25 May 2022, 11:22

UA version of The Doctor's Opinion

Adapted for UA from AA (See a way to make it better? edits welcome)


We of Underearners Anonymous believe that the reader will be interested in the medical estimate of the plan of recovery described in this book. Convincing testimony must surely come from medical men who have had experience with the sufferings of our members and have witnessed our return to health. A well-known doctor, chief physician at a nationally prominent hospital specializing in underearning and drug addiction, gave Underearners Anonymous this letter:

To Whom It May Concern:
I have specialized in the treatment of hiding, isolating, and
compulsive under-earning for many years.

In late 1934 I attended a patient who, though he had been a
competent businessman of good earning capacity, was an underearner
of a type I had come to regard as hopeless.

In the course of his third treatment he acquired certain ideas
concerning a possible means of recovery. As part of his
rehabilitation he commenced to present his conceptions to other
underearners, impressing upon them that they must do likewise with
still others. This has become the basis of a rapidly growing
fellowship of these men and their families. This man and over one
hundred others appear to have recovered.

I personally know scores of cases who were of the type with whom
other methods had failed completely.  These facts appear to be of
extreme medical importance; because of the extraordinary
possibilities of rapid growth inherent in this group they may mark
a new epoch in the annals of hiding, isolating, and compulsive
under-earning. These men may well have a remedy for thousands of
such situations.  You may rely absolutely on anything they say
about themselves.

Very truly yours,
William D. Silkworth, M.D.

The physician who, at our request, gave us this letter, has been kind enough to enlarge upon his views in another statement which follows. In this statement he confirms what we who have suffered underearning torture must believe—that the body of the underearner is quite as abnormal as his mind. It did not satisfy us to be told that we could not control our underearning just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a consider- able extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the underearner which leaves out this physical factor is incomplete.

The doctor’s theory that we have an allergy to hiding, isolating, and compulsive underearning interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem underearners, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.

Though we work out our solution on the spiritual as well as an altruistic plane, we favor hospitalization for the underearner who is very jittery or befogged. More often than not, it is imperative that a man’s brain be cleared before he is approached, as he has then a better chance of understanding and accepting what we have to offer.

The doctor writes:

The subject presented in this book seems to me to be of paramount
importance to those afflicted with addiction to hiding, isolating,
and compulsive underearning.

I say this after many years’ experience as Medical Director of one
of the oldest hospitals in the country treating addiction to
hiding, isolating, and compulsive underearning.

There was, therefore, a sense of real satisfaction when I was
asked to contribute a few words on a subject which is covered in
such masterly detail in these pages.

We doctors have realized for a long time that some form of moral
psychology was of urgent importance to underearners, but its
application presented difficulties beyond our conception. What
with our ultra-modern standards, our scientific approach to
everything, we are perhaps not well equipped to apply the powers
of good that lie outside our synthetic knowledge.

Many years ago one of the leading contributors to this book came
under our care in this hospital and while here he acquired some
ideas which he put into practical application at once.

Later, he requested the privilege of being allowed to tell his
story to other patients here and with some misgiving, we
consented. The cases we have followed through have been most
interesting; in fact, many of them are amazing.  The unselfishness
of these men as we have come to know them, the entire absence of
profit motive, and their community spirit, is indeed inspiring to
one who has labored long and wearily in this underearner
field. They believe in themselves, and still more in the Power
which pulls chronic underearners back from the gates of death.

Of course an underearner ought to be freed from his physical
craving for underearning, and this often requires a definite
hospital procedure, before psychological measures can be of
maximum benefit.

We believe, and so suggested a few years ago, that the action of
hiding, isolating, and compulsive underearning on these chronic
underearners is a manifestation of an allergy; that the phenomenon
of craving is limited to this class and never occurs in the
average wage earner.  These allergic types can never safely use
hiding, isolating, and compulsive underearning in any form at all;
and once having formed the habit and found they cannot break it,
once having lost their self-confidence, their reliance upon things
human, their problems pile up on them and become astonishingly
difficult to solve.

Frothy emotional appeal seldom suffices. The message which can
interest and hold these underearners must have depth and
weight. In nearly all cases, their ideals must be grounded in a
power greater than themselves, if they are to re-create their

If any feel that as psychiatrists directing a hospital for
underearners we appear somewhat sentimental, let them stand with
us a while on the firing line, see the tragedies, the despairing
wives, the little children; let the solving of these problems
become a part of their daily work, and even of their sleeping
moments, and the most cynical will not wonder that we have
accepted and encouraged this movement.  We feel, after many years
of experience, that we have found nothing which has contributed
more to the rehabilitation of these men than the altruistic
movement now growing up among them.

