The following is an excerpt from the book Don’t Be Afraid! written by Edward Spencer Cowles, M.D. and published in 1941. From today’s perspective some of this material may seem shocking, and yet, pathetically humorous. This physician treated “chronic alcoholics” with this method over a span of nearly 30 years. It would seem that Bill W. knew of this method. He wrote in Alcoholics Anonymous (Page 140):
“I well remember the shock I received when a prominent doctor in Chicago told me of cases where pressure of the spinal fluid actually ruptured the brain. No wonder an alcoholic is strangely irrational. Who wouldn’t be, with such a fevered brain? Normal drinkers are not so affected, nor can they understand the aberrations of the alcoholic.”
Perhaps we are fortunate that Bill did not fall into Dr. Cowles’ hands.
Alcoholism is one of the oldest of human problems, the solution of which has eluded scientists and social workers for generations.
Why do people drink to excess?
The number of those who drink to escape from worry, anxiety, or some haunting fear is legion. These people drink not because they are alcoholics but because they have a fear neurosis. With their feeling of inward insecurity, they feel unable to tackle the work and the responsibilities that are staring them in the face. They reach out for alcohol as a crutch.
These men and women do not want to drink. Many of them actually dislike the alcohol they say they cannot get along without. They know that the alcohol makes them feel infinitely worse the next day, when their sense of insecurity and nervousness is increased by the effect of alcohol on the system. Yet even with this full knowledge, their present fear is so acute that they feel they must have the temporary support they get from drinking.
It is a very grave mistake to class these nervous cases as chronic alcoholics no matter how much alcohol they consume to enable them to go against their fears. No one is a chronic alcoholic whose spinal fluid does not reveal intracranial pressure and the chemical changes that are positive indication of the disease. To call a “heavy drinker” a “chronic alcoholic” without absolute proof of his brain chemistry is as erroneous as to call every underweight young woman with a cough “tubercular.”
Chronic Alcoholism Is a Disease Not a Crime
No disease has aroused so much controversy and so many heated, violently partisan debates as chronic alcoholism.
Long after intelligent people have ceased to think of insanity as evidence of obsession by a devil that must be exorcised by prayer, magic rites, or terrible beatings, after we have abandoned the old practice of whipping all syphilitic patients on their admission to hospitals for treatment, after we have accepted the fact that suicidal impulses are not marks of moral depravity but symptoms of a melancholia that can result from nervous fatigue, there are thousands of people alas, some of them physicians—who continue to think of chronic alcoholics as creatures who lack the moral integrity, sense of decency, self-respect, and will power of normal men and women.
The chronic alcoholic is not a depraved individual, worthy only of contempt. He is diseased. He is not a social leper but a very sick man.
Chronic alcoholism is not a crime. It is a definite brain-chemistry disease. It can be diagnosed with chemical precision, and it can definitely be cured. It is not a matter of morals or will power any more than hay fever can be said to be. It is caused by a diseased condition of the brain covering—not an infection but an irritation—that produces an excess of brain fluid. The habitual drunkard craves liquor because of intracranial pressure. He has a pressure many times above that of normal individuals, even when he is not drinking.
Why, then, are some people chronic alcoholics and others not? Nearly everyone, in these days, drinks now and then by social custom. Some take a drink or two and stop. Others may take four or five drinks and some persons more than that, without any apparent change in their personalities. They may be a little gayer, a little more talkative, a little freer in their conversation, but there is no other change. They may wake up next morning with a headache, feeling irritable, but that is as far as it goes. They do not go right on drinking that day and the next until they land in a hospital.
The chronic alcoholic has no such power to stop. One drink may set him off. Two drinks may change his personality completely. From a modest man, he becomes a vulgar man. From a man of limited means, he becomes—in his own ideas—a man of great wealth. Once a man of moderate language, now foul words are on his lips. From a man of consideration at home, he becomes jealous and abusive. His whole personality undergoes a change.
Some men may have been drinking for twenty years before alcohol begins to effect this change in them. Others show the change after only a short while. It is when the individual reaches the point that drinking changes his personality, that he can truly be diagnosed as a “chronic alcoholic.”
What Makes the Change in Personality?
The explanation is that the meninges of the brain set up an allergic reaction to alcohol. The dose of alcohol necessary to bring about this allergic response varies with the individual. Some individuals are more susceptible than others.
I repeat, will power has nothing to do with this, any more than will power, good intentions, and respect for one’s family and one’s social position can keep the hayfever victim from sneezing when he walks through a field of goldenrod.
