Drunks

by Christopher Finan

  Although their independence had been clearly established, AA and NCEA still shared the goal of helping drunks, and their efforts often overlapped. They both gave the highest priority to breaking down the barriers that prevented alcoholics from receiving medical treatment in the nation’s general hospitals. From the beginning, AA’s leaders had believed that hospitalization was a necessary first step toward sobriety. Hospitalization was necessary because so many of the early AA members were men who had been drinking for years and were on the verge of physical collapse. They experienced delirium tremens and seizures when they were unable to get alcohol and sometimes died as a result. A hospital could also provide an opportunity for an alcoholic to think. Sober and sore, he had a chance to reflect on his life and to promise himself that he would never drink again.

  The problem was that most doctors believed that alcoholism was incurable. Mann consulted eight doctors before she met Harry Tiebout, who had given her the manuscript of Alcoholics Anonymous. Anderson, who also consulted many doctors before he found the right one, believed that doctors were hostile to drunks because they had tried to help them and failed. They could help a man recover from a binge, but no matter how much he had suffered, he was soon drunk again. “Physicians like to feel that they have the full cooperation of the patient and are likely to resent the patient who professes one thing and does another,” Dr. Dexter M. Bullard explained.23

  General practitioners did not have the time or the training to care properly for alcoholics. But what about the specialists in the field of psychology, which had grown astronomically in the decades since the days of alienist Joseph Parrish to include thirty-five hundred psychiatrists practicing in the United States? Many were willing to use the word “illness” when writing about alcoholism, but their understanding of alcohol addiction was also superficial. Some hoped to cure the patient through counseling aimed at underlying problems that they believed had driven the man to drink. More were convinced that the alcoholic was beyond help.

  Six of the doctors that Mann consulted were psychiatrists who could not find anything wrong with her and refused to accept her as a patient because they did not know what to do with “people like you.” “[When] I frankly admitted under questioning that my drinking was out of control—from then on they wanted no part of me,” Mann said. The psychiatrists did not have much hope for any methods of recovery. A psychiatric intern had only discouraging words for a woman who had relapsed. “Well, I see you’re back here again, despite ‘Alcoholics Anonymous,’” he said.24

  With many doctors either indifferent or actually hostile toward drunks, it was inevitable that hospitals would close their doors to them. According to the NCEA, only ninety-six general hospitals in the United States were willing to treat alcoholics in 1944, and only one accepted them without an argument. “I have long since lost count of the number of times that I myself have been told, on trying to gain admission for a desperately sick alcoholic, ‘This place is for sick people, not drunks,’” Mann wrote. Two of the men she was trying to save died for lack of medical care.25

  An average of twelve thousand people were dying of alcoholism every year, including many who could have been saved if they had made it to an emergency room. Actually, the number was probably much higher because many families begged their physician to spare them the shame of an alcoholic family member by citing some other cause on the death certificate. Deaths “occurred in flop houses, boarding houses, and homes where the physician was either not called or would not respond to the call to treat a drunk,” Mann said. Many drunks died in jail. “We, as a nation, are not wont to treat our sick in that fashion. . . . And yet to a great body of very sick human beings we offer only punishment for their illness. We behave as if we are still in the Middle Ages.”26

  As a result, AA and NCEA spent a lot of time trying to get drunks into the hospital. During the early years, Bob Smith succeeded in having drunks admitted to the Akron City Hospital using a diagnosis of “gastric distress.” Deaconess Hospital in Cleveland opened its doors to alcoholics only after AA appealed to the trustees, who overruled the medical staff. Clarence Snyder later described the difficulty he had in securing beds at the Post-Shaker Sanitarium, a hundred-bed facility in East Cleveland. The owner, Sara Post, was desperate for patients to replace those who had recently been moved to a new state facility. Snyder promised to pay twice as much as the state, but she was reluctant. Post didn’t like alcoholics and worried that they would be difficult patients. Snyder assured her they would be no more trouble than mental patients. “Most of ‘em won’t eat for the first few days; and if you taper ‘em off of booze, they’ll stay calmer than the loonies,” he said.27

  Post agreed to accept alcoholics until one day when Snyder brought in a man who was near death. The editor of the Cleveland Press had begged Snyder to help find the man, who was a reporter for the paper. He was found in an abandoned warehouse on skid row. It was winter, and the man was lying unconscious on a damp concrete floor, barely breathing. Snyder took him to the sanitarium, but when Post saw who it was she refused to admit him. The reporter had been married to her niece and had ruined her life, she said. Snyder said he pleaded with Post and offered more money, but she refused. Post relented only after Snyder threatened to remove all the alcoholic patients. The reporter eventually recovered and moved to Houston, where he wrote a series of stories for the Houston Press that were collected in AA’s first educational pamphlet. He cofounded the first Houston AA meeting with an alcoholic minister he had helped rescue from skid row.