Men and women underearn essentially because they like the effects
produced by hiding, isolating, and compulsive underearning. The
sensation is so elusive that, while they admit it is injurious,
they cannot after a time differentiate the true from the false. To
them, their underearning life seems the only normal one. They are
restless, irritable and discontented, unless they can again
experience the sense of ease and comfort which comes at once by
underearning and relaxing which they see others doing with
impunity.  After they have succumbed to the desire again, as so
many do, and the phenomenon of craving develops, they pass through
the well-known stages of a spree, emerging remorseful, with a firm
resolution not to underearn again.  This is repeated over and
over, and unless this person can experience an entire psychic
change there is very little hope of his recovery.

On the other hand—and strange as this may seem to those who do not
understand—once a psychic change has occurred, the very same
person who seemed doomed, who had so many problems he despaired of
ever solving them, suddenly finds himself easily able to control
his desire for hiding, isolating, and compulsive underearning, the
only effort necessary being that required to follow a few simple

Men have cried out to me in sincere and despairing appeal:
“Doctor, I cannot go on like this! I have everything to live for!
I must stop, but I cannot! You must help me!“

Faced with this problem, if a doctor is honest with himself, he
must sometimes feel his own inadequacy. Although he gives all that
is in him, it often is not enough. One feels that something more
than human power is needed to produce the essential psychic
change. Though the aggregate of recoveries resulting from
psychiatric effort is considerable, we physicians must admit we
have made little impression upon the problem as a whole. Many
types do not respond to the ordinary psychological approach.  I do
not hold with those who believe that hiding, isolating, and
compulsive underearning is entirely a problem of mental control. I
have had many men who had, for example, worked a period of months
on some problem or business deal which was to be settled on a
certain date, favorably to them. They took a drink a day or so
prior to the date, and then the phenomenon of craving at once
became paramount to all other interests so that the important
appointment was not met. These men were not underearning to
escape; they were underearning to overcome a craving beyond their
mental control.

There are many situations which arise out of the phenomenon of
craving which cause men to make the supreme sacrifice rather than
continue to fight.

The classification of underearners seems most difficult, and in
much detail is outside the scope of this book. There are, of
course, the psychopaths who are emotionally unstable.  We are all
familiar with this type. They are always “going on the wagon for
keeps.“ They are over-remorseful and make many resolutions, but
never a decision.

There is the type of man who is unwilling to admit that he cannot
underearn. He plans various ways of underearning.  He changes his
brand or his environment. There is the type who always believes
that after being entirely free from hiding, isolating, and
compulsive underearning for a period of time he can underearn
without danger. There is the manic-depressive type, who is,
perhaps the least understood by his friends, and about whom a
whole chapter could be written.

Then there are types entirely normal in every respect except in
the effect hiding, isolating, and compulsive underearning has upon
them. They are often able, intelligent, friendly people.

All these, and many others, have one symptom in common: they
cannot start underearning without developing the phenomenon of
craving. This phenomenon, as we have suggested, may be the
manifestation of an allergy which differentiates these people, and
sets them apart as a distinct entity. It has never been, by any
treatment with which we are familiar, permanently eradicated. The
only relief we have to suggest is entire abstinence.

This immediately precipitates us into a seething cauldron of
debate. Much has been written pro and con, but among physicians,
the general opinion seems to be that most chronic underearners are

What is the solution? Perhaps I can best answer this by relating
one of my experiences.

About one year prior to this experience a man was brought in to be
treated for chronic hiding, isolating, and compulsive
under-earning. He had but partially recovered from a gastric
hemorrhage and seemed to be a case of pathological mental
deterioration.  He had lost everything worthwhile in life and was
only living, one might say, to underearn. He frankly admitted and
believed that for him there was no hope. Following the elimination
of hiding, isolating, and compulsive underearning, there was found
to be no permanent brain injury. He accepted the plan outlined in
this book.

One year later he called to see me, and I experienced a very
strange sensation. I knew the man by name, and partly recognized
his features, but there all resemblance ended. From a trembling,
despairing, nervous wreck, had emerged a man brimming over with
self-reliance and contentment.  I talked with him for some time,
but was not able to bring myself to feel that I had known him

To me he was a stranger, and so he left me. A long time has passed
with no return to hiding, isolating, and compulsive underearning.

When I need a mental uplift, I often think of another case brought
in by a physician prominent in New York.  The patient had made his
own diagnosis, and deciding his situation hopeless, had hidden in
a deserted barn determined to die. He was rescued by a searching
party, and, in desperate condition, brought to me. Following his
physical rehabilitation, he had a talk with me in which he frankly
stated he thought the treatment a waste of effort, unless I could
assure him, which no one ever had, that in the future he would
have the “will power“ to resist the impulse to underearn.

His underearning problem was so complex, and his depression so
great, that we felt his only hope would be through what we then
called “moral psychology,“ and we doubted if even that would have
any effect.

However, he did become “sold“ on the ideas contained in this
book. He has not underearned for a great many years.  I see him
now and then and he is as fine a specimen of manhood as one could
wish to meet.

I earnestly advise every underearner to read this book through,
and though perhaps he came to scoff, he may remain to pray.

William D. Silkworth, M.D.