The two allergies—that to alcohol and that to pollens—are comparable in their effects. Everyone is familiar with the symptoms of hay fever—the irritation of the throat and nasal passages producing running of the nose and weeping from the eyes. The allergic reaction to alcohol is an irritation of the cells of the brain, causing them to weep. Under this brain edema—the brain now having from ten to fifteen times more fluid than it should have one or two drinks of alcohol are sufficient to set the patient off. He finds himself without the ability to stop drinking. Whereas formerly this person could take from ten to fifteen drinks with mild effect, now one drink effects a change in his personality.
A person whose brain chemistry is in this state has become a chronic alcoholic.
With the increase of edema, there is a corresponding disintegration of the personality. Cunning trickery takes the place of frankness. The alcoholic’s sexual life becomes promiscuous. His ethical values are disordered. He is wholly untrustworthy. Any oath given is worthless. He forges checks. He is peevish, sullen, harsh in manner, vulgar in speech—in total contrast to his normal reaction to life. He is, in fact, a Dr. Jekyll and Mr. Hyde.
This change in personality is the result of the pressure of the fluid in the brain on the higher centers of the cortex. The best part of the man—the last to develop evolutionally—is always the first to be affected by alcohol.
Contrary to general belief as to its effects on the nervous system, alcohol is not a stimulant. Its normal physiological action is sedative. At all times, it has a narcotic effect on the highest controlling centers of the brain. This leads to a release from control in the lower levels, bringing about a brisk flow of ideas with speech, action, and self-confidence.
Many men and some women drink to get this effect.
Alcohol seems to set them free from something. Actually, what happens when the higher centers of the brain are paralyzed by alcohol is a marked diminution of self-criticism; the power of deliberation and careful judgment are overthrown.
As more alcohol is taken into the system, the deeper centers are affected. We notice a further lessening of self- criticism, manifested by inflamed emotions, excited talk, aggressiveness, and fine sensory-motor disturbances, as exhibited in difficulties of speech and clumsiness in movements.
In the chronic alcoholic whose intracranial pressure is far above normal, these effects happen very swiftly. He is drunk with the first drink. And one drink may send him on a week’s debauch. He may know that he will lose his job by going on a week’s bout, and his family may be wholly dependent on him; yet he will sacrifice his all for this drunken spree. Once started, no one can stop him.
When he comes off the spree, he is full of excuses. He blames everybody in the world but himself. His wife has said the wrong word; his boss was unjust; he lost a client, or he dropped some money in the market, or he ran into some old college friends. . . . He possesses a million excuses.
Whatever excuse he gives and may believe in, the reason for his drinking is found in his brain chemistry.
Such men do not crave alcohol because they are weak characters. They are sick. Though they may not have had any alcohol for months, the intracranial-fluid pressure makes them emotionally unstable. Because of this instability, which is felt as a bewildered unease, the most strong-willed individual surrenders finally and reaches for “one drink.” He tells himself that this will steady him.
The chronic alcoholic gets, as he thinks, relief from emotional and nervous instability because even one drink now gives him a measure of unself-consciousness. He becomes almost instantly irresponsible, but he is not aware of it. His condition is such that one drink mounts to his brain, excites the chronically disturbed cells there, and increases the intracranial pressure. This pressure upon the brain and nervous system makes him a different man.
It is useless to plead with an individual who is in this condition to use his will power. He cannot.
Chronic Alcoholism Can Be Cured
There have been many apparent, temporary successes in “cure” through religious cults, a love affair, or psychoanalysis. In such cases, however, abstinence has not indicated will power against drink, nor is there any removal of the cause of emotional instability. In such cases, emotional debauches have been substituted for alcoholic debauches. While their intensity lasts, an alcoholic may be able to keep from drinking.
But none of these cures relieves the intracranial fluid pressure or changes the brain chemistry. The allergic reaction is still there in the cells.
If you take the intracranial pressure of these alcoholics—even when they have been entirely sober for a long period of time—you will find it from ten to fifteen times above the normal. Examination of the spinal fluid will reveal an increase of globulin and an increase of albumin, producing a protein reaction.
When you get these results from the tests, you may be sure that you have a chronic alcoholic to treat. Until you reduce the intracranial pressure to normal and the spinal- fluid chemistry to normal, there is no possible hope that this patient will not drink again.