  The hospitalization campaign received an important boost in 1939. Unable to find a place for one of his patients, Smith sought help from Sister Ignatia, the admitting nurse at St. Thomas Hospital in Akron. A member of the Sisters of Charity, Ignatia was a native of Ireland who had been raised to believe that drunkenness was a sin. But with the assistance of an emergency room intern, she had been helping alcoholics get treatment for several years before Smith approached her. “She was severely criticized by some of the nuns, and most of the doctors were bastards to her,” a medical intern, Thomas P. Scuderi, recalled. Overcrowding was a serious problem in American hospitals during the war years, but Ignatia found a place for Smith’s patient in a flower room that also served as a temporary mortuary. Although furtive in the beginning, officials at St. Thomas eventually agreed to treat alcoholics, even though most of the drunks were Protestant. A newly remodeled eight-bed ward opened in 1944 to accommodate alcoholics who began traveling to Akron from around the country.28

  Under the direction of Sister Ignatia and Smith, St. Thomas Hospital pioneered a treatment program in which AA played an important role. New patients were assigned an AA sponsor and required to demonstrate a sincere desire to stop drinking during an interview with Sister Ignatia or another admitting clerk. Each day of the five-day program had a theme. On day two, “Realization,” an AA member would guide the alcoholic through the first three steps of the AA program. The next day was devoted to “Moral Inventory.” Day four was the “Day of Resolution,” when the patient accepted the statement, “I can surely stay sober today”; the last day was devoted to planning for sobriety after discharge. Not many hospitals that agreed to accept alcoholics were willing to do more than detoxify them, but some worked closely with local AA groups, giving them the right to decide who would get treatment. In some large cities, drunks seeking treatment could call an AA “intergroup” for information.29

  One of the fullest integrations of AA and a hospital recovery program occurred in the Knickerbocker Hospital, a fifty-nine-bed facility on 131st Street in Upper Manhattan. A 1914 directory of New York City hospitals described the Knickerbocker’s mission as assisting the “worthy” poor, but made it clear that alcoholics were not admitted. In 1945, the Knickerbocker dropped its ban, opening part of a nineteen-bed ward for drunks and later turning over the whole ward for that purpose. From the beginning, AA members in New York played a central role in the operation of the ward. Admissions were handled through
the AA intergroup office in Manhattan, where the staff provided AA sponsors for all new patients. Even in the final months of World War II when hospitals were short-staffed, the Knickerbocker had no trouble finding sober drunks who were nurses to staff the alcoholic ward. As many as twenty AA volunteers worked as nurse’s aides every week.

  AA set the rules at the Knickerbocker. “No families, no friends, no business colleagues may visit the wing—unless they happen to be A.A. members,” explained Mann, who continued to work closely with AA. “This gives the patient a temporary but complete release from outside worries and irritations, and plenty of time to think over his situation, and to make plans for dealing with his alcoholic problem upon release from the hospital.” It also gave him time to talk to his sponsor, fellow patients, and the AA volunteers, many of whom were former patients. Women alcoholics were treated in private rooms attached to the ward, although male and female patients were not permitted to mix. After five days of treatment, the patients were released and immediately joined AA groups. More than three thousand drunks were treated in Knickerbocker Hospital during the first three years of the program.30

  NCEA also played a significant role in expanding hospitalization. It urged its affiliates “to survey the existing facilities (if any) for the care and treatment of alcoholics” and supplied a questionnaire to be sent to find local doctors who would be willing to treat them. The next step was to determine whether the affiliate had the financial resources to open a clinic like the ones in Hartford and New Haven. NCEA estimated that it would cost approximately $26,000 annually to employ a full-time psychiatrist, a psychiatric social worker, and three support staff. If the affiliate couldn’t afford a clinic, it was urged to open an information center staffed by one or two people who could refer alcoholics for treatment at local institutions. By the end of 1948, there were forty-one NCEA affiliates around the country. While none had been able to open a clinic, twenty-nine established information centers. On the national level, NCEA tried to educate doctors by offering a discount on subscriptions to the Quarterly Journal of Studies on Alcohol. In 1954, just ten years after the launch of NCEA, the number of general hospitals providing emergency care to alcoholics had grown from fewer than one hundred to over three thousand. AA groups had been organized in over two hundred of them.31

  Hospitalization was a critical issue, but there were many pressing problems. What could be done to help alcoholics who were lucky enough to still have jobs? At the time, almost every company in the country considered drunkenness grounds for immediate dismissal. The issue was so important that AA addressed employers directly in the Big Book. A chapter titled “To Employers” urged businessmen to see their alcoholic employees as individuals. While some would have to be fired, “there are many men who want to stop, and with them you can go far. Your understanding treatment of their cases will pay dividends,” it said. The Big Book offered detailed instructions for confronting the employee, helping him find medical treatment, and dealing with him after he returned to work, even encouraging patience if a clearly earnest man suffered a relapse. The Big Book also recommended itself as a source of information about alcoholism that could be shared with junior executives, who might be in direct contact with the staff and in a position to help employees before they had been reported for drinking. Finally, the employer was urged to see the recovered alcoholic as a resource. “After your man has gone along without drinking for a few months, you may be able to make use of his services with other employees who are giving you the alcoholic run-around,” it said.32

