Illustration · New books, tied for shipping, 1939. The plain bindings are invented; this is not a picture of any real edition.

The Big Book · 1939

The Doctor’s Opinion

AA’s first book needed a doctor to vouch for it. Silkworth did, and his letter still opens the book.

“…though perhaps he came to scoff, he may remain to pray.”

Dr. William D. Silkworth, closing “The Doctor’s Opinion” · Alcoholics Anonymous, 1939

A doctor’s word

By 1938, Bill W. and the first AA members were writing a book about how they had gotten sober. They knew how it might look: a crowd of former drunks claiming to have found the answer. They needed a doctor to vouch for them.

Dr. Silkworth did. That summer he wrote a letter on Towns Hospital stationery, then a longer statement. Both went into the book under one heading, “The Doctor’s Opinion.”

In it he described the “phenomenon of craving” that follows the first drink, the alcoholic who is “restless, irritable and discontented” without one, and the “entire psychic change” he had watched these men go through.

Alcoholics Anonymous came out in April 1939. The letter has opened every copy since. Later editions note that it has been “kept intact, just as it was originally written in 1939.”

Listen The Doctor’s Opinion About 1 minute

1937 and 1939, side by side

What changed in two years

In 1937 he wrote for doctors. In 1939 he wrote for anyone who picked up the book, after two more years of watching the first AA members.

Quotations are short excerpts. Page numbers for the Big Book follow the fourth edition.

1937

Writing for doctors

The illness: “…true alcoholism is an allergic state…”Medical Record, March 1937
The way out: “He must understand and accept the situation as a law of nature operating inexorably.”Medical Record, March 1937

1939

After two years of AA

The illness: “…a manifestation of an allergy…”“The Doctor’s Opinion,” p. xxviii
The way out: “…unless this person can experience an entire psychic change there is very little hope of his recovery.”“The Doctor’s Opinion,” p. xxix
What he had seen: “Newcomers have been unable to stay sober when they have tried the program minus the Deity.”Journal-Lancet, July 1939

What changed

The allergy stayed. The answer grew. In 1937 he already called the decision that saves an alcoholic “an inspiration.” By 1939 he had watched about a hundred alcoholics find it through a spiritual program, and he said so in print.

For a closer look

Go deeper

How the letter came to be written, why it first appeared without his name, and what he told doctors three months later.

How the letter came to be

In July 1938, Dr. Esther L. Richards, a psychiatrist at Johns Hopkins, suggested getting “a Number One physician who has a wide knowledge of the alcoholic’s medical and social problems to write an introduction.” Nine days later, on July 27, Silkworth wrote his letter on Towns Hospital letterhead. A longer statement followed; its date isn’t known.

The hospital’s owner helped too. Bill wrote that Charles B. Towns lent the book project $2,500, a loan that later grew to more than $4,000.

In the 1938 draft of the book, the letter ends with a row of dashes where the doctor’s name would go.

Whose opinion?

The book introduces the letter without naming its author: “A well-known doctor, chief physician at a nationally prominent hospital…”

The first edition printed it unsigned. According to AA historians, Silkworth’s name was added in the second edition, in 1955.

One word changed as well. In his July 1938 letter and in the first edition, he writes that he personally knows “thirty” of these cases. Later editions say “scores.”

The preface to later editions settles the question. It credits the letter to “the late Dr. William D. Silkworth.”

The first medical review

In July 1939, three months after the book came out, Silkworth described AA to doctors in the Journal-Lancet, a Minneapolis medical journal, under the title “A New Approach to Psychotherapy in Chronic Alcoholism.”

He reported that the program seemed to work for about half of those who tried it, and that “Newcomers have been unable to stay sober when they have tried the program minus the Deity.”

That November the Cleveland Plain Dealer, reporting on AA, called it “the first appraisal in a scientific journal of Alcoholics Anonymous.” Bill later reprinted the article in AA Comes of Age.

Sources

Alcoholics Anonymous (the Big Book), 1939; fourth edition, 2001: “The Doctor’s Opinion,” pp. xxv–xxxii, and the preface.
The Book That Started It All: The Original Working Manuscript of Alcoholics Anonymous. Hazelden, 2010.
Alcoholics Anonymous Comes of Age. Alcoholics Anonymous Publishing, 1957: p. 13 and Appendix E.
W. D. Silkworth, “A New Approach to Psychotherapy in Chronic Alcoholism,” Journal-Lancet 59, July 1939.
Letters of Esther L. Richards (July 18, 1938) and W. D. Silkworth (July 27, 1938), AA General Service Office Archives, as quoted by AA historians.
Cleveland Plain Dealer, November 4, 1939.
Pass It On. AA World Services, 1984.