The treatment is done by a series of lumbar punctures, ten days apart, and by allied medical treatment. At each puncture, an amount of the spinal fluid is drawn off. This is examined to check the chemistry as the treatment goes on. With each puncture, the pressure is taken.
By drawing off the fluid at predetermined rates, depending on the conditions found, the brain pressure can be reduced. The patient then is medically treated so that the superexcited cells of the brain covering are healed. This simple and harmless operation corrects the edema of the brain.
The operation can be done in the physician’s office without hospitalization, if the patient’s condition is not dangerous. The treatment does not require that a man who is capable of working shall give up his business or job. He can stop in at the doctor’s office, have the puncture made, his pressure taken, rest half an hour, and go back to his office desk. In cases in which the patient is exhausted by drinking or has some organic weakness, hospitalization for the first few weeks is recommended.
How the Cure Works
After the first lumbar puncture, relieving the pressure on the brain somewhat, the patient usually loses the desire for drink. Many patients report that the sight and the smell of alcohol become repugnant to them. No effort is required to keep from drinking.
As the treatment proceeds, all the irritation of the brain cells is gradually removed. The pressure becomes normal. The globulin, albumin, and sugar in the spinal fluid show as normal. When this condition has been brought about, you may be sure that the patient has, and will have, no impulse to drink.
Parallel with these changes in the brain chemistry go the changes in the patient’s personality. After the second lumbar puncture, the patient will usually tell you of the obsessions that have grown up in his mind as a result of his alcoholic debauches. Most of these fears, apprehensions, and jealousies disappear as the spinal fluid is drawn off and as the chemistry changes back to normal. Those that do not disappear should be discussed with the patient along the lines already indicated in discussing the various neuroses.
It is highly important that the patient shall understand all about his condition, all the facts concerning his brain chemistry and the spinal-fluid pressure as each puncture is made. There should be no mystery connected with the treatment. Complete and intelligent understanding is the first step toward his getting well.
By the time the fourth or fifth lumbar puncture is made, the patient’s personality will have changed back to its normal state. The craftiness will have disappeared completely. His love and tender regard for his wife and his children will have returned. He will be trustworthy once again. All the petty reactions of irritation disappear. The man is no longer irresponsible toward life and work.
As these patients go on in life, you are particularly struck by the fine quality of their mental and emotional balance. The personality is integrated and stabilized. They are able to carry their loads without breaking down under them.
An Alcoholic’s “Pilgrim’s Progress”
One man tells the following case history:
“An alcoholic’s Pilgrim’s Progress from the depths of sodden drunkenness to the heights of sobriety may be likened to Bunyan’s hero’s surveying from the Celestial City his toilsome path through the slough of despondency and the other hazards of the great classic. Looking backward, it seems unreal or allegorical.
“Starting in the usual social way, liquor gradually got hold of me, until by 1924 I was a confirmed alcoholic. Sprees of two and three weeks’ duration became frequent. I had attained to a good income and excellent standing in the legal profession, but alcohol forced me to resign from my firm.
“This sobered me for a while. But when I was faced with difficulty again, I sought relief in alcohol.
“Then followed trips to sanatoria, health farms, and as I went lower, three trips to the alcoholic ward at Bellevue Hospital, New York. There were numerous similar trips to the Jersey City Hospital and voluntary commitment to the New Jersey State hospital at Greystone Park. All without permanent result.
“By November, 1933, I was in the gutter.
“That was my final ‘bender.’ A friend had read of the method of treating chronic alcoholism by a reduction of the intracranial pressure through lumbar punctures. She persuaded me to try the treatment.
“The first puncture showed my intracranial pressure to be forty- eight. (I believe six is considered normal.) The doctor told me that unless the pressure was reduced I was headed for insanity. Treatments and punctures followed at regular intervals, and the pressure was finally reduced to around twelve.
“The bare recital of the treatment and its result does not be. gin to illustrate the inner change wrought in my brain and personality. During my drinking spells and in the remorse that followed each of these, my relatives and friends had besought me to use my will power. I needed no beseeching. No one could lecture me as well as I could lecture myself on the dire necessity of mastering the habit. I would try and try. But always the first drink started me on the road to insensibility and stupor. All that was needed was one drink and a cigarette.
“After the first lumbar puncture, however, the change in me was quite apparent to my friends and myself. There seemed to be something for my will to work upon. I found it easy to resist the craving. Gradually, as the treatment progressed, alcohol seemed no longer an indispensable part of my life. I ceased to think of it at all. In the end, my long years of sprees and drunk enness seemed almost unreal—as if they had happened to another man, not to me.