  The Big Book was right in predicting that sober alcoholics would play a role in helping their coworkers get sober. Several AA members began helping coworkers in the 1940s. David M. was inspecting bullets at the Remington Arms factory in Bridgeport, Connecticut, when he began taking men to AA meetings. Later he secured a job in the personnel department, which gave him an opportunity to talk to employees who were in trouble because of their drinking. His success in saving the jobs of twenty-two alcoholic workers led him to suggest to superiors that they adopt an official policy encouraging heavy drinkers to seek help. When they rejected the idea, he approached the medical director of DuPont, the company that owned Remington Arms. Dr. George H. Gehrmann had been looking for a solution for alcoholic employees for many years and had recently attended several AA meetings. “By God, you’re just the man I’m looking for,” Gehrmann said. In January 1944, David M. transferred to DuPont, becoming the first person hired by a company specifically to help alcoholics. During the same period, Warren T., an AA member who worked in a shipyard, was also counseling alcoholics full-time, although in an unofficial capacity. In March 1943, he informed the AA national office that in the first four days of his new job in the personnel department, he had met with seventeen men who wanted help with their drinking problem.33

  The Yale Center of Alcohol Studies gave strong support to these first steps. In a speech to the Economic Club of Detroit in 1946, Jellinek provided statistics to demonstrate the enormous damage that alcoholism was inflicting on industry. He estimated that there were 3 million Americans who were either alcoholics or heavy drinkers in danger of becoming alcoholics. Approximately 510,000 were unemployable, including skid-row “bums.” Two million of the others were workingmen, including 1.3 million who were engaged in skilled and unskilled jobs in manufacturing, construction, and public utilities. Because each one missed an average of twenty-two days a year due to illness, the economy was losing nearly 30 million working days to alcoholism annually. Drinking caused more than four thousand accidental deaths every year. Alcoholics died twelve years sooner than nonalcoholics. Jellinek insisted the United States could do better. His most hopeful statistic was that an alcoholic could be rehabilitated for between sixty and a hundred dollars. A program that encompassed every alcoholic would entail less than a third of the social cost of alcoholism.

  NCEA also focused on the problem of drunken workers. Its Chicago affiliate sponsored the First Industrial Conference on Alcoholism in 1948. Its greatest contribution to this phase of the alcoholism movement was Ralph McComb Henderson, a field secretary who traveled widely for NCEA before the Yale Center of Alcohol Studies hired him as an industrial consultant. “Lefty” Henderson was uniquely qualified for the job. He was a naturally gregarious man who had developed a successful law practice in his home state of South Dakota. One acquaintance described him as a “bear-like man, a friendly husky St. Bernard with a twinkle in his eye.” Another called him “an unmade bed.” A veteran of World War I, he became the state commander of the American Legion and served as the state chairman of the South Dakota delegation to the 1940 Republican National Convention. He had become an alcoholic by then, but he joined AA soon after.34

  Henderson traveled constantly over the next ten years, speaking to company executives and business groups about the importance of helping their alcoholic employees. He was a charismatic speaker who used his “ham-like” hands to make sweeping gestures. Selden Bacon, Jellinek’s successor as head of the Yale School, called him “the most magnificent platform artist I ever saw.” In 1950, Henderson and Bacon developed a program called the Yale Plan for Business and Industry that sought to convince businessmen that alcoholism was a problem that could be managed in a cost-efficient way by identifying the few problem drinkers and getting them help. It described nine steps in creating an effective program, including educating top management, assigning responsibility to an existing department, and developing a policy to decide who would be offered treatment and who would be fired. Henderson won a key battle at Allis-Chalmers, an important manufacturer of agricultural and other industrial equipment. In 1950, he and an AA member, George S., helped persuade company officials in Milwaukee to hire an alcoholism counselor who had gotten sober in AA. The company was undeterred when the counselor suffered a relapse and mentioned its program prominently in company publicity.35

  As companies began to start employee assistance programs, the evidence of their success grew. “For 28 yea
rs, I struggled without A.A., and my results were zero. With A.A. over the past five years, I got 65 per cent [sober],” Dr. Gehrmann declared. After the Allis-Chalmers program had been under way for eight months, the company reported that fifty-one of the seventy-one employees who had been identified as alcoholics had been helped. Not all had quit drinking and joined AA, but the others were either sober or had curtailed their drinking to the point where it was not interfering with their work.36

  A sober drunk named William Swegan launched the first employee assistance program in the military in 1948. He was already an alcoholic when he joined the Army Air Force in 1939. He had lost his mother at any early age and was plagued by fear and a sense of worthlessness throughout his childhood. For a few years, drinking had allowed him to escape his problems. At twenty-one, he enlisted in an alcoholic haze, and he continued to drink heavily after he was stationed at Hickam Field in Hawaii. He was badly hung over when he awoke to the drone of airplanes on the morning of December 7, 1941. While the main force of Japanese planes focused on the nearby naval base, three waves of bombers hit Hickam, killing and wounding more than a quarter of the men in his squadron. Swegan himself was nearly killed by a bomb as he and five other men huddled in the corner of a hangar. His five closest friends—all drunks—died in the attack.