“Then began the attempt to make a comeback in my profes. sign. I started anew at the very bottom in a minor position. While the going has been tough, especially in these days of chronic depression for lawyers, I have at last got a foothold.
“I have no difficulty in refusing proffered liquor. An amusing experience proved this to me in 1936. I was in a Southern city with a group of lawyers and returned with them from court after a victory. They all started drinking in celebration, but I had no difficulty in abstaining. When a telephone call came from an official of the client, I was the only one in the crowd who could be trusted to answer the call.
“I am firmly convinced by my own experience that in certain individuals like myself the continued use of alcohol sets up in the brain a pathological change evidenced by increased intracranial pressure. It is idle to expect the individual to exert his will power to resist the craving until that pressure is reduced. I know that the lumbar punctures effect that reduction.
“I have had no ill effects from the punctures. On the contrary, my general health is greatly improved. I know my mind is keener since I came out of the alcoholic fog eight years ago. I live in Washington, D. C., and in the early days of the New Deal, after my cure, I passed a civil-sernce examination for senior attorney with a rating of 100 per cent, including 5 per cent veteran’s preference. The eligible list was never used by the government, because the political incumbents who, under the law, were to be displaced were blanketed into their jobs by executive order. But the examination, costing thousands of dollars for thousands of applicants, served a highly useful purpose to me—it demonstrated that I had come back mentally. And all the way….”
Why People Drink
Far and away the largest number of people who drink do so for purely social reasons and with no ill effects at the time or later. No one but a rabid prohibitionist can raise any reasonable objections to anyone’s taking one or two or more drinks, when these do not bring about a change in the personality. It is only when the man or the woman becomes maudlin, amorous, or quarrelsome that we are disgusted. It is at the point at which alcohol changes the personality that the logical objection to it begins.
When the drinker is a chronic alcoholic and goes too far, brain-cell changes take place, patches of cells die. When these changes take place, the damage is beyond correction and beyond repair. However, chronic alcoholism need not reach that stage, now that we have this new treatment for it.
In the event that a lumbar puncture and examination of the spinal fluid do reveal the allergic condition, then this condition should be relieved and cleared up before treating the fear neurosis. The theory we work on is always to treat the organic disorder before proceeding to the treatment of the mental disorder.
Of course, it must not be overlooked that a person who starts drinking to steady himself against his own fear may become a chronic alcoholic. If he happens to have the brain chemistry out of which chronic alcoholics are made, drinking acts upon him like dropping a lighted match into a barrel of gasoline. His brain chemistry may be such that a small amount of drinking will put him in the chronic alcoholic group. On the other hand, he may drink heavily for years before the chemical change occurs.
The treatment for a fear neurosis that involves alcohol is no different in theory from the treatment for a case of mysophobia. It follows along the same lines that have been described fully in previous chapters of this book.
Are Lumbar Punctures Dangerous?
No, they are not dangerous in the least. We do them commonly in testing for syphilis and for various brain diseases. In fact, any complete examination today includes a lumbar puncture and an analysis of the spinal fluid.
It is true that many physicians, through ignorance, do not want to do lumbar punctures and will tell their patients that this is a dangerous and doubtful operation.
It is done in a few minutes, without anesthetic, and the patient experiences no pain except that felt when the needle pierces the skin. He may have a slight headache afterward, but there are no other effects if he is not already in an exhausted state.
I was the first medical man in the world to do a lumbar puncture for chronic alcoholism and the first to do lumbar punctures in the treatment of delirium tremens. That was in 1909. Since then I have worked out the treatment for these cases, and this treatment is carried on by many physicians everywhere in the world. I am convinced that the only way to put a chronic alcoholic back where he was before alcohol “got” him and altered his brain chemistry is by reducing the intracranial-fluid pressure, thereby lessening the emotional tension and reducing his feeling of inward insecurity. The treatment I have described will do this. It will bring the patient’s brain chemistry back to normal. It is the only method I know that will do this.
- Chronic alcoholism is not a sin. It is a brain chemistry disease.
- Moral suasion, psychoanalysis, and religious conversions cannot alter the facts of the brain chemistry any more than they can cure tuberculosis.
- Lumbar puctures that reduce the fluid pressure on the brain are the only means that will change the brain chemistry and give the patient the chance of a scientific cure.